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Home My Public Portal About9508 PENTLAND ST_Building__ IOA638A CE4503 B-B3 APPLICATION FOR BUILDING, PERMIT COUNTY OF LOS ANGELES BUILDING 95pg Pentland, Temple City DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER, NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DIST�AC N G TYPE P E FOR APPLICANT TO FILL IN `.j , CONST BUILDING STATISTICAL C ICATION S WER MAP ADDRESS ' BK /� PG CLASS NO DWELL UNITS (7 LOT NO BLOCK WATER NOT REQUIRED ❑ RECEIVED CERTIFICATE TRACT MAP HIGHWAY NO OF SLOGS NO (CIRCLET) STATE MAJOR SEC LOCAL SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF' 1 CONDITIONS EXISTING BLDGj TEL OWNER ' NO _WING EXIST CK YARD HWY STREET NAME WIDTH ADDRESS FRONT ARCHITE FR ( TEL P L ENGINEER NO SIpE P L 7 ADDRESS d TEL '0 CONTRACTOR TEL Y ADDRESS C DESCRIPTION OF WORK ri - a NEW ADD ALTER ' REPAIR MOI-ISH SO FT NO OF NO OF SIZE STORIES FAMILIES USE OF STRUCTURE 235# Compo. S n 1 s SIGNATURE OF APPLICANT ITTIQTN ROOF I VALUATION $ APPROVALS DATE INSPECTOR B SIGNATURE PC ' PMT FOUNDATION LOCATION FEE S - FEE $ ll. O FORMS MATERIALS - FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE 16 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 HER Y WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LA R CODC OF THE STATE OF CALIFORNIA LAT INC TO WORKMEN OMPENTB^TION 116 oANCE LATH EXT SIGNATURE O hill 1� HOUSE NUMBER COR PERMITTEE RECT AND POSTED IADORE55 FINAL PLAN CHECK VALIDATION ' CK MJOHN F LEWIS PRINCIPAL STR RAL ENGINEER O CASH PERMIT VALIDATION CK MD EASH L ,r•o 4 J8 4' SEP 13 1 D 1 1 .50— e ' I CE NBDD(F!V 11/78) t UJ/ _ •, APPLIC BU DING 'P T -_ COUNTY OF-LOS ES. •- BUILDING AND AFETY - - .FOR APPLICANLTO.FILL IN ADDRESS BUILDING_ I-elmLOCALITY CITY L� ZIP NRAST .� r NO OF BLDGS / ASSESSOR ' SIZEOF LOT ) X J NOW ON LOT / MAP BOOK ' ' AGE PARCEL • •T.� T"� ' DISTRICT 'GROUP" TYPE FIRE L D BY TRACT 57.2-• BLOCK' r LOT NO I CONST s - ..iEL n OWNER �+ •^ NO� 3� - / t� STATISTICAL SS�IUTION, EW ER/P ADDRESS �J-^�J/_ G/J' +1 '� CLASS NO DWEIL UNITS I BK PG^r .` _ CITY '/ Gr `e -- - ZIP'`, ARCHITECT OR TEL ENGINEER•--- NO -- �A\DATION ADDRESS _ _ _ _ BLDG SETBACK FROM TEL FRONT PROP LINE OF 77o1 e272 + (STREET) +- CONTRACTORICU sTOTAL SETBACK FROM TYPE OF EXISTING LIC HIGHWAY + YARD FRONTPROP LINE• HIGHWAY WIDTH' ' C ' ADDRESS NO I LIC CITY CLASS BLDG SETBACK FROM t •' 1r r. CONSTRUCTION LENDER SIDE PROP LINE OF (STREET( NAME AND 6RANCH v TOTAL SETBACK FROM TYPEOF EXISTING HIGHWAY + YARDS SIDEPROP LINE HIGHWAY WIDTH Q- ADDRESS CITY �+ 50 FT ' NO OF+ NO OF CHECK, +• •^ - '0 r SIZE STORIES - FAMILIES- 'ONE USE TON MAP D - DESCRIPTION OF WORK - /' - NEW r NO -' SPECIAL ADD / CONDITIONS •+ - --� AL Y ✓C e'/itoolALTER— FINAL �S- 8Y REPAIR DATE USEOF 1 DEMOL t R ''1' , - T EXISTING BLDG _�_ _ Z APPLICANT TEL r 0 IPRINTI ' NO BY(SIGNATURE( > _3 9'8 8 0 A_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ' m ' p THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES _ _ 'RP r -1„_ _ M? •I• • __ AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOIATION OF U THE LABOR CODE OF THE STATE OF CALIFORNIA IN RLLATINGTOWORKMEN SCOMN _ _ _1 Z » Z • 1 5 00_ _'r, PENSAigN INSURANCE I ' ' . ' _ n4 '• • 1 51 00�, SIGNATURE OF -- tel' -'�-_ �- - "" i ' Y_� - 5• ' PERMITTEE4 _ ,0 Q.j 5—8,f) ADDRESS Z F CITY NO PC Fee E -- - Permit Fee / 6& I f Issuance Fee / Totol Fee A5 elIS .._...,.. _ _ -j 1 WORKEOS COMPENSATION DECLARATION ,, • ' � � "' _�' 1 hereby affirm fico have o certificateomof consent to self 'APPLICATION FOIL BUILDING PERMIT insure or wcerbfl<ate of Workers Compensation Insurance a or o Artified copy thereof (Sec 3800 Lab C ) ' , COUNTY OF LOS ANGELES BUILDING AND SAFETY f • Policy No' Company r ' °Certified co Is hereby furnished BUILDING (� ❑ copy y, - FOR APPLICANT TO FILL IN`. 2 - ADDRESS 0 , Certified copy is filed with the county building mspec ' ' BUILDING \ , ' bon department r ADDRESS Date Applicant ' Cliv T • ZIP4�--7 LOCALITY - CERTIFICATE OF EXEMPTION FROM WORKERS; SIZE OF LOT ` mss'' ,NOWOOFN LOTS f NEAREST_ T COMPENSATION INSURANCE - _ CROSS ST (This section need not be completed d the peimn a for one '-E O v se + ASSESSOR _ hundred dollars ($I00)or less ) TRACT r/ ' BLOCK, \ LOT NO MAP BOOK PAGE PARCEL �A� � La Z - I certify that m the performance of the work for which this OWNER ye9Ns USE Z E NO , _ permit is rived I shall not emplo any person in any manner r i I. SPECIAL so as to become subject to I o! a Compensation Laws ADDRESS- CONDITIONS -Date 1� �Q J'Q�� Pt I lfr�" A , bca t• ' W CITY eCkC , ZIP NOTICE TO APPLICANT P after making this Certrflcate of NRC NITEECRt �l�j lip 95 DISTRICT GROUP, TYPE FIRE 4 SSED BY O Exemption you should become subject to the Workers' CONST Z E Compensation provisions of the Labor Code you must forth �• (�(AL,( { ((') q-7 / W with comply with such provnicns or this permit shall be _ ADDRESS474Z- `f` I\ J 1� a, deemed revoked i CONTRACTOR NOL STATISTICAL IF TION APTlo� NDO i Z LICENSED CONTRACTORS DECLARATION - ` LIC - CLASS NO 'DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chaplin 9 ADDRESS NO (commencing with Section 7000)of Division 3 of the Business and' LIC SEWER MAP Professions Code and my license Is in full force and effect Cltt LIC , BK• IG / VALIDATION SO FT NO OF NO OF _ CHECK License Number Lic Closs SIZE STORIES FAMILIES ONE " VALUATION OESCRIPTION'OF WORK NEW -- Contractor Date ' '� $ADD , 282 Q 6 A t I am exempt under Sec 'CLQ- -G=I. C,C ` B 8P C for this reason �U ALTER f ��DO =51l a• ,� REPAIR e,e IJ 8.3 Q, Dote USE OF r v EXISTING BLDG DEMOL •'' •Signature I APPLICAM TEL 1 . ( - 2 Q 7L OWNER-BUILDER DECLARATION PRINT 1 FINAL py T DATi 2'O..r I hereby affirm that am exempt from the Contractor's License ADDRESS l J E ST \9H LCY• e Low for the following reason (Section 7031 5 Business and FINAL ; I ( to ` Profe ons Code) By . _ ' e eL� Er I,' as owner of the property, or my employees with _ BUILDING , q ) 2,0i wages as their sole Compensation,will do the work and �r`� A t' the structure Is not Intended or offered for sale(Section LOCALITY L —4 +' • , I • , •� r/I( 5 �j 7044, Business and Professions Code) ^' MOVI ' � •+ v �p )F 7 , 'x , J{� �sl}17S iti I as owner of the property am exclusively contractingCONTRACTOR - 1 A z J 0.QV 1111 r with licensed contractors to construct the project (Sec 44 - T• ' n Ht ' fr'� " !1 2 U O U ` bon 70Business and Professions Code) ADDRESS s f REQUIRED . TOTAL SE Lt ! t ' y •`� •. \ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY• PROP LINE WIDTH I hereby affirm that there Is a construction lending agency for r FRONT ,�*t�\ ' `\ Cl s'1` "e•,r Iv •i the performance of the work for which this perms is issued P L �— (Sec 3097 Gv C I SIDE PL �J �•• ql _ Lender s Nome SIR IDMA Ref If $ P C Fee S -� r Pvmn fee S� Lender s Address r L I certify that 1 have read this application and state that the in hwance Fee. Who P/C N a above Information a correct I agree to comply with all County Invemgaben Fee ` 9 orch ces and I t jaws relating to budding construction Total Fee J IDMA Perm"i R on he by but r resentotives of this County