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HomeMy Public PortalAbout5111 SANTA ANITA AVE_Building__ 6A889A CIC#803 6.50 APPLICATION FOR BUILDINGPERMIT 1 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. DIST C .NO. GROUPpp. PR ES E FOR APPLICANT TO FILL. IN I coNST. BUILDING t,� �'`� STATISTICAL SSIFICATION I EWER MAP PG ADDRESS 0111 LC a D E CLASS.Nn---'- DWELL-UNITS LOT NO. BLOCK MAP BER Q O� / TAyTj.E YES NO TRACT ' J YJ USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT EXUSE OF1'Q�tvl C�" ISTING BLDG. + BUILDING EXIST. F", '`" SETBACK YARD HWY STREET NAME WIDTH OWNER 5� iMAILff 1 '�: T FRONT ADDRESS ' I1 n I F:J�i 9 SIDE' CITY �t PLG C..tT4c' N0'G - P L INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. in. i S: , fy�y ADDRESS '_ �f`� e` ✓ P NEr% TNo. CONTRACTORS Ur ADDRESS 17 7– S , G1, 0 t;1= .e/ c`S IY. l.._._. .« a.... DESCRIPTION OF WORK------------ NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIESFAMILIES USE OF STRUCTURE <v C, &OA SIGNATURE OF ..� ` APPROVALS APPLICANT I DATE INSPECTOR'S SIGNATURE ADDRESS l J+L Ci 1 *TU T "'ls O M FOUNDATION:-LOCATION FORMS,MATERIALS 5 �Q� ° P.C. S FRAME: FIRE STOPS, iJ FEE BRACING,BOLTS VALUATION ; FURNACE: LOCATION.. ✓ FEE �j�ryd GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READIS AP- LATH.INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND /Y STATE LAWS REGULATING B K LDING .CONSTRUCTION. LATH,EXT." SIGNATURE OFHOUSE NUMBER COR- PERMITTER `�� ({A� ,�+'•�C+-[�� Q r RECT.AND.POST D:,•• ADDRESS—(,57, r Gov FINAL• CLYDE N.DIRLAM,PRINCIPAL STRU URAL ENGINEER PLAN CHECK VALIDATION CIC. M.O. CASH PE 3MT VALIDATION,.-,l`CK.j M.O. CASH 7 4 1 a U DSC l 1 1 A 3.0 0 ®P WC{RKERS'COMPENSATION DECLARATION ~' I.h,u�e affirm,that I hgve certificate consent to self APPLICATION FOR BUILDING PERMIT , PiTsre,-or a certificate of Workers'Compensation Insurance, rr a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAIETY PolBUILDING icy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS \� J ❑ Certified copy is filed with the county building inspec- BUILDING / /� tion department. ADDRESS / / ]v I IA Ave.. Date Applicant CITY ZIP 7 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT wD 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 USE ZONE MAP OWNER O. "T��/��1�7 I certify that•in the performance of the work for which this / 1. NO. } permit is issued, I shall not employ any person in ny'manner �' SPECIAL ` �. so as to come subject to the Wor o alio S. ADDRESSr��•yy� // n •Fhv I//`t J�11-UL- CONDITIONS O - CITY 1 Girt A C� ( ZIP 1-2 V Dat Applica NOTICE APPLICANT: If, of aking s Certificate of ARCHITECT OR TEL. DISTRICT GR UP TYPE FIRE PROCESSED BY O ENGINEER NO. Exemption, you should bec a subject to the Workers' CONST. ZONE• tJ Compensation provisions-of the Labor Code, you mutt forth- ADDRESS C IL with comply with such provisions or this permit shall be iH deemed revoked. . TEL. STATISTICAL CLASSIFICATION A CONDO. zCONTRACTOR NO. LICENSED CONTRACTORS DECLARATION V LIC. CLASS NO. rL l DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ.FT. NO.OF NO OF CHECK License Number Lic.Class SIZE STORIES 0u FAMILIES DAPIET E T VAL ON a Contractor Date DESCRIPTION OF WORK / D A D ❑ $ /1 ❑I am exempt under Sec. ❑ V 01111. , ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF � EXISTING BLDG. US L -. DEMOL ❑ Signature APPLICANT I&CL N�f -r FINAL N OWNER-BUILDER DECLARATION 1 / DAT I hereby affirm that I am exempt from the Contractor's License ADDRESS `/� l I •C �17 Law for the following reason (Section 7031.5, Business and FINt(MAA1W Professions Code): PRESENT BY rk"p BUILDING A I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 2 6 9 IL 6 A the structure is not intended or offered for sale(Section LOCALITY '-�f'y� y -- 7044, Business-and Professions Code). MOVING TEL. ® # 0 0 0 0 0 1 ❑ 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). - 2_173.75 REQUIRED TOTAL SETBACK FRO CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ° ° 2'] 7 5 v I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. 