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Home My Public Portal About5909-5927 CLOVERLY AVE_Building__ EV.1 1/78) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDINFOR APPLICANT TO FILL IN ADDRESS SS ADDRx BUILDING ADDRESS 6909 LOCALITY � C NEAREST / CITY - M IL C, ZIP CROSS ST. �lJ� NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE I PARCEL DISTRICT GROUPTYPE FIRE PR CESSED BY TRACT ), BLOCK LOT NO., CONST. ZONE OWNER STATISTICAL CLASSIFICATION SEWER M<P ADDRESS G CLASS NO. 12�2 DWELL.UNITS_ L BV CITY . ZIP ARCHITECT OR TEL VALUATION $ ENGINEER NO. ADDRESS BLDG.SETBACK FROM TEL FRONT PROP.LINE OF (STREET) CONTRACTOR NO. HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING . LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. LIC.. + CITY CLASS // J� BLDG.SETBACK FROM CONSTRUCTION LENDE�:(,J)• g��(/W -� SIDE PROP.LINE OF (STREET) NAME AND BRANCH � ,j ,C HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING L. ADDRESS S /Q A/Itq V,-CITY.S, �4 JyIG 7/'Q" SIDE PROP.LINE HIGHWAY WIDTH . V SQ.FT. NO.OF NO. LF CHECK + _ SIZE STORIES FAMILIES ONE USE ZONE MAP DESCRIPTION OF WORK AV PDa 1,01t"rNEW ® 9 NO. � SPECIAL �W j9 L[- U /�� Dlff- �L ADD ® �/ CONDITIONS N ALTER BY z Alt) S wy AL A es REPAIR ❑ DA EL USE OFQS DEMOL ❑ 4F f EXISTING BLDG. Z APPLICANTp// TEL G (PRINT) L �J4•V+ "�- AO. Q BY(SIGNATURE( Q IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES 4 AND LAWS REGULATING BUILDING CONSTRUCTION.ICERTIFY THAT IN DOING THE S WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V ' THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z a p �7e pv n A PENSATION INSURANCE.' g z 1 ' d SIGNATURE OFj, ,# 0 0 0 0 0 1 PERMITTEE ADDRESSZ 2 0 0 4 3'0 Q /�gr _ Z CITY�s`dLtd)c1 TEL. Q o:o o J v NO. Q 21 7-7 Q P.C. Fee$ Permit Fee � � > Issuance Fee W Total Fee APPLICATION FOR BUILDING PERMIT PC //,CANT TO FILL IN (Print or type only) �vG—//� lS--/7— /1 —2/ —2,3 - �- rAUDID ts G COUNTY OF LOS ANGELES a� `� Q ��- 4d' l� V DEPARTMENT OF COUNTY ENGINEER CITY _ �i's4. LL= ZIP BUILDING ND SAFETY DIVISION f I NO.OF BLDGS. BUILDING SIZE OF LOT` '•� �'l NOW ON LOT ADDRESS Vr—, ,., 3.141-i ,F9-?j ,�,' 3 TRACT �� CG BLOCK LOT NO. LOCALITY 1.-E I.j TEL.q -atJh� NEAREST / T OWNER,J I{11�5 LaE� •.a" NO./,07"Ui CROSS ST. G. AS ADDRESS ASSESSOR 1 � ej Q MAP BOOK PAGE PARCEL �� DISTRICT GROUP TYPE FIRE PROCESSED BY Z' CITY j �. ( ZIP L } CONS ZONE ARCHITECT OR TELj Lu ENGINEER K 6_6/-I f;0;4NO. -�1 ti STATISTICAL CLASSIFICATION SEWER MAP ADDRESS A i:nApjA CLASSd.- DWELL.UNITS BK PG j TEL. 2 CONTRACTOR J NOLIC. USE ZONE MAP NO. y ADDRESS NO. G SPECIAL s LIC. CONDITIONS �_ 0 CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT NO OF NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIP OF WORK NEW + d O ADD _01 BLDG.SETBACK FROM 0� SIDE PROP.LINE OF (STREET) O L) ;v ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING REPAIR 1:1 SIDE PROP.LINE' HIGHWAY WIDTH N USE OF __ Z EXISTING BLDG. DEMOL ❑ + APPLICANT TEL CORNER CUTOFF, YES ❑ NO ❑ (PRINT) JAJijE`^ Ui,i_r>] IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) �� IN COASTAL PERMIT ZONE � �., YES ❑ NO [. e ❑ � VALUATION $ oo r r 3 ,14 4( I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES X` r' -,7 •p AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF 'THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF ]��Q PERMITTEE v ADDRESS DATE9fC 9 BY "t- TEL. FINIAL y CITY NO. MAKE CHECKS PAYABLE TO: FEE $ FET HARVEYT.BRANDT,COUNTY ENGINEER 2171�, / PLAN CHECK � VALIDATION CK. \M.o. CASH PERMIT VALIDATION CK. M.O. CASH J \ 8 2 -rs�c � u rr .3 5 1 0 s:L-1_J N 22 1 0 1, 1 9 0j 2 5 AI' ®S 76A638A CE#803 3-75' WORKERS' COMPENSATION DECLARATION insure-oraacertificate affI have a certificate