HomeMy Public PortalAbout5610-5618 1/2 ROSEMEAD BLVD_Building__ DEPARTMENT OF BUILDING AND SAFETY �7� APPLICATION FOS PERMIT
COUNTY OF LOS ANGELES BUILDING _
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN I�FOR OFFICE USE ONLY T
r DIBTRICT No. - — PLAN CK.NO -- --PERMIT NO
BUILDING I I'
ADOR¢pB � ®�
LOCALITY RECEIVED BY I DATE OF APPU DAT[ IRRU¢D
NEAREST
C BT
pUILDING
ADDRESS 1 3 b
DWNER i
MAIL LOCALITY T. G
ADDReea c
NEAREST S I ` IfJ(/ /O `/
Ta CROSS I ✓
CI N FIR[ NO or. TYPE GROUP
ARCHIT[CTOR ) TEL ZONE PLANS
ENGINEER I NO
BLDG
ADDRESS S[TBACK'LIN[
APPROVED
CONTRAOTO 1 '� BY /q� 1 I 1 DAT[
US
ADDRESS /l J ZONB-�� [D
rBY VI DATE
LEGAL ZQ Q CORRECTIONS
DESCRIPTION BLOCK
� 1
I
TRA
4?74N OF OLVM
SIZE OF LOT NOW ON LOT
UB[OF NO OF NO OF 1
EXISTING,ICO FAMILIES ROOMB J
DESCRIPTION OF WORE -
NEW ALTERATION - --
O
REPAIR MOVING DEMOLISH p
Bq FT OF - ',tf ' �•� Z
BIZ[ ROOMS STORIES
WALL ROOF j
COVERING COVERING
UBE OF N[W
13UILDIN /
/O
v Q
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT IN R AT[
AND AOR[[ TO CON Y WITH A L OUNRY OROINAN Cm FOUNDATION LOCATION
AND STAT[LAWS R LATA 1 INC OO NBTRIIOTION FORMS, MATERIALS
1. FRAME FIRE STOPS,
SIGNATURE OF BRACING, BOLTB
PERM ITT¢
LATH, INT. /
AUTHORIZE AOT 0
LATH. EXT I"
TAI.AiA-a law se P C B PLASTER. INT.
v ' `RE PLASTER. EXT
VALUATION r[c FINAL
APPLICATION FOR
BUILDING PERMIT
FOR APPLICANT TO FILL IN
BUILDING
BUILDING /y Y
ADDRESS / /�L li I/ LOCALITY
C NEAREST
CITY _A (� / ZIP CROSSST
y O OF BLDGS ASSESSOR
SIZE OF LOT /I 2/ NOW ON LOT o MAP BOOK PAGE PARCEL
T C< / BLOCK LOT NO Jv DISTRICT GROUP TYPE ` FIRE SSED BY
C ST
TEL 6—OS
OWNER NO STATISTICAL CLASSIFICATION SEWER P
ADDRESS CLASS NO DWELL UNITS BK PG
l/� USE ZONE NTEL
TEL
O
CITY ) ZIP 99 /j� !J
ENGINEER OR
Q /qp p'� /NCO CJ pJ '^ SON DITIONS
ADDRESS 7F/(,J',1 //Ej��/1 0 r(/ Moor ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑
CONTRACTOR D✓`� TNO L?I WeD BLDG SETBACK FROM
LIC FRONT PROP LINE OF (STREET)
ADDRESS NO HIGHWAY + YARD TOTAL SETBACK FROM I TYPEOF IEXIST1i7G
LIC FRONT PROP LINE HIGHWAY WIDTH
CITY CLASS
CONSTRUCTION LENDER � + a
NAME AND BRANCH D� BLDG SETBACK FROM
ADDRESS CITY SIDE PROP LINE OF (STREETI p
SO FT NO OF NO OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SIZE STORIES FAMILIES D ONE - SIDE PROP LINE HIGHWAY WIDTH a
DESCRIPTION'O,F LWAORK e,E7 ()l n/ NEW + - Z
69 Al W7/ vS�L Sl6u ADD ❑ CORNER CUTOFF YES ❑ NO ❑
ALTER IN OPEN SPACE YES ❑ NO ❑
USE /�"y ,.7/J�/E REPAIR
MSONG BLDG V QA/ `"`D lDEENpOL IN COASTAL PERMIT ZONE YES ❑ ��NO ❑
APPLICANTTEL
/� n` O NO /O/7 O (.h?J5 — INS C.E/L �J/
BY(SIGNATUREI 1(/L �i(� l�yDL/T'S /N 6-INAt- Al 'IV 7-/,V
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WDRK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CAUFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE 7
SIGNATURE OF FINAL /l l / BY
PERMITTEE DATE
ADDRESS '/p
CITY � / Np jPP 7/lo PC Fee$ Permit Fee
Issuance Fee —•
VALUATION$ � �
11 Total Fee
PLAN CHECK VALIDATION CK IN o CASH PERMIT VALIDATION CK m o < c"H
2 2�NOV 2 ,1 O 9.0 0 An,
�L leAe3ee aE/eoaB e/)e
rp Yv�
• APP LiltTATION FOR
BUILDING PERMIT
FOR APPLICANT TO FILL IN AUDDRING //
BUILDING f O ��/hQ� LOCALITYNEAREST
(�
ADDRESS v
CITY ,[J GF ZIP CROSSST
NO OF BLDGS A55ESSOR
SIZEOF LOT NOW ON LOT MAP BOOK PAGE I PARCEL
DISTRICT GROUP TYPE FIRE ESSE Y
TRACT ]BLOCKI - LTE NO S CONST ZONA
OWNER �f/K3 rrl '�-e T 3883 $TATISi1CACLASSIFICATION SEWER
ADDRESS o 163 CLASS NO �' DWELL UNITS BK PG
GTV ZIP USE ZONE MA �)OO
NO
ENGINEER
EERR NNO 2 SPECIAL O�
EO J CONDITIONS
ADDRESS
,L �7 I, ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONTRACTOR 6� 1c Q O ')D �y BLDG 5 ACK FROM
ADDRESS007 t'i NO a i aJ$ HRONT IGH Y P +NEO ARD - ISTREETI
1 TOTAL SETBACK FROM TYPE HWA EXIST'
rn`Z wOOc�.. LIC FRONT PROP LINE HIGHWAY WIDTH
CITY CLASS �' I
CONSTRUCTION LENDER + n
NAME AND BRANCH BLDG SETBACK-459M OV
�^ $IDE PROP ISTREETI
ADDRESS �� CITY LINEO 0 O
50 FT NO OF NO OF CHECK HIGHWAY + YARD TO FROM TYPE OF EXISTING
SIZE STORIES FAMILIES ONE SIDE PROP HIGHWAY WIDTH ti
+ Z
DESCRIPTION OF WORK lr • NEW
�� O ADD CORNER CUTOFF YES ❑ NO ❑
T`O ALTER IN OPEN SPACE YES ❑ NO ❑
USE OF -7'), REPAIR IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTINGBLDG .%�/Haa
l b DEMOL
APPLPRINITI (� W ��ff TEL
Ul IlD
BY ISIGNATUREI
HEREBY A WLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THEA IS CORRKTAND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENLSATION INSURANCE
SIGNATURE OF FINAL BY
PERMITTEE DATE
ADDRESS _
TEL �,�pJ7 P C Fee$ (f Permit Fee
CITY w� NO JT
Issuance Fee
VALUATION$ o2 Q D o
