HomeMy Public PortalAbout5349 TEMPLE CITY BLVD_Building__ t ,
.APPLICATION FOR BUILDING PERMIT
• COUNTY OF LOB ANGELES BUILDING AND SAFETY
'WORKER'S COMPENSATION DECLARATION FON APPLICANT TO FILL IN BUILOING ADDRESS _
I hereby affirm that I have a certiticete of concent to cell Irsun BUIIDING�DORFBB L G/
or a certificate of Mbrken Cannpenastion InatIrenee,or a cerlif ed 6 v�.
copy Oared(SSC 38M Lab C) cm ZIP
Policy NoI a 7? a'7L cnmpany�'�•�Fi rt�� 8o LO�Iry �t��l�G E ee/
—� SIZE OF LOT NO of NOW ON Lor ST
❑ Certified copy a hereby fumrahed NEAREST t
ROSSI
JECarkNed Copy Is filed With the eDRn bulId Ina cllon TRACT BLOC( LOT NO
department/��� USE ZONE MAP
Data J=Lai. Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' TEL NO YES NO
COMPENSATION INSURANCE '� WTTHIN 100D FT OF SCHOOL?
ADDRESS
(This section need not be completed If the permit le for one hundred �`�/JfOL E / DIaR1K%T GROUP TYPE CONST IRE ZONE PROCESSED By
dollars($10D)a km) �l /1 _ ���
1 oxVH that In the Performance,of the work for which this permit cm f li/ zIP / y�0 �i��� K'
Is ladled, I "I not employ any person In airy manner eo M to ARCHITECT OR ENGINEER TEL NO v,
become"act to tie WDlken'Compensatlon Laws srAT19'TIGLL CLASBIFlSATION APr CONDO
Date Applicant ADDRESS CLAAR r/0 �2L/ �L UNITS
NOTICE TO APPLICANT R, after making this Certificate of REOU IRED TOTAL SETBACK PROM EXIST
Exemption, you should become subject to the Workers CONTRACTOR TEL NO SETBACK YARD HM PROP UNE WIDTH
Compensation provisions of the Labor Code you must forthwith 45 ,
Canpty with such provisions or this permit shell be deemed revoked ADDRESS NO FROrvr
38 SIDE a
LICENSED CONTRACTORS DECLARATION C" LIC CyAs4� P L
1 hereby attkm that I am licensed aider provisions of Chapter B AS I 80 SIZE r 0 . STORES NO OF FAMIllE4 SEWER MAP
(commerwng wfth Section AIM)a DMWw 3 of the Business and NEW ❑ BK PG Dole. o
Professions Code and my license s In full Mme and effect
Lcxca,Number Lk; ams `—39 IPTION K 4mr _ c L y( ADD ❑ rALUA nn Q-0—
Contract"
'p u,
Contractor L Dee 1�T_S6'4 T rLs ALTER ❑ $ V Y� z
4.
❑ I am exempt under Seo 1 REPAIR
B SPC for this reason here, S her A DEMOL ❑ LOMA PIC e
Date rp'usE s t A 3 CA URM ❑
SignatureTEL No TDMA Penn• 1
❑ I, as owner of the property or my employees with wages es n ere O r ..
their sole oompa on,Will do the work and the structure is ,I ,I.
not intended or offered for sale (Section M44 Business anti 7 ,V N /✓IQ I k o S TB 0 3317 1:
PrOtea.lone Code)
YA LL TIE AP PDCANT OR FimARE 9ALO W D 000.0wNT IMIOIE A 1MSMIDO V 4 MAi6NL
❑ I, a. owner of the property am exclusively contracting with �E"A�raE>rP�o�rl rla ,nDp•^^W w�a�mrore1OiAT°AwN°a"ioe ►dAL � 1 ITEMS
licensed contractors to constr l Ve project (section 7014, Yea❑ NoJ/
TOTAL J EJJ
Business and ProfessionsCode)
WILL TEE INTBOm t19e Of TME BUlDINO aV TME APPDGVl1 DII RIMiE eU4Le10
CONSTRUCTION LENDING AGENCY occuAwraeoulREAPvurtwRmNsrnucr,oNae Enos,cawN moMTMEeovrN (_HEC�T 93.6-..
