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Home My Public Portal About5953 TEMPLE CITY BLVD_Building__ APPLICATION, F.PR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AT%, BUILDING ADDRESS 11� �_C• p I hereby affirm that I have a certificate of consent to self insure, 15'q S •�� — \-� 1 LV D or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3800,Lab.C.) T'e M LG C,,, \'� 8 Q LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDG NOW ON LOT El Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE CO COMPENSATIONEXEMPTION INSURANCE WORKERS' NEA-014 /�o c SSC a TEL NO.7-%4.9118% WITHIN 1000 FT.OF SCHOOL? YES (� NO (This section need not be completed if the permit is for one hundred ADDRESS ly GC- t (-V DISTRICT GROUP TYPE CONST. FIRE ZONE PROCE BY dollars($100)or less.) r Y P P CITY t ZIP 11780 8 � �✓fd=Airu �� I certify that in the performance of the work for which this permit 1 7 D is issued, I shall not employ any person in any manner so as to ehl�— become subject to the Workers'Compensation Laws. ARCHITECT O ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT C0060 Date Applicant ADDRESS CLASS NO.✓1 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of I REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 0 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovislons of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG } License Number Lic.Class D RIPTION OF WORK Ilk, ADD ❑ VALUATION O _ X00 U Contractor Date ✓ ALTER N��J 141! L6� cc REPAIR ❑ $ O ❑ I am exempt under Sec. BAP.C.for this reason DEMOL ❑ LDMA P/C# V Date: USE OF EXISTING BLDG. URM ❑ U SignatureAPPLICANT(PRINT) TEL NO. LDMA Perm# i JO❑ I, as owner of the property, or my employees with wages as Z l=i:•L•1 �Ar their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE •'- Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL i_I r! j OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY licensed contractors to construct the project (Section 7044, r_!I AL 64 o �a-+L Business and Professions Code.) YES 11 No El ._ - WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING 4..j'':.�•I\ OJo°F_ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR + 0!-1- GUIDELINES f(rif•7�� I hereby affirm that there is a construction lending agency for YES❑ NO❑ W the performance Of the Work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2 20 100 THROUGH 220.140 CONCERNING HAZARDOUS L''-ISI= '-I+•'== �•+•'=�lr Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address -f OWNER OR AGENT cI certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE r1 N with all county ordinances and State laws relating to building Z.00 gconstruction, and her_gby au ooze representatives of this County ISSUANCE FEE co co to enter upon lheAbov&-mbn ed property for inspection purposes. y, Z �if 0 \N �&V- o P INVESTIGATION FEE TOTAL FEE O I7� Sqn+um m m Aim Wo SEE REVERSE FOR EXPLANATORY LANGUAGE • WORKERS'COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT • I•hereby affirm that I have a certificate of consent to self ` insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY cy Nod&"—.a Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS J- 1 (A C• ❑ Certified copy is filed with the unty building.ins c- BUILDING p- /� Cl7 tion department. ADDRESS �7 L / `� CITY 2 ZIP D C4 L Date) — Applicant tL �IA / LOCALITY OF BLDGS. NEAREST CERTIFICAT OF EXEMPTION FROM WORKERS' SIZE OF LOT OW 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.) � y TEL.NO n p USE ZONE MAP OWNER L I certify that in the performance of the work for which this NO. SPECIAL n} permit is issued, I shall not employ any person in any manner ADDRESS Q ,A,) CONDITIONS •so as to become subject to the Workers'Compensation Laws. O CITY Zip. U Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY W NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO� 'D CONS1T. U Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS .5,Off 8`� , a with comply with such provisions or this permit shall ben�r/�,� TEL. deemed revoked. CONTRACTOR t✓/7/ NO.a / STATISTICAL CLASSIFICATION APT. CONDO. Z LICENSED CONTRACTORS DECLARATION CLASS NO. DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / ./V. O SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in D full force effect. CITY ,. CLASSBK VALIDATION SQ. FT. N OF NO. OF CHECK License Number Lic. Class SIZE 1 STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEIN ❑ Contractor �G�i L�Date //—/2—8 $ B� ElJ ADD ❑ Pool I am exempt under Sec. ALTER ❑ BAP.C. for this reason $ USE OF REPAIR ❑ EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DEC RATION (PRINT) NO. P- I I hereby affirm that I am exempt from the Contractor's License ' DATE (J Law for the following reason (Section 7031.5, Business and ADDRESS FINAL 1 Professions Code): PRESENT By � � A ❑ I, as owner of the property, or my employees with . BUILDING A wages as their sole compensation,will do the work and Poo 3307 59.25 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. 1 ITEMS ❑ I, as owner of thero ert am exclusive) contractingCONTRACTOR NO. with licensed contractors t construct the project (Sec- ADDRESS TOTAL .59 o 25 ; tion 7044, Business and Professions Code.) CHECK H ti REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. 4f7E�.•Yt59.25 CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT CHANGE 0001 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE ` Lender's Name P.L. 0000-0001 11/21/89 P.C. Fee$ Permit Fee LDMA Ref. # 6937 1 AM1120 Lender's Address I certify that I have read this application and state that the Issuance Fee O LDMA P/C# above information is correct.I agree to comply with all County Investigation Fee //�� ordinances and State laws relating to building construction, Total Fee i C L. LDMA Perm. # and hereby authorize re prM.— 1 of this County to enter upon the a o e-me tinnedrty for inspection purposes. r dt -//--1 `,? " SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date Y ' f WORKERS''COMPENSATION-0ECLARATION APPLICATION FOR e •'1 hereby,affirm that I have a certificate of consent to self BUILDING P E RM I T ' insure, or a certificate of Workers' Compensation Insurance, "`or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY policy No. Company f BUILDING j�— ❑ Certified copy is hereby furnished. FOR APPLICANT TO//FILL IN AODREss Z0 (� ❑ Certified copy is filed with the county building inspec- ; BUILI SS J 3 Cif p�N� tion department. ADDRESS JJ Date Applicant CITY .� /e G/ ZIP • Yi78 D LocALITY �L ` 1 NO. OF BLDGS. ' NEAREST 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.) 2 OWNER L/f .1 ',Ta4 a p. X00 USE ZONE MAP I certify that in the performance of the work for which this n SPECIAL >_ permit is issued, I shall not employ any person in any manner ADDRESS D CQh/q D '/C. CONDITIONS a- so as to become subject to the Workers'Compensation Laws. Armd" O CITY mt C ZIP Date Applicant ARCHITECT OR TE ly NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER DISTRICT Gggg,,,OUP TYPE FIRE RO $ED BY Q Exemption, you should become subject to the Workers' GS ^ �/� CONST e3 E J V Compensation provisions of the Labor Code, you must forth- ADDRESS�o 1 /d VIA �-P y[L( eV1./, LL' a with comply with such provisions or this permit shall be F 1 TEL.��yy// TATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR m .Q� NO.`'3 —/clo Z LICENSED CONTRACTORS DECLARATION t LIC. CLASS NO. !�!i tDWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 s ADDRESS �. / � QG( NO. SEWER MAP LIC. (commencing with Section 7000)of Division 3 of the Business � CITY L. � Q� CLASS and Professions Code,and my license is in full force and effect. VALIDATION 'SQ. FT. NO OF NO. OF CHECK BK. PG. License Number Lic. Class SIZE S RIES FAMILIES ONE t DESCRIPTION OF WOK NEW ❑ VALUATION t Contractor DateI $ >,.700" ACCTI e v Alaie / ADD ❑ v ❑I am exempt under Sec. I A ► ��I1/ 41, 5 (�/� p ALTER ❑ B.