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76A630A`CE08036-64 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES fRNEAREST
UILDING
DEPARTMENT OF COUNTY ENGIN$ER DDRESS LJ
BUILDING AND SAFETY DIVISION OCALITY
JOHN A. LAMBIE-. COUNTY ENGINEER
COLEMAN W. JENKINSSUP'T OF BUILDING OSS ST.
DISTRICT NO. GROUP TYPE P SSED BY
FOR APPLICANT TO FILL IN n CONST. ��
BUILDING Q 7/CA L. Dp/f� L.� CLASS NO.A�:_OW eLL UINOIT$ SE ER MAP .,
ADDRESS (J / D L- /L b/T /✓ Et
pG
LOT NO. a, BLOCK USE ZONE MAP
� ' NO.
TRACT SPECIAL
N0. OF BLDGS CONDITIONS
SIZE OF LOT NOW ON tat
USE OF
EXISTING BLDG. SETBACK FROM
OWNE 7, r A OL "ate FRONT PROP. LINE OF - (STREET)
TYPE OF EXIStI NO SETBACK HIGHWAY + YARD - TOTAL
ADDRESS XIGNWAY WID H 'FROM [.L.
441 a
CITY • +
ARCHITECT , NOL �O BL00. SETBACK FROM
ENGINEER SID E PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS ''4}+ f Q C HIGHWAY WIDTH FROM C.L. 1
CONTRA CTORV. NOL. /' + - O
AD OR ESS I� Ls . LI C'/�� CORNER CUTOFF YES E] NO El Q
C1 TY ' L� SEE REVERSE SIDE FOR SPECIAL APPROVALS v
W
DESC IPTION OF WORK10a
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. /�JL NO. OF NO. OF �O•'4
SIZE /I OO STORIES FAMILIES 1l /✓7 (/' ��".n�r��eU 4 /4 �/
USE C /O O / /1' H(/
USE OF RE
SIGNATU E OF
APPLICANT
VALUATION$ /.� Q"d-�J
(/ APPROVALS DATE INSPECTOR'S SIGNATURE
P.C n�S� AMT /6 FOUNDATION, LOCATION
FEE$ - ,//-- FEES FORMS, MATERIALS _ y O
FRAME, FIRE STOPS, /a 3/~ '/•_
HERE6Y AC KNOWLEDGE THAT I HAVE AND THIS RTO CO TION BRACING BOLT �f% f
ANDWITH
STATE THTT THE ABOVE IE CORRECT AND AGREE E COMPLY FURNACE: LOCATION � /0�I M/Pl <111<44.4;74
[1 _ w;74
%IIL ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCT$ C��A�CA��e�1�/
AUTHORIZED
UT ORI CONSTR VCT ION. 1 CERTIFY TMAT. IN DOING THE WORK E /` A .
TION
THE
HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. f 1( A' � �1
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAY- F 'v�� J
ING TO WORKMEN'S CnMPEN TION SURAN
LATH. EXT. (�SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED )4 A�
ADDRESS FINAL (Fly ��Y
JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION' M D. CASH PERMIT VALIDATION ` OK. M.D DASH
_,nip.4 0 5 5 LULG8 2 3 r, 5.50a
U04 7 7 ;+uC 18 1 A 74.50-
WORKERS' COMPENSATION DECLARATION
hereby $cer that havecertificate of consent to self APPLICATION FOR BUILDING PERMIT
ins,fe, or a certificate of Workers' Compensation Insurance,
or a certified copy the,�re�of (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
P�o,l icy No�y�Company "y T�lr r/_V/Yid
—CJ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
PY Y ADDRESS I
❑ Certified copy is filed with the county buildi inspec- BULLDwG '/ '2 u
tion department. ADDRESS / •/ /� L7
oat. ,. 'a �r Applicantry CITY n, 6: /21n zip 9%77..y LOCALITY
NO. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FR ORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSU NCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK I PAGE PARCEL
hundred dollars ($100) or less.) TEL
OWNER-/_ S Q N % USE ZONE MAP
/
'I certify that in the performance of the work for which this NO.
rySPECIAL Y
/
permit is issued, I shall not employ any person in any manner ADDRESS / �/✓ - CONDITIONS a
so as to become subject to the Workers Compensation Laws. //rI % % O
CITY „/ L ZIP i
Date�Applicant ARCHITECT OR TEL. W
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE , PROCESSED BY
Exemption, y CONST. ZONE
you should become subject to the Workers' O ,p 3 U
Compensation provisions of the Labor Code, you must forth- ADDRESS D /L' V_ 3 w
with comply with such provisions or this permit shall be TEL NM Z
/�/.•� STATISTICAL CLASSIFICATION APT. CONDO.
