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HomeMy Public PortalAbout5630 ROSEMEAD BLVD_Building__ DEPARTMENT OF COUNTY ENGINEER BUILDING - DIVISION OF BUILDING AND SAFETY COUNTY OF LOS ANGELES • WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO. PUN CK.OR REC.No. P'JE7RMIT NO/ --- �/ S ADDRESS -- � I I ZO RECEIVED BY DATE OFAPPL. DATE ISSUED _LOCALITY NEAREST =�^ CROSS ST. BUILDING ADDRESS �rICJ ,J OWNER 7 MAIL LOCALITY aLD--� �Q ---L- ADDRESS NEAREST \ C� TEL, CROSS ST. � '•�- CITY NO, ARCHITECT OR TEL. FIRE NO. OF TYPE GROUP ENGINEER NO. ZONE I PLANS BLDG. (�� R NO. ADDRESS SETBACK LINE J �t�L `1 TEL. USE APPROVED CONTRACTOR NO. _ ZONE .. BY DATE HOUSE NUMBERING ADDRESS LEGAL MAP NUMBER _NO. ASSIGNED BY-- DESCRIPTION LOT NO. BLOCK CORRECTIONS TRACT NO. OF BLDGS. SIZE OF LOT _ NOW ON LOT USE OF I NO. OF EXISTING BLDG. FAMILIES DESCRIPTION OF WORK o - NEW ALTERATION ADDITION D Z REPAIR - DEMOLITION _ r SQ. FT. _ NO. OF SIZE ROOMS STORIES EXT. WALL ROOF COVERING I COVERING USE OF STRUCTURE -- - - - APPROVALS INSPECTO 'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. 1AGREE TO COMPLY WYfH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF -- LATH, INT. G •-^'" " 7".5. PERMITTEE4egk ---..°.-- LATH. EXT. �s)► ,A- ADDRESS _ PLASTER, INT. AUTHORIZED AGT. _ ✓ C. PLASTER, EXT. FEE S HOUSE NUMBER COR- / RECT AND POSTED VALUATION g/ � FINAL 76A638A DBS 3 9-82 SA69BADBB.99.9APPLICATION FOR BUILDING PERMIT DIVISION OF BUILDING AND SAFETY ADUILDING DRESS C 17.V - Deportment of Couaty Fagineer , County of Loa AngeleS LOCALITY WM.J.FOX,COUNTY ENGINEER NEAREST �6 r �r CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. -- DISTRICT NO. GROUP I TYPE `�� I SEWER K MA P6 FOR APPLICANT TO IN Ji CONST. i ADDRBUILDESS 7W3d N.rOSEMEA0 � \)® tI�+• NUMABER STATE YES NO LOT NO. 50MTJ9TO CF LOT 12 BLOCK USE ZONE SPECIAL CONDITIONS TRACT r/ SIZE OF LOT Z bl I NO.OF BLDGS. BUILDING EXIST. C NOW ON LOT I SETBACK YARD HWY STREET NAME WIDTH USE—EXISTING BLDG. OFFICE 15140P FRONT P.L. OII OWNER Lr �. SIDE E p� /y F{.L. ADDRAILESS 0 t JZd E 6� .P -�•' A� y� �+ �+p��/ Aq�ry ® O TRACT DWELL. 1 UNIT 5 INDUSTRIAL CITY /fA �C 6d// P NO.*�1.!- / /17 7 DWELL. t UNIT 8 PUBLIC'BLDG. ATG6E1 q 2 DUPLEX I UNIT ARCHITECT OR TEL: 7 ADDN.,ALT.. ETC. r�Ic}tN��� J/��q 5$ LUNPY NO. a APT. UNITS 62 �A�� T 8 MISCEL. ADDRESS- 562310 • O�ENIGil1/ s, • 4 COMMERCIAL - Z• ��S'`��J TEL.�T INSPECTION RECORD CONTRACTOR , C tV A((� ANON�. r ' h} ADDRESS _ In�® /V.�� �/VtFiY /iC ♦ _ Z •ted c.. � � G'-� '0 .An.� DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SC. O.OF / NO.OF SIZE ��1G1 STORIES / FAMILIES USE OF STRUCTURE 1 I SIGNATURE OF a , APPLICANT n �C+t.t�Jf.P3 sl_. APPROVALS �A p�y ADDRESS 5G 40 iklt' ZdSE& P 7—e •r DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION $ //4✓a o -�� P.C. $ �}G -� -FORMS. MATERIALS FEE / FRAME:FIRE STOPS. ,BRACING.BOLTS VALUATION -� V E FURNACE:LOCATION, - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT:DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH.EXT. SIGNATURE OFHOUSE NUMBER COR- PERMITTEE ��o Rol RECT AND POSTED t A ADDRESS i d 2Gs�, � s I •(\i . FINAL Q t/ �• 4L_-ArCC,C Aa�..w�--� WM.J.FOX,COUNTY ENGINEER VALIDATION C.re.DIRLAM,CHIEF BLDG. INSPECTOR 8.00.. to ,U 3 8 6 6'U-0) MAR 716 . 