HomeMy Public PortalAbout5546 #105 ROSEMEAD BLVD_Miscellaneous__ NORALRS (OMPLNSAfION DL(LAR41101, ,-o1 na,atnar11 n quo MISCELLANEOUS APPLICATION
1 .
I hereht affirm that I have a cerificate of Luounl In a COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION II
Insure or a certified,, of Workers Compensdtunl InsuranLL Lr
a certified cont thereof (Sec 3800 Lab C)
Polio No Compam FOR APPLt'-AN7 TO FILL IN BUILDrvG
XBUIL EB ADDR[s L/
Certified cop` ,, hereht furnished! tj
SGI 'C�e71/ Loc•&ITv l
Certified cop\ Is I fled with the count` bmldmE mspecnnt CITY I ZIP 1 p� ` Ne+RI gr
department -I D CROs s-
Dale_ Apph Can _ 512E F LOT NO OF B-DG5 NOW ON LOT DIST, N GR P TYPE P BED By
CER-IFICATE OF E\LMPTION FROM NORKLRS 1 -- � IcoNs�
COLI PE NISyTION I\'SUR ANC E TRACT I B-OCF I LOT NO
rb CMCLC STATE.-JOR SECOND LOCAL
(This section need not be completed If the "ork In\ol\c( ASSESSOR MAP BOON (PAGE &P�ARZELUSENE ISPEGIA-CONDITIONS
M the permit Is for one hundred dollars KIWI or less'
I Le'W\ Ili 11 m n, p.rfurmlm. ,n Ili. Noll Iar ,h, L 111, OWNERp-rmn n i,suLa I sit d' not empia, am pLI.M In ,I iiialino Dropert)sit a, m become ,ud1.r m IhL \larken Cump,n,duu^ LaN, Amall bD J OCCUPANCY GROUPDate _ ApplicinI CIT` ZIPNOTICE TO1PDLI( ANT II illel mal,m_ Inti C.rull.ats OCCUPANT LOAD
of Exemption \ol should hCLO!"i subject to the INor,,er, PPLI" TIO"'FORAIT riAROIYARc 1
Compensrior oro\ ,iqn,of the Lobo Codc tot mus, lortimm J
comph NJnI sl❑ prouslom or Ihl, nermll .nail m o- in-( TRAILER USE GEOLO3s NSPECTIOh=1
I
OCCU4Nc1 INSOEC-ION_ Panic De,t-2s J j
LICE\SeD (U\TR AC fURs UGC LAR ATIO\
I li:rem altlrm I dl I am IlLen,cL under pro\i,mm m ( it Ipi,. SAFE-` PERMIT._ LIS-1-E.$BELOW
9 lcommcncin; \utl S—tion 7NIpt o1 Diu,Ion m Ih, Bu,ina, NO Or EM*S I
ma Prolep,iUm Cod and ml IICLn,: 11 it I1111 lnr, 1,10 LNLLI _
Ll:ah \I alb^ L1 ( 1„ PARNIh REG C PR01 I_ZV
BPA.:Er
on I. itLIMITED TIME USE
DATE DA-E
J I In, esemp 1„1111 the II,Ln,III- r,quir,111.111 1 I Illi F.O. TC '
II.-n,.d r,1 III, Ir 1 r.-nlLr.d Pio h„InnJ n-Int IN Or s
a"mc n. nil Oral „Ion d .Ip un\ ,\-,IIa❑ 7011 I{u,inL„ S eE Or Nc 01 - ATURE
and Prole„Ion, I.OUC 1 E%I6TINL BLDG STORIES
'RESENT LSE 0'EIUI�D NG FINAL �Pr^I'.7NrML &
Li: o Ret No UII
HOME M\ \LR Bt,11 DLI, DE( 1 sR d IU\ Nc D•E%IS711C BUI-JINLSrl� •L'
ON LOT AND USE
I herein all trm Ilia I tet .tLntpt trrnn IhI (nm nLlrn , LILLII,L f�
Lau lot the soh.min, re son ISLcoun 7(171 s BUSMLSs and
;P''""r��olesslons COdel NO PARNINL
1.1 I as nN iter Ill the SPACES PROVIDED
properl` till do the Nark nW Ili
structure 11 not Intended or olm«d fo sale(Section 7(Ltj� PROPOSED USE OF BUILDING
Business and Prraesslons Coder 7;11}�1- tl _ -7
CONSTRUCTION LENDING NGLNC) -
1 hereb\ affirm that There is d conaruction Iendm), agent\ Iii
the performance o, the uork for Nh1eh th11 perms, 11 I14ll.6
(SOC 3097 CI\ CI PROPOSED MAX OCC
Lenders Nam[ _____ _ _ _ •• IC+ T r 1 E O I I
Lender s Address
1 Denlft that I have read [his application and_ state &hal the
above Information is correct I agree To comph unit all Couno 1 PERMIT FEE
ordinances and State laws relating to building conmruc ion aflll
hereb` authona representatives of this Court In enter umin ISSUANCE FEE
,rte aDOW-mentioned r
ropers or Inspection porpU,c,
I TOTAL FEE
�{}
/�✓�� Q f V 0 SEE FEN ERM FOR E\Pl ANATORI LANbI AGE
rater-oI Pcrm me u.,.