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Home My Public Portal About5314 CLOVERLY AVE_Building__ 11585 5OBga�-APPLICATION FOR BUILDING PERMIT 1 11 DIVISION OF BUILDING AND SAFETY Bu1L°'NG Deportment Of County Engineer ADDRESS County of Los Angeles LOCALITY a JOHN A LAMBIE COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN 1 CONST Af 1-41 BUILDING STATE ADDRESS HWY3/� / CU YES e LOT NO G 13LOCK USE ZONE SPECIAL y� CONDITIONS TRA6T w {� i NO OF BLDGS p BUILDING EXIST SIZE OF LOT OX I`Z SNOW ON LOT /` YARD HWY STREET NAME SETBACK WIDTH USE OF ChoyP�l� EXISTING BLDG FRONT 4,cjr 16a '' y^ P L OWNER I J�IY!��l��ALIt9Y .4Y1 Ad fiy T• SIDE,, MAIL P L ADDRESS �A Me O TRACT DWELL I UNIT 5 INDUSTRIAL CITY Tl$g&A c TLAA�"GvP� t DWELL �/ I UNIT 6 PUBLIC BLDG ARCHITECT OR TEL 2 DUPLEX o 2 UNITS .7 ADDN,ALT, ETC ENGINEER NO 3 APT UNITS ADDRESS - 4 COMMERCIAL 8 MISCEL CONTRACTOR p 4 � NO INSPECTION RECORD ADDRESS cam'14 L DESCRIPTION OF WORK LL NEWA_ r ALTER REPAIR DEMOLISH r [ SO FT NO OF NO OF SIZE �� STORIES FAMILIES USE OF STRUCTURE y � SIGNATURE OF APPLICANT �� APPROVALS ADDRESS r3j° J/ >-�I�" j DATE NSPECTOR SIGNATURE G FOUNDATION LOCATION O P C $ FORMS MATERIALS /vv//��J��vJ^w// FEE FRAME FIRE STOPS VALUATION $ - BRACING BOLTS FEE FURNACE LOCATION v 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT - AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT AND STATE LAWS REGULATING BUILDING CONSTRUC- - TION 0 I V.//,{� LATH EXT SIGNATURE OF,Z/z' � �e4l //////l� z�. HOUSE NUMBER COR- - PERMITTEE b — . RECT AND POSTED ry ADDRESS FINAL d `" , JOHN A LAMBIE, COUNTY ENGINEER VALIDATION CLYDE_N DIRLAMYCHIEF BLDG INSPECTOR CK MO CASH ` N LAC a 8 7 ? AUG, ,3 1 400 1° r. l P 79AC38ACE#803 9 60 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES 13UIE'N DO DEPARTMENT OF COUNTY ENGINEER BbIMING AND SAFETY DMSION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTRICT NO jig ,;;U TYPE,/ HDOSSSED BY FOR APPLICANT TO FILL IN 0 / CONST BUILDING STATISTICAL CLASSIFICATION /�� SE ER MAP ADDRESS v �i `-�,L. VL-1 L. y CLASS NO DWELL UNITS_S�L_ K P G LOT NO BLOCK MAP STATE YES NUMBER HWY TRACT USEZONE SPECIAL NO OF BLDGS {„�� , CONDITIONS SIZE OF LOT �NOW ON LOT O/�./ USE OF EXISTING BLDG ''� m.,.3. BUILDING YARD HWY STREET NAME EXIST /"I, V/,,L! [,?�.L/�Xi STEL SETBACK WIDTH OWNER L NO FRONT �+ P L ADDRESS SIDE ARCHITECT OR �/, TEL P L ENGINEER o[-L,(-> NO t INSPECTION RECORD ADDRESS 1111LTEL O CONTRACTOR (� GL NO G V ADDRESS J Y O� �I'>!N `' 0 t Q DESCRIPTION OF WORK ` W `' 1 a NEW ` ADD ALTER REPAIR DEMOLISH N Z SQ FT NO OF NO OF - SIZE STORIES FAMILIES USE OF v,O Cys STRUCTURE Jc SIGNATURE OF APPLICANT VALUATION APPROVALS DATE INSPECTOIA SIGNATURE PC O PMT FOUNDATION LOCATION .�r FEE $ FEE $ FORMS MATERIALS /�[J ,`-p� nod 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 BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE , OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED I SHALL NOT LATH INT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT TO THE WORKMEN S COMPENSATIO A F ORNIA �- LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERM]TTE RECT AND POSTED ADDRESS FINAL i CLYDE PLAN CHECK VALIDATION cK M o CASH P D ERITLI VADATIONT cK URAL ER M 0 4SH L WO 3 4 6 2 I-,AR 7 LACcI3 4 6 j - �aR 7 1 0 12.0 0 ARTMENT OF �Zi4i-�G AND SAFETY APPLICATION FOR PERMT COUNTY OF LOS ANGELES r*, c + V I L®I G r M � WM J FOX CHIEF ENGI E �� ~ Iu �!