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Home My Public Portal About5624-5626 ROSEMEAD BLVD_Building__ LIM L�COVi�rY o i.OB ANG=s p 144�r� �+�+� WM. J. fbX• CHIEF ENRINEER a FOR APPLICANT TO FmL m FOR OFFICE VSE ONLY • DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDINE ADDRESS 4.. [�' 7 s� DINO � a LOCALITY a-.� urs � �-[.(�f RCUCIcVED DA CFf PPL r IBBU own OWNER !� a! •!�.• (r ADDREB nl e. "..L��J Fs 7 a!'�i+ jus •ADDRE®AIL to. = J�n .� LbCALITY ��/"� �� / 7 -WtI NEAREST d�/tidayA � p• f CITY �f%mow NC. OROBS ST. :1 1 ARCHITECT CR/' LFIRE `. NC.CF �j TYPE j SROUP�,•, ENRINEER �. NO. ZONE PLANS ■LDS. r CRD. D R SETSACK LINE t)�+ r TEL APPROVED DA / a CONTRACTOR • Lr'.-�� f y NO. SY USE APPROVED#d&' v / ADDRESS S f� ti�� .� ZON � BY DA4 DESCRIPTIO LOT NC. I ■LOCK �� CORRECLEMAL , TRACTS a wT NC.CF BLDSS. SIZE OF LOT • I N ON LOT -adAJAP V J4 UBE OF rd•:::.i {>-..• '� NC.OR NC.OR (" 1 INR B 1'i• 1 OMB• n' - mvi- -r en DEscRZPTIO�oF WORE •` NEW ALTERATION ADDITION O a REPAIR rT. / MOVINR A DEMOLISH C S Zmor E ��i t� RC MB ice' STORIES D. WALL � r J CCVERINR L_r,l , Door USE CR NEW SUILDINR {� i r• 1- ' • r IL 1 R HEREBY ACKNCWLEDE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION:LOOATION INSPECTOR DATE AND ABREE TO COMPLY WITH ALL OOUNTY CRDINANOES FORME•MATERIALS V M y., AND STATE LAWS RERULATINS ON MUII.DINS CONSTRUCTI . ,/ rRAME1 FIRE STOPS■ SISNATURE CF SMADIN06 BOLTS y OWNER �1 LATH,INT.I # AUTHORIZED AST Z-� LATH.EKT.1 h • I� 0ee-2 SBM OEM 4-47 ff P.D.Me 0 pj PLASTER,INT. a ` SEE PLASTER,®IT. VALUATION ee� FINAL �-�r p • APPLICATION gp A{/q �.8pa pg -Ap�.IRI pqq� 11�p�.(,IRI 1e� rpt 1r�I BA888A CC#808.9.SO A PLICA $ I O fd F®H® B U I L®H G � ll f COUNTY OF LOS ANGELES BUILDING ^J Z DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST t WILLIAM A.JENSEN SUPT OF BUILDING I CROSS ST. ". DISTR CT NO. ROUP TypE LROCE)9SED BY FOR APPLIC TO FILL IN , o �S I CONST. I BUILDING CAL CLASSIFICATION SEWER MAP ADDRESS BK PG .. 0 CLASS.NO.Y_DWELL.UNITS- LOT NITS LOT NO: / � 7„4K MAP STATE NUMBER Q �� HWY. YE NO TRA 1 USE ZO SPECIAL N NO.OF ILDGS. /CONDITIONS SIZE OF LOT I NOW OLOT USE OF , �^ EXISTING BLDG. 048UILDING YARD HWY STREET NAME EXIST. TEL. P SETBACK WIDTH NO. FRONTL P ADDRESS ,J�/. � /T SIDE ARCHITECT OR TEL. P.L•• ENGINEER NO. INSPECTION RECORD } ADDRESS d CONTRACTOR D7i ADDRESS S O DESCRIPTION OF WORW- r W ' d ADD ALTER REPAIR DEMOLISH h SO r7 �1 Z S ZE ' I / �APPPDX.$O.OF NO.OF TORIES FAMILIES USE OF 10, STRUCTURE �u a SIGNAT41ORE OF � APPLICANT VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE C. PMTFOUNDATION:LOCATION F E $ FEE $ FORMS.MATERIALS rFURNACE: FIRE STOPS, 1 HEREBY KNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED 1 SHALL NOTNT. EMPLOY ANY PERSON IN ANYMANNER SO AS TO BECOME SUBUECT TOTHE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. XT. SIGNATURE OF NUMBER COR- RECT AND POSTED ADDRESS FINALE%/' CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E PLAN CHECK VAT A ON PER141T VALIDATION CK. M.O. cwsH Imo: rN FOA638A 095.3 12-54 r•� APPLICATION FOR BUILDUNG PERMIT �. DIVISION OF BUILDING AND'SAFETY BUILDING J[� / D3ZiwI.Gcir-I/ Department of, ADDRESS County Engineer •. County of Los Angeles LOCALITY WM.J. FOX, COUNTY ENGINEER NEAREST �^ CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRIC�NO. G OUP SEWER MAP FOR APPLICANT TO FILL IN I TYPE BK PG BUILDING + CON ADDRESS MAP /►� / STATE ESQ •lw NUMBER /' / HWY Lc NWLBLOCK USE ZONE SPECIAL CONDITIONS TRACT tv NO.OF BLDGS. SIZE OF LOT / td,.�1� '•f�°-I NOW ON LOT . 4- BUILDING YARD HWY STREET NAME EXIST. USE OFSETBACK WIDTH EXISTING BLDG. ` - +`.✓" FRONT ' OWNER SIDE ' MAIL ADDRESS TEL. / 1 I DWELL. I UNIT 5 INDUSTRIAL _ CITY 2 DUPLEX_UNIT '6 PUBLIC BLDG. ARCHITECT OR TEL-. rr ENGINEER 1g ) NO.r Tb--r1 3 APT. UNITS 7 ADDN.,ALT.,' TC. ADDRESS ��,irr�/,� 4 COMMERCIAL 8 MISCELTEL ., CONTRACTOR n �/'�f1-4a1 NO. rF•-G ((]] a INSPECTION RECORD F ADDRESS - /i. •DESCRIPTION OF WORK NEW.6 ADD ALTER REPAIR DEMOLISH SO.FT. NO. OF NO. OF SIZES STORIES FAMILIES USE OF ST/RU-CTURE SIGNATURE:OF TF' •�J9i APPROVALS ADDRESS +{� ��/., _ �G. %lyi./�_.J�. DATE INSPECTOR'S SIGNATURE S P.C. S FOUNDATION:FORMS. MATERIIALSION FEE FRAME: FIRE STOPS, 1� ( (J $ BRACING, BOLTS VALUATION FEE f FURNACE: LOCATION, GAS VENT, DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE-READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREETO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH, EXT. SIGNATURE OF. r `� ' p HOUSE NUMBER'COR- PERMITTEE �/ �� '%� VC •-� ' _RECT AND POSTED 1 ! ADDRESS FINAL �IZc'��'� 4-:I--•`--_"_ -�, WM. J. FOX. COUNTY ENGINEER VALIDATION BY ..: 0 4Y4 " 71471 JUN1 .� l• DEPUTY / r � UTY. BY BY ~� ® DEPUTY DEPUTY DEPARTMENT OF BUILDING AND SAFETY AYYLI4A 1'1V1V r uK Yl:KlVlr l' COUNTY OF LOS ANGELES WM.J.FOX,CHIEF ENGINEER UILD R**;G NO. OF BLDG. ORD.NO. �. DISTRICT NO. PLAN CK.-NO.• PERMIT NO. PLANS SETBACK LINEeo/ FIRil APPROVED ! ,0 ZONE BY TE RECEIVED�Y `GATE OF APPL. DATE ISSUED USE ,�' APPROVED �j I ` � `� -Y ZONE BY DATE 'A APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY n . d' BUILDING S O E NAME .ADDRESSSa W Z ADDRESS LOCALITY W CITY CROSSS T. r - Q STATE TEL. LICENSE NO. : NO. E NAME MAIL (\ EO NAME 3 ADDRESS U _ ' Q ADDRESS s��.8y CITY. L/ NO.. CITY I. r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS O ' APPLICATION AND STATE THAT THE ABOVE IS.CORRECT U STATE TEL. AND AGREE TO COMPLY WITH ALL:COUNTY ORDINANCES LICENSE NO.. D NO. gQ AND STATE LAWS REGULATING BUILDING CONSTRUCTION. OZ LOT a w.6 y/l � / 0 2 ye�.�OT OWNER SIGNATURE OF ;SIZE OF L J I- � NO. OF BLDGS. -1 � Q- BLOCK NOW'ON LOT V AUTHORIZED AGT.�7 '^r••% J TRACT CORRECTIONS / O USE OF BLDGS. ` � f � �•q rQ s NOW ON LOT DESCRIPTION OF'fWORK", USE OF f f`// /� i /f BUILDING /I In/"�i 61 r1 istonst tt.Ui T .?i„-+; r -r1 ars m! are 1// / .AA @�+.�-1 !( '4 1 +/ cautioned to consult'rsith your local War Production Board Ui:ice be ore corn nenc- °� L:1 1 iz r NEW TYPE I GROUP NO.OFNO. OF ALTERATION ROOMS ! 'I -FAMILIES ADDITION SIZE REPAIR STORIES MOVING WALL COVERING DEMOLISH ROOF COVERING $ p FINAL FEE APPROVAL INSPECTO�t_S VALUATION � � FEE �'�'DA_T.E�' NAME' �'_ WORKERS'COMPENSATION DECLARATIGN hereby affirm that I have 'certificate of consent' rc self APPLICATION FOR BUILDING PERMIT � ' insure,'or a certificate of Workers'-Compensation Insurance, ' or a certified copy fhereof:(Sec. 3800,Lab. C.) 1, _ COUNTY'OF LOS ANGELES BUILDING:AND SAFETY 1 ' Policy No. Company ' Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN ' ADDRESS Certified copy is filed with the county building inspec- i BUILDING1:1 tion,department,. ADDRESS g(� r` LOCALITY L' NEAREST Date. Applicant '� CITY ZIP I . ,) CROSS CERTIFICATE-OF EXEMPTIONFR , OM WORKERS' NO.OF BLDGS. ASSESSOR }' COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT -MAP BOOK PAGE- PARCEL (This section need not,be'corripleted-if the permit is for one USE ZONE MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. • _ • h d TEL..:g ) �1 SPECIAL Y- I certlfrthat�iri the"perfbrmance of the work for which this` OWNER G NO.!� "� / 7 CONDITIONS.' 