Loading...
HomeMy Public PortalAbout5446 WELLAND AVE_Building__ (aS 76AG38A CE#80 EV.6/78) ..y APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS O BUILDING �� ADDRESS LOCALITY I /n ,�, NEAREST CITY �Jy' �i(_/ ZIP v CROSS ST. t; NO.OF BLDGS. ASSESSOR SIZE OF LOTo NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT BLOCK LOT NO. CONST ZONE TEL. .t�C� OWNER Ji/i'lity✓ i. f/ NO_53 t�7yf J STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS BK 13 PG CITY/ /G/ 14 ZIP ARCHI.1'2CV09' TEL. VALUATION $ ENGINEER NO. ADDRESS n BLDG.SETBACK FROM ISTREETI � TEL. / FRONT PROP.LINE OF CONTRACTOR- /�FG;✓� /�� NO.�yy �+� TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHWAY + YARD- = FRONT PROP.LINE HIGHWAY WIDTH %! ADDRESS .S'/y.4�!'l�'r'$1 iYJ NO—;2-C 2-1.5 yy _ �Q LIC. CITY9 ••� CLASS � / BLDG.SETBACK FROM NAME AND BRANCH CONSTRUCTION LENDER SIDE PROP.LINE OF ISTREETI NAME HIGHWAY + YARD = 'TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SO. NO.OF NO.OF ff CHECK + = w SIZ F _�b STORIES �✓7 FAMILIES 1 ONE ag DESCRIPTION OF WORK NEW ❑ P.C.Fee$ Permit Fee ADD ❑ Issuance Fee �V N ,//� ov4l /2Lte ALTER ❑ g _s v REPAIR �� Total Fee USE TI 6 DEMOL ❑ :9 1 6 2 3 A EXISTING BLDG.//_„j�� :!' - Z APPLICANT /+ L 0 (PRINT)C ��j 0 0 0 0 0 BY(SIGNATURE) //�� //rr `Z 0 - 5200 r /HAT,HAVE READ A-AMICATION AND STATE Y I HEREBY ACKNOWLEDGE ,6 THAT THE ABOVE IS CQRRECTJADa6/AGREE TO COMPLY WITH ALL ORDINANCES W o 0 - 5200-P AND LAWS REGULATING BUILD WGCONSTRUCTIONL4ERTIFY THAT IN DOING THE V WORK AUTHORIZED HEREBY ICL NOTE PERSON IN VIOLATION OF THE LABOR CODE OF THE ALI IA I ELATING T RKMEN'S CO 1204-78 PENSATION INSURANC AL SIGNATOR O PERMITTEE _ ADDRESS - ' Z TEL 7 yk�V C CITY -� NO. Q D USE ZONE MAP a NO. yd� SPECIAL rp � p v CONDITIONS •0 1 m FINAL rj B 6 DATE �s A ROAD DEPT.' PERMIT IS nEQUIRED* FOR 'ANY MATERIAL S•'".ORAQ;-: O. WORK DONE IN THE ROAD RIGHT OF WAY. Fowe38ACE#a'=8.5o A►PPL,ICATION FOR BUILDING' PERM-I' COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER - A°DREsa. BUMDING AND SAFETY DMSION LOCALiIla;I JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF..BUILDING CROSS ST. DISTRIQT NO. G P' TYPE PRO SED BY ' FOR APPLICANT TO FILL IN CONST. BUILDINGSTATISTICAL CLASSIFICATION, SEWER MAP ADDRESS, ,e ( ^ K' -" PG CLASS.NO.-/ y DWELL.UNITS LOT NO: -�• BLOCK MAP STATE. 'YES• NO. NUMBER, HWY. iRACT% / USE ZONE SPECIAL F NO.OF BLDGS. / CONDITIONS SIZE OF LOT d�`G' I•-NOW ON LOT - USE OF EXISTING BLDQ. Q Lf BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT q MAIL' /` P.L. e�L 6 ' ADDRESS G( SIDE=, p•� CITY Nmol INSPECTION RECORD - ARCHITECT OR rEL. ENGINEER NO. ADDRESS ° - TEL. CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER. REPAIR DE Sp. FT.. . NO. OF. NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF 4 APPLICANT lI � APPROVALS DATE INSPECTOR'S'SIGNATURE ADDRESS /� FOUNDATION:LOCATION FORMS,MATERIALS VALUATION $ FRAME:FIRE STOPS, BRACING,BOLTS {P•C. PMT. '�) �^O FURNACE:LOCATION, FEE 8 FEE $04.% GAS VENT DUCTS , 1 HEREBY-ACKNOWLEDGE THAT I HAVE.READ THIS AP- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH,INT. ••+AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS. G// ATING BUILDI CONCTR�N. LATH,EXT. SIGNATURE OF 1 1// HOUSE NUMBER COR-.. PERMITTEM RECT AND POSTED ADDRESS FINAL 2 � -- -CLYDE N. DIRAM., PRINCIPAL ST CT•RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASK PERMIL-T VALIDATION °K M•0 CASH o' -'•.� A ROAD DEPT. PE2,M7. IS R'QUIRED FOR ANY P.';.Sa n?, 5:. ,::-..__ `.. V:(.RK pp DONE IN THS ; jAL) R—i f OF WAY. ' 7GA999A CIE#6099.119 APPLICATION FOR ]BUILDING PERMIT • 1 COUNTY OF LOS ANGELES. BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRES3� -BUILDING AND SAFETY DMSION LOCALIT JOHN A. LAMBIE, COUNTY ENGINEER NEAREST O� CASSATT D. GRIFFIN,Sur T OF BUILDING CROSS ST. IC.(ij�,�L�O DISTRICTNO. GROUPT.P P ESSED BY FOR APPLICANT TO FILL IN CONST: BUILDING "� ��q STATISTICAL CL SSIFICATION SEWER MAP ADDRESS Q U) • � �' I BK PG CLASS.NO. WELL.UNITS LOT NO. BLOCK MAP yy STATE YES NO NUMBER -J HWY. TRACT I�3O USE ZONE SPECIAL lea NO.OF BLDGS. CONDITIONS SIZE OF LOT / �(/ I NOW ON LOT USE OF �J EXISTING BLDG. !'�'r6- -�' H I YARD HWY TREET NAME EXIST. r SETBACK WIDTH OWNER / FRONT y �f P.L. �l ADDRESS Gf ��P SIDE l TEL ' (1jj1 P.L. CITY NO.A. INSPECTION RECORD ARCHITECT OW 1 TEL. ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW I ADD ALTER REPAIR DEMOLISH FT. NO. OF NO. OF SIZE 6 STORIES FAMILIES USE OF STRUCTURE k OF �,�J � I� T cei APPROVALS DATE INSPECTOR'S SIGNATURE . FOUNDATION: LOCATION FORMS,MATERIALS $ FRAME:FIRE STOPS, �BRACING,BOLTS -I '�J'•4p L3 J t '----" FURNACE: LOCATION, FEE 9 I FEE $ I GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH,EXT. STATE LAWS REGULATING BUILDING CONSTRUCTION. ' SIGNATURE OF �, �'G!r' A'�, _ HOUSE COR- EE RECT AND POSTED PERMITT ADDRESS. -4°--� FINAL CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.G. CASH PERMIT VALIDATION -CK M.O. CASH LACo59579 FEB 2 JAA 6.Q Q ®, Ind / WORKERS'COMPENSATION DECLARATION I hereI have a certificate of consent to self insureboraafcertif ceirm rtificate of Workers'Compensation Insurance, A p t�CA LI �0 N F 0 2 U I L (I M I T orof ec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY �yNo.. CompanyMission Insurance Policy N Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS 5446 Welland Ave. Certified copy is filed with he county building inspec- BUILDING 5446Welland Ave. tion department. ADDRESS Date 12-18-86Applicant qnc= i no CITY Temple City ZIP 91780 LOCALITY Te le City CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. i�l•J (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT' BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNERAdela B. Rosas TEL -4442341 USE Z NE MAP I certify that in the performance of the work for which this ��f NO. permit is issued, I shall not employ any person in any manner 5446 Welland Ave° �, 1 SPECIAL @s so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS O CITY Temple City ZIP 91780 U Date ARCHITECT OR TEL. Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHDISTRICT GROUP TYPE FIRE PROCESSED BY O . Exemption, you should become subject to the Workers' ENGINEER NO. CONSTZONE UP Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be ADDRESS o ,` y N deemed revoked. CONTRACTOR B11t-Well ROOF No2542$88 STATISTICAL CLASXIC,ATION APT. ENDO. g LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. o� / I.L.DWEUNITS - NO.hereby affirm that I am licensed under provisions of Chapter 9 ADDRE5533�-� Verdugo Road NO 5 005 (commencing with Section 7000)of Division 3 of the Business and p v SEWER MAP LOS An el eS LIC' C-39 ^ Professions Code, and my license is in full force and effect. CITY g CLASS BK r PG Lal VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number 458005 Lic.Class C-39 SIZE STORIES FAMILIES ONE llt-Well Roof 12-18-86 reroof house & VALUATION 7 gs. i erg sob ContractorB• Date DESCRIPTION OF WORK NEW ❑ �. garage with s $ 1042-62 ; ElI am exempt under Sec. ❑ y`' �.S o ALTER ❑ B.BP.C. for this reason 0 mop. REPAIR ❑ $ Date. USE OF EXISTING BLDG. Dwelling DEMOL ❑ Signature APPLICANT r TEL. OWNER-BUILDER DECLARATION (PRINT) M. Madero TEL 2 FINAL �,- I herebyaffirm that I am exempt from the Contractor's License DATE p ADDRESS 10 Verdu o Road s Law for the following reason (Section 7031.5, Business and g.. FIN/ , Professions Code): PRE ENT "YO ❑ BUILDING G I, as owner of the property, or my employees with ADDRESS r wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY s 7044, Business and Professions Code). MOVING TEL. ❑ I,as owner of the property,am exclusively contracting I' CONTRACTOR NO. 6 b 7 5 A with licensed contractors to construct the project (Sec- ADDRESS a o 0 0 0 tion 7044, Business and Professions Code). :.. . o o REQUIRED TOTAL SETBACK FOR ;�� _ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - 0 0 0 c� I hereby affirm that there is a construction lending agency for FRONT (] 316-87 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ,. 26.25. LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that theIssuance Fee 10.50 LDMA P/CLJ above information is correct. I agree to comply with all County Investigation Fee r� ordinances and State laws relating to building construction, Total Fee $36° !5 LDMA Per r and hereby authorize representatives of this County to enter _. _....., ( upo the abo e-mentioned property for inspection purposes. OA 12-18-86 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Jf Ap cant cr Agent Date WORKERS'COMPENSATION DECLARATION I hereby affirm that I have certificate of consent to self p l bDUILD"N"b PERMIT insure, or•a certificate of Worr kers'Compensation Insurance, LIZ1 IJV 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 ADD Ess E] Certified copy is filed with the county building inspec- BUILDING LOCALITY C tiondepartment. ADDRESS 7 LL��. L v �T �+ NEAREST Date Applicant CITY" C' LL- _zZz ZIP J rJ CROSS ST. + ' CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT tor- 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. ;X NO. ':/Five C�(Zr •f r,67 :/e .0f6CA:-TEL. l SPECIAL I certify that in the performance of the work for which this OWNEPc. a GA.4 decwro ice/NO./ S� CONDITIONS CL permit is issued,I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE P CESSED BY 0 so as to become subject to the Workers'Compensatign Laws. ADDRES ` �� UC`A-2 .W l CONST. ZONE 99 ��.r. �,� r- CITY ZIP Date Applirnr ` ` STATISTICAL C 'IFICATION APT. CONDO. NOTICE TO APPLICANT: If, after making this"Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS- Exemption, Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. ;CONTRACTOR NO. BK. VALIDATION LICENSED CONTRACTORS DECLARATION LIC. ... :.:.-...........:.:::..: .. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. UATION 4' (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 $ v` tL Z 1SIZEISTORIES MIOLIES CHECK License Number Lic.Class $ Contractor Date DESCRIPTION OF WORK NEW L'�/fi ❑ ADD am exempt under Sec. ALTER Y Y ❑ FINAL B.BP.C. for this reason L C <t 0 REPAIR ❑ DATE d USE OF ❑ FINAL ! `f 6 •_ai I Date• EXISTING BLDG. DEMOL By Signature ' APPLICANT TEL. �UC 0- / - OWNER-BUILDER DECLARATION PRINT NO. /rJ I hereby affirm that I am exempt from the Contractor's License �l ���/� aw for the following reason (Section 7031.5, Business and ADDRESS rofessions Code): PRE E BUILDING I, as owner of the property, ormy 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- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD I PROP.LINE WIDTH D 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.). i SIDE o P.L. Q Lender's Name Lender's Address P.C. Fee$ Permit Fee e� :a 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 i, Investigation Fee ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County to enter E " upon,Jhe above-mentioned property,for inspection purposes. 'lr_. SEE REVERSE FOR EXPLANATORY LANGUAGE SignatureoApplicant or Agent Date ®s WORKERS'COMPENSATION DECLARATION I I hereaffirm that I have a cerof coent to insurebor a certificate of Worke s'tificate Compensat on Insuran elf Q p p d��ATD O NSO Q o U I L O 8 N GM PERM17 or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pol /Policy No.-Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING - •*�� / ADDRESS. Certified copy is filed with the county building inspec- r BUILDING �/�/ tion department. ADDRESS •� / /;' uj ��, �/ /.r LOCALITY NEAREST Date Applicant CITY E/,l� �Lf' C' ZIP t�/ 7J G� CROSS ST. Q NO.OF BLDGS. v ASSESSOR CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT N O NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE USE ZONE MAP (This section need not be completed if the permit is for one ' TRACT BLOCK LOT NO. NO. hundred dollars($100)or less.) �• ci,i;t TEL. [ l SPECIAL OWNER lx/f SRF �`���E�^ �NO.G �/J /r CONDITIONS I certify that in the performance of the work for which this DISTRICT GROUP TYPE FIRE PROCESSED BY O permit is issued,I shall not employ any person in any manner ADDRESS .�' C / �� J //� L' CONST. ZO E so as to become subject to the Worke'Compensation La�ws� 1 ®Q� •I s9 7 'LC.�� CITY T/.�`�C C" ZIP ��/�e��4� O ",�I Date Applicant = STATISTICAL CLASSIFICATION APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of :ARCHITECT OR TEL. Exemption, you should become subject to the Workers' j ENGINEER NO. CLASS NO. —DWELL. UNITS Compensation provisions of the Labor Code, you must forth- `ADDRESS SEWER MAP with comply with such provisions or this permit shall be + / — deemed revoked. CONTRACTOR TEL.NO. BK. PG,�6 7 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 Division 3 of the Business and LIC. 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 FA ILIES ONE DE RIPT.NOF ROK �/ ' C' NEW ❑ $ Contractor Date ❑ am exempt under Sec. L' 1 �_ C� AD ER FINAL B.&P.C. for this reason 1 i�. REPAIR DATE Date: USE OF DEMOL ❑ FINAL EXISTING BLDG. /.ii%.i/y (Lll� By Signature APPLICANT TEL. L OWNER-BUILDER DECLARATION PRINT �'/ bA .tL NO. y I hereby affirm that I am exempt from the Contractor's License 1�I Lai for the following reason (Section 7031.5, Business and ADDRESS.L��r G ev, �.tJC�f,/Z'L•) G" C Pr fessions Code): PRESENT © BUILDING I, as owner of the property, ormy 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- ` ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH D 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. iSec.3097, Civ. C.). SIDE 6 P.L. , �..>,. .. Q Lender's Name P.C.Fee$ Permit Fee Lender's Address rI certify that I have read this application and state that the Issuance Fee 6 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter Total Fee upon I the above-mentioned property for inspection purposes. -7,1524 ',152 t SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®s WORKFI"COMPENSATION DECLARATION 1 hereby affirm that 1 have insure, or a certificate of Workers' certificate of consent to self kers' Compens®tion Insurance, APPLICATION FOR BUILDING P E RM I T or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 'BUILDINGG� W r!� �E, Certified copy is hereby furnished. FOR APPLICANT TO FILL IN 'ADDRESS .S ! El � ❑ Certified copy is filed with the county building inspec- Ft, 1tion department. t,tiAN Dl f�� � C� ZIP LOCALITY Date Applicant NO.OF BLDGS. NEARESTCERTIFICATE OF EXEMPTION FROM WORKERS' (�� NOW ON LOT 7i CROSS ST.COMPENSATION INSURANCEASSESSOR (Thissection need not be completed if the permit is for one BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) T �,/l NO. Z � 4 ,36USE ZONE MAP I certify that in the performance of the work for which this SPEpermit is issued, I shall not employ any person in any manner ► ir R_ SPECIAL a- CONDITIONS O so as to become subject to the Workers'Compensation Laws. U CITY L(!(� ZIP Date Applicant ARCHITECT OR A NOTICE TO APPLICANT: if, after making this Certificate of ENGINEER TEL.NO.S Z' I+ cl- DISTRICT ROUP ONS - FIRE E OCESSE BY Q r) Exemption, you should become subject to the Workers' 77 Compensation provisions of the Labor Code, you must forth- ADDRESS C TiLX J �'�� �� 1P' a- with comply with such provisions or this permit shall be TEL STATISTICAL CLAS IFI TION APT. COND . N 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. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITYCLASS BK F PG J� VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lic. Class SIZE I STORIES FAMILIES ONE ,M 6 , NEW ElVALU/ATION DESCRIPTION OF WORK Contractor Date $ 6� e,70 b ❑ ❑ ►I am exempt under Sec. l ADDALTER ❑ B.BP.C. for this reason l�,r'�1l�G7v�'� $ REPAIR Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) L� NO.S 2—zIt I hereby affirm that I am exempt from the Contractor's License p� DATE Law for the following reason (Section 7031.5, Business and ;ADDRESS CE M. FINAL A rofessions Code): PRESENT By ii.'_ I .7 r +w I, as owner of thePro property, or my employees with BUILDING 6";ADDRESS 77,57 a � wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section i �C "' Ly 7044, Business and Professions Code.) MOVING TEL. ❑ 1,as owner of the property,am exclusively contracting CONTRACTOR / NO. T1;i AL 128 .50-s0- with licensed contractors to construct the project (Sec- / � 1 tion 7044, Business and Professions Code.) ADDRESS :;� yam,.• �+„F ,,,�:°•r-_ REQUIRED TOTAL SETBACK FROM EXIST. - CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH C ei��•E 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.). SIDECl_ 51 / ' Lender's Name t (yi! t_I F� LDMA Ref. # P.C. Fee$ Permit Fee J Lender's Address 0 1 certify that I have read this application and state that the Issuance Fee 13.0 LDMA P/C# R above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby out o ize repre ntatives of this County to enter upon the abo�ri r}1i ned pr party for inspection purposes. n i � 4,3 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature 4of A plican •r Agent Date 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 0903160053 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ITR: 10898 IT: 27 BL: B I SQ. FT STORIES TYPE I 5446 WELLAND AV I I ]STRUCTURE: 28 V-B I TEMP CA 917803509 I (ASSESSOR INFORMATION NUMBER: ] I NEAREST CROSS STREET: DAINES 18573-017-035 ] 1 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, Cl I TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 IISSUED ON: PROCESSED BY: I (EXIST OCC GRP: 103/16/09 SR I 10WNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 ILUCERO, ISAURA (626) 353-3460- 1 4,500 1 I 15446 WELLAND AVE. I I� ITEMPLE CITY CA 91780 1 FEES PAID ID SC IPTI N OF WORK I1 I ITEAR OFF AND REROOF 40 YEAR SHINGLES HOUSE 6 GARAGE I I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:] I (APPLICANT: TEL. NO: I I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.75 1 1 ] IAB STATE GREEN BLDG FEE 4500.00 VAL 1.00 ISPECIAL CONDITIONS: I I 1AC STRONG MOTION RESID 4500.00 VAL 0.50 1 I D2 PERMIT W/O EN HC 4500.00 VAL 132.60 1 ] I TOTAL FEES 161.85 I I ICONTRACTOR: TEL. NO: I ]APPROVALS DATE INSPECTOR SIGNATURE ] ]SAME AS OWNER - I I I 1 LIC. NO 1 1LOCATION AND SETBACKS I I I I ISOILS ENGINEER APPROVAL I I ] 1ARCHITECT OR ENGINEER: TEL. NO: - i 1FOUNDATION/TRENCH FORMS I I I LIC. NO: I ISLAB/UNDER FLOOR I I I I 1 1RAISED FLOOR FRAMING 1 1 I I ]MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:] (UNDERFLOOR INSULATION I I I 115OH277 3 001 I I I I I I IFLOOR SHEATHING I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I 1 NO 21 I IROOF SHEATHING I I SCHOOL WITHIN HAZARDOUS I (SHEAR PANELS I I ]AIR QUALITY: 1000 FEET MATERIALS I 1 ] ] I 1 NO NO NO I [FRAME INSPECTION ] I ] ]REQUIRED TOTAL SETBACK FROM EXIST 1 ]FIRE SPRINKLER HANGERS I ] ISET BACK YARD: HWY: PROP LINE: WIDTH: [ I I ] IFRONT PL- I ]INSULATION/WEATHER STRIPI I I SIDE PL-I I I I I (INTERIOR LATH/DRYWALL I I I [ I 1EXTERIOR LATH I ] I I ] I I 1RATED FLOOR/CEIL ASSEM. I I I ] I IRATED WALL ASSEMBLIES I 1RATED SHAFTS/OPENINGS I I IT-BAR CEILINGS I 1 I LOT DRAINAGE I I I 1 I IREPORT ID: DPR261 ROUTE TO: BS0508 I ] I ] I I I 1 I