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Home My Public Portal About5026 TEMPLE CITY BLVD_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY ' WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL BUILDING ADDRESS ' 1 hereby affirm that I have a certificate of consent to self insure or a certificate of Workers CompensationEo d•• Insurance or a certified BIIIIDWG ADDRESS 1v. C—k 1tsL. dr /Icopy thereof (Sec 3000 Lab C 1 CRY ^ `� ZIP `V` LOCALRY Policy No Company I G HIL Arks L ` NO OF BLDGS NOW ON LOT ❑ Cerhfwd copy is hereby furnished NEAREST CROSS ST �LCertmhed copy is filed with the county building inspection TRACT BLOCK LOT NO clewment USE ZONE MAP NO Date )-,e 9JApplicant (JEvASSESSOR MPP BOOK PAGE PARCEL 01 Q oc"er SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS ` OWN TEL NO COMPENSATION INSURANCE 2 )' 4 � WITHIN loon FT of SCHOOL' YES NO (Thea sechonneed not be completed d the permit ms for one hundred ADDR SS DISTRICT GROUP TY CONST FIRE ZONE PROCESSED BY dollars; ($100) or less) CITY ZIP ' I certify that In the performance of the work for which this permit `OP �7 3 Is Issued I shall net employ any person n arty manner So as to ARCHTTECT OR ENGINEER TEL NO become Subject t0 the Workers Compensation Laws STATISTICAL CLASSIFICATION ( APT CONDO Date Applicant ADDRESS CLASS NO / DWELL UNITS NOTICE 70 APPLICANT It after making this Certificate Of REOUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the VAxkers CONTRACTOR TEL NO SET BACK YARD HWV PROP LINE `MOTH Compensation pwwm of the Labor Code you must forthwith �[� S' L FRONT comply with such onwisi ops or this permit shall be deemed revoked ADDRESS LIC NO - P L LICENSED CONTRACTORS DECLARATION InIx3Z SIDE CITY LIC Ce P L I hereby affirm that I am licensed underprovmsens Of Chapter 9 L SEWER MAR (commencing with Section 7000)bf DlvmSlon 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES Professions Code and my license a in full force and effect 00 ' NEW BK PG } License Number -;819.17 La Class ADD ❑ VALUATION , O Contmetor CLMsibiIC.oDate 7-3o-113 col 3 M J $ O ALTER ❑ cc ❑ 1 am exempt under Sec ab"er- C- /N G REPAIR OV $ Q B BPC for this reason DEMOL ❑ LOk1A P/C/ 1110 Date USE OF EXISTING BLDG URM ❑ { a Signature TEL NO LDMA Perm. 1 Z ) I ❑ I as owner of the property or my employees with wages as = AIXT.aw their sale compensation will do the work and the structure is ADDRESS O ,(y net Intended on offered for sale (Section 7044 Business and FINAL DATE C 3303 113.65 Professions Code) W1 THE N'PLCANT OR FUTi-EF eVtt!#In OLLL'FNrT N.WRE A IMZARWna HMTERUL g— �} 1 ITEMS ❑ I as owner of the proper am excjusrve contracting with OR A MIXTURE CONTNNNG A m ARDOUS VATERAL EQUAL To OR GREATER THAN THE N N AMOUN15 a CIREO ON THE HAZARDOUS AUTERNLS VFORMAnW GUIDE? 1 FINAL BY �! licensed contractors to construct the project (Section 7044 YES El NO El _TOTAL 118 . 65 Business and Professions Code) WlL THE NTENOEO USE OF THE BUID N3 eV THE APRx,ANT OR FlITIME EULDNG // / CONSTRUCTION LENDING AGENCY COAST R REQUIROUAUFFE A RERun FOR STR T (MAO OR r E PERATgN FROM THE T FOR 5iowf L �/ K 118.65 GUM NR IXINfiY I.V.NAGEMENT g51fULT(9CAGMGI SEE f£RVIiTP.O CfECKL6T FOR "( (��/�� (y 0.10ELlES MI'tl\VG •Vll hereby affirm That there 19 8 construction lending agency for VES❑ rio❑ N the performance of the work for which this permit m Issued(SecREADTFIELJSAATERW.SNFORIJATiON I m` 3097 Cry C) CHECKLIST UNDER�MY REQUIREMENTS UNDER T4EGUIDELOS N EIEC S COORNNcUNTY COUNTY n,�,��,� Larders Name MATERIALS Z�CS REFORMING AND FOR s AT�ori�FROMxToifE SC QVD I��-O'301 ` 7/30/9e Lender Address 1019 1 AM,8.