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Home My Public Portal About4800 TEMPLE CITY BLVD_Building__ . APPLICATION FOR COUNTY OF LOS ANGELES INEER BUILDING PERMIT DBiILDDIINGAIDFSAFETYDMBIOO14 FOR APPLICANT TO FILL IN �oIORRCC O00 BUILDING ADDRES LOCALITY NEAREST CITY ZIP CROSS ST O OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL ` Z DISTRICT GROUP TYPE FIRE SED BY TRACT BLOCK LOT NO . /�)��` ONST ZONE TELO OWNER ] NO STATISTICAL CLASSIFICATION SEWER P . ADDRESS CLASS N� DWELL UNITS BK PG CITU USE ZONE MAP I1�r ZIP NO ARCHITECT OR TEL SPECIAL ENGINEER NO – ' CONDITIONS - ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRACTOR TEL BL G SETBACK FROM ' �" F NTPROP LINEOF (STREET) LIC ADDRESS34E, NO HI WAY + YARD = TOTAL SETBACK PROM TYPE OF LX($TING CITY LIC FRONT PROP LINE NIGNWAY WIDTH % L GLASS CONST UCTI ON LENDER + – NAME AND BRANCH BLDG TRACK FROM O ADDRESS CITY SIDE PR LINE OF (STREET) U SO F O OF NO OF CHECK HIGHWAY + YARD – TBA.CK FROM TYPE OF EXISTING CL' SIZE TORIES FAMILIES ONE SIDE PROP HIGHWAY WIDTH DESCRIPTION OF WORK NEW ❑ + H DD ❑ CORNER CUTOFF YES ❑ NO ❑ _ —ALTER ❑ 00" —REPAIR[] IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG EMOL APPLICANT L (PRINT) 0 BY (SIGNATURE( I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT AND AGREY WITH ALL OR AND LAWS REGULATING B - STRUCTION I C[R TI FY THAT IN DOING THE WORDY I WILL NOT EMPLOY ANY PERSON IN VIOL [LABOR CODE OF THE STAT[ OF CALIFORNIA IN OWORKMENSCONFE ATIOY NSURA C[ SIGNATURE OF FINAL � pY PERMITTEE DATEADDRESS TELPC Fee$ Permit Fee CITY NO VALUATION$ Issuance Fee /D OOD Total FSB PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CABH 9 4 1 D 9 6.0 0 AtP6 TLALILA Ct.BG)a I:n5 V C/p APPLICATION FOR ` COUNTY OF LOS ANGO.FC BUILDING PERMIT D PARBUILDINNGG AND AND UNn DWISSIO CO � LD ING ffOFLOT L CANT TO FIL IN ADDRESS BUILDING �Q E �1 L LOCALITY ASIEST L ZIP CROSS ST d A Ept OF BLDGS ASSESSOR � OW ON LOT MAP BOOK PAGE PARCEL DISTRICT 1GROUPITYPE FIRE ESSED By / TRACT BLOCK I LOT NO L T`' ZO NF TEL 5itflk IA J C NO STATISTICAL CLASSIFICATION SEWER bleAP ADDRESS CLASS NO �--DWELL UNITS BK PG CITYJ741 ZIP USE ZONE NOP / ARCHITE R#41 T Z SPECIAL ENGINEE /Q�� NO CONDITIONS Alopc, S /•I,O S /•L.` ROAD DEPARTMENT APPROVAL REQUIRED YES[:] NO ❑ CONTRACTOR HE -Z2O4r SLOG SETBACK FROM O j LIC FJMNT PROP LINEOF (STREET) NO O ( IGHWAY + YARD TOTAL SETBACK FROM TYPE OF [%(STING CITY LIC / - FRONT PROP LINE HIGHWAY WIDTH CLASS C _ CO TRUCTION LENDER + — I NAME AND BRANCH BLffS4ETBACK FROM O ADDRESS CITU DEP INE OF (STREET) T U SO FT NO OF NO OF CHECK HIGHWAY + YA TOTAL SETBACK FROM TYPE OF EXISTING C SIZE STORIES FAMILIES ONE ONE PROP LINE HIGHWAY WIDTH DESCRIPTION OF WOR � ((,'Wt J/V k NEW + 6. / DD ❑ . - CORNER CUTOFF VES ❑ NO = ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR USE OF SIN COASTAL PERMIT ZONE YES ❑ NO A ❑ EXISTING BLDG BLLDG UIS 7V•`-�C �DEMOL NN TF-C� .4 EL NOL LJ Z�CIf r _ S I HEREBY A 0 O[ THAT I VE READ THIS APPLICATION _ AND BTATE TX T TN ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS A 10 (LOINS C ST[UCTION 1 C[ IFY TXAT IN D 1 UT Rf2ED X6RUY I EMPL N N OF THE IGNA OE E 9TAT[ 0 C [LA I MO TO W ORNM X'6 • B T 1 SIGNA TUR FINAL � BY PERMITT DATE AO ES TEL -21 CITY PC Fee$ Q Permit Fee CITY L` NO +� Issuance Fes G� VALUATI ✓ f 700 r TDtBI Fee PLAN CIE VALIDATION cN .. CASH PEEMW VALIDATION D Mo CASH 083re10Y 223 01 4.40 TSASSaA CZOW3512/75 _ APPLICATION FOR COUNTY OF LOS ANGELES BUILDING PERMIT