4.0 01 . ' �- i aESPARTBENT OF SIIII.DEgG AND SAFETY AJrJrLm&LvAiAWJN rVAS JrDLTJaaa � *�v�a�rY of Los ANGELES r' vm. d. rox, ONicr lNRIN!!R /3 .Ar►�� U 0 L ® 9 N G _ FOR-APPLICANT TO FII.L FOR OFFICE UW ONLY - / DIQTRID/T�NO. PLAN l�UK.ME. PIR/MIT NO. SUILDINO ADDRESS 6.5anww'a LODACITY 1AW RIOe1VeD SY DATE R L. DAT!ISSIIm NlAREar r /I+ ! O • l DRD . NUILDIME 138 MAIL &0?Z ADDRI9S ► NEAR D C DI EL T +srb R Ic Rr MO.OR , OSOUP AROHITlOT D � N0. / ZONE PLANK d- eMRINEER DDRER /a 9 LF+M E/rm G SITRAOK LINE //��� APPROVED NT OORADTDR NaL'!/ID 61 SY IQ DAT! ,f, use + APPR R 2. W O LCs � I ZOM! ■Y frWZ ' DAT! I J Dsop°PrALIDN 5- Ma. / SLOOK i Tmw stimmyLek!�/ i * ..6 �`t 7.r 44, J ■IZ!DR LDr �O /� �Q I NO.OR SL r NOW ON LOT Z S u■!OR No.or rmlum / O DE9CBXFr N OF WORE ►' / New ALTERATION ADDITION / D s REPAIR p MOVINR DEMOLNINNO.or p W iE . !/ ROOMS ■TDRIe�■/ 004FICHINS 57 beC 0 OLL CIVEIIINO c Men USI OF NEW sU1LDINS A 1 HMENT AOKNOWLEDs! THAT 1 HAVE READ THIS APPROVALS APPLICATION AND ■TAT! THAT THE AROWE Is OOIIRIOT FOuNDATIUMi LUDATION INSPlO'I'OR DATE AND ASRE!TO COMPLY WITH ALL COUNTY ORDIMANUM RORM16 MATERIALS ,/A S AND IITAT!LAWJS/1/ •/W REE..R/ MMWWIN SOL79 U/LLATINR RUILDINR OON■TRUCTIOM. Ary �1 IR � /� �f '/s• {'f SISNATUR!OR t� D.j/Y� ��p OWNlR LATHr INT.t ri '19L� AUTHORIZED ALIT LATH.DIT.t IVALJU om OEM.tom �/� P.O. D PLA�WMI16 INT. TI ���® ` RSI _L_ PLA■TIR.OIT. QION re! �� FINAL 'GAGSSA CE*809.7.96 APPLICA TION FOR BUILDING. PERMIT BUILDING AND SAFETY DIVISION BUI ADDRESS IESS S O Deparbn%t of GOVanty Engineer 1 CoAty of Los Angeles LOCALITY T 6.SPLA Pr x 1-74/ JOHN A.LAMBIE. COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. DISTRICT NO. GR�UP I SEWER MAP FOR APPLICANT TO FILL I1NV TYPE BK PG �, CONST. r BUILDING /jQ �OS �J� � hV[J I ADDRESS 6 STATISTICAL CLASSIFICATION CLASS. NO. DWELL. UNITR LOT NO. BLOCK MAP �Q O STATE HWY NUMBER ES NO TRACT f'jM fJ nl S.d If 1+ USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS A,1 SIZE OF LOT Sd�( Z NOW ON LOT I / ,1^j I USE OF EXISTING BLDG.' C E " �_p�;1�; SETBACK BUILDING YARD HWY STREET NAME EXIT. OWNER A -• FRONT MAILy7 r— P. L. ADDRESS •1 J �0 GIY1�p 171.V /. fib, ' SIDE TEL.LT 1 I ! P. L. CITY �ln L g- I U NO.- INSPECTION RECORD ARCHITECENGINEER r+�?+ �Lf?�7 N s� NO.TEL.Ar. III �I �� ADDRESS V(O a9 0 LOAr&2n Gr 1•li rr f ry+ -f & CONTRACTOR CA I N E« CUN51 f1 N07 kr 7)I 1 I ADDRESS"Il�3 Gl K u 511-M t'IiA ?L II D �C i DESCRIPTION OF WORK - NEW ADD ALTER - REPAIR DEMOLISH SQ.FT. NO. OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE - '�U tf21 I zl.rj C 3, g,J . APPROVALS SIGNATURE OF APPLICANT • DATE INS ECTOR'S SIGNATURE ADDRESS FOUNDATION:LOCATION FORMS. MATERIALS �1 P.C. g FRAME: FIRE STOPS. 1 FEE BRACING.BOLTS $ i FURNACE: LOCATION. VALUATION FEE b GAS VENT. DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH LL COUNTY ORDIN.JNCES AND LATH, EXT. STATE LAWS REGU L G UILD1 COySTRU.CTION. SIGNATURE OF (�j'/ HOUSE NUMBER COR- PERMITTEE `-�»t W +-�Gf.� RECT AND POSTED ADDRESFINAL ' IOHN A.LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH L{Co 6 7 5 5 RPR -3 i• 1 .o 0 �_ d• ' APPLICATION FOR ,,RUIL®ING PERMIT .