of irm of Workers' Compensation eInsurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElCertifiedcopy,is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 541.7 Cloven Ave, ❑ Certified copy is filed with the county building inspec- BUILDING ADDRESS _ /t 91) o tion department. ADDRESS 17 C ov 1 jrn Ave ee Ct CA "1 17 Date ( Applicant CITY' curl I CL ZIP 11790 LOCALITY n CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT S1,000 NO. OF BLDGS. NEAREST NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR �•pp, rt 6 (This section need not,be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK 007 p� PAGE u0 O PARCEL O hundred dollars ($100) or less.) TEL. OWNER CI NO HIH)4iF6-Og USE ZONE MAP +�� I certify that in the performance of the work for which this NO' (G permit is issued, I shall not employ any person in any manner ADDRESS BOX B 7;L C I SPECIAL a CONDITIONS so as to become subject,to the Workers' Compensation Laws. /� O CITY grcad?_at ZIP �I0-77 Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. Z E Exemption, you should become subject to the Workers' w Compensation provisions of the Labor Code, you must forth- ADDRESS - 0- with with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATIO APT. CONDO. 0 deemed revoked. CONTRACTOR NO. z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 1V9 -DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK Removal o a NEW ❑ $ '$�QQ S'-FQ'crLQSe tN +VI2 UVIi}, l,ifi ADD ❑ ► ❑I am exempt under Sec. • _ LTER ❑ B.&P.C. for this reason m cover W dr v�[ CEPAIR ❑ ; Date: USE OF EXISTING BLDG. c6mmercTa DEMOL Signature APPLICANT TEL. FINAL A OWNER-BUILDER DECLARATION (PRINT) KeK Ma NO(31J)446-oft $ 3 DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS PD (37 �TCAd�A Q"t�tl0 7 FINAL Y�JA Law for the following reason (Section 7031:5, Business and Professions Code): PRESENT By BUILDING A,` "+• •a ❑ I, as owner ofthe property, or my employees with ADDRESS " wages as their sole compensation,will do the work and he structure is not intended or offered for,sale(Section LOCALITY --- -- I�//7044, Business and Professions Code.) MOVING TEL. , C LYJ I, as owner of the propg�ert 2�g� xcluye 4� CONTRACTOR NO. - - —' with licensed contractafiW c$Fis r �'TFie �t�j * ADDRESS 1?� 00 tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. �.,�• %�..s , -I� CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L.. (Sec. 3097, Civ. C.). SIDE P.L. Frill+',I—iJ t Lender's Name '.t�'•'t.. ��I_�. LP/ W P.C..Fee$ Permit Fee y z'ys u�j 11 0` Lender's Address o I certify that I have read this app'cation and state that the Issuance"Fee , 0 8 above information is correct. I a e•o comply with all County Investigation Fee �i v..� R ordina a and State lows re ting to building construction, Total Fee jJ 7• < and reby authorize repre ntatives of this County to enter up the ove-m lone property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT �1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS Q BUILDING ADDRESS S I 5 1 Clovefl Avenue I hereby affirm that 1 have a certificate of consent to self insure, l5q or a certificate of Workers'Compensation Insurance,or a certified 4 q C10%/ t' T' copy thereof Sec.3800,Lab.C. CITY ZIP [ e e Cz CA q�7$0 ( ) T-em C(fi Cl 1 T190 LOCALITY Policy No. Company SIZE OF LO NO. BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. S1 I OO O TWp NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR%5-F,7 PAGE 00 S PARCEL 7 (-' l SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 8 O TEL.NO. v YES NO COMPENSATION INSURANCE Kevi M°i WITHIN 1000 Fr.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred P Q gQ)( 13701 DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CI ZIP //' I certify that in the performance of the work for which this permit �rcad 1 a- CA G�1 I D 7 7 h,D� �-� V/ 3 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. 4 become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. IJ DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL.NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PLCL I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES O Professions Code,and my license is in full force and effect. NEW ElBK PG CD License Number Lic.Class DE CRIPTION OF WORK ADD ❑ VALUATION polo, W n.' ernoval o a. n-bears $ 11000 _ Contractor Date ALTER ❑ 1 am exempt under Sec. PaVI-0-ion Wall [2k Atee 1 JWO REPAIR ElB.&P.C.for this reason UnI.J5. Please refer io d�taaci 5 DEMOL 11LDMA Pic# Date: USE OF EXISTING BLDG. L URM El e rcia Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# 5rI, as owner of the property, or my employees with wages as eh o, MIR)�6-0$8$ p 1'-'(-'1 's their sole compensation,will do the work and the structure is ADD ESS /� S I7 - c not intended or offered for sale (Section 7044, Business and �0 �37a rwL,&z l cA Q 107 FINALDATTE q/ Q -- rOfeSSIOnSCOde.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 3_C?_ Lr O r { "Tz+'I�:' J I I r i)1'= 1, as owner of theproperty, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN. Y g THE AMOUNTS SPEC¢FIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY -i€7 T ASS 58 � -7 5 licensed contractors to construct the project.(Section 7044, YES❑ NO LrrJ/ f 1 d Business and Professions Code.) ;.HEI =_� - WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING - rfv i+ + •.t e - OCCUPANT REQUIRE APERMIT FOR CONSTRUCTION ORMODIFICATION FROM THE SOUTH S� t _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST !_{�fjNGIE ail' FOR GUIDELINES. / 1 hereby affirm that there is a construction lending agency for YES 1:1 NO 12 the performance Of the Work for Which this permit Is issued(Sec. I HAVE READ THE HAZARDOUS MATERI S INFORMATION GUIDE AND THE SCAQMD -t 3097,Civ.C. . 1` i '7 11/=0 � ) PERMITTING ECKLIST.LUNDERSTA MY-REQUIREMENTS UNDER THE LOS ANGELES I„}r1 EI I I'—I�{��3_ �yy/�•. :;� m. COUNTVC E, LE 2.CH R2. CTIONS 2.20.100 THROUGH 2.20.140 CONCERNING a Lender's Name HAZER I LS 1 No FOR OBTAINING A PERMIT FROM THE SCAQMD. .,4 s Lender's Address Aon 44 1 i iit;10�4 141 o 1 certify that I have read this application and state that the above information is correct. I agree t omply with all county RC.FEE PERMIT FEE ordinanc nd State laws relatin o building construction,and a. hereby th 'Ze representati of this County to enter upon ISSUANCE FEE the e- p r inspection purposes. a IZ 1 Z O INVESTIGATION FEE TOTAL FEE n sgnnun of"wxm or Aoe;n 0m 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 ItBUJ IING^AADDRESS 1,-i q BUI INC ADDRU J (Z `j/I 1 r vc, I hereby affirm that I have a certificate of consent to self insure, Cl- z�,pmt,; IC, �` X17 � or a certificate of Workers' Compensation Insurance,or a certified CI '` ZIP n PG'll r" / copy thereof(Sec.3800,Lab.C.) /,� y ��/Q Policy No. Company (� r LOC I Y //1_pf SIZE OF; OT NO.OF BLDGS.NOW ON LOT 7• v`J` ❑ Certified copy is hereby furnished. NEAREVr CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' wN ^ TEL NO. COMPENSATION INSURANCE X&J .� C' ( WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCE D BY dollars($100) or less.) CITY ZIP F° �q ' I certify that in the performance of the work for which this permit Ll�Z,, /`YYY r �!I' is issued, I shall not employ any person in any manner s0 as t0 ARCHITECT OR ENGINEER TEL NO. ✓ — �/ become subject to the Workers'Compensation Laws. STATISTICAL CLA SIFICATION APT NDO 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 t0 the Workers' CONTRACTOR / TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwithFRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP >- (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG O License Number Lic.Class DEW a} jIPTION OF WORADD VALUATON , Contractor Date _ y� K Elf ALTER ❑ $ w Q ❑ I am exempt under Sec. REPAIR El $ �11ok °' ttvvV�% a' B.