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HomeMy Public PortalAbout9810 LAS TUNAS DR_Building__ / � 1 76AG38A CE:--B032-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY ` JOHN A. LAMBIE. COUNTY ENGINEER NEAREST _ WILLIAM A. JENSEN, SUPT OF BUILDING CROSS STCnLOEAG��- DISTRICT NO. GROUP TYPE PROC SED BY FOR APPLICANT TO FILL IN ' d ff F y CONST BUILDINGSTATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS. NO.�DWELL. UNITS E B PG LOT NO. 441 442 443 BLOCK WATER CERTIFICATE: NOT REQUIRED RECEIVED ❑ TRACT16 ,5-61 MAPHIGHWAY SIZE OF LOT 150X130 NNO.OF OW ON LOTS NO. ��� ICIRCLE, STATE AJOR ECOND, LOCAL USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. Corp. OWNER Ruane CN 3-3 BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS 4934 N.Walnut Grove Ave FRONT ARCHITECT O , P. L. n ENGINEER L r ers N 2-5555 SIDE f r ADDRESS 644 Alamitos Ave, ,, L. B. P L a' O TEL. () CONTRACTOR Ruane Corp, NO - l � O ADDRESS 4934 N. W In t QKove W x N NEW ADD ALTER REPAIR DEMOLISH - Z S ZE T 3571 TORIES 1 FAMILIES USE OF STRUCTURE SIGNATURE OFA APPLICANT F' . .r'./ VALUATION $419000 t APPROVALS DZATTE/' INSPECTOR'S SIGNATURE P.C. PMT. ,�- FO ! MATERLOCATION FEE $ 70.00 FEE $ FORMSL/ (/ 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, y WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY 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 TO WO Kd1Eoa:fs.G9MR ON INSURA LATH. EXT. SIGNATURE ^� HOUSE NUMBER COR PERM ITTEE I/Y�� RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS, PRIN IP TR URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.G. CASH LA,o 1 1 1 51 APR 8 2 3 0 7 0.0 01 UAW 364 0JUL 21 1D140.00— a 7"LC7MpZE CI TV AP144-' /LEpte i/zCl e--A,77A-uoliJ 78A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT u COUNTY OF LOS ANGELES BUILDING 9810 LAS TUNAS DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY TEMPLE CITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. GOLDEN BEST DIS I T ROUP TYPE ' / P BY FOR APPLICANT TO FILL IN _ CONST. BUILDING STATISTICAL CLASSI ICATION y SEWER MAP ADDRESS 9810 LAS TUNAS DR. K P A CLASS. NO. DWELL. UNITS LOT NO. / 2 BLOCK WATER NOT REQUIRED ❑ RECEIVED ❑ CERTIFICATE: TRACT MAP HIGHWAY ' NO. OF BLDGS. NO. C (,/ O (CIRCLE) STAT MAJOR ECOND. LOCAL SIZE OF LOT �j`O .,';O NOW ON LOT USE-ZONE ECIAL USE OF CONDITIONS EXISTING BLDG. AUTO GLUB UP Iti. .TEL. OWNER NO. BUILDING EXIST. ADDRESS TERMINAL AWEX BOX 2690, L.A. SETBACK YARD HWY STREET NAME WIDTH FRONT �1 ARCHITECT OR TEL. P. L. Q- ENGINEER NO. SIDE P. L. ADDRESS CL TEL. 0 CONTRACTOR FEDERAL SIGN NO. 221-6141 v ADDRESS 1100 N. MAIN ST. L.A. Ix O DESCRIPTION OF WORK W NEW ADD �LTER) REPAIR DEMOLISH Z SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE STRUOCTURE INSTALL (1) DOUBLE FACE ILLUM. POLE S/I�GN Brix SIGNATURE OFJSP APPLICANT C+ VALUATION $ 800.00 APPROVALS DATE INSPECT9R' SIGNATURE P C PMTFO � UNDATION: 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 HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSATION INSURA LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 1100 N M ST. V.A. FINAL J':7V' JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.LhLoCASH 9 5 8 5'- JuL 13 ID 12.00" C-17r 7_�EMpL E C/7-Y' 76A638A CE4803 5-65 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING • DEPARTMENT OF COUNTY ENGINEER ADDRESS (/ BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST. DISTRICT NG P TYPE O S Y FOR APPLICANT TO FILL IN 1 ON ST. > BUILDING STATISTICA CLASSI ICATIONSEWER MAP ADDRESS �/ I-4S TI IVXS e CLASS NO.