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Home My Public Portal About9064 BROADWAY_Building__ 7SA95eACE#003-7-es APPLI-CATION FOR 'BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDIADDRESs I i4- Department of County Engineer County of Los Angeles LOCALITY . ✓ t• . .JOHN A. LAMBIE. COUNTY ENGINEER NEAREST �• CASSATT D. GRIFFIN. SUP'T OF BUILDING CROSS ST. YZ_ DISTRICT NO. GROUP TYPE SEWER MAP NG FOR APPLICANT TO FILL IN BK G ,t, ) y I CONST. ADDREBUILDSS ��GG /'JI LcL.LI(-,(,(t.�M�J STATISTICAL CLASSIFICATION LOT NO. 6� 3 CLASS. NO. DW BLOCK ELL. UNITS / MAPHWY Y YES NUMBER NO '� TRACT USE ZONE SPECIAL NO. OF SLOGS. ,��J CONDITIONS SIZE OF LOT G.Z1' Q NOW ON LOT {/ L l USE OF EXISTING BLDG. BUILDING EXIST. SETBACK YARD HWV STREET NAME WIDTH OWNER Mti FRONT j MAIL P. L. ADDRESS 4 01, SIDE TEL L P. L. CITY NO J INSPECTION RECORD ARCHITECT OR TEEl ENGINEER NO ADDRESS 1 �� TE CONTRACTOR ^^f'1 NO ADDRESS /.fUJ'EL'l _DES`fCRIPTIONOF WORNEW• ADD h ALTER x REPAIRSQ. FT. NO. OF SIZE C STOpIES O � APPROVALS SIGN URE OF APPLICANT DATE INSPECTON'R SIGNATURE ADDRESSG a NDATION: LOCATION RMS. MATERIALSS p, C, , E: FIRE STOPS. FEE _BRACING. BOLTS - $,7�- FURNACE: LOCATION. FEE ..r VALUATION 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 COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS R GU ATIN BUILDIN CO NSTRUCTIQN. LATH. EXT. _ SIGNATURE OF / ! C HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN A. LAMBIE, COUNTY ENGINEER. ' CLYDE N. OIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.0. CASH i PERMIT VALIDATIONCK. M.G. CASH °,Co0 '2.8 5�; JUL 1. 7 1 4.0 0 ^ "® y 79A.... .s.o.. l_,I APPLICATION F TR BUILDING PERMIT I COUNTY OF LOS ANGELES BUIL19'a Gam ' DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY 9V,9 JOHN A. LAMBIE, COUNTY ENGINEER NEAREST Imo" N WILLIAM A. JENSEN $UP•T OF BUILDING CROSS ST. DISTRI G P TYPE P O ES BY FOR APPLICANT TO FILL IN `- , CON ST. BUILDING G+-b STAASTICALC FICATION SEWER MAP ADDRESS CLASS. NO. DWELL. UNIT9 �BK P v '— LOTNO. BLOCK WATER NOT REQUIRED RECEIVED q TRACT �� CERTIFICATE:MAP o/qNIGHWwY STATE MAJOR SECON LOCAL LDG/� �,I NOW ON LOTS USE ZONE SPECIAL NO. (CIRCLEI SIZE OF LOT• r!/V/.( �� USE OF - III CONDITIONS EXISTING SLOG.. TX�'.�/�f . .' -�. N2 RO OWNER ' B ILo ING EXIST: SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT / ARCHITE OR T P. L ENGINEER: NO. SIDE ADDRESS CONTRACTOR$ NO. / INSPECTION RECORD ! O ADDRESS � �D�ESCRIPTION OF. WORK 8'LN6�1 In.��i . �Jn� l•:u�i✓�/.vl� O NEW 0 ADO9 ALTER REPAIR DEMOLISH SO.FT,t-) NO.OF. NO.OF /•fJl i// l(%:C CEJ /��c.J 401. �f. I(� ' Z SIZE STORIES FAMILIES USEOF STRUCTURE 4 I SIGNATURE OF✓^�'� w A L.IJ APPLICANT .Y VALUATION$ t I, � "� 0� - APPROVALS .DATE . INSPECTORS SIGNATURE FO MATERIALS ( //_�/ FEE $ FEE $ FORMS,/ ,FRAME: FIRE STOPS. HEREBY ACKNOWLEDGE THAT I HAVE REND THIS APPLICATION BRACING, BOLTI III ywA A/I AND STATE COUNTY THE ABOVE E CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. V✓w' I WITH ALL COUNTY GROIN qI CE6 AND STATE LAWS REGULATING WORK GA$VENT DUCTS / / AUTHORIZED CO NSTRUCTI WILL CERTIFY THAT IN DOING THE WORK TION OF THE HEREBY WILL NOT EMPLOY ANY LI SON IN VIOLA- LATH, INT. r TION OF THE LABOR COOS OF THE STATE A CALIFORNIA RELAT- INGTO WORKMEN SCOMPENSNTION INSURANCE. 