HomeMy Public PortalAbout5551-5553 WELLAND AVE_Building__ X , City of Temple City
4888A CC#803.9-60 APPLICATION FOR BUILDING PERMIT • '
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �J4, 11
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NQ. G O TYPE P S BY
FOR APPLICANT TO FILL IN CONST. r�
BUILDING STATISTICAL CL FICATION SEWER MAP
ADDRESS Rear of 5551 Welland K
CLASS.NO. DWELL•.UNITS
LOT NO. 11 BLOCK MAP STATE yE5 NO
NUMBER v HWY.
TRACT 10260 USEZONE SPECIAL
SIZE OF LOT 71X267 I NO.OF BLDGS. CONDITIONS
NOW ON LOT. 1
USE OF
EXISTING BLDG. ] Q]117[g Rt A�t. CaI'BOT`t BU BUILDING EXIST.
: YARD HWY STREET NAME T'
TELA,, SETBACK WID .H
OWNER DaurlsD.Na6k&Thomas-_NO`ED539�0 FRONT
r lne P.L.
ADDRESSAA5 Qni�]P�nt.M en ara 'SIDE
ARCHITECT OR TEL. P.L.
ENGINEER none NO. INSPECTION RECORD
ADDRESS O.
Santa Anita ConstFNE kT 79744 � a ! ' ' �"" `` '.o�
CONTRACTOR NO. � I !' l� 1 .. .-�.�� � :/`%
871?' E. Las Tunas, San Gabriel ,�� '�' ;`.
ADDRESS
U
DESCRIPTION-OF WORK
.i .W
a
NEWIM ADD ' ALTER REPAIR DEMOLISHSQ Z
S ZE•F11 NO.
g+ O Att• STOR IF
1 FAMINO.O IES 1
USE OF
-
STRUCTURE'
Dwelling & Attached Garage
SIGNATURE
APPLICANT
VALUATION$ �� '
-� 6-D
APPROVALS DATE INSPECT 'S SIGNATURE
PC. PMT, FOUNDATION:LOCATION
FEE $ ►-� G/ FEE $ FORMS,MATERIALS a.
FRAME:FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT 1 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 (J
BUILDINI:3 CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT ,LATH,INT. �'� / .fC�jAer TxvF+�
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN'S COMPENSATION LAWS O CALIFORNIA. LATH,EXT. 8 "zG G :�-✓. ,�
SIGNATOR /9 HOUSE NUMBER COR-
PERMITTE l RECT AND POSTED
ADDRESS ' FINAL 1 `r.1 I. :.n.,'>✓t s r p a
r
PLAN CHECK VALIDATION anK - CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER
M.O. CASH PERMIT VALIDATION cK M.O. CASH
LA.1;01 4 s 1 AUG 15 z 3 a 1 9 r5 �} '•
`r' '1 6 6 AUG 17 1 G 3 9.C: 0
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFET
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS��
I hereby affirm that I have a certificate of consent to self insure, BUI MG�DDRFSS / , l
or a certificate of Workers'Compensation Insurance,or a certifie CIT ! ZIP`Q
copy thereof(Sec.3 O(,�b.C.) � t J LOCALITY
Policy No. I,'�`� l Comparry ///ffW�i((����� SIZE OF LOT NO.OF BLDGS`NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST.
,la 5rtified copy is filed with the county buildin ns ion TRACT BLOCK LOT NO.
department. r.11, USE ZONE MAP NO.
Date Applicant, ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' PDRESS
• TE V YES NO
COMPENSATION INSURANCE g� WITHIN 1000 FT.OF SCHOOL? '
(This section need not be completed if the permit is for one hundred A
dollars($100)or less.) DISTRICT GROUP ;TYP ONST. FIRE ZONE PROCESSED BY
� CITY ZIP
I certify that in the performance of the work for which this permit y�r/ �--
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. (JO
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO.. DWELL UN
N0710E 70 APPLICANT If, after making this Certificate of REQUIRED' TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' R TO A 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. AgDrESE .(� LI�.,N� ', G� PL
LICENSED CONTRACTORS DECLARATION crlrlY �l CC'S c SIDE
PL
I hereby affirm that I am licensed underprovisions of Chapter 9 ` e
(commencing with Section 7000)of Division 3 of the Business and 80.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP a
Professions Code and my lic is in full force an effect. NEW ❑ BK, PG v
License N LIC.Class DESCRIPTION OF WORK App ❑ VALUATI`ONi ,
Contractor Date S ALTER ❑ $ •`3�1s
I W
D.
REPAIR ti
❑ I am exempt under Sec. $ Z_
BAP.C.for.this reason y DEMOL ❑ LDMA P/C#
Date: USE OF EXISTING BLDG. URM ❑ L
Signaturer'f a
A T ) L p q,1 LDMA Perm# A_•ti•S°a
❑ 1 as owner of the property, or my employees with wages as "� Lb ". O �I; °LIQ
their sole compensation, will do the work and the structure is ADD Coq L..L
not intended or offered for sale (Section 7044, Business and � � �`–�'Ci` FINAL DATE a 4 TTP HIS
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r W P� a
❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY 1 o I;A� IC4 4® 30
Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? �
licensed contractors to construct the project (Section 7044, YES❑ N� r j!i IJ —32
Business and Professions Code.)
