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HomeMy Public PortalAbout5717 RIO HONDO AVE_Building__ e APPLICATION FOR BUILDING PERMIT � • COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILD ADDRESS BUILDING ADDRESS J / �DbO I hereby affirm that 1 have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified ZIP LOCA copy thereof(Sec.3800,Lab.C.) 1e041e04 /tee �•J u Policy No. Company S E F LOT vY NO.OF BLDGS.N ON LOTC��' ��' ❑ Certified Copy is hereby furnished. 63 1 NEAREST CROSS ST. ❑ Certified copy is filed with the county building Inspection TRAfT BLOCK LOT NO. USE ZONE MAP NO. department. Date Applicant10 ESSOR MAP BOOK d PAGE ;E 2 SPECIAL CONDITION CERTIFICATE OF EXEMPTION FROM WORKERS' NER TEL NO. �rp� ^� YES NO ADDRESS COMPENSATION INSURANCE WITHIN loco FT OF SCHOOL? (This section need not be completed if the permit is for one hundred 0 � DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) ZIPr?Q e_ I certify that in the performance of the work for which this permit —��� (� t ( ^ 0 - � Is Issued, I shall not employ any person in any manner so as to CHITECT OR ENGINEER TEL NO. A become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. -2V DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of C ACTOR TEL NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' SETBACK 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. RESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PIL 0- I I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES NO.OF FAMILIES CC Professions Code,and my license is in full force and effect. 2 NEW ❑ BK PG ® v License Number Lic.Class DESCRIPTION OF WOR ADD VALUATIONy �,r Contractor Date ALTER 0' REPAIR ❑ ❑ I em exempt under Sec. � ���,[�'f�C� DEMOL ❑ B.&P.C.for this reason rr LDMA P/C 0 Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm H ❑ I, as owner of the property, or my employees with wages as O ACCUr a their sole compensation,will do the work and the structure is ADDRESS not Intended or offered for sale (Section 7044, Business and FINAL DATEj I c'; C 33307 {7 Professions Code.) WILLTHEAPPUCANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL r r � p party, am exclusively contracting With A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I Liz 99-1, as owner of the r0 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B licensed contractors to construct the project (Section 7044, Business and Professions Code.) YES El NO❑ ` TOTAL �-10�60 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING ��}{ � r.!'' OCCUPANT REOUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH f-1-ECK iLL eCj- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. /1 /' CHANGE .;X1 I hereby affirm that there is a construction lending agency for YES❑ No❑ �/J' // •' the performance Of the Work for Which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCACMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES r COUNTY CODE,TITLEZ CHAPTER 2.20SECTIONS 220.100THROUGH 220.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Y a Lenders Address OMMOnACEM 3479 (r :5.- � 0 1 certify that I have read this application and state that the above P.C.FEE PERMIT FEE Information is correct. I agree to comply with all county 60 ordinances and State law relating to building construction,and hereby authope rep a tativeS of this County to enter upon ISSUANCE FEE the above- tinned rty for inspection pure Q Z,a Q INVESTIGATION FEE TOTAL FEE D /D ,�77«A-41 11 , 6O SEE REVERSE FOR EXPLANATORY LANGUAGE '• . • ' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WO'HKER'$COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADRPRESSib gain i I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS � I . or a!certificate of Workers'Compensation Insurance,or a certified5`111P40 0 G copy thereof(Sec.3800,Lab.C.) ITY C�1- ZIP r7�C� / LOCALITY t✓ Policy NO. Company SIZE OF LOT �+ NO.OF BLDGS.NOW ON LOT �- ❑ Certified copy Is hereby furnished. �B Q cl NEARESTBLOCK LOT NO. ROSSnnST. ❑ TRACT Certified copy is filed with the county building inspection b iV KM department. .USE ZONE MAP NO. � ASSESSOR MAP BOOK PAGE PARCEL Date Applicant B SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NE[iRy���' X� o / YES NO COMPENSATION INSURANCE O'"'1wa N "ARG_, WITHIN 1000 FT.OF SCHOOL? ADDRESS ""� (This section need not be completed if the permit is for one hundred f Jed Q I�CVD)) DISTRICT 899UP TYPE CO ST.' FIRE ZONE PROCESSED BY dollars($100)or less.) ZIP n I certify that in the performance of the work for hich this permit [~C. �--/ A Is Issued, I Shall not employ any person in an anner so as to CHITECT OR ENGIN TEL.NO. JJJ become ubject to the Workers'Compen n S. STATISTICAL C�FICANON APT CONDO Date 4�AppllCent ADDRESS CLASS NO�DWELL UNITS ^ NOTI E APPLICANT., If, afte eking his Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject to the Workers' NTRACTOR TEL NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, u must forthwith v FRONT comply with such provisions or this permit shall deemed'revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE r C PL I hereby affirm that I am licensed under provisions of Chapter 9 SEWER P v (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES 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 � W i6 A{ 0 $ D4D y Contractor Data ALTER 11Z REPAIR ❑ ❑ I am exempt under Sec. - - _ .$ B.&RC.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTINGBLDG. .URM ❑ Signature APPLICANT fPRI TEL.N(}� n LDMA Peng# 3307 f2.O'LI +�I, as owner of the property, or my employees with wages as ae p their sole compensation,will do the work and the structure is DRESS ^ - TTEMS not intended or offered for sale (Section 7044, Business and W j� e _11_ of a- FINAL DATE C TOTAL 92. 00 Professions Code.) WILLTHEAPPLICANTORFUTUREBUILDINGOCCU T DLEA HAZARDOUS MATERIAL ` J `❑ 1, as owner of the property, am exclusively contracting with TO E AMOU LINTS SPECIFIED ON THE HAZARTAINING AD OUS DOUS MATERIALS NFORMATIONGUIDE?MATERIAL EQUAL TO OR GREATERTHAN FINAI. CHs-)K 82'1'1}- licensed contractors to construct.the project.(Section 7044, YES❑ N Business and Professions Code.) O-0 CHANGE _011 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING FOR GUIDELINES. OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST �f I hereby affirm that there is a construction lending agency for YES 11 NOZ 1 ` �J 0113130-011301 /16 ll� the performance Of the work for Which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD v ((( / Iif a 243097,CiV.C.). - PERMITTING CHECK T.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTYC ETI CHAPTER22DSECTIONS 220.100THROUGH 220.140 CONCERNING Lender's Name HAZAR SMA REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lenders Address Ic' 1 certify that I have read this application and state that the above < ., EE PERMIT FEE Information is correct. I agree to comply with all county 1� ordinances and State laws relating to building construction,and V hereby authorize ropresentatIves of this County to enter upon ISSUANCE FEE the ab entio a property for inspection purpo E6 INVESTIGATION FEE TOTAL FEE . r e,R SEE REVERSE FOR EXPLANATORY LANGUAGE. y WORKEOCOMPEINSATION DECLARATION ­�l offisp th4t I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, APPLICATION FOR" BUILDING PERMIT . or a certified copy thereof(Sdc. 3800;Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FORBUILDING APPLICANT TO FILL IN AMC- DLDNG �-7/7 HTJkJ Certified copy is filed with the county building inspec- ADDRESS 10 Al tion department. Date -Applicant CITY TC-tl 0 L& C_T-T ZIP V LOCALITYL� Aa I CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS.' NEAREST L - COMPENSATION INSURANCE' SIZE OF LOT NOW ON LOT CROSS ST. 61#4 _�LOCK ASSESSOR (This section need not be completed If the permit is for one hundred dollars($100)or less.) TRACT MAP BOOK PAGE PARCEL EL* O.(.p1p) -7 1 certif OWNER USE E' TM ZV 2A ,�that the performance of the work for which this OWP r permit is issued, I shall not employ any person in any manner ADDRESS IV 1`71v wit. Put owv/ap SPECIAL so asto become subject to the Workers'Compensation to' CON, DITIONS Date— N W-I U, Lk CITY ZIP NOTICE Td APPLICANT--If, after moking'tVis Certificate of ARCHITECT OR DISTRICT T _7 GWUP TYPE FIRE P OCEWD BY 0 ZONE Compensation provisions of the Labor Code, you must forth- -5 8 with comply with such provisions or this permit shall be ENGINEER N Exemption, you should become subject to the Workers' ADDRESS CONST.' V deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. 