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HomeMy Public PortalAbout9206 BLACKLEY ST_Building__ DEPARTMENTCOUNTY OF LOS ANGE ESAFETY i m L WM. J. FOX, CHIEF ENGINEER APPLICATION _ .. FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY �7 DISTRICT NO, PLANCK DR REC No PERY4IT N BUILDING ADDRESS O RECEIVED BYDATE OF APPL ATE 1 SUED LOCALITY ' _ —S NEAREST 1 CROSS BT. BUILDING OWNER �} �1 R�. -.� �� � rJ,1� ADDRESS / MAILC /� LOCALITY ADDRESH -/ a NEAREST `'� TEL, o f CROSS ST. CITY 1 NO /1D� FIRE NO OF I TYPE GROUP ARCHITECT OR TEL ZONE PLANS — ENGINEER NO. BLDG J /�jq7D49 SETBACK`LINE ADDRESS ^� USE APPROVED TEL ZONE BY J _ •DATE/b��_�� CONTRACTOR - NO. i HOUSE NUMBERING - r , ADDRESS MAP NUMBER NO ASSIGNED BY LEGAL CORRECTIONS " DESCRIPTION LOT NO. BLOCK _ - , TRACTNO. OF SIZE OF LOT jJ /� , NOW ON BLOT S� -3 _ / . . A H / I — .r "' - EX STN FM EJ - - DESCRIPTION OF WORK �° Lo NEW ALTERATION G I ADDITION Z D REPAIR—J-1 DEMOLITION f' Sq.FT. NO.OF _ SIZE ROOMS STORIES _ EXT WALL I ROOF _ COVERING OVERING USE OF STRUCTURE INSPECTION FOR APPROVALS OCCUPANCYAS I NSPECTOR'S SIGNATURE DATE ( FOUNDATION LOCATION FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- ' PLICATION AND STATE THAT THE INFORMATION GIVEN IS i FRAME FIRE STOPS, CORRECT BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION GRN VENT, DUCTS SIGNATURE O� /'7�� C-k&V LATH, INT PERMITTEE � �_ LATH, EXT. ADDRESS � � /� /` - I PLASTER, INT. AUTHORIZED AOT. PLASTER, EXT P C. �r FEE HOUSE NUMBER COR- o RECT AND POSTED VALUATION c FEE � i� � FINAL 76A63SA DBS 3 7-51 1 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT t COUNTY OF LOS ANGELESm mm I L ® 1 WM. J. FOX, CHIEF ENGINEER la u POEM FOR APPLICANT TO FILL IN + FOR OFFICE USE ONLY DISTRICT NO � PLAN CK-NO - PERMIT NO. � BUILDING ADDRESS LOCALITY „i itAoL I 'I l/ �/�.f.l�/{l. RECEIVED BY ,= DATE OF APPL` DATE ISSUED 1 NEAREST CROSS ST. r BUILDING OWNER ti. � �/�( . ,GL�//fU/r✓( ,P/�1 � ADDRESS G MAIL � /n .cam' LOCALITYI �i�.is ✓Z,� ADDRESS (J ' NEAREST I CITY �YI.d���J (• NO. CROSS ST /// FIRE NO OF TYPE_.p - OROUR. ARCHITECT OR / TEL. ZONE `l PLANS �� f �i/-� ENGINEER / .NO. BLD9. ORD NO ADDRESS BETBACKLINE ;?O APPROVED /jam TEL. BY / Y J' -DATE CONTRACTOR NO. UBE - % AXPPROVED ADDRESS ZONE S a-o-Q BY ' DATE LEGAL /'� } CORRECTIONS DESCRIPTION LOT NO. / I BLOCK ( r i _ k i TRACT f I - /f v / NO OF BLDGS. SIZE OF LOT Ttl �ID� I NOW ON LOT USE OF �I�NO OF I I NO OF Hr - EXISTING BLDG. P 6, a. ��' FAMILIEB ROOMS DESCRIPTION OF WORK / NEW ALTERATION ADDITION � O A REPAIR A F? MOVING DEMOLISH l_ p SO S ZE T ! //]J ROOMS STORIES /NO OF ' WALL ROOF COVERINGUSE OF NE /� I, C`OVVERINGn B U LD I NG W C �/`i'11 if A l"4 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATINGGG BUILDING CONSTRU/CTITIOON FRAME: FIRE STOPS, [, SIGNATURE OF /� n )�^� �_.,yII✓f' �J1' BRACING,BOLTS !/ QR > 9- /� J� PERMITTEE -�•(.d iO �Es�f� �//f11f,77�GGG11f LATH,INT.: AUTHORIZED AOT LATH,EXT.: OSS-3 50114 BETS 1-413 $ /6 8, O •-� P.C 6� PLASTER,INT. FEE PLASTER,EXT. VALUATION FEE v FINAL f DEPARTMENT OF BUILDING AND SAFETY ' APPLICATION FOR PERMIT CQUNTY OF LOS ANGELES - �'� WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY L / DISTRICT NO. PLAN CK.NO. �gPERMIT NO. BUILDINGD../1JC�d��ay ADDRESS L0CALITY'1 dA.� �f�.gfY� ® �. RE EIVED Y DATE OFAPPL. DATErxpIimetf ED NEARE9 I. 'p (r �<K! ,�/'� �rr...