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Home My Public Portal About5721 ROSEMEAD BLVD_Building__ WORKERS' COMPENSATION DECLARATION Hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insuresure,, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N/Aiw aoag� p any :Ae BUILDING 9/ice NT TO FILL IN ADDRESS r L s �� ❑ Certified copy is hereby furnished. �9� ADDRESS ❑ Certified copy is filed with the county building inspec- fADDR7ESS7 �� _ �}�-�tion department.Date Applicant �1.� l� ZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. �/� UNC S COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. 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 SPECIAL CONDITIONS O}. so as to become subject to the Workers'Compensation Laws. Q CITY ZIP U Date Applicant ARCHITECT OR TEL. DISTRICT I GROUP TYPE FIRE PRO NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZON Exemption, you should become subject to the Workers' `�() f w Compensation provisions of the Labor Code, you must forth- ADDRESS -�, �JCL with comply with such provisions or this permit shall be `yam L• STATISTICAL CLASSIFICATION APT. CO D0. !n deemed revoked. CONTRACTOR JJ l/� ��7 r� Z LICENSED CONTRACTORS DECLARATION �l�j LIC. CLASS NO.�DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS!3/ �7� NO. �,3V7 (commencing with Section 7000)of Division 3 of the Business LIC. (� SEWER MAP and Professions Cod ,and m licen is in full force nd eff ct. CITY (j CLASS ��v BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lir. ss / SIZE STORIES IFAMILIES ONE VALUATIIO . �,� &,CS7VP§ — '_9o� DESCRIPTION OF WORK NEW ❑ Contract $ L.iCJ ti., El /i�` L `�/ A/�C� �f _ ADD ❑ ► F�L!: o a I am exempt under Sec. c l. ALTER ❑ 3307 'To SI`• B.&P.C. for this reason USEOF ` REPAIR ❑ $ tt Date: EXISTING BLDG. DEMOL ❑ ITEMS Signature APPLICANT TEL. FINAL TOTAL 73 a 88 OWNER-BUILDER DECLARATION (PRINT) NO. DATE CHECK a+'u I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL CHANGE .00 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 LOCALITY , IO - QI1 1/ I� � the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. 77 15 1 A110 q I, as owner of the property,am exclusively contracting CONTRACTOR NO. M 11 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) 1 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY PIN' YARD HWY PROP. LINE WIDTH a I hereby affirm that there is a construction lending agency for A (o v the performance of the work for which this permit is issued 337(Sec. 3097, Civ. C.).* 1 ITEMSa�Lender's Name JQ� 2 Q� LDMA Ref. # TIjTAL +�8®& �./• Permit Fee J v � o( �v Lender's Address �jEr•6} 1 certify that I have read this application and state that the Issuance Fee O� - 75' LDMA P/C# above informati is correct. I agree to comply with all County Investigation Fee (; 5 ordi anc and tate laws relating to building construction, Total Fee LDMA Perm. # I�RrVI�- 01 1/222/93 r a h r ut orize�represe tatives of this County to enter t e b ve- en oned pro rty for inspection purpos s. 7781 1 Fin 1:11 1 J SEE REVERSE FOR EXPLANATORY LANGUAGE S natur f'Applicant or Agent Date V, *ORKERS''COMPENSATION DECLARATION -'I herby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insurrj or a certificate of Workers'Compensation Insurance, or a certifi d oo thereof(Sec. 3800, Lab. C.) y p Y—,�—� t COUNTY OF LOS ANGELES BUILDING AND SAFETY PoIic o. Com an d�'P d!1 ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with co my building i BUILDING h tion department. ADDRESS CITY t� ZIP LOCALITY Gcr G". DateL �°'Applic O.OF BLDGS. NEAREST CERTIFICATE OF EXEMJr PTIO RO RS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION SURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) L OWNER Np, USE ZONE MAP I certify that in the performance of the work for which this SPE permit is issued, I shall not employ any person in any manner ADDRESS / � C/ SPECIAL CL CONDITIONS so as to become subject to the Workers'Compensation Laws. O CITY ZIP Date Applicant ARCHITECr OR TEL, NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT ;GROUP FIRErCESSED BY O Exemtion, yoshould become subject t the.Workers' / �jyNELe Compensation provisions of the Labor Code, you must forth- ADDRESS �.L� CL with comply with such provisions or this permit shall be ^` TEL• � ATISTICAL CLAS ICATION APT. CONDO. N deemed revoked. CONTRACTOR •y G NO. 55c Z_ LICENSED CONTRACTORS DECLARATION ePC--1 LIC. CLASS NO. tiDWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS G / NO. LIC. SEWER MAP (commencing with Section y license of Division 3 of the Business CITY )rj CLASS VALIDATION and Professions Code,and my license is in full force and effect. BK PG SQ. NO.OF NO.OF CHECK License Number `�O�?