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78A638ACE08088-84 APPLICATION FOR BUILDINGPERM
COUNTY OF.LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 1.0e �( (,V/G
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP•T.OF BUILDING CROSS ST. p
DISTRICT NO GROUP TYPE P C SSED BY
FOR APPLICANT TO FILL IN as—,. CONST
BUILDING • STATISTICAL CLASSIFICATION SSE) ER MAP .,
ADDRESS ,y (�
vO G CLASS NO. � DWELL UNITS f K PG
LOT NO. AlBLOCK USE ZONE MAP
No
TRACT o� C SPECIAL
CITIONS �
/� N0.
SIZE OF LOT V 710 r NOW ON LOT
USE OF
EXISTING BLDG. SETBACK FROM !
OWNER bea L. "t7�d4 FRONT PROP. LINE OF _ (STREET)
) �ppT TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS l� X& G 4) HIGHWAY IWIDTHF.OM C.L.
CITY i 1w 6lT__\ I
ARCHITECT OR TEL. BLDG. SETBACK FROM
ENGINEER 4 � NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
��// dd _ 0
CONTRACTOR ��/� 'JTO/1'eSNOL /t /'6yo d + V
ADDRESS �� h47S 7-01/4-
LN 10olOd CORNER CUTOFF YES NO O
LIC
CITY a le L SEE REVERSE SIDE FOR SPECIAL APPROVALS w
DESCRIPTIO OF WORK
NEW ADD ALTER REPAIR DEMOLISH ^
SQ.FT. Q NO. OF NO. OF iti+l� LJ Ci� �.�..a O (-{ �c r(d''U(P h_L-! e..Ae
SIZE /d STORIES FAMILIES 1 ,//�� I J
USE OF `r` L(• n C"'K t~ . btj-' " t; (<
STRUCTURE e. / Q w
SIGNATURE OF �?�ldoS- is
.APPLICANT
C�,�Nt A•r7Ls�N�2 •�►n,cN� --�..trr+�`l�sryn
VALUATION$ IN
APPROVALS DATE r SPECTOR'SSIGNATURE
P.C. FEE$ �}Q FOUNDATION,, T LOCATION
-2.7FEE$
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT C�"P .1 r.G'1.1.E-.�.K•.�A..l...{' 4
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION ��yy/r`_
WITH ALL COUNTY O DINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS ho 6J
9UILDING CON UC N. 1 CER Y THAT. IN DOING THE WORK _
AUTHORIZED H BY ILL NOT SON IN VIOLA- LATH. INT. 3.�. r v�ug!'
TION OF THE B R D@GTi TH TE OF CALIFORNIA LAT• � A
ING TO WO M PETNSA�T'ION INSUR cE. LATH. EXT. S -L (q (��n��p A/I,GfL+/—A I
SIGNATU HOUSE NUMBER COR- .411
+ (j
PEftMITTE ' RECT AND POSTED .ala, - /4e14e1.+1
ADDRESS FINAL 9'Ifel ea
JOHN F. LEWIS. PRINCIP 'L ST C AL ENGINEER
PIAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION CK. As
LACo S O .7 5 FEB 1 2 3K. 3 5SOA A `° 0r I--
L::�,� 9 2 6 9FIAR 8 - 1 D 7 1.0 0- �'
F 76A63BA CE#8033-66 APPLICATION FOR BILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER. A D D R E ss
BUILDING AND SAFETY DIVISION LOCALITY r
JOHN A. LAMBIE-. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINSAUP'T OF BUILDING CROSS ST.
DISTRICT U TYPE P D BY
FOR APPLICANT TO FILL IN ® CONST.
BUILDING STATISTICAL�jCL�ASSIFICATION SEWER MA
ADDRESS CLASS NO. DWELL UNITS •'� P
LOT NO. BLOCK USE ZONE NO.
O! 0
TRACT — SPAL
NO. OF SLOGS. ..0 NCD'T.0 NS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLOC. SETBACK FROM
FRONT PROP. LINE OF (STREET)
OWNE v TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS 40 HIG AY WIDTH FROM C.L.
+
CITY
CITYTECT EL. BLD SETBACK FROM
%RCHIENGINEER O. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
Co L' 9p + _
AD — IC _ CORNER CUTOFF YES NO
C
CITY C A 'SEE REVEL P VALS
DESCRIPTIO OF WORK D PARKWAY TIJEE.RfipYi.4pa
NEW AXADD ALTER REPAIR DEMOLISH �,,,t f_
SQ.FT. NO. OF NO. OF r f r�AWIN Ktfr / .. - .44--
SIZE STORIES FAMILIES I ;i'dsl:'up
USE OF o n. 1�n
STRUCTURE A t '. ,,:, ::: , :'l,j:eYyY jfjl ® 'Cf
a, . 74iy�lA�p.s6Y4ulY�ctitvR f.F, s T_ .
