The URL can be used to link to this page

Home My Public Portal About5317-5319 VILLAGE CIRCLE DR_Building__ APPLICATION FOR COUNTY OF LOS ANGELES �, I L D I N G PERMIT DEPARTMENT OF COUNTY ENG ER BUILDING A JD SAFETY DNISION BUILDING rd FOR APPLICANT TO FILL IN ADDRESS 5317 AV BUILDING,..�f 1 i� /r /l�` ADDRESS.S J/ - v I L�L yf c� C.l!P, i/ �c LOCALITY CITY i1� L Z �.e% Zip 17�v NEAREST CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GR YPE FIRE PROCESSED BY / �+ T ZONE TRAC gOZ C / LOTL�rN�O.�J1 TE OWNE . 6VAIDe-e L LaG N0.7 YV /O /ID STATISTICAL CL''AS''SIFICATION SEWER MAP ADDRESS %� CLASS NO�OWEL+L.UNITS CITY ZIP US ZONE ARCHITECT OR TEL. �� SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR TEL. BLDG.4EQTBACK FROM NO FRON P OP.LINE OF (STREET) LIC. ADDRESS Ad NO. HIGHW Y + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP. LINE HIGHWAY WIDTH CITY CLASS _ CONSTRUCTIONS NDER + NAME AND BRANCH BLDG.SECK FROM It ADDRESS CITY SIDE PROP.L OF (STREET) CC) SQ. FT./(,C) NO. OF NO. OF CHECK HIGHWAY + YARD = OTAL SETBACK FROM TYPE OF EXISTING 0' SIZE �v STORIES FAMILIES ONE S OP. LINE HIGHWAY WIDTH O DESCRIPTION OF WORK NEW + _ N ,rL °ove ADD CORNER CUTOFF YES ❑ NO Z ALTER ❑ REPAIR IN OPEN SPACE YES ❑ NO ❑ USE OF ❑ IN COASTAL PERMIT ZONE YES ❑ NO EXISTING BLDG. RQ DEMOL ❑ APPLICAA TEL (PRI NT)�i �'>6UxlOFR �� NO. BY (SIGNATURE) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- HEREBY 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' MP ION RANCE. SIGNATOR F FINAL �'• ��J BYGs�" "'Q'�—f'� PERMITTE DATE '' / ADDRESS �^ TEL. P.C.Fee$ Permit Fee CITY NO. QQ Issuance Fee VALUATION V Total Fee PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.. M.O. CASH 947r�--OCT 2.5 . 1 U' 15.0 ® a' 76AG98A CE#8098 1275 `,�� i r \/ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN Wrint or type only) BUILDING ADDRESS 5317-1Village Circle D BUILDING a1/ ADDRESS 5317-19 V111 Circle Dr. CITY Temple City Z, 91780 - LOCALITY t NO.01 SLOGS. SIZE OF LOT4.5 Acre SNOW ON LOT 1 NEAREST CROSS ST. Baldwin TRACT 2 6O ld of Ep LOT NO 1 ASSESSOR MAP BOOK PAGE PARCEL TE DISTRICT IGROUPITYPE FIRE ESSED BY OWNER Im erial Savings N0. 95 —880 CONST ZONE ADDRESS 61 SO Lake St. CITY Pasadena ZIP 91101 STATISTICAL CLASSIFICATION SEWER P GLASS NO.A Lt .DWELL.UNITS BK PG ARCHITECT OR TEL. ENGINEER Ed FO to NO. — USE ZONE MAP ��yy ,�,�� r� � NO. CxO 0 ADDRESS( 2 1 E Railroad City of SPECIAL TEL CONDITIONS CONTRACTOR NO — LOICC�� / ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ ADDRESS 10017 Green Ste Nc237497 BLDG.SETBACK FROM CITYLIC• B-1 FRONT PROP.LINE OF (STREET) CLASS CONSTRUCTION LEND Ej� HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING NAME AND BRANCH 1m erial Savings FRONT PROP. LINE HIGHWAY WIDTH 6 aeasadena + ADDRESS 1 SO o Lkmy P }. SQ. FT. NO. OF NO. OF CHECK BLDG.SETBACK FROM SIZE STORIES 2 FAMILIES 2 ONE SIDE PROP.LINE OF (STREETI CD/� NEW )J HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING DESCRIPTION OF WOR y'•µ./ v SIDE PROP. LINE HIGHWAY WIDTH U New Development ADD El } o_ a LTER ❑ ti �. CORNER CUTOFF YES EPA IRE] 1:1 NO ❑ Z ❑ USE OF EXISTING BLDG.S' ' EMOL C3IN OPEN SPACE YES ❑ NO ❑ AP(PRIG ) TELA A8_3907 IN COASTAL ZONE YES ❑ NO ❑ BY (SIGNATURE) `t`t 1\ ENVIRONMENTAL CATEGORICAL EXEMPTION YES❑ NO ❑ 4 IMPACT EXEMPTION DECLARATION SIGNED (DATE) VALUATION$ 69',100'.OO IMPACT REPORT PROCESSED (DkTE) I HEREBY ACKNOWLEDGE THAT I HAVE READ TNIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED tJ y�/�A r{•� or HERE _ 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION F THE r+L �.3 ....G�'_ '.4_ SS .r.,it._•- r.�•.. LAG. �b.E OF THE STATE OF CALIF IN REL NG'A,,TO WORK COM NSATION IN RANO,!