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Home My Public Portal About5535 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDINGaPERMIT COUNTY OF LOS ANGELES BUILDINAND SAFETY \RKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN eu1 I hereby affirm that I ham a certdpme of consent to sell mare BULDING ADORE o a ceml"te of Nbrkers Compensation Ir19UrBnCe or a cenfie0 a o kno'd 131A o AGwL Y SIM OF LOT NO OF 81 CGS NOW pl LOT ❑ Certified copy a hereby fumehad NEAREST CROSS ST ❑ Cortdod Copya filed with the my bu Will inspection TRACT BLOCK LOT NO department USE ZONE A1IP NO Date Apgcarll ASSESSOR KW BOOK PAGE PARCEL SPECIAL CONOOHS CERTIFICATE OF EX PT1ON FROM WORKERS' NO COMPENSATION INSURANCE OWNER// e 3 L WITHIN 1000 FT OF SCHOOL? YES NO (This sactgn need not be Competed it the permit G forOne hundred ADDRESS ISTR DICT GROUP PE CONST FFiE ZONE By dollars IS 100)or IBRD) CRY I certify that in the performance of the work for which the permit ZIP �C/,JSr G issued I shall not employ any parson in arty, manner s0 as to ARCHITECT OR ENdNEER _ TEL becmesahon Laws SO oe sub)ect to the Workers CompmsrlCu CLASSsICA APT CONDO Data Applicant ADDRESS CLASS DA' NO ELL UNITS ` T. NOTICE TO APPLICANT If after making the Certificate of REOURED TOTAL Sgyp=FROA1 EwS{r� ExemptKm you should becorne subject to the NMkers CONmACTOR -.x SET BACK YARD MYY Pf�HFE wvIOT/f' 68 ComarGat*n gDweKrs of the Labor Code you mal forthwith I 7 -9 Jri FROf1T Comply with such PrewGloa or the Permit shell be tleerretl revoked ADDRESSLIC MD P L LICENSED CONTRACTORS DECLARATION .26 d } 7 y SIDE g I hereby affirm that I tion licensed underprow tore of Chapter 9 IXfy ° CLASS 4-/4 SEWER MAP (COmrnenLing with Sechm 7000)of Draslorl 3 of the Business and SO FT SIZE Nq OF STORIES NO OF FA b fVlwLvc .fTn} ProfeeDgns Code and my bcenee Gin full farce and all NEW o- BK PG yAVARY W! Lcense Number S.2 y2 y9 L, Claes �— a DE RIPTION OF WORK ADD ❑ waLLUATION lop. d Contractor RI1tZP/1 Date ALTER ❑ $ 001 oc 0000-0001 9/22/958 ❑ I em exemq under Sec .Jit/ S u p?✓Ii c it u S REPAIR 13 $ 2424 1 AM 8:39 Q BAPC for this reason O DEMOL ❑ LDMA PIC• W Date USE OF EXISTING BL00 URM ❑ 23 Signature (AANTI �.. NO LOW Perm A • 9 rw- o ACCT.. ❑ I as swear of the tionBrty d my emgoyeid with wetps as F ,3'303 111.18 their Bole carrpermalKn wntl do the work and tree structure G ADDRESS not intended or offered for sale (Section 7044 Business and 2SO16 IJ . Lam& dV4 FIKALDATE e G professions Code) 1 ITEMS wu TIE APR1VeR DA fUm/E auan.ls OCL11YNi RAlpte A NAZNp0U9 YRFIML r0` !Y� 7 1 ❑ 1 as owner of the property pm exc4awely contractmp with On A 1.UxmlE CPNpM1p A I1ALwrL0U9 rAATERVl EdHL ro OR a11EATPA RYN TIE licensed Contractors to construct the projeCt (Section 704411101R^s SfEcfEp ON TIE I1Azumave WIEPWB KpYMTIpN oust, FIAAL By � TOTAL 111- 18 mre Business and ProfeeaCode) `Ee❑ NEI- CHECK 111.18 M41 TIE MEADED USE OF TniE euulAa Br TIE APPIIVJIr ori FlIr1AE euinwa pccBRNrr rEOUmE A Foa.r IDB DpNDrM,p,pN pR uomuTw raou TIE BpirrN C .00 