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Home My Public Portal About5843 TEMPLE CITY BLVD_Building__ 088-3 25M SETA 0-45 --- 1 - - DEPARTMENT OF BUILDING AND SAFETY AP R PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE-USE ONLY BUILDING � DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS I ��z !1 M C e I• �5 I l _3 '(\ 7 LOCALITY RECTRY Y DATE OF APPL. DATE ISSUED NEAREST / �'.�J M�Zr j) 7 .- � �r'- Cl� CROSS ST. aC A BUILDING / / - OWNER 6 7 f 92 (r lrf5 (A) ADDRESS ADDRESS ' 'L V4 ..e LOCALITY NEAREST ` L.�\ TEL. CROSS ST. CITY In. NO. FIRE I NO.OF TYPE � GROUP ARCHITECT OR _ TEL ® ZONE �. I PLANS �� I ENGINEER NO. BLDG. ORD. NO. ADDRESS �'� "�" SETBACK LINE r TEL. APPROVED CONTRACTOR 1 .\. . NO. �„"p f,�,3 BY DATE Y p t USE ,vl._3 APPROVED ADDRESS �JC7��.'►ZiU �.1� ZON 1'E_' ,� BY DATE LEL DE CRIIPPTION I LOT NO. I BLOCK CORRECTIONS TRACT NO. OF OLD09. SIZE OF LOT I NOW ON LOT USE OF I NO.OF I NO.•OF EXISTING BLDG. FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION . O N REPAIR MOVING r i DEMOLISH 1 G Sq. FT. NO.OF i SIZE ,D. ROOMS STORIES r WALL ROOF COVERING �q�Q,a u� COVERING USE OF NEW BUILDING e. //�l_//IN� wtl1�►a �i':L�-tai �� APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, BRACING, BOLTS SIGNATURE OF OWNER t LATH, INT.1 AUTHORIZED AGT ` I LATH, EXT.: $ 1/ P. 0.6 PLASTER, INT. FEE PLASTER, EXT. _ /7 VALUATION �'� f •� C i' d ) FEE �"° FINAL '68S-9 88M SERO 6-46 �- DEPARTMENT OF BUILDING AND SAFETY , APPLICATION-FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER 6 U I L FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING ^� DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS If /Yl�w �y >r5 Q Q 1 LOCALITY RE EIVED BY DATE CF APPL. DATE ISSUED NEAREST (fi r 11—1– 4.,ee, CROSS ST. BUILDING OWNER ADDRESSMAIL LOCALITY w ADDRESS 1 A /� \ NEAREST TE CITY .,le �Gq_ NO. CRO98 8T. rJC ARCHITECT OR TEL. ZONE s I PLANB�` I TYP I GROUP ENGINEER NO. SETBACK ORD. NO. ADDRESS SETBACK LINE �+� TEI�� /`R1 Q APPROVED _CONTRACTOR wI/1�'�l�NO / U BY DATE � - �� `�„� USE `'� APPROVED ADDRESS i ,� G�'1�7 � ZONE � �+ BY DATE LEGAL �j DESCRIPTION/ ITLOT NO. 97-7 I BLOCK CORRECTIONS TRACT :�-.T� 7� I NO. OF BLDTB. SIZE OF LOT NOW ON LOT USE OF �-�-�--- I NO.OF ,�I�NO. OFo e-A°� EXISTING BLDG. �.?t-.Q--�. 'i FAMILICS ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION r ate, O Y IBN �e14Ai O i_ REPAIR MOVING DEMOL Sq. FT. NO.CF ` 3 to M D SIZE ROOMS \ STORIES I' r Cor WALL COVERING ( COVERING\ / USE OF NEW \ \ bLl w BUILDING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORME, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING, BOLTS OWNER LATH, INT.: AUTHORIZED AGS LATH, EXT.: P. C.B PLASTERP INT. FEE PLASTER, EXT. _ VALUATION V®'� FEE ZB.+, �Q FINAL Z> �� : APPLICATIO _,FOR BUILDING PERMIT COUNTY.OF LOS ANGELES I BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN rBUILDING ADDRESS ' I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 8 'YI_'l�L� /T L, CA or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sea 380,Lab.C.) �L E C/ /7gQ MYTY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. '70X /7's -101- NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT • BLOCK LOT NO. . department. AID. 1.5%1 1 626 VY2 USE ZONE MAP NO. 0' � ASSESSOR MAP BOOK PGE PARCEL A plic Vs8 9'0 2. _ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER _ L NO. COMPENSATION INSURANCE C+ r a F a �'I T 2�Z1 7� WITHIN laoo Fr.OF SCHOOL? YES No ADDRESS (This section need not be completed if the permit is for one hundred9703/ LAS TU/1�/3 S D R• DISTRICT --GROUP GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY _ .ZIP I certify that in the performance of the work for which this permit LC / _A-' d a v .? is Issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEERS f / TEL NO. e� me •J become subject to the Workers'Compensation Laws. TA7T C/p raC� It1� G'f y-��jOO STATISTICAL C FIpATION ss APT CONDO Date Applicant ADDRESS C D LL UN NOTICE TO APPLICANT., If, after makingthis Certificate Of �C Al. � S '( AN(rE �' REQUIRED TOTAL SETBACK FROM EXIST Exemption, I CONTRACTOR T NO. _ p you Should become subject o the Workers' SET BACK YARD HWY PROP LINE WIDTH Compensation provisions Of the Labor Code,you must forthwith �+C+ eoNs�u�T�uN Cv• � 7'+`7'9J9G comply with such provisions or this permit shall be deemed'revoked. ADDRESS UC.NO. FRONT PL CRA 13 SIDE 3e6(08! LICENSED CONTRACTORS DECLARATION �y/� LIC.CLASS I hereby affirm that I am licensed under provisions of Chapter 9 ` '^ ' a r ic-$ -�Z A SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF 8TORES NO.OF FAMILIES 1Ir Professions Code,and my license is in full force and effect. . , — — NEW [19 BK, PG License Number Lia Class ADD DESCRIPTION OF WORK VALUATION pool. LU ❑ Contractor Date 30 & ACE 2 M 6- LOT e!Q $ ALTER ❑ _� ❑ 11 REPAIR I am exempt-Under Sec. $ BARC.for this reasonDEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm N Z ❑ I,as owner of•the property, or my employees with wages as O their sole compensation,will do the work and the structure is ADDRESS.. FINAL DATE �:)` !