HomeMy Public PortalAbout9729 VAL ST_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (p,.m Gr IVOR GDIv)
BUc JZ COUNTY OF LOS ANGELES
ADOR DEPARTMENT OF COUNTY ENGINEER
CITY zlp BUILDIN AND SAFETY DIVISION
O OF BLDGS BUILDING
SIZE OF LO^^T '' '` C OW ON LOT 10
ADDRESS �pp ����
TRACT Ny � LOT NO LOCALITY il�tA.Ati Z.
OW NE / NE CRCSS ST
ASSESSOR
ADDRESS MAP BOOK PAGE PARC EL
(STRICT I GROUP ITYPE FIRE ROC ESSED BY
CITY ZIP �1D� �+ CONS ZO[IE
ARCHITECT OR TEL YV J1N/'�"' �lJ
ENGINEER NO
STATISTICAL CLASSIFICATION V SEWER MAP
ADDRESS CLASS NO O I DWELL UNIT J_BK CKLPG
CONTRACTOR54 TEL USE ZONE OP ()�
ADDRESS NO R PECIAL
�.
CITY LIC 1 _ CONDITIONS
CONSTRUCTION LENDER
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO
C
NAME AND BRANCH L BLDG SETBACK FROM v
FRONT PROP LINE OF - ` (STREET)
ADDRESS CITY HIGHWAY } ARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZ F STORIES FAMILIES ONE
I }
DESCRIPTION OF WORK
/ DO BLDG SETBACK FROM [e
C SIDEPROP LINEOF (STREET)
LER HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING U
REPAIR SIDE PROP LINE HIGHWAY WIDTH d
USE OF } = Z
EXISTING BLDG EMOL 111
FM
AN TE CORNER CUTOFF YES ❑ NO ❑
T) N
NATURE) IN OPEN SPACE YES ❑ NO ❑
' IN COASTAL PERMIT ZONE YES ❑ NO ❑
TION
EBY ACKNO LEDSK THAT I HAVE READ TH f APPLICATION
TE THAT THE ABOVE 10 CORRECT AND AGREE TO COMPLY `
LL ORDINANCES AND LAWS REGULATING BUILDING CON-
ONI CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPEM TION INSURANCE
SIGNATURE OF
PERMITTEE
ADDRESS
FINAL '2 BY
TEL / VA.
CITY NO DATE
MAKE CNEC&S P.11AULtPC PMT 10 FEE $ FEE b��
HARVEY T BRANDT, COUNTY ENGINEER /17.
PLAN CHECK VALIDATION K M O CASH _ PERMIT VALIDATION CK M O CASH
397PAUG 2923117.00
7 0 9 P SEP 17 2 3 0SG1(�/�"A- 1/�^.yp�1 2-52 0 • ♦ (gy
TSAS,GA CK* S E/T1 A ' "'"�W`-g , 7 1 OPSEp 17 2 3 7.0 0 •96
APPLICATION FOR BUILDING PERMIT
F(JIAPPLICANT TO FILL IN (P,,o et type mly)
U LDING COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
cl eoqY zip BUILDING AND SAFETY DIVISION
O OF BLDGS BUI LDIN Q
SIZE OF LOT OW ON LOT ADDRESS C roee
TRACTOA/ 460gyE LOT NO LOCA LIT
� T NEAREST
OWNER N CROSS ST
ASSESSOR
ADDRESS r MAP BOOK PAGE PARCEL
/� DISTRICT GROUP TYPE FIRE ,SSED BY
CITY ZIP V IC NST_ ZONE
ARCHITECT OR TEL t Q� .I!
