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HomeMy Public PortalAbout9615 LAS TUNAS DR_Building__ �2� 76A638T-z #803P-64 APPLICATION FOR BUILD��PER MIT (j CabUNTY OF LOS ANGELES BUILDING / / I ISS DEPARTMENT OF COUNTY ENGINEER ADDRESS to! BUILDING AND SAFETY DIVISION LOCALITY C; JOHN A. LAMBIE. COUNTY ENGINEER NEAREST+ COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST. ti V DIST IC NO U TYPE R ES Y FOR APPLIC NT TO FILL IN - i coNs . BUILDING ( STATISTICAL CLASSIFICATION S ER MAP ADDRESS' / �aS LC..IL �:5�' CLASS NO. DWELL UNITS BK PG LOT NO. J Oma" BLOCK USE ZONE M P NO. TRACT SPECIALIS NO. OF SLOGS. \./ CONDITIONS O IL.,2a.- LISFllV[4 k3 SIZE OF LOT NOW ON LOT � �� USE OF 7 � EXISTING BLDG. "� I BLDG. SETBACK FROM _ TEL. FRONT PROP. LINE OF (STREET) J_ NO. OWNER A V69 TYPE OF EXISTING SETBACK HIGHWAY + YARD TOTAL ADDRESS a. - HIGHWAY WIDTH F,9M c.L. CITY 1 t:yw I I BLfi T. CKFROM ARCHITECT O TEL. SIP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. d TEL. + = 0 CONTRACTOR -� NO V LIC. CORNER CUTOFF YES NO O ADDRESS NO " CITY CLASS =� SE REVEI1SF, SIDE FOR SPECIAL APPROVALS u DESCRIPTION OF WORK r0) AND PARKWAY TREE REQUIRED Z NEW ADD ALTER REPAIR DEMOLISH e SQ.FT. NO. OF ^ NO. OF SIZE STORIES dam^ FAM6LIE5 0 erml sorNeur er, s� -•a. •- 'Way at proae 1 USE OF 1� ' stallaflons shmdd Inp. f,kpni4:l , h- ,. „_xI "ant. Alfaden STRUCTURE f A 5 I !1 0,1; ' Office, or T. C. Co. En�lne:; c_ I,,, u.eie'y ir. order to avol ,c. SIGNATURE O � until Permit has been ia �ucd.�A for p:I '.,.y tree permit at T. APPLICANT City Hall. n VALUATION$ APPROVALS DATE INSPECTOR.'SSIGNATURE P.C. - PMT. /1 ,�� FOUNDATION, LOCATION -. FEE$ / FEE$ _ I ) FORMS, MATERIALS FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION ." b WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPL V Y PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE THE ST T LIFORNIA RELAT. ING TO WORKMEN' OMPEN ON IN U A C LATH. EXT. ..•a SIGNATURE OF HOUSE NUMBER COR- - PERMITTEE RECT AND POSTED ADDRESS FINAL - -� JOHN F. LEWIS, PRINCIPAL STRUCTURAL ErGIER PLAN CHECK VALIDATION CK. MO. CASH PERMIT VALIDATION CK. M.O 2 3 9 f`,"iy 5 2 3 D 1 9.75A Ljja 2 1 0 9 MAY 2 8 1 D 5 -0.5 O N _ a 76A638A"CE #803 1/71 APPLICATION FOR BUILDIN/G PERMI,.f ` COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITYNEAREST ,y FOR APPLICANT TO FILL IN CROSS ST. Print ort a onl �v BUILDING DISTRICT NO.. G P YP PRQ $E BY/ ADDRESSCI CONST. ` / y / STATISTICAL CLASSIFACAITION SEWER MAP LOT NO. f r/+ rt. BLOCK CLASS NO.�.�)DWELL,UNITS BK PG TRACT -+_ USE ZONE MAP / /y /y t NO.OF BLDGS. _ NO. �5./ v SIZE OF LOT NOW ON LOT U 1 SPECIAL USE OF L �- CONDITIONS EXISTING BLDG. TEL. OWNER _ NO. BLDG.SETBACK FROM ADDRESS N�S FRONT PROP.LINE OF (STREET) i TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + = ENGINEER NO. BLDG. HACK FROM ADDRESS SIDE PROP, OF (STREET) TEL o TYPE OF EXISTING SETBA HWAY + YARD = TOTAL 13- CON CONTRACTOR /`J //..�� NO. a HIGHWAY WIDTH FROM C.L. V ADDRES� „�/v 2(/. NO /� 'F CITY / (J/1/1�TE ,/cam C ASSN CORNER CUTOFF YES ❑ NO ❑ W CONSTRUCTION LENDER N NAME AND BRANCH SEE REVERSE SIDE FOR SPECI APPROVALS ADDRESS SQ. FT. //yy NO. OF NO. OF NEW !moi SIZE (/ ST'ORI'ES FAMILIES USE O 1 ADD STRUCTURE,- �iN ALTER ❑ REPAIR❑ SIGNATURE F APPLICANT t DEMOL ❑ VALUATION !_010 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. ��CJ FOUNDATION: LOCATION FEE $ f- `r FEE $ t' FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT 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 1 WILL NOT EMPLOY ANY PERSOW IN VIOLATION OF THE LATH, INT, LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S CO MPE NSA INSURANCE„ LATH, EXT, SIGNATURE 0 Cis,--,� �_LJ HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL S �- JOHN F. LEWIS. PRINCIPAL STRUCKRAL ENGINEER PLAN CHECK VALIDATIONCK M.O. CASH PERMIT VALIDATION CK. MO. CASH V o6 , 4 9;l MAY 1 _D 1 4,10 i. 62h3- MAY2,5 1D 2350- 14, d 76A638ACE48033-66 APPLICATION FOR BUILDIN PERMIT COUNTY OF LOS ANGELES BUILDING - DEPARTMENT OF COUNTY ENGINEER ADDRESS ) 0— L BUILDING AND SAFETY DIVISION LOCALITY Cv JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP T OF BUILDING CROSS ST. DI$TTR.IC N i P TYPE P Orr BY FOR APPLICANT TO FILL IN 5 (� CONST. i C" BUILDING _ y- _ STATISTICAL CLASSIF,(CATION SEWER MAP ADDRESS CLASS NO.1j�3 I--•�(/i`aIc:INIaS 1 �.-. UNITS GK PG �-ti ) DWELL LOT NO. BLOCK USE ZONE MAP O C' NO. TRACT ( _ SPECIAL N0. OF BLDOS. CONDITIONS SIZE OF LOT NOw ON LOT USE OF EXISTING "'� BLDG. SETBACK FROM 1 TEL. FRONT PROP. LINE OF (STREET) OWNER NO. t! �' HYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL p HIGHWAY WIDTH FROM C.L. ADDRESS 1 / !t-• oc T� "- 4Z 2 •c CITY f, ) . �3 i ^)L BLDG. SETBACK FROM ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS /' HIGHWAY WIDTH FROM C.L. CONTRACTOR G-'J .'i. e1 . A_ 33a 99 3 + LIC ,y31 CORNER CUTOFF YES NO �' ADDRESS,�Z� At-C•{4LVf= NO aO CITY �i •� :K� c�A �� SEE REVERSE SIDE FOR SPECIAL APPROVALS CD DESCRIPTION OF WORK NEW A-E.-�L TER REPAIR DEMOLISH N SQ.FT. NO. OF NO. OF Z SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT G✓1ti� `�..;L VALUATIONS ) s-loil •00 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. __07 PMT. Gn ) FOUNDATION, LOCATION FEE FEE$ FORMS, MATERIALS FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH. INT. TION OF THE LABOR CODE OF THE VJgrE OF CALIFORNIA RELAT. ING TO WORKMEN'S CoMPE SATION RANGE. LATH. EXT. SIGNATURE OHOUSE NUMBER COR- PE,RMITTEE �' r� RECT AND POSTED ADDRESS LZ C �� "`� �A �� �`� Fl N A L JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION (LKK . M.o CASH 3 7 F"' OCT 1. -9 1 D 0.0 Q Q WORKERS'COMPENSATION DECLARATIONp hereby affirm that 1 have certificate of consent to self APPLICATION FOR BUILDING PERMIT 1j�I insure, or a certificate of Workers' Compensation Insurance, or a certified��y�a eof (Sec p 3800 ab9C.) COUNTY OF LOS ANGELES G BUILDING AND SAFETY PolicyN 7 Com anSi6CSS 1:1 copy is hereby furnished. FOR APPL NT, O FILL IN BUILDING T /� GADDRESS L ( 7 rtified copy is filed with county building inspec- BUILDINGP�7nt�department. ADDRESS �- �����-� LOCALITY x DaV—( 1—e� Applicant �sr CITY t ZIP CROSS NEARESTT. U/ �j L' CERTIFICATE OF EXEMPTIO FROM WORKERS' NO. OF BLDGS. 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 ZO E MAP hundred dollars ($100)or less.) TRACT p� OCK LOT NO. Are, C- NO. ZC/© SPECIAL I certify that in The performance o�the work for which this OWNER Q CONDITIONS �. permit is issued, I shall not emplo erson in any ma r �y DISTRICT GROUP TYPE FIRE PROCESSED BY so as to become sub ect to The W k�r Com ensation a ADDR [ r CONST. ZONE U I 99 D97 0 ate / Aplican CIT E� ZIP STATISTICAL CLASSIFICATION APT. CONDO. ARCHITEC TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINES NO. �i� V Exemption, you should become subject to the Workers' CLASS NO. DWELL. UNITS LU Compensation provisions of the Labor Code, you must forth- EL ADDRESS SEWER MAP with comply with such provisions or this permit shall be _ ' TEL. deemed revoked. CONTRACT O • "8 NO BK. �PG, / Z VALIDATION LICENSED CONTRACTORS DECLARATIONQ Lw' , LIC. ' g 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSI �`�Q .NO. a VALUATION (commencing with Section 7000)of Division 3 of the Business and L 17 Professions Code, and my license is in full force and effect. CITY $ SQ. FT. NO. OF Z INC. OF CHECK License Number Lic.Class SIZE 0-0 STORIES FAMILIES ONE $ Contractor Date DESCRIPTION OF WORK NEW ❑ ADD El ❑ I am exempt under Sec. 'w Al "760, 'I❑ FINAL / n f l� B.BR.C. for this reason /^ REPAIR DATE � 7;' 0,0 0 0 0 Date: USE OF EXISTINGBLDG. 08`� STd U�'� DEMOL ❑ ey AL �, � 7 0 - 78.0.0 Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO.. ^ 'CFO o ])? ( d' 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 ❑ 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- ADDRESS tion 7044, Business and Professions Code). REQUIREDTOTAL 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 ao P.L. Q Lender's Name Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee f above ormation is correct. I agree to comply with.all County Investigation Fee g ordin n� s and State laws relating to building construction, Total Fee A d an e e y authorize repr tatives of this County to enter u on Fie ove-mention property for inspection purposes. 3 c, J T. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date .0s WORKERS' COMPENSATION DECLARATION ' insure her;boraafcertif cote of Wdrke sf iCompensat on ificate of eInsuran ent to lf APPLICATION FOR U I L D I N G 'PERMIT or o certified copy h reof Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY / Policy No. r 3. pony r, Q�� x BUILDING ❑ Certified copy is her by furnis ed. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING ADDRESS tion eparT enT. Com' lil Dare` Applican CITY I Z(6 ZIP LOCALITY NO. OF BLDGS. NEAREST _ ti CERTIF4 E OF EXEMPTION FRO ORKERS' SIZE OF LOT NOW ON LOT CROSS ST. + CJ t✓: COMPENSATION INSURANCE ASSESSO JKv (This section need not be completed if The permit or one TRACT BLOCK LOT NO. MAP OK PAGE PARCEL hundred dollars ($100)or less.) 1 j�/ EL. U ZON� MAP OWNER �lJ t _ NO. I certify that in the performance'of the work for which this / 7&z " SPECIAL 1' permit is issued, I shall not employ any pelson in any manner A SS (� CONDITIONSCL so as to becom subject to the Workers' om e tion Laws. CITY I ZIP D �� Applicant ARCHITECT TEL. DISTRIC GROUP TYPE FIRE OC SED O NOTICE TO,A PLICANT: If, after ma ing this Certificate of ENGINEER NO. CONS E F- Exemption, you should become subject to the Workers' U Compensation provisions of the Labor Code, you must for ADDRESS a with comply with such 'provisions or this permit shall be TEL. S ISTICAL C SI (CATION APT. ONDO. Z deemed revoked. CONTRACTOR N — LICENSED CONTRACTORS DECLARATION n h C. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS O (commencing with Section 7000)of Division 3 of the Business n LIC. SEWER MAP and Professions Code,and m license is in full force and effect. CITY (S Cj CLASS BK PG VALIDATION //�/� � SQ. FT. NO. OF O. OF ECK License Numbe © a` Lic. Class SG,-�4L� SIZE STORIES FAMILIES r--�. , / , t VALUATION �. Contractor � Date 'V DESCRIPTION OF WORK - El ❑ ► I am exempt under Sec. 120Y ADD ALTER ❑ B.