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Home My Public Portal About6119 TEMPLE CITY BLVD_Building__ 76Ag38AftE 8803 12/69 lo I r APPLICATION FOR BUILDINPERM fl COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS Aul COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or tvoe onl CROSS ST. BUILDING + DISTRICT NO. GROUP YPE CESSED BY ADDRESS SO ONS T. LOT NO. LOCK STATISTICAL S.ASSIFICATION S WER MAP CLASS NO. J DWELL:UNITS I3K RC�— TRACT /� ZONE[SP11E1 P I7O NO.OF BLDGS. . G SIZE OF LOT NOW ON LOT CAL USEOF NDITIONS EXISTING BLDG. TE OWNER C ' NO BLDG.SETBACK FROM ADDRESS FRONT PROP.LINE OF (STREET) TYPE 0 STING SETBACK HIGHWAY + YARD = TOTAL CITY / HIGHWAY W FROM C.L. ARCHITECT OR V VTEL. ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TE TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL CONTRACTOR �� I7(', NO. 333 HIGHWAY WIDTH FROM C.L. ADDRESS /Q xa � NO. / 'I' = o CITY �yIULIC. C CLASS CORNER CUTOFF YES ❑ NO Q C. O CONSTRUCTION LENDER C NAME AND BRANCH SEE REVERSE SIDE FOR SPECK,APPROVALS c ADDRESS A o SQ. FT. NO. OF NO. OF NEW //3/ f.•il �f G� ? STORIES FAMILIES USE OF ❑ J ADD STRUCTURE b� LC S c.. ALTER ❑ SIGNATURE Cjr REPAIR[] APPLICANT /��lL A DEMOL ❑ VALUATION S APPROVALS DATE INSPE R'S SIGNATURE P.C. PMT, FOUNDATION: LOCATION FEE S FEE S Q FORMS, MATERIALS M610 0, FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF TX STATE OF -CALIFORNIA I ELATING TO WORKMEN'S COMP ,,ION IIN UR . �J LATH, EXT. SIGNATURE OF _�ejl�i:�+ I�X� �` PERMITTEE HOUSE NUMBER COR- RECT AND POSTED ADDaI_ss FINAL JOHN F. LEWIS. PRI IPAL ST URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH' _ PERMIT VALIDATION CK. N.O. CASH �A�n6 5 9 .09 SEP 2 1 0 9.00- q `d 78489 CEA -,,' .APPLICATION FO BUIL INC PE IT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVLSIC) = JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST r r, I CROSS ST. FOR APPLICANT TO FILL IN I' DISTRICT N GR TYPE . P c Print ort a only) CONST. BUILDING i STATISTICAL CFICATION SEWER MAP - ADDRESS '�Lw//�i(� (�'/y` CLASS NO. DWELL.UNITS BK • PG LOT NO. BLOCK USE ZONE MAP NO. TRACT SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT, �X/ Q NOW ON LOT L. USE OF EXISTING BLDG. IVCAA BLDG.SETBACK FROM TEL 7_1641�a FRONT PROP.L-INEOF —4STREETI. OWNER d.Med.0,04) NO TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS �jij��/e/Y� HIGHWAY WIDTH FROM C.L. _ CITY '�� F�/« el; ABLDG.SETBACK FROM ARCHITECT OR TEL. ENGINEER NO. SIDE PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK .HIGHWAY + "YARD = -TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + = a CONTRACTOR /SSA NO. .,1 LIC. o ADDRESS S �- (/�A»�S NO. �Zs/�� CORNER CUTOFF YES El NO V ❑ CITYAA) lr�Al'321,�L CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS t DESCRIPTION OF WORK NEW ADD -ALTER REPAIR DEMOLISH SQ. FT. NO. OF U.al15 IdJ`/l-. AUIC—TO 6.AL•t- A-f AJ / "^ SIZE STORIES FAMILIES USE OF ..0 Ap.`r_ 7r'0 f7,.*./ 0- BX✓ .rte L X_ e.!`7�w_ I eli - STRUCTURE 4040 AOL /L ., SIGNATURE OF _ APPLICANT VALUATION$ ww APPROVALS D TE IN5P -1-5 SI ATURE P.C. PMT. FOUNDATION: LOCATION FEE$ FEES r FORMS, MATERIALS FRAME: FIRE STOPS, / 1Q I HEREBY ACKNOWLEDGE 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 REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH, INT. TION.OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION IN RANCE. LATH, EXT. SIGNATURE OF. - HOUSE NUMBER COR- PERMITTEE• RECT AND POSTED ADDRESS ;2•5''L- YC1e41?49— .94. FINAL JOHN F. LEWIS. PR NCIPAL'ST URAL ENGINEER PLAN CHECK VALIDATION. CK.. M.D. CASH _ PERNIIT VALIDATION CK. M.O. CASH WORKERS'COMPENSATION DECLARATION • • ^ i' hereby affirm that I have a certificate of consent to self APPLICATION FE"B _ ILDING PERMIT insure, or o certificate of Workers'Compensfion Insurance, ora certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELBUILDING AND�SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING f i F-1FOR APPLICANT TO FILL IN ADDRESS 1 ` 7-e_w - ` C,--, \ N\,. ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS %� �• ,/d LOCALITY �'��1n 'mss (✓�_^c� Dote Applicant CITY e,yja p , ZIP J NEAREST tl GROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 9C� r J,U NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE FSPEC hundred dollars ($100)or less.) TRACT �� BLOCK LOT NO. `—j G� > r TEL. IAL OWNER NO. Q �/ DITIONS I certify that in the performance of the work for which this v v�/1 (f, cve'l O permit is issued, I shall not employ any person in any manner j�/ / DISTRICT GROUP TYPE FIRE PR ESSED B (� so as to become subject to the Workers'Compensation Laws. ADDRESS em 4_ t}(,rC!, /R� p — CONST. ZONE t CITY r'� le Gi i ZIP Y(7U F� �op" '� 122 (. Date Applicant STATISTICAL CLASSIFICATION T. CONDO. ARCHITECT O ) TEL. NOTICE TO APPLICANT: If, after making this Certificate of AR Exemption, you should become subject to the Workers' ENGINEER �� NO. CLASS NO. DWELL. UNITS @. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP 2 with comply with such provisions or this permit shall be ;. deemed revoked. 