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Home My Public Portal About9154 WOOLLEY ST_Building__ r:- APPLICATION FOR SUILDING PERMIT FOR APPLICANT TO FILL IN A��ei=SS o i BUILDING ��. '1 J��//. ADDRESS / /.I(�L+" LOCALITY CITY j f,Lf C/ y ZIP CROOSSST. -26NC1&/7-W NO.OF BLDGS. / ASSESSOR SIZE OF LOT NOW ON LOT l MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT/Q BLOCK L �--+ CON E TEL. �� OWNER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS /�Q E CLASS NO. DWELL.UNITS B PG CITY / /L /fes ZIP USE ZONE [MAARCHITECT OR TEL. IAL ENGINEER NO. DITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL. CONTRACTOR NO. BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS oq 1,111NO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER + — a NAME AND BRANCH BLDG.SETBACK FROM u ADDRESS CITY SIDE PROP.LINE OF (STREET) w SQ.FT. y NO.OF / NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SIZE ( STORIES / FAMILIES ONE SIDE PROP..LINE HIGHWAY WIDTH 0. ❑ + = Z DESCRIPTION OF WORK NEW - — �� f/7 ADD CORNER CUTOFF YES ❑ NO ❑ ALTER ❑ REPAIR ❑ IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. IDEMOL ❑ APPLICANT TEL IPRINTI le e--w- 34VZ360. BY(SIGNATURE) LAREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ��i3 /�eTJ ,/ j. /E ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCESS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE UTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF R CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'SCOM• N INSURANCE. dREOf L. FINALBY EE DATE S gyp./ a4 t/ TEL. �70P•C.Fee$ Permit FeeQQIssuance Fee TION$ 5-77 Total Fee PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH (o O 8 5 5 LZGCT 28 1 D_ 4 8.7 5 •-,3 5S 76A638B CE/803B 6/76 r r APPUCATI®N FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION POR APPLICANT TO FILL IN BUILD,NG ADDRESS _ �j r �„ _ BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, r 14} ^ or a certificate of Workers'Compensation Insurance,or a certified CITY -.y� ` zip , `'t� �� copy thereof(Sec.3800,Lab C.) --r LG e4'z / � LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO department. I I USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERP'��'J r��_nc [�E NOS YES No COMPENSATION INSURANCE �1 l: �J G( � 7'� WITHIN 1000 FT OF SCHOOL (This section need not be completed if the permit is for one hundred ADDRESS ) g1 pl�� • DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY J ZIP { , .`l�1 e� is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO become Subject to the Workers'Compensation Laws. STATISTICAL CLqS/SIAFICATION APT CONDO DaterApplicant _ DDRESS CLASS NO. LY DWELL UNITS NOTICE TO APPLICANT. If, after . aking this Certificate O REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become ubject to the Workers' CONTRACTOR TEL NO SET BACK YARD HWY PROP UNE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRES6 LIC.NO. PL LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions 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 a License Number Lic.Class DESCRIPTION OF WORK ADD >K( VALUATION poll- C Contractor Date ALTER ❑ $ '4*S00 Lv L ;a0 S F ' tad P-6vm Ix REPAIR 11O ❑I am exempt under Sec. B.BP.C,for this reason DEMOL ❑ W LDMA P/C 7 Date: 0, USE OF EXISTING BLDG URM ❑ D- r r--'--- --r cc Signature :^,.;.ue : � 'i'(' :?') G APPLICANT(PRINT) � L�0 TEL NO� � LDMA Perm� z I, as owner of thefionp, rty, or my employees wit gas as a�V their sole compenswilldo the work and the s ructure is ADDRESS n�� 6d Gr t psi ,T �� a I�L3 not Intended or Offered for sale Section 7044, Business and a[ Pi �/ r�/rT FINAL DATE v Professions Code.) HALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL a(V J OR A MIXTURE CONTAIN'NG A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPEC IFIE ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES 11NOR Business and Professions Code.) ` 6 WILL THE INTENDED USE OF THE BUiDLING BY THE APPLICANT OR FUTURE BUiLD;NG � OCCUPANT REOU:RE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQVD)SEE PERMITTING CHECKUST FOR GUMEUNES. 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. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMDPERMITnNG 1 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LAS ANGELES COUNTY CODE a TITLE Z CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERN NG HAZARDOUS Lender's Name MATERIA RE RTIN D FOR OBTAINING A ERMIT FROM T SCAQVD. LAff 0 Lender's Address 0 0.LN MfF:.YT c I certify that I have read this application and state under penalty e of perjury that the above information is correct.I agree to comply PC FEE PERMIT FEE cm with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE o m to enter upon the above-mentioned p pert L for Inspection purposes. —7- 3 c7 3 ; INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1301220068 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW BUILDING ADDRESS: I ITR: 12115 LT: 17 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUP( 9154 WOOLLEY ST 1 I (STRUCTURE: 245 1 V-B R3 I TEMP CA 917801349 (ASSESSOR INFORMATION NUMBER: GARAGE: i NEAREST CROSS STREET: I5382-023-009 i OTHER: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI I (TENANT: (EXIST BLDG USE: RESID ISSUED ON: PROCESSED BY: EXIST OCC GRP: R-3 01/22/13 SR (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: ( FS ATE F�BY,� CODE: I CHANG, ANLAH I i � - I 16,000 19154 WOOLLEY ST ITEMP 917801349 I FEES PAID 1TION OF WORK 1 I IINSTALLATION OF 14 ROOF MOUNTED SOLAR PANELS CHANGE CONTRALTI I (FEE DESCRIPTION: QUANTITY- QOM: AMOUNT:IOR SEE ALSO BL 1211300022 (APPLICANT: TEL. NO: 11VEZZY, MICHAEL (626) 965-4286- IAA BLDG PERMIT ISSUANCE 27.80 1 I I 13080 12TH ST 1 TOTAL FEES 27.80 1SPECTnr• CONDITIONS: I IRIVERSIDE CA 92506 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IBURKE ELECTRIC (951) 368-4050- I 1 19825 ROTERDAM LN LIC. NO1 RIVERSIDE CA 92508 010896796 I (LOCATION AND SETBACKS I I I 1 i ISOILS ENGINEER APPROVAL I I I ARCHITECT OR ENGINEER: TEL. NO: - i [FOUNDATION/TRENCH FORMS I I I LIC. NO: I ISLAB/UNDER FLOOR (RAISED FLOOR FRAMING I I MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I 1UNDERFLOOR INSULATION [ I I I I I 1153H265 N 87 3 001 [ I I I I IFLOOR SHEATHING I I I [NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 1 0 NO 99 i [ROOF SHEATHING I I I I I � 1 SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I I 1AIR QUALITY: 1000 FEET MATERIALS I 1 I I NO NO NO 1 IFRAME INSPECTION I I I I I FIRE SPRINKLER HANGERS 1 i INSULATION/WEATHER STRIP( I I INTERIOR LATH/DRYWALL 1 I I I I 1EXTERIOR LATH [ I I 1 i iRATED FLOOR/CEIL ASSEM. (RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS I IT-BAR CEILINGS I I 1 I I 1LOT DRAINAGE I I I [REPORT ID: DPR261 ROUTE TO: BS0508 I I I 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 1211300022 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 12115 LT: 17 BL: .001 I SQ. FT STORIES TYPE 9154 WOOLLEY ST STRUCTURE: 24.9 V-B TEMP CA 917801349 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15382-023-009 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI IL I TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 ]ISSUED ON: PROCESSED BY: I 1EXIST OCC GRP: 101/04/13 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FINAL D TE FINAI, RY: CODE: ICHANG, ANLAH - 1 16,000 19154 WOOLLEY ST I 1- TEMP 917801349 FEES PAID ID CRI TION OF WORK INSTALLATION OF 14 ROOF MOUNTED SOLAR PANELS IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I APPLICANT: TEL. NO: I I I IIVEZZY, MICHAEL (626) 965-4286- IPI RES PV PC<10XW 153.90 I I 13080 12TH ST IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: I RIVERSIDE CA 92506 AB STATE GREEN BLDG FEE 16000.00 VAL 1.00 IP2 INSPCT RES PV <10KW 138.00 TOTAL FEES 320.70 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE ELITE ELECTRIC (951) 681-5811- I I 19415 BELLEGRAVE AVE LIC. NO ILOCATION AND SETBACKS RIVERSIDE CA 92509 418242 * I SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS 1 LIC. NO: 1 ISLAB/UNDER FLOOR RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( JUNDERFLOOR INSULATION 1 I153H265 3 001 I I I IFLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I 0 NO 21 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR PANELS IAIR QUALITY: 1000 FEET MATERIALS I I NO NO NO IFRAME INSPECTION I I I FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP (INTERIOR LATH/DRYWALL I I I EXTERIOR LATH I I I (RATED FLOOR/CEIL ASSEM. 1 IRATED WALL ASSEMBLIES IRATED SHAFTS/OPENINGS IT-BAR CEILINGS I I I I I* ADDITIONAL DATA ON FILE ILOT DRAINAGE I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I