Loading...
HomeMy Public PortalAbout9677 LONGDEN AVE_Building__ MAMA Ce#SCM 8/60 ,APPLICATION FOR 8lJIL®'ING PERMI'T'.-.-:---<_.._.... 1 COUNTY .OF'LOS•ANGELES ' ' 6UILD,NG _• ADDRESS ?' DEPARTNIENNT OF COUNTY ENGINEER BUILDING AND SAFEW DIVISION LOCALI a ,.JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT of BUILDING CROSS ST DISTRICT�I TYPE j0CESS;D BY ' FOR APPLICANT TO FILL'IN ��' 0' X ComS . ADDRESS F 1 h STATISTICAL CLASSIFICATION SEWER MAP p� BK CLASS.No.-LL-DWELL.UNIT /LOT NO: BLOCK MAP STATE NUMBER 6 C TAT YES NO TRACTL -ZONE: SPECIAL NO.OF L4LDGS., CONDITIONS SIZE OF LOT .3 NOW ON LOT USE OF.. ..; r . EXISTING BLDG. I16Z G k BUILDING YARD HWY STREET NAME EXIST. - SETBACK ff n 1 TEL. SETBACK WIDTH OWNER dx L 47 �/b(JL�+ NO. FRONT an ADDRESS - ! LEL[ IT+�t SIDE / ARCHITECT O TEL. ?.'L••' 1 ENGINEER SPECTION RECORD. ADDRESS �07 7��rp._ J r�, - - TEL. ' �'/7/)! �-_�2��'` � r CONTRACTOR NO° x,1+ , 10. ADDRESS - DESCRIPTION OF WORK - i rl NEW :-ADD X .ALTER REPAIR DEMOLISH ,/ / �� f-41 A-V SQ,FT. NO.OF NO.OF u,, I��SIZE rIJ6 Ff STORIES - 9 ' FAMILIES �•: ''USE..OF'' " /STRUCTURE OS SIGNATURE OR' APPLICANT 1 `\ VALUATION$ Li Q o -� - APPROVALS - DATE INSCTOR'S SIGNATURE PE P.C. FOUNDATION:LOCATION. FEE �• J $! J FEE.•�/. � _ ,FORMS,MATERIALS' 1 HEREBY ACKNOWLEDGE THAT 1'HAVE READ•THIS AP- FRAMEBRAC ING:FIRE STOPS. ,BOLTS !� G-•-_.�.- PLICATION'AND STATE THAT THE ABOVE IS CORRECT AND, 'sFURNACE:LOCATION, AGREE'TO COMPLY•WITH ALL COUNTY ORDINANCES AND GAS VENT,DOCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. (t �� I CERTIFY. THAT IN DOING THE WORK AUTHORIZED 1 LATH,1NT.�GI 4�J 7 /9,I II�:/ CJI WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ; WORKMEN'S COMPE�lSA IQ LAyg3 O CAlr�F II 1/v � � � C ((JJ =LATH.EXT.' ; SIGNATURE OF. .� 'HOUSE NUMBER.COR- / PERMITTE P �-,I RECT AND POSTED. D AORES ,6 `y�' ` FINAL , :CLYDE N. DIRLAM, PRINCIPAL.ST.RUCTURAL•EN. PLAN' CHECg VALUATION -cit. .'M.o. cAsl1 PERNIIt,V_ALIDATION. ' cr. mo.":,' .o 'cash � -1- . , ~%ss I.: • •76A638A CE #803 4/72 CI Of ZE"'• �'°�°" .'� APPLICATION FOR BUILDING PERMIT - COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF aOUNTY ENGINEER MAP BOOK / F,AGE PARCEL BUILDINGBUILDING Ali6 SAFETY DIVISION ADDRESS /p. MAKE 011E 0 PAYABLE TO: o HARVEY T. BAVbT, COUNTY ENGINEER LOCA LIT FOR APPLICANT TO FILL IN NEAREST <' Print or tvoe onl CROSS ST. BUILDING DISTRICT NO. GR TYPE PR•CES D Y 0 �j CONST. ADDRESS �LO,s/ l®AUcy e-A) hie, STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO.—;12—DWELL.UNITS BK PG TRACT USE ZONE MAP Q ' NO.OF BLDGS. NO: (� SIZE OF LOT NOW ON LOT SPECIAL �} USE OF F, CONDITIONS EXISTING BLDG. a LIigf Ott,S !` F TEL. OWNERT. (r # / No.. _5 14� BL G•SETBACK FROM p ADDRESSG ���LPL72� FR T PROP.LINE OF (STREET) 3 f — TYPE. EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY j*4e- v 11 /' HIGHWA WIDTH FROM C.L. ENG NARCH ITERTECOR V TEL �� T + BLDG•SETBACK FRO-1— d ADDRESS �5'� SIDE PROP.LINE OF ` (STREET) TEL. TYPE OF EXISTING SETBACK HIGH {• YARD = TOTAL . CONTRACTOR NO. HIGHWAY WIDTH FROM G.L. C ADDRESS NO. + LL CITY CILASS CORNER CUTOFF YES ❑ NO 9 CONSTRUCTNAME AND BRANCH CHON NDER SEE REVERSE SIDE FOR SPECIAL APPROVAL ADDRESS CVA0)Lf D btVD SQ. FT. NO. OF NO. OF ^ 1 e lao'seercygevt SIZE STORIES FAMILIES NEW 1:1Loll /USE OF ADD �+ STRUCTURE J -' ALTER ❑ / U KLP REPAIR❑ _ y SIGNATUREOrl1 2 a APPLICAN DEMOL ❑ '/ P[� VALUATIONS �'�.1j APPR VALS DATE INSP CTOR's GNATURE FEES V �L FEES �� FOUNDATION:MA LOCATION FORMS, MATERIALS FRAME: FIRE STOPS, q e I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS .1 -10 -22 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 G�, HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.�� trIALL 1J� '2-7 Ff:2V LABOR CODE OF THE STATE OF •CALIFORO NIA IN RELATING T WORKMEN'S COMPE SATION INSURANCE. LATH, EXT. ' �j�-.lJ SIGNATURE F PERMITTEE USE NUMBER COR- ,n RECT AND POSTED ADDRESS Vw`+ �' a/P ;v+ , Z.5/ �1, ���� - FINAL J Z. / PLAN CHECK VALIDATION P M.O. CASH _ PERMIT VALIDATION , CK. M.O.\ ,CASH•tl - A 2 '7 0 273 AUG 1_'z �! 4 .5 O^ - � Q _�I� AA APPImlCATJON FOR BUILDING PERMIT „FO.R-:AiFPLICANT T'0 FILL IN (Print or'type dn"10- .BUILDING- �; - COUNTY OFLOSANGELES A REss DEPARTMENT OF.COUNTY ENGINEER ' c(ry ' �Z�r' 7` zIP BUILDING AND SAFETY DIVISION _ BUILDING OOF BLDG 77 -I'SIZE-OF-LOT N LOT.' ADDRESS TRACT'/ LOCK OT NO. LOCALIT TEL. NEAREST OWNE NO. = CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE • FIRE SSE BY CITY. .. :ZIP. - CONST.. - . ZONE ARCHITECT OFi TEL. d� B - . gz— ' ENGINEER - - NO. STATISTICAL-CLASSIFICATION" _ SEWER MAP ADDRESS ,. _ CLASS NO. c2=ye DWELL.UNITS BK PG /� L' USE ZONE . CONTRA.CTOR�FJ C i � O UMA'P NO. =- L�GS� • ADORES © ` , SPECIAL LIC, CONDITIONS \ _CITY v CLASS ROAD DEPARTMENT APPROVAL" REQUIRED YES❑ NO❑ CONSTRUCTION LENDFR NAME AND BRANCH BLDG, ETBACK FROM FRONIT PROP.LINE OF (STREET) G ADDRESS- CITY' TOTAL SETBACK.FROM TYPE OF. EXISTING C GHW Y } YARD SQ. FT.'- NO. OF NO.-OF •-CHECK- HI '•FRONT.-PROP.. LINE HIGHWAY. WIDTH SIZE STORIES FAMILIES -ONE . p _ C ES"GRIP-TION OF WORK `- NEW -❑ + C /^ DD ❑ BLDG.SETBACKFROM' o C SIDE PROP.LINE OF (STREET). co ALTER ❑ HIGHWAY •F YARD _ TOTAL SETBACK FR TYPE OF EXISTING -• _ -- - - REPAIR❑ SIDE PROP. LINE GHWAY WIDTH- USE OF DEMOLFull + - - EXISTING BLDG, APPLICANT p TEL CORNER CUTOFF YES ❑ NO ❑ .. (PRIWT), ,5AM / .o. NO. BY (SIGNATUFIE) IN OPEN SPACE YES ❑ NO ❑ - Q - IN COASTAL ZONE - YES ❑, NO ❑ VALUATION$ ;!!�L040 oQ- - - - _ CATEGORICAL EXEMPTION YES-0 NO ❑, I HEREBY-ACKNOWLEDGE.THAT`I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT ANO.AGREE TO COMPLY IMPACT_. EXEMPTION DECLARATION SIGNED (DATE) WITH ALL- ORDINANCES AND LAWS REGULATING BUILDING CON- - STRUCTI_bN. 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 CALIFORN16f IN RELATING TO WORKMEN'S Cb MPENSATION INS ANCE. SIGNATURE OF PERMITTEE ' ADDRESS J,W, `� CITY ..-Ti _ ' 'NOTE-. / DIA T E %I B YF/!1 lC./✓f;(i'L"'�h6 11A KE C.NEC.KS PAYABLE.7'0: FEE"� � FEE $ HARVEY T. BRANDT, COUNTY ENGINEER .PLAN CHECK VALIDATION , cK: M.o.- CASH ® _ PERMIT-VALIDATION cic. /M.o. cASH � 2-727:73 H 1 0 3.G0 76A63.8A CE-9803 12-/.72 r - 76638A_C,Y��#80312/6 APPLICATION FOR BUILDIN PERMIT L -'� •.r,.. �� COUNTY OF LOS-ANGELES ASSESSOR DEPARTMENT--OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING G JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or tvoe onl CROSS ST. 4 BUILDING D CT_NO ' BY CVOST,ADDESS W-1'7 FICCA STATISTICAL CLASSIFIICATION MAP LOT NO.' BL K CLASS No_ DWELL,UNITS BK TRACT USE ZONE MAP /t NO.OF BLDGS. NO. (/ SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS r EXISTING BLDG. • E L. OWNER n BLDG.SETBACK FROM ADDRESS FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. ENGINEER / NO. BLDG,SETBACK