DEPARTMENT qND $OF OUNTYY D GIOEN BUILDINGyr FOR APP ICANT TO FIL IN ADDRESS ov E E ! BUILDING D ADDRESS rr LOCALITY `9'x �( CITY ` ( ZIP NEAREST CROSS ST S IF NO OF BLDGS ASSESSOR SIZE OF LOT O NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT 13 pyo/ TYP FIRE ESSED BY TRACT B OOCCK LOT NO I�F Z-- 5o O / y CO T ZONE C. O NO STATISTICAL CLASSIFICATION � SEWER MAP ADDRESS CLASS NO -20 DWELL UNITS BK PG Tz ZIP USE ZONE NOP CHITEC / TE L�� D.A .Z SPECIAL _ NGINEE /�� L NO )- LLSSUU CONDITIONS ��./�"o k_ ROAD DEPARTMENT APPROVAL REQUIRED YES[:] NO CONTRACTOR` TEL/�by2 BLDG SETBACK FROM A b FRONTPROP LINEOF TI ..A/r�yyam. LIC J ��jJJ MfY'Oc�l NO 1SFJ! HIGHWAY } YARD - TOTALAETIBACK FROM TYPO OF E%ISTIHG CITY CLASS l FRONT PROP LINE RIGH AY WIQTX CONSTRUCTION LENDER NAME AND BRANCH BLD SETBACK FROM ADDRESS CITY SI PROP LINEOF (STREET) SO FT NO OF NO OF CHECK GHWAY } TARO = TOTALSIDE SETBACK FROM TYPE OF EXISTING SIZyE�.� STORIES CFAMILIES - ONE PROP LINE I HIGHWAYWIDTH � �-I 1 O O NEW ? a a DD ❑ CORNER CUTOFF YES ❑ NO ❑ Z ALTER ❑ ❑ IN OPEN SPACE YES ❑ NO REPAIR ❑ E7(EISOF BLDA S EMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ TE IHENEBY N OGE THAT I HAVE HEAD TNI$ APPLICATION ' NO $T•TE THAT THE •Bay " IS CONES T AND AGREE TO COMPL WITH ALL ONOINANCEB AND UW$ E E BUIL NO RUCTION 1 TI THAT IN 0 INE E N 1210 HEREBY I L N PLOY T N N 1 OF THE LABOR CO E OF TATE TING TO WORN MCM' M IOM IM$ M SIGNATURE FINAL / .16 ' BY PERMIT TE DATE 4 ' //� C CITY E � TELV�a'220f PC Fee$ p�-J ' Zv Permit FBe eo J I$EDence Fee VALUATION ^ �a �(r/8,3 - / 2.. 0 s � Totel Fee � PLAN CHECK VALIDATION < H o CA.. PERM VALIDATION cN M 0 CABH 082�NOV 223 0 2520 554-DEC 1 1 0 69.0Ua!Jo :r55-3oDEC 123 0- 1620 ° "AGMA CROW30 11/75 r APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES _ BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN Bill I hereby affirm that I have a certificate of consent to sell insure eUl l Q I\V U or a certificate d Workers Comperreatcn Insurance or a c4aMfed ►J - - copy thereof (Sec 3800 Lab C) o 1P - L Pdcy, No Company NN SIZOF -OT " NOW ON LOT )NA IP El Certified Copy a hereby furnished - N I S - NST ElCertified copy s Sf CROSS filed with the county building inspection TRACT BLOCK LOT NO Q. department ZONE MAP NO Date Apphcant ASSESSOR MAP BOOK PAGE PARCEL _ sPEc1AL coNDTTIorvs CERTIFICATE OF EXEMPTION FROM WORKERS' R 7 COMPENSATION INSURANCE WTTRw 1000 FT OF SCHOOL? YES NO (This section need not be completed d the permit is for one hundred ESS + dollars ($100)or less) ` re, DISTRICT NGROUP TYPE CONST FIRE ZONEPROCESSED BY I cerdy that In the performance of the work for which this permit ZJP rO O /•1 Is Issued I shall not employ any person In any manner so as to els d /v become subject to the Workers Componsatwn LawsEER L NO e all STlmSTCAL CLASSIFIGTX]N APT CONDO Date Ci OR ENGIN Applicant ESS CLASS NO DWELL UMTS NOUCE TO APPLICANT It after making this Cerhfcate of REOURED TOTAL SETBACK FROM I Exemption you should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD Rwy PROP UNE Compensation provisions of the Labor Code you moat forthwdh FRONT comply with such provscns or this permit shall be deemed revoked SS LIC NO PL LICENSED CONTRACTORS DECLARATION SIDE CRY LIC CLASS P L I hereby storm that am licensed un inion v of the d Chapter 9 (commencing with Section my 7000)of Division f 3 of the Bu51n0Ss and SO FT SIZE NO OF STORIES NO OF FAMLJE3 NEW BK SEWER MAP PG Prdesecns Code and my Icelee s m full force and effect License Number 4El Class DESCRIP OF WORK _ ADD VALLUDggRRON pool Contracts Date C'' ALTER ❑ "' `tel --ILJI_� tCC— ❑ 1 am exempt under Sec REPAIR ❑ $ B&PC for this reason DEMOL ❑ IOMA PIC+ U�"' Dat USE.QE-EXISTING BLDG URM ❑ a Signature, — 23 z' Low Mm ❑ 1 as owner Of the property or my employees with wages as 2 AACT.i their sola canpersabon wnl do the work and the structure a ADDRESS rANs•a '90.50not Intended or offered for sale (Section 7044 Business and FINAL DATE Q Q �ceased contractors to Construct the Profesaons Code) WILLTHE APRJCNJT OR RIm1RE BULDI 10 OCCUPANT W D E A HAZAI>OGUa MXrEW .)C as owner d m the property aeXGIX%TU£CONWMN um* Contracting with OR A3 A I.MTERML EpILL TO OR GREATER T THE a 1 project (Section 7044 ��G0ED ON�HAW S��Rws INFORMATION GUM? pWAL BYl ACCT.V a BusTe9S and Professions Code) YES❑ w❑ {R�1� I WI THE IHrENpED USE OF THE BUDIIH3 BY THE APPUGNTr OR FUMiE Bl11ON , `^•"`• J.L.�.75 OCCU 04fr REQUIRE A PERMIT FOR CONarPo1OnRDN OR AgDIFCRRON FROM THE S01nH CONSTRUCTION LENDING AGENCY �LINES QUAUTY MMNGEMENT DISTRICT(SCACMD)SEE REPMTTI,Kl CIECKUST FOR w�2 ITEMS I hereby affirm that Mere is a constructm lending agency for YES�I NO❑ _ TOTAL 176. 22-5 n the performance of the work for which the permit is sued(Sec IHaIE READ THE Awe uoe�o aEwnmw3097 Civ C) CHECKUST I 0.4Uf✓D ATY RELES.Z1 CODE CHECK TILE 2 220 BE ��• `Lenders Name AMTE Ib QMD AA'Y'➢IAIG .uuT Lenders Address 1 0 o I certify that I have read this application and State Under peralty 0 of perjury that the above mformatlon is correct I agree to comply PC FEE !d PERMIT FEE [OOO--LprTr� J 12/1,5/95 R xTth all county ordinances and State lawn relating to bulking �0•✓ I1' ��•. construction and hereby allthoMe representatives Of this County ISSUANCE FEE ?O � 3W � ` ••Y�� V to enter upon the abcve-mentioned property for inspection purposes ✓ �. a . INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE ' APPLICATION FOR BUILDING PERMIT 00 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO Flu IN BUILDING ADDRESS 77 �� 1 hereby affirm that I have a certdD to of consent to aetl Insure BUILDING ADDRESS /t / , or a•cerhficate,of Workers Compensatm Insurance or a certifed Haw x copy thereat Nec 3800'Lab C) CITY aPn/ L � / ��V/ C i /Q Policy NO.Z,Q'{,(, ,t 1()7 (`,ofnpany G/ SIZE -O LOT 4r NO OF BLDG 1%'y ON LOT �,erlifed copy,s hereby furnished -/(o t ST CROSS ST /I ❑ Corti ed copy is filed with the county building Inspection TRACT BLOCK LOT NO M'].w USE NNE MAP fJ0 ' Det Applicant C5 /.-l+-. i ASSESSOR MPP BOOK FWGEPARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' TEL COMPENSATION INSURANCE 0R — W7111-1111IW7111-111110,00 FT of SCROOL7 YES No E (This section reed not be Completed d the permit s for one hundred O- Z14 dollars ($100)or less) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that In the performance of the work for which this permit n[A C Z1F '2 IS Issued I shall net employ anrs y peon in any manner so as to become subject to the Workers Compeneebon Laws ARCWECT OR ENGINEE TEL NO qA 0— �� STATISTICAL C TION APT CONDO Date Appllrant ADDRESS CLASS NO DWELL UNITS NOTCE TO APPLICANT If after making the Certificate of 33,10T Liao IVCIIL SA-le- Leilk. Q -I/A s REWIRED TOTAL SETBACK FROM E109T' Exemption you should become subject t0 the Workers' TEL NO SET BACK Y PROP LINE WIDTH Compensation pmwarore of the Labor Code you must forthwith S G YAfip HW comply with such provisions or the permit shall be deemed revoked ADDRE S UC NO PPL Ni n LICENSED CONTRACTORS DECLARATION -/Yql Ale &S,14I SIDE CITY LIC CL0.9 PL I hereby affirm that I am licensed urderprovlsrons'of Chapter B CAI, /0 SEWER MAP (eommer c g with Section 7000)of Drvlsron 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAIL JES NEW ❑ BK PO loo. Professions Code and my license a in full farce and effect LDense Number / L,c Class C-/O DESCR TION WOR ADD VALUATION O Contractor te Brad'-9Y ' �, �s ALTER O $ 3 OV 00 Q ❑ 1 am exempt under Sec J_IGO F n e' REPAIR El B&PC for this reason DEMOL ❑ $ ' Data USE STING BLDG LDMA P/C+t , W OOV A URM ❑ "" ( A23 aZ Signature APPLICANT(PANT! TEL NO LDfAA Perm• ' 1'f' .T.�e .� ❑ I"ore owner of the property a my empbyaes with wages as G/l Q7 1 Z ,'��TJMth�] their sole Compensation will d0 the work and the structure a ADDRESS _ �\ `J O (' not mtanded Or offered for sale (Sechm 7044 BusinesS and FINAL PTOf@9eerL4(.Oda) WILL TIE APRIOWT pit FUILPE eC1.Ofe OCCLiMNT IWDIE A HAZAgDOU9 MATEiLLL `�8 —( C ❑ I a8 owner Of the property am exclusively contracting with Ln A A10TLFE CONWiNG A MAIMDIXI.4 MAIERML EQUAL TO M OfEATEq TIYN TME AMolNi9 SFECJn D ON n E HAZJF9O119 MATEFfALB ff-() UTICN GtrIOET FINAL BY , Busimlicensetl andConProfesorssions to construct the protect (Batten 7044 y s❑ ftp� 3303 142_.71 BUBIneaB and Prafessians Code) Nil. TIE MNDFZD LIRE OF TIE SUDILNU BY THE i 14001 TCR F m T BLIO 711 2 I 1 L�Ir7 OCCUPANT REDRARE A PFIRAAT FOR C MICr x:TWN IXr AHE F TVI qN FROM TIE 9IXRM IV CONSTRUCTION LENDING AGENCY COAST AN auaurr Au+uaEr.Ezrr aarBcr tscAOMoI SHE FEgI,.r.no C1IEp(U87`Foq' TOTAL 193 2 �. cam1UNEs /Ysnv hereby affirm that there Is o c which the p lending agency for rEs❑ N. y�yt\ 193.21 the perfomnerlce d ifRe work for whDh this permit Is issued(sec m IMN/E IErn TIE IMUlD01r8MATETUL9 esawAnoNaLAOE AND TME scaoRERurnNa 3097 CIV C) CIECNDST I UIDER8PID MV R MtREW£ UNDER TME LDS ANnELE8 COUNTY CODE •� TmIE 1 CWIPTFR 321 SEC(1.1N8 a ZO,W T1iigIQ4]TD f r0 CONCERNPJO HAIAADOU9 Lender s Name uwTERw�poRn ,w0,F o A FEraar FReM TIE ScAoA® _ Larders Address NG[.it.-s'xs� 0 3..n 1 certify that I have read the applicaten and state under penelty, of perjury that the above information s correct I agree to Comply PC FEE YO. ` PERMIT FEE / '// 11 • rY I1V., with all county ordinances and State laws relating to building ConStrUChOn and hereby authorize representatives of the County ISSUANCE FEE to eMpr iporR he oho - toned Property for inspection W ses INVESTIGATION FEE TOTAL FEE m At/lN1t \ 7P r SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUT DF 95 I hereby affirm that I have a c ricate of D= to sell Iroure BIIILOMO or a cerMoat�d Yhrkers Compensation Insurance or a certllotl cop' therAo 800 C GTV ZIP OCALITY Poky SITE OF LOT I NO OF BLDGS NOW ON LOT ❑ hied copy is hereby furnished I NEAREST CROSS ST Certified copy filed with the c ty Iltllrg I CT BLOCK LOT NO depart USE ZONE MAP NO Date ICe ASSESSOR MAP BOOK FACIE PARCEL SPECIAL CONDITIONS A C RTI F ATE O E PTION FROM WORKERS' R C h 9 COMP ATION INSURANCE v .7 THIN 1000 FT OF SCHOOL? YES NO (This section need not be completed If the permit Is for One hundred dollars 13100)or low) DISTRICT GROUP TYPE CONST ME ZONE I PROCESSED BY I certify that In the performance of the work for which this permit Y IP Is Issued I "I not employ arry person In any manner so as t0 become Subject t0 this Workers Compensation Laws CHITECT O ENGINEER L STATISTICAL 7gATION PRT CONDO DatO Applicant