— FOR APPLICANT TO FILL IN v^ FOR OFFICE USE ONLY 1 DISTRICT NO PLAN C1 K�N�Oj PERMIT NO BUILD [CROSS DD E1NG SS 3,3I!(� OCALITY _�--- RECEIVED BY DATE OF APPL DATE ISSUED ala .i I ? EAREST V ST BUILDING�-3 / N t ADDRESS (� OWNER MAIL •- '`� LOCALITI�� ADDRESS -9&1 Bow NEAREST // TEL �°f � , CROSS ST /I CITY NO J n /n 0�w FIRE NO OF TYPE ' I GROUT;--j ARCHITECT OR TEL ZONE PLANS ••�/ ENGINEER NOBLDG -yQ / y ORD NO SETBACK LINE �C ADDRESS APPROVEDTEL - ,( / BY Ail DATE CONTRACTOR ,0/ `NO f�(� i a 6 �J ZUSE ONE/'( * BYPROVED� YrW DATE � A ADDRESS H�OU`SE NUMBERING , LEGAL DESCRIPTION LOT NO BLOCK MAP N MBER �� P � -FIELD CHECK BY I TRACT , 0 NO ASSIGNED BY AT �/ NO OF BLDGS CORRECTIONS— SIZE ; SIZE OF LOT 7 I NOW ON LOT USE I OF / {• ' EXISTING FANG BLDG p FaMiues j - DESCRIPTION OF WORK NEW I 'ALTERATION I I ADDITION1,7 I w1 O_ , REPAIR I I DEMOLITION I I I, _ - - - / SQ FT , NO OFAl SIZE ROOMS -'STORIES P17) �T 1�L1 D EXT WALL ROOF ��'l r COVERING A C,C..sl� I COVERING 4JOItI-4 _�Z W 8!z'4 G,, . 6>•c/D59-u�_Q USE OF STRUCTURE APPROVALS _ O INSPECTOR S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION LOCATION A -�� f"57 PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS ��L?" CORRECT 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS -•--�-��6 LAWS REGULATING B DING CONSTRC !ON X FURNACE LOCATION, SIGNATURE OF GAS VENT, DUCTS PERMITTEE ` � LATH, INT ` L ADDRESS IT LATH, EXT AUTHORIZED AGT PLASTER, INT 76A688A DBS9 10-60 $ S FF $ rf S T) �) ��p PLASTER, EXT � V $ 4 VALUATION FINAL l � I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMiT COUNTY OF LOS ANGELES BUILDING - Ap� r WM J FOX, CHIEF ENGINEER -as I I!a® � - - - FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO PLANCK NO PERMIT NO BUILDING ADDRESS .�3 y sl- �� GS-��_o j LOCALITY - RECEIVED BY DATE'OF APPL~ DATE ISSUED NEAREST CROSS ST ^ ,� BUILDING w r ADDRESS OWNER MAIL � / LOCALITY 61 ADDRESS01-1—IL NEAREST TEL CROSS ST CITY NO FIRE :NO OF I TYPE I GROUP, ARCHITECT OR TEL ZONE 'PLANS ENGINEER NO BLDG ORD NO , SETBACK LINE ADDRESS APPROVED TEL BY 1 DATE a CONTRACTOR NO o USE APPROVED ^ - a ZONE BY w DATE ADDRESS �� ^ HOUSE'NUMBERING LEGAL DESCRIPTION I LOT NO BLOCK MAP NUMBER FIELD CHECK BY , I TRACT ` NO ASSIGNED BY DATE NO OF BLDGS CORRECTIONS SIZE OF LOT NOW ON LOT F ' USE OF _ I NOOF I EXISTING BLDG FAMILIES y DESCRIPTION OF WORK NEW I I ALTERATION I I ADDITION r � s O REPAIR _ I DEMOLITION I� I ,.�.- .--.—. ..- - .^ .