00146671 CO CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION L LIC. CLASS NO. 2 I 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 �4 K SEWER MAP Profession's Code,and my license Is.in full force and effect. LIC. i CITY CLASS BK. 4 PG.13 STORIES YALIDATIOIN SQ. FT./ IN .OF NO.OF CHECK License Number Lic.Class, SIZE JLcc IFAMILES ONE VALUATION Contractor pate DESCRIPTION OF WORKlieltitvk. NEW $ I am exempt under Sec. ALTER B.&P.C. for this reasonA�P1_1"ILM, JAIL 1,R J REPAIR $ Date: USE OF k 4, DEMOL [3 ;97220A EXISTING BL 6 1474 Signature 'APPLICANT TEL, FINAL # ) NO. OWNER-BUILDER DECLARATION (PRINT I hereby affirm that I am exempt from the Contritclar's License DATE Low for the following reason (Section 7031.,5, Business and ADDRESS a2a50 5! By Professions Code): hgftc-Maa, , , JFY"�,X r,-A MtbtN[ 11 U -P 0,. "9" 2 a 5 010' BUILDING 41t r I, as-owner of the property, or my employees with ADDRESS wages as their soleation,will do the work and 0 6 1 0'�'Ej 7 the structure is not Intended offered for sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 1, as owner of the property, am exclusively contracting, CONTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code), ADDRESS REQUIRED CONSTRUCTION LENDING AGENCY SE YARD HWY TOTAL SETBACK R BACK 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. Lender's Nome 9 L LDMA Ref. # Lender's Address P.C.Fee$ Permit Fee t I certify that I have read this application and state that the lagree to comply with Oil County above information is correct. ?) '�LDLA P/C# Issuance Fee Investigation Fee ? ordinances and State laws relating to building construction, -Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter 9 upon the above-mentioned property for Inspection purposes. W SEE REVERSE FOR EXPLANATORY LANGUAGE SignattAh of Applicant or AgentDate 7T t WORKERS' COMPENSATION DECLARATION • ,I hereby affirmthat I have certificate of consent to self inure, ora certificate of Workers' Compensation Insurance, APPLICATION F I L ®I N G PERMIT or a° rtirLed cdpy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. - Company BUILDING ❑ Certified copy is hereby furnished. R. ADDRESS4�'11 OR APPLICANT TO FILL IN ' ADDRESS ❑ Certified copy is filed with the county building inspec- r�OCj �G tion department. Date Applicant L ZIP s LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' :71010 NOW ON LOT CROSS ST. + COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) pr TEL. USE ZONE MAP ¶ A� `I1 NO �� NO. 1 certify that in the performance of the work for which this9� SPECIAL >- permit is issued, I shall not employ any person in any manner �5 Pl Q9�1�'� A E � CONDITIONS C- as to b co a subject to the WorkersWthiskertificate tion Laws. /� q O XDate CITY 06111� ZIP � 9 V Applicant ` ARCHITECT OR TEL. NOTICE O APP ICANT: If, offer g of ENGINEER NO. ?ZQNDISTRICT k0UP CTMOPNST. FIRE E PROCESSED BY Exemption, you should become subject t the Workers' \� \/ tV Compensation provisions of the Labor Code, you must forth- ADDRESS J yyy with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. to deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATIONCLASS N@ _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 3-T-V STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ !' J ❑I am exempt under Sec. a ADD {�•J �p ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. _;i .�p�DEMOL ❑ Signature APPLICANT (PRINT) 1 `"�T^rC t S T NO. �6,"� FIN OWNER-BUILDER DECLARATION DATA I hereby affirm that I am exempt from the Contractor's License ADDRESS'15111 �i 0 4 0 �1� Law for the following reason (Section 7031.5, Business andFINAL 1 1Pr7ofT�ssions Code): PRESENT By YJ 1, as owner of the property, or m employees BUILDING P P Y Y P Y ees with ADDRESS RCCT o 4 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 3307 190.50 7044, Business and Professions Code.) MOVING TEL. 1' I `. I,as owner of the property,am exclusively contracting CONTRACTOR NO. � n�y Al pit t�A rn with licensed contractors to construct the project (Sec- ADDRESS �' ✓ TOTAL U1. (L.v o � tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETBACK YARD HA TOTAL PROP LINEFROM WIDTH CHECK 190.511 1 hereby affirm that there is a construction lending agency for FRONT r t the performance of the work for which this permit is issued P.L. 4 o (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name 111111111111M ''\\ LDMA 1 ��iVo Ref.R � 1 S, ry/1p9 8 P.C. Fee$ Permit Fee ® V Lender's Address `. ® 484 t8t�^ 1 certify that I have read this application and state that the Issuance Fee ® LDMA P/C# 3 above information is correct. I agree to comply with all CountyInvestigation Fee 3 ordinances and State laws relating to building construction, Total Fee LDMA Perm. It and hereby thorize representatives of this County to enter upon the ab ntioned property for inspecU pLWposes. 41,7,1 Vcr \/ S' ature a Applicant or Agent Dat� SEE REVERSE FOR EXPLANATORY LANGUAGE e ` APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES a BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BU((`ING ADDRESS I hereby affirm that 1 have a certificate of consent to self insure, BUILDING ADDREs f� ,pn�t ' ,(✓/ to M490 /e- . or a certificate of Workers'Compensation Insurance,or a certified CIT �� 77a Yv zIP �1+� l copy thereof(Sec.3800,Lab.C.) f / 1! Policy No. Company LOCALITY ZE OF LOT NO.OF BLDGS.NOW ON LOT V ❑ Certified copy is hereby furnished. 1-0 0 NEAREST CROSS ST.M U—A— O Ale ❑ Certified copy is filed with the county building inspection TRA BLOC LOT N 11 h� department. r--syo USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO p COMPENSATION INSURANCE 4"W C 1 ( •:�J WITHIN 1000 FT OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADpRESDISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) -E,--71-1 /e(a 1-f6 I certify that in the performance of the work for which this permit Cl �L lei Ll[ ZIP p. is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 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. 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 ;CE NO.OF S RIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG a RIPTION OF WORK License Number Lic.Class DES� ADD ❑ VALUATION ` C Contractor Date 0A11ALTER ❑ $ Z�- 9 5'1 ' c- a ❑ 1 am exempt under Sec. REPAIR ❑ $ F BAP.C.for this reason DEMOL ❑ LDMA P/C# LCl Date: USE OF EXISTING BLDG. URM ❑ n �Signature APPLIC N (PR T) 7 TEL NO. LDMA Perm# 23L t 1, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is ESS �� O Int.I o r not intended or offered for sale (Section 7044, Business and �'�(U f I��p� d1v" 1/1 u/ FINAL DA Q 3303 50.50 Professions Code.) 4 G WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINA Y Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, YES❑ No❑ C' a Business and Professions Code.) ACCT.■e 11yr WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING -�'y C` OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 33033 55 4 a-64 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES C ITEMOS I hereby affirm that there is a construction lending agency for ves❑ No❑ TOTAL2 1-f Pk W the perfOrmanCe Of the Work fOr WhICh this permit IS ISSUed(SBC. IHAVEREADTHEHAZARDOUSMATERIALSINFORMATIONGUIDEANDTHESCAOMDPERMITTING ` 506 . 14 w 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, HE4(FC 506.14 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. in Lender's Address OWNER OR AGENT CHANGE ,til] cI certify that I have read this application and state under penalty 4 of perjury that the above information is correct.I agree to comply P.C.FEE rs� PERMIT FEE N with all county ordinances and State laws relating to building S©"S v Z 7i�� (..�1 j 4— construction, and ereby But rize representatives of this C my ISSUANCE FEE / 1 fti` CO to enter upon th v - ned property for insgec on pur se z �7� IJ316 i AM 1:47 ro �!O INVESTIGATION FEE TOTAL �r �` Sqn Mgiw w A9rn1 0 o J SEE REVERSE FOR EXPLANATORY LANGUAGE 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 BL 0508 1302070006 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ITR: 6561 IT: 1 BL: .001 I SQ. FT STORIES TYPE [ 5717 RIO HONDO AV 1 ISTRUCTURE: 27 V-B I TEMP CA 917802433 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18587-003-019 I I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY Cl 1( (EXIST BLDG USE: RESID USE ZONE: R-1 T TENANT: ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 102/07/13 SR 1 (OWNER: TEL. NO- IBLDGS. NOW ON LOT: VALUATION: IFINAL.BATE FINAL BY: CODE: I (AYE MAW (626) 215-9117- 1 8,000 15717 RIO HONDO AVE I I� .1 1 ITEMPLE CITY 91780 1 FEES PAID DESCRIPTION OF WORK 1 I �I 1REROOF COMPLETE TEAR OFF AND WOOD SHEATING OSB RADIANT 1 1 ;IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IBARRIER PLYWOOD AND INSTALLING 30 YR SHINGLE 1 APPLICANT: TEL. N0: SOZA, MARIA (626) 285-8877- IAA BLDG PERMIT ISSUANCE 27.80 1 1 14533 SHIRLEY AVE AB STATE GREEN BLDG FEE 8000.00 VAL 1.00 ISPECIAL CONDITIONS: 1 JEL MONTE CA 91731 IAC STRONG MOTION RESID 8000.00 VAL 0.80 1 ID2 PERMIT W/O EN-HC 8000.00 VAL 183.00 I I 1 TOTAL FEES 212.60 I I CONTRACTOR: TEL. NO: [ [APPROVALS DATE INSPECTOR SIGNATURE IGOLDEN KEY INC (626) 285-8877- � 1_ I 14533 SHIRLEY AVENUE LIC. NO I ILOCATION AND SETBACKS TEL MONTE CA 91731 775115 * I 1 I, (SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: - 1 IFOUNDATION/TRENCH FORMS I [ I [ LIC. NO: jI (SLAB/UNDER FLOOR I [ 1 it 1RAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:'I 1UNDERFLOOR INSULATION I I [ 1147H265 3 001 I IFLOOR SHEATHING I I , INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 1 I 1 [ 1 0 NO 21 IROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS 1 1SHEAR PANELS I I 1AIR QUALITY: 1000 FEET MATERIALS 1 I I I , NO NO NO [ 1FRAME INSPECTION I I '1 IFIRE SPRINKLER HANGERS 1 (INSULATION/WEATHER STRIP, , [ INTERIOR LATH/DRYWALL (EXTERIOR LATH 1 1 I 1RA70 FLOOR/CEIL ASSEM. I I I IRATSD WALL ASSEMBLIES 1 1 1 1 I. (RATED SHAFTS/OPENINGS I I I IT-BAR CEILINGS , , I [ 1* ADDITIONAL DATA ON FILE II LOT DRAINAGE , I I , I 1 [REPORT ID: DPR261 ROUTE TO: BS0508 I I RI � COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1212110032 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST NEW BUILDING ADDRESS: I TR: 6561 LT: 1 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUPI 5717 RIO HONDO AV [ (STRUCTURE: 492 1 V-B R3 I TEMP CA 917802433 I (ASSESSOR INFORMATION NUMBER: I GARAGE: I NEAREST CROSS STREET: J 18587-003-019 I OTHER: I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY Cl (TENANT: (EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: [ (EXIST OCC GRP: 12/11/12 SR J [OWNER: TEL. NO: JBLDGS. NOW ON IAT: VALUATION: (FINAL E/ FINAL CODE: J JAYE AYE MAW (650) 636-6326- [ 72,930 [ 6�[ 5717 RIO HONDO AVE [ I 6 [ ITEMPLE CITY 91780 [ FEES PAID JD C P ION OF WORK [ I LEGALIZE 1 BEDROOM AND 1 BATH ROOM 492 SOFT. [ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: [ (APPLICANT: TEL. NO: I I [ ISAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.80 I [ I IAB STATE GREEN BLDG FEE 72930.00 VAL 3.00 ISPECIAL CONDITIONS: [ IAC STRONG MOTION RESID 72930.00 VAL 7.30 [ [ JB1 PLANCHECK W/ENERGY 72930.00 VAL 961.70 I [ [ JB2 PERMIT W/ENERGY 72930.00 VAL 1,131.50 [ [ ICONTRACTOR: TEL. NO: JFR INV WORK W/O PERMIT 339.60 DOL 339.60 APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I TOTAL FEES 2,470.90 LIC. NO I (LOCATION AND SETBACKS [ I [ ISOILS ENGINEER APPROVAL I JARCHITECT OR ENGINEER: TEL. NO: I JFOU]2WATION/TRENCH FORMS I J I LIC. NO: I JSLAB/UNDER FLOOR RAISED FLOOR FRAMING � I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J JUNDERFLOOR INSULATION I J I 3 OOI 1ST LEVEL FLOOR SHEATH J J I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS- I I I I I 0 NO 21 I 12ND LEVEL FLOOR SHEATH I � I SCHOOL WITHIN HAZARDOUS [ (ROOF SHEATHING I I [ JAIR QUALITY: 1000 FEET MATERIALS [ I [ [ NO NO NO IFIRE DEPT. FRAME INSPECT[ I I I [BLDG DEPT. FRAME INSPECT) [ _ L I� I J SHEAR PANELS I �I I JINSULATION/WEATHER STRIP( I (INTERIOR LATH/DRYWALL I [ [EXTERIOR LATH IT I I J ILOT DRAINAGE [ [ J (SMOKE DETECTION DEVICES J I I [ )FIRE DEPARTMENT APPROVAL( I I I I I I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I