The URL can be used to link to this page

Home My Public Portal About5321-5323 VILLAGE CIRCLE DR_Building__ APPLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DNI ION FADDRBUILDING ✓ .y -� E R APPLICANT TO FILL IN ADDRESS p!� 323 ViLLL1 G C .6 LOCALITY � ZIP �+ NEAREST�-% CROSSST.NO.OF BLDGS. ASSESSOR NOW ON LOT MAP BOOK PAGE PARCEL DISTRICTROUP YPE FIRE kSED BY �O BIe6GK LOT NO. Dyy //OWNER �.11,( T�} NOLIC8C:-1Z/J STATISTICAL CLASSIFICATION SEWER P ADDRESS 55ZS VILLN L CL L_j;;7 F-. CLASS NO-4tDWELL.UNITS BK PG MA CITY E"V.IjF.7 Cj--t-j Cl--t-jZIP 178'0 12USE ZONE NOP C20 0 ARCHITECT OR TEL. �� SPECIAL ENGINEER NO• CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR ' NO BLDG.SETBACK FROM LIC. FRONTIPROP.LINE OF (STREET) ADDRESS NO. HIGH t±:: TOTAL SETBACK FROkTYPEHIGHWOF AY E I DTING LIC. FRONT PROP. LINEWTH CITY CLASS _ CONSTRUCTION LENDER a NAME AND BRANCHIf BLDG.SETBACK FROM c ADDRESS.:ZrZ CITY SIDE PROP.LINE OF (STREET) C: SQ. FT. - NO. OF NO. OF CHECK HIGHWAY YARD = TOTAL SETBACK FROM TYP OF EXISTING C SIZE STORIES •7 FAMILIES ' ONE SIDE PROP. LINE HIGHNY WIDTH DESCRIPTION OF WORK NEW + y LN O COVa ADD CORNER CUTOFF YES ❑ NO ❑ poM ALTER ❑ REPAIR❑ IN OPEN SPACE YES ❑ NO ElUSE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG.. - L4 , DEMOL E31 J % /J APPLICAN A ' TEL. `1 ,, 1;4/ l7/ 1PRI NT) �(,r3, 1+�1�TJa�•= NO.�;-,8&-1Z7 17/ BY (SIGNATURE) l � � •t ��/•"J I�f� (�{rOn/'C- C/J��i,.`�✓ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE 1 LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPS ATION INSURANCE. SIGNATURE OF FINAL �r PERMIT. DATE ADDRESS J3 I�► -� /+ TEL. CITY 1��`'dE CITY NO, P.C. Fee$ Perr Issuance Fee VALUATION$ � �� E=« Total Fee /Z PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cm. M.O. CASH s s 3ro-Dec 2 :L D 1 2.0 0 ov.� 76AG38A C90803 12/75 , q APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING 53rZ I _23 Villa e Circle Dr BUILDING ADDRESS 1 r►• ADDRESS CITY Temple ZIP 9178n LOCALITY NO.OF BLOGS. SIZE OF LOT OW ON LOT �- NEAREST Baldwin GROSS ST. TRACT 29602 a LOT NO 1 ASSESSOR MAP BOOK PAGE PARCEL TE Op i DISTRICT GROUP TYPE FIRE SSED BY I OWNER m erial Savin S NO. -850 CONST. ZONA 1 ADDRESS 61 Soo Juke St. �� ` 91101 STATISTICAL CLASSIFICATION SEWER MP CITY Pasadena ZIP CLASS NO. 0 Z DWELL.UNI`�S-2:=1BK PG ARCHITECT � TEL ENGINEER .Rd Foerst 1 NO. _LAE ZONE@0.MA r�. ADDRESS 1 2 1 E. Railroad d a ECIAL TEL CONTRACTORN NO ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ ADDRESS10017 Green Sts No237 97 BLDG.SETBACK FROM CITYLIC• FRONT PROP.LINE OF (STREET) rpt- 11)1e City CLASS Bml CONSTRUCTI N LEND HIGHWAY + YARD = TOTAL SETBACfC FROM TYPE OF EXISTING NAME AND RANCH m e1 FRONT PROP. LINE HIGHWAY WIDTH B ADDRESS 6l Soo Lake CITY Pasadena. + CI- SQ. SQ. FT. NO. OF NO. OF CHECK BLDG.SETBACK FROM CD SIZE 305DI STORIES 2 1 FAMILIES 2 ONE SIDE PROP.LINE OF (STREET) C-� DESCRIPTION OF WOR /� f y�/� NEW HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF EXISTING CD -wiz•.', /0 SIDE PROP. LINE HIGHWAY WIDTH V ADD W New Development ❑ + _ O ALTER ❑ y Z EPAIR❑ CORNER CUTOFF YES ❑ NOUSE OF ❑ EXISTING BLDG. Single Family OL ❑ IN OPEN SPACE YES ❑ NO ❑ A PIP RINT BaldwinT0. 