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COUNTY OF LOS ANGELES _ TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0607110004
BUILDING-.AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT _
LEGAL ID _ _ - NO. OF CONST NEW BUILDING ADDRESS.
TR. 09285 SQ FT STORIES - TYPE OCCUP GROUP 9917 LAS TUNAS DR
STRUCTURE- 1 V C - TEMP CA 91780
ASSESSOR INFORMATION NUMBER. NEAREST CROSS STREET. AGNES
8587-031-026 -EXIST BLDG USE. THOMAS PAGE. GRID: LOCALITY TEMPLE CITY, C
EXIST OCC GRP USE ZONE:
TENANT ISSUED ON PROCESSED BY- EXPIRES ON
BLDGS: NOW ON LOT VALUATION: 08/18/06 JK 02/14/07
0
OWNER: TEL NO F;#AI, DATE FINAL BY. - CODE:
A AND G LTD LIABILITY CO (650) 216-2331- LIST ITEMS: _ /
370 COVENTION WAY
REDWOOD CITY 94063 SCRI TION-OF WORK
APPLvING FOR OCCUPANCY CERTIFICATION
OCCUP LOAD EXIST
APPLICANT TEL NO OCCUP LOAD NEW:
TEMPLE CITY ADULT DAY HEALTH CARE (626) 614-8999-
9917 LAS TUNAS DRIVE PARKING SPACES REQUIRED- SPECIAL CONDITIONS
TEMPLE CITY CA 91780 PARKING SPACES PROVIDED: '
EXIT HARDWARE: Conditional Use Permit 99-1403
CONTRACTOR TEL. NO LIMITED TIME USE
TEMPLE CITY ADULT DAY HEALTH CARE (626) 614-8999- NBR OF EXITS: _ FROM TO
9917 LAS TUNAS DRIVE LIC NO 'I �.
TEMPLE CITY, CA 91780 NONE FEES PAID
APPROVALS DATE INSPECTOR SIGNATURE
FEE DESCRIPTION QUANTITY: UOM. AMOUNT:
ARCHITECT OR ENGINEER: TEL NO: TRAILER USE
- 02 OCC/USE ISPECT OTHER 8500 00 SQF 432.60
LIC NO. TOTAL FEES 432.60 SAFETY PERMIT
TEMPI, STRUCT APPROVED
MAP NO- SEWER MAP BOOK: PAGE FIRE ZONE. CMP - TEMP' STRUCT REMOVED
NO. OF FAMILIES: DWELLING UNITS: APT/COND. •STAT CLASS:
NO
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
REQUIRED TOTAL SETBACK FROM EXIST
SET BACK YARD- HWY PROP LINE: WIDTH
FRONT PL-
SIDE PL-
REPORT ID DPR267 ROUTE TO. BS0508
? WORKERS COMPENSATION DECLARATIONMISCELLANEOUS APPLKC Al 1UN
,I 2G-OU53DRW12/gU
• i I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES "' BUILDING AND"SAFETY DIVISION
} insure,or a certificate of Workers' Compensation Insui ince or -
a certified copy thereof (Sec 3500•Lab C)
Policy No Company FOR APPLICANT TO FILL IN BUILDING G,�/
BUILDING ADDRESS ADDRESS
❑ Certified copy is hereby furnished 9 l l OCALITY
❑ Certified copy is filed with the county building inspection CITY ZIP
department -Te�pIC. C 'l QI• �8V NEAREST
Date Applicant SIZE OF LOT NO OF BLDGS NOW ON LOT D! 1111:: TYPE ESSED BY
/OY �ijf' CONSI
CERTIFICATE OF EXEMPTION FROM NVORKEI,S TRACT - BLOCK LOT NO
COMPENSATION INSURANCE NA IG—AY
NO ICIRCLEI STATE MAJOR SECOND LOCAL
1' (This*section need not be completed If the Norte m ol�ed gSSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars (1,100) n. less ) - _
WNER( 1 I certify that-In the pe*tormance of the %Cork for MiI_•h thi` Property 49 (o � TZIEL No4yS-5�1}— ^
Hermit is Issued I shin] not emplo am person 111 am jnallner
� so as to oecome sublec: to the Workers ComP;nsatlel Lams ADDRESSl�Z � +� � � `J� 1 v
r5 � ^ �� {I OCCUPANCYGROUP I I
I Date. 'APPIICdnt - - CITY , Q,• ZIP 1
NOTICE TO APPLICA\T If after making nils Cel_Llc.t'e I OCCUPANT LOAD
of Evemonon %ou sho�id oecome sunned to the \,orkers APPLICATIDN'FOR
Comper;aiior prm inions of the Ldno,Code ',OU rlulsL fo MWltl EXIT HARD11/AR=
ComPl I v Itn such provl,,ors or tills Perini[ Shall ne C-cried TRAILEP USE_ GEOLOGI INS-ECTION Ely No Spec Knowl ❑
reg oke d .
LICE\SED CO\TR',C-ORS DECL-�R 0 171 `r -CUPANC\ INSPECTION� J
1 nereh' .iii 1`177 Thal 1 21.1 :�`;f [hider PR 11S10i1� Oi i ,L PI_r SAFETY -ERMIT ;_IST ITEMS BELOV,
9[commenting v Ith Section- 000,of DI,I;lon `C`7 th_ Bi.slnes, -NO OF EXITS
and Pro;esslonc Co(je .til" niN Ilccn'- �s til ful' force anc-_,icer r—
CG R_: D PROVIDED
S11F_
= LICense \'L'.ilDer LIC Cl:;[ _ _ Sia CES
Conlydct,�r Dd'e LIMITED TIME USE
1 DATE -
DATE
am evemht from ,nz Ilcenslne r oJ1re,nCnl 6 dnl a, FFD,. TO
hcell;ed architect or a r_g: era P,r(avon.l ,n_in.or - — INS-EC=OP s
SIEE OF I NO OF '
aCl:;c In ,n' Pmfec.lon,ll CdPdut, (SCCUOII ;U_,t 3 Ise" SIGNATUR
E1,IS�ING BLD" STORIES
ano Professions Cod-) --
PRESENT USE O-EU,LDING, AL
I), �•�t!-t��'� CEJ e, i d�L A?DRO'J?,L
Llc or Rcg \'o Date
HOME UV1\ER-BLILDER DECLARATION No OF EXISTING BUILDINGS
ON LOT AND USE \
I hereby affirm that 1 am evempt from the Contractor , L'cense
I Lw,;, for the following reason (Section 70;13 Business and n /�
Fn. esslons Code) NO PARKING �J
❑ \1 as owner of the Propem ,will do'the work ar�i theSPACES PROVIDED
` /� �
structure Is not intended or offered'for;ale (Sectior 7074X- PRO-OSED USE OF BUILDING A)t.[A-
Business and Professions Code) +
CONSTRUCTION LENDING AGENCI
I hereby affirm that there is a construction lending agelU.x f0- 1
the performance of the Nork for-which this permit `I; ,ssued _
t (Sec 3097. Civ C 1 PROPOSED MAX OCC c
Lenders Name -._ APPLICANT(PRINT) TEL NU
Lender's .Address ADDRESS
I I certify that I have read this application and State th.,t the
above information is correct. 1 agree to comply with all C unty I PERMIT FEE
ordinances and State laws relating to building construciio and
heresy authorize repres to Lives of this County to enter-upon ISSUANCE FEE
j the above-ment tied pr perry for spection purposes
r
v.
TOTAL FEE , I!
n I SEE RE\FRSE FOR EXPLANATOR) LANGUAGE
Slgnd[ure of Permntee � f)= z 1
7