Total Fee dZ
PLAN CHECK VALIDATION CK w o c"H PEWIT VALIDATION CK mo"
o C"N
928LnNOV 223 D 1 4.40 �d
mE �aAeaee cE NKue ene _ 9 2 9 i NOV 2 .1 D 2 4.0 U 0�5
JRKERS COMPENSATION DECLARATION
,firm
3tifcatte of WorkesrtComtpenof consent to satonInsurane'f APPLICATION FOR BUILDING PERMIT
1. w copy thereof (Sec 3800 Lab C )
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
Certified copy is hereby furnished FOR APPLICANT TO FILL IN DRESS
ADDRESS
Ap 7"
Certified copy is filed with the county budding mspec- BUILDING
�(
tion department ADDRESS � tq- N• os� �a
Date Applicant CITY 1141V ZIP t '7O " LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS �J NO OF Bt / N EST •i •
Q
COMPENSATION INSURANCE SIZE OF LOT Z �'7 NOW ON LOT OSS ST
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars ($100)or len ) TRACT S 2 BLOIX LOT NO _I' N• MAP BOOT( PAGE PAROL
T� �jCJ3 USE ZONE
I certify that In the performance of the work for which this OWNER - �/✓ U /,LND
permit is issued I shall not employ an person any manner ADDRESS O 1� CI SPECLOL MAP R
so as to became subject to the Work Com sahon Laws CONDITIONS O
Dole ���&I Applicant CITY MON ZIP )• Of
NOTI TONT If, after makin ha Certificate of ARCHITECT ON S, gL t 0!(pj•t �� DISTRICT p TYPE FIRE SSED BY O
Exemption you should become subje to the Workers sL ODNST / ZONE U
Compensation provisions of the Labor Code, you must forth- ADDRESS ' LA) .L V6 rF 2- .-/c`-0 �••'1 I U
with comply with such provisions or ilia permit shall be TEL STATISTICAL OASSIFICATION APT DO 0-
deemed revoked CONTRACTOR �Jb NO 70 -
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS_
I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS NO
(commencing with Seaton 70001 of Division 3 of the Business and LIC SEWER
Professions Code, and my license is in full force and effect CITY CLASSpGi6 VALIDATION
50 FT NO OF NO OF CHECK
License Number Lc Clan SIZE STORIES Z ONE
VALUATION
Contractor Date DESUI OF WORK NEW
J ADD $ OOO�� a 7 Z 6
1 am exempt under Sec Zo12. S d W CALTER , • • ire z•
B 8P C for this reason /.V w4u" REPAIR f • • J / c=i
Date EXISTINGBLDG
v Bl a ceMOL 0 1 %—8
Signature APPU T ''f (� NO IV) -71
OWNER-BUILDER DECLARATION DAA
1 hereby affirm that I am exempt from the Contractor's License �¢ ],pl? 14 .,
Low for the following reason (Section 7031 S, Business and ADDRESS W' FIN
Professions Code) BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation will do the work and LOCis11iY '
the structure is not intended or offered for sale(Section
7044, Business and Professions Code) MOVING TEL
I as owner of the property, am exclusively contracting CONTPAL70R No
with licensed contractors to construct the project (Sec- ADDRESS
non 7044, Business and Professions Code)
L SETBACK i, �W
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIPS WIDTH -
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is Issued P L
(Sec 3097, Civ C ) SIDE 1 7 6 5 7 P,
PL
Lender s Name � • • . •'.
$ LDMA Ref Y
Lender s Address _ P C Foe$ Permit Fee SO I • • 7 a U
I certify that I have rood this application and state that the buarce Fee S ) LDMA P/C Is , o . • 7 a G L0 G
above information �tonect I agree to comply with all County Investigation Fee /�/�J
ordina ea and a laws relating to building construction Total Fee (! `- IDAfA Perm • () Pa I 2-87
and h r by auth ze representatives of ilio County to enter
upon a above honed property for Inspection purposes
e-o—V M F"EM►OR KXPLANATOIY LANGUAG
Slgnat n of Applt�ant«Agent
,w '„mPENSATION DECLARATION -
'fico I haver certificatek tionconsent ranself
ee, - APPLICATION FOR BUILDING PERMIT
.tr.ificate of Workers' Compensation Insurance,
d --opy there6f(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILD G AND SAF TY
r Acy No._ C.mp-. y /U-e
Certified copy is+;ereby furnished. FOR APPLI NT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building inspec- BUI LDIN 7,
lion department. ADDRES
Data Applicant CITUZIP e' - LOCALITY
�ERTTRCAiE OF EXEMPTION FROM WORKERS' _ ! -
If, NO. OF BLDGS.% NEAREST
COMPENSATION INSURANCE SIZE OF Lor p:-' jNOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one "Z. / ASSE55OR _
hundred dollars ($100)or less.) TRACil !�; BLOCK LOT NO r MAP BOOK PAGE! _ PARCEL
,!x�///�� c TEL USE ZONE MAP
OWNER r�'�C-/NY UA/ - NO. ��7�2L, )
1 certify that in the performance of the work or which this SPE T
permit is issued, shall not employ a person' any manner p �.' / SPECIAL 0
so a5 to become subject to the Wor 'Com nsafIan
Laws. ADDRESS /Z2-f7�-j � , - n 'L TR f--Y CONDITIONS O
M / CITY %�l f�N 1=.r C f- ZIP. 1z '•.
