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HomeMy Public PortalAbout5116 ROSEMEAD BLVD_Building__ %;-uryI -� BUILDING AND SAFVW.�_T , [su I LIA PY OF LOS ANGELES >. WIL J. FOX, COUNTY ENGINEER APPLICATION CAS_ 7. GRIFFIN, SUPT OF BUILDING -FOR OFFICE USE UFTLY FOR APPLICANT TO FILL IN DISTRICT NO. PERMI BUILDING _10/i, A �-- •-�. <`- � i"7 l6 r71:_ DDRESS �y�,�, RECEIVED BY ��, DAA E� Fryy--.� DATE 1 O LOCALITY ,_ 1 +4- ✓�"1 - NEAREST CROSSST, 1 ,V I� y BUILDING _ r ADDRESS OWNER _r;G �'��. C.0 t1' 1 MAIL �, P L-OCALITY ^_T C-• ------#� - b_ ADDRESS ilS ��.._, - NEAREST _ 9, " EL. CROSS ST. CITY 1 O 1- NO. OF FIRE TYPE GR ARCHITECT OR • TEL. ZONE I PLANS I 4 ,,�. ENGINEER NO. - .. BLDG. ADDRESS SETBACK LINE TEL. USE APPROVED,/: ' !:• CONTRACTOR NO. --_ ZONE BY '��•,.-r.. HOUSE NUMBERING ADDRESS __ MAP NUMBER •"-_ �•'a NO. ASSIGNED BYLEGAL DESCRIPTION I LOT NO. �.� I BLOCK 1__�.._ CORRECTIONS Jk- f _TRACT 1Z 3 a ._ i'y �I NO. OF BDB. _ r SIZE OF LOT 1�iSp '�" �� NOW ON LLOTG USE I . Z- / �i. EXISTING FAMNG BLDG. FAMIL � �F IJI..11+1ull i lull VF WORK ADDITION _ �l NEW V/ ALTERATION ` REPAIR HDEMOLITION 'F SQ. FT. 1 NO. OF SIZE 5`'� 7 ROOMS STORIES / EXT. WALL ly r ROOF C' COVERING �+'�+ 1-1����, I COVERING USE OF STRUCTURE r -- APPROVALS INSPECTOR'S SIGNATURE _ FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP W FRAME: FIRE STOPS, - PLICATION AND STATE THAT THE IN GIVEN IF BRACING, BOLTS 7r CORRECT. 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION. GAS VENT, DUCTS AND STATE LAWS R ULATING BUILDING CONSTRUCTION. , i ` /d ! SIGNATURE OF LATH, INT. / . / z ,L 4.__ PERMITTER--­ �• _ �/ 1 LATH. EXT. ADDRESS / 7 Z.t. -0'41 t' � 'L ___� PLASTER. INT. AUTHORIZED AGT. c.0V ti�7 _ PLASTER, EXT. _TI C. F — HOUSE NUMBER COR- RECT AND POSTED VALUATION 6 -50O FEE FINAL 76A638A DBS 3 9-52 I DI'vgSION OF BUILDING AND SAFETY Y Department of County Engineer i� County of.Los Angeies •WM'.'J. FOX, COUNTY ENGINEER: i - �_APPL:ICATION - " ",: •'�`� FOR APPLICANT TO FILL IN FOR OFFICE USE,ONLY !, _ DIST,RICT•NO. PTAH CK. OR REC.No. - PERMIT-No. 'BUILDING /j ( /� //(�! e�_• fi( _ / .ADDRESS G+,SCLOUtnn-0. ,..).fhl,� -"� CC.��710. _ moi '�' , - P�0�-.® ECEIVWBYt DATE AP L. DAT BBU D LOCALITY NEAREST CROSS ST. . BUILDING oi ADDRESS OWNE 8v ' � . Ll . MAIL' _r - - .LOCALITY ADDRESS �NI=AREBT - ` CROSS-8T. CITe�Cfi�... NOL Y. vd.'� �" � FIRENO.OF / TYPE GROUP ARCHITECT OR TEL' ZONE - I PLAN _ .t�"" ^• , I .1 ENGINEER'` - .Y� - NO. BLDG.; = v. eWe �,��1', N 9 _� ^ SETBACK LIN ADDRESS' UBE- '+ APPROVED TEL ZONE - BY ' DX' CONTRACTOR NO. a -Yb H'Offt.E NUMBERIN f- }. ADDRESS f O iiW•.'444vwvw4 MAO UMB ' NO. ASSIGNED BY LEGAL . CORRECTIONS DESCRIPTION LOT'NO. -i BL CK ; TRACTNO. OF>• � �w gf- SIZE OF LOT( � V�J ( NOW O BLD a LIP. , •_ b }per USE OF I NO. OF. .� � �0�~CriG c+ rI6-- 4. SJ. EXI9TING'BLDG. FAMILIES' /-A 05-, DESCRIPTION OF WORK NEW ALTERATION ADDITION- r REPAIR _ DEMOLITION `S�2-AAG 540770 Sq. FT., NO. OF w7/G.+ r� f SIZE ROOMS STORIES ,5' UCGDkf T A / EXT.WALL ROOF - ,.G/ 4 COVERING _.'I COVERING /ili'i �� � 4 �OW v USE OJF��,,R TRYMT,URE Ate\ //,!�� ,+/y/� /� /� _. rh-'C./Gl' wP=w �Q 0.T / {I ®/v 1�� (�/6r - �0 d' u S g a;O iY1 ��'Jq' �o�Ei rdlepv- INSPECTION FOR 'APPROVALS OCCUPANCYAS - INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION - FORMS, MATERIALS - 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- - - - PLICATION-AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRESTOPS, CORRECT. - BRACING, BOLTS 41 .AGREE TO COMPLY WITH.ALL COUNTY. ORDINANCES 'FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT,DUCTS - SIGNATURE 0 AV LATH, INT. ' PERMITTE fififi l -I`W"&. l.L"FG �. L*.it,u LATH. EXT. - ADDRESS - ZED -A �/ /i�"ft, J PLASTER, INT. .. - .AUTHORIGT. �G'3r , - . PLASTER, EXT. . yj A I0 ® ® III F•EE• HOUSE NUMBER COR- RECTAND POSTED VALUATIONFEE �R',. FINAL - �%76A63BA DBS 3 1-52 - L�UILDING /vt, `�•��,"' ' . .,e,. s • ADDRESS � / d/,4 l• J — .. APPLICATION LOCALITY 7`e'G, NEAREST �(�r_ DIVISION .OF BUILDING AND SAFETY CROSS ST. % Depaitment of County Engineer DISTRICT.NO. RECEIPT NO. PERMIT-NO: _ County,of Los Angeles WM. J. FOX. COUNTY ENGINEER ."OROU DATE RECEIVED DATE ISSUED CASSATT D. GRIFFIN, SUPT OF BUILDING j -FOR APPLICANT TO FILL IN;•.. TYPE CONST. RECEIVED�BY7 / ISSUED BX MAPMAILZ �I! d, /p_`P,{ /+® /}��, NUMBER 2 V STATE' WY /YES 'N:O� .ADDRESS zs-- , l.y�.�jtet f C.JfIC�S .'/ `ti•`�1 ` USE ZONE SPECIAL - l TEL.y CONDITIONS CITY / NO.( ARCHITECT OR - TEL. ENGINEER NO. 'BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS - )� ,G FRONT CONTRACTOR 7� (.!} t f- NO. //Z,-�"Y�/� P.L. SIDE.. ADDRESS P.L. BUILDING /y!rybATE / C�yO//�'RRECTIONS .INSPECTOR ADDRESS -�[ff� A0r4;?--.E-�.t"st�P tf • •° 0 ® 1 f �✓' LOT NO. BLOCK TRACTF �yt C,� �rNO. SIZE OF LOT ��v / 7`7 NOW�BL TS. C USE OF' /. J7/ U(� ��Nr 1✓ J' l EXISTING BLDG. .� J DESCRIPTION OF WORKi NEW - ADD ALTER REPAIR DEMOLISH D SO.FT. NO.OF NO.OF r• r, SIZE • L,( L/, STORIES FAMILIES - USE OF STRUCTURE / - 1+;;i 00, 71 N O.O F NT�f/j/!�//(d��✓/f/[�/i �(Q-�'// / / 2 ! EMPLOYHEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- ew ���� PLICATION AND STATE THAT THE IN GIVEN IS APPROVALS f 'INSPECTOR'S SIGNATURE /DATE / CORRECT. i ' I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION / ��y A. /meq AND STATE LAWS R -GULATT,,,IING BUILDING CONSTRUCTION. FORMS,MATERIALS ./ J ' / O/ FRAME: G,BOLTS v 91GNATURE'OF BRACING,BOLTS PERMITTEE -- t—`-�� FURNACE: LOCATION, , v�V `J/ / I�iGefJ 11'�E �L� I' GAS VENT,DUCTS ADDRESS /`1 lL LATH, INT. AUTHORIZED AOT. - - LATH, EXT. $ /�_V ®� e P.C.