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HomeMy Public PortalAbout9629-9633 LAS TUNAS DR_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) lJ FRE 29-31 E. LAS TUNAS DR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER LE CITY zIP9]_ 80 BUILDING AND SAFETY DIVISION SIZE OF LO1o6 NOW OONBLOT S 1 ADDRESS 3 TRACT BLOCK OT NO LOCALITY NEAREST %w CC 119Ln L -1111111TNO OWNER oI286_6358 CROSS ST. ASSESSOR ADDRESS 9632 WOOLLEYST MAP BOOK PAGE PARCEL CITTEMPLE CITY ZIP 91780 DISTRICT GROUP TYPE FIRE ���SSED BY CONST. ZO ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CLASSIFICATION SEWER /MAP ADDRESS CLASS NQ _OWELL.UNITS BK TEL. CONTRACTOR NO USE ZONE MAP LIC. NO. ADDRESS NO '-2— SPECTAONS CITY LIC. CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ NAME AND BCONSTRUCTIRANCHON NDER NONE 1� BLDG.SETBACK FROM C FRONT PROP.LINE OF (STREET) ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY } YARD - L SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW 0 El } d BLDG. FROM (STREET) P�.TAL SnT�UD�&1'�TDRY I�IWALL ADD SIDE PROP.LINE OF INTERIOR PETTIION ALTER ❑ HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE OF + DEMOL EXISTING BLDG. ❑ APPLICANT PRNT) DOMINIC MORTELL&O 28745 CORNER CUTOFF YES ❑ NO ❑ BY (SIGNATURE `�i� IN OPEN SPACE YES ❑ NO ❑ a IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ -)220 d U CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO / �f p WORKMEN'S COMP TION INSURANCE. % iA 6 4 v/'�. SIGNATURE F �,�/,/iJ`��'L-W(lr 22 PERMITTEE `G 96� LEY ST ADDRESS L� C� FINALIF �►}/� ITYTEMPLE CITY 91780 N86-63J DATE CO 2 �,-/J�'�" BYr- WiK1: CIII CK� IIA}AljLli TU: FEE PMT. FEE FEE HARVEY T. BRANDY. COUNTY ENGINEER ] 2t PLAN CHECK VALI ATION K Mo CASH _ Pn_RMIT VALIDATION CK. �.L0. CASH 76A638A CE#803 7/73 7 CY 6.;`fLb 1.4 1 4 2.v 0 A,C FOR APPLICANTAPPLICATION oIoonIFOR D G P RM tT FILL FB OUNTY OF LOS ANGELES 9 " 1 E. LAS TUNAS DR. DEPARTMENT OF COUNTY ENGINEER LE CITY ZIP 2 $� BUILDING AND SAFETY D SION NO.OF SLOGS. BUILDING _3/ �., � S SIZE OF LOT NOW ON LOT ADDRESS TRACT BLOCK LOT NO DC) I WELL LOCALITY 77_e, _( MT OWNER T, 0 N0L2H6CROSS ST. cy ADDRESS 9632 WOOLLEY ST ASSESSOR MAP BOOK PAG PARCEL DISTRICT 1GROUPITYPE FIRE ZPROSSE B CITY E LE CM ZIP 1 $ ��Og CONS+ Z � ARCHITECT OR TEL. Y/ ENGINEER NO. STATISTICAL CL,A,S SIFICATION SEWER MAP ADDRESS CLASS NO. l7CJ _DWELL,UNITS:: --: BK rG TEL. CONTRACTOR NO USE ZONE NO ©i+1 LIC, lJ ADDRESS LNO,IC r-- SPECIAL x.30 -_� LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO CONSTRUCTION LENDER r` NAME AND BRANCH U N V_ BLDG,SETBACK FROM FRONT PROP,LI NE OF (STREET) C ADDRESS CITY HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING - L SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH � SIZE STORIES FAMILIES ONE DES-CRIPTION OF WORK NEWSETBACK FR ❑ } A J `7 - '_ ADD � SIDEGPROP. LINE OF M (STREET) `vl iALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING %J-N��U,� �•T��t�`, HIGHWAY } YARD = HIGHWAY WIDTH EXISTING BLDG. REPAIR❑ SIDE PROP. LINE USE OF ry:1 j�' CUV V DEMOL ❑ } APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) TITAgn BY (SIGNATURE/f? >1, ,>- `//p ,�' IN OPEN SPACE YES ❑ NO ❑ \G HLCIJ" IN COASTAL ZONE YES ❑ NO ❑ s to VALUATION r f� CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I TI�FY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WIL NO EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF E STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM N ATION9 NS URANC E. 7 — � '� d,' �'r L �,�— SIGNATU ' •� PERMIT T ERMITT ADDRESS C 6 F FINALTEe. J�(/ W. J{,' /J� CLHALRVEY'lT. Y ` / NO. I`✓ N DATE C,� �i Y 1K[ C{IE( KS I'A}AI3L1: TU: FEE $ n � FEE BRANDT, COUNTY ENGINEER / "�C_� PLAN CHECK VALIDATION CK M o CASH w ��J//PERMIT VALIDATION CASH 6059-�AU6 idU23 u b -.UUA7 6 5 5 o`•Aub A� 76A 638A CE#803 7/73 _ -- <�7-/ T,y O t T�r. F'//-"f--4t-- c / 7`y 76A638A CE#803 3-68 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING / 2 DEPARTMENT OF COUNTY ENGINEER ADDRESS (D L'-S T BUILDING AND SAFETY DIVISION LOCALITY TErnf'z- JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST �G� r CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE P O Ess I�Y (Pant or type