&P.C. for this reason G S REPAIR ❑ Date: O USE OF EXISTING BLDG. DEMOL ❑ 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 ADDRESS FINAL Professions Code): PRESEN By BUILD G I, as owner of the property, or my employees with ADD ESS wages as Their sole compensation,will do the work and L CALITY , the structure is not intended or offered for sole(Section 7044, Business and Professions Code.) OVING TEL. ❑ 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.) CONSTRUCTION LENDING AGENCY ED SETT REQUIRED YARD HWY TOTAL SETBACK OP AL NEFROM WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issue P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name. w –39, { LDMA Ref. # P.C. Fee$ Per Fee Lender's Address f 0 1 certify that I have read this application and state that the Issuance Fee / i /�o V LDMA P/C# , 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, Total Fee LDMA Perm. # a and hereby authorize representatives of this County to enter upon The abo e- ationed p erty for inspect' purp es. �. a SEE REVER,SS FORE NATORR)Y LANGUAGE Sig ature of Applicant or Agent ° D.6e 5/^ � 0 ��`� (/v' • APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY ('/� WORKER'S COMPENSATION DECLARATION - FORAPPLICANT TO FILL IN BUILDING ADDRESS (;'✓uV J BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, S �� or a certificate of Workers'Compensation Insurance,or a certified Copy thereof 0 La .C CI ZIP I � � LOCALITY/ Policy No. Company L -VSI OF L NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE de NO. depa ent. Dat y'6 Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS ERTIFICATE OF EXEMPTION FROM WORKERS' o R , , ( TEL. YES NO COMPENSATION INSURANCE U WITHIN 1000 IT OF SCHOOL? ADD S (This section need not be completed if the permit is for one hundred ,6 ` DISTRICT GROUP TYPE CONST.' FIRE ZON PROC S BY dollars($100)or less.) CI k. ZIP 3170 I certify that in the performance of the work for which this permit '� (i/ Q� is issued, I shall not employ any person in any manner so as to ARCHITE T R ENGINEER TEL.NO. becomesubject the Workers Compensation Laws. 1 11 STATISTICAL CLASSIFICATION APT CO)950 Dat Wo Applicant ADDRESS CLASS NO. DWELL UNITS NOTI E T PPLICANT: If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemptio you should become subject to the Workers' CO R f 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. AD S N PL LICENSED CONTRACTORS DECLARATION CI (� LIC.CLASS SIDE Q PL O U 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 SO.FT SIZE NO.OF STORES NO.OF FAMILIES 0 Professions Code, nd y lic se is in full force d effec. NEW ❑ BK PG , t ` DESCRI WORK r ADD ❑ VALUATION y License Number Lic.Class '�fvr $ �. Contractor Date O �\ ` ALTER ❑ _ REPAIR ❑ ❑ 1 am exempt under Sec. $ B.&P.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ J sJ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# Z (ACCT n g ❑ I, as owner of the property, or my employees with wages as A 0 --+ �� nc their sole compensation,will do the work and the structure is �'DDRESS H 330" FINAL D QG ITEMS', M J not intended or offered for sale (Section 7044, Business and r 1 i i Professions Code.) J WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALrFINAL jell J . YAI' n ❑ I, as owner of the property, am exclusively'co tttacS�tg Wlth TOR A MIXTURE H AMOUNTS SPECIFIED ON THE INING A HAZARDOUS AAZARDOUS MATEIAL EQUAL TO RIALS INFORMATOION GUIDER THAN 1' to LI TOTAL - 25 licensed contractors to construct the project.