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HomeMy Public PortalAbout4930 ROSEMEAD BLVD_Building__ r� IMPOL1 Rel' : DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ? p OR L WM. J. FOX, CHIEF ENGINEER MNG FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING � �•a 7� I (9L�� ADDRESS ,g S (� 7 LOCALITY l �4, ,�, RECELVED BY E' DATOF ADPL. DATE ISSUED NEARESTn / �,f9 � Q CROSS ST. ? tj 5 BUILDING � T' ADDRESS 6) ."/o p fja 9 OWNER MAIL y,y��7 " LOCALITY �� L ADDRESS � � 4'b',Oi4 NEAREST CROSS ST. Q-fid LF� I CITY �d; tl. ri =.jA._%i � NO. - ZFIRE NO. OF ONE I PLANS I TYP I GROUP ARCHITECT OR TEL. ENGINEER NO. SETBACK ACK LINE � „ORD. NO. ADDRESS APPROVED TEL. BY DATE CONTRACTOR s�{ p NO. USE APPROVED ZONE,,- BY DATE ADDRESS HOUSE NUMBERING LEGAL DESCRIPTION I LOT NO. BLOCK �t MAP NUMBER /fir'✓��` FIELD CHECK QY TRACT NO. ASSIGNED BY,7- - � DATE _ NO. OF BLDGS.�. CORRECTIONS SIZE OF LOT Sp, 1? 2-0 I NOW ON LOT USE OF I NO. OF _ EXISTING BLDG. FAMILIES DESCRIPTION OF WORK NEW IAI ALTERATION I I ADDITION O REPAIR I I DEMOLITION I ,. O SQ. FT. ® NO. OF Z SIZE .4, ROOMS STORIES EXT. WALL .,, .�',`r'y'' - - Y erg' I ROOF {��' .L) �j / i^,f� {_ (' COVERING ir`[ ..P'� COVERING !.' a+'• . USE OF STRUCTURE n � APPROVALS _ INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-' FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN .IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED a FRAME: FIRE STOPS�� HEREON AND.WITH ALL-COUNTY ORDINANCES AND STAI'E , BRACING, BOLTS LAWS REGULATING. BUILDING CONSTRUCTION. FURNACE: LOCATION,SIGNATURE OF y���f ',e ��/�/��,.�� GAS VENT, DUCTS PERMITTTEJEp / 3 F yam/}- r S/- ADDRESS .3 oC-/6-1 A \ �, ,t� / '.�: LATH. INT. I LATH, EXT. - 11'___dfJJJfAddiii��� AUTHORIZED AGT. PLASTER, INT. 76A638A• DES3 10-50 P. C. $ T) S"�4A FEE �� � PLASTER, EXT. / VALUATION (J $ FEE 2 y -"' FINAL WORKERS'COMPENSATION DECLARATION f� hereby affirm that I havecertificate of consent to self A P P L•I CATION FOR BUILDING PERMIT `TLfII insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING /f Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 4�� Certified copy is filed with the county building inspec- BUILDING /� tion department. ADDRESS 36 M. Date Applicant CITY 6 4W4--- ZIP L7:77 i7 LOCALITY CJI& CERTIFICATE OF EXEMPTION FROM WORKERS' G NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT �v NOW ON LOT CROSS ST. TL (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.). TRACT BLOCK / LOT NO.Q^� MAP BOOK PAGE PARCEL EL_r+L� NO:�O J' USE ZONE MAP 1 certify that'in the performance of the work for which this OWNER O NO. permit is issued, I shall not employ any per n in any manner QQ�� "M �f i SPECIAL , ADDRESS R4� h ��✓✓ CONDITIONS so as to become subject to the Workers'C pensatio Lqws. / np'' O; CITY ( I(l�� ZIP V Date �pplicant 0: NOTICE T APL A T: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER 0. CONST. / Z U Compensation provisions of the Labor Code, you must forth- ADDRESS flv� ✓ W with comply with such provisions or this permit shall be []_ deemed revoked. TEL• STATISTICAL CLAS§JFICATION APT. DO. (n 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. SEWER P (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 BK VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF gORK NEW �❑ 61 ADD [I $ I am exempt under Sec. , ALTER B.BP.C. for this reason REPAIR $ R Date: USE OF EMOL ;27 4 9.'o A EXISTING BLDG. Signature APPLICANT TEL. S-� s/1 FINAL # PRINT CJ OWNER-BUILDER DECLARATION ' O' DATE ' ;I.0 e 6.Q 5 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Proffossions Code): PRE5ENT By 0 0 0 6 Q 5 OA! }tom( BUILDING I, as-,owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY �/�'>' o 7,1 7`8 7 the structure is not intended or offered for sole(Section 7044, Business and Professions Code). MOVING TEL. aCONTRACTOR NO. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETT BACK ED YARD HWY TOTAL SETBACK LINEROM WIDTH 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 /���jq m P,C. Fee$ Permit Fee sz LDMA Ref. # Lender's Address 3 g 1 certify that I have read this application and state that the Issuance Fee C/•L LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee f� 0 ordinances and State laws relating to building construction, Total Fee v. LDMA Perm. # and hereby aut orize repre�ntafiv thisCounty to enter upon the abov mentioned �st inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dat, APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN � I het-3by affirm that I have a certificate of consent to self insure, BUILDING ADDRESS