HomeMy Public PortalAbout5533 ROSEMEAD BLVD_Building__ r 7
res 76A67BA
CE N907(REV 11/76)
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING �33
ADDRESS
BUILDING J6 3 .�I/ ,5.5e, jo LOCALITY [ ��
ADDRESS JJ �Y. /�
NEAREST
CITY ZIP
CW
Si
NO OF BLDG5 ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK' PAGE PARCEL
DISTRICT UP TYPE FIRE PROC ED BY
TRACT BLOCK LOT NO ` f/ CONST ZONE r
OWNER IL T �L (5 D0 ✓ ..3
�] STATISTICAL CLA IFICATION SEWER MAP
ADDRESS Qf ER QAS$NO �� DWELL UNIT$ BK PG
CITY Lr IT ZIP Q�
ARCHITECT OR TEL VALUATION $
ENGINEER NO
ADDRESS BL SETBACK FROM
/� TEL FRONT PROP LINE Of ISTREEi1
CONTRACTOR C.!! NO ZZ TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD = FROM PROP LINE HIGHWAY WIDTH
ADDRESS ZS C ST NO D
CITY I O CLASS C + .
CONSTRUCTION LENDER BLDG SETBACK FROM
NAME AND BRANCH SIDE PROP LINE OF (STREET)
HIGHWAY + YARD TOTALS BACK FROM
ADORES$ CITY SIDE �(SDHG
V
SO FT NO OF NO OF CHECK + • • • • d
SIZE STORIES FAMILIES ONE Q
USE ZONE MAP
O 2 • - 2500 2 5 0 0
DESPTION OF WORK �C NO
CRINEW 1�
SPECIAL
�• D r1AJGS1dI ADD Cl / CONDITIONS • • • 25 0 0 T5 y�
ALTER FINAL BY 7.
ItW HC
'e-�s DATE 0212-80
REPAIR
USE OF DEMOL �9 70/r
EXISTING BLDG 2 _
APPLICANT /��L TEL 2 1
(PRINT; NOT— Q
]D
BY(SIGNATURE, {
MEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AIR STATE m -
THAT THE ABOVE IS CORRECT AND AGREE TO COMMY WITH ALL ORDINANCES 'y' $8 9 6 9 A
AND IAWS REGWTING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE S
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5COM # 4 - 23
PENSATION INSURANCE IteFl?.r" f re.
L 2 • • 1440
SIGNATURE OF
PERMITTEE • • - 14,405
ADDRESS 37-7 z
CITY Z—J. _ � 0 rL 0212-80
d NO Z l J
PC Fee E E Permit Fee
Issuance Fee Q U
Total Fee /
' APPLICATION FOR COUNTY OF LOS ANGELES
BUILDING PERMIT
DEPARTMENT OFSOuTYD�IINOENER
BUILDING
RENGINEERf
OR APPLICANT TO FILL IN B LD'N
DRES
OCALITY
ZIP NEAREST
CROSS ST
O OF BLOCS ASSESSOR
OT NOW ON LOT MAP BOOK PAGE PARCEL
/ DISTRICT GROUP TYPE FIRE SSED BY
� 3 BLOCK LOT NO C'O O C c ZO
TEL J, C!
L STATISTICAL CLASSIFICATION
SEWER AP
CLASS NO Z DWELL UNITS USE ZONE MAPNOT T i}.� SPECIAL
CONDITIONS
ADDRE ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONTRA A BLDG SETBACK FROM
LIC FRONTPROP LINEOF (STREET)
ADDRESS OA14 HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING
L FRONT PROP LINE HIGHWAY WIpTH
CITY CL
CONSTRUCTION LEND n + _
NAME AND BRANCH BLDG SETBACK FROM O
ADDRESS CITY SIDEPROP LINEOF (STREET) U
SD FT NO OF NO OF CHECK HIGHWAY } YARD =R
TOTAL SETBACK FROM TYPE OF EXISTING CC
S STORIES FAMILIES ONE I SIDE PROP LINE I HIGHWAYJ WIDTH o
DESCRIPTION OF WO EW + _ y
OD ❑ CORNER CUTOFF YES ❑ NO ❑ z
LTER ❑
IN OPEN SPACE YES ❑ NO ❑
REPAIR
USEOOF BLDG L ENOL [:] IN COASTAL PERMIT ZONE YES C] NOEXISTI ❑
APPLICAN TEL
PRIN �// N
001,
BY (SIGNATURE)
I HEREBY ACKOWTTIrGE T AT I HAVE TUG TI412 APPLIC ION
AND STATE THAT THE ABOVE IS CORRECT AND AYREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IM DOING THE WOR ACTH IZED
HERESY I WILL MOT EMPLOY ANY PERSON IN VI TIO F THE
LABOR CODE OF THE STATE CAL A TO
WORKMEN'S COMPEY N
SIGNATURE FINAL '1 Zli �� 7 BY
PERMITTEE PATE
ADDRESS
CITY P C F"$ PermR Fee v
IBluBncs Fee ^_
VALUATION �-7�
UCS TOW Fee i v
PLAN ClIECr VALIDATION CK M 0 CABH PERMIT VALIDATION'M D CA.H
5A,0FzMAY 25 Z g p 9 0.0 0
7346:MAY si 1 1 5 0.0 0
TGAS"A CUBGGU t■/Te
p �R
APPLICATION FOR COUNTY OF LOS ANGELES
BUILDING PERMIT DEPARTMENT SOF COUNTYy�nl�vLGINEER
FOR APPLICANT TO FILL IN ADDRESSL ✓�
BUILRDING - ( / eAE.�•t/
ADORES OCALITY wlr
NEAR1j
CIT ZIP CROSSESSTT /7
O OF ,LOGS ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
