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Home My Public Portal About5132 TEMPLE CITY BLVD_Building__ APPLICATION FOR COUNTY OF LOS ANGELES RTMENT OF BUILDING PERMIT °BULDNGANDSAFNTY fTY DIVSIONR FOR APPLICANT TO FILL IN DI 'SSADRE BUILDING ADDRESS / J/L241a ell LOCALITY ry r/ CROSSNEAREST C f� �i ZIP CROSS ST NO OF BLDGS SIZE OF LOT GY NOW ON LOT--% 1• MAP BOOR (5-41pK PAGE EL _ DISTRICT P TYPE FIRE P SSED iRACi� BLOCK LOT NO �A ^ 3 CONST NO v OWNER - //pp .�./ STATISTICAL CLASSIFI TION SEWER MAF ADDRESS a - / L// CLASS O _DWELL UNIT$ BK PG CITY loo�ls ZIP LISf�Zf7NE MAP ARCHITECTOR TEL r O ENGINEER NOPICIAL CONDITIONS ADDRESS TEL ROAD DEPARTMENT APPROVAL REQUIRED YES❑ O ❑ CONTRACTO /V/a �f NOo Ve-64fl BLDG SETBACK FROM FRONT PROP LINE OF (STREET) ADDRESS X40 ,S�LOHIGHWAY + YARD TOTAL SETBACK FROM I TV PE OF EXISTING CITY ��cG.l LICKS �" FRONT PROP LINE HIGHWAY WIDTH CONSTRUCTION LENDER + i NAME AND BRANCH O BLDG SETBACK FROM v ADDRESS CITY SIDE PROP LINE Of (STREET) SOFT NO OF NO OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPEOF EXISTING SIZE $70RIES FAMILIES ONE TOTAL PROP LINE HIGHWAY WIDTH + DESCRIPTION OF WORK NEW 2- ��j ADD CORNER CUTOFF YES ❑ O El ALTER IN OPEN SPACE YE ❑ O ❑ REPAIR USEOF ./� �� DEMOL IN COASTAL PERMIT ZONE YES ❑ O ❑ EXISTING BLDG Y Off APP(PRINT)LICANT TEL -60?- " BY(SIGNATURE( ?� !`w^•� 2-S60-0 ZV/7 9 1 HEREBY ACKNOWY THAT I HAVE READ THIS A ICATKN AND STATE �p•�yLI (:v THAT ME ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCE AND LAV REGILATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I N7 NOi EMPLOY ANY PERSON IN VKXATKN OF THE LABOR CODEOF THESTATE LIFORNIA IN RELATING TO WORKMEN S COM PENSATKNINSURANCE PERMITTEENARE OF FINAL (� �J p�� 'BY DATE ADDRESS �(1• X�3/// / e�J/L/lj 6 (/ TCL PC C Fee S Permit Fee / CITY N VALUATIONIssuance Fee iota- Fee PLAN CHECK VALIDATION ' ac r o CASH PERMIT VALIDATION o 'CASH/ h 9 7 8�JUL d8 1 D 3 4.0 Qat'* OS 7eAAIWACI!10 a en> s. WORKERS'COMPENSATION DECLARATION hereby affirm that I hovea certificate of consent to ,elf APPLICATION FOR BUILDING PERMIT insure or a certifmote of WorWorkers' Compeneahon Insurance or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY " Policy No Company BUILDING Certified copy is hereby furnished r FOR APPLICANT TO FILL IN ADDRESS S/ 3 Z e ed4 R ) Certified copy is filed with the county budding mspsc BUILDING nn hon department ADDRESS { l'� 7 Date Applicant CITY o ZIP LOCALITY `Q O c, NO OF BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST (This section need not be completed if the permit is for one TRACT BLOCK LOT NO ASSESSOR hundred dollars ($100)or less f MAP BOOK PAGE PARCEL TEL (PI USE ZgyE I certify that in the performance of the work for which this OWNER — J lr NO _ permit is issued, I shall not employ any person in any mannerADDRESS. ' K SPECIALi so m to become subject to the Workers'Compensation Laws CONDITIONS Dole APP crrr i ZIP O NOTICE TO APPLICANT If, after making this Certificate of ARCH TEL DISTRICT GROUP TYPE FIRE BY O Exemption, you should become subject to the Workers ENGINE R NO { CONST ZONE U Compensation provisions of the Labor Code you must forth ADDRESS V/Q - with comply with such provisions or this permit shall be L STATISTICAL CLASSIFICATION APT CO N deemed revoked CONTRACTOR NO �� Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO �.s _DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 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 CLASS BK PG VALIDATION ' - SO FT NO OF NO OF CHECK License Number tic Class SIZE STORIES FAMILIES ONE -vuuAnoN Contractor Date DESCRIPTION OF\YORK A NEW ^ $ , 1 am exempt under Sec ADD TER B CLP C for this reason �'Y�G AIN $ Date USE OF EXISTING BLDG DFMOL Signature APPLKANT - TEL FINAL OWNER BUILDER DECLARATION PRINT stisA NO S DATE —,� 1 hxeby affirm that I am exempt from the Contractor f License ' Low for the following reason (Section 7031 S, Business and ADDRESS R Professions Code) PREMISIT 8 0 kis 9 A BUILDING 1 as owner of the y employees ADDRESS # property a m em to sits with ADDRESS • e • e i i wages m their sole compensation will do the work and LOCALITY the structure a not intended or offered for sole(Section 7041, Business and Professions Code) MOVING - TEL I as owner of the property, am exclusively controciinp CONTRACTOR NO ( e 7 a with licensed contractors to construct the project (Sec- ADD - • e e%& Q 0 En tion 70", Business and Professions Code) ' CONSTRUCTION LENDING AGENCY I YARD KWY AL TOT LINE WIDTH '=`t p 9 BACK FRUIrI% EXIST06t-88 1 hereby affirm that there a a construction lending agency for _ _- FRONT—_ __ _—_ _ _—_ —the performane o cf We wwk foi which this permit is issued - — P f (Sec 3097, Civ C ) - SIDE PL Lender s Name DMA Ref R - PC Fee f Perms Fee Lender's Address pop certify that I have read this opplimtion and state that the - luunnce Fee L TDMA P/C R above information a correct I agree to comply with all Countytnvahgouon Fee $ ordinances and State Iowa relating to building construction Taml Fee TDMA Perm R R and hereby authorize representatives of this County to enter upon the obove entioned property for inspection purposes A/ —O 11111 REVEM FOR EXPLANATORY LANGUAGE W/,l � IYL i Sp of Applicant«Agent - Daie - � '