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HomeMy Public PortalAbout9514 LAS TUNAS DR_Building__ 0B.9 25M SETS 9-aa APPLICATION FOR PERMIT D, TMENT-OF BUILDING AND SAFETY COUNTY OF LOS ANGELESj TI WM. J. FOX, CHIEF ENGINEER �l .� DISTRICT NO. PLAN CK. NO. PERMIT NO. NO. C BLDG. ORD.NO. _ PLANE SETBACK LINE - FIRE APPROVED ZONE �w BY' DATE RECEIVED BY DATE OF APPL. DATE ISSUED USES APPROVED , ZONE " Y. DATE. I APPLICANT FILL IN HEAVILY OUTLINED-PORTION ONLY BUILDING O C NAME ADDRESS CJ F ILI W Z ADDRESS LOCALITY L .A9 = Z NEAREST U W CITY CROSS ST. • ,� .q ' w STATE Q LICENSE NO. NEL• NAME �4 E MAIL NAME LQT`^1 'Q"if ds k i ADDRESS U ��` �y O TEL. Q ADDRESS ,Iy<r/J�. - CITY NO. z CITY ff f I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS Z t� jp. �- :a /. ► O _ _ _ APPLICATION AND STATE THAT THE ABOVE IS CORRECT E f ;� AND AGREE TO COMPLY'WITH ALL COUNTY ORDINANCES U LICENSE NO. C.A NO. _ a 7 f A AND STATE LAWS REGULATING BUILDING CONSTRUCTION. Z SIGNATURE OF O , LOT NO. SIZE OF LOT .J F NO. OF BLDGS. OWNER J/ ,/ /f a! -'�.f .•/ Q IL BLOCK NOW ON LOT AUTHORIZED O � .J W S TRACT '�— C RRECTION D USE OF BLDGS. NOW ON LOT DESCRIPTION OF WORK USE OF BUILDING / Al E U5- j,6--Al Jul t v= NEW TYPE GROUP NO. OF NO. OF ALTERATIONv,r' ROOMSFAMILIES ADDITION v SIZE REPAIR STORIES (+. MOVING WALL COVERING � V DEMOLISH ROOF COVERING IN X $ P.C.S FEE ` FINAL APPROVAL ,� INSPECTOR'S VALUATION l FEE $ � 5 DATE �\�� \\ NAME 78A688A C6»8088-68 ■ _ . APPLICATION FOR BUILDING PERMIT _1 COUNTY OF LOS ANGELES BUILDING- 'DEPARTMENT f 'DEPARTMENT OF COUNTY ENGINEER AD°KESS 4 BUILDING AND SAFETY DIVISION LOCALITY = tiA JOHN A:LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICIblO. GROUP TYPE D BY FOR APPLICANT TO FILL IN 5r � I CONST. z �J BUILDING L STATISTICAL ASSIFICATION w I SEWER MAP ADDRESS.. �` /.2 �' / C.9 l�__(;0' r_ BK f PG CLASS.NO. DWELL. UNITS LOT NO.,— �-�. BLOCK STATEMAP NUM ER Q / �.WYYES O TRACT �(/ USE ZONE SPECIAL . NOOF BLDGS. CONDITIONS . SIZE OF LOT - I NOW ON LOT '�7. USE OF - EXISTING BLDG. BUILDINGEXIST. YARD HWY STREET NAME _ / g / SETBACK' WIDTH OWNER n C3 tdY`Y Le' _ i S '- _. _ CJO�". . FRONT MAIL � e/. r ,"�, P.L. ADDRESS �/� !J ['1_k SIDE J _ TEUf f p. P.L. CITY '�. .r`' ! I NO. J G INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. �"7 - A/ .ADDRESS ,q. TEL. /t,I 1.L•-'�" c i✓ CONTRACTOR fjFL-`iii' t�I°12 _�elie NOLO-`Y?yyj . �f DD - hESS �) q f" 7LS� l iI{+weirs — DESCRIPTION OF WORK NEW'. ADD ALTER 'REPAIR DEMOLISH SQ.FT..' "NO.OF NO.OF SIZE. STORIES FAMILIES US%FSTRU cl, CTU/R:E tt /gin f Jl.�I�L SIGNATURE O / v!/' APPROVALS APPLICANT L 3 fS1/L� DATE INSPECTOR'S SIGNATURE ADDRESS ;. /J �«� ,I i FOUNDATION: LOCATION FORMS,MATERIALS $ P.C. $�,.,„ FRAME:'FIRE STOPS. FEE i'W BRACING. BOLTS VALUATION lllfffrrr $ `/ FURNACE: LOCATION. FEE GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL'COUNTY ORDINANCES AND LATH,EXT. STATE LAWS REGULA I G BUILDING CONSTRUCTION. SIGNATURE OF /p_ �-Y HOUSE NUMBER COR_ PERMITTE ��'/�'��� r� �� F2ECT AND POSTED �� ADDRESS FINAL �- 7 �I°� CLYDE N.DIRLAM,-PRINCIPAL STRkPCINRAL ENGINEER PLAN CHECK VALIDATION cases PERMIT VALIDATION CK. M.O. CASH �C � .7 rn Jfj 6 1 A r? 11.55 ADBS.B 11.55 APPLICATION FOR 'BUILDING PERMIT _ v . DIVISION OF BUILDING AND SAFETY B"'LD t NG q�; L q s ` a,,S Department of County.Engineer ADDRESS .--•---z County of Los Angeles LOCALITY at-A 9 V_ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST (J CASSATT.-D. GRIFFIN, SUPT.OF BUILDING CROSS ST. \\I P'(RD�N+ FOR. APPLICANT TO FILL IN °IsrRlcr g' GROUP TYPE SEWER MAP �- `" BKBUILDPG C / CONST. ADDRESS 7 i l._A S ' ` V�Js�S 2 MAP - STATE YES f NUMBER Q© HWY LOT NO. �c81 1 i BLOCK USE ZONE TRACT NO. OF BLDGS. pp SIZE OF LOT 1�CU jC 2`a I NOW ON LOT t BUILDING EXIST. YARD HWY STREET NAME SETBACK WIDTH USE EX STOING BLDG. i" ill c R FRONT / r V C c/ OWNER ALt_R u SIDE MAIL ADDRESS !R5` 12- AS 1010A 5 'y " O_ TRACT DWELL. 1 UNIT 5 INDUSTRIAL TEL.TEL. 1 DWELL. I UNIT CITY @ori Pi` \Z TE - 2 'DUPLEX % 2 UNITS 6 PUBLIC BLDG. ARCHITECT OR ENGINEER NO. _ 7 ADDN.,ALT., ETC. 3 APT. UNITS 8 Misr-EL. ADDRESS 4 COMMERCIAL CONTRACTOR '+ C)lJe`� rr�ob4 INSPECTION RECORD ADDRESS _ -C. i.{s?,5'� r-r Y'✓A:Z,1 iZ__ DESCRIPTION OF WORK NEW D ALTER REPAIR DEMOLISH ` FT. NO. OF NO. OF SIZE (,O �.✓ STO lag I FAMILIES USE OF STRUCTURE ����AL3v lc.aOr`'t � G3l�ar7 r-:7 SIGNATURE OF _ APPLICANT 1 APPROVALS C ADDRESS ` Q< DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION AA � �.• - P.C. S FORMS, MATERIALS _ FEE FRAMES FIRE STOPS, - a�Q�J— S BRACING. BOLTS r...t VALUATION - FEE �- FURNACE: LOCATION, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS - APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. li AND STATE LAWS REGULATINOIBUILDING CONSTRUC- TION. LATH. EXT. SIGNATURE OF .HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRES z FINAL JOHN A.LAMBIE,COUNTY ENGINEER *IDATION CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR CK MO CASH 19 .9.'.:.7-L . "SEP '. ,1- 6 6 Q G.l ,, ., ; . 9 9 7 .a:: SEP 6 1 1 .2 0.'0 , . r' •- �, WORKERS'COMPENSATION DECLARA. .TION .' d _ he�� ~ ffirm,that I have a certificate of consent-,,to self • •sure, or a certificate of Workers' Compensation Insurance, A P I C�►T10_N. FOR B.0 I L®I IV C FERMI"T or a certifiedMcopy thereof (Sec. 3800,•Lab. C..)' - .. 'tee - `COUNTY OF LOS ANGELES BUILDING AND SAFETY • Policy No. Company - - - c Certified.copy'is•-hereby fu�nishe&: ; FOR APPLICANT'TO FILL INADDRESS BUILDING Certified copy is filed with the county building inspec- . BUILDING j ) S Tion depar`Tment. ADDRESS . Date ' '` Applicant CITY C l ZIP L7 LOCALITY CERTIFICATE OF EXEMPTION FRO4 WORKERS' _ .__ _,_... .. _._..-- -NO-OF BLDGS.• _' - -.- -' NEAREST ""COMPENSATION INSURANCE SIZE OF LOT C� _SNOW ON LOT CROSS ST. // ASSESSOR (This section need-not'be.completed if the permitis for one TRACT BLOCK L_OT NO. fCs MAP BOOK PAGE PARCEL hundred dollars ($100)or:less.) 6. USE ZONE MAP OWNER; NO. I certify that i,n-the performance of the,work for which'.this �- permit is issued;,)shall'not employ any person in any manner = ' ' SPECIAL - - ADDRESS- l_ CONDITIONS so as to become subject to the Workers'Compensation Laws. � 3 5� 'i1 ,� CITY - _ ZIP Date Applicant[ ?r� . NOTICE'TO APPLICANT:''If, after -making this Certificate of ARCHITECT OR TEL. Exemption, you-should become subject to'The 'Workers ENGINEER __ _NO. . N .-DISTRICT 'GROUP"-TYPE FIRE SSED BY...._ CO PEST ZONE hJ Compensaiion'provisions-of the:Labor Code, you must forth ADDRESS tu with comply +with-such,.provisions or this,perm it'shall be, -- -- �� TEL. STATISTICAL CLASSIFICATION. APT. CONDO. deemed-revoked.,,.• ,i• CONTRACTOR NO.. LICENSED CONTRACTORS DECLARATION.- -• CIC:' 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,and .., _ _ 3. LIC. Professions Code; and"my license is in full force.and,effecT. CITY CLASS "'EW P "VALIDATION " SEWER PG. SQ.-FL tNO,'OF,_ ., _ NO OE__ .., CHECK SIZE STORIES FAMILIES ONE License Number Lic.-Class VALUATION ... DESCRIPTI F WORK NEW-- "O Contractor Date $ ADD I am exempt under Sec ALTER : . B.&P.C.for this reason _..REPAIR• O ; _. USE OF Date: EXISTING BLDG. DEMOL Q .... a ._. .-. ..{ -- APPLICANT TEL. Signafure FINAL OWNER-BUILDER DECLARATION PRINT) - - NO:. DATE z' „. I hereby"affirm that I am exempt from the Contractor's License ADDRESS , Law for the following:reason'(SbCtion 7031.5, Business and FI Professions Code): PRESENT BUILDING f, I, as owner of the-0 roperty or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended proffered for sole(Section LOCALITY 7044, Business-and Professions'Code): MOVING"" TEL` I, as owner of the property,:am exclusively-contracting r5BA TOR NO. withlicensed"contractors to construct the-project-(Sec- 'tion.7044, Business and Professions Code). ED. :SOTAL.SETBACK FROM XIST.:. 2 5 4 T Q AoCONSTRUCTION"LENDING AGENCY K YARD-" HWY' PROP. LINE WIDTH' �I hereby affirm That there is a construction lending agency for # 0 0 0:0 0the-performance of the.•work for which this permit•is issued(Sec. 3097,•Civ. C.).Lender's Name _ O.,__ .... .._ Permit Fee" Zr _ --. :. _.. _. ... _ rCDMA Ref #Lender's AddressI certify.that I.have,iecid-th'is,application'and state that theIssuance Fee 5 LDMA•P/C#above information is correct.d agree to-complywith all County ion Feeordinances and State-laws relatin to buildin construction, _ _._ g- 9-. Total Fee Lb and hereby authorize representatives of this County to enter _ i 'CDMA Perm:#" upon the above-mentioned property for inspection purposes. 1 a '--Signature SEE REVERSE FOR EXPLANATORY LANGUAGE • - Signature of pplicont or-Agent' - •Date - - .. __.- -.._._. _ .. .. .:_ .. _ _ - _ ...,.. rO i APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES . BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION. 1' , r'<- FOR APPLICANT TO FILL IN " BUILDING ADDRESS y BUILDING ADDRESS a ;; < I hereby affirm that I have a certificate of consent to self insure, b or a certificate of Workers'Compensation Insurance,or a certified s G� 64„ copy thereof(Sec.3800,Lab.C.) CITY Tpq�� �I z)P ` ` 1� '"•. _•.