only) �t e8 r CONST. C�� L BUILDING �. rv-. / STATISTICALCLASSIFICATION SEWER MAP ADDRESS 6) j:/ `h CLASS NO. ,,-DWELL,UNITS BK PG LOT NO. G/FST y`7 Sy7 BLOCK USE ZONE MAP NO TRACT 14 - 2- SPECIAL CONDITIONS NO.OF BLDGS. SIZE OF LOT NOW ON LOT IV�Pl t7 USE OF EXISTING BLDG. BLDG.SETBACK FROM TEL. FRONT PROP,LINE OF (STREET) OWNER %W%C PW 't\ 2V7- S - TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL HIGHWAY WIDTH FROM C.L. ADDRESS /o.0 -(-c & + CITY BLDG.SETBACK FROM ARCHITECT OR ITEL. bZ y� SIDE PROP.LINE OF -(STREET) ENGINEER ., NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS "'� - V `_(,� HIGHWAY WIDTH FROM C.L. TEL. + - CONTRACTOR 0 W V* _; R NO. a LIC. C) ADDRESS NO. CORNER CUTOFF YES ❑ NO ❑ V CITY CL SS SEE REVERSE SIDE FOR SPECIAL APPROVALS oi,- U DESCRIPTION OF WORK a a- z NEW ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF /- STRUCTURE SIGNAF APP NT VALUATION $ Z, �Q APPROVALS DATE INSPECTOR'S SIGNATURE MEN P.C. Ll �( ` PMT. FOUNDATION: LOCATION FEE$ FEE $ 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, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WI NOT EMPLOY ANY PERSON IN VIOLA. TION OF THE LABOR CODE F THE STATE OF CALIFORNIA RELAT• LATH, INT. ING TO WORKMEN'S COMP SATION INSURANCE. � LATH, EXT. SIGNATURE Of� �c2, �� HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION cK. .O. CASH _ PERMIT VALIDATION CK. M.O. CASH [ f' .8220,'6 JI 3/1 2 3 D 41.851 76A 63JA CE#803 3-66 APPLICATION FOR BUILDING ERMIT COUNTY OF LOS ANGELESBUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER �) COLEMAN W. JENKINS, SUPNEARESTT OF BUILDING CROSS ST. FOR APP CANT TO FILL IN DISTRICT GROUP TYPE PROCESSED BY ( I t or type only) CONST. BUILDINGA / / �� �� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS / (� f-- 4/�� CLASS NO. C DWELL,UNITS� BK PG LOT NO. BLOCK USE ZONE MAP TRACT lK� 7 NO. CONDIIT ONS I SPECAl_ NO.OF BLOGS. SIZE OF LOT NOW ON LOT USE OF /� �nJ.. EXISTING BLDG, �L —�/ ©r" BLDG.SETBACK FROM �^ TEL. 'w FRONTPROP.LINEOF v �/l1 (STREET) OWNER �� �/� NO. Cvl 3 TYPE OF EXISTING SETBACK I HIGHWAY + YARD = TOTAL ADDRESSel6 2- jE-:_/ ,J—AS fiN/VRS HIGHWAY WI,D�TyH/ FROM C.L. C I T /" L-.,�J G> V l v + TECT R T BLDG.SETBACK FROM ENGINEE j j �� • • ?�?� SIDE PROP.LINE OF (STREET) _ TYPE OF EXISTING1 SETBACK HIGHWAY + YARD = TOTAL ADDRES '��� G �� L�� L HIGHWAY WIDTH FROM C.L. CONTRACT Q• NO. ,7- + a LIC. ADDRESS 2z L LIC CORNER CUTOFF YES ❑ NO v CITY L . SS - SEE REVERSE SIDE FOR SPECIAL APPROVALS U DESCRIPTION OF WORK Cn z NE ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE C _' 7S / 4" l T_ - I / STRUCTURE �� / /!/ ; 4/i /G-/✓ r516--N I] SIGNATUg�QP�� APPLICA VALUATION $ �J O©, APPROVALS DATE INSPECTOR'S SIGNATURE P.C.. Jam-+ PMT• // FOUNDATION: LOCATION FEE S V FEES 6p 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, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY IXWILLEMPLOY ANY PERSON IN VI A. TION OF THE LABOR ATE OF CALIF RN AT. LATH, INT. TOWORKMEN'S CSURANCE. LATH, EXT, SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRI CIPAL R TU .. M. RAL ENGINEER PLAN CHECK VALIDATION o. CASH _ PERMIT VALIDATIO CK. M.O. CASH I,-Ar, 9 6 8 9 tear 1 2 3 0 5.00Ntm Ar9690 PAY 0 600 76A631A CE31803 3-68 APPLICATION FOR BUILDING P RMIT 37 COUNTY OF LOS ANGELES BUILDING /^ DEPARTMENT OF COUNTY ENGINEER ADDRES BUILDING AND SAFETY DIVISION LOCALITY C - JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUP•7 OF BUILDING NEAREST CROSS ST. FOR APP IC NT TO FILL IN DISTRICT NO. GROUP TYPE PROCESSED BY (P t r t pe only) ` d/6 CONST. BUILDING n f �n ( STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO._;;-'e__DWELL,UNITS d BK PG LOT NO. BLOCK USE ZONE MAP NO. TRACT Cr-� SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF )) C f /f, EXISTING BLDG. L--J/ �I— BLDG.SETBACK FROM a �- `,/ FRONT PROP.LINE OF___4,S /u�/�r (STREET) OWNER SGS --/� _ TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS 91 6 _1 S t HIGHWAY WIDTH FROM C.L. CITY ,= G �L /1J le)6) + _ BLDG,SETBACK FROM _^RGIw4r.Iiw O M TE SIDE PROP.LINE OF (STREET) ENGINEE ME NO -I/ _ TYPE OF EXISTING SETBACK HIGHWAY + VARD - TOTAL ADDRESS yZS / �. /.