ADDRESS ( �'?It-G�_ SIDE PROP.LINE OF (STREET) �/ TEL TYPE OF EXISTING SETBACK HIGHWA YARD = TOTAL CONTRACTOR , Q /� NO, , HIGHWAY WIDTH FROM C.LLIC . ADDRESS 1pC S/D NO.: 07/ 2. . + - O CITY'g ,rv ASS CORNER CUTOFF. YES ❑ NO C ❑ c CONSTRUCTION LENDER Oc NAME AND BRANCH 'SEE REVERSE SIDE FOR SPECIAL APPROVALS t ADDRESS o v SQ, FT. NO. OF NO. OF NEW ❑ SIZE STORIELS/�,�' FAMILIES USE OF STRUCTURE /-T.4 f, .1,VlbjqW DD p E SIGNA URE OF �® REPAIR❑ APPLICANT y �s��..e-A.s/1 1' EMOL,❑ LVALUATION 5 llis7eeg) APPROVALS DATE 'INSPECTOR'S SIGNATURE P.C. 142 PMT. FOUNDATION- LOCATION FEES FEES �� FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION FRAME: FIRE STOPS, ter BRACING 7- BOLTS / x �'7Q 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 i WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ' LABOR CODE OF.THE STATE OF -CALIFORNIA IN RELATING TO LATH, INT. I ///pnfir), WORKMEN'S COMPENSATION INSURANCE. p• Ei LATH, EXT, SIGNATURE yi• HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL Q G 1 JOHN F. LEWIS. PRINCIPAL•5 RAL ENGINEER PLAN CHECK VALIDATION cK. .0. CASH _ PERMIT VALIDATIO. cK. M.O. CASH I.RCf_5•4 s 591 JUN19.z 3b 19.8 0 - LM.„_ s- 4.'8 69 MUNI 9 1 .n 3 3.0 0, �' �� WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certified copy thereof S . 3800, Lab. C Policy No. 0 t Company z COUNTY OF LOS ANGELES BUILDING AND SAFETY � BUILDING t ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDREss 22 \❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS LOCALITY . L Cly NEAREST Date ✓ �Z Applicant CITY 9 — ZIP CROSS ST. CERTIFICATE OF EXEMPTION F WORKER 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 �y 3 hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. (/ y L. SPECIAL (� I certify that in the performance of the work for which this OWNER O. CONDITIONS permit is issued, I shall not employ any person in any manner DISTRICT I GROUP TYPNST. ZONE FIRE PROCESSED BY ADDRESS CO4y so as to become subject to the Workers'Compensation Laws. SitJ Date Applicant CITY Q/ ZIP STATISTICAL CLASSIFICATION APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. LLI Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. cAA DWELL. UNITS EMMMIJA. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. TEL. �. f BK. PG, VALIDATION CONTRACT NO. � (�', LICENSED CONTRACTORS DECLARATION1 LIC. I hereby offirm'that I am licensed under provisions of Chapter 9 ADDRESS / NO. 3 ! VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. 7 Professions Code, and my license is in full force and effect. CITY CLASS $ �J- C / S°EFT STORIOES FAMILOIES CONE License Number/��� HECK _7X Lic.Class QQ p� �F $ Contractor to V" p () \ DESCRIPTION OF WORK NEW ❑ ' I am ex pt from the I censi requirements as I am a Pit j D�( a S7 ADD ❑': licensed architect or a registered professional engineer iie_•-- ALTER ❑, FINAL i acting in.my professional capacity (Section 7051, l� Q.� `� EPAIR DATE i Business and Professions Code). USE OF ❑ f" EXISTING BLDG. DEMOL ❑ FINAL By Lic.or Reg.No. Date APPLICANT TEL. " OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License D� Law for the following reason (Section 7031.5, Business and ADDRESS d a J Professions Code): PRESENT 0 d ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and _3 1 7.5 A the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. It a o a a o ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 2 0 1 0 G 0 0 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. o t, ` L CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH '. I hereby affirm that there is a construction lending agency for FRONT r the performance of the work for which this permit is issued P L r, 5 (Sec. 3097, Civ. C.). I SIDE PL 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• d above information is correct. I agree to comply with all County Investigation Fee / ordinanc s and State laws relating to building construction, Total Fee a4 1: O a `r i and er by authorize representatives of this County to enter i up t e above-mentioned pr perty for inspection purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applica rilli or A nt Dote ®s WORKERS'COMPENSATION DECLARATION ' hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY' Policy No. Company - Certified copy is hereby futnished. APPLICANT TO FILL IN BUILDING DD ESS 9677 E• Longde n ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS LOCALITY Temple City; Calif. Temple City NEAREST T Date Applicant CITY P Y zIP CROSS ST. Longden and Kaufman CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE ' SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL. his section need not be com' feted,if.the etmit is'for one. USE ZONE MAP R P. P hundred dollar's ($100)or less.) TRACT. BLOCK LOT NO. /f NO. TEL. SPECIAL } I certify that in the performance of the.work for which this OWNER p; fr i CONDITIONS B permit is issued, I shall not employ•any person in'any mannerDISTRICT .GROU .TYPE FIRE PROCESSED BY Q so as to become subject to the Workers'Compensation Laws. ADDRESS 96 7 7 E. Longden / CONST.. ZONE 7,9 V CITY Tem le ' C7 Ca.zIP /VV�dI Date' Applicant STATISTICAL C FICATION APT. CONDO. � NOTICE TO APPLICANT: If, after making this'Certificate'of ARCHITECT OR TEL. I 'Exemption, you should become subject to the Workers' ENGINEER __• NO. CLASS NO. DWELL. UNITS 0- Compensation provisions of the.Labor Code, you must forth- ADDRESSSEWER MAP with comply with such provisions or this permit-shall be " deemed revoked. EOL CONTRACTOR L WrenCe 'Kitt T BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION 6 LIC. I hereby affirm that I am licensed under provisions of Chapter 9 1 ADDRESS 9677 E g LOn den NO. VALUATION 00 (commencing with Section 7000)of Division 3 of the Business andLIC. O © � Professions Code,and my license is in full force and effect. CITY Temple Cit Calif.CLASS $ SQ.FT. NO.OF NO.OF CHECK Pool License Number Lic.Class SIZE STORIES FAMILIES ONE Contractor Y—Date. DESCRIPTION OF WORK Steel Concrete NEW ❑•I am exempt under Sec. I Landings 2 5 l ;.,-`V� ADD ❑ ALTER ❑ FINAL B.$P.C. for this reason c: EPAIR DATE', z� USE OF TINA Date: i EXISTING BLDG. DEMO ❑ Ay Signature - APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. i I hereby affirm that I am exempt from the Contractor's License I Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): I PRESENT ! `� 13BUILDING I, os owner of the property, or my employees with ADDRESS I �.O L 2 p wages as their sole compensation,will do'the work and 040 the structure is not intended or offered for sale(Section ± LOCALITY i *2 u'o e e o 1 rsf 7044, Business and Professions Code). MOVING TEL. Ai7Cl I, as owner of the property,am exclusively contracting CONTRACTOR NO. a L with licensed contractors to construct the project (Sec- i o � `3 ADDRESS tion 7044, Business and Professions Code). r r z REQUIRED TOTAL SETBACK FROM EXIST. ° ° �� ' ��' 'U CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT I� 0 1. 