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HomeMy Public PortalAbout9230 OLIVE ST_Building__ APPLICATI®N FOIA BUILDING PERMIT �. -COUNTY OF LOS ANGELES BUILDING,9 ) ADDRESS DEPARTMENT OF COUNTY ENGINEER, BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST I CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. j GRQLJP TYPE P Y N 'FOR APPLICANT TO FILL IN _ CONS ,f"I T. BUILDING O u e �t I SEWER MAP ADDRESS- 2 3 d v STATISTIC, SSIFICATION BK PG CLASS.NO. DWELL.UNITS Z LOT NO. A jV p dA BLOCK TRACT J/ Li1 Z US ZONE SPECIAL HWY YES NO. 70046 / yy / NO LDGS. r� CONDITIONS / SIZE OF LOT. 0 '6 / 4 6 I NOW ON ON LOT' - USE,OF` 1 7!NG 13LDrz. BUILDINGWEXIST. t SETBACK YARD HY STREET NAME WIDTH OWNER d FRMAIL P.ONT G��� 60 ADDRESS 3 FI S SIDE E / E CITY NO.; ,� 9 P.L. ARCHITECT oft TEL. INSPECTION RECORD , ENGINEER NO. •.ADDRESS CONTRACTOR 'OJf SPL/ NOlff 54f.0 ADD13ESS3151!7 WC LW� e LE B GO"-" f . 'DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.'FT. NO.OF NO.OF SIZE a STORIES A FAMILIES U O ST R Q 04C 01 v- t r SIGNATURE OF - VA S APPLICANT .. _ DATE INSP 6PIATURE ADDRESS FOUNDATION: LOCATION FORMS:MATERIALS i $ (D® P.-C. $ FRAME: FIRE STOPS. G FEE BRACING.BOLTS / VALUATIONS $J� FURNACE: LOCATION. —� // GAS VENT.DUCTS I jiEREBY'ACKNOWLEDGE THAT 1 HAVE READ THIS.AP- LATH.INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALLCOUNTY ORDINANCES AND LATH,EXT. 1 STATE LAWS. REGULATING BUILDING .CONSTRUCTION. SIGNATURE OF HOUSE NUMBER COR- PERMITTEEA RECT AND POSTED d!1:� ADDRESS-16 S 71' OSPest.Q FINAL DC7 7" CLYDE N.DIRLAM,PRIN(ZIPAL STRUCTURAL 6 R - PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. 'M.O. /'CASH./, ( 0,1 8 8 -5 R 'JM 16 1 A 1 .5.0 p '.A DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES U 0 L®0 '101' " G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY y/'1 /I y f DIST RIC PLAN CK. NO. PERMIT NO. ADDREIBS tj °t 6 b�Ed 1171A.' ! aq R CEIVED BY DAT F APPL. DATE ISSUED " LOCALITY !� ,- �!( ! "-p'&.'•/ Q NEAREST / J CROSS ST. E31 ILDING ADDRESS OWNERll MAIL �aQ „�[ e r 5' NEARESLOCALIT( f / ADDRESS l.,�; �Q CD _` ir`C lvi,i -7, TEL CROSS ST. CITY r-�% 1 '1 �.!;r( NO. 13 q 41 FIREI NO. OF I TYPE I GROUP ARCHITECT OR I TEL. ZONE PLANS ENGINEER NO. BLDG. ORD. NO. SETBACK LINE { ADDRESS APPROVED �{� BY DATE CONTRACTOR 1��0.kP:i M.C.IJItC'NO• r4% f9 !�77 USE APPROVED ZONE BY DATE ADDRESS �.f �`?` `y, J, HOUSE NUMBERING LEGAL DESCRIPTION I LOT NO. BLOCK MAP NUMBER FIELD CHECK BY TRACT NO. ASSIGNED BY SAT i NO. OF BLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT Y USE OF I NO. OF EXISTING BLDG. FAMI1' LIES i DESCRIPTION OF WORK NEW I I ALTERATION I I ADDITION REPAIR I I DEMOLITION I I I ;u SQ. FT. NO. OF D SIZE ROOMS STORIES EXT. WALL ROOF 1' COVERING I COVERING USE OF STRUCTURE r , S n APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREXY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION F PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED t FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND TATE BRACING, BOLTS LAWS REGULATING B ILDI( CO STRUCT} FURNACE: LOCATION, j 91GNATUR .OF y � �J, GAS VENT, DUCTS • PERMITTERT�� %'t sill ll! _ i ? LATH, INT. t ADDRESS 05 [ LATH, EXT. AUTHORIZED AGT PLASTER, INT. 7iA898A• DBSS 70-80 .�' P. C. $ ® 0 0 ® FEE PLASTER, EXT. VALUATION ��'"® �' $ FEE FINAL J I ' T PLt CITY 76AMBA CC 11866•1-61 APPLICATION FOR BUILDING PERMIT ' r COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS411& e BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN. SUPT OF BUILDING CROSS ST. DISTRI�cr'NO G O.UP TypE SED BY FOR APPLICANT TO FILL IN . .I-lj S� CONST. BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 9230 OliveSK PG 'CLASS.NO.