- __ _A SQ FT NO OF „ ') Z SIZE ` ROOMS STORIES " a y EXT WALL ROOF P COVERING COVERING USE OF STRUCTURE ' )01 , " APPROVALS ' INSPECTOR S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, HEREON AND WITH AL COUNTY ORDINANCES AND STATE BRACING, BOLTS ,. / LAWS REGULATING,B DING ONS�TRUC IONI FURNACE LOCATION, SIGNATURE OF // G// _ GAS VENT, DUCTS PERMITTER �-� i� LATH, INT ' ADDRESS_ // LATH, EXT ° AUTHORIZED'AGT PLASTER, INT 78A638A OBS3, 10-E0 $ . P C $ , co FEE PLASTER, EXT VALUATION ✓ - �• FEE $�� FINAL f ` I 7T t 76AG38A CE#803 B-63 APPLICATION FOR BUILDING PERMIT , COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY �/ I JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE P ESSED BY FOR APPLICANT TO FILL IN Sf CONST BUILDING STATISTICAL CLASSIFICATION - EWER MAP ADDRESS /I/ oV�RL CLASS NO __DWELL UNITS " BK PG LOT NO BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE 12 , TRACT MAP / HIGHWAY STATE MAJOR SECOND CAL — NO OF BLDGS NOI (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE SPECIAL - USE OF CONDITIONS r ' EXISTING BLDG A TEL OWNER NO Q IS ILDING EXIST ` SETBACK WARD HWY TREET NAM WIDTH ADDRESS Z± G,6FRONT ARCHITECT OR TEL P L C ENGINEER NO SIDE ,y ADDRESS TEL - ` O CONTRACTOR NO U ADDRESS / , OC DESCRIPTION OF WORK �I �° `' 1�"' ' ' a G LuCLNEW - ADDe ALTER REPAIR DEMOLISH If C X11 -, f' ' -N SQ F7 NO OF NO OF A-1 ,Ir Z SIZE STORIES FAMILIES J USE OF STRUCTURE SIGNATURE OF / �` •"�� APPLICANT ,y 14vi t SpA II VALUATION $ /SOO�DO �{ tj]^ V I APPROVALS ��' DATE INSPECTOR S SIGNATU E ` PC PMT �'/L FOUNDATION LOCATION FEE $ FEE $ CJ FORMS-MATERIALS FRAME AFIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS a r 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 J �i AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT r r ING TO WORKMEN 5 COMPENSATION INSURANCE LATH EXT SIGNATURE OFqqj HOUSE NUMBER COR PERMITTEE .V RECT AND POSTED ADDRESS FINAL JOHN F LEWIS PRINCTPAL STRUCTURACEN, R_ p r PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK MO CASH 7 5 7 9 JAN 2 8 3 1 D 8.00- '� f �� • ti Y y t 78AG88A CE#8C8,0 58 APPLICATION FOR BUILDING ,PERMIT , COUNTY OF I:OS ANGELES ° iUD ADIENG DEPARTMENT OF-COUNTY ENGINEERM DDRESS BUILDING AND,SAFETY DIVISIONLOCALITY JOHN A LAMBIE, COUNTY ENGINEER c` NEAREST CASSATT D GRIFFIN, SUPT OF BUILDING ^CROSS ST )- " DISTPd9j Nb�, GROUP TYPE Yy a FOR APPLICANT TO FILL' IN `4 - CONST BUILDING _ { STATISTICAL C�SIFICATION' `SEWER MAP- ^ ADDRESS r {� ✓` ` ' ,' k '� B G _CLASS NO MWELL UNITS LOT NO T `.1 BLOCK { NUMABER CY�� ^S-ITWATYE "YES ®3, - USE ZONE SPECIAL-' - m �- TRACT ` ' - R - , , ' ` NO OF BLDGS .CONDITIONS z, .�k� SIZE OF LOT Q I NOW ON LOT �� USE OF - EXISTING BLDG f BUILDING YARD j HWYx -v STREET NAME EXIST SETBACK F WIDTH „ OWNER - FRONT / e MAIL z- P L � ,- ADDRL°SS SIDE g TEL J V L t_ - CITY. NO �Y - - Y INSPECTION RECORD ARCHITECT OR _ e TEL ENGINEER- _ - NO °' �jl -f-1 -7— ADDRESS ! t ADDRESS " TEL ,CONTRACTOR" NO a , ADDRESS DESCRIPTION OF WORK , NEW )kll 'ALTER REPAIR DEMOLISH- SQ FyrT NO OF NO OF + +i SIZE4 STORIES FAMILIES USE OF _ STRUCTURE SIGNATURE OF APPLICANT APPROVALS DATE INSPECTOR S SIGNATURE ADDRESS r FOUNDATION LOCATION - t FORMS,MATERIALS' VALUATION$ C��}�� FRAME FIRESTOPS, BRACING BOLTS FURNACE LOCATION. P C PMT FEE $� % I FEE GAS VENT.DUCTS _ ra ` 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- � _ANT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND e ` STATE LAWS, REGULATING BUILDING CONSTRUCTION LATH,EXT y� IGNTUR AE OF - f HOUSE NUMBER COR- ERMITTEF •� nu� '—""� RECTAND'POSTED s i Y_ K