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COUNTY OF LOS ANGELES ADDRESS ,
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DEPARTMENT OF COUNTY ENGINEER
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JOHN A LAMBIE COUNTY ENGINEER NEAREST �i ✓
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COUNTY OF LOS ANGELES BUILDING /�
DEPARTMENT OF COUNTY ENGINEER °DDRESS !J
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
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WM. J. FOX, CHIEF ENGINEER
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I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
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AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
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76A638A CES#803 :/7APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER , MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDIADDRESNG { Avr
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COLEMAN W JENKINS, SUP T OF BUILDING
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I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION BRACING BOLTS �/IG" J I J`�I, iTY/dll�fl7/
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS
STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED A 09
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT
LABOR CODE OF THE SvqTE OF CALIFORNIA RELATING TO
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JOHN F LEWIS PRINCIPALqj�
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LACO'z 8 2.1 w.; 13 1 D 850 u
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
c* DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1309180072
PHONE (626) 285-0488 EXT
ILEGAL ID I NO OF CONST NEW I BUILDING ADDRESS 1
ITR 13329 LT 41 UN 002 I SQ FT STORIES TYPE OCCUP GROUPI 5021 CLOVERLY AV 1
I (STRUCTURE 881 1 V-B R-3 I TEMP CA 917803813 1
(ASSESSOR INFORMATION NUMBER GARAGE I NEAREST CROSS STREET LA ROSA 1
18590-022-025 OTHER 291 1 V-B U I THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY CAI
ITENANT 1EXIST BLDG USE USE ZONE 11SSUED ON PROCESSED BY
1 1EXIST OCC GRP 104/07/14 SR
10WNER TEL NO IBLDGS NOW ON LOT VALUATION IFINAL DATE FI`/AL BY CODE 1
ICHEN, HENRY J (878) 286-3236- 1 139,880 - 7'�[��/
15021 CLOVERLY AV I / � 1a
ITEMP 917803813 1 FEES PAID ID SC� RIPTION OF WORK
I I 11-STORY ADDITION 2 BEDROOMS 2 5 BATHROOMS, LAUNDRY ROOM, 1
I IFEE DESCRIPTION QUANTITY UOM AMOUNT IFAMILY ROOM AND REMODEL KITCHEN, OFFICE FRONT ENTRY & PORCHI
(APPLICANT TEL NO 1 146 SF PATIO TRELLIS 291 SF AND REROOF EXISTING HOUSE TO * 1
ICHEN, HENRY' J (626) 864-7919- IBI PLANCHECK W/ENERGY 139880 00 VAL 1,451 90 1
15021 CLOVERLY AVE IAA BLDG PERMIT ISSUANCE 27 80 ISPECIAL CONDITIONS I
ITEMPLE CITY CA 91760 IAB STATE GREEN BLDG FEE 139880 00 VAL 6 00 I 1
I IAC STRONG MOTION RESID 139880 00 VAL 14 00 I I
I _ IB2 PERMIT W/ENERGY 139880 00 VAL 1,708 10 1
ICONTRACTOR TEL NO 108 CERTIF OF OCCUPANCY 101 40 1APPROVALS DATE INSPECTOR SIGNATURE 1
IEVERGREEN CONSTRUCTION & REMODELING (213) 505-3293- 1 TOTAL FEES 3,309 20 1 1
13 SAGE CANYON ROAD LIC NO 1 ILOCATION AND SETBACKS 1 1
POMONA CA 91766 946278 1 1 1
1 ISOILS ENGINEER APPROVAL 1
(ARCHITECT OR ENGINEER TEL NO 1 (FOUNDATION/TRENCH FORMS CSI 1
LIC NO I (SLAB/UNDER FLOOR 1
1 r IRAISED FLOOR FRAMING
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1MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I �; � ��� IUNIERFLOOR INSULATION 1 I I
3 OO d�L ,MST LEVEL FLOOR SHEATH
INO OF FAMTLIES DWELLINC UNITS APT/COND STAT CLASS J I_
I 0 NO 21 1 ti; 12ND LEVEL FLOOR SHEATH I
1 SCHOOL WITHIN HAZARDOUS 1 1 IROOF ShEAThINC I
1AIR QUALITY 1000 FEET MATERIALS 1 I—
1 NO NO NO 1 t ' 1FIPE DEPT FRAME INSPECT1
1 1 \ 1BLDG DEPT FRAME INSPECT-II� I
ISHEAR PANELS
I
11NSULATION/WEATHER STRIPI
1 1 11NTERIOR LATH/DRYWALL
1 1EXTERIOR LATH
ILOT DRAINAGE 1
1 ISMOKE DETECTION DEVICES
I 1 IFIRE DEPARTMENT APPROVALI
1* ADDITIONAL DATA ON FILE I I f
IREPORT ID DPR261 ROUTE TO BS0508 11 I
_I 1 c�fia b
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1102230001
PHONE (626) 285-0488 EXT
(LEGAL ID NO OF CONST 1 BUILDING ADDRESS I
ITR 13329 LT 41 UN 002 SQ FT STORIES TYPE I 5021 CLOVERLY AV I
ISTRUCTURE V-B I TEMP CA 917803813 1
(ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LA ROSA
18590-022-025 1 1 THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY, Cl
(TENANT (EXIST BLDG USE RESID USE ZONE R-1 (ISSUED ON PROCESSED BY 1
1 (EXIST OCC GRP 102/23/11 SR 1
1OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINALrrDAIrTE FI CODE 1
1WANGSANDRA (626) 864-7918- I 1,710
150215021 CLOVERLY AV I
I/�1`' ` I
(TEMP 917803813 I FEES PAID 1 ESCRIPTION OF WORK 1
I I (CHANGE OUT 9 WINDOWS 1
I IFEE DESCRIPTION QUANTITY UOM AMOUNT I
1APPLICANT TEL NO I 1
SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 80 I 1
I IAB STATE GREEN BLDG FEE 1710 00 VAL 1 00 ISPECIAL CONDITIONS 1
I IAC STRONG MOTION RESID 1710 00 VAL 0 50 1
ID2 PERMIT W/O EN-HC 1710 00 VAL 82 20 I
1 1 TOTAL FEES 111 50 1 1
1CONTRACTOR TEL NO 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
ISAME AS OWNER - I
I LIC NO 1LOCAmION AND SETBACKS
I I ISOI1 ' ENGINEER APPROVAL I
(ARCHITECT OR ENGINEER TEL NO (FOUNDATION/TRENCH FORMS I I
I LIC NO 1 ISLAB/UNDER FLOOR 1 I
I I IRAISFD FLOOR FRAMING 1
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMF 1 1UNDERFLOOR INSULATION I I
1144H269 3 OSI I 11
I I IFLOOR SHEATHING 1
INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I I I I
1 NO 21 1 IROOF SHEATHING I 1
1 SCHOOL WITHIN HAZARDOUS 1 ISHEAP PANELS I
1AIR QUALITY 1000 FEET MATERIALS I I 1
1 NO NO NO 1 (FRAME INSPECTION 1
I (FIRE SPRINKLER HANGERS 1
IINSULATION/WEATHER STRIPI I
I I I I I
I 11NTERIOR LATH/DRYWALL I
IEXTERIOR LATH I
I I I I I I
I (RATED FLOOR/CEIL ASSEM I
(RATED WALL ASSEMBLIES I
1 IRATED SHAFTS/OPENINGS 1 1
IT-BAF CEILINGS I
I ILOT DRAINAGE 1 1
I I I
IREPORT ID DPR261 ROUTE TO BS0508 I I
I I I I I I