The URL can be used to link to this page

Home My Public Portal About5707 ROSEMEAD BLVD_Building__ APPLICATION FOR BIALDING PERMIT Y COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIEEE I hereby affirm that I have a certificate of consent to self insure, BUILDI-7177 NG ADDR or a certificate of Workers'Compensation Insurance,or a certified f G C� copy f(Sec.3800,Lab.C.) CITY ZIP PoliN ��-d D COmpe LOCALITY SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. of C9IC'ertified copy is filed with the count uildinc ' specti TRACT BLOCK LOT NO. department. USE ZONE MAP NO. L,-6ate M[- ApplicantUA�__ I ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS Q CERTIFICATE OF EXEMPTION FROM WORKERS' NER TEL NO. COMPENSATION INSURANCE Ka .C��.!"�� WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred A RESP (� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) L CI - ` I certify that in the performance of the work for which this permit �t �D� �_� ✓�( is issued, I shall not employ any person in any manner so as to ZIP• q 2lA C ITECT OR ENG ER 71'EL NO. become subject to the Workers'Compensation Laws. C' { y l� STATISTICAL CLASSIFICATION APT CONDO Date ApplicantDRESS ! �44eG" CLASS NO.� DWELL UNITS . A NOTICE TO APPLICANT If, after making this Certificate of � 6 � .� �L e- REQUIRED TOTAL SETI ACK FROM EXIST Exemption, you should- become subject to the Workers' CONTRyt�R` j -7EL NO. SET BACK YARD HWY PROWLINE WIDTH l7 1/I Compensation provisions of the Labor Code, you must forthwith �!) f �� j j- l�i� FRONT comply with such provisions or this permit shall be deemed revoked. ADDRES LIC NO. p L LICENSED CONTRACTORS DECLARATION '��'ti CS SIDE L.,(033 �yr_' t i:_: C G '�, LI CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 i � ` ��-" I d a SEWER MAP ` M- (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE JNO.OF STORIES NO.OF FAMILIESi i=::,. Professions Code,andel my licens is in full force and a fect. NEW ❑ BK PG _�I License Num er /�� LIC.Class DE RIPTION F WOR ADD ❑ VALUATION i f' tom, •l. 4-T ''U Contr .Date �� oil 1,(� t.f _,. . i W ALTER ❑ I am exempt under Sec. � REPAIR ❑ J�"Ilil:j'1= =z)II O H B.BP.C.for this reason Q DEMOL ❑ U LDMA P/C# U Date: SE OF EXISTING BLDG. a URM ❑ Signature f..y" i. til `lewlf Z APPLICANT(PRINT) 1. TEL NO. LDMA Perm# °�•f� s ❑ I, as owner of the property, or my employees with wages as `=' '!1 ' C3 Z their sole compensation, will do the work and the structure is ADDRESS l ? IJ,? # ?,_,�s not intended or offered for sale (Section 7044, Business and FINAL DATE a TT- Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE " �•" J ' 11 I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY y') i'' r r, licensed contractors to construct the project (Section 7044, i•. riL -iiieT+ YES❑ NO❑ Business and Professions Code.) -•Jr;Wit: •1:-1 :n WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING' C E •!* ==%�= •- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ty"4 AI,' GUIDELINES , I hereby affirm that there is a construction lending agency for YES❑ NO❑ CM the performance of the work for which this permit is issued(Sec. � IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING �E � N 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CII_IC 1101•-0 1.I _'i { 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. m i -r o Lender's Address Lw-,m f� L7� COWNER OR AGENT o I certify that I have read this application and state under penalty O perjury that the above Information is correct.I agree to comply , P.C.FEE 1,57 PERMIT FEE , Ill N of with all county ordinances and State laws relating to building 7 (� m constru ion and hereb authorize representatives of this County ISSUANCE FEE m r to 0 ab ned property for ins ti pur � ses. 6 41 .7 \a INVESTIGATION FEE TOTAL FEE /O /• 7' (� m �m �o SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT ' COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A)FRESS EBUDNG,A-1 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereffof�,(Sec.3800,Lab.C.) � CITY i� C' ZIP / �� Policy No.1dA/C-;20:? OCompany G 0!W-ca- 1 LOCALITY SIZE OF LOT OF BLDGS.NOW ON LOT C' ❑ Certified copy is hereby furnished. NEAREST CROSS Or. ❑ Certified copy is filed with the c n building i pec'o TRACT BLOCK LOT NO. depJaCtment.7— USE ZONE MAP NO. Date�a� Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' DOER L-dzr Ni?�s�,EL NO. COMPENSATION INSURANCE �� C �� WITHIN 7000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY zIP "e is issued, I shall not employ any person in any manner so as to �� -a e- 3 eLd become subject to the Workers'Compensation Laws. AR ITECT OR NGIN R L NO. p�- �- STATISTICAL CLASSIFICATION APT CONDO Date/�Ta' Applicant AD RE p •CLASS NO. DWELL UNITS •�rlf�_�CrC"U� s "7/ /d �, NOTICE TO APPLICANT.' If, after making this Certificate of �c'�L:rsc C�� /hc-c-cam REQUIRED TCTAL SET�7{C �gPM EXIST Exemption, you should become subject to the Workers' CONT CTOR TEL NO. SET BACK YARD HWY PROP''L}(I WIDTH Compensation provisions of the Labor Code, you must forthwith �r' � e��/LiJ• / FppM _;�; comply with such provisions or this permit shall be deemed revoked. ADDVtS LIC.NO. PL �. �L SIDE LICENSED CONTRACTORS DECLARATION clr CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 �� `+ �� t t - -- �_ E —:3 SQ.FT.SIZE .OF STORIE NO.OF FAMILIES SEWER.MAP (commencing with Section 7000)of Division 3 of the Business and y ;• �. yy} 119 Professions Code,and my license is in full force and a fect. L3,�- NEW ElBK PG -• -- License Number ��•�'Lic.Class DESCRIP ON OF WOjdK App VALUATI/ON 4C:fir -. lil Q Contractor /7,f/E1� �d/1�a`,Date ��S`-9'S` ALTER ❑• $ /� � V IY ❑dam exempt under Sec. REPAIR 11 $ t ;;ids tl?-•j_:(')_; =j' ii/'";� BAP.C.for this reason DEMOL ❑ LDMA P/C# - . ... A W Da USE OF EXISTING BLDG. URM ❑ IL Signature APPLICANT(PRINT) TEL NO. LDMA Perm# - Z ❑ I, as owner of the property, or my employees with wages as ZO :__•; .z their sole compensation, will do the work and the structure is ADDRESS -- not intended or offered for sale (Section 7044, Business and FINAL DATE a: Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �+ 44 ❑ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I, as owner of the = y t -•,•� property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINALBY 5.r1 ., -�� -�-- licensed contractors to construct the project (Section 7044, YES❑ No❑ i I IL -+-*=� i = +��•�� Business and Professions Code.) Ir r WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING (L: !t 7-—, OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH y/ H1-'='• :J,..-•.!= CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR (/�f jJ- j,_ .__ GUIDELINES Q, / �- jI11i- I herebyaffirm that there is a construction lending agency for ` � `h I g g y YES❑ NO❑ C4 the performance of the work for which this permit is issued(Sec. CD I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE 3CAQMD PERMITTING 3097,CIV,C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, �! TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 n.-PUL l-;,j(II Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. + a Lender's Address c@ {I O OWNER OR AGENT o I certify that I have read this application and state under penalty PERMIT FEE ' c of perjury that the above information is correct.I agree to comply P•C FEE awl lG CM With all county ordinances and State laws relating to building j constru ,,. hereby aori epresentatives of this County ISSUANCE FEE , m to a r f1 t 0 roperty for inspection purposes. m INVESTIGATION FEE TOTAL FEE 10 n SEE REVERSE FOR EXPLANATORY LANGUAGE : APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FPR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, ®UILDINGADDRESS S707 A - Avr, or a certificate of Workers'Compensation Insurance,or a certified 5716 NS Nom' copy thereof(Sec.3800,Lab.C.) STS F N� ` �L C / f-V ZIP LOCALITY Policy No. ��(� Company - SIZE OF LOT NO.OF BLDGS,NOW ON LOTvL- ❑ Certified copy is hereby furnished. I NEAREST CROSS V. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 1-1�b-9.SApplicant � � ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. ` DD COMPENSATION INSURANCE iT7VN'F>' WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS 3 pi �, h• DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less.) - CITY ZIP I certify that in the performance of the work for which this permit L V—L:6 s UV . /�Q + is issued, I shall not employ any person in any manner so as to -`�� become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. -Q ;2- DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith J NT MeD M Sy—s 3/d 3 V--6 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION �6 �� I C. SIDE CITY n'A LIC.CLASS� PL I hereby affirm that I am licensed underprovislons of Chapter 9 oA SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES I NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG a _ License Number Li DESCRIPTION OF WORK VALUATION �2�1�y� Lia Class�,� � ADD ❑ C Contractor C� -*-=��.. Date — /$- 9'S' ALTER ❑ $ B C �7 11I"f C L REPAIR ❑I am exempt under Sec. QdAAr-J $ B.BP.C.for this reason qAi y k 0 C �+ DEMOL ❑ LDMA PTC# W Date: USE OF EXISTING BLDG. URM ❑ CL Signature APPLICANT(PRINT) EL NO. LDMA Perm# L z ❑ I, as owner of the property, or my employees with wages as S CO /d 6 Z ; E.- . v their sole compensation, will do the work and the structure is ADDRESS O_ ... _I FINAL DATE 1•-'�I-r •.1�' not intended or offered for sale (Section 7044, Business and JJ� Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 11 I, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ NO Business and Professions Code.) -;.s L; - WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDINGe�lJv 3.