• y, �•." ,'? LOCALITY Policy No. Company SIZE OF LOT �) NO.OF BLDGS.NOW ON LOT C1 Certified copy is hereby furnished. Z (I' NEAREST CROSS ST wa l 1`W�r ("„SIJ/, Vek 1 13 Certified copy is filed with the county building inspection TRA�,TS! BLOCK LOT NO. Lr department. C> vji� USE ZONE MAP NO. ASSESSOR MAP BOOK PAGEQ PARCEL L Date Applicant .2 JS ( �� ( SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ER TEL,NO. COMPENSATION INSURANCEDDRESS WITHIN 1000 FT.OF SCHOOL? YES NO j (This section need not be completed if the permit is for one hundred �� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) Cm � CITE ZIP Ccertify 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 ARCHI TOR ENGINEER TIE J..NO. I become subject to the Workers'Compensation Laws. L' 2�L STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. / DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' 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. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS IAe SIDE q 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 STORES NO.OF FAMILIES _ ^_ Professions Code,and,my license is in full force and effect. NEW ❑ BK PG , .^(_',; DESCRIPTI NOF WORK ADD ❑ License Number Lic.Class �t n VALUATI N .- -_- LU IG.= V V Contractor Date ALTER _ El am exempt under Sec. REPAIR El � E f_� 4 . B.BP.C.for this reason DEMOL ❑ ;;( USE OF EXISTING BLDG. LDMA,P/C H "H.-'•'4; A! ��/� Date: L. URM, ❑ „6ignature APPLICANT(PRINT) TEL. O. LDMA Perm It �MJI, as owner of the property, or my employees with wages as L� ZO i�}'ttt= '-�EiI ty = :r •f f r=?' their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business.and 0 •1416 kH EL 0 FINAL DATE Professions Code.) 3-2 R-%� WILL THE APPLICANT OR�UTURE BUILDING OCCUPANT HANDLER HAZARDOUS MATERIAL j OR A MIXTURE CONTAINI A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN _ ❑ I, as owner of,the property,:am exclusively contracting with THE AMOUNTS ❑ SSPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > t t s --s—t' CE5 m 6 licensed contractors to construct the project.(Section 7044, YES❑ V.J. j"I' � $ Business and Professions Code.) ;Lf _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING _HE WILL •• " . OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST l;I'l1 f 3 c It FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES ElNO Elthe 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 ', —E� j 1_ •;`:'�"i i (;i III{ 1 To. COUNTY CODE•TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING is Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lenders Address owN�ora�ENT T ^' y!I o I 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 State laws relating to building construction,and a_ he authorize representatives of this County to enter upon ISSUANCE FEE . above-mentioned property for inpection purposes. % INVESTIGATION FEE TOTAL FEEIf wmof"IcaMwAq� SEE REVERSE FOR EXPLANATORY.LANGUAGE, WORKERS' COMPENSATION DECLARATION•.' I her, affirm'that I have a certificate of consent ici self iryiure,.or a certificate of"Workers' Compensation Insurance, ..,.- ,.: .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 APP ANT TO FILL IN ADDRESS � ❑ ..Certified copy is filed with the county.building inspec- BUILDING h tion department. ADDRE S , ��cj CITY Date Applicant ;.; ZIP / 11 Q'... LOCALITY. 1L' C__c`�•GG NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE of LOT _ NOW ON LOT CROSS ST, COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT' BLOCK LOT NO. MAP BOOK hundred " PA PARCEL dollars ($100) oraess:) i. OWNER r / NO. USE ONE, MAP I certify that in the performance of the work for which this NO. permit is issued,I shall not employ any:person in any manner ADDRESS SPECIAL d CONDITIONS." so as to become subject to the Workers'Compensation'Laws. /� .