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HomeMy Public PortalAbout5745 ROSEMEAD BLVD_Building__ WORKERS'COMPENSATION'DECLARATIONC 1 hereby affirm that I have a certificate of consent to self I�� N ®� N L�I L D I N G PERMIT %..insure, M a certificate of Workers' Compensation Insurance, ,,,.,'or a certified copy thereof.(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company S��tA rv+-ok- ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- ADDRESS 5 75/.5 a s� 2 Q� l+/at- tion,Qdepartment. " Date?_3_5z_z Applica. CITY T�j»�o 2 /7` ZIP ��7C9� i LOCALITY O.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT • h=;CROSS ST. • COMPENSATION INSURANCE ASSESSOR jThis section need not be completed if the permit is for one TRACT' BLOCK LOT NO. ASS BOOK PAGE S PARCEL hundred dollars ($100).or.less.) 1 G TL. OWNER'//¢ r+0��ew 'CO NO��40•y .11..2 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 60 6 ]�vSS/�+ fC p� �-a SPECIAL _ CONDITIONS so as to become subject to the Workers'Compensation Laws. . ` 413-216 ! _ `0., CITY Coop., Xu S 04;p ZIP ' T3-2/6 E_i' V Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT:-If, after makingthis.Certificate of ENGINEER 8/e 999 y,�7 DISTRICT GROUP TYPE FIRE;i i j PROCESS�FalBYy, 0•;,.+. t IIIA 7t'.S NO. CONST. ZONE Exemption, you should become. subject to the Workers' �CdG� # a Q fJ 11.5 H - ui Compensation provisions of the Labor Code, you must forth- ADDRESS //33 vi�>fo�' O f/ with comply with such provisions or this permit shall be �+� TEL•�C STATISTICAL CLASSIFICATION ."s;,gpT.i- CONDO. N' deemed revoked. CONTRACTOR (J�O� r.�a.— �Or+S* NOCK/ 396•�-?6I P �� '- LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS.3� p"'6 r oo r S7`' NO. ' 76 366 _ LIC. SEWER MAP _' jy�i (commencing with Section 7000)of Division 3 of the Business CITY O/+�00. -- and Professions Code,and my license is in full force and effect. 9i?6 CLASS ,a BK pG \/ALIDATION 7 Lic. Class_ S ZE����� STORIES I FAMILLIIES ONEK- _ f License Number / ' f�Y �O*�S* VALUATIOJd Contractor fib" dw Dafe' { DESCRIPTION OF WORK �� LOWQr• NEW ❑ . $ �� �O 00 _•= C2jCrN l/A'C. FL y. TI^pc/rf ADD ❑ ❑I am exempt under Sec. t•••; BAP.C. for this reason � ALTER f ® i ,..s_; _�• L S lti der inw' [✓G.0 C S $ -fir;- _. _ USE OF REPAIR ❑ _, J�::' L _ DateY4 EXISTING BLDG. Bti A- DEMOL ❑ 4 r APPLICANT. TEL.7"V Signature ��^•�' -� _ OWNER-BUILDER DECLARATION _ •.(PRINT)... U.N C-0-1 �j-O�,r,�(d/` NO. 551 d/ FINAL q� r i t`P:j^ `x 4 I herebyaffirm that I am exempt from the Contrcictor's License DATE Law fothe following reason(Section 7031.5, Business and ADDRESS 0dJ; D22 i"6 a^OOrf S7� FINAL �' =t' '°'= `4 Professions Code): PRESENT By ii•1'i�_ ❑ I, as owner'of theY employees m or,ro ert em to with BUILDING P P Y wages as their sole. tion,will do the work and ADDRESS the structure is not intended or offered for sale(Section LOCALITY _ .i;IjIY-lil it F 7044, Business and Professions Code.) MOVING TEL. 0 I, as owner of the property,am exclusively contracting CONTRACTOR NO. 377t _ 'i"v'`'(- .With licensed contractors to construct the project (Sec- ADDRESS - tion 7044, Business and Professions Code.) REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SETBACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for LInveitigation the performance of the work for which this permit is issued (Sec. 3097, CIV. C.).Lender's Name �/� LDMA Ref.q Permit Fee Lender's AddressI certify that I have read this application and state that the Issuance Fee � LDMA P/C# PooAbove information is correct. I agree to