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Home My Public Portal About4805 TEMPLE CITY BLVD_Building__ 76A63BA Cfi.#SP3 3-69 A4 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES 'U..l.. F ,C� QL OEPARTMENT,OF COUNTY ENGINEER ADDRESS 00 BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPT OF BUILDING NEAREST - — CROSS ST Q FOR APPLICANT TO FILL IN DISTRICT NO GROUP 'TYPE:PWST PUCCE SEP BY (PRINT OR TYPE ONLY( E U _ i/. �� BUILDING STATISTICAL CLASSIFICATION SEWER MAP ES ADOR �3//33 - - CLASS NO DWELL UNITS BK(>, PG '3 - LOT NO 3 BLOCK USE ZONE I MAP , NO TRACT SPECIAL 1 NO OF BLOGS CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG BLDG SETBACK FRO OWN TEL FRONT PROP LINE STREET) CG NO TYPE Oi E%I STI SETBACK HIGHWAY + YARD = TOTAL HIGH WAY WIDTH ADDRESS FROM C L CITY ARCHITECT 0 TEL BLDG SETBACK FRO ENGINEER NO SIDE OP 1-114 OF (STREET) TYPE OF "WING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L CONTRACTOR NOL _ _ _ +LIC - ADDRESS NO CORNER CUTOFF YES NO ❑ Q LIC U CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS y CONSTRUCTION LENDER NAME AND BRANCH ADDRESS Y SO FT NO OF NO SIZE STOFIES FAMILIES NEW USE OF App ❑ STRUCTURE M' „ ALTER ❑ REPAIR ❑ SIGNATUREOF DEMOIq VALUATION ❑ APPLICANT ` Z- VALUATION �� APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT nIry FOUNDATION LOCATION FEES FEE $ /Y ^ FORMS, MATKRIALS _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS, R T ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- 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-OF '` �, LATH, EXT PERMITTEE]�f c1dl&&_Alj HOUSE NUMBER CORRECT AND POSTED ADDRESS FINAL JOHN F LEWIS, PRINCIPAL STfy.CZURAL ENGINEER PLAN CHECK VALIDATION cK M o CA.H - PERMIT VALIDATION c% M"o cA3H I Ar, 4 1 6 7� X20 2 3 D 7.20 lA1',., 52539 JA 5 1 D 12.00 9 76A638A GE A8033-69 APPLICATION FOR BUILDING ERMIT ` COUNTY OF LOS ANGELES BUUILD IN DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY I JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPT OF BUILDING NEAREST CROSS ST FOR APPLICANT TO FILL IN Dls CT NO - GROUP TYPE.CONST - SED BY --- (PRINT OR TYPE ONLY)LD / ADBU'D ESS D S STATISTICAL C�SAIFELOLUNITS N L EWER MAP�/ CLASS N (,f LOT NO BLOWUSE ZONE O P O/ TRACT /.� SPECIAL �./ CONOIA IONS 7O X,O T NO OF SLOGS —- - SIZE OF LOT V NOW ON LOT � ,I i y-r � • - LISE OF EXISTING BLOC BLDG SETBACK FROM ' TEL / FRONT PROP LINE OF ' - -- - - - - -- (STREET) OWNER .y' j16- 69 TYPE OF E%IS fTBACK HIGHWAY t YARD = TOTAL ADDRESS •O HIGHWAY W170TH L _- LL i _ t = CITY--,;;;eaff ARCHITECT ORTEL BLDG SETBACK FROM ENGINEER NO SIDE PROP LINE OF (STREET) TYPE OF EItRTpIG SETBACK HI6 AY ♦ YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L TEL/ _ CONTRACT 6 0 3 -7 ADDRESS NO �` d- CORNER CUTOFF__- _YES-Q- -❑ _ CITY CLASS SIEVE REVERSE SIDE FOR SPECIAL APPROVALS C CONSTRUCTION LENDER NAME AND BRANCH ADDRESS ~ SO FT NO OFNMI O OF ❑ - SIZE STORIES FALIES NEW USE OF STRUCTURE 5OO 2 ADO Li-ALTER I "L REPAIR SIGNATURE OF 11 DEMOL APPLICANT VALUATIONS O-_ APPROVALS DATE INSPECTOR n SIGNATURE FEE FEE E O Q FOUFNODDATIONA LOCATI S111 I BRACING, OLT HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION FRAME FIRE STOPS, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY N, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- A V FURNACE LOCATION, TION I CERTIFY THAT IN OD ING THE WORK AUTHORIZED HEREBY M. 