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HomeMy Public PortalAbout6402 TRELAWNEY AVE_Building__ Te- APPLICATION cAPPLICATION FOR BUILDING PERMIT LI COUNTY OF LOS ANGELES AODRE'b9 02 Trelavn Ave. DEPAATNENT OF COUNTY ENGINEER BUIMING AND SAFETY DIVISION LOCALITY Temple Cit JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM JH SEN SUP TOP BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTRICT O - OUP TypE P CESSED BY J S Q CONST 'r L� BUILDING STATISTICALCLASSWICATION SEW ER MAP ADDRESS O2 Trelarme Av • CLASS NO�DWELL UNITS Q 47 EIK PD LOT NO 9 L BLOCK MAP f1 STATE NUMBERZO HWY YES( NO TRACT 12706 USEZONE SPECIAL NO OF BLDGS �I CONDITIONS 9"E OF OT NOW ON LOT --0 e C arage 8C BUILDING EXIST R, TEL SETBACK YARD HWY STREET NAME WIDTH OWNER R NO FRONT ela" va. T le Ci P L S `�� s, SIDE ARCHITECT OR TEL P L ENGINEERISTAIMAl"j) FTzMNO INSPECTION RECORO d ADDRESS �/ O c Poole Inc. N - 221 u A RE rea Ong vd• � O ate 0 DESCRIPTION OF WORK A W NEW X ADD ALTER REPAIR DEMOLISH Z SO FT NO OF NO OF O SIZE STORIES FAMILIES USE OF STRUCTURE PriH � wim Std SIGNATURE 0- APPLICANT VALUATION 3200*00 APPROVALS D TE INSPECT R9SIGNATURE UNDATl/ FJFORMSION MATERIALS ,Q 3 ' / FEE 7y FEE E /V FRAME FIRESTOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES ANO LTA TE LAWS RE ULATING GAS VENT DUCTS BUILDING CONSTRUCTION CE11111Y THAT IN THE P RMANCE OF THE WORK FOR WHICH T PERMIT I6 I66U6 ALL NOT LATH INT EMPLOY ANY PERSON IN AN MANNER SO AS O CO 6U BUECT TO THE WORKME OMP ATION LA S LI RNIA LATH EXT SIGNATUR F A-- I MBER COR- pE RECT AND POSTED AD e stone • FINAL CLYDE N DIRLAM PRINCIPAL ST CT RAL ENGINEER PLAN CHECK VALIDATION r D uex PERMIT VALIDATION c MO CASH Ll f .07 4 7 2 G Iti'Y 2 3 2 3 D 3 75 V07473 15 GL TEMPLE CITY f� I APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ABUILDING DDRESS O DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALIT JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUR T OF allILDING CROSS ST DISTRICT NO GROU TYPE P ^IB FOR APPLICANT TO FILL IN coNsr BUILDING nn �J STATISTICAL CLASSIFICATION SEWER MAP ADDRESS y[/ [, q CLASS NO DWELL UNITS LOT NO BLOCK WATER rypT REQUIRED RECEIVED 99 CERTIFICATE TRACT L Q MAP HIGHWAY NO OF BLDGS NO ICIRCLp STATE MAJOR SECON LOCAL SIZE OF LO NOW ON LOT USE ZONE SPECIAL USE OF � ' CONDITIONS EXISTING BLDG OWN TO 6�S BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT Zo ARCHITECT OR TEL P L ENGINEER NO SIDE } ADDRESS P L y O TEL V CONTRALTO N Ed ADDRESS G S O DES ON OF WORK WrV a NEW AD ALTER REPAIR DEMOLISH Z Sq FT 91� NO OF '/ NO OF SIZE STORIES v FAMILIES A USESTRUC Ar. SIGNATURE OF APPLICANT VALUATIONS 0 d APPROVALS PATE. INSPECTgR YSIGNATURE FEE FEE S OFORMSI MATERIALSON iz- rRAME FIRE STOPS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS ) ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS OUILOING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HERESY I WILL NOT EMPLOY IY PE N IN VIOLA LATH INT Ir✓1 TION OF THE LABOR CODC OF TX STAT F CA OflNIA RELAT ING TO WORKMEN 5 COMO IN NCE LATH EXT SIGNATUREOF HOUSE NUMBER COR PERMITTEE IRECT AND POSTED ADD =EE I FINAL V IRA— JOHN CHECK VALIDATION CK I NO [ASH JOHN F LPERMVNCI STRUCTURAL E GINEER _ PERALIDATIOIO N GK .0 D,BH L" 3943Z SEP18 1 D 11.50- . � - WORKERS' COMPENSATION DECLARATION11 A e y a certificate that I have r