• � 8s �nls6tle ply (
S G N A T U R E O F — f
APPLICANT
VALUATION.$
��� APPROVALS DATE INSPEC ORfSSIGNATURE
P.C. � PMT. FOUNDATION, LOCATION /
FEE.$ U' FEE.$ FORMS, MATERIALS
FRAME, FIRE STOPS,' 7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA'RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. + LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FI NAL
JOHN F. LEWIS. PRINCIPAL TR URAL ENGINEER
PLAN CHECK VALIDATIONCK M.O. CASH _ PERMIT VALIDATION CK M.O CASH
7 0 3 MAY 2`3 2 1q .5.6 3N
_ __• LAC0 8 7 0.4 m MAY 2 3 1 0 2 .2.50-
01
*� L�11I�1III1
16A638A CEA'303 5-65 u
38 APPLICATION FOR BUIL. INC PE IT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 119
BUILDING AND SAFETY DIVISION LOCALITY �!
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINSSUP'T OF BUILDING CROSS ST.
DI$EIWCT Nilp_lG O YPE PR B
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS 1 19CLASS NO.�DWELL UNITS BK PG
LOT NO. BLOCK USE ZONE MAP /�
TRACT / NO. go' 0
/ SPECIAL
NO. OF BLOBS. 1 CONDITIONS e/`
f� L
SIZE OF LOT NOW ON LOT /J
USE OF L `�
EXISTING BLDG. BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
op
N NO. TYPE OF EXISTING SETBACK HIGHWAY + YARO = TOTAL
ADDRESS Q �/^ HIGHWAY WIDTH FROM C.L.
CITY BLDG. SETBACK FROM
ARCHITECT OR TEE.
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTINGSETBACK HIGHWAY + YARD = TOTAL
ADDRESS �1' HIGHWAY WIDTH FROM C.L.
CONTRACTOR �L7r NOL + -
LIC CORNER CUTOFF YES NO V
ADDRESS NO
LIC
CITY C LASS SEE REVERSE SIDE FOR SPECIAL APPROVALS O
DESCRIPTION OF WORK VW
NEW v ADD ALTER REPAIR DEMOLISH NZ
SQ.FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
i
SIGNATURE OF
APPLICANT
VALUATION$ Gro
APPROVALS DATE INSP ECTOR'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION
FEE$ FEE$ FORMS, MATERIALS
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTII
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
SUILDI NO CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S CnMPE TI INSURANCE. -
/ LATH. EXT.
SIGNATURE OF d HOUSE NUMBER COR-
PERMITTEE of 2 Z.. RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG R
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.o CAB
- L&733-7103 NOV 15 1 D 4,0'0
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
L
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
or a certificate of Workers'Compensation Insurance,or a certified /00 Q
copy thereof(Sec.3800,Lab.C.) CITY ZIP LITY `� L II ' ILA 7!
F¢rN 7
- !e„ c eA It 7,'V LO
Policy No. Company SIZE OF LOT r NO.OF BLDGS.NOW ON LOT
1:1 Certified copy is hereby furnished. O toI NEAREST CROSS ST.
11 Certified copy is filed with the county building inspection T� BLOCK LOT No. Q n
department. 2-!J �'
USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BOOK PAGE PARCELf
03�� SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO.
COMPENSATION INSURANCE B �°' 02 2- WITHIN 1000 FT.OF SCHOOL? YES No
(This section need not be completed if the permit is for one hundred ADDRESS
� DISTRICT GROUP TYP ONST. FIRE ZONE PROCESSED BY'
dollars($100)or less.)
ETEL
I certify that in the performance of the work for which this permit CITY �D D _ 2
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER . fJX —4 4WC-r,�
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE 70 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 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 STORIES NO.OF FAMILIES
Professions Code,and my license is in full force and effect. NEW BK PG }
License Number Lic.Class
DESCRIPTION OF WORK ADD ❑ VALUATION
�j 0
Contractor Date °O ALTER I� $ �o�' V
❑ cc
I am.exempt under Sec. ` Ca e S REPAIR ❑ $ 0
BAP.C.for this reasonDEMOL 11LDMA P/C# V
W
Date: USE OF EXISTING BLDG.• 'URM ❑ a
t W
Signature APPLICANT(PRINT) TIEL NO. LDMA Perm# ` z
0*1, as owner of the property, or my employees with wages as E � 2 OZ E-ir-•�:T a v
their sole compensation, will do the work and the structure is ADDRES
not intended or offered for sale (Section 7044, Business and FINAL DATE Q Ja iD I =a 4
Professions Code.) 000.
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL f Zi�3��3 ' ITEMS
I. as Owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q
Y Y 9
licensed contractors to construct the project (Section 7044, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY YES El NO W TOTAL
��(�L �5 3 m .rte^E
Business and Professions Code.) .,
WILL THE INTENDED USE MI THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING !HEC Iv^.45
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH -
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ('�{�
GUIDELINES \rllANGE .00
I hereby affirm that there is a construction lending agency for YES❑ NO 19
W the performance of the work for which this permit Is issued(.Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING
3097,CIV.C.)
N CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, .1 �-y� ;.y _y r� ti `
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS s d;i+ �0 11 k I
Lender's Name MATERIALS REPOR`ING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. -
0 Lender's Address � � `•
pYV11ER OR AGENT 2 36 1 AM 9-4*
C
o I certify that I have read this application and state under penalty
0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE /�7. O
N with all county ordinances and State laws relating to building
< construction, and hereby authorize representatives of this County ISSUANCE FEECD
�j /
m to enter upon the above-mentioned property for inspection purposes. pf CO - 7�
INVESTIGATION FEE TOTAL FEE / �, L
S1—.1 .Ap nt m Agent .7
SEE REVERSE FOR EXPLANATORY LANGUAGE
t
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY f LAND DEVELOPMENT TEMPLE CITY CA 91780 BL OS08 0701230016
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST
{ BUILDING ADDRESS:
ITR: 29569 LT: 4 SQ. FT STORIES VNTYPE I 10052 RANDwICK DR
I (STRUCTURE:
(ASSESSOR INFORMATION NUMBER: I TEMP CA 917803348 I
18585-001-.035 � NEAREST CROSS STREET:
( THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, C`
( I I
TENANT:
(,EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON. PROCESSED BY: EXPIRES ON: I
1 JEXIST OCC GRP: 01/23/07 JK 01/18/08
TOWNER: TEL. NO: IB s. NOW ON LOT:� VALUATIN: FINAL DA
1004pD I+ � BY: CODE:
2,140
I 8PO, HSIAO (626) 582-8637-
10048 RANDWICK DRN('�}N
TEMP 917803348 { FEES PAID DESCRIPTION OF WORK I
I (REPLACE (6) WINDOWS LIKE FOR LIKE SAME SIZE SAME LOCATION
(FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:(
APPLICANT: TEL. NO: I T
BATIOFF DAVID - I.AA BLDG PERMIT ISSUANCE 27.75
IAC STRONG MOTION REBID 2140.00 VAL 0.50 (SPECIAL CONDITIONS:
ID2 PERMIT W/O EN-HC 2140.00 VAL 99.00 I
TOTAL FEES 127.25 I
ICONTRACTOR: -1
TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
(HOME DEPOT INSTALLATION (562) 981-1600- f
i
12774 FLORENCE AVENUE LIC. NO � LOCATION AND SETBACKS
SANTA FE SPRINGS CA 90670 881834 B
i
( i SOILS ENGINEER APPROVAL I I
ARCHITECT OR ENGINEER: TEL. NO: ; FOUNDATION/TRENCH FORMS I {
LIC. NO. SLAB/UNDER FLOOR I
I RAISED FLOOR FRAMING I
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( UNDERFLOOR INSULATION
147H273 3 Oil
NO. OF FAMILIES: FLOOR SHEATHING
DWELLING UNITS: APT/COND: STAT CLASS: I (
NO 21 1 (ROOF SHEATHING ( TT
T � 1
T SCHOOL WITHIN HAZARDOUS SHEAR PANELS I I I
JAIR QUALITY: 1000 FEET MATERIALS
i NO NO NO I (FRAME INSPECTION {
(REQUIRED TOTAL SETBACK FROM EXIST i /FIR$ SPRINKLER HANGERS
SET BACK 'YARD: HWY: PROP LINE: WIDTH:
FRONT PL-
SIDE PL- {INSULATION/WEATHER STRIP
i i I I
T (INTERIOR LATH/DRYWALL � I
(EXTERIOR LATH
I IRATED FLOOR/CEIL ASSEM.
{RATED WALL ASSEMBLIES ! I I
I
tRATED SHAFTS/OPENINGS
I I
IT-BAR CEILINGS
I II LOT DRAINAGE T
` �REPORT ID: DPR261 ROUTE TO: BS0508
f i
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