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Home My Public Portal About5319 TEMPLE CITY BLVD_Building__ -41 ,e.e•aAutoODli APPLICATION FOR BUILDING PERMIT Z COUNTY OF LOS ANGELES I BUILDINGJ /Cf DEPARTMENT OF COUNTY ENGINEER ADDRESS J RULDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINIMR NEAREST CA ATT D GRIPPIN purr of BUILowO CROSS ST U DISTRICT NO GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN -T K CON O ADDRESS_-BUILDING 5319 Tem le Cit __ _ _STATISTICAL CLASSIFICATION _ LOTNO `See Attached BLOCK CLASS N DWELL UNIT MAP STATE YES O NUMBER C910 / HWY TRACTZONE SPECIAL SIZEOPLOT SO X 150 NOWONLOTS 1 CONDITIONS USE OF Dwe 11 in S 000 FXISTINQ 13L.00 BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH OWNER Grace M• OW PRONT wDDREss 5319 Temple City Blvd SI E TTY Tem le Glt NO P L ARCHITECTOR TEL INSPECTION RECORD ENGINEER NO 8 TE CONTRACTOR NO DD DESCRIPTION OF WORK NEW X ADD ALTER REPAIR DEMOLISH 8 ZE - 360 STI'DOR ES FAMOLIES USE OP STRUCTURE 1 Detached, Garage SIGNATURE OF APPROVALS APPLICANT ADDRESS 8428 Melrose Place FOUNDATION LOCATION DATE INSPECTOR SSIGNATURE FORMS MATERIALS FRAME FIRE STOPS �160G FEE BRACING BOLTS VALUATION $6 001 FURNACE'LOCATION FEE GAS VENT DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AAP- LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM CDUNI'1'.ORLD�4f�CE ON LATH EXT `� 7 STATE LAWS Btl{1D11�2 W^ SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDREB 28 Melr FINAL << CLYDEN DIRLAM PRINCI ALSTRUCTURAL INEER PLAM CE=VALmATIOIf OIL Y O wH P®DUT VALIDATION Olt tl cwaH tCo 6 4L9 OCT PS 1 A 6.0 0 m, WORKERS T�MPENSATION DECLARATION hereby affum�fia I ohq&eff r cert Come natio Int to self APPLICATION FOR BUILDING PERMIT y insure, or a certificate of Workers' Compensation Insurance, •. or a certified copy thereof (Sec 3800, Lab C ) _ „ COUNTY OF LOS ANGELES - - BUILDING AND SAFETY_'. Polo No Company K&OO Certified copy a hereby furnished FOR APPLICANT TO FILL IN Certified copy u filed with a court building inspec- BUILDINGtion dd�eportQCmeIt '�� Dot- 1.1L $/(_ApplIca aTY z* G�Y - ZIP LOCALITY ' NO OF BlDGS / NEAREST CERTIFICATE OF EX ION FROM WORKERS' SIZE OF LOT sd'X J9�. NOW ON LOT CR05,5 ST COMPEN ON INSURANCE _ _ _ _ _ SES"_ - (Thn section need not be completed if the permit is'for one - TRACT BLOCK �LOT NO - a MAP BOOK - - PAGE PARCEL hundred dollars ($100) or leas ) „ _ i OWNER l2�iLt' /�i.•� /YIO'�/�/r7'.:pp.(�J� ZONE ' MAP I certify that m the performance of the work for which this NO permit is issued I shall not employ any person in any manner ADDRESS fj2-,W. am-M iW, _ _ — CONDITIONS so as to become cabled to the Workers'Compensation Lows / O CITY ZIP 9��G rj_ t - _ V Date Applicant ARCHITECT OR TEL/ j,)f— DI GROl1P TYPE FIRE BY � NOTICE TO APPLICANT If, after making this Certificate of ENGINEER //t! ✓/4 n/ Z/Aat ZONE O Exemption, you should become subject to the, Workers' GOLWTi? G L U •"1 V '1_ IST Q l� Compensation provisions of the Labor Code, you must forth _ ADDRESS Y V ✓/ f�J ✓ with comply with such provisions or this permit shall be TEL deemed revoked CONTRACTOR NO STATISTICAL CLASSIFICATION APT CONDO Z LI LICENSED CONTRACTORS DECLARATION CCLASS NO ' DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP ' BIMINI! EW (commencing with Section 7000)of Division 3 of the Busmess LIC 2� _ _ and Professions Code,and my license is in full force and effect Cir - CLASS BK PG ,"r TV^A-�LmATION SO FT2 OF !P— NO OF / CHECK 1 jriC .I t License Number�Lic Class SIZE O STORIES FAMIUES ! ONE P�iO/!b//�/ VACUA 1 �7 .4C1 Contractor Tscne ✓ DESCRIPTION OF WORK NEW $ ` ❑I am exempt under Sec i /� ADO ❑ ' O •� ► 1 ITEM. . B 8P C for this reason ALTER_ ❑ TOTAL 778 - 40 � ' j USE OF REPAIR ❑ _ CHECK -;M,' 40 Date EXISTING BLDG O �' DEmoL ❑ Signature APPLICANT L./m, yv _ I�.BJ �- FINAL - _OWE - :DCI OWNER-BUILDER DECLARATION PRI I hereby aff rm that I am exempt from the Contractor a License _ J.4S7GO0y GL L'6 DATE Law for the following reason (Section 7031 5, Business and '0'� U - FINAL, 0000-0001 10/ 489 Professions Code) ENT El 1, as owner of the o BUILDING , I yrVJ2 1 AM ]' pr party, or my employees wnh ADDRESS / 1 j wagesas their sole compensation,wJl do the work and the structure is not intended or offered for sale(Section LOCALITYpop ACT.i 7044, Busmess ond'Professions Code ) MOVING _ - - TEL __ _ _ , El1, as owner of the property am exclusively contracting CONTRACIOR NO •I t�`' ' t 1 ,V-i3-A7 926'7 with licensed contractors to construct the project (Sec - _ • ' - - a +) 1 ITEMS -- hon 7044 Business and Professions Code ) ADDRESS REQUIRED TOTAL SETBACx FROM I -`, i CONSTRUCTION LENDING AGENCY YAC trvav I t I TOTAL � EI 7Sr I hereby affum that there is a construction lending agency for 7FRONT -.,.'t, ',;•i ; CHECK �6.