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HomeMy Public PortalAbout9157 WOOLLEY ST_Building__ APPLICATION FOR- BUILDING PERMIT FOR APPLICANT TO FIEL'IN'lPrint or type only) FADDRESS COUNTY OF LOS ANGELES ' _ z. &OV S4 ?- DEPARTMENT OF COUNTY ENGINEER ASSESSOR df f/-' Cir zIPoBUILDING AND SA TY DIVISION NO.OF BLD S. BUILDING �J1IL NOW ON LOT ADDRESSBLOCK QLOT NO. LOCALITY ��ie% ---P. no- 5NOL `,_� _ CROSS ST.NEAREST 3 �. fJ(/(�/ E� S MAP BOOK PAGE PARCEL DISTRICT GROUP TYPEFIRE RO SSD BY CITY / /1 F' G T zip / o a i[//'� CONST. _ ZONE ARCHITECT OR EL. �� 7 ENGINEER p AJA-,ee NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO-.-:21 BK- PG CONTRACTOR (�w /' NOL' USE ZONE MAP LIC. NO. d �� ADDRESS NO. �/ SPECIAL LIC. CONDITIONS CITY• CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH B G.SETBACK FROM F ONT PROP.LINE OF (STREET) ADDRESS CITY C _ TOTAL SETBACK FROM TYPE OF EXISTING C SQ. FT. NO. OF ! NO. OF CHECK HIG AY i YARD - FRONT PROP. LINE HIGHWAY WIDTH O SIZE STORIES ! FAMILIES ONE F / NEW ❑ + u DESCRIPTION OF WORK ADD ❑ BLDG.SETBACK FROM co 4Ake SIDE PROP.LINEOF (STREET) r ALTER = TOTAL SETBACK FROM TY OF EXISTING 1!/ 1,VA3j,7+J .JhJ, i7DF�ey /7zaA HIGHWAY t YARD SIDE PROP. LINE HIGHW WIDTH USE OF 'P v REPAIR[] + EXISTING BLDG./r�E��/�DFNCL� DEMOL ❑ APPLICANT TEL PI /fIIE'n/,S N0. 3�y CORNER CUTOFF YES ❑ NO ❑ _ v`1 IN OPEN SPACE YES ElNO 1:1 ` BY (SIGNATURE) .4f., L IN COASTAL ZONE YES ❑ NO ❑ VALUATION OU��� CATEGORICAL E%EMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 1 5 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OFTATE OF LI �-.I FORNIA IN RELATING TO • � +]] �} WORKMEN'S COMPEN ON Q.'✓l.`NSURA � �+ ra•w.s-�' � �f:✓j�V SIGNATURE OF PERMITTEE c ADDRESSTE /+ 10, F NAL 7 CITY IA!5�7Ale C,ry NOL• a�✓ '�L DATE B MAKPMT.It E CHECKS PAYABLE TO: FEE � FEE W HARVEY T. BRANDT, COUNTY ENGINEER ( 21- PLAN `PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 7 1 4 1P"fE8 15 1 �f 21.75.®58 76AS38A CE#803 12/72 ' U 76/V638A CE 4803 I APPLICATION FOR BUILDI G PERMI'•• - � ' -COUNTX OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE _ PARCEL - BUILDING AND SAFETY DIVISION BUILDING C� ADDRESS / IL COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST , Print ort on.l CROSS ST. BUILDING / DISTRICT NO R TYPE �J� P B ADDRESS /✓ �. �(f �`C S �� © CONST. I/ q STATISTICAL C A SIFICATION Y SEWER MAP LOT NO. BLOCK CLASS NO. DWELL,UNITS PG TRACT USE ONE MAP NO.OF BLDGS. NO. SIZE OF LOT.0.0 — NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG. '7 OWNER Q/�Fi/�i f` y�j�gP.�j� L. 2 NO BLDG.SETBACK FROM ADDRESS l 6- ,�f p _oe ,� FRONT PROP.LI NE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY ..0gr C/T - HIGHWAY WIDTH FROM C.L. ARCHITECT DR loor TEL. + _ ENGINEER NO. BLDG.SETBACK F ADDRESS SIDE PROP:LINE OF (STREET) w/ ' TEL. � TYPE OF EXISTING SETBACK HIGH - + YARD = TOTAL a CONTRACTOR lt NO. HIGHWAY WIDTH FROM C.L. C07 LIC. ADDRESS NO, + ___ _ O LIC. I-- CITY CLASS CORNER CUTOFF YES NO ❑ W CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE JQJR SPECI&L APPROVALS z ADDRESS SQ. FT. �} NO. OF NO. OF NEW ❑ SIZE v STORIES FAMILIES D t7�°�il/ i2T/v ° �/� ^. /JVSP/�C'l/D r .L! `,>.}. USE OF ALTER. ❑ STRUCTURE SIGNATURE OREPAIR❑ A z F .` - APPLICANT DEMOL ❑ VALUATION S cl APPROVALS DATE INScroli', SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE S FEES s ( � FORMS, MATERIALS FRAME: FIRE STOPS, r I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING.-BOLTS r�� r A 11 'AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GASVENT, DUCTS STRUCTION.. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CAL RNIA IN RELATING TO - WORKMEN'S C ATILATH, EXT, SIGNATURE OF �[NC A HOUSE NUMBER COR- PERMITTEERECT AND POSTED ADDRESS _ E r�• FINAL 72, JOHN'F; LEWIS. PRINCI L PTRUCT- AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VAIMA I W CK. . M.O. CASH Olio 4 8 7,7 13 1 D 9.00- Kr WORKERS'CQMPENSATION DECLARATI6hI ..,' ( �. �� �•, • '� � � � hereby affirm that I have a cAlficatd-cif concent 4o,ielf 1 HCAT I N FOR BUILDING PERMIT insure,or a certificate of Workers'Compenstlgit;nsurA-ce,or a certified copy thereof JSec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company , Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS s.2 F. Certified copy is filed with the county building inspec- BUILDING �s�/ �y� tion,department. I ADDRES,Sr �y�lo •�T�'®�G.