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Home My Public Portal About5731 ROSEMEAD BLVD_Building__ WGRKERS' COMPENSATION DECLARATION APPLICATIONI hereby affirm that I have a certificate of consent to self FOR BUILDING PERMITinsure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, L . C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.�1 �� ompony �_/ BUILDING ❑ Certified copy is hereby furnished. —!3 FOR APPLICANT TO FILL IN ADDRESS 5-7 3J Aeas-ee.,eo ,d Certified copy is filed with the county building inspec- BUILDING ✓J77, tion department. �y�j Q ADDRESSdsPhc�i¢ rJ Date _� �� Applicant slw '`� CITY o J Cil ZIP C) LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. ZA S COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL ' hundred dollars ($100)or less.) ! TEL. OWNER cvfd 100 &el&j .NO. USE ZONE MAP I certify that in the performance of the workJor which this SPECIAL !� } permit is issued, I shall not employ any person in any manner ADDRESS V C&A V /r2. CONDITIONS a so as to become subject to the Workers'Compensation Laws. O CITY G/.t, 'd e •4 ZIP U Date Applicant ARCHITECT OR TEL.7! ix NOTICE TO APPLICANT:.If, after making this Certificate of ENGINEER 'T �Q(/S i NO, r DISTRICT GROUP CCONNST. ZONE TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' () Compensation provisions of the Labor Code, you must forth- ADDRESS O �' LeJOt9� �O /�f}0 -� (� 1uJ L with comply with.such provisions or this permit shall be , TEL.7STATISTICAL CLASSIFICATION APT. CONDO. u7 deemed revoked. CONTRACTOR /S NO. 7~157/ Z LICENSED CONTRACTORS DECLARATION I LIC: CLASS NO."DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.6 a A NK (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP � � CITY O)L/�-�F CLASS _ and Professions Code,and my license is in full force and effect. BK. . PG. VALIDATION CHt IZE STORIES MILLIIES ONEK SA License Number A ry a h?O L'ic. Class e y� r `t. VALUATION qp Contractor , St Date --` "�� DESCRIPTION OF WORK NEW '❑ ElI am exempt under Sec. QA!t/---& !�!d//AW ADD ❑ $ � • ALTER poll B.BP.C. for this reason I LL/ 14 Lu Afel4 le A;%,ro Al REPAIR ❑ $• Date: USE DEMOL El � EXISTING BLDG. Signature APPLICANT `` ,,Lt TE-7/9/Y� (PRINT).= TX �Ti�L/Cn'�NO. 7 ^l/ FINAL r �/ OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS 7 1Z 70f Law for the following reason (Section 7031.5, Business and a.0FINAL \/ ; 46, Professions Code): PRESENT By l BUILDING ❑ I, as owner'of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and . t Q. the structure is not intended or o , -� offered for sale(Section LOCALITY -- - - 7044, Business and Professions Code.) MOVING TEL. ElI,as owner of the property,am exclusively contracting CONTRACTOR NO. - with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) -REQUIRED TOTAL SETBACK FROM. EXIST. , CONSTRUCTION LENDING AGENCY. SET BACK YARD HWY PROP. LINE WD H I hereby affirm that there is a construction lending agency for FRONT. the performance of the work for which this permit is issued r ;fir (Sec. 3097, CIv. C.). SIDE -I !i tii_ �.-$ P.L. .. . Lender's Name. '+=i-�j• -r`' riy f!� LDMA Ref.# _ ...._ P.C. Fee$ fJ. Permit Fee O v (:1 ;�;•'•:i ,_I_I Lender's Address I certify th t I have read this application and-state that the Issuance Fee - LDMA P/C# above info ation is correct. I agree to-comply with all County Investigation Fee �! I 1 s Q.� L.1 ) ordinance and State laws relating to building construction, - Total Fee � � LDMA Perm. # - •"• ( and here authorize representatives of this County to enter _ upon the bove-mentioned property for inspection purposes. - ? AN SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Applicant or Agent Date I •; APPLICATION, FOR BUILDING PERMIT` COUNTY OF LOS ANGELE1 BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION 3 �seem �L��, I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS f or a certificate of Workers'Compensation Insurance,or a certified 5- E E D BLVD' copy thereof(Sec.3800,Lab.C. 22 CITY ZIP Ahn� LE '� LOCALITY Policy -70 10-4- S 13 pary -T� .G C I Cn SIZE OF LOT NO OF