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HomeMy Public PortalAbout9537 WEDGEWOOD ST_Building__ COUNTY OF LOS AN 'AP,PL I CAT 1 O N FOR DEPARTMENT OF COUN YGENLEM r NEER B U I L D I N G PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING �r+ � ADDRESS a P IXC.�g LOCALITY L p CITY Q , ZIP V CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT9d4y A7- NOW ON LOT MAP BOOK PAGE IPARCFh :U 17.4 tr DISTRICT IGROUPITYPE FIRE OC D BY TRACT �.00K i6Ia2 LiLOT NO. /D� CONrS E TEL. C� 4 OWNER j NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ,3 r�G �fegl9G CLASS NO.�DWELL.UUNITS BIN a CITYTe- 1 ���t ZIP 6 USE ZONE NOP __Doll ARCHITEC OR TEL. SPECIAL ENGINEER �' NO• 7� NDITIONS ADDRESS ®^ ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR TEL. BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) L ADDRESS err NO. HIGHWAY i• YARD TOTAL SETBACK FROM TYPE OF HIGHWAY EXISTING TN LIC. FRONT PROP. LINE CITY _--_ CLASS�`�' _ CONSTRUCTION LENDER + NAME AND BRANCH nl Cr. 11 hil A14 a BLDG.SETBACK FROM ADDRESS 4 �[ �`/ CITY P9�,S ( SIDE PROP.LINE OF (STREET) SQ. FT. NO. F NO. OF CKECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING LY SIZE 7 STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY1 WIDTH DESCRIPTION OF WORK 11= - NEW- K3.. + v &A`!7 + • ADD IN CORNER CUTOFF ES ❑ NO ❑ Z p / ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ + ^� EPAIR❑ USE OF • 1 IN COASTAL.PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. �! ((� tejee. DEMOL ❑ APPLICANTTEL (PRINT) D F- B M N0. BY (SIGNATURE) 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. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT THAT ANY PERSON IN VIOLATION OF THE / LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMP TION INSURANCE.. SIGNATURE OF v FINAL / BY PERMITTEE DATE ADDRESS CITY ` _ 1, C TEL. P.C. Fee$ �a(S� Permit Fee NO. + QQ�r}c�DN� 9� �' f� lqf ��' Issuance Fee VALUATION$ 4r �' ,� (f. 7�d rI a Total,Fee • PLAN CHECK/VALIDATION Q. CASH PERMIT VALIDATION CK. M.O. CASH 7 .8 5 ,Aab - _ I -.266�IXV 12 1 U 136.50 A� 2 6 5 6i#043 1z 52 3 D 4.0 5 A - - APPLICATION I CATION DING .FOR COUNTY OF LOS ANGELES I DEPARTMENT OF COUNTY ENGINEER U I- BUILDING AND SAFETY DIVISION. BUILDING FOR APPLICANT TO FILL IN ADDRESS `,7 BUILDING �y w ADDRESS ✓ I �I.� U�.. LOCALITY .... ,I� NEAREST CITY 11vZIP 940 CROSS ST. N6.OF BLDGS. ASSESSOR I SIZE OF LOT9,0/ J7e NOW ON LOT _s MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ESSED BY TRACE ESO# BLOCK LOT NO. hr �')-" CO g�CC TEL. J `/ OWNER A )[ CLASSIF CATION SEWER MAP ADDRESS Sri WgS_/jtR 6d& CLASS NO. —2 DWELL.UUNITS BK/ &G yid 'USE;ONE NOP {� 49CITY ' ` ZIP FF ARCHITECT OR TEL. 11 SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL. BLD SETBACK FROM CONTRACTOR �....�.�++"� NO . LIC. FRO T PROP.LINE OF (STREET) ADDRESS NO. HIGH Y + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP: LINE HIGHWAY WIDTH CITY --- CLASS _ CONSTRUCTION LENDER + ' NAME AND BRANCH a . BLDG.SETBACK FROM C ADDRESS SIDE PROP.LINE OF (STREET) L SQ. FT. NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM E OF EXISTING Cr SIZE2214D I STORIES FAMILIES ONE SIDE PROP. LINE HI AY WIDTH F t _ t 4 DESCRIPTION OF WORK NEW [Ell + �-e �+ � ADD ❑ CORNER CUTOFF YES ❑ NO ❑ Z ' S ALTER ' 7 e Ca r 12 d REPA R❑ IN OPEN SPACE YES ❑ NO ❑ USE OF COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. DEMOL f , AP PRINT)NT �e �yJL"- �Ijjr-0 ` ��f-.F. BY (SIGNATURE) I HEREBTEY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION j{�] Qft' r� �.pV��� ��.