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< r= A�PLIG Tl OR BU DING PERMIT
FOR APPLICANT TO SILL IN . FPrint'Gr type onlyl
COUNTY OF LOS ANGELES
AUDD TNG .R- A DEPARTMENT OF COUNTY ENGINEER'
CITY ( ZIP BUILDING AND SAFETY DIVISION
' NQ.OF RDGS. BUILDING
SI E NO.W ON LOT ADDRESS
TRACT LOT NO. c LOCALITY
OWN ,d N(i��iD S / 5 CROSS ST.
ASSESSOR
ADDRE=SS Z L„� MAP BOOK PA PARCEL
yy DISTd GROUP ' TYPE FIRE
-CITY 7� Z1P df 08 CONST.'/ ZOfJE)
ARCHITECT OR TEL CJ YY �J
ENG(N EER NO. STAT I.STI CAL CLASSIFICATION MAP
ADDRESS CLASS NO. / �J DWELL UNITS B�
TEL.
CONTRACTOR NO. USE ZONE NO.
LIC d /
ADDRESS NO. SPECIAL ,
U G CON D III ONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONST ION LENDER
NAME AND BRANCH( 9UDG.SETBACK FROM
FRCNT PROP.UNE OF (STREET)
-ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
SQ NO.OF NO.OF CHECK HIGHWAY + YARD FRONT PROP UNE HIGHWAY WIDTH
51 STORIES FAMIUES ONE
DESCRIPTION CIF WORK NEW ❑ + O
FDD BLDG.SETBACK FROM C2.4 ca (STREET ce
O
SIDE PROP.LINEOF 0
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + _ YARD SIDE PROP.LINE HIGHWAY WIDTH N
USE OF REPAIR ElZ
EXISTING BLDG. DEMO( ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT( NO.
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE)
t IN COASTAL PERMIT ZONE YES ❑ NO
IO ❑
VALUATN$
I .HEREBY AC*KrA DGE THAT I HAVE READ YHIS APPLICATION AND STATE
THAT THE ABOVE LS COf&EC.T AND AGREE TO COMPLY WITH All ORDINANCES 91,10
/ D�
AND LAWS REGkXATING BUILDING CONSTROCTK)K I CERTIFY THAT M DOING THE. /O
WORK ALMCRIZED HIEREBY I WLLL NOT EMPLOY ANY PERSON IN VK)LATION OF
THE LABOR CODE OF THE STATE OF CAU FORNLok IN RBA 'S CCVr4
PEN5ATION INSURANCE
Z
SI GNATU
ADDRESS t
FINAL BY —_l f
T ELI DATE d�Il1DY
CITY NO.
MAKE CHECKS PAYABLE TO:+iFEE $ FEE $��
ARVQY T.BRANDT,COUNTY ENGINEER
PLAN CHECK VALIDATION cx. r.0. uuH PERMIT VAUDATION crc M.O. cwsH
es 76A63M CE Reo3 3-75'
J
T
�awssaw oaaa Ia-ss .
' APPLICATION FOR, BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY "DU R GL
D.parbnsw of Gcnm Engl-4T
County of Los Aagales LPCAL E
WM.J. FOX. COUNTY ENGINEER NEAREST. �1�
CAGSATT D.GRIFFIN, Bur-T OF BUILDING CROSS ST.
DISTR�O. GEJUF TMP` SEWER
FOR APPLICANT TO FILL IN
CONST.
BUILDING -AK
q
ADDRESS MAP DTAT[ f
NUMBER - HWY
LOT NO. eAl AF BLOCK UGH ZONE SPECIAL -
p. ,(� �q ? r-�CONDITIONS
TRACT' / O �'��"4U J� CONDITIONSD _
60
NO. OF BLDOS.
SIZE OF L"O/vNOW ON LOT BUILDING YARD HWY STREET NAME EXIST.