comply with all County ee ordinances and State laws relating to building construction, Total Fee ! `a 0 LDMA Perm. # ( and hereby authorize representatives of this County to enter t u e above-mentione party for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si afure of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT 14��,,��,,C�+ '7�(p 1�0� COUNTY OF LOS ANGELES BUILDING AND SAFETY CwWORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS lhereby affirm that I have a certificate of consent to self insure, BUILDING A DRE S certificate of Workers'Compensation Insurance,or a certified CI ZIPthereof(Sec.3800,Lab.C.) LO ALIT Compan SIZ O L O.OF BLDGS NOW ON LOT KLZerttfied copy is hereby furnished. k NEAREST CROSSAT. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. departure USE ZONE MAP NO. Da pplicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS 91 CERTIFICATE OF EXEMP N FROM WORKERS OW TEL NO. Q COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? Yes No (This section need not be completed if the permit is for one hundred ADDRESS(/ DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit Q(/ is issued, I shall not employ any person in any manner so as to ooi A- become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLA SIFICATION 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' C TR O JEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. A D ESS -i Ito C.NO. P L LICENSED CONTRACTORS DECLARATION SIDE UC.cLAss � 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 SQ.FT.SIE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license. in full force arld effect. NEW BK PG 7 d DESC IPTION OF K VALUATION t 4n' L License Nber Lic.Class ADD ❑1 $VA00�, Contractoru ate ALTER El U REPAIR 11slC -:j_O ❑ 1 am exempt under Sec. $ , BAP.C.for this reason DEMOL ❑ �'-r LDMA P/C# - W Date: USE OF EXISTING BLDG. URM ❑ Signature ri'v` pp 4 J_5 Z APPLICANT(PRINT) TEL NO. LDMA Perm� 's L r;+- .L� u ❑ I, as owner of the property, or my employees with wages as s" - 174.3%C their sole compensation, will do the work and the structure is ADDRESS "�I`'j•'t '`"1 ' f / i k' not intended or offered for sale (Section 7044, Business and FINAL DA � ': I� -t- ' Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r Z(p--q S OR A MIXTURE CONDONING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � licensed contractors to construct the project Section 7044, YES❑ NO Business and Professions Code.) " WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING eC'(' •!---° OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH !-•.:..� Hill L i°•�'"I 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 YES❑ NO Ids W 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, Lender's Name TITTE 2,C REPORUNG.20 SECTIONS 2.20.100 THROUGH 2.20.146 ND FOR OBTAINING A PERMIT FROM THECONCERNING HAZARDOUS SCAOMD. �o Lender's Address N nnerar 0 o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.0 F E PERMIT FEE N with all county ordinances and State laws relating tobuilding construction,and hereby authorize representatives of this County ISSUANCE FEE aItr up the ab ve-mentioned property for inspection pur oses. J CID INVESTIGATION FEE TOTAL FEE //)3� / �✓ SEE REVERSE FOR EXPLANATORY LANGUAGE APPUCAMON FOR. BUILDING ER 0T COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION I FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS - i s Nnn l� I hereby affirm that 1•have a certificate of consent to self insure, y, �;- 5745 ,or a certificate of Workers'Compensation Insurance,or a certified � _' copy thereof(See.3800,Lab.C.) ;Cr—ale Cit Ca 91780 LOCALITYPolley'NbNWC184756 CompanyDavco Insurance SIZE 0+FLT y NO.OF BLDGS NOW ON LOT .Ve t e, en ❑ 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. Date7-13-92 Applicant Expressions Advertisin T ASSESSOR MAP BOOK PAGE PARCEL - SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS! OWNER ' TEL.No. atri.ni- Shoes YES NO COMPENSATION INSURANCE WITHIN 100D FT.OF SCHOOL? - ADDRESS (This section need not lie completed if the permit Is for one hundred E',;'�; DISTRICT GROUP- ITYPECONWr.' FIRE.ZONPPROCESSEDB7Y dollam'($100)or less.) - le'Cit e'5745 Rosemead CITY ZIP 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 ARCHITE R ENGIN TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APTg COND Data Applicant ADDRESS CLASS No. 2 Z DWELL UNITS. NOTICE TO APPLICANT.• If, after making this Certificate 'ofCONTRACTOR �NO REQUIRED TOTAL SETBACK FROM `EXIST Exemption, you ShOUId become subject t0 the Workers' SET BACK' YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,.you must forthwith eSsions Advertising (714)778-0999 FRONT comply with such provisions or this permit shall be deemed'revoked. ADDRESS LIC NO. PL 542 S. Rose St.. 530 949 LICENSED CONTRACTORS DECLARATION CITY LIC,CLASS SIDEPL o, I hereby affirm that I am licensed under provisions of Chapter 9 Anahe]IYlC-45 .. SEWER MAP ca (Commencing with Section 7000)of Division 3 of the Business and 80•FT SIZE NO.OFSTORES No.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK' PG � D CRIPTION OF W9RK• ADD ❑ License Number 530 949 LID.Class' C-45 � set individually VALUATION L`LJ Expressions 0. 7-13-92 � "� Contractor ALTER ' ❑ il1U[nina REPAIR ❑ ❑ I 23 am exempt under Sec. _ t'ti,.(:.i a JL ' B.BP C.for this reason DEMOL ❑ P/C p LOMA ,_13 i7_ IT USE OF EXISTING BLDG. 3 LIRM• ❑ Date: Signature APPLICANT(PRINT) TEL No. . PMA Rarm k _ ❑ I,as owner of the property, or my employees..with wages as ® IL �' =a a a their sole compensation,will do the work and the structure.Is ADDRESS x. —3 not Intended or offered'for sole,(Section 7044, Business and FINAL DATEr(. ,wa lw; ProfesaiOne Code.) WILLTHEAPPLICANTOR FUTURE BUILDINOOCCURM4THANDLEAHAZARDOUS MAm3iu1L 3 i ® (''f r _.5� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL To OR GREATER THAN •*•' ❑ I, 88.owner Of.the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMxnoN'GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ NO❑ Business and Professions Code.) ' WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE,BUILDING i01-010'0-001011 I;t L:� }, .t OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFIOMION FROM THESOUTH ! CONSTRUCTION LENDING AGENCY COAST IR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLISTFOR � ' � .AM; 9: 17 I t, I hereby affirm that there is a construction lending agency for YES❑ ' NO❑ the performance Of the work for whk;h this permit Is issued(Sec. I'HANE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD gg 3087,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES •,`o '` Lender'S Name COUNTYCODE,TITLE2.CHAPrER22DOECTIONS2al1WTHROUGH22Ml4DOONCERNING {'!.• •3 a'8 ' HA TARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. _ ^ Lender's Address OMMORAGM :1,'E I. cos o° I certify that I have read this application and state that the above T'1�'EM3 ' Information IS correct. I agree to comply With all County P.0,FEE PERMIT FEE a L C,.;:) ordinances and State laws relating to building construction,and `'�' t J �`fr� �h 3 x.-a 3 hereby auth ize representatives of this County to enter upon ISSUANCE FEE (: 1 • ;�,/ y thea entioned p rty for insp ion purposes. 