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Home My Public Portal About4846 CAMELLIA AVE_Building__ DEPARTMENT OF'BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES FE1 y{ 9 R 0 T WM. J. FOX. CHIEF ENGINEER gI/�i • int u FOR APPLICANT TO FILL,IN FOR OFFICE USE ONLY ADDRESS / 0 / 0 _� / ,- . /` `/!• DISTRICT NO. PLAN CK:NO. PERMIT NO. I sg a doe LOCALITY ! �♦ RECEIVED BY DATE OF AP�PLL.. gDATE ISSUED NEAREST ��{{ � /J-SSD �`�o C":'ST..rq_�t•>sff.. ^ c NG OWNER ^.a../Y•/i/ �/� i� 6�g ADDRESS lele9 X10 I�Tr W/ �+ MAIL ,p Q ADDRESS LOCALITY // I,f �j( NEAREST, ZuJ�C� _CITY /A�l`!i ♦ ND. � Ll1F IS I6 CROBB ST. AI u"Eu&FIRE NaF /V ARCHITECTOR TEL ZONE :; 'q PLANS �- ryPE, / GROyP ENGINEER NO. ` / gLpp- ORD.NO. ADDRESS SETBACK LINE G✓Z'/ / / - APPROVE :Q CONTRACTOR /I /ti li��N 13. BY / "'/J�r�_ 1 DATE � USE/ APPROVED ADDRESS ZONE- BY I DATE LEGAL - DESCRIPTION LOT NO. BLOCK �j y CORRECTIONS }} V TRACT G ��✓ L (� ��J l- �� L !' SIZE OF LOT UBE OF p� NO.OF NO.OF EXISTING BLDG. /(4 J•/� I FAMILIES I ROOMS DESCRIPTION OF WORK NEW �/ ALTERATION ADDITION i�Q.•./ /�/�.� '- G`" D _REPAIR MOVING No OFf DEMOLISH (\ l G SFT. G ROMS / STORIES `-- - T SIZE P O WALL _ • . —ArD COVERINGAIy( Y'dbErCOVERI NG/Ijjtefr it, USE NEW / 'yJ •f BUILDING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS' APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS .—_ -2707 AND STATE LAWS REGULATING BUILDING CONSTRUCTION.� a• / FRAME: FIRE STOPS. �/ SIGNATURE OF ��R�?�!, / .(�!/l[ BRACING,BOLTS PERMITTEE ---i LATH, INT. AUTHORIZED AGT LATH, EXT. 76AG38A-3 7-48 $ p-DFEE-q - PLASTER, INT. 7 r � pLASTE R,_•EXT. / S VALUATION FEE �.J• FINAL �f'�j ea APPLICATION FOR BUILDING PERMIT �. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS i Q• BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT O. GRIFFIN, SUPT OF BUILDING - CROSS ST. OISTRICT NO. GROUP TYPE. PR SSED BY FOR APPLICANT TO FILL IN ✓ I CONST. x STATISTICAL CLASSIFICATION I SE ER MAP BUILDING /f BK � ,PG ADDRESS CLASS.NQZLDWELL. 4UNITS LOT NO. BLOCK MAP NUMBER ..��N HTT yyE YES O TRACT USEZONE SPECIAL - / CONDITIONS NO.OF.SLOGS SIZE OF LOT' -� - I NOW ON LOT USE OF EXISTING BLDG. BUILDING YARD HWY. STREET NAME' EXIST. , I SETBACK - WIDTH _ . MAIL FRONT �D ( - MAIL P. N ADDRESS _ - SIDE TEL' CITY No. .. INSPECTION,RECORD RCHEN INEERT OR / L L7`(• 'NO. -40 r ADDRESS TEL. CONTRACTOR NO. !;'1 /JL vs� a (,� I/./CJuL ADDRESS DESCRIPTION OF WORE �� d rt'4�[ /�0 7' �- oY F• T—r v � _ NEW ADD .ALTER REPAIR DEMOLISH SO.FT. .NO.OF NO.OF - SIZE STORIES 'FAMILIES USE OF STRUCTURE I O SIGNATURE OF ' APPLICANT APPROVALS - DATE INSPECTOR'S SIGNATURE ., ADDRESS - FOUNDATION: LOCATION FORMS;MATERIALS VALUATION$ FRAME:FIRE STOPS. _ BRACING.BOLTS FEE S t7 FEE S Q FUGRNACE: OCATI VENI HEREBY ACKNOWLED E THAT 1 HAVE READ THIS AP - ' PLICATION AND STATE TKAT THE AB S CORRECT AND LATH.`INT. AGREE TO COMPLY L COU y/,F/6�RDINANCES AND STATE LAWS R B YSG CONSTRUCTION. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR PERMITTE RECT AND POSTED_ / - ADDRESS` "• / FINAL �Cb/�/.Inc CII• — CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHE&VALIDATION CK. M.G. CASH 'PERMIT ,VALIDATION (,:Kj M.O. GASH PACO5.9 7 1'S 'FEB 3 2 3 A 3.0 0-- L&5972% '.L5972% FB 3 1 A 12.00 .� , ,.A;,;=E ao3,;es APPLICATION ._:FOR BUILDING ,:PERMIT COUNTY OF. LOS ANGELES' ` Buaowc DEPARTMENT OF COUNTY ENGINEER nonREss BUILDING AND SAFETY DIVISION iocauTY JOHN A. LAMBIE, COUNTY ENGINEER "NEAREST CASSATT.O. GRIFFIN, SUPT of BUILDING CROSS STS - - ' 'DISTRICT O.- GROUP TYPE I Yi- PPLICANT TO FILL IN CONST. 15 FOR "A -, BUILDING. //// 'STATISTICAL CC _46SIFICATION SEWER.MAP ADDRESS _.LGL L lam/`...- 9 - - (.'-' ,P ' CLASS.NO.�DWELL.-UNITS LOTNO. .BLOCK ' -'NUM PER • STATE -YES` O 'HWY.. - TRACTUSE-ZONE SPECIAL - - J NO.OF SLOGS. .Z, CONDITIONS SIZE OF-LOT TDO k�CO '�NOW ON USE.OF - EXISTING BLDG. V L. L�. BUILDING - EXIST: SETBACK YARD HWY " STREET.NAME 'WIDTH'.. OWNER o'i /�/ FRONT' O a ' - - jMAIL ` ADDRESS •. O Y'O' `��t `^� G� SIDEP. - CITY / 4eGG , G." NO P.L. ARCHITECT O TEL. INSPECTION RECORD ENGINEER /fJ ��d NO. ADDRESS lV U+-cQ CONTRACTORi- ADDRESS DESCRIPT N OF WORK NEW ADD ALTER REPAIR "DEMOLISH. - - NO. OF - NO. OF ' - STORIESFAMILIES - - UE OF 1 f - - ' STRUCTU1Py.RE L. _ SIGNATURE OF ' APPLICANT APPROVALS '�'`DATE - 'INSPECTOR S.SIGNATU RE AR ESS CLIL/<_P�'(l-Q FOUNDATIONrLOCATION - FORMS,.MATERIALS • ` ' VALUATION $ !�(o I FRAME: FIRE STOPS 'BRACING, BOLTS Y1 FURNACE: LOCATION. FEE SI I FEE '� I. GAS VENT, DUCTS - 1 HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT-THE ABOVE IS CORRECT AND - ' AGREE�TO COMPLY WITH ALL.CO1.�lJ,T)f' ORDINANCES AND �- - STATE LAWS REG A G B PEG CONSTRUCTION. LATH,.EXT. SIGNATURE OF HOUSE NUMBER COR-. PERMITTEF RECT AND POSTED- ��C.�L ADDRESS - «` ' FINAL CLYDE N. DIRLAM, PRINCIPALS URAL ENGINEER PLAN CHECK VALIDATION CK. N.D. CASH < PERNUT VALIDATIO : CK M.D. CASH APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (P.im of rvoc oNly) BUILD `G L/f� COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY E �/T P BUILDING AND SAFETY DIVISION / NO.OF BLDGS. BUILDING SIZE OF LOT � C/lO NOW ON LOT ADDRESS Al L i • TRACT BLOCK LOT NO. LOCALITY / TEL o NEAREST _ OWNER NO2&.-2` CROSS ST. !! - ASSESSOR ADDRESS014 l- Gi MAP BOOK PAGE PARCEL T D15T RICT GROUP TYPE FIRE PRO ESSED BY CITY L // ZIP `�/ / CONST. ZON /'�T EAR CNG H ITNEIS C ERT OR TEL J" !� L /`� '` C� NO. STATISTICAL CLASSIFICATION SEWER MAP' ADDRESS CLASS NO._6L DWELL,UNITS BK . PG CONTRACTOR N, USE ZONE MP LIC. IVO LIC PECIAL C� ADDRESS CONDITIONS CITY LIC. (� CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO CONSTRUCTION LENDER NAME AND BRANCH FLOG.SETBACK FROM > FRONT PROP.LINE OF -(STREET) CD ADDRESS CITY CD HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING U SO: FT 'NO: OF NO. OF CHECK FRONT PROP. LINE HIGH WIDTH SIZE STORIES FAMILIES ONE CD } NEW = U DESCRIPTION OF WORK W ADD BLDG.SETBACK FROM h SIDEPROP.L INEOF ISTREETI Z ALTER ❑ TOTAL ETBACK FROM TYPE OF EXISTING r HIGHWAY } YARD = HIGHWAY WIDTH REPAIR.❑ SIC E OP. LINE EXISTING BLDG. DEMOL ❑ } APPLICANT TEL CORNER CUTOFF YES NO IPRINTI NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ ///1 IN COASTAL ZONE YES ElNO ❑ VALUATIONS z`" (,/ CATEGORICAL EXEMPTION YE$ NO ❑. I HEREBY ACKNOWLEDGE THAT I HAVE READ TH15 APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- 5TRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE T4TE OF CALIFORNIA RELATING TO WORKMEN'S OF THE ION IHSURA N[E. S `i SIGNATURE OF I �! J -C.Q U)2Ee l ;77-' PERMITTEE _ ADDRESS / ,y t .FINAL 1)�OACITY . �� / /Q ( NOL `SDA TE SL1F_ CHECKS 11LH E $ �,F HARVEY T.. EiRANDT, COUNTY EN ENGINEER PLAN CHECK VALIDATION M.O" CASH I PERMIT VALIDATION (CN.) M 0, CASH n r > 9 5 673 .DEC,J 4 1 D 4 4 OOA .v 76A638A CE 080312/72 �. -' DIVISION OF BUILDING AND SAFETY p Y 7 Department of County Engineer ll L R I>i County of Los Angeles 6P11 WM. U. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY I �: �f DISTRICT LN0. PLAN CK. BN REC.NO. PERMIT NO. BUILD,ADORE88 t�/ f l .O/)'1%/'! f",VeY Y nml�(71 J_— '� 4 1zl J LOCALITY DATE CF APPL___ DATEISSUED NEAREST CROBH BT. BUILDING OWNER ,JO� ✓�// / / /�!_ LOCALITY Y• o T/<��, L //G '�f MAIL- ADDRElill�^'}.bl�� i�L/.]�p/�1T/9) /f( r _ (,/y'. NEAREST N!1 lJl /13 /� FIREBH�• NO.OF TYROUP �_I ARCHITECT OR TEL ZONE '� PLANS ENGINEER NO. BLDG. ,[, Q Y /� ROS. NO. SETBACK LINE i_ ADDRESS // A ' - TEL L� `�(] y f/ ZONE 4 '� BYPROVED 2 CONTRACTOR !/tel%j/� NO.(Q// ! �l 7 //' NUMBERING' DATi� J HOUSE NUMBERING ADDRESS MAP NUMBER_! L t NO. ASSIGNED By — LEGAL - CORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT �� y / NO. OF BLDOB. SIZE OF LOT NOW ON LOT l USE OF N0. OR EXISTING BLDG. FANILIES /Z-117A-3. Saes 'Srun3 ui�. 7k/- `"'—YI DESCRIPTION OF WORK t n1 n (� p Y 9/1 //$� pec EN �W✓FYO D NEW ALTERATION ADDITION 99 " 111 A��Ec t ,e 7 REPAIR DEMOLITION A�} --- HEI. Fr. NO.OF !`Y SIZE wp ROOMS STORIES EXT.WALL ',( COVERING /Y�' I COVERING/niOIfNW N!!>u✓ per. �p A USE OF STRUCTURE - ilf�/�l/LQ�/ �a2, �iB�Ai9! No 0n -,fi INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION:DN: RIALS ON 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FORMS. MATERIALS 1 PLICATION AND STATE THAT THE INFORMATION GIVEN IS" FRAMEI FIRE STOPS, CORRECT. BRACING, BOLTS 11.,.�•�.� II 1t9��i 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION. I ' AND 19TATE LAWS REGULATING BUILDING.CONSTRUCTION: GAS VENT, DUCTS Le•� J t SIGNATURE EOFy LATH, INT. r e� ADDRESS ( /4(/}�l'1/ f/.//.� N- �. LATH. EXT. PLASTER, INT. AUTHORIZED AOL $ vPLASTER, EXT. P.0. •/ �� HOUSE NUMBER COR- f /1_ Q PEE _ RECT AND POSTED VALUATION E ,�_a FINAL �O FE 76A636A OBS 3 152 • 1 COUNTY OF LOS' S l >/ BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT-TOBSN hereby affirm that I have a certificate of consent to self insure, 4 or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) ZIP - '•'•""".-"'"� Policy No. Company ' _L LOCALITY SIZ OF LOT'. NEI OF LOG .NOW ON LOTMA) - 'fi • , ^ . El Certified copy is hereby furnished. C) NEARESTCROSS ST.•Qd V ,�i17 ❑ Certified copy is filed with the county building inspection TRACT BLOCK -Loi ' - ' .department A•�') -, - , 0 5USE ZONE MAP.NO. Date _ Applicant ASS-SOH MAP(��K -t PAGE` "RANGE _ Ova•/COG D QQ '.� / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ow E T 'Nor - - COMPENSATION INSURANCE Ill r WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred A�nr_ /�/_ -Tl./1f17 I' CISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED RV dollars (Stoo) or less.) /J}�9Q I certify that in the performance of the work for which this permit -' is Issued, shall not employ any person.in any manner SO as to 'ARC4ITECT OR D ER TELUmA -' become subject to the Workers Compensation Laws. ` S w.- •,/� ICAL CLASSIFICATION "" APT CONDO -Date _ Applicant A AS ',R CILV CLASS NO DWELL UNITS.�,�;_ :F s NOTICE -TO APPLICANT: If, after making this'Certificate' of �� gEDUIRED TOTAL Ste��((FROM- EX¢q�" .OI Exemption, you should become subject t0 the Workers' CO TRAG OR' _ T! O: SET BACK YARD - HWY PR'7P'L{ISE WI Compensation provisions of the Labor Code; you must,forthwith- Lf FRONT .j I SI comply with such provisions or this permit shall be deemed revoked. AD ESS - IC O. - ;P L. • _ • SIDEI IJ IFIL lt LICENSED CONTRACTORS DECLARATION c ^ 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 ST FT.SIZE NO F 5 ORIES N0.OF FAMILIES •• /_T / rIj .. - - NEW ❑' R, -6. - PG 1;17-4111 CHAIJ�iei s>E:; ._' a Professions Code,and my license Is In full force and effect. - y s�I �_ License-Number - LIC.Class - DESCRIPTION'0@WORK ADD _ VALUATION _ D - _ - IJ •=_C Q Contractor DateApo i Any :❑ $ C QUtl TOITpi_ I301 � s � Iy ❑.I am exempt under Sec. N1, - ON O REPAIR _.❑ V s� l. i4J�i' 1. B.BP.C. for this reason DEMOL ❑ CDMA P/C - - Ud Date: - LSE OF EXISTING BLDG. I URM ❑ : d Signature C _ - _I]QIJ—I]�)U�- JI i4i+G� co APPLICANT(PRINT) TEL NO � LDMA Perm k' as owner of the property, or my employees with wages as - - 1 Z 3'lryl 1 AI?11�.i4 heir Sole compensation,-will do the work and the structure is ADDRESS n ' O t . not intended or offered for sale.(Section 7044, Business and ..F A OAT Professions Code.) WILL THE APPLICANT.OR FUTURE BUILDING OCCUPANT HANOLE A HAZARDOUS MATERIAL - - OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I'ce 'J El I; ensed contractors to construct thee pps owner o{ the property, am exroojercontracting withct (Section 7044, ' AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUVOE? AL gy ie Business YES El NO Elantl Professions Code.) - I•- „ WILL THE INTENDED USE OF THE 3UIDLING BY THE APPLICANT OR FUTURE BUILDING = OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION.OR MODIFICATION FROM THE SOUTH G`QNr.ST'RUG`TION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES El NO 1-1 - - ry the performance of the work for which this permit is issued(Sec. -I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THEscAQMDPERMIiTINc ••'.r•NM• /r /� - ' 3097,.Civ.C.) 