Loading...
HomeMy Public PortalAbout9237 LOWER AZUSA RD_Building__ WORKERS'.COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT- at ' insure, or a certificate of Workers'Compensation Insurance, " a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. ' . Company_:5 +9 �_JroP60 Certified copy is-hereby furnished. FOR APPLICANT TO FILL.IN BUILDING 19 ❑ ADDRESS g7 4D !E� O Certified copy is filed-with the county building inspec- , BUILDING tion departrnent. ADDRESS �j Zv i,790 . : D • ' Date 4::Zk- Appl.icant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need'not be completed if the permit is for one TRACT BLOCK LOT NO: ASSESSOR hundred dollars($100)or,less.) MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER G 0. NO. �_Im6 NO. . permit is issued, I shall not employ any person in any manner, ADDRESS Z 0 SPECIAL so as to become subject to the Workers'Compensation Laws. CONDITIONS 0 CITY c.[ ''in&ZIP g 17 0 U Date Applicantn= NOTICE TO APPLICANT: If, atter making'this; Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE P.R SSED BY O Exemption,' you should-become subject`to the Workers' ENGINEER NO. CONST: ZONE V Compensation provisions of the Labor Code, you must:forth- ADDRESS �+rO� W with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR �s50 NO. 3$'3"J�J�Z STATISTICAL CLASSIFICATIO CONDO. Z LICENSED CONTRACTORS DECLARATION - LIC, CLASS NO. DWELL. UNITS I hereby affirm that I'am licensed under provisions of Chapter 9 ADDRESS !,6! p— Pon& 98576a., (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP 'Profession's Code,'ond my license is in full'foice and effect. CITY t'f sl�tfPl S:• CLASS 8 BIC PG -VALIDATION O / SQ.FT. . NO.OF NO.OF CHECK License Number '3[S 37-6 0 Lic.Class " L - SIZE STORIES FAMILIES ONE ' r r. DESCRIPTION OF WORK NEW ❑ VALUATION Contractor �L Tcl70 Datel ` ADD ❑ $ ❑I am exempt under Seca ALTER B.BP.C. for this reason. REPAIR $ USE OF Date:. EXISTING BLDG. - .4 V$ DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT O• NO. DATE I-hereby affirm that I am exempt from.the Contractor's License ADDRESS • 1 $ ! FINA Law for the following reason (Section 7031.5,,Business and Professions Code): P E • By, 11BUILDING ; 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 ;29 4 8.O A ' 7044;'Business and Professions Code). MOVING TEL. ❑ . # o e o I, as owner of the.property,am exclusively contracting CONTRACTOR NOs ot� with'licensed contractors to construct,the project (Sec- ADDRESS o o49.88 tion 7044, Business and Professions-Code). REQUIRED TOTAL SETBACK G 9 8.S V CONSTRUCTION LENDING AGENCY SET BACK YARD HWY T PROP.LINE WIDTH p o e I hereby affirm that there is a construction lending agency for FRONT 04,28-88 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ^ m LDMA Ref. p P.C.Fee$ Permit Fee V�f Lender's Address I certify that I have read this application and state that the Issuance Fee �` LDN1A P/C B a above information is correct. I agree to comply with all County Investigation Fee , 0 ordinances and State laws relating to building construction, Total Fee i LDMA Perm. #N 'and hereby authorize representatives of this County to enter 9 up ve-m oned property for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE S' nature 6f Applicant or Agent Date *WORKERS'COMPENSATION,DECLARATION 4' hereiry affirm fct I have certificate of consent to self j. APPLICATION' FOR B U I LD I of G PERMIT �,ips�re, 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 furnished. FOR APPLICANT TO FILL IN - nooRess Certified copy,is filed..with the county building irispec-• [ADDRESS ILDING Q &rj/, tion department. DDRESS /rZ3-7 �dfiJE2 2US�4 /z�• "O Date Applicant. TY 'TEMA_0 Crr r4.. ZIP /7Q,U LOCALITY CERTIFICATE OF EXEMPTION FROM,WORKERS' NO:OF BLDGS. NEAREST COMPENSATION INSURANCE ZE OF LOT /3& NOW ON LOT /9 CROSS ST. (This section need not be completed if the permit is for one ASSESSOR •hundred dollars($100)or less.) - ACT BOCK LOT NQ. MAP BOOK PAGE PARCEL i /!!'! TEL. USE ZONE MAP I'certify that'in the performance of the work for which this., WNER NO. NO. permit is issued,I shall not employ.any person in any manner' r IAL 4SEAST %Au�oc3,-rotJ D2. CONDITIONSso as to become subject to the Workers'Compensation Laws. O CITY �L°A{J�(l CA, ZIP 9/dD�o UI, Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE' TO APPLICANT: If, after makirig'this Certificate of ENGINEER PP0-0Z> otic– NO. �o'-_7g8 Exemption, you should become subject to the 'Workers �^ CONST. ;?AVE W Compensation provisions of the•Labor Code, you must forth- ADDRESS wlih comply with such provisions or this-permit shall be TEL, STATISTICAL CLASSIFICATION APT. DO. fn deemed.revoked. CONTRACTOR NO. v Z LICENSED CONTRACTORS DECLARATION LIC. :CLASS NO. A"" I hereby affirm that I am licensed under provisions of Chapter 9' ADDRESS NO. SEWER MAP (commencing with.Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force.and effect. ' CITY - CLASSBK PG: VALIDATION i SQ.FT. NO.OF NO.OF CHECK- i License Number Lic.Class SIZ STORIES FAMILIES A/ & ONE VALUATION DESCRIPTION OF WORK NEW Contractor Date 0 ADD 'J $ • Cl LI I am exem t.underSec. At2L°fZA•FT (�SSCe.1`(3L:�6S •. :p - ALTER ❑ � - " B4P.C. for this'reason i p REPAIR ❑ $ USE OF ❑ ; • Date: EXISTING-BLDG. ki P DEMOL Signature APPLICANT TEL. FINAL PRINT QROra� -w NO.ZSfo'–7909 •r OWNER-BUILDER DECLARATION DATE I•hereby affirm that I am exempt from the Contractor's License 3 9°y Lcfr°CK5S �`"DR"r Q�J/ Law for the following reason (Stictiori 7031.5, Business.and ADDRESS �+-+��"Z '�w��i �° �r FIN Professions Code): BY. ' ❑ BUILDING Sft-IMi� ; I, as owner of the property, or my employees with ADDRESS # 0 0 0 0,0 11 • wages as their sole coinpensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). ' 'MOVING TEL. o 0 9$'Qx' ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. o 0 0 9.8 Ob with licensed'contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS �, ��, tj,±. :1 0,06-87 FROM CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK WIDTH - I hereby affirm that there is a construction lending agency for FRONT the performance of the work,for which this permit is issued P.L. (Sec..3097, Civ. C.). SIDE P.L. ' Lender's Name LDMA Ref. # O.C.Fee$ PermitFee I ® ' Lender's Address 1 I certify that I have read this.application and state that the Issuance Fee LDMA P/C# - o above information is correct. I.ogree to comply with all County Investigation Fee ao ordinances and State laws relating to building construction, ' Total Pee LDMA Perm.•fi 'w`• •'' - ' n and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 'Y - / SEE REVERSE FOR EXPLANATORY LANGUAGE `1, Signature of Applicant or Agent Date / cam-= r - ...��. •. , r WORKERS'COMPENSATION DECLARATION s j; I hereby affirm that I have certificate of consent to self A P P L I�CATION FOR: ��J'I L.D I N C PERMIT- insure, or a certificate of Worr kers,'Compensation Insurance, l or a certified copy thereof*(Sec. 3800, Lab. C. V` COUNTY-OF LOS ANGELES I BUILDING AND SAFETY Policy No. Company erepy y s ., . . • :I' FOR APPLICANT TO BUILDING 2 F, li 1� ❑ ADDRESS Certified cois hereby furnihedFILL IN -11 ❑ Certified copy"ts filed with'the county building'inspec- 1 BUILDING 1 tion department. i ADDRESS -11 1 0 W e � Date , . Applicant i CITY {+ 'I' ZIP ,�' LOCALITY/ `VA L ' CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS.' NEAREST, , COMPENSATION INSURANCE • ' . SIZE OF LOT NOW ON LOT CROSS ST. SN C I N ItAS (This section need not be completed if the permit is for one ; ASSESSOR hundred dollars($.100)or less. I. TRACT' BLOCK LOT NO. MAP BOOK PAGE' PARCEL '+ TEL. i USE ZONE 'MAP I certify that'In'the performance of the work'for which this OWNER ft ieQ6. NO. permit is issued,-[shall not employ any person tn'any manner J ` n.�l� SPECIAL so as to became subject to the ers'Compens tion Laws. a ADDRE/^S�S S ' ' V tti'T'I KV G- !I` CONDITIONS 0 Date Applicari t „ CITY Psc-t4••D f A ZIP q •)Q NOTI.0 TO APPLICANT: If,•after m6king this Certificate o !. ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O • ENGINEER NO. CONST ZONE' V Exemption, you should become'subject-to. the Workers' �:,[,(/ �_Z_. Compensation provisions of the Labor Code, you muSt.forth- ADDRESS t 11 b .V ' Lt.l with comply with .such• provisions or this,permit shall be j, O-' deemed revoked. T TEL• STATISTICAL CLASSIFICATION APT. CO LX). Z CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. �' DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ' ADDRESS NO. SEVER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and "effect. CITY CLASSVALIDATION " SQ.'FT. NO.OF NO.OF CHECK BK.-'. PG. License Number Lic.Class SIZE STORIES FAMILIES ONE • VA ATION Contractor' Date I DESCRIPTION OF WORK NEW ❑ $ ❑ J�» h ►�Ro�r: ne I:l i ADD ❑ I am exempt under Sec. ALTER ❑ 1', B.&P.C. for this reason .O REPAIR ❑ $ I USE OFl 1,11 �a T ❑ Date: EXISTING BLDG. 7 1. 1 DEMOL V APPLICANT ' TEL. ' •Signature '� '• ' �• • ' � � c FINAL f OWNER-BUILDER DECLARATION PRINT a NO.X1, DATE 1 hereby affirm that I am exempt from.the Contractor's License ,. 8 7 5 A Law for the following-reason (Section 7031.5, Business and ADDRESS 0'w it - z S FIN # oaa0:0,1 Professions Code): I PRE 9y • BUILDING t' ° °•3 10.0 I, as owner of the•property, or my employees .with ADDRESS wages as their sole cornpensbtion,will do the work and. ( 0 0 033,00-9 the structure is not-intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 0 15 $8 ❑ I,as owner of the property,'am exclusively.contracting CONTRACTOR NO. , with licensed contractors to construct the project (Sec- ADDRESS i tion 7044, Business and Professions Come). ;1 REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the-work for which this permit-is issued P.L. (Sec. 3097, Civ. C.).- 'SIDE i I P.L. Lender's Name ' LDMA Ref?# P.C.Fee$ Permit Fee � c J�/ Lender's'Address /� ` I certify that I have read this application and state that the Issuance Fee V J LDMA P/C;N above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and'State laws relating to building construction, Total Fee t LDMA Perm:Il' R d hereby authorize representatives of this County to enter n the above-mentioned property.for inspection purposes. .s, m t CA�J1A/�— SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent � I 4 * � - 'r .AIICATION FOR �JI .DINCa PERMIT �.� COUNTY OF'LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a-certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified LoWSR ALLL1604, ROAM copy thereof(Sec.3800,Lab.C.) CIT Policy No. Company ZIP 'rF-H 'L C LOCALITY SIZE OF LOT ` NO.OF BUDGS.NOW ON LOT ❑ Certified copy is hereby furnished. O1419 NEAREST CROSS ST BLOCK LOT NO. ❑ Certified copy is filed with the county building.inspection TRACT ' USE ZONE MAP NO. department. Date Applicant I ASSESSOR-MAP BOOK PAGE PARCEL d-O L4-3I/32� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE pLe�r l L. WITHIN' 1000 FT.OF SCHOOL? YES NO � ' (This section need not be completed if the permit is for one hundred ADDRESS f dollars($100)or less.) �'. DISTRICT GROUP TYPE CONST. F PROCESSED BY CITY ZIP j, �l 953.12 I certify that 1n the performance of the work for which this.permit n4.. PAA q Z is issued, I-shall not employ any person in any manner so as to Ag'�C.�H,ITE�CTuuLO,L R E�wlNg1GIN/E�E�R /���/1'' T .� ,L �� ,qpm become subject to the Workers'Compensation Laws. � J"v''"�v r� 1{f��f. 2, ,f T ov STATISTICAL CLASSIFICATION i t NL •,� 1.2 Date Applicant ADDRESS .ems 11 mit CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of. oo pmr-l(� 511 V-3oo 11.014 ( REQUIRED TOTALS t r Q 1 •EXI Exemption, you should become subject to the Workers' C R R TEL N . SET BACK YARD HWY PROP J. WID Compensation provisions of the Labor Code, you must forthwith. , comply with such provisions or this permit shall be deemed revoked. FRONT ADDRESS �✓ NO. ^ 5 P IL r LICENSED CONTRACTORS DECLARATION SIDE j . C uc.c s PL 1 hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and O.FT SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. Ot�F, NEW BK i. PG, , d License Number. Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION b 0 Contractor Date b N4 ALTER ❑ � � 2 ��� — U ID N6 M ❑ 1 am exempt under Sec. REPAIR ❑ 0 B.BP.C.for this reason DEMOL LAMA P/C• r M. LLI :Date: , SE OF EXISTING BLDG. URM ❑ (L �v a. Signature - - , . 3303 ' 770.612 APPLICANT(PRINT)/� T.E}N LDMA Perm# ❑ I, as owner of the property, or my employees with wages as I •z/gl I� 2/ 9440b `: Z .�Eil their sole compensation, will do the work and the structure is A DRESS �1 ':. O not intended or'Offered for sale (Section 7044, Business and O a f1 e^- 1 kI1fINF-/ : )b FINAL DATE I a TOTAL 770. 6'1 Professions Code.) I W L THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL +•I 1t— •' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE '� _ "'I �.•T E K 770.61 ❑ 1, as owner of the property, am exclusively contracting With •, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �.• r licensed contractors to construct the project (Section 7044, t; f. G/E'', "I YES❑ NO❑ P7i3L a I.)t.F Business and Professions Code.j •- WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING i OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r CONSTRUCTION LENDING AGENCY 'COAST AIR QUALITY MANAGEMENT DISTRICT(SCARMD)SEE PERMITTING CHECKLIST FOR Cr L �'T 1A f-' GUIDELINES. 0000-000 051 I hereby affirm that there is a construction lending agency for YES❑ No❑ m the pefformance of the work for which this permit is issued(Sec. 0,484 1 PM D-31 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING N 3097,CIV.C.) CHECKLIS.