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Home My Public Portal About6421 TEMPLE CITY BLVD_Building__ APPLICATION FTOR BUILDING PERMIT PV APPLICANT TO FILL IN (Print Br tyPs 661y) ADDRESS 2 —� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO OF BLDOS BUILDING SIZE OF LOT /6Q NOW ON LOT ADDREsB F TRAC 16/3 LOCK LOT NO LOCALITY TEL NEAREST OWNER 40/ Y NO CROSS ST ASSESSOR ADDRESS I?/Oot. MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE SH BY CITY I ZIP ']' CONST ZONE ARCHITEC OR/.T/ Q f NOL �.D _ ENGINEER CC�i x7w �YA(( STATISTICAL CLASSIFICATION SEWER P ADDRESS /O. . a- cz CLASS NOa2, 13WELL UNITS Zr- SK27 PG CONTRACTOR /V� TEL USE ZONE MA NOP 63 ADDRESS w 0'4 NO 240 V\-z- SPECIAL LIC CONDITIONS CITY ✓caH�[ CLASS OAD DEPARTMENT APPROVAL REQUIRED YES NO❑ CONSTRUCTION LENDER -� NAME AND BRANCH LOG SETBACK FROM RONTPROP LINEOF (STREET) ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING C] SO FT NO OF NO OF CHECK H HWAY } YARD - FRONT PROP LINE HIGHWAY WIDTH U SIZE STORIES NO ONE HC DESCRIPTION OF WORK �� NEW ❑ [� ❑ BLDG SETBACK FROM DD SIDE PROP LINE OF IS TREETI ? ALTER ❑ HIGHWAY } YARD TOTAL SETBACK 1 TYPE OF EXISTING EPAIF SIDE PROP LINE IDHWAV WIDTH USOF EXISTING BLDG O[Lf a EMOL ❑ } APPLICANT �/�/rM //�` NOLi6/r�p CORNER CUTOFF VES ❑ NO ❑ (PR NT) 7Y4"✓J BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ llYy IN COASTAL ZONE YES ❑ NO 1:1VALUATIONS CES �� CATEGORICAL EXEMPTION YES❑ NO 61 I HEREBY ACXNOW EDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DAT[) WITH ALL ORDINANCES AMO LAWS REGULATING BUILDING CON STRUCTION I CERTIFY THAT IN OOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED IRATE/ H ERtoy I WILL MOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STAT[ OF CALIFORNIA IN RELATING TO //�� _ L WORKMEN f CO [ATION INSURANCE Aozzwj FfGD I T / - 2 SIGNATURE O �� PERMITTEE ADDRESS TEL FINAL CITY r`.O�� NO DATE XA 11 I/.f ' A f T !' f l NTT N FEE Y ~ FE HARVEY T BRANDY COUNTY ENGINEER PLAN CHECK VALIDATION cK Ho CASH PERMIT VALIDATION cK M o CASH I a(`., 1 9 2 2731 JW 29 1D 89.25- V 76A638A CERS0312/T2 76A638A CE 9803 3-69 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING / DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS SUPT OF BUILDING CROSS ST FOR APPLICANT TO FILL IN Dl�cr N R YPE CONST o (PRINT OR TYPE ONLY) BUILDING /'q'ZI 7- AC EL�1✓ "OVA- STATISTICAL CLA FICATION SEWER MAP ADDRESS P CLASS NO DWELL UNITS BKPte- LOT NO BLOCK USE ZONE I MAP '1 O� TRACT NO V SPECIAL NO OF BLOGS ONDITIONS SIZE OF LOT NOW ON LOT USE OF u EXISTING BLDG HeVs� �i}V[ BLDG SETBACK FROM OWNER .ERA/f-sT LL�' No jp FRONT PROP LINE OF (STREET) ISTI SETBACK HI6XWAY a YARD = TOTAL IDTH FROM C LADDRESS � � v<DITYT� l.�ARCHITECT OR TEL LIN ROM (STREET) ENGINEER NOwm SETBACK Y + YARD = TOTAL AOORESS �� IDTH FROM C L CONTRACTOR TEL + _ QN/N NO LIC ADDRESS NO CORNER CUTOFF YES ❑ NO ❑ C LIC L CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS y CONSTRUCTION LENDER NAME AND BRANCH �w �R . // 1,lzo / // p ADDRESS SIZFrNO OF 0E 2400 STORIES FAM0LIES NEW Cl STRUCTURE Q/"tL 6.10"j(A4ADD ❑ ALTER ❑ REPAIR X f SIGNATURE OF DEMOL ❑ APPLICANT VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE � FOUNDATION LOCATION FEE § FEE § J FORMS. MATERIALS FRAME FIRE STOPS, I HER ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRA L TS AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL OR INANCES AN LAWS REGULAT IMG BUILDING CONSTRUC- V CT TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I GAS WILL NOT EMPLOY ANY PERSON INVIOLATION OF THE LABOR CODE LATH, INT OF THE STATE OF CA LIFOR MIA IN RELATING TO WORKMEN'S COM- PENSATION INSURAN LATH, EXT SIGNATURE OF PERMITTEE HOUSE NUMBER CORRECT /� AND ADDRESS G T � 71'L 'rK AVt FINAL POSTED �L� / JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK M 0 CASH - PERMIT VALIDATION cR M o CASH A(` 2 4 4 8C; OCT28 1 D 172 5- TEAeeeA CEEeoe a-ee APPLICATION FOR BUILDINGPERMVr a COUNTY OF LOS ANGELESno DEPARTMENT OF COUNTY ENGINEER loREss BUILDING AND SAFETY DIVISION LOCALITY Ci JOHN A LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W JENKINS, SUP T OF BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTRICT -TRICJT NO GROU �oNPgE PR s By BUILDING F STATISTICAL CLASSIFICATION SEWER MA ADDRESS CLASS NO DWELL UNITS_ BK PG �7 LOT NO BLOCKLiUSE ZONE MAP OO TRACT _ - 7 -� SPECIAL NO OF SINO LOGS GONDITIONS SIZE OF LOT U ?