� / Lic. Class_ �G r SIZE STORIES FAMILIES ONE VALUATION C ctoF Pao 6' af•-I pate ��`—�0� "�–/� DESCRIPTION OF WORK NEW $ ADD ► ❑I am exempt under Sec. ' ALTFR ❑ 8.8P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL'❑ Signature APPLICANT ` TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) / /1[oc ej NO. I hereby affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS (!1/f' M FINAL Professions Code): PRESENT By wqt,jr� BUILDING tt4 To g 1, as owner of the property, or my employees with ADDRESS 4 g wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY , 3317 61.36 7044, Business and Professions Code.) MOVING TEL. a I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code.) ADDRESS ACCTA CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST. •�•��y 1kV SET BACK YARD HWY PROP. LINE WIDTH ti+JIJ7 1+:V eti! 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. ITEMS (Sec. 3097, Civ. C.). SIDE .'.�T�L �, o Lender's Name �/ � LDMA Ref. # CHECK 189.99 Lender's Address 99 P:C. Fee S Permit Fee CHANGE .00 I certify that I have read this application and state that the Issuance Fee ' /� LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 3 ordinances and State laws relating to building construction, Total Fee 45r 6 LOMA Perm. # 00110-0001 1180/92 and hereby authorize repr entatives of this County to enter upon bove-men!Wollidpr erty for inspects`n pu S./' 6614 1 A 'g5'�� ? c 7` fes/ SEE REVERSE FOR EXPLANATORY LANGUAGE natur o scant or Agent Date .WQRKERS' COMPENSATION.DECLP .ION ' �cfz`C/ t - -Onsurebo oa certif caffirm rte of Workers's' Compensation on I have a certificate of eInsuran ent to , APP I CATION FOR BUILDING PERMIT or a certified copy=_=t,thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Vic. Policy No. Company �� BUILDING - 11 ❑ Certified copy is hereby furnished. -�-3 FOR APPLICANT TO FILL IN ADDRESS J 7� l �C� tie \ Vfit vCA IVCertified copy is filed with the county building inspec- BUILDING C�• l ,I tion department. ADDRESS n G Date rZ �d Z` Wpplican CITY `� NO. ZIPOF BLDGS. / 8 D LOCALITY eV 12 ER FICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TE �7 OWNER ISO ��L. NO. y. USE ZONE MAP NO. I certify that in the performance of the work for which this t- /n,� X17 SPECIAL i } permit is issued, I shall not employ any person in any manner ADDRESS V / C. �7' CONDITIONS so as to become subject to the Workers'Compensation Laws. __ , .r Ov ( C zip - Dote Applicant ARC ITE R T L r2 DISTRICT GROUP TYPE FIR PROCESSED BY' - NOTICE TO APPLICANT: -If, after making this Certificate of /� mow_ � u (J CONST. ZONE _T� `i yvF- Exemption, you should become subject to the Workers' U ADDRESS Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be e- L-Lv w it TEL.N&4 STATISTICAL CLASSIFICATION CONDO. deemed revoked. CONTRACTOR L t&,4 NO. 1`d-�`��' •-)7 �- -, LICENSED CONTRACTORS DECLARATION [L', LIC. 7�� CLASS NO. ` — DWELL. UNITS - ADDRESS l7li S� 141 NO.Q�rvt,,'r I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. CITY rd4 CA 91.�f. CLASS 8 j VALIDATION and Professions Code,and my license is in full force and effect. BK. PG. 2 p� SQ. FT. NO. OF NO. OF CHECK �' .II �` License Number 4SZC-Y3 Lic. Class�rLL SIZE STORIES FAMILIES ONE 001130-9001 U 10/SIL /�} VALUATION �t1ii -ContrI* `'tirl�• Date Z DESCRIPTION OF WORK ^ NEW S -.O ;� jNFilj; { ADD ❑ ❑I am exempt under Sec. ALTER ❑ B.