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HomeMy Public PortalAbout5022 DOREEN AVE_Building__ / p F-qa lTEMPLE / G 331('IAt --Lv 11 vcAuuaYeos +�I APPLICATION FOR BUILDING PERMIT ( �J COUNTY OF LOS ANGELES ADOREISS d.? RE�E�✓ AVC DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OR BUILDING CROSSST. A-L• y tut$ DISTRICT NO. GROUP I TYPE PRO SED BY FOR APPLICANT TO FILL IN > CONST. ' F.f DING / S ATST,CAL CLASSIFICATION SE ER MAP r ESS :J C'Z-7- l�a2E'C^� AlI K PG CLASS.NO. , DWELL.UNITS L 3? O. zd S05�D 1 /fD + BLOCK 1 WATER NOT REQUIRED RECEIVED TRACT 11Z /J O CERTIFICATE: MAPHIGHWAY .♦ f NO.OF BLDGS. NO, ,CIRCLE) STATE MAJOR SECOND, CA SIZEOF LOT. ,SU Y 160 I NOW ON LOT / USE ZONE SPECIAL USE OF / , CONDITIONS EXISTING BLDG. /i OIJJF n y TEL./+ OWNER /- L y L R NO, ci Z3 lr UILDING EXIST. rJ� SETBACK YARD HWY TREET NAME WIDTH ADDRESS /b22 DO'Zh FfV AI/t- FRONT / ARCHITECT OR TEL. P.L. 'C / ENGINEER NO. SIDE P.L. ADDRESS TEL INSPECTION RECORD/, ,g �O CONTRACTOR NO. / . X/ fail CA ,'� J A u ADDRESS , f S /f1 t(lf O DESCRIPTION OF WORK = A n yU./,// // G ao ,Lc ����G . l�'rs/L.cIo? .�i+vfd� 6�I �wX,ZLL'CAse s ua Q ADD ALTER REPAIR DEMOLISH S SIZE f X I / STORIES FAMIOLIES y / f ' STEOTURE I�/?OO/YI �� 1 �O SIGNATURE OF / f 'J/.�/% .,1�'-Cd .ILVYGAA� -�1.,:i.i. A./V� � APPLICANT VALUATION$ APPROVALS /411r4"DATE INSPECTORS SIGNATURE FOUNDATION: LOCATION !! / FEE $ �' FEE $ FORMS. MATERIALS- N FRAME: FIRE STOPS. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS _ n1 ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, �)V WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS �1'M'✓ 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 SENINSU RANG LATH EXT. SIGNATURE OF �j\✓•A�,+ HOUSE NUMBER COR- PERMITTE� �� RECT AND POSTED ADDRESS -���-�— ti� FINAL CLYDE N. DIRL:AM. PRINCIPAL STRUCTURAL E R PLAN CHECK VALIDATION m m.o. cABK PERMIT VALIDATION cK w.o. CASK LiCp5 5 6 9"� OCT16 1 D $,QQ— o G7. 76A638A CE A8033.69 APPLICATION FOR BUILDING PERM/1I�/J �I COUNTY OF LOS ANGELES BUILDING U RElss DEPARTMENT SOF COUNTY ENGINEER / BUILDING AND SAFETY DIVISION LOCALITY .�/ p (.,� , JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING 'NEAREST i . . CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. DRO_/u TYPEt._ 1NST.. PR0 sEN (PRINT OR TYPE ONLY) 4 1 BUILDING STATISTICAL CLASS( (CATION SEWER MAP ADDRESS - en CLASS NO. DWELL UNITS BK PG LOT NO. BLOCK USEZ HE MAP �) Z{/1 NO. C/ TRACT ' I' SPECIAL N0. OF BLGGS. VVV CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. V X f BLDG. SETBACK FROM E OWNER Zy 11d, TN FRONT PROP-LINE OF (STREET ). HYPE OF EXISTING[ SETBACK HIGHWAY ♦ YARD TOTAL AYWIDTH FROM C.L. ADORESS CITY ` ITECT / + _ ARCH `TEL. BLDG.SETBACK ENGINEER NO. S10E PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWA YARD' - TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. p TEL. CONTRACTOR C/[/ NO. - - p}, ADDRESS NO. CORNER CUTOFF YES E3N0. ❑ 0 CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS Q CONSTRUCTION LENDER ~ NAME AND BRANCH w e_ N ADDRESS Z SQ. FT. NO. OF NO. OF ❑ SIZE STORIES FAMILIES NEW USE OF ADD ❑ STRUCTURE1d' R C]ALTE REPAIR SIGNATURE OF DEMOL ❑ APPLICANT 1L VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, n" FOUNDATION: LOCATION _ FEE 5 FEE $ f (T(J FORMS, ORMS MATERIALS IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, BRACING BOLTS ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FUR NAGE: LOCATION, WITH ALL OROMANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER CORRECT PER MIT TEE�� AND POSTED ADD RE Sl- ''62- 22"/•moi(J ' FINAL /`�ILG�p�`� JOHN F. LEWIS, PRINCIPAL SURAL ENGINEER PLAN CHECK VALIDATION CK. M.o. CASH - PERMIT VALIDATION CK. M.O. CASH t^,, 4 3 6 7�- AN 7 1 0 6.00- c' I 70A638A CE#60311.57 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES aD ILDIN 4 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST1. . FOR APPLICANT TO FILL IN DISTRICTN . G:LP PPE WBEK MAPF ` 1 `I /� �+ CONST. ADDRESS v 0 Z ` D O E E`V A N F - STATISTICAL CL SIFICATION / CLASS. NO. DWELL. UNITS LOT NO. f7 Y CU P Fr O BLOCK MAP STATE TRACT ISL Q NUMBER HWY. 'YES O USFZNE SP CI L I / N .OF SLOGS. [9� `CONDITIONS SIZE OF LOT-TO' X NOW ON LOT USE OF L� EXISTING BLDG. ' L L I N(S BUILDING - - EXIST. YARD HWY STREET NAME /'�t1 n �+! ELS SETBACK WIDTH OWNER CHA S E J S G L�.l FRONT MAIL /' c�+ R L: ADDRESS LTJ OZZ' UO /=GAvc � SIDE clrY BN LP �'.IT NOL.Ci R-G4 P L INSPECTION RECORD y' ARCHITECT OR TEL. � T•�/ L / ENGINEER NO. ADDRESS TEL. CONTRACTORNO. % �//•s / �O� ADDRESS � I -moi! /�1 [r r✓iY DESCRIPTION OF WORK NEW ADD �� ALTER REPAIR DEMOLISH SSO T. x ZE ' / STORIES 1 FAMIOLIES USE OF RUCTU mm 040 ^1\ ZI SI GNATURE OF �if. I'n� / APPROVALS APPLICANT f�FI �f DATE _INSPECTOR S SIGNATURE 1 ADDRESS Q !yL FOUNDATION: LOCATION C/ FORMS,MATERIALS FRAME: FIRE STOPS. /200 FEE BRACING. BOLTS /) �`9 D �A'LP/LM/ "f 1 VALUATION f .�� FURNACE: LOCATION. GAS VENT.DUCTS FEE Y I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY OR INANCES/AND 9 1 STATE LAWS EIS/LATING B ILD] IGI ONSTRUGT ION. LATH,EXT. SIGNATURE O �� HOUSE NUMBER COR- PERMIT TEt` _RECT AND POSTED ADDRES - `� FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK. M.O. GSH PERMIT VALIDATION CK. M.O. CASH iAC032339 JUL28 1 A 8.50 ®. ��A68HApp5,123, APPLICATION FOR BUILDING PERMIT DIVISION OF BUILDING' AND SAFETY BUILDING Department of County Engineer AODREss / County of Los-Angelee LOCALITY LTi Gi WM. J. FOX. COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT of BuaDING ml GROSS ST. 11,4E W F I DISTRICT NO. ROUP ITYPE � SEWER. MAPF FOR APPLICANT TO FILL IN i r- /Kf 4 BUILDING , CONST. ADORESS� MAP O STATE Y,Bp O J NUMBER 0 HWY LOT NO. / O BLOCK U E ZONE. SPECIAL CONDITIONS TRACT NO. OF BLDGS. anny SIZE OF LOT Y �J I NOW ON LOT / BU ILOING YARD HWY STREET NAME EXIST." USE OF SETBACK -WIDTH EXISTING BLDG. FRONT I P. L. N OWNER I, SIDE - MAILP. L. ADDRE TE t DWELL. i UNIT 5 INDUSTRIAL CITY • N 2 DUPLEX—UNIT- 6 PUBLIC BLDG. A RCHITEC L TE . ENGINEE - NO. 3 APT. UNITS '7 AODN.,ALT., ETC.. ADDRESS q COMMERCIAL 6 MISCEL. CONTRACTOR) i E of• 3! INSPECTION RECORD ADDREsa} a 4 �. /fir Pp✓ DESCAIP NOF WORK NEW ADD ALTER REPAIR 'DEMOLISH 50. FT. O. OF NO. OF ) T- SIZE TORIES FAMILIES • /USE OF STRUCT E SIGNATURE OF APPLICA��NQQT APPROVALS ADDRESSCI - /ham DI( ATINSPECTORS{s�SIGNATURE FFNOAr MATERIAL51 N / ORMS. FRAME: FIRE STOPS. � VALUATION BRACING. BOLTS 7 FURNACE: LOCATION. GAS VENT, DUCTS 7 .V I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT y/ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. ..ii AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. ONSTRUGTI �n LATH. EXT. SIGNATURE OF W(.P/ Z / HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS±+ FINAL WM. J.. FOX.' CouNrr EgINBEA VALIDATION .. BY .X0'1 21!5 6— NAR 9 .. DEPUTY DEPUTY BY _ BY - © DEPUTY 76Ae3B.�Z#ao311.57 APPLICATION FOR BUILDING PERMIT �. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER aoDREss BUILDING AND SAFETY DIVISION LOCALITY �rPct C(T JOHN A.LAMBIE,COUNTY ENGINEER NEAREST - CASSATT D.GRIFFIN.SUVT OF SU.LDING CROSS ST. DISTRICTNO. GROUP TYPE SEWER MAP FOR APPLICANT TO FII.L.IN JT_ BK PG _ S coNsr: BUILDING o ADDRESS J Q STATISTICAL CLASSIFICATION lb0 CLASS.�NO.--- DWELL.UNITS ' LOT NO: I7 �, BLOCK MAP STATE UUUN���UMBER d HWY. YES NO Uy o. TRACT ;ZO E SPECIAL NO.OF BLDGS. I %If CONDITIONS SIZE OF LOT NOW ON LOT 1 USE OF 0(I EXISTING BLDG. K. 1 BUILDING YARD HWY STREET NAME EXIST. OWNERI� 1A4R Lk:. n p �( LS S4ViZFRONTMAILK WIDTH ADDRESS 3u �Z A/ 0'S �E/Y ,/l A r SIDE CITY .-,`/ ' L T TEL lT '7�V P.L. ARCHITECT OR TEL 7•h'��',INSPECTION RECORD ENGINEER -NO. 4 , ADDRESS_ TEL. �7 // /'nJ CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW- ADD ALTER REPAIR DEMOLISH SO. FT. l/ NO.OF NO.OF SIZE 1 b STORIES FAMILIES - - USE OF STRUCTURE t 4 L. SIGNATUREO APPROVALS APPLICANT " 11 1 DATE /INSPECTOR'S SIGNATURE . . ADDRESS 2' FOOORMST ION ATERIIALS _/�• C. /�/_ O / S - P.C. s FRAME: FIRE STOPS. ) 2-5 ' /J /'lil,✓LG/"(ivLC ' FEE BRACING.BOLTS $,. FURNACE: LOCATION. VALUATION FEE GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP. LATH,INT. PLICATION AND STATE THAT THE ABOVE IS C RRECT AND AGREE TO COMPLY L^ IT ALL GOQNTY DI ANCES ANp STATE LAWS RE Ute/ � ING IL STRUCTI N LATH, EXT. SIGNATURE OF !/ HOUSE NUMBER COR- PERMITTE RECTAND POSTED �7 �qy ADDRESS L' Z. FINAL / -�7"7 O CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PIAN CNECK VALIDATION CK. M.O. GASH PERMIT VALIDATION CK. M.O. CASH L� . G286.9m+:��Ut� 16 ' 1 A 200 v F ®: . 3 vEA6]9P CE;6OR,-63 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES` BUILD' NG DEPARTMENT OF COUNTY ENGINEER ADDRESS SO BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMSIE. COUNTY ENGINCER NEAREST WILLIAM A. JENSEN. SUPT of BUILDING CROSS ST, OI TRICT NO G TYPEC E BY FOR APPLICANT TO FILL IN CONST, BUILDINGSTATISTICAL CLASSIFICATION SEWER MAP ADDRESS rU ZZ Q CLASS.NO.�_DW ELL. UNITS BK CP� ^ J LOT NO. 16 .SQ r O WATER ❑ Q CERTIFICATE: NOT REQUIRED RECEIVED TRACT / Z. ( U MAP HIGHWAY NO.OF LOGS. NO.�, / ICINGLE) STATE MAJOR SECON OCAL SIZE OF LOT ;16 6 ^ , ^(/ NOW ON LOT USE ZONE SPECIAL' USE OF - CONDITIONS EXISTING BLDG. _ TEL •e- OWNER p Z NO. C y v •TT BUILDING YARD WY. STREET NAME` EXIST. SETBACK WIDTH ADDRESS. 1�1 FRONT ARCHITECT OR. j' TEL. . P. L. _ ENGINEER �L� /7l NO. SIDE p P. ADDRESS b 0 G C - ,1', } .j O MAiMVa'>r'Y� P'. A.� i'` "'�. CONTRACTOR ¢,yi(,� NO b Z • ; K ADDRESS -c DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH f , SO. FT. C NO. OF -NO. OF ' SIZE J STORIES .FAMILIES USE OF � " R2.3 - .�.. .1. 7✓ 'A STRUCTURE �ZO,s—�Y r n ^� SIGNATURE OF AA/`,.tti _ Ude%fi��I'D APPLICANT 97M.41B7� WPFA � il, VALUATION S,_ O - �' - APPROVALS py �. AT INSPECTo sslcNgtu P.C. PMT' FOUNDATION: LOCATION r! .FEE 5 _,+ FEES FORMS. MATERIALS J fI FRAME: FIRE.STOPS. Y HER STATE AD HAT THE-ABOV 15 HAVE REPO THIS APPLICATION BRACING, BOLTS AND ALLTHAT THE-ABOVE ICORRECT AND AGREE E LA71 LYS FURNACE: LOCATION. . y WITH ALL COUNTY' ORDINANCES ANO STATE LAWS RTHELWORK GAS VENT. DUCTS AUILORI CONSTRUCTION. NOCERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA, ,AUTHORIZED OF THE EASON COOC-OF T STATE CALI ORNIA RELAT. LATH. INT„ 1' INC TO WORKMEN'S CO ION INSURCE. LATH. EXT' SIGNATUR � 4 HOUSE NUMBER COR- T• PERMITTE RECT AND POSTED �f .ADDRESS FINAL JOHN F. LEWIS. CI AL ST RAL ENGINEER PLAN CHECK VALIDATIpN_ cK. .M.o., C'SH PERMIT VALDATION cK. ..G. CASH LAC� 2 4 2 3G NOV -12 2 3 _D• . 4.63' --a - - 24246 NOV 12 1 D 18.550- .. • COUNTY OF LOS tHGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT-Of PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0106050057 PHONE: (626) 285-0488 EXT: GAL NO. OF CONST BUILDING ADD ESS: TR: 11290 LT: 10 BL: D UN: .002 SQ. FT STORIES TYPE 5022 DOREEN AV STRUCTURE: 2500 VN TEMP CA 917803437 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA DR. 8585-022-033 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: SFR W USE ZONE: XX ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 06/05/01 UT 12/02/01 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: VO DUKE SHARON (626) 475-1356- 5,000 5022 DOREEN AV ( -- —J TEMP 917803437 FEES PAID DDdn- 0 K INSTALL COMP SHINGLES OVER EXISTING ROOF (EXISITNG: 1 LAYER FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: OF WOOD SHINGLES AND R LAYER OF COMP. SHINGLES) PEI CAN TEL. N0: •L SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 5000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/OMEN=HC''-- �5000.00 VAL 132.60 r,OGELEST`AL-�FEES 160.85 AL CONTRACTOR: TEL. NO: �O`j APPROVALS DATE INSPECTOR SIGNAT RE SAME AS OWNER - LIC. NO I LOCATION AND SETBACKS / SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: / — FOUNDATION/TRENCH FORMS LIC. N0: / 11j1j1] SLAB/UNDER FLOOR RAISED FLOOD AMI?? MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP,:° �' n UNDERFLOOR INSULATION XX 3 o1: �,j HD L��� V�I� � FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/CONDI S CLASS:- --- ------_---- —---- NO 21 1\I i i1 —�,.,�:"- ROOF SHEATHING SCHOOL WITHIN HAZARDOUS C 12 U }" T t SHEAR PANELS f. *, AIR QUALITY: 1000 FEET MATERIALS L ,�"1 - NO NO NO FRAME INSPECTION SET BACK YARD: HWY: TOTAPROP LINE;FROM WIDTH.L SETBACK 46 4 <� FIRE SPRINKLER HANGERS FRONT PL- Servire'ij�la INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL— EXTERIOR LATH RATED OOR/CELL SSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: OS0508 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ,'` /p� /' 1 hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS O 2 2 .OUR/�� I"\ V/� or a certificate of Workers'Compensation Insurance,or a certified 50 Z 0 P. Copy thereof(Seo.3800,Lab.C.) CI ZIP LOCALITY � PLG , y Policy No. Company � �� SIZE OF LOT O NO.OF BLDGS.NOW ON LOT / �!)/- ❑ Certified copy is hereby furnished. O X 16 + CA/t v NEAREST CROSS ST.I l W F S� $ n' I W/� ❑ Certified copy is filed with the county building inspection TRACTO BLOCK LOT NO. 2 department. II L/ )� ' a US�E7ZONE MAP NO. Data-Applicant ASSESSOR MAPOBOOK PAGE— I h� PARCEL /( , 33 1` SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER�C M 1�0� / TEL.NO. ) vastED COMPENSATION INSURANCE /T v — 6 WITHIN 1000 FT OF SCHOOLS ADDRESS (This section need not be completed if the permit is for one hundred s�.•./r•L DISTRI O$pUP TVpE CONST.' FIRdollars(StW)or less.) CITY i7I certify that in the performance of the work for which this permit 5-�^is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO.become subject t0 the Workers'Compensation LAWS. S ISTICAL 55 FICATION ` I )Date Applicant ADDRESS CLASSNO. DWELL UNITS�LNOTICE TO APPLICANT: If, after making this Certificate Of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBExemption, you should become subject t0 the Workers' SETBACK YARD HWY PROP Compensation provisions of the Labor Code, you must forthwith J FRONT comply with such provisions Or this permit shall be deemed revoked. ADDRESS LIC.NO. FRFR PL LICENSED CONTRACTORS DECLARATION CITY LIC.Cas PIDE o 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 SO.FT.SIZE NO.OF STORES NO.OF FAMILIES C Professions Code.and my license is in full force and effect. NEW ❑ BK PG D O License Number D Lic.Class ESCRIPTION OF WORK ADD ❑ VALU O W , T Ta Contractor Date ALTER xy $ GO ❑ I am exempt under Sec. REPAIR $ BARC.for this reason DEMOL ❑ LDMA PICN USE OF EXISTIN BLDG. I URM ❑ Date: F Signature APPLICANT/PRINT) / TESL,IJLOn LDMA Perrnp t 