• \ I% CROSS BT n t�9 �� ` f � � BUILDING OWNER /'1�tij//} A >�J��' ADDRESS MAILLOCALITY l/v v l AODREB9 L` V�CITY TEL /� (� d NEAREST /' t CROBB ST. m NO FIRE NO.OF _ TYPE u GROUP ARCHITECT OR ZONE= PLANS _ENGINEER iN0 BLDG ( � 4;g-_N 0. ADDRESS BETBACK LINE APPROVED ` C CTOR � NO . BY DATE USEAPPROVED Ad RE ZONE 44'."' � BY DATE DESCRIPTION LOOT NQ.LE AL BLOCK 1idT� �d CORRECTIONS CG 49 TRACT ,j/ e� NO OF SLOG SIZE OF LOT5y a d / 4.6 I NOW ON LOTSuse OF 1/�!P NO.OF NO OF EXISTINGBLDG. 17 FAMILI[B ROOMS/ DESCRIPTION OF WORK NEW ALTERATION ADDITION /t O REPAIR MOVING DEMOLISH p SIZE [� NO. Z B _ROOMS STORIES D WALLj��,q(�JJROOF r COVERINGAilu, I COVERING `mt USE OF NEW BUILDIINNG ' zo 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS., APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE FORMS, AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FLOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS,MATERIALS FRAME: FIRE STOPS. �l SIONATURE OF ® BRACING.BOLTS / -4 A)$ PERMITTEQ f�.P�R� '� LATH, INT. ` e AUTHORIZED AQT LATH, EXT. 11� �. NY 7SA63BA-3 7-60 P.C.S PLASTER,INT. FEE PLASTER.EXT. r \� VALUATION 79 � G 0 10 FINAL � FEE �/ ©s 76A638A APPLICATION F BUIL PERMIT COUNTY,OF LOS ANGELES _ BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING � � G ADDRESS BUILDING ADDRESS c �� �// / LOCALITY !G NEAREST CITY "(� �j ZIP CROSSST v/� NO OF BLDGS ASSESSOR r' SIZE OF LOT NOW ON LOT MAP BOOK- PAGE - PARCEL DISTRICT GROUP TYPE FIRE 1P CESSED BY TRACT BLOCK LOT NO�j 7? J COQ EL OWNER �� NO �7� , /�� / STATISTICAL CLA ICATION SEWER MAP ' ADDRESS % CLASS N / DWELL UNITS - BK CITY ARCHITECT OR TEL VALUATION $ � ENGINEER NO - ADDRESS BLDG SETBACK FROM i TEL FRONT PROP LINE OF (STREET) CONTRACTOR V,60_ 51A-',0A,) NO 4 r%GyHIGHWAY + YARD _ TOTAL SETBACK FROM T PE OF EXISTING £ LIC FRONT PROP LINE _ IG AY _WIDTH - ADDRESS .J�� Z/- NO LIC + CITY �r� CLASS rt �! CONSTRUCTION LENDER _ BLDG SETBACK FROM / � ---� ' NAME AND BRANCH SIDE PROP LINE OF (STREET) } HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING 4 ADDRESS CITY SIDE PROP LINE HI G Y WID O SO F4192 NO OF NO OF CHECK / SIZE STORIE FAMILIES ONE ! 0 USE ZOt3E MAP / DESCRIPTION OF WOR � � ��''I NEW ❑ �� I NO 4 , SPECIAL ADD CONDITIONS- y� ALTER ❑ FINAL BY Z REPAIR O DATE USE TI DEt IOL El �� EXISTING BLDG Z t , APPLICANT TEL (PRINT( �Qr NO Q D BY(SIGNATURE) �em 4 r _ I HEREBY ACKN LEDGE THAT HAVE READ THIS APPLICATION AND STATE If Y r THAT THE ABOVE CORRECT AN AGREE TO COMPLY-WITH ALL ORDINANCES _ 2 O 2'Q A ING WORK AUTHORIZEDTING HEREBY IDWILL NOAND LAWS TEMPLOY ANY PE TRUCTION I IRSONHINTVIOLT ONTHE OF 'I ,' V THE LABOR CODEOF THESTATE OFCAUFORNIA IN RELATING TO WORKMEN SCOM Z #'o 0 0 0 0 1 ` PENSATION INSURANCE r 0 1 06, 00 L O O SIGNATURE OF PERMITTE _ 'o�^ 1/�0 6Q 0 O U r E • ADDRESS r r�jj U L �C Li.� ZO 0 506-80 CITY 1 1 L//%��j No Q PC Fee$ Permit Fee ego > F Issuance FeeLu a Total Fe D WORKERS'COMPENSATION DECLARATION 70 1. J ` hy&rebv`�abcti rtifcareofthal Wokers'CompensatoneInsurannt to ef APPLICATION OR BUILDING PERMIT ' `ce'rtified copy thereof (Sec. 3800, Lab. C.) 't COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING Policy No. ' Company -7 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 9206 E. Blackley ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS - 9206 E. Blackley St LOCALITY Temple City Dare Applicant CITY Temple City, CA ZIP 91780 RAREST CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF B_LDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF.LOT NOW ON LOT MAP BOOK I PAGE PARCEL USE ZONE MAP (This section need not be completed if the permit is for one hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. R j&. Charles F. TEL. / SPECIAL I certify that in the performance of the work for which this OWNER Oya N0285-8425 CONDITIONS CL permit is issued, I shall not employ any person in any manner C011�tt DISTRICT GROUP TYPE FIRE PRO SSED BY O so as to become subject to the Workers'Compensation Laws. ADDRESS 206 E. Black a St CONST. ZONE U �- x/12/83 c1TY Tem le Cit Dat Applicant ZIP 91780 STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after makin this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to The Workers' ENGINEER NO. CLASS NO. DWELL. UNITS 0. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. BK. PG, / VALIDATION .e LICENSED CONTRACTORS DECLARATION LIC. - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALVA ION (commencing with Section 7000)of Division 3 of the Business and LIC. Q Professions Code, and my license is in full force and effect. CITY CLASS $ /. SQ. FT. 61 NO. OF NO. OF CHECK 75G License Number Lic:Class SIZE. STORIES l T, FAMILIES 1 ONE 1;5 — ve P p Otil� T [tom Si $ Contractor Date D CRI:T Liv ng O"L WORK F1I am exempt under sec. inning and Bathroom ADD SS ger ALTER ❑ FINAL /7 B.&P.C. for this reason Com lete Batiroom Elec.Walls ❑ DATE REPAIR Date: USE OF Plumbin FI AL EXISTING BLDG. g DEMOL ❑ By Signature APPLICANT TEL. g OWNER-BUILDER DECLARATION PRINT NO. c, 1 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 ❑ BUILDING 1, as owner of The property, or my employees with ADDRESS wages as their sole 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 ❑ 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). REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT The performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE m P.L. . v Lender's.Name Lender's Address P.C. Fee$ Permit Fee H,/3 w I certify that I have read this application and'state that the g Y pp issuance Fee 0 a above information is correct. I agree to comply with.all County Investigation Fee . g ordinances and State laws relating to building construction, Total Fee V, d and hereby authorize representatives of this County to enter m upon the above-mentioned prop rty for inspection purposes. a ; l 7/12/83 SEE REVERSE FOR EXPLANATORY LANGUAGE es 777""'�— Sig Lure o A plicant or A ent Date � r WORKERS' COMPENSATION DECLARATION • 7 C_ hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure,'or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING p�6 / q„ )� tion department. ADDRESS (/Js G LOCALITY NEAREST Date Applicant CITY Lr ��l •• ZIP O� CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. CSA) ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK 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. {' ° t . TEL. /� �} i SPECIAL OWNER fT �M�CI NO.v1 -39/� CONDITIONS I certify that in the performance of the work for which this N DISTRICT GROUP TYPE FIRE PROCESSED BY permit is issued, I shall not employ any person in any manner _ e �. t �L'J so as to become subject to the Workers'Compensation Laws. ADDRESS - CONST. ZONE � Q(�' L'-�v _JDate Applicant CITY �/� �l ZIP ?b STATISTICAL CLASSIFICATION 1! APT. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. �y Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. 