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HomeMy Public PortalAbout5447 WELLAND AVE_Building__ 76A63SA CE#5091-62 APPLICATION FOR .BUILDINGPERMIT COUNTY OF LOS ANGELES BUILDING . DEPARTMENT OF COUNTY ENGINEER AD°REss .., BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER' NEAREST 1� WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. DISTR CT NO.. GROUP TYPE CESSED BY FOR APPLICANT TO FILL IN CONST.. BUILDING r I,1 ' STATISTICAL CLASSIFICATION EWER MAP ADDRESS J 7 BK CLASS. NO. DWELL.UNITS 1RG LOT NO. BLOCK WATER NOT REQUIRED RECEIVED ❑' /) CERTIFICATE: TRACTv MAP HIGHWAY STATE MAJOR SECOND,L A N .OF BLDGS. NO (CIRCLE) SIZE OF LOT �C NOW ON LOT 'USE ZONE SPECIAL., USE OF CONDITIONS EXISTING B G. / OWNER0_4.-iox 4E BfflUIIIfLDIINGEXIST. SETBACK YARD HWY STRE AME WIDTH ADDRESS FRONT ARCHITECT OR TEL. P: L• 16-0 ENGINEER NO. .SIDE P=L. A ADDRESS CONTRACTOR A', ART 1(60d 0 C ADDRESS �.' /, y'�o —e Cc Il- DESCRIPTION,.OF WORK L NE ADD ALTEB REPAIR DEMOLISH a SQ.FT. Q r• NO.OF NO.'OF SIZE. 3 STORIES AMILIE pp� USE OF t I �`l A STRUCTURE 4. SIGNATURE-OF APPLICANTfiX VALUATION$ 4610, 6 - �' } 1 > r •APPROVAdd ((),�y;��f-P DATr 1NSPECT,OR'S SIGN7IT�URE , P. 4. C. PMT. FOUNDATION: LOCATION FEE $ FEE $ "'FORMS, MATERIALS - FRAME: FIRE STOPS, �!� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS 6 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, . & WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS._ BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-- t' df J' •.f„/ tl" �.xi' LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN' OMPENSATION INSURANCE. //�J LATH, EXT. SIGNATURE I 1/ .. HOUSE NUMBER COR- f F Je r^ PERMITTEE RECT AND POSTED fp. -�a•R�.�j�� �a,-,� ADDRESS FINAL ,f^ d!&� m�'"'""�+aw�f,��� � JOHN F. LEWIS, Pf21NCP�AL STR URAL E15�GINEER PLAN CHECK VALIDATION cK. rq.o:. CASH _ PE, VALIDATION CK. M.O._ -CASH Lri�o 4 2 1 1 0 ';1iY 3 2 3 028.504, i~I;1.,0 7 8 4 V2.;,JUL 2 2 1. D 5 .7.b O . APPLICATION FOR BUILDING PERMIT FOR APPLICA TO FILL IN (Print or Type only) BUILDING COUNTY OF LOS ANGELES ADDRESS 5447 We 11and -DEPARTMENT.,OF COUNTY ENGINEER CITY em 1e Cit ZIP BUILDING AND SAFE DIVISION fi NO.OF BLDGS. BUILDING SIZE OF LOT 71� NOW ON LOT ADDRESS ' ,1 TRAC Marvin Lp OT NO2 LOCA LITTEREAREST _j L� ' OWNER Marvin CaS er NOL444-197 CROSS ST. ASSESSOR -1- ADDRESS5447 Welland MAP BOOK PAGE RCEL �+ DISTRICT GROUP TYPE FIRE PRO ;SSED BY CITYTem le lilt ZIP ^� CONST. /f Z NE(I ARCHITEC�pQ(� TEL. �. O1; L_ •rV/ ENGINEERt lof. Dev• Co NO. 445-356 r� �+ STATISTICAL GLASSIFIGATI t SEWER MA-P ADDRESS I2 S.Santa Anita AveCLASS NO.-C22 )DWELL.UNITSBK/I-.-PG CONTRACTOR Prof. Deve. CZ445-3560 USE ZONE NOP LIC. ADDRESS NSPECIAL O• CITY LIC. 3 CONDITIONS Arcadia CLASS Bl ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER r' NAME AND BRANCH Noae BL SETBACK FROM C FR NT PROP.LINE OF (STREET), C ADDRESS CITY HIGH AY + YARD .TOTAL SETBACK FROM TYPE OF EXISTING C SQ. FT 7� NO. OF NO..OF CHECK FRONT PROP. LINE HIGHWAY WIDTH F SIZE !/ STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ BLDG.S€TBA Tear out wallAa ulld ADD ❑ SIDE PROP.LINE OF (STREET) ALTERe REPAIR❑® _ TOTAL SETBACK FROM E OF EXISTING OO HIGHWAY + YARD - SIDE PROP. LINE HIG Y WIDTH USE OF EXIST NG SLOG-Residerice • DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ p IN COASTAL ZONE YES ❑ NO ❑ LPADDRE TION��4800.00 CATEGORICAL EXEM�TION YES❑ NO ❑ EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL - ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) _ ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE CODE OF T TA I OF CALIFORNIA IN RELATING TO EN'S COMP 8AT10 IN URANC E. i URE TTEE SS' FINAL s� BY da TEL. DATE V ' NO. MAKE_ CHECKS PAYABLE TO: FEE FEE RVEY T. BRANDT, COUNTY ENGINEER 1 1. , 2'• PLAN CHECK VALIDATION CK. M.O. `CASH, PERMIT VALIDATION CK. M.O. (CAf 4 9tt9gJUL '17 . 1 .0 1: 2:.0.0 A98 78AS38A CE9803 7/73 -' " y 8s 7SA638K CE/803 IREV.6/78) APPLICATION FOR BUILDING- PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN AARSS BUILDING ADDRESS 5447Tielldfid Ave• LOCALITY Tem le Cit 91780 NEAREST CITY P Y ZIP CROSS STNO.OF BLDGS. ASSESSOR. SIZE OF LOT 71 X 98.56 NOW ON LOT . MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P ESS Y TRACT 10260 BLOCK LOT NO. 20 CONST. Zj OWNER Mr. & Mrs. R. Stacey017, NO.575-1338 . �g STATISTICAL CLASSIFICATION SEVER MAPF ADDRESS CLASS NO. DWELL.UNITS F BK 14$ CITY Temple City ZIP 91780 ARCHITECT OR TEL. VALUATION $ ENGINEER NO. . ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF !STREET) CONTRACTOR NO. HIGHWAY + YARDTOTAL SETBACK FROM TYPE OF EXISTING LIC. - FRONT PROP.LINE HIGHWAY WIDTH ADDRESS 1p NO. _ LIC. + CITY CLASS CONSTRUCTION LENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OF � (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SO.FT. NO.OF NO.OF CHECK + _ fj SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ P.C.Fee$ ,[!J°' -� Permit Fee Open Patio ADD ❑ 116 � 7 Issuance Fee CA ALTER ❑ REPAIR ❑ Total Fee USE OING BLDG. Residence DEMOL Cl Z APPLICANT TEL 2 (PRINT) Russell J. Stacey ' NO. 575-1338 c BY(SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE REA THIS APPLICATI AND STATE uY THAT THE ABOVE 15 CORRECT AND AGREE TO OMPLY WITH ALL RDINANCES - IL AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF 3 2 4 3 A THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z PENSATION INSURANCE. - 5 O. SIGNATURE OP10407 # 0 0 0 0 0 1 PERMITTEE ADDRESSZ 21- 31,00 O CITY NO. G 0,0 0 3 1.0 o55 useJZo MAP D 0 3l 1 3'—7 9 NO. SPECIAL t- CONDITIONS os FINAL C BY d DATE WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, APPLICATION F O E BUILDING P MIT or a certified copy thereof(Sec. 3800, Lab. tCOUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No ©S>o Company /�'1 C. , / an BUILDING / Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS yt7 ! V ❑ Certified copy is filed with the county building inspec- BUILDING �(�r: </ --r e i tion department. ADDRESS LOCALITY //�� NEAREST /� Date Applicant-r— CITY llll i ZIP CROSS ST. �� 9 CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE I PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars($100)or less.) TRACT I BLOCK I LOT NO. NO. TEL. �-- SPECIAL y. I certify that in the performance of the work for which this OWNS /r f T. �E: \ N {h,W CONDITIONS '• i DISTRICT GR¢�.IP TYPE FIRE PRO SS BY O permit is issued, I shall not employ any person in any manner � rY� LJ CONST. ZONE 0 so as to become subject to the Workers'Compensation Laws. ADDRESS (� �(\ CITY �E� 1 Date Applicant �' / ZIP ' STATISTICAL CLAS ICATION APT. COND U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. / DWELL.UNITS IL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL_ r t� deemed revoked. CONTRACTOR �• �f.'7• Apra � NO, lj���/ � BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATIONLIC����/f� I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS .3�r + NO.. VALUATION (commencing with Section 7000)of Divisiot5 3 of the Business andLIC* G Professions Code, and my license is in full force and effect. CITY o� U:;?r.1� C'!f`�" CLASS C $ � J: /�� Lry,. SQ.FT. NO.OF ' NO.OF CHECK , License Number !i Class SIZE STORIES FAMILIES ONE � � � ��r/'— DESCRIPTION OF WORK A0 ,F NEVA ❑ $ Contractor L1941f / 40A Date E]1 am exempt under Sec. ADD E] bt FINAL B.BP.C. for this reasoner ffJp � ,ty� �r DATEDate: USE DG. -C/'06N FIN sr EXISTING BLX699 0 Signature APPLICANT TEL. `, g OWNER-BUILDER DECLARATION PRINT 6'LG3LPCa. C3�tif' a� NO. � -t,`` I hereby affirm that I am exempt from the Contractor's License Poo 0 0 0 0 0 Law for the following reason (Section 7031.5, Business and ADDRESS�e :) (% Professions Code): PRESENT 0 0 6 a 6 3 E] 1,I, as owner of the property, or myemployees with ADDRESS wages as their sole compensation,Will do the work and o a - 6a634 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. O 5 o 7 a S 7 ❑ 1, 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 TOTAL SETBACK FROM EXIST. 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. iSec. 3097, Civ. C.). SIDE 0 P.L. d Lender's Name I P.C. Fee$ Permit Fee Lender's Address rI certify that I have read this application and state that the Issuance Fee [t/t above information is c rect. I agree to comply with all County Investigation Fee 2 ordinances and State I ws relating to building construction, Total Fee ,�g 3 Y a' hereby authorize presentatives of this County to enter u n the above-mens ned prope�fy for inspectli�on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign t re of Applicant or Agent Date i ®s