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Home My Public Portal About5500 ROSEMEAD BLVD_Building__ APPLICATION FOR COUNTY OF LOS ANGELES BUILDING PERMIT DEPARTMEOF AFUETTYY DIVISION FOR APPLICANT TO FILL IN ADDRESS BUILDING N:!5S 6D ADDRESS SOD 2p412A0 LOCA LIT CITY / C- y Zip NEAREST CROSS ST NO OF SLOGS - ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT UP ITYPE FIRE SED BY TRACT BLOCK � L�Ogg /4T�NNO�A ^D O / IC!WAST, 20yL OWNERT'[M e4 CAS t�E.1 "J STATISTICAL CLASS(FICA ION SEWER ADDRESS AMID CLASS NO 0210 DWELL UNITS BK PG CITY USE ZONE MAP S ZIP NO RXV ENG IIEERARCECT ORFA�R TENOL SPECIAL C NDI TIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR LJ S,R(Q{ TE BLDG SETBACK FROM LIC FRONTPROP LINEOF (STREET) ADDRESS 00 WAj (��.MCM/ NO 2 / NIGHWA + YARD = TOTAL SETBACK FROM TYPE OR IXISTING CITY L.0N6- teI CLAS$ G FRONT PROP LINE NIGNWAY WIDTN CONSTRUCTION LENDER + NAME AND BRANCH ---GSETBXCKT95WO ADDRESS CITY SIDE PROP LINE OF (STREET) U SQ FT NO OF NO OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM E OP EXISTING 512E STORIES FAMILIES ONE SIDE PROP LINE HIG Av WIDTH DESCRIPTION OF WORN NEW ❑ + — CL H OD CORNER CUTOFF YES ❑ NO ALTER IN OPEN SPACE YES ❑ NO ❑ —REPAIR USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG DEMOL ❑ APPLICANT TEL (PRINT) NO BY (SIGNATURE) I HERESY ACKNOWLEDGE THAT I HAVE READ THIII APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDIXANCIS AND LAWS REGULATING BUILDING CON- STRUCTION 1 C[RTIIY THAT IN DOING THE WORK AUTHORIZED MEREeY I WILL NOT EMPLOY ANY PERSON IM VIOLATI OX 01 THE LABOR CODE Of INC STATE OF CALIIORNIA IN RELATING TO WORKMEN'S COMP[ ATIDN INSURANCE SIGNATURE FINAL �� BY PERMITTEE DATE I� ADDRESS TEL PC Fee$ Permit Fee CITY NO ( Issuance Fee VALUATION$ /0 ,10 Total Fee 45 PLAN CHECK VALIDATION CK CASH PEMWT VALIDATION CK MO CASH 04OX-SR 223 9 9.00 TEA[G[A C9011411113 i■/TG I 0 4,1,�.)Ts 2 1 B 15.0 0 X58 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDINGCOUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY e47Y zip BUILDING AND SAFETY DIVISION NO OF BLDGS BUILDING SIZE OF LOT NOW ON LOT ADDRESS TRACT BLOCKY LOTTTINO LOCALITY OWNER #U ( 4e (TIF NEARE CROSS ST ASSESSOR ADDRESS Ml[ S GOVL MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE _ESSVY CITY ZIP tJa Q CONST Z NE AROiITECT OR TEL V V ENGINEER lVr../� NO S �� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO �-d DWELL UNITS BK PG TEL-CONTRACTOR GPEIVOrL NO 7J 1 USE ZONE MAP �o-D& ADDRESS AMfA 2-7/69V e 3 SPECIAL c,Tr (r C !d UcU CONDITIONS CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED VES ❑ NO ❑ NAME AND BRANCH BLDG SETBACK FROM /J FRONT PROP LINE OF (STREET) ADDRESS —DITY TOTAL SETBACK FROM TYPE OF EXISTING SO FT O OF NO OF CHECK HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ + O 1 I ADD ❑ BLW SETBACK FROM ig�� EL SIDE PROP LINE OF (STREET) O ALTER ❑ TOTAL SETBACK FROM TVPEOF EXISTING Tri ❑ HIGHWAY + YARD SIDE PROP LINE HIGHWAY WIDTH USE OF REPAIR Z EXISTING BLDGDEMOL ❑ + -714 APPLICANT TEL CORNER CUTOFF VES ❑ NO ❑ (PRINTI O IN OPEN SPACE YES ❑ O ❑ BY ISIGNATU IN COASTAL PERMIT ZONE VES ❑ O ❑ VALUATION IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE is CORRECT AND AGREE TO COAIRY WITH All ORDINANQ-S AND LAMS RCGUATING BUILDING CONSTRUCTION I CERTIFY THAT N DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY My PERSON IN VIOLATION OF THE LABOR NDE OF THE STATE OF CALIFORNIA IN RELATING TO WORKh%N S COM PENSATION INSURANCE SIGNATURE O PERMITTEE ADDRESS TEL FINAL BY CITY NO DATE 0- - MAKE -- MAKE CHECKS PAYABLE TO PC $ PMT HARVEY BRANDT COUNTY ENGINEER FEE ��-� ) FEE $ / q. Fi v PLAN CHECK VAUDATION c c RE o CAIRN PERMIT VALIDATION cK mo cAsH s a s�lms 2a a� . 9.0 0 _ TO 4 2� 2 i e_ 15.00 • mR RBAE CE#4103 3)5 �"y,� APPLICATIOIVFOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) Bu M COUNTY OF LOS ANGELES ADDRESS S EqNB DEPARTMENT OF COUNTY ENGINEER CITY G BUILDING AND SAFETY DIVISION NO OFBUILDING _ SIZE OF LOT NOW OADDRESS) O O TRACT BLOCK LOCAL( OWNER NEARESTM CROSS$TADDRESS ASSESSOR Q SMAP BOOK PAGE PARCEL DISTRICT GROUP TV PEFIRE ROC BV AITV ZCONST ZONV EN�GINEECE ORVb L� NSTATISTICAL CLASSIfICATI SEWER MAP ADDRESS TELCLASS NO DWELL UNITS BK PG CONTRACTOR 0j" 1U&L USSEnEZONE MAPO 01 ADDRESS QO AIIC6-- ` SPECIAL _CONDIDONSCITY b G4 ' ClA55C4CROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER % — NAME AND BRANCH BLDG SETBACK FROM FRONTPROP LINEOF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING 50 FT NO OF NO OF CHECK HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK T-A ` NEW + O ADD ❑ BLDG SETBACK FROM ax SIDE PROP LINE OF ISTREETI O ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING ❑ HIGHWAY + YARD SIDEPROP LINE HIGHWAY WIDTH yu� USES REPAIR Z EXISTING BLDG DEMOL ❑ + "YO APPLICANT TEL CORNERCUTOFF YES NO ❑ (PRINT) NO IN OPEN SPACE YES ❑ NO ❑ BY ISIGNATUR IN COASTAL PERMIT ZONE YES 0 NO VALUATION $ I HEREBY AO NOVAEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES At0(ANS REGULATING BUILDING.CONSTRILCTION 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 IN RELATING TO VNRKMBN 5 COM PENSATION INSURA SIGNATURE OF r PERMITTEE ADDRESS TE FINAL BY CITY NO DATE �t 3 i110 - MAKE CHECKS PAYABLE TO FEE PC $ FET $ HARVEY T BRANDT COUNTY ENO INEER PLAN CHECK VALIDATION ac M 0 CASH PERMIT VALIDATION <�K 1110 CASH 849XAW24230 25_2_ 0ya 043�SFP 223 0 1620 ID44esp 2 1 0 69.00 • Ss TeAeaeAaaaoaBTs APPLICATION FOR BUILDING PERMIT FOR QPLICAIIT TO FILL IN (Print or type only BUILD,L* COUNTY OF LOS ANGELES -!%Y 4 ADDRESS �5 _ DEPARTMENT OF COUNTY ENGINEER CITY j C/" [EG/ T ZIP BUILDING AND SAF Y DIVISION -- NO.OF BLDGS. BUILDING /7 SIZE OF LOT NOW ON LOT ADDRESS_' l TRACT BLOCK LOT N� LOCALITY WARES OWNERH[//H/+�) BAG W9JN GO TEL 2492--% CROSS ST. / ASSESSOR ADDRESS 7a7 W. M /N MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P ESSED BY -CITY /�LN/9N/!