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HomeMy Public PortalAbout9465 BLACKLEY ST_Building__ r - 76AGD8A CE�rygg 80D 8-E8 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES - BUILDING L �l DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION ' LOCALITY JOHN A LAMBIE, COUNTY ENGINEER, NEAREST rI c 1/ I CASSATT D GRIFFIN SUPT OF BUILDING CROSS ST �..� N y` DISTRIC NO GBPII,F T PE PROCESSED BY FOR APPLICANT TO FILL IN I CONST BUILDING / Com' /.2/4GSTATISTICAL CLASSIFICATION - SEWER MAP ADDRESS (O J �`,J �- SK PGI CLASS NO DWELL UNITS" (' — G LOT NO YS BLOCK MAP �-'y1 STATE �,S 1 ?`> NUMBER t -'!./ HWY YES NO TRACT �.(f `�♦( F,. jy<(:�i/ tL) C (zC/�r USE ZONE SPECIAL � NO'OF BLDGS � CONDITIONS SIZE OF LOT NOW ON LOT t;./�� - USE OF EXISTING BLDG BUILDING EXIST J� SETBACK YARD HWY STREETINAME WIDTH OWNER / V C1. Vl� !G' �i l 'FRONT MAIL C,G ADDRESS E'(' SIDE /t TEL P L -INSPECTION RECORD CITY ARCHITECT OR TEL ENGINEER ENGINEER Y [f� ' NO. ADDRESS r i TEL CONTRACTOR SI- ' NO ADDRESS D��ESCRIPTION OF WORK NEW tiAp,DJ ALTER REPAIR DEMOLISH* SQ FT NO OF / NO OF SIZE STORIES FAMILIESUSE OF 5 ,. STRUCTURE f (Isl 0�A SIGNATURE OF GNATUREOFAPPLICAN FY. L �La^�' v( �"L �L _ APPROVALS DATE INSPECTOR S SIGNATURE ADDRESS FOUNDATION LOCATION _ FORMS MATERIALS VALUATION $ FRAME FIRE STOPS, BRACING BOLTS FURNACE LOCATION P C PMT GAS VENT, DUCTS FEE $ FEE $ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP= LATH, INT' ' PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RE�ULATIN PUILDING CO STRUCTION LATH EXT ' SIGNATURE OFAG' .' f HOUSE NUMBER COR- PERMITTE !C L-°�/� RECT AND POSTED ADDRESS �' -� FINAL CLYDE N DIRLAM, PRINCIPAL STRUCTURAL N IG NEER PLAN CHECK VALIDATION M0 CASH PERMIT VALIDATION CK m O CASH 1 Or j- }`f 7. r%�i ✓� •. TEMPLE CITY ['''fIIIII 74AS30A Cl#603 1-61 Y APPLICATION FOR BUILDIN G lPERMIT COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST � WILLIAM A JENSEN SUP T OF BUILDING CROSS ST ■ - -'� Lam/ FOR APPLICANT TO FILL IN DISTRICT NO GRP TYPE Ott PROCESSED BY J€' 1 CONST/ Cj p(_pt�rC(� BUILDING �! e STATISTICAL CLASSIFICATION SEWERMAPBK PG� ADDRESS / CLASS NO DWELL UNITS C.T Q LOT NO BLOCK WATER ]�� CERTIFICATE NOT REQUIRED ❑ RECEIVED TRACT /�IIS - i IPLRJ C MAPHIGHWAY �7 NO OF BLDGS NO 2 0/ (CIRCLE) STATE MAJOR SECOND (ICA OF LOT L � I NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG _ O A T L / �t OWNER y O BUILDING YARDHWY STREET NAME EXIST ADDRESS r(-" L� SETBACK WIDTH FRONT �/ ARCHITECT OR TEL P L Z-0 �✓L.i4-c- K L--/ O ENGINEER LV NO SIDE P L ADDRESS TEL 1 INSPECTION RECORD A 1 O CONTRACTOR �C�3 NO o ADDRESS 0 DESCRIPTION OF WORE -J s" �� a� • A � i NEW ADD ALTER REPAIR DEMOLISH SQ FT +.Z NO OF NO OF , /�I IZE �/ STORIES FAKIL.IES USE OF � � STRUCTURE �.- SIGNATURE APPLICANTAil VALUATIONS 270c) APPROVALS DATE INSPECTOR S SIGN4TIJAE PC I+� FOUNDATION LOCATION FEE S FEE S FORMS MATERIALS FRAME FIRE STOPS14 IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS !7 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT / ING TO WORKMEN S C MPENSA6NINSURANCE LATH,EXT SIGNATURE O HOUSE NUMBER COR- PERMITTEE RECT AND POSTED i 711 ADDRESS FINAL PLAN CHECK VALIDATION CK. I,o cases CLYDE P DST VALIDATIONTR CK M a ENGINEER L��a 6 0 1 6J Jrl D 1 5.' 