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Home My Public Portal About5526 TEMPLE CITY BLVD_Building__ TeAeBBA CENB08 B-e3 APPLICATION FOR BUILDING PERMIT��- "LJ COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS B=ING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUI T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE ESBED BY FOR APPLICANT TO FIIJ IN ,/�) �/ CONST �� ADDRESS DD BUILD' �J�J �J(/ /= �� STATISTICAL CLASSIFICATION SE K R MAP CLASS NO DWELL UNITS LOT NO 3 3 BLOCK J✓ 0O WATER CERTIFICATE NOT REQUIRED RECEIVED TRACT aA/ MAP p ^ HlcHwA ' D F SLOGS I NO .�Z'(9 """' I STATE MAJOR ECON LOCAL SIZE OF LOT QQ G7 WON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG Yo // //��.. f OWNERr .-4y-^ .[ ,9 NEo 4J BUILDING YARD HWY REET NAME EXIST ADDRESS/ Gt/' �ITECT /^ Lv � SFRONTARCK 1 r WIDTH ENGINEER O (/ t-^ NO SIDE �" P L ADDRESS CONTRACTOR G GG TEL w n C ADDRESS -t—/ �/V �� / DESCRIPTION OF WORK V C .wt .lil d N pADn ,/D ALTER REPAIR DEMOLISH y Z SIZE SO FTtS/26 00 STORIES F MIILIES NO OF 2 NO OFV / USE OF 4 STRUCT RE 4 L S A SIGNATUREVOVA APPLICANT _ yQ VALUATION S 1 `^ n e l 3 DO APPROVALS AT ( INSPECTOR E YIGM U PCPMT FEE S Sa FEES 13Z FOFORMSI MATERIALS' FRAME FIRE STOPS I HEREBY ACKNOWLEDOE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS / AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGIILATINO GAS VENT DUCTS L� WILDING CONSTRUCTION 1 CERTIFY THAT IN OOINO TXE WORK y AUTHORTLED HEREBY I WILL NOT EMPLOY ANY PEIISON IN VIOLA LATH INT 7 TION OF THE LABOR CODE OF THE STATE OI CA L11 RNIA RELAT _ INO TOWOgKME PENe CO ATION INSURANC r LATH EXT 4 7 SIGNATURE HOUSE NUMBER COR PERMITTEE RECT AND POSTED .� ADDRESS FINAL JOHN F LEWIS PRINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION CK No UEH PERMIT VALIDATION CK M O CASH LpLo9405'$VWllft p7 68.50e , jc9 7 7 4 I1ne2 2 1 D 13 7.00-�" '�d3u2�tm/ � 1 WORKERS COMPENSATION DECLARATION . - hereby affirm that have a cert)mpe of consent to ,elf APPLICATION FOR BUILDING PERMIT Insure'or a certificate of Workers Companstion Insurance or . a certified copy thereof (Sec 3800 Lob C �•' �L' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified co o hereby furnished BUILDING ❑ Py y FOR APPLICANT TO FILL IN ADDRESS Mdl L ❑ Certified copy Is filed with the county building mspec BUILDING �-y`` " /+ tion department ADDRESS .�rG//3 r �l CC_- ��/ �z"� LOCAUTY NEAREST Date Applicant CIT FM L 1ZIP - 17 d CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERSG /[.� OF BLDGS ASSESSOR SIZE OF LOT G ' + COMPENSATION INSURANCE X -7 NOW ON LOT D MAP BOOK PAGE PARCEL 1(This section need not be completed if the permit Is for one USE ZONE MAP hundred dollars ($100)or less ) TRACT - BLOCK LOT NO - NO �0 Y TEL �F[T i SPECIAL y I certify that In the performance of the work for which this OWNER—/0/0 s ( NO �4if "' CONDITIONS G permit Is Issued, I shall not employ any person In any manner �(7 ) DISTRICT GROUP TYPE FIRE PROCESSED BY V so as to become subject to the Workers Comp sat n Laws ADDRESS l/)��/�U+(f�Lr� L �� p/ Q V� CONST �.y^ ZONE O // /�� / OTrT-/UJ L/te 1, T zIP O i o 6 7 JV—_ -}'Date $fypplicanY7' L "--"r �� > STATISTICAL CLASSIFICATION APT CONDO G NOTICE TO APPLICANT If after making this Certificate of ARCHITECT ENGINEER OR �� /— NO(/ / CLASS NODWEIL UNITS_ Exemption you should become subject to the Workers N Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be y(I deemed revoked I CONTRACTOR TEFL BK C/'PG TO VALIDATION LICENSED CONTRACTORS DECLARATION to LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO - VALUATION (commencing with Section 7000)of Division 3 of the Business and LICO Professions Code and my license Is in full force and effect CITY CLASS f 1 0d SO FT�a QD NO OF NO OF CHECK License Number Llc Class SIZE STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW 1❑ $ - ❑ am exempt from the licensing requirements as 1 am a _ _ ,4' h ADD licensed architect or a registered professional engineer ALTER ❑ FINAL acting In my professional capacity (Section 7051, DATE REPAIR ❑ Business and Professions Code) - USE OF :IN IN _ EXISTING BLDG �f'Z'OL ❑ B q_! T^r-+•� Llc Or Reg No Date APPLICANT TEL T -'-- OWNER BUILDER DECLARATION PRINT -- NO n I hereby affirm that I am exempt from the Contractor s License '/ rj 9-(� 7 Low for the following reason (Section 7031 5 Business and ADDRESS - - Professions Code) I I - PRESENT ❑ - - _ - I as owner of the property, or my employeeBUILDING with ADDRESS wages as their sole compensation will do the work and the structure Is not Intended or offered for sole(Section LOCALITY - 7044 Business and Professions Code) MOVING - TEL :9 014 8 3 A I as owner of the property am exclusively contracting - CONTRACTOR NO tt with licensed contractors to construct the project (Sec 'gDDRESS - _ tion 7044 Businessiness and Professions Code) 2 - 36 &50 REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH hereby affirm that there is a construction lending agency for FRONT • 3;6 85 0 the performance of the work for which this permit is issued I P L - (Sac 3097 Civ C ) I SIDE. - _ _ _ r Q 7 -Fj PL Lenders Name 8 P C Fee$ 0 ermit Fee J>el, d % Lender s Address W I certify that I have read this application and state that the Nuance Fee above Information is correct I agree to comply with all CountyInvrsngonon Fee / +1y $ ordinances and State laws relating to building constructionr Tolaj Fre 6 N - and hereby authorize representotiv sof this County to ente u on t bo+e mentioned e y for inspection purposes 1 SEEIREVERSE FOR EXPLANATORY LANGUAGE Signature of ppLmnt or Agent Dote / t e �s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9?01 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL OSOB 1210020029 PHONE (626) 285-0488 EXT ILEGAL ID - NO OF CONST BUILDING ADDRESS ON PILE .- SQ FT _ STORIES TYPE 5526 TEMPLE CITY SL STRUCTURE 200 TEMP CA 917802529 ASSESSOR INFORMATION NUMBER _ NEAREST CROSS STREET LIVE OAK 8588-009-010 t _ �' THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY Cl I - ITENANT EXIST BLDG USE SWIMM USE ZONE TISSUED ON PROCESSED BY IEXIST OCC GRP 110/02/12 SR IOFANC PEIWII! TEL NO BLIX3S NOW ON LOT VALUATION FINAL S/ � p(]ATE FINAL BY CODE 15526 TEMPLE CITY BL 1 0 1 SO 1 /;? - TEMP 917802529 FEES PAID IDESCRIPTION OF WORK FILO IN POOL Y DOM AFUUNT IFEE DESCRIPTION QUANTIT1 IAPPLICANT TEL NO IWARD GEORGE (626) 442-3718- AA BLDG PERMIT ISSUANCE 27 80 110628 ROSEGLEN AVE 102 DEMOLITION INSPECTN 163 50 ISPECIAL CONDITIONS 1 TEMPLE CITY CA 91780 . 1 TOTAL FEES 191 30 (RESTRICTED USE AREA 1 3 CONTRACTOR TEL NO 1APPROVALS DATE INSPECTOR SIGNATURE WARD GEORGE (626) 442-3718- 1 1 110628 ROSEGLEN AVENUE LIC NO PEDESTRIAN PROTECTION TEMPLE CITY CA 91780 526197 C21 SE R DISCONNECTION ARCHITECT OR ENGINEER TEL NO - _ iABM DON PRIVATE DIS POSAL LIC NO UNDERGRND STRUCT RENOVALj AND SOIL RECOMPACTION IMP NO SEWER MAP BOOR PAGE FIRE ZONE CMP \ 1147H269 00 1 0 INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 0 NO 24 SCHOOL WSTHIN HAZARDOUS LAIR QUALITY 1000 FEET MATERIALS NO NO NO I I I i i REPORT ID DPR261 ROUTE TO BSO508