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HomeMy Public PortalAbout5779 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING E IT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN FE NG ADDRESS 00, I hereby affirm that I have a certificate of consent to self 7rfi re, BUILDING A DR S or a certificate of Workers'Compensation Insurance,or a ced ZIP copy thereof(Se 8 0, a .C.) __ A CALITY Policy No. Company SIZE OF LOT NO OF BLDG&NOW ON LOT v ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the c building iRs tion TRACT BLOCK LOT NO. departmep,, USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL W 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 ( P Pe DISTRICT GROUP TYPE CONST. FIRE ZONE PROCES dollars($100)or less.) ^ CITY ZIP S(0 S S I certify that in the performance of the work for which this permit V IBJ 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 CON60 Date Applicant ADDRESS CLASS NO. DWELL UNITS N0710E TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR �1 �;VNQ -I,n. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith \� �L% OILy, FRONT comply with such provisions or this permit shall be deemed revoked. /jDD ES LIC A 7051 PL > \ % SIDE a LICENSED CONTRACTORS DECLARATION CIT o u�cL S PL C I hereby affirm that I am licensed underprovisions of Chapter 9 � (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP Professions Code,and my lice a is in full force and effect, NEW ❑ BK PG C License Number , Lic.Class DESCRI TION OF WO r ADD ❑ VALUATION/#© �- ® C Contractor Date LL ALTER ❑ $ v ❑ I am exempt under Sec. REPAIR ❑ $ BAP.C.for this reason DEMOL ❑ LDMA P/C# e. USE OF EXISTING BLDG. URM ❑ 23 Signature APPLICANT(PRINT) TEL NO. LDMA Perm# ACCT.4 ❑ I. aser oft pro as ZO 3303 0 50.50 their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE I-0. 1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 39—7,1 ACCT a OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J �"i+v n 4 ❑ I, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES 11 No❑ `503 �'08°90 Business and Professions Code.) ITEMS WILL THE INTENDED USE OF THE 13UIDUNG BY THE APPLICANT OR FUTURE BUILDING 1 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST OI T AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR TOTAL 5: o , 1 hereby affirm that there is a construction lending agency for YES❑ NO❑ MD PERMITTING (-�[�� 159.40 the performance of the work for which this permit is issued(Sec. I HAVE READ THE 3097,Civ.C.) CHECKLIST 1 UNDERSTANDUMY REQUIREMENTS UNDER THE LOS ANGES MATERIALS INFORMATION GUIDE AND THE LES COUNTY CODE, CHANGE ° TITLE 2.CHAPTER 2.20 SECTIONS 2 20.100 THROUGH 2 20 140 CONCERNING HAZARDOUS 00 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address owNER OR AGENT 3 1 certify that I have read this application and state under penalty ����—���1 l �r'1f O 0 of perjury that the above information is correct.I agree to comply P.C.FEE �o. O PERMIT FEE �t7ry �, c°n '7 rn with all county ordinano and State laws relating to building �c VV + m u ion, and authorize representatives of this County ISSUANCE FEE 3 O � can above-mentioned property for i ero'4:41 L p r ses.c INVESTIGATION FEE TOTAL FEE /a 4 �7 0 a n° - Q J SEE REVERSE FOR EXPLANATORY LANGUAGE • WORKERS' COMPENSATION DECLARATIONI hereaffirm tha of coent to insure, or a certif catte of Worke s' Cocmpensat on Insuran elf P P L I CAS°16 N F6 6ILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 9p � ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING / 7 C� tion department. ADDRESS J �� CJT •' CITY C4 zip / D�®4 LOCALITY Date Applicant NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT //6 C S e NOW ON LOT 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.) �y,� gyp, TEL OWNER AJ7 /d/1 &V E. USE ZONE MAP I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS �� SPECIAL o- CONDITIONS O so as to become ubject to the Worker'C ensation Laws. ,n L CIN (/t//� �� L ZIP V Date filApplicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE P OCESSED BY O NOTICE A LICANT: If, after making this Certificate of ENGINEER NO. F Exemption, you should become subject to the Workers' �J CONST. ZONE w Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this v7 p y p permit shall be TEL. 'STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC, SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE I STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTIOrN OF WORKb� NEW CJ ❑I am exempt under Sec. ��wZ� �j+ /�°UZ�' ADD ❑ $ ALTER ❑ BAP.C. for this reason ' .�� REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT �� TEL.3�x / O FINAL OWNER-BUILDER DECLARATION (PRINT) /L NO. DATE I hereby affirm that I am exempt from the Contractor's License _ Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BU❑ By NG i L.:::....117 I, as owner of the property, or my employees ees with ADDRESS , wages as their sole compensation,will do the work and PIP o M: the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. i ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. .r4 with licensed contractors to construct the project (Sec- rt�•i•: o� tion 7044, Business and Professions Code.) ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. �•= i:•=•;`� YARD HWY CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH _��i, I hereby affirm that there is a construction lending agency for FRONT 2 1 i is the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE ;_ITriL. 62 m ��d P.L. '— _ ., Lender's Name, t S 7 LDM _�. A Ref.# _ P.C. Fee$ Permit Fee Lender's Address '-nt✓�j'�t _°_'= 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 Winvestigatlan Fee ordinances and State laws relating to building construction, 112. LDMA Perm. # �l' ""'' J.4r` '_rr Z 9 9 Total Fee __1:�_ 4 and hereb uthorize representatives of this County to enter ' u the ab e-mentioned property for inspectio pu poses. ,`;et ; itil' 7,z.- t \I �l� SEE REVERSE FOR EXPLANATORY LANGUAGE `� Slijfiature of Applicant or Agent l5ate L1,(iJV f tUAnn� L� C� "I RKERS'COMPENSATION DECLARATION d_ jl -q^ �1�� hereby affirm that I have a certificate of consent to self 'i.P,+ P P I I®I� F O BUILDING P E RM I T insure, or 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 BUILDING C ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Jr 7`7 ❑ Certified copy is filed with t ounty building inspec- BUILDING 77 Q 2 tion department. ADDRESS 1� n , Date II-�� Applica t tpe CITY l�C/ �/t zipL CALITY ILNO.OF BLDGS. EAREST CERTIFICATE OF EXEM ION F OS' SIZE OF LOT NOW ON LOT ROSS ST. COMPENSATIOF O INS AASSESSOR (This section need not be comp ed if is for one TRAM BLOCK LOT NO. ` MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) (� ,1 TEL. V NO.�3- 3 USE ZONE MAP OWNER NO. I certify that in the performance of the work for which this � .� I SPECIAL � permit is issued, I shall not employ an erson in any manner ADDRESS 2i CONDITIONS O so as to become subject to the W rs o ell ation Laws. / �j '''' --1'11 _— CITY t v ZIP a 0 Z V Date�Applicant ARCHITECT OR TELA G', O NOTICE TO APPL(ICCgANT: If, aft r m kin this C rtifi to of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY 9 » CONST. ZONE 17) Exemption, you should be com s bject o th W kers' t n '/ W Compensation provisions of the L r Code, y must forth- ADDRESS v v 2 N with comply with such provisions or this permit shall be e. C TEL. -y Z STATISTICAL CLASSIF I APT. CONDO. Z deemed revoked. CONTRACTOR A S/ — LICENSED CONTRACTORS DECLARATIONLIC. CLASS NO. ELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS WI;7 C;W-rou NO. r) `' (commencing with Section 7000)of Division 3 of the Business CITY /r/�yLO� fie-�/ LIC.CLASS SEWER MAP ': and Professions Code,and my license is in full force and effect. C � BK. PG. VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lit. Class SIZE STORIES I FAMILIES ONE VALUATION v " "' S� Date / ' DESCRIPTION OF WORK S l NEW $Contractor 14 (�(J ❑I am exempt under Sec. ( /� � A ADD ❑ pop. 1:1 B.BP.C. for this reason REPAIR ❑ " $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT Dj L/ FINAL i OWNER-BUILDER DECLARATION PRINT pp�� nn ®® DATE I hereby affirm that I am exempt from the Contractor's License ADDRESSoC.ZI I 1/�/— Y�/V� . Law for the following reason (Section 7031.5, Business and FINAL Professions Code): PRESENT By ❑ I, as owner of the property, or my employees with ADDRESS I �' wages iilheir sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section •, t 7044, Business and Professions Code.) MOVING TEL. y ❑ I,as owner of the property,am exclusive) contracting CONTRACTOR NO. P P Y� Y 9 �'_�w� .,r with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE 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. _ _? 38(Sec. 3097, Civ. C.). SIDE P.L. is -- -- Lender's Name :FI%�•�• s_._° ' P.C. Fee$ 73' Permit Fee �J • 0 LDMA Ref. # Jt,j{G_ ,.!_ Lender's Address ° I certify that I have read this application and state that the Issuance Fee a V 715-- Sabove info is correct.I agree to comply with all County Investigation Fee 3 ordinance"id St to laws relating to building construction, g Total Fee �a LDMA Perm. # and her y a thori a re re entatives of this County to enter • - -- - upon t abo - ntio d roperty for inspection purposes. it ,��—0� SEE REVERSE FOR EXPLANATORY LANGUAGE ignatu a of Applicant o Age Date r— • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0211070023 PHONE: (626) 285-0488 EXT: lEUA-L--fU-.