HomeMy Public PortalAbout5410 ROSEMEAD BLVD_Building__ DIVISION OF BUILDING AND'.SAFETYNGJk
Depart6ent of County Engineer �i � UILDI' Li
r ' Couat}y� of Los Angel' V
FOX,. COUNTY; ENGINEER P `APPLICATION
BUILDING_. '.. • -.->. .:. t
® eta �Sc3C
,::FOR.�P�rc�rrr_To_FILL:nv . . -, C-
• ,� . ADDRESS ._ =.7�';I�
ADDRESS 5,44 6_ - -
LOCALITY_' �:•(.� iy"�"'!a. �!•L ! 7 ."+i 'CROSS STe�'3✓\C^ ?
DISTRICT NO PLANCK. oR REC.=No PERMIT NONlEAFiEfiT
.
CROS!
OWNER OIV�R- Cl "i'Ie-s R.-MAIL,
EIVED'BY DATE,OF APPL DAT ;ISSUED
2 ie )
TELAL
ADDRESS IrJo :..l.G�. _ .'- _. _Ir-a e. ..1✓� .. "��. ..
I FI
'y jUSE ZONE I�NO OF - TYPE GROUP ,FEE ZONE
CITV" �I.: NO P. aJ 7s PLANS I •T., _... ;I ' :•.: t. ..
ARCH►TTE
ECT-OR; ' - L:- •. 1 ZONING:.- �-;__ _✓ DATE
fes, # _ D
-°ENGINEER" NO.: . ..i ..r,.: € e,. APPROVEDBy..:.,'
F'
—ADDRESS
SETBACK.., • . ., . , CLINE. t , N `
BUIL'DINORD.'.
I(4YI.t9
fr TEL.� - APPROVED' DATE
CONTRA
CTOR [m ®'
HOUSE{ NUMBERING s
ADDRESS
`LEGAL <'' t 1 MAPNUMBER ' NO.,ASSIGNED BY \•�
DESCRIPTION LOT NO - 1 ', BLOCK
" DATEINSPECTOR
TIONS
- .,.
:'TRACT p ` r -
NO .OF.BCDGS." �, � 'aD. t��f;d� 41` Zv:�7 .. F`1j.°,S'Ev� ��I' °ptUG IN E. ..
SIZE OF LOTL7Q �t� , NOW-ON i:OT
USE OF B .. . . ,.g.
..EXISTING' LDG.. W/� T'c® �4®... ::..-I .FAMIOLFIES.
DFSMMION OF WORK , ( t U " ` `%S///�'�%�i^�.'� , Com''.5 •�/u�.�_i'
NEW ALTERATION... •�� ADDITION. ,
REPAIR .DEMOLITION
SIZE 4ot -:-ROOMS,,.. 6 STORIES: .I.:fn::I'17 .' «4-. a&rh - 4C 0�t"_'i'
EXT. WALL. qw _ROOF
COVERINGI� COVERING' el
''USE,OF'. TRUCTURE
APPA r VALS
" - �' INSPECX'OR'S,SIGNATURE. _ DATE
- •. - - ♦.,... .�: :;, FOUNDATION: LOCATION
'µ FORMS,...MATERIALS7.
1,HEREBY ACKNOWLEDGE THAT-1,HAVE READ'THIS AP,
FRAME:
PLICATION AND,STATE THAT'THE INFORMATION GIVEN IBS. - '
CORRECT.,
r -.BRACING," BOLTS.
•I AGREE TO COMPLY WITH ALL.COUNTY .ORD�INANCES1,. "` - - -
AND STATE LAWS-REGULATING-BUILDING CONSTRUCTION-.: FURNACE:.LOCATION �.
.. GAS VENT: DUCTS ..., --. y•. .,. ti: ,
SIGNATURE.OF _ _ LATH, INT..� -
_.PERMITTE. .,�' .. .<.
ADDRESS `.. b/' - -
IL. LATH, EXT.` '
PLASTER,- INT ..
,-'AUTHORIZED�AGT.
, Q
PLASTER,'�P..C UI BER COR-
FEE, .� <. ,., HOUSE N ,
RECT AND'POSTED
FEE g FINAL
,
2753
f �
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76A638A CE#803=63'APPLICATION FOR.BUI.LDING PERMIT .'
