HomeMy Public PortalAbout5949 TEMPLE CITY BLVD_Building__ RT I12DING AND SAFETY APPLICATION FOR PERMIT
LINTY OF LOS ANGELES I
Ay(Q� ®' ,. ® '
Fr, IEF ENGINEER 21 LJT,
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
II ` ` '7DISTRICT NO. PLAN CK.NO. PERMIT NO.
BUILD
ADD EISS. 7 4I Qva ,v,i—l��
LOCALITY ! e",I za/e j RECEIVED BY DRESTATE OFAPPL.�j DATE ISSUECjD�C�
CROSS ST. • d' A f t`Ct f't- "�'t I r'p �• " 'Z � !" _ Yu ! O
OWNER A L II
► ADDRESS r + J u tV
ADDRESS CJ 4J MAILt �. to "-It LOCALITY t
NRT
CROSS ST. , f Q ,r F-
CITY ti■:• ' pt NO � NO
FIRE NO.OF TYPEGROUP
ARCHITECT OR�. TEL /fll ZONE PLANS .--/�-
ENGINEER ir' l^ NO. f/ if il
_BL'DG. ORD.NO.
ADDRESS -SETBACK LINE 1 e-. N, s1 5
APPROVEQTEL ',r
CONTRACTOR 1^ N137p/f :-BY y�UL�`Z'� DWTE/) ��C
USE- ,,p APPROVED--f
'
ADDRESS ZONE(, BY,
',� DATE J:3
��'d
LEGAL //�� a} CORRECTIONS
DESCRIPTION-- LOT NO. O4 I BLOCK !.
TRACT ,0/ No.Or SLOG
SIZE OF LOT A 7, /�� ` I NOW ON LOTS f f_.41144,UBEOF NO.OF' No OF
� � s•�j ����
EX BT NG BLDG. P: FAM Es ROOMS
/'-/.-/7 fiF
DESCRIPTION OF WORK
NEW ALTERATION ADDITION ,�'D,�//.f•.�(r<-
�� A
REPAIR MOVING
Bq.FT. l NO.OF Z
SIZE ROOMB �`r STORIES
WALL }l.�w 0 C ROOF p�6Y - �r��J /� / � A r
COVERING /. S �` I. COVERING
USE OF NEW
BUILDING
•�/ /Y!-�•tr f`. � d� rifir.fl r.G�r/
!•' r 4a..7� i/' it
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT IN3�ECTOR DATE
-" 7� ��
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDA7Pk: LOCATION
i4TER1AL5 y'v!�"/.✓�✓�ljk � o'fF/�
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS
,r FRAME: FIRE STOPS,
SIGNATURE OF /`" �/ BRACING,BOLTS
O_ 1 r r/C � f w���
PERMITTEE'rAJ�n`l_'
r-v '� t• LATH, INT.
AUTHORIZED AOT- LATH, EXT.
76AS38A 9-43
DBS-3 513M SETH $ P.0 $ // �0 �, PLASTER,I.NT.•.
FEE Jam+ PLASTER,EXT.
VALUATION FEE ~ "`� FINAL
WORKERS'COMPENSATION DECLARATION
1
6 I hereby affirm that I have a certificate of consent to self
�iirisure,�o1-o+��ertificate.of Workers'Compensation Insurance, APPLICATION FOR BUILDING PERMIT
or&.periified copy thereof(Sec. 31300, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
❑• Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING �/ /'/
ADDRESS
1:1Certified copy is filed with the county building inspec- BUILDING ..r
tion department. I ADDRESS , L;
Date Applicant CITY ZIP LOCALITY g/ t
CERTIFICATE OF EXEMPTION FROM WORKERS' OF LOT NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE NOW ON LOT CROSS ST.
,(This section need not'be completed if the permit is for one ASSESSOR
hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP.BOOK,. • PAGE PARCEL
! TEL. USE,ZONE MAP /
I certify that'in the performance of the work for which this OWNER NO.
Co
permit is issued, I shall not em p /s�� SPECIAL ~
so ds o become su^ubject to t W rkers'. m.p i ion ws: ADDRESS li CONDITIONS
Date 2' Applicant CITY ZIP L. Q
ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O
NOTICE TO APPLICANT: If, after making this Certificate:of 4-- —
ENGINEER NO. \�YO v CONST. ZONE
. Exemption;'you should become subject to the Workers' .,J V
Compensation provisions of the'Labor Code,.you must forth- ADDRESS �— V w
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFKATION APT. rNDO. N
deemed revoked. I CONTRACTOR . NO. zic,
;
LICENSED CONTRACTORS DECLARATIONLIC r CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.V O
(commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP
Professions Code, and my License is in full force and effect: CITY L CLASSBK. L/ PG. L__ VALIDATION
SQ.FT. NO.OF NO.OF CHECK
License N r Lic.Class SIZE STORIES FAMILIES ONE
' ,'VALUATION '•�$3,S 2 A •,
Contracto ! Date DESCRIPTION OF WORK NEW ❑
• ADD ❑ $ # o o,o,,,..2 3
... pill.
I exempt under Sec. 1 ALTER ❑ .( o o37.50 '
B.BP.0 is'reation REPAIR ❑ $
iUSE OF I; 0 0 037,505
" at EXISTING BLDG. DEMOL ❑ 1'
APPLICANT TEL.
Signet FINAL Q
. OW R- •D A ON PRINT f3 NO. DAT I .l.•1 2'''$7
I hereby affirm that I am exempt from the.Contractor's License,
Low for the following reason (Section 7031.5, Business and ADDRESS pl
Professions Code): �PR B
BUILDING.
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work arid-
the structure is not intended or offered for sale(Sectiori .LOCALITY
7044, Business and Professions Code). MOVING TEL.
1, as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and.Professions Code); >. $4 2 3 A
REQUIRED TOTAL SETBACK FROM' "+
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH 1 S # 0.0 0 0 oil
I hereby affirm that there is a construction lending agency-for FRONT 1' , �• + i
the performance of the work for which this permit is issued P.L. \ -I,,-;0 4 0.5 0
(Sec. 3097, Civ. C.). SIDE 4 �.
P.L. o 0 04Q pU •
Lender's Name ( �,2 4
IQ .�..;'' 'LDMA Ref.#
o
Lender's
Fee
1 P.C.Fee$ t Permit Fee . / ��vJ
I certify that l havefread tfiis-applicationrand state that the Issuance Fee l -� L/ LDMA P/C#
R dbove information Is.corre&l,cgree to-comply with-all County Investigation Fee �/
°q ordinances•and St s r616-ting�to building coragtruction, Total Pee f LDMA Perm.#
a ere of this County to enter-_
abov nti ropert for.nsppe r��;,�jTrr��,/pf//�rp`o`ses`• �// , , ,
' ' •• o � SEE REVERSE FOR EXPLANATORY-LANGUAGE
Signature of Applicant or Agent Date