6 DISTRICT GR TYP FIRE ESSED BY
TRACT L
BOCK LOT NO O Z `
_ TEL _5708OWNER STATISTICAL CLASSIFICATI N
SEWER P
ADDRESS CLASS NO -211OWELL UNITS BK PG
USE ZONE MAP
CkRC fin• NO G
ARCHITECT E / 1i SPECIAL
ENGINEER VV CONDITIONS
ADDRESSROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONTRACT
I E , BLDG SETBACK FROM
L rc FRONT PROP LINE OF (STREETI
O
ADDRES ! NQ TOTAL SETBACK FROM TYPE OF "ISTING
HIGHWAY } YARp
LIC FRONT PROP LINE HIGHWAY WIDTH
CITY CLA _
CONSTRUCTION LENDER A/ �— - r/
NAME AND BRANCH l BLDG SETBACK FROM p
ADDRESSCITY SIDEPROP LINEOF (STREET) C>
50 FT /.4 NO OF NO OF CHECK NIGKWAY } yA RO = TOTAL SETBACK FROM TypE OF EXISTING O
SIZ "// STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH
DESCRIPTION OF WORK _ EW } / -
DD CORNER CUTOFF YES ❑ NO ❑
LTER ❑EPAIR❑ IN OPEN SPACE YES ElNO ❑
USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG EMOL ❑
APPLICA T TEL
PRIX N
BY (SIGNATURE)
I HERESY ACKNOWLEDGE THAT I HAVE HEAD THIS AIPPLICATION
AND !TATE THAT THE ABOVE IG CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCE! AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORISED
HEREBY I WILL NOT EMPLOY ANY PERSON IyvIO5kOf THE
LABOR CODE 0! T TATE C I! A R ATIYG TO
WORKMEN 9 COMP ALM
SIGNATURE F / FINAL -) BY , G
PERMITTEE DATE
ADDRESS � _ /
TEL PC Fee$ POrmit Fee (�
CITY NO (''
VALUATION ! Q
^ Q Q Issuance Fee
�7�' Total Fee
'PLAN CHECK VALIDATIONS M o CABH PERMIT VALIDATION <Z_ o CASH
J5 0 9n1'r^I 25 2 3 �--- 3_6.00
�l32�tdAY .3123 0 1bS0 733&Mur �1 . 1 7eu0 �
- �%2 p rv-
Act
APPLICATION FOR COUNTY OF LOS ANGELES
BUILDING PERMIT
DEPARTMENTBUILD , OF AFETTYDIMIOOENex
BUILDING
FOR APPLICANT TO FILL IN ADDRESS
ADDRESS 5533 N ROSEMEAD BLVD
LOCALITY
CITY TEMPLE CITY ZIP NEAREST
CROSS ST
NO OF BLDGS ASSESSOR
SIZE OF LOT X.26—a NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE P ESSED BY
T ACT BLOCK�� LOT NO V Q Q CON>tT Zp
TEL O
OWNER • NO STATISTICAL CL S CATION
EWER
ADDRESS CLASS NO WELL UNITS BK/C�G
USE ZONE MAP
CITY ZIP NO
ARCHITECT OR TEL �Jl SPECIAL
ENGINEER G.F•P.S• NO 687-99 O 3 CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONTRACTOR TEL BLDG SETBACK FROM
LIG FRONT PROP LINEOF (STREET)
ADDRESS NO HIGHWAY + YARD TOTAL SETBACK FROM TYPE OP EXISTING
CITY LIC - FRONT PROP LINE NIGH WAY WIDTX
CLASS
CONSTRUCTION LENDER +
NAME AND BRANCH BLDG SETBACK FROM
ADDRESS CITY SIDEPROP LINEOF (STREET) L.1
SO FT NO OF NO OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING W
S1ZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH Q
DESCRIPTION OF WORK NEW
Cl N
DD CORNER CUTOFF YES ❑ NO ❑
ALTER ❑
EPAIR❑ IN OPEN SPACE YES ❑ NOUSE OF
❑
EXISTING BLDG DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑
APP
CA
XT NT BETTY MORIN NDL 687-999
BY (SIGNA R `
Y
HEREBYNO L[DG[ T T I HAVE HEAD THIS APPLICATION
AXD STAT[ THAT [ ABOV ! CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCE! AN LAW! REGULATINGBUILDING CON-
STRUCTION I CERTIFY THAT IN GOING THE WORK AUT MOM
IEED
HEREBY I WILL NOT EMPLOY A Y PERSON IN VIOLATION OF THE
LABOR CODE OF CALIFORNIA IN RELATING TO
WORKMEN ! CO [N! TION I RAN
SIGNATURE O FINAL BY
PERMITTEE DATE C��n/ C?7
ADDRESS / W
564 MATHO LOS ANGELESTEL ' ^^ . ^
CITY_ No _ PC Fea$ Permit FBB
l 33 2-o Inuence Fee ZZ 2,00
VALUATION 23F655•�U
Total Fee ZZ L o J
PLAN CMC% VALIDATIO CK M 0 CASH PERMT VALIDATION CK M O CASH
9 � 4�" 2623 0 20
1 11 9 1 3 APR 26 1 1 2 2 2.0 0 A%
nw[aA ec4[G[p 12/75 ^
APPLICATION FOR Co o OS ANGELES
DEPARTMENT OF COUNTY ENGINEER
k ��ILDING PERMIT BUILDING BIDING AND SAFETY DIVISION 7
FOR APPLICANT TO FILL IN ADOREss c
BUILDING 33 0$' S9 �.