8. permit is issued,I shall,hot-employ any person in any manner' �/f DISTRICT GROUP TYPE FIRE PROCESSED'BY O so as to become subiect to,the Wor r'Compensatio Laws. ADDRESS ® !" a CONST. ZONE U Date • Jy- Applicant w'"� CITY • IP J, / STATISTICAL CLASSIFICATION -• .' CONDO. ARCHITECT . TEL, NOTICE TO APPLICANT: If, after ing this Certificate of f ENGINEER 4i Q/ NO. �1-r 'y' CLASS NO. DWELL.UNITS W Exemption, you -should become :subject to the Workers' d Compensation provisions of the Labor Code, you must forth- ADDRESS 44/ SEWER MAP V) with comply with •such provisions or. this permit shall be i deemed revoked:•. " ! CONTRACTOR NO.��k w BK. SPG: VALIDATION LICENSED CONTRACTORS DECLARATION LIC. - Thereby off irm'that I am licensed under pirovisions of Chapter 9 ' ADDRESS IVO.. ` :VALUATION . (commencing with§ection.7000)of Divisio/t 3 of.the Business and I LIC Professions Code,and my-license is in-full-force and effect. 1 CITY CLASS. $ ' SQ.FT. NO.OF' / NO.OF CHECK ► ' • �' License Number • Lie.Class I SIZE / STORIES /' FAMILIES ONE ' Contractor Date I DESCRIPTION QF WORK'. ..%XF NEW [3 ` r i ADD ❑ :. '. I am'exempt under Sec. ❑ FINAL"') _ - ALTER REPAIR DATE ❑ B.BP.C.for this reason ' Dater USE OF EXISTING BLDG. DEMOL ❑ FINAL / ;n(� !•_0 J'll, •. ; APPLICANT TEL. By r Signature C 3. .. OWNER= Mawen NO. I hereby affirm that I am•ekeinpt from-the Contractor's License- (. Law for the following reason (Section 7031.5, Business and: - ADDRESS gAV it ► , Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my'employees-with ADDRESS LI r, 0 ti' wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY „ i 7- 04A 7044, Business and Professions Code)... MOVING TEL. ' -I,as owner.bf,the ro ert am exclusive) contractingCONTRACTOR NO. with licensed contractors to consfruct the project-(Sec- ADDRESS ' tion-7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HW`( PROP,. LINE WIDTH 4 :�7 ! C: 'L r I hereby affirm that there is a construction lending dgency for FRONT , o' o i the performance of the work for viihich-this permit is issued, P.L. _ Sec. 3097,•Civ. C.). SIDE �,.ti C U'-. v o PA Lender's Name P.C.Fee$ - Permit Fee = Lender's Address ' �! I'certify that I have read this application•and'stafe that,the Issuance Fee r above,information Is correct. I agree to comply with.all County nvestiguffon Fbe ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this.County to enter ,upon be a ve-mentions pr perty for inspection purposes. 1 i' c :11J-- SEE REVERSE FOR EXPLANATORY LANGUAGE ��, Si azure of Ap-Ika or Ag"enf Date ' WORKERS'COMPENSATION DECLARATION .� FOR BUILDING PERMIT RM I T hereby affirm that I have-a certificate of consent to self APPLICATION insure, or a certificate of Workers'Compensation Insurance, ; or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished: FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- tion 'BUILDING ��--yy tion department. ADDRESS c5 M. 11/ LOCALITY � NEAREST-.. Date Applicant i .CICAy ZIPqJ790. CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. -ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL USE ZONE (This section,need not be completed if the permit is for one ZIAL hundred dollars.($100)or less.) TRACT BLOCK LOT NO. N��jTEL. '•• OWNER GLNO X11 CONDITIONS 'CL I certify that in the performance of the work for which this I �d DISTRICT J.GROUP TYPE FIRE PROCESSED BY O permit is issued,I shall not employ any person in any manner ADDRESS CONST. ZONE V so as to become subject to the Wor ers'Compensation Laws. ��,Z 3 09 �j ' I ✓ - CITY ZIP �� Date.) Applica � STA ISTICALCLASSIFICATION Pi. CONDO. d NOTICE TO'APPLICANT: If, after making this Certificate of i ARCHITECT OR TEL•. _ E3 'Exemption, you should become subject to the WotkersENGINEER G.