$ - HOUSE NUMBER COR- G�//cs FEE. .RECT AND POSTED ao er' 1 VALUATION $� FEE FINAL I•Y `. 76A636A DBS 3 12-53 I,• a �� 7,6A639'A CE #803 3-69 APPLICATION FOR BUILDIN _ PERM147 u v �: ,'COUNfiY OF LOS ANGELES BUILDING DEPAR-?MENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY,' ' .tee 0 JOHN A. LAMBIE, COUNTY ENGINEER . NEAREST ,COLEMAN W. 'JENKINS', SUPT OF BUILDING' NEARECROSS'ST. DISTRICT NO.- GROUP TYPE CO T:-" PRO BY; 0 FOR APPLICANT TO FILL IN �� O (PRINT OR-TYPE ONLY) O - Z BUILDING / ( STATISTICAL,CIASSS'IFICATION ,., ., .SEWER MAP U ADDRESS Efit=- '�J ��7f' � ��'�O CLASS N0. -DWELL.UNITS 'BK. -.PG z Q LOT NO. -. BLOCK .- USE ZONE -NOAP-. - '• - TRACT �/ - `.'� .S�— - - �. ._ -� //jam ....SPECIAL U N0. OF BLD GS '` CONDITIONS e. . �' '- SIZE OF LOT NOW ON,LOT N USE OFQ EXISTING BLDG. q /7 I<--GI'� - BLDG. SETBACK FROM OWNER J�✓�^/l//� nj� TEL. FRONT- _j OF. (STREET•) A //Iv C/� �S 7NO.. _ LL �{/) TYPE OF EXISTING SETBACK HIGHWAY '+ YARD - •TOTAL ' ADDRESS-51A. •,f��-L T+/ HIGHWAY WIDTH• FROM C.L. - CITY II G/ � -�'�TvL � O�Nr . + o �l o ARCHITECT ORTEL J BLD .SETBACK FROM - Z L•I+enac . 50 ".�+ NO.�� L �/(!r SI PROP. LINE OF. (STREET) - ^ �c 7 / TYPE OF. EXISTING SETBACK HIGHWAY, + - YARD "_ ' TOTAL ADDRESS L"M, .I ® � 6`��'/� -HIGHWAY WIDTH FROM.C.C. CONTRACTOR- Se dl/"7 O U / NOLT�i`� +L 1C. _ ADDRESS 2-.f-50 /1A-.�I/fit% NO �yre I� �_ CORNER CUTOFF YES ❑ NO ❑ C � � LIC. , . I � �.. U CITY C>- ��'�'� CLASS � - SEE REVERSE SIDE:.FO SPE I L,APPROVALS�� � CONSTRUCTION LENDER C NAME AND.BRANCH !V ly OV111 [+�3 �I IOtU. t- 1. ADDRESS . '?t �J- V SQ. FT: NO..OF N0. OF /, �' 2 SIZE' STORIESUSE OF © FAMILIES NEW - 1 t; j ay STRUCTURE ,.S•A��' �> TN _J t-#0OL,• ADD • - ALTER ❑ -' - REPA:IR ❑ SIGNATURE OF DEMOL, ❑ - APPLICANT r' `/^��"v� 5 I �V C.o �,sa VALUATION $ / O �� � -APPROVALS DATE -iNsaEc a's sl NATURE P.C. PMT. //'' �/ 7�` FOUNDATION: LOCATION FEE,$ _ / FEE $ CL'7 / F FORMS MATERIALS I HEREBY- ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, - BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY, FURNACE: LOCATION, • WITH ALL ORDINANCES AND LAWS REGULATING BUILDING�CONSTRUC- GAS VENT•DUCTS - TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED. HEREBY 1.• " WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATHINT. - OF THE STATE,;OF CALIFORNIA IN RELATI)gG TO WORKMEN'S COM-_ , ., PENSATION.INSURANCE. SIGNATURE OF L •� LATH, EXT. PERMITTEE ^ HOUSE NUMBER CORRECT -�— - .AND POSTED AODRESS FINALG 7 ' o 9,1919 JOHN F. LEWIS_PRINCI.PAL ST TURAL ENGINEER PLAN CHECK VALIDATION CK.. M:b•- c PERMIT VALIDATION M•o•• SASH 2-;2 2 3 D 4 .1 .8 5 ,1. :G'GT14 n 69-7-5—, •/(pper� 76A638A E 8032-63 %-1PPLICATI�OIV: FOR_ .BU.I.LDI.NG PERMIT 4 � ':•��' � . .f.. •. r 'a.' COUNTY OF LOS;`ANGELES". 13U Nc ,, ,DEPARTMENT OF COUNTY ENGINEER—l' gDDREss ,�- BUILDING AND SAFETY -DIVISION Loca`LITY.'' C ku - 'JOHN.A'. LAMBIf COUNTY'ENGINEER" NEAREST _ ..WILLIAM P..':JENSEIV, Sur r;oF=BUILDING-` CROSS,STi- - ` u -. ,_" . -- DISTRICT_N O: GROUP TYPE FOR` APPLICANT' JO 'FILL IN' S'. CONsr . BUILDING- / _ STATISTICAL CLASSIFICATION SEWS R'MAP ADDRESS'' Y ta...,. ,CLASS_NO... .3DWELL..UNITS LOT NO._ _ WATER - NOT REQUIRED, r RECEIVED,'. / CERTIFICATE:MAP " .TRACT• - " _ NO. � f ..HaRc ei, STATE MAJORS OND, LOCAL _ NO.OF BLDGS. _ SIZE OF LOT NOW-ON LOT;` USE'ZONE SPECIAL USE"OF . NDITI S,'-- _ _ ? ,�, EXISTING BLDG. _ TEL .. �t 10 '.S OWNER'- ,� C •.NO - _ - BUILDING .YARD "HWY 'STREET NAME T' _ ACK WIDTH' - ADDRESS fir: FRONT -ARCHITECT':OR` -`. _ - 'TEL. ., .-.. P. L. 0 0 ENGINEER .r t, .;.NO.. :.• ;SiDE' -. P.;L } - ADDRESS + �- .TEL, -CONTRACTOR, yG ry'/l - NO Q7J). ADDRESS Q .� •' O ' DESCRIPTION.OF WORK,--.,, EW ADD: .ALTER, REPAILu R DEMOLISH - - - . FT. NO:-OF '" `NO. OF ?• .SIZE.. - STORIES FAMILIES .. USE OF - �;. STRUCTURE. - - SIGNATURE-OF. - APPLICANT VALUATION $ ? �,` '" .R'� �.• ._,. J - 'APPROVALS DATE 'INSPECTOR S SIGNATURE FOUNDATION; .LOCATION, .P.C. � ', PMT.- .. �/� ,J� FORMS,:MATERIALS �••'" �• ': :-,� FEE$.. _�(�? FEE -. -- FRAME:.FIRE'STOPS; I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS.APPLICATION. :BRACING_BOLTS - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO'COMPLY FURNACE: LOCATION. "& •"t.'. _ WITH ALL.COUNTY ORDINANCES AND STATE''LAWS REGULATING ' .GAS VENT, DUCTS,- ' BUILDING CONSTRUCTION. I 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 OFA - �jI- HOUSE.NUMB ERICOR - . -PERMITTEE- RECT ANDPOSTED. ' ADDRESS .. - ....: -FINAL JOHN F. LEWIS, PRINCIPAL ST RAL,ENGI,N,EER . PLAN'CHECK" VALIDATION PERMIT VALIDATIO CK. ' M.O. CASH:,, 2 1 2 5:G 'NOV 1 4,4,'D, .00 Lji- 6.00 TEMPLE COTY 78A038A CE4888• I-61', APPL:ICATIPN FOR BUILDING PERMIT COUNTY OF LOS ANGELES ABU DD EISS / .DEPARTMENT OF COUNTY ENGINEER BUILDING AND.SAFETY-DMSION LOCALITY JOAN A. LAMBIE.,C.OUNTY ENGINEER NEAREST ,WILLIAM.A:JENSEN, SUPT OF BUILDING CROSS ST. 'Q'LI ! 1 C3 1'l4 DISTRICT NO GROUP TYPE �'��/j P OC J3Yol FOR APPLICANT TO FILL IN �r O ONST...1�- _ BUILDING. / I STATISTICAL CLASSIFICATION, .SEWER MAP ADDRESS- S �•�I C n woclE� elg<l - B+V 0 LLAS.S NO. DWELL.UNITS LOT NO. L� CF5 i O 43 BLOCK WATER NOT REQUIRED - RECEIVED _ - CERTIFICATE:-._ �i�LL..JJJ ___ TRACT:: - Y' --... ' • moi{ MAP HIGHWAY STATE MAJOR,SECOND,.LOCAL SIZE'OF LOT f*?OY`I DS �DOX7a NOW ON'LOTNO.OF S r/ US ZONE -SPECIALN 0. LEI USE OF _ // - CONDITIONS - EXISTING BLDG. - TEL: ? .