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HomeMy Public PortalAbout5938 KAUFFMAN AVE_Building__ APPLICAT &eF6p4d �Y BUIL ING PERMIT FOR APPLICANT TO FILL IN- (Print or ryce only) BUILDING COUNTY OF LOS ANGELES ADDRESS / DEPARTMENT OF COUNTY ENGINEER ciT �1tif zIP BUILDING AND SAFETY DIVISION NO.OF SLOGS. BUILDING SIZE OF LOTS ON LOT a ADDRESS �� I TRACT BLOCK LOT NO. LOCALITY k,—r �at TEL e� NEAREST y� .1 'J O. .� CROSS ST. ASSESSOR ADDRESS " , , MAP BOOK PAGE PARCEL DISTRICT 1GROUPITYPE FIRE I PROC D JBY CITY ZIP .^/►•'� CONS Z61 E ARCHITECT OR TEL. �^ �� / v-,)_.,' ENGINEER NO. STATISTICAL CLASSIFICATION SEWERP ADDRESS CLASS NO. DWELL.UNITS BK /PG CONTRACTOR�y-i� &41'J TEL-24- SE ZONE MAP N O. ADDRESS ?a6?_# - ¢J I NO `A7 SPECIAL It CONDITIONS CITY.. `/ 7/'�'� <: CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONS- P. E OF (STREET) ADDRESS CITY HIGHWAY + YA D TOT SETBACK FROMI TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK F NT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES 'ONE } + [L DESCRIPTION F WORK 64'e- /�eupW ❑ V ADD BLDG.SETBACK FROM (STREET) C "❑ SIDE PROP. LINED p ALTER ❑ TOTAL SE ACK FROM TYPE OF EXISTING U HIGHWAY + YARD = REPAIR SIDE PRO . LINE HIGHWAY WIDTH � h USE OF DEMOL ❑ + = Z EXISTING BLDG. APPLICANT TEL - CORNER CUTOFF YES ❑ NO ❑ (PRINT) N0. IN OPEN SPACE YES ❑ NO ❑ "' BY (SIGNATURE) az IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION,$ i6xv I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED - HEREBY I WILL NOT EMPLOY ANY PERSON IN. VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIAIN RELATING TO WORKMEN'S COMPENSATIO INS URANC/EJ. SIGNATURE OF PERMITTEE / ADDRESS /) TEL. FINAL i r BY CITY NO. DATE /O /// �•� d MAKE CHECKS PAYABLE TO. P.C: $ PMT.;$ FEE' FEE HARVEY T. BRANDT, COUNTY ENGINEER PLAN*CHECK ALIDATION 'CK. M.O. CASH PERMIT VALIDATION CK. M.0. CASH .7 6'-'OCT 4 8 0 0 U A4 76A638A CE 03 5/74 76A638A CE48033-66 APPLICATION FOR BUILD G PERMIT 'COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER A D D R E SS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST ' COLEMAN W JENKINS.SUP'T OF BUILDING CROSS ST. DISTRICTN U T PE. PROC ED BY FOR APPLICANT TO FILL IN -5, T ADDRBUILDESS �J�7 CLASS NO A DWELL UINITS _ SEWER MPG• LOT NO. LOCK USE ZONE MAP NO. TRACT _ SPECIAL N0. OF BLDOS. CONDITION - ' SIZE OF LOT NOW ON LOT ' USE OF EXIST" J�yBLDG. SETBACK FROM TEL. FRONT PROP. LINE OF* OWNER NO. TYPE OF EXISTING I SETBACK HIGHWAY tAARD = TOTAL ADDRESS HIGHW Y I WID M I F R OM C.L. - CITY BLDG. SETBACK FROM - ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. r TEL. �. + CONTRACTOR / NO qq// LIC ADDRESS j4: NO ;Z26 15S, CORNER CUTOFF YES NO O CITY 4,06 j9LN i LIC C SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK ' W NEW ADD X LTER REPAIR DEMOLISH VJ SQ.FT. NO OF NO. OF Z SIZE STORIES FAMILIES USEOF STRUCTURE SIGNATURE OF APPLICANT VALUATIO „ D ,OO APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. �'U FOUNDATION, LOCATION