HomeMy Public PortalAbout5675 ROSEMEAD BLVD_Building__ �aa=f► ���=„ errs. APPLICATION FOR PRIti IT
DEPARTMENT OF tUILDING AND SAFETf. ..
COUNTY•OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER J
NO.OF BLDG.. ORD.•NO.1 DISTRICTNO.. PLAN CK. NO. PERMIT NO.
PLANS 0 SETBACK LINE 7, �'S?
FIRE APPROVED '*
ZONE \ BY DATE RECEIVED BY DATE OF APPL.. DATE ISSUED
USE APPROVED 1}}' 1 `a� r ►J'�{`,
ZONE �+ BY DATE
`7
APPLICANT FILL \IN HEAVILY OUTLINED PORTION ONLY
BUILDING
p NAME \ ADDRESS f�4V 14::, kAj! IL/' A-S
• �Z ADDRESS - LOCALITY'NICAR t.� -
V CITY \ C B /r+. C i �' iT( A 4...�i
Ic
STATIC TEL.
LICENSE NO. NO. \ g NAME (,,/a
K NAME ADDRESS
O b� TEL. ..✓
ADDRESS Af 65� CITY,^f _/ 11� � /�P .< NO.
Z CITY I HEREBY ACKNOWLEDGE THAT I -HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
U STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
LICENSE NO. No.
NO. AND-STATE L'AWS-REGULATING BUILDING CONSTRUCTION.
LQT NO,a. N � SIZE OF LOT ' + � 8160WN OR
`I I- NO. OF BLDGS. r e
< d ` AUTHORIZED AGT.-
BLOC
K NOW ON LOT a x'
$� TRACT Ga _ .
7 CORRECTIONS
D USE OF BLDGS. .y.�
NOW ON LOT ++� LME
t / V 7n i..o -
DESCRIPTION OF WORK7 �
1 .��j.
USE or
BUILD Nd Il' VOLIC / ' ' nlnN�f.1�� �I
This construction may be in violation c
vv
rniffinnAl in rmimilt wiflix1'11•T lrrr',i War0
PioductionBoardOffice-before commenc-
ing the vrork auti 6r5ed•in this permit.
' a
r
NEW � STYPE Yr GROUP JE
NO.OF NO.OF
ALTERATION ROOMS I , p s FAMILIES
ADDITION SIZE ,erg "+?4., *1 6
el
a Al
REPAIR STORIES /J A
MOVING WAG. COVERING
DEMOLISH ROOF COVERING
F'RIC $ �,�Q . FINAL APPR 9VAT....
'VALUATION / i/ REB
WORKERS'•COMPENSATION DECLARATION a, •
hereby affrrT that I have certificate of consent to Self
c , APPLICATION FOR BUILDING P E RM I T
Z insure, or b certificate of Workers'Compensation Insurance,
on a certified copy thereof(Sec. 3800, C•) R COUNTY OF LOS ANGELES BUILDING AND SAFETY
PoIIcr&t11_�_71 • Company L
❑
Certified copy is hereby furnished. . FOR•,APPLICANT TO FILL IN . BUILDING'DRESS �Ga�o�
Certified co is filed with the coun �'nginspec- BUILDING t � phtion department. ADDRESSrd75 •VbDate Applicant. _ CITY`MZIP LOCALITY ?� CrGGG
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTIOA FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCEASSESSOR
This section need not be completed if the permit is for one TRACT BLOCK LOT MAP BOOKPAGE PARCEL
undyed dollars ($100)or less.) TELib)
OWNER 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 ADDRESS ,�D 7,0-33 SPECIAL
CONDITIONS
. so as to become subject to the Workers'Compensation Laws. ,, /p� �j p O
CITY LAIrk` ZIP "L6-O`3� V
Date Applicant ARCHITECT ORTEJ.►f De
NOTICE TO APPLICANT: If, after.-making this Certificate of ENGINEER S NO`("o DISTRICT GROUP TYPE FIRE PROCESSED BY
CONST. ZONE
Exemption, you. should become subject-to the Workers' �� ,��� AA �/
Compensation provisions of the labor Code, you must forth- ADDRESS �112AC & S .tS. �r��' o�L cJ !�LGe_�-�--El-
with comply with such provisions or this permit shall be /.alt Darty �(�L TEL.-3 STATISTICAL CLASSIFICATIO APT. CONDO. h
deemed revoked. be .
NO. , 'ZDO"L ? Z
LICENSED CONTRACTORS DECLARATION NO � •7 gZ CLASS NO.a� DWELL. l9NITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 17 .
(commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP
CITY Lo 144644. t=--1
and Professions Code,and-my license is in full force and effect. CLASS O BK. PG. VALIDATION
_ SQ._FT. NO. OF NO. OF CHECK
License Number 76 c- Lic. Class �2 SIZE STORIES FAMILIES ONE
VALUATION
Contractor Date 0/4 Z DESCRIPTION OF WORK �r NEW ❑ $ �y�0 0
❑I am exempt under Sec. .
�S -Ul�IR� CL fr c� (J ADD ❑ s7 iJ✓v ►
ALTER ❑
BAP.C. for this rens REPAIR ❑ $
USE OF pp,,�,��,�
EXISTING BLDG. (An6'G�+Y •DEMOL ❑
Signature _ APPLICANT ` TEL.Gtcl) FINAL
ti NO. cy
O (PRINT)
NER-BUILDER DECLARATION DATE/�
I hereby affirm that I am exempt from the Contractor's License ADDRESS 660 U ; R-0 U� '9�3•L
Law for the following reason (Section 7031.5, Business and FINAL t
Professions.Code): PRESENT BY J "
❑ I, as owner of the property, or m em to ees with BUILDING 6 �' �
P P Y� Y P Y ADDRESS --
wages as their sole compensation,will do the work-and
LOCALITY
the structure is not intended or offered for sale(Sectioh , -• -• t'•-:�`:'•
7044, Business and Professions Code.) MOVING TEL.
❑ I,as owper of the property,am exclusively contracting CONTRACTOR NO. J.
with licehsed contractors to construct the project (Sec- ADDRESS. `•-'
tion 7044, Business and Professions Code.)
REQUIRED YARD HWY TOTAL SETBACK FROM - EXIST.
CONSTRUCTION'LENDING AGENCY SET BACK PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for -FRONT T-
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE = s
Lender's Name QI P L (� I. - -...__._. . _ _
Lender's Address P.C. Fee$ �/ Permit Fee / v LDMA Ref. # -.i�,:n:•:- '
I certify that I have read this application and state that the Issuance Fee ��`- 7� LDMA P/C# ►
3 above information is correct.I agree to comply with all County Investigation Fee
ordinances anthState laws relating to building construction, Total Fee LDMA Perm. # •.+1=_t`-"' 13 s 'j ;;.'
and hereby oriz presentatives of this County to enter
upon thea ve-m ned party for inspecti n pur oses. `�=L`• + 'f
°•r
o � SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Applicant or Agent Date
WORKERS'COMPENSATION DECLARATION
hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT �
Knsure, or a certificate of Workers'Compensation Insurance,
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Polic Company 7� lJ BUILDING (�
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
Certified copy is filed with the un wilding inspec- BUILDING -s O �,U
tion department. ADDRESS
Date 1 TA Appl!can CITY �`(`� ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. 'f
(This section need not be completed if the permit is for one ASSESSOR
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 C— NO.2S 40 NO.
permit is issued,I shall not employ any person in any manner � SPECIAL t�
so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS 0
DateApplicant CITY.- C�rj�Cb� —` S ZIP
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR ESSED BY 29
Exemption, you should become subject to the Workers' ENGINEER NO, CONST. ZONE Ly
Compensation provisions of the Labor Code, you must forth- ADDRESS ��
with comply with such provisions or this permit shall be IL
TEL. STATISTICAL CLASSIFICATION APT. CONDO.
deemed revoked. CONTRACTOR p• �} ( Z
LICENSED CONTRACTORS DECLARATIONLIC. L' CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS C� , NO. —!
(commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP
Professions Code, and my license is in full force and effect. CITY L CLASS�--� VALIDATION
/► j� SQ.FT. NO.OF NO.OF CHECK BK. PG.
License Number U..Class!`� SIZE IN
FAMILIES ONE
/�',�,,r� VALUATION
Contractoree� -X�RIJ��ate U —U DESCRIPTION OF WORK S NEW ❑
1 t\ f� ADD ❑ $ ,
I am exempt under Sec. IZ N`Ww\. l�' Z b ❑ •
tt � ALTER
B.BP.C. for this reason LA REPAIR ❑ $
Date: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL. f FINA 7
OWNER-BUILDER DECLARATION PRINT NO. �j.-
I hereby affirm that I am exempt from the Contractor's License c DATE VV s 6 5 7.6 A
Law for the following reason (Section 7031.5, Business and ADDRESS J Q1J�� -�. �I• Q0 FIN
Professions Code): PRESENT By - #,0 0 0 0 0
BUILDING
I, as owner of the property, or my employees with ADDRESS J - 4050
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section' LOCALITY ® o 0 0 4 Q 5 0 5
7044, Business and Professions Code). MOVING TEL.
QI,as owner of the property,am exclusively contracting CONTRACTOR NO. 0225-87
with licensed contractors to construct the project (Sec-, ADDRESS
tion 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK FRO
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
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
a
P.L.
Lender's Name
LDMA Ref. #
P.C. Fee$ Permit Fee (1
- Lender's Address
rI certify that I have read this application and state that the Issuance Fee Z& • LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total-Fee
an thorize representatives of this County to enter / LDMA Perm.#
on the ab - ned property for inspection purposes.
_ — SEE REVERSE FOR EXPLANATORY LANGUAGE
0
Signature of Applicant or Agent Date
WORKERS'COMPENSATION DECLARATION
�. ins'�ure, or afcertif carte of Worke s'tCompensat on eInsuran ent to lf APPLICATION FOR BUILDING PERMIT
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
PolicyNoCompany_ A—,-
a
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN Bull
AD ESSSS
,
Certified copy is filed with the county building inspec- BUILDING.•�� •� q./ �
lion department. ADDRESS !ems G•7F
Date 8/ Applicant_ � Jf�'4 'L`L CITY / ZIP LO LITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. EA ST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 1,ST.
(This section need not be completed if the permit is for one ASSMVR
hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP MPK PAGE PARCEL
OWNER U / I`' �L 0USE ZON 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 n,, / EC
IAL
so as to become subject to the Workers'Compensation Laws. ADDRES ,75 �/IG� DITIONS
Dote Applicant CITY ,d_ [� ZIP
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT ORrs s T •� �,! `�rf DISTRICT GROU PE FIRE PR CESSED BY
Exemption, you should become subject to the Workers' ENGINEER L u��6� 7 ST. ZONE
Compensation provisions of the Labor Code, you must forth- ADDRESS Sr _ �/�
with comply with such provisions or this permit shall be
deemed revoked. CONTRACTOR IDI ,7 STATISTICAL CLASSIFICATION APT. CONDO.
LICENSED CONTRACTORS DECLARATION / p ,/eta LIC, CLASS NO. DWELL. 5
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS,//fa/ f/k+e � NO. SEWER MAP
(commencing with Section 7000)of-Division 3 of the Business and LIC.
Professions Code, and my license is in full force and effect. CITY �L,vlllC�`� CLASS BK L_FG) VALIDATION a
�{ SQ.FT. . F NO.OF CHE
License Number _ + Lic.Class rte" SIZE ISTORIFAMILIES ONE 0
Contractor s I."� • �e 1 31 DESCRIPTION OF WORK
NEW ❑ VALUATION d
❑ a�A !L-LL/�r ADD a $ , 23 IU,
I am exempt under Sec.
ALTER
B.BP.C. for this reason REPAIR ❑ $ ACCT 10
Date: USE STOING BLDG. DEMOL ❑ 3307 41.41_
APPLICANT n TEL
Signature �4'1! FINAL ITEMS
OWNER-BUILD DECLARATION PRINT NO. DATE
I herebyoffirre that I am exem rom the Contractor's License �//�,�"" 4 3- a 45
Law for the following reason (Se ion 7031.5, Business and DRES 9trsr i /i6/ FINAL TOTAL
41.45
Professions Code): PRESENT, By CHECK
El 1,
I, as owner of the property, or employees with ADDRESS 4L-itLLr�7L
CHH� E o00
wages as their sole compensation,w do the work and
the structure is not intended or offered r sale(Section LOCALITY
7044, Business and Professions Code). MOVING TEL.
❑ I, as owner of the property,am exclusively c tracting CONTRACTOR NO. 00. 4/89
with licensed contractors to construct the proje (Sec- [(7� 1 AM102.7.t
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK
LINE WIDTH
I hereby affirm4h9l there is a construction lending agency for FRONT
the performance o rk for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L. Ot"- r_) :C •.D Eo1 C` 7 F
Lender's Name rz) Lri
LDMA Ref. M
P.C.Fee ( Permit Fee r ti Gl '� e
Lender's Address qp
I certify that I have read this application and state that the Issuance Fee �� LDMA P/C N M
117.
above information is correct. I agree to comply with all County Investigation
I ordinances and State laws relating to building construction, Total Fee ♦� LDMA Perm. 8 1n
I and hereby authorize representatives of this County to enter qd
s
up o the bove-mentioned property for inspection purposes.
�..D• Ci a t7
SEE REVERSE FOR EXPLANATORY LANGUAGE 3 W e .�•�
gnature f Applicant or Agent Date 0
a WORKERS'COMPENSATION DECLARATION� 7—�— P7
•I hereby affirm that I have a certificate of consent to self
insure, a certificate of Workers'Compensation Insurance, APPLICATION FOR BUILDING PERMIT
` ertsfied copy thereof(Sec. 3800, Lab. C.)
ISRfCOUNTY OF LOS ANGELES BUILDING AND SAFETY
P_olicyZ`NNoo-_37 -9 o'�Company BUILDING �/ .7 ��
jl 'J` Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 10
❑ Certified copy is filed with the county building inspec- BUILDING t
r p r
tion department. ADDRESS fp \ \ r J LOCALITYLG CQ�
Date �y—�6I—A'Applican�y..�wC C, CITY ' ZIP CROSSNEAREST• /��IS
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 _ 72-- s
hundred dollars($100)or less.) TRACT BLOCK LO O. NO.
TE �� SPECIAL }
I certify that in the performance of the work for which this OWNER / • NO. CONDITIONS IL
permit is issued, I shall not employ any person in any manner ` ` DISTRICT GROUP TYPE FIRE PROCESSED BY O
ADDRESS P % QT CONST. ZINE
so as to become subject to the Workers'Compensation Laws. _ I
"CIT a ZIP 2,2/Q' x O
Date Applicant ARCHITECT STATISTICAL CLASSIFICATION APT. ONDO. V
NOTICE TO APPLICANT: If, after making this Certificate of < ENGINEER NO. ng . CLASS NO. DWELL. UNITS 11"
Exemption, you should become subject to the Workers' P , BBIBB O.
Compensation provisions of the Labor Code, you must forth- `ADDRESS e1JL,1 SEWER MAP
with comply with such provisions or this permit shall be
deemed revoked. CONTRA;Q' BK. PG/ VALIDATION
LICENSED CONTRACTORS DECLARATION LIC
I hereby affirm that I am licensed under provisions of Chapter 9 A >l>° N 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 $ o� l7U 3� Oil
SQ.FT. NO.OF NO.OF CHECK , ;2 5 6 7.5 A
Lice Lic.Class SIZE STORIES FAMILIES ONE
Contractor Date
0 DESCRIPTION OF WORK /�� T NEW $ # 000023
Q ,o �- ADD ❑;. I ° o41,45
❑I am exempt under Sec. F r` 6E S�6 mtt T ALTERFINIAL
DATEo 0 0 [� 1 1, 5 3
❑ ✓
B.&P.C. for this reason (7IlL REPAIR ❑
USE OF FIN I Q 1 6 8 6
Date: . EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL. BY 5 6 7 6 A
OWNER-BUILDER DECLARATION PRINT NO.
I hereby affirm that I am exempt from the Contractor's License # a 0 a 0 0 1
Law for the following reason (Section 7031.5, Business and ADDRESS Poo
Professions Code): UPRESENT 10 - 59.25
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS a a a 5 9 2 5 3
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY I O 1 6-8 6
7044, Business and Professions Code). MOVING TEL.
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. r
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT 011111.
the performance of the work for which this permit is issued P.L.
JSec. 3097, Civ. C.). SIDE
D
P.L.
Lender's Name ,(�f ^'j 4
3 P.C. Fee$ /r'qS Permit Fee �i / —
Lender's Address //��
I certify that I have read this application and state that the Issuance Fee sV
above information is correct. I agree to comply with all County Investigation Fee
o finances and State laws relating to building construction, Total Fee
do hereby out a sent 'ves of this County to enter
up o the 40 -men on pr rN for inspection purposes.
fj �f,P I G/ � �y SEE REVERSE FOR EXPLANATORY LANGUAGE
1/Signa of Arli or t Date ®s
.c, �) �.,
• +' ;WORKERS'COMPENSATION DECLARATION '7- 1 5-sr-- 'Z
t I hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT
insure,'or a cerlificate of Workers'Compensation Insurance,
ort Y i. d copy thereof(Sec, 3800, b. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.-3_29/ ' ompany BUILDING /—
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS J
❑ Certified copy is filed with the county building inspec- BUILDING Q"SLGA"►SIS
tion department. -, . ADDRESS/ r'J p i1ZZO+
Dafeld—�6�� Applicant i 07t e¢/' 0(7 of L ' CITY 1�Mf Lbw+ GIT ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. ® CROSS ST. /L
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT
(This section need not be completed if the permit is for oneASSESSOR
.hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
v � L' II
USE ZONE NWP
I certify that in the performance of the work for which this OWNER r..c+�J �• S•A• NO.
permit is issued, I shall not employ any person in any manner ADDRESS P.'0 3 ��y SPECIAL 0
so as to become subject to the Workers'Compensation Laws. CONDITIONS
Date Applicant CITY v (,�IJ dS' AS ZIP 1710-v 4.3 s8 99
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ( DISTRICT GROUP TYPE FIRE TO SED BY' O
Exemption, you should become subject to the Workers' ENGINEER SCP C-. NO..r 'JO-�ti./� e-� CONST. ZONE
P P Y ADDRESS ��NLCG°ri U r PAIaw�� y•�� ✓
Compensation provisions of the Labor Code, you must forth- _ �
with comply with such provisions or this permit shall beEL. STATISTICAL CLASSIFICATION APT. ONDO. fA
deemed revoked. CONTRACT '/FfCIN?t' nr NO. .. d
LICENSED CONTRACTORS DECLARATION LIC, ,ry p CLASS NO. a-7 DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE 4 % SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and - LIC. - 7
Professions Code, and my license is in full force and effect. CITY CLASS BK � VALIDATION
NO.OF NO.OF CHECK
License f Lic.Class SIZE ®f STORIES FAMILIES ONE 24 5 9.8 A
` �� �� VALUATION
4ADESCRIPTION OF WORK N _rl # 0 0 0 0 'z 3
Contract ����p�N ��-� Date / [ �/f�J ADD ❑ ; ,
❑ I am exempt under Sec. G� 5
_f" ADD
61 _5
ALTER ❑ 1 - 300.90
B.&P.C. for this reason REPAIR ❑ ; � ° - 3 0 C19 0
Date: USE OF DEMO' ❑
EXISTING BLDG. 0 ,507-86
Signature APPLICANT L •� TEL. la s3 FINAL
OWNER-BUILDER DECLARATION PRINT/� (/ D �' DATE .
I hereby affirm that I am exempt from the Contractor's License ADDRESS{Q7fl� (.�• d�aM FINAL
Law for the following reason (Section 7031.5, Business and
Professions Code): PRESENT BY j
❑ BUILDING
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
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
tion 7044, Business and Professions Code).
REQUIRED YARD HWY TOTAL SETBACK FROM ST.
CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT 5 b 7.4 A
the performance of the work for which this permit is issued P.L. # o 0 0 0 0
(Sec. 3097, Civ. C.). SIDE
e Lender's Name
P'`' 1 o 27293
$ LDMA Ref. #
Lender's Address P.C.Fee$ 306190 Permit Fee /, 0 02729360
I certify that I have read this application and state that the Issuance Fee O,Sv LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee p I Q 1 6-86
ordinances and State laws relating to building construction, Total Fee p�.(� LDMA Perm.#
u and hereby authorize representatives of this County to enter
upon thea ve-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date
,. WORKERS'COMPENSATION DECLARATION VY- Cr 7—
1 I relay affirm that I have certificate of consent to self APPLICATION F OR BUILDING PERMIT
insure,Ar a certificate of Workers'Compensation Insurance,
gr,Q,cer ified copy thereof(Sec. 3800, Lam C.) Q COUNTY OF LOS ANGELES BUILDING AND SAFETY
PoIooIiiccyNn.�9/.'525"oyCompany ���inn �--a BUILDING
ElAD
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN DRESS 567 O.5
Certified copy is filed with the county building inspec- BUILDING GJ
1=� tion department. /7 ADDRESS LOCALITY PLES
Date i6- Applicant /D�'I '�-�r l �yS�. CITY• .rL' t ZIP CROSS ST. W. 71 UA—S
CERTIFICATE OF EXEMPTION FROM WORKERS' O.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
hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO.
TEL:ry -2 SPECIAL /_s5
I certify that in the performance of the work for which this OWNS v AJ �[i "i',,. NO CONDITIONS IL
permit is issued, I shall not employ any person in any manner �? y�� DISTRICT GROUP TYPE FIRE PRO ESSED BY O
so as to become subject to the Workers'Compensation Laws. ADDRESS, c? u` G7 �j �y r ( CONS ZONECAP
V
CITY �14I •' �• ZIP�,i�C�I1�%�JSfL� �c�(� ��
Date Applicant STATISTICAL CLASSIFICATION APT. DO. V
ARCHITECT TEL.'
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. f CLASS NO. DWELL.UNITS eye
Exemption, you should become subject to the Workers' r tL
Compensation provisions of the Labor Code, you must forth- ADDRESS Izz SEWER MAP H
with comply with such provisions or this permit shall be �-7' z
deemed revoked.
CONTRACT /a ) _ �y N .� BK. ��. VALIDATION
LICENSED CONTRACTORS DECLARATION / c �!'LIC_IC
I hereby affirm that I am licensed under provisions of Chapter 9 A r 'Yr'! (7 NO %/� VALUATION
(commencing with Section 7000)of Division 3 of the Business and LIC. ,,11''ll
Professions Code, and my license is in full force and effect. CI �/� CLASS $ 3 �.39; M9 ►
Q. FT. NO.OF NO.OF CHECK
License Nu Lic.Class SIZE cJ .1 STORIES FAMILIES ONE
• i $
Date/10_/49®I1_ /� DESCRIPTION OF WORK ROOILC-r ICE NEW
Contractor , �. ADD 5 6 7.8 A
I am exempt under Sec.
0. Sr�AI rnUnIU
ALTER FINAL # a 0 0 0 2 3
B.BP.C. for this reason REPAIR C]_ DATE v
Date: USE OF DEMOL ❑" FIN I a - 49.41
EXISTING BLDG.
Signature APPLICANT TEL. By a a a 4 9 4 15
OWNER-BUILDER DECLARATION PRINT NO. f
I hereby affirm that I am exempt from the Contractor's License ,ADDRESS f/// 1 0, 1 6-86
Law for the following reason (Section 7031.5, Business and
Professions Code): PRESENT
BUILDING
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
7044, Business and Professions Code). MOVING TEL.
I, as owner of the property, am exclusively contracting CONTRACTOR NO. ;25 6 7 9 A
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). # 0 0 0 0 0 1
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT I a a 6 R 6 3
the performance of the work for which this permit is issued P.L.
tSec. 3097, Civ. C.). SIDE a a a 6 a 6 3
0
P.L. 1 0, 1 6-86
Q Lender's Name
Lender's Address P.C. Fee$ Permit Fee
u10,5-()I certify that I have read this application and state that the Issuance Fee
Ove information is correct. I agree to comply with all County Investigation Fee / ¢
or i ances oad-ora-re-Ta-w-Ivelating to building construction, Total Fee
if and reby authorize rep se olives of this County to enter
upon he a¢dve-me ed p Wrty for is purposes.
D
�'� s �i SEE REVERSE FOR EXPLANATORY LANGUAGE ®s
ignature"pli �� ���L�� Date '
>r ` WORKERS'COMPENSATION DECLARATION 7
insure,
"Y affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT cu
i , or a certificate of Workers'Compensation Insurance, ,
certified copy thereof(Sec. 3800, Lab. C.)
/��L�eP6aY � ® COUNTY'OF LOS ANGELES BUI AND SAFETY
Pol' y No. Company 1 BUILDING
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ' ADDRESS
F-1
Certified copy is filed with the county building inspec- BUILDING
tion department. - f ADDRESS S 5 F
Date/a_411 ' Applicant(-/d_-c-.. �- � CITY E LE Cl ZIP s:LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. Q 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($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
TEL. USE ZONE MAP
OWNER XO V. S.A, NO. ZI ,
I certify that in the performance of the work for which this ty
permit is issued,I shall not employ any person in any manner ADDRESS D O CONDITIONS
PE IAC
so as to become subject to the Workers'Compensation Laws. 0
Date Applicant CITY OUS OiV ZIP Z/d-' S8 ®e
ARCHITECT O.R . TEL• a/3 DISTRICT GROUP TYPE FIRE PRO ESSED BY
NOTICE TO APPLICANT: If, after'making this Certificate of ✓� CONST. ZONE U
ENGINEER AG, ,NO.
Exemption, you should become subject to the Workers' t �
Compensation provisions of the Labor Code, you must forth- ADDRESS DO / �/�/, E/y! 5 P_I 3
with comply with such provisions or this permit shall be TEL ,yy��,� STATISTICAL CLASSIFICATION APT. ,CONDO.
deemed revoked. CONTRACT ,S NO. oC: zV6
LICENSED CONTRACTORS DECLARATION ) a 'T03
IC ,r CLASS NO. 1 &VMK. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDR 9/7 Jra �/ / NOW
(commencing with Section 7000)of Division 3 of the Business and (_ f LIC }7 SEWER MAP
Professions Code, and my license is in full force and effect. CITY ,d,) l +' CLASS / BK LIDATION
SQ. FT. Ii NO.OF NO.OF CHECK
License NU 5 r J 9 Lic.Class SIZE / 7 STORIES
FAMILIES ONE
.+ �j DESCRIPTION OF WORK COP$_r (� �{ NEW ❑ VALUATION Ott z 4 0 7.5 A
ContrPCt-(4;2?_aker% -/�/�4
We
ADD ❑ $ —~ # 000023
❑ I am exempt under Sec. `SE -AM ALTER ,
B.&P.C. for this reason 0 &,4-S REPAIR ❑ . $ 1 1,061.44
USE Date. EXISTING BLDG. YA DEMOL ❑ 0 1.0 6 1.4 4 U
Signature APPLICANT 7X/7-/7- ASSoC. IAIC. TEL. Z/ FINAL 0220-86
OWNER-BUILDER DECLARATION PRINT) uL NO. LO-6 -� DATE
I hereby affirm that I am exempt from the Contractor's License9z803
Law for the following reason (Section 7031.5, Business and ADDRESS 940 0Z4A/GE'J4,' .4FIN
Professions Code): PRESENT .By
,
❑ BUILDING
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
7044, Business and Professions Code). MOVING TEL.
❑ 1,as owner of the property,am exclusively contracting CONTRACTOR NO. r
with licensed contractors to construct the project (Sec- ADDRESS 5 O 7.7 A
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPREOTPAINEFROM WIDTH S o c o 0 0 1
I hereby affirm that there is a construction lending agency for FRONT i I.[_J p,=J�
the performance of the work for which this permit is issued P.L.
(Sec. 3097,Civ. C.). SIDE _
g P.L. °...G59. r O
Q Lender's Name `r' LDMA Ref. # a' 0. 1 6-86
P.C. Fee$ O I Permit Fee X V
Lender's Address
I certify that I have read this application and state that the Issuance Fee V V ,LDMA P/C#
C
information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee iLDMA Perm. #
and hereby au norize presentat' h' ounty to enter
upon the -me oned pr erty f �ection pur se
_ SEE REVERSE FOR EXPLANATORY LANGUAGE
0
gnature of Applicant or Ag t
• ;�. �' ' ' APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILPING KESS
BUIL ING DDRES$ J � �VmI S U
I hereby affirm that I have a certificate of consent to self insure, ��
or a certificate of Workers'Compensation Insurance,or a c 'tied ZIP 'f
cop�t_hereof Sec.3800,Lab.C.) � ,/•ru G C�`� LOCALITY
Polk.
O Comp FF^^ SIZE OF T l NO.OF BLDG&NOW ON LOT
Certified copy is hereby furnished. NEAR ST CROc��r,
TRACT BLOCK LOT NO. /lJ
❑ Certified copy is filed with t e county uildin 'nspection USE ZONE MAP NO.
departme�lt./T�
Dat '- 1— Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WO ERS' OWN TEL NO.
COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred A R SSS
dollars($100)or less.)
�r DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
, p
I certify that in the performance of the work for which this permit ZIP
4441
is issued, I shall not employ any person in any manner so as t0 CHITE OR ENGINEER TEL NO. QO �' ZLC<G✓�
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. 45?a DWELL UNITS
NOTICE TO APPLICANT.- If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CONTRACTOR O SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwithEe FRONT
�.
comply with such provisions or this permit shall be deemed revoked. ADDRESS -IC. P L
fyO
LICENSED CONTRACTORS DECLARATION ` SIDE
.-•. UC.c 3S PL
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and PSQ. .SIZE NO,OF STORIES NO.OF FAMILIES
Professions Code,and my license is in full force and ffect. NEW BK PG a
Li se�Numbe Li C s DE PO ON F WORK /' r ' ADD ❑ VALUATION , J ' .0
C rl rao k)r &V bU)i . O ��� /3 li CbJ ALTER ❑ � ��• C� U
1• M
❑ I am exempt under Sec. u W` REPAIR ❑ 0
BAP.C.for this reason DEMOL ❑ LDMA P/C# W
Date: USE OF EXISTING BLDG. URM ❑ co
I
Signature LICAN+T(PAINT) LDMA Perm# z
❑ 1, as owner of the property, or my employees with wages as AJhfis ~ ji 7 arF n
their sole compensation, will do the work and the structure is ADDRESS+�. /�• �' O :i r ^�
not intended or offered for sale (Section 7044, Business and -3 ?.0-A fto � 10 Al FINAL DATE i= L I-L `'' °-?
Professions"Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J •I I I Ef'_+
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 252 - 47
en^—r
❑ I, as owner of the property, am exclusively contracting With AMOUNTS SPECIFI D ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 7'
licensed contractors to construct the project (Section 7044, yes❑ No I L'I AL 2 2 m 47
Business and Professions Code.) �.I�1—r•;
WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING s_HOCK .i522°�'i
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR f:(��IiiI�L °1301GUIDELINES
I hereby affirm that there is a construction lending agency for YES❑ No❑
a the performance of the work for which this permit is issued(Sec.
W I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING -:,�.+ +•�!+?ii Fy*+4
N 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, i li Itt_E'-LI.�vI'y /'2 t 1
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. +rl °r,`s
o Lender's Address
0 OWNER OR AGENT
o I certify that I have read this application and state under penalty
o P.C.FEE P1=RMIT FEE /)
Of perjury that the above information is correct.I agree to comply oS pS (v
N with all county ordinances and State laws relating to building
C co struction, nd hereby authorize representatives of this County ISSUANCE FEE
m to n9r u o he abo tioned property for inspection urp se
ti ate- INVESTIGATION FEE TOTAL FEE � L n y
m m a AW1 6 or
SEE REVERSE FOR EXPLANATORY LANGUAGE