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HomeMy Public PortalAbout5317 LOMA AVE_Building__ DZ-3 11-43 L'SM SETS I -APLICATI©1V F09 PDRMIT ' DEPARTMENT OF BUILDING AND SAFETY ! COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER NO.OF BLDG. ORD.NO. DISTRICT PLAN CK. NO. JoERMINO. PLANS SETBACK LINE �'// FIRE APPROVED ZONE BY r DATE RECEIVED48Y �DyATTZOF/�AAPP'P/L. D TE ISSUED�/ USE / APPROVED �`� J+ "� �Y" ZONE hy BY DATE APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY � K BUILDING O NAME ADDRESS W 2 ADDRESS LOCALITY F O Y NEAREST UCROSS ST. W CITY A Q STATE ///► TEL. , LICENSE NO. I 1 NO. NAME i MAIL O NAME ADDRESS r 1' ' - '` TEL. U ADDRESS CITY .(/J"'�- NO. E OCI.y I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS U APPLICATION AND STATE THAT THE ABOVE 18 CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. y AND STATE LAWS REGULATING BUIL ING CONSTRUCTION. ZO LOT NO. /O SIZE OF LOT 60411 SIGNATURE OF OWNER < t INO. OF BLDGS. AUTHORIZED AGr 1 l W K BLOCK NOW ON LOT J TRACT / CORRECTIONS D USE OF BLDGS. NOW ON LOT DESCRIPTION OF WORK USE or `�,,_u e -BUILDING 1i 1. i WA ; Wits construction may be in violation of War Proauction Loard orders. You are Callf'(�nP 4 r nen1+ zer-0+ leeal War 0 ProductionBea:dOffice before commenc- - 22 auuicr_zea triis permit. Z D NEW [/ TYPE I GROUP �J r NO.OF NO.OF ALTERATION ROOMS FAMILIES ADDITION SIZE x✓`/��//J�/ REPAIR STORIES MOVING WALL COVERING DEMOLISH ROOF COVERING I $ FINAL APPROVAL FEE B/� I 'INSPECTO .VALUATION F86 ��� 1 0 E // NAME D13-3 42rSWSItTs� APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND_SAFETY ----_COUNTY OF LOS ANGELES BUILDING ' WM. J. FOX. CHIEF-ENGINEER l NO.OF BLDG. ORD.NO. DISTRICT NO. PLAN CK: NO. PERMIT NO.- PLANS O:PLANS SETBACK LINE S74/ FIRE APPROVED a� ZONE BY DATE RECEIVED BY DATE OF APPL. -DATE ISSUED USEAPPROVED /�/ /_1 0 .,� �/ e •����/ ZONE '-,®y DATE -APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY BUILDING �,f' - A � t p NAME ADDRESS 2 ADDRESS LOCALITY / G/1?-A7 F O NEAREST U Z CITY CROSS ST. Q STATE TEL. LICENSE NO. NO. NAME 2 MAIL E NAME ADDRESS t 3 O {r� S ADDRESS CITY I NO. It zCITY 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS V APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ZZ LOT NO. SIZE OT SIGNATURE OWNER OF 0 OF`L NO. OF BLDGS. AUTHORIZED AGT- •• lee� O _ BLOCK NOW ON LOT Ir -' TRACT CORRECTIONS _ D USE OF S NOW ON LOTL/ /f'Q fes/ fled 7rYQ✓/GC.� DESCRIPTION OF WORK USE BUILDIDI NG add l® J v � Z p _ � O NEW TYPE GROUP / (n NOOM ^ FAMIOLIEB� pA �l ALTERATION ROOMS /qw' ADDITION SIZE �f X 0 ✓l/� /yam/�-tea QY/ yv REPAIR STORES MOVING WALL COVERING � t DEMOLISH ROOF COVERING 4Cn n? /9 . P. C.s/ FINAL APPROVAL FEE INSPECTOR'S VALUATION REE W DATE 1 I NAME APPLICATION FOR CITY OF TEMPLE "CITY BUILDING PERMIT FOR APPLICANT TO FILL IN ADIDRESS a ` BUILDING DRESS �X AD5 317 :N . ' Loma LOCALITY NEAREST CITY Temple City ZIP 9-1780 CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP I TYPE FIRE PROCESSED BY TRACT - BLOCK LOT NO Q p� CONS ZON TEL • O OWNER NO 287-5384 •I STATISTICAL CLASSIFICATION SEWER MAP _ ADDRESS 5317- N . LOmd CLASS NO DWELL UNITS BK PG CITY' Temple City z1P917 8 0 ��USE ZO� MA oC O ! , ARCHITECT OR TEL �/�� SPECIAL ENGINEER NO n CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑ CONTRACT L R a n d o l C N L BLDG SETBACK FROM ^LIC FRONT PROP LINEOF (STREET) ADDRESS NO 1 86086 TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH CITY San Gabriel Ca . LIC FRONT C.-39 CONSTRUCTION LENDER a NAME AND.BRANCH0 BLDG SETBACK FROM V ADDRESS CITY SIDE PROP LINE OF (STREET) SQ FT NO OF NO OF CHECK HIGHWAY + YARDS - TOTAL SETBACK FROM TYPE OF EXISTING 1 1 SIDE PROP LINE HIGHWAY WIDTH w SIZE STORIES FAMILIES ONE - N DESCRIPTION OF WORK re-roof - house NEW' ❑ + = Z_ C Om h n le ADD ❑ CORNER CUTOFF - YES E] NO E] and 2 1 t h o on- flat ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ _ REPAIRX USE ONG BLDG DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NOEXIS ❑ APPLICANT TEL PRINT( H Randol NO 288--4040[ BY(SIGNATUR cizz I HEREBY ACKNOWLEDGE THAT I HAVE•READ THIS APPLICATION AND STATE /i�/7� i Llv✓ 5� •!.!O' �'� 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 OF FINAL V' By s PERMITTEE DATE ADDRESS 2 9L E. Valley- Rlvd .] , _- TEI, P C.Fee$ Permit Fee i2OO CITY N2 Q _'/ Issuance Fee 7, VALUATION y'�j a D s, /��1�/,+y`' � Totol Fee 12 . 00 �yPt: LN1XHEC-K tl',L PATI �J p-rc�c� O CASH _ PERMIT VALIDATION CK M O CASH J CY HOLDER:. _fty6pVjjgffipB 6�/7j6 1,)P )2- 2- T/S/D ;� A _ - - -DIVISION OF BUILDING AND SAFETY BUILDING Department of County Engineer County �of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION BUILNG FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS �1��r �- �/ {//i � +.rF'•_ LOCALITY � --y' �• _ NEAREST LOCALITY CROSS ST. I I ' NEAREST DISTRICT NO. PUN CK.oR REc. No. PERMIT NO. ] CROSS 9T. OWNER` RECEIVED BY DATE OF APPL. DATE ISSUED MAIL i �Z I' 1 �l„l✓j�" � ADDRESS it USE ZONE I NO. OF I TYGR I FIRE ZONE i TEL. /�/ •�i� ��n.1 /� PLANS � 7 -.,., CITY '•1 !�%? '/NO. y ARCHITECT OR TEL. ZONING DATED ENGINEER NO. APPROVED BY BUILDING ORD.No. ADDRESS SETBACK LINE: - TEL. APPROVED DATE CONTRACTOR NO. BY: HOUSE NUMBERING .r ADDRESS LEGAL IMAP NUMBER ; L-217 NO. ASSIGNED BYZ DESCRIPTION LOT NO. i BLOCK DATE � CORRECTIONS I INSPECTOR TRACT NO. OF SLDGS. - SIZE OF__L_OT NOW ON LOT USE OF NO. OF (}— EXISTING BLDG. - ��. FAMILIES "" T� �� �.����- � -� Q DESCRIPTION OF WO&$ z Z NEW ALTERATION ADDITION _ _'_. _j; REPAIR I DEMOLITION %• .>r^'' ._..�.."-..> ;_ _ SQ. FT. NO. OF SIZE 1© ROOMS ` STORIES E)Cr. WALL ROO COVERING I d )' �a' I COVERING USE OF STRUCTURE t' rI I APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS G ' I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PL P- FRAME: FIRE STOPS, CORRECT. PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS W T AL COUNTY ORDINANCES COMP Y 1 H L I AGREE TO • AND STATE LAWS RF+�C�%EATING BIWLDING¢ONSTRUCTION. FURNACE. LOCATION, �l / GAS VENT, DUCTS f•" SIGNATURE OF �' � � ,,�} LATH, INT. ' PERMITTE ADDRESS ` �"'S LATH. EXT. . PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. ® � S HOUSE NUMBER COR- FEE/}� � RECT AND POSTED VALUATION/ �S J s �kc fl FEE J FINAL 76A898A D88 3 2-88 APPLICATION FOR CTTY OF TEMPLE CITY BUILDING PERMIT BUILDING FOR APPLICANT TO FILL IN ADDRFSS LDING ADDRESS x' 5 317 N o. Loma LOCALITY ' NEAREST CITY Temple sitsityL. ZIP 917 8 Q CROSS ST. NO.OF'BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE I PARCEL DISTRICT GROUP TYPE FIRE SSED B TRACT BLOCK. LOT NO. �. CONST. ZOO OWNER Mar E. Stewart. , TZ287.-..5384 D v T, /J_ k )p STATISTICAL CLASSIFICATION SEWEgkfAP ADDRESS a 6.o'v a CLASS NO. DWELL.UNITS BK PG CITY Tem 1.e Cttt ZIP 9-1780 a'USEZO.NE. MAP ARCHITECT OR TEL.. NO. ENGINEER LIp, SPECIAL _ ( CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ �L t TEL q CONTRACTOR .LL. L R a n U o 1 NO..2 8 8-4 0.4 BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS 529. -.E. Y a 1.1 ey B 1.vt,, -1860.86 TOTAL SETBACK FROM TYPE OFEXISTING HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH LIC.' CITY San Gabriel C a . CLASS C,39 CONSTRUCTION LENDER + O NAME AND BRANCH BLDG.SETBACK FROM J ADDRESS CITY SIDE PROP.LINE OF (STREET) O SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES 1 FAMILIES ] ONE SIDE PROP.LINE HIGHWAY WIDTH , ❑ + = Z DESCRIPTION OF WORK NEW ADD ❑ CORNER CUTOFF YES ❑ NOre-roof garage on-111, ❑ 1504 c ni o 12xl8 ALTER .❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR EUSE X STOING BLDG. DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ APPLICANTL�N n TEL 288-40.40 (PRINT) _ . L . R a n d d o 1 NO. BY(SIGNATURE( / t �a IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES' y� ,y- HE WORK AUTHORIZEDAND LAWS HEREBING Y IDWILL NOT ING (SEMPLOY ANY PTRUCTION.I RERSON INTIFY TVIOI VING OLATION CS C.- p� ��•'`� M � A� THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- - PENSATION INSU'RAANNCCEE. lk SIGNATURE OF N J, y f b PERMITTEE / FINAL ' � B� "� DATE ADDRESS tvALUATION Y San 0aGr.te1 No.288-4040 P.C. Fee$ Permit Fee 9 . 00 0 . U0 Issuance Fee U Total Fee 9 . 00 P 3AN >HE -KyAubATIOM K�•M 0.--CASH PERMIT VALIDATION M.O. CASH POLICY 1101_DS-R: 5 1 FEB . 2 �: a �.�:� G � M . y6D 77, G"OUNTY-yr-L0S ANGELES ® �= ti's WM, J. FOX, CHIEF ENGINEER �I FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUfLDING DISTRICT NO. +PLAN CK. NO. PERMIT NO. ADDRESS- .G9'� 's -��""• �'"r,, a a.�.-�C4, � . LOCALITY ,e.�,..c..�;.�,!/ RECEIVED BY DATE OF AP�P�1L. DATE ISSU D .` NEAREST �/-- V _'_4L_.+,( ' .� -S �' � '*" —16` P-4,O,, CROSS ST. BUILDING OWNER ADDRESS p_ MAIL � ADDRESS 0 -..-' '.1�'Y✓�� 9. ?, LOCALITY- .f .�II-.,�,Il :' { ���%%ppGG NEAREST V CITYdi'1YP/Q��AyS'�'J Q.��� NO. CROSS ST. FIRE - NO.OF TYPE GROUP s'� ARCHITECT OR Y TEL. ZONE PLANS I I ENGINEER N- NO. BLDG. ORD. NO. - ADDRESS SETBACK LINE , APPROVED CONTRACTOR TEL. ` j �s �. NO. BY �� ,. P,.�_�� DATE USE 'APPROVED ADDRESS ZONE l'BY DATE r LEGAL I I BLOCK CORRECTIONS DESCRIPTION LOT NO. TRACT yp NO.-OF BLOBS. SIZE OF LOT/ ,�Sqq �� I NOW ON LOT USE OFI NO110.O1 .F I NO. OF EXISTING BLDG. 12 . ROOMB DESCRIPTION OF WORK I h� NEW ALTERATION I ADDITION p REPAIR MOVING DEMOLISH In Sq. FT. NO.OE* ,.i°' Z SIZE ' ROOMS STORIES " r. WALL r ROOF COVERING 4='- - I COVERING USE OF BUILDING NEW 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS - APPROVALS • APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION LOCATION, `APPROVALS ,. DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OR ®®® BRACING, BOLTS -.AI's 1,2,d-V'i: OWNER LATH, INT.: AUTHORIZED AGT Q LATH, EXT.:` P. C.111 PLASTER, INT. FEE PLASTER, EXT. 'n VALUATION �'" FINAL ;_,x. FEE „ /.iI ,,. �,0 � - -APPLICATION FOR ,>RUILDING PERMIT `� . COUNTY:OF LOS ANGELES . i BUILDING AND SAFETY WIRRKER'S COMPENSATION DECLARATION ADDRESS FOR APPLICANT TO FILL IN BUILDING ADDRES BUILDING .• I hereby affirm that I have a certificate of consent to self insure,. h ` 1-0"19 v� or a certificate of Workers' Compensation Insurance,ora certified copy thereof(Sec.3800,Lab.C.) C� ZIP ,.4C �,'` LOCALITY Policy NO. Company SIZE OF LCT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. r [� NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACTBLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant 253 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER /�,y TEL NO. COMPENSATION INSURANCE Tp IT Z�L4�' WITHIN 1000 FT.OF SCHOOL? YES NO Ns section need not be completed if the permit is for one hundred ADDRESS ( p p • DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) CITY - ZIPS , I certify that in the performance of the work for which this permit ..LX is issued, I Shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. -3 become subject to the Workers'Compensation Laws. STATISTICAL CL.A TION-- 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' CONTRACTOR• TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ov-GL-1 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL _ } SIDE LICENSED CONTRACTORS DECLARATION CITY LIQ CLASS P L 0 I hereby,affirm that I am licensed.underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000),of Division 3 of the Business and SO.FT.SIZE. NO.OF STORIES NO.OF FAMILIES - Professions Code,and my license is in full force and effect. NEW El BK PG O DESCRIPTION OF WORK _ ADD VALUATION , U License Number Lic.Class W Contractor Date ALTER ❑ $ a ❑ 1 am exempt under Sec. REPAIR ❑ $ Z BAP.C. for this reason DEMOL ❑ LDMA P/C# Date: USE OF E ISTING BLDG. URM ❑ S' nature O&Z 23 APPLICANT(PRINT) _ TEL NO. LDMA Perm# JL t Zs owner of the property, or my employees with wages as Z t-?CC'r T their sole compensation, will do the work and the structure is ADDRESS O �� ' not intended or offered for sale (Section 7044, Business and FINAL DATE 04 Q 03 50.50 Professions Code.) - C WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE AHAZARDOUS MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q FINAL BY ;,> n-.tr•r a licensed contractors to construct the project (Section 7044, Business and Professions Code.) - .YES❑ No C1 •�??yy WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING L130 i 158.265 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH TTCh;T � CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAQMDI SEE PERMITTING CHECKLIST FOR 1 GUIDELINES. - 2 ITEMS Ct i I hereby affirm that there is a construction lending agency for YES❑ NO❑ "t' ^A the performance of the work for which this permit is issued(Sec. TOT AL 209 Q 35 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING �"�{� 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY,REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, t. { �LJ7 •'' TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS (rE '3'' m Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. CHANGE .00 aD , _ Lender's Address OWVNER OR AGENT cc R. I certify that I have read this application and state under penalty a P.C.FEE PERMIT FEE / ��-yfy,_�i 0 of perjury that the above information is correct.I agree to comply C? f j-.130J -11/17/96 r ' rn with all county ordinances and State laws relating to building 11 "��' '' 1/. 7G m construction, and hereby authorize representatives of this County ISSUANCE FEE �� ? -{ j, [rylTl �?ar j S� o t nter up the above-m ntion d property for' pection p=rpo���� J 9 I INVESTIGATION FEE TOTAL FEE N Gig ure of 1—t or Agent Da SEE REVERSE FOR EXPLANATORY LANGINA� O 3 S • APPLICATION FOR BUILDING PERMIT , �•• ., a •_I A COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, 4o"/4 �C- 3 C L or a certificate of Workers'Compensation Insurance,or a certified T J copy thereof(Sec.3800,Lab.C.) C J�'.fn le zIP LOCALITY Policy No. Company SIZE OF.LOT t NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. D X 0a, NEAREST C OSS sT. ❑ Certified copy is filed with the county building inspection TRAIJ gBLOCK LOT department. 1 *® USE ZONE MAP NO. ASSESSOR MAP OOK PAGE PARCEL Date Applicant d SPECIAL CONDITIONS OWNE O TEL NO. CERTIFICATE OF EXEMPTION FROM WORKERS' C' 7`3� YES NO COMPENSATION INSURANCE ! WITHIN 1000 FT OF SCHOOLS ADDRESS n � (This section need not be completed if the permit is for one hundred , c RV-c , DISTRICT GROUP TYPE CONST.' FIRE ZONE OCESSED Y dollars($100)or less.) CIDL ,n 1 certify that in the performance of the work for which this permit —Fe—M � C i T ZIP I ( 9 Q 51 OY is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEERTEL.NO. l become subject to the Workers'Compensation Laws. e j 1 er 4[e` 71a -1-716 STATISTICAL CLAS IFICATION APT CONDO Date Applicant ADDRESS Rq. CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of VlJ f�S ri AW. SQ amo REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the WorkersCONTRACTOR TEL.NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE .�()" t' '!. C. CITY LIC.CLASS �7 a- 0 I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP 117 Ia v (commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE NO.OF STORES NO.OF FAMILIES �� NEW ❑ BK PG a� Professions Code,and my license is in full force and effect. 9--3-1 1 , TOTAL � 137 � 0 v License Number Lic.Class DESCRIPTION OF WORK ADD VALUATION C:: -! I'�u i•31�.i t o=•.10.. Contractor Date ALTER ❑. CHANGE 0,E P 13�r oD ly\S Tam l' �M" REPAIR ❑ $ �� ❑ I am exempt under Sec. l r. `tel V U B.&P.C.for this reason , St�pd e DEMOL ❑ ,r; USE OF EXISTING BLDG. LDMA P/C �I000—�y0�s • /22.4 �'tt Date: URM ❑ ii art Signature APP ICANT(PRINT) TEL.NO. LDMA Perm q ,'J t Al 3 7:33 ❑ I, as owner of the property, or my employees with wages as IV � a — 539 Z i their sole compensation, will do the work and the structureis ADDRESS n J not intended or offered for sale (Section 7044, Business and S l� o if- I c FIN DATE Q a:ice:F ,g Professions Code.) ANT 1331,1017 _ L OR A MD(TUREAPPLIC ON AI FUTURE HAZARDOUS MATERIAL EQUAHANDLL TOHAZARDOUSOGREATER THAN 3'!1. _+�.1 e,t_; ❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q t Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL /%tJ ' ITEMS licensed contractors to construct the project.(Section 7044, YES 0 NO 1:1 ( 1 ITEMS Business and Professions Code.) WILL THE INTENDED USE MI THE BUILDING BY THE APPLICANT OR FUTURE BUILDING Tj�TAL 591 - 56 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST fE� ;/ �IL' FOR GUIDELINES. t, r.i f'EIOK mak; j e._I>: I hereby affirm that there is a construction lending agency for YES El NO 1-1the performance of the work for which this permit is issued(Sec. .HANGS .00 I HAVE READ THE DOUS INFORMATION DE AND THE SCAOMD rn 3097,CIV.C.). PERMITTING CHECKLIST IR UNDERSTAND MY REQUIREMENTS UNIDER THE LOS ANGELES COUTITLE CHAPTER ICONCERNINGLender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Ra Lenders Address 0010101-1310111111 Ij ovmvtn on ADtart o 1 certify that I have read this application and state that the above 1625 1 AM 7 e 2 g information Is correct. I agree to comply with all county P.C.FEE PERMIT FEE ' N ordinances and State laws relating to building construction,and • I� 3,45 b a hereby authorize representatives of this County to enter upon ISSUANCE FEE 3, 0 ab ve-menti n�d property for i pec'on pur oses. _ —? INVESTIGATION FEE TOTAL FEE3f , ) , Sign m Al Mimnt w pm Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION v"hereby affirm that I have a certificate of consent to self insure, cf a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT pr a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified'copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS .53 11 ElN ll� .Certified copy is filed with the county building inspec- BUILDING .53t7 / ��0. �• tion department. ADDRESS L.tl TC�J `(-/' if, G ' Date Applicant CITY e, �. ZIP b LOCALITY NCr. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR MAP BOOK (This section need not be completed if the permit is for one TRACT BLOCK ILOT NO. PAGE PARCEL hundred dollars ($100) or less.) Q ` TEL. Z8?- 33g USE NE OP �•�.7 OWNER eNA NQ. 1 certify,that in the performance of the work for which this t SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS, L A �e / CONDITIONS a- so as to become subject to the Workers' Compensation L�'a^w��S.. O O 3 2 '"Lar�.1/La CiY - CITY f✓ ZIP U Date Applicant ARCHITECT OR I TEL:` 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE ESSED BY CONST. ZONE � Exemption, you should become subject -to the Workers' 3 iU Compensation provisions of the Labor Code, you must forth- ADDRESS /Ud with comply with such provisions oe :this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. in deemed revoked. � CONTRACTOR � p O. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. Z/ 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 LIC. SEWER MAP and Professions Code,and my license is'in full force and effect.- CITY `� �/\ CLASS BK PG VALIDATION _ SQ.FT.- NO. OF NO. OF CHECK License Number L c�Class SIZE �5f STORIES FAMILIES ONE ' VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ ADD !/v , ❑I am exempt under Sec. C 9-INC losu re— ALTER Signal. for this reason REPAIR ❑, $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APP(PRINT) n f p co •7 73 FINAL OWNER-BUILDER DECLARATION l•` C. l DATE ' I hereby affirm that I am exempt from the Contractor's License -7 Ve Law for the following reason (Section 7031.5, Business and ADDRESS S ►C 11�— FINA Professions Code): PRESENT By J ,p I, as owner of the property, BUILDING', or my employees with ADDRESS S 31 ,= wages as their sole compensation,will do the work and the structure is not intended or offered for sale Section LOCALITY C , 47 00 7044, Business and Professions Code.) MOVING TEL. CONTRACTOR NO. '• I I F' ❑ I, as owner of the property, am exclusively contracting z I ' with licensed contractors to construct the project (Sec- Ell- -tion 7044, Business and Professions Code.) 4 ADDRESS TAT t E. t� g CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM JE Ir-MEF. e »: SET BACK PROP. LINE I hereby affirm that there is a construction lending agency for FRONT fy f i taL w f t the performance of the work for which this permit is issued P.L. f - (Sec. 3097, Civ. C.). SIDE P.L: }�; -EY; Lender's Name IFjj t: "j i E -=a r;•r: m 3 a LLJ - -P;C. Fee$ Permit FeeLender's Address �_ �' y H '',o 1 certify that I have read this application and state that the Issuance Fee - �above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee s a and hereby authorize repres tatives of this County to enter n the above- ntioned r pert f r inspection purpos s a 3 2 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Appli nt or Agent Date . COUNTY OF LOS ANGELES TEMPLE CITYr # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS " RESIDENTIAL ADD/ALT/REP BUILDING AND,SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0003200068 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 11218 LT: 10 BL: E SQ. FT STORIES TYPE OCCUP GROUP 5317 LOMA AV STRUCTURE: 253 1 VN R3 TEMP CA 917803002 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: OLIVE 5388-007-010 OTHER: THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 03/20/00 UT 09/16/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL D E FINAL BY: CODE: LOPEZ ALBERT J;MARTHA J (626) 287-7338- 1 18,700 5317 LOMA AV / TEMP 917803002 FEES PAID DE R PTION OF WORK EX END LIVING ROOM _.__--- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: - TEL. N0. LUIS MOTA (626) 806 6876- AA BLDG PERMIT ISSUANCE 27.75 542 N. SUNSET AVE. _ AC STRONG MOTION REBID- 18700.00 VAL 1.87 SPECIAL CONDITIONS: AZUSA, CA 91702 AX BUILDING REV;I,EW=FEE- 54.70 B2 PERMIT WZ'ENEERGYf� TA�OOEES VAL 4404.58 88.90 CONTRACTOR: TEL. NO: APPROVALS��1��m APPROVALS DATE INSPECTOR SIGNATURE LUIS M MOTA GENERAL CONTRACTOR 818969283 542 N SUNSET AVE LIC. NO LOCATION AND SETBACKS AZUSA, CA 91702 623955 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. N0: / 1111111 SLAB/UNDER FLOOR �/ IL _ RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: GMP:= n UNDERFLOOR INSULATION J_ 3 `�1 U� L�(c �nu0 K� I ST LEVEL FLOOR SHEATH :- NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS NO 21 O ND LEVEL FLOOR SHEATH \ J . SCHOOL WITHIN HAZARDOUS 19 0F(- t�, ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS U A; � NO NO NO FIRE DEPT. FRAME INSPECT �� o REQUIRED TOTAL SETBACK FROM EXIST �0� 11 ®�� BLDG DEPT. FRAME INSPECT / SET BACK YARD: HWY: PROP LINE: WIDTH: ®B FRONT PL- �ePv o'_ �ap5 SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508