HomeMy Public PortalAbout5430 TEMPLE CITY BLVD_Building__ i
7APPLICATION F BUILDIN PE MIT
Tasel0 Neoa a-pe
COONTY OF LOS ANGELES BUILDING r
DEPARTMENT OF COUNTY ENGINEER ApDR ESS
AWL
BUILDING AND SAFETY DIVLSION LOCALITY C
/JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKIN9,SUPT OF BUILDING CROSS ST r
DI9TR T O GFI I TYPE H9lHD er
FOR APPLICANT TO FILL IN CONST
ISI LDINQ STATISTICAL CLASSIFICATION S WER MAP
ADDRE9 n CLASS NO DWELL UNI T9 BK P
LOT Z ♦ COCK USE ZON MAP
TRACT' NO
SPECIAL
01 BLDO•
SIZE OF LOT KOWMOOK LOT
USE OF
BEDS •Ere,LCN raoM
T.
IRDNT PROP LI MS 0■ TI[ tI
OWN RSTING �BLDG.JNO TYPE 01 EXISTING DETDAC HIGHWAY YARD = TOTAL
ADDRESS a MCC LL
CITY Q }
ARCHITECT OR TEL SIDO ROPSETLIK IRON _
ENGINEER NO DID! PROP LI M[ 01 STREET
TYPE 01 WIDTHEXISTMO /ROM C HIGHWAY } YARD = TOTAL
ADDRESS HIGHWAY WIDTK FROM C L �
TEL + = O
CONTRACTOR 9AJ NO V
LIC
ADDRESSXi BE NO CORNER CUTOFF YES NO O
LIC /
CITY CL SEE REV11= miliAlPIftY1BRpVALS IUL
DESCRIPTION OF WORK a
Z
E ADD ALTER REPAIR DEMOLISH No}e PRnrllis for curb, guffer, sidewalk. and driveway approach
SO PT �r V NO OF NO OF • • owls G e en ou e a
SIZE STORIES IAM
USE OP r m fel n Order to avc;
STRUCTURE a lengthy delay Survey E Deugn Work fakes fume and Is not start d
910 NA TUBE OF
Hal
APPLICANT J , 1 !/. C e♦ ,Ln� / /
VALUATIONS '� F �rI
A APPRO VA L9 ATH IVDP[CTOR'D SIGNPTLM
P C V PMT Q-'(/ POU NDATION, LOCATION
PEES PEES FORMS, MATERIALS 7/9
FRAME, FIRE STOPS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT
AND "ATE THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY FURNACE LOCATION J M FVVV-
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING QA5 VENT DUCT
•UILDINO CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT f/O
TION OF THE LABOR CODC OF THE STAT[ Or CALIFORNIA R[LAT
ING TO WORKMEN 5COMKN ATION INSURANCE LATH EXT 3
SIGNATURE HOUSE NUMBER COR-
PERMITTEE _ R NDP S
ADDRES4 '2)r [ o FINAL - ^U
cK M O CASH zy
JOHN F LEWIS PRINCIPAL ST C RAL ENGINEER
PLAN CHECK VALIDATION
PERMIT VALIDATIONCK MO CASH
X 2 1 2 9'Q JUN 1 23 D 4 7 5 0 s Q
Ln(o2 7 8 9G Ju,117 1 D 95.00—
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES. _ BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION , FOR APPLICANT TO FLL IN - BUIMNG ADORE
ss
I hereby affirm that I hake a certificate of consent to self Insure � EULDI G/i�Q� � % �D
or a certificate of ftrkers Compensation Insurance or a certified Y 1 b RI _
copy thereof(Sec 3800 Lab C) le (7714 zp9 / 74--10 LOCA
Policy No Company SIZE OF LIDT NO OF SLOGS NOW ON LOT F /
11Certified copy Is hereby furnished EST CROSS ST
❑ Certified Copy Is filed with the county building Inspection TRACT BLOCK LOT NO
department _ I USE ZONE MAP No
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL V
f SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' °J%J� JF+.I+oZ�S02�O G-
COMPENSATION INSURANCE tt�� ^ / iY'//QQ'' WITHIN ,0013 FT of scRaoL? YES No
ddlarssE100ion��)or1e t be completed d the Permit I9 for one hundred
ADDRESS
ES' /`p /'�1 R/I DISTRICT GROUP Tv CONST FEE ZONE PROCESSED 13Y_
I cortily,