0- 4 76A636ACEry6031068 ,APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT IOF COUNTY ENGINEER 'ADDRESS 9465 Blackiey - BUII.DING_AND SAFETY DIVISION LOCALITY Temple City, JOHN A LAMBIE,COUNTY ENGINEER NEAREST Cloverly & Allesaridro CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST J DISTRICT NO , GROUP `I`TYPEf I PROCESSED BY' +, FOR APPLICANT TO FILL IN — �Opu/ CoN�sIITPBG '. ]BUILDINGWER MA ' ADDRESS ' 9465 Blackle�y- St• STATISTICAL CLASSIFICATION- BK PG - LOT NO 61 L / / 6 BLOCK CLASS MAP NO DW/ELL UNITS STATI "+a Q r Tr _ NUMBER Q HWY YES O TRACNZssioh View Acres USEZONE SPECIAL � / 7Tl' NO OF BLDG S n CONDITIONS y SIZE OF LOT yG I NOW ON LOT 7 A? /i USE OF EXISTING BLDG LIi.P✓`/ �'1�/I BUILDING EXIST - SETBACK _YARD HWY STREET NAME WIDTH OWNER Robert Vanderhagen FRONT AMAIL DDRESS 9465 Blackley St• - P L SIDE _ TELA T6b P L _ x' CITY TM INSPECTION RECORD ARCHITECT OR TELrn ENGINEER Certified NOIR 6 _ • ADDRESS e• 1V •H•TEL E CONTRACTOR Owner NO ADDRESS Same, - _ ,- DESCRIPTION OF WORK NEW X ADD ALTER REPAIR DEMOLISH SO FT NO OF NO OF r SIZE 5/µ4 SCS•ft STORIES - - FAMILIES USE OF STRUCTURE n + S'Am Pool - T Std Plan & I I SIGNATURE OF APPROVALS APPLICANT R-. Vgnd.erhgjZtmn hT ! -/ r DATE INSPECTOR S SIGNATURE _ ADDRESS FOUNDATION LOCATION FORMS MATERIALS $ �00 00 FEE $ OU FRAME FIRE STOPS. BRACING, BOLTS + VALUATION $ O FURNACE LOCATION, �j FEE _ GAS VENT,DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH PLICATION AND STATE THAT THE ABOVE IS CORRECT AND INT AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND - f STATE LAWS REGULATING,BUILDING CONSTRUCTI N. LATH, EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS 9465 Blackley St• FINAL CLYDE N DIRLAM, PRINCIPAL STR URAL ENGINEER_ PLAN CHECK VALIDATION c Mo caste - PEBMIT VALIDATION cK MO C 0 4 1 0 ar 3 2 3 D 3 .0 CI i Ll'�'�0 4 1 1 nPR a 0 2 2,.a o ®', iTY OF:[.EMP_LE Cly 7EAG28A GE#608,0_59 APPLICATION FOR BUILDING PEERMI`I' - 1 - - COUNTY OF LOS ANGELES BUILDING % DEPARTMENT OF COUNTY ENGINEER ADDRESS 5D BUILDING AND SAFETY DMSION LOCALITY ` JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D GRIFFIN,.SUP•T of BUILDING CROSS ST DISTY NO G P T.pE ERSQESSED BY FOR APPLICANT TO FILL IN CONST BUILDING STATISTICALCLASSIF,ICATION SEWER MAP ADDRESS BK /p /SS l4 Ie -PS CLASS NO MAPO7 DWELL UNITS CJ LOT NO 2. �( ¢�/. � -BL /NUMBER `d J � STATE YES TRACT USE ZONE SPECIAL g� NO OF BLDGS_ CONDITIONS H SIZE OF LOT 125 a� I NOW ON LOT {p / r USE r Weld I EXISTITI NG BLDG c7 IjkAW*5!Fl7 BUILDING YARD HWY ST ET NAME EXIST D SETBACK WIDTH OWNER DQE FRONT < MAIL -&, P-L ADDRESSdlesSIDE P L CITY TNo INSPECTION RECORD - ARCHITECT OR TEL ENGINEER NO Vv, 7 ADDRESS CONTRACTOR NO ?"m G'o��,2 I s-a ADDRESS DESCRIPTION OF WORK NEW DD LTER REPAIR DEMOLISH SQ FT NO OF NO OF / ��/�/�- ��'GIH / 6 SIZE STORIES FAMILIES - SUSE OF" TRUCTURE SIGNATURE OF _ APPLICANT APPROVALS DATE INSPECT0 S SIGNATURE ADDRESS• _ FOUNDATION LOCATION -_�-_�� L� ©� FORMS,MATERIALS VALUATION -FRAME FIRE STOPS, I may{,' BRACING.BOLTS Id 0 GvD FEE $a/ - FURNACE GAS VENT,DUCTS LOCATION, ©S FEE S { I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND �,// L f�,( // ���- - STATE LAWS LAT] BUILDIhIG CO STRUCTION LATH,EXT SIGNATUREOFD -HOUSENUMBERCOR- PERMITTEE 'RECT AND POSTED ADDRESS T� FINAL CLYDE N DIRLAM, PAINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION Omo CAS" PERNIIT,VAI:IDATIO CK ,M O CASH LAro 9 4 8 0 JUIL 14 2 3 A 10'.50A - a ,1 �,2v1 -1 At_ 251.00 '- FOA DEPTIS RK;U;RED qq DONE IN THE ROAD RIGHT OZ yOF 7BA038A CE#6098-EY APPLICATION- FOR BU IL®�I�T�C' �'E TEMPLE C11Y 1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST CASSATT D GRIFFIN Sup-OF BUILDING CROSS ST pamaslowN an DISTRICT NO GROUP I TYPE P SED BY FOR APPLICANT TO FILL IN CONST BUILDING r STATISTICAL CLASSIFICATIONI SE R_ MAP ADDRESS J QC B �PG �5 CLASS NO DWELL UNITS -' LOT NOOM 2z Ly jg(j J�fj iPf NUMBER sp / MAP 'OIL % STATETE YES O TRACT USE ZONE SPECIAL pp NO OF BLDGS // A!) CONDITIONS SIZE OF LOT �Z O— O I NOW ON LOT USE OF dw ( /kx*b BUILDING EXIST EXISTING BLDG L YARD HWY STREET NA SETBACK WIDTH OWNER FRONT ADDRESS LCC L e SIDE p�L TELP L CITY No INSPECTION RECORD - ARCHITECT O TEL 00, ENGINEER �e If= NO /6-2'54 � /9 ly/e6 ADDRESS t � TEL CONTRACTOR S'e NO ADDRESS DESCRIPTION OF WORK NEW AD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAMILIES USE C _�u� J STRUCTURE (��fJ �( , SIGNATURE OF APPLICANT /� APPROVALS DATE INSPECTOR SSIGNATURE ADDRESS /,J/Lt� FOUNDATION LOCATION FORMS MATERIALS VALUATION $ DD FRAME FIRE STOPS, BRACING BOLTS FURNACE LOCATION, FEE $ �� I FEE $ OG I GAS VENT DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO AND STATE LAWSMREYU WITH TINGALL B COUNTY ILD NG CONS'iNkUCT ON LATH EXTSIGNATUR PERM TTE E OF ERECT AND POSTED OUSE NUMBER R ADDRESS YYY �� FINAL k ' A W 1"1711iGiN" CLYDE N DIRLAM, PR{INCIPAL STR fK URAL M o ENGINE ER CK M o CASH PLAN CHECK VALIDATION PERMIT VALIDATION Imo Q 1 2'a tilky 2 1 A 3 .00 ®P t O A ROAD DEPT PER,WI'T- IS REOU'^.D I' FOP A P d( f� 1I ,L 5 - .F-DONE IN THE ROAD R,Uri G OF �VAY. ' 7EA"BA CBS-.3..LD APPLICATIONFOR BUILDING PERMIT ` COUNTY OF LOS..ANGELES - ADD Ess DEPARTMENT OF COUNTY ENGINEER 'BUILDING AND SAFETY DIVISION LOCALITY �J e -JOHN A LAMBIE,-COUNTY ENGINEER NEAREST ST �+/O G CASSATT D GRIFFIN SUPT OFBOILDIND CROSS ' Ile DISTRIC 'NO GROUP T� PE P SSED BY - FOR APPLICANT TO FILL IN f I"CONST /" BUILDING STATISTICAL, CL FICA .1r SE ER•MAP a ' BK, Q/ ADDRESS` , CLASS NO D4VEL"L UNITS LOT NO S b BLOCK MAP _ STATE e p NUMBER t. HWy YES O TRACT4 15S! s-b� Q W" Z�D/Vp USE ZONE SPECIAL NO OF BLDGS S � CONDITIONS SIZE OF LOT NOW ON LOT V • _ - _ USE OF _ EXISTING BLDG " - BUILDING- a EXIST SETBACK YARD HWY STREET,N tlE WIDTH OWNER FRONT, MAIL t P L _} , ADDRESS SIDE ! TE4 P L CITY NO INSPECTION' REC RD' _ARCHITECT OR, I,� TE ENGINEER � NO, // - ' ADDRESS ' TEL -- CONTRACTOR NO ADDRESS DESCRIPTION OF WORE a ,• t-"" �'-Aj '�'ALI AO% t, NEW ,ALTER REPAIR DEMOLISH .