HomeMy Public PortalAbout4843 DOREEN AVE_Building__ 761.538ArCF #803 3.69 /
APPLICATION FOR BUILDING PER-MIT
• COUNTY OF LOS ANGELES BUILDING -`
DEPARTMENT OF COUNTY ENGINEER AooRE 55 �.. 4_2!5:Ac-tv
BUILDING AND SAFETY DIVISION LOCALITY •/j Iry
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST A
COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. �/` _ L7 le 0
DISTRICT NO. GROUP TYPE C NST: PROCESSED BV
FOR APPLICANT TO FILL IN
(PRINT OR TVP ONLY( • O
BUILDING / STATISTICAL CLASSIFICATION SEWER'MAP
ADDRESS AL - -
CLASS N0: ILLDWELL.UNITS_ BK ' PG
LOT NO / (f7 !�w USE ZONE MAP
�f ( NO. Q
TRACT (j jr'— SPECIAL ,o
' NO. OF BLOCS Q CONDITIONS —
SIZE OF LOT NOW ON LOTUSE OF
EXISTING BLDG. BLDG. SETBACK FROM A^ - /
�T EL. FRONT PROP. LINE OF Q_[!��-F.N •�J>L ''(STREET)
OWNER N0. TYPE OF EXISTING SETBACK I HIGHWAY' 'F YARD = TOTAL.
ADDRESS �'f pq�- HIGHWAY WIDTH FROM C.L.
CITY
ARCHITECT ORTEL. BLDG.SETBACK FROM
ENGINEER or N0. S1DE PROP. LINE OF (STREET)
TYPE OF E%(STING SETBACK HIGHWAY i YARD = TOTAL
ADDRESS HIGHWAY wID TH FROM C.L.
TEL.
CONTRACTOR NO.
O_
ADDRESS NO. CORNER CUTOFF YES L] - NO --- - 0u
LIC.
clTv w CLASS SE REVERSE SIDE_ FOR PEC A APPROVALS
CONSTRUCTION R4� u
NAME AND BRANCH < >6 w
2
ADDRESS b L 9G " °/ �"`LV-'7 Z
SO. FT. N0. OF N0. OF %
SIZE ^ STORIES' FAMILIES NEW cl
USE OF ADD 1�
STRUCTURE
/� /A�%%/� //�A ALTER C]
/TY/� /rG/ xl s REPAIR
SIGNATURE OF DEMOL
APPLICANT -
VALUATION $ / APPROVALS DATE INSPECT 's WqYUPE
FEE 5 FEE $ 7J FOUNDATION: LOCATION qq qq V
FORMS MATERIALS ✓ V 'K
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS,
BRACING BOLTS •» .
ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY :
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- FURNACELOCATION,GA5 VENT DUCTS
TION. I CERTIFY THAT.IN DOING THE WORK AUTHORIZED HEREBY I
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. �J•p''A{p� A,✓{A�
OF THE STATE OF CIFORNIA IN R LATING TO WORKMEN'S CO -
PENSATION INSURANC
SIGNAI LATH, EXT.
TURE OF
PERMITTEE O•� HOUSE NUMBER CORRECT
AND POSTED /
A00RES / f.� FINAL r4
JOHN'F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VA DATION M.O. ASH - PERMIT VALIDATION CA,. M•0 CASN
I�(,4 9 0 09 Myl2 1 D 2 7.75r
CITY OF MNiPLE CITY
76A638A CEA8038-6R APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS-ANGELES BUILDINGO �F
DEPARTMENT OF COUNTY ENGINEER ADDRESS /J
BUILDING AND SAFETY DIVISION LOCALITY / c/
JOHN A. LAMBIE', COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,BUP'T.OF BUILDING CROSS ST.
DISTRICT I GROUP TYPE. PROC SED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL DW
SSIFICATION SEWER MAP
ADDRESS 4843 N/ Doreen. Y p GLASSNO. BK PG
� ELL UNITS
•
LOT NO � r5-` ICK USE 20NE MAP
TRACT l NO.
/ SPECIAL
SIZE OF LOT i E N0. OF BLOOS. Cj CONDITIONS
2FS 7 ✓ NOW ON LOT
USE OF
E'I'T'
G BLDG. SETBACK FROM
TEL. PRONT PROP. LINE OF AI /%F. (STREET)
OWNER George HUieClll NO. TYPE OF 'EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS'4843 N. Doreen HIGHWAY WI FROM c.L.
CITYTemple City 'c w.a (,a' 1 1 +
ARCHITECT OR TEL. BLDG. SETBACK FROM _
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF I EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS � HIGHWAY WIDTH iROM C.L. 1
CONTRAR464d Flfg. Com an N,` 263-5181 + - _ O
ADDREss337 S. Woods Ave. K`Icl59496 CORNER CUTOFF YES E] NO O
CITY Los Angeles LCLASS ID C 39 SEE REVERSE SIDE FOR SPECIAL APPROVALS u
w
DESCRIPTION OF WORK w
Z_
NEW ADD ALTER REPAIR X DEMOLISH
SQ.FT. NO. OF NO. OF
SIZE STORIES /FAMILIES
USE OF /3 L?
Al
STRUCTURE /
SIGNATURE OF
APPLICANT
VALUATION$ 140,00 APPROVALS DATE INSPECTOR'S SIG NATURE
P.C. PMT. FOUNDATION, LOCATION
FEE$ FEE$ FORMS, MATERIALS
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND.STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDING CONSTRUCTION. 1 CERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIDLA- LATH. INT.
TION OF THE ABOR CODE OF THE STATE OF CALIFORNIA RELAT
-
INGTO W EN'S O PE f{04 TION l NSURANCE. va
LT"
EXT.
SIG R Y25HODS NUMBER COR-
P MI TE T AND POSTED A
ADDRESS -FI NAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION EK. M.D. GASH _ PERMIT VALIDATION cK. wo. GASH
LPILo2 5 7 1Q3 LE028 1 D 6.0)0
%sit/
DEPARTMENT OF BUILDING AND SAFETY'. APPLICATION FOR PERMIT .l
COUNTY OF LOS ANGELES ® � B
L
WM. J. FOX, CHIEF ENGINEER N�
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDIN �..,a a - DISTRICU/O.` PLAN CK.NO. PERMIT NO. r�
ADDRE98 F�-y-.c_I(/ ` -7 /-, 41A
LOCALITY a RECEIVED OATOF v/w I DATE ISSUED-
NEAREST
95U�
NEARE8T ' ) .�'C�//JNA C/�6/y/ /
CROSS 9T.
UILDING
OWNER F//,. (J ADDRESS �W.. �
MAIL. 7/�/ . -'LOCALITY ] , /� _�/ /r� //11 LY
ADDRESS .� i//(,(/ r
NEAREST 1 I`�` ' g
TEL. CR09B ST. Lp
CITY ND.
.+ FIRE NO. OF TY�PE/�/ GROUP
ARCHITECT ORS TEL ZONE PLANE
ENRINEER -•ANO.
BLDG. �r / � ORD.NO
ADDRESS � „ SETBACK LINE
CONTRACTO IpLGa./� NfY / �JJ(�AJ� �my
,PROVED DATE
ADDRESS � �1LJ L_(O°[i7� J ,[A�V/ I
USE APPROVED
a ZONE BY DATE
LEGAC
DESCRIPTIOON� LIT NO.. I�y �B�dc fT7 ' C�ORRECT/ICONS,J
TRACT /.11dry y9,�Q • I _.,�f F-1���.Y_ /'%-F_ 1.... !a'I �h
6/ISS l`-O I NOW ON LOT
SIZE OF LOT
USE OF �� NO.OFA NO.OF
EXISTING BLDG. FwNI UES I ROOMS
DESCRIPTION OF WORK
.NEW �� ALTERATION ADDITION '
I a
REPAIR MOVING DEMOLISH
SIZEFT. / NO.OF ! Z
SIZE ir' ROOMS J STORIES / Z
COVERING � COVERING �wJI.LRA2��',
Y
USE OF
NEW
BUILDING -
y
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATION: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FIRE STOPS.
SIGNATURE OF ® BRACING,BOLTS �i��/E✓ i
OWNER jI`6`lr� / �s LATH,INT.: �. �rC//-V
AUTHORIZED ABS �^''� `
LATH,EXT.:
OBS-3 25M SETS I-47 $ P.C.6 +/� PLASTER.INT. / +
' 'I`.
PLASTER. EXT.
VALUATION �/L� �""-'FINAL
FEE
DEPARTMENT OF BUILDING AND SAFETY APPLICATION "FOR PERTSIT
COUNTY OF LOS ANGELES f�[� n lJ(� n ® INS NS
WM. J. FOX, CHIEF ENGINEER I IJVJ V LLLJJJ
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY t
DISTRIC,T.NO-„ PLAN CK.NO. PERMIT NO.
