HomeMy Public PortalAbout6418 TEMPLE CITY BLVD_Building__ 76A638A CE 0603 3-69
APPLICATION FOR BUILDIN PERMIT,;'
COUNTY OF LOS ANGELES BUILDING -77
ADDRESS
DEPARTMENT OF COUNTY ENGINEER f
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING NEAREST
CROSS ST
FOR APPLICANT TO FILL IN DIsrRI;T NO GRO TYFferT PR BY
(PRINT OR TYPE ONLY) !
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESST Blvd -
CLASS NO DWELL UNITS BK PG 12
LOT NO BLOCK USE ZONE MAP 00
NO
TRACT SPECIAL
NO OF SLOGS CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BLDG SETBACK FROM
TEL6- '�'�'� FRONT P OF PROP
(INE BACK NIGHWAY ♦ YApp TOTAL e NO
OW NER J ,.t
ADDRESS 6418 Temple City Bl d HI WAY WIDTH I FROM C L
CITY Temple City, Calif. `
ARCHITECT DR TELBLDG SETBACK FIR (STREET)
ENGINEER NO $IDE PROP LINE OF
TYPE OF EXISTING SETBACK HIGHWAY ARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
TEL -
CONTRACTOR St One Roofing
TO
ADDRESS951O E. Valle NO l 9l CORNER CUTOFF - YES ❑ NO ❑ C
CITY Rosemead CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS C
CONSTRUCTION LENDER
NAME AND BRANCH
ADDRESS v
SO FT NO OF NO OF
S1ZE STORIES FAMILIES NEW
USE OF ADD ❑
STRUCTURE Resa-dence ALTER ❑
Recover roofing REPAIR ❑
SIGNATURE OF DEMOL ❑
APPLICANT
VALUATION S 660.00 APPROVALS DATE INSPECTOR N SIGNATURE
P C PMT FOUNDATION LOCATION
FEE $ FEE $ —FOR TERIALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY BRACING, BOLTS
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- FURNACE LOCATION,
TION 1 CERTIF T IN 001.6 THE WORK AUTHORIZED HEREBY I GAS YENT_ DUCTS
WILL NOT EMP OY I IN VIOLATION OF THE LABOR CODE LATH, INT
OF THE STATE F CA R.IA M RELATING TO WORKMEN 9 COM-
PENSATIOSU NCE LATH, EXT
SIGNATUR HOUSE NUMBER CORRECT
PERMITTEECC AND POSTED
ADDRESS 9510 E. Valle y Blvd. FINAL
RosenieaU, CX Calif. u a GASH _ JOHN F LEWIS, PRINCIPAL ST URAL ENGINEER
PLAN CH
PERMIT VALIDATION CS M O CASH
�14f a s s 0� JA30 1 D 12.00-
a
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES t BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN • �I ^ ESs
I he" affirm that I hfxie a certificate of consent to self ulaure . E 13
or a certificate of Workers Compensation Insurance or a certified b
Copy thereof(Sec 3800 Lab C) dT _ ) LP
OCAv
Policy SIZE OF LO NO OF 8 S NOW ON LOT G
❑ CendlBtl copy a he VbY furnished NEAREST CROSS ST
❑ CertAed copy a filed with the county building nupeotron OARCHTTECF
BLOCK LOT
departnienit USE ZONE MAP NO
DateAppliceM PP K PAGE PARCEL
07 6 SPECIAL CONDMONS
CERTIFICATE OF EXEMPTION FROM WORKERS OWNER TEL No
NO
COMPENSATION INSURANCE I 41411,— Z�- WITHIN 1000 FT OF SCHOOLI YES
(This Becton read not be completed d the permit s for one hundred I„
K DISTRICT GROUP � RE WNE PROCESSED BV
dollars ($100)or WS)
I Certify that n the perlormenCe of the work for which this perrolt