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NCr,A_-DWELL UNITS I_BKFDPG
CONTRACTOR TEL USE ZONE NOP O
LIC D
ADDRESS NO �1 D SPECIAL
CITY LIC CONDITIONS
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDER
NAME AND BRANCH BLD SETBACK FROM
FRO TPROP LINEOF (STREET)
ADDRESS CITY - TOTAL SETBACK FROM TYPE OF EXISTING
SO FT NO OF NO OF CHECK RIGH Y } YARD - FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
}
DESCRIPTION OF WORK EW V
G O OO ❑ SIDEGSETBACK PROP L NEOF M (STREET) PC
If O ALTER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM OF EXISTING E~j
REPAIR SIDE PROP LINE HIG WIDTH G
USE OF } = Z
EXISTING BLDG EMOL
A PP L I CA EL CORNER CUTOFF YES ❑ NO ❑
(PRINT) ND
BY (SI O NA TURF / IN OPEN SPACE YES ❑ NO ❑
t( [�o IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION Y O
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCE! AND LAW! REGULATING BUILDING CON-
STRUCTION C[RTIfY THAT IM DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION Of THE
LABOR CODE C THE STAT[ OF CALIFORNIA IN RELATING TO
WORKMEN'S COMP TION INSURANCE
SIGNATURE O
PERMITTEE
ADDRESS
TEL FINAL BY
CITY NO DATE 9,.,;-)
9� /� '�7� 1
,ifAAE
CHECKS PASAULE !O F C t / PMT P
FEE Y FEE 7
HARVEY T BRANDT COUNTY ENGINEER
PLAN CHECK VALIDATION CK M D CASH PEIMUT VALIDATION cK IN oo �CABX
3 9 5:AUG 29 1 D 3.0 0 Azla
76AGIBA CC*K3 ATA
APPLICATION FOR BUILDING PERMIT
COUNTY OFLOS ANGELES BUILDING AND SAFETY
1 B SS C
WORKER'S COMPENSATION DECLARATION FOR APISUCAUT FILL IN �-
I hereby affirm that I have a certdcate of consent to self uaure BUILDING ADDRESS �- Q
or a certificate of workers Compensation Insurance a s certified Vl
copy thereof(Sec 3800 Lab C) CtTv ZIP LOCALITY
Policy No Company SIZE OF LOT NO CF BLDOS NOW ON LOT
❑ Certified copy a hereby furnished DEME CROSS 3T
❑ Certified copy rs filed with the county bulldog Inspection TAT BLOCK LOT NO
department USE ZONE k1AP NO
Date Applicant ASSESSOR MPP BOOK PAGE PARCEL SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS OV44ER� c� II YES NO
COMPENSATION INSURANCE J wm+IN 1000 Fr OF SCHOOL?
(This section need not be completed If the permit a f«ane hundred ADDRESS
dd1am, ($100)or less) �� DISTRICT GROUP CWST FIRE GONE SSED BY
I certify that in the performance of the work f«which this permit CTry
a Issued I shall not employ any person In ary manner so as to •/
Sill to I Workers Compensa ARCHITECT OR ENGINEER TEL NO
/pm STAPSTICAL 1/FICATON APT CONDO
DBtO Applicant // _ ADDRESS CLASS NO SC's DWELL WITS
NOTICE TO APPLr-W If alter making this Cerfifrrate of RECURRED TOTAL SETBACK FROM EXIST
Exemption you should become subhect to the workers CONTRACTOR " TEL NO /� SET BACK YARD MYY PROP LINE WIDTH
Compensation prrnnsnns of the Labor Code you must forthwith Df pC,l FRONT
comply with Such prOwerona or the permit shall be deemed revolted ADDRESS /�7 1 DC P L
LICENSED CONTRACTORS DECLARATION a �� �
_ CfTV L LIC CLAS3 P L
I hereby affirm that I em Icerlsed underpnwacns of Chapter B SEWER MAP
(Commencing with Section 7000)of DNaron 3 of the Business and 50 FT SIZE NO OF STORES NO OF FAM0JE3
Pmfessens Code and my Igense Is In full 1«ce a9dveUGpt N ❑ BK �' , /`,}�[
License NumbersZ&ql Lc Class DESCRIPTION OF WORK A ADD ❑ $ p�oO V
Contract Date A ALTER ❑ cc
I
❑ I am exempt underSac REPAIR ❑ $ C.7
BBPC for this reason Q DEMOL ❑ LOMA P/C A W
Date USE OF EXI NG BLDG URM ❑ Q.
