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Home My Public Portal About5026 DALEVIEW AVE_Building__ fbEPARTNIENT OF':BUILDING AND SAFETY, APPLICATION FOR PERNIIT COUNTY OF ICIS 'ANGELESBUILDING +SWM: J. FOX. CHIEF ENGINEER iFOR APPLICANT TO FILL-IN' ' , FOR OFFICE USE ONLY ' , BUILDI (y PIY DIBTR , PERMIT NO: NG ^ '4 P� ltblqlA r LOCALITY ��: {pry�CEIV ED BY f DATE O♦F(A�PPL. D TE ISSUED NEAREST ^ _ d. � a// I /.' ` �T�1'� �/ I CROSS ST: ilvtN ^,-W � A BUILDING SO Y� �4c {I�cl'�/ !/ y ADDRESS _ OWNER W1 ^', WDA&A � .py _ ,/ y MAIL- 'O oZ DRN� Y/ 'e �/� i¢ LOCALITY ADDRESS - NEAREST TEL /y CR0988T. CITY MR/ e C/ NOjf* .DIP'I FIRE NO..OF TY GROUP ARCHITECT OR' - TEL. -ZONE PLANS I m. -...�-T ENGINEER NO. - - '.SLOG. �•. �� ,o./ .ORp!N4 BLDG.SETBACK LINfi Y'7 ADDRESSAPPROVED` - - ' TEL. _ - BY DATE CONTRACTOR ,' I b. "� - USE APPROVED - ZONE By - ' DATE..ti ADDRESS ' ., _ - HOUSE NUMBERING LEGAL Qu DESCRIPTION 'LOT NO./jv/ BLOCK 'MAP NUMBER � IELO CHECK BY-' TRACT, •p.a,C NO. ASSIGNED BYy''e'��D��ATF _ NO, OF BLDG9. - CORRECTIONS NOW ON LOT 'USEOF. - NO. OF _ - EXISTING BLDG:, , FAMLLIES' DESCRIPTION OF WORK NEW . LALTERATION� I 'LADDITION - •^.T2 O - REPAIR I I DEMOLITION SO. FT. - NO. OF _SIZE,, , - ROOMS, / .- STORIES / Z EXT. WALL e 1. ROO ' - ' COVERING ,�Al C�o I COVEFRr ING UBE OF T UgT t' ® Xl E KiiY m ' oe-M f 3 o Gia: ct Q 0— )6 o 0'19 - APPROVALS., ION D /S • - lQ INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1- HAVE READ'THISIAP- FOU N DATI ON:,LOCATION PLICATION AND .STATE' THAT THE.INFORMATION GIVEN IS FORMS, MATERIALS 7��.• y'i��✓ COI AGREE TO,COMPLY WIT"! HE CORRECTIONS.-LISTED . .FRAME: FIRE STOPS, •� HEREON ANDWITlJ ALL COU. ORDINANCES AND STATE - BRACING, BOLTS- or /• LAWS REGU��L;�A{T{IIN�NG BUILDING ONSTRU TION. FURNACE: LOCATION, - SIGNATURE"OF,!/� � GAS VENT, DUCTS ' PERMITTED ! - _ , , ADDREHSSS ��" - -�'- 1 LATH, INT. Ly LATH, EXT. " L/. . AUTHORIZEDAGT. - - - PLASTER, INT. - w .. e O FEE Q PLASTER, EXT - VALUATION S ��6a FEE �� FINAL •t, 7GA638A 1 CE#ao- REV.ep.. ) - APPLICATION FOR, BUILDING PERMIT a' COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO'FILLiN BUILDING ADDRESS "'o" D«J ,tom-.tom BUILDING ADDRESS II� rGW LOCALITY L, b�-y-r. _LL., �l'..�1 LG NEAREST p CITY ` ` ZIP �(CROSS ST. �yry _. NO.OF BLDG$. ASSESSOR SIZE OF LOT NOW ON LOT- MAP BOOK PAGE PARCEL TRACT DISTRICT GROUP TYPE FIRE PRO ESSED BV+ v BLOCK' LOT NO. I L >/ CONST Z 4E _ TEL. � . t) •e3 Y OWNER G SE: NQ STATISTICAL CLASSIFICATION - SEWER MAP ADDRESS ' CLASS NO, 2- / DWELL UNITS G BK"a DG CITY ZIP ARCHRECT OR .� TEL, VALUATION' ENGINEER ADDRESS � �F-E Qsuo 0 BLDG.SETBACK FROM _ - TE FRO NT PROP,LINE OF (STREET) CONTRACTORAl N TOTALSETBACKF ROM TYPEOF EXISTING - .}IC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH ADDRESS � � � O.C�AC ' G� I LIC. CITY 4 CLAS$ —ln CONSTRUCTION LENDER BLDG.SETBACK FROM , NAME AND BRANCH Q SIDE PROP,LINE OF LSTREETI TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS . CITY HIGHWAY +-WARD = SIDE PROP:LINE IHIGHWAY WIDTH 0 SO.FT. ` NO OF NO.OF CHECK + _ - V SIZE STORIES FAMILIES - ONE - - O DESCRIPTION OF WORK ' ,NEW ❑ P.C.'Fee$ / (d /) Permit Fee r7- S(�� to, ADD - Issuance Fee 7 ydj .ALTER -.❑ Z G C—BZ,'V REPAIR ❑ Total Fee EXIS USE MG BLDG. - DEMOL ❑ �+ — _ y .• O O 21%O A APPLICANT - TEL Cy - - , F # 6 a e a 23 (PRINT) - O. \ CL"' Q , t ^�atm ° - 2 a a 2 t.6 0- BY(SIGNATURE) �. 1 U-S 6-7�'j I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICPtlO ND SiAif - m a a a 2 '.6 0 U THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCE 2 AND LAWS REGULATING BUILDING CONSTRUCTION,I CERTIFY THAT IN DOING T S OE LABOR COCl ED HEREBY I LL NOVEMPLOY CALIIFORNIA IN RELATING TO INVIOLATIONEA➢OO F -- Z 0.A"1 3-78 H ' - PENSATIONINSURANCE SIGNATURE PERMITTEE ,. ADDRESS - R 0 21. 1 A Z .. TEL. 0 # a a a a s . CITY NO. Q USE ZONE MA a 2 G * 3&00 > SPECIAL > a0634.00Uux CONDITIONSFINA - - f - -• - EL DA �- BENT OF BUILDING 'AND SAFETY APPLICATION FOR PERMIT "RE� LOS ANGELES ,p p p ® �n apo X, CHIEF ENGINEER Rl CEJ L RQ 155 LLJJ ICANT TO FILL IN FOR OFFICE USE ONLY ,/ DISTRICT NO. PLAN CK.NO. PERMIT NO. PA A �r RECEIVEDrBY DATE OF APPL. DATEIB9UED A lJ j� BUILDING OWNER s s- S ADDRESS p O �/) ll i1�/ d MAIL 9 -,/J� LOCALITY1 / j//�..n �,• /%//I . i A DDR EBB wwJ d .`t c 390. I` i CITY �ry S/'//V(YG'�«� ✓ E F RERE9T /.l 4 �/ 1./ �.. TEL. ECR0599T. (� „4/ �^ �( . „LNO:IF I TYPE—, GROUP < ARCHITECT OR TEL. r. *ZONE a PLANS - ENGINEER NO. ! -' BLDG. ♦ � � ORD.NO. . 'ADDRESS Y . SETBACK LI NE zil1.4+- , - �• L• APPROVED /J) TEL. BY / DATE CONTRACTOR NO. 54 USE45;7APPROVED ` ADDRESS ZONE_VdWC BY DATE'S AL DE9CRCIPTION LOT NO. BLOCK ..vv CO E/CYTONS a-� /)4� TRACT qD 1 �i1/ /f1.r-.S/Al/ G LAVI� L•`./ U / • / �� S1ZE OF LOT V /. NOW ONO N LOT l USE OF NO.OF I NO.OF EXISTING BLDG. FI L... ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O 1 A � REPAIR MOVING � I. -DEMOLIS//H��•/�'`!• - p 9D FT O ROOMS STORIEEO I A � D SIZE r WALL I ROOF COVERING GC D COVERING I A USEor ' BUILDFNGW / c4l D U {�l.I• - Y 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS ` APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION /INSPECTOR DATE AND AGREE TO COMPLY WIT ALL COUNTY ORDINANCES FORMS,MATERIALS /Ty{J.�L E -2 W 1 AND STATE LAS REGULATI G B ILDING ONSTRUCTI N. •mow FRAME: FIRE STOPS, O SIGNATURE OF BRACING,BOLTS i ,f.✓✓ U 3;tle J OWNER � tATH,INT.: i AUTHORIZED AOT LATH,EXT.: oe9-3 25N Sc S a-N $ P.C.S I PLASTER,INT. / r FEES PLASTER,'EXT. ��• A ` / / VALUATION / ��/ / • cFF / �!