BADD UD RESBDIN
LOCALITY E is ED
�a_J RECEIVED
/� DATX OF/ L. A,T� �
NEAREST /
CROSS 9T.
BUILDING
OWNER
/_ /iy( /Ft ADDRESS
j� �/�L,f
MAIL LOCALITY
ADDRESS
NEAREST
TEL. CROSS ST.
CITY NO.
FIRE NO.OF TYPE GROUP
ARCHITEERT OR ��}�/ NO. Z
ENGINEONE PLANS
SLOG. ORD.NO.
ADDRESS SETBACK LINE i
APPROVED
TEL /
CONTRACTOR NO. BY N Od DATE
USE /,�//- APPROVED -,"DATE
ADDRESS
ZONE —
LEGAL �/ -/ CORRECTIONS
DESCRIPTION LOT O.ov BLOCK // 0 (/ O
TRACT
NO.OF BLO69.
SIZE OF LOT'S 2 M;Z X/-7 V NOW ON1LOUSEOFT l
EXISTING BLDp.!/Y.107/I Y-I F H�[B) I ROOM. v `
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
O
A
_ REPAIR MOVING DEMOLISH
SO.FT. / NO.OF ' Z
SIZE �f(..Jf� ROOMS STORIES / y
WALL �y.�/ � � � �� ROOF �� F
COVERING '%1/`"^�WI COVERING 1
USE OF NEW)
J
r
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THI.. APPROVALS
APPLICATION AND STATE THAT THE ABOVE 19 CORRECT. FOUNDATION: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS /
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. �O
FRAME: FIRE STOPS,
SIGNATURE OF BRACING,BOLTS
PERMITTEr LATH,INT.:
AUTHORIZED AOT I
LATH,EXT.:
Des-3 SOM SETS 7-47 IS P L. $ PLASTER. INT. _
FEE I PLASTER,EXT.
c VALUATION O FEE FINAL
ADDRESS
APPLICATION LOCALITY
NEAREST
DIVISION OF BUILDING AND SAFETY, CROSS ST. wAFn w r
Department of County Engineer DISTRICT NO. RECEIPT NO✓ PERMIT NO.
County of Los Angeles Jr ,7 T aj?/
WM. J. FOX, COUNTY ENGINEER OflOUP DATE RECEIVED OATEISSUED
CA9BATT D. SRIFEI N, HUP'T DF BUILDING /
FOR APPLICANT TO FILL IN ' TYPE CO HT. RECEIVED BY 89UED BY�
OWNER Fjq�!'PS' r a o Th k
{,./1 /�L_ y� MAP STATE
J MAIL ! �J\AN �A�/IH FN J NUMBER MWY YES NO
ADDRESS cr=,
LL_�I rI' c USE ZONE SPECIAL
.ITV /,K C 1./ y rypl' ^ CONDITIONS
ARCHITECT OR TEL.
NO.
BUILDINp YARD HWY STREET NAME EXIST.
ADDRESS SETBACK WIDTH '
/� / /� 1 r L ,{ FRONT � O/ /QOC
CONTRACTOR JI D /y ,/J /�OO NO.
���V ( n _p.L.
�r ray SIDE
ADDRESS//°.t66 /31' //4 /VT/� � FI/O�/4 P. L.
I _ DATE CORRECTIONS INSPECTOR
BUILDING /1 P N S
ADDRESS �] ,
LOT NO.PITA ,cam
4Ut�r�,0s1 / BLOCK G/��✓TydO /
TRACT )3 � CIG^ J j'`�
SIZE OF LOT, I,rj J 76 NOW ON LOGS
USE OF P� L 4j / N l✓AJ�fI I�N(�'� //LI 9
DESCRIPTION OF WORK ^y SfiL ,t. G.. O
NEW ADD /-- ALTER REPAIR DEMOLISH Z
SO. FT. ,q./� NO. OF NO.OF
SIZE STORIES FAMILIES
USE OF STRUCTURE
CIVIC k '
NO.OF
EMPLOYEES i
I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN IS APPROVALS INSPECTOR'S SIGNATURE DATE
CORRECT.
IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS, MATERIALS H Lug. J
�j FRAME: DPH.
SIGNATURE OF A/S iii� ��1 BRACINGG,,BOLTS
PERMITTEE ��✓✓���WW «""cc"" rL�'�I- �f
FURNACE: LOCATION,9
K•st/dWl �' 2"[ ,(
ADDRESS / �:a� rAd J-LArdNT, "
• ✓7
AUTHORIZED AOT f7 LATH, INT.
