HomeMy Public PortalAbout9421 1/2 BROADWAY_Building__ APPLICATION, FO -- .
BUILDING PERMIT
FOR APPLICANT TO FILL IN BUIADDRESS 9 a �� 4,,oc
BUILDING Cy -
ADDRESS LOCALITY -
` _ _ NEAREST
CITY `� ky
ZIP CROSS ST.
.NO.OFSLOGS. - ASSESSOR
SIZE OF LOT. - NOW ON LOT MAP,BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE OC ED BV
TRACT✓�(Hdl -O LOT NO, 2, CONT./ ZON E
OWNER NO. Cl V
STATISTICAL CLASSIFICATION SEWERMAP
ADDRESS -CLASS NO. DWELL UNITS D m" .
CITY .ZIP USE ZONE MAP '
NO. Q"O
ARCHITECT -
ENGINEER �` Q.Q]�G(,NO.� - /•4. SPECIAL
1CONDITIONS
ADDRESS I LSV 17- ROAD DEPARTMENT APPROVAL REOUIRED YES ❑ NO ❑ -.
, 'L•� TEL.
CONTRACTOR —w NO.- �1p 1, BLDG.SETBACK FROM
,^ FRONT PROP.LIN E OF ISTREETI
ADDRESS' NO. TOTAL SETBACK FROM TYPE OF E%ISTING
/��� --�AL ^ LIC HIGHWAY +' YARD = FRONT PROP.LINE HIGHWAY WIDTH
CITY V A .^ CLASS - C--6 _ - .
CONSTRUCTION LENDER /'••t + a
NAME AND BRANCH. BLDG.SETBACK FROM - OV
ADDRESS CITY
SIDE PROP.LINE OF (STREET)
. O
SO. NO OF IN OF
CHECK HIGHWAY + YARD TOTAL SETBACK FROM - TYPE OF EXISTING U
SIZE �'�. STORIES ` FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH d
DESCRIPTION OF WORK NEW
❑ + = Z
-•�C�...K ADD CORNER CUTOFF YES ❑ NO ❑
ALTER ❑ IN OPEN SPACE YES ❑ NO ❑
REPAIR ❑
USISTOING BLDG. ` �`� DEMO( ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑
APPLICANT TEL
(PRINT( �-i�� NO.C
BY ISIGNATU ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONAND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINA ES /
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOIN i -
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATIO O
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WOR.NILS
PENSATION INSURANCE.
SIGNATURE OF �RFL� L �2- / )�/? BY /G,YW�•-` ,
PERMITTEE ' - D ( -
ADDRESS_
TEL. P.C.Fee$ Q Permit Fee
CITY NO.
Issuance Fee
VALUATION $ V V
Total Fee' (J"O
PLAN CHECK VALIDATION CK. -.0- 'C;"SH' PERMIT VALIDATION cK` M.O. CASH
J 4 Gi�iauv _ -�
9 4 3 NOV .3 :,1 'D y 1 2.O O-Ai'
O3 16A6388 CE 0803B 6/76 - - -
T5A6]9A GE N9�]fi-. APPLI'CATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES I BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDREBB }
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST '
WILLIAM A. JENBEN, SUPT of BUILDING CROSS ST.
OI ST CT NO G!r TYPE PR S BY
FOR APPLICANT TO FILL co NST.
rD
I STATISTICAL CLAS IFICATION SEWER MAP
9421— Broadway, Temple City BK
CLASS. NO. DWELL. UNITS
BLOCK WATERNOT REQUIRED RECEIVEDCERTIFICATE:MAP HIGHWAvNO. OF BLOCS. NO. (CIRCLE) STATE MAJOR SECOND. LOCALOT NOW ON LOT USE ZO E SPECIAL
e$1 ence CONDITIONS
EXISTING BLDG. 286
- 'O p[ /
OWNER Richard 'Falcetana NO -9577 BU DING EXIST.
YARD HWY STREET NAME '
SETBACK WIDTH
ADDRESS 421'1—`B'roadwa Temple CityFRONT
ARCHITECT OR TEL. F. L.
ENGINEERNO. SIDE
ADDRESS ' P L D_
O
L.
TE - V
CONTRACTOR � � NO.
C
F
ADDRESS9242
DESCRIPTION OF WORK
a
NEW - ADO 'ALTER REPAIR DEMOLISH - - � Z
SO. FT. NO. OF NO. OF.
SIZE STORIES FAMILIES
USE OF
STRUCTURE Reside Ce
Cool in `Coi on ens' Unit
SIGNATURE OF
APPLICANT
VALUATION S 1 100.00
APPROVALS DATE . ♦ INSPECTOR'SSIGNATURE ,,
FOUNDATION: LOCATION
FEE S 7y FEE FORMS. MATERIALS
FRAME: FIRE STOPS, -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS
AND STATE THAT TME ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. `
WITH ALL COUNTY ORD CES ANO BTATE REGULATING GAS VENT. DUCTS
BUILDING CONSTpVCTI CERTIFY HAT IN GO. THE WORK
AUTHORIZE. HEREBY W L EM LOY ANY RSON IN VIOLA LATH. INT.
TION OF THE
LAB. C OF H STATE pLIFORNIA RELAT-
TNG TO WORKMEN'$ MPC N INSU CE. LATH. EXT,
SIGNATURE HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED '
ADDRESS FINAL
JOHN F. LEWIS. RINCIPAL ST URAL ENGINEER
PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION• GK. M.., CASH
._ �_ 111Lo 5 8 4 5 JUL 2 7 1 D • 1 725'- -
TEMPLE -CITY
v+oe+ce�'em.IEI APPLICATION FOR BUILDING P RMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS._
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSSST. /( L
DISTRICT NO. I GR TYPEE BY
FOR APPLICANT TO FELL IN j ; )
colNsr.
BUILDING C STATISTICAL CLASSIFICATION I SEWER MAP
ADDRESS
�` V K{ BKPG
CLASS.NO._DWELL.UNIT$� ,
LOT NO. / BLOCK WATER NOT REQUIRED I RECEIVED Lj
�•
CERTIFICATE: IJ
TRACT MAP HIGHWAY
NO. NO. O (CIRCLE) STATE MAJOR ECOND. LOCAL
SIZE OF LOT. '0 �� O INOW OF ONBLDGS LOT USE ZON5, SPECIAL
USE OF - CONDITIONS
EXISTING BLDG. /
TEL.
OWNER -Ct. Gp .• NO. BUI DING YARD HWY STREET NAME EXIST.
SETBACK WIDTH
ADDRESS
FRONT
ARCHITECT OR TEL. /P. L.
ENGINEER NO. / SIDE
P.L.
ADDRESS ' rI rn TEL.0 INSPECTION RECORD a
CONTRACTOrtk Ni�/�f)(L-O kJ'/ NO./ yJO7� 8
<4T&v
ADDRESS /l
DESCRIPTION OF WORK ' 6� , /'2/ �V �C�E+" /"/ 0
IAIXnd
NEW ADD ALTER REPAIR DEMOLISH N
.FT. NO.OF NO.OF 1 Z
IZE _ STORIES J FAMILIES f
USE OF
STRUCTURE eItc
SIGNATURE OF
APPLICANT
VALUATION$
_ APPROVAlS1T DATE INSPECTA R'S SIGNATURE
. - ov FOUNDATION: LOCATION '
FEE S fL"C' FEE ?-�`(� °� `� FORMS. MATERIALS
FRAME: FIRE STOPS. Bl�� / j I /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
4e f' Y
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WIT HALL 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- �j {Gr
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
INGTO WORKMEN'S COMPENSATION INSURANCE. LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR•
PERMITTEE - RECT AND POSTED �/ f d
ADDRESS/9 '36 Q +
FINAL
CLYDE N. DIRLAM, PRINCIPAL STa RAL ENGINEER
PLAN CHECK VALIDATION cK. M.O. CABH PERMIT VALIDATION DK. M.G. cAsH
LJ;Co 9 9 7 0 1 JUL 13 2 3 D 1 &0, 01
Lig 00089 JUL17 1 D 3 6.0 0 P
�Lfit�Z
,WORKERS' COMPENSATION-DECLARATION " . _ .- -. / " `--/
hereby-affirm,, ceci icat have a certificate scion Insurance,
noself, - •APPn OCAYMN. F�� . B n�� MNIG PER
r��i OT
. .insure, oca certificate of Workers'.Com penstion Insurance, or II LS I�J Il CI u�u
a certified copy thereof (Sec 3800, Lab. C)' _
„PolicyNcCC20-400 jEQ(��;n?? -Argonaut Ins. Co. COUNTY OF LOS�ANGELES BUILDING AND SAFETY,
Certified copy is hereby furnished. - - FOR APPLICANT TO FILL IN BUILDING
- ADDRESS' oc C
•'�, 'Certified copy is filed with the county,building mspec- BUILDING
hon department. ADDRESS 11421i LOCALITY'
NEAREST
Dote 1.1-1-81 Applicant :Howard'L. Randol -Co. CITY Temolp Ci,ry PCROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' No. OF BLDG? ASSESSOR _
`- COMPENSATION INSURANCE SIZE OF LOT NOW ONLOTMAP'BOOK PA PARCEL
(Thissection need not be completed if the permit is for one RE, E MAP - (�
hu ndred.dollhrs ($100)or less.) TRACT BLOCK LOT NO. NO. �Gd }
TEL .SPECIAL - y
],certify-that in the performance of the work for which thisT OWNER. „NO CONDITIONS O
( - - CT - GROUP TYPE- TIRE' PR ESSED.BY,permit isissued, shall not employ any person in any manner - q so asto become subject to the Workers'Comperrsation Laws f ADDRESSi - " ^I CONST., ZONE O
Howard L': RandollGo. CITY" Temple City P- 91780 IY/ 3
Date 11-19-81 'Applicant STATISTICAL CLASSIFICArI ON APT, CONDO. V-
ARCHITECT OR. - TEL.
NOTICE TO, AP.PII shout If, after making this Certificate of $ W
:Exemphon, you should become subject to the,Workers'! ENGINEER NO. CLASS NO: NITS_ 6
_ Compensation provisions of the:Labor.Code, you must forth ADDRESS 't SEWER MAP Z
with comply with, suchprovisions or, this ,permit shall be:,
,deemed revoked. ` - CONTRACTOR Howard- L. Randol- po, 2.88-4040 ' - BK' 6 PG, /-3- - VALIDATION `
LICENSED CONTRACTORS DECLARATION • LIC
I hereby affirm that I am licensed under provisions.of Chapter 9 ADDRESS 2 E Valle „Blvd. NO. 186086 VALUATION /
' (commencing with Section 7000)of Division 3 of the Business and - - LIC �frj�Q• ,
Professions Code, and my license is in full farce and effect.
CITYr Zss, CLASS - _ ' $
50. FT. NO. OF"
License Numher •186086 Lic. Class C-3Q SIZE . STORIES FAMILIES. ONE
ContracioHoward L.Randol Coote. 11-9-.81 DESCRIPTION OF WORK Re-roof house. NEW ❑ $' "��
Iam exempt from the licensing requirements as I'am'aSe rt n „ ADD '❑ _
licensed architect or a registered professional engineer _nd ar. ALTER ❑ FINAL
acting In my professional capacity, (Section 7051, REPAIR DATE
' Business and Professions Code). USE OF FINAL t i. -
_ EXISTING BLDG. "S FD v - DEMOL / t. ..
Lic.or Reg. No. Dale APPLICANT TEL By C., `•`��� I _ .
•-� OWNER-BUILDER DECLARATION' ' " ' (PR)NTIHoward LL Randol Co.No.288-4040 -
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and, ADDRESS 529 E Valley, Bl: SanGabriel
Professions Code): . - PRESENT' p IQ
.❑ I, BUILDING.*o , or*my employees with
_ ,..
of ADDRESS
wages as their sole compensation, will do the workLand
the structure isnot intended or offered for sale(Section' LOCALITY
7044, Business and Professions Code).., MOVING TEL. �. . �, 9 7[]A
❑ l,.as owner of the Property, am exclusively contracting - CONTRACTOR NO. -
with licensed contractors to construct the projecf (Sec- ADDRESS - - '#
..-. .tion 7044, Business and Professions Code).
REQUIRED .TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY
SETBACK YARD HWY PROP, LINE WIDTHs'e
I hereby affirm that there is'a construction lending agency for - FRONT 3 O O
.the performance of the work for which this permit is issued RL. - •• • x
(Sec.9097. Civ. C.).. - __ .- ..SIDE_ r a �.,e • 3 Q: 0'o
P.L. �. b.-a
Lender's Name _ _ '
_ P.C..Fee S PermiLFee ,2 QQ
_ . 'Lender's Address. _ - •
w I.-certify that I have read this application and state that theIssuance Fee 7.00 1 i
/
aabove information,is correct. I agree to comply with,all County „, Investigation Fee - . . .
