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HomeMy Public PortalAbout5115 SANTA ANITA AVE_Building__ X TEMPLE CITY, ,/11.5911 CII g908.1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 1wV0-Lt.,4tj,17L__eL*4VP.7 BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENQINEER NEAREST WILLIAM A.JENSEN SUP'T OF BUILDING CROSS ST. DISTRIGR�JP' 1yPE P BY FOR APPLICANT TO FILL IN F lei/) rl( CONST. 00 C� • BUILDING B �C�/ STATISTICAL CLASS, CATION S R MAP ADDRESS �� K CLASS.NO. /DWELL.UNITS LOT NO. BLOCK WATER.-• NOT REQUIRED RECEIVED TRACT 336.3 MAP CERTIFICATE: HIGHWAv NO.OF BLDGS. y NO. �VV (CIRCLE) STAT MAJOR ECON SIZE OF LOT. wX NOW ON LOT v USE ZONE' PECIAL USE OF 'CONDITIONS EXISTING BLDG. [�-. I OWNER CG.O NEI BUILDINGEXIST. SETBACK YARD HWY STREET�AME WIDTH ADDRESS I;r,1 FRONT ?/�/ � t ARCHITECT OR TEL P.L:. eta+ c V ENGINEER NO. SIDE P.L. } ADDRESS TEL. INSP$CTION,,RECORD 0. CONTRACTOR NO. - 1�/ /•- rj ! U ADDRESS . i Im DESCRIPTION OF WORK - — ►� � - '��'� � G f NEW ADD ALTER REPAIR DEMOLISH / •' � �j-� I / co SQ. f NO.OF NO.OF ,!ia:+tA� 1 l. �5 IZE (7 O STORIES FAMILIESUSEOF STRUCTURE i /!n/ /71rGLG� ✓ i 'Nr. �% SIGNATURE OF APPLICANT VALUATION APPROVALS DATE'. INSRECT,OR'S SIGNATURE P.C. PMT. /p��� FOUNDATION:LOCATION FEE E FEE $ � (/ FORMS,MATERIALS FRAME:FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, "' ! WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT U DCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK — A AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. ��� fl'. /6•(Ci TION OF THE LABOR CODE OF THE STATE-OF CALIFORNIA RELAT- /� j J ING TO WORKMEN'S COMPENSATION INSURANCE. LATH,EXT. %") ". 1 SIGNATURE OF ,jd � HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS' 2/s FINAL CLYDE N. DIRLAM, P INCIPALSTRU RAL ENGINEER PLAN CHECK VALIDATION cK. M.o. cnsH PERM VALIDATION M.O. CASH Uj�l9 4 1 2 ' .iuN 2� . 15.0 0 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ® �p ®�!�® WM. J. FOX, CHIEF ENGINEER L FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT fAD. PLAN CK.NO. PERMIT NO. BUILDING ADDRESS LOCALITY T X `�' 6 L" t'1 C RECEIVED BY DATE OFAPPL. DATEeIISSUED NEAREST } `� I�1 CROSS ST. N`� BUILDNG OWNER -7�V ADDRESS 3 [0VV-"Uq, ZZ 1,ug y MAIL ®�®® n/J LOCALITY ��C �- '�'L7t;1'L S t ADDRESS 7� fAc�By �r M0 1 ems. ND. A o NEAREST TEL CROSS ST. n•r- CITY FIRE ,� NO.OF TYPE A GRCUPs.�_- ARCHITECT OR TEL. ZONE PLANE wr.® `r¢ ENGINEER r3a u Im NO. r/4 BLDG. 7 ORD.NO. SETBACK LINE ADDRESS s'Yl- '5z _ APPROVED CONTRACTORy' `" NO. BY DATE USEAPPROVED ADDRESS ZONE BY DATE LEGAL ©� CORRECTIONS DESCRIPTION LOT NO. �Q BLOCK TRACT NO.OF SLOGS. �q SIZE OF LOT �1�-USEor { 0 I NOW ON LL�OT f'p� EXISTING BLDG. /\�C��Y�Ln.a I Fnuf Ee�'1I ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O A REPAIR MOVING - DEMOLISH SIZE / RO 64•FT. 6/ NO.OF `Z p D OMS �J STORIES WALL ROOF 5� r COVERINGa.