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HomeMy Public PortalAbout10619 DAINES DR_Building__ 1 ' >h ; 7 rti l � COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9808240010 PHONE: (818) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 10619 DAINES DR STRUCTURE: 0 VN TEMP CA 917802815 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: PAL MAL 8586-010-055 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: - 08/27/98 UT 08/27/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINA ,qAT o� �..I�N�A'L�BY:A-11 CODDE�:LYOU //,,��py/�/}/ 1061 KE-CHENG 280-2877 - 1 700 �/r ll �/Yh,' /(.( `� .%/U/�N/// 10619 DAINES DR. D QP//" TEMP 917802815 FEES PAID DESCRIPTION OF WORK/ DRYWLL CEILING AND WALLS OF GARA WITH 1/2" SHEET ROCK FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: � ����f-'� V c% APPLICANT: TEL 0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE - 27.75 AC STRONG MOTION-RESID700.00 VAL 0.50 SPECIAL CONDITIONS: AX BUILDING,REVIEW:F.EE 54.70 D2�PERMITt W/0-EN,HCB[1 G X700:00 VAL 43.50�� WI TOTAL7�F EES 126.45 CONTRACTOR: TEL. NO: J APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. 0: f� \� FOUNDATION/TRENCH FORMS LIC. NO:� � __ __ ll 117111 �1 „ SLA /UNDER FLOOR _ RAISED FLOOR FRAMING J, j=J f:-��;'� /-�> UNDERFLOOR INSULATION MAP NO: SEWER MAP 800K: PAGE: FIRE ZONE: CMP,:,;� �„ j �� Ii, ��v� (/ 147H273 3 `01 ��-'%!_'ii.�V l- _ FLOOR SHEATHING ' NO. OF FAMILIES: DWELLING NITS: APT/COND: STAT CLASS: �, _ NO 21 \\ J �'1 y,L ) ROOF SHEATHING � rl Fi 'li SCHOOL WITHIN HAZARDOUS ,'t.Sq t*. SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALSK� NO NO NO / �� 1�IJy FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE/ I1� ��,1��n1 FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- 'C `FC7VjC E.�,�� Vv INSULATION/WEATHER STRIP SIDE PL- — -- " IN ERIOR LATH/ORYWAIL EXTERIOR LATH RA ED FLOOR/CEIL ASS M. RATED WALL ASSEMBLIES RATED SHAFTS/OPENING T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 f DEPARTMENT OF BUILDING AND SAFETY ' APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 11 ® � ® � WM. J. FOX, CHIEF ENGINEER f� FOR APPLICANT TO FILL IN I FOR OFFICE USE ONLY ,( 1 1 P DISTRICT NO. py PLAN CK.NO. 'L1 PERMIT NO. BUILDING+ ADD E.S.. I.O h I.9 �1 N J J `.. r T 1 - �. I� LOCALITY �, I C 4 !G- . Ip M DATE ISSUED 7�,I ♦_� RECEIVED BY T D OFAPPL.' �� + ,l I;p+ NEAREST CROSS ST. T/�/2 L�/_ J1/�J4��/� �'(/,.g� /j�� I C��. I� BUILDING OWNER/i,��(/�F. Y. AYJAA�J//4NN/�/i(iN�{ ADDRESS ! C rLA MAIL 1^`// {(��� (/ LOCALITY C 1 1 ADDRESS/hA 19 P_. IC-J/JAiN All . I CITY�VT/ _ //n O -`L r.( [�/ a NEAREST l, A L ��— i,..� A �[,N(All NOLr//. //'TU ]/ - _ST. 1 , FIRENO.OF WE Ti GROUP ARCHITECT DR TEL ZONE �PLAN9 —Y Ij J ENGINEER TEI _ 'BLDG. (� GRD. NO.r ADDRESS r./ SETBACK LINE I Z U I /-. L. N -46/ TEL BYPROV'D _•.