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Home My Public Portal About4333 TEMPLE CITY BLVD_Building__ �t DIMSION OF BUILDING AND SAFETY I I j ®1 r�/.�A DepGrBaent of Covntp Engineer - V 1 l�yam ," Co. ty of Lo[ Angeles 2 LL' . - ' WM J FOX COUNTY ENGINEER APPLICATION : �- c.FOR APPLICANT.TO FELL;IN�`- ' '? wooaess - / G !1 pBU1LDING '73 3. 3 - JE - L�-%T LOCALITYr - ADDRH6B C NEAREST LOCALITY QS L�/�f��/Q~ -CROSSST fr!/ ROSS / Q/'/�� v C o DISTRICT NO PUN C• oe R[c No �-" PERMIT NO L K/ t.XJ X22_p OWNER' " V R5CEIV D BX-�a DAT OF /P'P�L�y -DAi IeHLEO ' `/ �Y��s .J T r /�J s ADDRESS T— ZY J UBH ZO NO OF 'ry�PJE _O/R�O RE ZONE CI =517 -e� TQC O I ti�B ARC ��II /� NO�� SIJ��6/.a syr wG HIT EN INEER OR ``I, t/ry./5� 'I . NO I �/(1�� 141-�} APPROVED B"YL ADO EBB oT/✓ Ifs .tcra �tID I ` i SETBACK BUILDINGLINE f 0/V�r CONTRACTOR y' er el�(/ O 29�7� g� A PROYco I - �A�C 1 ADDR 6 d F i 7� �� SQA (!1 HPUSE NUMBERING - a _ LEGAL MAP NUMBER O/� NO ASSIGNED BY DESCRIPTION LOT NO BLOCK I TRACT �Tl," GEG�9Z_ GATE - CORRECTIONS a IIJSPECTOR SIZE OF LOT Q S �J NOW ON LOT B INDU TRIAL 1"1A _ ' '3 .. ' USE OF NO OF sr,. �-L F�ti ' E% 8T GBL G - FA LIES j - O I DESCRnMON OF WORK, /S L4�c-1L 7/P` T - A NHW ALTERATION � REPAIR DEMOLITION ADDITION yS/+ ,D�ly/-/J�� iJLG✓ B ZEANO OF x -_0 �j ROOMS STORIES rI/ ILS �Yy_J q/�+j//•WALL COROOF VERING /y1rlaG COVERING 1. USE OF STRUCTURE h a O O��/�c •r / ,L- `� It '� hEBDS 5Y- QTc, �✓ �' APP6G INSPECTOROVALS R B SIGNATU RH f(70 FOUNDATION LOCATION �! FORMS MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- WIRE FRAME- FIRE STOPS PLICATION AND TATE THAT THE INFORMATION GIVEN IS BRACING BOLTS CORRECT ' I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION I AND STATE LAWS REGULATING BULDING COONSTRUCTION„ GAS,VENT �DUCTS SIGNATURE Or, e W /V ) / ATINT PERMITTEE � - 4.../ LATH O(T ADDRESS �AUTHORIZCD AO PLASTER INT ' 100 ' // PLASTER EXT ..1, S ` LLQ, ODS P C 7" 7 U HOUSE R- QBR COaNUMERECT AND POSTEDVALUATION FEE5'r FINAL„ ]CAOLBA, Dees Ae[ a1 ��6,-4 Y-�—J - � - -J4A�.14.� •t ♦• ��W. ♦ ! I 7BA836A CE 01103 12/00 CITY OF TFS'IPIE CITY APPLICATION FOR BUILDING PERMIT �1 COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK - PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT Or BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST BUILDING DISTRICT NO OUP TYPE P D BY ADDRESSTemple Boulevard CONST STATISTICAL CLASSIFICATION___ _SE ER MAP_ LOT NO =_> - _ --- _- BLOCK- - - - - -- - CLASS NO_�DWELL UNITS PG TRACT ,USE ZONEI MAP S NO OF LDGS NO B SIZE OF LOT NOW ON LOT PECIAL USE OF CONDITIONS EXISTING BLDG TEL OWNER O S ler CO. IO BLDG SETBACK FROM ADDRESS 4333 Temple rity Rlvri FRONT PROP LINE OF (STREET) CitTYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY Temple CIUi HIGHWA WIDTH I FROM C L ARCHITECT OR TEL I I } _ ENGINEER NO _ BL SETBACKFROM ADDRESS WT n rvT SIDE P LINEOF (STREET) CONTRACTOR VlI• in Roof Co. —NOL20/�lJSL11 HIGHWATYPE OF Y WIOTX F M" HIGHWAY, } YARD c = TOTAL ADDREss6O0 S. San Gabriel Bl No 16065�0(0LIU Y = o CITY San Sabriel 91776 CLASS C-39 CORNER CUTOFF YES ❑ NO CONSTRUCTION LENDER o NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS y SO FT NO OF NO OF ❑ _ SIZE STORIES FAMILIES NEW USE OF STRUCTURE Reroof rock roof ADD ❑ ALTER ❑ SIGNATURE OF REPAIR APPLICANT DEMOL ❑ VALUATIONS 1 OOO.00 APPROVALS DATE INSPECTOR'S SIONATURI FEE S FEES 12.00 FOUNDATIONFORMS MATERIAALS - FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND ASREE TO COMPLY FURNACE LOCATION WITH RU.ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS ST TION TION I CERTIPY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT LABOR CODE OF THE STATE Or CALIFORNIA IN RELATING 0 WORKMEN'S COMPENEATI INSURANCE LATH EXT SIGNATURE OF / , HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F LEWIS PR CIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION. CK M CASH _ PERMIT VALIDATION CK _MO CASH i pr., 7 7 4 8N h0Y 7 2D O- r • y _ r UILDINBUILDING ADDRES° APPLICATION LOCALITY NEAREST DIVISION OF BUELDING AND SAFETY CROSB BT Department of OoGnty Euglneer DISTRICT NO RECEIPT.NO PERMIT NO OoDnty of Los Angeles 15— 3 a �- WM. J. FOX, COUNTY ENGINEER GROUP DAT[RECEIVED DAT[ISBUm CABRATT D GRIFFIN, RUP'T or Bu,uaINR FOR APPLICANT TO FILL IN TYPE CONST R[OCIV[D BY SB [D BY _OAl �� r NUMBER ZV MAP HwY YES NO ADDRESS UB[ZOM[ SPECIAL T[L CONDITIONS ARCHITECT OR TEL ENGINEER a NO BUILDING SETBACK YARD NWY STREET NAME ADDRESS W 1DTN I FRONT G CONTRACTOR C n1 NOL 1 P SIDE ADDRESS -3!!r L .A 5 1 P L B 'LOING ,"1 , DATE CORRECTIONS INSPLOTOR ADDRESS LOT NO ^^.j[ I ''y BLOCK ' TRACT —✓/ ✓ Z 1 y NO Or BLOCS Bli[OF LOT D JI NOW ON LOT S use Or EXISTING DESCRIPTION OF WORK MO S NEW ADD ALTER REPAIR DEMOLIBH' Z BQ rT. NO Or NO Or I r BIZ[ STORIES rwwluto UB[Or STRUCTURE 1 0,006 C FAC M rr► t_ - L C-4 CTI^ FI 2E WI��L� �- I I NO Or EMPLOYEES - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS API- PLICATION AND STAT[ THAT THE INFORMATION GIVEN IRI APPROVALS INSPECTOR'S SIGNATURE DAT[ CORRECT 1AGREE TO COMPLY WITH ALL COUNTY ORDINANCES rOUNDATION LOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION rORMB MATERIALS rRAME rIREBTCPB, SIGNATURE 0 BRACING,BOLTS PERMITT[ c FURNACE LOCATION, ADDS C_ N _ GAS VENT DUCTS LATH INT. AUTHORIZED AMT LATH EZT. 00 P O B HOUSE NUMBER 7 COR-r[[ RECT AND POSTED VALUATION ' B r[E FINAL ZZ� o�aiBA wE 3 v u / f 2-6 _ =-13U 1 L. ® 6 N G ACGN[B APPLICATION Q.� LOOALrrY HKARWRT DIVISION OF BUILDING AND SAFETY OROB0 fm Deparbmnt of 0austy Rnghlew DIRT/IIOT NO. RLLCLIPVWD PERMIT NO. Oomty of LOB Aogdee , 3 02. D� WM. J. FQXr COUNTY ENGINEER 1 O UP DA [OE V[D nA 1 UED OAB6ATT D ORIF►1 M. BYrT DT, BYILDIMR > FOR APPLICANT TO SPILL IN TYPECONSIST. !J �45r6 ZZ-7 AMAIL DDRESS TJ TJ NUMBER �O S BMwy[ C XO [L U/R'�E ZONE 13ITY A0CONDITIONS AIGOHITEOTOR L TEa• � ' / / KNGIN[[R NO SWINT B[TBADNK YARD HWY ' YTR[R NAN[ WIDTH DONTRACTOR TEL. ANO. FRONT `J �O BID[ADORKSM O P L DD DAT[ OORR[CTIONB IN8P[DTOR ANOL FOR INDUSTRIAL WASTE FARANOF REM LOT NIL - BLOCK ' TRACT Y �' Ye BIZ[OF LOT X80 (A t 07 INe Op RLOTB. uBE or I DESCRIPTION OF WOR 1. 0 NEW ADD ALTER REPAIR D[MOLIRN elI[, ✓ . RTORIW FAMLLIW C' L [ G ) u. O►BTRUOTYRC r 1"a �rA t t N0.Or rR C 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TNIB AP- 1 PLICATION AND CTAT[ THAT THE INFORMATION GIVEN IB APPROVALB INBPECTOR•O SIGNATURE DATE CORRECT 1 OR[[ COMPLY WITH ALL COUNTY ORDIXANOm FOUNDATIONS LOCATION AND !TAT[ REDULATI NG BUILDING CONSTRUCTION rORM MATERIALB ✓ r ` S RAN[ FIR[BTOPG ` r GIONATURE OrG ' BRACIN ■OLTG _ Z PLRNITTE ►URNAD[I ADDRESSLODATIONr ^ DAev[Nr DUDTe d AUTHORIZED AOT LATH INT. /. LATH. Cm. �~ ! / O O OG P O • (y[I HOUSE NUMBER OOR- (.J R[ R[OT AND PORTED VALUATION a FCC D FINAL 9RARiRA DSR! MM DEPA'lT41EPJT[OF BUILDING AND SAFETY BUILDING 9 ' ® ' �_- _s COUNTY OF LOS ANGELES &_ 3p-S' V ' Y WM. J. FOX. CHIEF ENGINEER APPLICATION__ FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY L BUILDING �(J/� �{.. �1 T N0. I PLAN CK ORR R[e No- . PERMIT NO aDORMS T�.pp77� /C�cFi �,TY y�rV� 3`2=19,60 i � / 4 A OF APEL, DATE ILBU[D LOCALITY NREAREBT i BUILDING aooge OWNER GL/rF ]'►'141212 ADDRESS t MAIL yr - - -- c. -LOCALITY I ADDREBS Iols �� 6/VT/Qip NEARESTI Ty 47DROBB BT CITY S. Do'^/T NOL FIRE No OF ARCHITECTS �(i/fEL`t,��0 ZONE PLANS ENGINEER GG-•/R/rloieCA/o/FaaiM��'- 110 dIQ BLD° / R N 0?I/✓e,/00) �J�i/�i ��- BETBACK'LINC _ 1 ADDRESS T UMBA[ CNP NUMZtSE BP NO � CONTRACTORoBC `RC,'JA 0. EUSE NUMBRINI ADDRESS 2�t ASSIGNED BY LEGALla� 7123 CORRECTIONS ` DESCRIPTION LOT NO BLOCK _ _ Y ^ Iz TRACT L tiN6• T SIZE DF LOT ' ' Mp'N LDT°B NeA4 USE or No OF EXISTIN BLDG FAM.u[R l Tan;;7- DESCRIPTION _DESCRIPTION OF WORK ° NEW ALTERATION ADDITION = REPAIR -" DEMOLITION F No or SSI ZE 7u G ROOMS P"IN6TORIESEXT WALL ROOF COVERING QRIeK COVERING �6M <. Ny aQ � �� > ` USE Or STRUCTURE W S Ite36Nf Co/s11ti1t� / �� e'+•-- INBPECTION FOR N9p�°yB i APPROVALS OC_CUPAN°YAB INSPECT SBIGNATUgE ATE FOUNDATION. LOCATION ` FORMS, MATERIALS V I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- - - PLICATION AND STATE THAT THE INFORMATION GIVEN IB FRAME FIRESTOPA, / CORRECT BRACING. BOLTG I AGREE TO COMPLY WITH AND STAT[ LAWS REOULATINGABUILDING CONSTRUCRDINANCES T ON FURNACE LOCATION, GAS VENT DUCTS (� SIGNATURE OF( / �Y r.'✓�.Y'r.1.. LATH. INT J - PERMITTEr LATH. EXT ADDRESS PLASTER, INT AUTHORIZED cTf PLASTER. EXT FEE S ..J�✓ ,• HOUSE NUMBER COR_ ` ^p RECT AND POSTED VALUATION FEES FINAL of '16A411A ABG] '1.61 ' Te„fJeA CE RROJ 1/7I �?' I c¢yy APPLICATION FO BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING J ADDRESS _7 COLEMAN W JENKINS, BUP T or BUILDING LOCALITY f FOR APPLICANT T FILL IN NEAREST not r r DI CROSS ST ADDR E55 3 3 �7 /'T 6�� DISTRICT G i YPE CON T CESS Y ` _ L/ _ STATISTICAL CLASSIFICATION SEWER MAP LOT NO BLOCK l CLASS NO 2` DWELL UNITS BK PG33 TRACT USE ZONE I MAP NO OF BLDGS NO SIZE OF L NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG OWNER BLDG SETBACK FROM ADDRESS �,t �C �G FRONTPROP LINEOF (STREET) TWE OF EXISTING SETBACK HIGHWAY + YARD TOTAL CITY NIO HWAV WIDTH FROM C L ARCHITECT OR TEL ENGINEER NO BLDG SETBACK FROM ADDRESS SIDE PROP LINE OF (STREET) TEL__ TYPE OF EXISTING SET K HIGHWAY + YARD = TOTAL O CONTRA NO HIGHWAY WIDTH F C L U ADDR ryp + O CITY CLASS CORNER CUTOFF YES ❑ NO ❑ W CONSTRUCTION LENDER N NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL AP ROVALS ADDRESS SO FT NO OF NO OF NEW ❑ SIZE ST IES FAMILIES USE OF ADD ❑ 7 STRUC URE + + ALTER 6 z �i REPAIR SI ATURE OF ❑ It G `I— APPLICANT DEMOL ❑ VALUATION S 2 QP APPROVALS DATE 1NB P[c TOR•B SIGNATURE P C PMT , FOUNDATION LOCATION FEE S FEES �.J CJ FORMS MATERIALS FRAME FIRE STOPS Ej I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL ORDINAN CES AND LAWS REGULATING BUILDING COM- GAS VENT DUCTS STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY Y PERSON IN VIOLATION THE LABOR CODE OF THE 9T F CALIIORNIA IN RE I O TO LATH INT WORKMEN S C MPEM III 1454 URANCE LATH EXT SIGNATURE OF �/f HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS I N AL AIM At t-1 JOHN F LEWIS PRI CIPA S UCT AL ENGINEER PLAN CHECK VALIDATION CN MD CABH PERMIT VALIDATION CK MO CABH t p4320,,;,l FEB g 1 o 23.50 Q I WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified opy thereof (Sec. 3800, Lab. C.) cy No.' V 1, ?