3 I // {Y LATH. AN SIGNATURE O /f/P/�/' HOUSE NUMBER COR- / " - SIGN TU ,2� RESTANDPOSTED AODRE,,�� A -!.t '^�'7:P� r L� FINAL CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINE R PLAN CHECK VALIDATION cK. M.o. CASH PERMIT VALIDATION I , �; �a 3 5 2:2 i,VR 21 1 D 1 5.0 u" `s DEPARTMENT OF COUNTY ENGQil;ER r.a DIVISION OF BUILDING AND SAFETY ®� Ji COUNTY OF LOS ANGELES vv WILLIAM J. FOX. COUNTY ENGINEER APPLICATION CA98ATT D. GRIFFIN. HUP•T OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDINGS ,I 1, / DISTRICT NO. PUN CK.OR REC.No. PERMIT NO. ADDRESS 9/J ' �l LOCALITY �Jx/It" /I/ _ 7 C�L�JGI RECEIVED BY DATE OF APPL. DATE ISSUED CRO86 BT -er A IV r � BUILDING / ADDRESSMAIL OWNER � / �l� __� �-••� q ADDRESS �n " 6Ig � �_!'1}�./[iM/•"/ 'R LOCALITY / �.. /� „�/ CN RE A ST ROSS 8T. SV T rcI-til.a CITY �. V'/i �C/-/ TO��2,41 ARCH ITECT OR (/ TEL. ZONE I PLANS I TYFIRE NO. OF PE ENGINEER N ]�I J ADDRESS /l BLDG. ORD. NO. SETBACK LINE �1 A,/ CONTRACTOR �O<N.G TEL. I USE �A BBVPROV ED DATE ZONE ADDRESS HOUSE NUMBERING LEGAL MAP NUMBER NO. ASSIGNED BY DESCRIPTION LOTNpO. LOCK _ CORRECTIONS TRACT / 2 ; O BLOW SIZE OF LAT �O / I NONo'W ON LOT ' " J7 exle +OF G BLDG. v� No 0' /D 1s S3 (oB.N/.✓6 ON /N6 DESCRIPTION OF WORK S e p e A NEW ALTERATION ADDITION REPAIR Z r 80. FT. NO. OF SIZE .1� O ROOMS STORIES - EXT. WALLpp��7j� � ROOF COVERING 'ZZ4 _-Iziso COVERING: USE OF STRUCTURE/ - _ne.L.e�6ilrf:e.i .v1G w+-.a._ .•... �. oti/vs�TslD f=12-o..7 APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS .1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS. \Lj PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION. AND'STATE LAWS REGULATING BUILDING CONSTRUCTION.CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF 9 LATH, INT. PERMITTEE �wv-- _JJJfff �fiAf/!![ LATH. EXT. 7 ADDRESBG/� O l0 ��•R I V e;'_ PLASTER, INT. AUTHORIZED AGT: Q 'PLASTER, EXT. FEEC. S HOUSENUMBERCOR- e— O -O RECT AND POSTED VALUATION,/✓ I FEE S l5 ®C' FINAL , I TEAEB DHBi 9-SA 1 76A638A CENS03 B-04 APPLICATION FOR BUILDING 'ER IT COUNTY OF LOS ANGELES OUIL N , DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST. OI STRI NO GROUP - 'TY,PE �ESSED-BY FOR APPLICANT TO FILL IN _ CONST �2.�� BUILDIN STATISTICAL CLASSIFICATION 5 WER MAP ADORES CLASS NO._�DWELL UNITS �� .BK PG LOT NO, BLOCK Or USE ZONE MAP41 NO. TRACT J SPECIAL N0. OF BLDG S. / CONDITIONS 25 SIZE OF LOT NOW ON LOT USE OF EXISTINGBLOB. SETBACK FROM FRONT PROP. LINE OF (STREET) OWNER O' TYPE OF ADDRESS HIS AT EXID C.L.STING BE HIGHWAY } Yq = •TOTAL 'F OM CITY } LDa. 9 BACK FROM ARCHITECT OR TEL SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF E%19TIN0 SET'R HIGHWAY } YARD = TOTAL ADDRESS HIaNWAY WIDTH FROM C.L,I CL TEL } _ 0 CONTRACTOR NO u n _o LIC. CORNER CUTOFF YES NO m ADDRESS _ O F ITY ; LICLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS W DESCFfIPT46N OF WORK h Z_ NE ADD ALTER REPAIR DEMOLISH SO.FT. NO. OF NO. OF SIZE ��/' STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT VALUATION - APPROVALS DOTE INSPECTOR'S SIGIOTWfE P.C. pMT, ( FORMS,FOUNDATION, LOCATION 7I%I d' J^ FEE$ FEES MATERIALS /`• �f "3�—{'.4(�. FRAME, FIRE STOPS, I c V I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDING 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 RELAY. G RKMEN'SC S (NSU LATH. SIGNATURE NUMBER OF - HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS Gy FINAL JOHN F. LEWIS, PRINCIPAL STRUCTURALE (NEE PLAN CHECK VALIDATION OK. M.D. CASH _ PERMIT VALIDATION CK. M.O. .CASH LAC07.4 .916143 NOV22 1 0: . 6.0'0-.. "DEPARTMENT OF BUILDING AND SAFETY APPL'ICA'ravav-f OR PERMIT COUNTY OF LOS ANGELES ® � �0 •.-^P-.