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HomeMy Public PortalAbout9520 LAS TUNAS DR_Building__ 76A63BA'CE *803 1/7.1 - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL , ._ BUILDING AND SAFETY DIVISION BUILDING 5�� ADDRESS /J COLEMAN W. JENKINS, SUPT-OF SUILOING LOCALITY FOR APPLICANT TO FILL IN" NEAREST Print or type only) CROSS ST. _ .. DIST)( NQ,„ G �P TypCONST: P CESSE - BUJLDING �y � S C~J'1 CSJ4 G ADDRESS �-v 2.L` STATISTICAL CLASSIFICATION SEWER MAP LOT NO. ArBLOCK. 0�7.�7 .CLASS NO,=2w_..4—BWELL.UNITS BK TRACT - USE ZONEMAP - NO.OF BLDGS. NO. SIZE OF..LOT NOW ON LOT SPECIAL USE OF - CONDITIONS EXISTING BLDG. - TEL. OWNER NO. BLDG.SETBACK FROM ADDRESS - FRONT PROP.LI NE OF - --- -- ---(STREET) . TYPE OF EXISTING 'SETBACK HIGHWAY. + YARD = TOTAC CITY - HIGHWAY WIDTH FROM C.L. ARCHITECT OR -/ TEL. + _ ENGINEER NO. ,r- BLDG.SETBACK FROM ADDRESS ®•/ — SIDE PROP. LINE OF - - (STREET) TEL. TYPE OF EXISTING 'SETBACK HIGHWAY + YARD = u TOTAL Cl- HIGHWAY WIDTH FROM C.L. O CONTRACTOR NO. V LIC. ADDRESSCJ, ,C/ NO• + - O - -- ' -- ..__ LIC. CITY s ` CLASS CORNER CUTOFF YES ❑ NO ❑ W CONSTRIJCTlOf4LENDER N NAME AND BRANCH cL SEE REVERSE SIDE FOR SPECIAL AP R'OVALS M ADDRESS �, SQ. FT. NO. OF NO. OF - SIZE STORIES FAMILIES NEW USE OFADD STRUCTURE 450ir r .. ALTER ❑ ❑ �- , SIGNATURE OF REPAIR APPLICANT DEMOL ❑ - �; - �"�j - «.� VALUATION S ^ APPROVALS DATE INSPECTOR!S'SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEES FEES Zj2 FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS' _ 'AND STATETHAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL,ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED -- HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF 'CALIFORNIA IN RELATING TO - - -- - --- WORKMEN'S COMPE NSATIO NSUR E, 1; OJ ,y LATH, EXT, SIGNATURE OF HOUSE NUMBER COR-' PERMITTEE - RECT AND POSTED ADDRESS •^C�7 FINAL JOHN F. LEWIS, PRINCI A STR CK. •RAL ENGINEER PLAN CHECK VALIDATION CK. M.o. CASH s PERMIT VALIDA N M.O. CASH APR27 I D •- OB-3`e-40 25M APPLICATION FOR PERMIT :::DEPARTMENT OF BUILDING AND SAFETY �� � a COUNTY OF LOS ANGELES - j WM. J. FOX, CHIEF ENGINEER NO. OF5�� BLDG. ORD. N0. DISTRICT NO. PLAN CK. NO. PERMIT NO.g PLANS '!! SETBACK LINE (� lam• / FIRE APPROVED cJ cJy ZONE BY - DATE' r RECEIVED BY DATE OFAPPL. DATES ISSUED USE .APPROVED �t�.n �� //� p9`_�„����4_P�.�c��,•�q ZONE%_ BY DATE APPLICANT FILL IN HEAVIL Y OUTLINED PORTION ONLY _ BUILDING ast �ZOs. Tunas Dr", 0 NAME C• Deuel ADDRESS 2116. E W _Z ADDRESS 257 'S; Spring St.. , '' LOCALITY Temple 6ity, - F- U` NEAREST U w CITY Foos Angeles CROSS ST. (.J✓�•tA�J3�i���ef.��-�, wQQ – T��f - a LICENSE NO. 1005'ATETN ELKA Z7l�t- pj NAMLMearket BAsket 'Company - ZMAIL 0 NAMEElebtrical Produbts Corp• 03 ADDRESS 2116 -E. Los Tunas Dr. U ADDRESS 1128 VeniceBlvd• CITY Temple City -HTo' C I HEREBY ACKNOWLEDGE THAT 1 HAVE READ- THIS ZCITY Los An eles U C Zr� AND AND STATE THAT THE ABOVE IS'CORRECT LICENSE N0.125H8 NO PR O3 11 ND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ,y/, /n AND STATE LAWS REGULATING BUILDING CONSTRUCTION. - ZO LOT. NO. 'V •/6 !/E OF LOT"0X120 SIGNATU OWNERE OF Q1- - NO. OF BLDGS. 1. - AUTHORIZED AGT. -- 0. BLOCK NOW ON LOT 1 J m TRACT `s,�'l CORRECTIONS D� USE OF BLDGS. Public Market: !f 1 C� ,. -� )?A C.td'7 z4— � J Y NOW ON LOT DESCRIPTION OF WORK USE OF BUILDING Public Market _ Moving an existing roof -si n from Alhambra to 2116_ East Los Tunas Dr. Tem le Cit a NEW TYP n- I GRO - _ NO. OF I NO., OF�pp ALTERATION -X ROOMS FAMILIES` ADDITION SIZE REPAIR STORIES - MOVING -I .WALL COVERING - - DEMOLISH I aOOF COVERING $ P. C..P FINAL APPROVAL , 100.00 FEE ,/ i, e VALUATION FEE DATE // i INSPECTOR'S. 4' -Is ARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING SWM.S.J. FOX, CHIEF ENGINEER PLANS BLDG. FIRE (DISTRICT NO. PLAN CHK. FEE PER IT No. FILED ,SETS I ZONE C3^ ZONE �'�"'^- R€�EIPPT O. a� / TYPE OF /1 N/(�i]�� / /ice• BLDG. 1 II /, IV �� X GROUP }�`� � T BLDG. SET —' gDA�T/E F/APDL. RE//JC�/,'E/(SIV+ED Y D��T ISSUE .,ORD. NO."— d'� 9/� I CED ✓ �� ,�' APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY / _ BUILDINGI� / T O a NAME —_-� ADDRESS !/�� 6� CI,S 6/��`j 1- -I ADDRESS ESS �_' LOCALITY If NEARE U W CITY —_ CROSS ST. E STATE ►d, Ala R LICENSE NO.� _ Tet. No. � _NAME �// /� /,�✓ MAIL p NAME/ ,, 1J ���� do 3 ADDRESS Q ADDRESS /� /�� CITYyI,/1�,//`G/�.I(01— r/ jl TEL NO�/f;'J g0(Yj Z CITY L� 4/ // _ _ Ja /r A �V A/ �J .a �/ / �9 LOT SIZE OF LOT /�/{ O STATE R NO. OF BLDGS. LICENSE NO. TEL. No. m N J W BLOCK NOW ON LOT _ C r USE OF BLDG. CLA S'OF WORK TRACT J �� NOW ON LOT DESCRIPTION OF WORK NEW _ ADDITION II .DEMOLISH ALTERATION �!� REPAIR I MOVING USE: OF �'"• �j/'�, _ IND. OF ' BLDG. f� /yEf.?J ROOMS BLDG. �M I STORIES FA OF LI di FAMILIES CORREC ONS SPECIFICATIONS FOUNDATION MATERIAL I EXTERIOR PIERS THICKNESS—TOP THICKNESS—BOTT. I ..1 ` DEPTH IN GROUN —r _— Z SUP/P CTURE --- D SIZE SPACING SPAN R. W. PLATES ( ) i N - ---- (,i GIRDERS JOISTS—FLOOR5 JOISTS_CEILING7/�� BEARING WALLS PARTITIONS _ROOF RAFTERS FINAL. APPROVAL SILL BOLTS COVERING 3 / DATE� / p � I INSPECTQR'9 NAME WALL CrY I ROOF I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH &LL COUNTY ORDINANCES P.C. FEE S —'N'D STATE S G hTINRUILDING MNSTRUCTION. R SIGN__—._ �' � _ ---- VALUATION a FEE S � O�"JNER OR AUTHORIZ29 AGENT 138-3 8-313 d i DEPARTMENT OF BUILDING APPLICATION.FOR PERMIT COUNTY OF LOS ANGELES BUILDING PLANS BLDG. /> 7/� FIRE DISTRICTNO. PLAN CHK. FEE PERMIT No. FILED '/0 rl ZONE Cr ZONER�E, P � �..a•+-• TYPE OF . 7 BLDG. 1 11 111 IV V X GROUP BLDG. SETBACK LINE / DATE OF APPPL, RECEIVED //HY DATEISSLIEr/ }' ORD. NO. Z/a// APPLICANT FILL INNHEAe VIYTLINED'q�/"�RTIO�N ONLY BUILDING(//O ADDRESS ¢�a NAME r_... 1CL.P1_17 �t.8•v°tl� / v � � . gI Z ADDRESS LOCALITY Sa J CITY CROSS ST. a W STATE QI LICENSE.NO. TEL. NO. x III MAIL 0 O •' NAME VI/ 1 /�} / Z ADDRESS. _7j /',�/�/Q'!,� �UTS e y�"`v"� O CITY /� C��C..sI TEL NO.GGt'Gi (a1+ / ADDRESS 0 CITY��� J�' _ LOT (�YlJ ��% SIZE OF LOT/�/\ /�V U STATE NO. w TELT..No. U U NO. OF BLDGS. CLASS OF WOR Y• jWW BLOCK NOW ON LOT JV�'►6��g O /S/ / USE OF BLDG. B TRACT le (D NOW ON LOT ADDITION DEMOLISH DESCRIPTION OF WORK ALTERATIONI—I REPAIR J-1 MOVING • USE OF ..¢.. BLDG : ROOMS SIZE Q OF ; " p� {�.STORIER / NO. OF BLDG (.p X O IV / FAMILIES SPECIFICATIONS FOUNDATION CORRECTIONS/ ` EXTERIOR PIERS ( Ifs ///-• // ) MATERIAL 4 I K� vttl. THICKNESS—TOP I ° THICKNESS—.BOTTOM _i I DEPTH IN GROUND d T f SUPERSTRUCTURE SIZE SPACING SPAN R. W. PLATES (SILL) GIRDERS _ JOISTS—FLOOR JOISTS—CEILING I J Q BEARING WALLS I _Z PARTITIONS ROOF RAFTERS oG2 /'1-L2 o'119t I Q SILL BOLTS COVERING n , WALL�f,Q�2w..9.. I ROOF 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATTIIN,�.G BUILDING CONSTRUCTION. SIGN OWNER OR AUTHORIZED AGENT /T a o FINAL APPROVAL A P.C.FEE/$J ]1 (�(/ VALUATION $ � O QIZN FEE L ,° v DATE ) -dpilPECTOR'S NAME DB-2 6-86 91 v DEPARTMENT OF BUILDING � APPLICATION FOR PERMIT CQVNTY OF LOS NGELES BUILDING �..i'7'7 i?LAN346_1BLDG. FIRE DISTRICT NO. PLAN CHK. F P NO. TYPE FILEOF > I ZONE ZONE n RECEI BLDG. 1 11 III iv 1 X GROUP � EcJS fJti BLDG. SETBACK LINE DATE O�FlyyAPPL. R7 CEIVE` ®Y DE% }AATTIBSU.Ep ORD. NO. P u APPLICANT FILL IN IIEAV. OUTLINED PORTION X " a: a ��i1�,, Y�f, n D a NAME ADJ7RE3EYG L, F� B f W Z ADDRESS rG LOCALITY F aNEAREST a • f 1 U W CITY CROSS ST.It ! STATE -� - - - - - 6 I LICENSE NO. ria ,I� y/_L. NO. NAME _'�''��P w MAIL UNAME P I/l�C f Sa"=k��'1� ,. Z ADDRESS fib ' x� f N AA�� < ADDRESS J 7L/ O CITY TEL NO."4 Z CITY 6. (pj STATE ° p/� Q LOT$G rr4 SI OF LOT LIGF_N NO•CLA`S�S OF W� NO. l7 U NO. OF BLDG)Q��,,,p lJ B 0 BLOCK NOW ON LOT �`1 Q''�� A W D !�� USE OF BLDG. TRACT �1 NOW ON L T NEW �I ADDITION I_ DEMOLISH DESCRIPTION OF WORK • ALTERATION REPAIR MOVING \ _ ` USE F �• Y� w �F� BLDG. ! 8 INO. ROOMfi SIZE OF // S S NO. OF BLDG ID D x $� I FAMILIES i SPECIFICATIONS l FOUNDATION t` CORRE€,`TIONS • EXTERIOR�j PIERS J',o r 1 (/nt-- MATERIAL / fa s F /t II�tfi ` 7/ 1 Li/(f!AA THICKNESS—TOP -��^ I �..'� VI-11 le -1 THICKNESS_BOTTOM c, Jr'/L•:A' I U �I c1 Yr-�"�' �'� I DEPTH IN GROUND19 rFP�C.eP r-.. SUPERSTRUCTURE SIZE SPACING SPAN I .,,^ Ar l' R. W. PLATES (SILL) GIRDERS _I del `�9d 4r/ rA '�-P� G � ✓w-�'7'•D .�"��~L�� v7 / JOISTS—FLOOR /'A I GI' "���• 2�A., �. ,,1�`�'1n,1,•�._�<d ,tpc��� �.�pl� J JOISTS—CEILING BEARING WALLS �pL•�l.s. _ _ <.�'kr,-. ,QN '�a� I •/1 f a� '�B mc- CPARTPARTITIONS ITIONS y • .r^ ROOF RANTERS ash.N-1.�- � f ®% SILL BOLTS WALL (P-4,7Ay.ROOF 1 HEREBY ACKNOWLEDGE"'THAT I HAVE READ THIS fy '—'— APPLICATION AND STATE THAT THE ABOVE IS CORRECT (lt 11 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES F Ir AND STATE AWS REGULATINgh I DING ONS T�UCN. SIGN . ' I OWNER OR AUTHORIZED ALIENT _ FINAL APPROVAL P.C.FEE $ (J ®®®� FEE ATE oa.a e.as I INSPECTOR'S NAME VALUATION � D � DEPARTMENT OF BUILDING AND SAFETY -f APPLICATION FOR:PERMIT COUNTY OF LOS ANGELES F L 11194 ` WM. J. FOX, CHIEF ENGINEER ` 1 FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY J /�,t� 1l�a�( DISTRICT NO. PLAN CK.NO, PERMIT NO.BUILD �• ADDRESS -,if� 7 � j A K/°I't's +�"7R V� LOCALITY I le A J ✓ Cl C .1 RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST _ERCSS ST. q / /y ✓ I7 /J ADD EIS9 OWNER i�l�'I h-:(� �I6_ c3�.f'_ 14P, MAIL �t •� { LOCALITY ADDRESS �11// e�4-' C� `�1`"1" CITY 1`�N TEL.NO. 4TC2e6 9 9 CROSS STNEAREST. FIRE NO.OF TYPE GROUP ENGARCINEERITEC OR / t Q Na ZONE PLANS �,'•/ // r� (a, .J• BLDG. F/ z— f %VD.NO. • ADDRESS SETBACK LINE APPROVED TEL. BY DATE CONTRACTOR NO. USE APPROVED � ADDRESS s ZONE _ BY DATE LEGAL (p /� ::� /7 CORRECTIONS DESCRIPTION LOT NOJ/ - / BLOCK f/ I .J;""�••.lz. i'�-f. _ TRACT p 1 4,a.4 ` .«` ®!9)d �0-J SIZE OF LOT NOW ON LOTS / ti` USE OF //,,�� ��jj NO.OF NO.OF EXISTING BLDIgAR e-r I FAMILIES I ROOMS I DESCRIPTION OF WORK ;�pw = •NEW ALTERATION f ADDITION O A REPAIR MOVING DEMOLISH SQ.FT. NO.OFad�� j Z j SIZE "!� Ib ROOMS fps STORIES q�+�f >WALL ROOF I COVERING �d ��"',(� I COVERING UBE OF NEW BUILD.ING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. - FRAME: FIRE STOPS, y SIGNATURE OF��+ p• p� �9� [yup BRACING,BOLTS /filr.� ✓f' PERMITTEE ' ` ���w�`/ �L t W/i 1 S I �W;• LATH,INT.: AUTHORIZED AOT ��"- x.a`=a�•'>•' /// �`V x.1,61' � �""CA-t LATH,EXT.: DHS-3 512MSETS 7-47 P.C.S PLASTER,INT. +(�"��rvw.-* —_ FEE iJ 1 PLASTER,EXT. • >$ 4 0 , VALUATION FEE s FINAL DEPARTMENT OF BUILDING AND SAFETY arri.tcA rtuly -run rantni L COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. A11RE59 LOCALITY ��APJ��.� L,,:/`�� RECEIVED BY DATE OFAPPPLL.,y,/ DATEISSUED NEAREST CROSS ST. �s BUILDING OWNER L,.�J%/`/�� �`i�®i$'��' 3r ADDRESS MAIL m LOCALITY ADDRESS � �� NEAREST CITY NAL . CROSS ST. FIRE NO.OF TYPE r/ GROUP ARCHITECT OR ✓ TEL. ZONE ...... I PLANS �I P L ENGINEER- NO. �J BLDG. ORD.NO. ADDRESS SETBACK LINE a`,y APPROVED CONTRACTOR NO. BY DATE USE �j APPROVED ADDRESS t'VI �I 45L � � ZONEc- d BY DATE LEGAL / DESCRIPTION I LOT NO. / 10 I BLOCK CORRECTIONS ,/ TRACT • 4 -+� 6 / / 1 / NO.OF SLOGS. 6 SIZE OF LOT X/�f,) NOW ON.LOT ' USE OF - I NO.OF I NO.OF EXISTING BLDG. �!1 k FAMILIES ROOMS - ' DESCRIPTION OF WORK 0 NEW ALTERATION ADDITION r:.