� "� HIGHWAY WIDTH FROM C.L. TEL. CONTRA CTO �U_'O. �3 � + _ � LIC. /��7r�. ADDRES S NO. (J��<� CORNER CUTOFF YES ❑ NO ❑ V CIT ` LIC. SSG - `rS SEE REVERSE SIDE FOR SPECIAL APPROVALS oCR U DESCRIPTION OF WORK a r� z N W ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF C / IA STRUCTURE ✓ F_� .1 t L-./- `/M) W�4 L L S 6—,✓ — � ��/ SIGNATURE APPLICANT VALUATIONS a d i APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, FOUNDATION: LOCATION FEE S ZQ FEE S �yZ. Q Q 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, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION, I CERTIFY THAT IN DOICTHERK AUTHORIZED HEREBY I WILL N MPLOY ANY PERA- TION OF THE LABOR CODE STATE OF CALAT. LATH, INT. ING TO WORKMEN'S COMP NSURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PR CIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH I ' y 91:0' My 1 3a 7.2 fir_ yN Q_' I"AY 1 1 0 12.0 0 76A634A CEi18033-68 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING �^ DEPARTMENT OF COUNTY ENGINEER ADDRESS C• 72�InIIILJ BUILDING AND SAFETY DIVISION LOCALITY T JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. C� FOR APP I ANT TO FILL IN DISTRICT NO. S/ROUP cONST.� PROCESSED BY ( or type only) d a BUILDING / / STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. 9 DWELL,UNITS BK PG LOT NO. BLOCK USE ZONE MAP NO. / TRACT �pr� e_ Z SPECIAL NO.OF SLOGS. CONDI TI ONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. J �L- pn"C BLDG.SETBACK FROM /�� w� /' TEL. �/ FRONT PROP.LI NE OF � S- 171!iZ�- S (STREET) OW NE 119/��^^�77v i v �+ ,[f NO. X,.`/ ZSC3 TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL F I /r Tv(/v AS HIGHWAY WIDTH FROM C.L. ADDRES^Sy--' p CITY ! � /-Al! T C T ` Ir BLDG.SETBAnCK FROM + CT O EL. SIDE PROP.LINE OF (STREET) U ENGINEE . ?i3-y� ��"" TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS !i 'H G � HIGHWAY WIDTH FROM C.L. TEL t + = d USE CONTRACTOR NO. 23- IC. � ADDRES NO. lj� CORNER CUTOFF YES ❑ NO ❑ V Cr CITY LIC. SG SEE REVERSE SIDE FOR SPECIAL APPROVALS o U DESCRIPTION OF WORK o z NEW ADD ALTER REPAIR DEMOLISH SQ. F ..1 NO. OF NO. OF SIZE V STORIES I ' FAMILIES USE STRUOCTURE w A L� .S/civ c-N' G SIGNATU APPLICA VALUATION $ O ,DO APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. / FOUNDATION: LOCATION FEE S Q Q FEE $ (Q C! G 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, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION, 1 CERTIFY THAT IN DOING TH WORK AUTHORIZED HEREBY I WILL T EMPLOY ANY PERSON VIOLA. LATH, INT. TION OF THE LABOR CODE STATE OF CAL IA RELAT- ING TO WORKMEN'S COMP INSURANC LATH, EXT, SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL lG� JOHN F. LEWIS. PRINCIPAL ST TURAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATIO OK. M.O. CASH IAr, 9693 my 1 23 0 5.00 1. 76A63d,4 CE#803 3-68 / �' 1 1 L 7 ,7 ' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. J FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE PROCESSED BY rint or type only) .f St /� CONST./ BUILDING &/-If J STATISTICAL CLASSIFICATION SEWER MAP ADDRESS C� L-�S CLASS NO.�_DWELL,UNITS BK PG LOT NO. BLOCK USE ZONE MAP NO. / TRACT �� _ 'Z SPECIAL NO.OF BLOGS, CONDITIONS SIZE OF LOT /SNOW ON LOT USE OF USE C EXISTING BLDG. �E7 z 1� L v BLDG.SETBACK FROM OWNER po M/ (/'1 G 5 N 3 2 FRONT PROP.LINE OF Liff l L:� s-(STREET) �w +� n TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS b 2 / All S -r7G /"/X_,$ J�. HIGHWAY WIDTH FROM C.L. CITY i-- �� ' /�/� ,Vol + - BLDG.SETBACK FROM ECT O EL SIDE PROP.LINE OF (STREET) ENGINEE 0.;1_7 TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRES G /T14 HIGHWAY WIDTH FROM C.L. TEL + CONTRACTOR NO. Z Z3 { a LIC. CD ADDRES� C, NO. CORNER CUTOFF YES ❑ NO ❑ U CITY ' LIC.'SS G' S SEE REVERSE SIDE FOR SPECIAL APPROVALS 2 DESCRIPTION OF WORK Lu z NE ADD LTER REPAIR DEMOLISH SO' FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE */ � J" /4' SIGNATOR APPLIC VALUATION $ �00 O APPROVALS DATE INSPECTOR'S SIGNATURE P.C. \ PMT. FOUNDATION: LOCATION FEE $ 7 pZU FEE $ Z -G� FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMP OY ANY PERSON IN OLA. TION OF THE LABOR CODE OF HE TE OF CALIFO N RELAT. LATH, INT. ING TO WORKMEN'S COMPEN T URANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED 41 ADDRESS FINAL JOHN F. LEWIS, PRINCI-AL ST URAL ErNGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH 11AY 720- IAr_ 969S ,my 1 1 D 12.00 76A 638A CE#8.03 3-66 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING �] DEPARTMENT OF COUNTY ENGINEER ADDRESS LGl S 7r_.as )r T2 m A i BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST v COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST. 