HomeMy Public PortalAbout4343 TEMPLE CITY BLVD_Building__ APPLICATION FOR BUILDING PERMIT Il
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF LOS ANGELES -
AppRF55 DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
NO OF BLDGS BUILDING
SIZE OF LOT INOW ON LOT ADDRESS i
TRACT LOT NO LOCALITY
TEL NEAREST
OWNER NO CROSSST
ASSESSOR
ADDRESSC MAP BOOK PAGE PARCEL
TYPEED
ATV • ZIP C4QNDISTRICT ST ZON LLj
ARO ITECT OR TEL oi
ENGINEER NO STATISTICAL amSIFICATiogy S ER P
ADDRESS CLASS NO —o DWELL UNITS BK,
TEL CONTRACTOR NO'¢�" 9 USE ZONE'
Z�ONE' NOP
ADDRESS IS^ NO Z5 7 Al/V SPECIAL
LIC CONDITIONS
CITYCON CLASS ROAD DEPARTMENT APPROVAL REQUIRED VES ❑ NO ❑
NAME AND UCTION
LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRONT ROP LINEOF ISTREETI
ADDRESS CITY TOTAL SETBACKFROM TYPE OF EXISTING
50 FT NO OF NO OF CHECK HIGH AY + YARD FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES - FAMILIES ONE _ y
a
DESCRIPTION OF WORK NEW ❑ + O
ADD BLDGBACK FROM 4�
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ALTE TOTAL SETBACK FROM TYPEOF EXISTING
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EXISTING BLDG DEMOL [01 +
APPRINTIM TEL g— CORNER CUTOFF YES C] NO ❑
r IN OPEN SPACE YES ❑ NO ❑
BY ISIGNATU
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION
IHEREBY ACKN 7W EDGE THAT I HAVE READ TH15 APPUCAT*N AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AMID LAWS REGULATING BUILDING CONSTRUCTKIN 1 CERTIFY THAT IN DOING THE
WOW AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF L
"HE�TIONIC�NZE STATEOFUUFORNI IN REUTING iO WORKMENSCOM
SIGNATURE OF
PERMITTEE F�
ADDRESS
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CITY �/TGLIi¢ ;oY =3J9 ANAL BY
MAKE CHECKS PAYABLE TOPCE FEE $� /-1 FET W
HARVEY BRANDY COUNTY ENGINEER Z (,
PLAN CHECK VALIDATION cR M o CAeH PERMIT VALIDATION o c"m
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APPLICATIONFOR BUIL15ING PE �IT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING NEAREST r
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FOR APPLICANT TO FILL IN Dlbsr [ No GRou TYP CONST PR ye-pr
(PRINT OR TYPE ONLY) / r ?`�
BUILDING STATISTICAL CLASSIFICATION SEWER AP
ADDRESS C
CLASS NO DWELL UNITS BK P
LOT NO - BLOCK USE ZONE MAP D/ -
NO
TRACT /7 IG� l SPECIAL
NO OF SLOGS o� CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG /� �y�O BLDG SETBACK FROM
OWNER
C r NOL` — T/� TYPE OF ONT REOXPST INOE SETBACK HIGHWAY - + YARD =OF 15TTTOTAL^L)
ADDRESS HIGHWAY WIDTH FROM C L
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CITY 0
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ARCHITECT OR TEL BLDG SETBACK FROM (STREET)
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CONTRACTOR J NO
ADDRESS NO CORNEA CUTOFF YES ❑ NO ❑ `.
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CONSTRUCTION LENDER \ CF
NAME AND BRANCH
ADDRESS ) J� �v i Y I 1 Y•�� L•J�'
SO FT NO OF NO OF 2
SIZE STORIES FAMILIES NEW „] t ') �• 4 }I ,�
USE OF ADD ❑
STRUCTURE ❑
ALTER
REPAIR ❑
SIGNATURE DEMOL ❑
APPLICANT �/f�s�-�
VALUATION �/C/�- APPROVALS DATE INAPECTOR a aIRNATURE
P C PMT FOUNDATION LOCATION
FEES i -2, FEES FORMS, ATERIALS
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS,
BRA G
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY N,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRW- G FURNACE LOCATION,
TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I
AS VENT, QYCT�
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT
OF THE STATE OF�BALIFORNIA IN REL"G TO WORKMEN'S COM-
PENSATION INSUpAN
SIGNATURE � LATH, EXT
PERMITTE l.r NAUSE ND POSTEOR CORRECT '
ADDRESS FINAL-
JOHN
INALJOHN F LEWIS PRINCIPAL ST,RUCTURAL ENGINEER
PLAN CHECK VALIDATION cx o cAaH _ PERMIT VALIDATION cx MO CAeH
(`n'1'7 1 7� SEP 523 D 720A
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APPLICATION FOR BUILDING PERMIT w
COUNTY OF LOS ANGELES ADORE SS BUILDING _ °—`
P
DEPARTMENT OF COUNTY ENGINEER 3 � -
BUILDING AND SAFETY DIVISION LocaLlry T
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W NEAREST
JEN KINS SUPT OF BUILDING O
CROSS ST Z
FOR APPLICANT TO FILL IN DISTRICT NO GR u TYPL CONST PROCESSED BY w
_` (PRINT OR TYPE ONLY) J / Z
ADDRESS 4343 TenPLe C�'+V,SL,Jp TEe1 PlE C, STATISTICAL CL.AZS.S�IFICATION SEWER MAP 1
CLASS NO -. -./-DWELL UNITS BK PG 33 oQt
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TRACT / SPECIAL
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NO OF BLOGS Q
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CITY TEMPLE CITY (.R. ,a -
JARCHITECT OR E` TEL p•� BLDG SETBACK FROM
ENGINEER PPLIGRIT IOh [NLi CODMO 583-2204 SLOG
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APPLICANT LkaA r'1 -
VALUATION 54o Q - I APPROVALS DATE INSPcc TOR S SIGNATURE
F E $ FEE S '33 �2PIATFO FNOATION ATORIAALS
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY BRACING, BOLTS
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- FURNACE LOCATION,
TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I —GAS VENT. DUCTS
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT
OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM-
PENSATION INSURANCE
SIGNATURE OFLATH EXT
PERMITTEEAPPLIGATIOI! L-LIC. CORP HOUSE NUMBER CORRECT
ADDRESS 5245 n"Po&_P.+ St (�
. L Q O02Z AND POSTED / / _ A
FINAL
JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VcRALIDATION M o ;10-
AS. _ PERMIT VALIDATION cR M G CAE.
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APPLICATION FOR BUILDING PERMIT
1 COUNTY OF LOS ANGELES BUILDING AND SAFETY
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FOR APPLICANT TO FI]DG
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BUILDING Q
ADDRESS 43 4 F_r/,aL.E et A LOCALITY
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AND LAWS REGULATING BOLDING CONSTROCTKIN 1 CERTIFY THAT IN DOING THE a .'.
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PENSATION INSURANCE T
SIGNATURE OF / I 3 5 0 9 0 A
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ADDRESS ,c6 .✓T `'� '` ZZO _ # 6 0 0
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APPLICATI� VLDING PERMIT. _
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BUILDING
A FOR APPLICANT TO FILL IN _ ADDRESS
ADIDRESS 4a a•3 TI/y/ IC G
OCALITY
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
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AND LAWS REGULATING BULGING CONSTRUCTION I CERTIFY THAT IN DOING THE v •CLQ
WORK AUTHORIZED HEREBY I lL NOi EMPLOY ANY PE IN VIOLATION OF
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PENSATION INSURANCE (�C �( '
FERMI SIGNATUR
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APPLICATION FOR, BUILDING PERMIT
FOR APPLICANT TO FILL IN (Pn DI Gr Tyci .DIY)
[ElLDING 3 L� /3c V0 COUNTY OF LOS ANGELES
REss DEPARTMENT OF COUNTY ENGINEER
L!- C X zIP / �D BUILDING AND SAFETY DIVISION
NO OF BLOCS BUILDING
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THAT THE ABOVE IS CORRECT AND AOREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
LL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED DATE)
HEREBY I WILL HOT EMPLOY ANY PERSON IN VIOLATION OF TRE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATI INSURANCE
SIGNATURE OF
PERMITTEE
ADDRESS / LF I Di '
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J'-��p `_ �y FINAL Y _
CITY / G/ f L � C•/T�l/>NOL✓ -/6 GD DATE �/
IAKF CHOCKS PAYABLE 70 P CQ - PMT b
HARVEY T BRANDY COUNTY ENGINEER $
FEE FEE
30•
PLAN CHECK VALIDATION <N M D <AB« P <K
VALIDATION D <.BH
5 6 4�JAN a4 2-3 0 3 0.6 0 '� A�
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APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (P IDr o.type =Iy) '
noo elss 3 COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
NO OF BLDGS BUILDING NA
SIZE OF LOT NOW ON LOT ADDRESS
TRACT ( . LOCK LOT NO LOCALITY Q(JY� 'Y
TEL NEAREST
OWNER O CROSS ST
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
/ DISTRICT GROUP TYPE FIRE
OR PROCESSED BY
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jARCH TEC TEL SE OS
ENGINEER NO
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ofOV/ � CLASS �',bI CONDITIONS
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SIZE 570RIE5 FAMILIES ONE
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DESCRIPTION OF WORK NEW ❑ U
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IN COASTAL PERMIT ZONE YES NO E]
VALUATIONS Q
I NER[BY ACXN [COG[ THAT 1 HAVE READ TXIa APPLICATION
AND !TATE THAT TXf ABOY! ID CORRECT AMO AGRCL TO COMRLY
WITH ALL ORDINANCE[ AND LAW! REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORISED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF aTATL OF CALIFORNIA IN ELATING TO
WORNMCM'! COMP Ma TIOM IX AN
SIGNATURE OF
PERMITTEE
ADDRESS •
FINAL BY
TEL DATE
CITY �Y♦'iY1- �, NO EY t
�t1i1AE CHL CAS PAI ABLE 70 FEE /, FEE $
HARVT BRANOT• COUNTY ENGINEER / C. V _ �J
'PLAN CHECK VALIDATION CN Mo CASH PERMIT VALIDATION cN Mo CAaN
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' 1 0 7[:DEC 1.2 1 0 24.0 () Atlb
70ASMA C¢w[GL[pA 1 —
TG AB03 YB9 APPLICATION FOR BU ILD& PERWIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADORE SS J
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUPT OF BUILDING NEAREST
CROSS ST
FOR APPLICANT TO FILL IN Z
DISTRICT yo0 GR P_ YPE C ST PR S
(PRINT OR TYPE ONLY( /
BUILDING TATISTICAL CLASSIFICATION SEWER MAP
ADDRESS1753 C
CLASS NO DWELL UNITS BK PG
LOT NO BLOCK USE ZONE I MA O
NO
TRACT SPECIAL
NO OF SLOGS CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BLDG SETBACK FROM
TEL ! O FRONT PROP LINE OF (STREET)
OWNER NO G
TYPE OZWIDT
SETBACK HIGHWAY + YARD - TOTAL
ADDRESS XIGXW FROM C L
CITYIt
ARCHITECTOR TE 5DE POP LINEROM - (STREET)
ENGINEER
TYPE OF EXISTING SETBACK AY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
EL
CONTRACTOR NO }
LIC CORNER CUTOFFYES_❑- NO ❑ h("`
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NAME AND BRANCH
ADDRESS
SO FT NO OF ,NO 'OF " ❑ ?
SIZE STORIES FAMILIES NEW
USE OFAOT ❑
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REPAIR
SIGNATURE EMOL C]
APPLICANT l
VALUATION APPROVALS DATE INSPECTOR'S SIRNATUKE
P C PMT FOFNDA 6OMALOCATION
FEES FEE E ORM
LS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS,
BRA I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION,
NC, BOLTS
WITH ALL ORDINANCES AND LAWS HE WORK
A BURRED HEREBY
VENT,
TION I CERTIFY THAT IN DOINGRSON TXE WORK AUT F TH EL HEREBY I GAS
WILL NOT EMPLOY CALIFORNIAANYPERSON IN VIOLATION OF THE LABOR CODE LAT H, INT
OF THE STATE OF CALIN RELATING TO WORKMEN'S COM-
PENSATION INSU
T
PERMLATS, EXT
PERMITTT E
EE HOUSE NUMBER CORRECT
�Y AND POSTED
/
ADDRESS —��� FINAL / (�
Cny(ol+-ta- JOHN F LEWIS, PRINCIPAL STRUCTURAL
PLAN CHECK VALIDATION CK M O CAS. _ PERMIT VALIDATION CK M 0 cAe
fq(
2988"o DEC 5 1 D 1725
APPLICATION FOR BUILDING PERMIT�C' ,� �Je �Jj
FOR APPLICANT TO FILL IN (P,I,,t p, typo .,,w N
BUILDING COUNTY OF LOS ANGELES
ADDRFss aNOLOCAL11I DEPARTMENT OF COUNTY ENGINEER
CITv ZIPBUILDING AND SAFETY DIVISION
O OF SLOGSDING
SIZE OF LOT OW ON LORESS
TRACT OCK I LOTEST
OWNER NS ST17SSOR
ADDRESS MAP BOOK AGE P CEL
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NAME AND BRANCH BLDG SETBACK FROM ,
ADDRESS CITY FRONT ROP LINEOF (STREET) S
TOTAL SETBACK FROM TYPEOFEXISTING C
50 FT NO OF NO OF �� CHECK H]GHWA } YARD - FRONT PROP LINE HIGHWAv WIDTH
SIZE - STORIE9�! FAMILIES ONE I
DESCRIPTION OF WORK NEW ❑ }
❑ BLDG SETS FROM =
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I nTATEEMERY THAT
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AND STAT[ TXAT THE ABOVE 15 WS RET AND AGREE TO COMPLY IMPACT E%EM PTION DECLARATION SIOxEO (DATE)
WITn ALL ORDINANCES AND LAWS IN REGULATING W R AUTHORIZED
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HE
WORK GOOF TN STATE p1 CA�110 IM RELATING TO
W ORNM[N ! OTION INlURA E
SIGNATURE F
PERMITTEE
ADDRESS
TEL FINAL BY
CITY NO DATE L
MAKE FEE FEE CHECKS PAYABLE TO P C PMT $
HARVEY T BRANDY COUNTY ENGINEER
PLAN CHECK VALIDATION CK MO ✓H PERMIT VALIDATION ND CAO.
5891, - 923 D
7BA638A CER603 7/73 5 9 01 9 g D 1 2.0 p A`JG
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76Ah387A CE 98033.69 APPLICATION FOR BUILDING PERMIT �I
COUNTY OF LOS ANGELES BUILDING LE G !t
DEPARTMENT OF COUNTY ENGINEER ADDRESS 4 3
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING NEARES5T B b �' 4E:
ly
FOR APPLICANT TO FILL IN Dlsralc_r Ho GROUP TYPE CONST PROCESSED BY 1
(PRINT OR TYPE ONLY) 5 Boa f-� SPR/mak l3t�L`
BUI LOIN.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS G T
CLASS NO DWELL UNITS _— BN PG
LOT NO BLOCK USE
ZONE I MAP
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TRACT SPEOIAI
NO OF BLDGS n CONDITIONS
SIZE OF LOT K/4E NOW ON LOT
USE OF
EXISTING BLDG c BLDG SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
OWNER 0
TYPEOFIEXISTIO SETBACK HIGHWAY + YARD = TOTAL
ADDRESS
HIGHWAY WIDTH FROM C L
C r
�•
CITY p `/�
ARCHITECT OR LOG SETBACK FROM
ENGINEER NO SIDE PROP LINE OFTEL B (STREET)
TYPE OF E%LSTNG SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C l
TEL
CONTRACTOR O - + y
ADDRESS �j NO 7Z / CORNER CUTOFF YES El ❑ Ld
LIL Cd
CITY /, A. CLASS L/[p SEE REVERSE SIDE FOR SPECIAL APPROVALS 0
CONSTRUCTION LENDER G
NAME AND BRANCH w
a
N
ADDRESS Z
SINO OF
SNO OF
TTORIES FAMILIES NEW ❑
USE OF ADO 9
STRUCTURE c ALTER E]�� C.� REPAIR ❑
SIGNATURE 0 DEMOL ❑
APPLICANT
VALUATION y, APPROVALS DATE INSPECTOR S SIRNATU.E
FEE E /�9, z FEE S / P� 7 S FOUNDATION LOCATION
FRAME FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION,
WITH ALL ORDINANCES AMO LAWS REGULATING BUILDING CONSTRUC- ADUCTS
TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT
OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURA
LATH, EXT
SIGNATURE 0
PERMITTEE NOOSE NUMBER CORRECT
� AND POSTED
AO DRES54V FINAL G 0
G UNCT RAL
o ENGINEER
P AN FiE6Sg�AId JOHN F LEWIS. PRINCI AL STR
7:25PERMIT VALIDATION
pr_ 3 1 1 0% DEC19 1D 4 8.75~ v
APPLICAT6ON FOR BUILDING PERMIT
• COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FY.L IN IIIALDI A OIC
I hereby affirm that I him certificate of consent to eeO Insure BUI I /��. ✓el•
or a certificate of Milkers'Compensation In prance,or a os.it d C/• �� d
=:No C-►' n&b 5z- LOCALITY'
Pant SIZE OF LOT NO OF NOW ON LOT
❑ Certified copy fe hereby furnished CR0888T
❑ CerHfbd copy is filed MM the county budding InspectionEST
CT Inspection TRABLOCK LOT NO VSE ZONE MAP NO
department
Date+�+ZIIG Applicant f�-"y& ABBE990R MAP 11001( PAGE RWCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORICERS'H We-11aVAI N vq IST
TEL YES No
COMPENSATION P48URANCE wrnaN taco FT of 8C1100LT
ADDRESS J
I (Thu section need not be carhpleted tiro permit is7�H 10r one hundred Q DRICT GROUP TYPE COP6T FIRE ZONE
doll"(:IDO)orless) 5 V y3 1� 1
0� tf Oo
I certify that n the performance,of the work for whichMb perpermit / Ci zip
9�
! Is bend, I shall not employ ay person In any manner eo as to ARC/ttTECT oR T�No
become subject to the Mbrkm Compensation Late STATISTICAL CLASSIFICATION APT CONDO
i Data Applicant AOOf163 CLASS NO DWELL LWTS I
} NOTICE TO APPLICANT O attar making this Certificate of — REOUmFO TOTAL SETBACK FROM EAST
JI Exemption you should become subject to the Workers' '(}� TEL NO �// SETBACK YARD MYN PROP LINE WIDT
Compensation pruvislons of the Labor Code, you must forthwithr 3XIC FRONT
I' compty with such provblons or Ods Permit shall be deemed revoked /0 6 Q u LIC 1l. PL
f
LICENSED CONTRACTORS DECLARATION �' �o_J uc�LAes/ S SIDEf0.
BVI OIQ. CL P L �^ •'.'
I hereby affirm Wet I am licensed under provmbro of Chapter 9 r SEWER MAP
(commenebq Division Section 7090)of Delon S of the Business and SD FT SIZE No OF signets ND of FAMI IES NEW ex PG 110,
AGC T.i
Refe0>bfS Cods, my license Is m�Nl`tolce slid DESCRIPTION OF WORK ADD ❑ vALWrKMI //II �y� 3307 67.290
License NuConlnctor�Dete '� l ALTER ❑ $ Vf W 1 ITEM.` _
❑ 1 am exempt under Sec REPAIR ❑ $ TOTAL fi7 $9
B&PC for thisrenson DEMOL ❑ LDMAP/Ce CHECK 67.K
Date 119E OF EIISTING URM ❑ CHANGE .00
Stere AXr(,
1 ❑ L aown
owner of the property or my employees with wages es &w)tsC I
CDMA F e 0 0000-0001 5/ 1/90
Meir sole compensation,will do the work and the structure Is F
hat Intended or offered for sale (Section 7044 Business and !� N FBIAL DATI G 0419 1 AM 3:22
Profesllor"Code) WILL TIEAPPl1CAl1ip1 r1mxE elaneaowx+lNTIwraAANArIA0008 WTEAIAL 77a
❑ 1 as owner of the property, am exclusively contracting with °R AA�Mo Ar°raw TIE IIAL x9 T�qN ovum nNll j
licensed conbeerore to construct the Protect (Section 7044, , ❑ I 1
Business and Profeaslons Code)
WILL 11E ertvom U!OI TI!auanNo aY TIE AlRICJVIr 011 R7TUE illaena
_ CONSTRUCTION LENDING AGENCY �A�rt•co I p ACGT.i
i Fonar.n auALm•.•�•^••--aelRlcr Iacloloi acs I9WTfW a�Ielar S iT �?
1 hereby atltrd
In. that Os Is a construction lending agency for � B❑ f / 3-307 93.63
the performance of the work for which this permit Is baued(Sec 1 ITEMS
I IWE INKI nE IIAL11Od11 PNTBLLVD VI NTgN 011074 AIO TIE 9610YU
g .9D97 CNC) F6YRloAi OEgO4x I W M emenrta lPe]Fl1 M LLIB/i1OFLEe
d
Lender's Name F w °i 'o'•ioAPEnYTf�RhOnYTII '� TOTAL 93 . 453
ail$ LedersAddress CHECKT 9's.b? r
' I form that I have read Mb sip agree
to c and stele tihet the above PC FEE PERMIT FEE J /� C HANE � .00
ordrmatbn n correct I egfBB to coming with all county d `J J
artllnances arhd State laws relating re building construction,and P
hereby autho this County to enter upon ISSUANCE FEE
the °^°d W00-0001 5/ V9,0
��7 S o INVESTIGATION FEE TOTAL FEE
-J 17428 1 AM 9:33
SEE REVERSE FOR EXPLANATORY LANGUAGE r/
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILD
BUIL ADDRESS
I hereby affirm that I have a certificate of consent to sell Insure ESS
or a certificate of Wkukers Compensation Insurance or a certified G IP VA
copy thereof (S 3800+�La�b`-C�)
Policy No���i �//J— Cgrnparry s="� 6ew C T LOCALfiv `
SIZE LOT NO OF BLDGS NOW ON LOT
❑ Certified ropy is hereby furnished rv~ NEAREST CROSS ST
❑ Cerf f ed copy is flied with the cou ty building inspect" TRACT BLOCK LOT NO
_ departmennttl __ USE ZONE M_AP NO
Dat,rlt4PT/ Applicant G+—� ASSESSOR MAP BOOT( R1CiE PARCEL
— r77T SPECIAL CONDIPONS
CERTIFICATE OF EXEMPTION FROM WORKERS awN R T L
COMPENSATION INSURANCE CuJdJJ WITHIN 1000 Ff OF SCHOOLR YES 4w�
(The SeClon need not be completed if the permit Is for one hundred ADDRESS
�� AM DISTRICT GROUP TYPE CONST FIRE ZONE P,HOOI
dollars ($100) or less) ZlPQ _I issue that h the performance of the work for which this permit � X737 � o �Is Wsued shall not employ any person at arty manner s0 a5 t0 ARCHITECT OR ENGINEER TEL NO
become eu6lect t0 the Workers Compensation Laws STATISTICAL CLASSIFICATION APT Data Applicant ADDRESS CLASS NO � DWELL UNITSNOTICE TO APPLICANT It 'after making this Certificate 'of REQUIRED .TOTAL SETBACK FROMExemption you should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HwV PROP Ut€
Compensation pranslom of the Labor Coda you must forthwith 7
FRONT
coney With such prwlslons a this permit shell be deemed revoked ADDRESS / PL -
LICENSED CONTRACTORS DECLARATION 3vS 53 25 0 SIDE
CITY -tC SS P L
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(Canmencing with Section 7000)of Drvlsxxl 3 of the Business and SO FT SIZE NO OF STORIES I NO OF FAMIUES
Professions Code a %ICS�G4e Is In full force. NEW elfect NEW ❑ BK PG d
License Number • +0 Lc Class 1.�� f�ESCRwT10N OF Nt7RK ADD ❑ `/ALUATION , Q
Contractors.! Date ��+/C'�7 f3 N ALTER ❑ $ U
cc
1 CO{/fV lel✓/ J M
❑ I am exempt under Sec REPAIR ❑ $ 0
B&PC for this reason DEMOL Rw
LOMA Pic+ _ W
Date USE OF EXISTING BLDG URM ❑ ' EL
Signature .—+fir APPLICANT(PRINT) TEL NO LDMA Perm• 1 _ r Z
❑ 1 as am d the property Or my empbyees with wages as Z �CT.i
their sole cwnpere trop will do the Work and the structure Is ADDRESS O
not Intended or offered for Sale (Section 7044 Business and FINAL DATE G ..10.1 175.70
Professors Code) . NULL THE MFlIClNn OR FIInME&AILtlNG O Nrr!WALE A H DOUS WTEPVI �'2
❑ 1 as owner of the property ern exclusively contracting with � Ty�cs�o a+PAHA DOUOUG M DERILL EQUAL
�ORnAro� TER THAN T� 1 ITEMS
licensed Contractors to construct the project (Section 7044 FINAL BY > `
Business and Professions Code) YES❑ NO❑ TOTAL , 17-5. 70
WRL THE MENDED USE OF THE euOWA BY THE APfUCANT OR FUiU9E EUI g ryry�(I��/�(I �
OCULI MNT REQUIRE A PERM7 FOR CpISTRUCTION OR MOOFICATION FROM TIE SgITT1 �.Pl[.Lrf• 1�Jr J.70
CONSTRUCTION LENDING AGENCY C NR OUAUTY N NAGEMENT DSnLCT ISCAQMDI SEE RERMITRNo CHECKUST FOR
GUIDEUNES CH .110
I hereby affirm that there Is a construciXUl lending agency for res❑ No❑
a the performance of the work for which this permit a Issued(Sec
m 3007 Cry C) �C�clUTls I UNDD(R rsnv gEouwE MENns UNDER of OS AT�iOSUtS c� TY CODE ry'�r����f'r��
Trnz'2 R] O IONS 220100 THROUGH 220 140 C ERNNO WVV 0001 6'13/9
Lenders Name W RE OSTA}LNG A PERMn FROM THE SCADNp
Lenders Address 10,33'55 1 IM 2:20
Q I certify that 1 have read this application and state under penalty
of perjury that the above Information Is correct I agree to comply PC FEE PERMIT FEE �• y�
n With all county oldmances and State laws relating to builchng J w
constrlcten and Wfeby authorize representatives of this County ISSUANCE FEE -
`O .�enih r menigrled property for inspection . 4,
n6 NVESTIGATION FEE TOTAL FEE
cw�
SEE REVERSE FOR EXPLANATORY LANGUAGE `
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDA ss
I hereby affirm that I have a certificate of consent to self InsureESS e
m m
a certificate of Workers Compensation NG n Insurance or a certlfed 1-V '
copy thereof(Sac 3800 Leo C) GTY ZIP
Policy No 113 4g2-c mp v ST4-rAr FullJ/ C-17TC V LOCALITY
��`,,,...((( SIZE OF LOT NO OF SLOGS NOW ON LOT
7(1 Certdmd copy is hereby furnished NEAREST CROSS ST
❑ Certdled copy is filed with the county bulldog Inspection TRACT BLOCK LOT NO
department _ I USE ZONE_ MAP NO
Date�fQ Applrcant _ ASSESSOR MAP 8001( PAGE PARCEL
�l�l, sPEclu coNDmor+s
CERTIFICATE OF EXEMPTION FROM WORKERS OVER VES ND
COMPENSATION INSURANCE R S WITHIN 1000 FT OF SCHOOL?
(This section need not be completed if the permit Is for one hundretl / ESS n D
dollars 11 DO)or loss) IC DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
I certify that In the performance of the work for which this permit rv , E-1 /IONzlP / '733 I!;
a Issued I shall not employ any person In any manner so as to IC
become subject to the Workers Compensation Laws ARCHITECT OR ENGINEER TEL NO
sunsncAL cL TION APT coNoo
Data Applicant i ,
ADDRESS CLASS rq DWELL triers
NOTICE TO APPLICANT If after making this Certificate Of REWIRED TOTAL SETBACK FROM EXIST
Exemption you should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH
Cornpensaton provisions of the Labor Code you must forthwith T u r. 673-ffN ly FRONT
comply with such pTonsions or this permit shall be deemed revoked ADORE LIC !�f P L
LICENSED CONTRACTORS DECLARATION IRoIM uAlTgt D -r Jv SIDE
U PI
I hereby affirm that i am licensed underprevtslorls of Chapter 0 v Be7,-1- SEWER MAP
(commencing with Section 7000)of Dwisgn 3 of the Busmless and SO FT SIZE NO F STORIES NO OF FAMIUES
Professiorts Code a Ince rs in full force effect Opo ON/'IR NEW ❑ BK PG , d
LIc Class
LJCen9e Number SCR&TION OF NVRK ADD ❑ VAL/y Q
i
Contractor CpMS�✓ T;dWy Date _JAI(V A4j ✓l d C _ ALTER ❑ $" S�� U
J I amV$CBS ♦er Sac t'rtlXf 7 G'o� REPAIR ❑ $
O am exempt under Sec
88PC fa this reason /Jy'p/S 5-MOO, DEMOL ❑
DMA PICA W
Date USE OF EXISTING BLDG URM ❑ 1
Signature v .
CCTZ
APPLICANT(PRINT) - TEL NO LOMA Perm r T
❑ I as owner d the properly or my employees with wages es = AT.lr 1
their sole comperoatan will do the work and the structure Is ADDRESS F 3307 Mq.o.
not Intended or offered for sale (Section 7044 Business and _ FINAL DATE
_Q -
Professions Corte) _ _ 1 ITEMS
wtLL LIE MPLM.WT OR NmIPE BIALpNG OCCUiMNi WWp.E A 11AZMDOU9 MATEPoAL
❑ I ae Owner Of the Properly am axc OR A xQl(TURE CCNrNN Np A HAZA DDJS MATERIA.EIXY1 TO OR GREATER T THE TO
/�� ('y /'gyp
licensed COnhaCtOB 10 COTLatNct Ifle PmlaQt contracting
044 INm ePECffED ON T1E NAZMNlA4 xUlERM19 YFCRNATICN nUmE+ FINAL BY - TOTAL V d�
Business and ProfessKure Code) r s❑ No❑
y WILL THE NTENDEO USE OF THE BUDLING aY THE APiLANT COR FUTURE BUILDING CHECK 309.08
OCCUMNT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY Corsi AA o Y MANAGEMENT Di(SCAOMD)SEE PERMITTHO CHECKLIST FOR - ASI V'YINL (
GUDELNES
I hereby affirm that there Ea-a construction lending agency for YES ,,o Cl
a
the performance of the wok for which this permit Is owed(Sec C p
m II READ THE H4ZAFTCl1a MATEPIALBINFCgMAl10NOL10E AND THE eCALMO PERVITTMi ANOEILES COUNTY CODE OHO-0005 L'I10/],.
3087 Cr, C)
c, UE UST UN AS BD IT�Aa 2 20E M THRDUGH p 1I 0 CON RNNO HAZIADOUS ,
Lender S Nance MATE Fon OR OBTAINNG A PERMIT FROM THE SCAOMD 9 1 1 AM 8,11{{
Lenders Address _ /� 7CRi 1'11I Ll
0
I f fftdyperjury
that have read thio information
is and state under penally
g Of IxaRury that the above Information Ia correct I agree to comply PC FEE PERMIT FEE
R with all county aid I Aces and State laws relating to bulldrg
CAnstructm a by asulhDriZe representatmes of this County ISSUANCE FEE �F /
✓ < 10 enter mentioned property for Inspection purposes
m INVESTIGATTON FEE TOTAL FEE D D a
a d
SEE REVERSE FOR EXPLANATORY LANGUAGE
rA + WORKERS COMPENSATION DECLARATION
hereby affirm that 1 have a certificate of cement to ,elf APPLICATION FOR BUILDING PERMIT
insure 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 No Company rd
BUILDING
Certified copy is hereby furnished FOR APPLICANT TO FILL I ADDRESS
Certified copy is filed with the county bw Idi g impec BUILDING
hen department ADDRESS
Date,� ( gpplicant CITY ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS NO OF DGS NEAREST
COMPENSATION INSURANCE SIZE OF LOT MOW ON IOf CROSS ST Qi
(This section need nor be completed if the permit a for one ASSESSORhundred dollars ($100)or leu ) — TRACT BLOCK LOT NO MAP BOOK I PAGE - PAROL
115E ZONEMAP
I certify that in the performance of the work for which this OWNER NO
permit is Issued, [shall not employ any person in any manner ADDRESS —� SPECIAL
PECI TIONS
so m to become subject to the Workeri Compensation Laws
r
Date Applicant CITY i ZIP O
NOTICE TO APPLICANT If offer making chis Certificate of AR(Dil R OR TEL DISTRICT GROUPTYPE FIRE PROCESSED BY O
Exemption you should become subject to the Worker' NGINEER NO n O
CONST ZONE
Compensation provisions of the Labor Code, you must forth- ADDRESS N O d
with comply with such provisions or this permit shall be
deemed revoked CONTRACTOR ICaL CT FKaT1aJ APT CONDO Z
LICENSED CONTRACTORS DECLARATION LIC NO OVJEIL UNITS—
dl
I hereby affirm that I am licemed under provnsiom of Chapter 9 ADDRESSge
NO
(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 Ll4ae CLASS A SK P11f VALIDATION
SO FT NO O F NO OF CHICK
Llcense Num r Llc Class _ — SIZE STORIES FAMILIES ONE
VALUATION
Contractor Dote DESCRIPTION OF WORK NEWADD
❑ 1 am exempt under Sec ALTER
B 6P C for fhb reason REPAIR
DorUSE Of} LDG DE''AO • • • S925v
Signature /� .SL i�I APRICANT TEL7HNAL 1206-88
BUILDER DEC ION NNO DA
1 hereby affirm that I am exempt from the Contractors License
Low for the following reason (Section 7031 S, Business and &aidFINAL
Professions Cade) By
OBUILDING It r
I, as owner of the property, or my employsm with ADDRESS
wages as their sole compensotlon,will do the work and ,
the structure Is not Intended or offered for sole(Section 40CALFTY
7044, Business and Professions Code) MOVING TEL
I, as owner of the property, am exclusively connecting CONTRACrOR NO
with licensed contractors to construct the project (Sec- ADDRESS '
tion 7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCYTOAL SETBACK FROM
- CK YARD FLW1' T PROP LINE IDTN
I hereby offum that there n a construction lending agency for FRONT
the performance of the work for which this permit Is issued P L
(Sec 3097 Civ C ) SIDE
PL
Lender s Name
$ LDMA Ref 0
Lender s Address P C Fee f Permit Fee , -
1 certify that I have read this application and state that the {pwnce LON F/C#
above mfonnohon is correct I agree to comply with all County Investigation Fee
8 ordinances and State laws relating to budding construction, Taal LDMA Perm •
R and hereby authorize representatives of this County to enter
upon the above-m ti ed fo Ion ur
� f0 RfV@fE FOR EXPIANATWY LANDUAGA
Signature of Applicant or Agent Date
t F
WORKERS COMPENSATION DECLARATION
hereby affirm that I have certificate of consent to ,ell APPLICATION FOR BUILDING PERMIT
insure a a certificate of Workers Compensation Insurance '
or a certified copy thereof (Sec 38DO Lab C )
COUNTY OF LOS ANGELES BUILDING AND SAF TY
Policy No Company
11 Certified copy is hereby furnished FOR APPLICANT TO FILL INeuuDlNc 3 3
ADDRESS
Certified copy is filed with the county building nspec BUILDING
tion department ADDRESS 3 L
r O
Date Applicant CITY l ZIP o 0 LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDGS - NEAREST c
COMPENSATION INSURANCE SIZE OF LOT3(V 10 NOW ON LOT ST 7��
(This section need not be completed If the permit is for one - - __-- — -- - ASSESSOR _
hundred dollars ($100)or less ) _ TRACT BLOCK LOT NO MAP BOOK ' P E PARCEL
TEL q
91
1 certify that in the performance of the work for which this ONE
OWNER LL L SNO 1II USE ZIT NO
SPECIpermit is issued I shall not employ any person in any manner ADDRESS ` CONDIT16NS p
so as to become subject to the Workers Compensation Laws c U
Date Applicant CITY V ZIP ^F �r
N0710E TO APPLICANT If ohm making this Certificate of ARCTfI7ER I (� -al I DISTRICT GROUP TYPE FIRE BY O
Exemption you should become subject to the Worken' CONS ZONE
I 5G
Compensation provisions of the Labor Code you must forth- ADDgE55 � � 3 W _
with comply with such provisions or this permit shall be -
deemed revoked CONTRACTOR G TEL 4LA STATISTICAL FICATIiDN An ONDO Z
LICENSED CONTRACTORS DECLARATION _ LK CLASS NO DWELL UNITS___
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �� Sc'/ NC O— 5 SEWER
(commencing with Section 7000)of Division 3 of the Business and _ c LIC R _ _ ��r,./}�yMAP /y,�,��,5 A
Professions Code, and my license is in full force and effect CITY CLASS v BK PG V^""^'•"^
SO IT NO OF NO OFCHECK # . . . . 2 3
License Number tic Close SIZE STORIES FAAMLIES ONE
A VALUATION '
Contractor Date DESCRIPTION OF WORK) O NEW $ � rjco . OD I • • 4 9 01
ADD
I am exempt under Sec ALTER - •,. . 4 9.4 1 3
B BP C for this reason
Date REPAIR $ 9 O gI_g g
EXISTIUSE NG
-
%ING BLDG DE�'VOL
/'
Signature N7 Qj SI NO
RC� FINAL
APPLICTELANT
OWNER-BUILDER DECLARATION DATE
I hereby affirm that I am exempt from the Contractor s License ` -
Low for the following reason (Section 7031 S Business and ADDRESS O 1Q e5 1 �' FINAL
Professions Code) By -
❑ BDILD
I, m owner of the property or my employees with ADDRESS
i t
wages as their sole compensation will do the work and lkxi
,
the structure is not intended or offered for sale(Section LOCALITY
70", Busmess 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 - -
lion 7041 Business and Professions Code)
CONSTRUCTION LENDING AGENCY REWIRSET BACK YARD MWY pgpp LINE WIDTH
I hereby affirm that thxe iso construction lending agency for FROM
the performance of the work for which this permit Is Issued P L
' (Sec 3097 CGv C ) SIDE
PL
Lenders Nome
LDMA Ref
Lender s Address P C Fee S i Permit FN '
I certify that 1 have rood this application and state that the Issuance For LDMA P/C Y
above informottor,is correct I agree to comply with all County Inveaigation Fee
ordinances and State laws relating to building construction Total Fee LDMA Perm F
& and hereby authorize representatives of this County M enter
upon the above-mentioned property for Inspection purposes
SIM REVE111M FOR EXPLANATORY LANGUAGE
SigrwNre of Applicant or Agent Dote -
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS'ANGELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN auI
UWA
I hereby affirm that I have a certificate of corsem to self atat�
amara Bap ADDRESS _
or a certificate of Workers Compensation Insurance or a certified
copy thea(SeD_3800 tab C) .{.��&. 'aP `
Policy No� Company Ett �A�+l� to"Tv
( SIZE LOT NO OF SLOGS NOW ON LOT
El Certified copy s hereby famished - NEAREST CROSS
Sit
P Certdsd copy S filed wdh the county building inspection TRACT BLOCK LOT NO
department _ _ - _ _. _ _ = USE ZONE MOP NO
Datey� App.JLC&nt ASSESSOR BOO1< PAGE PARCEL 1 _ _
SPECIAL CONDITIONS
CERTIFICATE OF E TION FROM WORKERS' OV/IER TEL NO -
COMPENSATION INSURANCE — MTHIN 1000 FT CF SCHOOL' vEs ' No ,
(This sectlon neec!not he completed if the permit is for one hundred ADDRESS
DISTRICT GROUP TYPECONST FlRE DONE PROCESSEDSY
dollars($100)or less)
I certify that in the performance of trio vopemm[
rk for which this CITU LP
i
s issued I shall not employ arty person in arty manner so as to
beCOrt10 subject to the Workers Compensation Laves ARCHITECT OR ENGINEER TEL NO SfAi^n0� TION AFT
CONGO
Date Applicant n ADDRESS — _ CLASS NO � DWELL UNITS
NOTICE TO APPLICANT If after making this' Certificate of I ow REDUIRED TOTAL SETBACK FROM EXIST
EXempton you should become Subject' t0 the Wblkere R % TEL NO SET BACK YARD HWV PROP LIFE WIDTH
Compensation provs9ors of the Labor Code you must forthwith FRONT
comply wdh such Provisions Or this Permit shall be deemed revoked ADDRESS A LIC NO P L
CICACt 3
LICENSED CONTRACTORS DECLARATION pTy LIC SIDE
P L
I hereby affirm that I am licensed underprovisams of Chapter 9 SEWER MAP
(cortimenCRlg
with SectKm 7000)of DNlsen 3 of the Business and SO FT SIZE N I NO OF ES NO OF FAMILIES
Professions Code and My llicertsq is In full force and effect NEW ❑ BK
r
License Number Loc Class DESCRIPTION OF WORK ADD VALUATION
C� oO _
Contrecta to ��� ALTER ❑ $ �`"•, M
❑ 1 am exempt under Sac REPAIR ❑ $ v
BdPC for this reason DEMOL ALDMA PTC� W
Date USE OF EXLSTING BLDG URM ❑ IL
Signature APPLICANT( T) TEL NO LOMA Perm 1 Z
° ❑ 1 es owner of 11Xe Property or my employees with wages as 1 O ACC (.i ,
their sole compensation mll do the work and the structure is
net Intended or offered for sale (Section 7044 Businees and FINAL DATE Q ]JI�J 105.20
Professions Code) vMLL THE ARPLIGNT OR FpNHE BUILDING oceu HANDLE A IMZAr 9I.wT L `\ .� 7 1 ITEhS
❑ 1 as owner 01 the property am exclusively contracting with OR A MIXTtAE CCNTNNND A HAZAPD011S MATElY EO TO OR GREATER TION THE
licensed contractors to construct the project (Section n7 044 MelIN18 SPEARED ON THE HAZARDOUS LNTI3iMLS NFORWTDN GUM? FINAL BY > i OTAL 105 - 30
BUSI ESS eM Professions Code) yes❑ No❑ - CHECK
^-7_
MU THE INTENDED USE OF THE BUCLNO By THE Ai9lX/NR OR FUN�E Bl1LDND CHECK 105.3
OCCIFIWT SECURE A PERKT FOR cOFATR1mIpN OR AeOFICATION FROM THE SO
CONSTRUCTION LENDING AGENCY a�rELIASmMLrtY^cA'T 14ENT aslwc;T(S D)SEE PEPARTNO CHEacusT FoR C 1]IJ
1 hereby affirm that there is a construction lending agency for Yee❑ WE)
the perlOrmertce Of the Wok for Which this permit IS s&led(SDC I�VE READ HE I4WROOlF MATBRMSINFORMATION GLOE AND THE SGOI.OPEFS.L W
3097CN C) TTRE2CHAPTEH�] Op6�ECnWS2Nl00TH H DIIRE�UNDER E 110
Lenders Name COM:ERNNG IIAZMD0119 yW'J�UV�1 1L Jl�jr
N r MATEPoIL9 REPCRIHIG AAp FOR OBPMNO A PERWi FTeAi TFE SCMIAI
Lenders Address 7619 1 AM 9:�7
o aM¢a re I(IENT ,
I certify that I have read this application and State under Penalty PC FEE PERmrr FEE
Of perjury that the above mformaten s correct I agree to complly O r
vnth all county ordinances and State laws relating to buiding
COnstructon and hereby authorize representatives of this County ISSUANCE FEE
�
to enter Upon the above Theme property, II1SpeCtlIXl purposes •
NVESTIGAT)ON FEE TOTAL FEE O 0
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUI SS
I hereby affirm that I have a certificate of consent to self Insure
or a certlfcate of Workers Compensation Insurance or a certified Bli'1��-� LI Sy-VD . or
copy Tho qp/�f.71�S,'�,ec•I, 3�-8,00�x Lab C) �- TLS lr� Gt T ZIP LOCALITY r
Palior No IAC-.30-LLw�Z�Canperry-778'72 �I/IVI)
SIZE OF LOT NO OF BLOBS NOW ON LOT
❑ Certified COPY is hereby furnished NEAREST CROSS Si _
❑ Certified copy is filed with the c0 building Inspection TRACT BLOCK LOT NO
department USE ZONE MPP NO
Dati"i ft I I / ]�ippllCan ASSESSOR MAP BOOK RAGE PPAGEL
�" SPECIAL CONDITIONS
CERTIFICATE OF EX MPTION FROM WORKERS TEL NO
COMPENSATION INSURANCE I gppD 1 141 R I ri T�R9 0. S srs - 0 WITRIN 1000 FT OF SCHOCLx YES N°
(Thee Section need not be completed it the permit is for one Hundred /�Z / ale USTRICT GROUP TYPE PE PROCESSED BY
dollars IS 100)or less) i.!/ F 7 .f
nP
I certify that in the Performance of the work for which this permit cfiY n /1 7J 3 �hl /i_�
Ts Issued I Shall not employ any person In any manner so US to //O /C�
become subRct t0 the Workers Compensation Laws ARCHITECT OR ENGINEER TEL NO
SUTISPCPL CVSSIFlCATION PPT CONDO 1
Date Applicant ADDRESS CLASS NO Ix 19 DWELL UNhS
NOTICE 70 AFWLJC4NT If after makingthis Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption you should became subject to the Vyorkers CONTRACTOR *TELNOSET BACK YARD FTY✓'/ PROP UNECompensation provisions of the Labor Code you must forthwith w), c• dS •} 4� FRONT
coney with such pre ns"or this permit shall be deemed revoked E S P L
LICENSED CONTRACTORS DECLARATION O SIDE
CITY PL
I hereby affirm that I am licensed Underprovlslorm of Chapter 9 P1219 7N G� SEWER MAP
(commencing with Section 7000)of Division 3 of Me Business and SO FT SIZE NO OF STORfES NO OF FAMRIES
Professions Code and license s in full force effect NEW ❑ SK PG d
License NimlberGS57C v Llc C��';��� SCR W:: OF WORN ADD - ❑ VALUATION , Q
Contractor CYT I &Tel•AL'ws Date F ✓G6 O ALTER ❑ $ o, 0� � U
4 CoNAI-H _ - cc
❑ 1 am exempt under Sec REPAIR ❑ $
BSPC fa ISA this reason DEMOL ❑ PTC w 0U
Date USE OF EXISTING BLDG URM ❑ d
U
APPIJC (PRINT) TEL NO - LDMA Rum♦ 1 Z
ANT
❑ 1 as Owner of the property or my employ'eoS with Wages as =
their sale compensation volt do the work and the structure p ADDRESS F AM.,
not Intended or offered for Sale (Section 7044 BLlsmess and Q
Professions Code) L I ? 33D7 229.50
WILL THE AP%GNII OR FURPE BUILDW OCcuR HANDLE A HAZARDOUS WTERM
❑ 1 as owner Of the property am exclusively contracting With On A AMOUNTS URECFEepNON HE HAZMCa S IAATE4 N=UN-TOpN G RE TER THAN THE FINAL BY > 1 ITEM
licensed contractors to construct the project (Sectim 7044
Business and Pralasslors Code 1 YES❑ No❑ TOTAL 22c?. 50
WLL THE NTENDED USE OF THE BUCLW3 EY THE �CA.T OR FUTURE BUILDING
CONSTRUCTION LENDING AGENCY oorS REOUPE A PERMrt FOR caRICT(SCAC DR EE KRATON FROM THE SCUIR '. lK 229.50
COAST NE DUNfTY NANAOEMEM DISTRICT 19CAOMD)SEE PEPMRTPp CA�DRUST FOR
OUOEUNES rLTAL1T I-ir�
I hereby affirm that there Is a construction lending agency for YES El NOD U.1"Pe�!� .00
the Performance of the work for which this permit Is Issued(Sec
m 3097 CN C) IHAVE READ HAZARDOUS IMTEPU1a PFIXANTNN10UlOE ANJ THE$CAg1.m PERMnTW3
TrtECKUG IUNOERsr PG�MTIr our0100 THHROUGH THE
laCO�NCERNNINU `THwzYARoouS Q�]Q—�pi 5/17/93
Lander s Name M%TEHi PO .0 FOR OBTNNINO A PEPAQi FROM THE 90M)AC
Lenders Address 9738 1 AM 8:36
I certify that I have read this application and state under penalty
g
of perjury that the above information m correct I agree to comply PC FEE PERMIT FEE
$
win all county ordinances and State laws relating to building
g construction and hereby authorize representatives of this County ISSUANCE FEE
m to enter Upon the above-mentioned property for Inspection purposes
a
m
INVESTIGATION FEE TOTAL FEE D
SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF
DEPU
NT OFPUBOS LICETEMPLEGELES I TY $
WORKS 9701 LASTUNAS 0508 BUILDING I
ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91760 BL 0508 0303200001
PHONE: (626) 285-0488 EXT:
LEGAL ID NO. OF CONST BUILDING ADDRESS:
ON FILE SO FT STORIES TYPE 4343 TEMPLE CITY BL
STRUCTURE: VN TEMP CA 917804229
AASSESSOR INFORMATION NUMBER:SSESSOR 053 NEAREST CROSS STREET. LOWER AZUSA
THOMAS PAGE 597 GRID. A5 LOCALITY: TEMPLE CITY
TENANT' EXIST BLDG USE: INDUS USE ZONE 14-9 ISSUED ON PROCessw BY EXPIRES ON
EXIST OCC GRP 03/20/03 JK 03/14/04
OWNER. No- BLDGS NOW ON LOT: VALUATION: FINAL DATE CODE
DAVID BROCKMAN - 6,000 F � `
4343 TEMPLE CITY
80 VpAA
TEMPLE CITY 917
T/0 EXISTING, APPLYi1ROSIN,IBASESHEET,2PLYSHEETS,8ICAPSHEET
FEE DESCRIPTION QUANTITY LEN AMOUNT ALL MATERIALS GAF FIBERGLASS TRUMBULL ASPHALT
APPLICANT No
ROSA ROOFING INC (562) 691-5950- AA BLDG PERMIT ISSUANCE 27 75
5615 WESHAN PLACE AC STRONG MOTION RESID 6000 00 VAL 0 60 SPECIAL cONDITiONS
BREA 92821 D2 PERMIT W/O EM-HC 6000 DO VAL 149 40
-
TOTAL FEES 177 75
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
ROSA ROOFING (562) 691-5950-
5615 WESHAM PL LIC NO
BREA, CA 92621 5510750-39 LOCATION AND SETBACKS
ARCHITECT OR ENGINEER TEL NO FOUNPATIONITRENCH FORKS
LIC NO SLAB/UNDER FLOOR
RATS ED FLOOR FRAMING
MAP NO SEWER MAP BOOK PAGE FIRE ZONE CKP
144X2693 ,04 _) n ,��
MD. Of FAMILIES DUELLING UNITS APT/t.umu blAI CLA55i
FLOOR`:��_I� _ � � !
NO 21 JRODFSHFATHING
SCHOOL WITHINSHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS ,A`I \ �/ i
NO NO NOFRAME INSPECTION
REQUIRED TOTAL SET8AErTMr—Mnr—
SET BACK YARD. HWY PROP LINE WIDTH: _ I
FRONT PL- - INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATKfURTWALL
EXTERIOR LATH
RATED WALL ASSEMBLIES
RATED SKAFTS/UPENINGS
LOT D"IMAGE
REPORT ID DPR261 ROUTE TO BS0508
r '
I
- COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT
-DEPARTMENT OF PUBLIC FORKS 9701 LAS TUNAS ' ALTERATION/REPAIR
98UIMING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0710150033
PHONE (626) 285-0488 EXT
LEGAL ID _ NO OF CONST BUILDING ADDRESS `
ON FILE I SQ PT STORIES TYPE 4343 TEMPLE CITY BL I
STRUCTURE VN
TEMP CA NEAREST CROSS S2TREET \, .
ASSESSOR INFORMATION NUMBER
8592-004-053 THOMAS PAGE 597_ GRID A5 LOCALITY TEMPLE CITY, C
I `
TENANT EXIST BLDG USE COMME USE ZONE M-1 ISSUED ON PROCESSED BY EXPIRES ON
EXIST OCC GRP 10/15/07 SR 04/12/09
TOWNER TEL NO 1BLDGS _NOW ON T t ' VALUATION - - IFI
WONG TONY (626) 551-8830-
1230 W LAS FLORES AV LO3 800 iD SCR �ON OF YORK
CLICANT
ADIA, CA 91009FEE9 PAID18' HIGH PARTITION WALL ON SHOW ROOM AREA
FEE DESCRIPTION QUANTITY UOM AMOUNT
TEL NO I
IEDWARD MAK (626) 864-0452- IAA BLDG PERMIT ISSUANCE 27 75
13251 EVELYN AVE TAE STRONG MOTION OTHER 3800 00 VAL 0 80 (SPECIAL CONDITIONS
(ROSEMEAD CA 91770D2 PERMIT W/O EN-HC 3800'00 VAL 115 80
I I TOTAL FEES 144 35
ICONTRACIOR TEL NO ,\ 4 ` ,\\` APPROVALS DATE INSPECTOR SIGNATURE
IEDWARD MAX (626) 864-0452- 1
13251 EVELYN AVENUE LIC NO I l LOCATION AND SETBACK I I
ROSEMEAD, CA 91770 774980 B
I SOILS ENGINEER APPROVAL
(ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS
I
(
I LIC NO SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I 1UNDERFLOOR INSULATION I
I XX 3 011 I
FIAOR SHEATHING
IND OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I -
I NO 22 IROOF SHEATHING I I
I SCHOOL WITHIN HAZARDOUS I _ _ SHEAR PANELS 1
1AIR QUALITY 1000 FEET MATERIALS '
I NO NO NO 1 FRAME INSPECTION '
I Lit
(REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
ISE( BACK YARD SHY PROP LINE WIDTH
FRONT PL- - INSULATION/WEATHER STRIP( I
SIDE PL- -
INTERIOR LATH/DRYWALL
- EXTERIOR LATH
IRATED FLOOR/CEIL ASSEM I
(RATED WALL ASSEMBLIES
(RATED SHAFTS/OPENINGS
IT-BAR CEILINGS 1
\ I ILOT DRAINAGE
I I
REPORT ID DPR261 ROUTE TO 13SO508
A COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS SIGN
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0710110037
PHONE (626) 285-0488 EXT
LEGAL ID NUMBER OF SIGNS 2 BUILDING ADDRESS
ON FILE ISIGN DESCRIPTION 2• FOAM LETTERS W/ACRYLIC VINLY FACE I 4343 TEMPLE CITY BL
TEMP CA 917804229
(ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
18592-004-053 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY, Cl
(TENANT EEIST BLDG USE ISSUED ON PROCESSED BY E%PIRES ON
EXIST OCC GRP 10/11/07 SR 04/08/08
(OWNER TEL NO BLDGS NOW ON LOT VALUATION IFI P BY CODE
IHOME BUY - 7 000 /
14343 TEMPLE CITY BL r 1 1
TEMPLE CITY CA 91780 FEES PAID DgSCRIPTIONJOF WORK
2• FOAM LETTERS WITH ACRYLIC/VINLY FACE AND MONUMENT SIGN
IFEE DESCRIPTION QUANTITY UOM AMOUNT
PLICANT
JP& H SIGN INC (6261 L449-1166- AA BLDG PERMIT ISSUANCE 27 75 I I
9441 VALLEY BLVD AX BUILDING REVIEW FEE 54 70 ISPECIAL CONDITIONS
ROSEMEAD CA 91770 D2 PERMIT W/O EN-HC 7000 00 VAL 166 20
TOTAL FEES 248 65
I I
I94
NTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATUREAND H SIGN (626) 448-1166-
41 VALLEY BLVD LIC NO LOCATION AND SETBACKS
SEMEAD CA 91770 873439 C45 I I
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER TEL NO (FOUNDATION/TRENCH PORMS
LIC NO SUPPORT STRUCTURE
I
(MAP NO SEWER MAP BOOR PAGE FIRE ZONE CMP I I
OOI
NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS
NO 20 I I
I
SCHOOL WITHIN HAZARDOUS
AIR QUALITY 1000 FEET MATERIALS
NO NO NO I
I I I
I I I I
I I I I
I I I
I
I I I
I I I
I I
I I
� I I
I
• (REPORT ID DPP-261 ROUTE TO B90508