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HomeMy Public PortalAbout5200, 5202, 5204 ROSEMEAD BLVD_Building__ 76A638A CE#8038-64 APPLICATION FOR BUILDING �' ERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS -- , BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T,OF BUILDING CROSS ST. DISTRI T N� GR UP TYPE. -P SSED BY FOR APPLICANT TO FILL IN coNsr. ' BUILDING q STATISTICALL�fI LEAS IFICATION SE ER MAP ADDRESS ��(�d O,S G./'YJB/Zj Yt� CLASS NO..y2.'ZDWELL UNITS B PG LOT NO. 3 •�. �ORTldN BLOCK USE ZONE MAP TRACT �, Jj' 6 3 SPECIAL• B� N0. OF BLDOS. ((.. CONDITIONS SIZE OF LOT �-�f NOW ON LOT '4i USE OF EXISTING DG. C d' BLDG. SETBACK FROM TEL ��� � FRONT PROP. LINE OF (STREET) OWNER Pi.✓ � °�i.'NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS 3 J gIQ��O A ;ye. HIGHWAY WIDTH 'P O_M C.L. CITY C T ARCHITECT �R BLDG. SETBACK FROM ENGINEER �Q S• '.AlNO� ® 510E PROP. LINE OF - (STREET) TYPE OF EXISTING SETBACK HIGHWAY •� YARD - TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. d _ TEL. + = O CONTRACTOR NO V LIC. ADDRESS NO. CORNER CUTOFF YES NO O LO O LIC CITY CLAS SEE REVERSE SIDE FOR SPECIAL APPROVALS u W DESCRIPTION OF WORK N Z NEW ADD ALTER REPAIR DEMOLISH S' eST. NO. OF NO. OF SIZE � _ STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT �''^� VALUATION$ ✓/ /)-tet APPROVALS DATE_ \INSPECTOR'S SIGNATURE VP'��V ✓ p FOUNDATION, LOCATION FEE$ � FEE$ FORMS,_MATERIALS FRAME, FIRE STOPS, / + I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING bAS VENT. DUCTS �• i 'BUILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK , AUTHORIZED HEREBY I L / EMPLOY ANY PERSON IN VIOLA. LATH. INT. TION OF THE LABOR STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S n TI N INSURA NC LATH. EXT. SIGNATURE OFy HOUSE NUMBER COR- ,�- PERMITTEE RECT AND POSTED ` r ADDRESS j FI NAL ►r'��-��°r,— � ��"�� JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGIN. ER PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION CK. M.O. CASH � tL04 a E' 0;n 'UG 25 1 D4.00 � c�4 ,__ ©s 76A638A CE#803(REV.6/78) APPLICATION FOR, BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAF BUILDING vD {/ FOR APPLICANT TO FILL IN ADDRESS BUILDING ^^77 ADDRESS .Ss+� O. ,c l'vCJ LOCALITY NEAREST CITY ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT NO.W,ON LOT MAP BOOK PAGE PARCEL ��J7 -yy DISTRICT GROUP T P FIRE OC ED BY Tf/AW6: l ;2- BLOCK LO `L3 GQD NST. ZONE ` TEL. r OWNER/���✓/K Old J NO. f� < " STAlISTICALCLASSIFICA N -)SEWER MA ADDRESS 00 C L�� � �L� LASS NO. �Z� DWELL UNITS ,J BK PG CITY Thr1 ? C a ZIP ARCHITECT OR TEL. VALUATION ENGINEER NO. J 6 ADDRESS GC7 Gids BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF ISTREETI CONTRACTOR (!/ NO. TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHWAY + YARD . = FRONT PROP:LINE HIGHWAY WIDTH ADDRESS g.roe, E� jV,4rl,,�V NO. LIC. + _ CITY CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER SIDE PROP.LINE OF (STREET) NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACK FROM I TYPE OF I EXISTING ADDRESS CITY SIDE PROP.LINE IHIGHWAYI WIDTH 0 SO.FT. NO.OF NO.OF CHECK + = V SIZE STORIES I FAMILIES ONE OC DESCRIPTION OF WORK NEW 'P.C.Fee$ J Permit Fee O ADD ❑❑ Issuance Fee Z ALTER REPAIR ❑ Total Fee USE TI DEMOL EXISTING BLDG. ❑ Z APPLICANT. )) TEL . '7 C (PRINT( L ' /� L= . . NO. c� ♦ 3''� 1 a Q � ..sem- e 5 a BY(SIGNATURE) �rylvt > I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �`� '" c V he THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES �7 l� W AND LAWS REGULATING BUI G CONSTRUCTION.I ERTIFY T AT IN DOING THE / V WORK AUTHORIZED HEREB LL NOT EMPLOY A `PERSO IN VIOLATION OF / THE LABOR CODE OF THE S TE CALIFORNIA INR TING T WORKMEN'S COM Z �1 PENSATION INSURANCE. _ -r SIGNATURE OF, .�,.��I9 .# 0 0 1 0.0 0 1 PERMITTEE 3 77/ 3 (� _�� `f' Q 2 -A 3.00 ADDRESS Z 'TEL io•o o'43,005 CITY NO. Q USE ZONE MAP Q OI,`1 ;5r '7 9 NO. -o Cw SPECIAL CONDITIONS FINAL BY of DATE � � ©s 76A638A GE X803(REV.6/78) , • iR APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING FOR APPLICANT TO FILL IN ADDREss t BUILDING t / Sll6 ADDRESS LOCALITY NEAREST �Y CITY / !/G �-/ / 7 ZIP CROSS ST. ,r NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT BLOCK LOT NO. S CO�SL� ZONE -'77 TEL. �gbel 61 OWNER t eo NO. /j/�7 STATISTICAL CLASSIFICATION SEWER MAP ADDRESS Rov/fB L nJ CLASS NO. � WELL.UNITS s, ' BK 17ffPG CITY P//�(��1. ZIP fob✓ ARCHITECT OR ,�� TEL. VALUATION $ ENGINEER NO.. (( ADDRESS fG- '/, 2 BLDG.SETBACK FROM CONTRACTOR L7 //Vl TEL.NO.ZY14 J 7 FROf7T PROP.LINE OF J ,u STREET( /�`� ( zF HIGHWAY _+ YARD __ TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS/JPO 13('p�Z 0 NO. ��/L s FRONT PROP,LINE HIGHWAY WIDTH �QkD 11.4n CITY �""46,'1 V� CLASS + �d BLDG.SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH �, ; _ SIDE PROP.LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH C SQ.FT. NO.OF NO.OF CHECK + = V SIZE I STORIES FAMILIES ONE ad DESCRIPTION OF WORK NEW ❑ P.C. Fee$ Permit Fee %2iT�oa' � ADD -7 O IIA /�A�+ Issuance Fee y� V��/'Tv✓ ALTER 0 Q Z REPAIR ❑ Total Fee 9 l USE OF DEMOL EXISTING BLDG. /,t 7 / EllyaZ G APPLICANT \ � '4j i W NO. (PRINT) � J•-1479 � ` 7L J1 BY(SIGNATURE) Q I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE IS COR CT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING ING CONST UCTION.I CERTIFY-THAT IN DOING THE _ WORK AUTHORIZED HE B WILL NOT MPLOY ANY PERSON IN VIOLATION OF V THE LABOR CODE OF $T T OF CALIF NIA IN RELATING TO WORKMEN'S COM- Z PENSATION INSURAN . - Q J 070IL7A SIGNATURE OF PERMITTEE # 0 0 0 0 0 . ' ADDRESS 7 C 2,o 0 3 1( 0 0 �� TEL. /E�3 CITY NO. C '0'0 0 3 Q 0 0 t=i USE ZONE 7MA s =+ �'^�— CIAL `� . 9 DITIONS FINALcZ �i y BYCA oc DATE �BS 76A638A CE#803 1V V.6/78) - �t, APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAF FOR APPLICANT TO FILL IN ALDING DIDRRESSESS AD BUILDING ADDRESS LOCALITY NEAREST CITY 1/� �? ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP T FIRE- P CESSED BY TRACT LOCK LOT Wk) �J� ^ ST. ZONE ` v _7TEL. 6.U) f OWNER NO. STATISTICAL CLASSI�SIIFIICC�ATI EWER MAP ADDRESS CLASS NO�BWELL.UNITS (21B PG CITY ZIP ARCHITECT OR TEL. VALUATION $ ENGINEER NO. ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTOR NO. ws TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH ADDRESS p K/9 NO, LIC. + CITY CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER . NAME AND BRANCH SIDE PROP.LINE OF (STREET( HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SO.FT. NO.OF NO.OF CHECK + = dd SIZE STORIES FAMILIES ONE 2//�� DESCRIPTION OF WORK NEW, ElP.C. Fee$ O u Permit Fee ✓�`✓�'�— ADD ElIssuance Fee S ALTER ❑ 7 p�J b REPAIR ElTotal Fee �. . USE OF DEMOL EXISTING BLDG. O El z APPLICANT TEL (� (PRINT) �L/ N BY(SIGNATURE) KLoz-HEREBY ACKNOWLEDGE THAT I HAVE READ TH APPLICATION AND STATE �� " 7 2 4,7 A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES Lu AND LAWS REGULATING BUILDING C STRUCTION.I CERTIFY THAT IN DOING THE C� V WORK AUTHORIZED HEREBY WILL T EMPLOY ANY PERSON VIOLATION OF j V — _7 / I•#, p O O O O 1 THE LABOR CODE OF THE STATE OF IFORNIA IN RELATING TO KMEN'S COM. Z PENSATION INSURANCE. .2 O_O 4 3 0,0 SIGNA PERMT TEES OF e0 O 0 4 a 0,0 V ADDRESS Z Q,1 ,b 7 9 ? �{ O CITY�- [ /✓rte/ .NO. USE ZONE MAPQ NO. SPECIAL ►- �� L CONDITIONS FINAL b ��w, BY w DATE / �,r . ©5 76A638A CE;803114EV.6/78) - APPLICATION FOR BUILDING PERMIT I � COUNTY OF LOS ANGELES BUILDING AND SAFE Y FOR APPLICANT TO FILL IN ADDRESS LDING ADDRESS �j� �/ , d LOCALITY NEAREST CITY j ZIP' CROSS ST. 5 2 NO OF BLDGS. ASSESSOR SIZE OF OT D U NOW ON LOT, MAP BOOK PAGE P CEL DISTRICT GROUP ,TYPE FIRE PR ESSED BY ,J 2 7 B'LOCK LOT NQ/n-J ;7 CONST. Z - TEL. �v� li - t OWNER jY I tq - NO. . �].e'^H STATISTICALCLAS IFI TION S WE 4RN3 0 ADDRESS ,2 es o, >(/ rr�s✓�IVI CJ CLASS NO. DWELL.UNITS��r B G CITY ZIP ARCHITECT OR TEL. VALUATION J��G�_G ,} ENGINEER NO. $� O` 17 QC3V ADDRESSBLDG.SETBACK FROM � TELA ~ }� FRONT PROP.LINE OF (STREET( CONTRACJ)TO��R � NO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESSf. I �T NO. FRONT PROP.LINE HIGHWAY WIDTH LIC. + CITY LE i CLASS BLDG.SETBACK FROM NAMEE AND BRANCH CO N LENDER SIDE PROP.LINE OF (STREET) AND HIGHWAY + YARD = TOTAL SETBACK FROM I TYPE OF 1EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SQ.FT. NO.OF NO.OF CHECK + = l� SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW P.C. Fee$ / 1-0 Permit Fee !� a/ ADD ❑ Issuance Fee / ALTER ❑ REPAIR ❑ Total Fee If USE OF DEMOL ❑ EXISTING BLDG. 3 �'�j ZO APPLICANT TEL / (PRINT) NO. Q ;24-847A O #•O o o o23 BY ISIGNATURE) i > I HEREBY N LED HAT HAVE READ THIS APPLICATION AND STATE a � J_ •�J V 2 O O 2 a80 THAT THE AB CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES """�����` ^� Com` Lu AND LAWS RE EATING BUILDING CONSTRUCTION. CERTIFY THAT IN DOING THE s.� - �. — / / V •O O O 2 8 = WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF / 0 V THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z PENSATION INSURANCE. 7 �G`, 0,608-79 I'Ile SIGNATURE OF Z - 6 4 8 4 8• PERMITTEE � Z �' ADDRESS _�AA il-liCv U Z # o 0 0,0.0 O CITY r AIITNO. 