�� FINAL l/�' DEPARTMENT OF:BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES (� WM. J. FOX. CHIEF ENGINEER U ® O HS LLL111 FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAfi CK.NO. PERMIT NO. ADORES. V y�j A/ /T'V`{� d/ �� \' 1 -(-/ / '7�G. C LOCALITY O,y / /N''1 �/7//+��y RECEIVE'D/BY �I DATE OF APPL. �IDATE159UED NEARESTCROSSfreer 5-to V VRIf C7 /rV NEAREST. Q {^�5 BUILDING (/ n — n•^'__ OWNER ADDRESS / `/l�V/✓ t�f'/v1 MAIL ��//�� 1' /►�/. LOCALITY •ADDRESS ea NEARESTEL ^ O \ CITY B NCI. O CROSS 5T. FIRENO.OF TYPE GROUP�� ARCHITECT OR TEL. ZONE PLANE ENGINEER NO. BLDG. ORD.NO. ADDRESS SETBACKILINE J /� /��i /Y&I C/, _ TELAPPROVED - I r- 1 ' t . CONTRACTOR ND. BY DATE USE //�� APPROVED ' I ADDRESS \ ZONE'-I'i BY: - DATE LEGAL1 DESCRIPTION ULOTNOO.. /114) CORRECTIONS BLOCK �� ' TRACT NO.OF BLDGS. _ SIZE DF LOT Z L-� I NOW ON LOT USE-OF NO.OF I NO.OF EXISTING BLDG. FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION / _. ... A. REPAIR VIND DEMOLISH � 90.FT. / NO.DF .. .. JG Y"IrT, u Z SIZE ROOMS STORIES y WALL I ROOF .. V9 It:. .. F COVERING COVERING USE OF NEW BUILDING TA40 1 HEREBY ACKNOWLEDGE TH 1 HAVE READ THIS APPROVALS APPLICATION. AND STATE THAT HE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE - AND AGREE TO COMPLY WITH AL COUNTY0 DINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUIL G CO STRUCTIO d{FJ///A(/ AME: FIRE STOPS, SIGNATURE OF ik? '/ _ _ BRACING.BOLTS PERMITTE LATH, INT. AUTHORIZED AST LATH, EXT. 7SA638A 9J8 OBS-3 SOM SETS ,qf P.C.$ PLASTER,INT. ' / , m FEE PLASTER,EXT. VALUATION FEE �� V V FINAL WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self //(]�� D f(/,a //p�� I��pp �r�} 1��y �F1��lp�(y�� O �p}l��y�y/LT� JISI insure,,or a certificate of Workers' Compensation Insurance, ` ,APPdOC��T�0-UV Il �'ll�l BULD UV\l PERM"T or a certified-copyPolic �Lthereof Sec'3800,' ab. C.) - p (�f ! COUNTY,OFLOS ANGELES_ BUILDING AND SAFETY BUILDING - .Certified copyns"hereby furnished: FOR APPLICANT TO FILL IN 'ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department.department. ADDRESS LOCALITY - �,6_.. C%� - //�� pL 'y1 h NEAREST .Date-�^a� Applicant eY[P t+�M 1✓'0.►QfYr�tO CITY .ZIP V CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' IINO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT - NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed,if the permit is for one TRACT BLOCK LOT NUSE ZONE MAP �CS hundred,dollars ($100)or less.) O. /J INC. 'TEL - F- SPECIAL - - .} I:certify that in the performance-of the work for which this OWNE (r ' �NO. CONDITIONS - 6 permit is issued, shall not employ any person in any manner - - DISTRICT .GROUP TYPE FIRE PRO9ESSED BY O ADDRESS CONST. _ ZONE % U so as to become subject to the Workers'Compensation Laws. - - T, O 'C•r/�(� yr Date Applicant' - CITY ' ZIP STATISTICAL CLASSIFICATION APT. CONDO. 0' - ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after-making this Certificate of W- p you should become subject to, the Workers' ENGINEER a -' NO. ✓ CLASS NO. DWELL UNITS_ Exemption, y I � d Compensation provisions of the Labor Code, you,must,forth- 10)SEWER MAP Z with comply with such-provisions'or this permit shall be - - - -- deemed revoked CONTRACTOR NO. N BK PG• VALIDATION,. LICENSED CONTRACTORS DECLARATION_ ']� LIC - hereby affirm theta am licensed under provisions of Chapter 9 ADDRESS .$( NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and (f,., LIC. Professions Code, and my license is in full force and effect(- CITV LOW& 1.17 CLASS 1 ({ 50. F NO.'OF NO.OF - CHECK _^ D L ._ License Number ALL b�( Liic Clas�Ts(� SIZE STORIES FAMILIES ONE 7 6 6.9�A" Contractor 1 ell/(J fQQJylt.f.T77,a Q- DESCRIPTION OF WORK NEW �I $ Q I am exempt under Sec. - V- - '1� ADD f'❑" '2�e-,e 9 l.'8.0 ALTER ❑ FINAL B.BP.C. for this reason REPAIR ❑ .DATE USE OF Date: EXISTING BLDG. ❑ BYAL. DEMOL _ - 1050 3.-'0 Signature APPLICANT --TEL. AT _. OWNER-BUILDER DECLARATION (PRINT)ffXV_ 'NO. O _. 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason.(Section 7031.5, Business and ADDRESS - - -Professions Code): - - PRESENT - ❑ - I, as owner of the property, or my employees with BUILDINGADDRESS wages as their sole compensation,will do the work and y{-J �g• .� - the structure is not intended or offered for sale(Section LOCALITY .� , 7044, Business and Professions Code). - MOVING TEL. l.� ,(' 1 51!Q A 1, as owner of the property, am exclusively contracting CONTRACTOR NO. 2. V' " `� e e with licensed confractors'to construct the project (Sec- ADDRESS 'tion 7044, Business and Professions Code). t 1 REQUIRED ' TOTAL SETBACK FROM EXIST. ' -2 -.7,2.a.21 CONSTRUCTION LENDING:AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT D/t _ j°t°t7,2.8.2 J o the performance of the work for which this permit is issued ' P.t. - - P-' (Sec. 3097, Civ. C.). SIDE O `5, m Lender's Name, I $ - P.C. Fee'$ ��/Q ,�v^Permit Fee - - - Lender's Address x - rc I certify that I have read this application and state-that the / LI -S O - - fT PP, r Issuance Fee � - �� above information is correct. I agree to comply with all County Investigation Fee g '-ordinances and State laws relating to building construction, v and hereby authorize representatives of this County to enter Total Fee - upon the above-mentioge .property for inspection purposes. oex , a1- 1�r-i3 • SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or nt Date es WORKERS' COMPENSATION DECLARATION EI�Y p 1 sureba affirm that I have r certificate of consent to self APP LOC!/ VO rN FOR B O ®O G PER( {T insure, oro<artilicate of Workers' Compensation Insurance, u u�' [��J LL,, u�' [�d� u or o certified copy Ihereof (Sec. 3800, fob. C.) • � r: y ! COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo y Company ; ir . _ 0 Certified copy is hereby furnished, FOR APPLICANT TO FILL IN ADDRESS � �� r> - -'? r / v '-• '-r.