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Home My Public Portal About9529 WEDGEWOOD ST_Building__ FOA8984 CE„80810-68 APPLICATION FOR BUILDING PERMIT - 1 COUNTY OF LOS ANGELES ADD EISS 97y), 7 � Cl �'•' ,D 'Y eC W`° V DEPARTMENT OF COUNTY ENGINEER .f� BUILDING AND SAFETY DIVISION LOCALITY a JOHN A.LAMBIE,COUNTY ENGINEER NEAREST J CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST. L Y� 4- DISTRICT r ' DISTRICT NO. GROG UP Iy pE �� PROCCSS ED BY FOR APPLICANT�TO FILL IN _l -/- I CONST. I / L`T BUILDING STATISTICAL CLASSIFICATION I SEWER MAP ADDRESS SK PG CLASS.NO._�f_DWELL.UMTS Pr LOT NO. BLOCK MAPJr' NUMBER �� 0 ` STATE YES NO TRACT US5 ZONE SPECIAL. NO.OF BLDGS. �(J CONDITIONS SIZE OF LOT I NOW ON LOT ,..� USE OF �r�IO A EXISTING BLDG. BB LDING YARD HWY STREET NAME EXIST. OWNER �Y zn t,/ SETBACK , r ' WIDTH MAIL / r FPROINT ADDRES SIDE !/ TEL. P.L. CI NO' INSPECTION RECORD ARCHITEC OR . TEL. ENGINEER' NO. ADDRE§S �(w1 � .- 'CEL. CONTRACTOR O. ADDESS DESCRI ION OF WORK NEW ADD ALTER REPAIR DEMOLISH ;� � SFT. NO.OF t 1 SIZE STORIES STORIES FAMILIES USE OF STRUCTURE _;_E_ )� P J �l D "y SIGNATURE OF / APPROVALSf-opp APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION $ }�t FORMS.MATERIALS P.C. $ FRAME: FIRE STOPS. FEE �- BRACING.BOLTS VALUATION S FURNACE: LOCATION. FEE �. Q GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH.INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY WITH ALL COUNTY ORDINANCES AND LATH.EXT. STATE LAWS REG SLAT ILDING CONSTRUCTION. SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL (/, CLYDE.N.DIRLAM,PRINCIPAL TRUCTURAL ENGINEE PLAN CHECK VALIDATION CK. M.O. CASH MR=VALIDATION CK. M.O. , CASH 'LACo 8 4 1 4^ ,;uN 2 4 1 A 3.0 ° ®P BUILDING BUILDING y2��1 ADDRESS 1/V APPLICATION LOCALITY ` I NEAREST C to v�Y DIVISION OF BUILDING AND SAFETY CROSS ST. Department of County Engineer DISTRICT NO. RECEIPT NO. EMIT NOS County of Los Angeles / WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISy9UEDJ CA99ATT D. GRIFFIN, SUPT aF BUILDING FOR APPLICANT TO FILLIN TYPE CONST. RECEIVED BY 19 eG-B. OWNER iE.S id �4A`/6 MAP STATE ✓ MAIL ` T NUMBER HWY NO' ADDRESS G� ��/ USE ZONE SPECIAL CITY �iL1 �( 'Ci/'7 m t:iP7(®✓3T•fo �r CONDITIONS ARCHITECT OR' TEL. 7 C7��J ENGINEER NO. BUILDINGEXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS nn FRONT2D� a /qe Iv6 o J /a CONTRACTOR 4 1 jl /1 NOL• siDE I �Vl V Q r/ V P.L. / ADDRESS BUILDING DATE CORRECTIONS INSPECTOR ADDRE99ox- eG✓�`�6� w 0 0l� p N LOTNO.R/y� 117eS/?fa ' fl'o-AZLOCIC kC / /T y lj TRACTNO.OF SLO SIZE OF LOT �Y LOO 'D I NOW ON LOGS USEOF F_XIRTING BLOC. A'10 .5, ' -to DESCRIPTION OF WORK '°�`" '� n ' / NEW V ADD ALTER REPAIR DEMOLISH Z Sq.FT. NO. OF / NO.OF Y SIZE �/� O STORIES FAMILIES r USE OF STRUCTURE - �-�• NO.OF EMPLOYEES 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE IN GIVEN 19 CORRECT. APPROVALS INSPECTOR'S SIGNATURE DATE I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION AND STATE LAWS R ULATING BUILDING CO�NS�T��JtUCTION. FORMS,MATERIALS —/ FRAME: FIRESTOPS. SIGNATURE OF BRACING,BOLTS PERMIT TE _ FURNACE: LOCATION, OAS VENT,DUCTS ADDRESS LATH, INT. AUTHORIZED AST. a LATH, EXT. $ A�� .ef(� P•C•$ HOUSE NUMBER COR- / V FEE RECT AND POSTED VALUATION o-� FEE �� FINAL 76A638A DBS 3(3b S-54 I WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to Self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) I- 1 I COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No��4/0533?Iora�Company l , t') �G,'1's-ct (� � O� 11 Certified copy is hereby furnished. BUILDING 1 FOR APPLICANT TO FILL IN ADDRESS 9 d ,�1 Certified copy is filed with th co ty building inspec- BUILDING F/}d tion de artment. /�►�y�/) ADDRESS 4 oc Date Applicant CITY rr+•• -o ZIP 7 �� LOCALITY l C IFICATE OF EXEMPTI FROM WORKERS' O.OF BLDGS. NEAREST COMPENSATIO SURANCE SIZE OF LOT NOW ON LOT CROSS ST. a—mmiLA (This section need not be completed if the permit is for one I ASSESSOR TRACT BLOCK LOT NO. MAP BOOK WAGE PARCEL hundred dollars($100)or less.) I I OWNER O hA/ NO. USE NE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner -( I SPECIAL + so as to become subject to the Workers'Compensation Laws. ADDRESS s Q. CONDITIONS O U, Date Applicant CITY ZIP C4! NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO SSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. �)'+ CONST. ZONE U, Compensation provisions of the Labor Code, you must forth- ADDRESS "` � aE with comply with such provisions or this permit shall be �y� TEL. yI't STATISTICAL CLASSI IC TION APT. DO. N deemed revoked. CONTRACTOR • / f� NO. P & Z LICENSED CONTRACTORS DECLARATION ��yy,� LIC, CLASS IVO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS c A `�i A NO. 3U (commencing with Section 7000)of Division 3 of the Business and I LIC. SEWEYPP Professions Code,and my license Is in full force and effect. CITY ✓�a.