(.fvlt� O CLASS'NO. DWELL UNITS— 'Exemption, d Compensation provisions-of the Labor.Code, you must forth- ' ADDRESS SEWER MAP tri with comply: with-such ,provisions or this permit shall be EL deemed revoked..- CONTRACTOR NO. `' BIG L PG, / 7 VALIDATION ' LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I,am licensed under provisions of Chapter 9 ADDRESS - NO. VALUATION (commencing with Section 7000)of Division'3 df the Business and LIC. Professions Code,and my license is in full force and effect. ',I CITY CLASS $` , SQ..FT NO.OF NO.OF CHECK License Number Lic.Class I SIZE a[7 STORIES //FAMILIES ONE $ M r r :j DESCRIPTION OF WORK �rYYIG�vz� NEW ❑ / V r () O A Coritractor'° Date D e S ADD O f o 0 0 0 3 I am exempt under-Sec. ll ALTER FINAL 1-1/'G' ❑ bATE•7—/,?rFz ?'o o ()•7,82 �■ REPAIRBAP.C. for Phis reason USEOF ❑ FINAL / �— 41.7 S2Date: EXISTING BLDG. I DEMOL Signature APPLPT By NT /oaaAS OWNER-BUILDER DECLARATION pp I hereby affirm that I am exempt from the Contractor's License ADDRESS O s Law for.the following reason (Section 7031.5, Business and gessions Code): PRESENT -BUILDING I, as owner of the property, or my employees with ADDRESS C 50.6'A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY '+ n o 0 r 0 1' 7044, Business and Professions Code). MOVING TEL. CONTRACTOR. NO. ElI,as owner of the property,am exclusively contracting • �f 2'- 2 1 8.63 With- i / - th licensed contractors to construct the project.(Sec- ADDRESS' _ - + -> x 'tion 7044,Business and Professions Code). ry_— q.� 0 2 1 8 6 . REQUIRED TOTAL SETBACK FROM EXIST. Ldp f/ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 6-87; the performance of the work for which this permit is issued P.L:. j tSec. 3097, Civ. C.). SIDE o :'P.L. . Lender's.Name a Y.C.Fee, Permit Fee r Lender's Address p I certify that I have read this application and'state that the 7— Issuance Fee O S above Information is correct. I agree to comply with.all County Investigatipri F e „ ordinances-and State laws relating to building construction, Total Fee ; and hereby authorize representatives of-this County to enter Pon he above-mentione�op t for inspection purposes. A? CT : SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 04 01 Certified co is hereby furnished. BUILDING ❑ PY� y FOR APPLICANT TO FILL IN ADDRESS L de ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS �� LOCALITY NEAREST Date Applicant CITY ZIP e CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' Lex NO.OF BLDGS. / ASSESSOR COMPENSATION INSURANCE SIZE OF LOT (�/� NOW ON LOT I MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. TEL. SPECIAL > I certify that in the performance of the work for which this OWNER NO. CONDITIONS O. permit is issued,I shall not employ any person in any anner // q DISTRICT G UP TYPE FIRE PROCESSED BY IJ O so st subject to the e 'C mpensa n L ws. ADDRESS b 3e) / s� CONST. E li Vf CITY ff ZIP � 7 � S7ATI ICAL SIFICA710N APT. CONDO. NOTICE T • APPLICANT: If, o ter making this Ce ti ' o ARCHITECT OR TEL. _ ENGINEER NO. CLASS NO. WELL.UNITS UJ Exemption, you should become subject to the Workers' IL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. 11 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $ <79 , SQ.FT."�/� NO.OF NO.OF CHECK License Number Lic.Class SIZE 600 STORIES I FAMILIES ONE $ Contractor Date DESCRIPTION OF WORK P4670-' dAV1,WJJ NEW E] ADD El ❑ I am exempt under Sec. 611dALTER ❑ FINAL/ ' 1•.'- B.