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HomeMy Public PortalAbout6233 1/4-6233 1/2 TEMPLE CITY BLVD_Building__ 76AG30A Cie[O B-ei PPLICATION FOR LDI P AITIT;'✓/ ,C. COUNTY OF LOS ANGqG BUILOINO - c DEPARTMENT OF COUNTY ADDRESS BUILDING AND SAFETY DLOCALITY OF JOHN A LAMBIE COUNTY ENEAREST COLEMAN W JENKINS.BUP T OF CROSS 9T DISTRICT NO O P!FOR APPLICANT TO FIQ ONSTBUILDI NO i / S TATISTICA�SSIFICA ION SEWE MAP ADDQ E3S OV E Y CLASS NO DWELL UNITSBK PLOT NO / USE ZONETRACT � 9P ECIALnMO OT1SIZE OPLOT 7 1QO MOWO USE OPN � f.)vp LLDO SET" IROM TEL FRONT PROP LIME 01 (STR[[T) OWN R C D TYPE OF [[ISTINB e9TI1ACK CIGHWAY t YAR = TOTAL ADDRESS HUSHWAY WIDTH F11100C L IO O + A RTYHMw _ TEL I BLpO ![TBACR FROM ENGINEER NO •10[ PROF LI HE Or eTRKET TYPE OF I[EI$TINee[TBACK XISXWAY + YARD = TOTAL ADDRESS XIOXWAY WIDTH PROM C L CONTRACTOR M TOL f04 5(920 + - 0 ADDRESS /(J CORNER CUTO NO/ FF YES NOG' W F a LI`CLASS SEE DE FOR SPECIAL APPROVALS DESCRIPTION OF WORK Q. AND PARKWAY TREE REQUIRED R. NEW-" ADD ALTER REPAI DEMOLISH SQ IT NO OF NO'OF rIVWa ana Oy epproet SIZE OQ STORIES ^ FAMILIES sfelle}Toni should be taken out at iio L A C , A. USE RUOF I e, or STCTURE hd -- o ymeor's OI co Imncdle}oly In older to am Fom a le e uMll Permd hes been uAP suod. e_ I,� SIGNATURE OF PIY for parkway trim,1r APPLICANT 1 VALUATIONS © 014- APPROVALS (/ ATE INSPI[CTOR-ESIONJITUI19 CPMT �0 FOUNDATION, LOCATION FEE$ Q� FEE$ I o FORMS, MATERIALS () FRAME, FIRE STOPS I H[RmY ACNNOWL[OGC THAT 1 HAVE READ THIS APPLICATION BRACING BOLT Zl AND STATE THAT THE ABOVE 19 CORRECT AND ACRE[ TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REOULATINO GAS VENTU T GUILOINO CONSTRUCTION I CERTIFY THAT IN DOING THE WORK 1 AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA FLAT 'NO TO WORKMEN 9 C M PENSATION INSURANCE LATH EXT SIGNATURE PERMITTEE OF I J O HOUSE NUMBER COR- r J-T >•/ ADDRESS or- FINAL JOHN F LEWIS PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION G: M G CASH _ PERMIT VALIDATION cK M 0 CASH J'Lo346d—� JUL 8230 55.004 LACo Co 3 9 1 2`^ JUL 2 2 1 D 11 0.00- 2' e/L� Y rL-..Z M WORKERS COMPENSATION DECLARATION hereby affirm that I have r certificate of consent to self APPLICATION.,F,OR BUILDING PERMIT insure ora certificate of Workers Compensation Insurance \ Ifl or a certified copy thereof (Sec 381x1 tab C ) `COUNTY OF�LOS�ANGELES' BUILDING AND SA TY Policy No Company Canrfied copy is hereby furnished FOR APPLICANT_TO FILL`IN\``� AUILLD ING RESS Certified copy Is flied with the county building inspec BUILDINGfJ �J hon deportment ADDRESS - / ' t.. Date Applicont CITY P14F ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS NO OF EIDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST ASSESSOR (This section need not be completed if the permit is far one TRACT BLOCK LOT NO /dap BOO( PAGE PARI hundred dollars ($100)or less ) r ��i{,�.��.r UUUU�SSSS�FF/jji��' (( I certify that in the performance of the work for which this G D- - W ONO NO permit is issued I sholl not employ any person in any manner / SPECIAL so as to become subject to the Wor rs'Compenso Ion Laws ADDRESSDole .s �r. CONDITIONS_P.-,:5---W � J��� CITY ZIP NOTICE TO APPLICANT If,li after making this Certificate of NGIMNEER L DISTRICT GRQUP TYPECONS ZONE FIRE ZONE _ BY 0 Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth ADDRESS U with comply with such provisions or this permit shall be deemed revoked CONTRA-fOR yr. V STAnBnCAL CLASSIN TION APT cn LICENSED CONTRACTORS DECLARATION LIC CLASS NO � DWELL UNITS_ ? I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS SEVER MAP with Section 7000)of Division 3 of the Business and LIC Professions Code and my license is in full force and effect CITY CIASSZ Q 1,76 SK PG VALIDATION SO FT NO OF NO OF (AqOLEO( License Number Llc Class SIZE TORIES FAMIUES ONE VALUATION) a DESCRIPTION OF WORK NEW (/. OD E]l am App f , ;@8923A I exempt under Sec ALTER B 8P C for this reason Date Dots EXISTING BLDG g . is . . .j1 REPAIR of DEMOL I I • * 4988 EXI Signature APPLICANT TEL FIN �e • • - 49.885 OWNER-BUILDER DECLARATION NO DATB v I hereby affirm that I am exempt from the Contractor s License 0 207-88 Law for the following reason (Section 7031 S Buslnm and ADDRE FI PPrroliessions Code) n BUILDING p J} I, os e owner of the property, or my employewith ADDRESS T wage as their sole compensation,will do the work and In the structure Is not Intended or offered for sale(Section 70" Business and Professions Code) MOVINGOR NTEL loop 1, as owner of the property, am exclusively contracting with licensed contractors to construct the prolect (Sec- tion 7041 Businep and Professions Cade) CONSTRUCTION LENDING AGENCYOL YARD FI1VY DROP UNE WIDTH I hereby off irm 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 PL Lenders Name $ Z LDMA Ref Lender's Address P C Fes f Permit Fee r3 I certify that I hove rood this application and state that the (nuance Fee LDN P/C• above iniformctan is coaect I agree to comply with all County Inveu on Fee p $ ordinances and State lows relating to building construction, Total Fee- / LDMA perm t1 Q and hereby authorize representative of this County to enter a upon IhsS above-mentioned property fa inspection purposes er ( BFl BNtlffB N�EXPLANATORY IAMOOAOB y �7J lawn of Applicont or Agent Data 4. �tU e