Slpnature
APPLICANT(PRW7) TEL NO LDMA Perm♦ 1
11I as owner m the property « my employees a wager as = AGGT.: Z
their SOIB
not intended or offered for persatim will
(SectKin 7044 Busmess and ADDRESS FINAL DATE CC er
Profesaens Code) H ITEMS 158.85
vwLL THE APPLIC.Wi OR FaA ARDO o oCCIfMNi HUN-T A R GREATER
lAA1Efl HE ID^ — 1 ITE Is
❑ I BS OWrlef Of Ih10 property em a%C OR A IA%nXE LONTNNNla A HAZAI>OW0I.MTEPYL EWAL TO OR GREATER TWN THE
USotec contracting n 44 ANq{Anb SPECIFIED ON THE HALV S WTERWS NFORMNTICN OUDE'r FlNAL BY
bcensed contractors to construct the protect (SeaUa, 7D44 YEs❑ No❑ TOTAL 15$ . $rJ
s neva and Professions cede) C11ECK 158.85
041 THE RIZ ro USE OF THE BIlIXNO BY THE MODFINT OR FUTURE E SOUTH
aecuPurR REaumE A FESMT FOR CONIC?(SC ON OR EEa IRMT N FROM THE s OR
CONSTRUCTION LENDING AGENCY OOAm NR ouAury rwwaENENr Dlsrr4cT IscAouDl SEE PERAfRNO pEakusr FOR CHANGE .00
puoELUEs
I hereby affirm that there a a construction lending agency for YES 1:1 NO❑
the performance of the work for which this permit a asued(Sec
HAVEREAD<MT I JNDERS D IAIMTERwLSn60nAUNDER T DE AND THE LES CO PERNTT NO
OOOE
3097 CN C) CHECKLaT UNDERerM'D TAY REOIAREI.ENir UNDER THE L09 ANGELES COUNTY CODE
Lender a Nae a� ���, R F��; 1 9/26/95
Lenders Address 2504 1 PM 5:18
0 PwEn W,Mx,
g I certify that I have read this application and state under penalty PC FEE PERMIT FEE
of perjury that the above mformatxm Is correct I agree to comply rr
R with all county ordmences and State laws relating to budding .7✓
construction and hereby aulllome representatives of the County ISSUANCE FEE Q
er n thgl�ove-mentanetl property tar Iy
C� RIVESRGiV10N FEE TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
I
WORKERS'COMPENSATION DECLARATION ll
hereby affirm that I have r certificates Come of tionconsent to-self ., ARPLICATION FOR BUILDING PERMIT JISI
I insure 'or o certificate of Workers' Compensation Insurance
t or a certified copy thereof (Sec 39DO Lob C ) .,
COUNTY OF l05 ANGELES BUILDING AND SAFETY
I
Policy No Company
Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUI DING
ADDRESS
C71
Certifieddepartment
copy a filed with the county building tmpec- ABUILDING DDRESS
LFJ bon depanmant ADDRESS LOfp,UTy Q
Dote Applicantj%itln Ji9.!/NJ/O qtt ZIP
NEAREST
CERT�EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT m NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed If the permit Is for one BLOCK LOT NO USE ZONE NO •? 7
hundred dol lam (flop)or less ) J
TEL CONDITIONS
Y
I certify that In the performance of the work for which this OwNFRSPECIAL
NO CONDITIONS n•
permit Is Issued, I shall not employ any person In any manner DISTRICT GROUP TYPE FIRE PROCESSED BY O
so as to become subject to the Workers'Compensation Lows ADDRESS CONST / ZONE 74.& V
O Vim/ 0
Date Applicant ITYARCHITECT ZIP TEL
STATISTICAL KATION CONDO V
NOTICE TO APPLICANT If, after making this Certificate of -
Exemption, you should become subject to the Workers ENGINEER NO CLASS NO DWELL UNITS_ d
Compensation provisions of the Labor Code you must forth- ADDRESS SEWER MAP N
with comply with such provisions or this permit shall be TELZ
deemed revoked CONTRACTOR j, RK VALIDATION
LICENSED CONTRACTORS DECLARATION UC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NOWo VALUATION
(commencing with Section TODD)of Division 3 of the Business and
Professions Code, and my license Is In full force and effect CITY CUSS -00�J/ 50 FT NO OF NO OF CHECK ,
License Number -X952 Lic a. gL/ _ SIZEUC
