HomeMy Public PortalAbout5936-5936 1/2 TEMPLE CITY BLVD_Building__ w1wp
"T—ME4- OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM.'J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
/U DISTRICT NO. PLAN CK. NO. PERMIT NO.
ADDRESS /i ���r�P
LOCALITY ��/yJ�i Q RECEIVED BY DATE OF APPL. DATE ISSUED
v _
CROSSSST.
BUILDING
OWNER /,, '• o� ADDRESSMAIL
-d r}'/ly� .--e.�,_e.•cLCf�
ADDRESS/i �� Jy� J LOCALITY
NEAREST
TEL. CROSS ST.
CITY Vi//ss✓'
FIRE NO.OF 6� TYPE _ 1 BROUP__
•
ARCHITECT TEL. ZONE "�' PLANS ---��
ENGINEER NO.
BLDG. ORD. NO.
ADDRESS SETBACK LINE
APPROVED
CCINTRAOTOR ,, 4NO. �� 9 BY DATE
; USE APPROVED
ADDRESS _ 4✓./flZ+G7 ZONE BY DATE.
GAL
DESCRIPTION I LOT NO. I BLOCK CO Rip NS [�
TRACT
NO. OF BLDp9.
SIZE OF LOT NOW ON LOT
USE OF_,EXISTINGBLDG.BLDp. FAMILIICH I ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
REPAIR MOVING DEMOLISH / 6 AI 1 Lj
Sq. FT. NO.OF
SIZE ROOMS STORIES
WALL ROOF
COVERING COVERING
USE OF NEW
BUILDING
' C 1
i
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE
AND.AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS,
SIGNATURE OF BRACING, BOLTS
OWNER LATH, INT.:
AUTHORIZED AOT G✓lam f �'���
�•. LATH, EXT.:
-- �
$ P. C.41 PLASTER, INT.
FEE 6 PLASTER, EXT.
VALUATION 3 ('^��
FEE .V — FINAL ea -
(5S 76A638A .. -
CE#603(REV.6/78) -
APPLICATION FOR: BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS T.
BUILDING qq/
ADDRESS SCJd Tri C.E. IVP LOCALITY C��►'�tif—fie.
NEAREST �• �/ ��J
CITY � Z(i� ZIP X70p 0 CROSS ST.
NO.-OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
TRACT �/�� BLOCK ,• LOT NO. / J DISTRICT GROUP TYPE FIRE. C DBY
p p CONST. ZOv
.. . ... •. . . _• TEL: _• V �f r
OWNER T,t• ^�C-� =/: Z. NO.- -
STATISTICAL CLASSIFICATION S El P
o
ADDRESS 7 +S 3 0� :�/��Y1!LA YLJ CLASS NO. DWELL.UNITS �' BK PG
CITY ZIP
ARCHITECT OR TEL. VALUATION
ENGINEER• NO.
ADDRESS BLDG.SETBACK FROM
TEL FRONT PROP.LINE OF (STREET)
CONTRACTOR J NO.- HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
LIC, _ FRONT PROP,LINE HIGHWAY .WIDTH
ADDRESS on NO.
