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HomeMy Public PortalAbout9933 DUFFY ST_Building__ COUNTY OF LOS ANGELES 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 0203270005 PHONE: (626) 285-0488 EXT: L G L 0. OF CONSTI D G ADDRESS:. TR: 17200 :" LTo 9. BL: .001 SQ. FT STORIES. : TYPE' 9933 DUFFY ST STRUCTURE: VN. TEMP CA 917802608 ASSESSOR INFORRFATIom,NUMBER NEAREST CROSS'STREET: BALDWIN 8588-013-015 THOMAS PAGE: 597 GRID: A3 - LOCALITY:, TEMPLE CITY TENANT: E ST BLDG USE: RES SE ZONE: R- ISSUED 0 :. PROCESSED B EXPIRES 0 EXIST OCC GRP: 03/27./02 JK 09/23/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: MAGANTE;SAM 4,200 y��2- 9933 DUFFY V �' TEMPLE CITY 91780 FEES PAID DESCRIPTION OF WOR T/0 HOUSE & GARAGE; REROOF W/1/211CDX PLYWOOD& ELK,PRESTIGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 40YR FIBERGLASS SHINGLE CLASS A APPLICANT: TEL. N0: J W ROOFING SERVICE INC . (626) 852-2150- AA BLDG PERMIT ISSUANCE 27.75 415 GLADYS AC STRONG MOTION RESID, 4200.00 VAL 0.50 SPECIAL CONDITIONS: SAN GABRIEL D2 PERMIT W/O EN=HC_—::�4200500 VAL . 132.60 "GE LLOTALFEES�a. 160.85 CONTRACTOR: TEL. N0: ®� �` QD��� APPROVALS DATE INSPECTOR SIGNATURE J W ROOFING (626) 852-2150- 138 BRANCH COURT LIC. NO LOCATION AND SETBACKS GLENDORA, CA 91741 662149C39 SOILS ENGINEER APPROVAL ARCHITECT OR NGINEER: TEL. NO: FOUNDTTION/TRENCH FOR S LIC. NO: 1111111 SLAB/UNDER FLOOR - RAISED, FLOOR-FRAMING MAP NO: SEWER MAP BOOK:. PAGE: FIRE ZONE: CMP:'' ���� UNDERFLOOR INSULATION 150H269 3 p U O LC W��,K 3� FLOOR .S EATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: ' NO 21 �^ ROOF SHEATHING v �2 SCHOOL WITHIN HAZARDOUS a t'**t SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS. 0 ` L— NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST Q� IRE SPRINKLER .HANGE S SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- E'PVAC;E°V� INSULATION/WEATHER STRIP SIDE PL- N�OR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSE . RATED WALL ASSEMBLIES REED SHAFTS/OPENINGS. T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE/TO: BS0508 ' COUNTY OF LOS ANGELES 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 0307150024 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDR SS: TR: 17200 LT: 9 BL: .001 SQ. FT STORIES TYPE 9933 DUFFY ST STRUCTURE: VN TEMP CA 917802608 ASS SSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN 8588-013-015 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: R SID USE ZONE: R ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 07/15/03 JK 07/09/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: MAGANTE SAM (626) 285-8924- 6,000 �- y-0 3 i 9933 DUFFY TEMPLE CITY 91780 FEES PAID DESCRIPTION OF WORK REPLACE DRYWALL & EXTERIOR INSULATION; REPLACE BATHRM WINDOW FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: BUILD CLOSET FOR STACKED WASHER&DRYER; REPLACE SHOWER PAN APPLICANT: TEL. NO: CREATIVE STRUCTURES BY SHARELL (323) 751-1931- AA BLDG PERMIT ISSUANCE 27.75 1038 W 49TH STREET AC STRONG MOTION RESID 6000.00 VAL 0.60 SPECIAL CONDITIONS: LOS ANGELES 90037 D2 PERMIT W/O EN-HC 6000.00 VAL 149.40 TOTAL FEES 177.75 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE CREATIVE STRUCTURES BY SHARELL (323) 751-1931- 1038 W 49TH STREET LIC. NO LOCATION AND SETBACKS LOS ANGELES, CA 90037 793474 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150H269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PAN LS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/C IL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 ©S 76A638A CE#'803(REV.6/78) p. APPLICATION FOR BUOL®ING PERMIT COUNTY OF LOS ANGELES BUILDING AT SAFETY FOR APPLICANT TO FILL IN BUILDINGADDRESS BUILDING ADDRESS LOCALITY v NEAREST CITY ZIP CROSS ST. O OF BLDGS. ASSESSOR SIZE OF LOT ON LOT MAP BOOK PAGE PARCEL ter, DISTRICT GROUP TYPE "FIRE �OCEYE BY TRACT V v BLOCK LOT ! D O9 CONST. FIRE E .. OWNER - STATISTICAL CLASSI�ON 'S ER ADDRESS CLASS NO. DWELL.UNITS BK/ '/PG' CITY /' ZI ARCHI ECT OR TEL. VALUATION $ F ENGINEER NO. ADDRESS BLDG.SETBACK FROM TE . FRONT PROP.LINE OF (STREET) CONTRACTOR .� + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING LI HIGHWAY FRONT PROP.LINE HIGHWAY WIDTH ADDRESS O. LIC. + _ CIT CLASS BLDG.SETBACK FROM . CON R C ION LENDER SIDE,PROP.LINE OF (STREET) NAME AND-BRANCH HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING � ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH 0 SQeFT�• NO.-OF NO.OF CHECK + _ SIZ STORIES FAMILIES ONE //�� DESCRIPTION OF WORK NEW P.C. Fee$ V Permit * U_ 7 _ ADD ❑ Issuance Fee ALTER7f REPAIR ❑ Tocol Fee- USE'OFDEMOL ❑ EXISTING BLDG. ( -v z X 6 2 g,6 A APPLICANT TE ._ G PRINT( .0 - 2-1 BY(SIGNATURE) > 2 0 '-'5 0,4 Q IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - /' THAT THE ABOVE IS CORRECT•AND AGREE TO COMPLY WITH ALL ORDINANCES - to O 0.40 O U AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY'PERSON IN VIOLATION OF p THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM z 0 �+22—7 9 PENSATION INSURANCE. a d 6.2 8,+7A SIGNATURE F �p # o 0,0 0 0 1 PERMITTEE ADDRESS Z 2 0 0 9 - O Q TEL. r CITY NO. G o o o97,002: U USE ZONE' MAP � SPECIAL CONDITIONS g FINAL / BY am d DATE /�i�' /Y�'�/ • r- 7661638A CE 4803 12/69 APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING C r JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. Print ort a only) ROU _ BUILDING �f /^ DISTRICT NO. GP' CONST. PR ESSED BY /) t/ ADDRESS q y 3 3 tl �F7 �T /���`�L Ii�TL S C. / � p / STATISTICAL CLASSIFICATION SEWER MAP ' LOT NO. �"Lf BLOCK CLASS NO._j2?_&WELL.UNITS �- SK 'PG TRACT ZV - USE ZONE[MAP "y t'"��Q NOWONLOTS SIZE OF LOT ( �/ SPECIAL USE OF [a �InC ArG� CONDITIONS EXISTING BLDG. /V TEL OWNER ' +�^�'�C /2�SSD NO �7BLDG.SETBACK FROM ADDRESS qk ,� .ni1� y�, FRONT PROP.LINE OF (STREET) �_'LtI �� ! / TYPE OF EXISTING. SETBACK HIGHWAY } - YARD = TOTAL' CITY ^if"a7Y HIG WAY WIIID-TyH� FROM C.L. ARCHITECT OR Ln. TEL, } �/� ENGINEERC` 1 NO. BLDG.SETBACK FROM ADDRESS SIDE PROP. LINE OF (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CONTRACTOR NO. HIGHWAY WIDTH FROM_C.L. ADDRESS LIC. } _ NO. _ LIC. CD CITY CLASS " CORNER CUTOFF YES.[,J NO V CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS, B W SQ. ADDRESS �i O STORIES -I FAMILIES / NEW ❑ �/ I� � !