STORIES FAMILIES ONE
Contractor .�
y 0&0 Date DESCRIPTION OF WORK NEW C1 � O O
O
❑ I am exempt under Sec .94V0 O ADD
ALTER FINAL
B 8P C for this reason O REPAIR DATE
USE OF
Date EXISTING BLDGOEMOL FI
Signature APPLICAM TEL
By
OWNER-BUILDER DECLARATION PRIM NO
I hereby affirm that I am exempt from the Contractor's License
Law far the following reason (Section 7031 S Business and
Professions Code)
❑ I, as owner of the property, or my employees with BUILDING
.� 2 3 b A
wages as �
their sole compensation,will do the work and
the structure Is not Intended or offered for sole(Section LOCALITY
7044, Business and Professions Code) MOVING TEL f( •
I, as owner of the property am exclusively contracting CONTRACTOR NO - 2 • 2 1 8 b.3
with licensed contractors to construct the project (Sec ADDRESS
hon 7044, Business and Professions Code) �pLt�
CONSTRUCTION LENDING AGENCY SET BAQW( YARD HWY TOTAL SETBACK FROM INE WIDTH • ' 2 1 8631
I hereby affirm that there Is a construction lending agency for FROM pop. Q 8 06-840
the performance of the work for which this permit Is Issued P L
(Sec 3097, Civ C ) SIDE
- PL -
Lender s Nome
- Lender s Address
P C Fee f Permit Fee
I certify that I have read this application and state that the I.i,.Fee > ,
above Infarnaiion Is correct I agree to comply with all County Investigation Fee
ordinances and Sate jaws retailing to building construction, Twal Fee
D and hereby authorize representatives of this County to enter
Upon above-men oned operty for Inspection purposes
SEE EFVUW FOR EXPLANATORY LANGUAGE
Signature o Applicant m Agent Os
WORKERS COMPENSATION DECLARATION s
insure,
o affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT
inwre, or a certificate of Workers Compenstion Insurance or
�. certified copy thereof (Sec 3800 Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company pi
Certified copy Is hereby furnished FOR APPLICANT TO FILL IN ADDREBUIWISS R 7! 1 �/p S �-• Q�,p
'
Certified copy Is filed with the county building inspec BUILDING /I�� [� (�
tion department ADDRESS r/-- I `4 �• LOCALITY T-i--l"'NEARE
i'
Date Applicant CITY V" Cl T ZIP 0 CROSS STGoIdtKWe sxc —j'enE RC1' `
CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE MAP a O�
hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO r
I I ♦ TEL 1 7 SPECIAL y
W 'L q LVt / ,I Q YI
I certify that in the performance of the work for which NO .f CONDITIONS h this p r7 DISTRICT GROUP TYPE FIRE PR SSED BY 0
permit is Issued I shall not employ any person In any manner ADDRESS 1 7< q V q CYPE ZONE ('
so as to become subject to the Workers Compensation Laws op /` �y.J O g ZO cc
ata Cpf ' �� Applicant ` �� CITY {. L'LL� l CA � ZIP TEL!1 ' •+ D STATISTICAL IFICATION P7 CONDO
NOTICE TO APPLICANT If after makIrIlly this Certificate of ENGINEER NOto
ARCHITECT OR
Exemption you should become subject to the Workers C1.455 NO DWELL UNITS_ d
N
Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP Z
with comply with such provisions or this permit shall be
deemed revoked TEL CONTRACTOR I KI NO BK LPG &FQ VALIDATION
LICENSED CONTRACTORS DECLARATION V LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSNO VALUATION
(commencing with Section 7000)of Division 3 of the Business and UC
Professions Code and my license is in full force and effect CITY LJC =
License Number I Class SIZEFT Q STORIIEES FAMILLIIES CHE
ONE /1 ;2 1 6 1 6A
Contractor Dote DESCRIPTION OF WORK NEN' 1J O"tl # • • • is • 1
❑ ADO
am professional