1; TEL. VALIDATION CONTRACTOR BK. PG, LICENSED CONTRACTORS DECLARATION ,t] LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS (ilJ VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. - �oO Professions Code, and my license is in full force and effect. ;CITY CLASS $ SQ. FT. �) NO.OF } NO.OF CHECK License Number Lic.Class SIZE Yj 49 STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK —j , �/y. NEW ❑ ❑ I am exempt from the licensing requirements as I am a f/ // ADD P 9 9 ` /78-r_ tr' A I r e��[ licensed architect or a registered professional engineerJ� r ALTER ❑ FINAL /✓ acting in my professional capacity (Section 7051, �; 0 J REPAIR DATE ❑ . Business and Professions Code). USE OF � FINAL EXISTING BLDG. oI41 DEMOL ❑ B a Lic.or Reg.No. Date APPLICANT TEL. Y OWNER-BUILDER DECLARATION (PRINT) of// LO. Q KWPII NO. I hereby affirm that I am exempt from the Contractor's License ADDRESS �'�/ /ti%% �r-' I ,J Law fo the following reason (Section 7031.5, Business and r 7 Qr" r 4 " Prof Bions Code): PRESENT /r L"l t J BUILDING T Ali s e I, as owner of the property, or my employees with ADDRESS 7ewk;, -_ wages as their sole compensation,will do the work and LOCALITY G i �r Leif �.� (�� ` < < � � a �' e • the structure is not intended or offered for sale(Section ❑ 7044, Business and Professions Code). MOVING TEL.CONTRACTOR NO.I, as owner of the property,am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS 1 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. 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 PL (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ll 3P C. Fee$ pe )`�C Permit Fee__ Lender's Address Ly I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee` and hereby authorize representatives of this County to enter '. upon the above-mentioned property for inspection purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE •' as Signature of Ap icant or Agent Dote I APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDq G/D ESS00, I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �' or a certificate of Workers'Compensation Insurance,or a certified 6119 TEMPLE CITY BLVD. copy thereof(Sec.3800,Lab.C.) CITY ZIP 1046140 STATE FUND TEMPLE CITY 91780 LOCALITY Policy No. Company SIZE OF LOT NO OF BLDGS.NOW ON LOT ❑ Certified Copy is hereby furnished. I NEAREST CROSS ST. IV Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Data 11-1-95 Applicant RANDOL ROOFING ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE SUSAN MAXWELL 28.6-2881 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) 6119 TEMPLE CITY BLVD.CITY ZIP DISTRICT GROUP ;,,,ONST, FIRE ZONE PROCESSED BY / I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to TEMPLE CITY 91780ARCHITECT OR ENGINEER TEL NO Q �` become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. � DWELL UNITS NOTICE 70 APPLICANT.- If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL ROOFING 288-4040 FRONT comply with such provisions or this permit shall be deemed revoked, ADDRESS LIC.NO P L 529 E. VALLEY BLVD. 451937 SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.6LAg$, P L I hereby affirm that I am licensed underprovisions of Chapter 9PRIRT rA 91776 —iy SEWER MAP } (commencing with Section 7000)of Division 3 of the Business and S . .SI N F STORIES NO.OF FAMILIES a Professions Code,and my license is in full force and effect. NEW ❑ BK PGC ❑ License Number 451937 Lic.Class C-39 DESCRIPTION OF WORK ADD VALUATION COntracCRANDOL ROOFING Date 1-31-96 REROOF HOUSE WITH CLASS A ALTER ❑ $ 3,500.00 HOT BUILT UP ROOFING SYSTEM. REPAIR C ❑ 1 am exempt under Sec. $ F• BARC.for this reason DEMOL ❑ LDMA P/C# W Date: U EXISTING BLDG. IL URM 11 IL Signature PN17 &0�,aITEnss 142 20 APP N7� O. LDMA Perm# 4 p ROOFING $'-4040 TOTAL 1142 o 20 ❑ I, as owner of the property, or my employees with wages as - Z � � their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and 529-E. VALLEY BLVD., SAN GABRIEL FINAL DATE CKEC Professions Code.) J` / G 142 20 WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL Q J �I®hI (({� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY CHIVE LV I, as owner of the property, am exclusively contracting with .2 licensed contractors to construct the AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE project (Section 7044, Business and Professions Code.) ves 11 No El WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING 6 00000001 7/28/9-5OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR L(�[ q GUIDELINES. 1696 1 AN10 I hereby affirm that there is a construction lending agency for ves El NO 11 -.07 W the performance of the work for which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING N 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lender's Name, MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. oLender's Address O QYNER OR AGENT o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 114.90 N with all county 4hehorize and State laws relating to buil ing construction, n p entatives of his C my ISSUANCE FEE co to enter upo th aed p ty for inspec on p oses. 27.30 m INVESTIGATION FEE TOTAL FEE -—o o of Apo' fo 1 SEE REVERSE FOR EXPLANATORY LANGUAGE