&P.C. for this reason `•u / d' REPAIR ❑ $ 1 ITENS U OF ]�� Date: o EXISTING BLDG. DEMOL ❑ - TOTAL 42-45 o 45 Signature "APPLICANT FIN CASH 41.4-5 OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License DATE CHANGE ,(:I] Law for the following reason (Section 7031.5, Business and ADDRESS t` FINAL _ Professions Code): FADDRESS By 7 -: ❑ I, as owner of the property, or my employees with 00110-3- 1001 11/lM wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section 7044, Businessand Professions Code.) TEL. I, as owner of the property, am exclusively contracting TOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. J CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH J I hereby affirm that there is a construction lending agency for FRONT 0(0the performance of the work for which this permit is issued P.L. 1-11 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ° LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee ' I certify that I have read this application and state that the Issuance Fee LDMA P/C N 1� 71 above information is correct.I agree to comply with all County Investigation Fee J 1 ordinances and State laws relating to building construction,. Total Fee LDMA Perm. tY and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE % Signature of Applicant or Agent Date WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION F®R BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. CompanyBUILDING , r Certified copy is hereby furnished. 5 3 FOR APPLICANT TO FILL IN ADDRESS 15-?S j / 1,l t Certified copy is filed with the county building inspec- BUILDING— tion department. ADDRESS ?rlM`LE e-,,y 440,o6weve- Date Applicant CITY T ILS- L" 7 ZIP 917 jr0 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF SIZE OF LOT NOW ON LOT. NEARESST. ` COMPENSATION INSURANCE u 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.) OWNER A6/r# /✓.«`L— NO.3-SV-4 y9s USE ZONE MAP I certify that in the performance of the work for which this ,� NO. sopermit is issued, I shall not employ an person in an manner /� // /� C- SPECIAL as to become subject to the Worke s'Co pensat oo Laws. ADDRESS /750 ( 1 LS o y �T✓ CONDITIONS U Date !� Applicant �✓s \ CITY /-Mc,�f ,4 C ZIP /oo NOTICE TO APPLI ANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O ENGINEER NO. CONST. ZONE ~ Exemption, you should become subject to the Workers' V Compensation provisions of the La bar Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. NDO. to deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK 4 PG f�2 VALIDATION SQ.FT. o NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK 1':v✓lflvr �M % NEW U✓ VALUA�ION 1 d Contractor Date ADD ❑ $ 0? V✓V —� ❑I am exempt under Sec. ALTER 7 2 7.4 A ❑ B.BP.C. for this reasonREPAIR ❑ $ o Date: USE OF DEMO ❑' a a EXISTING BLDG. Signature APPLICANT ` �j /. TEL / FINAL 0618-87 PRINT nE ry /`T!t &iw— NO. �CS� /f95S OWNER-BUILDER DECLARATION DATE — I hereby affirm that I am exempt from the Contractor's Licensee /GSA �}y, Law for the following reason (Section 7031.5, Business and ADDRESS 1QSD FI Professions Code): FR B ❑ !Z_U BUILDING 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 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- tion 7044, Business and Professions Code). ADDRESS 2 7 9.Q.1 A CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP..gLINE WIDTCK FROM H # 0 0 0 0 0 1 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. a 2 1 8.6 3 (Sec. 3097, Civ. C.). SIDE P.L. a o2 1 8,63 25 Lender's Name / "5 l� CJ LDMA Ref.# Q 9,1 1 -B7 Lender's Address P.C.Fee$ Permit Fee I certify that I have read this application and state that theIssuance Fee `� J�/ ,LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee F?—� LDAAA Perm. fi v and hereby authorize representatives of this County to enter $ upon he ave-mentioned property for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant r Agent D to ti lt 'WORKEFIQ'`_OMP"PSATION DECLARATION !ciu affirm QW'ha o ceicate of consent to self os a certificate of Lars'rt rripensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof c. 3850, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �9s3 Tr.• � G! !�L• _ ❑ Certified copy is filed with the county building ins ec- BUILDING f ! ,,; n .,. tion department. ADDRESS T&Alpte Gr al. --^7 Date 1 r�J7 Applicant CITY ZIP 9 1 / b o LOCALITY �. CERTIFICATE OF EXEMPTION FROM WORKERS' S NO.OF BLDGS. NEAREST p COMPENSATION INSURANCE SIZE OF LOT 1407—X I NOW ON LOT 01da CROSS ST. 1M00 /� I, Coe (This section need not be completed if the permit is for one Z� ASSESSOR hundred dollars ($100)or less.) TRACT n�6 ``BLOCK LOT NO. l MAP BOOK PAGE PARCEL OWNER N1 L,L 6 P— be VC TEL. S l�0 USE!O��NEI certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner p,/ u p ff p / 0. so as to become subject to the Workers'Compensation Laws. ADDRESS5 F�IL 5/1 ��-G q� 5�� (SSV ONS O CITY 1-!iU S ZIP Date Applicant ARCHITECT OR TEL. ® NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROUP TYPE FIRE PROCESSED BY V Exemption, you should become subject to the Workers' ENGINEER SSE�p �O AVl=F NOM �J7(y-r�f �j CONST. / ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS L � / 7 / 3 with comply with such provisions or this permit shall be //�� Q QQ ``��t� tiD deemed revoked. CONTRACTOR /tea {r + J1( �Oi NO.iJfO�/06-7�� STATISTICAL CLASSIFICATION APT. C( NDO LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. Y'� DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS (,4 32 ifn AIdV1F A( '5J_, NO. I S SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY VA M ABL S CLASS B-1 /%,_ , 2- P � VALIDATION 7, SQ.FTC /�,l NO. F NO.OF CHECK BK. �'' License Number 3 /( S'C 9 Lic.Class_ SIZE �J o[0 STORIES FAMILIES ONE j 1 (061, `` y VALUATIONf� 7, ��'� (JO-1—SCO Date 1 / DESCRIPTION OF WORK Contractor r ADD ❑ $ ;! 0 0 0 0 I am exempt under Sec. V of L i ( ALTER ❑ I , I 6 9 8.8P.C. for this rea on /7(/ ;At ❑ $ CIG 0i - REPAIR )__?J/ 1. %J ')- a USE OF DEMOL EXISTING BLDG. ❑ ,j SignatureClot APPLICANT NO. FINAL o o Y (1 OWNER-BUILDER DECLARATION DATE Gr o Jp I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN 9 ' O Professions Code): PRESENT B ❑ BUILDING r r 7- 5 5 I, as owner of the property, or my employees with ADDRESS ? 0 0 0 0 0 1 wages as their sole compensation,will do the work and Oil. the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ( 1`3�! 9.25 I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ° 1,'5 a % 2 5 tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FR M L) 5 1 5 7 SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for LInvestigation the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). s Q Lender's Name O�� t "` ,� LDMA Ref. # t Permit Fee Lender's Address _p ' ;< I certify that I have read this application and state that the % e Issuance Fee �r LDMA P/C# above information is correct. I agree to comply with all County ee ordinances and State laws relating to building construction, Total Fee and her y authorize r pr entot' es f thi County to enter tx LDMA Perm. # 3 upon th above- nt' e prop " y r in ection purposes. o V1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date WORKERS'COMPENSATION DECLARATION C' &' 613 f 0 X,C - 41` 2_` L " � 7� 1 hereby affirm that I have a certificate of consent to self I I insure,-or d certificate of Workers'Compensation Insurance, APPLICATION R BUILDING PERMIT u or a certified copy thereof (Sec. 3800, Lob C. J Lel . ^ p COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Companymall f BUILDING ❑ Certified copy is hereby furnished. FOR PPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING rantion department. ADDRESS / /C L/ Date v� r Applicant � � l� CITY r/ i ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKER ' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT a.CROSS ST. (This section need not be completed if the permit is for one i ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNE d NO. USE ZONE MAP <—O I certify that in the performance of the work for which this / // NO. permit is issued, I shall not employ any person in any manner ADDRESS /' SPECIAL so as to become subject to the Workers'Compensation Laws. y l� CONDITIONS 0 CITY Zip V Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY O Exem tion, you should become subject to the Workers' S"` CONST/. ZONE I•- Compensatin provisions of the Labor Code, you must forth- ADDRESS O( �• ✓ �J , with comply with such provisions or this permit shall be �� TEL STATISTICAL CLASSIFICATION APT. CO N deemed revoked. I e CONTRACTONO. R LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS a�NO. 1 74 (commencing with Section 7000)of Division 3 of the Business and LIC. ,a SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS ri /� BK PGVALIDATION SQ.F . `r2,, OF NO.OF CHECK ; License Number Lic.Class SIZE �/ STORIES FAMILIES ONE 7 7 3.2 A VALU ION Contractor Date DESCRIPTION OF/WORK AD r,ADD # o00023 1:1I am exempt under Sec. ( ALTER C] o 049,411 B.&P.C. for this reason �^ REPAIR ❑.;• $ Date: USE OF DEMOL ❑: 0 0 o 4 9 4.13 EXISTING BLDG. Signature APPLICANT �• TEL ,/ . /�� FINAL 2 4 6$7 OWNER-BUILDER DECLARATION PRINT / d NO. DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS�i Law for the following reason (Section 7031.5, Business and FINAL Professions Code): PRESENT r. By � ❑ BUILDING 7 7 3.3 A I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY # o o a o 0 1 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. ( 0 o68,63 with licensed contractors to construct the project (Sec- ADDRESS o 0 o 6 a 6 3 5 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAL SETBACK PROP. LINE WIDTH 0 a 2[J. $7 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name o P.C.Fee$ L Permit Fee ` 7- 3 LDMA Ref. q '7Lender's Address I certify that I have read this application and state that the Issuance Fee ( Q (l LDMA P/C q above information is correct. I agree to comply with all County Investigation Fee a . ,3 ordinances and State laws relating to building construction, Total Fee Q LDMA Perm. N v and here authorize representatives of this County to enter upon e o e-mentip pro ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant oVAgent bate . COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9712300008 PHONE: (818) 285-0488 EXT: GAL . OF CONST NEW B I D G D R • ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5953 TEMPLE CITY BL STRUCTURE: 0 1 VN B TEMP CA 91780 ASSESSOR INOR ION NUMBER: NEAREST CROSS STREET: WOODRUFF THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED B EXPIRES EXIST OCC GRP: B 12/31/97 12/31/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DAT L 'BY: CODE: CHANG, BOB C (818) 289-4088- 3,000 238 S. ATLANTIC BLVD ALHAMBRA, CA 91801 FEES PAID DE CRI T ON 0 WORK TENANT IMPROVEMENT (PARTITION WALL) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: EL. 0: EVERSTRONG CONSTRUCTION, INC (800) 933-8913- AA BLDG PERMIT ISSUANCE 27.75 AE STRONG MOTION OTHER 3000.00 VAL 0.63 SPECIAL CONDITIONS: AX BUILDING REVIEW FEE - _ 54.70 A2 PERMIT W%ENERGY-HC: •3000.00.VAL 114.02 " - "TOTAL•FEES• ' 197.10 CONTRACTOR: TEL. N0: �: : ,,' �; "�' _' APPROV LS DATE INSPECTOR S GNATURE EVERSTRONG CONSTRUCTION, INC. (800) 933-8913- y-� 1033 WESTMINSTER AVE. LIC. NO OC ON AND-SETBACKS ALHAMBRA CA 91803 721681 +"`� SOILS ENGINEER APPROVAL ARCHITECTOR ENGINEER: TEL. NO: - i I; �LFOUNDATION/TRENCH FORMS LIC. NO:-, SLAB/UNDER FLOOR RAISED 00 N MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:, , UNDERFLOOR INSULATION 0. S: DWELLING S: C ND: S - -- - -- _ -- - - - - FLOOR SH G NO 22 ROOF SHEATHING SC A DO S RPANELS AIR QUALITY: 1000 FEET MATERIALS ;,. NO NO NO _ FRAME I SPECT ON FIRE SPRINKLER HANGERS INSULATION/ EA ER STRIP INTERIOR LATHIORYWALL EXTERIOR LATH RATED WALL ASSEMBLIES T- R C51LINGS LOT-IMINAGE REPORT ID: DPR261 ROUTE TO: BS0508 . COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT "DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9706040065 PHONE: (818) 285-0488 EXT: NUMBERLEGAL ID: OF M GNS: 1D G D SS: ON FILE SIGN DESCRIPTION: CHANNEL LETTERS IN EXISTING SIGN 5953 TEMPLE CITY BL TEMP CA 91780 ASSESSOR T O N BER: NEAREST CROSS STREET: WOODRUFF THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: T B 1 DW US E ISSUEDPROCESSED P S 0 BENTOYA OF TOKYO EXIST OCC GRP: 06/04/97 TC 06/04/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE Y: CODE: . CHANG, BOB C (818) 289-4088- 200 238 S. ATLANTIC BLVD EX H 9EU ALHAMBRA, CA 91801 FEES PAID D S P O NEW CHANNEL LETTERS FOR EXISTING SIGN -RED & WHITE LETTERS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: 0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AE STRONG NOTION OTHER- 200.00 VAL 0.50 SPECIAL CONDITIONS: AX BUILDING REVIEW=FEE L +_t 54.70 D2 PERMIT W/O;EN_HC' 'i! r, 200:00 VAL 43.50 TOTAL (FEES=) 126.45 CONTRACTOR: TEL. NO: APPROVALS DA E INSPECTOR SIGNATURE SAME AS OWNER �f'' LIC. NO 4� � "!� � {{y� LOCATION SETBACKS \—4 ;! .✓j�� • �, a;` SOILS ENGINEER APPROVAL ARCHITECT 0 GIN 0: 4:? d '� `) �(,; Ali �� °+ 5 - NDAT C 0 S LIC. N0: J,�'' SUPPORT STRUCTURE . MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:00 NO.OFFFAMILIES:bpi€C DWELLING UNITS: TT/C No D: STAT CLASS:;' NO 20 SC 00 AIR QUALITY: 1000 FEET MATERIALS '• NO NO NO 1 REPORT ID: DPR261 ROUTE TO: BS0508