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HomeMy Public PortalAbout6204 TEMPLE CITY BLVD_Building__ a f s APPLICATION FOWBUILDING PERMIT COUNTY OF LA8 ANGELES BUILDING AND SAFETY BUILDIN FOR APPLICANT TO FILL IN G ADDRESS WORKER'S COMPENSATION DECLARATION � D I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS rD Lr or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITv ZIP LO ALITY Policy No. Company SIZE OF L NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. g 71 I NEAREST CROSS4T ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL 25-' ®! O CD-10 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O NER A/�U TEL NO. COMPENSATION INSURANCE I (� (- WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred DRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) A It 1U C 1 certify that in the performance of the work for which this permit ZIP (-78 0 ��j� is issued, I shall not employ any person in any manner so as to (/ J become bj Ct t0 the Workers'C m en atiOn S ARCHIT T OR ENGINE TEL NO. o P v,L STATISTICAL CL SIFICATION APT CONDO Date �1 Applicant ) ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after ing this Certificate REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY UC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.IF FAMILIES I + NEW ❑ BK PG Professions Code,and my license is in full force and effect. � License Number Lic.Class DESCRIPTION OF WORK r ADD ❑ VALUATION Contractor Date tit Fx 5 n N oy ALTER ❑J3MTCC $ C ❑ 1 am exempt under Sec. � a � REPAIR ❑ $ C B.BP.C.for this reason 0J CJI qA ,/Q U� 1�•e s, DEMOL 11LDMA P/C# L Date: USE OF EXI ING BLDG. URM ❑ Signature ICANT(PRINT) TE NO. LDMA Perm# I S �8 a 5- Z ( _>_- I, as owner of the property, or my employees with wages as L (� O :°r their sole compensation, will do the work and the structure is ADDRESS Q ` not intended or offered for sale (Section 7044, Business and to FINAL DATE Professions Code.) WILL THE APPLICANT OR URE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL L Zb6 0 ❑ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES /I a FINAL BY > '�'•.'-T licensed contractors to construct the project (Section 7044, YES 11 NO ( "�'' `..L Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING j;33 j03 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR T�G�i+= GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ "` a-5 cv the performance of the work for which this permit is issued(Sec. I �- '' " '��f O� I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ 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 CHECK ' g Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. rf'iAN(sE 0 Lender's Address OWNER OR AGENT 0 o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.0 FEE PERMIT FEE d P 1 Y 9 PY a with all county ordinances and State laws relating to building ' construction, and hereby authorize representatives of this County ISSUANCE FEE r 10:2C. aI � ►/m o enter up povs entione pro erty for inspecti In p�p�os� INVESTIGATION FEE T es. / ` �J Z ro TOTAL FEE �� � -uro of a A¢nl SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION of coent to insure,or afcertif certificate of Worke s'tificate Compensat on insuran elf Al—'?L I CAIr 9%N F OR` n U I L�I N I T or a certified copy thereof(Sec. 3800, Lab. C.) ®LD61lITY OF L®$ ANGELES BaD9L®Oj�IQ'v AND SAFETY N00010484199�7 Western Employers Policy o. ompany ,.-_._.......:s••<...__: Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 6204 Temple City Blvd. ® Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 6204 Temple Cit Blvd. LOCALITY Temple Cit 1/13/86 Lytle Roofing Company NEAREST Dore Applicant Y g P Y CITY ZIP cRoss sr. Wnadriiff CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE d SIZE OF LOT NOW ON LOT 1 MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one y USE ONE MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. TEL, i 1 SPECIAL > I certify that in the performance of the work for which this OWNER NO. CONDITIONS IL permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSf D BY U so as to become subject to the Workers'Compensation Laws. ADDRESS 6210 Temple Cit Blvd. ��V v /y CONST. / ZONE ad Date Applicant CITY ZIP STATISTICAL CLASSIFICATION V �i✓, APT. JC0r*DO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. U ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' 1. N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Y with comply with such provisions or this permit shall be TEL. deemed revoked. _ BK. PG, VALIDATION CONTRACTOR L tle Roof NO. 71 LICENSED CONTRACTORS DECLARATION LIC, ` I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 2948 E. Walnut St. NO.1 8630 �VALLIIATION (commencing with Section 7000)of Division 3 of the Business and LIC. 6 QQ0�(Professions Code,and my license is in full force and effect. CITY Pa CLASS s 186303 C39 SIZE STORIES 2 FAMILLIIES CONE License Number Lic.Clasp Contractor Lytle Roofing Date 1/13/86 . DESCRIPTION OF WORK re roof NEW ❑ $ ADD ❑ :. ❑I am exempt under Sec. G F Glass CAp R-1 — REPAIR DATIE V A239 1,6A B.BP.C. for this reason �, 0 0 ate: USE OF DEMOL ❑ FIIdA o o `' EXISTING BLDG. houseFI F�Signatur APPLICANT TEL OW -Bu 16-4 U} ER DECLARAT PRINT Lytle Roofing CO. No. 792-5171 00087387- JRN I hereby affirm that I am exempt from the ontractor's License 2948 E. Walnut St. Pasadena Law for the following reason (Section 7031.5, Business and ADDRESS Q 1,2 4=8 6 Professions Code): PRESENT ❑ I, as owner of the property, or my employees with ADDRESSSS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I, 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). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH D 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. tSec. 3097, Civ. C.). SIDE P.L. o Lender's Name Lender's Address P.C.Fee$ Permit Fee 76.88 xI 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, and hereby authorize representative f this County to enter Total Fee upon th bove-mentio pert r Lnspectio Pur oses. �, AtI,j Q SEE REVERSE FOR EXPLANATORY LANGUAGE ignature o pp scan or Ag Date ®s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0011280064 PHONE: (626) 285-0488 EXT: L NO. OF CONST BUILDING DRESS: ON FILE SQ. FT STORIES TYPE 6204 TEMPLE CITY SL STRUCTURE: 0 TEMP CA 917801749 ASSESSOR INFORMATION NUMB R: NEAREST CROSS STREET: LONGDEN 5385-016-020 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY EXISTBLDG USE: R SID USE 70-FE-- ISSUED 0 : PROCESSED-BY: E P RES 0 : EXIST OCC GRP: 11/28/00 UT 05/28/01 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL PATE F CODE: BAGHDADLIAN;HOURIG (626) 286-2852- 1 0 , 6204 TEMPLE CITY BL -112-11c ) �- TEMP 917801749 TEES PAID SCRI ON OF WO&V DEMOLISH RESIDENCE- - 600 SQ. T. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: 0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 02 DEMOLITION INSPECTN 163.50 SPECIAL CONDITIONS: TOTAL FEES 191.25 CONTRACTOR: TEL. NO: / J APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO r�rl ✓? \\ EDESTRIAN PROTECTION SEWER DISCONNECTION 2� ARCHITECT OR NGI EER: TE 0: + "'I r l� ABANDON PRIVATE DISPOSALuu LIC. NO: / NDERGRND STRUCT REMOVAL AND SOIL RECOMPACTION MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: U rI f , �153H269 L1Ll�'I -� J�1������11 `�\ N0. OF FAMILIES: DWELLING UNITS: A T COND: STAT C ASS• -- ---- NO 23V _ - I —�- — SCHOOL HAZARDOUS " I r Y 1, AIR QUALITY: 10000No N0 FEET MATEERIALS �` a .�•�li "y' .;�i Service REPORT ID: DPR261 ROUTE TO: BS0508