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Home My Public Portal About5617 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING PERMIT �] COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADOREss �e I hereby aftlmn that I have a mp nsati Of Insurance to sen ftfie BUILDINGS"°I°RES9 �� `L� Q'Lv� > I e u a a certificate d Workers Compensation Irqurence ar a cerbletl �r�/^�r1 • COPY thereof(Sec 3800 Lab C) Cn, G' IID "It / S 0 LOCALITY Policy No W G A x{s,D L7 `�ppoany a� �kd�j [-I SU'E OF LAT NO OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished NEAREST CROSS ST ❑ Certified copy IS tied with the county budding inspeUpn TRACTBLOCK LOT NO departmentLASE ZONE /AAP NO Date t1CON ASSESSOR MAP BOOK PAGE PARCEL gra-Y-a.�-1}- APplrcanl (,TI SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' TEL I NO COMPENSATION INSURANCE R u y N U u 3 a� tf, WITHIN taco FT of s0t+oaLa YES ra (This section need rcpt be completed if the permit IS IM one hundred ADDRESS II. DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED B1' ddlam($100)« less) i t)) .1 ( (�Vtih 1 �.o osl I certify that n the performance of the work for which thin permit CRY pLak � q 17�l1 n y 6- �L 1 e issued I Shall not employ any person in arty manner so as to Y/O / J became wbect to the Workers Compensation Laws ARCHITECT OR ENGINEER TEL NO ��6� 4�7��1�''''....��s STATSTIC&L CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO -?O'Z DWELL UNITS NOTICE TO APPLIOANT If after making this Certificate of REWIRED TOTAL SETBACK FROM E%IST Exemp6an you should become aubtact to the Workers CONTRACTOR 'r nn � TEL No SET BACK MRD HWY PROP UNE WIDTH C nPsr SoUDn provisions Of the Labor Code you must fcrthwlth YT V t^,4.T"(-Ti rAJ the)S7 vsV4L comply with Such provmorn Or this permit shall be deerned revoked q . , ^ - pp pLIC NO PL [FRONT A�q Wit ,vim L%Ma� S 6' 10 IDE LICENSED CONTRACTORS DECLARATION �. LIC Cogs L I hereby affirm that I am licensed underprovlslorte of Chapter g SEWER MAP (commencing with Section 7000)of DNrsorl 3 d the Business arta SO FT SIZE NO OF STORES NO OF FANIlUES NEW ❑ BK P6 pop.Code and my license is In full force an/d��effe�ct�� 1-cense Number �1h �-IoS L, CW, / _(6 C� DESCR�TION of Nt7RK ADD ❑ .VALUATION "C d. Contractor .�¢�. _ Date U Y\ ALTER ❑ $ iff" ❑ 1 am exempt under Sec REPAIR Nr BAPC for this reason DEMOL ❑ 1 Z LtMAA P/C• A. T Date USE OF EMSTING BLDG URM ❑ rt'_ Signature ovv APPLICANT(PRINT) TEL NO LDMA Perm• 1313 1�4•�- ❑ 1 m aver d theen tionery w the employees with wages as Z ` thea sofa compeeatpn will do the work erld the etruclure s ADDRESS O � ITEIfa not intended or offered for sale (Section 7044 Business and FINAL DATE professional Code) TO TIE APPIICANr oR FUNRE euA.OHIO ocwr,Nr HNId.E A MATErUI p TOTAL 204 78 ❑ 1 as owner d the property am exclusivelycontracting with OR A MUnURE CONW A ILWIOWa WTERML Ea4L TO OR aPEATER TINN TIE EI„ 204.72 licensed contractors uCt the project (Section 7044 wars SICCED ON MAROOus WMRwsw GUIDE? FINAL t:H Business and Prdeselors Code) s❑ o❑ o LHAI rIj I WILL RAE MENDED USE OF TME BONST By THE NVJUN! OR FROLI SOUMH OOASTAIIR REOUHE A FERxVT FOR OONSmUCTAON DR AIDDFIL.UIDN FRCP THE T FOIR CONSTRUCTION LENDING AGENCY COAST AA awrry MNUGEAp1T PSTIST IscAapl sEE FERAmTwO cHECKusr FOR I hereby affirm that there IS a construction lending agency for vt:S 11 Es r ' `• �ITQfiQ-��Ili 5/12,c4 l N the perlor since of the work for which this permit Is Issued(Sec vice❑ No❑ I•c- { { ASI I m 3087 CiIV C) (HAVE rEAG TIE INZARp011a MATERYIs IFC(AMTx]NaupE ND TIE SCAOAb PERM1TTK1 l25y L AM 9:r-, TM-E2 CWPIER T]�SECipNS212U10p THignH}Nl I1iOaCONLERNNG HAZARDOUa PL Lender a Name WMRS REPoRnNG ANO FOR OBTAI%W A KE FROM TIE SCAOM Lender S Address p Pn01(A/Ofxr I certify that I have read this applpatlan and state under penaltyof parfury that the above PC FEE //) PERMIT FEE - - with all county ordmancem�'Stae`lam Ie'ta�ng to building D•a 7 /� construction and hereby authp representatives of this COunly f�SUANCE F€E .{ / to enterj;=mented ploporty,far msWbon pis a i� m ,/------_ ��xm � V PTVESTIGATgN FEE TOTAL FEE-Pa xerrawv.. � or / 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 BUAor+G ADDRESS I hereby affirm that I have a certificate of onnsem to eel I BUILDING ADDRESS or a of Workers Campersrt-F in I rants ora Ted Copy 1 00 Lob C) I t �V /1,f / -c— LP' L 21 LOCAufV Poicy No Comlpany S�OF LOT F 1 l= NO OF BLOGS L ❑ Certified copy a hereby tum I GT/C/!Q 1 NEAREST CROSS Sr ❑ Certified copy s filed with the Idling inspection l- C TRACT BLOCK LOT NO USE ZONE MAP HO dope"'m / Date APPI G ASSESSOR MAP BOOK PAGE PARCEL SPECIAL COlAR10NS CERRFK: F EXEMPTION FROM RKE S' ° R, TEL No COMPENSATION INSURANCE '7'�V 3 J IL vmmN t000 Fr of scRooLa �G NO r 1 (The sector need not be competed It the permit s for one 1Nrorea i1D 0 R� psTwcT GRouP rvPE sr FIRE ZONE;EPROC:ESSED�Ily (Thera($tion n e root I certify that in Ito performance of the work for which this perms p Is Issued I shall not employ any Person In arty manner so as to CTry ZIP I SS ��0 -� becarn sublecl the 11Ufkers Compensation laws ARCHfTE OR ENGNEER TEL NO STATLSRCALCLA,-SI FICATION APT CONDO Date Appflcant ,p6L ADDRESS CLASS NO 4'749L DWELLUNRS AMJTrE TO APPLrAAfT If altar making the OLfItt, Of // RECUIRED TOTAL SETBACK FROM EXIST Exemption You should become subject to the Workers CONTRACTOR NO 2 SET BACK YARD MYV PROP LINE WIDTH COMParMation prwe,onS of the Labor Code you must forthwith _jdG►3 ONT coney with such proveKKls or the permit shall be deemed revoked ADDRESS Du'I] LX: NO PP l- LICENSED CONTRACTORS DECLARATION 0� SIDE I Hereby affirm that I am licensed uroerpmveions of Chapter 9 CTiV (Joel � 5 Gc`LASS /I PL (commencing with Section 7000)of Division 3 of the Business and SO SIZE NO OF STORIES NO OF FAMILIES 0 SEWER AWP d Professions Cade and my Iioense is In full force aro effect I NEW BX PG , 1-cense Number S, j$(.� LX Clasa6 DESCRIPTION OF WORK /\ ADD ❑ wLUAnoN Contmcta y ,L(Date L �_/ ALTER ❑ $hae- bd ❑ f am exempt under Sec REPAIR ❑ a = B&PC for this reason DEMOL ❑ LpAy,PTC A Date USE OF EXISTING BLDG URM ❑ Signature vltii APPLICANLfRiVi_) LN/ TEL, Lp.N Perm♦ ,j ❑ I n owner of the Property on en �loyaes with wages as _ their sole cOmlperabho I Wdl do OK, work and the structure s ADDRESS . O f;,.I.T.t not Intended or offered for sale (Section 7044 Business and � ']!r` 11 k FI / 1 3.ycl:r - Professions CxKle) M THE IVRIGVIT Ori FUM1E eUM1!