HomeMy Public PortalAbout5322 CAMELLIA AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type Only) TEMPLE CITY
BUILDING CO GEI.E.S
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY Temple City zip 91780 BUII-DING AND SAFETY DIVISION
/.,(J� NO.OF BLOGS'. BUILDING
SIZE OF LOT---50 b NOW ON LOT ADDRESS
l
TRACT177D -1 BLOCK LOT NO. LOCALITY
EAREST
OWNER Ronald Bateman
TEL285- 8 ROSS ST.
ASSESSOR
ADDRESS 5322 Qamel 11 a MAP BOOK I PAGE PARCEL
DISTRICT GROUP TYPE FIRE ESS BY
CITY ZIP. ' n� �{•. CONS� ly// ZO
ARCHITE T R TEL..
ENGINEER NO.
STATISTICAL CLA IFICATION SEWER,)4p
ADDRESS CLASS NO DWELL,UNITS----- k'B PG
CONTRACTOR L , Randol
TEL _ USE ZONE MAP
, 88LIC. NO.
ADDRESS NO. 186086I SPECIAL
CONDITIONS
CITY San Gabriel Cal .CILC, •;3S C-39
ROAD DE PA RTM ENf APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER ?-
NAME AND BRANCH BLDG.SETBACK FROM 3
FRONT PROP.LINE OF (STREET) S
ADDRESS CITY
TOTAL SETBACK PROM TYPE OF EXISTING OC
SFT. NO. OF F CHECK HI HWAY } YARD - FRONT PROP. LINE +IIOHWAY WIDTH
SIZE STORIES FFAM)AMILIES ONE
DESCRIPTION OF WORK Re- b NEW y
Dw 1 & Garage w t t h DD E] SI E P TRACK FROM (STREET)
ITER ❑ HIGHWAY } YARD TOTAL 3ETB FROM TYPE OF EXISTING
12 x 18 Compo =
REPAIR SIDE PROP. L E HIGHWAY WIDTH
USE OF } _
EXISTING BLDG. DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ O ❑
(PRINT) H . L . Aa n d oNO
BY (SIGNATU RAE) IN OPEN SPACE YES ❑ NO ❑
t \ IN COASTAL ZONE YES ❑ NO
VALUATION$Y i a i 9 CATEGORICAL EXEMPTION YES❑ NO ❑
I HERESY ACKNOWLEDGE THAT I HAV[ READ THIS APPLICATION EMV IMRONMEMTAL
AND STAT[ THAT THE ABOVE IS CORRECT AND AGR[[ TO COMPLY IPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS R[GULATIMG BUILDING CON-
STRUCTION. I C[RTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERS IM VIOLATION 9F THE
LABOR CODE OF THE T [ CA FO MIA IN RELATING TO
WORKMEN'S COMP. N O INS
SIGNATUR F
PERMITTLE,
ADDRESS
FINAL BY
TEL
CITYNO. DATE
MAKE CHECKS PAYABLE TO: FEE $ aIXXg FEE 21 . 75
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. N.O. CASH PERMIT VALIDATION CK. M.O. CASH
7.`r'Xf; 1-5 1 2 1.7 5
l 70A638A CE9803 7/73 '~`�
" 7 4 A " G A C K I S = T o - . . A P P L I C A T I O N F O R - B U I L D I N G P E R M I T 1
C O U N T Y O F L O S A N G E L E S B U I L D I N G / , �� N C - c _ . ! A y p ,
D E P A B T N I E N T O F C O U N T Y E N G I N E E R A D D R E S S
B U I L D I N G A N D S A F E T Y D I V I S I O N L O C A L I T Y
J O H N A . L - A M H I E , C O U N T Y E N G I N � Q R N E A R E S T
Q k " A T T D . G I F R I N S U P T o D u L D S . C R O S S S T . J G e
D I S T R C T N O . G R O U P E E S S E D B Y
B U I L D I N G F O R A P P L I C A N T T O S 1 F I L L I N
I t C c O N H T ,
H E R M A P A D D R E S S 2 2 - N " C a m e l l i a " " S T A T I S T I C A L C L A S S I F I C A T I O N
B
C L A S S N O A Z �� I T ` =
L O T N O . B L O C K M A P I l y
S T A T E " Y ��
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T R A C T 1 - I " I W Y
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I N S P E C T I O N S E C O H D
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U P E O F S T R U C T U R E
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R E O F A P P R O V A L S
S I G N A T U
A P P L I C A N T
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F O R M S M A T E R I A L S - - J ,
s 9 , �� / ) P . a s '' r B A R A A C I N 1 B O L T S
V A L U A T I O N ��V s F U R N A C E S L O C A T I O N .