`y WM. J. FOX, CHIEF ENGINEER RU U9 FOR APPLICANT TO FILL IN I FOR OFFICE USE ONLY I BUILDING DISTRICT O. PLANCK.NO.•—•-PERMIT NO. ADD E59 N O L L AA.LLL++I�J - LOCALITY . & / 1 \ `-J Z DATE ISSUED //yy� J//7� REC IVED BY . { DATE OF APP 'Ly _ J /)�' / Ip l I . CNEARESTROSS T. , JGL;_tz" . / v t" p- •,/ :� 'I ., .I �/Z��/o // i'I� 1 I4. �FY�W (BUILDING 94bcT-v'r ./J F�s�l'e..,,9 y OWNER . �./�Q..A��1'�' ! 8UILDIADDRESS /• /Y MAIL 9/// q A�� w LOCALIT,Y T �s 1 ADDRESS // /AI �tr/(�f /nTE NEAREST '^ / CITY / / �n CR0993T. �)/� `T/(JA/A ,J FIRE NO.OF TYPEJ GROUP ARCHITECT OR TEL I ZONE I I PLANS . -L-I ENGINEER NO. BLDG. ' I ORD. NO. ADDRESS SETBACK LINE• APPROVED TEL BY I I� I I `DATE l� i CONTRACTOR NO. ZONE/ APPROVED I I I I ADDRESS DATE BYI LEGAL /� i ' f CORRECTIONS DESCRIPTION LOT NO. BLOCK 1 /y TRACT •)-I `+ e / 19/.!Y� _{.�'—i.clLC7 U --[!! _ bn XlG0 I NO. OF SLOGS. / 1G q 1 SIZE OF LOT NOWLOTTE O'2� - USE OFy�1. NO.OF NO.OF Li 1i EXISTING BIDS. �Ilp. FgMlticg I ROOMS j: /`�E�C� -�FA /T✓ .�I.^++�•-•�=a.-- I DESCRIPTION OF WORK � � 9 S 3-L- NEW NEW I� _I ALTERATION ADDITION ( $/ +.r2 5 a/n LZr//.VA-- •.s..�iy✓ REPAIR MOVING DEMOLISH 9HD. FT. I No- orROOMS STORIES / j - "" +'i ' V7 [9R�:. •.. nr Z 12E D F WALL ROOF y�� ,. , /)� - '(ti SL90RV 1`ll11 COVERING , COVERING y(J ,Y/Y�j((/yy J�tiu USE OF NEW 1 r/ 1 . ..._ . . . .._... BUILDING p I i 1 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THISt APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT IN9PEC OR / DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION / AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS. MATERIALS /), J /J�1 FRAME: TO S RE FIPS. 51GNATURE OF IN �AV� ,L( I}1,/L,VIN[/J. BRACG, ETO PERMITTEE_.,. / LATH. INT. a-J1 AUTHORIZED AST. I - LATH. EXT. / 76A6g A-a I0-50 $ P.C.III PLASTER. INT. FEE Q PLASTER. EXT. �� VALUATION -'I V FEE ��• FINAL LJ�/Y/Lre2 I� 1 �V 14A.38A CE 1H5•S.60 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELESB ILDLNG / DEPARTMENT OF COUNTY.ENGRIIEER ` ADDRESS BUILDING AND SAFETY DIVISION LOCALITY .JOHN A. LAMBIE. COUNTY ENGINEER -NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. UP -rypE P ESSED B FOR APPLICANT TO FILL IN I CONST BUILDING STATISTICAL CLASSIFICATION WER MAP ADati DRESS ,� BK G - CLASS.NO, DWELL;UNITS Z LOT NO. BLOCK MAPSTAHWY.TE YES �J NUMBER TRACT eL / USEZONE •SPECIAL SIZE OF LOT NOW ON LOTS L.O CONDITIONS USEOF EXISTING BLDG. � � _ - ^ BUILDING - E%IST. /•jam-? `� eFRONT YARD HWY STREET NAME SETBACK WIDTH OWNER p P. L. i(1 ADDRESS UCH SIDE ARCHITECTOR �^ p' L' ENGINEER iS./�GfJ r C•.c INSPECTION RECORD ADDRESS TEL. CONTRACTOR NO' ADDRESS0 0 �✓ DESCRIPTION OF WORK u W a w NEW - DD ALTER . REPAIR DEMOLISH � .Z SQ.2EFT.f /y ' NO,OF NO.OF S1G1 STORIES FAMILIES USE OF s STRUCTURE ! I•. 1-�11Q : . / SIGNATURED ' APPLICANT VALUATION$ APPROVALS b0g INSPECTOR.'S SIGNATURE PMT. Q FOUNDATION: LOCATION FEE $ I FEE $ '-FORMS, MATERIALS FRAME: F IRE STOPS, r I HEREBY ACKNOWLEDGE THAT 1 HAVE RE T IS APPLICATION BRACING, BOLTS AND STATE THAT HE ABO CORRECT A A REE TO COMPLY FURNACE: LOCATION. WITH ALL COU TT 'OR NC 5 AND STA L WS EGULATI T GAS VENT Ducts . OUILDING CONS RD RTI FT TH ERFORMA E - , OF THE WORK FOR I IS I SHAL LATH, INT. n EMPLOY ANY PERSO IN AS 8 M C TO THE WORKME 5 5 ' LATH, EXT. SIGNATURE HOUSE NUMBER COR- A , PERMITTE RECT AND POSTED ADDRESS AL 7•� SSV f ✓J�� LYDE N. DIRLAM,PFiINCIPAL STRUZTURAL ENGINEER PLAN CHECK VALIDATION cK. M.G. LASH PERMIT VALIDATION CK. 1 M.O. CASH [ Lo-0 0 7 � - Baa 2 3 1 0 12 ;0 0:,. APPLI CATION FOR