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HomeMy Public PortalAbout9077 OLIVE ST_Building__ APF%LICATION FOR BUILDING PERMIT FOR APPI ICANT TO FILL IN (Print or type on�ly) BUILDING - - COUNTY OF LOS ANGELES - ADDRESS t`y. ' DEPARTMENT OF COUNTY ENGINEER CITY � CQ Zip 0 BUILDING AND SAFETY DIVISION BLDGS. BUILDING SIZE OF LOT X P p 6 NOW ON LOT 3 • ADDRESS + TRACT /J BLOCK LOT NO. Z40 LOCALITY TEL, NEAREST OWNER /L,�, � J��J�✓�j NO,;qjl�; � a CROSS ST. D -� ASSESSOR ADDRESS �' Q L/✓5 S/ MAP BOOK PAGE PARCEL CITY s G 7 DISTRICT GRQUP TY E FIRE PRO SED BY �/�' j C iz- ZIP / { �o O 8 /y�)- C�T. v ZON ARCHITECT ORQ ' TEL h ENGINEER /g NO. STATISTICAL CLASSIFICATIONSE/W,,ERCAA P ADDRESS TEL. CLASS NO. L_DWELL.UNITS BK" / PG CONTRACTOR NO. USE ZONE NOP 10 LIC. ADDRESS NO. SPECIAL LIC. CONDITIONS CITY SS. CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD SQ.FT. STORIES NO OF CHECK - FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES � ONE } DESCRIPTION OF WORK NEW ❑ + - O ADD BLDG.SETBACK FROM of 14Dp yjDap Ck SIDE PROP ALTER El .LINE OF AIl��EETBACK FROM TYPE OF�EXISTING HIGHWAY + YARD = SIDVPROP.LINE HIGHWAY WIDTH , N USE OF ffJJ/ REPAIR 11Z EXISTING BLDG. &6l 0�,PCM/ G DEMO(LL ❑ + A(PRINT) + L CANT TEL NO^'°� `D� CORNER FF. YES ❑ NO ❑ + IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) �y IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION 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 1 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 lz PERMITTEE ADDRESS /(�f i CITY IZM A eZ �l T NO... �0 I'i�► DATEFINAl������ B( vp t, Q MAKE CHECKS PAYABLE TO: FEE FET $ V HARVEY T.BRANDT,COUNTY ENGINEER j rJ PLAN CHECK VALIDATION Cr_ M.O. CASH PERMIT VALIDATION CK.__)M... CASH 5 9 5EP-MtY 23 1 U •2 5.0 0 ®s 76A638A CE#803 3.75• i .,TEMPLE CHTY /6A=8A-#.--.i/-q .APPC.ICAT-ION' .FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING O , `r_ DEPARTMENT OF COUNTY ENGPMR ADDRESS `- BUMING AND SAFETY DIVISION LOCALITY 7 ' CE j_r JOHN A. LAMBIE, COUNTY ENGINEER NEAREST' WILLIAM A.JENSEN 80P'T OF-BUILDING, CROSS ST. �,S V4% 4) _ DIE GROUP TypE PR Y' FOR APPLICANT TO FILL_IN , S • B CONST. BUILDINGp STATISTICAL CLASSIFICATION SEWER MAP ADDRESS /O7/y E. ow VE Sr[ � CLASS.NO. DWELL.UNITS � B �•� _ LOT NO. O BLOCK L MAP STATE -YES O ' NUMBER• HWY. TRACT USE.ZONE SPECIAL ,/ • NO.OF BLD.GS. ( CONDITIONS 95100,5,= A47T�ZF" b RT f! r SIZE OF LOT �p$ �Q$ I NOW ON L'OT /�r 1 USE OF '1 a F : EXISTING BLDG. E BUILDING YARD HWY STREET NAME EXIST. TELSETBACK WIDTH OWNER E NO... a7 FRONT ✓ a • ADDRESS - 8 E. 04 11,45 r SIDE ARCHITECT OR , TEL. P.L. ENGINEER NO. INSPECTION RECORD ADDRESS ++ / TEL. g f.. b ._Fih �N o / CONTRACTORNO. O s ADDRESS. ., - .J _� r �• - DESCRIPTION OF•WORg I.D _ O xzt a,"1 G-aYe-[ NEW ADD ALTER REPAIR DEMOLISH SQ.FT.. NO.OF NO.OF �/� 2•r �.9�'`� .,F�'.,�ij1. -.4� SIZE O STORIES f FAMILIES .O r USE OF ' ��' L;'%•r _•-- STRUCTURE SIGNATURE OF APPLICANT VALUATION$ E� ; APPROVALS DATE INSPECTOR'S SIGNATURE ?3, FOUNDATION:LOCATION P.C. PMT. Qr /� FEE '� FEE.$ IIV - FORMS MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME:FIRE STOPS, .BRACING BOLTS b� PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE:LOCATION, AGREE TO COMPLY-WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH,INT. WILL.NOT EMPLOY ANY PERSON IN V16LATION OF T,HE WORKME41'S COMPENSATION LAWS OF .CALIFORNIA. LATH,EXT. I �Y SIGNATURE OF- HOUSE NUMBER COR- /• / ./ /1� PERMITTE RECT AND POSTED //w �/d FINAL 1 / 6 - /ff/f. ADDRES �J CLYDE N. DIRLAM,4A.I1961 AL STRUC URAL ENGINEER - PLAN CHECK VALIDATION CK.` M.O. CASH PERMIT V ATION ' c M.O. cash �.�.� _ 76A6S8A auB-A-5<<¢6 AP LIBATION �BUIL�NG PERMIT - COUNTY OF LOS ANGELES BUILDING �D • DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY ' o+ � Ct•r� JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. DISTRICT NO. ROy P TYPE PROCESSED BY ' FOR APPLICANT TSO. FILL IN 5 ,400" Gw, CONST. BUILDING . STATISTICAL CLASSIFICATION SEWER MAP ADDRESSCLASS NO. '-/DWELL UNITS BK///PG LOT NO. BLOCK USE ZONEMAP rf�j TRACT J / SPECIAL NO. OF SLOGS. CONDITIONS SIZE OF LOT NOW.ON LOT - - USE OF EXISTING BLDG. a BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF Jv v (STREET) OWNER i NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS (J ..rJ HIGHWAY WIDTH 'MOM G.L. CITY 4- ��+ = ZiC/ AR T OR TEL BLDG. SETBACK FROM NO. SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADD SSAo HIGHWAY WIDTH FROM C.L. C E + = L AD Q LIC NO Y - CORNER CUTOFF YES NO OU LIC ' SEE REVERSE SIDE FOR SPECIAL APPROVALS O CIT y CLASS � DESCRIPTION OF WORK W / a NEW � ADD ALTER REPAIR DEMOLISHf j , Z SQ,FT. NO. OF NO. OF _ �,�°�• _ SIZE STORIEA FAMILIES USE OF • •'' __ STRUCTURE SIGNATURE OF • ;^ d?t.w� ►� APPLICANT 7 �a VALUATION$ APPROVALS TE '1NSPE ' SIGNATURE P.C. PMT. �E FOUNDATION, LOCATION FEE$ FEE$ FORMS, MATERIALS FRAME, FIRE STOPS, / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL UNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDING NSTRUCTION. I IFFY THA IN DOING E WORK AUTHOR HEREB I WIL T EMPL N ON IN VI A� LATH. INT. TION OF HE DE - S E -_ ING TOW R E S G MP SAT) 1 E. LATH. EXT. t SIGNAT F 2 �s/ HOUSE NUMBER COR- PE4tMIT G�I� RECT AND POSTED ADDRESS F I NAL �` r .�'v� JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CR. M.O. CASH ,_ PERMIT VALIDATION CK. M.O CASH .L LO 2 1 9 7:0 '.t AY 2,0 2 7.5 0 - � LHuo 2 1 9 'S !SLAY 2 0 1 D 15.0 ON . APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES BUILDING ADDRESS 9077 E. Olive fit. DEPARTMENT OF COUNTY ENGINEER CITY Temple City zip 91780 BUILDING AND SIT DIVISION NO.OF BLDGS.SIZE OF LOT 62x186 NOW ON LOT 3 ADDRESS (/t ` TRACT 1121 V BLOCK D LOT NO. 20 LOCALITYNEAREST (_ OWNER Rolf L. Henriks 1285-81+06 CROS ST. ASSESSOR ADDRESS (s am e) MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIREESSED BY -CITY ZIP CONST. ZONE 41 ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CLASSIFICATION SEWER P ADDRESS CLASS NO. DWELL.UNITS BK PG CONTRACTOR owner NO. US NE MAP LIC. NO ADDRESS NO. SPECIAL LIC. �t CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED 1 YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRAN CTH,,� Coast Federal S&L BLDG.SETBACK FROM YY 1 ADDRESY120 Las Tums San. Gabriel FRONT P P.LINE OF (STREET) OF FHIGHW + YARD TOTAL-SETBACK FROM TYPE OF EXISTING SIZE Fr.394 STORIES 1 MILIES 1 ONEK FRONT PR P.LINE HIGHWAY WIDTH __ r DESCRIPTION OF WORK NEW + 8 BLDG.SETBACK FROM w y❑ ,add bedroom bath and ADD SIDE PROP.LINE OFF (STREET) O ALTER ❑ TOTAL SETBACK FRO TYPE OF EXISTING w laundry. HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTUSE H N -REPAIR 11EXSTOINGBLDG. residence DEMOL 0 + - Z APPL PRINANT Rolf L. Henriks NP85--8406 CORNER CUTOFF YES ❑ NO ❑ IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) " /+� IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION (/ 