HomeMy Public PortalAbout5646-5648-5650-5652-5654-5656 ROSEMEAD BLVD_Building__ ®5 76AS38R� .
CE/8Q3((REV.6/78)
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APPLICATION FOR: BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING j
FOR APPLICANT'TO FILL IN - � ADDRESS �csv /'C•osis -0L
BUILDING g
ADDRESS t l o LOCALITY 0Crrx
.�. all,
` NEAREST ,.�
CITY ZIP CROSS ST. 1-45 / ,sivof-v
N OF BLDGS. ASSESSOR
SIZE OF LOT � X Z 3� NOW ON LOT. MAP BOOK PAGE PARCEL
�v.L/Ny /�,�, Z. DISTRICT GROUP TYPE FIRE �PROC S BY
(TRACT 7 BLOCK( LOT NO. CONST.7 ZONE :W
TEL•.
OWNER �• I, L) NO.. . .
.'- STATISTICALCLASSIIF�ICATION SEVIER
)MAP
61-ADDRESS /�� J r �J+r��j — � CLASS NO. G2- DWELL.UNITS "BK /7PG
CITY �?�7�� ►� ZIP, c?/7•?
ARCHITECT OR TEL. VALUATION $ ��Q
ENGINEER NO.
ADDRESS BLDG.SETBACK FROM
TEL. FRONT PROP.LINE OF (STREET)
CONTRACTOR NO. I{IGHWAY, + YARD; _ TOTAL SETBACK FROM TYPE OF EXISTING
LIC. - FRONT-PROP.LINE HIGHWAY WIDTH
ADDRESS NO.
LIC. +
CITY CLASS
CONSTRUCTION LENDER BLDG.SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE OF (STREET(
HIGHWAY + YARD TOTAL SETBACK FROM TYPEOF EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH
SQ.FT. NO.OF NO.OF. CHECK + _
SIZE I STORIES FAMILIES ONE 0
T
DESCRIPTION OF WORK ' 418'1(1 w Cdl* NEW ❑ P.C.Fee$ Permit Fee
ADD ❑kn Issuance Fee
3' ALTER L Z
REPAIR ❑ Total Fee LJ
USE OF DEMOL
EXISTING BLDG. ❑ 2
APPLICANT TEL. C
(PRINT) 'hyyy M. S O.a .abQq C .
BY(SIGNAT �Rr`
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE {Y7
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LAABOR T ON INSDE Of THE URANCE.STATE OF CALIFORNIA IN RELATING WORKMEN'S COM- g -2 4.2 a 6 A
PENSIL
SIGNATURE OF
PERMITTE
2 00
ADDRESS Z
TEL. C a'o o 00v
CITY NO.Vq
0508-79
-USE ZONE MAP
NO..
G 3 SPECIAL �-
CONDITIONS
FINAL i/� J r BY d
DATE
,�P►�®'L 1 CAT_---t6-`N- F®R
1'N G PERMIT
--- �— R APPLICANT TO FILL IN ADIDRESS- -//I
FC I BUILDING
ADDRESS Y It/ LOCALITY l�
n NEAREST
CITY r( CROSS ST.
OF LDGS. ASSESSOR
SIZErOF LOT W ON LOT MAP BOOK PAGE r E6KEL
DISTRICT GROUP TYPE FIRE PROCES D BY
TRACT '' t BLOCK LOT NO. e� UO ONST.
OWNE � ` `,J.
STATISTICAL ri SSIFICAFrION SEWER MAP
ADDRESS oefti -//,d
CLASS NO. C20 DWELL.UNITS BK PG
CITY X ZIP USE ZONE
ARCHITECT
ARCHITECT O EL. NO.
ENGINEER NO. SPECIAL
CONDITIONS
ADDRESS ROAD-DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
TEL.