o. ADDRESS ti FINAL r - :.CLYDE N D7�IR�LAM, PRINCIPAL STRUCTURAL R PLAN'CHECK VALIDATION CK M O CASH PERMIT'VALIDATION M1 r CK r M O CASH -� 3,O TO' SEP Z3 _ s A6.00 � a i P. h ♦ - _ 1 a 840551 RL WORKERS'COMPENSATION DECLARATION I have a certificate of consnt to insure, or a certif carte of Workers' Compensation Insuran elf A P P L I CATION FOR BUILDING PERMIT ' or a certified copy theieof'(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.104-2251 l hmpany Fremont .Indemnity PY Y FOR APPLICANT TO FILL IN BUILDING Certified copy is'hereb furnished. _ ADDRESS � r ( Certified copy is filed with the county building inspec- BUILDING UU Tion department. ADDRESS 5314 N C 1 ove r 1 Date 10/94/84 Applicant-11, r in Roof Co. aTY Temple City ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE - SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for oneASSESSOR , hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify that.in the performOWNER- Mr. & Mrsance of the' for which this •Demski NO. NO. permit is issued, I shall not employ any person in any mannerSPECIAL 116a so s to become subject to the Workers'Compensation Laws. ADDRESS 5314 N. Cl Overt CONDITIONS O . CITY Temple City zIP - .. - . ..t V Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT_ GROUP TYPE FIRE PRO ESSED BY .. 0 ENGINEER NO. CONST.• ZONE Exemption; you' should become subject , you Workers- / Compensation provisions of the Labor Code, you must forth- ADDRESS 1 VX 1V/' � with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CON deemed revoked. CONTRACTOR Virgin Roof Co. NO. 28 -O 0 LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. BOX J NO. 160650 70 (commencing with Section 00)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in.full force and effect. CITY San Gabriel �1778 CLASS CBK I�y -.'VALIDATION' SQ. FT. NO. OF NO. OF CHECK License Number 160650Lic.Class C39 SIZE ISTORIES FAMILIES ONE 11� 0. ❑ VALUATION _ Contractor V i rq i n Roof CO-Date . 1 0/k24/84 DESCRIPTION OF WORK NEW ADD ❑ s 485.00 ' ❑ I am exempt under Sec. With ALTER ❑ p 9 9.4.A B.&P.C. for this reason REPAIR ❑ $ Date: USE OF 0 0 0 0 DEMOL # 0 EXISTING BLDG. ❑ Signature APPLICANTTEL. FINAL /I PRINT) Virgin ROOF CO No. 28 -0 0 Z G I a - 33,00 OWNER-BUILDER DECLARATIONDATE - 17 I hereby affirm that I am exempt from the Contractor's License Law for the following reason'(Section 7031.5, Business and ADDRESS P.O. BOX J SanGabr i el 91778 FIN 00033,005 ; Professions Code): PRESENT BY M. S 1 BUILDING .0 1 —84 I, as owner of the property, or my employees with ADDRESS 1 1_ _ 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). CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TOTAPREOTPAINEFRO WIDTH 1 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. Lender's Name Nil mo o LDMA Ref. # m P.C. Fee$ Permit Fee 22.50 Lender's Address certify-that I have read this application and state that the _. Issuance Fee 10 e 0 LDMA P/C# - above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee33.OO LDMA Perm. # u and he eby authorize representatives of this County to enter m upon t eabove-mentioned propert inspection purpose . a O (� SEE REVERSE