ADDFEF�S n CLASS NO DWELL UN ITS -4 NOTICE TO APPUNT If after making this Certificate Of1�51 ✓ REQUIRED TOTAL SETBACK FROM EXIST Exemption you shoWd become subject to the Nhrkers CON TEL NO I SET BACK VARO HWY PROP LINE WIDTH Compensation promions Of the Labor Code you must forthwith FRONT comply with such provisions or this permit shall be deemed ra.Vked RESS U PL LICENSED CONTRACTORS DECLARATION SIDE I hereby affirm that I am licensed underprwxrorw of Chapter 9 C P L } SEWER MAP a (commenarg with andSecbOn my 7000) i ONfull f 3 d the effect and SQ FTS NO T 9 NO OF FAMILIES NEW ❑ BK PG , 0 Professlors Code and my license s In full force and effect t.7 License Numb r Class DESCRIPTION OF WORK ADD ❑ V ��00 � W Contrad Date LTER ❑ O ❑ I u — REPAIR ❑ $ V PC for this reason &I vb DEMOL ❑ Pic d Date u OF XIS'RNG URM ❑ -_ Yn 2 Signature ( ) E LDMA Perm ❑ 1 as owner of the property Or my eRployeas with wages as Z WCT.i their sole comparisatlan will do the work and the structures E not IIIfBfYIBd M offered for gale (Section 7044 BU91r1839 and FINAL DATE_- ' Q Professions Code) vnu THE WLarw Sporn EWl0.E A HAZARDOUS WTEwu S ORA"xTURE CONI A HAZAROOUS WTERAL EQUAL TO OR GREATER TI W1 THE ❑ I 88 Ow11Bf d the property am BXdUSNely, contracting With ANOINTS SPECFIE THE 4ATERW.S efORAAIION oUOE+ FINAL BY �•-T 1 licensed contractors t0 construct the project (Section 7044 vEs❑ l0 1U I •T Business and Professons Code) 1 J5._c WILL THE D USE OF THE BIIICINO BY THE ARIX;ANT OR FUTURE BUUING71 OCCURiWT OURE A PEWIT FOR CCNSTWCTIDN OR 1lODIFlCATION FROV THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR ODA{lTY NENT DISTRICT rscA l SEE PERMT'RW CE GAULST FOR r GumEUEe , , 1 hereby affirm that there Is a construction lending agency for ' a the performance of the work for which this perms is ssuad(Sec YEs❑ TOTAL 236 - 35 ti 3097 CN C) DHE RE .N «R °" ,SEE COU C HE(k :c ] R SE 1 tO CONCERNNa DONS r74 Lenders Name Na A E Lenders Address GE ,nTl 0 Q I certify that I have reed this application and state under penalty Q Y d perjury that the atK1NB information 16 rBcl I agree o Comply PC -�D,�^ PERNNT FEE /�%• QI]�]—Ol'O1 10/29/5: Ki with ell county ordlnanc and S t we ra1eM1 to bulldaq U �• I nd =Blaby =Xtat County , ISSUANCE FEE foed nt . nh �.rty for on rpose (p 7rJ 2352 1 Ammo:4_ G�� INVESTK3ATK)N FEE TOTAL FEE O m v a /7 L SEE REVERSE FOR EXPLANATORY LANGUAGE r APPLICATION FOR BUILDING PERMIT t�MT COUNTY OF LOS ANGELES` BUILDING AND SAFETY �+ WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN 1 hereby affirm that I have a certificate of consent to self insure BUxpwO ADORE9 �� .6�f or a.certdicate�,A Workers Compensation Insurance or a certified ��r N • - Copy thereat—f Isec 3;282 i a c) �'MRS ZIP Tlolicy Clip' tl/ °cam V �ry /J /� SIZE OF LOT NO OF BLDGS NOW ON LOT Cr El Certified copy is hereby furnished //oZ.J!/ NEPAEST CROSS ST 1 13Cartified copy is filed with the county budding Inspecttiion TRACT BLOCK IAT NO - J USE ZONE MAP NO depart t DateAppllcantdidt ASSE350R MAP BOOK PAGE PARCEL �' SPECIAL CONDMONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL No COMPENSATION INSURANCE T> � ��'��\ WRHIN 1000 FT OF SCHOOLS YES NO ADDRESS(This section need not be Completed If the permit is dollars(E 100)or less) for one hundred 11�^./ -M t *FeN�>^ DISTRICT GROUP TYPE CONST FIREZONE1 PROCESSED BY I aertiy that h the t employ an of the work for which the Permit LP 44 �� // - 3 40 t b Issued I shall not empty arty parson at any manner so as to !' beCOrrla subject 10 the Workers Compensation Laws PACHRECT OR ENGWEER TEL NO r G. \ SWTLSOCALTION APT CONDO Date Applicant ADDRESS •• .... CLASS NO 01NELL UNfTS NOTICE TO APPLCANT If after making this Certdlcate ofjr-• AIL PUI/�1 �' 4YI.1/ REWIREDI I TOTAL SETBACK FROM EXIST Exempicn You Stcud became 6ublaCt to the Workers TEL NO SET BACK YARD HWV I PROP UNE VADTH Compensation Wavis10ns of the Labor Cade you must forthwith _ FRONT comply with such provisions or this permit shaft be deemed revoked LICENSED CONTRACTORS DECLARATION LC C�LP.SS ;°E ,64 I hereby affirm that I em licensed underprovisxxis of Chapter 8 (COmmerxxrg with Section 7000)of Drvlslon 3 of the Busmess and 80 FT NO OF STORIES NO OF FAMiUES SEWER MAP Professions Code andel my license is In full force and effect NEW EJ BK - PG i "--153. 648 d License Number��!S 1 LIC Class DESCRIPTION OF WORK ADD ❑ VALUATION , TOTd I —153_ 64 8 Contractor �1//.✓LIe�ID2.,I�.le ALTER/,��y/ a • El I am exempt under Seccc REPAIR O $ ECK iJ�1..6Tf4'T BBPC far this reason DEMOL ❑ LOMa PIC s 7 24 -ate+W Date B E OF EXISTING LDG �" URM Ela 1 h OL Signature APPIJO; (PRra) LDhM Perm 0 1 AM 7:56? T ❑ 1 as owner of the property or my employees with wages as 541 nIq their sole compensation will do the work and the structure iS AGGRESS F X30,57 riot intended or offered for Sale (Section 7044 BUSmless and A FINAL DATE 11 DI^RA Q C - r PTOfestuons Code) Wl.L TIE A CANT OR FUNIS&AIDING occewur HP A HAZAROple MATEF1Al �_ f U •U 7 ❑ I as owner of the property am eXGLisrvety COntraCtinlg Wlih OA A MIxTURE CGNPII11a A Iwumau IMTERML cowl TO GR GREATER THAN THE \ M AI.glHle SPECFED q1 THE VWZNiOple MATERwla RFarANRON IXI[E'+ 1ri *7''��'jam`+' IiCamed Contractors to Construct the protect (Section 7044 YES❑ ND❑ FINAL f31' > TOTAL I 210.57 Business and Professors,Code) ( THE PfTENaEO USE CF TIE auaLwo er TIE APPLMANT aR F00M BOLDING OGCA.PAAR FEGURE A PERMIT FPR CCMKJ(1CT1bl CR MOOffIGATI'JN FRON TIE 60VR1 CONSTRUCTION LENDING AGENCY cav^r An olwTrY M.++AGEMEI+T oisnacr Iscroum sEE PERI.fTTP1G cHEcrcusr FOR \ 13 GnmFIINEe I hereby affirm that there is a construction lardring agency for s 1:1rip❑ r \ Pam the performance of the work for whch this permitm issued(Sec m 3087 Cry C) IH CKUSa THEHA)SViND MATERLLL WNTS UNDER U E UCS T I-IE OC FER1 ODDS n cREcxusr I uaoERsuup Mr REOIKEMENTs Iw.oER THE Los wsGELEs coulrry coDE TfRE 2 GRAPIER 120 SECTgNS]20100 TiiWGH R 10 TAO LONCERI�q HA3.N€OL8 LafdBr S Name MATEFAALS REPCRTNG NA FIXi OHPfiMG A PERIQT FigAr TIE SC/oM0 Lenders Address o °m'a"on�rcr I certify that 1 have Mad this application and State under penalty s Of penury that the above information is Correct I agree t0 comply PC FEE `/� PERMR FEE / �/ with all county ordmancas and State laws retailing to building • o $ construction and hereby authorize representatives Of this CaurHy ISSUANCE FEE 7,oD �o to enter the �menWned property far IrepecixTn 1 RNESTIGATION FEE TOTAL FEE �'1/ O.• SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS COMPENSATION DECLARATION `- 'TC" . _..._.... 1. 4 hereby affirm that I have a certificate of,convent to+self insure or a certificate ofWorke4'CompensationInsurance _ APPLICATION FOR .BUILDING PERMIT or cgrlif+ed copy`thereof (Sec 38DO Lab C ) "` - I - /,pF•r� p , 'A _ COUNTY OF LOS ANGELES BUILDING.,AND SAFETY Pblicy Noli YJU sCompany l..✓V - Cenfied copy is hereby furnished' ' + - FOR APPLICANT TO FILL IN ABUnloRESS ,j - + Ceitifi co is filed wrth 'assn ildm i ti BUILDING L' s J,d hon d rt enc '`� ADDRESS �� L ✓ ' Dote" Applicant CITY ZIP + LOCALITY rC TIFI TE OF EXEMPTI FROM WORKERS `" - - NO OF Bi - - - NEAREST - - - -- • COMPENSATION INSURANCE' i"' + SIZE OF LOT O NOW ON LOT CRO55 ST n , (Thu section need not be completed if the permit is for one - - - ^t- ��) hundred dollars($100)or lea ) , TRACT BLOCK LOT NO rGi MAP BOCK ASSESSORr + 1 PAGE PARCEL _ _ TEL ' USE ZONE MAP I certify that in the performance of the work for which this OWNER �//' NO _.7_ MA permit is issued, I shall not employ any person in any manner _ ' _ _ ��' - ) so as to become subject to the Workers Compensation Lowe ADDRESS" Z 0 CONDITIONS O i. A _ .. 1 _ _ _ L _ _ U Date ApPbccnt " ' ' CITY ZIP TFL N NOTICE TO`APPLICANT 'If after making`this Certificate of DISTRICT_ GROUP_ TYPE , __ FIRE BY_ N NEER 0 Exemption, you should become subject to the Workers' - NO O ( ' CONST ZONE Compensation provisions of the Labor Code you must forth- ADDRESS/No E ! 0O d), with comply with such provisions or this permit shall be - - TEL STATISTICAL CLASSIFICATION ZZ APT CONDO ZZ_ deemed revoked ,1 , ` • + - CONTRACTOR T NO LICENSED CONTRACTORS DECLARATION , - - - - - tIC- - . CLASS NO DWELL UNITS- , I hereby affirm that I am licensed under provisions o1 Chapter 9 ADDRESS J NO _ (commencing with Semon 70DO)of Division 3 of the Business and _ s SEWER MAP , Professions Code, and my license is in full face and effect CITY CLASS P - ' � :2 Y VALIDATION + SO FT _ NO OF _ NO OF _ CHECK License Num LIL CI�, STORIES FAMILIES ONE t VALUATION Contracto Date DESSIZ- DESCRIPTION OF WORK` - � f ❑ I am exempt under Sac =r �R 539,9A_ B BPC fw this reason _ AMO REPAIR - f - ` -- - •- "� • • • • 2 3 ' - _ _ _ Date - i I USE OF FxIS _ DF" - I • •7 3 32 Signature - -- - - - APPLICANT ' TEL FINAL OWNER BUILDER DECLARATION _ _DINT _ p V_ _ _ F� _ DATE - — - - �--• • 7 33 2 5 I hereby offum that I am exempt from the Contractor a License ADDRESS / 6 s _ R 'n'_' +_' I 0 4 9 9"8 6 Law for the following reason (Section 7031 5, Business and _ Professions Code) _ Pldi� _ B BUILD NG _ I, os owner of theproperproperty, or my employees with ADDRESS woges as thou sole compensation,will do the work and iL i the structure is not intended or offered for sale(Section LOCALITY `704, Business and Professions Code) -` MOVING - -- TEL--- I EL-I as owner of the property,am exclusively con hactmg _ CONTRACTOR -- - -y_- NOwith licensed contractor to construct the project (Sec- tion 70" Business and Professions Code) ADDRESS i t CONSTRUCTION LENDING AGENCY BACK YARD HWY TOT PROP LINE WIDTH SETBACK FROM EXIST - i_ '` 5 5 4,2 A — I hereby affirm that there is o construction lending agency fw FROM ri the performance of the work for which this permit a issued "P L- --- - - - 4 - - .L _ _ # • • • • •,I (Sec 3097 Civ C ) SIDE _ 1 • • 9675 ' P L Lender a Name _ e s LOMA Ref R 96756 P C Fees 3 7� Pwmit Fee ' 111111, >- Lender s Address -• , I I 0 1 O 1 t-86 I 6 -I cerci that I have rood in app6c tion and state that the --- -- ---- Issuance Fee - U•' ✓ LDMA,P/C 0 , - above norma tamed r comply with all County -- Investigation Fee- - L/-,6, _ordt c an Stat I r at to buiWmg construction _ Toml Fee ~f` • IDMA Perm`#'� ''- G and re out n r vas of ihu County ter, , upo the bo rho ry for mspechon • SEE RFVERLE FOR EXPLANATORY LANGUAGE - Signature of Applicant or Agent WORKERS COMPENSATION DECLARATION a imurebo affirm that I have r certificate of tionconsent to self APPLICATION FOR B_UILDING_PERMIT insure or a certificate of Worker Compensation Insurance, - or akamfi�e►d�c.o�p.sy�th�ereof (Sec 3000 Lab C ) _ COUNTYiOF LOS ANGELES _ ._ BUILDING AND SAFETY- Poli�y No L(l�_Company � YU.J11 Certified copy is hereby Turn" FOR APPLICANT TO FILL IN MIRRESTS 4q90u A) e 11L_ R Certified copy is filed with the county building troF»c- LDAl tan deportment A) AmRE55 Era+ �E Date 'Z q i Applicant `�' � OT IP - LOCALITY (� NO OF BLDGS NEAREST - CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT - NOW ON LOT CROSS ST LQW S RA COMPENSATION INSURANCE ASSESSOR (Thu section need not be completed if the permit is for one - TRACT BLOCK ' LOT h10 MAP BOOK - -- PAGE PARCEL hundred dollars ($100)or•less ) TEL -u` jRY.O; NO USE ZONE-npe I certify that in the performance of the work for which this /J ..sy SPEOAt } i permit is issued I shall not employ any person in any manner ADDRESS �_ (. -G CONDRIONS 0- so so as to become subject to the Workers'Compensation Lows O CITY ZIP - U Date Applicant ARCHI OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY d' NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO L CONST - ZONE O Exemption, you should become subject to the Workent -��a �_ q Compensation provisions of the Labor Code, you must forth- ADDRESS i y ✓ '�y' with comply with such provisions or, this permit shall be - TEL STATISTICAL CLASSIFICATION AFT CONDO u) deemed revoked I , CONTRACTOR I NO CLASS NO DWELL •ITS_ Z LICENSED CONTRACTORS DECLARATION � � Flo I hereby affirm that I am licensed under provisions of Chapteriii SEWER AW - (commencing with Section 7000)of Division 3 of the Business UC and Professions Code,and my liceme is in full force and effect CITY CUSS 6-10 BK PG VALIDATION SO FT OF NO OF CHECK License Number! �s "7 Llc Class I,ty C/o SIZE STORIES FAMILIES ONE VALUATION Controcioo�__•��pafe _ DESCRIPTION OF WORK NEW ❑ $ Q�O ❑1 am exempt under Sec App ® O loop❑ B&P C for this reason REPAIR ❑ $ Dole USE OF EXISTING BLDG —1 O OEMOL ❑ __ Signature APPLICANT TEL NNAL r� OWNER-BUILDER DECLARATION PILRUT NO DATE / ✓/ / A(C i .i I hereby affirm that I am exempt from the Contractor's License ADDRESS G _ Low for the following reason (Section 7031 S, Business and FINAL , `�Ij7 �C if .Professions Code) PRESENT _ _ E] 1, as owner of the BUILDING - BY_ 1 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 70M, Business and Professions Code ) MOVING _ _ TEL__ _ _ ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO a^G7 4c�r with licensed contractors to construct the project (Sec- ADDRESS - - - L.CLOS tion 70" Business and Professions Code ) CONSTRUCTION LENDING AGENCY SET REQUI YARD HWY _ OTAL SETP A.. FROM _ - TOTAL _ 72 . 53 j hereby affirm that there u a construction lending agency for FRONT I_HECK 1 L J 1 the performance of the work for which this permit is Issued - PL (Sec 3097 Civ C ) SIDE =HANGE ,(ISI PL Lender's Name BENINESE ' PC Fee$ U Q Permit Fee TDMA Ref Y 3 Lender's Address a PP- I certify that I have read this application and state that the T Issuance Fee LAMA P/C E , 7113 1 Ah 3:L above information Is correct I agree to comply with all County In rosngoeon Fee i ordinances and State laws relating to building construction, Total Fee 'LDMA Perm - ` and hereby authorize representatives of this County to enter IYq uporMtIhe bove-mentioned property for Inspection purposes _ '(At f- == r-z�j 9L 8_ E REVERSE FOR_UP ANATORY LANGUAGE - - - If nature of AWI=nt or Agent Dale