�qlD ELL UNITS BK PG LOT NO. BLOCK USE ZONEMAP NO. l//'1 TRACT SPECIAL NO. OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM OWNER ` ��. f CNOL FRONT PROP. LINE OF (STREET) r„ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS /J`� ' ,t� If HIGHWAY WIDTH FROM C.L. CITY 6 L- / ���/�^f/ES + ARCHITECT OR TEL. BLDG. SETBACK FROM ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OFEXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CONTRACTO 5+e e`-a i// H NO�-1. '� (/� + ADDRESS �` M/7iAl NO -J- 3 C'' CORNER CUTOFF YES NO S CITY " �2- CLASS — � SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK e ,R r 3 NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO. OF NO. OF /� �( �'-•'` SIZE STORIES FAMILIF_S USE OF STRUCTURE i n, SIGNATURE OF APPLICANT i VALUATIONS `LOlt ^� APPROVALS DATE INSP EV-2y—'s.IGNATU RE P.C. PMT. FOUNDATION, LOCATION pp FEE$ FEE$ FORMS, MATERIALS FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 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 9UILDI 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 CODE OF THE STATE OF C tLIFORN IAELAT. ING TO WORKMEN'S COM EN ATION SUR NCE LATH. EXT. SIGNATURE OF `� HOUSE NUMBER COR- PE,RMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O CASH LALO 5 8 1 3 8 NOV 14 1 D 8.0 0 M WORKERS'COMPENSATION DECLARATION ' stir , or -cer that I have r certificate of consent r self A P P L I CAT�O N, ®� BUILDING. PERMIT �croslue, or a.certificate of Workers'Compensation Insurance, ' or a certified copy thereof'(Sec..38p00, Lab. C.) ,a. COUNTY-OF LOS AI�NGELES BUILDING AND SAFETY" ' Policy No ti• aA CompanyS le, I 9a BUILDING 19 Certified copy is hereby furnisheYJ.. FOR ArrP��PLccICAN�TI TAO FILL IpN ADD ESS ��/O ❑ Certified copy is filed wit he unty building inspec- ATO ADDRESS i�' N� UCAS , D�tv� 'on partment. CITY �Gr 'dxv 'iIP DlJ LOCAI7Y Date Applicant. �J/ NO.OF Bl. NEAREST ERTI KATE OF-EXEMPTION FR W RKERS' SIZE OF LOT h IZ O NOW ON LOT CROSS ST. ri COMPENSATION INSURA !! u ASSESSOR -7 /� (This section need not be completed if the permit is for one TRACT 175 cc•BLOCK LOT NO.1 MAP'BOOK �� PAGEd�/ PARCEL.a�� hundred dollars ($100)or,less,) OWNERt��MK 6� NO. USE ZONEMAP I certify that in the'performance of the work for which this _ , M. permit is issued,,i shall•not•em to an person in an mann ADDRESS' ��� E, L�$'Cc�l�lAs ij SPECIAL'. ? P P Y Y P Y CONDITIONS I so as to become subject to the Workers'Compensation-Laws. , s •O i CIN C>ffy ZIP Date Applicant ARCHITECT OR pp TEL DISTRICT GROUP TYPE FIRE PROCESSED BY- NOTICE TO APPLICANT: If; after•making this Certificate.of ENGINEER �Al e-NO. - CONST. O' Exemption,,.you. should become subject'to the Workers' 1' p,,.� �, r ,,�p� Uw Compensation provisions of the Labor Code,.you'must forth- ADDRESS ao W•8Bi LT+ uf_ 'A Gc' a with comply with.such provisions or this permit shall be 1, pp�� TEL•Q STATISTICAL CLASS FIC N APT. CONDO. ' " N deemed revoked. " ' CONTRACTORNO.pI�; � _Z .LICENSED CONTRACTORS DECLARATION ' �r LIC. np CLASS NO.. DWELL. UNITS' I hereby affirm that I am licensed under provisions of Chapter 9ADDRESS W . P V�i, �� NO. lob (commencing with Section 7000)of Division:3 of the Business, LIC. Q ;SEWER MAP and Professions Code and my%license is in:full for and effect. CITY' CLASS`s' BK PG. o VALIDATION SQ. NO. OF NQ.OF _ CHECK License Number `rs Lic-;Class SIZEj� STORIES ..