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Home My Public Portal About9502 OLIVE ST_Building__ i DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELESa ®� WM. J. FOX, CHIEF ENGINEER 193 UP FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY FADDRESS G /� pp /¢�J DISTRICT NO. PLANCK. NO. / PERMITypNO. �'�So � l All1.V t.A-A-j S� �Y D J RECEIVED BY DATE OF APP `DATE ISSUED CROSS 87, („f(r(�„ VA.1,IJI J•� BUILDING ADDRESS OWNER vb[_Al�d V �'I��a.d a MAIL �G /f LOCALITY �. C ,ram I ADDRESS rl �„ I?. U,yeY cA' -I-J� S'-� NEAREST TEL. CROSS ST. C a CITY �[±r ; .! 1:_� NO. ('II. �+Q FIRE __— NO. OF TYPE GROUP ARCHITECT OR TEL. = ZONEPLANS � ENGINEER NO. BLDG. ORD NO a y SETBACK LINE a e 4 ADDRESS APPROVED TEL BY DATE CONTR' CTOR NO. USE �( l APPROVED ZONE A—/ BY DATE ADDRESS HOUSE NUMBERING; LEGAL ' DESCRIPTION I LOT NO. I BLOCK y MAP NUMBER FIELD CHECK BY r TRACT r ' NO. ASSIGNED BY DATE / I NO. OF BLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT USEOF I NO. OF 7 1 _ EXISTING BLDG. FAMILIES DESCRIPTION OF WORK / FREFAIR I I ALTERATION I I ADDITION O I I DEMOLITION I I I n �f /e�r`,",�fyJ FT. NO. OF ROOMS STORIES Z WALL ROOF r ERING COVERING USE OF STRUCTURE cJ APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGRFX TO COMPLY WITH THE CORRECTIONS LISTED FRAME:FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. �r FURNACE: LOCATION, . SIGNATURE OF ` GAS VENT, DUCTS PERMITTEE- --�� A LATH, INT. ADDRESS •` G1 °:r U L a,1 tiB__ s LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 76AGSBA•ON23 Io-BO $=cr0FEE / ® PLASTER, EXT. VALUATION /► FINAL /a G' J.v Ge DIVISION OF BZJZa.DI�TG AND SAFETY �� p Department of County Engineer _ j� NG Cocatp of Lm An lea WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT NG TO FILL IN ADDSS -�'1 BUILDING ADDRESS . 9z (J/^ �s(f�I-ff I•% LOCALITYNEAREI �. ")��+�� C fes/ / / �} CROSS ST. f„ (� I! =14 IL (/ LOCALITY • \- NEAREST DISTRICCTNO. PLAN CK.an Rac.No. PERMIT NO. n \ CR088 ST. l r vnA^Tl ?P l7 OWNER G�2(/f{� RECEIVED BY DATE OF APPL. DATE IISSU�ED^ MAIL DDRE88 7 D �(��n �j � A I1�sds07/ •`r 21 e— .7 rz/ USE ZONENO. OF I TYPE I GROUP I FIRE ZONE CITY ,_(�/V)•�1.6i.(�L._ ��rL�f/� NO. TEL."�l Cy Q�..�. r!1'Ij- PLANS ARCHITECT OR I TEL. r ZONING DA7= ENGINEER L NO. /� (� APPROVED BY- ADDRESS BUILDING SETBACK LINE. i F./ O'VI;-yo TEL. . APPROVED DATE CONTRACTOR NO. BY: HOUSE NUMBERING ADDRESS p LEGAL MAP NUMBER A (tea NO. ASSIGNED DESCRIPTION LOT NO.a BLOCK _ g �+ DATE I CORRECTIONS I INSPECTOR TRACT J /y/7 6 SIZE OF LOT/ �3 I NO. OF NOW ON LOT OT � fNO. OF EXISTING BLDG. FAMILIES I I DESCRI MON OF VPORB- a NEW ALTERATION ADDITION REPAIR DEMOLITION I Sq. FT. / NO. OFI SIZE �� ROOMS V STORIES e EXT. WALL� ROOF COVERING G,Q�S'-Y—, COVERING I USE OF STRUCTURE ' APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT. DUCTS SIGNATURE OF /, LATH, INT. PERMITTEE ADDRESS 7 DV 6 �1 /��' ? ! \ - LATH, EXT. T AUTHORIZED AGT. PLASTER, INT. `o-oq PLASTER, EXT. $ a 1 4J FEE HOUSE NUMBER COR- , RECT AND POSTED VALUATION FEE t FINAL .r� 76ASSBA DBB 8 2-53 7911636ACX#8022/o. . APPLICATION .FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING '?O DEPARTMENT OF COUNTY ENGINEER ' BUILDING AND SAFETY-DMSION LOCALI JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM,A.JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. 1. GROUP I PE _ P CESSED BY FOR APPLICANT TO FILL IN BUILDING STATISTICAL STATISTICAL C�L�ASSIFICATION SEWER MAPS ADDRESS // �y� 1 CLASS.NO. 2 DWELL.U INis �Z-& LOT NO. ! //G Y� �S r BLOCK MAP NUMBERX-0 , H1N1f. YES NO TRACT v USE ZONE SPECIAL \ yy S NO.OF BLDGS. CONDITIONS �. SIZE OF LOT &—/X 1 ( 7 I NOW ON LOT =\ USE OF /i�j EXISTING BLDG. Y 4Se-%IV 7'Zy&it Al- BUILDINGYARD HWY EXIST. . Y/ . TEL SETBACK STREET NAME \ W DTH OWNER ov'r7'J eo4 y/to-s' N07 FRONT vZ ADDRESS gV /d� SIDEO \ ARCHITECT OR TEL. ENGINEER No. INSPECTION RECO ADDRESS CONTRACTOR �Y d O / ADDRESS l / i>� QT-�. Lt� _ __� V DESCRIPTION OF•WORK F NEW '-'ADD ALTER REPAIR DEMOLISH SO.FT. / NF NO.Ol CL SIZE STORIEE,SS FAMILI& y USE OF ��/�t�S•'f 7�! "J_ STRUCTURE FI SIGNATURE O oor APPLICA VALIDATION$ � - APPROVALS DATE INSPECTOR'S SIGNATURE FEE '$ I FEE.$ , FOUNDATION:LOCATION/ FORMS,MATERIALS !!) 4. �;5./t� lA lnryAt'llJ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME:FIRE STOPS, PLICATION AND STATE THAT THE ABOVE IS CORRECT AND BRACING BOLTS AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND FURNACE:LOCATION, GAS VENT,DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE , WORKMEN'S Co NSATION LAWS OF CA 1FORNIA. LATH,EXT. SIGNATURE O HOUSE NUMBER COR- PERI ITTE RECT AND POSTED ADDRESR FINAL CLYDE N. DIRLAM, PRINCIPALS RAL ENGINEER PLAN CHECK VALIDATION CK. M.C. CASH PERNIIT_.VALIDATIO K. M.C. CASH 76A895A CE#5091-62 (294 APPLICATION_ FOR bUI:LDIIVG. PE RW COUNTY OF LOSANGELES BUILDING t� DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE . CESSED BY j FOR APPLICANT TO FILL IN ONsr [ADD DING QQ � !STATISTICAL CLASSIFICATION S WER MAP RESS BK. P CLASS. NO. DWELL.UNITS: NO. + BLOCK WATER NOT REQUIRED RECEIVED �y CERTIFICATE: CT., !/ MAP HIGHWAY STATE MAJOR SECOND v4L NO.OF BLDGS.. NO. ICIitCLEI OF LOT NOW ON LOT USE ZONE SPECIAL OF CONDITIONS TING BLDG.�'----(( TEL //ER V X NO. bo BUILDING' EXIST. SETBACK YARD ,HWY TR T NAME WIDTH RESS 3 Og' �tYV►+c ' j FRONT L ARCHITECT OR• TEL. I P. L. ENGINEER NO. SIDE ADDRESS C i, TE c CONTRACT/OR�I�Q� '6 NO. //9A'P— A4;. ADDRESS Y aCJ� o.. •, { C DESCEItNOF WORK - / :r-'_.�,I�o.�.��!�_ �,ri:. ��?,..�- ran IP ►.. EW ADD .- ALTER R AIR DEMOLISH SQ.FT. NO.OF NO. OF � If\ 1 9�• �lil C I � � "i-y sd�t ivy�Fs 6 SIZE If STORIES FAMILIES r. USE OF } :+ STRUCTURE 1 SIGNATURE OF , APPLICANT r VALUATION $ I �y y �O - APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEE'$ FEE $ — FORMS, MATERIALS FRAME: FIRE STOPS, t 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 VIOLA- LATH,.INT. TION OF-THE LABOR CODE OF THE STATE OF CALIFORNIA'RFLAT. WG TO WORKMEN'S C MP SATION IN UR GE �9 I6�JJyyNN_� LATH';EXT. SIGNATURE OF a (J�!`. SCS:A_ F70U'SE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL ':JOHN F: LEWIS, PRINCIPAL STRUCTURAL EN' PLAN CHECK VALIDATION -' C' K. M.O. ;CASH _ PERMIT VALIDATION CK. M.O. GAS p CITY Off' ^ 7BAMBA C6#803 B_BB APPLICATION FOR BUILe®ING P1E.RMI`I' COUNTY OF LOS ANGELES BUILDING r' rJ DEPARTMENT OF COUNTY ENGINEER ADDRESS aC_ BUILDING AND SAFETY DIVISION tocatl JOHN A. LAMBIE. COUNTY ENGINEER NEARES CASSATT D. GRIFFINSup•T OF BUES BUILDING CROSS ST. �•C b� I. DISTRICT NO. GRyO= PE CSED BY FOR APPLICANT TO FILL IN v.�^ i J I olvsr. ABUILDINGDDRESS � !� STATISTICAL CLASSIFICATION SEWS MAP PGrr I t �/ BLOCK CLASS.NO. DWELL.UNITS S l V LOT NO, p� NUMBER HWY. YES m TRACT L/ y USE ZONE SPECIAL X 3 I NO.OF BLDGS. j CONDITIONS SIZE OF LOT NOW ON LOT J{�J•� USE OF EXISTING BLDG. t'A- BUILDING EXIST. r+ SETBACK YARD HWY STREET NAME WIDTH OWNER (r FRONT g ,, F MAIL P.L. -C_�.) ADDRESS SIDE TEL. P.L. CITY NO. INSPECTION RECO ARCHITECT ORr TEL. ENGINEER NO. vi ADDRESS { CONTRACTO // TEL ADDRESS,// y DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT` � APPROVALS CIATE4 INSPECTAR'S SIGNATURE ADDRESS FOUNDATION: LOCATION J` I I FORMS,MATERIALS I�y!/�,.r `r * 1�; ��N•A./�.r 1 VALUATION S � Q� FRAME:FIRE STOPS, / BRACING,BOLTS P.C. l PMT. d� FURNACE:LOCATION, FEE $ I FEE $ GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT. �J PLICATION AND STATE THAT THE ABOVE IS CORRECT AND // AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS R B LATING ILDING ONSTRUCTION. LATH,EXT. SIGNATURE HOUSE NUMBER COR- ~/ PERMITTWF RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM. PRINCIPAL SpAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIOCK. M.O. CA6H y LACCo 9 9 8 7 ULU 2 U 1 U 1.0 V M Of REM L I6A6661%06#6092/110 APPLICATION FOR BUIL®INO PERMIT ' .1 COUNTY OF LOS ANGELES BUILDING (fi''1' DEPARTMENT OF COUNTY ENGINEER ADDRESS \J BUWING AND SAFETY DMSION LOCALI ` JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. X F OR APPLICANT TO FILL IN DISTRICT NO. GROUP TYP P CESSED BY CONST.. NG �J STATISTICAL CLASSIFICATION I SEWER MAP SSgte !� BK PG CLASS.NO.•�DWELL.UNITS 10 . -7 BLOCK MAP NUMBER: ') HSE YES NO / / y USEZONE SPECIAL NO.OF SLDGS. CONDITIONS' F LOT !O NOW ON LOT NG BLDG. ,��t��C. BUILDING YARD HWY STREET NAME EXIST. rf TEL. SETBACK WIDTH �j `` G( NO. FRONT SS /�7SIDE ECT OR TEL. P•L• EER No. INSPECTION RECO ADDRESS CONTRACTOR - / rp4ei / O ADDRESSJ�c;{{ 6 6ZzLe/yF71®C V DESCRIPTION OF WORK' ti NEW ADD ALTER REPAIR DEMOLISH �J SQ.FT. / V V NO.OF ! NO.OF SIZE STORIES / F (LIES y USE OF STRUCTURE �- I SIGNATURE O APPLICANT VALUATIONS 61-0 I mazmmqmfaom APPROVALS DATE INSPECTOR'S SIGNATURE FEE $ I PMT. $ o� FOUNDATION:LOCATION FORMS,MATERIALS ME:FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS AP- FRAME BOLTS 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. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S CO NSATION LAWS OF CA 1FORNIA. LATH,EXT. SIGNATURE F HOUSE NUMBER COR- P OR- PERMIT�E � RECT AND POSTED L � ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION Cr. M.O. CASH PERMIT VALIDATION CK M.O. CASH 9 9 8 8 F CLC 20 1 D 2.0'0 Or / APPLICATION FOR BUILDING PERMIT �1 FOR APPLICANT TO FILL IN (Print or type only) • City of Temple City IJ BUIL,4TIJG 9502 Olive COUNTY OF LOS ANGELES ADdhEss DEPARTMENT OF COUNTY ENGINEER CITY Temple City zip 91780 BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS 9502 Olive TRACT BLOCK I LOT NOpp�7 LOCALITY Temple City OWNER Houser TEL NO. 1�5�+5�+ NEAREST. Cloverl ADDRESS 9502 Olive ASSESSOR MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY CITY'Tem le Cit zip 91780 ^rUJ COW9T� ZONE ARCHITECT OR TEL. 7 D / �Y/ ENGINEER NO. ' STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. 2d DWELL.UNITS BK0 PG ` CONTRA CTORPaCli}1C InstallerC, 29 070 USE ZONE MAP LIC. p NO. ADDRESS10 0 Eo Grand Ave o NO. 211598 ( SPECIAL CONDITIONS � CIT12emple City CL SS Sy ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM F FRONT PROP.LINE OF (STREET) ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK HIGHWAY + YARD - FRONT PROP. LINE HIGHWAY WIDTH ,C SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ + C BLDG.SETBACK FROM Remove & reinstall cabinets ADD ❑ SIDE PROP.LINE OF (STREET) ALTER HIGHWAY •}• YARD TOTAL SETBACK FROM TYPE OF EXISTING & a pliances SIDE PROP. LINE HIGHWAY WIDTH REPAIR❑ USE OF EXISTING BLDG.Resldentlal� DEMOL ❑ + APPLICA T y TEL 1. CORNER CUTOFF YES ❑ NO ❑ (PRINT) (.'Z1�.0 Installers N0. 44207070 BY (SIGNATURE) 0— IN IN OPEN SPACE YES ❑ NO ❑ - `�• IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ 3600.00 CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA. IN RELATING TO WORKMEN'S COMPENSATION INSUR / SIGNATURE CF J PERMITTEE ADORESS10920 Eo Grand Ave. TEL. , FINAL _ BY ' CITY Temple City NO. 44P-407 DATE MAKE CHECKS PAYABLE TU: / FEE $ FEE_-T HARVEY T. BRANDT. COUNTY ENGINEER 35.25 PLAN CHECK VALIDATION CK. M.O..+10' A10'CASH _ PERMIT VALIDATION CK. M.O. CASH _"_ -•"---- F? sti� .Iger !>S A 1 '1 76A638A CE#803 7/73 �� /��-�VVV 2�//�(/�+P" - - ._ -„ ^ • APPLI ATIOI 'FOR BUILDING PERMIT CQUNTY& LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS a or a certificate of Workers'Compensation Insurance,or a certified G fJtu�fr copy thereof(Sec.3800,Lab.C.) CITY ZIP TCwP ..f� C�,'%� LOCALITY Policy No. Company SIZE OF LOT 'hg NO OF BLDGS.NOW ON LOT ElW �^4 Certified copy is hereby furnished. W4 le jL NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. �y department. %-1110 as USE ZONE MAP NO. Date Applicant ASSESSO MAP OK PAGE PARCEL OS n 30 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' o R TEL NO. COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES No MI I (This section need not be completed if the permit is for one hundred R r DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit Ci r � ZIP is issued, I shall not employ any person in any manner so as to (� J become subject to the Workers'Compensation Laws. ARCHI CT OR ENGINES TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.42L_ 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 UC.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 STOFE7 NO.OF FAMILIES Professions Code,and my license is in full force and effect. 8 NEW ❑ BK PG , IL DE CRIPTION OF WORK VALUA ON License Number Lic.Class ADD pp Contractor Date ITM J£� ALTER ❑ $ ZZ. ' O® C I- I 11❑ I am exempt under Sec. $ C BAP.C.for this reason DEMOL ❑ U LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ s Signature APPLICANT(PRINT) TEL NO. LDMA Perm# 1, as owner of the property, or my employees with wages as Z rIL•t� - Id(`WWW their sole compensation, will do the work and the structure is ADDRESS F not intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTNNING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ❑ 1, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? ' WILL Q licensed contractors to construct the project (Section 7044, YESFINAL BY > Business and Professions Code.) WILL ❑ No 11 - WTHE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 33-3-5 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR OUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR .: TTS; GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ TOTAL 155 o 3 cN the performance of the work fo which this permit is issued(Sec. 01 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING ��ss 15 C4 3097,CIV.C.) / CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 1_.i�'•_TI ':°- TITLE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. CARE °fl_ o Lender's Address OWNER OR AGENT 0 c I certify that I have read this application and state under penalty e of perjury that the above information is correct.I agree to comply P.C.FE PERMIT FE '} +4 !' f 4+= c P 1 Y 9 PY O •�a LI_I�l—Iv)_!.1 I�: trt .� CM with all county ordinances and State laws relating to building •� construction, and hereby authorize representativos of this County ISSUANCE F1 210 4 b MOAT' ; AM 7'-zr4 m to ent r pon the o e-mentioned property for inspection pur oses. Ab) tin INVESTIGATION FEE TOTAL FEE gg a7. ,lain m a Q Ag m 0.o 6 e� SEE REVERSE FOR EXPLANATORY L NGUAGE 6.7UD/4 bn WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self ®® ® p insure, or a certificate of Workers'Compensation Insurance, L®am® ■ LICATRAM N IMUIUDING PERMIT or a certified copy tl {�f(Spc. 3800, Lob. C.) Policy No. IV85-R�2$ mpany Fremont Indemnity COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. FOR APPLICANT TO FILL IN 1:1BUILD 102 Certified copy is filed with the county building inspec- BUILDING 9502 Olive tion department. ADDRESS Date 11/7/85 Applicant Virgin Roof Co. CITY Temple City ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST 21Z 1 COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS T. ) (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER Rick Houser TEL. USE ZONE MAP 1 certify that in the performance of the work for which this p NO. �/G� permit is issued, I shall not employ any person in any manner 9502 Olive I SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS 0 CITY Temple City ZIP @9 Date Applicant ARCHITECT OR TEL. O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PRO ESSED BY Exemption, you should become subject to the Workers' h CONS_T/ ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS �tU 3 with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFI ATION APT. rNDO. deemed revoked. : CONTRACT&Rirgin Roof Co. No.287-0507 LICENSED CONTRACTORS DECLARATION P.O. BOX J LIC. 160650 CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP San Gabriel X39 Professions Code, and my license is in full force and effect. CITY CLA BK VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number 160650 Lic.Class C39 SIZE STORIES 1 FAMILIES ONE Virgin Roof Co. 11/7/c85 DESCRIPTION OF WORK Re-roof house & NEW ❑ VALUATION Contractor Date ADD $ 2609.00 ❑ 1 am exempt under Sec. garage with. Class A-fiber lass ❑ shingles.. 21 squares ALTER ❑ B.BP.C. for this reason g q REPAIR ❑ $ Date: USE OF dwe 1 i in DEMOL ❑ EXISTING BLDG. g Signature APPLICANT TEL. FINAL —9 3 4 4,7 A PRINT) Virgin Roof Co. NO, 287-0507 OWNER-BUILDER DECLARATION DATE # o 0 0 0 0 I hereby affirm that I am exempt from the Contractor's License ADDRESS P.O. BOX J, San Gabriel 91778 Law for the following reason (Section 7031.5, Business and FINA o o59,25 Professions Code): PRESENT BY ❑ BUILDING o 0 o 5 9.2 5 U I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY �, 2-$5 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAPREOTPAINEFRO WIDTH 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued I Pm La (Sec. 3097, Civ. C.). SIDE 3 P.L. Q Lender's Name ' P.C.Fee$ Permit Fee $48.75 LDMA Ref. # Lender's Address x I certify that I have read this application and state that the Issuance Fee 10. .50 LDMA P/C# = above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, $59.25 �•: _ J and hereby thorize representatives of this County to enter Total Fee LDMA Perm. # 3 upon the ove-mentioned proper for I spection purposes. Vv� SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur o Applicant or Agent Date tOv t