•1�,/ �' 1��� '� �_/`�� SQ FT /� t NO OF / NO OF SIZE v 1. STORIES ( ` FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT ' APPROVALS DATE INSPECTOR S SIGNATURE FOUNDATION LOCATION ADDRESS `e FORMS MATERIALS ,, } VALUATION $ �a FRAME FIRE STOPS, BRACING,,BOLTS FURNACE LOCATION, PMT FEE �� I FEE $. I _ GAS VENT DUCTS ` 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PL P- LATH, INT / ' PLICATION AND STATE THAT THE ABOVE IS CORRECT AND - AGREE TO COMPLY WITH ALL COUNTY ORDIN////����NCES AND ' /� . 'rte... STATE,LAWS`R,F�') U ATIN UILDING CO RC LATH EXT - SIGNATURE OF/Y" ff HOUSE NUMBER COR- 5� ' PERMITTE ����,lllll RECT AND POSTED ADDRESS FINAL t 9 CLYDE N DIRLAM, RINCIPAL STRUCTURAL`EIN PLAN -CHECK VALIDATION mol CASK _ PERMIT V ATION 4"CK IMO CABH �, LA061 ,2 4 1 110 .11A Y P L. 7GA638A CE#809-6-57 APPLICATION FOR BUILDING PERMIT �. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE,COUNTY ENGINEER NEAREST CASSATT D GRIFFIN,SUP T OF BUILDING CROSS ST r'2a7 DISTRICT NO GROUP SEWER-MAP FOR APPLICANT TO IN - CONTypS Ir BK G BUILDING J" C STATISTICAL CLASSIFICATION ADDRESS a /t _ CLASS NO DWELL UNIT L CK MAP STATE _ NUMBER - I..IWY YES LTRACT U ZO E SPECI _ Q C7 ^� I NO OF BLDGS CONDITIONS SIZE OF LOT NOW ON LOT USE OF /l a*e 0 ' EXISTING BLDG ��� BUILDING EXIST > SETBACK YARD HWY STREET NAM , _WIDTH OWNER. FRONT MAIL /' �� '� P L - ADDRESS p✓ SIDE CITY ' ° INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO - f` ADDRESS EL 7 CONTRACTOR DESCRIPTION OF VfbRK NEW ADD ALTER REPAIR DEMOLISH y-- SIaZE yr- �' O OF NO OF STORIES FAMILIES v USE OF STRUCTURE �. G Y W SIGNATURE OF / ' APPROVALS APPLICANT DATE INSPECTOR_SSIGNATURE ADDRESSellyk FOUNDATION LOCATION FORMS MATERIALS E" $ FRAME FIRE STOPS -FEE BRACING BOLTS � VALUATION - $ FURNACE LOCATION FEE GAS VENT DUCTS ff�j /! I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND ! _ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES-AND STATE LAWS REGU TING BUILDING CON TRUCTION LATH EXT SIGNATURE S. % HOUSE NUMBER COR- --� FERMI RECT AND POSTED ADDRESS FINAL �" a JOHN A LAMBIE COUNTY ENGINEER -CLYDE N DIRLAM, PAINC116AL STRUCTURAL NGIN ER PLAN CHECK VALIDATIONM o CASH PERMIT VALIDATION CKM o H LAC,05.274 DE;.231 6 9.25A2 IJACO 5 3 8 7- ,DEC 2'17 1 , 1 8.5 0 ®P" APPLICATION FOR BUILDING PERMIT J COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION ,FOR APPLICANT TO FILL IN BUIL NG DDRESS I hereby affirm that I have a certificate of consent to self Insure, BUILDI ADDRESS �pp or a certificate of Workers Compensation Insurance,or a certified copy thereof (Sec 3800,Lab C) zIP . p� 5 ����� ,70 ,) LOCALITY ' Policy No Company SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished NEAREST CROSS ❑ Certified copy Is filed with the county building inspection TRACT BLOCK LOT NO department . - USE ZONE MAP NO Date Applicant ASSESSOR Ma BOOO PAGE PARCEL SPECIAL CONDITIONS y, /� CERTIFICATE OF EXEMPTION FROM WORKERS' Q TEL NO — YES NO COMPENSATION INSURANCE ZS�S— S WITHIN 1000 FT OF SCHOOL'? + ADD ES L (This section need not be completed if the permit Is for one hundred �•/ DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY :,[dollars ($100)or less) V I certify that in the