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HomeMy Public PortalAbout8916 LONGDEN AVE_Building__ LaPG° UCS MOM FOR-R— o U�LMHO PERPAr � COUNTY OF LOS ANGELES BUILDING ARID SAFETY WORKER'S COMPENSATION DECLARATION ADDRESS BU FOR APPLICANT TO FILL IN BUIL ��� G ADDRESS / ING v 1 hereby affirm that I have a certificate of consent to self Insure, 6 B or a certificate of Workers'Compensation Insurance,or a certified CITY zIP copy thereof(Sec 3800,Lab C r_ C /'at .j r Policy No - -T ifs '� Compa fps.c(� F LOT l�c�i� i LOCALITY c �/ s SIZE OF LOT NO OF BLDGS NOW ON LOT fCertified copy Is hereby furnished -50 NEAREST CROSS ST ❑ Certified copy is filed with the co bulldin Inspectlo TRACT BLOCK LOT NO department QQ v /0 T V USE ZONE MAP NO f Date f9�^`0Appllcan ASSESSOR_MAP BOOK PAGED PARCEL y� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS/// owNER S�,/� J s t TEL NO ���� //�/ No COMPENSATION INSURANCE C.�' rig �J WITHIN 1000 FT OF OOL1 yg ADDRE / / (This section need not be completed If the permit is for one hundred 6 G( DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars(x100)or less.) CITY /t _ 1--)A ZIP ��� I certify that In the performance of the work for which this permit �d'("(�� b` C_w/" Is Issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGINEERA TEL NO q './ C/o become subject to the Workers'Compensation Laws jL 3Q7 -/ D STATISTICAL CLLAASS�IIFICATION APT CONDO Date Applicant ADDRESS/ , CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate ofCOTO s TEL REQUIRED TOTAL SETBACK FROM EXIST CO Exemption, you should become subject to the Workers' q/,, L- SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Las ` Q 8�g���v FRONT comply with such provisions or this permit shall be deemed revoked ADD�ss ^ LI�O PL 66 Mfr S' >- LICENSED CONTRACTORS DECLARATION CITY r��t�� LIC CLASS SIDE U I hereby affirm that 1 am licensed under provisions of Chapter 9 SEWER MAP � (commencing with Seotlon 7000)of Division 3 of the Business and SO S NO OF STORES NO OF FAMILIES Professions Code,and my license In full force and effect Z NEW BK PG H License Num, �4`�`� LIC Class rJ DESCRIPTION OF WORK ADD ❑ VALUATION D in it.�2 to Contractor Date ` ALTER ❑ �� DD' �� Z –2—q A� kQc&d REPAIR El❑ I am exempt under Sec $ B&PC for this reason DEMOL 1:1 USE OF EXISTING BLDG URM ElLDMA P/C# Date. } Signature APP C NT(P/R,INT) TEL NO / LOMA perm# El 1, as owner of the property, or my employees with wages as YL� Q� ---2 74:? p their sole compensation,will do the work and the structure is ADD ESS (�,,y,�I /� F not intended or offered for sale (Section 7044, Business and d ,/�'► �="�^ 4 FINAL DATE G X31-7 1CI02.73 1 Professions Code) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT RANDLE A HAZARDOUS MATERIAL Z •• j I�'��*(C ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ' Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? F1 licensed contractors to construct the project (Section 7044, YES❑ NO T!TAI Business and Professions Code) y r. WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK 11�Li a f V OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH /y CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST (d/ CHANGE I hereby affirm that there is a construction lending agency for FOR GUIDELINES YES El NOX p the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAGMD 10/15/90 f '}} 3097,riIV Ci) PERMITTING INGCHECKLIZTCIUND�ZTANDMONS2IREMTHROUGH2401{4000NCNERNFING 1�GO0 -3GO1 10/15/90 ;b Lender's Name U IA =ER TIONS I G FROM THE SCAOMD / i A q a Lenders Address OWNER OR AGENT `t`7f-) i r7 (L _ I 0 1 certify that I have,read this application and state that the above PC FEE PERMIT FEE ,r- ` Information Is correct I agree to comply with all county D ,�J�� ordinances and State laws relating to building construction,and O hereby authorize representatives of Is County to enter upon ISSUANCE FEE the v ntio a�pr •rt fo tion purposes ! m �• �.