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 INS CE LATH, EXT SIGNATUREF / L/ HOUSE NUMBER CORRECT PERMITTEE ' J- ��,111"` IA��YY�Y�� AND POSTED AOOR ES. 7.z2:%-� FINAL JOHN F LEWIS, PRI CI PAL 5 TURAL ENGINEER PLAN CHECK VALIDATION cK M o cAnH _ PERMIT VALIDATION cK No cASN t4r, 40899 mml6 1 0 6.00 4 TEMPi,E I.ITY ]WIM"IMMY BD APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES woLD ISSSG 805 Temple CityBlvd. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY Temple City, California JOHN A LAMBIE, COUNTY ENGINEER NEAREST Lower Azusa Road WI IAMA JENSEN our Tor BUILDIMG CRO$SST DIST N GROUP TYPE P OC D FOR APPLICANT TO FILL TIN Q Z CONST ADUILDINGDRESS 4805 Temple Vit Blvd. STATISTICAL CLASSIFICATION SEBWKR MAP CLASS NO DWELL UNITS LOT NO33 Temple Ulty., BLOCK NUMAP MBER �.O H ATE YES TRACT 14647 USEZONE1 SPECIAL SIZE OF LOT 0X107 NOW ON LO g 1 CONDITIONS USCOF EXISTING BLDGIce Cream BUILDING EXIST TEL SETBACK YARD HWY STREET NAME WIDTH OWNER I TE 1 FRONT / ADDRESS 132 E. LivgOak Ave.Arcad I SIDE ! ARCHITECTP L ENGINEER INSP N RECO DRESS Ol CO t. 4-7459 /oo /7 > TEL I ( 119I r /�/ J�'L.. (fes O CONTRACTOR # - / ^ V ADDRESS 1 2 E. Live Oak 2151 `1 `"' ��'"'�' G - Arcadia DESCREMON OF WORE i / /� / ✓ �Wo�' �� G— Uf NEW ADD ALTER REPAIR DEMOLISH /� ,/ j�� Z SO FT NO OF NO OF A 1!I/c ��S //JA /�f5�`E SIZE I STORIES FAMILIES .- SUSE OF TRUCTURE Hamburger IIni SIGNA APPLICAN VALUATION O I( APPROVALS GATE INSPECTOR 991GNATURE FEE L� FEE E �- FORMSMATERIALS FOUNDATION ION P C PMT FRAME FIRESTOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS RKGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE OF THC WORK FOR THIS PIRMIT IB IB O 1 SHALL NOT LATH INT EMPLOY ANY PER N IN Y MANNER 80 A ME BU.ECT TO THE WORKM S CO SATION L F C FORNIA LATH EXTUSE NUM SIGNATUR ^JHECT AND POSTE (0 /iI ' PERMITTE I ADDRESS FINAL ArcaUla, a O a CLYDE N DIR PRI GIPAL SiR RAL ENGINEER PLAN CHECK VALIDATION c No CASH !y PERMIT/VY LIDATION cK No GAMIN ? ! 6 G J U 4. 5 � ' 1 F T8A8MACEN80]28] APPLICATION FOR BUILDING PEWIT ,, COUNTY OF LOS ANGET BUILDING / DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY F JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SU•T Or BUILDING CROSS ST DISTRI T O GROUP TYPE R ED BY FOR APPLICANT TO FILL. IN �� Z CONST BUILDING 1 /r STATISTICAL CLASSIFICATION SE RMAP ADDRESS CLASS NO DWELL UNITS �� K G LOT NO BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE TRACT / MAP H1aNwAY NO OF BLDGS / NO (CIRCLE) SPATE MAJO CON LOCAL SIZE OF LOT NOW ON LOT USE