ADDRESS LOCALITY
ry U
NEAREST
CITU rL` G I1^ ASSESSOR
ZIP D CROSS ST
SIZE OF LOTf84 A 25o NOW ON LOTS O MAP BOOK I PAGE PARCEL �f
DISTRICT GROUP TYPE FIRE PROCESS BY
a
TRACT ` / BLOCK LOT NO L�d P F CONST ZOtIE
OWNER y e"i paj roo' . NO STA TISTICVAL CLASS(FICA ION _ 0
Q SEWER MAP _
ADDRESS 1[��1� //��♦, L CLASS NO JSL DWELL UNIT$ L- BK/SPG
WI11� 109E CA, ZIP USE ZONE NOP o7 oo& ED
CITY pp..�,
SPECIAL t;
ENG NARCIEER R - �� NOL�pL�' e' 3 CONOIT ONS
ADDRESS' -) ROAD DEPARTMENT APPROVAL REQUIRED YES NO ❑
CONTRACTOR T C> TEL SLOG SETBACK FROM
LIC FRONT PROP LINE OF (STREET) 11
ADDRESS -211 NO HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OP EXISTING
CITY LIC FRONT PROP LINE HIGHWAY WIDiH
CLASS
CONSTRUCTION LENDER + -
NAME AND BRANCH BLDG SETBACKFROM d
ADDRESS CITY SIDE PROP LINE OF (STREET) 8
SQ FT NO OF NO OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING CC
SIZE STORIES FAMILIES ONE SIDE PROP LINE I HIGHWAYI WIDTH
DESCRIPTION OF WORK NEW +
'wowjf ow. -11. c DD ❑ CORNER CUTOFF YES ❑ NO Z
`` ALTER L crr N T't-Iz- Cx I[ (tip IN OPEN SPACE YES ❑ h0
—REPAIR
USE OF IN COASTAL PERMIT ZONE YES NO
EXISTING BLDG F E TAIL PEMOL
APPLIC T>lr r No
- 141 r
PRIM K C
BY (SIGNATU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BUILDING COW-
ST RUC
TIONI CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OP THE 1
LABOR CODE Of THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN J S COMPENSATION RANCE
RE
SIGNATPERMITTEE OF FINAL -�'t By
DATE ) /ly
ADDRESS1!( r]
CITY IKJ F NOL 2/f7 PC Fees / ff 0 PermitF
DZ —5-b Imuenoe Fee
VALUATION /`T/a/ oV
— Total Fee V ��
PLAN CHECH VALIDATION CK M o CASH PERMIT VALIDATION cK .0 CASH
56U 1,668.60'-
1 1 1 fzMAR Ila 3 ® 1 1 2,5 0 5 1 1 2 FZMAR 11 - 1 0 � 2.9 6 85 0 Ast
T.AEEEA CC.EG). 12/75 - - -� - - -- - - - _
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKERS COMPENSATION DECLARATION / ' "- - FOR(APPLICANT.TO FILL IN Y BUILDING ADDRESS C C •�
I hereby affirm that I have a certificate of consent to self isurs BUILDING ADDRESS J J J CDSPi LN A jA
or a certificate of Workers Compensation Insurance or a car flied
copy thereof(Stec 3800 Lab C)
Policy N/
DE PLS. ci! 1 t1 .Li Oft ocn C1
SIZE OF LOT NO OF BLOCS NOW ON LOT
❑ Certified copy s hereby furnished /�-/9 OX Zg 7 g c7 t u t 1 NEAREST CROSS ST
❑ Certified copy Is filed with th my buI H g Inspection .B % LOT
- ' V im- ,1 /� I USE ZONE MAP NO /
Dat0&3W AppiIOant ASSESGO P K - MGEO� PARCEL /� /T
J (_ 1 1 1' /. .� SPECIAL CONDMONS
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE 0ppFEi6 e ` O t. TEL - - WTHIN 1000 FT OF SCHOOL, YES _ No
(This Section read not be completed d the permit B for one hundretl r 1�/1=SS PWD O� �. ^'I ID DISTRICT GROUP TYPE CONST FIRE WDIGESSED BY
dollars ($100) or less) X H47 1tI ,
CITY
I certify that In the performance of the work for which this Permit `f.\ ;TJZ 1 \ 1 O4', L�(� .�I] ,�1`•`r
a Issued I shall not employ any person in any manner so as t0 CHITECT OR EN EER) TEFL - CJ F•A' '
become subject to the Workers Compensation laws r/T1 3 no SWTISTICPL CL/SSI CATION APT C
Date Applicant ` CDDRE » CLASS NO � DWELL UNITS
NOTICE TO APPLICANT If after making this Certificate of DO T II N[:) S7, Z006 (03/.2 REWIRED TOTAL SE FROM EXD7
%
Exemption you should become subject to the Workers �ory� ,1 TE44 NO SET BACK
wYAAO MYY j w,I J •1.
