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HomeMy WebLinkAbout10519 (5) � • C MMUNITY DEVDELOPMENT DEPAR�IVT�� ��p/'TL 21660 E.Copley Drive Suite 190 O (909)860-3195 Fax(909)861-3117 �C j� ,, � O PRESS �'�" BUILDING PERMIT APPLICATION � �O� FIRMLY T �pR�� Z� � p/ - APPtICATION f�/� PERM{T �/ P�C � � �'L__ DATE �� '7 NUMBER �3/ N $ ISSl1E TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER p ADDRESS ZONING SETBACKS � CIIY ZIP TEL. FRONT Ryy ❑ S APPLICANT TEL. REAR � � SIDEISIDE STREET RW ❑ CONTRAC70R � SIDE ❑ ADDRESS `,y� � CITY ZIP TEL PROPOSED USE V/�/ 0 ARCWENG/ z DESIGNER NO.DWEL. / NO. NO. � A�DRESS UNITS / STORIES�_BEDROOMS�,_ � CITY ZIP TEI. � u� DESCRIPTION SQ.FT; FACTOR PSF ADJ.AREANqLUA710N � OWNER-BI;ILDER DECLARATION �p/qpp/qEM O I HEREBY AFFIRM UN�ER FENALTY Oi PEILAIRY THAT I Mi EXEMPT FROM 1HE COHTRACiOq$U- +�a�8�� W CW9EUIMFOqTMEWILdNINGREA50N(SEC.7o37.5BU51NES5ANDPROFES910HSWDE:ANVqTVOR (n U COUqryWHlp�{�pUIPESAPERYITTOWNSTitt1CLALTER.YPROVE.DEY0LI5N.ORRECNRANY4TRUC- W PBfIWDBCI( iURE,Pf11OR TO ITS I66UAHCE,�LBO REIXIIRES THE�1VPL1!'Xf�FOP SUCH PEFWIT TO FILE A SIGyFO � 4T�TEYENT 7M�T NE OR SNE IS UCENSED WR8UAN7 TO iHE PROVISIONS OF THE COMTqACTOp5l1. W CENSE LAW(��TEH e(CQMYENCMK3 NATH SECTqN 7000�OF DIYLSION 3 OF THE BUSWESB NID Pfb� � P�� � FESSIONSOODE)Oq1HATHEOqSHE1SE%EMPTTHEREF�ANDTHEBASISFORTHEI�LLEf360EXEMP- (�J TION.ANVVK1L11TIDNOFSECTION703i.58Y1.NY�PPLICANTFORAGERWTSUBJECTSTHEAPPLICAMTO Z (jg-�� � r, ALMLPENILLTYOFNOTAAOREiWNFIVEMl1NDRED00�V1R5(i5�9).): � �I,ASOVMEROFTt1EPRNERTY.�RMYEMPLOYEESW4THWAQE3A3THE{RSqLECQYPEHSATqN, 0 COt11TBfC18i 1N0.L DO 7HE WpPo(,Alm THE STRUCTUIiE I&NOT IME�D6D OH OFFERED FOR SA�E(SEC.70N,BUSI- J � NE55 M�PIWGESSIONS CPOE:THE CDNTRACTORS LICENSE LAW DOES ND'f APPLV TO AN ONMER OF = PROPEHfY WH08UfiD50R MIPqOVES THEREON.MIO WMD UUES SUCM NORN XIYSE�F OR MERSELF O(i m LZ THROLXiH HlS Op HER OWN F�IPLDYEES,PROVI�ED THAT SUCH WPfiOVE4ENT5 ARE NOT WTENDE�Ofl 4 OFfERfDFOR5KE1F.1/0WE`lE0.SF1EBULdN60RiMPRpyEyEM4SSOlflWITHMpNEYEAEIOFCqiPIE- Z i�Oti,iHE OWNfiR�6UItDER MALL HI1VE THE BURDEN Of PROVMK3 THAT NE OF SHE Db NOT BUIID OR = pIPROVEWRiHEPURPOSEOFSKF). W OI,ASOWNEflOFiMEPibPERTY,NAE%CLUSNEIY�pMHACTWOWITHLICEK4EDCONTRA�TORS Q TO CONSTRUCT 7FiE Ppq1ECT(SEC.7W4,BUSiNE44 AND PROFESSIONS WDE THE CONTR�TOFlS LI- Va�uatbn ADJ.AREA W CEfISEUWDOESNOTAPPLY1011iOWNEROFA9ROPEATYMMOHUR.DSORI/APfqVE9lMfPEqJ,AND � VRIOCONfNACT5iOfl5UCHPXO.lECT5WITX�CONTMCTOq(S�LICENSEDPURSt1ANTTOiMECONTpAC- QUANTITY DESCRIPTIQN �E � TORSLICENSEUW.). 0 ❑I NA E%EMPT 1N10EP SEC. B.6 P.C.FOR THIS REASMI � 3 � � � OATE OWNER U Z W sLICENSED CONTRACTORS DECLARATION W Q 1 HEREBY AFFIitlA WOER PNNLTY OF PERJUflV THAT IMi LICENSE�UTAEN PROVISqNS OF CHAVTER � � p, •(COMMIENCMH3 WIiH SECTId170o0)OF DNISqN]Of THE BUSINE55 A11D PROFESSqNS CADE,AND Z � X NY IICENSE l5 @I FtA.I FONGE AND EFfECL m lll / 0 LICENSE CLA C/� � LIC.NO. ..