-1 ! DATE! f CONTRACTOR biT(_ C/ NO. USEw ZONE /� By!ROVED 1 I DATE I ADDRESS _ LEGAL ( I CORRECTIONS I 1 I DESCRIPTION LOT NO.f� 3 L 1 BLOCK{- TRACT EI y/0 x NO. OF BLDG& 1 SIZE OF LOT I V I NpW❑N LOT USEOF1�l�S NO,OF i NO,OF EXISTING BID.. FAMI LIE. ROGMB f DESCRIPTION OF WORK T?9RTS NEW ALTERATION ADDITION p ........... . _.... ..............a.alrai yup. z REPAIR MOVING I DEMOLISH 50.FT. NO, OF .. . , .... -- • . .... vD LeR�I,�e. .ni: D SIZE V ROOMS STORIES I F WALL COVERING S I T(fGG Q I CDVOERING USE OFNEW ��jlyQT� !a CyA ^ ' BUILDING /G /N K. I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVEIS CORRECT INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: MATERIALS LOCATION �� AND STATE LAWS REGULATING BUILDING CONSTRUCTION. v // /� FRAME: FIRE STOPS, SIGNATURE OF J(�}.' L./b' -'!f�D-/�{ ' I BRACING, BOLTS / /rn PERMITTEE n IA✓ GW/'0' As A'1V I i/ LATH, INT. AUTHORIZED AST. LATH, EXT. 7swsaew-a I0-50 $ P . PLASTER, INT. - QO/OOQA +� PLASTER.VALUATION (� FINAL > ✓r' �7 DEPARTMENT OF BUILDING AND SAFETY .COUNTY OF LOS ANGELES - WM. J. FOX, CHIEF ENGINEER APPLICATIONS. FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY /� /�� DISTRICTN O. PLAN CA. oR REc.No. '- RTI BUILDING ADDRESS l��n Qd A/ . RECEIVED SY DATE OF APPL. DATE 149U ED LOCALITY 7'L NEAREST BUILDIG CROSS ST. A / N �^ ADORE B6' OWNER /MAILnT i-.I/wA�i/ .C? �.GALr,f • "�'1" �'F• r ADDRESS/O%/7/ Ti �1 �. 10' ` LOCALITY �! TE ii/' CROSS ST, . l L //�-// - 4- CITY,� _ O i Y i� _ NO. / -TD 7I =IRE NO.OFONE PLANS C� I nPE� GROUP i/ ARCHITECT qh TEL ENGINEER NO. 11 BLDG. _ ORD. NO. / 9ETBACK:LINE ADDRESS �„J USE APPROVED TEL ZONE BY t tDATE CONTRACTOR NO. HOUSE NUMBERING ADDRESS MAP NUMBER ANO. ASSIGNED BY LEGAL /� qq — CORRECTIONS DESCRIPTIO//�N /�/JL�OT//nNO. ,-JOC. BLOCK TRACT �]L�'./s.N.LI/,&A/� {I��� U P 6�/ 114 I NO. OF BIDGB. / SIZE OF LOT ^ NOW ON LOT USE OF /J I NO. OF I E%I$TIN BLDG. fda / FAMILIES / DESICRIPTION OF WORK Da NEW ALTERATION ADDITION L - -_----___- _- -_- _ - - 0 Z f REPAIR DEMOLITION M. F . NO.OF SIZET �� V ROOMS STORIES EXT.WALL -�( 7�� ROOF COVERING �+ / C V I COVERING (a USE OF STRUCTURE �a�r✓c'? T �xit' r. INSPECTION FOR APPROVALS OCCUPANCY AS INSP TOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN 19 FRAME: FI, BOLTS 6r CORRECT. BRACING, BOLTS _ IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS 81014ATURE OF n v � LATH, INT. ' L i 1�• PERMITTE _ G► LATH• EXT. ADD RES9 n _ �'� n��A - PLASTER, INT. AUTHORIZED AOT. PLASTER, EXT. ^� HOUSE NUMBER COR- S 0 FEE RECT AND POSTED VALUATION FEE r�� FINAL 76w63BA DES 7-51 - DB-3 25M SETS APPLICATION ,FOR PERMIT I<EPATr .,NT OF BUII,DING-AND SAFETY r ' UNTY OF LOS ANGELES JUL 2 1945BUILDING; J�1Le�1ll �I WM.J. FOX, CHIEF ENGINEER NO..OF `-.BLDG. ORD.NO: DISTRIC'NNO. PLAN CK. NO.jd;' PERMIT NO. PLANS SETBACK LINE FIRE / APPROV BD ZONE /l BY DATE RR�E,C�EIIV_ED_BY DATE DATE OF APPL. DATE ISSUED USEJI ZONE _• By DATE DATE "-�/`�v`'— o 7 AI. /AV APPLICANT FILL IN HEAVILY,OUTLINED PORTION ONLY . ///e ' O a. NAME ADORES, )/ Y h NVR J W Z ADDRESS LOCALITY / -XII. I Z (^`- NEAREST a ' R W CITY . I / f/. CROSS ST. Q ,TATE LICENSE NO. w 1 x0. H NAME ..d J JIU v' W MAIL V 0 NAME p . ; ADDRESS'-� Q ADDRESS O CITY U� NO. , Z CITY I HEREBY ACKNOWLEDGE THAT ] .HAVE READ- TXI9. O APPLICATION AND STATE'THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH.ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. O LOT NO. SIZE OF LOT / I/ D: SI OWNER '! `w ^S OF I �,�`"�l, �(,Id� \ NO. OF BLDGS..^ �T �/ '`�`_-`�X07• Q C. BLOCK NOW ON LOT 1. ✓V".' AUTHORIZED AGT. BIIS_ -j 0j CORRECTIONS TRACT AAll.um - O USE OF BLDGS. NOW ON LOT DESCRIPTION OF WORK /- v S/ USE OF ' _ rJ��r /6 .BUILDING • � • _•�.� .•may - NEW / TYPE GROUPNO OF NO. OF rJC�J 0� ALTERATION ROOMS FAMILIES ` ADDITION SIZE REPAIR STORIES e/ MOVING WALL COVERING DEMOLISH ROOF COVERING r C.• - S FEE S r , FINAL APPROVAL -. VALUATION G D 0, �- FEES �y� A/;//� NAMINSE /,y "/ NAMH �� 'FCO AJ T- T5AG38A CE0603 8-63APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELESnoILDIN l - = !DRES1 DEPARTMENT OF COUNTY ENGINEER t BUILDING AND SAFETY DIVISION LOCALITY , JOHN A. LAMBIE- COUNTY ENGINEER NEAREST � '� 6 WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTR GTO. OUP TYPE ESSED BY \ FOR APPLICANT TO FILL IN CONS t F'. BU[UD I NG F; STATISTICAL CLASSIFICATION WER MAP ADDRESS ®� C( BK w�' CLASS. NO. DWELL. UNITS LOT NO. ,e) �(/ BLOCK WATER CERTIFICATE: NOT REQUIRED ❑ RECEIVED TRACT MAP ,t_ HIGHWAY NO.OF BLOCS. NO.�LA (CIRCLE) STATE MAJOR SECOND LOCAL SIZE OF LOT NOW ON LOT USE ONE SPECIAL USE OF //may CONDITIONS EXISTING BLDG. '� - _ TEL/�// OWNER NOr] / B ILDING EXIST. C G SETBACK YARD HWY STREET NAME WIDTH ADDRESS q ARCHITECT OR EL. P. 1, " l• ENGINEER NO. SIDE ADDRESS TEL. v -� 'w ✓ i AM,d�C':- a` CONTRACTOR NO. ADDRESS ��• �sAk•KOS DESCRIPTION OF WORK NEW ' ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE ,y STORIES FAMILIES/ USE OF STRUCTURE 0 X467 SLo�n�E�$S^A e-ND Aw/woop l +. td NT Ac SIGNATURE OFdk�{T -T -d- APPLICANT_ V VALUATION $ �� APPROVALS DATE INSPECTOR S SIGNATURE P.C. �GI PMT. �4Y FOUNDATFORMSI, MATERIALS FEE ON $ , ��^ FEE $ FRAME: FIRE STOPS. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS • '�dJ! ,"tf� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE I'LOCATION. Av-� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT:,OUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK , AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH:INT II-.µ ms TION.OF.THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT _ ING TO WORKMEN 5 C MPENSATION INSURANCE. LATH. EXT. SIGNATURE OF //// //7� HOUSE NUMBER COR- A PERMITTEE ((GI` /'/ �� RECT AND POSTED 4-21-(,P ADDRESS FINAL -ZI�G� / , f-��✓'�% JOHN F. LEWIS. PRINCIPAL STHYC RAL ENGINEER ' PLAN CHECK VALIDATION M.D. CASH PERMIT VALIDATION CK M.D. CASH L}�Q72o2w DEC 31 23 u 35.50.4 � ���� Lto7339�G Mi 7 1 D 71.00- 76A638A