COUNTY O LDS ANGELES ADDRESS
DEPARTMENT
�
DEPARTMENT OF COUNTY ENGINEER' - AD°REss
,I
BUILDING AND SAFETY DIVISION LOCA11TY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
-'WILLIAM A. JENSEN, Sup•r OF BUILDING - CROSS ST. �' Elb
DIST IC INK. OUP TYPE '� a D B
FOR APPLICANT TO 'FILL IN coNsr.'� �v �
BUILDING STATISTICAL CLASy`IFICATION SEWER MAP
ADDRESS 0 p. //., 7� K`- PG/
'CLASS. NO. `f' DWELL. UNITS
LOT NO. .BLOCK <� WATER ' I�I,,
si CERTIFICATE: NOT.REQUIRED I?CI RECEIVED 1:1TRACT � - MAP ll /'. 'HIGHWAY GHWAY STATE MAJOR SECON LOCALS '
NO.OF SLOGS. NO. �!r ( RCLE).
SIZE OF LOT o NOW ON LOT i'/�. USE ZONE SPECIAL
USE OF - CONDITIONS '
EXISTINGBLDG.
TEL
OWNER ., l /'o NO f y
/ BU L ING EXIST.
SETBACK WIDTH
YARD HWY STREET NAME'
'
1 ADDRESS y ��. �[L FRONT ✓ (/ ,
ARCHITECT OR I TEL. �7 P. L.
ENGINEER � /- NO.! �,c,��' SIDE
ADDRESS - _ - O.
�
`CONTRACTOR r NO.
ADDRESS
DESCRIPTION OF WORK
NE ADD ALTER REPAIR DEMOLISH . �� A �/p/,gyp//J Z
S FT. NO: OF NO. OFI/ +Y �7 L'iPU (�
SIZE 90 FAMILIES I
USE OF/ _ •K � 'r �i -/�
STRUCTURE
SIGNATURE OF �� .�Cn� e./•J�,. `�..,' IJ R .�
APPLICANT
VALUATION $ ad rt 4 rF
APPROVALS '�j'DATE INSPECTOR'S SIGNATURE
FOUNDATION:.LOCATION,
- P.C. /`}-�� � PMT.' C.�d a `
FEE $ e 1.! v FEE $� G, ��. FORMS..MATERIP:LS '�"';,A,«�.Ldji .,
FRAME: 'FIRE S P
D /
I HEREBY ACKNOWLEDGE THAT I,HAVE READ THIS APPLICATION. BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS (/ " I.
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN'VIOLA- LATH, INT.
TION OF THE LABOR CODC OF THE TATE OF CALIFORNIA RELAT-
INGTO WORKMEN'S COMPENSATION, SU
11 RAN
LATH, EXT.
SIGNATURE OF / HOUSE NUMBER COR-
PERM ITTEE
OR-PERMITTEERECT AND POSTED `,D 'I� ' l'��:• �. `P
ADDRESS .j7 ' FINAL'
1.J
+ JOHN F. LEWIS. PR�INCiPAL'STRUCTU RAL ENI.NE
PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION CK. M.O. ` CASH
L 0 0 F Eta .42 3 D 1 1 b
0 V
6 1 4 1..110MAR j 1 D 2 2.0 0
r Y !.
DIVISION. OF BUILDING AND SAFETY I .
Department of,County Englneer ,
Oounty'_of Los Angeles `
WM'.'J. FOXY;COUNTY ENGINEER
,. ' APPLICATION
FOR APPLICANT TO FILL`.IN FOR,OFFICE USE ONLY
DISTRICT NO. PLAN CK. ?R.Rt ;No PERMIT N0
SuiLD
� ��e� 6��ryy .0k
1p g•- y�
ADDRE99.s,J, ,4b/� f. �0F'�'6t�?^,i"��71 bi4i :' ,.,� ......�..... "t �Ac.�d
, {{ +yam ��yyp ��mm •,.
RECEIVED•BY DATEOFAPPL'} DATE ISSUED
CA
LOLITY is a
,,
iNEAREST
`..CROSS ST.. Tom.' • -F`R BUILDING` _
r•. ADDRESS "`� {'� Q ^`IV
.
OWNER''w ,+ �' :�✓�$ .. ice, /.
MAIL.
LOCALITY ' 1 �I �-^�•- �"� � �d,
tom_ O E _
ADORE r f NEAREST
( ' y''^g •TEL .,.� " ;`• G_. 'CROS3:ST ('M
a
CITY, NO.::NO �: .,a. � ZONE'" .',..I1 PLANS No.or" TYP '}.) GRyC.+LJP
'ARCHTECTR
'TEL
ENGINEER NO . - • B'- _ .