1 9-8 the performance of the work for which this permit is issued P.L. Sec. 3097,Civ. C.). SIDE AA ,, 'P.L. Lender's Name 3 P.C.Fee$ �— Permit Fe /A3 Lender's Address p i i (.certify that I have rea this application and state that the Issuance Fee above information is correct. I agree to comply with,all County Investigation Fee �, 2 ; ordinances and State laws relating to building construction, Total Fee SCJ and hereby authorize representatives of this County to enter up the�abovej ntion� e�p perty for inspection purposes, p N. Q ES , .� -3 p'LJ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent' Date ®s APPLICATION FOR BUILDING PERMIT • COUNTY OF LOS ANGELES BUILDING AND SAFETY Ot WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN .► ., � �Ay9DRESS BUILD/ING ADDRES �/C•�/ %' w I hereby affirm that I have a certificate of consent to self insure, %� or a certificate of Workers'Compensation Insurance,or a certified CITY 7 G IP copy thereof(Sec.3800,Lab.C.) �- LOCALITY Policy No. Company SIZE OF LOT N F BLDG&NOW ON LOT L ❑ Certified copy is hereby furnished. NEAREST CROSS 11 Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. I USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK��n� PAGE 01q PARCELO�� �p SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NER ],, EL (� COMPENSATION INSURANCE �j1t �C' ��rJl dy'L l�J WITHIN 1000 FT.OF SCHOOL? YES NO AD RErS ( e O1.rP ' ±* (This section need not be completed if the permit is for one hundred �,j DISTRICT GROUP TYPE CONST FIRE ZONE.. gOCESSED BY dollars($100)or less.) CIT ZIP -� �I .E,t:*■:�� I certify that in the performance of the work for which this permit r_ cx, ///� is issued, I shall not employ any person in any manner so as to O ��� !O ��v become subject to the Workers'Compensation Laws. ARC ITECT OR ENGINEER T L � ��' Ande� � STATISTICAL CLASSIFICATION APT y ;rJDp Date Applicant Sg CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of ry d 4{/r ILZ- M REQUIRED TOTAL SETBAC;'fC P%m -LEXrS�,•, 64 Exemption, you should become subject to the Workers' CONTR R TEL N . SET BACK YARD HWY PROP L•INEr-+- WIDTH Compensation provisions of the Labor Code, you must forthwith W \ FRONT /�--- '=a comply with such provisions or this permit shall be deemed revoked. ADDR S II 11 LIC.NO. P L i: r1N:3 Pl LICENSED CONTRACTORS DECLARATION V J7 SIDE a`-i_: CIT /- UC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 C, SEWER MAP t=+:-:n ' + - .• (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES =1�•:L+ ct t,= Professions Code,and my license is in full force and effect. NEW ❑ BK PG ® r,� T License Number Lic.Class DES IPTION OF WORK 1 by ` + ` ADD ❑ /v S VALUATI N Contractor Date ALTER $ � de ElI am exempt under Sec. REPAIR ❑ O P'tit:':l 0 4 I— BAP.C.for this reason DEMOL ElLOMA P/C# W Date: USE OF EXISTING BLDG. URM El •�:■} D_ SignatureAPPLICANT(PRINT) TEL NO. LDMA Perm# co 11I, as owner of the property, or my employees with wages as Z s i T HL 1 `3 � -1 7 their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE Q CH =1 _ ,_� Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ✓a t• - I, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY r ��••s� ='- AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? icensed contractors to construct the project (Section 7044, yes 11 No❑ Business and Professions Code.) APA WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING I:('1j-1ry_)?IKI-•• —_ 'I :+C' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - - — 'f L/ . - CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES •� f i a':L i +' +-: JJ1 �NJ I hereby affirm that there is a construction lending agency for VES 1:1 NO No❑ a the performance of the work for which this permit is issued(Sec. N 3097,CIV.C.) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. 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 SCAOMD. ❑ Lender's Address p OWNER OR AGENT o I certify that I have read this application and state under penalty c of perjury that the above information is correct.I agree to comply P.C.FEE / /� /' PERMIT FEE /, !�•.� CM with all county ordinances and State laws relating to building �J A construction, and hereby authorize represent ti sof this County ISSUANCE FEE / n� ato e r upon the 0,1 e- entio perty r' pecti p poses (o m INVESTIGATION FEE TOTAL FEE ��■ / ti Em Wm of C Aec:n Osto T jJ,�,_QgQa SEE REVERSE FOR EXPLANATORY LANGUAGE I WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have �insure, or a certificate of Workers' certificate of consent to self kers' Compensation Insurance, APPLICATION F®R BUILDING P E RM I T sorra.certified copy thereof Seci 1100.��Lab�C_) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N • Gompany���%�^�u�+� V BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS q & L.b r� ^ ❑ Certified copy is filed with the county building inspec- BUILDING L o yl AwQ tion department. -� C Dore Applicant CITY' C, ZIP g l T p o LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT r CROSS ST. I�A-I _eVVkCaM COMPENSATION INSURANCE "� ASSESSOR 1c,-,n r This section need not be completed if the permit is for one TRACT �� �-s BLOCK LOT NO. MAP BOOK J 6 PAGE P' PARCEL hundred dollars ($100)or less.) `USE ZONE MAP OWNER I ei1A, t4V-nN0. Zg - 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 �� L wA � CPQ. CONDITIONIL S so as to become subject to the Workers'Compensation Laws. C ^ ��b O CITY ZIP `�, U DateApplicant ARCHITECT OR TEL, DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS w with comply with such provisions or this N p y p permit shall be TEL. �: STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 92 c%k DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 4 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 I STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW 1:1 $ L TIOO Bp El am exempt under Sec. F< g 00.11x• LO,�I� ADD 10 ALTER ❑ !; BAP.C. for this reason REPAIR $ USE OF + Date: EXISTING BLDG. S r.e_C'c1A DEMOL ❑ Signature APPLICANT 11 TEL. J / OWNER-BUILDER DECLARATION (PRINT)ME4,f le NO. FINAL DATE I hereby affirm that I am exempt from the Contractor's License c Law for the following reason (Section 7031.5, Business and ADDRESS . o FY AL ).� Professions Code): PRESENT B r-/-/ ( BUILDINGS;: e3 I, as owner of the property, or,my employees with ADDRESS 1 wages as their sole compensation,will do the work and --,..- r, the structure is not intended or offered for sale(Section LOCALITY 33'_)! -Q.f 7044, Business and Professions Code.) MOVING TEL. I�-t El 1, NO.I,as owner of the property,am exclusively contracting ' with licensed contractors to construct the project (Sec- TOTHAL �s�o 75 tion 7044, Business and Professions Code.) ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. + �EC 58.75 CONSTRUCTION LENDING AGENCY FInvestigation YARD HWY PROP. LINE WIDTH , 1 hereby affirm that there is a construction lending agency for CHANGE the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's NameLDMA Ref. # Permit Fee 7 j ` `Lender's Address 554 AN ="`ZI certify that I have read this application and state that the Issuance Fee 13 LDMA P/C# above information is correct. I agree to comply with all County ' ordinances and State laws relating to building construction, Total Fee _51 LDMA Perm. # and hereby authorize representatives of this County to enter upon the abo - entj e p operty for inspection pur oses. AJTTS� SEE REVERSE FOR EXPLANATORY LANGUAGE SI nature of pplicant r Agent Dole a 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 1112130026 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I 1 ON FILE I SQ. FT STORIES TYPE I 9677 LONGDEN AV I ISTRUCTURE: 55 V-B I TEMP CA 917801457 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15383-019-009 I I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl 1TENANT: IEXIST BLDG USE: CHURC USE ZONE: R-2 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 112/13/11 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FIN BY: CODE: 1 ITEMPLE BETH DAVID (626) 287-9994- 1 18,000 I y I 19677 LONGDEN AV I I I ITEMP 917801457 I FEES PAID ID SCRIPTION OF WORK 1 I I ITEAR OFF AND RE-ROOF ON A MODIFIED BITUMEN ROOF SYSTEM 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( I (APPLICANT: TEL. NO: I I I IBEACH CITIES ROOFING (310) 375-1442- IAA BLDG PERMIT ISSUANCE 27.80 1 I I IAB STATE GREEN BLDG FEE 18000.00 VAL 1.00 ISPECIAL CONDITIONS: 1 1 AE STRONG MOTION OTHER 18000.00 VAL 3.80 I I ID2 PERMIT W/O EN-HC 18000.00 VAL 352.10 1 I I I TOTAL FEES 384.70 I_ I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I IBEACH CITIES ROOFING (310) 375-1442- 1 1 I 11717 CAMINO DE LA COSTA LIC. NO 1 ILOCATION AND SETBACKS I I IREDONDO BEACH, CA 92077 659506-C39 I I I I I I I ISOILS ENGINEER APPROVAL 1 I I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I LIC. NO: 1 JSLAB/UNDER FLOOR I I I I i I I IRAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( IUNbERFLOOR INSULATION 1 I 1153H269 3 O61 1 I I I I I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I 1_ I 1�� 0 NO 22 i i ROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS 1 LW]l\�V\=VTI 1 (AIR QUALITY: 1000 FEET MATERIALS I I I I 1 NO NO NO 1 IFRAME INSPECTION I 1 I I IFIRE SPRINKLER HANGERS 1 I I I (INSULATION/WEATHER STRIPI I I I (INTERIOR LATH/DRYWALL I I I I (EXTERIOR LATH I I I I I I IRATED FLOOR/CEIL ASSEM. I I I IRATED WALL ASSEMBLIES I I I I (RATED SHAFTS/OPENINGS I I I IT-BAR CEILINGS I I I I ILOT DRAINAGE I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 1 I I I l COUNTY OF LOS ANGELES TEMPLE CITY #1 0 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9703030040 PHONE: (818) 285-0488 EXT: LEGAL NO. OF CONST I G ADDRESS: ON FILE SQ. FT STORIES TYPE 9677 LONGDEN AV STRUCTURE: V TEMP CA 917801457 ASSESSOR 0 0 NUMBER: NEAREST CROSS STREET: GOLDEN WEST 5383-019-009 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY TENANT: ST BLDG USE: CHURC USE ZONE: R-Z ISSUED N: PROCESSED BY: EXPIRES 0 : EXIST OCC GRP: 03/03/07 TC 03/03/98 I OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL B CODE: TEMPLE BETH DAVID (818) 287-9994- 1 14,000 �����• 9677 LONGDEN AV TEMP 917801457 FEES PAID DESCRIPTION Of WORK � n ® REMOVE EXISTING ROOFING/RECOVER ITH CLASS A TORCH DOWN FEE DESCRIPTION: QLPANTIT . AMOUNT: 0• �� STUPAK & ROSER ROOFING (818) 338-1805- AA BLDG PERMIT ISSUANOE� 27.75 AE STRONG MOTION 'OTHER 11:4000-00'VAL` �Z.94 SPECIA CONDITIONS: D2 PERMIT W/0 EN FHC��� 14000-00 VAL�285ti60, TOTAL FEES �316:29� ® (�i CONTRACTOR: TEL. NO: APPROVALS APPROVALS DATE INSPECTOR SIGNATURE STUPAK AND ROSER ROOFING (818) 338-1805- �► _�;� L, 1631 S ORANGE AVE LIC. NO \\ WEST COVINA CA 91790 470638 C39 J t G 0 �' 3CATIUN AND SE78ACKS I — ---" _ SOILS ENGINEER APPROVAL NA 1 11 ARCHITECT OR ENGINEER: TEL. O: ' a�M 0� CEJ II II CA FOUNDAT ION/TRENCH FOR S LIC. NO: � t I��"� r� SLAB/UNDER FLOOR PAISED FLOOR G MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: N1�DERFLOOR INSULATION 15311269 3 01 0. OF FAMILIES: DWELLING UNITS: AP CND: STAT CLASS: FSR SHEATHING NO 22 ROOF SHEATHING SCHOOL WITHIN HAZRS ®� SHPANELS AIR QUALITY: 1000 FEET MATERIALS - NO NO NO RAE INSPECTION REQUIRED OTA SETBACK OM EXIST E S, LER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- R R LAT D WAU i EXTERIOR LATH I � ' RATED F 00 I SS RATED WALL ASSEMBLIES TED SHAFTS/OPENINGS T-BAR CEILINGS i LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: SS0508 i I • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 6[,0508'9807280031'' PHONE: (626) 285-0488 EXT: 1 LEGALID: NO. 0 CO ST NEW BLII Lffrff(-l7AffD-FE—SS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP �-9677 LONGDEN AV.. STRUCTURE: 0 2 VN B TEMP CA 917.801457 ASSESSOR INOR ON WEAREST-CROSS STREET: KAUFFMAN 5383-019-009 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY XS DG USE: COMME USE ZONE: IS EDO : PROCESSED BY: EXPIRES ON: EXIST OCC GRP: B 06/18/99 UT 12/15/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL CODE: TEMP9677LE BETH LONGDEN DAVID818) 287-9994- 13,000 1-171-01 TEMP 917801457 FEES PAIDSCRIP- IO (-•NEW FIRE ALARM SYSTEM FOR TEMPLE APL. N0: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT': - ---- - -- - - POST ALARM SYSTEMS (626) 446-7159- D1 PLANCHECK W/O EN-HC 13000.00 VAL 226.95 610 N SANTA ANITA AA BLDG PERMIT ISSU�ANC�® 27.75 SPECIAL CONDITIONS: ARCADIA, CA AE STRONG MOTION, T•ME�O —R—1 000.00 VAL 2.73 D2 PERMIT /U.— f� ' QPE-O V524.43AL 267.00 I(L7ES CONTRACTOR: TEL. NO: �oS ES APPROVALS DATE INSPECTOR SIGNATURE POST ALARM SYSTEMS (818) 446-7159-. 610 N. SANTA ANITA AVE. LIC. NO LOCATION AND SETBACKS ARCADIA, CA 91006 670585010 SOILS ENGINEER APPROVAL 6 � ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FO S LIC. NO: 1111111 SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP 0: SEWER MAP BOOK: PAGE: FIRE ZON3: -CMP.Oj,n nBu L �C ���0'nO--'K � DERFLODRINSULATIO¢uiJUFLOOR SHEATHING 0. OF FAMILIES: DWELLING UNITSf: T/CO : STAT CLASSt'NO 22 p d ` el, y ROOF SHEATHING SCHOOL ITHI HAZARDOUS l tr SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS [J ❑ ` r1 rrt - NO NO NO A ® J1 - FRAME INSPECTION 4 1 Ll o 4 F SPRINKLER a,. 'C service�ha�vtl INSULA ION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LAT RATED FLOOR/CEIL ASSEM.FLOOR/C RATED WALL ASSEMBLIES RATED 5 S/OPE GS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508