HomeMy Public PortalAbout5441 RYLAND AVE_Miscellaneous__ ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 1004120001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I
ON FILE I SQ. FT STORIES TYPE OCCIIP GROUPI 5451 RYLAND AV I
ISTRUCTURE: 1 V-B R-3 TEMP CA 917802722 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: DAINES 1
18586-024-013 (EXIST BLDG USE: THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, Cl
I (EXIST OCC GRP: USE ZONE:
ITENANT: I (ISSUED ON: PROCESSED BY: EXPIRES ON: 1
1 BLDGS. NOW ON LOT: VALUATION: 104/12/10 SR 10/09/10
I
I 1,200 1 I
(OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE:
JHUANG, BONNIE (626) 794-0288- ILIST ITEMS: fin �^n•
16743 LONGMONT AVE. I
ISAN GABRIEL CA 91775 1 IDEISCRIPTION OF WORK II
I I [FINALIZED EXPIRED PERMITS BL 0709070017, EL 0709070010 [
1 JOCCUP LOAD EXIST: IPL 0709070004 [
(APPLICANT: TEL. NO: - IOCCUP LOAD NEW:
SAME AS OWNER I I I
I 1PARKING SPACES REQUIRED: ISPECIAL CONDITIONS: [
I 1PARKING SPACES PROVIDED:
I (EXIT HARDWARE:
(CONTRACTOR: TEL. NO: I 1 LIMITED TIME USE 1
ISAME AS OWNER - JNBR OF EXITS: 1 FROM TO 1
J LIC. NO
I I FEES PAID I I
I I (APPROVALS DATE INSPECTOR SIGNATURE 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( [
[ARCHITECT OR ENGINEER: TEL. NO: I TRAILER USE I I I
[ - JOA PERMIT ISSUANCE 27.75 1 I I I
LIC. NO: 101 R/M OCC/USE INSPECT 145.95 ISAFETY PERMIT I I I
I [ TOTAL FEES 173.70 1 1
I I TEMP. STRIICT. APPROVED
I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (TEMP. STRUCT. REMOVED I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I
I NO I J I
1 SCHOOL WITHIN HAZARDOUS I I I
JAIR QUALITY: 1000 FEET MATERIALS I I I I
1 NO NO NO I J I I I
I
REQIIIRED TOTAL SETBACK FROM EXIST I I [ I
ISET BACK YARD: HWY: PROP LINE: WIDTH:
IFRONT PL- I I [ I
I SIDE PL- [ I [ I
I I I I I I
I I I I I I
I
I I I I
I I I 1 I I
I I I I I I
IREPORT ID: DPR267 ROUTE TO: BS0508
I I I [ [ [
&`' W RKEgS'COMPENSATION DECLARATION
CE 875(11-84) MISCELLANEOUS APPLICATION
,.ft+ CE 875
I hereby affirm that I•Have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
insure., or a certificate of Workers'Compensation Insurance,or
a certiflod copy thereof(Sec.3800,Lab.C.).
Policy No. Company FOR APPLICANT TO FIL, IN ADDR NG j,� At
ADDRESS JH //
Certified copy is herebyfurnished.
BUILDING LOCALITY I
ADDRESS
❑ Certified copy is filed with the county building inspection LOCALITY
departmerit. ' CROS ST
Date Applicant NEAREST DISTRICT N . GR P TYPE PROCE SED B
,3 Y
CROSS ST. CONST.
�I 0
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL
COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY
NO. OF HLDGS. STATE MAJOR S6 CO ND OCAL
NO. (CIRCLE)'
(This section need not be completed if the work involved TRACT ' NOW ON LOT USE ONE SPE IAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) USE of
0 4
SIZE OF L T Y, 10 EXISTING BLDG.
I certify that in the performance of the work for which this v o
permit is issued,I shall not employ any person in any manner OWNER
so as to become subject to the Workets' Compensation Laws. MAIL �� 1"'
/ OCCUPANCY.GROUP o
ADDRESS�Lf.4 /
Date Applicant SU1
NOTICE TO APPLICANT: If,after making this Certificate of CITY --z ~ NO. OCCUPANT LOAD
rn �� l
Exemption, you should become subject to the Workers' --
Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE:
with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑
deemed revoked. ❑ ❑ No Spec. Knowl.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW)
9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS
ness and Professions Code,and my license is in full force and
effect. k.Ci PARKING REq'D �' PROVIDED
SPACES
License Number Lic. Class Citi
LIMITED TIME USE
Contractor Date DATE DATE
FROM: TO:
I am exempt from the licensing requirements as I am a
licensed architect or a registered profbssional engineer ' SIZE OF F INSPECTOR'S
acting in my professional capacity (Section 7051, Bus- EXISTING BLD IE SIGNATURE
iness and Professions Code). FINAL APPROVAL
PRESENT USE OF BUILDING
Lic.or Reg.No. Date � ey
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
ON LOT AND USE Al 2 40 A
I hereby affirm that I am exempt from the Contractor's r
License Law for the following reason (Section 7031.5, Busi-
ness
usi # o 0 0,0 3 Q
ness and Professions Code): NO. PARKING
1, as owner of the property, will do the work and the SPACES PROVIDED I o o' 8.Q50
structure is not intended or offered for sale (Section ' 0 0 0 $0.5 0'6
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
issued(Sec.3097,Civ.C.).
Lender's Name
PROPOSED MAX. OCC.
Lender's Address
PERMIT FEE J
I certify that I have read this application and state that the
above information is correct.I agree to comply with all County ISSUANCE FEE
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter TOTAL FEE
upon�t 'abo e-mentioned
�property yfTspec 'pn purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of PermitteeDatetll
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