+LI p CwKn to 4Qur 1 certify that I have read this epplicatm and state under penally zR of perjury that the above Information Is correct I agree t0 comply PC FEE PERMIT FEET F with all county ordinances and State laws relating to building Construction and hereby authowe representatives of this County ISSUANCE FEE W ent;C the above-men ned property far Inspection purposes = I ` m ///I'l_ '2-3 643 NVESTIGATION FEE TOTAL FEE wain.w Aa.n ow / SEE REVERSE FOR EXPLANATORY LANGUAGE J COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT" TEMPLE CITY CA 91780 BL 0508 1003150011 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS IM 14467 LT 24 SQ FT STORIES TYPE 5026 TEMPLE CITY BL STRUCTURE 22 V-B TEMP CA 917803829 ASSESSOR INFORMATION NUMBER i NEAREST CROSS STREET 18589-014-009 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY Cl TENANT EXIST BLDG_ USE _RESID, USE ZONE R-1 ISSUED ON PROCESSED BY EXIST OCC GRP �� - 03/15/10 SR OWNER TEL NO BLDGS NOW ON LOT VALUATION F LM FINAL BY CODE HEATHER MOREL HERITAGE/TRUST ALITA, - 4 850 L 5026 TEMPLE CITY SL / Ir TEMP 917603829 FEES PAID DESCRIPTION OF WORK REMOVE COMPOSITION, INSTALL #15 FELT 30 YEAR MALARKY COMP 1 ( FEE DESCRIPTION QUANTITY UOM AMOUNT TAPPLICANT TEL NO JOE IANGDON (714) 608-8226- IAA BLDG PERMIT ISSUANCE 27 75 116312 ARLINTON LANE _ JAB STATE GREEN BLDG FEE 4850 00 VAL 1 00 SPECIAL CONDITIONS HUNTINGTON BEACH IAC STRONG MOTION RESID 4850 00 VAL 0 50 D2 PERMIT W/O EN-HC 4850 00 VAL 132 60 TOTAL FEES 161 85 ICONIRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE JJ N L ROOFING INC (714) 536-1816- 116312 ARLINGTON LN LIC NO LOCATION AND SETBACKS 1HUNTINGTON BEACH CA 92649 648337 C39 SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER TEL NO IF (FOUNDATION/TRENCH FORMS ' LIC NO SLAB/UNDER FLOOR I IRAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP ' - UINDERFL00R INSULATION I 194H269 3 00 I FLUOR SHEATHING IND OF FAMILIES DWELLING UNITS AFT/COND STAT CLASS NO 21 ROOF SHEATHING /J SCHOOL WITHIN HAZARDOUS 1SHEAR PANELS 1T IAIR QUALITY 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST IFIRE SPRINIG:.ER HANGERS SET BACK YARD HWY PROP LINE WIDTH FRONT PL- �- _ (INSULATION/WEATHER STRIPI SIDE PL- ANTERIOR LATH/DRYWALL - EXTERIOR LATH (RATED FLOOR/CEIL ASSET RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS I I LOT DRAINAGE k BS0508 REPORT ID DPR261 ROUTE TO 71 6A695=CE Y803 ,/ APPLICATION FOR BU ILD( G PE COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL Bu BUILDING AND SAFETY DIVISION ADIDRESS ( A7 �T COLEMAN JENKINS, BUN T or BUILDING LOCALIT FOR APPLICANT TO FILL IN NEAREST ,,Ht Or typ, OIYI CROSS ST BUILDING DISTRICT N p TYPE OC B t l� /� .r /IQ CONST ADDRESS /V L Yw' STATISTICAL CLASSIFICATION SEWER MAP LOT NO LOCK CLASS NO DWELL UNITS 19W pG TRACT USE ZONEMAP NO OFSIZE OF LOT p XIF I NOW ONBLOTS SPECIAL 44 USE OF /'� CONDITIONS EXISTING BLDG S/ �CAL70 OWNER q Li /►I r TEL J O .Q BLDG SETBACK FROM ADORES FRONT PROP LINE OF (STREET) ;SIDEPSF XISTING SETBACK HIGHWAY } YARD = TOTAL WIDTH FROMCL ARCHITECT OR TELNGINEER NO FROM ADDRESS P LI (STREET)TEL XISTINGSET HIGHWAY } YARD = TOTAL EL. CONTRACTOR NO WIDTH FROM C L 8 ADDRESS NO = pp CITY CILASS CORNER CUTOFF YES ❑ NO E] LVL( CONSTRUCTION LENDER CL NAME AND BRANCHSEE REVERSE SIDE FOR SPECIAL APPROVALS z ADDRESS SO FT NO OF NO OF NEW ❑ SIZE STORIES FAMILIES USE OFADD ❑ STRUCTURE ♦ ALTER REPAIR %fGNATURE OF APPLICANT CAN NT ss �� OEMOL ❑ VALUATIONS �V APPROVALS DATE INSPECTOR'$ SIGNATURE PC PMTFOUNDATION LOCATION FEE 5 FEES 3 . FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON GAS VENT DUCTS STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION Of THE LATH INT LABOR COD[ OF THE ST'.TE FORNIA IN RELATING TO WORKMEN S CO • IoM I URANC[ �'.—•,, LATH EXT SIGNATURE O N7 HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS iwll FINAL JOHN F LEWIS PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CN NO CASH _ PERM VALIDATION cm N o CAB. . ..A , 2 0,4 89 AM23 1 0 3,00- 9