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HomeMy Public PortalAbout5350 ENCINITA AVE_Building__ b&BA $5°#803 9-67 � APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ?, [., a DEPARTMENT OF COUNTY ENGINEER ADDRESS �5 �0 (t:7 BUILDING AND SAFATY DIVISION LOCALITY 7 JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. DISTRICT NO. GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN CONST. (Print or type only) �Q 0 BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 5350 Encinita CLASS NO.�Z_DWELL•UNITS_ef, BKP PG,�'(/i LOT NO.1 BLOCK A USE ZONE MAP D TRACT 11492 iN�/ SPECIAL NO.OF BLDGS. �l CONDITIONS SIZE OF LOT72x163 NOW ON LOT 1 USE OF EXISTING BLDG, residence BLDG.SETBACK FROM L / TEL. FRONT PROP.LINE OF (STREET). (STREET). OWNER) m NO- - TYPE OF EXISTING SETBACKHIGHWAY + YARD = TOTAL ADDRESS 5350 Encinita HIGHWAY WIDTH FROM C.L. CITY Temple City LCL a SSD C� + ,�� ' "—o ARCHITECT OR TEL. SIBLDG.SETBACK FROM /1' �j�� (STREET) SIDE PROP.LINEOF L ENGINEER NO. _ TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS HIGHWAY WI-DTH FROM C.L. TE CONTRACTOFROd1ne Builder NOL 442-3862 -�--L- 6 0 + '5as J o ADDRESS5327 N Peck Rd NO O CORNER CUTOFF YES\71 NO ❑ CIT'Wl Monte crass B-1 SEE REVERSE SIDE FOR SPECIAL AP OVALS o W DESCRIPTION OF WORK �- z NEW DD ALTER REPAIR DEMOLISH SIZE T 252 STORIES 1 FAMILIES 1. USE OF STRUCTURE SIGNATUREF / APPLICANT 2� y- VALUAT10 $ � p .�- APPROVALS DATE INS P C OR'5 SIGNAT RE P.C. PMT. - 7 �'• 'FOUNDATION: LOCATION /�� FEE$ FEE $C�/• 7, — FORMS, MATERIALS �J FRAME: FIRE STOPS, el I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS i 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 1 WILL NOT EMPLOY ANY PERSON IN VIOLA. TION OF THE LABO ODE OF THE STATE OF CALIFORNIA RELAT- LATH, INT. ING TO WORKMEI,+I'S C MPENSATION INSURANCEVC-4) l( � LATH, EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTEE - RECT AND POSTED ADDRESs53 N Peck Reit, El Monte JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. }�rCASH _ r} PERMIT VALIDATION CK. M.O. CASH 9 5 1 0� AFF 2 2 D 2 7.75— G 76A638A CE#803 9-68 "''` ef 7 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ABoloRess53 ��/� DEPARTMENT OF COUNTY ENGINEER JJ BUILDING AND SAFETY DIVISION LOCALITY /e- JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. " v - FOR APPLICANT TO FILL IN DISTRICT NO. I GREY R UP TYPE �� PROCESSED BYf (Print or type only) ✓ Qg CONST BUILDING /� ' STATISTICAL CLA SIFICATION "j�,— (SEWER MAP ADDRESS CLASS NO, DWELL,UNITS— K P LOT NO. BLOCK USE ZONE MAP (y�� N O. TRACT r CONDIT ONS AL NO.OF BLDGS. SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG, BLDG.SETBACK FROM , EL ,l FRONT PROP .LINE0F "�' -(STREET) A dl OWNER - NO G TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL HIGHWAY WIDTH FROM C.L. ry�� ADDR 9 � _ W � / U + ?C> CITY 7 BLDG.SETBACK FROM itf ARCHITECT OR TEL. SIDE PROP.LINE OF / / (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS r� HIGHWAY WIDTH FROM C.L. TE CONTRA CTO ` NOL 2jf � LIC. ADDRESS, NO, D CORNER CUTOFF YES NO LIC. C CITY CLASS I` SEE REVERSE SIDE FOR SPECIAL APPROVALS LL CONSTRUCTION LENDE u NAME AND BRANCH /✓Ca -�`� ADDRESS Q / , SQ. FT. NO. OF NO. OF NEW ❑ `F ��• n 1! R SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE, p ALTER ❑ 1M4,Lit 'ItOdfEPAIR SI NATURE OF A PLICANT �/� DEMOL ❑ -ip VALUATION $ do O APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. Z" FOUNDATION; LOCATION FEE S FEE $ ` I FORMS, MATERIALS FRAME: FIRE STOPS, l I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS 7 - 749 f.�J AND STATE THAT THE 'ABOVE IS CORRECT AND AGREE/TO COMPLYON- FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BU/LDI NG CGAS VENT, DUCTS STRUC TI ON. 