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Home My Public Portal About9965 LOWER AZUSA RD_Building__ r APPL.Ir...ATION FOR -BUILDING PERMIT FOR APPLICANT TO FILL IN ADDRIESS ' �/ BUILDINGi�- ADDRESS wLOCALITYNEAREST w CITY bb C T ZIP CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT k§X6 NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ROC ED BY TRACT BLOCK LOT NO �8 �� CONST ZONE H Z) OWNER Ir STATISTICAL CLASSIFICATION j�SEWER MAP Z ADDRESS ftcdd eD CLASS NO DWELL UNITS iL. BK CITY ZIP USE ZONE OP eZ O/ P- ARCH ECT OR Q NOZ -�TEL - PECIAL M ! CONDITIONS 2 ADDRESS OO - AW3, 4MI!�%ttt, ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL CONTRACTOR NO BLDG SETBACK FROM LIC FRONT PROP LINE OF (STREET) ADDRESSj o71 + __ TOTAL SETBACK M TYPE OF EXISTING LIC 3 '�^"�� HIGHWAY YARD FRONT PROP LINE HIGHWAY WIDTH CITYSTRUCCLASS + U a CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM _ ® 8 SIDE PROP LINE OF a (STREET) cx ADDRESS CITY O SQ F NO OF NO Of CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING SIZE SIDE PROP LINE HIGHWAY WIDTH S 3 STORIES FAMILIES ONE a _ w DESCRIPTION OF WORK IT NEWj + ry Z ADD LJ CORNER CUTOFF YES ❑ NO ❑ - ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ USE OF REPAIR ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ ! EXISTING BLDG DEMOL ❑ APPLICANTTEL •,.'�R �+'- Ef�Z ! �E (PRINT) Q,( NO •�� BY ISIGNATU l _1" 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Jit/ %14-4 r l—,OG#(-r' THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM PENSATION INSURANCE m i KE`' Oro/✓!1't 4�C SIGNATOR FINAL/6 i-T -2 BY PER MITTE DATE OC Y ADDRESS V �j Q CITh ��. e/1i(_La_a _gUSgD/NOL P C Fee$ -7 CJ • 3 0 Permit Fee w Issuance Fee VALUATION$ 8"7 Q 0 v Total Fee v . V PLAN CHECK VALIDATION CLc o CASH PERMIT VALIDATION cic La CASH 2 2 �stlAi 1 5 2 3 • 3 _.3 0 •� ®t 76A6986 CE/8MMOB APPLICATION FOR COUNTY OF LOS ANGELES OF COUNTY w :j3UILDING PERMIT DEPARTMENT BUILD NG AND SAFETY DIV ION ENGINEER FOR APPLICANT TO FILL IN AUDDRIESS C BUILDING / ADDRESS !� . LOCALITY NEAREST CITY p ZIP CROSS ST ,�'� /, NO OF BLDG5 ASSESSOR SIZE OF LOT Ab• W NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP T FIRE ED BY T OCK [LOT ZONE.. -� TEL Q OWNER 3 NO STATISTICAL C I 10 SEWER ADDRESS CLASS NO G;7-4 DWELL UNITS BK PG CITY ZIP USE ZONE NO ARCHITECT OR TEL SPECIAL ENGINEER NO CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL CONTRACTOR N BLDG SETBACK FROM /� �1 FRONTPROP LINE OF ISTREED ADDRESS �2 HCl�'` I N0�764* TOTAL SETBACK FROM TYPE OF EXISTING ,Q� HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH CIT �/ /rte�� CLASS C CONSTRUCTION LENDER + a NAME AND BRANCH BLDG SETBACK FROM OV SIDE PROP LINE OF (STREET) oc ADDRESS CITY Q SQ FT NO OF NO OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING �j SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH w + = Z DESCRIPTION OF WORK NEW C1 ADD ❑ CORNER CUTOFF YES ❑ NO ❑ ALTER IN OPEN SPACE YES ❑ NO ❑ REPAIR USE OF REMOL IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG APPLICANT W TEL (PRINT( V NO� �7Y BY(SIGNATURE) i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM PENSATION INSURANCE SIGNATURE OF FINAL V—p2 PERMITTEE DATE/(� .r ADDRESS TEL 07 PC Fee$ 3. 7.0 Permit Fee MVALUATION Issuance Fee 4�4ff • O 6p Total Fee PLAN CHECK VALIDATION Cm M o CASH PERMIT VALIDATION M o cAsH 8850'0-.dL 252 .3 D 4320 ♦ 88610AUL 25 �, D 61.00Abi ®f 76A888A CE/808A 8/77 ^ - _ I � SiRKERS'COMPENSATION DECLARATION �a� +� 15; j(affvm that I have certificate of consent to :elf r APPLICATION BUILDING PERMIT cl �t ure,•or a certficate of Workers' kers'Compensation Insurance,or a certified copy thereof(Sec 3800, tab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli o Company , Certified copy Is hereby furnishedFOR APPLICANT TO FILL IN BUILDING bs ADDRESS ElCertified copy is filed with the county building inspec- BUILDING tion departments / ADDRESS i Date '` ' Applicant l� CITY zip NO OF BLDGSf LOCALITY CERTIFICATE OF EXEMPTINEAREST ON FROM WORKERS' SIZE OF LOT �bZ " NOW ON OT / OSS ST ` COMPENSATION INSURANCE (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less) TRACT BLOCK LOT NO t MAP BOOK PAGE PARCEL OWNER EL '�j� USE ZONE M / 1 cern that in the performance of the work for which this JO certify p / / 6-2, SPECIAL d permit is issued, I shall not employ any person m any manner ADDRESS Z CONDITIONS O so as to become subject to the Workers'Compensation Laws +� (� Date Applicant CITY ZIP NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT TEL DISTRICT TUP TYPE FIRE PROCESSED BYExemption, you should become subject to the Workers' ENGINEER 7 NO 0 CONST ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS O I 56" &&Jl( N with comply with such provisions or this permit shall be TEL STATISTICAL cLASSIFI TION APT DO Z deemed revoked 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 Professions Code, and my license is in full force and effect CITY CLASS SK PG - VALIDATION � l SQ FTs NO OF NO OF CHECK Licens Jmbe ��ig� Lic Class_ SIZE .3 STORIES FAMILIES ~"" ONE /4` NEW 0 VALUATION Contra or to '� DESCRIPTION OF WORK $ 5O p 1 am exempt under Sec 3;1 4ADD 0+ ALAR , B 8P C for this reason /� REPAIR $ ;2123. 1 A u9E or- EXISTING F • • • • Date EXISTING BLDG a DEMOL # 23 - Signature APPLICANT TEL FlNAL PRIPITr NO I • 3 9 2 0 7 OWNER-BUILDER DECLARATION `f9 E7 DATE ,9-- I hereby affvm that am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS / RNA • • 392075 Professions Code) FRMr4t BY aBUILDING 1 214-84 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 sole(Section LOCALITY ' 7044, Business and Professions Code) MOVING TEL 1 I,as owner of the property,am exclusively contracting CONTRACTOR - NO # I 1 p with licensed contractors to construct the project (Sec- ADDRESS I * 471.75 tion 7044, Business and Professions Code) REQUIRED YARD HWY TOTAL SETBA • • 4 7 1,7 5 cz, CONSTRUCTION LENDING AGENCY - SET BACK 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 PL - _ o 1, 1 4—8 5 (Sec 3097, Civ C ) SIDE P L Lender's Name '` LDMA Ref N Lender's Address P C Fee S Permit Fee I IS A_0 1 certify that 1 have read this application and state that the Issuance Fee O LDMA P/C M , above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee -7 1S LDMA Perm B U and hereby authorize representatives of this County to enter kiiiii upon thea ve-m ntioned party for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE � ` O� Signature of Applicant o ent Date s WORKERS'-COMPENSATION DECLARATION I%ereb...a�ffirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance, APPLICATION FOR BUILDING PERMIT u or a certified copy thereof(Sec 3800 ) Poll o � �Sg Company COUNTY OF LOS ANGELES BUILDING AND SAFETY rBUILCertified copy is hereby furnished FOR APPLICANT TO FILL IN DING ADDRESS Certified copy is filed with the county building mspec- BUILDING /O tion department ADDRESS (► Date Applicant CITY ZIP LOGgLITY ERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST (This section need not be completed of the permit is for one TRACT BLOCK LOT NO ASSESSOR hundred dollars($100)or less ) TEL MAP BOOK PAGE PARCEL USE ZONE IMA I certify that in the performance of the work for which this OWNER JAI IWE Q NO NO _ permit is issued, I shall not employ any person in any manner �w3/T�� C—?j SPECIAL so as to become subject to the Workers'Compensation Laws ADDRESS CONDITIONS rj Date Applicant CITYeglMe Of / ZIP NOTICE TO APPLICANT If, offer making this Certificate of ARCHITECT OR TEL DISTRICT GgOUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO w ,l , // CONST ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS5`V 0 �//�• W with comply with such provisions or this permit shall be A!�t G. deemed revoked CONTRACTOR �'V ` TEL e STATISTICAL CLASSIINIZATIOONN APT CONDO Z LICENSED CONTRACTORS DECLARATION �c LIC 1 CLASS NO_21V DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS L 1f� NO ZZ 3g (commencing with Section 7000)of Division 3 of the Business and �,�a Z rL LIC G�p ,/s �R MAP Professions Code,and my license is in full force and effect CITY CLASS 7 BK PG VALIDATION ^x ' SQ FT NO OF NO OF CHECK 7aLicense Number- 7l tel' Lic Clas O 14 T SIZE STORIES IFAMILIES ONE VALUATION �NG ?Z2./Lao? DESCRIPTION OF WORK 1 NEW ❑ Contractor DoteJ' 1 am exempt under Sec 1 g1,6� �(� ADD $ALTERPool2797.3A B&P C for this reason 4619Lmosumair cmAl REPAIR $ �U e v # e e s e 2 3 USE OF 57,38 Date EXISTING BLDG SOL I e e Signature APPNPRIM a A �'31140p FINAL / 57.385 OWNER-BUILDER DECLARATION e ppTE (,j NO 1 hereby affirm that I am exempt from the Contractor's License ADD -7 O �� 6�� r7 0 9.2 2 8 7 Law for the following reason (Section 7031 5, Business and R Professions Code) MUNI DBUILDING 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,wdl 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 7044, Business and Professions Code) I E TOTAL 8 3 2 0 A CONSTRUCTION LENDING AGENCY WRACK YARD HWY PROP LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT # • • • •�e�� the performance of the work for which this permit is issued P L (Sec 3D97, Civ C ) SIDE ' •7 8 0 0 PL Lender's Name e e e 7 Q Q Q czi LDMA Ref M f, P C Fees Permit Fee ({I Lender's Address ( 1. 0-87 I certify that I have read this application and state that the Issuance Fee Oso v tDNA PSC fl a above information is correct I agree to comply with all County Investigation Fee $ !Nature tate laws relating to budding construction, $ rize representatives of this County to enter Total Fee LDMA Perm M men o property for inspection pyrposps $EE REVERSE FOR EXPLANATORY LANGUAGE Applicant or Agent Dcdo ' - APPLICATION FOR,BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY VVORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS wr LUWe�� I hereby affirm that I have a certificate of consent t0 self Insure BUILDING ADDRESS ��,w7� PsWts(/,, or a certificate of Wbrkers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec 3800,Lab C) rf C LOCALITY T' Policy No A fT7 1 71 -� 9y Company�� v SIZE OF OT NO OF BLDGS NOW ON LOT 1 eIM e Ci ❑ Certified copy is hereby furnished Z ' NEAREST CROSS ST ❑ Certified copy is filed with the county buildi maps BLOCK LOT NO department494-9 1 USE ZONE MAP NO Date /a 9/9 Applicant C ASSE R MAP BOOK PAGE PARCEL- SPECIAL 6.2 (� SPECIAL CONDITIONS CHP.. CERTIFICATE OF EXEM ON FROM WORKERS' �-- — TEL NO YES a. NO COMPENSATION INSURANCE AlIf _ -C J WITHIN 1000 FT OF SCHOOL? (This section need not be completed d the permit is for one hundred RES �� dollars($100)or less) -J �. DI/ST'RI'CT/ GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit 6•V is Issued 1 shall not employ arty person In any manner so as to C Y ZIP a//�Ole become subject to the Workers Compensation Laws ARCHITECT OR ENGINEEFf TEL NQ Y, STATISTICAL CL IFlCATION APT CONDO Date Applicant ADDRESSX CLASS NO 2DWELL UNITS NOTICE TO APPLICANT If atter making this Certificate of RWAQ► WIRS"PlfrlA 04, REQUIRED TOTAL turn EXIST Exemption, you should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY P P�E WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT 67 61 comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL1:29 ,rr LICENSED CONTRACTORS DECLARATION O SIDE CITY LIC C S PL -FFA. - I hereby affirm that I am licensed underprovisions of Chapter 9 T eA (commencing with Section 7000)of Division 3 of the Business and SQ ZE NO OF STORIES NO OF FAMILIES SEWER MAP ' T O Professions Code,and my license is in full force and effect NEW ❑ BK PG LI�CCY• �ts License Nymber IMO B LIC Class g DESCRIPTION OF WORK ADD ❑ VALUATION CHANGE °LL c ConJractor 9LWA e� I•✓.�31�iea 16te �/a/9�,/ ALTER ❑ $ (0,500 ❑ I am exempt under Sec: IAA J REPAIR $ DODO-'l�001 '8•� �-T 'k z B&P C for this reason 1=00'\N C�Ot..UM N '� DEMOL ❑ LDMA P/C• 6,7556 Date E OF IS71 G BLDG Q URM 13Signature T 18 _ T( T L NO _� LDMA Perm#(015 Z � ❑ I.as owner of the property or my employees with wages as AWA-JN their sole compensation will do the work and the structureis ADDRESS F til t T.4 rat Intended or offered for sale (Section 7044 Business and 04. A► CJJ FINAL DATE Professions Code) D 3330 13,t.5 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL .. ❑ 1, a8 owner of the property am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1 ITEMS AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL + licensed contractors to construct the project (Section 7044 YES❑ NO❑ TOTAL Business and Professions Code) WILL THE INTENDED USE OF THE 9UIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH [' 1. '' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR L HEC k 13•t°G-t GUIDELINES 1 hereby affirm that there is a construction lending agency for GUI ❑ ❑ C HAhIGE .011 a the performance of the work for which this permit Is Issued(Sec 3097 CIV C) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING a 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 )1�'IAf1_Citl�l f i L C L Lender a Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD �[JJ(VV��1I]�JL0 iiJJllJJ10 7 14 7 Lenders Address OWNER OR AGENT W•1 �V I 9:24 0 I certify that I have read this application and state under penalty PC FEE ( ' PERMIT FEE �GD, / of peryury°that the stave Information Is correct I agree to comply with all county ordinances and State laws relating to building construction and hereby au ze representatives of this County ISSUANCE FEE / to enter upon the C - property for inspection purposes (v'AID ID S y INVESTIGATION FEE TOTAL FEE 1` a Au°° Dw O SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'-COMPENSATION DECLARATION hereby affirm that I have certificate of consent self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy_thereof (Sec 3800, Lab C) - COUNTY OF LOS ANGELES BUILDING AND SAFETY &,LW_/ `1s S�CZ,ri,&lX MS YL 009100 ElCertifiedcopy is hereby furnished FOR APPLICANT TO FILL IN BUIL ADDRINSG ❑ Certified copy is filed with the county building inspec- BUILDING 4CqETa1FIC4ATE'10F partmnt ADDRESS DateApplrca CITY ? .� ZIP LOCALITY NO OF BLDGS NEAREST EXEMPTION FROIIVyJ ORKERS' SIZE OF LOT NOW ON LOT CROSS ST COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO MAP BOOK PAGE PARCEL hundred dollars($100)or less) TEL OWNER USE ZONE MP �1 3 �a� NO �T I certify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any mann ADDRESS/0.70, CONDITIONS n- so as to become subject to the Workers'Compen n La 0 CITY ZIP 2 Z. Dat Applrca - ARCHITECT OR w` TEL DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO PPLICANT If, after making thr Certtfrcate of ENGINEER !vc NO CONSTZONE Exemption, you should become subject to the Workers' W Compensation provisions of the Labor Code, you must forth- ADDRESS V a with comply with such provisions or this permit shall be to deemed revoked CONTRACTOR � TEL_Z dQ> ATISTICAL CLASSIFICATION APT CONDO Z LICENSED CONTRACTORS DECLARATION - LIC �/j`�C NO DWELL UNITS — 9V6 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Z003/ /3[cz_sgl E NO LIC SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITY /1llrl�l /� CLAS and Professions Code,and my license is in full force and effect BK PG VALIDATION SQ FT NO OF NO OF CHECK License Number -&� /Lrc Class SIZE I STORIES FAMILIES ONE VALUATION Contractor1p/¢! Z��( p� ` jDESCRIPTION OF WORK NEW El El am exempt under Sec E� f ADD 13 ► ALTER ❑ B&P C for this reason 4m& �L REPAIR ❑ $ Date EXISTING TNG BLDG Eye fJA4ft DEMOL//' APPICANT ❑ Srgnatur (PRINT) EkA.)61ZX. L,tpTEL p"j/�—s}3ps" FINAL OWNER-BUI ER DECLARATION e� DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS��2✓�/JL-Oo+xl �t�P4/1! Law for the following reason (Section 7031 5, Business and .FINAL 1 Professions Code) PRESENT BY ❑ 1, as owner of the property,Y� or my employees with BUILDING .T ADDRESS _ wages as their sole compensation,will do the work andLoca►uTY yyt r 3317 58. the structure is not intended or offered for sale(Section 9 7044, Business and Professions Code) ONNO MOVING 1 I �- ❑ 1,as owner of the property,am exclusively contracting TRACTOR with licensed contractors to construct the project (Sec- ADDRESS a TOTAL. ?123 0 63 tion 7044, Business and Professions Code) R � TOTALFROM EXIST { EtYL sad CONSTRUCTION LENDING AGENCY CK YARD HWY PR�P aE I hereby affirm that there is a construction lending agency for FRONT C f{ANGE ,011* the performance of the work for which this perm it is issued P L (Sec 3097, Gy C) SIDE PL Lender's Name !ILiI��Is�sIJ� 11?/' it 1 L.00V AV D Ref Ref # Lender's Address PC Fee$ Permit Fee � Ey�,t,7 i 4t;�,� O I certify that I have read this application and state that the Issuance Fee o2 � LDMA P/C# S above information iscorrect I agree to comply with all County Investigation Fee / tZ ordinances and State laws relating to building construction, Total Fee .4 LDMA Perm # and hereby authorize representatives of this County to enter upon�the above-mentioned property for inspection purposes ' * SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 1 WORKERS,COMPENSATION DECLARATION r l hereby, affirm that I have certificate of consent self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec 380,, Lab - C) COUNTY OF LOS ANGELES BUILDING AND SAFETY P lic o / Compariy /� �61 Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADR ❑ Certified copy is filed with the untybu - BUILDING ,rtiion department ng in '�R Date Y Z/'�Applicant CITY B LOCALITY NO OF BL NEAREST CERTIFICATE OF EXEMPTION F WORKERS' SIZE OF LOT NOW ON LOT CROSS ST COMPENSATION INSUIWANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100)or less) TEL OWNER NO 45 USE ZONED oZ VC/%� I certify that in the performance of the work for which this r IAL permit is issued, I shall not employ any person in any manner ADDRESS ' fi a CONDITIONS d so as to become subject to the Workers'Compensation Laws V CITY ZIP Date Applicant ARCHITECT ORTEL DISTRICT GROUP TYPE FIRE PROCESSED BY ad 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 with comply with such provisions or this permit shall beQ EIM NLO STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked CONTRACTOR WE /t LICENSED CONTRACTORS DECLARATIONLIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS MO P T L 414.231 -7 SEWER MAP (commencing with Section 7000)of Division 3 of the BusinessLIC and Professions Code,and my license is in full force and effect CITY CLASS ay BK PG VALIDATION �(a SQ NO OF NO OF CHECK License Number T q/7 7 Lic Class_ SIZE STORIES FAMILIES ONE ,,� nf�- .. DESCRIPTION OF WORK NEW ❑ VALUATION .40ConteactorAJ odM��i�L�/t/�te ~�� 9�J ❑I am exempt under Sec ADD ❑ pop.❑ B&P C for this reason Ex REPAIR i ate USE OF DUSTING BLDG DEMOL ❑ Signature APPLICANT TEL -AS FINAL OWNER-WIEDER DECLARATION (PRINT) NO 7 DATE � I hereby affirm that I arffexempt from the Contractor's License ADDRESS d� Law for the following reason (Section 7031 5, Business and FINAL i Professions Code) PRESENT BYBUILDING A{{Tet ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and33157 187.1-t the structure is not intended or offered for sale(Section LOCALITY Poo7044, Business and Professions Code) MOVING TEL 1 ITEM ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO TOTAL 1 7 with licensed contractors to construct the project(Sec- ADDRESS tion 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM IXIST CHECK JF7■14 CONSTRUCTION LENDING AGENCY SET BA YARD HWY PROP LINE WID I hereby affirm that there is a construction lending agency for FRONT CHANE ,1311 the performance of the work for which this permit is issued PL (Sec 3097, Civ C) SIDE Lenders Name P L 40/ 00011—owl 10/10/90 PC Fee$ Permit Fee ,/ LDMA Ref x 3225 1 AM 10 a 15 Lenders Address 0 I certify that I have read this application and state that the Issuance Fee ,3 LDMA P/C k 10. above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relatingto bui dingconstruction, Total Fee % LDMA Perm M and he y authorize sentatives of this County to enter upon above-me on d prope for inspection purposes } n 40-19` os_LO � $EE REVERSE FOR EXPLANATORY LANGUAGE Signatur Applicant or Agent Date WORKERS'COMPENSATION DECLARATION hereby affirm that i have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or a certified cotpyy thereof(Sec 3800, Lob C ) NGELES BUILDING AND SAFETY - PoldilC f j7 Compaq 321) la A� „ COUNTY OF LOS A ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL iNeuILDING Ile 5 lnawi- 4.3m ADDRESS Certified copy is filed with the county bui inspec- BUILDING 4�RTIFICATE de ariment ADDRESS �- - Date Applica CITY ZIP LOCALITY OF EXEMPTION RO WORKERS' NO OF BLDGS NEAREST COMPENSATION 1 U NCE SIZE OF LOT NOW ON LOT CROSS ST j (This section need not be complete if the permit is for one ASSESSOR hundred dollars($100)or less) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL TEL USE ZONE MAP I certify that in the performance of the work for which this OWNER NO �/ jV0 permit is issued, I shall not employ any person in any manner uA G v CONDITIONS O CIAL so as to become subject to the Workers'Compensation Laws ADDRESS V Date Applicant CITY ZIP _ O NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE D BY Exemption, you should become subject to the Workers' ENGINEER NO COtV57 ZONE P Y I /' W Compensation provisions of the Labor Code, you must forth- ADDRESS 5�0 y with comply with such provisions or this permit shall be CONTRACTOR n LIL �, STATISTICAL CLASSIFICATION APT CO Z deemed revoked LICENSED CONTRACTORS DECLARATION . 0 CLASS NO _DWELL UNITS I hereby affirm that 1 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 CLASS SK PG VALIDATION SQ FT NO OF NO OF CHECK License Number Lic Clas I y 6) SIZE STORIES FAMILIES ONE &' t1� VALUATION Contractor /S/L Date DESCRIPTION OF WORK W AD $ O i1r ( M El , I am exempt under Sec ox U_ ALTER , B&P C for this reason vie REPAIR ❑ $ USE OF X344.6 A Date EXISTING BLDG DEMOI Sign h-SNEIiIIIIII. APPLICANT TEL FINAL # • • • 023 ER-BUILDER DECLARATION PRINT NO DATE I hereby affir t 1 am exempt from the Contractor's License I • * 49.41 Law for the fol owing reason (Section 7031 5, Business and ADDRESS FINAL Professions Code) By BUILDING • • • 4 9.4 1 ❑ - I, as owner of the property, or my employees with ADDRESS ,L r to , it 7 wages as their sole compensation,will do the work and LOCALITY 1 1. 12-85 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 7044, Business and Professions Code) . /r r,4 •• EXIST CONSTRUCTION LENDING AGENCY SET BACEK YARD HWY TOTAPROPSETLINE WIDTH 47� I hereby affirm that there is a construction lending agency for FRONT A 3 6 1.0A the performance of the work for which this permit is issued P L - - (Sec 3097,Civ C )r l SIDE # • e e • e 1 A PL Lender's Name LDMA Ref # I • • 6 a 6 3 Lender's Address PC Fee E Permit Fee ' •6 • • 6863 I certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct I agree to comply with all County Investigation Fee /� 1206-85 ordinances and State laws relating to building construction, Total Fee LDMA Perm # u and hereby authorize presentatives of this County to enter u bove- en d property for inspection purposes ^ IL SEE REVERSE FOR EXPLANATORY LANGUAGE i igriat re of Applicant o Agent Date 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 1110310002 PHONE (626) 285-0488 EXT LEGAL ID I NO OF CONST NEW BUILDING ADDRESS ITR 9848 IT 80 BL 001 I SQ FT STORIES TYPE OCCUP GROUP 9965 LOWER AZUSA RD I ISTRUCTURE 120 1 V-B B I TEMP CA 917804041 ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET 18589-025-038 1 1 THOMAS PAGE 597 GRID B5 LOCALITY TEMPLE CITY, Cl TENANT JEXIST BLDG USE COMME USE ZONE JISSUED ON PROCESSED BY I JACK IN THE BOX JEXIST OCC GRP B 111/10/11 SR I I I I I OWNER TEL NO 1BLDGS NOW ON LOT VALUATION IF NAL TE FINAL BY CODE IMAKI, JOHN (407) 422-1574- 15,000 19965 LOWER AZUSA RD I TEMPLE CITY CA 91780 FEES PAID IDESCRIPTION OF WORK TENANT IMPROVEMENT RESTROOM RE-IMAGE NEW TILE, PAINT AND IFEE DESCRIPTION QUANTITY UOM AMOUNT IFIXTURES APPLICANT TEL NO I i PARK, PHILIP (951) 276-1523- IA1 PLANCHECK W/EN-HC 15000 00 VAL 294 70 1 1425 W LA CADENA DR 1AA BLDG PERMIT ISSUANCE 27 80 ISPECIAL CONDITIONS (RIVERSIDE, CA 92501 IAB STATE GREEN BLDG FEE 15000 00 VAL 1 00 _ LAE STRONG MOTION OTHER 15000 00 VAL 3 20 I 1A2 PERMIT W/ENERGY-HC 15000 00 VAL 346 70 CONTRACTOR TEL NO IFS INV WORK W/O PERMIT 257 00 DOL 257 00 JAPPROVALS DATE INSPECTOR SIGNATURE IVWC BUILDERS, INC (951) 276-1523- 1 TOTAL FEES 930 40 1 1425 W LA CADENA DR, UNIT 12 LIC NO I ILOCATION AND SETBACKS RIVERSIDE, CA 92501 795458 B I I I ISOILS ENGINEER APPROVAL I ARCHITECT OR ENGINEER TEL NO i IFOUNDATION/TRENCH FORMS I I I I - I 1 1 1 I LIC NO I (SLAB/UNDER FLOOR I I I I IRAISED FLOOR FRAMING I I I I I 1-1 I IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I (UNDERFLOOR INSULATION I I I 1 3 041 11 1 - I I I IFLOOR-SHEATHING__ I I I INO OF FAMILIES-DWELLING-UNITS APT/GOND STAT CLASS I I I I I 1 0 NO 22 I IROOF SHEATHING I I I I I I I I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I LAIR QUALITY 1000 FEET MATERIALS I I I I I I NO NO NO I IFRAME INSPECTION I I I I I I I I I I I IFIRE SPRINKLER HANGERS I I 1 I I (INSULATION/WEATHER STRIP( I 1 I I I I I I I (INTERIOR LATH/DRYWALL I I I I I I I I I I I (EXTERIOR LATH I I 1 I I IRATED FLOOR/CEIL ASSEM I I I I I IRATED WALL ASSEMBLIES 1 1 1 I I I I I IRATED SHAFTS/OPENINGS I I 1 I I IT-BAR CEILINGS 1 1 1 I I I I I ILOT DRAINAGE I I I I (REPORT ID DPR261 ROUTE TO BS0508 I I 1 I I I 1 I I