_I',;-: <$'.. /i-2 not intended or offered for sale (Section 7044, Business and ', � 5 �!. Professions Code.) 'WRLTHEAPPLICANTORFLITURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a ,I3,_I Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?, FINAL 3• t licensed contractors to construct the project.(Section 7044, 1 IYEB,❑ NO❑ A i Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING 1 OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST : PI`l, FOR GUIDELINES. I hereby affirm that there Is a construction lending agency for YES❑ NO❑ y the performance of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,Civ.C.). PERMITTING CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ! ' • COUNTYm CODE,T .E2,CHAPTER 2.20SECTIONS22Q100THROUGH220.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lenders Address amaoRaovrr o° 1 certify that I have read this application and state that the above PC.FEE g Information Is correct. I agree to comply with all county PERMIT FEE I dN ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE F ; the ab mentioned property j r I pec j n purposes. INVESTIGATION FEE OTAL FEE 81 reroroAppOmn xApwa °aro i jSEE R _E FOR EXPLANATORY LANGUAGE I I � WORKERS' COMPENSATION DECLARATION ' hereby affirm that I have certificate of consent to Self APPLICATION F R �B U I L D I N G PERMIT J insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, La C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY \ &_&X�QCompony ctnee, Pol� No. 7 Certified copy is hereby furnished.�=/—rf� FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING /gyp tion department. ADDRESS d0 G Date Applicant CITY ZIP LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT ! CROSS ST. COMPENSATION INSURANCE ASSESSOR 7 f� (This section need not be completed if the permit is for one TRACT e• BLOCK LOT NO. MAP BOOK ! PAGE PARCEL ,V% hundred dollars ($100)or less.) TEL, OWNER USE ZONE MAP NO. I certify that in the performance of the work for which thisG+ O/ �o off SPECIAL y permit is issued, I shall not employ any person in any manner ADDRESS 7 G 4 ' CONDITIONS CL soas to become subject to the Workers'Compensation Laws. p O CITY ZIP 70O U Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: if, after making this Certificate of ENGINEER NCONST. ZONE Exemption, you should become subject to the Workers' U Compensation provisions of the Labor Code, you must forth- ADDRESS �� '.L LU a- with comply with such provisions or this permit shall be // TFL• STATISTICAL CLASSIFICATION APT. coNDO. N deemed revoked. CONTRACTO //C l/'V �• �,,// Z_ LICENSED CONTRACTORS DECLARATION a CLASS NO. G-5 UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS !/, o� NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY - e,4 BK /,— pG �r f VALIDATION SQ. FT. NO. OF NO. OF CHECK p License Number Lic. Class SIZE STORIES FAMILIES ONE f Q VALUATION Contractor DESCRI ON OF WORK NEW ❑ $ /V/ Y.- ElI am exempt under Sep .ADD ❑ ► ALTE ❑ BAP.C. for this reason er EPAIR ❑ $ Date: US F TING BLDG. DEMOL Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. 7 Y 9/ I hereby affirm that I am exempt from the Contractor's License DATE !! Law for the following reason (Section 7031.5, Business and ADDRESS FINAL _ Professions Code): PRESENT By NO F; 'C s. BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY t•,- the structure is not intended or offered for sale(Section _�3 lilt–Li:ltl E• i�i��ir?'�i 7044, Business and Professions Code.) MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. `r"�ty s All with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT-BACK YARD HWY TOTAL SETBACK IE FROM 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. Lender's Name 3 Lender's Address P.C. Fee$ Permit FeePoo LDMA Ref. # 1 certify that I have read this application and state that the Issuance Feoowo� tDA P/C# 3 above information is correct.I agree to comply with.all County Investigation-Fee ordinances and State laws relating to building construction, Fee LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date