(Section 7044, YES❑ No❑ f`CHECCHECK33.25Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST CONSTRUCTION LENDING AGENCY OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �J CHANGE n (I I (y t,U]/•,�q CHANGE FOR GUIDELINES. `� Y'"'1 C j7T F-A I hereby affirm that there is a construction lending agency for YES❑ No❑ r., �y i •� �9 the 7,Civ.performance Of the Work for which this permit IS ISSUed(SBC. r-2 FOI HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE$QUO� � � —I .n `�' I t -- `�II 3 1 9V 3097,Civ.C.). -` ! �. PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS lQJL3E3> "^J —4 m Lenders Name COUNTY CODE,TITLE 2,CHAPTER 220 SECTIONS 2.20.100 THROUGH 220.140 CONCERN IN La'i I— A ' pr)+� - l�j+� �j°"t 3, HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQ tri M•-4 9iy 1 S !Zt I 7°.E4J G. Lender's Address r- —I oG. OWNER OR AGENT rri I certify that I have read this application and state that the above , �� t.rJ g information .is correct. I agree to comply with all county P.C.FEE PERMIT FEE �7 Q ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. a CCT i ocl m INVESTIGATION FEE TOTAL FEE .rj a SlpneWn of ADWk°m aAOenl Debry SEE REVERSE FOR EXPLANATORY LANGUAGE I WORKERS' COMPENSATION DECLAP-NTIONL insure,oraafce of cane of Worke s'1 Compensation eIIns uran e, APPLICATION FOR BUILDING PERMIT . or a certified copy thereof (Sec. 3800, Lab.,C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING � ❑ Certified copy is hereby.furnished. FOR APPLICANT TO FILL IN ADDRESS j l —c ((J S D' El Certified copy is filed with the county building inspec- BUILDING / D� , tion department. ADDRESS ' ! q 77 Date t ApplicanCITY C ZIP rr Q LOCALITY NO. C BLDG NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. "� L e f P7� v�' COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL• OWNER N0. USE ZONE MAP 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 CONDITIONS a so as to become subject to the Workers' Compensation Laws. / O CITY QZIP V Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificateof ENGINEER NO. CONST. ZONE O Exemption, you should become subject to the Workers' " U Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. rn deemed revoked. CONTRACTOR � '�e c'�e/� NO. Z_ LICENSED CONTRACTORS DECLARATION . LIC. CLASS NO. 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 LIC. 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 IFAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ s :3 , 7 D v L ❑ ❑I am exempt under Sec. ADD ► ALTER ❑ B.&P.C. for this reason REPAIR $ Date: USE OF f EXISTING BLDG. TELr � C� DEMOL El Signature APPLICANT(PRI T). 100' t4 lJ LONO. FINAL OWNER-BUILDER DECLARATION DATE - 3 elf? 2 I hereby affirm that I am exempt from the Contractor's License r1ilt ° Law for the following reason (Section 7031.5, Business and ADDRESS 7 FINAL 1 ITEMS Professions Code): PRESENT BY BUILDING ❑ I, as owner of the property, or my-employees with ADDRESS TOTAL 3-29 - 14 wages as their sole compensation,will do the work and CHECK jy`=°f4 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. pool (CHANGE LJ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- LADDR tion 7044, Business and Professions Code.) TOTAL SETBACK FROM EXI T. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH 1 1pE °- Ihereby affirm that there is a construction lending agency for 7171 1 ttii °`' the performance of the work for which this permit is issued "' (Sec. 3097, Civ. C.). _ _ O- C ( s�� '7�Co / 1� Lender's Name / 7. LDMA Ref. # m Lender's Address �Y PermitFee �1 certify that I have read this application and state that the Issuance Fee �� LDMA P/C#above information is correct. I agree to comply with all County n Fee �1 N ordinances and State laws relating to building construction, Total Fee 7 LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. a a - .• SEE REVERSE FOR EXPLANATORY LANGUAGE n Signature of Applicant or Agent- Date • APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APP ANT TO FILL I BUILAG ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDIN DRESS or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY / l/ ZIP Company LOCALITY Policy No. SIZE OF LCT .OF BLDGS.NOW ON LOT El Certified copy is hereby furnished. NEAREST CROSS S. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. ` department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OW ER TE 0. / COMPENSATION INSURANCE a y r x7 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDUSS/ ,{� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) 6 V r. CIT ZIP �� y/ I certify that the performance of the work for which this permit C/�1 � I-plop p yr_� is issued, I shall not employ any person in any manner so as to `.J• O become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. / P STATISTICAL CLASSIFICATION APT CONDO Date9—13-1 Applicant Coy MfJ ak ADDRESS CLASS NO. .1.2— DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should became subject t0 the Workers' CONTRACTOR 1 TE O. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwithVI r FRONT comply with such provisions or this permit shall be deemed revoked. ADDR SC�p LIC.NO. P L LICENSED CONTRACTORS DECLARATION I / SIDE TY � /1 LIC.C S PL / I hereby affirm that I am licensed underprovisions of Chapter 9l� SEWER MAP IE t/ (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORS NO.of FAMILIES a Professions Code,and m Ii nse is in full force and effect. I NEW 1:1BK PG , O License Number ( Lic.Class DESCFtITTION� FWORK ADD ❑ VALUATION V Contractor Date Q( � ��(JJl P'.�� ALTER $ Q0�' Cr O ❑ I am exempt under Sec. REPAIR ❑ $ U BAP.C. for this reason DEMOL ❑ LU LDMA P/C# CL Date:. USE OF EXISTING BLDG. URM ❑ U) Z Signature APPLICANT(PRINT) TEL NO. LDMA Perm# ❑ I, as owner of the property, or my employees with wages as Z t'` 'ir their sole compensation, will do the work and the structure is ADDRESS 00, 50 C-. not intended or offered for sale (Section 7044, Business and FINAL DATE 0 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J J. ❑ I, 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 ! r r 3 licensed contractors to construct the project (Section 7044, CCHANGE '` °Ir YES❑ NO❑ C 1 Business and Professions Code.) ;L I1O•:WILL THE INTENDED USE OF 7HE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH pMCONSTRUCTION LENDING AGENCY COASTAIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FORIt b`1GUIDELINES. YYY�����,I hereby affirm that there is a construction lending agency for YES❑ No❑ jF;L ,�N the performance Of the WOfk for Wt11Ch this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 'r-' 'a %•C1 .i•-J°L' 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. o Lender's Address OWNER OR AGENT o I certify that I have read this