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HomeMy Public PortalAbout5785 ROSEMEAD BLVD_Building__ �ORKERS'COMPENSATION DECLARATION re boraa certificate of Workers's'tCompensat on Insuran elf Ju APPLICATION F® tU I L®'N G P E RM I T :.� a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.119760*71 Company STATE SrVND K71Certified copy is hereby furnished- V:f �y FOR APPLICANT TO FILL IN1316, ADDRESS ? / ' S SD Certified copy is filed with the county building inspec- J. BUILDING tion department. ADDRESS Ejy1 L C° /-31—92 Q,e� �. jy/) CITY T ,/E e- T ZIPLOCALITY Date Applicant NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION F WORKERS': SIZE OF LOT NOW ON LOTCROSS 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 ($100)'or less.) • as.TEL. OWNER USE ZONE MAP I certify that in the performance of the work for which this SPEpermit is issued, I shall not employ any person in any manner ADDRESS��Q N G 1 CONDITIONSaso as to become subject to the Workers'CompensationLaws. O CITY L 0/Ur"r N Q I F. ZIP 8Date Applicant ARCHITECT'OR TEL.NOTICE TO APPLICANT: If, after makin this Certificate of ENGINEER NODISTRICT GROUP TYPE FIRE PROCESSED BY Q g' CONST. ZONE Exemption, you should become subject to the Workers' ` ��®U- �� CL Compensation provisions of the Labor Code, you must forth- ADDRESS ✓ �� with comply with. such provisions or this permit shall be,. TEL STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR fg � .T SiA O. 3S y z Z LICENSED CONTRACTORS DECLARATION " LIC. CLASS NO. 3' DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Mg s. -5/4/J &PfW$'1Fi0. $$90 yy 'LIC. J 1 SEWER MAP (commencing with Section 7y license of Division 3 of the Business CITY..,Y,4. tn/91L1F P,0,04 '3 CLASS C-7� • ' and Professions Code,and my license is in full force and effect. BK. M. VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number '3961,2`/'- Lic. Class C-`/S SIZE NO FAMILIES ONE • - � VALUATION ContractorR;M15 d- -CA'3 64—ft' ate /='3/-`I2 DESCRIPTION OF WORK NEW .. ADD •❑ El1 am exempt under Sec. ALTER ❑ BAP.C. for this reason REPAIR ❑ $ Date: OF EXISTING BLDG. DEMOL ❑ Signature' APPLICANT t ` TEL• FINAL OWNER-BUILDER DECLARATION (PRINT) k S.} 3 S/L1CJ NO. '�S8 �/- Z I hereby affirm that I am exempt from the Contractor's License. DATE r " Law for the following reason'(Section 7031.5, Business and ADDRESS /,� S. 5' JU /T FINAL Professions Code): PRESENT - B El , or m I, as owner of the property, employees with BUILDING - P P Y Y P Y ees ADDRESS _;%��!:� •-c wages as-their sole compensation,will do the work and ® ='•'the structure is not intended or offered for-sale(Section LOCALITY- 7044, Business and Professions Code.) MOVING TEL. CONTRACTOR NO. - •v _ I,as owner of the property,am exclusively contracting Ir with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) =-`•I_c`• 'd;•_,,,_'-; REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - I hereby affirm that there is a construction lending agency for FRONT i€t'HI the performance of the work•for.which this,permit is issued Pu La s •+ : _ ,� (Sec. 3097, Civ. C.). � ' SIDE . P.L. Lender's Name `"•`'I' LDMA Ref. q CH, _IL• t-- iY P.C. Fee$ �J Permit Fee +/ t' NG •I Lender's Address _ I certify that 1.have read this application and state that the Issuance Fee All , LDMA P/C# above information is correct.I agree to comply with all County Investigation Fee V ordinances and State laws relating to building