• O A fREPAIR MOVING DEMOLISH 0 Sq.FT. NO.OF SIZE ROOMS STORIES D WALL ROOF r COVERING - I COVERING f USE OF NEW BUILDING ' I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT_ FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATINGBUILDINGCONSTRUCTION. FRAME: FIRE STOPS, , _ SIGNATURE OF BRACING,BOLTS OWNER LATH,INT.: AUTHORIZED AGT. "Ed"A tv, LATH,EXT.: DSS-3 25M SETS t-a7 $� AL P C 111PLASTER. INT. FEE PLASTER, EXT. $ ®® VALUATION FEE FINAL Y�' p ! �✓"� ' + . W-RKERS' COMPENSATION DECLARATION ,,I hdre boraa irm tha catte of have a c srtCicate of consnt to at on ensuran elf APPLICATION FOR- BUILDING PERMIT or a.-ertified 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 El .'Certified copy is filed with the county building inspec-. [ADDRESS DRESS .� -g' �. tion department. ' Date�'� Z Applicant CITY .NT ZIP et'I ! V LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMP IOKAN RKER E.OP LOT NOW-ON LOT CROSS ST. COMPENSATION IASSESSORpr�� (This section need not be completed if the permit is for one CT BLOCK LOT NO. MAP BOOK O PAGE ©�� PARCEL hundred dollars($100)or less.) �- TEL OWNER NO. USE ZONE" MAP / I certify that in the performance of the work for which this SPECIAL - permit is issued, I shall not employ any person in'any,manner ��/ CONDITIONS O so as to become subject to the Workers'Compensation Laws. CITY ZIP _ U Date Applicant ARCHITECT OR TEL. 0 PP DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. Z ,NE F_ Exemption, you. should become subject to the•Workers' Q Compensation provisions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall be {/ / n� TEL �/Q STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked.' CONTRACTOR l� 1 C� NO. o/O z LICENSED CONTRACTORS ADDRESS LIC.. p� n CLASS NO. 69� DWELL. UNITS DECLARATION �2 �7 I hereby affirm that I am licensed under provisioris.of Chapter 9 o G, g-S -C J#O'9k NOLIC. SEWER MAP (commencing with.Section 7000)of Division 3 of the Business. CITY Zf CLASS t VALIDATION and Professions Code,and my license is in full force and effect BK. PG. SQ. FT. CNO. OF TNO. OF CHECK License Number Lic. Class_ SIZE �d o STORIES IFAMILIES ONE ❑ VALUATION -U Contractor Date Z DESCRIPTION OF WORK t' EW $ �rrJ1 O� DD ❑I 941 exe pt under Sec. ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF ' EXISTING BLDG. DEMO' ❑ APPLICANT TEL. Signature (PRINT) NO. FINAL ii OWNER-BUILDER DECLARATION DATE lCy� I hereby affirm that I am exempt from the Contractor's License ADDRESS FINAL Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT' BY ❑ 1, as owner of the property, or my employees with BUILD , c ADDRESS, wages as their solecompensation,will do the work and :1 -• - • =•r -_-- the structure isnot intended or offered for sale(Section LOCALITY 7044, Business and Professions Code,) MOVING, TEL. , 3 CONTRACTOR NO. . ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct.the project (Sec- ,, tion-7044, Business and Professions Code.) rInvestigation il.: µi.r} 1 5 TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH J k( "–I I hereby affirm.that there is a construction lending agency for ::y 'the performance of the work for which this permit.is issued _ (Sec. 3097, Civ. C.)., - Lender's Name. �(/t LDMA Ref. # Permit Fee r Lender's Address f/ 0 I certify that I have read this application and state that the Issuance Feel �� LDMA P/C# , 8 above information is correct. I agree to comply with all County ee O d ordinances and State laws relating to building construction, Total Fee / • (J LDMA Perm. # a and hereby authorize representatives of this County to enter upon t e abo4e-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE `SOVature of Applica or Agent Date WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self A P P L LCAT I O N FOR BUILDING. P E RM I T insure, ora certificate.of Worr kers' Compensation Insurance, �� , or a certified copy thereof (Sec. 3800, Lab. C..) � � COUNTY OF LOS ANGELES BUILDING AND SAFETY PVe licy No. Company S� �Ti11l�Q rtified co is hereb furnished. FOR APPLICANT TO FILL IN BUILDING' D py y ADDRESS Irtified copy is filed with they building inspec- BUILDING y ^ •'tion/d/ep2artment. ,. .. ADDRESS z".4 DateApplicant CITY f� ZIP LOCALITY rt ' CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST SIZE OF LOT NOW ON LOTy CROSS ST. J01 Y e/ COMPENSATION INSURANCE ASSESSOR (This section need not be completed"if tk6'permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) �yJ TEL "NIR. / - �" USE•,ZONE NO. 0 l V,"7 I certify that in the performance'of the:.work for.which this // ���))��,///�,� / permit is issued, I shall not employ any person in any manner ADDRESSZJ� /�u� {VCG / SPECIAL a- CONDITIONS so as to become subject to the.Workers':Compensation•Laws. .T O CITY. �� V1 / ti ZIP Date Applicant. ARCHITECT O TEL. / NOTICE TO APPLICANT:.If, after making this Certificate of ENGINEER ( �ECC� N DISTRICT GROUP TYPE FIRE PROCESSED BY Q J CONST. NE F- Exemption, you should .become. subject to the Workers' J O w Compensation provisions of the•Labor Code, you-.must forth- ADDRESS U �\\ �. with comply with such ,provisions or this permit shall be /� TEL. STATISTICAL CLQSSIF,ICATION APT. CONDO. N deemed revoked. CONTRACTOR yYll/W(X7�✓ ANO. Z LICENSED CONTRACTORS DECLARATION 'n LIC. CLASS NO. DWELL. UNITS I Ihereby.offirm that I am.licensed under provisions of Chapter 9 ADDRESS l�s7UNO'S,vQNO.�~ V. (F i / _ LIC. C ?CI SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITYr4/V 4,4.b7���L CLASS J/ and Professions Code,and my license is in full force and effect. BK. PG. VALIDATION -� SQ. FT. NO. OF NO. OF ' CHECK /r License.Number L/3�»3R tic: Class /- 9 SIZE STORIES FAMILIES ONE VALUATION Cant ractorE 1zL)e0� e&0Jf_Date �` � � DESCRIPTION OF WORK p¢� Q 2ov€i� NEW ❑ ElI am exempt under Sec: rj [_ "L�- Lj *6,7— 41 ADD El E y^ ALTER ❑ ► B.