�- 4, J kj l6 r�� � 4all;_•^" Z USEOFJ'� �{�r'' ADD ' �A° STRUCTURE �t' S�/•[}G/'�f�C g�,{� - r �,. �a ,f ALTER ❑ ! .' f'.F.a :C;S;? �!. ^' .G-�- _.?" ' Z.O. REPAIR❑ SIGNATURE OF APPLICANT '� ( DEMOL ❑ - .. .. _ -_. -- VALUATION S APPROVALS` DATE ,•,:,(NSP 'TOR'g I 'NATURE PMT._TPC. FOUNDATION: LOCATION F E S FEES I �s FORMS, MATERIALS �/ 7.1 L FRAME: FIRE STOPS, ^J f [�lv I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS ` 4-7/" p „P,d Ar_ , AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, - WITHALL- ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VE DUG TS Af �.. ST RUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED. _ / HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. LATH, EXT, SIGNATURE OF)� `� HOUSE NUMBER COR- PERMITTEE �/� j/ �� RECTAND.POSTED - -- --••h. ADDRESS, MQ//l(D/.v� �+ rp II1G1'A Cly FINAL -/.A • ,.JOHN.F. LEWIS..PRI,NCIPAL.ST'R.U.CTURAL N'GT R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION' cK. CASH I (',8321.- JA j 2 1 D 1 7:25N . II . 1A � ATION FOR BUILDING PE IT DEP =OUNT Y OF LOS ANGELES / T OF COUNTY ENGINEER ADDRESS BUILDING ANL' SAFETY DIVISION LOCALITY -7� JOHN A. LAMBI',8,"%u UNTY ENGINEER NEAREST - WILLIAM A. JEN9`. N F•i OF BUILDING CROSS ST. l e C DIST CT NO. G OUP TYPE P -El BY FOR APPLICANTFILL IN `� J-- CONST. tT. BUILDING � -3 ' STATISTICAL CLASSIFICATION SE ER MAP ADDRESS BK G CLASS. NO. DWELL. UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: TRACT / /��c']� Q - P HIGHWAY STATE MAJOR SECOND, L CAL SIZE OF LOT F'y/\ J� I NOV/ON LO USOZONE SPECIAL RCLEI USE OF /% //� '�c CONDITIONS EXISTING BLDG. TEL. �— OWNERNO. BUILDING EXIST. YARD HWY tz4. STREET JIE ADDRESS qC J7 d t - SFRONTK WIDTH ARCHITECT OR T L. P. L. ENGINEER NO. SIDE P.L. ' } ADDRESS CL / �c TEL. INSPECTION RECO O C[OOJNTYR�AtCTTORL -� •tiiY►'1 NOL' J� IJ O ffsRIP NOF WORK u w a NEW -a ALTER REPAIR DEMOLISH NEW N SQ. FT. NO.OF NO.OF / SIZE �Q STORIES FAMILIES USE OF / STRUCTUR �jyt.:.r� b'Y7Yt• SIGNATURE O APPLICANT VALUATION S APPROVALS DATE INSPECTOR'S SIG. I P.C. P.T. C��' FOUNDATION: LOCATION FEE $- FEE $ FORMS, MATERIALS FRAME: FIRE STOPS, IHEREBY ACKNOWLEDGE THAT I 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 COMPENSATION INSURANCE. �� SIGNATURE O % HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 2 FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL =—I PLAN CHECK VALIDATION CK. M.O. CASH PERNIIT VALIDATION CK. M.O. C/ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT - COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER I' FOR APPLICANT TO,FILL IN' ' FOR .OFFICE USE ONLY DISTRICT NO. /�/PLAAN CK`. NO. PPERMIIT,NO. ADDRES BUILDING / fMll -PJ �.l / ➢ 7 AV' S LOCALITY - + "- RECEIVED BY .DATE OF APPL. DATE ISSUED NEAREST CROSS ST.. a3�..r� at.�.. � „ BUILDINGp �� ADDRESS OWNER MAIL `o e• -• - - LOCALITY T ADDRESS •, �Ijyy/L � f(.�p� - _ NEAREST ,-1'EL.'. - J CROSS ST `NO:�CF.k 71% FIRE NO. OF, _ TYP GROU ZONE [PLANS I I .� •' _ ARCHITECT �!p� �` TEL. _ ENGINEER •p(-/ NO. BLDG. / /� ORD. NO. -' ADDRESS" - - SETBACK LINE �J,i' q� APPROVED TEL. BY DATE CONTRACTOR /�. NO. 4 USE APPR E I '- ? �f�f • ZONE BY DAT EJ ADDRESS .