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HomeMy Public PortalAbout5322 ROSEMEAD BLVD_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY C p ,,a' DISTRICT NO. PLAN CK.NO. PERMIT /NO. BUILD ADDRESSING U �i �.5 Ci/'/'f /4j_.) LOCALITY 4 / ♦ C ) RECEIVED BY DATE OFFAPPL. DAT/E�IrySSUED CNEAREST ROSS ST. BUILDING OWNER ADDRESS �d TZ6.S�5ln�'x� MAIL CJS �p Q-�..�ne /moi..-sJ LOCALITY o o p J Re �q TEL �/3 CROSS STNEAREST. i M c /Y G �✓,/V 4 CITY 1��� N O. V FIRE NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANS.' Y ENGINEER �"""'-'"'`" NO. BLDG. / ( DRD.N ADDRESS SETBACK LINE _ APPROVED TEL. TEL. _ CONTRACTOR �"/ By DATE NO. USiEAPPROVED ADDRESS ZONE BY DATE LEGAL DESCRIIPTTIIOON,,� LOOTyNO. 2-0 /, CORRECTIONS TR13ACT r'�"'-' .S f� �a/ 5' SIZE F LOT I NOW ON LOTNO.OF S USE OF EXISTING ND.OF EXIBTINOe G FAMILIEB I I ROOMS - r DESCRIPTION OF WORK NEW ALTERATION ADDITION ---C7V !cam' iJ �J""/rIfPsY}�r / A REPAIR MOVING DEMOLISH G7 Sq.FT. NO.OF SIZE W'm ROOMS '�' STORIES WALL L O / 1 I ROOF COVERING� �+'�7�s�7( COVERING USE OF NEW BUILDING I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS - APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATIONI: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF� i! BRACING,BOLTS Y PERMITTEE LATH, INT. AUTHORIZED AOT LATH, EXT. 7BA63BA-3 7-49 $ P.C.® LPLASTER.EXT. TER,INT. -�" FEE -� 549 VALUATION , FEE FINAL t DEPARTMENT OF BUILDING AND SAFETY t APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER BE FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING � � DISTRICT NO. PLAN CK.NO. PERMIT NO. ADDRESS 2, 6 2-6Z -704 f g� LOCALITY 15A4 RECEIVED BY. DATE OF APPL..y DATE IBBD UE NEAREST / W ...�0 ~� CROSS ST. /� /� �° ,fin J� / /� OWNER C� � FADk� i ADDREISS CCe C"Js�+ M52JJ '& � , MAIL Q® lS � LOCALITY ADDRESS NEAREST TEL. CROSS ST. CITY NO. FIRE NO.OF TYPE OROU ARCHITECT OR TEL. ZONE '�"' PLANS ENGINEER O. e' y� ORD.NO, ADORES S TBACK LINE Q � iY if RL I� / }may 1, APPROVED CONTRACTOR rd s _t�P J7' /t�®. US DATE �&OeNE / �{/� �} �T��'j A� �r ZONE �"' ABYPROVED DATE ADDRESS '4 t 6' A' c twi t- LEGAL 2,0 CORRECTIONS DESCRIPTION p-LOT NO,/] BLLOCK TRACT J O /1 SECNO SIZE OF LOT S-40'XI NOW ON LCT'- / (� /Q � I . USE F BIEXISTINGSLDG. R1 MILEROOMS® C T Q. RA,1 DESCRIPTION OF WORK 3 ;� NEWALTERATION ADDITION REPAIR g� MOVING DEMOLISH 9 ZNO.13F E (� , ROOMS STORIESWALL ROD COVERING U 7- CG I COVERING i!f au LDING �5 /1✓(�—L O?H,6//914V 7- Se t, ,7- r7e1� g—= &-nrRl�' y _wAs2) / Q r� 7;0WAf/. Cf .vrJ /" �r7t�✓oa11 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS C9 1I/,-w;47 4vp APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE' FORMS,MATERIALS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FLOCATION FORMS. AND STATE LAWS REGULATING BUILDING CONBTRUCTION. , FRAME: S, E STO FIRP SIGNATURE _.fBRACING.BOLTS PERMITTEE 11 - �`" �� o ' " �y6 LATH, INT. AUTHORIZED AGT 'P-" �'����"`�" LATH, EXT. 7GA63BA-3 2-50 �� P.C.III PLASTER,INT. FEE l(J r. 0 PLASTER,EXT. VALUATION !8 , 666��� FEE FINAL V OM.PENSATION DECLARATION hereby`, ,ffirm I have to certificate of consent to self insure, a s cert; date of Worker's',smpensation Insurance, A P P L I CATION FOR BUILDING .PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No, Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 3vCfA22g�ga,al ❑ Certified copy is filed.with the county building inspec- BUILDING z � �� tion department. ADDRESS ✓ 1 /0 E �P LOCALITY NEAREST , Date Applicant CITY ��t ZIP ¢' CROSS ST. 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 k7 hundred dollars ($100)or less.) TRACT BLOCK LOT NO. � NO. TEL. (- ) / SPECIAL y. I certify that in the performance of The work for which this OWNER etc lt.f�eS '�v,-LcC, NO. - 3ts CONDITIONS DISTRICT GR UP TYPE FIRE PROLE ED BY O permit is issued, I shall not employ any person in any manner L CONST. ZONE lJ ADDRESS U✓Y LL ClA i�it D"V('e ,��/ so as to become subject to the Workers' m ensation Laws. LIU C9 Date Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CO O. 11- NOTICE TO APPLICANT: If, after making this-Certificate of ARCHITECT OR / TEL. L.1 ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to The Workers'' /� / Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be z deemed revoked. TEL' BK PG, VALIDATION CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION / LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commericing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $ 1500 , SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE .._ ❑ $ Contractor Date DESCRIPTION OF NEW 1WORK �! I am exempt under Sec. �L IYl E3 GCY/L nk YYl a� ADD. ❑ ALTER FINAL B.