�B/+l ZIP {� CONST ZONA, ARCHITECT OR 4C E/24S�-FL �'e B '�� ENGINEER ..T• K/NNf A ' 02 3 2S/ STATISTICAL CLASSIFICATION <SEWER M � ADDRESS/5.133 (-QM/L,Q u90 $T CLASS NO, DWELL.UNITS BK P PG CONTRACTOR YJN ER NO .2 •5*6Z6 USE ZONE MAP NO. ADDRESSOJ , /v/M/N NO. 03 SPECIAL Y,/ LIC CONDITIONS Y-pC+� 73 CITY /9[ /$7N//,3',� CLASS ROAD DEPARTMENT APPROVALJifQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPEOF EXISTING SO,FT. NCIOF NO.OF CHECK HIGHWAY + YARD FRONT PROP.LINE HIGHWAY WIDTH SIZE/ zJf� STORIES / FAMILIES ONE DESCRIPTION OF WORK NEW NEW gs,ra — ADD ❑ BLDG.SETBACK FROM z / TIC- G WfI1 y SIDE PROP.LINE OF (STREET( rrO r14 c'4/T ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING o. 1 USE OF REPAIR ❑ SIDE PROP.LINE MIG WAV WIDTIH Z EXISTING BLDG. DEMOL ❑ - - -7V APPLICANTNT) PL E N S/`�T Trl NOL Zr3�}sj CORNERCUTOFF YES NO ❑ IN OPEN SPACE YES NO ❑ BY ISIGNAT 9'0, IN COASTAL PERMIT ZONE VES ❑ ❑ VALUATION $ OCtO �. HEREBY ACKNOWLEDGE THAT I HAVE READ THISA AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMFIT WITHWITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN GOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THELABOR CODER THE STAT PENSATION INSURANCE. CALIFORNIA IN RELATING TO WORKMEN'S COM SIGNATURE S r... PERMITTEE T ADDRESS — �/C RGAO Tf T y'y �J 9; + " FINAL I =� BY CIN SNl7�/ST/C�/ NO. 2r3-rr2S I DATE I MAKE CHECKS PAYABLE TO: P.C. PMT. HARVEY T.BRANDT.COUNTY ENGINEER FEE / D FEE PLAN CHECK VALI?ATION CK. CASH PERMIT VALIDATION CK. M.O. CASH 2 8 % nTC 1 ^2l3 U D 75.1 C) i ` v Ino / U J v a 16A638A CE Y803 3.75 � APPLICATION FOW*` COUNTY OF LOS ANGELES .. - BOLDING PERMIT D BUIILDINNGG�ANDF SAFETY DIUNTY VISION BUI LOIN' FOR APPLICANT TO FILL IN ADDRESS,] BUILDING [ENNEE S oO ®i(S M� �Z/ LOCALITY / I ZIP O NEAREST CROSS ST NO OF BLDGS `�` ASSESSOR LOT NOW ON LOT O/yL MAP BOOK PAGE PARCEL �-r / DISTRICT GR UP T PE FIRE P ES BY (P// BLOOCK LOT N t�O p N T jgHE ry /} L ST`A/TISTICAL CLASSIFICATION V +y SEWER MAP S 02 ^A CLASS Nei ! DWELL UNITS BK PG 1 /./ ZIP USE ZONE NO ^ �0� ECT EL /n/ `�' SPECIAL ER b/S Q'� CONDITIONS S Q(f ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ LTO TEL /JFPI) BLDG SETBACK FROM LIC OJ6L7 FRONTPROP LINEOF (STREET) ADDRESS NO HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF UISTING LIC FRONT PROP LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER - } - NAME AND BRANCH BLDG SETBACK FROM ADDRESS CITY SIDEPROP LINEOF (STREET) S SO FT19 NO OF NO OF CHECK HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING C SIZE STORIES FAMILI ONE SIDE PROP LINE HIGHWAY WIDTH 0 DESCRIPTION OF WORK , �^ u/ NEW } _ DD ❑ CORNER CUTOFF YES ❑ NO ❑ Z ALTER Cl mtq EPAIR❑ IN OPEN SPACE YES ❑ NO IJ USE OF EXISTING BLDG EMOL IN COASTAL PERMIT ZONE YES ❑ NO C] APPLIC TEL (PRINT) NO O(7 By (SIGNATU HERESY ACKNOWLEDGE AT I HAVE READ THIS APPLICATION AMD STATE THAT THE AEOY IS CORRECT AND AGREE TO COMPLY WITHALL 0MDIIMNCES AND LAWS REGULATING BUILDING CON- STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORISED HEREBY I WILL NOT EMPLOY AMY PCRSOM IN VIOLATION OF THE LABOR COOK OF TMC STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE ^ SIGNATURE OF FINAL DY PERMITTEE DATE ADDRESS TEL PC Fee$ Permit Fee SI J CITY NO lawnoe Fee VALUATION $ 1 Total Fee PLAN CHECK VALIDATION -- M o CASH P / VALIDATION cK mo CASH 6 4 6�MPY 2 3 D 45.4 MAGNA CIS•BOS111n/TS V /nMryRV1 `� y/ D 7 5.7 5 r. WORKERS COMPENSATION DECLARATION 'I hereby affirm that I have a aerti of consent to ,elf APPLICATION FOR BUILDING PERMIT LS Insure or a certificate of Workers CompempensnInsurance Insurance or a certified�copy�thereof (Sec 38DO Lob C ) }} Policy No ry s(-.I Company F1061tcAi XXY COUNTY OF LOS ANGELES BUILDING AND SAFETY Cenified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS D0 D Certified copy is filed with the county building mspec BUILDING 5,5,00 (/V� .� O �,y� �f tion department ADDRESS • 1 7` SE� LOCALITY NEAREST Date Applicant ✓`r Kc✓`^" CITY TEMPLE C-LTY ZIP CROSS ST 40 �S RTIFICATE OF ASSESSOR EXEMPTION FROM WORKERS SIZE OF LOT J."4As 1L I NOW ONNO OFLDGS LOT / MAP BOOK PAGE PARCEL COMPENSATION INSURANCE (This section need not be completed if the permit is for one p'YL USE ZONE O m TRACT K LOT NO hundred dollars ($IDo)or less ) /� > TEL93v SPECIAL J z O J I certify that in the performance of the work for which this OWNER Lau OR1J6 Las NO - 9 CONDITIONS /4 Y LIN S 6 permit is issued I shall not employ an DISTRICT GROUP TY FIRE PROCESSED BY U P P Y Y Person in any manner ADDRESSS5AP Al, Z0S6"EA� /O �/ CONST ZOyE pL so as to become subject to the Workers Compensation Laws 'l 5 �j 3 O CITY MOLE c CA, ZIP Dab Applicant after STATISTICAL CLASSIFICATION APT CONDO NOTICE TO APPLICANT If alter mubj this Certificate of ARCHITECT OR TEL su Exemption you should become subject to the Workers ENGINEER Se uI.I�SA NO ,G�}3!P R,g55 NO DWELL UNITS_ y Compensation provisions of the Labor Code you must forth ADDRESS N.83- KEU✓!✓4.'m IJ 6iLI {� 9I�j, SEWERµqp Z 01,11110 m with comply with such provisions or this permit shall be deemed revokedCONTRACTOR4. .�.., FS NO ?- BK A- PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 18,133 E 944-ep" NO 21_50-45s VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC p Professions Code and my license is in full force and effect CITY I NO V5-M-f �, CLASS $ I NO License Number /�/. '"r L¢ Classes SIZES 0 SORNO IE / FAMILLIIES CHECK Contractor L'P L I14pKim- Dobe DESCRIPTION OF WORK NEW ❑ ElI am exempt from the licensing requirements as I am o Or 41t rieft- FINAL �ff� Ql ADD licensed architect or a registered professional engineer ALTER ❑ - acting in my professional capacity (Section 7051 cowo ❑ DATE REPAIR Business and Professions Code) USE OF 'Q FINAL EXISTING BLDG , (090 DEMOL ❑ By Lic or Rag No Dote APPLICANT TEL1 PC OWNER-BUILDER DECLARATION PRIM) LPL D. wEef'oEai. NO :X4-23X7`` I hereby off um that I am exempt from the Contractor s License ADDRESS I 3 3 E O FrrIL-P-0AO INfl(J R v� Law for the following reason (Section 7031 5 Business and Professions Code) BUILDING ADD Al &SQPfeW ❑ I as owner of the property or my employees with ADDRESS , wages as their sole compensation will do the work and ��/yI�FJ 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 r with licensed contractors to construct the project (Sec ADDRESS / non 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST eSET BACK PROP LINE WIDTH hereby affm that Thera is a construction lending agency for FRONT / the performance of the work for which this permit is issued P1. (Sea 3D97 Civ C ) SIDE PL Lender sNome _ r $ Lender s Address P C Fee t Permit Fee W I certify that I have read this application and state that the Issuance Fee above information is correct I agree to comply with all County Investigation Fee ordinances and State jaws relating to building construction Total Fee and hereby authorize representatives of this County to enter upon e a ov en ned property for inspection purposes O� _f/6 % / � ✓��}_ � ro, SEE REVERSE FORE PLANATORY L NOUAGE SPtInctir2wof Applicant or Agent a ms APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADV I hereby affirm that I have a certdXmie of consent to sett tr u ADORE d0 or a cerhlicete of Wofkere Compensation Insurance or a cerMied CITY Mipip ,� copy t ( SIr c 380 La C) LOCALfTV Policy No Party SIZE OF NO OF� NOW ON LOT ,&1tertdied cop�a fume NEAREST CROSS ❑ Caddied copy m filed with the county building Impaction TRACT BLOCK LOT NO �m,/gnt�r USE ZONE MAP NO JC Dat��l[�a�. Applicant A99E930R MAP BOOK fYGE R4♦iCEL SPECIAL CONDITIONS CERTIFICATE OF EXE ON FROM WORKERS ER L NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL' YES (Thm section need not be completed if the permit is for one hundred ESS 7a7, GROUP TVPE CONST FPEZONE PROCdollars 1$100)or less)I certify that in the pertormance of the work for which this permitHm9ft �I n �(rs issued I shall not employ any person in arty manner so es N O' �f become 9 bjed to the Workem Compensation Laws OR ENGINEER TEL NO S4JISRCAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO 15? 'Z DWELL UNITS NOTICE TO APPLICANT If after making this Certificate of REOUIRED TOTAL SETBACK FROM EXIST EKempten you should become subject to the Workers TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisoes of the Labor Code You moat forthwith FRONT comply with such prowsens or this permit shall be deemed revokedESS _I IAC y P L LICENSED CONTRACTORS DECLARATION ro SME�p LIC CLASS P L Thereby affirm that I am licensed undergovrsions of Chapter 9 mQs L"� SEWER MAP lcommencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORES NO OF FAMES Professions Code ,a_nn(QQJ 7 license rs in full force and effect NEW ❑ BI( PO , a License Nu ber 1(L7Yb Lic Class�)M�fj DESCRIPTK)N OF WORK ADD ❑ V LUATTON 0 p p CDntractor�Date ��O�YJ ALTER_ ❑ $ C, cc ElI am exempt under Sec REPAIR $ e&PC for NElis reason DEMOL ❑ LDMA P/C� W Date 0 h URM ❑ I IL EJOSr 00 Signature (pRy;) 1 NO JY LDMA Perm. i ❑ I as owner of the property or ray employees with wages as A = A""l .i their sole compenaaton veil do the work and the structure is RE n Q Jt[I� 5 41.�4 not intended or offered for sale (Section 7044 Business and h f S ICA q#777 FlNAL DATE Profeasons Code) wjL THE APPLICIXT OR FuTU E 131.1 o ocaaxr HANDLE A nazAPnoue w RNL Z'ZZ4U Q 1 HEM ❑ I as owfler 01 the pmperty am exclusively Contracting with OR A MIXTURE CON QN2No A HAIARpoOe YAiERNL EIX TOOn O(EATER T THE T9TAL 542 - 24 licensed contractors t0 construct the project (Section 7044 N.KKIMa 9PECEEO ON THE HAZNSOlS ANTEFEALe jFOftllA11pf1 CJAOE� FNAL BY �! Business and ProfessHom Code) YEa El No❑ H 1 ` J42.24 w1u riE rnoN PE of THE aua.ja BY THE AOR MODF 0 on FROM T animNo .NE r �cwsar as pQiw�rrr ANA�wu�EnE�asrncr xi i )SEuoaaae'a T"nina CHiECKLisr�wa CONSTRUCTION LENDING AGENCY owepwa CNRNGE - I hereby affirm that there is a constructor lending agency for YES❑ No❑ the performerice of the work for which this permit is Issued(Sec m 3097 Civ C) cHwau.R�rulupERsi �urawlr.�rrrs�UNDER�THE iuOS wx3ELEcaiviTr °CODE 13030-120-11 r Tm_Ez URz0SCCTwSz20100Hz20140GONCERNMHu Lenders Name T' E 1 Lender s Address 3 o axAe aR.ReAr o I certify that I have read this eppii,,atKm and state under penalty of Perjury that the above information is Corea I agree to Comply PC FEE PERMIT FEE r with all county ordrmnces and State laws relating to building 1 construction and hereby authorize representatives of this County ISSUANCE FEE ,j /• p� upon hB abo—vir ae d mperty for irLVPa_ f' r m _/ C,� J NVESTKIATION FEE T01AL FEE /j` oa.s ro„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 BUILDNc I hereby affirm that I have a certifoate of consent to sell mum Btn_DYVG Ss OJ2MbQJ> or a cerhfoete of workers Compensation lnq rance or a certified ADOREG OS TCil"i cA copy thered (Sec 38DO Lab C LOCALITY CITY �/� ZIP Policy Nd bLj5:. lOL'1? �C�,y Ft cA�Ar��' C F LOT C c l� Bl] SIZE OF LOT NO OF SLOGS NOW ON LOT PrCertdiod copy is hereby furnished I NEAREST CROSS ST ❑ Ceridled copy is flied with the county budding uspecton TRACT BLOCK LOT NO T37 a A W 14 department USE ZONE MAP NO Data 1-8-9(o Applicant G O ALA# yT(0'— ASSESSOR MAP BOOK PAGE PARCEL &—3 SPECIAL CONDITIONS ' ^: CERTIFICATE OF EXEMPTION FROM WORKERS TEL d NO COMPENSATION INSURANCE RTC C,iz ACWA'L 17$9- 38 YArfmN 1000 FT OF scIIDOLT Yes NO. (This section need not be completed if the permit s far one hundred ADDRESS , / y� /�I dollars($100)or less) .moi 7Y oseA.A eol A 1 1/0 DISTRICT GROUP FIRE ZONE PROCESSED BY f I certify that in the performance d the work for whioh this permit Q'-4e - S O 1 Is Issued I shall rot employ any person In any manner so as to J become subject to the Workers CompereotiM Laws ARCHITECT OR ENGWE TEL NO STATISTICAL CATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If after making the Certificate of REOUIRED TOTAL SETBACK FROM EXIST Exemption you should became, subject to the workers CONTRACTOR TEL NO 119g��LL.,,, SET BAGf YARD HWY PROP UNE WIDTH Canpansati n proveore of the Labor Cade you must forthwith C O XAOI--r mrr` -02A comply with such provisions or the permit shall be deemed revoked ADDRESS LIC NO FRONT IL LICENSED CONTRACTORS DECLARATION L/wI f r ,fV l D '� SIDE I hereby affirm that I am licensed urderprowslons of Chapter S G✓CAAny�5.4 C/1 SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIESProfessore Code and my berme is in full force and effect I I NEW ❑ &( PO d Lioerse Number.S62/0 S LIC Clags�-/0-GG/ �� DESCRIPTION O WORK '- ADD ❑ VALUATION , O Contractor C O".