F E l f , O A 8 V E N T D U C T S
1 H E R E B Y A C K N O W L E D G E T H A T I H A V E R E A D T H I S A P - L A T H I N T .
P L I C A T I O N A N D S T A T E T H A T T H E A B O V E I H C O R R E C T A N D
A G R E E T O C Q M P L Y W I T H A L L C O U N T Y R D I N A N C E 9 A N D 1 1
S T A T Y L A W S R E G T I N G B 1 G U C T I O N . L A T H E X T "
S I G N A T U R E O F H O U S E N U M B C O R -
P E R Y I R E C T A N D P O S T E D
A ���� N . F r a v e . B a l d w i n P k . , �� / - t i r G o F y
C L Y D E D I R L A M P R I N C I P A L E N G I N I K E R
C m = V E M I T I O N c 1 L Y . O . c a r n i C I c . Y . O - C a n t
i 6 9 2 . 4 - N O Y 3 1 A 1 2 . 0 0 ��m F .
ti APPLICATIONfOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN j BL�11
I hereby affirm that I have a cera floste of coneerrt to self h9m
ore of Abrhers' I a CertlfiDli \
Copy .ZP
LOCJU_Fr1'
��. S0E LOT No.OF BLD08 NOW ON LOT
❑ copy Is hereby fgrnW)ed. NEAREST CROSS ST
Dopy !s ftlad the rmu T y hvedion TRACE BLOCK LOT IJO
n� USE ZONE MAP NO.
Data ' 111 ASSESSOR MAP BOOK PM R*F1Cr=L
v dr-1 S>�CONDFO
CERTIFICATE OF EXEMPTION OM WORKERS'
COMPENSATION INS CE `r YATI-N 1000 FT.of SCHOOL? YES NO
(Thh section need not be completed If the permft Ie for one hundredDt3TFrCT QAOUP CONST. FIRE ZONE E3SED BY
doG ($100)or leas.)
I car-tffy that In the perforrnance d the work for which thcrry 21P "4— aO `3
le fseued I aha➢ root employ flrry person In any manner eo as t0 ARCHRE£T OR ENCiR�i TEL Na
become aub)ect m
to the Workers'Compensation Laws. s401STIC�1 APT CONDO
Dale Applicant ADDRESS CLASS Na =11El1 L"T8
IvOTCE 70 AFPL CANT.• ff, after mskh this Cert}flcffie dREQUL ED TOU1L SETBAf,K FROM EXIST
Exemption, you should become mb;ect to the VMxrkers' ' SET BACK �XRD IfiYy PROP LAE VV9TH
Compensadon provisions d the Labor Code, you must fortti%th - FfIONT
oompty wfth such provtelons or this permft shell be deemed revoked. PL
LICENSED CONTRACTORS DECLARATIONLIC PL SIDE
I hereby affirm that I em IlCertaed uTderprovbloie d Chapter, 9. JY� 8EwEA MAP
(oxnrnencIxV with )d Division 3 of the and NO.OF STjr tJO.OF E8
Prdeealoco Code, I In full force ` NEW ❑ BK PG 1
License Number LIC. //J��' Q ADD ❑ , , ACC:T.T
Contractor Date ' ALTER ❑ 3303 49.1
1:1.1 am exempt u REPAIR $ 1 ITEMS
r
BAP.C.for thle ree&)n DEMOL ❑ LDMA P/C t 89 �}{y�
Dete: U 0 USE OF 00871 D URM ❑ �f
L 4
lire APPLrANT(PEAT) TEL Na LDW Permr f nr�Z
El as owner d pr
the operty, or mes y employewfth wages as ZO `
their sole compensation, will do the work and the abUOture Is ADDRESS 0
not intended or offered for sale (Section 704-4, Business and FINAL D03ft PrdaealOrls Code.) V&L THE APPLICANT OR FUTURE w■DW CCcLFWT FLA DLE A FVSAFDOU8 Awarvl 1 7/12 95
❑ I as owner d the property, em exdemhrety contractirLg with aR A IMrrrJE COrralfQ A FAZAFflOUs W034AL ECU-1L TO OR GREATER THAN TFE
AMOLNTe SPE-CF ON TFE HA7.1RDOUa uAF3Lrle 141OHL410N GUI ET FWU.BY
liceneed contractors to constijot the project (Secdon 7044, vEs❑ No❑ e, ]` 1 N1 9:28'
Rmbess and Prdeealone Code.)