BUILDING PERMIT "f I OF LOS ANGELES ' �A.. . BUILDING'AND SAFETY WORKER'S COMPENSATION DECLARATION FOR AlPUCANT TO FILL IN BUILDING npDPESE I hereby affirm`tfiat I have a certificate of consent to self insure, BUILDING ADDRESS - - R O or a certificate of WorkersCompensation Insurance,or a certified 904-q 8,40ADW,19y All CITY ' ZIP F. m L L - c D - copy thereof (Sec.3800;Lab.C.) f Policy No. Company Em PL GAT CA. - / OW ON LOCALITY SIZE OF QCT / NO.QF BLDGS.NOW ON LOT ❑'Certified copy is hereby furnished. - G O 1! / ASO /.7l NEAREST CROSS ST.- ❑ Certified copy is filed with the county building inspection. TRACT BLOCK LOT NO. .J �/LT 40� /9w ONDITIONS 0 SPECIAL C deParime0t. USE ZONE MAP NO. Date Applicant ASSESSOR MAP K?S7 PAGE PARCEL - q CERTIFICATE OF EXEMPTION FROM WORKERS' - OWNER TEL No _ COMPENSATION INSURANCE ON7V/L'.L ONNA ABBO 96--14 7S-2, WITHIN 1000 FT.OF SCHOOL? VES Nx (This section need not be completed if the permit is for one hundred ADDRESS - ' dollars_ ($100)or less.) 9`061y RVAP LO r. I DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BV CITY ZIP' I certify that in the performance of the work for which this permit L /22e, GfjL/f. l O 0 p %. WIDTH is issued, I shall'-not employ any person in any manner so as'to gRCHITECT OR ENGINEE TEL NO.beCOm(�B�S��ubjeL��t t,c the Workers'COmpensatioo Laws. STATISTICAL CLASSIFICATION Date LL Applicant / �d M A A1+M NQ f Z ADDRESS - CLASS NO. � DWELL UNITS NOTICE TO APPLICANT.- If, after making this Certificate of REQUIRED TOTAL SETBExemption, you should become subject t0 the Workers' CONTRACTOR TEL/NO. {SET BACKYARD HWV PROP Compensation provisions of the Labor Code, you must forthwithr 711 %^,i M1Rf 2 i 3e9'-9VT2comply with such Provisions.or this permit shall be deemed revoked.. ADDRESS . LIC.NOpLLICENSED CONTRACTORS DECLARATION CITY UO/ASSOs PILE0 I hereby affirm that I am licensed underprovisions-of Chapter 9 SEWER MAP (Commencing with Section 7000)-Of Division 3 of the Business and 50.FT.SIZE NO F STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. 9 NEW ❑v BK PG SSC//O S /T . DESCRIPTION OF WORK ADD VALUAT ON 0 D W License Number /L�ia Class ConlractorA�R/'+t/qz. 11-"Itq a 5'- t- ?c ALTER ❑ � ®'I am exempt under Sec. /T o " REPAIR ❑ Z B.&P.C.for this reason IVs F Avr P46 jam/+(£ 5 'DEMOL ❑ WMA P/C K Date: _ [ G USE:OF EXISTING BLDG.' URM ❑ a Signature -t�1/1'nl�r. --/� _ • 1/ .c c��TT w i...w-—� APPLICANT(PRINTI TEL NO. LDMq Perm• - •, I • N47c -�• ,V ❑ I, as owner of.the property, or my employees wit ages as _ 7C rt�T{Fy� their sole compensation, will do the work and the Structure is ADDRESS _ F -, � �l(•!L/ 'rot intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) - O _r� r • WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL O ~ J ''001 _I/ 3/9i 6J OR A MIXTURE'CONTANING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE L ❑ I, as owner of the property,-am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY a T (� licensed contractors to construct the protect (Section 7044, 1 1 Agig" , Business and Professions Code.) YES❑ - NO❑ - _ - _ tr LWILL THE _ OCCUPANT i REQUIRE A PERMIT FOR NTENDED USE.OF THE CONSTRUCTION ORUIOUNG BY THE AMODIiFI ATON FROM THE SOUTH -aF '[ T J l t• {,t L� �I 11'� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAQMDI EE PERMITTING CHECKQST FOR ~1 ' ITEMS GUIDELINES .L f TIiTAL 296 --:Pg I hereby affirm that there is a Construction lending agency for YES❑ No❑ _ f, , I• _ the performance of the work for which this permit is issued(Sec. A i t 9 A IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTINGT,t' C:HE(:Yt �'{'t" 1 3097,Civ.