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76A638A CEtt8038-64 APPLICATION FOR BUILDING PERMIT
C C-JNTY OF LOS ANGELES BUILDING
DEPI:RTMENT OF COUNTY ENGINEER ADDRESS LGJ'L
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST.
DISTRICT NO. GR OU TYPE PR E SED BY
FOR APPLICANT TO FILL IN L CONST.
BUILDING )) STATISTICAL CLASSIFICATION SEW MAP
DDRESS
AJ .7 CLASS NO..�L ':3 DWELL UNITS 6KL~PG
LOT NO. BLOCK USE ZONE MAP !jam•/� /
NO. C
TRACT J IJ SPECIAL
NO. OF BLDGS. CONDITIONS
SIZE OF LOT /� NOW ON LOT
r
USE OF
EXISTING BLDG, BLDG. SETBACK FROM A .(, / )
TEL. FRONT PROP. LINE OF '! C (STREET)
OWNE -Q NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L. ,{
CITY ' (, •�-' h / o(_
III T r R T L (✓ BLDG. SETBACK FROM
A
RCH TEC O EL SIDE PROP. LINE OF (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
CON TRA CTORO NOL + — O
LIC CORNER CUTOFF YES NO O
ADDRESS NO
CITY C aIC
s SEE REVERSE SIDE FOR SPECIAL APPROVALS u
Lu
DESCRIPTION OF WORK N
AEW ADD ALTER REPAIR DEMOLISH Z
- NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE --.-
I _
SIGNATURE OF,
APPLICANTVo
VALUATION$
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION, LOCATION
FEE$ FEE$ L FORMS, MATERIALS
FRAME, FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT$
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING'
GAS VENT. DUCTS
9UILDIN0 CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
LATH. EXT. I !
SIGNATURE OF j" HOUSE NUMBER COR- •>w
PERMITTEE «Nl •� 1,C1, 1� RECT AND POSTED .1a
ADDRESS r- Fl NAL
JOHN F. LEWIS, PRINCIPAL STRU UIRAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION (,CK. M.O CASH
17?PARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES S U I L D ' N G
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDDISTRICT NO. PLAN CK.NO. PERMIT NO.
ADDRESS NG '2� K ` 72- Q/
LOCALITY RECEIVED BY DAT OF A PL. DATE ISSUED
CROSSNEAREST ��
OLA�-v L / 7
CROSS ST. '
�- I OF BUILDING
OWNER ADDRESS o w
MAIL ♦ / 4
MAIL ADDR89 (� LOCALITY
NEAREST
CITY r-" CROSS ST.
OF
ARCHITECT OR TEL. ZONE I PLANS �? I TYPE GROUP7""�"
ENGINEER - NO. fes" _(r
BLDG. ORDiNO.
ADDRESS SETBACK LINE
APPROVED
TEL BY DATE
CONTRACTOR
USE APPROVED
ADDRESS �BY DATE
LEGAL _ -- �-
DESCRIPTION I LOT NO. I BLOCK CORRECTIONS
r
TRACT .3
NO.OF SLOGS. �
SIZE OF LOT -%' I NOW ON LOT /f/o7
USE OF _ NO.OF O
N .OF F_
EXISTING BLDG. I FAMILIES I ROOMS
DESCRIPTION OF WORK
NEW - ALTERATION ADDITION
�1
REPAIR MOVING DEMOLISH 47
Sq. FT. ip NO. OF Z
_SIZE ! +�,= ROOMS STORIES' }
WALL - -"! ROOF f
COVERING Cf I COVERIN "''
USOF NE
BUILDING W ,Le..-t:�( ._'' .✓':,:�
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING.BUILDING CONSTRUCTION,
FRAME: FIRE STOPS,
SIGNATURE OF1 aR �y 4�_ BRACING,BOLTS ,
OWNER LATH,INT.: 'Q
AUTHORIZED AGT. LATH,EXT.:
DSS-3 25M SETS 1-47 $ P.C.$ /( , PLASTER. INT.
_FEE_ ! `/�^•', PLASTER, EXT.
VALUATION 5- 30c) FEE '�"� s _ FINAL
DEP.kRTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER .
FOR APPLICANT TO FILL FOR OFFICE USE ONLY
BUILDING 0 ec- AM DISTRICT N PLAN CK.NO. PERMIT NO.
ADDRESS/�6/
O TAf
DATEISSUED
LOCALITY _ REIVED, Y ' DATE FAPPL. /
NEAREST t c0
CROSS STS ''
-BUILDING,
ADDRESS
OWNE ADDRESS �� /�/.C> L/�L/�I&II
MAILQ �l LOCALITY / s
ADDRESS_ !. 6
r
NEAREST
No.
l
ITY NO. CROSS ST.' � _,Aa,L ��iv'� ,,L-)
FIRE NO.OF TYPE ORO
ARCHITECT ORTEL.TEL ZONE I PLANS
ENGINEER / NO.
� BLDG. - ORD.7O.
ADDRESS - SETBACK LINEl
APPROVED _
L .
��® ���,�y,� -
TEL _ DATE
CONTRACTOR $S9'+�� NO. - BY -
USE / APPROVED
ADDRESS / ZON / BY DATE
LEGAL ,/�',/ CORRECTIONS
DESCRIPTION I LOT NO., / (/ I BLOCK
TRACT 7,- -
,�, NO.OF BLDGB.
SIZE OF LOT O.-�$ � ` I NOW ON LOT
USE OFNO.OF 11 NO.OF
EXISTING.BLDG ./ - FAMILIES ROOMS
DESCRIPTION OF WORD
NEW ALTERATION,'' I ADDITION
. O
A
REPAIR MOVING DEMOLISH y/ p
SIZE T. ®® ROOMS♦' STORIES / - Z
D
r
WALLROOF -
COVERING �� ' I. COVERING -•USE or NEW -
BUILDING
-1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS ' .
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS v x,
.AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FIRE STOPS,
SIGNATURE OF BRACING,BOLTS ✓�
OWNER LATH,INT.:
.a
AUTHORIZED AOT�" LATH,EXT.:
��
DBS-3 25M SETSV7 $ P.C.i - PLASTER.INT.
l� /�b FEE PLASTER,EXT.
VALUATION FINAL
FEE
APPUCAMON.FlO.R. , IPUL�,NG PERNT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
¢WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING-ADDRESS
I hereby affirm that I have a certificate of consent to self-insure, BUILDING ADDRESS
Ty
or a certificate of Workers' Compensation Insurance,or a certified a�
copy thereof(Sec.3800,Lab.C.)
CITY s ZIP
Policy'No. —7 36 `' Company F�'TL-y ��� `• a LOCALITY° -moi
SIZE OF LOT NO.OF BLDGS.NOW ON LOT /, -
❑ Certified copy is hereby furnished. - iW 1 NEAREST CROSS ST. d
yy.Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE ZONE MAP NO.
e•'& ASSESSOR MAP BOOK PAGE � • PARCEL
Date J "-G 'JApplicant �.� l`•/-1,- OR Q/ - SPECIAL CONDITIONS �
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER, TEL NO. ! YES NO
COMPENSATION INSURANCE 1Z - (� WITHIN 1000 FT OF SCHOOL'
.
This section need not be com leted if the permit is for one hundred ADDRESS( P P 1 DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars ($100)Or less.) CITY �JL ZIP -
I certify that in the performance of the work for which this permit
is issued, I'shall not employ any person in any manner.so as'to ✓ LF��c
become Subject t0 the Workers'Compensation Laws. ARCHITECT OR ENGINEER - TEL NO.
STATISTICAL.CLASSIFICATION APT CONDO
.Date Applicant - ADDRESS- .,CLASS NO. 1 DWELL UNITS
NOTICE TO APPLICANT.' If, 'after making this Certificate of REQUIRED TOTAL SES�� FFM LE
Exemption, you Should become subject to the Workers' ACTOR TEL NO. SET BACK YARD HWY PR®fIUDJ oT
Compensation provisions of,the Labor Code, you must forthwith - i FRONT 3a0� 6L ebq
comply.with such provisionsorthis permit shall be deemed revoked. A R sS L 'LIC.NO. PL 76
LICENSED CONTRACTORS DECLARATION _ �n SIDE
GI LIC.G SS P1 TO
I hereby affirm .that 1 am licensed underprovisions of Chapter'9 ��� GL �l� SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO,OF TORI S NO.OF FAMILIES - '
Professions Code,and my license.is In full force and effect. Z NEW 1:1 BK PG D CHECK 969eh°>-
License Number Lic.Class. .— DESCRIPTION:OF WORK ADD VALUATION iCHANGE .000
Contractor Date -G� — 2 art ALTER El $ 1
REPAIR ❑ cmkwhs ,
lmwo
❑ I am.exempt under Sec. $ F--
00 U
BAP.C.for this reason ,' (, DEMOL ❑ LDMA P/C#' ` 1535 1 PM re26111
Date: USE OF TINS.BLDG. URM ❑ - CD
Signature e vV ��77 �/��{;��
APPLIC T(PRINT) i r,�,� TEL 0. LDMA Perm# :�. - V 11 t�ii lyi(Nt�i1—
❑ I; as owner of the property,'or my employees with wages as -Lr " Z� Z Z
_their sole compensation, will do the work and the structure is ADDRES
not intended or offered for sale (Section 7044, Business and &�22 z-/,- FINAL DATE _ Q
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDINGOCCUPANT HANDLE A HAZARDOUS MATERIAL 71 J
❑ 1, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
P P Y. Y 9 AMOUNTS SPECIFIED ON'THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed'contractors to construct the project'(Section 7044, ves EJ No El \
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ,
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH µr d
CONSTRUCTION LENDING AGENCY.` COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR G r �O
the
1
UIDELINES.
I.
ere affirm that there is construction lending agency for ves El ❑
the perfrf ormance Of the Work for
r Wf11Ch this permit IS Issued(Sec. 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,
N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.1'40 CONCERNING HAZARDOUS '{/`'/dwL►{' '
3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD,
CL Lender's Address
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 �q-&^ PERMIT EFS 52.2
o with all county ordinances/andSlplaws relating to building �+� I/construction hereby esentatives of this County ISSUANCE FE QC0 to Don the abo rty for inspection pu pose
_ 6/�/� f INVESTIGATION FEE TOTAL E ./
Signator pl ant Ag n Odte
SEE REVERSE FOR EXPLANATORY LANGUAGE `
.y. �'• 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 0808280036
PHONE: (626) 285-0488 EXT:
ILEGAL ID: NO. OF CONST NEW I BUILDING ADDRESS: 1
ITR: 6755 LT: 18 SQ. FT STORIES TYPE OCCUP GROUPI 9933 HOWLAND DR I
I (STRUCTURE: 226_ 1 V-B R3 I TEMP CA 917803235
(ASSESSOR INFORMATION NUMBER: I GARAGE: _ I NEAREST CROSS STREET:
16589-005-014. I OTHER: - I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
I I I I
(TENANT: (EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: EXPIRES ON: 1
1 (EXIST OCC GRP: 109/11/08 SR 03/10/09 1
i I I I
1OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: (FINAL DA E FINA BY: CODE: 1
IMARKIS, TED/MARIA - I 33,500
19933 HOWLAND DR
ITEMP 917803235 FEES PAIDIDESCRIPTI N OF WORK I
I 1 - (ADD 5'X42"-6' TO WEST SIDE OF HOUSE, ENLARGE ONE BEDRM, ADD I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ILAUNDRY RM, & BATHROOM, ADD BEDRM & CLOSET 226 S.F.
I-APPLICANT: TEL. NO: I I I
ILUIZ R. NUNEZ ASSOC. (626) 284-0055- IB1 PLANCHECK W/ENERGY 33500.00 VAL 550.61 1 I
1324 LOS HIGOS ST. IAA BLDG PERMIT ISSUANCE - 27.75 ISPECIAL CONDITIONS:
IALHAMBRA, CA 91801 IAC STRONG MOTION RESID 33500.D0 VAL 3.35
1 (B2 PERMIT W/ENERGY 33500.00 VAL 647.79 1
1 -1 TOTAL FEES 1,229.50 1 I
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
IRON OWENS (626) 285-7725- 1 1-
15924
15924 N. RENO AVENUE LIC. NO I ILOCATION AND SETBACKS
ITEMPLE CITY, CA 91780 276346 I 1 1 -61 I
ISOILS ENGINEER APPROVAL I 1
I I
(ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS
r LIC. NO: I ISLAB/UNDER FLOOR I I I 1
I I I�I
I (RAISED FLOOR FRAMING
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 (UNDERFLOOR INSULATION
3 O11 I 1
I 11STi-LEVEL FLOOR SHEATH
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I
I NO 21 1 12ND LEVEL FLOOR SHEATH 1 I 1
I I I I I
SCHOOL WITHIN HAZARDOUS I - IROOF SHEATHING .�};r�6 i •I 1
(AIR QUALITY: 1000 FEET MATERIALS 1 I
NO NO NO IFIRE DEPT. FRAME INSPECTI
I 1-1
IREQUIRED TOTAL SETBACK FROM EXIST IBLDG DEPT. FRAME INSPECTI I I
ISET BACK YARD: HWY: PROP LINE: WIDTH:
IFRONT PL- I
SIDE PL- I SHEAR PANELS (4
I IINSULATION/WEATHER STRIPI I A•,(�
I 11NTERIOR LATH/DRYWALL I
1 IEXTERIOR LATH 1,
I_ 1�
I 1 1LOT;DRAINAGE
I I I I I I
1 I 1SMOKE DETECTION DEVICES 1 I 1
I I I I I I
I IFIRE DEPARTMENT APPROVAL(
IREPORT ID: DPR261 ROUTE TO: BS0508 ,
I I I I I I