LIC. + _
CITY CLASS
CONSTRUCTION LENDER BLDG.SETBACK FROM
BRANCH. - SIDE PROP.LINE OF ' )STREET)
NAME AND
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH
SQ.FT. NO.OF NO.OF CHECK+ _
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW ❑ P.C._Fee$ c .d p_ Permit Fee J u
. . 198
LvAceADD ❑❑ Issuance Fee 7
ALTER
REPAIR ❑ 'Total Fee a+
USE OF DEMOL ❑
EXISTING BLDG. Z
APPLICANT TEL ° .10 3 9 2 A
(PRINT) NO.� j v Vo I/
# 000023
BY(SIGNATURE1,4Q'
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH APPLICATION AND-STATE uY 2 ° ° 1' 2 0 0
THAT THE ABOVE IS CORRECT AND AGREE TO COM LY WITH ALL ORDINANCES __ �L
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE - S 12 0 0 U
WORK AUTHORIZED HEREBY TWILL NOT EMPLOY ANY PERSON IN VIOLATION OF w
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM. _ _ Z q p -
PENSATION INSURANCE. 09.2'1 —7 8
SIGNATURE 2 0 3 9.3 A
PERMITTEE
ADDRESS 7
# o 0 0 0 0 1
Z
' TEL. '
C 20 ° 2200
CITY NO. - Q
USE ZONE NO. ,� O O 0 0 0.2 2- 0 0 XO
C SPECIAL 0'9.2 1 —7 8
CONDITIONS
FINAL S� f� BY
iL
DATECJ`�J �O ��-
®S 7GA636A - n
CE 1803(REV.6/78) LII o1S
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY'
FOR APPLICANT TO 1H LLL IN'LDINGt ADDRESS
ADIDRESS �.Z W �T^�b- LOCALIT �'
NEAREST
CITY ZIP . ( _ r NEAREST. C7 -a
14 NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON.LOT. MAP BOOK PAGE PARCEL
DISTRICT GROUP I TY0 FIRE SED BY
TRACT BLOCK T vL LOT NO. "{ , (,� ZONE
OWNER �t t$ :` TEL
(�7 ,'D p
STATISTICAL CLAS99CATVSEWER ffiAP
ADDRESS Y -m• �+5 � CLASS NO. ��DWELL.UNITS BK PG
CITY ZIP 611'7p
ARCHITECT OR TEL. VALUATION'$ /M 6/S
ENGINEER NO. f(✓
ADDRESS BLDG.SETBACK FROM
TEL. FRONT PROP.LINE OF (STREET)
CONTRACTORNO. HIGHWAY• + YARD TOTAL SETBACK FROM TYPE OF EXISTING
LIC. - '.FRONT PROP..LINE HIGHWAY .WIDTH
ADDRESS AAA NO. , _
LIC. +
CITYCLASS
CONSTRUCTIO• DER BLDG.SETBACK FROM
SIDE PROP.LINE OF )STREET)
NAME AND B NCH
HIGHWAY + -YARD = TOTAL SETBACK FROM TYPE OF EXISTING m
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH ®-
SQ.FT. --+�� NO.OF NO.OF CHECK + _ U
SIZE o�I STORIES FAMILIES. ONE In
DESCRIPTION OF WORK 15 t 4 OJ NEW P.C.Fee$ Permit Fee
NCSS t Dt3VrE CA—rLW ADD ❑
❑ Issuance Fee
ALTER
REPAIR ❑ Total Fee /3
USE OF DEMOL ClEXISTING BLDG. � Z A O 9 4 6
APPLICANT . TEL. O
(PRINTI A-tt-r '514 Q NO.�' 0 0 010,
BY(SIGNATURE) �X_ya 00p�
I HEREBY ACK LEDGE.T14AT I HAVE,READ THIS APPLICATION AND STATE Y
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL,ORDINANCES W 0 0 1 3 Q Q V
LAT
AND LAWS-REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Z _
N OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN ELATING TK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY OO WORKMEN'N IN S COM- Z Q C 4.�
PENSATION INSURANCE.' _ g
.d
SIGNATURE OF
PERMITTEE
ADDRESS S �L�/TJ�
/ O
CITY lCS— Np zd'�=a
USE ZONEOP D
�Z SPECIAL
i CONDITIONS
m
FINAL BY d
DATE
Ds 76A638A r
CE#8W(REV.I I/78) -�
APPLIC 4WFh-E$UlLprfqGPERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS /
BUILDING -934 7 LOCALITY
IC- NEAREST
CITY ;�7 L'F_ `-I ><` ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK' PAGE PARCE
DISTRICT GROUP TYPE AE
MUSSED BY
TRACT BLOCK LOT NO..
7-, TEL.
OWNER 7• NO.
STATISTICAL C ASST TION SEWER MAP
ADDRESS . 1-.C- D/ V ' CLASS NO. DWELL.UNITS BK PG
CITY ,+/[ ( e) ZIP
ARCHITECT OR TEL. VALUATION $ 60
ENGINEER NO.
ADDRESS BLDG.SETBACK FROM
/ TEL. �, FRONT PROP.LINE%QF REETI
CONTRACTOR GI �.I[ NO b u Z TOTA BACK FROM TYPE G .
LIC. HIGHWAY + YARD = FR T PROP.LINE HIG WIDT
ADDRESS •O• D NO. I'O
LIC. t =
CITY 1'4JQ y&/6 6,6. CLASS
CONSTRUCTION ENDER BLDG.SETBACK FROM
NAME AND BRANCH
SIDE PROP.LINE OF (STREET)
�•
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING d
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH Q
V
SO.FT. NO.OF NO. LF CHECK + _ ag
SIZE STORIES FAMILIES ONE
USE ZONE MAP �a �
DESCRIPTION OF-WORK �D0 Wl NEW El NO. � �&/ U
SPECIAL
Clfiv U OD `j/1l s0 ' ADD ❑ CONDITIONS70 h
ALTER 01 FINAL BY �•_ -��- .