2 4 • .'HEI`_ : )S a s_v to A1�.� � INVESTIGATION FEE TOTAL FEE •� A roOFAppleaata, -2.7-1 19 • C t'IA IGE a I tw[ SEE REVERSE FOR EXPLANATORY LANGUAGE, COUNTY OF LOS ANGELES I TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS COMMERCIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 _ BL 0508 9811190056 PHONE: (818) 285-0488 EXT: r LEGAL I 0. OF CONST NEWI UILDING ADDRESS: ON FILE SO. FT STORIES TYPE OCCUP GROUP 15745 ROSEMEAD BL STRUCTURE: 0 1 VN B TEMP CA 91780 ASSESSOR INFORMATION BER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: E ST BLDG USE: COMME USE ZONE: C- SS ED ON: --PROCESSED BY: EXPIRES ON: NU PAIR EXIST OCC GRP: B 11/19/98 UT 11/19/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINALrDATE FINAL BY: CODE 3709C INVESTMENT - 1 1,000 2 i SAN DIEGO, CA9211137 FEES PAID DESCHiPTION 0 WOR 3 NEW INTERIOR WALL FOR SHOE REPAd SHOP FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICA L. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AE STRONG MOTION OTHER�1000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/0 EN-HE" . 0. :%Q VAL 65.40 L ET0TI EES 93.65 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - � LIC. NO 'TON AND SETBACKS ! i SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: - / �,� 1 OU DAT 0 /TRENC FORMS LIC. N0:( �/- -J �llllll 1t SLAB/:UNDER FLOOR I _ r RAISlfff FTOOR FRAMING I MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMm.; ' �; F`� 1 L„�; - , ry� UNDERFLOOR INSULATION 150H265 3 04 J U L=� J� �j GL ll�V ! 1 TOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APTN/OCOND: STAT CLASS,. N --- _ ROOF SHEATHING SCHOOL WITHIN RXARDOUS �\ / _'r� fr'. // SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS �� / �, ���,'� NO NO NO �� / ! _�.' f!/r FRAME INSPECTION +J IJp�j41'�� R SPRINKLER A G RS C oervice lhz` INSULATION/WEATHER STRIP INTERIOR AT DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSE . RATED WALL ASSEMBLIES MATEr D SHAFT- OP INGS T�BA�R CEILINGS LOT D AIN GE REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUTLIrIRG-PEWF DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9811170025 PHONE: (818) 285-0488 EXT: --- - —_ GA ID: NUMBER OF SIGNS: 1 'B- ADDRESS:_-_ R SS:: ON FILE SIGN DESCRIPTION: NEW CHANNEL LETTER SIGN-ILLUMINATED 5745 ROSEMEAD BL. ?SMP CA--91'780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: XIS BLDG USE: ISSUED ON: PROCESSED-BY, EXP R S ON: NU PAIR EXIST OCC GRP: 11/17/98 UT 11/17/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINALUDATE FINAL BY: 3AALOAAC INVESTMENT - 1,000 SAN DIEGO, CA9211137 FEES PAID DESCRIPTION OF WORK'7 D FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEN CHANNEL LETTER SIGN APPLICANT- TEL. NO: SUCCESS SIGN (626) 280-8932- AA BLDG PERMIT ISSUANCE 27.75 820 E. VALLEY BLVD. AC STRONG MOTION RESI 000.00 VAL 0.50 SPECIAL CONDITIONS: SAN GABRIEL, CA AX BUILDING RE,VI=EW�FEE�� 54.70 D2 PERMIT W/0 N-H�GEL.ES T 00�00'VAL 65.40 R► IOTS148.35 CONTRACTOR: TEL. N280-8932- APPROVALS DATE INSPECTOR SIGNATURE SUCCESS 820 E VALLEY BLVD LIC. NO LOCATION AND SETBACKS SAN GABRIEL CA 91776 739177 C45 SOILS ENGINEER A—P—PREOVARF ARCHITECT OR G L. O: FOUNDATION/TRENCH-FORMS LIC. NO: SUPPORT STRUCTURE 14AP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMO I�� D L J C ��j ©LnAn 0. 0 FAMILIES: ELLING CT7S.1 TS: APT CO D: STAT C1 L _ NO 20 p -, ,n�7S rel SCHOOL WITHIN HAZARDOUS :� t•. AIR QUALITY: 1000 FEET MATERIALS U NO NO NO A ❑ 1,�J; � SepvEl iae Thai REPORT ID: DPR261 ROUTE TO: BS05O8