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 •CAL. NIA IN RELATING TO WORKMEN'S COMPE NS TION RANC E. ( LATH, EXT, \ SIGNATURE OF 0 .! HOUSE NUMBER COR- PERMITTEE REC T AND POSTED ADDRESS ' I FINAL I JOHN F. LEWIS. PRINCIPAL ST R URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION GK., M.O. CASH �('f 0 7 G :n �E"2 7 r D 1 725- 76A638A C&#803 8-64 APPLICATION FOR BU I&DIG PE MIT COUNTY OF LOS ANGELES BUILDING ADDRESS ��' f DEPARTMENT OF COUNTY ENGINEER - BUILDING AND SAFETY DIVISION LOCALITY r , JOHN A. LAMBIE. COUNTY ENGINEER NEARESTh COLEMAN W. JENKINS,SUP•T.OF BUILDING CROSS ST. / -/ DISTRICT NO. GROUP PE P' O ESSED BY FOR APPLICANT TO FILL IN 1. s CONST I BUILDINGn STATISTICAL CLASSIFICATION S WER MAP Rt ADDRESS 12 5350 Encinita T. C. , CLASS NO. DWELL UBK/y PG LOT NO. BLOCK USE ZONE MAP NO. TRACT SPECIAL NO. OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT _ USE OF IXSTIM G BLDG. SETBACK FROM / TEL. FRONT PROP. LINE OF (STREET) OWNER J. -I NO. TYPE OF EXIST]NG SETBACK .HIGHWAY + YARD - TOTAL ADDRESS 1701 Rosewood Dr. Monrovi HIGHWAY WIDTH 'F M C.L. CITY Monrovia BLDG. SETBACK FROM ARCHITECT OR TEL. SIDE PROP. LINE C (STREET) ENGINEER NO. - TYPE OF E%ISTING SETBACK HIGHWAY �- YARD - TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. d O CONTRACTOR�T it in Roof NO 287-0507 + v ADDRESS 600 S S B IC CORNER CUTOFF YES NO O CITY;San Gabriel CLQA S, SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK n Z rVALUATION ADD ALTER REPAIR DEMOLISH NO. O NO. OF STORIES FAMILIES URE residence /" RE OF ANT $ 997.00 APPROVALS DATE I N SP E C TOR'SSI O NATURE PMT. p� FOUNDATION, LOCATION FEE$ 8,QO FORMS,.MATERIAL_S FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION �1 WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS f� 9UILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK AUTHORIZED HERE Y I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. pG TION OF THE LAB R CODE OF THE STATE OF CALIFORNI RELAT- ING TO WORKMEN' MPENSATION 1 SURANCE. LATH. EXT. SIGNATURE OF J HOUSE NUMBER COR- G �� PERMITTEE J RECT AND POSTED ADDRESS Marcia Madden sec,' . FI NAL JOHN F. LEWIS, PRI CIPAL ST C URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH -t`tl1rJ Q b <? 1-1 r-.` , 1 5 1 O r;!J i 76A638a'CE08038-84 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT.OF COUNTY ENGINEER ADDRESS 5 -s 3 0 fir, s BUILDING AND SAFETY DIVISION LOCALITY j LL JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. DISTRICTNO. GROUP TYPE, B- ESSED BY FOR APPLICANT TO FILL IN CONST. BUILDING � + STATISTICAL CLAS IFICATION EC ER MAP ., ADDRESS L350 �N� S CLASS NO._g-DWELL UNITS. BKS/ PG LOT NO. BLOCK A USE ZONE MAP• /. �g NO, TRACT SPECIAL N0. OF SLOGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF I S ATr. CAAAC-C BLDG. SETBACK FROM - TEL. FRONT PROP. LINE OR ' (STREET) OWNER T. A/zrm-1 NO. TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL ADDRESS HIGHWAY WIDTH_'FR 0 M C.L. + z�C) _ CITY BLDG. SETBACK FROM ' ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. - TYPE OF EXISTING SETBACK HIGHWAY -F YARD - TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. 0 _ 0 CONTRACTOR a� L/c NOLO 43-3o,3' + r V r^6 CORNER CUTOFF YES NO ADDRESS ,9� y/ ctS NO. 'O D El 0 LIC H CI Sr. &-G - 'SEE REVERSE SIDE FOR SPECIAL APPROVALS UJI DESCRIPTION OF WORK h NEW DD ALTER REPAIR DEMOLISH �/ t Sq.FT. NO. OF NO. OF "'' "' SIZE STORIES FAMILIES .� USE OF L' STRUCTURE v PIS r- 1%-o774oV4 SIGNATURE O I APPLICANT VALUATION$ Z or)per APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION, LOCATION P.C. �� PMT. G FEE$ FEE$ AME, FIR ATERIAL.