—I—DWELL.UNITS `2 LOT NO. O BLOCK A WATER NOT REQUIRED RECEIVED CERTIFICATE: 11 TRACT NO.OF BLDGS. NOP HI(cGRc E>HWAY STATE MAJOR SECOI�TD, L SIZE OF LOT. I NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL OWNER Em R. Mo orod NO. BUILDING EXIST. SETBACK YARD HWY STREET NAME. WIDTH' ADDRESS 9230 Olive Temple City FRONT �• ARCHITECTOR TEL. P.L. ENGINEER NO. SIDE P.L. ADDRESS INSPECTION RECORD 0 ' CONTRACTOR Vi r TE T70507 u 99 ADDRESS 6001 Sm San' Gabriel Blvd,,. O DESCRIPTION O;p WORK 6.G. Lun sn NEW ADD ALTER EPAI DEMOLISH Z SQ.FT.- NO. NO.OF IZE' STORIES FAMILIES USE OF STRUCTURE Re-roof H Front of Gara - SIGNATURE APPLICANT VALUATION$ 666 0 00 APPROVALS DATE —INSPECTOR'S�S{IGNATURE FOFORMS.MATERIALS LOCATION FEE $ FEE'$ 8 e 00 FRAME:FIRE STOPS, 1 / 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 'BRACING,BOLTS AND STATE THAT THE ABOVE 18 CORRE9T AND AGREE TO COMPLY FURNACE'.LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT' DUCTS 1 1 /• I .BUILDING CONSTRUCTIO 1 C TIF THAT IN DOING THE WORK.- AUTHORIZED HEREBY I LL O PLOY ANY PERSON IN VIOLA- LATH,INT. i TION OF THE LABOR DE STATE OF CALIFORNIA RELAT- - ' / \ ING TO WORKMEN' O T N INSURANCE.. LATH,EXT.'. SIGNATURE 1• HOUSE NUMBER COR- / v \- PERMITTE RECT AND POSTED I J I 4 XVI ADDRESS 600 S,.San JZFfib ri Is 1 Blvd FINAL San Gabriel CLYDE N. DIRL,AM, PRINCIPAL STRRAL ENGINEER PLAN 'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK�. M.0.' CASH LAG02-5-5 2 7a AUG 3 -1 'D 8 00 or, 4 71 WORKERS'COMPENSATION DECLARATIGV' ►' 'I ,; hereby affirm that I ,have a certificate of consent to self' A p P L I CAT I®N F OBUILDING PERMIT ,. insure or certificat f W rkers'Compenstion Insurance,or. �certifi e o ( �� C.) .� COUNTY OF LOS ANGELES BUILDING SAFETY IP81i o., Co. n8 y'— t' BUILDI ertified copy is hereby furnished. FOR AP ANT TO FILL IN ADDRES ertified copy is filed with the coun uildin 'nspec- BUILDIN - on de art of ADDRESS LOCALITY ' NEAREST at pelican CITY t ZIP CROSS ST: ` CERTIFICATE-OF EXEMPTION FROM WORKERS' NO.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 i USE ZONE. MAP a - TRACT BLOCK LOT NO. �) NO. hundred dollars($100)or less.) TEL. K/! SPECIAL /. I'I certify that in the-performance of the work for which this OWNER NO. I CONDITIONS. permit is issued, I shall not employ an arson in.an manner, ;' DISTRICT GROUP TYPE FIRE SSED BY y p P y Y p y ADDRESSLaCVOK CONST. ZONE so as to become subject to the Workers'Compensation Laws:'` © �NS 09 Date' Applicant CITY ~ZIP. STATISTICALCL,)VgTION APT. CONDO. -U ARCHITECT OR TEL. (JJ NOTICE TO APPLICANT: If,'after making this Certificate of ENGINEER NO. CLASS NO. DWELL. UNITS LU Exemption, you should become subject to the Workers' y Compensation provisions of the Labor Code, you must forth- I ADDRESS' SEWER MAP with•comply with such provisions of this'permit shall be TEL . ), t® deemed revoked. ? SK. PG VALIDATION :CONTRALTO O. LICENSED.CONTRACTORS DECLARATION ., I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE VA UATION (commencing with Section 7000)of Division 3 of the Business and LIC, Professions Code i s is;n full force an effect. CITY CLASS s �• y SQ. NO.OF NO.OF CHECK License Ni ic.CI SIZE _ STORIES FAMILIES ONE Pd 5 3 �_9 A ., Co act ,Date DESCRIPTION OF WORK NEW $ }� �ra. a a o21 am exempt from the licensing requirements as I am a ADD ' . licensed architect or a registered professional engineer A R. FINAL /-� 2' ° o-b Q,4 8 acting in my professional capacity (Section 7051, R PAIR DATE [ G- _ BusinesstniLbns_Code)- t pp .0 ° ° O.4'S �7 f� FINAL r� r�4 (.. EXISTING BLDG. . oC % DEMOL :Q` By4,r ��� 0 S2 2-181 Lic.•orReg.No. Date v� APPLICANT TEL.. OWNER-BUILDER DECLARATION (PRINT) NO. I he affirm that I am exempt from the Contibctor's License , Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT y . . BUILDING 1, 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 offeted'for sale(Section LOCALITY. 