FOR EXPLANATORY LANGUAGE 0 -• Sign t re of Applicant or Agent Date - -- - -- - --- --- •. �° WORKERS' COMPENSATION DECLARATION hereby d certificate that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of W99 kers' Compensation Insurance, or a certii 'o te{�gf� c. 3800 Lgb. C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nb � a9! �XCompany � � ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESG ❑ Certified copy is filed with the• my but i in pec- BUILDING ) �-y-- 4CE partment. ADDRESS Dare �C CITY ZIP LOCALITY Applicant N . OF BLDGS. ICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO.' MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. a� OWNER NO. U ONE MAP 1•certify that in the performance of the work foe which this ) SPE permit is issued, I shall not employ any person in any..manner ADDRESS / / SPECIAL CONDITIONS so as to become subject to the Workers' Compensation Laws. O CITYI ZIP U Date Applicant ARCHITECT OR TEL. //�� II// NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER NO.7'��O�ED DISTRICT P TYPE FIRE CESSED BY CONST. ZONE O -Exemption, you should become subject to the Workers' /] � AA - � w Compensation provisions of the Labor Code, you must forth- ADDRESS /� • v� ° O with comply with such provisions or this permit shall beTE � �r 7 STATISTICAL CLASSIFICATION APT CONDO. Z deemed revoked. CONTRACTOR (SCj �j / — LICENSED CONTRACTORS DECLARATION �� NO 3/t-'7 3� CLASS NO. c / DWELL. UNITS Ihereby affirm that I am'licensed under provisions of Chapter 9 ADDRESS a(D SEWER MAP 1- :F (commencing with Section 7000)of Division 3.of the Business LIC. / r tT, and Professions Code.agd tp erase is in full force qgd�ffect. CITY CLASS BK PG w.i.;.,,.VALIDATION /JUiC�/1„ / ' SQ. FT. NO. OF NO. OF CHECK _.e:,� s- s ig __a License Number Lic. Class SIZE STORIES FAMILIES ONE __ �j VALUATION :S,= It,i t fto Contractor ~Date // / DESCRIPTION OF WORK l� j NEW ❑ _� ADD ❑ 5 7O `` ► sII'';LtC. ,D3 ❑1 am exempt under Sec.' n ALTER ❑ B.BP.C. for this reason l /� T� REPAIR ❑ USE OF Date: i� EXISTING BLDG. DEMOL ❑ ,( Ail yl E Signature APPLICANT jj � � / TEL. �f c �7 FINAL OWNER-BUILDER DECLARATION (PRINT) (.F/A a NO.a3lO LvJ _ DAT I hereby affirm that I am exempt from the Contractor's License ADDRESS 0 f�' �� Law for the following reason (Section 7031.5, Business and FIN Professions Code): PRESENT B L BUILDING ❑ 1, as owner of The property, or my employees with ADDRESS i T-C wages as their sole compensation,will do the work and the structure is not intended or offered for sale Section LOCALITYOpp, i= Al 7044, Business and Professions Code.) MOOING TEL. CONTRACTOR NO. f"" r -- 21� ❑ 1, as owner of the property, am exclusively contracting :. `_t' , ._! with licensed contractors to construct The project (Sec- ADDRESS tion 7044, Business and Professions Code.) C`�,`-"NUt. CONSTRUCTION LENDING AGENCY SETT BACKK YARD HWY TOTAPROP.SETBALINEFROM 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. I/6"Y (Sec. 3097, Civ. C.). SIDE P.L. Wit=: i i}F ra�; i Lender's Name LDMA Ref. # m P.C. Fee$ • lJ Permit Fee r Lender's Address I certify that I ha a read this application and state that the Issuance Fee =� v LDMA PSC#- formatio i corr above ine. I agree to comply with all County Investigation Fee 44^ 8 oinc a d S e I wi relating to building construction, Total Fee ✓ 1 LDMA Perm. # a and er y ri p sentatives of this County to enter Lab en an d roperty for inspectio purp sgs. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant Agent Date APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADORES BUILDING ADDRE S C a V I hereby affirm that I have a certificate of consent to self insure, �j f (/ or a certificate of Workers' Compensation Insurance,or a certified s Y copy thereof(Sec.3800, Lak2.C.) -�{ ) / C,. ZIP�j C 6 LOCALITY Policy No. �� ,3 Q6 Company � �� SIZE OF LOT/C`- NO.OF BLDGS.NOW OGN LOT ' [ Certified copy is hereby furnished. NEAREST CROSS ST. S-C-e-rtified copy is filed with the county building inspe tion TRACT BLOCK LOT NO, USE ZONE MAP NO. department. y ,/� DateL-a_ SApplicant //�!i ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ° R VES No COMPENSATION INSURANCE U� . //AI WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS f / G .6.. ��- �/ DISTRICT GROUP TYPE CONST, FIRE ZONE PR C ED BY dollars ($100) or less.) �U J /� I certify that in the performance of the work for which this permit �71, �,,.r �� ZIP ,t 5.Vb R^3 —V 3 is issued, I shall not employ any person in any manner so as toG� U become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT C DO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' C NTRACT R SET BACK YARD HWY .., PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ;` �p v .� G� G " FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS ,.o LIC.NO. P L LICENSED CONTRACTORS DECLARATION S:3 1 SIDE LIC. S P L I hereby affirm that I am licensed underprovisions of Chapter 9 �`� SEWER MAP >- (commencing with Section 7000)of Division 3 of the Business andS NO.OF ST IES NO.07AMILIES a Professions Code,and my license is in full force and effect, et) / NEW ❑ BK PG O � 3 Sr RIPTIN F WORK ❑ , V License Numberc��c t�� '� Lia Class OOVALUATION /� ADD " Contractor"�6t)C:`L L'`JAnate q'Z 'C1 �` C} Q�/�S ALTER El OC /q � /)11 REPAIR ❑ I am exempt under Sec. $ F" BAP.C.for this reasonEMOL ❑ LDMA P/C# tL W 6 �� :pd'd`✓ �:�yf � ,,, � Date: USE OF EXISTING BLDG. CL URM ❑ U) g Si nature APPLICANT(PRINT) TEL NO. LDMA Perm# Z 1 ' ❑ I, as owner of thero ert or m employees with wages as Z p p y y em p y O g ADDRESS f�::t f F their sole compensation, will do the work and the structure is _ not intended or offered for sale (Section 7044, Business and FINALVE�/'� Q = .� _7.1,'_>5 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALv O'W "I/ 1 7 '{' {,, OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE / Z J S T I L-M" ❑ I, as owner of the property, am,exclusively contracting with FINAL BY j AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, --f T':� J. -"''-° ��" Business and Professions Code.) YES❑ NO❑ j-1; � J. -3 � 1. -_ 5 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - {,E,•1 +.