CONSTRUCTION LENDING AGENCY 00AST An QUALTw A1An1O DISTRICT Isuolml SEE°EwArTr+o clEaaar FOR mcoEUES I Hereby affum that there G a co struohon lending agerxy for res❑ No n the performance of the work for whgh the Permit G Issued(sec r'I/� a9 IIVUEIEAD TIE OpUDYATEBNBfEoewuTKMId1DEAO TIE SVpxOPERAR1Np X00-0001 9/ 8/95 a 3087 CN C) of r uR/E �&sum w rENTs uaER DIE uos ANDEIE9 csiwrr soca Lenders Name Iw �rEPo C Aaron apq,* a r:�THE w uaooia 2207 1 AM 8000 LerKlers Address w 1 certify, that I have read the appl"hDn and state under penalty Of perjury that the above INorrtGlpn is Correct I agree to cornpy' PC FEE / PERI. FEE with all camty ordinances and State laws relahnlg to building construction and rBby BUIhprue reprasentetrves of the County ISSUANCE FEE to enter n theoo- honied property for InspectKm purposes m NVESMAT10N 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 FILL IN BI Og�•A�DR^ess I hereby affirm that I have a c«tenate a cornem to eat Rsllle J.7.7 /� OSfHfcNt� «a certlfcate a Vyorkers Co mperoatgn Irmurance « a Cerafetl 7�' / p copy (Sec 38 0 lab c) �- �vl N7 (,JT / 7p� tAGurtv Policy w•�o038 0 �,y Lo IIIBA COPY a II«Bby furlFehed 91IE L/5"r�W s y y lq OF OLIX's l�V off I.oT NEAREST CRW^.+ ST ❑ Certified copy te filed with the county bulldog Repealonl TRAM 36 2 3 R1 K Lf NO (S USE aor+E wr No department E R�R�EL %7,6z Appcenl ASSESSOR MAP I Mob 32 V SPECIAL CONDITION' Data CERTIFICATE OF EXEMPTION FROM WORKERS' owNER COMPENSATION INSURANCE ME /GFvi✓E 9 S'/6'�I 6 WRNIN IODO FT OF scxlooLa YES No (Tho section need not be competed It the permit a for One hundred dollars(E 100)or lase) s 75 DISTRICT OPOUP TYPE CONST FIRE ZONE PROCESSED SY 4 I cettfy, that m the performance of the work f«Which the permit CITY e issued 1 shall not employ any pelaon In any reamer w m to ZFC became subject t0 the Nbrkera COmpareancn Lowe r CT OA ENGaa EA CxYt TEL NO� l SWTISTI(AL CLAASSnIF'ICATgN MT CONDO Date Applicant 3�q.x ✓ `/T/ rr •.Jt CLASS NO $!A DWELL UNRS AOTCf 70 APPLICANT If after makug the Certificate of /dV W s� ` -? T SOURED TOTAL SMACK FROM EXIST Exemption You should become subject to the Wbrkws TEL ��JJ SEF BACK YARD HWY PROP UNE YAM Coarperaatlon prowmoro of the labor Cade you must forthwith my [! "'`T Z 5 -7ay6 FST comply with such provogns«the permit shell be deemed rawked uy/SS ��-y �T_ LICENSED CONTRACTORS DECLARATION . /}G��r —" Thy `R� � 1 hereby affirm that I am licensed uMarprpvapra a Chapter 0 A( r. 'I UC p P L (commencing with Section 7000)a Dlvspn 3 a the Buamew mid SO FT'S`IZEE No OF S NO FAMLES O SEWER MAP Profeemns Code and my Ilceeree o in full tote snit as ppm NEW ❑ BK Po a Lc«ae Number 6 70,QS Lc Class �SC�T10N WORK ADD ❑ aL WIC , O Contractor Date E O 1C / Bot- Yi 8 ALTER ❑ $ 7 _�_Q_ ❑ I am exempt under Sec T I m) 2 TOiEF"-T REPAIR ❑ BEPC f« the reason *21/TFi+ra1 Sc,*v (.FAIT/AL DEMOL . IlIALA PID I Date USE OF EMSTING VA45,A)wC URM ❑ L G 7V 1 17`'LfI�L� SIW Mn Q.IL j WO-1-0--W2 LpAA Pro r ❑ I as sale c rn the property d my employees With wepee m4 CKCK 188.10 