HomeMy Public PortalAbout6047 IVAR AVE_Building__ 76AB38A CE#803 8-63 AY PUCATlO ON FOR BUI LM vim/' PERWT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS ��/ �
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYP PROCESSED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING 7 STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS Q / �i �� CLASS. NO. DWELL. UNITS BK "P��
LOT NO. / (/� / BLOCK WATER NOT REQUIRED RECEIVED
�� - CERTIFICATE: El
TRACT .g 9 MAP HIGHWAY
/n NO.OF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND. LOCAL
SIZE OF LOT F C/ NOW ON LOT USE ZONE SPECIAL
USE OF w, T" /� CONDITIONS
EXISTING BLDG.
y EL..0 g
OWNER G6 TNNEoL3l UILDING. YARD "EXIST.
ADDRESS (o 04& �� V � tc. SETBACK
HWY STREET ME ���ID�
ARCHITECT OR - TEL. P. L. ..J/'
ENGINEER NO. SIDE n O
ADDRESS -
d
TEL. 0
CONTRACTOR NO. u
ADDRESS
0
DESCRIPTION OF WORK
W
C.
NEW D ALTER REPAIR . DEMOLISH - N
AD
SQ. FT. NO. OF NO. OF _
SIZE STORIES FAMILIES
USE OF «
STRUCTURE Ed
SIGNATURE OF .
APPLICANT
VALUATION $
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT FOUNDATION: LOCATION
FEE $ FEE $ rmO. FORMS. MATERIALS /}
FRAME: FIRE STOPS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS .e
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 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.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE ' RECT AND POSTED
ADDRESS `J FINAL , y� `�. sf t�vj
�!J_�I�.A y)1 e. 1. JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN
PLAN CHECK VALIDA%Z TfIV�4[V�GG!CCK. M.o. CASH PERMIT VALIDATION CK. M.O. CASH
: =gipL LFI o9 4 0 .0 JUN 30 1 D 9.00 �.
C'
76AMA�CE#803 P/60 .APPUCA` ION .FOR BUILDING PERMIT
COUNTY .OF LOS. ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER . A°DREss ✓ �.
BUILDING FIND SAFETY DIVISION LOCALITY.
JOHN A. LAMBIE,-COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN Sup'T OE Bu1LDING CROSS ST. -
DISTRICT NO. GRO P TYPE
FOR APPLICANT TO FILL:IN CONST. qj( �
BUILDING STA ISTICAL CL 7FICATION I -SEWER MAP
ADDRESS �, .. 1 .BK PG
CLASS.NO. DWELL.UNITS ` -
LOT NO. G�jV BLOCK MAP i J( j\ STATE - YES O
NUMBER.. 1.1 l,J HWY.
TRACT 7 USEZO SPECIAL NO.OF BLDGS. t }ff ._f� CONDITIONS -
.SIZE OF LOT / p -KNOW ON LOT / //(/ 7V
USE OF
EXISTING BLDG. BUILDING EXIST.
- TEL. - , SETBACK YARD HV1/Y STREET NAME WIDTH -
OWNER ,� /®flls c3^✓ . NOT-S.;'V ; FRONT
ADDRESS �GU�f 7 r/, L1/�Q.4! lS�yc ei SIDE
p ARCHITECT OR .TEL. - - P.L.
ENGINEER NO. INSPECTION RECORD
ADDRESS _ - -
TEL. a
CONTRACTOR ✓Yl.�ht1 NO. O
" ADDRESS
DESCRIPTION OF WORE 0
s NEW ADD ALTER REPAIR. DEMOLISH - _ _ • V
SQ.FT. NO.OF. - NO.OF - RWi
SIZE STORIRE FAMILIES
USE OF 7—
STRUCTURE
SIGNATURE OF -
APPLICANT - -
VALUATION$
r APPROVALS. i DATEINSPECTOR'S SIGNATURE'
P.C. - - PMT. �(j_,�� FOUNDATION: LOCATION
FEE $ I I FEE $ C./ FORMS, MATERIALS - -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS,
BRACING, BOLTS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION;
AGREE.TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS
STATE LAWS- REGULATING BUILDING CONSTRUCTION. -
I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH, INT.
WILL.NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN'S COMP SATION LAWS OF CALIFORNIA. LATH,EXT.
_ SIGNATURE O HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRES FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN
PLAN'CHECK VALIDATION CK. M.O.. CASH PERMIT VALIDATION CK. M.O. CASH
_ F. ®7
A P fN OR BUIL
L[
FOR APPLICAN Ype only)
BUILDINGCOUN
ADDRESS o 04'7 ► DEPARTMENT
CITY�EVn C:i La BUILDING A ISION
) YYp BUILDING
SIZE OFLOT��10� i 1IQ=711) ADDRESS ✓�
TRACT)Cq4o�(- BLOCKY LOCALIT
NEAREST
OWNER �A/ �1 {,D 1 C.✓ CROSS ST
(ob'`1 /� � �) ASSESSOR
ADDRESS Oi G MAP BOOK PAGE CEL
DISTRICT GROUP TYPE FIRE PROC SSED BY
CITY L L� �-•r— CONST, ZONE 1
ARCHITECT OR T L. �O —
ENGINEER NO.
STATISTICAL CLASSIFICA TI N SEWER AP
ADDRESS �- CLASS NO.- 1-2—DWELL.UNITS BK PG
TEL,
CONTRACTOR NO USE ZONE MAP
LIC. NO. V
ADDRESS NO. �I SPECIAL
LIC. CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES E] NO C]CONSTRUCTION LENDER _
NAME AND BRANCH AILDG.SETBACK FROM >
F�RONT PROP.LINE OF (STREET) a:
ADDRESSCITY CD
TOTAL SETBACK FROM TYPE OF EXISTING V
SQ. FT NO. OF 1 NO, OF ,� CHECK HI WAY } YARD - FRONT PROP. LINE HIGHWAY WIDTH
SIZE O STORIES FAMILIES ONE O
+
DES-CRIPTION OF WORK
NEW ❑ d
ADD -� BLDG.S BACK FROM C/)
C a<` y+ ' SIDE PRO INE OF (STREET) Z
l +� ALTER HIGHWAY } _ T L S BACK FROM TYPE OF EXISTING
Y�1 VGL N� OP. LINE HIGHWAY WIDTH
REPAIR
USE �7 _ f
EXISTING BLDG. 1`ry(p.�y i L VI r � DEMOL ❑ +
APPLICANT �A [,f TEL y CORNER CUTOFF YES ❑ NO
jj
(PRINT) e i Lel �////������'��I��G V NO.Z _ !/
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
Q 1 IN COASTAL ZONE YES ❑ NO ❑
VALUATION•P s'7 �Q.Ce'
CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. IC
THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO / ;
WORKMEN'S COMPENSATION INSURANCE.
SIGNATURE OF �Y
PERMITTEE
ADDRESS ! e--
TEL ) r FINAL BY
CITY �G
NO. 7-3/Z l DATE •. �l ?
Q QQ
.HAKE CHECKS PAYABLE 70: F E + FEE P
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMITV ATION CK. MO. CASH
L._.
1r_ , 2 1 3:'3 y 8 2 0 2 1.7 5 e 11
11 A638 CE#803 12/72
J
APPUCAMON FOR -BULDING 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. OT � 7 7�• J _
or a certificate'of Workers' Compensation Insurance,or'a certified
copy thereof(Sec.3800,Lab.C:) Cl , ZIP
� �'EmPCt 9 v LOCALITY
Policy No. Company - SIZE OF LOT/off X 6 NO.OF BLDGS.NOW ON LOT
-NEARES ROSS ST.
Certified copy is hereby.furnished. t� ' �1G
10/
❑ Certified copy is filed with-the county building inspection. TRACT BLOCK LOT NO
department. , /04t
USE ZONE MAP NO.
Date Applicant
ASSESSOR MAP BOOK PAGE PARCEL - - -
7
'' SPECIAL CONDITIONS :,� �
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TIL NO. / 7 �� /" ��
COMPENSATION INSURANCE "v 9�^ /0- WITHIN 1000 FT.OF SCHOOL? YES NO
(This need ned not be completed if the permit is.for one hundred ADDR S
P - �� �(�' ✓A� 'DISTRICT - GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars ($100)or less.) ,Y
certify that in the performance of Ahe work'for which this'permit CITY n� ZIPDd 3 -
is issued, I shall not employ any person in any-manner so as to ARCHITECT OR ENGINEER TEL NO.
beco",fb,'e' the Workers'C pensato Laws. -'STATISTICALCLA�jSSIFICATION � APT CONDO
ateApplica ADDRESS CLASS NO.• 1 DWELL UNITS - '
NOTICE TO APPLICANT If after making this ,Certificate of REQUIRED TOTAL SETBACK FROM ' EXIST
Exemption, you should become subject t0 the '.WorkersCONTRACTOR TEL,NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith FRONT
comply with such provisions or this permit shall be deemed revoked:, ADDRESS LIC.NO. ,P L
LICENSED CONTRACTORS DECLARATION"', SIDE
_ CITY - `LIC'CLASS PL
I hereby affirm that I'am licensed underprovisions.of Chapter 9 SEWER MAP d
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE_,_ NO.OF STORIES NO.-OF FAMILIES.
Professions Code,and my license is in full force and effect: NEW D BK PG U
License Number Lic.Class D SCRIPTION OF WORK_�r ,a ADD ❑, VALUATION
Contractor, Date AA A ALTER $ �
HC r06C A 6 REPAIR ❑. cn
I am.ezempt under.Sec.
BAP.C. for this reason [.L DEMOL ❑. LDMA P/C
.Date: USE OF EXISTING BLDG. ..-.- - URMT' ..❑ :'.x ' . .
Signature 'APPLICANT(PRINT) TEL NO. LDMA Perm -
I,:as owner of the:property, or my employees with wages as Z
YYY their sole compensation, will do the'work and the structure Is ADDRESS3 13
not'intended.or offered for sale (Section 7044, Business and FI C .
NAL DATE
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 3
ORA.MIXTURE CONTAINING A HAZARDOUS.MATERIAL EQUAL TO OR GREATER THAN'THE J
1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALSANFORMATION GUIDE? Q � 1
FINAL BYr _ � Yi ( ,g
licensed contractors'to construct the project (Section 7044, } , `
YES❑ NO.❑-
Business and Professions Code.) y�'ly c s.
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE APERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH. '
CONSTRUCTION LENDING AGENCY - COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR - L ENS
(L:
- GUIDELINES. - - _ '
I hereby affirm that there is a construction lending agency for YES 1:1 NO 11Mt-IT{ i - _ -75
'Cy the performance Of the Work for Wf11Ch this permit IS ISSUed(.Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING .. -V - L-
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 ` ' " --•1r r
3 Lender's Name. MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. �'LS F•. 'i c eJ
I _ i.t trst'I:
o Lender's Address
OWNER OR AGENT
O
o I certify that I have read this application and state under penalty
o P.C.FEE PERMIT FEE ;i [�-i ii j� '•fi
of perjury that the above information is correct.I agree to comply �� si
N with all county ordinances and State laws relating to building
< construction, and hereby authorize representatives of.this County Iy SUANCE FEE-
co
(o
to a on the ove-mentioned property for inqct n p s.
INVESTIGATION FEE TOTAL FEE
tO Y !ice
Sq tur.or Anpiwm or A9eni Dare /.
SEE REVERSE FOR EXPLANATORY LANGUAGE
{ WORKERS'COMPENSATION DECLARATPDN
r• 57r or afcertif cats of Workere't o-ntpensat on ensu an elf' A PPI UCAy d o IJ.VM FOR,.,
o�`a certified copy,ahereof (Sec.` -8W,"Lb$. C.) \
COUNTY OF LOS ANGELESBUILDING AND SAFETY
Policy No Company
G1" Certified cBUILDING
opy is-hereby furnished. - FOR APPLICANT. TO FILL IN
ADDRESS �
Certified copy.is filed with'the'county butldin9inspect. BUILDING
tiondepariment. ADDRESS
'
760
Date Applicant' CITY C C 'r ZIP /' LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' / NO.-OF BLDGS: NEAREST
COMPENSATION INSURANCE SIZE OF LOT D X/�� ` NOW ON LOT CROSS ST.
(This.section need snot be completed'if:the permit is for'one, ASSESSOR
hundred dollars($100)or,less.) TRACT BLOCK'_ LOT NO MAP BOOK PAGE PARCEL
. ✓� y
r
certify that'in the performance.of the work'for which'.this OWNER � ��.� NO. �7ti NEI.* OP
permit is,issued, I;sh6ll not employ any person in any manner- F .
USE
•' �' SPECIAL
;sous to become suubject.to'the Workers'Cop�mpensation Laws. ADDRESS 60*�` •�YA ® 'CONDITIONS 0:
6� lV(/ - CITY e ZIP
Date Applicant #2! --------------
NOTICE°TO APPLICANT: If; after n aking'this Certificate of ARCHITECT OR TEL.. DISTRICT G UP' TYPE FIRE PROC�,SSED BY Q
ENGINEER NO., CONST ZONE . /,/_
Exemption, you should become subject to' the. Workers' L-/
Compensation provisions of the Labor'Code;.you.musf•forth- ADDRESS W`v .I�.�/ U
with comply with 'such provisions or this permit shall be
deemed revoked:. TEL. STATISTICAL CLASSIFICA ION APT. C NDO (q
CONTRACTOR- NO. Z
LICENSED'CONTRACTORS DECLARATION,. LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSNO: SEWER P
(commencing with Section 7000)of Division 3 of the Business and LIC '
Professions Code, and my license is in ful1 1l force and effect.• CITY . ��" CLASS VALIDATION
SQ. F NO. OF `` NO. OF CHECK BK. PG. (
License Number Lic.Class SIZE„ STORIES 1 FAMILIES '' ONE; N
DESCRIPTIOt3 OF WORK F L Qp ❑ VA N ,
LUA
,. r NEW ,
Contractor Date $
❑ I dm exempt under Sec. ADD
ALTER
B,BP.C. for this reason REPAIR $ /,
USE OF L d CJ�f s
Date EXISTING BLDG:. DEMOL
APPLICANT // TEL.
Signature r PRINT O 6. NO. jKALjn -76OWNER-BUILDER DECLARATION. E `-
hereby affirm'that 1,am exempt from the Contractor's or's Licensee ADDRESS LD�.�� ��
Law for-the following reason (Section 7031.5, Bustne3s and FINA
Profen ' ns Code):,
PRESENT By
BUILDING"
Io.as owner of the property, or my, employees with ADDRESS :. 1 A^ r .
wages,as their.sole compensation,will do the work and t �'
the structure is not intended or offered for sale(Section LOCALITY' ^
J044, Business and Professions Code):' MOVING TEL.
I, as owner of.The- ro erT am exclusive) contracting
CONTRACTOR N0.
❑ -
P P Y . r g04'85A
with licensed contractors to,construct the project (Sec-
ADDRESS
tion 7044; Business and Profession's Code):
REQUIRED TOTAL-SETBACK R
CONSTRUCTION LENDING'AGENCY SET BACK YARD HWY PROP. LINE WIDTH Il -.2 0 9,2 5
hereby affirm that there is a construction lending agency for. FRONT :oaf) o o'2 0 9.2 5&
the performance of the work forwhichthis permit is:issued P.L. 1 9
(Sec. 3097, Civ: C.). SIDE f Q
P.L. \
Lender's Name o
m. P.C. Fee$ Permit Fee Ll r
CDMA Ref #.
Lender's Address / 1�j
aI certify.that I have read this application and state that the Issuance Fee C Lam+ v a CDMA P/C#
s qt, above information is correct: I agree to comply with all County Investigation Fee
,f$ ordinances and State, laws relating--to building construction, .
and''hereby authorize representatives'of this County to enter Total Fee t - CDMA Perm. #
�f
u"he above-mentioned property for inspection purposes.
y` ^\ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent - :Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0506_ ; a` -BUILDING PERMIT
` DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL. 0508 9702200005
PHONE: (818) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 5904 LT: 121 SQ. FT STORIES TYPE OCCUP GROUP 6047 IVAR AV
STRUCTURE: - 0 1 V R3 TEMP CA 917801522
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: GARIBALDI
5386-011-071 OTHER: 653 1 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: USE ZONE:. ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 02/20/97 TC 02/20198
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY:. ODE:
WEAVER TOM L;DARLENE G 1 4,500
6047 I VAR AV
TEMP 917801522 FEES PAID DESCRIPTION OF WORK
ATTACHED COVERED PATIO WITH PARTIAL VICE WORK
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 4500.00 VAL 0.50 SPECIAL CONDITIONS:
AX BUILDING REV.IEW,'-FEE r(;N 54.70
D2 PERMIT W/O SEN=HC` X4500!00 VAL 133.05
TOTAL FEES 216.00
CONTRACTOR : TEL. N0: (�� - =�\\� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER.. -
LIC. NO �j �f - LOCATION AND SETBACKS
J (/�C� / SOILS tNGINEER APPROVAL
ARCHITECT OR ENGINEER: EL. N0: :`J� _� \ FOUNDATION/TRENCH FORMS
T _
LIC. N0: /�! �t �� I = �`�� SLAB/UNDER FLOOR
I _ I f ` -�iTi, 1
RAISED'FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: � J i� �. 1<<li ii� �� UNDERFLOOR INSULATION
3 01 - — --—
S�VEL FLOOR SHEATH.
NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS
NO 21 \ /" 17
> � ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS C \, ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS ��� o`V�� � 7 i
NO NO NO /� FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL SETBACK FROM EXIST n� �� _ �� BUIG DEPT. FRAME INSPECT
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL C�/�q� __ �� 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
_e
APPLMAMON FOR BULONG P,ERNT
+ COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI ADDRESS s ` l
�•� `�'�� "
I hereby affirm that I have a certificate of consent to self insureBUILDING ADDRESS
, y ^YAR_
or a certificate of Workers' Compensation Insurance,or a certified 7
//
copy thereof(Sec.3800,Lab.C.) CITY s ZIP ,'7
6-0 /
` ,/7� C I U LOCALITY
��� /^
Policy No. / ry Company JJ SIZE OF LOT f NO.OF$LDGS.NOW ON LOT `tel
❑ Certified Copy is hereby furnished. ;L NEAREST CROSS ST.
Certified copy is filed with the County building inspection TRACT BLOCK LOT NO.
department USE ZONE MAP NO.
Date, /� plicant ASSESSOR MAP BOOK PAGE PARCEL -
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. 8/
COMPENSATION INSURANCE 6 v----'L ' ����7 3 WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred ADDRESS
6 U y�/(_ DISTRICT GROUP TYPP�CONST. FIRE ZONE PROCESSED BY
dollars($100) or less:) Y /rL�/�_� � -
CITY- ZIP &0 �/
I certify that in the performance of the work for which this permit ( g/�p G
is issued, I shall not employ any person in any manner so as to �" ✓ T.C�C�-e
become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. 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 &A66� T&o F1"V& t12 rS7UV FRONT
comply with such provisions or this permit shall be deemed revoked. "ADDRESS LIC.NO. - PL
LICENSED CONTRACTORS DECLARATIONCITY-- L vc'A A lir-c- 6n7SS'oZ SIDE
?LC �l LIC.CL SS P L
I hereby affirm that I am licensed underprovisions of Chapter 9 ( �� :?'? SEWER MAP
(commencing with Section 7000)of.Division 3 of the Business and SQ.FT.SIZE NO;OF STOFfIES- 1, 'NO.OF FAMILIES
Professions Code,and my'license is in full force and effect. NEW BK PG Dd
License Number Lic.Class 'DESCRIPTION OF WORK - ADD ❑ 'VALUATION ov - - O
Contractor C ✓G Date /Z-6 �7=?O YES =K/ Tev6 D S $ - `� 0 ' 0
ALTER ❑
611 f/1,17- O F b d.3C 6A4REPAIR ❑ O
❑ I am exempt"under Sec. $ I-
EAP.C.for this reason C� A r $a s . �C9 DEMO ❑ W
LDMA P/C# -
Date: USE OF EXISTING BLDG. - URM' ❑ ' V _ a
��'•s�-'r
Signature APPLICANT(PRINT) TEL NO. LDMA Perm#- _ ECK 10s�
�ry
ElI, as owner of the property, or my employees with wages as ZO �$ n n 0 —
their sole compensation, will do the work and the,structure is ADDRESS
not intended Or offered for sale (Section 7044, Business and FINAL DATE Q>3303 17506
PIOfeSSIODS Code.) - WILL THE APPLICANT'OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL `'J- o •_J OW4-�hII�- 12/ V
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE j+ �M
S
El I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY Q
! � -� a
licensed contractors to construct the project (Section 7044, � !'lil
.YES❑ NO❑ - - •g-
Business and Professions Code.) /+ /�y -
WILL THE INTENDED USE OF THE BUIDLING BY..THE APPLICANT OR FUTURE BUILDING �.•Lj�tr\ 165.65
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ CHECK
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES.
I hereby affirm that there is a construction lending agency for YES❑ No❑
the performance Of the work for which this permit IS Issued(SeQ. 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 HAZARDOUSI
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.
o Lender's Address
tQ OWNER OR AGENT
o I certify that I have read this application and state under penalty
PERMIT FEE
P.C.FEE'
C
of perjury that the above information is correct.I agree to comply
with'all county ordinances and State laws relating to building
oo COnstr Ction, an ;:��=atives of this County ISSUANCE FEE
to ent r upo ainspection purposes.
•a �Z INVESTIGATIONFEE TOTAL-FEE L"'� - -
Z. J
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SEE REVERSE FOR EXPLANATORY LANGUAGE
' 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 0102070006
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 5904 LT: 121 SQ. FT STORIES TYPE OCCUP GROUP 6047 IVAR AV
STRUCTURE: 0 1 V R3 TEMP CA 917801522
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: GARIBALDI
5386-011-071 OTHER: 0 1 V R3 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 02/07/01 UT 08/06/01
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE JFINAL BY: CODE:
WEAVER TOM L;DARLENE G 1 1,700
6047 I VAR AV
TEMP 917801522 FEES PAID DESCRIPTION OF WORK
GRAPE ARBOR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER AA BLDG PERMIT ISSUANCE 27.75
D2 PERMIT W/O EN-HC 1700.00 VAL 82.20 SPECIAL CONDITIONS:
�—.—=TOTAL FEES 109.95
�oGE�. ®\
CONTRACTOR: TEL. NO: wD�� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO / LOCATION AND SETBACKS
//r tM1y SOILS ENGINEER APPROVAL
+ ARCHITECT OR ENGINEER: TEL. NO: 1 5t \ FOUNDATION/TRENCH FORMS
LIC. N0: ��-- SLAB/UNDER FLOOR
�fy4 ��_ RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP,::} nrr} UNDERFLOOR INSULATION
3 II 0-1-
���, � SCJ���
ST LEVEL FLOOR SHEATH
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS ----- -----------------------------
NO2ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS \ '�� \1 ." `�b �'' // ROOF SHEATHING
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- 0 �� � SHEAR PANELS
SIDE PL-
INSULATION/WEATHER INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
i
LOT DRAINAGE
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS0508
COUNTY OF LOS-NGELES.- . _ TEMPLE CITY . . # 0508 BUILDING PERMIT
DEPARTMENT OF�PUBLIC'WORKS '`' 9701 LAS. TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFELY y' LAI�D DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9908190054
PHONE: (626) 285-0488 .EXT:
LEGAL ID NO. OF CONST :NEW BUILDI G:ADD SS
TR: 5904 -LT:' 121 a! " SQ. FT STORIES TYPE OCCUP GROUP "`',604T 1VAR`AV'"
d STRUCTURE: 0' 1 VN R3 TEMP;CA 91.7801522
ASSESSOR INFORMATION .NUMBER: .. GARAGE: .410 1 NEAREST CROSS STREET rokn
5386-011 071 OTHER c' - . THOMAS PAGE 596 .GRID H2 LOCALITY TEMPLE CITY
"...
M TEN NT ;: USE ZONE ISSUED ON.�,Z4-r,4...;P..ROCESSE BY: _,,EXPIRESON ari .
� ..-_.__. EX ST�BLDGr USE._.._:
_.. _
EXIST OCC GRP. 08/19/99 UT 02/15/00
OWNER: - TEL.' NO: BLDGS. NOW ON LOT: . VALUATION : FINAL DATE FINAL BY CODE: =`
WEAVER TOM L DARLENE G.,: (626) 286-7633- _2 5 600 Ati
E
� {�
6047 IVAR AV - j
TEMP 917801522 FEES PAID DESCRIPTION OF WORK ;
NEW RESIDENTIAL GARAGE;
FEE DESCRIPTION: QUANTITY: UOM AMOUNTS
APPLICANT: TEL. NO:
-_r- SAME AS OWNER - AA BLDG PERMIT ISSUANCE .27.75
AC STRONG MOTION RESID _ 5600.00 VAL..;.. 0.56:' SPECIAL.4CONDITIONS:.
AX BUILDING REV:I,EW=EEE i. --
54:70
D2 PERMIT W/0%EN-HC:-- —5600�00 VAL 149.40
CONTRACTOR: TEL. N0: ®� K�Q�d-��TOTA �S 232.41 APPROVALS DATE INSPECTOR SIGNAT RE
SAME AS OWNER L'ly
LIC. NO LOCATION AND SETBACKS
-�F-/-E
/ SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: EL._NO:- (/ FOUNDATION/TRE C FORS
LIC. NO: SLAB/UNDER FLOOR
1111111 '
AISED FLOOR FOU ING-
MAP NO: SEWER MAP BOOK: PAGE: FIRE.ZONE: CMP:- UNDERFLOOR INSULATION
3 � 0 1U D LV V OO K 3 'LEVEL FLOOR SHEATH
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS-' —
NO 21 \ O D ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS �\ 19 J I� ROOF;SHEATHING
AIR QUALITY: 1000 FEET MATERIALS \ 0 D' 30 '
NO_ NO NO V FIRE DEPT. FRAME INSPECT
Q 5
REQUIRED TOTAL SETBACK FROM EXIST (s C� BLDG DEPT. FRAME INSPECT r� t
FRONTTSET ACK PL YARD: HWY: PROP LINE: WIDTH: %% �,�p-� 0����0 SHEAR PANELS r /
SIDE PL- iqe Z
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
I
LOT DRAINAGE
SMOKE-DETECTION DEVICES
FIREIDEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS0508