Date `� // , I Applicont ARCHITECT OR TEL O
NOTICE TO APPLICANT: If, after maki this Certificate of ^ - �If') r71,C DISTRICT GROUP tYPE _ FIRE TDBY
f,
ENGINEER ) ,r9L .NO
Exemption, you should become subject to the Workers' /}�� CONST. Z NE ly
Compensation provisions of the Labor Code, you must forth- ADDRESS ,,U) , L - �' V� � . -� ?r. � �-V. � / 6
with comply with such provisions or this permit shall be - w
h TEL.; STATISTICAL CLASSIFICATION APT. I YONDO, Z
Jeemed revoked.
CONTRACTOR / 7r- C P NO;
LICENSED CONTRACTORS DECLARATION - 'LIG CUSS NO. DWELL. UNITS_
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
(commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP
Professions Code, and my license is in full force and effect. CITY CLASS BK. z PG, /6/'" VALIDATION
SO. FT. NO.,OF NO. OF CHECK
License NumberT Lia.Class SIZE STORIES FAMILIES ONE
11 VALUATION _
Contractor Date DESCRIPTION OF WORK NEW _ -
_ ADD I $ , + ✓ �' _
I am exempt under Sec.
ALTER _ r'
B.BP.C.for this reason F REPAIR
USE v
Date: EXIST
ING BLDG DEMOI..
APPLICANT TEL 92 S
Signature
OWNER-BUILDER DECLARATION (PRINT) NO. - DATE � r2"/ -
I hereby affirm that I am exempt from the Contractor's License - n Q '_-
Law for the following reason (Section 7031.5, Business and ADDRESS FIN J
Professions Code): PRESENT BY
❑ BUILDING -
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and Pilo.
the structure is not intended or offered for sale(Section LOCALITY -
7044, Business and Professions Code). MOVING - TEL -
I, as owner of the property, am exclusively contracting CONTRACTOR - NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). !
REQUIRED TOTAL SETBACK F
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
1 hereby affirm that there is a construction lending agency for FRONT L,
the performance of the work for which this permit is issued P.L.
(Sec. 30W, Civ. C.). SIDE -
RL
,nder's Name _ -
'CMA Ref. Jr
'er's Address P.C. Fee 5 I 7 Permit Fee �')
' [ /
L J V LDMA PI
/ PF
fy that I haver d tis application and state that the Issuance Fee /C#
/ information Is codec, I agree to comply with all County Imesl;gatian Fee c`,_ - -
ce4 gnd State lows relating to building construction, To+al Fee 'J LOMA Perm. #
by,outl7orize representatives of this County to enter
abo e-me ti9 oned property for insp
q �n ^
/ �— Li � g SEE REVERSE FOR EXPLANATORY LANGUAGE /
ure of Applicam or Agent s Date - ~
WORKERS'COMPENSATION DECLARATION
I hereby affirm That 1 hovea certificate of consent to self APPLICATION FOR BUILDING PERMIT
I insure, or a certificate of Workers'Compensation Insurance,
or o certified copy thereof (Sec. 3800. Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building mspec- BUILDING
lion deportment. -�' ADDRESS
Dote, Applicant " CITY ZIP _. LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one ASSESSOR y
hundred dollars($100)or less.) TRACT BLOCK LOT NO, MAP BOOK PAGE PARCEL d
TEL USE ZONE MAP
I certify that in the performance of the work for which this OWNER NO. NO U
permit is issued, I shall not employ any person in any manner SPECIAL Lit
so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS J
Date Applicant CRY ZIP ARCHITECT OR TEL >_
.
NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROUP TYPE FIRE PROCESSED BY
Exemption, you should become subject to the Workers' CL
ENGINEER NO. CONST ZONE
Compensation provisions of the Labor Code, you must forth- ADDRESS d
with comply with such provisions or this permit shall be
deemed revoked. TEL STATISTICAL CLASSIFICATION APT. CONDO.
CONTRACTOR NO. W
LICENSED CONTRACTORS DECLARATION LIC CLASS NO. DWELL UNITS_ h
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
(commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP
Professions Code, and my license is in full force and effect. CITY CLASS L- BK PG VALIDATION
50. FT. NO.OF NO, OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW
VALUATION
Contractor Dale El VALUATION
ADD El ,
1 am exempt under Sec. ❑
ALTER
B.BP.C. for this reason REPAIR ❑ S
Dote: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL. FINAL
OWNER-BUILDER DECLARATION PRINT NO. DATE
I hereby affirm that I am exempt from the Contractor's License
Low for the following reason (Section 7031.5, Business and ADDRESS FINAL
Professions Code): PRESENT By
afBUILDING
'as owner of the property, or my employees with ADDRESS
wages their sole compensation,will o the work and LOCALITY ,
the structure
for is not intended or offered for sole(Section
-- 7044, Business and Professions Code). MOVING TEL
I, as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY SETT BACKK YARD HWY IOTA PROP LINE VKUM
WIDTH
hereby affirm that there iso construction lending agency for FRONT
to performance of the work for which this permit is issued P.L.