#%i oGCI T RMQ E A IMZA(✓Dol1S MATE ❑ I ea owner of the Property alit exclusively conhechrg with OR A 301A C 11NO A MAZAFOOVS NATERA-EO TO OR GREATER TLNI TIE i licensed Contractors to construct the protect (Section 7044 NAO�s sFECIFEo aN rHE Nu woous i.UTERAL9 waRMATioN ouwE+ FNAL BY > L flleulass and Professions Code) vas❑ No❑ AccT.t NLL THE NIEIOEO USE OF TME e1BOUNG BY TIE AFPIJGWi CA FUTURE eUAfq S CONSTRUCTION LENDING AGENCY °CCU""T�a A FERIAT Fon CONSTFNOTIDN on MooFKATaK FROM THE$uLTH ��I]� 11)5,,Il COAST AS QUA-riV AWMG NT gSTPoOT(9 11MD1 EE PERMTTNO G CKUST FOR QuCEI11Ee I hereby off," that there s a construction k9 xli lg agency for ns❑ No❑ 7 ITEM N the performance Of the wank for which the permit a issued(Sec /�� y O 3097 Cw c INAYE PEAO TE HAUHp0115 WTERH.9lFORNAIIONaUDE Alp TE 9(J<)I.OPEfM1iN0 TOTAL 155 . 830 " LenderaNeme 7/d/'(•HL�t(^ �l ' ,„ WPp�; FORaaa. ARIS �,D°'"�"'m°"� CHECK 155."Ti Lenders Acidness B Uc-vr<�T avui a.ABMT H .I-i3 L r�IGE I I certify that I have mad the apocmatron a and seta ret t comely PC FEE l .5129 PERMIT FEE 7 V With penury that ordinances above Information t corracl l agree b bulipyO11��_1�I J 1 �/ y�/G4 win cW an erebu and state lawn ivestlof h building castructian and hereby authorize representatives of me County ISSUANCE FEE to ender upon the above-mentioned property,for Inspect Te 55,6 1 Ail 9:40 NVESTgATION FEE TOTAL FEE D SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION P4er8Wdffir4a cm fiat I haver certificate of tionconsent to self APPLICATION FOROBUILDING PERMIT Insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof(Sec 3800, Lab C ) COUNTY OF LOS ANGELES#' (e BUILDING AND SAFETY Policy'No Company ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN AppPOSE-NOD Vb ❑ Certified copy Is filed with the county building inspec- ARD N tion department n CITY ZIP 2 ' LOCALITY Dote Applicant h10 & CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ROSS ST + COMPENSACOMPENSATIONINSURANCE ' CS ASSESSOR ((Thu section need not be completed if the perms Is for one TRACT &OCK LOT F10 MAP BOOT( PAGE pgRCyl fLundred dollars ($10))or less ) TEL OWNER NO — USE ZONE MAP certify that in the performance of the work for which This NO SPECIAL } permit is Issued, I shall not employ any person in any manner ADDRE so as to become subject to the Workers' Compensation Laws �� E CONDRIONS a0 CITY ZIP U Dale Applicant ARCHITECT OR TEL NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO DI TRI ROUP TYPE �� IRE D BY Q Exemption, you should become subject to the Workers' O(� 2 CONST $JE t5 Compensation provisions of the Labor Code, you must forth- ADDRESS o J ✓{ a with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION deemed revoked CONTRACTOR NO z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter ADDRESS NO (commencing with Section 7000)of Division 3 of the Business UC SEWER MAP and Professions Code,and my license is in full forceand effect - CI FT Ti;T OFNO OF CLASS CHECK &C PG VALIDATION SQ License Number Lic Class SIZE STORIES MLIUES ONE VALUATION ContractorDate DESCRIPTION OF WORK NEW O = 00 ❑I am exempt under Sec ALTER ❑ 100 B&P C for the reason REPAIR ❑ $ Date _ USE OF EXISTING BLDG rtF O ❑ 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 Cade) PRESENT By _ ❑ I as owner of the property, or my employees with BADDRESSlllA�.CT.i wages as(heir sole compensation,wdl do the work and LOCALITY , 307 43.75 the structure is not intended w offered for sole(Section 7044 Business and Professions Code ) NIN031 R TEL r 1 1 5 ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS TOTAL 43. 