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- /l �• PENSATION INSURANCE. Y�� SIGNATURE OF ` /L Cry}�j� PERMITTEE ADDRESS �^ CITY TEL.NODAT z�d BY MAKE CHECKS PAYABLE TO: FEE $ FET HARVEY T.BRANDT.COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH a PERMIT VALIDATION CK. M.O. CASH 9 0 .3 r .G1rT 22 1 .D 8 2.5 0 A--;B (es 76A63BA CE#803 3.75' OP, 7GA638A CE0808 8-68 APPLICATION FOR BUILDING PERMITLJ _ C COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY-ENGINEER ADDRESS'7. BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST / WILLIAM A.JENSEN,SUP'T OF BUILDING CROSS ST. DISTRICT NO GROUP TYPE ESSED BY FOR APPLICANT TO FILL IN CONsr_ BUILDINGSTATISTICAL CLASSIFICATION. WER MAP • ADDRESS ' yT O •c• 1.CLASS.'NO. DWELL.UNITS BK PG LOT-NO. BLOCK WATER CERTIFICATE: NOT REQUIRED ® %RECE'IVE'D ❑ TRACT MAP /' ' HIGHWAY STATE MAJOR SECOND,LOCAL NO.OF BLDGS. NO.�Q" (CIRCLE) - SIZE OF LOT X NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. ,I 8l TEL (� � OWNER OFMO. I BUILDING YARD HWY R AME EXIST. SETBACK' NWIDTH ADDRESS ;s—' •Cr FRONT ARCHITECT OR TEL: P. L. ENGINEER'• NO. SIDE ADDRESS TEL. _ �'+ 'ice= 1'i V CONTRACTOR NO. �• dor ADDRESS /• r 0- DESCRIPTION OF WORK , �; ;' �O G .. CIS)( U,.V i 4I xJ? 89V-"I ✓JL �4r _.t/ /C•X_f_ Vl NEW ADD ALTER REPAIR DEMOLISH I' L' Z SO.FT. NO.OF NO.OF / l'� +g i �rjltr cle" a e SIZE STORIES FAMILIES USE OF 9 L� / STRUCTURE DEA) •7.} C�l�G4d �Efxsl � O / SIGNATURE OF APPLICANT-' PPLICANT r VALUATION $ 6-� APPROVAL$ GATE INSPECTOR'S SIGNATURE P.C. -_ PMT. FOUNDATION: LOCATION FEE $ FEE $ p -�^ 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 1 WILL NOT EMPLOY ANY PERSON IN v10LA LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. n LATH.EXT. PERM TTEE SIGNATURE OF `��w �/ HRECT AND POS EDNUMBER R f ADDRESS �77 �• FINAL JOHN F: LEWIS, PRINCIPAL STRUCTURAL E R PLAN CHECK VALIDATION CK. M.O.- CASH PERMIT VALIDATION CK. M.O. CASH t -07-8- .SUN 15 -'1 D 4.0.ON v D'o 7 9- JUN.1 5'..--1 D.- s _ APPL :CATION FOR / COUNTY OF LOS ANGELES �,U5 DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING' FOR APPLIG�NT TO FILL IN ADDRESS )p'7 BUILDING ADDRESSNEAREST sJ LOCALITYzlyll CITY `/ ZIP / �� CROSS ST. 4-) ry A0.OF BLDGS. ASSESSOR SIZE OF LOT ` NOW ON LOT MAP BOOK PAGE PARCEL �j DISTRICT GROUP TYPE FIRE PR CES BY TRACT ��b�$ /BLOCK LOT NO. z® Q Q l CONST Z2E C/V (� r O OWNER L. W V a 7Gl��,I STATISTICAL CLASSIFICATION "SEWER_MAP .ADDRESS CLASS NO.- � DWELL•UNITS /•I BINCXG CITY ZIP 'USE ZONE MAP C7� 1, NO. ARCHITECT OR TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS- ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR TEL. BLDG.SETBACK FROM • LIC. .FRONT PROP.LINE OF (STREET) ADDRESS 'NO.' HIGHWAY + YARD TOTAL SETBACK FROM HTYPE OF IGHWAY WIDTH LIC. FRONT PROP. LINE CITY CLASS. CONSTRUCTION LENDER + d - �U & v NAME AND BRANCH BLDG.SETBACK FROM c ADDRESS CITY SIDE PROP.LINE OF (STREET) C. 'SQ, FT. NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING 9Z SIZE STORIES. FAMILIES ONE I SIDE,PROP. LINE HIGHWAY, WIDTH DESCRIPTION OF WORK ��® NEW ❑ + ADD CORNER CUTOFF YES ❑ NO ❑ Z ALTER ❑ / REPAIR[] IN OPEN SPACE YES ❑ NO ❑ USE OF EXISTING BLDG. �r►]C/J �J� /q��CDE�M�Oy/L ❑ IN COASTAL PERMIT ZONE YES ❑ NO '❑ AP PRI NT)NT .®Y` /r/G./aNOLir!