to enter u n t abov rot proper r mspection uurrrppoos�seesss , m to Dallis SEE REVERS[FOR EXPLANATORY LANGLI , Sgna re Apphcani em s I • - t f. _ WORKERS sCOMPENSATION DECLARATION APPLICATION FOR BUILDING'�PERMIT I f herby cffir'm"tfidl I have a certificate of consent to self , , insure or a certificate of Workers Compensation Insurance or q)certifIad copy thereof (Sec 13800 Lab C )I, ,r _ - }{) Policy No Company COUNTY OF LOS-ANGELES,,, BUILDING-AND SAFETY - a Certified copy is hereby furnished , FOR APPLICANT TO FILL IN BuuDING s ADDRESS Certified copy is filed with the county building inspec BUILDING - - i - r •tion deportment '• ADDRESS t. Dote ` Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS - NO OF BLDGS _ NEAREST , COMPENSATION INSURANCE SIZE OFLOT �F NOW ON LOT Z CROSS ST - (This'section need not be completed if the permit is for one - TRACT `�/� BLOCK LOT NO ASSESSOR - hundred dollars ($I00)or less ) t MAP BOOK ` PAGE PARCEL M TEL AjIj' USE NE MAP^ h certify that yin tOWNER Nphe performance of e work, ch this - rd0 h permit is issued I shall not employ n person net TJB(i SPECIAL- so as toWALICA I to the We Co t aws ' '�RE� �D ' COFOITIONS - O u Date 'Applicant CITY Tp�t C ZIP - - -- NOTIC If,,otter king Ili Certih of ARCHITECT OR t TEL DISTRICT GROUP TYPE FIRE t PROCESSED BY O Exemption you should become, sublet .to the W rkeri,-•, ENGINEER �UI-srG NO ry/ •L CGNST ZONE a L•, Compensation provisions of the Labor Code you must forth ADDRESS �L�L1 3 W with comply with such provisions or this permit shall be _ - TEL �' STATISTICAL CLASSIFICATION APT CONDO . 11.Ldeemed revoked t s CONTRACTOR NO Z LICENSED CONTRACTORS DECLARATION _ LIC 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 ofthe usiness and . _ LIC SEWER MAP Professions Code `arid my license is in full force d'nd effect CITY CLASS ELK PG VALIDATION 1 SO FT nq OF NO OF CHECK License Number tic Class SIZE STORIES FAMILIES ONE i VALUATION Contractor Dole DESCRIPTION OF WORK NEW $ z U 00 1 t . ' - � ' ' � I am exempt under Sec CO LO _ B 8P C for this , i ALTER ADD Poo. ' _ f - ` REPAIR Dote USE OF . _ ' EXISTING BLDG + DEMOL Signature -' APPU NRINTT ` I T L �1 Q7 FINAL OWNER BUILDER DECLARATION _ _ DATE ;17 7 3 6 A I hereby affirm that I am exempt from the Contractor s License -. (� 'e' �eln ' Low fo the following reason (Section 7031 5 Business and ADDRESSr�ITL `� ` FINAL' � • • • �,�,� Prof ions Code) • - ` • _ _ By r ( • • 4 9,8 8 BUILDING I as ownheir the property, nor my employees and ADDRESS q7 I wages as then sole compensation will do the work and the structure Is not intended or offered for sale(Section LOCALITY 7041 Business and Professions Code) MOVING- •- TEL r i• * 49885 I as owner of the property,am exclusively contracting CONTRACTOR '_ NO with hcensed contractors to construct the prolech(Sec gDDRESS - r , o a 2 5 8-7 tion 7041, Business and Professions Code) A ' , CONSTRUCTION LENDING AGENCY' • SE7 gpCED SETBACK K YARD HWY TOTAL PROP LINE I-WIDTH' - S 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 ), 54DE " 17 _ PL Lenders Name t r • 2 LDMA Ref N Lender s Address P C Fee f Permit Fee ✓ I certify that I have read this application and state that the _ Issuance Fee , LDMA P2 N 9 above information is correct I agree,to comply with all County, Investigation F•e p ordina as and St e I ws relating to building construction, Tohl Fee 0+ -- LDMA Perm N ' and or y author nlpa.1 of this County to enter , upo he bove-m i roperry or inspection p poses ' SEE REVERSE FOR EXPLANATORY LANGUAGE itincture of cont a pent Date _ T