�! v/Q LOCALITY NEAREDate Applicant t CITY /�i fs 1-1F els s T 1;01— ZIP �J CROSSSST. CERTIFICATE OF EXEMPTION FROM WORKERS' /yy�f/ NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT L • NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for oneUSE ZONE MAP TRACT BL hundred dollars($100)or less.) OCK LOT NO. NO. 3'• EL. f SPECIAL )� I certify that in the performance of the work for which this OwNERA �.�i/y ��R.dr-.���/�� 0.� �� CONDITIONS permit is issued, I shall not employ any person in any manner ADDRESS c��/ �( � �T DISTRICT GROUP TYPE FIR09 E PR CESSED BY so as to become subject to the Workers'Compensation Laws. �Q '� �/ ' CONST. ZONE 0 CITY ��rl� �� ZIP !/78 Q a Date Applicant ! STATISTICAL CLASSIFICATION APT. CONDO. ARCHITECT-OR TEL. Ly NOTICE TO APPLICANT: If, after making this Certificate of. ENGINEER d"4 NO. CLASS NO. c�-- DWELL. UNITS— Exemption, D. you should become subject to the Workers' � Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MA with comply with such provisions or this permit shall ben ., TEL. �l deemed revoked. CONTRACTOR NO. BK. +�/ 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 Division 3 of the Business and LIC, Professions Code, and my license is in full force and effect. ' CITY CLASS $ C--:2,6­0 SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE,T400 00 STORIES FAMILIES ONE . L�P��E' NEW $ Contractor Date DESCRIPTION OF WORK ❑ ❑ ADD I am exempt from the licensing requirements as I am a i �'1C1�S�t�n/6 ��i�� ��L/ licensed architect or a registered professional engineer p' rte- ��/� ALTER DATEL acting in my professional capacity (Section 7051, r, �� /vim/ ea�� AME J�O�B REPAIR ❑ . Business and Professions Code). USE OF A EXISTING BLDG. �i9,�,�9f�� DEMOL ❑ FIN �� By Lic.or Reg.No. Date I' APPLICANT n/���/Cv �jTEL OWNER-BUILDER DECLARATION (PRINT) I hereby affirm that I am exempt from the Contractor's License Ir n / Law for the following season (Section 7031.5, Business and " ADDRESS !IS/ ld1�ff� ST /Z1AC'&( i; Professions Code): i:: PRESENT ❑ BUILDING I, as owner of the property, or my employees with !: ADDRESS wages as their sole compensation,will do the work and I e7 1 1,8 A the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). I MOVING TEL. 11 0 0 0 0 0 1 ❑ Ii, , as owner of the property, am exclusively contracting t CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 2 0 0 5 200 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. o 0 0 5 2 0 0 v CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH Ihereby affirm that there is a construction lending agency for I: FRONT O v 1 0.2 6-82 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. 1 Lender's Name I 'T3.4-0P.C. Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee aboveinformation is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, t Total Fee v Q and hereby authorize representatives of this County to enter upo above- tinned property for inspection purposes. ( SEE REVERSE FOR EXPLANATORY LANGUAGE $ignotu of plicant or Agent Dole ~ I ®s WORKERS'-COMPENSATION DECLA•RATbN , . % ' a. �' ` hereby affirm that I'have a cr�tificate 2of consentq pelf° r. L I A`T 9 ION ( (B-'U- I L D I N G P�E RM I T insure, ora certificate of Workers Com-p-4nsation Insur'o'Ae, or a certified copy thereof(Seca 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company �+ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ C _ ❑ Certified copy is filed with the county..building inspec- BUILDING }ion department. 61 ADDRESS f ) LOCALITY rj NEAREST ^ Date Applicant CITY l ZIP CROSS ST. CERTIFICATE OF EXEMPTION.FROM WORKERS' If N OF BLDGS. -ASSESSOR COMPENSATION INSURANCE SIZE OF LOT MAN LOT MAPBOOK PAGE PARCEL (This-section need not be completed if the permit is for one USE ZONE MAP ®� hundred dollars.