- COUNTY OF LOS ANGELES ( BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS tt BUILDING ADDRESS S S '✓ I C S !'1 �'ir� I hereby affirm that I have a certificate of consent to self insure, LD j 1 ��,1 or a certificate of Workers'Compensation Insurance,or a certified �C 3n / U •M r"�� rii — r copy thereof(Sec.3800,Lab.C.) Policy No. Company CITY !� C r ZIP 91 -7-,?0 LOCALITY 1 r� SIZE OF LOT NO.OF BLDGS,Now ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST.0i 17'� El copy is filed with the county building inspection TRACT BLOCK LOT NO. -9 A )2 department. ;'i;cP,ty -;--�2 ey f.l I� / 3 USE ZONE MAP NO. AS ESSOR MAP B,OK PAGE PARCEL Date Applicant S- 3,, 7 0-z v �� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �� �/�,( CJ Z�Z_�`rr WffHIN 1000 FT OF SCHOOL? YES ` NO COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred ADDRESS 1 V� Al v rl/Ti �,r 7-�. ,J DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) �Tt I certify that in the performance of the work for which this permit C Jl4 y,/ J F ZIP is issued, I shall not employ any person in any manner so as to become s bject the Worke 'Co ensation.L ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date & Applica � .Cs.�^Y'�sJ' ADDRESS CLASS NO. � � DWELL UNITS"- NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CoyrRACTOR. 1 TEL L40. /^ SET BACK YARD HWY PROP.-INE WIDTH Compensation provisions of the Labor Code, you must forthwith : �P ,>✓Gey �/3 �ZJ - FRONT "- comply with such provisions or this permit shall be deemed revoked. AWBESS LIC.NO.7, ` PL �= , ✓ 2 0G� LICENSED CONTRACTORS DECLARATION SIDE y 'Y� CITY LIC.CLASS PL ,�,3 _ _4e.0_, I hereby affirm that I am licensed underprovisions of Chapter 9 ') SEWER MAP .I �O (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE O.OF STOR S NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG d— } License Numbe Lic.Class DESCRIPTIp�gF�WORK ADD ❑ VALUATION ;z*RL 64 L °i '7'Q ®•-F-' % r'-t. ( 17thC � fjiJ -7� � ( ':?:K _l').-,0 Contractor - � Date 'r ALTER $ �• �- Z� � r•iyA�.IGIE REPAIR ❑ T�= .OLD ❑ I am exempt under Sec. $ I"• BAP.C.for this reason DEMOL ❑ U LDMA P/C# USEOFE ISTINGBLDG. I.PAO S:i,)I�E" % ?/4rLU Date: URM ❑ Ur-_i a co Signature irr »aij�+l5 ^ APPLICANT(PPoAIT) TEL NO. LDMA Perm# _+ L- L t:.: _ -Z ❑ I, as owner of the property, or employees with wages as Z ;-�:• their sole compensation, will do the work and the structure is ADDRESS O I`.1'•. not intended or offered for sale (Section 7044, Business and FINAL DATE a - h l 9 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL -J ` OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J _:. 7:5,;; ❑ I, a3 owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL 8 .- — -- licensed contractors to construct the project (Section 7044, YES El NO� EQL !•�li-•.]