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HomeMy Public PortalAbout5620 ROSEMEAD BLVD_Building__ -3 rt4 UCv'11�L F:� Cll /: 7BAMBA CE#803 2/60 APPLICA'T'ION FOR BUILDING PERMIT w 1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS B=ING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST C, WILLIAM A. JENSEN SuP T OF Buil DING CROSS ST. DISTRICT NO. GROUP TypE _ SSED BY FOR APPLICANT TO FILL IN 5r� �`r' coNsr -cC2 BUILDING S/� STATISTICAL CLASSIFICATION SE ER MAP ADDRESS ((oo /I/6, Tera ra 9A b $L U , /• BK Phi CLASS.NO.�WELL.UNITS-:�P—j i .17 LOT NO. f_� i BLOCK MAP STATE S NO {� �� [� NUMBER HWY. TRACT T I�-v F-L( USE ZONE SPECIAL NO.OF BLDGS. ^ CONDITIONS SIZE OF LOT , © I NOW ON LOT i !f�` USE OF ' EXISTING BLDG. t,wn vt .t! LZp.Q..2 BUILDING EXIST. TEL q SETBACK YARD HWY STREET NAME WIDTH OWNER C., l" {L„ 1 j.J f ti NO.Iii 1 FRONT ADDRESS S ,3 U 1V` 1 t5c?, P.L. SIDE ARCHITECTOR �q / TEL. P.L. ENGINEER J. tJ. JvI.�.Nl)I/ NO. AT11l1 INSPECTION RECORD ADDRESSIJ.OA n1kt Qb '{r1 h C) q CONTRACTOR/G� O A'S M G.CL r/ NO. �1 J I1 s ADDRESS- `7U ��r -/yt ri�� I L u�• D 1�ESCRIPTION OF WORK rb NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF Qt SIZE 3,21 STORIES FAMILIES USE OF STRUCTURE (S A.nem. !z-- SIGNATURE OFP1 APPLICANT VALUATIONS a APPROVALS DATE INSPECTOR'S SIGNATURE P.C. ✓ PMT. d FOUNDATION:LOCATION FEE $ FEE $ FORMS.MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME:FIRE STOPS, PLICATION AND STATE THAT THE ABOVE IS CORRECT AND BRACING.BOLTS FURNACE:LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'SCOMPE ATI LAW CALIFORNIA. LATH,EXT. SIGNATURE I HOUSE NUMBER COR- PERMITTER RECT AND POSTED ADDRESa FINAL CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION Cy. M.o. CASH PERMIT VALIDATION CIC M.O. CASH �, 3 7 6 J (' 1 D 2.0 1: P � {�/1��,' q A }p���p FOR I1�p IIII �yI �y( ��1I ppp � y�q(8p'�/�y1�yI qty - JA888A CC#808.9-BO ALL LL UCATRO Tl LL !!ll� Aavt�l�LDRNG o M1 ■ f/ COUNTY OF LOS ANGELES BUILDING y/ ADDRESS DEPARTMENT OF COUNTY ENGINEER ryLtJ BUILDING AND SAFETY DIVISION LOCALITY �? 9 JOHN A. LAMBIE;COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. .-.., .... ...:. ..:.- ,. .:,.....:... :;..,.. ,:: :,.. .•..- -.. DISTRICT NO. GROUPP S D BY• TYPE FOR APPLICANT TO FILL IN I ' L CONST.'_ L STATISTICAL CLASSIFICATION SEWER MAP BUILDING ADDRESS CLASS.NO. DWELL.UNITS BK P LOT NO. I3 MAP STATE / BLOCK NWIABER J HWy• ES , NO TRACT Stickjo 1L/ � Tant USEZONE SPECIAL JZ /y .J CONDITIONS SIZE OF LOT /� �X /GI NOW ON LOTS G+ l l USE OF (meq' ti EXISTING BLDG ��itAEI�ClC-Ll1CS 1 �J T)A�L BUILDING EXIST. YARD HWY STREET NAME �/ TEL _ yJ� SE"iBACK WIDTH OWNER Cit gell5Q#.Q, ' NO.��I.7fl [7 FRONT !� 1,L. ADDRESS 70 k) V, 11J Jy� SIDE ARCHITECPO TEL. �P.L. .•. ENGINEERM JJ 'M. L-410a y NO ��7J1? `. / INSPECTION RECORD ADDRESS A-1 . Rol'6 9{ &ID .Ak 7� JJ��Q�,•�����/ l TEL. -)//-7f O CONTRACTOR A>A SSV 4+W } i NO.Ar, 7//-7 f U ADDRESS �?a N .Pc►a I� �� 1 O DESCRIPTION OF WORK 6/ G��7l L T C''/7^X/' W NEW ADD ALTER REPAIR DEMOLISH Z I SO,FT. NO.OF NO.OF r fI !�3(/7 414 To • $IZE /f�/!J STORIES J/ FAMILIES / SUSEOFTRUCTURE / /tT OO�tgtc C h �/ / r�IL•/ 'T`.i�C / � F�71f:S r% 196/7 y SIGNATURE OF G� / m - 'APPLICANT I `� �/fQ41J VALUATION d� I APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION FEE $ 2, I FEE $ FORMS.MATERIALS �) >/�`(�/ /`IiP ;!•G L r�� F-1.1 ;FIRE STOPS. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING,BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION. WITH ALL.COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH, INT. EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT TO THE WORKMEN'S COMPENSATIO AWS OF CALIFORNIA. LATH,EXT. SIGNATURE O HOUSE NUMBER COR- RECT AND POSTED ADDRESS 'JC} 1' �� �✓ FINAL CLYDE N. DIRLAM, f RIACIPAL STR kJRAL ENGINEER PLAN CHECK VALIDATION cK. M.o. CASH PERMIT VALIDATION ;) M.o. CASH WORKERS'COMPENSATION DECLARATION 1 860211 U affirm I have a certificate of �tself insure,or a certificate of Workers'Compensation Insurance, � PPU CAT 0 q F(02 OUNLOING PERMIT C or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.IV85-2251&II„pany Fremont Indemnity BUILDING / J Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 6 c Certified copy is filed with the county building inspec- BUILDING 5620 N. Rosemead Blvd. tion department. ADDRESS Dote 10/86 Applicant Virgin Roof Co CI1Y Temple City ZIP LOCALITYaj,A 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 'LESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER Mrs. CaSrier NO. SPE permit is issued,I shall not emp.loy any person in any manner 1020 Huntington ton Dr.. / SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS g CONDITIONS te CITY San Marino ZIP @9 DaApplicant NOTICE TO APPLICANT: If, after making this'Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO SSED BY b ENGINEER NO. Exemption, you should become subject to the Workers' ��� CONST. ZONE on Compensation provisions of the Labor Code, you must forth- ADDRESS s —IrmfA with comply with-such provisions or this permit shall be I TEL. STATISTICAL CLASSIFICATION APT. NDO. g deemed revoked. CONTRACTOR Virgin Roof Co NO, 287-0507 LICENSED CONTRACTORS DECLARATION LIC. 160650 CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P 0 Box J NO. (commencing with Section 7000)of Division 3 of the Business and LICSEWER MAP Professions Code,and my license is in full force and effect. CITY San Gabriel CLASS C39 BK PG VALIDATION SQ.FT. NO OF NO.OF CHECK License Number 160650 Lic,Class C39 SIZE 1600 STORIES 2 FAMILIES ONE VALUATION Contractor Virgin Roof Co Date 4/10/86 I DESCRIPTIONOFWORKTear off exist. ro f4Ew 0 $ 3865.0 n0 to sheathire-roof with ] ADD I am exempt under Sec. ALTER ,•� #30 3 # 15 and ravel. 16 s s. � $ + B.BP.C. for this reason REPAIR USE OFr Date: + EXISTING BLDG. COIIImerClaI DEMOL Signature APPLICANT Virgin Roof Co TEL. 287-0507 FINAL OWNER-BUILDER DECLARATION PRINT g NO. DATE S { I hereby affirm that I am exempt from the Contractor's License P 0 Box J, San Gabriel, CA 91778 . Law for the following reason (Section 7031.5, Business and ADDRESS FIPI l Professions Code): PRESENT By - I, as 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 ;24465A 7044, Business and Professions Code). MOVING TEL. I,as owner of the property,am exclusively contracting CONTRACTOR NO. # 0 0 0 0 0 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 1 0 0 6 a 6 3 REQUIRED YARD HWY TOTAL SETBACK R� CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT a o o 6 a 6 3 1, the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SSILDE 4- 1 8-86 P.m e Lender's Name LDMA Ref. # P.C.Fee$ Permit Fee 58. 