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HomeMy Public PortalAbout9177 LAS TUNAS DR_Building__ J6A638A'CE98036-69. APPLICATIONS FOR BUILDI eGPERMIT_ ..COUNTY OF LOS ANGELES BUILDING /' DEPARTMENT OF. COUNTY 'ENGINEER ADDRESS / BUILDING AND -SAFETY DIVISION LO C A L I T Y� JOHN Ac LAMBIE. COUNTY ENGINEER NEAREST f COLEM'A N'W. JENKINS,SUP'T.OF BUILDING CROSS ST. DIST ICT NO .GROUP YPE., P O Y FOR APPLICANT-TO FILL IN• ' D cONST,. BUILDING /y�� - ,STATISTICAL ASSIFICA-TION ., ,SEWER MAP ADDRESS... / .I/ CN ' LUNITS. - DK SPG LASS NODWELL . LOT NO. BLOCK/ USE ZONE .MAP - NO. TRACT /.. . �• :SPECIAL N0. OF BLDGS. CONDITIONS _. SIZE SOF LOT :NOW ON LOT USE OF EXISTING B DG.. G'�-S ^ /�(9� BLDG. SETBACK FROM TEL:. FRONT PROP.-LINE OF'- EET) - OWNER �., S NO• TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL' ADDRESS HIGHWAY WIDTH "FROM C:L'. - - CITY - - - BL SETBACK.FROM' ENG'NIEETEC RTV/lee�� NOL SI PROP.-LINE OF - - -' (STREET) . OF .EXISTING SETBACK •HIGHWAY, +, YARD TOTAL ADDRES /�. oe t- / /y6CA HIGHWAY WIDTH FROM C.L. CONTRACT. �C L��cv� /Irl LIC CORNER CUTOFF YE NOE] OV ADDRESS '3 F ,2%e NO r - - LI ~�® ISEE,REVERSE SIDE FOR SPECIAL APPROVALS O. CITY CLASS DESCRIPTION 0 .WORK u W a NEW •ADD - ALTER 'REPAIR'- DEMO LIS�H moi°' ,�,({ " N SQ.FT. -NO. OF NO. OF kr -6/ 4'' SIZE STORIES FAMILIES USE OF STRUCTUREoa Sf' - - P SIGN`TUREOF APPLICANT ,V.ALUATI.ON$ d•� - - J APPROVALS DATE .INSPECTOR�S SIGNATURE P;C. PMT. FOUNDATION, LOCATION - F -FEE..$ -FORMS; MATERIALS FRAME; FIRE STOPS, I HEREBY ACKNOWLEDGE THAT,I. HAVE READTHIS 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 9UILDING' CONSTRUCTION. I TI Y THAT. DOING WO K _ AUTHORIZED HEREBY W' LL T PL Y P ',/JT'Iy� L'ATH. INT. ' TION OF THE LAB. L� �; F1� L - ING TO WORK MEN'SE SATION'INSURAN LATH. EXT. SIGNATU RE'O F. [HOUSE NUMBER COR- - PERMITTEE RECT AND POSTED ADDRESS _ ` FINAL - •' , JOHN F. LEWIS.. PRINCIPA L'STRUCTU RAL EN PLAN CHECK 'VALIDATION CK M.o. .CASH PERMIT`VALIDATION CK. M.O. CASH AUG 75- 15 - 1 4 3`3 AUG 15 2 0 �. �,p APPLICATION FOR BUILDING PERMIT "iiOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES LDING ADIDRESSq1772 _ DEPARTMENT OF COUNTY ENGINEER ZIP BUILDING AND SAFETY DIVISION CITY f. NO OF BLDGS BUILDING e;:P SIZE OF LOT �Q NOW ON LOT ADDRESS TRACT W BLOCK LOT NO LOCALITY TEL NEAREST - OWNER NO CROSSST .✓ ASSESSOR ADDRES R� MAP BOOK, PAGE PARCEL DISTRICT GROUPT PE FIRE PRESSED Y CITY : �-} aft, ZIP ONS ZONE ARCH) ECT OR TEL ENGINEER NO STATISTICAL CLASSIFICATIOte SEWER M P ADDRESS CLASS NO O DWELL UNITS BQ5 PG �,. TEL 11,, CONTRACTOR � NC1�7 a USE ZONE MAP LIC NO ' -o C/ ADDRESS ` NO Z SPECIAL LIC /'1 CONDITIONS CITY _ CLASS CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ NAME AND BRANCH BLDG SETBACK FROM FRONT PROP LINE OF iSTREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ FT NO OF NO OF CHECK HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIPTION OF WORK C ! NEW + 4 O v ADD BLDG SETBACK FROM 0 x SIDE PROP`LINE OF' (STREET) O ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING u L.1lJ ❑ HIGHWAY .+ _.YARD SIDE PROP LINE HIGHWAY WIDTH N USE OF REPAIR Z EXISTING BLDG V /J DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) �' 7 � NO _ INOPEN SPACE YES ❑ NO ❑ BY)SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION $ k- 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 CONSTRUCTION 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 CALIFORNIA IN RELATING TO WORKMEN S COM PENSATION INSURANCE SIGNATURE OFA PERMITTEE V ADDRESS + ] FINAL ^h BY �a NOL Lr DATE ! CITY / I MAKE CHECKS PAYABLE-TO FEE $ J FET- / O HARVEY T.BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION GK' M O ' CASH 7231, D 4.40 8 4 9 r-,APR 22 1 ®' 2,4.0 0 ego i 76A638A CE#803 3 75 L9 -� /( NA638ACE08038-64 APPLICATION FOR BUILDING PERMIT .. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER' ADDRESS , BUILDING AND SAFETY DIVISION LOCALITY, JOHN A. LAMSIE• COUNTY ENGINEER NEAREST COLEMAN W JENKINS,SUP'T OF BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTRICT No GROUP, TYPE PRO SSED By 17. CONST BUILDING STATISTICAL LASS]FIC ATION• SEWER MAP ADDRESS S CLASS NO DWELL UNITS �'� -BK PG LOT NO T. BLOCK USE ZONE MAP - TRACT - NO - _ SPECIAL j NO OF BLDGS l CONDITIONS SIZE OF LOT !� NOW ON LOT USE OF -f- ' I G ` BLDG SETBACK FROM �l_ TEL FRONT PROP LINE OF (STREET) OWNER / D/ NO TYPE OF E%ISTI NO SE_T_BACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY 'F M C L CITY U �S_ ARCHITECT OR TEL BLDG SETBACK FROM - ENGINEER NO SIDE PROP LINE OF (STREET) TYPE OF EX STING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L a CONTRACTOR _ < < TEL /SQ/��11���`�. t + _ U ADDRESS © O NO �[.�V CORNER CUTOFF YES NO ❑ O CITY S LI LASSms`s~ SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK N Z_ NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE IAIOW SIGNATURE OF APPLICANT VALUATION$ APPROVALS DA TE INSPECTOR'S SIGN RE P C PMT FOUNDATION, LOCATION A FEE$ FEE$ FORMS,_MATERIALS 'FRAME, FIRE STOPS, ~' I HEREBY ACKNOWLEDGE THAT I 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 9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA" LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COMPEN ANC E LATH EXT SIGNATURE OF D ,HOUSE NUMBER COR- PERMITTEE RE AND POSTED ADDRESS FINAL Ia9 A;- i PLAN CHECK VALIDATION CK Mo CASH JOHN F LEWIS PRINCIPAL STRUCTURAL EN NEER PERMIT VALIDATION CK MO CASH OCT13 6 4 0 1T 1 D 8.0 ON APPLICATION FOR' SUIL®ING PERMIT • COUNTY OF LOS ANGELES BUILDING AND SAFETY i WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ^'1/ BUILDING ADDRESS t 1,h�reby affirm that'I have a certificate of consent to self insure, , , G v _4r.a certificate of Workers'Compensation Insurance,or a certified CITY zIP copy thereof(Sec,,%W,Lab C) LOCALITY JET LOCALITY Policy No 4 Company �usm SIZE OF LOT C• A r I NO OF BLDGS OW ON LOT y❑ Certified copy is here y furnished 5� 56- NEAREST CR SS ST Certified copy is filed with the county budding Inspection TRACT BLOCK LOT NO ment Q USE ZONE MAP NO depa �qn/ ASSESSOR MAP BOOK PAGE PARCEL Dater Apphca � y ,, r � � SPECIAL CONDITIONS 1' CERTIFICATE OF EXEMPTION FRO ORKERS' OWNER a ' TEL O 8 YES NO COMPENSATION INSURANCE V WITHIN 1000 FT OF SCHOOL? ADDRE (This section need not be completed If the permit Is for one hundred D 0 S DISTRICT GROUP TYPECONST' FIRE ZONE P CESSEI Y dollars( 100)or less) CITY ZIP �i) ya � � � r�I certify that In the performance of the work for which this permit l /p4'is issued, I shall not employ any person In any manner so as to ARCHITECT O EN INE R TEL NO �.i become subject to the Workers'Compensation Laws Ao STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS �1' CLASS NO �—DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate oft REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become SUbJBCt t0 the Workers, CONTRACTOR AI�n/ Tom- —�` SETBACK YARD HWY PR©PiINE WIDTH Compensation provisions of the Labor Code, you must forthwith �1�jK�•/ FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS I Ir NO PL ''t.