_I L Business and Professions Code.) :•is,„WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR 01 7 GUIDELINES q;lf';1''(;� I�i`i•.I 1 hereby affirm that there is a constriction lending agency for YES[I NO ❑ "`' "' '- `? a the performance of the work for which this permit is issued(Sec. 9 ;� C', 3097,CIV.C.) (HAVE READ I HE UNDERSTAND MY ENTS UNDERTION HE AND THEANGELES CDPERMI TINGODE, e:y'S` •••• CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE L03 ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS i Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. ❑ Lender's Address 0 on AGENT c I certify that I have read thiPonpropedy ation and state under penalty perjuryof that the above infn is correct.I agree to comply P.C.FEE L/ PERMITEEE o with all county ordinancestate laws relating to building / G-�� �..Z N construction, and hereby But representatives of this County ISSUANC FEE ,/ .%to enter upon tpeabove- an for inspection purposel . 2 J f -ZI '-L INVESTIGATIONFEE' ATOTAE F O sgAe q t n pert Wte il' SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT a' COUNTY OF LOS ANGELES BUM ING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR PPLICANT TO FILL IN BUILDI G ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurancy or a c r'' d A JIM. copy thereof(Sec.3800,La C.) - C ZIP 6A17 1 LOCAU Policy No., Company SIZE OF•LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEARS OSS ST Certified copy is filed with theunty ilding inspe TRACT BLOCK LOT NO. Datedepartme USE ZONE MAP NO. Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS O O CERTIFICATE OF EXEMPTION FROM ORKERS' ER TEL O. [� COMPENSATION INSURANCE JA 00'WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred R S DISTRICT GROUP TYP CONST FIRE ZONE PR ESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CIN ZIP is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. O become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE 70 APPLICANT.' If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' RACTO TEL SET BACK Compensation provisions of the Labor Code, you must forthwith 72 _9700 © YARD HWY PROP LINE WIDTH d FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS DDR S LI NO. PL Cq- LICENSED CONTRACTORS DECLARATION — SIDE I hereby affirm that CR uC.CLASS PL I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and S .FT SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,a d my license is in full force and f t. NEW BK PG ® a License Num�er Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION/� �f �� O Contractor Date ALTER ❑ $ �O ov` U cc ❑ 1 am exempt under Sec. REPAIR ❑ $ - B.BP.C.for this reason DEMOL ❑ LDMA P/C# USE..o ,151 BLDG. URM ❑ ;,�••, , Date: — r d Signature AP ( N'T.) T O LDMA Perm# "'103 z rsp c ,co ❑ I, as owner of the property, or my employees with wages as J � Z their sole compensation, will do the work and the structure is A FESS O 1 not intended or offered for sale (Section 7044, Business and P� of/�/6 �• FINAL DATE Q _;_ Professions Code.) HANDLE A HAZARDOUS MATERIAL V��� Af"C I a WILL.THE APPLICANT OR FUTURE BUILDING OCCUPANT ` J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE licensed contractors t0 construct the project (Section 70444, FINAL BY ❑ 1, as owner of the property, am exclusively contracting 4AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? , � _J_=a i•.1 Business and Professions Code.) YES❑ NO❑ �j WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING '`MEM OS OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR I M„1 j AL =1. y f=g- y 1__a GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No El (. ;C Sstl4 1741.15 C4 the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING ; p�(!