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Home My Public Portal About10511 FREER ST_Building__ TEMPLE CI'T'Y -�..•� gipp. 79AS36A CE q80!•1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DIs�RICT coPrvsr. l c B BUILDING STATISTICAL CL S FICATION WER MAP ADDRESS -C S K P CLASS.NO. DWELL.UNITS r' , LOT NO. /� BLOCK '� WATER / CERTIFICATE NOT REQUIRED RECEIVED TRACT /�� YD MAP 1 /y HIGHWAY �y NO.OF BLDGS. _ NO (� (/ ccIRCLEI STATE MAJOR SECON LOCAL SIZE OF LOT +7 0 x NOW ON LOT USE ZONE SPECIAL USE OF /� CONDITIONS .EXISTING BLDG. /y 0/Y1 � TEL./' G OWNER NO.(�/ t2 BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS /OS i/ E./�iYE A� '&-lw /G /�� FROLT ARCHITECT OR TEL. ENGINEER ow hfe SIDE P.L. d ADDRESS TEL. INSPECTION RECORD 0 CONTRACTOR NO. CG ADDRESS O DESCRIPTION OF WORK W CL N NEW ADD ALTER REPAIR DEMOLISH Z SQ. T. J NO.OF NO OF BIZ �•�/ STORIES FAMILIES USE OF STRUCTURE �� /0- SIGNATURE O-SIGNATURE OF APPLICANT VALUATION S_3 - / APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, FOUNDATION: LOCATION - _�„__- ._„_�_ -• FEE $ FEE $ (S / FORMS, MATERIALS-1. ATERIALS FRAME: FIRE STOPS, AL/P/` I HEREBY 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 CoNSTRUCTI0N. I CERTIFY THAT IN DOING THE WORK % t AUTHORIZED HEREBY I WILL NOT EMPLOY MANY PERSON IN VIOLA- LATH, INT. f I r TION_OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. LATH,EXT. SIGNATURE OF J _ �f0 HOUSE NUMBER COR- / PERMITTEE %)I,eo �L�"`- COR- RECT AND POSTED .I I !� n ADDRESS FINAL J) CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E R PLAN CHECK VALIDATION C . M.O. 'GASH PERMIT VALIDATION cK. M.O. CA9H L6 3 1 roily 14 1 0 6.0 0kv 76AS30A CE#80310"50' APPLICAT'ION FOR BUILDING PERMIT • . •- ".�'• . COUNTY OF LOS ANGELES BUILDING JJ 'DEPARTMENT OF COUNTY ENGINEER ADDRESS Q // BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEARESTf CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. kizf DISTRIC NO. GROU TYPE P SED BY FOR APPLICANT TO FILL IN I CONST. ADDRESS BUILDING JO✓�/ '� � Eg STATISTICAL C cS� SEB ER,MAPp �� ' LASSIFICATION ( CLASS. DW •NO. ELL. UNITS LOT NO. / �(/ J `ffb ,BLOCK MApSTATE NUMBER HWY. YES O TRACT USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT jj�/ �p I NOW ON LOT f USE OF /O�� ' EXISTING BLDG. o /7 �/ BUILDING � EXIST.- /7.G/+[J�t7 T �7t Cif rRQ/J SETBACK YARD HWY. STREET NAME WIDTH OWNER AIL �y(7 FRONT M0DRESS /O��I +' `i /Q P.L. . . SIDE CITY o•GJ3'�7�J P.L. ARCHITECT OR �'�.//�,,AI EL. .+ +� INSPECTION RECORD ENGINEER D�l�'ry � NO. ADDRESS - TEL. A •'�� b CONTRACTOR NO. lk + 1 ADDRESS A.a _ J DESCRIPTION OF WORK NEW (I.4ulgl ALTER REPAIR DEMOLISHF`, c4- '',.��1 •, ..GYiI .'�in �I' �.,vr/'J/N�Y�� SO.FT. pJ NO.OF NO.OF ` rJ /a7,�'v'J'%L�• Ao fC_ii3 L".Ti�+�f:�� A'1•/f � SIZE �{ �,� " STORIES I FAMILIES WSE OF STRUCTURE - RDD FD DEN •'TO HO,-I E SIGNATURE OF •,,,�.// ///�� - APPROVALS APPLICANT / / ,p �' L ADDRESS �Qa� I / /7 PE-R S� DATE . INS ECTOR'S SIGNATURE, FOUNDATION: LOCATION • $ _FORMS.MATERIALS, S�` P.'C. $ FRAME: FIRE STOPS. •\FEE BRACING, BOLTS. VALUATION $ 5 0 FURNACE- LOCATION, - FEE GAS VENT,DUCTS - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,I,NT:+<SY zt X'Ims '3))A'2i D �' PLICATION AND STATE THAT THE ABOVE IS CORRECT AND p AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT..$/. ��IJ J�•/�d�l. :•• STATE LAWS REGULATIN�G BII/�/IIILDDINGn C./pNSTRUCTION. SIGNATURE OF "n/�' 'd [/'; HOUSE NUMBER COR-, - 'P,ERMITTEE '^�^��1lYY (J sL./�L�I� RECT AND POSTED ADDRESS FINAL -,p 1. I- CLYDE N.•DIRLAM, PRINCIPAL STRUCTURAL EN ER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. c sH �_'_ 3 2'.3 7.u; �'f1R 9 ' , :1 A 6.Q. . APPLICATION FOR BU I �� EAIT� n: iCR APPLICANTIN (Print or type on BUILDING -D� � �, COUNTY OF LOS ANGELES , ADDRESS 1 DEPARTMENT OF COUNTY ENGINEER CITY 7konLe— uAiAll ZIP 91,780 BUILDING AND SAFETY DIVISION / i 'NO.OF BLDGS BUILDING - .� Ai- SIZE OF LOT D b NOW ON LOT ADDRESS - �� TRACT//;Z BLOCK / LOT NO LOCALITYNEAREST OWNER 0 LL NOL -3 GROSS ST ASSESSOR ADDRESS IOTjl �& MAP BOOK PAGE PARCEL. DISTRICT GROUP TYPE FIRE PROD. SSED BY CITY �/ ZIP Q -Q - -�}! CONST. Z E - ARCHITECT OR TEL. J 1✓" �� ENGINEER NO _ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS r CLASS NO.�-_-DWELL,UNITS BK PG CONTRACTOR �T• NOL ��USE ZONE MAP NO. ADDRESS NO SPECIAL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH Aanom,, BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS G/4 CITY 0 400 _ TOTAL SETBACK FROM TYPE OF EXISTING O HIGHWAY YARD U SO FT NO OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE 3'-�. STORIES FAMILIES ONE C= + O DESCRIPTION OF WORK NEW ❑ V Lu BLDG.SETBACK FR ADD - (STREET) i SIDE PROP. LINE OF Z ALTER ❑ TL SETBA FROM TYPE OF EXISTING / HIGHWAY + YARD = REPAIR❑ SI �P INE HIGHWAY WIDTH Q�7 USE OF Ir'�S� DEMOL ❑ + - EXISTING BLDG. S/ 1` ❑ APPLICANT TEL CORNER CUTOFF YES NO (PRINT) lFa&eprG94 4QA/JN0. -� BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ Q /�'�zQAzIN COASTAL ZONE YES ❑ N�Sp , VALUATION Y bz Lpl�30 Pig cj CATEGORICAL EXEMPTION YES❑ NO ❑ IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED TE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE �• - / _ �1 LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPE NS TION INSURANCE. �•,"f +.i' �- --'',�,,OO f_ i SIGNATURE OF _',,C% 7•�, R><. 17ft PERMITTEE ADDRESS dJ sY l� Z _ FINAL B•Y J TEL y �j CITY E /� J NO. �JJ DATE Ftil 1'K C_IIL 'KS P; YA131- 10 FEE FEE HARVEY T. BRANDT, COUNTY ENGINEER PLAN CHECK VALIDATION CK' M O CASH _ , PERMIT VALIDATION (f)-. CASH 'FEB 20 1 0 5 5.5 Q ®93 76A638A CE#803 12/72 ,n; wn'•3 25M SETS =•A6— DEPARTMENT OF BUILDING AND SAFETY " r -- - --Tc;nTlL;iv, :IP_ rFY.M�f GQUNT'Y OF LOS ANGELES q 7 WM. J. -FOX, CHIEF ENGINEER u .C' L FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDINGa pF/ DISTRICT-.NO. PLAN CK. NO. PERMIT NO. ADDRESS e; "'1 o"J LOCALITY RECEIVED BY DATE OF. APPL. DATE ISSUED NEAREST CROSSST. -/�w'"�"`Cr'E...- ..C'�.�•' �«•,zc""Gii/'y� .'�?'"�ij„-�f- ly�r%> J M•J�`}r� 1 a BUILDING OWNER ADDRESS �" Q / l l l -i. MAIL - LOCALITY e�G-+ISna,c_ c-t e".1 . ADDRESS / f �,/ NEAREST CITY NOLOL l'• r CROSS ST. FIRE NO.OF Jam'I TYPE , f I GROUP ARCHITECT OR TEL. ZONE PLANS � -ENGINEER N_O. _ BLDG. ORD. NO. ADDRESS y/ .? uQ� SETBACK LINE ' /} t Q{��Ctf+l'S TEL. / �.. / � BY ` CONTRACTOR NO. t DATE //y !!•• ` ` USE APPROVED ADDRESS �/ (/ �� *l�.IGG`I f!'S ;`rli / � ZONE� � BY DATE LEGAL CORRECTIONS + DESCRIPTION I LOT NO. I BLOCK TRACT g-' O /�. ,f•!. �tdS-.3• �- �c .. f'r''+ -ff r._-. NO.-OF BLOGS. ti ( SIZE OF LOT �a X ! 'O `' I NOW ON LOT �Jf'i 'Z, ,.�.t'r USE OF _ NO.OFO. OF EXISTING BLDG. i FAMILIES I NROOMB_ DESCRIPTION OF WORK NEW _ALTERATION ADDITION O REPAIR M_OVINO _ DEMOLISH �_, SQ..FT. / 1 L� D NO.OF �T `` Z SIZE ��(, 41/' ROOMS V STORIES / r WALL •�`� ROOFS^ pA COV ERING GGC.� C� ,i COVERING 'r:•-C<t•..e� �c+y I USE OF•NEW / I B U ILD 1•N•G�..�t._(,�e�� i APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS INSPECTOR DATKa ' APPLICATION AND STATE THAT,THE ABOVE IS CORRECT FOUNDATION: LOCATION, i I FORMS, MATERIALS • I ,,.� ��. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES , AND STATE-`LAWS REGULATING BUILDING CONSTRUCTION., FRAME: FIRE STOPS, BRACING, BOLTS' t.t ;E SIGNATURE OF OWNER �( ///� � !/' _X/ aGLATH, INT.: AUTHORIZED AGT I. Iti.i} ` • -LATH, EXT.:, P:OC. LASTER, INT. /{ � FEE PLASTER, EXT. VALUATION �� FEE p{J�-� FINAL �� ,1 / i PERMIT-,.. APPLICATION FOR BUILDING COUNTY OF*LOS ANGELES �, �:, BUILDING AND SAFETY FOR APPLICANT TO FILL IN B ILDING ADDRESS WORKER'S COMPENSATION DECLARATION _ I hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDRESS � a�� or a certificate of Workers' Compensation•Insurance,or a certified copy thereof (Sec.3800,Lab C) CITY�m '� ZIP LOCALITY Policy No. Company �/1 3 _ SIZE OF LOT NO OF BLDGS NOW ON LOT- El OT ❑ Certified copy-is hereby furnished •p X I�b NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO department. - USE ZONE MAP NO' - - Date Applicant ASSESSOR MAP BOOK PAGE PARCEL ,,,///�� O q SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO COMPENSATION INSURANCE iZoCi�n,� T -k WITHIN-1000 FT OF SCHOOL? YES NO 0 (This section need not be completed if the permit Is for one hundred ADDRESS i' [� f dollars($100)Or less.) {0JE.DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CIT T�1ti 'Q (; •(,A ZIP j �i �, • ' is Issued, I shall not employ any person in any manner'so as to l 1 � become subject to the Workers'Compensation Laws ARCHITECT OR ENGINEER TEL NO STATISTICAL CLASSIFICATION APT "CONDO Date Applicant ADDRESS CLASS NO- 2 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 SET BACK YARD HWY ' PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith compl with such provisions or this ermit shall be deemed revoked FRONT Y P P ADDRESS LIC NO P L LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC CLASS P L I hereby affirm.•that I am licensed underprovisions of Chapter 9 s 4r 'SEWER MAP - >- (commencing with Section 7000)of Division 3 of the Business and SOF SI OF STORIES NO OF FAMILIES a Professions Code,and my license is In full force and effect NEW. ❑ BK PG p2 V License Number LIC.Class DESCRIPTION OF WORK ADD VALUATION Contractor Date �`• - � � ALTER E] $ OO C �� v W .'^' d t�-�1D cru ❑ I am exempt under Sec REPAIR El N$ Z BAPC for this reasonDEMOL ,❑ -,LDMA P/C# Date USE OF EXISTING BLDG URM ❑ Signature� APPLICANT(PRINT) TEL NO LDMA Perm I,I,as owner of the property, or my employees with wages as' Zys �� their sole compensation, will do the work and the structure Is ADDRESS' not'intended or offered for sale (Section 7044, Business and FINAL DAT R' _,L,{1,ti (c i a_(1 s • �PfOfeSS10r1S Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r - I, as owner Of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE / J property, am exclusively contracting AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE1 FINAL BY licensed contractors to construct the project (Section 704444,, I' Business and Professions Code) ves ElN.0,11 • 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 r�COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR • : _:�,= GUIDELINES _ . n - •` :,3'r:.ii I hereby affirm that there is a construction lending agency-for VES❑ No❑ �• p k..' :,.. , s i 1-AL S3� a'�� a the performance of the work for which this permit Is Issued(Sec i oa; 'ti's p1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING , 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 Lender's Name, MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD ' o Lender's Address _-- O - OWNER OR AGENT o• I certify that I have read this application and state under penalty of perjury that the above Information is correct'I agree to comply P C FEE �Vr PERMIT FEE N with all county ordinances and State laws relating to building ®��r/ is 41111 )=1_G.I _ OD construction, and hereby authorize representatives of this County hSSUANCE FEE �� CD to enter upo the above-mentioned property for Inspe Ion purposes ' 'tom j AN 1 11 1 �3� � � INVESTIGATION FEE TOTAL FEE rj' ^ sQnmu.e oGAOWoat or' m oxle -✓ �y SEE REVERSE FOR EXPLANATORY LANGUAGE 49COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS _ RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA -' BL 0508 9610220013 PHONE: (818) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 11290 LT: 11 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 10511 FREER ST STRUCTURE: 171 1 V R3 TEMP CA 917803446 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 8585-021-020 OTHER: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/22/96 TC 10/22/97 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY LIU ROBERT W;GRETCHEN Y (818) 448-5550- 1 12,690 /j Q 10511 FREER ST 1�zU-�I TEMP 917803446 FEES PAID DESCRIPTION OF WORK' FEE DESCRIPTION: QLIANT��Y�UOM'; /J AMOUNT: EXTEND BEDROOM AND BATHROOM 171.5 SQ. FT. APPLICANT: TEL. NO: ' vX�j �'J O9 SAME AS OWNER - AA BLDG PERMIT ISSUANCES 27.75 AC STRONG MOTION RESIDE 12690:00-VAL n1-t27 SPECIAL CONDITIONS: AX BUILDING REVI,EWJEE - 54e,70 B2 PERMIT W/ENERGY 12690.,00 VA 295",:521 U ` ��;T}OTAL FEES 379.24-a CONTRACTOR: TEL. N0: .� ` •� \ G APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - \ 1 LIC. NO o � LOCATION AND SETBACKS Z fflSOIL:, ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: G'L� ��n G' V U` I1 ��:I d. FOUNDATION/TRENCH FORMS LIC. N0: fT SLAB/UNDER FLOOR L RAISED FLOOR FRAMING `� .1 1-�G MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 1) -Ts-T—IEVEL FLOOR SHEATH N0."OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLAS;i: NO 21 Q 7N—DI EVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS — G !/� ROOF,SHEATHINGf•`I AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST BLDG,DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS SIDE PL- f INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 WORKERS' COMPENSF�TION DECLARATION herent'to self •ino,reboraafcertif certificate of Workers' C mtpensat on Insurance, AP P L'I CAT I O.N FOR BUILDING PERMIT or,a tcertified copy thereof (Sec. 3800, Lab. C.) . COUNTY OF LOS ANGELES '' . ' ' BUILDING AND SAFETY Policy No. Company BUILDING' ❑ Certified copy is hereby furnished.. FOR APPLICANT TO FILL IN ` ADDRESS �s' , ��eft� S ❑ Certified copy is filed with the county building inspec- BUILDINGh p n d Tion department. : ADDRESS I®� r ��e� S�� Q (r CALITY Y2y11 le C'-� •CA { 1 /-90 CITY" Tevt+ C�t` � ZIP CA 1 1 9 8 0 t LO �Q� 1 � l Date `Applicant ' - NO. OF BLDGS. _ ::' NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 1? NOW ON LOT CROSS ST COMPENSATION INSURANCE = ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK 8� S'. PAGE 2 1 PARCEL 0.20 hundred dollars ($100) or less.) LZV TEL. j, USE ZONE MAP OWNER UC�'Iv Z • �,- Y,'. NO..47�9�$sb - NO. - C� I 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 IJ O'S I 1 -FRvrb-K ST. CONDITIONS so_ as to become subject to the Workers' Compensation*Laws. -�^ 0 _ CITY revAe -- Ct'4- ZIP CA I. g0..• � .Date S' Applicant- ARCHITECT OR . TEL. DISTRICT' GROUP TYPE FIRE- PR CESSED BY O NOTICE TO APPLICANT: If,'-after making this Certificate of ENGINEER NO.• CONST. ZONE ~- Exemption, you should become subject' to the'.Workers', g• w Compensation provisions of the Labor Code; you must forth- ADDRESS t " N -- TEL comply-with ,such provisions- or,this permit shall be TEL STATISTICAL CLASSIFICATION CONDO Z deemed•revoked. - CONTRACTOR NO n'� — LICENSED CONTRACTORS DECLARATION _ LIC- CLASS NO 4- UNITS I hereby affirm that I am licensed under provisions of Chapfer,9 - ADDRESS NO SEWER MAP (commencing with Section 7000)of•Divisibn 3 ofIthe Business LIC. .and Professions Code,and my,icense is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT O. OF INC) OF 1 CHECK ` License Number Lic..Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ Contractor Date -$ (3 cy /� Q GIoSK ADD El am exempt under Sec. ALTER ❑� ► • - . B.BP.C..for this reason a`�'1` O r4V-0 REPAIR ❑ $ USE Ot- \ Date: EXISTING BL ' DEMOL El' Signature APPLICANT - L• _-- FINAL ! -OWNER-BUILDER DECLARATION : ' (PRI N DATE'777/4/;. I hereby affirm that I am exempt from the Contractor's License = = Law for the following reason"(Section 7031.5, Business and AD ESS FINAL( t Professions Code): PRESENT BY BUILDING r�•t•y• ❑ I, as owner of the property, or my employees with ADDRESS S�rI�O �rn. wages as their sole compensation,will do the work-and LOCALITY I��(� '` i the structure is not intended or offered for sale(Section J=�I? T tc7.1i 7044, Business and Professions Code.) MOVING TEL- 2^9� i ITEMS-- -project p� ❑ CONTRACTOR NO:, t ? S��tl=_ - I, as owner of the property, am exclusively contracting _ with licensed contractors to construct the (Sec- ADDRESS #Ii�r,L $� 'y tion 7044, Business and Professions Code.) { L tai REQUIRED TOTAL SETBACK FROM '" EXIST. r - �. CHECK 106°,,,,,, CONSTRUCTION LENDING AGENCY SET BACK YARD- HWY PROP LINE WIDTH t I hereby affirm that there is a construction lending agency for FRONT (;��}Ni�E- ;1� 1 the performance of the work-for which this permit is•issued P.L (Sec. 3097, Gv. C.). SIDE •P L - (t t i i Lender's Name LDMA Ref # 0000-171301 A5/16/89 P C Fee$ Permit Fee �t=tV�i 1 t1�'� -t o�j Lender's Address I certify that I.have read this application and state that the Issuance Fe, LDMA P/C#, above information is correct. I agree to comply,with all County Investigation Fee 8 ordinances and State laws relating to building construction, Total Fee _3 LDMA Perm' # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. �10 .� -.�p SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ; R S COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0610100002 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 11290 LT: 11 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 10511 FREER ST STRUCTURE: 65 1 VN R3 TEMP CA 917803446 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: HALIFAX 8585-021-020 OTHER: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/10/06 JK 10/05/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: RECRIP,ION FIN A CODE: LIU ROBERT W;GRETCHEN Y (626) 448-5550- 6,980 10511 FREER ST [[4�� If TEMP 917803446 FEES PAID OF WORK EXPAND KITCHEN AREA 65 S.F. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER _ - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 6980.00 VAL 0.70 SPECIAL CONDITIONS: AX BUILDING REVIEW FEE 54.70 B2 PERMIT W/ENERGY 6980.00 VAL 182.82 FR INV WORK W/O PERMIT 128.50 DOL 128.50 CONTRACTOR: TEL. NO: TOTAL FEES 394.47 APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: - FOUNDATION/TRENCH FORMS] / �n LIC. NO: SLAB/UNDER FLOOR / C/ RAISPD FLOOR FRAMING O /� MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: C:?: UNDERFLOOR INSULATION ((/ 3 01 1ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/GOND: 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 INSPECT f� SET BACK YARD: HWY: PROP LINE: WIDTH: i FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL • REPORT ID: DPR261 ROUTE TO: BS0508