$ �� =P'
LATH, EXT.HOUSE N MBER COR-REST NUMBERTEDiw. ��
FINAL
76A638A D85 3'!Bb 5.54 '
AOBS-9
11-55 APPLICATION FOR BUILDING PERMIT
11-85
DIVISION OF BUILDING AND SAFETY BUILDING i
Depmtment'of County Engineer ADDRESS r
County of Los Angeles LOCALITY f'
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN. SUPT OF BUILDING CROSS ST.
DISTRICT NQ. OUPTYpE SEWER MAP
FOR APPLICANT TO FILL IN ONST/tl ; BKAPDRF3 PG
BUILDING `}/ Q /a / / 7 c� /- MAP STATE
BUILDING
5 r.l V , /IJSPEC
Ct ^�1/O R l_. a R — NUMBER �OIQ HWY YES N
LIY4 -. �i C� 5,�7�s'OF CK USE ZONE GOND TI ONS - Llp I I� pa-TE OF
p C Jl ,6 '3'
_ NO.OF SLOGS. BUILDING T O-� EXIST.
SIZE OF LOT .FjC X 1�� O NOW/O�N�LOT
gL. SETBACK YARD HWY STREET NAME WIDTH
USE OF \/\I C_ 1 I �)\I \T �Y
EXISTING BLDG. �1 GSR FP. LT f•_ ���L rpb
OWNER L; : i�n (�_` SIDEMAIL
�J
' ADDRESS ^-��J : /J 'x
J A I\. r �I- �V.� f O TRACT DWELL. 1 UNIT
TEL. 5 INDUSTRIAL
CITY �" M P L NO. 1 DWELL. 1�� UNIT
ARCHITECT OR TEL. P DUPLEX 2 UNITS 6 PUBLIC BLDG.
9 ENGINEER NO. 7" 3 APT. _UNITS 7 ADDN.,ALT., ETC.
y _ y.
ADDRESS ,(,� f ,Ar IJ / 4 COMMERCIAL 8 MISCEL.
CONTRACT0 Cc /LLNO. -Gr{ c 1 INSSPECTION RECORD
ADDRESS41 I� Y�I��'IA '��ILL"'Q-� FO 1- J,F:
DESCRIPTION OF WORK
NE ypADD ALTER REPAIR DEMOLISH �/s • hP G� / ��e
SO. FT. NO. OF NO. OF /�S✓ l (�•fi1•
SIZE STORIES FAMILIES_I_ //.G� �2e ✓�/
USE OF STRUCTURE j /'/'
N'v Iv/ P. /Yn �`iL��lc as
SIGNATURE OF
APPLI1� S r`'y •APPROVALS
CANT• O 'ADDRES p � 'C- DATE INSPECTOR'S.SIGNATURE
6 !, P. G. $ O F FORMS.MATERIALS LOCATIONNA ((1r-1--3� I�ja vyl /A✓I,
FRAME: FIRE STOPS, �C
VALUATION $ O G BRACING, BOLTS
FEE FURNACE: LOCATION.
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT. DUCTS `
APPLICATION AND STATE THAT THEIASOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT.
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. LATH. EXT.
r
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE '-�� RECT AND POSTED
ADDRESSF-/a_A FINAL IB�aa•A
JOHN A.LAMBIE. COUNTY ENGI EER VALIDATION CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR.