� FAMILIES ONE (�����1l�,�p� `' Q VALUATION. OO . ContractorTl •sf1�II + y1r•Date `e ' DESCRIPTION OF WORK Q NEW ❑ $; Oo©•�• ❑I am exempt under Sec.' '`' L ADD ❑ . ALTER ❑ BAP.C. fo reason REPAIR ❑ $ ate:' USE OF. EXISTING.BLDG.WIC L DEMOL Signature - APPLICANT TEL. FINAL O NER-B ECLARATI N: (PRINT). NO,% - W6 i• I hereby affirm that I am a rom the Contractor's License �1~ DATE Law for the following reason (Section 7031.5, Business and ADDRE55 1w• VV� �/� �t FINAL Professions.Code): PRESENT' By ❑ I, as owner of theproperty,•or m employees with BUILDING YADDRESS ACCT_t '' 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. ❑ " 1,as owner of the property,.am exclusively contracting CONTRACTOR NO. TEt`.r with licensed contractors to construct the project (Sec- ' ' tion 7044, Business and Professions Code.) ADDRESS i TOTAL 38= 00 i REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. ! EI{� CONSTRUCTION LENDING AGENCY' SET BACK PROP. LINE WIDTH + I hereby affirm that-there is a construction lending agency for FRONT ' GN �(i� b(JI the performance of the work for which this permit is issued P.L.' CHANGE. •' (Sec. 3097, Civ:C.)'.. . SIDE P.L. r f 2y/1.5•. Lender's Name Li(.ICII!"GtIL�1 !_t/3+ P.C. Fee$• Permit Fee •&'0 •��Ref.# , , , ; Lender's Address , .77100 . � ,Aj•!I Q;�t` a 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# ' above information is correct:I a iee,to complywith all Count. Investigation Fee o -ordinances-and State laws rela ing to buildig construction Total Fee 0O , LDMA Perm. # a he eb tnor' resentatives of this Coynty to enter + u n e a e-m ntion property for inspec/tio ur oses. ' �P P'6 a � •' SEE REVERSE FOR EXPLANATORY LANGUAGE Sign of ppllcant or Agent Date WORKERS' COMPENSATION-DECLARATION *hereby Affirm that I have certificate of consent to self APPLICATION FOR BUILDING .P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a Certified copy thereof(,Sec: 38 Lab C tpek�� COUNTY OF LOS ANGELES BUILDING AND SAFETY Compan S-I10 1:1BUILDING Certified copy is hereby furnished. FOR APPLI ANT TO FILL IN ADDRESS 9 /Q r J s Certified copy is filed with the county building inspec- BUILDING - tion Nl' tionn�deppa'rtment. ADDRESS Dated plican v CITY rQ I Z ;:LOCALITY /tO VGA• �j / a NO.OF BLDGS. NEAREST CERTIFICATE OF EXEM 10 FROM WORKERS' SIZE OF LCX XIIa0 NOW ON LOT CROSS ST. 9-Q �pR/ COMPENSATI NSURANCE. 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.) �}, J-0 / Lr /' OWNER L/N/� T4 7D� 'IQ ,e7 i(.�'l a USE ONE NO. 0 �/a I certify that in the performance of the-work for which this T =� SPECIAL AJ permit is issued, I shall not employ any person in any manner ADDRESS CONDITIONS CL so as to become subject to the Workers'Conipensatibn Laws. ` O CITY /L zIP Date Applicant ARCHITECT OR V TEL. DISTRICT GROUP TYPE FIREXPRO"CESSEDBYNOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONEO Exemption, you should become subject to the Workers' n� 2 Compensation provisions of-the Labor Code, you must forth- ADDRESS .G a with comply with such provisions or this permit shall be a` TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR 0/YNO �C. NO. }lj "V Z_ LICENSED CONTRACTORS DECLARATION LI i CLASS NO.� DWE . UN I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS /� S'n7 Al FAY i7.V✓a N NNW / �fJ LIC. SEWER MAP (commencing with Section 70Iic of Division 3 of the Business CITY VAI)t ? n�(/IY l C� CLASS and Professions Cod and m license is in full force and effect. BK, PG. VALIDATION xc ` `, SQ. FT. NO. OF NO. OF CHECK License umber w' •Lic. Cldss / --J SIZE STORIES FAMILIES ONE i DESCRIPTION OF W RK t�✓/I NEW ❑ VALUATION Cant Date �• Z' O ` ADD' ❑ ❑ a exempt under Sec. �!./M �P 6� �c� S! ALTER ❑ poll ' B.BP.C.'for this reason 0 It r/i fV 117 v f-P C REPAIR ❑ $ USE OF s j yAl Date: EXISTING BLDG. ^ DEMOL"❑ SignatureAPPLICANT �L• FINAL OWNER-BUILDER DECLARATION (PRINT) v' J DATE 7� I hereby affirm that I am exempt from the Contractor's License ADDRESS f SA A/ t&(7•�Y��O !