-S �- U INVESTIGATION FEE TOTAL FEE n sgn.e.e a Ao~V Awro D� SEE REVERSE FOR EXPLANATORY LANGUAGE /YJ t* "� WORKERS' COMPENSATION DECLARATION I hereby, affirm that I haCertificate of consent to self Wor iQsure, or a certificate of Workers' Cornpensation Insurance, - L/�1t1 lJ IJV v �J�J Llu�f�fu or a.certrfied copy thereof (Sec 3800, lab. C ) COUNTY OF LOS ANGELES L�JNG A D FETY Policy No Company / BUILDING ❑ Certified copy is hereby furnished _ FOR APPLICANT TO'FILL IN ADDRESS ❑ Certified copy is fried with the county building inspec- BUILDING ' tion department �, ADDRESS 22. LQ(1&, �J Cue 68- CITY (ter ZIP LOCALITY ALG' �+ Date Applicant -7 NO OF BLDGS CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT i { &00 �•�. NOW ON LOT NEAREST CROSS ST COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the•permtt is for one TRACT *90* Er r14 BLOCK LOT NO WW MAP BobK PAGE�� P C -hundred dollars ($100)or less ) - TEL OWNER 014AIZL0 AIJ(� NO(gl%)44& USE ZONE MAP ' NO I certify that in the performance of the"work for which this SPECIAlf permit is issued, 1 shall not employ any.person^in any manner ADDRESS 461 OX' V- 09- CONDITIONS d ,so as.to become•subject.to the,Workers' Compensation Laws O CITY ApCCsLlalf'L ZIP Date Applicant ARCHITECT OR TEL � NOTICE TO APPLICANT If, after-making this Certificate of ENGINEER IP16 iJA�J6 CPS TEL No glg 3`99 1W DISTRICT G UP' C N FIRE- PROChSfS]ED�JBY rExempption,- you-,should,become-.,subject to the Workers' K,�� � J w Compensation provisions of the Labor Code, you,must forth- ADDRESS. . L65 t� �.•-CJ-� �/ ,V v a ..with comply with such provisions or this permit shall be - TEL STATISTICAL CLASSIFICATION APT CONDO N 1*1 Z deemed revoked,, et L- ,. CONTRACTOR NO — LICENSED CONTRACTORS,DECLARATION LIC CLASS NO 5��DWELL UNITS Thereby 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 _8 and Professions'Code,and my license is-in full force and effect CITY CLASS BK PGLIDATION SQ FT NO OF NO OF CHECK „�•bra� License Number Aic Class SIZE Site STORIES �- FAMILIES ONE, M 33 , DESCRIPTION OF WORK NEW EI Contractor - Contractor - Date 1 iTENj ADD ❑ ❑I am exempt under Sec c� -rJNtT D TOTAL } Tt ALTER ❑ / n aa f��ttCCrr =; :t4al�t B&P C for•thrs reason t ' USE OF I T � (�' REPAIR ❑ S//) �DO� v V l.•fTGt f� 1454.0.4 Date EXISTING BLDG DEMOL ❑ ' VVVIIICHANGE a1; Signature APPLICANT 'ClNIAQTEOT), 1!(PRINN303.114FINAL OWNER-BUILDER DECLARATION , DATE I hereby affirm that I am exempt from the Contractor's License �N _ 0006-0601i�i�� j "Law for the following reason (Sectwn-7031 5, Business and ADDRESS 9i, -MNA4 -0-- t8V FINAL _ 1Mi a ProPRESENT Professions Code) T [:] '•By ��r 1 ni I1 �7 BUILDING I, as.owner of the property, or,my employees with ADDRESS _ wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section s 7044, Business and Professions Code ) MOVING "• ' TEL D ❑ I, as ownef of the property,-am exclusively contracting CONTRACTOR NO ►/�1 /j� ' ONEC with licensed contractors to construct the project (Sec- ADDRESS \'tion 7044, Business and Professions Code ) y M REQUIRED TOTAL SETBACK