CK MO CASH
I ;SCO 8 7.9 1 'UAUG 1 16 � �4_ .0 0 1. 1,I 8.0 0 "
:_Zr
d
insure or kTXE S'C of
DECLARATION - - 4:1 S. '- •_ . .,..._ ..._,I �.._/ ,. _ _•YS ' ``- - -.+.. _,_.._. ... ,
WORkERS COM �/�
ti$.here, or affirm that have rr certificate of consent to self d"L PPUC /n� TNON FOR �p n n�n ® NIG PE��`�, T s {
` Workers' Compensation Insurance (/'� u (/`� u`� DU LUJ LL u� u�u
or 6,'certified copy thereof (Sec 3800, Lab. C-)`9 ' -•- -. -�- _ .. _ .._
• • • - COUNTY OF LOS ANGELES BUILDING-AND SAFETY . -
Policy No. Company -- - - - - - - - - -- - -
0... Certified copy is hereby furnished.. FOR APPLICANT TO %L IN- ' - - BUILDING
N
ADDRESS&riified w
copy is filed: ith the county bwldinb inspec "-" BUILDING
z'jC; - � /t!_
• - tion'department• : S• ,v ADDRESS 7 / s p ..-�,,," t �'' • I '
Date r t` `APplicanf - CITY LP LOCALITY
n
CERTIFICATE OF EXEMPTION FROM WORKERS' -' • "-' "r' - O.'OF BLDGS.- - E NEAREST _
W U COMPENSATION INSURANCE` ••- - SIZE OF.LOT ' NOW ON LOT CROSS,STr. "L ��u' -
(This'sectiom:rieed not be"kompleted`if-the permit;isJorrone. - - - �� - - - - ASSESSOR '- -i" .rt .•. ;x,
hundred dollars ($100)or less.) - TRACT -�- BLOCK- '� LOT NOr '� - MAP BOOK'" - -d4 PAGE PARCEL
TEL
OWNER. _ L'a cL NO. ✓U' -7' USE ZONE MAP
I;ertify that in the performance of the work far which this NO. ,I}
permtl is Issued, (shall not employ any person in any manner _ r i EP(� C- SPECIAL -• -• -- - -- - -' d
so as to become subject-to the'Work rs'Compensation laws. - ADDRESS, - U"j�C.L.L' /(' - < '1_ CONDITIONS !_U
.le . c 'T' T CITY e.tt{!. ..`__..1.: TCS 'ZIP . _7b".0 1 FK
Date ti3. `r 'Applicent o ...
NOTICE TO'APPLICANT 'If,'offer making' t s Certificate? of
ARCHITECT - TEL DISTRICT., ,GROUP, TYPE .__ FIRE -PRO SSED.BY _ ' O
ENGINEER I"L' F I'+ NO. f V
Er'Semption, you should become subject c the`,Workers' 5.` 7((� CONST - ZOI%y�� - t W
Compensation-provisions•of the Labor Code you must forth- gODRE55. - _�w`DV R.-� +_ ,J_ - .- — �:J N
with comply--with such,provisions or this permit shall be - .STEL' STATISTICALCLASSIFICATION ` •APT. C DO. - ` Z'
deemed revoked. _'t i CONTRACTOR Cl ^,Y( NO.. t _ _
LICENSED CONTRACTORS DECLARATION; ., -• •-.-- -- -, - - - LIC. .v --; CLASS NO. 'Z m.ELL.
1 hereby affirm,that I am licensed under provisions.of Chapter 9 ADDRESS NO.
In en with Section 7000)of Division 3 of.the Business and _ SEWER MAP
__ __.. . --_.. - ._.._.LIC. _ .._ ,.
Professions,Code, and my license Is in full-force:and effect. CITY CLASS - "'9X""' "' - . ^ '- VALIDATION
-
v, .-- 9 SQ. FT. Pi
NO.OF _ __ NO:OF CHECK -
LicenseNumber " Lic.-Class SIZE STORIES FAMILIESONE
a VALUATION
ss. s•. s DESCRIPTION OF WORK. Q. T iGN NEW --0
Contractor Date
, " $
r ADD
I am exempt under Sec. -t.° - '�
- •r 8i for this reason _ F X r O C - REPAIR..0 $-
.Date' •u - USE OF .. It
- ❑
EXISTING BLDG. DEMOL
SI nature •'- 's - -- APPLICANT /' - 4e_Ar; TEL -
g (PRINT) C � It C L- /� 'Y NO. ��4 7A FINAL `��UP�
. OWNER=BUILDER DECLARATION - _ __ _ _ -'DATE if .. -_ .•
_;hereby affirm that I.am exempt from the Contractods License (' ,/L �,• „r
Law for the following redson.(Sectioo 7031.5,'Business and ADDRESS �+ �. FIN 't ''" > �4e0 3.5'A '
Professions Code): " " ' '"'-" "
PRESENT
- - 'BY _ - '
® . r. BUILDING - - :e e e e e;1.•.,
1, as owner of the property,.or my employees with ADDRESS _ _ _ _
wages as their sole compensation,will ad the work and - - - '� - ' 8
the structure is not.intended or offered for sole(Section' LOCALITY - ^_ t D - I • • 4 9.8 8.
••7044; Business and Professions'Code):' - -- 'MOVING-". ^' TEL --' - +: - - -•
I., as owner of the property, am exclusively contracting _ CONTRACTOR - NO. i - �;,• a e 4 9.8 8 U.-I, as
to construct the project (Sec- - - -' '- Y - t - -
tion 704, Business and Professions Cade). ADDRESS .