75 tion 7044, Business and Professions Code ) EIRE CONSTRUCTION LENDING AGENCY SET gig D vARD Hwr TALPSETBACKROP EFROM WIDTH CIECY. 43.7` I hereby affirm that there Is a construction lending agency for FRONT _ .00the performance of the work for which this permit is Issued P L (Sec 3097, Civ C ) SIDE PL Lender s Nome ^'�G 0000-0001 1/30/90 i { P C Fee f Permit Fee O• 715 ID'K4 Ref Y Z Lender's Address 3587 1 AM 3'47 a I certify that I have read this application and mate that the Issuance Fee r 0 LDMA P/C N above Information is correct I agree to comply with all County Investigation Fee ordinance nd State jaws relating to building construction, Total Fee 5 LANA Perm t and here authorize representan of this County to enter LYq upon th ve- naoned pro or inspection purposes fu REVERY FOR EXPLANATORY LANWAM ' Signature of Applicant or Agent Date t i COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC FORKS 9701 IAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOWD;NT TEMPLE CITY CA 91780 BL 0508 0711010016 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS BK 62 PG 2 PC SQ FT STORIES TYPE 5617 ROSEMEAD BL STRUCTURE 78 VN TEMP CA 917801804 _ ASSESSOR INFORMATION NUMBER NEAREST'CROSS STREET _ � • �( 5387-031-059 THOMAS PAGE 596 GRID H4- LOCALITY TEMPLE CITY, C TENANT EXIST BLIX) USE COMME USE ZONE C-3 ISSUED ON PROCESS® BY EXPIRES ON EXIST OCC ORP 11/01/07 SR 04/29/08 ! I OWNER TEL NO BLIOS NOW ON IAT VALUATIONFINjEI. D71TG FI Y CODE E 6 G DEVELOPMENT - ^I 22,340 5617 N ROSEMEAD BL TEMPLE CITY CA 91780 FEES PAID DESCRIPTION OF YORK CLASS A BUILT-UP ROCK IFEE DESCRIPTION QUANTITY GUM AMOUNT APPLICANT TEL NO IFRENCH (310) 782-4224- JAA BLDG PERMIT ISSUANCE 27 75 1669 4TH ST lAE STRONG MOTION OTHER 22340 00 VAL 4 69 SPECIAL CONDITIONS H B CA, 90254 D2 PERMIT W/O EN-HC 22340 00 VAL 435 00 TOTAL FEES 467 44 I ICONTRACTOR TEL NO , • 1- t (APPROVALS DATE INSPECTOR SIGNATURE (MIDWEST ROOFING CO INC (310) 515-1464- 1305 W 132ND ST LIC NO (LOCATION AND SETBACKS GARDENA CA 90247 769615 C39 SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS I I LIC NO ISIAB/UNDER FLOOR RAISED FLOOR FRAMIAO MAP NO SEWER MAP BOOR PAGE FIRB ZONE CMP [RiDBRFLOOR INSULATION I I 147H265 3 Oil FLOOR SHEATHING IND OF FAMILIES DWELLING UNITS APT/COND STAT CLASS NO 22 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS I (SHEAR PANELS AIR QUALITY 1000 FEET MATERIALS I NO NO NO FRAME INSPECTION (REQUIRED TDTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD HWY PROP LINE WIDTH (FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH I I I FATED FLOOR/CEIL ASSF7C RATED WALL ASSEMBLIES IRATID "3;AFTS OPENINGS IT-BAR CEILINGS (IAT DRAINAGE REPORT ID DPR261 ROUTE TO BEOSOB I I I APPLIC=�ONFOR BUILDINQ PfRMIT COUNTY OF LOS ANGELES BUILDINGUD SAFETY r WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILD`NO ADDRESSROS-K--- or OSE M Iil'J f3l..J Q . I rlemby affirm that I have a Compensation Of consent to self ensure �61 2oSEPW4eNL7 J34✓O or a certlfIOate d Workers Compensatgn Insurance or a certified copy thereof(Sec 3800 Lab C) CITY LST Policy NO G T Company T�I'1T LP 17 qo LOCALITY ❑ Cerhfled c SIZ