performance of the work for which this permit C 4�?LG .o /` ZIP 1790+ '�� Is Issued, I shall not employ any person in any manner so as to ARCHITECT OR El'aINEER / TEL NO ✓ become subject to the Workers'Compensation Laws 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' CONTRACTOR�C�N`�r TEL NO SET BACK YARD HWY PROP LINE WIDTH _ Compensation provisions of the Labor Code you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS J UC NO PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC CLASS P L I hereby affirm that I am licensed underprovlslons of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business andSQ T 7 d NO OF STORIES NO OF FAMILIES Professions Code,and my license is in full force and effect v NEW 11 BK PG poll. }' ` DESC TION OF WORK ' ADD ❑ VALUATION Q License Number LIc Class $ $000— 0 Contractor ,Date ALTER cc ❑ am exempt under Sec REPAIR El0 B&PC for this reason fl/ DEMOL ❑ LDMA P/C# W Date USE OF EXISTING BLDG URM ❑ _ d 1 nature `�•`- Z /59 APPLICANT(PRINT) TEL NO LDMA Perm# _ 1 I,-as owner of the,property, or my employees with wages as z 1��'-T°a their,sole compensation will do the work and the structure Is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE Q _�U� Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of theproperty, am exclusive) contractor Wltfl OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE - + Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY 7 g licensed contractors to construct the project (Section 7044, YES El NO El Ac l 1 °g Business and Professions Code) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING h jJi,(}j OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r CONSTRUCTION LENDING AGENCY GOAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR J. —I_S GUIDELINES � I hereby affirm that there is A construction lending agency for YES❑ No❑ . I t I 1ver r the performance of the work for which this permit Is Issued(Sec14� 277,*'--- N I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING m 3097, CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE N TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD o Lenders Address - C H,;NGE +� OVrtJER OR AGENT O o I certify that I have read this application and state under penalty PC FEE �y� PERMIT FEE /y oof perjury that the above Information Is correct 1 agree to comply /•�D I _ a with all county ordinances and State laws relating to building �..7 C/ 000 i-0001 7,17;- _ a construction, and hereby a representatives of this County ISSUANCE FEE O j co toe nter o the ove n n property for inspection purpos s � , --tJC L F 1 !+ ID f .'7 er— INVESTIGATION FEE TOTAL FEE ID sV-et a of APvi1Agent ode SEE REVERSE FOR EXPLANATORY LANGUAGE r I APPLICATIORFOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN Bul IN�Dss I hereby affirm that I have a certificate of consent to self insure, BUILDING D13ESS_ 17 or a certificate of Workers' Compensation Insurance,or a certified 7y � (f�_ copy thereof(Sec.3800,Lab.C.) clEM PL- -IF (J zip /f / 760 LOCALITY Policy No. Company SIZE OF L TO X / ( NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. 