13 !. Lender's Address 1 certify that I have read this application and state that the Issuance Fee 10.50 LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee 68.63 LDMA Perm. # u and hereb authorize representatives of this County to enter upon th bove-mentioned pr party f inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ®+ k I Sign re of AppTicanf or Agent Date W4;iRKERS' CMPENSAT ON DECLARATION y hereby affirm that I have a certificate of consent to self p L'CATON ®gip BU, I L®I N G PERMIT insure, or a certificate of Workers'Compensation Insurance, ens or a certified copy thereof (Sec. 3800, Lab. C.) I COUNTY OF LOS ANGELES 1BUILDING AND SAFETY P❑olicyNo�6�46;Z Company 67A re 01ca *-t - Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING'ADDRESS ADDRESS; (v '� O j2,a% Certified copy is filed with the county building inspec- BUILDING tion department. ' ADDRESS _G p T = 7'f F/�OL J Date / - - Sir Applicant /413.v-. S.G/-+A L 6FdT1 J CITY --G=I- i f Zip LOCALITY, ` ' t-+ 1,(r t 7 CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS STI UC `J (This section need not be completed if the permit Is for one TRACT BLOCK LOT NO. 3 ASSESSOR hundred dollars($100)or less.) MAP BOOK PAGE PARCEL TEL. I certify that in the performance of the work for which this OWNER R L c G NO. as -bF F 38� USE ZONE NO. permit is Issued,I shall not employ any person in any mannerLJ I SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS S3 1L C a G o tS 7b CONDITIONS p CITY 0 n S n d LA A ZIP U Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT_ GROUP TYPE FIRE PRO ESSED BY Exemption, you should become subject to the Workers' ENGINEER NO. (J CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS ✓] $ �' Q with comply with such provisions or this permit shall be TEL. k1 Y' STATISTICAL CLASSIFIC7yTIO'N APT. CONDO. CO deemed revoked. CONTRACTOR .C. S h �+ i ,NO. Go- G 31 L/ Z LICENSED CONTRACTORS DECLARATION /y,Z SFS- E: C-+ra v r---rla C LIC. WELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS r- NO.�S p/ CLASS NO. DSS SEWER MAP (commencing with Section 7000)of Division 3 of the Business and qq 6 LIC• Professions Code,and my license is in full force and effect. CITY W AJ iyA tirl CLASS C—�S 7 BK. PG. VALIDATION p SQ. FT. NO.OF NO.OF CHECK License Number3S g6 Lic.Class C- 3� SIZE STORIES FAMILIES ONE �t J VALUATION ContractorA-13.G. 5,G/1 0.+r,6�Date J �'�-- '� DESCRIPTION OF WORK NEW ❑'+ s 6 evQ• O 0 ❑I am exempt under Sec. A C.L 3 W A V L; ADD ❑.;.• ® c ALTER 8$ 5 A ❑s: '� /) /� � B.&P.C. for this reason REPAIR ❑s $ ''' (i V # 0 0 0 0 2 3 Date: , USE OF g DEMOL ❑ EXISTING BLDG. o - 49.4-1 Signature APPLICANT TEL. FINAL ✓�J OWNER-BUILDER DECLARATION PRINT NO. DAT ° ° ° 4 9 4.1 3 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL 0 1.25-88 Professions Code): P EN BY ❑ BUILDING I, as owner of the property, or my employees with ADDRESS 8 8 3 6 A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. # 0 0 0 0 0 1 ❑ I, as owner of the property,am exclusively contracting p CONTRACTOR NO. 0 0 6 8.6 3 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). _ CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.L NE WIDTH o 0 0 6 8 6 3 I hereby affirm that there is a construction lending agency for i FRONT 1.25-88 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. _} Lender's Name r2q '' ° LDMA Ref. # a P.C.Fee$ Permit Fee �� Lender's Address / I certify that I have read this application and state that the Issuance Fee (� L LDMA P/C# ° above information is correct. I agree to comply with all County Investigation Fee j °o ordinances and State laws relating to building construction, V Gt n and hereby authorize representatives of this County to enter Total Fee LDMA perm. 3Lhe above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ure of Applicant or Agent Date