[; e v SIDE LICENSED CONTRACTORS DECLARATION CITY LIC CLASS PLto _ U I hereby affirm that I am licensed under provisions of Chapter 9 SQ FT G� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and Sfif NO OF STORES NO OF FAMILIES i ITEMS 1 L 1 t�f I_° O Professions Code,and my license is in full force and effect /Q/er{ NEW BK PG , TOTAL i f�7+ 1� License Number Llc Class0. � DESCRIPTION F WORK 1 VALUATION ���W -� �a3 ADD ❑ Contract-? rab`�i1�J - Z/ ate I I/Lf 9// ALTER ❑ ° �' i 11�7 REPAIR 1:1 .I�z_ ❑ I am exempt under Sec T x9a, 7,* • CANGE .10 1 B BPC for this reason DEMOL ❑ vS Date USE OF EXISTING BLDG URM 1:1LDMA P/c n �I�,Iji�-I�}�Ij i ri;�i�l,/'-`I_ Signature APPLICANT( INT) O TEL NO LDMA Perm k z 13;.74 v 1 AM u 27 Elp o I, as owner of the property, or my emith wages asAOL �' p their sole compensation,will do the work and the structure Is ADDRE 0. / not intended or offered for sale (Section 7044, Business and 44 e L (J v/ FINAL DATE Q _ Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HAND LE A S IAL � �� � _ o– OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO G EA HAN J �• -_ ❑ 1, as owner of the property, am exclusively contracting With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY I `wl C I� i 1CI v T' licensed contractors to construct the project (Section 7044, Business and Professions Code) WIL El No C3t- 1_f is WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING Li OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �� �3 i, l..I}•.1?h� vj lel CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES / 1hereby affirm that there is a construction lending agency for YES ElNO❑ the performance of the work for which this permit Is issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD J 3097,CIV C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES /�/77-" COUNTY CODE,TITLE Z CHAPTER 220 SECTIONS 2 20 100 THROUGH 220140 CONCERNING �{ - Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMDCI Le0. nders Address Address O'"EN OR AGENT o I certify that I have read this application and state that the above !/ r• �'�� Information IS correct I agree to comply with all county PC FEE PERMIT FEE ordinances and State laws relating to building construction,and 7U� a hereby aUthOTIZB representatives of this County to enter upon /y.7 i;7"5- ISSUANCE FEE the above-mentioned roperty for Inspection purposes a 1 INVESTIGATION FEE TOTAL FEE of Appko wAg� Due SEE REVERSE FOR EXPLANATORY LANGUAGE <% \i ORKERS' COMPENSATION DEC,LARATIOM nure herebor affcertif carte of WorkersrtComtpensahon Insuran elf A P P L I CATION FOR BUILDING P E RIS I T or a certifiedcopy thereof (Sec 3800, Lab C ) rCOUNTY OF LOS ANGELES BUILDING AND SAFETY �p Policy No �0L44?&pany Wv7 BUILDING / ❑ Certified copy is hereby,furnished -7-�� FOR APPLICANT TO FILL'IN ADDRESS �L% 7 Z'fiffl/ J* ❑ Certified copy is filed.with the county building inspec' BUILDING / 7 _ ys� A- f - � Ut� + tton department ADDRESS ��•�� CITY t ZIP V LOCALITY Date AI cant I I �lO St NO OF BLDGS CER- KATE OF EXEMPTION FROM WORKERS' 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 LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100) or less ). 