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COUNTY OF LOS -ANGELES BUILDING `—
• Or
DEPARTMENT OF.COUNTY'ENGINEER ' ADDRESS.
-BUILDING AND SAFETY"DIVISION LOCALITY
JOHN A.LAMBIE,.COUNTY ENGINEER NEAREST /rII�PQy
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. Ll7 4fJ'$d•
``
, •' "`' -"` - `• DISTRICT NO. TYPE
GROUP' - P CESSED'B
FOR' APPLICANT TO FILL IN `S I'C ONST.
N BUILDING'. f A../ �+ �r STATISTICAL SSIFICATION -SEWER PG
ADDRESS `1
CLASS.NO.- DWELL.'UNITS' 'I 7
LOT NO: J�
. BLOCK.� ,MAP ---�. � l STATE
_ NUMBER ® (�J HWY. Y,ES.
TRACT Q ZONE SPECIAL
NO.OF,'BLDGS: ` I CONDITIONS
SIZE OF LOT I -NOW ON LOT �r
USE OF., :ifllo_010
EXISTING BLDG. ) - BUILDING EXIST.
YARD HWY STREET NAME
e SETBACK WIDTH
OWNER .. ONT .
FR sem,
MAIL � a� �+ /� L :. P.L:.. ,.
ADDRESS /L'/ /(f3.c ha SIDE SIDE - _ "
TEL. P.L.
cli Y'' No. INSPECTION RECORD '
ARCHITECT O - TEL. "
.ENGINEER NOl 59 ,
ADDRESS
TEL:' .J''i i'y �.%I �Q 1>-A Yl '�X.•��/f.'/ 1 �
CONTRACTOR �yJ S� NO:
ADDRESS
DESCRIPTION OF WORE
NEW ..�AD9/' ALTER _ -REPAIR DEMOLISH' -
SQ:.;FT NO.OF j-, NO.OF
. SIZE �(y STORIES / FAMILIES/
USE OF STRUCTURE
.
SI :. / APPROVALS
GNATURE OF -
r; "APPLICANT .":r•®•� '.
_ DATE INSPECTOR'S SIGNATURE
rj ADDRESS FOUNDATION: LOCATION j,
FORMS,MATERIALS.
MATERIALS
P:da $. . FRAME: FIRE STOPS. '-
FEE ,BRACING..BOLTS /�7- ,_
VALUATION 2. ®Op `' $,i �� QO FURNACES LOCATION. -
FEE GAS VENT,DUCTS
'1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH.INT.
. PLICATION AND STATE THAT THE.ABOVE IS CORRECT AND "_ -
AGREE TO COMPLY WITH ALL COUNTY ORDI-NANCES AND
"STATE LAWS REGU 'TING ByILDIfjA CONSTRUCTION, LATH, EXT.-
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE "RECT AND POSTED
ADDRESS FINAL _F._3--o
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN.GJN&9R
PLAN CHECK VALIDATION" CK. M:O. CASH PERMIT VALIDATION cK. M.O. CASH
076. 09 11 1. A 12.UQ . I
OF
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'I have a certificate of'consent to'self -. /U\ p �Q� O O d D 0J p. G3G
insure, or a certificate of Workers' Compensation Insurance, �u
or a' AT
L'ertified.'copy thereof (Sec. Lab C.)
Policy N11-?47--Compgny Nld':
COUNTY'OF t05 ANGELES ` BUILDING HIVID SAFETY '
�;- t. i ... .,.,., :-BUILDING:
❑ Certified copy.is hereby-furnished.. FOR APPLICANTITO BILI•IN; ADDRESS /v�}/./ �qy
Certified copy is Ied:with:the county building inspec
BUILDING i -
•
I�
/. ., :, ADDRESS S VE.
tion department. �.' G( e .
<. _
Date s. 9 APPlicant
CITY': Ca F IBP
t t: O. O LDGS LOCALITY
4 ERTIFICATE;OF'EXEMPTION FRO WORKERS' SIZE OF LOT 2�_ NOW`ON LOT CROSS ST.
COMPENSATION'INSUR CE' 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.
I certify that in,the performanceofthe-work for which this n/q _
OWNER M-12, S. A NO. 6 Z/b/ .
USE,;ZONE MAP
permitis,issued, I shall•not.,ernployany.person`in any manner ADDRESS }
NO.
SPECIAL i1
CONDITIONS
so.as to become subject to the Workers'Compensation„Lawsr I O
. .
.
CITY„-�-: P�. C ..C . ZIP -
4 Date ' -Applicant ARCHITECT OR :NOL DISTRICT I GROUP:'TYPE FIRE NC
SSED BY '”NOTICE.TO APPLICANT:-If, -after making'this'.Certificate of ENGINEER ... -
Exemption, you should` become •subject to the ,Workers' U'
LU
Compensation Provisions'of the:Labor Code, you„must forth- ADDRESST� E ►E —
with comply, with such-provisions or this permit sholl be TEL STATISTICAL'-CLA FI ATION APT. CONDO
deemed revoked CONTRACTOR / Ac+W0 �If�V�f�d0. 5 _
LIC CLASS NO: DWELL.”UN
_ Z
LICENSED CONTRACTORS DECLARATION. . ; ..
I hereby"affirm that I am:licen'sed under rovisions of Chapter9. ADDRESS oil W. 6AR E, NO. / 3
p _
LIC. QQ SEWER P.
(com' ncing`_with Sectio_n 7000)of Division'3 of.the Business CITY �VI�T Cdr//N (�}, CLASS
and Rrofessions`Code,and my license is in full;force;and.effect. BK: „PG: VALIDATION
"License, Number.' (�✓� Lic. Class I �T STORIIEES F MILLIIES" ONE
K
5 FT.
Contractor Date' /9,.
,� v VALUATI N O
DESCRIPTION OF WORK rQb'o� NEW ❑. a ^11.x'
❑1.'arni exempt der Sec. 1 N ( ADD'
B,&P.C. for this reason '
._ ALTER ❑
D/LCQ D/ RdDYQE REPAIR' a
Date: e� OL ❑
US .OF
EXISTING BLDG:” I RE�IOf?lC�. DEM
Signature FINAL
APPLICANT = TEL. /
(PRINT). TtYt OpEIlXL NO: . t7D�9S
OWNER-BU ILDER,DECLARATION
I hereby affirm that I am.exempt,from.the Contractors License' r
DATE"
ADDRESS �� 1 - CoulN
.Law for the•following reasom,(Section 7031.5, Business and ;, FINAL`"
Professions Code) PRESENT. ;BY ;
BUILDING ACCT.®r
❑ I, as owner of the property,'or my employees with., ADDRESS _
wages as their'sole comperisation,will do the workand LOCALITY M `� }
the structure is not intended or offered for sale=(Section d�
7044, Business and Professions'Code.) MOVING TEL D 3;'= rl 1 ITEM_,
CONTRACTOR NO.
❑ 1, as owner of the property, am"exclusively.contracting - tc
with-licensed contractors to construct the project (Sec- TOTAL 246- –e' '
ADDRESS
tion 7044, Business and.Professions Code) ' ti. y,. F ii 1 .; 2466"5
REQUIRED TOTAL SETBACK FROM' EXIST–
BACK
CONSTRUCTION LENDING AGENCY SET BACK. YARD HWY PROP. LINE WIDTH ��
I.hereby affirm that there is a.construction lending agency for FRONT
CHANGE r ,L�ij '
the performance-.of�the work for which this perrnitis issued : ' P.L.- "'
(Sec. 3097, Civ: C:): SIDE• .
q r
P.L.:' 000&-00011. t •t9/2"'}
Lender's Name. - i
A
CDMA Ref #' .JLgt94 t.l AM 9:1
Lender's Address P.C. Fee$ Permit Fee •
3
I certify that I-have read this application and state,that.the Issuance Fee LDMA P/C#
above.inform6tion'is•correct. I agree to comply with.all County Investigation Fee
ordinances-and'Stdte.`laws relating to building construction; Total Fee ra Aq LDMA Perm .#. ` a a
a and her 'b authorize representatives,of this County to enter _ _
a upon th ve-m t ned.prooerty for inspection'purposes `._
„ ! 1 SEE'REVERSE FOR EXPLANATORY LANGUAGE .. d ` ,.; `� a. :,, y
Signature f plicant or Agent Date
COUNTY OF LOS ANGELES"t 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 0511010013
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS: z
TR: 15683 LT: 39 SQ. FT STORIES TYPE 5121 KAUFFMAN AV
STRUCTURE: VN TEMP CA 917803946
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8589-011-011 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 11/01/OS JK 10/27/06
OWNER: TEL. NO: BLDGS. NOW ON LOT: , VALUATION: FINAL DATE FINAL BY: CODE:
TAKEDA NORMAN L;SUZANNE (626) 287-8771- 14•,000L/ / -
5121 KAUFFMAN AV 6
TEMP 917803946 \ FEES, PAID- DESCRIPTION OF WORK
BATH REMODEL
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
TOM O'LEARY' (626) 287-0927- AA BLDG PERMIT ISSUANCE 27.75 -
5823 AGNES AVE AC STRONG MOTION RESID 14000.00 VAL 1.40 SPECIAL CONDITIONS:
TEMPLE CITY CA 91780 B2 PERMIT W/ENERGY 14000.00 VAL 312.18
TOTAL FEES 341.33
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
TOM O'LEARY CONSTRUCTION (626) 287-0927-
5823 AGNES AVENUE LIC. NO LOCATION AND SETBACKS
TEMPLE CITY, CA 91780 489354 B-1
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
147H269 3, 01
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508