HomeMy Public PortalAbout5032 TEMPLE CITY BLVD_Building__ TSASSSA CE V BOS I B3 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUR T Or BUILDING CROSS ST
DIST�R CT NO GROUP TYPE ESSED BY
pTRACTOR_.-fZeA4*"l
OR APPLICANT TO FILL IN RI coNsr
DING STATISTICAL CLASSIFICATION 6 WER MAP
RESS BK G
'CLASS NO DWELL UNITS _v
NO BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
CT MAP NI GHWAY"^
NO OF SL GS NO ICIRCLE) STATE MAJOR ECO LOCAL
OF LOT NOW ON LOT USE ZONE SPECIAL .
OF J..� CONDITIONS
TING BLDG v//Ly ,
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E NO BUILDING YARD 'HWV TREET NAME EXIST
��}�R� SETBACK WIDTH
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DESCRIPTION OF WORK a ADD ALTER REPAIR DEMOLISH Z
FT NO F NO OF
STORIES FAMILIES
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SIGNATURE OF '
APPLICANT
VALUATION $ vO
APPROVALS DATE INSPECTOR 96IONAiuNE
_ O FOUNDATION LOCATION
FEE $R`� FEE $ FORMS MATERIALS
FRAME FIRE STOPS
I HERESY ACKNOWL[DGR THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN 9 CO NSATION INSU CE dZkT+1 EXT / /A4
SIGNATURE OF HOUSE NUMBER COR
PERMIrrEE RECT AND POSTED
ADDRESS a FINAL
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JOHN F LEWIS PRINCIPAL ST TURAL ENGINEER
PLAN CHECK VALIDATION CK MO cheH
PERMIT VALIDATION CK M O CASH
LA(q 5 1 5 7 C; OCT 4 1 D 11-50—
APPLICATION FOR BUILDING PERMIT-
- COUNTY OF LOS ANGE S BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL INS , BUILDING 55 _
I hereby affirm that I have a cerhfcate d consent to self insure BUILDING � /f a �� )
l�
a a certdoate of Workers Canperlsaton Insurance w a certified CfiV - -
copy thereof (Sec 338800 Lab C) }/f�-r- G•
Polly 1[loy No 13 O�.r Corp n,,-S I TTI G FoAIA OF 64
NO OF BLDOS NOW ON LOT LOCALRY
❑ Carpfied copy is hereby furnished NEAREST CROSS ST ,
❑ Cernfied copy a fled with the county balding inspectKNl ' T BLOCK LOT NO
-
department USE ZONE MAP NO
Date$uAS nnw'�nt TOK RU 66E�I P n
ASSE MPP PAG6I q L O ; sPECIu coNanons
CERTIFICATE OF EXEMPTION FROM WORKERS' gVNER Q TEL NO -
COMPENSATION INSURANCE H R -2V' WITHIN 1000 FT of SCHOOL' I YES No 1
AGGRESS DISTRICT GROUP TY ST FIRE ZONE PROCESSED BY
(This Becton reed not be completed d the permit a for Dna hundred 3� G H LA
dollars ($100)w lase) ti
I cenefy, that m the performance d the work for which the permit CITY zP T
e Issued I shall not employ any person in any manner s0 as t0 AflC/4TECT OP ENGINEER TEL NO O� ?ef"4�
become subject to the Workers Cwrperoatlon Laws STATGTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO �1 //— DWELLUNITf
NOTICE TO APPLICANT N after making this Cem5mte of REQUIREDTOTAL SETBACK FROM EXIST,
Exempton you should become subject t0 the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH
Compensation prowsgln of the Labor Code you nest fortfrwntn L a.g 10
FROM
comply with such Provnspns or this permit shall be deemed revoked ADDRESS UC NO PL -
LICENSED CONTRACTORS DECLARATIONC aq3 SIDE 1C �j',� PL
I hereby affirm that I am licensed urWerprowscre of Chapter B SEWER kvIP
(commencing with Section 7000)of Division 3 of the Busmese and SO FT SIZE NO OF 11EI I NO OF FAMILIES '
Professions Code and my license Is In full force and effect ZLO 00 NEW BK PG , d
License Number 2819 3 9 L,c Class DESCRIPTION OF WORK ADD ❑ WLUATKIN
ConROe� Data f�-21-9,f ►'L L Pt— 1✓G ALTER 11 $ �I5O
cc
❑ I am exempt under Sec 0 304R, (r CL REPAIR ❑
• BSPC for this reasonML DEMOL ❑ LOW PIC - ' W
Date 115E OF E NG BLDG URM ❑ ' fA
SignatureAPPLICAM(F'fevT1 _ TEL NO LOMA Perm• Z
❑ 1 as owner of the Property or my employees with wages as b O
PEI A�
thOr sole compensation will do the work and the structure a ADDRESS -
W intended Or Offered for sale (Section 7044 Business and FINAL DATE G
Professions Coda) N"THE IAncANr OR FUTURE BucnuG Oo L!i0i n R M A flAz vRoous r.VSERUL 7 _
OR A I.m(Tl1♦E CCNPYNp A HAZAfCQ13 MATERNL EOUN.TO On GREATER THW TILE -
❑ I as owner xe•the property em the protect
contracting with AApU113 sPECFrm GN TIE RAZNWII.S wTETAua YFpRNAT4prr GLmET FINAL BY >licensed contractors to construct the project (section 7044 YEs❑ ro❑
Business and Prolessrons Code)
"LL TE HfiErDm USE OF Tf BUDLNe BY THE AiWGNr OR FUTURE BULIITXI ,
OCCUPAM REOlR1E A VERAfi FOni CONa1mUCIgN GR MOpVY.,irpN FRGU TE 90UTI1 r
CONSTRUCTION LENDING AGENCY coAmr AIR aulury NNurEr.ENr oeTwcr Isuwo BEE PERMTTNp wECKler Fna
aroEUNEs r ,
I hereby affirm that there Is a construction lending agency for YES❑ �❑
,v the performance of the wok for which the permit a ensued(Sec
m IHWE READ 11E IIV.IRD0IA RER VFOfAUNDE THE AIO TIE 9CApMDPEWRTTNO
w 3087 Civ C 1 aEr 2 4 urCLFnsowo Mr rEomEAENre woEa THE Los AKa E cwurry woE '
TITLE 1 LS WF R 130 MD FOR911010p T KRW FROM
CpNpERtdNG RAZIADGU9 ! i
Lenders Nan119 AUTEniW9 fEPORTIN(i IND FOR OBUNN3 A PERAR FRpA THE
Taj Lenders Address
O
I catty that I have read the application and state under penalty 1
of penury that the above information is correct I agree to cornply PG FEE PERMIT FEE C 1
with all county ordinances and State laws relating to building 7
constnCton and hereby authonze representatives of tfm Caaay ISSUANCE FEE 3O
loan Ih wve-rtodn property for msPacton purposes
NVESTIGATON FEE TOTAL FEE / 4
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SEE REVERSE FOR EXPLANATORY LANGUAGE