1:1I, as owner of the property, or my employees with wages as Z a their sole compensation,will do the work and the structure is ADDRESS ►Y ri�� •T not intended Or offered for sale (Section 7044, Business and `S � FINAL DA 4-1.75 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q f ITEMS P pe '/ y 9 THE AMOUNTS SPECIFIED ON THE HAZAROpUG MATERIALS INFORMATION GUIDES F1NILL YE ❑ NO Ti ITAL �8" licensed contractors to Construct the project.(Section 7044, // ® 5 7 Business and Professions Code.) WILL L THE INTENDEDREQUIRE USE MI THE BUILDING BY THE APPLICANTMODIFICATION FFROM BUILDING 0 CONSTRUCTION LENDING AGENCY COAST IR REQUIRE MANAGEErFOR eENT DISTRICT(ION OR BC OMD)SEE PERMITTING CHEG�: � 'CHECK 415.10 1 FOR GUIDELINES. 'CHANGE •i]Il 1 hereby affirm that there is a construction lending agency for YES NO the performance of the work for which this permit is issued(Sec. ❑ R 3D97.C.IL,_C. 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD (11l(� { -`/_ PERMITTINGO CKLIST UNOFASTAND SEMYNS z..I )THREVENTS UNDR THE LOSANGELES LItILIQ—OCIU1 O/iV/�,�I Landers Name �L/ COUNTY COD Ig TTLALSREPORTINGAND FOR OBTAINING A PERMIT FROM THE SCAOMD. 2n Lender's Address Al 154i4 1 Ar'^ 7:'f_I pANFA1F o I certify that I have read this application and state that the above information Is Correct. I agree t0 comply with 911 county P.C.FEE I PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE / the mentioned property for inspection pure/ose . t<j 2(S -Y D INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGU E _ -850395- LA WORKERS•COMPENSATION DECLARATION /fir' /� .G� �rI��L1� �r�} �rr��y �f�rylp��/[.��" . •'r PIER �/f��///L�� _ I hereby affirm that I have a certificate of consent to self /Ok PIJL0 /Cl\ II 00 V Lf ^R BURDO V' , PIS11�111 T insure, or a certificate of'Woikeri Compensation Insurance, /rUll 11 �7 G"ll 111111 or'o certified copy thereof (Sec 3800, Lab. C.) - COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Na.y85-2251 skamPar1yFrefnont' Indemnity - ❑; Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADORENS J-1 Certified copy is,filed with the county building inspec- - BUILDING E-J tion department.', ADDRESS5022 N. Doreen Ave. DaieR/22'/85 t' AppliconV i rg i In Roof Co. CITY Temp I e City ZIP - ; LOCALITY 9 - - - CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST. • •COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS 5T. (This section need not besompleted if the permit.is for oneTRACT BLOCK SLOT NO. ASSESSOR ' hundred dollars ($1.00)or less.) r MAP BOOK' PAGE PARCEL Mr. 2 l l a TEL' USE zpNE MAP (.certify that in the.performance of the work for vimich"lhis OWNER y -' NO.' 111` NO. - } permit is issued, I'sh'all not employ any person in any manner - � - SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS t, b0 CONDITIONS _ Q Y .�. : V Date •'�• Applicant .