USE OFSETBACK WIDTH
EXISTING BLDG. G r FRONT
P. L
OWNER
ADD G E fQ . SIDE
ADDRESS E
TEL DWELL 1 UNIT D INDUSTRIAL
CITY C NO. '
2 DUPLEX-UNIT 8 PUBLIC BLDG
ARCHITECT OR TEL' -
ENGINEER NO. 3 APT UNITS 7 ADDN.,A-LT., ETC
ADDRESS 4 .COMMERCIAL 8 misc-PrICAf jad
CONTRACTO No INSPECTION EECOBD
ADDRESS 71 'I . .
.DESCRIPTION OF WORK
N ADD ALTER REPAIR DEMOLISH
Y
SO. FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OFXrAUCT RR-r_ r
D
SIGNATURE OF
APPLICANT APPROVALS
ADDRESS 60 DATE. lx3P CTOR'S SIGNATURE
f P. C- S FFORMS, MATERIALS
TION 5� _
O FRAME: FIRE STOPS,
VALUATION O �- BRACING BOLTS 1
PEE FURNACE: LOCATION,
GAS VENT, DUCTS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT .
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT.
AND STATI LAWS RIOU TIN au
RU
T1om- LATH KXT.
SIGNATURE OF . HRQCT ANDB�KD
PCRYITT[E
ot
AD'lDRFrINAL IES S� Cr
WIL d. FOX. Couxrr QNQMMM TION
BY
• - - DI�UTY � 4- - -- DK
�
BY BY
m DM-UTY � DEPUTY
ge-JR w ORKERS'COMFENSAT16N DECLARATION
U�IfaiY affirm that I hoye a certtfJcale of consent-to 'self. AP#�LICATIQN,,F�R BUILDING PERMIT
Insure, or d certlflcatb of Workers' Com nsatron Insurance, r
or a c&r ffled copy't• (Sec. 3800,Lob. C.)
. OLINtIf OF� QS•ANG� BUILDING AND SAFETY
Policy No nny
Certifted.copy Js hereby furnlshed, FOR i4PPLICANT TO FILE IN AWREZ
BUILDING
r
Grtlfied copy b filed with the'cou ty IdtAg Irtlpec- BUILDING
tion-department. ADDRESS
Dote: -:22—WAP licpra , CAY ZIP dY ,
CERTIFICATE OF EXEMPTION FROM NO.OF
COMPENSATION INSURANCE 512E OF LOT I NOW ON T ST. .
CMI§ion need not be'com letbd tf the.permlt Is for one TRACT
hundred dolkrs ($100)9r leia.� NO. MAP tX70K . PAGE PARCC3
1,4ertlfy that ln'the perfot-monce'4—the'work for which this b'WtER NO.
permlt is Issued, 1`9011 not-4mploy anyri to any-manne-r � z
so as to becomb sub(ect to the Workers C mpinsWldn Lpws. -ADDRESS
(Ica�1t CiIY A�. A� - OC
�e��# �P ARO�ffECT !'+ L e DISTRICT GROUP TYPE RRE, BY O
NOT}C3•TO APPL4GsNT,' if, after Awking thl■:Certfflmt� of ® .
Exemption, you should become subject to the Workers' pp{ST• ZONE
.�'Q� ' D
Compensation provlslans'of the Labor Code, you mtW forth- ADDRESSQ+ lJ a
31
wit,comply•with such provisions or this perml) shall be-
CA
deemed,rwokod.. Ij RQH`'� �. TEL STATISTrA1_OASSI TFON AFT.
LICENSE CONTRACTORS DECLARATION LK_ QASS NO. DWELL UNITS
I hereby affirm that I am Ikensed under provlslons of Clgpw 9 NO.