MLL THE NTE DED ME OF THE awLNG BY THE OFi FuTFE w■DM
OCCURWT A PEFMT FOR coNarRucnoN ORl FHOY THE SOUTH
CONSTRUCTION LENDING AGENCY COAST W rT°IOTFICT tecAaAD)sff TTM T POR
orr1Fl.Fa
I hereby affirm that two Is a oyTotruct n kxxIing agency for YES❑ No❑
the� pwloa ffner of the work for which this permit to famed(Sec. i rwE FEAR THE F{AZAFDOUB uaErULa rFCR►uvlo►r euoE Aro THE ecs001W PEFrnTNc
3007,Ctv.C.) C EMJST.I U E8451k D MY REOUFEUBM LNDM THE LDB NQELM 0"(Y COOF
TTTLE 2,C-MPTER 2.20 SECT10N8 22a 100 11-1�22Q 140 CONCEFINM FNZARDOU8
Landers Name ►44EA4_e FEPORTHG AIC POR o6PJ+la A PFFMT FFpY THE BCACMU
Lenders Address
0 Gran CA mer
I certify that I hake this application and stabs under penalty P.C.Fri I'ERMT FEE
o( perkuy nL
that the hforatlon Is oorrect.I agree to oomply
with all county end State Iawe to 6dng
COr16tfr�, and this tSSLk NCE FEE D
io ember upon the property for
oPA EST)OATUN FEE TOUIL FEE /
r r Q / v
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION FOR BUILDING PERMIT
- COUNTY OF LOS ANGELES.,4.' ` ^ `. BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR AFPLICAWF TO Flll IN BILDIING ADDRE
I hereby affh n that I have a cerdflcate of consent to eeff BU bW ADDRESS -
or a certificate of Vkdoars' Compensation Insurance,,ora Com.
copy.thereof(Sec 38 Lab aTYT r ZP
Policy rro. ry Ti-c►.� f�, 1 J
mz=oFALo� No.of eLDoa Now ON Lor
❑ CN3rtlfled copy to hereby furrilehed. NEAREST CPKM ST.
Q Certtfled copy is flied with the oatty'bullotnj In paction TRACT BLOCK - LOT 40.
Lt E aOrE .T.o Na
Date��int .� A8S>8308 BOOK PAC3E
�` BPECLAL CONDi'TiON3
CERTIFICATE OF EXEMPTION FRAM WORKERS' TEL Na
COMPENSATION INSURANCE M -% 1000 Fr.OF SQ-r ? YES 40
(I hie vection neeco
d not be mplgted If t-,6 perriitt is ADDRESS for one handfed "CL^ DtffrWT QROUP TYPE CON IST. FRE W E PFlOCES3ED BY
ddlarm iS'�oo)or lase.) crry �
I certJfy that In the performwork performance of the rk'for which thls p&mft {J,/
le lseued., I shall not ertpby any person In arty marvlef bo as to ARCHffFC•T OR ENQlEE1� ,. TF1.NO, r 1
become,eub}ect to`1f1e Workers'CORIpefSmBtlgn taws. S➢OT3TIC�-CLAS8ti-lr,ATION APT CONDO
Data• AppD--a ADDRESS CLASS NO. DWELL UNITS
NOT)CE TO AfftCWT..- -If, after making thle Certificate of REQURED TOUL SETBACK FROM EXIST
Dmmptlon, you shock become sublect to the Work s'. TEL NO- SET BACK Vim i fy PROP LAE VWDTH
ComPer—fbn provleiorn of the Labor Code,.you mus# fm lJ7Wf h ?V03-
corrpy with much provisions or this permit shall be deemed revoked, SS LJC.Na PL
FRONT
LICENSED CONTRACTORS DECLARATION SUE
I hereby efflnn that I am Ilcenaed underprovimiorm of Chapter 8Arc
9El"JEAi MAP -
(comrnenctng with Secibn.7000)of Dtvfsbn-3 of the Bu0nese and SO.FT.817E NO.OF STORES, NO.OF FAktUES NEW El BF( pa
Code,and my ficenae la In full Tome and Oct
Lfcenee Num U Llc Class DE9CR8T1DN OF woFac ADD ❑ YILLI/Qlar cb
Conttactor Date .�-�r- s- OIL ! ALTER $
❑ I am emmpt under Sac. ` 'S i REPAIR ❑
RAP.C.for this reason DEMOL Q LDWIA P/C
Date USE OFa eLDC� URM ❑
APPLICANT( J TE1-NO. LDMA Pwm f Coz
❑ 1 as owner of the prop", or n-y errpioyeee with waves ao ,v l-7 Yo j. Z
their sole cornpenestion, wU do the work and the structure Is ADDRESS
rot Intended or offered for male (Section 7044, Business and d r- - AnGL FRAL a1
Profeealone Code.) 1M1 THE APPUCANT Oft ftfRF� IIMN
aADM OCOT FWP-E A KUNIX U9.M,4ER41 3 1
El 1. as owner of the property, am exck"'ty contracUng with OR A MUTIIW
E CONP"HG A HAFDOUS MMUWL EQUAL TO OR OFEAFEA TH1yN TFE ACCT.r
A►AouNTa oN TFE HWARDOUe I1-TEFMLe IFORM,4ION.ouDE? FnAL BY �n
Icenmea contractors In Code.)