'P DISTRI T NO.� GROUP TYPE PROC S]FD. FOR APPLICANT TO FILL IN �, � CONST. / Hyl Y BUILDINSTATISTICAL C ASSIFICATION SEWER MAP ADDRESi"j- Las .-e U�.L ASS NO. DWELL UNITS BK PG LOT NO. 175 laz j, ,Q �U�174BLOCK US ZONE MAP .� NO. C TRACT 6561 SPECIAL 35 x 1, • NO BLDGS. CONDITIONS j SIZE OF LOT NOW ON LOT Tyne USE OF EXISTING BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF (STREET) OWNER r t P87-45 I - T �7�,� TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS 0621 Las 1U'r1as Drive HIGHWAY WIDTH FROM C.L. CITY Temple City, + _ ARCHITECT OR _ TEL. SID PROP.ACK FROM ENGINEER II SIDE PROP. LINE OF - (STREET) �/ 1?l��y� TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS 9170 Lapse Tunas Temple Ii V� HIGHWAY WIDTH FROM C.L. CONTRACTOR v hn MarscL EL. 286-9Q + _ > _ p. ADDR ES51Il L 1CVV 015 CORNER CUTOFF YES � NO El c CITY Sar. Ga CIL SEE REVERSE SIDE FOR SPECIAL APPROVALS C DESCRIPTION OF WORK 0 NEW ADD ALTER REPAIR DEMOLISH F met SQ.FT.�/� NO. OF 2 NO. OF SIZE 1 0165 STORIES G FAMI LIFS USE OF j 11 STRUCTURE C q ,� Q z+ ,M. Aaw )IF blSIGNATURE Ff, l -�' Lf i 1 APP LtCANT a-U— ! !�� VALUATION$ C^ ,00 } + APPROVALS DATE INSPECTOR'S SIGNATURE ' PMT. j FOUNDATION, LOCATION FEE$ S U FEE$�G f FORMS, MATERIALS $. FRAME, FIRE STOPS, j I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK A AUTHORIZED HER I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. -7- T TION OF THE LAB CODC OF THE STATE OF CALIFORNIA RELAT- INGTO WO KME S OMPENSATION INSURAN E. LATH. EXT. k2 SIGNATU w,� '/,IT HOUSE NUMBER COR- PERM ITT .=t''� RECT AND POSTED 04 ADDRESs z s: F I N A L ' JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIO CK.'`ll M.o CASH t r : 19' Jn!31 1 0 6 5.5 G j APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A DEt l 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 c\ L- copy thereof(Sec.3800,Lab.C.) CITY � � ZIP^ Policy No. Company �6t4 PL_ �` �✓ ` 1177 g© LOCALITY , SIZE OF LOT NO.OF BLDGS.NOW ON LOT [I Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS V d d CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE J\ ( WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS ct rZ C �I,}S DISTRICT GROUP TYPE CONST FIRE ZONE PROCES E BY dollars($100)or less.) ti CRY ZIP f� �+ I certify that in the performance of the work for which this permit �eca, In QO� 'l �' 4( is issued, I shall not employ any person in any manner so as to ARCHITECT O ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT C NDC` Date Applicant ADDRESS CLASS NO.C;796A 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. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL 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 D BK PG ® �- DESCRIPTION OF WORK ADD ❑ VALUATION 0_ License Number Lic.Class Q Contractor Date ALTER ❑ $r /v'B� U El am exempt under Sec. REPAIR 11 $ Q B.&P.C.for this reason DEMOL ❑ LDMA P/C# V Date: USE OF EXISTING BLDG. URM ❑ CO SignatureAPPLICANT(PRINT) TEL NO. LDMA Perm# j Z �❑ I, as owner of the property, or my employees with wages as I I ZO AC'w-I ,0 their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE C ��:i ,i -1[LI Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J 11 r} OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE .t f i EMS 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, 1 YES ElNo 11 TOT I NL 6B m 40 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK ar; OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECK 6 W CONSTRUCTION LENDING AGENCY I COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. rL1(11AL,]E. a LIJ I hereby affirm that there is a construction lending agency for YES❑ NO❑ W the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 1 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LAS ANGELES COUNTY CODE, C4 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS �.�il�!f .��ILII 1 '; j`��5.: tr Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address I OWNER oa nc+exr -174"1 L fill .j-14 0 c I certify that I have read this application and state under penalty P.C.FEE PERMIT FEE of perjury that the above information is correct.I agree to comply �`�0 N with all county ordinances and State laws relating to building i• m constru n, and hereby authorize representatives of this County ISSUANCE FEE��. yo a to r on the bo - ntio ro erty for inspection purposes. 7 A ��� 7 INVESTIGATION FEE TOTAL FEE Q m Ppptieanl m A9 Oma I SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATIMIFORBUALDING PER IT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION t -FOR APPLICANT TO FILL IN Bu16 ING ADDRESS I herebyaffirm that I have a certificate of consent to self insure, (BUILDIINNIG DD EqSS .�y or a certificate of Workers'Compensation Insurance,or a certified I ` 1 6 L. h n A S copy thereof(Se 38800,Lab.C.) C CITY ` CI \ ZIP LOCALITY Policy No. Company �+ ��� ��^ SIZE OF LOT r NO.OF BLDG&NOW ON LOT is hereby f NEAREST CROSS ST. RF-Certified copy y urnished. I E ❑ Certified copy is filed with the county building inspection 'TRACT' ';• BLOCK.' LOT NO. departmg\1;4 C `1� USE ZONE MAP NO. Date v• J Applicant X)7� ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER_0,. C TEL NO. YES NO Z$-1 qq WITHIN 1000 Fr OF SCHOOL? u COMPENSATION INSURANCE (This section need not be completed if the permit is for one hnd ADDRES DISTRICT GROUP TYW CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance ofr for which this permit O �' is issued, I shall not emplo person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to orkere'Compensation Laws. STATISTICAL CL SIFICATION APT CONDO DateApplicant 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' NTRACTOR TEL NO. 1 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith O 00 h L FRONT comply with such provisions or this permit shall be deemed revoked. ADDR ,n LIC.NO.I•O� PL LICENSED CONTRACTORS DECLARATION 1I Ila L4 � CL SIDE CF 2 L UC.CLAP q P L; I hereby affirm that I am licensed underprovisions of Chapter 9 (� 1 SEW€R MAP (commencing with Section 7000)of Division 3 of the Business and S .FT.S NO.OF STORIES NO.OF FAMILIES Professions Code,and my lic►e{�skis in full force and of t. NEW ❑ BK I PG ® a License Number b 1 Jn LID.Class 'DESCRIPTION OF WORK ADD ❑ VALUAT N Q ��11 i to $ Contractor tll Q S A '�D a v`Date b I j s•It If ALTER ❑ O O ❑ 1 am exempt under Sec. + 't ro ,6' 141 REPAIR ❑ U B.&P.C.for this reason e A (lam i W A DEMOL 11LDMA P/C# W Date: USE OF EX TING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. t LDMA Perm# z ❑ I, as owner of the property, or my employees with wages as Z ACCT.'r' their sole compensation, will do the work and the structure is ,ADDRESS 0 -6.98 not intended or offered for sale (Section 7044, Business and FINAL DATE / Q S03 15 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL W�Z-_ -1 1 ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY r- r licensed contractors to construct the project (Section 7044, T 13TAL �,•._-6 —93 Business and Professions Code.) YES El NO 1:1 WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING �fI.1 ` - 15;6.98 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR �, GUIDELINES. CHANGE =f-,.0 I hereby affirm that there is a construction lending agency for YES❑ NO❑ Nthe performance of the work for which this permit is issued(Sec. 1: O) 3097,CIV.C.) IHAVEREADTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING / C4 I TITLE 2.CHAT UNDERSTAND MY TER 2 20 SECTIONS 2 20.00 ROUGH 2 REQUIREMENTS0 14UNDER THE 0S ANGELES 0 CONCERNING COUNTYCODE, 0000-000 j O/ 15�95 Lender's Name I MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 0 Lender's Address , 0897 1 AM 9:56 ' O j OWNER OR AGENT - c I certify that I have read this application and state under penalty oIP.C.FEE PERMIT FEE of perjury that the above information is correct.I agree to comply /J� \ N with all county ordinances and State laws relating to building c� construction, and hereby authorize representatives of this County ISSUANCE FEE `• t ato terupon he above-mentioned property for inspec'on urp�c s. �y 5 7� S 'INVESTIGATION FEE TOTAL FEE ftmtum of AOP10-1 m Age FW_.