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HomeMy Public PortalAbout9459-9473 LAS TUNAS DR_Building__ �. APPUCATIONFOR BWLDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION. FOR APPLICANT TO FILL IN BUILDING R sus . I hereby affirm that I have a certificate of consent to self insure, BUILD IN DRES � (p or a certificate of Workers' Compensation Insurance,or a certified /4-s �'� ' copy thereof(Sec.3800,Lab.C.) CITY ZIP' LOCALITY Policy No. Company SIZE OF LOT N0.OF'BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the County building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant _ SPECIAL CONDITIONS CERTIFICATE OF.EXEMPTION FROM WORKERS'. OWNER d ^�// EL NO. COMPENSATION INSURANCE t� b� v Vl/ WITHIN 1000 FT.OF SCHOOL? YES NO ADDRESS (This section need not be completed if,the permit is for one hundred oO lat-/l// •S�r j p DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) ITY - ZIP I 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 CLASSIFICATIO APT CONDO Date Applicant- ADDRESS CLASS NO. IEP?a 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 FRONT comply with such provisions or this permit shall'be deemed revoked. ADDRESS LIC.NO.' P IL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 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 d License Number Lic. Class DESCRIPTION OF WORK ADD ❑ VALUATION Q Contractor ' Date ALTER El $ U ElI am exempt under Sec. ZInn / REPAIR El $ B.&P.C. for this reason L!V/f � L DEMOL V LDMA P/C# W Date: USE F X&TING BLDG. URM ❑ $ (n � i:i n y. Z -Signature APPLI A INT) 'T L NO. LDMA Perm# ' �rz :- �� ❑ I, as owner of the property, or my employees with wages as Z 'r'�t•' their sole compensation, will do the work and the structure is ADD Ess O T EMS not intended or offered for sale (Section 7044, Business and 6 .', FINAL E Q ' f � rofessionS Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT'HANDLE A HAZARDOUS MATERIAL TOTAL :175-- 90 0 as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING'A HAZARDOUS MATERIAL EQUAL-TO OR GREATER THAN THE AMOUNTS SPECIFIED,ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B 'L' ;_1715..j�" licensed contractors to construct the project (Section 7044, YES❑ O O j ,�—-- - �� NEC"f; 1 • `r�} ,Business and Professions Code.) }' I` li WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING •6.6AUL n l OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ U 6' C°'� ii611'i1- sl 161 '1t,�:,•• r�,• the performance of the work for which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3:45 c �. 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, M 3:45 N - TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address O - OWNER OR AGENT o I certify that I have read this application and state under penalty .06 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE a with all county ordinances and State laws relating to building 1 tion, and hereby a thorize representatives of this County ISSUANCE FEE " to enter on the o e en tined pjoperty for inspection p rposes 9� J . 9� INVESTIGATION FEE TOTAL FEE � .6EA17 j/Z 1,4oe.S67a/E � G SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION insure bot afcertif carte of WorkersrtCompensation ensurancef.• . APPLICATION 1FOR B U I L D I N G PERMIT or a certified copy thereof (Sec. 3800, Lab C.) ',': �� • COUNTY OF LOS ANGELES _ BUILDING AND SAFETY. Policy No. Company ? Tr:i BUILDING -t ❑ ' Certified copy,is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS -TL)iv l?�2 BUILDING , Certified copy is filed with the.cou y building inspec- U tion deportment. ADDRESS J �'. V� •. CITY" !(L �i'l ZIP LOCALITY Date 'ApplicanT NO:,OF BLDGS. CERTIFICATE OF EXEMPTION FROM'WORKERS- '; SIZE OF LOT' NOW ON LOT NEAREST, - 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 d6llars'($100)or less.) y TEL. �PiC- Q MAP OWNER.. J dsVCj NO. & J ( USE ZONE � �: NO. I, certify.that in the performance of the work for which this permit is issued;1 shall not employ any person in any manner_. ADDRESS SPECIAL ` CONDITIONS so as to become subject'to the Workers'Compensation Laws. O CITY ZIP U Date Applicant; ARCHITECT OR TEL. NOTICE TO APPLICANT:'If, after making this Certificate of ENGINEER. NO. DI TRI GROUP TCYOPE ZRNE P SSED BY O Exemption, you should become subject to. the-Workers' 'I W Com ensation provisions of the tabor Code you must, ADDRESS I J �//� / � P P Y v/ / with,comply with such,provisions or this'permit shall be TEL.A n STATISTICAL CLASSIFICATION AP . CONDO. N deemed revoked. CONTRACTOR• 1 � NO.S(d- �� 33� Z LICENSED CONTRACTORS DECLARATION / '' ,�yy LIC "CLASS NO. WELL.,U* I hereby affirm that I am licensed under provisions of Chapter ADDRESS (� wl07i� ' NO. D (commencing with Section 7000)of Division'3.ofthe Business - /l/!ON.� LIC. SEWER MAP - CITY o EC CLASS �'4S - and Professions-Code,and my license is:in full force and effect: _, _ BK PG- VALIDATION ' SQ..FT. NO. OF NO. OF CHECK" License Number � O � Lic..Class e ^*' SIZE I STORIES FAMILIES - ONE VALUATION 3& DESCRIPTION OF WORK NEW ❑ Contractor /CrYA1f / Date If ADD ❑ ► ❑1 am exempt under Sec. - ALTER '❑ B.&P.C. for this reason REPAIR ❑ $ Date., USE OF _.. EXISTING BLDG. DEMO' ❑ Signature APPLICANT TEL. tae FINAL ,i OWNER-BUILDER DECLARATION .. (PRINT). ►v LCA NO.a �J : DATE I hereby.affiimthat I am exempt from the Contractor's License ADDRESS f �` (4-1 PA-/_L70 !}lei AUM-1-* y t W/-V Law'for the following reason (Section 7031.5, Business and FINALY . Professions Code): PRESENT'. r BUILDINGk•[•t aF ❑• .,I, as owner of the property, or my employees ,with ADDRESS 'wages as their sole compensation,.will do the work and 4�'e1�- a"?c LOCALITY I) � - the structure isnot intended or offered for sale(Section • MOVING TEL.. J 7044, Business and Professions Code. l {{ �• 11' ❑ as owner of the.property, am-exclusively contracting CONTRACTOR NO. 1 2 1 c r-D ' with licensed contractors to,construct the project.(Sec- - -- TOTAL 43='75 tion 7044,'Business and Professions Code.) ADDRESS: - {• . REQUIRED TOTAL SETBACK FROM = EXIST. ' •HECK 61M1ta i•. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY' PROP.-LINE WIDTH I hereby affirm that there is a construction lending-agency for FRONT i:Nr fiE the performance of the work.for which.this>perrnit is,.issued P:L. (Sec. 3097, Civ"C.). SIDE P.L. Lender's'Name 1900-0110 ` J/90 P.C. Fee$ Permit Fee LDMA Ref. # O tf i ,Ef_; 3 Lender's.Address '�7 �/1 ' o. I certify that have'.read this a lication and state thaf•the ssuance Fee 1, ` �' V LDMA P/C# o Y PP - 8 above information is c rrect. I agree to`comply with all,County Investigation Fee o ordinances and Sta a ws gelating to building construction, - Total.Fee • / LDMA Perm. # Q and hereby authori representatives of this County to enter upon the above' tiooe petty for inspection u'poses. �(} SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applican or Agent Date APPUCATION, FOR BUILDING PERMIT COUNTY`OF•LOS ANGELES BUILDING AND SAFETY .. WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a,certificate of consent to self insure, GLNG'ADDRESS - or a certificate of Workers':Compensation Insurance,or a certified ZA4 :01C CITY ZIP �f Lt� lid copy thereof (Sec.3800,Lab: C:) , cc�� G'l/ -f ©� LOCALITY - Policy No./�;G� Company,5� 'T'�"'� SIZE O -LOT NO.OF BLDGS.NOW ON LOT ' ❑ C4tified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACTBLOCK LOT NO. - department. licant ,• �. Z_ USE ZONE MAP NO. Date A /•� /�., // -ASSESSOR.MAPBOOK _ PAGE -' PARCEL ' •PP SPECIAL CONDITIONS . .. - CERTIFICATE OF EXEMPTION FROM WORKERS' QWNE TEL No. COMPENSATION INSURANCE / —D� WITHIN.1000 FT OF SCHOOL? YES NO' (This section need not be com leted'if the permit is for one hundred ADDOSS P P DISTRICT GROUP, TYPE CONST.- FIRE ZONE PROCESSED BY dollars($100) or less.). • ' CITY ZIP - I certify that in the performance of the work for which this permit is'i'ssued, I shall not employ any person in any manner so as to O •S/ ��— "� become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER eTEL NO.1 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' CONTRACTOR 6fA]/f 7 - TEL NO. - L SETBACK - YARD, HWY PROF .WIDT Compensation provisions.of the Labor Code, you must forthwith- FRONT v FRONT comply with such provisions or this permit shall be-deemed revoked. ADDRE S_ LIC:NO. (� �Ol.. PI_ ' LICENSED CONTRACTORS DECLARATIONCII L T sloE �~ TY - � LIC.CLASS PL •�•`�-_ I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP C (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE. NO.OF STORIES NO.OF FAMILIE& CHECK ^rte Professions Code,and my license is in full force and effect. NEW ❑ BK PG 'LL�1t�1 C 1j-''■U�'a License Number Lic.Class DESCRIP ON OF RK .. :ADD ❑ VALUATION —' - 'C�•CHANGE � .000 Contractor /� �/_ 1_/� Date T — �' TER. AL Ela I am exempt under Se REPAIR 01300-013131 2/23/9-3 DEMOL ❑ 83.t A =a% U B:&P.C.for this reason s`e■. r W LDMA-PJC# .. USE OF EXIST BLDG. a Date:. 2 �—51 URM. ... U . Signature APPLICANT(PRINT] _ - TEL NO.- LDMA Perm# - Z ❑ I,•as ow r of the:prope r mp o s with wages'as i y Z I their e compensati , ' ' do the work and the structure,is ADDRESS y FINAL D_AT - ~ ACL`■T ` not ' tended or offere r sale (Section 7044, BUSIneSS and WILL A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR Professions Code.) �-�j � � t},j07_.. . WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL '� /— �� -� J ❑ 1, as Owner of the property, 'am exclusive) contracting with, GREATER THAN THE P P Y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? - ;FINAL BY licensed contractors to.construct the project (Section 7044, I YES❑ No❑ - - TGICCMr _ r7.. i Business and Professions Code.) - - WILL THE INTENDED USE OF`THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - - TOTAL 245.X6.2 ,> OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH. �(� _ CONSTRUCTION.LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR CHECK i c GUIDELINES. +" '�■*+• I hereby-affirm that there'is a construction lending agency for YES❑ No❑. HAME. .., N the performance Of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SOAQMD PERMITTING ■ 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING'HAZARDOUS - 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROMTHE SCAQMD. NI• {yyo—,3ry1�i 3/ 3/913 o Lender's Address • OWNER oaAceNT., - - M - - _ Li[V4J U 1 �1■3 o I certify that I have read this application and state under penalty 4 • 8 7G I V 4 of perjury that the above information is correct.I agree to comply P.C.FEE p PERMIT FEE with all'county ordinances and State laws, relating to building U ' �� 7 75' construction, and hereby authorize representatives•of this County - ISSUANCE FEE '' / ' to enter up e a ve-mentioned prop for inspection purposes. (C15 a -- — INVESTIGATION FEE TOTAL FE - r Signature of cant or.Agen Da SEE REVERSE FOR,EXPLANATORY LANGUAGE. 