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HomeMy Public PortalAbout9729 WEDGEWOOD ST - Building ADBS-8 1.55 APPLICATION FOR BUILDING PERMIT f•85 DIVISION OF BUILDING AND SAFETY BUD elsN wa �000� Deportment of County Engineer epi County of Los Angeles LOCALITY JOHN A. LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN Z_ 'r Al—' /2 G CONST BUILDING 7 � ,,+ A p ADDRESS / �� Tom. we-do a wo0c1� MAP NUMBER n 0O0 STATE HWY YE O LOT NO. /V, /ZO/ OF S. (Sa/O F�`� ✓ USE ZONE SPECIAL ©©,�}}r+ CONDITIONS TRACT A4I S S/OV/ ,! ;Lei r7 Kik jF.Tl �®O O NO.OF BLOTS. dBUILDING EXIST. SIZE OF LOT S70 \,e-/ Q NOW ON LOT YARD HWY STREET NAME USE OF SETBACK WIDTH EXISTING BLDG. FRONT P.L. OWNER SIDE MAIL P,L. ADDRESS 1 DWELL. 1 UNIT 6 PUBLIC BLDG. ARCHITECT OR TEL. 2 DUPLEX 2 UNITS 7 ADDN.,ALT., ETC. ENGINEER NO. 3 APT. UNITS B MISCEL. ADDRESS 41 COMMERCIAL 1. CONTRACTOR NO. INSPECTION RECORD ADDRESS rlt DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH r G\11 EV45-66 t,_w°f�R af{r-- SQ.FT NO.OF NO.OF SIZSTORIES FAMILIES /�-� (� .+� 0( ft • J�-7— USEsOF$TRU�T�U`_F, �.... IS I vla►r�� F� 1y/�� al.� -�.d� Al,_,i>PL I� • T_1'i R r k:1`f— oZ0 x g C'� h1 CI �7 ► l n � D�r9.c,.. SIGNATURE APPLICANT APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION'LOCATION fI OO P•C• $ 050FORMS,MATERIALS I�// 0l.✓/1� o.e.sv FEE a�I ! "ems FRAME: FIRE BOLTSS. r— VALUATION FEE $�S ap'° FURNACE: LOCATION.,/ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT.DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT r�/), AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. tiL I�_ �Pit e. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. ^ LATH. EXT. u ' - SIGNATURE OF HOUSE NUMBER COR- _Z PERMITTE RECT AND POSTED 07 ADDRES FINAL OHN A.LAMBIE,COUNTY ENGINEERATION CLYDE N.DIRLAM. CHIEF BLDG. INSPECTOR' d-501. CASH 5 5 3 5° I!PP,2 7 1 6 17.5. 0 A i � '315-00 >n 5G0 / � _ V 9 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PER T or a certified copy thereof (Sec. 3800, Lab. C.) Policy NoRCS 13788f�ampany Royal Ins. CO. .TOB #2011 COUNTY OF LOS ANGELES BUILDING AND SAFETY Cir ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING MCertified copy is filed with the county building inspec- BUILDING ADDRESS 9729 Wedgewood Street R tion department. ADDRESS 9729 Wedgewood Street Temple City, 91780 • Date 2/16/84 Applic CITY Temply City ZIP 91780 LOCALITY CERTIFICATE OF EXE-MpT16 FR M WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT D X I Z J NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ;U/�,6t — M r I [)Or ASSESSOR hundred dollars ($100)or less.) TRACT rY BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER ARTHUR PERLENFEIN No. N/A USEZONE MAP I certify that in the performance of the work for which this rJ0 } permit is issued, I shall not employ any person in any manner ADDRESS �f� 9729 Wedgewood Street SPECIAL 0. so as to become subject to the Workers'Compensation Laws. �! '! C CONDITIONS O U Date Applicant QTY Temple City ZIP 91780 a NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL.ENGINEER NO. DISTRICT GRTYPE FIRE U Exemption, you should become subject to the Workers' r ,/ CONST. NE O OUP PROCESSED BY NE U Compensation provisions of the Labor Code, you must forth- —� W with comply with such provisions or this permit shall be ADDRESS 3 iP 1T 00 ri H deemed revoked. CONTRACTOR CAL-PAC ROOFING Ittib. 9240805 STATISTICAL CLAS�SIIFIC7TION APT. I CONDO. Z LICENSED CONTRACTORS DECLARATIONLIC CLASS NO. " DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 618 N. Eckhof f St. NO 379503 mmow (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 Temple Citv CLASS B - BK. /V PG. VALIDATION SQ. FT. NO, OF NO, OF CHECK License Number •3 9503 Lic.Class B SIZE STORIES FAMILIES ONE UATION ❑ $AL 7,980.00 Contr 2/16/84 DESCRIPTION OF WORK RE-ROOF WITH DEC NEW ❑ 1111111.❑ I am exempt under Sec. TILE 30 sq's ICBO 83409 ADD ❑ ALTER B.&P.C. for this reason REPAIR X❑ $ Date: USE OF EXISTING BLDG SINGLE FAMILY DWELLING DEMOL ❑ Signature APPLICANT TEL, FINAL OWNER-BUILDER DECLARATION PRINT) CAL-PAC ROOFING NO. 924-0805 DATE �'�.%''�- I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESSFINAL Professions Code): PR SENT By V— ❑ BUILDING I, as owner of the property, or my employees with ADDRESS "77 n Z Q wages as their sole compensation,will do the work and LOCALITY V the structure is not intended or offered for sole(Section 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 1 TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued PA_ (Sec. 3097, Civ. C.). SIDE a P.L. 'r lender's Name LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee • / �j �� ' - i I certify that I have read this application and state that the Issuance Fee 107-" X LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter LDMA Perm. # ( u the above-m�en d fDpert�forinspect urposees-.16/O'F SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Sig Lure of Applicant or Agent Dote