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HomeMy Public PortalAbout4940 ROSEMEAD BLVD_Building__ DIVISIOF OF BUILDING AND SAFETY ObliArtment of County Engineer B U1 � ' of Los Angeles PI �-'J WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ,�.�/� DISTRI T NO. PLAN CK. OR REc.NO. PERMIT NO. UILDNG ADDRE199 �'� (/) 5 I 7'-1 0 �C�✓' DATF�OF APL. � D,Ai E ISSUE LOCALITY 10 / 3 � S HE CROSS ST. ./✓"� BUILDING nADDRESS �• US c-I�0 OWNER Q' J9 �•Av.L�, MAIL �/��� LOCALITY (A ADDRESS �' "'it a)y ,'(7- CROSS ST. O A Q Wt1 TEL CITY .--Vl--�A Z NO.•. FIRE NO.OF Tyftr GROUP I Z ARCHITECT OR TEL ZONE PLANS ENGINEER NO. SETBACK LINE O I 1414 ORD. NO. ADDRESS •s' TEL ZONLIBEE BYPROVED DATE CONTRACTOR NO. y�HOUSE NUMBERING `R� ADDRESS MAP NUMBER NO. ASSIGNED BY LEGAL DESCRIPTION LOT NO. p_ CORRECTIONS TRACT c NO. OF BLDGB. SIZE OF LOT OSx NOW ONLOT USE OF NO. OF EXISTING BLDG. FAMILIEe DESCRIPTION OF WORK m • o NEW ALTERATION ADDITION Z D r REPAIR DEMOLITION Bq.FT. /� NO.OF SIZE .2 C.l ROOMS STORIES EXT.WALL I R COVERING POVERING •. "6,)— USE OF STRUCTURE � INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FO.RMB, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- `7 4 .Y PLICATION AN 'STATE THAT THE INFORMATION GIVEN 19 FRAME: FIRE STOPS, r COR A®REE TO COMPLY WITH ALL COUNTY ORDINANCES BRACING,BOLTS F `��Gr © iA� pn AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, �yy �F✓ t.') // OA9 VENT,DUCTS SIGNATURE OF LATH, INT. ri1� a' �'✓e� �D�e. , PERMITTE /� �lJ� 4 !II✓1� LATH. EXT. ADDRESS r PLASTER, INT. n r Pr A I t AUTHORIZED ABT. PLASTER, EXT. P.C. I I S FEE HOLI9E�NUMBER COR- RECTiAND POSTED VALUATION FEE FINAL 76A63BA DBS 3 1-51 'DrVISiON OF BUILDING AND SAFETY 'BUILDING Department of County Engineer County of Los Angeles AppLYCATION WM. J. FOX, COUNTY ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICCCyyyTTT NO. PLAN CK. OR REc.NO. PERMIT NO. BUILDING �/ X-3 CCS (Jo ADDRESS J ! L//1 b,(J cs � R CIVSD-BY DATE OFAPPL DATE ISSUED LOCALITY / —,if "- - ` KEAREST ROSS ST. BUILDING�_<1: /' ADD ESS Y•V (� OWNER MAIL ¢� LOCALITY CL ADDRESS jy9 ' .NOAREST /► _a TRL CROSS ST. �Y`JJJJ CITY NO. FIRE NO.OF P ARCHITECT OR TEL ZONE PLANS ENO NEER NO. ^ _ BLDG. SETBACK LINE ADDRESS UBE _ � APPROVED CONTRACTOR Tom-' ZONE BY DATE NO. Doo HOUSE NUMBERING ADDRESS MAP NUMBER ��� NO. ASSIGNED BY LEGAL CORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT' ' b NO. OF BLD®B. SIZE OF LOT X I NOW ON LOT USE OF NO. OF EXISTING BLDG. FAMILI68 O DESCRIPTION OFWORK A c, NEW ALTERATION ADDITION Z D t- REPAIR � DEMOLITION SQ.FT. NO.OF SIZE ROOMS STORIES EXT.WALL I ROOF a COVERING , COVERING USE OF STRUCTURE INSPECTION FOR APPROVALS OCCUPANCY AS I NSPECTOR'S SIGNATURE DATE _ FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, CORRECT. _ BRACING, BOLTS _ I A®REE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BU I PjING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF0 ist: LATH, INT. PERM] FE! / g��'fr !'� r �L�.ATH. EXT. ADDRESS� b✓ l�N _/II�.A�G�.f3/1 _�, PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. P.C.$ —� �.'� FEE HOUSE NUMBER CD,R- �" RECT AND POSTED VALUATION /� `� FEE / ID FINAL 7GA639A DBS 3 1-52 APPLICATION FOR BUILDING PERMIT • COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD/DRESS I hereby affirm that I have a certificate of consent to self insure, BUILDINRESS or a certificate of Workers' Compensation Insurance,or a certified go copy thereof(Sec.3800,Lab.C.) CITY ZIP �j LOCALI " 7 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. USE ZONE MA NO. department. /� Date Applicant ASSESSOR MAP BOOK PAGE PARCEL J ✓{ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE ADDRES WITHIN 1000 FT.OF SCHOOL? YES NO ,/� � � ] (This section need not be completed if the permit is for one hundred O S K m.c��/t� GL /� V DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit C/ is issued, I shall not employ any person in any manner so as to J L�� become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. 1 P 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' 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. PL LICENSED CONTRACTORS DECLARATION PILE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 >_ (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP CL Professions Code,.and my license is in full force and effect. NEW ❑ BK PG C�') License Number Lic.Class DESCRIPTION OF WORD ADD ❑ ALUAT ON POO.- 0 ~ Contractor Date ALTER $ 9` w /O rte ev GAJ."ite��Zv-� 0_ ElI am exempt under Sec. REPAIR El $ Z o/r�jcyG+ � �Q�/ice q' ' �'7 •f��12�- B.&P.C.for this reason DEMOL O LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm# _ •.-.- �, I,:as owner of the property, or my employees with wages as Z - a their sole compensation, will d0 the work and the structure is ADDRESS O __ not intended or offered for sale (Section 7044, Business and FINAL DATE Q _ E° Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL c!JJ 9 I )EN OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ' ElI, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY i5 i.Gs(i tt � m 3!5 licensed contractors to construct the project (Section 7044, YES❑ NO❑ Business and Professions Code.) �;s z' 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. hereby affirm that there is a construction lending agency for YES❑ No❑ N the performance of the Work for Which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING C?•j ? Civ.C.3097, _li's , ;i t,' cam; . N ) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ _t TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. =4litL o Lender's Address O OWNER OR AGENT o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE /,,/ la N with all county ordinances and State laws relating to building df < construction, and hereby authorize representatives of this County II SUANCE FEEco co to enter upon the above-mentioned property for inspectio purposes. (p `T m / INVESTIGATION FEE TOTAL FEE 11:2r sgn.0",ol Apph" Oete SEE REVERSE FOR EXPLANATORY LANGUAGE