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Home My Public Portal About6042-6044 TEMPLE CITY BLVD_Building__ .i.XY, TEMPLE CITY , � '6 8 -8 7 A BSACE�8091 1-62APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION' LOCALITY ~ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST f WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. DIST CT N G OUP TYPE P SSED BY FOR APPLICANT TO FILL IN 110NST BUILDING STATISTICAL CLASSIFICATION SE ER MAP ADDRESS V CLASS.NO. DWELL.UNITS LOT NO. -Z 4 BL06 WATER NOTREQUIRED RECEIVED / CERTIFICATE: TRACT (C MAPIGHWAY STATE MAJOR OND LOCAL NO.OF BLDGS. NO. (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE SIIECIAL USE OF CONDITIONS EXISTING BLDG. TEL. OWNER NO. BUILDING YARD HWY RE T.NA E EXIST. SETBACK WIDTH ADDRESSAl. Or FRONT ARCHITECT OR TP• L. ENGINEER NT. SIDE ADDRESS ` ; t; i r<, � / 6 CONTRACTOR �•� (y! v .nn f�..• l �r 1 ' aI r- ADDRESS DESCRIPTION OF WORK `�'�`'f �'" � ° '� " u tf NEW ADD x ALTER REPAIR DEMOLISH 2 SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT VALUATION $ t APPROVALS /DAT/ n INSPECTORS 51GMATURE FEE $ FEE $ r FOUNDATION: LOCATION /t FORMS, MATERIALS / I r ( t FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE'THAT I HAVE READ THIS APPLICATION BRACING. BOLTS AND STAYS THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING' GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK + AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA-_ LATH. INT. J 9 TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENS IO EURANCE. - LATH,EXT. SIGNATU F HOUSE NUMBER COR- / �;•�� ' PERMITTE RECT AND POSTED L / ADDRESS FINAL (IV I v JOHN F. LEWIS. PRINCIPAL STRAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDAbONCK. M.O. CASH LHGO 4. 9 1 5Q.- SEP 2 7 1 D 6.0 0- a WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION F O I� BUILDING PERMIT insure,or a certificate of Workers'Compen ion Insurance,or a Ad_Sy (,S�c. 3600, Lab.r/XCCOUNTY OF LOS ANGELES BUILDING AND SAFETYPoompany Certified copy is her fu fished. _ ' BUILDING � FOR APPLICANT TO FILL IN ADDRESS (l/ ❑ Certified copy is filed with the cot3nt�buildi�inspe - , BUILDING ,v tion department. ADDRESS 1001-:1 :' LOCALITY C • • NEAREST OF- Date Applicant CITYZIP CROSS ST. Pop CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL 4 (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. �o ,� l TEL. � SPECIAL I certify that in the performance of the work for which this OWNER �V NO. CONDITIONS 6771 0 permit is issued, I shall not employ any person in any mannerDISTRICT T FIRE OCE D BY U so as to become subject to the Workers'Compensation Laws. ADDRESS � S / Z Q9 r Date Applicant CITY ZIP g�rv3 57AT(STIC) ASS!IEVALION APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. _ LU Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS H Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. CONTRALTO ^ BK. PG, VALIDATION I' /'yA LICENSED CONTRACTORS DECLARATION sT �/e'�wQ� LIC. O sus I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ,VALUATION (commencing with Section 7000)of Division 3 of the Business and ,( LIC. Professions Code, and my license is in full force and effect. CITY /T�T �,'/✓I* CLASS $ / SQ.FT. NO.OF NO.OF CHECK License Number ��/5��!' Iyicc..Class SIZE STORIES FAMILIES ONE __I�; �/ IcWP•wc.I DESCRIPTION OF WORK NEW $ Contractor a Date D Elam exempt from the licensing requirements as I am a " icensed architect or a registered professional engineer R FINAL acting in my professional capacity (Section 7051, T a DATE Business and Professions Cbde). USE OF r EXISTING BLDG. DEMOL FINAL Lic.or Reg.No. Date J;APPLICANT TEL. By OWNER-BUILDER DECLARATION x (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License 