HomeMy Public PortalAbout5025 WILLMONTE AVE_Building__ ` TEMPLE- CITY
IBASSSA CM#803 A/90 APPLICA`fIOWF'OR BUILDING PERMIT - -
COUNTY OF LOS ANGELES ADILDIN 6 r✓ 3 ,
DRES
DEPARTMENT-OF COUNTY ENGIIVEER
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. 3 L9J J— ['
DISTRICT NO. GROUP TYPE '�+� ESSED BY
FOR APPLICANT TO FILL IN' �� coNsr. I
BUILDING STATISTICAL CLASSIFICATION ER MAP
ADDRESS %/� BK
CLASS.NO._LDWELL.UNITS
LOT NO.ray. BLOCK MAP
APER H STATE
N 'YES O
TRACT USE ZONE SPECIAL
NO.OF BLDGS. �� CONDITIONS L��
SIZE OF LOT ff I NOW ON L-OT 0.0-�
USE OF
EXISTING BLDG. ♦zL L l !J� BUILDING YARD HWY sTI� NAME EXIST.
TEL. SETBACK 7'i WIDTH
OWNER NO. FRONT Gam •%
7� P.L. SCJ
ADDRESS ,`� - - SIDE
ARCHITECT OR TEL. P.L. -
ENGINEER . No. INSPECTION RECORD
ADDRESS �" f
TEL. !rn/ '7.7>'' �'G} t'ti��4Ls►i1:i a
CONTRACTO�Ry 7 , . NO. -78 / O
ADDRESSc+�I(S 1 Z / r��. L IJ A T,C �
DESCRIIMON OF WORK �✓ �C
. --
NEW �DD ALTER REPAIR DEMOLISH
SQ.FT. ee`�� NO.OF NO.OF s' i
SIZE /K STORIES FAMILIES
USE OF
-
STRUCTURE ' '_,L. C. L��
SIGNATURE OF
APPLICANT
VALUATION 3 v�� I -
APPROVALS DATE INSPEECT/OR,''SS U
SIGNATRE
P.C. !fC PMT. 1'0 FOF.ORMSIMATERALSON JI!/ +lT'�An � .`+-•f P
FEE $ FEE $ FRAME:FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- 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. !`
I CERTIFY THAT IN DOING THE WORK AUTHORIZED LATH,INT.
WILL NOT EMPLOY ANY PERS N IN VIOLATION OF THE 1
WORKMEN'S COMPENSATION WS OF'•CALIFORNIA. LATH,EXT. ✓f !
SIGNATUREOF HOUSE NUMBER COR- J
PERMITTE RECT AND POSTED.
ADDRES -G FINAL r -
� CLYDE N. DIRLAM, PRINCIPALSTRU TURAL ENGINEF�R
-PLAN.CHECK. VALIDATION Com/ m.o. cnsH � PERMIT'VALIDATION M.O. CA8H
LACo
71 1.64
r7 A
AIORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self P L I"AT F ` R [�1 I ®� PERMIT
insure, or a certificate of Workers'Compensation Insurance, _ V
or a certified copy thereof(Sec. 3800,Lab. C.) �' COUNTY OF LOS ANGELES BUILDING AND SAFETY
+Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRIESSS
Certified copy is filed with the county building inspec- ;. BUILDING
tion department:' ADDRE,S�S �`/� , f\ �r�lr`,6�v� /^ LOCALITYEl '
Date Applicant CITY / 1VI Vii/= ZIP `/ _ CROSSNEAREST T. oe-wiw e44 .d
CERTIFICATE.OF EXEMPTION FROM WORKERS' .. } A. fit? N OF BLDGS. ASSESSOR
COMPENSATION INSURANCE.: i SIZE OF LOT S NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed,if.the petmit is'for one USE ZONE MAP //
hundred dollars($100)•or less.) TRACT BLOCK LOT NNO. NO. ` 6.
��/P/e�'JC .�. �''M� •� S� Y:r• ! SPECIAL `l
I certify that in the performance of the work-for which this OWNER CONDITIONS 0
permit is issued,I shall not employ any pars i y manner [� !.!! _r DISTRICT GROUP .TYPE FIRE PROCESSED BY
so as to become subject to the Worker} ation Laws ADDRESS G(l tG%F�dllf//,: CONST. ZONE V
6// CITY / ��! /'L'� �! ZIP c /. � � � / 0
Date Applicant V I STATISTICAL CLASSIFICATION APT. CONDO. ECJ
NOTICE TO APPLICANT: If, aft et ma �iis' t of ARCHITECT OR TEL.
'Exemption, you should become subject to
t orkers' ENGINEER �� NO. CLASS NO. �� DWELL. UNITS Q
Compensation provisions.of the Labor Code, y ust forth- ADDRE `` SEWERAAP 0
with'comply with such provisions•or this p it shall be ` TEL. I z
deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION
LICENSED CONTRACTORS DECLARATION LIC,
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION
(commencing with Section 7000)of DivisioA 3 of the Business and LIC.
Professions Code, and my license-is in full force and effect. CITY CLASS $ (�
SQ.FT. NO.OFNO.OF CHECK >:
License Number ,UIE.Class .1 SIZE STORIES FAMILI z ONE
Contractor Date j DESCRIPTION OF WORK
NEW $
ADD ❑ •:...:.'.,
❑ I am exempt under Sec. ALTER ❑ FINAL
B.BP.C. for'this reason REPAIR ❑ DATEUSE OF
c. ?
Date:' EXISTING BLDG. DEMOL ❑ By AL
SignatureAPPLICANT TEL
C
s
OWNER-BUILDER DECLARATION PRINT L'� N
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS
Professions Code): PRESENT
E] BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sale compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY
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 TOTAL SETBACK FROM EXIST. S 3 0,2 A
CONSTRUCTION LENDING AGENCY' SET BACK YARD HWY PROP.LINE WIDTH
I hereby affirm that there-is a construction lending agency for FRONT y! 0 0 0 0 0 1
the performance of the work for which this permit is issued P.L.
tSec. 3097, Civ. C.). # SIDE 2 0 0 40.50
'o 'P.L.
e Lender's Name .. _ ., .. 0 ,: ( 0 'J 0
Qm� 1 ,
P.C. Fee$ Permit Fee 12 7-82
Lender's Address �j
p I certify that I`have read this application and state-.that the Issuance Fee Gr
above Information is correct. I agree to comply with.all,County Investigation Fee
ordinances an . to laws relating to building construction, Total Fee
and her y th ize representat' esof is County to.enter
up R, o entioned pro r f spect
io
n purposes.
p SEE REVERSE FOR EXPLANATORY LANGUAGE
IgWoWiie of Appli n of Agent Date Os