� C1�°s�+� I COVERINGlPM 1' USE OF NEW BUILDING -D W ELL0v C Ca a�� - G�vti, ►�-4 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS VPQ APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION:LOCATION NSPEC GR D TE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS - fj AND STATE LAWS REGULATING BUILDING CONSTRUCTION. G FRAME: FIRE STOPS, SIGNATURE OF. T BRACING,BOLTS PERMITTEF~� LATH,INT.: AUTHORIZED AST 467 LATH,EXT.: G DSS-3 SOM SETS 7-47 $ 0� P.C.111 PLASTER,I NT. 571701, FEE PLASTER,EXT. VALUATION FEE FINAL OF COUNTY E DEPARTMENTNG1N8� BUILDING `d -t�°IiIVISION OF BUII.DZAiG AND SAFZ;"PY COUNTY OF LOS ANGEM WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT'D. GRIFFIN;.SUPT OF BUILDING FOR APP_I.ZCANT TO FILL IN FOR OFFICE USE ONLY- BUILDING r y� q� j) Dig M- 1 O. PLAN CK.OR Rec.No. PERMIT NO. ADDRESS J III I oal? ,! �L C LOCALITY e_M P L C (!. I-T SI RECEIV D BY DATE OF APPL. DATE ISSUED CRE S9 ST. 5- L .�• lidiLDING OWNER j !'AA�,�,.;5 / ADDRESS MAILA DR1:SS S A, _ LOCALITY L C RAREST CITY /. 0. o o• O o 5 lv`L� CROSS ST. A/ ARCHITECT ORTEL, FIRE NO: OF TYPE U GRO ENGINEER S M NO ZONE I PLANS ADDRESS SETBACK LINE ,16 / AN! TEL. USE APPROVED CONTRACTOR - /vI E' NO. ZONE BY DATE ADDRESS . HOUSE NUMBERING LEGAL'- MAP NUMBS NO. ASSIGNED BY DESCRIPTION I LOT NO. l� BLOCK' - 4c,-is -.s-3 CORRECTIONS TRACT 0.1 OF BLOGS. SIZE OF LOT �� �R?+1 I IVOW ON LOTUSE-OFOF 10, v JOUSTING BLDG. �FL�:f Nt7 ��f�` NAMILI6B I IDESCRI moN OF woBx C �'�•a�-�- .a�� �ora�- ®� s me - NEW ALTERATION ADDITION ^, � �1MA9 r;0-092 0 IC, Z REPAIR DEMO!•(TION ROOMS 7 ry s / r Q. FT. 3� �i STORIES SIZE o EXT.WALL r- ROOF COVERING �� CG.t? I COVERING C Q:`�} . .00` USE OF STRUCTURE AMOVALe INSPECTOW6 SIGNATURE DATE FOUNDATION:LOCATION FORMS, MATERIALS 7�' �E',Ge r ••--.� / r+ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. FURNACE:LOCATION, yy I AGREE TO COMPLY ,11TTHH ALL COUNTY ORDINANCES GAS VENT, DUCTSG AND STATE LAWS REG°lATING BUILDING CONSTRUCTION. SIGNATURE O . Q, LATH, INT. �r PERMITTEE ADDRESS ` :Sf A66 o LATH. EXT. PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. e� f� 00 P. C. Ear HOUSE NUMBER COR- G�! FEE RECT AND POSTED VALUATION FEE .+�� FINAL ss6sv" J� a WZPASTMENT OF ]JUMMUG AND SAFETY J rrLl&%0JL A Awm K va rzsuna L COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL-IN FOR OFFICE USE ONLY ADD EIN 3 -0 A U Ld DISTRICT NO. PLAN CK.NO. PERMIT NO. LOCALITY Ekne RECEIKE�D'SY DATE OFAPPL. DATE ISSUED NEAREST CROSS BT. au f� OWNER ./ ®.s ADD EISB� !//' �✓C/ // f f" t�' '� ADDRESS -3-703 �//OU1�. LIF MAIL LOCALITYt'��d i'�.• !j/�"' `' gp�� l`0 QY NEAREST U.�AQ P CITLE' e( NO.� 7 CROSS ST. r TEL. RIRE NO.OF gym? -TYPE / ORDYPj ARCHITECT OR ZONE PLANE l� ENGINEER ®GlJ/��i' NO. BLDG. Y cv Y or .NO. ADDRESS SETBACK LINE APPROVED CONTRACTOR ® No. BY DATE y USE APPROVED ADDRESS R ® ZONE�' BY DATE DE CGIPTCORRECTIONS IION [ LOT NO. Q® BLOCK l TRACT ®.ya (P \ Ap /p. t O V P f ' / r� NO.OF BLOBS. SIZE OF LOT 4� Z,�IA. l I NOW ON LOT USEOFor EXISTING BLDG jjj�W_�,�r'�.u�l G' NOFAM.ILOFIES f ROOMS 3 1 � DESCRIPTION OF WORK NEW ALTERATION ADDITION O A REPAIR MOVING DEMOLISH p s4.FT. No.ofROOMS / D WALL Roor SIZE �0® � STORIES .fig r COVER,No Qv� I COVERING BUILDINDi �' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE FORMS, AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FLOCATION FORMS.MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAMEI FIRE STOPS, SIGNATURE OF BRA13 BOLTS PERMITTE LATH, INT. AUTHORIZED AOT LATH, EXT. 7bAG38A-3 2-SO $/ p P P.0,9 J..