CEn8038.63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING / u� j/ZP� DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY / JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. V . DISTRICT NO. GR TYPE FOR APPLICANT TO FA.L IN v CONST. C i BUILDING q _ STATISTICAL CLASSIFICATION S WER MAP ADDRESS p/d//f/ BK CLASS. NO. DWELL. UNITS ` .S LOT NO. C;jj (� Z BLOCK WATER /' CERTIFICATE: NOT REQUIRED ❑ RECEIVED TRACT V 0 MAP Q HIGHWAY NO.OF BLOGS. rj NO (CIRCLE) STATE MAJOR SECOND, LOCAL SIZE OF LOT NOW ON LOT !t USE ZONE SPECIAL USE OF r I CONDITIONS EXISTING BLDG. OWNER _yP�/ ��4{�IJE Nai�Y6/6 BUILDING EXIST. I� pan SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT 'j'/ . )^ ` n ' .T X ARCHITECT OR TEL. P, L �Ll/ {�wilrrL�a/ J Cl ENGINEER NO. SIDE P. L. ADDRESS L TEL. C CONTRACTOR E NO. U ADDRESS 0 DESCRIPTION OF WORK W a NEW ADD ALTER REPAIR EMOLIS Z SO. FT. NO. F NO. OF SIZE 'ST - IES FAMILIES USE OF STRUCTUR SIGNATURE OF APPLICANT VALUATION $ �`�r �-9 APPROVALS DATE INSPECTOR SIGNATURE P.C. PMT. �p./� FOUNDATION: LOCATION FEE 5FEE 1 ♦ (/V FORMS. MATERIALS FRAME: FIRE STOPS. I 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 I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S C MPENSATION INSURANCE_ LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE A RECT AND POSTED ADDRESS /f/(<~ FINAL JOHN F. LEWIS. PRINCIPAL STRID- URAL ENGINEER PLAN CHECK VALIDATION CK. M,O. CASH PERMIT VALIDATION DK. M.O. CASH ____T _ lri{; 7 2 6 8 M, JAN 51 0 4.00- 76A638A CE"03 1/7i 'APPLICATION FOR BUILDING PER IT COUNTY OF LOS ANGELES ASSESSOR • DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING �S ADORess v Aff S OR COLEMAN W. JENKINS, SuvT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or tygl only) CROSS ST. DISTRICT NO. GROUP TYPE P ESSED BY [SIZE UILDING A� p^ ASE 'C ` r1 O � CONST. X/ DDRESS .(✓�lJ U .7 OT NO. �Cjl �agLOCK STATISTICAL CLASSIFICATION '7L A/SSI FICA TION SEWER MAP��' CLASS NO.2_(_OWELL,UNITS BK PG RACT `�a Q >"� USE ZONE MAP V NO.OF BLDGS. NO. I/ OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG. /�lv T L. OWNER L h• L`L' BLDG.SETBACK FROM ADDRESS AA ey ae, FRONT PROP.LINE OF (STREET) f 1./ TYPE OF EXISTING SETBACK HIGHWAY } .YARD = TOTAL CITY HIGHWAY WIDTH I FROM G.L. ARCHITECT OR TEL. } _ ENGINEER ` NO. BLDG,SETBACKF ADDRESS rt/` SIDE PROP. LINEOF (STREET) CONTRACTOR'D IJV L No HIGHWAY HIGHwAVPE OF EWSDTHG FROM C.L.CK HI AY } YARD = TOTAL O U LIC. Aooaess �4 q �nvGI��U �Ny No. 07q%y7 +�+ = o CITY (//1(/l� `ALI CLASS/!J CORNER CUTOFF YES LJ NO'[_] W CONSTRUCTION LENDER a NAME AND BRANCH 'UJ Al - SEE REVERSE SIDE FOR SPECIAL APPROVALS Z ADDRESS w� SQFT. NO. OF NO. OF 1 NEW ❑ ✓W SIZE STORIES FAMILIES STRUUSE CTURE C'A 12A ADD ALTER ❑ CON T REPAIR❑ SIGNATURE OF /� APPLICANT Q� xayc.j' F OEM( ❑ / & VALUATION S -IvO© 7� APPROVALS ATE INSG roN'S s arp RE P.C. PMT. FOUNDATION: LOCATION ry FEE $ FEE $ .J D FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION FRAME. FIRE STOPS, BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITHALL ORDINANCES AND ,LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STIR UC TI ON. I CERTIFY THAT IN DOING THE WORK AUTHORIZED , HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LA TH, NT. LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMP,E(Ny�Ti ON S/URRAANCE. /�//1� LATH, EXT. SIGNATURE OF ✓/ ///� ,A 14 HOUSE NUMBER COR- PERMITTEE ( /�/H'l//H� La.G4G�`w/?l–= / RECT AND POSTED ADDRESS_I��—Tr-y^moi_.r•C� ^^-� /Jw-G FINAL JOHN,.F.,LEWIS, P,A CIP L STR L L.ENGINEER PLAN CHECK VAALIDATION cK. M.O. cABH _ � PERMIT VALIDATION CK. o. ' CA.I 2 9 1 D 2 8 5 Q APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a Certificate of Workers'Compensation Insurance,or a certified CITY ZIPcopy thereof(Sec.3800,Lab.C.) LOCALITY Policy NO. Company SIZE OF LOT 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. USEZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. YES NO COMPENSATION INSURANCE ADDRESS _ WITHIN 1000 FT.OF SCHOOL? (This Section need not be completed if the permit is for one hundred DISTRICT .GROUP TVPESANST. FIRE ZON `PROC ED BY dollars($100)or less.) Cm nP �,. '- I certify that in the performance Of the work for which this permit is issued, I shall not employ any person in any manner Eo as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL IFICATION APT CONDO c.. Date Applicant ADDRESS CLASS NO. scDWELL UNITS NOTICE TO.APPLICANT If, after making this Certificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST EXemptloit�you should become subject to the Workers SETBACK YARD HYv1' PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT Comply with such provisions or this permitshall be deemed revoked. ADDRESS LIC.NO. - PL T a LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE PL W I hereby cing that I em licensed under provisions of Business Chapter 9 SEWER MAP � (commencing with Section 7000)of Division 3 of the Business and SQ.FT.512E NO.OF STORES NO,OF FAMILIES l%. Professions Cade,and my license is in full force and ailed. I I NEW ;[� BK PG ¢ License Number Lia.Class DESPFRIFTION OF WORK.. - ; - ADD R�f1j VALUATION 01 Contractor Date - ri rr ALTER ❑ $ R I am exempt under Sec. ,( REPAIR $ 1W- BARC.for this reason DEMOL ❑ LDMA P/C k Date: USE OF EXISTING BLDG. URM ❑ 'gnature APFLICfIM(PRI 1 `._f' V .Tl<l+!!p ,•/-�,y � LOMA Peml Z as owner of the property, or my employees with wages as it Sole compensation, will d0 the work and the structure is ADDRESS. O - 0 - intended or offered for sale (Section 7044, Business and 4'r - FINAL DATE fBSSIODS Code.) MULTHEAPPUCANTORFUTURE BUILDING OCCUPANT HANDLEA HAZARDOUSMATERIAL M ' � tE'.'S:� S owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q y g THEAMOUNTS s�IFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDO FINAL BY need contractors to construct the project (Section 