� the performance of the work for which this permit is issued - '(Sec 3097, Gv C )Lender's Name fe 3 • in Permit Fee • CDMA Ref Yi 0DOD-0001 12/ 6/8? 2 Lender's Address n W.nWe cr g I certify that I have rood'this application and state that the Issuance F r� ✓ LDMA P/C Y , 7309 1 AM1O:26 above information is correct I agree to comply with all County _ loveshgonon Fee , ordinance and State laws relating to building construction, Total FeeAWA • �' TDMA Perm Y < and her au ze repreeemahv of this County to enter J lYR u e abov - ed ape r inspection purposes EER REVERSE FOR E"LANATORY LANGUAGE ^ pn n o �plaant u A ent J ate .. • - - WORKERS' Cgij P NGATION DECLARATION hereby affirm lwt I hods certificate of tnt to self APPLICATION FOR BUILDING PERMIT insure or a certificate of Workers' Compensation ion Insurance, on a certified copy thereof (Sec 3800, Lob C) '- _ - - • COUNTY OF LOS ANGELES ' BUILDING AND SAFETY Policy No Company El Certified Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS El Certified copy is filed with the county budding mspec- BUDDING hon department ADDRESS Lk - CITV ZIP I LOCALITY ,re Applicant OF BLDOS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF Lo NOW ON LOT cRoss S7 - COMPENSATION INSURANCE - ASSESSOR— (This section need not be completed if tBe permit is for one - TRACT BLOCK LOT NO MAP BOOK - - -_ PAGE PARCEL - hundred dollars ($100) or'less ) L OWNS USE ZONE MAP ' I certify that in the Performance of the work for which this INO permit is issued, 1 shall not employ any Person in any manner ADDRESS CONI TIONS tw as to become subject to the Worker Compenwtion Lows O CITYAleZI Date Applicant ARCH) TELCc NOTICE TO APPLICANT If offer making this Certificate of ENGINEER NO _ DISTRICT G P � T'[,//r ARE E PROCESSm BV O Exemption youshould become subject to the Workers o7s y _ Compensation provisions of the Labor Code, you must forth- ADDRESS 1 a with comply with such provisions or this Permit shall be TELSTATISTICAL CLASSIFICATION APT W N deemed revoked CONTRACTOR NO z LICENSED CONTRACTORS DECLARATION LIC CLASS NO - DWELL UNfTS_ I here affirm that I am licensed under ADDRESS �d SEWER MAP by provision of Chapter9 (commencing with Section 7000)of Division 3 of the Business LIC and Professions Cod _e,and my license is in full force and effect CITE C1ASS SK PG VALIDATION 50FT NO OF NO OF CHECK License Number LIC Class SIZE STORIES FAMILIES ONE VALUATION Contractor DotDESCRIPTION OF WORK NEW El $ ' e ' ❑1 am exempt under Sec I •` ADD ❑ _ ► - ALTER_❑ B 8P C for this reason REPAIR ❑ Date L1SE ISTINGOF _ IXDEfJ,OI ❑ Signature APPLIG°'NT;IDG -- - TEL - FINAL - OWNER-BUILDER DECLARATION (PRINT) NO DA I hereby affirm that 1 am exempt from the Controcior's License - - - - - 1 Low for the following reason (Section 7031 5 Business and ADDRESS FINA r _ Professions Code) , _ _ PRESENT _ _ _ _ __ By El 1, as owner of the o BUILDING + {CCT.i property, or my employees with _ ADDRESS wages cs their sole compensation,will do the work and M1 •- - - _ - 3307 - - 60.511 LOCALITY the structure is not intended or offered for sole(Section ► - , 1 ITEM 7044, Business and Professions Code ) MOVING - - TEL ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO ' Ac with licensed contractors to construct the project (Sec- TOTAL 60 _50 hon 7044 Business and Professions Code ) ADDRESS CONSTRUCTION LENDING AGENCY SPT YARD HWY AL Lac FROM W I T - I hereby affirm that there is a construction lending agency for FRONT __ - _ •�I DTHI the performance of the work for which this permit is issued - P L " (Sec 3D97, Civ C) SIDE , Lender's Name P L 0�000f-0001 12/ 6/89 LD Ref It - 7.11/0 1 Q9:30Lender a Address PC Fee f Perme Fee r - 0 I certify that I have read this application and state that the Inuanae /0 .5 jQ LDMA P/C 0 pool above information is correct I agree to comply with all County Inveatigotion Fee ordinances d State laws relafi to build construction, Total Fes I LDMA Perm p and here uthon r sen t es oft unty to enter _ above- r than Purposes ' t SEE RRVERM FOR EXPLANATORY LANGUAGE, i / Sipnotvra of Applicant a Agent Dais r r )