'ZL f NO USE ZONE, OP OWW 1,66 NER I certify that in the performance of the work for which thisSPECIAL `� permit is issued„I shall not employ any person in any manner ADDRESS % //�(� Cf CONDITIONS CL so as to become subject to the Workers'Compensation Laws ��j O /ter �/I / t Le -ZIP y/' ?0 U Date Applicant v��r I ARCHITECT OR TELUoe DISTRICT GROP TYPE FIRE PROCESSED BY NOTICE TOA LICANT If, after Z making this Certificate of ENGINEER NO , CONST NE `� 00 Exemption, you should become subject to the Workers' / f J/ � , � U Compensation provisions of the,Labor Code, you must forth- ADDRESS V liG �=z"�� a with comply with such provisions or this permit shall beTEL I STATISTICAL CLASSIFICATION APT CONDO N deemed revoked CONTRACTOR (��� �J NO Ge _- �� � Z LICENSED CONTRACTORS-DECLARATION ADDRESS /4t4) dI' t LIC , CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 -LIC (commencing with Section 7000)of Division 3 of the Business LIC , '� SEWER MAP and Professions Code,and my license is in full force'and effect CIN %J/j y fol CLASS ` /-45— BK PG VALIDATION SQ FT NO OF NO OF CHECK •'License Number .7 L7��7 / 'Lic Class (/ SIZE I STORIES FAMILIES ONE VALUATION Contractor y E�Date ` r DESCRIPTION OF WORK ; ADD ❑ ; �_ ❑I am exempt under Sec f tK M �/ ' `Gb C ❑ �� ALTER ❑ , B&P C for this reason � `� USE OF REPAIR ❑ $ Date ( EXISTING BLDG DEMOL ❑ Signature c APPLICANTTEL / FINAL OWNER2BUILDER DECLARATION (PRINT) /�` /.( NO Q� DATE —�/ I hereby affirm that I ai exempt from the Contractor's License ADDRESS" f v[� / f�� Y/!� Law for the'following reason (Section 7031 5, Business and FINAL = �- Professions Code) PRESENT By ❑ I, as owner of the property, or m employees with BUILDING ,',},; ,Ir - P P Y� YADDRESS _ wages as'their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 7044, Business and Professions Code ) MOVING TEL CONTRACTOR NO 1, as owner of the property, am exclusively contracting , with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code ) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 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 ' ;nom (Sec. 3097, Civ C ) 11SIDE t' PL _ Lender's Name J �f (' r =' A LDMA Ref # / -4 66 "' 0<�j�1�- !(� P C Fee$ / Permit Fee Lender's Address ` a 71P - � 2 � - o I certify that I have read this application and state that the Issuance Fee �✓ LDMA P/C# o ` above information is correct I agree to comply with all County Investigation Fee , y� ordinances and State laws relating to building construction, Total Fee LDMA Perm # a and hereby authorize representatives of this County to enter i E ' upon the above- endo d property for inspection_purposes "- "' ;jrl +a a SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu f plican�t Date J WORKERS' COMPENSATION DECLARATION *Insure, or a�certificate of Workers' Comipen'sat on Insuran elf APPL I CAT I O N v F O R BUILDING PERMIT or a certified copy thereof (Sec 3800, Lab ,C ) _I R COUNTY OF LOS AN(sEIES BUILDING AND SAFETY P h�e �oBUILDING _Company >�/j� �efL�LD LJ ,Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS Date Applicant �a�GUI 1 CICO,. CITYTayjv— ZIP LOCALITY T ', _ 'NO OF BLDGS NEAREST 'CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST COMPENSATION INSURANCE ASSESSOR t(This section need not be completed if the permit issrfor one TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100) or less ) TEL OWNERNO USE ZONE MAP I certify that in the performance of the work for which this NO •permit is issued, I shall not employ any, SPECIAL person in any m ner ADDRESS CONDITIONS d so as to b come subject t th Workers Compensate O t �.