ordinances and State laws relating to building construction, $34.00
Total fee
m and hereby authorize representatives of this.County to enter Y
Q upon the 6v e tion of pr'per or inspecliori purposes. -
a / -
SEE REVERSE FOR EXPLANATORY LANGUAGE - - -
S gnqWre of APPllcant o Agent - Pis
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BE 0508 1301160028
PHONE: (626) 285-0486 EXT:
ILEGAL ID: NO. OF CONST NEW 1 BUILDING ADDRESS:
ON FILE SQ. FT STORIES TYPE OCCUP GROUP 9421 1/2 BR0ADWAY
ISTRUCTURE: 168 1 V-B U I TEMP CA 917802446
ASSESSOR INFORMATIONNUMBER: GARAGE:
18588-003-019 j OTHER: HAST CROSS STREET: TEMPLE CITY
TI
THOMOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI
I TENANT: - I
(EXIST BLDG USE: USE ZONE: jISSUED ON: PROCESSED BY:
(EXIST OCC GRP, 101/28/13 SR 1
I
IOWNER: - TEL. N0: IBLDGS. NOW ON LOT: VALUATION: . I FAIJ DA'{' / FS AL BY: CODE:
CHEN, KATHY (626) 287-2715-
9421 1/2 BROADWAY 7,730 /� no
(TEMP 917802496 FEES PAID jDESCRIPTIONOF WORK
1168 S.F. OF ENCLOSED PATIO ADDITION
APPLICANTTEL. N0: IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: I
( : '
SAME AS OWNER - jDl PLANCHECK W/O EN-HC ]]30.00 VAL 155.60 I
IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS:
AB STATE GREEN BLDG FEE ]]30.00 VAL 1.00
IAC STRONG MOTION REBID 7730.00 VAL 0.80
ID2 PERMIT'W/O EN-HC 7730.00 VAL 183.00
(CONTRACTOR: TEL. NO: TOTAL FEES 368.20 (APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO 1 ILOCATION AND SETBACKS
I
I_
ISOZ LS ENGINEER APPROVAL I I I
_j
ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS
jSHENG, JOHN (626) 710-7403- .
15926 TEMPLE CITY #G LIC. N0: (SLAB/UNDER FLOOR I� 3
ITEMPLE CITY CA 91780 5310728
jRAISED FLOOR FRAMING
_1
(MAP NO. SEWER NAP BOOK: PAGE: FIRE ZONE: CMCo1I UNDERFLOOR INSULATION }y
•
NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 11ST LEVEL FLOOR SHEATH
21 i ��.1. -- �
0 NO 12ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS IROOF SHEATHING
(AIR QUALITY: 1000-FEET MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT( 1
1 I IBLDG DEPT. FRAME INS PECTII
ISHEAR PANELS
(INSULATION/WEATHER STRIPI I I
1 1_ 1 I
I LINTERZORLATH/DRYWALL
ry 1 (EXTERIOR LATH
1 ILOT DRAINAGE
931
I 1 ISMO KE DETECTION pEVICES I I I
1 (FIRE DEPARTMENT APPROVAL( I
I
_ IRE PORT ID'. DPR261 ROUTE T0: BSO508
-I
r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BE 0508 0712200067
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
I ON FILE SQ. FT STORIES TYPE OCCUP GROUPI 9421 1/2 BROADWAY
I ISTRUCTURE: 399 1 VN R1 I TEMP CA 917802446
(ASSESSOR INFORMATION NUMBER: I GARAGE: NEAREST CROSS STREET: ALESSANDRO
18588-003-019 I OTHER: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, C
1TENANT: 1£XIST BLDG USE: USE. ZONE: 11SSUED ON: PROCESSED BY: EXPIRES ON: 1
IEXIST OCC GRP: 102/13/08 SR 08/11/08
I I I I
10WNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IF AL DATE FIN BY: CODE: 1
I POOSANGTONGCHAI NOPPORN;CHEN KATHY - I 59,260 �J
19421 1/2 BROADWAY -V�f-6%
�+ I
ITEMP 917802446 I FEES PAID IDESCR PTION OF WORK
ADD MASTER BEDRM, BATHROOM, WALK-IN CLOSET AND LAUNDRY WITH I
IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ISTORAGE 399.75 S.F.
