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HomeMy Public PortalAbout5743 CAMELLIA AVE_Building__ 6638A CE.#8036-61 APPLICATION FOR BUILDING P//ERMI COUNTY OF LOS ANGELES ADORE . ISS Z 3 A10 , C 11 1�EL-e-/ /-) DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY 7 E M 4 f C ' JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DIST,R�T N GROUP TYPE P OCE! FOR APPLICANT TO FILL IN ��, Q CONST BUILDING `7y STATISTICAL CLASSIFICATION SEWER ADDRESS�--! R-3 IJ©, N MIF4LIH BPCLASS. NO. DWELL. UNITS-. LOT NO. .�� O/ © � �j BLOCK WATER �s CERTIFICATE: NOT REQUIRED I XI RECEIVED TRACT �j �j / MAP HIGHWAY - �t NO.OF BLDGS.. NO. STATE MAJOR SECOND, OCAL ��� (CIRCLE) SIZE OF LOT SIO X 1 �`.7J I NOW ON LOT USE ZONE SPECIAL USE OF / CONDITIONS EXISTING BLDG. HOUFr / ��% I EL T . OWNER CIiii RLF.4 13 t1 t21J� NOfar 7163_; ,BUILDINGEXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT ARCHITECT OR TEL. P. L. _d �'I�f� �'�L., } >- ENGINEER NO. SIDE O' P.L. f;0 ADDRESS nn TEL. INSPECTION RECORD m CONTRACTOFICAIIJje BL'l L'r CG,VST,(e} NO.AT GrY/f3� p H ADDRESSbl'LU N4 tCAQN=MJ�N Atia T_. L W DESCRIPTION OF WORK a- z Z_ NEW DD ALTER REPAIR DEMOLISH SQ. FT. .� ,_ NO.OF NO,OF JS STORIES FAMILIES USE OF STRUCTURE 13F-D 2BCg1 BATH 1�14MILV QC,-Ai t:ITC ti v' z ttic I>F SIGNATURE OF 7 APPLICANT fi� _. VALUATION APPROVALS tN I DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOC TION FE I FEES FORMS.MATERIALS FRAME: FIRE STOPS, 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. ICERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFOR IA RELAT- ING TO WORKMEN'S COMP NSATION INS URA CE. LATH, EXT. SIGNATURE OF - }LOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STF,,UETURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION ( CK. M.O. CASH i i j r i6A538AC`Eu8a3-8-64 APPLICATION F R BUILDI G PERMIT COUNTY OF LOS ANGELES BUILDING _ DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST. > DISTRICT IN GROU TYPE P CE BY FOR APPLICANT TO FILL IN j`6'r' CONST. 7, s�-�r ADDRHIN STATISTICAL C ,ASSIFICATION J SEWER MAP / O• CLASS NO. DWELL UNITS BK/ -PG I ! LOT NO. _SQ, ��; .J �`_5` BLOCK USE ZONE MAPS TRACT NO.�j SPECIAL �.yl N0. OF BLD IS. CONDI TI N SIZE OF LOT,_, L (u+J NOW ON LOT USE OF N EXI STI "-� BLDG. SETBACK FROM 1 TEL. . FRONT PROP. LINE OF i - (STREET) OWNER ! NO. • TYPE OFEXISTING SETBACK HIGHWAY + YARD = TOTAL HIGHWAY WIDT FROM C.L. ADDRESS _ �_� - CITY �� ARCHITECTCCR TEL. BLDG. SETBACK FROM ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. a TEL. ^ + 0 T NO -S NC CORNER CUTOFF YES NO O F- I C I T i c L A L°� '� d SEE REVERSE SIDE FOR SPE CIAL A I PROVALS L DES RI ION OF WORK NEW A e. ALTER REPAIR DEMOLISH J,/ /G� C• SQ,FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE - -�--� I - SIGNATURE OF APPLICANT VALUATION$ !/�d • �-O APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION, LOCATION FEE$ FEE$ FORMS, MATERIALS yzr FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZEHEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE E LABOR CO OC OF T STATE OF CALIFORNIA RELAT- ING TO WORKMEN' COMP ATI INSURANCE. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE _ RECT AND POSTED ADDRESS O O a Fl N A L • d, JOHN F. LEWIS, PRINCIPAL STn.K. RAL ENGINEER PLAN CHECK VALIDATION CK. M O. CASH _ PERMIT VALIDATION M.OCASH I 144 6 bx 1 I o 2 7.7 5 I I f 76A638A CE#8031-62 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDRESS / 7 Q , DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY T JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT NG TYPE BY FOR APPLICANT TO FILL IN CONST. BUILDING STATISTICAL CLCATION SEWER MAP ADDRESS ,�7�3 CLASS. NO. DWELL. UNITS _ LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE:: TRACT AY NO. �4� CGRCLE) STATE MAJOR SECONICLOCAL NO.OF SLOGS. SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. �/ �� OWNER /� `AM IV NO BLJIL61NG EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT ARCHITECT OR TEL. P• L• ENGINEER NO. SIDE I! ADDRESS aO TEL. !J �� u j CONTRACTOR •' NO. ADDRESS G., Q DESCRIPTION O WORK ' u NEW ADD ALTER REPAIR DEMOLISH Z SQ.FT. NO.OF NO. OF SIZE C7 /^STORIES FAMILIESUSE OF - STRUCTURE 7,0)(2-0 SIGNATURE OF APPLICANT I VALUATION $ / 1 APPROVALS DAT INSPECTOR'S pIGNA7U RE P.C. PMT. FOUNDATION: LOCATION 0 FEE $ FEE $ ♦ FORMS, MATERIALS 6L- d( ,4, FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- LATH, INT, ING TO WORKMEN'S COMPE ATION INSURA E. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE (((���� RECT AND POSTED ADDRESS � r G FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH I �t1Lo 4 7 6 5 SEP 2 5 1 D 4.00— 4 76A638A CE #803 1/71 14' jI _4. APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING [✓- 7 it: E L ,q ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY L e 1 r FOR APPLICANT TO FILL IN NEAREST , Print ort a onl CROSS ST. BUILDING `� DISTRICT NO. GROUP TYPE PROCESS D BY ADDRESS741 i CA M ���y l/ !� r es � CONST. aC�z �i r V STATISTICAL CLASSIFICATION SEWER MAP LOT NO. ®yy,, b BLOCK CLASS NO. / ZDWELL,UNITS BK PG TRACT �.J USE ZONE MAP NO.OF BLDGS. NO. p SIZE OF LOT NOW ON LOT lQ -J SPECIAL USE OF + CONDITIONS EXISTING BLDG. . It} , OWNER �.�,5' NOL BLDG.SETBACK FROM !� L � � . ADDRES 3 M ��( L FRONT PROP.LINE OF� (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL f- - ] CITYMf!Lr HIGHWAY WIDTH FROM C.L. ARCHITECTPR TEL. t4G. (G O + '2 _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP. LINE OF (STREET) TEL TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL c- HIGHWAY WIDTH FROM C.L. O CONTRACTOR NO. C.0 _ ADDRESS LIC. + NO. O LIC. U CITY CLASS CORNER CUTOFF YES ❑ NO ❑ 1y CONSTRUCTION LEN DE a NAME AND NCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS , SQ. FT. NO. OF NO. OF NEW SIZE STORIES USE OADD FAMILIES STRUCTURE T(� ,/j IE 1�/3tJ/tT' P �A 1�J� A"IS ALTER ❑ PAIR❑ SIGNATURE OF APPLICANT ( EMOL ❑ VALUATION $ (/� APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, [L FOUNDATION: LOCATION FEE S ��-- FEE $ IJ �� FORMS, MATERIALS FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS ST RUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE ATE OF 'CALIFORNIA IN RELATING TO WORKMEN'S CO. AT N INS RANO E. LATH, EXT, SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED zi ADDRESS FINAL ^ JOHN F. LEWIS, PRINCIPAL RU::TURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIONCK. M.O. CASH s !;1 x-11 1 0 15.0 0, a J 76A638A CE 0803 1/71 -'�R� APPLICATION FOR BUILDI ��G PEMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS 113 COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. Print or tVDe onl BUILDING OIST51CT NO Gy.5P TYPE P O \4 CONST, ADDRESS Vff Yi9 4v j, J • �" STATISTICAL CLASSIFICATION S ER MAP LOT NO. S�JBLOCK CLASS NO.Cgz. DWELL,UN ITS TRACT USE ZONE MAP NO.OF BLOGS. //'' NO. SIZE OF LOT NOW ON LOT �✓ ( SPECIAL USE OF r CONDITIONS EXISTING BLDG. "� TEL. s `/ OWNER r-.q% •y O• G �7 BLDG.SETBACK FROM ADDRESS / s, FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY • HIGHWAY WIDTH FROM C.L. ARCHITECT O TEL. + _ ENGINEER NO. BLDG.SETBA FROM ADDRESS SIDE PROP.LIN (STREET) TEL. TYPE OF EXISTING SETBACK 'fi+GH,,,WAY + YARD = TOTAL p CONTRACTOR �,('f'Z� NO. HIGHWAY WIDTH FROM C.L. '"- U LIC. ADDRESS Np. + = O LIC. ~ CITY CLASS CORNER