47� WORKERS' COMPENSATION DECLARATION P, lnsurebor a cerfif cate of Workers' Comtpensat on e of eInsurancnt to ef -APPLICATION . f O R: BUILDING PERMIT or a certified'copy thereof (Sec. 3800,lab.,C.) . COUNTY OF LOS ANGELES BUILDING AND S FET Policy No. Company BUILDING. " ❑ Certified copy.,is hereby"furnished. FOR TO FILL IN ADDRESS 4" El. Certified copy is.filed with the county building inspec- BUILDING . _ ++ ADDRESS- tion department.. 7 `C =Date Applicant CITY ZIP NO. OF BLDGS. / LOCALITY CERTIFICATE"-0F.EXEMPTION FROM WORKERS SIZE OF. LOT S'C17� NOW ON'LO7' ��rj�y� NEAREST.. . COMPENSATION INSURANCE"' ." - CROSS ST. v 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. qq OWNER �Hlfyy NO. SE ZONE . MAP ✓i\ , 1 certify that in the performance-,of the work for which this SPE 106 I is issued, I shall not employ any person,in any manner ADDRESS : SPECIAL CONDITIONS a 'a as to.become subject to the,Workers'Compensation Laws. _ OU CITY ZIP i �:. Datej 1/- Applicant ^ ARCHITECT OR TEL. DISTRICT GROUP TYPE EIRE _ PR SSED BY NOTICE TO APPLICANT: If, after, making this.'C ificate of ENGINEER 'NO. CONST. Z E 0 Exemption; you should become subject to,the Workers'. Q U -Compensation provisions of the Labor Code, you must forth- ADDRESS ✓ a .with comply with such provisions :or this permit shall be . TEL." STATISTICAL CLASSIFICATION A N deemed revoked. CONTRACTOR 27 NO. Z_ LICENSED.CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS- 1-hereby NITS1•hereby affirm that l am licensed under.provisions of Chapter 9 ADDRESS NO. (commencing with'Section 7000)of Division 3 of the Business LIC. SEWER MAP CITY,: CLASS ' and Professions Code',and my license is in full force and effect: BK. PG.'J13 VALIDATION SQ. FT. NO: OF NO. OF CHECLicense Number Lic Class SIZE STORIES FAMILIES ONE VALUATIONDESCRIPTION OF WORK NEWContractor' Dote /❑I am exempt under Sec. 9- / Cd 'j a9 ADD ❑ALTER B.&P.C. for?his reason REPAIR ❑ s Date: USE,OFEXISTING BLDG. DEMO' APPLICANT TEL. 'sSignature 4 D / L(PRINT)Z►�l, ,u 21N T NO. O b�OWNER BUILDER DECLARATION DAT -hereby affirm that I am exempt from:the Contractors License > H..L legLaw for the following-reason (Section 7031.5; Business and ADDRESS a?- G�N� S " oi�.V�;�'/�9 FINALProfessions Code): PRESENT -'r. By.'" ,:307 $l.:'(3 BUILDING l p ❑ I, as owner-of theproperty, or m 'em to ees with Y P Y ADDRESS ITEMIa wages as.their sole compensation,will do the work and LOCALITY 't --'�- tlie structure is not inTended'or offered for-sale(Section MOVING TEL. ► 11) � 9O '"� ' 7044, Business and Professions:Code.) ` [Investigation TRACTOR NO. C: ❑ I, as owner of-the property, am exclusively contracting : '•-�"���.�'�., `-` ;t: e•�_�with licensed cont Factors:to'construct the project'(Sec- -RESSition 7044, Businessand Professions Code.) GEQUIRED_ TOTAL SETBACK•FROM EXIST.- CONSTRUCTION LENDINGAGENCY T-.BACK YARD.' HWY' PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for ONT the performance of the work for which this.permit is issued L. y 01I0il-ulCl i1• , % i.(Sec. 3097.Civ..C.)., DE- t Lender's Name tPA!'� �a11� Ref #Fee$ Permit FeeLDMA a Lender's Addresst6 t 1 certify that'I have read this application and state that the Issuance Fee � LDMAP/C#above information is correct. I agree to.comply with all County Fee 3:307 int:.'. f 8 ordinances and State laws relating to building construction, 7= Total Fee ��� �' LDMA Perm. # sJ �+ i ,, a and hereby authorize representatives of this County to enter 'J� N I ITEMS, 17 a upon.the above-mentioned property for inspection purposes. - \� Ti � , ® : / /J! SEE REVERSE FOR EXPLANATORY LANGUAGE \ - Lz.1r Signature of A licant or Age Date \ /� CHECK - 1 '�. WORKERS' COMPENSATION DECLARATION �• t hereby affirm that I„Piave certificate of consent to self APPLICATION P P L I CATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation n Insurance, or 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 BUILDING / ADDRESS (//��J S (O 1 ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS � L �� Date Applicant CITY fPIE I 6A ZIP !L790 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. .. G Dverl (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK t LOT NO. MAP BOOK PAGE PARCEL EL. USE ZONE MAP I certify that in the performance of the work for which this OWNER O. C NO. permit is issued, I shall not employ any person in any mannerADDRESS 1 Wq 9� SPECIALi so as to become subject to the Workers' Laws. CONDITIONS U; Dote L/!6 �1 ApplicantCITY f ZIP 7 7 NOTIC TO PPLICANT: If, after making this Certificate f ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O ENGINEER NO. CONST. ZONE I" Exemption, you should become subject to the Workers' V Compensation provisions of the Labor Code, you must forth- ADDRESS E W with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Cn deemed revoked. CONTRACTOR NO. � �� � LICENSED CONTRACTORS DECLARATION LIC, CLASS NO.—LDWELL. 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 and LIC. SEWER MAP Professions Code, and my;license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FIC NO. OF NO.OF CHECK License Number Lic.Class SIZE ISTORIES FAMILIES,. ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW D $ ° ;2'8 9 6 8 A ❑ I am exempt under Sec. r / ALTER ❑ , # o 0 0,oto B.BP.C. for this reason REPAIR ❑ _ ( 0 0 2 5 0 USE OF Date: EXISTING BLDG. DEMOL ❑ Signature APPLICANT t TEL. o o o 2&5 0 U g OWNER-BUILDER DECLARATION PRINT ;'U NO. `S7� DATEFINAD I hereby affirm that I am exempt from the Contractor's License ��2./ O 2, 3. 8 Low for the following reason (Section 7031.5, Business and ADDRESS WO-Y ,, FI l' Professions Code): PREbENT ® 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 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS K FROM CONSTRUCTION LENDING AGENCY SETQBACKD YARD HWY TOTAPROP.LCNE 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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. # P.C. Fee$ Permit Fee Lender's Address g I certify that I have read this application and state that the Issuance Fee LDMA P/C N o above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm'fl ' o and hereby authorize representatives of this County to enter upont o=e-mention?c1AroZpeZrtyfor inspection purposes a �dp SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent rate iNORKERS',COMPENSATION DECLARATION f. I hereby offirm that I have a certificate cf consent to self insure, -6rr a certificate of Workers' Compensation Insurance, APPLICATION FOR- BUILDING PERMIT or a certified copythereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. ®d-2j22Company s��, -/ Q `Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDINGADDRESS Certified copy is filed with the county building inspec- BUILDING 7�� s �� r tion eepartmmeennt. ADDRESS (f! Date v // C! / Applicant CITY /-C-G� �/ zip LOCALITY -TERTI14CATE OF EXEMPTIOF OM RKERS' NO. OF BLDGS. NEAREST COMPENSATION URANC SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be.completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE' - PARCEL /,� X15 TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER K'/`t��Z C�i/�/�6l� INO. 9' NO. permit is issued, I shall not employ any person in any manner ADDRESS �� iV /V V /e 'er SPECIAL so as to become'subject to the Workers'Compensation Laws. . / CONDITIONS CITY 1� /1lo `7 C Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT, GR UP TYPE FIRE PR ESSED BY Q g ENGINEER W` NO. �� CONST. Z NE U Exemption, you should become subject to the Workers' / ,) , l Compensation provisions of the Labor Code, you.must forth- ADDRESS D 'l- oil'//� `�t`' �_ ✓ W_ . .with comply with such provisions or this permit shall be tD_ deemed revoked. *41-1 ' Smws TEL. ? j 7�l STATISTICAL CLAS IFICATION APT. CONDO. (q CONTRACTOR NO.��J //.�V• Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. � DWELL. UNITS 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 7i 37i .—ac NO. ��� ' (commencing with Section 7000)of Division 3 of the Business and LIC t i SEWER MAP Professions Code, and SZ license is in full force and effect. CITY CLASS % S BK PG.' VALIDATION (�� ` "t"r SIZE STORIES FAMILLIIES CHECK A License Number / Lic,Class ❑ • VALUATION # o+o o,e 2 3 Contractor �'-L �7/�-j Date DESCRIPTION OF WORK _ NEW $ �= ADD 1 am exempt under Sec. S`�' y7 6534 ALTER B.BP.C. for this reason REPAIR Q $ [ � �( 'O 0;0 6 a 3 405 Date: EXISTING BLDG. (USE OF DEMOL 'C] I t7�- p Signature APPLICANT -7 FINAL` _ # o;o o e 23 OWNER-BUILDER DECLARATION PRINT GLS G�� O: 7�3 �yG DATE 11 �r I hereby affirm that Iam exempt from the Contractor's License ADDRESS 32i -G`1 e� A U ' /3DB FIN 10'0 7 1,73 Law for the following reason (Section 7031.5, Business-and Professions Code): PRESENT BY RR p 1, QBUILDING O 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' 7044, Business and Professions Code). MOVING ' TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. o �o with licensed contractors to construct the project (Sec- s 1 71,7 tion 7044, Business and Professions Code). ADDRESS REQUIRED YARD HWY TOTAL SETBACK F zo to 1 7 1.7,5 5 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. O 9, 1 5;-:8 7 . (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name CDMA Ref.'M L P.C..Fee$ ✓ Permit Fee r Lender's Address g I certify that I have read this application and state that the L Issuance Fee !tJ•t�� CDMA P/C N above information is correct. I agree to comply with all-County Investigation Fee - o ordinancesandState laws relating to building construction, - Total.Fee CDMA Perm. N o and hereby authorize representatives of this County to enter < upon the�i6o �td property f inspection purposes. �. SEE REVERSE FOR EXPLANATORY LANGUAGE i nature f Applicant or Agent - - D/, -- - - ' + ��!CNKERS'4OMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to selfI } 'insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BU I-L D i N G PERMIT' or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY' PolicyNo. Company �.mm Y FOR APPLICANT TO FILL IN BUILDING Certified co is hereby furnished. ADDRESS �^ Certified copy is filed with the county building inspec- BUILDING tion department. . ADDRESS Date 7, Applicants CITY' h ZIP LOCALITY CERT FICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. • • NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. -Al (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify that'in the performance of the work for which this OWNER — NO: d +' NO, permit is issued, I shall not employ any person in any manner SPECIAL ' so as to become subject'to the Workers'Compensation Laws. ADDRESS Y1 a/-- CONDITIONS O CITY ! i . ZIP .c V Date Applicant' ARCHITECT OR TEL. �v NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT _ G UP TYPE FIRE PROCESSED BY O ENGINEER NO. Exemption, you should become subject to the Workers' �p CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS ( i( 3 W with comply with such provisions or this permit shall be W deemed revoked. TEL STATISTICAL CLASSIFICATION APT. �ONDO. N LICENSED CONTRACTORS DECLARATION CONTRACTOR NO. 3 L�pyyELL. UNITS LIC. CLASS NO. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS-17-12N&,S0 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and ,,//pper� LIC �p Professions Code, and my license is in full force and effect. CITYC 6 �� CLASS C—q,5 VALIDATION SQ. FT. NO.OF NO. OF CHECK BK. PG. License Number s7�9 `a Lic.Classes SIZE STORIES FAMILIES ONE P-7924 A VALU TION Contractor z _Date /S DESCRIPTION OF WORK NEW ❑ $ .UI '#,o 0 0 0 2 3 6 S ❑ jjj��� V r I am exempt under Sec. A&` ALTADD ER ❑ �( ' a B.BP.C. for this reason J / `' REPAIR ❑ $' l a7332 Date: USE OF DEMOL ❑ EXISTING BLDG. Signature APPLICANT TEL FINAL o o(0 7 -32 0 OWNER-BUILDER DECLARATION (PRINT) NO. 3 DATE/ I hereby affirm that I am exempt from the Contractor's License 0 9, 1 5,i-8 7 Law for the following reason (Section 7031.5, Business and ADDRESS 7a3a a ire�b p L Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044; Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. ;R.793ibA with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). #'o'o•o e o REQUIRED TOTAL SETBACK FROM t CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. UNE WIDTH ('0'0 9 7 5. I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. o'o 0 (Sec. 3097, Civ. C.). SIDE 9 6,7 5 c2� P.L. 'Lender's Name ^ 09, 1 b�87 P.C. Fee$ 3,�2 Permit Fee 6 r LDMA Ref. a Lender's Address ��11 I certify that I have read this application and state that the Issuance Fee V, LDMA P/C# o above information is correct. I agree to comply with all County Investigation Fee C 0 ordinances and State laws relating to building construction, Total Fee 4 J LDMA Perm. M N and hereby authorize representatives of this County to enter m Aun�the above-men ' ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ApplicMr Agent Dote APPLICATION I I COUNTY OF L•OS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL.IN., 1 BUILDI A DRE S I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS ,9y// •J,a, �'� ' '� or a certificate of Workers' Compensation Insurance,or a certified -7 ro s.zui� copy thereof S c.3800,Lab C.) CITY Ria ZIP Xg /?� / LOCALITY Policy.No. V �'tO� Company C� SIZE OF LOT NO.OF BLDGS,NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. L7'Certified copy is filed with the county ilding inspection TRACT BLOCK LOT NO. ' department.G 91 - USE ZONE MAP NO. . Date' �Q 7 1 licant ASSESSOR MAP BOOK PAGE PARCEL Pp _ - SPECIAL CONDITIONS CERTIFICATE OF EX MPTION FROM WORKERS' OWNER ^^ f ` TEL No. COMPENSATION INSURANCE ©4 1 C Da / WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS 9�/:/ `,d�.a.'7"J1M� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCE D BY dollars ($100) or less.) C/ v� �wZIP ' I certify that in the performance of the work for which this permit Piz e 5,CA is issued, I shall not employ any person in any manner so as to become subject t0 the Workers'Compensation Laws. ARCHITECT OR ENGINEER- TEL NO. 1 STATISTICAL CLASSIFICATION APT CON150 CLASS NO. � Date Applicant ADDRESS � DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you ShOUId become Subject t0 the Workers' CONTRACTORTELN9. res ?�1 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith . �'� 1 �� r ly�q/S�/��g3,0 3,0 FRONT comply with such provisions or this permit shall be deemed revoked. ADD ES � ' LIC.NO. d PL CITY LICENSED CONTRACTORS DECLARATION 5.24" Ni . 1.4v& ` , Z/ZO SIDE ' 2 LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 ��7 ✓ G r f� SEWER MAP a (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES `v` Professions Code,and my license is in full force an>d effepy NEW ❑ BK PG ��r� .,'e r; License Number Z Z Lic.Class DESCRIPTION OF WORK ADD `❑ VALUATION Q TE ri, Contractor Date �.�ll ALTER El $ o� i I1_ _ V SAS;",;", ..1/L► 1�1Q REPAIR .❑ TOTA: a7''� a 0 0 ElI am exempt under Sec. $ I - BAP.C. for this reason DEMOL ,❑ Lw' ' "'UU V Date: USE,OF EXISTING BLDG. N URM LDMA P/C# ;"" �2 -!1 i n_. Signature APPLICAN (PRINT) �v .I� XpI LDMA Perm# z El 1, as owner of the property, or my employees with wages as II.V V 30 Z rAi�? a F1``-i their sole compensation, will do the work and the structure AD ��is r 03 F_ _••_i �4:f+:__ not intended or offered for sale.(Section 7044, Business and 'v � �D FINAL DATE a +I'�' A1-F •�: tit':n•=r Professions Code.) ` WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ` `�� / 2 T I E r, ❑ 1, as owner of the property, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ` P Y. Y' 9 AMOUNTS SPECIFIED THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY < ;j *"e� licensed contractors to construct the project (Section 7044, I€! Business and Professions Code.) wes❑ No WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING F .qty OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECK - "'' �'"� CONSTRUCTION LENDING AGENCYCOAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR -r - GUIDELINES. f.Ia'•N IJ o! U I hereby affirm that there is a construction lending agency for YES❑ No C� w the performance Of the Work for which this permit IS ISSUed(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAN Y REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, r- TITLE 2,CHAP R 2.20 S G IONS 2. 100 THROUGH 2.20.140 CONCERNING HAZARDOUS E I�,36 II_I-t ILIi_'a, .). li i... Lender's Name MATERIALS RE RTING FOR O NTNG A PERMIT FROM THE SCAQMD. r ` o Lender's Address •+-'=4 � �M "3= O OWNER OR AGEN - o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree t0 comply P.C.FEE e PERMIT FEE with all county'ordinances and State laws relating to building acon truction, d hereby authorize representatives of this County ISSUANCE FES m 2 to ter up0 e ab o entioned property for inspec^tion purpops. m U INVESTIGATION FEE TOTAL FEE atu of Applicant w Agent Dala SEE REVERSE FOR EXPLANATORY LANGUAGE / n COUNTY OF LOS ANGELES. ..�r-' ', BUILDING AND SAFETY i WOFk�-IR'S COMPENSATION DECLARATION FOR APPLICANT TO FII_L'IN BUILDING ADDREss I hereby gaff. ) that I have a certificate of consent to self insure, BUILDING ADDRESS l� 7 u 7 �2 or a-certificate of Workers' Compensation-Insurance,or a certified "` copy thereof(Sec,3800,Lab.C.) , CITY t �- /T ZIP Policy NO.�— Company �� T UNo. �L (-:t I LOCALITY `� SIZE OF LOT NO.OF BLDGS.NOW ON LOT Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county buil ing inspection TRACT BLOCK LOT NO. .� USE ZONE MAP NO. department. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ? TEL NO. YES NO COMPENSATION INSURANCE 1 �V� WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS J -� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED.BY dollars($100)or less.) CITYI 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. 0� become subject to.the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. _,pj-2 DWELL UNITS NOTICE TO APPLICANT.- If, after making this Certificate of REQUIRED TOTAL.SETBACK FROM EXIST Exemption, you -should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PR.LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �Lj - k'(� C v ) 32—_ FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS q �w, LIC.NO. PL yi. (_ a SIDE _ _ LICENSED CONTRACTORS DECLARATION CITY uc.cLAss P L ,Liv �1_ ,r�t I hereby affirm that I am licensed underprovisions of Chapter 9 —•A 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. i NEW ❑ BK PG406 .44 h License Number � Lic.Class U DESCRIPTION OF WORK ADD E] VALUATION i I"IT~L ® Q Contractor _ Date e - ALTER 0 $ ©� ��Lr` it f-=°' U El I am exempt under Sec. `-L REPAIR ❑ CHANGE ''�` ti' U B.&P.C.for this reason DEMOL OLDMA P/C# _ W Date: - USE OF EXISTING BLDG. �Uf;M .,❑ �.tI300-13013,I Lf il'i�'•_ Q_ i ( I°� Signature APPLI A,T,(.g�RNT) C TEL NO. LDMA Perm# .w+410 �. 3 A'` `-r` � Z ❑ 1, as owner of the property, or my employees with wages as tM` —S �) 13 32— Z t�0 . ir their sole compensation, will do the work and the structure is ADDRESS O ---- 1*41 not intended or offered for sale (Section 7044, Business and 1/1)- 1 6 17a)B' FINAL DATE ~ ---� ° '`I Z D Professions Code.) / ITEM - OR THE APPLICANT OR FUTURE BUILDING OCCUPANT-HANDLE A HAZARDOUS MATERIAL i Z.3— J 1 i = ❑ 1, as owner of the property, am exclusively contracting with ORA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �•.......•. .FIT L �'•—��'°—� � '�- licensed contractors to construct the project (Section 7044, i m YES El NOJ4 Business and Professions Code.) �: _. WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING I•HE `. '1�+-a k'y' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR - ........ - P.HANGE e�� 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 THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING ,* ,.y a •-- N 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. }�I?1_t—�j Ig j �-a TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD: i.-t-t j o y CL Lender's Address i Ail a ti O OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE �r/D /' PERMIT FEE - N with all county ordinances and State laws relating to building < construction, and h eby authorize representatives of this County ISSUANCE FEE ro to pon the a ve-mentioned property for inspec/on purp/o�ses. 'Vv a q/..2 �"`� INVESTIGATION FEE TOTAL FEE Sign a of A li nt to SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION,DECLARATION �' - eself *airm rcertificate or Workers"CompensationInsurance FORB UI L D N GP E RM LT msuAPPLICATIONI or a certified copy thereof(Sec. 3800,.Lab. C.) COUNTY OF..LOS ANGELES BUILDING�AND,_SAFETY: Policy No.: - Comp6ny BUILDING Certified copy"is hereby furnished. FOR,APPLICANT TO FILL 1N ADDRESS � ��. ' g 5, ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS /.. Lt.V VA_ i Q ; G�: l7 b a s Dare Applicant ZIP' I �.Y� LOCALITY GIV NO. OF BLDGS. NEAREST CERTIFICATE OF-EXEMPTION FROM WORKERS' 'SIZE OF LOT 'NOW ON LOT CROSS ST. � �r COMPENSATION INSURANCE1p. `f Z ASSESSOR ` (This section need not be'cornpleted'if the permit is for one TRACT ' lite BLOCK LOT'NO. '" MAP BOOK 1 PAGE PARCEL hundred dollarsi($100)or less.) TEL. d , OWNER-T;ii ,n NO. S'7 -00� USE ZONE MAP' I certify that in the performance of.the work for which this NSPECIAO. s L permit is issued, I shall.not.employ any person'in anymanner ADDRESS Z� - .