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Home My Public Portal About5033 WILLMONTE AVE_Building__ TEMPLE CITY i8A888A C81f808 tV 80 APPLICATION FOR BUILDING PEFZMIT - "1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS M.U,Vi BUILDING AND SAFETY DIVISION- LOCALITY �� /� G '•` % JOHN.A. LAMBIE, COUNTY ENGINEER NEAREST . WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. e z:�. j DISTRI T GROUP SED BY FOR APPLICANT TO FILL IN •�` �j _ ONSI: BUILDING _ '-l STATISTICAL CLASSIFICATION SgWER MAP ADDRESS 6 c'3 3 l'll1�.L!°1 a�/T�L �= BK G CLASS.NO.--Z--DWELL.UNIT u2MAP LOT NO. a• BLOCK NUMBER HWATE YES NO TRACT USE ZONE SPECIAL �- NO.OF BLDG!. CONDITIONS SIZE OF LOT cO d �.+ I NOW ON LOT A USE OF EXISTING BLDG. BUILDINGYARD HSTR EXIST. TEL. SETBACK ' WY NAME WIDTH OWNER - NO. FRONT P. f �. [ADDRESS R SIDE. ARCHITECT OR TEL. P.L. ENGINEER NO. '/ INSPECTION RECORD ADDRESS CONTRACTOR 'DR IZ NO •, Q S • �, ADDRESS A 2-A—T16 DESCRIPTION OF WORE �" + tiI- � 0 _ r ,, NEW E ADD ALTER REPAIR ' DEMOLISH ,•,a r e,�m+ Aja SQ.FT. / NO.OF NO.OF SIZE / A STORIES FAMILIE SUSE OF �/-T�RUCTURE iJVV�e�1._L �%, Afe— `�T t�"�= r 0 �� .•�•�r SIGNATt)R 'OF ^ Ltlx-O H I St rz�` APPLICANT VALUATION$ Q I °. �-�� ' `'� d" � r PROVALS DATE INSPEETOR'S SIGNATURE P.C. PMT. FOUN TION:LOCATION e n a FEE $ FEE $ FORMS.MATERIALS / : STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ FRAMEF H13 AP- BRACING IRE BOLTS /.6•/•! Q l�r�/! Ai. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND -FURNACE:LOCATION, l AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. �e • •r �� 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH,INT. �i"(fi WILL NOT'EMPLOY ANY PERSON IN VIOLATION OF THE fill - �1• i ; ,WORKMEN'S COMPENSATIOtj LAWS OF CALIFORNIA. LATH,EXT. �S•`'% ' SIGNATURE-0 HOUSE NUMBER COR- PERMITTEV RECT AND POSTED - 41 ADORE! A �1'-� :FINAL � � ( CLYDE N.. DIRLAM, PRINCIPAL STRU RAL ENGINEER PLAN CHECK VALIDATION c M.O. cAsx PERM VALIDATION cc M.c. • CASH E1v(; 2' 1 3 OCT 1 3''D TEMPLE -CHTY 'BA888A C6}1808 z/Bo APPLICATION FOR BUILDING PERMIT - 1- COUNTY OF LOS ANGELES BUILDING r ° DEPARTMENT OF COUNTY MGM= . ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST ! WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. C.®!� DISTRI T GT I TYPE P SSY FOR APPLICANT TO FELL IN LS'" CONST. ,� BUILDING STATISTICAL C DIFICATION R MAP ADDRESS a33 M p 7` .0BK LASS.NO. WELL.UNITg LOT NO. BLOCK MAPf1 STATE YES" NO NUMBER l.� HWY: TRACT USE ZONE SPECIAL. • 81Z£OF LOT I NO.OF BLDGS. CONDITION NOW ON LOT USE OF EXISTING BLDG. BUILDING YARD HWY STREET NAME EXIST. TEL SETBACK WIDTH OWNER . NO. t FRONT P.L. ADDRESS SIDE , ARCHITECT OR TEL. i P-.-L. ENGINEER No. INSPECTION RECORD ADDRESS CONTRACTOR ` ) r(A,V !� lLNO. �� l� , l-� r O ADDRESS V DESCRIPTION OF WORK NEW k ADD ALTER REPAIR • DEMOLISH SQ.FT. NO.OF NO.OF ' SIZE t v U STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT VALUATION$ &-V I APPROVALS DATE INSPECTOR'SS19NATURE P.C. PMT. / FOUNDATION:LOCATION FEE '$ FEE $ f_• A FORMS•MATERIALS RAME FFIRE STOPS, 1 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. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE �q WORKMEN'S CO P SATION WS OF CALIFORNIA. LATH,EXT. �V�I�I ✓/i� 1' 4✓' SIGNATURE O HOUSE NUMBER COR- PERMIT OR- " PERMITTE RECT AND POSTED ADDRES -C - FINAL r CLYDE N. DIRLA_M, PRINCIPAL ST R RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. QWH PERMIT VALIDATION cK. a.o. 