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HomeMy Public PortalAbout5029 TEMPLE CITY BLVD_Building__ L r-2=TMENT OF BUILDING AND SAFETY�;Za 2, APPLICATION FOR PERMT COUNTY OF LOS ANGELES WM J. FOX. CHIEF @I FOR AM=70 FILL IN FOR OFFICE USE ONLY � �T DISTRIp NO PLAN CK NO RMIT NO BUILDING V(/1 1 !C ADDRESS 0 (,�J al T 1 [IVES Y AT. OFAPPL DATHISSU[D LOCALITY �Y (/ NEAREST i �'I �- // CRO QT v CAZE BUILDING ADDRESS D Q / OWNER �( A MAIL LOCALITY Let ADDRESS /nl'J Q / NEAREST .�L CROSS Cf CITY j-,I/ NO 147' 7 7 ( FIR[ NO OP•�� P ARCHITECT OR' TEL ZONE PLANS ENGINEER -`r�� �[ NO BLDG O SETBACK LIN[ O ADDRESS I APPROVED "r THL BY DAT. CONTRACTOR lZ.w NO , 7. '}1 1 US[ /) APPROVED j.., J ZONE (-}� BY DATE ADDRESS /w-]� /��, /l�1- - .i�L, HOUSE NUMBERING LEGAL / DESCRIPTION LOT NO (� O BLOCK MAP NUMB IELD CHECK BY TRACT NO ASSIGNED SY ATic NO OF BLDGS CO TIONS Blze oP LOT NOW ON LOT / e�(M-A.6a FiW w,T as 6r 0 7 c� 3/ UBEOP NO OF EXISTING BLDG Q/fj- PwHlup / �-(S -sz DESCRIPTION OF WORK NEW I ALTERATION I I ADDITION I Qw. T Cn "� AJOT d� 2 NL�6 ,Om'C /d Fc�Id O RtPAIR I D.MOLMON A GQ� c7 P o BO PT NO OR // � SIZE 'V ROOMS C� STORIES .y . U > COVER NO -Y'(ICCp COVERING / / E' �M,�� P USE OF STRUCTURE i i FL G / 7 c2o OVAW INSPECTO SIGNATURE DATE I HHR[DY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STAT[ THAT TH6 INFORMATION 61VEN IS FORMS, MATERIALS 4 /i CORRECT 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRESTOPS. �1ER[ON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS / LAWS REGULATING BUILDING CONSTRUCTION FURNACE LOCATION. / G / SIGNATURE OF I H � ; GAD VENT. Duero - d aA PERMITTEE / t' / I LATH, INT f ADDRESL 9.. yX'�w� -IA/S-- Gt.� . LATH, EKT L' / AUTHORIZED AOT PLASTER, INT TOwpOA OW 10.00 s P C 0 B � � Faa PLASTER, 8XT s vALuwnoN F[. ©_ FINAL 4 y G . 'L y WORKERS' COMPENSATION DECLARATION here o affirm that 1. f W r cs'Co to of tion Int to ,elf � APPLICATION FOR- BUILDING PERMIT .insure or a certificate of Workers' Compensation Insurance, ` or a certified copy thereof (Sec 3800, Lob C ) - COUNTY OF LOS ANGELES BUILDING AND SAFETY ' Polity No Company ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN %DRRFISSSS p ❑ Certified copy r filed with the county building inspec- BUILDING 51Y2 tion department ADDRESS JO GIT Q p CIT)l Date Applicant CITY ZIP 7 7 0 0 LOCALITY _ NO OF BILDUSNEAREST- - CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT d NOW ON LOT CROSS Si COMPENSATION INSURANCE I ASSESSOR (This iection need not be completed if the permit is for one TRACT #33.2 ,7 BLOCX I LOT NO MAP BOOK - PAGE I PARCEL hundred dolkm ($100) or less ) ` I OWNER XIAO-130M At I" L O USE ZONE MAP I certify that in the performance of the work for which this I - NO Permit is Issued, I shall not employ any person in any manner ADDRESS '- — CONIIAL so as to become subject to the Worker'Compensation Laws Ov CIIV &S ctV CA zip ?11940- Date Applicant �,�� ARCHITEI-T TEL DISTRICT GROUP TYPE FIRE SSED BV K NOT T AP CANT If, after making thea Carl, of ENGINEER -NO CONST ZONE Exemption, you should become subject to the Workers ,,'^I1 Compensation Provisions of the Labor Code, you must forth ADDRESS - - TV with comply with such provisions or this permit shall be TEL STATISTICAL CLAS.SIFICATIDN pApr CONDO deemed revoked I CONTRACTOR NO ���� z LICENSED CONTRACTORS DECLARATIONIC t CLASS NO DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS SDs, 7—C/4 pir- (commencing swithCo Section 7000)of is in fu 3 of the Business %.. LIC SEWER MAP and Professions Code,and my license is in full force and effect CITU i•/s'� CLASS BK PG VALIDATION SO FT NO OF NO OF CHECK - License Number Lic Class SIZE ORIES 1 FAMILIES 1 ONE VALUATION , Contractor Dote DESCRIFIION OF WEIRK NEW ® S _ ADO ►❑I am exempt under Sec ALTER ❑ B 8P C for this reason REPAIRUSE OF ❑ _ Oats EXISTING BLDG DEA10L ❑ Signature - 'i' (P I -�0 t O O FINAL OWNER-BUILDER DECLARATION _. DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS �� .�.� ` Low for the following reason (Section 7031 5, Business and . FINAL - ■ Professions Code) By BUILDING _ LalQ 1 as owner of the property, w my employees with ADDRESS I r 3W 1W.88 wages as their sale compensation will do the work and the structure is not intended or offered for mile(Section LOCALITY , 1, Jlt 1 ITEMS ' 7044 Business and Professions ssions Code) 1+�C�r.8'$ CONTRACTOR NO J ,VTIwlI, as owner of the property am exclusively contracting �L� with licensed contracto4, r CELL to construct the project (Sec- ADDRESS - - ` K M.8888 lion 70Business and Professions Code ) -- - ` /yEAss�� Iyy CONSTRUCTION LENDING AGENCY SET B� YARD HWY AlPROP CK FROM WIDTH NFy�e .00 I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L ` (Sec 3097, Civ C ) SIDE I Lender's Nome P` J 0000-=1 6/15/89 SMA Ref Y 2 Lender's Fee a Address , "90 1 AM 8j44 o "1 certify that I have read this application and state that the Issaance Fee LDMA P/C III above Information Is correct I agree to comply with all County Inveaegolion Fee ordinances and Stare Iowa relating to building construction, Total Fee LDMA Perm Y < and hereby authorize representatives of this County to enter _ Y v - RY4 upon the above mentioned property for inspection u s /_S _ SEE REVERSE FOR EM XNATOEY LANOU SiRnatwe of Applkont gent i � fj