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7BABSBACE08098-64 APPLICATION FOR BUILDING PERMIT \
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS L A/V Gllrc
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS SUPT OF BUILDING CROSS ST. (� � ' `
FOR APPLICANT TO FILL IN DISTRI Tw�N! ERD�lCONST �RSED BYSS �G•G�`
BUILDING ' STATIS ICAL CLASSIFICATION SEJ ER MAP
ADDRESS u, •G CLASS NO. 0 DWELL UNITS ' BK PG
LOT NO. BLOCK USE ZONE MAP
NO. D //1
TRACT �7��6 / � SPECIAL V
{
r, NO. OF SLOGS.
CONDITIONS
SIZE OF LOT GD .00 ON LOT
USE OF
EXISTING BLDG. BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OWNER l _° NO. fi-T -1020.6 TYPE OF EXISTING SETBACK V HIGHWAY + YARD = TOTAL
ADDRESS I C I fi- ft-4 HIGHWAY WIDTH FROM C.L. '
-
CITY / ia ILI I v
+
ARCHITECT OR EL. BLDG. SETBACK FROM
ENGINEER f{-��O NO. SIDE PROP.'LINE OF (STREET)
TYPE OF EXISTING ISETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L. G
CONTRACTOR�D Bn�eS NOLjj
lLIC ? yC,0 + (C•
ADDRESS 1 L /� r� S TUNI�JSNO /(S CI,Ej CORNER CUTOFF YES NOEj
C
CITY Y •T c�ASS SEE REVERSE SIDE FOR SPECIAL APPROVALS u
DESCRIPTION OF WORK
NEW ✓ADD ALTER REPAIR DEMOLISH
SQ.FT. ISS NO. OF NO OF Nl J(+'�A L•-Ct_ S.- (2f Ct1? F:Fi.. t f
SIZE STORIES FAMILIES J
USE-OF I 1` lG•rJ Y-C�)d F'!A`t.ay�•..�Pl
STRUCTURE E S / e L 6d 1 _ _
SIGNATURE OF "� 7i e -til n kiv4--c-o'l, L"'.4',
APPLICANT (J
VALUATION$ 116,cy6-0 APPROVALS DATE INSP/ECTOR'SSIG�NvATURE
P.C. [}O PMT. 4J d FOUNDATION,FORMSMATERIALSON J �'T ,��,EAi✓r���'f '�•A' 'f
FEE$ FEE$ /
FRAME, FIRE•ST0PS, 4- 1 1
I HE
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT Tip L+J �:x'Lit1s� •Ce.(_„
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS +t`� J W C.Y 'J ✓LQ+
AUTHOR ZE H EBY TI O .. 1 CERTIFY'��T/H•�AAT."NIN DOING Y PERSON H WORK
WnT
TION OF T L B COD H STATE OF CALIFORNIA RELAT- LATH. INT.
ING TO WO PIE '-ATIO RANGE.
LATH. EXT.
SIGNAT E OF a- •� HOUSE NUMBER COR- / •` r,
PERMITTEE RECT AND POSTED �� ��OJ /!/1�7.!_+'it_.•J1/�a� )
ADDRESS Fl NAL liA f
JOHN F. LEWIS. PRINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION C M.G. CASH _ PERMIT VALIDATION CKy _0."Qs.
�ril,o 8 0 7 8 FEa 1 2 3 3 2.0 0 c L
I r i�,",tZ 8 1 D 6 G l�
O 7
Lr 2
WORKERS'COMPENSATION DECLARATION
1 insureboraa certif catte of Worke s'tCompensation cate of Insuran elf I APPLICATION.PFORBUILDING P E RM I T
or a.certified copy Thereof(Sec. 3800, Lob. C.)
COUNTY OF LOS ANGELES j BUILDING AND SAFETY
Policy No. Companyak
.El Certified copy is hereby furnished. FOR APPLICANT T FILL IN ADDRIESS
/6TH 7�q
❑ Certified copy is filed with the county building inspec- BUILDING Q47
tion department. ADDRESS
Date Applicant CITY a ZIP O LOCALITY
NO.OF BLD S. NEAREST
CERTIFICATE.-OF EXEMPTION FROM WORKERS' - SIZE OVLOT ®� NOW ON LOT CROSS ST.
COMPENSATION INSURANCE �j � ASSSOR pSeS 4:2,05-.(This section need not be completed if the permit is for one TRACTJ. BLOCK Q S. LOT NO. '� ASS ESBOOK• dPAGE 3- PARCEL��
hundred dollars ($100)or less.) TEL. �.
OWNER a Jli' NO USE ZONE MAP
I certify that in the performance of the work•for which this NO.
permit is issued, I shall not'employ•onypemon in any manner ADDRESS O dl`j , ' e-1 SPECIAL a
CONDITIONS
so-as to become subject to.the Workers'.Compensation Laws. . � � OO
CITY _Z IP_ d
Date Applicant -ARCHITECT TEL•
NOTICE TO APPLICANT: If,. after•makin this Certificate•of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY• O
g CONST. ZONE
-Exemption, you should become-:subject to the,-.Workers'
Compensation provisions of the Labor Code, you•m.ust forth- ADDRESS ' D�' 13 k/ -,� w
13
N .
with comply with such provisions.-or this permit shall beTEL•` STATISTICAL CLASSIFICATION, APT. CONDO. Z
deemed revoked. CONTRACTOR e / L: O� Gc> ; .
LICENSED CONTRACTORS•DECLARATION LIC, CLASS NO.CP 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 LIC. ..SEWER MAP
and 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
Contractor Date DESCRIPTION OF'WORK a' NEW ❑ $ Ode
r DD' :❑
❑I am exempt'under Sec. �' ►
ALTER. ❑.
B.& for this reason "� '� REPAIR ❑ $•
USE F
Date: EXI ING BLDG. � DEMOL ❑
Signature APPLICANT
'TEL c� FINAL y
OWNER-BUILDER DECLARATION (PRINT).' NO� DATE G4
I hereby affirm that I am'exempt from the Contractor's License _ -
Law for the following reason,(Section 7031:5, Business and ADDRESS FINAL n a
ACCT.g
Professions Code):� .�� � � .. PRESENT � B '
I, as ownerk& the ro ett or.my employees with BUILDING Y _ 3301 15°ru79••
P P Y� YADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for'sale(Section LOCALITY , 1 ITEMS'
❑ 7044, Business and Professions Code.) MOVING. TEL. TOTAL 158o79
1,as owner of the property;"am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project,(Sec- ADDRESS: CHECK .155.79
tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CHANGE'
CONSTRUCTION LENDING-AGENCY SETBACK YARD. HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is,issued P.L.. '
(Sec. 3097, Civ. C:). SIDE.
p.L.. 5074 1 AM10145
Lender's Name -f 3
� P.C. Fee$ Permit Fee LDMA Ref.# '•
Lender's Address, ,
o I certify that I have read this application and state that the Issuance Fee 7 LDMA P/C N
above information is correct.I'agree to comply-With all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee a, / LDMA Perm.-# ;
a and hereby'authorize'representatives of this County to enter ,
uP eabove-mentioned property r,inspaction purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
tura of Applic nt or,Ag nt Date -
COUNTY OF.-LOS ANGELES TEMPLE CITY # 0508 U LDING PERMIT
DEPARTMENT OF PUBLIC WORKS. • 9701 LAS TUNAS ;,, rf ALTERATION/REP.AIR
BUILDING AND SAFETY'/. LAND DEVELOPMENT': •TEMPLE•CITY CA 91780 �!BL 0508•.9907300049
PHONE: (626) 285-0488• EXT:
EG D: 0. OF COS iC -\ _IL IN l SS:
TR: 29569 LT: 7• SQ. FT STORIES TYPE 1007ti.RANDWI.CK-DR.
STRUCTURE: 0 VN • TEMP CA`917803348,�.
ASSESSOR I FOR IO BER: NEAREST CROSS STREET: GREEN
8585-003-037 THOMAS PAGE': 597. . GRID: B4 LOCALITY: TEMPLE CITY
TENANT: EXI ST BLDG USE: RESID SE-ZONE: R- N: PROCESSED BY EXPIRES
EXIST OCC GRP: ' 07/30/99 UT 01/26/00
OWNER: TEL. NO: • BLDGS. NOW ON LOT.: VALUATION: FINAL DAT FINE .BY: ' ODE:
L00-PETER;HANNA (626) 448-3414- T. 700 -a
dd
10072 RANDWICK DR -I,
TEMP 917803348 FEES PAID ESCRIP ION OF-WORK.
CHANGE OUT OF 4 EXISTING WINDOWS''
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: 0:
SAME AS OWNER AA BLDG PERMIT;ISSUANCE• 27:75
AC STRONG MOTION-PSI.D 700.00•VAL 0.50 SPECIE CONDITIONS:
D2'-PERMIT W/OSE -HC "'-"�-�70Q:_00 VAL "•43.65
E E�'A'l. EES 71.90
CONTRACTOR: TEL.. NO: 05 ��T APPROVALS'- DATE INSPECTOR SIGNATURE.
SAME AS OWNER �-
•LIC. NO CAT D C S
SOILS ENGINEER APPROVA
ARC ECT OR ENGINEER: TEL. 0: - fOUNDATIONPRENCH S
LIC. NO ' 111]111 SLAB/UNDER FLOOK
• , RAISED FLOOR.F
14AP NO:747H273 SEWER MAP B00 PAGE: FIRE 20N3: CF
�U �®��� UNDERFLOOR INSULATION
FLOORSHEATHING'
0. OF FAMILIES: OND:*STAT CLAS
NO
ASNO 21 ROOFS T I G
AIR QUALITY: 1000 FEETT HIN MATERIALS• 49
]- HAZARDOUS *' S R P E S
NO NO NOA ' �y FRAME INSPECTION
REQUIRED S T C EIS 46/ _w1Ot� FIRE--SPRINKLER. GERS
FRONTSET ACK PL- YARD:. HWY:' PROP LINE: WIDTH: S@rVIC2 T�at� INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR
TH
' 0 A
E OR LATdtH
RATED FLOOR/ICEIL ASSEM. V
TED WALL ASSEMBLIES
RATED.SHAFySjOPE S
T-BAF CEILINGS '
OT RAW GE
REPORT ID: DPR261 ROUTE TO: MON,
_• _ ' COUNTY-OF LOS ANGELES , I TEMPLE CITY # 0508 C-BUrLDING PER-MIT
DEPARTMENT OF PUBLIC WO�tKS f 9701 LAS TUNAS ----ALTERATION/REPAIR
BUILDING AND SAFETY /,SAND D�1IELOPMENT'-e TEMPLE CITY CA 91780 �-BL 0508 9907020025
PHONE: (626) 285-0488. EXT: - ,
29569 LT: 7 NO. OF - CO S B DI GADDRESS:.
TR:
SQ. FT STORIES TYPE 1072-RANDNICK DRI
STRUCTURE: 0 VN TEMP CA 917803348
ASSESSOR INFORMATION NUMBER: NEAREST-CROSS STREET: GREEN
8585-003-037 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
TENANT:
WWI DG USE: RESID USEZOE: R-1 ISSUED ON: PROCESSED EXPIRES ON:
EXIST OCC GRP: 07/02/99 UT 12/29/99
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATIO : FINAL DATE FINAL BY: CODE:
LOO PETER;HANNA (626)• 448-3114- 1. •700 �-7f .�
10072 RANDWICK DR �U
TEMP 917803348 FEES PAID DESCRIPTION OF WORK -
CHANGE_OUT 3-WINDOW AND 1-PATIO-DOOR
PPLICANT: TEL.
FEE DESCRIPTION: QUANTITY: UDM: AMOUNT':
- - •
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 700.00 VAL 0.50 SPECIAL CONDITIONS:
D2 PERMIT W/0 EN'-HC�7`0 00 VAL 43.80
GELE8 FAL,FEES 72.05
CONTRACTOR: TEL. 0: �OCJ �/�A� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO LOCATION AND SETBACKS
SOILS ENGINEERAPPROVAL '
ARCHITECT OR ENGINEER: TEL.-NO: ` OU D TIO /TRENCH FORMS
LIC. NO: 1111111. SLAB/UNDER.FLOOR
RAISED FOOR G
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CT
E -MC � UNDERFLOOR INSULATIO147H273 3 1i DO ���O LJ llKS
FLOOR 5 TH NG
0. OF F IL ES: . E G NITS: CO : STA C SSG-
NO 21 ROOF SHEATHING
SCHOOL THIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS O
NO NO NO � A I+���Jy F RAME INSPECTION �7
REQUIRED 0 S TBACK FROM ST4b�, � S L R G S 6
SET FRONTCK PL-
YARD: NWY: PROP LINE: WIDTH: �� Se nl;l a'khat INSULATION/WEATHER' STRIP
SIDE PL-
TMTERI-07-LATH/DRYWALL
RIOR LATI
TE OUR E SEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508