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Home My Public Portal About5749 PRIMROSE AVE_Building__ I APPLICATION FOR BUILDING PERMIT •' ,� COUNTY OF LOS ANGELESr y s4 BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD RES I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRE or a certificate of Workers'Compensation Insurance,or a certified CI[ J M � copy thereof(Sec.3800,Lab.C.) 1 CJ ZIP /,�� LOCALITY /J Policy No. Company SIZE OF LOTNO.OF B GS.NOW ON LOT ❑ Certified copy is hereby furnished. X d 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 BOO G PAGE PARCEL O 0// 2�119 — / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NER TEL NO. COMPENSATION INSURANCE I M tMe. (C b3-1100JWITHIN 1000 FT.OF SCHOOL? Yes No (This section need not be completed if the permit is for one hundred \ DRESS e lA r+� W -Ski ®�, DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) v� CITY ZIP �� ,,y ,/ I certify that in the performance of the work for which this permit � —6 (1Q �3 Y is issued, I shall not employ any rson in any manner so to (� beco a subject to a Workers' n tion Laws. w ,1@ ARCH` OR NGf KNEE TEL NO. T-7 v ] STATISTICAL CL�ASSIF/CATION APT CONDO Date� •-7 plicant ADDRESS CLASS NO.�L DWELL UNITS / NOTICETO APPLICANT. If, after making this Certificate OfREQUIRED TOTAL SE7i ACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRA R . - A TEL NO.a SET BACK YARD HWY P E WIDTH Compensation provisions of the Labor Code, you must forthwith W \ FRONT �' °At comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L —a . °'� LICENSED CONTRACTORS DECLARATION r SIDE CITY LIC.CLASS",,,,. PL j TC I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP i (commencing with Section 7000)of Division 3 of the Business and .F SIZE NO.OF.6TQRIES NO.OF FAMILIES NEW BK A PG TOTALg °if� Professions Code,and my license is in full force and effect. , �1 /� dd r( License Number Lic.Class DESCRIPTION OF WORK +� r ,.ADD ❑ VALUATION' CHECK 1672.20 Contractor Date �R- ALTER ❑ $ 2 00 00c) CHANGE C C ❑ I am exempt under Sec. �p REPAIR ❑ $ } / F BAP.C.for this reason V� DEMOL ❑ LDMA P/C# 0000-0010-11 5 i 4/20/93 u Date: tEOF EXI G BL G. URM ❑ 92-7� 1 A 111°13 V Signature qr' '''' a g IC NT RIN EL NO. LDMA Perm# At-.(;I°s L ❑ I, as owner of the property, or my employees with wages as - Z { "IM their sole compensation, will do the work and the structure isRESS O x-13 �_ ° not intended or offered for sale (Section 7044, Business and FINAL DATF Q a ITEM-3 Professions Code.) L THE APPUCANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL f A MIXTURE CONTAINING A HAZARDOUS MATERIAL EOUAL lb OR GREATER THAN'THE I I �j72 .22°1_II, as owner of the property, am exclusively contracting WlthOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 9 licensed contractors to construct the project (Section 7044, �' �; j5 Business and Professions Code.) ❑ No❑ .° CHECK =0 -F°L THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �{�t5 tCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH (^ t•h ANGE pISISCONSTRUCTION LENDING AGENCY AST AIR QU.AUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR U GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ 1 iA the performance of the work for which this permit is issued(Sec. �+ G ; — Ztr , 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,C11 y` / TITLE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2.20 140 CONCERNING HAZARDOUSv .i y �1�a`8 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. \/ ry� o Lender's Address 0 OWNER OR AGENT ✓�� o I cert' hat I have read this application and state under penalty c of rjur that the above information is correct.I agree to comply P.C.FEE �� iy+ PERMIT FEE .�n N wi all county ordinances and State laws relating to building �{ V m c nstr ion, and hereby au orize representatives of this County ISSUANCE FEE ae r upon th bo Toned roperty for insp tion n m ii � S INVESTIGATION FEE TOTAL FE pe1Wp M Applicant or Agent DAIa (J SEE REVERSE'FOR EXPLANATORY LANGUAGE ' L I CCT=-T' O FOR S U L O HJ G PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS —7 p� I� pe— I hereby affirm that I have a certificate of Consent to self insure, BUILDING ADDRESS / �9 1 i v V 5'4 /3V` - or a certificate of Workers'Compensation Insurance,or a certified 5749 Primrose Avenue copy thereof(Sec.3800,Lab.C.) CITY ZIP Temple City, CA I LOCALITY Policy No. Company SIZ QF LOT NO OF BLpGS.NOW ON LOT ❑ Certified copy is hereby furnished. V X ]90 f NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. 6561 1 661 USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL 8587-011-010 1 1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE Rowland Trust 2876092 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS 6 3 Chelsea Road Suite 20 DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) r CITY ZIP I certify that in the performance of the work for which this permit � is issued, I shall not employ any pe n in any manner so as to San Marino CA 9 08-2453 '�� ' become subject to the Workers'C ensation Laws ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date-9-1-93 Applicant ADDRESS CLASS NO.—� DWELL UNITS �. ; NOTICE TO APPLICANT.' If, after making this Certificate Of REQUIRED TOTAL SETEl gGKFROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PRORdk °� WIDTH Compensation provisions of the Labor Code, you must forthwith None/Owner FRONT 351-53 comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L i LICENSED CONTRACTORS DECLARATION Same a above s!oE - CIT6�e LIC.CLASS P L �•'f''� •� I hereby affirm that I am licensed underprovisions of Chapter 8 (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES NEW ❑ SEWER MAP PG �s'rI t +1-,_ O Professions Code,and my license is in full force and effect. 2 ] r 4_, . C DESCRIPTION OF WORK Z i t tf 1-' IL License Number Lic.Class ADD �. VALUATION Add additional square footageQ, /�j TOTAL Contractor Date ALTER ❑ $ ! ` 0o { i rH,ECE, La._��e C,C to second story of residence.. REPAIR El _ 11 I am exempt under Sec. I- BAP.C.for this reason DEMOL ❑ LDMA PTC# U Date- USE OF EXISTING BLDG. a Single FamilyResidence URM ❑ _ _u Signature 0 i1E-0gii,I *j/ !/ a 'P'§ PP ICANT(DINT/ TEL NO. LDMA Perm# ❑ I, as owne the property, or my employees with wages as Same wr<er Z 1596 1, their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and Same FINAL DATE/ a Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL f+ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J XKI, as Owner Of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, Business and Professions Code.) ves 11 No ly WILL THE INTENDED USE OF THE BUIDLING By THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NOA CM M 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.) I CHECKLIST I UNDE STAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, None TITLE 2,CHAPTE 20 SECTIONS 2 20 00 THROUGH 2 20.140 CONCERNING HAZARDOUS i Lender's Name MATERIALS RE NG AND OR ING A RMIT FROM THE SCAOMD. 0 Lender's Address 0 OWNER OR X111— o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree t0 comply P.C.FE % PERMIT FEE N ��(f with all county ordinances and State laws relating to building d (� const ruCyly and hereby authorize representatives of this County ISSUANCE FEE to enter fp n the abovelorentioged property for inspection purposes. /p 0 roIf 9-1-93 INVESTIGATION FEE TOTAL FEE tW--t a Wr..t dF A?ea ' Dae Ea SEE REVERSE FOR EXPLANATORY LANGUAGE • APPLICATION FOR BULDING PERMIT COUNTY OF LOS ANGELES BUILDING AND S FETY • WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS 5 9 4q I hereby affirm that I have a certificate of consent to self insure, B I'NG7 AADRESS , —� or a certificate of Workers'Compensation Insurance,or a certified '1 bN copy thereof(Sec.3800,Lab.C.) CITY ZIP LOCALITY Policy No. Company SIZE OF LOT NO. BLDG&NOW ON LOT ❑ Certified copy is hereby hirriished. vzz a i NEAREST CROSS ST. ❑ Certified copy is filed•witVIQ county building inspection TRACT BLOCK LOT NO. department. '• USE ZONE MAP NO. /7 Applicant ASSESSOR P BOOK PAGE • PARCEL Date V ,�7 Q// eVe �_ / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE MMT05elSS - Ci L WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred AD RESS dollars($100)or less.) I"kC_ °� (� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CIT JA& &)® zq is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER `' TEL become subject to the Workers'CompiensaGtion.Laws. �C_ � ��—1�� STATISTICAL CLAy�IFICATION APT CONDO Date " Applicant �r'��[�.�\RUQ),_ AD RESS ! 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' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY UC.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 SQ.g SIE NO.OF STORIES NO.OF FAMILIES i Professions Code,and my license is in full force and effect. 77 NEW ❑ BK PG �._, g 1 License Number Lic.Class DESCRIPTION OF WORK% r ADD JC VALUATION A`"i•'a Contractor Date KQ ALTER ❑o PMMA: $ ``'��I`' �r •u )il CY7REPAIR ❑ DD 1 iTEMS. C ❑ I am exempt under Sec. $ • . TOTAL 6 4 v F- 4 17 BAP.C.for this reason DEMOL ❑ LDMA P/C# L� �J C Date: USE F�EXISTINM!iBLDG. URM ❑ t''I�ECK 417.80LaL Signature APP L Qyz L MNT) ��`,Aut ins N LDMA Perm# Z CHANGE aC0 z ❑ I, as owner of the property, or my employees with wages as I�-� O their sole compensation, will do the work and the structure is R not intended or offered for sale Section 7044, Business and e FINAL DATE Q I I I I' ��'' �+� r ( c Ji -.JIB J I 6i 219 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �� 4— OR A MIXTURE CONTAI ING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE A WT as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL By ; � R •�,F licensed contractors to construct the project (Section 7044, YES❑ NO /Y Business and Professions Code.) ��• WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ athe performance of the work for which this permit is issued(Sec. cm IIS �%. O) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMI:kT.NOD .� % rrt 41 N 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTYaQD �y I"L'1 ••-•I ti� C".11 TITLE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20 140 CONCERNING HAZA"U •,"�} ''y CJ,.t ....I Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 1 671 a. o Lender's Address '� I'r1 NP C OWNER OR AGENT e I certify that I have read this application and state under penalty i'rf O of perjury that the above information is correct.I agree to comply P.C.FEE pp PERMIT FEE L'"�''/�� 6��y N with all county ordinances and State laws relating to building •du ��'7 1'V m construction, and hereby authorize representatives of this CountyISSUANCE FEE enter upon the above-mentioned property for inspection purposesM a p rf Ad INVESTIGATION FEE TOTAL FEE �J M of Applkmnl m NMI! 0.:M O� �`alo�r, a.SEE REVERSE FOR EXPLANATORY LANGUAGE f•i FrA '=' �� + L 10