~17 f Olt— Date ALTER 11 cc ❑ 1 am exempt under Sec Orn 1 1 LZ-340ftki S 't"elV� REPAIR ❑ BEPC far the reason DEMOL ❑ LOW P/C• W Date USE OF EWTWG BLDG URM ❑ d 1 CO 11 Signature 1 as d r�owner the prop" or my employees with wages as �' eP�TLT ,3. -1-D11110 S L G`16 -0LOW�m• _ AUT-T their Site Compensation will do the work and the structure a ADDRESS 303 3414.15 ss not intended or offered for Sale (Section 7044 Busineand 12a 65 l4A wot-Y 'TICII.d- CQ tiZ33 FINAL DA Prode9BK ns,Dade) 'Z2 i 1 ITERS ALL TIE APF CONI NI FUTIAE!ARDOUG MATERIAL HAFlJLE A R GZ Tia HANTT E ❑ 8S Owner d the pmPerN am 6%OIUSNBfy contracting with OR A MI%MiE CONDIMIO A HAIMR0DU.9 MATERIAL EOU11 ro OR ORFATER THAN THE '1 falg NAOUI T9 9 CFED Ori TIF wTLVpda MA1ETtUl3 PFORWTgN IX1ioE'+ FINAL BY TOTAL 414. 15 Busmed contractors to construct the prefect (Section 7044 Buslnass and Professions Code) TEs❑ ro❑ CHECK OwL-CO THE . QUTA O USE OF THE eUpLPKI BY THE A1000 On FU T E SouNm g/�iE/�CK 414.15 OOASTMNR OUp A FERWT FOR CONSTRUC1YMl OR x10061CATi0N FiidA THE 9WTe 0f1TE .00 CONSTRUCTION LENDING AGENCY OuDE wR a+`+n*v"x A-rrr nsrraGr Isc'roMal BEE cERunwa clFcauaT hon aloEUNEs I hereby affirm that there Is a cwstrudlon lending agency for YES❑ Na❑ the performance of the work for whoh this permit a issued(Sec m IMAVE READ TIE HAZAADIXa wTEfGY.6050nMATKJNdIOE AAD TIESWIOPERAOTIIlI (N�T��T(�T� N 3087 CN C) CHECKLaT I UNMRSWN ATI REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE { 000-0001 1/ 8/96 TIRE 2 CHAPTER 220 SECTKA9 2 20100 T OH 2201.0 CONCERNtW i Lenders femme NATEIiALB REPORIW AFD FOR OB4Mi0 A PEnAfT FROM TIE&:IMO o Lenders Address 4139 1 P"12:04 CI aMRn w A�Nr I Certify that I read the application and este under penally �✓ 0 of perjury that above nfpirlatiori a correct I agree to conply PC FEE PERAYT FEE with all c n Ord noes and State laws relating to building _l1/R constr by authorize representatives of the County ISSUANCE FEE < to t above-mentoried property for nspectan p1 O n INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO lFILL IN BUILDING ADDRESS `C�)o � m l 1 heretry affirm that I Imre a certificate of consent to sell rave SUIL�BGJ(Xl[TESS 0r �w JyJV v or a cerbfcate of Workers Compensation Insurarce or certified 'J(JL) TMJ;1,0 � G/ copy thereof�'gep��y3 0 C) GT�By�P(,E Ci /( /�J✓ LOULrtv Policy No� Curoerty$hq� '� SIZE OF T NO OF BLDG$ NOW ON LOT Certified oopy Is hereby furnehad Y. .100 NEAREST CROS ST ❑ Certdted Copy B filed withthe c WItfing iorn TRACT BLOCK LOT NO (J rl USE ZONE AVP NO Applicant ASSESSOR AMP 8009 PAGE PARCEL SPECIAL CONDffIONS CERTIFICATE OF EXEMPTION FROM WORKERS w4e=R V N IO ti O(L TELNO S 1000 FT OF SCHOOL? YES l ONO COMPENSATION INSURANCE $Q� This section need not be completed If the permit q for one hundred ADDRE1Y D. �D DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars(5100)Or less) QT n � �y I teddy that n the performance of tlm