C X0212-86
REQUIRED - TOTAL SETBACK FR M.,_ - X T.
-'- "`• .P -CONSTRUCTION LENDINGAGENCY - - SETBACK -YARD HWY 'L SETB LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT �• v - ,p'r. '' '
the-performance ofthe•work*for which-this-permit is issued P.L. - - --"._ -`- -• - -
(Sec. 3097, Civ. C.): - SIDE -
mPL
\ ... .-_ . . _•_ _ _..
-de ;'s Name ,
PC Fee.B-• - _ -__ Permit
Lender's Address -
J� t
certify that.I_have,read this applimtion_and state that the ..__ _ - Issuance Fee S"L� -LDMA•P/C#'L
-:_
a above information is correct. agree to comply with all County ' Investigation Fee f j ••• - �t '
a (j `c
ordinances and State laws relatingFo building•consiruction, - _ _ Total Fee- — -/ ,Q-0- - LDMA Perm It^ --- - -- •• --
and hereby authorize representatives of this County to enter T - -
m u n the above-mentione rop rty,for inspection purposes. - -
SEE REVERSE FOR EXPLANATORY LANGUAGE
..--- S'gndture of plicant or.Agent .._ _Date
WORKERS' COMPENSATION DECLARATION. - /� �p r FOR
II ll��
hereby affirmthathave a certificate of consent to self ' A` PP.L� ��®N FOR B 1 ILDN� PER
67
insure, or a certificate of Workers' Compensation Insurance, - W LI U0. �/ Il �J�/u
or a certified copy thereof,(Sec. 3800, Lab. C ) - ,- ,.,LOUN .- OF LOS ANGELES _. BUILDING*AND SAFETY
Policy No:- Company ' ' -
❑. Certified co Is hereby furnisRed.._ } , FOR APPLICANT TO FILL IN BUDDING
PY. Y -
❑, Certified copy isfiled with the county building inspec - - BUILDIDING
NG _ _ _ -
-lion department - ADDRESS
.
Date Applicant ' Cm 'c'- ENt'cE iT Locaurr zip 9/740. -
' - - - NO. OF BLDGS. i ^
CERTIFIECOMPENSATION IN URANCEORKERS' SIZE OF LOT OD` ' NOW ON LOT- _ NEAREST A -
.. CROSS ST.
COMPENSATION INSURANCE � - '
(This section need-lnot•be completed if.the permit is for,one- .TRACT; BLOCK.-.. LOT NO, I. ASSESSOR ''// -PARCEL �g ;
= MAP BOOK p-cSdS- - PAGE II-Q -
hundred dollars ($100) or less:) ' - ' ' : - gg TEL' MAP
-•....' OWNER X&IVIVY Y 4'(✓ANNN.LJA.Y NO.11'1,3 USE ZONENO. .
-1 certify.that.in the performance of the work'for which this ]SPECIAL
,Permit Is issued,.I shall not employ any person in any manner ADDRESS�If 913 a GREEN VENUE- — CONDITIONS d
so osto.become subject to the Workers' Compensation Laws. O
... " CITY E/Vo6 ts/T . zip 9/980 .. .. - U
_Date - Applicant ARCHITECT OR TELO:
DISTRICT. GROUP TYPE FIRE PROCESSED BY
NOTICE TO'APPLICANT: If, after making this Certificate of ENGINEER '. � - NO. C ST. ZONE - ., �
Exemption, you should become subject to the Workers' ' - C)
Compensation provisions of,the Labor Code, you must forth- ADDRESS-
with comply with such provisions,.or this permit,shall be - TEL STATISTICAL CLASSIFICATION tl APT.. CONDO.
deemed revoked. CONTRACTOR NO. .� . - Z
UCENSED'CONTRACTORS DECLARATION - _ LIC. """ - CLASS NO. a L •DWELL. UNITS_
I hereby affirm that I am licensed under provisions of.Chapter 9 ADDRESS NO.