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 SCA.OMD. ' o Lender's Address C OWNER ON AGENT cI 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•O FEE PERMIT FEE 7 a with all county ordinances and State laws relating to building w �^ - , m construction,and hereby authorize representatives of this County ISSUANCE FEE -I / m to r upon th ove-me Boned pror y pection pure es. (�o, (0 INVESTIGATION ATION FEE TOTAL FEE � 504tr Ayp1mM or Apert De SEE REVERSE FOR EXPLANATO LANGUAGE WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self insure, or a certificate of Worr kers'Compensation Insurance, APPLICATION FOR"B U•I L D I N G P.E'R'M I T or a certified copy thereof(Sec. 3800, Lab. C.,) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING 1:1 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS (�(LJr2ZU ❑ Certifiedcopyis fil'ed'with the courity'liuilding inspec- BUILDINGr 7 q tion department. ADDRESS /237 Lmc�Z� LLS• �� Lc-- 1 Date Applicant CITY, e^,P& ZIP q7 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDG& / NEAREST COMPENSATION INSURANCE. ; SIZE OF LOT I� 6?:z NOW ON LOT [ CROSS ST. (This section need not be'complete8 if the permit is for one ASSESSOR hundred.dollars'($.100)or less.). TRACT BLOCK LOT NO. MAP BOOK . PAGE PARCEL I a or TEL.'2d3 USE ZONE MAP OWNER 1�v1/s of t NO.SSF—CS/S I certify that'in the performance of,the work for which this /L NO. permit is'Lssued, I shall not employ any person in any manner ;1/d'!v SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS �lz37 '�L.J �L �Zt�Sa4 #� rl CONDITIONS O CITY CdZIP. I 1 7 t 6 V Date Applicant j IX. NOTICE TO APPLICANT:"If, after making'this Certificate of ARCHITECT OR ' TEL. DISTRICT. G UP TYPE FIRE PROCESSED BY O ENGINEER lJ�C1r K N�lv►- NO. =I CONST. ZONE h- Exemption, you• should become subject-to. the 'Woikers' (NC� V Compensation provisions of the Labor.Code,•you must forth- ADDRESS 9 gIs C .L-Mnd LI) f).1. ARC—� ;' JI � L,I with,comply.with such provisions or this permit shall be deemed revoked: TEL. STATISTICAL CLAS IFIL ION APT. CONDO. N CONTRACTOR NO. K LICENSED CONTRACTORS DECLARATION -LIC, • _ I'CLASS NO. WELL. UNITS Z I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS- NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code,and my'license is in fulPorce and-effect. CITY CLASS BK = VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number• Lid.Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ VALUATION ION Contractor Date ADD ❑ $ 01V 8 9,7.: 8 A ❑1 am exempt under Sec.• „ G �� � ALTER ❑ # o 0 0 0 2 3 0111. B.&P.C. for this reason - REPAIR ❑ $ ; ) °'re 9 7?2 Date: USE OF• DEMOL ❑ o a:- C,7 2:2 EXISTING BLDG. SignctuFe APPLICANT �! TEL. 8'/ u FINAL' 0 2'1. 8-88 OWNER-BUILDER DECLARATION PRINT.iq zl' e 11IDEZ NO. �S DATE I hereby off irm that I am exempt from the Contractor's.License / Law for.the following'reason (Section 7031.5,' •�Business and - ADDRESS �I3/ cdl� 7�SA -FINAL \�1 Professions Code): - PRESENT BUILDING 1, I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and i the structure is noNV t 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 contr6ctorKAo construct the project (Sec- tion-7044, Business and Professions Code). ADDRESS 1 REQUIRED TOTAL SETBACK ` CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name • CDMA Ref. N ' :Lender's Address P.C.Fee$ rmit Fee I certify that I have read this application and,state that the Issuance Fee. LDMA P/C H above information is correct. I agree to comply with all County' Investigation Fee q ordinances and State laws relating to building construction, Total Fee CDMA Perm..4 N and hereby.authorize representatives of this County to enter m upon the above-mentioned property for inspection purposes. ; E SEE REVERSE FOR EXPLANATORY LANGUAGE m Signature of Applicant or Agent Dote WORKERS'COMPENSATION DECLARATION I 'I r hereby affirm that I hove certificate of consent to self A P P L I CATION F`®R BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, ' or a certified copy thereof(Sec. 3800, b. c.) COUNTY OF LOS ANGELES i BUILDING AND SAFETY Policy No. Compon to ❑ Certified copy is hereby furnished. ' FOR APPLICANT TO FILL IN BUILDING 3 ADDRESS Certified copy is filed with the co y buil irtspec- f BUILDING tion department.. ADDRESS I Date , �^ Applicant / 1 CITY ZIP LOCALITY CERTIFICATE OF EXEMPT] OM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS.ST. (This section need not•be completed,if the permit is for one ASSESSOR hundred dollars($100)or.less.) TRACT BLOCK LOT NO. MAP BOOK PAGE' PARCEL y� TEL.' OWNER ^� Q NO. USE ZONE MAP I certify that'in the performance of the work for which this NO. permit is issued,:I shall not employ any person'In any manner i PECIALi so'as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS f t Date' Applicant CITY V ZIP NOTICE TO APPLICANT: If, after making this Certificate of '' ARCHITECT OR 7EL. DISTRICT GROUP TYPE FIRE PROCESSED BY O i ENGINEER NO. CONST. ZONE 117— I " Exemption, you should become subject to the -Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be 3 d deemed revoked.. TEb7/ STATISTICAL CLASSIFICATION_W e* ffei APT. NDO. Z CONTRACTO No. �DWELL UNITS LICENSED CONTRACTORS DECLARATION LIC•3 CLASS NO. ' I hereby affirm that I am licensed under provisions of Chapter 9 tf ADDRESS' [r NODI (commencing with Sbction 7000)of Division 3 of the Business and I LIC, d SEWER AAF`P Professioni Code,and my license is in full force and effect. I CITY CLASS O BK VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number -3��n1l Lic.Class! SIZE STORIES I FAMILIES -ONE _ e VALUATION Contractor S1 �i✓JnU L Dafe —� DESCRIPTION OF WORK Illi iLlT Qdil NEvv ❑ $ n ADD ❑ U O• ❑I am exempt under, ALTER Sec. 2'9 71,4'A, .. �Q B.BP.C. for'this reason I 1I REPAIR ❑ 'S ' �� USE F Date' EXISTING BLDG. DEMOL ❑ q Signaturb APPLICANT TEL.' ;FINAL ° 0,31:1 � 1 6 czi OW BUILD R DECLARATION PRINT J esS , _ NO. DATE 'I hereby affirm that I am.exempt from the Contractor's License 2 T-88 Law for the following reason (Section 7031.5,'Business and i ADDRESS �7 -FINAL- Professions Code): PR .,by, �r ❑ BUILDING 1, 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 i 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 y \ tion 7044, Business and Professions Code). 1� +I CONSTRUCTION LENDING AGENCY •• I� '• SETBACK REQUIRED .YARD HWY� TOTAL SETBACK LINE WIDTH'-. I hereby affirm that there is a construction lending agency for III FRONT j the performance of the work for which this permit is issued P1. (Sec. 3097, Civ. C.). j SIDE P.L. Lender's Name ' LDMA Ref. p li P.C.Fee$ 7 Permit Fee Lender's Address I - I certify that I have read this applicatio and tate that the i Issuance Fee LDMA P/C R g above information Is correct agree to mply ith all County I Investigation Fee q ordinances and State Id relating build! g construction, I Total Fee LDMA Perm. N and here y, thorize r presentat es of th' County to enter ,I upon•'the bo -ment' ned prop rty for I pection purposes. m �` �• SEE REVERSE FOR EXPLANATORY LANqUAGE gnaturis o Applicant or of Date i ,—WORKERS'COMPENSATION DECLARATION - A: I hereby affirm that I have a-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.) i COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO F LL IN BUILDING C( �/ ADDRESS. -7 ZIA Certified copy is filed with the county.building inspec-. BUILDING J tion department. ADDRESS tJ Date Applicant CITY ZIP d LOCALITY r ` CERTIFICATE OF EXEMPTION.FROM WORKERS' NO.OF BLbbg. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST, / (This section need not be completed if the permit is for one TRACT BL K LOT NO. ASSESSOR hundred dollars ($100)or less,) MAP BOOK PAGE PARCEL TEL. USE ZONE MAP / I+certify that'in the performance of the work for which this OWNER Q 6 NO. NO, �(O permit is issued, I shall not employ any person in'any manner ADDRESS LI-AL (/►� � SPECIAL , so as to become subject to the War rs'Co cation Laws: //77 CONDITIONS CITY V ZIP /9 74. Date Applicant � NOTICE TO APPLICANT: If, after making­this Certificate,of• •• ARCHITECT OR TEL.' DISTRICT: G OUP TYPE FIRE P CESSED BY O ENGINEER NO. .. Exemption, you should become subject to the Workers' '� 1 CONST/ Z NE V Compensation provisions-cif the Labor Code, you must forih- ADDRESS ' �� V ` W with comply with such provisions or this permit,shall be 0.' deemed revoked. TEL. STATISTICAL CLASSIFICATION AFT. NDO. Z CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9. ADDRESS NO. SEWER MAP (commencing with Section,7000)of Division 3 of the Business and LIC, Professlons Code,and my license is in full force and effect. t• CITY CLASS9K ". �' VALIDATION SQ. NO.OF NO.OF CHECK License Number Lica Class .SIZE STORIES FAMILIES, ONE DESCRIPTION OF WORK & NEW ❑ $ �J�.� Gtintractor Date v I am exempt under Sec. I, ADD ❑ o ❑ ALTER � B.&P.C. for'this reason / OY' REPAIR ❑ $ Date: UpE'OF DEMOL ❑ 8 2 S A EXISTING BLDG. # o o,o o,2 a Signature APPLICANT TEL. ' •FINAL' OWNER-BUILDER DECLARATION PRINT NO. DAT Z 1 a-1- 49.88 8 I hereby affirm that I am exempt from the Contractor's,'License ADDRESS •'PIN o 0 0 4 9.8 8 0Low,for the following reason (Section 7031.5, Business and . Profe ns Code): R BUILDING -7 r 11. 'W t 8 7 I, as owner of the property, or MY employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY the structure-is.not intended,or offered for sale(Section 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-1044, Business and Professions Code). REQUIRED TOTAL SETBACK F CONSTRUCTION LENDING AGENCY SET BACK YARD' 'HWY PROP. LINE WIDTH I hereby off irm•that there is•a construction lending agency for FRONT the performance'of the work for which this permit is issued P.L. I ' (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ? LDMA Ref. p a ' P.C.Fee$ Permit Fee —3 Lender's Address 1 certify that I have read this application and state that the Issuance Fee-' t ✓ t/ kLD P/C N R above information is correct. I agree to comply with all County Investigation Fee °q ordinances and State laws relating to building construction, Total Fee LDMA Perm. p and.hereby authorize representatives of this County to enter up n thea ve-ment''oned property for inspection purposes. to � .. , A 7 SEE REVERSE FOR EXPLANATORY LANGUAGE S lure of Applicant or Agent Date WORKE,RS'COMpENSATION DECLARATION Ii it hereby a1 cer that I Have certificate of consent self g FFLICATIO' N FOR' :�UILDING PEItIVIITinure; or a certificate of Worr kers'Compensation Insurr ance,ora certified copy thereof•(Sec. 3800, Lab.'C.) ;f COUNTY-CIF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified co is hereby furnished. BUILDING PY r FOR APPLICANT TO FILL IN ''� S ❑ ADDRESS Certified copy is filed with the county building inspt3c- BUILDING tion department. ADDRESS .37 ALI° Date Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST , '.COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) . TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL L. OWN ' CNTEO 13 I — USE ZONE MAP ER I certify that'in-the performance of the. work for which-this NO. permit Is.issued,I shall not employ any person in any mannerSPECIAL , so as to become subject to the Workers'Compensation Laws.• ADDRESS tlV CONDITIONS O Date a'/ Applicant CITY ZIP �. NOTICE TO APPLICANT: If, after ma ing'this''Certificate of. ARCHITECT OR TEL. ''DISTRICT GROUP TYPE , _ FIRE PROCESSED BY O ExemNST.ption, 'you should become subject to the Workers' ENGINEER N COZ NE 1-- Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be 11L' deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. NE Z CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION L1C, CLASS NO, DWELL. UNITS '1.hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (wmme icing with;Soction 7000)of Division 3 of the Business and. LIC. Professions•Code, and'm'y license Is in full force and effect. CITY 'CLASS i I' BK VALIDATION SQ. FT.. NO.QF NO.OF CHECK License Number. Lic.Class - SIZE STORIES FAMILIES ONE 7 9 4,3 A • I VALUATION Contractor Date DESCRIPTION OF WOR NEW ❑ T ADD ❑ $ �� #'o 0 0 0 23- ' I am exempt.underSec. T�JJAW /� ALTER ❑ '0 0 3'],5 0 B.BP.C. for this reason «UVG�L���T REPAIR. ❑ $ ' Date: USE OF DEMOL ❑ o•o e 3 7 5 0 5 I EXISTING BLDG. Signature APPLICANT TEL. FINAL• ' OWNER-BUILDER DECLARATION , PRINT NO. DATE r O 9.1 7''`8 7 I hereby affirm that I am exempt from the Contractor's License, - 9 Law for the following r6asoW.'(Section 7031:5, Business and'. ADDRESS :,I pl Pr fessions Code): PRESENT BUILDING ' I, as owner-of the property, or myemployees with„ ADDRESS 't 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. - 11A11 -❑ I,as'owner of-the property,am exclusively contracting I CONTRACTOR NO. I # 7.9 a 4 with licensed contractors to construct the project'(Sec-'; . 0 0 0 oto i tion 7.044, Business and Professions Code): ADDRESS i REQUIRED TOTAL SETBACK FROM I ° °.4(150 'CONSTRUCTION LENDING AGENCY- i SET BACK YARD HWY PROP.LINE, WIDTH t I hereby affirm that there is a construction lending agency for FRONT I' the performance of the work for which this permit is issued,•• P.L. j ° °.'O 4 Q 5.0 (Sec. 3097, Civ. C.). SIDE ' P.L. p 9'2 3 i 8'7 Lender's Name c P.C.Fee$ Permit Fee LDMA Ref. R Lender's Address e 1 eertif that I have read this a lication and state that the L Y PP Issuance Fee• LDMA P/C N above information'is correct. I agree to comply with all County Investigation Fee �." ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County.to enter iDNA Perm...* $ upon the above- ntioned pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ---------� Signatureof Applicant or Agent Date t. / WORKERS'COMPENSATION DECLARATION I;~!raby affirm that I have a certs of-consent to Sel APPLICATION FOR, B U I L D I ISI G `P E RM I T irisute, or a certificate of,Workers'Corp,Co Lob.mnC;ion Insurance !! or'o certified copy thereof (Sec.3COUNTY OF LOS ANGELES' i'( BUILDING AND SAFETY r' r.mpany Polii Nd reby furnished. I FOR APPLICANT TO-FILL IN ADDR SS Certified coe L t copy.is filed with.the county building ' spec BUILDING t—X 9r:epa�tment. ADDRESS LOCALITY �.� �J /� NEAREST .dte Applican I CITY (moi / ryZIP CROSS ST. / ' ERTI ICATE OF EXEM W S' I NO.OF BLDGS. ASSESSOR COMPENSi4Tl0 INSU NC 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 hundred dollars($100)or less.) I TRACT BLOCK LOT NO.a,,4 NO. `Jr TEL. SPECIAL I certify that in.the performance of the work for which this OWNER NO. JI67 v CONDITIONS• � �� _ - DISTRICT :GROUP TYPE FIRE OC ED BY O permit is issued, I shall not employ any person in any manner �-• so as to become subject to the Workers'Compensation Laws. ADDRESS S r �N ,/J CQNST. ZONE U li CITY t ZIP s r ? O Date IApplicant STATISTICAL CLASSIFICATION APT. CO b NOTICE TO APPLICANT: If, after making this Certificate of'' ARCHITECT O TEL �� ENGINEER 9.(//# NO.. f 2 CLASS NO. /!! DWELL.UNITS • 'Exemption, you should become subject. to the Workers' _ �.✓ a, Compensation provisions of the Labor Code,•you must:forthi' ADDRESS f ZS 3 s �V/ SEWER MAP with comply with such provisions or thi's permit shall'be ) deemed revoked. I ' I A4 TEL. '�'h/ BK PG; VALIDATION CONTRACTOR N`�/ NO. '" G/ w LICENSED CONTRACTORS DECLARATION' IC. , I hereby affirm that I am licensed under,provisions of Chapter.9 ADDRESS Z _ / VALUATION (commencing with Section 7000)-of Division.3 of the Business and LIC. 5 2 3 Professions Code, and my license is in-full force'and effect. CITY t; ,! CLASS $ •= o ss HECK SIZE '© SIO DRIES ( FAMILIES CONE ► ° �• y License Number •Lic.Cla 1 I' $ u! Contractor7✓/�/y •7G G�VS + -Date' �y I DESCRIPTION'OF WORK NEW /� I •y2 L ADD ❑'I am exempt under Sec. 3• IJ i ALTER: ❑ FINAL B.BP.C. for this reason DATE ' REPAIR ❑ " • � USE OF Date:I EXISTING BLDG. DEMOL ❑ FINAL NAL Signa APPLICANT TEL. y - DER DECLARATION PRINT ' , % NO. (� I hereby affirm I am exempt from the Contractor's License , �2 58.2 A Law for the foil ing reason (Section.7031.5,.•Business and ADDRESS (o _ _ (5 /�/�✓6 Professions Code): PRESEN # 0 0 0 0 2 3 BUILDING 8 7 2 8-1❑ I,-as owner of the property, -or my employee's With ADDRESS wages as their sole compensation,will do the work orifi the structure is not intended or offered for sale(Section LOCALITY ° a 8'7 2 8 � U 7044, Business and'Professions Code). I MOVING TEL. ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. 8 O'� —8 5 with licensed contractors.19 construct the project(Sec- ADDRESS -tion 7044, Business'and Professions Code). REQUIRED f YARD HWY' TOTAL SETBACK FROM EXIST. y..'' CONSTRUCTION LENDING AGENCY SET BACK PROP.LINE WIDTH I hereby affirm that there is a construction lending'agency f it FRONT' the performarice•bf the work for which this permit is issued P.L. , ter' tSec. 3097,rCiv.:C.). I' j SIDE o •P.L. �. I A -Lender's NameT �L• �'��� '• , # �'2 5 1 j `j s , . 7S 17' 5498.2 P.C.•Fee$ / Permit•Fee' L'ender's ' I certify that I have read this application and state that the �" �.?� Issuance Fee / V ° Jr 4 9 8.2 5 cyi above information is correct. I agree to comply with.all County Investigation Fee �. q q ordinances and State laws relating to building construction; Total Fee �/ 0 S ' O 8 2_$6 and hereby.authorize r esentatives of this County to nte� on bov - rty for inspection � SEE REVERSE FOR EXPLANATORY LANGUAGE ' • i a p scant or Agent 18 i OI'ACERS'CQMP'ENSATION DE CLARATION;,� ' /�}(y✓�ir`m that I have a certificate of consent to,s@'If ir$bw, ora certificate of Workers'Compensation Instiran e,, A P P L i CAT I ON F�O R.;B U I L D I.N G•� PERMIT or a certified copy thereof(Sec. 36120, Lab. C.) �; COUNTY OF LOS ANGELES j BUILDING AND SAFETY Policy Nof so1!/ ompany..8d0 1r� �: 0 PY r' F.OR•QQPPLI.CANT TO FILL INTADDRLESSING Certified•co is.hereby-furnished: Certified copy is filed:with the'coii uildin pec- '"" BUILDING ; tion deportment.- ADDRESS ��, '� � �Date Applicant; CITY �c !✓>Y ZIP /' ITY. ' CERTIFICATE OF EXEMPTION OM WOR d NO:OF BL S. NEAREST ! ._ - COMPENSATION INSURANCE �- SIZE OF LOI.'. NOW ON LOT CROSS ST. _. (This section need notbe completed if the permit is for-one — - ASSESSOR• " '' hundred dollars($100)or less.) TRACT BLOCK LOT MAP BOOK PAGE PARCEL USE ZONE MAP -7 OWNER d12 ✓ .s N �� NO. �. r���•.. , . I certify that,in the.performance of the�wo}k for�which;this t: .� permit is issued,I"shall not employ any person in any manner _ SPECIAL �'d so'as to become subject to the Workers''Compensatioh Lows. ADDRESS �Nl+�✓ /✓ CONDITIONS V. T., CITY AD ZIP:. _ :0t: Date Applicant' ARCHITECT O ��y� TEL. / ;O NOTICE TO APPLICANT: If;after making this'Cettifica'te of W ' DISTRICT "_GROUP 7 PE. FIRE P SSEDBY' Exemption,. you 'should become subject',for the.Workers' ENGINEER /L[i/Jy»S NO: .Q CONST.' ZONE i :• Compensation provisions of the Labor Code,-you must'forth- ADDRESS . ^' - b=Z- - --- -- - ' with comply with such. provisions or•this, permit,shall be' TEL. #A deemed revoked. �/; +� 3 STATISTICAL CLASSIFICATION APT. COND . z CONTRACTOR:' �% ��,' ` 'Q' NO..r _ LICENSED CONTRACTORS DECLARATION. - :LIC.ti ` ' CLASS NO.'1__4Q' DWELL. UNITS. I hereby affirm that I am licensed under provisions of Chapter'9' ADDRE SEWER MAP (commencing.with Section 70D0),of-Division 3 of the Business and :' i- �� ;y� ;�•F^'LIC. '.t -• .Oro,fessions Code;and my license is in full"force and effect.l, CITY.2i/I�n7Q ! ,, CLq�S i BKJJ ;- " VALIDATION" 7, SQ. NO.OF, :�. NO. OF'' CHECK ;i License Number A� Lic.Class SQ t SIZE / STORIES FAMILIES :ONE '' /s4Cl GG�!Sl 9.:p. 4 - hVALUATION 7' " �NEW DESCRIPTION OF WORK �t $ / f v n o 2.5 5 3, i•A Contractor Date ,' ADD � / ' '. ✓- L� �s�'•= t>/[�>'i ALTER # a o o- 02.3 ❑ I am exempt under Sec. II ,` B.BP:C. for this rea n I" l REPAIR4`Q -I$" I.-IL-6-.6 4.5 9 USE OF EXISTING BLDG, ,/'� DEMOL ° g b 6 4 5 9 Signature APPLICANTTE ', ' 'FINA O ER-BUILDS ECLARATION PRINT ,vA4W6r t�V• '- �; DATE O 9 3 O''$6 I hereby affirm that I am eice pt from the Contractor's License �`�I--- Low for'the following"redson (Section 7031.5, Business.and ADDRESS �✓ P✓K !i®f '�/ 0. ? •n. Professions Code): PR 5EN :.g BUILDING c "V �' I, as owner of the property, or my employees with _ ADDRESS" _ _. _ _A_ t _ wages as their sole compensation,will do' work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business.and Professions Code).- MOVING " TEL. CONTRACTOR.. NO., '• I iti '' ] i ,I, as owner of the property,am.exclusively contracting with-licensed contractors'to construct the project (Sec- ADDRESS ''� p.� " tion 7044,.Business and Professions Code). I( 0�37 X REQUIRED TOTAL SETBACK. RO T: I I ���"•: CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 111 hereby affirm that there Es,a construction lending agency for FRONT ` the performance of the work-for which-this permit-is issued - P.L.. - - (Sec. 3097, Civ. C.))./ SIDE �' Lender's P.L. No' [/f/ li LBFC�AL/F a LDMA Ref.,# 1 $ P.C.-Fee$-:1146*4r619, Permit Fee'• Lender's Address ����% 'certify that I have.read this.application-and state that the _ Issuance Fee AA�� LDMA P/C# a' above inform on is correct. I agree to comply with all County ` Investigation Fee 2 i ordinances, d tate law relating to building construction, I;,,. - Total Fee 3 / LDMA Perm:# u and,,h a oriz r sentdtives of this County to enter upo ve-m ti d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ; nO,1 !�! S�I nature o ,. t. r t Date' - - x 1 /�L� /.iii•�i�1 /U/�g i�-• `3t`':+NORKERS'COMPENSATION DECLARATION :s•7'1 hereiiy offirin:,that I have:a certificate'.of.consent to self APPLICATION 'FOR-BUILDING. PE:R_ MIT- " in'u e, or a certificate of Workers'Compensation Insurance, or'o certified copy thereof(Sec' 3800, Ldb.'C.) �060P. oy� I ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy o. •orripany.. rtA 4a.'-,/Mj. �p• BUILDING 2 �: .=•Certified copy is hereby furnished: , FOR APPLICANT TO FILL IN ADDRESS . Certified copy is filed with the:county b0ilding'inspeo- BUILDING r1 ' tio//n'depaftment: ADDRESS 9Z 37 Lotope USN k�. , Date 5/5/9-7 Applicant4411mere. , CITY -RM 644 _, ZIP 91WO LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS" ' NO.OF BLDGS. NEAREST .COMPENSATION INSURANCE- • -- SIZE OF LOT NOW-ON LOT CROSS ST. 4, (Thisseetion need not be completed•if'the permit is-for-one' ASSESSOR.„ '•'':9'c hund,red•dollars($100)or.less.) •;a ;,, ;, TRACT BLOCK' LOT NO. MgP'BOOK''' PAGE.. PARCEL ; .; �}' , TEL. pp�� USE ZONE MAP OWNER /Illbt�IaA/ T-20(x, _ NO:57WIL70 /7 I certify that in the performance'of the work for which this ;.� NO. v, �, permit,iiijtsued, I shall not employ any person in any manner • SPECIAL - 0. ADDRESS, CONDITIONS so ds to'become'sukiject to-the Workers'Compehsatiori'Laws. � •• �� '� �• ' � -- 'O Date' �' Applicant , v.. CITY -4actf Df - ZIP. . . i ARCHITECT R 7EL... .�:... V0 . . NOTICE TO'-APPLICANT::If, after making this Certificate of , QQ r DISTRICT - GROUP..TYPE FIRE PROCESSED BY Exemption,+you should 'become',subject to- the Workers"� - ENGINEER.C�'ftMj •.._D. ku.$O NO.W�S 23 0 CONST.• ZONE / Compensation provisions'of'the Labor-Code, you must forth-forth- ADDRESS -- - �• / !� ( - ; IL with comply •with•."such provisions or this permit"shall be TEL.'7 STATISTICAL CLASSIFICATION ' APT. CO Z deemed revoked., _ CONTRACTOR-(:'a I mea. C'ow 5� No. 6�3 LICENSED CONTRACTORS DECLARATION -• - :LIC; CLASS NO. 11�DWEiL, UNITS I hereby dffirm that Lam licerised under-.provisions of Chapter 9 ADDRESS 22(.32 iWbe u 5P 9 NO.301%l q (commericijrig with Sect-ion 7.000)ofDivision 3 ofi the Business and -. _ - •_LIC _• SEWER MAP Professions de,•and my•license•,is in full force and effect. CITY 1�pNRanr7�NO:OF 64A- CLASS "' ' "' CoVALIDATION " SQ.ET. Ro.OF CHECK BK. License Number 3018114 '' Lic.Class SIZE STORIES IFAMILIES ONE • - //�� VALUATION DESCRIPTION � _ :. j1W11CK IONy J S �- -DESCRIPTION OF WORK '- "' W C� Contractor Date p NE Ilia m exempt under Sec. Re�►auJ W A.LL ___ _ ADD- $ r , ALTER f ,•'. B.&P.C. for this reason REPAIR Date: .. USEOFEXISTINBLDG. DEMOL Q , 'Signature APPLICANT TEL. DAT OWNER-BUILDER DECLARATION PRINT NO. E " +hereby affirm that I am exempt from-the Contractor's License F 'Low for the#ollowing•:reosdn'(Sectioh 7031:5, Business and ' ADDRESS. .• pj' "'Wofessioris'Code): PRE EN -• ` 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, contractors to'construct the project (Sec- : ADDRESS tion 7044, Business and Professions Code). S�V /X„I• ,,' _• REQUIRED... .. TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD' HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FROM the performonce•of-the work-for which this permit is-issued P.L. - - - • �•°-° 4••0.50=' (Sec.'3o97, Civ. C.). SIDE o ° °'4.0"5.0':' a , P.L. s Q Lender's Name o 5.o 5 j-.8 7' SLDMA Ref:#. o P.C.Fee$ _.. Permit Fee. .. = Lender's Address Q i x I certify'•that I.have read this.appl!cation and state that the ' Issuance Fee - i LDMA P/C'# above information is correct. I agree to comply with all County Investigation Fee- ; ,ordinances and State laws relating_to building.construction, . and hereby authorize representatives of this County to enter Total Fee / LDMA perm:# S upon the abo entioned property for inspection purposes. 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date WO4d ' '�CO�APENSATION DECLARATION k`'I sur ebp affirm that:I haver certCom.e of consent to self P■ ,L I CAT I N F O� ' B U I l EA N d P E RM I T � Ifl insure,.or a certlfiicate'of Workers'Corripensatiorr Insurance, , I or a certified copy thereof(Sec. 3800, Lab: C.) , p' 11 - 1. sj, COIJNTY*OF'LOS ANGELES �. BUILDING AND SAFETY Policy No. Company ❑ ,Certified copy is hereby furnished. . FOR APPLICANT TO FILL IN UW;r 1 BUILDII`4 ADDRESS Certified,copy is fi:led'with the county building inspec- BUILDING' sy tion deportment. ADDRESS � Date Applicant CITY 'ZIP LOCALITY 71/111 , CERTIFICATE OF EXEMPTION FROM WORKERS' [' NO.OF BLDGS. NEAREST. COMPENSATION INSURANCE SIZE,OF LOT NOW ON LOT CROSS ST. �J, I -..(This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)'or less.) TRACT,' BLOCK LOT NO. MAP.BOOIC , PAGE. PARCEL. v TEL. USE ZONE OWNER (© I certify,that in the.performance of the work. for which this I,. O yn.� I NO. :permit is issued„I sPeall not employ any peison in any manner I• ,�/�� SPECIAL �t so as-to become subject'to the Workers''Compensation Laws. ADDRESS �� l I CONDITIONS 0. CIT ZIP. ' V Date �Z: -S24pPlico _ r . NOTICE;TO APPLICANT: If, after making'-this Certificate of ARCHITECT OR TEE DISTRICT GRO}}}111P' TYPE' FIRE PROCESSED BY O ENGINEER: C I • CONST. ZOE V Exemption, you should become subject'.to .the Workers' �^ Compensation provisions of'the Labor-Code, you must forth- ADDRESS ��ti/ 1/ W with comply with such provisions or this permit shall be -r I' a deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. rNDO.. fA CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION •j? LIC; . CLASS.NO. ' DWELL UNITS I hereby affirm that I:am licensed.under provisions of Chapter 9 ADDRESS NO.. SEWER MAO (commencing with Section 7000)of Division 3 of the Business and �j• ;, LIC. �Pfdfessions Code,and my'license is in full force and "effect. CITX,' CLASS' ,,QQ VALIDATION ' SQ._1;Fi. NO.OF NO.OF CHECK. BKIAL'' '�� License Number Lic.Class SIZEi STORIES FAMILIES -ONE . VALUATION Contractorpate DESCRIPTION•OF'WORK 7i >/ ADD ❑ ; /���` (J(/ ❑I am exempt under Sec. / [ ' l(-�' Q pow. �r ALTER B.BP.C. for this reason It' REPAIR ❑ $ Date: USE OF D EMOL r EXISTING BLDG. ❑ Signature APPLICANT y � `',,, TEL FINAL. OWNER-BUILDER DECLARATION PRINT L . DATA ' I hereby affirm that I am,exempt from the Contrtictor's License taw•.for the following reason (Section. 7031..5, Business and -ADDRESS 1 (.t rC a:'. pl r B77177,A Professions Code): y BUILDING I, as owner of the property, or my employees with ADDRESS Wages as their sole compensation,'will do the Work and s .fhe'structure is not intended or offered for sale(Section LOCALITY E1 °,°'LI Q 5 7044;'Business and Professions Code). MOVING TEL. I V _ CONTRACTOR NO. o'o;o 2- I,as owner of the,properfy,am exclusively•contracting f.