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COUNTY OF LOS ANGELES
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DEPARTMENT OF PL:BLIC WORKS
•e�ro' SAN G;&B?IZL VALLEY REGIONA-L OFFICE
THOMAS TWE-A%NSOV D.svie BUILDING ASID SAFETY
1.25 S Bald rin Avenue
Arcadia, CA 91007
(818) 574-0941
MICROFILM I NYOR-gATION
Record Search
1933-1.954
Building Address CCp!UCS --1(10 i�tw A� mciRocality
Previous A_cdr-ess 2-2- O 0
Tract No. _ Lot No. Lot Size
Building Perini issue Date Final Date
Descriptio of Work
r �
} Scr. Ft
'i
uilding Pe it Ssue to Final nate
• Descri on of Wo
Sq Ft
Buildin ran Issue Da Final Date
Descri do of Work
0
Scy Ft
Building Per 1 ssue Date anal Date
Das
Sq Ft
F
Building Permit sue Date r'` Fina ate
Description of rk
Sq, Ft
Sewer Permit Ua Issued
Private Disposal System Rate Xnspected
Public Sewer Connection
Date 114 By
1
111. J� -T
TEMP.. I T Y
78M444 DBS 78 I1 BB
IVIISCELLANEOU APPLICATION 1 `
DIVfSION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS
Dep in ent of County Engluber
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS �0
CASSATT D GRIFFON SUP T OF BUILDING
LOCALITY_
OR APP T IN NEAREST
OWNER CROSS ST
ADDRESS MAILDISTRICT O G UP TYPE N
tE Q�j y
CITYNO \`+- MAP STATE
TEL2p
NUMBER61 HWY YES O
CONTRACTOR NO 6�7 USE ZONE SPECIAL
UK CONDITIONS
ADDRESS
LEGAL
DESCRIPTION I LOT NO BLOCK BUILDING EXIST
SETBACK YARDI HWY REST NAME I WIDTH
NO OF BLDGS FPR LNT ice_,✓ cw
TRACT NOW ON LOT v�
USE OF SIDE
SIZE OF LOT EXISTING BLDGP. J
APPLICATION FOR INSPECTI N RECOHD
INSPECTION I SAFETY PERMIT 9� 'J,
TRAILER USE I LIMITED TIME USE
el
DATE DATE ..�
FROM TO _.,..., ...W. _I
USE OF STRUCTURES OR DEVICES
INSPECTION FOR
La 1
OCCUPANCY A APPROVALSM �� Z.,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS DATE INSPECTOR'1fS1k URO
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES OCCUPANCY APPROVAL
AND STATE LAWS EGULAXNG BUILDIN¢ CONSTRUC GROUP OCC LOAD
TION
SIGNATURE OF TRAILER USE
PERMITTEE
o SAFETY PERMIT
AD ES TEMPORARY
w STRUCTURE APPROVED
TEMPOBARY
STRUCTURE REMOVED
FEES
FINAL APPROVAL
JOHN A LAMBIE COUNTY ENGINEER VALIDATION-')CLYDE N DIRLAM CHIEF BLDG INSPECTOR
CK MOf CASH /
,hLo 5 8 9 61-1 SEP 2 4 2 2 D 1500-
RS COMPENSATION DECLARATION CE 76M4
84) MISCELLANEOUS APPLICATION
I y mum that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
insure or a certificate of Workers Compensation Insurance
e or
a certifi�d copy thereof(Sec 3800,Lab C)
Policy No Company FOR APPLICANT TO FILL IN BUILDING
ADDRfiSS
M Certified copy is hereby furnishedUILDING p Zk q � GIT
ADDRESS R LOCALITY
Certified copy is filed with the county building inspection LOCALITY
NEAREST
department CROSS ST
Date ` Applicant AREST �r �I ��� DISTRI NO, GROUP TYPE P CESSED BY
CRO88 ST �„ O� CONSTJ / u `
CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL v
COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP t11GMWAY STATE MAJOR SECOND LOCAL
N
NO OF BLDGS O (CIRCLE)
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less)
O USE OF
SIZE OF L
I certify that in the performance of the work for which this EXISTING BLDG 0
permit is issued I shall not employ any person in any manner ow S�
so as to become subject to the Workers Compensation Laws r L NI OCCUPANCY GROUP
MAII7D OR ESS till G � s D - O
Data Applicant W
NOTICE TO APPLICANT If after making this Certificate of CITYCLQ,_ = q i %;r4eoL.�Ig—3 SD_ q 1% OCCUPANT LOAD N
Exemption you should become subject to the Workers
Compensation provisions of the Labor Code you must forth APPLICATION FOR EXIT HARDWARE
with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec Knowl
deemed revoked Panic Devices
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION
I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT LIST ITEMS BELOW
9 (commencing with Section 7000) of Division 3 of the Busi• NO OF EXITS
ness and Professions Code and my license is in full force and
effect PARKING
SPACES RBq D D PROVIDED D
License Number Lic Class PARL FILLL INC
LIMITED TIME USE
Contractor Date DATE DATE
I am exempt from the licensing requirements as I am a
FROM TO
licensed architect or a registered professional engineer SIZE OF No of INSPECTOR S
acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES SIGNATURE
mess and Professions Code) FINAL APPROVAL Q
PRESENT USE OF BUILDING S
Lic or Reg No Date 110
HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS
ON LOT ANI � FEE
I hereby affirm that I am exempt from the Contractors d�!
License Law for the following reason (Section 70315 Busi
ness and Professions Code) NO PARKING
I as owner of the property will do the work and the SPACES PROVIDEDl���j— �{ t
structure is not intended or offered for sale (Section j `�{ �'cU
707611
44 Business and Professions Code) r�
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING
I hereby affirm that there is a construction lending agency I \
for the performance of the work for which this permit is 1
issued(Sec 3097 Civ C)
Lender s Name
PROPOSED MAX OCC
Lender s Address .
PERMIT FEE r
I certify that I have read this application and state that the
above information is correct I agree to comply with all County ISSUANCE FEE
ordinances and State laws relating to building construction
and hereby authorize representatives of this County to enter TOTAL. FEE BO
up n the above entio mope r mspe tion purposes
fj 7` , SEE 4EVERSE FOR EXPLANATORY LANGUAGE
i ature of Permittee ate ff
L
WORJCERS COMPENSATION DECLARATION _
CE 875(11 84) MISCELLANEOUS APPLICATION
..'� CE 875
`I hereby'affirm that I have a certificate of consent tself I COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
insure or a certificate of Workers Compensation Insurance or
a certified copy thereof(Sec 3800,Lab C)
42
Policy No CompanyFOR APPLICANT TO FILL IN ADDRess
Certified copy is hereby furnished XXi pDDREss Low p LOCALITY
Certified copy is filed with the county building inspection 1 LOCALITY NEAREST
department 3M CROSS ST
Date Applicant NEAREST �y 1ST ICT NO GROUP TYPE �f CE686D BY
CR098 ST ((/�t ��. Cit l V O I/ � CONST
CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL : O�
COMPENSATION INSURANCE DESCRIPTION I LOT No BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL
NO OF BLD68
No (CIRCLE)
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.)
SIZE OF LOT U86 OR
1 certify that in the erformance of the work for which this EXISTING BLDG
0
permit is issued,I sha not employ any person in any manneRX OWNER of buildm eAL-NI- 1 Lo
so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP C,
ADDRESS
Date Applicant
NOTICE TO APPLICANT If,after making this Certificate of CITY TNoL OCCUPANT LOAD
Exemption you should become subject to the Workers
Compensation provisions of the Labor Code you must forth- APPLICATION FOR EXIT HARDWARE
with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION
deemed revoked ❑ ❑ No Spec Knowl
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices
1 hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW)
9 (commencing with Section 7000)of Division 3 of the Busy NO OF EXITS
ness and Professions Code and my license is in full force an
effect Name of business Z- RIS PARKING
SPACES RES D PROVIDED
License Number Lic Class
LIMITED TIME USE
Contractor Date DATE 0 DATE
ElI am exempt from the licensing requirements as I am a PROM TDA nsvecroR s
licensed architect or a registered professional engineer size OF NO OF , s NATURE
acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES
mess and Professions Code) FINAL APPROVAL
Lic or Reg No Date PRESENT USE OR BUILDINGse
HOME OWNER BUILDER DECLARATION NO OR EXISTING BUILDINGS O ��
ON LOT AND U86 �
1 hereby affirm that I am exempt from the Contractors ^��
License Law for the following reason (Section 70315 Busi-
ness and Professions Code) NO PARKING
I as owner of the property will do the work and the SPACES PROVIDED
structure is not intended or offered for sale (Section
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING
I hereby affirm that there is a construction lending agency -
for the performance of the work for which this permit is
issued(Sec 3097 Cry C) r
Lender s Name
PROPOSED MAX OCC _9 T
Lender s Address 1
PERMIT FEE
I certify that I have read this application and state that the25.00
-�
above information is corre t I agree to comply with all County ISSUANCE FEE
ordman and State law relating to building construction
and he b authorize rep of this County to enter �1�0_TAL FEE 25.00
"
upon t ea ove mentiroperty for inspectio p s ,
iI, ��� SEE REVERSE FOR EXPLANATORY LANGUAGE
XX XX ,
Signature of Permittee to _
°
WORKERS COMPENSATION DECLARATION 75M444IELLANEOUS APPLICATION
CE 875(11 84)
I hereby affirm that I have a certificate of consent to self COUNTY,_ L�S ANGELES BUILDING AND SAFETY DIVISION
insilxe or a certificate of Workers Compensation Insurance or
a certified copy thereof(Sec 3800 Lab C)
Policy No Company FOR APPLICANT TO FILL IN BUILDING ✓�`` -
ADDRESS q'0'DO
❑ Certified copy is hereby furnishedBUILDING LOCALITY
ADDRESS
F1 Certified copy is filed with the county building mspection
LOCALITY NEAREST
department CROSS ST
Date Applicant NEAREST DISTRICT NO I QROUP TYPE GESSED BY
-.5CONST Jr
CERTIFICATE OF EXEMPTION FROM WORKERS CROSS ST LEGAL
COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAr STATE MAJOR SECOND LOCAL
N
NO OR BLD68 O (CIRCLE)
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less) USE OR
d
I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG) L�
permit is issued,I shall not employ any person in any manner OWNER O+ _ y
so as to become subject to the Workers Compensation LawsMAIL p OCCUPANCY GROUP
0
Date Applicant ADDRESS Iv
NOTICE TO APPLICANT If, after making this Certificate of CITY NOL 9nq `aS^6��g OCCUPANT LOAD y
Exemption you should become subject to the Workers z
Compensation provisions of the Labor Code,you must forth APPLICATION FOR EXIT HARDWARE
with comply with such provisions or this permit shall be TRAILER USE C] GEOLOGY INSPECTION No Spec Knowl
deemed revoked. Panic Devices
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION
I hereby affirm that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Busi-
ness
SAFETY PBRMIT (LIST ITEMS BELOW)
and Professions Code,and my license is in full force and AnL No oP exlTs
effect e r�71•KTs ' PARKING REQ D PROVIDED
License Number Lic Class -FLOKIS1
LIMITED TIME USE
> Contractor Date DATE[ DATE
I am exempt from the licensing requirements as I am a FROM TO
licensed architect or a registered professional engineer SIZE OF No OR INSPECTOR s
acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES SIGNATURE
mess and Professions Code) FINAL A PROVAL /
Lic or Reg No Date PRESENT USE O/�►P_�pBUILDING , `
HOME OWNER BUILDER DECLARATION ON LOT AND USE
NO OR EXISTING BUILDINGS lYAn, O FE
I hereby affirm that I am exempt from the Contractors {/
License Law for the following reason (Section 70315 Busi QQQi]—OQQ 1 4� �/93
ness and Professions Code) NO PARKING
I as owner of the property will do the work and the SPACES PROVIDED 9013 1 AM10:43
structure is not intended or offered for sale (Section
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY N pFROPOSED USE OF BUILDING
I hereby affirm that there is a construction lending agencyTV
for the performance of the work for which this permit s s�"� S IF
issued(Sec 3097 Civ C)
Lender s Name
PROPOSED MAX OCC
Lender s Address ` o
PERMIT FEE J
I certify that I have read this application and state that the
above information is correct I agree to comply with all County ISSUANCE FEE
ordinances and State laws relating to building construction J �+
and hereby authorize representatives of this County to enter TOTAL FEE 5
upon the atione roperty for inspection pu po, s
Alf
r SEE REVERSE FOR EXPLANATORY LANGUAGE
0 Signature of Permittee at _