Work for winch the permit CRY 642.,EA apv-Le-Y p p - e comed I stroll not employ arty osteon n any vis 80 as ro APCHr ECT f rINEF�,,,�.. ! TEL NOI�/�� QO Oecorrs eu6ject ro the Workers; Cartportsetpn laws //'"'�,�,t�j sunsTTDAL TION APr corno Date Applicant *4q(� 0 ASS NO DWELL UNITS NOTICE TO APPLICANT If after making me Certdcate of p2� '` --"� 6 �� REQUIRED TOTAL SETBACK FROM EIDT Exemption you Should! become eubled to the Workare TEL SET BACK YARD MYv PROP LINE nST DORpBn98tlmt Drovlelone of the Labor Code you must forthwith uorv� SON.5 .5 ( ( -5736 , CDTTpy With Such provisions or this permd shell be deemed revoked 95 PQM LICENSED CONTRACTORS DECLARATION � � �.y NDIQ S PL OV 1 hereby affirm that I am Ilcersed underprovelors of Chapter 9 CITY LIUC �cc �,-y P L (comment mg with Section 70DO)of Division,3 of the BuasDnle"and $0 FT SIZE NO OF STORIES NO OF FAMIUES``�O SEWER AMP Professlore Code,e�,ryy lase n In hill tortethio�` NEW ❑ BK PO 0 License hAlrrlper '�'1�(a r`P Ltc C eL�� J OESCRVT K, ADD ❑ WuwTION , U Contractor 1 ''vcO Date �' Iiltl. c .`L AlOrvvntaL.? $ y�dD• `— a ALTER ❑ 13I am exempt under Sec REPAIR ❑ $ Z BAPC for the reason DEMOL ❑ Lou P/C Date USE OF URM Cl ' Sgrmhrte APPUCANT jPRWI` Jryr-.TSI,,,`) -iF7��ry/p LDkM Psm• ) ?3 , ❑ 1 as owner of the property or my employees with wages as �" • '/•�'�73 O W = ACCT.x them sole dor offered wdl do the S work and the ehuchlre s ADDRESSOR 160,E n'p►b3 ozCm A.!r Dk FINAL DATE Jai.03 ` .50 nd Intended or offered for sale (Section 7044 Bwmem and ll�• �1 'J Professions;Code) w4 TIE ARPUGNr of FUTUE surflnG OCCMMMT IViIhE A MAiAfmOtq iAK ER4L 2-2 1 ❑ I tie owner of the property am exCluervey C firacting With OR A 1RYTI.RE OGITrNNNO A RALJONS WTERI EOUWL TO OR Q EATER 1TMIl TE $ I"nsed ContraMrs t0 COM19mlIC1 the prgaCt (Section 7044 AYOIMTsl M ON Tiff 1MZ/r✓DOl5 MATERNLS wFCRWTKN WOE+ FINAL BY A�AC�CT.A VES❑ T. Buasmee and Professions Code) ru TIE NTE D % OF Fo BIIIX110 aY TWE AMLICAwT OA FDOIA T etanir+o 3303 159.68 CONSTRUCTION LENDING AGENCY °0M1°R�o A PERWT Fon mKsrmx:TloN a+IAoostuTONo(LH THE saint GU0EI NR DWIIiY 4NN(£AENi dmRlCr ISUOrr01 BEE PEPAri11NO LIECKD9T Fort 2 ITEMS OIAfEWE9 I hereby affirm thin there is a c trudon lending agency for M❑ o TOTAL 210 - 18 the perform enoe of the work for whch this DermR q sSUSd(Sac IIIerE LEAD TIE TERALSPs pueE AH)rReeuoWO FEwarrw 3097 Civ CI OECxUSi UTDERSbfID ID(tERTIELps. I-EsCOUNTYCODE CHECK 210.1E pop TIRE x xo SE x t 01 e x xo I.e CONCEI WWZAPDOUS `1r p Lenders Name MA,ERAL,RE FOR PERva FROY RIE SLAdAO C1�1\UE .00 int Lerdera Address d o.rn a.ar.r rT��t �l� I certly, that I have read this application and State under ton q correct I agree to Comply PC FEE 50 penalty PERMR VyLR,r-- FEE 0W1 1/26/96 d Pe jury the eboo Imo me ` �i 3 !> J wrth ep ab s end State laws relanrg to Wlldllg of !" t[[� wM c di ion uthonie representetNes of this County ISSUANCE FEE ca y ¢ O • 463 1 A 110:0 J V/•�. D hp ntlanN prOperlY fon trgl� INVESTIGATION FEE TOTAL FEE / ✓ isy � SEE REVERSE FOR EXPLANATORY LANGUAGE