CUTOFF YES ❑ NO ❑ W CONSTRUCTION LENDER nj NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS Z ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE ALTER ❑ SIGNATURE OF REPAIR ❑ APPLICANT EMOL VALUATION $ ell'o APPROVALS DATE IN5PECTOR'S SIGNATURE P.C. PMT. ) FOUNDATION: LOCATION FEE $ FEE $ Lj FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. LATH, EXT, SIGNATURE OF����l �IItif� HOUSE NUMBER COR- PERMITTEE /1LGL RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRI CIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH AW 7;33 6 � 1 s 3.00 v WORKERS'COMPENSATION DECLARATION a certificate of coent to se insurebor a certificate of Worke s' Compensat on Insurance, APPLICATION FOR BUILDING PERMIT or a certifiGc Fgpy,the2re�i5(S�e6c.2800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. YlYZSJ Company Fremont ind BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the coLulty building inspec- BUILDING 5743 N. Camelia l l a Ave.. tion department. / ADDRESS LOCALITY14, NEAREST Date Applicant CITY Temple Cit ZIP CROSS ST. RTIF ATE OF EXEMPTI N FROM WOR RS' �/� v G NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT % /—F 6S NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one 5a5C USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. TEL. SPECIAL I certify that in the performance of the work for which this OWNERC1larles Burns NO. — '/ CONDITIONS tL permit is issued, I shall not employ any person in any manner As above DISTRICT GROUP�Cyo NST.PE FIRE E P CESSED BY O so as to become subject to the Workers'Compensation Laws. ADDRESS 0 Date Applicant Im CITY ZIP STATISTICAL LASSIFICATION APT. CONDO. 0 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. U Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS a Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAPPIIIIIIIIIIIIIIIIIIIIII OA with comply with such provisions or this permit shall be Z deemed revoked. TEL' VALIDATION CONTRACTOR J.L•S h l p l e R f No. 792-2437 BK. PG, LICENSED CONTRACTORS DECLARATION 265 N.V i ne do Ave LIQ 309178 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and Pa S adenar Ca. 9110 7 LIC. C 3 9 $ 2 ,651 . 00 Professions Code, and my license is in full force and effect. CITY CLASS ► SQ. FT. NO.OF NO. OF CHECK I License Number Lic.Class SIZE STORIES I FAMILIES ONE Contractor Date DESCRIPTION OF WORK Reroof house NEW I am exempt under Sec. w/220# 20 yr Fiber Glass ADD El ALTER ❑ L B.BP.C. for this reason shingles g DATE REPAIR 2g Date: USE OF DE OL FINAL EXISTING BLDG. B APPLICANT TEL. Y r Signature PRINT J.L.SHIPLEY RFG Np792-2437 OWNER-BUILDER DECLARATION , �LJ rZZ I hereby affirm that I am exempt from the Contractor's License ADDRESS 265 N.VINEO AVE,PFS 9110 7 Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 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). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name $ P.C. Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the � y pp� Issuance Fee a above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee u and hereby aptho5ize representatives of this County to enter upon theab e- en ned p perty for inspection purposes. ��. 