Or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800, Lab.C.) CITY zip 1 ( / fjLOCALITY _ Policy No. Company [SIZE OF LOT NO.OF BLDGS.KOW ON LOT ❑ Certified copy is hereby furnished. SQ `�C ZLL�" NEAREST CROSS ST. ❑ Certified copy is filed with the county'building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. � ASSESSOR MAP BOOK PAGE PARCEL Date Applicant 0 003 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL N ;�O. YES NO COMPENSATION INSURANCE . U8 8 1 Zvi: WITHIN 1000 FT.of SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS i /�'eM/f I—V D DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) ��''r Y�°�� CITY I certify that in the performance of the work for which this permit f is issued, I shall not employ any person in any manner so as to ARCHITECT OR EGINEER TEL NO. become subject to the Workers'Compensation Laws. - STATISTICAL CLASSI V ICATION 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' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith v FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L SIDE LICENSED CONTRACTORS DECLARATION 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 SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES � ' Professions Code,and my license is in full force and effect. aD NEW El BK(' PG / d License Number - Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION Contractor Date fa L e ALTER $ rr U �L r7- TJzAQ REPAIR ❑ $ OO El am exempt under Sec. BAP.C. for this reason TWO OVITS DEMOL ❑ LDMA P/C# V W Date: USE OF EXISTING BLDG. gG !`. URM ❑ 0- G Signature - APPLICANT(PRINT) TEL TDMA Perm# Z A g ❑ I, as owner of the property, or my employees with wages as C/4 e� 2 Z f^A(.#��,g their sole compensation, will do the work and the structure is ADDRESS 0 ., _,3 5,-; _-, not intended or offered for sale (Section 7044, Business and O FINAL DATE Q �I. -t=' -'' 0. PfOfeSSIORS Code.) _ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS �( OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER El I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044; 6.0-AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY s g C!T. YES El EJ •, Business and Professions Code.) �— is .I 1 i ;4 ' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - � � �I1L: 1 si.r v_-. OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FORZy GUIDELINES. €i��f I hereby affirm that there is a construction lending agency for •YES❑ NO❑ -------'4-- - T-I i • 1 - 14 a the performance of the work for which this permit is issued(Sec. LTf IL ' 100 m - I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PE RMITTING 3097,CIV.C.) CHECKLIST,I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, r.L:�T.. 161.14 N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS ll�-SS _ ELenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. ' _ o Lender's Address CHANGE '}jt j OWNER OR AGENT O o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comp) P.C.FEE PERMIT FEE P J Y 9 Y S'o 4I'•. �`si{ { i� �f =p o with all county ordinances and State laws relating to building a construction, and hereby authorize representatives of this County ISSUANCE FEE sO "- - -"" - I r; m CJL 21- .16 at e t r upon the above-menti ned property for inspectio purp es: INVESTIGATION FEE TOTAL FEE re of plicanl or Age(nl1 ` ^ • Date (a T `�►'K� ,/—�'C-_I/y�•_/ SEE REVERSE FOR EXPLANATORY LANGUAGE / J WORKERS'COMPENSATION DECLARATION `<I he,e�, ^ firm,i'l have a certificate of consent to self insure"ora ce,�•'ifirate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT u or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND S FETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS V G/1 �� 1—Me-? L(f'/ Certified copy is filed with the county building inspec- BUILDING ( �/�,r� n /� tion department. ADDRESS U-Se,—R-E* A,tiv 9 i Date Applicant CITY Q[ ZIP LOCALITY 91 CERTIFICATECOMPENSATION INSURANCE ORKERS' r1 �q� NO. OF BLD NEAREST � 1 SIZE OF LOT aW NOW ON LOTT CROSS 5T. & (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 j� /�J TEL. USE NE MAP / P� I certify that in the performance of the work for which this OWNERI&-J �XIYh /� /1/D'/Yfi�!}A/NO. S SPE permit is issued, I shall not employ any person in any manner c —Y SPECIAL ] so as to become subject To the Workers'Co ensotio Laws. ADDRESS r/)/&se Re- D I CONDITIONS 0 CITY ZIP U Date Applicant NOTICE O AP (CANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GR UP TYPE FIRE PROCESSED BY O Exemption, you should become subject to The Workers' ENGINEER NO. CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS � �J-t/ -/ ✓ W with comply with such provisions.or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. DO. . 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 U NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER P Professions Code, and my license is in full force and effect. CITY CLASS BK PGVALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE 7 VALlJ TI Contractor Dare DESCRIPTION OF WOR l� NEW ❑ ; I am exempt under Sec. � Id /� (/ oiyll� T ` ADD ❑ l (/ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ '2 7 7 a 7 A Date: USE OF EXISTING BLDG. DEMOL o;o o e o l APPLICANT TEL. Signature FINAL OWNER-BUILDER DECLARATION PRINT NO. DATE` — 01 2 IL 8 8 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FI ° 1 24,88' Pro essions Code): PRESENT BUILDING 1, as owner of the property, or my employees with ADDRESS a 2 7,—.8.7 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. 1, 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). K FROM CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TOTAPROP.pLINE WIDTH 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 LDMA Ref. m P,C. Fee$ Permit Fee Lender's Address //,, I certify that I have read this application and state that the Issuance Fee Cl c S� LDMA P/C fi above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. M and hereby outho ize representatives of this County to enter upon the above- ntioned roperty for inspection purposes. < �� Z� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date a WGRKr;S'-°,,OMPENSATION DECLARATION yinsure,or afircertificatehereyy of Wo ke s' Compensat on Insuran elf APPLICATION F®R BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C. • COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 3� SG/s/��// L✓�' Certified copy is filed with the county building inspec- BUILDING ..�r1� y� tion department. ADDRESS //�� Q o (� D. Date Applicant CITY V 1�� ZIP / / /v LOCALITY 31"CERTIFICATE OF OF EXEMPTION FROM WORKERS' n`t NO.OF BLDGS. NEAREST .q ���r► COMPENSATION INSURANCE SIZE OF LOT q o,6 NOW ON LOT CROSS ST. Pe (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 /q LL TEL. C� USE ZONE MAP /S I certify that in the performance of the work for which this OWNER FrC/11 kJ, Jl/d�� NO. 2 - NO. A permit is issued, I shall not employ any pers n in any mannerL113,0 UO ,3 SPECIAL'. ADDRESS '[ Q < .Q Q�� CONDITIONS so as to become subject to the Workers'Co ensation ws. [ O < - CITY 6 LLL ZIP 9/7 U Date a I Appl i NOTICE tO APP (CANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP I TYPE FIRE PROCESSED BY O V Exemption, you should become subject to the Workers' _ ENGINEER NO. CONST. ZONE 2 Compensation provisions of the Labor Code, you must forth- ADDRESS 5.�� �� 3 with comply with,such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. LNDO. deemed revoked. CONTRACTOR NO. N LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS U NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER kAAF Professions Code, and my license is in full force and effect. CITY CLASS BK - VALIDATION SQ. FT, Jy NO. OF. NO. OF CHECK License Number Lic.Class SIZE (/ TORIE / FAMILIES ONE O_FS Wf 4 NEW VALUATION DESCRIOgOle, Contractor Date /� $ 23 4 a 9 A ❑ 1 am exempt under Sec. F al 41AVAIVILY h®,n AADDR Q # o'0 0 0 2 3 B.&P.C. for this reason �X 7U�/A��i I TG CI«6 b EPAIR ❑ $ !A - 633,05 Date: USE OF �i DEMOL EXISTING BLDG. ❑ Signature APPLICANT TEL. Q /y ® o (f$ PRINT K/Yh (�� NO.�A��7 FINAL -�� Q !$ Y OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License `//� A/At U 111166 A # o ° 0 0 2 3 Law for the following reason (Section 7031.5, Business and ADDRESS7�'3� L:U b FIN r/ Pro scions Code): PRESENT By A - - 2295 BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and o 0 0 2 2 9 5= the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 0 9 14-87 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 FROPM I: CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 27 9,1..0 A the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE # o 0 0 0 0 P.L. Lender's Name �, 25 T LDMA Ref. N m P.C. Fee$ 6,3310� Permit fee t o o ° 7 2 Lender's Address 3 ^O 04y $ I certify that I have read this application and state that the x J� Issuance Fee r LDMA P/C ff -0 9. 1 4 . 8 above information is correct. I agree to comply with all County Investigation Fee UT - ° No 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. f) p v o N and hereby auth rile representatives of this County to enter CA © O upon the above- entioned roperty for inspection purposes. J_i 1 �!J'7 0 c• a SEE REVERSE FOR EXPLANATORY LANGUAGE D< CH �. f -Applicant or Agent �5 n Signature of to