thea tole d M offered r as the work and the structure a SS n /�� rot nteMed w offered f« Gale (Section 7044 Bemrlem and 7/ ✓£ of D2�S - AlrJo FINAL DQ! - Q T•I4AN& .00 Profetallona Code) WILL.TIE ARVGNr Ort FUTURE AILIND OCCUMMi IaNDIE A NAx.FDCll6 MATERwI ❑ 1 as Owner a the property am eWuw* contracting Wirth OR A MomAE COerWFxD A 1lALFade M.TFILAL Eg11L ro OR GREATER TWI TIE licensed Contractors to construct the project (Section 7044 eAOlna a CFtCEtD ON LIE NATM0019IIIiTERFle KORwO10N aoET FINAL BY'8-24- 4 Buwnata and ProfeteNau Code) Yat❑ No VI 1 1 'fdT'Y OCC TIE IMQUIFI D Ilea« TIE BUCIID BY TRE ARl1CFri 0•I f11111RE BlilrrNO OLCUYAS FEOIAE A FERUi FOR COMSfix(SC 011 tDI ME F1GQ4YN FiDM TIE T FOR CONSTRUCTION LENDING AGENCY cMm An olwjrY•'•"' .Finn parwGr tar.IOAD1 ME Fvvr*F+D aEaruar FOR IwoeuEa I thereby affirm that (hare a a ebrmtnNctpn lendug agency, for M❑ Nocff N the perfomsnce cif tile Work for which the panful a asued(Sec 0 IIIWE IE.D TIE IULVi0009 WREw4a IFonYAl10NDUpF NDTIE acFaro FewNnTNO N 3007 CN C) CNEOaer I ul eFSIA D W PEOUi1.ENa U DER TE ILe AND s COUNTY Cope Land"a Name 0 x OMPTEP:20 sECTpN9 x A Iso lllpllDN:xis IID COIICERNONO IeAxA1C«!a Re�D A Fewer FrOM TIE eOlalo Lenders Address P 0 Q 1 certify that I hale head the application and state undo penalty a ayPC FEE PERMIT FEE pJ� part" that the above Information s correct I es to comply with all county ordinances and Sate laws relatsg to ddding (G Co struchor, and hereby audlonze reprawntairm of the County ISSUANCE FEE p lo Qpl Me�hRye- - y f« aPechainW Wsee ( b eNESTgA71oN FEE TO'PL FEE O P / O+ J A -b Ai C A SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATIONS FOR BUILDINGaPERMIT COUNTY OF LOS ANGELEAND SAFETY WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS yJ I hereby affirm that I have a certillnate of consent to adf insure - ROk or a cerhlurate of workers Compensation tilauraTce or a certified copy dioreol(Sec 3800 Lab C) ZIP Policy NoAzr2e-�31er?eupppm, OF L SIZE OF LOT NO OF Bt.DGB NOW Oft IAT copy a hereby furnished NEAREST Cerbl copy a filed with the ounty budding Inspection TAT BLOCK LOT NO dapartliem I USE ZONE AAP NO Date 9 Applicant ASSESSOR AVP BOOK PAGE PARCEL SPECIAL COP DITIONS CERTIFICATE OF EXEM FROM WORKERS' R Ta O O COMPENSATIO 1 URANCE D WITM 1000 FT OF SCHOOL? rots No Rhe,Becton need not be completed it the permit Is far ore hLwdmd ADDRESS O R V Va olsTracT OROIRST Fwd ZONE PROCESSED BY dollars($ICO)or less) ZIP m I cerlty, that s the performance of the work for which this perm? r, �� E�DD� m Issued 1 shell not employ arty person any manner so as to ARCHaTECT ENGINEER TEL NO become subject to the VATrkam Cpnpeneaton Laws SATI9TIGL ZI I APT CONDO Date Applicant ADORES, CLASS NO C52 DWELL UMTS NOTICE TO APPLrANT If after making this Certdirate of REQUIRED TOTAL SETBACK FROM EAST Exemption you should become subject to the Workers T)j�Qr 4/ SET BACK YARD Mvy PROP UNE WIDTH Compereeton prorsoro of the Labor Coda you must forthwith S YY FRONT carrolY with such provisions or the permit Mall be deemed Hawked APDRESO, LIC NO Pl- LICENSED CONTRACTORS DECLARATION C � "'r 7 O SHOE LIC PL I hejeby eHlrm that I am licensed wlderprovsorro of Chapter 9 SEWER ANP (cormmmiclg with Section 7000)of Drvnson 3 of the Business and So FT SIZE NO OF STORES NO OF FAMILIES Profession Code_UN my ticeres IS In full farce and effect NEW ❑ BK PQ , d Lio�}1e G 101 O Cj� A DESCRIPTON OF WORK ADD ❑ I QN p Cauractor�Data Q� w ` ALTER ❑ $ f.