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Home My Public Portal About5403 WELLAND AVE_Building__ .2. TEMPLE CHTY U6311Ae3#110,32/00 APPLICATION FOR- BUILDING PERMIT . 1 COUNTY OF LOS ANGELES BUILDING E .3 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALI JOHN A. LAMME, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. �aA-+/T DISTRICT NO. GROUPyypE PR CESSED BY FOR APPLICANT TO FILL IN CONST. BUILDING �- STATISTICAL CLASSIFICATION SEWER MAP �• BK PG ADDRESS 0 6 / CLASS.NO. WELL.UNITS I '� LOT NO. a BLOCK MAPcq� __ STATE YES O y NUMBER-OHO-6HWY. TRACT �- 1 USE ZONE SPECIAL SIZE OF LOT 71.X. .67, �' I NO.OF BLDGs. CONDITIONS NOW ON LOT USE OF EXISTING BLDG. BUILDING YARD HWY EXIST. STREET NAME TEL /� ETBACK WIDTH OWNER .!O . ADDREssn- d mj &�pl 11 fa / 9'' SIDE ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECORD ADDRESS TEL. a CONTRACTOR y NO. O ADDRESS DESCRIPTION OF WORK • .f cR PSA � s�l�,/I.9'1��'�!+'.,+ �)7�.y:-..3s.'�ir z.'+ - �-' .1�1•C..'yfif:,.�< E'' " NEWDD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF t,r`.�t°;:; iM - • °3 �+!- lel �" p� SIZE 2 STORIES FAMILIES USE OF - ,,f s'i FrI/rb ixYA STRUCTURE t y I s z SIGNATURE OF APPLICANT VALUATION$ .�{ APPROVALS . d DATE INSPE&OR'S SiGIVATURE FEE $ I FEE. `/ FOUNDATION:LOCATION FORMS,MATERIALS /�f �XfL1r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME:FIRE STOPS, BRACING BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE:LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S COMPENSATION LAWS OFOfALIFORNIA. LATH,EXT. SIGNATURE.OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EOH PLAN CHECK VALIDATION cic. M.o. cAsa PERMIT VALIDATION cK. M.o. 0 : fila "� '� f . �� `' OF !TEMPLE CITY" 76A638A CE#8032-63 APPLICATION FOIA BUIL DING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY-.DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST L WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST. DISTR�T NO. GROUP ITYPE ESSED.BY FOR APPLICANT TO FILL INJ CONST.16 BUILDING 9 STATISTICAL CLASSIFICATION S ER MAP ADDRESS Q ' Z, C// BK g� CLASS.NO.!E rr DWELL.UNITS J 1. LOTINO. BLOCK WATER . NOT REQUIRED -RECEIVED ❑ CERTIFICATE: TRACT MAP HIGHWAY STATE MAJOR SECOND OCAL NO.OF BLDGS. NO rth (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE 9PECIAL USE OFCONDITIONS EXISTING BLDG. ^ A-I - TEL. OWNER NO. BUILDING YARD HWY S R ET NAME EXIST. SETBACK . WIDTH ADDRESS Q466 �' FRONT ARCH ITECT OR EL. P• L• ' ENGINEER NO. SIDE a ADDRESS P. L. tiZ�'D OV 1 TEL. CONTRACTOR • • D ♦ f�,y d' I O _ _ t ADDRESS ° V DESC• IPTION OF WORK I 044 z NEW ADvV ALTER REPAIR DEMOLISH SQ.FT.' N.O.OF NO. OF SIZE' STORIES FAMILIES , USE OF LL� 90� STRUCTUREjoza.,G .� a SIGNATURE OF J4 APPLICANT VALUATION S dp APPROVALS PATE31 INSPECT R'S SIGb0.A1fRE FOUNDATION:. LOCATION. / ) FEES �`� FEE S .-=-+ FORMS, MATERIALS FRAME: FIRE STOPS, 1.HEREBY'ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - GAS VENT, DUCTS BYILDING 'CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK A�°1THORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH, INT•. TION OF THE'LABOR CODE OF THE STATE OF CALF ORNIA RELAT- +TO WORKMEN'S COMPENSATION INSURA E'. >r tLATH.EXT. " SIGNATU F HOUSE NUMBER COR- PERMITTE Avz. RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRU'CT' L ENGI. ER PLAN CHECK VALIDATION CK. M.O. CASH. _ PERMIT VALIDATION CK. M.o. CASH 02553Q NOV14 1 D 6.0 ON IT WORKERS'COMPENSATION DECLARATION i hereby affirm-That I have r certificate of consent to self APPLICATION F®RBUILDING PERMIT insure, Br a certificate of Workers'Compensation Insurance, or a certified coy There Sec. 38", b. C.) �/�� J�� COUNTY OF LOS ANGELES BUILDI AND SAFETY Policy NYV ompan - -" �' BUILDING Certified copy is hereby furnished. FO APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- FADDRESS do depV�l / Date icant L' [ADDRESS ZIP —` s' LOCALITY C CERTI CATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE OF LOT NOW ON LOT CROSS ST. nJ (This section need not be completed if the permit is for one 2,(pv Z ASSESSOR hundred dollars($100)or less.) T 0 BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. ` USE ZONE MAP I certify that in the performance of the work for which this S J NO. d� NO. ` -�"2- permit is issued, I shall not employ any person in any manner Z SPECIAL so as to become subject to the Workers'Compensation Laws. ESS /� 666�� CONDITIONS O V • ZIP �d V Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of HITECT OR T L. DISTRICT GROUP TYPE FIRE PRO ESSED BY O Exemption, you should become subject to the Workers' NEER NO. CONST.J 13 Cov ZONE U Compensation provisions of the Labor Code, you must forth- RESS ✓t n with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. 