�{ y"7 e CC OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR CHANGE t I A r GUIDELINES. C�f-sNGE I hereby affirm that there is a construction lending agency for YES❑ NO❑ C4 the performance of the work for which this permit is issued(Sec. rnI HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, MINI _ } 1 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20 140 CONCERNING HAZARDOUS .ft..ltl )1 11 1 6 9/ 3/5`7 5T Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. _ t L. ti' 4 x{ o Lender's Address •`_ _L I AI I10�4!1 O OWNER OR AGENT o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 1 Q r �� oN with all county ordinances and State laws relating to building 6i m construction, and hereby authorize representatives of this County ISSUANCE FEE atoopatetel upon the aJ20e ntioned property for inspection purposes. _ INVESTIGATION FEE TOTAL FEE �� ^ 5 f APPI-et a A vmtu,e ogent Date SEE REVERSE FOR EXPLANATORY LANGUAGE • COUNTY OF LOS ANGELES - TEMPLE CITY ## 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0505260035 PHONE:. (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 17190 LT: 6 SQ. FT STORIES TYPE OCCUP GROUP 5314 CLOVERLY AV STRUCTURE: 0 1 VN R3 TEMP CA 917803105 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: BLAKCLEY 8590-005-008 OTHER: 499 1 VN U1 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZONE:' ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 05/26/05 JK 05/21/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: FAN-CHIANG KUO;FAN KAO-HAN (626) 285-8124- 14,770 ��_ _ 5314 CLOVERLY AV Ye////YJs TEMP 917803105 FEES PAID DESCRIPTION OF WORK TOOL ROOM 499 SF. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: - SAME AS OWNER - - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 14770.00 VAL 1.48 SPECIAL CONDITIONS: AX BUILDING REVIEW FEE 54.70 D2 PERMIT W/O EN-HC 14770.00-VAL 300.60 TOTAL FEES 384.53 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING - MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 1ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT 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,�,. j/\ SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS _ SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE - SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: ES0508 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 0507130067 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 17190 LT: 6 SQ. FT STORIES TYPE 5314 CLOVERLY AV STRUCTURE: VN TEMP CA 917803105 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BLAKCLEY - 8590-005-008 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 07/13/05 JK 07/08/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINA` ATE .I AL BY: CODE: FAN-CHIANG KUO;FAN KAO-HAN (626) 285-8124- 2,000 9/6 (- 5314 CLOVERLY AV J - TEMP 917803105 FEES PAID DEtCRIPTION OF WORK GARAGE DRYWALL, NEW DOOR, ONE WINDOW FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 _ AC STRONG MOTION RESID 2000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 2000.00 VAL 82.20 TOTAL FEES 110.45 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION XX 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS - SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS - LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508