��0. CL7 ❑ I em exertlpl Sec C 23 REPAIR ❑ $ 1TiArl.i BAPC for the reason DRMDL ❑ ADMA P/C A 3303 50.50 Gate USE r�AID BLDG 11RM ❑ Signature APPLICANT TPRNT) TEL NO TDMA Perm♦ w1y.M ❑ I as Avner of the property or my employees wdh wages as z AM Avner . ��le War sole co pensation will do the work and the structure a ADDRESS M125.75 not Intended or offered for safe (Section 7044 Business and FINAL DAVE Professional Code) eau TIE APPuuM ORFTIIIIIE BUILDING occUMhff R4rolE A IVYlpous waER.L 2 ITEMS ❑ I as owner of the property em exclusively contracaq with OR A Monied�Oi°�o A RAZAnpous AMIEAMI EQUAL To OA OAEATEA nus nE ALp0 BIWEIED OR IIrE INZMpola wIEPLLLLB.FORUAl101I OupE? FINAL BY ` > hcaaed Contrectore to construct the prMect (,sols 7044 vE5❑ �❑ AL 176. 25 Busmesa and Professions Cade) GCO TIE fmElpm L�O' TIE sliovio In, TIE AAalrem OR F`Wv anaua 00ATr T WGUIREQUALM A rErwr FOR TRIcT(rioN aft I E PEF aoN sou TIE SCUM-1 FOR CONSTRUCTION LENDING AGENCY coe,T Ae a+NI*r uAuwOEUEM asnocr IsuoAlor WE.EAurnr+o clECKum R0A ( ( ,QQ oumElrEe I hereby affirm that there Is a construction WWwQ agerioy for v.Es❑ WO a the porfarmerce of the work far which the Permit s Issued(Sec u 11*c PEM TIE INZAIio0u9 WTErA4.91FOAMAIIDNOWE ANa LIE stoup Rwunno QQQO-�1 9/21/95 3097 Cry C 1 nEuum I uioersouio IA1'REOUIREMENIp uunER TIE we uioElEs cowry wad Lenders NamewoEqus Rwinw Auo IOITpaI.Cq A IF OYbTHE IUUu Is 2402 1 AM 8s42 Lenders Address o awc.a.mm Q I car* that I have read the apphcaWn and state under penalty y of perjury that the above Information is correct I agree to comply PO FEE �✓n 5-L) PEFMT FEE & with all county and State lave relating; o butlr➢rq construction and authorize represonler s of On RSUANCE FEE !30to enter Icon the for IllepeTl a m MESTIGATION FEE TOTAL FEE .....a Aw.w. ✓ SEE REVERSE FOR EXPLANATORY LANGUAGE : APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN I hereby affirm that I here a certacate of consent to eau .ot.e 0 3 t M EA O Q L V or a certificate�docff Workers ��aaCompensation Insurance « a canif*d Cr�,� copy thereof Y-'�T.ilbd2r.,m 4��I♦ 1�2MP rig � L«A� RTIKy No � wL� SIZE OF LOT NO OF BLOCS NOW ON LOT ❑/CerMietl copy q hereby tumshetl ST CROSS ST ,CI Certr ieo copy is filed with the county budGnp^pectm TRACT BLOCK LOr No USE ZONE ANP NO Datel men t Applicantsq� ASSESSOR MAP BOOK PAGE iMRCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTI N FROL WORKERS' RTEL Ins No COMPENSATION INSURANCE 1� TT retro+ 10OD FT OF SQN0OL7 T(This Section need not be completed if the pemet a f«one hundred SS dollars IS 100)or ass) JJ N O Yi P Iii DISTRICT