FROM' EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY' :- PROP LINE WIDTH [.hereby affirm that there is a construction lending agency for FRONT the performance of the,work for which'this permit is issued "P L v fr1 t-•x �JI�/► L ll/ (Sec ,3097, Civ C ). SIDE P L Lender's Name 1 �• , , r— ,� DMA Ref-# -0W PC Fee$ / PermitFee _. � Lenders Address Y ,,_„i M0 1-certify that I hcfve read this application and state'that the Issuance Fee r•-• r-� LDMA P/C#- above information is correct I agree to comply with all County Investigation Fee ordinances and State jaws relating to building construction, Total Fee r— 1,LTM!P r # ' < and hereby authorize representatives of this County to"enter upon the above_mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE;.! t•.1 U4 t Signature of Applicant or Agent Date �'^ i�� --' '•'i" i ,y - a appUCQMOO N FOR PUMDNG p[ G ]rr ,! - �1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL DDRE ` '/ BUI ING AD RE �NC7 4 • ,-I hereby affirm that I have a certificate of consent to self insure, YJ1 Am— copyor a certificate( of Workers'Compensation Insurance,or a certrfled CITY ZIP / t� copy thereof(Sec 3800,Lab C) (� q Policy No.��. ��7`�D Companu`7c. � ( LOC° � SIZE OF LOT NO OF BLDGS NOW ON LOT /� �/!f Certified copy is hereby furnished NEAREST CROSS ST ❑ Certified copy Is filed with the c tTnty building inspect n TRACTBLOCK LOT NO department /0 G USE ZONE MAPNO J {' ��, <4 ASSESSOR MAP BOOK PAGF�O PARC�O 16 Date- DAppllcan Jt–JCA'OK (J z__ SPECIAL CONDITIONS a CERTIFICATE OF EXEMPTION FROM WORKERS' TEL NO �C��iCCIT COMPENSATION INSURANCE 8 qu��Z73 WITHIN toxo Fr of HOOL7 s No ADDRESS (This section need not be completed if the permit Is for one hundred6' � DISTRICT GROUP TYPE CONST' FIRE ZONE PROCESSED BY dollars($100)or less) I certify that in the performance of the work for which this permit CITY n`� CA F/" /" Is Issued, I shall not employ-any person In any manner so as to ARCHITECT OR ENGINE -TE NO r/ become subject to the Workers'Compensation Laws Itt ` 3 T O STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS ••��_– CLASS NO 1LSL—DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of l.. ' REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CO TOR0vt TE NO �i SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ' 6�� 136 PL comply with such provisions or this permit shall be deemed revoked ADD ESS LIC O FRONT �JTYa� SIDE >' LICENSED CONTRACTORS DECLARATION CITY LIC CLASSo P L a C) I hereby affirm that I am licensed under provisions of Chatter 9 so FT SI NO OF STORES NO OF FAMILIES SEWER MAP � (commencing with Section 7000)of Division 3 of the Business and zqE II Professions Code,and my license is in full force and effectp s- a / NEWX I BK PG CD License Num LIc Class (� DESCRIPTION OF WORK ADD- VALUATION D 0 W ❑ Contracto Date _ _ ALTER ❑ $ /eel ❑ I am exempt under Sec ^� '_2 REPAIR ❑ $ B&RC for this reason � DEMOL ❑ LDMA P/C# USE OF EXISTING BLDG Date URM ❑ Signature APPLI T(PR NT) TEL NOL DMA����� LDMA Perm# _ E] I, as owner of the property, or my employees with wages as S "r`f O � .I_] Q g their sole compensation,will do the work and the structure is ADDR not Intended or offered for sale (Section 7044, Business and s 4r&L4fqC NAL DATE <> �3!