- j V OA7E CON7MCTON � 111 � WORKERS'COMPENSATIONDECLARA710N Q a!/i _ �+��� /�'TY� � I HEREB FIRM IXIDER PENALTV OF PE0.NRV ONE OF THE FOLLONANG DECUM710N5: � (�(� � 1 HAVE AND WILL MAINTAM A CERTIFICAiE OF CDNSOJT TO SELF-INSURE FOF YNDa(ERS' � COMPENSATION,AS PROVtDEp BY SECTION aloa OG THE UB011 COOE,FOq THE PERFORMAJICE U Oi'THE WiDRKFOiI WXIC117HI5 VERMI7ISISSLIEO. � -� -,!`� /' 0 1f ..l � _I HAVE Af�WRL MIJNTAIN WORKERS COAIPENSAtION INSURANCE,AS REOUIRED BY SECTpN ' 1 . Q 3700 OF iHE LABOfl CODE.FOH TNE PERFONYANCE OF THF WORK WR NMICM THIS PEPMR IS "� ""`. � ISSUEO.MV WO ERS' ENS�TION INSU iCE CAA�ER NID POLICY NUMBER�RE: CQMSTRUCTION � uaaf£P y�,J��,/�"`� ��� ^- • PLAN REVISW zPoLIC�N�YBEp !Y(O�S�— ,�-�_ �J t�� ELECTRIC �� Q Q (fFa53ECIbN1�N0T8E00MPlE�EDOFnEPERL�f6FOR0uEH1lDREDOolURS(Sta�ORLESS} PIUMBWG Z �CERTiFV7HATN7THEPEHWRIIANCEOFTHEWDRKFORWINCNTHISPERWTI5155UED.1 MECMANICA� C`} 5HALL NOT EM0.0Y N1Y PERSON IN RNY NANNER 50�5 TO BECOME SU&IECT TO T}7E (/� WOPo(EHS'COIAPENSATIONLAWSOFCALIPORNIAANDAGREETMAiIF SHOULDBECOME INSPECTIONFEE � SVBJE iTOMEWOANER5COM7EN5AT ROVISKMISOFSECT DOOFTHEU�BbR � coo sH�u n� noNS ISSUANCE � SMIP p pATE: APPLICANT: � � ENERGY P/C WA FINLUAE705EWAEYAHKEAS'COMQENS�TIONC A�OEISUIMWFUL,ANDSHALLBE � SUBJEC7ANE4PlOYERMCNWa1ALVENALiff5MIOCIVRFl ESUFTOIX�IENU6AqEpTHIX15M�D ENERGYPERMIT � DOLUNS�S1m,IXp),IN�O�ITKri TO TME COST Oi COMPENS�TION,DANAGES/S PROVDED FOR IN �l SECiqN 77oe OF THE IABOR CODE,MlTEREST,AND�iTORNEY3 FEFS. RETENTION FEE: W � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: I HEHEHV AFFlRM WiDER PENALT'OF PERNi1Y THAT THERE IS A WNSTRUCTION LENDNW A�ENCy z FOR THE PERPoRM�NCE OG1ME WOAK WR NMICH iH13 PERYIT IS IS5UEU(SEG�Oof,CIV C.�. W � LEIAER'SN1WE ti LEMER'S�RE53 � ICEXTIGYi1fATIHAVEREADTN�SA>OLIGTIONANDSTATETIIA�7HEABOVEINF011YATpNISCOqpECT. TOTA�FEES � I A/iREE TO C04PLY NATM ALL CITY ANO OIXINTY OROINANCES IINO STATE UWS RflATINO TO WILDING � CONSTNUCTION,ANDHEREBVAUT/qRRENEVHESEMATIVESOFTi13COUNTYTOEN7EHUPONTHE ABOVE-IJENTqNEO PROPEHTV FOR INSOECTqN PUHPOSES. � COMMENTS �' ���4�+.a-,.�o/Enr� � E(PRIMn � � � (n gplM pFpg�p DAT � RECPT.NO. 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' , � ;(> :n�+.�w � �..�,., r � • � F .,�„,,,,,M,,,,�„�� , C O U N TY S A N rTAT I O N D I S T R I C TS � OF LOS ANGELES COUNTY i �` � 1955 Workman Mill Hoad/Room 207/Whittier,California CHARLES W.CARRY Maifing Address:P.O. Box 4998,Whittier,Caiifornia 90807 Chief Enginear and General Manager � Telephone:(310)699�7417/From Los Angeles(213)685•5217 � Hourss:7:00 a.m.-4:30 p.m.Mon.-Thura. , u�—r'" p � ! �I�: ______i +s.. - 7:00 s.m.-3:30 p_m.Frt.. � SEWERAC�E SYSTEM CONNECTlON FEE °""`'°E"�D� � � Complete Itema 1 throvgh i0—PLEA8E TYPE OR PRINT � /� ;" pgde; 1� � r r6'. f "!.� t�+rre io�v� �� ( 1. Property Owner Q � �� o � � �S ��1�.