�i U..J/•i'(,�(.�j (,�Z'-< AND STA 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 f'- /�(I f �.�,�)S _Al2 {�...0 oa lavc) HEREBY IrWILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR ODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPE TION INSURANCE. SIGNATURE PERMITTEE OF FINAL B /I� _JDATE G/ ///,,,��� �! ADDRESS .C: Fee$ Permit Fee Q Issuance Fee VALUATION•P �G V Total Fee PLAN CHECK VALIDATION CK. M.O. CASH I PERMIT VALIDATION'M.O. CASH 3 5 4 LIZ,IUL-29 1 0 6.0 0 e96 76AG38A C9*8096 I1/75 veep- �. + IORgRS'COMPENSATION DECLARATION + r APPLICATION FOR BUILDING PERMIT J1 r + t j!affirm that have a certificate of consent to self br a certificate of Workers'Compensation Insurance, or a certifieu copy thereof(Sec. 3800, Lab. C.), COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR AFPLICAI�IT TO FILL IN BUILDING SYr3 �L1 ❑ Certified co is filed with the count building inspec- ADDRESS PY Y 9 � P BUILDING tion department. ADDRESS 9537 - W43 Wedgewood Ave Date Applicant CITY Temple City ZIP 91780 LOCALITY A& ' CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT 90 r t OW ON LOT 3 CROSS ST. (This section need not be completed if the permit is for one TRACT 9281 Mis. WMA — LOT NO. 12 ASSESSOR hundred dollars($100)or less.) MAP BOOK PAGE PARCEL TEL. USE ZONE MAF I certify that in the performance of the work for which this OWNER Darrel & JoAnn Beaman NO. NO permit is issued,I shall not employ y er n in any manner 9537 Wedgewood Ave SPECIAL so as to be ome s ject to the Wo ers' o pensation Laws. ADDRESS CONDITIONS 0 I ,/►M CITY Temple City ZIP 91780 Date ` Applic t d` v 09 NOTICE TOA LICANT: If, aft aking this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCES ED BY O ENGINEER —j]— NO. F` Exemption, y u should becom subject to the Workers' CONST ZONE Compensation provisions of the Labor Code, you must forth- t 1V/ ADDRESS with comply with such provisions or this permit shall be in TEL. STATISTICAL CLASSIFICATION APT. C NDO. deemed revoked. CONTRACTOR —0— NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK VALIDATION SQ.FT. NO.OF NO OF CHECK License Number Lic.Class SIZE 504 STORIES 1 FAMILIES 1 ONE VALUATION Contractor Date DESCRIPTION OF WORK NEWGa504 S ADD $ /� f✓ i)0 V Garage .F ADD ❑ (/` V 01111"❑ I am exempt under Sec. g ALTER ❑ B.BP.C, for this reason Remove existinq wood structu IRFAIR ❑ $ Date: USE OF aoo enclosed patio oJ1 11XN DEMOL EXISTING BLDG. 0 Signature APPLICANT — DATE I hereby affirm that I am exempt from the Contractor's License 953] Wedgewood T.C. 91780 # 0 0 0 0 0 Law for the following reason (Section 7031.5, Business and ADDRESS gFIN Professions Code): PRESENT 0 &8 8 BUILDING ^ n I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and o 0 1 2&88c' the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. Q 1,0 7+-v�7 ❑ 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). CONSTRUCTION LENDING AGENCY SEETTBACK YARD HWY TOTAPREOTPAINEFRO 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 g P.L. Lender's Name P.C. Fee$ permit Fee L 3 Ref. # Lender's Address r pop. I certify that I have read this application and state that the Issuance Fee 10,5© LDMA P/C# above information is correct. I agree to comply with all County Investi atian Fee cX� ordinances and State laws relating to building construction, g Total Fee r+ LDMA Perm. # and her by authorize re re ntatives of this County to enter 4 upon ove-menti a roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A611cont or Agent Date 0