� (O SEE'REVERSE FOR EXPLANATORY LANGUAGE APP.LI1, "ATION FOR, BUILDING -PERMIT COUNTY OF LOS ANGELES' BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO.FILL IN BUILDING ADDRESS o 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 C"' %.- 5 _";�"`J N S - copy thereof(Sec.3800,Lab.C.) CITY ZIP �� Policy No. Company r T- �T LOCALITY e-, 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. USE ZONE MAP NO. Date Applicant ASSESSPAGE zp PARA/ / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE I,N L L `_` l E V—%- -1_4S23 WITHIN 1000 FT.OF SCHOOL? YES NO (This section.need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) q�o�� \_A N p(t` DISTRICT GROUP TYPE CONST, FIRE ZONE PROCE Y CI Y ZIP `� 'J/ I certify that in the performance of the work for which this permit ^ „K LF G`+ �• � Yee is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT R ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CdNDO 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 Aw a a 0 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRE LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY uC.CLASS PL I hereby affirm that I am licensed u.nderprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO. F STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG ® } License Number Lic.Class DESCRIPT��r�pK A ADD � VALUATION BD U Contractor Date 7f ALTER $44,0d T 1 w G 1�s N-Ati REPAIR ❑ OO ❑ I am exempt under Sec. BAP.C.for this reason DEMOL ❑ USE OF EXISTING BLDG. LDMA P/C# h� W Date: URM ❑ Gn IFFLC FS rY Signature APPLICANT(PRNT) TEL NO. LDMA Perm# _Z �nol ner of the property, or my employees with wages as ZO le compensation, will do the work and the structure is ADDRESS nded or offered for sale (Section 7044, Business and FINAL DATE G I Professions Code.) s wLL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I 11 I, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER J HUT.GREATER THAN THE AMOUNTS SPE�CIFl{Ey ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > ^• licensed contractors to construct the project (Section 7044, YES❑ NQS -'=(L-` i�-' T Business and Professions Code.) [[[ WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING ( OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - �I EM'ti _CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES .5.9+ ? -4 I hereby affirm that there is a construction lending agency for YES❑ N C•-'EI i;1 C11 the performance of the work for which this permit is issued(Sec. �•t�lofi. i ?s'7•. 0) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING a 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, .I•;ANG li) $ Lender's Name TMA ERIITLE ALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOCHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 R,MDNG HAZARDOUS p o Lender's Address owwEp OR AGENT c I certify that I have read this application and state under penalty P.C.FEE PERMIT FEE of perj that the above information is correct.I agree to comply �. -�; , �3 c- N th county ordinances and State laws relating to building — � �"`� '=``•r-� 1 AN ''`'� m co uction,and hereby authorize representatives of this County ISSUANCE FEE . LL V) to ter upon thea 6e-mentioned property for inspect i pu os �V Io «�1 k (� INVESTIGATION FEE TOTAL FEE/ Q �[ 7 SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION insurebor a certif ca a off Workers' Compensat on Insurancef APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company DU DING�� /_ T -t+ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS \ b l� ` �� Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS I. TqV N QR S `1)%1 LOCALITY rvn .-c- ^T C \ \ O NEAREST ` '�J N A C r t v 7 Date Applicant CITY ` F V^ l E T ZIP , � CROSS ST. �7 CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR � COMPENSATION INSURANCE SIZE OF LOT 5 I` k0 NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP `� O O. hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. �/f SPECIAL >.I certify that in the performance of the work for which this OWNER �J 0 t N'� ` �l� ZEAL NO.