FEE$ FEE$ FORMS, MATERIALS FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THATA HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS JUILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'SCO'PENS T'^A 'SSU PN l/ (� LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - RECT AND POSTE ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK. M O. CASH _ PERMIT VALIDATION CK. M.O CASH Lkr),6:7�3 9 b .JAS!1 '� 1 .D 6.0 Q� `- APPLICATION FOR 'B.UILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) " BUI L.DI NG COUNTY OF LOS ANGELES - - ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY G CAN •ZIP 7B�0;`;70 BUILDING AND SAFETY-DIVISION SIZE OF LOT •/ - LDING OWOONBLOTSADIDRESSTRACT BLOCK LOT LOCALITY TEL.� NEAREST OWNER O ( / CROSS ST. }, ASSESSOR ' ADDRESS 3 r MAP BOOK PAGE' PARCEL _ DISTRICT GROUP TYPE- 'FIRE PRO ESSED BY IA-2-434c L� CONSS�y -ZON ; �. CITY ZIP S. ARCHITEC # TEL, ENGINEER IiG7 110 1 STATISTICAL CLASSIFICATION-- SEWER MAP ADDRESS CLASS NO. _DWELL,UNITS BKS PG CONTRACTOR 'NOL USE ZONE MAP LIC. NO. ADDRESS t 5 NO, 3 SPECIAL _ ��M,�,�n./� LIC. CONDITIONS CITY Y�1\.)lV l� CLASS ' ROAD DEPARTMENT APPROVAL REQUIRED YES[j NO ❑ CONSTRUCTION LENDER �• NAME AND BRANCH - BLD .SETBACK FROM - d `FRO T PROP.LINE OF (STREET) C C: ADDRESS - CITY _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHW Y } YARD - a' SQ, FT NO OF NO. OF CHECK I FRONT PROP LINE HIGHWAY WIDTH F SIZE STORIES `FAMILIES ONE - C: LL DESCRIPTION OF WORK NEW ❑ - V I ice' .../ ADD E] BLDG.SETBACK SDE PROP. L IN OFOM (STREET) ? /\,�O JC�i� ALTER 'HIGHWAY, } TOTAL SETBACK FROM T OF EXISTING YARD = REPAIR❑ SIDE-PROP. LINE - HIG Y WIDTH USE OF �a-, - } 1. = EXISTING BLDG. C DEMOL ❑ APPLICAN� - - L CORNER CUTOFF YES ❑ NO ❑ (PRINT) 0 *nm 0. _ BY (SIGNATURE) IN OPEN SPACE - YES ❑ NO ❑ ' Q IN COASTAL ZONE YES ❑ NO ❑ 'VALUATION s O� CATEGORICAL-EXEMPTION YES❑ NO^❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE ISCORRECT AND,AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ,ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION C CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE y LABORCO OF THE STATE F CALIFORNIA IN RELATING TO '� ) /` ) �. a ` `7V WORKMEN' CO ION IN U NCE \ I y F - SIGNATU E PERMIT- ADDRESS FINA /f�i _. TEL. CITY NO. - DAT //i/C1(/f/J��(/ - IPMT Q r MA KF_ C1/ECKS'PAYA BLE TO: PEE �,� FEE $ HARVEY T. BRANDY. COUNTY EN-GINEER .PLAN CHECK VALIDATION CK - M 0 CASH ERMIT VALIDATION. . CK M O CASH 5 9,3,-APR 18 4,_q D .0.. 0 e � 22 pppp 76A 638A•CE#803 7/73 �� 7� Y.J,-/�I iII •�+)9 $ v ` 'c) 0 e� 1 76 Cflr 3 R11-/78) 1 , APPUcAT N OR BUNG PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN A>'�RESS BUILDING / ADDRESS ,,`` LOCALITYNEAREST CITY L_ CLT ZIP V CROSSST NO OF BLDGS ASSESSOR_ SIZE OF LOT NOW ON LOT MAP BOOK•, - PAGE I PARCEL DISTRICT GROUP I TYPE FIRE R- ESSEDBY TRACT BLOCK LOT NO CONS TEL OWNER Ci,"O 2-SC-2-I-71 STATISTICAL CLASS FICATIO SEWER MAP ADDRESS -I J (/IiF�FT-144J CLASS NO. DWELL UNITS BK PG CITY " ZIP L ARCENGINEERT ITECORKget r-�O VALUATION $ ADDRESS _ BLDG SETBACK FROM TEL FRONT PROP LINE OF (STREET) CONTRACTOR 'PL-A#3 NO 7—lau '3I HIGHWAY + YARD = TOTAL SE FROM TYPEOF EXISTING ADDRESS "•l1J(�'�N LICO Z,Z�O� FRONT PROP LINE HIGHWAY WIDTH Q •I LIC - + 1 CITYpLfZ G CLASS CONSTRUCTION LENDER BLDG SETBACK FROM NAME AND BRANCH SIDE PROP LINE OF ((STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF 1EXISTING d; ADDRESS CITY- SIDE PROP LINE HIGHWAY WIDTH, Q SO FT NO OF NO OF CHECK + '• _ V SIZE STORIES FAMILIES ONE USE ZONE - MAP _ DESCRIPTION OF WORK NEW Q NO SPECIAL d. !C t _S ADD CONDITIONS N d�jejv ALTER ❑ FINAL .4116 BY _ II REPAIR DATE / USE OF EXISTING BLDG DEMOL �. -_Z APPLICANT TEL C (PRINT) NO ~ I f ✓ J , BY(SIGNATURE) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE f(f be ! THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES . AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF _ V THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM. /r !!/ Z PENSATION INSURANCE SIGNATURE OF '- PERMITTEE ADDRESS Z TEL CITY NO Q D , PC Fee$ Permit Fee > r . IV6 f(.i issuanc.W Fee W � d ' DEPARTMENT OF BUILDING AND SAFETY APPLICATION FORPERMT I/ COUNTY OF LOS ANGELES , _ U I L.®I G ' WM. J. FOX, CHIEF ENGINEER �� t r FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. • 'BUILDING N. j�Trnrl �/�7iT AVE �^,� DQ ADDRESS i� A1(1((Uj�.7 r lY1KLV A `- � I, n� /� LOCALITY 1'EiuIPLE C IllECE D BY DATE OF APPL. DA E IS UED CROSS NEAREST. WOODRUFF AVEli Yl'1 /11`' N ' I�` /(I� �,y ,/ /' U 1 L 1-Ul 1JL ib ADDRESS '7/) /Yi /`44Y' AIXA! OWNER � MAILP& 41U iU8 W'fIf• • LOCALITY ADDRESS Ytl - IVEOREST ���� _ TEL:'�'�y' CROSS ST. �S CITY Ij.A. 12 NO.a o� 387.7 ZONE PLANE Z I TYPE GRg ARCHITECT O ([j TEL T7 rx1 Z4 ENGINEER x $ . G. SIS TH NO•D V `-' SET!ILDG. LINE ADDRESS 256 S .r���.�jj��''��YYMO STL.A. APPROVED V -' CONTRACTOR R 'TEL. is1'S.LVJL BY DATE NO. uruvtu USE APPROV 11 BB:a ZON BY DATE J ADDRESS t111W:J HOU E NUMBERING LEGAL SCRIPTION LOT NO. BLOCK MAP NUMBER --FIELD CHECK BY— )E _ TRACT - -NO. ASSIGNED BY - .- DATE NO. OF BLDGS. CORRECTIONS IONS OF LOT T i NOW ON LOT RE' USE OF I NO. OF e�"a. �. �7 G"� ��[D e"n '� i.�.Lfu...e_.✓ EXISTING BLDG.- FAMILIES ' DESCRIPTION OF WORK NEW I x I ALTERATION I I ADDITION REPAIR I I DEMOLITION SQ. FT. NO. OF �✓/rte^-SACS d G c'� -i✓ moi'' "'��� 41 SIZE 90 ROOMS 6 STORIES 1 z EXT. WALLROOF COVERING S'I'U 0I COVERING ljumpo f' USE OF STRUCTURE L.A. UUU 1 APPROVALS INSPECTOR'S SIGNATURE DATE 1 :HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. . - I AGREE TO COMPLY WITH THE CORRECTIONS 'LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUITURE OFLDING CONSTRUCTION. ( -�f FURNACE: LOCATION, / -SIGNPAERMITTEE �. )LiiU� i �JN � H�V r : rjt GAS VENT, DUCTS rnT FX CO LATH, INT. ADDRESS - LATH, EXT. _ -GMEER �fi�• Q� j �•' T�-10 D - PLASTER, INT. a IAC O•ov P. C. $ 10 - . � 1, FEE nk Q (lPLASTER, EXT. f d ,� 'VALUATION - FEE $ / ��r p� W— I p ti �yX/K �• � I I , W .� . •,-t.}1��fq{,��q.-pp,p.1�.p_L�qq�o_� .' 7GA638ACE4BO32-63 APPLIC'AT�ION ,FOR BUILDINGPERMIT COUNTY, OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY�ENGINEER ADDRESs 5, 38 "N,. Kaufan BUILDING AND SAFETY DIVISION " LOCALITY `. Tem le: Cit 'r'• -' JOHN'A.'LAMBIE, COUNTY. ENGINEER 'NEAREST'" WILLIAM A.--JENSEN. §UP'T OF BUILDING CROSS STr Las -Tunas ' DISTRICT NO,' "GROUP' -TYPE .,: '' PROCESSED BY- -FOR Y-FOR APPLICANT TO FILL IN- . 5.08 2=B3 corlsT. V W Ckland BUILDING' STATISTICAL CLASSIFICATION`" . 'SEW�KER,'MAP , ADDRESS I 8 -N. .Kauffman. Ave: 'CLASS NO.'2DWELL UNITS E-I`ll PG"• L_OT NO POI'. .Of 1011"& '102-_ BLOCK- WATERr - _ _ CERTIFICATE: -,N_OT REQU' -IRED ®- ,._ RECEIVED 6 :-y TRACT 61 - MAP HIGHWAY NO OF BLDGS NO 2OO (CIRCLE), STATE MAJOR SECO D;L AL SIZE OFUS�99ESNOW ON•LOT USE ZONE SPECIAL y "1 USE OF _ - - .4,- - -� CONDITIONS _ -EXISTING BLDG.'- b ), - - - -- _ EL:^ nr3- 4Y 'OWNER - BUILDING EXIST. /1 •� SETBACK YARD HWY, STREET NAME 1 . WIDTH ADDRESS Las Tunas Dr. FRONT OR _ c 't Kaur'ffuran -i� 6,0 ' , TEL. P L ' ENGINEERH1753 p ARCHITECT SIDEa A'DDRE55 + /� 'I rd I �V 11 ILL : rl 1 .� bL1rS17 !/1t •VI{ / /y + �Y'1 CONTRACTOR• ;.J, y; NO. yJ ADDRESS- '^:': 7 16�-,W �� O�'l✓ �'i!/•YG�j,' ' O �/l 3 DESCRIPTION,OF-WORK (� a �,�� ,. NEW ADD, I ,{ALTER`,% REPAIR •DEMOLISH SO. FT NO OF -NO- OF ,��' /N `+^'%/! i✓r - SIZE' Q0.•' "'.r STORIES FAMILIES 'USE OF •�• - ./{, / Y.' x' , ST UCTU RE'h Ci Ha1;1: pw SIGNATURE qF'_ ,•'.• p ,APPLICANT l� - •�- ,� �'- s 4 VALUATION"S ZOO OOO.-00 - �' APPROVALS, ATE INSPFrTOR s�SIGNATURE • •FOUNDATION LOCATION FEE 5'-'No ',Feel 'Y'• FEE-S ell, FORMS,-MATERIALS � '• , FRAME FIRE STOPS, , '1 - •, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE.ABOVE IS CORRECT,' NO AGREE TO COMPLY 'FURNACE LOCATION i WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING , GAS VENT BUILDING CONSTRUCTION I-CERTIFY THAT IN DOING THE WORK _ AUTHORIZED HEREBY I WILL,NOT EMPLOY ANY PERSON IN VIOLA- -LATH.-INT' ,/ �/A�,i..a.• �,�1 ' TION OF'THE,LABOR CODC OF THE-STATE OF CALIFORNIA RELAT- INGTO WORKMEN'S COMPENSAT N INSURANCE LATH, EXT y� . SIGNATURE OF ti HOUSE NUMBER-COR- j // _('/� • `/ , 'PERM'ITTEE_' RECT AND POSTED + ADDRESS gol --,JOHN F. LEWIS, RIN IPAL ST RAL ENGINEER_,• • PLAN CHECK VALIDATION.. PERMIT V DATION CK M o CASH ' L Oi 1 1 8 7 OCT 9 4 4 D .0.0 A L Lo 3 1 0 81 :OFc 4 1 D G 6 7.0 0� IT , 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 a certified copy thereof (Sec. 3800, Lab. C.) ?w4L-tiv7'f9 G.lflfZy✓ COUNTY OF LOS ANGELES BUILDING AND SAFETY �1� Policy No. Company ertified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS e�1J��'� � SCertified copy is filed with the county building inspec- BUILDING tion de�ariment. �7 ADDRESS �37c^��"'^� /t'�('f Z-- \ r CITY" <pntr� (� �C-c ZIP �lt���'+ LOCALITY Date Applicant `t f NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKE S' SIZE OF LOT NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCE ASSESSOR' (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK I PAGE PARCEL hundred dollars ($100) or less.) TEL. ZONE MAP USE .t� 9 OWNER I-i" Lo- G(. NO. UNO. ✓ `w�6I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS �� L4� vhf/�g ✓ 3 SPECIAL CONDITIONS a so as to become subject to the Workers' Compensation Laws. O � CITY (A G2 ZIP 108-1 U Date Applicant ARCHITECT OR TEL � NOTICE TO APPLICANT: If, after-makingthis Certificate of ENGINEER 43,4- NO. DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE F Exemption, you should become subject to the Workers' C // U Compensation provisions of the Labor Code, you must forth- ADDRESSff0 4' 1 2a with comply with such provisions or this permit shall be v ...c.g� �� . 1.�c TEL.Ilt( N deemed revoked. ONTRACTOR 1 NO �I� 7 91 STATISTICAL CLASSIFICATION APT. CONDO. Z LICENSED CONTRACTORS DECLARATION Qo Z i•+aS LIC• 6 CLASS NO. 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 Business 1 .n �" � 427af LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY'5A--.4 ►- �✓P- e_ CLASS BK. PG. VALIDATION c �_ SQ. FT NO. OF NO. OF CHECK License Number 7SZ 34<0 Lic. Class C 3 SIZE 4 QCT STORIES NO d ONE VALUATION Contractor Contractor Date DESCRIPTION OF WORK t7.�V NEW ❑ADD El �. $ .�, o Qen I►u. Taub Ruli— (d ► ❑I am exempt under Sec. � er +� � avt�� ALTER 1-1 B.&P.C. for this reason (z al. REPAIR ❑ $ USE OF Z r- •- Dat e: EXISTING BLDG. U t DEMOL ❑ Signature ` ` �" APPLICANT G TEL. Si g OWNER-BUILDER DECLAR131.5, ON (PRINT) �e� �+�►s � tt.�, NO?I+�-3�(7�j7�l' FINAL y+�✓�� nn C /I Q DATE I hereby affirm that I am exempt from thontractor's License ADDRESS'ZrJ Z [� - ia1 t Z7�t - Law for the following reason (Section Business and FINAL ,• ';= ••• Y"� Professions Code): PRESENT' By 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. , ', u ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. ""'"" with licensed contractors to construct the project-(Sec- ADDRESS tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT BACKK YARD HWY TOTAPROP.SETBALINEFROM yd DTH 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 Name LDMA Ref. # P.C. Fee$ Permit Fee ' Lender's Address 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 nvestigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # a and hereby autho ' e representatives of this County to enter u n t v -mentioned prop�rt for inspection u��ses. {trt W,I 1;//pp �'• 1{ (S 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur Applican or Agent Date WORKERS'COMPENSATION DECLARATION _t I hereby affirm that I have certificate of consent to self A P P L I CATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy Thereof (Sec. 3800, Lab:C. COUNTY OF LOS ANGELES BUILDING AND SAFETY. Policy mpany Z�.. �Vt" � _ Certi ied coy is hereby furnis ed. FOR APPLICANT TO FILL IN BUILDING ADDRESS 5938 N. Kauffman IETCertified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 5938 N Kauffman Temple City 91780 Date Applicant CITY T.0 ZIP 91780 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS'• NO. OF BLDGS: NEAREST. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need-not be completed if the permit is for one - ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER -CityOf Temple City TEL-. .285-2171 USE ZONE MAP I certify that in the performance of the work for which this NO. perm itis:issued,lshall not employ any person in any manner ADDRESS 5938 N. Kauffman _ - SPECIAL ' - - ••t� so as to become subject to the Workers'Compensation Laws. CONDITIONS O Temple City ZIP 91780 U CITY Applicant gg NOTICE TO APPLICANT:'if; after making 'this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED.BY ENGINEER NO. Exemption, you should become subject. to the Workers' - � CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS t C-6 / - with comply with such. provisions or this permit shall be a6i deemed revoked. TEL - STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTORD & W AssociateS N LICENSED CONTRACTORS DECLARATIONCLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS9067 E. Las Tunas Dr.NoLIC.451865 (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 BK ' VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number 451'865 tic.class R SIZE STORIES FAMILIES ONE Builders VALUATION NEW "1✓1 ; 1750.00 ContractorD & W' Associate Date DESCRIPTION OF'WORK ' ❑ 1 am exempt under Sec. Installation of temporary ADD ❑ , B.&P.C. for this reason handicap ramp. ALTER EJREPAIR ❑ s' Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. qp,�_qnu DATE ..Z I hereby affirm that I am exempt from the Contractor's License 9067 E ' Las Tunas Dr. T C Law for the following�reaADDRESS E. . T.C.(Section 7031.5, Business and . FINA Professions Code): "' PRESENT By 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 ' �0 8 iI 4 A '7044, Business and Professions Code). MOVING"' -TEL. - ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. # © o o ° o 1 with licensed contractors to construct the project (Sec- ADDRESS. tion 7044, Business and Professions Code). 1 o o 49.88- REQUIRED 9 8 8•.. REQUIRED TOTAL SETBACK FROM ST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT ° ° ° 4 9.8 8 v the performance of the work for which this permit is issued - P.L. (Sec. 3097, Civ. C.). SIDE 1 0.0 9=-8 4' m P.L. Q Lender's Name 3 LDMA Ref. # P.C. Fee$ - Permit Fee Lender's Address ' I.certify that I have read-this application..and state that the Issuance Fee c LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee Q ordinances and State laws relating to building construction, Total FeePerm. # d and hereby authorize representatives of this County to enter, upon the ove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE T Signature of Applicant or Agent - Date • F APPLICATION FOR BUILDING PERMIT COUNTY-QF LO&'ANGELES d.BUILDING AND SAFETY '' WORKER'S COMPENSATION DECLARATION.'' "FOR'APPLICANT TO FIL IN BUILDl r,.- . I hereby.affirm'that I have,a cerhflcate�of consent to self insure; BUIL J S or a certificate of Workers'.'Compensation Insurance, or a certrfledz eaki .Copy thereof,(Sec•, 8r 0, b C� CIT �• ZIP ',�� LOCA LIT -Policy No. "Company- _ Dv SIZE OF LOT NO.OF•BLD S NOW-ON LOT- NEAR T CROSS T ❑ Certified'copy is hereby-furnished El Certified copy is fled wit_h the co y,liwldmg insp } TRACT BLOCK"- - LOT•NO, 1. — • department - ; - - USE ZONE 'MAP NO - ��/�� ASSESSOR MAP BOOK Q�7 .PAGE �/c PQOC�. Dateca�N`JLpplicant, GQ SPECIAL CONDITIONS-- D CERTIFICATE,OF EXEMPTION FR WORKERS' o NER << T COMPENSATION INSURANCE wlTHini 1000 FT',OF SCHOOLS YES NO (This section need"not be Completed If,theperfllit iS'fbr,One hundred ADDRE I - _ - DISTRICT' GROUP TYPE CONST FIRE ZONE• PROC - dollars ($100)or'Pess.) - / V ' CITY '- •ZIP I'certify thaYm the per formance`of 'he work-for.whii lkthis'permit issued;-I'shall'not'employ' so a to`. become sub ect t ,Workers' ' ARCHITECT OR'ENGINEER - - dEL Q�...,., . '7�- '.'STATISTICAL CLASSIFICATION' APT CO DO- Date Applicant ADDRESS -- o - -- CLASS NO .DWELL UNITS NOTICE TO APPLICANT. If, after maki this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, -you should '•become ,.subject- -to•:'the, Workers". CO AC O• SET BACK_ YARD - HIM -To LINE WIDTH,,, _ Compensation provisions of.-the Labor',C e, you must.forthwith - r FRONT comply witli'Such provisions or-this permit shall be deemed revoked- r ADDRE • L - P-L ti 42 SIDE '- LICENSED CONTRACTORS DECLARATION' ClT LIC• 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•SIZ , NO OF 'TORIES' NO OF FAMILIES Professions Code,and y license is In'full force an effe t "' NEW ❑ PK• PG CL License Num er - LIC CIBSS r 1J SCRIPTI N OF W ADD O VALUATION' �� Contractor t. Date �" ��') ALTER ❑ $ . .— ❑ I am ez_empt under Sec cc REPAIR ❑ $ n B.&PC for thi's reason th '� DEMOL ❑ " (� LDMA P/C;#. (jJ `. -. - - " - USE XIS NG BLDG - URM ❑ - _ 'I- Date` Signature APPLICANT(PRINT) _ TEL NO'' LDMA Perm_# _ ID9 z Z I, as Owner of'the-property; or.my employees with wages-as'. y= their sole compensation, will do the work and the structure is ADDRESS ' not intended or offered for sale (Section-7044, Business and FINAL DATE, y Q i'[:_I4 Ei_l—i_•._i_i, `=�j �C Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL q ` OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER-THAN THE 7°i a .L H?t 54 ❑ I, as owner of the po'co scram exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY :�• licensed cor tractors to 'construct ahe project (Section- 7044, , Business and Professions Code) YES'0No❑ - _ ' • - WILL THE INTENDED USE OF THE'BUIDUNG BY'THE APPLICANT OR FUTURE BUILDING - _ _ _ • 'OCCUPANT A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH • - - CONSTRUCTION LENDING` AGENCY COASTAIRQUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR _ ' GUIDELINES I hereby,affirm that there Is a const�uction•lending.agency,'for, YES❑ Nod -- a the performance'of the work for which this permit iS issued(Sec rn - I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING, a 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 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE•SCAQMD EL L'ender's Address. O - . ON ER OR AGENT o I certify that-I,have read this application and state under,penalty , C ' PC FEE' ERMIT FEE t - d •of perjury hat the above Information is correct agree to comply t .a with all unty- ordinances and ee ws relating ,to building'const n, d hereby But zentatives of this County - - ISSUANCE FEEto ent above-me Ione for insp ction urp s' V INVESTIGATION F "TOTAL'FE '• - • ' SC-1 It AnPic It a AB SEE REVERSE FOR.EXP ATORY LANGUAGE 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 1203270072 PHONE:. (626) 285-0488 EXT: ILEGAL ID. NO. OF CONST I BUILDING ADDRESS: 1 ITR: 6561 _ LT: 101 BL: .001 I SQ. FT STORIES TYPE 1 5938 KAUFFMAN AV 1 I (STRUCTURE- y ; V-B TEMP CA 91780 - 1 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET- WOODRUFF 18587-025-902 II - THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl 1 (TENANT: - IIEXIST BLDG USE: COMME USE ZONE: C-1 (ISSUED ON: PROCESSED BY: IAT & T MOBILITY t1EXIST OCC GRP: 107/09/12 SR I I I I I 10WNER:� _ TEL. NO: IBLDGS. NOW ON LOT:' VALUATION: IFINAL DATE FIN BY: CODE: 1 ICITY OF TEMPLE CITY - 'I 7,500 - 19701 LAS TUNAS-DRIVE 1 ITEMPLE CITY CA 91780 1 - FEES PAID IDUC ION OF WORK 1 I IMODIFICATION TO AN EXISTING WIRELESS COMMUNICATION FACILITY 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IAT THE EDGE OF PARKING LOT IN A CITY OWNED PARK (APPLICANT: TEL. NO: I I IWDR LLC LJ DANIEL FOX (949) 644-0944- jA1 PLANCHECK W/EN-HC _ 7500.00 VAL 178.90 I - 1P0 BOX.8823 ;IAA BLDG PERMIT ISSUANCE - - 27.80 (SPECIAL CONDITIONS: INEWPORT BEACH.- - - IAB STATE GREEN BLDG FEE 7500.00 VAL 1.00 1, I 1A2 PERMIT W/ENERGY-HC 7500.00 VAL 210.50' ( I 1 TOTAL FEES 418.20 ICONTRACTOR- TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IALIANTEL INC. (800) 274-7074- .I I 138444 SKY CANYON DRIVE LIC. NO 1 - (LOCATION AND SETBACKS 1 1 1 IMURRIETA, CA 92563 911917BC10 1 1 . 11 i - 1 - ISOILS ENGINEER APPROVAL 1 i (ARCHITECT OR ENGINEER: TEL. NO 1 IFOUNJATION/TRENCH FORMS I I (ROME, JEFFREY (949) 760-3929- 11 SAN JOAQUIN PLAZA LIC. NO. 1 ISLAB%UNDER FLOOR I I I 1#360 C-020876 I + 11 1 INEWPORT BEACH, CA 92660 1 IRAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( _ - (UNDERFLOOR INSULATION I I I 1150H269 - 3 001 I I IFLOOR SHEATHING 1 INO. OF FAMILIES- DWELLING UNITS: APT/COND: STAT CLASS 1 - - I - 0 NO 22 I IROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAP PANELS I I I 1AIR QUALITY: 1000 FEET MATERIALS I I I I I 1 NO NO NO I IFRAME'INSPECTION I 1 IFIRE SPRINKLER HANGERS I I _ I I I 1 11NSULATION/WEATHER STRIPI I I 1 I 1 (INTERIOR LATH/DRYWALL I I I I I I 1 1 (EXTERIOR LATH I I I I I I 1RATED,FL0OR/CEIL ASSEM. I I I IRATEU WALL ASSEMBLIES I 1 1 I I I I 1 IRATED,SHAFTS/OPENINGS I I I I I I I 1T-BAR CEILINGS I I I I I I ILOT DRAINAGE I I I REPORT ID: DPR261 ROUTE TO: BS0508