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 Division 3 of the Business and LIC. I Professions Code, and my license is in full force and effect. CITY CLASS $ f SQ. FT. INC. OF NO. OF CHECK License Number Lic.Class SIZE ISTORIES FAMILIES ONE � ❑ $ Contractor Date DESCRIPTION OF WORK 10DA r NEW I am exempt from the licensing requirements as I am a U,0(� a �� ADD licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, ❑ DATE REPAIR Business and Professions Code). US F FINAL DEMOL EXISTING BLDG. [:JB Lic. or Reg. No. Date APP(ICAN `�n�� O �6-ag Y OWNER-BUILDER DECLARATION (PRINT) fl h 3, ��� E I hereby affirm that I am exempt from the Contractor's License q �� '��Lt 116- Law for the following reason (Section 7031.5, Business and ADDRESS G G s C /1��+ �Co Professions Code): PRESENT El BUILDING - -„ I, ags owner of the propperty, or my employees with ADDRESS z 4 O 7J A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044,Business and Professions Code). MOVING TEL. #'o 0 0 0 0 I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- PRE 2,0 a 6 O 0 tion 7044, Business and Professions Code). TOTAL SETBACK FROM EXIST. 0 0 0 CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH ��7�O 9O FJ- I hereby affirm that there is a construction lending agency for O 2 / —8 I the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name r Lender's Address Permit Fee I certify that I have read this application and state that the Issuance Fee aabove information is correct. I agree to comply with all.County n Fee finances nd State law relati to building construction, Total Fee and hereby thorizere r sent t' es of t ;o ty to enter upon the a ve,-mj do d pro r purpos.es. a SEE REVERSE FOR EXPLANATORY LANGUAGE Os Si Lure of Applicant or Agent Dote r "NRKERS' COMPENSATION DECLARATION • I her:':by affirm that I have a certificate of consent to self nsfhie, c;"a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT certi7ed'copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY F2, No. ZZ Company' Lc�L �tino�— BUILDING 9z�� ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS (/ ( fir Certified copy is filed with the county building inspec- BUILDING ?20 Tion department. / ADDRESS /� � Com/ lqlDate ! -� I Applicant r� d � CITY' /� Ci/ ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGT NEAREST SIZE OF LOT NOW ON LOT CROSS SL COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK �� GO PAGE d PARCE hundred dollars ($100) or Tess.) (� TEL. q OWNER /.4 /III-`S' /�// NO� 'g/ USE ZONE MAP I certify that in the performance of the work for which this 7 / SPE d SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS !iO SPE /-ry r�G� �V� CONDITIONS /7' / o��al so as to become subject to the Workers' Compensation Laws. ) 0 CITY -Fe t-n I� G. ZIP Date- Applicant ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY ' CONST. ZONE O Exemption, you should become subject to the Workers' / w Compensation provisions of the Labor Code, you must forth- ADDRESS �� - V ��� a • `with comply with such provisions or this permit shall be TEL 44 STATISTICAL,CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR eW• NO. D-Z/.S� — LICENSED CONTRACTORS DECLARATION LIC. f�7 CLASS NO. 67,1? UNITS i I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP y!_ ! ,a (commencing with.Section 7000)of Division 3 of.the Business and Professions Code,and my license is in full force and effect. CITY' CLASS BK PG. .j :fT/ALIDATION V3 SQ. F.T. . OF NO. OF CHECK License Number ��S D3� tic. Class 13 SIZE �- I FAMILIES ONE E t= L- VALUATION Contractor Date - DESCRIPTION OF WORK NEW $ � , `�/Q, _ ,4, /V��O ¢'� ADD 6� ❑I am exempt under Sec. /� rL`(r:°v°• _�. ,_ , ALTER ❑ B.