REPAIR- ❑ DATE; '(
USE OFDEMOL ❑
EXISTING BLDG. CIF O
APPLICANT .r TEL
(PRINT) L �. N CU O '
BY ISIGNATURE) v/
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE {`Y,,� z 1 3 S 2 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V # o o 0 0 0 1
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: z
PENSATION INSURANCE.' ' 2 n -.3&00
Q
SIGNATURE &OF Cj, L ( .l 34,00
PERMITTEE ,I 0 7 2 1 - 8 0
ADDRESS = Z
�y O
CITY - NO. 12 8
D
P.C.Fee$ Permit Fee::;�7/ s >
� J r
Issuance Fee
W
d
Total Fe
I•
76A638A CE 0803 1/71
APPLICATION FOR BUILDING PERMI�
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK / PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESJ� a 6 il,CJ;
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY PJ i E•
FOR APPLICANT TO FILL IN NEAREST /
Print or tvoe onl CROSS ST.
DISTRICT NQ. G. UP TYPE PR Ell QY
BUILDING
/ CONST.
ADDRESS �, 0 CJ ~�/ �� ! :7
LOT NO. BLOCK
STATISTICAL CLASSIFICATION SEWER MAP-
CLASS NO.OZdl DWELL.UNITS BKCPG60
TRACT USE ZONE MAPC90
NO.OF BLDGS, s� NO. (/
SIZE OF LOT NOW ON LOT ` �[ SPECIAL
USE OF "\ CONDITIONS
EXISTING LDC•
TEL U
OWNER NO. - 0&L BLDG.SETBACK FROM
ADDRESS FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY - ti HIGHWAY WIDTH FROM C.L.
ARCHITECT OR TEL. .I• _
ENGINEER NO. BLDG.SETBA ROM
ADDRESSSIDE PROP.LINE (STREET)
n }}
EL TYPE OF EXISTING SETBACK AY + YARD = TOTAL 3
CONTRACTO �� NO 6�"/ HIGHWAY WIDTH FROM C.L. C
V
CC LIC.
ADDRESS d JQ ! NO. "o + r = C
LIC. ❑
CITY ,y CLASS CORNER CUTOFF YES NO Lu
CONSTRUCTION LENDER a
NAME AND BRANCH /YI.p-•YrL.sr.. SEEREVERSESIDE FOR SP IAL /PPROVALS
ADDRESS / Z(p L `
SQ. FT. NO. OF NO. OF NEW ❑
SIZE • STORIES S FAMILIES
USE OF ADD ❑
STRUCT
ALTER
REPAIR[]SIGNATOR
APPLICA DEMOL ❑
VALUATION 5 O O APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE S FEE S FORMS, MATERIALS
FRAME. FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT 1 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. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1WILL NOT EMPLOY ANY PERSON IN OLATION OF THE LATH, INT.
LABOR CODE OF THE STATE OF •CALIFORNI IN RELATING TO
WORKMEN'S COMPE S IONS INSURANCE.s LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESSFINAL
JOHN F. LEWIS. PRIN IPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
LAo 5 - 2 1 a 1Al E-3 i Q . 1 2,00-
®S 76A638A _ n
CE 8803.(RE4.6/781 lIL'1`
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES, BUILDING AND SAFETY
yF,OGGR��APPLICANT TO FILL IN n��RESS���� � �
ADILDINGDRESS _13th L- t (i' LOCALITY
'7 NEAREST
CITY • / CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
TRACTBLOCK LOT NO. DISTRICT GROUP PE [:FIRE SSED BY
ONST;
2 f
OWNER G�1A NO. �Z f t
/��J
STATISTICAL CLASSIFIC N SEWER
MAP-
ADDRESS
6aT� C .ti1ClICJ/'709 .IAAF CLASS NO. y�r DWELL.UNITS BK PG
CITY / til' ZIP .-�P! �a �✓
ARCHITECT OR TEL. VALUATION
ENGINEER NO. /
ADDRESS BLDG.SETBACK FROM
TEL.. FRONT PROP.LINE OF (STREET)
CONTRACTOR NO. TOTAL SETBACK FROM . TYPE OF EXISTING
LIC. HIGHWAY. + .YARD = , .FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS NO.
LIC.
