HomeMy Public PortalAbout9440 LEMON AVE_Building__ •76AB38A CE#803.10-56t APPLICATION FOR' B U I L®I 0 V V✓I ■ E R I '■ '• �•
BUILDING AND SAFETY DIVISION BUILDING
aDDREss
Department of County Engineer �
County of Los Angeles = LOCALITY
'JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN. SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP ,I TYPE SEWER 'MAP PG
FOR APPLICANT TO FILL IN BK.
_ CONST:
ADDREBUILDIN STATISTICAL CLASSIFICATION '
G' -Z e+r• CLASS. NO. DWELL. UNITS
LOT NO. •r• -BLOCK ,MAP ,STATE
YES
NUMBER O
TRACT USZZQNE SPECIAL "
NO.OF BLOGS. / !) ►- CONDITIONS�i �- 31•- �Et� „S
SIZE OF LOT Op�41��J•� ��V1 NOW ON LOT �It�-6�.•� �y ,ri _ �•
USE OF /1 G S/ LJ/",< �/ �''' <�V r(!
EXISTING BLDG. N ` F, BUILDING EXIST.
_T q SETBACK YARD HWY STREET NAME WIDTH
OWNER - J OH W• 4- FJ • F_ FrRONT
MAIL -
ADDRESS da A114-Al PV1.;__ I- ?iIDI-
c►TYTF.y P L F JT7� rTio'F "T^7-s'l2 INSPECTION RECORD
ARCHITECT ORfp �j rf TEL.�y '
ENGINEER ICOl7FIT'��t�r/- NO. LT 6--7/bA112 17 r19 �,.. . ,.q r- P
ADDRESS Ni -
4
TEL
CONTRACTOR r 1` NO. q -
ADDRESS -
DESCRIPTION OF WORK
NEW• ADD 6/ ALTER k1_1EPAIR DEMOLISH } ,�/ J� /�/� .t �//� /� �1
SQ. FT. NO.,OF NO. OF ,+ /V 1 d-h l/T1U/► //J A//L 2 /DU�LC
SIZE 1G 'j 0 STORIES ,. FAMILIES �• `/ `
USE OF STRUCTURE Z+XL3 S,7'dIJS - PLCO Jl'SY'F•D CHtr
��Sl'N
• APPROVALS - u �L
SIGNATURE
APPLICANT �/ � Q DATE INSPECTOR'S SIGNATURE
ADDRESS�yp�nn D Y/ L-7-6.415L VC • FOUNDATION: LOCATION j K� ��
FORMS, MATERIALS r /_
$ FR,4ME: FIRE STOPS
P
E• �„' BRACING. BOLTS
,� $ FURNACE: LOCATION.
FEE ~ G
VALUATIQ .4S VENT..DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INTO �! I ✓ r�i��� /���,/f/'�
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH, EXT.
AGREE TO COMPLY���NNN���111TH L C UNTY ORDIN CES AND
�,dSTATE' LAWS REOIJKATI BU ING RU ION. -
SIGNATURE OF `/7/ •HOUSE NUMBER COR- [-p.
PERM ITTEE J
`TEEE RECT AND POSTED
ADDRESS `� �• ' FINAL'
JOHN A. LAMBIE. COUNTY ENGINEER, -=LYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION 0-4K. M.O.' CASH PERMIT VALIDATION cK: M.O. CASH
,1'--0-.:8,0—tn ,:AuG13 1 6 Z 4.2 5 A�
1 .3 2r 1.-n AIS 1 3..3:5 0 �.
•- FYI` a�i'J �,is-rim. ✓ /
• � L . -APPLICATION FOR)BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING Cts Le ,D COUNTY 'OF LOS -ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY �. c -/ ' '^ -_ ZIP BUILDIN/G�- AND SAFETY DIVISION
F LOT 1 1 XZW NOW ON LOTNO.OF S. BUILDING'
AD
SIZE OF LOT Z'
TRACT BLOCK LOT NO LOCALITY
TEL. NEAREST
OWNER til(" NO. CROSS ST:
ASSESSOR .
ADDRESS _O LP.w"vx MAP BOOK- PAGE- PARCEL
^~ DISTRICT 1GROUPITYP I
FIRE CE�SEO BY
CITY c C— ZIP _ _7- CONST. -ZONE--
ARCHITECT_ OR —� •- TEL.
ENGINEER - NO.
_ STATISTICAL CLASSIFICATION _ SEWER MAP
ADDRESS CLASS N _DWELL.UNITS /� BK' �tii
CONTRACTOR �S - LT L. �• D USE ZONE MAP- T
LIC. _ NO.
ADDRESS 2G� �e NO. �� SPECIAL
LIC. Q� CONDITIONS -
CIT_Y CLASS �J
ROAD DEPARTMENT APPROVAL REQUIRED Y-ES� NO
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.S TRACK FROM
`— FRONT ROP.LINE OF (STREET) CL
ADDRESS CITY C7
TOTAL SETBACK FROM TYPE'OF EXISTING U
SQ FT NO. OF - NO. OF CHECK HIGHW } . YARD - FRONT PROP. LINE HIGHWAY WIDTH
SIZE 566104 STORIES ( FAMILIES ONE CD
1 ' 1 } - V
DESCRIPTION OF WORK NEW ❑ - a
❑
ADD BLDG. TBACK FROM - -N
SIDEPR INEOF (STREET)_. Z
ALTER ❑ HIGHWAY + YA _ TOTAL SETBACK YPE OF EXISTING
_ RD -
REPAIR[] SIDE PROP. LINE HI Y WIDTH
USE OF
NG BLDG. ( •m' -C'E . DEMOL }
EXISTING
�1 CORNER CUTOFF, YES-❑ NO ❑
APPR NT) - NOL G 3310
(PRINT) SI E .
BY (SIGNATURE) L ` - + IN OPEN SPACE - YES El ❑
Q ` IN COASTAL ZONE YES ❑ NO ❑ _ -
VALUATION �Y - 0 - - - CATEGORICAL EXEMPTION YES NO ❑
HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS APPLICATION ENVIRONMENTAL-
AND-STATE THAT THE ABOVE IS CORRECT•AND AGREE TO COMPLY IMPACTEXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS-REGULATING BUILDING CON=
-STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
'HERE B_Y I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABORCODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMP TION INSURANCE.
SIGNATURE 0
PERMITTEE
_T
,-
ADDRESSS- n O r 2 ,
FINAL
CITY t,� IIU�,��Q NOTE L 7 DATE BY -
11,1tiE (JILCKS 13 -ABLE 10: FEE $ FEE
HARVEY T. BRANDT, COUNTY ENGINEER
e.)
PLAN- CHECK VALIDATION cK M O CASH _ PERMIT VALIDATION CK mo CASH
2 9 5 473 AUG 2 7 1 -D 3 tQ Q A
�_76A638A CE#803 12/72 --
APPLICATION FOR,BUILDING PERMIT
FOR APPLdGANT TO FILL IN (Print or type only)
-BUILDING 1 COUNTY OF LOS ANGELES
ADDRESS d DEPARTMENT OF COUNTY_, ENGINEER
CITY - ZIP /7�p BUILDING AND -SAFETY DIVISION
t
NO.OF SLOGS. BUILDING
SIZE OT - Zd NOW ON LOT Z— ADDRESS
LO C , LOT NO �� LOCALITY L
E y NEAREST
OWNER _ '—J,2- CROSS ST
ASSESSOR
A_DD SS MAP BOOK PAGE PARCEL
DISTRICT lZROUPITYPE FIRE E S S E D BY
CONST
CITY Z IlP -"
ZONE
ARCHITECT OR TEL. �
ENGINEER NO.
- STATISTICAL CLASSIFICATION'. SJ,E/WER MAP
ADDRESS - CLASS NO. 1"2�DWELL•UNITS /r(BKI<,IPG
CONTRACTO TEL 3 USE ZONE MAP —7 O Q3
LIC. NO. C�—
ADDRES NO �/ SPECIAL
LIC. s/ CONDITIONS
CITY CLASS
, ROAD DEPARTMENT APPROVAL REQ-UIRED YES❑ NO []
-CONSTRUCTION LENDER
NAME AND BRANCH BLDG,SETBACK FROM
"- FRONT PROP.LINE OF (STREET)
ADDRESS CITY
HIGHWAY YARD —_ TOTAL SETBACK FROM TYPE OF EXISTING O
SO F - NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH-
SIZET STORIES FAMILIES. ONE tr
} O
DESCRIPTION OF WORK NEW C�
ADD BLDG.SETBACK FROM a
- - - - SIDEPROP. LINEOF (STREET) GO
ALTER ❑ _HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING
-
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE
EXISOT NG BLDG. �'1.A��,�-(�� .- _DEMOL ❑ +
APPLICA T TEL (J/� CORNER CUTOFF YES ❑ NO ❑.
(PRINT) SILYNI )"7
NO.Z 3j 33 o -
BY-(SIGNATURE IN OPEN SPACE _ YES ❑ NO ❑
�
a IN COASTAL ZONE YES ❑ NO ❑
VALUATION$ CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL ,
ANDSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT _ EXEM PTION•DEC LA RATION SIGNED (DATE)
WITH ALL 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
WORKMEN'S COMP TION IN_5U_RANC _ / 7
SIGNATURE -
PERMITTEE -
ADDRESS 2 e-V'C. �Q +7�7./
TE
FINAL-
CITYIL
` 9\ v•� � NOL•1�✓ U(Jb DATE - �• 46 -F Ft*
%l.lAE (JIL-CKS PAYA131-E 10: FEE FEE'
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION OK M O CASH
�y (' 2 9 5 373, AUG � 7- D 3 5 . 5 G
76A638A CE#803 12/72
,fir+ ' - `���/ 1 ' •
'APPLICATION �FOR "BUIL'DING-a.PERMIT :
JT,OR'ABPLICANT TO FILL IN onlv)' •':
., •:. a-'y
BUI LDING- •-'° - - '° ,COUNTY•,OF;,LOS .ANGELES
ADDRESS �O rn v /'1 }' ,,.,i.. DEPARTMENT-*,OF- COUNTY••`ENGINEER
CITY .� C z•IP - - �AUILDING;AND SAFETY' DIVISION-
(� NO.PF BLOGS. BCJIL'DING
rSIZE OF LOT 9�/'joP NOW,ON LOT ' ADDRESS;,
TRACT BLOCK, L'OT NO LOCALITY iQf;�`
% TEL. NEAR
EST /^
OWNE-R- NO. CR OSS tS,.,,
.., 'ASSESSOR
ADDRESS �'. � �,� ± �;Q MAP,`BOOK 'r PAGE: �`•'� PARCEL i
n f ''yam •DISTRICT" GROUP` TYPE FIRE .. ''PROCESSED-BY
GZONE
CITY' �P /�I�'/, /•/ YZIP ...#4.::� ;� :� OpI �• ,�
dRCHITECTtiOR.� - TEL.`
.ENGINEER �';, - ,r_- -,e _ NO., ,,,%�;• rt;� :STATI5TICAL+CL•�A`SSIFI•CATION' SEWER MAP `
ADDRESS ��° ti ,..r� y' oC
1 ,CLASS"N ' DWELC,UNITS�O. .. BK -. PG
CONTRACTOR .O / I`1'I�f H .NOL. /-�J -•71 SE ZONE MAP'''
y LIC. /� J NO:
-ADDRESS' '�S •,C Ate NO.'-'Q2;0 G- .•��� 'SPECIAL•
J/ - - LIC: o ]CONDITIONS •, _' --., - - ,
CITY'S %?./T(.10 > " 'CLASS -.•I. - - _
R Q.A.D D E P ART M E N T',-'A'P P ROV AL REQUIRED YES❑ NO ❑
CONSTRUCTION-LENDER
NAME AND BRANCH y - - - BLDG.SETBACK-FROM"•;'„ -
_ FRONT PROP:LINE OF,' (STREET)
ADDRESS . ' CITY ,
'
T,HIGHWAY• } 'YARD 07 A L•SET BA-C K'FROM _TYPE OF; EXISTING
SQ; FT_ -NO.-OF - .NO. OF CHE,O•K' _ � ,-. ,} FRONT PROP, LINE HIGHWAY WIDTH
SIZE .STORIES f FAMILIES •/'
d
DESC RI NE SOF WORK - NEW '� "- • ' r U
�• ADD- BLDG.-SETBACK"FROM :+
SIDE PROP.LINE OF (STREET)
LTER ❑
TO-T A,L SETBACK FROM .,TIG iWA . EXISTING I-'
'^- _ HIGHWAY''- +.' YARD'. - U
,0 Y G�r't.� REPAIR
SIDEP ROfP. LINE HIGHWAY WIDTH -ly
USE OF
EXISTING':BLDG•_/Fle djP-ry,Ce 'DEMOL ❑ N
AP(PL:CANT �/ '174/y'�' ,, EL"33 )� �CORNER;CUTOFF. -- ',YES'❑, ..NOh,❑
IN.PPEN SPACE - •YES•❑„ NO .❑. -
BY (SIGN•ATUIRE_) - '1 -~ ,
IN COASTAL PERMIT ZONE-_ YES'•❑ NO ❑
VALUATION, `' 76rO 0'.QV'.1 '_.`. �/-/yL7�• 7 ,,�/
•,I HEREBY-ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, •" '�_• /' �'"��
AND• STATE THAT THE -ABOVE'IS CORRECT AND AGREE TO:COMPLY••
WITH' ALL -ORDINANCES AND LAWS -RE GULATI_NG BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY' I-WILL',•NOT EMPLOY' ANY PERSON IN 'VIOLATION OF THE-
LABOR CODE.+OF -THE STATE OF -CALIFORNIA IN',RELATING .TO
WORKMEN'S COMPENS ION
SIGNATUREOF I RANGE.
" 'Y•�' -
PERMITTEE - �' •' - -
ADDRESS
_ �t --77 ;FINAL..'', > Br j y
•CITY'' •NOL yam , DA1TE -•� , .
d u_.
P.C.'Qa` T.;
MIAKE,CHECKS PAYABLE TO: FEE"✓ FEE
HARVEY T. BRANDT, COUNTY'ENGINEER
'PLAN'CHECK VALIDATION :-C K' -� M 0 CASH, PERMIT VALIDATION CK -M O CASH
76A638A CE*803 P/7.4
t
76A638A CE4803 8-63 APPLICATION FOR BUILDING PERMIT'.
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 9440 E,-Lemon-Ave
BUILDING AND SAFETY DIVISION LOCALITY Temple ity
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. /�
DIST CT.N 'U TYPE P OCE B
FOR APPLICANT TO FILL IN ��L> CONST.
BUILDING STATISTICAL CLAS IFI ATION SEWER MAP
ADDRESS 9440 E. Lemon Ave . CLASS. NO." DWELL. UNITS �;_ BK c!t O
i
LOT NO. 2 BLOCK WATER
T,,, CERTIFICATE: NOT REQUIRED ❑
ARECEIVED
TRACT Santa Ana L MAP /' HIGHWAY STATE MAJOR SECOND. OCAL
NO.OF BLDGS. NO. v (CIRCLE)
SIZE OF LOT NOW ON LOT UO SPECIAL
USE OF CONDITIONS
EXISTING BLDG.House and Qaracig- 7512,
OWNER John W. Littler NO. BU LDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS 9440 E. Lemon Ave FRONT Q
ARCHITECT OR TEL.
P.
L.
60
ENGINEER StandarCl plan NO. SIDE
ADDRESS
a
TEL. O
CONTRACTOR A N7�J 10 V
ADDRESS to 0 U
DESCRIPTION OF WORK O
• i- W
CL
NEW X ADD ALTER REPAIR DEMOLISH - Z
SO. FT. NO. OF NO. OF
SIZE 481 STORIES FAMILIES
USE OF
STRUCTURE Private swim ponAStd- p1da 211a,4
SIGNATURE OF
APPLICANT
71 VALUATION 52500. 00 APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. f FOUNDATION: LOCATION ;
FEE $ -3 , FEE $ / (/ FORMS. MATERIALS 4'
FRAME: FIRE STOPS,
f I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGR TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LA S REGULATING GAS VENT. DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN OI G THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY FNV E SON IN VIOLA- LATH, INT.
TION OF THE LABOR CODE OF THE STA OF CA IFORNIA RELAT-
ING TO WORKMEN'S COMP SATION IN A E.
LATH. EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTEE �7 ECT AND POSTED
ADDRESS S S/ l Fireston i "If,,AL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
V 0 6 3 1 JUN 29 2 3 D 3.7 5 ••
� `uv 0 6 3 2 JU'N 2 9 1 D 15.00-
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY.
WORKER'S COMPENSATION DECLARATIONFOR APPLICANT TO FILL IN BUILDING ADDRESSell I v ON
I hereby affirm that 1-have a certificate of consent to self insure, BUILDING ADDRESS
or,a certificate of Workers' Compensation Insurance,or a certified
copy thereof(Sec 3800,Lab C.) CITY � ZIP
7�Q LOCALITY
POIICy No. Company SIZE OF LOT NO OF BLDGS NOW ON LOT'
❑ Certified copy Is hereby furnished' NEAREST CROSS ST
❑ Certifled•copy Is filed with the count y•build Ing Inspection TRACT BLOCK LOT'NO
department - - USE ZONE MAP NO.
Date A Ilcant ASSESSOR MAP BOOK PAGE PARCEL ; //////
PP SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER /J, b/J r _ TEL NO YES NO
COMPENSATION INSURANCE } 1/f//7f /► ,(� WITHIN 1000 FT OF SCHOOLS
ADDRESS `1 A fI�/�•r .
(This section need not be completed If the permit Is for one hundred r[fo DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY '
dollars($100) or less)
1 certify that In the performance of the work for which this permit CITY- ZIP f /�I �`tQis Issued, I shall not employ any p son In any manner,so as to ARCHIIT CT OR ENGINEER TEL/NO 'V
become s je t t0 the Workers'C nsatio a STATISTICAL CLA SIFICATIO APT CONDO
Date• Applicant ADDRESS CLASS NO i= DWELL UNITS -•
NOTICE ITY APPLICANT If, aft along this Certificate of REQUIRED TOTAL SETBACK FROM EXIST,
Exemption, •you should become subject to the Workers' CONTRACTOR JJO SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith /V/X�/ FRONT
comply with such provisions or this permit shall be deemed revoked ADDRESS/ u P IL
LICENSED CONTRACTORS'DECLARATION SIDE
CITY � LIC CLASS P L
I hereby affirm that I am licensed underprovisions of Chapter_9 SEWER MAP_
(commencing with Section 7000)of Division 3 of the Business and SQ FT SIS NO OF STORIES NO OF FAMILIES
Professions Code, nil my cense Is In full force an effect NEW BK PG ,
License Number LIC.Class DES /� ADD ❑ VALUATION
Q
Contractor Date ALTER ❑ $ � `� U
17
ElI am exempt under Sec REPAIR E3 $
B&PC for this reg
DEMOL ❑ LDMA P/C# W
• - Da USE OF EXISTING BLDG URM ❑ 3 -
co
._ Signature ' ' APPLICANT(PRINT) TEL NO LOMA Perm#. - a Z
❑ I,'as owner of thepe or my employees with wages as .
their sole compensatiori,�wdl do the work and the structure Is ADDRESS.. 9-` F %J1J0 *8. -J
not Intended or offered for sale (Section 7044,,Business and i FINAL DATE j•a i
Professions Code) Z 1
.. ._ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE rr�••� JL
Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'S FINAL BY �' y, Al•4 i'.4
licensed contractors to construct the project (Section 7044,
Business and Professions Code) res 1:1 No❑ 3
30
7 161.37
WILL THE INTENDED USE OF THE BUIDUNG BY.THE APPLICANT OR FUTURE BUILDING - a
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '
CONSTRUCTION LENDING AGENCY 'COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 2 ITEMS
GUIDELINES -
I hereby.affirm that there Is a construction lending agency for YES El NO❑• ° " 'TOTAL 2 10 .. 12
a the performance'of the work for which this permit is issued(Sec HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING c ��(( i���! q
3097,CIV.C) CHECKLIST I UNDERSTAND MY,REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHECK 210.ii .
'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 SCAOMD f;L1ALit_C a1�1
o , Lender's Address
CHANGE V
- 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 PC'FEE PERMIT FEE �f 10
00 I— 1 i
N with all county ordinances and State laws relating to budding 2/ 9/9,-",
< construction, and hereby authorize representatives of this CountyISSUANCE FEE f r 3102 1 AM 10:19
to enter upon the above-mentioned property for Inspection purposes.
(0 INVESTIGATION FEE TOTAL FEE
sVre a APwt Apem
SEE REVERSE FOR EXPLANATORY LANGUAGE
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate'of consent,to self
insure, or a certificate of Workers' Compensation Insurance, A P P L I CAT I OrI�I "FORB lJ It WN G PERMIT'
ora certified copy'thereof,(Sec: 3800, Lab:.C.) �r
_ -- COUNTJk0tJs S*=.A _BUILDING-AND-SAFETY
Policy No. Company '' a ,
' FOR APPLICANT TO-FILL IN BUILDING. I`��`i�
Certified copy-is hereby furnished. ADDRESS
�❑ Certified co is filed with the coup buildin ins c- -BUILDING
L PY t g_ Pe ADDRESS' �N �'
.-tion department.,, '- Y
'Date' CIN=' T ZIP. �TJ O LOCALITY ; ,.
APPlicant° '. NO-OF BLDGS.• ,NEAREST -
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF'LOT` (y� `` NOW'ON LOT CROSS ST-t ;
-'COMPENSATION INSURANCE,,' �y'� ASSESSOR
(This'section.need.not'be completed if the permit is for one TRACT BLOCK ,�1.- LOT�NO, •-- MAP BOOK.' �� �'° PAG6;�� PARCEL
hundred dollars ($100) or.less.) , n TEL
OWNER. USE"ZONE MAP
I certify that in the-performance'of the1work''for which this' �1 ' NO
permit is issued, I shall.not employ,a person,in any manner' ADDRESS V ! : N CONDITIONS _ ¢
•� - '����� �CONDITIONS ' ^�/°"'�'•;;a
so as to become subject to.the War s'..Compensation Laws. O
CITY -.� D ..� ZIP_,. ��• h_ U.
Date / Applicant ARCHITECT OR . .' ',, TEL DISTRICT" GROUP TYPE ",FIRE PROCESSED,BY, 1 d'
NOTICE T , APPLICANT- If,'.;after m- g is Certificate'of; ENGINEER- NO 'Y' - , CONST OZONE- ' 0a•
Exemption,..-you.should .become 'subjec. to the Workers' y ' �: YUL .
€ Compensation provisions of.the Labor Code, you,must forth- ADDRESS ,' QQ-> - :•'
with.comply,with such -provisions,or this permit shall be TEL- / STATISTICAL"CLASSIFICATIO APT ,CONDO N
deemed revoked. ;' ' CONTRACTOR NO 3p��Sxri Ste, /- Z
LICENSED'CONTRACTORS.DECLARATION,: QCr,(ff1 � / Q/ IC. y=CLASS NO. — - ELL:,UNITS
ADDRESS �(/ ��•
heieby'''affirm that I am licensed under provisions of Chapter 9 SEWER MAP
(commencing'with,Secfion 7000)of'Division 3 of the,Business-, �J�,, r LIC. „•
•
.,.and Professions Code,'.a��ense is in'full•foice and effect. CITY/I/[J t�! CLA55 BK PG..ate, VALIDATION',
r = - 'SQ:,`FT NO'OF,'7 - NO.OF' _ CHECK
SIZE ' STORIES. FAMILIES ONE '
License Number 6c. Class "
.j VALUATION
' :Contracfor �•y ` /�//' ' 'a' Date ✓ DESCRIPTION OF WORK _G W ; /1j'�✓O�Y ,�
I am ADD ❑
exempt under,Sec. - _ ❑ _
a
ALTER•
B&P C. for_•this'reason REPAIR ❑ ;
Date: 2 USE OF .
_ EXISTING'BLDG' DEMOL ❑'
t .. APPLICANT TEL - �
Signature -FINAL-
OWN -BUI R DECLARATION (PRINT) t 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 a AL;CT'.g
Prof ssions•Code)' PRESENT _ _ BY �µ
I,.as owner of,th'e ro er - l
,. BUILDING.