8- O IN COASTAL ZONE YES ❑ NO ❑ BY (SIGNATOR ENVIRONMENTAL CATEGORICAL EXEMPTION YES❑ NO ❑ / IMPACT EXEMPTION DECLARATION SIGNED (DATE) VALUATION$ 66 100 s 0 IMPACT REPORT PROCESSED (DATE) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED H B1^'I WILL NOT EMPLOY ANY PERSON IN VIOLATION F THE L BOR CODE OF THE STATE OF CAL,4PIN RE ING T6. W ' NSATION IN RAN 1 n SIGNATURE FINAL'; L BY PERMITTEE DATE . �lZ�7V ADDRESS 1001 Gr-An- Street $ -FEE $ 119-14 FEE TE CITY Temple City NOL. PLAN CHECK VALIDATION CK. .O. CASH PERMI LI IONCK. M.O. CASH 9 0 1 NFEB ;60 2 0 11 9.1 4 Bid 76A6386 CEIl803A�3 1 2• V�00T i4' 1 D 3 9 ?.13 dw 76AS38B CE*S03A,!,/,7,3A WORKERS' COMPENSATION DECLARATION I hereby coff cer that I have a certificate of consent to self APPLICATION F BUILDING PERMIT Insure, or a certificat of Workers'Compensate=,nssuurance, or a certif'ed co t eof(Sec. 3B00, b-T COUNTY O LOS ANGELES BUILDING AND SAFETY Policy No. Compan 1 T(l� 8� a ❑ Certified copy is hereby furnished. APPLICANT ILL I ADDRESBUILDINS Certified copy is filed with the county 'Id' ins p c- 5Rg tio�rn'7�depa�,r,t�ment.ate��-Applica 6 ZIP iez. �_ LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE v ASSESSOR (This section need not be completed if the permit is for one TRACT LOCK LO NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TERJel ?q94 i USE ZONE MAP OWNER N I certify that in the performance of the work for which this lNO. permit is issued, I shall not employ any person in any manner ADDR /p[� SPECIAL a so as to become subject to T ensation Laws. P CONDITIONS O CITY d ZIP Date Applicant i ARCHITECT OR DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of y ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' to Compensation provisions of the Labor Code, you must forth- ADDRESS ✓ N with comply with such provisions or this permit shall beTEL• STATISTICAL CLASSIFICATION / APT. CONDO. deemed revoked. CONTRA ebb No 1[J�� Z LICENSED CONTRACTORS DECLARATIONLIC. CLASS NO._ DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS! (commencing with Section 7000)of Division 3 of the Business 5 LIC. +SEWER MAP and Professions Code,a my li nse is infull force d ect. CITY }��, CLASS BK PG VALIDATION SQ. FT NO.NO. OF NO. OF CH CK License Number. Lic. Class SIZE t7®f/(J I STORIES CX FAMILIES O VALUATION Contractor �® Date stow " DES,CRIRIPfI F O ❑ $ ❑ �7" I ❑ ,I am exempt under Sec. ADD z ALTER BAP.C. for this reasonUSE OF: ;' EPAIR r. $ Date' EXISTING BLDG. DEMO ❑ Signat a APPLICAN j� TEL. /1��ln/ g OWNER-BUILDER DECLARATION (PRINT p/ NO. dG�' /(.� FINAL DATE � I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS r 0 FINAL Professions Code): PRESENT BY BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 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- ADDRESS tion 7044, Business and Professions Code.) _ REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency f FRONT the performance of the work for which this permit 1 ed P.L. (Sec. 3097, Civ. C.). SIDE Pk�/k .L. �. :., .. Lender's Name, LDMA Ref.# B P.C. Fee$ Permit Fee et-11d,11 } Lender's dress . 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# '- above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee / w LDMA Perm. # and her orize repr ntatives of this County to enter g on th ab e- ion pr e t for inspection purp sess. o ! A SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date