GROUP suFIRE NNE PROCESSED BY ,6 .3 wi— bI certify that m the porf«mance of the work for which the permit a M (�' y is ,S0 P eed I shall not empty any person m ner arty manoro u to eOarTe auDfaCl b the Norkels CortpBreatKnt Lawn ARCHITECT OR ENGINEER TEL NO STATISTICAL C.L. J APT CONDO Date ApplicantADDESS CLASS NODWELL UNITS NOTICE 70 APPLMANT If after making the Certificate of REQUIRED TOLL SETBACK FROM EIOST Exemption you all0pro beporTlB subject ro the Workers CONTRACTOR TEL SEr BACK ypgp F1V/Y PROP UNE WIDTH Compensation proveions or the Labor Coda you must forthwith ,� L , ' -L/►y/ FRONT conWIY with such provisions or the permit shad be dBertiBd revoked ADDRESS LjCr ftp, �� P L LICENSED CONTRACTORS DECLARATION3�'10 GAO D W �(I�� SIDE PL 1 hereby affirm that I am licensed unrq derprov cof Chapter p n A'"TO AAV a (commencing with Section 7000)Of Orvision 3 of the Blcmtens and SO FT SIZE NO OF STORIES NO OF FAMILIES SEWER MAP Professions Code and my boar_tse a in full force and f((eet NEW ❑ BK PG 010. a LiceTne Numq� l ri 17 /�1 L, CX DESCRIPTION OF WORK ADD ❑ DM O .Es�� z ...` - aaE. 300 (� Contractor Date s ALTER ❑ $ 1 CHnn w.L. l77a '..C. REPAIR ❑ $ ❑ lam arempt abler Sec SAP for the reason S. DEMOL ❑ LOMA P/C Date 113E OF EXISTING BLDG URM ❑ RI signatUra ACCT.O APPLLOJIT v"� TEL NO LOW Por.0 = ❑ I as owner d the property d ret empk aril with wages e8 ,]� them site dor offered MTII do the Hark Site B smeau;a a ADDRESS F ,�..� not untended « dlBrBd for Bale (section 7044 &Ietnesa arta FINAL DATE Professions Code) i 1 waL ire APNGM OR nrA HA OIADVIO ooawm ILIAL A R GREATER THE 10-4—id/ ❑ I er owner r the property em the Prosy p(SeCh n WIRY AVI A AITS W DOKGReT A I ZARDO S 1 ATERNL EDWL ro OR GREATER 1RAri nla ecemed contractors b c«xiwct ma aolect tsectiort 7044 •Awr>s sPEraeo ON rIe NAr�or>ns u.TEwua.saMUTON ainc, FINAL BY ACCT.: aameas and Professions Code I "e❑ MO Cl64Z33Q3 125.75 WILL Tie.rTENaEo use OF TIE aLV1AiD er TIe rPnrcv+r oR wnslE auaowo omA,wNT rEclnE A FERWT Fon DONBTRBCTIai OR MOasIC.,TgN FROM THE eaurN CONSTRUCTION LENDING AGENCY «CAST A lDUALITY uwrAOEAEKT DISMOCT IaCA«U)SEE PEPoATNq c CKIJsr Fon 2 ITEMS I hereby affirm that there is a corutrucipn lending agency for ,Ee❑ „p❑ TOTAL 176.25 a the performance of the work for Which the Parma u issued(Sec o IIWE RE,D TIEHAINmDa$NATERYL!WFQAMTIDNrIIImE AIq 11E BDAdOfERNrtM r 3097 cN c) aeausT 1 UNDERswo My FE« IvENTa UNDER THE LDa Na 3 co,Nry cocE C�ECK 176.25 TITLE 2 DIPPTER t 20 SECTIONS 220 100 THKNXi1 2"14000001 N,L,IIDOIIe bF13� Lender B Name 1A{TERM!TENRrryD ftp FDR OBV JNNG A PE1OR m THE SCAOAm Lenders Address .00 p aw.of AONI g I certify that I have read information applicmation a site slate under penalty PO FEE D �fiM PERWT FEE O 1 8/ 9/TJ d peal that tris etas mfaa id St a carred I Spree ro D $ wah all ccu ordinances are state Iawe reletug b building cOnsBud m he Eby a neproeentatries or QWcounty ISSUANCE FEE 0 1751 1 AN 7:51 b enter the above- t properly for I purposes m WESTKNTION FEE