WILL THE INTENDED USE'OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �{,fes' {'JIB
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH v!ii'!I'StiL + s
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(scAQMO)SEE PERMITTING CHECKLIST FOR
GUIDELINES
I hereby affirm that there is a construction lending agency for YES❑ WEI
r 1 y{ [ j [�
W the performance Of the Work for which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING L�L)L.14��t001 61' sr!4
3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,
TITLE 2,CHAPTER 2.20 SE NS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS ���••/ Ai-� p°518
Lender's Name MATE LS EPO NG AN FOR OBTAINING A PERMIT FROM THE SCAOMD. :i(_6 � Ail 7°•1!
o Lender's Address
OWNER OR
c I certify that I have read this application and state under penalty
of perjury that the above Inf mation is correct.I agree to comply RC.FEE PERMIT FEE
N with all co ty ordinance a d State laws relating uild g i
m construction, hereby thorize representatives of t Co ty ISSUANCE FEE �b
to enter upon e 0 -me loned tic ur
m C INVESTIGATION FEE TOTAL FEE
+
Stnatmol ARAl«AqW Osie /
SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
BL 0508 1007060029
PHONE: (626) 285-0488 EXT;
ILEA ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1
TR: 10260 LT: 11 UN: .002 I SQ. FT STORIES TYPE OCCUP GROUPI 5553 WELLAND AV 1
(ASSESSOR INFORMATION NUMBER: ISTRUCTURE: 147 1 V-B R-3 I TEMP CA 917802932 J
GARAGE: I NEAREST CROSS STREET:
18573-015-029 1 OTHER: 167 1 V-B U THOMAS PAGE; 597 GRID: D3 LOCALITY: TEMPLE CITY, Cl
I
ITENAM: (EXIST BLDG USE: USE ZONE: JISSUED ON: PROCESSED BY: ]
I ]EXIST OCC GRP: 108/04/10 VG 1
TOWNER: TEL. NO: 1BLDGS. NOW ON LOT: 11
VALUATION: IFINAL DATE FIN Y: CODE: 1
ISEE, WING KEUNG (626) 534-3528- i 25,130
15553 WELLAND AV
I
ITEMP 917802932 J FEES PAID 1 CRIPTION brAWORX J
1 I 1147 SF. ROOM ADDITION MASTE BATHROOM, CLOSET AND-198?-Sr. I
I ]FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:J =N WAXQGOVEM 1
JAPPLICANT: TEL NO:
[LAW. TIM (909) 869-0732- JB1 PLANCHECK W/ENERGY 25130.00 VAL 452.90 1 I
1324 S. DIAMOND BAR JAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: 1
1DL?1MOND BAR CA 91765 JAB STATE GREEN BLDG FEE 25130.00 VAL 2.00 1
I JAC STRONG MOTION RESID 25130.00 VAL 2.50 1 { \ 1
25130.00 VAL 532.90
I JB2 PERMIT W/ENERGY
JCONTRACTOR: TEL. NO: ITOTAL FEES 1,018.10 APPROVALS TE INSPECTOR SIGNATURE 1
ISEE, WING KEUNG (626) 454-1066-
IREBECCA KWAN
15553 WELLAND ST. LIC. NO 1 JLOCATION AND SETBACKS J I 1
NONE,
]TEMPLE CITY, CA 91780 1 ISOILS ENGINEER APPROVAL I I I
I
JARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I
JABLE DESIGN (909) 869-0732- J
]324 S DIAMOND BAR BLVDLIC. NO: I JSLAB/UNDER FLOOR I I J I
1#348 NONE I 1 1 1 J
DIAMOND BAR CA 91765 J RAISED FLOOR FRAMING '
]
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1UNDE,ZFLOOR INSULATION J J I
I 3 001 1 I I I
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 'i
11ST LEVEL FLOOR SHEATH 1 1 I
NO 21 I 12NDLEVEL FLOOR SHEATH I J I
SCHOOL WITHIN HAZARDOUS -1 ]ROOF SHEATHING I I 1
JAIR QUALITY: 1000 FEET MATERIALS 1
J NO NO NO i IFIRE DEPT. FRAME INSPEC JI
I 1 1 1 ]BLDG DEPT. FRAME INSPECT 1 ,G.,j
1 1 ]SHEAR PANELS
I 1
1 1 11NSULATION/WEATHER STRI ' 1
1 I JINTERIOR LATH/DRYWALL
I 471V
1 1 1EXTERIOR LATH 1 1
1 I I
I JLOT DRAINAGE
1 i ]SMOKE DETECTION DBVICES 1 1 1
1 I IFIRE DEPARTMENT APPROVAL( I I
J I I I I
J I I I I
1 'REPORT ID: DPR261 ROUTE TO: BS0508 1 1 1 I