-ec. 3097, Civ. C.). SIDE
PL
endei s Name
LDMA Ref. a
ender's Address P . Fee S Permn Fee '
1 ,edify that I have read this application and stale that the Issuooce Fee LDMA P/C M
above information is correct. I agree to comply with all County �n.esrigoeon Fee
ordinances and Stale laws relating to building construction,
and hereby authorize reprasen Lives of this County to enter TOIOI Fee LDM4 Perm. M
upon the above-mentio operty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applmont or Agent Dale
WORKERS COMPENSATION DECLARATION
I hereby affirm that I have o certificate of consent rself
maw APPLICATION FOR BUILDING PERMIT
re a certificate of Workers Compensation Insurance
nce
br a certified copy thereof (Sec 3800 Lab C ) r�
Policy NoO a 1 Company �/yG[ COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING
ADDRESS
❑ Certified copy is Bled with the county building inspec BUILDING
tion department ADDRESS
DateApplicant CITY ZIP !2/1790 LOCALITY
CERTIP16ATE OF EXEMPTION FROM WORK S 4 NO OF BLDGS NEAREST _
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars({100)or less ) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL
TEL USE ZONE MAP
I certify that m the performance of the work for which this OWNERNO
permit is Issued I shall not employ any person in any manner ADDRESS O / C 3 SPECIAL
so as to become subject to the Workers Compensation Laws CONDITIONS O
Dote—Applicant
CITY OR ZIP U
NOTICE TO APPLICANT If after making this Certificate of ENGIWR TEL
DISTRICT GROUP TY FIRE E Q BY O
Exemption you should become subject to the Worker'
Compensation provisions of the Labor Code, you must forth ADDRESS s,D W
with comply with such Provisions or this permit shall be - d
deeW
disarmed revoked CONTRACTOR No���S- �.f STATISTICAL FICATION APF CONDO Z
LICENSED CONTRACTORS DECLARATION / UC CLASS NO DWELL UNITS_
I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS p NO J O /zIN
(commencing with Section 70130)of Division 3 of the Business and SEWER MAP
Professions Code, and my license is in full force and effect Cm 52 CLASS 6K PG VALIDATION
63 9 �.//�� SO FT NO OF NO OF CHECK
License Number 110 L Lic Closs� SIZE STORIES I FAMILIES ONE
,,_ NEW VALUATION
Contractor Date�� DESCRIPTION OF VAM f \ 60z'0
❑ ADO
I am exempt under Sec LL /
ALTER
B 8P C for this reason REPAIR f I�
USE OF p
Date EXISTING BLDG DEMp'
Signature
OWNER-BUILDER DECLARATION FR= T� ��6p DATE I-7 //fW
FIKAL
I hereby affirm that I am exempt from the Contractor s License L _I
Low for the following reason (Section 7031 5, Business and ADDRESS FINALProfessions Code) /7� BT A IQ • ' •'• • 2
F-1 1,I, at owner of the property or my employees with ADDRESS
wages as their sole compensation will do the work and
the structure is not intended or offered for sale(Section LOCALITY
7064, Business and Professions Code) MOVNG TEL Poo
❑ I os owner of the property, am exclusively contracting CONTRACTOR NO -�'—
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY BACK YARD I HWY I TOTAL SETBACK FROM EKIST
PROP NINE WIDTH
I hereby affirm that there is o construction lending agency for FRONT
the performonce of the work for which this permit is issued P L 31 1 29.3 A
(Sec 3097, Civ C ) r i� I ' 1 SIDE
Lender s Name IDMA Ref A
6 4i � � PC Fees Pe mn Fee Q ( • • 4550
Lender s Address
I certify that I have read this application and state that the Issuance Fee f O LDMA P/C 0 • ' • 45506
above mformotion is correct I agree to comply with all County Investigatwn Fee
ordinances and Statens
laws relating to building construction, Total Fee 1 209-88
and hereby outhorize representatives of this County to enter LDMA Perm •
upon the above mentioned property for inspection purposes ,
TER RRVII FOR EXPLANATORY LANOUAGR
Sigrsature PI ant o (Lent Dote
WORKERS COMPENSATION DECLARATION _
t I hereby affirm that I have certificate of consent tonAPPLICATION FOR BUILDING PERMIT
,insure, Or a certificate of WorkersComCompensation Insurance
or a certified copy thereof(Sec 38D0, L ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No I I III03 Com ny '— �,,�T U
❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN �� 5-010 N I CJ,Qrh�C�-
❑ Candied copy n filed with the c my building,'ding In - - TNG �V1�
tion department J� rYt�CL 1t/ 'ISL Lc,l '—
�t
Date — Applicant
CITY -Q I71 `�"'- BL-1 P LOCK
CERTIFICA OF EXEMPTION FROM O RS SIZE OF LOT NO N LOT MR ST LL Vl O�
COMPENSATION INSURA
(Thu section need not be completed d the It a for one - ASSESSOR
TACT &GCI( LOT NO M4P BOOK PAGE PARCEL
hundred dollars ($100) or less )
TEL
OWNER - NO USE ZONE INO
MAP
I certify that in the performance of the work for which this SPECIAL Y
permit is issued, I shall not employ any person in any manner ADDRESS CONDITIONS d
so as to become subject to the Workers' Compensation Lows _ Q
CITY ZIP U
Date Applicant ARCHITECT OR TEL ce
TYPE
NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO DISTRICTUP FIRE SSED BY t-
Exemption, you should become subject to the Workers! �� -3 /[ , V
Compensation provisions of the Labor Code, you must forth- ADDRESS _ `_ t� Q.0
with comply with such provisions or this permit shall be TEL i STATISTICAL CLASSIFICATION APT CONDO
deemed revoked CONTACTOR NO — I z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS— -
I here affirm that I am licensed under ADDRESS e-� NO SEWER MAP
by provisions of Chapterii? DC
(commencing with Section 7000)of Dlwuon 3 of the Business a
and Professions Code,and my license n in full force and effect Cin BK PG ACtZA[IDATION
50 FT NO OF NO CHECK
License Number Lic Close SIZE STORIES FAMILIES ONE �:,I}� 17.I_'
Contractor Date DESCRIPTION of WORK T NEW ElVALUATION= 1 ITEtI�
El am exempt under Sec El A r ► TI}IML 137 - 07
B 8P C for this reason V
REPAIR ❑ : �/ (! ' 1. ._
Date EX NG BLDG �2�- ❑ • 1. � •I-I-
g APDL T FINAL
Signature OWNER-BUILDER DECLARATION (PRINT) L HAM NO 7 DATE _p[� -
I hereby affirm that I am exempt from the Contractor's License 7T_.�CIOCt1
Low for the following reason (Section 7031 5 Business and ADDRESS FINAL L- 1 AMr•li
Professions Code) PRESENT Bya --
❑ 1, m owner of the property or my employees with BUDDDIINNGS
wagesas their sole compensation,will do thework and / 3307 2L.9
the structure is not intended or offered for sale(Section LOCALITY
7041, Business and Professions Code ) MOVING TEL 1 ITEMS
❑ I as owner of the property, am exclusively contracting CONTACTOR NO
with licensed contractors to construct the project (Sec- - - TOTAL 212.93
tion 7044, Business and Professions Code ) ADDRESS ^_ (`�( 2 ' ,97
CONSTRUCTION LENDING AGENCY SEi BAO YARD HWYED AL SE paAOCEFROM E%I \ .�, y\ CRANE Oct.
hereby affirm that there a a construction lending agency for FRONT I -
the performance of the work for which this permit is issued P L "
(Sec 3097 Civ C ) SIDEgy
Lender's Name r'-'' `.
