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HomeMy Public PortalAbout4922 FRATUS DR_Building__ APPLICATION FOR BUILDING PERMIT - FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS ZZ e ,C. DEPARTMENT OF COUNTY ENGINEER CITY y� ZIP 1174 O BUILDING AND SAFETY DIVISION LDING SIZE OF LOT 40`�l Z-I NOW ON LOT ADBLDGS DRESS V9 2- /J&Q f TRACT ��`�p{�' (?S /�BLOC/K�',��.w I' LOT NO ! O LOCALITYTEL NEAREST z,­ OWNER Y� J !T /C[ R� NO C OSS ST Z� IO n � �I ASSESSOR ADDRESS /�/ / (�/Q� MAP BOOK PAGE PARCEL CITY ZIP ���dY DISTRICT G UP TYP FIRE CESSED BY ` ST ZO ARCHITECT OR TEL ENGINEER �/ vo NO.S/ "'r� STATISTICAL CLASSIFICATON '`SEWER AP ADDRESS t /q ( S/Lflo1 X7—,44"m Ir.7 CLASS NO �f DWELL UNITS J BK PG CONTRACTOR LerJ —5jO,4 w T O A^ff+�n�3L. U ONE NOP SPECIAL ADDRESS e �L�/ NC b CONDITIONS LIC CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM FRONT PROP LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ FT � NO OF NO OF CHECK HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH SIZE �/ STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW + = a O ADD ❑ BLDG SETBACK FROM w 4 rLr. C A SIDE PROP LINE OF (STREET) O ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING USE OF REPAIR ❑ SIDE PROP LINE HIGHWAY WIDTH Z EXISTING BLDG DEMOL ❑ + APPLICANT ,,�aI wI` '' TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT( (�/9N NOS IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( IN COASTAL PERMIT ZONE � YES ❑ NO ❑ VALUATION$ Poo 1a (�3�7�]�/j-�► IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR COD/OFTH TEOFCALIF NIA IN RELATING TO WORKMEN 5 COM''PENSATION INSUSIGNATURE O PERMITTEE ADDRESS o ��� FINAL �f BY TEL T TEL DATE/�"v/ CITY Y �"' NO � MAKE CHECKS PAYABLE TO FEE;$ ✓ FEET HARVEY BRANDT.COUNTY ENGINEER PLAN CHECK VALIDATION cK J M o `CASH.CASH- PERMIT VALIDATION CK M o CASH 614dUL- 1523 ® .3 1.x' 5 ', , d 3r; " - 6�1 Sri JUL 15 1 D 6 2.2 5 ®" ; OS 76A638A CE#803 3 75 T APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING �� COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY LEM IN. Cl ZIP q ! BUILDING AND SAFETY DIVISION NO OF BLDGS BUILDING SIZE OF L/OT ) i �fNOW ON LOT ADDRESS TRACT i((?'4�5' BLOCK LOT NO LOCALITY OWNERL7CJNOL 'CROSS ESTST Q" s _ ASSESSOR ADDRESS 1A , MAP BOOK PAGE PARCEL y DISTRICT GROUP TYPE FIRE PROCESSED BY CITY e i ZIP .�./ CONST ZONE V/1, �j ARCHITECT O TEL •� 1 o/ , ✓-'?13- ENGINEER NO i Q STATISTICAL CLASSIFICATION SEWER MAP - ADDRESS CLASS NO.,, 2_L--DWELL UNITS BK PG CONTRACTOR TEL USEIZONE NOP LIC ADDRESS NOSPECIAL CITY LIC �- t CONDITIONS L CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER (c� � NAME AND BRANCH Ve:; C BLDG SETBACK FROM C FRONT PROP LINE OF (STREET)' c ADDRESS CITY HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING SQ FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE C: + - LL DESCRIPTIOOF WORK NEW 1Z N ADD BLDG SETBACK FROM M SIDE PROP LINE OF (STREET) ALTER ❑ T � OTAL SETBACK FROM TYPE OF EXISTING "1 _ _ '�ce HIGHWAYi } YARD = d-- REPAIR❑ SIDE PROP LINE HIGHWAY WIDTH USE OF } _ EXISTING BLDG P4� DEMOL ❑ APPLICANT ' TEL CORNER CUTOFF YES ❑ NO E](PRINT) Ile Ln q0 15-T-76702 f� IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE) _ U �.iC.�Ls 2 IN COASTAL ZONE YES ❑ NO ❑ VALUATION 'Q , CATEGORICAL EXEMPTION YES❑ NO ❑ 1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATIONjJ1 LABOR CODE OF THE STATE OF CALIFORNIA IN RELA �q✓ '� f ; /► ♦� WORKMEN'S COMPENSATION INSURANCE c • i �v /- v f SIGNATURE OFC4 ' PERMITTEE yy ' ADDRESS J / FINAL BY CITY Q�,j1 /� J� NOL ' DATEQMA KF_ CIIECKS ! AYABLE TOFEE FEE1HARVEY T BRANDT COUNTY ENGINEn PLAN CHECK VALIDATIONCK M O CASH PERMIT VALIDATION CK M 0 CASH / J54�jUN -14- 1 ..D _ 7.2 Q,Abu 76A638A CE#803 7/73 1 .r - I APPLICATION FOR BUILDING PERMIT . FdR APPLICAtIT TOFILL IN (Prl,,t or type only) BUILDING DEPARTMENT ADTY OF LOS ANGELES DRENT OF COUNTY ENGINEER SS 2- � � i` , CITY , 7.P, BUILDING AND SAFETY DIVISION f' p NO OF BLDGS BUILDING SIZE OF LOT 'O f ri NOW ON LOT ADDRESS 'r V,, �� •��' i TRACT //, BLOCK LOT NO I LOCALITY 11 TEL NEAREST OWNER MV_AwQ_S \C64 t?NO -755'07 CROSS S ASSESSOR ADDRESS �� {�Q'�US MAP BOOK PAGE PARCEL n. C) DISTRICT GROUP TYPE FIRE PROCESSED BY CITY le 1�.1 ZIP �7 dO CONST ZONE J/ ARCHITECT OA EL - �� � ENGINEER e& ,4e�Q[�NO STATISTICAL CLASSIFICATION SEWER MAP ADDRESS / CLASS NO _DWELL UNITS t BK PG CONTRACTOR /h'/1 TEL USE ZONE MAP LIC NO ADDRESS NO SPECIAL CITY LIC CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NCl❑ CONSTRUCTION LENDER1 r } NAME AND BRANCH - '�- W Q_�e(tV BLDG SETBACK FROM a FRONT PROP LINE OF I (STREET) .CC, ADDRESS CITY �� 1e e\� HIGHWAY YARD TOTAL SETBACK FROM TYPE OF EXISTING tx SQ FT NO OF NO OF CHE K FRONT PROP LINE HIGHWAY WIDTH H SIZE STORIES ' FAMILIES ONE C. + LL Nl�DESCRIPTION OF WORK NEW ❑ v BLDG SETBACK FROM Z �� \1 rOQ r a ADD SIDE PROP LINE OF y`� (STREET) W", if ALTER ❑ HIGHWAY + YARD _ TOTA ELT BA FROM TYPE OF EXISTING REgip �' SIDE LINE HIGHWAY WIDTH PAIR❑ USE OF + _ EXISTING BLDGt DEMOL ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) 1� L�QNO BY (SIGNATURE) IN OPEN SPACE YES ❑ NO Q IN COASTAL ZONE YES ❑ NO ❑ VALUATION •Y 7 UOQ , CATEGORICAL EXEMPTION YES❑ NO In 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO /�/� i WORKMEN'S COMPENSATION INS URANC ���% ��/✓"✓J� �p�/!rf,..� G SIGNATURE OF PERMITTEE ..- ADDRESS FINAL BY TEL CITY NO DATE/ ��� ! �- � MFlKF CHECKS PAYABLE 10 _FEE FEE HARVEY T BRANDT COUNTY ENGINEER ll PLAN CHECK VALIDATION CK M 0 CASH _ PERMIT VALIDATION CK M O CASH ►�,.�/'� 7 '5 3il"APR 29 1 U 5 5.5 0 ,&9d 76A638A CE0803 7/73 DEPARTMENTCOUNTY OF LOS ANGELES AFETY BUILDING WM. J. FOX, CHIEF ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDINGDIST O. PLANCK OR RE o PERMIT NO ADDRESS � � rv. 'r A �� 33. RE IVED BY DATE OF APPL. DATE ISSUED LOCALITYNEAREST �./L- �(/n �^ f CROSS ST. F►/� � �fN / / i BUILDING ADDRESS OWNER (� 11 uf, LOCALITY -T-F M PL1-1- MAIL ADDRESS '3 /i'i 10 ofk zm NEAREST -/ / \ TEL. CROSS ST. Fr -r L F? ® ( AT aL CITY //"l/- I NO. FIRE I NO OFI TYPE GROUP ,_ ARCHITECT OR TEL. ZONE V PLANS -� ENGINEER NO. BLDG _/ ORD. NO. SETBACK LINE .7 Q w'_r M I N �IP�. l ugiL ADDRESS USE gj APPROVED �,C46 NO ZONE BY DATE CONTRACTOR�r � HOUSE NUMBERING , ADDRESS V ` `�4iV {!' I MAP NUMBER 1-0 L NO ASSIGNED BY LEGAL CORRECTIONS DESCRIPTION LOT NO. I Sb BLOCK _ TRACT �if LL-.i7 1 / NO OF SLOGS SIZE OF LOT f?a L`1QX I,(, NOW ON LOT . 90 USE OF I�}VC-�tA'GE I NO OF EXISTIN BLDG. FAMILIES DESCRIPTION OF WORK °a ------------------- NEW ALTERATION ADDITION Z -- D r REPAIR DEMOLITION Sq FT. p NO OF SIZE ]S ROOMS STORIES I EXT WALLROOF COVERING SYU''rn I COVERING p M Pb USE OF STRUCTURE MIAIELL1NE W(TH fl-r:i'RrHE'D ��A-R, l SlKia INSPECTION FOR ` APPROVALS OCCUPANCYAS INSPECTOR'SfSIGNATURE DATE FOUNDATION: LOCATION / `t FORMS, MATERIALS IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLIC ATION AND STATE THAT THE INFORMATION GIVEN 13 FRAME FIRESTOPS, �� CORRECT BRACING, BOLTS I AGREE ����BBBB�COMPLY WITH ALL COUNTY RDINANCES FURNACE. LOCATION, AND STATE \ REGULATING BUIL STRUCTION t / GAS VENT, DUCTS SIGNATURE O ' LATH, INT. PERMITTE G LATH, EXT ,� D�Gt-e9.+�a,,•✓ ��Z.�� 46 ADORE55 PLASTER, INT. AUTHORIZED AOT. PLASTER, EXT. �_ HOUSE NUMBER COR- RECT OR- FEE d RECTANDPOSTED VALUATION IJo FEE S.3 FINAL ` vim S 76AS38A DBS 3 7-51 /" 76A'Lri3 V.l CE 98Q3 12/69 1'l APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING �4_ ADDRESS /`CCT JOHN A LAMBIE, COUNTY ENGINEER d �, COLEMAN W. JENKINS. SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST Print or tvoe onl BUILDING DISTRICT NO GRO P CONST rPR CESS�E�D BY ADDRESS STATISTICAL C�j�°'SSIFICATION SEWER MAP LOT NO �(/ BLOCK CLASS NO �/ DWELL UNITS —BK—P--Q_ TRACT _ USE ZONEMAP NO OF BLDGS �NO 20 r SIZE OF LOT6e NOW ON LOT _ / SPECIAL USE OF CONDITIONS EXISTING BLDG TE OWNER NO BLDG SETBACK FROM ADDRESS �� � �' FRONTPROP LINEOF (STREET) TIP OF EXISTING SETBACK I HIGHWAY + YARD = TOTAL CITY HIGH WIDTH FROM C L ARCHITECT OR TEL \ + _ ENGINEER NO BLDG SETBACK FROM (STREET) ADDRESS SIDEPROP LINEOF TEL TYPE OF EXISTING1 SETBACK HTGH+�i'AY + YARD = TOTAL CONTRACTOR NO4 � 73 GHWAY WIDTH FROM C L LIC + = a ADDRESS NO 7 CD LIC �j E] ❑ U ,i1 CITY CLAr,J f CORNER CUTOFF YES � CONST CTION LENDER NAME AND BRANCH E REVERSE SIDE FOR SPECIAL APPROVALS / W ADDRESS �y f!4'-,7., -. ^j)1 J�� fFi{% J✓/.��Z SQ FT / NO OF NO OF NEW ❑ (,�' / SIZE / STORIE FAMILIES QA USE OF ADD 7d STRUCTUR ALTER v REPAIR❑ SIGNATURE OF I APPLICANT DEMOL ❑ VALUATIONS .�DDS--° APPROVALS DATE „ 'NSP OR'S S NATURE P C "7PMT /� FOUNDATION LOCATION / / FEE S FEE $ �`�f3�� FORMS MATERIALS (0 FRAME FIRE STOPS, � 0 C �„ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS I AND STATE THAT THE ABOVE IS Co RRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS ST RUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT y- LABOR CODE OF THE STATE OF CALIFORNIA IN REL ING TO WORKMEN'S COMPENAA419N I URANCE LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL (f JOHN F LEWIS PRINCIPAL STIR RAL ENGINEER PLAN CHECK VALIDATION CK M D CASH _ PERMIT VALIDATION CK M o CASH T I ,�'� 5 1 4 8R CLAY 2 9 i D 2 7.7 5' APPLICATION FOR BUILDING PERMIT . FOR APPLICANT TO FILL IN, (Print or type only) BUILPJNG COUNTY OF LOS ANGELES ADDRiaS ZZ �cI ¢7T�S DEPARTMENT OF COUNTY ENGINEER CITY — ZIP 7 f 740 BUILDING AND SSAyFFETTY�(DIVISION NO OF BLDGS BU IDING SIZE OF LOT 460-k- 1-2- 9 NOW ON LOT / ADIDRESS 4CJ�Z jj ��i /��iJ - TRACT /b y 7S BLOCK LOT NO o LOCALITY 7 ; //�! TEL NEAREST OWNER (� NO CROSS ST ASSESSOR . ADDRESS �iZ �� �4Tuf 6, MAPBOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P ESSED BY -CITY ��J� 4j�' ZIP %�d v Q TQ y CO ZOr j ARCHITECT OR __ ^� TEL V [�/ ENGINEER NO STATISTICAL CLASSIFICATION SEWER MAP' ADDRESS 01 TEL CLASS NO -2-1DWELL UNITS BK 4 ilPG CONTRACTOR OC4 Aj teIL-_ NO USE ZONE MAP LIC / NO �-O ADDRESS NO �/ SPECIAL LIC CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM FRONT PROP LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ FT NO OF NO OF CHECK HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW CK + p ADD ❑ BLDG SETBACK FROM cz Q �C(o� SIDE PROP LINE OF (STREET) - O -- - _ - ALTER- ❑ = TOTAL SETBACK FROM _ TYPE OF EXISTING w HIGHWAY + YARD = SIDE PROP LINE HIGHWAY WIDTH N USE OF - REPAIR ❑ Z EXISTING BLDG DEMOL ❑ + A(FIRNT)�CANT NOL ) �SY CORNER CUTOFF YES ❑ NO ❑ IN OPEN SPACE YES`❑ NO ❑ BY(SIGNATURE( Q //�j IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION.p Cf�/'� '� -7-"> I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �� tole � �'- THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE ST TE OF CALIFORNI N RELATING TO WORKMEN S COM PENSATION INSURANCE SIGNATURE OF Vey PERMITTEE ADDRESS W 7 &L., FINA CITY 7�NYLU* &ile N�GdCf �1�i DATE MAKE CHECKS PAYABLE TO F E $ FET HARVEY BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION CK m o CASH PERMIT VALIDATION cK M o CASH 5 a - 'DEC" 1.4 41 v i �J U Al t 03 76A638A CE#803 3 75 APPLICATION FOR . BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDRESS S7 �' or a certificate of Workers'Compensation Insurance,or a certified E copy thereof(Se 3800,Lab C) f _ / CLP(-- / ZIP k LOCALITY Policy No Company / �� f`�y'W SIZ O LOT C' NO OF BL GS NOW ON LOT �rtified copy'IS hereby furnished NEAREST CROSS ST 1:1 Certified copy IS filed withth county bul Ing Inspection TRACT BLOCK LOT NO department USE ZONE MAP NO ASSESSOR MAP BOOK PAGE PARCEL Date/ d` pphcant t + SPECIAL CONDITIONS CERTIFICATE OF EXEMPTI FROM WORKERS' QWIgER J TEL NO _-en� ✓/ YES NO COMPENSATION INSURANCE vt1k12 WITHIN 1000 FT OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred DISTRICT GROUP I TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) CI I certify that In the performance of the work for which this permit 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 T STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS ` CLASS NO 6;V I DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, I CONTRACTOR EL ? ©6� p you should become subject to the'Workers' f�� i ,,— SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ✓t/ f 7 � comply with such provisions or this permit shall be deemed revoked ADDRESS v-- 'LIC N FRONTP L G L w / SIDE }' LI LICENSED CONTRACTORS DECLARATION n' CLASS p L 1 hereby affirm that I am licensed under provisions of Chapter 9 CI 05 'ry►crop Cb, SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZFr� NO OF STORES NO OF FAMILIES C) Professions Code,and my license is In full force and effect 7/ NEW ❑ BK PG ® 8 1 D CRIPTION OF WORK VALUATIO W License Number J 3 7 7 Lic Class � Aomd, ADD 41b Contractor L C-IMr-M ie/TlfDate I R ALTER $� �� zI am exempt under SecB&PC for this reason �. DEMOL LDMA P/C# Date us STINGURM El Signature APPLICANT(PRINT) TEL NO LDMA Perm It i ❑ I, as owner of th perty, or my employees with wages as f" p their sole compe tion, will do the work and the structure is ADDRESS - not Intended or offered for sale (Section 7044, Business and FINAL DATE i_ Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDL€A HAZARDOUS MATERIAL I J 3 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUA TO OR GREATER THAN Q ❑i 1,I A owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL I U I II " licensed contractors to construct the project (Section 7044, ` + yF ,��'s Business and Professions Code) ves❑ No❑ _ _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING =T{L -i Ic OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEEIPERMITTING CHECKLIST �'I/I �/ 1 ) ' ( { FOR GUIDELINES JJI((f I•( / (N s V_ I hereby affirm that there Is a construction lending agency for YES El Nd 1-1 the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS<)NDER THE LOS ANGELES I m COUNTY CODE TITLE CHAPTER 220 SECTIONS 2 20 100 THROUGH 220110 CONCERNING1 ^a 721 Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD "' ' Lender's Address OWNER OR AGENT o I certify that I have read this application and state that the above Information is correct I agree to comply with all county PC FEE PERMIT FEE ordinances and State laws relating to building construction,and !� a here thorize rep sentatives of this County to enter upon ISSUANCE FEE the bo mention ropertyfor spectionp�ose n INVESTIGATION FEE TOTAL FEE �, 7' f 0+ Sly m of AppO Ayenf Gem / d SEE REVERSE FOR EXPLANATORY LANGUAGE, 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 0911090013 PHONE (626) 285-0488 EXT ILEGAL ID NO OF CONST I BUILDING ADDRESS ITR 16475 IT 150 SQ FT STORIES TYPE 4922 FRATUS DR STRUCTURE 2100 V-B TEMP CA 917803719 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET SPARKLETT 18590-028-014 I THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY, Cl ITENANT IEXIST BLDG USE RESID USE ZONE R-1 JISSUED ON PROCESSED BY 1 I IEXIST OCC GRP 11/09/09 SR I I I 10WNER TEL NO IBLDGS NOW ON LOT VALUATION IFINAL DATE AL B CODE 1KLEMAN, PATRICIA A (626) 285-6552- I 5,500 14922 FRATUS DR 1 I ITEMP 917803719 I FEES PAID IDEStAIPtION OF WORK I I IREROOF OVER EXISTING WITH 30 YEAR COMPOSITION SHINGLES � I I IFEE DESCRIPTION QUANTITY UOM AMOUNT 1 1APPLICANT TEL NO I I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 75 1 IAB STATE GREEN BLDG FEE 5500 00 VAL 1 00 ISPECIAL CONDITIONS I IAC STRONG MOTION RESID 5500 00 VAL 0 55 ID2 PERMIT W/O EN-HC 5500 00 VAL 149 40 I TOTAL FEES 178 70 I CONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I I LIC NO I ILOCATION AND SETBACKS I I I I I I I ISOILS ENGINEER APPROVAL I I I I I I (ARCHITECT OR ENGINEER TEL NO I IFOUNDATION/TRENCH FORMS I I I 1 LIC NO I 1SLAB/UNDER FLOOR I I I I I I I I I IRAISED FLOOR FRAMING I I I IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I (UNDERFLOOR INSULATION I I I I144H265 3 001 I -1-1 1 I I IFLOOR SHEATHING I I I INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I I I I 1 NO 21 IROOF SHEATHING I I I I I I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I 1AIR QUALITY 1000 FEET MATERIALS I I I I 1 NO NO NO 1 IFRAME INSPECTION I I I I I I I I I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I I I ISET BACK YARD HWY PROP LINE WIDTH I I IFRONT PL- I (INSULATION/WEATHER STRIPI I I I SIDE PL- I I 1-1 I I (INTERIOR LATH/DRYWALL I I I I I I I I (EXTERIOR LATH I I I I I I I I I IRATED FLOOR/CEIL ASSEM I I I I I IRATED WALL ASSEMBLIES I I I I I I I (RATED SHAFTS/OPENINGS I I I I I I I I I IT-BAR CEILINGS I I I I ILOT DRAINAGE I I I I I I I I IREPORT ID DPR261 ROUTE TO BS0508 I I I I