� CITY ZIP Date pplcant ��uer�; '-'iii t'�Cb ARCHITECT OR TEL O DISTRICT GROUP_JTYPE FIRE ZRC SSED BY NO E TO APPLICANT If, after making this Certificate of ENGINEER NO _ Exemption, you should become subject *to, the Workers' yy CONST E U Compensation provisions of the Labor Code, you must forth- ADDRESS J.0� SI S a with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT Z deemed revoked CONTRACTOR N _ LICENSED CONTRACTORS DECLARATION LIC CLASS NO 22� DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE NO (commenting with Section 7000)of Division 3 of the Business ense LIC SEWER MAP and Profess ions,Code,and my licis in full force and effect CITY U CLASS S BK VALIDATION SQ FT NO F NO OF CHECK FIG License Number Lic Class G`f SIZE I STORIES FAMILIES ONE VALUATION, Contractor 7�JS( > � �n,Date DESCRIPTION OF WORK NEW ADD $ ♦ M s' El ❑I am exempt under Sec ❑ ;-;;f ALTER B 8P C for this reason- USE OF REPAIR $ ❑ Date EXISTING BLDG DEMO' ❑ ✓-; s a,• 1 Sinature g APPLICANT TEL FINAL -= t - ..I 3j ' •},� 4.;;;, OWNE (PRINT) NO ILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031-5, Business and ADDRESS FINAL T: Professions Code) Y PRESENT B fi BUILDINGr• !r ❑ 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 LOCALITYpolo 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- f tion 7044, Business and Professions Code ) ADDRESS -1-i-1;-_;-)i 4_,_ 47 REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 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 J Maxi^ter P L Lender's Name ` ) qQ1 c�,, LDMA Ref # U 1e�l�1 i 1 ren 1- /D' P C Fee$ Permit Fee ,Lender's Address u �}+ W `S�� r,uc.• r o, 9 L I certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct I agree to comply with all County Investigation Fee f n ordinances and State laws relating to building construction, Total Fee I 1 3 8�^ LDMA Perm # and hereby authorize representatives of this County to enter upon the abov mentioned pro erty for inspection purposes rpplicaen �— SEE REVERSE FOR EXPLANATORY LANGUAGE ig of Ant or gt Date ' APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING ADD;P,/"' E S ';1 '• WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN �7 � �� ' BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure, 7� M a certificate of Workers'Compensation Insurance,or a certified CITY ZIitv P copy thereof(Sec 38Las Tunas pr 00,Lab C) LOCALITYTemple C _911780 _ Policy NO Company SIZE OF LOT NO OF BLDGS NOW ON LOT Certified copy is hereby furnished 7418 NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO department 05905 USE ZONE MAP NO ASSESSOR MAP BOOK PAGE PARCEL Date Applicant 72 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER GALAXY Mt INC TEL NO—100-8692 WAIN 1000 FT OF SCHOOL? YES No COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit Is for one hundred mninins 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 Alhambra, 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 Kai Chan IRIR-282-1109 STATISTICAL CLASSIFIC TION — % APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of 221 W. Las Tunas Dr:- San Gabriel 91776 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become SUbJBCt t0 the Workers' CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith L FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L �'EGEC rE/) y, LICENSED CONTRACTORS DECLARATION CITY LIC CLASS PIDE oCL hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP U (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE NO OF STORES NO OF FAMILIES / C= Professions Code,and my license is in full force and effect NEW El BK 1:5 PG ® 0 DESCRIPTION OF WORK ADD E] VALUATION W License Number Lic.Class p Contractor DateBlaildALTER El $ Z ❑ 1 am Exempt under Sec REPAIR ❑ B&P C for this