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HomeMy Public PortalAbout6009 GOLDEN WEST AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES U I L®I NG WM. J.'FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLANCK NO. PERMIT NO. BUILDING � � �J /y ADDRESS d O , G D C '' —_ LOCALITY - �C J '� C RECEIVED BY DATE OF APPL. DATEISSUED NEAREST 1 USS'CS `✓'� � -Z. CROSS ST.- V d f? t� L u - d d ` BUILDING ADDRESS �� �Q g .,a c�bC/v G,s r.S OWNER Lk ! --r MAIL J ,LOCALITY ADDRESS b V, •Q v�.o r_- N w a x% I/•�k. NEAREST ROSS CITY �' NO. , FIRET. FIRE PL ® TYPE GROUPr ARCHITECT OR � TEL. ZONE PLANSS .� ENGINEER NO. BLDG. f,♦ / ♦ 0J2Q./, • SETBACK LINE ADDRESS - APPROVED--, - ,� TEL. BY / N DATE CONTRACTOR NO. USE APPROVED ZONE / BY DATE ADDRESS �T HOUSE'NUMBERING LEGAL DESCRIPTION L NQ. !tJ' BLOCK MAP NUMBER2?7!�::Q -'—FIELD CHECK BY TRACT vd�p/ NO. ASSIGNED BY —^ DAT NO OF BLDGS. CORRECTIONS SIZE OF LOT G�" /f/�4I NOW ON LOT_ X USE OF _O OF EXISTING BLDG. - Q SE/(o f FAMILIES ♦ (� DESCRIPTION OF WO die-s d)-j NEW I I ALTERATION I I ADDITION I - 0 REPAIR I DEMOLITION SQ: FT. �j t�f NO. OF n �.i ✓[JdTi�A��O 7-= �..��r Lne♦fK �� Gi SIZE'. ' rf 7 ROOMS STORIES J/ Z EXT. WALL [ CC ROOF / �p /✓o _ iT/o w ./) f•?!r �ti.4Gd. r COVERING `� d I COVERING d"®m 1 . USE OF STRUCTURE lag/`Ceo a,3,- f�lS Mal, �F- a t.5 ee0jd;�7 tIPP 4 eA r -0,114"w i �1 ! 0 APPROVALS' + INSPECTO�2'S SIGNATURE" DA E ti• I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-� FOUNDATION: LOCATION e PLICATION AND STATE THAT THE INFORMATION GIVEN IS �, FORMS, MATERIALSiC:da....� CORRECT. ♦. 1 AGREE TO'COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWSREGULATING BUILDING CONSTRUCTION. '� f FURNACE. GA3 VENT, _ SIGNATURE OF (/�f.�� PERMITTE/�'�jg q �/q�/� f� �.1 1 Gc �1 ��OCdI.L &_, AO '.�L LATH, INT. ADDRBSS _ - LATH, EXT. �GO♦N<o AUTHORIZED AGT. PLASTER, INT. - 7aAeseA• DOSS 10-50 $ P C. 8 FEE PLASTER, EXT. VALUATION FEE $ j0-• FINAL G�" G..«r�...10 `� -��" 76A638A CE#^03 1-67APPLICATION FOR BUILD NG PERMI r C � `COUNTY OF LOS ANGELES ABUILDING DDRESS Q �% DEPARTMENT-OF,COUNTY ENGINEER BUILDING AND SAFETY DIVISION L o c A L I T Y ' ' JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST DISS^ ICT N _ GR TYPE P - E ED BY RADDRESS. APPLICANT TO FILL IN .� ��' CONST' . I //�J �+ STATISTICAL ALAS IFICATION SE"R MAP 40(o !�(� GtN•�'� _Lf�% - -. BK PG CLASS NO DWELL UNITS BLOCK USE ZONE MAPJNO /SPECIAL PA E NG BLDG, kti- B 'BLDG. SETBACK FROM rID �A, ��/i EL pp - FRONT PROP LINE OF (STREET) e `(`OAhlf10 OZ O b 0 TYPE OF EXISTI NO FSETBACK HIGHWAY YARD = TOTAL ADDRESS O (0a HIGHWAY FROM C L CITYC'cti. L—roe - ARCHITECT OR TEL BLDG 9 BACK FROM , ENGINEER NO SIDE PROP LINE OF - (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L j ` L + _ CONTRACTOR , NO - LIC p ADDRESSkllj NO CORNER CUTOFF YES NO C CITY rIAQQ LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS - c DESCRIPTION OF WORK r c L` F� rO IRED _ _ n NEW ADD ALTER REPAIR DEMOLISH - a SQ.FT NO OF NO OF e: s15 r cguar, rSIZE STORIES FAMILIES - ^ appTO& FE 11; USE OF STR CTURE AwA 00 �•� s,ipe, or T. C. Co. Engirrc'�:;j+- •-�!i^•"C )+ ;,`1'n`o:do'rrfb •eJoi )-we IIf, q— 'A'7 ;"rl Q w, •�,. ;. i i� SIGNATURE OF ) unfil Permit has beeB_issued.'A i ior`�arkwa 'frao'pe' et;T:tC A P P L I C A N T C�fy HeII.- ��j�+f VALUATION$ - /}�%�/ ;�7 0!�17�/ V�. �+ t'�•" moo ,'AP_PROVALS ,DATE IN9PEGTOR'9910NATURE P C PMT - FOUNDA•�IO,N,-LOCATION FEE$ ,� FEE$ FORMS;MA-TERIALS '' FRAME, FIRE STOPS, �9 •� 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 WAS VENT DUCTS' 9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK, _ - AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA= LATH DINT 8 ✓,�� G/ !- TION OF TME LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ' ING TO WORKMEN'S COMPENSATION INSURANCE '- LATH-EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - REC AND POSTED ADDRESS EI NAL _ JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG R PLAN CHECK VALIDATION CK M O CASH PERM VALIDATION CK. M O CASH DL"2 62 3 D 2 i .r7 j i X0.2 6 5 6� jAN.18 I3:5 a �. WORKERS' COMPENSATION DECLARATION -insure, oraffirm a certificate tof WorkersrtComie of pensdT on Insurance, eto lf .A P P L.I CAT I O N FOR: U LL D I ISI G«,P E RM I T t� a certified'c'opy`thereof (Sec 3800„Lab C ) 3'COUNT-Y`OF LOS ANGELES .;L.; BUILDING AND,SAFETY Policy No - ” 'Company 7 r 'Certified copy.is.hereby,furnished = FOR APPLICANT ,TO'FILC IN ADDRESS' .Cy E"V y BUILDI r i ADDRESS'�GtO f D '•S 7 El +Certified copy is"filed,with the county building inspec-. BUILDING' ? _ tion department- r' ;, ADDRESS �, �f t ' Date + Applicant ' CITY EHPL�- '` -ZIP // ? LOCALITY F z,' NO',OF'BLDGS NEAREST ' CERTIFICATE"OF'EXEMPTION FROM-WORKERS'`• : SIZE 61"1 _NOW ON'LOT CROSS ST �7Q/ 7+./f GvTXJ�/I�fi�fJ� ' COMPENSATION INSURANCE ASSESSOR This sec need not be completed'if the' rmif is for orie- TRACT ' J BLOCK ` 'LOT NO ASSESMAP' O R, S �_ PAGE r, _ PARCEL hundred dollars'($100) or•less ) •',• 'a' ''• :. r.. TEL " - _ - OWNER 9C1? ISI A�v NO�/�� USE E" MAP ./ I.certify that-in The perfor orrice he,,work W which this `' NO �—17 ° perm T'is issued, Ilshall'n employ an manner, ADDRESS p�/ �,d"� ��N( { ( O— SPECIAL.= -� s-- -�i C 'a s to become sublet to The Wor er Comp nsati m Laws. T� �(/ ', CONDITIONS O CITY ��% �� ZIP- %- U V Date Ap ca ARCHITECT'OR TEL' w ' 'NOT,I T APPLICANT I , i erTi care of ENGINEER-_% NO DISTRICT: GROUP TYPE., FIRE RO SSED,BY i O Exemption, you should become'=sub e t to the, orkers 0 CONST 7�A1€. w Compensation provisions of'the-Labor, 'de;you ust.forth'-,', `ADDRESS Ud � .ra t� W. LU with comply with such provisions or l!his mw shall be - TEL " STATISTICAL CLASSIFICATION APT CONDO " rA deemed revoked ` CONTRACTOR NO - r �`/ Z LICENSED CONTRACTORS,DECLARATION, LIC CLASS NO ' DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 - 'ADDRESS, NO - ,(commenang with Section 7000)of Division 3-of the Business LIC 4 SEWER MAP' and Professions Cdde,•and my license is in full,force and effect CITY" CLASS BK r� _ VALIDATION "• ` SQ FT NO OF, , NO OF _CHECK •License Number Lc,Class SIZE STORIES FAMILIES ONE ; r VALUATION. -'' c• {•f. Contractor Date DESCRIPTION OF WORK /1 �l�Ri/22 NEW ❑ .T + Olaa aM i• ADD ❑ j O V r- I am exempt under Sec " �/b ► a" � ALTER ❑ ,t B&P C for,this reason JQr UrSECAF REPAIR Date N EXISTING BLDG /�' DEMOL D Signature APPLICANT TEL OWNER-BUILDER DECLARATIONS (PRINT)' UB-r,B/P %J" NO `3 FINAL / DATE, r I herebywdffirm that I'am exempt from The Contr'actor's License ADDRESS pv0� G OLS E�GtI 'J' e Law for the following reason (SecTiori`7031 5„Business and FINAL Professions Code) ? PRESENT" v.`:- BY•. w I, as owner of The property; or 4my employees with ADDRESS wages as their sole compensation•will do the work and .:tib s% - ` e the structure is not'mtended or offered•for sale(Section LOCALITY ' r. ti :F 7044, Business and'Professions Code ) MOVINGI i _TEL, c �` _- CONTRACTOR 11 NO _ 0 I, as o\"er of the property;,am exclusively contPoctmg r *'•' with licensed contractors to construct the prolect (Sec- ,K ADDRESS'' tion 7044, Business and•Professions Code:)` ` CONSTRUCTION LENDING AGENCY, -REQUIRED TOTAL SETBACK FROM EXIST, =.0 SET BACK YARD HWY -PROP LINE WIDTH' rs ,t I hereby affirm that4here is a construction lending`agency for FRONT , „. '+` �; "" in The performance of the wofk:for'which_this per"rriit is issued -P L °L:� (Sec 3097, Civ'C ) SIDE t ; Lender's'Name a s u 7 x� '__ !t,'t±l �f'WC, a _ _ .. -3 S' LDMA Ref.# Lender's Address' P C _Fee$ Permit Fee �' ;� ; ;7 ! i,r_1n .ij _ �y fy that I Have read this application,and state•that the J ^ Issuance Feer (/ '�� LDMA P%C# above i or rrecT I"agree to comply'with all,County Investigation Fee-' _ _ "4 .•,, ordinan. and Stare:la relating to building construction, Total Fee, LDMA Perm # andher b authorize repr sentatives�of,this County To enter _ on the ove- entione property for inspection'purposes 14 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f or Agent _ Date WORKERS' COMPENSATION DECLARATION . to self insure,o as certificate of Workers_'-Comtpensat on consent Insurance, ; APPLICATION FOR BUILDING PERMIT 10r a certified copy thereof (Sec 38o6,-'Lob ,C ) COUNTY OF LOS ANGELES -BUILDING AND SAFETY Policy No Companyf BUILDING '' J ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS c ❑• Certified copy is filed with the county building'4nspec- '. BI s• �((�� — tion department. / J'— Date' Applicant CITY I� ZIP I 1-7�b LOCALITY PLC— Date' OF BLDGS NEAREST CERTIFICATE OF EXEMPTION`FROM-WORKERS' SIZE OF LOT �-{ IOW ON LOT 3 CROSS ST COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK, PAGE PARCEL hundred dollars ($100)or less.) TEL OWNER ` NO' USE ZONE MAP, I certify that in the performance of-the work for which this NO permit is issued,•I shall not employ any person .^ I _m any manner ADDRESS l CJ' vV 1 l SPECIAL ((�� rr CONDITIONS so as to become sublect.to the.Workers'Compensation,Laws CITY 1�/� ZIP "['1 O t Date Applicant 'ARCHITECT OR TEL NOTICE TO,APPLICANT If, after making,this Certificate of ENGINEER- NO DISTRICT GROUP CONST TYPE FIRE E PROCESSED BY O H Exemption,• you should become subject to the Workers' �/� w Compensation provisions of the Labor Code, you must forth- ADDRESS 5:Of d with,comply with such provisions or, this permit shall be r { TEL STATISTICAL CLASSIFICATION APT CONDO N deemed revoked CONTRACTOR NO z LIC CLASS NO DWELL UNITS LICENSED CONTRACTORS DECLARATION; ADDRESS NO ,) I hereby affirm that I am licensed under provisions of Chapter 9 - LIC 1 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect CITY CLASS / BK VALIDATION SQ FT NO OF NO OF CHECK ' *R SIZE STORIES FAMILIES ONE ' License Number Lc Class• VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ El , ADD Poo.1 am exempt,under Sec, �7 < �Z YP [Ell ; ALTER ❑ B&P C. for this reason-' REPAIR ❑ $ Date ,USE OF EXISTING BLDG DEMOL Signature - - APPLICANT •- TEL - FINAL • OWNER-BUILDER DECLARATION (PRINT) NO • I hereby affirm that I am-exempt from the Contractor's License .- - - - - - DATE - - - Law for the following reason (Section 7031 5, Business and ADDRESS FINAL yr ssions Code) PRESENT BY PP f I, as owner of the property, or my employees with BUDREINS ADDRESS wages wages as their sole compensation,will do the work ando•JCI e the structure is not intended or offered for sale(Section LOCALITY , M, 7 t b� 7044, Business and Professions Code) MOVING TEL i T rM ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO 7 A11 ITE=tib 60 - 50 p �y with licensed contractors to construct-the prolect'(Sec- ADDRESS " II�TttL' �.Y a -�AIJ tion 704'4, Business and Professions Code ) s HECK 60.50 CONSTRUCTION-LEND ING•AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that there is'a construction lending agency for FRONT- CHANGE .011 the performance of the work for'whch this permit is issued -P-L (Sec 3097, Civ C ) SIDE Lender's Name - p L 13MO-0701 12/12/89. a LDMA Ref # Lender's Address L { P C Fee$ Permit Fee 7468 1 AM11°e J4 - - - , 0 1 certify that I Have read this application and state that the IssuanceFee LDMA P/C# ►. above informaton is correct I agree to comply with all County Investigation Fee - - „ ordinances and State laws relating to building construction, Total Fee i LD MA Perm # a and hereby authorize representatives of this County to enter A the bove-mentoned pro rty for inspection purposes p� �1�N I ( t SEE REVERSE FOR EXPLANATORY LANGUAGE _ gnature of Applicant or Agent Dat WORKERS' COMPENSATION'DECLARATION insure, hereby a certificate of Worke srtGompensat on ensurfin ent'to lf AP R L I CAT I O I!I FOR R U_ I L D IN, G :PERM 1 T - ora certified•copy thereof (Sec.3800,°Lab C ) - ' - _ "' I ' :'� t _ COUNTY-OF-LOS-ANGELES BUILDING`AND SAFETY *; Policy No - Company -� q " � .'Certified copy is liereby'furniahed AOR APPLICANT TO FILL IN r ADDRESS BUILDING-�O� :. _ , • , Certified copy is filed -- BUILDINGp00 del 2S _.tiomdel5artrrenf ADDRESS,`7• .r; (� - o-' CITY i_�� ZIP �. :Date Appliccint' °`' ` LOCALITY NO OF BLDG 'CERTIFICATE'OF EXETION`FROM,WORKERS' SIZE&'10T LOT ? 'Zt ,NOW.ON LOT', NEAREST, MP - - CROSS ST "•COMPENSAT,ION',INSURANCE L / }� ' {'(This section need"not'B6 cornpleted if,th'e Permit is for'one " TRACT,. V D BLOCK' LOT NO J' - ASSESSOR n - hundred-dollars,($100) or;less-)-�;• ;,� TEL MAP BOOK y, . PAGE- PARCEL r f i.,. OWNER' G(_ NO USE ZONE, MAP NO •a.;l certify,tha-t;in�the performance of,the•,work fof which this - " - ^' SPECIAL':', t permit is,i"sued;I shall not employ anylperson$in any'manner ADDRESS Q �C Q ��s� CONDITIONSCL so,as to become subject to th'e'Workers'Compensation Laws " Q CITY ZIP. 'F U Dare Applicant ARCHITECT'OR T L pp DISTRICT GROUP TYPE,_; "FIRE • P�C�SSEDQNOTICE;TO APPLICANT•"-If, after-:mdking this•Certificate of ENGINEER - NO ` CONST ZONE0 Exemption;' you" should-become,'subject .To The Woikers' , Compensation provisions of the Labor'Code, you must forth- ADDRESS .-1 �'©� /�•�. '� - u 4 a with•complyf Zilh such provisions-or this-permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO,' Z deem_ed'revokecI'2. ,.' CONTRACTOR - NO+._ _ LICENSED;,CONTRACTORS.DECLARATIO,N LIC CLASS-NO'pa�DWELL,UNITS I hereby affirm that•I am licensed under provisions of Chapter 9 , ADDRESS`: NO (commencing with Section 7000)of Division-3 of the Busmess LIC SEWER MAP and Profession's Code,:and my license-is in full force and.'effect CITY - CLASS BK ; ,VALIDATION PG % r^t, SQ NO OF NO OF -.'� CHECK r` " License',Number' " ' Lic�,Class SI STORIES FAMILIES ONE ` VALUATION' - ConTrgcTor f Date- " DESCRIPTION OF_WORK NEW $ - �., ADD I am exempt under Sec '4' e2�N .ALTER. ❑ B&P C' for This reason ` ¢ REPAIR 0 ; ~. ' E OF Date. EXISTING BLDG -DEMOL " Si nature a F,- APPLICANT __.`. TEL —Q g. n (PRINT) � V St/ NO FINAL OWNER-BUILDER'DECLARATION DATE ,0 rr Vere y affirm that I'am'q from the Contractor's,License =�, // y�j r'the'followmg reason;(Section'7031 5, Business and ADDRESS'�OD 06 lit �� FINAL ions Code) PRESENT,ww, BUILDING (".,cis owner'of, the property, or my employees with ADDRESS— wages • as'their sole compensation will do The work and � � the structufe is not intended or offered for sale(Section LOCALITY t/ 7044,.Busyness and Professions Code ) MOVING ' r -TEE-14 �' 3• #I tI� CONTRACTOR NO ,r 'E fir' 38 �,•_ 1, as owner of' •ihe-property;am exclusniely conirdcTLng f 70 " with licensed•contractors to-construct the'project (Sec- . ADDRESS,' • - _ _ L, tion 7044;Business and Profe'ssion's Code ), , - {_:(sE1 !. ). `••• REQUIRED TOTAL SETBACK FROM' 'EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD PWY. PROP LINE WIDTH r t tl t Hied I hereby affirm that there.is a construciion lending agency for = FRONT s - " the performance"of the work for which this,permit is issued -'P L f e (Sec 300' Civ C') SIDE' Lenders'Name ,p L _ ODD[[-[10l'i 1 LDMA Ref #r' _•rhL} 1 hU l;�4-r. Lender's'Address : P C'Fee$ Per mrt`Fee a I certify that I hale read this application and state that the • Issuance Fee• �� LDMA P/C# pip '3 above information is correct I agree-to comply w_th all County Investigation Fee ordinances and State,lows relating to building construction, F Total Fee �•25 LDMA'Perm # a and hereby authorize representatives of'this County to enter_ ; upon the above=meniiooned property for, inspec/tion purp sec C' �rJc/1/L/ `� / SEE REVERS.E_FOR EXPLANATORY,LANGUAGE 'Signotu�e of Applicant or Agent ate 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 1207030063 PHONE (626) 285-0488 EXT ILEGAL ID- '1 NO OF CONST BUILDING ADDRESS. 1 ITR 6561 LT 95 UN 003 SQ. FT STORIES TYPE 1 6009 GOLDEN WEST AV 1 I ISTRUCTURE 2600 V-B TEMP CA 917801719 I (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET• 1 15385-019-011 i I THOMAS PAGE: 597 GRID A2 LOCALITY TEMPLE CITY CAI (TENANT (EXIST BLDG USE RESID USE ZONE R-2 (ISSUED ON PROCESSED BY I I (EXIST OCC GRP 107/03/12 SR 1 (OWNER TEL NO IBLDGS NOW ON LOT _ VALUATION IFINAL DATE FINAAL�, B CODE 1 (WANG, JACK - 1 1 9,300 16009 GOLDEN WEST AV ITEMP 917801719 1 FEES PAID _ D SC IPTION OF WORK I I (REROOFING WITH 30 YEAR COMP ITION SHINGLES I - I IFEE DESCRIPTION QUANTITY UOM AMOUNT I I (APPLICANT TEL NO I I I IJERED, MIKE - IAA BLDG PERMIT ISSUANCE 27 80 I - 12651 AVALON ST IAB STATE GREEN BLDG FEE 9300 00 VAL 1 00 ISPEC=AL CONDITIONS I (RIVERSIDE CA 92509 IAC STRONG MOTION RESID 9300 00 VAL 0 90 I. I CD2 PERMIT W/O EN-HC 9300 00 VAL 216 60 I TOTAL FEES 246 30 1 1e GiJ��zv' e ti ICONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIONATUPO ICALIFORNIA CONSTRUCTION AND ROOFING (951) 352-0809- I I 12651 AVALON ST LIC NO 1LOCATION AND SETBACKS (RIVERSIDE CA 92509 776538BC39 I 1 r I I I I (SOILS ENGINEER APPROVAL 1 I 1 1ARCHITECT OR ENGINEER TEL NO i (FOUNDATION/TRENCH FORMS I I I I LIC NO 1 (SLAB'/UNDER FLOOR I I I (RAISED FLOOR FRAMING I I, IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP (UNDERFLOOR INSULATION I I 1150H269 3 001 111 I i (FLOOR SHEATHING I I INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASSI I I I 0 NO 21 1 (ROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS ISHEAP• PANELS ��—1AllI 1AIR QUALITY 1000 FEET MATERIALS I I I I 1 NO NO NO I (FRAME INSPECTION I I I I 1 IFIRE,SPRINKLER HANGERS I I I I I IINSU:ATION/WEATHER STRIPI I I I I I (INTERIOR LATH/DRYWALL I I _ I I I I 1 (EXTERIOR LATH I I I I I I i I (RATED FLOOR/CEIL ASSEM. I I I I IRATED WALL ASSEMBLIES I I I - i (RATED SHAFTS/OPENINGS I I I I IT-BAR CEILINGS I ILOT DRAINAGE 1I I I I - I (REPORT ID DPR261 ROUTE T0. BSO506 t + WORKERS'COMPENSATION DECLARATION su hereby'affirm that I haver certificate of consent to self , q P.p L I CAT I O N --F R'- BUILDING—PERMIT insure, or a certificate of Workers;Compensation Insurance, I• '` ` or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company I I - ' Certified copy is hereby furnished' BUILDING FOR APPLICANT TO FILL IN •ADDRESS O OCertified copy is filed with the county building inspec- BUILDING tion department ADDRESS 4550e.- �9b�lrC��Vv �� ` LOCALITY t- �,J G� (�/� NEAREST 'Date Applicant CITY /yP� ZIP' CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' NO 'OF BLDGS . 7 ASSESSOR v ' COMPENSATION INSURANCE SIZE OF LOT ," NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed rf the permit is for one USE ZONE MAP•• O hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO' OWNER /6l /raj �s•� !� SPECIAL 11,certify that m er orm ' of work for k,ch this N0�6 fCONDITIONSpermit is issu I shall not employ y perso manynner _ DISTRICT, GROUP TYPE FIRE PR SSEp_BYso' s T eco bject Tothe Wor rs'Co ensaws ADDRESS Ld00 (50 L 1J'��J�,,,-s7 CONST ZONE V CITYv ZIP O App STATISTICAL CLASSIFICATION- APT;, CONDO NOTI TO, APPLI T If, after akmg is Certif to of ARCHITECT OR- A TEL Exemption, ,you shou subject Th orkers' ENGINEER /�/ �/ NO CLASS NO DWELL UNITS d Compensation provisions of The Labor Code, you must forth- ADDRESS - r SEWER MAP N 'with comply with such provisions.or this'permit shall be TEL deemed revoked OR �CZ _ NO � ^ , BK C jam,, /� /- t- VALIDATION ' CONTRACT LICENSED CONTRACTORS DECLARATION •� LIC 6 hereby affirm that I'am licensed under provisions of Chapter 9 ADDRESS /!%L NO VALUATION r (commencing with Section 7000)of Division 3 of the Business and LIC O Professions Code,-and my license is in full force and effect 1 CITY ��V• CLASS $ F v SQ-FT NO OF- NO OF CHECK , License Number - Lic Class SIZE<�y STORIES pc FAMILIES ONE $` Contractor Date - ' DESCRIPTION'OF WORK NEW =" ` -5TGA 7ADD I am exempt under Sec - �'XVC - r ALTER FINAL /�' 7 03,9'A B&P.C. for this reason• a DATE m� /— - REPAIR #•o 0 0 0161, USE OF ' Date• DEMOL EXISTING BLDG --- - - _ � FINAL • = Signature APPLICANT TSL ���� By T� 7J,Q ' OWNER-BUILDER DECLARATION PRINT e- 619Ml. 1 Xo.;2s.:d'. I hereby affirm that I am exempt from the Contfactor's License /'� ` �• a v o 3 p , Law for the following reason (Section 7031 5,,Business and ADDRESS uzi C_ �. i 11. 2-83' Prof scions Code) - ., BUILDING I, as owner•of The property, or my employees with, ADDRESS• », , wages as their sole compensation,will'do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business•and Professions Code) MOVING TEL „ CONTRACTOR NO E I, as,owner of the property, am exclusively contracting ,•,_ with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). r REQUIRED t TOTAL SETBACK FROM EXIST' » CONSTRUCTION LENDING AGENCY SET BACK YARD• HWY' PROP LINE WIDTH j hereby affirm that there is a construction lending ogency'for FRONT r the performance of,the work for which This permit is issued P L (Sec 3097, Civ C ) SIDE v Lender's Name• - P L • - , - - - " 'c = iz» _r •i, P C Fee$ - •Permit Fee �•2 ,,S Lender's Address I certify that I have read this application and state'that the Issuance Fee T, d• v _ information is correct I agree to comply with all County Investigation Fee " relating to building'construction, Total Fees O(;;Od ut onz repro motives of This County to,entere-m bone roperty for inspection purposesSEE REVERSE FOR EXPLANATORYLANGUAGE App ica Agent Date ®s WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, APPLICATION" FOR BUILDING, PERMIT or o certified copy thereof (Sec 3800,•Lab C ) -COUNTY.OF LOS ANGELES BUILDING AND SAFETY } cy No Company BUILDING PY y FOR APPLICANT TO FILL IN ADDRESS O� Certified co is hereby furnished Certified copy is filed with the county building inspec- BUILDING / tion department ADDRESS' /J0 �j(DC.�,�-A Scf-A0(C–• LOCALITY Date Applicant CITY ��/�1P (' /� ZIP //7� CROSS ST G'Z7 CERTIFICATE OF EXEMPTION.FROM WORKERS' NO OF BLDGS ASSESSOR; , COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for.one USE ZONE MAP hundred dollars ($100)or less ) TRACT' BLOCK LOT NO NO TEL O SPECIAL } I certify that in the perform of&orkforh this OWNERTO r3 zT �/^jQNO .2a�,p 7��5� CONDITIONS CL DISTRICT GROUP TYPE FIRE PROCESSED BY O permit is issued, I shall n employanner c. �� / CONST ZONE U so as to become subject o the W Laws ADDRESS 6Q `7 �l•��A/64/ r /GyCIN Rl� c ! ZIP �/ 7 0'Date Ap a STATISTICAL C SSIFICA710N APT CONDO— I NOTICE TO APPLICANT If, ate of ARCHITECT OR TEL / Exemption, you should become subject to the Workers' ENGINEER " NO CLASS NO DWELL•UNITS I Compensation provisions of the•Labor Code, you must forth- t• Z 'ADDRESS SEWER MAP with comply with' such provisions or this permit shall be _ deemed revoked TEL CONTRACTOR NO BK PG, k."e VALIDATION, LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION ' �s,� (commencing'with Section 7000)of Division 3 of the Business and LIC ii.. �" Professions Code, and my license is in full force and effect CITY CLASS sk SQ FT NO OF" NO OF CHECK License Number Lic Class SIZE STORIES FAMILIES ONE $ Contractor Date DESCRIPTION OF WORK S+' CCtf NEW ❑ ❑ I am exempt under Sec /'d�2 ADD El ALTER ® FINAL- REPAIR B&P.0 for this reason ❑ DATE - � - Date. USE OF FINAL EXISTING BLDG - DEMOL ❑ By Signature APPLICANT'� TEL g OWNER-BUILDER DECLARATION (PRINT) .T '2Xlnd� NO,;,f 3lS� I hereby affirm that I am exempt from the Contractor's License ADDRESS O 0�7�' 6: t �� , Law for the following reason (Section 7031 5, Business and Professions Code) pR BUILDING „ j, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 2 K 7'A 7,044, Business and Professions Code) MOVING TEL t{ o o"a j, as owner of the property, am exclusively contracting CONTRACTOR NO ` with'-licensed contractors to construct the project (Sec- ADDRESS o o Q Q s ' tion 7044, Business and Professions Code) " 4 1 V U REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH ® t'0 1 -8 2 I hereby affirm that there is a construction lending agency for reon the performance of the work for which this permit is issued (Sec 3097, Civ C ) m t Lender's Name ' Lender's_Address Permit Fee I ceriify that I have read this application and state that the Issuance Fee 1 0 o formation is correct I agree to comply with all County _ ordinanc a jaws relating to building construction, Total Fee �� and her authorize presentatives of this County to enter upon t above anti ed property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signa or Agent Date ®s - e