/ �T' Law for the following reason (Section 7031.5, Business and FINAL i,l•y. ,_- Professions Code): PRESENT By Y❑ AI J'�f TL5 7r 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 o�offered for sale(Section LOCALITY 7044, Business and Professions Cdde.) MOVING TEL. �tf.; T off• ❑ I, as owner of the property,.am exclusively contracting CONTRACTO NO. _ -- with licensed contractors to construct the project (Sec- ADDRESS • tion 7044, Business and Profe'ssibns Code.) - ,I,, REQUIRED TOTAL SETBACK FROM EXIST. - i - CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that'there is a construction lending agency for FRONT x 57 the performance of the work for which this permit is issued P.L. i�r-r.t! (Sec. 3097,Civ. C.). SIDE f.i v'� P.L. CHANGE B Lender's Name LDMA Ref. #P.C..Fee$ Permit Fee (/ Lender's Addre I certify ss i • that I ha read this application and state that the Issuance Fee C� LDMA P/C# ® -•�•) i._ M/i=; ,� 3 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee Ji O LDMA Perm. # and hereby authorize representatives of this County to enter upon th ove-men lone roperty for inspection purposes. o .-g_�y SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Applicant or Agent Date APPLICATION FOR {BUILDING PERMIT COUNTY OF LOS ANGELES I_w BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN ,� BUILDING ADDRESS �QjS D G I hereby affirm that I have a certificate of consent to self insure, BUI N DDRESS (J` or a certificate of Workers'Compensation Insurance,or a Certified Two -L.04 CITY ZIP ,--n copy .thereof Sec.3800, ab.C. hen IJ P6 lfcy lVo. �y N Compar)y 4�r2t U/lr/c7!! � IACALITY SIZE OF LOT NO.OF BLDGS.NOW ON LOT ��✓n �e GL ❑ Certified copy is hereby furnished. P-111"er /~s ' NEAREST CROSS ST. rtified copy is filed with county building inspection TRACT BLOCK LOT NO. part e USE ZONE MAP NO. Date Applicant " ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ON R TEL NO. YES NO COMPENSATION INSURANCE e •I WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS �L dollars($100)or less.) J<'G `I% DISTRICT GROUP WN, FIREZONE PROCESSEDBY CITY ZIP I certify that in the performance of the work for which this permit �/O is issued, 1 Shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO 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' C RACTOR t� NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith to gi FRONT comply with such provisions or this permit shall be deemed revoked. A LIC. PL LICENSED CONTRACTORS DECLARATIONCITY � S SIDE LIC.C ^� P L I hereby affirm that I am licensed underprovisions of Chapter 9 '14-14— `JY 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 my license is in full force and effect. NEW BK PG o U Licen mber Lic.ClassLy C ESCRIPTION OF WORK ADD ❑ VALUATION CD Contract Date ALTER ❑ v rr LU ❑ 1 am exempt under Sec. - caaM' REPAIR ❑ $ z BAP.C.for this reason w S! �/�/ Q DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDQ. JURM ❑ '✓p Signature APP NT(PR EL NO. LDMA Perm# i ❑ I,as owner of the property, or my employees with wages as < < ✓7 ZO Hti s: n their sole compensation, will do the work and the structure is ADDRESS ✓ „r. not intended or offered for sale (Section 7044, Business and ���� �CS7_ FINAL D TE 7 yi)c'F�7.71. Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL / � OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1 J I j C•j•�. 1 El I, as owner of CONTY ( the property, am exclusively contracting with AMOUNTS S CON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL licensed contractors to construct the project (Section 7044, • : Business and Professions Code.) ves❑ No y i 105.30 WALL THE INTE E SE'OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING -.1•--.1 -� OCCUPANT REQUIRE RMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ? �T i.�; 1L;�.1 a•:7'+. CONSTRUCTION LENDING AGENCY COAST AIR QU UTY GEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKUST FOR GUIDELINES I hereby affirm that'there is a construction lending agency for YES❑ N ivH�i€-1 � llil W the performance of the work for which this permit is issued(Sec. 'HAVER ARDOUS I INFORMATION GUI DE AND THE SCAOMD PERMITTING 3097,CIV.C.) C .I U Q NTS UNDER THE LOS ANGELES COUNTY CODE. TLE 2.C R 0 SECTIONS 2. 0 THROUGH 2.20.140 CONCERNING HAZARDOUS I'}j�fill j �1_i� 3 Lender's Name MATERIA P INC AND FOR ING A P�MIT FROM THE SCAOMD. IL o Lender's Address19s ? iL�••J p ,OWNER OR ENT ' o I certify that I have read this application and state under penalty oP.C.FEE PERMIT FEE /D of perjury that the above information is correct.I agree to comply i N with all county ordinances and State laws relating to building hereby authorize repes of this County hSSUANCE FEE an r pon the bove! tinned prop�asenta a 0 p1lrpQses. , Q A ! INVESTIGATION FEE TOTAL FEE D Q n .ate «llpanl Dale ✓ v SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION 11 . re, o affirm that I have r certificate of consent to self L I ��� � � � I I�G PERMIT ` r> Isure or a certificate of Workers' Come Insurance Compensation , or a certified cppy th gf�..,(rS4 3800Lab.Lab. C.) �j,� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy I J(►�J�7'Compdny V �71�) i'Y��'�4s VBKL ING Certified copy is hereby furnish d. p' ) ) 9 FOR APPLICANT TO FILL IN ESS /O Certified copy is filed with th coun bui ing inspe i ADDRESS f G -r tion department. a Date�` x CITY � W-6-11T`6 ZIP 4 ITY t 19 ql Applicant I NO OF BLDGS EST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT O �► 100 NOW ON LOT ore ST. COMPENSATION INSURANCE !,,`` ' SORh'(Thissection need not be completed if the permit is for one RACT�W1 BLOCK LOT N . OOK o.�� PAGEI2 PARCELhundred dollars ($100)or less;) `� ry— fjy -'lp Nd � pj, o ONE MAPOWNER Lltrlld6To� IInW' �1 1g `71NO.I certify that in the performance of the work for which this {{�� K SPECIAL.permit is issued, I shall not employ any person in any manner ADDRESS��7 -Z v`- CONDITIONS dso as to become subject to the Workers'Compensation Laws. �j p^ sem, Q CITY / 1 A CA ZIP 0 /oDate Applicant ARCHITECT OR TEL.EJtyNOTICE TO APPLICANT:.If, after making this Certificate•of ENGINEER %1���G NO!/�T/ TRICT GROUP TYPE FIRE PROCESSED BYC CONST. ZONE 1- Exempption, youu should become subject. t'the Workers' +r1��. {� h � aCom ensation rovisions of the Labor Code, ou must forth- ADDRESSIZO%41 �1� 7with comply withsuch provisions'or this permit shall be b`T1E� + TICAL CLASSIFICATION APT. CONDO. N •deemed revoked. .-CONTRACTOR NOS/ A,q — Z LICENSED CONTRACTORS DECLARATION CLASS NO. oL�i DWELL. UNITS ,; ���. q Z I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSru-'fit. SEWER MAP 'r•'•' s (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in II force a effect. 0 NO. OF NO. OF CLASS CHECK BK. _L�V�►LIDATION {•z ,. .�{ Frr* �Q �Q.el: License Numbe i . Clas SIZE 6 STORIES FAMILIES ONE lfGro'� �oN t _tL VALUATION a sL Contractor ISN1f� �! a e DESCRIPTION OF WORK NEW ❑ $,�?0��� - t .i I ={ SL1 y) ADD ❑I am exempt under Sec. R ❑ ® :'; ALTE .1 �O IM J:60s GU N14 El REPAIR CHANGE ,lel B.BP.C. for this reason Date: \, ' USE OF CArAJ r0j?.r I,1�L d � EXISTING BLDG. DEMOL ❑ '` APPLICANT l�p� �1/� ! TEL, Signature A1' & ser'f�..� ow;N FINAL 0000-0001 ` ' /i='i OWNER-BUILDER DECLARATION (PRINT) N �� .'r 1 :�i �, I herebyaffirm that I am exempt from the Contractor's License _ DATE ?,+3- s_._., P ADDRESS �Nu� N l� q s. t'::t.: Law for the following reason'(Section 7031.5, Business and �,(� FINAL Professions Code): PRESENT By i ❑ I, as owner of'the property, or my employees with BUILDING ADDRESS - wages as their sole compensation,will do the work and K. LOCALITY the structure is not intended or offered for sale(Section � ---'- '='"' •_+� 7044, Business and Professions Code.) i.MOVING TEL. V J =1it CONTRACTOR NO. 4•,.-; ❑ I,as owner of the property,am exclusively contracting jR•v D� 1 _ s 1,_ri•.: with licensed contractors to construct the project (Sec- ADDRESS C•7 ' -• -c— -' tion 7044, Business and Professions Code.), I_I l HL =:_t•�� %'/ REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH L: ;f, ;:` I hereby affirm that there is a construction lending agency for FRONT —� theerformance of the work for.which this permit is issued - (Sec. Civ. C.). • SIDE , C--. C'= �•-I Y_•..i -r. r . : ?`;i-1s�s(]L =' l P.L. F u C C� Lender's Name �/ D/ - Iw ,. r,L:... S P.C. Fee$ O ' Permit Fee c 31- `t .:L AAA R�f. # ;'t-I ;"# � t° Lender's Address �j _• ® iL1`' A I certify that I have read this application and state that the Issuance Fee r` °J LDMA�F # 3 above inf rmotion is correct.I a ree t comply with all Count Investigation Fee o4-,l Ord'Inan sand St to I s relating t buildng construction Total Fe 0 e LDhAA Perm. # AsigncTurg' heby ou - ize pres tati a of this-County to enter abo ne grope or inspection purposes, o �'q I SEE REVERSE FOR EXPLANATORY LANGUAGE••..:• n y'' "" ° of pplicont or Agent Date :i t__� ,-� Y' COUNTY OF LOS ANGELES TEMPLE CITY 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0405200056 PHONE: (626) 285-0488 EXT: LEGAL D: NO. OF CONST NEW BUILDING ADDRESS: TR: 6561 LT: 441 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 9810 LAS TUNAS DR STRUCTURE: 1300 1 VN B TEMP CA 917802208 ASSESSOR INFORMATIO NUMBER: NEAREST CROSS STREET: GOLDEN WEST 8587-027-027 •THOMAS PAGE: 597 GRID: A3 - LOCALITY: TEMPLE CITY, Cl TENANT: affS T BLDG USE: COMME USE ZO' ISSUED ON: PROCESSED BY: EEPIR S ON: HEALTHCARE PARTNERS EXIST OCC GRP: B 07/23/04 JK 07/18/05 OWNER: TEL. NO: BLDGS. NOW ON OT: VALUATION: FINAL DATE FINAL BY: CODE: SHI JR-MING;YU-HUEI (626) 446-9788- 60,000 1_�� 2006 TERRA LN ARCD 910078141 FEES PAID DESCRIPTION Of WORK TENANT IMPROVEMENT - REMODEL NURSES STATIONS, OFFICES EXAMS APPLICANT: TEL. N0: FEE�DESCRIPTION: QUANTITY: UOM: AMOUNT: & WAITING ROOM, CONSTRUCT HANDICAPPED COMPLIANT TOILET BENICK, INC. (818) 882-9671- Al PLANCHECK W/EN-HC 60000.00 VAL 879.60 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AE STRONG MOTION OTHER 60000.00 VAL 12.60 A2 PERMIT W/ENERGY-HC 60000.00 'VAL 1,034.83 TOTAL FEES 1,954.78 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE BENICK, INC., 8188287199 (818) 882-6971- 8537 KELVIN AVENUE LIC. NO LOCATION AND SETBACKS -- WINNETKA, CA 91306 4279096 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: _?EL. NO FCUP,% IONN TRENCII FORMS ENVISION ARCHITECTURE (310) 839-7515- 3647 KALSMAN DR., n1 LIC. NO: SLAB/UNDER FLOOR LOS ANGELES, CA 90016 NONE �I 2�1IGu F1.00R FRAMING MAP NO: SEWER MAF BOOK: PAGE: FIRE ZONE: CMP. UNDERFLOOR INSULATION ! 3 04 N0. OF FAMILIES: D L NG UNITS7-AFT–/CON D: STATCLASS: FLOOR SHEATHING NO 22 ROOF SHEEATHING SCHOOL WITHI HAZARDOUS SHEAR PANELS/ AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRA! EM i E P NI LER ANGERS - INSULATION/WEATHER STRIP —W I T R OR LATH/DRYWALL EXTERIOR LATH RATED FLOOR C IL ASSEM. RATED WALL ASSEMBLIES RATED S AFTS/OPE INGS T-BAR CEILINGS —�-�` LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508