�(i.--` Certified copy is filed with the county building inspec- BUILDING _ r-... lion-depoHment. - —_— — -___. ADDRESS- lY_"'.--r L-' Y-� 1 -1 -u i,1. 1 :- LOCALITY •-_ _•_ ;'. '..•.•: .• �., - 1 / NEAREST Date Applicant � t'..0 ;1.<• (L>. - (:. CITY 1 1 " ZIP --f I " L CROSS SL - CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL USE ZONE MAP (This section need riot be completed if the permit is for one hundred dollars ($TOo)or less.) TRACT BLOCK LOT NO .-- NO. TEL. _ ,� SPECIAL ' 'r r / 1' ' I certify that in the performance of the OWNER- i, L work for which this y I NO. a CONDITIONS J peril is issued, I shall not employ any person in any manner _ DISTRICT GROUP TYPE FIRE PROCESSED BY r so as to become subject to the Workers'Compensation Laws. ADDRESS _ °' ±' _ CONSt. ZONE r CITY ZIP r;.. p_ Data Applicant - I STATISTICAL CIA551FICATION APT. CONDO. 5' ARCHITECT OR TEL. 'NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER �..)I. t_l NO.r lr 'CLA55 NO. - Oweu. UNITS_ Exemption, you should become subject to the Workers • 6,1 • Compensation provisions of the Labor Code, you muss forth- ADDRESS L i` F ' r...'-.EI t.. (-'-fi'; 1 �- SEWER MAP i with comply with such provisions or this permit shall be - ' .deemed revoked. 'I-` L'i_, . TEL..t. _ y' VALIDATION .. CONTRACTOR i�f•.:'!t� I .'..V s•`.y'--NO. `''14' '% •� BK. ' ' PG, • LICENSED CONTRACTORS DECLARATION 1 I,Fseraby affirm that I am licensed under provisions of Chapter 9 ADDRESS - - -+ �'J'y. t (" I NO. I I �' VALUATION (commencing with Section 7000)of Division 3 of the Business and r Professions Code, and my license is in full force and effect. CITY �! 12 LIC I `A 11 CLAS$ " T SO FT.� _ NO OF NO. OF CHECK License Nu myber it�" ,- I IL Lic.Class 1' SIZE "`i STORIES - FAMILIES ONE ' .` ,t •I1..R C.C�1f t.,. Xli... DESCRIPTION OF WORK NEW $ S/ i `� �'✓ e'.ee,• _ 'Contractor ''+`'dale �:�a ".^r_ c_.T srs.j.,l _� �', I _ ADD ❑ ;% • • •i I:.I' am exempt under SBC. - ALTER ❑ FINAL _ .. -' .!- I �; '.( r �_. ❑ DATE e'. • B.SP.C. for this reason REPAIR Date: UZit Ur EXISTING BLDG. / c-r. !_. DEMOL ❑ FINAL 0 Signature APPLICANT ice,`�,C C - TEL -- BY OWNER-BUILDER DECLARATION PR N, i. •I., v NO. i t _ READ CAREFULLY ,r- I hereby affirm that I am exempt from the Contractors license THIS APROCATION 15= A' BURPING Law for the following reason (Section 7031.5, Business and ADDRESS `!�I. : !