���`y15Y CONDITIONS d permit is issued, I shall not employ any person in any manner11 c DISTRICT GROUP TYPE FIRE P ESSED BY 0 so as to become subject to the Workers'Compensation Laws. ADDRESS CA6 �+ Cld �.L t 7 CONST. OE ,5 0 `/ CITY r-- LE C ,'F ZIP 1�0 0 X Date Applicant STATISTICAL CLASSIFICATIO API" CONDO. 1_ NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR. TEL. (J ENGINEER N A NO.�Y b�� j CLASS NO. _�DWELL. UNITS W Exemption, you should become subject to the Workers' H Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR C fit- NO. ��`3�1 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC, I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. U Ou Professions Code, and my license is in full force and effect. CITY CLASS $ , SQ. FT NO.OF -1_ NO. OF CHECK License Number Lic.Class SIZE �10 STORIESFAMILIES ONE $ Contractor Date DESCRIPTION OF WORK FE'"L•+�C� NEW ❑ ADD 11I am exempt under Sec. _ PSC+! fid ALTER FINAL B.&P.C. for this reason REPAIR DATE Date: USE OF �j FINAL EXISTING BLDG.\-�Z A%` S rt S DEMOL ❑ By Signature APPLICANT ` TEL. OWNER-BUILDER DECLARATION PRINT QOM\Kk ZE��AFiolL y �, I hereby affirm that I am exempt from the Contractor's License C , r Law for the following reason (Section 7031.5, Business and ADDRESS b � c<-el aw-t�- 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. �,� 2A ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM dEX �,IQ. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE (�G( I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE P.L. i i Lender's Name P.C. Fee$ 3_0� Q Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee U above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee 3" v and hereby authorize representatives of this County to enter j upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE u 8 Signature of Applicant or Agent Date ' m= WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company / Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Pol Certified copy is filed with the county building inspec- BUILDINGQ b ❑ tion department. ADDRESS ` c L v W k5; (� LOCALITY At-1, W0 (, NEAREST Date Applicant CITY N^ t t t ZIP l t� 6 0 CRO55 ST. CERTIFICATE OF EXEMPTION 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 ZONE MAP n -- hundred dollars ($100)or less.) TRACT BLOCK LOT N� 0_ NO. \ TEL. �' SPECIAL n, I certify that in the performance of the work for which this OWNERVOtAtWtil kkC � 14NO. CONDITIONS O permit is issued, I shall not empl ny petA A `, ' DISTRICT GROUP TYPE FIRE PROCES BY U ADDRESS `�? w 1 t `•L i' ST CONST. ZONE so as to become subject to the _ rkers'C ' � � 1/ _�/3 ' �✓� CITY �� L �1 ZIP �� 1 I�Date App i _ STATISTICAL CLASSIFICATION CONDO. V ARCHITECT Oq TEL.NOTICE TO APPLICANT: If, ter making �A NO. 3 3 }� tL Exemption, you should become subject to the Workers' ENGINEER H CLASS NO. DWELL. UNITS N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be deemed revoked. TEL. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that l am licensed under provisions of Chapter 9 ADDRESS / NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS SQ. FT. NO. OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE S Contractor Date DESCRIPTION OF WORK t NEW ❑ ❑ f ADD I am exempt from the licensing requirements as I am a •].` � L licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, u }js 4- GREPAIR ❑ DATE Business and Professions Code). USE OF C —1 DEMOL ❑ FINAL EXISTING BLDG. ETAS S ` L�i By Lic.or Reg. No. Date APPLICANTTEL. ` OWNER-BUILDER DECLARATION (PRINT) �f�Ca„NO. Lp 6 3JA I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS A6 11 L WCr 1,,- 't 4 _T Cw rLF C t` 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). 