� NOW ON LOT E 01- EXISTING FEXISTING BLDG SLOG SETBACK FROM TE FRONT PROP LINE OF `-I I•� (STREET) OWNER NO TYPE OF (STING SETBACK HIGHWAY + YARD = TOTAL ADDRESS / - HIGIIWA WIDTH FROM G L CITY / 160 1 60 /o + ;?o = 30 ARCHITECT OR TEL BL SETBACK FROM EET) ENGINEER NO SI PROP LINE OF TYPE OF EXISTING SETBACK + YARD = TOTAL ADDRESS HIGHWAY WIDTH F TEL + = y CONTRACTOR NO d COIQ 71 ADDRESS NCORNER CUTOFF YES ❑ NO ❑ U CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK i EW ADD ALTER REPAIR DEMOLISH 'CrFT NO OF NO OF _ SIZE STORIES FAMILIES /O 6 USE OF O STRUCTURE SIGNATURE OF O �S APPLICANT VALUATION S -. APPROVALS DATE IKSP TORE EIS A LAR[ PC PMTq ,06 FOUNDATION LOCATION FEES FEES FORMS MATERIALS Y I HERESY ACKNOWLEDGE THAT I HAVE MAD THIS APPLICATION FRAME FIRE STOPS AND STATE THAT THE ASOVE IE CORRECT AND AGREE TO COMPLY BRACING BOLTS C FURNACE LOCATION WITH ALL COUNTY ORDINANCp AND STATE LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK GAS VENT DUCTS AUTHORIZED NEWBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LASOR CODE OF THE STATE OF CALIFORNIA RELAY IND TO WORKMEN S COMP INCE LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESSFINAL Q (o JOHNIF LEWIS PRIN IP L STRUCTURAL ENO ER PLAN CHECK VALIDATION CK M O GASH _ PERM VALIDATION CK NO CASH Uk,06656�S OCT 1 1 D 9.00- . i AWORKERS' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I hereby affirm that I hove a certificate of consent to self insure or a certificate of Compensation Compeaon Insurance, or a mmfi//ec�o oc�[p/y t ereof (Sec 3800, L C COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nd� Company BUILDING .II�Lw�JI( Certified copy is hereby furnished FOR APPLICANT TO FILL IN ApppEu a/ Certified copy Is filed with the county building Inspec- E"DID SSS Z ioon� department r�/y/ Dote L�6L—L�Apphca n'v� � G� NO OF BLDGS NEARE ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT NOW ON LOT ROSS5T C COMPENSATION INSURANCE ASSESSOR CROSS ST (This section need not be completed if the permit is fat one TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100)or leu ) TEL OWNER NO 115E ZONE MAP I certify that in the performance of the work for which this INO permit is issued, I shall not employ any person in any manner ADDRESS jkAzi CONDITIONS i d so as to become subject to the Workers'Compensation lows 0 CITY ZIP Dote Applicant ARCHITECT OR TEL DIST ICT GROUP I TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO CONST E r Exemption, you should become subject to the WorWorkerske Compensation provisions of the Labor Code you must forth ADDRESS �!/O with comply with such provisions or this permit shall be TELLn STATISTICAL CLASSIFICATION APT I CONDO Z deemed revoked CONTRACTOR NO — LICENSED CONTRACTORS DECLARATION LIC CLA55 NO AZOV DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP (commencing with Section 7OD0)of Division 3 of the Business UC and Professions Code,and my license is in full force and effect CITY CLA55 r BK PG VALIDATION '' ��.T,A� 50 F7 NO OF h10 OF CHECK License Number l 0 - Lic Chin917 SIZE STORIES FAMIUES ONE VALUATION ` Contracto P'NN7'1.k lin t '1 Date QOML T q I DESCRLPnON OF WORK NEW ❑ $ .o� ► ElI am exempt under Sec „DD E3 _ALTER ❑ B 8P C for this reason REPAIR ❑ $ OF Data EXUSEISTING BLDG � DErAOI ❑ Signature bxr.� \ APPLICANT TEL FINAL WNER-BUILDER DECLARATION (PRI NO i ATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS FINAL 1 Professwro Code) WINT By r ❑ I, m owner of the property, or my employees with BADDRESS rtr- I •T wages as their sale compensation,will do the work and 37,07 the structure is not intended or offered for sale(Section LOCALITY ' K E] 7044, Business and Professions Code ) COVING TEL OR NO I, as owner of the property,am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS - TOTAL i tion 7044 Business and Professions Code ) CONSTRUCTION LENDING AGENCY SET 11 D YARD Hwy Tu sErena FROM WIDTH EXIST L-��H 1� •>1 PROP LINE I hereby affirm that there is a construction lending agency for FRONT - , CHANGE •�I_I the performance of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE PL Lender's Name G/ TDMA Ref N IJI]I iQ—Ijl�l'1 Y/dl�!'1 PC Fee S Permit Fee r/V nj 2b J 1 11 Z Lender s Address o I certify that I have read this application and state that the Inuonce Fee kA PTC N , above information is correct I agree to comply with all County Investpauon Fee ordinances and State jaws relating to building construction, Total Fee LDMA Perm N Q and hereby authorize representatives of this County to enter ' gYnqn the ai!SeSentioned openy fat mspecbon27purpo r Sipnotwis of Appl¢ant or Agent Dab 11 fNN RiVERsi FOR EXPLANATORY LANGUAGE