ZONE SPECIAL 1-71 CtR USE OF EX STING BLDG e,� e� PA/��Q� C CONDITIONS OWNER S F NO BUILDING EXIST O SETBACK YARD HWY STREET NAME WIDTH 11121 - ADDRESS Q ( -, pzo N /y7�YI� FRONT ARC ITECT ENGIINEER OR G/✓/�}}/Tn/��////�.I�jr��jjN��O�� QQJ /J/O SIDE ADDRESS /yd&06Nle &V'A; /eIV P L } ^', `� 0 CONTRACTOR CL�yf� • JO NO ')/�US ADDRESS 30 KC) 1 p/-2t/(t 0 O DESCRIPTION OF WORT{ G a NEW ALTER REPAIR DEMOLISH - SO FT NO OF NO OF SIZE STORIES FAMILIES USE OF C STRUCTURE ,?,-S /,:?,- SIGNATURE IGNATURE OF APPLICANT VALUATION $ 3 7d �� APPROVALS DATE IRBP 991oNATu ! PC PMT FOUNDATION LOCATION FEE $ FEE $ FORMS MATERIALS FRAME FIRE STOPS / 1 HEREBY AC.NOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATIQN WITH ALL COUNTY ORDINANCES AND STATC LAWS REGULATING GAS VENT DUCTS OU ILDING CONSTRUCTION I CENT'Y T116T IN DOINGITHE WORR AUTHORIZED HEREBY I WILL ,EI ANY PERSON IN VIOLA LATH INT TION OF THE UBO. CODC R T F CALWORNIA RELAY ING TO WORKMEN S COMR LATH EXT Q SIGNATURE OF HOUSE NUMBER COR / PERMITTEE a RELY AND POSTED ADDRESS �/ FINAL JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK '14 D CASH _ PERMIT VALIDATION CK NO CASH Lilo 7 4 6 3:- AER 9 4 4 D I U B I '! I 76 E ?,j�BeC*c003 3.89 � r , . ; • Q�PPLICATIO � Op IJ�L ING PERMIT COUNTY OF LOS ANGELES / s 1N0 O� F DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY F JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPT OF BUILDING NEAREST CROSS ST FOR APPLICANT TO FILL IN DISTRICT NO GROUP TYPE Co ST PROCESSED BY (PRINT OR TYPE ONLY) YO BUI L0I NG 5 �� ' pp STATISTICAL SLA IFICATION SEWER MAP ADDRESS S71`\' CLASS NO lbl UNITS BK G, PG LOT NO '� BLOCK USE ZONE NMA OP I�0 TRACT SPECAL NO OF ON! CONO TIONS F, FYI Q SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG BLDG SETBACK FROM OWNER a TENOL /5f FRONT PROP LINE OF (STREET) TYPE OF EKISTI BETBACK HIGHWAY + YARD = TOTAL ADDRESS H ) HI6M WAY W��IjjDTH FROM C L CITY A'C_. O O' 'YO' ` _ ARCHITECT OR _ TEL BLDG SETBACK FROM ENGINEER NO SIDE PROP LINE OF (STREET) PE OF EXISTNG 9ETBACK HIGHWAY + TARO = TOTAL ADDRESS Ai A7 HIGHWAY WIDTH FROM C L TEL + CONTRACTOR NO I LIC - AGGRESS NO CORNER CUTOFF YES _ NO ❑ C LIC V CITY CLASS SEE REVERSE SIDE FOR SPECIAL,APPROVA" n CONSTRUCTION LENDER NAME AND BRANCH 11I ADDRESS ,= (5,4 SO FT NO OF NO OF 2 SIZE STORIES FAMILIES NEW �A USE OF ADD ❑ , Ac STR ULTUR AV O U ALTER ❑ ^1 REPAIR ❑ _ "' -�.n '�t�,dll SIGNATURE- DEMOL ❑ APPLICA VALUATION l DA oo P` "APPROVALS _ AT INa P[ Kw • H uRc P C o PMT /O /j� FOUNDATION LOCATION FEE 5 '3 FEE E/L , J V MATER IA LS FRAME FIRE STOPS, - HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRA LT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT, DUCTS FURNACE LOCATION, i WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH)INT j OF THE STATE OF CALIFORILA IN RELATI G TO KMEN S COM- PENSATION INSURANCE LATH TEXT 1 SIGNATURE OF PERMITTEE HOUSEINUMBER CORRECT L J L � ANO POSTED � ADDRESS-3//'/ FINAL �—� JOHN F -LEWIS PRINCIPALS URAL ENGINEER PLAN CHECK VALIDATION LCS� H' o CA$H _ PERMIT VALIDATION CK M 0 CASH tAr,, 3468R aw23 2 3 0 96.301t , apr_4 i 3 09 Mill ,'1 0, G'tr WORKERS COMPENSATION'OECLARATION hereby Daum that I haver certificate ns tion In,to ,elf - — APPLICATION_�FO_R BUILDING PERMIT insure or o certificate of Workers Compensation Insurance orp�cpr fi copy th r of S 3800 Lab C ) "' - yV(/ ��P� ,p n COUNTY OF LOS ANGELES ; BUILDING AND SAFETY - "'t. Policy Dorgan;lits !ice `�/�6rnir - - - Cemfied copy is hereby fumuh� �� FOR APPLICANT TO FILL I BUILnINr' O /'f! a ADDRESS (N', Fkr Cendied copy is filed with'the county bwlding inspe< A DRESS p' lG e /Zeduz�7 III le tion'depanmenit s `i ADDRESS O (/ Date �� Applicant, `� ? CRY 1- ZIP L ' LOCALITY `CERTIFICATE OF EXEMPTION FROM WORKERS _ "' NO OF BLDGS- - • I NEAREST COMPENSATION INSURANCE I" SIZE OF LOT NOW ON LOT ST (This sechEROCK l0T NO on'need not be completed if the permit is for one --- - -- -- - - -- ASSESSOR -- - - hundred dollars (SI00)Or less ) TRACT ) MAP BOOT( PAGE PARCEL OWNER Y m � - ' NO ' USE ZONE I certify that in Hie performance of the work'for which this ,r permit is issued'l shall not employ any person in any manner _ _ _ _ _ _ __ //s ?i SPECL4L -"-' _ ` " " ' 6 so as to become subject to the Workers'Compensation Laws ADDRESS `� CONDITIONS V _ _ - _ _ `— i, CITY_ _ ZIP _ Date ` ' ' Applicant ' ' ' i i S __ _ _ _ r ,K NOTICE TO APPLICANT'-If'after making this Certificate of ARCHITECT L DISTRIC7_ GROUP TYPE _FIRE _ D BY_ _ Q Exemption ' you should become subject to the Workers NGINEER NO T ZONE c Compensation provisions of the Labor Code, you must forth ADDRESS �" 3 _ •- wlthicomply with such provisions or this permit shall be TEL IN STA FICATI AP7 COtJ00 = deemed revoked r'1 �. I CONTRACT, -( � _ Z DWELL UNITS' LICENSED CONTRACTORS DECLARATION 1 - - - -- - LIC - CLASS N0 j 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESV ��Ir NO (commencing with Section 7000)of Division 3 of the Bininess and SEWER MAP 'I Professions Cade, and my license is in full force and effect CITY CLASS 'BK _ PG- 'I VALIDATION - •),I) ? 0 1 _ _ SO FT __ - N0 OF_ NO OF _ _ _ _ CHECK I , License Num lAf�'T ./ Lm Class SIZE STORIES FAMILIES ONE VALUATION / DESCRIPTION OF WORK - NEW' O ' Contractor ' hJ _Dote _ - ADD 0 1 am exempt under Sec , ' y ALTER B 8P C for this reason _ REPAIR Da USE OF DEMOL i I EXISTING BLDG Jef --Signature APKKANT TEL flNAI _ I OWNER-BUILDER DEC ARA I _ _ (PRINT)_ NODATE - I hereby affirm that I am exempt from the ntroctor s License Low for the following reason (Section 7031 5, Business and ADDRESS q 1 -Professions Code) ` _ "" PRESENT BYaoa,4 ❑ BUILDING I, as owner of the property or my employees with ADDRESS wages as their sole compensation will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044 Business and Professions Code) MOVING - TEL I as owner of the property, am exclusively contracting _RAROR NO with licensed contractors to construct the project (Sec- tion 7044 Business and Professions Code) ADDRESS ' I §9 8 Q 5 A -- CONSTRUCTION LENDING AGENCY -- - REF BqED YARD HWY TOTAL SETBACKPROP UNE WIDTH - - �-- - � - 7 - - - - -- I hereby affirm that there is a construction lending agency for, FRONT t I `� is is • • "]-' the performance of the work for which this permit is issued + PL- (Sec L-(Sec 3097 Civ C ) SIDE 2,---• 4 9 818' I 3 Lender s Name-j��_ P L . 4,9 8 tai� i S - __ _ LDMA Ref N - - - P C Fee S '- ' Perme Fee- = Lenders Address � 0 3 1 9-8 4 I certify that I have read this application and state thot_the -_ _ - Issuance Fee - a - IDMA P/C N - I ---- above information is cored I agree to comply with all County Imestipotion Fee - ordinances and State jaws relating to building construction - T.11F. - LDMA Pwm-N and hereby outhoriz sentatives of this County to enter $ u e above- niton p or mspedi" p `pose 1 ' _ _ 1SEE REVERSE FOR EXPLANATORY LANGUAGE I i 1 Signature of p ic 1 or Agent _ e APPLICATION,FICRBUILDING PERMIT _ COUNTY OF LOS ANGELFES BUILDING AND SAFETY • WtIRKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN EUG � I hereby affirm that I have a certificate of consent to Self insure �RL01 I, or a certificate of Workers Compensation Insurance or a Cerhtled aw y� copy thereof (Sec 3800 Lab C) crTv ZIP 9)7pv LOCALfTY , PolicyCOrnf>arry SIZE OF 107F V, NO OF SLOGS NOW ON LOT ❑ Certified copy,s hereby furnished NEAREST CROSS ST ❑ Certified copy,is filed with the county building Inspection774� / 6`'� BLOCK LOT N j� !l~�' �/1 o department 7 J USE ZONE_ MAP NO Date Applicant ASSESSOR MAP BOOK PAGE900 s/ PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO Yes — COMPENSATION INSURANCE U . WITL WITHIN 1000 FT OF SCHOOL' NO dolls s($10 need not be completed d the permit O la one hundred E /l� ./fN 4Q- dollars ($100)or less) p OO !'✓ DIBTAIGT GROUP TYPE CONST FIRE IDNE PROCESSED BV I cerbN that In the performance of the work for winch this perms CTTY A�AIOr ZIP`TJ O ✓ �J 8-0- �.V is issued I shall not employ any person In any manner Bo as to ll become sublet[ tot Workerafom�L JLaws AR Ci OR ENGINE - SEL} 1-0 � CONDO Date ��L`>, (;�••yl 71TT�'� CLASS CL'ASS'IFICATK)N Ppphcant ADDRESS CUSS NO � DWELL UNITS NOTICE TO PPLICANT If after makig thus Ceruflcate of ` `L REWIRED TOTAL EM Exemptmn you should became sublect to the Workers TOR N__Op/ SET BACK YARD HWv PROP )• WID Compensation provlaiere of the Labor Code you must forthwithOo%'d'j'� Rt .1 comply With such provisions or this permit shall be deemed revoked ADDRESS yuGr NO FROL NT LICENSED CONTRACTORS DECLARATION c. L4 3` J PDE TONAL 193112 I hereby affirm that I am licensed underprovisrore of Chapter gfo� �" ' P LMAp - lcommenanp with Sectlon,7000)of Division 3 of the Business and SO SIZESNO OF STORIES NO OF FAMILIES ER NEW ❑ BK PO Professions Code and my, license IB In full face effect ► CHANGE ,[I� License Number ( Lc Class DESCRIPTION OF VAJRK ADD ❑ VALUATION Conimctoi�'��4- Date — N49"AJ, ALTER ❑ $ 170130-131701 12,12"", ❑ 1 am exempt under Sac R� REPAIR ❑ $ 5-T7 BBPC for this reason DEMOL ❑ U� LDMA IF r ! W Date us EX1 G BLDG URM ❑ T Signature Z lFRBJTI LL LDMA Pum• / Z 1 , 1 ❑ I as aver of the property will d my er ork and heh wages as . A t O MCcT.T their sole canPareahon will do the work and the structure Is _not intended or offered for sale [Section 7044 Business and _ A FINAL DATE I Professions Code) OR TIE A CON OR G A BUY.DLA ODCWM HUAL T A R WEA IiR WIIE E '� 1 ITEr1u ❑ I as aver of the Property am exclusively contracting vnih OR A IAznuE NNWNND A HAZAranouB MATERMI EQUAL ro OR aREATEa Tlwu THE ng AlAO1MIS SrfcmED ON THE HAZANDaIS MATFJMLa INFO 1,YMOl GUN' licensed conireclors to construct the project (Section 7044 vEa❑ NO� FINAL BY ` > rr TOTAL 240 . 30 Business and Professions Code) wLL THE INTENDED USE OF TIE 13SOU1O BY Tiff APPJCNa OR FUTURE BULONG CHECK - 240.cCI OCCUP PEDIARE A F RAR FOR 001,1 CrgN ON OODFILRIDN FRAM TIE 9IX1TH CONSTRUCTION LENDING AGENCY COAST AA Qu NANAFEMENT DISTRcT ISCAam1 SEE FEm,rTTcul c CKUST FOR hereby affirm that there is a construction larding agency, for ❑ s N ^ i ` CHANGE .J! 'N the performance of the work for which this permit is issued(Sec Yfs ' m 3087 Cry C) IHAVEREAio THE HAZARDDl9 NATERIALSINFCYAMTKIN aI1PE AND THE 9LAg0PERMnTlA3 H CHECJ(LIST I UNDERSAND TTLE2W REPUREWNTS JNOi TIE LOS A I-ES COUMY CODE 13000-13601 1/?QI TC Lenders Name IMlEflV18 REPOmIaNO pNDC9 ZCm)1WNO A PE(AfT�FItOM THE 9CIgMD� A5 Lenders Address 5 3720 1 AMILI: 1x1 O aAren rA rumor I oeTbly that I have read thus appi,calbon and state under penalty dof penury that the above mformahon is correct I agree to comply PC FEE PERMIT FEE , with all count Insnces and State lawn relaMg to budding Canstr and Direby authorize representatives of this County ISSUANCE FEE / to upon t red property fpr inspection purposes n (� m �'y,• �• A/J, // NVEST aATION FEE TOTAL FEE o.. SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT y COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BULd'N! ss hereby affirm that I have a certificate of consent to self insure BIRDN RESS �� —' , O or a certificate of Workers Compensation Insurance or a cerlif ed lJ 6 cell" L✓0 copy thereof(Sac 3800 Lab C I � �€ Gs LOCALITY en'ZF2 Policy No Company SIZE OF LOT NO OF B S NOW ON LOT ❑ Certified copy is hereby furnished` NEAREST CROSu ST ❑ Certified copy s filed with the county buildrlg Inspeclan i TRACT BLOCK LQI NO '1-exZ� department - 3 USE ZONE MAP NO _ Lp Date Applicant ASSESSOR?013 JBOOI( RY3 PARCEL SPECIAL CONDITIONS Z CERTIFICATE OF EXEMPTION FROM WORKERS' awNER TEL No - 00 COMPENSATION INSURANCE a^'/ WRHIN 1000 FT OF SCHOOLS VES NO (Thts section need not be completed it the permit s DISTRICT one hundred "m om 0 N CmDISTRICT GROUP TYPE CONST FIRE ZONEZPROGESSED BY dollars ass) MIR I Dertity that in the performance of the work for which this permit �+p.w is Issued I shall not employ any person in any manner so as to A4�c/ become Subject to the Workers Cion tion Laws AACH CT OR ENGINEER - TEL NO ��(�5� SlATISTICAL CLASSIFICATION APT CONDO Datel—V /J Applicant ��LYd� ADDRESST-�,� \ - t CLASS NO DWELLUNM NOTICE TO APPLIGMT If after making this Certificate of �`A r U -.D A/wrn o A-+ REWIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the Workers CONTU&CLORR SET BACK YARD HWY PROP LINE WIDTH Compensation provrears of the Labor Code you must forthwith '15 _ ccmpN with such provisions or thin permit shall be deemed revoked ADDRESS LIC NO - P L _ LICENSED CONTRACTORS DECLARATION --6 ~ SIDE CITY UC B P L I hereby affirm that 1 am licensed urderprovslos of Chapter'9 SEWER MAP , (cornniencing with Section 7000)of Dwiswn 3 of the Buanhess and SO FT SIZE NO OF STORES NO OF FAMIUES Professors Code �a`V my license s in full force and effect NEW ❑ w PC ► }d Lovers,Nurr �71Z.5 L. Class $ DE N of Worm ADD ❑ vALUATaN O Contractor (yrflpate 1-31 Yr ALTER ❑ $ ❑ 1 am exempt under Sec REPAIR ❑ _ p�p BBPC for this reason DEMOL ❑ LIIfAA P/C♦ •T Date USE OF EXISTING BLDG (IRM ❑ 173017 5I{.00 Srp'iature APPLICANT(FIRWT) TEL NO IDMA Porm I - 1 ❑ I as owner of the property or my employees with wages as I their sale compensation will do the work and the structure s ADDRESS Al'- ,AT ' not intended or offered fa sale (Section 7044 Business and FINAL DATE C '�-1 7 1U7.1U Professions Code) WL1 TIE To or EI OR AF0.1GNr F eU1DIIle OCCIiMNT WlCIE A ILVlJAOUS INSEnN1 El3—I6�Q JJ'JJ CCNnN A iNIAnDeVe NATERL O eREA1ER TIMN TIE I� 88 owner of the property em exclusrvey contrachrg with OR A MIXTURE M10Wna SFECFED ON ThrE ABopus MAMEFi a Irso TION ai oE, FINAL By > 2 ITEM licensed contractors to construct the project (Section 7044 r s❑ nom_ (ifTAL �c b� Business and Pmfesslors Code) wu THE wrQUEo use of TNR euoEr+a e, ThE APPLICANT as FunrtE eT-FLao N CONSTRUCTION LENDING AGENCY OuOn PE"Mu°EARa�ME o°fS IfTnNCIFCONE USTFfRwR CHEi_K 157.tG I hereby affirm that there s a construction lending agency for ❑ sND�_ , (HANGE i .09 m the performance of the work for which this permit Is issued(Sec IwwE REw TIE NnznoousNwERws r1FORMATIONOUDE AID TIE SUpr.O FERMTTNA N 3097 CIV C) pECw.Isr lRII1ER3TMl0 NIY REOOGEMF.NTa UNDER THE IDs AN[E1Es DOI.MV coOE 1 1 TIRE 2 a TER 220 SEDT S 220100 Tli✓d1G4110140 CONOERNM NAIAPDOU9 Lender a Name rAATEwus REvormw ANo FOR oawNro A vERwr FRw TIE screw 1 1 I 1 I �I} !: /, e ax Lenders Address jp i 0 5 1 fl'11i1��_ I certify that I have read this apoicatXlfl and state under penalty of penury that the above Information Is correct I agree to campy PC FEE rO PERAUT FEE with all county ordinances and State laws relating to building L7 T/ •l O oC .7 S construction and ¢reby authorize representatives of this County ISSUANCE FEE // , to enter u rn•l' ova-mentioned property for Inspection purposes (o �� 47 1 NVE^uT10ATION FEE TOTAL FEE o.. SEE REVERSE FOR EXPLANATORY LANGUAGE ,