(i.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, @ TITLE 2,CHAPTER 2.20 SECTIONS 220 100 THROUGH 2.20.14D CONCERNNG HAZARDOUS j Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Oi 1_ Lender's Address ¢ DwweR OR AGENT 3 1 certify that I have read this application and state under penally 0. Of perjury that the.above,information is Correct.I agree t0 comply, PC.FEE `� iF-C PERMIT FEE - w with all county ordinances and State laws relating to building m Construction, and hereby authorize representatives.Of this County ISSUANCE FEE �F , t ent upon the above-m tinned property for purposes. caC �, L INVESTIGATION FEE TOTAL FEE N 4v1un a ASI We OS��.J SEE REVERSE FOR EXPLANATORY LANGUAGE yVCft7CER5'COMPENSATION DECLARATION Y affirm that-I have a certificate of consent to self n PP��CA,�O®!�O FOR !fin n��D��nG PERn��T I j uta, of a certificate of Workers' Compensation Insurance; (T=y\ _ u� uv u� u sou L_J or o cenrfiad colfl thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND S/ ETY pal icy No Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS CL Certified copy is filed with the county building inspec- BUILDING O /s v tion department. ADDRESS Date Applicant CITY ZIP r L/ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF EGGS. NEAREST COMPENSATION'INSURANCE - SIZE OF LOT V 6 NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one / ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL, USE ZpNE ' I certify that in the performance of the work for which this OWNER NO. /f NO. permit is issued, I shall not employ any person in any manner './l� SPECIAL so as to become subject to the Workers'Compensation Laws. em` ADDRESS - sN CONDITIONS Date ^/ APPlicant'o<-�" L�'�`r" ' CITY caw .-{r 2 ZIP /11)"_ t NOTICE TO APPLICANT: If, after making this Certificate of �Xv� TEL' rpy�r DISTRICT ,GROUP TYPE FIRE PR SSED BY Exemption, you should become subject to the Workers' �,NO' 0'i CONST ZONE ZONE h— Compensation provisions of the Labor Code, you must forth- ` R E/ W ADDRESS with comply with such provisions or this permit shall be �. e>! / T � I d' deemed revoked. - IL STATISTICAL CLASSIFICATION APT. CONDO. CO CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION . .6 LIC CLASS NO. 2 DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS V NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY y CLASS VALIDATION SQ. FT . F NO. OF CHECK BK PG. License Number lic.Class SIZ OR S FAMILIES ONE - ' VALUATION DESC O OF WORK S NEW O Contractor Date _ ADD $ f!889.9 A e am exempt under Sec. _ �� t ALTER ❑ D • • • •.2 3 " B.BP.C. for this reason .REPAIR ❑ 9 !I) 'e 3 213 00f Dote: USE OF O 2,3� 1,8 9 5 - EXISTING BLDG 4J C Mr` f DEMOL El Signature APPLICANTTEL..sc FINAL _ OWNER-BUILDER DECLARATION PRINT A/CO3) NOa�! S F DATE •' I hereby affirm that I am exempt from the Contractor's License (� //��/f Law for the following reason (Section 7031.5, Business and ADDRESS 9 eC 7 (... FIN Professions Code): E - By _ 0 5 7.4'A IV( BUILDING _ -T J� I, as owner of the.compensation, or,my employees with ADDRESS _ v' wages ct their sole compensation,will f o the work and LOCALITY the structure is not intended or offered for sola(Section f 7044, Business and Professions Code), MOV CONTRACTOR NO.WG ' TEL. 1• \ , s\ • (ti\s 3 8&5 0 +r a, -\ � 'i;\\ I I,.as owner of the property, am exclusively contracting ,•"ee 3 8 a•5 06 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code)._ -CONSTRUCTION LENDING AGENCY FROM EXIS 9 0't.1 ,"�$8 SET BACK PROP, LINE WIDTH REQUIRED YARD HWV TOTAL SETBACK I hereby affirm that there is a construction lending agency for FRONT _ the performance of the work for which this permit is issued PA. - (Sec. 3097, Civ. C.). SIDE ' P.L. lender's Nome -- g 57 ( LDMA Ref.'