issue that h the t employ an of the wok for which this permit C / P51 7eO
IS issued shell not empty any person at an, manner iso es to
become subject to the Workers Compensation Laws ARCHITECIr OR ENGINEER fTEL NO -
STATISDCAL FICATION APT CONDO
Date Applicant ADDRESS - CLASS NO DWELL UNrTS
NOTICE -TO APPLICANT If after making this Certificate ofREQUIRED TOTAL SETBADK FROM E)aST
Exemption you should become sublet[ to the Workers CONTRACTOR - TEL NO SET BACK
YARD HWV PROP UNE WIDTH
Campensahon provisions of the Labor Code you must forthwith VL/
FROM
comply with such pfovlSbn4 or this permit shall be deemed revoked ADDRESS LIC NO PL
LICENSED CONTRACTORS DECLARATIONSIDE
CITY - DC CLASS PL
I hereby affirm that I am licensed underprovotonm of Chapter g
SEWER MAP
Division with Section 7000)of Divisn 3 of the Business and SO FT SIZE NO OF STORIES 110 OF FAMILIES `
, }
Professors Code and my license is in full faNEW BK PG
and effect 0-
License,
License Number Lic Class DE RIPTION OF vORK ADD ❑ VALUATION O
Contractor Date Iy a ALTER ❑ $ 00 00 8
❑ 1 am exempt under Sec -1 D REPAIR ❑ $
B BPC for this reason 3O 19a CDI,— s e DEMOL ❑ CJ
LOMA P/C s W
Date USE OF EXISTING BLDG URM ❑
J$gnature APPLICANT(PALMI _ TEL NO LDMA Perm♦ CT:f
4d I as a ner of the property or my employees with wages as =
their sole compensation unit do the work and the structure Is ADDRESS _ 4 � lro.
not intended or offered for sale (Section 7044 Business and FINAL DATE Q ITEMS�y� .AV
85
Pr0169610r1a Code) MILL THE APPLGNL OR FUTURE aU101W OGGIPrNi WNIXE A HAZMppU9 MATER41 I Z �, q� �� 1 iTLI h7
❑ I as Owner of the property am exclusively contrachnlg With OH A MIXTURE C !,IiA A HAI/3iDIXl9 MATERIAI.Eq TO OR GPEATER TW I TIE A� y C
AM(xMa a CFED CN TIE IIAZAfiDtll3 MAIERML411FOfeAATKp!GUIDE? FINAL BY /T(O�TA 158 Ce8
licensed contractorsProles o CC6VUC1 the protect ($eCTKlnI 7044 Cl W11 y(T�yR ,158.85
Business and Professore Code)
MTLL A P Wlip USE OF TME BUDCCXI H0 BY THE MCQFICT OR F T el SOOT-1
OCCUMHT OUNUTE A PERKr FOR C DISTRICT
( qty IXi a PERM ION FROM TIE 90Un1 /�E�A�I�
CONSTRUCTION LENDING AGENCY T Uws lww_rTY MANADEMENT osmcr tsuaMOl saE FERunEuuc GECKusr TOR owe .00
I hereby affirm that there is a construction lending agency, for yFs❑ WE] '
the performance of the wok for which this permit Is Issued(Sec 0000-0001 10/ 3/95
m IHAVEREID TIEHERSWOl91MTEPoAle lFORIMT EFt T-1E
TIE 9CJS CoWrY CTME
Lend CN C) CHECKLIST IINUER20 SE MY 1,13 220 100 IMER THE LOS ANGELES CDUMV CooE
TIRE Z S FtEP R 2W aE FOIA 210100 TIWOIgH}RO TI CONCERNNa HAZ.NOOIH '
Larder S fdaR10 IMIERNLa REPpTrlq ANp FOR ORPINWD A PEFi.PT FROM THE 9CAicM0 2607 1 PM I Si17
o Larders Address '
O oMen w�xr
I certify that I have read the application and state under penalty `
of perjury that the above Information Is Correct I agree t0 Comply PC FEE PERMIT FEE
vnth all county ordinances and State laws relating to buildng IL-11 15-5-
construct and hereby authorize representatives of the County ISSUANCE FEE 30 -
sn^,er IUo;the above, property for inspect on r
INVESTIGATION FEE TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE