HomeMy Public PortalAbout6333 SALTER AVE_Building__ 76A638A CE9803 9-68 O'q am
6849 APPLICATION FOR BUILDIN - PERMIT
COUNTY OF LOS ANGELES ADDRESS 6 No
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY Temple City
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST ) +�,.�!
COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. I�VILX lJ�`�
FOR APPLICANT TO FILL IN Dls�T N GROUP TYPE--.-r— P SSED'BY
(Print or type only) d♦ 6 �� CONST•.
BUILDING STATISTICALASSIFICATION -I-EWER MAP
ADDRESS 6393 North Salter CLASS NO. DWELL.UNITS BI_ P
LOT NO. BLOCK 0 E MAP
NO. G V
TRACT SPECIAL
NO.OF SLOGS. OD 1 CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF l
EXISTING BLDG. BLDG.SETBACK FROM
OWNER Bessie Frankfurt NO.
d2� FRONT PRO (STREET)
O ro TYPE OF EXISTING SETBAC HIGHWAY + YARD = TOTAL
ADDRESS6323
HIGHWAY WIDTH FROM G.L.
CITY Temple City + _
BLDG.SETBACK FROM
ARCHITECT OR TEL. SIDE PROP.LINEOF (STREET)
ENGINEER NO. TYPE OF 1EXISTING1 SETBACK HIGHWAY YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
CONTRACTO TEL.NO, +
LIC
ADDREss60O S. San Gabriel Bl,NO' 160650 CORNER CUTOFF YES ❑ NO ❑
LIC.
CITY San Gabriel 91776 CLASS 0-39 'SEE REVERSE SIDE FOR SPECIAL APPROVALS
CONSTRUCTION LENDER c
NAME AND BRANCH
ADDRESS
f
SQ. FT. NO. OF NO. OF NEW ❑
SIZE STORIES 1 FAMILIES
USE OF ADD ❑
STRUCTURE
ALTER ❑
SIGNATURE OF REPAIR
APPLICANT DEMOL ❑
VALUATION$340.00 APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE$ FEE$ 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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE 'LATH, INT.
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION 1 URANCE. ;LATH, EXT.
SIGNATURE OF 'HOUSE NUMBER CO
PERMITTEE. RECT AND POSTED
ADDRESS iF I N AL
JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
cki
2 '6 6 0 DEC 3 1 D 9.G 0
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1112220059
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST BUILDING ADDRESS: 1
ON FILE I SQ. FT STORIES TYPE 6347 SALTER AV I
ISTRUCTURE: 2631 V-B TEMP CA 917801429 I
1 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 5383-020-022 i I THOMAS PAGE: 597 GRID: Al LOCALITY: TEMPLE CITY, Cl
TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 IISSUEb ON: PROCESSED BY:
(EXIST OCC GRP: 112/22/11 SR
(OWNER: TEL. NO: 1BLDGS. NOW ON IAT: VALUATION: IFINAL DATE FINAL BY: CODE: I
ISOLIMAN, MALAK (626) 222-3793- 1 6,000 1 I
16347 SALTER AV I I I
ITEMP 917801429 1 FEES PAID IDESCRIPTION OF WORK 1
I. (REPLACE COMP SHINGLE ROOF, 25 YR TO PRE-EXISTING CONDITION I
lAA
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I (DAMAGED DUE TO WIND) + DAMAGED FACIA BOARD 12-24 IF 1
[APPLICANT: TEL. NO:IMULLEN, JULIAN (714) 366-2941- BLDG PERMIT ISSUANCE 27.80 I I
132158 CAMINO CAPISTR JAB STATE GREEN BLDG FEE 6000.00 VAL 1.00 ISPEC7AL CONDITIONS: 1
(SAN JUAN CAPISTRANO IAC STRONG MOTION REBID 6000.00 VAL 0.60 I I
ID2 PERMIT W/O EN-HC 6000.00 VAL 149.70 [
I 1 TOTAL FEES 179.10 I I
(CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE I
(IKON BUILDERS INC. (714) 365-5918- I I I
132158 CAMINO CAPISTRANO A 336 LIC. NO 1 1LOCAi1ION AND SETBACKS I I I
ISAN JUAN CAPISTRANO, CA 92675 966760-B I I I I I
I (SOI ENGINEER APPROVAL I I I
(ARCHITECT OR ENGINEER: TEL. NO: 1FOUNDATION/TRENCH FORMS I I I
1-1
LIC. NO: I (SLAB IUNDER FLOOR I I I
I I I
1 RAISED FLOOR FRAMING I I
1
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I I
1153H269 3OOI I 1-1 I
IFLOD SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I I
I 0 NO 21 I IROOF,SHEATHING I I I
SCHOOL WITHIN HAZARDOUS I ISHEAij PANELS
AZR QUALITY: 100
NN0O
0 FEET MATERIALS i E D IFRAME INSPECTION I I I 3
1
1
IFIREISPRINKLER HANGERS I I I
(INSULATION/WEATHER STRIPI I I
I.
(INTERIOR LATH/DRYWALL 1 1 1
I EXTEF IOR LATH I I I
I I I I I I
I (RATED FLOOR/CEIL ASSEM. I I I
I I IRATED WALL ASSEMBLIES I I I
I I IRATED SHAFTS/OPENINGS I I
IT-BAR, CEILINGS I 1 I
I I I I I I
I (LOT DRAINAGE I I I
I I I I I I
IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I
i
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES �� ®� {�,�
WM. J. FOX, CHIEF ENGINEER N
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
[ADDRESS
ILDING � w // DISTRICT NO. iPLANCK. NO. PERMIT NO.
DRESS wJ [N��-1. • r `sem 9 F6 ® �o
/J _ RECEIVED BY DATE OF APPL. DATE ISSUED
CALITY '.
AREST C
OSS ST. �,�.,��j /��L ®+ rs7J.,!f- ss• ' BUILDING
r ADDRESS 3
NER"
IL v /� y! ,✓ LOCALITY �p�ry
�' L/yA. 1 �" f NEAREST S 1 IL LTEL. . CROSS ST.TY � y+ .f ,�� NO.;fi � FIRE NO. OF TYPE GROUPCHITECT OR � TEL. ZONE PLANSGINEER NO. BLDG. ,1 ORD. NO.
SETBACK LINE a Q { I`t'GI 4
DRE88 APPROVED
TEL. BY DATE
CONTRACTOR NO. USEAPPROVED
ZONE _1 BY DATE
42
ADDRESS HOUSE NUMBERING
LEGAL
DESCRIPTIONZ®D�J FIELD CHECK BY
DESCRIPTION I OT NO. HLOCK 4 MAP NUMBS
TRACT q� NO. ASSIGNED By--! / HATE
• d NO. OF SLDGS CORRECTIONS
W
SIZE OF LOT -- I NOON LOT
' USE OF NO. OF i r1 /oD`'Q71
EXISTING BLDG, I FAMILIES"'
DESCRIPTION OF WORK
k� /c -/.a.i'�l_c=
�DI` e4(r, B A e
NEW I I ALTERATION I I ADDITION
REPAIR I I DEMOLITION I I I x
' 1� 7_n 111 /j(!7�a :(� Y�"r e9 ,:c B
SIZE !� 00-4- ROOMS � STORIES / t y Z
EXT. ALL ,+ I ROOF r
COVERING-�d % /'(�i f') COVERING i/, s s`� 6 'sem o a 7-G'
USE OF STRUCTURE /
APPROVALS
INSPECTOR'S SIGNATURE DATE
E 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION q I
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS
CORRECT. _
1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS,
HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS
LAWS REGULATING, UlIL NG CQNSTN.,FtUCTIIO
.r-t8'�(/ FURNACE: LOCATIO
'
SIGNATURE.Or
-� GAS VENT, DUCTSPERMITTE ` 1-
//J LATH, INT.
.ADDRESS v
® LATH, EXT. ,
AUTHORIZED AGT. A! j -
-� PLASTER, INT.
78A838A, 13998 [O-SC4�'� P. C. 8
7 ® W-m ®®m® FEE aI t� PLASTER, EXT.
VALUATION �.1 A $ TO f
FEE Z9 FINAL 'Av cl- 4
I '
WORKERS' COMPENSATION DECLARATION
hereby
irm rI have a certificate of consent
nainsurer acertifcate of Workers' Compensation surrce, APPLICATION FOR BUILDING P E RM I T
or a certified copy ther of(Sec. 3800, La COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.�59Company N� BUILDING
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS r � r G f�
Date Applicant CITY Vh L v ZIP LOCALITY
NO.OF BLDGS. NEAREST
C RTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. L O:lJ C r-
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. USE ZONE MAP
OWNER f NO.
I certify that in the performance of the work for which this SPE
permit is issued, I shall not employ any person in any manner ADDRESS Z Vf� 4A) S SPECIAL a
e c
so as to become subject to the Workers'Compensation Laws. CONDITIONS O
CITY ZIP U
Date Applicant ARCHITECT OR TEL•
NOTICE TO APPLICANT: If, after makin this Certificate of ENGINEER NO. DISTRICT ;OUP TYPE FIRE P CESSED BY
g CONST. ZONE ►—
Exemption, you should become subject to the Workers' i� U
Compensation provisions of the Labor Code, you must forth- ADDRESS ��� 3 Y 3 a
with comply with such provisions or this permit shall be TEL (T' STATISTICAL CLASS ICATION APT. CONDO. Z
deemed revoked. CONTRACTOR �U NO. �O _
LICENSED CONTRACTORS DECLARATION . ADDRESS SZb fv- C(, VS NO. t UC� "'�, CLASS NO. DWELL. UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business LIC.
and Professions Code,and my license is in full force and act CITY oblliM CLASS BK PG VALIDATION
` i SQ. FT. NO. OF NO. OF CHECK
License Number 42— Lic. Class SIZE I STORIES FAMILI ONE
DESCRIPTION OF WORK NEW I VALUATION
Contracto/ijV ate J
$ { OD ..
❑
C1 ❑ b (/ ,
I am exempt under Sec. D �o G'41 ADD
ALTER
// ❑
B.&P.C. for this reason lL REPAIR I$
Date: USE O
EXISTING BLDG. DEMOL
Signature APPLICANT TEL• Li / FINAL
OWNER-BUILDER DECLARATION (PRINT) JI.V ' V ! } NO. DATE ^'(( '4 t
Ihereby affirm that I am exempt from the Contractor's License /�
Law for the following reason (Section 7031.5, Business and ADDRESS /v US f/[/+F FINAL 1
Professions Code): PRESENT :By ^•
BUILDING
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and ,'307
the structure is not intended or offered for sale(Section LOCALITY 11011.
7044, Business and Professions Code.) MOVING TEL. I i i� =
❑ I, as owner of the property,am exclusive) contractingCONTRACTOR NO. TOTAL
with licensed contractors to construct the project-(Sec- ADDRESS
tion 7044, Business and Professions Code..) I ` .4t 1135.25
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH {f••— nLlt
I hereby affirm that there is a construction lending agency for FRONT CHAKI ICE
the performance of the work for which this-permit is issued P•L•
(Sec. 3097, Civ. C.). SIDE
Lender's Name P.L. Ii{ iSIS—IJj](� 121/9 i
3
$ LDMA Ref.# �r`ll� y;1•=f
- P.C. Fee Permit Fee c�
Lender's Address
I certify that I have read this application and state that the Issuance Fee /cJ LDMA P/C#
3 above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee /per, o`� LDMA Perm.#
reby authorize representatives of this County to-enter
g on e a v -mentioned property for inspection purposes.
` tSEE REVERSE FOR EXPLANATORY LANGUAGE
Sig ature of Applicant or Agent Datel t
r V
COUNTY OF LOS ANGELES TEMOLE CITY # 0508 BUILDING FER111
DEPARTMENT OF PUPLT.P WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0407130008
PHONE: (626) 285-0488 EXT:
LEGAL ID: N 0 C0N NEW POTEDI G ADDRESS:
ON FILE SQ. FT STORIES TYPE OCCUP GROUP 6333 SALTER AV
STRUCTURE: 438 1 VN R3 TFMP CA 917801429
ASSESSOR I'NFci4MTION NUMBER: GARAGE: NEAREST CROSS STREET: LONGDEN
5383-020-026 OTHER: THOMAS PAGE: 597 GRID: Al LOCALITY: TEMPLE CITY, C
TENANT: IS B GUS : USE ONE: SLUE^ ON: PROCESSED B PIPES ON:
EXIST OCC GRP: 08/19/04 JK 08/14/05
OWNER: TEL. NO: BLDGS. NOLJ ON LOT: VALUATION: FINRL UAI E FINAL BY: CODE:
LEE HUNG SALTERAAVE (626) 683-3938- 36,310 /;2633A
TEMPLE CITY FEES PAID UESCRIPIION OF ORK
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 MASTERBEDROOM, BATHROOM ADDITION 4F 438 SQFT.
APPLICANT: TEL. NO:
SAME AS OWNER. - B1 PLANCHECK W/ENERGY 36310.00 VAL 587.22
AA BLDG PERMIT ISSUANCE 27.75SPEC[AL-LONDITIUiJS:
AC STRONG MOTION RESID 36310.00 VAL 3.63
82 PERMIT W/ENERGY 36310.00 VAL 690.86
CONTRACTOR: --IEL. N0: TOTAL FEES 1,309.46AA?PRuV�A�— DATE INSPECTOR SIGNA7U.4-E'—
SAME AS OWNER -
LIC. NO LOCAMR AND-SETBACKS II
SOILS ENGINEER APPROVAL 1
ARCH!'=CT
E. ME'K CO. LIES;CNE. (626) 202-6548-
2427 W. MAIN ST. #i LIC. NO: �:;LF.r.7U;JCER FLOOR
ALHAMBRA, CA 91801 NONE
IRAI D F� L06R FRAMING
MAP N0: S:W[R i�i:,N 80jK: PAGE: FIRRE�ZONE: CNP•. �1+i�6ERFi.00R iNS�L rCATI-ON
3 03
NO. OF FAMILIES- 0 --L NG UNITS: AP ICO : STAT CLASS: S'r �LEVEL OOR SHEAT
NO 21 wL LEVEL FLOOR SHEATH i
SCHOOL ITHIN HAZARDOUS ROOF SHEA- TTHRG
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL SETBAC FROM EXIST ON DAPI. FRAME INSPECT
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- SHL"AR PANELS l
it
SIDE PL-
INgULA'ION/ EA HER STRIP j,`=.�(r
INTFaIGR LATH/DRYWALL 1141
EXTERIOR LATH
T1s-�
LOT OR INAGE
SMOKE DETECTION DE ICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE 70: BS0508
e ,
COUNTY OF LOS ANGELES 'TEMPLE CITY 9' 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0407130016
PHONE: (626) 285-0488 EIAT:
LEGAL ID: NO. OF CONST ADDRESS: i
ON FILE SQ. FT STORIES TYPE OCCUP GROUP 6333 SALTER AV
STRUCTURE: 1 1 VN R3 TEMP CA 917801429
ASSESSOR INFORMATION GARAGE: 436 1 VN U1 NEAREST CROSS STREET: LONGDEN
5383-020-026 OTHER: THOMAS PAGE: 597 GRID: Ai LOCALITY: TEMPLE CITY, C
EXIST G USE: USE ON : ISSUED 0N: -PROCESSED EXPIRES ON:
EXIST OCC GRP: 08/19/04 JK 08/14/05
OWNER: TEL. NO: BLDGS. NOW ON LOI: RAD—AlION: FINT Ar—D T FINAL BY: CODE:
LEE HUNG PAK (626) 683-3938- 13,675 ��_��
633A SALTER AVE _
TEMPLE CITY FEES PAIC D SCRIP ION OFWOO—
NEW 2 CAR GARAGE DETACHED.
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - 01 PLANCHECK W/O EN-HC 13675.00 VAL 241.23
AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS:
AC STRONG NOTION RESID 13675.00 VAL 1.37
D1� W/O EN-HC 13675.00 VAL 241.23
CONTRACTOR: TEL. NO: peer 1� TOTAL FEES 511.58
APPROVALS DATE It.SPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO LOCATION AND SETBACKS
SOILS ENGINEER Ai PPROVAL - -
ARCHITECT—�O:i EDC° TEL. N0:
E. MELK CV. UES!Lgtk (626) 202-6548- I i
2427 W. i•,AiN ST. #3 LIC. NO: SLAU!1IN13CR 'r OOR
ALHAMBRA, CA 91801 >IONE
AISFD FLOOR FRAUP1 G
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: NDcnFLOOR NELATION i
03
S'r T LEVEL FLOOR SHEATH
NO. OF F PIL ES: DWELLING TS: AP /COND: STAT CLASS--
NO
LASS
NO 21 ZODLEVEL FLOOR SHEATH
SCHOOL I HAZARDOUS ROOF SREATHNG
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DENT. FRAME INSPECT
REQUIRED OTA SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT -
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- SHEAR PANELS
SIDE PL-
INS LA ION/ NATHER STRI
INTERIOR LATH/DRYWALL
EXTERIOR LAfR
OT DRAINAGE
SMOKE DTEEllO D CS
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS05O8
GA638A CE#803 10.36 APPLICATION F®R �Bl)IL,®ING PERMIT
BUILDING AND SAFETY DIVISIOFFir BUILDi��NG
Department of County Engineer ADDRESS
County of Los Angeles LOCALITY
JOHN A.LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE SEWER.K MAP
FOR APPLICANT TO FILL M S _ "I CONST.
BUILDING .le� I
ADDRESS /a 7 f1a / STATISTICAL CLASSIFICATION
CLASS.NO DWELL. UNIT
LOT NO. BLOCK MAP
NUMBER IlyyY• YES, O
TRACT USS ZONE SPECIAL
r NO.OF BLDGS. CONDITIONS
SIZE OF LOT.7 Z I NOW ON LOT
USE OF
EXISTING BLDG. BUILDINGEXIST.
YARD .HWY STREET NAME
11 SETBACK WIDTH"
OWNER i f. 1/G S et T FRONT
MAIL �/ _-p. L.
A -
ADDRESS �+ �N�f�� / SIDE
P.L.
CITY 7v-i /l/e. G►f� Hof ;.I11iSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER NO..
ADDRESS /y� / p //� '.
J 'I ///../�G� /Y�j/ 'm do i'I
,@ TEL.
CONTRACTOORp d7�/ZJ•� �1��'Ce, NO. 22:4PT�D �)f 2_Y
ADDRESS�7 O�0, - �/VG/A)k I ' `k.3
!�
DESCRIPTION.OF WORK
EW ADD ALTER REPAIR DEMOLISH
.FT. /,{3 STORIES. t' FAMIO
C1LIES , �'�, I JI ! r� �/�Y `" " •i t1
USE O TRU TURE LLI 1G' G CJe3� .1� )v -/c R`x l A
h.
APPROVALS
SIGNATURE OF
APPLICANT DATE INSPECT R'S SIGNATURE
ADDRESS FOUNDATION:LOCATION
FORMS. MATERIALS
P,P.C. 8 FRAME: FIRE STOPS.
f (9�� FEE BRACING.BOLTS12-1k,07_
VALUATION S ® FURNACE: LOCATION.
FEE �s GAS.VENT.DUCTS r i
1 HEREBY ACKIAO
GE THAT 1 AVE READ THIS'AP- LATH. INT. 6 -7 ! . ✓l��r�tir�(t! "
PLICATION AND ATT EA 1S CORRECT AND
_ t
AGREE TO COMPAL O ORDINANCES AND LATH. EXT.
STATE LAWS RNG U G CONS UCTION.SIGNATURE OF HOUSE NUMBER COR- c�Z,�Sn/ / 6/yPERMITTEE RECT AND POSTED l3" . 7( ,OAry,, pl
ADORES •J �` FINAL v Z.('S"e U{'✓Wt 2C.i '
OHN A.LAMBIE.COUNTY ENGINEER., CLYDE N.DIRLAM.PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION cic. m.o. CASH• PERBEIT VALIDATION cli. N.C. CASH
.3 3 6 895- OCT 16 1 6 20.501 -0
�+ 3 8 9 2'U_% OCT 3Q 1 Z .QQ
WORKERS'COMPENSATION DECLARATION -
hereby affirm that I have certificate of consent to self APPLICATION F ORBUILDING PERMIT
insure, or a ce7tificate o¢•Workers'Compensation Insurance,
or a certified copy thereof(Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
• ADDRESS lj� d' �• C.��
Certified copy is filed with the county building inspec- BUILDING .J
tion department. ADDRESS 7 � LOCALITY L`'
NEAREST
Date Applicant CITY / p ZIP l7 d CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK w PAGE PARCEL.
(This section need not be completed if the permit is for one USE ZONE MAP •-_Q,4'0
'0d
hundred dollars($100)or less.) TRACT BLOCK LOT NO. y� NO.
TEL. '7 �('r/ SPECIAL >
I certify that in the performance of the work for which this OWNER y�" �s �Z? NO. S/3'�� '` CONDITIONS IL
permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PRO ED BY O
so as to become subject to the Workers'Compensation Laws.
ADDRESS �7�' AS' Q,Hc>>✓E CONSTZONE
IV I CITY h-C �-s /_ 0
Dat -Applican A Liv Zip STATISTICAL CLASSIFICATION An. CONDO. U
NOTICE TO APPLICANT: If, after makin this Certif' to of ARCHITECT OR TEL.
g ENGINEER NO. CLASS NO. / DWELL. UNITS—
Exemption,
you should become subject to the Workers' ea.
Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP 44
with comply with such provisions or this permit shall be TEL.'7 G�J
deemed revoked. CONTRACTOR �Q NO. (J— BK. .l PG p / VALIDATION
LICENSED CONTRACTORS DECLARATION LIC.
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 9�3 " C7- NO.3i7VALUATION
(commencing with Section 7000)of Division 3 of the Business and / LIC. r
Professions Code,and my license is in full force and effect. �EFT�/ OSTORIES / n0!&!OIES CLASS� � CHECK $ /� � O ►
License Number 7 / Lic.Class (v ONE
t,
Contractor � C&)/C71,J_7' Date Z DESCRIPTION OF WOR 2V6SQZ>141W ❑
ADD
� .
I am exempt under Sec. 1 Y:/Y6 i�Osn �� — gLTER FINAL
cS ❑ DATE
B.BP.C. for this reason REPAIR .10 C_
Date: USE OF DEMOL FINAL
EXISTING BLDG. ❑ By �-
Signature APPLICANT TEL.
PRINT NO. 7/
DZ/ y0—
OWNER-BUILDER DECLARATION Gam}
I hereby affirm that I am exempt from the Contractor's License ADDRESS OD �7� �/. �f ® 0 (1
Law for the following reason (Section 7031.5, Business and `�
Professions Code): PRE ENT �
BUILDING ./7 hl
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and ,
LocAUTY '— P C i
the structure is not intended or offered for sale(Section (; 1 0,2" P
7044, Business and Professions Code). MOVING TEL.
❑ ONTRACTOR NO. o u o
I,as owner of the property,am exclusively contracting
with licensed contractors to construct the project (Sec-
tion 7044, Business and Professions Code). I ADDRESS I o Ll 2,v
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY i SET BACK YARD HWY PROP. LINE WIDTH ri T
I hereby affirm that there is a construction lending agency for FRONT o o (L�'C
the performance of the work for which this permit is issued P.L. y,
JSec. 3097, Civ. C.). SIDE L ? C
i P.L.
i Lender's Name
a3w S a
P.C. Fee$ Permit Fee
- Lender's Address
c I certify that I have read this application and state that the Issuance Fee t
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, L�Z� 0 Q
I and hereby authorize representatives of this County to enter Total Fee / l
upon the above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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Signature of Applicant ent Date ' ®s