� OWNER .� L. NO.CYT6ZJ BUILDING - EXIST. ' -1. -Ir• / - SETBACK YARD HWY STREET NAME, WIDTH" ADDRESS ✓3 S' G� C✓ /. �(1��j e- FRONT , ." �l 11!510 /}..}"I ARCHITECT OR -- TEL. P:L. lz /1/(/ ENGINEER NO. SIDE P.L. ADDRESS TEL. INSPECTION.RECORD - O CONTRACTOR NO. 09 'ADDRESS - DESCRIPTION'"OF WORE u Lu a NE ADD ALTER REPAIR DEMOLISH -- - - h SQ.FT. / A �.l NO.OF - NO.OF ? IZE ,� her STORIES FAMILIES USE OF - STRUCTURE' •Q SIGNATURE OF df C^C•KT - - APPLICANTX - - ' VALUATION$ �OCJ I - ., _ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. _ - PMT. � IL FOUNDATION: LOCATION _ FEE_ . .FEE $ /Vi &,o FORMS,MATERIALS - FRAME:FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 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. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- J q TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- INGTO WORKMEN'S COMPENSATION INSURANCE. LATH.EXT. - A1`tn�k' ��� �"���- �•° SIGNATURE OF HOUSE NUMBER COR PERMITTEE_ , Pecl1� �" !/-/-}��C�'G®SGC-a--,Q RECTANDPOSTED ADDRESS.. FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EcNE PLAN CHECK VALIDATION CK. M O. CASH PERMIT VALIDATION' CK: M.o. t. I • nn / , . iie "WORKERS COMPENSAT. r'; . .. ION DECLARATION -, � � , I=F erebyt affirmRhat I havea,certi icate-of'consent to self insure';or a`certi.icate of Workers 'Compensation;)Insurance A P_PLI T;IOIV F` KR .:� JILDIIV:C� IP.EKM.JT •R or•a:'certifd co thereof Sec.:3800;.Lab PY ( ;Ft )�,;,• COUNTY OF CLOS ANGELES BUILDING=AND SAFETY'- 'ef, v CO -rPolicy:No ompany 7:. y, Gertifi e d copy is.h .. BUILDINGFORAPI ANTT ;ereby, FILlN_ BUILDING ,:. ❑,..,Certtfred copy;is,filed with the.county buildmg,mspec .., �' A, ADDRESS a'tion:departent:F m � a �p CITYLL-,_ r' 'ZIP r LOCALITY f 1 t✓ ? Dated%GLApplicant � .` O.'O_F BLDGS +, NEARESTs CER7IFIGATE:OF,EXEM,PTIONFROM:WORKERS: ~ p_x, SIZE`OFLOT:'..`' CROSS ST , ° t r COMPENSATION`INSURANCE + ASSESSOR Mi . z NOW ON LOT r a ( pleted rf the permit;-is for.one TRACT BLOCK LOT NO w AMP-gOOK PAGEt PARCEL This section nes k: ed -hot, coin hundred I rs do la ($100),ar-less ) �y E OWNER �." �t/: k USE,-ZONE% MAP. S.� �4 �• �Ci/IQU F: L,certify that-_in'„the, erformance.of the.^work;tfor.which.This ”' - : p „ ;= ' ', 'SPECIAL } permit;lsissue&;1''shall,notempI y�anypersoninanymanner ADDRESS-0J• rC�SG- E L�Q so'os,to become-subject'to the.Workers'Com ensation.Laws. CONDITIONS " O y I rap °11 CITY, .G ..1.'r�^Tl•:'ZIP, U - ,-, -, Datelicani. L .SGG�/f'CL ARCHITECT OR_ TEL _•, „ PP , DISTRICT GROUP .TYPE s FIRE ,PROCESSED BY :,NOTICE TO-APPLICANT: If,'°after,makm' this Certificate'of .- ENGINEER NO` 't ZONE Exem',tion;.:`: ourshould .become. sub'e_ct:to„the -Workers ” h , P. Y, .� I �� Com ensation- rovisions of:the Labor,Code ou':must''fort'R :. ADDRESS--, d 't P.,. P . ..Y., wi1Fi,,'comply;-with such:.provisions or Th is;permit--shall,;be /^ 1 STATISTICAL'.CLASSIFICATION APT.-. CONDO . •deemed revoked.:.; :', r CONTRACTOR',_-C 'R.` �LV ! � a,.. ,r } 3 ,:.^ v' ,, ,. CLASS'NO' DWELL. UNITS -`LICENSED:CON TRACTORS DECLARATION. e . O I herebyaffirm.that-l;am'licensed•:underprovisions:of Chapter`9 ADDRESS" . •6 `LIC,` a :- (commenang with:Section 7000)_of Division 33of,'the' si S*",.'. �! _. and Professions'Code'and m aicense-is in:fulhforce eft t: CITY, : Y. CLASS, -�Gs .': ;', VALIDATION SEWER MAP Y BK PG d r,.: SIZE,,;- STORIES - i FAMILIES ONE .. Y SQ,FT NO NO ,OF HECK 'License.Number � 6 b Lic Class ,... { DESCRIPTION OF WORK,'= B�~ t / n �y p NEW ,.,. ontraclorL'ti"rQL' 5��� s3 �";�/ •7� ` ' � u ,ADD ,❑, A TION• ❑ dlJ� I.am exempt under`Sec � S �� B.BF C. for,-this reason $ :t ALTER ❑° 2 �` REPAIR USE.OF Date. EXISTING BLDG r- `MMOL"'❑ ' Si``nature -rp APPLICANT rz TEL' Li z x• 9 (PR NT). FINAL >' OWNER-BUILDER',DECLARATION a NO? r.r DATE D-•f j (iG C T �' • b, •.,. nse ,. r I:he�eb affirm-that I am'exem t from the Contractor s Lice; ADDRESS •'.:'.•. :'.'• Law..for the following season (Section?'7031.5,­-Business and %FINAL ..•, 19�_� '+ Professions Code) By PRESENT n x x ❑ -I; as owner.of th'e' property, or.,-my employees with , ' ; ADDRESS' x i 5 r' wages as theirsole compensation,•will do,'the work and =- - u t • e' 4d . ,. . LOCALITY. '. i .L•T,'s' !the structure isnoYintended or offered for•,sale(Section „ g µ 7044;•;Busmess and Professions'Code, x :•- MOVING TEL , I as ner` f 1 ' propert'? x 1' I i CONTRACTOR' NO ; tt - ❑ ow., ,o he' - _•y, am,e.c usrve.y contract ng r with'licensed,contractors-.to-construct the.' ro'ect; 5ec P I #4t tion 7044, Business and..Professions'Code,.), ADDRESS A , z ::REQUIRED.: i, TOTAGSETBACK FROM,..., EXIST, r .'- . TlltfL „? ' , =� rr: _ CONSTRUCTION,LEND[NG AGENCY-, Fln --:- ,YQRD,,; HwY. ,.'- PROP.ZINE.:-:, 'WIDTH• 1,hereb'y,affirm;,thatthe�e„is a construction-lending agency for - ., 9�_. t,the performance of,theework#or-,which;Thispermit is-issue(Secy M97 Civ. :(-� (7Lender's Name.o ,.. ; r P•ermitFee ('- LDAAA Lenders Address = J�t 47111 F(}I certif. 