The URL can be used to link to this page

Home My Public Portal About10569 OLIVE ST_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDINGCOUNTY OF LOS ANGELES ADDRESS/D. G P J�9 ` t DEPARTMENT OF COUNTY ENGINEER CIT ZIP BUILDING AND SAFETY DIVISION y-Irv,W NO.OF BLDGS. BUILDING SIZE OF LOT 7.3, NOW ON LOT ADDRESS TRACT BLOCK LOT NO. ` LOCALITY Cog& NEAREST OWNER NO rP�.J�� CROSS ST. Z5�7 ASSESSOR ADDRESS a �' vtV MAP BOOK PAGE• PARCEL -CITY /or ZIP �� DISTRICT GROUP CANS__ ZONE PRO ;D BY ARCHITECT ORV TEL. ENGINEER NO. STATISTICAL CLASSIFICATION WER M TEL. ADDRESS CLASS NO.�/DWELL.UNITS K 1_WG CONTRACTOR NO. V;�; NO: LIC. SPECIAL ADDRESS NO. CONDITIONS LIC. CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLD .SETBACK FROM FR T PROP.LINEOF —ISTREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK HI HWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE L� STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW ❑ + CL0 _ ADDisr BLDG. ACK FROM n SIDE PROP. (STREET) O ALTER ❑ QT T TYPE OF EXISTING Lu HIGHWAY + YARD D RbP.LINE IGHWAY. WIDTH , N USE OF REPAIR ❑ Z EXISTING BLDG. �S. DEMOL ❑ + APPL CANT_ TEL CORNERCUTOFF YES ❑ NO ❑ (PRINT) NO. y IN OPEN SPACE YES ❑ NO ❑ BY ISIGNA Q@ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ (J Q 1I HEREBY ;^;Y THAT THE ABOVE IIS CORRECT AND O�LEI)d THAT IAG EE O COMPLY W THAVE READ'THISIH ALL ORDINANCES AND STATE IJ' �f � I AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE f j x ..E�j� . j WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION Of /J THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- K PENSATION INSURANCE SIGNA RE OF t,7i Q�.' -1-en 77,Mb /.✓ r �.ljl/ -- �LJLGL''J�?C. !✓CT PERMIII "� -� ADDRESy C' Q:iV� \�--- FINAII,`,�� BY OF' TEL. DATEAr- tTBRANDT, E CHEC AYABLE TO: FEE FET r HARVECOUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION C`K M.O. CASH 8 2 1 APR 20 1 ® 8.2.5_ 0 a°8 ®s 76A63BA CE#803 3.75' TEMPLE CITY 78A83BA CE 11SO$-1-81 APPLICATION FOR BUILDING PERMIT ll COUNTY OF LOS ANGELES BUILDING�� C� DEPARTMENT OF COUNTY ENGINEER ADDRESS ✓ V BUILDING AND SAFETY DIVISION LOCALITY 1 JOHN A. LAMBIE. COUNTY ENQINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DISTR ,ICT N GRCLUP TYPE PR C S D FOR APPLICANT TO FILL IN /L/1 ,\_Y7 coNsr. BUILDING r STATISTICAL C SIFICATION SEWER MAP ADDRESS ®J 6 '� IJ�I V'{ e. c� CLASS.NO. DWELL.UNITS G LOT NO. CL el A47 94lW BLOCK WATER NOT REQUIRED RECEIVED JJ q CERTIFICATE: TRACT E7 / d rte+ MAP HIGHWAY STATE MAJOR SECOND, OCAL SIZE OF LOT Ky / I NO.OF BLDGS. NO. Q (CIRCLE) NOW ON LOT USE ZONE PECIAL USEOF + / CONDITIONS EXISTING BLDG. ' 1/ � JJ "I EL.. OWNER V�. . NO. BUILDING p� SETBACK YARD HWY STREET NAME WIDTH ADDRESS", 2� /e;"P/& am I� I1 FRONT `� e ARCHITECT OR EL. P.L. 9�pel ENGINEER NO. SIDE ADDRESSnINSPECTIO REC RD O CONTRACTOR C/)3, Ebc�- Pel0H� . j�!'�MjSJ U ADDRESS Z�-� IC e C: n DESCRIPTIO OF WOAK �- r - 117v?OJ W �� ?Z4 5a N ADD E M __ Rii DEMOLISH N _ Z SQ. OF NO.OF ' IZ STORIES FAMILIES USE F STRU RE SIGNATURE OF APPLICANT VALUATION OW I APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. . FOUNDATION:LOCATION FEE $ FEE $ FORMS.MATERIALS FRAME:FIRE STOPS. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING,BOLTS ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PE SON IN VIOLA- LATH,INT: TION OF THE LABOR OIA RELAT. COD F THE STAT OF•C ORN ING TO WORKMEN'S CO N ON INS RAN LATH,EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTEE A RECT AND POSTED ADDRES 2 L FINAL CLYDE N. DIRLAM. PRINCIPAL ST AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASs PERMIT VALIDATION cK o. CASH L: Col-2.2 2 OCT 9 1 D 6.0.0' CANCELLED Al RE-kZ �-�", �� I ERM ITTE: 76A638A CE#803 2-63APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADOREs BUILDING AND SAFETY DIVISION LOCALIT C JOHN A. LAMSIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. DlSrTN��ej GROUP TYPE P OC&Ee ?, FOR APPLICANT'TO FILL IN CON BUILDING0�/G D '� v� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 4 K �G .1- CLASS..NO. DWELL.UNITS LOT NO. FYOe N'79 '►-w •776LOCK WATER CERTIFICATE: NOT REQUIREDro RECEIVED ❑ TRACT D MAP, HIGHWAY STATE MAJOR SECOND,LOCAL -y y NO.OF BLDGS. NO. ICIRCLE> SIZE OF LOT 19^ NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. ] F Q�.p OWNER I!'{7� etre.l NO. 2,Sj - BUILDI G EXIST. ` r— SETBACK YARD HWY STREET NAME WIDTH ADDRESS z6 U FRONT ARCHITECT CFR TEL. ENGINEER NO. SIDE / ADDRESS P L 1 (�U CL � TEL. CONTRACTOR rim Q C'V NO. ADDRESS Zb— l-ty- Q DESCRIPTION OF WORK ,Vi, a h NEW ADD ALTER REPAIR MOLIS Z SQ.FT. NE OF SIZE ST RIES , FAMILIES USE OF STRUCTURE SIGNATURE_OF APPLICANT VALUATION � C/ v APPROVALS DATE INSPECTORS SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE -FEE $ FORMS, MATERIALS / FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. / WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PE SON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE F C FORNIA RELAT- ING TO WORKMEN'S COMP1. SATI N INSU CE LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS /ter y M' FINAL. AM b,� JOHN F. LEWIS.'PHlNCIPAL STr'_ Ro(LEN GINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH L iGo 2 9 6 61123 ROV 2 9 1 D 4.0 0- .7 76A638A CE#803 2-63 APPLICATION FOR .BUILDING PERMIT COUNTY OF LOS-ANGELES AooREIS G O DEPARTMENT OF COUNTY ENGINEER , BUILDING AND SAFETY_ DIVISION LOCALITY� JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SuP'T OF BUILDING CROSS ST.- v) DISTRI N GRO TYPE PFj C BY. FBD R APPLICANT TO FILL-IN' coNsr: c STATI ICAL CLAS FICATION SE R MAP J OL , �/� ` CLASS. NO. DWELL.UNITSBK � N-7� y� � BLOCK WATER NOT REQUIRED ' RECEIVED ❑CERTIFICATE:MAP HIGHWAYSTATE MAJOR SECONNO.OF BL•DOS. NO. D „(.CIRCLE)NOW ON LOT USE ZONE SPECIAL USE OF -CONDITIONS EXISTING BLDG. 'TEL. J + • OWNER . e i v NO. ^/ZaI. BUALDING EXIST. r-s SETBACK YARD HWY STREET,.NAM'E WIDTH ADDRESS - e i yJ 7 :FRONT / r ARCHITECT OR 6 TEL. P• L• ENGINEER NO. SIpE :L: ADDRESS P - a _ EL. 1 . O [NE TRACTOR r�we. e(� Off/-/` _ / r� n V RESS /CHl �� p/1�7s '4 6' i r .Ir r +F/1`' ,� iAY !� Cd DESCRIPTION O ORI{ ADD LTER REPAIR DEMOLISH ,y/ f / f✓ !1 �f� /jr " CAIZ FT. NO.OF NO. OF s5� / ) f J/✓f FI '�?y �y��r�✓G A STORIES FAMILIES OFUCTURENATUREOFPLICANT UATIONAW ✓ U-C� I // y APPROVALS d" ATEj INSPECTOR'S SLIGN&TpRE FOUNDATION: LOCATION FEES FEE $ FORMS, MATERIALS FRAME: FIRE STOPS,' / I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS Y AND STATE THAT-THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. -- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING' GAS VENT, DUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK tom✓[ AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA+' LATH.-INT. � TION OF THE LABOR CODE OF THE STATE OF. AL RNIA RE AT- ING TO WORKMEN'S COMPE ATION INSURAN `. IIrIY 'LATH.EXT j�} +� 5;5 s SIGNATURE'OF HOUSE NUMBER COR- F PERMITTEE. RECT AND POSTED `Q `r AA ADDRESS `�/ Gr/ ' �' ` FINAL I�!!r!� m•� /�r`FY JOHN F. LEWIS. PMN'dIPALISTRU RAL ENG1"lEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION. CK. M.O. CASH LACO 2 9 6 7 14DV WORKERS';COMPENSATION DECLARATION • •as I r}Sersf'' film that I hove a certificate of consent to self 1 .�PIPL I ATI N FOR BUILDING PERMIT it sy!re, or a certificate of Workers'Compensation Iniurance, or o certifi9d copy thereof (Sec. 3800, Lab. C.) ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ,.. .:....,.,.; _.... BUILDING tUy Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ❑ Certified copy is filed with the county building inspec- [ADDRESS UILDING �0�� D��G,� tion department. /,Date Applicant ITY J>t' (,. ZIP �17&v LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' -V .78j-WNO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT 7Z NOW ON LOT I CROSS ST. (This section need not be completed if the permit is for oneASSESSOR hundred dollars($100)or less.) TRACT 74 90 1 BLOCK • LOT NO. r7 MAP BOOK PAGE PARCEL TEL. I certify that in the performance of the work for which this . OWNER ��Urrj✓ ,0 /74 NO. O/' �� `� USE NE� NOP permit is issued, I shall not employ any person in any manner - SPECIAL so as to become subject to the Workers'Compensation Laws. 'ADDRESS �LI G '�'� Ste'. CONDITIONS //y ?CITY sq .� c + ZIP tai Date I Applicant 6{ ARCHITECT OR TEL. NOTICE TO PPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' L^ CONST., ZONE Compensation provisions of the Labor Code, you must forth- " ADDRESS 4 C-tff `J t with comply with such provisions or this permit shall be 0/�G TEL. STATISTICAL CLASSIFICATION APT. J&6N56TJ deemed revoked. CONTRACTOR v NO. 9-1LICENSED 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 BK PG CZv VALIDATION a OF NO.OF ) CHECK License Number Lic.Class SIZE STORIES FAMILIES ( ONE VALUATION NEW � Contractor Date DESCRIPTION OF WORK ADD $ O I am exempt under Sec. + �+•� t � ❑ ❑ W, B.BP.C. for this reason ALTER U OF nZ Z REPAIR $ Date: EXISTING BLDG. /L E.S DEMOL ❑ — t�, Signature APPLICANTTEL. FINAL OWNER-BUILDER DECLARATION (PRINT) U 6-re! NO. �/I 1DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS ��3�G Gr rse S f FINAL Professions Code): PRE ENT By ` BUILDINGER . I, 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 sale(Section LOCALITY 7044, Business and Professions Code). MgVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. y with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). - REQUIRED YARD HWY TOTAL SETBACK -•-i t{: �'_i_ 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 P.L. (Sec. 3097, Civ. C.). SIDEcv P.L. �)_� AL �. . � c v+:� Lender's Name -..:.;...... ..:.• , .._ �� s.•J LDMA Ref.# –�t• _ Lender's Address P.C. Fee$ Permit Fee ® r•L ;,h i- o t- I certify that I have read this application and state that the Issuance Fee �V LDMA P/C N above information is correct. I agree to comply with all County Investigation Fee p ordinances and State laws relating to building construction, Total Ft ,_t . fi4'r Fee -/ LDMI_ A Perm.# I_ i'i: _13I 1_s and hereby authorize representatives of this County to,enter .. r; aGr upon the a ove-mentioned property for inspection purposes. �Ir,�: ,_ f�r'i-''i-1, 111 /0 �7 00-1 26" ' 1 & SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent` D'ate WORKERS'COMPENSATION DECLARATION ° A A ` insurp, or afcertif certificate of Workers' Compensation Insurance,eent to lf . t ?P 0 I I� OR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY t Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ®� u Certified copy is filed with the county building inspec- BUILDING I fi ® �1p �� , tion department. ADDRESS vV /� Date Applicant CITY, ZIP 1-7 V LOCALITY ale 1: CERTIFICATE OF EXEMPTION FROM WORKERS' 9 NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT 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.��JJ__ MAP BOOK PAGE PARCEL I certify that in the performance of the work for which this OWNER (/ NO. USE ZONE M `f(J ��rMAP ?I permit is issued, I shall not employ any person in any manner -- SPECIAL so as to become subject to the Workers'Com pe ation Laws. ADDRESS 066 01 I NG CONDITIONS Date :22 Applicant s CITY !� ZIP NOTICE TOAPPLICANT: If, after ma n this Cert ate of ARCHITECT OR TEL. lf3 DISTRICT GROUP TYPE FIRE PROCESSED BY g ENGINEER J Vll.r, NO. '� 7 CONST. ZONE Exemption, you should become subject to the orkers' (+ / j Compensation-provisions of the Labor Code, you must forth- ADDRESS O)1 � L AIL . `3 with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. 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 BK. PG VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE 0 VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ s v f Aat-H � ADDpoll, I am exempt under Sec. ALTER ❑ LIS , B.BP.C. for this reason REPAIR ❑ $ aa:i Date: USE OF DEMO' EXISTING BLDG. ❑ Signature APPLICANT TEL. FINAL ' OWNER-BUILDER DECLARATION PRINT NO: DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole comRensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL =' ?•+ -- 1 - NO. % ' ••-•:.:-• I, as owner'of the property,am exclusively contracting CONTRACTOR "•(,� ;•:-_ with licensed contractors to.construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS �••. , s REQUIRED TOTAL SETBACK SMINN CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH .I hereby affirm that there is a construction lending agency for FRONT t the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name Q LDMA Ref. q $ Lender's Address 11 P.C..Fee Permit Fee 3 / I certify that I have read this application and state that the Issuance Fee CJ Q. LDMA P/C q above tnformation is correct. I agree to comply with all County Investigation Fee �y/,� ordinances and State laws relating to building construction, Total Fee G�G� LDMA Perm. q and hereby authorize representatives of this County to enter upon t e above-m fitioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ig lure of Applica r Agent Date WORKERS;COMPENSATION DECLARATION L. i hereby affirm that I have certificate of consent to self APPLICATION P P L I CAT I jO N FOR BUILDING PERMIT insure, or a certificate of Worr kers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Po)icy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ' ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS ��SG CITY /PL•, s A- ZIP 5?/7 (50 LOCALITY Date Applicant C.r NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT COMPENSATION X Z 2 NOW ON LOT CROSS ST. COMPENSATION INSURANCE ® ASSESSOR (This section need not be completed if the permit is for one TRACT 76 i U BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. OWNER � 7jr1 JL) 6 C.t r?f o/%( NO. //Cj>3j USE ZONE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner "-ADDRESS (j 5 Gj/ ci-C SPECIAL � so as to become subject to the Workers'Compensation Laws. g CONDITIONS O 5 CITY .... /� ~ ZIP r /7.F ' Date c�Q Applicant ARCHITECT OR TEL. 134 0 NOTICE TO A PLICANT: If, after maki this Certificate of ENGINEER // NO. DISTRICT GRQUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ¢ CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS �GU 41 _ %�f a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. � -� Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.—DWELL. UNITS - 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect, t CITY CLASSBK PG r Y VALIDATION SD. FT. y NO. OF NO.OF CHECK License Number Lic. Class SIZE pC�� STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ '7 3 Z^ ADD ❑ 6� El Ll U 2 Poo4 I am exempt under Sec. v` ZS ALTER ❑ i' BAP.C, for this reason °3 rw c/ c' REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature s APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. I her affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ^`ADDRESS FINAL a Professions Code): .PRESENT B i I, as owner of the property, or employees with BUILDING y ACCT aaY � ti wages as their sole compensation,mY emP ADDRESS v will do the work and 6a® i ` + the structure is not intended or offered for sale(Section LOCALITY 3� ,� �u�, ,s:�� o6a 1 7044, Business and Professions Code.) MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. TOTAL1 ,! j EMS with licensed contractors to construct the project (Sec- ADDRESS 6.Ep,o 63 tion 7044, Business and Professions Code.) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. \ T.H£�. 68.63 CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 1HAINGE 0001 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Namef17/81 . LDMA Ref. # 1101313-1131010 1 y P.0Fee$ Permit Fee Lender's Address ► �'43 1 A u o ' I certify that I have read this application and state that the Issuance Fee Sv LDMA P/C# above information is correct.I agree to comply with all County r Investigation Fee / ordinances and State laws relating to building construction, Total Fee O{�o 6 LDMA Perm. # ( and hereby authorize representatives of this County to enter upon the move-mentioned roperty for inspection purposes. a. /05• SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of Applicant or Agent Date 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 0311040013 PHONE: (626) 285-0488 EXT: LEGAL ID: No. OF CONST BUILDING-ADDRESS: TR: 7690 LT: 80 BL: .001 UN: .003 SQ. FT STORIES TYPE 10569 OLIVE ST STRUCTURE: VN' TEMP CA 917802865 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: PALL MALL 8586-029-029 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RE ID USE ZONE: R-1 ISSUED ON: PROCESSED B XPIRE . EXIST OCC GRP: 11/04/03 VG 10/29/04 . OWNER: TEL. NO: B DGS. NOW ON LOT: VALUATION: FINAL DATE FIN Y: CODE: GONZALES ALFONSO;LUPE - 3,100 , 10569 OLIVE ST / -1 TEMP 917802865 FEES PA D D S RI ON 0 WOR RE OVE REPLACE 1 WINDOW AND 1 SLIDING DOOR, RELOCATE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 WINDOW APPLICA EL. 0: PRIME BUILDERS (909) 780-8624- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 3100.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/0 EN-HC 3100.00 VAL 115.80 TOTAL FEES 144.05 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE PRIME BUILDERS (909) %0-8624- 16596 CITRUS VIEW CIRCLE LIC. NO LOCATION AND SETBACKS- RIVERSIDE, TBAC SRIVERSIDE, CA 92504 795780 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER" TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION XX 3 01 FLOOR SHEATHING 0. OF FAMILIES: DWELLING ITS: PT/CO D: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED LOOR/CEI ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES I TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT i TEMPLE CITY CA 91780 BL 0508 0205150041 PHONE: (626) 285-0488 EXT: I GA I 0. OF CONST BUILDING TR: 7690 LT: 80 BL: .001 UN: .003 SQ. FT STORIES TYPE 10569 OLIVE ST STRUCTURE: VN TEMP CA 917802865 ASSESSOR INFORMATION N ER: NEAREST CROSS STREET: PAL MAL 8586-029-029 I THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY TENANT: I IS G USE: RESID UE ZONE: R- ISSUED PROCESSED EXPIRES 0 : l EXIST OCC GRP: 05/15/02 JK 11/11/02 OWNER: TEL. NO: BLDGS. NOW ON OT: VALUATION: FINAL DATE FI L BY: CODE: GONZALES ALFONSO;LUPE - 800 6--17-oL 10569 OLIVE ST f TEMP 917802865 FEES PAID DES- ION OF WOR REROOF OVER EXISTING ROOF _ FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: A NO: TEMPLE CITY ROOFING CO (909) 608-0622- AA BLDG PERMIT ISSUANCE 27.75 1216 BEGONIA CT AC STRONG MOTION RESID 800.00 VAL 0.50 SPECIAL CONDITIONS: UPLAND 91784 D2 PERMIT W/O EN-HC 800.00 VAL 65.40 TOTAL FEES 93.65 CONTRACTOR: APPR ALS DATE INSPECTOR SIGNATURE TEMPLE CITY ROOFING CO. (909) 608-0622- 1216 BEGONIA COURT LIC. NO 1 LOCATION AND SETBACKS UPLAND, CA 91784 HIC SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CM : UNDERFLOOR INSULATION 147H273 3 01 FLOOR SHEATHING O. OF F I S: D E LI G S: P COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL A DO S SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR AHDRWL EXTERIOR LATH ED FLOOR/CEIL ASSE . RATED WALL ASSEMBLIES EDSHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE AI AG REPORT ID: DPR261 ROUTE TO: BS0508