� (((/// CONDITIONS so as to become subject to the Workers"Compensation Laws. O CITY IP q 1-7 2- - Date Applicant. ARCHITECT OR TEL. DISTRICT,. GROUP''TYPE FIRE PROCESSED BY NOTICE TO APPLICANT:.,if,. after making this Certificate of ENGINEER ' NO. CONST: ZONE 0 Exemption, you should become subject to the Workers' v Compensation provisions..of.the Labor Code, you must forth- ADDRESS • l7J (/ L-lG,LG� a with comply with. such-provisions or ihis permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO: N deemed revoked.' CONTRACTOR l NO. Z LICENSED CONTRACTORS DECLARATION, LIC. CLASS NO. DWELL. UNITS r ADDRESS NO. I hereby affirm that I 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 CITY, CLASS and effect: _ BK. PG• 23 VALIDATION SQ.,FT. NO. OF NO. OF CHECK • _ License Number Lic.:Class' SIZE I STORIES FAMILIES ONE ' �,"1A VALUATION A NEW DESCRIPTION OF WORK •❑ Contractor Date I -{ r07 6...857 :- ADD ❑1 am exempt under Sec 1 l}-� � - ► ` ALTER B.&P.C. for this reason O� / ACC { 1 ! �`\ III/ / 1 REPAIR; _ $ / �/ Ai.0 A USE OF .,307 ;�•7. 1 Date: EXISTING BLDG,V fAe1D •e/Al & DEMOL �, �! �It7o{� Si nature APPLICANT. TEL p rr• r 9 OWNER-BUILDER DECLARATION, (PRINT)" . Sr,,(• W.P_y► r NO. 57 �bD0 FINAL v z�� � _ _ DATE AL I hereby affirm that i am exempt from the Contractor's.License - ! TOTAL 312.,86 Law for the following!teoson (Section:7031-.5; Business and ADDRESS37aS) swdl IRA,t-Y r I-f 9'w7►T�','. FINAL -tttt J�• Professions Code). PRESENT ByTl�lv1 BUILDING I; as owner of the property, or my employees with ADDRESSCHANGE .(„iii -wages as their sole compensation,will do the,work and the structure is not intended or offered for'sole(sole Section LOCALITY , ;+ 7044, Business and Professions Code.) MOVING TEL. ❑ i, as owner of the property, am exclusively contracting CONTRACTOR NO. TJOCI iW 1 -` a�y1 with licensed contractors:to.construct the project.(Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM, EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - H I herebyaffirm that•there-is a construction lending agency for FRONT the performance'ofahe wotk.for which.this perm'if'is'issued P.L. - (Sec. 3097, Civ. C.). SIDE _ Lenders Name, m • , LDMA Ref # _ e 375. P.C..fee$ r/! e• Permit Eee of S�� S „E 3 Lender's:Address / 7 I certify that I have read this application and state that the ��•�/ -Issuance fee a/ / LDMA P/C#µ loop, ` o , above information is correct. I agree to:comply with all County Investigation Fee 8 ordinances and State laws relating to.building construction, Total Fee g / LDMA Perm.# a and hereby authorize representatives of this County to enter u on th e aboveL.m ntioned propertrfor inspection purpos s SEE REVERSE FOR EXPLANATORY LANGUAGE "l Signature'of Applicant or Agent' Date � 1. WORKERS'COMPENSATION DECLARATION I su re, o affirm that I'haver certificate of consent,to Self APPLICATION . FOR B U I-L®I N G: PERMIT insure, or a certificate of Workers' Compensation Insurance, ora certified_ py thereof (Sec. 3800,-Lab. C.) �q ft �' - ^ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N Oo4Fpany —(�Gc3(r. ' ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ' BUILDING `. ADDRESS (^ ❑ Certified copy is filed with the county building inspec- BUILDING / tion department. ADDRESS (? Date Applic CITYrz; C� I ZIP LOCALITY v� RT I ATE OF EXEMPTIOWFROM O 1 S' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT" NOW ON LOT CROSS ST. (This section need'nor be completed if'the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP e I certify that in the performance of the,work'for which this OWNER NO. NO N permit is issued', I shall not employ any person in any manner ADDRESS ^ SPECIAL • so as to become subject to the Workers'Compensation Laws. ,` CONDITIONZ U v j Zi O CIT CLlcrf-& .� E,1 Date' Applicant ZIP I= NOTICE`TO APPLICANT: If, after making this`Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O ENGINEER NO. CON ZONE Exemption; 'you should' become subject to ;the Workers' (� Compensation provisions of:the Labor Code, you must forth- ADDRESS s '-�`' W_ with comply with such provisions or this permit shall be deemed revoked. TEL• STATISTICAL CLASSI ATION APT. CONDO. N CONTRACTOR Coftv.NO. 3� Z LICENSED CONTRACTORS DECLARATION LIC y CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter ADORES NO. 3 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code,and'my license is in full force and effect. CITY CLASS BK: . PG VALIDATION ? SQ. FT. NO.OF NO. OF, CHECK License Numb J Lic.Sass � SIZE STORIES FAMILIES ONE ' ❑ VALVA 10 DESCRIPTION OF WORK NEW Conti Date,_ n ADD ❑ $ ❑ I am exempt under Sec. ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. ' FINAL A OWNER-BUILDER DECLARATION PRINT NO. DATE I hereby affirm that I-am-exempt from the Contractor's License Law for the following.reason (Section 7031.5, Business and ADDRESS FI 9 3,1 !1 °A Professions Code): p # o 0 0 0 0}1, ❑ BUILDING I; as owner of the property, or my employees with ADDRESS �. o 0 6 a 6 3 wages as their sole compensation,will do the work and 6 6 3= the structure is not intended or offered for'sale(Section LOCALITY o o•o 7044, Business and Professions Code). MOVING TEL. 0 U.0 5-8 8 I, as owner of the property, am exclusively contracting CONTRACTOR NO. ' with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY ` ' SET BACK YARD HWY 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. '• (Sec. 3097, Civ: C.).- SIDE P.L Lender's Name 0 m P.C. Fee$ Permit Fee ! LDMA Ref. # Lender's Address /j 0 1 certify that I have read this application and state that the Issuance Fe CJ r �O LDMA P/C#„ above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, i R and hereby authorize representatives of this County to enter Total Fee J. LDMA Perm.'# m upon the above-men ' ned pro erty for inspection purposes. SEE REVERSE FOR.EXPLANATORY LANGUAGE Signature of Applic nt Agent D e APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES. BUILDING AND AFETY • WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUI w ADDRESS By INf ESS I hereby affirm that I have a certificate of consent to self insure, G� or a certificate of Workers'Compensation Insurance,ora certified CITY ZIP copy thereof(Sec.3800,La .CJ 4 E0- LOCALITY Policy No. ompany SIZE OF LOT c NO.OF BLDGS.'NOW ON LOT "9-Certified Copy Is hereby furnished. NEAREST CROSS ST. ✓❑ Certified copy is filed with the c ty building i c' TRACT BLOCK LOT NO. ' USE ZONE MAP NO: department. ^ ASSESSOR MAP B K PAGE PARCEL 1 Date�Appli ,/! L� SPECIAL O TIONS OWNE TEL.NO. 4 CERTIFICATE OF EXEMPTION FROM WORKERS' • ZD �lEy �� �j _ �p YES NO COMPENSATION INSURANCE �Y ff WITHIN 1000 FT OF SCHOOL? DDRESS (This section need not be completed if the permit is for one hundred Qe �:� ��D%� DISTRICT- GROUP TYPE CONST.' FIRE ZONE P OC SED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY ell ZIP is Issued, I shall not employ any person in any manner so as"to ARCHITECTVR EN INEER TEL.NO. ' become subject to the Workers'Compensation Laws. SSS• _ ��� S ATISTICAL CLASSIFICATION PT CONDO Date Applicant AVORESS r.eST CLASS NO. WELL UNITS Gobi r7 . NOTICE.TO APPLICANT: If, after making this Certificate Of / .2 d�L/�14 JY`EIV' �T REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CO ACO NO. 9/ 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. ADDRESSL C. O. PL SIDE LICENSED CONTRACTORS DECLARATION LIC.c ss PL cO3- I hereby affirm that 1 am licensed under provisions of Chapter 9 M-2.� NO. F S RE NO.OF FAMIL SEWER MAP 4C�ei- �4,(commencing with Section 7000)of Division 3 of the Business andProfessions Code,and my license_is.in full force an�ffect. 7° NEW ❑ BK PGPoo. License Number Lic.Class / � DESCRIPTION OF WORK ADD ❑ VALUATION w D �4r, 1.41 a $ °a =SRF 2�_4 �2COX) Contractor Date _ ALTER '�z REPAIR C-HE{.•i• ❑ I am exempt under Sec. $ "' - B.BP.C.for this reason USE OEXISTING BLDG. DEMOL ❑ ?;•�e'I���t�� LDMA P/C# � //F Dat [ O /�lC��/#/- URM. C3 _ aRi Signatu APP ANT(PRINT) _ TEL.NO. LDMA Perm# El1, as owner of the property, or my employees with Wages as �� p f 1 s �I` 0:i.!6 their sole compensation,will do the work and the structure is ADDRESS I _ not intended or offered for sale (Section 7044, Business and -Z L`�L 1//T�Z 41 / FINAL DATE / Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q Y 9 THE AMOUNTS SPECIFIED ON THE:HAZARDOUS MATERIALS INFORMATION GUIDE? FINALV Bry p licensed contractors to construct the project.(Section 7044, ❑ 1:1 �-} Business and Professions Code.) YES' No !/ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING [ - OCCUPANT REQUIQUALITY MANAGET FOR MENT DISTRICT (SCAOMD) FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST ' FOR GUIDELINES. 111666 I hereby affirm that there is a construction lending agency for YES NO❑ //�.�� ��y/// the performance of the work for which this permit Is issued(Sec. I HAVE READ THE.HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �J— �O COUNTYCODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING / z� Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. a Lender's Address OWNER oRAGENT o' 1 certify that I.have read this application and state that the above information is correct. I agree to comply With all county P.C.FEE PERMIT FEE ordinances and St to laws relating to building construction,and ¢. representatives of County to enter upon ISSUANCE FEE the�.b.o;v- i e r y f ction purposes. j/�/j ®0 f� `-Geld✓' INVESTIGATION FEE TOTAL FEE tissS nantorA�nt � /Once �G. - SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT i1 _ COUNTY OF LOS ANGELES. - - BUILDING AND SAFETY =" WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN sulL ING ADORES �+/, U}�LDING ADDRESS Z�7 di / v/ �T o5 I hereby affirm that I have a certificate of consent to self insure, '7 6 S (�4r S '�U N�S or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP opy thereof(Sec.3800, b.c.) Tr-1%4X- Ct c z-A LocnuTY,7��PG POIICy NO. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT Certified copy is hereby furnished. 4-91 (yo NEAREST CROSS ST. ❑ Certified copy is filed with the building inspec' TRACT BLOCK LOT NO. department.