&P.C. for this reasonREPAIR ❑ $ [late: USE OF DEMO, ❑ EXISTING BLDG. Signature APPLICANT (PRINT) NO. FINAL OWNER-BUIL DECLARATION DATE Z_/0 -qq hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS-1 I L FINAL Professions Code): PRESENT BY ❑ I, as owner of the property, or m employees with BUILDING P P Y• YtADDRESS wages as their sole compensation,will do the work and LOCALITY ADDRESS- the structure is not intended or offered for sale(Section 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 HW TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK 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 P.L. Lender's Name �� ,/� LDMA Ref. # B P.C. Fee$ �' 1 Permit Fee (� • 13 , Lender's Address I certify that I have read this application and state that the Issuance Fee LDMA P/C# 3 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS FIRE SPRINKLER BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1003080013 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF ADDED/RELOCATED BUILDING ADDRESS: ON FILE SQ. FT SPRINKLER HEADS 5721 ROSEMEAD BL STRUCTURE: TEMP CA 91780 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15397-012-043 1 1 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl 1TENANT: 1EXIST BLDG USE: JISSUED ON: PROCESSED BY: YOSHINOYA JEXIST OCC GRP: 03/09/10 SR OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFINAL DATE F1144L BY: CODE: IYOSHINOYA AMERICA INC. (310) 527-6060- 1,850 991 W. KNOX ST. ITORRANCE CA 90502 1 FEES PAID JDD9SCRIPTION OF WORK REMODELING SUPPRESSION SYSTEM FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: JASON PLUNIK (800) 541-7605- IDO FIRE SPRINKLER PC 1850.00 VAL 82.11 IPO BOX 331027 JAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: JPACOIMA, CA JAB STATE GREEN BLDG FEE 1850.00 VAL 1.00 1 ID2 PERMIT W/O EN-HC 1850.00 VAL 82.20 TOTAL FEES 193.06 CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE ALPHA SYSTEMS FIRE PROTECTION (800) 540-7605- JP0 BOX 331027 LIC. NO 1FIRE DEPARTMENT INSPECT JPACIOMA CA 91333 LOMITA 1FIRE SPRINKLER HANGERS J 1 1ARCHITECT OR ENGINEER: TEL. NO: IFIRE DEPARTMENT APPROVAL LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 001 I 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 20 SCHOOL WITHIN HAZARDOUS 1 AIR QUALITY: 1000 FEET MATERIALS 1 NO NO NO 1 1 1* ADDITIONAL DATA ON FILE 1 1 REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0912070035 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 5721 ROSEMEAD BL I ISTRUCTURE: 2400 1 V-B B I TEMP CA 91780 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LAS TUNAS I 15397-012-043 I I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl ITENANT: IEXIST BLDG USE: RESTU USE ZONE: 11SSUED ON: PROCESSED BY: 1 IYOSHINOYA TEMPLE CITY STORE [EXIST OCC GRP: B 102/09/10 SR I (OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: DAT FINAL BY: CODE: I IYOSHINOYA AMERICA, INC. (310) 527-6060- 1 110,000 1 [ 1991 W. KNOX ST. I I . ITORRANCE CA 90502 I FEES PAID ID SCRIPTION OF'WORK IT.I. REMODEL DINING, SERVING, KITCHEN & BOTH RESTROOMS W/NEWI IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:ISEATING LAYOUT. PROVIDE (REPLACE) NEW KITCHEN HOODS SYSTEM *1 (APPLICANT: TEL. NO: I I I IMIZUNO (213) 487-9964- IA1 PLANCHECK W/EN-HC 110000.00 VAL 1,324.32 1 I 12917 TEMPLE ST. IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: I 1 LOS ANGELES CA 90026 AB STATE GREEN BLDG FEE 110000.00 VAL 5.00 I 1AE STRONG MOTION OTHER 110000.00 VAL 23.10 1 1 IA2 PERMIT W/ENERGY-HC 110000.00 VAL 1,558.02 1 I ICONTRACTOR: TEL. NO: 1 TOTAL FEES 2,938.19 1APPROVALS DATE INSPECTOR SIGNATURE 1 ISHIN SHIN CONSTRUCTION CORP. (626) 279-7991- 1 1 I 19324 E GARVEY AVE #J LIC. NO 1 ILOCATION AND SETBACKS I I I IEL MONTE CA 91733 858568E 1 I I I I I I ISOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUNDATION/TRENCH FORMS I I I IATELIER-U (213) 487-9964- [ 1- I I I 12917 TEMPLE STREET LIC. NO: 1 ISLAB/UNDER FLOOR I I I ILOS ANGELES, CA 90026 NONE I I IRAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I 0L o ('\ 1UNDERFLOOR INSULATION I I 1 I 3 041 ,I �� n y.l oc,`e [\Ott 0%% •�� 1 FLOOR SHEATHING I 1 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: �1ti • �/�1 �(� 1 NO 22 I IROOF SHEATHING I I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS 1 I 1 NO NO NO 1 1FRAME INSPECTION I I 1FIRE SPRINKLER HANGERS 1 I I IINSULATION/WEATHER STRIP( I I I I IINTERIOR LATH/DRYWALL I 79I (EXTERIOR LATH 1 1 1 1 I IRATED FLOOR/CEIL ASSEM. 1 I I IRATED WALL ASSEMBLIES I 1 1 IRATED SHAFTS/OPENINGS I I IT-BAR CEILINGS I 1* ADDITIONAL DATA ON FILE II 1 I I [LOT DRAINAGE t 1 1 1REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I I