HomeMy Public PortalAbout5632 GLICKMAN AVE_BUILDING_6/19/1997_COUNTY OF LOS ANGELES TEMPLE CITY k 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9706190001
PHONE: (818) 285-0488 EXT:
L
ON FILE
NO.
SQ. FT STORIES
STRUCTURE: 0
OF CONST
TYPE
VN
BUILDING ADDRESS:
5632 GLICKMAN AV
TEMP CA 917802710
NEAREST CROSS STREET: LIVE OAK
THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY
ASSESSOR0 B
8586-016-002
TENANT:
EXIST BLDG S
EXIST OCC GRP:
U ZONE: R-1
ISSUED ON: PROCESSED BY: EXF44itl-om-�
06/19/97 TC 6/19/98
OWNER:
ALLEN ALBERT;MARGARET TRS
5632 GLICK14AN AV
TEMP 917802710
TEL.
(818) 447-4775-
BLDGS. NOW ON LOT:
1
VALUATION:
6,300
FIN D FIN
j
BY: CEDE:
.J1
FEE DESCRIPTION:
AA BLDG PERMIT ISSUANCE
AC STRONG MOTION RESID
D2 PERMIT W/O EN -HC
I
I
REPORT ID: DPR261
FEES PAID
QUANTITY: LION:
6300.00 VAL
6300.00 VAL
TOTAL FEES
ROUTE TO: SS0508
AMOUNT:
27.75
0.63
166.95
195.33
DE*RIFI
TEAR OFF APPLY `1/2' CDX, GAF TIMBERLINE 25YR. COMP.
SHI LE
APPLICANT: TEL. NO:
EAGLE ROOFING (626) 291-5700-
NS:
CONTRACTOR: TEL.
EAGLE ROOFING (818) 291-5700-
6327 W LIVIA AVE LIC. NOOCATL�D
TEMPLE CITY CA 91780 698529 C39
APPROVALS DATE INSPECTOR G E
S TBA KS
SOILS ENGINEER APPROVAL
ENGINEER:ARCHITECT OR _ NO:
LIC. NO:
FOUNDATION/TRENCH 0 MS
SLAB/UNDER FLOOR
MAP NO: SEWER MAP BOOK: PAGE: FIRE 20NE: CMP:
150H273 3 01
UNDERFLOOR INSULATION
FLOOR SHEATHING
. OF FAMILIES: DWELLING N / 0 D: STAT CLASS:
NO 21
-
ROOF SHEATHINGSCHOOL
G
WITHIN HADMU699-
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
SHEAR
FRAME INS EC ION
FIRE SPRINKLER N S
REQUIRED TOTAL T A IST
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL-
SIDE PL-
INSULATION/WEATHER STRIP
INTERIOR L /IrRPGAL(--
EXTERIOR LATH
A D TC -PR-
RATED WALL ASSEM LI S
T -BAR CEILINGS
LOT DRAINAGE
u
LICENSED CONTRACTOR'S DECLARATION
I hereby affinn under penalty of perjury that I am licensed under provisions
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code, and my license is in full force and effect.
rLicense lass4-JLic. No.
Con cto s SiDate
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the following reason (Sec. 7031.5, Business
and Professions Code: Any city or county which requires a permit to
constnx;l. alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed
statement that he or she is licensed pursuant to the provisions of the
Contractors License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he or she is
exempt therefrom and the basis for the alleged exemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a
civil penalty of not more than five hundred dollars ($500).):
❑ 1 am exempt under Sec. , BA P.C. for this reason:
[ Electrical, Plumbing & Sewer Permits Only ]
❑ I, as owner of the property, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions Code:
The Contractors License Law does Trot apply to an owner of property who
Wilds or improves thereon, and who does such work himself or herself,
provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion,
the owner -builder will have the burden of proving that he or she did not
build or improve for the purpose of sale.).
[ All Other Permits I
❑ [,as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Sec 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her
own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sod within
one year of completion, the owner -builder will have the burden of proving
that he or she did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business and Professions
Cocil Contractors License Law does not apply to an ownerof property
who builds or improves thereon, and who contracts for such projects with
a contractors) licensed pursuant to the Contractors License Law.).
r�
WORKER'S COMPENSATIQU D4CLI'4.T04NI,
I hereby affirm under penalty of perjury one of the following ciltions:
re ��
M
❑ 1 have and will maintain a certificate of consent to self -insure for
workers compensation, as provided for by Section 3700 of the Labor
Code. for the performance of the work for which this permit is issued.
❑ I have and will maintain workers compensation insurance, as required
by Section 3700 of the Labor Code, for the performance of the work for
which this permit is issued. My workers compensation insurance carrier
and policy number are:
Policy Number `"y'C/ O
7
❑ 1 certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become
subject to the workers compensation laws of California, and agree that if
I should become subject to the workers compensation provisions of
Section 3700 of the Labor Code, I shall forthwith comply with those
provisions.
Applicant Signature
Dale
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER
TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706
OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES.
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
unincorporated Los Angeles County only,
This is to certify that I, as permit applicant, am familiar with the requirements
of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los
Angeles County Lobbyist Ordinance) and that all persons acting on behalf
of myself complied and will continue to comply therewith through the
application process.
Applicant (Print Name) Applicant Signature
Owner Signature Date Company Name (if employed by an entity/agency) Date
JOB ADDRESS 'a
LOCALITY
HAZARDOUS MATERIAL DECLARATION
Will the applicant or future Wilding occupant handle a hazardous material
or a mixture containing a ham rdous material equal to or greater than the
amount specified on the hazardous materials infonnation guide?
Yes ❑ No ❑
Will the intended use of the building by the applicant or future Wilding
occupant require a permit for construction or modification from the South
Coast Air Quality Management District (SCAQMD)? See permitting
checklist for guidelines.
Yes ❑ No ❑
I have read the hazardous materials information guide and the SCAOMD
permitting checklist, I understand my requirements updei the Los Angeles
County Code Title 2, Chapter 220 Sections 220.1 �0 through 220.140
concerning hazardous material reporting and for obtaining a permit from
the SCAOMD.
ASBESTOS NOTIFICATION
❑ Notification letter sent to SCAOMD or EPA
❑ 1 declare that notification of asbestos removal is not applicable to
addressed project -
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending
agency for the performance of the work for which this permit is issued
(Sec. 3097, Civ.C.).
Lender's Name
Lenders Address
N�
I certify that I have read this application and state
under the penalty of perjury that the above
information is correct. I agree to comply with all City
and County ordinances and State laws relating to
building construction, and hereby authorize
representatives of this County to enter upon the
above-mentioned property for inspection purposes.
6 �;7
'*4 icant or Ajil Signature Date