HomeMy Public PortalAbout5703 ROSEMEAD BLVD_Miscellaneous__ lr)t I.I it;,"4 ,:1'.l t. ,R: -I I j;N A
L_I—/A FN '_J U Z—, I—I i.-. -IN 1 IL_-;d IN
I hcch..- M."irm that I b.ave -,I cuiticicaw or ciiem [0 Sell Wt'N'!"Y 01: LDS ANGEUES BULDING AND SAITTY DIVISION d
insur-.or a cLruliLatc of Workers'C,impeo..anon limirmice.or
I ceruried copy ilierea isec. .1809. tan. (,.I
Polie" No r:(J4 APPLICANT ro FILL-N BUILDING
Y fied copy is hereby furnished. LOCALITY ADORES
('erti -
LOCALITY
❑ ("ertified cop) is filed With the Count', blilldl:!-' IIP-I)CC11011 CRY f — — . 7_1
department. ZIP NEAREST
CROSS ST.
Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. I GROUP TYPE —IPR-CE..ED BY
CERTII-ICAH: 01: LXLMPTION FROM %%,0AI\I RS' TRACT BLOCK I CONST.
COMPENSNI'ION INSURANCE LOT NO. MAP HIGHWAV
IThis icetion need not be completed if the %it ik invol%ed CIRCLE) STATE MAJOR SECOND LOCAL
by the permit is for one hundred dollars IS 111 ill Ili- le%%.) ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS
I certify that in the perl',)rmance ill* the %%ork lit %thich Ihi% OWNER TEL NO.
not is issued. I shall ot emplo% any person Ili tit% mannerso as to become subject to Elie Workeri* Coniften-ai;on Laws. ADDRESS OCCUPANCY GRCUP
Date--' - — _' Applicant CITY ZIP
NOTICE TO APPLICANT: If. after making dii Certificate OCCUPANT LOAD
or Exemption. you shouid become subject To .,*.e Workers' APPLICATION FOR
Compensation pro%ibions of the Labor Code.)-)Lj 11t1.,1 !orthwith EXIT HARDWARE:
comply with such prtv.i-iinns or Lills fellilil. -41all he deemed TRAILER USE GECJLUGY INSPECTION❑
revoked. No Spec.Knowl. ❑
LICENSED CONTRACTORS DE( LARNI'ON OCCUPANCY INSPECTIONS Panic Devices El
I hereby affirm that I am licensed under provisium of Chapter SAFETY PERMIT C] tLIST ITEMS BELOW i
9(commencing with Section 7000)of Di%ision 3 of.lie Business NO.OF EXITS
E]
and Professiois Code,and my license iq in full fore.: Llid effect.
PARKING- REWPROVIDED
D
License Number Lie. SPACES E::=-
COIlLractor 1111 c LIMITED TIME USE
DATE DATE
Ej I am exempt from the licensing 17CLILlirenienEs as I am a
FROM' TO:
licensed architect or a registered profe%sion-d engineer
acting iOF INSPECTOR'S
07
S ZE OF STORIES ATURE
n my profch.sional capacil) (Seetion 70::1. Businem Exis TING BLDG.
and Prolessions Code).
N PRESENT USE OF BUILDING
Lie. or Reg. No. Date FINAL APPROVAL
HOME OWNER-BUILDER DIA LARAIRIN
NO.OF EXISTING BUILDINGS
ON LOT AND USE
I hereby affirm that I ani exempt front [lie Coniniett-Cs License
Law for the following reason ISecEion 7031.5. Business and
Professions Code!: NO.PARKING
El1. as owner of the propert%. dill du the %%oik and the SPACES PROVIDED
.Structure is not intended or ollered fill sale jSe lion 7044. PROPOSED USE OF BUILDING
Business and Professions Code).
CONSTRUCTION LENDING AGENCY
f hereby affirm that there is a consIrLIC11011 lCilklille It!eIIC3 lor
the performance of the work Ior %OliCll this perms' Is IS.%LlCd
(Sec. 3097.Civ.C.). PROPOSED MAX.OCC.
Lender's Name APCA7PR,,,,r 1 tTEL NO.
Lender's Address F9 1. 1, tAl 4
ADDRESS-/
1 certify that I have read this application and slat: 01.111 the I
above information is correct. I agree to comply with.111 CUUnty PERMIT FEE
ordinances and State laws relating to building construction•and
hereby authorize representatives or this county to enter upon ISSUANCE FEE
the above-mentioned property for inspection purposes. I
[TOTAL FEE
31 X 1111,4 SEE REVERSE FOR EXPLANATORY LANGUAGE
Date