�"7 PLASTER,INT. / FEE PLASTER,EXT. _ VALUATION LLL FEE 13, `r-�� FINAL - + V r WORKERS' COMPENSATION DECLARATION ,.I-hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T ' insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING / -- ADDRESS ❑ Certified copy is filed with the county building inspec- BU L Ss /�� �/1ri7/Cl tion department. 1/706 DateApplicant CITY e ZIP 1/706 LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) ,rte USE ZONE. MANOP TEL I e Z7 I certify that in the performance of The work for wOWNER 61L4 �rjS7-ee__'which this permit is issued, I shall not employ any person in any manner ADDRESS sr//S r `� ArI/TA k,,&,'ISPECIAL CONDITIONS a so as to become subject to the Workers'Compensation Laws. O `/3/ �-- ,7 CITY T C zip 1/'7W v Date Applicant -_` V ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE Ul ESSED BY O Exemption, you should become subject to the Workers' CONST �e ZO Compensation provisions of the Labor Code, you must forth- ADDRESS ��� ter_. ` a with comply with such provisions or this permit shall be TEL• ) STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR ;GZ2�57- 119kW NO. -=� '7 I / Z LICENSED CONTRACTORS DECLARATION /,, LIC. CLASS NO. CADWELL.UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS a(�I � NO. 3 (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,-and my license is in full force and effect. CITY -7 G CLASS c 3 BK VALIDATION + License NumberZ _Z1909 fLic. Class Com) SIIZE�./' STORIES FAMILOIES ONEK p VALUATION Contractor_-J?Z T �1+�//&Date ?I/3/ DESCRIPTION OF WORK NEW ❑ it , I am exempt under Sec. /-Zoo F/Al ADD ❑ALTER ❑ BAP.C. for this reason REPAIR $ Date: USE OF 1.1�s DEMOL ❑ EXISTING BLDG. �L 'Signature, APP(PRINT) &7* ( llf NO. $17 ICANT TEL ITS FINAL,-^- OWNER-BUILDER DECLARATION /`�_ DATE f I hereby affirm that I am exempt from the Contractor's License ADDRESS �W /` � ��T C 1 Low for the following reason (Section.7031.5, Business and FI Professions Code): PRESENT BBUILDy �yr- _ ❑ I, as owner of the property, or m employees with +u I a P P P Y+ YADDRESS ING1 wages as their sole compensation,will do the work and / 3 cO c the structure is not intended or offered for sale(Section LOCALITY 0� � -�+a tit 7044, Business and Professions Code.) MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- TOTAL 59.25 tion 7044, Business and Professions Code.) ADDRESS CONSTRUCTION LENDING AGENCY SETOBACK YARD HWY TOTAL SETBACK LINE FROM ' WIDTH CHECK 59.25 I hereby affirm that there is a construction lending agency for FRONT CHANGE .00 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). [Investigation DE L. Lender's Name OiI0zl-01010)j 3/13/9 8 LDMA Ref. # Fee$ Permit Fee G'= Lender's Address , 1i%%tet � [�} I certify that I have read this application and state that the Issuance Fee —5 LDMA P/C# 3 above information is correct.I agree to comply with all County Fee ordinances and State laws relating to building construction, Total Fee r�� LDMA Perm. # and hereby authorize.representatives of this County to enter z upon the above-mentioned pro erty for inspection purposes. j`ad-J SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date