� ��1�e�� �',��I�-I 1 I+� � � S 2. Facility Name I°t2(��S(��'t�_ 2frj,�'�,�' ,��''1"�C � �3. Addr�a of ProPBhY--_-_.t��L�.�..�L�/ l"�_� [?I j^^r M(����j��J. Major Croas Streets �r�(STRE�A � � T �pni �s,.�i �z�ai ,��'�-� Thomes Cauide Page 4. Contdet �1L��`�,� r�_J�,II� Phone Number.(3iD)___�_��.^• — 'ir'!�1�. 5.���Meilir�Address ��`5x� `(^(7i�f2{�'7��(�' �(.�"� � i �� i��i2�,rmR��'{.--�—f f�,_�'Rw�__ (IF DM'R X7 FAUM/BOVE) (STREEn (clrvi (STAT� Ri% 6. Counry Aesesaor p Book,Page,and Parcel Number; �" 1 � '�'�� Z Structure is: Proposed ❑ Existing,Date 4f Construction 8. User Category and Units ot Usage:(Check the appropriate bax and provide the applicabie information) a. Residential: � Single Fa�fl Home{s) Tract N ii' S� Lots ► Mumber of Units: ❑ Du lex ❑ Tri lex ❑ ur lex ► Number: ❑ Five Units or More ► Number of Units: ' ❑ Mobile Home Park ► Number of S aces: ❑ Condominium ► Number o!Units: b. Commercial: ❑ HotellMotel ► Number of Rooms: ❑ Convelescen[Hos itaUHome fir the d ► Number of Beds: ❑ alher S i : ► Im rwemant 5 uere Foota e:-_ c. Institutional: ❑ Cal e/Universit ► Numtrer of Students: � Q Privata Schoo! ► Im rovement uere Foota p: < _.. _.. . _ ❑ Church "��������+�M-���"� ' � ► im rovament uare Foofe e: d. Industrial: ❑ All Categories , `;.� ► A!I indusFrial dischargers must obtein a permit for � induatrial wastewater discharge. s. !rt oMer to proceas thla applecation a.Gomptete.siet oi_anchitectural blue prints must be submitted, This is not required for canversion from septic tank t�sewe�conneoti0n. �o. j;cerlN,y/*h� the information provided in thig_applioetion.is.true and cort+�ct to t/he best of my knowledge - I I"'`+ �F``I �jvt(",��CL I'�G1Y��.S tl '�,'Q�" J7 OWNEA d ❑ AGENT FOR OWNBH ��NATURE) (DATE) � Please psy by check or money orda�only.(Csah wlll no!W axaputl.) � Make checks pey�ble to:COUWTY SAWITATION DISTRiCTS OF LO&ANGELES COUNTY. Returned checks will be subject ro a peneHy. � FEE CALCUlATION FOR RESJDENTIAL,COMMERCIAL,AND INSTITUTIONAL CATEGpRfES ' � x a /��r� � � �� � � j Numher W Units of Usage, �/ Cannectian Fee Per UN[of Usage Connection Fee ,.._._�_ _—. � SPECIAI CREDITS(O�,y It AypllceEle) ,. ' � In orclerto recetve cred�t of demolition C7 dEMOLITION CR&DIT or lormer use must bs su�tted Wkh ynur _ a � � r. � ❑ CHAh1(3E I!V U$E GREDIT" appiication(e.g.Demolk�on Permits,originai � ❑ AD bALOREl1�"�AX CAEDiT plarts)• AmtexatFon ate _ �'' { . -. a ���� pf Less Than Zero,Errter Zaro) � Capnection Fee Due `� r . (For Dis(ricfs' se Y p � FEfi PA1"MERkT��� �t ,?�j�� ��� � °����'�� � ; -�� F t " �.> j 1�C. ❑�l�,EY N� ApPro•red bY _ J , I From: i � ;1!.�� ;��,d� � , J � . �f��� ���"`Ck.No. l�i�� Pertti�{rb.:—.�_--�--DaNat , r ' , .Rmayp� i 5�" +x i + ! VYMI7E COPY—COUNTY SJfN�TMfON OIS'fRICiS OF LOS ANGRES COUN7Y ' � ; ,� YELLOW COPY—BF11lD�NG DERARfMENT � - j PINOO NDt 8liAMTE� .. .. �( � � q}7� I