0 issued I shell not employ any person In arty manner s0 as 10 ENGINEER TEL NO O�
became subject t0 the Workers Compensation Laws SWTIS71CA1C�TIDN APT CONIDO
Data Applicant ADDRESS CLASS NO OWE'L UMTS
NOTICE TO APPLICANT If after making this Certificate of REOUIRED TOTAL SETBACK FROM EXIST
Exemplon you should beconve subject to the Workers CONTRACTORw ' TEL NO SETBACK YARD "YY PROP LINE WIDTH
COMPErn
ISalICn Proal0/a r
of the Lebow Code YOU must fOrthWth t -�w' V 7
CNnp1y,with such prowsors Cr this permit ahm
all be deemed revoked ADDRESS LIC NO FPRNT
LOY
LICENSED CONTRACTORS DECLARATIONSIDE CL
0
1 hereby affirm that I am bcar, CITU LX: CLASS P L sed uMerprovsors of Chapter 9 SEWER MAP 0
(COmnandn0 with Sector,7000)of Duvlaon 3 of the Business Bnd SO FT SIZE NO OF STORES NO OF FAMILIES NEW ❑
Prufessicrls Code and me a SK POy license In fuU force and effect , 0
License Number Lic C1maDE TKX+oF wORx lJ�� ADD ❑ U
/�/yf) w
ContractorDate 1 ALTER ❑ $ "'•'i/ G.
❑ I am exempt under Sec REPAIR ❑ $ Z
BAPC for the reason liff
DEMOL ❑
LOW PID. 23
Dare USE of EXtSTPrURM ❑ ACCT.:
Sjunatere Nr r TEL N1O TDMA Perm. 33[13 X0.50
2/1,E owner of the property or my emWiges
employees With waas 7'y1i G 1
their sole comperneten will do the work and the structure s
not Intended or offered for sale (Section 7044 Slyness and FDUL /�
professions Code 1 wit TIE APPLICJwT OR FU URE ELILDelp CCdRANr H/AALE A IMLApOl13 MATERNL ACC T.a
OR A MXTIRE CONTNNING A HNL�Da6 MATEn EQUAL TO OR NEATER T1wN TIE T
❑ 1 as ovmef of the property am exchowly contracting with - < p
licensed COnitlaa0re to Corslrlicl the prgecl (Section 7044 AIgIMiB aFEcsiEycN THE Iwzu+oous MATEruN.s Nvdlwnw clnE+ gt1A1,By '1-`T > t 1 ��(� 17Cr.65
BUssess and Prate9aena Code) YES❑ NO�d 2 ITEMS
w{l. TIE INTENDED USE aF THE cal BY TE APRIGVIi aA FFC*l auuxNO
CONSTRUCTION LENDING AGENCY o R[OWE A FERAsr FOR coNsnral CACIl on E PEuTON(3C THE f FOR O y c
COAeT NR OUAOTY NANNDEI.ENT dSnRLT 19LAGe1 BEE PERA(ITNG CIECKUei FOR TOTAL 1--A
woEurEs
I hereby affirm that there is e construction lending agency for YES 13 NoCHECK,
the performance of the work for which this Permit is sued(Sec NVUE READ TIENMT1JiDpUS MATEnaLL811YORMAfKM pupE AIC rIE sva.o aErwr*rvo ��/�
�p 3097 Cry C) CIIECKLITT RSTnL M'REO 91➢CER TIE Lpe ArgEus COUNTY CCCE CHANGE .00
Qj LBrldere Name d R}MCTKIHB� De TMggNCCO�NCE IMZMDOVS
OQ Lender Address EW"TF 0000-0001 7/24/95
1 Certify that I hays read this application and state under penalty PC FEE PERMT FEE 7539 1 PM 5:18
Of perryry that the above Information s Correa I agree to cartny �v �C'-Q. 9b
with an County ordlrMnces and rIWe lane relating to budding _ 11
CNeb nd hereby sentstws of tle8 CW ISSUANCE FEE �1
Qc o the nor InepeCtgn61%
Z � INVESTIOATX)tJ FEE TOTAL FEE
iG . SEE REVERSE FOR EXPLANATORY LANGUAGE'