� PERMIT WHEN PROPER f(LIED OUI, Professions Code): E N SIGNED,. pND:.MACHINE VALIDATED BUILDING FOR THP"CORRECT PERMIT FEE IN THE I, as owner of the property, or my employees with ADDRESS =ATIpJJ SPACE. PERMISSION IS wages as their sole compensation,will do the work and THERETOTtE GRAT17, IO •pO SUCH WORK AS INDICATED IN THIS APPLI _ the structure is not intended or offered for sale(Section LOCALITY CATION, IN ACCORDANCE WITH, AND 7044, Business and Professions Code). MOVING TEL. SUBJECT TO'ALL OVTHE PROVISIONS OF ❑ . ' I, as owner of the properly, am exclusively contracting CONTRACTOR NOTHE euILDING--CODE; ORDINANCE f{ e e e s•e with licensed contractors to construct the project (Sec- #2225 OF THE COUNTY OF LOS lion 7044, Business and Professions Code). ADDRESS ANGELES,AND RELATED LAWS. ,- r REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH THIS PERMIT BECOMES NULL AND VOID c Y I hereby affirm that there is a construction lending agency for FRONT IF WORK IS NOT COMMENCED WITHIN the performance of the work for which this permit is issued P.L. 120 DAYS FROM THE DATE OF ISSUANCE (Sec. 3(N7, Civ. C.). SIDE OR IF WORK IS.SUSPENDED AT ANY v C rs.J m P L TIME DURING CONST6UCTION FOR V ` MORE THAN 120 DAYS, OR IF ANY Lender's Name - - - WORK IS DONE ON THE SAID BUILDING $ /•,� I -/ OR STRUCTURE IN VIOLATION OF ANY Lender's Address P.C. Fee$ �..) ` L' Permit Fee T COUNTY ORDINANCE OR STATE LAW W RELATING THERETO. I certify that I have read this application and state that the f -' a Issuance Fee ' a abovo information is correct. I agree to comply with all County Invastigotion Fee - _ A ROAD DEPT. PERMIT IS REQUIRED FOR ordinances and State laws relaling to building construction, Tosal Fee ' T �? .r; ANY MATERIAL STORAGE OR 'WDONE IN THE ROAD RIGHT OF WAY��. u and hereby authorize representatives of this County to enter upon the above-mentioned.froperty for inspection purposes. • '\ (, j ; r ��_;;.., -. _ P - SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Lgten b- - Dote •'Gs wWORKERS' COMPENSATION DECLARATION - �I,hereby affirm that I have.a certificate of consent to.self Q O �(/,� ///n0(��`� �rr�lI��Ipp�� gyp} �pPyp� PER �9❑L� insure or a certificate of-Workers' Compensation Insurance -��PL6�(/"tl .�®ll'V 11 ®�_ BU��D�8'V'�'. 11 IS 11 X10 T711��:: ; or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS 'ANGELES ' BUILDING AND SAFETY Com an -'ZiFEz✓t fH s:. •, .. ». » --.Policy No p y BUILDING "�❑7. Certified copy is hereby Furnished., , FORAPPLICANTTO FILE-IN ADDRESS Certifiedcopy is,filed with the county building'inspec ' ' BUILDING - - - - - • r - - - - tion department. .• ADDRESS. - -, iii.. _ bate-1-9 TApphcanr ��+� � �- CITY fGT��L4 Gift zIw `�I/7gp r� LOCALITY - - __ ...... -. .NO OF BL)GS..: '.+., ,-- NEAREST _ CERTIFICATE OF EXEMPTION FROM WORKERS ».'