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HomeMy Public PortalAbout5752 TEMPLE CITY BLVD_Building__ M1 , ►Y11.WA-CE y903•1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT.OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY' ^ JOHN A. LAMBIE, COUNTY ENQINEER NEAREST / WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DIST 1CT NO. GROUP TYPE ESSED BY FOR APPLICANT TO FILL IN coNSTy BUILDING ® k7tt713 Q� STATISTICAL CLASSIFICATION EWER MAP ADDRESS � � 0 +* �/ CLASS.NO. DWELL.UNITS �K/! PG LOT NO. I r p �A BLOCK WATER NOT REQUIRED RECEIVED TRACT r�p �. CERTIFICATE: MAP HIGHWAY STATE MAJOR ECO LOCAL NO.OF BLDGS. NO. (CIRCLE) SIZE OF LOT a~I NOW ON LOT -gr— USE ZONE SPECIAL USE OF ,.f� h CONDITIONS EXISTING BLDG. W+ Y�G�. TEL. ,; ' OWNER NO. Q BUILDINGYARD HWY EXIST. e SETBACK ST EET NA E. WIDTH _ADDRESS /' I ItRE ' FRONT q�� ARCHITECT OR TEL. P.L. ENGINEER NO. SIDE- ADDRESS P.L. d t TEL. r p IN§PECTIO_N RECORD O CONTRACTOR NO. .12 s 1r r j V ADDRESS °�' E. A.43A••s 6, !,I. j /� / r.% _L: ! l✓� / p' DESCRIPTION OF WORK 7 �� 3 ���Y�.�'��i �%'l/�i 10 ti W NEW AD ALTER REPAIR DEMOLISH r' Z SQ.FT.• .. NO.OF OF' IZE STORIES', FAMILIES USE OF STRUCTURE / y SIGNATURE OF "F APPLICANT �'' - f VALUATION$ �pur� or APPROVALS 1DAT INSPECTOR'S SIGNATURE P.C. PMTm FORMSMATERIALS FO ! LOCATION FEE $ FEE �'"�r'' FEE FRAME:-FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS �,•+J x�r� '},`:,{!'/vr'i� ANDSN. TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATIO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS .,~ J } n r BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING.THE WORK r AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN CF VIOLA- LATH,INT. Ll ` ���. •,9 f( _ TION OF THE LABOR0O .OF THE STATE OCALIFORNIA RELAT- ING TO WORKMEN'S C PENSATION INSUR E. Y• I r, r ' ®. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE_ ' RECT-AND POSTED ADDRESS FINAL >!:"�: .r-i"�•�+•='•a�-.',r..,�l CLYDE N. DIRLAM, PRINCIPAL STR' URAL'ENGINEER. PLAN CHECK VALIDATION CK, M.D. CASH PERMIT VALIDATION CK,. M.O. CASH DS-3 8.48 SM SETS APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND.SAFETY Y v COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER NO.OF BLDG. ORD:NO. DISTRIC'T_NO. PLAN CK. NO. PERMIT NO. PLANS SETBACK LINE r� LI„r.•� r�y� FIRE APPROVED ZONE BY DATE RECEIVED BY /DATE OF APPL. !DATE ISSUED JI ZONE / �13PY�ROVED DATE APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY tC BUILDING NAME _ ADDRESS wy n U W ADDRESS LOCALITY ~a NEAREST J V W CITY CROSS ST. .fLaw�-�ir.✓ C STATE EL' NAME LICENSE NO. .. NO. � v Z MAIL �..' F NAME 11 , 11� ADDRESS TEL ADDRESS '/jU'' , /l O CITY %�/ G NO. E zCITY I HEREBY ACKNOWLEDGE THAT 1 •HAVE READ THIS O APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICEUSE--NO. !, NO. _ �/ AND'STATE LAWS REGULATING BUILDING CONSTRUCTION. Z LQT NO52 p SIZE OF LOT�OXI SIGNATURE OF O OWNER "+ 8 6 Y NO. OF SLOGS. AUTHORIZED AGT.�- ­&) BLOCK NOW ON LOTy'�. J m TRACT CORRECTIONS W USE OF SLOGS. NOW ON LOT DESCRIPTION OF WORK USE BUILDIDI NG y/ J NEW TYPE [ GROUP r O NO.OF NO.OF !� ALTERATION ROOMS !ham FAMILIES ADDITION SIZE X/1/ REPAIR STORIES / MOVING WALL COVERING DEMOLISH ROOF COVERINGr C $ P.C.'e / FEE FINAL APPROVAL INSPECTOR'S 'VALUATION /DQ FEE = DATE O y NAME —1/ TEMPLE VT Y 76A639A CE#803 2-63 APPLICATION .FOR BUILDING PER COUNTY OF LOS ANGELES BUILDING Aj DEPARTMENT OF COUNTY-ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST / f WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE SSED BY F R APPLICANT TO FILL IN � � CONST. �' STATISTICAL CLASSIFICATION S ER MAP CLASS. NO. DWELL.UNITS K 11,6G Y,-.,,4 S. LOCK WATER CERTIFICATE: NOT REQUIRED RECEIVED TRACT MAP �j �� HIGHWAY STATE MAJO ECON ,LOCAL NO.OF SLOGS. � NO. �/!! (CIRCLE) SIZE OF LOT jo NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL. OWNERy NO. BUILDING EXIST. �. SETBACK YARD HWY TR T NAME WIDTH ADD.RESS( ,3 0• FRONT I