cxwer An olwnY MNIAoorEHr iamucr IeDADRo)IEE realrrTelo xaEaaur
I hereby affirm that there Is a canatructiat lending IJIi
p agency for m❑ ra
the performer"of the work for which this permit Is lasted(Sec I NAVE HEAD TIE HAZARDOUS MRTewEa IRR MION WM AND TIE SCAoie
9087 CN C) iBtlQT7e1D
"71AwJyII�u'woc!nmaawrgAF6vwfr E We m
Lender,Name 100 MIQCCNC
Ri0YTH6 ecAao VWI.I-CIU01 10/I3/90
Lender.Address `��`
I certify that I have read this applividim and able that the aboe 1 AM 8 �4
Information Is correct I agree to comply with all county PC FEE PERMIT FEE g29,063
ondirumcee and Stale Laws relating to bulWaq construction,and ISSUANCE FEE
etrlhorbe 1eP Pe eMRIN prof this upon 4
h [Qse�inspectim purposes�o INVESTIGATION TION FEE TOTAL FEE . /
•Y��ahrrv...u.. "or (�
SEE REVERSE FON 1911PLANATORT I ANG11111 ,
COUNTY OF IAS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC FORKS 9701 LAS TUNAS ALTERATION/REOAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91700 BL 0508 1503160007
PHONE (626( 285-0488 EXT
LEGAL ID NO OF CONST BUILDING ADDRESS
ON FILE I SQ FT STORIES TYPE 5349 TEMPLE CITY BL
(STRUCTURE V-B TEMP CA 917803149
(ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET OLIVE
8590-006-010 THOMAS PAGE 597 GRID A4 LOCALITY TEMPLE CITY CAI
I I
TENANT (EXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY
IEXIST OCC GRP 103/16/15 SR
(OWNER TEL NO BLDGS NOW ON IAT VALUATION (FINAL DATF, FI};AL BY CODE
LY XUAN H,VAN G (626) 285-7047- 2 000 1
15349 TEMPLE CITY BL
ITEMP 917803149 FEES PAID DESCRIPTION OF FORK
I IREPAIR DAMAGID WALL CAUSED Y CAR RUN-AWAY REFRAME WALL I
I (FEE DESCRIPTION QUANTITY DOM AMOUNT IREPAIR DRYWALL AND REPAIR STUCCO
(APPLICANT TEL NO
ISAME AS OWNER - AN BLDG PERMIT ISSUANCE 27 80 1
AB STATE GREEN BLDG FEE 2000 00 VAL 1 00 (SPECIAL CONDITIONS
IAC STRONG MOTION RESID 2000 00 VAI, 0 50
ID2 PERMIT W/O EN-HC 2000 00 VAL 82 20
I TOTAL FEES 111 50 I
ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1
ISAME AS OWNER -
LIC NO LOCATION AND SETBACKS
I SOILS ENGINEER APPROVAL I I I
ARCH ITECT OR ENGINEER TEL NO (FOUNDATION/TRENCH FORMS
LIC NO 1SLAB/UNDER FLOOR 1
1RAISED FLOOR FRAMING
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CHP I UNDERFLOOR INSULATION
3 001 1
I ` FLOOR SHEATHING
IND OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I
1 NO 21 1 1ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS (SHEAR PANELS I
(AIR QUALITY 1000 FEET MATERIALS I
NO NO NO 1 FRAME INSPECTION
1FIRE SPRINKLER HANGERS (
I I I
I I INSULATION/WEATHER STRIP( I
I I
(INTERIOR LATH/DRYWALL
I I
(EXTERIOR LATH / n`
1 (RATED FIAOR/CEIL ASSEM �(
RATED WALL ASSEMBLIES
RATED 9HAFT9/OPENINGS
I I
II T-BAR CEILINGS I I I
LAT DRAINAGE I I
IREPORT ID DPR261 ROUTE TO BS0508 I I I
I I I I I I