# � Lender's Address P.C. Fee f L..J r Perm / it Fee /'O rJ I I certify that 1 have read this application and state that the ..at ce Fee ` V •J LDMA P/C# o above information is correct. I agree to comply with all County Investigation Fee G q ordinances and State laws relating to building construction, Total Fee o N LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection JpurposseesL: U( pz�•--' G`�Ll//W'"Y T—/ —O Q SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a Certificate of consent to self insure. BUI UNG AD ESS or a certificate of Workers'Compensation Insurance,or a certified �` copy thereof(Sec.3800.Lab.C.) Cm ZP LOCALITY Policy No ConWaM' SIZE OF LOT NO OF SUGGS NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST GROSS ST 11 Certified copy is filed with the county building inspection TROT BLOCK LOT NO department USE ZONE MAP NO Dare Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL, Wes NO (This section need nol be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED t!Y dollars 1$100)or less.) CITY ZIP issued. I uthat the performance of the work for which this permit - _ d. 1 shall not empty any person at arty manner Sp as to ARCHITECT OR ENGINEER TEL NO 7 become subject to the Workers Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. 11, 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 r Compensation provisions OI the Labor Code, you must forth With FRONT d comply with such provisions or this permit shall be deemed revoked ADDRESS LIC.NO. P L 0 LICENSED CONTRACTORS DECLARATION PILE GTY LIC CLAPS PL W J I hereby affirm that I am licensed underDrovisblts of Chapter 9 (commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE., NO OF STORIES NO.OF FAMILIES SEWER MAP Ly Professions Code,and my license is in full force and effect. Q,;„.;.. ` NEW ❑ BK PG , Y License Number 7 r' ' Lic.Class DESORPTION OF WORK ADD Q VALUATION Q Contractor.: _ Date ALTER ❑ $ r 0 CL ❑ 1 am exempt under Sec. REPAIR ❑ $ W BBRC.for this reason DEMOL ❑ LDMA P/C• ~ Date, USE OF EXISTING BLDG. URM ❑ I crryy Signature APPLICANT(PIiYT) TEL NO LDMA Perm• .� :IV._4r ❑ I, as owner of the property, or my employees with Wages as I = N their sole compensation, will do the work and the structure is ADDRESS O ..I�A not intended or offered for safe (Section 7044, Business and FINAL DATE G ' Professions Code.) WILL THE APPLICAW OR FUTURE BUILDNO OCCUPANT HAIOE A HAZARDOUS MATERIAL OR A MIXTURE CONTNMM'i A HAZARDOUS WITERIAL EGI TO OR GREATER THAN THE _ S/ /96 ❑ I, as Owner Of the property, am exclusively contracting 4. AMOIMTS SPECIFIED ON THE HAZARRDOUS MATERIALS FfOOAATKw GUDE> FINAL BY licensed contractors to construct the project (Section 70444, A1q�f� Business and Professions Code.) W50 ND❑ F 1 rv1R0 WILL THE MTENCED USE OF THE BUIOUNC BY THE APPLICANT OR FUTURE BUILDING .0 7.7 OCCUPINT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH l Arm CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT ISLAOADI SEE PERMITTING C1ECXUST FOR •� TTCI FJ GADEUNEs I hereby affirm that there is a construction lending agent' for mss 11 NO TOTAL 296 - ;y the performance of the work for which this permit is issued(Sec, IH/YE READ THE HAZAFIpOUSMATEFI1Als INFORIMTIONp1ApE AND THE scAOMg PERMTTwG //�{L�A�(�U/ WCK 3097,Civ.C.1 CHECKLIST I UNDERSAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. •. 