{cornm*nd.hg" Section 7006)of DlvWon 3 of the Buslne4s acidLIC SEWER
Professions Code, and my license Is.ln full force arils effect. UTY CLASS BK PG. VALIDATFON
S9,FT
NO.OF. NO.OF CFEOC
Uterse'Number LI¢Cr512E STORIES ONE
VAL y�
'Contrbctor 01di* DFTION OF W001( A - _ .J j V'•� z Q s
ELI am exempt under,Sec' ( , °L Y a
ALTER- a
9.3P.C. fpr th4 reason RfPR 2 11 •3
Date D�(1S°NdJ
G BLDG. ? bEMOL °1h/ �a.9,0
$lgnatufd
OWNER-BUILDER flECLARATIOf�[ =PRR F1 6 °4 87.8.0 6-
-1 hereby affirm that'1 am exempt from the Conh-ce es License. ADORf5��L0 o.1 `l4� .1 8 8 7
Law for the followingis rea4on (Section 7031.$, "Irand o9. 1 t
Professions Gose): .. PREWW
I 719.E 4 A
aBUILDING
-1, as owner of the prop",''w my enlplpyees with ADDRESS #.o o ° o.23
wagbs dk their sold c`dmpensatlon,will do the'wdr� cirp6-
the structure is not Intended or offered fat sale(Section LQCALITY
1 .° 2 9*1 9,0
7044, Business and Professions Code)..: MOVING ;Ei r _-- Y
nI, a{owner of the property, am exclusively4aniractlr� NTRACTOR ;-`` �.•' o e'2 9 3_9 08
with'licensed contractors to construct the-Project (Soc- 4�
Noo 7044, "mess and Professions Code): >�` ` rex; \ f:. _V�b 9,•1.8 8 7
ADDRESS
CONSTRl1�TIbN LENDING AGENCY. YARD•. Hyf '
I hereby affirm that there Is a.don Ion lending agency fqr T �. UtE W1D " `� ;;^�4 y ;; :- 9 7 1.5 A
the - \' , 'o,o o . o r�
perforniarrce o-th4,wcrik for which this pdrmlt 14 issued
3097, clv. C). sIDE '`� t •,= f- _;,A '.3 5&2 5.
P.L 56,25
Leader's Nam. ` '` s ' 0_'a27.
-88
Le.rtders Address _ P.0 Fee 1 V P.rrnrt FM
1 certtfy that I haw read-this gppllcatlon and sio thatknea
the Issuance P/
° above Information Is totrect.J agree toly wtth.al l County
ordinances and Skate krws relating to bulldlnq construction, InTowl F« �7.. NW;p `_>f
and hireby authorize representort] of this County fo enter
tort]
the t1 Irspectlon p4jrpo—
MVIIIIIIIIIS1111 POR DIPLAMATORY LAMGUA04
of ,Or A6snt Dasa
XCOUNTY OF LOS ANGELES TI24PLN CITY 9 0508 BUILDING PERMIT
Ir DEPARTMELPP OF PUBLIC WORI.B 9701 LAS TUNAS
13MDING AND SAF&'I'Y / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1403120072
PHONE: (626) 285-0488 ETT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
ON FILE SQ. FT STORIE.9 TYPE OCCIIP GROUP 5342 CAMELLIA AV
STRUCTURE: 0 1 V-B R-3 THIP CA 917803244
ASSESSOR INPORKMON NUMBER: GARAGE: NEAP13ST CROSS STREET:
8589-002-016 OTHER: TH06U.S PALE: 597 GR»: A4 LOCALITY: T124PLE CITY
TENANT: FTTgT BLDG USE: RESID ISSUED ON: PROCESSED BY:
RTT T OCC GRP: R-3 03/12/14 SR
OWNER: TEL. NO: BLDGS. NOW ON TAT: VAI;=ON: F TE FINAL BY: CODE:
LAN, Wimm (626) 864-3653- 500
5342 CAMELLIA AV
TEMP 917803244 FEES PAID DM9CRIPTIO19 OF WORK
CONSOLIDATE WORK ON BL 1401020032, BL 1402060060, BL 131118
FEE DESCRIPTION: QUANTITY: UCH: AMOUNT: 00007. ENLARGE (E) BEDROOMS, INCLUDES BATHROOM i CLOSET
APPLICANT: TEL. NO: (60 SQ.FT) INTO (E) GARAGE. ADDITION OF 70 SQ.ET. AT FRONT
SANE AS OWNER - AA BLDG PERMIT ISSUANCE 0.00
AB STATE GREEN BLDG FSB 500.00 VAL 0.00 SPECIAL CONDITIONS:
AC STRONG MOTION RFSID 500.00 VAL 0.00 NO FEE'S PER14TT
B2 PERMIT W/ENERGY 500.00 VAL 0.00
TOTAL FEES 0.00
CONTRACTOR: TEL. NO: APP DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO LOCATION AND SETBAC79
SOILS ERGILKEIZ APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS
LSC. NO: SLAB UNDER FLOOR
RABID FLOOR FRAMING
MAP NO: SEFIER MAP BOOK: PAGE: FIRE ZONE: CLIP: =ERFLOOR INSULATION
3 00
FLOOR SHE2TH@R3
NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS:
1 NO 99 _ ROOF SHEATH-ING
SCHOOL WITHTN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSLILA.TI O49 WEATH:E R STTtI P
rnrrkmrOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR CELL ASSEM.