PL —f � 0000-001010000-00101 11/ 6/89
Lender's AdAddress
PC Fees Permit Fee Ref 6590 1 AM10c59
i
g I certify that I have read this application and state that the 1CQ, luuanceFee405
µ P/C N .01
above information is correct I agree to comply with oil County In_vesngotwn Fee
ordinances a State jaws relating to building construction, Total Fee r Perm p
g and hereby uthorize repre tatives of this County to enter
rT upon thea Ye-mens�,an/ operry for Inspection purpos
n2 N /" YJO -3_L5 / _ TEE WERfB WB EXPLANATORY LANOIlA6L �Cpp C7 +�+InL
Signoture of�PPI,94nt or Agent Date `40 `Q O VI CJI
heWORKERS COMPENSATION DECLARATION
reby affirm that I haver certificate Come of tion Inca sal, APPLICATION FOR BUILDING PERMIT
insure ora certificate of Workers Compensation Insurance
or o certified copy thereof (Sec 3800, Lab C )
Policy No Company COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is hereby furnishedFOR APPLICANT TO FILL IN �REss
Certified copy is filed with the county building mspecBUILDING t
tion department RESS —� O �
Date Applicant CITY r ZIP 7 LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT Nb ON DG NEARESTT �(- J
COMPENSATION INSURANCE
(This section need not be completed If the permit Is for one TRACT BLOCK LOT NO ASSESSOR
hundred dollop($100)or leas ) MAP BOOK PAGE PARCEL
N USE ZONE /
I certify that In the performance of the work for which this OWNER 2 NO
permit is imod, I&hall not employ any person in any manner ADDRESS Y �� J SPECIAL
so as to become subject to the Worken ompenaatlon laws CONDITIONS O
Dote Applicant CITY ZIP lY
NOTICE O APPLICANT If, taper making Certlfl to of ARCENGM OR NLO DISTRICT GROUP TYPE FIRE SSED BY
Exemption, you should become subject to the Worken,' C' CONST ZONE
Compensation provisions of the Labor Code, you must forthu ADDRESS U J V 0 ✓ 3 W
with comply with such provisions or this permit &hall be a
deemed revoked CONTRACTOR NO STATISTICAL CLASSIFICATKKJAPT CONDO Z
CLASS CONTRACTORS DECLARATION LK: ASS NO 'n DWELL UNITS_
I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS NO
(commendrg with Section 700D)of Division 3 of the Business and LIC SEWER MAP /
Professions Code and my license n in full force and effect CITY CLASS BK L PG 1bq VALIDATION
SO FT NO OF NO OF CHECK
License Number Lic Cla SIZE STORIES FAMILIES ONE
vALUAnoN
Contractor Dote DESCRIPTION OF WORK `' $ O pit a� C
I am exempt under Sec ADD O
ALTER
B&P C for this reasonIS, REPAIR $
�o7aea
Dote USE oENOI
EXISTING BLDG 4.9,(
Signature APPLICANT TE �1 FINAL # • • • • 2 3
OWNER-BUILDER DECLARATION WiINi DATE
I hereby affirm that I am exempt from the Contractor's License I • - 37.50
Low for the following reason (Section 7031 S Business and ADDRE
F1BUILDING FINAL
Professions Code) BT . • • 3 7,5 0 iia
I, as owner of the property, or my employees with ADDRESS
wages t then sole compensation will o the work and LOCALITY 010, 0928-88
the structure n not f intended or offered for sole(Section
7061 Business and Professions Code) MOVING TEL
® 1 as owner of the property, am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec- ADDRESS
hon 7061 Business and Professions Code)
CONSTRUCTION LENDING AGENCY SET A" YARD HWY TaTAILSETEACK
PROP UK WIDTH 2 1 1 4 0 A
I hereby affirm that there iso construction lending agency for FRONT #ie • e e 1
the performance of the work for which this permit is issued PL
(Sec 3097 civ C ) ^' SIDE I • • 4 0 5 0
(IM, PL
Lender s Nome • • • 4 R5 06
''ll IDAAA Ref Y
$ Lender t Address P C Fee fS—d Permit Fee (.J .
11, 15-88
I certify that I have read this oppbcation and state that the I. once Fee v s-0 LDMA P/C Y
above information is correct I agree to comply with oil County Inv ,gw on Fee
$ ordinances and State jaws relating to building construction, Total Fee .0 TDMA Perm
Q and hereby authorize representatives of this County to enter
upon the ab a-men an property for inspection purposes
9 M RRV@M FOR EXPLANATORY LANGUA09
Sign Nr of Applicant or Ag 1 Don
WORKERS' COMPENSATION DECLARATION
h hereby off insure,
kers'' ComComthat have a certificate of consent to ,elf APPLICATION FOR BUILDING PERMIT
insure, or a certificate of Worpensation Insurance -
.or a certified copy thereof (Sec 3800, Lab C) - -COUNTY OF LOS ANGELES BUILDING AND SAFETY /
Policy No I -Z-Company 45T - TliLl D
BUILDING
IL❑TMJ Certified copy is hereby furnished R244"'�<
OR APPLICANT TO FILL IN gODaFcc
Certified copy is filed with the county but inspec- O N•
tion department S S t3LU
Date _6 Applicant '/ I � ✓G �Z ZIPDGS LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' LOT FLOW ON LOT REO SST '[MN 17R
COMPENSATION INSURANCE _ ��R
(This section need not be completed if the permit Is for one BLOCK COT NO MAP BOOK pqC{ PAjiCEL
hundred dollars ($100) or less ) TEL r
NO LKE ZONE MAP
NO
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner S SPECIAL d
w as to became subject to the Workers'Compensation Laws CONDITIONS O
PDate Applicant ECT OR TEL DISTRICT GROUP TYPE �/ FIRE BY t�NOTICE TO APPLICANT If, after making this Certdlcate of ER NO 5,b(� F\3Chi -+— � 0Exemption, you should become subject to the Worker' ZONE
Compensation provisions of the Labor Code, you must forth- S a
with comply with such provisions or this permit shall be p TEL O.y » STATISTICAL CLASSIFICATION AFT CONDO N
deemed revoked CONTRACTOR J ".) M NO uta "3 ZJ z
LICENSED CONTRACTORS DECLARATION UC CLASS NO DWELL UNITS_
I hereby affirm that I am licensed under provmons of Chapter 9 ADDRESS NO Q 7 SEWER MAP
(commencing with Section 7000)of Division 3 of the BusinessLIC
CI �lbN q l'73 CLASS '-U
and Professions Code,and my license is in full force and effect BK PO VALIDATION
r �] �/ SO FT NO F NO OF CHECK
License Number J�Z� 7 / LIc Class C—44- SIZE SIDRIES FAMILIES ONE
,�tt �rT���,Yt ,, ee DESCRIPTION OF WORK NEW ❑ VALUATION
Conhactor,!��r KLutlLDateJ�� _ o""�
1 ADD ❑ S Bao ,
❑1 am exempt under Sec HE S
ALTER ❑
B 8P C for this reasonZ S� REPAIR ❑ $
�e USE
EOFEXJSTING BLDG DEMOL ❑
Signature APR NO E)S- -tib•TEL FINALCANT
OW -EIER DK TC1N ♦� DATE /
I hereby affirm that I am exempt from the Contractor a License ADDRESS 2444 M A145 roLiI
Law for the following reason (Section 7031 5, Business and FINAL 1
Professions Code) property, or my employees - BT {T.t
❑ I as owner of thees a
BUILDING q0D
wagas thesole compensation,will do the work and 3307 54.25
the structure is not intended or offered for sale(Section LOCALITY , 1 ITEhIS
7044 Business and Professions Code ) MOVIN13 TEL
❑ 1, ce owner of the property,am exclusively contracting CONTRACTOR NO
with licensed contractor to construct the project (Sec- ADDRESS TOTAL 'rJ9 2.!