� ;� ,. HOUSE NUMBERING _ LEGAL . DESCRIPTION I LOT NO, Cl BLOCK, - MAP NUMBER -FIELD CHECK BY NO.! ASSIGNED BY `�C..,l G• DATE TRACT/ /�+ /f - - - r No. of eLOGs; CORRECTIONS SIZE OF LOT ��. .,� / �� I NOW ON LOT USE OF - I NO. OF, U •'c�.r'"T�!i^VTA:i/' - EXISTING BLDG.. FAMLIES DESCRIPTION OF-WORK NEW I"ALTERATION -,I. I ADDITION. - .. r 0 REPAIR I I DEMOLITION I I I V- SQ. FT. NO. OF Jp SIZE- /s 0, ROOMS r STORIES- O/G /Z�, _ D EXT..WALL' .ROOF v r COVERING - .I COVERING USEOF STRUCTURE APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS ,}.p CORRECT. - t' AGREE TOS COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. •' �` FURNACE: LOCATION,.. .. SIGNATURE OF GAS GAS VENT, DUCTS - PERMITTEE P,cii A-r'� �-.-'•'a4�v�/. //, ' LATH, INT. ADDRESS _ LATH, EXT. AUTHORIZED AGT. PLASTER, INT. - 7eweaeA Deas 10-50 17$ /9�D1U P. C. $ 1 © __ /7 VV�,� FEE PLASTER,-EXT. VALUATION - Q $ -7 FEE Z 7 FINAL 76A638A C'#803-"6-57 APPLICATION FOR BUILDING PERMIT .. - COUNTY OF LOS ANGELES BUILDING Y, DEPARTMENT'OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. -GGiC.... - - DISTRICT Giv R (TYPE _ SEWER ( - i _ - FOR APPLICANT-TO :FILL IN """JJ" K PG CONST: _ BUILDING 1 "�`�l� STATISTICAL GLLASSIFICATION ADDRESS ..J�J -� c4J CLASS. NDWELL. UNITS V" LOT NO. ( - - BLOCKMAP STATE YES - .....). . . . . NUMBER ®O HWY. O TRACT - - E ZONE SPECIAL _ NO.OFBLDGS. ' —CONDITIONS,' ' SIZE OF LOT /� I NOW ON LOT , USE OF a ry' < EXISTING BLDG. BUILDING EXIST: YARD HWY STREET NAME - SETBACK WIDTH OWNER [/ _ FRONT MAIL q q P. L:. �• .r ADDRESS . SIDE - r .TEL. A P:L. CITY No. v INSPECTION RECORD', ARCHITECT OR TEL.. < - ENGINEER %D4"�`'1A.;LA NO. 7/y A ADDRESS - �- TEL. - - CONTRACTOR NO. ADDRESS ._•-•�"'� / DESCRIPTION OF WORK " r ,Y _ NEW D - ALTER REPAIR > DEMOLISH ,/ SQ.FT. JZ4 NO.OF NO.O SIZE STORIES PAMI I - - , U F TR TU RE SIGNATURE OF APPROVALS APPLICANT IL - - .DATE INSFEG-TeR'S-S'I ATURE- ADDRESS 'FOU NDATION:'LOCATION FORMS,MATERIALS P. FRAME: FIRE STOPS, $ ,5-DO 0 FEE $ - BRACING, BOLTS VALUATION FURNACE: LOCATION, C ""^�..�� FEE GAS VENT,DUCTS 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS AP- LATH,INT. �Y""v _ PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RE ULATING BUILDING CONSTRUCTION. LATH,EXT. �® i' SIGNATURE OF HOUSE NUMBER COR- PERMITTE vvv RECT AND.POSTED ADDRESS FINAL JOHN A. LAMBIE,COUNTY ENNIAEA. CLYDE.N. DIRLAM, PRVNCIP STRUCTURAL Er�G-I ER PLAN CHECK VALIDATION CK. M.O. CASH r PERMIT VALIDATION CK. M.O. CASH , ? 4 .2,4-Sv MAR 2'7 1, A .C..Q Q pi � r ' WORKERS' COMPENSATION DECLARATION - flrilWorkers'certificate of consent-to ol , • ®�"` Rn insure, or acetifcateof Compenstnlnsurance, or A'P�LRC �UOM 'F O R L 9) q certified copy,thereof (Sec. 3800; Lab. C.) --COUNTY OF.LOS ANGELES BUILDING AND.SAFETY, Policy No. Company 0 Certified.copy is hereby.furnished. FOR APPLICANT TO-FILL IN' ADDRESS Certified copy is filed with the'county building inspec- BUILDING(� �. tion department... ADDRESS, 1 r LOCALITY' � - °, /) NEAREST '. Date sr•Applicant CITY / ZIP CROSS ST. �/�� CERTIFIC,4TE`OF-,EXEMPTION FROM WORKERS' NO. 