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Home My Public Portal About5743 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING PERMIT r COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUI��DDRESS I hereby affirm that t have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified CI ZIP' copy thereof(Sec.3800,Lab.C.) _ T!� LOCALITY Policy No. 4 �o��ip8�ny v_ SIZE OF LOT NO.OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished. r NEAREST CROSS STIF ❑ Certified copy is filed with the coun ildin inspect' n TRACT BLOCK LOT NO. depaSrtfinent.d/ �t USE ZONE MAP NO. Date v 7 Z7 Applicant -ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMP N FRO WORKER OWNER TEL NO. COMPENSATION INSU CE L• Q _ Z 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.) B DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY 0� I certify that in the performance of the work for which this permit CITYi is issued, I shall not employ any person in any manner so as to ZIP , become subject to the Workers'Compensation Laws. ARCHITECT CV ENGINEER TEL 140. -� STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. �� DWELL UNITS N07ICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CO TRACTOR t TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 14d, FRONT comply with such provisions or this permit shall be deemed revoked. A _ IC.NO. PL LICENSED CONTRACTORS DECLARATION , �� SIDE CI'[� LIC. S PL I hereby affirm that I am licensed underprovislons of Chapter 9 '— 'q e"L �J^ 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. --?f (o I NEW ❑ BK PG License Number I .CIaSS DESCRIPTION OF WORK ADD ❑ VALUATION_ O Contractor allALTER ❑ $ ❑ 1 am exempt under Sec. REPAIR ❑ Q B.&P.C.for this reason ( (� DEMOL ElLDMAPSC# ��,ee�" W Date: USE OF EXISTING-BLDG. URM ❑ RCT o V a Signature APPLICANT(PRINT) f TEL NO. LDMA Perm 3303 50.50 Z 1:1I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE a oiis _,Q Professions Code.) 8-/d-17!5 D 70.80 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of the y y g OR A MIXTURE CONDONING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE property, am exclusive) contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 0 licensed contractors to construct the project (Section 7044, ves 11 No❑ /�V/ Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING T�TA�t ITE {S. OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH .a.., o CONSTRUCTION LENDING AGENCY COAST NR QUALITY MANAGEMENT DISTRICT GUIDELINES. CHECK SEE PERMITTING CHECKUST FOR CHECKCHECK 11e�V I hereby affirm that there is a construction lending agency for YES El No 11W the performance Of the Work for which this permit IS ISSUBd(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHANGE a 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 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQVID 0 Lender's Address 0 0 00-0001 g/ 7/95 OWNER OR AGENT 1704 �� /o�� e I certify that I have read this application and state under penalty 1 e of perjury that the above information is correct.I agree to comply P.C.FEE M• PERMIT FEE N with all county ordinances and State laws relating to building CD construction,and hereby authorize.regfegentatives of this County ISSUANCE FEE 3O t er upon the above-ment' a far m Avinspect' purpo s. INVESTIGATION FEE TOTAL FEE V y) 11 ely� !/ I 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 ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 3 or a certificate of Workers'Compensation Insurance,or a certified I CITY 7 ZIP copy thereof(Seg-3890,Lab.C.) z`1PI-67 C 1'ry I Loc IT P�oli/cv N16 7h ompany n ` SIZE OF LOT NO.OF BLDG&NOW ON LOT IJ Certified c py is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the county buildin p n TRACT BLOCK LOT NO. USE ZONE MAP NO. depatr�tm�en�t/.1.c� Date��n Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERTEL NO. COMPENSATION INSURANCE '1^' 'l l7 WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYP ONST. FIRE ZONE Zz, SED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY ZIP 'D� is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. ' become subject to the Workers'Compensation Laws. STATISTICALCLA SIFLCATION APT CONDO Date Applicant ADDRESS CLASS NO. M DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONT f E N J C, SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith i T2s Z J'��!"