&P.C. for this reason Y������ CL' S �. 71 $ REPAIR ❑ D te: USE OF EXISTING BLDG. DEMOL T-1 9 APPLICANT TEL. Signatu FINAL R=BUILDER DECLARATION (PRINT), ayyjp�l6 .Np. 3v d/�` �p1• DATE 2 �" I hereby affirm that I am exempt from the Contractor's License ADDRESS L�S�L){'✓64S Q,� � ��0 Law for the following reason (Section 7031:5, Business and FIN f Professions Code): . PRESENT - B BUILDING T $ ❑ I, as owner of the property, or my:employees with ADDRESS } e s wages as their sole compensation,will do the work and �� LOCALITY �� the structure isnot intended or offered)for sale(Section , . y: � s 134.25 7044, Business and Professions Code MOVING TEL.- { � _ ❑' I, as owner of the property,,am exclusively contracting CONTRACTOR NO. 1 :; with licensed contractors,to construct.the Project Sec- TOTAL ---n � ^ tion 7044, Business and Professions Code.) ( ADDRESS O AL i•>= 4 o ,y�.,,�$ REQUIRED TOTAL SETBACK FROM EXISL x'�j�•t'�/ ff"°' 2 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY` PROP. LINE WIDTH: CHU,lt t:��t"ir-� I hereby affirm-that there is:a construction lending agency for FRONT -0 the performance'.of the work for4thich-this'permit is issued P.L. CHANGE � = (Sec. 3097, Civ. C.). 'SIDE. Lender's Name. JC�-Ct��� C/1�Iv'� m `1 LDMA Ref. # ' P.C. Fee$ - Permit Fee 2,3 Lender's Address. ;`/ *• 1 , AM'Oa 1: oI certify'that I have read this application.and state that'the Issuance Fee V LDMA P/C# above i tion is correct.'l agree to comply with all County Investigation Fee. 8 0 ance a Slate laws c Iating.to,building construction, Total Fee / ` Yk LDMA Perm # y and he y ut orize repr ntatives of this County to.enter up o ov enti'on prop rt'y for inspection urpose Q • _ JpZ 78 SEE REVERSE FOR EXPLANATORY LANGUAGE Si ture,of Applicant'LrAgent• " Date APPLICATION FOR BUILDING PERMIT M 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, B jNGG�tFSS�Q� TINA or a certificate of Workers' Compensation Insurance,or a certified 7 �C 4 �•t/� J copy thereof(Sec.r3800,gLab.C.) C .�f r� �y ZIP�/ �D LOCALITY Policy No.A7�l�7-p-.7 Company Q SIZE/AF T NO.OF BLDGS.NOW ON LOT Lid Certified copy is hereby furnished. �! /—� C/ �� J r F. /, NEAREST CROSS ST. ❑ Certified Copy is filed with the Count building inspection, TRACT BLOCK LOT NO. department. USE ZONE MAP NO. - Date /� Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EX TION FROM WORKERS' OWNER - �^ L NO. COMPEN ION INSURANCE W WITHIN 1000 FT.OF SCHOOL? YES NO (This section need.not be completed if the permit is for one hundred AD �S�_ � 'VTJ /�b r DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY { dollars ($100)or less.) TJ y CI ZIP I certify that in the performance of the work for which this permit '17Y is issued, 1 shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER EL O. !I �• become subject to the Workers'Compensation Laws. / C D�� h ws e 1j �pS��il�O STATISTICAL CLASSIFICATION APT CONDO Date Applicant Ac_ ESjS `' /� I IL 7I ++�]�N� 7a�f O CLASS NO. �. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of Z3 ry i 0,4,k Mlc, ``� 0 Y' CA / ` -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 23 comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL a LICENSED-CONTRACTORS DECLARATION SIDE ° J LIC.CLASS P L. '+ '+ °?fi I hereby affirm that-1 am licensed underprovisions of Chapter 9 /� SEWER MAP /V0 (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES - 1 ITEMS Professions Code,a my license is in full force and a fect. /! NEW ❑ BK PG �- License Number Lia Class DESCRIPTION OF WORK ADD VALUa7oN a-!� , TOTAL �0 e 700- Contractor bT— Date �I2 ALTER ❑ $` CHECK E0°700 ❑ I am exempt under.Sec. �.. REPAIR ❑ $ CHANGE °000 BAP.C.for this reason DEMOL ❑ LDMA P/C# �7pWDate: USE OF EXISTING BLDG. URM ❑ - rff-0001 10/�{ 5/lC0-Signature PeLI A�N1T PRI ) L NO. LDMA Perm# (g 1 AMID-0522 ❑ I, as owrier of the property, or my employees with wages as �`� `' � ZN( �� Z T their sole compensation, will do the work and the structure is ESS 0 3303 197 }O L FINAL DATE not intended or offered for sale (Section 7044, Business and 3 N� Q� �i � / Q 1 PfOfeSSIOr1S Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL f ! `�' J , ❑ 1, as owner of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE �? property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL JBY+I Ji�►� ACCT R licensed contractors to construct the project (Section 7044, °JL '\ ) - YES❑ NO❑ 33 3.5 \� Business and Professions Code. 4 503 J_g, WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OOASTANT REQUIRE A AIR QUALITY MANAGEMENT T CONSTRUCTION DISTRICT(SCAQMDRSEQEDPERMITTNG O ECKLISTOFOR ' 2 ITEMS MIFICATION FM THE SUTH CONSTRUCTION LENDING AGENCY GUIDELINES. I hereby affirm that there is a construction lending agency for YES El No E3 TOTAL 556 - 34 N the performance of the work for.whlch this permit IS Issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING //'' « '�4 ° 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHECK 556.34 '� TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS CHANGE . 0 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. IL Lender's Address O OWNER OR AGENT - o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE �j J 7 0000-0001 11/22/95 with all county ordinances and State laws relating to building a�<S / }4�� i Aii11�?t CO construction, and hereby authorize representatives of this County j/�/' ISSUANCE FEE D �- ro to enter upon th ove-mentioned erty.for inspection purposes. j/ INVESTIGATION FEE TOTAL FEE Sqn mer Ap nt Dale `J SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION' FOR APPLICANT TO FILL IN BUILDING D RESS I hereby affirm that I have a certificate of consent to self insure, BU LDING ADDRESS /� or a certificate of Workers' Compensation Insurance,or a certified % D +"�`�'� r Copy there V4 �fJS t _C), �/V�, CITY �� ZIP LOCALITY Policy�N//��aa// �f �•yL Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS.ST., `D Certified Copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date/1�-�Applicant ASSESSOR MAP BOOK PAGE PARCEL o SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' - OWNER TEL NO. ��� COMPENSATION INSURANCE \� — WITHIN 1000 FT OF SCHOOL? .YES NO (This section need not be completed if the permit is for one hundred ADDRESS p ,v - r-- L�� �+ `�• DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit• �,� .CI O!//" ,Ld( /✓5 is issued, I shall not employ any person in manner so as to become subject to the Workers'Com e Ion Laws. ARCHITECT OR EN NEER TEL NO. _ 1 P STATISTICAL CL S�ICATION APT CONDO Date Applicant ADDRESS CLASS r DWELL UNITS NOTICE TO APPLICANT O after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, 'you should become subjectto 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.N . P L LICENSED CONTRACTORS DECLARATION �S• �`/� ¢�" SIDE CITY LIC.C ASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 C SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES N0.OF FAMILIES ���... Professions Code,a d fmy lice a is in full force and effect. i NEW ,rte BK PG a License Number 1 t � Lic.Class ` l DESCRIPTION OF WORK ADD. ❑\ VALUATION ) , O Contractor — Date /-2- � tP ALTER ❑ $14 ElI am exempt under Sec. REPAIR ❑ $ /Q �^ DEMOL ❑ U BAP.C.for this reason `. r(/\ l ,f LDMA P/C# 3 UJ Dat ' USE OF STING BLDG. URM ❑ �(`�( � Signature APPLICANT�PhINT) T L N LDMA Perm# ACCT. Z ❑ I, as owner of the property, or my employees with wages as f�0 ZO 3303 50.50 their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and4--lorI S • s FINAL DATE Q 1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL t Z.—l(/.-� AI f.T JL ❑ I, as owner of theproperty, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q ACCT. 1,i 1 Of} Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY. > 3303 104 a 7rJ licensed contractors to construct the project (Section 7044, yes❑ No Business and Professions Code.) WILL THE INTENDS USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - 2. -ITEMS OCCUPANT REQUIRE A ERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. TOTAL 1.59 m 40 I hereby affirm that there is a construction lending agency for YES❑ NO a the performance of the work for which this Mit is issued(Sec. CHECK 159.40 � IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ({j/� j' TITLE 2,CHAPTE 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS C1-fAhiGE- .00 d Lender's Name MATERIALS REP RTING AND R gBTAINING A P�T FROM THE SCAQMD. o Lender's Address OWNER OR AGENT If t fr1f7�1 ft 1 C [Se o I certify that I have read this application and state under penalty 0000-0001 12/ 5/9.1 o P.C.FEE /"^^, 5 PERMIT FEE of perjury that the above information is correct.I agree to comply r L/ U (r>(! a with all county ordinances and State laws relating to building �:= 3605 1 FM 6 35 m construction,and herebauthorize representatives of this County ISSUANCE FEE to enter up%,I'tabove-- tion roperty f spection purposes. INVESTIGATION FEE TOTAL FEEm o.e ^ /DO• SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING agDR -�- I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �(' or a certificate of Workers' Compensation Insurance,or a certified A Y LQ (�/� P70 copy thereof (Sec.3800,Lab.C.) TY n ZIP / LOCALITY Policy No. Company _ SIZE OF L T /V'' NO.OF BL GS.NOW ON LOT ❑ Certified copy i8 hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county•building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date ° Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' °W � TEL NO. COMPENSATION INSURANCEAA WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROC'/'E/��s.�,71E/D BY dollars ($100)Or less.) CITY ZIP 7 ((�� /y�v y � . Ila 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 ARCHI ECT OR ENGINEER TEL NO. become Subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APTONDO Date Applicant ADDRESS - CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate Of EFRONT TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRACTOR - TEL NO. YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be:deemed revoked. ADDRESS LIC.NO.LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP- (commencing with Section 7000)of Division 3 of the Business and %Q.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. 13016 NEW ❑ BK PG , >- Professions ON OF WORK VALUATI N 0 CL License Number Lic.Class ADD ❑ 9 Contractor Date ALTER ❑ $ ❑ I am exempt under Sec. REPAIR El $ 0 BAP.C.for this reason DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ - - CL Signature APPLIQNZ.( RINT) TEL NO. LDMA Perm# - �•V' Z, I, as owner of the property, or my employees with wages as / / • ,,/_ `n 0 Vit:t-I =s their sole compensation, will d0 the work and the structure is R IO (..f)„ .Y� 1'/dAV�! loo FINAL DATE Q '. ,j •'�*__II I not intended or offered for sale (Section 7044, Business and p�� C/ - Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS ATERIAL i _� J , ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER HAN THE _ Y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Ety licensed contractors to construct the project (Section 7044, 1`•' Business and Professions Code.) ves 11 No❑ __ - p s WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1 '.