$___ -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 A. WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS ui BUILD I NG CONSTRUCTION. I CERTIFY THAT, IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. 6 TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'Sg[? IyNJS ANCE. LATH. EXT. SIGNATURE OF � --'/ HOUSE NUMBER COR- PERMITTEE j' RECT.AND POSTED. A 0 D R E S 5 •S�= FINAL v 0 JOHN F. LEWIS. PRI CIPAL STRECtVRAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH LAU0 3 L 6" I'llty 6 1 D 4,00 76A638A CE#&33844 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING C- , t � G DEPARTMENT OF COUNTY ENGINEER ADDRESS S 3�a c. BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W'JENKINSSUP T OF BUILDING CROSS ST FRE APPLICANT TO FILL IN DISTRICT NO( �' CONST-TYPEPjss D' J n STATISTICAL SSIFICATION - SEWER MAP _ 3JO Gi S C. CLASS NO DWELL UNITS BK V PGBLOCK A USE ZONE MAP /nNOV�` SPECIALNOOP BLDGS CO I IONS NOW ON LOT NG BI-DG, �1BLDG SETBACK PROM L TEL, PRONT PROP LINE OP � �/� — (STREET) TYPE OF EXISTING SETBACK HIGHWAY YARD — TOTAL ADDRESS S C/LWl`e HIGHWAY P M C L CITY ARCHITECT OR TEL BLDG SETBACK FROM +, ENGINEER �� NO SIDE PROP LINE OF ' (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS �//� ,p `' HIGHWAY WIDTH H� PROM C'�JL // CL CON TRACTOpR.`4{��/^` W�/�." NOL / 3— D�a' 6t t "' —f + `_ Q ' OV ADDRESS/00 7,l C . leuLily NO LIC CORNER CUTOFF YES NO O H c YS� �L /7? LIc $� SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK 00#1ACIS7 'z"a NEW ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAMILIES USE OF qq�� tri`, q /� 44 STRUCTURE ly �c—\�f�� 2L7 "il L �� J / A �� .m c/ C9 ., /Ap p dt it P rr� SIGNATURE OF APPLICANT VALUATION$ - /� APPROVALS DATE, INSPECTOR'SSIGN�ATURE FES$ FEE$ 42O FOUNDATION, LOC ION FORMS, MATERIALS FRAME, FIRE STOPS, ti I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS SUILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABORCOD- OF THE STATE OF CALIFORNIA RELAT \ ,, ING TO WORKMEN S COMPENSATION INSURANCE l LATH EXT V SIGNATURE O I/ ..L� HOUSE NUMBER COR- PE4RMITTEE_ ` T 77 RE AND POSTED ADDRESS �( Fl NAL PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL ST URAL EN c SEFER PERMIT VALIDATIONCK _t,io 0 4 5 13 1 0 4.0 0, R COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0301290032 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING AD RESS: TR: 11492 LT: 1 BL: A SO. FT STORIES TYPE OCCUP GROUP 5350 ENCINITA AV STRUCTURE: 143 1 VN U1 TEMP CA 917803114 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: OLIVE 8590-001-001 OTHER: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/29/03 JK 01/24/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: GOMEZ HENRY;DOLORES V (626) 285-4746- 3,000 5350 ENCINITA AV TEMP 917803114 FEES PAID DESCRIPTION Of WOR 11'X131 COVERED PATIO - ICBO #2228P FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: GALKOS CONSTRUCTION (714) 373-8565- AA BLDG PERMIT ISSUANCE 27.75 5412 BOLSA AVE #G AC STRONG MOTION RESID _ 3000.00 VAL 0.50 SPECIAL CONDITIONS: HUNTINGTON BCH 92649 D2 PERMIT W/O EN-HC 3000.00 VAL 99.00 TOTAL FEES 127.25 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE GALKOS CONSTRUCTION (714) 373-8545- 5412 BOLSA AVE STE G LIC. NO 'All ? � LOCATION AND SETBACKS HUNTINGTON BEACH CA 92649 492715 HIC SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: �' --� FOUNDATION/TRENCH FORMS LIC. NO ; I SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:.. UNDERFLOOR INSULATION 3 01 ST LEVEL FLOOR SHEATH NO. 