1�i •.,; - {'
O�rR'D .D
SETBACK LINE •'`
ADDRESH s
USE,°.° APPROVED .+ryry �^
. : !`TEL {` ZONE `'BY '� ".OATE}..'ro SA`
CONTRACTOR ' L),�•,,;;,t iV_ . ' NO. ,HOUSE,+NUMBERIND -
:.I .'
C3
MAP.NUMBER` . NO:,ABBIGNEOSY "
.. ,
CORRECTIONS
.: GAL'
.•; .-,.. - -
LE
DESCRIPTION I LOT NO. BLOC
i K
.TRACT. ''A'' fes. `,•
NO. OF-SLOGS
�y v
61ZE,.OF LOT {' pT�}- � p.',i ` I NOW ON�LOT t ..
,,..USE OFA' ..��1, 4'?n i- I FM lO E9 ''' )
EXISTING BLDG.,'J•
�;., . `..•DESCR=IPTION,OR��WORK •:... � ,;'; " . . � ::� ',C.
�[ r :
NEW'-` ALTERATION - ,ADDITION f��7 Ij
a
..REPAIR.' '; "DEMOLITION
t
6Q FT. „ NO.OF '
rr y ”
:SIZE'•c:' 1� /' '67r.; ROOMS ` '.BTORIE9
vF
EXT.,WALL � _ *. I. COVERINGp
COVERINW. cA.USE Of-STRUCTURE
L IS
-INBPECTIONFOR a - _ ! ' p APPROVALS
OCCUPANCY AS - `"-= INSPECTO 'S'BIGNATU DATE
R
FOUIVOATION: LOCATION
r MTERIALS;
F„ORMSA
I HEREBY ACKNOWLEDGE THAT 1 .HAVE READ THIB AP ' - r
.PLICATION AND STATE'THAT.THE INFORMATION GIVEN IS : FRAME FIRE STOPS ' r
CORRECT.` 'BRACING,_BOLTH
I.-AGREE TO COMPLY WITH ALL,COUNTY;,ORDINANCES `,4C
AND STATE LAWS REGULATING BUILDING CONSTRUCTION R
FUN E .
i z•
. LOCAT N'
• F ,x' GAS VENT, DUCTS R
t _
--SIGNATU
141
REE OF Y '� LATH., INT Z
e J'�F t'�*` .t � '• v.ry LATH EXT e
} !};ADDRESS
�{ �:.; PLASTER, INT.
...AUTHORIZED AOT
' PLASTERS EXT •`i ; �
N''� P:C.S ' V f
F4 HOUSE NUMBER COR
EE
' 'RECT AND POSTED'. � } :
'VALUATION FEE FiN'AL i
� 7EA636A�,'D953•:`1-52
DEPARTMENT OF.•BUILDYNG AND:-SAFETY
COUNTY-OF.LOS ANGELES. pMV1 k C j '
U.. FOX,'.CHIEF ENGINEER APPLICATION.: �x t
. . SE NLY` �
FOR APPLICANT''TO FI'LL'-IN." F R'OFFYCE U
- O rD f -
D15TRIC PLAN P.N CK.,OR REc':NaO BUILDING-
"'PERMIT N
-ADDRES3
REC VED_ BY DATE;OF APDL: ,DATE ISSUED --
,LOCALITY Teyn p'- (� :1 r �, ; '
NEAREST
"C(2DS551`WC.:V�� :1'.\�� R "' � UICDING
T Bz '0 '�(,
.OWNERt�l�'V1.C.✓�L 't_` r -/yam -.
MAIL pp��,,tt c. ^ ...LOCALITY _/ .GLr'
ADDRESS IS ID/ -..�� S�.V'C•',V►:8��1� y' - ,NEARESTE ' .
TEL�,�/1-,y/.c
CITYT�� .V If r L'11'.~.Y NO./7/ io . FIREV-17. ' •I NO OF I T TE -
ARCHITECT OR, L. -
ZONE PLANS
ENGINEER ,* W'vl V NO. - BLDG. v
-
_, ... -'.
r t
.,.i j- .. .. -.. SETBACK>'LlkE & �7,,i "` •I
CONTRACTOR - TEL. ' ZONE:. 'BYPRDATE� a
NO. '. t G
LI$E
VE
D MBE
-ADDRESS / MAP.,NU MBER
LEGAL," 4 ¢"CORRECTIONS 1 • t ;.F
<` DESCRIPTION LOT NO F. ^BLOCK
TRACT J
y.
N'&.-`.OF BLDS. J�//�}y� .;ti
l,.i-�t�� 5?91'T}. -�.,t e
ZE,OF LOT' ISO 1r. 4 D G
L•NOW ON-LOT: /,y il
USE OF •' NO.±OF To - ��'; ®�,Q t -`�� - .
EXI5TIN BLDG. 'I F4i(L1Es
DESCRIPTION OF WORK '
/c Ism'
+Q
ALTERAT,ION ADD_ ITION -. 2.
REPAIR DEMOLITION
9GI FT:., NO:OF
.•91ZE1- D.O. ' -ROOMS STORIES J V
��COV ERiNQ' �.�.J'V C C�}. ".I ,CDYERING�Q+ "(L°�w,f
USE-OFSTRUCTURE
er"c`.�
w n�rid�,pp /assts
APPROVALS
OCCUPANCY r'a- .:
,,. .. . � �• � � _.,_ ,;r,-._IN3PECT.OR,'S,SIGNATURE ..:. DATE.- -
FOUNDATION: LOCATION
:,FORMS.•MATERIALS
I;HE REBY„'ACKNOWLEDGE'THAT I CHAVE'R' EAD THIS AP
PLICATION AND STATE THAT THE"INFORMATION ,GIVEN Ib PBS s�=' Il.�•,.� -
L� ,!
- FRAME "FIRE STOPS,
^
'CORRECT - - ti BRACINQ:BOLTS. - i .., 3
7 v •';
Z':^1'AGREE To COMPLY.WITH ALL COUNTY=ORDINANCES.) / ;V,-%
-
,ANDfSTATE_L:AWSf.REGULATING B UILDING-.CONSTRUCTION ,FURNACE:'LOC^TION, ,
r. , .GAS VENT. DUCTS;_. .
*SIGNATURE OF�VvRO M ii - LATH, INT
le _.: -. - .. � { C,D. � LATH'. EXT ' i.": •+ -
SD
ADDRESS. .., .. ,. .^
.PLASTER.-INT - -
`.AUTHORIZED_AGT._ `�` - A --
-, PLASTER-EXT.' i - -
P.'C
HD$ _ -
�y
E NU BER OR
p-O FEE ^. .. U5 M C p s
r;RECT AND POSTED'
FINAL- :.:...' f•-,F-^f'l•.�" ,tG�'(�7' C/
76A63BA DBB3 7.51'-. - - .�• ..
76A638A CE#,6O3 6 62 APPL.ICA'l"1_®"NFO.R .E,UI.L®ING. PEERMIT
'COUNTY.OF LOS :ANGELES` ADDRESS,
1
'DEPARTMENT' OF COUNTY ENGINEER ADDREsS.
BUILDING AND SAFETY DIVISION, LoGa�ITY \�
N '
.'� JOH •A.;LAMME, COUNTY'ENGINEER" :, s'� NEAREST — -
-- WILLIAM A.,JENSEN;SUP•T.OF;BUILDING. - ," 'p; GROSS ST.. -
.. - DISTRICT+NO: GROUP,"TYPE`- P -O .E - ED,e Y .
' FOR APPLICANT.TO FILL';IN
ONST.., - ..:
B,UILDI'NG ` ..�. S-TAT. I$TIC4;,L:CLASSI F�CATION
;-
'.SEWER MAP
G
DWELUNITS.ADDRESS CLASS. NO_
LOT .
. -
NO. I BLOCK •WATERNOT,REQUIRED. RECEIVED
TRACT- /OC_ - -_. .MAP CERTIFICA IVED
� HIGHwav-'
. _'..,. NO.-OF BLDG$._ NO. Q=� ''(CIRCLEY - ..
TATE AJR.SECOND LOCA'
O
SIZE OF LOT' �J - NOW-ON LOT, - USE ZONE 'SPECIAL• _
--.U$E OF-.' CONDITIONS.,
EXISTING BLDG!
�`
,
TEL.- - a
-:OWNER + ��, `�C NO BUILDING
''YARD HWY STRE NAM - EXIST
- SETBACK_ ., -WIDTH,
ADDRESSS .. �Lr' O'�,�• - FRONT
ARCHITECT OR .TEL -` _'.P. L. .Q •��cf'.TJ �'
ENGINEER, :. -ND,. 'SIDEell (L
.
ADDRESS - i r, O
rEL .. -
CONTRACTO - V
ADDRESS `_�` .. t1 L„�
r
O
DESCRIPTION .OF WORK: - W
EL
NEW - 'ADD ALTER I.REPAIR DEMOL
SQ: FT. ,: ..-... .NO. OF.'. NO. OF. + (.. .; ,. .:.`. _
SIZE STORIES FAMILIES _ -
''USE OF- -i - - -
-STRUCTU'RE -
$,JGNATURE Q
APPLICANT
,'VALUATION,$ �j�' 7 `. ' Z.
APPROVALS
DATE INSPECTOR'B.SIGNATURE -
'P.C: .-. PMT =.O -
;/1-��- F. UNDATION:,LOCATION '- - `.`• ;,
-.'FEE $._, -FEE $ - "V
FORMS,-MATERIALS,
- FRAME;;,FIRE�STOPS,• -
I HEREBY 'ACKNOWLEDGE THAT I HAVE":READ THIS,>APPLICATION 'BRACING'. -
-AND STATE THAT_THE'ABOVE IS:;CORRECT AND'AGREE TO,COMPLY FURNACE-:' LOCATION
WITH ALL.•,COUNTY,,;ORDINANCES -AND- STATE LAWS.'REGUL-ATING ,-,1 GAS VENT, DUCTS
.., -
<,... _
a
.' BUILDING,CONSTR UCTION...I^"CERTIFY THAT"IN.DOING,THE 'WORK- ,. .. . _.. .. ,. '
,-
AUTHORIZED HE BY I .WILL NOT EMPLOY ANY PERSON,IN VIOLA -LATH,'INr. '
t
-TION OF THE-LA OR CODE• OF THE STATE'OF CALIFORNIA RELAT"
-,ING TO WORK1.ME 'COMP.ENSATION I�NSU RANG LATH EXr. '��
SIGNATURE OF i ,HOCISE NUMBER-COR
PERMITTEE { `,RECT AND POSTED• _
ADDRESS- W i FINAL-
JOHN
INAL
J PRINCIPAL
F. LEWIS. ST.R C URA( ENGINEER
PLAN CHECK VALIDATION cr. M o. cnSH r CK.` M O. CASH S
."PERMIT MIT VALIDATION
DEPARTMENT OF BUILDING AND SAFETY 1, APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
t DISTRICT NO. PLAN CK.NO. PlERMIT NO.
BUILDADD EIBS 5410 North RosbmeadL,ww,,, sT ;4-• 7
LOCALITY Tsmple City. Californj, RECEIVED BY.. DATE OF APPL. DATE ISSUED
BT
CROSSanes Drve ' `
CROSS BT. LDQii • s �
Concrete
.r - 4 BUILDING
CSpecialties
OWNER oncrete. S ecialties' Co. ADDRESS.,.. l --•`•-`��'* ;�.•!7 itt �s -
MAIL
ADDRESS 5410 North Rosemead _' LOCALITY
NEAREST ff a
TEL CROSB ST.
CITY Temple City. Cal. ND.
FIRE NO.OF TYPE-- - GROUP
ARCHITECT OR TEL. { ZONE PLANE
ENGINEER NO.
BLDG. ORD.NO.
A OREHS :LOG.
APPROVED
CONTRACTORNeon Producst NO, AT 268351, BY " DATE
APPROVED
ADDRESS 1240 So. Cha'el. Ave. llhat UBNE.�'� BY DATE
LEGAL CORRECTIONS
DESCRIPTION LOT NO. BLOCK _ ^
TRACT - j '''d+,'.�.. '. - 7. 4,"�'-d
NO.OF BLDGB.
SIZE OF LOT I .NOW ON LOT _
USE OF - NO.OF NO.OF I /
EXISTING BLDG. FAMILIC ROOMH
DESCRIPTION OF WORK o- n/��-p L 1-._'- 7;r.
NEW _ $ ALTERATION' ADDITION f ' )
REPAIR hiOVING DEMOLISH - O
Sq.FT. NO.OF Z
SIZE ROOMS STORIES, _ r
WALL I ROOF ..
COVERING- COVERING. C
USE OF NEW t
BUILDING
Double Face Neon Sign. , (1)
1 HEREBY ACKNOWLEDGETHAT i HAVE READ THIS APPROVALS,
APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DAT
AND-'AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION;: LOCATION -
FORMS,MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION:
�- FRAME: FIRE STOPS.
SIGNATURE OF BRACING.BOLTS
PERMITTEE LATH. INT.
a
AUTHORIZED-AGT_ ' LATH. EXT.
7GA63SA-3 2-SU $ 825.00 P.C.!!F PLASTER.INT.
FEE PLASTER.EXT,.
VALUATION FEE 6.0.0 '. FINAL 06�,��`
`�
MPLE
m
76A638A CE.4803 2-63,.`/-\P'PI_;ICAT-ION .-FOR BUILD]L•DI N,GPERM I.T ,,': "{�
COUNTY OF LOS" ANGELES BUILDING
DEPARTMENT OF:COUNTY ENGINEER ADDRESS •S /�' N,` ,.' �:
BUILDING°AND SAFETY DIVISION LocALITV
JOHN A. L;4MBIE, COUNTY ENGINEER' NEAREST
WILLIAM`A. JE_NSEN. SUPT oF,BUILDINO -,;... '' GROSS ST..'•'
DISTRICT-NO GROUP TYPE .'PROCESSED B , .r
='FOR.APPLICANT.':TO,,FILL IN coNsrar
BUILDING '' - STATISTICAL CLASSIFICATION SEWER;MAP - +
ADDRESS. C/'-• -,Cet2.-:' _ BK
- CLASS.,NO.��DWELL}UNITS
LOT 1NO. '6LOCK' " " WATER',
CERTIFICATE: NOT REQUIRED RECEIVED
TRACT'.• .' (r. MAP HIGHWAv .: .
O. OF BLDGS. / NO. —�0�� .,(CIRCLE)- STATE AJOR;SECOND LOCAL
N
SIZE-OF•L'OT,','� '�' NO_W ON_,LOT ( `USE ZONE. SPECIAL
USE.'OF CONDITIONS';'
,•.EXISTING.BLDG. - - .P /� �/ /; ,.r •, ;; i
TEL. '7 .f V, ( �_ I ..,- ':'
OWNER,
- .+NO. 717 'BUILDING' ' - _ EXIST.
'YARD -,HWY STREET NAME
_/ SETBACK_ WIDTH.
ADDRESS -,'Z Gs. B.. L�G7' FRONTS-+.: '. -
-:ARCH.ITECT`ORIEL. P. L :I'• m�,4%�•c t.q- ���.
'ENGINEER --LL NO./ SIDE
ADDRESS •"� i f1 e OL .P. L. 0-
.-T
EL.
,:'TEL. -
CONTRACTOR• NO , ^
ADDRESS V .
DESCRIPTION OF .WORK � F "'
NEW�.. ADD- - 'ALTER., REPAIR DEMOLISH._
SQ. FT. :v NO. NO. OF ...}
SIZE �Q •.4ES FAMILIES
USE''OF - -
STRUCTURE - A - -
',w
SIGNATURE
OF' - - r hlg
APPLICANT
VALUATION. rj' D-_�
AFP ROVALS -,;.DATE .� INSPECTOR'S SIGNATURE '
P.C. ,, PMT.. �y.p FOUNDATION.-LOCATION .�
,���-`' FORMS;,MATER IA'LS--`
FEE S FEES - -
. FRAME: FIRE STOPS. _ ;,-
I HEREBY ACKNOWLEDGE THAT, I HAVE READ.THISAPP.LIGATION -.BRACING,-BOLTS'
...�
•AND.STATE THAT THE.-ABOVE 15 CORRECT AND AGREE TO.COMPLY - '-
FURNACE: :LOCATION WITH. ALL COUNTY ORDINANCES AND.STATE LAWS REGULATING
GAS'VENT. DUCTS
-BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE_WORK, -
AUTHORIZED HEREBY I,WILL NOT EMPLOY ANY PERSON IN VIOLA-
'
.-TION OF.THE LABSRCE OlTTHE•STATOFCALIFORNIA`RELAT-'ING TO WORKMENENSATION INSUR CE. LATH EXT.SIGNATURE OF - HOUSE NUMBER COR -
PERMIT.TEE - - RECT AND POSTED,,
- ..
FINAL`,.
.,
JOHN F.-LEWIS.=PRI-NCIPAL STRUCTURAL EN
PLAN CHECK VALIDATION K. M.O':. CASH PERMIT VALIDATION CK.' M D CASH {-
2 6 8`3.
r�liG.1 N
• Lr'�
76A638A,ABS 9 3:•58 L ; • - - - -,
PPLI -BUILDING PERMIT
7,
.. - ' BUILDING
DIVISIO'14-`OF}BUILDING AND SAFETY
..,. • ADDRESS —
Department of"
County Eaglne®r - �®
Countp of-Los Angeles LOCALITY
WM-J': FOX. (tOUNTY.ENGINEERNEARESTE'
CASSATT'D GRIFFIN ySpT,OF BUILDING i .:CROSS ST.
u
DISTRICT NO. GROUP - "TY E y� 3EWBER :MAP
PG
OR APPLICANT TO FILE;IN ,`
�� - IrCONST.. I."
,...BUILDINGS. ,. ,..-, - -.� , .. ' •- - - .P
/p1. MA- -STATE
,ADDRESS: NUMBER•'. -`r.•-••G�./ HWY
.
LOT NO' - - •BLOCK - USEZONE'. SPECIAL ..�
CONDITIONS 1 '"fsslC.n•^ :. �" `•f'`
TRACT . ,, y..�."f r..'g ;.; ._.- ..' '-1 :CE-,✓
.SIZE OF`LOT�/g�.x ��.Q, .• . K NOW ON LOTS 1 . BUILDINGRD_
Y -- - '`.y .EXI,T.
P.L, YARD: �Y STREEpME' ---
SETBACK • WIDTH•«'
'.USE . FRONT
EXISTING iBLDG:'.WLP.�Y-� /`./LII(+ �-7�'_y��..p j /�'
_OWNER6) r:;i_'-e ie -y Ivgcz,,C'1/iit ' ei2 P.L. ,
P.L.
.MAIL. ..�{.� /y .. ;:
ADDRESS /cl� % ,t '- O TRACT-DWELL i UNIT
5 - -
'INDUSTRIAL
7r� ii p \TEL •/� 1 DWELL: 1 UNIT,
.CITY /t�::VJ/J Ia/tom _` 'V.Y)-Y.'` - iNO. /- - :. '.'i ._r ._- 6 .-PUBLIC,BLDG., ....
.. 2 ..DUPLEX'... L-UNIT. ,7 -
ENGHNTECT OR -' ,�TEL. - -- ADDN.ALT ETC. -
EER - NO. - 3I -APT -- UNITS -
- ,- - .
. - 8' `MISCEL. -
, ,ADDRESS 4 :COMMERCIAL.
TEL - - -INSPECTION.:RECORD'_
CONTRACTOR .�w•V1:r� ✓� � NO: � �, '� -
ADDRESS
-' J,,
DESCRIPTION OF`WORK .
�p.-OD: ALTER .REPAIR v DEMOLISH'
5Q: FT. _ NO OF j 'NO. OF
SIZE �` - STORIES `.i / FAMILIES
.-USE'OF STRUC URE- _
SIGNATUREOF._ -
APPLICANT'" APPROVALS - -
ADDRESS �� . - " " -•,' DATE; INSPECTOR'S SIGNATURE;
P.C. $- .F
FORMS, MATERIALStOi'`a �+s �.1. AC.�d/'§BL.�. CA ,-
FRAME FIRE STOPS,
VALUATION $ - BRACING...BOLTS
-1 HERE 'FEE - ,FURNACE: LOCATION, �- -
BY- ACKNOWLEDGE. THAT I ,HAVE READ THIS . 'GAS VENT;:pUCTS`
APPLICATION AND STATE THAT THE'ABOVE 1S CORRECT,' '
AND AGREE TO COMPLY WITH,ALL COUNTY ORDINANCES LATH, INT.p-
AND STATE LAWS., REGULATING., UILD,ING CONSTRUC-,'
TION �. . . LATH EXT.'��. ,. C7 11 , t.-•-
SIGNATURE-0 HOUSE NUMBER COR- ,
" -PERMITTEE '..RECT AND"POSTED .
ADDRESS FINAL
7
Wm.... FOX,COUNTY;ENGINEE.R VALIDATION C. N. RL^AM'.CH1E0F�BLDG. INSPECTOR _
�3 `�; EIP 2 1'
2 5 c 6. `0'
-
WORKERS'COMPENSATION DECLARATION
I hereby affirm tha{;I have-p. certificate, of consent to self �: I �.E RM,I'T
N
insure,:or a certificafie of,blockers .Compensationnlnsurance, ..APPLICATION_ O. B.�.'L®. N G:
or a certified copy thereof`(Sec: 3800, Lab..C.),'' COUNTY OF LOS ANGELES c BUILDING.AND_SAFETY
�j
Polic' h�G�+ "I�Sn�i—Company
w BUILDING. 1
ert fi'ed copy is hereby furnished.. FOR APPLICANT TQ FILL`IN ADDRESS,
1.0 U
BUILDING . 1 -
CertifiecJ
copy.is filed with the county building•inspec ':a ADDRESS• O C vt7`' f
on department:.
!V/'!7►'� 177 ..wld/V 1 f� CITY,:. e'/ ZIP LOCALITY,.
DateJ0�1�y� Applicant NO. OF BLDGSI
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' " SIZE OF LOT :'NOw'ON,Lot CROSS_ST
COMPENSATION 11NSURANCE
�,, ASSESSOR
.(This,'section.- d"not,be completed if=the permit;'is for one TRACT' BLOCK" LOT N0. MAP BOOK PAGE ^ PARCEL•
hundred dollars,($100),or less )• TEL. /
v OWNER tr NO: a/f uSE ZONE'' MAP
s : NO
I certify that in`The_performance;of the."work-;for-which this' "; �^/ SPECIAL '
permit is•issued I shall not-employ any person:in any manner ADDRESS CONDITIONS'
so as,to;becomb subjeet•to the Workers:Compensation,Laws �' C
city- e f .zip 3 °4
Date. A licant ARCHITECT-OR TEL., /!i ...
PP .., r
NOTICE:..TO APLICANT`.•If, after making,'this Certificate.of _ ENGINEER /9 j1') --: NO: r0�. j G ZONE.-
_ Y
DISTRI ROUP TYPE PROCESSED B
o.. CONST , v.V
Exemption, you should; become,:subject o, the'Workers' w
Compensation.provisions of.the Labor•Code,-you must forth ADDRESS
with.,amply =with such.;provisions or^,this permit shall be y.' EL.3w STATISTICALCLASSIFICATIO APT: CONDO.°
deerrt'ed revoked i. y� ri, Z
CONTRACTOR /V /.".' .l� f NO. (�
„ LIC _ CLASS NO r�r2 DWELL. ITS
}
LICENSED CONTRACTORS DECLARATION ADDRESS C1 �IS� � '1� 6u✓C %U
I hereby affirm that I cirri- censed:under provisions of,Chapter 9 :11. - SEWER:MAP`
(commencing'with'Section 7000)of"Division 3 of the'Business, .' nP off,.
r
and,Professions.Code,,and my license,is in,f611 force and effect EK PG. V
CITY.. O(�CJ `�'
.
SQ. FT '., NO. F / NO:OF " CHECK
/ SIZE STORIES FAMILIES ONE
License.Number'!� jLic,Class ^Y •
•
VALUATION
V wrn I� Jl� DESCRIPTION'OF WORK_
? L_ NEW =
Contractor Date ADD ;
I am exempt under Sec
N I ALTER
,B`.&P C for this'reason <'_ /V / REPAIR $.
Date USE OF
EXISTING BLDG `DEMOL ,
Signature APP
LICANT' TEL::�/U, '' FINAL `
:(PRINT). V Y NO. O
OWNER-BUILDER.DECLARATION DATE
I hereby affirm-that I bm exemptfrom`the.Contractor s;License ..
Law'for'The following'reason-(Section'7031:5, Business and IN
ADDRESS A
Professions Code): . PRESENT _ BY-••L
Z c!S
BUILDING
% ' 1, as owner.of the property, or;my;employees with ADDRESS s '
wages as-their.sole compensation:will do the work -
the'structure'is,not intended or,offered:for,sale(Section LOCALITY '
7044,'Business'and Professions'Code ) - E
,� MOVING TEL t
•>• ' CONTRACTOR
_ I;as.ownerof:the:property;+am ezdusively-_contracting t� I
;•with licensed-contractors tO..construct.the�.praject;(Sec- - "•''• '� y'. - -
aion'7044, Business and Professions Code.) r 3 c
ADDRESS
REQUIRED.. :TOTAL SETBACK F.ROM44' EXIST.. _
i YARD'%,' HWY
"`,CONSTRUCTION"LENDING.AGENCY;'• SET.BACK PROP. LINE WIDTH
I Fiere6y affirm that fhere,is.o construction lendirig agency for. FRONT
the'performance'of the-work for which.this permit is issued P:L:
SIDE
(Sec: 3097; Civ. C ) � .:' r. _
^
Lender's'Name.
;:
m " Permit Fee, t ,t l
_.�� ,CDMA-Ref. #
3 Lender's Address
- this'a lic6tion and state That.the r Issuance Fee : LDMA'P/C# `
r
I certify,that I'have read pp '
a
above information is correct, Lagree"to comply:with all County Inv'e'stigation Fee
o ,;ordinances`and,State;.laws:relatingSiq•buildiog construction ;. = z Total'Fee LDMA'Perm. #
a dnd.hereby authorize re
mpresentatives of this County to enter �I
r
�, u on the above-men loved property.•for inspection purposes.
� I I
SEEREVERSE FOR EXPLANATORY LANGUAGE.' "
�...
Signafure;of App w or Aqient,,I, Date