SEWER MAP
.(commencing with Section 7000)of Division of the Business � LIC. � �- '
and Professions Code,and mylicense is in.full force and effect. CITY+ CLASS BK VALIDATION
_ SQ FT_' NO. OF NO. OF CHECK
License Number-- ' Lic Class ' - SIZE: , STORIES FAMILIES ONE '
VALUATION
Contractor - Date DESCRIPTION:OF WORKADD 0
I am exempt under Sec. OC/eC0 /N ' 00/' _
ALTER ❑ - . _
..: B.BP.C.-for,this reason - .Is Y t - .. lyilmoN_fA/N!E - -- REPAIR ❑ $ -
USE.OF
EXISTING BLDG. - --"" - ' ''DEMOL Signature APPLICANT_ APPLICANT TEL _ - FINAL
•DOWNER-BUILDER.DECLARATION (PRINT) - NO. ' . ;, AT
;DE 2:
.Ihereby affirm that I am exempt from the Contractor's License �-
Law for the following,reason (Secficn-7031.5;;Business and ADDRESS - _ i•' FINAL. -
Prof sions.Code): - - PRESENT- _ - B /. y
BUILDING Iv P. F., T ANT.T
I, as owner of the Property or my employees with ADDRESS ORCIN VE/✓zlf 7// -
wages as their sole compensation;wL
ill do the work and OCALITY-- - - _ t-- vJ 1 ®` 3307
the structure is not intended or offered for sole(Section //.
7044;-Business and Professions Code.) MOVING - _ TEL ! 1ITEh•j
❑. 1, as owner,of the property, am exclusively.contracting CONTRACTOR - NO. - _
with licensed contractors to construct the project (Sec- - -- ADDRESS - ' "'" -' ' - TOTAL 113- 63'
tion'7044, Business and Professions Code.) - CHECK - ilr G
+. . ,REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE 'WIDTH -
- Thereby affirm that there is a construction lending agency for FRONT : ICHANrE` L=�.
he performance of the work for which thispermitis issued P.A.
(Sec. 3097,;Civ. C:). - SIDE. -
Lender's Name' -: - —
$ _ - _ QO. AO LDMA Ref. q V�VV FIJVL •li�,�'L,.'L ] :,
-
RIC. Fee$ Permit Fee _. 345 :1 Ah' ]❑ it
3 Lender's Address
a I certify that I have read this application and state thbt the. - ' ksu.Rce'Fee /d LDMA'P/C k '" " D
8, above information iscorrect.-1 agree to complywith:ofl County Investigation Fee
ordinances and tate laws.relating-to,building'c'onstruction, Total Fee.- - �" LDMA Perm. p -- -
a and '}eby authorize representatives of this County to enter
m upo II a abov =mentioned property for inspection pure ses
a
I� ..SEE REVERSE FOR EXPLANATORY LANGUAGE r
Signature of Applicant or Agent 'Date - - - -
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUILDING ADDRESS - 413 21 O,PEE^I
I hereby affirm that I have a Certificate of Consent to self insure, - D Ef VfN[/f
or a certificate of Mrkers'Compensation Insurance,or a certified ZIP
TE/yPIE e/7jv CA -
copy thereof(Sec.3800,Lab.C.) CITY CII 9/7Q0 LOCALITY 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. - CO
department. ' IJER q.ZLlf/4
USE ZONE I MAP NO.
DateA—Applicant ASSESSOR MAP BOOK PAGE .PARCEL d s-
pP SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' owNER TEL.NO. J�
y fU /JA/NA /.� n/ ,0WITHIN 10DO FT.OF SCHOOL? YES NO
COMPENSATION INSURANCE � ADDRESS � -
(This section need not be completed if the permit is for one hundred aOAP N VFNL/E DISTRICT '- GROUP [TYPECONSTFIRE ZONE PROCESSED BY
dollars($100)or less.) CITY - - .TIP
I certify that in the performance of the work for which this permit T NCE C'/ 9/7 6 - . 1
is issued, I shall not employ any penton in any manner so as to ARCHITECT OR ENGINEER TEL.NO.
become subject to the Workers'Compensation Laws. STATISTICAL CLASSON,IIFICATIAPT CONDO
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' CONTRACTOR TEL.NO. SCKLYARDHVIY PROP LINE WIDTH
Compensation provisions of the'Labor-Code. you must forthwith R E LFRONIT
comply with such provisions or this permit shall be deemed revoked. .ADDRESS LIC.NO.LICENSEDCONTRACTORS DECLARATION CITY LIC.CLASS (oa,),
I hereby affirm that I am licensed under provisionsof Chapter 9 SO.FT SIZE' NO.OF STORES NO.OF FAMILIES SEWER MAP �,
(commencing with Section 7000)of Division 3 of the Business and -.
Professions Code,and my license is in full force and effect. NEW BK PIS D >.• ,>fA, U
DESCRIPTION OF WORK VALUATION W_
License Number Lic.Class - ADD ❑
' NEAIe�/.YdaJs J a
Contractor Date _ �I ALTER $� 000.00
_23,90,91, EW S I RJ EIJ REPAIR ❑
El I am exempt under Sec.