_J7 21 f Professions Code) ITEM'S WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �•• J it+'.l OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ' ❑ I, as owner tr the property, ru exclusively contracting With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > licensed contractors to construct the project (Section 7044, YES❑ NOR - �Am TOTAL ;��)- Business and Professions Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING f;HE : . j i i)� ,! OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ��JJ/�� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST �/ _ rt U� FOR GUIDELINES N hereby affirm that there is a construction lending agency for YES❑ NO 3 the 3097,performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD j Q—�p/•� ) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES / // f C '1 COUNTY CO TLE PIER 220 SECTIO 2 20 100 THROUGH 220110 CONCERNING II�I0I0-0IIT, 13/1 1�7t! ; Lender's Name HAZAR ERI S PORTING AN F TAINIyG A PERMIT FROM THE SCAOMO ^�i i CL Lenders Address {OMV-OVADVI V �� P IL. J C3 1 certify that I have read this application and state that the above PC FEE PERMIT FEE information Is correct 1 agree to comply with all county pCJ P ordinances and State laws relating to building construction,and t3 /• u T9 hereby au nze representatives this County to enter upon ISSUANCE FEE f 0—1�-�L7 t m on pe s tion purposes 3 INVESTIGATION FEE TOTAL FEE '7 0 swuan a Mara. A._ 0m ©�l7)' O SEE REVERSE FOR EXPLANATORY LANGUAGE AWORKERS' COMPENSATION DECLARATION } • r insure, or affcertif certificate of WorkeFs' Compensation Insuranc`e{1 ° Q p p M CCQU S O N FOR o UTL D N G p E R Y or a certified copy thereof (Sec 3800, Lab`C ) r• COUNTY OF LOS ANGELES' BUILDING AND SAFETY ` Policy No/LlZI el Company CA El .'Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed•with thecou tld mspec_ BUILDING/1lGt l L . ` ZZ N tion department ADDRESS .fY Date ApplicariT t CITY it V�' 'CIL I ZIP LOCALITY F EXEMPTION FROM,WORKERS' NO OF BLOT NEAREST CERTIFICATE O - �"���� SIZE OF LOTNOW ON LOT CROSS ST - COMPENSATION INSURANCE ASSESSOR (This section need not be completed'if�th'e permit is for one TRACT = BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars-($100) or less') TEL OWNER - �1�1`I'r I�C( C' NO-SCIl%1Zk D USE ZONE MAP NO I certify that in the performance 'a`the work for which this G � ii 10N�., . SPECIAL ' >_' permit is issued, Ishall not employ any person in any manner ADDRESS O�" `• H^ - CONDITIONS 0- so as to become•subject to the Workers'Compensation Laws j p� Q / O s CITY - f9/*,-J4 dib-, 9A F-L_ ZIP "1 1 i 7(40U Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE - FIRE PROCESSED BY Q NOTICE JO APPLICANT If, after making, this Certificate of ENGINEER,.., = NO CONST/. J. Z E � Exemption, you should become -subject to the Workers' �! '/ U Compensation provisions of the Labor Code, you must forth-• ADDRESS - i' GIJ�t a with comply with such'provisions or this permit shall be /� 01/R TEL� � /_pC�O STATISTICAL CLASSI ATION �u PT CONDO Z deemed revoked ' CONTRACTOR 0A L AL,4 (9 L _ _ LICENSED CONTRACTORS DECLARATION - LIC 6,651 , CLASS NO DWE UNITS '•f i,j �` I hereby affirm'that I am licensed under provisions of Chapter 9 ADDRESS 6 03 revf 1-D NO 6,r - r, (commencing with Section 7000)of Division 3 of the Business CITY CO lV �� LLIIC�� ` /6 SEWER MAP _jj j •' ? and'Professions Code,and m Ice se ism full force and.effect l BK PG VAND N �j G SQ FT NO OF NO OF /,, CHECK ' License Number ✓��b Lc Class �+ "I SIZE STORIES FAMILIES (y ONE TOTAL 1 TA • i76 ®5 97 .Contractor Date ` / DESCRIPTION OF WORK NEW r Jer. PiPI/(I�CG�`i� ADD ❑ r �• E] I am exempt under Sec ALTER ElD �• fiii�l� ,i_if B&P C_ for this reason // $ Date �'–1/� �� USE OF -. REPAIR ❑ - EXISTING BLDG DEMOL ❑ 