HomeMy Public PortalAbout5078 SULTANA AVE_Building__ FY CITY OF TEMPLE CITY
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BooReISNSG Q�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALLE Y
JOHN A LAMBIE, COUNTY ENGINCER NEAREST
WILLIAM JENSEN 9UrTor BUILDING CROSS AI
DISTRICT NO GROUP I TYPEPRO E
50 FOR APPLICANT TO FILL IN CONST
BUILDING D��,p_��� STATISTICALCIABS IFICATION SEWER MAP
BUILADO {`ter--���/� IS aila S
CLASS NO DWELL UNITS
IAT NO e - BLOCK NUMBER oZ HWYE YES O
TRACT San 8 USEZONE SPE IA �J
SIZE OF LOT 57X206• Y NO OFBLDGS �p CONDITI ICY
NOW ON LOT 2 -/ Ir
USE OF Dwel m & (,'ara e
EXISTING BLDG tt [ BUILDING YARD H REET N ME EXIST
OWNER Gene V. fLis NO-AT U SETBACK P' WIDTH
FRONT
P L
ADDRESS SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION RECORD
ADDRESS •�� I. /` / a
CONTRACTOR Santa Anita ContrNaT
ADDRESS 17 E. Las Tunas, San Gabriel '- - A'�YJ O
DESCRIPTION OF WORK
fiUF
FT❑�A[DD
ALTER ara�p]�µ= OF AIR ONO OLFSH
SIZE 9G6 JI DRIER' FAMILIES I
OF
STRUCTURE DWelliX19 & Attached Gara eJI
1
SIGNATURE OF
APPLICANT
VALUATION$
f� ��O//TT APPROVALS DATE INSPECT R 5 SIGNATURE
FO
FEE $ FEE E �(/� W
FOUNDATION LOCATION J / / / I v� `I
FORMS MATERIALS �/
FRAME FIRESTOPS I
IHERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 1 BRACING BOLTS l/
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMT IS ISSUED ISHALL NOT LATH INT
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN S COMPENSATION LAWS OF CALIFORNIA 1
LATH EXT / J
SIGNATUR L HOUSE NUMBER COR-
PERMITTE Q- RECT AND POSTED
ADDRES9 FINAL
��
CLYDE N DIRLAM P NCI AL 5TR L ENGINEER
uL�
PLAN CHECK VAIMATION � mo uaH PERDUT V ATION (!Ili
Il mo wH
LCo4733 - ?R 3230 1500 . in
p
LAC,5427Ti 1 D 300//0
APPLICATION FOR BUK-DING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKERS COMPENSATION DECLARATION FOR APPUCANT.TO FILL IN etaLDING�RES9
e O E
I hereby affirm that I have a cerirfioate of consent to eeM IntlUre O
Dt
or a Certificate of Workers Compensation Insurance or a certified Clio ZJP
cop' thereof(sec 3800 Lab C) all
g0 LOCALITY /
Policy NO Company SREt NO OF BLDGS NOW ON LOT
11 Certified copy is hereby furnished O 1 'L NEAREST CROSS ST
❑ Certified Copy is filed with the county budding inspection TRACT BLOCK LOT NO
Ole-
department I USE ZONE MAP NO
Date , Applicant ASSESSOR MAP BOCK PAGE PARCEL , - '
IAL C
SPECONDfT10NS0,
/)_ 9
CERTIFICATE OF EXEMPTION FROM WORKERS OWNER L o NO
COMPENSATION INSURANCE a" u ' S 4'l 60 b wr-HIN 1000 FT of SCHOOL1 YES No
(This section need not be Completed If the permit rs for one hundred ADDRESS �O \ L DISTRICT GROUP TWE CONST ME ZONE PROCESSED BY
dollars($1001 or less) k
I certify that in the performance of the work for which this permit GTY .N o ZAP
Is trot Issued I &hall t employ any person in arty manner so as to ���OV OR ENGINEER TEL NO C1
bec bred to the Workers tion Lowe 9WTISi1CA1 TKTN PPT CONDO
Date 11 Applicant u' ADDRESS CLASS NO � DWELL UNITS
NOTICE TO APPLICANT If after makrg this Certificate of REOUIRED TOTAL SETBACK FROM ENIST
Exemption you should become subject to the Workers CONTRACTOR Oma`/ TEL NOEt
SET BACK YARD HWY PROP UNE WIDTH
Campensahon provuicris of the Labor Cade you must forthwith
FRONT
comply with such povsiofl4 or this perms shell be deemed revoked ADDT�SS UC NOLICENSED CONTRACTORS DECLARATION DE
CT' - LIC CLASS - L
I hereby affirm that I am licensed underprovisions of Chapter B SEWER MAP
(Colllnlencirg with Section 7000)of DNleion 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES
Professions Code and my license s In full force and effect I NEW ❑ BK PG , d
Lrcense Number LIC Class RIPTION OF WORK ADD ❑ VAL"TION / p
Contractor Date ALTER ❑ $ -'1.�1��' U
,¢ 14iW IAU.o o SY _ O
❑ cc
I am exempt under Sec REPAIR `� $ ' F
BAPC for this reason 'i AIU-0 JWWfAk NS o DEMOL 1� - W
P/C
Date USE OF EXISG 1 LDNM
TINs
�Z hwo w.WleW uRM d a
Signature APPLICANT IFT�/T) .f LDMA Perm♦ 1 Z
1�1 as owner of the property a my employees with wages as C• b 1/L 'Y � $ lI— 1� ` T.i
their sole componsabon will do the Work and the Structure is ADDRESS 77Y1 �fe
not Intended or offered for sale (Secton 7044 Busmese and b IMYI it O FINAL DA Q 1313 -��c� 11+7''''.))17
Professions Code 1 WILL THE APRJrINT n1 FUTURE BUlf1N0 OGGURVfi HANa.E A HAZAf S MATERIAL `` TuAtI-Z�17 .G�
OR A MemfiE L NIN13 A MATERIAL EQUAL To OR GREATER THAN TIE I
❑ I as owner of the Property am exclusn eN
contracting with AAIDUli9 sFaaFEo an TIE HAz,woous MATFFWlB PEOlAATDN BuoE+ FlNAL BY 7
1,63rised contractors to construct the Proled (SeCtIM 7044 `
Business and Professions Code 1 YEs❑ wig, r /y�/y/
WU TIE NTENDEO USE OF TIE BU9ONG Br TME APRJLAAT M FU URE BUILDING „MT1I(TTG�EM117.LI
CONSTRUCTION LENDING AGENCY rGOAT-MR oREuOuLay AuPE10TMr FNOrR 00m11&TR(=D)SEE PERMTnDnNNoFRcOHMEaTHuEuBTOFOR
sumaH ' .00
I hereby affirm that there is a construction lending agency, for YES❑ w�
a the performance of the work for which this permit is Issued(Sec I
m 3087 Civ C) Iraq sLpDEggNp MriwFn�rHt uirnELesAOwiENnY cooE i l
r
Lender&Name w�tifrR�M�oppA�Nq _VPj(r rT�Fn�ouAToiE � A 9 17J7 11 s
Lenders Address L 1` V
0 (MA pi.rgM
1 certify that I have read this application and state under pernalty,
of perjury that the above mformation Is correct I agree to comply PC FEE PERMIT FEE -owith all county ordinances and State laws relating to Wilding
5
construction and hereby allftMe representatives of this County tsSUANCE FEE
g to enter upyrtihe aboTe-meet rtr for i put s
m [/ �LA/ Z� PIVESROATION FEE TOTAL FEE
� i m
1\ SEE REVERSE FOR EXPLANATORY LANGUAGE