'CHECKUST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20SECTIONS 2IN 20.100 THROUGH 2 20,140 CONCERNING HAZARDOUS / Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCACMD. o Lender's Address p WYNEX OP P6ENi - 'o I certify that I have read this application End state;under penalty _ �n Of perjury that the a6Sea r anon is correct.I agree t0 comply P.C.FEE /�/, QV - PERMIT FEE $ w all county c s nd State la s relating.to Lil Ing m onstR ti d herb thorize pres to Ives of is ISSUANCE FEE ;p toe r upon t entibned Sporty for nsp p p(�j• !O - - v.- :+4 a VE TIGATICN FEE TOTAL FEE ' m / } i i REVERSE FOR EXPLANATORY LANGUAGE - I 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 9804070025 PHONE: (818) 285-0488 EXT: GAL NO. OF CONST BUILDINGADDRESS: TR: 14467 LT: 59 SQ. FT STORIES TYPE 4846 CAMELLIA AV STRUCTURE: 0 VN TEMP CA 917804240 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8589-016-009 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUEDON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 04/07/98 UT 04/07/99 OWNER: TEL. N0: - SLOGS. NOW 0 LOT: VALUATION: F[Ny�./� L BY: �C DE: OWNER: VICTOR E (818) 286-2249- 1 ON: /G' 4846 CAMELLIA AV TEMP 917804240 FEES PAID DESCR PTI N OF WORK REROOF EXISTING HOUS NLY) WITH BON IT TILE PER CAL S- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: PERMIT APPROVED BY CITY ATTORNEY APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RE-SID 3000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN=HCS'--X3000:00 VAL 99.15 m%GELETOT AL-U ES 127.40 CONTRACTOR: TEL. NO: X05 UNTL APPROVALS DATE INSPECTOR SIGNATURE SAMELIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: i, \ ( FOUNDATION/TRENCH FORMS u LIC.-NO: SLAB/UNDER FLOOR '2' � [ � - ' ..1- �� -'�� RAISED FLOOR FRAMING - _ MAP N0: SEWER MAP BOOK: PAGE: FIRE 20NE: CMP.: R, r� �' f'� 144H269 3 01 '�� ""( ' ��'" '�� UNDERFLOOR INSULATION FLOOR SHEATHING NO. OF FAMILIES: DW LL N U I S: APT/GOND: STAT CLASS:,, --- - - NO 21 �� ROOF SHEATHING CH WITHIN HAZARDOUS �� ; { *� �� SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS I/ ' NO NO NO �/ � �E ,. i�/��/// �/, FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST ��V/8� r '�C�` �� FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: /C _ '�1L FRONT PL- �� VTCB ' "�� INSULATION/WEATHER STRIP SIDE PL- - '-- --' INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR7CEIL ASSEW.