7044, YEs❑ NoO mass and Professions Code.) OWILLCC THE INTENDED USE OF THE BUILDING BY THE APPLICANT IO FUTURE BUILDING OCCUPANT QUALITY MANAGT FOR EMENT DISTRICT (SCONSTRUCTION OR D)SEE PERMITTING CHECKLIST SWISH r CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMDI SEE PERMITTING CHECKLIST FOR GUIDELINEC1SRHf . ereby affirm that there is a construction lending agency for YES NQ pertormance Of the Work for which this permit Is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 7,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REOUIREMENTS UNDER THE LOS ANGELES ��RR �BB pE p pp COUNTY COOS TITLE2,CHAPTER 2ASECTIONS 22.IOOTHROUGH 2",IQ CONCERNING dens Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCACMD. der's Address ' ovmm aR AOfM rtify that I have read this application and State that the above FEE FEE PERMIT MIT rmaHon is correct. I agree to comply with all county P.C. ,tr inances and State laws relating to building construction,and by authorize representatives Of this County to enter upon ISSUANCE FEE ! -/ bove-mentioned property for inspection purposes. INVESTIGATION FEE TOTAL FEE ,.aemcmm o�.aM Sow ../ t SEE REVERSE FOR EXPLANATORY LANGUAGE APPUCAMON' FOR MOM PERMIT COUNTY OF LOS ANGELES " BUILDING AND SAFETY 'WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN - euaDlNc ADOREss f - BUILDING A DRESS - - 1 - 'I,.hereby-affirm that I have's certificate of consent to self insure; ' ,� � - � - .r -. Or a certificate-of Workers'Compensation'Insurance or a Certified ` copy thereof(Sec 3800,Lab.C) '':' CITY ZIP Y I' Poll No-11 S o1-7'9 TA Z tFL[A1D �LocALITv .. Policy Company, T y °. SIZE O L NO.OF BLDGS NOW ON LOT - ❑ Certified Copy.IS:hereby'furnished ' _ �� 7 - _ NEAREST CROSS ST .�•p� ,1A ,I'.' ❑ Certiflgd copy is filed with the county,building inSpeG110p, TRACT .. 'BLOCK - LOT NO:. department. - - — .' b ,r °d''. USE ZONE MAP NO. .... ... �1.-�/ •.- ASSESSOR MAP BOOK - - PAGE -_._. -PARCEC_. "' ' Date/i - y Applicant - -(' '" 3. SPECIAL CONDITIONS" CERTIFICATE OF EXEMPTION FROM WORKERS'- OWNER '. .• - TEL.No. - ' 1 COMPENSATION INSURANCE ADDRESS - Id7a� l-G. 3G' � UUJ' 'WITHIN 1000 FT OF SCHOOL? EVES NO ✓, - � _ (This Section need not be Completed If the'Pennit IS for One hundred Q619I •� ' - DISTRICT• GROUP TYPE CONST' FIRE ZONE ROCESSED BY' d_ollers(S100)or less) - CITYZIP , I Certify that in the performance of the work for which this permit' ..is Issued I shell not employ-any-person-in any manner ad as to ARCHTECT OR ENGINEER _ ,TEL.NO. _ O �°3 ' become Subject to the Workers''Compensation Laws. I STATISTICAL CLASSIFICATION APT DO _..._ r ,) .. ADDRESS d/71 ' Dale - Applicant I, _ _,..,. .' _ - ., .. CLA55 NO. , ''DWELL UNITB ' NOTICE.To'L APPLICANT: If, after making. this,Certificate of _ REQUIRED TOTAL SETBACK FROM EXIST CONTRACTOR TEL NO: Exemption, you ShOUId b¢COm@ SUbj@Cl l0 ,the Workers'. -�- - � BET,BACK_ .YARD HWY PROP