249-79 TILE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2.20 140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPOmING AND FOR OeWNING A PERVIT FROM THE SCAOMD Lender's Address o»ePw ,r T, I certify that I have read this application and state under penalty Q. of perjury that the above information is correct.I agree to comply PC FEE PERMIT FEE w with all county ordinances and State laws relating to building m construction, and hereby authorize representatives of this County ISSUANCE FEE 7o t0 enter upon the above-mentioned properly for inspection purposes. Z INVESTIGATION FEE TOTAL FEE l�I •quNn a M✓<+��u AT�� IAIe SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES- TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR •'�' BUILDA.�G AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1201110029 PHONE: (626) 285-0488 EXT: (LEGAL ID: O. OF CONST ITR: 11218 LT: 2 BL: B I SQ. FT STORIES TYPE 9064 BROADWAY ADDRESS: I ISTRUCTURE: 1400 V-B 9064 BROADWAY ASSESSOR INFORMATION NUMBERTEMP CA 917802313 : _ NEAREST CROSS STREET: � I 5388-002-002 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EXIST OCC GRP: 101/11/12 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FINAL ATE F BY: CODE: 1 (ABBOTT LONNIE R;DONNA M 2,800 /l 19064 BROADWAY , I TEMP 917802313 FEES PAID IDkSCIRWTION OF WORK ITEAR OFF REROOF ONLY 1400 SOFT AND INSTALL NEW SHINGLES 25 IFEE DESCRIPTION: QUANTITY: DOM: A40UNT: IYEARS (APPLICANT: TEL. NO: ISRAEL DEKEL (818) 593-8161- IAA BLDG PERMIT ISSUANCE 2].80 I 118643 A, CACOLLINS ST. IAB STATE GREEN BLDG FEE 2800.00 VAL 1.00 (SPECIAL CONDITIONS: �TARZANA, CA 91356 IAC STRONG MOTION REBID 2800.00 VAI, 0.50 _ ID2 PERMIT W/O EN-HC 2800.00 VAL 99.10 - TOTAL FEES 128.40 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IL A CONSTRUCTION AND ROOFING, INC. (818) 652-2138- 1' 1 1 118643 COLLINS STREET LIC. NO ILOCATION AND SETBACKS JTARZANA CA 91356 965125 ISOILS ENGINEER APPROVAL 1 ARCHITECT OR ENGINEER: TEL. N0: i (FOUNDATION/TRENCH FORMS LIC. NO: i - (SLAB/UNDER FLOOR RAISED FLOOR FRAMING I (MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 - (UNDERFLOOR INSULATION 1147H265 3 00 1 1 FLOOR SHEATHING IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 iROOF SHEATHING Fill /•'✓ SCHOOL WITHIN HAZARDOUS SHEAR PANELS (AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION I_ FIP.c SPRINKLER HANGERS - INSULATION/WEATHER STRIP I I IINTERIOR LATH/DRYWALL I IEXTERIOR LATH I (RATED FLOOR/CEIL ASSEM. IRAT'ED WALL ASSEMBLIES RATED SHAFTS/OPENINGS I I I - �IT-EAR CEILINGS 1� AppiTTONAL DATA ON FILE ILOT DRAINAGE - I IRE POET ID: DPR261 ROUTE T0: BS0508 I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BOILOING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 - BE 0508 1112220010 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 11218 LT: 2 BE: B SQ. FT STORIES TYPE 9064 BROADWAY 1 I 1STRUCTURE: 208 V-B -[ TEMP CA 917802313 1 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15388-002-002 [ I I i THOMAS PAGE: 596 GRID: H9 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 11SSUE0 ON: PROCESSED BY: (EXIST OCC GRP: 101/05/12 SR I 1 1 TOWNER: TEL, NO: IBLDGS. NOW ON LOT: VALUATION: _ FINAL DA Fl;n: CODE: (ABBOTT LONNIE - 1 15,000 