`• CITY ZIP - - - ' -- - - -,K NOTICE TO APPLICANT: If, offer makingthis tARCHITECT OR TEL Certificate of ENGINEER NO. ,DISTRICT GROUP TYPE • FIRE PRO ESSED BY _ Exemption; you should' become subject' to the 'Workers' CONST. ZONE .y Compensation provisions'of the Labor Code, you must forth- ADDRESS - a L - W with comply with}such provisions or this,permit shall)be - - -CO TEL "-- STATISTICAL CLASSIFI[ATION APT. C DO. - "in deemed..revoked. .a . , CONTRACTOR Virgin Roof • N0.287-0507 !) �L LICENSED CONTRACTORS DECLARATION. - - - LIC. CLASS NO. DWELL.'UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. BOX J NO. �160650 (commencing with Section 7000)of Division 3 of the Business and _ LIC SEWER MAP Professions Code, and my license is in full force'and effect. CITY $ b 'e CLASS BK �.' "— -VALIDATION -- ' _ SO. FT. _ _ NO. OF _ NO.OF _CHECK License Number-'160650 Lia Class C39 SEE FAMILIES ONE .'• ( . . . -- - p - - VALUATION V i i Roof CO. 8/22/85 DESCRIPTION OF WORK NEW• ❑ 1 4000 Contractor ra n• Dale ADD ❑ $ 5 i I am exempt under Sec. Class A fiberglass' com . 1 DT� ` p .. - ALTER ❑ :.. B.BP.C. for this reason shingles. 21 s uaresREPAIR ❑ $ - - -- - � - - - - - Dale: USE OF dwelling DEMOL ❑ EXISTING BLDG. -- - - - - - - - -Signature - -- - APPLICANT Virgin Roof Co. No. 287-0507 FINAL A 28 1.5 A OWNER-BUILDER DECLARATION (PRINT_ _ _ _ DATE - Iherebyaffirmthatlom.exempt from the.Contractor'sLicense P..O. BOX J San Gabriel- 91778 - 4 . f - # • •.•.,•••..1 • Law for the following'reason (Section 7031.5, Business and ADDRESS • FIN -Professions Code): - PRESENT - BT ( • ._4 9 8 8 - . BUILDING ❑ I, as owner of the property, or my employees w - - __. _ ith ADDRESS _•j- wages as their sole compensation,Will do the workand I ° • • 4 9'8 8ic=i� the structure is not intended or offered for sale(Section LOCALITY D - 7044, Business and Professions Code). -" - ^ MOVING - TEL. --` - '8 2 9=8 5 . I,'os owner of the property, am exclusively contracting - CONTRACTOR NO. D With licensed'contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). :REQUIRED _ YARD HWY TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY - '- SET BACK PROP. LINE WIDTH I hereby affirm that there is o construction lending agency for FRONT ' the performance of the work for which this permit is issued P.I. - (Sec. 3097, Civ: C.). SIDE PA. _ _ .. .. .. m Lender's Name $ - •38 LDMA Ref. N P.C. Fee S Permit Fee - - Lender's Address - D 1 certify that I have.read.this application and state that the - Issuance Fee 10.50 LDMA:P/GW - - -- a above information is correct. I agree to comply with all County Investigation Fee t g ordinances and State laws relating to building construction, Toml Fee - - - - '- --and h eby authorize repr-sentati res of this County to enter 49.88 TDMA Perm.'R - m upo Fie above-mentione rope SLY-for inspect'-'Tn�pTurp ses a - 8 pccy SEE REVERSE FOR EXPLANATORY LANGUAGE ' lure o1 Applicant or Agent-- Dote'