HomeMy Public PortalAbout5546 #204 ROSEMEAD BLVD_Miscellaneous__ WORKLRS (Oki I'INSAIION III ( I NR \I IONMISCELLANEOUS APPLICATION
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1,
1 herLb% affirIliy
al I nL I LLIInILIIL UI LomLnl la a0 (OUNIY Of IOS ANGII FS BUILDING AND SAFETY DIVISION I�L
I Insure or a Lertll Icalt of Worl,Ln (onlpul,nlon IIISUI InLL 0I
1 certified LOP) thereof ISec 18011 f ah ( )
Rdu) No. (onlpall) FOR APPLICANI TO FILL III BUILDING
BUILDING ADDRESS � ADDRESS
® (Lrti NLd Lop) I, IILrlh) IIIrI1NIILII Y�/���'���'(/�/�Y/ Al 14IJl.IC! LOCALITY
t (ertllled clip% I,IIILd Unit IIIL LountI buildnit, III pLlllllll CITY ZIP �j NEAREST
department �/ CROSS IT 1
Due \pphl on SIZED L/OT NO OF BLDGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY
( I RI If If At Ill 1 al NII'I ION I RONI \\ORAI If+ 3,1� —_- ___ _ __ cortsr
BLOCK LOT NO
.l (ONIPLNSAIION INSURAN( I IItACT N1LRY... l
wY mlwclX� STATE MAJOR SECOND LOCAL
(Thi% S tIImI nod lint be compkiLd If on. mud IInOI%td ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS 1
b) the permit n for one hundred dull it% hI/R)1 ill It%%)
LEL NO
v I tool) Ili II In ILL Ix rlann mLL til Ihl %...1L I,,I ,%IuJ1 this OWNER
ptrmn b usuLd I Shill nor Lulpi0% m) pLISOO til 1n) it iun`r ADDRESS '
SO as to become %Ub)eu to Iht Worker (onlpin,111an 1 te, OCCUPANCY GROUP r'
Dne _ APPIILInI CITY ZIP —
NOTI(L TO AI'PI I(AN 1 II BILI in ding Ibl. ( 1111111 OL OCCUPANT LOAD
of Exemption Lou should betomL ,uhlell lu IIIL \\UrLLrs APPLICATION FOR
Cum PLmenon pro%Ivon,of the Libor(adL yn1 must lordivalt ^ EXIT HARDWARE
CUMPI) %ull %ULIl pnTblUlA or hits Nnuil ,hill bL llt Ull,.d TR 111 ER OIL LJ GEOLOGY INSPEC ICON❑ No Spec KMWI Elrevoked {{ P
Panic Devices ❑
I IC LNSI U (ON I RA( I ORS UI ( I AK \I U IN OCCUPANCY INSPLCTIONW
I hLrLh) dthrM 111,111 tin 11Ltrned Undtr pio%isioos ill I Il 1pltr SAFETYPERMITO LIST ITEMS BELOW,
J 9(CUmMe11L111g"till SLLnon 70001ul DILnlom l lit lhl BL%IIIL„ NO OF EXITS
and Prof-S,lOI1S(odL Old ui) IICUi,L 1% In lull IOILL Ind Dol
- l/ �� �J�/ 1-_ I/•n t� PARKING RED D PROVIDED
,�/L L
1 I ulna Ill'
n
I IL ( I , SPACES
1 I onti Ilwl Out LIMITED TIME USE
• I DATE DATE
❑ 1 am exempt from the 11Ltru1119 rlyunlnani. I, II Im a FROM TO
3 LLenxd irchiltcl or 1 rcgl,,.rLd ptolt,suind tn_U1LLr
nling In 111) pwlL„Ion,d L Ipitil) (sLlbOn 711,1 lin,m... slrF or No O INSPECTOR s
1 LXIbnNGwIK ____ ,l opus_ SIGNATURE
and PtolL„lon, (odL 1 -- - --
Lac or RLI; No ])I[, PRESENT USE OF BUILDING FINAL APPROVAL 14/1 d
11 II(MII OWNI R 111111 DI R OI ( I \R \110N N 1 01 1 .IIHCst BUR UINL a1
LIN Ill AN U IISL 1 14
1 hInnli U nq
trtb) Ill II till LSL ,t 110111 Illi.Illi. ( SU
till ran
Ural . 1�Lta
IaW 411 IIIL 61110xulg let,011 ISLLIIIXI 7(111 , Ilu.nu_ uW
ProlL,Smin (odt) NO PARKING
rul I t, oumr of Ill, pngxli% 11.11 dig ILL 111-1L 1d 111, sPLLF,r Ro rtDCD__
s11GLIUK 1, not Ont-ndtd ill ,1111111111-11111 ("'Oh"t 11111 )( PRO,Osr O USE OF BUILDwo
Business and Prokssion, (odL) -- -
I (ONSIR(1( ]ION I I NI)IIN(I \(11 N( 1 t-"�- e' � (fi .n
IILrl hl 1111 rill Ilio 1Ill IL 11 11011.11111 t 111.1 IL 11111111 11 bn
ILL IlLnann mLL til Iht x%111( Ln ahllh Ili, IIT limn n L,uul - - --
(tiel 11197 (I% ( 1 PROPOSED MAX UCC
`-1 LendLfs Name APPLICANT IflU?I TEL NO
I Lndtr, Addrts. Ano Ess 3
1 LLrIny that I It lit rL ld Ili, apphLaIlan old ,I UL 11111 I111. S• O,V / ))�j
abovL Inform neon IS LorrLtI I agrLt to Llullpb %%till all( Rlult PERMIT FEE
ordinances and Slate laws relating to building consarlltlllq Ind
hereby authorve rlpre,ent IIOLS of Ihl, Collin) it, Lnitr'upon ISSUANCE FEE
thL abOVLn1LIIIIOlkd Prorkrry for n1,I,lLnon pu RXta.
IOTAI ILL
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