HomeMy Public PortalAbout6217-6219 TEMPLE CITY BLVD_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
F'L
G 'z Z s w� �� 3G(/Y� COUNTY OF LOS ANGELES
S DEPARTMENT OF COUNTY ENGINEER
-_ C L r/= zI P (.?Sry BUILDING AND SAFETY DIVISION
NO.OF BLDGS. , BUILDINGSIZEOF LOT aC( C7 NOW ON LOT ADDRESS &;X aL ,
TRACT / 79 BLOCK LOT NO. LOCALITY a�
TEL. NEAREST f-�
OWNER (/ 7f NO. re,'� ROSS ST.
ASSESSOR
ADDRESS 014- 6'& _ V, MAP BOOK PAGE PARCEL
r�
OFDISTRICT P GROUTYPE FIRE PROCESSED BY
CITY c ZIP r/J � Ste. D p � CONST Z�
ARCHITECT OR TEL. V
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO.` J
f/ DWELL.UN ITS F BK9&G
CONTRACTOR fe-4i VL 6 NEOL. USE ZONE MAP
LIC. NO. -:)-v 013
ADDRESS NO. SPECIAL
CITY LIC. CONDITIONS
CONSTRUCTION LENDER CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
ADDRESS CITY HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. FT yY NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE /S STORIES FAMILIES ONE
DESCRIPTION OF WORK L NEW ❑ c
ADD BLDG.SETBACK FROM
SIDE PROP.LINE OF (STREET) m
ALTE ❑ HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING I~
Cj
REPAIR[] SIDE PROP. LINE HIGHWAY WIDTH OW.
USE OF h
EXISTING BLDG. DEMOL ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES ❑ NO C]VALUATION:$ - � 1
I HEREBY ACKNOWLEDGE THAT i HAVE R D THIS APPLICATION ;3 -�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURANCE.
SIGNATURE OF
PERMITTEE
ADDRESS �cg
FINAL / IBY
CITY_T_ C,-,L. 415: NOL• � DATE 3 ��'-7(7
MAKE CHECKS PAYABLE E'TO: FEFEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN•CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.o. ASH
2 5 5 rFR 19 1 D 1 5.0 0 A:;d
76AG36A C6#803 5/74
0?,,p
DZPAHT14ENT OF BUILDING AND SAFETY ArruLUAILLM t Vtc rzx m A
COUNTY OF LOS ANGELES BUILDING
WM. J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
1,15-)2-a / DISTRICT NO. PLAN OK.NO. PERMIT NO. -
BUILDING
ADDRESS ( 1 5-)2-a
r
LOCALITY /
rt. _�E ' t -tt t r RECEIVED BY DATE OF APPL. DATE ISSUED
'-"
NEAREST C�
A141 /- '�'
C O B ./ti tn....."r _g it r _._., r ��h I'
�rOf
U 13UILDINB
1... k .g
OWNER !-'1�`fit' o.rJ / ADDRESS
MAIL f tj `r LOCALI r w C. �1
ADDRESS t f. C 7 L t .t _f
T NEAREST ,,��+•
1 r TEL. DROSS ST. J r O
t : NO. �"� FIRE NO.air TYPE ,/ GROUP
ARCHITECT OR TEL. ZONE �� PLANS b� I
ENGINEER NO.
BLOB. %YLr t l D7'
SETBACK LINE v`"
A D APPROVED
DATE
O
CONTRACTR G 'rert+�fr NOL USE PPROVED
ZONE( � " BY DATE
ADDRESS
/ CORRECTIONS
LEGAL
DESCRIPTION LOT Nd- `� BLOCK
TRACT N/ { 4/ 11;
NO.OF SLOGS. /
SIZE OF LOT f?S~ )l i A l) NOW ON LOT
USE OF NO.v�� X F MIOL E6 ROOM
E 18TIN HL
DESCRIPTION OF WORK 2- /i✓S-T fr' %r���''-�
NEW ALTERATION ADdIT10N O
REPAIR MOVING DEMOLISH
2
NO.OF3 ' D
gtZE l.7 ROOMS gTORIEB r
WALL ROOF
OOVICRING COVERING
Bu LDINa
I HEREBY AOKNDWLEDBE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATION?LOCATIONINSPECTOR DATE
r s�
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAMES FIRE STOPS. � , LL
lr {+r• �: B12ACING,BOLTS r
SIGNATURE OF'Y �j 5 fr t ,•�r
PERMITTE' ` — LATH, INT.
. , r' a
AUTHORIZED ABT ... LATH, EXT.
7GA63BA-3 7-49 $ P.C. PLASTER,INT. .
FEE PLASTER,EXT. _
< S N p
VALUATION FEE �^ FINAL I t v Nr 3 - "�
WORKERS' COMPENSATION DECLARATION
R herebf affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance, APPLICATION F OR M I L D I N G PERMIT
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. �� Company 7�
Z?"Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 7 y
PY Y ADDRESS ��—:Z�
❑ Certified copy is filed with the county building inspec- BUILDING �3or
tion department. ADDRESS "�/ —J ,c?L�
Date—z—�`�—Applicant CITY 0 t ZIP 9 1 �b LOCALITY -
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FR WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSU NCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL.