/J �/f�J1� BY (-SIGNATURE) 1 - 1 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 CON= STRUC TI ON. [-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 COMPENS ION INSURANCE. SIGNATURE OF ° FINALa BY PERMITTE DATE C� ADDRESS D 77 6 QUEOLC 157 CITY '� p(� C! NoXSJfo6 P.C. Fee$ Permit Fee ®+7e Issuance Fee VALUATION$ d Total Fee PLAN CHECK VALIDATION CK. M.O. CASH e , PERMIT VALIDATION CK. M.O. CASH 2 1. 2 �j;; 7GA638A C6#8098 12/75 - COMPENSATION DECLARATION M insw eli:',gffirm that I have a certificate of consent to self APPLICATION FOR �U��UNG PERMIT � ins'•&, orb certificate of Workers'Compensation Insurance, 6r 6 certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDINGn ` Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS / r Certified copy is filed with the county building inspec- BUILDING ' &jVG / A tion department. ADDRESS V Date Applicant CITY (jl�y ZIP 6217 NEAREST2� LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' r f0 L• NOW ON LOT �! CROSS 5T. COMPENSATION INSURANCE SIZE OF LOT /Q� (This section need not be completed if the permit is for one TRACT �!2[ !J LOT NO. MAP BOOK PAGE PARCEL ASSESSOR hundred dollars($100)or less.) BLOCK L j�� TEL.,2 USE Z NE MAP I certify that in the performance of the work for which this OWNER r I!` NO.G NO. permit is issued, I shall not employ any person in any manner I✓ I�S SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS /1V I CONDITIONS 0 CITY el ZIP �D @S Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCE SED BY 0 Exemption, you should become subject to the Workers' ENGINEER NO. 'If( CONST`./ ZONE Compensatioprovisions of the Labor Code, you must forth- ADDRESS '' vU 3 V with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. I CON 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. t' 7J NO.OF / NO.OF / CHECK License Number Lic.Class SIZE s7 ( STORIES L FAMILIES ONE 1� --/ VALUATION Contractor Date DESCRIPTIONOF WO /�°r�l^r !� AD I am exempt under Sec. ALTER / B.BP.C. for this reason REPAIR ❑; $ Date: USE OF EXISTING BLDG. �t y�iiJ� DEMOL ❑ 1 5 a 6 A Signature APPLICANT TEL./� f �j.�/_ FINAL # o a o 0 0 1 OWNER-BUILDER DECLARATION (PRINT) !�l�C„S N0 J 7 l� DATE I hereby affirm that I am exempt from the Contractor's License Com/-IP�� FINAL - 171.75 Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BY am BUILDING = I, as owner of the property, or my employees with ADDRESS o 0 17 1.7 5 c: wages as their sole compensation,wil I do the work and 1. the structure is not intended or offered for sale(Section LOCALITY 0 225-85 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). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP LINEFROM 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.). SIDE I P.L. Lender's Name ) j ' P.C. Fee$ Permit Fee / �/� LDMA Ref.# Lender's Address ' I certify that I have read this application and state that the Issuance Fee 0, LDMA P/C a above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee /-7/ .75 LDMA Perm. a and hereby authorize representatives of this County to enter up,9.94he above-mentioned property for inspection purposes. Z N f6 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date' WORKERS'COMPENSATION DECLARATION• I hereby affirm that I have a certifitate of consent W ReltMN FOR D insure, or a celP41ficate of Workers'Compensation Ifisurance, ��� PERMIT or a certified copy thereof(Sec.3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company :. - BUILDING FOR CANT Certified copy is hereby furnished. APPLITO FILL IN ADDRESS 77 Certified copy is filed with the county building inspec- BUILDING �.y tion department. ADDRESS 6/�1 L/✓� d LOCALITY NEAREST Date Applicant } CITY r L C t T ZIP �` 7 D L7 ROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for oneej� USE ZONE MAP hundred dollars($100)or less.) TRACT ! y BLOCK y LOT NO. �D NO. 17 TEL'! EL. g�f i� SPECIAL 3- ' OWNER + + Q 7 � NOG1 S 77'[ CONDITIONS 9L I certify that in the performance of the work for which this { DISTRICT 1GROUP ITYPE FIRE I PR SED&Y O permit is issued, I shall not employ any person in any manner r:ADDRESS '9V� ° ®Z•1�0— d5 CONST. ZONE. V so as to ecome subject to the Wo s' om ensaticn Laws. I p CITY 'rrG�-/t�LE ad `T zip /71O S`0� '3 -� Date- 41 pplicant STATISTICAL CLASSIFICATION APT. CONDO. I— NOTICE TO APPLICANT: lf; after making this Certificate of 5 ARCHITECT OR TEL. ENGINEER NO. CLASS NO.�DWELL.UNITS11.1111 Exemption, you should become subject to the Workers' 4. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP til with comply with such provisions or this permit shall be "e yy� (� deemed revoked. TEL.CONTRACTOR NO. BK. e�ILPG,43 VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Divislot)3 of the Business and LIC. Professions Code,and my license is in full force and effect. CITY CLASS $ J©� SQ.Fr NI5.OFNO.OF CHECK License Number Lic.Class , SIZE STORIES FAMILIES ONE Contractor Date [ DESCRIPTION OF WORK DD NEW ❑ I am exempt under Sec. + i�(��C- ADD lot ALTER ❑ FINAL REPAIR C] DATE B.&P.C. for this reason Date: USE OF EXISTING BLDG. R"'S1 r D'�1J« DEMOL C] By Signature APPLICANT TEL. 6y OWNER-BUILDER DECLARATION PRINT .. • L+ �/�Q 1!�S NO.� ��dl� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 4o� ®L-/!�� Sr �• y17 fO D - 0970A U 7O Professions Code): PRESENT1 �y BUILDING 0 0 a o 0 U 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). MOVING TEL. T El1,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- A ADDRESS (? n t'!— ' 4'tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST. SET BACK YARD HWY PROP.LIN WIDTH D I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued Pa Lo tSec. 3097, Civ. C.). SIDE 'o P.L. Q Lender's Name P.C.Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee A) 5_ 6 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County to enter upon the above-mentions property for inspection purposes. + , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®s W ORKE S'�COMPENSATION DECLARATIONffirn�- t I have a certificate of consent to self /a� p I� � R IL I G PERMIT cerT�� cSte of Workers'Compensation Insur nce, or a ce?tified copy thereof(Sec. 3800, Lab._C. Policy No. Company ti / COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS -7 7 Certified copy is filed with the county building inspec- BUILDING /'� J�} �J tion department. ADDRESS �(J (J L_ LOCALITY NEAREST Date Applicant TY 7��/lii C ZIP CROSS ST. ERT ICATE OF EXEMPTION FROM RKERS' k N OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT ;MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one LITE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. TEL. I SPECIAL I certify that in the performance of the work for which this OWNER /-( NO. .S' � CONDITIONS CL permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PR SED BY O so as to become subject to the Workers'Compensation Laws. ADDRESS 7'-e' !R/ CONST. ZONE U (JO Date Applicant CITY ZIP STATISTICAL CLP�$SIFICATION APT. JCTDO. NOTICE TO APPLICANT: If, after making this Certificate of . ARCHITECT OR TEL. I Exemption, you should become subject to the Workers' a ENGINEER NO. CLASS NO. DWELL.UNITS CL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MJPG H with comply with such provisions or this permit shall be � yfL deemed revoked. CONTRACTOR G Uo"�lr710. BK. VALIDATION LICENSED CONTRACTORS DECLARATION /� I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS e LIO. ?_o VALUATIO (commencing with Section 7000)of Division 3 of the Business and ti LIC. Professions Code, and my license is in full force and effect. CITY DV �J CLASSHECk Licen ber 03 6 Lic.Class � 3 SIZE TORIIES AMILLIIES CONE ContrL,O� -'�Date DESCRIPTION OF WORK O NEWEl I am exempt under Sec. arADD ❑ 2 9 78 A ALTER ❑; FINALB.BP.C. for this reason DAL .- # o 0 0 0 0 REPAIR Date: USE OF DEMOL ❑ FIN I o o 7 EI0 0 EXISTING BLDG. By g APPLICANT TEL. o 0 0 �]8 Q Q Signature PRINT NO. OWNER-BUILDER DECLARATION ; I hereby affirm that I am exempt from the Contractor's License ADDRESS 0 9.23-85 Law for the following reason (Section 7031.5, Business and r Professions Code): PRE5ENT ❑ BUILDING 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). 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). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH D 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. tSec. 3097, Civ. C.). SIDE 0 P.L. Lender's Name a =P.C.Fee$ Permit Fee QJCf Lender's Address /d c ,1 rI certify that I have read this application and state that the Issuance Fee [ J G/ above information is correct. I agree to comply with all County =Investigation Fee ordinances and State laws relating to building construction, Total Fee 9 reby authorize representatives of this County to enter _ up thea e-mentioned proper for inspection�purposes. /� c/ � � ' o , Oy 2/�2x / G ) CEJ SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Signature of Applicant or Agent Date CCU TY CF LOS ANGELES TEMPLE LiTi # 0508 Bill!DING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS 1,":AS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE Clry .^.A 91780 61. 0508 0410250012 PHONE: Ct• 2185-0488 EXT: LEGA ID: NO. OF CONST BUILDINGADDRESS: TR: 11218 LT: 20 BL: D SQ. FT STORIES TYPE 9077 OLIVE ST STRUCTURE: 2200 VN TEMP CA 91780'3024 AS ESSOR INFORMATION NU B R: _—I' NEAREST CnOSS STREET: ROSEMEAD 5388-005-021 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG ESID USE ZO :--R--3— ISSUED ON: PROCESSED B S !: EXIST OCC GRP: 10/25/04 JK 10/20105 OWNER: _ TEL. N0: BLDGS. NOW ON LOT: VALUATION: FINAL-fDATE 1NAL BY: CODE: SIT, SIU (626) 287-8298- 4,000 //�O — 9077 OLIVE ST �J TEMP 917803024 FEES PAID I1 RIPT�ION OF 6OYK TEAR OFF AND REPLACE WITH COMPOSITION SHINGLES HOUSE AND FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: GARAGE APPLICANT: TEL. 0: SAME AS OWNER - AA BLDG PERMIT ISSUANC'c 27.75 AC STRONG MOTION RES1D 4000.00 VAL 0.50 (SPECIAL CONDI IONS: ID2 PERMIT W/O EN-HC 4000.00 VAL 115.80 TOTAL FEES 144.05 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND -SYT-BACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. 0: OUNDATIOd/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 147H265 3 01 N0. OF FAMILIES: DWELLING UNITS: APT/GOND: STA CT/7S: FLOOR S EAT I G NO 21 RXOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST RE SPRINKLER ,.4' V ERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/ ASSEh. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOTI DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508