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 2 b 3.2 A the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE ? • • • • • J P.L. Lender's Name `` 2 • • 2 2 0 C Lender's Address P.C. Fee$ Permit Fee �J • • 2 2 :'H I certify that I have read this application and state that the Issuance Fee ` a Ive in rmation is correct. I agree to comply with all County Investigation Fee 01 5-80 ordt a es and State laws relating to building construction, Total Fee -� and reby outhori representatives of this County to enter = p e above- ned or inspection purposes. i C• �/�— /o -/S- SEE REVERSE FOR EXPLANATORY LANGUAGE 0 �5 Signature of Applicant or Agent Date ' 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 0603220002 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST BUILDING ADDRESS. TR: 6561 LT: 174 BL: .001 UN: .002 3Q. FT ' STORIES TYPE 9629 LAS TUNAS DR STRUCTURE: 210 VN { TEMP CA 917802109 ASSESSOR INFORMATION NUMBER: ' 'TEOMASTBGE: SSS 97R88GRID: A3 LOCALITY: TEMPLE CITY, C 8587-019-036 1 TRUANT: EXIST BLDG USE: COMME USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: DOMINICS SHOES EXIST OCC GRP: 03/22/06 JK 03/17/07 OWNER: TEL. NO: 'BLDGS. NOW ON LOT: '- VALUATION: FINi DAT D� i Y: CODE: MORTELLARO DOMINIC;MARY A (626) 286-6358- 1,300 11 9632 WOOLLEY ST TEMP 917801443 UES•PAID DESgRIPTION OF WORK REMQ•VE EXISTING APPLY 1ROSIN, 1 BASE 2 PLIES, AND 1 CAP. ALL 'FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: MATERIALS ARE GAF FIBERGLASS WITH TRUMBALL ASPHALT APPLICANT: TEL. NO: ROSA (562) 691-5950- AA BLDG PERMIT ISSUANCE 27.75 1 5615 WESHAM PL AS STRONG MOTION OTHER 1300.00 VAL 0.50 SPECIAL CONDITIONS: BREA, CA 92621 112 .PERMIT W/0 EN-8C 1300.00 VAL 82.20 II TOTAL FEES 110.45 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ROSA ROOFING, INC. (310) 691-5950- '1 5615 WESHAM PLACE LIC. NO I LOCATION AND SETBACKS . BREA CA 92621 551075 639 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FO (DATION TRENCH FORMS LIC. NO: i SLAT UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150H269 3 01 FLO)R SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: NO 21 ROOF SHEATHING I SCHOOL WITHIN HAZARDOUS SHE PANELS AIR QUALITY: 1000 FEET MATERIALS E1• NO NO NO I FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST 1 FIRSPRINKLER HANGERS SET BACK YARD: BUY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATE I RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES I RATED SHAFTS OPENINGS T- (BAR CEILINGS i p r LOT, DRAINAGE REPORT ID: DPR261, ROUTE TO: BS0508 �, i COUNTY OF LOS ANGELES TEMPLE CITY DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS # 0508 TENANTNIMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1311070064 PHONE: (626) 285-0488 EXT: ILEGAL ID: II NO. OF CONST NEW I BUILDING ADDRESS: I ITR: 6561 LT: 174 BL: .001 UN: .002 I SQ. FT STORIES TYPE OCCUP GROUP[ : 9629 LAS TUNAS DR I I 11STRUCTURE: 0 2 V-B B [ I TEMP CA 917802109 [ [ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: CAMELLIA 18587-019-036 I I I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI ITENANT: EXIST BLDG USE: COMME USE ZONE: JISSUED ON: PROCESSED BY: 1 EXIST OCC GRP: B [01/07/14 SR I (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL' TE FINAL BY: CODE: 1 IMORTELLARO DOMINIC;MARY A (818) 286-6358- II 7,000 I ' I 19632 WOOLLEY ST I1 [TEMP 917801443 DES IPTION OF WORK it FEES PAID I IILEGAI,'IZE RECONSTRUCTION OF.INTERIOR STAIRS & TENANT 1 I �I!FEE DESCRIPTION: QUANTITY- DOM: AMOUNT: IMPROVEMENT FOR OFFICE I (APPLICANT: TEL. NO: I I [ ISAME AS OWNER - 'IA1 PLANCHECK W/EN-HC '7000.00 VAL 162.50 I I IAA BLDG PERMIT ISSUANCE 27.80 ISPECT-AL CONDITIONS: I -IAB STATE GREEN BLDG FEE 7000.00 VAL 1.00 1 I 1AE STRONG MOTION OTHER 7000.00 VAL 1.50I E I IA2 PERMIT W/ENERGY-HC 7000.00 VAL 191.10 1 a �t� �R 1t.I ICONTRACTOR: TEL. N0: I TOTAL FEES 383.90 IAPPROV S �'E DATE INSPECTOR] SIGNATURE ISAME AS OWNER I LIC. NO II 1LOCATZON AND SETBACKS I � I I ISOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER: TEL. NO: - ! IFOUNbATION/TRENCH FORMS I 1 LIC. NO: j ISLAB/,UNDER FLOOR I I 1 I (RAISED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ !� 1UNDERFLOOR INSIILATION I I 3 001 1 1 IFLOOR SHEATHING I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I 0 NO 22 I IROOFISHEATHING I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I [AIR QUALITY: 1000 FEET MATERIALS I I 1-1 1 1 NO NO NO I IFRAME INSPECTION I I 1 I I IFIRE 'SPRINKLER HANGERS I I I I I INSULATION/WEATHER STRIP[ I [ (INTERIOR LATH/DRYWALL I I 1 1 I [EXTERIOR LATH I I (RATED FLOOR/CEIL ASSEM. I I 1 I IRATED WALL ASSEMBLIES (RATED SHAFTS/OPENINGS 1 IT-BAR CEILINGS I I I ILOT DRAINAGE I 1 I I [REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I I I