_ SIZE OF'LO7 : NOW ON LOT-, CROSS ST. ^�• -"COMPENSATION INSURANCE r' - - - • _ ASSESSOR _' _ .. This section be�<om leted if the erm it is for one- � - � � • MA.P 600K ��"'+ `� ( P P TRACT BLOCK LOT NOr PAGE PARCEL "hundred dollars ($100) oi' less ) .;°- ' / • TEL. { .: •. ''- OWNER '�7/Gp� ISO✓"NO. S-M USE ZONE , MAP I certify that in,the performonce of the work for which this - - �f o NO: SPECIAL ,permit is issued, I shall not employ any person in any manner - ADDRESS Sd ZCo -- N•- 'INRs-'EV 1G1..! CONDITIONS l �' so as to become subject to the Workers'Compensation.Laws. - - O ' - - CITY .fG-1 Ft-Io 6t1 . :tip 9./.72o .. - v Date - Applicant ` - '' ARCHITECT OR TEL. Ol NOTICE,TO APPLICANT: If;'after making this Certificate of ENGINEER. JArW.S -C;,Y --NO. - r ST . CONST. , ZO 'E 0 . Exemption, you should-•become subject to the'Workers ' + - D V' ((�� RIOT G OUP FIRE ROCESSED BY 11� �,deem r v . .P Y .. _.: CONTRACTOR. ZG % LG AVN F , . •. O3 '. N .Com ensdtion revisions of the Labor Code ou must forth ADDRESS h2 with comply with such-provisions or .this permit shall be TEL. STATISTICAL CW$$IFICATION APT CONDO Z ed evoked. ! Low NO. S/�'ZS.� v_/\ LICENSED CONTRACTORS DECLARATION - - E+ UC. CLASSNO.�DWELL.UNITS -° hereby affirm than am licensed under provisions of-Chapter 9_ ADDRESS /� 'J• C2ENS.9Lam' NQ Z'�Z-11I - LIC -/ SEWER MAP (commenting with Section_7000)of Division 3 of the Business CITY (19rL120--A' CLASS if(0 It and Professions Code,:and my license isin full forceand:effecf.y BK, 'PG , :`VALIDATION" 23Z'//( - SO. FT. 'e NO. OF NO. OF CHECK ' _ 'License Numbei Uc. Class Gfol" SIZE ZZ.0- 'STORIES I FAMILIES / ONE . /L- .. _ VALUATION' "t Contractor -btfV�'O"' t Date• DESCRIPTION OF WORK Ii.VGc-O'$I - ,NEW ❑� / , _ - _ - ADD .CJ 'S •I,CJO ❑1 aim exempt under Sec. _ G '.lsTf l�ATtD CpJ - J . El ALTER_ 8.8P.C. for this reason - REPAIR $ Date: - APPLICUSE,OFANT' _. . - ❑ l`V ;1 �V - EXISTING BLDG., DEM ❑ ,Signature APPLICANT' TEL - FINAL OWNER-BUILDER DECLARATION - (PRINT) ScoT CoCEJE.r-•c• NO.$rf$ q ... DATE hereby affirm that I am exempt from.the Contractor's License ADDRESS , II4p- ..C 6Nf2Q .. l.,/AL✓uf 1 ; 'Law for the folldwtng.,reas_on.(Section7031 5, Business and FINAL' Professions Code) Pi .. - • •• - - . By ., BUILDING �.a 1 ❑ L'as owner.of theProperty,* or m em to employees with ACCT �r . Y P Y ADDRESS, _ wages asineir sole compensation; will do the work and '- - '- - - - ," - •��, LOCALITY 36 4� the structure is riot intended or'offeied.for sale(Section > , 704, Budiness,ond Professions Code.) - MOVING' , -TEL D'•... ' " - ,'' I ITEM' ❑ I;as owner of the property, am exclusively contracting CONTRACTOR NO. v 6 .with licensed contractors to construct'.the project (Sec - ADDRESS - - TOTAL .491--B'' "tion 7044,.Business and Professions Code.)., - - f(I� p ' [[� REQUIRED- NOTAL SETBACK FROM EXIST. - - - 'h! ` t.HEC.y "FJ•✓L CONSTRUCTION LENDING AGENCY r .. SET BACK YARo ,HWY p PROP. LINE WIDTHr Thereby affirm that there.isra construction lending agency for .FRONT + -. - - _ : - . . •- _ (:RANGE .011. the performonce of the work'far which this permit is issued P L - (Sec. 3097, Civ,.C.). - - SIDE :: 'r ,. Lender's Name •� 8 ' 'P.C., LOMA Ref. a. . . 