tion 7044, Business and Proferloas Code ) (E(�, 59,2;
CONSTRUCTION LENDING AGENCYUIRED SET YARD HWY 'OTAtBAOCEFROMEXISTC .00
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P L
(Sec 3097, Civ C ) SIDE
PL ODOO-0001 12/ 8/84
y Lenders Name
PC Feef Permit Fee TDMA Ref Is 7369 1 AM QJ ¢9
Lender's Address /{
a I certify that I have read this application and state that the Ivuonce Fee V LDMA P/C N
above information is co t I ogres to comply with all County Investigation Fee (�
ordinances and State la relating to buildug construction, Total Fee `l I _DMA Perm N
and hereby authors esentabves of this County to enter
upon the above i property for inspection purposes o
ME REVERSE FOR EXPLANATORY LANGUAGE
Stgnatur f*pINMNw Altent Date
J \
4 . WORKERS COMPENSATION DECLARATION
hereby affirm that I have rk rs, Ccote of tidnconsent to self APPLICATION FOR BUILDING PERMIT
' insi}re or a certificate of Workers Compensatidn Insurance
or a certified copy thereof (Sec 3800, b C )
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING / ,
Certs} o is filed with the court buildin ms ADDRESS O
PY ty g Pec BUILDING D
non rtment (^ ADDRESS
Dote Apphcont .7 CITY ZIP LOCALITY c
E IFTCATE OF EXEMPTION FROM WORKERS NO OF BLDG$ hffAiREST L
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST AAJAJ
(Thi section need not be completed if the permit is for one TRACT BL LOT NO ASSESSOR
hundred dollars ($100)or less ) MAP BOOK PAGE PARCEL
TEL USE ZONE
I certify that in the performance of the work for which this OWNER NO NO 1�
permit is issued, I shall not employ any person in any manner �/� SPECIALS
so as to become subject to the Workers'Compensation laws ADDRESS V CONDITIONS U
APP CITY ZIP
NOTICE TO APPLICANT if, after making this Certificate of ARGI R F TEL
0 DIS ICT GROUP TYPE HRE PROCESSED BY OE..
Exemption, you should become subject to the Workers' ��y./ CONST ZONE U
Compensation provisions of the Labor Code you must forth AODRESS �./r Vp - J
with comply with such provisions or this permit shall be TEL?/ STATISTICAL CLASSIFICATION APT CONDO
'deemed revoked CONTRACTOR 2
e CQ
LICENSED CONTRACTORS DECLARATION LIC OASS NO DWELL UNITS_
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP
(commencing with Section 7000)of Divivon 3 of the Business and I 1 UC
Professions Code a my license is in full force and off t CITY Z*/��N CLASS Pr BK PG y/L4�L 2 A
SO FT NO OF NO OF OiEfX
License Number L c Class SIZE STORIES FAMILIES ONE # e e e e 2 3
VALU ON
Contractor Dote DESCRIPTION WORK NEW
r-11 am exempt under Sec ADD $ , ) • - 57.38
ALTER
B 8P C for this reason /
n USE /A� t
EXISTING BLDG
APPLICANT
? 57,385
K DEAWI . .
$grwfur ANT TEL FINAL '
OWNE UI ER DECLARAT PRINTa&EC DATE 0603 -88
1 hereby affirm that I am exempt from the Contractor s License
Law for the following reason (Section 7031 5 Business and ADDRESS
Professions Code) INtZ,tN1 /
❑ BUILDING '
I as owner of the property, or my employees with ADDRESS r
wages m their sole compensation,will do the work and LOCALITY
the structure is not intended or offered for sale(Section
704, Business and Professions Code) MOVING TEL
❑ 1, as owner of the property am exclusively contracting CONTRACTOR NO ;@9921 A
with licensed contractors to construct the project (Sec
tion 70", Business and Professions Code) ADDRESSi # e e e is is 1
CONSTRUCTION LENDING AGENCY REQSET I YARD Hwr T '� LNE WIDTH ( e - 9675
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P L e e e 96755
(Sec 3097, Civ C ) SIDE
Lander s Name PL 0617-'88
8LDMA Ref Y
Lenders Address P C FMS �� Permit Fee //ryry Lc�J
I certify that I have read this application and state that the W..Fee OL a IDhW,P/C Y
above information i correct I ogres to comply with all County Investigation Fee / /
$ ordinances and State lows rs ng t siding construction, Total Fee LDMA Perm w' i
OZ h u raze repress tiv of this Countyrot
u is ntioned or inspection
f6 OVERfE FOR 11EXP ANATORY LANGUAGE
5 e of Applimgeem or ADore
•WORKERS COMPENSATION DECLARATION
• APPLICATION FOR BUILDING PERMIT
I hereby affirm that I have a certificate of consent to self
insure or a certificate of Workers Compensation Insurance .. -
or a certified co y thereofBUILDING(Sec 3BOO Lab C ) COUNTY OF LOS ANGELES BDING AND SAFETY
Polity I
NO 3� Company 'VM
❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN �O
® Certified copy u filed with the wunty budding Impec- BUILDIIJG - _
hon deportment '°momOle
Dote 4/Applicant J�r a1r ZIP NEAREST
k _ EXEMPTION
NO Bl NEAREST
CE TIFICATE OF EMPTION FROM WORKS S' 512E OF LOT NOW ON LOT CROSS 5T
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACE SLOOC LOT NO MAP BOOR PAGE PARCEL
Hundred dollars ($100)or less ) TEN
OWNER ,y 115E ZONE MAP if/ /"
I certify that in the performance of the work for which this �,,{( o�•od
permit is issued I shall not employ any person in any manner ADDRESS O ✓ CONDITIONSSPECIAd
sa as to become subject to the Workers'Compensation Laws O
CITY ZIP
Dara Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO CONST Z
ONE-
Exemption, you should become subject to the Workers' .
