HomeMy Public PortalAbout5702-5704 SULTANA AVE_Building__ N Ot BUILDING AND SAFETY IIDepartment of County-Engineer
ltft. �
County of Los Angeles
M. J. 'FOX, COUNTY ENGINEER 1 2' 5 APPLICATION
-1 FOR APPLICANT TO FILL IN• FOR OFFICE USE
UlLDING Pym. DISTRICT NO. PLAN CK.ori REC.No:
ADDRESS Q �/ G� f �� O
RE LIVED DATE OF APPL.
LOCALID//►►TE BUEQr---
TY ! , ' I O S� // r
N;EAREBT
RGBB ST. r BUILDING
ADDRESS O
OWNER leh
MAILLOCALITY I AA f C�.,:T Y
ADDREB9 el ( A. NIcARETcL- BT
CROSS"BT. .b u I,A
CITY NC. FIRE NO.OF TYPE GROUP
ZONE — PLANS �•'.
ARCHITECT R TEL
ENGINEER NC. BLDG. a A ORD. NO.
SETBACK LINE
ADDRESS """`m""�-
USE
p� APPROVED
CONTRACTOR
NO. ZONE 11�� BY DATE
ROUSSE NUMBERING
ADDRESS. M*.P NUMBER 0 4a NO. ASSIGNED BY
LEGAL". �.
DESCRIPTION LOT NO. BLOOK RRECTIONS
s�cArvgrawirAer xcEp AIP5
TRACT /4 3� �4a j `, •
' _ �- 740 �Z
BITE or L r7Z _ �`rNowD'oFK�oT�°
USE OF x d IFm jppUvf NO.OF •d
EXISTING BLDG. FAMILIKS O
DESCRIPTION OF WORK
NEW _ ALTERATION ADDITION D
REPAIR DEMOLITIONr
Bq.FT. Q O.OF
_SIZE ,6 � NROOMS � STORIES
EXT.WALL
COVER NG s /el( e ) I COVERING
USE OF STRUCTURE
i
t t
INSPECTION
rCR '--� \ IPECAPPROVALS
TOj�'B SIGNATURE DATE
FION.LOCATION
WWMATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APS FRAME: � E STOP
-PLICATION AND STATE THAT THE INFORMATION GIVEN IH
CORRECT. BRACING,@ TS ZV
1. A®REEE'LAWS MAS
WITH ALL COUNTY ORDINANCES FURNACE: LOCATION,
AND STATREGULATING BUILDING CONSTRUCTION. GAB VENT,DUCTS "w
SIGNATURE OF LATH, INT. .3-
PERMITTEE
e EXT.
��
ADDRES '�y��*f�1��'s�c�� LATH,���� \
AUTHORIZED AGT- ` PLASTER, INT. G..-
PLABTERv EXT. 1 ..) �+y ►���.
FEE B a �m HOUSE NUMBER COR-
Hf ( r•'4 a� RECT AND POSTED I
VALUATION PEE B ( FINAL ,GR
76AS38A DBS 3 1-52 `L-11 •(:`
1� • YORKERS'COMPENSATION DEC
LARATION
a` hrcertificate
t consent lfir ► orcertificate of Workers'Compensation Insurance, ® ®
L CA�ION BUILDING PERAIT
of a certified
copy thereof(Sec. 3800, Lab. C.) / COUNTY OF LOS ANGELS BUILDING AND SAFETY
Policy No._Compony ti
'Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building inspec- BUILDING ' 7 c� F
tion department. ADDRESS rJ,� U
Date _ Applicant CITYZIP LOCALITY L,
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. r NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT G CROSS ST.