CONTRACTORNO. BLDG.SETBACK FROM'
LIC. FRONT PROP.LINE OF (STREET)
ADDRESS NO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC.' FRONT PROP.LINE HIGHWAY WIDTH
CITY CLASS _
CONSTRUCTION LENDER ( a
NAME AND BRANCH BLDG.SETBACK 8
ADDRESS CITY SIDE-PROP.LINEOF (STREET) Of
SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL SETBACK FR TYPE OF EXISTING U
SIZE STORIES FAMILIES ONE SIDE PROP.LINE HWAY WIDTH a
t = Z
DESCRIPTION OF WORK _ NEW -
` ADD CORNERCUTOFF YES ❑ NO ❑
ALTER ❑ IN OPEN SPACE YES ❑ NO ❑
USE OF REPAIR ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG. DEMOL ❑
APPLICANT TEL Gi
(PRINT) NO.
BY(SIGNATURE) 6 Z'//-7 �yN�L,,p
• I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE yrt /!/l//1(,. �� 0•C�01A46- /drs
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE /J��-+�/'//�//' ��LJ L /1ti �/�.r/J 1•l��kr
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN TING TO WORKMEN'S COM-
PENSATION INSURANCE.
SIGNATURE OF FINAL BY
PERMITTEE
BY �' ✓�!
PERMITTEE DATE `
ADDRES
TEL.
CITY 70� P.C.Fee$ Permit Fee 3
N
VALUATION�PAl
QQ Issuance Fee
/L V
V Total Fee
PLAN CHECK VALIDATION CK. M.O. CASH v PERMIT VALIDATION cK. M.O. CASH
0 1 AUG . 5 l B 3 .5.0 0 A�c;
h 7GA638B CE 0803B 6/76 -
L _M
."ICATION FOR ' -" =
BUILDING PERMIT "
FOR APPLICANT TO FILL'IN ADDR .r� -Q �— -S w
BUILDING v . 10
_
ADDRESi=•646°567 1Oa5650�6 z� 6.- A 6 LOCALITY 4
CITY �Rosenieae�B1®temple G y;Car CROOSSST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT 75/1,235 NOW ON LOT 1 MAP BOOK PAGE PARCEL y
DISTRICT GROUP TYPE FIRE ED BY
TRACT S V LOCK, LOTNO. 1z• CONST. _ ZE °z
OWNER r7011T1.T/e,..pontrelli TEL. m
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS 1134. So® San Gabriel Bl. CLASS NO. /S DWELL.UNITS �BK� 7G
San. Gabriel`•Ca''®" 917176 . USE ZONE MAPARCITECT
` CITY >4 NO.
ENGIN ER OR Roberk S';' Lee TEL d 3 SPECIAL a
CONDITIONS
ADDRESS 1 E`;' Himtinaton.11ROAD.DEPARTMENT APPROVAL REQUIRED , YESE] NO❑ a
CONTRACTOR Pasadena, a a 1 O BLDG.SETBACK FROM
LIC. FRONT"PROP.LINE OF (STREET)
ADDRESS NO. TOTAL SETBACK FROM TYPE OF EXISTING
LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
CITY CLASS _
CONSTRUCTION LENDER + a
NAME AND BRANCH BLDG.SETBACK FROM-- 0
ADDRESS CITY SIDE PROP.LINE OF (STREET) im
SO.FT.
NO.OF
NO. CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SIZE' 5000 STORIES 6 FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH y
DESCRIPTION OF WORK" Maso n.-Block NEW ® + = z
ADD ❑ CORNER CUTOFF YES ❑ NOv ALTER EF-11 ❑
R ,❑ IN OPEN SPACE YES ❑ NO ❑
E XIS
OF BLDG. REEPAIR PAIRMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NOTIN ❑
APPLICANT '" i, TEL
(PRINT) NO. 7Y
BY(SIGNATURE(
• ('HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANNG ITHE, IZ'•"'�V�K `��Fl "� �"�' r
THAT THE ABOVE.IS CORRECT AND AGREE TO COMPLY WITH ALL ORDIr
4 67 Zo A01,
VyOR AUTHORIZEDAND TING H HEREBY IDING WILL NOT EMPLOY ANY PETIFY RSONHNTIN DOING VIOLATS Lb IS •G•�/7
THE LABOR CODE OF THE STATE OF/CAUFORNIIIN RELATING T WORKMEN'SCOW
PENSATION INSURANCE. '
SIGNATURE OF. FINAL BY
PERMITTEE DATE.-
ADDRESS
_.�" TEL. /� P.C.Fee$ 6 / � •Permit Fee p� QCITY NOIssuance Fee
VALUATION$ �/ '� ' ' T
tal Fee
PLAN CHECK VALIDATION cic ` M.o. CASH PERMIT VAL DAT" Q-k.,l M.O. CASH
6 $NAY ':50 2-5
.6 8 9 A.0 '. .1:
OS 7I A638B CE#80319 8/77 6 9 O L`A LIG 2-5 .y .0 ( 2 Q �C
.2 ,J V ta.W
C�
'APPLICATION ®� C UNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
B U R LD I N G PERMIT BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN ADDRESS m
e
BUILDING
ADD RE ° J LOCALITY
NEAREST
y
CIT ZIP CROSS NNEAREST.
r. �JroyyeL'OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCE BY
TRA K OT NO. O g , CONST., JE
OWNER u �J IF
STATISTICAL CLASSIFICAN SEWER M—AA
ADDRESS CLASS NO._DWELL.UNITS L— BK/ !PG
r
CITY ZIP USE ZONE
ARC NO. V Y�
ENGINEER o. Np, SPECIAL
CONDITIONS
ADDRESS ' ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
TI
CONTRACTOR • NO. BLDG.SETBACK FROM
l&llbll4v N LIC. FRONT PROP.LINE OF (STREET)
ADDRESS NO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC. FRONT PROP.LINE HIGHWAY WIDTH
CITY CLASS _
CONSTRUCTION LENDER + O.
NAME AND BRANCH BLDG.SETBACK'FROM. U
ADDRESS CITY SIDE PROP.LINE OF (STREET) OCx
SQ.FTi O.OF NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING .
SIZES] TORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH N
DESCRIPTION OF WORK NEW ❑>
ADD Cl CORNER CUTOFF YES ❑ NO ❑
I YDEMOLOL
LTER IN OPEN SPACE YES ❑ NO ❑
EPA
USE OFTINBLDG. ❑' IN COASTAL PERMIT ZONE YES ❑ NO-EXI ❑
APPLICANT TEL
(PRINT) NO.
BY(SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM.
PENSATION INSURANC
A
P
SIGNATURE f� FINAL BY
PERMITTEE r v DATE
ADDRESS
TEL. P.C.Fee$ Permit Fee ��..
CITY NO.
VALUATION
Issuance Fee
.✓ QT�Z7 of,,`�
Total Fee -2 �
'PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
3 0 O.L"Z,IUM, :50 .1 U 2 7 E9.5 0 ,&:56
h 76A638A CE/803A 8/77 _ - - ._
5s 76AS38N
CE J1993 AE"/78)
APPLICATION F'OR• BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFET
FOR APPLICANT TO FILL IN ADDRESS N- -;
BUILDING //r ®� .�. -
ADDRESS 4 !y 4p .• ��` �Ly:►/ _ LOCALITY
NEAREST
CITYtg
��PU1/ ZIP0 CROSS ST.
SIZE LOT .1 Z5 y Z.S 7 NO. BLDGS. ASSESSOR
NOW ON LOT. MAP BOOK PAGE PARCEL
r 'DISTRICT GROUP TYPE FIRE d -<
ESSED BY
TE
• 9- BLOCK LOTLL/�NCO.. qqZ- CONST. ZONE
OWNER I--S. NQG�t7+hs-2-1 for /�®0
j�/"_ STATISTICAL CLASSIFICATION SEWER P
ADDRESS �!1� �+ L-�/ R-P, + CLASS NO. ��-'DWELL.UNITS Blf/ PG
CITY e M f7�TTi 64, ZIP 41100 .
ARCHITECT OR TEL. VALUATION 1—,5-0 Q
ENGINEER NO.
ADDRESS BLDG.SETBACK FROM
TEL.: FRONT PROP.LINE OF (STREET)
CONTRACTOR U NO. HIGHWAY + YARD __ TOTAL SETBACK FROM TYPE OF EXISTING
LIC. FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS NO. _
LIC. +
CITY CLASS
CONSTRUCTION LENDER BLDG:SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE OF (STREET(
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH
SQ.FT. NO.OF NO.OF CHECK + = V
SIZE STORIES FAMILIES ONE �
DESCRIPTION OF WORK NEW ❑ P.C.Fee$ �2- /, /6, Permit Fee
ADD ❑ Issuance Fee
ALTER ❑ Z
emss-
/ REPAIR ❑ Total Fee
"USE DEMOL El _ _
EXIS ING BLDG.' -7 Z
APPLICANT TEL / C
(PRINT) NO. 02� • C
3
BY(SIGNATURE) 4
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES / W
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF u 7 3 4,0 A
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z G
PENSATION INSURANCE.
d o 0 0 0 0 1
SIGNATURE OF IJ
PERMITTEE rc �' 2 a - 34,00
ADDRESS v 2'
Z O c ¢ 34,000
TEL.
CITY NO. c I G22'-79
USE ZONE MA
NOP C ? M
�}
�" SPECIAL
CONDITIONS
FINAL
DATE
@s 7GA638A
.1
CE/803(REV.6/78) . -
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BU LDING FOR APPLICANT TO FILL IN ADDRESS
�- -Q
BUILDING
ADDRESS r LOCALITY
NEAREST
CITY ZIP CROSS ST. Q�J
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE I PARCEL
DISTRICT GROUP. TYPE FIRE P C ED BY
T w BLOCK LOT NOt/,31L. �DU J _ OS NST., ZONE
Ni& �
TEL. U ✓61iC q/y, c?�
'OWNER NO.
STATISTICAL CLASSIFICATION ER MAP
ADDRESS
15GAO CLASSNO. d2L 0 DWELL.UNITS �J BK/-7PG
CITY ZIP
ARCHITECT / TEL. VALUATION $ ����
ENGINEER G �/ NO.
ADDRESS BLDG.SETBACK FROM
L. FRONT PROP.LINE OF (STREET)
TE
CONTRACTOR TN 11 HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
LIC,c� - FRONT PROP.LINE HIGHWA WIDTH
ADDRES 3 Oaf _
LIC. +
CITY CLASS e
CONSTRUCTION LENDER BLDG.SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE Ofd EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH
SQ.FT. NO.OF NO.OF CHECK + _ w
SIZE STORIES FAMILIES ONE /- 99
DESCRIPTION OF WORK NEW P.C.Fee$ to g Permit Fee /
c.) ❑
ADD Issuance Fee us
ALTER ❑ g
REPAIR ❑USE Total Fee
TIEX STING BLDG. IDEMOL El C
APPLICANT,• TEL
(PRINT) MlwekN Q7!2 'y G /►_Y� .
BY ISIGNATUREIL, c, A
SKY s s -
I HEREBY AC OW DGE THAT I HAVE READ THI A PLICATION AND STATE O �j 7 U
THAT THE ABO IS C RRECT AND AGREE TO COMP Y ITH ALL ORDINANCES U. O O
AND LAWS REQ(JLATINJ&BUILDING CONSTRUCTION.I C I Y THAT IN DOING THE 5 _
WORK AUTHO ED REBY I WILL NOT EMPLOY ANY P ON IN VIOLATION OF u
THE LABOR COD HE STATE OF CALIFORNI IN RELATING TO WORKMEN'S COM- Z /�
PENSATI URAN . g 2 4 Q 9 A
6
SIGNATURE 0 0 0 0 0 0
PERMITTEE
ADDRESS Z 2'0 0 8.a O O
TEL 6 ¢ 0 0 0 o 88,00LE
CITY NO. QC
USE ZONE NOP Q 0 0 -1.24-79
SPECIAL �
CONDITIONS
I BYm
FINAL-
;7,
�,�!' V /' �, �/
" APPLICATION FOR BUILDING PERMIT �
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION i FOR APPLICANT TO FILL IN BUILD NG ADDRESS
BIJILpI G ADDRESS S C
I hereby affirm that I have a certificate of consent to self Insure, N
or a certificate of Workers'Compensation Insurance,or a certified 0! 3 lei.
copy thereof(Sec.3800,Lab.C.)
Ia 9 `r'�/�� LO
Policy No. Company SIZE O ! /T NO. BLDG&NOWON LOT e ik f
❑ Certified copy is hereby furnished. NEAREST qROSB ST
❑ Certified copy is filed with the county building Inspection TRACT: BLOCK LOT NO.
department. PARCEL
USE ZONE MAP NO.
ASSESSOR MAP BOOK PAGE
Date Applicant SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TELD
'/ �! O.
COMPENSATION INSURANCE Et(W61tCf \ ao�' �3 WITHIN 1000 FT.OF SCHOOL? YES NO
AD RES,SI
(This section need not be completed if the permit is for one hundred Will A) r Rose 'y-d DISTRICT GROUP TYPE CONST' FIRE ZONE PROCESSED BY
dollars($100)or less.) CTIY ZIP ff V O
I certify that in the performance of the work for which this permit w e` 1i 7SJ
DY
3 If
is Issued, I shall not employ any person in any manner so as"to ARCHITEOT OR ENGIWER TEL NO.
become sublept to th0brkers'Compo Om Laws. STATISTICAL CLASSIFICATION APT CONDO
Date •' C Applicant 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' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith FRONT
comply with such provisions or this permitshall be deemed-revoked. ADDRESS LIG NO. PL
LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS FIDE C
I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP c.2
(Commencing with Section 7000)Of Division 3 Of the Business and
SO.Fr..,SIZE NO. NO. FAMILIES r�
Professions Code,and my license is In full force and effect. NEW ❑ BK PG ® O;
License Number LIC.Class DESC IPT`ON OF WORK ADD ❑ VALR000
�41TAV NIT raw o 6iContractor Date r/ ALTER �
❑ I am exempt under Sec. �J REPAIR ❑ $
BARC.for this reason DEMOL ❑
LDMA P/C
Date: USE OF I ING BLDG. .URM 13 M
Signature APPL (PRINT) pppp � TEL NO. LDMA Perna
❑ I,as owner of the property, or ERY employees with wages as N ' V-0 3 —0(?ZZ ps
their sole compensation,will do the work and the structure is ADDRESSsvLL I ACCT.a
not intended or offered for sale (Section 7044, Business and 0 &1/"o � 2 1461,& a,t FINAL DA a -?0! 93.63+
°G
Professions Code.) VALLTHEAPPLkANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL
❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL DUAL TO OR GREATER THAN a I ITEMS
Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed'contractors to construct the project.(Section 7044, YES❑, NO❑ `� TOTAL C v 4
Business and Professions Code.) WILL
OCC THE INTENDED USE MI THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK
93.63
OCCUPANT REOUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH � VV I:rIGVr�
CONSTRUCTION LENDING AGENCY COAST GUIDELINES.QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST .00 r;J I
I hereby affirm that there Is a construction lending agency for YES El NO❑ �� �
the performance of the work for which this permit IS Issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD '
3097,Civ.C.). PERMITTING CHECKLETITLEIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELESCOUNTYCO \ �I — `Er} J[�
ia• Lender's Name HAZARDOUSOMATERIAL S REPORTING AND FOR OB2.CHAPTER Z20 SECTIONS TAINING NG A PERMIT FROM THE SCA20.100THROUGH 220,140 OMD. 1 I.I 'r C f 7
Lenders Address I 0308 1 AM 8E 15
OWNER OR AGENT
o I certify that I have read this application and state that the above RC FEE PERMIT FEE
information is correct. I agree to comply with all county
ordinances and State laws relating to building construction,and I1)11,63
hereby authorize representatives of this County to enter up ISSUANCE ISSUANCE FEE o�
the above- �ention d pro N FEE TOTAL FEE
e y for Inspection purposes. �It i 3.
`• INVESTIGATIO
3. 3
s4„amemAonow°orAoa ___ J
ocro
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION FOR WILDING PERMIT
_ COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION' i FOR APPLICANT TO FILL IN BffDINGADDREM-R n1 hereby affirm that I have a certificate of consent to self Insure, BUI D G/A/DDRESS / /� mor a certificate of Workers'Compensation Insurance,or a certified CITY a ZIPcopy thereof(Sec.3800,Lab.C.) U'' L
Policy No. Company SIZ O LO NO.OF BLDG . ON LOT 1
❑
Certified copy is hereby furnished. NEAREST ROSS ST
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department.' USE ZONE MAP NO.
Deb Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNE D j(,J/V TEL NO. YES No
COMPENSATION INSURANCE WITHIN 1000 Fr.OF SCHOOL?.
(This section need not be completed if the permit is for one hundred Jttrg A49 RowzJ Aid, DISTRICT GROUP TYPE CONST.' FIRE ZONE POC iD BY
dollars($100)or less.) Civ ZIP / Jc//
I certify that in the'performance of the work for which this permit @ 7 t
Is issued, I shall not employ any person in any manner so as to ARCHIT CT OR ENGIIOER TEL NO. 9�
become subject to the Workers'Compepsation I aws..... STATISTICAL CLASSIFICATION APT CO
Data �— G Applicant rCEi/G241d ac Il/A ADDRESS CLASS NO.. DWELL UNITS
NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' Y�O OR�3 TEL NO. SETBACK -YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith FRONT
comply with such provisions or this permit shall be deemed-revoked. ADDRESS LIC.NO. PL
LICENSED CONTRACTORS DECLARATION CI. LIC.CLASS SID
C
I hereby affirm that I am licensed under provisions.of Chapter 9 SEWER MAP v
(commencing with Section 7000)of Division 3 of the Business and SO.Fr.SIZE N .OF STORES NO.OF FAMILIES OC
Professions Code,and my license Is in full force and effect. NEW BK J PG CD
License Number LID.Class DE CRIPTION OF WORK ADD vALt ION ly
6I °=
Contractor Date ALTER ❑
❑ I am exempt under Sec.
REPAIR ❑
BARC.for this reason DEMOL ❑ LOMA P/C 0
USE OF EXISTING BLDG.
Date: URM. ❑
Signature APPLICANT(PRINT) TEL NO. LDMA Paan i
❑ 1,as owner of the property, or my employees with wages as ...• a
P � �oa
their sole compensation,will do the work and the structure is ADDRESS
not Intended or offered for sale (Section 7044, Business and FINAL DATE G C� 43.1%1 o _
Professions Code.) WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL4:J� ) �
❑ 1, as owner of theproper, am eXC1USIveI COntrectin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN qq qy {y
ty, y. g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL 1 -ITEMS.'
E S
licensed contractors to construct the project.(Section 7044, Y6S❑ NO❑
Business and Professions Code.) 4 TOTAL 43.75
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING
TH
CONSTRUCTION LENDING AGENCY COASTOCCUPA IR QUAREQLITY
MANAGEMENTIT FOR
DISTRICT
(SC OMD)SEE
FROM ING HESOUST NECK
��((/ 4� 75
COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PFAMITTING CHECKLIST v vf\ `tJ e f
FOR GUIDELINES.
I hereby affirm that there is a construction lending agency for Y ❑ NO❑ CHANGE .00
the performance Of the Work for which this permit IS Issued(Sec. �Es HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD
3D97,.CIV.C.). ERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �} / [y
`3• UGH 22D.140 CONCERNING
Lender's Name AZARDODUSMATDo
COUNTY CODE. ITLE ERIAISREPORTIAPTER NGANDFOROBTAINNGSECTIONS APERMITFROMTHESOAOMD. C000-0001 4/25/7)
Lender's Address { 3{�I AM o is
01YNEi OR AGENT
o° 1 certify that I have read this application and state that the above P.C.FEE PERMIT FEE
information is correct. I agree to cor iply with all county /�.
ordinances and State laws relating to building construction,and l/
hereby authorize representatives of this County to enter upon ISSUANCE FEE I 3 . n.0
the above-mentioned property for Inspection purposes.
INVESTIGATION FEE TOTAL FEE
8q,xmed AppkadmAped DoSEE REVERSE FOR EXPLANATORY MOUAGE,
• ' '� COUNTY OF LOS ANGELES ' TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS TENANT IMPROVEMENT
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9807210103
PHONE: (818) 285-0488 EXT:
LEGAL ID: NO. OF CONST — NEW SUMMING ADDRESS:
ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5648 ROSEMEAD BL
STRUCTURE: 0 1 VN B TEMP CA 917801800
ASSESSOR INFORMATION BER: NEAREST CROSS STREET:
5387-028-006 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: C M E USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
VITAMATRIX, INC. EXIST OCC GRP: B 07/21/98 UT 07/21/99
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE:
135 NWISTARIAEAVM TR (818) 447-8001- 3,500 eX —f w w4w4__
ARCD 910078008 —FEES-PAID D SCRI TION OF WORK
REMOVAL OF EXISTING AND INSTALLATION OF NEW WALLS-T.I.
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IMPROVEMENTS NO NEW SQUARE FOOTAGE
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID —- _ 3500.00 VAL 0.50 SPECIAL CONDITIONS:
AX BUILDING REVIEW-FEE- = 54.70
D2 PERMIT W/0 EN-HC ;'c;3500..00'VAL 115.80
--TOTAL .FEES 198.75
CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - `.• i \. " "
LIC. NO LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FO NDATION BENCH FORMS
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
3 04
FLOOR SH A HING
NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS:
NO 22 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PA ELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
FIRE SPRINKLER HA GE S
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
TED FLOOR/CEIL ASS M.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DR INAGE
REPORT ID: DPR261 ROUTE TO: BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0201040018
PHONE: (626) 285-0488 EXT:
LEGAL ID: . OF CONST BUILDING ADDRESS:
ON FILE SQ. FT STORIES TYPE 5646 ROSEMEAD SL
STRUCTURE: VN TEMP CA 917801800
0 NEAREST CROSS STREET: LAS TUNAS
5387-028-006 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY
TENANT: EYOTTEWUSE:
UEPROCESSED EXPIRES .
S 0
EXIST OCC GRP: 01/04/02 JK 07/03/02 .
OWNER: TEL. 0: B DGS. NOW ON LO VALUATION: FINAL DATE FINAL BY: CODE:
CHUNG;ALICE (626) 285-3589- 1 7,100
P.O.BOX 5215
PASADENA 91117FEES PAID DESCRIPTIONOF WORK
T/0 ALL ROOFING;INSTA MODIFIED BITUEM ON EXISTING SHEATING
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ON WHOLE BUILDING
APPLICANT: L. 0•
J W ROOFING SERVICES (626) 852-2150- AA BLDG PERMIT ISSUANCE 27.75
138 BRANCH OAK CT AC STRONG MOTION RESID 7100.00 VAL 0.71 SPECIAL CONDITIONS:
GLENDORA 91741 D2 PERMIT W/0 EN-HC 7100.00 VAL 183.00
TOTAL FEES 211.46
CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE
J W ROOFING (626) 852-2150-
138 BRANCH COURT LIC. NO LOCATION AND SETBACKS
GLENDORA, CA 91741 662149C39
SOILS ENGINEER APPROVAL
ARCHITECT OR G 0: FO DA 0FOINS
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR NG
MAP NO: SE ERMAP PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
147H265 3 04
0. OF S: L G I S: AP CON STAT C S FLOOR SHEATHING
NO 22 ROOF S EAT R I N G
SCHOOL 0 SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED S CFROM EXISTR S G S
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULAT 0 /WEA HER STRIP
SIDE PL-
INTERIOR
EXTERIOR LAT
RATED S .
RATED WALL ASSEMBLIES
RATED SHAFTS-7070grOff-
T-BAR CEILINGS
LOT DRAINAGF-
REPORT ID: DPR261 ROUTE TO: BS05O8