&P.C.for this reason DEMOL ❑ � � Date: USE OF EXISTING BLDG. URM ❑ LDMA P/C# A'_CT Signature A P (CANT(PTT) \ TEL NO. LDMA Perm# 50 1i ❑ .1,as owner of the property, or my employees with wages as � �� v t qtr,' Z their sole compensation, will do the work and the structure is ADDRESS yy _ N� _" not intended or offered for sale (Section 7044, Business and 1 'ivEf .4 I XV!k/�, FINAL DATE Q yt_.?_,,a Professions Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALCyr •}; I, as owner of the property, am exclusively contracting with A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J -r' -(� -=° '-' ❑ AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, i EN'S LY s- Business and Professions Code.) YES 11 NO • WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING Ifff h' "E �-• #"1g•"'� OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH .1 I I"fI•- -$-5-+' mm �`' 4J CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR GUIDELINES. i":;..Ef_•'�` 3 i elf lj I hereby affirm that there is a construction lending agency for YES❑ NO❑ a the performance of the work for which this permit is issued(Sec. CHANGE A�•til7tE' 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, N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. f' aI"toE--)1I -• o Lender's Address `hi O OWNER OR AGENT ' i o I certify that I have read this application and state under penalty 523tS of perjury that the above information is correct.I agree to comply P.C.FEE .�� PERMIT FEE N with all county ordinances and State laws relating to building V m cons action, and heauthorize representatives of this County ISSUANCE FEE m enter upon the abov mentioned prop ty for insp tion.pur seq. �---+ a,J�r t^ l ail INVESTIGATION FEE TOTAL FEEL/0 r Sgnalure.ol applicant or Agent owe v SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION insureborafcertifcarteofWorkes' ComtpensatoneInsuranof APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ BUILDING 5 �1 ^ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS r d Certified copy is filed with the county bui ding inspec- BUILDING �C, / tion department. ADDRESS 0() Date & Appli CITY tr ZIP LOCALITY T, C-s RTI CATE OF EXEMPTION FROM WORK NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 2— CROSS ST. (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. ASSESSOR hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL . TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER rt2 Cebu A /gNO. 20 NO permit is issued, I shall not employ any person in any manner ADDRESS 2 rL �i C' SPECIAL so as to become subject to the Workers'Compensation Laws. CONDITIONS O c� wa -Date Applicant CITY ZIP „� � NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE F�ESSED BY W ENGINEER NO. CONST. / �E V Exemption, you should become subject to the Workers' V Compensation provisions of the Labor Code, you must forth- ADDRESS Dr Lil with comply with such provisions or this permit shall be deemed revoked. TEL pc STATISTICAL CLASSIFICATION APT. NPO. (n CONTRACTOR YYGC�� NO. 1! % %YAP LICENSED CONTRACTORS DECLARATIONCLASS NO.y DWELL. UNITS- LIC NITS LIC. I hereby affirm � that I am licensed under provisions of Chapter 9 ADDRESSd ,6 0 p �J� NO. � �3 (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force aXdffect. CITY SJ[a. `' CLASS BK PG VALIDATION Z SO. FT. NO. OF NO. OF CHECK License Num Lic.Class SIZE STORIES FAMILIES ONE �,L VALUATION Contraco '�*�� Date S DESCRIPTION OF WORK GC O NEW ❑ ADD I am-exempt under Sec. $ �� 11:1ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF /�� ` EXISTING BLDG. CJ C�— DEMOL ❑ Signature APPLICANT r' / TEL. CC�� FINAL . OWNER-BUILDER DECLARATION PRINT r �LvlfiL�—J NO. Q / DATE -7�S I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS d�0l' y dt, FINAI 7 2-a.9 A Professions Code): PRESENT BY F-1 BUILDING # e a 0-41! 