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars($100)or less.) TRACE BLOCK LOT NO. MAP BOOK PAGE PARCEL
OWNER GDM TEL _ USE 7� E MAP
I certify that in the performance of the work for which this N6.5q6—!!0.&. Y/JX/y NO.
permit is issued, I shall not employ any person In any manner625 �I # �3 SPECIAL
so as to b am subject to the Work"C m tion Laws. ADDRESS RE f V 2 CONDITIONS U
Date `v APPlicanf� CITY L T ZIP / 0
NOTICE O APPLICANT: If, after eking this Certificate of ARCHITECT OR TEL. DISTRICT GR P TYPE FIRE PROCESSED BY O
ENGINEER _
Exemption, you should become subject to. the Workers' �� N NO. - 1 CONST. ZONE
w
Compensation provisions of the Labor Code, you must forth-
ADDRESS13QE��
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. ENDO. r)
deemed revoked. CONTRACTOR NO. �' Z
LICENSED CONTRACTORS DECLARATION7 LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS dVL NO. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and LIC, y
Professions Code, and my license is in full force and effect. CITY CLASS BK iV PG VALIDATION
SQ. FT. NO.OFa NO.OF CHECK
License Number Lic.Class SIZE ( STORIES ✓ FAMILIES ONE 76
VALUATION
DESCRIPTION OF WORK NEW ❑, /�
Contractor Date I Mr ADD $ p(,
I am exempt under Sec. AqD ❑'
ALTER ❑ '
B.BP.C. for this reason REPAIR
Date: USE OF p( 1 T DEMOL ❑t; $
EXISTING BLDG. IV UG
Signature ° APPLICANT �.„ NO. FINAL
O NER-BUILDS DECLARATION PRINT W �• DATE
I hereby affirm that I am exempt from the Contractor's License S J,�/7//�y
Law for the following reason (Section 7031.5, Business and ADDRESS "'1
Professions Code): PRESENTIle
BUILDING
1, as owner of the property, or my employees with . ADDRESS r
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.
1,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).
CONSTRUCTION LENDING AGENCY SETT BACK YARD HW Y TOTAL FROM
SETBACK WIDTFt
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 JJVV�� 77
P.L. B
Lender's Name
c ,. LDMA Ref. q
P.C. Fee$ Permit Fee
Lender's Address ,u ��•
t -
1 certify that I have read this application and state that the Issuance Fee LDMA P/C ff
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
and hereby authorize representatives of this County to enter
ntioned property for inspection yurp ses.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature at Applicant or Agent Date
�kk 4-WORKER.COMP9NSATION DECLARATION
sure, draafcertif cairm tte of Workers's'ComPpe of ensat on ent to self
Insurance, A P P L I CA N FOR BUILDING PERMIT
or a cersif Lsd coy thereof(Sec. 3800, Lob. C.)
A COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. 56 Company-Cl--�'= /VE/
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS /U
❑ Certified copy is filed with the county building inspec- BUILDING, --7 U SULK A ��
tion depart ent. ADDRESS -7 R�" !'
Date Applicant iL//�11 CITY !" /-� C� l ZIP /DGS ®� V 'LOCALITYNO.OF l
CERTIFICA E OF EXEMPTION FROM WORKERS' I U NOW ONLLOT 0,4/F CR038SST.
COMPENSATION INSURANCE SIZE OF LOT
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars($100)or less.) TRACT AA�� / BLOCK p, LOT NO. ASSESSOR
MAP BOOK PAGE PARCEL
TEL.
MAP
I certify that in the performance of the work for which this OWNE
RMl Al -CA 1 NO. r! 2761 US ZONE O. S
permit is Issued, I shall not employ any person in any manner ADDRESS 3G7� L� /� SPECIAL
so as to become subjjeect to the Wo er'Compensation Laws. /� CONDITIONS U
Date*64f �` Applican CITY �S ZIP tJ�
ARCHITECT OR TEL. c'/ DISTRICT OUP TYPE FIRE PRO SSED BY O
NOTICE TO APPLICANT: If, after making this Cer ificate of' ENGINEER �/� C LN J U CONST. ZONE (-
Exemption, you should become subject to the Workers �`� �/� rX� _1
Compensation provisions of the Labor Code, you must forth- ADDRESSZ 'Y ,� :2[' ✓ '✓ u V a
with comply with such provisions or this permit shall be TEL. / STATISTICAL CLASSIFICATION APT. NDO. Cl)
deemed revoked. CONTRACTOR l c N0.7 G�Z" z
LICENSED CONTRACTORS DECLARATION IIC. CLASS NO. d. DWELL. UNITS_ immew-J
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 3 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 A �-/d- CLASS BK. I— PG VALIDATION
f
License Numbed U 2 ` Lic.Class SIE Z STORIES AMID01 ES CONE
B, ! VALUATI N
Controcto&Aar � �/Da `y-' DESCRIPTION OF WORK p N $ O
I am exempt under Sec. ❑
LT
B.&P.C. for this reason ) REPAIR ❑ $ #a a 0 0
Date: USE OF
EXISTING BLDG.:5j/J t/Vt-�/-!4`�'I ��"t`L /�/ DEMOL ❑
VV
Signature APPLICANT g� O. BOG FINAL 0
OWNER-BUILDER DECLARATION PRINT DATE -8
I hereby affirm that I am exempt from the Contractor's License �Cjf�jf� '� �n FINAL
Law for the following reason (Section 7031.5, Business and ADDRESS
Professions Code): FRE5ENT BY
❑ 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
7044, Business and Professions Code). MOVING TEL.
55
❑ 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). S y 9.��
CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK
SET BACK PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT tt o 0 o a u
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE 1,7 4 Q c
P.L.
Lender's Name o 22 _t
CDMA'Ref. # 1.7 y�'�� Jc s
Lender's Address P.C.Fee$ 02 Permit Fee O 2 .j _ 8
c
1 certify that 1 have read this application and state that the Issuance Fee [ l!. v LDMA PSC#
? above information is correct. I agree to comply with all County Investigation Fee
? ordinances and State laws relating to building construction, Total Fee G D CDMA perm.#
and hereby authorize representatives of this County to enter
upon the above-mentioned property for inspection purposes.
e
W. Z SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Applicant or Agent Date
'r
WORKERS'COMPENSATION DECLARATION
I JhebV`affirm that I have a certificate of consent to self ®
rLICATIOkl F" 'UI` I ' IT
ih9Gre, or a certificate of Workers'Compensation Insurance,
or•a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.• • Company BUILDING
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING 151 p J_ �' UG �� q
tion department. ADDRESS 66 /
Date Applicant CITY (11_=:� e( ZIP Si LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. .( NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT lll� CROSS ST.
(This section need not be completed if the permit is for one r ASSESSOR
hundred dollars($100)or less.) TRACT yo BLOCK LOT NO. MAP BOOK PAGE PARCEL
^ A� TEL. USE ZONE MAP
I certify that in the performance of the work for which this OWNER O AC0 N�JO.� .{}5'�7o NO.
permit is issued, I shall not employ any person i any manner ADDRESS ei� L� {�J/ `1► 1� ��3 SPECIAL �+
so as to o subject to the Work 'Co p ti Laws. pp CONDITIONS O
0"73 N CITY #U" ZIP -
DateApplicant ARCHITECT OR TEL.��r- S7 DISTRICi GRO TYPE FIRE PROCES ED BY O
NOTICE TO APPLICANT: If, after making this Ce,tificate of ENGINEER > u� NOS W`Tf D CONST. ZONE I^
Exemption, you should become subject to the Workers' /� �� � ll e�t�� � n/ V
Compensation provisions of the Labor Code, you must forth- ENGINEERADDRESS r 0� 7T `7/ sor °� a
with comply with such provisions or this permit shall be ,��Jy�,���� p_, n,,/� TEL. STATISTICAL CLASS ICAT N APT. CONDO. N
deemed revoked. CONTRACTOR OLU ?PO Ll- NO. z
LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITI-1—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. ,r
(commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP
Professions Code, and my license is in full force and effect. CITY CLASS BK L- PG VALIDATION
SQ.FT `` NO.OF NO.OF CHECK
License Number Lic.Class SIZE I v STORIES FAMILIES ONE
'• VALUATION '76'
DESCRIPTION OF WORK NEW ❑ i
Contractor Date p� ADD $
All e 0 ❑
ab
r_1I am exempt under Sec. ALTER ❑
B.BP.C. for this reason REPAIR 4l/,5'1S9
USE OF {S ❑'
Date' EXISTING BLDG. 1S10 LIU ( � DEMOL ❑;' /
Signature APPLICANT pp� TEL. FINAL
O NER-BUI DER ECLARATION PRINT dit� pcC'JO� NO. DATE
I hereby affirm that I am exempt from the Contractor's License n,,S µ
Law for the following reason (Section 7031.5, Business and ADDRESS F
Professions Code): PRESENT / AJI
BUILDING (�
[, 1, 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
7044, Business and Professions Code). MOVING TEL.
❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. l
with licensed contractors construct the project (Sec- ADDRESS -7
tion 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH r
I hereby affirm that there Is a construction lending agency for FRONT iS
the performance of the work for which this permit is issued P.L.
(Sec. 3097,Civ. C.). SIDE \
P.L.
Lender's Name
a P.C.Fee$ Permit Fee LDMA Ref. q
Lender's Address
I certify that I have read this application and state that.the Issuance Fee LDMA P% fi '
above information is correct. I agree to comply with all County Investigation Fee
3 ordinances and State laws relating to building construction, Total Fee `t LDMA Perm.N
v and hereby aur orize representatives of this County to enter
$ up the bov -menti ed property for inspection up
oses.
SEE REVERSE FOR EXPLANATORY LANGUAGE
m
Signature of A licant or Agent ate
WORKERS'COMPENSATION DECLARATION
her affirm that I have certificate of consent to self A P P-�0 ICAT I®N FOR BUILDING P E RM I T
insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 380t00,-Lob.
,/CC.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No:_'7�Company GF�vs�Jl C.P . ..-• . BUILDING
❑ Certified copy is hereby furnished. C.V7FOR APPLICANT TO FILL IN ADDRESS
a�Certified copy is filed with the county building inspec- BUILDING ^'
tion department. ADDRESS 11 A
Date,a"[ Applicant ZIP LOCALITY i
CERTIFICATE OF EXEMPTION FROM WORKERS' / _�.h NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT t,F 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. Ck USE ONE MAP
I certify that in the performance of the work for which this OWNER 0 NO. - NO.
permit is issued, I shall not employ any person in any manner d Q rf n n SPECIAL
so as to become subject to the Workers'Compensation Laws. ADDRESS I4q6 Iw D, CONDITIONS
Date Applicant CITY 146 ZIP 1
NOTICE TO APPLICANT: If, offer making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY
g ENGINEER NO. CONST. ZONE
Exemption, you should become subject to the Workers' �}}� 9-' /
Compensation provisions of the Labor Code, you must forth- ADDRESS v/J V
with comply with such provisions or this permit shall be TEL. 9r� AA STATISTICAL CLASSIFICATION APT. NDO.
deemed revoked. CONTRALTO NO. fi`r s
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 0M DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS AN— NO Z56 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business andn LIC.
Professions Code, and my license is in full force and effect. CITY l:, OJ2 I mNb-yl CLASS aO BK �� 1� VALIDATION
n SQ. FT. NO.OF O OF CHECK 3&5 A
License Number !) U?225 �Liicc.CClot;�+ � SIZE STORIES FAMILIES ONE O
�JJ!11 i f�'T ?i VALUATION # 0 0 0 0 2 3 V
DESCRIPTION OF WORK NEW
Contractor a-e ADD ❑ ; I®� I a a 4 9 41 0
❑I am exempt under Sec. nagALTER ❑ , o o a 4 9 4 1 51 -
�
B.&P.C. for this reason GAroW6
009�5 REPAIR ❑ $ 220-88
Date: USE OF cn
DEMOL E] Js Z
EXISTING BLDG.
Signature ICAN; TEL.� _`�Z FINAL
OW ER-BUIL ER DECLARATION PRINT 2 NO. tl DATE
I hereby affirni that I am exempt from the Contractor's License Zle.� S'
Law for the following reason (Section 7031.5, Business and ADDRESS Wi FINAL
Professions Code): PRE ENT By
❑ I, as owner of the property, or my employees with ADDRESS 1
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY ' 1-i•:L•. oa
7044, Business and Professions Code). MOVING TEL.
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. C.-
y-7T710' ==�
with licensed contractors to construct the project (Sec- _
tion 7044, Business and Professions Code). ADDRESS
REQUIRED TOTAL SETBACK r 3
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH s�t�
I hereby affirm that there is a constructionlending agency for FRONT r �� f
the performance of the work for which this permit is issued P.L. �' - 6''�`"`
(Sec. 3097, Civ. C.). SIDE i;HA h]` _):I_
P.L.
Lender's Name LDMA Ref. #
°o P.C.Fee$ .1N•:Permit Fee I I_I—�Iti)_I ,j�`.'7 f�`'
Lender's Addresspop
I certify that I have read this application and state that the Issuance Fee LDMA P/C# ' irtn All 9:!'4
? above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee LDMA Perm.
and here orize representatives of this County to enter ,,;• .-•
n
upon t o ove- entioned property for inspection purposes.
(�
= SEE REVERSE FOR EXPLANATORY LANGUAGE
Signot a of Applicant or Agent Date
I.4' „#V-DWORKERS'COMPr NSATION DECLARATION
V,rereka, affirm that I have a certificate of consent to selfI ®� 6 FOR �U I L®I PERMIT
insure,+Pr a certificate of Workers'Compensation Insurance, �i� �J
or a cert+f+ed copy thereof (Sec. 3800, Lab. C.) //;; ,' COUNTY OF LOS ANGELES BUILDING AND SAFETY
Polic P%. -7�Company S pJ rr//V19
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING /)
q 6' ' ADDRESS C/
❑ Certified copy is filed with the county building inspec-
tion BUILDING �� — SUL7-AVA /V5
'Jdepart nt. 7 A,,,, - - ADDRESS /� �y /y
Dat V Applicant � /14"P—� CITY r M/'L� ��/ r ZIP "/���G LOCALITY /
CERTIFICATE OF EXEMPTION FROM WORKERS NO.OF BLD T NEAREST
COMPENSATION INSURANCE SIZE OF LOT�7 S� NOW ON LOT CROSS ST. l�G.� 0(�/
(This section need not be completed if the permit is for one / / ASSESSOR
hundred dollars($100)or less.) TRACT I l� BLOJCKK y�c LOT NO. MAP BOOK PAGE PARCEL
OWNER /'r ��IeD�,�J NOTEL.. ( �+ USE NE ENO
.n /_I certify that in the performance of the work for which this oC(-
i IALermit is issued, I shall not em to an erson in an manner / /, /�`,o as to becomes bject to the Work s' omp nsat on Laws. ADDRESSQ3G7G �� �✓ 7 �® DITIONS O
CITY / A-S/ r:: � ZIP Q- U
Dat v Applicant ARCHITECT OR TEL 5-7� DISTRICT GZ31
P TYPE FIRE PTED BY O
NOTICE TO APPLICANT: If, afte making this Certificate of ENGINEER �5�1 U/— 'v� NO. �/S6 CONST. ZONE U
Exemption, you should become subject to the Workers' c^
Compensation provisions of the Labor Code, you must forth- ADDRESS� F ��R/O/ sr SUI x h t `� 7? d
with comply with such provisions or this permit shall be L. ;. STATISTICAL CLASSIFICATION APT. CONDO. N
deemed revoked. CONTRACTOR ION -7�' 9� t O.7 X�L
LICI hereby affirm Elthat II amSED CONTRACTORS censed nder provisions f Chapter 9 ADDRESS [� l—�� �� 'O.3�5 / ` S NO DWELL. UNITS
(commencing with Section 7000)of Division 3 of the Business and �f/fir /��^ /� LIC SEWER MAP
Y //�J/�/JG �4� CLASS BK. 6+ PG. Z� ,1A}I �T O r
Professions Code, and m license is in full force and effect. CITY 10�
�{ SQ. FT. NO.OF NO.OF CHECK
License Number.y 1 Lic.Class r✓ 1 SIZE STORIES FAMILIE ONE I o 4 1 559
�J/��/��f� q�A � 2 VALUATION yp;J�
r/•r/N I�YVV r/V�/`�1 r Date J DESC�I OF WORK ADD
D ❑ $ ,4,/�(/D� O 1 1 5 $
Contracto J
I ❑ I am exempt under Sec. U� AffAALTER ❑
B.BP.C. for this reason REPAIR ❑ $
USE OF
Date: EXISTING BLDG. /A,YI y� DEMOL ❑ 1- 7 6 4,6 A
Signature APPLICANT TEL. '
/ DATE - 969.70
FINAL # a a o 0 23
OWNER-BUILDER DECLARATION
PRINT Q /'�/ NO.7--/ b 1 9 6 9 7 0
1 herebyaffirm that I am exempt from the Contractor's License A� m x
p ADDRESS 367 O L�/'/ • /��Y-� f FINAL a a 969.7 0
Law for the following reason (Section 7031.5, Business and
Professions Code): PRE EN By 0 8 1 1 8
❑ 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
7044, Business and Professions Code). MOVING TEL.
❑ I,as owner of the property, am exclusively contracting rADDRE
ACTOR NO.
with licensed contractors to construct the project (Sec- SS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY ACK YARD HWY TOTAL-SETBACK
LINE WIDTH
I hereby affirm that there is a construction lending agency for T $9 9, 5 A
the performance of the work for which this permit is issued P.L. y.
(Sec. 3097, Civ. C.). �} 0 0 0 0 0 1
11,79(1-- 5
Lender's Name a i
LDMA Ref. q I, ��9 0,� 5
m UU/V ✓ e$ t Permit fee +Ts-
Lender's Address !!'�� aj, '1 j—$$
I certify that I have read this application and state that the Issuance Fee ,5V LDMA P/C q
above information is correct. I agree to comply with all County ation Fee /1
q ordinances and State laws relating to building construction, Total Fee v LDMA.Perm. q
N and hereby authorize representatives of this County to enter 11111111
Au,pthe above-mentioned property for inspection purposes.
I�= SEE REVERSE FOR EXPLANATORY LANGUAGE
ign ure of App icant or Agent Date
WORKERS'COMPENSATION DECLARATION
I�h ;by lbffirm that I have a certificate of consent to self APPLICATION BUILDING PERMIT
insure, or a certificate of Workers' Compensation Insurance,
or a certified
f copy thereof(Sec. 3800, Lob. C.),/ COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. 'T U& Company A D� BUILDING
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS L
Certified copy is filed with the county building inspec- BUILDING *
A
tion department. ` ADDRESS v 17A
Date�eZ= rD Applicant `� G�U1(T�� CITY r — �V ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT OW 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 NNE MAP
I certify that in the performance of the work for which this OWNER NO. /J,J. NO.
permit is issued, I shall not employ any person in any manner ADDRESS CONDITIONS G.'
so as to become subject to the Workers'Compensation Laws. U
Date Applicant CITY ZIP W_
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT I G UP I TYPE FIRE I PROCESSED BY O
Exemption, you should become subject to the Workers'
ENGINEER NO. CONST. Z E G V
Compensation provisions of the Labor Code, you must forth- ADDRESS OW.
with comply with such provisions or this permit shall be r ��/,l TEL. pp STATISTICAL CLASS( (CATION APT. ONDO. [A
deemed revoked. CONTRACTOR S 1f✓i1CC� NO. d 0���'
LICENSED CONTRACTORS DECLARATION LIC, r CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS A FigNO. D y�
(commencing with Section 7000)of Division 3 of the Business and d LIC.
A y/ SEWER MAP
Professions Code, and my license is in full force and effect. CITY o� CLASS —H BK PGVALIDATION
SQ. FT. NO.OF I NO.OF CHECK
License Number
Llc.Class Vg 7 b/ SIZE STORIES FAMILIES ONE VALUATION
Contractor J owef gq_f&�IT/N6�te I_a�8a j DESCRIPTION O&WORK I ����yy NEW ❑ $ �.
❑ ( IC '�Q K- ADD ❑ .
I am exempt under Sec.
ALTER ❑;
B.&P.C. for this reason I REPAIRUSE OF
❑ . 5
Date: EXISTING BLDG. DEMOL ❑
Signature APPLICANT do TEL FINAL A 9 0 9 5 A
OWNER-BUILDER DECLARATION PRINT C AIDS NO. 70 DATE
1 hereby affirm that I am exempt from the Contractor's License ADDRESS of /®� /��" FINAL $# 0 0 0 0 0
Law for the following reason (Section 7031.5, Business and
Professions Code): PSIT By I o o60,50
❑ BUILDING
1, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and o o 0 6 Q 5 0 ri
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code). MOVING TEL. Q 3; 0 2`'8 8
❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK MWEIIIIIE
SET BACK PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L.
Lender's Name
o P.C. Fee$ Permit Fee LDMA Ref. #
Lender's Address '
I certify that I have read this application and state that the Issuance Fee LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee --
ordinancesand Stat laws relating to building construction, Total Fee J LDIyW Perm.#
and here y au ri representatives of this County to enter
upon t f ned property for inspection purposes.
'U�'l �& J )� , Ise 3 y
qr
i SEE REVERSE FOR EXPLANATORY LANGUAGE �h'4'— J 0
g tur of Applic r Agent Date g -S
�_ J / 1 ,
i
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 0609250008
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
ON FILE SQ. FT STORIES TYPE 5704 SULTANA AV
[STRUCTURE: 3500 VN TEMP CA 917802369
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5387-024-009 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C
TENANT: IST BLDG USE: RHSID US8 ZONfi: R-3 ISSUED ON: PROCESSED BY: EXPIRES ON:
IST OCC GRP: 09/25/06 JK 09/20/07
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE:
ACON ROBERT;SU RUA (626) 358-4410- 6,000 �7
567 ALTA VISTA AV '?-1
MROV 910161630 FEES PAID DESCRIPTIlON�OF WORK
REMOVE EXISTING ROOF & REROOFING 30 YRS COMPOSITION SHINGLES
PER DESCRIPTION: QUANTITY: DOM: AMOUNT:
APPLICANT: TEL. NO:
LEE (213) 760-3838- AA BLDG PERMIT ISSUANCE 27.75
3650 COTTONWOOD CIR AC STRONG MOTION RESID 6000.00 VAL 0.60 SPECIAL CONDITIONS:
WEST COVINA CA 91792 D2 PERMIT W/O EN-HC 6000.00 VAL 149.40
TOTAL FEES 177.75
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
BATMAN ROOFING CO. (213) 760-3838-
3650 COTTONWOOD CIRCLE LIC. NO LOCA^ION AND SETBACKS
WEST COVINA, CA 91792 740542 C39
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. NO: SLAB,UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
150H265 3 01
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE: SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION WEATHER STRIP
SIDE PL-
INTERIOR LATH DRYWALL
EXTERIOR LATH
RATED FLOOR CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
i
REPORT ID: DPR261 ROUTE TO: BS0508
I
1
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 0609250007
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
ON FILE SQ. FT STORIES TYPE ; 5702 SULTANA AV
STRUCTURE: 3500 VN TEMP CA 917802369
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5387-024-009 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: RESID USE ZONE: R-3 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 09/25/06 JK 09/20/07
OWNER: TEL. NO: SLUGS. NOW ON LOT: VALUATION: FINAL DATE FIN BY: CODE:
ACON ROBERT;SU RUA (626) 358-4410- 6,000
567 ALTA VISTA AV
MROV 910161630 FEES PAID DESCRIPTION OF WORK
REMOVIE EXISTING ROOF & REROOFING 30 YRS COMPOSITION SHINGLES
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:
APPLICANT: TEL. NO:
LEE (213) 760-3838- AA BLDG PERMIT ISSUANCE 27.75
3650 COTTONWOOD CIR AC STRONG MOTION REBID 6000.00 VAL 0.60 SPECIAL CONDITIONS:
WEST COVINA CA 91792 D2 PERMIT W/O EN-HC 6000.00 VAL 149.40
TOTAL FEES 177.75
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
BATMAN ROOFING CO. (213) 760-3838-
3650 COTTONWOOD CIRCLE LIC. NO LOCATION AND SETBACKS
WEST COVINA, CA 91792 740542 C39
SOILS ENGINEER APPROVAL
i
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. NO: SLAB UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
150E265 3 01
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21 ROOF,SHEATHING 6
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION WEATHER STRIP
SIDE PL-
INTERIOR LATE/DRYNALL
EXTERIOR LATH
RATED FLOOR CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508