0000 OOG1 9/ °/°9 Lender's Address - Fees Permit Fee + 3 X81 ] AM 9:jif I certify that I have read this application and state that the Issuance Fee r�O LDMA P/CN D - 8' above information.is correct. I agree to comply with all County investigation Fee'• _ _ -, . . . . R• , ordinances and $tate laws relating to building construction, Totfil Fee' • LDMA Perm. p: , a and hereby o horize representatives bf this County to enter 1 upon'the obo e- a tjb/ye�'property for inspection purposes - o . ///FQV/!A SEE REVERSE FOR EXPLANATORY LANGUAGE Signature'of Applicant or Agent _, - .Date t� COUNTY OF LOS ANGELES TEMPLE CITY p 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91980 BL 0508 1211070023 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST NEW HUILDING_ADDRESS: _ _ ITR: 2.4020 IT 16 SQ. FT STORIES TYPE OCCUP GROUPI 5026 DALEVIEW AV 1 I (STRUCTURE: 285 1 V-H R3 I TEMP CA 917803519 (ASSESSOR INFORMATION NUMBER: I GARAGE: NEAREST CROSS STREET: GRAND 18574-007-016 I OTHER: _ THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI I TENANT: EXIST BLDG USE: PV SO (ISSUED ON: PROCESSED BY: I (EXIST OCC GRP: R3 111/07/12 SR I TOWNER: TEL. N0: 1BLDGH. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: 1 GARRISON, HILDE (626) 82]-9]10- 20,000 1I �7 15026 DALEVIEW AV IT�ON OF WORK ITEMP 917803519 FEES PAID ESOT I I I INSTALL (19) ROOF MOUNTED V SOLAR PANELS (19) MICRO-INVERTEI I IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IRS, (1) SUB-PANEL, (1) AC DISCO AND CONNECT TO EXISTING MAIN I APPLICANT: TEL. NO: I ISERVICE PANEL I ILEBEAU, DAN (949) 872-5658- AA BLDG PERMIT ISSUANCE 2].80 1 1 1310 PALM ST UNIT A JAR STATE GREEN BLDG FEE 20000.00 VAL 1.00 ISPECIAL CONDITIONS: I IBREA CA 92821 IP1 RES PV PCIIGKW 153.90 IP2 INSPCT RES PV 110KW 138.00 1 TOTAL FEES 320.70 CONTRACTOR: TEL. NO: 1APPROVALS PATE INSPECTOR SIGNATURE (CERTIFIED SOLAR PROS INC (949) 872-5658- 1 1310 PALM STREET LIC. NO ILOCATION AND SETBACKS 1UNIT A 934858 1 . HREA CA 92821 ISOILS ENGINEER APPROVAL - I I PI I I ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR - RAISED FLOOR FRAMING III III I I NAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP JUNDERFLOOR INSULATION 3 001 1 1 I 11ST LEVEL FLOOR SHEATH INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 NO 20- 12ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING 1ALR QUALITY: 1000 FEET MATERIALS 1 NO NO NO IFIRE DEPT. FRAME INSPECTI I I I I I (BLDG DEPT. FRAME INSPECTI I ' - , ISHEAR PANELS INSULATION/WEATHER STRIPI I -111 (INTERIOR LATH/DRYWALL I I I IEXTERIOR LATH I I I (LOT DRAINAGE I I iSMOKE DETECTION DEVICES 1 1 I (FIRE DEPARTMENT APPROVALI I* ADDITIONAL DATA ON FILE IREPORT ID: DPR261 ' ROUTE TO: BS0508