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HomeMy Public PortalAbout5439 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS G /fit or a certificate of Workers'Compensation Insurance,or a certified 5y I ~' S copy thereof(Sec.3800,Lab.C.) CITY ZIP �,��'`p7, r �`� 91790 LOCALITY Policy No. Company }C SIZE O LOT NO.OF BLDGS.NOW ON LOT Cv ElCertified copy is hereby furnished. NEAREST CROSS ST. L Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Datet4 Applicant c-7-11— C�L41L 1-111 ASSESSOR MAP BOOK PAGE PARCEL /� - -3 SPECIAL CONDITIONS r ^O CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER / TEL NO. �•/ G/ COMPENSATION INSURANCE g WITHIN 1000 FT.OF SCHOOL? Yes No (This section need not be completed if the permit is for one hundred ADDRESSC' dollars($100)or less.) J OS��I11 ,_ DISTRICT GROUP T CONST. FIRE ZONE PROCESSED BY ZIP y ll I certify that in the performance of the work for which this permit is issued,'I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. AR HIT CT OR ENGINEER /� TEL NO. ����� J�I4JQS 80� 3 OQ STATISTICAL CLASSIFICATION APT CONDO EkvDate Applicant ADDRESS CLASS NO.. DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of 3 s A10,19 (4 7 REQUIRED TOTAL SEABACK FROM EXIST Exemption, you should become subject to the Workers' C NTRACTOR TEL NO.. Q SET BACK YARD HWY PR(3IA:LINE WIDTH Compensation provisions of the Labor Code, you must forthwith5l I'V FRONT comply with such provisions or this permit shall be deemed revoked. DDRES / LIC.NO. PL -- LICENSED CONTRACTORS DECLARATION SIDE °_.',•. # C Y _� _ _ LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 /(/� j�J SEWER MAPCL (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES _ Professions Code,and my license is in full force and effect. NEW BK PG ;s !( � {� �? p, v DESCRIPTIO OF WORK ADD ❑ VALUATION , CHEM t :0 License Numbera1©�/3� Lic.Class v C> _:• x i A t•R Contractor u6n86,T'�LA, Date �� ALTER ❑ $ D Ov ,� v CHAtit,IG Eli iW a REPAIR C3N El am exempt under Sec. $ z B.&P.C.for this reason DEMOL ❑ LDMA P/C# E I s Hi Date: USE OF EXISTING BLDG. URM ❑ y 2.1' Signature APPLICANT(PRINT) TEL NO, LDMA Perm# ❑:I,:as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE !R /9,J R Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL `V ✓ 0'" / OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE < ' El I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY - I licensed contractors to construct the project (Section 7044, YES El No❑ Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING z OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR ink: u GUIDELINES. 9'I .. •T I hereby affirm that there.is a construction lending agency for YES❑ NO❑ N the performance of the work for which this permit is issued(Sec. - e7` I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING `.� 3097,Civ.C) CHECKLIST.I UNDERSTAND MY REQUIREMENTS.UNDER THE LOS ANGELES COUNTY CODE, Vt q{ .r.►; +�_, N TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS -•- aLender's Name MATERIALS ORTING AND FORQ$TP�ING AA PELRM T =THE SCAQMD. o Lender's Address CC.T�///! T O OWNER OR AGENT --I ' 5 , o 1 0 I certify that I have read this application and state under penalty f' t = °= "-' = '� ' p P.C.FEE PERMIT FEE of perjury that the above information is correct.I agree to comply I-�_•t: ":?E cm with all county ordinances and State laws relating to building _ •:i construction, and hereby authorize representatives of this County / S7 ISSUANCE FEE00 to enter upon the above-mentioned property for inspection pur oses. ( 4'!!' - ��,�` _� INVESTIGATION FEE TOTAL FEEC+LT' Sigmt :oi Appl w u Agan e "/�'�+�-�'+�$_ /]`-• / SEE REVERSE FOR EXPLANATORY LANGUAGE -APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY I' WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS i or a certificate of Workers' Compensation Insurance,or a certified copy there (S c.3800,La ) VZEOqFL(3T S IP LOCALITY Policy Company NO.OF BLDGS.NOW ON LOT -- ❑ Cer'ie copy is hereby furnished. NEAREST CR 5, ertified cop is filed with the co ty uildin nspec TRACT BLOCK LOT NO. ' depar t: USE ZONE AP O. Dat Applicant 41 ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTI KATE OF EX PTION FRO WORKERS' OWN TEL NO. COMPENSATION INSURANCEIF WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADD SS DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) zIP I certify that in the performance of the work for which this permit ✓ CA � .0+ � is issued, I shall not employ any person in any manner so as to ARCHITECT GINEER TEL No. J become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. !9A DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' TRACTOR T 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. AI5DRE LIC'MIA . o. P L • SIDE LICENSED CONTRACTORS DECLARATIONC O LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9ff2 SEWER MAP }• (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO. F STORIES IVNO.OF FAMILIES a Professions Code,and my lice s is in full force and e e NEW BK PG U DES RIPTION OF WO ADD ❑ VALUATION License Numbe c.Class _ O Contractor Date ALTER ❑ W CL "z— REPAIR ❑ GO El am exempt under Sec. $ n z BAP.C.for this reason V 0, S t DEMOL Cl LDMA P/C# Date: U OF EXISTING BLOIS. ' URM ❑ �- Signature APPLICANT(PRINT) TEL NO. LDMA Perm# '-- ❑.1,-as owner of the property, or my employees with wages as Z -i(:'•: , their sole compensation, will do the work and the structure is ADDRESS O FINAL DATE not intended or offered for sale (Section 7044, Business and G Professions Code.) WILL THE APPLICANT O TURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL " $ J OR A MIXTURE CONT NG A HAZARDOUS MATERIAL EQUAL.TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFI N THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, �X f YES❑ XPEE / `.i•M a'3 Business and Professions Code.) _ _ WILL THE 2 BUIDLING BY THE APPLICANT OR FUTURE BUILDING i• OCCUPANT RR CONSTRUCTION OR MODIFICATION FROM THE SOUTHCONSTRUCTION LENDING AGENCY COAST AIR QDISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES.I hereby affirm that there is a construction lending agency for YEs❑ _ _� ��..the performance of the work for which this permit is issued(Sec. _a._� , 0 73097,CIV.C. 1HAVE REA RIALS INFORMATION GUIDE AND THE SCAQMXPEICTTIDNEG.CHECKL .IUNDERSTAND MY REQUIREMENTS UNDER LOS ANGELES CTITLE 2,CHAP 220 SEC N .100THRO . 0.140 CONCERNINGDOUS CHET'.' Lender's Name ZER TIN AINING THE SCAOMD. o Lender's Address I-�"IHI`GEE O AGENT 0 1 certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE , N with all county ordinances and State laws relating to building / ✓` _y i_? L_p,s construction, a d hereby authorize rese�tativ? of this Count I SUANCE FEE s M to y io opertyection rposey $ -�'Tom' �i�r PN "",i`= INVESTIGATION FEE TOTAL FEE wre.o: cam a m Da: i SEE REVERSE FOR EXPLANATORY LANGUAGE 1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR I hereby affirm that I have a certificate of consent to self insure, BUILDING SS r ES or a certificate of Workers'Compensation Insurance,or a certified Rmexne24 C) copy the380 b.C. CITY ZIP Y/� G - �_ 04 LOCAJLITY1111/1 Policy No Company `ZCi SIZE OF LOT NO.OF BLDGIS.NO N LOT ❑ Certified copy is hereby furnished. NEAREST CROSS S . ,&Certified copy is filed with the county building inspectiop TRACT BLOCK LOT NO. department. USE ZONE MAP NO. DateeSA,-9t Applicant eg j ASSESSOR MAP BOOK PAG PAR L O t: SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' Ow R TEL NO. COMPENSATION INSURANCE WITHINt000 FT.of SCHOOL? Yes No This section need not be completed if the permit is for one hundred DRES ( P p � DISTRICT GROUP T PE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) ZI I certify that in the performance of the work for which this permit = n is issued, I shall not employ any person in any manner so as to ARCHITECT R ENGINEER T L 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 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' C N RACT R TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith - [FRONT comply with such provisions or this permit shall be deemed revoked. AD KESS 41CLICENSED CONTRACTORS DECLARATION ( co E LIC CLA I hereby affirm that I am licensed underprovisions of Chapter 9 '` �_ SEWER MAP -- (CommenCln with Section 7000)of Division 3 of the Business and SQ.FT. E NO.OF STORIES NO.OF FAMILIES a NEW BK PG '"'" CD Professions Code,and y license is in full force and effect. / 2� # •°=t =r v License Number _ Lic.Class W DESCRIPTION OF WORK ADD �,p VALUATION ® -'" ';'i=x';• n n O Contractor/�� � �ta(E! Date 0317 g� ALTER $ eco ia•s U W ❑ I am exempt under Sec. 1710 REPAIR El $ =j 3; 60� •5-•--'-'S ti z B.BP.C.for this reason DEMOL ❑ LDMA P/C# {;#- "'1 ,i I`t _. Date: USE OF EXISTING BLDG. URM ❑ Signature _ A IC T(PR T) igELO LDMA Perm# _ ❑ I,:as owner of the property, or my employees with wages as Ff4 0 i t. 4 M, _ their sole compensation, will do the work and the structure is ESS k- " FINAL DATE ^'?:•• �� I i i�"r•' not intended or offered for sale (Section 7044, Business and Q _�_! _r:_sz._;^ Professions Code.) -T ; WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL "r •`�• ''C OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE �' J 'f' }•`�` ,: ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY a licensed contractors to construct the project (Section 7044, } LEq_ '`, .Business and Professions Code.) YES El NO 11 '— -M WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING i;i-' i-' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR F'j r GUIDELINES. _j rie •1 1 hereby affirm that there is a construction lending agency for ves❑ No❑ the performance Of the work for which this permit IS issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ( j" -• 11 i 5 ?t�: TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS' -- i .+.i i Y Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 3 :t 3 Ar r=)w_ 0 Lender's Address - 0 OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE , 7-1 PERMIT FEE N with all count ordinances and State laws relating to building m constru hereby authorized��resentatives of this County ISSUANCE FEE to n th bove enti property for inspection purposes. �. i, INVESTIGATION FEE TOTAL FEE � s nawre.ot dim« Date `'j i SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY • WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A DRE s I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a certified 3 sle �"r/�J � copy thereof(Sec.3800,Lab.C.) CITY ZIP �tm o Pe ,—:' LOCALITY Policy No. Company SIZE OF LCT NO.OF BLDGS.NOW ON LOT Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNS //�� TEL NO. COMPENSATION INSURANCE � �' S C.oX R. WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS // v LI /_-'-6y Av� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) GCJ �f D /yA I certify that in the performance of the work for which this permit CIT JL �LP/�/ e ZIP /9/3Z e /7-� 3 is issued, I shall not employ any person in any manner So as t0 �9R ENGINEER TEL NO. ,5,�/� 1C✓ become subject to the Workers'Compensation Laws. L E / J J STATISTICAL CLASSIFICATION APT CONDO Date - Applicant ADDRESS NQ,, CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of z yze-6�� �E �i�L REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CO R TOR TEL NO.