Compensation ploslons of the Labor Code you must forthwith ' W fL PAl TI 714-3'730423
FROM 1
coney with each provisions or this permit shall be deemed revoked ADDRESS �t�1I �' �`rE� uC NO� ZS yi- p L _
LICENSED CONTRACTORS DECLARATION /!N G(� SIDE J J .Y-
G LIC CIA PL
I Hereby affirm that 1 am licensed unarp
drovlsans of Chapter 9 r/A� Cff' qu gv SEWER MAP
(comfrenclrg with Section 7000)Of Dlvislon 3 Of the Business and soFT SIZE NO OF STORIES NO OF FAMILIES
Professions Code and my license Is In full force arid effect .,I
, O8 NEW ❑ BK IOD t 1�NNUE .fJ1,I }
License NU"�be�{i ZS� L. Class SCRIPTIO OF WORK ADD VALUATION , a
Contractor,�IsD EJIELI Date `S .3 VEM"l- ALTER "� - 13,1000-13001 S/
❑ 1 am exempt under Sec p ` D I1'bfJ AT REPAIR ❑ $ J/� t0 5047 1 FM 5:0t 0
B&PC for this reason ,`v �x�rrt a DEMOL ❑ LCMA`P//c. ' 8
D 1 &f, I LG aLDD URM ❑
Signature t� •tel P'f -_
\ �'4-77(eLDMA Perms O z
❑ I as owner of the property or the
employees with wager asA f .i
their sole compereatKn well do the work arc1 the structure Is T '°►�<<' C � e
not Intended or offered for Sale (Section 7044 Busmess and 1.15 V-' .7 JiN r3111 FlNU DATE
Professions Code) W U_THE APPLMAM OR FUTURE 3UUeNe IX'.CUWJfT HANDLE A HAZARDOUS MATEWL 4 � 1 ITEM:-
0
as owner of the Cr A ruxTURE dO MNING A Hwwoous MATERAL EOUAL TO OR GREATER THAN THEproPertY ern exclusively contracting with Ts cITFl,,,E�oN THE HAziwoouS IA,ITEA145 NFonMAnorl GUIOE2 _FINgL By i
licensed contractors to construct the project (Section 7044 YEs Nolo,
Business and Professions Code) _.
Ni_ THE MENDED USE OF THE SUIXUNG eV THE A Ci,FT OR FUTURE BJUDNG CHECK
OCCUMIT REQUIRE A FERMT FOR CCNSTR1CTgN OR MOOFIWT"FROM THE SOUTH IlL fL
CONSTRUCTION LENDING AGENCY COAST AR canary MANAGEMENT oaTRRCT IscAOMDr ME PERMITTING CHECKLIST FOR Il 1
GUnEUIEa -MANIGE
I hereby affirm that there a a corstructan lending aperlCy for YES❑ _A
N the performance of the work for which this permit Is Issued(Sec
m n 3097 GV C HAVEFEAD TIEHALIRpOUSMATERI SWFORMAT1pVGW MDIRE SCADMO PEF)MRA r1 I() CHECKLIST I UNDERS MY REOUI EMENTS UNAS ANGELES COUNTY CODE
T L U_ n)C L .✓ i47 Y4
2 CHAPTER 2 20SECTIONS 220100 THROUGH 2 20140 CONCEWH
iNG RDOUS I �Ivhl L 1
Lenders Name MATE W REPJRTW3 AND FOR OHIAINING A PERMT FROM THE SCAOMD
Lenders AddressRa �r.. 1 AM11.45
0
I certify that I have read this application and state under penally
g of perjury that the above Information IS torr t I agree to Comply PC FEE �Q Q PERMIT FEE&
F, with all count ordinances arc! State relating to building L L
4 hit hereby 0 ZB rePre falrves of this Courrty A /D� ISSUANCE FEE / �O
e r u abo props nor Inspect r ses 7 (cA
gA 3 y INVESTIGATION FEE TOTAL FEE J D / , /
G
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 +
I hereby affirm that I have a certdoate of consent to sell Insure B1fILDIN ESSn /
o a c"icate d Workers Compensation Insurance or a ce '3 KOSEwe 'v SZ11P
copy thereof B00 Lab C) Ir � ZIP
policy No e-/0 C L/r �9 • Locum
SIZE OF LOT
NO OF BLDOS NOW IXd LOT
❑ Certified Copy as hereby furnished! O/ -/�� NEAREST CROS9 ST
�Certihed copy is filed with the my Idlrg Inspect n WacT BLOCK LOT NO
/ t PAGE PAIICEL USE ZONE ANP NO
Data Y jl 34 t ant `L AssEssoR 2533 DS SPECIAL CONDMONs
CERTIFICATE OF EXEMPTION FROM WORKERS' TEL NO
COMPENSATION INSURANCE WITHIN 1000 FT OF SCHooL7 YES I NO
(TIXs secban need not be carpleted d the permit a for one hundred
ADDRESS
)
DISTRICT GRIXIP TYPE CONST FIRE ZONE PROCESSED BY
dollars I E IJ 00 Su.C P,E�
I that the performance d the rink for who
ZIP
IS Mup the permit DS IJ y 3- S/
tl Shall rorty t employ aperson I any mariner 80 as to f OR ENGINEER TEL tK)
become subject to the WGrkem Compensation Lars r'O �vAt2Q 3 -g2 -//Q STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS /� CLASS NO DWELL UNFS
NOTICE TO APPLKANT If after making the Certificate d 750 ��/�Q'/,$ REQUIRED TOTAL SETBACK FTROM EXIST
Exemption you BhOUId become subWct to the Workers TEL NO SET BACK YARD HWY PROP LINE WIDTH
Compensaton provisions d the Labor Code you must forthwith ra E11 --4v o /a T- 7/./-5-734`)
comply with such prove ns or the permit shell be deemed revoked ADDRESS yc 1 PROM
o
LICENSED CONTRACTORS DECLARATION 2 1L/A7 5-T416 416 a$S P L
p
loE
I hereby affirm that I am licensed underpmveions d c Chapter 9 LIC C1.0~1/J a SEWER ANP a
(o0mmenci g with Section 7000)of DUmorl 3 of the Business and SO FT SIZE? NO OF STORIES NO OF FAMILIES CL
Professions Code end rrry_Ircgnye a In full force aryl effect 261 NEW ❑ BK PO , U
License Nu b ZS J Class J.� DESS OF WORK ADD ❑ wuU�o,N,���� �
Contracts 5 CIPV /Gate 3 �/ P LL T D — ALTER ❑ $ A��!/!X-O R
a
❑ 1 am exempt under Sec REPAIR ❑ $ _
BBPC for this reason DEMOL LOMA P/C
Date USE OF EXISTING BLDG - URM ❑
Signature NT(FlTs`lT) TEL NO LDI.N Perm I
❑ 1 as owner d the property or my employees with wages as ICN��� fLoo{C.5 7.4T-S6P �-
then sods compensation will do the work and the structure is ESS p �f.� I .i
not Intended or offered for sale (Section 7044 Bumness and FINAL DATE
Prafe=o ns Code) wu THE MCLIGNr OR FUTURE BaIaNLG 0 7 HANDLE A HAZARDOUa AWERUL
ClI as owner Of the property am exclusively contracting With nit A MORLRE(%lNPlltio A HA2ARDOl14 NATERNL EDWL To On GREATER THAN THE _/ I ITEI7_�
Iroensed contractors to construct the profect I`Secton 7044 AFUlxnB SPE D ON THE HAZARDOUS MATERWL91F1UMoN oUDEI F1 Bw i
Business and Professors Code) YES❑ WAr 13THL 1 V 1 65
w'LL THE WTFf!]ED USE CF THE aUIDl1R3 EY THE APFIJCANT OR FIITIRiE BIAILM'1 t�� _
OCOUPAfn REOURE A RERAOpJSTRUCT1oN T FOR OR MOO PCN FrioA1 THE SOUTH r IILC�)l`
CONSTRUCTION LENDING AGENCY CCAST A++ouurrY nlAwaEAENr asrRor IscAOAoI SEE PERWTTINp cHECKusr FOR
J
GUIDELOELlEe CIO
hereby affirm that there a a co sirudon lending agency for YES❑ No❑ '_rlRt�uE
the performance of the work for winch this permit is issued(Sec IHME READ TIE MAZAimOU91MTER419 KOR.WTIONpI.OEAfD TIE9VAI.O PE0.NTTYIG
3097 CN C) Lar RSGIio MY REWIPEMENTS u R TIE LP ANGELES cOUIRY CODE _
R 2 ZD SEC OI 1100 TMO ]ZO IAO LONCERNPIo HAZAAOQLs
Lenders Nagle AM O ANWpAv LUT FF THE SOIDMD np�11J-�IJf_II 4�I./)'y
Lenders Address
ROlA�„T 1 t' 4772 1 PM 5112-
I certify that I have read this application and state under penalty '
g of penury that the above Informaten is correct I agree t0 co nilly PC FEE ' G 1( PERMIT FEE
R with all my ordnlancea and a laws relating to budding ' 1 �
and eutlnOnz tatrves of the County t^ySUANCE FEE / X40
g to the - rty for inspect
T/'-'
RN T1GAT10N FEE TOTAL FEE d !O
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION FOR BUILDING PERMIT 14k �]
COUNTY OF LOS ANGE6ES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO Flu IN BURRING ADORERS-z.
I hereby aftm that I have a candcate of consent to soft nsue BUII�NG ��
or a certificate d m
Workers Capo
eresi n Insurance Cr a certified S3 93 E
copy thereof(sec 3800 Lab C) 'E'H PC r C/T ZIP LOCALITY
Policy NO Compary, SIZE OF LOT NO OF BURGS NOW ON LOT
❑ Certified copy is hereby furnished I NEAREST CROSS ST
❑ Certified Copy is hied with the County building Inspection TRACT BLOCK LOT NO
dBpartrtrent I USE ZONE MAP NO
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS /j_ O 7/
CERTIFICATE
CERTIFICATE OF EXEMPTION FROM WORKERS' D - TEL No 7
COMPENSATION INSURANCE 7� WITHIN 1000 FT OF SCHOOL' VES NO
(Thea sector need not be completed If the permit is for one hundred ADORE 6 3 ��/ ,
dollars($100) or low) DICT (GROUP TYPE CIXJ3T ZONE PROCESSED BY
I Certify that m form
the performance of the work for which this permit ZIP
Is issued I shall not employ any, person In any manner so as to
become subject to the Vklrkm Compensation Laws ARCHITECT OR ENGINEER TEL NO
SWTISTICAL CTION APT CONDO
Date Applicant ADDRESS CLASS NO� DNEUL UINITS
NDTICE TO APPLIGNT I after making this Certificate of
Exemption you should become subject to the Workers - TEL NO SET BACK TOTAL SETBACK FROM E)pST
Canpensaton prowmons of the Labor Coda SET BACK YARD HW V PROP URE YADTH
you moat forthwith FRONT
CDmPIY with such Prov6ores or this permit shell be tleerrlBd fe..dl8d ADDRESS 11C NO PL
LICENSED CONTRACTORS DECLARATIONaj-y OLDS a IDE
I hereby athrm that I am I"nsad underpovisIons of Chapter aSEER MAP -
(Commencing with Section 7000)of Division 3 of the Busmess and SO FT SIZE NO OF STORIES NO OF FAMIIJES WJ',��� i_ .__ 1
Professeorm Code and my, license es In full force and effect I NEW ❑ SK PG 1 tC9
RIPTION OF K VALUATION
Lcerise Number Lc Class ADD ❑ a �M " t �T.i O
Contractor Date ALTER ❑ W
❑ I am exempt under SecQ.
REPAIR [I $ ~ ITEM' z
BaPC for this reason DEMOL ❑ —
Date USE OF EXISTING BLDG URM 13Slgnsturo APPLICANT(PRINT) TEL NO LAMA perm. HECY, 1211.S-
❑ 1 as owner of the property w my employees with wages as Z
their sole compensation will do the work and the structure * ADDRESS K
not intended Or offered for sale (Section 7044 Buismess and FINAL DATE
Professions Code) wru TIE APPIx'ANT oR FInUIE BUiIJ,YIJG occwxr HANCIE A HAznPoous MATERAL 1� —t (I I e /
11
l as owner Of the property am exckneNRty, contracting with OH A 1,14E CCNWKND A H/SAFI]pUa AWTE IV EQUALToOR GREATER THAN THEliuers �/ ✓ 7 JO_�1 J_ 1 5N 1� S
NAo NTs SPECFTED ON TIE 1 Asoous MATERAL4 W0f1J MTION GUIDE, Q
Business
contractors o construct Dna project (Section Toaa YEs❑ eD❑ FINAL > :14�
Busnneas a�Prdeasona Code)
OMU-CC THE INTENDED USE OF THE M�BY CT THE A➢P'JC_rNr OR FU T eLleNc
OLCURWr REq.nE A PERMIT FpR C TRICT(1C ACI IDI MODFxJTgH FFCM TIE ap1TH
CONSTRUCTION LENDING AGENCY GUM An auurrY MvaAOEAENr IrsrRrcr IscAOMDI sEE PERurrnc r+Ecxusr Fos
ewlx ones
I hereby aHNm that there is a construction lending agency for �s❑ no❑
the performance of the work for which the permit a owned(Sec
m NAVE READ THE HAUADWS NATERM191NFORMAnONGU1DE AID TIE aDAp.DIENAIIilD
3097 Cry C) CIECYJJST I UNDERSTAND AIV REGUREAENTS UNDER TIE U06 ANGELES COUNTY CODE
T 2 CHACTER 220 SEO S 220100 THRIXMH 220140 CONCERMNG INZAnpOl19
Lender a Name eMTERIAL9 REPORTRD AND FDR CBLVYIG A PEf FPKW THE SCALMO
Lenders Address
c avmER w AorNr
I certify that I have read this application and state under penalty
g of penury that the above enfonnetan a correct I agree to comply PC FEE PERMIT FEE �� Q
R with all county ordinances y ordi aes and wa state Ioretailing to budding /
to iDn a1BdaUowB-eby antorisdZ property fpr I�rmpectonHPDs of thisCounfy IGSSUANCE FEE O'C�y /' /O
r/147 INVESTIGATION FEE TOTAL FEE (.p_-0
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 BLanaq ADpRESS
I hereby affirm that I have a certificate of consent to self meure BUILDINC7 ADDRESS
or a oerbfrate of Workers Compereabon Insurance or a certified 5K33 41'LCJ
copy thereof (Sec 3800 Lab C) CIT)( ZIP
Policy No �MQ2652 Canperp120LL9tJIN INQ4 A IAGLRV
SIZE OF LOr NO OF a DGS NOW ON LOT
❑ 001Aed Copy Is hereby furnished NEAREST CROSS S
❑ Certified Copy Is filed with 1 my wilding I on TRACT BLOCK LOT NO
depia',rttm nntty` USE ZONE MAP NO
Date=��l Applicant ASSESSORMA➢BOOK PAGE PARCEL
SPECIAL CONDITIONS M� O
CERTIFICATE OF EXFROM WORKERS' TEL NO
ATIO
COMPENSINSURANCE W ffftiN 1000 FT OF SCHOOL+ YES NO
(This section need riot be completed it the permit a for one hundred >7 1 EASTRICT GROUP GDNSTZFMIREZONE PROCESSED BY
dollars($100)or less) City La
I certify that in the performance of the work for rms
e which the pe �Q� d
m ued I shell not employ any persom n any, manner so as to ARCIGTECi ENGINEER TEL NO
become subject t0 the Workers Compensation taws STATISTICAL CLASSIFlCAigN APT CONDO
Date Applloanl ADDRESS CLASS NO �? ELL t1MB
NODCE TO APPLICA1117 N after makrtg the Cerhlxate of REWIRED TOTAL SETBACK FROM EXIST
ExemMen YOU should become Subject to the Workers CONTRACTOR TEL NO SET BACK
Compensatnn provewrs of the Labor Code you must forthwith 1 YARD PROP LINE WIDTH
FROM
cOrtWy with such prwlsrore or the perms shell he deemed revoked ADDRESS UC NO PL
LICENSED CONTRACTORS DECLARATION �� IC 3 PILE
CITU LIC CLASS PL _
I hereby affirm that I am licensed urderproveons of Chapter 9 � /h P/ G Jv +._
(commencing;with Sectuon 7000)of DNIBpn 3 of the Su&neas and SO F7 SIZE NO OF IES NO OF FAIMJES SEWER MAP
Protesvcns Code and my license Is 1n full force and effect 4 Ce r, I NEW ❑ BK PG PON.