'that lc'have-'read this;a” licatian,and state•-that,the = > LDMAP/C#,Ypp :, `t at., Issuance Fee' ..above information is'correct;Pa r'ee-to'com I :with all Count n Feeordinances and:State'Jaws.relating to 6uilding_:consTruct�on s :. ;Toial':Ne- _ :LDMA�Perm. # t a hereby,' representatives.of this County to enter upon,The above-mentior ed>p pert`.for inspection_purposes -' j ; I � /� 4- �C 6, SEE REVERSEyFOR EXPLANATORY LANGUAGE .,aS. - li . - Signature'of Applicant or Agent •-Date . - s APPLI,CA IT • COUNTY OVLOS ANGELES BUILDING ANDSAFETY: FOR APPLICANT.TO FILL IN xx. WORKER'S COMPENSATION DECLARATION s _" BUILDING ADDRESS BUILDING �� I here. affirm hat I have a certificate of consent to self insure vt �•��(� esEC � or a certificate of Workers-CompensaUonansurance;or,a certified ..copy,thereof (Sec 3800, Lab.C` ZIP = -t fi , :V 3 r. .. CITY_ , .LOCALITY Policy NO:' ^' - ''Company''' - '' _ "'' „ '-s SIZE,OF•'LOT•�. NO OF:BLDGS,NOW�,ON.LOT-,'• /- - - _ °- - ... .- ',ts; - - - - REST'CROSSST. ❑•Certified copy is hereby furnished " ,. 'xNEA ��. r . - ,,.. TRACT :- .BLOCK LOT NO"..- - ❑'Certified•copy is filed With:the county_building,inspection _. . , M departmen£" " „USE ZONE P NO + ASSESSOR MAPBOOK• "PAGE•- - - -PARCEL w Date Applicant ,. 539g D%9 k -. " •-' + S�CIA CONDITIONS:-, .: OWNER .TEL NO. NDI a^:. YES. O 3 L GO CERTIFICATEOF EXEMPTION,FROM WORKERS i�• No , <- ..COMPENSATION INSURANCE �//�. scrooL� '1:JCl9�V .WITHIN 1000 FT.,OF, . •- 3 ". a - -. ...r ,. (This'section'need not be Completed if the permit Is,for'one�hundred ADDRESS ��,�� e „DISTRICT'=< '"GROUP TYPE'CONST FIRE,ZONE. PROCESSED BY dollars ($100) or'Iess;} .r ' "CITY _. - certify that;m the performance of,the,work.for which this permit ,a ZIP. ...< , - _ Is issued,il shall.not.employ an p y y person in any manner so::as do ARCHITECT OR ENGINEER ,t - TEL•NO: 3 • •- become:subject to the Workers-Compensation Laws. ', =- -STATISTICAL CLASSIFICATION APT.. CONDO Date_'"' Applicant _3 ADDRESS: fir_ TS .:. '..:. -- _- .f CLASS NO DWELL UNI NOTICE<"TO' APPLICANT.,. If;.after making this.,Ce-rUficate, ,of" ' - REQUIRE '' TOTAL SETBACK FROM 'EXIST • .�.: ; - TEL C SET BACK .> =::YARD, :'.HWy-c-.;.. Exemptions`you` should,>°become..subject` to.,';the' Workers CONTRACT,O T PROP LINE ^,WIDTH Compensation•provisions,of-the:Labor.Code, yolatmust forthwith %��/a���' :FRONT t comply-,with`such,pro'yisions.or this permit;°shall be`.de,emed•revoked .' gDDRE$S ' = LIC.NOr. -t "P L µ.. +^k. n, _ _.'.. SIDE . • LICENSED CONTRACTORS'DECLARATION CITY� �-' - -�,- LIC.CLASS P L'�:''� . I:,,hereby•affirm that I am licensed'underprovaisions of'Chapter g"- SEWER MAP (commencing with Section.,7000)of:Dlvisioh'3,of the Business.and ,.SQ:FT.SIZE.'. ..- NO:.-0F'STORIES�:. NO..OF'FAMILIES - - .,., . ' Professions Code,and my.license;is m full force and effect -- - - .;DE RIPTION ORK -.VALLI _ Q NEW ❑ •PG'- License Number. Lic.Class h ADD ❑ Contractor Date;.:.' -.ALTER ❑ cc REPAIR ❑' �' ❑ I am`exempt`under;Sec. B.&P,C.for-this reason DEMOL -Y # W' :Date h.; URM' ` ❑ LDM USE OF. BLDG .8w.- - A P%C Signature ` ``�- _ .•_ •- CANT(PRINT)•" - TEL'NO, ., irLDMA Perm# APPLI ii ❑ I,"as.owner of the property or,my employees•with wages as F . —fin z C.Tas {/ their. solecompensation, will.do•'the work,and,the'structure is. ADDRESS � e . _,., -�:• p7 c� 'not'intended or offered for, (Section 7044 Business and �'� �e-�e� SI�a- FINdL DATE G .��D '; 1eJ�a Professions Code.)'.' n ` _ WILL THE•.AP"UCANT'OR FUTURE BU(LDINGOCCUPANT HANDLE A HAZARDOUS MA RIAL - _ CMS+ , .. OR A MIXTURE CONTAINING A_HAZARDOUS.MATERIAL EQUAL-TO OR GREATER THAN_THE (J v - J - �TC.i iJ,-•. (] I;; as owner of the property, am.exclusively•cbntracting With AMOUNTS SPECIFIEb ON THE HAZARDOUS•MATERIALS INFORMATION GUIDE?, FINAL_BY T A "r fu _ licensed contractors to construct'the project-.(Section 7044, i,�Tt7L �'+ M g �ES NO Business and Professions Code.). 182.55,;'" .WILL-THE-INTENDED,USE OF THE BUIDLING:BY-THE�APPUCANT,OR.FUTURE_BUILDING-f _ - EL��' - ATION'FROW THE,SOUTH _ ° _-. -- -, ., _ OCCUPANT REQUIRE,USE OF FOR CONSTRUCTION OR. rr{{�� L•T7 CONSTRUCTION.LENDING'AGENCY'. ' COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD).SEE PERMITTING CHECKLIST�FOR�' r hf(�� ;Q0 llV .G , UIDECINES', ' .-- `. I hereby affirm that there Js a cons tructipn.lendirig'agency for Yes(]``•No-❑, -f °i'A` + ' '- - `>' e l•� the performance of the work for,which this,permif is•issued'(Sec: .• f rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND,THE SCAQMDPERMITTING { J (] 3097 Civ.'C.j • y. CHECKLIST. UNDERSTAND;MY REQUIREMENTS+UNDER,THE LOS ANGELES COUNTY;CODE, p gJ /7,C ,� :TITLE 2;CHAPTER12.20'SECTIONS 2.20.,100 THROUGH,2.20.140 CONCERNING,HAZARDOUS ., .��� _ } �V LenderS Name - - MATERIALS REPORTING AND'F,OR'OBTAININGA:PERMIL.FROM THE SCAQMD [)o o; Lenders Address - 4 OWNER OR AGENT uF `° 242& 1 Af'I o,'• '(,certify that ( have-read this application ar d<state under-penalty E• - - P.C.FEE. : PERMIT FEE - of perjury that the above Information Is correct.l'agree to comply N with alt county ordinances-and''State.laws`relating; to building r 's c • constru tion',:and hereki authorize re resentatives of"this-Count SSUANCE FEE ` y: p y ``Q� :_. ¢000-oQo 1 9/22/,9 c a,, to ente i e ab A-mentioned property for inspecti pur ses ` "' INVESTIGATION FEE - -TOTAL FEE. - �429 g, L :� C < CSO SEE:REVERSE FOR EXPLANATORY_LANGUAGE - � " AP_PLI PION F . . . IJIL l IT . -': GOUNTY;OF COS ANGELES_ .,:BUILDING,AND SAFETY r _ .,. ,, � ^- :.BUILDING.ADDRESS-' - WORKER S COMPENSATION DECLARATION w FOR`APPLICANT.TO FILL IN r ..n: ,'. ...:..,'c. - BUILDING AQDRESS. I hereby affirmthat Ihave a certrflc` of consent to Self Insure-, nn' or,a cer,,tlficote.of Workers' Compeh's#oijnsurance, or a cert ied copy thereof(Sec 3800,'Lab C), :< CITY ZIP - r LOCALITY'. ..- ' ',': •Policy'No -'. "CompanyGS NOW-0N LOT - s:> . SIZE OF LOT NO OF BLD - - - Certified copy,is hereby furnished ST "r fi ., : : •- i.. _Ghon TRACT--. ' -- . BLOCK � LOT NO - - - Ce tl ed copy Is fled--with.the, county buddmg nspe, ti c ,USE ZONE S'MAP NO � OS department. 4 ASSESSOR MAP BOOK PARCEL'- ,. ... Date_".:. ?PPlicant. , ,>` ;� ,� SPECIAL CONDITIONS ^: :,., ... . OWNER.r'3- ',.. _ - `:YES"-. ,N CERTIFICATE OF EXEMPTION`FROM WORKERS TEL NO, . �- •, .. t. .:. ., HIN 1000 FT SOF`SCHOOL?- . .. ,. COMPENSATION INSURANCE _ , - ..-" .:r, , -,i' _.;r ., -.c .•• ,.-r•." .ADDRESS- ' ,r•.. ..,;»". .• :. '. ., : WIT •. ,,' O• .,.- (This secUon need not;be+completed._rf the permd Isforone hundred, : ,•'DISTRICT: . .GROUP' TYPECONST.. FIRE-ZONE ''PRO ESSED BY• w dollars (:$100)�or-less 1, ,.*.. W �. . .CITY` zip CITY' - - I.certify that in the'performance of.,the,.work for'which this pe ymd s issued I shall not `employ any person in any manner so as"'to- -- ' : " - - c- F .ARCHITECT OR ENGINEER -,°- - TEL NO. - ,•" beCOme�SU )ecnq othe Workers"Cor�b s Ion v�s ',' - - STATISTICALCL"ASSIFICATION. AP CON �.. /1 ,,� IO O. �. !. ' CCvv����aa--,, CLASS NO. DWELL UNITS' Date Applicant \ Q�T'�i"[. ADDRESS. a` NOTICE :TO' PPLICANT. If,. after .making', ihls .Certificate'°'of' ' REQUIRED' TOTAL SETBACK FROM EXIST Exemption,', your.,should become': subject"'to .:.the •:Workers `CONTRACTOR ' TEL NO; ,,SET,BACK, ;YARD, " HWY` ROP LINE_ WIDTH ,Compensation.provisiohs of the;-Labor=Code,`.y0U_musV forthwith "J•�/lf^� FRONT' P :Complywith;such.provisions'or.this permit;shall bdAeemed revoked.-' -` ADDRESS` LIC'-NO.: , LICENSED CONTRACORS DECLARATION, J " ' SIDE' N-• - .ATION! LIC.. CITY, - -LIC.-CL SS,• TR .Thereby affirm that1,am licensed'underprovisions of Chapter:9. SEWER MAP ;a i (commencing with Section 7000)of.Division 3'of the Business and.. .SO..FT.SIZE :�- .NO OF.STORIES. ', .NO'•OF.FAMILIES;-: -•- - ' ' - Pro fessions'Code,and'm ,license'is:in full force and effect r '' EK PG Y, NEW'. ❑ ' DES RIPTION-OF WO _ ApD.- ❑, VALUATION • - O Llcense'Number Lic Class , s + Contractor -Date �' ri CWctr ALTER ❑t "'$ �' P OL Ej; I am_exempt.under Sec. Y REPAIR ❑DEN a ' B:&_C.for this reason ' ' K qOL Date USE of xI�71NG BLDG > E �. URM" ❑ ' e (n Sighature '• �. LI d� T).,`!-' + TEL NO, - LDMA Perm�# D D *" ` APP CANT(PRIN " ❑ 1, as owner,of the-'property; or m em to ees.with Wages as "- s4 rY P Y 9 ZO .t744 1 ADDRESS - •..: thea sole-compensation, well do the.work.and the structure,Is:' not intended or•offered for-sale (Section'J04'4, Bushes''and :^ FINAL Professions-Code):.: BUILDING „. TE '. :. WILL'THE"APPLICANT-0R-FUTURE OCCUPANT HANDLE A N AZARDOUS MATERIAL DA -OR A MIXTURECONTAININGA HAZARDOUS'MATERIALEQUAL TO-0RGREATER THAN THE owner' of the .property,'am'exclusively contracting with, _ �' AMOUNTS.SPECIFIED.ON THE NAZARDOUSMATERIALS INFORMATION GUIDE? BY OR gyp. ( _. E.,.• TOT licer sed contractors to construct 'the pro Section 7044 1, !ttL z4, Business and Professions Code:) a ipp WILL.THE INTENDED-USE OF'THE BUIDUNG:BY•THE APPLICANT OR;FUTURE BUILDING ',CHECK:', ,• 1VV a,1O `," :- ,. - ,_ •' •". _ ,:: OCCUPANT REQUIRE A PERMIT FOR ODNSTRUCTION'OR,MODIFICATION FROM THE'SOUTH - ,••, CONSTRUCTION�LENDING,AGENC.-`�/ ' - -: COAST,AIR QUALITY:MANAGEMENT.DISTRICT'_(SCAQMD).SEEPERMITTING CHECKLIST F0R•�� - 00 :..r. .-. -..., •:.,GUIDELINES.,.:,. _ it - :'1 e b fieri by.affiem,that there:is:a construction'lending,agency.for. -YES❑ No the"performance of the work*for which thIS7-permit is,issued(SeC I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING m: 3097,'Civ.C.) _ _ ., s •. '=CHECKLIST'UNDERSTAND MV.REQUIREMENTS UNDER THE-.LOS•ANGECES�COUNTYCODE,. 1 JDC �, 'r ,., ',TITLE 2,;CHAPTER,2.20.SECTION$'2.20.100'THROUGH2.20.140 CONCERNING HAZARDOUS°; ,� 1 l 77 Lender S`Name MATERIALS REPORTING.AND FOR OBTAINING A PERMIT FROM THE SCAOMD: la� AM 10a C . , am-�216p ,{ oLenders Address. o.. , .OWNER OR�AGENT o.: I'certify thaCl have read this appI&tlon:and stafe under,penalty :' _ .,.� ,,,.:.., ., P.C;'.FEE ''•_PERMIT FEE of perjury that the:above informatlon'is correct:l agree.to,comply r - 6" • ,with all county,ordihandes and<State'-'laws relating'to.Ibuilding, "` `C7 �. construction;and hereby,authorize+representatives of this`'.County' "5 ISSUANCE;FEE to eJr po they- e,mentioied property for Inspection purposes. ..'L 1-1 Y..V 'f I .,. - r IIMM P9 t, INVESTIGATION FEE'” ` 'TOTAL,:FEE,`, 'r Si, ur., f APpi cant.or e} J SEE,REVERSE FOR EXPLANATORY LANGUAGE' . ' el 'i� r.. • j OFS'ANGELES IONFORDU PERMIT_ PPLICAT DINu ILDING`AND SAFETY. COUNTY' BU WORKER'S".COMPENSATION QECLARATION' "i • ' '," BUILDwG ADDREss _,•.,a.: '� .:.'t...•:- :,:. - `� 'insure BUILDING,.ADDRESS FOR;APPLICANT TO FILL IN I.hereby,affirm,that i,have a certificate of consent-to,self Insure, or;a,certrficate;of,Workers Compensation-Insurance;or" certified; '' y^ .:.CITY - =ZIP. copyahereof(Sec 380Q,Lab.C.) r ' t • Policy No: Company S' o. - ,SIZE OF LOT -:,� � � NO-OF BLDGS.,N ON LOT"`',� ' ❑ Certified copy'is•hereby furnished. 3:U LOCALITY 11 EAREST Certified copy is filed,wif the count ,buildin -inspection TRACT _,BLOCK;' ,LOT NO ,. ::. ,r.,....,. .. , y 9,,.:', „ ' .� !. '\USE ZONECR S-MAP NO. i department ,' ,l,f .^r C „. G , ,.. OS •a `-, ,a. '�ASSESSOR'MAP'BOO ?'-PAGE PARCELf'•,� k: Date- Applicant o w �8 - SPECIAL CONDITIONS -N CERTIFICATE OF^EXEMPTION..FROM WORtKERS "' / a ; OWNER COMPENSATION INSURANCE ' ''• .. (y,{-r"m�' ✓7fR`"� �©• WITHIN.7000 FT OF SCHOOL? YES �a NO ' .. ,'., .':':a... +,. .'. 'r,... `..-.r'. .:.ADDRESS' :T - I (This se'iion need,not_be completed 1f the.permd Is for one hundred - , ,•� a 4,.,.C •r C...-.�{.. DISTRICT', •GROUP TYPE CONST FIRE'ZONE PRO ESSED BY dollars ($1O0)fbr.less`) ' .,.., •.' g, . .r.' CITY- ARCHITECT S ZIP - '�:.�• I;certify'thaJ+in the performance of.the Work for which this p'e`rmit S _ Is issued,'-[ shall,not-;employ anyzoerson in;any manner so as �• !, ARCHITECT RENQINEER'- ,-. • ;; TELeNO. `.r'-- _ - becomesublectao"the Workers',Compensaiion.Laws: `. � /-` � STATISTIC CLASS; �ON•.-� -APT.'-"• CONDO',r. cc„°✓ `,.,. off- Sr -' Date- - - -Applicant - - .ADDRESS. °'+',• t• ° CLASS NO'_'DWELL UNITS' ZI } .-.. .- - .. w•...„ `. n...� -` .NOTICE.-TO APPLICANT.. If`::after-makrng this'Certrficate �of� � � � - , _ � 'REQUIRED' � . TOTAL SETBACK FROM �:EXIST Ezem tion' OU" should.'•:become'. -subecta to:, the=.. Workers' CONTRACTOR .,-. ^ •."'� '•TEL;NO' SET.BACKYARD "HWY'_ PROP'LINE WIDTH P Y 1, Comperlsatiom provisions.df the.Labor,Code, you;must forthwith `�/iZ�1-f!�1 r` ' t - r .t FRONT •f comply;with-such provisions-or�this"perniii'shall'be,deemed revoked ADDRESS`- N.•-' +< uG:No: ' . _ _ Ik,T p s ' LICENSED CONTRACT.O'RS DECLARATION ' sDE . . I, - .PIL . .�ti t4 •,,i,,'ov - - - _ •, rCITY ,�� " LIC CLASS _ ';. I hereby_affirm=that I ,am,licensed"^underprovisions,aof'Chapter 9 - � - '(commencing with Section,.7000);of-Divislon"3.Of the Business and, S .T:SIZE:, .s: NO.OF STORIES NO OF FAMILIES:, , , " NEW ( , BKW� PG _ . R MAP Professions Code,and'myrllcense is.,an cull force and effect =DESCRIPTION OF'.WORK - •' _ -_ VALUATION O License Number• Llc Class ADD ❑ s t- L L O „ Contractor.., Date = . <.,; �, 1 C'. �>ti ALTER ❑ � ;.. REPAIR ,❑ y L�-t - �. ❑ I,am exempt:under Sec. B.&P.0 for this reason A -, - : USE.OF EXISTING BDG."' Signature` .. ,_ , • ., .. .: -, - LLJ LDM P/C# - � �^l ,, APPLICADYT,(PR/NT),. - _w '`-,..TEL•NO. ;- LDMA Perm#c �•,,,, r �- c 1 �. F I; as owner,of,the` roert or_.m em to ees'with:wa es-as t- �''j� 0� " '^ Z4.x ^ i. . ADDRESS. _ _ • eir sole:compensation, wlll•do the work.andahe structure is. - ••. ''7 `�- — '� 7 S^{.v2-'I' �C,�LGcp� .Sl-. l� 16. FINALDATE O '.not intended or offered for sale'(Secfion 7044,,Business and Q "3 neB .:, Professions Code.) �-{ t `'r p WILL THEAPPLICMT-OR FUTURE„BUILDING,OCCUPANT, A HAZARDOUS ATERIAL , ' I - ORA MIXTURE CONTAINING,A HAZARDOUS MATERIAL•.EQUAL TO OR GREATER THAN.THE- •' - - "- a.e-•, ❑ I,:as owner'of the property,'am exc usively' Contracting with .E, ,�. „ - - g AMOUNTS SPECIFIED'ON THE HAZARDOUS MATERIALSINFORMATION,.GUIDE?'.; - ` -., `�"�_;� FI licensed contractors to construct.the. prolect (Section 7044, NES❑'` No NAL BY, ; Business and Professions Code.) f,., OFiTHE BUIDLING BY THE APPLICANT OR FUTURE:BUILDING - - - -1JI-I'� k r4 WILL,THE'INTENDED;USE J'Fi.t.s. -C OCCUPANT REQUIRE A.PERMITjFOR;CONSTRUCTION OR;MODIFICATION FROM THE SOUTH - - •”' CONSTRUCTION_LENDING.AGENCY COAST'AIR QUALITYWANAGEMENT DISTRICT(SCAQMD)-SEE PERMITTING.CHECKLISR FOR r f��. .. -GUIDELINES.'• "I hereby affirm that:there,Is a:_construction'lending.agency.for. 3 'p _ .,.`. :. ,• - ...• ...:._ c. .,• YES' NO❑:- - "�'i.kx+. �+i I"�I l 3"i L i N' tfie°performance,ofaheworkforwhichthfspermitas,Issued{Sec 'r- -� - -I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PER `.m. 30971', Civ..C:j _ M T E CHECK� °. � r „- -y:, �= .- ,.,, . �.�--" � :1' ','�CHECKLISTI UNDERSTAND'MY-REQUIREMENTS UNDER THE LOS ANGELES GOUNTV,CODE, 1 J t TITLE 7,CHAPTER:2:20 SECTIONS 2:20.100-THROUGH2.20.140 CONCERNING`HAZARDOUS, - � Lenders Name _' `- MATERIALS REPORTING AND FOR OBTAINING A;PERMIT FROM THE SCAQMD. IGE o'; Lender's Address :. ,: -k 1, .. n - , • ,, 'OWNER.OR AGENT, .., J tID411 o 'I certify that have`read this,application'and state•urider`penalty: • o. _ .,, , .; .. - 'I PC FEE.- .". - - PERMIT, ,. s ..1C,_ of perjury,that.the above informatiomis correct:I agree,o compy 1(I )1 _I f y,t , ' C _ 1 , with, all`county' ordinances and State,laws°relating'to building `•�� ¢• , construction an&hereb 'authorize representatives:of' his. cunt '" ' -•'` "` - ^.ISSUANCE.FEE-'n, - 3 `� 'T •'-` "�-:��' m.. YI Y t _ to to up the e-nentioned.'property'for inspecti n u oses. `: O p !;fid INVESTIGATION FEE :TOTAL FEE ^ ( 59 atiir (APPI ntar A9 i SEE,REVERSE;FOR:EXPLANATORY LANGUAGE. WORKERS' COMPENSATION DECLARATION I-herebafirm tcertificate Inaofassureorayertifcate of Workers' surn APPLICATION FOR BUILDING PERMIT or a cer:fied copy thereof (Sec. 3800, Lab. C.). COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING E] p c Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS s-/ G�•o_re_M e- ❑ Certified copy is filed with the county building inspec- BUILDING � S2 tLeo�L Q jvd� . S tion department. 7-7 - 1 {o Cct 7 —4;, ` Dare /� CITY ZIP ( / LOCALITY Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST . CROSS ST. �)1 V . COMPENSATION INSURANCE ASSESSOR Q? (This section need not be completed,if the permit is for one TRACT BLOCK LOT NO. MAP BOOK 5-3bb PAGE t%n /7 PARCEL � 0 hundred dollars ($100) or less.) TEL. USE ZONE MAP �- OWNER Q NO. I certify that in the•performance,of the work for which this NO. permit is issued, I shall not employ any person in any manner ADDRESS S �8�lk2 ��'�- 3 SPECIAL �/ CONDITIONS so as to become subject to'the Workers' Compensation Laws. /� / O CITY � c/ - ZIP 7 7{o U Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT:'If, after makingthis Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PR ESSED BY CONST ZONE H Exemption, you should become subject to the Workers' Z - w Compensation provisions-of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. 'CONDO. N deemed revoked. CONTRACTOR Z NO. CLASS NO.�DWELL. UNITS LICENSED CONTRACTORS DECLARATION LIC. 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 w Contractor Date DESCRIPTION OF WORK NEW ADD ❑ s'� eel ElI am exempt under Sec C - ALTER ❑ --• - B.&P.C. for this reason D REPAIR ❑ $ i Date: USE OF EXISTING BLDG. DEMOL ❑ A Si nature APPLICANT TEL. _ g FINAL 7 3;; (PRINT) LO e 2 NO. ?O� -: OWNER-BUILDER DECLARATION _ DATE J'- _ Z ,.. °T'-' I hereby affirm that I am exempt from the Contractor's License ADDRESS (T/.Z(//U• CLLGcA/ �` ( ^" - z Law for the following_reason (Section 7031:5, Business and FINAL ,' • Professions Code): PRESENT ByBU LDING ;i- )f _ t, I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and `'" f L? the structure is not intended or offered for sale(Section LOCALITY pool -. A.i='- 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.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY s;z r,.. !rt ° 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 Name. LDMA Ref. # Lender's Address P.C. Fee$ �O A� Permit Fee a 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee, oordinances and State laws relating to building construction, Total Fee �� / LDMA Perm. # a and hereby authorize representatives of.this County to enter upon he above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of AVP icant or Agent Date •s .� - ANORKERS'COMPENSATION DECLARATION _ - - hereby affirm that I have a'certificate of consent to,-self insur.06 , certificate of Worke'rs:.Compensdtion Insurance :.- PLICATI:OIl1 FOR:' �UILDI�V=G PERIOl11T or a t�rtifiecycopy (hereof Sec 3800- Lab C ( ) COUNTY OF COS ANGELES BUILDING AND SAFETY ' Pokey No Company k ' Certified copy is hereby furnished. FOR,APPLIC_ANT_TO FILL,'IN ooDREss ❑ Certified.copy is_filed with'the'county building inspec L /itE Drt �Z. .'' tion:department BUILDING q DDRESS 7, ,� .. .may' -'7 / k CITY:<C~/�L Z 9J' !'768 .. :•Date APPlicant �� ZIP` C` LOCALITY N z 2/� NO:OF BLDGS., k NEAREST 'r .CERTIFICATE..OF'`EXEMPTION FRONT WORKERS SIZE:OF LOT ' x_;.iJ7 NOW ON LOT S NSATION INSURANCE f CROSS ST (This section''need�oi'be comp , ASSESSOR. 7 leted'if"the permit is for:one `I,Y,y. TRACT g`31'3' BLOCK LO7:NO. �' hundred dollors;,($100,)'or less ) - t ':: TEL: MAP BOOK, PAGE PARCEL USE.ZONE MAP I certify that'in The performance,of.the:work for'which'This ' 8'W), OWNER NO: nl/ permit,i issued;I,shall.not:em to an erson.in an' manner, ADDRESS - E"Lf�Gr'" =G pa ' :�/ L ECTAL :� �• � P P Y Y P. Y'. ✓' - CONDITIONS so as to become suk j'ect to the,Workers' Compensation Laws n : - CITY '� C/* A�i '. G/T 'ZIP I ' >. [✓ Date Applicant i ARCHITECT.OR, ��i �t TE `' ! '1 NOTICE TO-APPLICANT: If,;after makin .ihisfCeritficate,of r: ENGINEER - /r/ler7•- "'NO." 3 V DISTRICT" GROUP. TYPE FIRE4PROCESSED,�BY O9 CONS ZONE0 Exemption, you shoul:d•.become subject o'..-the Workers , Q7t! w O /. Compensation:provisions of-the tabor Code, you:must+foith- ADDRESS :/ '. Al' C � ;' �• J� , „- with comply- with such,•provisiona or: this permit shall'be TEL t� STATISTICAL.CLASSIFICATION APT..' CONDO deemed revoked ;- L. CONTRACTORGLONO.'; 6.S 7 , LICENSED CONTRACTORS DECLARATION, ` ' •� } ADDRESS _ �L.I{ N 1 SS NO. LIC.- CLASS DWELL. UNITS hereby,affirm that I•am licensed under,provisions of�Chapter9 NO.._ + (commencing:with Sectionr7000)of Division 3;of the-Business �': �_n /` l— -LIC.S SEWER MAP CITY o,N +"'� '--3• !`i CCASS ;,?,.`�_(,t. VALIDATION and:Professions Code•and my license ism full force'and effect BK. `_- PG SQ..FT:' s' NO.OF NO. OF T ' tiCHECK p Licer se'Number' Lic: Class SIZE v' STORIES - �t , 'FAMILIES:�,t',_}moi? •ONE, r ON VALUATI " • i.. . ' DESCRIPTION OF WORK NEW ❑ J'3 Coritractor Date .,. _ A t f >. y O1�G `.�/T�`�G ADD.. ❑ ..+ ACCT a ❑I'amexempt under Sec. R �� -- r B:&P C, #or.this reason - -7 i ALTE L I t �`Jb Li REPAIR a, T Date: USE.OF" . . � 1 ITEM!; �i 1�' EXISTING BLDG. CEJ _ DEMOL n ' Signature APPLICANT . TEL _ 11Tri „�-` :OWNER-BUILDER DECLARATION} iEi (PRINT). NO. �� �''� hereby affirm that Lam exempt:frorn the Contractors License '-, a � a , 7 FINAL 'Law:for the .following reason {Section 7031.5, Business and FIN Irl Professions Code)::, PRESENT C O- - [I. :. Iv. l_ tt.ai 5 ,� '� _eY• ✓_� 307` �� .5 1' ❑ I, as owner of the property or my.employees with o ADDRESS " y, ��1 �, t' ' wages as their sole compensation;will-do the work and O { 'E' _ z tlle,struct're is not intended'or.offered for'sale(Section �y1, 1 LOCALITY F � Gl ,} t �t 1 �. t t_<: 92 7044', Business End Professions bode:) j y :�s �.• MOVING TEL: - Tat ss r t `If _ owner.of,the ro ert am exclusivelycontractingCONTRACTOR`., L: f l t t NO C� `, IJ;51. ;'with license l'contractors.to construct the_prolect (Sec " ' y' tion 7044, Business and Professions Code:.) fi" 7 a; CHANGE a ADDRESS M �•Lj ri } QUIRED TOTAL SETBACK FROM• EXIST= YARD HW ` t CONSTRUCTION LENDING AGENCY SET.BACK PROP LINE WIDTH I hereby affirm that therelis a construction lending agency for FRONT.: the performance of the' for whicFithis permit is issued F.L." ,. ti`• t�tOU-Ill1�,1 1f iI'?t�: (Sec ::3097 CiV:'C ) SIDE ' Lender's Name.' R° o - _ m Lender Fee$ 01 :? Permit Fee P C. (v;/� s Address CDMA-Ref. # � r a 1 certify that-I`have read this application and-state that the µ Issuance Fee ` �:• CDMA P2# ' 8 above information'is correct.(l a'g`ree to comply with all County--, w ' Investigation Fee n N, ordinances and State laws relatingr to building -construction, ? Total`Fee v.� / > iDNA Perm. # and"hereby authorize-representatives of this.County to enter upon th ab'ove=,mentione� property foe.inspection purpo es .' _. SEE REVERSE FOR EXPLANATORY LANGUAGE ' CJS 7� _Signature of Applicant or gent Date -. - ' s V_wvAPPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADORUS hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS q or a certificate of Workers' Compensation Insurance,or a certified S O " copy thereof(Sec.3800,Lab.C.) CITY ZIP ^t 7-7 V LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. or ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date Applicant - - ASSESSOR MAP BOOK PAGE PARCEL`'', SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. . COMPENSATION INSURANCE ,B r_0_o WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS dollars ($100)or less.) 1 C' v D DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY ZI00 I certify that in the performance of CITY P the work for which this permit is issued, I shall not employ any person in any manner SO as t0 ARCHITECT OR ENGIN 11 R TEL NO: become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFI ATION 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 t0 the Workers' CON ACT 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 P L O U 1 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 El 1 1: BK PG 0 License Number Lic.Class DESCRIPTION OF K ADD ❑ VALUATIO , U W Contractor Date ALTER ❑ $ CL ❑ 1 am exempt under Sec. REPAIR ❑ $ Z BAP.C. for this reason DEMOL k LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) - TEL NO. LDMA Perm# AC'C'T_$ ❑ I, as owner of the property, or my employees with wages as Z ,W'" l n ( their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DAT a j ITEMS P fessions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 2 0 A p q OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J -1 TOT t"fL -9 38 g 0 I, as owner of the property, am exclusively contracting with FINAL BY AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, _ l; f;�: j fi 10 Business and Professions Code.) YES 11 No❑ t_r o WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING •� HANG OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �• �;-1� Ii' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. ' I hereby affirm that,there is a construction lending agency for YES❑ No❑ the performance of the work for which this permit is issued(Sec. 000 0-0001 1/226/96 3097,CIV.C.) (HAVE READTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, V I N.I. s+7 1 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS _ 4'•1•C 1,! P !.I.2 Lender's Nagle MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address CC GWNER-OR AGENT 3 _ 1 certify that l have read this application and state under penalty F F" 0 PC FEEPERMIT FEE. p of perjury that the above information is correct.I agree 4b:c8mplya „ - X", ' with all county ordinances and State laws relating Ito, r . M construction, and hereby authorize representatives of this County ISSUANCE FEE to enter th above entioned property for ins ti pur ores. 4 3'0 d - •,,,I �Ct..�(,. SIh4,VESTIGATION+F;ETOTAL FEE l .,�- / a igwlure of Apd�canl w Agent Dale ,r a' '� SEE REVERSE FOR EXPLANATORY�tANGLIAGE ti 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'917,80. - BL 050.8.'1210100055 PHONE: (626) 285-0488 EXT: - - LEGAL ID: NO. ,OF CONST BUILDING.ADDRESS: ON FILE - SQ. FT STORIES. TYPE.. 5116'ROSEMEAD BL - ,STRUCTURE: + V-B _ TEMP'CA 00000 - (ASSESSOR INFORMATION NUMBER: - .,1. NEAREST CROSS STREET':- , 15388-019-030. - - ( ' THOMAS PAGE: 596 '.'GRID: HS LOCALITY:. TEMPLE�CITY', C TENANT: _ - IEXIST BLDG USE: CHURC USE ZONE: R-3ISSUED ON PROCESSED BY - EXIST: OCC GRP.:.. :az. 110/10/12 :.SR -. .. (OWNER: .. TEL,. NO. - IBLDGS. NOW ON LOT,:. - VALUATION: ,I FINAL DATE FINAL BY: CODE:. _ ISEVENTH..DAY ADVENTIST CHURCH, JESUS (951) 8.92-4243- - _ 2,500 - 15116 ROSEMEAD BLVD. ISAN GABRIEL CA 91776 _ I FEES PAID - IDESCR.IPTION OF WORK - - (INSTALL UTILITY POLE IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: (_ } - APPLICANT: TEL. NO: SAME AS OWNER - IAA BLDG -PERMIT ISSUANCE 27.80 I . . f - IAB STATE GREEN BLDG FEE 2500.00 VAL 1.00 IS EOIAL COND TICCC���TTTS` Dl PLANCHECK W/O EN-HC 2500.00 VAL 84.20 �� - Q - - D2 PERMIT W/O EN-HC 2500.00 VAL 99.00 �-u z r�. ,, - - _ TOTAL FEES 212.00 CAAM-Vi il (CONTRACTOR: _ TEL. NO: " - APPROVALS_� :DATE INSPECT R SI ATUR ISAME AS OWNER -- LIC. NO I .. ILO CF" N AND SETBACKS ,, - b - - SOILS ENGINEER APPROVAL L (ARCHITECT OR ENGINEER: TEL. NO: - U'QDAT ON/TRENCH"FORMS I LIC. NO: I _ SLAB,/UNDER FLOOR - - - IRAISED FLOOR FRAMING (MAP NO: SEWER MAP BOOK: PAGE: FIRE .ZONE: CM-: J �IUNDERFLOOR.INSULATION I - I144H265 . 3 0C� FLOOR. SHEATHING .� INO.;OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: _ 0 - NO 21 _ - i ROOF,. SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR'PANELS. - (AIR QUALITY: 1000 FEET MATERIALS .. - NO NO NO (.FRAME INSPECTION , FIE SPRINKLER HANGERS ;. INSULATION/WEATHER STRIPI� _- .'INTERIOR LATH/DRYWALL. ' EXTERIOR .LATH RATED FLOOR/CEIL ASSEM,- �. _ - RATED WALL ASSEMBLIES JRATED SHAFTS/OPENINGS . T-BAR CEILINGS - I I.LOT DRAINAGE - .. IREPORT'.ID: DPR261 ROUTE TO: BS0508 .- a