- a 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ;4�{-DryGE s 1JI TITLE 2,CHAPTER 2.20 SECTIONS MO.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address _ 0 OWNER OR AGENT 3•� f f '••!i:. lVi�r= o I certify that I have read this application and state under penalty LIIll 001, I�t(j . �! i=e .•! 0 of perjury that the above information is correct.I agree to comply P.C.FEE' `�p �Q PERMIT FEE / n Q�O;: j —, 1:1,•sc M with II county ordinancesdh tate laws relating to building (� (J ._• _ I__ cons io , and hereby aurepresentatives of this County ISSUANCE FEE / . toe u n the above-menoperty for inspection purposes. (p un M Aygicunl m Apenl ONa C70<1 INVESTIGATION OAL FEE / � SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self it ®p insure, or a certificate of Workers'Compensation Insurance, At'8 ® L'CAT-I®� �®®p ,���`®I��° PERMIT or a certified copy-thereof(Sec. 3800, L b. C. t ' �```'S C 179 3 017 --y - COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No�"� ompany j Certified co is hereby furnished. BUILDING 0 copy y FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. • ADDRESS S (,3 0 1 Oso n ea— Q� Date °� IJ -Applicant CITY, f:, Jt/i E ,T' ZIP 9/7 0 LOCALITY CE TIFI TE OF-EXEMPTION FROM WORKERS' v 1W.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 L07 NO.. MAP BOOK PAGE PARCEL TEL.' OWNER er or r e. NO. USE ZONE MAP 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 //+�� 1 nn - } 2 SPECIAL IL so'as to become'subject to the Workels'Compensation Laws. ADDRESS - 10 1 v u PI 1 I(I' On r CONDITIONS cin ._ U r (""a zip //off U Date Applicant' _ 09 ARCHITECT OR TEL O NOTICE TO APPLICANT:�If, after making this Certificate of f k k DISTRICT GRO P TYPE FIRE SSED BY ENGINEER >~ ✓'t O. a�s s a 73 Exemption, you 'should become subject•to The Workers' ��Q� //11 i�S CONST/ ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS J a FO �. / h e. 'S4 h L�GbnG�. /V IL with comply with such,provisions or.this,permit shall beIn , 11 II //'ti TEL., STATISTICAL CLASSIFICATION APT. NDO. deemed revoked.. CONTRACTOR 00AJ °r) �,On NO.t(OS 393-76dO , r LICENSED CONTRACTORS DECLARATION .-. CLASS NO. DWELL, UNITS ..�cr LIC:; a I hereby affirm that I_am licensed under provisions of Chapter 9 ADDRESS •!d 0 (. a IVO.4$43 (commencing with Section'7000)of Division 3 of the Business andI (� SEWER MAP ; Professions Code, and my license is in full force and effect. CITY kerg -I dd 3�0 2- CLASS A"s`C� ,* �' VALIDATION No License Number 484329 Lic.Class—& �!r SQ.FT. STONO. IES FAI U CHECK BK. PG. SIZE STORIES � FAMILIES ONE b VALUATION DESCRIPTION OF NEW ContractoWJOHae I`- Date 7 ' _ C� ` ADD $ / S L').00 (('� CO]❑ , I am exempt under Sec. - SOI I• �. a1 E r 1—0 O I n S " ALTER �� � " B.BP.C. for this reason REPAIR $ Date: EXISTUSEOING BLDG. ar C�i U S L DEMOL ] ' 6 4 9.7 A ; # a'aa - 23 Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT) O 11 e I NO. 3 �O DATE• - affirm that I am exempt from the Contractor's License yJ {� !�`Qr,," t•� ° ° 917.2'2 Law for the following reason (Section 7031.5, Business and I hereby ADDRESS r-�• �O rd L'r C' /✓7u�' FIN Professions Code): PRTEE NT By o o - 97,225- ' BUILDING I, as owner of the property, or my employees with ADDRESS � O� 1 ;1 j-$7 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS' L/ tion 7044, Business and Professions Code). REQUIRED . YARD' HWY TOTAL SETBACK-FRO l CONSTRUCTION LENDING AGENCY SETBACK PROP. LINE WIDTH i ;2 6 6 4,8 A I hereby affirm that there is a construction lending agency for FRONT I . the performance of the work for which this permit is issued P.L. #•0•0 0.0 0';1 (Sec. 3097, Civ. C.). SIDE P.L. .. fl °•1 2'4;88 Lender's Name 2 w LDMA Ref. # o e = Lender's Address P.C. Fee$ Permit Fee ✓ ) a, 1 ?4,8 8 a• I certify that I have read.this application and state that the Issuance Fee. J r/ LDMA P%C# ' O O,9-8'7' above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, _ Total Fee LDMR Perm:N and hereby lauthorize representatives of this County to enter ; upon t above-m do d prop ty fo inspection purposes. to �{ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of pplican1 or Agent to O i a COUNTY'OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTJiENT••OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND'SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9801140034 PHONE: (818) 285-0488 EXT: LEGAL ID: .•OF CONST G ADDRESS: ON FILE SQ. FT STORIES TYPE 5630 ROSEMEAD BL STRUCTURE: 0 VN ,TEMP CA 917801803 ASSESSOR-INFORMATION N0WER: -NEAREST CROSS STREET: 5387-028-021 - I THOMAS PAGE: 596 GRID: H4 CALITY: TEMPLE CITY EUS-T-060-USE: 0 SE ZONE: C-5 ISSUED0 PROCESSED BY: XPIRES 0 : EXIST OCC GRP: 01/14%98 UT 01/14/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: ALUATION: MAL—DATE FINA CODE: RENSAC INC (626) 447-5350- 13 6,700 1020 HUNTINGTON DR SMAR 911081828 EES PAD SCR P IO 0 R REPAIR FLAT PART OF BUILDING W H CLASS A HOT BUILT UP FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ROOFING SYSTEM-23 SQ. APPLICANT: E NO: 1 RANDOL ROOFING (626) 288-4040- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION•.RESID_•Y-----67OO.00.VAL 0.67 SPECIAL CONDITIONS: D2 PERMIT W/-O;EN-HC-=--=-_ --6700:00 VAL 166.95 �TOTAL�FEES a, 195.37 CONTRACTOR: TEL. N0: f' i`r�~ \ '` APPROVALS DATE INSPECTOR SIGNATURE RANDOL ROOFING AND CONSTRUCTION (818) 288-4040- ' �.•� 529 E. VALLEY BLVD LIC. NO ''j �.� � t; UO-C-ATION AND SET13ACKS SAN GABRIEL, CA 91776 451937/6 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: ' ILL_i ` ,___� i'� FOUNDATION/TRENCH FORMS LIC. NO� '� "?`1111111 ��I S A /UNDER FLOOR a , a I- --- — —�---------- -"__-d RAI D OOR ING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:T ,i'1 i i�__1 ;� ' t't rl+ UNDERFLOOR INSULATION 147H265 3 +04 LOO SH EATHING 0. OF FAMILIES: DWELLING S: APT/CON ' STAT C SS: NO 22ROOF-SHEATHIFIG \ �i � SE ES H HAZARDOUS LS AIR QUALITY: 1000 FEET MATERIALS NO NO NO �•` 3.L , =t�!. ,•, f FRAME INSPECTION R5QUIR5D TOTAL SETBACK 0 EXIST �) `;�,� i_ �C�; r. FIR SPRINKLER ERS SET BACK ,YARD: HWY: PROP LINE: WIDTH: se FRONT PL- �`R' rVtce ;�'� INS LATION/ ATHER STR P SIDE PL- INTERIOR LA EX ERIOR LATH RATED FLMUCIE-17XIIEM. RATED WALL ASSE14BLIES RATED'Si H S/0 G T-BAR,CE I El-R—S i 0 -DirAINAGE REPORT ID: DPR261 ROUTE TO: BSO5O8