0��-- Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT " 1 6 1,9 A ❑ I, as owner of the property, or my employees with BUILDING ADDRESS wages as their sole compensation,will do the work and #; 0 0 0 0 0 1 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- ADDRESS iron 7044, Business and Professions Code). REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY t SET BACK YARD HWY PROP. LINE WIDTH 10.20-81 I hereby affirm that there is a construction lending agency for r FRONT ' the performance of the work for which this permit is issued P L (Sec. 3097, Civ. C.). SIDE P.L. i. Lender's Name Lenders Address P.C. Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws r lating to building construction, 4 - and here thorize rep tatives of this County to enter Total Fee U pon f ab a-me n d ro er r insp ction Pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat of Applicant or Agent Date ®s I WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION F [" BUILDING PERMIT insure,or a certificate of Workers'Compenstion Insurance,or a 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 BUILDING • p > . ADDRESS ; i' Certified copy is filed with the county building inspec- BUILDING //�� rr ./ tion department. ADDRESS C47-^ arotc en at-to . LOCALITY /'� �!, ^' NEAREST Date Applicant CITY 'r P8 ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT ICO P gs, NO.OF BLDGS ASSESSOR NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE (This section need not be completed if the permit is for one USE ZONE MAP �r hundred dollars($100)or less.) !TRACT BLOCK LOT NO. NO. } TEL. ',y SPECIAL g, OWNER AL. 33061AI65 NO Z13 6p CONDITIONS 1 certify that in the performance of the work for which this. O permit is issued, I shall not employ any person in any manner ` > ®a DISTRICT GROUP TYPE FIRE PROCESSED BY so as to become subject to the Workers'Compensation Laws. ADDRESS CArL66- eA AF-rLL•I2 CONST. ZONE CITY Ml� S ZIP i�O Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. U T NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER ARCHITECT OR. Ek i.14) PNILwPS y Aril. N L13)35 o41� Exemption, you should become subject to the Workers' ,1 n,� pt CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS 40 avond ,94 D� zc6 v UARre SEWER MAP with comply with such provisions or this permit shall be TEL.. deemed revoked. CONTRACTOR W14 K. W&4 NO. 13 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm thaP I am licensed under provisions of Chapter 9 ';ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. a CITY CLASS $ SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES IFAMILIES ONE y DESCRIPTION OF WORK s 6$! NEW Contractor Date �' I am exempt from the licensing requirements as I am a ADD licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, REPAIR DATE Business and Professions Code). USE OF + DEMOL EXISTING BLDG. ❑. By Lic.or Reg.No. Date FINAL APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. p I hereby affirm that I am exempt from the Contractor's License ®l r Low for the following reason (Section 7031.5, Business and " ADDRESS �7 Professions Code). :PRESENT ❑ BUILDING V I, as owner of the property, or my employees with . ADDRESS wages as their sole compensation,will do the work and �� r the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. �� / %q, J� I, as owner of the property, am exclusively contracting CONTRACTOR NO. Iv-4M, Q P with licensed contractors to construct the project (Sec- a ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH �. I hereby affirm that there is a construction lending agency for FRONT t the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. { /( Lender's Name , ' � Permit Fee `r Lender's Address P.C. Fee$ r I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee 1/ ordinances and State laws relating to building construction, Total Fee 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 I WORKERS'COMPENSATION DECLARATION hereby affirm that I haver a certificate of consent to self APPLICATION F O 3 U I L®I N G PERMIT insure,or a certificate of Workers'Compe tion Insurance, or a cert; ' c py hereof Sec. 800, Lab COUNTY OF LOS ANGELES I BUILDING AND SAFETY Poli o. pany •�1 ❑ i BUILDING I Certified copy is he furnished./F GJ FOR APPLICANT TO FILL IN ADDRESS , �ffJ_ a/rtifted copy is filed with the coup y build ng inspe BUILDING tion department. ADDRESS a��/�` / V .�� LOCALITY NEAREST Date Applicant CITY ZIP CROSS 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. NO. J`�/ } TEL. p 't � PECIAL ,,�� I certify that in the performance of the work for which this OWNER NO. / I` DATIONS/t=//r V permit is issued, I shall not employ any person in any manner DISTRICT R FIRE P ESS BY so as to become subject to the Workers'Compensation Laws. I:ADDRESS - � VaN �. 57 Date Applicant CITY �&KJ7 ZIP D STATISTICAL CLAsbI TION APi. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. _ ty Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO.y7 DWELL. UNITS H Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP LP with comply with such provisions or this permit shall be Qo —' deemed revoked. v. 7EL.�(>f 7,97-PPA"' BK PG VALIDATION CONTRALTO NO 77 ! LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSJV.J A/-I�,Q , VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY 7 60 CLAIF $ SQ. FT. NO.OF NO.OF CHECK License Number �rr�/Lic.Class SIZE STORIES FAMILIES ONE L Contractot�� —pate DESCRIPLJW OF WORK 1 c�/�� (� NEW ❑ I am exempt from the licensing requirements as I am a ADD ❑ , licensed architect or a registered professional engineer R FINAL acting in my professional capacity (Section 7051, 7— DATE AIR Business and Professions Code). USE OF DEMOL FINAL t EXISTING BLDG. ❑ By .- Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License / Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ❑ BUILDING " I, as owner of the property, or my employees with ADDRESS ;: i 1 6 2.O A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ! # 0 0 0 0 0 1 7044, Business and Professions Code). MOVING TEL. I, as owner of the property,am exclusively contracting CONTRACTOR NO. 2 0 0 3 1, 00 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS. 0 0 0 1 f`C c REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH IO 2 O' 1 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 o P.C.Fre$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws rel ting to building construction, Total Fee and here uthorize represen atives of this County to enter upon a ve-ment' ed ty for i spection purposes. 't Signatu / SEE REVERSE FOR EXPLANATORY LANGUAGE o / [ Applicant or Agent ate ®s i 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.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ej�'l sa �'� Certified copy is filed with the county building inspec- FBLDING !� [ O / tion department. RESS f� "f �O�T �'I C:1 I�W� LOCALITY ��C-�`-�� r NEAREST Date Applicant T LT ZIP CROCERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE OF LOT QQ � D NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for oneUSE ZONE MAP hundred dollars ($100)or less.) . TRACT BLOCK LOT NO. - / NO. n TEL.