1APPLICANT: TEL. NO: I I I
IYU YAO TANG (626) 456-3816- 181 PLANCHECK W/ENERGY 59260.00 VAL 841.36 1 I
15926 TEMPLE CITY BE. AA BLDG PERMIT ISSUANCE 27.75 (SPECIAL CONDITIONS:
ITEMPLE CITY CA 91780 1AC STRONG MOTION REBID 59260.00 VAL 5.93 1 I
IB2 PERMIT W/ENERGY 59260.00 VAL 989.84
TOTAL FEES 1,864.88 I
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ISO CAL CONSTRUCTION (626) 712-4823- 1 1 1
IP.O. BOX 96 LIC. NO ILOCATION AND SETBACKS
SAN GABRIEL, CA 91778 832488 B
I SOITS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: I 1FOUNDATION/TRENCH FORM
II I
I .
LIC. NO: (SLAB/UNDER FLOOR 1
I I 1RAISED FLOOR FRAMING 1 1 1
1
(MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMPil /^� /� (� UNDERFLOOR INSULATION I I
3 --
I ���o� 1 , `Vc O V (I 11ST LEVEL FLOORSHEATH
1N0. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I I I
NO 21 / ��� _ (2ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS �Uo `J` ROOF SHEATHING I^ �I
AIR QUALITY: 1000 FEET MATERIALS' ,2 rl',l 6I
NO NO NO J L (FIRE DEPT. FRAME INSPECT(
IREQUIRED TOTAL SETBACK FROM EXIST 1 IBLDG DEPT. FRAME INSPECT
ISET BACK YARD: HWY: PROP LINE: WIDTH:FRONT PL-
SHEAR PANELS
I SIDE PL-
INSULATION/WEATHER STRI
(INTERIOR LATH/DRYWALL
I I
EXT£R IDR LATH '
I
ILOT DRAINAGE
I I (SMOKE DETECTION DEVICES I I
IFIRE DEPARTMENT APPROVALI
I I I I I I
I
1 _ iREPOAT ID: DPR261 ROUTE TO: BS 0508 1 1 I 1
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 1209170079
PHONE: (626) 285-0488 EXT:
(LEG L ID: NO. OF CONST BUILDING ADDRESS:
SQ. FT STORIES TYPE 9421 1/2 BROADWAY
I ISTRUCTURE: V-B TEMP CA 917602446
(ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET-
18588-003-019 THOMAS PAGE: 596 GRID: 34 LOCALITY: TEMPLE CITY, Cl
I
TENANT: (EXIST BLDG USE: RES ID USE ZONE: ft-1 IIS SUED ON: PROCESSED BY:
I IEXIST OCC GRP: 109/17/12 SR
I I I
IOMER: TEL. NO: 18LDGS. NOW ON LOT: VALUATION: IFINAL DATE FI Y: CODE: 1
I POOSANGTONGCHAI NOPPORN;CHEN KATHY (626) 287-2715- 1 2,,500 I I X71
19421 1/2 BROADWAY I1
ITEMP 917802446 FEES PAID
IDESCRIPTION OF WORK I
I (INSTALL NEW WINDOWS (7) LE 3
1 IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: I
(APPLICANT: TEL. NO: I
ISAME AS OWNER - AN BLDG PERMIT ISSUANCE 27.80 I 1
I IAB STATE GREEN BLDG FEE 2500.00 VAL 1.00 (SPECIAL CONDITIONS:
I IAC STRONG MOTION RESID 2500.00 VAL 0.50
ID2 PERMIT W/O EN-HC 2500.00 VAL 99.00
I TOTAL FEES 128.30
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE '
ISAME AS OWNER - I I- .
I LIC. NO I LOCATION AND SETBACKS
I I I
I ISOILS ENGINEER APPROVAL I ]
1ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS
I - I 1 1 1 I
I LIC. N0: I SLAB/UNDER FLOOR
I I IRAISED FLOOR FRAMING I -
I I I
NAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( IUNDERFLOOR INSULATION
1147H265 3 001 1
I I IFLOOR SHEATHING
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I ,
1 0 NO 21 1 IROOF SHEATHING I I I
I SCHOOL WITHIN HAZARDOUS (SHEAR PANELS
(AIR QUALITY: 1000 FEET MATERIALS
I NO NO NO 1 (FRAME INSPECTION
I I I
I IFIRE SPRINKLER HANGERS I
II I
]INSOLATION/WEATHER STRIP I
I (INTERIOR LATH/DRYWALL
I I I I I
E%TERIOR LATH
I
]RATED FLOOR/CEIL ASSEM. I
(RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
I I I
T-BAR CEILINGS
I I I
I (LOT DRAINAGE
I I
IMPORT ID: DPR261 - ROUTE TO: BS0508
I I I I I I