406 G .2'o ] 8 7.0'0 USE ZONE MAP 7 Q NO. 8700 v C J\. SPECIAL CONDITIONS X O O -79 /�j Q BY IN 01 DA EL L U �U✓ v I 76A638A• CE#8031REV.6/78) i • APPLICATION FOR .BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AN�SAFE FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING r — ADDRESS `J Z ® • LOCALITY NEAREST CITY ZIP O CROSSST. 7 NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE' ESSED BY TRACT BLOCK LOT •. CO T. ZONE 4.1 OWNER / ,1,*,Jf� moo. `� �� STATISTICAL CLASSIFICATION EWER MAK ADDRESS l CLASS NO. -v�5WELL.UNITS BgKG CITY ZIP ARCHITECT OR TEL. VALUATION ENGINEER NQ n / U L1 ADDRESS ZZ S y $ 1 BLDG.SETBACK FROM TEL. •� FRONT PROP.LINE OF (STREET) CONTRACTOR e NO.2 HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING v LIC. FRONT PROP-LINE HIGHWAY WIDTH ADDRESS �Z G/ .NO.LIC. 36)? + CITY /— . CLASS CONSTRUCTION ENDER �G�404,t /� BLDG.SETBACK FROM NAME AND BRANCH A V SIDE PROP.LINE OF STREET( �J HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH C SQ.FT. NO.OF NO.OF CHECK + = V SIZE STORIES // FAMILIES ONE DESCRIPTION OF WORK ry G� NEW P.C. Fee$ �� Permit Fee / O ADD ❑ Issuance Fee s-rfi� ALTER Z REPAIR ❑ Total Fee USE OF To Q DEMOLEXISTING BLDG. E / Z a O APPLICANT TEL (PRINT) F N0.22 a• G BY(SIGNATURE) N. ct 0 �� Q I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION D STATE -7� 79 V ' THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION,I CERTIFY THAT IN DOING THE _ WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF / U •THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM -/ Z A 6 1, LCJ„ ^ PENSATION INSURANCE. y"' n ^ - 4/�l g G SIGNATURE OF ^ �/ 0'0. o o PERMITTEE 3 --- 2I0io 2500 ADDRESS 2 2.13 0 0;o o = CITY ' NO. Z2"'J'• Q 2 0 0 0 USE ZONE MAP Q 0 6 2 9)—7 9 C--'�• SPECIAL ONDITIONS 'r 01 FINAL �'/ ^�� BY DATE ✓• � ` �jdj ©S 76A638A tE/803(REV.6/78) a ' APPLICATION FOR. BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SA BUILDING 6I 20 rRCHITECT OR APPLICANT TO"FILL IN D ADDREss LDING S �� Vc� LOCALITYNEAREST (� cax ZIP CROSSSTNO.OF BLDGS. ASSESSOR LOT NOW ON LOT MAPBOOKPAGE PARCEL DISTRICT GR TYPE FIRE �A[ESSED BY BLOCK 9.3�' - Q CON '. ZTELNO. alS STATISTICAL CLASSIFICATION ER M S CLASS NO. cy DWELL.UNITS Ir PG ZIP , ECT OR� �� TEL.?.1 VALUATION �ER NO.. S �Z� . G —5 h/ � BLDG.SETBACK FROM / FRONT PROP.LINE OF (STREET) ACTOR // /( • I, 2 HIGHWAY + YARD .= TOTAL SETBACK FROM TYPE OF EXISTING �' LIC. 3 FRONTPROP.LINE HIGHWAY WIDTH ADDRESS C 3/ NO. LIC. + .45' CITY 1-14. CLASS B CONSTRUCTION LENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP,LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP,LINE HIGHWAY .WIDTH O SQ.FT. NO.OF NO.OF CHECK t = V SIZE I STORIES FAMILIES ONE O DESCRIPTION OF WORK NEW P.C. Fee$ Permit.Fee b u X( ADD ❑ Issuance Fee y � �^ ALTER ❑ Z [J REPAIR ❑ Notal Fee USE OFDEMOL ❑ EXISTING BLDG. L ��� Z ZO APPLICANT �A TEL (PRINT) / /! . NO.ZZ3— !Yr C BY(SIGNATURE( 2,vo > IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AN TATE /_77 V THAT THE ABOVE IS CORRECT.AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V. WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM A Z PENSATION INSURANCE,. 7 C® . �4'bL5A SIGNATURE OF PERMITTEE r o 0 0 0 ADDRESS T O O s o 1°Off&Q Q TEL.Z .�J LL CITY ! NO.` �� /` 1010 106005, USE ZONE NOAP nn CSG V S > 0629'�' 9 CONDITIONS x-.77AL E. 6y5Fr� � FINAL // BY u°Ci DATE �/ i �.79 d -VORKERS'COMPENSATION DECLARATION insure,oraaffirm certif cane of Worke a certificate s' Compensat oof n Insuranceent to , APPLICATION FOR BUILDING PERMIT or a certified copy thereof Sec. 3800, Lab. C.) y ���S,�i�, ,p y COUNTY OF LOS ANGELES BUILDING AND SAF TY Polis No om7an Q- ❑ Certified copy is hereby furnished. FOR APPLIC NT TO FILL IN BUILDING ^� t..1[v,7 n�C t ADDRESS Certified copy is filed with the county building inspec- BUILDING E] tion department. ADDRESS V ^y LOCALITY 1 '2--(p--A -Applicant CITY ( ` CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred,dollors ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. L USE ZONE [NO. I certify that in the performance of the work for which this OWNER ►� NO. b1 permit is issued, I shall not employ any person in any manner /, � IAL so as to become subject to the Workers'Compensation Laws. ADDRESS DITIONS U CITY ZIP i Date Applicant ARCHITECT OR TEL. TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. 2.�� DISTRICT GRO P Exemption, you should become subject to the Workers' "� CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS /U W. with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR s NO. STATISTICAL CLASSIFICATION APT. fNDO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 2�DELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Lk (commencing with Section 7000)of Division 3 of the Business andL C SEWERTP Professions Code, and my license is in full force and effect. CITY o A (�� CLASS BK VALIDATION L SQ. FT. NO. OF NO.OF CHECK V License Numbers V Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ j� ADD ❑ $ l I am exempt under Sec. Ct t7 Lt7 ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL ❑ EXISTING BLDG. Signature APPLICANT TEL. FINAL 2 8 5 3.b A OWNER-BUILDER DECLARATION PRINT NO. DATE — I hereby affirm that I am exempt from the Contractor's License #,o a 0.0.011 Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT BY ��� i J ­ 49.88 BUILDING = ❑ I, as owner of the property, or my employees with ADDRESS o o;e 4'9.8 8 v 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. 12o7-87 ❑ 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). CONSTRUCTION LENDING AGENCY SETT REQUIRED YARD HWY TOTAPROP.ALINE CK F 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 m P.C. Fee$ Permit Fee 3 LDMA Ref. # Lender's Address ` 3 $ 1 certify that I have read this application and state that the IssuanceFee 10,6J LDMA P/C# 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. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant gent Date - APPLICATION FOR BUILDING PERMIT i1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING RESS .�-O I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec a .) �� h cy CITY ZIP,y p_- g r J`1 01�� �� 7�`Q'��� LOCALITY i Policy No. ! (7{ 4 Company SIZEOF I OT NO.OF BLDGS.NOW ON LOT �- ❑ Certified copy is hereby f rnishad. NEAREST CROSS ST Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. q,�,, USE ZONE MAP NO. Date Applicant--fu Q TJ e I Y" ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERp�� � TEL.NO. YES NO COMPENSATION INSURANCE JI!.L I PX '* S � " #f WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed.if the permit is for one hundred 1�->o DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP a.b I certify that in the performance.of the work for which this permit �i . o v �,� j le" is issued, I shall not employ any person in any manner so as to ARCHITECT ORENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making.this Certificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith R LJA[E 51S Cb .r7 , � 6 FRONT comply with such provisions or this permit shall be deemed revoked. AD KESS LIC.N PL PA,10 � SIDE } LICENSED CONTRACTORS DECLARATION cITY LIC.CLASS(`//'- P L a_ I hereby affirm that I am licensed under provisions of Chapter 9 C— �� G T SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF STORES NO. FAMILIES CD Professions Code,and my license is in full force and effect.v NEW ❑ BK PG , o. License Number V Lia Class L" J DESCRIPTION OF WORK qpp ❑ VALUATION r yvj V F b� I `I2� S ALTER ❑ $ ` z Contractor ate /, �I -/&-vtznEL REPAIR ❑ ❑ I am exempt under Sec. B.BP.C.for this reason c 2 bt- SOr DEMOL ❑ LDMA P/C# Date: SE OF EXISTING BLDV U V URM ❑ Signature APPLICAN PRINT) TEL.NO. LDMA Perm# ❑ 1, as owner of the property, or my employees with wages asP � ' -7 — �' p « their sole compensation,will do the work and the structure is ADDRES L" "T _ � S /Y Q il not intended or offered for sale (Section 7044, Business and FINAL DATE � Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ` `�� ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ NO )& Business and Professions Code.) ax,:,: Y• WILL THE INTENDED USE OF THE BUILDING 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 :.Tti the performance Of the work for Which this permit Is issued(.Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD - = 3097,CIV.C.). - PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 4'MIL, ° - �. COUNTYCO ITLE 2,CHAPTER SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING -.. -~-- Lender's Name HAZARDO MA RIALS REP ,PRT G AND FOR OBTAINING A PERMIT FROM THE SCAQMD. lfLenders Address OWNER OR AGENT A/ o' I certify that I have read this application and state that the above T RMFEE FEE P.C. �/ PERMIT r - information is correct. I agree to comply with all county o ordinances and State laws relating to building construction,and � hereby thorize repre entatives of this County to enter upon ISSUANCE FEE �� thea V entiongd perty fo nspection p oses. . INVESTIGATION FEE TOTAL FEE - - Sig-W..f ApplkaM w Ap.M oam 4' SEE REVERSE FOR EXPLANATORY LANGUAGE, WORKERS' COMPENSATION DECLARATION L reby affirm that I have certificate of consent to Self APPLICATION FOR BUILDING PERMIT insure, or a certificate ofWorr kers' Compensation Insurance,or acertified copy thereof'(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Up k4lp ❑ Certified copy is filed with the county building inspec- BUILDING T _ tion department. ADDRESS C 1 b /O Date Applicant CITY ZIP LOCALITY ( . NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR. (This section need not be completed if the permit is for one TRACT' BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. OWNER NO. USE ZONE MAP I certify that in the performance of the work for which this - NO. permit is issued, I shall not employ any person in any manner ADDRESS �ij SPECIAL' a ~ CONDITIONS so,as to become subject to The Workers'Compensation Laws. 0 CITY fe ZIP Date Applicant ARCHITECT OR TEL. NOTICETNT: If, after makin is ertificate of ENGINEER NO DISTRICT GROUP TYPEPRO ESSED BY CONST. ZONE 0 Exemption, you should .become, subject to the.Workers' ® f � // Compensation provisions of the Labor Code, you must forth- ADDRESS w a with comply with such,provisions 'or this permit shall be TEL. / STATISTICAL CLASSIF�ATIO-N APT. CONDO.. N deemed revoked.: CONTRACTOR k,$ NO. -r�Gd BATON�� Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.�JDSNELL. UNITS I hereby affirm that I am licensed under provisions of Chapter ADDRESS NO. (commencing with Section 7000)of Division3 of the Business LIC. SEWER MAP and Professions Code,and my-license is in full force and effect. CITY 2 CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number G�%! G �rBi Lic. Class SIZE I STORIES FAMILIES ONE, VALUATION Contractor LAIA113, Date L DESCRIPTION OF WORK S el' NEW $ GGO ADD E]❑1 am exempt under Sec. / s .. ALTER ❑ , B.BP.C. for this•reasonREPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMO' El Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT).' NO. ! I hereby affirm that I am exempt from the Contractor's License DATE �O Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By t n K ❑ I, as owner of the property, or m employees with. BUILDING P P Y� YADDRESS "'`""' ��-_y _ wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , u•g' _s=_, 7044, Business and Professions Code.) MOVING TEL. *. 1 ' El1, as owner of the property, am exclusively contracting CONTRACTOR NO. a °� with licensed contractors to construct the project (Sec- ADDRESS ='M` tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION'LENDING AGENCY SET BACK YARD HWY PROP, LINE 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. SIDE (Sec. 3097,Civ. C.). -i 4; .._. • _ P.L: z e 3I Lender's Name LID AAA Ref: # N P.C. Fee$ Permit Fee Lenders Address - o I certify..that I have read this applicationand state that the Issuance Fee '7 LDMA P/C# above information is correct. I agree to comply with al I County Investigation Fee X� 6 ordinances and State laws relating,to building construction, Total Fee U CDMA Perm. # a and hereby authorize representatives of this County to enter o upon the above-menti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu of plicant or Agent `---Date WORKERS' COMPENSATION DECLARATION �' , L insureboraffirm that I ha a certificate of Wo ve kcertificate of e s' Compensation eInsuran ent to lf ( -+ ,`� APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) a ? ( y�{ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No: Company ^^ I l ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN ADDRESSBUILDINa py- y ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 15 L CITY ZIP L/17 LOCALITY Date Applicant' NO. OF BLDGS. NEAREST CERTIFICATE OF:EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. 'COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE" PARCEL hundred dollars ($100) or less.) TEL. OWNER NO. USE ZONE MAP I certify that in TheNO. performance of the work for which This SPECIAL >_ permit is issued, I,shall not employ any person in any manner - ADDRESS y 0 e p L CONDITIONS a- soas.to become subject to the Workers' Compensation Laws., 0 /lCITY -7 / Le ZIP l7 d Date S ,Z 4P/"Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT:'If, after:making this ertificate of ENGINEER_ NO. CONST. ZONE Exemption, you should become subject.to the Workers' {�{� �' w Compensation provisions of the Labor Code, you must forth- ADDRESS S• a_ with comply with such provisions or this permit shall be L TEL. A STATISTICAL CLASSI KATION APT. CONDO. to deemed revoked. CONTRACTOR g 5 1, 4, NO. Z,&4/ 1r ��-�� Z LICENSED CONTRACTORS DECLARATION LIC. 7� CLASS WELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 52 7. s NO. J 5�7��7 a SEWER MAP (commencing with Section 7000)of Division 3 of the Business q LIC. CITY M.0AJ /��G' CLASS COO and Professions Code,and.-my license is in full force and effect. BK PG " " 23 VALIDATION t— p SQ. FT. NO. OF NO. d' OF CHECK License Number �J 9 d Lic. Class O. SIZE STORIES FAMILIES ONE. �,�+/'.y VALUATION t4i•LI•T Contractor e 14A/ ate '-'C- Z 5° �—a DESCRIPTION OF WORKttlA t-e- & NEW q D D ADD El $ ��y � ► 3307 37.50 ❑I am exempt under Sec. 4 py�W�+ ALTER ❑: 1 ITEMS B.BP.C. for this reason REPAIR ❑- $ f,'1Tw� 0 Date: USE OF TOTAL 1 tL 37®8V EXISTING BLDG. DEMOL '❑ Signature APPLICANTTEL. FINAL MILK 37.50 OWNER-BUILDER.DECLARATION (PRINT). ON NO. Z 6 DATE �+� •0 e I hereby affirm that I am exempt from the Contractor's License S �' Law'for the following reason (Section 7031.5, Business and ADDRESS �/2 S T' h i�,OZZ FINAL ' t ry� pp Professions Code): PRESENT BUILDING .,By .. 1 5/i�JlG7 I, as owner of the property, or my employees with ADDRESS " • wages as their sole compensation,will do the work and t rdr� ( ` ,:r AN 9:2? LOCALITY C 1 P _ . the structure is not intended of offered for sale.(Section } J t/ P -, 7044, Business and Professions Code.) MOVING. TEL. 3307 •01 ❑ 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 FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH. �`� •�� I hereby affirm that there is a.construction lending agency for FRONT the performance of work for which this permit is issued F.L. 00 (Sec. 3097, Civ. Ci). / SIDE 1 � N P.L. Lender's Name. {&(41 LD MAA # 000 � V7 Lender's Address 2 S f\ /�^ e d cr7 P.C. Fee'$ 7s _'Y'10 Permit Feelot- Lender's P ' � 3 ► 35 1 • a • I certify that I have read this application -'h-,,t/,d state that The Issuance Feed ` O s,� LDMA P/C# above information is correct. I agree to comply with all County Investigation.Fee 8 ordinances and State laws relating to building construction, Total Fee A * LDMA Perm. # a and hereby authorize representatives of this County to.enter upon th bove=mentioned property for inspection purposes. f ary $! •�Y� SEE REVERSE FOR EXPLANAT L IGUA(# ■ .�' - Signature of Ap cant or Ageni• Date W , WOR HERS' COAD PENSATION DECLARATION l .her€Dyaffirm that I havea certificate of consent to self irsure, or ci,certificaeof Workers' opensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) Policy N©M37TCompany �id/� �,r� / COUNTY OF LOS ANGELES BUILDING AND SAFETY r '•.�/tel Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING -2E tion department. ADDRESS .Z v 3-t7 ? ` Date / -Z-6 Applicant r CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FRO ORK RS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (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 TEL. USE ZONE FNO I certify that in the performance of the work for which this OWNER NO.permit is issued, I shall not employ any person in any manner �A � Z, IALso as to become subject to the Workers'Compensation Laws. DRESS S G-tJN p DITIONS 0. T(� U Date Applicant CITY ZIP � NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIREy CESSED BY 0 ENGINEER NO. CONST. ZONE F— Exemption, you should become subject to the Workers' U Compensation provisions of the Labor Code, you must forth- ADDRESS —5101 — W with comply .with such provisions or this permit shall be n- deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. CONDO. fn CONTRACTOR �/C7 C p NO. Z LICENSED CONTRACTORS DECLARATION * LIC f9 p CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS -4 NO. +`� (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY /I. I CLASS C— ti BK PG VALIDATION _ �. SQ. FT. NO.OF NO.OF CHECK PP LicenseNumber Lic.Class C— SIZE STORIES FAMILIES ONE n / VALUATION �/ $!� Co • Date / r�'1 �� DESCRIPTION OF WORK NEW ❑ $ Contractor ❑ / ❑ 1 am exempt under Sec. ?j— 2 / e DD ❑ pill.B.&P.C. ALTER for this reason REPAIR ❑ $ Date: USE OF DEMOL ❑ EXISTING BLDG. Signature APPLICANT NOFL. INAL (PRINT) ( ' OWNER-BUILDER DECLARATION d . �/4f.