�a f•1 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR IV - GUIDELINES. - Of� I hereby affirm that there is a construction lending agency for YES❑ No❑ 14 the performance Of the Work for which this permit IS ISSUed(Sec. IHAVE READTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMDPERMITTING j f_f I l.., s= ..^ �: '•`� -E• 3097,Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 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. _,a- o Lender's Address s i�'??y. -- O OWNER OR AGENT - o I 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.FEEPERMIT FEE N with all county ordinances and State laws relating to building �o^ O v° I ,:. zc 5 _ ,,• __. . < construction, and hereby authorize representatives of this County ISSUANCE FEECO T pon the above-me oned pr ert r inspection purposes. __ _ ,hi s ' -r. _may "C', ! �� INVESTIGATION FEE TOTAL FEE �e/1N, Sgnaw of Applicant o Agent Dale SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION msure hereboraafcertif cairm ne of WorkersrtCompeificate �sat on i�s��a��ef APPLICATION FOR.,B U I L D.I N G PERMIT ,. , . or a.certified copy thereof (Sec. 3800; a C.)�.` COUNTY OF LOS ANGELES BUILDING AND:SAFETY Policy No Compan �,tic�l. : . w Certified co is hereby furnishe -fP c.2 y2' FOR APPLICANT TO FILL'IN- BUILDING. ('9 /^ LIK" /� -( /� PY Y ADDRESS J_(N C�. !�L A/1 - .- PSL-•. ❑ Certified copy is filed with the county building inspec- BUILDING ± - „� ADDRESS tion department. L_ CITY' �C% C/'L ZIP• f O �/. LOCALITY Date,Applicant NO. OF BLDGS. CERTIFICATE OF-EXEMPTIO OM.WORKERS' SIZE OF.COT NOW ON LOT NEAREST CROSS ST.'' COMPENSATION IN RANCE' ASSESSOR ,,•1� {7 (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE u' Z PARCEL' �J hundred dollars ($100)'or less.) OWNER S TEL. USE ZONE MAP Z� NO. NO. . ,I certify that in the performance of the work for which this ( SPECIAL: permit is issued, I shall not employ any person in any manner ADDRESS d CONDITIONS so,as to become subject to the Workers'Compensation Laws: 0 CITY ZIP Date Applicant ARCHITECT OR TEL. ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after"making this'Certificate of CONST. ZO E Q Exemption, you should become 'subject to the Workers' w Compensation provisions of the Labor.Code, you must forth- ADDRESS 3 with comply with such provisions or this permit shall be 1 / TEL. (7 STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR c 1q �i NO. u .t Z LICENSED CONTRACTORS DECLARATION LIC. 'xA p CLASS'NO. � � DWELL. UNITS I hereby affirm that I am licensed under'provisions of Chapter 9 _ ADDRESS L'• �/ (GN,�� NO. �vl �O l LIC. SEWER MAP .(commencing with Section'7000)of Division 3 of the Business CITY �•( L j CLASS �j and Professions Code,and my license'is i -full force and effect. BK, PG... VALIDATION (�- SQ.'FT �y•�-� NO: OF NO. OF CHECK License Number ` ` Lic. Class SIZE O V STORIES FAMILIES ONE VALUATION 60 Contractor Date 1 �� DESCRIPTION•OF WORK NEW ❑ Z y / ADD ❑ ❑I am exe under Sec. _! �r�q �LC 23 -ALTER Q. •••^-=' - _ _ . - AfPT B.B�P.C.'for this reason 62 e, REPAIR E 'AUT. Date:. USE OF _ EXISTING BLDG. DEMOL^❑ 4ii'l 1'�II `Pira '�t Signature APPLICANT . TEL. FINAL t OWNER-BUILDER.DECLARATION' (PRINT). NO. ' DATE I hereby affirm that I am exempt from"the Contractor's License A t•T°a Law foe the following reason (Section'7031.5;'Business and ADDRESS FINAL (�. i Professions Code):. PRESENT By. `r`3 +' ITEMS 1� a 0:,, BUILDING, 1 1�!Ir,. . ❑ 1, as owner of the property or-my'employees with ADDRESS 2 J wages as their sole compensation;will do the work and (' the structure is not intended or offered for sale(Section LOCALITY Iti (}ITAL. .�, e u 7044, Business and Professions Code.) MOVING TEL. , '237. �� ❑ I, as owner of the property,,am exclusively contracting CONTRACTOR NO. i.:1��1}{E[(,�Y 4L °��, with licensed contractors to construct the.project (Sec- ADDRESS CHANGE ■lIL) tion 7044, Business and Professions Code.) F 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 601011-0011 f1{��9,i the performance-of the-work for.which this permit is issued . P.L. (Sec. 3097; Civ: C.). SIDE., °11 M .< P.L. ' _ AM _ _ { Lender's Name LDMA Ref. #- ; P.`C,Fee$ O• c! Permit Fee Lender's Address• o' I certify that I have read this application and state that the Issuance Fee LDMA P/C# ,. above information is correct. I agree to 0 comply with'alI County Investigation Fee ordinances and State, laws relating to building-construction, Total Fee LDMA Perm. #` Q and hereby authorize representatives of this County to enter upon eabove-mentioned property for inspection purposes. r(-fZr a - � SEE REVERSE FOR EXPLANATORY LANGUAGE � w tnatu're-7—Ap—plicant or A t- Date' _ . ' • •r - P' COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDINc,.R Ff BUILDING ADDRESS ' �•,` • C '�-"" ' I hereby affirm that I have a certificate of consent to self insure, �0 L , ,A a p , or a certificate of Workers' Compensation Insurance,or a certified �`'� A& CITY ZIP �C f copy thereof(Sec.3800,Lab.C.) .7(s 00V LOCALITY Policy No. Company SIZE OF LOT / NO.