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HomeMy Public PortalAbout5036 ROSEMEAD BLVD_Building__ ©s 76A638A CE#803(REV.11/78) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS.ANGELES BUILDING AND SA Y FOR APPLICANT TO FILL IN ADDRESS G LDING -ADDRESS 5036 N. Rojemead Blvd. LOCALITY ` E- 0 NEAREST CITY ZIP 917 6 CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPST. ZONE E FIRE CESSED BY TRACT BLOCK LOT NO.. Al N CON owNEr�ieleri H 1 Eid86-7012 STATISTICAL CEASSIFICATION. /� SEWER MAP'--j' ADDRESS5036 N. RodemeadCLASS NO. DWELL.UNITS V` B�rP .SG CITY an Gabriel Ca. ZIP 91776 � - . ARCHITECT OR TEL. VALUATION y� ENGINEER NO. ADDRESS BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) CONTRA(HQR L. Randol Co. Inc Nc�88-4040 HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. LIC. + CITYCLASS BLDG.SETBACK FROM CONSTRUCTION LENDER SIDE PROP.LINE OF (STREET) NAME AND BRANCH D' HIGHWAY + YARD = TOTAL SETBACK FROM TYPEWOF EXISTING �. ADDRESS CITY SIDE PROP.LINE HIGHAY WIDTH_ SO.FT. NO.OF NO.OF CHECK + _ ®C SIZE STORIES FAMILIES ONE o ❑ US ONE MAP_HJT/ P„ DESCRIPTION OF WOR NEW NO. 3 SPECIAL ADD ❑ CONDITIONS �y 12X18 ALTER El FINAL r7 10.� °}� BY DATE ( { REPAIR _ USE OF DEMOL EXISTING BLDG. APPLICANT TEL (PRINT) H. L. Randol Co. NO-288-4040 BY(SIGNATU �� Q IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES _ AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Z WORK AUTHORIZED'HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OFz THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z 4 0[�_b A . PENSATION INSURANCE.' dY 0 0 0 0 0 1 . SIGNATUREO, 2 ° 0 2 2 0 0 PERMITTEE ADDRESS Z o 0 0 2 2,0 0 tS. O CITY San Gabriel, Ca. No 288-4040 c C ��,2 4- 0 a P.C. Fee$ Permit Fee > F Issuance Fee 7 ono�c W 221 U D d Total Fee0107 DEPARTMENT OF BUILDING AND S��� �' PLICATION FOR PERMIT COUNTY OF LOS ANGELES�'1�t 2 aD ��� wm. J. FOX. CHIEF ENGINEER 'BUILDING FOR APP CANT TO FIL IN FOR OFFICE USE ONLY - DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING A 1 DDRESS �J J (may LOCALITY j/ / 1 RECEIVED BY DATE OF ADPL. DATE IBSUED NEAREST Q 9—-7— Q CROSS ST. BUILDING ADORE OWNER d• ADDRESS � � r r e•��5 4-- E`er � , ! , P 0 ADDRESS NEAREST � A \ �i ��/� � �MAIL LOCALITY tD CITY / /J V / Y TEL. CROSS ST. NO. FIRE ._I- NO.DF TYP$ OR ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. / ORD.NO. � ADDRES SETBACK LINE 4C/ lj� TEL / APPROVED ��— -----'` CONTRACTOR ! i V NO. a 4 �j i BY DAT[ USE APPROVED ADDRESS ZONE BY DATE LEGALZO CORRECTIONS DESCRIPTION �pL}OT NO. BLOCK / TRACT SIZE OF LOT {• l! V I NOW ON LOTS '�•G ' USE OF NO. EXISTING BLDG. FAMILIES f I ROOMS /O/{�J�i D T.G�NGr7 ems+ /csyG DESCRIPTION OF WORK 3,o ,�, NEW ALTERATION ADDITION O REPAIR MOVING DEMOLISH - O/� -i/.L��t/r �G'.✓ Ted O F SO. T. NO.OF Z. SIZE [J LmJ w ROOMS STORIES WALL ROOF COVERING I COVERING USE OF NEW 1 BUILDING - Gc.v .SGT/rJoc.1 -r—c) .-=u Av.--/" - 1 HEREBY ACKNOWLEDGE.,THAT I HAVE READ THIS APPRO`IALSy- APPLICATION AND STATE THT THE ABOVE IS CORRECT INSPECTOR DATE 'Y AND AGREE TO.COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION FORMS,MATERIALS !//J"/"/� —�,'�; ✓ S AND STATE LAWS $GULATING BUILDING CONSTRUCTIONfy _ FRAME! FIRE STOPS, SIGNATURE DF ". BRACING,BOLTS t• PERMITTEE — LATH, INT. AUTHORIZED ADT LATH, EXT. 76A639A-3 z-sa $ P.C.S f' PLASTER,INT. V�✓ •" FEE / �— PLASTER.EXT. VALUATION />ys� r� / FEE ` ° FINAL NAL APPLICATION FOR. BUILDING PERMIT i1 COUNTY OF-LOS ANGELES '••% ' `tUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN B UILDINGDRESS BUILDING ADDRESS I+hereby affirm that I have a certificate of consent to self insure, 5�3� O$E1��ArD 3L-Up or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof((Sec.3800,Lab.C.)Policy No.