` USE ZONE MAP NO. Dat j�^ App li Cnt , - ASSESSOR M OgJG PA E PARCEL LTIO� /G^►C�Jy ��l SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. YES NO COMPENSATION INSURANCE .G. GC-uTR'( S Q CF A(=E $tg-[f cF trj^a�� WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred f,40- (3-77— (2G/4 DI/? Ci/4 p g L DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit ea0 ,6✓)�(� �. is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. /•� become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO 1 P S� SpG[.g �tiD �3 Q lZ Date Applicant ADDRESS CLASS NO. DWELL UNITS t 3Z V EL.H.4 V C-AJ S-r W CST u+v A NOTICE TO APPLICANT. if, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONT i�ACTQP TEL.N SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 9 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS I O. / PL .7 SIDE LICENSED CONTRACTORS DECLARATION t LIC.Cu PL I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)Of Division 3 of the Business and SQ.FT.SIZE NO.OF STO ES F FAMILIES Professions Code,and mylicense is in full force an act. 2-� NEW ❑ BK PG License Num r, LiC.CIaSS DESCRI ON OF WORK ADD ❑ O�.f D C f}�� vaLUATIo"�.�;00,00 - U :O D - n Contractor Date � I-�/ ALTER ❑ z ❑ i~+ - �• _ ❑ I am exempt under Sec. REPAIR B.&P.C.for this reason DEMOL ❑ n USE OF EXISTING BLDG. LDMA P/C# __LI( :;{ e'4. Pa (�C {C L/a Cr URM.. ❑ .I 71 EMS Signet s APPLICANT(PRINT) EL.NO. Q LDMA Perm# I ii'� ❑ I, as owner of the property, or my employees with wages as t G "� f$r� �—` Z p Tt!T L 4 m 29 their sole compensation,will do the work and the structure is ADDRESS Co t _ not intended or offered for sale (Section 7044, Business and T- f7r-LH� re-g �T- Co ' Yrla g O FINAL DATE Q '•_*(�' i': 14 o '7' Professions Code.) 3 1 — CHANGE WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE AHAZARDOUS MATERIAL U J li S OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q °•I"'" ❑ 1, as owner of the property, am exclusively-contracting With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, Business and Professions Code.) ves 11 No 1:1 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING I� t 9./ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH, CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST IL Ar tt jE j 5 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 THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD L"! I, i •••L. ;, "' L.-.1 ' 3()97,CIV.C.). - PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 1-1 f i '- m COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address rr OWNER OR AGENT - i'.:. .....2 'IL I certify that I have read this application and state that the aboveti-`• +l rri information is correct. I agree to comply with all county RC.FEE PERMIT FEE ordinances and State laws relating to building construction,and '' f'' - hereby author representatives of County to enter upon ISSUANCE FEE n n d pro y fo ction purposes. � -� "• f•.:1 g P"-� INVESTIGATION FEE TOTAL FEE 4., -fir y J a 1_•.E SEE REVERSE FOR EXPLANATORY LANGUAGE 5Yd WORKERS'COMPENSATION DECLARATION insure, or a}certifi atte.of WWorkers' Comtpensat on eInsurance` APPLICATION FOR BUILDING PERMIT or 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 g �! 'T'J i,+_ ADDRESS (.dS� � ❑ Certified copy is filed with the county building inspec BUILDING / da /� tion department. ADDRESS 6 L cJ d 5 ' 64LC; ( G„ q'f .7/B o Date Applicant CITY G t 7- ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST / v vin / v COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. C L Li t (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. Ce 1101/ USE ZONE MAP I certify that in the performance of the work for which this OWNER 't / NO.. 6— roZ /j NO. permit is issued, I shall not employ any person in any manner ADDRESS - CC-T ( ',i' SPECIAL so as to become s ju �b bjject to the Workers'Compennsation Law,s../� / / �/ CONDITIONS o 11 %Ga L-7 /i�—✓"�/�/AsGG� ITY �iCf l��/�L ZIP ( b Date Applicant's ARCHITECT OR TEL. NOTICE TO APPLICANT: If, a�feY making t'is Certif tate of ENGINEER NO. DISTRICT GROUP TYPE FIRE � PROCESSED BY O Exemption, you should become subject to the Workers' �j CONST. 20NE U Compensation provisions of the Labor Code, you must forth- ADDRESS '" dy t✓ V - 0-1W with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. I CONDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. ZZ�DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. / Professions Code,and my license is in full force and effect. CITY CLASS BK L� 1.•-> VALIDATION SO. FT. NO.OF NO. OF CHECK License Number Li,c.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORKNEW ❑ $ , Q ADD ❑ ❑ I am exempt under Sec. 11" ALTER ❑ , B.&P.C. for this reason XrN SdL REPAIR ❑ $ Dote: USE OF MOLE EXISTING BLDG: Dr APPLICANT TEL. Q Q 6 A Signature / C8(S) FINAL /(J PRINT LAI O G C/ NO: p i ,. OWNER-BUILDER DECLARATION - DATE/K I herebyaffirm that I am exempt from the Contractor's License Law fothe following reason(Section 7031.5, Business and ADDRESS �(S /Z6 �Vft' �+ � « FINA # o o v o '' Professions Code): By ,-1 ,o, o.9 6 7 5 ❑ BUILDING I, as owner of the property, or my employees, with ADDRESS wages as their sole compensation,will do the work and o 10,6 9 6,7 5.r,= the structure is not intended or offered for sale(Section LOCALITY t Q Q 7 8 j-88 7044, Business and Professions Code). MOVING TEL. I, as owner of theproperty, am exclusive) contractingCONTRACTOR NO. Y r z with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK . . � ••'4='" t " pz,Q,i Q,7 A CONSTRUCTION LENDING AGENCY w .. SET BACK YARD HWY H PROP. LINE WIDT �`. I hereby affirm that there is a construction lending agency for FRONT #'o o io:e 2 3 the performance of the work for which this permit is issued P.L. ti o l0 7 (Sec. 3097, Civ. C.). SIDE ;l °. _ f P.L. ,. '•� � r` ,t"a• � Lender's Name " LDMA Ref. # P.C. Fe16-6 e$ ✓ Permit Fee r Lender's Address `_d I certify that I have read this application and state that the Issuance Fee (V,, V v LDMA P/C;q , ,t `_A •_.t= above information is correct. I agree to comply with all County Investigation Fee j ^ t 0 ordinances and State laws relating to building construction, g Total Fee V .715 LD"' Perm. N 1 o and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date "�tiORKERS'COMPENSATION DECLARATION {:I hereby affirm that I havecertificate of consent to self APPLICATION,. F®R BUILDING. P E RM I T insure, or a certificate of Workers' Compensation Insurance, or b certified copy thereof Sec. 3800, La b. C. ,� d37--, ,;��..�,,b`6 �`Ly -�.�— _ .COUNTY OF LOS ANGELES BUILDING AND SAFETY 'Policy.Nq�,L.�Company ❑ Certified,copy is hereby furnished. fOR APPLICANT,T FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building'inspec-� BUILDING�. ,/� ' tion department. ADDRESS S Datef Applica CITY ZIP LOCALITY CERTI I ATE OF EXEMPTION FROM WORKERS'- NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section•need not be completed if the permit.is for one ASSESSOR.- hundred dollars ($100)or less.) - TRACT BLOCK LOT NO. MAP BOOK- I PAGE PARCEL TEL. ®a� USE ZONE MAP I certify that,in the performance of the work for which this OWNER• /J� NO. '1`�! NO. permit is issued; I shall not employ any person in any manner -�17 SPEGtA ^� G so as to becomesubject to the Workers'Compensation Laws. ADDRESS Q L�O"� r f� CONDITIONS / O � O CITY f ZIP J C Date Applicant �. NOTICE TO APPLICANT: If,. after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. CONST. ZONE 0 _ Compensation provisions of the Labor Code, you must forth- ADDRESS W with comply with such provisions or. this permit shall be + TEL. ATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR — NO. LICENSED CONTRACTORS DECLARATIONLIC• CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS (7 6 �� NO r (commencing with Section 7000)of Division 3 of the Business and LIC. I ISEWER MAP Professions Code, and my license is in full force and effect. CITY ISLA CLASS I BK. .,PG VALIDATION SQ. FT. NO. OF NO: OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE �r_ VALUAT ON �// ' �0 Y�°� ' [ NEW t] Contractor/`' Dote a /.. DESCRIPTION OF WORK❑ ADD ❑ $ . V 1 am exempt under Sec. ~.� ❑ ALTER BAP.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL EXISTING BLDG. Signature APPLICANT TEL. :FINAL OWNER-BUILDER DECLARATION PRINT)' NO. DAT / z.9 7 3. 0 A i hereby affirm that I amexempt from the Contractor's License Law for the following.reason (Section 7031.5, Business and ADDRESS FINAL # 0 0 0 0 0 Professions Code): PRESENT BY ❑ y employees BUILDING r� .°e1 .3 I, as owner of the property,•or m em to ees with ADDRESS ' wages as their Tole compensation,will do the work and o'° 1 0 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. 0 5 31 .:g with licensed contractors:to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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. y (Sec. 3097, Civ. C.). SIDE . . P.L. Lender's Name P.C. Fee$ Permit fee S LDMA Ref. # Lender's Address _ 3 I certify that I have read this application and state that the i? y� pp� Issuance Fee LDMA P/C# _ 2 above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. #. and hereb authorize representatives of this County to enter W upon t bove-mentioned pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 1 WORKERS'COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION P P L I C�4T I O N FOR BUILDING U I L D I N G P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob. C.) C /. y- COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No�_ "may Company . ) ,%., . -(- Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �. Certified copy is filed with the county building inspec- 7ADDRESS r tion department. f r' i- W Date �_ ' .' Applicant ""it r'�r CITY f.. ZIP LOCALITY! CERTIFICATE OF EXEMPTION FROM ORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE I PARCEL L1. TEL. USE ZONE MAP O I certify that in the performance of the work for which this OWNER NO.'' NO. U permit is issued, I shall not employ any person in any manner SPECIAL W so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS --L Date Applicant CITY ZIP y. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL, DISTRICT I GROUP I TYPE FIRE PROCESSED BY ENGINEER NO. CONST. ZONE d Exemption, you should become subject to the Workers' LL' Compensation provisions of the Labor Code, you must forth- ADDRESS 0 with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. STATISTICAL CLASSIFICATION APT. CONDO. W LICENSED CONTRACTORS DECLARATIONr LIC. CLASS NO. DWELL. UNITS H I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. ' (commencing with Section 7000)of Division 3 of the Business and / LIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY J CLASS BK PGVALIDATION / r SQ. FT. NO. OF NO. OF CHECK License Number f4 Lic.Class �Z 4 SIZE STORIES FAMILIES ONE VALUATION s j3 DESCRIPTION OF WORK NEW Contractor, Date_ ADD 11 $ oil.1 am exempt under Sec. �` ALTER El B.BP.C. for this reason I REPAIR ❑ $ Date: USE OF EXISTING BLDG. - ! DEMO" ❑ Signature APPLICANT TEL, FINAL OWNER-BUILDER DECLARATION PRINT) NO. DATE I'hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESSFINAL Professions Code): PRESENT By 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 7044, Business and Professions Code). MOVING TEL. Opp. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- e • tion 7044, Business and Professions Code). FInvestigotion TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name LDMA Ref. # Permit Fee ' Lender's Address certify that I have read this application and state that the Issuance Fee LDMA PiC# ibove information is correct. I agree to comply with all County Fee xdinances and State laws relating to building construction, Total Fee LDMA Perm. # nd hereby outh9rize representatives of this County to enter upon the abovy,9=mentioned property for inspection purposes. 1 ✓I f' SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu Of plicant or Agent r r e WORKERS'COMPENSATION DECLARATION r ' affirm that I have o certificate of consent to self APPLICATION FOR BUILDING PERMIT . vv insuresure,, or a certificate of Workers' Compensation Insurance, or 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 BUILDING (Jj /A/ /. v ❑ ADDRESS t� LA Certified copy is filed with the county building inspec- � BUILDING ,A/ `m tion department. ADDRESS l.!'/ AkS 78a Date Applicant CIT j ZIP 1./C�� LOCALITY oq CERTIFICATE OF EXEMPTION FROM WORKERS' n NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT 19�O X fl NOW ON LOT VA/C CROSS ST. Qdr .(This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER NO. j NO permit is issued, I shall not employ any person in any manner ADDRESS / PE AL so as to become subject to the Wo ers'Compensation Laws. CONDITIONS O t U �1 _ t CITY ZIP Date-5 Applicants D' NOTICE TO APPLICANT: If, after making this Certificate f ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O ENGINEER NO. CONST ZONE V Exemption, you should become subject to the Workers' ���� Compensation provisions of the Labor Code, you must forth- P P Y ADDRESS � Lt1. with comply with such provisions or this permit shall be 0 deemed revoked. S TE STATISTICAL CLASSIFICATION APT. [CONDO. cn CONTRACTOR 1 NO. -33 LICENSED CONTRACTORS DECLARATION LIC. ` Q CLASS NO. Zy DWELL. UNITS Z I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ,Z Za0 N . d 7��/ SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY p a not- CLASS Is VALIDATION �^ 15-01 � SQ. FT. 3-NO.OF NO.. / CHECK BK. PG.License Nu ber / c.Class SIZE /OD� STORIES pN� FAA- ONEVALUATION �9 2 a$'AContractor e •3• 11 •09 DESCRIPTION OF WORK NZ NEW $ � S-co ��. # a o o,o'23 +1l I am exempt under.Sec. i�� ���� ADD0 07�j32 • ALTER B.4P.C. for this re son ,• / REPAIR ❑ $ o007•332=Dat EXISTUSE OING BLDG. (.u�f"a1 C1�P�/ L-- DEMOL ❑ 0 3 1 9+—8 8 U Signature APPLICANT TEL• FINAL OWNER-BUILDER ECLARATION PRINT �t<< O. DATE I hereby affirm that l am exempt from the( .or ctpr's License ADDRESS FINA ,Low for the following.reason (Section 7031. Business and Professions Code): PRS N B BUILDING q(pl. N I �� Y n 2 El . 1, as owner of the property, or my employees with. ADDRESS 9 2 a 9 A wages as their sole compensation,will do the work and' the structure is not.intended or offered for sale(Section LOCALITY '# 0 0 0 0 o iJ 7044, Business and Professions Code). MOVING TEL. 1, as owner of the property, am exclusively contracting CONTRACTOR NO. � o 1 06d 3 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS o o 106:135 REQUIRED L SETBACK F S CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAPROP. LINE WIDTH _ O 3;� 9 8 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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name Fsl LD MA Ref. N Lender's s P.C. Fee$ i Permit Fee , 3 I certi that I h ve read this a lication and state that the , S� LDMA P/C p o P ._ . Issuance Fee ' o abov informatio is correct. I ag a to comp with all County Investigation Fee, 0 ordin nces and a laws rI- g to but ng construction, Total Fee 3 LDMA Perm. # R and reby a ri e r resent fives of s County to enter < upo t abo e e t' n d pr erty for pection purposes. d3.2J• SEE REVERSE FOR EXPLANATORY LANGUAGE ,� Signature o App icant or Agent Date WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION: F O.R BUILDING PERMIT or a.,certified.copy,thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No/_�!!U-7 omp anyA�L ❑ Certified copy is hereby furnished. � FOR APPLICANT TO FILL IN BUILDINGADDRESS ❑ Certified copy is filed with the county building inspec- BuaowG Tion department. ADDRESS. CITY' G� ZIP (, LOCALITY �f) Date Applicant �G u• if�- NO. OF BLD S. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST 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 OWNERNO. USE ZONE MAP NO. I certify that in the performance of the work for-which this permit is issued, I shall not employ any person in any manner ADDRESS SPECIAL d CONDITIONS s as to become subject to the Workers'Compensation'Laws. O U CITY ZIP .. • � D to c t L ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR CESSED BY N CE APPLICANT: If, a.ter ma ing .th' erti tcate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' �,�U� (_ G �t w Compensation provisions of the Labor Code,.you must forth- ADDRESS ..d' / withcom ply with such provisions•or this permit shall be. TEL. STATISTICAL CLASSIFICATION APT. CONDO. v7 J Z deemed revoked. •- � CONTRACTOR / NO. p LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. 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. OFTN-0-0 F .• CHECK License Numb 4Q !' Number j�? f'es Lic. Class, SIZE STORIES IFAMILIES ONE VALUATION Contractor�L_ . �. /�/ •Date — Z DESCRIPTION OF WORK / /. OO NEW ❑ f ADD ❑ ❑I am exempt under Sec. t 7li�L ►. ALTER B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL Q O ER-BUILDE (PRINT) NO. DATE I hereby affirm at I am ex pt am the Contractor's.License Law for the Ilowing rea o ection.7031.5, Business and ADDRESS FINAL 1 Professio " Code): . PRESENT B qA ❑ BUILDING Y ANT, e B I, as owner of the property, or my "employees with ADDRESS wages as their sole compensation,will do the work and 3307 L--.;e 63 . the structure is not intended or offered.for sale(Section LOCALITY t T M 7044, Business and Professions Code.) , MOVING TEL. , I ITEMS CONTRACTOR NO. �, I, as owner of the property, am exclusively contracting I., 6 with licensed contractors to construct the project (Sec' ADDRESS TOTAL 83 tion 7044, Business and Professions Code.) `. �.K t REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT CHANGE ,!!!I the performance of the work for which-this permit is issued P.L. (Sec. 3097, Civ. C.): SIDE Lender's Name %}f�o[i—�[lJ, ��.=4•f� m LDMA Ref. # P.C. Fee.$ Permit Fee p, �O 5165 1 AN ate: Lender's Address i 0 1 certify that.I hove read This application.and state that the 'Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County InvestigationFee 0 ordinances and State laws relating to building construction; Total Fee ego (/G LDMA Perm. # a and hereby authorize representatives of s County to:enter upon the above- tioned property fo spection purposes. 2 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature.of A r P� �V ica o 'Date / APPLICATION FOR BUILDING PERMIT it t ` COUNTY OF LOS ANGELES BUILDING AND SAFETY BUIL G A D WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN lF� she - BUILDIN � - <h I hereby affirm that I have a certificate of consent to self insure, I r a.certificate,of Workers'Compensation Insurance,or a certified O " Kpy thereof L b. ) MOP ZIP �'l jo LOCA MY Policy No. Company NO.OF BLOGS. W 0N LOT ❑ Certified copy is hereby fur ished. NEAREST CRO ST. Cyertified s filed wi h the count building inspection TRACT BLOCK LOT NO. Co.py y 9USE ZONE MAP NO. Mmet. 'Datlicant / ASSESSOR MAP BOOK PAGE PARCEL . p / SPECIAL CONDITIONS . CER IFICATE OF EXEMPTION FROM WORKERS' OWNER T ' O i WITHIN 1000 FT OF SCHOOL? YES NO COMPENSATION INSURANCE ADD 1 DISTRICT. GROUP TYPE CONST.' FIRE ZONE XEIIE BY (This section need not be completed if the permit is for one hundred - dollars($100)or less.) CITY z sr / <l� I certify that in the performance of the work for which this permit y V V is issued, I shall not employ any person in any manner so as to ARC CT ORE IEE TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL IFICATION APY I UNDO 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 T �N 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. W' IC. PL LICENSED CONTRACTORS DECLARATION C. S PIL U I hereby affirm that 1 am licensed under provisions of Chapter,9 SQ.FT SIZE NO. F STORES NO. FAMILIES— (commencing SEWER MAP � (commencing with Sectio 7000) f Division 3 of the Business and NEW ❑ BK PG O. Professions Code, fi S s in full force ale License Nu a LiC.CI l SCRIPTION W RK ADD VALUATIOy� yV, rjK Contractor �% ( - b `� ALTER ❑ "-' REPAIR ElI am exempt under Sec. B.&P.C.for this reason DEMOL LDMA P/C s USE OF EXISTING BLDG. Date: URM ❑ Signature APPLI T T) / PTF ,�17 'r LDMA Perm n ❑ 1, as owner of the property, or my employees with wages as (C// W p A' their sole compensation,will do the work and the structure is ADDR l H _— not intended or offered for sale (Section 7044, Business and / FINAL DATE C `K7 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANTH NDLEAHAZARDOUSM TERIAL A0 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL QUAL TO OR GREATER THAN Q •� "'—`I ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATIONGUIDE7 FI licensed contractors to construct the project.(Section 7044, VES❑ No❑ ``L 93as '-= Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING ;r1�..,K OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH j`t 4 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST �.� f �'q �j :i - FOR GUIDELINES. �� '• :!ifi I hereby affirm that there is a construction lending agency for vas El No El the performance Of the WOfk for Which this permit IB ISSUed(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMDyv 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES "}E')�j(`x••_ j !• , i �. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100THROUGH 2.20.140 CONCERNING �� I t '>.I I_+S u,-Hi. l: ar Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING APERMIT FROM THE SCAQMD. i a Ar Lender's Address owNvtoRAOEr+r 16 o I certify that I have read this application and.state that the above information .is correct. I r8@ to comply with all county P.C.FEE ` PERMIT FEE ^r r7ir $R ordinances and State laws Eating to building construction,and Z107fGf (/ a here authorizer rese atives f this County to enter upon ISSUANCE FEE the ve merition pr e yfor s(;eeti4n p S Q / INVESTIGATION FEE TOTAL FEE � a signature l .?'Ape. Dem Il SEE REVERSE FOR EXPLANATORY LANGUAGE r f 'ORKERS' COMPENSATION DECLARATION ` insure,boraffirm a' certificate of Workers' Compensation'oI have a certificate of consent ensuran of A P P.L I CATION . FOR BUILDING PERMIT or 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 a�oRess � Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS ( d.