application and state under penalty o P.C.FEE r�'yi PERMIT FEE , d of perjury that the above information is correct. I agree to comply 0 110;_I 113131 �4 ;3/9-- a with all county ordinances and State laws relating to building lJ 1� i s ' m constr CtiOn, and hereby authorize representatives of this County ISSUANCE FEE `7'�i� _L hi.i °•i"O m to en upon the above-r� toned property for inspection purposes. til 5 ` % _ mn aof �Q(2� INVESTIGATION FEE TOTAL FEE ^ ✓5gwmreo Mwv �� � SEE REVERSE FOR EXPLANATORY LANGUAGE 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 0206210016 PHONE: (626) 285-0488 EXT: DUPLICATE LEGAL . OF CONST BUILDING ADDRESS: TR: 6561 LT: 178 BL: .001 SQ. FT STORIES TYPE 9615 9621 LAS TUNAS DR STRUCTURE: VN TEMP CA 917802109 ASSESSOR IN ORM 0 MBER: NEAREST CROSS STREET: TEMPLE CITY BLVD 8587-019-037 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE-2 o-NC- ISSUED ON: PROCESSED Y: EXPIRES ON: EXIST OCC GRP: 06/21/02 JK 12/18/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINRL DATEY: CODE: MOLLI MOK (626) 286-5669- 6,000 9516 LAS TUNAS DR LXFIKLLi TEMPLE CITY FEES PAID DESCRIPTION OF WORK REMOVE EXISTING ROOF; REPLACE W/ BUILTUP ASPHALT ROOF APPIICAN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEL. NO: OSMOND CONSTRUCTION & DEVELOPMENT (626) 675-7052- AA BLDG PERMIT ISSUANCE 27.75 1108 S CALIFORNIA ST AC STRONG MOTION RESID 6000.00 VAL 0.60 SPECIAL CONDITIONS: SAN GABRIEL CA D2 PERMIT W/O EN-HC 6000.00 VAL 149.40 TOTAL FEES 177.75 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE OSMOND CONSTRUCTION AND DEVELOPME (621) 451-0699- 1108 S. CALIFORNIA ST. LIC. NO LOCATION AND SETBACKS SAN GABRIEL, CA 91776 7913698 SOILS ENGINEER APPROVAL RCHITECT 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 150H265 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: AP /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- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED LOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS OPEN NGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF�t OS 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 0006140037 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 178 BL: .001 SQ. FT STORIES TYPE 9615 9621 LAS TUNAS DR STRUCTURE: 0 VN TEMP CA 917802109 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: KAUFFMAN 8587-019-037 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: 06/14/00 UT 12/11/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL B DE: 9615-9621 LAS TUNAS PROPERTY (626) 286-8698- 1 3,000 9615 LAS TUNAS DR TEMP 917802109 FEES PAID DESCRIPTION OF WORK CLOSING EXISTING DOORWAY 61X6 " AND EXISTING WINDOWS ALONG FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: EAST SIDE--- � � Z L�yG APPLICANT: TEL. N0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AE STRONG MOTION OTHER 3000.00 VAL 0.63 SPECIAL CONDITIONS: AX BUILDING REVIEW FEE 54.70 D2 PERMIT--W/O EN-HC 3000.00 VAL 99.00 TOTAL.:fEES 182.08 CONTRACTOR: TEL. N0: SAME AS OWNER APPROVALS DATE INSPECTOR SIGNATURE -tIC. NO LOCATION AND SETBACKS 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 150H269 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 L >' REQUIRED TOTAL SETBACK FROM EXIST i FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- _ INSULATION/WEATHER STRIP SIDE PL 96'�v `� („� INTERIOR LATH/DRYWALL +�--t EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508