til.L T.,r •�
LK:ensa Number S-Z G– ((G DESCRIPTION OF WORK ADD ❑ VALUATION
Lx: Class :v SII_
Contractor Date S fEwe ALTER DZI $ 9,000 1 ITS v
W
❑ I em exempt urltler Sec REPAIR ❑ $ TOTAL 16Q„}
BSPC for the reason DEMOL ❑ HE"K —
- 1C 1.9
Date USE OF Ex snDMAP/C A 1 NGB DG URM ❑ CNANIE ,Q I
^ enure APPLICANT —TEL NO LOW Perm It '
❑ I as owner of the property or my employees with wages as F�'r C1 F Cie? •O hc' Ir 2
their sole compensation will do the work and the structure Is AUIXiESs +lil3+'i?001
not Intended or offered for sale (Section 7044 Business and (1 11 /r /-� �1' aF FlNAL DATE �
Professions Code) MILL T11E APPJLM`r nR FURIiE 9Ur.CfA CCCIIMNr IWJpfE A IMZMOpIJe MATERIAL ?••� .-9� � �L L 1411 L X11 I
❑ I as Owner Of the property am ex(kIsIVBIy contractingwith A 41XIURE COhflA 3 A W�ZAAOOIe WTEFLLL EOLML TO OR NEATER THVI TYE 1 1' ['I�
AMCUNI9 SPECIFIED OII THE nuzAnocus WTER !FORMATION OIIOE+ FINAL BY / •j Y`J.TG'�J
licensed contractors to construct the project (Seth m 7044 YEs❑ ND❑ 1\ TOTAL '} 19-,;-7 r
&cress and Professwre Code)
will THE NTENDED USE OF TIE alNR11,1G IN TIE APn.KANT CR S FUTURE BLIL`b ^ 7
OCCUP RECURE A PEPMT FOR CCNSTPLCnON Ce MOOFICATKJN FROM mE H
CONSTRUCTION LENDING AGENCY COAST AIR OMAw,oEMENr DISTRICT 19CAOMDI KRIAITTNG CI CKu Fon IHE[Yi ..1, ' t
LULrY SEE
WIDEUES
I hereby affirm that there is a construction lending agency for �Es❑ TIO❑ L T LJit'���IE ,I-Ill
the performance of the work for which the permit Is Issued(Sec
m1IMYE MEAD TIE IwZAA00115MATERIAL9lFORMATKJN Gl]DE AND TIE 9CAOx0 PEPARTaq
n 3097 CN C) rIECKDST I IFICERBgIY1 W REQ IFIEW a UNDER TIE LCB ANGELES C Y CCOE
Lender a Name MnTEraALsEPorTiio,suvn F�soawru o ATInpJGH aFP coNc �HAZAnoous
U=LUU—U IU 1 5l26t i 4
Lenders Address 5417 1 AN 10:c0
g f Penfy Uel 1 Ise read the applca Is and elate under PomallY PC FEE /// PERW FEE / v
d peal! that the above ufarid S a coned I ague to compy (`J
R whin all ordlnarnces end State laws relating to bulldog
coram and hereby authprlZe representat.at Ue County I^ E FETE 'L
g to enter tared property for mspecten purposes/J 76 7d
m S-2(p��4 NVESTIGATKNJ FEE TOTAL FEE �/ / ni/,
eoe.. •e.+ ora / /7!V_
SEE REVERSE FOR EXPLANATORY LANGUAGE
_ . APPLICATION FOR BUILDING PERMIT �]
COUNTY OF LOS ANGELES BUILDING AND SAFETY
•WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS >r
' I hereby affirm that I have a certificate of consent to sell insure BUILDING ADDRESS
or a certdcate of Workers Compensation Insurance or a certifed
copy ther�e�oyf(Sec 38800�Labb C C �
Policy NdAA--4? yaAB/o ,y Com'• IADADT
OF LOT r� 2( NO OF BLDOS NOW ON LOT
❑ copy a hereby tumefied Q X. �'6// NEAREST CROSS S R
TRACT BLOCK LOT NO ""t �avw^
Certifed copy a bled with the county binloirg inspection uSE NNE MAP NO
deperfienl
Dated\Ap �y+� ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' TEL NO
COMPENSATION INSURANCE • S d O VVITIHIN 1000 FT OF SCHOOL? YES NO
(This section need not be completed if the perms is for one hundred ADDRESS
dollars($100)of loss) (_Zr /, rj �'�.� DISTRICT GROUP TY CONST FIRE NNE PROCESSED BY
I cerbN that in the performance of the work for which the permit4A4A Ta-1 �D� ^ 2
b I or ell I shell not employ Work any person at airy, mariner so as to �3- r
Uecoma subject t0 the Workers Canpenmtpn Lave PACAQTECT OR ENGINEER TEL NO
SIATISTICPL CLIEICATION APT CONDO
Data Applpanl ADDRESS CLASS NO �P.SSC;4 DWELL UNITS
NOTICE TO APPLKANT If after making the Certificate of REWIRED 1041 SETBACK FROM EXIST
EXemplion you should become subject to the Nbrkem CON TEL NO SET BACKYARD MYv PROP LrE WDTH
Conpensaton pronsons of the Labor Code you moat forthwith
canpty,with such M vrsrons or the permit ehall be deemed revoked SS UC NO PL
PROM
LICENSED CONTRACTORS DECLARATION19?1"03 �' SIDE