�JX1 _ SIGNATURE O FINAL / BY PERMITTEE DATE G �� ADDRESS. Q IY FEE 119-14 FEE CITY Temple City No 8- 0 7, PLAN CHECK VALIDATION CK. M.O. CASH PERMIT A DATION CK. FJ.O. CASH 9 0 3-FEB 20 2 1 1 9.14 89b- 1 1 9 ro-OCT 119rOCT i4 1 397_ .13 ®�18 76A638B CENS03A 5/73 ' T IT APPLICATION FOR BI�ILDIIVG PERM COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS - I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 5317-5319 Village Circle or a certificate of Vlbrkers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3300,Lab.C.) Temple City 91780 LOCALITY Policy No. 625246 CompaoyBronco Roofing SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy Is hereby furnished. 1 2 NEAREST CROSS ST. GICertified copy is filed with t county buildin�,1;�ectl TRACT BLOCK LOT NO.��epartment. ty 7 USE ZONE MAP NO. Date 9-18-9 2 Applicant w l/ ASSESS/� OR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEM M ORKER � Village Circle HOA 818-967-7921 TEL WITHIN 1000 Fr OF SCHOOL? YES No COMPENSATIO SURANCE ADDRESS (This section need not be completed if the permit is for one hundredDISTRICT GROUP TYPE CONST' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit IS issued, I shall not employ any person In any manner so a3 to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION A" CONDO Date Applicant ADDRESS CLASS NO.-- 2- DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of �v REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR Bronco Roofing /zEN2632-1057 SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwithNQ FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS 1152 Kraemer Blvd. A4 93 7 P L LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE a PL V I hereby affirm that I am licensed under provisions of Chapter 9 Anaheim 92806 SEWER MAP OF STORES SIZE NONO.OF FAMILIES-FT. . (commencing with Section 7000)of Division 3 of the Business and SQ. FADD ❑ BK PG Professions Code,and my license is in full force and effect. 2900 344837 C39 DESCRIPTION OF WORK ❑ VALUATION Lu License Number Lim Classn. Tea of e i t'n f Contractor Bronco Roof3&, 9-18-92 Rk d,' Expires 5/94 Rerppf with Cal Shakes REPAIR ❑ ❑ I am exempt under Sec. S BARC.for this reason DEMOL 1:1LDMA P/C H Date: USE OF EXISTING BLDG. URM ❑ i Signature APPLICANT PRI LDMAPermN tr ( NT) TEL NO. AC-,7.? ❑ 1, as owner of the ro 9 Bronco Roofing 14-632-1057 0 477 �0� ;s p party, or my employees with wages as g 4L.._, i ,_� their sole compensation,will do the work and the structure is ADDRESS 11- not not intended or offered for sale (Section 7044, Business and 1152 N. Kraemer Blvd. Anaheim 92806 FINAL DATE e 1 I IEhl= Professions Code.) wILLTHEAPPLICANTOR FUTUREBUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL J� TC•']A�^,I 204.23 pp 23 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ) I;r'IL .e� "'P'e s.P ❑ 1, as owner of the property, am exclusively contracting with. THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ No❑ CHECK Business and Professions Code.) WILL THE INTENDED USE THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHANGE AGE OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit is issued(Sec. fi�t:6J- i j/51 3097,Civ.C. I HAVE READ THE HAZARDOUS SINFORMATION GUIDE AND THE SCAOMD ). PERMITTING CHECKLIST.I UNDERSTAND TAND MY RFAUIREMENTS UNOF3i THE LOS ANGELES i 19. COUNTY CODE,TITLE 2.CHAPTER 220SECTIONS 225,0.100THROUGH 22M140 CONCERNING _ 1 1 AM1 a25 is Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. RLender's Address OWNER OR AGENT o I certify that I have read this application and state that the above information Is correct. I a ree to comply with all county P.C.FEE PERMIT FEE Lz IF - ordinances and State laws I ting to building construction,and 741 bx authrepresan vas of this County to enter upon ISSUANCE FEE .Pem.orize an' n rop f ins n purposes. �L 9-18-92 INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE