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Home My Public Portal About9560 KENNERLY ST_Building__ 76A638A CE#803 3-68 APPLICATION FOR BUILDIN PERMIT COUNTY OF LOS ANGELES BUILDING. DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY ` JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST sl CROSS ST. i DISTRICT NO. GJ3PWP TYPE –PR' S •D BY FOR APPLICANT TO FILL IN " � CONST. (Print or type only) L/ � D e / BUILDING .STATISTICAL CfL_YSIFICATION SEWER P ADDRESS 9560 Kennerl . Temple City CLASS NO._SL—DWELL,UNITS. SK PG'v LOT NO. BLOCK USE ZONE MAP OF NO. TRACT SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG, BLDG,SETBACK FROM TEL. FRONT PROP.LINE OF (STREET). OWNER Earl E. P. tdlm NO. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL HIGHWAY WIDTH FROM C.L. ADDRESS 560 B nrie I CITY ARCHITECT OR TEL. BLDG.SETBACK FROM (STREET) ENGINEER NO. SIDE PROP. LINE OF TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS - - rf HIGHWAY WIDTH FROM C.L. CONTRACTOR 'V Roof NOL 287-0507 + O ADDRESS NO 1606 O CORNER CUTOFF YES E] NO E] U IC. CITY Gabriel CLLSSC-39 SEE REVERSE SIDE FOR.SPECIAL APPROVALS DESCRIPTION OF WORK a_ Reor z NEW ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTUREReroof Himse with 235# Composition Shingles. SIGNATURE OF APPLICANT VALUATION $ 346.W APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PM � $T. FOUNDATION: LOCATION FEE $ FEE FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS 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 HERJIWILL NOT EMPLOY ANY PERSON IN VIOLA. TION OF THE LAOF THE STATE OFCALIFORNI RELAT. LATH, INT. ING TO WORKMEN , IQN 1 RAN E. O'$ LATH, EXT.SIGNATURE OHOUSE NUMBER COR- PERMITTEE L RECT AND POSTED ADDRESS 00 S.San Gabriel, Sad Gabr: el FINAL JOHN F. LEWIS, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH A898 p - 1-6f 7i ACS#809 APPLICATION FOR BUILDING COUNTY OF LOS ANGELES BUILDING C1 ..-,� 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 NN GR�.UP' E FOR APPLICANT TO FILL IN BUILDING _ STATISTICALC ICATI SEWER MAP ADDRESS 6G �EN.✓��y K f CLASS.NO. DWELL. UNITS-1 ._a LOT NO. .�y t aS-/ Cf LO%aS BLOCK WATER NOT REQUIRED RECEIVED TRACT �3G.?O CERTIFICATE: _ _ _ MAP HIGHWAY NO.OF BLDGS. NO. (CIRCLE) TATE MAJOR SECOND, LOCAL SIZE OF LOT 6-1,6 X _117 rYS I NOW ON LOT � USE ZO E SPECIAL / / USE OF CONDITIONS EXISTING BLDG. OWNER �� L`i /-, �MA4/ NO.AT6- 7172 BUILDING Z-� 'EXIT. SETBACK YARD HW ST EET NAME _ WIDTH ADDRESS Y*�c NNc%'L 1' FRONT ARCHITECT OR TEL. P. L. ..� ENGINEER NO. SIDE P. L. V' G ADDRESS a TEL. INSPECTION RECORD/ 0 , CONTRACTOR r�W NO. f, ADDRESS j \0 DESCRIPTION OF WORK NEW (gD2 ALTER REPAIR DEMOLISH /Z SQ. FT. NO.OF NO.OF $IZE 7 r", STORIES FAMILIES / USE OF STRUCTURE AOoL Li✓i NG !r'JiiRTt:P)..► ��I, l3NYN ��✓tiro �'A4�. LL/rax s.�oF' SIGNATURE APPLICANT .�LJ+*.c+ 1 _ VALUATION APPROVALS 'DAT INSPECTOR'S SIGNATURE nn qq ( FOUNDATION: LOCATION FEE $ C'it,l � FEE $ FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS 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. ICERTIFY 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 TD WORKMEN_ M�PENSAT � LATH, EXT. SIGN T E ERMITTEF' HOUSE NU MBER COR- PRECT AND POSTED ADDRESS/ y'��<% �'= ^'�`rRly,, /tMP1C"C-'iiy FINAL CLYDE N. DIRLAM, PRINCIPAL ST CT RAL ENGINEER PLAN CHECK VALIDATION cm M.o. CASH PERMIT VALIDATION CK.ll M.O. CASH i .. .. 375 4 Ili 21 n0 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 1103100073 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 13620 LT: 24 BL: .001 SQ. FT STORIES TYPE 9560 KENNERLY ST I I _STRUCTURE: V-B TEMP CA 917803837 1 ASSESSOR INFORMATION NUMBER: .. I NEAREST CROSS STREET: 18590-014-012 I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl (TENANT: IEXIST BLDG USE: RESID USE ZONE: R=1 ' 11SSUED ON: PROCESSED BY: I I IEXIST OCC GRP: 103/10/11 SR I I I I I (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: I F.LNAL PAITE FIN Y. CODE: I IPITTMAN, RICHARD (909) 643-3430- 1 7,870 1 ' 1 19560 KENNERLY ST 1 1 ITEMP 917803837 FEES PAID IDYSCRIF#riofq bF WORK I I IREPLACE (12) EXISTING WINDOWS WITH RETRO-FIT VINYL DUAL-PANEI I _IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IWINDOWS, LIKE-FOR-LIKE REPLACEMENTS I (APPLICANT: TEL. NO: I I I GUERRA, CARLOS (818) 349-5566- IAA BLDG PERMIT ISSUANCE 27.80 1 1 120735 SUPERIOR ST. IAB STATE GREEN BLDG FEE 7870.00 VAL 1.00 ISPECIAL CONDITIONS: I ICHATSWORTH, CA 91311 1AC STRONG MOTION RESID 7870.00 VAL 0.80 1 ID2 PERMIT W/O EN-HC 7870.00 VAL 183.40 I 1 1 1 TOTAL FEES 213.00 1 1 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I ICALIFORNIA DELUXE WINDOWS INC. (818) 349-5566- 1 1 1 120735 SUPERIOR ST. LIC. NO I ILOCATION AND SETBACKS I I I ICHATSWORTH CA 91311 774518 B I I I 1 1 I I ISOILS ENGINEER APPROVAL I 1 1 _1 1 I I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I I - I I 1-1 1 I LIC. NO: I (SLAB/UNDER FLOOR I I I I I I I I I I I IRAISED FLOOR FRAMING 1 1 1 I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION I I I 1144H269 3 001 1 1 1 I I IFLOOR SHEATHING I I I INo. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I I I NO 21 1 IROOF SHEATHING I I I I _I 1 11 1 I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS I I I I I NO NO NO I IFRAME INSPECTION I I I I _I I I I I IFIRE SPRINKLER HANGERS I I 1 I I I I I I (INSULATION/WEATHER STRIPI I I I I I I I I I ANTERIOR LATH/DRYWALL I I I I I 1 11 1 I I IEXTERIOR LATH I I I I I I I I I I IRATED FLOOR/CEIL ASSEM. 1 I I I I I I I IRATED WALL ASSEMBLIES 1 1 I I I I I I I IRATED SHAFTS/OPENINGS 1 I I I I I I I I IT-BAR CEILINGS I I I I I ILOT DRAINAGE I I I I I I 1 IREPORT ID: DPR261 ROUTE TO: BSO508 I I I I I I I I I WORKERS'COMPENSATION DECLARATION fj I herby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING PERMIT 111 .,insure, to a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, L b. C.) > COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli No. 3 /y-L' Company ? BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS /T/ Certified copy is filed with the county building inspec- BUILDING _ tion depart en . ADDRESS F LOCALITY - NEAREST , Date Applicant CITY ` ZIP CROSS ST. dERT'1Ff6ATE OF EXEMPTION FROM WORKERS' ,NO. 11 IIDGS�. ASSESSOR SIZE OF LOT 3 S X//7, NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE !! �/ p / USE ZONE MAP / (This section need not be completed if the permit is for one TRACT !' h ZU BLOCK LOO °iC•r T NO. hundred dollars ($100)or less.) TEL. SPECIAL - y- I certify that in the performance of the work for which this OWNER J l NO. R � / CONDITIONS permit is issued, I shall not employ any person in any manner L DISTRICT OUP TYPE FIRE PR CES EF BY O ADDRESS q.57/_.0 � /�/j I CONS ZONE 41 so as to become subject to the Work rs'Compen tion Laws. c DO 3 ��///i- 4-iU�( iiTY 6 ZIP / Z3 O Date Applican STATISTICAL C IFICATI N APT. CONDO. U NOTIC TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. // ENGINEER NO. CLASS ELL. UNITS W Exemption, you should become subject to the Workers' IL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR j NO. _ 13/ BK. P v VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Z S S NO.5ads3v VALUATION v (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY,' G°� % CLASS - / $ f d o.D d SQ. FT. NO.OF NO. OF CHECK , License Number 0-S 3 YL Lic.Class SIZE STORIES FAMILIES ONE Contractor Date / �j DESCRIPTION OF WORK /' NEW 1 am exempt under Sec. / O ADD ALTER FINAL 7 ` B.BP.C. for this reason REPAIR ElDATE _ l Date: USE OF DEMOL FIN EXISTING BLDG. lr�S i _ g El Signature APPLICANTTEL. OWNER-BUILDER DECLARATION PRINT AleotwT NO. X .s I hereby affirm that I am exempt from the Contractor's License ► Law for the following reason (Section 7031.5, Business and ADDRESS 0_/Ppap, Jy Professions Code): PRESENT ❑ 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. 