• i Y / 4 Q 5 0 with licensed contractors to construct the project (Sec- j tion 7044, Business.and Professions.Code). ADDRESS 1 > >.. ' 0 8 2 7 8 7 REQUIRED, TOTAL SETBACK I ` t CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.AINE ' WIDTH t ) •I hereby.off irm that there is a construction lending agency for FRONT the performance of the work for•which this permit is issued (Sec. 3097, Civ. C.). 91DE a. , P.L. Lender's Name CDMA Ref. # '? P.G.Fee$ Permit Fee Lender's Address I certify that 1 have read this application and state that.the Issuance•Fee LDMAI P/C# ? above information is correct. I agree to comply with all County Investigation Fee �. ordinances and State Ibws relating to building construction, I Total Fee �„ LDMAiRerm: # and hereby authorize,representatives of this County to enter -upon the abo -mentioned ppertyor inspection purposes. I. i o c a l i SEE REVERSE FOR EXPLANATORY LANGUAGE ; I Signature of Applicant.or A,6effi Date I' a COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT ` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1304150076 PHONE: (626) 285-0488 EXT: LEGAL ID: 1NUMBER OF SIGNS: 1 BUILDING ADDRESS: ON FILE [SIGN DESCRIPTION:-.NEW&WALL SIGN LED CHANNEL LETTERS SIGI 9237 Q LOWER AZUSA RD I TEMP CA 917803743 ASSESSOR INFORMATION NUMBER: 1i NEAREST CROSS STREET: 8590-029-034 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY CAI TENANT: 1EXIST BLDG USE: [ISSUED ON: PROCESSED BY: AUTO SERVICE [EXIST OCC GRP: 104/15/13 SR 1 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: [FINAL DATE FINAL BY: CODE: IJOE AUTO AND BODY (626) 285-4673- 1 1,400 1 19237E I I23 1COVI 917231600 FEES PAID IDE C IPT ON OF WORK INEW WALL SIGN LED CHANNEL LETTERS IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ (APPLICANT: TEL. NO: I IWEIMAN, QUAN (626) 673-2888- IAA BLDG PERMIT ISSUANCE 27.80 I 1 18963 GARVEY AVE IAB STATE GREEN BLDG FEE 1400.00 VAL 1.00 ISPECIAL CONDITIONS: 1 IROSEMEAD CA 91770 AX BUILDING REVIEW FEE 54.70 1 1 1D2 PERMIT W/O EN-HC 1400.00 VAL 82.20 1 1 I I TOTAL FEES 165.70 (CONTRACTOR: TEL. NO: 1 [APP. OVALS DATE INSPECTOR SIGNATURE 1 TART SIGNS AND PRINTING INC (626) 288-2283- I 1 I 18963 GARVEY AVENUE LIC. NO 1 1LocATION AND SETBACKS I I IROSEMEAD CA 91770 965157 * I 1 I I I I ISOILS ENGINEER APPROVAL I I I [ARCHITECT OR ENGINEER: TEL. NO: - 1 [FOUNDATION/TRENCH FORMS I I I 1 LIC. NO: i ISUPPORT STRUCTURE I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( I I I I I 001 I I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 1 I I I 1 NO 20 1 1 SCHOOL WITHIN HAZARDOUS I I I I I LAIR QUALITY: 1000 FEET MATERIALS I I I I I 1 NO NO NO I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I 1 I I I I I I I* ADDITIONAL DATA ON FILE I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1304150066 PHONE: (626) 285-0488 EXT: LEGAL ID: IMBER OF SIGNS: 1 BUILDING ADDRESS: I ON FILE SIGN DESCRIPTION: NEW WALL SIGN LED CHANNEL LETTERS SIGI 9237 C LOWER AZUSA RD I I I TEMP CA 917803743 ASSESSOR INFORMATION NUMBER: II NEAREST CROSS STREET: 18590-029-034 1 1 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY CAI ITENANT: (EXIST BLDG USE: (ISSUED ON: PROCESSED BY: IA-ZAD'S AUTO PARTS (EXIST OCC GRP: 104/15/13 SR (OWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: IFI�/NA�L DATE �FI/NAAL BY: CODE: 1 [JOE AUTO AND BODY (626) 285-4673- 1 1,400 1` '�lXl� Al 9237E ICOVI 917231600 FEES PAID 1DESSCRIP ON OF WORK 4I 1 [ [NEW WALL SIGN LED CHANNEL LETTERS [ FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: (APPLICANT: TEL. NO: I I IWEIMAN, QUAN (626) 673-2888- 1AA BLDG PERMIT ISSUANCE 27.80 ] 8963 GARVEY AVE IAB STATE GREEN BLDG FEE 1400.00 VAL 1.00 ]SPECIAL CONDITIONS: I ROSEMEAD CA 91770 AX BUILDING REVIEW FEE 54.70 D2 PERMIT W/0 EN-HC 1400.00 VAL 82.20 [ [ ] I TOTAL FEES 165.70 CONTRACTOR: TEL. NO: I IAPP OVALS DATE INSPECTOR SIGNATURE [ART SIGNS AND PRINTING INC (626) 288-2283- I 1 18963 GARVEY AVENUE LIC. NO I ILOCATION AND SETBACKS ] I ] IROSEMEAD CA 91770 965157 * [ 1 ] ] ] ]SOILS ENGINEER APPROVAL I I I I ]ARCHITECT OR ENGINEER: TEL. tiO: - [ ]FOUNDATION/TRENCH FORMS I I I LIC. NO: ] ISUPPORT STRUCTURE I I ] 1 1 I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:] ] I I I 1 001 I ] I [N0. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I ] ] ] NO 20 1 1 1 1 ] SCHOOL WITHIN HAZARDOUS I I 1 1 1 ]AIR QUALITY: 1000 FEET MATERIALS I I I 1 ] NO NO NO I I I I I I I I I I 1 I I I I I 1 I I I I I I I I i I I I I ] I ] 1 ] I I I I 1 1 1 1 1 1* ADDITIONAL DATA ON FILE IREPORT ID: DPR261 ROUTE TO: BS0508 1 1 ] 1 I I [ I ] I COUNTY OF IOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS COMMERCIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0912010006 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST NEW I BUILDING ADDRESS: 1 ON FILE SQ. FT STORIES TYPE OCCUP GROUPI 9237 LOWER AZUSA RD 1 ]STRUCTURE: 336 1 V-B B I TEMP CA 917803743 I (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 1 18590-029-034 I I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPEL CITY, Cl ITENANT: (EXIST BLDG USE: COMME USE ZONE: C-1 11SSUED ON: PROCESSED BY: (JOE'S AUTO BODY 1EXIST OCC GRP: B 112/01/09 SR ] (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: (JOE'S AUTO BODY - J 30,000 1 19237 LOWER AZUSA RD. I I I ITEMPLE CIYT CA 91780 I FEES PAID IDESCRIPTION OF WORK J (INSTALL ONE PRE-FAB SPRAY BOOTH WITH FIRE PROTECTION I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 I (APPLICANT: TEL. NO: I I I IMONDRAGON (562) 755-0625- JAA BLDG PERMIT ISSUANCE 27.75 1 I 114059 GARFIELD AVE. JAB STATE GREEN BLDG FEE 30000.00 VAL 2.00 ISPECIAL CONDITIONS: I IPARAMOUNT, CA 90723 JAE STRONG MOTION OTHER 30000.00 VAL 6.30 J J J ID2 PERMIT W/O EN-HC 30000.00 VAL 536.70 I I I 1 TOTAL FEES 572.75 J J ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE 1 1PERFORMANCE SYSTEMS CO. (562) 790-1762- 1 1 114059 GARFIELD AVE LIC. NO I JLOCATION AND SETBACKS I J I [PARAMOUNT CA 90723 661143 B I I I J J J I ISOILS ENGINEER APPROVAL J I JARCHITECT OR ENGINEER: TEL. NO: J FOUNDATION/TRENCH FORMS I I J LIC. NO: I JSLAB/UNDER FLOOR I I I I IRAISED FLOOR FRAMING J I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I JUNDERFLOOR INSULATION I I I XX 3 001 1 I 1 I I I IFLOOR SHEATHING J I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I J I J NO 22 1 IROOF SHEATHING J I J SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS ] I I JAIR QUALITY: 1000 FEET MATERIALS J I J J NO NO NO 1 IFRAME INSPECTION I I I J IFIRE SPRINKLER HANGERS I I I J JINSULATION/WEATHER STRIP] I I I I IINTERIOR LATH/DRYWALL J J I I [ 1EXTERIOR LATH J I I I [ r�\r� � ( IRATED FLOOR/CEIL ASSEM. ] ] I J \'P-)��u ]I Ilt am ISI 1 RATED WALL ASSEMBLIES 1 J 1 I J ]RATED SHAFTS/OPENINGS I J I [ IT-BAR CEILINGS J I I [ ILOT DRAINAGE 1 I J I ] ]REPORT ID: DPR261 ROUTE TO: BS0508 J I J I I J I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS COMMERCIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1008230046 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1 1 ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 9237 R LOWER AZUSA RD I [ASSESSOR INFORMATION NUMBER: ISTRUCTURE: 49 1 V-B B I TEMP CA 917803743 1 18590-029-034 1 I NEAREST CROSS STREET: ROSEMEAD THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY, Cl 1 (TENANT: [EXIST BLDG USE: COMMS USE ZONE: M-2 TISSUED ON: PROCESSED BY: 1 1CLEARWIRE 1EXIST OCC GRP: B 110/18/10 SR [ TOWNER: TEL NO: 1BLDGS. NOW ON IAT: VALUATION: IFINAL DATE FI Y: CODE: 1 1ANGUS O'BRIEN (626) 454-5222- 1 1 30,000 1 14134 TEMPLE CITY BL. I 1 1ROSEMEAD CA 91770 1 FEES PAID I SCRIP ION OF WORK 1ADDING CLEARWIRE ANTENNA TJEXISTING MONOPOLE ADDING 1 EQUIPI IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:IMENT CABINET TO EXISTING LEASE AREAD (INTERIOR) OF UNIT #R I 1APPLICANT: TEL. NO: 1 I 1CLEARWIRE/AMERICAN TOWER, CHIP CLIIS (213) 305-1970- 1D1 PLANCHECR W/O EN-HC 30000.00 VAL 455.90 I 1 12361 CAMPUS DR. 240 AA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: IRVINE CA 92612 AS STATE GREEN BLDG FEE 30000.00 VAL 2.00 1AE STRONG MOTION OTHER 30000.00 VAL 6.30 1 1 ID2 PERMIT W/O EN-HC 30000.00 VAL 536.40 I ICONTRACTOR: TEL. NO: I TOTAL FEES 1,028.40 (APPROVALS DATE INSPECTOR SIGNATURE 113ERLINER COMMUNICATIONS INC. (714) 231-5842- 1 1 114270 ALBE .S WAY LIC. NO 1 [LOCATION AND SETBACKS I 1 1 [CHINO, CA 91710 908692 I 1 1 1SOILS ENGINEER APPROVAL 1 1 1 1ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I (AMERICAN TOWER (972) 999-8900- I 18505 FREEPORT PKWY. LIC. N0: 1 [SLAB/CINDER FLOOR 1 I 11RVING, TX 95063 NONE 1 I I 1 1 I IRAISED FLOOR FRAMING 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I I 1144H265 300 1 1 1 IFLOOR SHEATHING 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I 1 NO 22 1 ROOF SHEATHING 1 1 SCHOOL WITHIN HAZARDOUS I (SHEAR PANELS I I [AIR QUALITY: 1000 FEET MATERIALS 1 1 I NO NO NO I I11 11I 11FRAME INSPECTION FIRE SPRINKLER HANGERS I I 1 1 1 I IINSULATION/WEATHER STRIP[ 1 I I I I 1 I INTERIOR LATH/DRYWALL I I I 1 I 1I I1 1EXTERIOR LATH [RATED FLOOR/CELL ASSEM.1RATED 11 i II1 WALL ASSEMBLIES I [ I I RATED SHAFTS/OPENINGS I 1 T-BAR CEILINGS 1 I I 1LOT DRAINAGE 1 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I 1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0203120004 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER­DT-STGNS--. 1 BUIL ON FILE SIGN DESCRIPTION: "TEMPLE CITY INDUSTRIAL PARK" 9237 LOWER AZUSA•RD TEMP CA 917803743 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 8590-029-034 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY TENANT: S 5 D 0 EXPIRES EXIST OCC GRP:• 04/08/02 JK 10/05/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: A DATION: Mo FI Y: CODE: O;BRIEN;ANGUS (626) 454-5222-201 2,000 4134 TEMPLE CITY BLV ROSEMEAD 91770 S 0 FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: NEW TENANT/ADDRESS PqEE SIGN APPLICANT: TE 0: ANGUS O'BRIEN - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESIO 2000.00 VAL 0.50 SPECIAL CONDITIONS: Al PLANCHECK J,EN=F(C—:: —!000aQ0 VAL 82.10 A2 PERMIT W GY fIA E T 4r OPV L 204..53 88 CONTRACTOR: TEL. NO: �CJ ,`"' TT /�/�. APPROVALS DATE INSPECTOR SIGNATURE LOS ANGELES ENGINEERING, INC. (626) 454-5222- �. 4134 TEMPLE CITY BLVD LIC. NO LOCATION AND SETBACKS ROSEMEAD CA 91770 NONE SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: 0 IO / RE C OR S FERGUSON, KERMIT (626) 445-2350- 333 N. SANTA ANITA AVE LIC. NO: ���� SUPPORT STRUCTURE STE. 5 NONE ARCADIA, CA MAP N0: SEWER MAP B00 PAGE: FIRE ZONE: CMP O;Ia [P n �Bu �� 0 ��` O TRKS) 0. 0 S: DWELLING UNITS: AP /CO D: ST C ASS: v �I NO 20 j 0 SCHOOL I R D A S �'f�l�t�+; AIR QUALITY: 1000 FEET MATERIALS ❑ , j,i•— NO NO NO ❑ �C `S'E!rVICE:Shad VV REPORT ID: OPR261 ROUTE TO: BS05O8 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0607070050 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUR GROUP 9237 LOWER AZUSA RD STRUCTURE: 0 1 VN C TEMP CA 917803743 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: RIO HONDO 8590-029-034 THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: C 08/31/06 JK 08/26/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE INAL BY: CODE: TEMPLE CITY INDUSTRIAL PARK (805) 732-6393- 40,000 4134 TEMPLE CITY BL / C/ ROSEMEAD FEES PAID DESCRIPTION OF WORK INSTALLATION OF 4 OUTDOOR CABINETS & 6 ANTENNAS AT AN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: EXISTING CELL SITE APPLICANT: TEL. NO: TOM DUARTE (714) 730-3243- Al PLANCHECK W/EN-HC 40000.00 VAL 652.18 2913 EL CAMINO REAL AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: TUSTIN, CA 92782 AE STRONG MOTION OTHER 40000.00 VAL 8.40 A2 PERMIT W/ENERGY-HC 40000.00 VAL 767.28 TOTAL FEES 1,455.61 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE JITNEY CO., INC. (714) 998-0995- 1057 E IMPERIAL HWY LIC. NO LOCATION AND SETBACKS SUITE# 605 719304 RIC PLACENTIA CA 92670 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOMMATION TRENCH FORMS TRUSSNET - 8105 IRVINE CENTER DR. LIC. NO: SLAB/UNDER FLOOR IRVINE, CA 92618 NONE RAIESD FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP UNDERFLOOR INSULATION 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRA14E INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATE/DRYWALL VIn 8RT8RIOR LATH RATED FLOOR/CEIL ASSEM. ILATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTS TO: BSO508 t 1 ! • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT i DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0608020040 PHONE: (626) 285-0488 ERT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 9237 LOWER AZUSA RD STRUCTURE: 50 VN TEMP CA 917803743 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 8590-029-034 THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: COMME USE ZONE: C-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/03/06 JK 07/29/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL D TE FINAL BY: CODE: TEMPLE CITY INDUSTRIAL PARK - 15,000 177 E. FRONT STREET - COVI 917231600 FEES PAID DESCRIPTION OF WORK INSTALLATION OF GENERATOR BACK-UP FOR VERIZON SITE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: JOE DURAN (619) 247-0229- AA BLDG PERMIT ISSUANCE 27.75 P.O. BOX 435 D2 PERMIT W/O EN-HC 15000.00 VAL 300.60 SPECIAL CONDITIONS: LEMON GROVE 91946 TOTAL FEES 328.35 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE BAY CITY ELECTRIC WORK'S INC. (619) 938-8200- 12208 INDUSTRY ROAD LIC. NO LOCATION AND SETBACKS LAKE SIDE, CA 92040 748133BC10 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 144H265 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION `` ,NMy REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER GERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION WRATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 �9� I