&P.C. for this reason REPAIR DATE Date: USE OF DEMOL FINAL EXISTING BLDG. Signature APPLICANT T�a a 5 NO By , OWNER-BUILDER DECLARATION PRINT �G I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 00 Professions Code): PRESENT BUILDING 1, as owner of the property, ormy employees with ADDRESS wages as their sole compensation,will do the work and 22 7 1 1.0 A the structure is not intended or offered for sale(Section I LOCALITY 7044, Business and Professions Code). I MOVING TEL. a a a a a 1 ❑ 1, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 2,° ° 2350 tion 7044, Business and Professions Code). REQUIREDTOTAL SETBACK FROM EXIST. x CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH a a a 23.5 0 I hereby affirm that there is a construction lending agency for FRONT 0,25-82 I the performance of the work for which this permit is issued I P.L. f tSec. 3097, Civ. C.). SIDE 0 P.L. Lender's Name 3 I Lender's Address P.C.Fee$ Permit F I certify that I have read this application and state that the I Issuance Fee O.- ( above information is correct. I agree to comply with all County I Investigation Fee ordinances and State laws relating to building construction, Total Fee o � J and hereby authorize repr tatives of this County t enter I :( u bove ention pr petty for inspection pu po SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Signature of pplica r A nt Date I , WORKERS' COMPENSATION DECLARATION ` I hereby affirm that I have APPLICATION FOR 'P U I L D I N G PERMIT insure, or a certificate of Workers' certificate of tangent to self kers' Compensation Insurance, or a certified copy thereof(Sec. 3600, Lab. C.) COUNTY OF LOS ANGELES I BUILDING AND SAFETY Policy Na. 01223829�ampanyState Comp. Ins. FLTnd BUILDING El Certified APPLICANT TO FILL IN Certified copy is hereby furnished. ADDRESS 5626 N. Rosemead Blvd. 0 Certified copy is filed with t county buil insp BUILDING ! tion department. ADDRESS 5626 N. Rosemead Blvd. Temnle ail±20 4/1/92 . A I;c CITY'Ibm le Ci CA. zip 91780 LOCALITY Date PP • NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FR WORKE SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSTANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK 5387 PAGE 028 PARCEL 021 hundred dollars ($100)or less.) TEL. USE ZONE OP / OWNER Re saCInc. NO.447-6160 I certify that in the performance of the work for which this �3 SPECIAL > permit is issued,I shall not employ any person in any manner ADDRESS 1020 Huntln On Drive CONDITIONS a: soas to become subject to the Workers'Compensation Laws. 0 CIN an Marino, .CA ZIP 91108 'U Date Applicant ARCHITECT OR TEL. loe DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE O Exemption, you should become subject to the Workers' p V Compensation provisions of the Labor Code, you must forth- ADDRESS ,DO e 3 CL with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. to deemed revoked. CONTRACTOR tie RoofingCO. NO. 792-5171 - Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.�DWEU.. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 2948E Walnut St No•186303 SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. , and Professions Code,and my license is in full force and effect. CITY Pasadena CA. CLASS C 39 BK VALIDATION SQ. Fr. N.O. OF NO. OF CHECK ' License Number 186303 Llc. Class C39 SIZE 23scrs I STORIES 1 IFAMILIES ONE DESCRIPTION OF WORK NEW ❑ VALUATION Contractor Lytle Roofing Date 3/31/93 T 2r 000 $ ► ElI am exempt under Sec. with .GAF Class • ADD El'A' f ALTER BAP.C. for this reas 4 shin les. .UL R21 REPAIR ® $ ate USE OF EXISTING BLDG. •Commercial DEMOL ❑ f Signa is APPLICANT TEL FINAL OWNEyI-BUILD R[DECL ION PRINT) le Lytle:Roofing CO. NO. 792-5171 DATE I hereby affirm that am exempt