HomeMy Public PortalAbout9507 OLEMA ST_Building__ ®s 76A631�A it •.
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APPLICATION FOR. BUILDING PERMIT
COUNTY OF LOS ANGELES 'BUILDING AND SAFETY
FOR
APPLICANT TOFILL IN
om' ADDREESS
BUILDING
ADDRESS 17-.5-V ! /L ////
LOCALITY
y� / NEAREST
CITY �/ � e ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK. PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROC�B$ED BY
TRACT 1 3 BLOCK LOT NCA a �.3 Q CONS_ T.. ZONE sx/Jam@
/�l� TEL.
OWNER C/ &71d 66 NO.
STATISTICAL CLASSIFIC
ATION EW A
ADDRESS %9'96 7 Oe�1Y,4 CLASSNO. / DWELL.UNITS BK 7:-,
CITY ZIP
ARCHITECT OR TEL. VALUATION $
ENGINEER NO.
ADDRESS �j J� �y BLDG.SETBACK FROM
E
CONTRACTOR c/✓G7 /7 �, N r 7� FRONT PROP.LINE OF (STREET)
�' y-� �j' HIGHWAY + YARD = TOTAL SETBACK FROM TYPE EXISTING.
cS~�< L'��///NC?3v� 7 FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS 71c
LIC. +
CITY df '�✓� � CLASS
CONSTRUCTION LENDER BLDG.SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING
ADDRESS CITY SIDE PROP:LINE HIGHWAY WIDTH
SQ.FT. NO.OF NO.OF CHECK + _
SIZE ?- STORIES of— FAMILIES / ONE QQ
DESCRIPTION OF WORK NEW ❑ P.C.Fee$ Permit Fee '(J
/lrcot-?ole4 fir-
f2'�C"f'7 /.r -V�_/ ADD Issuance Fee y
ALTER ❑ /
REPAIR ❑ Total Fee
USE OF �� , DEMOL ❑
EXISTING BLDG. / J��� ,�yy� C'�/D � � ZO
APPLICANT TEL
G= �! NODIp"7'/7d 7_F o'� 3 . Q
BY(SIGNATURE) '� 1�G1
115 v
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V
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- Z
PENSATION INSURANCE. g J2 1 2d 6 A
IL
SIGNATURE OF �7'6 � # o 0 0 0 0 1
PERMITTEE 05615(
,/
ADDRESS 7147,e-4c ��Y�� z 2 -. 1 9600
CITv o-G04'-w:oZf:.�v� N `�~' � a o e 1 9 b 0 0 ,
0
USE ZONE MAP 1. 13-78
j NO. 0 0
SPECIAL r�-
CONDITIONS
G� of
FINAL /� �/ / BY CA
DATE 6
_.76A6389 CIS#8031,-s, APPLICATION.-FOR BUILDING PERM-1I'T
COUNTY 'OF LOS ANGELES '• BDD els"sem ;'rf
DEPARTBOW OF COUNTY ENGINEER ,' r t
BUILDING AND SAFETY DM. LOCALITY. � .•� -�.
., JOHN A.LAMBIE.COUNTY ENGINEER" NEAREST..
CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST.. �.
FOR APPLICANT TO FILL nv DISTRICT.NO. GROU TYPE EWER MAP
S
BUILDING ..` r ,Z o`� '. I CONST ���K
.-ADDI;E•S3:�/-��' �iLG. iffr' . STATISTICAL CLASSIFICATION
ry CLASS. DWELL.UNITS V+ I
LOT NO. er'` q^ fit" BLOC., MAPF' STATE YES Nd
j NUMBER. _ • HWY. �-
T� USEZONE SPECIAL -.
NO.OF.BLDGS. CONDITIONS-
•SIZE OF'LOT ,�y I NOW ON LOT i
EXI-STING - slaerl e i�d' �� BUILDINGEXIST. ,
SETBACK YAR'U HW Y �,.STREETNAME WIDTH
OWNER' !C bWAe 4! 4Q-'W-,17 FRONT.