&P.C. for this reason /C7 REPAIR ❑ $ =+�+9r Date: USE OF EXISTING BLDG: DEMOL ❑ -. Signature APPLICANT TEL. �•� (_l l_I;-E3,j_7 f /-•� g (PRINT) NO. Z/v� FINAL z:•.;1.' ; f_ OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License Gd Law for the following reason (Section 7031.5, Business and ADDRESS 2177 v`f�ir FINAL =_j;F Profewions Code): PRESENT ' By = e BUILDING ❑ I, as owner of the property, or my employees with ADDRESS .. wages as their sole compensation,will do the work and 1 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..) CONSTRUCTION LENDING AGENCY I REQUIRED SETT BACK YARD HWY TOTAL SETBACK WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. *- (Sec. 3097, Civ. C.). SIDE, P.L. Lender's Name t". -` i LD/�AtRef. #mit P.C. Fee$ Permit Fee Lender's Address ,pppp 'o pop I certify that I have read this application and state that the Issuance Fee LbMALP/C# above information is correct. I agree to comply with all County Investigation Fee / 3. 6 ordinances and State laws relating to building construction, Total Fee I CDMA Perm. # a and hereby authorize representatives of this County to enter upon the abov -me tioned property for inspection purposes. s• - t'-'' w ( 31 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicogk Agent Date Ex (nf( •: WORKERS' COMPENSATION DECLARATION I herzb affirm that •1 have a certificate of consent to self insure, or a;certificate of Workers' Compensation-insurance, AP.P L I CATION .FOR BUILDING PERMIT ata 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 BUILDING ADDRESS ` ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Q ci Date Applicant CITY, ZIP LOCALITY (P--NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. `� COMPENSATION INSURANCE This section need not be completed,if the permit is for one ASSESSOR ( P P TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) T OWNER �ls USE ZONE. MAP 7 7 �J I certify that in .the performance of the work for which this /� NO. 7 �S f0 permit is issued, I shall not employ any person in any manner ADDRESS ) (J /� SPECIAL sous to become subject to the Workers' Compensation Laws. CONDITIONS }� O - / CITY. / ZIP �{ U Date Applicant ARCHITECT O TEL. Q� NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP I TYPE FIRE PROCESSED BY O Exemption, you should become subject to the' Workers' ( CONST. ZO E U Compensation provisions of the Labor Code, you must forth- ADDRESS C x`3 ✓ w CL with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATIONAPTCONDO. N . deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION . . LIC. CLASS NO. R DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE I STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ (`�� Contractor Date El ADD ❑ s L/ �� ► I am exempt under Sec. I ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License DAT Law for the following reason (Section 7031.5, Business and ADDRESS FINA Pro essions Code): PRESENT By BUILDINGI, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and — - the structure is not intended or offered for sale(Section LOCALITY 7044, Business and.Professions Code.) MOVING TEL..' , � T f� ❑ .I, as owner of the property, am exclusively contracting CONTRACTOR NO. t with licensed contractors to construct the project (Sec- j '•i:-Ey ADDRESS tion 7044, Business and Professions Code.) .;HIr_:•„ _ ,, REQUIRED TOTAL SETBACK FROM EXIST.