* ' .. " ZIP Date Applicant LOCALITY CITY; NO. OF BLDGS. �7 NEAREST ERT AICATE OF EXEMPTION FROM WO KE ' SIZE OF LOT NOW ON LOT CROSS ST. Cr` COMPENSATION INSURANCEASSESSOR (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 USE ZONE MAP / C—�t OWNER, Z NO. D9 NO —�� I certify that in the performance of the work for which this SPECIAL d permit is issued, I shall not employ any person in any manner ADDRESS 4 � _I CONDITIONS so as to become subject to the �ge ' n aws. O Ll �,p�j CITY ZIP Date Lllo ApplicanARCHITECT OR TEL. 0 NOTIC APPLICANT: If, aftcate of ENGINEER NO. DISTRICT GROUP TYPE FIRE ESSED BY CONST. ZONE 0 Exemption, you should become subject to the Workers' Q^�� w Compensation provisions of the Labor Code, you must forth- ADDRESS �J a with comply with such provisions or this permit-shall'be TEL. �o� STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION ' LIC. CLASS NO. 2 �-- DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS V 1f�0 NO. l� (commencing with Section 7000)of Division 3 of the Business �, ''� �JQ ',� LIC. n SEWER MAP CITY (0'� �Y CLASS f� �j and Professions Code and m license is in full force and effect. gK• L pG.�V/ VALIDATION f /yy SQ. FT. NO. OF NO. OF CHECK License Number ` ' / Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contr Date DESCRIPTION OF WORK Q�tQ. NEW ❑ ; _ ❑I am exempt r Sec. a ADD ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL 'OWNER BUILDER DECLARATION .. (PRINT) ' tN 4110-1-)N6. �.3fl�C�l DATE I hereby affirm that I am exempt from the Contractor's License iL� �/ y 5c� l�•pQ Law for the following reason (Section 7031.5, Business and ADDRESS AG U�"> FINAL Professions Code): PRESENT By. ❑ I, as owner of theproperty, or m em to employees with BUILDING Y P Y ADDRESS 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. , t •_• ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO.with licensed contractors to construct the project Sec- s P I ( ADDRESS - :t---`'-• � ���••-� tion 7044,Business and Professions.Code.) REQUIRED' TOTAL SETBACK FROM EXIST: CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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: (Sec. 3097, Civ. C.).. SIDE P.L., _ Lender's Name. i.' `4 LDMA Ref. #. m P.C. Fee$ Permit Fee Lender's Address , f'`.' F'`' o 1 certify that I. have read this application and state that the Issuance Fee G JLDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee p / R ordinances and State laws'relating to building construction, Total Fee LDMA Perm. # a and hereby authorize presentatives of this County to enter upon the above-m coned property for inspection purp s ss. � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature plicant or Agent to —'�WORKERS'�CUMENSA'I IUN DECLARATION IT insure certificate of Workers' Comtpennsat oconn eInsuran ent to lf P P t ��.� ■ ®� ®� �' I��� or q certified copy thereof Sec. 3800, Lab. C.) ` •�� x1 COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nc ampany d= ❑ Certified copy +s hereby furnished. FOR APPLICANT TO FILL IN S rtifADDRESS 63 . 1 ADDRES40--- Certified copy is filed with the county building inspec BUILDING tion department: ADDRESS � _ KtiS (� Date 2'r Applica CITY• ! ZIP LOCALITY ERTIFI ATE OF EXEMPTION 40M RKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURAN SIZE OF LOT NOW ON LOT CROSS ST.' (This section need not be completed if the permit is for oneASSESSOR hundred dollars ($100).or less.) -. TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL" USE ZONE MAP I certify that in the performance of the work for which this OWNER q 'Z. NO." 0" fides NO. permit is issued, I shall not employ any person in any manner p SPECIAL ADDRESS Opt ��iYl d� Q 7- —/ CONDITIONS � o so as to become subject to the Workers'Compensation laws: � O CITY �r ZIP . Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROLE. ED BY O Exemption, you should become subject to the Workers' CONST.L ZONE' v Compensation provisions of the Labor.Code, you must forth- ADDRESS / 3. /! with comply•with such provisions or this permit shall be TEL. p .7 STATISTICAL CLASSIFI ATION APT. CONDO. Cl) CONDO.- deemed revoked. CONTRACTOR NO. O �7 LICENSED CONTRACTORS DECLARATIONLIC. f " CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Q NO. / raj (commencing with Section 7000)of Division 3 of the Business and / LIC. SEWER MAP Professions'Code, and"my license is in full force and effect. CITY SS A-� 16s CLASS 46- 6KPG, VALIDATION SQ. FT. NO. OF" NO.OF CHECK ' Licehse.Number7 7 � Lic.Class_ SIZE STORIES FAMILIES ONE _- VALUATION ContracioTlG'/La.�1Cf/a (� Date Z DESCRIPTION OF WORK ^^ j NEW ❑ $ FTam exempt under Sec. W q .S ' 'Pte. J�'G ADD ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. Cal1L r C DEMOL ❑ Si nature APPLICANT �^ �� TEL. FINAL SigOWNER-BUILDER DECLARATION' PRINT W L c�lr l NO. DATE / I hereby affirm that l am exempt from the Contractor.'s License ADDRES � V ' f�.1( FI L Low for the following reason (Section 7031.5,-Business and' TI Professions Code): PRE ENT J BUILDING 1, as owner of the property, or my employees with ADDRESS wages as"their sole compensation;will do the work and V the structure is not intended or offered for sale(Section LOCALITY . 7044, Business and Professions Code). MOVING. TEL. ® 9"$8 Ca 7 n ],.as owner of the property, am exclusively.contracting CONTRACTOR NO. n with licensed contractors to construct the project (Sec- # ° ° ° 01'0 '1 tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING.AGENCY SETT BACKK YARD HWY TOTAL SETBACK _ WIDTH I - 14363 hereby affirm that there is a construction lending agency for FRONT _. the perform6nce°of the work for which this permit is issued P.L. _ ° ° 1 4 3,6 3 0 (Sec. 3097, Civ: C.). SIDE P.L. 0 1.2 6'-88 Lender's Name P.C. Fee$ Permit Fee 15 LDMA Ref. # Lender's Address g 1 certify that I have read this application and state that the - Issuance Fee JS LDMA P/C# g above information is correct. I agree to comply with all County Investigation Fee0 ordinances and State laws relating to building construction, Total Fee iLDMA Perm: # and hereby a,uth ize representatives of this County to enter upon thea 'ov a ned property for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of plicant or Agent D to t a`�KERS'CtOMPEN5ATION,DECLARATION Q !ns�r`r Ytificate of WorkersrtCompensat Coificate of mpensation ent to lf � +A P P L I C AT I O N .FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, La . C.) �' COIINTY,OF..LOS ANGELES B L D SAFE Y Policy Nd4S6S�-4,Company ❑ Certified copy is hereby furnished. BUILDING 1 FOWAPPLICANT.TO`FILL IN ADDRESS CIIJ ❑ Certified copy is filed with the county building inspec- BUILDING t� tion department.. ADDRESS y LOCALITY /+ C''' '• NEAREST D,pte o :Applicant CITY v� :. `t ZIP. CROSS ST. ERTI LATE OF.EXEMPTION FROM OR _NO._OF`BLDGS. a• ASSESSOR COMPENSATION INSURANCE SIZE OF LOT• NOW ON LOT �'. MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one ` / :/ USE ZONE MAP ^ / ' "hundred dollars ($100)or less.) TRACT BLOCK t LOTV. --TZI NO. / TEL." J SPECIAL f! r OWNER NO. I CONDITION ���1 d c I certify that in the performance of the work,for which this04.01 permit is issued, I shall not employ any person in any manner (J- DISTRICT GROUP TYPE FIRE CESSED BY O •so as to became subject to the Workers'Compensation Laws. ADDRESS �r _ © CONST. ZONE U 5499;01 . Date Applicant CIT /-, ZIP STATISTICAL CLASSIFICIiTION APT. ICONDO. ARCHITECT., ` •TEL. ! �L/ 1r NOTICE TO APPLICANT: If, after making this Certificate of U Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS � Compensation provisions of the Labor Code, you must forth- ADDRESS /� v SEWER MAP �/-7 d z O O U H Z with comply with such provisions or this permit shall be 10 deemed revoked. TEL: BK PG VAUDATION CONTRACTOR V r��A NO. ) _3 LICENSED CONTRACTORS DECLARATION y�' �q3 LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS d:rc 7,O,o.,'S S,NO. \ VALUATION 12 4 O O,2 O (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY - N. l f�� CLASS 16! $� Q�t� 0 2400.205) SQ. FT. NO.OF NO. OF CHECK , ! 0.1 4=86 License Number Lic.Class / SIZE b STORIES FAMILIES ONE &V (nom i NEW lti . $ Contracto " ✓v Date :� DESCRIPTION OF WORK ❑ I am exempt under Sec. ADD' ❑ //V y li L•-+ ALTER ❑ FINAL B.&P.C. for this reason REPAIR DATE ❑ J Date: USE OF EXISTING BLDG. /���// DEMOL E] F1 B . t 114, Signature - �� - APPLICANT TEL. y OWNER-BUILDER"DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Law for the.following reason (Section 7031.5, Business and ADDRESS" Professions Code): PRESENT 2 6 4 4,4 A ❑ BUILDING I, as owner of the property, or my employees with ADDRESS d ## 0 0 0 0 0 1 wages as their sole compensation,will do the work"and 12.8'J 4,25 the structure is not intended or offered for sale(Section LOCALITY a 7044, Business and Professions Code). MOVING TEL. ❑. CONTRACTOR a NO.I, as owner of the property, am exclusively contracting 0 283 4,2 5 v with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 1.J _8 7 REQUIRED YARD HWY TOTAL SETBACK FROM - EXIST. O O CONSTRUCTION LENDING AGENCY .SET BACK PROP. LINE 'WIDTH 11011. • 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. . (Sec. 3097, Civ. C.). SIDE FD P.L. o Lender's Name P.C. Fee$pC Q Permit Fee i - Lender's Address • ' I certify that I have read this application and state that the Issuance Fee > a above information is correct. I agree to comply with.all County Investigation Fee g ordina son tate luting to building construction, Total Fee (sem IJ and here uthorize represen tives s County to enter upon the ve- ntioned pr er for i pection.purposes. 0 o— SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Applicant or Ag t Date - ®S ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 _ BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDINS AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9902110029 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 8526 LT: 10 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 9473 LAS TUNAS DR STRUCTURE: 882 1 VN B TEMP CA 917802126 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY 8587-008-017 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: B 03/25/99 UT 03/25/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINA CODE: WANG JAW J;JEAN TRS 19,000 580 OLD MILL RD SMAR 911081652 FEES PAID DESCRIPTION OF WORK TENANT IMPROVEMENT FOR DENTAL OFFICE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: PHAM (714) 550-9228- Al PLANCHECK W/EN-HC 19000.00 VAL 359.52 515 N. FAIRVIEW ST AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: SANTA ANA, CA92703 AE STRONG MOTI,ON--OTHER—._-19000..00 VAL 3.99 B2 PERMITiW%ENERGYGE,LE �19000:00'VAL 404.58 � TOTALn&EES 795.84 CONTRACTOR: TEL. NO: ®� o�� APPROVALS DATE INSPECTOR SIGNATURE LONG CONSTRUCTION (714) 281-3731- 515 N. FAIRVIEW ST. LIC. NO LOCATION AND SETBACKS SANTA ANA, CA 92703 38418 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO. 1111111 SLAB/UNDER FLOOR L , RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CAK U 0 ��V O K� UNDERFLOOR INSULATION FLOOR SHEATHING Na. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: _ NO 22 O 0 wi ROOF SHEATHING 19 0 �a SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALSAV NO NO NO 0v FRAME INSPECTION __ y FIRE SPRINKLER HANGERS arvic�����V INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH 9 RATED FLOOR/CEIL A SEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 i 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 0705090061 PHONE: (626) 285-0488 EXT: DUPLICATE _ ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1 ITR: 8526 LT: 10 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUPI 9453 LAS TUNAS DR 1 STRUCTURE: 1900 2 VN B I TEMP CA 917802126 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: CLOVERLY 18587-008-017 I I THOMAS PAGE: 596 .GRID: J3 LOCALITY: TEMPLE CITY, Cl (TENANT: 1EXIST BLDG USE: COMME USE ZONE: (ISSUED ON: PROCESSED BY: EXPIRES ON: 1 IREMAX 1000 REALTY (EXIST OCC GRP: B 105/09/07 VG 05/03/08 (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL B CODE: 1 IWANG JAW J;JEAN TRS - 1 78,000 107/24/07 STEVE PAN I 1580 OLD MILL RD ISMAR 911081652 1 FEES PAID IDESCRIPTION OF WORK I .I I ITI REALITY OFFICE I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( I (APPLICANT: TEL. NO: I I I ILIN (626) 287-7896- IAA BLDG PERMIT ISSUANCE 27.75 1_ I IAE STRONG MOTION OTHER 78000.00 VAL 16.38 ISPECIAL CONDITIONS: 1 JB2 PERMIT W/ENERGY 78000.00 VAL 1,185.86 I I I ,TOTAL FEES 1,229.99 I 1 ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 IKONG, WOK TUNG (626) 289-5539- 1 1 12168 S. ATLANTIC BLVD., #511 LIC. NO ILOCATION AND SETBACKS I I I IMONTEREY PARK, CA 91754 702065B 1 I I I I I I ISOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I IKT CONSTRUCTION ENGINEERING CO. (626) 289-5539- 1 1 1 I I 2168 S. ATLANTIC BLVD. LIC. NO: I SLAB/UNDER FLOOR I I I NONE IMONTEREY PARK, CA 91754 i IRAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION I I 1 3 041 1 1-1 I I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I NO 22 1 IROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS I ISHF.AR PANELS I I 1AIR QUALITY: 1000 FEET MATERIALS I I I_ I 1 NO NO NO IFRAME INSPECTION FIRE SPRINKLER HANGERS I 1 INSULATION/WEATHER STRIPI I1 I I (INTERIOR LATH/ RYWAL 1 I 1 _ - P I I 1EXTERIOR LATH I I I IRATED FLOOR/CEIL ASSEM. 1 1 I I IRATED WALL ASSEMBLIES 1 I I I I IRATED SHAFTS/OPENINGS I I I IT-BAR CEILINGS I I I 1 I ILOT DRAINAGE I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I I L 5 .- 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 0312170003 PHONE: (626) 285-0488 EXT: LEGAL NO. OF CONST NEW BUILDING ADDRESS: ���L;✓ TR: 8526 LT: 10 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 9463 LAS TUNAS DR �� STRUCTURE: 1000 1 VN B TEMP CA 917802126 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY 8587-008-017 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: ISSU ON: PROCESSED BY: EXPIRES ON: JEI (LEARNING CENTER) EXIST OCC GRP: B 12/23/03 VG 12/17/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: WANG JAW LJEAN TRS - 12,000 j�k 580 OLD MILL RD / '- ' SMAR 911081652 FEES PAID D SCRIPTION OF WORK T.I. FOR LEARNING CENTER FOR NO MORE THAN 30 STUDENTS; FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: CONSTRUCT 3 CLASSROOMS AND 1 OFFICE APPLICANT: TEL. NO: CHU MONDY S (626) 272-8709- AA BLDG PERMIT ISSUANCE 27.75 4951 ROBINHOOD AVE AE STRONG MOTION OTHER 12000.00 VAL 2.52 SPECIAL CONDITIONS: TEMPLE CITY 91780 Al PLANCHECK W/EN-HC 12000.00 VAL 244.57 A2 PERMIT W/ENERGY-HC 12000.00 VAL 287.73 TOTAL FEES 562.57 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LEAVON DEVELOPMENT (626) 260-4600- 428 PARK AVE LIC. NO LOCATION AND SETBACKS MONTEREY PARK CA 91754 613257 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NC: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION 1 `� FIRE SPRINKLER HANGERS ' INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO:-BS0508 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 1011230032 PHONE: (626) 285-0488 EXT: (LEGAL ID: I NO. OF CONST NEW BUILDING ADDRESS: 1 ITR: 8526 LT: 10 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUPI 9471 LAS TUNAS DR 1 I (STRUCTURE: 932 1 V-B B I TEMP CA 917802126 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: CLOVERLY 18587-008-017 1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl I I I I (TENANT: 1EXIST BLDG USE: COMME USE ZONE: (ISSUED ON: PROCESSED BY: IFELICIA TSAI IEXIST OCC GRP: B 102/07/11 SR I 1 _I I 1 (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: CENTURY PLAZA - 1 42,720 l K I I I FEES PAID (DESCRIPTION OF WORK I' I I (TENANT IMPROVEMENT IN A (E)1132 SQFT STORE SPACE FOR A HAIR I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ISTUDIO WITH ONE ACCESABLE RESTROOM AND ONE STORAGE ROOM I (APPLICANT: TEL. NO: I I I (JIMMY LEE (909) 590-8807- JAI PLANCHECK W/EN-HC 42720.00 VAL 689.30 1 I 113841 ROSWELL AVE IAA BLDG PERMIT ISSUANCE 27.80 (SPECIAL CONDITIONS: I. (CHINO, CA 91710 IAB STATE GREEN BLDG FEE 42720.00 VAL 2.00 1 1 IAC STRONG MOTION RESID 42720.00 VAL 4.30 1 I IA2 PERMIT W/ENERGY-HC 42720.00 VAL 810.90 1 (CONTRACTOR: TEL. NO: I TOTAL FEES 1,534.30 (APPROVALS DATE INSPECTOR SIGNATURE ISIPENG XIN (626) 848-2736- I I 1 12468 1/2 DEL MAR AVENUE LIC. NO I ILOCATION AND SETBACKS I IROSEMEAD, CA 91770 890143 1 1 I I I (SOILS ENGINEER APPROVAL 1 I I I I I I I I 1ARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS I I I (PETER LEE ENGINEERING INC. (626) 280-9000- I 1 1 1 1 18748 E. VALLEY BLVD. #L LIC. NO: I (SLAB/UNDER FLOOR I I I IROSEMEAD, CA 91770 53948 I I I I I I I (RAISED FLOOR FRAMING I 1 I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I. 1 3 041 1 11 I I I (FLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I I NO 22 1 IROOF SHEATHING I I I I I I 11 1 I SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS 1 I I NO NO NO I (FRAME INSPECTION (FIRE SPRINKLER HANGERS I I I I I I I IINSULATION/WEATHER STRIPI I _ I I I I I I I (INTERIOR LATH/DRYWALL I" M I 1 IEXTERIOR LATH I I I I I I I I IRATED FLOOR/CEIL ASSEM. 1 I I I I I I 1 IRATED WALL ASSEMBLIES I 1 I I I I I I (RATED SHAFTS/OPENINGS I I I I I I IT-BAR CEILINGS I 1 I I I I I I I 1 I ILOT DRAINAGE I I I I I I I I (REPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF.,PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR �4 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0804300051 PHONE: (626) 285-0488 EXT: (LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: ITR: 8526 LT: 10 BL: .001 I SQ. FT STORIES TYPE 1 9471 LAS TUNAS DR STRUCTURE: V-B I TEMP CA 917802126 I (ASSESSOR INFORMATION NUMBER: - NEAREST CROSS STREET: CLOVERLY 1 18587-008-017 �. THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: COMME USE ZONE: C-1 11SSUED ON: PROCESSED BY: EXPIRES ON: I IPOLYGOLD INC. (EXIST OCC GRP: - 104/30/08 SR 10/27/08 I (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: IINVESRVE (MANAGEMENT COMPANY) (626) 407-6270- 1 3,000 1 11300 E. MAIN ST.#210 1 I � IALHAMBRA, CA 91803 - I FEES PAID (DESCRIPTION Of-WORK 1 I I 1APPROVAL FOR CREATING NEW SHOWROOM/CEILING FOR THE FIRST I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: IFLCOR. NO ADDITIONAL FLOOR AREA ON SECOND STORY (APPLICANT: TEL. NO: I I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.75 I - I IAE STRONG MOTION OTHER 3000.00 VAL 0.63 ISPECIAL CONDITIONS: IAX BUILDING REVIEW FEE 54.70 1 IA2 PERMIT W/ENERGY-HC 3000.00 VAL 113.85 I TOTAL FEES 196.93 1 I (CONTRACTOR: TEL. NO: - (APPROVALS DATE INSPECTOR SIGNATURE I SAME AS OWNER - I- LIC. NO ILOCATION AND SETBACKS I I I ISOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I I LIC. NO: SLAB/UNDER-FLOOR I 1RAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION I I I 1150H265 3 Oil I- I I (FLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I NO 22 I IROOF. SHEATHING I I I SCHOOL WITHIN HAZARDOUS ISHFAR-PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS I I I NO NO NO I IFRAME INSPECTION � IREQUIRED TOTAL SETBACK FROM EXIST I IFIR.E SPRINKLER HANGERS �I I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I_ I IFRONT PL- I (INSULATION/WEATHER STRIPI I SIDE PL- I_ I JINTERIOR LATH/DRYWALL I. IEXTERIOR LATH I1 I I (.RATED FLOOR/CEIL ASSEM. I (RATED WALL ASSEMBLIES I I (RATED SHAFTS/OPENINGS I I I IT-BAR CEILINGS I I (LOT DRAINAGE I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0706060040 PHONE: (626) 285-0488 EXT: LEGAL ID: INUMBER OF SIGNS: 1 BUILDING ADDRESS: ITR: 8526 LT: 10 BL: .001 ISIGN DESCRIPTION: NEW WALL SIGN CHANNEL LETTERS SIGN 9453 9455 LAS TUNAS DR TEMP CA 917802126 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 18587-008-017 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl TENANT: 1EXIST BLDG USE: JISSUED ON: PROCESSED BY: EXPIRES ON: IRE/MAX 1000 REALTY 1EXIST OCC GRP: 108/06/07 SR 02/02/08 OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: FINAL DAT I BY: CODE: 11NVE SERVE INC. (626) 458-3435- 1 3,800 19455 LAS TUNIS DR. TEMPLE CITY CA 91780 FEES PAID IDESCRIPTION OF WORK INEW WALL SIGN CHANNEL LETTERS SIGN 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I (APPLICANT: TEL. NO: 1 1WEI MAN QUAN (626) 288-6872- 1AA BLDG PERMIT ISSUANCE 27.75 1 1 18919 E. GARVEY AVE. 1AX BUILDING REVIEW FEE 54.70 ISPECIAL CONDITIONS: 1ROSEMEAD, CA 91770 1D2 PERMIT W/O EN-HC 3800.00 VAL 115.80 TOTAL FEES 198.25 (CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE 1ARTIST SIGN AND ART SERVICE CORP. (626) 625-2888- I 1 18919 E GRAVEY AVE #C3 LIC. NO 1LOCATION AND SETBACKS 1ROSEMEAD CA 91770 811413 C45 (SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: 1 (FOUNDATION/TRENCH FORMS I I LIC. NO: 1 ISUPPORT STRUCTURE 1 I I I I I I I MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMPP: I I I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I 1 I I NO 20 SCHOOL WITHIN HAZARDOUS (AIR QUALITY: 1000 FEET MATERIALS 1 1 1 NO NO NO 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I (REPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I