•7JS- SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith. _ 6oS oZ7 "96`G FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS �/ LIC.NO. P L LICENSED CONTRACTORS DECLARATION ��� /yLL�� /}C^/ SIDE CITY/Jl-4 pc`A#1 LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 � ? 4 ' SEWER MAP _ } (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES - a Professions Code,and my license is in full force and effect. NEW 1:1 BK PG =- V License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION , ' •t. �G '•'i'»»3 0� Contractor Date S 7- 6L 11 J/G ALTER El / o v °._: l .'''� _: W O -S'l E 6 L J .e-A11,IJ6 EPAIR ❑ - T y I-- El ❑ I am exempt under Sec. $ 3 2 I E. - U DEMOL ❑ TOT 41 �ep-a� �� CL 8.&P.C.for this reason �� J�Q LDMA P/C# !I AL ..d.�=2- 9 n- Date: USE OF EXIST46Z4ING BLDG. URM ❑ ;w :»{ _;? �,�;- N •F -` Z Signature APPLICANT(PRINT) TEL NO. LDMA Perm# ❑ I, as owner of the property, or my employees with wages as 7-0 N OO' �� S �a J b Z their sole compensation, will do the work and the structure is AD KESS / y�A 0 i not intended or offered for sale (Section 7044, Business and [3 ^rGolv�Cli�K FINAL DATE t `._ Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I J i ,11E F OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE CCC!!! ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPEC FIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q f• {' M licensed contractors to construct the project (Section 7044, FINAL BY > A Business and Professions Code.) ves❑ No WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING •'_ : Z OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CO CONSTRUCTION LENDING AGENCY AST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR Fy:L ji') f3yt� GUIDELINES. I hereby affirm that there is a construction lending agency for VES❑ NOEADT the performance of the work for which this permit Is Issued(Sec. IHAVERHEAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ.C. "-_I 0 i i 1 9 04- CHECKLIST I UNDERSTAND MV RECUR ENTS UNDER THE LOS ANGELES COUNTY CODE, _,E.ILI_j-._ISI �, », r , TITLE 2,CHAPTE .20 SECTIONS 2. 1(JO THRO H 2.20 140 CONCERNING HAZARDOUS Lender's Name MATERIALS TING AND F NTNG A P MIT FROM 7 E SCAOMD. 42 o Lender's Address O - OWNER AGENT 61 40� o - I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEEp� PERMIT FEE /F N with all county ordinances and State laws relating to building C m construction, and hereby thorize representatives of this County ISSUANCE FEE tonenter n the bov io property for inspectio pur oses. j `1' INVESTIGATION FEE TOTAL FEEco � / O 2 � lure Of Ap t r Dat (� g a ,J SEE REVERSE FOR EXPLANATORY LANGUAGE I I . e APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL�DI/NG ADDRE s I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 7� or a certificate of Workers'Compensation Insurance,or a Certified 39 R05ENfA0. &[VJ7• copy thereof (Sec.38`000,La�.) CITY ZIP Policy No. ` Company 4 9 /dd LOCALITY 8 IZE OF LOT NO.OF BLDGS.NOW ON LOT '- ❑ Certified copy is hereby furnished. ��/cJO/�� O %Z 2 NEAREST CROSS ST. W-T-5ertified copy is filed wit count ection TRACT BLOCK- LOTfI ��•Q department. - �/Q `/7 USE ZONE MAP NO.