� DATE I hereby affirm that I am exempt from the Contractor's License 3 Law for the following reason (Section 7031.5, Business and ADDRESS ier. za&y Sf: FINA Professions Code): PRESET A•� By BUILDING I, as owner of the property, or my employees with ADDRESS 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. —4 8 4 9 5 A I, as owner of the property, am exclusively contracting CONTRACTOR NO. # 00 0 0,0;1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). •� 0 0 6 8 6 3 REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby off irm that there is a construction lending agency for FRONT 0 0 0 6 a 6 3 c=i the performance of the work for which this permit is issued P.L. 203-87 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name m P.C. Fee$ Permit Fee LDMA Ref. # Lender's Address 3 o I certify that I have read this application and state that the Issuance Fee # loop above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction; Total Fee R and hereby authorize representatives of this County to enter LDMA Perm. # upon the above-mentioned property for inspection purposes. n 'g SEE REVERSE FOR EXPLANATORY LANGUAGE Signal y4 of Ap, cant or Agent Date APPLICATIONFOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY ORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD KESS I hereby affirm that I have a certificate of consent to self insure, BUILDING A�DRESS . rV,�W b,�d .., or a certificate of Workers' Compensation Insurance,or a certified e� (//�1L copy there f S c. gab.C.) / CIubv ZIP !� �1�(NI LOCALITY f Poli y'No. Company SIZE OF LO NO.OF BLDGS.NOW ON LOT �ertified copy is hereby fu4nI NEAREST CROSS ST. ❑ Certified copy is filed with inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. DateJ�(-?Applicant ASSESSOR MAP BOOK PAGE PARCEL� SPECIAL CONDITIONS 54 CERTIFICATE OF EXWO KERS' OWNER TEL NO. — COMPENSAE 0 M A WITHIN 1000 FT.OF SCHOOL? YES NO P P ADDRESS. ri1J�- DISTRICT GROUP TYPE ONST. FIRE ZONE PROCESSED BY (This section need not be completed if the permit is for ne hundred \�./,1l dollars ($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit s issued, I shall not employ any person in any manner so as to O" become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. _ P STATISTICAL CLA IFJCATION APT CONDO Date Applicant ADDRESS - CLASS NO. c;( DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' NTR CTOR QbNO 2 SET BACK YARD. HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith / pl6 J l'/ FRONT \ comply with such provisions or this permit shall be deemed revoked. ADR 0 •LI Off. _ P L ) LICENSED CONTRACTORS DECLARATION TY p (�q LIC.CLLASS / PSIDE- I hereby affirm that I am licensed underprovisions of Chapter 9 V "'mow 1 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 ffe�t. NEW El BK PG , License.Nu er Lic.Class S DESCRIPTION OF WORK /ADD ElVALU ON a Contractor 1 DateI1 ALTER 1:1 $ O V Au REPAIR ❑ O ❑ I am exempt under Sec. $ F_ BAP.C.for this reason DEMOL ❑ LDMA P/C# V W Date: USE OF EXISTING BLDG. URM ❑ `�j3 a' Signature APPLICANT(PRINT) TEL NO. LDMA Perm# i Z • ACCT.,: ❑ 1,'as owner of the property, or my employees with wages as 0 ANT G their sole compensation, will do'the.work and the structure is ADDRESS 50.50 J not intended or offered for sale (Section 7044, Business and FINAL DATE � 1 Professions Code.) Z WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q 8 Y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 5 ACCT■r licensed contractors to construct the project (Section 7044, yes❑ No❑ Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING (: k,�y ITEMS OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 4•tjAl�l*�L� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR H N6t .00 GUIDELINES. - �,,�• I hereby affirm that there is a construction lending agency for YES❑ No❑ tTOTAL IN-59 40 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 �tr�mMp flfli 'I'I RVHa� 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, l`S lt7'7'0001 1 i!lIYYY[[VTTT 99 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. 3460 1 PM 6:06 o Lender's Address p OWNER OR AGENT o I certify that I hav ead this application and state under penalty 0 of perjury that th a me information is correct.I agree to comply P.C.FEE s. D•`'~� PERMIT FEE / / o with all county d' antes and State laws relating to building ' /, < constructic , and h eby authorize representatives of this County ISSUANCE FEE to ente4APPN4t TA911 e ion d property for inspecti n p rp s. o a 1� INVESTIGATION FEE TOTAL FEE p 9e r` Signature oOate SEE REVERSE FOR EXPLANATORY LANGUAGE 'KERS' COKMPENSATION DECLARATION' insu r o C tificcite ofoWorkers' Compensation Insuran of APPLICATION FOR BUILDING PERMIT or a ified copy thereof (Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY I,I Pol'cy No Company F71certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING `' ' ADDRESS D2 Sp2Utw Certified copy is filed with the county building inspec- BUILDING ��►s� r rt tion department. ADDRESS S�]C,�rL0C9 �3Z64 Date Applicant CITY � ,vr �, ' -% ZIP 77 LOCALITY >,LG i� CERTIFICATE OF EXEMPTION FROM WORKERS' fg NOW ON LOT CROSS NO, OF BLDGS. NEAREST . COMPENSATION INSURANCE SIZE OF LOT D( lJ (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 A11106 TEL USE ZONE A lv0 1 - L�. NO. I certify that'in the performance of toe ' rk for whi Is 4 permit is issued, I shall not employ ny pers in any a ner ADDRESS /T/O Q��� GCS ! �:Z SPECIAL so as to be omeYnsubject to the W r rs' ns aws. CONDITIONS U Date V f Applic t CITY 1 /13C�` ZIP NOTIC TO A PLICANT: If, ter i is ertificate of ARCHITECT OR TEL. DISTRI GROUP TYPE FIRE PROCESSED_ BY O ENGINEER NO• CONST. ZONE (— Exemption, you should bec ub t to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS V with comply with such provisions or this permit shall be TEL. STATISTICAL CLASS ICATION APT. I ObNDO. Cl) deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. P SEWE (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. PG.9Y VALIDATION SO. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE r STORIES FAMILIES ONE VALUATION DESCRIPTION Contractor Date DESCR'IPPTIION OF WORK / J_ NEW ❑ $ ado ❑ I/1 R -m��r ADD ❑ V(/ I am exempt under Sec. ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ 2 8 3 S 7.A 1 USE OF Date: EXISTING BLDG. qIEMOL ❑ # o,o o 0.23 Signature APPLICANT //��,,����J TEL FINAL PRINT)FRf7+�is /;-J#/ NO.` J- /�i OWNER-BUILDER DECLARATION 2iaiz2=;� DATE ',° Jr Z3 8 I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and 1 ADDRESS �"" FIN 5 7,3$_ b o o v Professions Code): PRESENTB ,[ 11 3.-r r 8 7 oft BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED WY TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HPROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 8A the performance of the work for which this permit is issued P.L. 7 a (Sec. 3097, Civ. C.). SIDE 0,0 00 P.L. Lender's Name P.C. Fee$ Permit Fee b LDMA Ref. # 7 a _ Lender's Address ® .3 O / U I certify that I have read this application and state that the Issuance Fee 0JV LDMA P/C# ' abovirif rmation is correct. I agree to comply with all County Investigation Fee 0 ordi nce nd State la relating to building construction, Total Fee LDMA Perm. # R hereb uthoriz a esentatives of this County to enter up n t e-m ti d property for inspection urpo es. SEE REVERSE FOR EXPLANATORY LANGUAGE i Lure o pplic n or Agent APPLICATION FOR BUILDING PERMIT i COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN -BUILDIN VDDR s I hereby affirm that I have a certificate of consent to self insure, B°"°N0 b RES$t1 Vwa • MQJ or a certificate of Workers' Compensation Insurance,or a certified V^��7 copy thereof (S S , ab.C.) �� ZIP J 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 count building inspection TRACT BLOCK LOT NO. departm nt. !(fiye USE ZONE MAP NO. DateApplicant "V` ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTI N FROM ORKERS' y/j�(� — OO COMPENSATION INSURANC OWN A_ NOAr- tob WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred AD SS W1 0. �OOYI�` DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit �0 G is issued, I Shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER �EIwNO. a become subject to the Workers'Compensation Laws. S:IV. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS U`O CLASS NO. aRA DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' NTRACTORMM QQ TE NO. - SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith S X77 FRONT comply with such provisions or this permit shall be deemed revoked. ADD E ` LI P L ALM SIDE LICENSED CONTRACTORS DECLARATIONC ® LIC.CLAS P L I hereby affirm that I am licensed underprovisions of Chapter 9 g4jSEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and m se is in full force and efffW NEW BK PG d License Nu er Lic.Class "` DESC ON OF W ADD ❑ VALUATION , O Contractor Date 1- ,m ALTER El $ (AID -A- U W- REPAIR ❑ O ❑ I am exempt under Sec. $ F- B.&P.C.for this reason DEMOL ❑ U LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ _ d Signature APPLICANT(PRINT) TEL NO. LDMA Perm# Z ❑ I, as owner of the property, or my employees with wages as ZO their sole compensation, will do the work and the structure is ADDRESS - not intended or offered for sale (Section 7044, Business and FINAL DATE / %G =__ti `Ej Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of the property, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ^ P y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y S licensed contractors to construct the project (Section 7044, YES❑ No❑ fit" I Business and Professions Code.) fc WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING � ??(,e j,>,,.•:e.._ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH " CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR l GUIDELINES. _, i I r- } I hereby affirm that there is a construction lending agency for YES❑ NO❑ p, cu the performance Of the work for which this permit IS Issued(Sec. (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 15 TP ce n`sg�@ 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, S C;K7 a TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Fw 5�:..I.?'•. '-'=e°- f Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address OWNER OR AGENT O o I certify that I happlication and state under penalty O P.C.FEE PERMITTEE of perjury thatation is correct.I agree to comply () _ N with all cound State laws relating to building D• m constru ion, ae representatives of this County ISSUANCE FEEto enter 'ponted property for inspection purposes. L• �v t �r rr )_` a INVESTIGATION FEE TOTAL FEE 10 signawre oe Dream or A e i D- a3 � SEE REVERSE FOR EXPLANATORY LANGUAGE 16 (�. 1?�ORKERS' COMPENSATION DECLARATION ffcer that I haver certificate Cirate of consent to self 'APPLICATION FOR BUILDING PERMIT insure; or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) r� COUNTY OF LOS ANGELES - .BUILDING AND-SAFETY' •. Policy No. Company Q BUILDING' ❑_ Certified copy is hereby.furnished. •. FOR APPLICANT TO FILL IN ADDRESS zo ❑ . Certified copy is filed with the county building inspec- BUILDING /tion department. , �,µ//-►�(/� ADDRESS - t t Date "� pplicant�,L, Vvr'+V`� CITY ZIP LOCALITY Tf 'n p NO. OF BLDGS. NEAREST C RTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT J\ 4fJ NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL:�� hundred dollars ($100)or'less.) o TEL. OWNER NO: USE ZONE MAP . NO. I certify that.in the performance of the work for which this SPECIAL >_ p� permit is issued, I shall not employ any,person in any manner ADDRESS ?j L(} V CONDITIONS a- so as to become subject to the Workers' Compensaton'Laws. /f O CITY L -zip Date Applicant. ARCHITECT OR I TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICENGINEER NO.E TO APPLICANT: If, after making this Certificate of CONST. ZONE Exemption, you should become subject to the Workers' '/ U Compensation provisions of the Labor Code, you must forth- ADDRESS ®� Y a with comply with such provisions or This.permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. 2 u - Z LICENSED CONTRACTORS DECLARATION LIC j CLASS NO. DWELL. UNITS - I hereby affirm'that I am licensed under provisions of Chapter 9 ADDRESS 71A- (commencing with Section 7000)of Division 3 of the Business LIC, SEWER MAP and Professions Code,and my license is in full force and.effect. CITY RAW CLASS 48BK PG VALIDATION R SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class B SIZE STORIES FAMILIES ONE y ��q y� VALUATION0 Contractor.-A /�/ /6M'Dote DESCRIPTION OF WORK NEW ❑ ADD ❑I am exempt under Sec. ► 'y�i /� ALTER B.&P.G;-for this reason $ UCCOF REPAIR ❑ Date: DEMOL ❑ EXISTING BLDG. APPLICANT TEL. -y Signature FINAL OWNER-BUILDER DECLARATION (PRINT) 8 NO. Ba� DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS D S FINAL / Professions Code): PRESENT BY ❑ MING I, as owner of the property, or my employees'with ADDRESS d U� 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.) MOVINGTEL. ❑ 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.) {- CONSTRUCTION LENDING AGENCY SEPFRONT BACYARD HWY TOTAPROBACNEFROM WIDIST TH I hereby affirm that there is a construction lending agency for the performance of the'work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name ,/P� LDMA Ref. # Permit Fee �✓ Lender's Address f 0 1 certify that I have read this application and state that the Issuance Fee �` / LD AA P/C# above information is correct I agree to comply with all County Investigation Fee 8 ordinances and St to laws relating'to building construction, Total Fee (d LDMA Perm. # Q and hereby author ze representatives of this County to enter upon`ihe abo e- ntioned.'property for inspection,�urp�os�es.s. '/' L('/ SEE REVERSE FOR EXPLANATORY LANGUAGE gnature o Applicant or Agent '*DDatte��. _ WORKERS' COMPENSATION DECLARATION :t sure bto sf o%tafirm certif certificate of Worke s' Compensation consent Insuran e, APPLICATION FOR.. BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) P T Tr COUNTY OF LOS ANGELES F BUILDING AND SAFETY Policy No. Com any 1 BUILDING ❑ Certified copy is hereby,furnished. FOR APPLICANT TO-FILL IN'.- ADDREss Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS I-M icl, L l Z JCITY - ;., ."ZIP ( LOCALITY Datea/ 9LApplicant "1. NO. OF BLDGS. NEAREST CERTIFICATE OF EXEM ION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATIOURANCE ASSESSOR r22 p Q (This section need.not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK J/>6 PAGE /% PARCEL hundred dollars ($100) or less.) TEL' USE ZONE MAP OWNER NO.qgL p I certify that in the performance of the work for.which this SPE permit is issued, I shall not employ any person in any manner ADDRESS S (-, G���- SPECIAL CL CONDITIONS so as to become subject to the Workers'Compensation Laws. L � O CITY ( /Y( ZIP 3V Date Applicant ARCHITECT OR if EL. D NOTICE TO APPLICANT: If, after makingThis Certificate of ENGINEER ;, O DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE Exemption, you should become subject to the.Workers' W Compensation provisions of'the Labor Code, you must forth- ADDRESS DGS Y a with-comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. to deemed revoked. CONTRACTOR NO. =JU Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.�DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS k NO.�l �J _(commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force' nd effect. CITY CLASS � BK PG VALIDATION ./ SQ. FT. �NF ] NO. OF CHECK License Number• SIZE / FAMILIES ONE VALUATION Cic. Class Contractor424(9t eO Y DESCRIPTION OF WORK NEW ❑ $ �,- f ❑I am exempt under Sec .' � - ,�, ADD _ y ALTER ❑ B.&P.C. for this reason L :�4 r���V REPAIR ❑ $ Date: SE OF XISTING BLDG. DEMOL ❑ APPLICANT TEL. Signature (PRINT). O u, �C% NO.GQ' J FINAL OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS -C.T /A f IlkFINAL Professions Code): PRESENT By ❑ I, as owner of the ro ert or m employees with BUILDING P P Y�. YADDRESS wages as their sole compensation,will do the work and d -r the structure is not intended or offered for sale(Section LOCALITY - 7044, Business and Professions Code.) MOVING TEL , ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. IZ -n»•• with licensed contractors to construct the project (Sec- ADDRESS -�- tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. o- CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the wo"rk for which this permitisissued P.L. (Sec. 3097, Civ. C.). SIDE._ +i r j Fa- G .. P.L. =.r..a:-<<" Lender's Name. LDMA Ref. # P.C. Fee$ Permit"Fee • O Lender's Address o I certify that I have read this application and state that the Issuance Fee LDMA P/C# , 8 above information is correct. I agree to comply with all County Investigation.Fee f7 R ordinances and State laws rel Ting to building construction, Total Fee CJ � LDMA Perm. # i a and hereby authorize represe, .aS�ves of this County to enter upon the Bove en o d er, for.in'spection urposes. a 09 SEE REVERSE FOR EXPLANATORY LANGUAGE Signa),re o pplicant 'r Agent Date F COUNTY OF LOS ANGELES TEMPLE CITY r # 0508 r BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9903030055 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 SQ. FT STORIES TYPE OCCUP GROUP 5200 ROSE14EAD BL STRUCTURE: 0 1 VN B SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 5388-019-031 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES 0 . HOLLY YOUNG LANG. CLASS & BOOK CENT EXIST OCC GRP: B 04/06/99 UT 04/06/ OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DAT FINAL BY: ODE: CHEN I CHANG;SHIU H (818) 441-4698- 22,000 2700 MONTEREY RD SMAR 911081730 FEES PAID DESCRIPTION OF W T.I. IMPROVEMENTS- NTERIIR WALL FO FICE SPACE AND STORAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - Cl PLANCHECK W/HC 22000.00 VAL 373.24 AA BLDG PERMIT ISSUANCE- 27.75 SPECIAL CONDITIONS: AC STRONG MOT -RESID-- __--22000.00 VAL 2.20 10 OR LESS STUDENTS C2 PERMI,T�W%HANDI�OAP,=,P %'j 22000:00 VAL 439.11 C�y�� !-TOTAL)�EES 842.30 CONTRACTOR: TEL. N0: ��' ly� � APPROVALS DATE INSPECTOR SIGNATURE ,'SAME AS OWNER LIC. NO �%� LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: ;I \` - \\� FOUNDATION/TRENCH FORMS LIC. NO1 11111111 111 SLAB/UNDER FLOOR I RAISED FLOOR FRAMING . 'MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: i Jai II,' t�, r� ���)' i� UNDERFLOOR INSULATION 3 `�1�4_ (�_� ! L `fJ ��!J t;1.:i1 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS —--- –� NO 22 n/� r � ��I ROOF SHEATHING SCHOOL WITHIN HAZARDOUS i , 7z t*= SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS li ' FRAME INSPECTION NO NO NO �� � � Jay� � FIRE SPRINKLER HANGERS �V.cSL-�2�� INSULATION/WEATHER STRIP INTEi2I0R LATH/DRYWALL _ EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'SCOMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ��/ �� .. I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS T R f/' 8Jd /W1YlI or a certificate of Workers' Compensation Insurance,or a certified t'1�q copy thereof(Sec.3 0 La/b.C.) 1 �J/ ( CITY�• Y�� nzJ ZIP LOCALITY Policy NO. ��1 Company " /"'� �''"� SIZE OF LOT 11 /�'1!IL s NO.OF BLDGS.NOW ON LOT ertified copy is hereby furnished. 7—% NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. de ar°I�tnent. I�/, ii1�r11r USE ZONE MAP NO. Date �•1 ��".+ Applicant ��• "�+�VI'Rl'� ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER {{ (� c TEL NO. YES NO COMPENSATION INSURANCE AI I/ i 1 WITHIN 1000 FT.OF SCHOOL? ADDRESS (� t (This section need not.be completed if the permit is for one hundred � �,q&A �.q�cl,� DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) '' t VIII tYu• J I certify that in the performance of the work for which this permit CITY ZIP 11 /� is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. P STATISTICAL CLASSIFICATION APT CONDO Date Applicant- ADDRESS CLASS NO. --V� 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 /�LrtN� f�1 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith II�G f I-i/ LJ1�1 IJ� /�1 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESSf f' r �� n r LI'C.NO, rn SIDE LICENSED CONTRACTORS DECLARATION I 11`rl Y/AI t#Ait S CITY U� �� LIC.CLASS CITY I J P L I hereby affirm that I am licensed underprovisions of Chapter 9 V is �j SEWER MAP (commencing with Section 7000)of Division 3 of the Business and S . T..SI E NO.OF STORIES NO.OF FAMILIES 23 Professions Code,and my e is in full force anteff ct. NEW 11 BK PG ACCT. t� Li7 a License Nu er Lic.Class p DESCRIPTION OF.WORK ADD ❑ VALUATION - 330e 181x60 O Contractor ' �. Date �' 1� C G ALTER $ +00 4 El am exempt under Sec. p� REPAIR El1 ��MS 0CO DEMOL El $ TOTAL 81-60 B.&P.C.for this reason LDMA P/C# v Date: USE OF EXISTING BLDG. _ - URM ❑ E096E ev'A Q. U) Signature APPLICANT(PRINT) r TEL NO. LDMA Perm# g D W f d �� X13 �� o ACCT.T z ❑ I, as owner of the property; or my employees with wages as their.sole compensation, will do the work and the structure is ADDRESS (� �, / n� 0 not intended or offered for sale (Section 7044, Business and liI (LQ� !^Y FINAL DATE -.1 0 -0001PI 1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A.HAZARDOUS MATERIAL / J ❑ I, as owner of the property, am exclusively contracting with AAMOUNTSTS ECFIIEDTNG ONITHEHAZARDOUSMATERAILS NFFORMATTIIONRGUDE?ER THAN THE 1 ITEMS FINAL BY licensed contractors to construct the project (Section 7044, YES❑ No❑ Business and Professions Code.) TOTAL -1 ®' '� WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING /• �t _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECK 1018 Q./0 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. (4('t I hereby. affirm that there is a construction lending agency for YES❑ No ElCHANGE .00 y a the performance Of the Work for which this permit IS ISSUed(Sea I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 0000-00019/14/95 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address ^/♦,�r/I� 0 OWNER OR AGENT x;,306 1 Af M�10 a 43 0 1 certify that I have read this application and state under penalty 4 of perjury that the above information is correct.I agree to comply P.C.FEE /b PERMIT FEE / with all county ordinances and State laws relating to buildingoo N7 con ru tion, ii hereb authorize representatives of this Count ISSUANCE FEE to er upon o ovementioned property for inspection purp0 s. a .3 ' � INVESTIGATION FEE TOTAL FEE JD �j. (� O Signa[ !of Al;,-or Agent Date / Q / SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0710170046 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: 1 I BUILDING ADDRESS: ON FILE ISTGN DESCRIPTION: ILLUMINATED CHANNEL LETTERS 5220 E ROSEMEAD BL SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15388-019-007 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl (TENANT: 1EXIST BLDG USE: JISSUED ON: PROCESSED BY: EXPIRES ON: POSTAL PRO JEXIST OCC GRP: 110/17/07 SR 04/14/08 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DA BY: CODE: CHEN I CHANG;SHIU H (818) 441-4698- 1 1,800 1 EXPIRED2700 MONTEREY RD ISMAR 911081730 I FEES PAID IDESCRIPTION OF WORK 1 (ILLUMINATED CHANNEL LETTERS -(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( (APPLICANT: TEL. NO: IJ & H SIGN INC. (626) 448-1166- IAA BLDG PERMIT ISSUANCE 27.75 1 19441 VALLEY BLVD. IAX BUILDING REVIEW FEE 54.70 ISPECIAL CONDITIONS: IROSEMEAD, CA 91770 ID2 PERMIT W/O EN-HC 1800.00 VAL 82.20 1 TOTAL FEES 164.65 1 I I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IJ AND H SIGN (626) 448-1166- I I 19441 VALLEY BLVD. LIC. NO I ILOCATION AND SETBACKS IROSEMEAD, CA 91770 873439 C45 I I I I I I ISOILS ENGINEER APPROVAL 1 1 I I I I I I 1ARCHITECT OR ENGINEER: TEL. NO: I IFOUNPATION/TRENCH FORMS I I LIC. NO: ISUPPORT STRUCTURE I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( I 001 I I I I I I I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I NO 20 I I I I I I I 1 SCHOOL WITHIN HAZARDOUS IAIR QUALITY: 1000 FEET MATERIALS NO NO NO I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I i I A I I I I I I I I I I I I I I I I I I I I I I I I I 1 IREPORT ID: DPR261 ROUTE TO: BSO508 I I I 1 I I I I I i APPLICATI OR BUILDING PERMITf COUNTY OF LOS ANGE4I8& BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS - hereby affirm that I have a certificate of consent to self insure, I,_�'.�v_ /1 or a certificate of Workers' Compensation Insurance, or a.certified C >I copy thereof (Sec.3800,Lab.C.) CITY ,AA / /� ,/J��4 ZIP LOCALITY PolicyNo. B��''`jy � ._Companyt'�2 UvL� (��/��jVZ7 SIZE OF LOT NO.OF BLDGS.NOW ON LOT R _ ❑ Certified copy is hereby3umis ed. NEAREST CROSS ST. JG¢ ❑ Certified copy is filed with ounty buil ing i spection TRACT BLOCK LOT NO. � USE ZONE MAP NO. department. / RCEL . ��ccii �� �� ASSESSOR MAP BOOK PAGE PA Date 1 6 Applicant L SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER COMPENSATION NO. ._ COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is fon one hundred ADDRESS 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 )I is issued, I shall not employ any person in any manner so as to ARCHITECT O E PXEER- - TEL O. tJ a become S ect to the Workers'Compensation Laws. y y, 2 L� STATISTICAL CLASSIFICATION APT CONDO Dat e �Applicant. ADDRESS ` /n /�/i {{i\A!I�) 7 n��/1J. CLASS NO. S + DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of -W 1 0 e� / � ' •" `CJ 5 ��`'�^'�C�' REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should becomesubject to the Workers' ACTOR � �` EL O. �7 q SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �2( � (, w� �� 15 C FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS / P L LICENSED CONTRACTORS DECLARATION U3 LJIL�\eb2- SIDE LIRC.CLAS P L CI I hereby affirm that I am licensed underprovisions Of Chapter 9 SEWER MAP F1�raz f L; (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SI NO.OF STORIES NO.OF FAMILIES +NEW ❑ BK- PG --, 41, ." s } Professions Code,and my liC se is in full force and e fect. d License N er Lic.Class DESCRIPTION WgB4—� e t ADD ❑� VALUATION lop' .fi r-�+:, .Q L.1 to cid � � -�i ALTER $ t � I ,�tl•_ U Contractor ;_:"'• s � 40 O:l' C `C.< ��G PH-=r ; 0111. El I am exempt under Sec REPAIR 0 $ . BAP.C. for this reason DEMOL ❑ �L(; LDMA P/C# ! ':•�t,+L ;r: W USE OF EXISTINGJL BLDG. URM ❑ "' a.7 C` a _ ate: E. 430 ;VIASignature ` aL, ��� A I NT PRINT TEL NO. LDMA Perm# _ z...., Z El 1, as owner Of the property, or my employees with wages as T �— Z -'-=- I r'! c; :•_ their sole compensation, will do the work and the structure is ADDRESS // '� 0 (tom a 1r c not intended or offered for sale (Section 7044, Business and v0 �'•� -T LA.V\, `J� 4 FINAL DATE a M-TL PM -17 ` D PfOfeSSIOr1S Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ��', ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q 330; 564.15 p y Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B licensed contractors to construct the project (Section 7044, YES El NO 1:1 7 ITEMS 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 d` m 7` CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR � , GUIDELINES. 607.90 0 7 090 1 hereby affirm that there is a construction lending agency for YES El NO 1:104J! 7 U cu the performance Of the work for Which this permit Is Issued(Sec. [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, � � u�� 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. o Lender's Address -0001 p OWNER OR AGENTTn (,- o I certify that I have read this application and state under penalty it 934 LLL( TTT i ILII 1 TTTT 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE o with all county ordinances and State laws relating to building ✓✓ m tr CtiOn, and hereby authorize representatives of this County - ISSUANCE FEE t e to up t-he,ab v -rn@ntio d p erty for inspe�ctiorlpu poses. ; a `-'�`3 lIp q, INVESTIGATION FEE - TOTAL FEE ID v SiBnalure of Applicant r Agenl Dale SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATIL N FGPR BUOLM RWT I -,PPLICANT'rO FILL IN (Print ort YPe vjjyl BUIL cammmk , , 11 .. COUNTY OF LOS ANGELES,' - j — DING ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION CITY ZIP 9 -NO-OF BLDGS. BUILDING SIZE OFLOT ZOO m' .2-oo" NOW ON LOT A-)C,(4 L ADDRESS .2C9 el OT�O ew.