certificate Come of consent to ,elf APPLICATION FOR BUILDING PERMIT insure, or a certifiante of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800 Lob C ) COUNTY OF LOS'641EIIf - BUILDING AND SAFETY Policy No I Company BUILDING ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the coun)y building IrinpeC- BUILDING 1 hon department ADDRESS Date Applicant CITY ZIPG LOCALITY NO OF NEAREST CERTIFICATE OF EKEMPTION FROM WORKERS" SIZE OF LOT NOW ON LOT CROSS ST COMPENSATION INSURANCE (This section need not be completed ofthe permit is for one TRACT BLOCK I LOT NO Mp,p BpOx 6-; f' pAOE o a PAROL �a hundred dollars ($100) or less ) OWNER i NLp USE ZONE MAP iA— � I certify that in the performance of the work for which this INO permit is issued, 1 shall not employ any person in any manner ADDRESS 402N4, As&e SPECIALIONS d so as to become sublect to the Workers Compensation Laws p� O CITY 7 ZIP C (rr Date AR Applicant CHITECT TELK NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO DISTRICT GROUP CONST TYPE I PROCESSED BY rQ Exemption, you should become subject to the Workers' /� _ / Compensation provisions of the labor Code, you must forth- ADDRESS V�� Y with GCll!-est- comply with such provisions or this permit shall be �( TEL - 'n deemed revoked CONTRACTOR G 41 /�'� NO STATISTICAL CLASSIFICATION APT CONDO Z LICENSED CONTRACTORS DECLARATIONUC CLASS NO DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ¢off- Tr.� Q t j Mx NO now SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC and Professions Code,and my license is in full force and effect CITY L's' U CSS BK PG VALIDATION SOFT t. } OF NO OF CHECK License Number Uc ClassSIZE > .1 STORIES FAMILIES ONE VALUATION Contractor Dal DESCRIPTION OF WORKS Q FEW ❑ 11 ❑ am exempt under Sec Q� ` � ' ADD 0 polo s, O77 nrs�,rv�!p � ALTER ❑ B 8P C for this reason BNL IX��'n r"b W c.Gao4X FAIR ❑ f Me USE OF EKIsTING BLDG MJW7,1 ❑ Signature APPLICANT - TEL —y , (PRINT) t a- H �, t2 FIO .Ql -&VW FINAL, 4 -=7-_! OWNER-BUILDER DECLARATION � I hereby affirm that I am exempt from the Contractoes License a 1�Y� NwhR rT_ Low for the following reason (Section 7031 5, Business and IX FINAL^_ Professions Code) - By r a El I, as owner of the properly, or my employees with BUILDING ADDRESS wages as their sale compensation,will do the work and the structure is not intended or offered far sale(Section LOCALITY 0 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- tion 7044, Bumness and Professions Code ) ADDRESS ^:,'l7 pu"rD CONSTRUCTION LENDING AGENCY Bq YARD HVyv PROP LIN F WIDTH I /" I hereby affirm that there is a construction lending agency for FRONT . r' c ITcii,- the performance of the work for which this permit is issued P L - riI I a' c� 1 (Sec 3097, Civ C ) SIDE +' P L Lenders Name PC Fee$ /iJ Perms Fee /r V Ref N Lenders Address L/ I certify that I have read this application and state that the Issuan �T 75- LDMA P/C N above information is correct I agree to comply with all County Investigation Fee 7/ ordinances and State lawn relating to building construction, Taal Fee ,0 6. 3 6 1 LDAKA Perm N < and hereby authorize representatives of this County to enter �_jy _ :-� ',i{LI I,1 TY4 upon the bore-mentioned prq(xrry for in"clion pu � � s n a -242 i-{' fj Y _ fQ ItEVEM FOR EXPLANATo"LANGUAGE Signature of A)Splicallt or Agent Dbte