- RATED WALL ASSEMBLIES RATEDSHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: OPR261 ROUTE TO: SS0508 COUNTY OF LOS ANGELES TEMPLE CITY s 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/RESP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE PITY CA 91780 SL 0508 0405170025 PHONE: (626) 285-0488 EXT: LEGAL ID: - NO. OF CONST NE"W BUILDINGADDRESS: TR: 14467 LT: 59 SQ. FT STORIES TYPE OCCUP GROUP 4846 CAMELLIA AV STRUCTURE: 1418 2 VN R3 TEMP CA 917804240 ASSESSOR INFORMATION NUMBER: GARAGE: - NEAREST CROSS STREET: 8589-016-009 OTHER: - THOMAS PAGE: 597GRID: A5 LOCALITY: TEMPLE CITY ENA : MIT 7 8L G US E USE ZONE: ISSUED ON: PROCESSED BY- EXPIRES ON: EXIST OCC GRP: 05/17/04 VG 05/12/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE `,�I BY: CODE: SHRUBAR VICTOR E (818) 286-2249- 13,800 y 4846 CAMELLIA AV X TEMP 917804240 RLU FEES PAID DESCRIPTIO F WOR FINISH WORK UNDER PERMIT #8911 (ADD 8 REMODEL EXIST 1-STORY APPLICANT: TEL. N0: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 8 ADDITION OF 2ND STORY) AND REROOF RES WITH BONITA TILE SAME AS OWNER - AA BLDG PERMIT ISSUANCE 1 27.75 AC STRONG MOTION RESID " , 13800 00 VAI-r, < 1.38 SPECIAL CONDITIONS: B2 PERMIT W/ENERGY X`13800.00 VALE 312.18 TOTAL.FEES 341.31 CONTRACTOR: TEL. NO: +r;; y' git=Y'.`�� r \ - •., w � APPROVALS DATE INSPECIOR SIGNATURE SAME AS OWNER 1= .i^)' •�,as _ -1;c.` `` "R. - z. LIC. NO i LOCATION AND SETBACKS 1 SOILS ENGINEER APPROVAL ARCHITECT-- O 'ENGINtER: TEL. 1:0: OUNO� ATION/TRENCH FORMS LIC. NO: / SLAB/UNDER FLOOR - RAISED FLOOR FRAMING I MAP NO: SEWER MAP BOOK: PAGE: FIRE,ZONE: CMP: - UNDERFLOOR INSULATION 3 01 ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNI S: APT/CON : S AT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST - BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: _ FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP 1' ,h/J /J Zp (, _ r / - INTERIOR LATH/DRYWALL EXTERIOR LATH - �tiiSGLori �l�7-Y 65 is a17F + � LOT DRAINAGE SMOKE DETECTION DEVICES .k FIRE DEPARTMENT APPROVAL , f , •F, �. , ti� -y` REPORT ID: DPR261 ROUTE TO: RS0508 .F1"4-. •a „ 1'>L. . J-iP"�lLO�a""�AA Ai 'Atli" �./R,4 Af�vP�,asaRav+ o �o aovoo 0 COUNTY OF LOS ES � BUILDING AND SAFETY U WORKER'S COMPENSATION DECLARATION FOR APPLICANTTO a _ - BUILD�Nr� pq s , hereby affirm that I have a certificate of consent to self insure. BUI mG A DRES - /7f �/ or a.certificate of WorkersCompensation Insurance,or a certified f -----G��[.-G.�- 1 copy thereof(Sec. 3800, Lab. C.) 21P ' LOCALITY � �// Policy No. Company SI of LOT i - N rOIF LDG .NOW ON LOT ❑ Certified copy is hereby furnished .� �/' I�E Ofl `, NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LO E USE ZONE [MAP NO department. 46 (jr 5 Date Applicant ASS SOHAP PAGE PARC O 490 IAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O0" E - T NO Y NO COMPENSATION INSURANCEL E WITHIN 1000 FT of SCHOOL' (This section need not be completed if the permit is for one hundred AD/7�gE6�j/� JDISTRICT GRoup TYPE CONST, FIRE ZONE PROCESSED 6Y dollars ($100)or less.) 