'QWH APPLICATION-.AOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN WqS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS r / � J . or a certificate of Workers'Compensation Insurance,or a certified Ef 7 I�J Q`M pA17-e_ iVe_ copy thereof(Sec.3 00,Lib. - CIT G.� i% ZIP r 790 Policy No. Compan ( LOCALITY 5/�� rc � SIZE QF L TD NO.OF BLDGS.NOW ON LOT NEAREST CROSS❑ Certified copy is hereby furnished. 1 ❑ Certified copy is filed with t un building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. depart en??t.��LG�� Date.9ZIMYApplicant -ASSESSOR MAP BOOK p�p� PAGE PARCE�Q� /� Ws O SPECIAL CONDITIONS CERTIFICATE OF EXEMPTIO FROM WORKERS' OWNE t TEL NO. YES NO COMPENSATION INSURANCE 1�T r l F� �w�" `Z 67 WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) 5,9313 I certify that in the performance of the work for which this permit TgAA 4,e G ZIP O� _� is issued, I shall not employ any person in any manner so as toele become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. � DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CqqTRACTORSET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith CCi, z& w j f 'P,, / FRONT comply with such provisions or this permit shall be deemed revoked. RESS LIC N /� PL A D LICENSED CONTRACTORS DECLARATION A1,2/-1A ` SIDE CIT��-N / ce LIC.C S PL I hereby affirm that I am licensed underprovisions of Chapter 9 . 0SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SQE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and ffact. 91 o 0 1 1 NEW ❑ BK ,`� PG a DESCRIPTION OF WO K VALUATION U License Number��ZI�t Lic.Class ADD Q Contractor�y /��,Lc!3?`� Date 1' ��W a �� ALTER ❑ $ ❑ I am exemptunderSec. —""' � 3` REPAIR ❑ == $ BAP.C.for this reason DEMOL ❑ LDMA P/C Date: II USE OF EXISTING BLDG. URM ❑ `�`�' cL;_1 e- IL ij� o.z_ a) Signature AP LICANT(PRINT LDMA Perm# Y Z ❑ I, as owner of the property, or my employees with wages as LC f21 Q_ D� Z . �.{: a their sole compensation, will do the work and the structure is ADDRES `� O FI C•f not intended or offered for sale (Section 7044, Business and - d �j- � / FINAL DATE a -- Professions Code.) _ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 1a ii r OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE "'I J ITEMS EM S ❑ li en owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY '` licensed contractors to construct the project (Section 7044, I r Business and Professions Code.) VES❑ NJ2r 1 js�HL r�. �y WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECK CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES i I hereby affirm that there is a construction lending agency for YES El NON S HALNEI a the performance of the work for which this permit is issued(Sec. O1 3097,CIV.C. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING ) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. _1y.JJ LIL L o Lender's Address a 3 T I"o�t 0 OWNER OR AGENT vL'1.tti .L I ._ c I certify that I have read this application and state under penalty C ofl perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE �-[G N w all county ordinances and State laws relating to building U aJ T m constru 'On, and hereby authorize representatives of this County ISSUANCE FEE /. � to nter u e roperty fo 'n ve onspection purposes. (� 7` o� INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE