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Home My Public Portal About5658 LOMA AVE_Building__ TEM PLctTy 76A638A CE Ii8032-63 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 WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. rLL DISTRICT NO. GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN O CONST. BUILDING � �,? - O STATISTICAL CLASSIFICATION WER MAP ADDRESS •�' c��I,"W (�lifkA CLASS. NO.�DWELL. UNII jTS�_' BK PG LOT NO. BLOCK WATER NOT REQUIRED 7X I RECEIVED / CERTIFICATE: rr --li TRACT - 6 MAP NO. 2C) 6 fC(CIRCLE) STATE MAJOR SECOND CA NO. OF BLDGS. SIZE OF LOT � GHWAY � NOW ON LOT USE ZONE SPECIAL USE OF ,,,,,,///�� CONDITIONS - EXISTING BLDG. �.. /��+ TEL. /` OWNER w 0 r NO. BUILDING YARD . HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS FRONT " d cq / ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE ADDRESS O TEL. (J CONTRACTOR ix ADDRESS DESCRIPTION OF WORK w CL N NEW ADD) ALTR REPAIR DEMOLISH Z SQ. FT. NO. OF NO. OF - SIZE ° ORIES FPA USE O STRUCTURE SIGNATURE OF _ APPLICANT - VALUATION $�/ P / 777 APPROVALS /DATE INSPECTO - IGNATURE P.C. PMT. OUNDATION: LOCATION FEE $ FEE $ FORMS, MATERIALSRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THISBRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREURNACE: 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 CDOC OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSATIO INSURANCE. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- dd % PERMITTEE RECT AND POSTED• ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL S�CK,5 URAL`ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION M.O. CASH 8970 X15 . 22:00co - APPLICATION FOR BUILDING PERMIT FOR APPLICANT_ TO FILL IN (Print or type onIV) BUILDIN--.� �__ COUNTY OF LOS ANGELES ADDREss� �-%?� /�flf ��= DEPARTMENT OF COUNTY ENGINEER ' r e!?;, /� 1 BUILDING A D SAFETY DIVISION CITY=-f�1�/ ��/j` / C{!?;,✓7�ZIP SIZE OF LOT J JC j CJS/ NOW ON LOTNO,OF S BADDRESS1 �4.QG TRACT / BLOCK LOT NO. LOCALITY /l . NEAREST OWNER,/ NO.NOL E GROSS � ST. ✓ .�JE..C', l/ ASSESSOR ADDRESS-� � MAP BOOK . PAGE PARCEL r DISTRICT l?! TYPE FIRE ESSED BY CITY 4��/ �C ZIP CO T. ZONE ARCHITECT O �/� TE.L.,�// ,, JJ// L )� - ENGINEER/e�� /'�.LJ� r�JGLP fal/�rQ, STATISTICAL CLASSIFICATION S W E R MAP ADDRESS /� /`/lG� /�)��% CLASS NO.-__31:DWELL.UNITS BK6_>, _>y USE ZON CONTRA E MAP _ N AJC. ADDRES ,.� SPECIAL S�� J �� LIC. CONDITIONS CITY �� CLASS `�' ROAD DEPARTMENT APPROVAL REQUIRED YES NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM a FRON PROP.LINEOF (STREET) ADDRESS CITY H - TOTAL SETBACK FROM TYPE OF EXISTING _ IGHW Y } YARD - � SQ. FT:� NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH C SIZES STORIES FAMILIES ON L } 4 DESCRIPTION OF WORK NEW ADD ElSIDE p ETPBACKLINE FOROM (STREET) ALTER ❑ HIGHWAY } FROM TYPE OF EXISTING ` � - SIDE PROP. LINE HIGHWAY WIDTH REPAIR❑ USE OF DEMOL ❑ } EXISTING BLDG. APPLICANT TEL CORNER CUTOFF YES ❑ NO E](PRINT) N0. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ QQ IN COASTAL ZONE YES El NO VALUATION W� FjV'' �'�, CATEGORICAL EXEMPTION YES NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT ND AGREE TO COMPLY ' IMPACT EXEM PTION`DECLA RATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REG LATiNG BUILDING CON- STRUCTION. I CERTIFY�TIHAT IN DOING HE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE! HEREBY I WILL NOT1EM P�OY ANY PERS /IN VIOLATION OF THE LABOR CODE OF T'E S ATE OF CA ORNIA IN RELATING TO /, - WORKMEN'S COMP SA 0 I SU'ANC . / a SIGNATURE O ' : P ERh11TTEE ADDRESS / FINAL CITY TEL. NO. DATE o MAKE CIIECKS PAYABLE TO: FEE }}} FEE HARVEY T. BRANDT. COUNTY ENGINEER / L� "� `/ G/t , J PLAN CHECK VALIDATION CK. M,0. ASH PERMIT VALIDATION CK M.O.31 L ) 76A 638A CE11803 7173 4 o'LZ JUL 10 3 J.2 5 ,&V�J DEPARTMENT OF BUILDING AND SAFETY f APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM.'J. FOX, CHIEF ENGINEER FOR OFFICE USE.ONLY FOR APPLICANT TO FILL IN �f ,/ DISTRJC.T_NO. PLANCK. NO. PERMIT NO: BUILDING ADDRESS n/ HY�J i 1's ' .�7- 3 LOCALITY tt� RECEIVEBY )DATE OF APPLE^/ DAT�EE ISSUE�D�^" NEAREST g � ��•• LS �-¢�-�Zo3 �J! �-t`i G�� -=�]/ CROSS ST, �L3 :fv .l�l BUILDING ADDRESSOWNER MAIL LOCALITY �.. ADDRESS �J ;,q-c t (st. �'—�l... NEARESTTEL - - �' ' CROSS ST. CITY -/J �a �(,/Ly NO. �/� . FIRE I NO.-OF I TYPE I GROUP� '.. ARCHITECT ORTEL. ZONE PLANS - ENGINEER N0. BLDG. - ti ORD-.//NO,•. SETBACK LINE ADDRESS � j APPROVED TEL. BY DATE CONTRACTOR - f. =,?�'�•�=0"y�.-i NO. USE / APPROVED - ZONE /. BY DATE ADDRESS - n ;HOUSE NUMBERING ' LEGAL Q DESCRIPTION I LOT NO. ,` I BLOCK MAP NUMBER yL� FIELD CHECK BY TRACT . NO. ASSIGNED BY�"/0,' nEDATF NO. OF BLDGS. CORRECTIONS SIZE OF LOT V, ( f `'� - I NOW ON LOT �~ ��r- ).-y � A )bv EXISTING BLDG, I NO.FAM OFs L.�Pi O F / / ��yn, J.[C'(��!a✓" — -a, DESCRIPTION OF WORK NEW ' _ ALTERATION ( ADDITION , �G5�6 n E' /�'Nt717A L1.QaA csQ j,F?�V O . REPAIR I I DEMOLITION SQ. FT. ) d" NO. OF �. SIZE ,l I ROOMS STORIES - Z a EXT. RING (P" /�I ROOF - f' COVERING �••�'� �COVERING USE OF STRUCTUREU - APPROVALS• INSPECTORIS SIGNATURE DATE 1 HEREBY. ACKNOWLEDGE THAT I HAVE READ*THIS AP- FOUNDATION: LOCATION �r��► PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORAGREE TO, COMPLY WITH THE CORRECTIONS LISTED I FRAME: FIRE STOPS, ' HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS . LAWS REGULATING "BUILDING CONSTRUCTION. - eo - FURNACE: LOCATION, c/ SIGNATURE OF �`�,� GAS VENT, DUCTS �- (� PERMITTER - LATH, INT. ADDRESS LATH, EXT. 4 ' AUTHORIZED AGT: PLASTER, INT. - 7EA688A, 0888 10-50,, P. C. $ ��JQ FEE . PLASTER, EXT. VALUATION .FEE $�� FINAL I 76A638A CE #803 3-69 APPLICATION FOR BUILDI PERMIT �i 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 CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO GROLP� TYPE PROC D Y r (PRINT OR TYPE ONLY) oil BUILDING STATISTICAL CLASSIFICATION EWER MAP ADDRESS CLASS NO. DWELL.UNITS BK PG 42, LOT NO. BLOCK USE ZONE MAP /j O NO. VV TRACT SPECIAL NO. OF BLDGS. COND TIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDfiWpl 1 ing BLDGSETBACK FROM TEL. FONTY .PE OF PROP.EXISTING 5 SETBACK HIGHWAY + YARD _(ST O AL) OWNER Willard J. Snell No. ADDRESS 5658 Loma Avenue HIGHWAY'l WIDTH FROM C.L. CITY Temple Cit ARCHITECT OR TEL. DG.SE FROM SIDE PROP. LI (STREET) ENGINEER NO. S TYPE OF EXISTING SETBACK AY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. _ CONTRACTORVirgin O CO. N0 y287-0507 + d ADDRESS 600 S. San Gabriel N0160650 LIC CORNER CUTOFF YES ❑ NO L LIC, CITY San Gabriel CLASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS C CONSTRUCTION LENDER ~ NAME AND BRANCH LL a f! ADDRESS SQ. FT. NO. OF NO. OF ❑ SIZE STORIES 1 FAMILIES NEW STRUCTURE Reeoof House & Garage USE OF ADD ❑❑ ALTER with Comp. Shingles REPAIR ] SIGNATURE OF DEMOL ❑ APPLICANT VALUATION $ 545.00 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION $ FEE $ FEE 0 FORMS MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS TION. ICERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. LATH, EXT. SIGNATURE OFHOUSENUMBER CORRECT PERMITTEE AND POSTED ADORE�0 S. Stn" el.San Gabriel San el.San Gabriel FINAL JOHN F. LEWIS, PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION cK. nn.o. CASH ► Ar",�.6 3 0 3 ALrG 12 1 D 9.0 0 r v WORKERS':COMPENSATION,DECLARATION ••.'1 hereby affirm that I have a certificate of consent to self APPLICATION FOR' B.0 I L®I.N G 'P E RM I T insure, or a•certificate of Workers' Compensation Insurance, oP`a certified'copy'thereof'(Sec. 38005aa C.) e cC111Densation COUNTY OF LOS ANGELES BUILDING'AND SAFETY Policy No.4301142-9Qompany ryu BUILDING �- ❑ Certified copy is.hereby furnished. FOR APPLICANT TO-FILL IN ADDRESS ❑ Certified copy is filed with the county'building inspec- BUILDING tion department. ADDRESS 5658 Loma Date �=�5-A� Applicdnt I _ Pv w_ Centel" CITY ZIP 91780 LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE'OF EXEMPTION FROM WORKERS' ,�`�"/ SIZE OF LOT ' NOW ON LOT 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.) TEL. OWNER 6J111 1 d J. Snell NO. 'L8 _ USE ZONE MAP I certify that in the performance of-the work for which this NO. permit is issued, I shall not employ Iany person in any manner ADDRESS 5658 Lana SPECIAL so as to become subject to the Workers' CONDITIONS CL Compensation Laws. O CITY Tenple City ZIP 91780 U Date Applicant ARCHITECT OR TEL. � NOTICE TO APPLICANT: If,. after making this Certificate'of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY i CONST. ZONE LU Exemption, you should become subject to the Workers' /)�. U I LU Compensation provisions of the Labor Code,,you must forth- ADDRESS . !! ✓ f/ CL with comply'with such, provisions "or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked.. '. CONTRACTOR L. &'W. NO.818-287- Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS ADDRESS 8812 Las Tunas Drive- NO. 205 I hereby affirm that l,am licensed under provisions of-Chapter 9'. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITYAb GA�ribl CLASS _ BK PG.. VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number 20�i�4a��' Lic: Class C - R SIZE STORIES FAMILIES ONE • VALUATION Contractor. _ to - '�ri-Q I - DESCRIPTION OF WORK NEW ❑ $ _ ADDEl ❑ (� I am exempt under Sec. ALTER BAP.C. for this reason REPAIR ❑ $ Date: �—Z S_ y USE,OF. - vn. d xn EXISTING BLDG. DEMOL ❑ Signature'7��,LC !', -�'��`-4� APPLICANT TEL.(PRINT). NO. FINAL- OWNER-BUILDER DECLARATION _ j I hereby affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT : By ,- ,V� - 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 poll 7044, Business and Professions Code.) MOVING TEL. CONTRACTOR NO. 3 I E ❑ 1, as owner of the property, am exclusively contracting M with licensed contractors the project (Sec- ADDRESS €'_t1 HL a`:' 00 tion 7044, Business and Professions Code.) _ REQUIRED- TOTAL SETBACK FROM EXIST. "•.-.; ,€f_I CONSTRUCTION LENDING AGENCY 'SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT tLifll�3� aII the performance'o£the work for which this permit is.issued P:L.' (Sec.•3097, Civ. C..).: SIDE P.L. ' �i Le - nder's Name i` _•. I_tl_-Wa I{I i BQ LDMA Ref. # _ - P.C. Fee$ Permit Fee ,;.tl+,• Lender's Address t O o 1 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 6 ordinances and-State laws relating to building construction, Total Fee ��• LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. a a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 9690006 SB WORKERS' COMPENSATION DECLARATION f'consent'to self insure, oraafirm certif carte of Worke s',CompeI have a certificate �sat on Insurance, APPLICATION . FOR. B U I-L®I IV G PERMIT or a certified copy'thereof(Sec. 3800, Lab. C.) I a COUNTY'OF LOS ANGELES BUILDING AND'SAFETY Policy No.'W0007146 Company Beaver Ins°. BUILDING ❑ Certified copy is hereby furnished.. FOR APPLICANT TO FILL IN ADDRESS _ . X Certified copy is filed with the county"building inspec- ADDRESS BUILDING- tion department: �! 'Date 7-1-89 - Apph`canr ' Vir;in Roof Co. ciTY, Tem le Ci't � zip 91780 LOCALITY NO.-OF BLDGS. NEAREST _. CERTIFICATE OF'EXEMPTION'FROM WORKERS' SIZE OF LOT NOW ON LOT 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.) ' TEL. OWNER-Willard Sriell NO. jQ I certify,that in the performance of the work for which this - } USE NE MAP INO. " SPECIAL" a_ Perm it is issued,'I shall not employ any,person'in any manner ADDRESS " -5658'"LOma- `"'- �• CONDITIONS O so as to become sub1ect to the Workers' Compensation Laws. ._ ,_.. . _ U CITY---Temple City zIP 917$0... Date Applicant ARCHITECT.OR TEL DISTRICT OUP TYPE FIRE ' PROCESSED BY O NOTICE TO APPLICANT: If, .after making.this Certificate of ENGINEER NO` 4,r.. _ CONST ZONE U Exemption, you should become: subject to. the Workers' w 1 �V1 r Compensation provisions•of the Labor Code, you must forth- ADDRESS "' N with.-comply with such:provisions or_this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CO O. Z deemed.revoked. CONTRACTOR, Vir in Roof CO. NO. 287-0507 _ - LICENSED CONTRACTORS DECLARATION' LIC. CLASS NO. DWELL. UNITS ADDRESS NO� I hereby affirm that I am licensed under provisions Chapter.9 LIC. r ,-(commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and m license is in force and effect. CITY CLASS C39 - VALIDATION Y SQ. FT. NO. OF NO. OF CHECK BK. PG.,_ License Number 160.65G. Lic.,Class" C 3 9 SIZE 28_ s g STORIES 1 FAMILIES ONE VALUATION Virgin. Roo'f�'Co.Dote` 6=30-89 DESCRIPTION.OF WORK House t� Gard e• NEW ❑, Contractor ❑1 am exempt under Sec. Over existing apply Class A ADD ❑ $ 4000.00 ALTER .❑ _ B.&P.C. .for this reasonFiberglass Shingles. (28 sQs REPAIR ❑ a Date: USE.OF .. EXISTING BLDG Dwelling DEMOL Signature APPLICANT__ TEL.. FINAL ) ' OWNER-BUILDER DECLARATION (PRINT). Vir" in Roof Co. NO. 287m-6507 DATE""-� I hereby affirm that I am exempt from the Contractor's License -Law for the following reason.(Section7031.5,-'Business and ADDRESS P.O. BOX J San Gabriel 391778 FIN' Professions Code): PRESENT • BUILDINGEl I, as owner of.the'property, or mY employees with . ADDRESS �, • wages as their sole compensation,will do-the work and /''t"• f s the structure is not intendedor offered for sale(Section LOCALITY . .s — 7044, Business and Professions Code. MOVING =• TEL. ,1 ;`, i _ .. �r I: CONTRACTOR NO. ❑ I, as owner of the property, am exclusively contracting 5 Tl, _y with licensed-contractors to construct the•project (Sec- ADDRESS tion 7044, Business.and Professions Code.) DUO � ;ae REQUIRED --TOTALSETBACKTROM EXIST. CONSTRUCTION'LENDING AGENCY ' SET BACK PROP. LINE WIDTH ) } ,- the performdnce of the work forwhich this permit is-issued PL YARD. HWY J I hereby affirm that there is a construction.lendin agency for FRONT �EI l ` (Sec. 3097, Civ. C.'). SIDE. - PA:- Lender's Name mr` - „ - . . _ _ _ •� 27 8'.. jo =1i� r7LDMA Ref. !513PC: Fee.$ Permit Fee Lender's Address -1r ■G a I certify that 1.have read this applicaTion and state that•the Issucince Fee LDMA P/C# 8 above information.is correct..I agree to comply with all County Investigation:Fee.: - d ordinances"arid State laws relating,to building construction, I Total Fee _ 68.63 LDMA Perm. # Q and hereby authorize representatives of this County tit enter -� UR on the above,:mentioned.property for inspection purposes. 1—(}-89.• SEE REVERSE FOR EXPLANATORY LANGUAGE 5' nature of Applicant or Agent Date WORKERS'.COMPENSATION DECLARATION ereby affirm that I have'a certificate of consent to self A h p L I CAT I® 1' FOR, BUILDING: PERMIT insure, or a certificate of.Workers' Compensation Insurance; ' . or a certified copy thereof.(Sec. 3800, lab C.). COUNTTOF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING. p ❑ Certified-copy is hereby furnished; FOR APPLICANT TO FILL IN'. ADDRESStJ ❑- Certified.copy is filed with the county building inspec- Q BUILDING tion department. ADDRESSdM A A ". b V L- l/ Date. Applicant CITY .. LG Ci ��.. ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT "NOW ON LOTS NEAREST COMPENSATION'INSU RANCE. CROSS`ST. ASSESSOR (This section need not be completed if The permit is for one TRACT BLOCK LOT No. MAP$OOK PAGE d PARCEL 06 hundred dollars ($100).or less.) TEL 3Z OWNER ,E, ELL NO. S�` USE ZONE, MAP NO. I certify that in the performance of•'The work for which this. ,t permit is issued, I shall not employ any person i nymanner ADDRESS .5� Q I�A ��+ - SPECIAL CONDITIONS so as to become subject to the;W-ork Comp cation Laws.` ,^A 0 +7� CITY 'v► �+6_�= ' ZIP Date-----CA licant ARCHITECT OR TEL PP ' DISTRICT GROUP .TYPE FIRE' PROCESSED BY NOTICE TO PPLICANT: If—after making,this. erti tate o ENGINEER NOy .: CONST. ZONE R Exemption,: you should become, subject To the Workers `. i Compensation provisions of the Labor Code, you must forth- ADDRESSQ� - li W CL with comply with •such provisions or this.permit shall be A �v Op STATISTICAL CLASSIFICATION APT. . CONDO. Z deemed revoked. CONTRACTOR 0. r7 1" 8 — LICENSED CONTRACTORS DECLARATION �c LfC CLASS NO. ' DWELL. UNITS — ADDRESS hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �o r��b ' G 'A LIC SEWER MAP (commencing With Section 7000)of Division 3 of the Business CITY..' �/r' CLASS and Professions Code;and my license is in full force effect: BK. PG. VALIDATION SQ.FT NO. OF NO. OF CHECK'' License Number 4;-7 Lic. Class SIZE STORIES FAMILIES ' ONE (�(� n_ /� n ALUATION Hl�t��f 1. tV,lt��' �1 3 DESCRIPTION OF WORK �1 O C_Q✓E2 NEW $ o0 Contract r ate ,n �. . ❑1 am exempt under Sec. Fr c4L `off-SSS 10,:. ADD ❑ •, _ ALTER ❑ B.&P.C.-for Thi on _ REPAIR ❑ a D e USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL' FINAL 'O NER-BUIL ER.DECL RATION (PRINT). NO DATE � },U ;•� _ I her affirm that I am exempt.from the Contractor's License ; Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code). PRESENT By ❑ JL BUILDING l; as owner'of the property; or my employees with ADDRESS n41+i°* a wages as their sole compensation;will do the work and 4.8.75 the structure is not intended or offered for sale(Section LOCALITY } �,_.'. 7044,,Business-and.Professions Code.)' MOVING TEL 1. ❑ J, as owner of the property, am exclusively contracting CONTRACTOR NO. g' ADDRESS with licensed contractors to construct the project:(Sec- �+ • tion 7044.Business and'Professions Code,) � -} � REQUIRED TOTAL SETBACK fROM' EXIST: v 3d r µ 9'7 'CONSTRUCTION LENDING AGENCY SET BACK YARD' HWY PROP LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT:' " 2 ITEMS the performance of.the work for which this permit is issued P.L. * p4 g � (Sec. 3097, Civ: C.)., SIDE _ 10TAL S42 m,9 3 Lender's Name' CHEM 14 • LDMA'Ref # PIC. Fee$ Permit Fee oaJtj 3 Lender's Address � ^GHA�f�E a I certifyThat I have read this.,a lication.and slate that the Issuance Fee P/C# ' above iformation is correct. I a pee to-complywith aII Count lnvesti otion Fee p^ g 9 - y g / d ordinances and St laws relating to budding construction, Total`Fee ' '� ` " LDMAPerm. # _ - App Q andrher, th t e repr ntatives of This.Countyto enter 1 1 tH1 7;aaue ntion ro erty for inspection urp sec. " ` SEE REVERSE FOR EXPLANATORY LANItAGE' l� gnatu k of ppli ant or Agent 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 1408250101 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 16305 LT: 5 SQ. FT STORIES TYPE + 5658 LOMA AV I (STRUCTURE: V-B TEMP CA 917802450 1 (ASSESSOR INFORMATION NUMBER: 1 NEAREST CROSS STREET: DUFFY I 15387-018-001 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI (TENANT: JEXIST BLDG USE: RESID USE ZONE: R-1 11SSUED ON: PROCESSED BY: J IEXIST OCC GRP: 108/25/14 SR 1OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFI AL D TE FIN L BY: CODE: 1 ISNELL, DEBORAH - - 7,500 I 15658 LOMA AV I / ITEMP 917802450 1 FEES PAID 1DE RI TI N &F WORK \, 1 . REPLACING 3 WINDOWS IN LIV NG AND DINING ROOMS 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( i JAPPLICANT: TEL. NO: I IJ ISAME AS OWNER - 1AA BLDG PERMIT ISSUANCE 27.80 J 1 JAB STATE GREEN BLDG FEE 7500.00 VAL 1.00 ISPECIAL CONDITIONS: IAC STRONG MOTION RESID 7500.00 VAL 0.80 J ID2 PERMIT W/O EN-HC 7500.00 VAL 183.00 J TOTAL FEES 212.60 CONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I I LIC. NO I ILOCATION AND SETBACKS I JSOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS 1 J LIC. NO: I ISLAB/UNDER FLOOR J J I IRAISED FLOOR FRAMING J I l I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CM001 (UNDERFLOOR INSULATION I I FLOOR. SHEATHING J INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: J NO 21 (ROOF SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I - JAIR QUALITY: 1000 FEET MATERIALS I NO NO NO j' IFRAMz3 INSPECTION IFIRE SPRINKLER HANGERS J (INSULATION/WEATHER STRIPI 11NTERIOR LATH/DRYWALL IEXTERIOR LATH IRATED FLOOR/CEIL ASSEM. I IRATE? WALL ASSEMBLIES I RATED SHAFTS/OPENINGS I I I I I I IT-BAR CEILINGS 1 I ILOT DRAINAGE J (REPORT ID: DPR261 ROUTE TO: BSO508 I I I I I I