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Home My Public Portal About6106-6108-6110-6106 1/2 TEMPLE CITY BLVD_Building__ a R . APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR S IC I hereby affirm that I have a certificate of consent to self insure, ByL�uLDIN ADDRE ^� / to /�O V,G.6 or a certificate of Workers'Compensation Insurance,or a certified C '�� 1 TY �J l/d copy thereof(Sec.3800,Lab.C.) A r� C•�IT t01-r ZIP /y� Policy No 2 23 b—DO.3 Company��L�CLu 6r�w ` / T • r 7? LOCALIT G, SIZE OF LOT NO O�LDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST Certified copy is filed with the county b 1 ing spection TRACT BLOCK LOT NO. depa m nt. USE ZONE MAP NO. Date C 3 Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ER TEL/NO. COMPENSATION INSURANCE Vol-) S O(o-off WITHIN 1000 FT OF SCHOOLS YES NO (This section need not be completed if the permit is for one hundred ADD ESS p Al lJ 9 �� DISTRICT GROUP TY ONST. FIRE ZONE PROCESSED BY dollars($100)or less.) 0 r 1v I certify that in the performance of the work for which this permit c � `LG iT ZI� 7 (� �� is issued, I shall not employ any person in any manner SO as t0 A CHI ECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject to the Workers NTRACTOR EL O. ` SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith by�/N Q�' IXr ` '��"!�7 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS _ LIC NO✓�� PL LICENSED CONTRACTORS DECLARATION Q-i�� S! 7 SIDE C ,O �� LICXL PL I hereby affirm that I am licensed underprovisions of Chapter 9 12ALD PJ1 V '�� EWER MAP > (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES I NO OF FAMILIES CA Professions Code,and my license is in full force and effect. NEW BK PG C � � v License Number7-IFS Lic.Class -3q DE CR TION OF WORK ADD ❑ VALUATION 5j d QQ °� , IL Contractor ) 5 Date 1) - o vo d zz Apo 10l 0JIr ALTER ❑ $ IQ, a P�s6 �' G�/�7� WONJ REPAIR C ❑ 1 am exempt under Sec. $ F' BAP.C.for this reason Idbv.,t]�L V„/r, IM&� 1, DEMOL ❑ C CDMA P/C# LL Date: USE OXI$JIS�LB.�7, n L URM 11 Cr Signature �� /+ APPLI T(PRINT) TEL NO. LDMA Perm# ❑ 1, as owner of the property, or my employees with wages aS 0 P ArwN s Z their sole compensation, will do the Work and the structure is ADDRESS /l G� �. Q�Ap L p�f� O not intended or offered for sale (Section 7044, Business and ! �� '�� `' FINAL DATE a =�1�� ;��n is_I Professions Code.) D WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J + 11-S l' ❑ 1, 8S owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? _ licensed contractors to construct theproject Section 7044, FINAL BY i ( YES❑ NO i 1 I.`'1L 4.'l m La Business and Professions Code.) X La� WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING f + OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH `'' �°' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR , GUMEUNES. t•Iff?('�(�C a)_1. I hereby affirm that there is a construction lending agency for YES❑ No)3L CM the performance of the work for which this permit is issued(Sec. 01 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING � _ 3(197,Civ.Ci.) TITLE 2.CHECKCHAPTER 1I 2 20AND MY SECTIONS REQUIREMENTS 20. HRO GH 2 20 1140 CONCERNING HAZARDOUS ANGELES COUNTY S iJ�-IJ4��r{�+-I 1!J r Lender's Name �od MATERIALS REPORT G AND TAINT P IT FROM T SCAOMD o Lender's Address C z.tiL A t 1C o C."7 OWNER OR ADEN c I certify that I have read this application and state under penalty c of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building d' construction her authorize representatives of this County ISSUANCE FEE / �O anter up 0 e b e 'oned property for inspection purposes. (v INVESTIGATION FEE TOTAL FEE / Me SEE REVERSE FOR EXPLANATORY LANGUAGE v� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADD SS -� B� RESS �J A„^ D I hereby affirm that I have a certificate of consent to self insure, IILDING ADD /20 0/z cf �,Y/Gjp�2� or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.9C.) /P6 L� r/7— zip /+��7 Policy No. ZTr3 DOa Compar O�`�' `^'� `Z ,1 � LOCA SIZE OF LOT NO�BLDGS.NOW ON LOT -2.. ❑ Certified Copy is hereby furnished. NEAREST CR S ST Certified copy is filed with th County b 'di inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' gW NER TEL NO COMPENSATION INSURANCE Pv! T-14S WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS `� T dollars($100)or less.) 0 1 W & J DISTRICT GROUP CONST FIRE ZONE PROCESSED BY CIT lvL J �G ZIP �� y `� I certify that h the performance of the work for which this permit (fir -,T Q[ 7 D (/A bissued, I shall not employ any person at any manner SO as to ARCHITECTDORENgNEER TEL NO. become subject to the Workers'Compensation Laws. 66 STATISTICAL CL�TION APT CONDO Date Applicant ADDRESS CLASS NC DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become sub;;ect to the Workers' CQNTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith "l-t/US C, &F-3319-73-e-1 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION 64-V7 1f1J,7&AJ `57 4%ZA0 3 SIDE � A AllLIC.C P L I hereby affirm that I am licensed underprovisions of Chapter 9 Y 441-✓1 �V/`�` > (commencing with Section 7000)of Division 3 of the Business and .FT.SIZE NO.OF STORIES I NO.OF FAMILIES WER MAP n Professions Code,a d my license is in full force and effect. NEW BK PG , C License Number & LLiIC.Class d,39 DE RIPTION OF WORK ADD ❑ VALUATION Contracto 's i�� -6� 0� 041) �� ALTER ❑ $ �� ❑ I am exempt under Sec. REPAIR $ $ F C: B.BP.C.for this reason I/L,6"6�/� � �j Sff(N¢ EMOL 11LL LDMA P/C# a Date: USE OF I `N`BLDG.j26277AURM ❑ Signature APPLI NT(PFUNT4 TEL NO. LDMA Perm# _ e ❑ I, as owner of the property, or my employees with wages as ! S Z t-s1:! e v their sole compensation, will do the work and the structure is ADR '` / � _ /� 14,A ) 08 O s,7_T not intended or offered for sale (Section 7044, Business and K Irv►�� i r 13 � "J FINAL DATE a _�� 16 �1= Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 9 1 iT OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 13 I, as owner of the property, am exclusively contracting With AMOUNTS SPECIFI ON THE HAZARDOUS MATERIALS INFORMATION GUIDES ; I �- EMS licensed contractors to construct the project (Section 7044, FINAL BY TOTAL - YES ElNO IAL _IL6a p1�� Business and Professions Code.) WILL THE INTENDED USE OF THE BUIOUNG BY THE APPLICANT OR FUTURE BUILDING CHECK I�5.-cj OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR r: GUIDELINES. CH j`igG-E a1_{ I hereby affirm that there is a construction lending agency for YES❑ NO C C-4 the performance of the work for which this permit is issued(Sec. 0) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING _ 3097,CIV.C.) - 1 CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 1nvJ EAvJCY / t TITLE 2.CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS f l ll,10-I,��`•I�1 10 [/0 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD t :n Lender's Address — 0 OWNER OR AGENT oI 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 / N with all county ordinances and State laws relating to building ��J � constructio d hereby authorize representatives of this County ISSUANCE FEE / ' �/_yt co o e ter up a m do d property for inspec n rposes. (p -7 — ro INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE DEPARTMENT OF-BUILDING AND SAFETY : ' APPLICATION•FOR PERMIT COUNTY OF LOS ANGELES BUILDING '® I WM. J. FOX: CHIEF ENGINEER �. FOR PY.ICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. �PL^A14-CK.N13. PERRMIT NO. ADORE96 LOCALITY 7'9,y A �// ( � RECEIVED BY )DATE�yOF APPfL. DATEISSUED CRNEARE OSSS T. If ��.Ud�`rr�. js/�•`�i BUILDING OWNER ''' . ,/Gy9. ADDRE99 C) ��'.aJ fP? . It:A .r�!.7e.-: �, f.� �� ..••. ,. MAIL ADDRESS d 7/ �!!!�/ ./, Yu+l •/ LOCALITY q NEAREST ((/ / � � TEL. ,/ fl CROSS ST: ,'°'i+�> iL ylY-•.. (,J�� CITY !9. f :FAy:pi!�.jluu NO. �"�'' (7 .�. , FIRE NO.OF TYPE 71pup ARCHITECT OR TEL. ZONE PLANS _ ! r ENGINEER. NO. p BLDG. i / � ORD.No. ADDRESS s2rrrr� ! _ SETBACK LINE :.,�1°Q, ; ,.; / 1-161 1 APPROVED TEL. By DATE CONTRACTOR NO. USE y�� .�APPROVED ADDRESS ZONE Sy. DATE LEGAL - CORRECTIONS' DESCRIPTION LOT 140.' BLOCK ' TRACT '4 y 2+:L. / SIZE OF LOT !,�®jr j5 I NO.OF BL � + NOW ON LOOTS OTUSEOF NO.13F 0.OF EX STING BLDG. It I FAM LIE f I ROOMS DESCRIPTION OF WORK NEW I ALTERATION I ADDITION O REPAIR MOVING DEMOLISH T� SIZE .y �/ / STORIES D SIZE �aCr'A: ROOMS W . WALL Roar COVERING rG °iG� I COVERING li�jl Csl�;p.sE��y r USE OF NEW / BUILDING /!1� _/.//tlLf M - I HEREBY ACKNOWLEDGE THAT I HAVE, READ THIS �/' APPROV S APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOLINDATION: LOCATION 0490ECTOR DATE n/ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES !FORMS,MATERIALS .7 AND .I�Y AND STATE LAWS REGULATING BUILDING CONSTRUCTION. .,sem'') 7 FRAME: FIRE STOPS ��i '`' SIGNATURE OF /,7 j BRACING BOLTSY /, I PERMITTEE �J �1//� //ll + I r_ rS'e LATH,INT.: AUTHORIZED AST // _ 1x "G a t flV • / _ LATH,EXT.: l OBS-3 SOM SETS 7-47 $ ' "P.C.III PLASTER,INT. FEE PLASTER,EXT. ,pp�� VALUATION P:J�`� FEELr�+., FINAL ,,/y�L•y DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES � � � � ® ' Nw� WM. J. FOX, CHIEF ENGINEER OF FOR AP LICANT TO FILL IN• FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING r ADDRESS s • �b LOCALITY s[,csy�0 s RECEIVED BY DATE OFAPPL. DATE ISSUED NEAREST f✓./ ��, /ice �- � & CROSS ST. �d ' Y ADDREBUILDISS � Ly� B OWNER ADDRESS a a..• 7 O 6 �� MAIL ® r�� LOCALITY (� ADDRESS NEAREST // C �&. TEL. /�� CROSS ST. /A A crJ_ w CITY NO. FIRE NO.OF TYPE 6r ARCHITECT OR TEL. ZONE PLANS �[� L ENGINEER 0 NO. BLDG. � /''''f� ORD.NO. ADDRESS ..yd7i��• s SETBACK LINE /�, APPROVED CONTRACTOR BY I DATE USEEG2 ,APPROVED ADDRESS ZON-�BY DATE LEGAL � A CORRECTIONS DESCRIPTION LeOpTpNyO. BLOCK TRACT eewe NO.•Ot BLDt3B. SIZE OF LOT 40 )f I NOW ON L'OT ~� USE OF �� [fCbGb6ryI0.OF a NO.OF EXISTING BLDG. r•• FAMILIES ROOMS � �� DESCRIPTION OF WORK NEW ALTERATION k ADDITION a 0 J i a REPAIR r J t MOVING DEMOLISH :Q. ZE ;' ; � ROOMS STORIES D WALL I ROOF COVERING /°.A.�if9 COVERING USE A BUILDING ('�fy'I� :� % I a- .4 e _ .�.4ti w �•+ . '.�le'/1!!r2t..(c2.(r- _ '� ---- .;—t'=� • yam. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPR � _,r �•�,�,��{ APPLICATION AND STATE THAT THE ABOVE 19 CORRECT SPEC�p R w DATE iP AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCESINFOUNDATION. ION V�3 FORMS,MATERIALS V AND STATE LAWS REGULATG,BUILDING CONSTRUCTION.. a FRAME'FIRE STOPS, SIGNATURE OF jBRACING,BOLTS PERMITTEE ✓ LATH,INT.: I9� , AUTHORIZED AOT- / LATH,EXT.: f��r ✓ ~ 4r r S)GS-a SUM SETS 7-47 $a P.0 R w�IL/ PLASTER,INT. PLASTER,EXT. VALUATION -� FEE - FINAL DEPARTMENT 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 DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING aJ_', 6c, r� �1®a ® ,/ �j +� ADDRESS e P.i an t. / / 7 e LOCALITY ( '%"9. RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST CROSS ST. rr�g'. fZU–� BUILDING OWNER ADDRESS ,al CG1 v5' nA n r3��4f1 e44�. *a`, l W u MAIL �� ble LOCALITY ADDRES NEAREST .4 (� TEL /l`�f/ CROSS ST. �, =L�� . .• 1 CITY NO .706 7 6 • FIRE IVO.OF TYPE , GROUP ARCHITECT ^ TEL. ZONE PLANS / ` ENGINEER NO. – 1 BLDG. ! SNO. ADDRESS SETBACK LINE 1r�.,O�7 q �� APPROVED //�/�J/ TEL. DATE CONTRACTOR NO. BY USE APPROVED ADDRESS ZONE ,fir{ ,BY DATE DESCRIPTION LOT NO. '� BLOCK Cf i CORRECTIONS TRACT Lr �."r 7 BLDG SIZE OF LOT I NOW ON LOTS USE OF ` I NO.OF EX _I NO.OF _MISTING BLDG. FAMILIES ROOMS DESCRIPTION OF WORK NEW I A,4ALTERATION I I ADDITION O REPAIR MOVING DEMOLISH :1).FT. NO.OF I SIZE ROOMS STORIES - y WALL ROOFCOVERING A I COVERING/A'141�fdCf��(,[ r USE OF NEW BUILDING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROV ' , APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION, LOCATION 18 ECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS �,I , -1 LI AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME., FIRE STOPS, SIGNATURE OF BRACING,BOLTS PER14ITTEE� ~4 i�L`f LATH,INT.. r),7_ / AUTHORIZED AGT v —v ' LATH,EXT.., 999'3 SOM SETS 7-47 $ P.C.G PLASTER,INT. ®� FEE PLASTER,EXT. /All VALUATION � FEE *6 0 FINAL