TONL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL INDula AroREs�-� I hereby affirm that 1 have insurea certificate of consent to sell insure nsat-k-e or a certificate �Go�off7riv000rp/iummt Compensation Irnur w1,�e(1cceeVd*d -4F 61)eN copyPolicy r.o✓�(\�Y /�L \b Ca 4tg \��/' 1 i RS-2EOF ` NO OF SLD03 NOW ON LOT L ' ❑ Certified copy Is hereby furnishedCROSS 5 ❑ Certified copy m 1 the puny bullol mepeCipn ^ T BL0� LOT NO C_,rE te'/,-111 . ZONE NO Det Dant ASSESSOR MAP BOOK PAGE PARCEL SPECUL CONDITIONS CERTIFICATE OF EXEMPTION R WORKERS' 'to COMPENSATION INSURANCE IN WITHIN 1000 FT of SCHOOL? HES NO (Thi.creed not be completed A the permo is for one hundred ,ll 0 ,J OISIRICT GROUP TYPE F6iE IDrE PROCESSED 01' 15100)w lase) Carey that in the performance of the work for which thin permit !J� Zn 1a8ued I shall not employ arty pereon In arry marlrler so as t0 ARCRRECT ENGHEER TEL / r 0 become eublaLn to Ind Workers Compensation Laws STATISTICAL CLAS TION APT CONDO Dale Applicant ADDRESS CUSS NO � DWELL UVTS NOTICE TO APPLCANT N aftw maknp this Cerkicate of L"BACK' TOTAL SETBACK FROM EXIST Exemption you shDM become subject to the Yorkers ' YARD NYIY PROPDCanpersahon Pmwelors of the Labor Code YOU mst Whwdhcomply WM such prwnlors w this permit shall be deemed revokedLICENSED CONTRACTORS DECLARATION UC �S.`. 79 1 hereby affiml that I am licensed underprwsnnS of Chapter B SLIVER MAP (commertcslp with Section 7000)of Division 3 of the eusnesa and so SIZE NJ S NO OF FAMlIES Professions Code a0 Ic nee n m full force end act NEW BK P3 , TOT{ I 7 .79 a License Number go Class /0 ADD contractor aimmocALTER ❑❑ $, r 00 CFECK 167.79 ❑ 1 am exempt under Sac �1REPAIR ❑ C ,00 0 $ BAPC for this reason DEMOL ❑ Date EXISTING R URM ❑ LPN Plc 0�0-0001 9/ $/95 Sgn0ture NO LDW Par.• V12 1 AN 9:17 Z ❑ f as owner o1 the property or my employees with wages ea ACCT.i tlt r soh compensabon will do the work and the Structure n3303227.54 not mended or offered for Sale (Section 7044 Busmen and FINAL DATE GL Profeaaom Code 1 MILL THE APR1CNrT M FUME STWNa OCCIPMn n fOlL A INU100118 AU,EBAL G ❑ 1 W owner of the property am exclusively Con" arlp with M A AIO(iLTE coanuraa A IIATAroous WTERIAL Ed To OR OIEATFR TWR THE Q... TrITEMS kceroed Comractorn to CoMtruct the A4wM19 bPECFTiD ON nE WSAROWa MATEPoAl2.FpeARIgN aUpE, FINAL BY JTAL 227. 54 project (Section 7044 YEs❑ NOIs1R"L{Cl{B Business ertd Prolessoro Code 1 CHECK 227.S4 wit THE M USE aF T11E eunw BY TIE APRA:ANT OR FIlTUf1E el.S p accuwrr PECIrE A PETAST FaR CC14Tms1CTON oR NppFlGad FRCAr TIE souDl CONSTRUCTION LENDING AGENCY 47 owEVEa I hereby affirm that there s a corstruclon finding apercy for YEs❑ nn a the performance of the work for which thin Parma is issued(Sec C .00 m 3007 Civ C) pE W no P!I Aml UNDER_THE Ip,LJES eCOlp CODE iv Lenders Narita AW MALS RpORf q�Me�aSDJdKI A FRR>1 INE LeTldors Address 1 9/20/95 Q MFA U1 AR1R I certify that I have read due applcatin and state under penalty �p� g of perjury that the above Inlormeton n correct I apse W comply PC FEE PERLYT FEE n 00• Z 2`� 1 