&P.C. for this reason W f n>�W "o 1�S �� REPAIR 1:1 DATE `(i 2 Date: - USE OF �yy FINA EXISTING BLDG. S000J, - DEMOL ❑ B Signature APPLICANT TEL. Y OWNER-BUILDER DECLARATION PRINT /14 cxylL 0--nTN I hereby affirm that I am exempt from the Contractor's License ' Law for the following reason (Section 7031.5, Business and ADDRESS 2 2 5 7 6 A Professions Cade): PRE ENT Z ��nE�-� ❑ BUILDING PV #.0 0 m © o I, as owner of the property, or my employees with ADDRESS N wages as their sole compensation;will do the work andLOCALITY S� &A-15R;6-t- ;t o:e 49.88 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. 8 8 5 z ° ® I; as owner of the property, am exclusively,contracting CONTRACTOR NO. ^-` a 4 9, with'licensed contractors to construct the project (Sec- ADDRESS 7,3 1 -8 5 tion 7044, Business and Professions Code). REQUIREDTOTAL 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. (Sec. 3097, Civ. C.). SIDE m P.L. v Lender's Name i P.C. Fee$ Permit Fee - Lender's Address I certify that I have read this application and state that the Issuance Fee d. above information is correct. I agree to comply with.all County Investigation Fee $ ordinances and State laws relating to building construction, Total Fee u and hereby outhorize representatives of this County to enter m upon the -mentioned property for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE 0s Signature of Applicant or Agent Date . /-� t?S',CgMPENSATION DECLARATION . , � APPLICATION FOR BUILDING PERMIT I hereb aff n that 1 have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.)' qa ?? ST,Q 7 c .1—U�{ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. ompany IN Certified copy is hereby furnished.. BUILDING FOR APPLICANT TO FILL IN ADDRESS 3 2 2 ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion deportment. ADDRESS eJ� DC F 13 L U Date 3—1-f-OtmS_Applicant LT"N Ay J''a/v 0 CITY T� ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' O. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS IT (This section need not be completed if the permit is for one TRACT BLOCK LOT NOASSESSOR . hundred dollars ($100)or less.) MAP BOOK P E PARCEL TEL. USE ZONE MAP OWNER .Jo Al W U NO. I certify that in the performance of the work for which this MA permit is issued, I shall not employ any person in any mannerADDRESS r7�: SPECIAL 0 so as to become subject to the Workers'Compensation Laws. CONDITIONS CITY ALlllf,416A AZIP V Date Applicant ARCHITECT OR TEL NOTICE TO APPLICANT: If, after making this Certificate of . DISTRICT GROUP TYPE FIRE PROCESSED BY Q /Exemption, you should become subject to the, Workers' ENGINEER NO. �( CONST. ZONE t3 Compensation provisions of the Labor Code, you must forth- ADDRESS J I�U V LU with comply with such provisions or this permit shall be ��T TEL.2� C" deemed revoked. CONTRACTOR V F � iNp NO. 9a�� STATISTICAL CLASSIFICATION APT. C DO. N LICENSED CONTRACTORS DECLARATION, / ^ LIC CLASS NO. _DWELL. UNITS �. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 32,51 �j p ,Wl L fl NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWS P Professions Code, and my license is in full force and effect. CITY CFR ;?v 5 C-, 0% CLASS 6— VALIDATION BK. PG. SQ. FT. . NO. OF NO. OF CHECK a J a F9 5— SIZE I STORIES FAMILIES ONE License Number Lic.Class T pp•� / P R DEAiv ' Cl VALUATION Contractor f 7CE 10%/V 0 Date /� v v DESCRIPTION OF WORK NEW ADD ❑ $ Z 9,1 69 A ❑ I am exempt under Sec. ❑ ALTERlol. •# 0 0 0 0,0 .1 B.BP.C. for this reason REPAIR E] S Date: USE OF DEMOL ° ° 6 Q 5 0 EXISTING BLDG. Signature APPLICANT TEL. FINAL a a 6 6 0 5 0 5: OWNER-BUILDER DECLARATION PRINT NO. DATE I hereby affirm that I am exempt from the Contractor's License Q 3, 1 5�-8 8 Law for the following'reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT F-1 UILDING 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). CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for LInvestigation the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name LDMA Ref. # m Permit Fee Lender's Address g I certify that I have read this application and state that the Issuance Fee CLO , LDMA P/C# above information is correct. I agree to comply with all County ee S ordin ces and State laws relating to building construction, Total Fee //y o and reby authorizer sentatives of this County to enter t✓r LDMA Perm. # upo t e above-menti property for inspection purposes. �`a SEE REVERSE FOR EXPLANATORYLANGUAGE 'S0 �'iJv Signature of Applicant or Agent Date if JI_ Gj��/� //Ll