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). REQUIRED TOTAL SETBACK FROM EXIST. �5 3 9.'8 A CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT # o G o G'o 1 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE I oil 24,'88 FO P.L. o Lender's Name - ° o 1 24.8 8' P.C. Fee$ Permit Fee 0099--86 Lender's Address W I certifythat I have read this application and state that the PP Issuance Fee above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee v and hereby authorize representatives of this County to enter m upon the above-mentioned property for inspection purposes. - d a SEE REVERSE FOR EXPLANATORY LANGUAGE a Signature of Applicant or Agent Date es #910279 SB APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADD s BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, 9560 E. Kennerl or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3800,Lab.C.) Republic LOCALITY PC997500 Indemnity Temple Cit NOW LOPolicy No. Company y SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ® Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 7-1-92 Applicant Virgin Roof Co. ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. YES NO COMPENSATION INSURANCE Earl Pittman WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred 9560 E. Kennerl DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit Temple Cit 91780 f)� - 3 3 e is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICALCLA IFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 4X� DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR TELNOREQUIRED TOTAL SETBACK FROM EXIST . . Exemption, you should become subject to the Workers' SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Virgin Roof Co. 287-0507 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL P.O. Box J 160650 SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL o l C39 i b Gare I hereby affirm that I am licensed under provisions of Chapter 9 San SEWER MAP SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES L (commencing with Section 7000)of Division 3 of the Business and 14 S S. 1 NEW ❑ SK 1/�/ PG Professions Code,and my license is in full force and effect. v 160,650 C39 DESCRIPTION OF WORK ADD ❑ VALUATION W License Number Lic.Class a Virgin Roof C 6-30-93 Over existingroof apply $ 1747.00 Contractor ®ate ALTER ❑ _ Class A Fiberglass Shin les. REPAIR ❑ $ ❑ 1 am exempt under Sec. B.&P.C.for this reason 14 S s. DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ .; Dwelling— Z Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# ❑ 1, as owner of the property, or my employees with wages as Virgin Roof Co. 287-0507 C their sole compensation,will do the work and the structure is ADDRESS F •_ not intended or offered for sale (Section 7044, Business and P.O. Box J San Gabriel CA 91778 FINAL DATE Q - Professions Code.) M WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q "."a:'" i, �}• ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY I'-1!P f a licensed contractors to construct the project.(Section 7044, YES❑ No I_ K` ' Business and Professions Code.) -•• CK WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH //n�� _('';,.''.'�}cf _ e13�; CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I(� I hereby affirm that there is a construction lending agency for YESKI El NO _ 1• the performance of the work for which this permit is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD - `''-3- •—'-;k 'ir•j„Lt`'J�r• 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES a t �. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING ,,„•i,z, �''�I 's,' ;a Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. ' aLender's Address OWNER OR AGENT o I certify that I have read this application and state that the above FEE P.C. PERMIT FEE o $ information is correct. I agree to comply with all county �f 3t3 N 57•37 ordinances and State laws relating to building construction,and ¢. hereby authorize representatives of this County to enter upon ISSUANCE FEE Te e abovetione property for inspection purposes. 13_ r00 .�.� 9-18-91 INVESTIGATION FEE TOTAL FEE/ g V-e Apgirant tt Aqa Dab SEE REVERSE FOR EXPLANATORY LANGUAGE 940130 SB COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A R„E.s� I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 0 or a certificate of Workers' Compensation Insurance,or a certified 560 Kennerl copy thereof(Sec.3800,Lab.C.) CITY ZIP Policy No. AC3339 company Alpine"Ins._Co. Tem le City 91780 LOCALITY SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified Copy is hereby furnished. I NEAREST CROSS ST. Certified Copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 12-19-94 Applicant Virgin i n ROOF Go- ASSESSOR MAP BOOK PAGE PARCEL g SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE Earl Pittman WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS 9560 Kennerl DISTRICT GROUP TYPE C NST. FIRE ZONE PROC dollars ($100)or less.) ^ CITY ZIP I certify that in the performance of the work for which this permit Temple Cit 1]80 is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. I p STATISTICAL CLASSIFICATION APT IONDO 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 Virgin ROOF Co. 818-287-0507FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L 600 LICENSED CONTRACTORS DECLARATION San Gabriel 160650 PILE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 San Gabriel C39 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and m license is in full force and effect. NEW ❑ BK PG �- v 1+2 s s one a License Number 160650 Lic. Class C39 • DESCRIPTION OF WORK ADD ❑ VALUATION > O Contractor Virgin Roof CvaIle 6-30-95 Tear off then ALTER [D $ 2988.00 U ❑ I am exempt under Sec. and cap sheet, REPAIR ❑ $ 0 B.BP.C.for this reason DEMOL ❑ LDMA P/C# W Date. USE OF EXISTING BLDG. URM ❑ a Dwelling (A Signature APPLICANT(PRINT) TEL NO, LDMA Perm# Z ! El 1, as owner of the l. property, or my employees with wages as Virgin Roof CO. 1818-287-0507Z their sole compensation, will do the work and the structure is ADDRESS J 0 not intended or offered for sale (Section 7044, Business and 600 S. San Gabriel San Gabriel 1 76 FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of theOR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE u property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 7 1 T `j - licensed contractors to construct the project (Section 7044, YES El I Business and Professions Code.) j_j 1 HL `- 0-7 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - r. • 10' y-E•,+; rf:i•s�w-7 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR S'M..AI �� %V GUIDELINES. ///"'��'��'NWW/��"'"`�� I hereby affirm that there is a construction lending agency for YES❑ NON L (/ t '_4 Hi l3t =1 101_l the performance of the Work for which 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, r C N 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. IJOi f i} a Lender's Address --•, OWNER OR AGENT `�ilwf_J i L!j;y y e if•j 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 PERMIT FEE with all county ordinances and State laws relating to building 133.32 W construction, and hereby authorize representatives of this County ISSUANCE FEE co to enter pon the above-JS1 tinned property for inspection purposes. 24.75 INVESTIGATION FEE TOTAL FEE O SEE REVERSE FOR EXPLANATOR A{J 'h16