(yrf�, /'� 5 ECIAL 8 I certify that in the performance of the work for which this OWNER 'SO 'I�(C NO. --31 CONDITIONS permit is issued, I shall not employ any person in any manner �- DISTRICT GROUP TYPE FIRE PROCESSED BY CONS 41 so as to become subject to the Workers'Compensation Laws. ADDRESS �p -- `�� 2 r129 CITY SN7i7V 3 1 P1 ZIP 1773 Ib Date Applicant STATISTICAL CLAe T}QfV (O APT. CON NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR `L' TEL. v Cv/ M_ ENGINEER N ythv.SOAj N0 3 C CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' �� tH Compensation provisions of the Lqbor Code, you must forth- ADDRESS � Bqf6 Q3.0 P 4 SEWER MAP � with comply with such provisions or this permit shall be TEL. VALIDATION deemed revoked. CONTRACTOR NO. BIC 252, LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. C� 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 135D STORIES Wp IFAMILIES 0 0 ONE $ Contractor Date DESCRIPTION OF WORK NEW ❑ ADD ElI am exerppt from the licensing requirements as I am a 0 UA/1TS /�( nl I V ❑ licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code). USE OF DEMOL FINAL EXISTING BLDG. ❑ By Lic.or Reg.No. _Date APPLICANTTEL. OWNER-BUILDER DECLARATION (PRINT) C�E/L�p O V N NO. J -300 1 . I hereby affirm that I am exempt from the Contractor's License ADDRESS 0 ��r rJ�O � �1 X511;17__Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT y p !�� 04TY BCAk �I, as owner of the property, or my employees with ADDRESSwages as their sole compensation,will do the work andthe structure is not intended or offered for sale(Section LOCALITY7044, Business and Professions Code). MOVING TELI, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- •C! tion 7044, Business and Professions Code). LADDRE TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY PROP LINE WI �t I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 1' Lender's Name � p�Lender's Addressvl v Permit Fee �j7,I certify that I have read this application and state that theIssuance Fee /above information is correct. I agree to comply with all County Fee ordinances and State laws relating to building construction, Total Fee and hereb authorize representatives of this County to enter 2� upon t e ab e- entioned property for inspection purposes. { til✓y� f ��1 (�CJ SEE REVERSE FOR EXPLANATORY LANGUAGE \{ 0 Signature of App c t or Age V7 Dote ®s i! WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self P P L I CATION FOR BUILDING P E RMI T -' insure,�r a certificate of Workers'Compensation Insurance, ,� - or a certified copy thereof(Sec. 3800, Lab. C. \ Policy No. Company S[ L 'UN�S �' COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING Certified copy is hereby furnish FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the c un building inspey- BUILDING Q, y J(� Hand partment. _ I ADDRESS D�G P (/ ��f. 9lLy ." LOCALITY 6Q ! '// NEAREST Date ( 4�/ y Applicant V"°' ;.CITY ZIP CROSS ST. CERTIFI TE OF EXEMPTION FROM WORKERS, 'NO.OF BLDGS. -ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 10 O r9z NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE ESPECIAL hundred dollars($100)or less.) TRACT BLOCK LOT NO. �? TEL. -r I certify that in the',performance of the work for which thisOWNER ��l!i� W NO. DITIONS JIL permit is issued,I shall not:employ any person in any manner DISTRICT ' .GROUP TYPE ' FIRE PROCESSED BY O so as to become subject to the Workers'Compensation Laws. ADDRESS CONST. ZONE Date Applicant CIN ZIP STATISTICAL STICAL CLASSIFICATION CONDO. NOTICE TO APPLICANT: If; after making this Certificate of ARCHITECT OR 1' ,�y�}7( TEL. Exemption, you should become.subject to the Workers' ENGINEER UI �r+�^�Y NO. ` CLASS NO. DWELL.' UNITS U+ Compensation provisions of the'Labor Code, you must forth- (s •��22 ADDRESS �j) 1 SEWER MAP with comply with such provisions or this. permit shall,be �(' deemed revoked. CONTRACTOR. eD�t •I\c W. Aj �1�: ' Y BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION .� LIC ' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 60 ko NO..4014 VALUATION ; +(commencing with Section 7000)of DivisioA 3 of the Business and ) n LIC. �' Professions Code, and my license is in full force and effect. CITY 1 -CLASS ;/, 0�0 ® " SQ..FT. NO.•OF NO.OF CHECK License Number. Lic.Class SIZE STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑` I fG. ADD li[ ❑ ❑I am exempt under Sec. ' G 8 '� � 0,,'�� ALTER ❑ FINAL : r . B.6P.C. for this reason REPAIR DATE USE OFFINAL Date: EXISTING BLDG. !�7DEMOL' E] Sy.• � ' -- Signature APPLPRIN7T NO. .l?( —93.3 '. OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from'the Contractor's License ADDRESS' Law for the following reason (Section•7031.5, Business and Professions Code): BUILDING ; ❑ I, as owner'of the pd(Operty, 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 i 7044, Business and Professions Code). MOVING TEL. ❑ I,.cs owner of the property,am exclusively contracting CONTRACTOR NO: ° l �;,v'+0 with licensed contractors to construct the project (Sec-• ADDRESS ° '�31 f, tion 7044, Business and Professions Code): REQUIRED TOTAL SETBACK FROM EXIST. f O CONSTRUCTION LENDING'AGENCY SET BACK YARD HWY PROP:LIN WIDTH y; I hereby affirm'}hat there is a construction lending agency for FRONT the performance of the•work for which this permit is issued P.L. tSec. 3097, Civ. C.). SIDE ; ?, Lender's Name 3 ; P:C.Fee$ Permit Fee f Lender's Address I certify t'I have'read this application and state that the Issuance Fee I above i f rmation is correct. I agree fo cornp'ly with all County Investigation Fee ordinan s d State laws relating'to-building construction, Total Fee I he y uthorize rep re�ntctives of this County to enterupon a ve-mention dope�ty for insp tion p. ses. o , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature,of Applies or Age Dae ®s WORKERS'COMPENSATION DECLARATI7Nr '• q insure,or afce?ificateafirm thatlof Workers'Compenstion In urancehave a certificate oconsent to .,olr r APPLICATION F O R R U I L D I N G PERMIT certified co y thereof(Sec. 3800, Lab. C.) CER � �,p ufv ri COUNTY OF•LOS ANGELES •BUILDING AND SAFETY iblicyNo. Company A -'BUILDING u Certified copy is hereby furnislie : FOR APPLICANT TO FILL IN ADDRESSp �� )- �[•� Certified copy is filed with the c Yy building"nspec- i BUILDING / e tion' ep riment. /,( ADDRESS �O Y p 0 (�7'1 ZE �!(� fs LOCALITY �G1 Date l g Applicant (!1 i CITY TSI LG T ZIP CROSSNEAREST. T. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT DO X JS S. 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. NO. > i T /� TEL. I tF . � 'SPECIAL . I• I certify that in the performance of the work for which this OWNER 1' - SOC NO. q-3Y3�• CONDITIONS permit,is issued, I shall not employ any person in any manner (� DISTRICT GROUP TYPE FIRE PROCESSED BY LJ so as to become subject to the Workers'Compensation Laws. ADDRESS ((� �,,T 0••�� . �O CONSNE �/W -I�I'/L9 G ! Date Applicant CITY ZIP 3 ' STATISTICAL CLASSIFICATION APT. ]CONDO. ARCHITECT OR .,n TEL. Q NOTICE TO APPLICANT: If, after making this Certificate of • ENGINEER. I�ON �o �P� NO.�3 7�8 ' �� = � IL IL Exemption,, you• should become'-subject to the''Workers' CLASS NO. DWELL.UNITS ']I(�A ay p/9sS Compensation provisions of the Labor Code, you must forth- ADDRESS /yp,U SEWER MAP 9& with comply with such .provisions or this permit shall be deemed revoked: CONTRACTOR ��1A//11� I/1f pA) TEL. �s 2 BK.r PG, VALIDATION NO. J 7 • LICENSED CONTRACTORS DECLARATION ereby affirm that I am licensed under provisions of Chapter 0' ADDRESS 60 CitS? �(� NO. ; (commencing with Section•7000)of Division 3 of the Business and �y�� L VALUATION , Professions Code, and my license is in full force and effect. CITY LA' f6fs G 0634LASS ltb $ License Number. T '�+ Lic.Class SQ.FT. NO:.OF NO 'OF CHECK l'• SIZE �'3Sd STORIES ?NVD FAMILIES. I�• ONE '`,►i 1 r /WC 6 'Coniractorfr/lll/>1/ /� �y4f►Vl! q}e ZT (p DESCRIPTION OF WORK NEW $ �0 • ADD O,i / •l'..34iie'�s pG,�i,7;yt 141:FZi4#g.E14; I am exempt from.the licensing requirements as I am a O 01J t TS � O, v, ,,, . licensed architect or aregistered-professional engineer ALTER Q FINAL +• Lzh k(C1,3 �;i_'� , a i�F�P�3Q�iEQ: �rT1 acting in my professional -opacity (Section 7051, ., DATE REPAIR u:r •� �z FIR�. E3a�®a1M-8.APFP:Id'1f41 Business and Professions Code).' USE OF EXISTING �7 FINAL '"", EXISTING BLDG. LJ By 44�c• A, Lic.or Reg.No. r. Date APPLICANT ��j TEL. � _ OWNER-BUILDER DECLARATION (PRINT) DC7 . YD v/�L NO., -3v i7 c�`"" ° ° ° `v I hereby•affirm that I am exempt from the Contractdr's License [[cc /�a��1 1, ,� s� D/� ,� Law for the following reason (Section 7031.5, Business and ADDRESS �TD � G�A�+�ILLO C 517, v Professions-Code): PRESENT v BUILDING O V O��- '',,II �T / �y e.,o ��'•'!� it u I, as'owner of the property, or my employees-with ..,ADDRESS / ` t✓i 6, o/ wages as their sole compensation,will do the work and hw, -�.4 _S [ADDR LITY ' the structure is not intended or offered for sale(Section C�-•' ` 7044, Business and,Professions Code). NG TEL'. DI, as owner of the property,'am exclusively contracting RACTOR• NO. �t with licensed contractors-to construct the project (Sec- {4 5 2 A ESS tion 704.4, Business and Professions Code). � • I UIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for NT 2 5.3 1 3,7 the performance of the.work'for which this permit is issued (Sec. 3097, Civ. C.). E ° 7, " •J.J Lender's Name Q62,4--82 ee S� ` Permit Fee•Lender's Address �/ 7I certify that I have read this application and state that the %{v (' �� Issuance Fee J +'SODabove information is correct. I agree to comply with all County igation Fee ordinances and State laws.relatin to buildin construction, y •-� I ` d g g Total Fee 3 3 3 /.3 Td b (2y+ and hereby-authorize representatives(of this County to enter ! h upon the a entioned property for inspection purposes. ) Joe i /Z�V/` SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Sign re of Applica r Agent J/ S'S Dgate �[ i 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 0312150038 PHONE: (626) 285-0488 EXT: LEGAL I • Ro. OF CONST BUILDING DDR SS: TR: 39984 LT: 1 UN: 1 SA. FT STORIES TYPE 6044 TEMPLE CITY SL A STRUCTURE: VN TEMP CA 917802054 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5385-014-039 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: REBID USE ZONE: R-3 ISSUED ON: PROCESSED BY: EXPIRES ON: i EXIST OCC GRP: 12/15/03 JK 12/09/04 OWNER: TEL. NO: B DGS. NOW ON LOT: VALUATION: FIN L DATE FINAL BY: CODE: N/A - 2,500 _ ' o FEES P IDESCRb IPTION OF WORK T/0 AND REROOF BUILTUP ROOF ON 6044 TEMPLE CITY BLVD BLDG APPLICANT: TELNO: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: (5 UNITS) . TWENTY FIRST CENTURY ROOFING (818) 248-0861- AA BLDG PERMIT ISSUANCE 27.75 2438 FAIRMONT AVE AC STRONG MOTION RESID 2500.00 VAL 0.50 SPECIAL CONDITIONS: LA CRESENTA 91214 D2 PERMIT W/O EN-HC 2500.00 VAL 99.00 TOTAL FEES 127.25 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE TWENTY FIRST CENTURY ROOFING (818) 248-0861- 2438 FAIRMOUNT AVE LIC. NO LOCATION AND SETBACKS LA CRESCENTA CA 91214 C39 SOILS ENGINEER APPROVAL AR HIT CT OR G NEER: EL. NO: ! FOUNDA ION/TRENC FORMS LIC. NO: SLAB/UNDER FLOOR ISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150H269 3 01 FLOOR SHEATHING 0. OF FAMILIES: DW LLING UNITS: APT/COND: STAT CEA-SS- NO ASS:NO 21 ROOF SHEXTHTNG SCHOOL ITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME'INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER A ERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR ATH/DRYWALL EXTERIOR LATH RATED F 00 CIL ASSEM. RATED WALL ASSEMB IES TED'SHA TS OPE G T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: SS0508