the project (seofion 7044, YEe❑ ,7,x35 172.65
BueJrleee and Profeeebrle Coda) �
rFe KrE►DED USE OF THE KWUM BY THE APPLICANT OR FUTLXE B�DIp
CONSTRUCTION LENDING AGENCY QLAL-rFEC"z£A PB:MTWEL4 FOR OR NE Pow ION THE r uTHFoe 1 ITEI'S
�_ Daum IAyuc�err o��Ncectiowo>sEF ai�rTt:Na d-EozleT FOR
1 hereby afArm that there f8 a construariaT kxn ing agency for �❑ a� TOTAL 1
the performance of the work for whlctl this permR to leased(Seg iH&E FEADTHE w.zARDot6MSBlf:ORW.vloNGUIDE AIC THESCACAUPEFSC TM DECK 172.65 .
3087,Ctv.C.) a-IEaa.ta[ UNDEFU[AND MY uNNbm THE Lce�Es Cou rY cocF_ (�-,1,,� .
00
Landers Name Tnl.E 2,CFNPTEFI 220 100 A PE3i,><T FROMT-E eGCOJU F�VARoolie xt
Lenders P¢idresa �� -
o
urW OR AQrr
-
O 1 certify ihat I have read the appricabon and state order penalty 01010& C X I 5/18/95
RQ d peroy that the above"ormatton b correct 1 agree to ax y PJ•FEE PEFW FEE
with afl oar ty ordFrancee and State laws rekdtng to bulding 0477 1 A�110 59
of this County - r3st�ANCE FEF .
2!54a�ndn,��"*entatl%ee
for lnapeyY.r,.S MrE8T13410N FEE TOTAL FEE r -
^ .�+•
of Q Ate.
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO F1L1 IN eU ADDREs8
I heraby affirm that I have a certfficate d coneerrt t0 Belf Insure, ,,3C,
AM CL l_
or a cer- cate of Workers' Compensation h durance,or a cerfflW adv
v 14orrl
G�Lab.C.) p l�NFo fJ,� -I P C 1 � C) 0 L°cwTM
NO' Cpany Sa E of Lor - NO.Of:BL.DOS NOW ON Lor
❑ Certified copy 18 hereby fumial- d. I NEARE8T CROSS ST.
❑ Cerrmed copy he feed with %9 �Zld1ng h,epectbn Tfwcr BLO(:}( Lor No. - '
lJBE DINE MAP NO.
D�� ApO nt ASSESSOR MAP BOOK FMAE FARCFI
BPECW_CONDfflOfd9
CERTIFICATE OF EXEMPT11WRONNI WORKERS' owtaER T-Na
COMPENSATION INSURANCE w7,w loco Fr.of ? YES NO
(Thla Becxbn need not be corr>pleted If the pertnft he for one hundred ADDRE88 CAM DfBTRICT GROUP CONST. FFiE DONe PflocEssm BY
dollars(5100)or Ieae.)
I certify that In the performance of the work for which this permitCITY M -r� I •11 ff J�
O y _
i Is Waued, I sha➢ not empty any person In erry manner so as to ARCtfrECT OR E?JQIJEER Ta N0. Q13
becorrle eub)ect to the Workars'Compensation Lswe. swift K AFT CONDO
Date Appllcent ADDRESS 011.89 NO. 11 11 UNTTB
NOT1C E TO APPUCAW: M, after making thle Certlficate of REOLARED TOOL 8ErBACK FROM EAST
Exemption, you should become aubjeat to the Workers' CONTRACTOR Ta Na 8�T BACK )ARD I WY PROP LrE wQn�
• Compermaetion proyWorb of the Labor Code, you must forthwith FRONT
oDn#y with ouch provisions or this permit shall be deemed revoked. A PL
LICENSED CONTRACTORS DECLARATION g 8L
E{.-, L.IC.