11j((( E q 7/;'1 Signature APPLICANT P h, _ g NER-B ILDER DECLARATION (PRINT) C(��C� a EWAN r, L �'!j G��'pZ� FINAL ���"/,�� DATE/?,., r dl'&c j hereby affirm that I am exempt from the Contractor's License ADDRESS G0� ra/e�'Gr d /COtQ/ fJ _ Law for the following reason (Section 7031 5, Business and FINAL , 1 14 Professions Code) PRESENT - - By BD El1, as owner of the property, or my employees with a ADDRESS'('I'�ir wages as their sole compensation,will do the work and 77,, the structure is not intended or offered for sale(Section LOCALITY _r,�,L,7 ;``to (= 7044, Business and Professions Code ) MOVING- TEL D = '� /`+may ❑ I, as owner of the,property, am exclusively contracting CONTRACTOR NO C !/ 'CIS f•t` --with licensed contractors to construct the project (Sec- ADDRESS y TOTAL 2� ® 13 tion 7044, Business and Professions Code ) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST E_j- (; CONSTRUCTION LENDING AGENCY SET BACK 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" L•t �f.3L ,LIU, (Sec 3097, Civ C•) SIDE PL . Lender's Name E i�31 i�-3 iJi �'' �i}tL.'0 P C Fee$ / •� Permit Fee Oi/ LDMA Ref N ' Lender's Address c€ill.n A j certify that I'have read this application and state that the Issuance Fee �a U LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee ordinances a t la ' relating to building construction, Total Fee LDMA Perm # < and hereb a izea resentatives of this-County to enter U pon}h a enh ed pioperiy for inspct�iony"ur�ose/s SEE REVERSE FOR EXPLANATORY•LANGUAGE , S nature of pplcant or Agent- —Date`7—_ APPUQ%MO ] FOR,R. o M LIMHO PERMF COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BLI DDRESS BU DING ADDRESS I hereby affirm that I have a Certificate of consent to self Insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab C CI CAZIP�/� �� �p LOCALITY Policy No 4 — ompany ""�I SIZE OF LO V NO OF BLDGS NOW ON LOT 0 Certified copy Is hereby fumished ������� NEAREST CROSS ST ❑ Certified copy is filed with the coun building Inspection TRACT _` BLOCK LOT NO �0 USE ZONE MAP NO department pp ASSESS R MAP BOOK PAGE PARCEL Data t/11L�App6cant � �� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNVW� Q TEL N�_2 34WITHITH J NO COMPENSATION INSURANCE IN 100D FT OF SC L� ADDRE ' (This section need not be completed If the permit is for one hundred 7 r DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) CITY/ CA 9 zIP 9l I certify that in the performance of the work for which this permit 7 IS Issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGIN �d ^ T NO become subject to the Workers'Compensation Laws /m l�n, 3 —124C> STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRE U U CLASS NO 049 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of Q -Tt"s fir' REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CON TORS TEL NOSETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith f % FRONT comply with such provisions or this permit shall be deemed revoked ADDRE 647 (Y{/9r J LIC FNO���� PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC CLASS 6 PL 0- hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and IZ p NO OF STORES NO OF FAMILIES O Professions Code, nd my license is In full force and eff t l O 7i I`1 BK PG U DESCRIPTION OF WORK ADD ❑ VALUATION D W License Nu r � Llc Class � a Contract Date� C3L-��� n-- J ALTER $/� �O ❑ � ElREPAIR I am exempt under Sec $ (: B&P C for this reason DEMOL ❑ LDMA P/C# V Date. USE OF EXISTING BLDG URM ❑ �' Signature APP PR T) /} TEL NNOL / LDMA Penn# I 131, as