reason DEMOL A2 LDMA P/C# Date USE OF EXISTING BLDG URM ❑ Signature APPLICANT(PRINT) TEL NO LDMA Penn# j y employees 9 WILLIAM NG GALAXY MTG. 818-300-8688 0 1:1 I, as owner of the property, or m em to ees with wages as IL their sole compensation, will do the work and the structure is ADDRESS r;C=•i ,s not Intended or offered for sale (Section 7044, Business and 2550 W. Main St. #308 Alhambra Ca. F1 LLDA _�� Professions Code) WILLTHE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL /` Jj �~ I, as owner of the r0 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ` ,iy property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B > fcensed contractors to construct the project (Section 7044, YES❑ No Business and Professions Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _i v�`6 j IfiF 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❑ I i TEM the performance Of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD TOTAL i�r'+L= 3097,Civ.C.) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES S.�5"Q °Y "' COUNTY CODE,TITLE 2•CHAPTER 2 20 SECTIONS 2 20 100THROUGH 2 20140 CONCERNING {_•{- ia Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lender's Address OR AG� MMTR o I certify that I have read this application and state that the above PC FEE PERMIT FEE Information Is ract I agree to comply with all county _ - ordinances and Sta laws relating to building construction,and ISSUANCE FEE hereby authorize reresentatives of this County to enter upon the above-mention pro�1 fo on purposes. m n INVESTIGATION FEE TOTAL FEE a om !/ SEE REVERSE FOR EXPLANATORY LANGUAGE I WORKERS' COMPENSATION DECLARATION •c� -Oeliy affirm'that I have certificate of consent to self ILv APPLICATION FOR BUILDING PERMIT • •, we,or a certificate of Workers' Compensation Insurance, • qr a'cert,ffi )i� cop,y thereof (Sec 3800, Lab G COUNTY OF LOS ANGELES BUILDING'AND SAFETY I PAC;N97 �3 T1r ipany -BUILDING -7 `01ICertified copy is hereby furnished FOR APPLICANT TOTILL IN ADDRESS �/ / , Certified copy Is filed with the county building inspec- ADDRESS 1 ' Lk 1' Datetion department /J/ ,A�� �7%� Applicant"' �� �L�s✓f CITY L I ZIP �O `� LOCALITY NO OF BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST COMPENSATION"INSURANCEASSESSOR (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.) LL/ NO USE ZONE MAP OWNER / NO �J 1 certify that in the performance of the work for which this // __ SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS �-�c CONDITION nfr- 0- D (� so as to become subject to the Workers' Compensation Laws �� O CITY / r i ZIP U Date Applicant ARCHITECT OR TEL Q' NOTICE TO APPLICANT If, after makingthis Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY CONST ZONE Exemption, you should become subject to the Workers' ��� )3/ w Compensation provisions of the Labor Code, you must forth- ADDRESS r a with comply with such provisions or this permit shall be TEL � STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked. CONTRACTOR - NO /p" �/ _ LICENSED CONTRACTORS DECLARATION /� LIC CLASS NO DWELL UNITS - L hereby affirm that I am licensed under provisions of Chapter St ADDRESS / Q����X NO ���� (commenting LIC SEWER MAPen ng with Section 7000)of Division 3 of the Business �. •- �'.--� and Professions Code,and my license is in full force and effect CITY Z .Ez--7 CLASS BK VALIDATION �/`� :9 q /! SQ FT ST OF FA OF CHECK License Number /( rT� Lic ClassC.