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., 6 S� I • /17 7, 6 USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE 'PARCEL Date Applicant SPECIAL CONDITIONS ' CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE CV0 S' —O XVITHIN 1000 FT.OF SCHOOL? YES NO ADDRESS (This section need not be completed if the permit is for one hundred -1 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 G�qV O /r, 0 6 �(/ is issued, I shall not employ any person in any manner so as to ARC ITECT O ENGINEER TEL NO. become subject to the Workers'Com ens ion Laws. _ STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRG ESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this rtificate of 2- C. S• REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CORA TOR TEL _ r� SET BACK YARD HWY PROP LINE - WIDTH Compensation provisions of the Labor Code, you must forthwith UY FRONT comply with such provisions or this permit shall be deemed revoked: A RESS [ LIC NO. PL LICENSED CONTRACTORS DECLARATION �` SIDE CI Y_.r�+ p LIC.Ct na P L I hereby affirm that I am licensed 'underprovisions-of Chapter 9 ` C(1' `� �� ��' SEWER MAP (commencing with Section 7000)of Division 3 of the Business and S0.FT,SAO NO.OF STORIES NO.OF FAMILIES Professions Code,and my+ic a is in full force and,effect. ;q NEW ❑ BK PG y >• qy a � f DESCRIPTION OF WORK ADD ❑ VALUATION � - -- Q License Number Lic.Class qT ir Contractor Date Z° / ALTER U El am exempt under Sec. REPAIR ,❑ p_�D� 3M31il4ats O TTEMS I-_ BAP.C.for this reason DEMOL •❑ LDMA P/C# I ••, + ' W Date: USE OF EXISTING BLDG. • URM ,❑ _ JIG. I I.�- 1 ••°-�6 �'`- o- Signature APPLICANT(PRINT) � TEL NO. LDMA Perm# � =j4"7- Z TiV❑ I, as owner 0f the property, or my employees with wages as C Z. O �� �' their sole compensation, will do the work and the structure is ADDR SS not intended or offered for sale (Section 7044, Business and 2_ZZ- FINALDATEQ .. Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL j ,lV + } I ❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q +:-'E�o `I-fl�+ 6/11/93 Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > .•t AMER, licensed contractors to construct the project (Section 7044, YES❑ NO$ %� - i � Business and Professions Code.) WILL THE INTENDED USE MI THE BUIDUNG BY THE APPLICANT OR FUTURE 2 ITEMS�L M - BU-11- -OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ,. i i�f IJ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. TOTAL IAl-T 1 hereby affirm that there is a construction lending agency for YES ElN0� t L a the performance of the work for which this permit is issued(Sec. ' I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECK '1-fn z! - i 1 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. N - TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS ( i�I I 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. -g}',`ANG(E _ IL Lender's Address OWNER OR AGENT O o I certify that I have read this application and state under penalty { O P.C.FEE _ PERMIT FEE IJf3l-�If II 1 �-}f � u� of perjury that the above information is correct.I agree to comply /L / ! /D• vo N with all county ordinances and State laws relating to building 7 (Q(�J 7 1975 1 AM a5 construction, and hereby authorize representatives of this County j �/ �/ ISSUANCE FEE �� 7 ,� V ID toe upon the above-mentioned property for inspection purposes. < INVESTIGATION FEE TOTAL FEE if ado � Sig-t—of 'plicani or Agpnf Date SEE REVERSE FOR EXPLANATORY LANGUAGE 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 1110100003 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST NEW I BUILDING ADDRESS: 1 ITR: 6561 LT: 677 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUPI 9520 LAS TUNAS DR 1 I _ISTRUCTURE: 126 , l V-B E I TEMP CA 917802104 I (ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: 1 IB587-012-013 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl I I I I (TENANT: IEXIST BLDG USE: COMME USE ZONE: (ISSUED ON: PROCESSED BY: 1 (OLYMPIA EDUCATION INSTITUTE (EXIST OCC GRP: E 110/12/11 SR I I I I I (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: ILIN, MICHELLE (626) 309-9395- 1 300 1 19520 E. LAS TUNAS DR ITEMPLE CITY CA 91780 I FEES PAID IDESCRIPTION OF WORK 1 I �[.p tI INSTALL TWO WINDOWS IN NON-BEARING PARTITIONS AND NINE DOORSI 1 tV ti `) IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( 1 (APPLICANT: TEL. NO: I I i ILIN, MICHELLE (626) 309-9395- IA1 PLANCHECK W/EN-HC 300.00 VAL 94.40 1 I IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: IAB STATE GREEN BLDG FEE 300.00 VAL 1.00 I IAE STRONG MOTION OTHER 300.00 VAL 0.50 IA2 PERMIT W/ENERGY-HC 300.00 VAL 50.10 I _ I ICONTRACTOR: TEL. NO: IFR INV WORK W/O PERMIT 257.00 DOL 257.00 (APPROVALS DATE INSPECTOR SIGNATURE I IWEN JEN HE (323) 327-2734- TOTAL FEES 430.80 1__ 1187 S GARDNER STREET LIC. NO 1 ILOCATION AND SETBACKS I ILOS ANGELES, CA 90036 911301 B I I I I I ISOIL.S ENGINEER APPROVAL I I I I I I I I 1ARCHITECT OR ENGINEER: TEL. NO: I 1FOUNDATION/TRENCH FORMS I I 1 LIC. NO: I ISLAB/UNDER FLOOR I I I I I 1 I I I (RAISED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( IUNDF.'2FLOOR INSULATION I I I 3 C-41 I 11 I I --I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I I 0 NO 22 1 IROOF SHEATHING I I I I I I I I SCHOOL WITHIN HAZARDOUS I ISHEPR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS I I I NO NO NO I FRA'::: INSPECTION I IFIRE SPRINKLER HANGERS I I 1 (INSULATION/WEATHER STRIPI I I I I_ I 11NTERIOR LATH/DRYWALL I I I.EXTERIOR LATH II I I I I I I I IRATED FLOOR/CEIL ASSEM. i I I I I I I I IRATED WALL ASSEMBLIES I I I I I I I I I IRATED SHAFTS/OPENINGS I 1 1 IT-BAR CEILINGS I I I ILOT DRAINAGE I I I I I I I IRE ID. 1_ ROUTE TO 5 - ,. rasa COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9709080051 PHONE: (818) 285-0488 EXT: LEGAL D: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 677 BL: .001 SQ. FT STORIES TYPE 9520 201/2 LAS TUNAS DR STRUCTURE: 0 VN TEMP CA 917802104 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8587-012-013 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: C ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 09/08197 UT 09/08/9 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: ODE: TSAI;ASSOCIATES (818) 446-0446- 1 6,800 �� 114 LAS TUNAS DR 6�r ARCD 910078512 FEES PAID DESCRIPTION OF WORK REMOVE 1 LAYER, 3 LAYER HOT MOPIN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 6800.00 VAL 0.68 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC, ,6800.00 VAL 166.95 TOTAL FEES 195.38 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO i LOCATION AND SETBACKS r.� SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. N0: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150H265 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- 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 SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1212120051 PHONE: (626) 285-0488 EXT: LEGAL ID: INUMBER OF SIGNS: 1 BUILDING ADDRESS: ITR: 6561 LT: 677 BL: .001 ISIGN DESCRIPTION: INTERNALLY ILLUMINATED LED CHANNEL LEI 9520 1/2 LAS TUNAS DR I I I TEMP CA 917802104 1 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 1 18587-012-013 1 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI (TENANT: IEXIST BLDG USE: JISSUED ON: PROCESSED BY: I IGERMAN PIANO IEXIST OCC GRP: 112/12/12 SR I (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: ' VALUATION: IFINAL DA FIN L BY: CODE: J IEDISON (626) 757-1098- 1 1,800 1 I 1114 LAS TUNAS DR I (ARCD 910078512 1 FEES PAID 1 ESCRIPTI N OF WORK 1 I IINTERNALLY ILLUMINATED LED HANNEL LETTER WALL SIGN 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 1 1APPLICANT: TEL. NO: I I I ILE, KEN (626) 571-9288- JAA BLDG PERMIT ISSUANCE 27.80 1 18902 GARVEY AVE JAB STATE GREEN BLDG FEE 1800.00 VAL 1.00 ISPECIAL CONDITIONS: J IROSEMEAD CA 91770 JAX BUILDING REVIEW FEE 54.70 I 1 ID2 PERMIT W/O EN-HC 1800.00 VAL 82.20 1 1 I TOTAL FEES 165"70 1 1 ICONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE 1 INEW SIGNS AND PRINTING INC (626) 571-9288- 1 I 18902 GRAVEY AVE LIC. NO 1 JLOCF�IION AND SETBACKS I I I JROSEMEAD/CA/91770 965512 1 1 I 1 1 JSOII,3 ENGINEER APPROVAL J JARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS 1 1 1 J LIC. NO: J ISUPPORT STRUCTURE J I I I I I I I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: J I I I 1 001 I I I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I NO 20 1 SCHOOL WITHIN HAZARDOUS I I I JAIR QUALITY: 1000 FEET MATERIALS 1 J I NO NO NO I I 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 IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0304040045 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 677 BL: .001 SQ. FT STORIES TYPE 9520 201/2 LAS TUNAS OR STRUCTURE: VN TEMP CA 917802104 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY 8587-012-013 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIS BLDG USE: RESID USE ZONE: C- SSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 04/04/03 JK 03/29/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE Y: CODE: TSAI;ASSOCIATES 8,000 114 LAS TUNAS DR ARCD 910078512 FEES PAID DESCRIPTION OF WORK NEW BUILT-UP HOTMOP ROOF FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: LEDFORD ROOFING (800) 673-6549- AA BLDG PERMIT ISSUANCE 27.75 41082 TAVA LN AC STRONG MOTION RESID 8000.00 VAL 0.80 SPECIAL CONDITIONS: HEMET 92544 D2 PERMIT W/O EN-HC 8000.00 VAL 183.00 TOTAL FEES 211.55 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LEDFORD ROOFING (909) 765-5557- 41082 TAVA LANE LIC. NO LOCATION AND SETBACKS HEMET, CA 92544 429636 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION X 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: - NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- IN ERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/C L SSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPE INGS 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 SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1204130014 PHONE: (626) 285-0488 EXT: LEGAI, ID: (NUMBER OF SIGNS: 1 I BUILDING ADDRESS: 1 ITR: 6561 LT: 677 BL: .001 (SIGN DESCRIPTION: INTERNALLY ILLUMINATED LED CHANNEL LEI 9520 LAS TUNAS DR I I I TEMP CA 917802104 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 18587-012-013 I I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI I I I I (TENANT: (EXIST BLDG USE: (ISSUED ON: PROCESSED BY: I IEXIST OCC GRP: 104/13/12 SR I I I I I 10WNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: IMEISHOW, DIN (626) 309-9395- I 1,300 I 19520 LAS TUNAS DR I I ITEMPLE CITY CA 91780 I FEES PAID IDESCRIPTION OF WORK 1 I (INTERNALLY ILLUMINATE LED CHANNEL LETTER SIGN IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( (APPLICANT: TEL. NO: I I INEW SIGNS (626) 571-9288- IAA BLDG PERMIT ISSUANCE 27.80 1 18902 GARVEY AVE IAB STATE GREEN BLDG FEE 1300.00 VAL 1.00 ISPECIAL CONDITIONS: I IROSEMEAD CA IAX BUILDING REVIEW FEE 54.70 I I ID2 PERMIT W/O EN-HC 1300.00 VAL 82.20 I I 1 .I TOTAL FEES 165.70 I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I INEW SIGNS AND PRINTING (626) 571-9288- 1 1 I 18902 GARVEY AVENUE LIC. NO I ILOCATION AND SETBACKS I I I IROSEMEAD, CA 91770 956512-C45 :'! I I I I I I ISOILS ENGINEER APPROVAL I I I I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUND.ATION/TRENCH FORMS I I I LIC. NO: ISUPPOR.T STRUCTURE I I I I I I I I I I I I I I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:i I I I 1 OJI I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I NO 20 I I I I I I I SCHOOL WITHIN HAZARDOUS I I I I (AIR QUALITY: 1000 FEET MATERIALS I I I I 1 NO NO NO I I I I I I I I I I I I I I I I I I I I I I f I I I I I I ! I I I I I I I I I I I 1* ADDITIONAL DATA ON FILE I I I I I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I