deemed revoked. CONTRACTOR Q/C/y IN ^oq
LICENSED CONTRACTORS DECLARATION ,� UC. CLASS NO. '52-1 DWELL. UNITS_
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �� -A` 13LID NO. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business LIC
and Professions Code,and my license is in full force and effect. CITY �/</7'/Fj A1D CLASS G3 9 BK PG VALIDATION
n 4 l SQ. FT {J NO. OF NO, OF CHECK
License Number /JL/ / �/ Lia Class G� SIZE STORIES FAMILIES ONE VALUATION
Contractor I7-4. Date /";? ' DESSICRIPTION OF WORK / NEW El
LJ
Da�
❑1 am exempt under Sec. L�.®� - z ",A '<S ,
B.BP.C. for this reason ALTER ElCL�Q7� � REPAIR $
Date: USE OF
EXISTING BLDG. 'DEMOL ❑ ..__
Signature APPLICANT TEL. FINAL .
OWN UILDER DECLARATION (PRINT). Q ..QJX RO NO✓Tp Z--dGGr DATE �,z/•Z Cj L `!� {r
3%,IJ
I hereby affirm that am exempt from the Contractor's License /� _
Low for the following reason (Section 7031.5, Business and ADDRESS L/� 7Lo_� FINAL ' 'j {E.n
Professions Code): PRESENT By V
❑ I, as owner of theproperty, or m employees with BUILDING t:l l'rfL .�'a s°' = 'a-%v
YtADDRESS
wages as their sole compensation,will Bo the work and -"Z C
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.) j 001.t_I_ITilj1 7^T.1_,
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. UNE WIDTH •M ai
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.
m 3 LDMA Ref. N
P.C. Fee$ Permit Fee
Lender's Address
o I certify that I have read this application and state that the Issuance Fee LDMA P/C N
8 above information is correct. I agree to comply with all County Imesngation Fee G
R ordinances and State laws relating to building construction, Total Fee /' Q LDMA Perm. N
c and hereby authorize repr sentatives of this County to enter
upon above-mention proper
four inspection purposes.
' `
[/ SEE REVERSE FOR EXPLANATORY LANGUAGE
Si 907
ore of Applicant or Agent Do,e
COUNTY OF LOS ANGELES TEMPLE CITY p 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91480 BL 0508 1402030032
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW BUILDING ADDRESS:
ITS: 29922 LT: 12 1 SQ. FT STORIES TYPE OCCUP GROUPI 6718 BURGHARDT RD
(STRUCTURE: 992 1 V-B R-3 I SIAS CA 917752614
ASSESSOR INFORMATION NUMBER: 1 GARAGE: NEAREST CROSS STREET:
15386-008-070 1 OTHER: THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY CAI
I
(TENANT: (EXIST BLDG USE: PHOTO (ISSUED ON: PROCESSED BY:
EXIST OCC GRP: R-3 102/03/14 SR
I
TOWNER: - TEL. N0: IRLDGE. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY CODE:
1T LAWRENCE W;HELLON ❑ (626) 309-9383- 33,000
871BBf�
8710 URGHARDT RD
ISGAB 917752614 FEES PAID SCRIPTIO OF WORK
I (ROOF MOUNTED PV SYSTEM 33 MO ULES. 7.46 KW DC 1
IEEE DESCRIPTION: QUANTITY: BOM: AMOUNT: 1
(APPLICANT: TEL. NO:
ISOTO, BRITTANY (714) 471-6452- (AP. BLDG PERMIT ISSUANCE 27.80 1
120285 S WESTERN AVE IAB STATE GREEN BLDG FEE 33000.00 VAL 2.00 ISPECLAL CONDITIONS:
TORRANCE CA 90501 IPI RES PV PCllOKW 153.90
IP2 INSPCT RES PV <10KW 138.00
TOTAL FEES 321.70
(CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
VERENGO SOLAR (310) 803-9053- 1