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' USE ZONE. MAP TRACT BLOCK `LOT NO NO. J' hundred dollars ($100)or less.) I� EL G / SPECIAL OWNER / NO Q CONDITIONS r' f� I certify, that, in 'the, performance of the work for which this - DISTRICT [GROUP. TYPE FIRE PRO SSED BY. permit is issued;;)shall not employ any person in any manner ,z CONST. ZONE so'.as to become subject to the'Work'ers'Compensation Laws. ADDRESS JJ Date- Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. NOTICE;TO APPLICANT: If, after making this Certificate of ARCHITMT.O TEL. , LU ENGINEER NO. CLASS NO. DWELL. UNITS ` Exemption; you should'become subject to the Worker's; N . _. Compensation provisions of the Labor Code, you must forth- P P Y ADDRESSr SEWER-MAP _ Z with comply with such provisions or this permit shall be �� _ deemed revoked. TEL. BK PG VALIDATION CONTRACTOR NO. LICENSED.CONTRACTORS DECLARATION, LIC. I hereby.affirm that I am licensed under provisions of Chapter.9 ADDRESS -,,. .NO. VALUATION _ (commencing with Section 7000)of Division 3 of the Business and LIC. �j Professions Code, and my.license is in full force and effect. CITY CLASS $ SQ. FT. INC. OF NO. OF .. CHECK License Number Lic.Class .SIZE STORIES FAMILIES ONE ` Contractor Date DESCRIPTION OF WORK NEW a $ I am exempt from The licensing requirements as l am a aicensed architect or a registered professional engineer L7 ADD' ALTER , Q FINAL acting ,In my professional capacity (Section 7051, REPAIR DATE Business and Professions Code). USE OF000, EXISTING BLDG. DEMOL Q - FINAL By Lic.or Reg:No. Date - APPLICANT TEL. - OWNER=BUILDER DECLARATION (PRINT) NO." I hereby affirm that l am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS' " Professions Code)': PRESENT aBUILDING.._. „ I, as owner of the property, or my employees with t ADDRESS o, wages as their sole compensation, will do the work and z 3 2,0 A the structure is not intended or offered for sale(Section LOCALITY w •. 7044;-Business and Professions Code). MOVING .TEL. #,0 0 0 0 0 ❑ CONTRACTOR 'NO. P; as owner of the.property, am exclusively contracting 2 , 5,2 0 0 with licensed,contractors to construct the project (Sec- 0 ro tion 7044, Business and Professions Code). ADDRESS 0 REQUIRED TOTAL SETBACK FROM EXIST. o o'o rj 2 Q 0 CONSTRUCTION-LENDING AGENCY- YARD HWY U SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency'for FRONT 03'02-82 the performance of the work for.which this permit is issued P.I. (Sec. 3097, Civ...C..).':. SIDE P.L Lender's Name` P.C. Fee$ Permit Fee ✓i �• Lender's Address w I certify,that I have read this application and state that the Issuance Fee ���0 i� above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee 00' w and hereby authorize representatives of this County to enter �' .. aupon the above-mentioned.property for inspection purposes. mf �� � -13'100 3 - SEE REVERSE FOR EXPLANATORY LANGUAGE_. 1 Signoture of-P, plicant r Agent, �� Dote ©s APPUCAMON GROG o MLUNG. PERMT T COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIIy S I.hereby affirm that I have a certificate of consent to self-insure,. BUILDING ADDRESS _ 7UU Irl, IV ora certificate of Workers' Compensation Insurance,or a,certified 9933 DUFFY ST copy thereof (Sec.3800,Lab.C.) CITY ZIP n TATE Fi�TATiJ TEMPLE CITY,. CA. . 