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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'