PL
19
I hereby affirm that I am J$cem Qd inderprovtalons of Chapter 8 CITb SEWER MAP
(cornmerntrp with Swdon 7000)of DMalon 3 of the Business and 8Q Fr.S2E ND.OF srOREs Na OF FAJAUEs er rrry NEW El BK Po polo.b In full force !1
Llcenae NumbLIC.Class f OF�c ADD ❑Contractor ezc G�S Data — e ALTER ❑
❑ I ern exempt under sec.
G ro fQ. REPAIR ❑ $
BAP-C.for thle reason DEMOL ❑ LDMA P/C+
Dt. USE OF E=n NO BLDG URM ❑
Ta Na LIMIA Phan 0
AM.T
❑ I, as owner of or my emwployees rch wages as
their soie do the work and the strxture h ADDRESS �
not Intended or offered for sale (Seotion 7044, Budr»ee and �FPJAL DOVE 189.1,5
Professkyw Code.) wLL TW-APPLICANT DR RM-**BUI-D xl ocaMNT RANOLE A MZAFD"MaIFL,L = 3_ 1 ITEM
El 1,I, as owner of the property, am excuelvcontracting with OR A Mrd
oOC P"40 A RAZAFUOJB N4E1zdAL eQUAL To OR CFF-CER THAN THE OL {y i
JFM ON TFE FIAZAMCV8 MA159I&B Ff!( UqN �a4 R NAL BY TOTAL 13 7 1 c
ecerleed corltradors to corletrucf the pro}eat (Section 7044, AAODUMre 8FECYEs El No Elrr
Business and Profeeabrle Code.) /' ��J
YLL TFE MENDED UDE OF TFE RtV M'i BY TFE APPMANT OR FU UM BUR-DM
L�11{L 1�•1C
QR
OCIwNT REOIE A P9�fT FOR COHBTRVCTION OR IIOOgGO'K)N FICM TFE BOOTH
CONSTRUCTION LENDING AGENCY 0aWT AS oIAALrrY WAN04061T DfTFWTr(5aN°'1D)"SEE P84FFHO C EMUST FOR � � .�
n.E,PEs
I hereby affirm that tilers Is a oormtrudbn fending agw)cy for Yss❑ ra❑
the performanoe of the work for which this permft Ie Issued(Sec.
I FIA►z raFAo rHE FIAZARDoue uATETaAl.e rHRaRuaprr ouoE AND THE ecr.ow FEFO&TTlq
3087,Ctv.C.) a,�I Ur1)ER541D WY REO1179,E"UNDER THE L0e ANGE Ea COLWY.(o ryyyt-�_ryy-y i 2/
10R.5 ry f bC
TM-E 2.C"W EA 2-20 SECTIOM L2aloo THPOVOH 22 lap COMCEFM43 FMZARDOIlD IDIDO J-1.LPJ 1 .J 10 7.J
L-erldere Name M4SiALe FEPORTMO AND POR COW"A PERM T FROM TFE 8CAQUa
Lenders AddrHaa ow.rw on err rr VT2 1 AM 10:IJl
o_
444 I certIfy that I haae read thio epplbfftbn arld state udder penalty
Y of pw)-ry that the above Inforr s la oorrect I agree to comply Ra FEE PERWT FEF
R with ell my ordinances and State lave reieting to buldlrg
b the ebo+�mentiorled propert� of this County t98t1AJJCE FEF
u FNVE9TK3ATION FEE TOTAL FEE (B
n or
SEE REVERSE FOR EXPLANATORY LANGUAGE
• APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ' '- ' BUILDING VD SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLK AHIF TO FILL IN BnADDRESS
1 hereby affirm that I have a certificate of conaerrt to saH Inaurs, BULaJO ADDRESS
or a carttficate of Vlbrhem'Cunponeation Insuranoe,or a car ftW 3 2 Z. ``
Copy thereof(Sec.3800,Lati C.) CTII `� z>P / 7�d LOCALITY
Po&- L t�S�ot3 co,� '1"ira'►Se r�>
J�
S=OF N.J.OF BLDos Now ON LOT
yl SCC&-It d copy Is hereby fiunW)od. NEAFEST CROSS ST.