�� Date'K'0� = AppliCa _ SOR P BOOK PAGE PARCEL t�( ��� •� ��3 �� S ECIAL CONDITIONS CERTIFICATE OF EXEMPTION FR WORKERS' OWNER Q ti nT'EL NO. p� COMPENSATION INS NCE TNIT r� 5 c/S 27"'/(, WITHIN 1000 FT.OF SCH L? YES NO (This section need not be completed if e permit is for one hundred ADDRESS ^ /fi�6— /U�t 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 PAJILA01,c0/J1A 13A 17137 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 QfilVel A Q 7? STATISTICAL CLAS/SI-(CATION APT CONDO Date Applicant ADDRESS �3�J�O CLASS NO. � DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of' I7O AJ. r--/��(l (��(LS /�V�• p0 A REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTRACTOR - TEL NO. SET BACK YARD HWY PROP LINE- WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESSA e LI O. - P LY3110 WAkIz LICENSED CONTRACTORS DECLARATION sIDE _ C TY LIC.CLAS P L - I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES ' i 8 EM'� 0 Professions Code,and m license is in full force and effect. IS11927 , NEW BK L PG i Z s; DESCRIPTION OF WORK ADD-- ❑ VALUATION , €s I:119 4« # +-,I V License Number Lic.Class Contractor AAS 8y/LA KS Date 'C7 ALTER ❑ $ DDDje.06, �HEJLy3 Fa;il� El REPAIR. ElI am exempt under Sec. $ ii-•s HH.�AH�tE BAP.C.for this reason DEMOL ❑ _ W Lit �r USE OF EXISTING BLDG. LDMA P/C# 3 tl ate: URM ❑ I#ILI—_i - .cA Signatur r hi"f Z APPLICANT(PRINT) TEL O. LDMA Perm# � I_` ! "f �- ❑ I, as owner of the pro or my employees with wages as BJP /��4✓C 8vg 6pj3"3/O� Z ,3i their sole co Ion, will do the work and the structure is ADDRESS f" 0 y _ .11_ not intended or offered for sale (Section 7044, Business and U k). AA#A. LI) IQ"Ao{r-�` FINAL DATE Q t I i I is Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL /M� i} OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE • ~� J !.. NEI- as '•"'�' •'•= ❑ I, owner Of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY - > -,ut t,;;-�='•y licensed contractors to construct the project (Section 7044, ':i iris-5 fs Business and Professions Code.) YES❑ NO❑ �'. WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 00 it iii i _- GUIDELINES. �«•I. ?«t '_ 00F.t i •':•': , I hereby affirm that there is a construction lending agency for VES El NO❑ C V + a the performance of the work for which this permit is issued(Sec. +=:� �'c t_ I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) •� •+., _R N 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 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD, C) Lender's Address 0 OWNER OR AGENT . o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE / O PERMIT FEE $ with all county ordin s a State laws relating to building c/!/ / constr on, an er by a orize representatives of this County ISSUANCE FEECO / O to ter nloned pro e purposes. (C, a INVESTIGATION FEE TOTAL FEE / � naw Aod m ar A oe�e / 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 0411090040 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: 2 BUILDING ADDRESS: ON FILE SIGN DESCRIPTION: INSTALLATION OF (2) SET ILLUM CHANNEL 5431 ROSEMEAD SL SGAB CA 917762212 ASSESSOR I FORMATION N MBER: NEAREST CROSS STREET: BROADWAY 5388-024-041 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON: PEP BOYS AUTO EXIST OCC GRP: 11/09/04 JK 11/04/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE f AL BY: CODE: A;M ENTERPRISES (626) 457-2945- 6,500 - 1025 FREMONT AV "7q ALHM 918031324 FEES PAID DESCRIPTION OF WORK INSTALLATION OF (2) SET ILLUM CHANNEL LTRS, REFACE TO (2) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: DOUBLE FACE SING CABINETS 5439 ROSEMEAD BLVD. APPLICANT: TEL. NO: COURTNEY (909) 597-3157- AA BLDG PERMIT ISSUANCE 27.75 2328 BROWN DEER AX BUILDING REVIEW FEE 54.70 SPECIAL CONDITIONS: CHINO HILLS, CA D2 PERMIT W/O EN-HC 6500.00 VAL 166.20 TOTAL FEES 248.65 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LOREN ELECTRIC SIGN (562) 946-7545- 321 VAN NORMAN LIC. NO LOCATION AND SETBACKS MONTEBELLO, CA 90640 455415C45 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 20 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508