°I'I: .L OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR h T'•'y;;'r* GUIDELINES i d I�!1:! I hereby affirm that there is a construction lending agency for YES❑ No AL - 8 -'+ c.i the performance of the work for which this permit is issued(Sec. I-` _ • - I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING a 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.2 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS - Lender's Name MATERIALS REPORT AND FOR OBTAININ RMIT FROM THE SCAOMD. IL Lender's Address �� _%2 �_•r�lNGE O OWNER OR AGENT b•"�� o I certify that I have read this application and state under penalty C of perjury that the above information is correct.I agree to comply P•C.FEE mm SAS PERMIT FEE r _ r 1. ,.• E:.c N with all county ordinances and State laws relating to building b— !J. V' ��• _I_,;i 1—_I_t I� _;=�7I t CO construction, and hereby authorize representatives of this County ISSUANCE FEE 01� m to enter upqiqhe above- ntme ioned property for inspection purposes. �. mC INVESTIGATION FEE TOTAL FEE 171 9punup d Mp..,M.AWl a l! SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT • COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDJUG ADDRESS f I hereby affirm that I have a certificate of consent to self insure, BUILDING AD KESS ,{` , or a certificate of Workers'Compensation Insurance,or a certified 'S `�R copy thereof(Sec.3800,Lab.C.) CI7.^Y ` zIP .,p• > t 1 G LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT No. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS y D CERTIFICATE OF EXEMPTION FROM WORKERS' OWN R. TEL NO. COMPENSATION INSURANCE ✓1 GaPY WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS p DISTRICT GROUP C TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP �J I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to a become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION 17 APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE 70 APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRRAMR / TEL NO. ��f� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Y�t° -�✓ 22 Z 6 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS C O. F L IPM1 LICENSED CONTRACTORS DECLARATION �i dG"UV SIDE —' TY LIC.CLAS PL I hereby affirm that I am licensed underprovisions of Chapter 9LEZ SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES "OLE: L�,L Professions Code,and my license is in full force and effect. NEW ❑ BK PG 3 e a License Number Lic.Class DESCRIPTION OF WORK App E] VALUATION Contractor Date ALTER ❑ �$ 11 j t•'• a'` m g REPAIR ❑ CHECK ECK "ti= `� ❑ I am exempt under Sec. $ . :o BAP.C.for this reason f��j C/e( .S 'e�9 DEMOL ❑ LDMA Pic# Fly =r Date: USE OF EXISTING BLDG. URM ❑ 0' g Cr Signature APPLICANT(PRINT) TEL NO. LDMA Perm# ],j 1,;j I_I�I� _ j 112 A eI/ LF 7_� ❑ I, as owner of the property, or my employees with wages as Z i11�t;�-�•� their sole compensation, will do the work and the structure is ADDRESS O `"'`J i ^1°3,Q. not intended or offered for sale (Section 7044, Business and FINAL DATE 54da4d--4i,( +r LI• L ` Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 5J 1 16„ 90111. '1 1�r� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE i I ❑ I, as owner of the property, am exclusively contracting 4, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 1 licensed contractors to construct the project (Section 70444, t(I�tiL 107 o= �0 Business and Professions Code.) YES❑ NO❑ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �� "(„l OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECK 1r.: CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR /„ f• GUIDELINES. 141,11 'rsi3: I hereby affirm that there is a construction lending agency for YES❑ NO❑ W the performance Of the Work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 1 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, '1 n i TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS I I;I ilj 133 13 1311 _/ 1- _I Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 0 Lender's Address �'t 11 e. ! AM 8:46 O OWNER OR AGENT o I certify that I have read this application and state under penalty cof perjury that the above information is correct.I agree to comply P.C.FEE ;�� PERMIT FEE C4 a with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE (to enter upon the above-mentioned property for inspection purposes. INVESTIGATION FEE TOTAL FEE aM1,w�o d Avnkme«Awm Geo D SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING DDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS / �✓ or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) C% / r./ ZIP LOCALITY Policy No. Company SIZE LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) F�-,7 ��/� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CRY ZIP G /,/Q� - is issued, I shall not employ any person in any manner so as to �/L( =/ become subject to the Workers'Compensation Laws. ARCH CT OR ENGINEER TEL NO. STATISTICAL CLASSI ICATION APT CONDO Date 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 to the Workers' CONTRA OR TEL NO. �/ SET BACK YARD HWY PROP UNE WIDTH Compensation provisions Of the Labor Code, you must forthwith �• lw.f- sa. 7/y ss6/l A FRONT comply with such provisions or this permit shall be deemed revoked. I ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION '� 33 7`1S' SIDE ClCIT LIC. LASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 �+�/ �Ni1 �� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG a License Number Lic.Class DESCRIPTOF RK ADD ❑ VALUATIO IJ Contractor Date b .t/oit wtii < ALTER C1 $ ��• E�D CC". F ❑ I am exempt under Sec. REPAIR 11 $ F- BAP.C.for this reason DEMOL ❑ W LDMA P/C# USE OF EXISTING BLDG. Date: URM ❑ =yl.!_} ,�• d Signature - f- a U" APPLI T(PRINT) J TEL NO. LDMA Perm# �t `}:, z 11I, as owner of the property, or my employees with wages as /��••r �� r�'6•�L� Z their sole compensation, will do the work and the structure is ADDITESS0 not intended or offered for sale (Section 7044, Business and -Z?&S— ✓^ FINAL DATE Q =• JL Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 12;` OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J "�^17 -157 1 1 -1=' ❑ 1, as owner of the property, am exclusively contracting 4AMOUNTS SPE�FIEDI ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY ; ivl16 e licensed contractors to construct the project (Section 70444,, YES 11 No LSF Business and Professions Code.) EMS WILL WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH A�q -'y �=d•' CONSTRUCTION LENDING AGENCY COAST NR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR !LI 11 t1� ,i��'-11 � ® '—a`7-•? GUIDELINES. _ I herebyaffirm that there is a construction lendingagency for .r •'j` 2-0/-i the performance of the work for which this permit is issued(Sec. IHA ❑ No❑ s Inti=ti +-�� IHAVE READ I HE UNDERARDOUSY REQUIREMENTLS S UNDER INFORMATION GUIDE AND ANGELHE ES COUNTMD CODE. =:fs i[.{7j!-' 3097,CIV.C.) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 1-F4"79 r 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. p Lender's Address 6p r; ;_ •(OWNER OR AGENT 11000-03,� Jf !iI:•J I certify that I have read this application and state under penalty 1 i i x __ P.C.FEE PERMIT FEE =±;�+: V ;_ of perjury that the above information is correct.I agree to comply •D `fj(} D � _ i y�,_ , with all county ordinances and State laws relating to building construction,and h uthorize representatives of this County ISSUANCE FEE to enter upon t ove- oned pe inspection purposes. !o d ---7-9 S-� INVESTIGATION FEE TOTAL FEE X . 40 Apprsm a A.0 Oaro 0 SEE REVERSE FOR EXPLANATORY LANGUAGE I COUNTY OF LOS ANGELES i TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT I TEMPLE CITY CA 91780 BL 0508 0210230008 PHONE: (626) 285-0488 EXT: i LEGAL0. COBUILDING SS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5707 ROSEMEAD BL STRUCTURE: 1736 1 VN B TEMP CA 91780 ASSESSOR INFORMATIONNUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY E I —BG S : CO S 0PROCESSED P 0 : EXIST OCC GRP: B 10/29/02 JK 04/27/03 OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: FIN E FINAL BY: CODE: CALAC INVESTMENT - 3,500 3709 tl SAN DIEGO, CA9211137 FEES P ID R PT 0 OF WORKor— T-ISAR CEILING W/2 FLUOR. LIGHTS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: INF BUILDERS (626) 574-0138- AA BLDG PERMIT ISSUANCE 27.75 120 W CAMINO REAL AC STRONG MOTION RESID 3500.00 VAL 0.50 SPECIAL CONDITIONS: ARCADIA 91007 D1 PLANCHECK W/O EN'=HC' 3500.00 VAL 98.43 D2 PERMIT .W/O-EN=HC, _-3500.00 VAL 115.80 TOTAL-FEES 242.48 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE INF BUILDERS `' ' ! �' ''� �' •� (626) 574-0138- � •.: 120 W CAMINO REAL LIC. NOLOCATION AAND SETBACKS A, ARCADIA CA 91007 4905478HIC \ ,.\ SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: T - r 0 0 C FORMS LIC. NOe; SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: UNDERFLOOR INSULATION 3 ? 04. '41 J. �, �'' `_. . FLOOR S A G NO. OF FAM S: G UNITS: AP CND: STAT CLASS: NO 22' r; — — — �— , ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAW PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION FIRE.'•` � .fir . SPRINKLER HANGERS INSULATION/W THER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED /CE L ASSEM. RATED WALL ASSEMBLIES RATi E SHAF S 0 GS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 I