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GA636A CE„603lo-se APPLICATION FOR BUILDING PERMIT.. . . . -1•
COUNTY OF LOS ANGELES BUILDING -
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY oe
'JOHN A.LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN SUPT OF BUILDING CROSS ST.
+ DISTRICT NO. GROUPP ESSED BY
FOR APPLICANT TO FILL IBUILDING
N TYPE
ADDRESS �[+ IS y ® STATISTICAL CLASSIFICATION SE ER MAP
BK ,PG ,
�j CLASS.NO. DWELL.UNIT I ..
LOT NO. ' ,(,AIV /\ BLOCK MAP . STATE YES O
`� � NUMBEHWY.
TRACT `7� USE ZONE SPECIAL
yy�� NO.OF BLDGS. CONDITIONS,
SIZE OF LOT9OJC� }( I NOW ON LOT
USE OF .
EXISTING BLDG. BUILDING YARD HWY RT NAME EXIST.
-` �+ /� SETBACK .'WIDTH
OWNER " �,SF"�L� �y �/�J T. (�IP� FRONT
MAIL' qq P.L. _ goo
ADDRESS V GISC SIDE
C �� TEL. P.L.
CITY
No i. - I
ARCHITECT OR TEL. NSPECTION RECORD
ENGINEER NO.
ADDRESS
CONTRACTOR NO.
L_ADDRESS ,
DESCRIPTION OF WOBK
NEW/ ADD ALTER REPAIR DEMOLISH
� 1
FT. NO.OF NO.OF
SIZE �7/`Yg' STORIES FAMILIES �!
USE OF STRUCTURE �'�•J r 6?� "..�1�/�,/r��dlr�+ ��`y- ��.
SIGNATURE OF PPRO ALS
APPLICANT
DATE INSPIGTOR M AZURE
ADDRESS .FOUNDATION- LOCATION
FORMS,MATERIALS %I/LL.
$ Q� P.C. 8 O FRAME: FIRE-STOPS.
VALUATION VFEE `® BRACING,BOLTS
FURNACE: LOCATION: �C
FEE $ GAS VENT,DUCTS 1`T�•
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY JIVITH ALL COUNTY ORD ES AND LATH,EXT.
STATE LAWS 'RE G LDING NS CTION.
81GNATUR'E OF HOUSE NUMBER COR.
PERMITTE RECT AND POSTED
ADDRESS FINAL
CLYDE-N.DIRLAM,PRINCIPAL STR' . RAL ENGINEER
PLAN CHECS VaLMATION CK. M.O. CASH PO MIT VALIDATION f CK: I M.O. CA6H'
1AC049401-n 1,PR132 3 A 2. 1•.00
rP.ro 4'9.4 :1 E�' PPR 13. . .A' 4.2..0.0
WORKERS'COMPENSATION DECLARATION
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 FILL IN ADDRENSs
Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS /' " LOCALITY /
%+ NEAREST
Date Applicant CITYV2, CA ZIP L 7417 CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSQR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOTASAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one /J' USE ZONE MAP
hundred dollars($100)or less.) TRACT BLOCK LOT NO. o NO.
`, TEL. SPECIAL }
I certify that in the performance of the work for which this OWNER - '° NO.DAik_9oo7 CONDITIONS 9L
permit is issued,I shall not employ an perso in any manner s DISTRICT GROUP TYPE FIRE PROCESSED BY O
o as to become subject to the Worke Co ensation Laws. ADDRESS on. p CONST. Z E U
Date '— ✓ CITY/ t CA s ZIP / Q E O
�lica ATISTICAL C SSIFI TION APT. CONDO. F_
ARCHITECT O TEL.
NOTICE TO APPLI NT.'If, w r aking this Cer . ate ENGINEER NO. CLASS NO. DWELL. UNITS LU
'Exemption, you should become subject to the Workers' Q.
Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N
with comply with such provisions or this permit shall be TEL.
deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION
LICENSED CONTRACTORS DECLARATION LIC.
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. -V LUATION
(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
SQ.FT. NO.OF NO.OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE a
Contractor Date DESCRIPTION OF WORK NEW ❑';
I am exempt under Sec.
11T0uADD ❑.
� u ALTER ❑:. FIN
B.BP.C. for this reason G' �ss REPAIR
DATE ✓
Date: USE OF DEMOL FIN;)y
EXISTING BLDG. ❑, B
Signature' APPLICA(P RNT + . ^'� v[/�a NO.-,OW
OWNER-BUILDER DECLARATION ` �e Si �+ y�
I hereby affirm that I am exempt from the Contractor's License gDDRE55 �d �? �OSC A. /� C �dI ��
Law for the following reason (Section 7031.5, Business and cam-rj
Professions Code): PRESENT /
BUILDING 4001` _ a
' I, as owner of the property, or my employees with ADDRESS c o 0 0 0
wages as their sole compensation,will do the work and LOCALITY
the structure is not intended-or offered for sale(Section 7 0 0 F
7044, Business and Professions Code). MOVING TEL.
I, as owner of the property,am exclusively contracting CONTRACTOR NO. I c n o f; fj LR
with licensed contractors to construct the project (Sec- ADDRESS —P (I
tion 7044, Business and Professions Code). i� s Q `
REQUIRED TOTAL SETBACK FROM EXIST. i
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.
iSec. 3097, Civ. C.). SIDE
o P.L.
`o Lender's Name +
Lender's Address P.C.Fee$ Permit Fee
I certify that I have read this application and state that the Issuance Fee
above information is correct. I agree to comply with,all County Investigation Fee //
Mnature
laws relating to building construction, Total Fee (p�
representatives of this County to enter `
' ed ro erty for iy�spection purpose1E APO I fe s.
SEE REVERSE FOR EXPLANATORY LANGUAGE
nt ar a Date' ®s
z '
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1302040020
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
ITR: 24579 LT: 6 BL: .001 I SQ. FT STORIES TYPE 10769 LYNROSE ST
I ISTRUCTURE: 1400 V-B I TEMP CA 917802925
ASSESSOR INFORMATION NUMBER:
18573-011-025 I � NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY CAI
ITENANT: 1EXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY:
(EXIST OCC GRP: 102/04/13 SR
OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL Y: CODE:
110769 IJAZNRO (805) 304-7383- I 5,200 I 1\
10769 LYNROSE ST I `
TEMP 917802925 '1 FEES PAID I DOCkrPTION OF WORK
I I IREMOVING OLD WOOD SHAKES & INSTALLING LIFE TIME WARRANTY
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IWITH COMPOSITION SHINGLE
(APPLICANT: TEL. NO: .I I
ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 I 1
I IAB STATE GREEN BLDG FEE 5200.00 VAL 1.00 SPECIAL CONDITIONS:
IAC STRONG MOTION RESID 5200.00 VAL 0.50 1
D2 PERMIT W/O EN-HC 5200.00 VAL 149.40 1
TOTAL FEES 178.70
ICONTRACTOR: I I I
IAS OWNER TEL. NO: - i APPROVALS DATE INSPECTOR SIGNATURESAM1
LIC. NO I ILOCATION AND SETBACKS
ISOILS ENGINEER APPROVAL 1
I
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUNPATION/TRENCH FORMS
I - I
LIC. NO: I ISLABYUNDER FLOOR I I 1
(RAISED FLOOR FRAMING I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP-fl
1150H277 3 0q IIINDEyFLOOR INSIILATION I I I
I IFLOOR SHEATHING I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I_
0 NO 21 I IROOFISHEATHING TV
SCHOOL WITHIN HAZARDOUS Ep�
I � I
(AIR QUALITY: 1000 FEET MATERIALS I ISH PANELS
NO NO NO IFRAME INSPECTION I I
I I (FIRE SPRINKLER HANGERS
I I
(INSULATION/WEATHER STRIPI I
I I I
ANTERIOR LATH/DRYWALL I I I
(EXTERIOR LATH I I I
IRATED FLOOR/CEIL ASSEM. I I
1RATFD WALL ASSEMBLIES I I 1
IRATED SHAFTS/OPENINGS
I I I
IT-BAR CEILINGS
I LOT DRAINAGE
I I I I
I jIREPORT ID: DPR261 ROUTE TO: BS0508 I I
I I I I