'T��•�TC! Icertify that in the performance of the work for which this permit ' is issued, I shall not employ any person in any manner so as to ARC TELT OR GI ER TEL become subject t0 the Workers'Compensation Laws. ��• �y� ,f•1 1 . [CAL CLASSIFICATION _ . 'i` APT CONDO Date Applicant q S115 VGl p� 9 _ V CLASS No. DwFLL uNITs _ _T:f:_:._�v; NOTICE TO APPLICANT. If, after making this Certificate' o1 E " �+� REQUIRED - TOTAL SQB¢¢yy�� FROM ExyySS7�� _S Exemption, you should become subject to the Workers CO TRACOR T�O. SET.BACK YARD. HWY PR17V§NE Wldifi"- Compensation provisions of the Labor Code, you must foI with FRONT comply with such provisions or this permit shall be deemed revoked. AD ESS LIG. 0. - PL - WTI _ . SIDE At 115 Ch=i LICENSED CONTRACTORS DECLARATION (� LIC.CLASS - Pt- - 1 hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and 'SQ FT SIZE NO. O qF s ORIES NO.OF FAMILIES //r� / LLIAkIr_t Professions Code,and my license is in full force and effect. , -. ` " NEW ❑ BE C_T PG�(O IFT�N1tt!!]] r t It License Number Lia Class DESCRIPTION O WORK ADD - VALUATION - - / . Am i _ ar�J : p° '(111rtL Contractor Date ALTER "� $AW4 Elam exempt under Sec. N(0 Oilo REPAIR ❑ $ B&PC. for this reason & ( DEMOL. ❑ LDMA PIC Date- SE OF EXISTING BLDG. URM ❑ L Signature gpPLICAT(PRINT) TEL NO. LDMA Perm# - �JIJ)~-I—( Jt: nI " as owner of the property, or my,employees with wages as Z :�?11 1 NrE1 i=b4 heir sole compensation, will do the work and the structure is ADDRESS O not intended or Offered for sale (Section 7044, Business and E A OAT PIOfessions Code.) WILL THE APPLICANT OR FUTURE.BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALWS-34 ❑ I, a5 Owner Of the pfoperly, am exclusively COntfaCllllg with OR A AAMOUNTSTURE SPECIFIED CONTAINING ON THE HAZARDOUS MATERIALS ATERAILS NOUAL TO FORMATONHGUII GUIDE? THAN THE AL BY licensed contractors to construct the project (Section'7044' YES Cl NOD - - Business and Professions Code.) - OWILLCC THE INTENDED USE OF THE BUIDLINR 9Y THE APPLICANT ON FUTURE E SOUTH OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMnnNG cHEcuusT FOR GUIDELINES ppp I hereby affirm that there is a construction lending agency for YES No❑ the performance of the work for which this permit is issued(Sec, I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING U�I � m 3097,CMV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY Coos W 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 Lender's Address GWNER OR AGENT RG o I certify that t have read this application and state under penalty 0 of perjury that the above r "tion is correct.I agree to comply PC.FEE j�/ .// PERMIT FEE vi all county c s "Non State la s relating to uil ing m onstn ti , d herb thorize Pres to ives of is ISSUANCE FEE few r upon t nenti0red operty for nsp i p a VE TIGgTION FEE TOTAL FEE ME- of ANN I REVERSE FOR EXPLANATORY LANGUAGE