�. CLASS BK. 10 VALIDATION �j 2 SQ.FT. NO.OF NO.OF CHECK License Number`` 36 41 - Lic.Class SIZE STORIES FAMILIES ONE �� VALUATION Contractor,,., Date 7 DESCRIPTION OF WORK In NEW ❑ $ J? 5DD 00%)ADD ❑ I am exempt under Sec. ALTER ❑ 010, B.BP.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL EXISTING BLDG. ❑ Signature APPLICANTj TEL.-7 FINAL OWNER-BUILDER DECLARATION PRINT �V l►N n.•c7:.S //NC�O. 1 O O j DATE 2 0 5 9.5 A I hereby affirm that I am exempt from the Contractor's License FIN 6 a N . c rI oY S l- Law for the following reason (Section 7031.5, Business and ADDRESS # 0 0 o a 0 1 Professions Code): PRESENTB BUILDING I, as owner of the property, or my employees with ADDRESS ° 16238 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, o a 1 6 2 3 8 I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 09.02-88 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROPLINECK FR WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name C LDMA Ref. N P.G.Fee$ Permit Fee J Lender's Address EI certify that I have read this application and state that the Issuance Fee ..� LDMA P/C p g above Information is correct. I agree to comply with all County Investigation Fee ordi antes and State laws relating to building construction, Total Fee LDMA Perm.fi a9 her y authorize representatives of this County to enter $ *Signature above-mentiongid property for Inspection purposes. i e � SEE REVERSE FOR EXPLANATORY LANGUAGE of Applicant or Agent to APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADS Ess f I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified 9529 E. Wedgewood copy thereof(Sec.3800,Lab.C.) CITY ZIP I AC3339 Alpine Ins. Co. Temple City, CA 91780 LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. �I Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 12-29-9 Applicant Virgin Roof Co. ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS 9529 E. Wedgewood DISTRICT GROUP TYP¢�$ONST. FIRE ZONE PROCESSED BY dollars($100)or less.) /,{/�� I certify that in the performance of the work for which this permit Temple City, CA CITY ZIP 91780 is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. QEW_L DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Virgin Roof CO. 287-0507 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL 600 S. San Gabriel Blvd. 160650 SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter s San Gabriel CA C39 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. 3400 1 NEW ❑ BK PG , > License Number 160650 Lic.Class C39 DESCRIPTION OF WORK ADD ❑ vALyanoN a Contractor n g� Vir iRoof C date 6-30-95 Tear-off and a 1 ALTER 1:1one layer $4013.00 C 112 ❑ I am exempt under Sec. #30 and Class 'A' Fiberglass REPAIR ❑ $ C BAP.C.for this reason Shingles. (34 S s.) DEMOL ❑ LDMA P/C# C Date: USE OF EXISTING BLDG. URM ❑ a Dwelliniz Signature APPLICANT(PRINT) TEL NO. LDMA Perm# _ L ❑ 1, as owner of the property, or my employees with wages as Virgin Roof Co. 287-0507 ZO fiL•r•I . their sole compensation, will do the work and the structure is ADDRESS --j 3 � 600 S. San Gabriel Blvd. San Gabriel FINAL DATE = ISL _ �'; •ill not intended or offered for sale (Section 7044, Business and r Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL — Z� S a OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY °—� licensed contractors to construct the project (Section 7044, I 1 1-L 1-37 a 40 YES❑ NO Business and Professions Code.) Jy- I i-- •r. WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING li D. ..7 l : OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH t• •� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR f:�#ANGE ,ijl F GUIDELINES 77��,, I hereby affirm that there is a construction lending agency for YES 11NO fel tN the performance Of the Work for Wf11Ch this permit IS ISSUed(Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMDPERMITTING Strlil-j— IsIJ1 1lF r71 :� 1 3097,CIV.C. CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, cm TITLE 2,CHAPTE 20 SECTIONS 2 20 THROU 2 20 140 CONCERNING HAZARDOUS j Lender's Name MATERIAL REP ANG AND FOR OB THE SCAQMD. +�4 ('�']10 n 4,, LrL r IL Lender's Address OHNE NT c 1 certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building construcon, and herebyauthorize representatives of this Count ISSUANCE FEE 'LO CD ,to me �pon the abo ention erty for inspection purposes W rop . T 12-29-94 W INVESTIGATION FEE TOTAL FEE 8' •t d .eat u 1 0.:.o SEE REVERSE FOR EXPLANATORY LANGUAGE