Loading...
HomeMy Public PortalAbout5780 TEMPLE CITY BLVD_Building__ 76 BA CE#808 9-88 FOR' I 1 G PERMIT APPLICATIONR BU LD COUNTY OF LOS ANGELES BUILDING- DEPARxMENT-'OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY'DIVISION JOHN A. LAMSIE, COUNTY ENGINEER LOCALITY COLEMAN W. JENKINS,- SUP•T•OF BUILDING NEAREST CROSS ST. DISTRICT NO. G UP TYPE• PRO ES BY FOR APPLICANT TO FILL IN Z CONST. Print ort a onl' ). ©r BUILDING T of�� /�R STATISTICAL C SSIFICATION SEWER MAP ' ADDRESS, $OO � /E-x� C� Gr f CLASS NO. DWELL•UNITS BK PG LOT NO.J°�z BLOCK USE ZONE MAP CZ-(9 0 NO. (/ TRACT V� SPECIAL NO.OF BLDGS. .CONDITIONS SIZE OF LOT VO 1115- NOW ON LOT USE OF p EXISTING BLDG. O v IS BLDG,SETBACK FROM �� L. +'� FRONT PROP.LINE OF (STREET). OW NE �/ ( TYPE OF EXISTING SETBACK HIGHWAY } YARD _ -TOTAL ADDRESS6'VOQ TE Al Eke C, 3;, HIGHWAY WIDTH FROM G.L. + CITY — M'pLr= C ITT BLDG.SETBACK FROM ARCHITECT R TEL, p/o� SIDE PROP.LINE OF (STREET) ENGINEER Nr /l. NO. /.3 TYPE OF EXISTING SETBACK HIGHWAY + YARD --= TOTAL ADDRESS 3 HIGHWAY WIDTH FROM C.L. CONTRACTOR- p•Wi� Q NOL 33/- o/ + /.So a� ADDRESS. /•r 134t e &C 411-;NO. O. CORNER CUTOFF YES ❑ NO ❑ C3 /? / LIC CITY C,,V _ � _ /! �!/7.Z-e LASS —1 „.._ -SEFIt- DESCRIPTION OF WORK - C `TAPPROACH, W AND PARKWAY TREE NEW ADD ALTER REPAI Emo ISFV J14" - ! SQ FT r� NO OF f O L �.�s_ •.i�..,.'L - ' :;atrr.•, approach i SIZE O STORIES ( FAMILIES• - _ _ ! 'a i. USE OF t'.• i,;l ;+ em y.. .. ••t �5 i STRUCTURE B / v �� t(ca, c: t. c. .. s_:.; .-. ::. A + v r�siay.` L! D_, tt`.i. a�:: 1l;,no�Astarte P unfit Pcrmir has h:� fsuacl. Apply ;or P_-ri i6j trco-pormlt a • SIGNATURE OF f�_ _ ..__.�.. _____.__ _ .,�• APPLICANT 10UST.RT9ii'ytjEE�CCE/� IVC'lii 1 VALUATIONdn_gVV.9_o_' .agppROVALS r• DATE INSP OR•S SI TUBE , P.C. J/ / - PMT. 7 f FOUNDATION: LOCI4TION 1 FEES /(Q p(�+ [FEE-5 ,�� FORMS, MATERIALS, '. 7 FRAME:AFIRE-STOPS•;" a\ •• t`\ 1 HEREBY ACKNOWLEDGE THAT i NAVE READ THIS APPLICATION BRACING BOLTS 1 , , ti•v AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. ' L WITH(ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS '••� s BUILDING,:CONSTRUCTION• 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED'HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- :j, -LATH; INT.; ••— _ s,_ .i•� .n i"• )r!IN! ING TO WORKMEN'S C MPENSSAATTIION�INSURANCE. � ,, ,t �Z.I%a��+�. Y"� L LATH, EXT. O HOUSE NUMBER COR- SIG PERMITTEE• RECT AND POSTED ADDRESS 2 LLd - ell G/ FINAL JOHN F. LEWIS, PRINCIPAL ST 'CTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O: CASH PERMIT VALIDATION CK. M.O. CASH LACo742 � 8 NUy26 23, 0 1 .6 1 L 8 3 2 oZ� Fu. 7 D 2707.5- 76A63#;%-46609167 APPLICATION FOR BUILDING PERMIT C.OUNT14OF LOS ANGELES. S U I L D I N G DEPARTMENT OF COUNTY ENGINEER ADDRESS swoow, nemeare Av laiij.. BUILDING AND SAFETY DIVISION L O C A L I T Y p JOHN A. LAMBIE.COUNTY ENGINEER NEAREST COLEMAN W. JENKINSSUP'T OF BUILDING CROSS ST. M he A4 Al- ' ,DIST ICT GR UP TYPE PR 5 BY FOR APPLICANT TO FILL IN p NST. BUILDING STATISTICAL CLASSI ATION EWER MAP ADDRESS E,r B/V� CLASS NO. D LL UNITS BK PG yg LOT NO. ^S BLOCK USE ZONE MAP' y90 ///��� NO. (/ TRACT O ,� SPECIAL L-7�II NO. OF BLDG'S. CONDI T O SIZE'OF LOT S!% NOW ON LOT USE OF EXISTIN BLDG. BE BACK FR / TL: FRONT P OP. LINE OF OWNER TOL: TYPE OF EXISTING I SETBACK IOHWAY + ARD = TOTAL ADDRE,.SS/ ,O O�, HI WAY WIDTH FROM C.L. CITY ! : -A ARCHITECT OR TEL. BL0.0. SETBACK FROM ENGINEER - NO. SIDE PROP. LINE OF (STREET) TYPE OF EXISTING. SETBACK HIGHWAY, + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. �HA grC• TEL y + _ CONTRACTOR-1 Z;a f NO % ,, ADDRESS C.' U1� NO 7.5 Z CORNER CUTOFF YES NO CITY E: `ICCLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS e DESCRIPTIOR OF WORK � I I NEW ADD ALTER REPAIR DEMOLISH SQ.FT. [[r NO. OF NO. OF SIZE IJ STORIES, FAMILIES USE OF STRUCTURE SI NATURE OF APPLICANTt d GV VALUATION$ �,O •O •DO APPROVALS D T INSPECTO 'SS A URE P.C. PMT. FOUNDA71ON, LOCATION 1/ FEE$ FEE$ `� FORMS,MATERIALS O FRAME, FIRE'STOPS, / 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS L AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION IV WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS GUILDING CONSTRUCTION. .1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. - LATH. EXT. SIGNATURE OFL�� •� HOUSE NUMBER COR- PERMITTEE REC AND POSTED ADDRESS .99-d-In"n FINAL JOHN F. LEWIS. PRIN 1PAL ST URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIONCK. M.O CASH I D 4 �.Q h n .... - .. ` • APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES BUILDING ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY •� ' ` ZIP BUILDING AND SAFETY DIVISION No.OF BLDGS. BUILDING SIZE OF LOT 491 X/7 NOW ON LOT ADDRESS ADDRESS TRACT C�rS 6 BLOCK LOT NOL/r57 7 LOCALITY TEO NEAREST OWNER NO ��� � CROSSST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE CESSED BY CITY ZIP j'a CONSTf ZON, I ARCHITECT OR TEL. �-J ENGINEER NO. STATISTICAL CLASSIFICATION SEWE AP ADDRESS CLASS NO. -.2—7-- DWELL.UNITS BK PG ' TEL �y CONTRACTO ' ' NOt7�0 // USE ZONE MAPLIC G G ADDRESS ��G~tg. N0 .31J�2 SPECIAL C LIC. CONDITIONS CITY CLASS C'3 ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP. OF )STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ O ADD ❑ BLDG.SETBACK SIDE PROP.LINE OF (STREET) O ALTER ❑ HIGHWAY + YARD = TAL SETBACK FROM TYPE OF EXISTING REPAIR 11 PROP.LINE HIGHWAY WIDTH , N UPS __ Z EXISTING BLDG. DEMOL C3 + APPLICANT TEL CORNER CUTOFF YES C] ❑ IPRINTI NO. IN OPEN SPACE YES ❑ NO BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION40 IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURA E. SIGNATURE OF PERMITTEE v ADDRESS TEL. DATE FINAL A EL !^^� -2� BY CITY NO. � MAKE CHECKS PAYABLE TO: FEE $• FET HARVEY T.'BRANDT,COUNTY ENGINEER 3-3 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONCK. M.O. CASH 2:= ' t; 27 1. 4 3.3D Asa T ®s 76A638A-CE 0803 3.75' (PL 6 N'�PAI TMENT OF BUILDING AND SAFETY" APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING 11VM. J. FOX. CHIEF ENGINEER PLANSBLDG. �4" FIRE DISTRICT O. PLAN CHK. FEE PERMIT No. FILED -(d�SETS I ZONE � ZONE �ECEIpT TYPE OF J1yp� / -7 * ` I , Jl �//t/yA `J 1 BLDG- 1 11 111 IV A X GROUP DATE J61r A/PjL. RECO IVED Y /DATE ISSUED BLDG. SETBACK LINE ORDS NO. �•�� ''� f APPLICANT FILL IN HEAFIV D PORTION ONLY � OBUILDING 4" S y E NAME ADDRE9 "p ®` f W ADDRESS LOCALITY W Z ~a NEAREST V W CITY CROSS ST. G' ® y STATE LICENSE NO. L. N,0.0" K NAME � WMAIL • (pFa NAME pp��,►�� � � ADDRESS O C ADDRESS ® !vA dr/�` CITY v r Y TEL NO. CITY s;r,,�F d!r•.+ , 1 � LOT S (p / _ _ SIZE OF LOT L7 V/I• U STATE y7r �G T NO. OF BLDGS. l LICENSE NO, ,S 4�d 1EL• N 4fI9! BLOCK NOW ON LOT /p �f � _10 USE OF BLDG. CLASS OF WORK I � NOW ON LOT --•� ; DESCRIPTION OF WORK dNEW ALTERATION I—{ REPAIR N I -I MOVING H I BLDG.F D �) !^ ROOMS INO. OF �� SIZE OF.O •� 8T )RIES No. OF tj BLDG. S FAMILIES I CORRECTIONS SPECIFICATIONS FOUNDATION z 9-347 4:v cav l � 6 MATERIAL EXTERIOR I PIERS THICKNESS TOP r �[ THICKNESS-BOTTOM ! et 0/1/ ]!/, DEPTH IN GROUND � a Z. S �ERSTRLICT RE em,-,f 31J 7 'SlaE 198PACING SPAN 1,a .+ , 'V IV /•/� !! `N a R. W. PLATES (S )_ r ., _ f d ss •` }'/r/� 7.2-2f GIRDERS JOISTS—FLOOR JOISTS—CEILI._- BEARING WALLS p PARTITIONS ROOF RAFTERS FINAL APPROVAL SILL BOLTS �- .!y'� 1 COVERING DATE '/ r�� �, IN6PECTOR's NAME WALL I ROOF I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE-fig CORRECT l�q AND AGRE T COMPLY WITH ALL COUNTY'ORDINANCES P.C. FEE/$? ND ST REGUL/TIN B ILDING GON5TRUCTION. �.f��j�/y SIGN /f VALUATION S � T 0 FEE •; F� O NBR OR AUTHORIZED AGENT 1311-8 1E-39 ~ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) " B UILDING T MP�.E Ci' c.'v,D COUNTY OF LOS ANGELES ,- DEPARTMENT OF•COUNTY ENGINEER d'La. a`a' zIP l`7$b BUILDING AND SAFETY DIVISIONBUILDINGNO.OF SLOGS.SIZEOF LOT/QO X I I NOW ON LOT ADDRESS —'s-'900 , /_ _'5'97 TRACT(0,5 BLOCK LOT O.. LOCALITY / TEL. NEAREST OWNER r JAL M �T10. -• ;� CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICTQUP FIRE CESSED BY !! JCTYPSE��j ONZ IR CITY ZIP jj �g �'D,q Fg �j ENG NARCH IEER OR TEL "'[ +;�ro!1 s� STATISTICAL CLASSIFICATION SEWER MAP T ADDRESS f2/. k/. S (J 1 'T`�a�L �' CLASS NO. DWEL-�LJZ ,UNITS •- BK P CONTRACTOR TEL. USE ZONE MANOP d / NO ADDRESS NO LIC' SPECIAL LIC. i'r CONDITIONS CIT-Y CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ � CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) n ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING C HIGHWAY + YARD SQ, FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH slzEgg,m ISTORIES FAMILIES ONE a + DESCRIPTION OF WORK NEW ❑ C ADD BLDG,SETBACK FROM D s SIDE PROP.LINE OF (STREET) ALTER ❑ HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE OFM_ t EXISTING BLDG. ft . DEMOL ❑ APPLICAN _ ,srnL, TEL (�� y� CORNER CUTOFF YES ❑ NO ❑ (PRINT) ISD�` /27 BY (SIGNATOR , , IN OPEN SPACE YES ❑ NO 1:1 qs IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ s (f "ro CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE S OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENS 0 NS URANCE. f� SIGNATOR PERMITTE _ .+ a / tv► � v 'y ADDRESS rf1 �. +•+ f' i •( .w �� It�r �� a2ti •�.�o. V 1r, ..tf!••. + •,) FINAL�1 CITY D' •- NOL•• •DATE jj +P.C. .LI;1tiEC.!lt::Fil�ScF?._I�1:r113L,L•7�Oc •FEE $ FEE HARVEY T. BRAN DT,,.COUNTY:ENGINEER -'����__� PLAN CHECK VALID6Pi ION,•'„• ;,, "M:Ot.,.:;cnsrl •:�'; PERMIT �LIDATION CK. O. CASH 7 5 5 LZ JUN 27 2 3 D 7 2.0 0-ems 76AG38A CE8803 12/72 _ 7 5 6i"r-JUN 27 1 0 3 8 8.5 0 OVO • COUNTY OF IAS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0802200013 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I TR: 6561 IT: 595 BL: .001 I SQ. FT STORIES TYPE I 5800 TEMPLE CITY BL I ISTRUCTURE: V-B I TEMP CA 917802112 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WORKMAN 1 18587-018-031 1 1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl 1TENANT: IEXIST BLDG USE: COMME USE ZONE: C-2 ISSUED ON: PROCESSED BY: EXPIRES ON: [ 1EXIST OCC GRP: 102/20/08 SR 08/18/08 I [OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: (FINAL BY: CODE: 1 IWONG, GLENN (323) 268-6714- 1 15800 TEMPLE CITY BL. 1 700 1 I� I 1 ITEMPLE CITY CA 91780 I FEES PAID IDESCRIPTION OF WORK lU/ I I IREPATCH STUCCO, REPLACE TWO PORCH POST [ I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( I (APPLICANT: TEL. NO: 1 1JUAN CASTRO (323) 793-1064- IAA BLDG PERMIT ISSUANCE 27.75 1 I 1918 W. 20 STREET IAE STRONG MOTION OTHER 700.00 VAL 0.50 ISPECIAL CONDITIONS: I 1LOS ANGELES CA 90018 ID2 PERMIT W/0 EN-HC 700.00 VAL 43.65 I I 1 TOTAL FEES 71.90 1 I ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE [ (JUAN CASTRO (323) 793-1064- 1 11918 W. 20 ST. LIC. NO I ILOCATION AND SETBACKS I I I IAS ANGELES, CA 90018 NONE I_ ISOILS ENGINEER APPROVAL I I I 1ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNOATION/TRENCH FORMS I I I 1 LIC. NO: 1 (SLAB,/UNDER FLOOR 1 I 1RAIS D FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: C24F:1 (UNDERFLOOR INSULATION I I 1150H269 3 Oil I I I I I I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: II I [ I 1 NO 22 1 IROOF SHEATHING I I I I SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALSI I I I I I NO NO NO 1 1FRAME INSPECTION I 1 (REQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS ISET BACK YARD: HWY: PROP LINE: WIDTH: I 1 I [FRONT PL- I (INSULATION/WEATHER STRIPI I I I SIDE PL- I I I I I I I IINTERIOR LATH/DRYWALL 1 I I 1EXTERIOR LATH I I I I I I I I I IRATED FLOOR/CEIL ASSEM. I I I (RATED WALL ASSEMBLIES I I I I 1 IRATED SHAFTS/OPENINGS 1 I IT-BAR CEILINGS 1 I 1LOT DRAINAGE (REPORT ID: DPR261 ROUTE TO: BS0508 1 1 I I I I APPLICATION� FO R6UILD'INOPERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR PLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure, BUILDING AD or a certificate of Workers'Compensation Insurance,or a certified CITY 'ZIP copy thereof(Sec.3809,Lab.C.) J _ �i 7�O Policy No. Company /�� -G•- LOCALITY SIZE OF T ,e NO.OF BLDGS.NOW ON LOT NEAREST CROSS ST�j J ' ❑ Certified copy is hereby furnished. W ❑ Certified copy is filed with the County building inspection TRACT BLOCK LOT NO. depart nt. USE ZONE MAP NO. Dat@=Applicant ASSESSOR MAP BOO PAGE%n PARCEL I �' F� �j i SPECIAL CONDITIONS CERTIFICATE OF EX PTION FROM WORKERS' OWNER TEL •^ WITHIN 1000 FT OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS (This section need not be completed If the permit is for one hundred 3, DISTRICT ..GROUP I.TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit to issued, I shall not employ any person in any manner so as to ARCHITECTOENGINEER TEL.NO. !rte become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 42?.2 DWELL UMTS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTORTEL_JA NO. SETBACK YARD HWY PROP LINE WIDTH VVCompensation provisions of the Labor Code,you must forthwith d_^ (IV �I FRONT comply with such provisions or this permit shall be deemed-revoked. ADD LIC.NO. PL' �ZMWI_�41 AZLE. SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P C I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP c� (commencing with Section 7000)of Division 3 of the Business and 80.FT.SIZE, NO.OF STORES NO.OF FAMILIES G Professions Code,and my Iicen Is in full force and effect. NEW ❑ BKI PG 0 License Number Z I DESCRIPTION OF WORK VA�UA= O D Lic.Class b C ADD ❑ Contractor Pate g �-� ALTER ❑ $ G d ' Z ❑ I am exempt under Sec. REPAIR ❑ B.&P.C.for this reason DEMOL ❑ LDMA PIC a Date. USE OF EXISTING BLDG. -URM ❑ i Signature APPLICANT(PRINT) TEL NO. LDMA Perm# Ti •, El 1,as owner of the property, or my employees with wages as —bb/ ' their sole compensation,will do the work and the structure is ADDR FINAL�� a not Intended or offered for sale (Section 7044, Business and .T f Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANTHANDLEA HAZARDOUS MATERIAL 1 f© 2 / OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a _ �;i,,, �r r-y _ _79 ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY y •.e 1. R_,r .. licensed contractors to construct the project.(Section 7044, YES❑ No•❑ Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH .;Z a CONSTRUCTION LENDING LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMO)SEE PERMITTING CHECKLIST FORGUIDELINES. 1 I hereby affirm that there is a construction lending agency for YES ❑ NO❑ the performance of the work for which this permit is issued(Sec. 3097,CIV.C.. 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD I - "-% -• PE'RMTITING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES • COUNTY CODE,TITLE2.CHAPTER 220 SECTIONS 220AWTHROUGH 220.140 CONCERNING _ _!.(•i - ic•_ Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. I J!I�� Lenders Address ONN���� vee-- I certify that I have read this application and state that the above information is correct. I agree to comply with all county P.C.FEE PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-"Ioned property for inspection purposes. S ro INVESTIGATION FEE TOTAL FEE r s m Allid Dme SEE REVERSE FOR EXPLANATORY LANGUAGE.