owner of the property, or my employees with wages as f( S '^ `�`�_2 3v p wC a their sole compensation,will do the work and the structure Is ADORE , F Hl• - o r not Intended or offered for sale (Section 7044, Business and s 4 6A (DO FI DATE G 307 1002.7S Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL � 111, as owner of the r0 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I iTEML, property, am exclusively contracting with THE AMOUNTSSPE FlED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE! F11 licensed contractors to construct the project (Section 7044, YES ElNo TOTAL Business and Professions Code) Wm WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHEC 1 1013_I.7C CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there Is a construction lending agency for YES 11 NO CHANGE �E!E the performance of the work for which this permit is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD- �3 3097,Civ.C.) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTYCOD TI 2,CHAPTER2 20SECTIONS2 29,WTHROUGH 220140 CONCERNING �� Lender's Name HAZAR IAL TI D F R G A OM THE SCAQM /e— D 1313130-00131 10/15/'913 �,�IJ 1 Ahi71: o Lenders Address OMERORAGENT �` SJ 0 1 certify that 1 have read this application and state that the above PC FEE PERMIT FEE - information Is correct I agree to comply with all county p 3316 3j6 P , ordinances and State laws relating to building construction,and O hereby author representatives of this unty to enter upon ISSUANCE FEE ? �_S�110 Zto the tion ro !.qn purposes _ INVESTIGATION FEE TOTAL FEE sIRm,Aa ,,,�.,,, oro DOv�• 6Z SEE REdERSE FOR EXPLANATORY LANGUAGE /'► 3. r!`f:• APIP CAMON FOR o M UM NO PER M N' � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS QJyC D r I hereby affirm that I have a certficate of consent to self insure, BUILrte" / or a certificate of Workers'Compensation Insurance,or a certified CITY—.-� zIP copy thereof(Sec 3800.Lab C) CEz � LOCALITY �P� ' PQIICy NO Company SIZE OF LOT OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished NEAREST CROSS T ❑ Certified copy Is filed with the county building Inspection TRACT BLOCK LOT No eo department I USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK- PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' a_ TEL NO WITHIN 1000 FT OF SCHOOL? YES No COMPENSATION INSURANCE ADDRESS /' (This section need not be completed if the permit is for one hundred �/ �J O i `� DISTRICT ��)) ROUP TYPE NST' FIRE ZONE OCESS BY dollars($100)or less.) CITY r ZIP y certify that In the performance of the work for which this permit 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 STATISTICAL CLASSIFICATION APTC ONDO 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' CONT OR ` JFLfN0 SETBACK 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 AD DR LIC NO P L _ `tY - /&O7 3 SIDE } LICENSED CONTRACTORS DECLARATION Cl LIC CLASS P L a I hereby affirm that I am licensed under provisions of Chapter 9 — 1 SEWER MAP 8 (commencing with Section 7000)of Division 3 of the Business and Sq FT SIZ NO OF STOR S NO OF FAMILIES Professions Code,and my license is In full force and effect NEW ❑ BK PG D 0 LicenseNumberLlc Class DESCRIPTION OF WORK ADD ❑ VALUATION w Contractor Dater ALTER ❑ $ Z_ ❑ El am-exempt under Sec REPAIR BAPC for this reason DEMOL ❑ LDMA•P/C# Date. USE OF (STING URM ❑ Signature LI INT) T _ ��c.., LDMA Penn# ❑ 1, as owner of the property, or my employees with wages as —505r-7 p l�il 4 t •4 their sole compensation,will do the work