❑ Certtfled copy 1M Hlgd with the county buldlrQ h%.-C ion TRACT BLOCK LOr N0.
I� USE ZONE MAP NO.
departh�-
DaW 10::5L1 Applicant ASSE8BOR MAP BOOFc PALE POFIG L
BPECa/11.COrDfTIONB
CERTIFICATE OF EXEMPTION FROM WORKERS' 2g YES NO
COMPENSATION INSURANCE r s /� WTI-M TOW Fr.OF SCHOOL?
(TNM aedlon need not be completed If the permit b for one hundred SCJ �� DISTRICT GPIOUP CONST. � PROCESSED BY
dollars(3,00)or leas) f 2
I Certify that M the the work for whish permit CTfY %GM Zp �Cl �J3
Is Issued, I shall not any In any maraca so ae to ARCHrfEGT lE3 /�
become aubject to the Lewe gVI0V r-AL CLAS8F1CAT" APT CONDO
Date 140^ Fwlnt ADDRESS CLFtss Na _ DWELL uNrTs
NOTUE TO APPLC4JVT: H, ' this Cwttflcate d REWRED TOTAL SETBACK FROM DOST
E— ptlon, you should to the VvIod'srs' , NO• SET BACK )ARD HWY PROP UW wUTI-I
C rIXxxsatlon provlalons of the Labor Code, you must forthwtth Dd /l 2 y1-7
FROtfT
conn*with such prwbiom or this permit shall be deemed revoked. ADDRESS LIC.NO. P
Q bKl— soE
LICENSED CONTRACTORS DECLARATION Lr PL
I I I G�
hereby affirm that em Irensed urlderprv�kabrle d Chapter 9 gEyyEq MAP
If (comnlerx*Q wI h Section 7000)of Dtvtslon 3 of the Business and eQ Fr.SIZE NO.OFa NO 8
Prdeeabrls Code,and my Ik,erlee le m full force and
NEW ❑ w Po ,
License Number Lv a# act DE YOCR< ADD ❑ MLUAOION
Contractor 99CM4& Dam S'1,1 , i��1 ALTER NO $ ''� 8
❑ I am exempt under Sec. REPAIR ❑ $ 23
B. P.D.for&M reason DEMOL [I ACCT.
r
Dales USE OF EXtsIT NO BLDG U RM T1LDI.LA P/C 3303 96.51
CID
SkInature APPUCAITr(PFVVT) TEL NO. LDMA Perm r 1 Z
❑ 1, as owner of the property, or my enployeae with *Wm as O ACCT.0
their sole compensation, Will do the work and the structure Is ADDRESS
not immndad or offered for sale (Section 7044, Buain&m and FKAL DAM 3303 190.44
Profesalorm Code_) waL n-e Arm:xr OR FImRIE auILoNo occuPwT i-urnue A i-uzuoorre uAre%kL
`q
El I, as owner of the property, em exckJeively ContraCtfrlp with OR A NCOIFE CONW"A FV7}FDOUa►IATE'IAL RCL AL TO OR GFEATE3 THAN THE
ITEl1S
AAXXR WECFED ON TFE FHZARCOUB u/SHaALa IFM
OF /SION GLIDE? FINAL BY
fM
keneed contractors to construct the proOd (Secbon 7044, YBB i8
Business end Professions COde.)