� - O . Cilt ZIP Date Applicant. ARCF1ITECT OR TEL. NOTICE TO APPLICANT: If, after-makingr this ENGINEER NO. DISTRICT GROUP TYPE FIRE P OCESSED BY Certificate of CONST. ZO E � Exemption; you should .become,subject to the Workers' n �f t /. � LU Compensation provisions of the Labor Code, you must forth- ,ADDRESS �°0 V with comply with.such provisions .or this permit, shall be TELE STATISTICAL CLASS�ON APT. ICONDO. Z deemed revoked: CONTRACTOR - NO. LICENSED CONTRACTORS DECLARATION y 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. OF NO. OF CHECK License Number Lic.'Class SIZE : STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ VALUATION Contractor Date $ CiC� ADD ❑ poll- ALTER - ❑1 am exempt under Sec. ALTER B.BP.C. for this reason REPAIR ❑ $ - Date: USE OF EXISTING BLDG. DEMOL ❑ Signature - APPLICANT ,TEL.NO (PRINT), FINAL OWNER-BUILDER DECLARATION . -DATE I hereby affirm that I am exempt from the Contractor's License Law ffor"the following reasonion'(Sect7031.5,"Business'and ADDRESS FINAL Q Pr fessions Code): PRESENT - ByBUILD NG 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 forsale{Section LOCALITY 7044, Business and Professions Coder) MOVING TEL. _ ► i .f TTL—,tr ❑ I, as owner of the property, am exclusively contracting , CONTRACTOR NO. -' with licensed contractors-to construct the project (Sec- It':H� r € ADDRESS tion.7044, Business and Professions Code.) }'` REQUIRED NOTAL SETBACK FROM "EXIST. S..¢ h CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT _ 4.j the performance of.the-work foe Which this.permit is"issued 'P.L.. (Sec. 3097, Civ.,C..): SIDE. ` PA.—.. _ • - -?i t{SI. I I,fly I 1 $ Fee - i Lender's Name LDMA Ref. # .. G P C.Fee Permit 3 Lender's Address k� ` oI.certify that I have read this application and state that the .. Issuance Fee " LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 8 ordinances and State laws relating to building construction, Total Fee ° LDMA-Per m. # a and hereby authorize representatives of this'County:to enter u on�theab ;;enti�onedoperty for inspection pSEE REVERSE FOR EXPLANATORY LANGUAGE gent -- -Date COUNTY OF LOS ANGELES BUILDING AND SAFETY V1/ORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL"IN � BUILDING DRESS I hereby affirm that I have a certificate of consent to self insure, 44-9 B N ADDRES �" �� or a certificate of Workers' Compensation Insurance,or a certified G✓( fr1 10 7Scopy thereof(Sec.3800,Lab.C.) t' fns ZI / r// LOCALITY 17 �1� C �-/ / O " V - Policy No.. Company SIZE Ot LOT NO.OF B DGS.NOW ON LOT - ❑ Certifiedcopy is hereby furnished. NEAREST CROSS Sq. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE. MAP NO. department. Date Applicant ASS S ORMA�P,�BOOK i PAGE PARCEL fGc 1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O)NNER / j, ��F � COMPENSATION INSURANCE ( ! ( �I (Qil1 WITHIN 1000 FT OF SCHOOL? YES NO This section need not be completed if the permit is for one hundred A RESS _ ( P P >> *70 DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) / ,V ' Y ZIP / I certify that in the performance of the work for which this permit CIT0 9 Cd C/ 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 CLA SIF CATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO, P L LICENSED CONTRACTORS DECLARATION SIDE _ 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 El BK PG License Number Lic.Class DESCRI TON OF ORK ADD ell VALUATION O Contractor Date ALTER El $ // ` U f 0 El am exempt under Sec. ,f REPAIR 11 $ 0 BAP. C.for this reason e �I"e � �EMOL ❑ LDMA P/C# W . Date: LI�E OF ISING BLDG. ,URM ❑ CL Signature APPLICANT(PRINT) TEL NO. LDMA Perm# ''}`�` Z ❑ I, as owner of the property, or my employees with wages as Z A(_c ,v their sole compensation, will do the work and the structure is ADDRESS 0 '_�. FINAL DATE s� ��' C;'- ot intended or offered for sale (Section 7044, Business and - 330 1 f_I Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL `6eJ I, as owner of the property, am exclusive) contracting Wlttl OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q I Y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, s Business and Professions Code.) YES ElNo ElACCT o v WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING "-1" - -t .. OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _3 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SOAQMD)SEE PERMITTING CHECKLIST FOR 104._:I r _ GUIDELINES. q r, �' ,.: , I herebyaffirm that there is a construction lending age nc for i I Et 'S 9Y YES❑ NO❑ N the performance of the work for which this permit is issued(Sec. (_#� � '1-..a.o...yh rn 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 152 - 80 3097,CIV.C.) - CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, r• TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS - CHECK i=' y Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMITFROMTHE SCAOMD. 'f;=i a'30 CL Address CHANCE ,3 (t O OWNER OR AGENT 0 1 certify that I have read this application and state under penalty o of perjury that the above information is correct.I agree to comply P.C.FEE /�� PERMIT FEE N with all county ordinances and State laws relating to building �.d'" �/' �� f?js_I-I LIf _9j' 8 f y`_; m construction, and hereby authorize representatives of this County ISSUANCE FEE / ii ,:I i cto en r upon the above-mentioned property f r inspection purposes. (f! III 1 (=t!3 31 A y ' m idl,c ! Lt s ,�� V J-?� INVESTIGATION FEE TOTAL FEED d J� ergo, a of Applicant or Agent SEE REVERSE'FOR EXPLANATORY LANGUAGE DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J:;FOX, CHIEF ENGINEER FOR APPLICANT TO PILL IN FOR OFFICE. USE ONLY 74 ADDRESS LAS DISTRICT NO., PLAN CK. NO. PERMIT NO. BUILDING ADDRESS V. @ LdrJJ TUN ' LOCALITY NEAREST '($�����^^ ,�{p/1.