HomeMy Public PortalAbout4929 GOLDEN WEST AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR AO�)LICANT'TO FILL IN (Print or type only)
BUILaINGCOUNTY OF LOS ANGELES
ADDRESS 62'CDEPARTMENT OF COUNTY ENGINEER
CITY`" G - 4:! IPC BUILDING AND SAFETY DIVISION
NO.OF BLDGS. BUILDING
SIZE OF LOT .Z-SX 7e�0 NOW ON LOT ADDRESS
TRACT . &2 BLOCK LOT N lb LOCALITY
f L NEAREST
OWNER NO �// CROSS ST.
j ,, ASSESSOR
ADDRESS �J MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE RO SSED Y
CITY ZIP _ CONST Z E "♦
ARCHITECT OR TEL.
ENGINEER NO. STATISTICAL CLASSIFICATION
��j// SEWER M
ADDRESS CLASS,NO.a.LLDWELL.UNITS BK G
CONTRACTOR ��(,.� NOL' 'LE
LIC.ADDRESS NO. CIAL
LIC. DI TIONS
CITY CLASS
CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
NAME AND BRANCH BLDG.SETBACK FROM
ADDRESS CITY
FRONT PROP,LINE OF (STREET)
_
SQ. FT 7 NO. OF NO. OF CHECK HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING
SIZE � STORIES FAMILIES 'ONE -
FRONT PROP. LINE HIGH Y WIDTH
DESCRIPTION OF WORK G NEW ❑ U
ADD BLDG,SETBACK FROM
SIDE PROP. LINE OF (STREET) o
�,qzL ALTER [E] HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING V
—REPAIR SIDE PROP. LINE HIGHWAY WIDTH d
USE OF 1 + - Z
EXISTING BLDG. DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
BY (SIGNA IN OPEN SPACE YES ❑ NO ❑
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION�,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LA80R CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURANC
SIGNATURE
P E R M IIT T.E�E
I ADDRESS
FINAL 4 BY
TEL. o
CITYNO. DATE <}
11AKE CHECKS PAYAE3LE TO. P. E PMT.Q
HARVEY T. BRANDT, COUNTY ENGINEER FEE 7�w FEE
PLAN"CHECK VALIDATION CK M O. CASH _ ERMIT VALIDATIOID CK. M CASH
1 9 r SEP Ld 1 U 9.5 U Arc
76A638A CE#803 5/74
F APPLICATION FOF�'`, ING PERMIT
. COUNTY OF LOS ANGELES BUILQING AND SAFITY
WORKER'S.COMPENSATION DECLARATION TO/ FILL I�iN��I�-t Ave—
or
�� .3 AMllE7
I hereby affirm tflet I have a certfNcate of consernt.to & Mears, B�DfNo ADDRESS Z ^6r%/c�fF/� W tst Ave—
Z (moo
or a certHicaie of 'C.01' eaf n Irnrranoe,or a cerWled CfTY ]
copy thereof Lab.C.) ,e ZIP LOCALITY
Pocky Comperry S� LO7
copy b funbbed. .� -�I y OF<31oOs�ON
LOT
�ertiffed tEARE CROSS ST.
ElCertifted copy b fled wlU1 the Ing Inepectlon BLOCK LOT N0.
ZONE MAP NO
RTI OF EXEMPTION FROM WORKERS' OWER TEL No. YES NO
COMPENSATION INSURANCE AdidKj w1THIN 1000 FT.OF SCHOOL?
(This eectlon reed not be cotTpieted H the pemltt b re for ohundred
ADDRESS0taouP TYPE CONST.. FRE ZOrE PFiCGESBED BY
ZIP
doUare($100)a leen)
CITY
I cerjffy that to the periorwonce,of the work for%Cir;t this pe
Is boned, I Ma not wV oy arty person.i.arry nTvuvw so as to
N�q¢TECT Ofl ET1ofdEEA _Ta NO. ,f/
become arbjed to U,e Workers'Conperaafbn Lowe SU STIC,,L a,,,SSWlCJ rK)N Com
Dena ")cant ADDRESS CLASS NO., C'12/ _ DWELL UNITS APT
NOT)CE .TO AffUCA%7: If, after makhrg this CerdfkCata 'of REQkVIED T01AL SETBACK FROM EXIST
Exenpdon, You should become subject to Ute M bars' TEL 40. SEF BACK )AM HWY POOP.LSE. WIDTH
Com enmition provisions of the Labor Code, you runt forthwith N71 9010 FRONT
Cortpy with a#1 provbbne or.this permk shall be deemed revoked. L.IC.NO. -
PL
LICENSED CONTRACTORS DECLARATION46-7 �
rm S
I hereby aNlthat I am Hoeinsed underprobl
vons of Cheptar 9 Cm CLA8,9 P L
(oommenckV wkh$action 7000)of Walon 3 of t*'Brnioeas and 34.FT.SIzE 40.OF TMRES NO.OF,FAAlJES NEW SEWER MAP
Profeeelorre Code,and rrry Hcense b Tri full force -
Lc..Nurber .Ckm DESCRPTION Ot WORK - ADD + 3 0010. , g
D �
Contractor Date p4py ALTER [� $ v
❑ I em under Spec _ �""` REPAIR ❑ Z
BdP.C.for ttlb reason DEMOL ❑ LOW P/Q 0 —
Date-- LISE OF EXISTNG BLDG_ URM -0 y
31�1ahrre }
(m
LRAM Perm
0 L.ae owner of the Property: a my ernpioeee ywtth wages as O `AIL�T 1
their Sole oomperae5m *111 do the work and the structure is Ay tT r r"1
not hltan�S"M 0 offered for Bale (Section 7044, Buetneea and FINAL IMM
wrLL AaQLrc wr Oa ocawNr HANDLE A ire u YAr .:�� 619.55
PrafeadorTe code} ]�}FEE
OR A1tOnTFE CONTAa!!q A
n ►l4rFML ECAJAL TO OR GFEArEi THAN THE
❑ I, as owner of the property, am excluatvely con& dfnp with AMCLINTe 8PECFID ON THE u�aAi��oauvnN GLIDE? FNAL `7 IT
loaned oontracLora to oxistruct the project (Sw5on 7044,
Buelneee and Proteaciona Gods.) Tea❑ No❑ T.'FJT' � �r''y p
V LL THE Kn®bED USE OF THE BUIDLHO BY TE APPLIGWT CR R Fe 1 V{FL 670 _(LJ 7
OCQiwNT REQUIRE A PERMT FOR CONSTRUCTION OR FROM THE 801JTH �j�U.C
CONSTRUCTION LENDING AGENCY 00An AY1 auALrry WNAUD@lT DrerracT MQAI f 1 SEE PsauT 1ING a-Ec+a.IST FOR - C'. { K
I hereby affirm that U1ere b le a conatrucd n Ong agency for Yea El No Elth4t7- f
a e periormence of the
work for whldl thio permH b b80 a WUSaa ��AI
(Seo. Fl�READ THE HAZARDOLA iALS ef3oRIAN GLIDE AND THE FEFLKTTM -
3097,Ctv.C.) C1-�C7CLrBT.I UP EiTaR10 WY REOUFEAEMrS UNDER THE L0e ANGELES COUNrr CODE .�
Landes Name W KnU .LB�FEPOHTl10 Z.209ECTO 118 00 AA PErYT�TFE CONCETINING E
°2�"'� �iCJ 1 5112I94
LwxWa Addreee 171 1 Ali & 18
I owMy that I base read thio application and state under penalty
of perjury ttlet the above Informatlon is corned.I agree to corrpfyF� I 0 PERMT FEE
w"wall Dainty ordinances and Stet, laws relwi T ID bung 0 93-
� , of this County aV ��
o wEsTIOATION FEE TOTAL FEE. /
AMA— AM-
a.
SEE REVERSE FOR EXPLANATORY LANGUAGE
1
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have r certificate of romans .elf APPLICATION. FOR BUILDING P E RM I T
• Insure, or a certificate of Workers' Compensation Insurance,
or Vkckx-0 d copy thereof (Sec 3890, Lab. C )
GQUNTY OF,LOS ANGELES BULDINQ AND SAFETY
F'ollty No. Company BUILDING q
' ❑ Certified copy is hereby,furnished. FOR- FI TO FI IN',. ADDS 2 1
Certified copy is filed with the county building Inspec- BUILDING, 'RESS
oe
L flon department. ADD
V Doig Applicant No. OF BLDG& NEAREST 2mf/e
CffY ZIP LOCALITY
'CERTIFICATE OF EXEMPTION FROM WORKERS' Sig OF LOT . O rC Z�� NOW ON LOT ST Gtr
COMPENSATION INSURANCE ASSESSOR
This section need not be com feted If the permit Is for one TRACT BLOCK . LOT-NO. MAP BOCK per. PARCg
hundred dollars (;100) or less OWNiER L ��0�� TEL. MAP
No. USE ZOt,E
I certify that In the performance of the work for.which this �` 1 �AL
permit Is Issued, I shall not employ any person In any nnor ADDRESS -" 1 CONDMONS
so'as to become sub`ect to The Wo Co.mpe
_ CFTy ZIP
Date NOTICE TO P Appll or mak Is:Certificate of EW.A r> R NOARCHITECT OR . -- D GROUP TYPE RE P�O�S`�BY O
Exemption, you should become w6 ed to the Workers' hd �T• ZONE /�)
Compensation provisions.of The Labor Code, you mutt forth- ADDRESS
with .comply with such provlslons,or this. permit shall be TEL. ATISTICAL CIASSIFtCAT10N . APT. CONDO. Z .
deemed revoked_' CONTRACTOR �� NO. a —
. UCENSCONTRACTORS.D�CIARATION , 11C.11C. CLASS NO. UNITS
F�
I hereby a+flrm that I am licensed under provislons•of Chapter9 ADDRESS NO. SEWER MAP
(commencing with Section 7000)of Division 3 of the Bwlrmn UG
and lofealons Code,and my license is In fuII force CITY' CLASS BK. PG. VALIDATION
!!// so. Fr No. of No. of a-Ecx n 1-
Ucense Number T��r LIc Class SIZE STORIES FAMILIES ONE VALUATFON tT•t:T*i
Confr bare y`f DESCRIPTION OF woRx -ANEW DD ❑ = 2 g 9�.DD ti17 293•�t l
exempt u Sec f5G , I ITEM
-
.&P. for this reason �T ��� L�USE OF / � /L ` R1ITER El _ ATRL 293 . 50
Date: EX1STING BLDG. ��� DEh10l ❑
Signature APP-(UCANTZ�Al z 7 FINAL ��f •x{
OWNER-BUILDER DECLAR,AT}ON DATE _
�Zlons
affirm thwt I am exempt from the Contractor's License , PP
the following reason (S�ction 7031.5, Business and ADS �t� FI Code): _. _. gp - &XKJ_III)31 4/ 7/�9
I, as owner of the property, or my employees with ADD NG
wages as their sole compensatlon,will do the work and X41: i�l
the structure Is not Intended or offered for sale Section LOCALITY , y}. Ly(t
•.70644, Business and Professions Code.) A#NG NC
El - )
I, as owner of the property, am exclusively contracting NO.
with licensed contractors•to construct the pro(ect (Sec- ADDRESS
tion 7044, Business and Professions Code.)
CONSTRUCTION LMENDING AGENCY YARD FW, FROM
I hereby affirm that there Is a construction lending agency for FRONT
the performance of the work for.which,this permit Is Issued P.L
(Sec 3097, CIv..C.)._ SIDE
Pa
Lender's Name Q ]�
P.C.Fee Permit F« LDMA Re4. i
Lenders Address ,
I certify that I have read This application and state that the Issuance Fes d D LDMA P/C f
above Information Is correct. I agree to comply with all County Invettlgatlon Fee
ordinance and State laws relatlno to building construction, Total Fee �.S LDMA Perm i
and ' by authorize re ntativee of this County to entad,
n e above- ed property for Intpectlon purposes.
50 KRVEW FOR EXPLANATORY LANO{JAGE
SJgrJWe of AppllGant or AgentDato
- APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN
I hereby affirm that I have a ceorMca b of coneent to self hkm ADDRESS
U&47'—
or a oattficabe of Workers' Comperrsetbn Ineurance,or a oerHod Z
oopy thereof(Seo.3800,Lab.C.) LooALrrr
lr� —
Policy
ty aF Lor ria.OF BLDOa NOW ON Lor e�
❑ Cermled copy Is hereby fumfabed. VNEAREST CF4388 ST.
CerMW copy is flied with the TRACT BLOCK LOT Na lA O W e'er "g d N Z'
USE ZONE AMP Na
Date 7=7 �rt 7(,tr _
ASSESSOR AMP BOOK PAGE I WP.C&
sPFaAL ccmrnc s y!
CERTIFICATE OF EXEMPTION FROM WORKERS' ow�F� TE-�'
COMPENSATION INSURANCE
OW,eA ej Lx) %M-11N1000 FT.OF SCHDX? YES NO
(TND seWm need not be ccrrpietsd H the pwn-dt Its for one Nxx red Zq
ZONE
dotisrs(b too)or Ieea) 1'� (I DrBrwcr oROUP TYPE cora8r. F>RF���777 P> seFn sy
I certify that in the performance of the work for which this pwnitt CnY e i
/ _0 /`
Is issued, I shall not employ arty person hrty amanner so an to T/ Na y1
become skod to the Workers'Compernation Laws swnsTic&CLA88MATION APT
Date Appkant ADDRESS CUBS ND. DWELL UNITS
NOTICE TO APP�. If, after makfng this Dwttflcate of REQUIRED TOT L SETBACK FROM EXtsT
Exemption, you dxxk become subject b the Workers' CONTRACTOR TEL Na SET BACK dkM FM1YY PROP LIKE WIDTH
Campensab Do provfdoce of the Labor code, you must forthyft J)'t 1 0010
ax"with such provlebrm or It*permbt shall be deemed revolted. F= mdm6.5x/y PRorrG —
Y � � � LIC.NO. �''n PL
LICENSED CONTRACTORS DECLARATION 7'` �
I hereby affirm that I am Hceneed inderprwbbne of Chapter 9,/ C �'�� G P L
(conwrierxfp with Section 7000)of Dlvlebn 3 of the BuelrKm and■ SQ NO.OF 40.OF E8 SEWER AMP
Prolecabom Code,end my kense b In futl force and ePfeot. !� I NEW BK Po ,
Licerne rkunber Z LkL Class DE of ADD ❑ N1LUalON
Contactor Dobe 27a nn t;C Y ALTER ❑ s O 5&i
El am arempt under Sec. '� REPAIR ❑ $ z
B.&P.C.for this reason Cs� �C , DEMOL A UOMA P/C I
Date: USE OF STN° URM ❑
Signature 1z -
i APPLICANT ! LOAM Perm 0 2t.
El I,.mowner of the Property, or rry employees wlffr weoee asACCT.i
..th& ode oomperteatbn, will do the work and the structure is
no( intended or offered for sale (Section 7044, Buefnees and MAL DAM CJ .4F(
Profeealare code.) Q M-L T1�ARLICMT oR FlITTlFE 000 RANT HArDLE uuEr�
❑ I, as owner Of ffr0 OR A I�CTlFE COHPMIO A HAZARDOUB Al4ER6kL 20LML ro OR OFHATEA TFMN THE i
fceneed ca aclora construmot the project (8 di 7044 1 Aarotarls ear a+THE w z!raas wve a 0roauarorr coast
Bu*ma and Professions Code.) `�Zl vas❑ mo❑ Al ACCT i
%%&L 71-IEHTEID®U%'OF THE BF�LNe BY TFE APPLICANT OR PURR L
BFDNU •T
OCCUPANT ReO sic A PEF64T FOR CCUSTFI ICnON OR MOORG41ON F FCC THE OCUTH 3303 4.U8.31
IO
CONSTRUCTN LENDING AGENCY OOW AR alALrry L~49 SENT DOTFU T W.ACW es TTM a-Ecw-bT FOR
aucejw&
I hereby affirm that there Is a cormfirdfon leMVQ agency for y❑ No El 7 1TDIS
a the perfomHarrce of the work for whish this permit Is belled(Sec.
a 3097,Civ.C. I i FEAD TFE HAZARDOUS LWERALS IFOFY410N GLADE AND THE OC.AOLC PE3iLT M TOTAL 488 - 71
CHECIQ.BT I UFDE WO MY FMOLNFUCKrB LACER THE LOS ANCE-ES COUNTY CODE,
TM_E 2•CHMPT ZM SECTIONS 220,00 THRO"220,40 CONCE44M HMZAFDOUD
Larders Narne L VAL S FEPORTMO AID FOR C"ANQ A PeFUT FROM THE _ 71
Leaders Addreee f_� .��
O C"em 0e MUMT
I ow fy that I have read t-is appfbation and stale Larder pemaky P FEF PESTIAT Fid
of perkry tW the above tr(onnatbri b correct.I agree b comply
with all canty arcfln ea and state owe rsleting io btrMng D Em • 2 0ICIC—DDU 1 7I 7/94
b emir hereby aufhortzeProPert n pQ Z(�.
X99 FTI :21
m rrvEeTxiArloN F� TOTAL FEE �J -
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARAT10N FOR APPLFCANT TO FILL INA2,-,q
I hereby affirm that I have a cerdfcate d coneerd to self kmire Bj Il/
or a cerdfbaLe of Workers' Compensation h wrance,or a certH%d IJLDdJO Z
copy thereof(Seo.3800,Leh C.) CITY -
LOCALffY
Polcy No. °o Berry OF LOT Nto.CF BL.DOS NOW ON"LOT
❑ Certffied copy b hereby fLrnWvd. NEAREST sT.
❑ Cerdfled copy b flbd wfth thedlnp hopedbn TRACT BLOCK LOT No
USER ZONE MAP Na.
Deme ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDf xws
CERTIFICATE OF EXEMPTION FROM WORKERS' TEL NO.
COMPENSATION INSURANCE wm-rm loco Fr.of scklooL?
vis NO
(This eecdon need not be corrpieted ff the permR b for one hundred ADDRESS
ddlar8 ($100)or lees.) DLSTRICT GA(" TYRE CONST. FRE 3CNE
i cerf fy that fn the performance of the work for w doll this petTrft
b ue
issd, I &hall riot employ any person In Any rrranrnr eo ee to ARCtaI ECT eNtortEER Tu-NO. `
become ambled to the Worker&'Conperraetbn Laws 8P,T13Tr L CLASSM-AMON APT
Date ."p cant ADDREss CCAs NO.- --2 Z— DWELL UNITS
NOTKE 7D APPf-rAW H, after makkmp thio CwNcate d REOUFED TOVL SETBACK FROM EXIST
' 6aemptbn, you should become eubloct to the Wbrkm' TEL NO. SET BACK YARD HWY PROP UNE WDTH
Comperreatbn provWons of the Labor Cade, you mLmet brHr th /�
cortpfy with each Pravblane or this pertnlf shell be deert,ed rBwked. 88 //Q rYY � 2 Fir
Y PL
LICENSED CONTRACTORS DECLARATION ne� SK)E
crry V LCCLASS PL
I hereby afArm that I am Ibermed inderprovisbrb of Chapter 8 6 3EWER MAP
(corrrrtrer#ip wfth Section 7000)d DMalon 3 of the Bu*aae and Ba Fr.822E No.OF STOW-8 40.OF FAMES
Profeeebrre Code, my Ilcen&e Is In fuO force and NEW ❑ BK PCa
Li ,
cense Number C1aae of of wogs / ADD ❑ ��a+
Contractor Date ALTER ❑ $
❑ I am exempt order Seo. REPAIR ' $ Z
BAP.C. for this reason DEMOL ❑ LDMA PIC m►
Date: USE OF DQ9TNG BLDG URM ❑
Sonleh1
" APPUC.ANT(PMV'r) TEL NO. U30M PST t
o.I,.es owner d the property, or my errrpioyeee with wages as
ACCT.T
"thew &oie corrperreatlon, will do the work and the struchue Ie ADDRESS .
not Intended or offered for sale (Sectio, 7044, BuskT and FINAL DAM 33W 72ctZ
U 1 ITEMS
Prnte&elone Code.) WILL THE APPLICJNn OR FUnlE BULDNO O=PWr FL4DLF A Lr U!&kL _
❑ I as owner d the OR A UXTLFIF OW"0a A FW_ARX""CUML EQUAL TO om�vea 7FM THE i .
Immed oontracfom constixtd the pro)t'r aontrecttnp wtth, A&10k1 e�CN TFE HAZARDOUS L T TIALS GLIDE? FINAL aY TOTAL 72 -53
proleat (seotbn 704x, YEe❑ �❑ CACK
''}�j �'�'
BLefnea&end Profeealorre Code.) RLL TFE N EMXD USE OF THE BLULN0 BY TFE APPUCANT OR R TFLIE BL&bM C1�CK f 2•E,5
OCCUPANT FEOLAFE A PERIU FOR QYHnaJCTION OR FFION THE SOUTH
CONSTRUCTION LENDING AGENCY COAeT AIR OUALFFY•..vAaE).��DrsTFICT(eC1o►D)8EE PEFAAn7M CFEaameT FOR aVAGE AI
(ate NEa
I heretry afffrm that there Is a coratnmotbn lendkrp agency for YES❑ No❑
N the Performance d the work for which aria permft le ksamed(Seo
0 3097 CIr a) IOFV{YE FEtHATD I FIE LMEZ/AM WY FlEOLI EM3fM LNUER THE L.OB Mi EI-ES 0 UY �y'yy''-GOD{ i 9] 9]
TITLE 2,CHAPTER 220e`0 SECTK MB 220.100 TFHOUGH 220.140 COf�i6/O FMZARDoue L�JV-LA-IV 1117/7�
Lenders Nanle WrEFMLB FEPORTNOAND FOR 0814+40 A PEFMT FPDN THE BCJdQ
Lendees Addreee 6136 1 Ali 9
0 000W uA Amir
I certify that I here read this appticafion and stale Limier penafty
f�GLS
of mb pero-y that the above Inforation cor'rea I agree to cw#y RQ FEE PEF7.fT FEE
wfth all oounty NdTances and State Tawe refettnp to txjktnp
oorretructbn and,hereby authorize represent±H— of 0* C—Tty gt1ANCE FFE
to enter property for hvpeDcbm purp
oses
.
CD Q NVES1lCWION FEE TOD1L FEF
SEE REVERSE FOR EXPLANATORY LANGUA13E
� . � .4: �` � f j, ! -1.,_Y-�..a�.r_ v�. ..-•L-ter.,.. .�-�.f��•,r r. `—�� ..-tr�.�-.. -_ �� _— r-- .- r..__�-.. .. _. - - _
V�ORKERStCOMkKJ ATIOfJ �?ECtA17dT1CMF :3 i l lH t t rT s: ..r
. y ftfflrrh that ) have gl.certtficatq of.ctirtae�tttb self -L
r
tnsgre, oraterttfi�cate of V�orken' CompeMallohlrqurance,. A ��CA130 __FII _.4V- � w PERMIT
or'a cerfffied copy thereof{Sec: 3>�00, Lb b.'C) _ - - - -
t > { : COUri7Y OF LOS ANGLES BUlLbfNa.SAID S ETY
Pn cyNp, =Company_ r - -
.~ Certtfled.copy Tsehereby fumished: ti,} .. ;r FOR APPLICANT TO FILL INBUILDING -�
ADDRESS
"' irftfJed topy Ys f�(ed with=tkiti durity bulldln�
Irispec-
WJfIDIF4G
Yl o ni d epar fth b nt, ADDRESS
.yn, Appleant, '. h4'' l �. CITY V YID LOCAITTY I
l`C RTIC'�4
FIT1 Of'�MFT101 f ROM Wp��
OR� ' �" -- y ._._ -. _- -Na.-OF B-D�.—---- -- Nt RfSI_
{ 3.
K moi:, SIZE LOT N)W ON LOT ST..
C
OMPQJSr4,
TaOM1NSU RANOE
:section needrFiat t'corriplefed t,�fhe perml}la for-one. - ___ __. -- _ Y
ktq.gt►*�d dp((4fs(;100)of)ems TRACT B10C3C LOT NO. 4r
List
cMtf�!tttc�it�l olm�q of tfie •,,. f wfilch,thlr' ' �¢ _ NO' �L✓ NO
pirmltli`I»ued,t}n131 '1 emp(b'y a nany7n ADDRESS- 1-- - - �� g {est f_ _. } -- - -_•- - -- n.-.-- - a
sb'ailo Deco e'.ru To t}1b HVot Con�pentati COf DfT10NS l r ',+ Q
ZIP_ ._ ._:
NdT1 O' I -•rnbklri' C�ktlfictrh ofiRECT OR NO D} t1CT.. GRQ�1B1 TYPE_a.-.--_ HRJ_ _ BY.+:
Exlmptloh;,.ybci' 'betori5.e 1 to-fhli%W&k"' / n r,
compdrisaNdn pfovlstonrof the-Labor Code, y66-must forth- ADDRE � ' OOfbTrr ZOfE- - -
wlth comPlY wlt[i.�such provldona or',thta,,perlrslR shall be • - _ --- -- - - —- - - - �tf {/J -
deeyted r4Ya e4#• n . '... ��,•, ti_ OR . -TEL St TISTIGL CJ ASSI T10rt I _ - -- - -
LICENSEDCONTkA.UORSDEa RAT40N. - - _ -- - a1.S5tJ0. D'WT�1$-UNnS
hweb)tgf(irm I am IlcansQtr y(td�r provlslormof Chapter 9 ADDRESS
( RR`MTr Sect�.�).yofpjvtilon3oft}ie Buslobn and SEyV62 MAP r,c
o s o�s:Codb' a!?� iity-Ilcehsd l#I]n full'foFte'd d'e FbcY. f CLASS - - _ -�- F -. -VAAJD ,TMN i
Lrit.Cltrsi.. l $Q) 57dtilE� AM1LE5 -� �b r.', .7,L' 1 ✓jl
Fc Tta&_NmiSer` �..
�ontratfor DESCRIPT}ON-Or ►JEN—
nI am exempt under'Sec.
B,iP.C. fqr this regson REPAIR.__ _ '— —*-- --J_
IFKV I�NG BLDG. 1
6.1 7.9A-
OWNER-BUILDER
fDE{LARATICMI - - - .. INT DAT# . . ^ ,._ �_ #-o • r •Y
I affirm that-Lam exem fromthe-'Conftoctot s Ucnnse
Low the followln4'fel�h (Set'tl$h'7031.$,'.Bus[rlesa and ADDRESS '� -
'Pta�ns'code). _. __ ., . v ..�.=_ � •- _.
I as ownPRESENT-
er of the ofr�y •mployebs with122
wages as their RoleIon rl'd6 the wcrfc dnd ► _ =� r F_•,
the sfttture Is not Intended,or offered for Pole(Section?:
7oM, Buslheaaand Professions C4ckr -` -- µpylNp--' - r. - ��_ -._ T
I as owrw of the property, am exclusively controctlpg OR 1 NO. f
-wlfh'hcensed contractors to'construct•the�coleQADDRESS
Non 70k1, Bualnee and Professions Code}
TOT FROM, ).4'.. _
CONSTRufCTION"LENDING_Ar ` '_ - 7' IAZC YARD` KWY - PROF. UNE tiVIDTHt _ r- _ i
l•tagreby affirm that there 1%.q construction lending agbrwy for ��- .
L ,,,w. •,• ' I .
the-Wormance of ffwwork-fof wfiltrh-?hlt permit.Is-IYsued -
-(S�c.3097, Crv, C,). -SIDE I `
IwlnClera Nariye
_.- tAh4,Ref.
• teddek's Addrw -� '-. '_ r- P.C. Fee
I mortify.that I..lwve read this appllcatigrt.and'state_that the ., - _ - - fVuance-Fee f/- i 1p��-PIC4
abaw Information b corm. I agree to cofnpfy with all County, ~Y - ^ 1 �:- •. ,
JnJMtigatton Foo l
4rolrl, 4s qnd State Ip s CQ}atln IIdIr�y c4rir�14tlon, - - ---_ ._ : _. _�.._ TotaFFs. - ✓ iDMA P.rm. 1
and f»reby buthorin rep"weri of this County.to enter -l
ve mention for Inspection p'
. _
Still FrAMPOt DQLANATOIN'LANGUAGE
54ghatun of or-Ap.At m l
' � R$}CO1G�P�NSAT I �EC1A�A .. •_.. . _ : .- � -�. -_ __._....��_,_ --.
^. ON ,-� - ,. J�?T��'i �k��'i�T.-M ?S'i. .� �.,•{• ;� ~I
b. affirm tIccYte hate. qq..ce Imi of cons�rnit to.self CAT
� ��I�DI ��
ffrsuro�or o certificate of lfdorr,er3 m nsaflon I rarlce, - t -
or p L&tiffled copy therbof'fSec. - -
- rQUNTY OF LOS ANfoELP BUILIbT r ,
•,,.• � - t•.•,,,: �� ,:ts '.,,' Nit QiNb �A QTY :G•
PoUWNo. CP7�PanY `. -
BUILDJNG , C2_
Qerti4led'cpy Wherebyfurnbhed. t �,} '.. -FO A ICANT•TO FILL IN ADDRtSS f
Certtfjed dopy'I4 fJle�14'Rh'thb county br1tYEling IhS a tJG.
tidn 'ent: r ADDRESS
DC[te c y' Appllcn CITY ZIP• LOG4UTY
Ff�AFE OF ION INR,dNCF, �: SIZE O�LOT 'NOW Ot!LOT St. .
ftls`'weL lon'rleacknot be com feted if'thd permit'icfor one - - - - - BLOCK tbT --, -
r}Irn*od dollacs($-0W)or IPPtkkT. , ., t+•4: p
15_ T
^f'4pcllfy thvt'Ir the perfdr, h 'of the' w¢fk,fgr which this 4r•- / �y� NO
-710. i
pgrrolt Ja lssubd1 I sFiall'not employ y pbr}dn In'dny.rr�rlher SPEClA1
io ai 7b bd�orne wblect to th'e VII¢rViceFs'iCo4ridenigtlotrtaws. - ADDRESS_ _=1 . .. _.__ 5'
Dgte'- ,Tom`,'App II d}rt '„f, y :.•;• , r
NOTICE TO APPLICANT:`If,`affd+:'fhbkMj� 'this'CeF(tfi>" of �H�OR _ICI_- _ TYRE FIR1; _ -BY__`{
Exerhptlonr.you }should �e orne *uhloct-30,the Workers' CONST' zONE
CaTnperaat(on'provt{Ibns df.the Labor Codi;.�ou musf'forth
�(I$a gomply with .iueh provttlons vr•thlxt;pgrmlt shgll be,.-r-_,,� _.. _T._ -._. _
deemed rwoked•. STATISTICAL CLASSIRClTJON APT.
".� 'r t i CONTRACTOR NO.. _ _
LLCENS®CONTRACTORS DEf1ARATIOAI. r ,�,. -. y. ._..._ w_ ..-4 �1G - CLASS NO. UNITST - - -
Ifiprekyypffirm thot,J am licensed urdgr provlsloro'pf Ghupfer.9 td0`
AW
( "' n wttfi SQctkx'C00))&Fbivkslon�-pf the Busir0m and _ .---- .- - - - UC, -'--.1. SEWER
Proewmlo u Code;"dnd h,y.11tbhse"fs-1n'fvll fpfte;dr�d'effeGt. CITY CLASS - -1- -YA1DA��(]�-
SO. F7� OF S)E_ C]IECK f Y• I
, .�l1 'Szf- _ dQ�S.� AMJLES ORE
LIS Nyrriber' o' latj --• - fir
_YJ71r
DESCRIPTION OF WO21 �C/'f—' - NEW
- �VI,-
ntro br Pilo n• j
APP
1 am exempt under Sec.
wt I ALTER t a
B.dP.C.fbr this reason Rl>7AlR _ _ -�. _.._ _ .---• - .-
DaTs:` - =ILr��OF.. DEMOL
FXiS CI Nd BLDG. ti-
Qfe' W BUILDER TION' - _ �'oL p - 3 A�`� '
,lFwobyaffIrm-thatLamlexempt-front the Ggntraators-flcense �j �R�yjy^��,r�/ �. •.P o;a;.� t
Law fw the folloy+iingNghaoh'(Sdclron 7Q3.1.5,Bu{Ihew and -:FI
#- =
Prof orrs_coo '� �.. - � - r, o,b a,6 3
BUILDING
as owndr of the property, o my empl !�}y wJtb:` ADDRESS --- _ -- -• _ _ r x�; _ a
T w� ;� `•�` rr`. 4 4. r S, b e .p 6 1-6 3 a.
wo�'es as-fhil�sole compen�atlon' �rllf db tfie and � t• � `f• .' '
the structure Is not Intended or'off ered fve,rie($ectlon `}
-r�`-� 7F}k4;-Buslnew-and Professlons Cgde): - - +'`_ MOVING - r -- � -- - "1; "-' 'f .+�L -' 1 r7 F .
4�_ I;as'ownef,.of ihe: a excrbsly I contractln
NO.
n. 8 _.
prapb<ty, fn J Y. 9
-with'ilcensed-controctars to construct the 4tolect (S o-..
tion 70.44„Beslnew and Professions Code). -_ x Y
_•. 'CONSTRUCT1OJ9�DING AG#NCY.- SET g,�IREDREM i^AI;D {WY- PROP."UrE STM; r `rl
1 fiMroby affirm that there Is a.construction lend Ing ogencyfor FRONT L
•the•Performgni`.e of the work-for•which this-o rrnit 14gibed -
(Sec. 3097`, Civ. C -SIDE _ }
Lenders Name
LDMA W.
-a F.e' - -- -'- Perm it fee - - -
Lender�`.Agdreaa
I cwttfy.,that L have read.th4 app]lcatl,00_and skno that the -. - _ - 6.6.ncefee l d IDAAA{�/C•- ._ -c I . }`'j
7
above Inforrrwtl6n Is correct. I ogrbe to comply with all C•ounly - I !on FM
;and-
l tes and State lgws.ro Ind to ufldl�G �&n3 .4tAn, ovest�crtl - g _ -• - _ _ .- - '
avthorize Ives thli Goo to a OMA P'”' 9n property for Irispectio
-Sip kart orAQent - Lic" - -. . . • - - - - - - -µ- - -., - t 'm I
o MAPwsA-hol,4 �ECLAR'ATION _ 1.a#i•F fi' r i`:; . . - _
+ l hgrgbyiaffl,rm tfi4,t I �hgvq a.c}�, mte pf 4onsent to self
�Linur; ar a certificate df Wor)cq�s �omPeltsatlon ltisuroxe, APPI 4TI N7 PERMIT.
'or'd.cel'tifIad,cppy.tfierdof(56c 3800E Lab.'tj
Polky'4Jo �.w ; COUNTY Of-LOS A-NGELES purLbIN4 ANN 3�► 5 w i
��Company-
,Certtflid copy ii hereby f4mlahed. �, ,•.r . . ..'i FOR APPLICANT �0 FILL I/N AAl i'
Certified tbpy is ft{e¢'WIW-thd c&ntybelldinginsPec ILDING 7
t-J tlon',bl� Ment. ADDRESS
Nite Applicant _ CAY nP
''CERFIFICATt OF EJ(!`AIIPTION lROAtI WORKS" _� s . - -TJCI-.AF- LDC --ar• - i �..._ .- _
�'CQMPEN5ARON.INSURAN� OF OT 'NOW ON LO7- ST.
({#W section need.nat be'com leted ff the Permit is forgone - - 1= --- - - -
h4RdrgdAo�lacs (S)00)or Ipzz TRACT T BLLO�OyCy� LOT NO.
y 1 ��y p P�
certifY tha)'jn thq-perforr�,ance i)f the wcFk for.`,vhl`ci'thtrUSE
TR
�-
pe It If f pd 'T aha
not dfnploy arjyr�,�,n f any nl''nner. SPEC AL•'- - _ _ -- -'
so'as to ers'bje2t td�e rk 'Com' `ADDRE8S _ r_ �'_ _ __,r COt� mot$ Q
CITY- - -- ZIP_.. T
7fC3 TO' CANT:-If,- >rridklni ' Certlficno of ARCHITECT OR _ QISTRICL. P', TYPE_ _ RRl-
EkeirholoFr, yoU-should Mit► subject -to-Nthe-Wprken - T� Z�
i oml&s lon plovlslord of ae Lgbor'fiode;•l]oo must forth=
'With .eomli y--wlth- such--prbvWons or'.thla,permit :hall .be - T --- ---- . .-- - -- ---- -.
d@ med.MYoked,.., . , .• :i - I STAT75T1CAL CLASSI - 1 APT. I
LIC E45W CONTRgCTC 4js D�{'1t.RAT10N .. . • - _ _ -__ ...� - - •I '.CLASS NO' - I U US -
1.F�er�by afti ti l clm Ilceraed rider provworn of C xrw 9' Nb 1
f cam mgrid rg_w S on•70Q0�9f vW_ob 3 of the 6asl nea a zed _ _ -- _ __ .-- _ -LTC.__ _ _-._ AkAP
P7 of ildrp.Code,''ond-rrt .ifoehise-u'Tnfullforce'artd`effed.: p1Y- CLASS
_ -}O� BK PG.
y(>c'gnseumbe' Llc Cla>■ r- $YbRE5 PAMI _.Qom_ 1 i. Li
y T�
contFacfoi ,?' ', z. ', DESMPflON OF7MORIC- - ---- - # -r
�. ADD- - t/ - • -= ,F--•--�i .`'-
I am exempt ur�r$ec.-
r ALT9k l'
i,3P-C:. fqr this-roc
Date'
S{4ttQ rs CIWNER-BUILOER'DEdARA710f F
a hereby,afflnnfl at larnexemptfromthe-Contrgctor's-Ucense y:
law for the follavAr[gWbdsdn,(Sdt4fon 7031.$,,.Bus lnest gnd`
Ibnf Code t.
,..� ,
BUILDING
I, as ownatr of fhe property or my emp.loydes wlth
wa4ei as tfielr ible'comp irnatlon,will do-*e work apd - - r. . — - - # • T �.. {
- the structure lir not Intended or offered foriale(Sdctlon r
LOG,iT1Y z -�.� r -
- -7044 By,rne�sarad afesala,rcada). - ,wo„1i,G...._ r _ �- -iEt -- -- - - . { -_ -_-1-'.L.+:a_6 ,6.3_.� ..
. I, asfowrler'b4e jwopgrty; gryn oxcluslvbly contioctlno _" NO•
with llcensbd:conmicton'.to construct the project (Sec-
-fl4n 7044, Builnen and Profefalons Code). '
- CpNST{2C1C1}OFl �JDING A ICY _ yAfp. tNJY -UNE - D } r - + i_stir•, n .i
I hereby"af#Jrm that there.Ia a cbnstructIon IandIIng agency for FST
- 4
the-perfotrrwnce7of tM work+for'which thh pernlH--ItI-Issued...
`r
.(S�c. W, Clv. C SIDE {
Lotoder"s Nome I r T
W. f ;W'•.']' .i zea}-
Lends"s Address - - - P.E f - r - - fYFM -
4 I.certtfjsThat a haw.read thls.appllcatlon d6d,stats'that the _ -- Lwm, P/C-I.
-
above Inforrpdtlon b coffq T. I agree to comply with all County Inyootgatfon Fw
ord Pt+tand§" IaY F(Imn ty bulldlrro cgnftruttlon, _ _ b - -� �Lb+rvi P,r.,, 'I
AncLauthorize repress of this County to enter - - TofchFse
ovb mentlo fpr Inspection' m mrimm pixkmAkATo�yU17�1U1WaIkpnt r Awrit
COUNTY OF LOS ANGELES TEMPLE CITY f 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPKENT TEMPLE CITY CA 91780 BL 0508 0403010003
- -- - PHONE: (626) 285-0486 EXT:
GA.L ID: NO. OF COMET BUILDING
5342 LT: 120 SG. FT STORIES TYPE 4929 GOLDEN WEST:AV
STRUCTURE: VN TEMP CA 917803936
INFORMATION • NEAREST CROSS STREET: LA ROSA
"018"023 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C
TEkANT: EXIST BLDG USE: RESID -ME MU: ff-I ISSUED ON: ---NMESSED BY: -MIRES ON:
EXIST OCC GRP: 03/01/04 VG 02/24/05
OWNER: TEL. NO: BLDG$. NOW ON-EM'.-- VALUATION: F I NALJDA7 E Flj* BY: CODE:
LO STEVEN Y;NICHELE W (626) 309-9900- 1'p00
4929 GOLDEN WEST AV
TEMP 917803938 -FEES PAID DESCRIFKION Or WORK
REPLACE FRONT BAY WINDOW
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG NOTION RESID 1000.00 VAL 0.50 SPECIAL CONDITIONS:
D2 PERMIT W/O EM-HC 1000.00 VAL 65.40
TOTAL FEES 93.65
CONTRACTOR: TEL. NO:
APPROVALS DATE INSPECTOR SIGKATURE
SAME AS OWNER -
LIC. NO LOCATION AND SETBACKS
SOILS ENGINeMFMT0WU
ARCHITECT TEL. NO. F /TRENCH FORMS
LIC. NO:
RAISED FLOOR FRAXING
MAP W: SEWER MAP DOCK: PAGE: FIRE CMP:
xx 3 01
MO. OF FAMILIES: DWELLING LIMITS: APT/COND: STAT CDW FLOOR SHEATHING
NO 21 -
SCHOOL WITHIN HAZARDOUS SHEAR PANn-r—
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
REQUIRED TOTAL SETBACK FRCIM EXIST FIRE SPRINKLER HAAGER9
SET BACK YARD: HWY: PROP LIME: WIDTH:
FRONT PLINSULATION THEIR STRIP
-
SIDE PL-
INTERIOR LATH7MZYQXn
RATED FL
RATED SHAFTS/OPENINQS__ _
T-BAR CEILINGS
i
RE1�kI` T1�NSNSNt2b1 - --- -*M TO: M0509--
i
CODYTT-OF LOS AYGELES TEMPLE CITY / 0508 BUZ.LDIYG PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAB TU➢AS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT THMPLIC CITY CA 91780 BL 0508 0506070005
PHONY: (626) 285-0488 SIT:
LJQXL ID: NO. O1 CONST BUILDING ADDRESS:
TR: 38970 LT: 4 SQ. NTT STORIES TYPR 4929 GOLDEN MEET AV
BTRUCTUR3: 3000 VY T113[P CA 917803938
ASSESSOR INFORMATION NUF®ER: YElYEST CROSS STREET: LA ROSA
5309-014-064 THOMAS PAGE. 597 QRID: A5 LDCALITY. TEMPLE CITY, C
CYT: FSIST BLDG USH: REBID USE EOICH: A-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EKIST OCC GRP: 06/07/05 JK 06/02/06
OAYER: TIL. N0. SLOGS. NOW ON LOT: VALIDATION: F ATE FINAL BY: CODE.
LO STEVEYjMIC M- (626) 309-9900- 6,500 /. �a
4929 GOLDEN NEST AV 1
TEMP 917803938 LAS PAID DESCRIPTION OF HORS
TRAY-OFF AND REROOFING HOUSE KITH LIGHT N=IGHT TILE
FEE DESCRIPTION. QUANTITY: DOM: AMOUNT:
APPLICANT. 'TEL. N0.
SA}IC AS OIENNR - AA BLDG PERMIT ISSLDUKM 27.75
AC STRONG MOTION REBID 6500.00 VAL 0.65 SPECIAL CONDITIONS:
D2 PERMIT W/O EN-HC 6500.00 VAL 166.20
TOTAL YHYB 194.60 -
COYTRkCTOR. TEL, YOB APPROVALS DATE IYSPZCTOR SIGNATURE
SAME A8 OWNXR - -
LIC. NO - LOCSTIOY AND SYTBACXS
SOILS HYGIYY.YR APPROVAL
ARCHITECT OR EYGIYEYR: TEL. NO: - Ni'ONIHDlTIOY TRENCH FOR.MB
LIC. NO: SLAB UEDXR FLOOR
RAISED FLOOR FRIMIYG
MdP N0. SEIFXR MAP BOOK. PAGE: FIBS ZONE: CMP UNDERFLOOR INSULATION
144MG9 3 01 )
FLOOR SHEATHING
NO. OF FANILIZS: DWELLING UNITS. APT COPD: STAT CLABS�
NO 21 ROOF SBSATHIYG * D 1_
(12
SCHOOL WITHIN HILZAR OUS SHEAR PANELS
AIR QUALITY: 1000 FEET MpAT1ERIA.LS
YO NO YO
AJO I3iBP347TIOY
REQU2RE:I) TOT1L SETBACK FROM EXIST FIRE SPR'T]YT•HR HANGERS
Ste! BACK Y1RD: EMT. PROP LIVE: WIDTH:
FRONT PL- IBNSULATION NEATHRR STRIP
BIDE PL-
INTERIOR LATH DRYWALL
RITZRIOY LATH
RATED FLOOR CEIL ABSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS OPEYIXGS
T-BAR CHILINGB
LOT nRA-IN GIZ
REPORT ID: DPIL261 ROUTE TO: DS0508