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