HomeMy Public PortalAbout5546 #104 ROSEMEAD BLVD_Miscellaneous__ IORF LRS ( OtIPL\S>TIO\ DL( L\RaflO\ 76 BTS CE 875 11 Bal MISCELLANEOUS APPLICATION r�
1 herein alfum that I have a certl lMle rl -onsem o self
insure or a Lertifinteof tlolLCr% Lonimnunon fnsurinte or COUNTY OF LOS .ANGELES BUILDING AND SAFETY DIVISION '
A Lcrtiflyd Lnp% IhLreol ISCL 3814) Lab ( I
Pollcn \n —1 ,nmam❑ FOR APPLICANT TC FILL IN VUILDIRc
Certified LOP, I% hrrebn 'urnsshLo BUILDING Ll.b N. Rus�A� BLVD 'Q
>COREss Loc,ur
1 h ❑ Certified _ops I,hied ,ith she xlnn buddm IntpLl[Jon LOCALJTv Y[ww Esr
department Temple City cwo¢s sr
Date 1pPh-ant ......r OISTR Ic cR rvr¢ cessEO ev
.Ro S. sT W�} +� co Ne T'�•
CLRTIFI( \TE Of L\E\IPTIO\ FRO\I t('RnL R� LECAL [� •�
t,)\IPr\S MON I\A R %\l L oEscPlP- OY Lor Yo OLccx I..••
' INO Jf DLOO^ ,E ICa•CL[I
STA" MAJOR SECOND LOCAL
by t section need nn[ he hundred d ll the nod inn tilled f-RAC- loin JN LOT use -ON[ Slee AL conn mons
by the perms Is for one hundred dollar, 6I1101 or less 1 Iu3E ow
1 I sl.. Or Lor _
E CISTIYO wL.7v
1 =e•tJ% halm hl rv,o-nan.r •r ' t s � t L ,hlc'I his
permit n ssu Ld I ,hall ill, mplon In, ne-%on n an, MIMILcrNER
SO AS '0 LeL •ITLu
, bleL a he 't orkt-, n^Lncaur^ ' I„c A L �.1,� OCC'JP AMC 3ROCO
AO ow¢ss I E/ S8M -
Date l,vvhcan
NOTICL To \PI'Llt\\T I' u e -n.vr_ - -SIL rtr $] c - 13KOADWAYYc ^CCUP�V- I_C-aC
[%emet'n I 'vu ,nrnl,l hAorl' ,u' lec • h, U., Ar
tLmren S' on era ieu,n, a It, I IN n
,ou •nu%t , 'I
deemed m tit-,n' ill' n„ III , 11 .flail '• =Aiu. ISE = .Co Zr Y .__- cN —_ NO SCrc '<,C
LII L\SCD,0\1 R\(TORS DU LAK A'I(' JCCJP4NCY INSPEc-lOs Can C De' rec
1 he eb, a"Irm hit I _A lice^sed unde vm,merso ( tar _ SAr E-- PERMIT —
' 0 'LImn enune ,n,,h SCL on -0001 of Dnncl tei _ 1, .he Bu — I`Is- ITEMS .111.0 YO or E\I-s
nese and O , .cum, C,d Ind m ke", 111 irr ^ arc
sr%ces +eo J r I •,+o nOeO
o LI.Lnu \I Irv _— I . C'I,
LIMITED TIME USE
[ or -iLl" I'll
e, ❑ I Am ,\^•rpt 10111 'P' ILLn,mc rLat Lc 11-9 c 1, 111
h[rmed dTLltl LL e=lmered --•`Iewontl •nvnee -r_E o• No C- .N s.e crow
z aL lr_ r n p-enJ ^ - ” „ ' Il -,19-Iv' R_OO -pe _p SI ATu E
3 mesa..la I til „0.n 'U"
LIL r K c ARE OF OU'L.IYc FIN A� ROV AL
a \� — _ fI� _
IIU`IL ( \\\I R bI ILULR DEC\': \fl')\ YO IF ¢xlsn NC 111u1LOINo3
IN LOT AID USE J
I hrrcrL el vin hat t am L\cmpt 'mm h^ C,n;IL[a S - - -
I LIL.na La, re th, folio„uI- ret,on ISLLn,•n -^_I ' Bu,)
ness and P elesslons Code) Yo .,wlclNe
I as awner of theSPACES rRovin Eo
proper•, ,n ill da 1•c ,Leri. and the
arut tire Ie not intended or offered III, .de 'S,Lnon
i 044 Nuwn,s and Pwi, ow(ode) y
LO\STRLMO\ LENDI\G \Gl \C' A PROPOSED USE Or OUILOIMO
I li.icb, atfGnu that there IS a Lanatnlcttan lendme ISLn,, bwrigm
1 for Ilk pLrlunnanLL of IhL %ark for µhlLII 1111% pLrmn IS
ISSLILd (SIL 3007 Ci, C )
LendLr a Name
PROPOSED I+Ax OCC
Lender s Addrecs _ I1l1
I Certd% that I htle rend t111s applvLlion anti ,tate that the PERMIT FEE 25.00
above mfninitnm l%UTrtLLt I Ieo.L 10 IOMPl) nVthall(O[Ial' ISSUANCE FEC
ordm.lm.cs and Stale laps relating to buddim Lonstrultlon
[ and herebs authorize representatnes of this (fount) to enter TOTAL PEE 25.00
upon tht I enr-mentioned pmperil for mepeLtio Purpose%
SFC RL\FRSE FOR E\PLANATORI LANGL' \GF
I �
SIEn a of Per ittee Date