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Home My Public Portal About9721 WEDGEWOOD ST_Building__ �l�AfdJBA CE b803 12/69 be �,_ a• APPLICATION FOR BUILDI G PERMPr �. COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS • . COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print ort a onl CROSS ST. BUILDING DISTRICT NO. GRO TYPE R SS Y ADDRESS CONST. STATISTICAL CLA SIFICATION SEWE MAP C��__;�'L__ LOT NO, BLOCK CLASS NO. 0 DWELL.UNITS BK PG/a TRACT (,�� I USE ZONE MAP j) /I• NO.OF BLDGS. NO. SIZE OF LOT NOW ON LOT d 1 SPECIAL USE OF I CONDITIONS EXISTING BL G. TEL OWNER NO . / BLDG.SETBACK FROM ADDRES ( FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITE O TEL. + d2v _ c20 ENGINEER NO. BLDG. ETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CONTRACTOR NO, HIGHWAY WIDTH FROM C.L. ADDRESS NO + = G LIC. C CITY CLASS CORNER CUTOFF YES ❑ NO ❑ CONSTRUCTION LENDER c NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS t ADDRESSid t-:r j 4 SQ. FT. NO. OF O. OF NEW ® /C�� z SIZE ,STORIES FAMILIES ADD ❑ `, V L / 0Lj USE OF STRUCTUFlE jfiALTER ❑ Q SIGNATUREO REPAIR❑ APPLICANT „ DEMOL ❑ " VALUATION 5 . APPROVALS DATE INS CTOR'S IGNA TU RE P.C. f/� PMT. FOUNDATION: LOCATION P FEE 3 p FEE S (�� FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ TN19 APPLICATION BRACING BOLTSJA AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF. THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COM ENSAT ON INSURANCE. LATH, EXT. SIGNATURE OF I;LaHOUSE NUMBER COR- C� PERMITTEE 7 RECT AND POSTED l ADDRESS ` FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATIONCK. M.O. CASH' I ►L!'.. 6 2 4 6 AUG 10 2 3 D 8 2.8 0,& 4 \ I Rr., 6 7 6 IR SEP 15 1 D_ 13 8.0 0- �- APPLICATION FOR •BUILDING PERMIT FC*'AP_P, ICANT TO FILL IN (Print or type only) TEMPLE CITY ADDRESS721 E Wedgewood St. COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER cle Cit ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SNOW ON LOT ADDRESS T7� / BLOCK LOT NO � LOCALITY L NEAREST OWNERH A Todd NO. CROSS ST. .. ASSESSOR ADDRESS - 9721 E Wedcfewood St• MAP BOOK PAGE PARCEL. I DISTRICT FIRE ESSED BY CITY Temple City ZIPJ.P!;3CYPSE NT. ZONE ARCHTEL ENGINEER IT OR Knowlton NO.EX3-302 �Oo STATISTICAL CLASSIFICATION S WEIR MAP ADDRESS1220 • CLASS NO / DWELL,UNITS BK42'�PG VY CONTRACTOR • TEL.rflo_ co US ZONEFN , ADDRESS 11901 Inblewood NO, ..! ECIAL LIC. 1 NDITIONS CITY Hawthorne CLASSC-61 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH none BLDG.SETBACK FROM I FRONT PfIOP.LINE OF (STREET) L ADDRESS CITY L_ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD L SQ, FT. NO. OF NO. OF CHECK FRONT PROP, LINE HIGHWAY WIDTH SIZE 208 STORIES FAMILIES ONE CF DESCRIPTION OF WORK NEW ❑ + ADD ® BLDG,SET 16'X13' Patio Cover SIDE PROP.LINE OF (STREET) ICBO#k2138 ALTER ❑ HIGHWAY + YARD _ TOTAL SETBACK FRO YPE OF EXISTING V REPAIR❑ SIDE PROP. LINE HI AY WIDTH USE OF EXISTING BLDG, Residence DEMOL [:] + APPLICANT Airflo TEL 973_540 CORNER CUTOFF YES ❑ NO ❑ (PRINT)) N0. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ 500. 1 CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE_ OF CALIFORNIA IN RELATING TO ,WORKMEN'S COMPENSATION I URANC E. G2R 'C-/�'•�✓/ ez If" SIGNATURE OF PERMITTEE ADDRESS ~J ,gyp//) CITY NOL DIA .E / 1— 7// B Y •/ / , MAKE CHECKS PAYABLE TU: FEE �• FEE HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDA NGASH / PERMIT VALIDATION CK. M.O. CASH 5 3 3•Z"JUN 2 D 7•2k, 401 5 3-4L*T_JUN 14 1 D 1 2.0 0 A98 7GA638A CE9803 7/73 - - ' i APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUII_2DIp ADDRESS � I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 0� � or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800, b.C.) T Policy No. Company �C T�/�J Y �P ZIP LOCALITY _ SIZE OF LOT NO.OF BLDGS,NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ,'Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date-9-1—,!(—OApplicant / ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER COMPENSATION INSURANCE Gs�! �/ WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS f- O�E• DISTRICT GROUP TYP ONST. FIRE ZONE P ESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY ZIP is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL N0. d Q �J become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE 70 APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. 4f.2/' 2 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION /GO �� SIDE CITY L .� LIC.<_3 PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIDE NO.OF STORIES NO.OF FAMILIES Professions Code,and m lic se is in full force and eff cp, NEW BK PG , }L 6��06 C 3 DESCRIPTION OF RK ADD ❑ VALUATION License Number Lic.Clasgs �+ 1 Q Contractor c 60 Date / —/ ALTER ❑ $ V f cc ❑ I am exempt under Sec. u•XI 15�0U 6^ 'b z� REPAIR ❑ $ 0 BAP.C.for this reason C� / DEMOL 11 LDMA PIC# U Date: USE OF EXISTING BLD 15PURM ❑ 1 O_ �' 04 ACCT � � Signature APPLICANT(PRINT TEL NO. C� LDMA Perm# Z ❑ I, as owner of the property, or my employees with wages as .d Z 3303 158.85 their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and b Ga FINAL DATE a 1 IT01S Professions Code.) WILL THE APPLICANT OR FUTURE ILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ! TOTAL �` OROA MIXT RE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE o 85 ❑ I, 8S owner of the property, am exclusively contracting with AMOUN PECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �J licensed contractors to construct the project (Section 7044, YES NQ❑ t#tECI: 158085 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHANGE �j OCCUPANT REQUIRE A PERMIT.FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH a�y CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDEUN S. I hereby affirm that there is a constriction lending agency for YES W NO❑ O� _��01 �, �'� C4 the performance Of the work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING +y �y {r� a 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, G 17D 1 Al 111 a O76 TITLE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATER VILS EPORTING OBTAINING=HE SCAOMD o Lender's Address v J C) OWNER OR AGENT c I certify that I have read this application and state under penalty 4 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE / J� N with all county ordinances and State laws relating to building •J construction, and hereby authorize representatives of this County ISSUANCE FEE ✓Q ato enter upon the above-mentioned property for inspection pu poses. , W INVESTIGATION FEE TOTAL FEE Iwa a Apµanl m Ap• D:2o SEE REVERSE FOR EXPLANATORY LANGUAGE