A�10:51 $ CKW4'qT lawsreetutp to busdtp Laenntwes of Ifus 15911ANCE FEEry for — i 04VESTIOAT10N FEE TOTAL FEDI� . /a, vCJ SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDINGGPERMIT COUNTY OF LOS ANGELES BUILDINAND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN e0n.ou+tR I hereby affirm that I have a certificate of consent to sell reuna jam' or a CoMflcate of Workers CompereaWn Insurance or a comfed Cfry J copy thereof(Sec 3000 Lab C) Policy Nom 714I 2. Comtxary V9&-f A1r I2LIJQA � / d0 912E OF L NO OF BLDG&MON ON LOT ❑ Certded copy a hereby fumehed NEAREST CROW ST ❑ Certified copy is filed with the comity building inspection TRACT BLOCK LOT NO Dateapartment I B_31_R�Applicant [ /,W3 $1ere ASSESSOR AMP BOOK PAGE PARCEL USE ZONE IMP NO 'i/ N�10 l 3 SPECIAL CO" CERTIFICATE OF EXEMPTION FROM WORKERS ea (� rte/ COMPENSATION INSURANCE YATNIN 1000 Fr OF SCHOOL? YES NO 0 him section need not be completed if the permit is for one hundred 95 �,,��.sy� C dollars($100)or less) r- cwftm .7 DISTRICT —1111 TYPE CONST RPE"%PROCESSED I certify that m the performance of the work for which the perms a as ad I shall not employ any person n any mariner, DD as to CT OR ENGIN TEL N� �� became subjem to the Workers Compensation Lava 1�l.pd(/.110 9 TISTICAL CLAg9SFI TION Dale Applicant l CLASS NO f � DWELL LDMAGTICE TO APFL)CANT II after making the CartdKate of ' pEOURED TOTAL Exemption you should become subfect to the Workers T NO SET SICK YARD HWY Compensation prov®ons of the Labor Coda you mist forthwithComply with Mich pruveprn or the permit Man be deerted revoked ;-, 1 L,D PLL FRONT 33000 1 ITE LICENSED CONTRACTORS DECLARATION IUWN SIDE I hereby aNum that I am licensed u derprovalons of Chapter g DC CLASS PL SEWER MAP 00 (camTercnrng with Section 7000)of Drwcn 3 of the Business,end OF STORIES NO of FAMILIES Professions Code and my license Is n fuer face and effect NEW ❑ SK PG CHECK 3065.00 R Llceree Number 47019S L,c Casa.$_ RESTADD ❑ %%LUAnON DON Contractor to —B-St- �' ALTER $ 0 SO CHANGE •� Cr ❑ I am exempt under Sec REPAIR ❑ $ 0000-0001 7/ 3/95 g BBPC for thus reason DEMOL ❑ u Date of LIRA ❑ LDMA P/C 1 1152 1 AN10:54 leu ACCT. z Signature MR TELNO LDAM f9m♦ - Z I as owner of the property or my ernpbyees with wages as Ztheir site compereatpn Will do the work and the structure a O �}/�� r1'' /1/�not Intended or offered for Sale (Sedan 7044 Business and FINAL DATE Q 3303 3836.00Prolesscns Code) DlT fnf111lH eum,o OCox111lr A HUAM US rMTEr6V. r,0 —`f—'l 7 ITE I IJ ❑ I ere OWI19r of the properly BRI excl ensfy Lo ractog with OR A„DtTaM CD Ar,1NG A IW.MppUS MAERML EOU1L TO on aREVER nwN TIE d T04 3836.00 licensed Contract= to CDetnct the Project (Sectwn 7044 Awa s� o nE NAs vRoola AllaEl�Ns KowAanal awl FINAL BY > Business;and Professcrne Code) Yes❑ Ip❑ �1�/�1/ Wu TIe r EQUIRo use xI TSE elIWRO er 111E A14LGVrr oR nouns eaaaF,O CHECK 3836.00 COAST AIR CONSTRUCTION LENDING AGENCY GUIDELINES MW OCCUMMr�aunE A PR1AT wit CORSrtaclpK on I,00sr,ATCN FBpw THE saunR .00 ThFR DWIITY NANAOE1.QNi dHfHLi