5 NEAREST CROSS ST. 07 ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant �SgO OO� �l� r SPECIAL CONDITIONS �� �/ CERTIFICATE OF EXEMPTION FROM WORKERS' ER e���E� TEL NO fD7 YES NO COMPENSATION INSURANCE <. WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADD SS £ �� �� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) J ^� -7 ,✓ I certify that in the performance of the work for which this permit CITY`/�/t/7LC C� ZIP / is issued, I shall not employ any person in any manner so as t0 gRCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. /�•A'��� /rULL-&E ,_� STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS /` {— CLASS N0. � DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of :300 �^ S` ��l/1LC_� REQUIRED TOTAL SETBACK FROM EXIST _ Exemption, you Should become Subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION PILE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 4EWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. ®Q NEW BK PG , License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION 0 Contractor Date `30`x ALTER ❑ $ ElI am exempt under Sec. REPAIR ❑ $ �_ 0 BAP.C.for this reason DEMOL ❑ - - W LDMA P/C# Date: USE OF EXISTING BLDG. - URM ❑ a Signature APPLICANT(PRINT) TEL NO. LDMA Perm# r - { z l 1, as owner of the property, or my employees with wages as Z 11 their sole compensation, will do the work and the structure is ADDRESS - -. FINAL DATE ~ 1 f 1 a_ 21231? _ ' -q» + not intended or offered for sale (Section 7044, Business and Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL i_= ',F `z y} ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY ;•! r. ;: _r u �,. licensed contractors t0 construct the project (Section 7044, YES F-1 No❑ Q »r �� » Business and Professions Code.) w WILL THE INTENDED USE OF THE BUITHE APPLICANT OR FUTURE BUILDING -» OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION ON OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR 1,1 iI- I'E » GUIDELINES. - d. ». .t.:?:•.I I hereby affirm that there is a construction lending agency for YES❑ No❑ t °`"% r =t a the performance of the work for which this permit is issued(Sec. == -•• rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. •;•i N 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 SCAQMD, », - - _r IL Lender's Address f.i3 OWNER OR AGENT _ —••'• y..r'—,.jrHi o I certify that I have read this application and state under penalty - p P.C.FEE s� PERMIT FE _ of perjury that the above information is correct.I agree to comply L A/3 G �•��y t_I' 71� � 60 with all county ordinances and State laws relating to building 7i 6 7 V a co construc'on, and herebthorize representatives of this CountyISSUANCE �• D f to ente po h ove- ti ned property for inspection puSrpoC$/eS. Z f ' `s INVESTIGATION FEE TOTAL FEE ® D I»_•'�_�;'�.