120285 S WESTERN AVE LIC NO T ILOCA;TON AND SETBACKS
T TORRANCE CA 90501 935263 - 1
ISOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL, NO: TFOUNDATION/TRENCH FORMS
LIC. NO: i iSLAH/UNDER FLOOR
IRAISED FLOOR FRAMING
(MAP N0: SEWER MAP BOO{: PAGE: FIRE ZONE: CMP: 1 UNDERFLOOR INSOLATION I I I
3 001
IFLOOR SHEATHING
INC. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 11
1 NO 20 IROOF SHEATHING
I I
SCHOOL WITHIN HAZARDOUS (SHEAR PANELS
(AIR QUALITY: 1000 FEET MATERIALS
NO NO NO (FRAME INSPECTION 1 I
FIRE: SPRINKLER HANGERS
I
I I IINSiiLATION/WEATHER STRIP( I I
INTERIOR LATH/DRYWALL T
(EXTERIOR EACH
I I (RATED FLOOR/CEIL ASSEM. I I I
I 1RATED WALL ASSEMBLIES I I I
I IRATED SHAFTS/OPENINGS I I I
I I IT-BAR CEILINGS I I I
ADDITIONAL DATA ON FILE
I ILOT DRAINAGE
(REPORT ID: DPR261 ROUTE TO: BS0508
I I I I I I
f
COUNTY OF LOS ANGELES TEfirIE CITY iJ U508 BUILDING PERMiT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/RE._,
BUILDING .AND SAFETY / LAND DEVELOPMENT TEMPLE CaTY CA 91780 BL 0508 0408020032
PHONE: 1626) 285-0488 EXT:
LEGAL ID: N0. OF CONS _ - NEB "GII.DINi ADDRESS: T
TR: 29922 LT: 12 SQ. FT STORIES TYPE "COUP GROUP 8718 BORCHARDT RD
STRUCTURE: 940 2 V R7 crea CA 917752614
ASSESSOR INFOR!ATIOIN NUMBER: GARAGE: 748 1 VN L'^, NEAREST CROSS STREET: MUSCATEL
5386-008-070 OTHER: THOMAS AGE: 596 GRID: G3 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BL G USE: USE :ONE: ISSUED ON: PROCESSED BY: EA;'IRES ON:
EXIST OCC GRP: 08/31/04 JK 00/26/05
OWNER: f L.is BLDGS. NOW L::L' VA!LAf 1ON: fRM
Cl. fi! BY: C^
8718STEWART LAWRENCE W';HEL LON D (818) 286-Sb io- 750,000 !� '
8718 61775260? FD I y
SCAB 917752614 --------TE—E$ MID- I TIO'r: CI WORK �----
A DITIONSTUDIO, 2 BATH & MA.S'f Eft "UiTc 940 S.F. i
FEE DESCRIPTION; QUANTITY: Till'": AMOUNT: AND 3 CAR GARAGE 748 S.F.
APPLICANT: - TEL. NO:
SAME AS OWNER jBi PLANCHECK 6.,;ENERGY 150000.00 VAL 1,513.58 _
AABLDG PERMfT NDI
ISSUANCE 27.75 SPECIAL CUT7G4S_.
AC STRONG 14
Oi'.ON RESID 150000.00 VAL 15.00
B2 PERMIT -::•:tiEP.GY 150000.00 VAL �i,780.68
_ TOTAL FEES l 3,337.01
�CGNTRACTGR:- -- TEL. NO: APPROVALS ------ DATE ---- r.�ar,;TOR Sl GNATURF
SAME AS OWNER - -
LIG NO LOCATION' AND SETBACKS !
SOILS FiNrINEERAPP:ROVAL ! I
lei
_
ARCHITECT OF E<GINeERt _L. NO; —.— �OC'!J'J, CN%TRENCfi FORi•Iv_
Pi AMGND EFI6. ?i3) 22: 3453- S.A:'.j Ur:.Eft FLOOR
c- '
12680 AGOURJ% 7,.r,5 LIC, NO:
Ij
�CALASAS, CA ._� �' �/ ___
IR�IyE..^'c'Li:K FRPi'_.iNG /
�Mr3 NO. SEWER rAR E00: PAGFo FIRE ZONE—_.—j7?: c sT
11ND'cRFLOGR INSULA'_
N_UL; [(1?i �
31 LEVEL FLOOR SHEATH
NU. OF FA.MIL: 5: DNeLLING UNITS: APT/GONG: STAT CLA55 I j
NO 7NDFLOOR 5'rI EAiH
SCHOOL WITHIN HAZARDOUS ft00F SHEATHING i—
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT
REQUIRED - TOTAL SETBACK FROM WIDTH M --—�-BLDG DEPT. FRA: E INSPECT
FR BALK YARD: t1lJY: PROP LINE: WIDTH: ,
FRONT PL-
SHEAR PANELS
SIDE PL-
_, _ INSULATIGNj iJEkIHER GIR IP 6 fi i
INTERIOR L<oiii/DRYWALL I
EXTERIOR lATFl ---
i
LOT DRAINAGE
SMOK'e DETECTf O -6EVICESI
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE 10: BSO508 i�_--