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HomeMy Public PortalAbout4950 MCCLINTOCK AVE_Building__ 0NORKEN'COMPENSATION DECLARATIONhereaffirm t��f / nsurebor a certificate lof Worke se Compenstion Inwrances gr ' APPLICATION F®R BUILDING PERMIT !'certified copy thereof(Sec. 3800, Lab. C.) COUNTY,OF LOS ANGELES BUILDING AND SAFETY 'olicy No. Company LDINGZ -n Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �J C! �M `�'L � ��� �-� Certified copy is filed with the county building inspec- BUILDING �-� 1/9..5(7 S. /1l-C(,G/It/i d C,- 4 L- C'i T. tion department. ADDRESS rr r . LOCALITY71: .✓t ,, late Applicant CITY / 6.=/'l7 �F r� ZIP �� f CROSSNEAREST T. C vy CERTIFICATE OF EXEMPTION FROM WORKERS' 'NO.OF BLDGS. ASSESSOR C f NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE SIZE OF LOT � )C ! / This section need not be completed if the permit is for one I I eIc USE ZONE MAP ,c, wndred dollars($100)or less.) TRACT BLOCK LOT NO. -� N0. �� TEL.J� a I SPECIAL 9L OWNER /�?7 (�_>���� �j NO./ � G �� I CONDITIONS certify that in the performance of the work for which this _ termif is issued, I'shall not employ an person in an manners r DISTRICT GROUP TYPE FIRE PRO ESSED BY V' p yVSZC7, yp K' ADDRESS `�] p 'J /�/L'C=/�/�✓r���C CONST.. ZONE IN o as to becomee'subject to the W.oe`,t6 Laws. a '-s'I /L :L�•� - CITY T��� L:C C_ // ZIP)ate Applicon STATISTICAL CLASSIFICATION APT. CONDO. V ARCHITECT OR TEL. 50TICE TO APPLICANT: If, after,rjlGking th s Certificate of ENGINEER NO. CLASS NO. DWELL.,UNITS � :xemption, you should become subject to the Workers' ty .ompensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP vith comply with such provisions or this permit shall be •� /� �1 leemed revoked. CONTRACTOR �� 1`/T���/� ®�r�� ��' 7 �t' BK•6 PG,!le VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ` 10a cl / /�'��d NO. �7�� 3 I VALUATION commencing with Section 7000)of Division 3 of the Business and I .�- LIC. a 1+ �rQfessions Code, and my license is in full force and effect. CITY �� L Cfr CLASS /�� • $ / �l,+ ` I SQ. FT. NO:OF NO.CiF CHECK ,!cense Number`2 //`�� I Lic.Class t� /// I SIZE ( STORIES,` FAMILIES ONE :ontractor �^�/2 VDate ^/ ��r l DESCRIPTION OF WORK rJ/J7/T/d 1v C1 NEW 13 ] I am exempt from the licensing requirements as I am a I [�QSL�I /h/�bt! le0a/=(��jt(�� ? ADD licensed architect or a registered professional engineer _ ALTER t FINAL acting !h my professional capacity (Section 7051, /r{�(IJt a,dwS �r�(CCO jCPT REPAIR ❑ DATE Business and Professions Code). USE OF ` C FINAL EXISTING BLDG. J /, DEMOL ❑ ic.or Reg.,No. Date APPLICANT . TEL. ll s By OWNER-BUILDER DECLARATION (PRINT) r✓7 C�I�7��/LS N0.�7�" '� 1� hereby affirm that I am exempt from the Contractor's License ADDRESS J J ��"/C C'������C -F/1.3 a 0 A .aw for the following reason (Section 7031.5, Business and. �0 'rofessions Code): PRESENT o a o 0 0 BUILDING I, as owner of the property, or my employees with ADDRESS �A wages as their sole compensation,will do the work and I LOCALITY „y/ 2 a 1 2 1l,0 0 the structure is not intended or offered for sale(Section g/' 7044, Business and Professions Code). i MOVING TEL. .0 01 2 4 0 C I, as owner of the property, am exclusively contracting CONTRACTOR NO. 0 i1 0 9-8 r�• with licensed contractors to.:construct the project (Sec- ADDRESS I tion 7044, Business and Professions Code). I 1 III ss' REQUIRED TOTAL SETBACK FROM EXIST. 