704;13usiness and Professions Code). MOVING 7EL. --I, as owner of the'property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project�(S.ec- gDDRESS z 5 3•Z 0 A tion 7044, Business and Professions Code). REQUIRED -TOTAL SETBACK FROM EXIST: # ° a o 0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE -WIDTH 1 I hereby affirm that there is a construction lending agency for FRONT 2-° 1. 1.5 0 0 the.performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.).. SIDE 1O ° 1 1 5 =' P.L. O 0 Lender's Name 1 .105 2 2—8 1 Lender's Address P:C. Fee$ li'i Permit Fee I 'certify thot I have read,this application and -state that the - :. y pp Issuance fee , above information is correct. I agree to comply with all County' Investigation Fee _ ordinances and State lows relating to building construction, Total Fee nd•Her thorize representatives,of this County to enter ) ' � fh above en'on r e ty for insp �puroses. � •1, j; SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Signature of App can or Agent. Date WORKERS'COMPENSATION DECLARATI R--N ' hereby affirm that I have a certificate of consent to self APPLICATION FORD U I L D I N G PERMIT IM ificatg gf W rkers'Compenstion Insurance, or {I�eJ� o ( I ��e1S1C.) COUNTY OF LOS ANGELES �� BUILDING SAFETY fi�lfyJ� Com ny copy is hereby furnished. FOR AP ANT TO FILL IN BUILDIADDRESScopy is filed with the coun ildin 'nspec- F ILDINrt nt DRESS LOCALITY --NEAREST Pelican TY ZIP CROSS ST. CERTIFICATE OF EXEMPT ION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE f SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one. P USE ZONE EMA hundred dollars ($100)or less.) TRACT BLOCK LOT NO. S NN TEL. � AL0. I certify that in the performance of the work for which this OWNERNO. ITIONS permit is issued, I shall not employ any person in any manner DISTRICT GROUP CONST. LT _FTYPE FIRE SSED BY V ADDRESS so as to become subject to the Workers'Compensation Laws. �a7 �© 4— r / r�e A� �•�/ t- Date Applicant CITY ZIP STATISTICAL CL,, tS C14TION APT. CONDO. V NOTICE TO APPLICANT: If, after makingthis Certificate of ARCHITECT OR TEL. ,����fJ ENGINEER NO. CLASS NO. DWELL. UNITS LL Exemption, you should become subject to the Workers' t` ry Compensation provisions of the Labor Code, you must forth- �.. ADDRESSSEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTO %. O. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE VALUATION (commencing with Section 7000)of Division 3 of the Business and Professions Code i s is in full force an of ct. CITY CLASS $ y�[� SQ. NO.OF NO.OF CHECK License N ic.Clams SIZE STORIES FAMILIES ONE 5?� O r Co act � Date DESCRIPTION OF WORK NEW $ �taaaa21 ADD ❑ am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer A R ❑• FINAL �J 2 a - 604 �3 DATE ' "p acting in my professional capacity (Section 7051, R PAIR ❑ a o 0 6�• BusinessP ssi ns Code). OF /� FINAL r` EXISTING BLDG. _1C % DEMOL ❑ J c, / .�_ � Lic.or Reg.No. Date • APPLICANT TEL. By 0 5 c 2—8 1 OWNER-BUILDER DECLARATION (PRINT) NO. ��� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ❑ 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 5 3 7,0 A tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROMEXIST. 0 0 0 0 0 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 2 a 1 1 .�, 0 0 the performance of the work for which this permit is issued P L (Sec. 3097, Civ. C.). SIDE P.L. •o 0 1 1. C n= Lender's Name 0 522-8 1 P:C. Fee$ Permit Fee Lender's Address I certifyThat I have read this application and state that the pp Issuance Fee above information is correct. I agree to comply with all County Investigation Fee 3 ESIgnature nces and State laws relating to building construction, Total Fee er thorize representatives of this County to enter h above en 'one r e ty for insp n pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE ®s of App can or Agent Date ,c p Y • r APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION BUILDING ADDRESS FOR APPLICANT-TO FILL IN [BU!1L0,NG SS /I hereby affirm that I have a certificate of consent to self insure, `�Ve 5 -or a certificate of Workers'Compensation Insurance,or a certified clL? ZIP Copy thereof(Sec.3800,Lab.C.) /etm /p, CSI 9/790 TY _ Policy NO. Company SIZE OF LOT f /47 NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. 1?1110 T} Q NEAREST CROS T. ❑ Certified copy is filed with the county building inspection TRACT /3�T BLOCK LOT LOT NO. department. //1/I r 1 6 4 swv-,.,r7 USE ZONE MAP NO. Date Applicant ASSESSORBOOK PAG00/ PARCEL SPECIAL CONDITIONS o CA1 CERTIFICATE OF EXEMPTION FROM WORKERS' ER l TEL NO. COMPENSATION INSURANCE l/ n Alavno vl4hdeMem ) 3a797 WITHIN 1000 FT.OF SCHOOL? YES NO ADDRESS DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY (This section need not be completed if the permit is for one hundred a.30 . /vim 6 f• dollars($100)or less.) C� ZIP I certify that h the performance of the work for which this permit P�'17 `� �'�' q17� �O/I' te_Q �1 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. d J X ;J become subject to the Workers'Compensation Laws. STATISTICAL CL' SSIFICATION APT CONDO Date Applicant ADDRESS CLASS N( DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to 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. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS P L � I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP r1 (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. /iSo f / NEW BK PG , O License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION V Contractor Date N95OOF ALTER ❑ dd cc A�e! e -hie rvP{ e O ❑ 1 am exempt under Sec. REPAIR ❑ � V B.BP.C.for this reason DEMOL ❑ UJI LDMA P/C# IL Date: USE OF EXISTING BLDG. URM 11N Z Signature AP LICANT( NT) r TEL NO. LDMA Perm# i-i.l.rea 01, as owner of the property, or my employees with wages as C4S A �fn?e17�'L 6_3 Z Or, their sole compensation, will do the work and the structure is AD ESS �� ` �7 O � !)-�• '=�'-°`)- not intended or offered for sale (Section 7044, Business and �1oZ3 O 11ve 77L/ .�' %moi C.4 FINAL DATE Professions Code.) WI LL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDL A HAZARDOUS MATERIAL EI 1, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE '� Q TOTAL 202.05 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES licensed contractors to construct the project (Section 7044, FINAL BY > n Business and Professions Code.) YES 11NO CHECK WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH %3 zl :! CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NOW ` i {{ 1s ` the performance Of the Work f0�which this permit IS ISSUed(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING Ijl_I?I�;-LI(;Ij t!�23 ! C,J3097,CIV.C.) CHECKLIST.I UNDER D Y REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHA 0 S IONS 2 THROUGH 2.20.140 CONCERNING HAZARDOUS ,Lt-� /�y t e Vii+ Lender's Name MATERIA PORTING INI G A PERMIT FROM THE SCAOMD, 26 5 # AN 10°=f 00 Lender's Address � NE c I certify that I have read this application and state under penalty of perjury that the above information is Correct.I agree to comply P.C.FEE PERMIT FEE ' N with all county ordinances and State laws relating to building m constructio Rd-hereby authorize representatives of this County ISSUANCE FEE ro to en pont -m tinned property for inspection purposes. a6,- W � INVESTIGATION FEE TOTAL FEE W ; n g Dale y SEE REVERSE FOR EXPLANATORY LANGUAGE JWORKERS'COMPENSATION DECLARATION hereby affirm that I have r certificate of consent to self I APPLICATION FORBUILDING 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 r Policy No.—.1L.—Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 7 S ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS ` ow a—L _ i Date Applicant CITY Aptex- f., rn ZIP !7 G LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT O 125NOW ON LOT CROSS ST. r "1'7-4 5 (This section need not be completed if the permit is for one ASSESSOR TRACT BLOCK LOT NO. MAOK PAGE PARCEL hundred dollars($100)or less.) TEL USE NE MA P I certify that in the performance of the work for which this OWNER 6'A-7-i 1 MI elv�ZNO..2—,�:Zr2T NO. permits issued, I shall not employ any person in any manner SPECIALt so as to become subject to the Workers'Com ensat' Laws. ADDRESS 3t, v' �`. CONDITIONS a CITY 1; 4 G ZIP / v U` Date Applicant _ ARCHITECT OR TEL. a NOTICE O PPL CANT: If, aft a f is rtifi to of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 Exemption, you should become s ecf t he orkers' CONST. / ZONE I--; Compensation provisions of the Lab r Code, you must forth- ADDRESS / `�` di with comply with such provisions or this permit shall be 7 L✓ STATISTICAL CLASSIFICATION APT. ONDO. N deemed revoked. CONTRACTOR O. Z 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 • VALUATION DESCRIPTION OF WORK NEW fJ Contractor Date ADD O $ J:3 000 ❑I am exempt under Sec. F-x£rx-CET po S , ALTER B.&P.C. for this reason L fit SS 14 LOG WLV-00t+*f I REPAIR $ USE OF Date: MISTING BLDG. EMOL ❑ All 3 6.0 APPLICANT A' Signature FINAL fj # o o,o,o o l� OWNER-BUILDER DECLARATION (PRINT),>e•Z _ DATE I� I hereby affirm that I am exempt from the Contractor's License ADDRESS ` FINAL Low for the following.reason (Section 7031.5, Business and �- '') ° 24675 VT ssions Code): PRESENT By / BUILDING I, as owner of the property, or my employees with ADDRESS ` ° ° 2466755 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ' 0 $ O 5% 8 8 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). OM CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK pL NEFR 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 P.L. Lender's Name LDMA Ref. R I P.C.Fee$ Permit Fee �(t✓i Lender's Address I certify-that I have read this application-and state that the Issuance Fee. V ., \ LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee / C� ordinances and State laws relating to building construction, Total Fee •CJ V LDMA Perm.N 3 and hereby authorize representatives of this County to enter upon the �-mentioned erfy for inspection purposes. g c SEE REVERSE FOR EXPLANATORY LANGUAGE , a e of licant r Agent Date '• WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate-of ' certifof consent to self insure,or a certificate of Workers'Compenstion Insurance,or } APPLICATION FOR ' BUILDING PERMIT agtfid cGopy thereof(Sec. 3800, Lab. C.) I COUNTY OF LOS ANGELES BUILDING AND SAFETY ` Policy f�O.o ��'zompony Certified copy is hereby furnished.• / FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING l tion epa tment. ADDRESS (! L LOCALITY r NEAREST -- Date Applicant i! ,� CITY r^ ZIP tt'1 CROSS ST. F R1 r)r�S ASSES CER KATE OF EXEMPTIO ROM WORKER ' SIZE OF LOT i'D ,a NSOR OW ON LOT MAP BOOK PAGE FARCELc. COMPENSATION.INSURANCE' (This section•need not be completed if the permit is for one USE ZONE MAP d hundred dollars ($100)or.less.) TRACT BLOCK OT NO. NO. r TEL. jam/ SPECIAL g I certify that.in the performance of,the work-for which this OWNER c4' --�'T CONDITIONS O DISTRICT GROUP TYPE FIRE PRO SSED BY permit is issued, I shall not employ any person in any manner ` U ADDRESS d CONST. ZONE so as tobecomesubject to the Wor 'rs'Compensation Laws ` O Date 6 Applicant r r A , CITY ! y`. ZIP •g �' STATISTICAL CLASSIFICATION APT. CONDO. V ' ARCHITECT OR TEL. NOTIC TOA LICANT: If, after making t Certificate of uL Exemption;• you should become subject to the Workers'- ENGINEER NO. CLASS NO. r� DWELL. UNITS CI. 'Compensation provisions of,the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR EL. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION ' /�t NO. 33 LIC. t I hereby affirm thcit I am licensed under provisions of Chapter 9 ADDRESS, ,/ 9 d NO 7/ ` VALUATION (commencing with Section 7000)of Division 3 of the Business and'. ' LIC. Professions Code, and my license is in full force and effect. CITY CLASS '"'!� $SQ. + SIZE . I STORIIES I' FAMILLIIES / CHECK ONE ' License Number�3/ 2�� Lic.Class ContractorY��)--4�—tate �?_ DESCRIPTION OF WORK „� .� NEW ❑ $ ❑ I am exempt fro the Ilfi icensing requirem n'ts as I am a ADD licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7.051, REPAIR ❑ DATE Business and Professions Code). USE OF NAL FI EXISTING-BLDG. DEMOL ❑ FI By Lic:or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License 1 3 Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and i the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. _ (; '/ n,0 A 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.' 2 u o 9 ] ( (� CONSTRUCTION'LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FF..iRT , • o c'G ' the performance of the work for which this permit is issued J ' (Sec. 3097,-Civ. C.).Lender's Namee$, Permit FeeLender's Address I certify that I have read this application and state that theIssuance Fee ;7i above information-is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, and hereby authorize repr•sentativves of this County to enters Total Fee, ' upon a OV71mention property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE :I Signature pplicanf A t Date FIs • 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 HL 0508 1403170107 PHONE: (626) 285-0488 EXT: ILEA ID: NO. OF CONST I BUILDING ADDRESS: 1 ITR: 11492 LT: 7 BL: .001 SQ. FT STORIES TYPE 9230 OLIVE ST 1 I STRUCTURE: V-B 1 TEMP CA 917803125 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ENCINITA I 18590-001-006 1 1 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI I (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: 103/17/14 SR 1 (OWNER: TEL N0: 1BLDGS. NOW ON LOT: VALUATION: IF T F NAL CODE: 1 IJIMENEZ AGUSTIN;MINERVA (626) 232-6557- 1 8,000 1 / 1 19230 OLIVE ST 4 ITEMP 917803125 1 FEES PAID - DE4CRfPTfON F WORK I I IRETILE BATHROOM WALLS, PAINT WALLS, REMOVE AND REPLACE IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:ICABINETS I (APPLICANT: TEL. N0: ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 I IAB STATE GREEN BLDG FEE 8000.00 VAL 1.00 ISPECIAL CONDITIONS: AC STRONG MOTION RESID 8000.00 VAL 0.80 1 B2 PERMIT W/ENERGY 8000.00 VAL 201.30 I TOTAL FEES 230.90 1N • 1 ICONTRACTOR: TEL. NO: i 1 APPROVALS DAT INSPECTOR SIGNATURE 1 ISAME AS OWNER 1 LIC. NO 1LOCATION AND SETBACKS I I 1 1 SOILS ENGINEER APPROVAL I I I 1ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION TRENCH FORMS I I I I _ 1 I / I LIC. NO- 1 1SLAB/UNDER FLOOR 1 I 1 1 I 1RAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 4( - 1UNDERFLOOR INSULATION I I I 1 3 00 I I I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I 1 NO 21 1 1ROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I (AIR QIIALITY: 1000 FEET MATERIALS I I I I 1 NO NO NO I (FRAME INSPECTION I I I I 1 1 I 1FIRE SPRINKLER HANGERS I I 1 I 11NSULATION/WEATHER STRIP( 1 1 1 I (INTERIOR LATH/DRYWALL I I 1 I 1EXTERIOR LATH I I I I I I 1 1 IRATED FLOOR/CEIL ASSEM. I I I IRATED WALL ASSEMBLIES I I I IRATED SHAFTS/OPENINGS I I 1 I I IT-BAR CEILINGS I I I I I I I 1 I ILOT DRAINAGE I I I 1 1REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I