P. P ty,-or my'.employees�with. ADDRESS y I � • •, _ r t�JL: °� '
y wages as theirrsole'compensation;will do the work and ' -•• `,
LOCALITY`
the structure is noYintended or'offered forsale'(Section
7044,-Business and'Piofess'oris_Code.) MOVING TEL` ► ;" g _
property*, CONTRACTOR NO. _ _
❑ I, as owner of theam exclusively contracting _._ . ....._ .. �31 i - ? ti'._
with licensed con'tractors'to construct•the project (Sec-„ -- _ ..
)- ADDRESS r r v a•�'T
tion 7044,'Busines•'s•and Professions Code. y n I`TE�'{5
^ REQUIRED. _ TOTAL,SETBACK FROM EXIST S r' '.,
' CONSTRUCTION LENDING AGENCY" SETBACK, " YARD 'HWY PROP. LINE • WIDTH. 1 t y r , -•o'
I hereby affirm Thar thele is-a construction lending agency for FRONT TI tTAL' +- m '
the. erformance•of the work:for,w,hich this'Per'mif.js issued
(Sec. Civ. C.). 'SIDEt C
P•L - - - _.Y... ti ti
Lender's Name ;. :, {.�"ANGE.
o � X^ LDMA-Ref �"
' P C"Fee$ tJ+,' Permit Fee' ,
Usnde'r's.Aadressw Y
d I certify fhat'I have read,This application and slate that`fhe Issuance Fee " LDMA'P/C'#
a
8 above information,is correct I agree to complywith all.County Investigation Fee"' •� r 7940 J AM10a?6
or4fmances-and•State laws:relating to building construction, Total Fee . LDMA Perm'# -
a and hereby autho ize'representatives'of this County.to enter -
Mt�e above- ioned'pr Qrt for inspectioin-pur oses.' `" - -
a - ] t
0 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant ol Agent e k-
.i
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 i BL 0508 9706050042
PHONE: (818) 285-0488 EXT: f �-
LEGAL ID: NO. OF CONST 'BUILDING .
..ON FILE- SQ. FT STORIES TYPE 9440 LEMON AV
STRUCTURE: 0 VN TEMP CA 917801302
ASSESSOR INFORMATION NEAREST CROSS STREET:
5382-014-023 -,THOMAS PAGE: 596 . GRID: J1 LOCALITY: TEMPLE CITY
TENANT: - S SE: RESID USE ZONE: R- PROCESSED EXPIRES .
EXIST OCC GRP: 06/05/97 . TC - - 06/05 98
OWNER: TEL. NO: BLOGS. NOW ON OT: VALUATION: FINAL DATE FINAL B CODE:
TAKEMURA,JOHN (818) 447-4170- 1 1,700
9440 LEMON AV SC P 0 O F
TEMP 917801302• 0 WORM
BOLT PERIMETER WALLS TO FOUNDATION PER ENGINEERING DETAILS
FEE DESCRIPTION: QUANTITY: UOM: " AMOUNT:
TE
GREG SYLVIS- (818) 449-6118- AA BLDG PERMIT-ISSUANCE 27.75
- AC STRONG MOTION RESID 1700.00 VAL 0.50 SPECIAL IONS:
D2 PERMIT W/O
H�L�TOTALOFEES VAL 1182.20
0.45
CONTRACTOR: TEL. NO: ���\ ��J APPROVALS DAT INSPECTOR1 RE
GREG SYLVIS GENERAL CONTRACTOR (818) 449-6118-• �j
500 BELLMORE WAY LIC. NO (�^ A 0
PASADENA, CA. 91103 443627 B i `%JJ
- O �/ SOILS E G R APPROVAL
ARCHITECT 'j, p n` G—� 0 A CH FORMS
LIC. NO: , SLAB/UNDER FLOOR
' L1j�_ - RAISED FLOOR FRAMING
1MAP NO:53H265 SEW P BOOK: PAGE: FIRE ZONE:: MP01 �I} __l
� C W O� I � DERFLOOR ATION
�`J� VFLOOlt SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT7COND: STAT CLASS:
NO 21 Q 0 h ROOF SHEATHING
SC r ci ���� oPANELS
AIR QUALITY: 1000 FEET MATERIALS- 0.
NO NO NO- o i FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXISTD� FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION/WEATHER S
SIDE PL- . j C�
INTERIOR—LATH/DRYWALL
EXTERIOR LATH
RATED L ASSET.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
-BAR CEILINGS
LOT i
DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508