HomeMy Public PortalAbout6039 SULTANA AVE_Miscellaneous__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0807290004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1
ITR: 5904 LT: 295 BL: .001 1 SQ. FT STORIES TYPE OCCUP GROUP 6039 SULTANA AV 1
ISTRUCTURE: 1 V-B U I TEMP CA 917801550
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GARIBALDI ]
15384-016-025 (EXIST BLDG USE: I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
I 1EXIST OCC GRP: USE ZONE:
TENANT: ISSUED ON: PROCESSED BY: EXPIRES ON:
1BLDGS. NOW ON LOT: VALUATION: 107/29/08 SR 01/25/09
1 I 1,000
(OWNER: TEL. NO: I IFINAL D T FI CODE:
LIST ITEMS:
ILONG, JOANNE (626) 329-1092- I
16039 SULTANA AV I I I
TEMP 917801550 [ INSCRIPTION OF WORK I
I IRE-CONVERT GARAGE BACK TO ENDED USE
I IOCCUP LOAD EXIST: 1 I
[APPLICANT: TEL. NO: [OCCUP LOAD NEW: I I
1SAME AS OWNER -
IPARKING SPACES REQUIRED: ISPECIAL CONDITIONS: 1
(PARKING SPACES PROVIDED: I [
I IEXIT HARDWARE: I 1
ICONTRACTOR: TEL. NO: I [ LIMITED TIME USE [
SAME AS OWNER - INBR OF EXITS: [ FROM TO [
LIC. NO
[ FEES PAID
I
I ]APPROVALS DATE INSPECTOR SIGNATURE I
[ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] 1
[ARCHITECT OR ENGINEER: TEL. NO: I ITRAILBR USE I I
[ - 10A PERMIT ISSUANCE 27.75 1 1 [ [
1 LIC. NO: 101 R/M OCC/USE INSPECT 145.95 ISAFETY PERMIT I I I
1 1 1
TOTAL FEES 173.70 I [(TEMP. STRUCT. APPROVED
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (TEMP. STRUCT. REMOVED I 1
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:OI I ] ] I
I I 1 I I I
SCHOOL WITHIN HAZARDOUS
1AIR QUALITY: 1000 FEET MATERIALS 1
[ NO NO NO [ I [ [
IREQUIRED TOTAL SETBACK FROM EXIST I I [ [
ISET BACK YARD: HWY: PROP LINE: WIDTH: ] ] ] I [
FRONT PL- [ [ I I I
SIDE PL- [ [ I I I
I I I ] ] I
I 1 I 1 ] 1
I I I I
I I I I I
IREPORT ID: DPR267 ROUTE TO: BS0508
I I I I I I
WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION
I hereby affirm that I have a certificate of consent tself COUNTY OF LOS-ANGLES BUILDING AND SAFETY DIVISION
insure, or a certificate of Workers'Compensation Insurance,e,or
a certified copy thereof(Sec.3800,Lab.Q.
Policy No. Company FOR APPLICANT TO FI LL IN BUILDING
A ADDRESS
Certified copy is hereby furnished. wooeEssJb6gqU 11,4 l) LOCALITY
/T
i
❑ Certified copy is filed with the county building inspection LOCALITY /�, /� NEAREST
department. ��mN ` CROSS ST.
Date Applicant NEAREST r DISTRICT NO. I GROUP TYPE P ESSED BY
CROSS GA (r /O/fCONST. ,
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d !//�
COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL
NO. (CIRCLE)
NO. OF BLDGS.
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) USE OF
SIZE OF LOT EXISTING BLDG. d
I certify that in the performance of the work for which this
r 0
permit is issued,I shall not employ any person in any manner OWNER
so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP li/4a/ �JI
} 0
AGGRESS 603-9 SIC-7-IfAl /�-
Date Applicant rEL. G G
NOTICE TO APPLICANT: If,after making this Certificate of CITY (, C! Ivo, O`�2 rrr�/a j OCCUPANT LOAD y
Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: z
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑
❑ ❑ No Spec. Knowl.
deemed revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices
El
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 ��C� �, �� !a p��� ^—
effect. PARKING REQ'D PROVIDED
�� �grx SPACES
License Number Lic. Class 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 professional engineer SIZE OF NO. OF INSPECTOR'S
acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE
iness and Professions Code). FINAL APPROVAL
PRESENT US OF BUILDING I'., ?
Lic.or Reg.Na. Date ` -J
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
ON LOT AND USE J.
I hereby affirm that I am exempt from the Contractor's
License Law for the following reason (Section 7031.5, Busf- -- --
ness and Professions Code): NO. PARKING _L6_L• +.T
SPACES PROVIDED TT
as owner of the property, will do the work and the L -TEN;
structure is not intended or offered for sale (Section 70T
nHI : - z=
7044,Business and Professions Code). 11=1 _ _ 45
CONSTRUCTION LENDING AGENCY PROPOS O USE OF BUILDING at r _64r
�•1 1�1[�
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.Q.
Lender's Name
PROPOSED MAX. OCC. -
Lender's Address � qq
I certify that I have read this application and state that the PERMIT FEE
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 he above-mentio ed=nspec' tion purposes.
1 se1_3 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of ermittee Date