- CONSTRUCTION ='•i-=r' - LENDING AGENCY SET BACK YARD HWY PROP. LINE I hereby affirm that there is a construction lending agency for FRONT tL.it{�16E ,4 C the performance of the work for whiph this permit is issued "P.L. (Sec. 3097, Civ. C.). SIDE P.L. _.. . t!;r!1-0�t t. S Lender's Name. - �_ ---'�• -°�•=-• m / LDMA Ref. # w 7 { P.C. Fee $ Permit Fee �CJ7+:.`fE 1Lender's Address ►I certify that I have read this application and state that the Issuance Fee LDMA P/C#above information is correct. I agree to comply with of I County Investigation.Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # a and hereby authorize representatives of this County to enter IT the above-me tion d rop rty for inspection purp ses. �g J SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Applicant or Agent Date • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9811090008 PHONE: (818) 285-0488 EXT: LEGAL ID: 0. OF CONST BUILDING ADDRESS- TR 11492 SQ. FT STORIES TYPE 9206 BLACKLEY ST STRUCTURE: VN TEMP CA 917803136 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET ENCINITA 8590-009-002 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY TENANT: NI-S-TTEUG-USE. RESIDUSE ZONE - ISS D 0 PROCESSED EXPI EXIST OCC GRP: 11/09/98 UT 11/ /99 OWNER: TEL. NO: BLDGS. NOW ON LOT. VALUATION: FINAL DATE FINAL BY: CODE URIBE;RICARDO,BERYL (626) 796-7337- 1 10,000 ? 9206 BLACKLEY ST �2 7 TEMP 917803136 FEES AI ESCRIP ION WORK( KITCHEN REMODEL AND NEW CEILING I JACENT BEDROOM FEE DESCRIPTION: QUANTITY. UOM: AMOUNT- APPLICANT: TEL. NO. SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27 75 AC STRONG MOTION RESID 10000.00 VAL 1 00 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC-10000:00 VAL 216.60 (TOTAI;�-FEES 245.35 CONTRACTOR TEL. NO ®� ��� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: 0• FOUNDATION/TRENCH FORMS LIC. NO: 1111111 SLAB/IiNDER FLOG WATnT7EOOR M47H265 SEWER MAP BOOK PAGE: FIRE ZONE: CM01 "1�7 UNDERFLOOR INSULATION FLOOR EATHING NO OFFAMILIES: DWELLING S: 0 SS: \ NO 21 p ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS 0 t=c'1 -- NO NO NO CJS FRAME INSPECTION REQUIRED TOT 0 XIST E SPRINKLER HANGERS SET BACK YARD HWY: PROP LINE: WIDTH FRONT - �C �(L61vj e INSULATION/WEATHER STRIP SIDE PL- IN 0 LAT D EXTERIOR LATH RATEDLOOR ASS . RATED WALL ASSEMBLIES RATEDAF 0 INGS T-BAR CEILINGS LOT DRAINAGF REPORT ID DPR261 ROUTE TO BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9811050005 PHONE: (818) 285-0488 EXT: LEGAL 0. OF CONST BUILDINGADDRESS TR: 11492 SQ FT STORIES TYPE 9206 BLACKLEY ST STRUCTURE. 200 TEMP CA 917803136 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ENCINITA 8590-009-002 THOMAS PAGE: 596 GRID: A LOCALITY TEMPLE CITY TENANT YU—STF—BEff USE. RESID USE ZONE: SS D PROCESSED B EXPIRES ON: EXIST OCC GRP: 11/05/98 UT 11/05/99 OWNER: TEL. NO: BLDGS. NOW ON LOT- VALUATION: FINAL DATE FINAL BY: C URIBE;RICARDO,BERYL (626) 796-7337- 1 0 641 SANTA ANITA 2 -2,3 -11 . 2 " SAN MARINO, CA FEES PAID DE RITPTTION 0 DEMOLISH SINGLE CAR GARAGE ON EAST SIDE OF PROPERTY FEE DESCRIPTION QUANTITY: UOM. AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 02 DEMOLITION INSPECTN�� 163.50 SPECIAL CONDITIONS: TOTAL—FEES 191.25 CONTRACTOR' TEL. NO: ® QO�A� APPROVALS DATE INSPECTOR SIGNATURE SAME AO LIC. NO ) PE�f N PROTECTION SEWER DISCONNECTION ARCHITECT OR ENGINEER: TEL. NO: WON PRIVATE DIsF6TAT LIC NO: 1111111 UNDERGRND STRUCT REMOVAL Ir , AND SOIL RECOMPACTION M47H265 SEWER MAP BOOK: PAGE: FIRE ZONE: CMP01� �U Q L �� r1 ���I�� NO F FAMILIES: 0 : STAT CLASS: , v��I u NO 24 � O 0 SCHOOL I HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS O NO NO NO t REPORT ID: DPR261 ROUTE TO: BS0508