RATED WALL ASSEMBLIBB
RATED 9HAFL'S OPE INlGS
T-BAR CEIL32009
+ ADDITIONAL DATA ON FILE
LOT DRAT AGE
REPORT ID: DPP-261 ROUTE TO: B90508
COUNTY OP LOSrANGFq, TEMPLE CITY 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE. CITY CA 91780 BL 0508 1311180007
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5342 CA,MFT,T.TA AV
STRUCTURE: 400 1 V-B U TEMP CA 917803244
ASSESSOR RFORJIM=ON NU BER: GARAGE: NEAREST CROSS STREET: BLA.C`1=
8589-002-016 OTHER: THOMAS PMS: 597 GRID: A.4 LOCALITY: TEMPLE CITY CA
TENANT: EXIST BLDG USE: GARAG ISSUED ON: PROCESSED BY:
=ST OCC GRP: U 11/18/13 SR
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: F114AL DATE FINAL BY: CODE:
SCHLOTFRLDT RICK L;T7AUN L - 500
5342 CALLA AV
TEMP 917803244 FEES PAID DE8CRFPTIOlN OF WORK
TO FINALIZED EXPIRED PERMIT FOR A NEW GARAGE
FEE DESCRIPTION: QUANI=: CON: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.80
AB STATE GREEN BLDG FEE 500.00 VAL 1.00 SPECIAL CONDITIONS:
E2 ADD ITFSPECT HPLY RTE 1.00000 HOU 144.90
TOTAL FEES 173.70
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO LOCATION AND SRTBACb9
SOILS ENGINEER APPROVAL
AR,CCT OR ENGINEER: TEL. NO: F'0 ON TRtENCH FORMS
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRA14ING
MAP 140: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
3 00
FLOOR SHEATHING
NO. OF FAMTT,TRS: DSdRT.TT277 UNITS: APT/COND: STAT CUSS:
1 NO 99 ROOF SHEATHSIPG
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 10 0 0 FEET MATER ALS
NO NO NO FAAMR INSPECTION
FIRE SPRINKLER HANGERS
- INSULATION/NE&THIR STRIP
INTERIOR LATH DRTKALL
iai OR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMLIF9
RATED SHAFTS/OP ESINGS
T-BAR CRIIJ2OS
LOT DRAINAGE
REPORT ID: DPP-261 ROTTTR TO: BS0508
•COUVTY OF LAOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT W. PUBLIC WORKS 9701 LAS TUNAS RESIDE[TPIAL ADD/ALT/REP
BUILDING AIM 9AFETY / LAND DEVELAPK T TEMPLE CITY CA 91780 BL 0508 1402060060
PHONE: (626) 285-0488 ETT:
LEGAL ID: NO. OF CONST Nli"w BUILDING ADDRESS:
ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5342 CAMELLIA AV
STRUCTURE: 0 2 V-B R-3 TEMP CA 917803244
ASSESSOR INFORMATION NUMFlFG• GARAGP: bEEAR ST CROSS STREET:
8589-002-016 OTHER: T73ORPS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: USE ZONE: ISSIIID ON: PROCESSED BY:
ED= OCC GRP: 02/06/14 9R
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALID 0-N, : FllqXL DATEF BY: CODE:
LAM, WIN= (626) 864-3653- 1 2,000
5342 CAI�A AV A-��q
TEMP 917803244 FEES PAID DASClkIPTICkq OF WORK
LEGALIZED BATHRCO AND CLJET SEE ALSO BL 1401020032
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.80
AB STATE GREEN BLDG FEE 2000.00 VAL 1.00 SPECIAL CCND=CN9:
AC STRONG NOTION RESID 2000.00 VAL 0.50
131 PLANCHECE W/ENERGY 2000.00 VAL 90.30
B2 PERMIT M/ENERGY 2000.00 VAL 90.40
CONTRACTOR: TEL. NO: TOTAL FEES 210.00 APPROVALS DATE INSPECTOR SIGNATURE
SAME AS ONNER -
LIC. NO LOCA=ON AND SETTACKS
SO11A ENGINEER APPROVAL
ARCHITECT OR ENGIIUiER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. NO: UNDER FLOOR
RAJ-= FLOOR FRAbffNG
MAP NO: SEWER NAP BOOL: PAGE: FIRE ZONE: CfE: UNDERFLOOR INSULATION
3 00
1ST ISVEL FLOOR SHEATH
NO. OF IES: D'ST=�227G UNITS: APT COND: SPAT CLASS:
0 NO 21 2ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS ROOF SHEATHIRG _
AIR QUALITY: 1000 FEST MATERIALS
NO NO NO FERE DEPT. FRAME INSPECT
BLDG DEPT. FRAME INSPECT
SHEAR PANELS
INSULATION w A= STRIP
T►rrkLIOR LATH DRYWALL
EXTERIOR LATH
LOT DRAIN LM
SMOKE DETECTION DEVICE9
FIRFi DEPARTT-= APPROVAL
REPORT ID: DPR261 RO= TO: BS0508
i
1
COUNTY OF WS ANGELES TEMPLE CITY Y 0508 BUILDING PERMIT
DEVARIKEN'T OF PUBLIC NORYS 9701 LAS TUNAS Pmim 4TIAL ADD/ALT/REP
BUILDING AND SAFMR '/ LAND bRVELOPMENT TEMPLE CITY CA 91780 BL 0508 1401020032
PRONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEM BUILDING ADDRESS:
ON FILE 9Q. FT STORISS TYPE OCCUP GROUP 5342 CAMELLIA AV
STRUCTURE: 1733 2 V-B R-3 TEMP CA 917803244
ASSES9OR INFORMATION NUMBER: GARAGE: 334 1 V-B U NEARFIST CROSS STREET:
8589-002-016 017-MR: THCHM PAGE: 597 GRID: A4 IDCA-=: T90[PLE CITY
TAT= EYIST BLDG USE: USE KWE: I.BBUED ON: PROCESSED BY:
EZIST OCC GRP: 01/02/14 SR
01¢NE3t: TEL. NO: BLDGB. NOM ON LOT: VALAATION: M NATE �7Y: CODE:
LAM, WIN IR (626) 864-3653- 1 7,000
5342 CAMFIJ�In AV
TEMP 917803244 FEES PAID bksciLiptioN OF WORK
70 SQ. FT. ADDTION TO EZISTING GARAGE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.80
AC STRONG MOTION REBID 7000.00 VAL 0.70 SPECIAL CONDITIONS:
D1 PLANCHECI W/O EN-HC 7000.00 VAL 141.30
D2 PERMIT W/O EN-HC 7000.00 VAL 166.20
TOTAL FEES 336.00
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIG3'ATURE
SAME AS OWNER -
LSC. NO LOCATION AND SETBACKS 4,1
SOILS ENGINEER APPROVAL
ARCHITECT OR E4GINEIER: TEL. 190: FOUNDATION/TRENCH FORMS
LIC. 190: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEVER MAP BOOL: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
3 00
1ST LEVEL FLOOR SHEATH
NO. OF FAr4:ri.rES: DWE LING UNITS: APT/GOND: STAT CLASS:
0 NO 21 2ND LEVEL FLOOR SHEATH
SCHOOL MIT= HAZARDOUS ROOF SHEATH 1C
ABR QUAI=: 1000 FEST MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT
BLDG DEPT. FRAME INSPECT
SHEAR PANELS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYMALL
EXTERIOR LATH
LOT ERA NAGE
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPP-261 ROUTE TO: BS0508