OWNER / NO, `j ��i USE ZONE MAP
I certify that in the performance of the work for which this �, NO.
i
permit is issued, I shall not employ any person in any manner ADDRESS —/ ,C. a&`/Q � ,� SPECIAL }a
CONDITIONS
so as to become subject to the Workers'Compensation Laws. OS
CITY I ZIP �/ 7$>lJ U
Date Applicant ARCHITECT OR TEL. a
DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE
Exemption, you should become subject to the Workers' �7 r / iU
Compensation provisions of the Labor Code, you must forth- ADDRESS <. �'fi� Of-5J V 3 a-
with comply with such provisions or this permit shall be TEL. Z
deemed revoked. CONTRACTOR — NO.AS�—v66 p STATISTICAL CLASSIFICATION APT. CONDO. Z
/ �: '
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. ? DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 4 6116 F40. )7 7 ti
(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. CIN agferk R vw CLASS C3 9 BK PG. VALIDATION
SQ. FT. p NO. OF NO.OF CHECK
License Number 3 7 7 Lic. Class C 3 SIZE/49 STORIES FAMILIES ONE
� VALUATION
Contractor WXJOT"c"?/Trt' Date 6 a 9-?A DESCRIPTION OF WORK %lr`[�0,*X �f10 . NEW ❑ $ LU ION
❑I am exempt under Sec. /�f��( R A, � ADD ❑ ►
r ALTER ❑
B.BP.C. for this reason - d a T,, /` REPAIR ❑ $
te: US
EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL. FINAL
OWNER- ER DECLARATION (PRINT) NO.
I hereby affirm that I a xempt from the Contractor's License DATE
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL
Professions Code): PRESENT
ElY Y I, as owner of theproperty, or m to with BUILDING
ADDRESS
wages as their sole compensation,willemPees 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.)
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL PROP SETBACK 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
P.C. Fee$ Permit Fee d '� ��/ LD.MA Ref. #
Lender's Address ,J ,
I certify that I have read this application and state that the Issuance Fee �7' LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
^
ordinances and State laws relating to building construction, Total Fee LD"Perm. #
and hereby authorize representatives of this County to enter
up^on9 above-m coned prope ty for inspection purposes.
Q/61 SEE REVERSE FOR EXPLANATORY LANGUAGE s'.
Sign of Applicant or Agent Date :,
4 APPLICATION FOR 13UILDING PERMIT �
COUNTY OF LOS ANGELES BUILDING-AND SAFETY
WORKER'S COMPENSATION DECLARATION I FOR APPLICANT TO FILL IN BUILD G ADDRESS.
I hereby affirm that I have a certificate of consent to self insure, eU LDING ADDRE $�.
or a certificate of;Workers'Compensation Insurance,or a certified I CITY /, ( C` L.v ZIP •
copy thereof(Sec.3800,Lab.C.) _ L LOCALITY
Policy No. Company's/RT,(��dk�n SI E OF LOT O.OF BLDGS.NOW ON LOT
' led copy is hereby furnished. NEAREST CROSS ST
❑ Certified copy is filed with the county building spectlon I TRACT BLOCK LOT NO.
• department. ',
USEZONE MAPNO.
ASSESSOR MAP BOOK PAGE PARCEL
Date Applicant J'f` SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION OM WORKERS' NER TEL NO. .YES NO
COMPENSATION.INSURANCE I M.0,91mgWITHIN 1000 FT.OF SCHOOL?
ADDRESS—
(This
D R(This aectiomneed not be completed If the permit Is for one hundred DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
dollars MOO)or less.) ( � zIP
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 t0 ARCHITECT OR ENGINEER TEL. O.
become subject to the Workers'COmpensati0n Laws. STATISTICAL CLAAISSIIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you Should become subject to the -Workers' CONTRACTOR TEL .O. SETBACK 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. ADDRESSLI O. PL
}
LICENSED CONTRACTORS DECLARATION CI LI LASS• SIDE
C
I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v
SO. .S NO. STORES.- NO.OF FAMILIES _
(commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG
Professions Code,and my license is in full force and effect.
RI ION OF WORK VALUATION , a
License Number i 7 7 Lia.Class ��� I ADD ❑
'Contractor ti07'`Juh�o/%s1A�A `-�v� I DOO. ®"O v�
. �� I / �aaggAel ALTER. ❑ �
❑
lam exempt under Sea REPAIR $!
B.BP.C.for this reason DEMOL ❑ LDMA P/C#
Date. USE OF EXISTING BLDG. URM, ❑
Signature APPLICANT(PAINT) TEL NO.
