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Home My Public Portal About5329 WELLAND AVE_Building__ Q 6AG38A CE 0803 1/71 �•r ' APPLICATION FOR BUILDGRM COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DMSION BUILDING ADDRESS 573 COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY dO04�� FOR APPLICANT TO FILL IN NEAREST Print or tvDe onl CROSS ST. BUILDING DISTRICT NX G TYPE P D ADDRESS �'y�� i �� O CONS O LOT NO. 49W 3 O BLOCK STATISTICAL CLASSIFICATION SEWER MAP O CLASS NO. DWELL,UNITS BK PG TRACT ? bo US ZONE MAP ^ NO.OF BLDGS. e, NO. , (/ SIZE OF LOT )(&/ NOW ON LOT ` s SPEC USE OF `�� i v CONDITIONS EXISTING BLDG. CEJ G� TEL. OWNER J NO. � BLDG.SETBACK FROM � ADDRESS L/L/�iz /�lL FRONT PROP.LINE OF (STREET) CITY ��( ��- W WIDTH FROM EXISTINGTYPE OF SdTBACK HIGHWAY + YARD = TOTAL H GHWAY ARCHITECT OR TEL. + ENGINEER NO. BLDG,SETBACK M ADDRESS SIDE PROP.LINE OF (STREET) CONTRACTO -dS'- .l fr �* �T15r ( ''! TYPE EXISTING SETBACK HWAY + YARD = TOTAL Q NO.O. ��77 T HIGHWAY WIDTH FROM C.L. V LIC + ADDRESS,- .� . .1�'7/. NO'. .7-67 0 = Q LIC. v CITY CX/ l�- CLASS 'S CORNER CUTOFF YES ❑ NO W NAME AND BIz RANCHNDE = + SEE REVERSES E FOR SPECIAL A ROVALS ADDRESS or SQ, FT. ,� / NO. OF NO. OF NEW ❑ SIZE cSTORIES FAMILIES USE ADD STRUCTURE ' ALTER ❑ SIIGGNATUR REPAIR[:] APPLICANT wiere.le�l DEMOL ❑ s- VALUATIONS APPROVALS DATE N3P TOR's IGN TUR. P.C. PMT, FOUNDATION: LOCATION FEE 5 FEE $ �� J FORMS, MATERIALS FRAME: FIRE STOPS, qy I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS f4" AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. "! `6-7 LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S NSA ON �� INSURANCE LATH, EXT. SIGNATURE OF � � HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS r FINAL JOHN F. LEWIS. PRI t►L STR AL ENGINEER PLAN CHECK VALIDATION CH. M.O. CASH _ PERMIT VA N CK. M.O. CASH cu LACo 4 6 9 3"- MAR 1 -D 5.2 5 78A620A C8#swii-66 APPLICATION FOR BUIL®INC PERMIIT - 1 COUNTY OF LOS ANGELES BUILDING , DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASBATT D.GRIFFIN.SUPT OF BUILDING CROSS ST. DIST RI O. G OUP PROC SED Y FOR APPLICANT TO FILL IN O sT. 7 I BUILDING2 ^� ADDRESS 3Rea= of �� N.Welland STATISTICAL CLASSIFICATION I SEWER MAP PG CLASS.NO. f DWELL.UNITS LOT NO. 30 BLOCK MAP [^ STATE YES O 10260 • NUMBER J HWY. TRACT ry U ONE SPECIAL SIZE OF LOT 71x26 r - I NO.OF BLDGS, 2 r CooCONDITIO NOW ON L07 ) USE OF Dwelling `�/al ./ EXISTING BLDG. g & Garage BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER Francis E. Watson AMAILDDRESS 5329 N. Welland FP.Lr 0 SIDE Temple City NO101 88009 P L, INSPECTION RECORD ARCHITECT OR TEL. -ENGINEER NO. ADDRESS TE CONTRACTOR Santa Anita Const. O. r7 ry/ ADDRESS AT f 9(�F�+ DESCRIPTION OF WOREeA- '�� r ��- - •�-�-� �+• NEWX ADD ALT ' REPAIR DEMOLISH /1 - - NO.OF SIZE gob + '210 arms"TORIES 1. FAMIILIES1 USE OF STRUCTURE tc/�� Dwelling, & Crarage-Atahed a v v SIGNATURE OF' APPROVALS APPLI CAN D TE INSP T0R'S SIGNATURE ADDRESS A - FOUNDATION: LOCATION �,. FORMS,MATERIALS 2- I ��- C j --- P.C. 11 / C 0 FRAME: FIRE STOPS, rA f FEE. / S BRACING.•BOLTS �• !2 VALUATION I $ FURNACE: LOCATION, r [-FEE GAS VENT.DUCTS l L 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND ` AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND V STATE LAWS REGULATING BUIYDING CONSTRUCTION. LATH,EXT. SIGNATURE OF HOUSE NUMBER.COR- PERMITTE RECT AND POSTED ADDRESS71Z Ai4- FINAL �! CLYDE N.DIRLAM,PRINCIPAL STRUeMRAL ENGINEER PLAN CHECK VALIDATION cK M.O. CASH' PEMW VALIDATION K. M.O: CASH, LACo7 0 1 2 NOU.2 6 2 3. A 1 5.0 O A M L�Co? 480° Q '&E_C11 1 A 30.00 10 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN '$UILDIN ADDRF.- 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 1 �`�C copy thereof(Sec.3800,Lab.C.) ZIP rf � C,j (�� LOCALITY Policy No. Company SIZE OF L T NO.OF BLDGS.NOW ON LOT i ❑ Certified copy is hereby furnished. NEAREST CROSS BY ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL ��/ o SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER COMPENSATION INSURANCE Den 0 1,5C -?q WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) rsn - DISTRICT GROUP IVECONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit Y,rli-'�0 f ZIP I �� 'D� is issued, I Shall not employ any person in any manner s0 as to ARCHITECT OR ENGINEER TEL 6 7 S become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. al 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 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS 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 SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW oo' BK PG v DESCRIPTION F WORK VALU ON License Number Lic.Class �j (r0/�f & ADD ❑ p Contractor Date ALTER ❑ $ �Q v W El REPAIR ❑I am exempt under Sec. t � z fi BAP.C.for this reason Q j/IVG r-,� DEMOL ❑ LIMA P/C# Date: USE OF EXISTING BLDG. URM ❑ S• ature APPLICANT(PRINT) TEL NO. LDMA Perm# as owner of the property, or my employees with wages as Z {r r y their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? _ licensed contractors to construct the project (Section 7044, FINAL BY > _-�� ,_ Business and Professions Code.) ves❑ No❑ Ci �.-20 o 6=� WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ;:irt'ECK CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES °.p 15•If9= I hereby affirm that there is a construction lending agency for YES 11 NO❑ P! CM m the performance Of the WOTk for which this permit IS ISSUed(Sec. 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING C43097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. N TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS 5/2 ;:{v+: Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. -• A-u• Lender's Address =k yti) C OWNER OR AGENT o I certify that I have read this application and state under penalty n� C of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE C11 with all county ordinances and State laws relating to building CO const ion, and hereby authorize presentatives of this County ISSUANCE FEE / ato er u on the above- entio Perty for ins pec`o�n uryo INVESTIGATION FEE TOTAL FEE /� �. 7 !J.y / �r um o uticmA m A9mt Dme SEE REVERSE FOR EXPLANATORY LANGUAGE