+p, RECEIVED BY DATE OF APPL. DATE i5SL1ED CROSS ST. �R M-6 d I � BUILDING o� _ , -� ADDRESS OWNER. . . t�',o�� ' itAN �PIRDWc- C ar MAIL LOCALITY ' ADDRESS - NEAREST ,•w^-����_ TEL. - CROSS ST. /Vf/I'/1 CITY - NO. FIRE ( PNO. OSF I TYPE ( GROUP ARCHITECT OR TEL.. - - ZONE ENGINEER NO. BLDG. ORD. NO. • - SETBACK LINE ' ADDRESS APPROVED - to NO. C c BY _ DATE CONTRACTOR ACk)ff.. W�40,S,I�N CV NO. IF gUSE - APPROVED ZONE BY DATE ' ADDRESS 13`�� r� -NMOW I L:+I+{VlowTj, HOUSE NUMBERING LEGAL LOT NO..: _ MAP NUMBER FIELD CHECK BY DESCRIPTION I , 9 BLOCK _ TRACT ' - NO. ASSIGNED BY DATE NO. OF SLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT USE OF - I NO. OF EXISTING BLDG, FAMILIES ' DESCRIPTION OF WORK _ NEW I I ALTERATION I I ADDITION O REPAIR I I�DEMOLITIONI.. _ I I - A SQ. FT'. NO. OF O SIZE ROOMS STORIES. .Z EXT. WALL ROOF r COVERING I COVERING USE,OF STRUCTURE tt APPROVALS INSPECTOR'S SIGNATURE DATE 1 HERESY ACKNOWLEDGE THAT 1 HAVE READ-THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN 19 - FORMS, MATERIALS CORRECT. . ' ' 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME:.FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS, - LAWS REGULATING .BUILDIN�CONSTRUCTION FURNACE: LOCATION, SIGNATURE OF (jJ� GAS VENT, DUCTS PERMITTEE -' `-Y� LATH, INT. ADDRESS LATH, EXT. AUTHORIZED AGT. , . .... , PLASTER, INT. 7GA6maA, DBss 10780 $ �� P. C. $ FEE PLASTER, EXT. VALUATION FEE $ '���� FINAL � I 17 �'�� _ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS COMMERCIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1308280041 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST NEW 1 BUILDING ADDRESS: 1 ITR: 6561 - LTi 681 SQ. FT 'STORIES TYPE OCCUP GROUPI 9514 LAS TUNAS DR jSTRUCTURE: 25 1 V-B B I TEMP CA 917602104 (ASSESSOR INFORMATION NUMBER: NEAREST 'CROSS STREET: CLOVERLY 18587-012-016 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI (TENANT: (EXIST BLDG USE: COMME USE ZONE: C-1 JISSUED ON: PROCESSED BY: (EXIST OCC GRP: B 101/08/14 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFI DA7E FI AL BY: CODE: 1 ITSOU SU CHIN HUANG (626) 451-0789- 20,000 19508 LAS TUNAS DRIVE (TEMPLE CITY CA 91780 FEES PAID D SC PT IW OF WORK - (FRONT FACADE IMPROVEMENT 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( 1APPLICANT: TEL. NO: I I IFAN, DAPHNE (626) 928-7746- ID1 PLANCHECK W/O EN-HC 20000.00 VAL 326.90 1_ 12550 W. MAIN ST 211 IAA BLDG PERMIT ISSUANCE 27.80 1SPECIAL CONDITIONS: 1 IALHAMBRA CA 91801 iAB STATE GREEN BLDG FEE 20000.00 VAL 1.00 1 I 1AE STRONG MOTION OTHER 20000.00 VAL 4.20 1 1D2 PERMIT W/O EN-HC 20000.00 VAL 384.60 (CONTRACTOR: TEL. NO: TOTAL FEES 744.50 JAPPROVALS DATE INSPECTOR SIGNATURE IPETRA CONSTRUCTION MANAGEMENT INC. ('626) 233-8148- 1 12550 W. MAIN STREET STE 211 LIC. NO 1 (LOCATION AND SETBACKS ALHAMBRA CA 91801 761300 * 1 SOILS ENGINEER APPROVAL 1 I � -_ I I I 1ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I LIC. NO: ISLAIi/UNDER FLOOR 1 I 1RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I 1UNDFRFLOOR INSULATION 1 3 00; _ (FLOOR SHEATHING ( 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I 0 NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHE!-:K PANELS I I 1 (AIR QUALITY: 1000 FEET MATERIALS NO NO NO i FRAMs, INSPECTION FIRE SPRINKLER HANGERS I ( 1 I (INSULATION/WEATHER STRIPI I I (INTERIOR LATH/DRYWALL I EXT RTOR LATH I 1 I- .- I 1 RATED FLOOR/CEIL ASSEM. IRATED WALL ASSEMBLIES IRATED SHAFTS/OPENINGS I 1 IT-BAR-CEILINGS * ADDITIONAL DATA ON FILE I _ ILOT-DRAINAGE (REPORT ID: DPR261 ROUTE TO: BS0508 1 1 1