BLDGS.NOW ON LOT Certified copy is hereby furnished. a'- o9' J NEAREST CROSS ST 11 M. Certified copy is filed with the county building inspection TRACT BLOCK LOT NO department. ��- USE ZONE MAP NO. Date ' Applicant G w 10ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE AMIE Gtr 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.) Je(!,,,Y D- DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED QY I certify that in the performance of the work for which this permit CITY E CAT ZIP)- /Wo �O _• - �LG�L 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 CLnASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 01 oZ 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 c C- 1 FRONT comply with such provisions or this permit shall be deemed revoked.... ADDRE S LIC.NO PL n LICENSED CONTRACTORS DECLARATION SIDE C CITY LIC.CLASS (� PL L I hereby affirm that I am licensed underprovisions of Chapter 9 mc' PAP< u SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES O Professions Code,and m license is in full force and effect. r NEW ❑ BK PG FC - License Number � e 2-Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION ® u Contractor T [LSCc— _Date �� O 9y@ff ALTER J14 $ U ❑ I am exempt under Sec. REPAIR ❑ z $ B.BP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Safi .23 Signature APPLICANT(PRINT) TEL NO. LDMA Perm+F W I, as owner of the property, or my employees with wages as Z 3303 —.2-32 their sole compensation, will do the work and the structure is ADDRESS F �- not intended or offered for sale (Section 7044, Business and FIN61,DATE Professions Code.) VWILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ACC 1 R t OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE '•77 ��yy n(� _��'yy EI 11, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL ,.7. 663 �50 W Lt licensed contractors to construct the project (Section 7044, - °-I Business and Professions Code.) YES 1L ❑ No❑ 33{'� WILL THE INTENDED USE OF THE BUNDLING BY THE APPLICANT OR FUTURE BUILDING ��SLti 145.11 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR 2 ITEMS GUIDELINES. .'- I hereby affirm that there is a construction lending agency for YES❑ NO❑ tIT L 1195 j 6 11 f the performance Of the work for Which this permit is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING q E q u` 3097,CIV.C.) CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. CASH 195°61 OUGH 2.20.140 Lender's Name MATERIAL REPORTING AND FOR OBTAINING ATITLE 2.CHAPTER 2 20 SECTIONS 2 20 100 PERM T FROM THEOSCAOMD.G HAZARDOUS R CHANGE .00 Lender's Address OMER OR AGENT I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE bPERMIT FEE 0000_0001 7/23/96 with 34 all crnthe a as and State laws relating to buildingZZ ° M constructiod he authorize representatives of this County ISSUANCE FEE n/J 7.97 1 AM 9:03 03 to enter up abo mentioned property for inspection purpose 1-1 / d INVESTIGATION FEE TOTAL FEE IF �rpcXuro M AaWw a 0.^te SEE REVERSE FOR EXPLANATORY LANGUAGE C. -7 WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR �U I L D I N G P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Date Applicant CITY ZIP LOCALITY N OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT W ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. WNER USE ZONE MAP I certify that in the performance of the work for wh' is NO. SPECIAL permit is iss-ed, I shall not employ erson in n anne ADDRESS -� a CONDITIONS so as to be om subject to the rkers'C ns n Law . OO ,/ . CITY ZIP Date A— nt ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTIC O PPLICANT: If, fter ak ng this Certi ENGINEER NO. CONST. ZONE �- Exem ion you should become subject to the Workers' �i , / U Co ens ion provisions of the Labor Code, you must forth- ADDRESS ��0 v L��G"� a wit comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION�// J CONDO. N deemed revoked. CONTRACTOR No. G , Z LICENSED CONTRACTORS DECLARATION ADDRESS •4/ s, C. n�ii/�� CLASS NO.c2Vd2' DWELL. UNITS ys., I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business Salr-e IC. and Professions Code,and my license is in full force and effe t. CITY ,/� CLASS BK PG VALIDATION ` SIZE STORIIEES I FAMILLIIES ONE VALUATION License Number e Lic. Class VALUATION Contractor Date DESCRIPTION OF WORK NEW $ pf/" t ADD ❑ pop.El I am exem rider Sec. ALTER ❑ � /1 B.&P.C. for this reason REPAIR ❑ = $ J�J Date: USE OF EXISTING BLDG. rDEMOL ❑ /y Signature APPLICANT TEL. �� FINAL OWNER-BUILDER DECLARATION (PRIN NO.. DATE ° I hereby affirm that I am exempt from the Contractor's L' riser Law for the following reason (Section 7031.5, Bus' ss and ADDRESS S • /�/!/ FI 23 Professions Code): PRESENT r..,, By ACCCTov BUILDING ❑ I, as owner of the property, or m mployees with ADDRESS tiJJ wages as their sole compensation ill do the work and the structure is not intended o ered for sale(Section LOCALITY 7044, Business and Profes ' ns Code.) MOVING TEL. ❑ I,as owner of the pro ty,am exclusively contracting CONTRACTOR NO. with licensed contr ors to construct the project (Sec- ACCT.� ADDRESS ;.I i� 98.63 tion 7044, Bus! s and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. ITEM' CON UCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm at there is a construction lending agency for FRONT the perform ce of the work for which this permit is issued P.L. TOTAL 1.'_0 a 34 (Sec. 309 , Civ. C.). SIDE P.L. CHECK 150 .34 Len is Name P Cl TDMA Ref.# (.H� (�� .130 $ P.C. Fee$ /7� Permit Fee !1 � Lender's Address •• lo. I IIINRI- certify th have read t cation a s to that the Issuance Fee LDMA P/C# above! rma ion is car t.I e to comp) th all County Investigation Fee / 0110100¢-0001 $!12/921 ordi nces a Sta ws ing to buil i construction, Total Fee (O LDMA Perm. # o ?Pon or' re en atives of t i ounty tp ent r ' '_ ►;973 1 AM 9:15Pon e a ve- entio a pro erty for ' ecti- rpo s. o SEE REVERSE FOR EXPLANATORY LANGUAGE ,dir' Signature of Applicant or Agent D ` APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL INBUILDING DRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 1 or a certificate of Workers'Compensation Insurance,or a certified 3 copy thereof(Sec.3800,Lab.C.) CITY' ZIP LOCALITY Policy No. ompa SIZE OF LOT NO OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST Certified copy is filed with the cou ty buildin inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date IF r ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE /alp WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TY E CONST FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP 1 certify that h the performance of the work for which this permit Ap s.- become P /� bIssued, I shall not employ any person in any manner so as to ARCHITECT ENGINEER TEL NO. 6 become subject to the Workers'CO enation Laws. STATISTICAL CLA SIFICATION 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 T NO. �^ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith SY �� --FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PLggr } LICENSED CONTRACTORS DECLARATION • • SIDE a CITY �LC. LASS P L C I hereby affirm that I am licensed underprovisions of Chapter 9 . C.7 (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE .OF STORIES NO.OF FAMILIES SEWER MAP a+ Professions Code,and my license is in full force and effect. NEW BK PG Q License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION ® W Contractor ALTER ❑ $ j4611316 J-96 CL ❑ 1 am exempt under Sec. t REPAIR ❑ Z $ BAP.C.for this reason L DEMOL ❑ USE OF EXISTING BLDG. IDMA P/C# Date: � URM ❑ 23 T Signature APPLICANT(PRINT) TEL NO. LDMA Perm# ACC ACCTAr r ❑ I, as owner of the property, or my mployees with wages as Z r�a c� their sole compensation, will do the work and the structure is ADDRESS O 3303 not intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL '�.(� ANT OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE —3 V / J ryy,.+�•I s 4 ❑ I, as owner of the property, am exclusively contracting with FINAL BY j licensed contractors to construct the project (Section 7044, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? ��n Business and Professions Code.) VES 11 NO❑ 33103 11 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ITEMS OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 2 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FORGUIDETOTAL 3190-5 o 61 1 hereby affirm that there is a construction lending agency for YES❑ No❑ + the performance of the work for which this permit is issued(Sec. CHECK ECK 195 a 61 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) / CHECKLIST I UNDERSTAND REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHANGE H TITLE 2.CHAPTER 2 20 SECTIONS E a�� ONS 2 20.100 THROUGH 2 20 140 CONCERNING HAZARDOUS C. Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address M OWNER OR AGENT C 3 I certify that I have read this application and state under penalty 0000-0001 7/15/96 c of perjury that the above information is correct.I agree to comply P.C.FEE Jj� PERMIT FEE 2 / t with all county ordinances and State laws relating to building ' � J (P 7�j 7 1 PM 5e44 GO construction, �heebyuthorize representatives of this County ISSUANCE FEE to enter u� the nti property for inspection purposesg INVESTIGATION FEE TOTAL FEE an a/q • r SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELEt� itt4PLc CITY # 0503 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0408160027 PHONE: (626) 285-0488 EXT. LEGAL ID: NUMBER OF SIGNS: B IL�IN;: ADDRESS: ON FILE SIGN DESCRIPTION: ILLUMINATED WALL SING 5T31 RCSEMEAD BL Ti NP CA. ASSESSOR FORIN TION M NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C TENANT: S BLDG USE: ISSUE OW- PROCESSED BY: EXPIRES ON: TIM WANG EXIST OCC GRP: 08/16/04 JK 08/11/05 OWNER: IEL. NO:- BLDGS. NOW L:i LOI: Vr1UAT10N: FIN DATE FINAL BY: CODE: CALAC INVESTMENT (858) 565-8333- 2,000 /`` 3709 SAN DIEGO, CA9211137 FEES PAID D-E§CllTT5;a U'r WORK FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: ILLUMINATED WALL SING APPLICANT: iEl.. NO: XU (626) 444-8181- AX BUILDING REVIEW FEE 54.70 _ f 2812 PECK RD AA BLDG PERMIT ISSUANCE 27.75 SPECIAL T:ONUII0NS: EL MONTE, CA 91731 D1 PLANCHECK W/O EN-HC 2000.00 VA! 82.11 TOTAL FEES 164.56 CONTRACTO.".: TEL. NO: APPRuVk7s DATE INSPECTOR SIGNATURE ' SUCCESS SIGN (626) 444-8181- ' 2812 PECK ROAD LIC. NO LOCATI D�SE TACKS SUITE# A 739177C45 I EL MONTE CA 91731 SOILS EUC1NEER APPROVAL ARCHITECT CR !:NGIl�— IE O: FUWtI.A. I^!J/TRriJCliONUS I ! LIC. N0: 1 MAP N0: SEWER'iSAP BOfiS--. PAGE: FIRE LONE: CMP: - 00 PT0. OF FAMIL L•S: DWELLING UNITS: AP CUND: STAT CL SS: - NO 20 — SCHOOL WITHIN HAZARDOUS I i AIR QUALITY: 1000 FEET MATERIALS _ NO NO NO ----_ — REPORT ID: DPR261 ROUTE TO: B50508 COUNTY OF LOS ANGELES I TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS , 9071 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9608090009 PHONE: (818) 285-0488 EXT: DUPLICATE LEGA ID: NUMBER OF SIGWS—'. l BUILDING ADDRESS: ON FILE SIGN DESCRIPTION: ADD 1 SIGN TO EXISTING POLE 5731 ROSEMEAD BL _ TEMP CA ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED--ON- PROCESSED Y: EXPIRES ON: LANICO TV & APPLIANCE EXIST OCC GRP: 08/09/96 TC 08/09/97 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATEFINAL Y: CODE: CALAC INVESTMENT - 1,400 p-?'o�'� � ol � FEES PAID ESCRIPTION OF WORK ADDITIONAL SIGN CABINET FOR EXISTING POLE SIGN 2lX1O' _ FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. O: SIGN ART CO (818) 287-2512- i AA BLDG PERMIT ISSUANCE 27.75 i AE STRONG MOTION OTyER 1_400.00 VAL 0.50 SPECIAL CONDITIONS: D1 PLANCHECK W/•0 E�HC �;_ ct400.;00_ VAL 82.11 D2 PERMIT W/O E�N�H�CyL� �14001W VAL 82.20 TOTAL FEES 192.56 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE HSIEH, EDDY (818) 287-28124 425 S CALIFORNIA LIC. NO LOCATION AND SETBACKS SAN GABRIEL,CA 491427/C45, 1 � SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: / FO NDATION/TRE C FOR S LIC. NO:i / �,;;i••� SUPPORT STRUCTURE FO MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CO: �DF L i C 0 u u[N 0. OF FAMILIES: DWELLING NITS: APT/CO D: STAT CLASS- - 0 x �� l'y i,•, NO zo I � L7 r1rLI} SCHOOL WITHIN RNZARDOUS � - �® 1000 FEET MATERIALS AIR QUALITY: NO NO NO 1 ice 1 REPORT ID: DPR261 ROUTE TO: BS0508