MAIL �� y� / P.L.,
ADDRE-S9 ,%- 'D CV'G. C-ot-l) ' SIDE
I tR r �. C f TEL. P.L1
CITY.
NO. INSPECTION RECORD.
ARCHITECT OR( � �, �C�� !`m„xFF•..
ENGINEER, , f'!f 7 �+'T�T3(�1b
ADDRESS•
TEL
CONTRACTOR l.LJ 1LJ NO.
ADDRESS,.
DEscmplrioN OF WOR$
NEW "HADD ALTER' REPAIR DEMOLIS14-
SO.FT. "NO.OF NO.OF
SIZE 712e:9 STORIES ;z FAMILIES
USE OF,STRUCTURE . fo'�
81GNASURE OF APPROVALS
APPLICANT
DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
$ �7 ti , FORMS,MATERIALS
V P.C. 8 FRAME: FIRE STOPS.
t FEE � BRACING,BOLTS
'VALUATION $ ge.Ce, FURNACE: LOCATION,
FEE GAS VENT,DUCTS
I HEF. REREAD THIS ACKNOWLEDGE THAT I HAVE REATHIS AP- LATH,INT:
PLICATIO 11[a D STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING •BUILDING CONSTRUCTION. LATH,EXT.
SIG*ATURE OF HOUSE NUMBER COR-
PERMITTEFE RE CT AND POSTED
ADDRESS FINAL
r- CLYDE N.DIIILAM,PRINCIPAL STRUCTURAL ENGIJ,SEEER
PLRN CHECK VALIDATION CK. M.O. CAS PERMIT VALIDATION. CK. M.O. CASH ;
•,
,� fr
- �,:���-�.�,'.y�y,.•2�,,�•• � �',�,.: G-sit.:
TBA 53 BA CFjll-'03,5-65 APPLICATION FOR BUILDING ERMIT
COUNTY OF LOS ANGELES BUILDING 9 O 7 DQE
DEPARTMENT OF COUNTY ENGINEER ADDRESS
r BUILDING AND SAFETY DIVISION LOCALITY ! e
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST. a
DISTRICT NO. GROUP TYPE PR ESSED BY
FOR APPLICANT TO FILL IN s' CONST.
BUILDING �Jn _ STATISTICAL CLASSIF CATION SEWER MAP
ADDRESS .$O ®��M �TMV CLASS NO. / DWELL UNITS / BL PG
LOT N� � �„� BLOCK USE ZONE MAP t]
TRACT �.�/ SPECIAL`S D
N0. OF BLDG5. ��' 1i{ / CONDITIONS
SIZE OF LOT �p O NOW ON LOT
USE OF (-
EXISTING BLDG. BLDG. SETBACK FROM
�� TEL. FRONT PROP. LINE OF D ���a (STREET)
OWNER ///��T L NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESSysoz HIGHWAY WIDTH FROM C.L.
CITY -ra /Q�a LS ---- + _
�• L r BLDG. SETBACK FROM
ARCHITECT OR TELf SIDE PROP. LINE OF (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY -I- YARD = TOTAL
ADDRESS TE 7 HIGHWAY WIDTH FROM C.L.
CONTRACTOR NOL V673W W + 0
ADDR Slvo NO LIC f CORNER CUTOFF YES NO OU
CITY CLASILI SEE REVERSE SIDE FOR SPECIAL APPROVALS LIC O
DESCRIPTION OF WORK ri
a
NEW Ve ADD ALTER REPAIR DEMOLISH / yL� �� �� N
SQ.FT. NO. OF NO. OF T7
SIZE STORIES FAMILIF_
USE OF /JLZ 7 � � _
STRUCTURE A it,
SIGNATURE
APPLICANT
VALUATION$ /• APPROVALS DATE INSPECT 'S SIG NATURE
h9 FOUNDATION, LOCATION q�
FEE$;3a g'� FEE$ FORMS, MATERIALS -pClz (P.
FRAME, FIRE STOPS, `
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
BUILD I NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK _
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIO LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RE AT-
ING TO WORKMEN'S COMPENSATI N IN RANO
LATH. EXT.
SIGNATURE O OUSENUMBER COR-
PE4tMITT RECT AND POSTED F 7
v
ADDRESS L
JOHN F. LEWIS. PRINCIPAL ST URAL ENGINEER
PLAN CHECK VALIDATION cK. M.D. CASH _ PERMIT VALIDATION CK. M.O CASH
7 2=4_•1u` NOV 2 3�i A
�ACo.. .. .... . . 9 _ 3 2.0 0. � •
,';� 8 5 7 0% JAN 6 1 D 6 4.00-
'
,, ..;:,,APPLICATION FOR" `�
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BMJ I L D I N G PERMIT BUILDING ANDFETY DIVISION
BUILDING ��
FOR APPLICANT TO FILL IN ADDRESS
ADDREBUILDSS /Sv S�
��}}�� ��// /'yq� �y LOCALITY r-
NEAREST
CITY Z5".' « `I/ 7 ZIP �/ �� CROSS ST. d g^Z
,y NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE RO SSED BY
TRACT � BLOCK LOT NO. `a �'.� �� CONST. ZON_9
y� -7 'D i
OWNER ff,}u/J�f(/»C1,�7/� NOL STATISTICAL CLASSIFICATION esrL;upG WER MAP
ADDRESS 790 ('Jcc-7///'T TCLASS NO��OWELL,UNITS
CITY -///O` C%; 7 Zip ( � f7 d USE ZONE NOP
ARCHITECT OR NOL
ENGINEER �" CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONTRACTOR TEL. BLD .SETBACK FROM
NO FR NT PROP.LINE OF (STREET)
LIC.
ADDRESS NO. NI HWAY + YARD. = TOTAL SETBACK FROM H GHWOF AY EW DTIHG
LIC. FRONT PROP. LINE
CITY CLASS. _
CONSTRUCTION LENDER
NAME AND BRANCH BLA ETBACK FROM O
ADDRESS CITY SIDEP LINE OF (STREET) v
SQ, FT. NO. OF NO. OF CHECK HIGHWAY + YARD = TAL SETBACK FROM TYPE OF EXISTING 0'
SIZE STORIES `F,AMIILlIESS ONE SID LINE HIGHWAY WIDTH CD
DESCRIPTION OF WORK 5 (IC/V/✓� NEW ❑ + L
Llj
yj
G0 �lJ 'sJ �,_/�-� � ADD ❑ CORNER CUTOFF YES ❑ NO Z
JJ�� //cAj( ALTER Cl�j�/� /y✓� Q� IN OPEN SPACE YES ❑ NO ❑
" REPAIR[:]
USE OF [:] IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG. DEMOL
APPLICANTg� ) TEL / ryry �_19,�LJ, �, zA '
(PRINT) QY�N 1 ✓ NO. f0,�`L f76 •r r / ..
t U
BY (SIGNATURE) Angn::42
I HEREBY ACKNOWL D E THAT 1 HAVE READ THIS APPLICATION
ANO STATE THAT THE AIIIOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON N VIOLATION OF THE
LABOR CODE OF THE S TE' OF ,CAL'IF NIA• IN RELATING,TO
WORKMEN'S COMP 5AT1 INSURE:' -- ••
SIGNATURE OF �, FINAL 1...� r' /lJ BY
PERMITTEE �+� DATE (� L
ADDRESS
CITY /G/ *oCE C/" / NO. 2.7 P.C.Fee , Permit Fee
Q Issuance Fee
VALUATION
/� Total Fee
PLAN CHECK VALIDATION < rr M.O. CASH — PERMIT VALIDATION CK. M.O. CASH
4 9 0 ti0 29 2 3 D .5.4 08 1.
_ • 2 4AUAUG S 1 D 9.0 0 ®5o
76AG38A ce#110,119 1z/Is
"76638ACEASOP8-64 APPLICATION FOR BUILDING PERM'QT
COUNTY OF LOS ANGELES BUILDING
�V�
DEPARTMENT OF COUNTY ENGINEER ADDRESS ,5
BUILDING AND SAFETY DIVISION LO C A LI T Y7 v L
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST.
DIS C N U TYPE. PR B
FOR APPLICANT TO FILL IN �_ ! CONST.
'BUILDING "_G / STATISTICAL CL SIFICATION SEW R AP
ADDRESS U CLASS NO. DWELL UNITS BKk PG
LOT NO. BLOCK USE ZONE MAP 'f�71
NO. �X�*' l
TRACT ! SPECIAL
N0. OF SLOGS. CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
I G BLDG. BLDG. SETBACK FROM
TEL. ) FRONT PROP. LINE OF •�/rC..- (STREET)
OWNER -/ . NO..
e • TYPE OF EXISTINO• SET_BA -HIGHWAY + YARD = TOTAL_
ADDRESS - HIGHWAY I M C.L.
CITY L Z . 7-t/ BLDG. SETBACK FROM +
ARCHITECT O TESIDE•PROP. LINE OF (STREET)
' ENGINEER NO.
TYPE OR EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS .b 'v HIGHWAY WIDTH FROM C.L. d
"' TEL + = 0
CONTRA CTO /R� �
LIC
ADDRES �/ G NO. CORNER CUTOFF YES NO O
CITY L L clC SEE REVERSE SIDE FOR SPECIAL APPROVALS W
DESCRIPTION OF WORK )
z
EW ADD ALTER REPAIR DEMOLISH
T. NO. OF • NO. OF
SIZE rZ STORIES FAM IES
USE �• _ �, t
STRUCTURE c�
7-1;SIGNATURE OF
APPLICANT :
VALUATION$ 3v V R p--v APPROVALS DATE IN§PE R'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION �✓
FEE$ 6 FEE$ l, (� FORMS,,MATER[ALS___ _6 b
FRAME, FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION • BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDI NO CONSTRUCTION. 1 CERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY•I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENS ION INSURANCE.
LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR-•
PERMITTEE ^ R.ECT AND POSTED.
ADDRESS <r64l V - FINAL
JOHN F. LEWIS. PRINCIPAL ST r URAL ENGINEER
PLAN CHECK VALIDATION C M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
..I..&.8 2-3.6tO DEC2.2 2 1 4.63- 4
' _ - - 8 2 3 76 DEC 2 2. 1 D 1 8.5. 0, •v
DEPARTNS:NT Cr COUNTY ENGRm
DMSION OF BUILDUM AND SAFETY
COUNTY OF LOS ANGELES B mum I LD I N G
WILLIAM J. FOX, COUNTY ENGINEER APPLICATION
CASSATT D. GRIFFIN, SUPT OF BUILDING
FOR APPLICANT TO JIM IN FOR OFFICE USE ONLY
BUILDING ` DISTRICT NO. PUN CK.OR R.C.No. PERMIT NO.
ADDRESS
LOCALITY EIVED BY DATE OF APPL. DATE ISSUED
NEAREST V7 —
CROSS ST
BUILDING � ':e—OWNER �.
I, � ADDRESS �-
ADMAIL
DRESS ��/ LOCALITY 7 e •
CROSS ST.
NEAREST
CITY NO TEL. O O f1 /
ARCHITECT OR TEL, FIRE NO. OF I TY OUP
ENGINEER NO. ZONE PLANS ��
ADDRESS T12Iee�� / 13ETBACJK�JLINE �L ORD. NO.
CONTRACTOR N107. ZONE/`7 HYPROVEDUSE DATE
\
ADDRESS HOUSE NUMBERING
LEGAL 2 MAP NUMBER P—LOO3 NO.ASSIGNED BY
DESCRIPTION I LOTNO.y- ^�3I BLOCK
p CORRECTIONS
TRACT l`/ T `4�-3
SIZE OF LOT L r I NO.OFMOW
BLOT
USE OF NO. OF
EXISTING BLDG. ' RAMULI..
DESCRIPTION OF WORE O -
RE AALTERATION ADDITION
IR DEMOLITION I Z
D
r
SQ. FT. NO.OF
SIZE ROOMS STORIES
EXT.WALL ROOF
COVERING COVERING
USE F STRUCTURE 0 ,
(s q
APPROVALS
INSPECTC 'S SIGNATURE DATE
FOUNDATION:LOCATION
FORMS, MATERIALS
r r
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, �
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS i 'I•!I v
CORRECT.
I AGREE TO C MPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION.
AND STATE LA EGULA } G BUILDING CONSTRUCTION. GAS VENT, DUCTS
SIGNATURE O y� LATH, INT.
PERMITTE �
ADDR
Jar LATH. EXT.
e PLASTER, INT.
AUTHORIZED AGT. d"�s`�
PLASTER, EXT.
$ P. C. S HOUSE NUMBER COR-
FEE RECT AND POSTED 4-1
VALUATION REE i �� FINAL
76A698A 01183 9-8$ _
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES rm
� ®�
WM. J. FOX, CHIEF ENGINEER
OR APPLICANT TO FILL IN FOR OFFICE USE ONLY
F7. 7
AlDISTRICT NO. PLAN CK. NO. PERMIT NO.
D D L E A 6 (S T � � �e&3
RECEIVED BY DATE OF APP,L. DATE ISSUED
N! P _ C 7 Y � fol.- Z.`� f J �—2-7BUILDI
- � ADDRESS
P'�-6 � ��PD A- S-r
1 f Q _ ` ADDRES8
�` - GV A /� LOCALITY � _ v! ��trl�A NEAREST
TEL CROSS ST.
CITY NO. FIRE /-NO. OF I TYPE I GROU�_
ARCHITECT OR TEL.
ZONE J PLANS
! ENGINEER / iNO. 1 f BLDG. m ORD. NO.
SETBACK LINE 2--pr/cp /111!/..
ADDRESS / APPROVED
TEL i 1 BY DATE
CONTRACTOR ( /� �/� q�Q NO. �6 USE APPROVED
AlONE eq/ BY DATE
ADDRESS ()�� k/1 A/f 7'0 A F,1 RQ xE HOUSE NUMBERING
LEGAL
DESCRIPTION LOT NO. 'LZZ, BLOCK ` '- MAP NUMBER -�/� FIELD CHECK BY
TRACT / 3 NO. ASSIGNED BY BATF'
NO. OF BLDGB. CORRECTIONS
SIZE OF LOT Z �[ / j I NOW ON LOT L.
USE OF ! NO. OF f _
EXISTING BLDG, /� S `y� A\J I FAMILIES
DESCRIPTION OF WORK
NEW I I ALTERATION I I ADDITION
O.
REPAIR I I DEMOLITIONrQ. FT I I I
NO OFO
SIZE 85AR06MB STORIES
"" I n. 'hi Rin Iv/dz I nfr, (/ AI 1,,,z,-) Is a
EXT.WALL IROOFr
' COVERING COVERING Ij Po n (:
USE OF STRUCTURE
l r A A/ —1-0 _ /,f'�'/ I l 99 F,-,,•,-li i , Ij
'rteAPPed IA 141 —INSPECTORALS'S SIGNATURE aDATE
I HEREBY JACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS
CORRECT. !
I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS,
HEREON AND I WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS
LAWS REGULATING/UILDING-CONSTRUCTION. FURNACE: LOCATION, v
SIGNATURE OF /&f.
[/) s} GAS VENT, DUCTS
PERMITTEE?n �'� flf7.tl :-1
' , LATH, INT.
ADDRESS w eLt' b v L 4
' LATH, EXT.
AUTHORIZED AGT.
PLASTER, INT.
76AGSOA. DBss fD-SO $ P. C. $
(V O 0 D FEE PLASTER, EXT.
VALUATION FEE $ � FINAL / Itis 'Z3
I '
' APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL INSDG AI
RES
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRE _ .�� G%�G�97utJ
MA
or a certificate of Workers'Compensation Insurance,or a certified O O�� S
copy thereof(Sec.3800,Lab.C.) CITY GC- G T Y ZIP 11.75-0 LOCALITY
Policy No. Company SIZE OF LOT NO,OF BLDGS,NOW ON LOT 7 GG
EI Certified copy is hereby furnished. 7(000 S6 , ewve NEAREST CROSS ST
❑ Certified copy is filed with the county building inspection TRABLOCK LOT NO.
department. /gS3 1 oZ S USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BOOKS 3 PAGE O`4 PARCELO 46 / /
/` SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL 0.
COMPENSATION INSURANCE 4-�-vop5 , —2776 WITHIN 1000 FT OF SCHOOL? YES No
(This section need not be completed if the permit is for one hundred ADDRESS stn�1 DISTRICT GROUP TYPE CONST. FIRE ZONEJ,�PROCESSED BY
dollars($100)or less.) 9,5-0 DG(FIVA 57-
I
7-
1 certify that in the performance of the work for which this permit CITY ��nL� C JT`� zIP�17 9-0
is issued, I shall not employ any person in any manner so as to /
become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO.
STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. 02 L DWELL UNITS
NOTICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL
LICENSED CONTRACTORS DECLARATION SIDE
CITY LIC CLASS PL
I hereby affirm that I am licensed underprovisions Of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF AMIDES
Professions Code,and my license is in full force and effect. 10 Z NEW El BK pe-6 ® C
License Number Lic.Class ADD ❑ VALUATION O
DESCRIPTION OF WORK C
Contractor Date BY/' ��3 ALTER ff. oQ 00 qQ
❑ I am exempt under Sec. G TU.PE - REPAIR 11F
B&P.C.for this reason C.
-, LDMA P/C# II
Date: USE OF EXISTING BLDG. S`DE��AG URM ❑ U
•..
Signature APPLICANT(PRINT) / TEL YO. LDMA Perm# i t• 1 L
❑ I, as owner of the property, or my employees with wages as �` (J/ ,�S b -2 7 2 Z '
their sole compensation, will do the work and the structure is ADDRESS O FINAL DATE -� �3 =ri t%° �Ic� `t
�
I not intended or offered for sale (Section 7044, Business and s L SrLZ P`FC/j C t0 G I
Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL A J
1, as Owner of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY ACC-1.0
licensed contractors to construct the project (Section 7044, 19 °E.
Business and Professions Code.) YES C1 No
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 / Q�X-
I
CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FORGUIDEUNES �(/hereby affirm that there is a construction lending agency for YES NO� :0TAL.• 26,:,; = 75
a the performance of the work for which this permit is issued(Sec. _
0 IHAVEREAD THEHAZARDOUS TERIALSI FOR 1ATION GUIDE AND THE SCAOMD PERMITTING L z •z
3097,Civ.C.) CHECKLIST I UNDER AND REQUIRE N UNDER HE LOS ANGELES COUNTY CODE, CHECK
TITLE 2,CHAPTER 2 2 SE I NS 2 20.1 OUGH20 140 CONCERNING HAZARDOUS
3 Lender's Name MATERIALS REPORTIN AN F R OBTAIN G PERMIT R THE SCAOMD. ;=1�:1N E- ° 1=
C3 Lender's Address oaNER OR AGENT i'1
0
Z; I certify that I have read this application and state under penalty
0 of perjury that the above information is correct.I agree to comply PC.FEE O �� PERMIT FEE 1� [;(Ijj rlil_I} i �i=•c
c0v with all my ordi n s and State laws relating to building d _
< co tructi n, and her y '°I
m y uthorize representatives of this Count ISSUANCE FEE / - _�_O X.
M toe ter u o the abov tinned property for inspeotion� purposeg. (O
< s seA
CD INVESTIGATION FEE TOTAL FEE
cm a AW-t
SEE REVERSE FOR EXPLANATORY LANGUAGE
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 1002240001
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I
ITR: 14533 LT: 22 BL: .001 I SQ. FT STORIES TYPE [ 9507 OLEMA ST [
I [STRUCTURE: V-B I TEMP CA 917801344 1
]ASSESSOR INFORMATION NUMBER: [ I NEAREST CROSS STREET: [
15382-014-046 ] I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 IISSUED ON: PROCESSED BY: 1
[ [EXIST OCC GRP: 102/24/10 SR [
(OWNER: TEL. NO: [HLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE:
IGIORS, LOUIS (818) 304-4217- [ 7,0001 r 9507 OLEMA ST I 1
I
TEMP 917801344 1 FEES PAID IDESCRIPTION OF WORK [
[ I [DRY WALL PATCHING WHERE NEEDED [
IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:[ 1
APPLICANT: TEL. NO:
IVERED NISSAN (800) 209-8589- [AA BLDG PERMIT ISSUANCE 27.75 1 [
16241 GLADE AVE. #101 [AB STATE GREEN BLDG FEE 7000.00 VAL 1.00 ISPECIAL CONDITIONS: [
WOODLAND HILLS 91367 [AC STRONG MOTION RESID 7000.00 VAL 0.70 1 [
[B2 PERMIT W/ENERGY 7000.00 VAL 182.82 ]
[ TOTAL FEES 212.27 [ I
]CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE [
IGENERAL REMODELING & CONSTRUCTION* (800) 209-8589- I 1 I
15632 VAN NUYS BLVD. #290 LIC. NO ] [LOCATION AND SETBACKS [ ] I
IVAN NUYS, CA 91401 531665 B I I [ [ I
I I ISOILS ENGINEER APPROVAL 1
(ARCHITECT OR ENGINEER: TEL. N0: [ IFOUNDATION/TRENCH FORMS I I I
]1 LIC. NO: I ISLAB/UNDER FLOOR I ] I I I I
(RAISED FLOOR FRAMING [ I [
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ (UNDERFLOOR INSULATION [ I
1153H265 3 001 1 ] [ I
IFLOOR SHEATHING [ [ I
N0. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1
[ NO 21 1 IROOF SHEATHING [ I [
I I I
] SCHOOL WITHIN HAZARDOUS 1 [SHEAR PANELS [ [ ]
[AIR QUALITY: 1000 FEET MATERIALSI I ] [ I
NO NO NO 1 (FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST [ FIRE SPRINKLER HANGERS ] [
ISET BACK YARD: HWY: PROP LINE: WIDTH: [ [ [ I I
IFRONT PL- I [INSULATION/WEATHER STRIP[ [ I
[ SIDE PL- [ [ [ I I
[ [ (INTERIOR LATH/DRYWALL ] [ I
] I EXTERIOR LATH [ 1 I
I I IRATED FLOOR/CEIL ASSEM. I I I
I 1 IRATED WALL ASSEMBLIES ] I I
1 (RATED SHAFTS/OPENINGS
IT-BAR CEILINGS [ I [
I ] ILOT DRAINAGE [ [
I I I
[ IREPORT ID: DPR261 ROUTE TO: BS0508 [ 1 I [
I I I 1 I I