0501 -87 Lender's Name /� LDMA Ref. # ' P.C. Fee$ Permit Fee OGi 3, Lender's Address 57 I certify that I have read this application.and state that the Issuance Fee LDMA P/C# pool above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, 9 and hereby #thorize representatives of this County to enter ITotal Fee 4 LLDMA Perm. # i up a e-mentione pr rty for inspection purposes. i fA _�� i '�• SEE REVERSE FOR EXPLANATORY LANGUAGE re o A plic or Agent Date -.► WORKERS'COMPENSATION DECLARATION insu a hereby afirm ce•�W1 coattehhave f Worke s'Compensation ent to Insuran e,' APPLICATION FOR BUILDING PERMIT 11 or a certified f py thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 1:1Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING �� t ❑ ADDRESS Certified copy is filed with the county building inspec- BUILDING / N;� /1 � I-r-�� tion department. ADDRESS �. l,�!/►j t-/�'-C!� N Date Applicant CITY { c,/1l t'`� CI r 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 TRACT BLOCK LOT NO. ASSESSOR hundred dollars($100)or less.) MAP BOOK PAGE PARCEL OWNER T PEV14A5 KiAtsNo-gAl,q- 7 USE ZONE MAP 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 c {� /� ,/� SPECIAL so as to become subject to the W ors' o sation S. ADDRESS S� � ' J �1-(�� rt/v �/-t CONDITIONS O CITY 01 ( ZIP Date1Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, aft making 1 is Certificate of / DISTRICT G OUP TYPE FIRE P SED BY O Exemption, you should become subject to the Workers' ENGINEER T CONST. ZONE V Compensation provisions of the Labor Code, you must forth- ADDRESS �� J LtJ with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. ; CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ 11LCt�SFD -Po R ( ADD ❑ , I am exempt under Sec. ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT NO. DATE 1 hereby affirm that I am exempt from the Contractor's License I o o Q,5 Law for the following reason (Section 7031.5, Business and ADDRESS FINAL I J o 0 0 lj U 5 S:Zalr PRE E BYBUILDING 1 1 0-87 of the property, or my employees with ADDRESS sole compensation,will do the work and 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). IIIIIIIIIIIIR REQUIRED YARD HWY TOTAL SETBACK o CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name �} P.C.Fee$ Permit Fee 5Q71 LDMA Ref. # Lender's Address e I certify that I have read this application and state that the Issuance Fee /0,J v LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee j ordinances and State laws relating to building construction, Total Fee V r LDMA Perm. N and hereby authorize representatives of this County to enter $ PSigng ve- ned a ry for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ature pplicont or Agent Date 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, BUgQjNG ADDRE or a certificate of Workers'Compensation Insurance,or a certified AVE• copy thereof(Sec.3800,Lab.C.) CITY PL C (Ty, ZIP o LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDG&NOW ON LOT ❑ 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. Date Applicant ASSESSOR MAPOK PA6 D PAR V 7 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION P I N FROM WORKERS' OWNER A K TEL NP. 7 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS w ,r .! .�.y� dollars($100)or less.) i •/T M TA N FIA A .•�- DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY CITr^ � n ZIP ��C I certify that in the performance of the work for which this permit V o is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. �} become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 4.1 — DWELL UNITS NOTICE 70 APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ' ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS P L 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,and my license is in full force and effect. NEW ❑ BK PG a DESCRIPTION O WORK VALUATION License Number Lic.Class � ADD ❑ C Contractor Date PICALTER f1• $ C a ❑ I am exempt Under Sec. REPAIR ❑ H BAP.C.for this reason DEMOL ❑ LDMA P/C# LL Date: USE OF EXISTING BLDG. URM ❑ 7 Cra Signature A3,CANT 1 J N LDMA Perm# ? �I, as owner of the property, or my employees with wages as C� �Q K � /L ZL``g their sole compensation, will do the work and the structure is ADDRESS ==11L 5I,.0 not intended or offered for sale (Section 7044, Business and /le �/�� Le. ..e o FINAL DATrF,� a Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ! 1 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? FINAL B -' 8 licensed contractors to construct the project (Section 7044, YES 1:1 N09 ASE I 's Business and Professions Code.) j"' C WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING .1:ltls: OD.45 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR , Tti F GUIDELINES. z 1 i E G I hereby affirm that there is a construction lending agency for YES❑ NO IL athe performance of the work for which this permit is issued(Sec. TOTAL I AL_ :1-96 m 9r -a 0 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHECK { r�E TITLE 2.CHAPTER 2.20 SECTIONS 240.100 THROUGH 2.20.140 CONCERNING HAZARDOUS i�HE r. 1 1 n a�!_I Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD, CHANGE c rj CL �i Lender's Address 0 OI NER OR AGENT c I certify that I have read this application and state under penalty 4 of perjury that the above information is correct.I agree to comply P.C.FEE �^ PERMIT FEE FF o y g �• a 1� U001-31-00131 iii I .'``u N with all count ordinances and State laws relating to building construction he entatives of this County ISSUANCE FEE t C0 to an o e- peHy for inspection purpo •!O �-E i Ai 1 9:51 C0 INVESTIGATION FEE TOTAL FEE «Agyc Do SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF 10S 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 Jill 5AtjTA AN r �. copy thereof(Sec.3800,Lab.C.) CITY ZIP l� �f ALE, c I r '(�/?0 LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT ` BLOCK LOT NO. department. 130.3 v. •, USE ZONE MAP NO. Date Applicant ASSESSOR MAP 1 BO K PAGE PARCEL BS/ (��9 ��2 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERTEL NO. � ,� COMPENSATION INSURANCE a� r-1{ (E WITHIN 1000 FT.OF SCHOOL? YES �/ . R No (This section need not be completed if the permit is for one hundred ADDRESS t A /� A /� C- dollars($100)or less.) ✓1 I) J P"r^ A �T-A A V DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CITY Tem PLE- C gly ZIP is issued, I shall not employ any person in any manner so as to W ` become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. � —6 I STATISTICAL CL*IFJCATION APT CONDO Date Applicant ADDRESS CLASS NO. ifp�l 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�i TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS W LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC..CLASS P L 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,and my license is in full force and effect. NEW BK PG d DESCRIPTION OF VALUATION License Number Lic.Class �_N ADD ❑ i�' Contractor Date ALTER ❑ Cf/� 0 ❑ I am exempt under Sec. p 5 ti e� REPAIR O B.BP.C.for this reason -I DEMOL ❑ CDMA Pic# W Date: USE OF ISTBLD URM ❑ f 0- Signature APPLIC 1 INT) / TEL N LDMA Perm# j Z as owner of the property, or my employees with wages as , jA S ZO ANT.4 their sole compensation, will do the work and the structure is ADDRESS rpt ,\ Q not intended or offered for sale (Section 7044, Business and /n f- A'N/M f;'LE• / / 7�D FINAL D G 01, ,-3l31Li 66.45 Professions Code.) WILL THE AP TOR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J a C`+1% OR A MIXTURE NTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Z +.I L.I I'= ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y licensed contractors to construct the project (Section 7044, YES❑ No L� TOTAL ® 'fig-� Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING E..�� 66.45 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COASTlIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR Il I hereby affirm that there is a construction lending agency for YES 11 NqK CHANGE °I} W the performance of the Work for which this permit Is issued(See. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 6/15/93 3097,CIV.(i.) S ANGELES COUNTY CODE. CHECKLIST 2.CHAPTER 2.20 SECTIONS 2.20. 00 THROUGH 2.20.140 CONCERNING HAZARDOUS II II d i 5 f 9 J Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 0260 - 1 - _ 0 Lender's Address I} j� 1 �j i f° 1 c OWNER OR AGENT o I certify that I have read this application and state under penalty 97/nN B FEE of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE a with all county ordinances and State laws relating to building CO construction, and hereby authorize representatives of this County ISSUANCE FEE �f / z0-0001 _, the ab r inspection purposes. /: INVESTIGATION FEE TOTAL FEE /e //_ 02 N -7:52, o nt SEE REVERSE FOR EXPLANATORY LANGUAGE i APPLICATION FOR BUILDING PERMIT COUNTY OF 10S 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 .�/�� f�1 �✓ or a certificate of Workers'Compensation Insurance,or a certified 5,111 5AWM AIV M ' copy thereof(Sec.3800,Lab.C.) CITY ZIP Policy No. Company ■ p 1.c e I r �7 4 "' LOCALITY SIZE OF LOT NO.OF BLDG&NOW ON LOT ❑ Certified copy is hereby furnished. 1 2, NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. )336.3 '1 Z USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOPK PAGYgRARCEL Bs7 0012 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 0.COMPENSATION INSURANCE S - E+�5 11 �"7J7� WITHIN 1000 Fr OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS 5111 5 A•ftrr^ AM ITA PtWE-• DISTRICT GROUP TYPE CONST, FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit v1 )L F 1 is issued, I shall not employ any person in any manner so as to ARCHITECT E GINE TEL NO. rr�� Ole- � become subject to the Workers'Compensation Laws. STATISTICAL CL*IF)CATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS Vi LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY UC.CLASS PL I hereby affirm that I am licensed underprovislons of Chapter 9' SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW OR BK PG } a D SCRIPTION OF ADD ❑ VALUATION License Number Lic.Class �_S � / polo. Q Contractor Date ALTER ❑ ❑ I am exempt under Sec. p 1 5 1 CeZ7 REPAIR �. BAP.C.for this reason DEMOL ❑ U PIC# III Date: USE OF"Mr BLDWJ URM ❑ EL Signature APPLIC NT) TEL LDMA Perm# z - 6 as owner,of the property, or my employees with wages as y �" �� qNO. - �i7 Z (�jI+P•'O L:41, ,F their sole compensation, will do the work and the structure is ADDRESS rpt „� not intended or offered for sale (Section 7044, Business and ,�j 1/Q-141// �' / �� FINAL D G 3301 66.45 Professions Code.) "LL THE AP OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J i pp��� ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE NTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q ! 1 1�I[•J Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYZ licensed contractors to construct the project (Section 7044, YES❑ NO R I > TOTAL 1 AL 66- 45 Business and Professions Code.) OCCTHE INTENDED USE MI THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK 6.475 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH vv 'J CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. CHANGE .00 I hereby affirm that there is a construction lending agency for YES❑ Nq C4 the performance of the work for which this permit is issued(Sec. G) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING cm 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 0000—f;l00 6/15!0" Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 132,50 1 AMa i o Lender's Address I OWNER OR AGENT oI certify that I have read this application and state under penalty NO FEE 0of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE � 1 N with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE / Li�Ct�—I� 1�� ��I:�y m t the abo - r inspection purposes. 41' L• _b , n ` ! INVESTIGATION FEE TOTAL FEE 0261 s AN 7:52 A nl f SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0203260017 PHONE: (626) 285-0488 EXT: LEGAL ID: N . Of CONST NEW BUILDING TR: 13363 LT: 12 SQ. FT STORIES TYPE OCCUP GROUP 5111 SANTA ANITA:AV STRUCTURE: 0 1 VN, R3 TEMP CA 917803620 ASSESSOR I 2 OTHER : NEAREST CROSS STREET: FREER THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY TENANT: S L E: S 0 PROCESSED 8 0 : EXIST OCC GRP: 03/26/02 JK 09/22/02 OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUA ION: F1 FINALBY' ODE: TIPTON;GILBERT M. & MERCEDES S. (626) 964-0454- 1 700 18333 MESCAL STREET 62 -,�- ROWLAND HTS 91748 0 OF- WORK--RELOCATE KITCHEN, CREATE FAMILY RM, NEW ANGLED WALLS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: . SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION R_9SJA-===--J00S.00 VAL 0.50 SPECIAL CONDITIONS: W/ B2 PERMIT E GY-X700-0 VAL 48.02 OGEL It AU 76.27 SAME AS TEL. NO: _ SOS V�Ty APPROUG DATE INSPECTOR SIGNATURE LIC. NO LO kTION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TE 0: FOUNDATIONPRENCH FORMS LIC. NO: 1111111 SLAB UNDER FLOOR RAISED FLOOR FRAMING P NO: SEWER MAP BOOK: PAGE: FIRE ZONE: IR CMPO [PUDD L J(C �n n O �J UNDERFLOOR INSULATION v K S E FLOOR T FAMILIES:NO. OF DWELLING UNITS: / ON : STAT CLASS- NO SS:NO 21 Q Q ii D LE EL FLOOR SHEATH a El SCHOOL WITHIN HAZARDOUS - 1*, ROOF SHEATHM9-- AIR QUALITY: 1000 FEET MATERIALS 0 /'�, NO NO NO ©+9�i FIRE DEPT. FRAME INSPECT REQUIRED 0TAL SETBACK FROMEXIST 4Pjb � BLDG DEPT. S C FRONTSET ACK PL- YARD: HWY: PROP LINE: WIDTH: C SerVIC a That SHEAR PANELS SIDE PL- S A O A S R INTERIOR LAT /DRYWALL EXTE-M-FUTH OT DRAINAGE SMOKE-DETECTION DEVICES FIRE D P RTME T APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 r I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1411190063 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW 1 SIIILDING ADDRESS: ITR: 13363 IT: 12 I SQ. FT STORIES TYPE OCCUP GROUPI 5111 SANTA ANITA AV STRUCTURE: 290 1 V-B U I TEMP CA 917803620 [ (ASSESSOR INFORMATION NUMBER: I, GARAGE: I NEAREST CROSS STREET: I 18574-009-012 I OTHER: I THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI (TENANT: 1EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: I IEXIST OCC GRP: 111/19/14 SR [ ]OWNER: TEL. N0: IBLDGS. NOW ON LOT: VALUATION: I FTXAL DATE FINAL BY: CODE: [ INGUYEN, TU VAN (626) 592-0155- 1 10,000 1I 15111 SANTA ANITA AVE dW ITEMPLE CITY CA 91780 I FEES PAID 1DSCRIP ION OF WORK I I ]COVERED PATIO 290 SF. & ADD SLIDING GLASS DOOR I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ I (APPLICANT: TEL. NO: I I [ [SAME AS OWNER - �AA BLDG PERMIT ISSUANCE 27.80 1 I [ AS STATE GREEN BLDG FEE 10000.00 VAL 1.00 [SPECIAL CONDITIONS: [ [ AC STRONG MOTION REBID 10000.00 VAL 1.00 [ [ I IDI PLANCHECK W/O EN-HC 10000.00 VAL 184.10 1 I I ID2 PERMIT W/O EN-HC 10000.00 VAL 216.60 [ ] ICONTRACTOR: TEL. NO: [ TOTAL FEES 430.50 (APPROVALS DATE INSPECTOR SIGNATURE I ISAMB AS OWNER - I I I I LIC. NO I ILOCATION AND SETBACKS I I [ [ [ ISOILS ENGINEER APPROVAL I I [ (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I [ LIC. N0: SLAB/UNDER FLOOR I [ I I I IRA SED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( [UNDERFLOOR INSULATION I [ I 3 001 [ [ [ I 1ST LEVEL FLOOR SHEATH [ [ I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I [ [ I [ 0 NO 21 I 12ND LEVEL FLOOR SHEATH [ [ [ [ SCHOOL WITHIN HAZARDOUS I IROOF SHEATHING [ [ [ AIR QIIALITY: 1000 FEET MATERIALS I I I I [ NO NO NO I IFIRE DEPT. FRAME INSPECTI I I (BLDG DEPT. ZRAME INSP TI "'F I I ISHEAR PANELS [ IINSULATION/WEATHER STRIPI I [ I I I I I [ [ IINTERIOR LATH/DRYWALL [ I I (EXTERIOR LATH I . I (LOT DRAINAGE i [ [SMOKE DETECTION DEVICES ] I I I I I I FIRE DEPARTMENT APPROVAL( I I I I I I REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0110010038 PHONE: (626) 285-0488 EXT: LEGAL ID: 0. OF CONST D S : TR: 13363 LT: 12 SQ. FT STORIES TYPE OCCUP GROUP 5111 SANTA ANITA AV STRUCTURE: 0 1 VN R3 TEMP CA 917803620 ASSESSOR 0 0 R: GARAGE: NEAREST CROSS STREET: FREER 8574-009-012 OTHER: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG S . USE 0 ED 0 S .0 . EXIST OCC GRP: 10/01/01 JK 03/30/02 OWNER: TEL. 0: BLDGS. NOW ON LOT: VALUATION: INAL BY: ODE: TIPTON;GILBERT M. & MERCEDES S. (626) 964-0454- 1 2,730 18333 MESCAL STREET 'ri4q-- ROWLAND HTS 91748 SDESCRIPTION FINALIZE PERMIT #6946, 0261, 0545 (3BD/1BA ADDITION, APPLICANT: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: RESTUC pA 2 NEW WINDOWS, AND PORCH) O b C/Yw SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 -f /0 AC STRONG MOTION RESID 2730.00 VAL 0.50 SEAL CO-IDITIO S: B2 PERMIT W/ENERGY�'�2730.00 VAL 108.90 ��STO- L-- EES 137.15 CONTRACTOR: TEL. NO: - �O�j ®� APPROVALS DATE INSPECTOR S GNATURE SAMELIC. NO LOCATION AND-SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: . NO: // _ L 0 DA '0 RFORMS LIC. NO: �� SLAB/UNDER FLOOR -- �1RAISED 0 R G AP N0: SEWER MAP BOOK: PAGE: FIRE ZON3. LSTERLOOK IULSTION lu I 3 LL (C �1VICLEVEL � HEATH 0. OF S: DWELLING UNITS: P /CO : STAT C S NO 21�� ND LEVEL F OOR SHEAT ,!11 SC RD / ;' AIR QUALITY: 1000 FEET MATERIALS f (� n 6-11 r• "• R00 S NO NO NO - 11: 1 FIRE DEPT. FRAME INSPECT REQUIRED 0 SETBACK 0 IS G8�! O ILII JI_A�I/t�`y / BLDG DEPT. F SP SET BACK YARD: HWY: PROP LINE: WIDTH: U FRONT PL- C `�ervIC@��a �V SHEAR P NELS SIDE PL- I S ATI T S INTERIOR LATH/DRYWALL EXTERIOR LOT DRAINAGE SMOKE C O DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 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 1403140011 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: [TR: 13363 IT: 12 SQ. FT STORIES TYPE 5111 SANTA ANITA AV I [STRUCTURE: 1500 V-B TEMP CA 917803620 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 18574-009-012 1 I THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CA[ TENANT: EXIST BLDG USE: RESID USE ZONE: R-2 (ISSUED ON: PROCESSED BY: 1 1EXIST OCC GRP: 03/14/14 SR 1 OWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: [FINA DA E FINAL BY: CODE: INGUYEN, TU (626) 592-0155- 1 1 1,000 I 15111 SANTA ANTIA AVE TEMPLE CITY CA 91780 FEES PAID CR PTIO OF WORK 1 REPAIR AND REPLACE DRYWALL [FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1 [APPLICANT: TEL. NO: I [SAME AS OWNER - [AA BLDG PERMIT ISSUANCE 27.80 I- [AB STATE GREEN BLDG FEE 1000.00 VAL 1.00 ISPECIAL CONDITIONS: IAC STRONG MOTION RESID 1000.00 VAL 0.50 D2 PERMIT W/O EN HC 1000.00 VAL 65.40 [FS INV WORK W/O PERMIT 344.00 DOL 344.00 CONTRACTOR: TEL. NO: TOTAL FEES 438.70 APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - I_ I 1 LIC. NO ILOCATION AND SETBACKS I I I I 1SOILS ENGINEER APPROVAL 1ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNDATION/TRENCH FORMS I I I LIC. NO: I (SLAB/UNDER FLOOR I I I I 1 1RAISED FLOOR FRAMING 1 1 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( 1UNDERFLOOR INSULATION 1 I I [ 300 I 1 IFLOOR SHEATHING 1 I [ INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I I 1 NO 21 1 1ROOF SHEATHING I I [ SCHOOL WITHIN HAZARDOUS [ [SHEAR PANELS I I I [AIR QUALITY: 1000 FEET MATERIALS [ I I I I 1 NO NO NO IFRAME INSPECTION [ 1 1 1FIRE SPRINKLER HANGERS I I I 11NSULATION/WEATHER STRIP[ [ [ I (INTERIOR LATH/DRYWALL I I I I [EXTERIOR LATH [ I [ I [ [RATED FLOOR/CEIL ASSEM. [ [ [ I [ IRATED WALL ASSEMBLIES [ I I I I I IRATED SHAFTS/OPENINGS 1 I IT-BAR CEILINGS I I I I 1LOT DRAINAGE 1-1-1 I [ [REPORT ID: DPR261 ROUTE TO: BS0508