LDMA Perm p
❑ 1,as owner of the p rty, or my employees with wages as Z ;; •-.
their sole compensation,will do the-work and the structure is ADDRESS
not Intended or offered for saleSection 7044, Business and FINAL DATE ~
Professions Code.) ( �. `'"''j "$
W ILLTHE APPLICANT OR FUTURE BUILDING OCCU PANT HANDLE A HAZARDOUS MATERIAL
❑ I, 83 owner Of the property, em estclusivelY Contrectin with ' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I I'I rE'7'S
• g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B a
licensed Contractors to construct the project.(Section 7044, -YES No ' r• 8 623
Business and Professions Code.)
,_;,
WILL THE INTENDED USE OF THEBUILDING BY THE APPLICANT OR FUTURE BUILDING r- —�.w
OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �• irI:•.ri4 81.3 oa"i.:=
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST
FOR GUIDELINES. , 34- 4 ��,)t,?•�� +12
\ C A I%
I hereby affirm that there-is a construction lending agency for i YES❑ NO❑
the performance of the work for which this permit is issued(Sea
� I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD �
3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES
COUNTY CODE,TTTLEZ CHAPTER 2.20 SECTIONS 220.100THROUGH 220.140 CONCERNING ' r—I;"`: {"!'"` f'D='/92
Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING APERMIT F'ROMTHE SCAQMD. =1 . I I C?tl�• 6/2' �'
3
q Q
.
Lender'sAddress. I OMMORAGOff 1: •` •L�i-` r 1 �,4'=.�441
°o I certify that I have read this application and state that the above ' P.C. EE PERMIT FEE
information Is correct. I agree to comply with all county ;
ordinances and State laws relating to building construction,and
hereby authorize repress Ives of this County to enter upon ISSUANCE FEE ,'J' f
l the a s entioned pro y for inspectn purposes. S
% 7J
i
INVESTIGATION FEE TOTAL FEE / '
ftffi%C6fAPMCGMa MW (O
SEE REVERSE FOR EXPLANATORY LANGUAGE-
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1103090057
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I
ON FILE I SQ. FT STORIES TYPE 1 6219 TEMPLE CITY BL 1
ISTRUCTURE: V-B I TEMP CA 917801750 1
ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: 1
5385-011-007 I I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I I I I
TENANT: EXIST BLDG USE: RESID USE ZONE: R-3 [ISSUED ON: PROCESSED BY: I
(EXIST OCC GRP: 103/09/11 SR [
[OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: [
IJAMES & MARIE LONG (909) 985-2188- 1 3,000 1 1
11557 UPLAND HILLS DR I I I
(UPLAND, CA I FEES PAID ]DESCRIPTION OF WORK ]
I I ]REPLACE WINDOW SASH 5 WINDOWS ]
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] I
(APPLICANT: TEL. NO: I I I
[ACCURATE DOOR SUPPLY (909) 595-7998- IAA BLDG PERMIT ISSUANCE 27.80 1 1
1433 W. ALLEN AVE. AB STATE GREEN BLDG FEE 3000.00 VAL 1.00 ISPECIAL CONDITIONS: I
SAN DIMAS, CA 91273 AC STRONG MOTION RESID 3000.00 VAL 0.50
[
ID2 PERMIT W/O EN-HC 3000.00 VAL 99.10 1
I I TOTAL FEES 128.40 I I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE [
]ACCURATE DOOR SUPPLY (909) 592-7998- 1 1 ]
1433 W. ALLEN AVE. LIC. NO 1 1LOCATION AND SETBACKS I [ ]
ISAN DIMAS, CA 91273 816938 I 1 [ I I
[ I ISOILS ENGINEER APPROVAL [ [ I
(ARCHITECT OR ENGINEER: TEL. NO: 1 [FOUNDATION/TRENCH FORMS I I [
� spy
1 LIC. N0: I ' + ` SLAB/UNDER FLOOR [ [ I
] (�." ! F ���• RAISFD FLOOR FRAMING [
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:] ��+ - +; �'f [UNDERFLOOR INSULATION I I I
1153H265 3 0.01 1- ] 1 1
t �y.Y ` I FLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I
NO 21 1 IROOF SHEATHING I I I
SCHOOL WITHIN HAZARDOUS [ ISHEAR PANELS I I I
AIR QUALITY: 1000 FEET MATERIALS I I I I I
NO NO NO ] IFRAME INSPECTION I I I
]
NFoll'
�?� [FIRE SPRINKLER HANGERSl�I JINSULATION/WEATHER STRIP[ I I
] [ (INTERIOR LATH/DRYWALL [ [ [
1 EXTERIOR LATH I I [
I I RATED FLOOR/CEIL ASSEM. 1 I I
[ I IRATED WALL ASSEMBLIES [ I I
I I IRATED SHAFTS/OPENINGS ] I I
[ I IT-BAR CEILINGS I I I
� � I
] [ ILOT DRAINAGE I [
IREPORT ID: DPR261 ROUTE TO: BS0508 [ I ] ]
I I I I I I