� SIZE STORIES FAMILIES ONE ... VALUATION _ Contractor Dot '// DESCRIPTION OF WORK [ v el'///Ct NEW ❑ $ 30)06 - ADD Li ► ❑I am exempt under Sec ' Gt 1v �,L�Z:1 �lre LTER ❑ B&P C for this reason !%1�'Z t� .0 Aft Y 'AIR ❑ $ Date u ° -P DEMOL Signature APPLICANT TEL C> FINAL g OWNER-BUILDER DECLARATION (PRINT) �r1L- GL/�y NO 6 � 5 DATE /� I hereby affirm that I am exempt from the Contractor's License j Law for the following reason (Section 7031 5, Business and ADDRESS FINAL. Professtons Code) PRESENT By �/ i .( s Ir BUILDING 'I, as owner of the property, or my employees with ADDRESS 774-i' r , 5- 25 wages as their sole compensation,will do the work and C C ,/� •i`,,,._t the structure is not intended or•offered for sale(Section LOCALITY C.. �i ��p ( T-, #�- 70", Business and Professions Code ) MOVING TEL ®� _)!M CONTRACTOR NO ❑ I, as owner of the property, am exclusively contracting :r(� •I4;IttfE., s= with licensed contractors to construct the project (Sec- ''9•� -t ADDRESS ••U:--.5. tion 7044, Business and Professions Code ) � - .IiC!•s, Q -,Jc' REQUIRED TOTAL SETBACK FROM EXIST �t CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH i-'� � e�tt( 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 y._ r. 2 _ _ LDMA Ref # I P C Fee$ Permit Fee �� � Lender's Address , I certify that I have read this application and state that the Issuance Fee Jr� LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, Total Fee LDMA Perm # a and hereby authorize representatives of this County to enter up he bove-m nti ed property for inspection purposes L 7 / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 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 1006280003 PHONE (626) 285-0486 EXT ILEGAL ID NO OF CONST BUILDING ADDRESS I ITR 5905 LT 2 BL- 001 I SQ FT STORIES TYPE I 9177 LAS TUNAS DR 1 I _ISTRUCTURE V-B TEMP CA 917801937 1 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET. ENCINITAS 15387-016-002 1 THOMAS PAGE 596 GRID. J3 LOCALITY TEMPLE CITY, Cl TENANT (EXIST BLDG USE COMME USE ZONE C-1 (ISSUED ON PROCESSED BY ISHELY IEXIST OCC GRP I 106/28/10 SR 1 (OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINP-L DATE FINAL BY CODE (UNIVERSAL TAX SERVICE - 4,800 1 19177 LAS TUNAS DR I to I ' ITEMPLE CITY CA 91780 ' FEES PAID IDESCRIPTION OF WORK (INSTALL TORCH DOWN ROOF SYSTEM OVER EXISTING ONE LAYER CAP IFEE DESCRIPTION QUANTITY UOM AMOUNT ISHEET ROOF FLAT ROOF (APPLICANT- TEL NO: I I IKEFFER'S ROOFING CO (909) 608-0622- IAA BLDG PERMIT ISSUANCE 27 75 I IAB STATE GREEN BLDG FEE 4800 00 VAL 1 00 ISPECIAL CONDITIONS: IAC STRONG MOTION REBID 4800.00 VAL 0 50 ID2 PERMIT W/O EN-HC 4800 00 VAL 132 60 1 1 1 I TOTAL FEES 161.85 (CONTRACTOR TEL NO: I (APPROVALS DATE INSPECTOR SIGNATURE IKEEFER'S ROOFING (909) 608-0622- 1 11216 BEGONIA COURT LIC NO I ILOCATION AND SETBACKS (UPLAND CA 91784 760903 C39 1 I .- ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS I I LIC NO ISLAB/UNDER FLOOR I 1 I I I (RAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK PAGE FIRE ZONE CMP I - (UNDERFLOOR INSULATION I I 115OH265 3 001 I I I I I IFLOOR SHEATHING I INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS- I IA� I NO 22 I IROOF,SHEATHING I SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I (AIR QUALITY 1000 FEET MATERIALS I I I 1 NO NO NO 1 1FRAME INSPECTION (FIRE SPRINKLER HANGERS I I I (INSULATION/WEATHER STRIPI I 1 (INTERIOR LATH/DRYWALL 1 1 1 I I I IETERIOR LATH I I I 1 IRATED FLOOR/CEIL ASSEM I I I I I r (RATED WALL ASSEMBLIES I I f IRATED SHAFTS/OPENINGS I I I IT-BAR CEILINGS I I (LOT DRAINAGE I I I IREPORT ID- DPR261 ' ROUTE TO BS0508