-e OT NO. TRACT 5 Le cl 6 - 6w LOCALITY L. xv( TEL NEAREST ATL e,*(_ec_-,-v­­- NO. _F,'I CROSS ST. OWNER > ASSESSOR MAPBOOK PAGE ADDRESS PARCEL N0 DISTRICT GROUP TYPE FIRE P OCESSF'D BY -CITY Cc7y ZIP CONST x-�­ ZONL,- ARCHITECT OR EL. ENGINEER J, 4.*-%cs i­I Jyl //P" STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 2Q,4460 TEL. CLASS NO.-Ar DWELL.UNITS BK, /TPG CONTRACTOR NO. USE ZONE MAP LIC. NO ADDRESS NO. SPECIAL LIC. CONDITIONS 7d CITY CLASS CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES- -NOZJ-- NAME AND BRANCH BLbG SETBACK FROM (STREET) ADDRESS CITY -FRO,:TPROP.LINF OF SQ.FT. NO.OF NO.OF H,,jnIWAY YARD TOTAL SETBACK FROM m, TYPE OF EXISTING: ,Q-4�jr_ CHECK FRONT PROPAINE HIGHWAY� WIDTH S TORIES FAMILIES ONE ' DESCR�IPIJOIN OF WORK NEW + ADD ❑ BLDG,SETBACK FROM d - SIDE PROP.LINE OF (STREE I ALTER [-TOTAL SETBACKFROM -TYPE OF EXISTING 0 ' HIGHWAY + YARD SIDE PROP LINE, HIGHWAY WIDTH USE OF REPAIR EXISTING BLDG. + DEMOL ❑ APPLICANT TEL CORNER CUTOFF Y 0 f OI 31 (PRINT) 4 0 IN 01`Etl SPACE YES a t No 8Y,(SIGNATURE) zk. IN C(,ASTAL PERMIT ZONE -C] VALUATION$ THAHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE T THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES -AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA INR�IATING T9WORK OEN'S COM- /--�/- PENSATION INSURANCE 1,w.w- - SIGNATURE OF L PERMITTEE 'ADDRESS -S FINAL' BY X� NO, Cify -,9 c. cz�,-, 61 iz, TEL. C� i D�Tl' P'C* F-- IPMT.s FEE FEE HARVEY T.BRANDY,COUNTY EN i MAKE CHECKS PAYABLE TO: $ ENGINEER so PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION WAV. cv�-'_`Wf 5 0 1,5 7 2.2 F 2- .5 41-JUH 2 9 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9905130077 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: 1 BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 SIGN DESCRIPTION: FOAM AND PLASTIC LETTERS 5200 ROSEMEAD BL SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5388-019-031 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 05/13/99 UT 1/09/99 OWNER: TEL. NO: BLDGS. NOW_ON LOT: VALUATION: FINAL DATE FINAL B CODE: CHEN I CHANG;SHIU H (818) 441-4698- 900 ��• 2700 MONTEREY RD SMAR 911081730 FEES PAID DESCRIPTION OF WORK SIGN FOR HOLLY YOUNG LANGUAGE CLASSES AND BOOK CENTER FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: GOLD SIGN CO. (626) 814-3003- AA BLDG PERMIT ISSUANCE 27.75 1406 VIRGINIA AVE. AE STRONG MOTION OTHER_ 900.00 VAL 0.50 SPECIAL CONDITIONS: BALDWIN PARK, CA D2 PERMIT W/O EN-HC`-- 900.00 VAL 65.40 TOTAL--FEES 93.65 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE GOLD SIGN (818) 814-3003- 1406 W VIRGINIA AVE LIC. NO ��,' �� ��/ LOCATION AND SETBACKS BALDWIN PARK, CA 91706 506392 C45 SOILS ENGINEER APPROVAL \ /TRENCH FORMS ARCHITECT OR ENGINEER: FOUN9ATION TEL. NO: . /' \ LIC. NO;" SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:_1 00 '1/�� ✓ C� NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:- NO LASS NO 20 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALSNO NO NO �`• / _ REPORT ID: DPR261 ROUTE TO: BS0508 WORKERS' COMPENSATION DECLi'i,RATION APPLICATION FO BUILDING PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensiion Insurance, or - a certified copy thereof (Sec. 3800, Lab. C.) -,— COUNTY OF LOS AN LES �, BUILDING AND SAFETY Policy No. Company_ / 7�r /1�� BUILDING ❑ Certified copy is hereby furnishe FOR APPLICANT TO-FILL IN ADDRESS ertified copy is filed with the c u t uil ing ins c- BUILDING /1 �tio^n department. �i 46:6T-1 /p G ADDRESS 'p��o Q, 4�7 LOCALITY Date) CR®~-,I ApplicantC��r 1T-1�C/ /5 P4 CITY -� � � - ZIP CROSSNEAREST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS.' ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one. USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. TEL. r SPECIAL I certify that in.the performance of.the work for which this OWNER ,r � NO. CONDITIONS DISTRICT GRO TYPE FIRE ED BY permit is issued, I shall not employ any person in any manner : ADDRESS LJ O rCIU/A �^' -- CONST: J,ZONE so as to become subject to the Workers'Compensation Laws. l/ice 4 @9 Date Applicant CITY ZIP STATISTI L CLAS CATION APT, CONDO. NOTICE TO APPLICANT: If, after.making this'Certificate of ARCHITECT OR TEL �n7 Exemption, you should. become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Qy - Compensation provisions of the Labor Code, you must forth- . ADDRESS SEWER MAP � with comply with such provisions or this permit shall be deemed revoked. ACTOR -/ TEL. BK PG VALIDATION CONTRACTOR 7 NO. T7° Z'� LICENSED CONTRACTORS DECLARATION �•/ LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS /✓�Se� �/�!�(� NO-?60/(?/' VALUATION (commencing with Section 7000)of Division 3 of the Business and �,_,/ LIC. /J c Professions Code, and my license is in full force and effect. CITY AM*? CLASS G_lO $ I � 5 3 3 6 A" _ 2��/')/91— / !/ SQ. FT. NO. OF NO. OF CHECK License Numbert-/a•-'0/9 Lic.Class SIZE T FAMILIES ONE # ° ° ° ° 2`3 Controctor(- 'T/r�05-P `T Date �Q � DESCRIPTION OF WORK ���iV� NEW El ,-'o 2:° ° 2 �, 6 0 ❑ I am exempt from the licensing requirements as I am a /L r �Q� ADD ❑ ° °.° 2 1 .6 0�` licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, /j(17— �[_ �/ 1��j PAIR ❑ DATE 9 Q 2 Q'_8 1 Business and Professions Code). USE OF EMOL FINAL EXISTING BLDG. DEMOL ❑ By ey . Lic. or Reg. No. Date APPLICANT TEL, OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Law for the following-reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT FT 1, -- I, as owner of the property, or .my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 2.5 3 3,7 A 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property,.am exclusively contracting CONTRACTOR NO. r 0`o i0 0 0 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 2,0 o 3& 0 0 REQUIRED TOTAL SETBACK,FROM ]DISTTH CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE I hereby affirm that there is a construction lending agency for FRONT ° °,° `3 4. 0 D the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE , 0-5,20-81 P.L. Lender's Name i m Lender's Address" P.C. Fee S . ® Permit Fee j I certify that I have read this application and state that the:. Issuance Fee i 6above information is correct. I agree to comply with all CountyInvestigation Fee ordinancesand State laws relating to building construction, Total Fee m` and herzM authorize repr sentatives of this County to enter aupon' e bove- entio e pro rt for,in purposes. ^p?� SEE REVERSE FOR EXPLANATORY LANGUAGE a S gn6ture o,a nt r A e t. Date Os APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN aUl G ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUI G ADDRESS or a certificate of Workers' Compensation Ing,or a certified ' copy there"hereby CIT ZIP LOCALIT Policy No. Company (/� �1/V SIZE LO NO.OF BLDGS.NOW N LOT ❑ Certifiehed. NEAREST CR SS ST. Certifiecounty building inspection TRACT BLOC LOT NO. department. [� (�' `A ,/�,,,/� USE ZONE MAP NO. ' Dat jw'_jJi (4;;plicant YT/f/�tAA D��:Y/�/ ASSESSOR MAP BOOK PAGE PARCEL ' 1 - I l SPECIAL CONDITIONS CERTIFICATE OF EXEMPTIONiOM�1AFCERS' o ER ELN YES NO COMPENSATION INSIIRANCE WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ICI DISTRICT GROUP TYPE CONST. FIRE ZONE �ROCESS dollars($100) or less.) I certify that in the performance of the work for which this permit ( ZIP, c0"l-2, 0� �' is issued, I shall not employ any person in any manner-so as to CT OR -GINEER - l• TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CL SSIFICATION 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 t0 the Workers' AEL 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. ADD ESS LI .N P L LICENSED CONTRACTORS DECLARATION SIDE C Y. LI C S / PL I hereby affirm that I am licensed underprovisions of Chapter 9 R- SEWER MAP (commencing with Section 7000)of Division 3 of the Busine s and SQ.FT.SIZE NO.OF STORIES NO.OFFAMILIES Professions Code,and jic e is in full force d ffe I NEW IK BK PG a License Nurr�er Lic.Class DE CRIPTI O WO a f - / App ❑ VALUATIO 0 1 ALTER El $ U Contracto❑ AVcc I am exemp un Y de�S ! D I \V��N� G t� IIEPAIR ❑ $ O0 B.&P.C. for this reason Q 9 ON41 DEMOL ❑ V LDMA P/C# W Date: US OF EXISTING BLD URM ❑ - Signature _ APPLICANT(PRINT) kJ TEL N We LDMA Perm# z ❑ I, as owner of the property, or my employees with wages as O Hi-yo os their sole compensation, will do the work and the structure is ADDRESS .'' �5.. FINAL DATE ,3�j -1s f a.f�. not intended or offered for sale (Section 7044, Business and a0 - PfOfeSSIOrS COde.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALl'L.L' J ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Y AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, {; ' .o Business and Professions Code.) WIL INTENDED No E3 f7 86. WILL THE TENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDINGYES 13 ?