,7 HM T
Compensation provisions of the labor Code, you must forth- ADDRESS l/P V/ ..J
with comply with such provisions or this permit shall be TEl STATISTICAL CIASS KATION RAPT CONDO
deemed revoked CONTRACTOR NO
LICENSED CONTRACTORS DECLARATION / LIC CLASS NO ELN U ITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS,3044 k.NO SEWER MAP
(commencing with Section 7000)of Division 3 of the Business UC
and Professions Code,and my license is in full farce and
�effeectt CI NO G NO OF CUSS CHECKCHECKBK PG "yLATALIDATION O
License Number rci nd�zLic Classkan1�_ ySIZE I STORIES FAMILIES ONE VAWATION ITEM
Contractor a //; / DEscRIPTION of woRK ADD O 5 ► CHEF
ElB 8P C for itiTOTAL 134 o2
am exempt under Sec ANTER ❑ r 1�4...�
REPAIR ❑ CHANCE ,1111
s reosan 5
Date USE OF
EXISTING BLDG OE int ❑
Signature APPLICANT TEL FINAL 1311300-131301 11: 719
OWNER-BUILDER DECLARATION (PRIM) NO
1 hereby affirm that I am exempt from the Contractor's License f & DATE _ 4�S�r 1 AM S'%4.
Law fp the following reason (Section 7031 5, Business and ADDRESS FINAL
Professions Code) ey
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sale compensation will do the work and ,
the structure is not intended or offered for sale(Section LOCALITY
7014, Business and Professions Code ) MOVING TEL
❑ I, os owner of the property, am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec ADDRESS
tion 7044, Business and Professions Code )
CONSTRUCTION LENDING AGENCY IRED YARD �, AL UNE WIDTH
OX FROM IX
I hereby affirm that there is o construction lending agency far FRONT
the Performance of the work for which this permit is issued P L
(Sec 3097, Civ C ) SIDE
PL
Lender s Name
PC Fee 5LDMA Ref t
Pa ma fee
Lender s Address
I certify that I haver d this application and state that the luuonce Fee S LDMA P/C 0
above informat n s co ect I agree to comply with all County Investigation Fee /
ordinances and I relating to budding construction Tora1 Fee 3 (O LDMA Perm It
< and hereby out i e ntotnves of This County to enter
AYI upon the alio rty for inspection pis
I M REVERSE FOR EXPLANATORY LANGUAGE
Sig ant Agent
WORKERS COMPENSATION DECLARATION
hereby:affirm that I have w ceCmte of consent to self APPLICATION FOR BUILDING PERMIT
insure• a certificate of Worr kers' ompenaation Insurance, -
• or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SA
Policy No Company BUILDING
❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS �6 OSF�1
❑ Certified copy Is filed with the county building inspec- NG
�1 b.S�'�� �- J
tion department .f
Dote Applicant - 1,
' ��' ZIP LOCALITY v
NO 5FBU3Q5 NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT or NOW ON LOT CROSS ST - O
COMPENSATION INSURANCE _ _ ASSESSOR
(This sedwn need not be completed if the permit is for one TRACT BLOCK LOT NO AWP BOOK PAGE PARCEL
hundred dollars ($100) or lees ) �L USE ZONE MAP
' OWNER �' L N NO ( 7�('
I certify that in the performance of the work for which this NO
permit is issued I shall not employ any person in any manner ADDRESS ` EI 3/?,, v CONDITIONS a
so as to become subject to the Workers Compensation Laws _ _ O
CITY ZIP C/T
Dore Applicant ARCHITECT OR TEL K
NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO DI ROUP COP
ARE D BY O
Exemption, you should become subject to the Workers �� ../iT
Compensation provisions of the Lobus Code, you must forth- ADDRESS T
with comply with such provisions or thin permlt,sholl be TEL STATISTICAL CLASSIFICATION APT to
deemed revoked CONTRACT NO z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO i5kDWELL uNlTs
I hereby affirm that I am licensed under provisions of Chapteri? ADDRE NO
(commencing with Section 7000)of Division 3 of the Busineu
LK SEWER MAP
and Professions Code,and my license Is in full face and effect Cin CLASS BK M• VALEDATION
SO FT NO OF NO OF CHECK
License Number Lic Class SIZE I STORIES FAMILIES ONE
VALUATION
Contractor Date DESCRIPTION OF WORK NEW $ 61
El1 am exempt under Sec L i&ee ('e'er LN33 ADD ❑ ,
,, ALTER ❑
B 8P C for this reason �AI. V �% REPAIR ❑ $
Date USE-OF.