YALL TI USE OF TIE BUIDLMO BY THE AFPLJCANT OR RTTURE MLDNO
OCpiWli FEQXTE A PE I&T FOR CONMTFUGTION OR YOOFCJQIOH FROM TFE SOUTH
CONSTRUCTION LENDING AGENCY COAT Ari CUALRY 60NAGBAENT DISTRICT MCACW SEE PEI:& O CFEC1 Iffr FOR
rr El.F s WINE .00
Tnance d
I hereby affirm that two Es a cor>atructiorl lerdlrp eQer>Qy for YFs❑
the perforthe work for which thio permit 1e 1salJed(Seo. HAZAFDOI1e W-TEFL-L8lFC~PION GLDE Aro THE MCACAAD F�TTM
3087,Ctv.C.) ►rr FEOUFEa6TTa IIIOF]T THE We ArreaEa COUNTY coDF; p�
LerdaraName ilp
Fi7R100 APEF �THEEIC�1CL "K�O1B �—W01 10/ 5/7JLendes Addrew 2651 1 AIM:29
0
1 cwtfy that I have reed thIe application and state under peneity,
of pe4-r y that the above Information Is Correct.I agree to oortpty P'G �( PEl4AT FEF
with all County or�lencee and State Yews rafatIIV to buldlrV (�
hereby authorfzs rspreeenmtivas d thisaco°unnt°y' ISSUANCE FEE 3 0
m property for trTapec tlons�-j[err posse_
(�^�j�•'.,,�/,l� NVEBTpAS10N FEE TOTAL FEE � �/ O
o T
n �
SEE REVERSE FOR EXPLANATORY LANGUAGE
•, APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BU DNO
I hereby affirm that I have a cerHifcate of 0ormeat to satf Insure,
or a certificste 0f Nbrkers' Compensation Insurance, or a oertttled
copy thereof(Sea 3800,Lab.C.) CITY ZIP
LOCAL
PQncy Na W C(p L St O Z.3H torr Q n sag of LOT No.of eLDO&crow ora LAT 1 a_
N7Certmed copy is hereby fumle-Wed. NEAREST CROSS ST
❑ Cer Mad Copy Is fired with the tiding h9pectlon TRACT BLOCK LAT NO
118E 3klE AARP Na
Date Appl ASSESSOfl MAP BOOK PAOE PARCEL
/�..► BPECW_COf�DITfONB �
CERTIFICATE OF EXE FROM WORKERS' Na _ r
COMPENSATION INSURANCE f7 wATwa T000 FT.of Bc+aoL7 NO
(Thio section need not be completed H the permit le for one hundred + w/Q. /L �� pCSTFd T GROUP TYPE CONST. W P}IOCESSFD BY
dofars ($100) or lead.)
1 -y�
I cartffy that in theparforTnan, the work for which thio permit CM
l& lasued, I &-Weil not arty any manner s0 as to v
_tOct to � AnORME OR D ClOJEET TEL NO
'x^'."�.uyciu w 841Tf8T}G�L CLA48F7C»�TION APT CONDO
Date APd t ADDRESS CLAS.s Na DWELL UNT'S
N07TCE TO AFPLOCAN... H tills Certifbate Of REQUIRED TUU L SETBACK FFgM EMST
F_—TObn, you e-Watid subject t0 the Workers' CONTRACTOR , TEL �NaSET BACK *AMD I�yY PROP UNE wnTN
Corrpermetlon provtal n& of the Labor Code, you must brtfwIth -ZY/—
,'0
ST
corrpy with such provlmlons or tufa pit al-tall be deemed revoked. ADDRESS LU. - p L
LICENSED CONTRACTORS DECLARATION3wz , e) C 73L,f/
SCE
9'uc7 LIC. P L
mpr
I hereby affirm that I am Iicensed uncieovfmbrm of Chapter 8 SEWER MAP
(commerx*p with Section 7000)of Dfvlelon 3 of the Business and 911 FT.Sag NQ 9TT�REs NO 9
Profeedaae Code,and my Ilcerae fa In furl force and effect NEW El BK pa ,
License Number Lk-CkmDESCOF /) f ADD El �
Ma- Q++
Contractor Dateyy� /` r ALTER s
❑ I am exarrpt under Sec. REPAIR ❑ $
RAP.C.for tt le reason DEMOL ❑ L[AAA P/C f
Date_ USE OF E)08TNG BLDG URM ❑ P
Skpature APPLICANT(PFiW) TEL NO. Ld.1A Perm• wVr1 _Z
El I, as owner of the property, or my errployeee with wages as Z ACGT.0
their sale coepersafion, will do the work and the etrwture Is ADDRESS 0 .
not Intended or offered for sale( Section 7044, Buaineee and FWAL DATE
Proree&rons Code.) YA1 TFE APPUcwT OR PUTLkRE BUI-DM OCCUAWT HANDLE DLE ►weiAL
❑ I, as owner of the property, am exckraNe}y contracting with oR A uonR A waarDOu&LL4H;AL EOluAr To oR�Tavya ne ] ITQ ?