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 ' :e tl 7-1.7 5 7044, Business and Professions Code). MOVING TEL. CONTRACTOR NO. 1 7-1 7 5 v I, as owner of the property, am exclusively contracting e • with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 0(� 1 5't-8 7 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY ED TOTALSETBACK 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 P.L. Lender's Name m P.C. Fee$ Permit Fee LDMA Ref. # Lender's Address 3 I certify that I have read this application and state that the / o Y PP Issuance Fee ! LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm.'# o and hereby aur ize representatives of this County to enter m upon the ve- ention d property for inspection purposes. a CX SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of pp/ ant or Agent D44 _ . i APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDIjJGaDD�iESS I, ,� VrK e` I hereby affirm that I have a certificate of consent to self insure, CJ � `i-+(/ .,,V/ �'I/ r� 11 or atcertificate'of Workers' Compensation Insurance, or a certified CITY ZIP GAY copy thereof (Sec.3800,Lab.C.) LOCALITY Policy NO. Company SIZ OF L NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) CITY ZIP 1 certify that in the performance of the work for which this permitO is issued, I shall not employ any person in any manner s0 as to ARCHITECT R ENGINEER TEL No. E "r/ become subject to the Workers'Compensation Laws. oaUC? Of-_V STATISTICAL CLA SIFICATION APT CONDO Date Applicant ADDRESS / 7 l CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the • Workers' CONTRACTOR TEL NO. SET BACK 'YARD_ HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ. T.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. Q NEW 1:1 BK PG , a License Number Lic.Class DESCRIPTIO OF RK. DD ❑ VALUATION Q 0o U Contractor Date ALTER $ ElI am exempt under Sec. REPAIR El $ 0 BAP.C.for this reason DEMOL ❑ LDMA P/C# lJl Date: USE OF EXISTING BLDG. URM ❑ y% 1C0 Signature APPLICANT(PRINT) TEL NO. LDMA Perm# •' rte?' S. Z ❑ I, as'owner of the property, or my employees with wages as O their sole compensation, will do the work and the structure is ADDRESS _/ ^,_ _. .,_�. v'• �.I': not intended or offered for sale (Section 7044, Business and a N �V' �i FINAL DATE Q rofessions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J `Li.I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? a i �-�5 FINAL BY > t..•i;i licensed contractors to construct the project (Section 7044, YES❑ NO! Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR _.- •.•• GUIDELINES. I hereby affirm that there is a construction lending agency for YES 11 No '�'ML- theki performance of the work for which this permit is issued(Sec. -r;t I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING i".