/Company /"i�r� .r-�/*�yf COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING Certified co is filed with the countMd' m ADDRESS Pe Wec- ADDR SS / jtion department ADDRESSDote /7` �- �fAppl'cant •�' - CITY � - 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 NASSESSOR O } hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL d �! TEL. USE ZONE MAP O I certify that in the performance of the work for which this OWNER /r (..NO, MA U permit is issued, I shall not employ any person in any manner i^' �./ /7 / it� ice/ SPECIAL J so as to become subject to the Workers'Compensation Lows. ADDRESS /� r CONDITIONS CITY / '•'' ZIP y� >_ Dale Applicant I:=iF NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Q a Exemption, you should become subject to the Workers' ENGINEER NO. CONST. ZONE cc: r4q! Compensation provisions of the Labor Code, you must forth- ADDRESS O with comply with such provisions or this permit shall be rd deemed revoked. CONTRACTOR ."j.. TEL,.. STAA3TICAL CLASSIFICATION APT I CONDO. W LICENSED CONTRACTORS DECLARATION . LIC. CLASS NO. DWELL. UNITS_ f—. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Section 7000)of Division 3 of the Business andf LIC SEWER MAP LIC. Professions Code, and my license is in full force and effect. CITY �" - BK PISVALIDATION SO, FT. NO.OF NO.OF CHECK License Number / / ( Lia Class f' SIZE ISTORIES FAMILIES ONE ❑ VALUATION Contractor-:•/l ," Date / DESCRIPTION OF WORK NEW I am exempt under Sec. ADD ❑ $ , ALTER f$.BP.C, for this reason /OL 1_' `�O s ❑ $ e - REPAIR Dote: USE OF 7 EXISTING BDG. DFmni ❑ • . Signature APPLICANT TEL i" ' 'r D ` /'" OWNER-BUILDER DECLARATION PRINT :, ,/ NO. FINALDATE I hereby affirm that 1 am exempt from the Contractor's License Low'Tor the fallowing reason (Section 7031.5, Business and ADDRESS., FINAL Professions Code): By ❑ BUILDING — I, as owner of the property, or my employees with ADDRESS wages os 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 CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED BACK YARD HWY TOTnLMOP ALINE'ROM 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 OMA Ref M P.C. fee$ Permn Fee Lender's Address ' I cenify that I have read this application and state that the lesaance Fee LDMA P/C If above information is correct. I agree to comply with all County Invesegorwn Fee j $ ordinances and State laws relating to building construction, coral Fee LDMA Perm. N R and hereby authorize representatives of this County to enter upon t1hp above-m int'' ed property fyc action purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dare APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY _ WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDINGADDRESS —� BUILDING ADDRESS I hereby affirm that I have a certificate of consent to Self insure,or a certificate of Workers'Compensation Insurance,or a certified , Copy thereof(Sec.3800,Lab.C.) CITYZIP N i 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. I USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. COMPENSATION INSURANCE ADDRESS wlrtfwlunoFT.OFscHoolT YES NO (This section need not be completed it the permit is for one hundred -f i'�- {!f : % DISTRICT GROUP TYPE DONST.' FIRE ZONE PROCESSED BY dollars(6100)or less.) CITY _ ZIPS I certify that in the performance of the work for which this permit i8 issued, shell not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. l become Subject to the Workers'Compensation Laws. STATISACAL CUSSIFICATION APT C O 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. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit Shall be deemed revoked. ADDR LIC.NO. FRONT PL d LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE PL W I hereby affirm that I em licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE NO.OF STORES NO,OF FAMILIES Ly Professions Code,and my license is in full force and effect. NEW -,�] BK PG ��i.��-•� � License Number Lic.Clan DESCRIPTION OF WORK ADD VALUATION , 7.1U Contractor Date ALTER ❑ $ f T'IEM:I CD REPAIR ❑ YUTAL 6�w� � ❑ I am exempt under Sec. : � B.BP.C.for this reason - DEMOL ❑ '.�. t7A USE OF EXISTING BLDG. LDMA P/C M Date: URM ❑ Signature APPLICANT(PRINT) TEL.NO, LDMA Perm N ❑ I, as owner of the property, or my employees with wages as _ their sole compensation, will do the work and the structure is ADDRESS `,)i•R.I'� Y ` �� Dot intended or offered for sale (Section 7044, Business and FINAL DATE -C Professions Code.) WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEAHAIARDOUS MATERIAL J { OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EWAL TO OR GREATER THAN ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE7 FINAL BY licensed contractors to construct the project (Section 7044, TEs❑ No❑ Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING �• '•# OCCUPANT RE W IRE A PERMIT FOR CONSTRUCTION ON MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY CCOA T MIRE DUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERM `, ITTING CHECKLIST .. =.n5y e+l I hereby affirm that there is a construction lending agency for TEs❑ NO❑ aY + the performance of the work for Which this Permit IS Issued(Sec. 1 HAVE READ THE HAZARDOUS MATEAIALa INFORMATION GUIDE AND THE SCADMD 3097,CIV.(i.). PERMITTING CHECKUST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES r y COUNTY CODE.TITLES.CHAPTER2S SECTIONS M11XITHROUGH 2 A,IGCONCERNING IIT 93.16, Lenders Name HAZARDOUS MATERIALS REPORTING MOOR OBTAINING A PERMIT FROM THE SCAOMD. �C v Lenders Address a.,IrR OA AaERT t ,_ _ t.LnLGWW.I•��M1�• ' :r•'. o I certify that I have read this application and state that the above information is correct. I agree to comply with all county PC.FEE PERMIT FEE ordinances and State laws relating to building construction,and < hereby authorize representatives of this County to enter upon ISSUANCE FEE •� LTLr'.Cl�"'r+4�•jI; +�� the above-mentioned property for inspection purposes. 3 Ci LTLr' L < i INVESTIGATION FEE TOTALFEE -'{ _ _ Ih17 SEE REVERSE FOR EXPLANATORY LANGUAGE 1 WORCE�R.S COMPENSATION-DECLARATION ,a ,mf(vm thathave cerie of consent to ,elf — — - APPLICATION FOR- BUILDING PERMIh_ ._ _ ms4re ora certificate Com of Workers Compensation Insurances: ' `�o"a certified copy thereof (Sec 3800 Lab` C ) -- - C - 1 COUNTY OF LOS ANGELES BUILDING AND SAFETY _ Policy No iCompany _ _ "0 Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING _ Certified copy is filed with the county building inipec BUILDING ,/ �� G/r LV tD ADDRESS y t tion department) ' ` • ADDRESS e! I ` Te Dara T � Applicant CITY r�T G/ ZIP LOCALITY 1. I CERTIFICATE OF EXEMPTIONTROM WORKERS' _ NO OF BLDGS - NEAREST_ _ , _ - _ _ 'n' • ' COMPENSATION INSURANCE SIZE OF LOT I/O P(4%W NOW ON LOT ST t _ _ _— _(This section need not be completed if the permit a for one _ - --_ -_--- ASSESSOR____- hundred dollars ($100)or less ) i TRACT BLOCK LOT NO MAP BOOT( pA, PARCEL _ TEL USE ZONE I certify that in the performance a work for which is ONTER 4 NO permit n issued, I shall not emp n person m any m tit .fir e �((�� Y SPECIAL - - - - - - - IL se as to become iublect t Co pensatm s ADDRESS 84'3 / e C/ b• I r" CONDITIONS O V. Date bcant - - CIN G/1� -�/ __ ZIP _ - _ "_ - - ,9 NOT T If, after making this Certificate of ARCHITECT 01 a��C TEL DISTRICT GROUP TYPE FIRE TED BY_ _ _ G Exe n u should become sabjectrto the Workers ENGINEER i.� rpD �` (/ CONST/, ZOPE T Com nsation provisions of the Labor Code, you must forth ADORE55 �s /'�/✓�. S.• o/ A'� ✓ 3 W with comply wlth,such provisions or this permit shall be deemed revoked , ` . 11 . CONTRACTOR K.EJ� TEL STATISTICAL CLASSIFICATION APT C NDO LICENSED CONTRACTORS DECLARATION -LIC - CLASS NO - DWELL UNITS_ 1 hereby offmn that I am licensed under provisions of Chapter 9 ADDRESS 5 d @ NO (commencing with Section 7000)of Division 3 of the Business and - LIC - -- - SEWER MAP i Professions Code and m% y license is in full force and effect CITY _ CLASS - - - - VALIDATION- - i ' 50 FT NO OF NO OF CHECK BK y- PG I 1 License Number Lic Class SIZE �&O STORIES FAMILIES-1 � ONE - ' ' ' ' VALUATION Contractor ` Dote DESCRIPTION OF WORK � AL � f � s I am exempt under Sec aW.�� CBI/I• ADD B 8P C for this reason { USE 0' REPAIR Date EXISTING BLDG F R!0A40i • D ivuN Sigriature _ APPLICAtdT rEL � 1 6 a 9 A PRIM AP&Am BO /yb NO S (,a O FINAL OWNER-BUILDER I am exempt DECLARATION ,fir _ _ _ DATE - - _-1 # * 0 e 0 2 3- _ .1 hereby affirm That I g r exempt from the 31 5 Business License ADDRESS 8 I (r C p&VO� nt , Law for the following reason (Section 7031 5 Busmen and �i FINAL 11 Professions Code) MIMI - BT - - 1 - 28688 - BUILDING I, as owner of the property, or my employees with ADDRESS 1 2 8�1 8 8= wages as their sob compensation will do the work and - - - _ " - , - - • e c- the structure is not intended or offered for sale(Sedan LOCALITY 7044, Business and Professions Code) - - - - MOVING - -TEL ' - - - - - - 0 a 1 4-8 5 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-- \ t I - CONSTRUCTION LENDING AGENCY REQUIRSET BAYARD HWY TOTALPROP LINE 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 - �2 0 3 0 A (Sec 3097 Civ C ) SIDE - PL Lender s Name " - - � - \ Q - '1 . 34. a00 - _ - - _ - - - P C Fees ! Permit Fee ✓� D LDMA Ref w . . 3 4 8 0 -- - Lender's Address , I certify that I have read this application and state that the _ _ _ Issuance Fea V LDMA P/C M , _ above information a correct I agree to comply with all County Invesng000n Fee 0 _34a 1 4-85 , ordinances and State laws relating to build ng construction, Taal Fee - LDMA perm If -� and hereby authorize representatives of this County to enter upon the obove-mentioned proorty for inspection purposes -- t fEE REVEIME FOR EXPIANATOILY LANGUAGE 1 - SipnoNro of Ajsplimnt or Agent gab-