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HomeMy Public PortalAbout5811-5811 1/2-5813 TEMPLE CITY BLVD_Building__ 7GA638A CE 0803 12/69 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER M `25?1 PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY r.. FOR APPLICANT TO FILL IN NEAREST Print or tvoe onl CROSS ST. BUILDING DISTRUT NO. GROUP I TYPE CESS-D BY ADDRESS 5811 Temple City Blvd. LOT NO. BLOCK ` r• CONST�j _ v STATISTICAL CL SI FICA TI ON •J�� SEWER M �� — � - CLASS NO. DWELL.UNITS BKle.PGIC W. TRACT USE ZONE MAP NO.OF BLDGS. NO. .[�(7 SIZE OF LOT NOW ON L �OT SPECIAL USE OF � CONDITIONS EXISTING BLDG. TEL. OWNER WeSle .11lse NO. BL :SETBACK FROM ADDRESS 5813 Temple City Blvd. F NT PROP.LINE OF (STREET) CITY Temple City _ x.HW F EW DTIHG FROM G.L. HIGHWAY + YARD = TOTAL ARCHITECT OR TEL. .1. _ ENGINEER NO. BLDG. BACK FROM ADDRESS SIDE PROP. (STREET) TEL TYPE OF EXISTING SETBACK HIG = TOTAL CONTRACTOR Rigid fCo. NO. 2 HIGHWAY WIDTH FROM C.L. LIC ADDRESS S d Ave. NO. + = G LIC. C. CITY a Angeles CLASS CORNER CUTOFF YES El ❑ CONSTRUCTION LENDER C NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS I- u ADDRESS Ov SQ. FT. NO. OF NO. OF NEW SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE Re-roof with ALTER ❑ composition SIGNATURE OF REPAIR[:] APPLICANT DEMOL ❑ VALUATION S 24o.00 APPROVALS DATE INsPOR's GNATURE 31 P.C. PMT. FOUNDATION; LOCATION AV FEES FEES FORMS, MATERIALS ,7 =�+� yi FRAME: FIRE STOPS, 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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. 1CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATIQM�r1N8tlRAl1� . nOnRT] 1V + LATH, EXT, SIGNATURE OF +�S�aL.ah71L, 11 V lir 11 HOUSE NUMBER COR- PERMITTEE Ag_ RECT AND POSTED ADDRESS 337 So Woods Av ue L A 22/ F I NAL JOHN F. LEWIS. PRINCIPAL STRCK. AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION M.O. CASH F,�„ 0 0 7 173 14AR 19 1 D PI-1-7 oN I6A666A CE0608 a_aa APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS / y- J BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER -NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. 7, DISTF�ICT N GR TYPE P ES E BY FOR APPLICANT TO FILL IN 4-,Q coNs , BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ,� Y CLASS.NO. DWELL.UNITS /BK / LS LOT ,� s� BLOCK 3/'g WATER NOT REQUIRED RECEIVED ❑ CERTIFICATE: TRACT MAP HIGHWAY •� NO OF BLDGS. INO. (CIRCLE) STATE MAJO GOND OCAL SIZE OF LOT 5T JS JSP NQW ON LOT USE ZONE SPECIAL USE.OF', F CONDITIONS EXISTING BLDG: 1A,1LZ �/ y a TEL,�I (y�7a OWNER V 7 NO BUILDING EXIST. 1 ) ti SETBACK YARD HWY STREET NAME WIDTH ADDRESS p /p i A/061 `FRONT ARCHITECT OR "� T P. L. iL ENGINEER L e,j'! /r NO. 1" SIDE In ADDRESS r6 �A /4ey) P. L. , < k TEL '- •^p G 1 CONTRACTOR . NO. ' ,N✓ � � V ,fC ADDRESS 3 Z +IV1�Y+V9(�hr ✓/JIISOM ermi or curb, gu er, sl dWa and driveway approachinb DESCRIPTION OFWORK stallations should be taken out at the L. t n&— Office, or T. C. Co. Engineer's Office immediately'in order to av Sib SQNEW VADD ALTER REPAIR DEMOLISH delay. Survey Design or takes lime an Is noa cy. s SQ.FT. fes" NO.OF NO. OF until Permit has been issued. Apply for parkwaytree permit'at T. CZ SIZE J STORIES FAMILIES City Hall. USE OF STRUCTURE C1�1 SIGNATURE OF �� o APPLICANT VALUATION $ /� !J�`Z) APPROVALS DATE INSPE d SIGNATURE FEE $ p� �S PMT. �r��y FOUNDATION: LOCATION ✓ FEE FORMS, MATERIALS FRAME: FIRE STOPS, 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 REGULATING GAS VENT. DUCTS y'vl-31 I I•)r BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK , ti:y•;i 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 W.ORKMEN'S COM PE S O IN AN A• f LATH.EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE J RECT AND POSTED // }' ADDRESS ++'p/� q T' FINAL �0- ( "� JOHN F. LEWIS. PRINCIPAL'ST URAL•••ENG•I.NEER PLAN CHECK VALIDATION cK. M.O. CASH PERMIT:VALIDATION'• • cKr'. .•M.O`. CASH LAGIo 0 0 4 6 r`i�iu"11 2 3 D 4 .7 5 d ; Lk0424% .S - 2 .b. 8 '5.50N TEMPLE CITE' ►eamacc#ao9.I—el APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGMEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER - NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DIS RCT O. GROUP TYPE P SSED BY FOR APPLICANT TO FILL IN i® '7 CONST. BUILDING • STATISTICALCLASSIFICATION S ER MAP ADDRESS BK P CLASS.NO. DWELL.UNITS== LOT NO. Re.7 BLOCK WATER NOT REQUIRED RECEIVED Lj CERTIFICATE: TRACT 34 MAPHIGHWAY y7 NO.OF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND, LOCAL SIZE OF LOT 6e /� J NOW ON LOT USE ZONE SPECIAL EXISTING BLDG-7�%°'����',j�ry / CONDITIONS USEOF ' TEL. C' OWNER NO. BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS-.:W8 o• FRONT ARCHITECT OR TEL. P.L. ENGINEER NO. SIDE P.L. ADDRESS TEL. INSPECTION RECORD QCL CONTRACTOR rb i NO. V ADDRESS/01 • ^"" ^' Taw 01.DESCRIPTION OF WORK ► f••)4 \ 0 .00" - " A W NEW AFT. NDD il ALTER REPAIR DEMOLISH S ZE A53 / STORIES FAMILIES IES A r � ' USE OF STRUCTURE �� / v SIGNATURE OF APPLICANT 1 VALUATION$/8do + oco I APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION 1 FEE $ FEE $ � FORMS,MATERIALS FRAME:FIRE STOPS. 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS ' AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING. GAS VENT DUCTS BUILDING CONSTRUCTION: 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED.HEREBY i WILL NOT MPLOY ANY PERSON IN VIOLA- LATH,INT. TION OF THE LABOR CODE OF THTR E OF CALIFORNIA RELAT- ING-TO WORKMEN'S COM ENSATIOANCE. - e LATH,EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STR-LQTURAL ENGINEER PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.O. CASH 9 2 8 2 .�,� J'tltl 2 3 D I-J I 6•-5 9 JUL �j 1 D w �� 2 7 `� �� (�, 9.0 0 'BA686A D89•9 8.88 APPLICATION FOR BUIL®-INN P.K-RMIT 1 v''DIVISION OF BUILDING AND SAFETY ADUILbING DRESS 5"l3 % aon.o4 Ci 7 <! R161AI Deportment-of County Engineer County of Los Angeles LOCALITY r G WM.J. FOX..COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING 'CROSS ST. d O MLV DISTRIC GROUP I SEWER MAP PG FOR APPLICANT TO�FILL ,INyy f Sw` F-L I TYPE `V ADD EBUILDISS ` l3 ���yP�e _``T �J1I��7• NUMAP STATE E �Z C]p ' HWY YES LOT NO.to GAS BLOCK• USE ZONE SPECT // CONDITIAS TRACT - NO.OF BLDGS. BUILDING EXIST. SIZE OF LOT J � NOW ON LOT ' SETBACK YARD HWY STREET NAME' WIDTH USEEX ST NG BLDG. / -! y7r?i� /T• CSS FRONT `d. P.L CJ OWNER 1LfL✓e`S�� rl' �• - SIDE P.L. MAIL ADDRESS 4VI O TRACT DWELL. 1 UNIT C �/ R� TEL..# I DWELL.• I•UNIT 5 INDUSTRIAL CITY 6.4•r �``� ,'E� NO. 6 PUBLIC BLDG. ARCHITECT OR�� w�/,�7�6]'EL�A 'LS�ffF/ 2 DUPLEX I UNIT 7 ADDN.,ALT.. ETC. ENGINEER J/ �+� NO• 3 APT. UNITS ~ ADDRESS -/"1 °' fCL�erbc ' •'L COMMERCIAL 8 MISCEL. TEL INSPECTION RECORD CONTRACTOR NO. ADDRESS ��. .n A R w C? vud-lq DESCRIPTION OF WORK _ e� ) �/ la "Co u c�a al ' NEW/ ADD ALTER REPAIR DEMOLISH Q. FT. j/j9PO NO.OF / NO.OF SIZE 11 STORIES FAMILIES® 1I USE 07TRUCT RE �• 1401,41-al tali n. ��Ja LJfFm►-r-r� mss,o�/c� - - SIGNATURE OFf APPLICANT � '� A' ^ 'd API;RRO,i/ALSn ADDRESS 4K2-7 eY e0' Fe"Z-Ipe Z 4•'0c/' 1 DA E INSPF 'S SIS NATURE FOUNDATION:LOCATION �» $ Ct , P.C. $ Q O FORMS.MATERIALS -'?s )G� B Lo– p r FEE FRAME:FIRE STOPS. CC fA, tf VALUATION O O BRACING,BOLTS IO ISL�C-� `fi�U:• _ B FURNACE:LOCATION, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT,DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. L AND STATE LAW�LATING BUILDING CONSTRUC- TION. LATH.EXT. •' SIGNATURE MP HOUSE NUMBER COR- PERMITTEE �— RECT AND POSTED �• 3.L ADDRESS FINAL u WM.J.FOX.COUNTY ENGINEER VALIDATION C.N.DIRLAM,CHIEF BLDG. INSPECTOR .QCT 3 meq' 3� MA'S MAR 14 .. 1 2 2.0 0 -,,WORKERS'COMPENSATIOf DECLARATION hereby.affirm 'that I haWo.rk certificate of consent to self ����p p l C o►T I O N FOR BUILDING .PERMIT �] insure dr a tisrtificate of Workers'Compensation Insurance, , 1 o certified copy'thpreof (Sec. 3800, Lab. C.) j� {"' �1�/�COUNTY OF LOS ANGELES BUILDING AND S FETY Policy No.-Company +W Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING J ADDRESS Certified copy is.filed with thecounty building inspec- •BUILDING !` / tion department. ADDRESS, Date Applicant CITY T� �-If� ZIP , LOCALITY a CERTIFICATE OF EXEMPTION FROM WORKERS' N OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW-ON LOT CROSS ST. (This section need not be completed if the permit is for oneASSESSOR • hundred dollars.($100)or-less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP OWNER IffhYkW I certify that in the.performance of the work for which this r` NO' NO. permit is'issued, I shall not employ any person in any manner ��� SPECIAL d� so as to become subject to-the Workers' ensation L ws. ADDRESS lll/// CONDITIONS Date 0 Applic ,L�/ CITY _ ZIP 117 ARCHITECT OR TE. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO you should T: If, after making fhis Certificate of CONST' ZONE Exemption, you should .become subjects to the Workers' ENGINEER NO. -Compensation provisions of the Labor Code, you must forth- ADDRESS ✓ 'v �r W with comply with such ,provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Q. deemed revoked. Z CONTRACTOR NO. LICENSED CONTRACTORS DECLARATIONLIC, CLASS NO. ZDWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9" ADDRESS NO. SEWER MAPNEW (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASSBK PG: VALIDATION SQ.FT. INC.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK � re--"&L- to0w., VALUATION � NEW (`L Contractor Date r., ADD ❑ $ v am exempt under See. S pill. , ALTER B,BP.C. for this'reasonDate: C1 $ - REPAIR USE OF EXISTING BLDG. DEMOL ❑ Signature ' APPLICANT 1 J EL. FINAL `]6 2 9 A OWNER-BUILDER DECLARATION PRINTffl DATE I hereby affirm that I am exempt-from the Contractor's License .Law for the following.reason (Section 7031.5, Business and ADDRESS FINA # 0 0 0,o o �' Professions Code): PRESENT BY / BUILDING A 'O - 6a63 I, as owner of the property, or-my employees with ADDRESS (X wages as their sole compensation,will do the work and •'° °'O b 6 3.� the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). CMOVING TEL.ONTRACTOR NO. , lO al 0 °i 8 7 I, as owner of the property,am exclusively contracting , with licensed contractors to construct the.project (Sec- ADDRESS tion 7044, Business and Professions Code). 'REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 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 P.L. Lender's Name LDMA Ref. N e $ P.C.Fee$ Permit Fee r s �� Lender's Address I certify that I have read this application and with ea that the Issuance Fee 10' s (/ LDMA'P/C q above Information is correct. I agree to comply II County Investigation Fee �( 3 9 ordinances and-State laws relating to building construction, Total Fee YJ ,-� LDMA Perm. p N and'hereby authorize representatives of this County to enter upon the a e- property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnat of Applie or Agent Date 4 WORKERS'COMPENSATION DECLARATION hereby affirm That I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure,or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800, Lab. C.) E�� ,aany Argonaut COUNTY OF LOS ANGELES BUILDING AND SAFETY Polic9f4o20-400-10 ❑ Certified co is hereby furnished. INEAREST UILDING PY Y FOR APPLICANT TO FILL IN DDRESS J ® Certified copy is filed with the county building inspec- BUILDING 5813 Temple Cit Blvd.tion department. ADDRESS p y OCALITY Date 11-1-83 Applicant Howard L. Randol Co. CITY Tem le Cit ZIP 91/80 ROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP . hundred dollars($100)or less.) TRACT BLOCK LOT NO. A. NO. TEL. t ECIAL i I certify that in the performance of the work for which this OWNER Chiman Cad D.D.S. NO. 28 7-4094 CONDITIONS DISTRICT GROUP TYPE FIRE PROCESSED BY u permit is issued, I shall not employ any person in any manner ADDRESS so as to become subject to the Workers'Compensation Laws. `D CoNST. ZONE Date"11-4-82 ApplicanfHOWard- L. Randol CO. im CITY Temple City ZIP 91780 STATISTICAL CLA SIFICATI APT. CONDO. � NOTICE TO APPLICAI`FT: If, after making this Certificate of ARCHITECT OR TEL. LU U Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS CL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be e deemed revoked. CONTRACTOR Howard L. Randol C�Eo. 288-4040 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS- 529 E. Valle Blvd. NO. 186086 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. _ 2286.00 Professions Code, and my license is in full force and effect. CITY CLASS $ SQ. FT. NO.OF NO.OF / CHECK License Number 186086 Lic,Class C-39 SIZE STORIES FAMILIES ONE . $ Contractor Howard L. RandolDate 11-4-82 DESCRIPTION OF WORK NEW ❑ I am exempt from the licensing requirements as I am a — ADD El ❑ !am or a registered professional engineer ALTER ❑; FINAL / a acting' in my professional capacity (Section 7051, • _ REPAIR DATE Business and Professions Code). USE OFFINAL (^ EXISTING BLDG. COIIIlIlercial DEMOL ❑`. By L: EXISTING or Reg.No. Date APPLICANT Howard L. Randol COTEL. 288-4040 ;. OWNER-BUILDER DECLARATION PRINT IVO. I hereby affirm that I am exempt from the Contractor's License ADDRESS 529 E. Valley B1. San Gabriel Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT EJ BUILDING ' I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 9 7 5 9.9 A 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 CONTRACTOR NO. with licensed contractors to construct the project (Sec- 2.0 05200 tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. 0005200:5 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONT .6—8 2 the performance of the work for which this permit is issued P.L. (Sec.5097, Civ. C.). SIDE P.L. Lender's Name 3 P.C. Fee$ Permit Fee 43.50 _ Lender's Address I certify that I have read this application and state that the Issuance Fee 8.50 above information is correct. I agree to comply with all County Investigotion Fee ordinances and State laws relating to building construction, Total Fee 52.00 and hereby authorize representatives of this County to enter r upon th abov -menti ne property for inspection purposes. 2 11-L/-&2- I SEE REVERSE FOR EXPLANATORY LANGUAGE Signal re of Applicant or Agent Dote + ®s WORKERS'COMPENSATION DECLARATION r ient to self nsurebpr aaffirm certif certificatethat of Workers'certificate Compensat on insurance, APPLICATION FOR BUILDING P E RM I T or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No PC 975585 Company Republic Indemnity Certified copy is hereby furnished:, FOR APPLICANT TO FILL IN BUILDING ADDRESS a 0 0 ® .Certified copy is filed with the county building inspec- BUILDING I department. ADDRESS .5811I.Tem le City Blvd. LOCALITY C� NEAREST Date 11-1—.96 Applicant Randol R'nofing CITY Temi2l e ri ty ZIP 917180 CROSS'ST. WMA� CERTIFICATE OF EXEMPTION FROM WORKERS' ' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL ' (This section need not be completed if the permit.is for one 1 USE ZONE MAP hundred dollars($100)or less.)•, , at TRACT BLOCK- LOT NO. �. NO. TEL. SPECIAL y �' " I certify that in the•performance'of,the,wo�k•for which this OWNER NO. _ CONDITIONS Q. permit is issued, I shall.not em to ari arson!@-any manner DISTRICT .GROUP TYPE FIRE PROC ED BY p p y' yp y ADDRESS 5813. Temple City $lvd' CONST. ZO�(E U so as to become subject to the Workers'Compensation Laws. 'zd� 7 Im Date—3 2-T ti- CITY Temple Cit Zip 9.1780 O` f/ $5' Applicant STATISTICAL CLASSIFICATION APT. 16PNDO. I- NOTICE TO APPLICANT: If, after.making this Certificate of ARCHITECT OR TEL. L U ENGINEER NO. CLASS NO. DWELL..UNITS LLI Exemption, you should become subject to 'the Workers' 9L Compensation provisions of the Labor Code, you must forth- ADDRESS- SEWER MAP with comply with such provisions'or this permit shall be Z deemed revoked. i, CONTRACTOR Randol Roof i NO, i BK. PG, VALIDATION LICENSED'CONTRACTORS DECLARATION LIC, I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with'Section 7000)of DivisioA 3 bf the Business and LIC• Professions Code, and my license is in full force and effect. CITY 'San Gabriel CSS C-39 $ 1,100.00 ' 451937 C-39 SIZE TORIIES fAMILLIIES CONE License Number Lic.CI6ss . $ :contractor Raridol.:Roofing Date 12-16-85 DESCRIPTION.OF WORK - — -bu. NEW ❑ I am exempt under Sec. 'l. with 3—ply: f ibe7rglas. ADD ❑. ALTER ❑ FINAL ® DATE B:BP.C.for this reason REPAIR Date: USE OF EXISTING BLDG. Commercial._­ DEMOL ❑ Signature APPLICANT TEL. OWNER-BUILDER DECLARATION I PRINT . a.ndol Roofin NO. 28.8-4040 I hereby affirm that I am exempt from the Contractor's LicenseA-3 8 a 8 A Law for the following reason (Section 7031.5, Business and ADDRESSGabriel # 0 0 0 0.0 Professions Code): PRESENT ❑ BUILDINGo o49,88 I, as owner of the property, -or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY 0•o 0 4 9 88 c=i the structure is not intended or offered for sale(Section ; 7044, Business and Professions Code). 11110VING TEL. 0 �,2 8 6 ❑ i, as owner of the property,-am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project.(Seo- '� ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY SET BACK PROP. LIN WIDTH ©I ' - I hereby affirm that there is a construction lending agency for FROM - - - the performance of the work for which this permit is issued j1 P.L. tSec. 3097, Civ. C.). i SIDE, B -P.L.` v Lender's Name Lender's Address I; P.C. Fee$ Permit Fee3918 x I certify that I have read this application and state that the '' Issuance Fee 10.50 above information is correct. I agree to comply with.all County Investigation Fee ordinances and State laws relating to building construction, I Total Fee 49.88 � and hereby authorize representatives of this County to enter I g$ upon th above-menti ned T perty for inspection purposes. d 1 f o r 12-16-85 SEE REVERSE FOR EXPLANATORY LANGUAGE Sign tura of Applicant or gent, Date ®a WORKERS'COMPENSATION DECLARATION i hereby c certificate that I have a certificate of consent to self APPLICATION . FOR B U I.L D I.N G PERMIT insure, or a certificate of Workers''Compensation Insurance, or a certified copy thereof(Sec. 3800,,lab.-C.) COUNTY OF LOS ANGELES BUILDING AND SAFETYPolicy NoCC2Q-:,424.�"Q27 , Argonaut. Ins ❑ Certified copy'is hereby furnished. ' - w FOR APPLICANT TO FILL IN BUILDING aCertified.co is filed with the count building inspec- BUILDING DDRESS tion department. y g p ADDRESS ' 5.8.1 1 T e.mp 1 e City Blvd. LOCALITY Rando.l Ro o f in NEAREST • 11'-1-•84Appllcant .Tempe Ct .y ZIP .9Q Ros CERTIFICATE OF EXEMPTION FROM WORKERS' I NO.OF BLDGS -ASSESSOR COMPENSATION.INSURANCE I SIZE OF LOT NOW ON LOT.'' .. MAP BOOK PAGE PARCEL (This section need not be completed if the-permit is for one I USE ZONE MAP hundred dollars($100)or less.) i TRACT BLOCK LOT NO. NO. Jp D,r . C h,im a n• Lad- TEL7 SPECIAL. I certify that in the performance of the work for which this OWNER NO-287,4094 ' J --2, CONDITIONS IL permit is issued, I shall not employ any person in any manner -Templea DISTRICT GROUP' TYPE FIRE PRO SED BY O so as to become subject to the Workers'Compensation Laws. ADDRESS 5,813 ' C t 1. CONST. ZONE V f CITY Temple' C.it Y zIP.917 8 Q Date Applicant (( STATISTICAL IFICATIO APT. CONDO. U r NOTICE TO APPLICANT: If, after making this,Certificate of ARCHITECT OR TEL.' ' ENGINEER NO. CLASS NO. _DWELL. UNITS LU 'Exemption, you should become subject'- to the Workers' 1L Compensation provisions of the Labor"Code, you must forth- ADDRESS _• .� SEWER MAP with comply with such provisions or this permit shall -be deemed revoked. ff E VALIDATION n TN&CONTR dol RoO LICENSED CONTRACTORS DECLARATION LIC; I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 5 2 9 E Val/ley Val/layNO.1 8 6 0.8 6. VALUATION " (commencing with Section 7000)of Division 3 of the Business and " C Professions Code,and my,license is in full'force and effect. CIT$ S an' Q ah r i•e,"l .917 7 CSS C c3 9 $ 8 Q O...O Q oil. 6 Q 8 6 C,39 SQ'Fr- NO.OF No.OF '' -CHECK License Number Lic.Class SIZE STORIES .FAMILIES ONE Randol Rofiaf,ing .1P23;84 DESCRIPTION OF WORK Retroof hld;g NEW ❑ $' Contractor fe ❑ I am exempt under Sec. r Tali th. $ 3 1 (' % ADD ❑ _ _ ALTER ❑;, FINAL B.&P.C. for this reason I I REPAIR DATE" Date: USE OF S DEMOL FINAL f , EXISTING BLDG. i ❑ By qy Signature I APPLICANT �r " 'TEL. OWNER-BUILDER DECLARATION PRINT Ran d o l RO o f in g_ , NO'.2 8 8--A U.4 Q ,. I hereby affirm that I am exempt from the Contractor's License ADDRESS 5.2 9 E V a 11 ey S , Q. n 7 ,A 91776 Law for the following reason (Section 7031.5, Business and � �+0 0 Professions Code): PRE N 1 °'° I O, 0 ❑ ) IBUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and I c 2. o 7—8 4 the structure isnot intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). ;' , MOVING TEL. ❑ I,as owner of the property,am!exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tiori-70", Business and Professions Code).. '' REQUIRED YARD HW`! TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SETBACK PROP. LINE WIDTH I hereby affirm that there is a construction.lending agency for FROM the performance of the work for which.this permit is issued' ISec. 3097,Civ: C.). j i SIPE' } < P L Lender's Name , Lender's Address P.C.,Fee$ Permit Fee 30'. Q Q "• . I certify that I have read this application and state that the Issuance Fee' 1 Q-.5 Q above information is correct. I agree to comply with.all County Investigation.Fee ordinances and State laws relating to.building construction,. Total Fee 40.. 5 0 and hereby.authorize•representatives.of this County to,enter upon the above_mentioned pro arty for inspection pu oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant,or Agent Dafe ®s f COUNTY OF LQS ANGELES' TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS COMMERCIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1211190045 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: 1TR: 6561 IT: 614 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 5813 TEMPLE CITY BL I [STRUCTURE: 267 1 V-B B TEMP CA 917802113 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: WORKMAN 18587-015-003 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl (TENANT: EXIST BLDG USE: COMME USE ZONE: C-1 ISSUED ON: PROCESSED BY: 1 ILAD/LAD FAMILY DENTISTRY 1EXIST OCC GRP: B 111/19/12 SR I (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: 1FI DATE FINAL BY: CODE: 1 ILAD CHIMAN;JASHU TRS LAD FAMILY TRU (626) 287-4094- 1 60,000 5813 TEMPLE CITY BL. TEMPLE CITY CA 91780 I FEES PAID IDIMCIZIPTION OF WORK 1 (INTERIOR TENANT IMPROVEMENT & ADDITION (PHASE #2) DENTAL IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:IOFFICE (APPLICANT: TEL. NO: I I ITALWAR/DESIGN CONCEPTS, SHIV (909) 591-3939- IAA BLDG PERMIT ISSUANCE 27.80 1 14091 RIVERSIDE DR IAB STATE GREEN BLDG FEE 60000.00 VAL 3.00 ISPECIAL CONDITIONS: I ICHINO CA 91710 1AE STRONG MOTION OTHER 60000.00 VAL 12.60 I 1 IA2 PERMIT W/ENERGY-HC 60000.00 VAL 1,034.90 I TOTAL FEES 1,078.30 1 1 (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IC M M CONSTRUCTION INC (858) 692-7896- I 1 1 IDBA C M M ENGINEERING & CONST LIC. NO I VACATION AND SETBACKS I I I 125231 DANA VIEW LANE 884810 * I 1 I I 1 [DANA POINT CA 92629 1 [SOILS ENGINEER APPROVAL 1 I 1 (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS F I I ITALWAR, DESIGN CONCEPTS, SHIV (909) 591-3939- 14091 RIVERSIDE DR. #110 LIC. NO: 1 '_n`� �6 JSLAB/UNDER FLOOR I `l 1 IIjCHINO, CA 91710 NONE C 1 +L' , 1 RAISED FLOOR FRAMING I I 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( -1 (UNDERFLOOR INSULATION I I 1 1150H269 3 001 1 V�ez-,& FLOOR SHEATHING j INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I et`s �•` I I I I 0 NO 22 I r \ ✓O IROOF SHEATHING SCHOOL WITHIN HAZARDOUSI v� sQ l [SHEAR PANELS (AIR QUALITY: 1000 FEET MATERIALS I I 1 NO NO NO 1 1FRAME INSPECTION I IFIRE SPRINKLER HANGERS Tyr I � 1 [INSULATION/WEATHER STRIP( I 1 IINTERIOR LATH/DRYWALL 1 1 1 1 EXTERIOR LATH (RATED FLOOR/CEIL ASSEM. I RATED WALL ASSEMBLIES 1 TS /OPENINGS 1 I 1 I I* ADDITIONAL DATA ON FILE T 1 I I I� NA I I IREPORT ID: DPR261 ROUTE TO: B30508 I I I I I - Y —COUNTY OF LCIS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS COMMERCIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1206260067 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1 ITR: 6561 IT: 614 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUPI 5813 TEMPLE CITY BL I ISTRUCTURE: 267 1 V-B B I TEMP CA 917802113 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WORKMAN I 18587-015-003 I I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: COMME USE ZONE: C-1 (ISSUED ON: PROCESSED BY: I (LAD/LAD FAMILY DENTISTRY (EXIST OCC GRP: B 111/19/12 SR I (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IF DATE FINAL BY: CODE: 1 ILAD CHIMAN;JASHU TRS LAD FAMILY TRU (626) 287-4094- 1 70,000 1 --,/ 1 5813 TEMPLE CITY BL. TEMPLE CITY CA 91780 1 FEES PAID ID SCRIPTION OF WORK 1 I [ (INTERIOR TENANT IMPROVEMENT & ADDITION (PHASE #1) DENTAL I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IOFFTCE I (APPLICANT: TEL. NO: I I 1 TALWAR/DESIGN CONCEPTS, SHIV (909) 591-3939- IA1 PLANCHECK W/EN-HC 50000.00 VAL 745.15 1 1 4091 RIVERSIDE DR IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: [ ICHINO CA 91710 IAB STATE GREEN BLDG FEE 70000.00 VAL 3.00 1 IAE STRONG MOTION OTHER 70000.00 VAL 14.70 [ 1 I 1A1 PLANCHECK W/EN-HC 70000.00 VAL 231.35 ICONTRACTOR: TEL. NO: 1A2 PERMIT W/ENERGY-HC 70000.00 VAL 1,148.70 1APPROVALS DATE INSPECTOR SIGNATURE I IC M M CONSTRUCTION INC (858) 692-7896- 108 CERTIF OF OCCUPANCY 101.40 1 I DBA C M M ENGINEERING & CONST LIC. NO I TOTAL FEES 2,272.10 ILOCATION AND SETBACKS I I 25231 DANA VIEW LANE 884810 (DANA POINT CA 92629 [ [SOILS ENGINEER APPROVAL 1 1 1 1ARCHITECT OR ENGINEER: TEL. NO: 1 1' I IFO'MDATION/TRENCH FORMS I I ITALWAR, DESIGN CONCEPTS, SHIV (909) 591-3939- I p,` Z"e `kt'pwox I� op 1 1 4091 RIVERSIDE DR. #110 LIC. NO: i •��' - `l� 1 (� [SLAB/UNDfiR FLOOR I /f 1 'CHINO, CA 91710 NONE / RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( b.+��{��j� �5 �1�. d3/� y' `�'� (UNDERFLOOR INSULATION I I 115OH269 3 OOI VVV 111 j � p'y� 8 �� ®C�'e a u�, Do K 1 I FLOOR SHEATHING I I 1 I.O. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 ll T1 I 0 NO 221 (ROOF SHEATHING 1 I I I I t0\do�1�LL 1 , l�>,/ I 1 SCHOOL WITHIN HAZARDOUS i /�� �' { vl�r (r1gG. w(ys `[SHEAR PANELS orlI 1AIR QUALITY: 1000 FEET MATERIALS [ NO NO NO [FRAME INSPECTION i 11 L C p Gtj �V '761P!� 1 e\ a�t\�1 [FIRE SPRINKLER HANGERS04 INSULATION/WEATHER STRIP 1 INTERIOR LATH/DRYWALL I c 1 (�� Vl�'A ttL� a. r (�y �U •(b i EXTERIOR LATH 1 IRATED FLOOR/CEIL ASSEM. 1 1 (RATED WALL ASSEMBLIES Z" Z�(lt ivfG ,1t�C''Q (�'Q&J� IRATED SHAFTS/OPENINGS [ [ rg FILE uetk` [T-BAR CEILINGS r ll I I* ADDITIONAL TA O ILE I I 43 (LOT DRAINAGE IREPORT ID: DPR261 ROUTE TO: BS0508 I I I 1 I I t I I I I •COUNTY OF LOPS hNGELES 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 1211080066 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 6561 LT: 614 BL: .001 1 SQ. FT STORIES TYPE [ 5813 TEMPLE CITY BL I ISTRUCTURE: 800 V-B TEMP CA 917802113 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: WORKMAN 18587-015-003 I I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl (TENANT EXIST BLDG USE: COMME USE ZONE: C-2 JISSUED ON: PROCESSED BY: LAD FAMILY DENTISTRY (EXIST OCC GRP: 11/08/12 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: 1 ILAD CHIMAN;JASHU TRS LAD FAMILY TRU (626) 287-4094- 1 1,500 15813 TEMPLE CITY BL. I Ikl TEMPLE CITY CA 91780 I FEES PAID ID SCRIPTION OF WORK I REMOVE INTERIOR WALLS, FLOG ING, CEILING, RESTROOM FIXTURES [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: AND LIGHT FIXTURES (APPLICANT: TEL. NO: 1 IMITRE, MARC (858) 692-7896- IAA BLDG PERMIT ISSUANCE 27.80 I 1 125231 DANA VIEW LANE IAB STATE GREEN BLDG FEE 1500.00 VAL 1.00 ISPECIAL CONDITIONS: [ (DANA POINT CA 92629 D2 PERMIT W/0 EN-HC 1500.00 VAL 82.20 I I TOTAL FEES 111.00 1 (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE I IC M M CONSTRUCTION INC (858) 692-7896- IDEA C M M ENGINEERING & CONST LIC. NO ILOCATION AND SETBACKS 125231 DANA VIEW LANE 884810 1 I I I (DANA POINT CA 92629 I ISOILS ENGINEER APPROVAL I [ I (ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS I I I LIC. NO: (SLAB/UNDER FLOOR I I IRAISED FLOOR FRAMING I I I (MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: cmp:l 1UNDERFLOOR INSULATION I I 115OH269 3 001 1 1 I I I I I IFLOOR SHEATHING I I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 0 NO 22 I [ROOF SHEATHING I I I I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I LAIR QUALITY: 1000 FEET MATERIALS 1 I NO NO NO I (FRAME INSPECTION (FIRE SPRINKLER HANGERS I I I [ I (INSULATION/WEATHER STRIP( I I 11NTF.RIOR LATH/DRYWALL 1 I I 1 [EXTERIOR LATH I I I I I I (RATED FLOOR/CEIL ASSEM. I I I [RATED WALL ASSEMBLIES [ I (RATED SHAFTS/OPENINGS [ IT-BAR CEILINGS I I I* ADDITIONAL DATA ON FILE I I ILOT DRAINAGE IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1306120044 PHONE: (626) 285-0488 EXT: LEGAL ID: INUNIDER OF SIGNS: 1 I BUILDING ADDRESS: I ITR: 6561 LT: 614 BL: .001 [SIGN DESCRIPTION: INSTALL (1) SET OF ILLUMINATED LETTER[ 5813 TEMPLE CITY BL I I I DENTISTRY" I TEMP CA 917802113 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WORKMAN I 18587-015-003 1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl [TAT: [EXIST BLDG USE: [ISSUED ON: PROCESSED BY: LAD/LAD FAMILY DENTISTRY 1EXIST OCC GRP: 106/12/13 SR 1 (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: 1MSCRTI FI BY: CODE: I ILAD CHIMAN;JASHU TRS LAD FAMILY TRU (626) 287-4094- [ 2,200 I 15813 TEMPLE CITY BL. [ 1 ITEMPLE CITY CA 91780 I FEES PAID IOF WORK) SET OF ILLUMINATED LETTERS READIA "LAD FAMILY 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[DENTISTRY" 1 (APPLICANT: TEL. NO: IDIAZ, JORGE (626) 644-6259- 1AA BLDG PERMIT ISSUANCE 27.80 1 11802 GREVELIA ST IAB STATE GREEN BLDG FEE 2200.00 VAL 1.00 ISPECIAL CONDITIONS: ISOUTH PASADENA AX BUILDING REVIEW FEE 54.70 1 I 1D2 PERMIT W/O EN-HC 2200.00 VAL 99.00 I I 1 TOTAL FEES 182.50 1 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IBX SIGNS INC (626) 334-5600- I 1 [ 11028 W KIRKWALL ROAD LIC. NO I ILOCATION AND SETBACKS IAZUSA CA 91702 746856 I [ ISOILS ENGINEER APPROVAL [ 1 1ARCHITECT OR ENGINEER: TEL. NO: - 1 IFOUNDATION/TRENCH FORMS I I LIC. NO: 1 ISUPPORT STRUCTURE I 1 I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ I I [ 1 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I 1 NO 20 SCHOOL WITHIN HAZARDOUS 1 [ I I I [AIR QUALITY: 1000 FEET MATERIALS I I 1 I I NO NO NO I I I I I I i I I I I I I 1 I I I I I I I I I I [ I I I I I I I 1 1* ADDITIONAL DATA ON FILE I [ 1 I 1 (REPORT ID: DPR261 ROUTE TO: BS0508 1 1 I I