Il ARCHITECT OR TE P• L•. ENGINEER SIpE P. L. y ADDRESS O I TEL. U CONTRACTOR NO. j ADDRESS OO DESCRIPTION OF WORK uVi I a NEW ADD. ALTER REPAIR DEMOLISH Z SQ.FT. NO.OF NO. OF -•-- - SIZE STORIES FAMILIES USE OF STRUCTURE �1 SIGNATURE OF APPLICANT VALUATION 5 APPROVALS f-)ATE INSPECTOR' SIGIjAT E FOUNDATION: LOCATION F E 5 FEE 5 FORMS, MATERIALS )U FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS 9 \ C AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, .0 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOIN THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PER N IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF GAL RNIA RELAT- ING TO WORKMEN'S COMPENSATIO INSURAN• LATH,EXT. i SIGNATURE F HOUSE NUMBER COR- PERMITTEE RECT AND POSTED P _.�•��' ADDRESS FINAL 'I JOHN F. LEWIS. PRINCIPAL STRUCTURAL.ENG ._R PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. cnsH r �..V. • _ . :.o.s. 9 :0� JM17 1 -6.0.0- 0 WORKERS'COMPENSATION DECLARATION APPLICAT)QN FOR BUILDING PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, ur.o certified copy thereof(Sec. 380, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUIL El ADDDINr tJ , Certified copy is hereby furnished: FOR APPLICANT TO FILL IN ADDREss� s���iC G� (iC, ❑ Certified copy is filed with the county building inspec- BUILDING l 0 se Bit V1ID tion department. r� ft Date Applicant CIN � ZIP LOCAUi�J OF R, ,tom NEART CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT aSU NOTW ON L S ROSS . Ave— COMPENSATION INSURANCE / ASSESSOR (This section need not be completed if the permit is for one TRACT sp BLOCK LOT NO. � MAP BOOK �� PAGEO/ PARCELOL hundred dollars ($100)or less.) TEL OWNER %/a x -0 4Jd 1/AI NO.-V6-$i'06 USE ZONE NOP d I certify that in the performance of the work for which this fin[ e%� SPECIAL a permit is issued, I shall not employ any person in any manner ADDRESS ,�'jr.�..• Q cit ` v CONDITIONS so as to become subject to the Workers'Compensation Laws. O CITY ZIP CA /78-0 U Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO BY ix NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO• O Exemption, you should become subject to the Workers' o �✓ CON ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall bee, ) O•NSTATISTICAL CLASSIFICATION APT. Como. Z deemed revoked. CONTRACTOR LC�ltLIG CLASS NO. �1 DWELL. UNITS LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lic. Class SIZE I STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $�ioa-� e- ADD IC�/ll ► Elam exempt under Sec. Pop ALTER :© B.&P.C. for this reason REPAIR • $ ' Date: USE OF EXISTING BLDG. DEMOL Signature APPLICANT TEL, E": g OWNER-BUILDER DECLARATION (PRINT) IAJt1 L//I�NO. ��8�06 FINAL I hereby affirm that I am exempt from the Contractor's License DATE C Law for the following reason (Section 7031.5, Business and ADDRESS ���� Mewk cxg Aw✓al. FINAL �F'• Professions Code): PRESENT Y By z tic BUILDING El . a I, as owner of the property, or my employees with ADDRESS 6"f.Va wages as their sole compensation,will do the work and 1; the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. ;l I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct.the project (Sec- tion 7044, Business and Professions Code.) ADDRESS ••l.?.-. -�. REQUIRED TOTAL SETBACK FROM EXIgT. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - I hereby affirm that there is a construction lending agency for FRONT - the performance of the work for which this permit is issued P.L. (Sec.3097, Civ. C.). SIDE- • P.L. i' { ":�Q Lender's Name 3 P.C. Fee$ A Permit Fee fit . LDMA Ref. # : -- Lender's Address - ,I certify that I have read this application and state that the Issuance Fee �� LDMA P/C# , - - ' above information is correct.I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee U) Perm. # __. `-`,` and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. • GfMd� 'O a. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ppl,c or Agent ate