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH hereby affirm that there is o construction lending agency for FRONT O � he performance of the work for which this permit is issued P.L. ;Sec. 3097; Civ. C.). SIDE .ender's Name sender's Address P.C. Fee$ Permit Fee - I ' certify that I have read this application and state that the Issuance Fee tbove information is correct. I agree to comply with all County Investigation Fee ) trdinances and State laws relating to building construction, Total Fee D` and hereby au horiz presentatives of this County to enter** tp e a ov ioned prfor inspection purposes. __17- JSEE REVERSE FOR EXPLANATORY LANGUAGE ignatur of Applicant or Agent Dote ®s i WORKERS'COMPENSATION DECLARATION s hereby affirm that I have certificate of consent to self P P L I CAT I N ®R BUILDING PERMIT � insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 'y O S lVe e X/N rd cK- i ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING yq �O C ���r�C�L L tion department. ADDRESS Date Applicant CITY 67z A If JrVzIP :LOCALITY "TQN CERTIFICATE OF EXEMPTION FROM WORKERS' -NJ OF BLDGS. / 'NEAREST COMPENSATION INSURANCE SIZE OF LOT tJ 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 OWNER V� NO. ° USE ZONE MAP I certify that in the performance of the work for which this �/ f /] _ p NO. of } permit is issued, I shall not employ any person in any manner ADDRESS '7 S� �[ E ` ��/✓L �C�� j�" / SPECIAL so as to become subject to the Workers Compens n Laws. /1 CONDITIONS O� Date r�� Applicant �f/-- v CITY �^ ZIP NOTICE TO APPLICANT: If, after ry king this Certificate of ARCHITECT OR TEL. ENGINEER NO. DISTRICT GROUP TYPE FIRE PRO ESSED BY Exemption, you should become subject to the Workers' CONS ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS "'°0 3 T with comply with such provisions or this permit shall be �� _ 9L n� /� TEL f' STATISTICAL CLASSIFICATION CONDO. Z deemed revoked. CONTRACTOR /T w�s� NOf���'�T7�'' .��' / LICENSED CONTRACTORS DECLARATION I'C' �/ /f LIC, /� / CLASS NO._ADWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS/0,22'a !V , /ex-1 1m ee-S NO.Q 9&1'3 J (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code,and my license is in full force and effect. CITY �� t%r Cir CLASS ��� VALIDATION BK.V PG. '7 SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class h �/ SIZE / STORIES}, FAMILIES ONE ,/ y�2 /� I DESCRIPTION OF WORK 1>1 TION O NEW ❑'. VALUATION Contractor f/ 6A Y Date / _ / _ $ f Q ❑ I am exempt under Sec. ..(t[Q SA % Av�10 /00 r— e-L� ADD r ALTER 0 loll. B.BP.C. for this reason �U N d S ! C �� REPAIR ❑ $ Date: USE OF EXISTING BLDG. S DEMOL ❑. Signature APPLICANT ...� EL...?g6 [, FINAL g PRINT) Gly i'�1/E'S NO°C��-�T�� C OWNER-BUILDER DECLARATION t� / �J y- DATE` I hereby affirm that I am exempt from the Contractor's License ADDRESS Q 6 /�l /�m 2d S� / e FINAL r Law for the following reason (Section 7031.5, Business and Professions Code): ' PRESENT By ❑ BUILDING I, as owner of the property, or my employees with ADDRESS ^ wages as their sole compensation,will do the work and 1J the structure is not intended or offered for sale(Section LOCALITY bli, A.-as 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). c ( 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 FRONT - / the performance of the work for which this permit is issued P.L. :2 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name_G.�. '•• :,., ;.,,,,:•;:.n..• •. 71 J-0 LDMA L# ] Lender's Address P.C.Fee$ PermitFee I certify that I have read this application and state that the Iss/oe LDMA Pabove information is correct. I agree to comply with all County Investigation Fee � civ ordinances and State laws relating to building construction, Total Fee LDMA P and hereby author' representatives of this County to enter ;.... .....,. , upona v - ioned propert for inspection purposes. 0 �p SEE R VERS�t7(PL ATORY XGUAGE Sign ur of Applicant or Agent Date @° APPLICATION FOR BUILDING PERMIT � • �` r COUNTY OF LOS ANGELES BUILDING AND SAFETY ` WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI ESS I hereby affirm that I have a certificate of consent to self Insure, BU I ypD�ESS �O C or a certificate of Workers'Compensation Insurance,or a certified l'4J7 copy thereof(Sec.3600,Lab.C.) '� ZIP 9® LOCALITY Policy NO. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT Certified copy Is hereby furnished. NEAREST ST. ❑ Certified copy is filed with the county building Inspection , -1 Ice BLOCK LOTNO.I � � department. -t Z �d• La+ USE ZONE MA N . � 7 Date Applicant A14 SSESSOR MAP F574 PARC SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' LN j--7 I WITHIN 10M Fr OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit is for one hundred So C� 1 t�•�cJ L► k DISTRICT /SOUP TYP NST.' FIRE ZONE O BY dollars($100)or less.) -y CT a/ J �L�, 4v I certify that in the performance of the work for which this permit Y f/y'1 pe C&4-c-4 ZIP 1 / h 1 (f 5 N)--� ( v�/ is issued, I shall not employ any person in any manner so as to HITECT WEER V become subject to the Workers'Compensation Laws. 12 r -�) �3,� ATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS nCLASS NO. DWELLUNITS 96Y`1 O ® PkwL/ NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' NTRACTOR rT LINO / SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith .7 FRONT comply with such provisions or this permit shall be deemed revoked. D e �, �® LIC.NO. PL SIDE } LICENSED CONTRACTORS DECLARATION JDESC�I LIC CLASS P L I= o I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v NO.OFSTOR NO.O FAMILIES (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG ACCT°v C Professions Code,and my license is in full force and effect. ® jI �.. r�ONOF WORK VALUATION sd•.07 `56.`>-W License Number LID.ClassOn aslerixdmoADD 2 700 TTC _ y Contractor Date ALTER ❑ $ s I i i iM ❑ I am exempt under Sec. Q REPAIR ❑ $ TOTAL•• 'x-56=93 BARC.for this reason and -raw i1 0 DEMOL ❑ �tiIC -4° CHECK � : LDMA P/C p L� Date: USE OF EXISTING BLDG. URM El CHANGE °TO ,.,/$Ignature P LICANT(PR T) �^- J&NO. s� LDMA Perm# L9 I,as owner of the property, or my employees with wages as s • 'h h �•-� 1r 5 i p 0100013-1131010 1 9/14/91] their sole compensation,will do the work and the structure is //1� F not intended or offered for sale (Section 7044, Business and C l _ 0 Ck FINAL DATE < .Iv� j :2- Professions Code.) _ !L WILLTHEAPPLICANTORFDTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL J ❑ I, eS owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES E: No M Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMITFOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH CONSTRUCTION LENDING AGENCY COAST AIR OUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No .*- IQ the performance of the work for which this permit Is Issued(Sec. .a:.. 1•,_,1 3097,CIV.C.. I HAVE READ THE HAZAR 3 MATERIALS INFORMATION GUIDE AND THE SCAOMD ".1 i+ rry"I •••-•I ,,; m ) PERMITTING C ECKUST.I ERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES r . r-•? 1•„ '.-� ,-_I aid COUNTY COD ITLE2, ER 220SECTIONS 220.100THROUGH22Q14000NCERNING �••-' I r••, I--•• I"'. "'•� ° Lender's Name HAZARDOUS 7ERIA RTINGAND FOR OBTAINING APERMIT FROM THE SCAOMD. 44T ly-I Ap li Lenders Address 0 1 certify that I have read this application and state that the above a I,gP�OR Information is correct. I agree to comply with all county RC.FEE �/ PERMIT FEE ordinances and State laws relating to building construction,and !�° hereby authorlRaM�Umq_—_qo * ty to enter upon ISSUANCE FEE f 3:1 :" � t bove men .4, INVESTIGATION FEE TOTAL FEE ILLe . e^I` Aye'( fi^ of Appkn° DnE° ° C1•i •L7 R�1 I'• a p'i� SEE REVERSE FOR EXPLANATORY LANGUAGE 1J 1 I"'! I . APPLICATION FOR ILDING PERMIT C COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDI FOR APPLICANT TO FILL IN NG ADDRESS WORKER'S COMPENSATION DECLARATION g o DR � U D f I hereby affirm that I have a certificate of consent to self insure, BUIL N �/�/�I C or a certificate of ftrkers'Compensation Insurance,or a certified ' 'copy thereof(Sec.3800,Lab.C.) CI 9 r I •� LOCALITY S T POIICy NO. Company t ZIP SIZE OF L T .OF BLDGS.NOW ON LOT ��V� ' ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACTBLOCK T NO. (� `J�'�� USE ZONE MAP NO. department. ASSESSOBOOK E L Date Applicant 231 ( R- 1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FRONT WORKERS' ADME� /'t� � S�TEL _-? / WI���`TMIN 1000 FT OF SCHOOL7 YES NO COMPENSATION INSURANCE l ADDRESS (This section need not be completed if the permit is for one hundred sO Yb Cl 1)G+ . DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CIU_ zIP I certify that in the performance of the work for which this permit e M ' _t �� -1190 �Q d f�—� 10 Is Issued. I shall not employ any person in any manner so as to AR I•IITECT ORIENGI ER T L O become subject to the Workers!Compensation Laws. ...� •-�-'I�a.e �� �'� ' STATISTICAL CLASSIFICATIONAPi CONDO Date Applicant ADDRESS r CLASS NO. DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of ZONA /�Logorido ° kwu REpUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' C OR TEL NO. G (� SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith - r 9 T FRONT comply with such provisions or this permit shall be deemed revoked. ADDLIC.NO. PL 5_() SIDE LICENSED CONTRACTORS DECLARATION CITY - LIC.CLASS PL - leI hereby affirm that I am licensed under provisions of Chapter 9 M to SOL.Er.SIZE NO.OF RES NO.OF FAMILIES SEWER MAP CD (commencing with Section 7000)of Division 3 of the Business and (� T� NEW BK PG ® : 0 Professions Code,and my license is in full force and effect. — v License Number LIC.Class DESCRIPTIOri OF WORK ADD ❑ VALUATION _ !'IL•.T a Contractor Date ALTER ❑ -+ '} i-+ -: 01 ❑ I am exempt under Sec. , REPAIR ❑ $ 1 I�•EM_. DEMOL ❑ LOMA P/C q TO 1.17 o 30 B.&P.C.for this reason '• 'i- TIAL —_ Date: USE OF EXISTING BLDG. URM ❑ �L. r /,,1g_.na.tur:.r ICANT(PRINT) a TE �'�� �� I il n+JL` LDMA Perm 0 of the property, or my employees with wages as r � -���� C Cs�H�`•�t3E .1301 their sole compensation,will do the work and the structure is ADDR sC, not intended or offered for sale (Section 7044, Business and J C �' I til C F1 DATE a Professions Code.) MATERIAL I��� ® 1'j{-I �!1!!r WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATER �I � OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN f/ ❑ I. as owner of the property, am exclusively contracting with THE AMOUNTS SPECT ED ON THE HAZARDOUS MATERUUS INFORMATION 6UIDE7 FINAL BY 2876 7] t]a licensed contractors to construct the project (Section 7044, ❑ No 28 r 6 1 AN G n'`� Business and Professions Code.) YES WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAGMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO 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 CHECKLIST.I UND S D MY REQUIREMENTS UNDER THE LOS ANGELES -�• iY t ..� G.I t COU IF TITLE2,CHA SECTIONS THROUGH 2.20.140 CONCERNING I-+_l ,„_, .� may. ^-•.! -? Lender's Name US TERIA R I AND FOR O AIN PERMIT FROM THE SCAQMD. •J_l r} n)1• Lenders Address MAXORAGMT 0 1 certify that I have read this application and state that the above RC.FEE information is correct. I agree to comply with all county PERMIT FEE 12 rJ ordinances and State laws relating to building construction,and /'3 hereby authorize resentat of this County to enter upon ISSUANCE FEE ova-menti grope f inspection pu �j 3z /Q INVESTIGATION FEE TOTAL FEE F.•. I� '-rl ry 1_.: &OtWtnnolMpkmn DMO 1.— ..)•r•• n n.• SEE REVERSE FOR EXPLANATORY LANGUAGE C.4 n I Pj ,ti ,--, til APPLICATION FOR WILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD KESS I hereby affirm that I have a certificate of consent to self insu BUILDI D e C— L� G� or a certificate of Workers'Compensation Insurance,or a certified CITY zIP copy thereof(Sec.3800,Lab.C.) `� LOCALITY POIICy NO. Company SIZE OF LOT NO.OF BLDGS,NOW ON LOT - < <•-Ze ❑ Certified copy is hereby furnished. 2, NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection ` BLOCK pt�� T NOL04 USE ZONE MAP NO. /�/ 7 department. 10 f., pSS RMA goo PAGE PARCEL7 ''� -1 Date Applicant e,lr SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' � E TEL NO. a YES NO ADD COMPENSATION INSURANCE RESS �� �� 7� WITHIN 10D0 FT.OF SCHOOL? ' (This section need not be completed if the permit is for one hundre \ M 0-C, in+0 G DISTRICT GROUP I TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) v I certify that in the performance of the work for which this permit CITYFe C 1 ZIP 1 -790 �tDy _ —3 V IS Issued, I Shall not employ any person in any manner So 8S ARCHITECT ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL C I ICATION APT CONDO Date Applicanti ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' NTRACTOR TEL NO. �7 SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith - 5�5� / FRONT comply with such provisions or this permit shall be deemed revoked. Nk, ADD v LIC.NO., PIL -I-v c�. SIDE LICENSED CONTRACTORS DECLARATION Xdx( 1 s LIC.CLASS P L CL c I hereby affirm that I am licensed under provisions of Chapter 9 �,� 0 0 -e 0, SEWER MAP 7 (commencing with Section 7000)of Division 3 of the Business and �•FT SIZE NO. STOR NO.OF FAMILIESFALTER W ❑ BK PG ��/ // O Professions Code,and my license Is in full force and effect. Q ® t� DESCRIPTION OF WORK D ❑ VAWATION W License Number Lic.Class 10- Contractor Contractor Date ❑ $ GO Dem © 6� ❑ I am exempt under Sec. N REPAIR El $ BARC.for this reason Q DEMOL L P/C p Date: USE OF EXISTING BLDG. URM ❑ /Signature CANT(PRINT) TEL.NO. LDMA Perm N Ltd 1,as owner of the property, or my employees with wages as �7�79 pr AIr their sole compensation,will do the work and the structure is ADDREM II l not intended or offered for sale Section 7044, Business and C e 1 +0 C + FINAL DATE7 Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL ^4 r + y (� ❑ I, as owner of the ro OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN i I t E !j p pert), am exclusively contracting with THE AMOUNTS SPECT ED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ No �.�� I—OTA' a 00 Business and Professions Code.) _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK jy rI OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH t fr�EC8 o i L CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST _ E FOR GUIDELINES�. / CHANGE •)I� I hereby affirm that there is a construction lending agency for YES❑ NO L T7 N the performance Of the work for Which this permit Is Issued(Sec. I ' 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,Civ.C.). i PERMITTING CHECKArrNDE3STAND MY REQUIREMENTS UNDER THE LOS ANGELES �r--,,{{''��COUNTY CODE,TITL220 SECTI N3220AWTHROUGH 220.140 CONCERNINGfi��_i-LrVi.ji �i I�Fii'SLender's Name U MATERl AND Rc.AININGAPERMITFROMTHESCAOMD. Lender's Address I ���� 456") i P.m _.-� 0 1 certify that I have read this application and state that the above $ Information IS Correct. I agree to comply with all countyRC.FEE PERMIT FEE ordinances and State laws relating to building construction,and I �n hereby authorize resentatives of this County to enter upon ISSUANCE FEE ) � �IbovP-menti propsr inspection purpDe-. I �� t , spr - INVESTIGATION FEE TOTAL FEE Y r — (�(J mwa�oWmaq/ oco SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0110180020 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 4902 LT: 50 SQ. FT STORJES TYPE' OCCUP GROUP 4950 MCCLINTOCK AV STRUCTURE: 0 1 VN R3 TEMP CA 917804103 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: GRAND 8574-023-016 OTHER: THOMAS PAGE: 597 - GRID: D4 LOCALITY: TEMPLE CITY TENANT: I5 D SE: USE ZONE: rSSUED 0 : PROCESSED XP S 0 EXIST OCC GRP: 10/18/01 JK 04/16/02 OWNER: TEL. N LDGS. NOW ON OT: VALUATION: FINAL SATE FI BY: CODE: CAPRA DAVID J;MARY A (626) 279-9171- 2 8,000 a�( 4950 MCCLINTOCK AV u TEMP 917804103 F55S PAID DEFC-RIPTION KITCHEN REMODEL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: T . SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG NOTION RESID 8000.00 VAL 0.80 SPECIAL CONDITIONS: 62 PERMIT W/ENERGY --"---8000.00 VAL 201.30 GELEOT. EES 229.85 CONTACTOR: TEL. N0: - �O� �/� APPROVALS DATE INSPECTOR SIGNATURE LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECTG L. 0: - / OU DA ON 0 S LIC. NO!j 1111111 SLAB/UNDER FLOOR L RAISED FLOOR FOUR - MAP NO: SEWER MAP BOOK: PAGE: FIRE 20NE: GMP:3 ' Ifl/ UNDERFLOOR INSULATION jol-9 u U C MY A,� 1ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APTCO : STAT CLASS:21 - �1 D LEVEL FLOOR SHEATH SCHOOL I HAZARDOUS !� ❑ h, ROOF SHEATHING AIR QUALITY: 1000 FEET ME3ATERIALS 0 i"* NO NO NO A 8C nn FIRE DEPT. FRAME INSPECT REQUIRED 0 AL SETBACK FRO DG DPT. FESEC SET BACK YARD: HWY: PROP LINE: WIDTH: D k cz FRONT PL- SlEtV[C2 Tb8 SHEAR PANELS SIDE PL- I N SULAT ID ST IP r✓L INTERIOR LAT /DRYWALL EXTERIOR LOT DRAINAGE 0 ECT 0 C S FIRE DEPARTMENT APPROVE REPORT ID: DPR261 ROUTE TO: BS0508 t 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 0812090037 PHONE: (626) 285-0488 EXT: ILEGAL ID: I N0. OF CONST I BUILDING ADDRESS: I ITR: 4902 LT: 50 I SQ. FT STORIES TYPE I 4950 MCCLINTOCK AV I ISTRUCTURE: V-B I TEMP CA 917804103 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GRAND 18574-023-016 I I THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE-CITY, Cl ITENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: [EXIST OCC GRP: 112/11/08 SR (OWNER: TEL. NO: IBLDGS. NOW ON IAT: VALUATION: IFINAL PAT FI CODE: ICAPRA DAVID J;MARY A (626) 279-9171- I 12,000 1 ' I 14950 MCCLINTOCK AV II I I ITEMP 917804103 I FEES PAID I SCRIPTIO]k OF WORK I I I [BATHROOM REMODEL I I [FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1 I ]APPLICANT: TEL. NO: I I I ITOM (626) 287-0927- IAA BLDG PERMIT ISSUANCE 27.75 1 I 15823 AGNES AVE. IAC STRONG MOTION RESID 12000.00 VAL 1.20 ISPECIAL CONDITIONS: I ITEMPLE CITY CA 91780 JB2 PERMIT W/ENERGY 12000.00 VAL 275.22 1 I [ I TOTAL FEES 304.17 1 I ICONTRACTOR: TEL. NO: 1 [APPROVALS DATE INSPECTOR SIGNATURE ITOM O'LEARY CONSTRUCTION (626) 287-0927- I 1 I 15823 AGNES AVENUE LIC. NO 1 ILOCATION AND SETBACKS I I I ITEMPLE CITY, CA 91780 489354 B-1 [ I I I I [ [ ISOILS ENGINEER APPROVAL [ I ] (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I LIC. NO: I (SLAB/UNDER FLOOR [ I ] IRATSED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ IUNOERFLOOR INSULATION I I I I147H277 3 001 1_ [ 1 I I I IFLOOR SHEATHING I ] I [NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I_ I I I NO 21 1 [ROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I [AIR QUALITY: 1000 FEET MATERIALS 1 I [ I I I NO NO NO 1 (FRAME INSPECTION ] IREQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS v ISET BACK YARD: HWY: PROP LINE: WIDTH: I I [ I I IFRONT PL- I [INSULATION/WEATHER STRIPI I I I SIDE PL- ] I I I I [ I (INTERIOR LATH/DRYWALL I I I I ] 1EXTERIOR LATH ] I I I I (RATED FLOOR/CEIL ASSEM. I I [ I I IRATED WALL ASSEMBLIES I ] I I (RATED SHAFTS/OPENINGS I I I I 1 IT-BAR CEILINGS I ] I I I [LOT DRAINAGE 1 I I IREPORT ID: DPR261 ROUTE TO: BS0508 1 I I [