19064 BROADWAY I (� TEMP 919802313 FEES PAID INSCRIPTION OF WORK ROOF-MOUNTED SOLAR PANELS (PV) I IEEE DESCRIPTION: QUANTITY: DOM: AM0UNT: 1 APPLICANT: TEL. NO: HOSE, JEANINE (818) 782-0700- ID7 ADDNL PLANCHECK FEE 1.00 HOU 109.40 I 15500 ERWIN ST #1121 IAA BLDG PERMIT ISSUANCE 27.80 iSPECIAL CONDITIONS: I VAN NUYS, CA 91411 IAB STATE GREEN BLDG FEE 15000.00 VAL 1.00 IAC STRONG MOTION REBID 15000.00 VAL 1.50 IDS PERMIT W/O EN-HC 15000 00 VAL 109.40 - CONTRACTOR: TEL. NO: TOTAL FEES 249.10 (APPROVALS DATE INSPECTOR SIGNATURE IRONCO ELECTRIC (818) 782-0700- 1 15500 ERWIN ST #1121 LIC. NO (LOCATION AND SETBACKS [ VAN NUYS, CA 91411 611593C10 [ ISOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: F0RNUATION/TRENCH FORMS LIC. N0: SLAB/UNDER FLOOR I if (RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I UNDERFLOOR INSULATION 1197H265 3 G01 I FUJOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: . 0 NO 21 - (ROOF SHEATHING I I I SCHOOL WITHIN HAZARDOUS [ ISHEAR PANELS (AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION 1 I I I I FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP[ _ (INTERIOR LATH/DRYWALL EXTERIOR LATH I I I RATED FLOOR/CEIL ASSEM. 1 1 RATED WALL ASSEMBLIES _m I IRA:EO SHAFTS/OPENINGS I I I I T-SAR CEILINGS LET DRAINAGE IREPORT ID: DPR261 ROUTE 14: BS0508 I I I I COUNTY OF LOS ANGELES TEMPLE CITY R 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS .RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1310300074 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: ITR: 11218 LT: 2 BL: B SQ. FT STORIES TYPE OCCUR GROUPI 9064 BROADWAY I ISTRUCTURE: 124 2 V-B R-3 I TEMP CA 917802313 (ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 15388-002-002 OTHER: 62 1 V-B U THAMES PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY CAI TENANT: IEXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: IEXIST OCC GRP: 111/06/13 SR IOWNER= TEL. N0: IELCGS. NOW ON OT: VALOAT ION: IFx NAL TE FINAL BY: CODE: 1CHUN9064 CHING MA - 19,560 19064 BROADWAY /// /' L TEMP 91]802313 FEES PAID 15/;CRI T ION OF WORK '—M1 1 ILIVING ROOM EXTENTION 124 SF. AND NEW PORCH 62 BE. 1 I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: I (APPLICANT: TEL. NO: 1 IHOA NGUYEN (714) 337-9238- IB1 PLANCHECK W/ENERGY 19560.00 VAL 359.60 113882 SUMMERWOOD PL IAA BLDG PERMIT ISSUANCE 27.80 SPECIAL CONDITIONS: (GARDEN GROVE 92644 IAB STATE GREEN BLDG FEE 19560.00 VAL 1.00 I I AC STRONG MOTION REBID 19560.00 VAL 2.00 I .1B2 PERMIT W/ENERGY 19560.00 VAL 423.10 CONTRACTOR: TEL. NO: 108 CERTIF OF OCCUPANCY - 101.40 APPROVALS DATE INSPECTOR SIGNATURE I LANDING CONSTRUCTION GROUP (714) 337-9230- 1 TOTAL FEES 914.90 —_ 113882 SUMMERWAOD PLACE LIC. NO I LOCATION AND SETBACKS ' IGARDEN GROVE, CA 92844 963678 I I SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEERON/TRENCH FORMS : TEL. NO: 1 - i 1 FO�e:pATII I LIC. NO: i — ISLAB/UNDER FLOOR I .1 (RAISED FLOOR FRAMING MAP NO: SEWER NAP BOOK: PAGE: FIRE ZONE: CMP:( IUNDFRFLOOR INSULATION I 3 001 ISTALEVEL FLOOR SHEATH INC. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: �. 0 NO 21 12ND,LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS JR0017 SHEATHING ATR QUALITY: 1000 FEET MATERIALS � NO NO NO (FIRE DEPT. FRAME INSPECTI BLDG OE PT. FRAME INS RECTI SHEAR PANELS I INSULATION/WEATHER STRIP I i' 11NTERIOR LATH/DRYWALL 1EXTERIOR LATH LOT,DRAINAGE ISMOKE DETECTION DEVICES IFIRE DEPARTMENT APPROVAL( I II I I IREPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I