UC C ASS P L
I hereby affirm that I am boensed underprovisions of Chapter B LL SEWER MAP Y
(commerlCnq with Section 7000)of Dmwn 3 of the Business and SO FT SIZE NO OP RIES NO OF FAMILIES pre NEW ❑ W PG
Code and my Ilcarse a In full torte and off
Lper�e t�urnba — L,c Cms G of y�vR W 5; ADD ❑ wwAnoN oc
$ o
'Fars ALTER ❑
U
G L "'
❑ I em exempt under Sec ` REPA(R ❑ $ ti
BSPC for the reason DEMOL ❑
DMA P/C A
Date USE OF EXISTING BLDG URM ❑
SbnaNro RNT) TEL NO-5( LDVIA Perm♦ —
❑ I as owner Of the property or my employees with wages as �Z3 z --
their sole compensation mil do the work and the structure Is ADDSS F ACTT.;
not intended or offered for sale (Section 7044 Business and FINAL DATE
Q --ll— i yr
Professions COfle) YALL TIE APR.K VfT OR FUME BUILDING OCCLAANT HArLIE A INZARDOIIS MATERML
\ ❑ I as Owren Of the property am exclusively contractingwith OR A MXTUM CCNTNN A HAZArpOVa IMTERMI EQUAL TO OR GREATERlicenTHAN TIE Q — _
WOUNiS a CIFED�NIE I Dd1S NATEfGl3 LYFOn WMON(HYDE? FERAL By
Business
ed cod Proles ci construct t tfe protect ($scion 7044 7-
BU9111e69 BTId PTf8e91ar6 Code) "U❑ NO
w1LL TIE INTENDED QURe9E VI TIE BONsTn BY THE APRJUNI CP FIITLPE SOUTH
CONSTRUCTION LENDING AGENCY COASTr PEOUPE A TERMr FOR C MILT OTKJN«,. KHW N Front TIE T FOR j 71 ice,COAST AA OLWYTY ENT gaIiLGT ISGAOi.01 SEE PERWTTNp LHECKUai FOR JJ.IJ
GUDEUAE9 _ i _
I hereby affirm that MOM! e a COnstruction lending agency for r 3❑ No t Inc
r, the performance of the work for which this perms is wiled(Sec
mIIwIEPEAR THEIWNiDOU9MATERN5�NF0lAIATKJN GLIDE AND THE SG•QMa PErARTN3 T '(
3087 DN C) CLEC UST I UNDEHSTANa uDER THE Lea ANOELE9 COUNTY CODE TOTAL{AL +"625
Tn 2 CWP Or✓91 zitroe DIAD cCNCERiNG HAZARDOUS
LeMars Name NA -
, -HEV
Lendma Address
.1.1
HAhhiE pp
I certify that I have above
the appion an and state under penalty
g
with
perjury that the eboye s a118110n1 a=red I ting ro cORply PC FEE / PERMR FEE /2,::E$ with all county ortlinarraa antl State laws relating to building f/O n1 �
constructn ooze representatives of the Counly Ir SUANCE FETE / '/,, i)IiQI]—U001 4r 1�•'Y4
ro W pon the above-memo ulon
perfy for epectpurposes — p 1 7'U
INVES ATION FEE TOTAL FE� Q ;2. D 4755 1 AM ��Y1
Am.o T
SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 US TUNAS SIGN
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9907280006
PHONE: (626) 285-0488 EXT
LEGAL ID NUMBER OF SIGNS 3 BUILDING ADDRESS
BK: 105 PG: 86 PC 9 SIGN DESCRIPTION TWO WALL SIGNS AND ONE REFACE (CHANGI 5533 ROSEMEAD BL
TEMP CA 917801802
ASSESSOR INFORMATION KLMER NBRDWAY
5387-032-D58 THOOMASTPAGEE 596CROSSREEGRID OA
LOCALITY TEMPLE CITY
TENANT. EXIST BLDG USE ISSUED ON PROCESSED BY mwrwff�
OFFICE DEPOT EXIST OCC GRP 07/28/99 UT 01/ 4/00
OWNER: TEL NO EILDGS NOW ON LOT: VALUATION. FINAL DATE -rnum-iT CODE
FEMINO JAMES J,SUE - 8,000 d„1Lv_
PASO 911177155 / V U
REMOVE EXISTING WALL LETTERS AND IM TALL NEW LETTERS AND
FEE DESCRIPTION: QUOITITY UOM AMOUNT REFACE ONE SIGN
APPLICANT TEL NO
AD ART ELECTRONIC SIGH CORP (310) 523-9500- AA BLDG PERMIT ISSUANCE 27 75
19603 FIGUER0A AE STRONG MOTION _OTHER 8000 DO VAL 1 68 SPECIAL CONDITIONS
CARSON, CA AX BUILDING REVIEWAFEEiwwAl.\ 54 70
ER
D2 PNIT.W%OXEN-HCC E LES 8000:00 VAL 183 00
CONTRACTOR: TEL 514
NOT TAL6FEES 267 13 APPROVALS DATE INsPnT6W-9rfflUT0ffF--
AD-ART ELECTRONIC SIGH CORP (310) 523-9500-
19603 FIGUEROA ST LIC. NO LOCATION AND SETBACKS
CARSON CA 90745 711214045
/I SOILS ENGINEER APPRMAr-
ARCHITECT OR ENGIMEEF_ ILL NU: FOUNDATION/TRENCH FMW_
LIC NO lllllli
MAP NO: SEWER MAP BOOK: PAGE FIRE 269E____W-
iDD 'UBLIC WORKS
NO OF FAMILIES: DWELLING LIMITS. APT/COND STAT CLASS
NO 20
__3cR5a_vTTwrlr_ HAZARDOUS
.Che_
AIR QUALITY 1000 FEET MATERIALS
NO MO NO A l Dy
ServMce 7ha'L
REPORT ID DPR261 ROUTE TO BS0508