* ER OF SIG B INGADDRESS: ON FILE SIGN DESCRIPTION: 1ACM' IN RED, 'SECURITY SYSTEM' IN BL 5779 ROSEMEAD BL TEMP CA 91780 ASSESSOR I 0 BER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: S UED 0PROCESSED 8 PIR 0 : ACM SECURITY SYSTEM EXIST OCC GRP: 11/07/02 JK 05/06/03 OWNER: TEL. NO: B DGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT - 900 Q SAN DIEGO, CA9211137 FEES ID DESC�T OF WORK�y ONE SET ILLUMINATED CHANNEL LETTER SIGN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. N0• YU (626) 444-8181- AA BLDG PERMIT ISSUANCE 27.75 2812 PECK ROAD AX BUILDING REVIEW.FEE_ 54.70 SPECIA CONDITIONS: EL MONTE 91731 D2 PERMIT W/O-EN=HC-- - 900.00 VAL 65.40 ;TOTAL FEES 147.85 CONTRACTOR: TEL N0: AT APPROVALS DATE INSPECTOR SIGNURE SUCCESS SIGN PRINTING INC. (626) 444-8181- . . ;. 9363 VALLEY BLVD, #A LIC. NO LOCATION AND SETBACKS EL MONTE CA 91731 739177C45 SOILS ENGINEER APPROVAL ARCHITECTOR ENGINEER.- TEL. NO: _ OUNDAT 0 TR NCH FORM LIC. N0: _ SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: 00 0. OFFAMILIES: DWEL G ITS: PT COND: STAT CLASS:- NO SS:NO 20 SCHOOL WITHIN A DO S AIR QUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508 9 ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9902250033 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: BUILDING ADDRESS: ON FILE SIGN DESCRIPTION: WALL SIGN ILLUMINATED 5779 ROSEMEAD BL TEMP CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY ENA E IS B G SE: ISS E 0 : PROCESSED Y: EXPIRES ON: BEAUTY SOLUTIONS EXIST OCC GRP: 02/25/99 UT 02/25/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT - 1,680 3709 SAN DIEGO, CA9211137 FEES P DESCRIPTION OF WOR INSTALL ONE WALL SIGN-ILLUMI ATED APPLICANT: E0: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: �� Z ITAL CUSTOM SIGN (626) 444-6027- AA BLDG PERMIT ISSUANCE 27.75 2651 N. LEE AE STRONG MOTION OYJE�0 VAL 0.50 SPECIAL CONDITIONS: SO. EL MONTE, CA AX BUILDING��ttEV•TE -F 54.70 D2 PERMI %�1�I, Cr,ELES ,,.�1 O.� VAL 82.20 CONTRACTOR: TE 0: 0c- �(JA 165.15 APPROVALS DATE I SPECTOR SIGNATURE KYI CHOW SHAR (626) 444-6027- �. �► 2651 N LEE AVE LIC. NO LOCATION AND SETBACKS #2 & 3 652665 C45 SOUTH EL MONTE, CA 91723 SOILS ENGINEER APPROVAL ARCHITECT OR 0: 0 D 0 RE C FO S LIC. N / 1111111 SUPPOR STRUCTURE L , MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: GNP.1)U pD �C n��1//11� oS lo-11/7 0. OF FAMILIES: DWELLING UNITS: AP /CO : ST CLAS L/ NO 20 0 0Ail- SCHOOL IT 0 S 1 tip AIR QUALITY: 1000 FEET MATERIALS ® r^u NO NO NO A46,'c El 0��5 service-Ma"� * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES ' TEMPLE CITY # 0508 `-B17ILDING PERMIT J DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS .. TENANT IMPROVEMENT •' BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9903120041 PHONE: (626) 285-0488 EXT: EGA ID: NO. OF CONST NEW B D, G-- DD ESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5779-ROSEMEAD BL STRUCTURE: 0 1 VN B _- TEMP CA 91780 ASSESSOR INFORMATION BER: NEAREST CROSS STREET: 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: EXIST B DG E: COMME USE ZO FE: ISS D 0 —PROCESSED EXPIRES ON: BEAUTY SOLUTIONS EXIST OCC GRP: B 03/12/99 UT 03/12/00 OWNER: TEL. N0: LDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: DE: CALAC INVESTMENT - 5,000 �� 3709 SAN DIEGO, CA9211137 FEES PAID ESCRIP ON OF WOR T. I.-PARTI-T'ION WALLS (3)"" OR FACIAL AND-STORAGE ROOMS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:APPLICANT: EL. O: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AE STRONG MOTION O.:HER 5000.00 VAL 1.05 SPECIAL CONDITIONS: AX BUILDING?SaE � 54.70 81 PARTITION WALLS (3) D2 PERMI A' N-GEIS SOQO� O-VAL 132.60 CONTRACTOR: TEL. N0: O� r 216.10 ,�/ APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - V LIC. NO LOCATION AND SETBACKS ` SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: 0: / FOUNDATIO RE C FORMS LIC. NO: 1111111 SLAB/UNDER FLOOR RAISED FLOOR F G MAP N0: SEWER MAP BOOK: PAGE: FIRE 20N3: CMP pD nO�[�u� UNDERFLOOR INSULATION v I�I FLOOR SHEATHING 0. OF FAMnTERSTMEEING NTS: A CO D: STAT CLAS NO 22 O p _ ROOF SHEATHING It11�_ SC 00 IHAZARDOUS (r SHEAR S ❑ AIR QUALITY: 1000 FEET MATERIALS � NO NO NO A El y FRAME INSPECTION 11of FIRE SPRINKLER H NG RS INSULATION/WEATHER STRIP INTERIOR XTERIOR LATH RATED FLOOR/CEIL ASS M. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508