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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0211010004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADURMS:
TR: 12157 LT: 11 BL: .001 i SQ. FT STORIES TYPE OCCUP GROUP 5703 SULTANA AV
STRUCTURE: 1 VN U1 TEMP CA 917802368
ASS5SSOR INFOR14ATION NUMBER: INEAREST CROSS STREET: LAS TUNAS
5387-029-010 + EXIST BLDG USE: THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
EXIST OCC GRP: USE ZONE:
TENANT: PROCESSEDISSUED ON:DGS. 0 O 11/01/02 JK 04/30/03
OWNER: TEL. NO: FINA E FI L CODE:
CHAN KEN GUO WEI;WOO REGINA MAIN KI (626) 285-8218- S: � ��n
5703 SULTANA AV
TEMP 917802368 DESCRIPTION
CONVERT ACCESSORY LDG BACK TO INTENDED USE AS STORAGE RM
OCCUP LOAD EXIST: REMOVE INTERIOR WALLS,KITCHEN,CLOSET IN GARAGE, & CARPORT
APPLICANT: TE . NO: OCCUP LOAD NEW:
SAME AS OWNER -
PARKING SPACES REQUIRED: SPECIAL CONDITIONS:
PARKING SPACES PROVIDED:
EXIT HARDWARE:
CONTRACTOR: TEL. LIMITED TIE USE
SAME AS OWNER - NBR OF EXITS: FROM TO
LIC. NO
FEES D
APPROVALS DATE INSPECTOR SIGNA URE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
ARCHInCT OR ENGINEER: R USE
- i OA PERMIT ISSUANCE 27.75 ,
LIC. NO: 01 R/M OCC/USE INSPECT 145.95 SAFEJY PERMIT
TOTAL FEES 173.70 1
TEMP4 P 0
I
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: TEMP.; STRUC . REMOVED
0. OF FAMILIES: DWELLING S: P /CO : STAT C S
NO
SCHOOLT N HAZARDOUS +
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
REQUIRED OTAL SETBACK-FROM EXIST
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL-
SIDE PL-
REPORT ID: DPR267 ROUTE TO: BS0508
WORKERS'COMPENSATION DECLARATION a M I SC L L LA N EO U S A P P L I C AT I�N
1 '1 .6. CE 87. 41, � CE 875 (11-84)
I hereey affirm that I have a certificate of consent to self I
insure, or a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES IBUILDING AND SAFETY DIVISION
a certified copy thereof(Sec.3800,Lab.C.).
Policy No. Company FOR APPLICANTTO FILL IN BUILDING 2
pDORES5 5��2, ` k2,
I 1
Certified copy is hereby furnished. BUILDING LOCALITY l�_ 1 C
ADDRESS «4/
El Certified copy is filed with the county building inspection LOCALITY '
NEAREST It I
department. �- CROSS ST.
Date Applicant NEAREST DISTRICT NO. GROUP TYPE P O SSED BY
CROSS ST. + S�O �� CONST.
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL
COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL
NO. (CIRCLET
NO. OP BLD GS.
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) USE OF
SIZE OF LOT EXISTING BLDG. y^ �C `
I certify that in the performance of the work for which this :r Z o
permit is issued, I shall not employ any person in any manner OWNER ' , ' r5 b.T y
so as to become subject to,the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o
Date Applicant ADDRESS G, S , { W
rEL. OCCUPANT LOAD
NOTICE TO APPLICANT:-If, after making this Certificate of CITY �`� + ND. j a�- jl �' tin
Exemption, you should become subject to the Workers' z
Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE:
with comply with such provisions or this permit shall beI TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. now
deemed revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices El
I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT ❑ (LIST ITEMS BELOW)
9 (commencing with Section 7000) of Division 3 of the Busi I NO. OF EXITS
ness and Professions Code,and my license is in frill force and
effect. , •� ' PARKING REQ'D PROVIDED
! � SPACES LL��J
License Number Lic. Class -
LIMITED TIME USE
Contractor Date DATE DATE
❑ I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer SIZE OF NO. OF Pf10 M: To: INSPECTOR'S
acting in my professional capacity (Section 7051, Bus' EXISTING BLDG. STORIES SIGNATURE
iness and Professions Code). FINAL APPROVAL
PRESENT USE OF BUILDING
Lic.or Reg.No. Date
HOMEOWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
ON LOT AND USE o70�0
I hereby affirm that I am exempt from the Contractor's
License Law for the following reason (Section 7031.5, Busi=
ness and Professions Code); NO. PARKING
❑ I, as owner of the property, will do the work and the. sPAces PROVIDED '-
-;
structure is not intended or offered for sale (Section
7044,Business and Professions Code). _ _ _
I PROPOSED USE OF BUILDING I +' ..
CONSTRUCTION LENDING AGENCY `3
I Hereby affirm that there is a construction lending agency 1
for the performance of the work for which this permit is; I ---........
TIMi 1L 'Z,54
issued(Sec.3097,Civ.C.).
Lender's Name -- } i:�, y_- , I
PROPOSED MAX. OCC. (-i�y{•i,a` o`':'
Lender's Address �� D !
PERMIT FEE
I certify that I have read this application and state that the
above information is correct.1 agree to comply with all County. ISSUANCE FEE _ �. .a�i:i._Ii�(s i ; i
ordinances and State laws relating to building construction, =- J.=: -
and hereby authorize representatives of this County to enter TOTAL FEE ! �ri �..
upon the above-mention property for inspection purposes. SEE REVERSE.FOR EXPLANATORY LANGUAGE
I Ti5'9
Signature of Permitt Date