LINE WIDTH Compensation provisions of thetLatior Code, you must forthwith O V1' FRONT - - complywith such provisions or this permit shall be deemed revoked. ADDRESS : - C.NO. ` PL ' sloe a LICENSED CONTRACTORS DECLARATION uty LIC.C PL . o I hereby,affirm that I am licensed underprovisions of Chapter 9 SEWER MAP ,. `(CommencingWith Section 7000)Of Division 3 ofthe Business and SO..FT.SIZE NO.OF STORES NO.OF FAMILIES •' C ProfessionsCode and my license Is in full force and effect: -3.i 17 - NEW ❑ BK- wG- o DES IPTION OF WO yMe5 e�jMyRIF ATION ` License Number; �"�� E Lic.Class C 37 - � ADD.- ro y Contractor s r Date' ,9 - _ ALTER ❑ UZ7. = Z 41 ❑ I ame%empt unoer Sec. REPAIR 8.8P.O torlhis reason EMOL ❑ PIC a. ' USE OF EXISTING BLDG. f - - _- .Date: . t' ..- . . ._.. _ URM' ❑' _ _. ;.:. �/Signature" - APP (CANT PRINT) TEL. O.' LDMA Perm a" I ; O as owner of the property, or my employees with.wageslas H$' — - - _ - their sole compensation,will do the work and the.structure is ADDRESS - Au'�I c FINA L.DQ R " not intended or offered for sale (Section 7044, Business and C '?SIl7 �4 j " Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL j - ❑ I as'orwpar OflthO ro�e OR'A MIXTURE CONTAINING A HAZARDOUS'MATERIAL EQUAL TO OR GREATER THAN • - { MS � p p rty;am exclusively contracting'with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDEI FINAL 1 ITEMS licensed Contractors to construct the project.(Section 7044, YES❑.' No ^ " Business and Professions Cotle.j - .. TOTAL•Y {J'„�, 63 WILLTHE INTENDED USE OF THE BUILDING BY,THE APPLICANT OR FUTURE BUILDING ` OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THEBOUTH ,. CONSTRUCTION LENDING AGENCY.r _ - COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST' '311q S �J l CASH S� I . - "..FOR GUIDELINES�. ( - , •• 3`� CHANGE •IJI I hereby affirm that there'is a construction lending.agency for YES❑ No ))),pp'p! _ - - the performance of the Work for which this permit is Issued(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND'THE'SCAOMD {' , 3D97,CIV.C.j. PERMITTING CHECKLIST.I UNDERSTAND EpUIREMENTS NDER TME LOS ANGELES - _ / (yin` 1:YL COUNTYCppE.TITLEI, ETR P` ASE NS4A.IWT GH 2.'10.1LDCONCERNING jr'jn'I�r`' rI f(�( Lentlel's Narne [�1..7 v( HAZggDOLE MATERI EPoRTING I�OBTAINII PERMIT FROM THESCAOMO." 0000-I110111 YJ 4',f++)r 0 2 // fno n� J _ I.; y - 'Lenders Address-7��`!� �� ,�6 lcil/z,o—T— � _ . jJIJ.':�• 1 All 7:C'Cl �.. r RV1>EP p,1G li 1 certify that I have read this application and state that the above PC FEE PERMIT FEE - $ _ information'is correct. I agree to comply with -'ell county N ordinances and State laws relating (,,to building construction,and _ _ - _ r U a3. hereby eu[hOrii@ representatives o6this Coll 3 . Fly to enter upon - - - ISSUANCE FEE > the above- lentionedPr ertY for' {pection purposes. _ a__Z�0n INVESTIGATION FEE TOTAL'FEE - - slpmonmMo .. - SEE REVERSE FOR EXPLANATORY LANGUAGE.