{-I OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH -- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR gars(;� GUIDELINES, _ .y p .1 hereby affirm that there is a construction lending agency for YES❑ NO❑ N the performance of the work for which this permit is issued(Sea TOTAL 137 ® 2O O IHAVE READ TH HAZAR US MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097, CIV.C.) CHECKLIS, . DERST MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, r •�- - N TITLE 2,C A ER 2.2 E TIONS 2.20.100 OUGH 2.20.140 CONCERNING HAZARDOUS - ;.HECK J,+��c _I Lender's Name MATERIALS EPORTING FOR A RMIT FROM THE SCAQMD. ❑ Lender's Address OWNER OR �•�Irli�4]E o CIO AG NT O o I certify that I have ad this application and state under penalty of perjury that the bove information is correct.I agree to comply P.C.FEE PERMIT FEE //� ,ry _ o �� Com/(,r r_''Y_,i-. N with all c myKdines and State laws relating to building [!#otn •LI.I_!a constru anauthorize re resentativ of this Cou t ISSUANCE FEE00 P Y ato ent upon the rdperty for i pectin rp 5 d' !,��,9ia 1 AM 8e�,I INVESTIGATION FEE TOTAL FEE nate JJJ d (C7 SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0209030071 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 SQ. FT STORIES TYPE OCCUP GROUP 5200 ROSEMEAD BL STRUCTURE: 0 1 VN E2 SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 5388-019-031 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRE ON: OLYMPIA EXIST OCC GRP: B 05/22/03 JK 05/16/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE I AL BY: CODE: CHEN I CHANG;SHIU H (818) 441-4698- 3,500 . 2700 MONTEREY RD 64)1' 1"C SMAR 911081730 FEES PAID DESCRIPTION OF WORK T.I.- ADD RESTRM;NEW STOREFRONT;REMOVE EXISTING STAIRCASE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT.: DONE W/O PERMITS APPLICANT: TEL. NO: SAM STEPHENSON (626) 653-0409- Al PLANCHECK W/EN-HC 3500.00 VAL 113.19 2207 W MERCED AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: WEST COVINA 91790 AC STRONG MOTION RESID 3500.00 VAL 0.50 A2 PERMIT W/ENERGY-HC 3500.00 VAL 133.17 TOTAL FEES 274.61 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LEDFORD SERVICES (909) 765-5557- 41082 TAVA LN. LIC. NO LOCATION AND SETBACKS HEMET, CA 92544 429636 A SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 04 FLOOR SHEATHING NO. OF AMILIES: DWELLING UNITS: PT/COND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 t COUNTY OF -LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS- 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0703290054 PHONE: (626) 285-0488 EXT: _ ILEGAL ID: INUMBER OF SIGNS: 1 I BUILDING ADDRESS: 1 I ON FILE _ ISIGN DESCRIPTION: INTERNALLY ILLUMINTED LED CHANNEL LETI 5214 ROSEMEAD BL I SGAB CA 917762279 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: - I I 15388-019-007 I I THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl ITENANT: (EXIST BLDG USE: (ISSUED ON: PROCESSED BY: EXPIRES ON: I (EXIST OCC GRP: 103/29/07 JK 03/23/08 I 1 0WNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: iFINAL DA RRETBY: CODE: CHEN I CHANG;SHIU H (626) 441-4698- 2,300 12700 MONTEREY RD I I I ISMAR 911081730 I FEES PAID IDESCRIPTION OF WORK I I IINTEPNALLY ILLUMNINTED LED CHANNEL LETTERS I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 I (APPLICANT: TEL. NO: I I I WU (626) 444-8181- IAA BLDG PERMIT ISSUANCE 27.75 1 1 12812 PECK ROAD IAX BUILDING REVIEW FEE 54.70 ISPECIAL CONDITIONS: I IEL MONTE ID2 PERMIT W/O EN-HC 2300.00 VAL 99.00 1 I I I TOTAL FEES 181.45 I I (CONTRACTOR: TEL. NO: I - - (APPROVALS DATE INSPECTOR SIGNATURE I ISUCCESS SIGN AND AWNING, INC. (626) 444-8181- 1 1 I 12812 PECK ROAD LIC. NO I ILOCATION AND SETBACKS I I 1 IEL MONTE CA 91731 739177 C45 I I 1 I 1 I I ISOILS ENGINEER APPROVAL 1 I I 1ARCHITECT OR ENGINEER: TEL. NO: j IFOUND.ATION/TRENCH FORMS I I I I LIC. NO: I ISUPPORT STRUCTURE I I I I I I I I I MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMPP: j 1 001 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I I I NO 20 I SCHOOL WITHIN HAZARDOUS 1 1 I I I 1AIR QUALITY: 1000 FEET MATERIALS 1 I 1 1 NO NO NO i 1 I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I. - - IREPORT ID: DPR261 ROUTE TO: BS0508 I I 1 1 I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0211070024 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: 1 BUILDING ADDRESS: ON FILE SIGN DESCRIPTION: 'MP VIDEO' IN RED 5214 ROSEMEAD BL SCAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 5388-019-007 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY TENANT: EXI T BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON: MP VIDEO EXIST OCC GRP: 11/07/02 JK 05/06/03 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: CHEN I CHANG;SHIU H (626) 441-4698- 1,200 2700 MONTEREY RD SMAR 911081730 FEES PAID DESCRIPTION OF WORK ONE SET INDIVIDUAL ILLUMINATED CHANNEL LETTER SIGN IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: I SUCCESS SIGN PRINTING (626) 444-8181- ID2 AA BLDG PERMIT ISSUANCE 27.75 2812 PECK RD #A AX BUILDING REVIEW FEE 54.70 SPECIAL CONDITIONS: EL MONTE 91731 PERMIT W/O EN-HC 1200.00 VAL 82.20 TOTAL FEES 164.65 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN PRINTING INC. (626) 444-8181- 9363 VALLEY BLVD, #A LIC. NO LOCATION AND SETBACKS EL MONTE CA 91731 739177C45 } SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: j FOUNDA=TION/TRENCH FORMS LIC. N0: i SUPPORT STRUCTURE 1 ' MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I 0.0 NO. OF FAMILIES: DWELLING UNITS: APT/CON : STAT CLASS: NO 20 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO I REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 �� BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0209030071 PHONE: (626) 285-0488 EXT: DUPLICATE LEGAL ID: N0. OF CONST NEW BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 SQ. FT STORIES TYPE OCCUP GROUP 5200 ROSEMEAD BL STRUCTURE: 0 1 VN E2 SGAB CA 917762279 ASSESSOR INFORMATION dUMBER: NEAREST CROSS STREET: BROADWAY 5388-019-031 THOMAS PAGE: 596 GRID:__H5_._ LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: OLYMPIA EXIST OCC GRP: B 05/22/03 JK 05/16/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL A FINAL BY: CODE: CHEN I CHANG;SHIU H (818) 441-4698- 3,500 / � 2700 MONTEREY RD SMAR 911081730 FEES PAID DE CRIPTION OF WORK T.I.- ADD RESTRM;NE TOREFRONT;REMOVE EXISTING STAIRCASE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: DONE W/O PERMITS APPLICANT: TEL. NO: SAM STEPHENSON (626) 653-0409- Al PLANCHECK W/EN-HC 3500.00 VAL 113.19 2207 W MERCED AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: WEST COVINA 91790 AC STRONG MOTION RESID 3500.00 VAL 0.50 A2 PERMIT W/ENERGY-HC 3500.00 VAL 133.17 D7 ADDNL PLANCHECK FEE 1.00 HOU 109.35 CONTRACTOR: TEL. NO: TOTAL FEES 383.96 APPROVALS DATE INSPECTOR SIGNATURE LEDFORD SERVICES (909) 765-5557- 41082 TAVA LN. LIC. NO LOCATION AND SETBACKS HEMET, CA 92544 429636 A SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 22 ROOF SHEATHING J SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QNOOLITY: 10NO O FEET MANERIALS FRAME INSPECTION',J- i i FIRE SPRINKLER. HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL e EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: SS0508 ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1002220085 PHONE: (626) 285-0488 EXT: (LEGAL ID: INUMBER OF SIGNS: 1 BUILDING ADDRESS: 1 ON FILE ISIGN DESCRIPTION: 1 WALL SIGN CHANNEL LETTERS 5200 ROSEMEAD BL SGAB CA 917762279 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 1 15388-019-007 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl I I I I (TENANT: IEXIST BLDG USE: 11SSUED ON: PROCESSED BY: 1 1 (EXIST OCC GRP: 102/22/10 SR 1 I I I I 1OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINA.L DATE FINAL BY: CODE: ICHEN, JUDY - I 1,400 1 1 15220 N. ROSEMEAD BL. 1 1 1 ITEMPLE CITY CA 91780 FEES PAID IDESCRIPTION OF WORK 11 WALL SIGN CHANNEL LETTERS 1 1 (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 1 1APPLICANT: TEL. NO: I I I ISIERRA'S SIGNS (626) 401-2544- IAA BLDG PERMIT ISSUANCE 27.75 1 I 11930 N. ROSEMEAD BL. IAB STATE GREEN BLDG FEE 1400.00 VAL 1.00 ISPECTAL CONDITIONS: 1 IS. EL MONTE CA 91733 IAX BUILDING REVIEW FEE 54.70 1 1 I ID2 PERMIT W/0 EN-HC 1400.00 VAL 82.20 1 1 1 1 TOTAL FEES 165.65 1 I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE' 1 ISIERRA'S SIGNS INC. (626) 401-2544- 1 i 11930 N. ROSEMEAD BLVD. LIC. NO 1 ILOCP_^ION AND SETBACKS I I IS. EL MONTE, CA 91733 939455 C45 I - I I I ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I 1 LIC. NO: (SUPPORT STRUCTURE I I I i I I I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:II I C I 1 001 1 I I I I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I . NO 20 I SCHOOL WITHIN HAZARDOUS Y9����® o (AIR QUALITY: 1000 FEET MATERIALS L//�® / 1 NO NO NO EI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I I I I I 1 i I I I I I I I I I I I I I I 1 IREPORT ID: DPR261 ROUTE TO: BSOS08 I I I I i I I I