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HomeMy Public PortalAbout6340 ROSEMEAD BLVD_Building__ A I - 76AG38A CE#80310-68 APPLICATION FOR BUILDING PERMIT COUNTY OF- LOS ANGELES BUILDING / DEPARTMENT OF COUNTY ENGINEER ___ADDRESS BUILDING AND SAFETY DIVISION LOCALITY 7`��tQ /�C �/ ►/ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN,SUPT OF BUILDING CROSS ST. (J DISTRICT NO. / G P J� g ` PIYOC SSED,BY FOR APPLICANT TO FILL IN _�I 'C -c T. BUILDING STATISTICAL CLAIOSIFICATION - SEWER MAP ADDRESS G 3 o a _ /L R- P SK PG. . CLASS.NO. DWELL.UNITS—1 LOT NO. C- �"l/ �� BLOCK MAP , TATE NUMBER J HWY ES, TRACT USE ZONE SPECIAL i CJ NO.OF.B /J/ SIZE OF LOT I NOW ON LOT USE CONDITIONS - USE OF EXISTING BLDG. BUILDINGYARD HWY STREET NAME EXIST. - SETBACK WIDTH OWNER M 4 JV f(-C_ ,¢..(� // C / FRONT. MAILP.L. ADDRESS �n G t � F S !� %!I P)6',P SIDE TEL. P.L. CITY NO. INSPECTION RECORD ARCHITECT OR TEL. _ ENGINEER NO. ADDRESS CONTRACTOR«�1 iC f'' TEL. -7 X�''S•7^�ir� `� � �c Cotlr-'J NO. f 7 -�''Yr ADDRESS �/�`/ 5 ` 1,4 P Sc 7_0 A/ 44 Ar DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH - -_ SQ.FT. NO.OF NO:OF SIZE STORIES FAMILIES USE S_/ G STRUCTURE SIGNATURE OF •`lr��R ,/J . APPLICANT lhh�.teeAPPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS / !� / E M FOUNDATION: LOCATION �o FORMS,MATERIALS VALUATION FRAME:FIRE STOPS. BRACING,BOLTS P.C. I PMT. �� I FURNACE:LOCATION. FEE $ FEE $ GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- STH.INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL,COUNTY ORDINANCES AND' ' . STATE LAWS REGULATINGUILDIINNG CO TRUCTION. LATH,EXT. PERSIGOF `y�{y +� /� /r�JlB^ HRECTANDPOS EDNUMBER R ADDRESS `� r -n ''" _.- FINAL I CLYDE N.pDII�R}LAM, TPRRIINCIPAL STRUCTURAL=—p R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M. f DRIG/1✓FIG VTOL EN 76A636A CE#8036-68 APPLICATION FOR BUILDING PERMIT -- COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. f DISTRICT NO. GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN I conlsr. I BUILDINGI SEWER MAP ADDRESS f± STATISTICAL CLASSIFICATION BK PG CLASS. NO.�(JDWELL. UNITS -^? LOT NO. j { BLOCK --- MAP STATE NUMBER - HWY. -yES.+. NO TRACT tt ,/0611USE ZONE PECIAL - I'- NO.OF SLOGS. CONDITIONS SIZE OF LOT - I NOW ON LOT USE OF /~ EXISTING BLDG. BUILDING YARD HWY EXIST. STREET NAME SETBACK WIDTH OWN J ER f FRONT 1 MAIL P.L. f-- !': Z4 N_ ADDRESS SIDE TEL. - P.L. CITY NO. I ARCHITECT OR TEL. NSPECTION RECORD ENGINEER NO. ADDRESS TEL. r CONTRACTOR��4 NO. I ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS.MATERIALS $ P. C. $ FRAME: FIRE STOPS, r FEE BRACING, BOLTS VALUATION - $ "j '-�lj FURNACE: LOCATION, FEE r --�- GAS VENT, DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH. EXT. SIGNATURE OF -s HOUSE NUMBER COR- PERMITTEE RECT AND POSTED y ADDRESS - FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENG AIE R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. :CASH i r 7 1 F i OF /J 4 µµ 76A688A CE#8086-68 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST I CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST, DISTRICT NO. GROUP I TYPE I PROCESSED 8,Y FOR APPLICANT TO FILL IN +W/Jry BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS - I BK PG -. CLASS.NO.!DWELL.UNITS LOT NO. •-._.! BLOCK MAP STATE NUMBER HWY. NO TRACT - - USE ZONECIAL NO.OF BLDGS. _ ONDITIONS SIZE OF LOT I NOW ON LOT - USE OF EXISTING BLDG. BUILDINGEXIST. _. SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT MAIL P.L. ADDRESS SIDE TEL. _P.L. CITY NO. INSPECTION RECORD ARCHITECT OR TEL. — ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS "/ '­ - 2 �� DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATUREOF APPROVALS APPLICANT f DATE INSPECTOR'S SIGNATURE ADDRESS - FOUNDATION: LOCATION FORMS.MATERIALS $ P.C. $ FRAME: FIRE STOPS. FEE BRACING, BOLTS VALUATION t; $ r✓ j,,�-�L'.' FURNACE: LOCATION, FEE ��_ GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL A?`2,3- CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. rCnS r. OF 76A636A CE 6036-58 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING f DEPARTMENT OF COUNTY ENGINEER A°DREss BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT GROUP TYPE PROCESSE BY FOR APPLICANT TO FILL IN ::�I CONS T. I -� BUILDING _ I SEWER MAP ADDRESS 4 STATISTICAL,CLASSIFICATION BK - PG CLASS.NO. _ DWELL. UNITS ./ "7 C% LOT NO. BLOCK MAP STATE ` Ei NO NUMBER HWY. TRACT USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT - I NOW ON LOT „ USE OF EXISTING BLDG. UI G YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER X., _i Isa FRONT I MAIL P.L. . ' _ -- ADDRESS 1 SIDE TEL P.L. CITY No., I ARCHITECT OR TEL. NSPECTION RECORD ENGINEER NO. ADDRESS fj TEL. r CONTRACTOR µ N A' O. " A' ADDRESS/ DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS r - FOUNDATION: LOCATION FORMS,MATERIALS I $ P. C. $ FRAME: FIRE STOPS. r FEE BRACING, BOLTS r VALUATION J r $ FURNACE: LOCATION. FEE GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ HIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT. STATE LAWS REGULATING BUILDING CONSTRUCTION. HOUSE NUMBER COR- SIGNATURE OF PERMITTRECT AND POSTED f EE ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EENGI,EER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH OF Gr 6R1f71*,#t s!QtfN 76A639A CF#8036-5a APPLICATION FOR BUILDING PERMIT i COUNTY OF LOS ANGELES BUILDING ADDRESS DEPARTMENT OF COUNTY ENGINEER AA BUILDING AND SAFETY DIVISION _LOCALITY JOHN A. LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING ROSS ST..0 m 011,011 - D!STRICT NO. GROUP I TYPE l PROCESSED BY FOR APPLICANT TO FILL IN " -' coNsr. BUILDING -fSEWER MAP ADDRESS �J�� r"' `r - �'?' ja' STATISTICAL LADSSIFICATION I BK PG BLOCK LASS. N WELL. UNITS LOT NO. MAP STATE i"YES;' NO NJMBER HWY. \ TRACT USE ZONE I SPECIAL T I' NO,OF BLDGS. 'f �' CONDITIONS L �'� ✓ (' SIZE OF LOT I NOW ON LOT USE OF EXISTING BLDG. BL ILDING YARD HW Y STREET NAME WIDTH SETBACK OWNER - } FRONT MAIL - P. L. •�l - __ !.� ADDRESS - SIDE TEL. _Pb L. CITY NO. _ INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS L ^� DESCRIPTION OF WORK ' t NEW ADD ALTER REPAIR DEMOLISH SQ. FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPROVALS APPLICANT - _ DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION __/2— _ _ _FORMS,MATERIALS $ P. C. $ FRAME: FIRE STOPS. FEE _BRACING, BOLTS I VALUATION $�� FURNACE: LOCATION, FEE 1 -, _GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND — AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND �— .K STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH,EXT. _ SIGNATURE OF HOUSE NUMBER COR- PERMITTEF RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION (.CK. M.O. CASH PERMIT VALIDATION -'CK. ; M.O. CASH w ' 7 OF i r f{y 7GA638ACE#80311-57 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ;� i, DEPARTMENT OF COUNTY ENGINEER AODREss /.•, c: L: ' U BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATP D.GRIFFIN,SUPT OF BUILDING I CROSS ST. / C_ DISTRICTNO. GROUP)' -{TYPE —}-� SEWER MAP r FOR APPLICANT// TO FILL IN f ''" r� I CONST. K P ADD EISS r7G .f 4.,, V{/ STATISTICAL CLASSIFICATION CLASS.NO.1� DWELL.UNITS- �..«.. O LOT NO. BLOCK Z MAP STATE TRACT NUMBER �,If /,' HWY. YES NO + USE ZONE SPECIAL ��yy .• NO.OFBLDGS ,�) *- CONDITIONS ,. - .j m SIZE OF LOT L» I NOW ON LOT W& MCI •-- -' "p""USEOF _ �✓ EXISTING BLDG. BUILDING EXIST. I SETBACK YARD HWY STREET NAME WIDTH Z OWNER VA AIL'' FRONT MAIL P.L. = L�'Y% J!((,` {:'�J OS. ADDRESS A 'p SIDE .N TE �P.L: CITY INSPECTION RECORD ARCHITECT OR TELL,,� _ ENGINEER No. 3 ADDRESS TEL.L. CONTRACTOR NO. AbDRESS DESCRIPTION OF WORK — ,L ;' 12,44v v f „f NEWI ADD ALTER REPAIR DEMOLISH T. NO.OF NO.OF SIZE ,66� STORIES FAMILIES USE 01F STRUCTURE SIGNATURE OF ' �, APPROVALS j�t�, ✓�C APPLICANT DATE INSPECTOR'S Sl. NATURE ADDRESS FOUNDATION: LOCATION -ORMS.MATERIALS P.C. S FRAME: FIRE STOPS, j �✓*''/ `-�"� FEE ... _3RACING.BOLTS 0' VALUATION FURNACE: LOCATION, FEE GAS VENT.DUCTS IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PL P- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH,INT. 2' AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH,EXT. SIGNATURE OF — HOUSE NUMBER COR- PERMITTEE e'� —'(� i I _ +�+ y RECT AND POSTED ADDRESS _ FINAL (/q PPRoX) 2 2 S j rA,l. CLYDE N.DIRLAM. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATIONc i M.O. CASH PERMIT VALIDATION rCK.'% M.O. CASH _F Y 7BA638A CE#'8035-61 APPLICATION FOR BUILDING PERMIT ILJI COUNTY OF •LOS ANGELES BUILDING / 5-/�y A/2ea DEPARTMENT OF COUNTY ENGINEER 4DOREss BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER. NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP YPE PR C Y FOR APPLICANT TO:FILL IN S' cONST. BUILDING STATISTICALM FICATION SEWER MAP ADDRESS BK PG CLASS.NO. WELL. UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: . Ej TRACTMAP ��jj HIGHWAY TATE MAJOR SECOND, LOCAL No.OF BLDG NO. D (CIRCLE) SIZE OF LOT ,(�y ^yI^NOW ON.LOT USE ZONE SPECIAL EX STO N/GA/,�B��LD/G��'//✓[ / �g CONDITIONS A-, - T �7-TEL. L- OWNER NO. •. BUILDING YARD HWY STREET NAME EXIST �8�� � �. �� SETBACK WIDTH ADDRESS F ARCHITECT OR TEL. - P.L . f! s } ENGINEER NO. SIDE P.L. IO ADDRES CONTRA INSPECTION RECORD CONTRACTOR /� �c�•�/�Y�DO. "� ADDRESS /{[�t ��C(jiJ(� L/4 f W , DESCRIPTION OF WORK H / NEW eo/ADD ALTER REPAIR DEMOLISH - Z SQ.FT. NO.OF NO.OF IZE STORIES FAMILIES USE OF STRUCTU - J SIGNATURE OF ' APPLICANT VALUATION$ 600. APPROVALS DATE INSPECTOR'S SIGNATURE FEE FEE $ FOUNDATION: LOCATION FORMS,MATERIALS 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, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS _ BUILDING CONSTRUCTION. I CERTIFY HAT I �7, THE WORK AUTHORIZED HEREBY I WILL NO N IN VIO A- LATH,INT. TION OF THE LABOR CODE OF, E O 1 A T ING TO WORKMEN'S COM PEN SAT NSUR l 1. 6 LATH,EXT. i SIGNATURE OF ADVANCE NEON SIGN CO. HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS. 960 N0. :BROADWAY - L. A. 1.2 FINAL % - CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E 6`rN--M PLAN CHECK VALIDATION cK. M.o. cwsw PERMIT VALIDATION cK. M.o. cASH LAGo 1 4 8 6- FEB 27 1 U 6.00-- `, 76A:638A CE#803 9-67Ci�� r, APPLICATION FOR BUIL ING PERI T COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN DISTR CT N J,;R�OURfET. P � 2 (Print or type only) vJ BUILDING �QSe�a �� STATISTICAL C ASSIFICATION SE ER MAP ADDRESS 340 IVB Ai CLASS NO. DWELL,UNITS BK PG LOT NO. - BLOCK USE ZONE MAP NO. TRACT SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT IN O OW ON LOT USE OF j� ], EXISTING BLDG, tr 1�•' &A BLDG.SETBACK FROM ,, TEL. FRONT PROP.LINE OF (STREET). OWNER t NO. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL .� I HIGHWAY WIDTH FROM C.L. ADDRESS to, Rusew%e'r4 CI TY 'Temple + ' fi } _ BLDG. BACK FROM ARCHITECT O TEL. SIDE PROP. OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBA HWAY } YARD = TOTAL ADDRESS HIGHWAY WI-DTH FROM C.L. Autuavi CONTRACTOR -.� ' r+ NO. LIC. ADDRESS - - t' "�' NO. r� CORNER CUTOFF YES ❑ No G7 LIC. CITY _ CLASS -� &.� SE REV RSE SIDE FOR SPECIAL APPROVALS DESCRIPTIO OF WORK a z NEW ADD ALTER REPAIR DEMOLISH , SQ. FT. NO. OF NO. OF - SIZE STORIES FAMILIES USE OF STRUCTURE r6w1 J Q SIGNATURE OF APPLICANT s C VALUATION I C�'� �t s APPROVALS DATE` INSPECTOR'S SIGNATURE P.C. PMTFEE'$ UNDATFORMS,I MATERIALOCA FEE$ ION � 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, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA. TION OF THELABOR CODE OF THE STATE OF CALIFORNIA RELAT. LATH, INT. ING TO WORKMEN'S COMP `TINSljj2ANCE. //L`\\YY\\qq�' LATH, EXT, SIGNATURE OF C HOUSE NUMBER COR- PERMITTEE RECT AND POSTED / ADDRESS awn ���tc�orl(. FINAL JOHN F. LEWIS. PRINCIPALSTR TURAL ENGINEER CK. PLAN CHECK VALIDATION <2:)-_-. CASH _ PERMIT VALIDATIO CK. M.O. CASH 1 3-770-- t'Ci'21 2 3 D 7.2 0 2 51% W!2:2 1 0 1.2.00-N 76A638A CE #803 3-69 APPLICATION FOR BUILD NG PER T r' COUNTY OF LOS ANGELES BUILDING O DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST.__ FOR APPLICANT TO FILL IN DISTRICT N0. GROUP - - T PE CONST. PR (PRINT OR TYPE ONLY) BUILDING �?� STATISTICAL CLASSIFICATION SEW R MAPF ADDRESS 3� . �,j�r,(.��f�/� �,.�cLfL�. CLASS N0. DWELL.UNITS BKPG LOT NO. '` BLOCK USE ZONE MAP ��JJ �} - N 0. cq O C..�3 TRACT 4 k% (J - SPECIAL N0. OF BLDGS OND TIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF (STREET) OWNER/, , NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL WAY WIDTH FROM C.L. ADDRESS�r.Q = - CITY ARCHITECT OR TEL. BLDG.SETS ROM ENGINEER N0. SIDE PROP. LINE (STREET) JHIGHIWAY E OF EXISTING SETBACK Y YARD = TOTAL ADDRESS WIDTH FROM C.L. _ } CONTRACTOR�.��' NOL + C ADDRESS �`'� NO CORNER CUTOFF YES .❑ NO L' LIC. C CITY '�/���j CLASS �� SEE REVERSE SIDE FOR SPECIAL APPROVALS � CONSTRUCTION LENDER w NAME AND BRANCH N ADDRESS Z rSTRUCTI,LRE T. NO. OF NO. OF ❑ STORIES FAMILIES NEW OF �.�, -c' ADD ❑ ALTER`]�RREPAIRATURE OF DEMOLICANT - VALUATION SAPPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE $ FEE $ 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 ERTIFY THAT I D NG THE WORK AUTHORIZED HEREBY t WILL NO MP Y ANY RS IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE ST 0 CAL NIA N RELATING TO WORKMEN'S COM- PENSATION IN RA E. LATH, EXT. SIGNATURE OF PERMITTEE HOUSE NUMBER CORRECT AND POSTED ADOREFINAL 70 ` JOHN F. LEWIS, PRI CIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION cK. M.O. CASH { r,r_ 4 1 6 3LR" r'u,R19 1 0 9.0,0- 77 76A636A•CE #803 3-69 APPLICATION FOR BUILDING PER/MIT �I COUNTY OF LOS ANGELES BUILDING /��/Q /V• �5�,,,� ek� lo� DEPARTMENT OF COUNTY ENGINEER ADDRESS G �1 r BUILDING AND SAFETY DIVISION LOCALITY Pi1s� le CL JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. dA1_ d FOR APPLICANT TO FILL IN DISTRICT Ny70. GRO P TYPE C ST. PR OC SSED BY (PRINT OR'TY E ONLY) BUILDING ' STATISTICAL CltC>SIFICATION SEWER MAP ADDRESS' /� CLASS N0. DWELL.UNITS SL BK PG 70 LOT NO. BLOCK USE ZONE MAP NO. X003 TRACT L.�ry� f'lp �. Q �(/� SPECIAL NO. 0 BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. ^rA#Z BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF (STREET) OWNER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. .� �, gSE7 .P ' CITY h ne .! + BLDG.SETBACK FROM ARCHITECT OR n TEL SIDE PROP. LINE OF (STREET) ENGINEER 1 N0. SS . TYPE OF EXISTING, SETBACK' HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + } CONTRACTOR �. N0. 2 C v LIC. 9 CORNER CUTOFF YES ❑ NO ❑ O ADDRESS i� N0. J V LIC. a CITY `�.'� wo4 CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS 0 CONSTRUCTION LENDER _ A U NAME`AND BRANCH 0,7� D' �' w a ADDRESS r - z SQ. FT. N0. OF N0. OF SIZE STORIES FAMILIES NEW USE OF ADD ❑ STRUCTURE •�•'�` A R • y'/py ppy REPAIR ❑ J _ •� IGNATURE OF DEMOL ❑ APPLICANT i VALUATION $ A APPR VALS DATE - INSPECTOR'S, SIGNATURE PIVIT$ FOUNDATION: LOCATIO FEE $ FEE N -j•_04 FORMS MATERIALS FI I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS RE STOPS, APPLICATION FRAME: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 I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFOR A IN RL TING TO WORKMEN'S COM- PENSATION INSURANCE.^ SIGNATURE OF ^I/r/\ LATH, EXT., PERMITTEE HOUSE NUMBER CORRECT , nt AND POSTED ADDRESS— ^ fJ) Wrl�� FINAL�� JOHN F. LEWIS, PRINCIPAL STRU TURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION LK. M.O. CASH Uf 4& SUJ6 .2 3 D 1 9.801 E er� 20, 49—%o 0030 1 D 33.001_, v ] i 't r ©5 76Ab, 9A ,. CE N6 IR_V.6/76) 1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN AuaowG ADDRESS , BUILDING ADDRESS E� LOCALITY °Z NEAREST j CITY UZ ZIP CROSS ST. // NO.OF BLDGS. ASSESSOR SIZE OF LOT (Q1. ' ` OW ON LOT MAP BOOK PAGE PARCEL CLt � ((� i DISTRICT GROUP TYPE / MIRE PROCESSED BY TR CT BLOCK LOT NO. COtyb�/.- ZONE )3 u L�� �►J� A ' Y�IJ�. 77 OWNER T� /Cip (9fM � NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS -9-3 (�'f` � ��� S - CLASS NO. `^- DWELL.UNITS BK"70G CITYARC ;I/ ENGI{NEERTO I� ��.p '.alc7/, 1IyA"F/TEL N^O. �[��j��lJ� VALUATION ADDRESS 11LW 1(JAA r/(�II�I� 991WIK SETBACK FROM V �iFRONT PROP.LINE OF (STREET) CONTRACTOR ��° ' v��/. NO. ` HIGHWAY + YARD __ TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS ' NO. LIC. + _ CITY CLASS CONSTRUCTION LENDER ` ` BLDG.SETBACK FROM NAME AND BRANCH N SIDE PROP.LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING ADDRESS tA CITY SIDE PROP.LINE HIGHWAY WIDTH SQ.F NO.OF / NO.OF CHECK + _ SIZ STORIESFAMILIES ONE TEM DESCRIPTION OF WORK Gi NEW ❑ P.C. Fee$ S p'LA-3 Permit Fee 6, (� /��—V 714,4 M.Krzp, 7-6')� ADD ❑ L(� �L Issuance Fee ��-' -S a ST 2F0 PV� (1° ALTER ❑ z G O 0 � tS�,n^Z REPAIR ❑ C Total Fee /rz) USE OF w EXISTING BLDG. DEMOL ❑ ft' C 2 0 0 0 0�y APPLICANT, 'Ia �,pQC TEL '/Y F s� (PRINT) S W t�W(Q. FiO. [�� !/7� 6 1 D G 0 0 0 0 7 2 U 'f' Q ` BY(SIGNATURE( ►W L/ > 0 9, 1 4-78 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE V Z 0 2 a7 A THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE S WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V # o o o o 2 3 THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z PENSATION INSURANCE. 2 0 o'7 2 0 0 d Y ' 0 SIGNATURE OF o o o 7 2 0 0 PERMITTEE ADDRESS Z O g 1 4-78 O CITY NO. Q ;202S 8A C USE ZONE MAP ®� ! < # 0 0 0 0 0 1 NO. > C. /L SPECIAL 2066&50 ACONDITIONS' FINAL leq-q- � Bl- 7,20 ri DATE 0/ 6 l #ZJIi G�:7 6 v 76A638A CE #803 3-69 � APPLICATION FOR BUILDI G PERMIT ~ •COUNtlf OF LOS ANGELES BUILDING ,l1 DEPARTMENT OF COUNTY ENGINEER ADDRESS (✓ BUILDING AND SAFETY DIVISION LOCALITY A JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRI T N0. TY (►�/r-T P OC sY (PRINT OR TYPE ONLY) �• Y� '� BUILDING STATISTICAL CLAS IFICATION 19EWER MAP ADDRESS 'Q N 1 OS M E Ipqy CLASS NO. DWELL.UNITS BK PG LOT NO. ^ BLOCK USE ZONE MAP /7 i(1 �7 �..•+'-' �r /� NO. 0 (— TRACT,�c� N S Le J I zi / .� SPECIAL N0. OF BLDG L/ CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM TEL. ' FRONT PROP. LINE OF (STREET) OWNER •K jZ'� A. K c r NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS _ _r HIGHWAY WIDTH FROM C.L. Q S A .5TCt2 R,U " l IN 7 Z.: ,Q �n' L. l.r_ / � + HITECT OR TEL. BLDG.SETBACK FROM (STREET) - NEER NO. SIDE PROP. LINE OF TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL RESS HIGHWAY WIDTH FROM C.L. TRACTOR ELc c r2 — lJ NOMI -08133 + } RESS S '�, S j T- LI 2 6 CORNER CUTOFF YES ❑ NO ❑ C �0 1„U 4 Lc 6A f,,, i F - CLASS �Jp -, SEE REVERSE SIDE FOR SPEC APPROVALS ou STRUCTION LENDER F E AND BRANCH L ADDRESS CL 4 V SQ. FT. N0. OF NO. OF ❑ SIZE STORIES FAMILIES NEW USE OF ADD ❑ STRUCTURE 1,1?Q i T o- p L F ALTER ' 0 £ REPAIR ❑ SIGNATURE O r DEMOL ❑ APPLICANT O VALUATION S APPROVALS D TE INSPE .R'S SI .;4E R P.C. PMT. ✓<:� FOUNDATION: LOCATION FEES R (L' FEE S FORMS MATERIALS (o I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY BRACING BOLTS WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- TION ONSTRUC- FURNACE: LOCATION, TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I GAS VENT DUCTS WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. LATH, EXT. SIGNATURE OFF PE HOUSE NUMBER CORRECT ERMITTE AND POSTED ADDRES FINAL JOHN F. LEWIS, PR NCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. .o. CASH - PERMIT VALIDATION CN. M.O. CASH ( {',�1. 9 6 ,SEP 2 2 2 3 D 7 2 0, ( 19820 SEP 2.4 1 D 12.00; � C 76A638 CE#8031-62 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS p � BUILDING AND SAFETY DIVISION LOCALITY J JOHN A. LAMBIE. COUNTY ENGINEER NEAREST or WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYF P ESSED BY FOR APPLICANT TO FILL IN S"a �� J CONsr. BUILDING O/� STATISTICAL CLAS FICATION SEWER MAP ADDRESS (,r:� T d 'yam lcaellf K CLASS. NO. °' DWELL.UNITS--• LOT NO. �. L BLOCK WATER NOT REQUIRED RECEIVED i. CERTIFICATE: TRACT MAP �)/, HIGHWAY STATE AJOR SECOND, LOCAL NO. BLDGS. NO. O� (CIRCLE) SIZE OF LOT NO ON LOT USE ZONE SPECIAL USE OF /y CONDITIONS EXISTING BLDG. /• -; EEL. l OWNER /'y/�����f �N� O. BUILDING YARD HWY STREET NAME -EX IST. / SETBACK WIDTH ADDRESS lj,�l�� ��,7 G"' .FRONT ARCHITECT OR TEL. P. L. �z ENGINEER NO. -SIDE / ow P//L./ // L - G. ADDRESS d 'q l�Ii 1 f �/' •`�, �/� -.l A J� u CONTRACTOR /� /�'/G�✓/ANO. 'T/�>''�'�B� ,/ v I' ("J (j .s�`�„ �iy� ADDRESS //O/�jr GGA{�'���✓,y %O _ i O DESCRIPTION OF WORK f Lu a H NEW DD ALTER REPAIR DEMOLISH Z_ SQ. FT. NO. OF NO. OF SIZE fG STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF , APPLICANT VALUATION ,�y�,/� APPROVALS DATE INSPECTOR'S SIGNATURE FEE $ - FEE $ 61 FOUNDATION: LOCATION FORMS, MATERIALS 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, 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- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSAT INS ANCE. LATH, EXT. SIGNATURE OF HOUSE'NUMBER COR- Al-// PERMITTEE RECT AND POSTED ! / l- ADDRESS e"do" FINAL JOHN F. LEWIS. PRINCIPAL ST TURAL ENGINEER PLAN CHECK VALIDATION _ PERMIT VALIDATION CK. M.O. CASH L&O 4 9 1 61Q01 SEP 28 4 4 D .00 " - a LAC0 4 91 7 SEP 2 8 1 D 4,00— 76A638A CE x$8036-62APPLICATION FOR BUILDING PER IT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY 1` JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT N GRO TYPE P OCE - VD BY FOR APPLICANT TO FILL IN '57 C) CONST. BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS I"Iqo CLASS. NO. DWELL. UNITS " LOT NO. BLOCK WATER CERTIFICATE: NOT REQUIRED ® RECEIVED r TRACT ) U MAP HIGHWAY NO.OF B GS. NO. Q (CIRCLE) STATE MAJOR SECOND, LOCAL SIZE OF LOT NOW ON T USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. 7 - TEL. i/ OWNER - ` NO. BUILDING J EXIST. SETBACK YARD HWY / STREET NAME WIDTH ADDRESS DA EDI-RONT r' r ARCHITECT OR TEL. 'P. L. ENGINEERNO. .SIDE P. L. CL ADDRESS O TEL. V CONTRACTOR -D,A, j N NO. g_178y ADDRESS S r 4 O DESCRIPTION OF WORK v W CL NEW ADDALTER REPAIR DEMOLISH h Z SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF A ' APPLICANT VALUATION $ APPROVALS DATE INSPECTOR'S SIGNATURE _ � PMT FOON FEE FEE � FORMS, MATERIALS FRAME: FIRE STOPS, ,�� yy�,, : 7�^� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS _ 7.. 6, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, r � WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS y BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK h TAUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF HE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S CO PENSATION I URANCE. LATH, EXT. .� SIGNATURE OF HOUSE NUMBER COR- PERMITTEE -� RECT AND POSTED ADDRESS FINAL =� JOHN F. LEWIS':'PRINCIPAL ST,- R AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIONM.O. CASH 1LU _ 7 4 2: d'ift 6 1 D e.0 0 81 F-.2.5 6 7 .AP 4ICATION FOR BUILDIN.a PERMIT . ,tgUI`4TY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, B ILDINGA�RES or•a certificate of Workers' Compensation Insurance,or a certified , copy thereof( c.3800, //,� -/�(,Labi C CITY ZIP/ ( j \ Pol� y No.10 .C. Company S�'0.d-� 1 k NdD�l W1 "'1 1 b. P LOCALITY SIZE OF,LOT NO.OF BLDGS.NOW ON LOT g o�� Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. . . department. C I � USE ZONE MAP NO. • Date 4/2T Applicant � - J��_ ASSESSOR MAP K PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE .OF EXEMPTION FROM WORKERS' O TEL NO COMPENSATION INSURANCE109� Y (f Z(� WITHIN 1000 FT.OF SCHOOL? ves ;t-,4.1 ;No (This section need not be completed if the permit is for one hundred ADDRESS - dollars($100)or less.) `J DISTRICT GROUP TYPE CONST. FIRE Z '-:PROCESSED BY CITY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to /'n� HITEC R ENGINEER -TEL O. I 'F1,,y�(�cit�F become subject to the Workers'Compensation Laws. As C�' 33�� t s.-. W� STATISTICAL CLASSIFICATION APT-• CONDO Date Applicant , pp DDRES A CLASS NO. DWELL UNITS _ L= NOTICE TO APPLICANT If, after making this Certificate of �0� U L_ W,15 Exemption, you should become subject to the Workers' CONTRACT REQUIRED TOTAL SETBAINEFFt0tv1 EXIST -• TEL NO. SET BACK ' YARD -HWY. PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith X11 • �• 7 FRONT comply with such provisions or this permit shall be deemed revoked. DD S LIC.NO. p L f It7j l01 0�i 1j LICENSED CONTRACTORS DECLARATION C � .CL FIDE 6,j 116 PM I hereby affirm that I.am licensed underprovisions of Chapter 9 t SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO. T. qq NO.OF STORIES NO.OF FAM IE � Professions Code,and my/license `is in full force and effe t. NEW ❑ BK "PG O License Number553434 Lic.Class DE RIPTION OF WORK , ADD ❑ 00 , "` U V VALUATION Contractor �1.11n'D Date 1 /2�1/4 U ALTER ❑ • n- `<;Vis`;� n•�is; '�._:fn ❑ I am exempt under Sec. REPAIR ❑ �'!!l -- •?�Z BAP.C.for this reason DEMOL ❑ $ Oe, A�. - '�-IC LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature {:H (: PLICA T( INT TEL NO. LDMA Perm'# .r' �",•.. . El 1, as owner of the property, or my employees with wages as -7 • r Z ' i_HE_;E their sole compensation, will do the work and the structure is A DRESS. O_ not intended or offered for sale (Section 7044, Business and d `70 1z NIS - 17.11pp FINAL DATE < Professions Code.) WILL T " HE APPLICANT OR'FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES El No El 'fj it ji)-�jj j_i= - - Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING C OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - •� •=•Len; '= •_• _- �-• - CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ��� � GUIDELINES. I hereby affirm that there is a construction lending agency for ves 1:1 No 13the performance Of the Work for which this permit IS ISSUed(SBC. IHAVE READTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, v1 TITLE 2.CHAPTER 2.20 SECTIONS 2.20..100 THROUGH 2.20.140 CONCERNING HAZARDOUS m Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. _ m -Lender's Address Q OWNER OR AGENT i 3 I certify that I have read this application and state under penalty ' CL P.C.FEE _ PERMIT FEE 0 of perjury that the above information is correct.I agree to comply CO with all county ordinances and State laws relating to building M construction, and ereby authorize repres atives of this County y ISSUANCE FEE /o j to r upon t bove-mentid r per or inspection purposes. $ o N Z INVESTIGATION FEE TOTAL FEE J f � 6 (� can Agent pap SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADORES BUI I hereby affirm that I have a certificate of consent to self insure, � U or a certificate of Workers'Compensation Insurance,or a certified &LDI G ADDRESS ZIP J'7 L�+ copy thereof(Sec.3800,Lab. .) / / 8 LOC Pl.� I Policy No. Company SIZE OF 1-0117 1 NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished, NEAREST CROSS ST. ertified copy is filed with t ounty it ing inspection OCK LOT NO. MAP NO. TRACTdUSEZONEepartment D /b v APPIICant -ASSESSOR MAP BOOK PAGE PARCEL Date OW R TELNO. SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' r 'Q .1� WITHIN 1000 FT.OF SCHOOL?. YES NO COMPENSATION INSURANCE ADDRESS(This section need not be completed if the permit is for one hundred (S r DISTRICT holo TYPE CONST.I FIRE ZONE P CES BY dollars($100)or less.) ZIP /� c?` I certify that in the performance of the work for which this permit % g 5'o is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. ���../// VVV""" become subject to the Workers'Compensation LAWS. STATISTICAL CLASSIFICATION '' r'__ PT CONDO Date Applicant ADDRESS CLASS NO. UNC` NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED JF TOTAL SETBACK FROM EXIST ACTOR TEL.NO. Exemption, you should become subject to the Workers' CpyT� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /JL,� E/ FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. C�n P L F 0 -3/c a C--s Al >_SIDE ��'• -1 LICENSED CONTRACTORS DECLARATION CITY in LI .cLAss PL _4*701r jU 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 SQ. SIZE NO.OF STORES NO.OF FAMILIES . r—' Professions Code,and my license is in full force and effect. DESCRIPTI NOF ORK NEW BK PG l»7 �^ License Number�D�- /// Lic.Class qpp ❑ VALUATION E I I�L 6 — A ��/_/ �Date �� � ALTER ❑ - ' ' �� z Contractor!'/`� T Q� � Q(� -1 -J ❑ I am exempt under Sec. ` REPAIR ❑ CHOSE B.BP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ 0 0II ' I CI - Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# ' I . l $.!.�!:: 1 1`ii 6 �."�g+.iii ❑ I, as owner of the property, or my employees with wages as p �•-•— _ their sole compensation,will do the work and the structure is ADDRESS F- ACCT =� not intended or offered for sale (Section 7044, Business and FINAL DATE CPON- _v.Ir __7�; Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN `'` ❑ I, as owner of the property, am exclusively.contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y � 1 `1 '"»r licensed contractors t0 construct the project (Section 7044, YES❑ NO❑ _I'�AL -�an . Business and Professions Code.) �Villi 1` E. WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH `,••f�iL-r; CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST f�FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES m. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. 9:42 • Lenders Address OWNER OR AGENT 3126 _ AMI '^i e 4'2 o 1 certify that I have read this application and state that the above information is correct. I agree to comply with all county P.C.FEE PERMIT FEE �� N ordinances and State laws relating to building construction,andCA6 ' a. here thorize representatives of this County to enter upon ISSUANCE FEE th bo a mentioned pro for inspection purp/o$es. INVESTIGATION FEE TOTAL FEE JP gne ure of Applicant or Agent Gale � SEE REVERSE FOR EXPLANATORY LANGUAGE - APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUI DING ADDRESS IA. Ro �� 5L_-VQ. or a certificate of Workers'Compensation Insurance,or a certified CITU G ZIP I " copy thereof(Sec.3800,Lab.C.) StATF IvAdD Policy No. 1221282-B Company A4)aD& } 8Q LOCAur�r—,ter- rz j-G- r7 / SIZE OF LOT NO.OF BLDGS.NOW ON LOT � (a�� � Certified Copy is hereby furnished. NEAREST CROSS ST. ❑ Certified Copy is filed with Mo �ulspection TRACT BLOCK LOT NO. Cepa a t. USE ZONE MAP NO. PAGE PARCEL Date App li ASSESSOR MAP BOOK SPECIAL CONDITIONS OWNER TEL.NO1C7) CERTIFICATE EXEMPTION FROM WORKERS' �J' I 10 pF CAL IF J QC ..2 O WITHIN 1000 FT.OF SCHOOL? ves No COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit is for one hundred �� DISTRICTOUP TYPE T.' FIRE ZONE ROCESS BY dollars($100)or less.) CIN, .ZIP I certify that in the performance of the work for which this permit q ID a o(J is issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEE TEL.NO. 71 become subject to the Workers'Compensation Laws. M CA I I STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of CONTRACTOR I 1 And 9JXft)W&- FNO. 66- REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' TEL60L 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. P L LICENSED CONTRACTORS DECLARATION CITY LIC.CSIDE d PL L LAS C ' hereby affirm that I am licensed under provisions of Chapter 9 � 85a G S SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE IrNO.OFSTORES I NO.OF FAMILIES C Professions Code,and my license is in full force and elle t� NEW ❑ BK PG F- License Number r1 DESCRIPTION OF WORK I ADD ❑ VALUATIO w pp��r�520?22 Lic.class ] d y Contractor�i.Gl A4,12VTl�ate �O�l r) ' 5/(�l�ls ILO T 1 �'�O it ALTER ❑ s O ' — Z_ ll ❑ I am exempt under Sec. .r l -QVS Hl_ REPAIR ❑ $ /6, BARC.for this reason 2 7 SoVTN ELE 20PAQ owDEMOL ❑ CDMA P/C It Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm n Z I ❑ I, as owner of the property, or my employees with wages as O AICCT. their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATi , Q '257.52 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN � ; - APPLICATION FOR BUI DING PERMIT �1 COUNTY OF LOS ANGELES - BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD Ess BU)LDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, ,/ or a certificate of Workers'Compensation Insurance,or a certified CST, V. 0 ,5 A ZIP C�/-6 copy thereof(Sec.3800,Lab.C.) Policy D."*99�/�/O��ilCompanySG //tl/�J�i� L-G LOCALIa�-�- �PLC SIZE OF LOT, r NO.OF BLDGS.NOW ON LOT d �1-� led copy is hereby furnished. Y1 �r 6 NEAREST CROSS ST. Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. I USE ZONE MAP NO. Dat Applicant J, y� x/6/1/c TiP z;P ASSESSOR MAP BOOK PAGE PARCEL w I ` gZ / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. D a;� WITHIN 1000 FT.OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS Q (This section need not be completed if the permit is for one hundred D 46 ,tJ1-1 DISTRICT GROUP TYPE CONST.' FIRE ZONE P OCESSED Y dollars that or less.) n 3 I certify that in the performance of the work for which this permit CITY Q OG L H A f'i� ZIP � � �02 t �/ is issued, I shall not employ any person in any mariner so as to ARCHITECT OR ENGINEER TEL.NO. 71 become subject to the Workers'Compensation Laws. Eci'S !`� STATISTICAL C F N APT CONDO Date Applicant ADDRESS O. CLASS N -DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of aai d`D REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTORn TEL.N.7/�} 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. ADDRESS LIC.NO. P IL N LICENSED CONTRACTORS DECLARATION CITY LIC-CLASS SIDE ; C I hereby affirm that I am licensed under provisions of Chapter 9 9 4) )f I SEWER MAP ''' v SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES . (commencing with Section 7000)of Division 3 of the Business and •-� -- -�-�r'•+ � NEW ❑ BK PG Ij ,...c:�§,131 Ot Professions Code,and my license is in full force and effect. I- � �� jC.4. /7c DESCRIPTION O WO K ( _tttLADD ❑ VALUATION N �a , i -Ott= ILLJ License Number o c.Class /7 Contractod tA&pAPI, Me bate��C �g�� ALTERx $ Wr TOTAL ,?; -If-j,i {"� 0 - ❑ I am exempt under Sec. REPAIR ❑ $ ;;j HFCI--' B.&P.C.for this reason i DEMOL ❑USE Oa'i,E .00 "ST LDMA P/C# -"li-1ii',:E - Date: URM Signature CA LICANT(PRINT) TEL.NO. '7 LDMA Perm# Z II 0111 13 1, I ❑ I, as owner of the property, or my employees with wages as l��E LL -75-1--73 their sole compensation, will do the work and the structure isRESS 87 p y 1 tLL E Aii' "s alenot intended or offered for sale (Section 7044, Business and m ES e oZ FINAL DA a t i _ '- Professions Code.) LL . APPLICANTOR UTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J �, 1 i L3 e•. ❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONT ING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Y g THE AMOUNTS SPEC IED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, TOTAL 3 i"=fi'-` VES❑ NO Business and Professions Code.) _I.__,.: �.�S WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING '•.,;HECK —. �e`?'=' OCCUPANTREQUIREAP MIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY NAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST (•LL��//•�1:�S i n I 1 FOR GUIDELINES. yf�!!'I!.-. I hereby affirm that there is a construction lending agency for VES❑ No the performance of the work for which this permit is issued(Sec. 3097,CIV.C.. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES l�}�it f ?ii ;! — aD COUNTYCODE,TITLE?,CHAPTER 220 SECTIONS 220.100 THROUGH 2.20 CONCERNING 'F'')�J '�'"''J. Lender's Name HAZARDOUS ERIALS REP N AND R BTAININGAPERA F MTHESCAOMD. i L,r a=^ a Lender's Address f/ i i� owr+ER OR AGENT o' I certify that I have read this application and state that the above information is Correct. I agree to comply with all county P.C.FEE Q 00 PERMIT FEE ✓ Q ordinances and State laws relating to building construction,and v` V v a. hereby authorize representatives of this County to enter uponISSUANCE FEE t property for inspection purposes. u 3 ® IGAT ON EE )K51 TOTAL FEE SEE REVERSE FOR EXPLANATORY LA M017,09,E�o APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a certified copy thereoff(Sec.3800,Lab.C,) 1 CITY% J �i ZIP Policy No.�t: I t 1 7 F'.. `'It) f"T�:x�'t:. ,. Y h"'t y. 1, .., �1 � LOCALITY �tyJ Company SIZE OF ECT NO,OF BLDGS.NOW ON LOT �I Certified Copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. + i ASSESSOR MAP BOOK PAGE PARCEL Date• I Applicant t "', . `,;`�..._ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' TEL N COMPENSATION INSURANCE C �' S. '� � � ''% t,^ WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDRESS P i T, r 4617-L." (y DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) I certify that in the performance of the work for which this permit CITY Zip _7 is issued, I shall not employ any person in any manner so as to t r� MCHITECJ,OR ENGINEER TEL NO become subject to the Workers'Compensation Laws. ,, r, �'Z ), STATISTICAL CLASSIFICATION APT CONDO Date ApplicantADDRESS ti y d1 CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of L. A Ail) 'v REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACVR- T` ..-. TEL NO. � SET BACK YARD HWY PROP LINE WIDTH } Compensation provisions of the Labor Code, you must forthwith ✓ 7l } `'; FRONT CL comply with such provisions or this permit shall be deemed revoked. ADDFESS' LIC.NO. P L O z i I�_OVA w SIDE U LICENSED CONTRACTORS DECLARATION CITY r LtC CLASS P L W I hereby affirm that I am licensed underprovisions of Chapter 9 F 7 ' "� SEWER MAP J (commencing with Section 7000)of Division 3 of the Business and SQ.FT. IZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect, NEW ❑ BK PG , } License Number.z�J'l'1 4 Lic.CIBSS r ` D CRIPTION OF WORK ADD ❑ VALUATION r 3 Q Contractor` 47 wFDate %.I !-S.-r--'F ` ALTER ❑ r ■M' O REPAIR 1111 ❑ 1 am exempt under Sec. $ 1 � LLJ BAP.C.for this reason DEMOL ❑ LDMA P/C x Date: USE OF EXISTING BLDG. r .. .e' URM ElTOTA TOTAL tf Signature FPYCA�T(PRINT) FF TEL NO., ryry LDMA Perm# { -21* ❑ I, as owner of the property, or my employees with wages as i r r: t '1 - t df Z ty4 their sole compensation, will do the work and the structure is ADDRESS r f t. r O not intended or offered for sale (Section 7044, Business and _'''�� ' I - 4 r3 • r !& I' ''�" FINAL DATE F' Professions Code.) ' WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL :3 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE El 1, OWn of the property, am exclusively contracting 4AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > liceenn sed coo ntractors to construct the project (Section 70444,, Business and Professions Code.) YES❑ No 0 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING t �.,/ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH J F r 1 'I,y n 1. CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)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. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20 140 CONCERNING HAZARDOUS m Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address CC OWNER OR AGENT 3I certify that I have read this application and state under penalty EL of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE U) with all county ordinances and State laws relating to building ✓� M construction, an5L hereby authorize repres atives of this County ISSUANCE FEE 0 to$rifer upon t, above-mentigtt 4451per, for inspection purposes. g .;� ' r - INVESTIGATION FEE TOTAL FEE N �� Ageni -r oma. ►TT-' SEE REVERSE FOR EXPLANATORY LANGUAGE ..---APPLICATION FOR BUILDING PERMIT � —"Plv COUNTY OF LOS ANGELES _ BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILLIN BuD l> (� �7r 1 hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 3�0 or a certificate of Workers'Compensation Insurance,or a certified copy thereof ft(]Sec.3800,Lab.C.) �vh le c j ` ZIP LOCALITY Policy No+tfq-s V pbagMiCompany Q Vh r �,,_,,�� SIZE OF LCT NO.OF BLDGS.NOW ON LOT L�Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified:copy is filed with the county building inspection TRACT BLOCK LOT NO, USE ZONE MAP NO. department. Date Applicant� l r l ASSESSOR MAP BOOK PAGE PARCEL + SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER COMPENSATION NO. COMPENSATION INSURANCE r WITHIN 1000 FT.OF SCHOOLS ves NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY IT . dol-1-0 "4r,-�� ZIP �Or! X I certify that in the performance of the work for which this permit' C is issued, I Shall not employ any person in any manner SO.as.t0 ARCHITECT OR ENGINEER TEL NO become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT -CONDO Date Applicant ADDRESS CLASS NO. 49- 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 w TEL NQ. SET BACK YARD HWY PROP LINE WIDTH. Compensation provisions of the Labor Code, you must forthwith Cq-IV>. TCQ�� ��. 2-4[3Z -&11 C FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION Se 7 A S SIDE ILCITO I hereby affirm that I am licensed underprovisions of Chapter 9 (JJ SEWER MAP (commencing with Section 7000)of Division 3 of the Business and, SQ.FT.SIZE NO.O.STORIEST NO.OF FAMILIES � Professions Code,and my license is in full force and effect. 2•� ewc, pne NEW ❑ BK PG O License Number Lic.Class (,-Z� D PTION OF WORK ADD ❑ VALUATION , U LLI Contractor 5: rR Y Date G` ALTER ❑ $ CL l- N REPAIR ❑ Z ❑ 1 am exempt under Sec. $ B.BP.C.for this reason DEMOL V, LDMA P/C# Date: USE E sa�G IILDG.i URM ❑ V10-Ar- A AL Signature HL•L•I n � AP LI NT(. INj � TEL NO; LDMA Perm# [3I, as owner of the property, or my employees with wages as_ � r G\e4Q- �i Z 3303 18sn In their sole compensation, will do the work and the structure is ADDRESS 0 { ITEMS not intended or offered for sale (Section 7044, Business and FINAL DATE Q 1 ITEMS Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE.A HAZARDOUS MATERIAL G A� �..q`k..n� w�� J TOTAL I I F'1 --{r1-� ❑ 1, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE. FINAL BY a licensed contractors to construct the project !Section 7044, ®/ T CHECKlSS n 10 Business and Professions Code.) YES❑ No WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHANGE n on OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. �/� I hereby affirm that there is a construction lending agency for YES C3C NO r 0000_0001 3/26/96 the performance of the work for which this permit is Issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING �s 3097,CIV.C.) CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, G'C� TITLE 2,CHAPTER 2.20 SECTIONS 2. 0.100 THROUGH 2.20.140 CONCERNING HAZARDOUS -1. 2 Lender's Name MALS RFpORTINC�NQ FSR O AINING P PERMIT FROM THE SCAQMD. Lender's Address ® / cc OMER OR AGENT 3 1 certify that I have read this application and state under penalty a P.C.FEE PERMIT FEE , 0 of perjury that the above information is correct.I agree to comply with all county ordinances and State laws relating to building DO construction, and hereby authorize representatives of this County ISSUANCE FEE ,cO to enter u on the above-mentio d property for inspection purposes. ✓:C g ( ,e�� -3 1 ZL -4! INVESTIGATION FEE TOTAL FEE 1 , -m A.P.—w Apem Dale w l�J o SEE REVERSE FOR EXPLANATORY LANGUAGE 11 WORKERS COMPENSATION DECLARATION hAr_7 affirm That 1%hav certificate of consent Ta se"t' • APPLICATION FOR B U.I L.D I N G PERMIT , •� 'insure,-or a itertifiAle'of Workers' Compensation Insurance, or'a certified copy thereof (Sec. 3800, L b. C.) ;,.. COUNTY•_OF LOS ANGELES BUILDING AND SAFETY Policy Not,W%.mpany i u _ Certrfied.copy-is hereby furnished. FOR APPLICANT TO FILL IN BUILDINGy ADDRESS Certified copy is filed with'the county buil ng inspec- BUILDIN tion department: ADDRESSG i E LA Date /b• - Applicant• �.`/� CITY ri i ZIP. LOCALITY ' CERTIFICATE OF EXEMPTION F M W RKERS' NO. OF BLDGS. NEAREST COMPENSATION INSU NCE' SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if-the permit.istfor one BLOCK ASSESSOR ; hundred dollars ($100.)or less.)i . - TRACT- LOT NO. T MAP BOOK PAGE PARCEL TEL. QE, pIcertify that'in the performance of the work for which this OWNER NO - O > permit is issued, I shalt riot employ any person in any manner PECIAL - O. so o's'(o become subjectto th'e,Workers"Compensation Laws. ADDRESS r k ti� l�t�- CONDITIONS ;~ U Date , t Applicant CITY CT t.( 'VL % ZIP pp CHITE OR TEL. DISTRICT GROUP- .TYPE FIRE PROCESSED BY. O NOTICE TO APPLICANT: If, after making this Certificate of - ENGINEER CONST. ZONE U Exemption, you should become 'subject to the Workers' -�j tj`�(� W Compensation.provisions of the Labor.Code, you must forth- ADDRESS YI� ��,F L -✓ 0 ®- with comply with' such provisions or this permit shall be N TEL. STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked.-, CONTRA CTOR = N0.71�('' LICENSED CONTRACTORS DECLARATION LTC.- CLASS NO. - DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS `J' 7j }� 0. A . (commencing with Secfion7000)of Division 3 of the Business and LIC:. SEWER MAP Professions Cod license license is.in'full force and effect. CITY i%} U ? '�� CLASS BK` VALIDATION .SQ. FT.- NO. OF NO. OF _ CHECK Lice nse'Numbe.r ` /'c r Lic.Class i SIZE STORIES FAMILIES ONE. ❑ VALUATION t .l DESCRIPTION OF WORK ' NEW- Contractor. t`��pf .r ii Date f _ $ o 000 r r, ADD, _ am exempt under Sec. f Q�fi ' ALTER 0110z 22 1,5 A B.&P.C. for this reason REPAIR. . $ # o 0 0 o2 3 USE OF EXISTING BLDG.y EMOLDate: Q Signature APPLICANT -TEL. FINA 8 70.2 0 PRINT t/ Y t - NO. OWNER BUILDER DECLARATION 1.-I hereby affirm that I am exempt from the Contractor-'s License j� yj��-�,,r- 0 0 8 7 2 _ Law for the followmg-reason,(Section 7031.5, Business and ADDRESS . �c'l t 7�TI FIN 0" 'Professions Code): PRESENT By 0 6,0-7-85 BUILDING I, as owner of The property, or my employees with ADDRESS _ wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY Poo.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- - tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM. EXIST. } CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH . z 2 2„C�S hereby affirm that there is a construction lending agency for FRONT }�'o the-performance of The work for which this permit is issued -- P.L. - - I. 0 j_7j 5 0 (Sec. 3097, Civ. C.). SIDE i, '33,5 5 P.L. 0 - - 0. I lender's Name j y� LDMA Ref. # ® t - - --. - -- P.C. Fee (J-I eF rmi1 Fee Lender's Address r -.I certify that.1 have read this application,and.state that the Issuance Fee- i1 v - LDMA P/C-# above information is correct. I agree to comply with all County Investigation Fee /!,) $ ordinances and Stare laws relating to building construction, Total Fee �` (,f LDMA Perm:# v/ U and hereby authorize re resentatives of this County to enter m upon the bove-menti ed property for inspection purpgses. �'', ' fc 8� SEE REVERSE FOR EXPLANATORY LANGUAGE -- Sign Tu a of Applicant o of-- � ate Qr WORKERS'COMPENSATION DECLARATION f� I hereby affirm that I have a certificate of consent to self '71LJII insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT . a pc�ert'fiedyycopy thereof (Sec. 3800,�1[aJb. C.) COUNTY OF LOS ANGELES BUILDING AND AFETY Policy t i `\S6�7Q Company `(\C)V) 0" Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 6 3 O oS q—&-tq c C 0 Date Applicant CITY 1w-L L0 � ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO'OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be.completed if the permit is for.one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL ` TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER U11n h M NO. 7lsOO NO. J�✓�J permit is issued, I shall not employ any person in any mannerSPECIAL Zz � Mi so as to become subject to the Workers'Compensation Laws. ADDRESS ,0V 6C V CONDITIONS O 4 Dote ld"+�A+`�)Applicant V4 f L_C (TCITY V �� ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR 1� TEL 7 a DISTRICT GROUP TYPE FIRE P OCES_SED BY O ENGINEER G Y" +CCI M �/r NO. '! Ql7 CONST. ZN E / U Exemption, you should become subject to the Workers' (� } Compensation provisions of the Labor Code, you must forth- ADDRESS 5 �Q t/ —3 W with comply.,with such provisions or this permit shall be a- I deemed revoked. CLL- Ih Y s NO. STATISTICAL CLASSIFICATION� APT. CONDO. Z CONTRACTOR + //(/ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 3 41 NO. 0 I (commencing with Section 7000)of Division 3 of the Business and t -t LIC (� t SEWER MAP Professions Code, and my license is in full force and effect. CITY O�� 0 K U 13A h CLASS �7 ` BK PG VALIDATION I p I> ` SQ. FT. NO. OF N0-0. F CHECK f License Number A 6 7 S78 Lic.Class 1O 1 SIZE STORIES FAMILIES ONE ,A- J ❑ VA ATIONN ^ Contractor r",e-'CE- Qt kS j Date / E)—*3a '�7. DESCRIPTION OF �/ NEW t O U iii ❑ C+ i�l V 1\.*. ADD ❑ , I I am exempt under Sec. (� +�-� ALTER ❑ II B.BP.C. for this reason J� U z t (( REPAIR ❑ s Date: USE OFEXISTING BLDG. , l.E S DEMOL ❑ Signature APPLICANT TEL. FINAL ` 82 4 3 A I OWNER-BUILDER DECLARATION PRINT Ltl, +~,f NQ.J 4• 2 DATE Z/ I hereby affirmthat I am exempt from the Contractor's License ADDRESS °'3 8 8 5 0 Low for the following reason (Section 7031.5, Business and FIN Professions Code): PRESENT By ° - 38a5 0 53 BUILDING j ❑ I, as owner of the property, or.my employees with ADDRESS 0,3 0"8 7 I wages as their sole compensation;will do the work and LOCALITY the structure is not intended or offered for sale(Section 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). ROM CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.pL NECK F 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. I (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name t LDMA Ref. # P.C. Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee ( v L LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee a �) ordinances and State laws relating to building construction, Total Fee V v LDMA Perm. #i and here y auth rize re esentatives f this County to enter upon t bov enti ed pr p rt f inspection purposes. O SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date o APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION . FOR APPLICANT TO FILL IN rLOCALITY DRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, 6340 N. Rosemead or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3800,Lab.C.) Policy No. WC 5216:1614- �1N�1MrAM Temple City �y� Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT — Certified copy is hereby furnished. 3.86 2 NEAREST CROSS ST. Y❑Certified Copy i3 filed with the CO nt UildI inspect.On TRACT BLOCK LOT NO. YUSE ZONE MAP NO. J depa ment Date I� Applic ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. YES NO COMPENSATION INSURANCE Commercial Properties (714)773-1500 WITHIN 1000 FT OF SCHOOL? ADDRESS — (This section need not be completed if the permit is for one hundred DISTRI GROUP TYPE ONST.' FIRE ZONE OCES ED B dollars($100)or less.) 1160 S. Harbor Blvd. ,, Fullerton ! CITY zIP o0W( I certify that in the performance of the work for which this permit Fullerton 92632 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. 1 become subject to the Workers'Compensation Laws. G Architects 714 553-1117 ST IST CAL ICATION Q T CONDO Date - Applicant ADDRESS CLASS NO. DWELL UNITS . NOTICE TO APPLICANT: If, after making this Certificate of 18201 Von Karman, Suite 250, Irvine REQUIRED TOTAL SETBACK FROM EXIST Exemption, you ShOUId bBCOm@ subject t0 the Workers' CONTRACTOR TEL.NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith '714)632-3210 FRONT comply with such provisions or this permit shall be deemed revoked. AcrbRESS LIC.NO. P L 1064 N. Tustin Avenue SIDE } LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L c 1 hereby affirm that I am licensed under provisions of Chapter 9 Anaheim FT SIZE NO.OF STORES NO. FAMILIES SEWER MAP � (commencing with Section 7000)of Division 3 of the Business and 30,000 1 NEW ❑ BK PG CD Professions Code,and my license is in full force and effect. v �+� DESCRIPTION OF WORK ADD ❑ VALUATION - Licen ber Lic.Class remodel interior & exterior ContrantALTER ' $ of existing retail buil n 11I am exempt under Sec. REPAIR ❑ $ / __.. B.&P.C.for this reason DEMOL LDMA P/C# Date: USE OF ISTIN B G. URM ❑ Retail a Signature APPLICANT(PRINT) TEL.NO. LOMA Perm# Z ❑ I, as owner of the property, or my employees with wages as r O AC'.C T their sole compensation,will do the work and the structure is ADDRESS FIN ATE Q311` 11 not intended or offered for sale (Section 7044, Business and 000. x.9,.3; ='�'_•=- Professions COde.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �. j1 T iF�L: --- OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ` Q •'• ''TE'�� ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FIN 00 licensed contractors to construct the project.(Section 7044, YES El NO I I-'3 A= :LJ I"n `° Business and Professions Code.) WILL rjrl WILL THE INTENDED USE MI THE BUILDING BY THE APPLICANT IO FUTURE BUILDING CHECK ;���a•-(- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST' Ak � ISI FOR GUIDELINES. . i''!l3 i1 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. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 0000-0100 i Cif 11/ j m. COUNTY CODE•TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING - 3 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. I� 04irE 7 n e Lenders Address �I EE °26 a OWNER OR AGENT 6 o I 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 �' $$ ordinances and State laws relating to building Construction,and J U v a. hereby authorize representatives of this County to enter upon ISSUANCE FEE r^ the above-mentioned property for inspection purposes. `.J INVESTIGATION FEE TOTAL FEE ' O $Ipnewn of Mph w Apem oem SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, A P P L I CAT I .N FOR BUILDING PERMIT ,or 9 certified copy thereof (Sec. 3800, Lab. C.) s r /� • COUNTY OF LOS ANGELES> BUILDING AND SAFETY Policy No.� Company `� �X F✓ F/` t Certified copy is hereby furnished. FOR,APPLICANT TO FILL IN BUILDING /_2 J Certified copy is filed with the county building i ec- BUILDING r���!) ADDRESS �'/ Lo 21 4-V tion department. DRESS /- ( �r e,4 f,�>, / Date< d -Z7—Mpplicancl, CITY L� ZIP LOCALITY (� CERTIFICATE OF EXEMPTION F ERS' N16. OF BLDGS. NEAREST COMPENSATION INS NCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL p TEL. USE ZONE MAP OWNER �i 7 e ,NO. Cr! 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 OSerii e �� SPECIAL so o3 to become subject to the Workers'Compensation Laws. CONDITIONS O C n U Date Applicant CITY P IY NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL: DISTRICT GR UP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. /� CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS 51(4/ LtJ- wlth comply with such provisions or this permit shall be § TEL �) 5 ATISTICAL CLASSIFICATION APT. CONDO.' Z' deemed revoked. CONTRACTOR 7 �� NO. ��t LICENSED CONTRACTORS DECLARATIONLIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ��v Jil�I NO. S !� (commencing with Section 7000)of Division 3 of the Business and LIC ffII SEWER MAP Professions Code, and my license is in full force and effect. CITY W f L✓� Yl _F0 CLASS G ``4 BK PG VA—�MZW7 A G� SQ. NO.OF NO.OF CHECK License Number S� Q / Lic.Class SIT ISTCRIES FAMILIES ONE S f # 0 0 0 023 Sf/l[(�eq 20 e NEW VALUATION Contractor Date�l, �Z7- �/ DESCRIPTION OF WORK ❑ f 1 am exempt under Sec. � !'�® 1 0 * 3Z5.0 r _ DD V O L�v�f ��� ALTER ❑ , I Q 2 9 7. -99" B.BP.C. for this reason Lr ex, REPAIR [ $ Date: USE OF DEMOL 8 2 Q 8•A EXISTING BLDG. /DATE # 0,0 0 0 0 1l Signature APPLICANT ,;,6 INAL OWNER-BUILDER DECLARATION (PRINT) .,) 1 -,- 49.88 I hereby affirm that I am exempt from the Contractor's License ?3� � � v f �� Law for the following reason (Section 7031.5, Business and ADDRESS INAL Professions Code): PRESENT By BUILDING 0 0 0 4 9 8 8 I, as owner of the property, or my employees with ADDRESS © T % wages as their sole compensation,will do the work and 1 Q,2 9"8 7 the structure is not intended or offered for sale(Section LOCALITY 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). REQUIREDTOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name 2 LDMA Ref. # Lender's Address P.C. Fee$ -? Permit Fee 3 I certify that I have read thisapplicationand state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee and hereby authorize re resentat'ves of this County to enter LDMA Perm. # n e above-mend prop rty for inspection purposes. k7 SEE REVERSE FOR EXPLANATORY LANGUAGE gnatu of Applicant or Agent Date ii APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A DR SS I hereby affirm that I hav^ a certificate of consent to self insure, BUILDING ADDRESS ,,AA O or a certificate dt Workers' Compensation Insurance,or a certified Li ��ecj V�`V copy thereof(Sec.3800 C.) CITY ZIP LOCALITY Policy No. Company SIZE OF 1_01% NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS T. Iy�r�•Certified copy is filed with the county building inspection TRACT BLOCK LOT N0. r 'department USE ZONE MAP NO. ASSESSOR MAP B OfS„_ (PJAGE� / PARCEL Date-5-3-4-4 Applicana` SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' o NEf} TEL No. COMPENSATION INSURANCE -) 1�5� WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS L f 'n ���' dollars($100)or less.) 7 z> DISTRICT GROUP TYPE CONST: FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit t -�-v �� ZIP 1q2(, r� /n f is issued, I shall not employ any person in any manner so as'to t ffj,v CHITECT O GINEER TEL NO. become subject to the Workers'Compensation Laws. > STATISTICAL CLASSIFICATION APT CONDO tgolplDate Applicant D1 RESS 'e1� lJ �p` �� CLASS NO. � DWELL UNITS NOTICE TO APPLIG4NT.. If, after making this Certificate of `� �� �' REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CqNTRACTOREL NaSET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,-you must forthwith { �1 r Its FRONT comply with such provisions or this permit shall be deemed revoked. ADpRESS �� a i LIQ N`O lL� SIDE LICENSED CONTRACTORS DECLARATION CIT LIC.CJL I s T IP L I hereby affirm that I am licensed underprovisions of Chapter 9 �O`t�0 -2, SEWER MAP a (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OFORIES NO.OF FAMILIES Professions Code,and my I'c Be is is in full force and effect.- ( t NEW 1:1 BK PG v License Number `r' LiC.CIaSS, ��� IbE8CRIPTION OF WORK ADD E] VALUATION License Numbe� ( yy� O Contractor Date ALTER a ❑ I am exempt under Sec. REPAIR ❑ z BAP.C.for this reason :VC c DEMOL ❑ LDMA P/C# Date: USE W EXISTING VLDG. URM ❑ Signature APP CANT(PRINT) TEL NO. LDMA Perm# f ' ❑ I„as owner of the property, or my employees with wages as Ck4 t I. z CIlb z ADO!*a their sole compensation, will do the work and the structure is ADDRESS M O 0 L�, `�1 FINAL DATE ~ Rj L_ not intended or offered for sale (Section 7044, Business and Q -- Professions Code.) T-FIM WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL "V— A i 1 i :!•= OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q a i 5 FINAL BY > -1's=.fL ,_b licensed contractors to construct the project (Section 7044, €f,?�i -- VES❑ NO❑ Business and Professions Code.) t WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ;,l :.j OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FORr,. � GUIDELINES. - -. t:�L I hereby affirm that there is a construction lending agency for YES❑ NO❑ a the performance of the work for which this permit is issued(Sec. )HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING _ . . 3097,CIV.C.) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, Q. 1 TITLE 2,CHAPTER 2.20 SECTIONS 2.20,100 THROUGH 2.20.140 CONCERNING HAZARDOUS :_%Ii.:(.7 =''-. Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. -- o Lender's Address - O OWNER OR AGENT .• �'r .,':l -•'' _ ,�y,0 ` o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building construction, and hereby authorizes r esentatives of this Count hSSUANCE FEE ) �,`7^ to ent ry(pon the abov) entioned p p ty for inspeion purpsys , 'f'(J a V\ 1 INVESTIGATION FEE TOTAL VEE S' ure.o/Apgsant«Agenf Dete SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT «. COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRES � c3 or a certificate of Workers'Compensation Insurance,or a certified •3110 ,['rc"M /T1G- copy thereof(Sec.3800,Lab.C.) CITY- - ZIP C /CIO LOCALITY Policy No. 20I f Company SIZE OF L T NO.OF BLDGS.NOW ON LOT :. s�_/O ❑ Certified copy is hereby furnished. NEAREST CROSS S7. ❑ Certified copy is filed with the county building inspection t TRACT, BLOCK LOT NO. department.' USE ZONE MAP NO. Date_ iF_Y.1 Applicant—// I ASSESSOR MAP BOOK PAGE PARCEL ' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER/ TEL NO. WITHIN 1000 FT.OF SCHOOL? r+/y 6/ YES NO • COMPENSATION INSURANCE f (This section need not be completed if the permit is for one hundred ADDRESS ///, 11 ,QO[[ �� dollars($100)or less.) S WF 1Z 7JQ elx DISTRICT GROUP T E CONST. FIRE ZONE PROCESSED BY I certify that.in the performance of the work for which this permit CITv�,'Q V^ ZIP is issued, I shall not employ any person in any manner so as to gRCH1T 7 OR ENGINEER TEL NO. become subject to'the Workers'Compensation Laws STATISTICAL CLASSIFICATIO APT CONDO Date Applicant ADDRE 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' TOR TEL NO. �J p SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of•ihe Labor Code, you must forthwith OOr rw Z ,. f/�L / / a FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS / LIC.NO. PL �. *S . 2 SIDEIL LICENSED CONTRACTORS DECLARATION' LIC. LASS PL 0I hereby affirm that I am licensed underprovisions ,of Chapter-9 I W.I. Z.^ �� SEWER MAP(commencing with Section 7000)of Division 3 of the Business acid SIZ NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and 'effect. ,'I NEW ❑ BK PG License Number S�GO3y Lic:Class y/C DESCRIPTION OF WORK ADD ❑ VALUATION , 23 tU Contractor Date,. /f Jam! ALTER ❑ $ ld 6��' ta/) ❑ I am exempt under Sec. is REPAIR ❑ $ 333 181.94 BAP.C.for this reason DEMOL ❑ LDMA P/C# 1 I�EMS USE OF EXISTING BLDG. /� Date: : CA�••n�erC �.,L URM ❑ TOTAL :18 1 m 94 Signature .APPLICANT( ) TEL NO. LDMA Perm# CHECK •I—1.,_'� R l rt lt�.� ❑ I, as owner of the property, or my'employees with wages as —'-! Z �p; their sole compensation, will do the work and the structure is ADDRESS .itrt L (AGE ,�ILI not intended or offered for sale (Section 7044, Business and Tp FINAL DATE /y Q Professions Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE,A HAZARDOUS MATERIAL g� / C "-t'`•I v S OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ❑ I, as owner of the property, am exclusively contracting with Q ' AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > •nuFe,n1—L���}�. •ti>�'_7? •:•f' licensed contractors to construct the project (Section 7044, Business and Professions Code.) -YES❑ NO❑ ,� 9 $386A{! a 42 ' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST FOR ACCT.8.S' GUIDELINES. I j I hereby affirm that there is a construction lending agency for YES❑ No❑ 1JO3 0 R 42", the performance of the Work for which this permit Is Issued(Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATIONGUIDE AND THE SCAOMD PERMITTING 3097,Civ.C.) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ITEMS' TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS I Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD, TOTAL AL 3 19 - c Lender's Address CHECK '�? s' O—ER OR AGENT 3�, a..., 3 I certify that I have read this application and state under penalty CHANGE p of perjury that the.above information is correct.1 agree to comply P.C.FEE PERMIT FEE - ~=9 r,) ,l �� � t•ftAi9t1L =)-}(rowith all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County O ISSUANCE FEE 7O r,erty for inspection purposes. "� '7 /' c '—'�-"�' !]4jl i3]-!]i]{]�, •/'��, 9:ro I�O INVESTIGATION FEE TOTAL FEE ��- ro�• 7_}_34 1 P i -z 1 1 SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9608080015 PHONE: (818) 285-0488 EXT: DUPLICATE LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: ON FILE SO. FT STORIES TYPE OCCUP GROUP 6340 ROSEMEAD BL STRUCTURE: 31984 1 V M TEMP CA 917801544 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-026 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME ISSUED ON: PROCESSED BY: EXPIRES ON: VALU MART EXIST OCC GRP: M 08/09/96 TC 08/08/97 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY* CODE: VANNIER WILTON E CO TR VANNIER TRUS (818) 355-1239- 1,500 Sc��G� ll� 209 OAK MEADOW RD (> SIER-910242611 FEES PAID DESCRIPTION OF WORK FIRE ALARM SYSTEM FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: GALLEGOS, DAVID (714) 458-0900- AA BLDG PERMIT ISSUANCE 27.75 AE STRONG MOTION OTHER 1500.00 VA L 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O,EN-HC- LE CQ1500.:00 VAL 82.20 TOTAL FEEES� 110.45 CONTRACTOR: TEL. NO: �- //� APPROVALS DATE INSPECTOR SIGNATURE WESTEC COMMERCIAL SECURITY, INC (714) 725-6200- 100 BAYVIEW CIRCLE LIC. NO �/f LOCATION AND SETBACKS NEWPORT BEACH, CA 92660 NONE SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: /r--- j7/ \ - \� FOUNDATION/TRENCH FORMS LIC. N0: , SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP N0: SEWER MAP BOOK: PAGE: FIRE ZON3: CMP04 �,I ��� � ��, ���(����� UNDERFLOOR INSULATION FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 22 o i , ROOF SHEATHING SCHOOL WITHIN HAZARDOUS \ i / �.; � ��' SHEAF: PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO D� `�-`-�-� FRAME INSPECTION FIRE SPRINKLER HANGERS g zS_9 INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS ' T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES' -BUILDING AND SAFETY- WORKER'S COMPENSATION DECLARATION FOR,APPLICANT TO FILL IN BUILDING A D s I hereby affirm that I have a certificate of consent to self insure, BUILDING ADD ESS or a certificate of Workers' Compensation Insurance,or a certified S �` copy thereof(Sec.38 0,Lamb.Com) (T fP7� T^ CITY ZIP Policy No. '^"'— Company `�` "'— r� _tc LOCALITY T C SIZE OF LCT NO.OF SLOGS.NOW ON LOT ❑�/CC gr'tified Copy is hereby furnished. NEAREST CROSS ST. — I yCertifie l Copy is filed with the unty uildin�Insp TRACT BLOCK LOT NO. TT deLp'art ent. �� USE ZONE MAP NO. Date✓ RppliCant ASSESSOR MAP BOOK PAGE - PARCEL SPECIAL CONDITIONS OWN TEL NO. CERTIFICATE OF EXEMPT N FROM WORKERS' �n YES No COMPENSATIO INSURANCE /�` WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS D 041 DISTRICT GROUP TYPE CONST. FIRE ZONE PROCE SED(3Y dollars($100)or less.) � �_ CITY �! ZIP f, I certify that in the performance of the work for which this permit �i V` /Y) is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OFf ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. Iq ­� DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CON C�T/OR �� ��A I TEL NO. SET BACK YARD HW.Y PROP LINE WIDTH Compensation provisions of the Labor Code; you must forthwith 5'QI 'V �F�G1`' c7 FRONT Comply with Such provisions Or this permit shall be deemed revoked. ADDRESS ® ,/ LIC.NO. /� P L >- �����IG �`� ��� ��Q/ c` SIDE O' LICENSED CONTRACTORS DECLARATION CITv ` �� /Z> ucLAsg P L 0 I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division'3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,4,gld y license is in full force and effect. NEW BK PG O J��Q Cr•' DESC IPTION OF WORK VALUATION , U License Nu�i'be� Lic.Class /„ r ADD ❑ $ � W Contractor$�I Date40V V' ALTER ❑ �d� W SS/'o rA/ r_-C7 fn ❑ I am.exempt under Sec. REPAIR ❑ $ Z B.BP.C. for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ 23 Signature APP ANT(PRINT TECL NO. �+ LDMA Perm# nr •r ❑ I, as owner of the property, or my employees with wages as � J (% Z ACC CCU.a their sole compensation, will do the work and the structure is ADDRES.�j /' A� ,/� O 351 ] 5I j a �j not intended or offered for sale (Section 7044, Business and e f0 ls'� �`� Al w zo INAL DAAT,E� / Q Professions Code.) S Jo WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J OR A❑ MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY Ai 'a' licensed contractors to construct the project (Section 7044, H`C E °s VES❑ NO Business and Professions Code.) ;( WILL THE INT NDE OF THE BUIDLING BV THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAQMD)SEE PERMITTING CHECKLIST FOR ITEMS GUIDELINES. . I hereby affirm that there is a construction lending agency for YES 1:1 •r N TOTAL -49Z_;- 5 the performance of the work for which this permit-is Issued(Sec. IHAVE READT ZARDO SMATERIALS INFORMA SIDE AND THE SCAOMD PERMITTING f�11i ' 3097,Civ.C.) CHECKLIST NDERSTA MY REQUIREMENT D HE LOS ANGELES COUNTY CODE, CHECK '9!V a•: TITLE 2, APTER 2.2 EGTIONS 2.20.10 H H 2.20. 0 CONCERNING HAZARDOUS Lender's Name MATERI S REPORT AND FOR OBT PERMIT F THE SCAQMD. CHANGE =00 m Lender's Address _ OWNER OR AGENT 3 1 certify that I have read this application and state under penalty �I a P.C.FEE ,c-� PERMIT FEE 101000-000 rnt0 I -0 ; rj 3 / 0 of perjU a the above information is correct.I agree to comply �,�D J D tJS� �� 1i! .`..:. wit II cou ty ordinance tate laws relating to building 1 AM Oj,;l m nstructi and here But a presentatives of this County ISSUANCE FEE 'S'= o ente Ont a ntjpned roperty for inspection I;ILur oses. p2 3® INVESTIGATION FEE TOTAL FEE �• r/' CV ,oro Aodram«Apem Gae ` f7 7O V SEE REVERSE FOR EXPLANATORY LANGUAGE