00 � deemed revoked. TRACTO NO. LICENSED CONTRACTORS DECLARATION LIC, `` CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 4 oc NO. J __ R MAP _ (commencing with Section 7000)of Division 3 of the Business and LIC, AWE Professions Code,and my cense is i force and effect. CITY CLASS ' BK PG VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number U L Lic.Class SIZE STORIES FAMILIES ONE 7CIC-ool, NEW VALUATION Contractor Date C DESCRIPTION OF WORK ADD $ I am exempt under Sec. el 01111./ ALTER B.BP.C. for this reason REPAIR $ L./ Date' EXISTING BLDG. DEMOL 9 8 9 5 5 A USE Signature APPLICAN rj_I TEL. FINAL OWNER-BUILDER DECLARATION PRINT 7r//U O. DATA #$ 0 0 0 0 0 1 1 hereby affirm that I am exempt from the Contractor's License O�S J �� ( o 0 6 Q 5 0 Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT SIR Y x ❑ BUILDING 0 o 0 6 Q 5 0 5 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY ® 2 1 -88 the structure is not intended or offered for sale(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). Form CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.L NE 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 '? P.C.Fee$ Permit Fee LDMA Ref. N Lender's Address e L 1 certify that I e re application and state that the Issuance Fee V LbMA P/C R 2 above informs n i rrec I agree to comply with all County Investigation Fee ? ordinances to la rel Ing to building construction,, Total Fee66, il and hereb u orize r res tatives of this County o ent LDMA Perm.R upon ov -ment' ne roperty for inspection rpo s 0 ` SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signature o pplicant or Agent Dote 1 J , •'t• WORKERS'COMPENSATION DECLARATION •i ,he;e6;'or after that I have r certificate of consent to Self A P P L I CATION 'FOR BUILDING PERMIT ' insure, or a certificate of Workers'Compensation Insurance, or a certified copy thref(Sec. 3800, LobC.)� �r COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Company_ a//�� Certified copy is hereby furnished. F R APPLICANT TO FILL IN BUILDING d '3 � *Certifiedcopy is fil d with the county building inspec- BUILDINGrtment. ADDRESSDateApplicant CITY ZIP 1 t� LOCALITY ,41t�l ('JdV, ATE F EXEMPTION FROM WORKERS' 512E OF LOT 7/ L NOW ON LOTS NEARESST. COMPENSATION INSURANCECROSS (This section need not be completed if the permit is for one J.WASSESSOR hundred dollars($100)or less.) T BLOCK LOT NO. MAP BOOK PAGE I PARCEL TEL. USE ONE MAP I certify that in the performance of the work for which this OWNER NO. NO. 1 —} / permit is Issued, I shall not employ any person in any manner -SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRES ��•�^ CONDITIONS O Date Applicant CITY ZIP V g ARCHITECT OR TEL. �^ , NOTICE TO APPLICANT: If, after makin this Certificate of o� DISTRICT GROUP TYPE FIRE PROCESSED Y O Exemption, you should become subject to the Workers' ENGINEER NO. ^ CONST. t ZONE V Compensation provisions of the Labor Code, you must forth- ADDRESS �tQ "-9,) V W with comply with such provisions or this permit shall be D. deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. / CONDO. U) CONTRALTO NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. Q DWELL. UNITS'r 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, I SEWER MAP # 0 0 0 0 2 3 ' Professions Code,and y icense i ull force and effect. CITY '6 AV? CLASS BK � PG.// V LID SQ.FT (� NO.OF NO.OF CHECK License Number Lic.Class SIZE Q G/� STORIES FAMILIES ONE 98 Sr /��/ _ I NEW VALUATION i1v o a 4 8 5 9 8 Contractor pate l!O DESCRIPTION OF WORK ,ww.GIJ ; _ � ADD ❑ r 10,27-87 I am exempt under Sec. ALTER ❑ �r B.BP.C. for this reason ❑ $ (y7� REPAIR Date: USE OF DEMO' / EXISTING BLDG. ❑ Signature APPLICANT TEL. FINAL +3� OWNER-BUILDER DECLARATION PRINT /t{y�/Sd NO. a"� DATE �GQ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS �� g FIN Professions Code): PREbFN By BUILDING 9 6 7.9 R ElI, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and # o 0.0 0 0 1 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ® 1 - 827.25 I,as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- a a 8 2 7.2 5 tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK rj 2 4 2 8 8 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 P.L. (Sec. 3097, Civ. C.). SIDE P.L. •' Lender's Name - P.C. Fee$ �� • Permit Fee LDMA Ref, q Lender's Address ��) I certify that I have read this application and state that the Issuance Fee /0 ASD LDMA P/C N ' above info ation is correct. I agree to comply with all County Investigation Fee n I ordinanc srul to laws relating to building construction, Total Fee G— ar herbzis representatives of this County tp enter LDMA Perm.upon a ntioned property for inspection rpose . SEE REVERSE FOR EXPLANATORY LANGUAGE 51gn a of Applicant or Agent