from a Contractor's License ADDRESS2948' E. Walnut St. Pasadena CA Law for the following reason (Section 7031.5, Business and . FINAL Professions Code): PRESENT By ❑ 1, as owner of the property, to BUILDING r:;• s P Pe rtY� or m Y.employees Yees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY :33131• ;!1,7 7 7044, 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 !' ti L �- 70 m 3 tion 7044, Business and Professions Code.) ! { _ REQUIRED TOTAL SETBACK FROM EXIST. ' ` V~ CHECK 1',.3- CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WID M. { t. _ I hereby affirm that there is a construction lending agency for FRONT r� ' ` (; CHANGE the performance of the work for which this permit is issued P.L. 6 J (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name N 0 N E � 7.1115/91 LDMA Ref. # P.C. Fee$ Permit Fee53--,;38'• , 80is i P11 :21102 Lender's Address i I certify that I have read this application and state that the Issuance Fee 1�3,;CI; LDMA P/C p q above information is correct.I agree to comply with all County I Investigation Fee 3y ordinances and State laws acing to building construction, Total Fee t LDMA Perm. #1 an hereby autho ' repr ting of this County to enter u the abo me !o property for inspection purposes. 10 7/3/91 I SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of ATO nt or Agent Date I WORKERS'COMPENSATION DECLARATION I hereby that I to se insure, orairm afcertif certificate of Worke s'Compensation a certificate Ofconsent Insuran elf APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ✓ r'" r Certified copy is filed with the county building inspec- BUILDING / /✓ tion department. ADDRESS LOCALITY NEAREST Date Applicant CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP l�' hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. TEL. SPECIAL I certify that in the performance of the work for which this OWNER NO. CONDITIONS permit is issued, I shall not employ an person in an manner DISTRICT GROUP TYPE FIRE PROCESSED BY P P y y P y ADDRESS � � ' CONST. ZONE so as to become subject to the Workers'Compensation Laws. CITY ^ ZIP STATISTICAL CLASSIFICATION APT. CONDO. Date Applicant ARCHITECT OR TEL NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER -NO.., CLASS NO. �''~' DWELL. UNITS Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. _ BK. PG, � VALIDATION CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $ "' ► SQ. FT- , NO. OF NO.OF CHECK License Number Lic.Class SIZE f STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ $ S (� ADD El ?! I am exempt under Sec. f' • • • • ALTER ❑ FINAL B.&P.C. for this reason REPAIR ❑ DATE • h Date: USE OF DEMOL ❑ FINAL • ;'(7 12 EXISTING BLDG. IF Signature APPLICANT TEL. By X• [ .p OWNER-BUILDER DECLARATION (PRINT) NO:' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS '' Professions Code): PRESENT BUILDING Pq 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 !a'• • •;• • 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. • �. 6", with licensed contractors to construct the project (Sec- ADDRESS Tion 7044, Business and Professions Code). • • G REQUIRED TOTAL SETBACK FROM EXIST. d CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ► 7, ? 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 m P.L. + Lender's Name P.C. Fee Y Permit Fee Lender's Address y I certify that I have read this application and state that the x Y pp i Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ig ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County to enter upon the above-mentioned,property for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®s