IaCbMpl SEE PERWTTPq oECKuan TOR I hereby affirm that there a a construction lending agency for �s❑ w❑ l! n the performance of the work for which this permit a issued(Sec � m 3097 Cn C) TIME READ TIIE1wTArppUa MAlERwLBFFDWMT10NeLRDEAND nE BOAOwDPEPoAITTxe NIRJI! J1 �� m1lE2a1APfER tR]OCiDN9140 IOD TIiOUdR]YO 1COaCEIa@A IwlMpolq r1r1(1T1—lAR Lender a Name IAUEBUtE naPDRrr,o AID Foe OaDllm,o A PEwAi moo TIE BGaW 95 Lenders Address 2127 1 AM 10:19 o D.vrn W AO[M I CenAy that I have read the application and state under penally h g of Perjury that the above information a Correct I agree to comply PC FEE aQ PERWT RE /O $ with an County ord rigm,, and State laws elebrq to building Sp CDaotction and hereby authiX¢e'repassmatlMa of the Canty tSSLNNCE FEE �F 3 0 to enter Upon the above-men red property for inspection purposes pf WESTIOATTON FEE TOTAL FEES 9 9 !/ SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 SL 0508 1210150047 PHONE (626) 285-0488 EXT LEGAL ID I NO OF CONST NEW BUILDING ADDRESS BX 105 PG 86 PC 9 SQ FT STORIES TYPE OCCUP GROUPI 5535 ROSEMEAD BL I IsTiIUCTURE 0 1 V-B M I TEMP CA 917801802 I (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET 15387-032-058 I I THOMAS PAGE 596 GRID H4 LOCALITY TEMPLE CITY CAI ( ISSUTERANT EXIST BLDG ED HOMETOWN BUFFET IEXIST OCC GRPE MRESTA USE TONE I12/12/12N PROCE SRRfiD BY I I I I (OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINA;L D TE FINAL. BY CODE 1 11020IBUFFETS DI INC - I 17 Soo Ip �1 /iJl I 13020 DISCOVERY RD � fY I IfiAOAN MN 55121 I FEES PAIDIDES ION OF FORK I IREMOVING SEATING BOOTHS AA INSTALLING FREE STANDING ACTION I IFEE DESCRIPTION QUANTITY DOM AMOUNT ISTATION I APPLICANT TEL NO I I ISCHNIERE, STEVEN (951) 241-6876- Al PIANCHECK W/EN-HC 17500 00 VAL 343 20 1— 1 125251 ALESSANDRO BL AA BLDG PERMIT ISSUANCE 27 BO (SPECIAL, CONDITIONS MORENO VALLEY 92553 IAB STATE GREEN BLDG FEE 17500 00 VAL 1 00 I LAE STRONG MOTION OTHER 17500 00 VAL 3 70 I 1 IA2 PERMIT W/ENERGY-HC 17500 00 VAL 403 70 I I (CONTRACTOR TEL NO ID7 ADDNL PLANCHECK FEE 0 50 HOU 54 70 1APPTiOVALS DATE INSPECTOR SIGNATURE I ED DEACON CORPORATION OF CALIFORNIA (949) 222-9060- TOTAL FEES 834 10 1 I 17681 MITCHELL NORTH SUITE 100 LIC NO VOCATION AND SETBACKS 1 1 IRVINE CA 92614 760475 I 1— ISOILS ENGINEER APPROVAL I I I —1 1— 1 I (ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS I I I I I I I I I LIC NO I ISIAS/UNDER FLOOR I 1 I I IRAISED FLOOR FRAMING I 1 I I 1 I IMAP NO SEWER MAP BOOR PAGE FIRE TONE CMP I UNDERFLOOR INSULATION I I I 3 001 I I I I I IFLOCK SHEATHING I I IND OF FAMILIES DWELLING UNITS APT/COND STAT CIA-S 1 1_ I 1 0 NO 22 IROCF SHEATHING I I I I --1—1 I I SCHOOL WITHIN HAZARDOUS I SHEAR PANELS 1AIR QUALITY 1000 FEET MATERIALS I I I I 1 I NO NO NO I FRAXE INSPECTION I I I FIRE SPRINKLER HANGERS I I I IINSLLATION/WEATHER STRIP( II [INTERIOR LATH/DRYWALL I I 1 I EXTERIOR LATH RATED FLOOR/CEIL ASSEM I I I I I I 1 (RATED TALL ASSEMELIES I I I (RATED sHAFT9 OPENINGS 1 I IT-BAA CEILINGS ILOT DRAINAGE I I I 1 Ila£eGRr ID DPa261 aoDre TO Bs050e