and the structure is DR ; 4�•��} not intended or offered for sale (Section 7044, Business and FINNN,AAA111�...DATE Q 330-7 Professions Code) // /S ITEMS L THE APPLICANT OR FUTUReBBUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY `y •3� licensed contractors to construct the project (Section 7044, YES❑ �/�a� _ �I,���}L n.r� m (30 Business and Professions Code) CAA-•� 28.130 WIL E INTENDED U OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING v UPANT REQUIREA MIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH (� CONSTRUCTION LENDING AGENCY OAST AIR QUALITY M GEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST CHANGE •{}i i FOR GUIDELINES _ I hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit Is issued(Sec I HAVE READ DO TERIALS INFOR TION GUIDE AND TH .SCAQMD g 3097,CIV C) - PERM G EC ST I U ERSTAND MY I ENTS UND THE L ANGELES _ _ } ��}� 4/ 6/913 �+ U E,T LEZ 220SE NS 100THR0 2 NCERNING ' �6 Lender's Name R ER RTIN FO AINING A MIT FR QMD t]�[J i AM (�1•`�.�. R. _ T {3 1 A I a4r a Lender's Address ogentio a read this apple n and that the above orrect t0 corn with ell County PC FEE PERMIT FEE f� 11 tate I rel g to bu ing construction,end v re ent vas Of t County to enter upon ISSUANCE FEE ro rty f INVESTIGATION FEE TOTAL FEE DM. SEE REVERSE FOR EXPLANATORY LANGUAGE, COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT - _TEMPLE CITY CA 91780 BL 0508 1301280060 PHONE (626) 285-0488 EXT. ILEGAL ID I NO. OF CONST NEW BUILDING ADDRESS 1 ITR 47106 LT 1 UN 1 SQ FT STORIES TYPE_ OCCUP GROUPI 8916 LONGDEN AV A I _ISTRUCTURE - 176 1 - V-B R3 I:,. TEMP CA 917801567 ,(ASSESSOR INFORMATION NUMBER GARAGE NEAREST CROSS STREET 15384-003-025 OTHER I - THOMAS PAGE. 596 GRID H2 LOCALITY TEMPLE CI'T`Y CAI I _I I I ITENANT IEXIST BLDG USE RESID (ISSUED ON PROCESSED BY I EXIST OCC GRP R3 102/27/13 _ SR 10WNER TEL NO IBLDGS NOW ON LOT - VALUATION I FINXy,, DA;E - FI AL BY CODE 1 IMAR, ANGELA (626) 322-7677- 1 20,000 1 18916 LONGD•EN AVE I - - ITEMPLE CITY CA 91780 1 FEES PAID - IDESCRIPTION O WORK _ 1 I I s - IROOF MOUNTED SOLAR 10 PANEL KW 3 3 1 _(FEE DESCRIPTION QUANTITY UOM AMOUNT (APPLICANT TEL NO I - IGARCIA, MIKE - _ (949) 23570208- IP1 RES PV PC<IOKW - 153 90 1451 W LAMBERT ROAD - _ IAA BLDG PERMIT. ISSUANCE 27 80 ISPECIAL CONDITIONS IBREA CA 92821 - IAB STATE GREEN BLDG FEE -20000 OO-VAL 1 00 I I - IP2 INSPCT RES PV <10KW 138 00 I TOTAL FEES ' 320 70 _ ICONTRACTOR TEL NO- 1 _ 1APPPOVALS _ DATE INSPECTOR SIGNATURE 1 ISUNBEES GROUPS INC (714) 676-8888- - 1 i "Y - I 1451 W LAMBERT ROAD STE 212 LIC NO - 1LOCP_TION AND SETBACKS BREA CA 92821 970591. I I I - _ ISOILS ENGINEER APPROVAL I I• I I 1ARCHITECT OR'ENGINEER TEL NO IFOUTDATION/TRENCH FORMS-I I IDOUG ENGINEERING' (949). 285-5104- 1102 PINON TREE LANE LIC. NO SLAB/UNDER FLOOR' ICOSTA MESA CA 92627 - r CG9163 I - •1 I _ I ° RAISED FLOOR FRAMING I N ' I I MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I UNDERFLOOR INSULATION 1153H261 M 15 - 3 OJI - - 11ST,LEVEL FLOOR SHEATH INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I _ 1 0 NO 20 I 12ND`LEVEL FLOOR SHEATH I I J I I I 1 SCHOOL WITHIN HAZARDOUS 1 IROOF SHEATHING 1 (AIR QUALITY 1000 FEET MATERIALS 1 NO NO NO 1 (FIRE DEPT FRAME INSPECTI I I (BLDG DEPT FRAME-INSPECT( I ISHEAR PANELS I I I I - I I 11NSULATION/WEATHER STRIPI I I (INTERIOR LATH/DRYWALL I I I (EXTERIOR LATH I- - r - - ILOT DRAINAGE I I I I 1 ISMOKE DETECTION DEVICES 1 1 IFIRE DEPARTMENT APPROVALI - I • IREPORT ID DPR261 ROUTE TO BS0508 I I I I I I