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 REDUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPELI SZ SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: BS0508 APPLICATION FOR: BUILDING PERMIT iJ COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING �DTESS BUILDING ADDRESS / � .J ����/Y�•`T I hereby affirm that I have a certificate of consent to self insure, O H C i iT�1 V'2 or a certificate of Workers'Compensation Insurance,or a certified CITY s ZIP G� copy thereof(Sec.3800,Lab.C.) �•'►'7 / .1 L / '7 Q LOCALITY 11 �� Policy No. Company SIZE OF T NO. BLDGS.NOW ON LOT 7-e,,w ❑ Certified copy is hereby furnished. NEAREST CROSS ST. - TRACT BLOCK LOT NO. ©L � Vim' ❑ Certified copy is filed with the county building inspection uSEZONE MAP NO.. department. y Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS NDH NS CERTIFICATE OF EXEMPTION FROM WORKERS' ADDRESS o ER 0— D/ 1"� e TEL.NO. C ��� YES No COMPENSATION INSURANCE J WITHIN 1000 FT.of SCHOOL? _ ' (This section need not be completed if the permit is for one hundred J 0 i a DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY zip �'7 p 1 certify that in the performance of the work for which this permit / �'a is issued, I shall not employ any person in any manner so as to ARCHIT C OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.�.� fDWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of REOUIRED TOTAL SETBACK FROM EXIST C NTR TOR TEL.N Exemption, you Should become Subject t0 the Workers' /J p[� / SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 0 I S� Q T N I FRONT comply with such provisions or this permit shall be deemed revoked. ADDRES LIC. . `� P L IM BLAc� DE LICENSED CONTRACTORS DECLARATION DIT' / / LIC.CLASS P1L C I hereby affirm that 1 am licensed under provisions of Chapter 9 C� SEWER MAP V (commencing with Section 7000)of Division 3 of the.Business and SO.FT.SIZE NO.OF STORES NO.OF FAMILIES Ct Professions Code,and my license is in full force and effect. (�� NEW ❑ BK PG , CD DE CRIPTION OF WOR qpp ❑ VALLI ION 0 W License Number Lic.Class $ 6 a Contractor Date ALTER ❑ P CO) z ❑ I am exempt under Sec. / REPAIR P- BARC.for this reason i7 P-- (�L G DEMOL ❑ LDMA P/C H Date: USE OF EXISTING BLDG. URM ❑ z Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# .Z _.t.- n El 1, as owner of the property, or my employees with wages as p =�' their sole compensation, will do the work and the structure is ADDRESS .H ;•i`li not intended or offered for sale (Section 7044, Business and FINAL DATE A Q -w Professions Code.) \[ ' 4 WILL THE APPLICANT OR FUTUREBUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL V J Y OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN s--„_,,, ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY S I ` g d licensed contractors to construct the project.(Section 7044, YES❑ NO❑ j 9 14�L l '� Business and Professions Code.) �{ i% WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING '=s`-�='+� •''-= 9" OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST �{3L!fF 71L 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. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD r:r.-•.: 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES m. COUNTY CODE,TITLE 2.CHAPTER 2.20 SECTIONS 220.100 THROUGH 220.140 CONCERNING 3 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. f Lender's Address L x.35 1 AN i;?1 L� OWNER OR AGENT . o- 1 certify that I have read this application and state that the above FEE PERMIT FEE P.C. information is co pct. agree to comply with all county ordinances and ate I w elating to building construction,and c7 ¢- a by authoriz repress atives of this County to enter upon ISSUANCE FEE / e above-mentio d pro y for inspection purposes. ¢ V INVESTIGATION FEE TOTAL FEE / et A�nra�� Daft SEE REVERSE FOR EXPLANATORY LANGUAGE.