•($100)or less.) TRACT BLOCK LOT NO.. NO. a` L. SPECIAL y. I certify that in the performance of the work for which this OWNER CONDITIONS !L permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY O so as to become subject to the WcLrkers'Compensate S. ADDRESS CONST. ZONE (,1 5 jCDate Applicant CITY. ZIP ::STATISTICAL CLASSIFICATION APT. C�O. NOTICE TO APPLICANT:.If, after mak g this.Ce�.t,i to'' 11RGFiLTECT'012 TEL;•. ENGINEERS_• rLo CLAS NO. a DWELL UNITS LU Exemption, 'you should become.sub "ct to the' kers: l` Compensation provisions of the Labor Code,you,must.forth aDDRtsS•• ,.' SEWER with comply with such provisions 'or this permit shall b deemed revoked.' CONTRAFTOR ` NO. BK• k, VALIDATION 0 A LICENSED CONTRACTORS DECLARATION LIC. il P0 0 0 0 21-4 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and ; LIC, I u 2 6y Professions Code, and my license is in_full force and effect. CITY CLASS $' ► " SQ. NO.OF a NO.OF, CHECK License Number' Lic.Class SIZE ' STORIES 1 FAMILIES ONE (3a J QQ® o o 2 6 5j -,5 LE Contractor Date DESCRIPTION OF WORK NEIN ❑t 06 2 b—8 ' ❑ ADD I am exempt under Sec: '"•-e�b17ti..• � =•� [� LTER ❑,s FINAL B.BP.C. for this reason I EPAIR ❑ DATE SE OFe F L t Date: EXISTING BLDG. DEMOL ❑' y 9 Y'llie Signature APPLICAN .r OWNER-BUILDER DECLARATION PRIj I I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.51"Business.and ADDRESS . Professions Code): PRESENT' I, as owner of the property, or my BUILDING employees with ADDRESS + wages as their sole compensation,will do the work and ' LOCALITY r the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL, I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to coristruct the project (Sec- ADDRESS tion 7044, Business and-Professions Code). REQUIREDTOTAL SETBACK FROM EXIST. ` CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending'agericy for I FRONT j J 6 1 .F the performance of the work for which this permit is issued P.L. tSec. 3097, Civ. C.). SIDE l; u u c o c i5 J P.L. , , . .. o Lender's.Name I ; c -Z ^ J 2 1 P.C.Fee$ Permit Fee •� t _ 2 r T Lender's Address ,� r� � � r� � r I certify that I have read this application and state that the �, CTC�S.eS Issuance Fee ^ above information is correct. I agree to comply with.all County i Investigation Fee - , .• ordinances and State laws relating to building construction, Total F �Z— I and hereby authorize representatives of this County to enter u on the bg�e@- oned property for inspection purposes. ' . i SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of p scant or Agent Date es ' 5 COUNTY OF LOS ANPELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS j 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9709040014 PHONE: (818) 285-0488 EXT: CONSTLEGAL ID: NO. OF G D S : TR: 14396 LT: 49 SO. FT STORIES TYPE 9157 WOOLLEY ST STRUCTURE: 0 VN TEMP CA 917801351 S SSO 0 BER: NEAREST CROSS STREET: 5382-016-029 i THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY EN S . SI USE 0 ED 0 : PROCESSED BY: R .. EXIST OCC GRP: 09/04/97 UT 09/04/98 OWNER: TEL. 0: BLDGS. NOW ON LOT: VALUATION: FINAL DAT FINAL BY: CODE: ROACH MONICA M (000) 000-0000- 1 4,200 301 HARVARD DR ARCD 910072637 FEES D MCRIPTION OF WORK TEAR OFF AND RECOVER WITH EL 40 YR. COMP. SHINGLE FEE DESCRIPTION: QUANTITY: LION: AMOUNT: APPLICANT: T ROLAND WORRELL (626) 447-4819- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 4200.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 4200.00 VAL 133.05 TOTAL FEES 161.30 CONTRACTOR: TEL. NO: APPROVALS DA E INSPECTOR SIGNATURE ROLAND WORRELL GEN. CONT. (626) 447-4819- 306 HARVARD DR. LIC. NO LOCATION AND SETBACKS ARCADIA, CA 91007 401427 B SOILS ENGINEER APPROVAL i ARCHITECT 0 G TEL. 0: FOUNDATIONPRENCH FORMS LIC. N0: S�/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDIRFLOOR INSULATION 153H265 3 01 0. OF IES: DWELLING S: APT/COND: STAT CLASS-. FLT SG NO 21 ROOF SHEATHING SCHOOL WITHIN RXZXMUS SHEAR PANES AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED OTAL SETBACK OM EXIST FIRESPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL• t ASSEM. RAT D WA L ASSEMBLI 5 RATED S S OP G I T-BAR CEILINGS DRAINAGELOY REPORT ID: DPR261 ROUTE TO: BS0508