B.BP.C.for this reason DEMOL ❑ `
LDMA P/C If
USE OF EXISTING BLDG. +
Date: URM ❑
Signature APPLICANT(PRINT) TEL.NO.
LDMA Pe m N
❑ I, as owner of the property, or my employees with wages as E rVY.r JUTANNF/ lJON ;/� a�6—d90 Z
O
their sole compensation, will do the work and the structure is ADDRESS ,
not intended or offered for sale (Section 7044, Business and I]OREEN I7YC. C• FINAL DATE ..
Professions Code.) La O
OR A HE MIXTUREC NT ORCONTAINING
NG A HAZLDINGARDOUS
S MATERIAL EQUAL
TOHAZARDOUS MATERIAL
N Q J OR A MIXTURE CONTAINING A HAZARDOUS MMATERI LS INF TO TI N GUIDE?THAN
❑ I, as owner of the.property, ru exclusively contracting 0with44, THEAMOUNTS SPECIFIED ON THE HAZAflDOUS MATERIALS INFORMATION GUIDER FINAL BY
licensed contractors to construct the project.(Section 7044, YES❑ NE❑
Business and Professions Code.)
WILL THE REOUIEO USE OF THE BUILDING BY THE APPLICANT IO FUTURE 9ESOUTG ' �^`�
OCCUPANT QUALITY MANAGEERMIT MENT
DISTICT(SNOMD)SE KATION FROM THEGOUTH _/(� 9 v7y /
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT pIBTgICT(SCAOMD)SEE PEflMITTING CHECKLIST 'H" J
FOR GUIDELINES.
I hereby affirm that there is a construction lending agency for YEs❑ NO❑
the performance of the work for Which this permit is issued(Sec. HAVE READ THE HPSAgOOUe MATERIALS INFORMATION GUIDE AND THE SGIOMO '
3097,CIV.C.J. PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOG ANGELES
COUNTY CODE,TITLE$CHAPTER 2.M SECTIONS PMAWTHROUGH YI'a.1Q CONCERNING O O
3 Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE GCAOMD.
Lenders Address arwm ae aamT p -
o I certify that I have read this application and state that the above
inform ' n Is correct I agree to Comply with all county P.C.FEE PERMIT FEE
ordin ces and State s relating.to building construction,and
¢. her y BUthonZe re ntetiv.of this County to enter On ISSUANCE FEE
lh bov'mention property for inspection purpo
m _ 6 Z INVESTIGATION FEE TOTAL FEE '
SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY k 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91760 BL 0508 0512210022
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 13645 LT: 48 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 4843 DOREEN AV
STRUCTURE: 45 1 VN R3 TEMP CA 917804140
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: LOWER AZUSA
8585-024-034 OTHER: 294 1 VN U1 THOMAS PAGE: 597 GRID: CS LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 12/21/05 JK 12/16/06
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINA DATE -FINAL BY: CODE:
NGUYEN, PETER - 40,000
4843 DOREEN AV
TEMP 917804140 PEES PAID DESCRIPTION OF WORK
ROOM ADDITION TO DINING ROOM 45 S.P. PORCH ADDITION 46 S.F.
PER DESCRIPTION: QUANTITY: DOM: AMOUNT: REAP. PATIO 248 S.F. AND REFRAME 750 S.F. ROOF
APPLICANT: TEL. NO:
KAMEN LAI (626) 288-2051- AA BLDG PERMIT ISSUANCE 27.75
8748 VALLEY BLVD 1)K AC STRONG MOTION RESID 40000.00 VAL 4.00 SPECIAL CONDITIONS:
ROSEMEAD, CA 91770 AX BUILDING REVIEW FEE 54.70
B2 PERMIT W/ENERGY 40000.00 VAL 733.92
TOTAL FEES 820.37
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
P S REMODELING CORPORATION (626) 378-2781-
9059 WOOLLEY ST LIC. NO - LOCATION AND SETBACKS -
TEMPLE CITY, CA 91780 7540898
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. N0: FOUNDATION/TRENCH FORMS \`
LIC. N0: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: - UNDERFLOOR INSULATION
3 01
IST LEVEL FLOOR SHEATH
N0. OF FAMILIES: DWELLING UNITS: APT/COND: 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 INSPECTLTI
i
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- SHEAR PANELS
SIDE PL-
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH �0 L
LOT DRAINAGE
SMOKE DETECTION DEVICES -
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BSO508
1