©70)VI09=l�I Company /i7 , S rJ r + � _ ' v-SIZE OF LOT NO.OF BLDGS.NOW ON LOT OSS ST. 15 Certified copy is hereby furnished. 57O X g f ❑ Certified copy is filed with the ount buildin ins tion TRACT BLOCK LOT NO. ENTLtA.1J� y g P� 8 Q USE ZONE MAP NO. department. n Date Applicant ASSESSOR MAP BOOK PAGE a O PARCEL y � SPECYAL CONDITIONS a CERTIFICATE OF EXEMPTION FROM WORKERS' OWNJSER2778�J 4 EL.NO. �l YES NO COMPENSATION INSURANCE `�� S�/A J I IA J-) ST --11'11 WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred mJ&"V .D/Z DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP p I certify that in the performance of the work for which this permit f45 A,0 E n/A ( (01— V3 1 ��O ✓ is issued, I Shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.N �-• become subject to the Workers'Compensation Laws. SI'YWO Nl f^/J �` Y yq-J 79 1 STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of LjAjDE�J (/C- 64A9 Gs9 %12_01 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL.NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith Z�� FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS �wA ww LIC.NO. PL - ��vl.6_ `i' SIDE _S_ �a a LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL o ISO affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE NO.OF STORES NO.OF FAMILIES -- - i`moi E, Professions Code,�aLnd my license is in full force and effect. NEW BK PG 7 , _ r .= O I- License Numb T� Lic.Class DESCRIPTION OF WORK AA ADD ❑ VALUATION t_;i� 10 sr 6 4-."L G4,R A-C— Contractor Date — — ALTER ❑ 3' -.2 X13 '❑ 'CHANGEe ?�I ❑ I am exempt under Sec. z REPAIR $ B.BP.C.for this reason DEMOL •❑ LOMA P/C# USE OF EXISTING BLDG. 01! Date. Signature '/ APPLICANT(PRINT) TEL.NO. _URK 11 -,•_I. ( /✓ n LDMA Perm# Z .. ,� ❑ 1, as owner of the property, or my employees with wages as p their sole compensation,will do the work and the structure is ADDRESS M1K0 i not intended or offered for sale (Section 7044, Business and FINAL DA Q g! 4 T 1L ,. Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y i Ul j=)''g_ L- licensed contractors to construct the project.(Section 7044, YES❑ NO R Business.and Professions Code.) !ItE-4-t €s`. , ' WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING "' "' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH »...ri 1,--� -r 1 i CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST _; �NGIE _l FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO 9- the performance of the work for which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD _-- " ' - •S 'l PERMITTING HECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES •1�`I I[ 3097,Civ.C.. f __ m. COUNTYC E,TITLE 2, AP ER 2. CTIONS 2.20.1Q0 THROUGH 2.20.140 CONCERNING _Lender'shame HAZARD S M REPORTIN ND FOR OB INTO MG A PEfiMIT FROM THE SCAOMD. (y"; _ S J 4 a I I a Lender's Address r C^V o. OWNER OR AGENT . to I certify that I have read this application and state that the above information is correct. I agree to Comply with all county P.C.FEED �� PERMIT FEE ordinances and State laws relating to building construction,and ' a. hereby aut orize representatives of this County to enter upon ISSUANCE FEE the abov entio props for inspection purposes. �3 a YL-J—_ INVESTIGATION FEE TOTAL FEE n SIpreN Applk t d Agent Deb ' SEE REVERSE FOR EXPLANATORY LANGUAGE -' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS /�p n 1, _50 , ���/�/J rr✓� I hereby affirm that I have a certificate of consent to self insure, 5036 N. ROSLrAE FA15 5 —•VJ✓ or a certificate of Workers'Compensation Insurance,or a certified IP SPY thereof(Sec.3800,Lab.C. n S i��� �� 5 A N 68 5 R 1 E L ZIP 1' 76�aa� LOCALITY�£M�L C i Policy NO.o 'Company SIZE O�OT �' NO.OF BLDGS.NOW ON LOT NEAREST CROSS ST. Certified copy is hereby furnished. ,�'/—y� ❑ Certified CO is filed with th4e county building inspection TFl/�CT BLOCK LOT NO. F>ET�—. �� de�(pJJartm��ent��Pyl1t 9 P f 3 'O USE ZONE MAP NO. Date— Applicant ASSESSOR BOOK PAGE^O PARCEL SP/IAL COD ON OWNER •� 8 aA TEL. O. 8 �! CERTIFICATE OF EXEMPTION FROM WORKERS' LUT'H F-R 5 EVA, 1 A $1$ /_ 79/ WITHIN t000 FT op SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit is for one hundred 3 g G O ED&E 1/I.C-VJ die r DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY zIP ey ? 1 certify that in the performance of the work for which this permit A 5A ENA 91107 - 1310 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. A RJA S!MO N 1 A S IH 81145M' STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS /Z B/ CLASS NO. DWELL UNITS S L//✓/fin/ ✓ls. ���`n/��4+ 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 OWNER FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL -2:i'-! A15 _ LICENSED CONTRACTORS DECLARATION CITY S MF_ LIC.CLASS PIL a T—r.i I hereby affirm that 1 am licensed under provisions of Chapter 9 SEWER MAP I 1: t' — (Commencing with Section 7000)of Division 3 of the Business and so. .SIZE NO.OF STORES NO:OF FAMILIES c l:TAL. 4 a 4 a: -_ O Professions Code,and my license is in full force and effect. .30� NEW ❑ BK 4 PG `; _, - f.. DESCRIPTION OF WORK ADD VALUATION , t•7 +' 4'•�r a''-W License Numb �' Lic.Class fl wO g1=D cro Contractor Date �— % 1 ALTER ❑ P-S3 oym, • REPAIR ❑ e p ❑ I am exempt under Sec. $ �� ' B.&P.C.for this reason CovvE►eT BSD. i.170 FAM Ly DEMOL ❑ LDMA P/C# te: USE OF EXISTING BLDG. URM ElSFR _ - a3 ,- Signature APPLICANT(PRIN12 TEL.NO. LDMA Perm# Z ❑ I, as owner of the property, or my employees with wages as Q W AlE 51 O - their sole compensation, will do the work and the structure is ADDRESS FINAL DATE Q ' not intended or offered for sale (Section 7044, Business and 0 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL Z— _.� - M )'W.J,I.°� I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q - ;:rC• p p y, Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL `J ?,_ _ _a;`-r licensed contractors to construct the project.(Section 7044, YES❑ NO I� Business and Professions Code.) Ml' WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR COAST AIR QUALITY MANAGEMENT DISTRICT(ION OR SCAOMDOSEB PERMITTING CHEATION CKLIST I S-y-- [i,,, 6•.,,'�._ - as 6�.° UTH CONSTRUCTION LENDING AGENCY COAST AIRLINES. _ _ I herebyaffirm that there is a construction lending agency for ❑ :- =i t: _ a 6L 9 g Y VES NO •.:.ice_. the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD ;4 i 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES `:'�i'j!'{}=i. °-- m. COU�O*DETITHAPiER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING r3 Lender's Name HAZEPO G AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address a. OWNER OR AGviT. _�. -j—Y3 ii-3g �:• D1 •1. :: Ml1 6 o 1 certify that I have read this application and state that the above information is correct. I agree to comply with all county P.C.FEE PERMIT FEE` a., 1^I ordinances and State laws relating to building construction,and a. hereby authorize representatives of this County to enter upon a e� ISSUANCE FEE / the ve oned pr rty for inspection purposes. l r• INVESTIGATION FEE TOTAL FEE J � (0 sgaman of Avc1la.°i ar Age°i oaro . SEE REVERSE FOR EXPLANATORY LANGUAGE