exempt from the licensing men as I am o -�� prC� 2 • • 3 Q,O Q
licensed architect or a registered professionall engineer ALTER FINAL /
acting in my professional capacity (Section 7051 i REPAIR DATE S •i• . 3 &00cam,
Business and Professions Code) USE OF
EXISTING BLDG DEMOL FINAL
Lic or Reg No Date APPLICANT TEL BT ( 0 2 —81
OWNER BUILDER DECLARATION PRINT NO
I hereby affirm that I am exempt from the Contractor s License
Law for the following reason (Section 7031 5 Business and ADDRESS
Professions Code) I PRESENT
❑ BUILDING
I as owner of the property or my employees with ADDRESS
wages as their sale compensation will do the work and
the structure is not intended or offered for sole(Section LOCALITY
7044 Business and Professions Code) MOVING TEL 1 A
I as owner of the property am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec
lion 7044 Business and Professions Code) ADDRESS • • • 1
REQUIRED TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP UNE WIDTH Z • 52 00
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued PL is, • 5 2 0 0 6
(Sec 3097 Civ C ) SIDE
Lender s Name PL 1020-81is
Lender s Address PC Fee S Permit Fee j
w I certify that I have read this application and state that the Issuance Fee 7
above information is correct I agree to comply with all County Inveoigaeon Fee
ordinances and State jaws relating to budding construction
VI
and hereby authorize representatives of this County to enter Total Fee
upon the abo re mentioned property for inspection purposes
n SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Appli nt or Agent Dore ms
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1202270021
PHONE (626) 285-0488 EXT
LEGAL ID NO OF CONST BUILDING ADDRESS
ON FILE SQ FT STORIES TYPE 9729 VAI, ST
(ASSESSOR INFORMATION NUMBER (STRUCTURE 3300 V-B I TEMP CA 917800000
NEAREST CROSS STREET GOLDEN WEST
15383-017-011 I I THOMAS PAGE GRID LOCALITY TEMPLE CITY Cl
(TENANT (EXIST BLDG USE REBID USE ZONE R-1 (ISSUED ON PROCESSED BY
FIST OCC GRP 02/27/12 SR
(OWNER TEL NO IBLDGS NOW ON LOT VALUATION JFINkL DAT& FPUA BY CODE
ICHING HSID, KETTY (626) 641-6115- 8,770 I "')
19729 VALLEY ST
ITEMP 917800000 FEES PAID N OF WORK
TEAR OFF RE ROOF WITH 30 YR TIMBERLINE UNDERLAYMENT 30 LB
FEE DESCRIPTION QUANTITY UOM AMOUNT PAINT FASIA BOARD FRONT FOOD AND REPAIRS
(APPLICANT TEL NO I I
(CARDENAS, APOLIMAR (626) 375-9842- IAA BLDG PERMIT ISSUANCE 27 80 1 I
IAB STATE GREEN BLDG FEE 8770 00 VAI, 1 00 ISPECIAL CONDITIONS
AC STRONG MOTION RESID 8770 00 VAL 0 90
D2 PERMIT W/O EN-HC 8770 00 VAL 199 80
TOTAL PEES 229 50
ICONTRACTOR TEL NO
APPROVALS DATE INSPECTOR SIGNATVRE
1CARDENAS GENERAL CONSTRUCTION (909) 469-6285- I 1 4
1652 LORRAINE AVENUE LIC NO (LOCATION AND SETBACKS 1
POMONA, CA 91767 926051 ]
SOILS ENGINEER APPROVAL
]ARCHITECT OR ENGINEER TEL NO I (FOUNDATION/TRENCH FORMS
LIC NO SLAB/UNDER FLOOR
(RAISED FLOOR FRAMING
(MAP NO SEWER MAP BOOR PAGE FIRE ZONE CMP1UVDERFLOOR INSULATION
1153H269 3 001
I IFLOOR SHEATHING I ]
ING OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I .(
] 0 NO 21 1 IROOF SHEI
SCHOOL WITHIN HAZARDOUS ISHRAR PANELS
1AIR QUALITY 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION ]
FIRE SPRINKLER HANGERS
_IINSUTATION/WEATHER 51RIPI ]
I{
11NTERIOA (ATH/DRYWALL I 1
I ]
1 ]EXTERIOR LATH I I I
] (RATED FLOOR/CEIL ASSEM
(RATED PALL. ASSEMBLIES ] I
Iw+TED SHAFTS/OPENINGS
IT-BAR CEILINGS
\ ' ADDITIONAL DATA ON FILE
]
I I II,CF DRAINAGE I I
IREPORT ID DPR261 ROUTE TO BS0508 1 I I
I I I I I I