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Home My Public Portal About4852 TEMPLE CITY BLVD_Building__ 7CA[3[A CEee02 9-07 Te WR — C;f I APPLICATION FOR BUILDING PERMIT LJII COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDREss 6 ,6 at BUILDING AND SAFETY DIVISION LOCALITY IG JOHN A LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W JENKINS, SUP T OF BUILDING CROSS ST FOR APPLIC T FILL IN DISTRICT NO GROUP TYPE ET PROCESSED BY Pn nt or a onl JG.. BUILDING A STATISTICAL CLASSIFICATION EWER MAP ADDR (/ CLASS NO DWELL UNITS= BKG PG LOT NO OCK USE ZONE MAP 20 NO TRACT �' SPECIAL NO OF SLOGS CONDITIONS SIZE OF LOT N N ImPT USE OF I EXISTING BLDG BLDG SETBACK FROM . ISTREETI TE FRONT PROP LINEOF OWNER NO TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L CITY 80 + - 2C ARCHITECT TEL BLDG SETBACK FROM EE RTI ENGINEER NO SIDE PROP LINE OF TYPE OF EXISTING SETBACK HIGHWAY ARD = TOTAL ADDRESS A HIGHWAY WIDTH FROM C L /� + _ d CONTRA TE O O ADDR B f 1, S CORNER CUTOFF YES ❑ NO ❑ U IC CIT CLA 3-`� SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK N NEW ADD AL REPAIR DEMOLISH SO FT NO OF NO OF SIZE STORIES FAMILIES PAPPLICA.UZ F CTURE TUR VALUATIONS 4 d APPROVALS GATE IKa P[croR'e SIGNATURE P C PMT O SEEN FOUND—FORATION MATLOCA BION FEE S FEE S IP. FRAME FIRE STOPS I HEREBY ACKNOWLKD C THAT I HAVE READ THIS A"LICATION BRACING BOLTS AN,WITH BALL THAT TH[ ABOVE 1/ COIUIECT AND AGREE TO CO.PLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STAT[ uwe N[OULATING GAS VENT DUCTS BUILDING COXSTRUCTIOH 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WIL NOT [YRLOY ANY N IH VIOLA LATH INT TION OF THE LABOR COD F THE STATE C IF NIA RELAY IND TO WORKMEN S COMP ON I SU N [ LATH EXT SIGNATURE OF HOUSE NUMBER COR- P ERMITTE RECT AND POSTED p ADORE FINALAt I t JOHN F LEWIS PF CTURAL E PLJI CHECK VALIDA N CK M O CASH _ PERM VALIDATION CK M D cABH UJCO5 5 3 4W J l8 1 D 1. 2_.00~ WORKERS COMPENSATION DECLARATION - hereby afAirmthat I havecertificate of consent to ,elf mAPPLICATION FOR BUILDING- PERMIT aycert 'e or a ificate of WorInsurance,kers' Compensation Insurance, -. or a certified�pcop-�y�t�he�reof (Sec 3800, Lob C ) �.+ COUNTY OF LOS ANGELES - t .BUILDING AND SAFETY Polis of�1'Company 39 � /x//46 BUILDING 1 Cenfied copy is hereby furnished FOR APPLICANT TO FILL'IN _ ADDjLEii ❑ Certified copy a filed with the county budding t - BUILDING - tion department ADDRFSS Date Applicant OTY w—T Ci ZIP LOCALITY CERTIFICATE OF EXEMPTION FRO ORKERS' SIZE OF LOT NOW ON LOT i NEAREST -- - CROSS ST COMPENSATION )NSU ASSESSOR (This section need not be completed if the permit is for one TRACT - BLOCK LOT NO MAP BOOK - _ PAS PAS hundred dollars ($100)or less ) i I TEL OWNER 14 USE ZONE MAP I certify that in the performance of the work for which this b_ ��s permit is issued I shall not employ any person in any manner _ ADDRESS v Ll� INO SPECIAL ONS ' d so as to become subject to the Workers Compensation Laws O CITY ZIP ' Date Applicant - ARCH) TEL DI TRI ,GROUP TYPE FIRE p BY 0 NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO TYPE Z E Exemption you should become subject to the Workers, �{�N Compensation Provisions ofithe Labor Code, you must forth- ADDRESS �' ./ f�f � with comply with such provisions or this permit shall be deemed revoked I CONTRACTOR 4. STATISTICAL CLASSIFICATION APT I CONDO Z LICENSED CONTRACTORS DECLARATION - UC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO 4119V (commencing with Semon 7000)of Division 3 of the Business UC SEWER MAP and Professions Code,and my license Is in full force and effect CITY CUSSBK PG VALIDATION e� 7�7 SO Fr ,b OF NO OF CH License Number 31 / Lic Class p SIZE STORIES FAMILIES ONE VALUATION Contractor�L(L Q� //'f �?/T/b„tis DESCRIPTION OF WORKORE:19 ft NEW ❑ $\5•/-- /tO t ❑1 am exempt under Sec ADD C3 / ► - ALTER ❑ B&P C for this reason PAIR S VEXI ING DEMOL ❑ Signature APPLICANT TEL _ - FINAL O ER-B R DECLARATION (PRINT) NO t DATE I hereby affirm that I onCjsifempf from the Contractors License Law for the following reason (Section 7001 5 Business and ADDRESS Y FINAL. 1 _ - Professions Code) _ El 1, as owner of the property, or my employees with BADDREss .i-�r A*uCT.0 - wages as their sole compensation,will do the work and LocnuTv - •-_ ► R` 03307 _ 143.6, the structure is not intended or offered for sale(Section , 704, Business and Professions Code ) MOVING TEL _ w• . ' i TTM❑ I as owner of the property am exclusively contracting CONTRACTOR NO s„ "':'�� -- - with licensed contractors to construct the project (Sec- - Amu - - -. _ - s -,. , - - .TOTAL - 143.63 tion 704, Business and Professions Code ) ,- - - _ �y CONSTRUCTION LENDING AGENCY UIQ' YARD HWY CK FROM ISL .... !' )IDECK 143.63 BACKINEWIDTH - I hereby affirm that there is a construction lending Ogen for FRONT .00 the performance of the work for which this permit is issued P L .- (Sec 3097, Civ C) SIDE PL Lenders Name J _ _ 000D-W01 ly/.7LJi 7L _ LDMA Ref N 6, R 1 AMID:10 P C Fee$ Permit Fee 3 Lenders Address -♦ _ loop _ S I certify that I have read this application and state that the Issuance Fee if )DMA P/C N above Information is correct I agree to comply with all County 7vT- iwn Fee _ 7 - ordinances and State jaws relating to building construction, Total Fee (o J LDMA Perm N )< and hereby outhoriz representatives of this County to enter - - Yy upon above-m coned property for inspection purposes ' SEE REVR$E FOR EXPLANATORY LANGUAGE ISight ApplKant or Agent Date