AAIOIMB�Tlf HAZARDals LL4H4ALafFORL06 M OUDE7 FU AL BY
Sceraeed contractors to construct the project (Secti)n 7044, vEs❑ �
. � TOTAL 1 _55
Business and Professions Code.) wu T}f WENDED use OF TFE BUOLNG BY TFE APPLICANT OR FUTLFZ s■n■a a i
y�
OcaF1NT Re011�A PERA rr FOR ICJUOTt
OR MOOFN FROM -E SOUTH MCK 125■
CONSTRUCTION LENDING AGENCY CO'$T Ara QUALnY WANAGaem MiRICI (SCAOW SEE PERU M C1eGa_eT FOR ri{/�y .�Wy
I hereby afitrm that there Is s ooratrudbn Verdfr>Q eganar,E .Fa l{!tt E
oy for vee❑
a the Wfxmance of the work for which this permit Is lsaued(Seai fI►E READ LLATEA"PC-CF64v1oN GLEE AM TFE SCACAC P9irTrM
3097,Ctv.a) CFE uDEfagP►D MY REOL RE14D a UNDER THE L08 ANGE1m COUNTY Cook �y-y-y-��_�y�
Lenders Name 2 AND oE�v 4NQ A PEFM 1010 THROU13H�Tre 0000—"1 9/ 7/95
Landers Addreas 2192 1 Ali 11:`,15
yQo 1 certify that I have read Us appilCafiora and state under peraRy PC FTS PE3II.QT FEE
y of perjury that the above trrf0rma8on is corracL I agree to comp* Or
R with ail cant* adnancee and State levee relating to Wktnp J r
and hereby aUllc za rapre&errtatiYas of d* Canty ISSUANCE FEE . 30
io abate mentioned property for t PiPOeea
9 -Q PIVEff"T10N FEE TOTAL FFfy
.Aq�
SEE REVERSE FOR EXPLANATORY LAINGIIAGE
COIIiTV OF LOS AI�GELE$ r TEMPLE CITY 0508 - _ BUILDING PWIT_ - -
DEPARTMENT OF PUBLIC WOW 9071 LAS TLlliAS" ALTERATIQM/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT. ,` ' TEMPLE CITY-CA _ _ I BL 050a 9707310052 - _
PHONE: (818) 285-048�I EXT: - {
LEGAL I D: - _ NO, OF CONST Lulpi _
TR: 17780 -"LT: 1� : SO. FY $TORIES. TYPE CAMELLIA:AV.
M. LJCTLiIE: 0 VM EMP CA 917803244-.
_ `MEARUT CROSS STREET-
8589-002-020 THOKq PAGE: 597 : GRID'-A4 LOCALITY:
TEMPLE.-CITY.
T ENAN!r, *IST BLDG USE- MID USE-: - E](IST OCC GRP.. . ; EXPIRES ON:
07/31/97 � TC - 07L31/98- -
MORALES CARL 8 OWNER: _ - �[. 'l. IM ON LOT. VALLIATION: FINAL DATE- F I KAL CODE:.
1': . 6,000
5322 CAMELLIA AV
TEMP 917503244 = FEES PAID Uml
TION(r PIC
OUT.¢1;NDOY$ TO VINYLS - SAME SIZE
EE DESCRIPTIOIL QUAMTiTYa+UOM:' .AMOIIUT;
AMERICAN HOME IMPROVEKENtr PROD. (800) 807-96x9 ALDG PEhM1T IS§1"u .,. 27. -I
AC STRONG.MOTION RE9p '6000.W VAL 0. SPECIAL E6WITTw9___
D2 PERMIT 41/0 EN-Hl� U0 VAL 150.
{mil � `fOF.E$ 178.35
AMER CAM HOPE IMPROVEMENT _(310) 944-3400-
V
J LIC. NO _
10415 SLllSHER DRIVE NR - ,
SANTA FE,SPRIIN6E, CA. 721379¢3
TMW
LTC. 100- -0SLAB/LX ID ER FLOOR '7-7
RAISEDLFLPOW FRAMING-
MAP Jm: .SEWlER W BOOK: PAGE� FIRE ZONE: amF t6M�I UUDM'N-
147H269 3 -01 U B��G .�1 tl O R f!\SFLOOR SHEATHING..
1 +
NO. OF. FAMILIM,DWELLING UNITS.' APT/COKD: STAT CLASS
_ NO 21 p r;, ,WITHIN HAZARDOUS '
`.
AIR'MAL ITY: 000 FEET MIATERIALS �/�
NO NO' NO l� - - j
SET BACK YARD: HYY: - PROP LIME: WIDTH: f
FRONT Pt- � 1
' SIDE PLIN'TERIOR LATH/DRYWALL
-
t
RATED R�L'AMUITFT
T-BAR CEILINGS
* ADDITIONAL DATA ON FIDELOT DRAIMr
_
SPORT ID: DPR261 ROUTE TO:.BS0508
�� T
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