3 o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Appli nt or Ag t Da ms WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self A P P I C AT I O N FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, , or a certified co thereof (Sec. 3800, Lab. C.) aCOUNTY OF LOS ANGELES BUILDING AND SAFETY WP�v3-a3P,363 Policy No. + ompany Certified co s hereby furnish'unt BUILDING moi, Pv v FOR APPLICANT TO FILL IN ADDRESS' ^ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 5743 T LOCALITY NEAREST , .. Date Applicant CITY TMP14111111 Ci tv ZIP CROSS ST. } CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR SIZE OF LOT f NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE O (This section need not be completed if the permit is for one / USE ZONE MAP U hundred dollars ($100)or less.) TRACT -e �! BLOCK 1OT NO. SPE NO W TEL. ,, '`� SPECIAL I certify that in the performance of the work for which this OWNEles Burns NO. 8? 44 4 ,i / CONDITIONS permit is issued, I shall not employ pn person in an manner DISTRICT GROUP TYPE FIRE PROCESSED BY P P Y Y P Y CONST. ZONE 0}C so as to become subject to The Workers'Compensation Laws. ADDRESS 193 8}lUVQ _ Q r.= CITY ZIP Ix Date Applicant -STATISTIC L SSIFIfATION RPT. " ONDO: O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. d ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' W Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION 2CS N.S�$Tt- �V LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS • NO. 0 9178 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY Pasadena,Ca.91107 CLASS C 119 $ , SO. FT. NO.OF NO. OF C0 HECK License Number Lic.Class SIZE STORIES FAMILIES ONE Contractor Date $ DESCRIPTION OF WORK NEW Q / ADD I am exempt under Sec. w/ 220# 20 yr riber r'Iasq;S ALTER 0 FINAL � +�Q B.BP,C. for this reason REPAIR DATE *, -'' Date: USE OF FINAL DEMOL EXISTING BLDG. E] By Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT c' Nag .»'► 37 71 1 hereby affirm that I am exempt from the Contractor's License , L4 Law for the following reason (Section 7031.5, Business and ADDRESS 7 T` Q Professions Code): PRE NT llllllll aBUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. -- ❑ CONTRACTOR NO. I, as owner of the property, am exclusively contracting / a' with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST. r YARD HWY SET BACK PROP. LINE WIDTH , 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 m P.L. Q Lender's Name P.0 Fee$ Permit Fee r, J Lender's Address I certify that I have read this application and state that the Issuance Fee above information is correct. I agree lo comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee A — v and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. d ,� < SEE REVERSE FOR EXPLANATORY LA L G Signature of Applicant or Agent Date ®s r APPLICAMN FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY 1p WORKER'S COMPEN$911ON DECLARATION FOR APPLICANT TO FILL IN Com. I hereby affirm that I have a certHicafe of ooment to self hheure, � f�` A / or a oertfflc fe of Y�brfrers' Compensation Insurance,or a oerfflW rr ��/. C.4'Cv�1�V( i�fr copy thar9ol( B C.) 1 ).a✓+� G . PblIcy fJo ComperryV J i``•//1 C`TySIZE OF LOT .OF aDOa Now ON LOT ❑ CertfM1ed oopy is hereby furnished. NENFEST CFiOS8 �,eltf .d Copy Is filed with tfhe COU TRACT BLOC}( LOT 40. / ]r/ 113E ZONE MAP NO. ¢atedeRr„ aL Applk�nt A38E890R MAP BOOR( PhGE PARGEL /WPI 8PEClALCONXTONS CEF TFFCATE OF EXEMPTION FROM WORKERS' TEL Na YES No COMPENSATION INSURANCE wm N 1000 F r of SCHOOL? - db0a section be completed ff the permH b for ohs hundred lap ofeTrcT aRouP z Yr. ZONE PROCESSED By dbUars(E100)or ) CTTY J � I certify thaf In the %�bec�orre e work for which thio perrnft Is.famed I shell notrson In srry manner so ee t0 ARcHrrEct OR ENGa�R NO. D� —� a become dhbjeot to thperraetion Laws. BDUISTICv1L APT CONDO uVL� Z J Date AADORFSB�y p ) L CLASS Na TDWELL UNM IYOUCE TO APPLK1thb Certf Icate of 7 S Z/ T REQUIRED TOou_sl BAC+c FROM E� Exerrhption, you shio the VSbricera' 9ET BACK ryyy PRbPCampermatign prwkeor YOU meet forttnvfth' C , tic /Z+ RIONT comply wRh such provielone.or thb permit Shall be deemed revoked. as �t7 7 LI-NO. S s L LICEpSED CONTRACTORS DECLARATION DE Crt-yL�,�,r LIC.CLASS P L 1 hereby,affirm thst I am Ilcensed underprwIsiom of Chapter 8, SEWER MAP (carunencft with Sagtlor 7000)of DMsbn 3 of the Badness and 4a-FT.Sri Na OF STORES NQ.OF FA,A XS ProteaSiorla Code and my, In furl force And NEW El BK PG } LicenseNumberClewDESCRIPTION OF �J 4E W 6h'C ADD El $ Jot lTfl �� 84 Coritrgctor �'/�*. Nate ALTER C3 ❑I am exempt under Seca ` REPAIR ❑ cc RAM.for thb reason -DEMOL ❑ LDMA'P/C f Date: VSE OF EXISTINGSkratu -`, ��l✓� URM ❑ 1 m APPtJGANT(, Z ro / TEL 40. / LDMA Permr ACCT.t Z ❑ 1, as owner dt the pfteIty; or my errpbee yewRth 4mow as =�`— FT44 Y i tfVAT 3018 compensation, wUl do the work and the structure le '�"7 X3 ° [Ise 125.55 not Intended or offered for sale (Sacbm 7044, BuefneSe arid. �v °""� 1 ITEMS PfOte38iOne Code.) - wLL THE APPJdkNT OR hfl FE Fa LDING OCCUANT HANDLE A HAZARDOUS UCEWL ❑ I, as owner d the property, am azdliBtValy COnt7BOtfnp with °AA�ax�e UFIE P AHVAfDous uaaauS NOFWAFIOr GUIDE? — TOTAL 125 -55 cen 6 ..contractors t0 �truct the project (Secbm 7044, YES❑ CLEC 1 .55 &rihiee3 and R4.6. Code) Y&L TTE NTQOm USE of THE aUDLM EY THE APRXANT OR RM-FE BILDING FEOURE A P9zLT FOR CONSTFif.JCTMNFFIOM THE SOUTH CONSTRUCTION LENDING AGENCY m wmma DrarFaCT �SEE PB4wtrW cHECIa Pon t{7 RRL .00 I hereby affirm that thereIs a mia6u0ibn lerdlnp aperny for YES❑ �.=&=-y the performance d the work for wtlich WS permit Is Issued(Seo. �+7/ t p PEPSATTM 3087,Civ.a) �i�.P >�ulAlu3 u►oa1 KnON�oe ir+< COUNTY LRJUtTLLA r� r r f 4/?5 Lender6 Name ►l�4ERAL.l3 � .100 11�e110H -m1 0 o 8CJ�01�. D i I erhder s Address PNMT 34 1 p 'I124 OMW OR SQ2 I certify that I have read this applbation and state under penatty . d perjury Cva the above lffkxrwtion be caned I aQw b Comply. P.C.FEF PERVIFT FEE with all county ordhhences and im" re-haft t0 bu6mnp coratru bcc> and hereby a ropreeantatlyee of thb County nSUANCE FEE' �0 to enim uponfor hTSpecfion �eeJ� CD M/ESTIGATION FEE TO�,L FEE ^ d or SEE REVERSE FOR EXPLANATORY LANGUA13E COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0103290015 i PHONE: (626) 285-0488 EXT: LEGAL ID: NO, OF CONST NEW ERJILDING ADDRE�5 TR: 6561 LT: 555 UN: .002 SQ. FT STORIES TYPE OCCUP GROUP 5743 CAMELLIA AV: ASSESSOR INFORKATION STRUCTURE: 25 1 VN �3 TEMP CA 917802502 NUMBER: GARAGES NEAREST CROSS STREET: WORKMAN 8587-017-009 OTHER: 288 1 VN 16 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TEPLANT: EXIST BLDG USE: USE ME: I SSUED ON: PROCESSED BY-' EXPIRES ON: EXIST OCC GRP: 03/29/01 UT D9/25/01 ubmLx: TEL NO: BLDGS. NOW ON LOT: VALUATION: FINAL BY: E: SB�S�ELRIAMjBURNS DEBORAH A (626) �87-4943- 2,450 TEMP 917802502 ADD 25SQ. FT. ADD., RE-ROOF EXISTING ROOF, ADO ONE NEW SLOPE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL, NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 2450.00 VAL 0.50 SPECIAL CONDITIONS: BUILDING 54.70 D2 D2 PERMIT - E L E S VAL 99.00 i P� 181.95 CONTRACTOR: TEL. W: APPROVALS UTF---TNspErToR SIGNATURE SAME AS OWNER - �0 ��� LIC. NO LOCATION AND SETRACKS A� SOI LS ENGINEER_KM9MV17 ARCHITECT OR ENGINEER . 7EL. NO: FOUINDATION/TRENCH ORMS IL SLADAMDER FL LIC, 1111111 0 e 3 ` I Uo L�� WAG Ka IST LEVEL FL50FTRU7T__ SCHOC1 WITHIN HAZARDOUSROOF SHEATHING AIR.QUALITY: 1000 FEET MATERIALS �,(fj�L � f� FRANt INVECT �O No NO REQUIRED TOTAL-SETBACK FROM B(IST �A t� . FRAME INSPECT SET BACK YARD: HWY: PROP LINE: DTH; FRONT PL- Service'TWOLI SIDE PL- r INTERIOR LATH/DRYWALL LAU EXTERIOR LATR_ 4 .- LAII REPORT ID: DPR261 ROUTE TO: RSD508