�••I�f,=i 3097, Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS � Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. S_j"j••t,,_,,,, __,. p Lender's Address OWNER OR AGENT O o I certify that I have read this application and state under penalty _3_ • oP.C. E PERMIT FEE Ah(•. tl, P. . S„',_I, ` ! __.7 7•_ of perjury that the above information is correct.I agree to comply O o with all unty ordinances and State laws relating to building xa c=-w a construct: n, and hereby authorize representatives of this County ISSUANCE FEE o / ly� {='J - PM m p�(p d 20 $o enter u on the above-mentioned operty for inspection pu oses. a INVESTIGATION FEE TOTAL FEE 6• <D Sgmture o1 Ap.F-t'&AWO J�oa�e ` SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES T 1PLE CITY 4 0508 BUILDING P_i'MIT DEPARTMENT OF PUBLIC WORKS 111101 LAS TUNAS TENANT IMPF.'VEMENT EUiLDING AND SAFETY / LAND DEVELOPMENT -s'ENPLE CITY CA 91780 BL 0508 040818'0O ,4 'PHONE: (62.6) 285-043:; EXT: LEGAL ID: ~�— NO. OF CONST NEW BUILDING ADDRESS: r I TR: 8526 LT: 10 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 59.25 5927 CLOVERLY AV j STRUCTURE: 32 1 `!`- B TEMD CA 917802126 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: I-AS TUNAS i 8587-0O3-017 THOMAS PAGE: 596 GRID: j3 LOCALITY: TEMPLE CITY, Cl TENANT: EXIST FLOG USE: COMME USE ZONE: iSs'ED ON: PROCESSED BY: EXPIRES ON: LU SANDWICH EXIST OCC GRP: B 08/18/uI' JK 08/13/05 l OWNER: J TEL. NO: BLDGS. NOW UN LUT: VALUATION: FN?N' -'A7� FINAL Y; CODE: WANG JAW J:JEAN TRS 5,000 580 OLD MILL �iI) _ SMAR 911C31652FEES PAID nIP'I1Os OF WORK ItF.ANT IM. ROVEMENT STORAGE R00M FEE DESCRIPTION: QUAN'1TY: 1-101-M AMOUNT: APPLICANT: — TEL. N0: H D CONSTRUCTION (626) 456-4534- AA BLDG PERMIT ISSUANCE 27.75 4418 FANDON AVENUE AE STRONG MOTION OTHER 5000.00 VAL 1.05 s`PEUIAL CONDITIONS: EL MONT,E, CA 91732 AX BUILDING REVIEW FEE 54.70 j A2 PERMIT W/ENERGY-HC 5000'.00 VAL 152.49 I TOTAL FEES 235.99 �_��__ CONTR.ACTGR��— TEL. NO: APP:<OVALS a .TE INSPECTOR SIGNATU�,;-: H D CONSTRUCTION' (626) 595-0444- 4418 FANDON AVENUE LIC. NOL OCATION ANO SETBACKS EL MONTE, CA 91732 636105 B * I i=0i;.S ENGINEER APPROVAL ARCHITECT—i7i cNNiFEfn. - TEL.NOc—� :, ..-' ;';'4"cP:C? FORMS -- --- LIC. NO: isL AiU'i"crc MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE; CFiP: rftriU�RSSULA.TIONi I--_-- --�-_I 3 04 jF!:GR SHEATHING I i NO. OF FAMILIES: DWELLING UNITS: AF7COND: STAT CLASS: I_ _ NO 22 IROOr_SHEATHING _ SCHOOL WITHIN HAZARDOUSSSHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS N,0 NO NO <; lNSr=C.TI0N: — - irc;'lINKLER HANGERS I iN.-' L TION/WEATHER STRIP I _1 i TEt15R LATH/DRYWALL F':TFRI(TRF LATH I _ i Rik ,ED F'COR/CEIL ASSEM. �! I (RATED Un_LL ASSEMBLIES I Sii1SFTS/OPENINGS I T-BAR CEILINGS * ADDITIONdAL DATA ON FILE LO?DRAINAGE --frt - - REPORT ID: DPR261 ROUTE TO: BS0508 -I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0404080020 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BU LDING ADDRESS: . TR: 8526 LT: 10 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 5925 5927 CLOVERLY AV STRUCTURE: 1230 1 VN B TEMP CA 917802126 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-008-017 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: B 04/13/04 VG 04/08/05 OWNER: TEL. NO: BLDGS. NOW ON L01: VALUATION: FINAL AT FINAL BY: CODE: WANG JAW J;JEAN TRS 6,000 ��. 580 OLD MILL RD SMAR 911081652 FEES PAID CRIPT ON OF WOR INSTALL DIMIZING WALL SEPARATING TWO UNITS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: ARCH-IM INC. (626) 284-0371- Al PLANCHECK W/EN-HC 6000.00 VAL 146.04 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AE STRONG MOTION OTHER 6000.00 VAL 1.26 A2 PERMIT W/ENERGY-HC 6000.00 VAL 171.81 _ TOTAL FEES 346.86 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE TOP PROPERTY SERVICES (626) 216-8441- 1300 E. MAIN ST., #210 LIC. NO LOCATION AND SETBACKS ALHAMBRA, CA 751865 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS ARCH-IM INC. (626) 284-0371- 1300 E. MAIN ST. LIC. NO: SLAB/UNDER FLOOR ALHAMBRA, CA 91803 NONE RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: A T/COND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CELL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508