�rJ/l� �% b�� FRONT comply with such provisions or this permit shall be deemed revoked. ADDR� LIC.NO. PL LICENSED CONTRACTORS DECLARATION �4 Ad`s IL t 71e SIDE PL I I hereby affirm that I am licensed underprovisions of Chapter 9 CITYr"d i j0 1W00 LICCCLA�S SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF qtORIES NO.OF FAMILIES Professions Code,a my license is in full force and effect. NEW 1:1 $K PG ® d � ' License Number / Lic.Class C- DESCRIPTION OF WOR G ADD VALUATION U Contracto Date �'Ja" f ALTER ❑ � ' �o D: ❑ 1 am exempt under Sec. REPAIR ❑ B.BP.C.for this reason DEMOL ❑' LDMA PIC s W Date: USE OF EXISTING BLDG.,/ •7-) f L URM ❑ �� IL Signature APPLICANT(PRI T 1 ` (� TEL NO. LDMA Perm# z MTb i a ❑ I, as owner of the property, or my employees with wages as r EO < <��o -O 3�1� ZO ��,v �� their sole compensation, will do the work and the structure is ADDRESS D, m✓M� �� ' e not intended or offered for sale (Section 7044, Business and V d� ��I FINAL DATE a Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL '1 OR A MIXTURE CONTAININ A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ❑ I, as owner of the property, am exclusively contracting with' Q AMOUNTS SPECIFIED O E HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � d. licensed contractors to construct the project (Section 7044, ACCTaa Business and Professions Code.) YEs 11 No WILL THE INTENDED USE OF THE CONSTRUCTION TI THE APPLICANT OR FUTURE T BUILDING 3303 1080 70 OCCUPANT REQUIRE A PEWT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY M GEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ITEMSGUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No TOTAL �. o ,� o, the performance of the work for which this permit i§issued(Sec. 8 L I HAVE READ THE HAZARDOUS MATERI ON GUIDE AND THE SCAOMD PERMITTING (ti�JE/"I( j, 7 t Y� a 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY R UNDER THE LAS ANGELES COUNTY CODE, CHECK v�♦ TILE 2,CHAPTER 2.20 SE THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTI THE SCAOMD. Lender's Address CHANGE °00 C OWNER OR AGENT G I certify that I have read this application and state under penalty rt of perjury that the above information is correct I agree to comply P.C.FEE �-� PERMIT FEE 0000-0001 8/10/95 N with all county ordinance tate laws relating to building ' construction, and here �I•Ize representatives of this County ISSUANCE FEE �� to enter upo Ioned property for inspection purposes. 17$,�' 1 AM 9=3� INVESTIGATION FEE TOTAL FEE Sgnawwe ram W AEew owe SEE REVERSE FnR FYaI ANATnRV LANGUAGE APPUCAT0N FOR BUILDING PERMT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN B IN ADDRESS A I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �� IL or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,La C.) I� CITY ZIP LOCALITY Policy Policy No. 49 Company SIZE OF LO NO.OF BLDGS.N ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS . ILIA J)'k Certified copy is filed with the county �b(uilding inspection TRACT BLOCK LOT NO. USE ZONE �MAP O. Date e Applicant ra 1Z ar- A ofAi_ I ASSESSOR MAP BOOK PAGE PARCEL � OWNEp, /J9— •) SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM UHORKERS' / 6, / J (j') �� TEL NO. WI(fTHIN 1®000` FT OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS R (This section need not be completed if the permit is for one hundred Pi a DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY zIP I'O I I certify that in the performance of the work for which this permit q &D (% Is issued, I shall not employ any person in any manner so as to ARCHITECT OR E `TEL NO. become subject to the Workers'Compensation Laws. i STATISTICAL C IFICO�AiT�IIOrrN�� APT CONDO Date Applicant ADDRESS CLASS NO. �15WELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of CONTRACTOR T NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith _ —S) FRONT comply with such provisions or this permit shall be deemed-revoked. AD KESS LIC. O. PL �- �� a SIDE LICENSED CONTRACTORS DECLARATION I CITY LIC.CLASS PL I here affirm that I am licensed under provisions of Chapter C by p plat 9 C SEWER MAP (commencing with Section 7000)Of Division 3 of the Business and So.FT.SIZE NO.OF STORES NO.OF FAMILIES C Professions Code,a m licenses in full force and effepc`t..y NEW BK I PO I.- License Number LIC.Clear C `7'8 DESCRIPTIO OF WORK �r „ ADD ❑ VALUATION W 4Z SD—TO 1 o. co Contractor i f Dile 31 �—� �y ALTER ❑ / t7'�i ❑ 1 am exempt under Sec. REPAIR El BARC.for this reason I DEMOL ❑ I USE OF EXISTING BLDG. LDMA P/C K Date: URM. 11 Signature I APPLICANT(PRINT) TEL NO. LDMA Perm 1) El 1, as owner of the property, or my employees with wages as l U P � k I - O - z their sole compensation,will do the work and the structure is I ADDRFSS1 Ave- 1iI:IL•I o s not Intended or offered for sale (Section 7044, Business and �` 1 + el- H&lie— Fl DATE PTOf@sSIOr13 Code.) I WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANTHANDLEA HAZARDOUS MATERIAL �� ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Y g THE AMOUNTS SPEPIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, � YES 11 No � �};:��r�• Business and Professions Code.) WILL THE INTEADEb USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH .7'•,,'�,Ij3-3. CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)'SEE PERMITTING CHECKLIST FOR GUIDELINES. '+ I hereby affirm that there is a construction lending agency for FO 1:1 No ? 1 I EMM the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD I+;I i IL 5__� 3 L 3097,CIV.C.). i PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES _^ COUNTY DF-TITLE CHA 220SECTIONS220.100THROUGH 220.140 CONCERNING - F'1.tI:.('•X., ?"?^t .••• n e S Name I �MATERIALQtiEP NG�fJDTj06OBTAINING APERMR FROM THE SCAOMD. Lenders Address GNNFA ORAGOU (�(//f CHANGE o' I certify that I have read this application and state that the above I Information Is correct. I agree to comply With all county RC.FEE /f L PERMIT FEE ordinances and State laws relating to building construction,and ' d) hereby authorize representatives of this County to enter upon ISSUANCE FEE a�7,1- the y ` a mentio ed p arty for inspection purposes. .n . ::-r �� f t� T)01,175(6 � _`�6 � INVESTIGATION FEE TOTAL FEE i BSM 0f APP5cW W AMU LL•�'r . �f- SEE EVERSE FOR El(P OR Y LAN MAGE. 17� _ _ „ Jo APPLICATION FOR BUILDINGPERMIT ~ j COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION I FOR APPLICANT TO FILL IN , A,r BUILDII��DDRESs I hereby affirm that P•have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified J copy thereof(Sec.3800,Lab.C.) �,� CIS - ZIP/' Policy No. - �o I G. LOCALITY , .�� SI OF LOT NO.OF BLDGS.NOW ON LOT NEAREST CROSS ST. ❑ Certified copy is hereby furnished. _ ❑ Certified copy is filed with the couneF spect' n TRACT' BLOCK LOT NO. depaSrftne�n+t.d� I USE ZONE MAP NO. Date v /—Z7 Applicant — -ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPT ORKER OWNER TEL NO. COMPENSATION INQ _ WITHIN 1000FT.OF SCHOOL? YES NO (This section need not,be completed if the permit is for one hundred I A KESS dollars($100)or less.) a- jDISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY ZIP I certify that in the performance of the work for which this permit CITY 9' Gy(, D �� is issued, I shall not employ any person in any manner so as to t-P C1 become subject to the Workers'Compensation Laws. A CHITECi E GINEER TEL O. p STATISTICAL C IF ATION APT CONDO , Date Applicant ADDRESS CLASS NO DWELL UNITS A1077CE TO APPLICANT If, after making this Certificate of REQUIRED TCTAL SETBACK FROM EXIST Exemption, -you should become subject to the Workers' MCOTRAIIR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of.the Labor Code, you must forthwith; Id t r FRONT comply with such provisions or this permit shall be deemed revoked. /LIC.NO. PL SIDE LICENSED CONTRACTORS DECLARATION Lit. S PL I hereby affirm that I am licensed underprovisions of Chapter 9 FVAL R MAP (commencing with Section 7000)of Division 3 of the Business and ZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. [C/ NEW ❑ PG >- a License Number v I .Class DESCRIPTION OF WORK 1 ADD ❑ :�ON (' Contractor � � � I ALTER ❑ eD' — U �. ❑ I am exempt under Sec. REPAIR ❑ $ 0 BAP.C.for this reason DEMOL ❑ LDMA P/C# +S6 t+ W Date: USE OF EXISTINGBLDG. URM ❑ r CT Mar 0- Signaturer `�` �° � co APPLICANT(PRINT) TEL NO. LDMA Perm# Z ❑ I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE p G yr °Tr ��°Pro Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL .• �� -/ J IJ ❑ 1, as owner of the property, am exclusively contracting With I OR A AMOUNTS URE CONTAINING THE HAZARDOUDOUS S MATERIALAL S EQUAL TO OR ION GUIDE? BY TER THAN THE FINAL licensed contractors to construct the project (Section 7044, YES 11 No❑ JBY Business and Professions Code.) ITE11- WILL THE INTENDED'USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING T,JTAt � OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH m VVV CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. _ CHECK -121.30 I hereby affirm that there is a construction lending agency for I YES❑ NO❑ CHANGE �}�ry CM the performance of the•work for which this permit is issued(Sec.' IHAVEREADTHEHAZARDOUSMATERIALSINFORMATIONGUIDEANDTHESCAQMDPERMITTING CHANGE °00 a 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 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. i 0000-0001 3/ 7/9. o Lender's Address OWNER OR AGENT 0 cI certify that I have read this application and state under penalty M 170' 1 All 9e 10 ' G of perjury that the above information is correct.I agree to comply P.C.FEE tiJ , PERMIT FEE 00dW 0 - N with all county ordinances and State laws relating to building v construction,and hereby authorize re egtatives of this County ISSUANCE FEE ��30 m t er upon the above-menti a er —far inspect' epurps, a INVESTIGATION FEE TOTAL FEE D CD � 5 Ican Dare �r SEE REVERSE FOR EXPLANATORY LANGUAGE