91780 LocnuTv� -17 Policy No. 1 0 46.1. 40 Company S SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS 9T. Certified copy is filed.with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 11-1-94Applicant RANDOL ROOFING ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE ALBERT CHIANG 446"0722. WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.), - 2030 TERRA LANE [:DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY CITY ZIP - I certify that in the performance-of the work for which this permit ARCADIA 9100.7. �� �-3 3 is issued, I shall not employ.any person in.,any manner so.as to ARCHITECT'OR ENGINEER TEL NO. become subject to the.Workers Compensation Laws. STATISTICAL CL�Aj$SIFICATION APT 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. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL ROOFING 288-4040 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO, P L L .529' E. VALLEY BLVD. 451937. SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L 1 hereby affirm that I am licensed underprovisions of Chapter 9 — SEWER MAP } (commencing with,Section 7000)of Division 3 of the Business and SQ.FT.SIZE NIT OF STORIES I NO.OF FAMILIES a Professions Code,and my license is in full force and effect. NEW El BK PG D V El Number -451937 Lic.Class .0-39. DESCRIPTION OF WORK - ADD VALUATION ContractorRANDOL.ROOFING Date 1-31-94 ALTER 13 $ 2,000.00 I0 • O 3 PLY .HOT BUILD 'UP ROOFING REPAIR )❑ ❑ 1 am exempt under Sec. $ B.AP.C.for this reason SYSTEM, 'CLASS A ROOFING DEMOL ❑ W LDMA P/C# CL LU Date: USE OF EXISTING BLDG. - -URM ❑ F - .N SF z Signature APPLICANT(PRINT) I TEL NO. LDMA Perm# "3`»•f.:! p a ❑ 1, as owner of the property,`or my employees with wages as RANDOL. ROOFING 288-4040 z O ADDRESS `r `�' I their sole compensation, will do the work and the structure is - not intended or offered for sale (Section 7044, Business and S GABRIEL FINAL DATE q Q iTEM'_ Professions Code.)' WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUSMATERIAL �`� S, ❑ I, as owner of the property, am exclusive) contracting with. OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE a/ Q S{) � o � H y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY ..�. .. -.. .. licensed contractors to construct the project (Section 7044, 5 Business and Professions Code.) ves 1:1 No❑ f 'C WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ' CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. - I hereby affirm that there is*,a construction lending agency for YES❑ NO❑ _ the performance Of the Work for WI11Ch this permit IS ISSUed(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING i S!ijl I—{moi';i€yy ir`•ii{�?` 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS =f �; 1i 0 c"' Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CL Lender's Address O OWNER OR AGENT ' o .1 certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 78.90 NN with all county ordi s and State laws relating to building a construction, nd her uthorize reoresentatives of thCo ty - ISSUANCE FEE - � to enter pe a nti ed pr er for ins ge ' ¢ 6! INVESTIGATION FEE TOTAL FEE 105.30 - ;pe ure of Appic or I Dale SEE REVERSE FOR EXPLANATORY LANGUAGE