CITY CLASS
BLDG.SETBACK FROM
CONSTRUCTION LENDER
NAME AND BRANCH SIDE PROP.LINE OF (STREET(
HIGHWAY + YARD = 'TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY. SIDE PROP.LINE HIGHWAY '-WIDTH
SQ.IT NO.OF NO.OF CHECK + _
SIZE CSTORIES FAMILIES ONE
DESCRIPTION OF WORK 9:191WW, c�/6� NEW P.C.Fee$ Permit Fee
oQ,-7fd ADD ❑ �f
Issuance Fee /
��� - 1 •• - ALTER ❑ /� z
N REPAIR ❑ Total Fee
USE OF DEMOL ❑
EXISTING BLDG:' OZ
APPLICANT TEL.
(PRINT(
D
BY(SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE-READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES ° ld
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE 1 V
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 INSURANCE. O A L U 5 n
IL
4 A
SIGNATURE OF # 0 0 0 0 0
PERMITTEE y
ADDRESS SJ Y_ � Z 2 " 0 1300
TEL. J� 0 'o o o O
CITY NO.- 2 C" O
USE ZONE MAP
No. 0�0D a 'I' a25• 78
CB.—L SPECIAL y
CONDITIONS
FINAL �L BY
m
DATE �,! �'
WORKERS' COMPENSATION DECLARATION
I have a certificate of consent to
insure, oraa certif catte of Workers' Compensation insuran elf APPLICATION FOR BOU I L D I N G P E RM I T
or a certified copy thereof(Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company -�:: f c= / ('h'_J
EJCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING x�3
ADDRESS
❑ Certified copy is filed with tho count building inspec- BUILDING C.. Ct c � '
tion department. ADDRESS S 7f� Wil'-/� -COF
/ CIN 11`( C C % ` zIP a
Date 4:12 Applicant LOCALITY o
NO.OF BLDGS. NEAREST Jr
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL. 8ral
OWNER 46U/S'* IfLnIq I&—Q5eZ-NO. 'J-i§-?g USE ZONE OP
I certify that in the performance of the work for which this SPECIAL p�
permit is issued, I shall not employ any person in any manner ADDRESS /C�`J-� 4 t!e-r-ioAl /r10, CONDITIONS !1
Cl-
so as to become subject to the Workers'Compensation Laws. O
CITY Cpglc= C7 7 a ZIP
Date Applicant ARCHITECT OR TEL. 0
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY
Exemption, you should become subject to the Workers' CON ZONE 0
Compensation provisions of the Labor Code; you must forth- ADDRESS ��/QLU
with comply with such provisions or this
p y p permit shall be TEL. N
deemed revoked. CONTRACTOR 4F/{GLC [TiDor-..e NO.d j/-�'�jpp STATISTICAL CLASSIFICATION APT. CONDO. Z
_ LIC. CLASS NO. DWELL. UNITS
LICENSED CONTRACTORS DECLARATION s, �
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 3.7' X11- �:t!/ /�Y.I:NO./ / �v<j
LIC. SEWER MAP
(commencing with Section y license
of Division 3 of the Business CITY 1r!°t%Nl-(. �-i CLASS �.5�
and Professions Code,and my license is in full force and effect. BK. PG. VALIDATION
—� SQ. FT. NO. OF NO.OF CHECK
License Number- � Lic. Class �� SIZE STORIES FAMILIES ONE
_ VALUATION
Contractor_ E/jGGP_ ktwli'+a Date 4``S �4' DESCRIPTION OF WORK NEW ❑ $ �QcJ
El ADD
i- ❑ c� ►
I am exempt under Sec. �r��)�'C/� G../'?1JC+P� r/�/ ALTER ❑
BAP.C. for this reason �4�I. �� REPAIR ❑ $
Date: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL. FINAL o
OWNER-B ILDER DECLARATION (PRINT) NO.
I hereby affirm that I am exempt from the Contractor's License DATE
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL @�
Professions Code): PRESENT By
❑ I, as owner of theproperty, or m o BUILDING
Y employees P Yees with ADDRESS
wages as their sole compensation,will do the work and LOCALITY
the structure is not intended or offered for sale(Section
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
tion 7044, Business and Professions Code.)
REQUIRED TOTAL SETBACK FROM EXIST.
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
P.C. Fee$ Permit Fee
Lender's Address
I certify that I have read this application and state that the Issuance Fee , 3O LDMA P/C tf
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee �4`.�`� LDMA Perm. #
( and hereby aut orize representatives of this County to enter
upon v mentioned property for inspection purposes.
rA
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date
i t
WORKERS'COMPENSATION DECLARATION '
hereby affirm that r have a certificate of consent to self A P P L I CAT I G N FOR' BUILDING PERMIT
insure,,or a certificate of Workers'Compenstion Insurance,or
o certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No..= Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS s 2—
Certified copy is filed with the county building inspec- [ENGINEER
NG / �e
tion department. SS l® l �• �� w LOCALITY
�� c, NEAREST of
Date ' 's �� 7 App icant 7'. t✓ r ZIP CROSS S7.
CERTIFICATE OF E PT FROM WORKERS' y NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE F LOT 2 a� X // 0� NOW ON LOT / MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE MAP .•� �y
hundred dolla7s ($100)or less.)
BLOCK LOT NO. NO. aC
R NO. 9/ 360% CTEL. � SPECIAL a
I certify that in the performance of the work for which this 2 CONDITIONS
permit is issued, I shall not employ any person in any manner ' DISTRICT GROUP TYPE FIRE PR CESSED BY U
so as to become subject to the Workers'Compensation Laws. SS � �!� CONST. ZO E
Date Applicant ZIP STATISTICAL CLASSIFICATION APT. CONDO. U
TECT OR TEL. aa�� yy W
NOTICE TO APPLICANT: If, after making this Certificate of NO. CLASS NO. AF UNITS tL
Exemption, you should become subject to the Workers' tI1
Compensation provisions of the Labor Code;you must forth- ADDRESS SEWER.MAP
with comply with such provisions or this permit shall be TEL r —
deemed revoked. CONTRACTOR p C!r/' NO.��G 6 S ?3 BK., r!PG, J Y VALIDATIOM
LICENSED CONTRACTORS DECLARATION // /CLIC.
I hereby affirm that I am licensed.under provisions of Chapter 9 ADDRESS A9 2 :3 S �i fes . /2.0�G VALUATION
(commencing with Section 7000)of Division 3 of the Business and
Professions Code, and my license_is in full force and effect. CITY / CLASS $ ,
SQ.FT. NO.OF' NO.OF CHECK
License Number Lic.Class SIZE STORIES / FAMILIES ONE
$
Contractor Date DESCRIPTION OF WORK _ NEW ❑. ,
ElIADD
I am exempt from the licensing requirements as I am a � jE2f �
licensed architect or a registered professional engineerALTER ❑:' FINAL ,�,, ••�
acting in my professional capacity,(Section 7051, I REPAIR DATE
❑,
Business and Professions Code). I USE OF �j/9.0/10FINAL
EMOL r
EXISTING BLDG. /9.0 /10 D ❑ B
Lic.or Reg.No. Dcite APPLICANT TEL. y
(PRINT) (+� 9p r NO. NyG 33 3 /
- OWNER-BUILDER DECLARATION i
I hereby affirm that I am exempt from the Contractor's License I P
r✓ /
Law for the following reason (Section 7031.5, Business and ADDRESS /�:��8 �� t(Xr T• Ci
Professions Code): PRESENT
El
I BUILDING �/ L �r✓ / O
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and 25 5 3 v. 0 A
the structure is not.intended or offered for sale(Section I LOCALITY _
7044, Business and Professions Code). MOVING TEL. , ��// ` F o 0 o a o 1
❑ I, as owner of the property, am-exclusively contrcicting I CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS 2 c 1 9 6.00
tion 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK FROM EXIST, o 0 1. 9(�C C
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH � ,
I hereby affirm that there is a construction lending agency for FRONT O �.,1 9— 1
the performarice of the work for which this permit is issued P.L.
(See. 3097, Civ. C.). SIDE
P.L. �.
Lender's Name i!2 ' ^P_ 1
' Lender's Address P.C. Fee$ Permit Fee
j I certify that I have read this application and state that the Issuance Fee
Y' above information is correct. I agree to comply with all County Investigation Fee,
3 ordinances and State laws relating to building construction, Total Fee
and hereby a honze representatives of this County to'enter
c upon a e-me tioned property for inspection purposes. I
¢o F I
• 'CS I SEE REVERSE FOR EXPLANATORY LANGUAGE
gnature pplicant or Agent Date I ®s
JWNNT OF BUILDING AND SAFETY -"FLlL 1'lUN YUR YMM.fl'
NTY OF LOS ANGELESqj{
WM.J.FOX, CHIEF ENGI�NCEER NOVIIv2 8 i d` , BUILDING
NO. OF �1� BLDG. f.,}'� �I ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO.
PLANS SETBACK LINE Y v I •'�4�, /�, ,/
FIRE APPROV8D 2 Y/ gf • 1 r df�4.
ZONE /' BY DATE / �A i
RECEIVED BY DATE OF APPL. DATE 138UED
aAPPROVED • q y / f _
ZUSONE E~�.IBY D�T�E �r � .if \��✓�'��: a �f /���/�! �� I
APPLICANT FIL HEAVILY OUTLINED PORTIONONLY
E BUILDING O AI
O E NAME ADDRESS
I-III
WI
ADDRESS LOCALITYNEA EST
1 L n�(p �. C `1 I T �I� L+l'C �•
W W CITY DN L CROSS ST. WOO ice.0
1�
a STATE TEL. m� �{ 'yam
LICENSE NO. NO. E NAME 7_A key( t®i FA-Rj A (J YIII
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EMAIL
O NAME 3 ADDRESS I I�� E• �/IYo� �C�//&I-A-c— Q
ADDRESS �I nm �' O CITY
Z CITY 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
O APPLICATION AND STATE THAT THE ABOVE 13 CORRECT
U STATE TEL AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
LICENSE NO. LL NO. nn ��•• AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
Z LOT NO. I 13c7� SIZE OF LOT�i�IX I7d SIGNATURE OF
OWNER
NO. OF SLOGS. IIJJ�6Jr�/dF f�a. �/
Q BLOCK NOW ON LOT N O N F" AUTHORIZED AGT.�
O K / /
J w TRACT (Oco I CORRECTIONS
O USE OF BLDGS. N O 1\(F-
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NOW ON LOT
DESCRIPTION OF WORK ,/F�—r y p *L r--,;4
`qJ�c���;.� �,+ a-"
USE OF
BUILDING FF 1 ff L�� /fit /�M I(iNI A '
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NEW TYPE \R y GROUP d0"
NO. OF v NO. OF o
ALTERATION ROOMS / FAMILIES
ADDITION SIZE ;2_5717I /+./
REPAIR STORIES C
MOVING WALL COVERING M E¢5TUCC-O
DEMOLISH ROOF COVERING G O M 1'O
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FEE S ► �� FINAL APPROVAL
INSPECTOR'
VALUATION
VALUATION (] FEE / DATE I NAME
COUNTY OF LOS 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 0505130011
1 PHONE: (626) 285-0488 EXT: DUPLICATE
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 6561 LT: 195 SQ. FT STORIES TYPE 5936 5936 1/2 TEMPLE CITY BL
STRUCTURE: 2100 VN TEMP CA 917802010
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS
5587-019-028 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C
TENANT: 'EXIST BLDG USE: COMME USE ZONE: C-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 05/13/05 V 05/08/06
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI IN BY: CODE:
5936 TEMPLE CITY INVESTMENTS (626) 215-8995- 4,000
5936 TEMPLE CITY BL
TEMPLE CITY 91780 FEES PAIDRI TIO OF WORK
T/O EX ST ROOF AND INSTALL BUILT-UP ROOFING
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
GODINEZ (626) 357-4474- AA BLDG PERMIT ISSUANCE 27.75
AE STRONG MOTION OTHER 4000.00 VAL 0.84 SPECIAL CONDITIONS:
D2 PERMIT W/O EN-HC 4000.00 VAL 115.80
TOTAL FEES 144.39
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
WEST COAST ROOFING (626) 357-4474-
501 W. FOOTHILL, SUITE G LIC. NO LOCATION AND SETBACKS
MONROVIA, CA 91016 606827 C39
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS
LIC. NO: SLAB UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
150-269 3 04
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS:
NO 22 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH DRYWALL
EXTERIOR LATH
RATED FLOOR CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
S
REPORT ID: DPR261 ROUTE TO: BS0508