�;' ,'II r 99--re o Applicator A enl Date I SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY ItiORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILD G ADDRESS I•hereby affirm that I have a certificate of consent to self insure, BUIL4G= 4P or a certificate of Workers' Compensation Insurance,or'a certified copy thereof (Sec.3800,Lab.C.) CITY PL� A ,Ty ZIP /-'�D LOCALI Y Policy No. Company SIZE OF LOT c 'f NO.OF BLD SNEAREST CROSS ST..NOW ON LOT ❑ Certified copy is hereby furnished. _ ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' R — C COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred S /' L � DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) �\ I certify that in the performance of the work for whic s permit I?t::-i�/�`�y e ZIP 1 � is issued, I shall not employ any person in any ma o as to r CT V become subject to the Workers'Co e S t Law ARCHITECT OR ENGINEER TEL NO. �A}� STATISTICAL CLA SIFI,ATION APT CONDO Date Applicant !VL ADDRESS CLASS NO.C� DWELL UNITS—/, NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you -should become Subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES _ Professions Code,and my license is in full force and effect. NEW El BK PG 0- License Number Lic.Class DESCRIPTIO;OF WORK ADD ❑ VALUATION• , C; +,z - Q Contractor Date v ALTER ❑ $ _""f;_ -"a• ` ElI am exempt under Sec. REPAIR ❑ $ j''. BAP.C.for this reason DEMOL ❑ T= r>I £e a_c W Date: USE OF EXISTING BLDG. URM El _ ` '';� IHL i `•(` Signature APPLICANT(PRINT) TEL NO. LDMA Perm# f _ a.._Z ❑ I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and r DATE a D ; t�: Professions Code.) WILL THE APPLICANT OR FUTURE'BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL /bf 9� (II ':, - ;? i) i l .- OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE VVV ❑ I, as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? BY 0 ^ licensed contractors to construct the project (Section 7044, •.__,; Business and Professions Code.) ves 1:1 No❑ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDEUNES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ N the performance of the work for which this permit is issued(Sec. IHAVE READ THE 3097, CIV.C.) CHECKLIST.I UNDERSTAND UMY REQUIREMENS MATERIALS OTS UNDER RMATION GTHE OS ANGELES UIDE AND THE QPERMITTINGMD COUNTY CODE, N 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 SCAQMD.'.: _ CL Lender's Address x 'f O.NER OR AGENT o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE-" •1� I;�. y/�. with all county ordi c s and State laws relating to building Construc'on, an he y thorize representatives of this County ISSUANCE FEEGO . co t en1 b me tioned property for inspe ionpurpoSe� a lY7 ,5 INVESTIGATION FEE TOTAL FEE10 r Sg--of Applicant pr Agent Oa e / SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0007240013 PHONE: (626) 285-0488 EXT: LEGAL I 0. OF CONST BUIL]DI-NG ADDRESS ON FILE SQ FT STORIES TYPE 9467 BLACKLEY ST STRUCTURE' 0 VN TEMP CA 917803157 ASSESSOR 0 A ON NUMBER: NEAREST CROSS STREET ALESSANDRO 8590-004-016 THOMAS PAGE 596 GRID J4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE RESID USE ZONE: R SU D ON PROCESSED BY EXPIRES ON EXIST OCC GRP 07/24/00 UT 01/21/01 OWNER: TEL NO BLDGS. NOW ON LOT VALUATION. FINAL DATE FINAL BY: CODE MCCONNELL ANN N TRUSTEE;MCCONNELL A (818) 285-4956- 4 2,500 9465 BLACKLEY ST TEMP 917803157 FEES PAID DE