EXISTING BLDG DEIAOI ❑
Signature APPLICANT
-0,V4 L- 7 U &/6v No Zi? FINAL 23
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License OATS ACCT.IF
,Law for the following reason (Section 7031 5, Business and '� �9 Y17 'Ai e-5 k FINAL
'PeM salon e), - .�- NT - 50.150
X 11T-�1 I, �foziflttSl/e/progeny, or my employees with �� IF
1
woges oti
s their sole compensation,wtll do the work and J,,/
the structure n not intended or offered for sale(Section LOCALITY CT.i
7044, Business and Professions Code ) CONTRACTELTOR ElR NO / `M3 108.90
I as owner of the property, am exclusively contracting N
with licensed contractors to construct the project (Sec- ADDRESS I V " { // 2 ITM
bon 7044, Business and Professions Code ) 1 1 .YJ/\
CONSTRUCTION LENDING AGENCY I YARD AL NCEFRQN WIDTH IST TOTAL 159 . 40
I hereby affirm that there iso construction lending ogency for FRONT _ CFIECK •'�
the performance of the work for which this permit is issued PL
(Sec W97 Civ C ) SIDE •�
PL
Lender s Name
P C Fee f 0•�b Permit Fee x(pQ LDMA Rel 1
2 Larders Address �/� 0000-0901 6/11/96
0 1 certify that I have read this application and state that the Issuance Fee v c/a/ LD IA,P/C Y , � 1 rJ�13
above information is correct I agree to comply with all County Investigrnwn Fee e /�
ordinances and State laws relating to building construction, Total Fee %D IDAW Perm
and hereby authorize representatives of thts County to enter '
upon the above-mentioned property or inspection purl
V,_ / E/(n Og G SEE REVERSE FOR EXPLANATORY LANGUAGE
&gnature of Applicant or Agent to
CbUNTY OF LOS ANGELES TEMPLE CITY 0 D508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUBUS TENANT IMPROVEMENT
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0106280017
PHONE (626) 285-0488 ENT
ON FILE SG FT STORIES TYPE OCCLP GROUP 5610 1/2 ROSEMEAD BL
STRUCTURE 500 1 VN B TEMP CA 917801842
ASSESSOR INFORMATION NUMBER 5387-028-017 NEAREST CROSS STREET
THOMAS PAGE: 596 GRID H4 LOCALITY TEMPLE CITY
TENANT EXIST ULOG USE LOMME___0E 2NE ISSUED ON PROCESSED BY EXPIRES ON:
CHEN, ROGER EXIST OCC GRP B 07/18/01 UT 01/14/02
OWNER: TEL RO: OLDrS NOW ON LOT WONG CHARLES;KEN,JIM;IRENE LI - 5,000
9200 VALLEY BL [ ( Ol
ROSM 917701900FEES PAID
'
TEMA T11 IMdROVEMENT FOR 6UIAL OFF
FEE DESCRIPTION QUANTITY: UOM AMOUNT:
APPLICANT- TEL NO-
KWOK (323) 728-4833- Al PLANCHECK W/EN-HC 5000 00 VAL 129 62
109 E FLORAL DR AA BLDG PERMIT ISSUANCE 27 75 SPECIAL CONDITIONS
MONTEREY PARK AE STRONG MOTION:�OTHER�5000.00 VAL 1 05
A2 PERMIT�W/ENERG JHCLE$5000.00 VAL 152 49
PN TOTAL-FEES 310 91
CONTRACTOR TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
NONE - �0�' NTy
LIC NO TION 5t;RCKS
NONE
ARCHITECT OR ENGINEER FOUNDATION/TRENCH FORU-
KWDK TERENCE (323) 728-4833�/
109E FLORAL DR LIC NOll 1111SLAII/UNDER FLOUR
14DNTEREY PARK, CA C-24796 J'
RAP NO: SEWER MAP BOOK PAGE: FIRE ZNr__7W-3 VVF1 04 M EMC �l'��,��0 �K 6
FLOUR SHEATHING
NO Of FAMILIES M=0 LIMITS APT/COND- STAT CLASS�_
NO 22V a' g ��-� OOF SHEATHING
�\SCHOOL WITHIN O 0 1SHEAR PANELS;
AIR QUALITY 00 FEET MATERIALS \ (/ ❑
NO NO MO A ❑ -.IISFRAME INSPECTION
:?O.O
4 O t� FIRE SPRINKLER HANGERS
ServlceThaINSULATION/WEATHER SnU
�o
INTERIOR LATH/DRYWALE--
EXTERIOR LATH
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID DPR261 ROUTE TO BS0508
COUNTY OF LOS ANGELES TEMPLE CITY A' 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SIGN
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9803260077
PHONE (818) 285-0488 EXT
LEGAL ID NUMBER W-Mgr—T BUILDING ADDRESS
ON FILE SIGN DESCRIPTION NEN 10 LETTER FOAM SIGN 5610 1/2 ROSEMEAD 8L
TEMP CA 917801842
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
5387-028-017 THOMAS PAGE 596 GRID H4 LOCALITY TEMPLE CITY
TENANT EXIST BLDG USE ISSUED ON PROCESSED BY EXPIRES ON
OMEGAS INTERNATIONAL EXIST OCC GRP 03/26/98 UT 03/26/99
OWNER TEL NO SLOGS NOW ON LOT VALaOTW_ FINAL DATE FINAL CODE
HONG CHARLES KEN,JIM,IRENE LI - 400 ¢_z_q L
9200 VALLEY 6L
ROSH 917701900FEES PAID DESCRIPTTdw uF WORK
NEN FOAM LETTER SIGN (10 LETTERS)
FEE DESCRIPTION QUANTITY UOM AMOUNT
APPLICANT TEL NO
SUCCESS SIGN (626) 280-8932- AA BLDG PERMIT ISSUANCE 27 75
AE STRONG MOTION OTHER40400 00 VAL 0 50 SPECIAL CONDITIONS
AX BUILDING REVIEW-FEE=_\ 54 70
02 PERMIT W/O-EN-HC GE L E C 400'00`VAL 43 50
05 P, TOTAL(FEES T 126 45
CONTRACTOR ILL NOAPPROVALS DATE INSPECTOR SIGNATURE
SUCCESS SIGN (626) 280-8932- V V y
820 E VALLEY BLVD LIC NO LOCATION AND SETBACKS
SAN GABRIEL CA 91776 739177 C45
LIC NO lllilli 1`
CNPI
F, U[35 CL 0P)ANO OF FAMILIES DWELLING UNITS APT/CUNO STAT CLASS
C�
NO 20SCHOOL WITHIN HAZARDOUS
AIR QUALITY 1000 FEET MATERIALS
NO NO NO
t0t`/
S°7vMce Th%�
REPORT ID DPR261 ROUTE TO BS0508