HomeMy Public PortalAbout9015 GARIBALDI AVE_Building__ 76AS38A D135-3 12-54
APPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY BUILDING ADD
Department of County Engineer v
County of Los Angeles LOCALITY
WM.J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUP'T OF BUILDING NEAREST
CROSS T. /� l
FOR APPLICANT
APPLICANT TO FILL IN DISTRI O. GRO� (TYPE ISEWBK MAP
PG
BUILDADDRESS �y /C��`J c�,•:4E^C�' t4+G� � MAP gQO�/� CONST. TAT J-+
NUMBER YO
LOT NO. /C1 BLOCK Z> / USE ZONE SPECIAL
,� ® �_ f CONDITIONS
TRACT < 5 / 4 1L�
� //�' NO. OF 8LDG5.
SIZE OF LOTS d I NOW ON LOT / BUILDING YARD HWY STREET NAME EXIST.
USE OFe , SETBACK WIDTH
EXISTING BLDG. ,�G{ FRONT
o • P. L. �(J
OWNER (i ,••G-G.�{� SIDEMAIL
ADDRESS
c TEL. 1 DWELL. 1 UNIT rJ INDUSTRIAL
CITY _ NO.
2 DUPLEX_UNIT 6 PUBLIC BLDG.
ARCHITECT OR TEL.
ENGINEER t NO. 3 APT. UNITS 7 ADDN.,ALT., ETC.
ADDRESS 4 COMMERCIAL 8 MISCEL.
TEL. G� CJLv INSPECTION RECORD
CONTRACTOR NO.
,/-
ADDRESS //
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ. FT. y (� NO. OF NO. OF
_SIZE / (/ STORIES FAMILIES
USE OF STRUCTURE —
SIGNATURE OF 3
APPLICANT L_ ' l 4,L.� l..- APPROVALS
ADDRESS DATE INSPECTOR'S SIGNATURE
S P. C. S FOUNDATION:FORMS, M T RIIALSION
FEE FRAME: FIRE STOPS,
VALUATION S� 00 BRACING. BOLTS
FEE FURNACE: LOCATION,
GAS VENT, DUCTS
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT.
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. % LATH, EXT.
SIGNATUREOF Jam. r HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS 12 Z � FINAL t
WM. J. FOX. CouNTY F_N(mNEEn� '��' ALIDATION
BY G' ISY6 2 8 U) MR 16 1 2.00
a
DEPUTY 'DEPUTY
� J
BY BY
DEPUTY DEPUTY
i
78A638A DBS-9 12.34
APPLICATION FOR BUILDING PERMIT Z
DIVISION OF BUILDING AND SAFETY BUILDING
Department of County Engineer ADDRESS -
County of Los Angeles LOCALITY
WM. J. FOX, COUNTY ENGINEER 7
CASSATT D. GRIFFIN, SUP'T OF BUILDING NEAREST - }P
CROSS ST.
DISTRICT NO. GROy1P SEWER MAP
FOR APPLICANT TO FILL IN ( ` I ;PE BK PG
CONST
ADDREBUILDISS / IC�rLd .IZL., �// MAP \ �`� STATE YES
'\ ���� HWY
LOT NO. C.�� BLOCK{� USE ZONE SPECIAL
i • .- -` CONDITIONS
f'
TRACT
SIZE OF LOT P/ Q(, I NO. OF BLDGS. /
NOW ON LOT BUILDING YARD HWY STREET NAME EXIST.
USE OF SETBACK WIDTH
EXISTING BLDG. C� 1 I
` —FRONT /d Q
ee / P. L.
OWNER SIDE
MAIL
ADDRESS V
�- �'. , �Z• TEL. DWELL. 1 UNIT 5 INDUSTRIAL
CITY < NO.
2 DUPLEX_UNIT 6 PUBLIC BLDG.
ARCHITECT OR TEL. v_-
ENGINEER NO. 3 APT. UNITS 7 ADDN.,ALT., ETC.
ADDRESS 4 COMMERCIAL 8 MISCEL.
CONTRACTOR, _-%� / ; L rTi0:.7cx c^ j L- A INSPECTION RECORD
ADDRESS
"DESCRIPTION OF WORK
NEW ADD 11 ALTER REPAIR DEMOLISH
SO. FT.`j / NO. OF J NO. OF
SIZE Z(1 C STORIES FAMILIES
USE OF STRUCTURE —
SIGNATURE OF / ^+` //
APPLICANT ®' 11" ' `i1fF.' 'APPROVAI�4f,`
ADDRESS Q !/ - - - DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
P.C. S _FORMS, MATERIALS �- 2
✓
FEE FRAME: FIRE STOPS.
VALUATION L 1'
F
$ d. P' _BRACING.BOLTS .� /7 E
EE - FURNACE: LOCATION,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT '!
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT.
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. LATH,EXT. 1
SIGNATURE OF : HOUSE NUMBER COR- 7( ,
PERMITTEE ' -" RECT AND POSTED
L 1
ADDRESS ' FINAL J
WM. J. FOX. CousrY ExGmE a VALIDATION
BY _ --G1 0 5 519 !fit 2 1 6.00
w
DEPUTY DEPUTY!%
BY BY
® DEPUTY DEPUTY
.APPLICATION FOR COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING PERMIT BUILDING AND SAFETY DIVISION
BUILDING y�
FOR APPLICANT TO FILL IN ADDRESS . ` ✓
BUILDING //�� L',p,
ADDRESS V �/��G LOCALITY
��yy NEAREST
CITY ZIP V CROSS ST.
NO.OF SLOGS. I ASSESSOR
SIZE OF LOT ,�- NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT 1GROUPITYPE I FIRE PTROCfSSED BY
TRACT IBLOCK I LOT NO. !, Q CONST' Z
TE V L
OWNER _ d /� NO STATISTICAL CLASSIFICATION
'''�''7A�S SEWER P
ADDRESS CLASS NOpGL—DWELL,UNITg BK PG
CITY � Cj'T ZIP /��D USE ZONE O. n
ARCHITECT OR NEOL SPECIAL �/� '/+
ENGINEER CONDITIONS Xj /�J ` -
ADDRESS ROAD EPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONTRACTOR TELVg4-,a'I7I II V BLDG.SETBACK FROM
LIC. vFRONT PROP.LINE OF (STREET)
ADDRESS 1&3 NO. HIGHWAY t YARD = TOTAL SETBACKFROM TYPE OF IDOSTING
CITYC FRONT PROP. LINE HIGHWAY WIDTH
I ^ lI O fi "LC -�
CONSTRUCTION LENDER
NAME AND BRANCH w BLDG,SETBACK FRCM
ADDRESS CITY (STREET)
SIDE PROP.LINE OF
OTAL SETBACK FRO pE OF EXISTING
SQ, FT NO. OF NO. OF CHECK HIGHWAY t YARD = AY WIDTH
SIZE & STORIES FAMILIES I ONE _ SIDE PROP. LINE
❑ t pp,
DESCRIPTION OF WORK NEW
DD• CORNER CUTOFF YES ❑ NO ❑
QQtp O EPA IR❑ IN OPEN SPACE YES ❑ NO ❑
EO I N COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG. bw [.L e ENOL
I
APPLICANT TEL
( (PRINT) r- o.
4T S
I
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT 1 HAVE HEAD THIS APPLICATION
AND STAT[ THAT THE ABOVE 12 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
I STRUCTI ON. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LA SOK CODE OF TH[ STAT[ OF CALIFORNIA IN RELATING TO
WORKMEN'S CO M F[N//NOATION IKa URANC[.
/ / LA � FINAL /I -/ 7 DY
SIGNATURE OF ` -T� /!-� /O
PERMITTEE DATE
, I ADDRESS
. I
CITY C.(J,�L70f/p'\ HOLY ^• P.C. Fee$ / Permlt Fee Z
Inuance Fee
VALUATION$ (� o,
I � Total Fee ,o;2b
I •
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO cK. M.o. CASH
6,9.7 5
e7
rt r O 1l��p
-a 30 1 o. 1 1 62 5
81-1079 McCozmick
WORKERS' COMPENSATION DECLARATION 2.C�
Insure or affirm.
lertlflcatelo Wve a orkers'Colcate of consent mponstlon Inssuranoce o'r APPLICATION F OR BUILDING PERMIT
a certlfled copy thereof (Sec. 3800, Lab. C.)
Policy NPl-'+5�2 CompgnyFreme�' Indemn't'y COUNTY OF L05 ANGLES BUILDING AND SAFETY
r`
❑ copy v FOR APPLICANT TO FILL IN BUILDING Ee -
Certtfled co Is hereby furnished.
BUILDING
ADDRESS
Certified copy is filed with the couhty building Inspec- BUILDING
tion department. ADDRESS 9015 Gribalai LOCAU
ST
Date 9/17/81 Appllc.nt Rigid Mfg- COMPanY Cry TeTla le-City ZIP mg 917§1 CROSS ST.
CERTIFICATE OF EXEMPTION FROM N✓ORKERS' NO. OF BIbGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT AMP 900K [PAGEPARCEL
(This section need-not be completed If the permit Is for one USE ZONE
hundred dollars (;100)or less.) TRACT BLOCKLOT tVO. NO. d —�
TEL_
I certify that In the performance of The work for whlch this OWNER Bruce McCormick No.283-5528 /�' CON IDIO
TNS 4 SPECIAL O
peTmlt Is Issued, I shall not employ any person In day manner D15TRICT GROU TYPE FIRE BY V
so as to become subject to the Workers'Compensatlon Laws. ° � ST' ZONE OC
CITY le Ci zip 91 1 JrvO� 0
Date Applicant STAT1ST1c.AL aASSIFICATION APT. 1CGNT)O.
NOTJCE TO APPLICANT: If, after making this Certificate of ARCHENGIN=OR t TEL
CLASS ti0.�_DWH1_ UNITS d
Exemption, you should become subject to the Workers' 0COmpensatlon provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z
with comply with such provlslons or this permit shall be
deemed revoked. OR gigia mfg. cogpanA. 263-5181' BK. PG, VAUDAT}ON
LICENSED CONTRACTORS DECLARATION L�
J hereby affirm that I am licensed under provisio.ns.of Chapter 9 ADDRESS Woods-Ave. td0. 1 VALUAMN
(commendng with Section 7000)of Division 3 of the Business and LIC
Prafeulons Code, and my license is In full force and effect. CITY Los eleB Q
C8 ASS —3 L
ZA
SO. FT. NO. OF NO.OF CHECK
License Number. ri4144 r�Llc.Class f r 9 SIZE STORIES FAM LIES ONE + Q, OZ)
ContTact�dL Mfa. C T�a�are 1 81 DESCRIPTION OF id NEW Els ! y
❑ I am exempt from the I,Icenslhg requirements as I am apreparett tr ADD ❑
licensed architect of a registered professional engineer"-, ALTER ❑ FINAL �r 7 p
aSREPAIR
ting In my professional capacity. (SBctlon 7051, ❑ DATE /
Buslneu and Professions Code). U OF
Ex ST]NG BLDG. ElBy u
Llc.or Reg.No. Date APPLICANT TEL
OWNER-BUILDER DECLARATION PRI NO,
I hereby affirm that I am exempt from the Contractor's Llcense r/�7
Law for the following reason (Section 703 1.5, Buslneu and ADDRESS YYY
Profeulons Code): - Fllz�l IN,IN I
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and 2 a.9 A
the structure Is not Intended of offered for sale(Section LOCALITY
7044;Buslneu and P'rofeulons Code). MOVING TEL y
❑ I, as owner of the property, am exclusively contracting ONTRA'CTOR NO. # o e o o e ;
with.licensed contractors to construct the project (Sec- ADDRESS10 0 2 2
tlon'7044, Buslneu and Profeulons Code). -
REQUIRED TOTAL SEFBAO(FROM EXIST.
CONSTRUCTION LENDING AGENCY SIFT YARD HWY PROP, LINE WIDTH ? • 0 2 2 O 0'6
I hereby affirm that there Is a construction lending agency for FRONT
the performance of the work for which this permlt Is Issued P.L dX, 40 0 .9.2 2-8.1
(Sec. 3097, Cly. C.). SIDE
P.L
Lender's Name
_$ Lender's Address P.C. Fee f. Permit Fee 0
' I certl that I have read this application and stgte that the" Nuance Fee _
abov formation Is correct. I agree to 4omply with all�gunty Inv"garlon Foe �y�
Al.
State laws relating to building construction, Total F« -(JV
-authorize repr ves of this County to enter
-rp.gntlon rty f Irl"ctlon purposes.
LEE REVERSE FOR EL�NANATORY LAH01JAGi �
^ f leant or Agent 1• ��
APPLICATION FOR BUILDING PERMIT
' COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPBMTION DECLARATION FOR APPLIC—AlIT TO RLL rN BUILDING ADDRESS ,
I hereby affirm that I have a oardficate of ooroerd to sett insure, moa
or a certtilcata of Workers'Cornpersadw Irsuranoe,or a oerttibd
COPY (sea ) ZIP
LOCALTY
y C� OF NO.OF BLDG&NOW ON
❑ Certffbd copy Is hereby tumwwd. NEAREST MOBS ST.
CeriN{ed Copy Is 11led with the buNdng TRACT BLOCK LAT No. A
USE ZONE WP N0.
�. A88EB80R MAP PAGE
Date APPIICafd7 SPECIAL coNcK om
CFATIFFCATE OF ElE]PTION FROM WORKERS' 01 res NO
CO#PENMTION INSURANCE WrrFW 1O FT.OF SCl-IOOLt
ADDRESS
(This section need not be completed H the permit Is for one hundred O�"j/ DteTArCT oAotrP . F1RE ZONE PROCESSEDBY
dolian(;t 00)or less.) .
I oow*fy that In the perfornw ce of the work for whk h th a permCrrr ZIP
it
Is Issued, 1 snarl not employ any person in any manner so as to IN EER TEi NO.
become sub}erd to the Workers'Compensation Lava SDO7STWAL aAQ81RCAION AFT CONDO
Deis AppM1prd APDREBBCLASS NO,OZ Z DWELL UNrrS
NOTICE TO APPLICANT H, after making this Certfflonts of REOLHRED TOTAL SETBACK FROM EX8T
Exemption, you should become subject to the Workers' SETBACK Vm FWY PROP LAE WIDTH
Compernntlon provisions of the Labor Co(* you must forthw tth
comply with such provisions or th In permit shell be deemed revoked , FRONT
w
PL
LICE20M DECLARATION uo. PPL
I hereby aNtrm that I am Ik:lrsed under provWons of ChWW 9 ea Na FAv1a� �MAP
(oommenoing with section 7000)of Division 3 of the Burow and
Proks ons Code, 1 Is In full force NEW ❑ BK P(3
License,Nhtrnber Lia Circa ON OF WOF►rc ADD VALUA , i 1
Contraotor Dale JE r ALTER .❑ $ �rr T
r?CC 1 .T ?
❑ Ism undersea REPAIR ❑ $ 3307 �7..
e,rornpt .
& P.C.for this reason DEMOL ❑ LDUA P/C r 1
Data: 118E BLOc� $ URM. ❑
ACCT.'Lr
Slgnahue APPUCMf-r TEL No. LDMA Perm e 7
❑
I. to owner of the property, or my emwith "was wwages ss
the&sole compensabdrr,will do the work and the structure IsADDRESS �� ? ITEMS
not Intended or offered for sale (section 7044, Busirew and
. - 9/ TIJTF� �. _ 1
Prolmalons Code.) $�
WtLLTM AaQLroArrr OR PUTURe�•ryas OCOIIiWT FMNaxeA Fw.ARDOUe WQwIA1 "
OR A la%TIIL CONMWAM A HAZARDOUS W aWNAL L'OUAL TO OR O MUM TFAN .Q
❑ I, m owner of the property, em exdustveiy c�t+�nG h TFC AMOUNTS ereor®ON THE HAZAFDOUS WrEF Ata ROKWAPMON vuraer FWAL BY !f > 141.16
60erued contractors to COnshuct the pnoOd.Meabon 7044, rm❑ -VIV/
BUslrlew and PRJ<eaeiona Code.) -VI
THE wTBgMD uw Or TFe auaora er THa Apmjc V+T on n.rrL*z a■om
OOCUrwNT ra0Uea1 A PaaaT POR COMITFR1OTFON OR FNODMIKMN FROM TFE SOUTH
CONMUCTION LENDING AGENCY U1.
AIR QUAUTr DI MUCT Ismael ew PEFUTrsa Greaser
1 hereby affirm m that thereor
In a cstrw5w laodkV agenoy for Yin 1:1QIpID�—t7�01 �I 11191
the perfor srwe of the work 11r whkh this permit Is issued(sea
0 3087,M a). 'P,:STT TF"'"Z",►.UNCOMUIM ArY R.o"'� r„�,�:'o A°CI f�014 1 Wi 9:lt�
p. aourrr 2,aruare,LW Lal,m L211 CON:3n
d Landers Pierce A TrQ erwoFo
Lender'.Address
ow. OR As�
I ow"that I have reed this appifcaflon and sbLe that the above PC FEE PERtFfT FEE n
Information is correct. I agree to comply w ith all oounty tJ f� 3
ordinances and State le"reiaring to b,Akfing oonsftucrior> and
Aeby mAhortze raKeeendatiYees of this County to enter upon MUANCE FEE.
-3,41 WVESTK3IQION FEE TOTAL FEE ,
R. Al v
SM RrM=FOR MG"MTORY LVAJAGE
C
K 'S'COMPENSATION DECLARATION
rm .t:
t I have a certificate of consent to self APPLICATION FOIA BUILDING. PERMIT
Insuro, or a certificate of Worker: Compensation Insurance,
cr o certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS-ANGELES BUILDING ANDS FETY
Policy No._Company1� I &AM
' Certified copy Is hereby'furn[shod. FOR APPLICANT TO FILL IN. ADDRESS SS
ADD Rt�S
Certified copy Is filed'wlth'this county building Inspec-
tion department. v �-
Date �-�l^g 2 Applicant X,'/�90 ���� CITY 7_ ZIP LOCALITY
CERTIFrATE OF EXFlr K)tsl FRAM W00IRS' No. OF BLDGS NEAREST
COMPENSATION INSURANCE Sig OF LOT NOW QN a ST.
(This section need n9t be•com leted If the permit Is for one G AMES50R ,
hundred dollars ($100)or lea. - TRACT 6BLOCK LOT NO. C/ tiy�p'gpp� PAGE PARM
TEi $r
I.cp"Ify that In tis» performance of the work for whlch.thls �� �T �u �' y � NO.
permit h issued, I shall not employ any n In any manner L SPECIAL
so os t9 become sublect to the Work Co pbniatl A qC 19 1 L I)/ CONDI noNs g
Fx�7J ' CITY el-7--f".111'
Date � �"Kppllcant ARCHfTECT OR. � � TEL �
NOTICE TO.APRLKANT: If, after kite 'thls Certtflcate of DISTRICT.. P TYPE - FIRE 7T,
Q .
Exemption, you should b.c6nr a subject to the Workers' /}Q� CIX � �
Compensallon Provisions of the Labor Code, you•must forth- ADDRESS Y
with comply with such provlslbas or this permit shall be - �� �� TEL .y.7y z3 STATISTICAL TION .AFT.
de+m�d revoked. '.
LIONS®CONTRACTORS DECLARATION CL.A13 No DWELL UNrTS ^`
I hereby affirm that I am I Icerued under provlslonr of Chapter 9 ADDRESS L�Y S�=NO.�izy Z 7 2—
((cuommeridnq with Section 7000)of Division 3 of the Buelress and - LIC. SEWER MAP
i'rofesslons Code, and my license is In full fora and effect. C]TY O )�� l CLASS VALIDATION
7 S.Q.-
l� Fr. NTOO.OF NQ.Of'
CHECK
K BK PO.
License Number Z 7Z Llc.CI Sig SRIES ONE
]� �— ✓ r7 .d D NEW VALUATFON
Contractor K c p ��C�,.. �+—2 3'—��
DESCRIPTION or ;
ADD
1 am exempt under Sec. (JJ
ALTER
B.iP.C. for this reason REPAIR ElS v
Date! USE OFNG BLDci, DEMOL El ;R9,0 31 8 A
PqV
Slgrwture APPLICANT TEL ANAL # c o'b o'uJ1
OWNER-BUILDER DECLARATION PRINT NO. DATA _ .
I hereby affirm that I am exempt from the Contrgctor'sidcense ,I a#a b; 6 3
Law for the following reason (Section 7031,5,'Business and RNA
Profe cions Code): BY u o,e b a 4 3w& '
I, as owner of-the property, or my employees with 'LD' "
wages as their sole compensation,will do the-work and 2 �I '�$8
the structure Is not Intended or offered for safe(Section LQCALrrY
7044, dvslness and Professrons Code}. MOVING TEL
I, as owner of the property, am exclu;Ively controctIng NO.
with licensed contractors to construct the,project (SecADDREM
-
, tion 7041, Business and Professlons Code).
TOTAL SETBACK FROM
CONSTRUCTION LENDING AGENCY YARD FT1A+Y PROP. UNE W
L hereby affirm that there U a aonstructlon lending agencyfor L.
the performance of the work for which this permit Is Issued P.
(Sec. 3097, Civ. C.). SIDE `'t-,
P.L.
Lenders Name f '
LDAAA Ref.,i ;
$ Lendefs Address P.0 Fee Permit Fee
I certlfy that I hava read this application and state that the Issuance Fee tDNA P/C f
above Information Is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction,
Total Fee IDMA Perrrr. f
and FM99459 au Ize representatives of this County to enter
upo eine d pr for I on purposes.
>�VJf1/!it POR DQLAlIATORY LAN 0UA0✓t ,
^ STgrwhrre 67 A4*mni or Agent .. Doie V - - .
WORKERS'COMPENSATION DECLARATION
hereby affirm thatificate of consent to self
Insure, or a certificate
' have a certificate
of Workers' Compensation Insurance, APPLICATION FOR BUILDING P E RM I T
or If py thereof Sec. 39W La C-) COUNTY OF LOS ANGELES. BUILDING AND SAFETY
l BUILaNc
Certified FOR APPLICANT TO FILL IN
❑ Certtfled;o f#f I ri 6u I BURRING
tion department. ADDRESS LOCAUTY
NEAREST
Date Applicant CITY Z1P cizoss ST.
CERTIFICATE Of EXEMPTI NO.OF BLDGs. ASSESSOR
COMPff TIO CE SIZE OF LOT NOW ON MAP BOOK PAGE PARS
(This section need not be com If the pormlt is for one USE ZONE d 3
hundred do I I ats($I QO)or lam TRACT B1OCK LOT NO. .
14
I certify that In the performance of the work for which this O'W� CCNDflKxZ O.
DISTRICT GROUP =
FIRE � By Q
permit Is hued, I shall not employ any person in any manner ADDRESS n� T / ZONE
to as to become subject to the Workers CompsIon Laws. (J V
Dat ^ �ppllcant CITY ZJP SfATISTTCAI TION APT.
NCCE If, after makl this CertificateofLU
I�2 NO• a.ess No. _bwELL UNITS
Exemption, you should become su ect to the Workers N
Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP
with comply with such provisions or this permit shall be - 2
deemed revoked. 0 NIL �PG7d VALIDATION
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 ADDRESS VALUATION
(commendr�with Section 7000)of Dlvislon 3 of the Business and / O O
ProfmWons Code, and my license is In full force and effect. CITY = oil.sp. NO.OF NO.01
License Number SIZE STORES FAMILCES ONE
or
DESCRIPTK)N OF woRx Sl NEw El
Contract
'
ADD ❑ ��3 4 9, 7'A
I am exem under Sec /
4
ALTER E] FINAL
J
0 0 0 0 0
B.BP.C_ for this reason REPAIRLYE ❑ /!
Date: of D� ❑ *h,
Signature NAL /� o 0 0 o e'.I-
EX1511tJ(`SignatureAPPUC Nr 2'e G 3 6 7;5
OWNER-BUILDER DKIARATICN 0i N
I hergby affirm that I am exempt from the Contractors License o 0 0 3 6.7 5 tss
Law for the following reason (Section 7031.5, Busine" and
Professions Code): 0 7 0.8—8 3
I, as owner of the' Y employees BUILDING
property, or m em I with ADDRf55
wages as their sole compensation,will do the work and
the structure is not Intended or offered for sale(section LOGLITY
704+, Business and Professions Code). MOVING TEL
CONTRACTOR
❑ I, as owner of the property, am exclusively contracting NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
C0IJSTR(JCT1C}N LENDING AGENCY gT I YARD ENVY TOTALP��FROM I
WIDTH ,
I hereby affirm that there Is a construction lending agency for Fir
the performance of the work for which This "rmlt Is.Issued P.L
,Sec 3097, Cly.1C.). SJ DE
P.L.. .
Lenders.Name n
Lenders AddrP.C Fee S Perm It Fee v{
ess
I certify that I have Is applltation and state that the y�e Fee b SO
S
a
bove I Ion Is correct. to comply with.all County Invesrtparion FM
e$ nd �5tate laws I nq to bullding construction; Total Fee rnd h authorize ropy. n lves of thLs County to enter
u ve-m toned Inspection purposes.
5111111111 RffVNM K*DCPLANAT01Y LANGUACK
Nn of Appl nt Elcrlr �
COUNTY OF LOS ANGELES T 2(PL.R CITY # 0508 BUTLDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TONAB ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TE3[PLR CITY CA 91780 BL 0508 0710170042
PHONE: (626) 285-0488 ETT:
LEGAL ID: NO. OF CONST BUSKING ADDRESS:
TR: 5904 LT: 102 UN: .002 SQ. FT STORIES TYPE 9015 GARIBALDI AV
STRUCTURE: VN TEMP CA 917801546
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEIMAD
5384-006-015 TH06OLS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C
712ANT: EZIST BLDG USE: RFS ID USE ZONE: R-2 ISSUED ON: PROCEB&ED BY: EMPIRES ON:
M= OCC GRP: 10/17/07 SR 04/14/08
OWNER: TEL. NO: BLOCS. NOW ON LOT: VALUATION: FINAL � BY: CODE:
LAE PATRICK AILOE WILLIAM, EZM,Y LA 626255799 - 1,200
9015 GARIBALDI AV
TEMP 917801546 FEES PAID DESCRIPTION OF WORK
CUOWIE 5 SMISTING WINDOWS TO REMAIN SAME SIZE CHANGE 1
FEE DESCRIPTION: QUANTITY: DOM:. AMOUNT: EXT TIM WINDOW LARGE SIZE IN THE LIVING ROOM
APPLICANT: TEL. NO:
SAME AS 0WNER - AA BLaG PERMIT ISSUANCE 27.75
AC STRONG NOTION RFS ID 1200.00 VAL 0.50 SPECIAL CONDITIONS:
D2 PIRXIT W/O EN-HC 1200.00 VAL 82.20
TOTAL FEES 110.45
CONTRACTOR: TEL. NO: APPkOVALS DATE INSPECTOR SIGNATURE
SANE AS OWNER -
LIC. NO ON AND SETBACKS
I
90IMS ENGIw-RER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FO&5HUNT=CH FORMS
LIC. NO: SIAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP 190: 9 MAP BOOK: PAGE: FIRE ZONE: CMP: OMERFLOOR IRSULATION
1508165 3 01
FLOOR SHEATHING
NO. OF FAMILI&S: D5 ELLIM UNITS: APT COND: STAT CLASS:
NO 21 ROOF SHEATHIM
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME IASPECTION
REQUIRED TOTAL SETBACT FROM EXIST FIRE SPPLUM ER HANGERS
SET BACK YARD: HWY: PROP L]M: Wl=:
FRONT PL- INSULATION WEATHER STRIP
SIDE PL-
UF=OR LATS DRYWALL
EXTERIOR LATH
RATED FLOOR/CELL ASSEH.
RATED WALL ASSEMBi TR4
RATED SHAFTS OPMV NGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508