CRIPTIO F WORK REMOVE/REROOF WITH 30 YR CLASS A I RGLASS (ELK) SHINGLES FEE DESCRIPTION QUANTITY: UOM: AMOUNT: OVER 30# ASTM FELT PPLIC TEL. N0: SAMUEL M BOGNER DBA BOGNER ROOFING - AA BLDG PERMIT ISSUANCE 27.75 1732 BINGDEN RD. AC STRONG MOTION RESID 2500.00 VAL 0.50 SPECIAL CONDITIONS: PASADENA, CA D2 PERMIT W/O EN-HC!! �2500 00 VAL 99.00 �OGELESTOTCAC--FEES 127 25 SAMUEL CONTRACMOBOGNER (626)N797-5346- APPROVALS DATE INSPECTOR SIGNATURE BOGNER ROOFING LIC. NO LOCATION AND SETBACKS 1732 BRIGDEN RD 433435 C39 PASADENA CA 91104 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER. FOUNDATION/TRENCH FORMS LIC NO / 1111111 SLAB/UNDER FLOOR L RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK PAGE FIRE ZONE: P• {�/J UNDERFLOOR INSULATION 147H265 3 3 II Ou ❑ D \, O I�` FLOORS N0. I IES DWELLING UNITS: APT/COND: STAT CLASS:— JJJ u �] NO 21 O ROOF SHEATHING SCHOOL WITHIN HAZARDOUS E) ` SHEAR AIR QUALITY• 1000 FEET MATERIALS Q Q r, NO NO NOQ , ®y FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD HWY: PROP LINE: WIDTH �// ❑ FRONT PL- �'(EaPV7C�-1���� INSULATION/WEATHER STRIP SIDE PL INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID DPR261 ROUTE TO: BS0508 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 BL 0508 9609170017 PHONE (818) 285-0488 EXT- _16GAL ID NO. OF CONST BUILDING ADDRESS: ON FILE SQ FT STORIES TYPE 9465 BLACKLEY ST STRUCTURE: 0 V TEMP CA 917803157 AgSESSOR 19FORMATION NUMBER: NEAREST CROSS STREET OLIVE 8590-004-016 THOMAS`PAGE: 596 GRID: A LOCALITY• TEMPLE•CITY TENANT- T BLDG USE RESID ISSUED ON. PROCESSED BY- EXPIRES ON- EXIST OCC GRP 09/17/96 TC 09/17/97 OWNER. TEL. NO BLDGS NOW ON LOT- VALUATION• FINAL DATE FINAL BY- CODE. MCCONNELL ANN N TRUSTEE,MCCONNELL A (818) 285-4956- 1 2,610 9465 BLACKLEY ST TEMP 917803157 FEES PAID D SCR PTION OF WORK REMOVE/RECOVER WITH 25 YR CLASS A FIBERGLASS SHINGLE APPLICANT: TEE-NU. FEE DESCRIPTION QUANTITY. UOM: AMOUNT SEXTON ROOFING (818) 963-6882- AA BLDG PERMIT ISSUANCE 27 75 718 ALOSTA AC STRONG MOTION RESID 2610.00 VAL 0.50 SPECIAL CONDITIONS GLENDORA, CA 91740 D2 PERMIT W/OHC' Q (2610,00 VAL 99 15 TOTAL (FEES 127 40 CONTRACTOR TEL NO. ( � �� APPROVALS DATE ANSPECTOR SIGNATURE SEXTON ROOFING (818) 963-6882- 718 E. ALOSTA LIC NO LOCATION' D SETBACKS GLENDORA, CA 91740 601896/C39 e SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER T L 0: FOUND 10 /T EN FOR LIC. NO SLAB/UNDER FLOOR W /� p O p C RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK' PAGE FIRE ZONE: CMP ��� ��/ I UNDERFLOOR INSULATION 147H269 3 01 'LOD UUU UUU� �1 NO. OF FAMILIES DWELLING ITS: APT/COND. STATAPT/CO CLASS: p 6 ."� -1 TUDOR SHEATHING NO 21 O 0 g° Aco ROOF SHEATHING 0 429 SCHOOL I I HAZARDOUS �/ ❑ ®� EAR PA LS AIR QUALITY: 1000 FEET MATERIALS NO NO NO 6��0 a _ ( FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIS FIRE SP IN LE H GE S SET BACK YARD. HWY: PROP LINE: WIDTH: FRONT PL- 'orviomINSULATION/WEATHER STRIP - SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEMFLOOR/CE RATED WALL ASSEMBLIES RATED SHAFT /OP NI GS T-BAR CEILINGS i LOT DRAINAGE t , REPORT ID• DPR261 ROUTE TO: BS0508