HomeMy Public PortalAbout4919 KAUFFMAN AVE_Building__ DEPARTMENT.OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF-LOS ANGELES "' I L®I
iWM. J. FOX, CHIEF ENGINEER
s
FOR APPLICAIJT,TO FILL IN FOR OFFICE USE ONLY
DISTRI NO. PLAN CK. NO. PERMIT NO.
BUILDING5,7
s ��
ADDRESS ��11
y/ / I/
RECEIVED BY -: DATE OF APPL. DATE ISSUED
LOCALITY. TeA / �( j/ i
NEAREST /
CROSS ST., v /�!�`LLGfBUILDING / / �a
�lr ADDRESS 1!`
OWNER ..�.. 4 ! y > ..
MAIL ,p LOCALITY -_ T
ADDRESS , V NEAREST ; '. ^- .
p ,p TEL. CROSS ST. p)4-,L
CITY _ O" `' oL NO. . FIRE I NO. O �'I TMP I G_7P
ARCHITECT OR'" TEL. ZONE
ENGINEER NO. BLDG.
SETBACK LINE
ADDRESSAPPROVED --
A' TEL. } BY _ DATE ..
CONTRACTORJ:' SLI !V NO. Q /0 USEAPPROVED
ZONE
- ,
ADDRESS Q.�(� �, Q `I^ BY DATE
�Y/ HOUSE NUMBERING -
LEGAL ���.b
DESCRIPTION .LOT NO, BLOCK `�" MAP NUMBER. -FIELD CHECK BY
TRACT ~® NO. ASSIGNED BY/524MZi�,-DATE _
NO. OF BLDGS. Tb CORRECTIONS
SIZE OF LOT NOW ON LOT P� %aZ/ 3 t ?[ A, �f
USE OF I NO. OF - IO J
EXISTING-BLDG.. . FAMILIES- -
.DES RIPTION OF WORK
NEW `I k ALTERATION I , ADDITION I
str®s G ejo e co-- `7) a 8[?Ra a r G o v r— p
REPAIR I I DEMOLITION 'I I I -` - .- . • � //��.,�-�-,-�� - - A_
SQ. FT: NO. OF s Fc.. -,V. G1
SIZE or
ROOMS STORIES / v Z
EXT. WALL /`�G I CROOF -OVERING / I'
COVERING V 9 /G/S� �iSO�OT.E Vf+L✓
USE OF STRUCTURE
APPROVALS
INSPECTOR'S SIGNATURE DATE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AIP- FOUNDATION: LOCATION h
PLICATION AND STATE THAT THE INFORMATION GIVEN/,IS ' FORMS,MATERIALS
r'p�y.,,i �
CORRECT. \ P
I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS,
HEREON AND WITH ALL COUNTY ORDINANCES AND ST'.TE BRACING, BOLTS �' �./ ,j Z•-
? LAWS'REGULATIN BUIL-ING CONS'IP UC ION. FURNACE: LOCATION,
SIGNATURE OF. GAS VENT,.DUCTS
.S
PERM 1 TTE -
v� f LATH, INT. -
'!f ADDRESS
LATH, EXT. t t Az
AUTHORIZED AGT. -
` PLASTER,.INT.
76AGD8A• 0088. 10-56 $ � P. .• r
I] �/ pA ce FEE PLASTER, EXT.-
VALUATION d' V FEE �.. 30FINAL G�E'a�.P/-.-z-2.✓ q�q f"L
WORKERS,COMPENSATION DECLARATIQN
I hereby affirm That I haver certificate of consent:to self A �P L CAU (0 M F O D �nn
insure, or a certificate of Workers' Compensation Insurance, � APP L/�1 �`-'J LI V U�1 IJ Ul/LI
ora certified copy The'eof (Sec.: 3800, C.) COUNTY OF LOS'ANGELES' BUILDING AND SAFETY
Policy No. Company
Certified cop y'is hereby furnished. JOR:APPLIChNTT FILL IN ADDRESS
rtified copy is filed with the county'building inspec- BUILDING
ti dep rtment. +
ADDRESS
CI
IF LOCALITY
Date ��� Applicant NO. OF BLDGS.. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'. ' SIZE OF LOT NOW ON LOT" _ 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 .. `.�,/,C NO y 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,in'any manner ADDRESS Q JWICONDITIONS SPECIAL a
so as to_ become subject to.the Workers'Compensation Laws: i O.
CITY ZIP r
„Date Applicant ARCHITECT OR TEL. DISTRICT " FIRE PROCESSED BY
NOTICE TO APPLICANT:•If_after, ER making this Certificate of ENGINENO.' GROUP TYPE CONST. ZONE 0
,Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code; you.must•forth- ADDRESS �t�6 a
with comply with such provisions ,or this permit shall be TEL. - STATISTICAL CLA SIFICATIO APT. CONDO. N
deemed revoked. CONTRACTOR r 1 NO: �''� Z
LICENSED CONTRACTORS DECLARATION //__ ' LIC. CLASS NO:�DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS l(/ / - NO•�7 SEWER MAP
(commencing with Section 7000)of Division 3 of the.Business LIC. ;
and.Professions Code,and my license isinforce and effect.- CITY CLASS BK PG VALIDATION
SQ. F& OF- NO. OF CHECK
License Number Lic. Class SIZE TORI FAMILIES ONE '
n( /f ❑ VALUATION
Contractor Date V ` DESCRIPTION OF WORK arias NEW $ ��.
ADD
ElI am exempt under Sec. nma. �Gt�L('
ALTER
BAP.C. for this reason' REPAIR El $
Date:
USE.OF
EXISTING BLDG.�rf DEMOL ❑
Signature APPLICANT 0 'p NO. FINAL_
OWNER-BUILDER DECLARATION. DATE
I hereby affirm that.I am exempt from theContractor's License
Law for the following'reason (Section 7031.5, Business and ADDRESS '^ " FINAL L
Professions Code): PRESENT By s
•• =E "
❑ I, as owner of The property, or. BUILDING my'employees with ADDRESS
wages as their sole compensation,will do the work and
LOCALITY f S w
the structure is not intended.or offered for-sole(Section � t1�rn _� ._yc
7044, Business and Professions Code.) MOVING EL. D 1_t"E{, Vit.,,.,:.L
. '
❑ 1, as owner of the property, am exclusive) contracting CONTRACTOR N T
with licensed contractors to construct'the project.(Sec- ADDRESS y
tion 7044,'Business and Professions Code:) YI -7 1
t.REQD TOTAL SETBACK FROM. EXIST.CONSTRUCTION.LENDING AGENCY `
UIRE
BACK YARD HWY PROP. LINE WIDTH - {I hereby affirm that there'is a construction lending agency for NT `-Ht 'K ' •the performance of"the work for which this permit is-issued HAN"
(Sec. 3097, Civ. C.). j /��. SIDE. . .H�;(':•�r -
L.
Lender's Name,'
\ / LDMA Ref. # a 4.
Lender's Address P.C..Fee$- Permit Fee. i
o I'certify that I have read this application and state that the Issuance Fee LDMA P/C#
8 above information is correct. I agree to comply with all County Investigation-Fee
d. ordinances and-State laws relating to building construction, Total Fee cJ• / I LDMA Perm. #
a and he authorize representatives of this Count toe ter
upon abpve-m _property f r inspectio purp es.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or A 1
7 Dai
VORKERS'COMPENSATION DECLARATION M
insure, oraafcertif carte.dfave a certificate of Worke s'. Compensation eInsurance; A PIP��CAU�O LI V F O M d D �l C�. PER
G
la
or a certified copy thereof (Sec. 3800,.Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No;2.Z [j y*gpty 7 a
- BUILDING.. ,
❑ Certified copy is hereby furnished. r FOR APPLICANT TO FILL IN ADDRESS 4.11
BUILDING �y
�. Certtfied.copy is-filed With the county building inspec- kia Y' 4VLe ��vv1�iD. e-
•tion department.
ADDRESS !/ `
�[y j Z (f)( n(e CITY,Te I e, 6 ZIP ��� v LOCALITY
Date lApplicant' � O NO. OF BLDGS. NEAREST '
CERTIFICATE OF EXEMPTION'6 OM WORKERS' SIZE OF LOT 7,e 16 U- NOW ON LOT I CROSS ST: W<'�Y /cry uSO�
COMPENSATION INSURANCE' p� ASSESSOR /
This section need not be completed if the ermit is for one TRACT'1'50 O -BLOCK LOT NO. }� MAP BOOKc� 8' // PARCEL �'`
( P PPAGE;>C710
hundred.dol(ars ($100) or-less.) q9__ , TEL.
OWNER n/11 !1 Yl !��. �'Yl NO. g USE ZONE 24L 2 MAP ��°7 /
I certify that in the,performance of,the work for which this ISPECIAL
/�/�� NO
permit-is issued, I.shall-not employ any person in any manner ADDRESS:SaY1ve / CONDITIONS d
so as to,become subject to the Workers'.Compensation Laws. O
CITY ZIP'
Date Applicant ARCHITECT OR TEL
NOTICE TO APPLICANT: If, after .making this:Certificate of ENGINEER -NO. - 'DISTRICT GROUP CONST FIRE
RNE PROCESSED BY O
Exemption, you'should become;subject to the Workers' ,rte f/ �/ �f.. w
Compensation provisions of the Labor Code; you,must forth- ADDRESS . _ (// ✓✓✓ a
with comply with such provisions or this permit shall be _1�-4 TE1__`7•Jq_ CJ S + ATISTICAL CLASSIFICATION APT. CONDO, Z
deemed revoked. CONTRACTOR �j6 E' C/ i 7 tgNO. {{ / 7 ..+� _
LICENSED CONTRACTORS'DECLARATION ADDRESS �'�� 1'. Wi 1V 1E10: 7J fj �j� CLASS NO. d" DWELL. UNITS 1
I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP
(commencing with-Section 7000)of Division 3 of The Business LIC.
CITY ( CLASS �J�
and Professions.Code;-and my license is in full force and effect. BK � PG / VALIDATION
SQ.,FT. NO. OF NO. OF CHECK
License Number ✓ (7 J' Lic.'Class`_ SIZE.: STORIES FAMILIES' li ONE
j VALUATION
Contractor I � Date �� Z DESCRIPTION OF WORKc'�l�l�e/ Q�ly► NEW ❑ $
I ADD
❑' ❑ D
I am exempt under c m b— 1er Se "4
'LdjZd ALTER
B.BP.C. for.ihis reason bQ'f'}�Ya�"✓1� ❑ E ' • _ - '.
USE OF,
Date: EXISTING BLDG.` 's VD6L.❑
Si nature APPLICANT �� TEL.
9 (PRINT) N►t I W� NO. FINAL J
OWNER-BUILDER DECLARATION DATE / �2.1 e7
I hereby affirm-that I am exempt from the Cont'ractor's License ' GZO cz'j'Fq c6t?�/� .
Law for the-following reason (Section 7031'.5;'Business.and gDDRESS LFINAL
Professions Code): PRESENT Q By .17 � 1
BUILDING. / _ 3
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. r _
❑ I, as owner of the property;_am exclusively contracting CONTRACTOR N0. 1 i `1•[
with licensed-contractors-to construct:the•project.(Sec-
ADDRESS T E ER; '1 4, ,cg.l3
tion 7044; Business and Professions Code.)
CONSTRUCTION LENDING AGENCY SETlBACKD TOTAPROPgIINEFROM' WIDTH 'r•_
YARD HWY y Y 6 [t
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.
IDEP:L.
Lender's Name., € s[I i_{i't
LDMA Ref. #
P.C. Fee$ Permit Fee /�� Ail '
Lender's Address
o I certifythat I have read this application and state that the Issuance Fee .Q LDMA P/C#
8 above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating-to building construction, Total Fee IV5 40 LDMA Perm. #
< and hereby authorize representatives of this County to enter
u on Th above-m'n' ned,property.for-inspection purposes.
.-
o' SEE REVERSE FOR EXPLANATORY LANGUAGE
Si ature o AppI'i °^t WAgent �—.Ddte — /(
2
COUNTY OF LOS ANGELES '!� BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING i;D' s
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS
or a certificate of Workers'Compensation_Insurance,or a certifiedI7�! IP
copy thereof(Sec.3800,Lab.C.) CITY
Y L G� LOCALITY
Policy No. Company SIZE OF LOT // NO.OF BLDGS.NOW ON LOT
El Certified copy is hereby furnished. (6.5- p NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. /-,g �' �9ZclfA
department.
USE ZONE MAP NO.
ASSESSOR MAP BOOK PAGE PARCEL ! /^J
Date Applicant K I SPECIAL CONDITIONS
OWNER,. TEL.NO. - ,\
CERTIFICATE OF EXEMPTION FROM WORKERS' S/L�t J�,n N5 Ut j 010 �8 3b9-��p�! WITHIN 1000 FT.OF SCHOOL? YES NO
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the permit is for one hundred {lye/9L���Ci[�liJ�l/ �//� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
I certify
($hat or less.) CITY ZIP
JK
°7• .
I certify that in the performance of the work for which this permit �w/pt� (i!7-` �x � s
r-A
is issued, 1 shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER TEL.NO, u
become subject to the Workers'Compensation Laws. _ Srdoc/s, u,1/� L fir STATISTICAL CLASS ICATION APT CONDO
Date f7 Applicant 7 - � ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you.:should become Subject t0 the Workers' CONT CTOR 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. ADDR LIC.NO. PL
SIDE }
LICENSED CONTRACTORS DECLARATION CITY LIC.Cr --PL °-
I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES NO.OF FAMILIES 0
Professions Code,and my license is in full force and effect. I—% NEW 1:1 BK & PG I--,
License Number Lic.Class DESCRIPTION OF WORK AD� VALUATION D W
f10•l� �su77'ER ,�ti•;�•t/s cif, Si/9�,E a
Contractor Date ALT R ❑ $ . vcv, ov
St! REPAIR ❑ —
❑ 1 am exempt under Sec. r
B.BP.C.for this reason DEMOL\,[IUSE OF EXISTING BLDG. �, LDMA P/C#
Date: / URM ❑
Signature APPLICANT(P,RINT) )� TEL.NO. LDMA Perm# i
El I, as owner of the property, or my employees with wages as ( ` . /1 N - ! 0 r—T ,L
their.sole compensation,will do the work and the structure is ADDRESS
not intended or offered for"sale (Section 7044, Business and x'744,3 D✓erlAve, L Q 'C FINAL DATE a-."-
Professions Code.) '''''i1N
WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLE AH DOUS MATERIAL `-- *;—, I— 1' •{•�— ,,-,
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN � � µ
.. . ...._._ .. S'-?
I, as owner of the property, am exclusively.contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �
licensed contractors to construct the project-(Section 7044, ves❑ No� i I f ' *j` ;
Business and Professions Code.). ° -' °°
LDING
OCCU ANT REQUIREA PERMIT OR CONST RUCTION OR MODIFICATION FROM THE WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE SOUTH 1 .,-j ':r s,
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST
FOR GUIDELINES. r:
I hereby affirm that there is a construction lending agency for YES❑ NO�] L-HN
the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD
3097,CIv..C.).. PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES _
' I-j
COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING 0000-11111-1—ii� _I '��{
Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
a Lender's Address 0726 1 HIM. '7::9
Q, OWNER OR AGENT
••
o' I certify that I have read this application and state that the above
g information is correct. I agree to comply with all county P.C.FEE PERMIT FEE
N ordinances and State laws relating to building construction,and
a. ereby authorize representatives of this County to enter upon ISSUANCE F E
the above-mentioned pr e y for inspection pur o
a INVESTIGATION FEE TOTAL FEE-
SEE REVERSE FOR EXPLANATORY LANGUAGE
N;VORKERS' COMPENSATION DECLARATION
`NeiarliW m affirthat I have o certificate of consent to selfMb
nsure, or a certificate of Workers' Compensation Insurance, L/�.� �'�L/ '� u V C U O L 0 D H G. p.E u l
or a certified copy thereof•(Sec. 3800; Lab. C.) '
COUNTY,OF LOS ANGELES y,' s BUILDING.AND'SAFETY
Policy No. Company
Certified copyJs_hereby furnished. - FOR APPLICANT TO,FILL''IN
Q .• BUILDING;
ADDRESS
Certified•copy is filed with the county building'inspec- BUILDING .
tion department. ADDRESS " c \CN :�!A V.C';F.AA
Date Applicant, CITY A L- C ZIP -k (70O LOCALITY. - P'
CERTIFICATE OF EXEMPTION,FROM WORKERS r. NO: OF BLDGS. NEAREST
' COMPENSATION INSURANCE
SIZE OF,LOT 17S NOW ON LOT :'I CROSS.ST.
' ". '.• _ - _ -. -.
(This section.need not be completed if the permit_is for one t®, ASSESSOR'
hundred dollars ($100)or less.) TRACT BLOCK LOT NO J MAP BOOK PAGE PARCEL
„e
?[STEL.
OWNER �tQ�. r� C �iy'' NO.ZSS_ �I USE NE MAP
I certify that in the performance'of the work"for which this NO:.
permit is issued, I*shall not employ any..p sontn
any manner ADDRESS �.�1\ K�U" P SPECIAL
so as to become sub'ect to the Workers'- ampsai n'Laws � � �' CONDITIONS 0
'1 '� Z'�•0 'fN. CITY.•-V9,-k ,� c-�V ;ZIP 'It-113 a
Date Applicant, "
NOTICE TO APPLICANT: df, after• king is Cer tate of ARCHITECT OR' TEL. , DISTRICT G OUP TYPE FIRE PR ESSE BY O
Exemption, you should, become' ubject to the Workers' ENGINEER r r NO: CONST. Z E
Compensation rovisions'of the L or'Code,. ou:^must forth L, /
P P Y 'ADDRESS '"« �J l K.I �::.. � _ LJ,
with comply with such of
or this-permit.shall be. STA `
deemed revoked. CONTRACTOR STATISTICAL CLASSIFICATION APT. rONDO� N
TEL: 1AS51FICATlO
NO.
' LICENSED CONTRACTORS DECLARATION LIC'. CLASV NO. `DWELL. UNITS
Z
I,hereby affirm that I am licensed under`provisions of Chopter.9 ADDRESS Np, e
(commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP
Professions'Code,"and"my license is in full force and effect. CITY ""CLASS :VALIDATION
SQ. FT.•� tt NO.'OF NO. OF CHECK.
SIZE U10 STORIES FAMILIES ONE'
PG
License:Number" Lic.Class Q
VALUATION
Contract Date DESCRIPTION OF
-WORK (� ?, NEW ] $
1'YC W ADD 0
I om exempt under Sec - l "
ALTER
B.BP.C,.for this reason
REPAIR
Dat OF
.
USE,.' e E MO
EXISTING BLDG. DEMOL Q
Si nature _ APPLICANT 8 7 S-d A
g OWNER-BUILDER DECLARATION PRINT � �Q� +�. Lic+ �eS �R.NO S '3 bl FINA
I hereby affirm that'I'am exempt from..the Contractor's:License Q o" o 0 0,011
ADDRE55.�lal\�. KaU rF !VI AW- T ��."fit <
Low for the following:reason (Section 7031.5, Business andFINAL
Professions Code) gY c _ C(iL 11 01 06113
.
BUILDING x a6A:3 v
I, as owner of.the.property or my employees with ADDRESS
rS �. .
wages as their sole compensation,will,do the work and `' .,
the structure is not intended or offered#or sale(Section LOCALITY
7044.:Business and.Professions Code)? MOVING TEL
0;-1. 1 2 8 7'
CONTRACTOR' NO.
I, as owner of the property,am exclusively:contractjngtwith.licensed contractors to construct the"project (Sec-• ADDRESS
tion`7044, Business and Professions Code).
REQUIRED , _TOTAL SETBACK p
CONSTRUCTION LENDING AGENCY SET BACK;". 'YARD HWY PROP. LINE WIDTHI'
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
P.L.
Lender's Nome,
LDMA Ref:#
P.C. Fee$ Permit Fee
Lender's Address
0 1`certify that I have read this application and-state that the, Issuance Fee 5 LDMA PTC#
o above information is correct. I agree to comply with all County Investigation Fee
0 ordinances and tate. laws vela g to building construction, Toral Fee
and hereby a ori a rep se fives of this County to enter �' TDMA Perm. # -
upon the abottrin Jtr/ tion d erty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig lure of Applicant o A t= Date.
t-
,x WORKERS'COMPENSATION DECLARATION
I hereby affirm .thet I have a certificate of consent to self n' n /nl O ,� -� "� nnn��('
insure, or,a certificate of\k,orkers' Compensation Insurance,' /�= [ �h A 111 ' (JC/,LJ U �J
or"a'cert ifind'copy�thereof (Sec.'3800, Lab. C ) '• t'
COUNTY OF,LOS ANGELES BUILDING SAFETY
Policy No Company....
: Certified coy is hereby furnished, : FOR APPLICANT TO FILL IN �- \ KAU
Q ,: ,, BUILDING
P Y
�' Certified copy is filed.with the county building inspec- gUItDING ! `�
ip�
tion department. ADDRESS ��� 6� I�V \ r1 A-IVA R e C i'i- t v
ADDRESS
ell,8W
%
`?6,u
Date,, A licant- CITY ZIP
T • LOCALITY �--U 1n'
PP T C l IIA.:S.I�'
CERTIFICATE OF EXEMPTION FROM.WORKERS''` NO. OF BLDGS. NEAREST i
SIZE OF LOT; 7-S_ NOW ON LOT CROSS ST.
COMPENSATION INSURANCE ' • C•tS4
(This section need not be completed if the permit-is fon one - ASSESSOR
a hundred dollars,($100)or•less.) - j CT�I S .��., `' NO. �. MAP OO PAGE PARCEL
TRA -0 `- BLOCK, LOT L. `i
OWNER.'_5 � "i y`� .C� a . � NO.'Z$_=S�'16�1 USE. B NEK' MAPW.
I certify that in the`per'forrriance"of the work,.for which this _ NO
permit'is issued-, I'shall not employ an 'o son in d manner SPECIAL •
ADDRESS ��.i
so as to become'subject.to the,Worke mpens ti Lows `- I�AU`. t CONDITIONS U
y y y r
r _' +'•�• .,^.O U. rl� - CITY 1 h CCT -
Dote Applicant ..
ARCHITECT OR TEL.
NOTICE TO APPLICANT: if,
'after, Eking this C ti tate of - DISTRICT. GROUP TYPE FIRE PROCESSED BY O
Exemption,:you sKbuld become subject 'to t '•Workers' EN N
E GINEER NO.
Compensation.provisions of the L bor-Cod must forth- ADDRESS JL . IT')
W
with,cornply with,.such provisions or this permit shall.,be - TEL
CONST ZONE
`u,
deemed,revoked.- R,- STATISTICAL CLASSI ATION APT. C DO. Cf)
CONTRACTOR NO. -
LICENSED CONTRACTORS DECLARATION -LIC. CLASS NO. DWELL. UNITS
I hereby
re y'offirm that I am licensed under provisions of Chapter'9 ADDRESS = NO.
(commencing with Section 7000)of Division of the Business and LIC. a SEWER MAP
Professions Code; and my license ism full force and effect.' CITYV CLASS. VALIDATION
SO. FT- Sv� NO. OF NO. OF . CHECK BK. PG.-
License Number Lic.Class SIZE STORIES FAMILIES ONE
VALUATION
Contractor Date DESCRIPTION OF WORK �� i COf\V ,
NEW
DESCRIPTION _600 ` CI_`
I am exempt under Sec. w�c���e V
.� ADD, �..
w` ih p
B.&P.C.-for this reason A 5....'.
ALTER
Date" . USE OF
REP iR ;Q
EXISTING BLDG. DEMOL.
Signature yti iticJ��i ? 7 FIFIAL,
APPLICANT EC.
OWNER BUILDER DECLARATION (PRINT)
1 hereb affirm that l am-exempt from the Contractors License -+
Law;for the following reason (Section 7031.5 Business and ADDRESS �C�k�, NVQ.V r� '1 I1I � e": f{
rofe`ssions Code):' R E ,By # 1
:.
FINAL �9
I, as owner of the property, or my employees with ADDRESS 4
wages as their sole compensation,will do'the' work and d e o
LOCALITY
5 9,.2 5
the structure is not intended or offered for'sale(Section n e s
7044, Business arid-Professio.ns Code) MOVING'.' TEL
I,as owner of the co eri am exc)usivei coniractin CONTRACTOR NO :a o 0 0.5: r5.1
92
with licensed contractors'to construct the project (Sec- " 4
tion 7044, Business and Professions Code). ADDRESS R , k c i� �� 2 - i +2�=.. „�\ `;Q� 8- -8
RE QU I RED' TOTAL t SETBACKEXIST.
8
CONSTRUCTION LENDING AGENCY SET BACK YARD:' *WY ` . PROP. LINE WIDTH FROM �t ? i O
I hereby affirm•that.there is,o construction lending agency.for FRONT �.
the performance of,'the work for which this permit*is issued
(Sec. 3097, Civ. C.). SIDE'
P Lr. `•l
r
Lender's Name , + :,;� ✓
P.C. Fee$ Permit Fee I LDMA Ref. #
Lender's Address
3
$ .1 certify that I have read.this application and state,that the Issuance Fee i a [LDMA P/C#
g above information is correct. I agree to comply with all County Investigation Fee
S ordinances an tatelaws relating to building construction,
and hereby h ize represe tives of this County to enter Total Fee LDMA Perm. #
upon the ve entio e r perty for inspection purposes.
�' l` �� SEE REVERSE FOR EXPLANATORY LANGUAGE
n
/nature of Applicant r Agent Date
.WORKERS' COMPENSATION DECLARATION
I,hereby affirm that.I have a certificate of consent r self Ll �R (�V � (a LI VV
nsure,•or a certificate of Workers' Cormperisbtion Insurance, LlL/-�� LI LI�1 Lf LN(JVl►
or a certified copy thereof.(Sec..3800, Lab. C.,) CO
LINTY OF LOS ANGELES BUILDING AND SAFETY'
Policy.:No Company
❑ Certified.copy is hereby.furnished.: ' FOR APPLICANT TO FILL IN ao�Ress
❑ Certified;copy,is filed'with the county building inspec-
BUILDING
tion department: ADDRESS
Date A licant CITY' E! ZIP �` ` Y /�,`'
LOCALIT.
GOMPENSATION':INSURANCE DGS. NEAREST
CERTIFICATE OF,EXEMPTION,FROM WORKERS SIZE OF LOT " x �a NOW ONNO. OF LCOT "- rz CROSS ST..
PT
ASSESSOR � a'
(This section-need'nof be complefed if'Lthe permit i's``for one TRACT BLOCK' lOT NO.' MAP BOOK PAGE S b. PARCEL D
hundred dollars ($100)or less.)' 1+. ,, TEL. WFr—4 -
OWNER_ :GL / {t 85� NO.• Z MAP
I:certify'that imthe perbformance of the .work,.for,which.this
!—
1-4
USE ONE
permit is issued, I shall not employ;any_persori in any manner ADDRESS _ , C... _ Id
SPE AL
CONDITIONS
so as to become-subject to the,Workers'Compensation,taws. O
CIN ZIP'
Date Applicant- ARCHITECT OR TEC'..
ENGINEER: DISTRICT GROUP ,TYPE FIRE PROCESSED BY
NOTICE.TO APPLICANT: If, after,making this Certificate of NO. . . CONST. ONE F-
•Exemption-;:you ;should become subject to the. Workers' U
Compensation provisions of the,LaborSCode; you:must forth- ADDRESS" / ✓ CL
with p y p this permit shall be TEL. STATISTICAL CLASSIFICATION- APT. CONDO.
deemed rtrevokedh such,.,provisions, CONTRACTOR " NO.,
LIC
"LICENSED CONTRACTORS DECLARATION- '• ,
- CLASS NO DWELL. UNITS '
ADDRESS NO.
Z
I hereby affirm that'l am'licensed under provisions of Chapter9, SEWER MAP
(commenting with Section 7000)of Division 3""of The Business LIC.;
CITY-. CLASS`
and Professions-Code,•and my license is in full.force Arid effect. BK, PG. VALIDATION
SQ..FT. NO. OF ,`. NO. OF ': CHECK
SIZE STORIES FAMILIES ONE
License Number _ Lic. Class -
10
` VALUAT N
Contractor Date DESCRIPTION OF WORK h544�] « vL�de NEW '•❑
$
ElI am exempt under Sec
lfl"i?0 6C.JI V( ADD ..
isSTER B:&P.C. for this reason .
d�'h A
Ir-a .. -. ._ .
REPAIR EJ. $
USE OF
Date EXISTING BLDG �'iv ; 1� -PEM
Signature.. APPLICANT : �'�
9, (PRINT). . (� / NO: -0'�{J O FINAL .1.
OWNER-BUILDER DECLARATION . DATE
I hereby affirm that I am exempt from the Contractors License _ /2,r:/,3
Law for the.following;reasori (Section'7031.5, Business and ADDRESS FINAL +.
Professions Code) .• ',` PRESENT - By a
❑' 1, as owner of the
-property,.or em _lo ees with BUILDING p aYp
P P..,,Y, Y P Y ADDRESS ` ��y�
wages as'th'emsole cor-hpensation,will do-the work and. _
the structure is.not'intended or offered for sale(Section LOCALITY
7044 Businessland Professions,Code )- MOVING " TEL.
❑ I, as owner,of the property, am;e,xclusiv.ely contracting CONTRACTOR NO. _ ff y
with.licensed contractors to construct the project (Sec' ADDRESS
tion 7044, Business and Professions Code.,) s.Iii.
CONSTRUCTION LENDING.AGENCY REQUIRED YARD TOTAL SETBACK-.FROM- EXIST..
L _
SET BACK RD HWY PROP. LINE WIDTH I -
I hereby affirm that there is a cont
struction lending agency fon FRONT .�A•'
"th'e.peeformance of the work for which this-permit,is'.issued P.L.
(Sec.,3097, Civ. C.). SIDEJ..
Lender's.Nome "'-'
LDMA Ref. # '.+tilt .• s t Pt
Lender's Address P C. Fee$. . _ Permit'Fee p • Q O
3a -
o I certify that I.have read this application and state that the Issuance Fee LDN1A'P/C#
- a .
above information is correct. l agree to complywith all County Investigation.Fee8 ordinances and State laws relating;to.building construction,, Total Fee ee LDMA Perm. #
Q and hereby authorize.representatives of this County.to enter
upon the above-mentio d grope ty for•inspection purposes.
a
(/ 0 h 'I SEE REVERSE FOR EXPLANATORY LANGUAGE'
Signature of Applicant or Agitlint Date J a
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 0901080001
PHONE: (626) 285-0488 EXT:
ILEGAL ID: - NO. OF CONST. BUILDING ADDRESS:
ITR: 15080 LT: 5 I SQ. FT STORIES TYPE I 4919 KAUFFMAN AV
I ISTRUCTURE: 18 V-B I TEMP CA 917804247
(ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: -
18589-016-017 1 I THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, Cl
I I I I
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1
IEXIST OCC GRP: 101/03/09 SR 1
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IF NA`L DATE FIN BY: CODE: 1
ILISA (626) 487-5666- 1 3,900
14919 KAUFFMAN AV
ITEMP 917804247 I FEES PAID IDESCRIPTION OF WORK 1
I IT/O OLD ROOF INSTALL CLASS 30 YR COMPOSITION SHINGLES 1
I IFEE DESCRIPTION: QUANTITY:.UOM: AMOUNT: 1 (ONLY RE-ROOF HOUSE) 1
1APPLICANT: TEL. NO: . I I I
(ALFRED LAU (626) 285-9016- IAA BLDG PERMIT ISSUANCE 27.75 1 I
14533 SHIRLEY AVE. IAB STATE GREEN BLDG FEE 3900.00 VAL 1.50 ISPECIAL CONDITIONS: 1
IEL MONTE, CA 91731 IAC STRONG MOTION RESID 3900.00 VAL 0.50 1 1
I ID2 PERMIT W/O EN-HC 3900.00 VAL 115.80 1 I
I I TOTAL FEES 145.55 1 I
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
(GOLDEN KEY INC. (626) 285-9016- 1 1 1
IDBA NEVADA GOLDEN KEY LIC. NO 1 ILOCATION AND SETBACKS I I I
14533 SHIRLEY AVENUE 775115 C39 I I 1 I I
1EL MONTE, CA 91731 I ISOILS ENGINEER APPROVAL I 1
1ARCHITECT OR ENGINEER: TEL. NO: 1I 1FOUNDATION/TRENCH FORMS 1 I
1 LIC. NO: I (SLAB/UNDER FLOOR 1 1
I I I I I I
I 1 IRAISED FLOOR FRAMING I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( 1UNDERFLOOR INSULATION I
I I I
1144H269 3 001 1 1 I I
1 l (FLOOR SHEATHING I 1 1
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I 1 I
NO 21 IROOF SHEATHING
1 SCHOOL WITHIN HAZARDOUS. 1 ISHEAP.' PANELS I
I I I
1AIR QUALITY: 1000 FEET MATERIALS I I I I I
1 NO NO NO I IFRAME INSPECTION
I I I
IREQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS I I I
ISET BACK YARD: HWY: PROP LINE: WIDTH: 1 I I I I
IFRONT PL- I (INSULATION/WEATHER STRIPI I I
I SIDE PL- I I 1 I
I 1 (INTERIOR LATH/DRYWALL
I I I
I 1EXTERIOR LATH I I 1
I I I I I I
I (RATED FLOOR/CEIL ASSEM. I I I
I I IRATED WALL ASSEMBLIES
I I I
I I IRATED SHAFTS/OPENINGS 1 I I
I I I
I I IT-BAR CEILINGS I 1'
I I I
ILOT DRAINAGE I I I
I I I I I I
I IREPORT ID: DPR261 ROUTE TO: BS0508 1 1 I I
r _
n ° COUNTY OF LOS ANGELES ^� a' r TE PLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9904230016
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 15080 LT: 7 SQ. FT STORIES TYPE 4914 KAUFFMAN AV
STRUCTURE: 0 VN TEMP CA 917804246
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8589-019-018 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: RESID USE ZONE: R ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 04/23/99 UT 10/20/99
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY• CODE:
NAJERA JOE (626) 574-8491- 1 3,000 /
701 E. NORMAN AVE f '
ARCD 910063616 FEES PAID DESCRIPTION OF WORK
TEAR OFF, NEW PLYWOOD, INSTALL GAt2O CLASS A COMP. SHINGLE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. 0:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 3000.00 VAL 0:50 SPECIAL CONDITIONS:
D2 PERMIT W/O_EN=HC, 3000,00 VAL 99.00
OA
CONTRACTOR: TEL. NO: ®� T ® � 127.25
� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO LOCATION AND SETBACKS
SOILSa ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: /�M FOUNDATION/TRENC FORMS
LIC. N0:"� 1`111'111 SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: u O n/ `� UNDERFLOOR INSULATION
144H269 3 0 IlJIL1wJ_ FLOOR SHEATHING
(DFc))KS
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS
NO 21 0 0 i I' ROOF-SHEATHING
SCHOOL WITHIN HAZARDOUS I Z?l 0 t. SHEAR PANELS !/
AIR QUALITY: 1000 FEET MATERIALS 0 �,
NO NO NO 01.
®y FRAME INSPECTIO
REQUIRED TOTAL SETBACK FROM EXIST G� -pl��� FIRE SPRINKLER HANGERS
SET BACK YARD: __HWY: PROP LINE: WIDTH:
FRONT PL- rvoce Tj�tS INSl1GATI0N/WEATHER STRIP
SIDE PL-
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASS MBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508