construction, - Total Fee "� � t� LDMA perm. # and hereby authorize representatives of this County to enter g upon the above-mentioned property for inspection purposes. DAA%i -'��-qZ SEE REVERSE FOR EXPLANATORY LANGUAGE Date ature of Applicant or Agent WORKERS'COMPENSATION DECLARATION ® ' insure,hereby certificate of Workers'affirm that I have a tCompensation ificate of Insuranceeni to , �� L I ��T I®N F R U I L D I N G P E RM I T or a certified copy thereof(Sec. 3800, Lab. C:) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN A ILDIN O e A t✓ ❑ Certified copy is filed with the county building inspec- ADDRIIN � Rose _pi department. per, Date pplicant 4 I-, CITY �cr.t t ZIp O- LOCALITY NO OF BLDGS. NEAREST QG* CERTIFICATE OF EXEMPTION F W KERS' [ADDRESS .:;>-O/,�k F LOT I? D( NO .ON LOT CROSS ST. COMPENSATION INSU ASSESSOR Row (This section need not be completed if the permit is for one BLOCK• LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL.•���� R NOjY3 (5 USE ZONE MAP I certifythat in the NO. performance of the work for.which this `� i� permit is issued, I•shall not employ any person in any manner dsQ'�'i O-F'1s? V(t-V6 a SPECIAL dCONDITIONSso as to.become subject to the Workers'Compensation Laws.. ++ Q l� C ZIPD9V Date Applicant ECT OR TEL,NOTICE TO APPLICANT: If, after making'}his Certificate of � p DISTRICT GROUP TYPE FIRE. PROCESSED BYQ EER NO. I Exemption, you •should become subject t the Workers' p p CONST. E tp Compensation provisions of the Labor Code, you must forth- : ADDRESS _ -a �p0 �-oZ, `fy with comply with such provisions or this permit shall be L• 3-• STATISTICAL CLASSIFICATION APT. CONDO. U) deemed revoked. CONTRACTOR r 0 NO. �- Z . LICENSED CONTRACTORS DECLARATION ) LIC, CLASS NO. �� DWELL. UNITS I hereby affirm that I am licensed under provisions of.Chapter 9 ADDRESS W rsWO( N(f fl LIC. SEWER MAP _ (commencing with Section 7000)of Division 3 of the Business . t :�:i and Professions Code,and my license is in full force and effect. CITY' sySS BK. PG. ,, VALIDATION SQ. FT: NO. OF NO. OF CHECK' License Number Lic. Class SIZE STORIES FAMILIES ONE VAL ATION w I . ContractorDafe' DESCRIPTION OF WORK= -`GS C% cuts NEW El 10, LID 10, -, ADD Elf 1,_ nL. ;j m . Elam exempt under Sec. r• cr r' _- ; ALTER pOO o-o _•iiGi:t :_° ._: B.BP.C. for this reasonREPAIR ❑ $ i.-i'AN-61E ,I]l Date: USE OF' EXISTING BLDG. e—t:.)I%A r-- IC-.2 L i-A k-- DEMOL ❑ Signature APPLICANT TEL. _ - g (PRINT). NO. 3' �3 Z FINAL ''f°'I '•li II t, L°f!" OWNER-BUILDER DECLARATION �. DATE ��� �'i'`-"�"�' �' "' ''-• I hereby affirm that I am exempt from the Contractor's License ADDRESS '0 O e a oDf .. `, Law for the following reason (Section 7031.5; Business and FINAL Professions Code): PRESENT �� rj�e _ 1 �f By ❑ I, as owner of the ro ert or m employees with BUILDING: l� oxj P P Y, YADDRESS wages as their sole compensation,will do the work and LOCALITY TIFF iz cc-q 0-A -: the structure is not intended or offered for sale.(Section -- --- 7044, Business and Professions Code.) MOVING - TEL. -• I,:: I, as owner of the property,am exclusively contracting CONTRACTOR NO. Z •L i C; with licensed contractors to construct the project (Sec- (` .z..- -' 2�` ADDRESS Y' `� ry -L-: •� tion 7044, Business and Professions Code.) _ REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. C�•r•EC: CONSTRUCTION.LENDING AGENCY SET BACK PROP. LINE WIDTH' I hereby affirm that there is a construction lending agency for FRONT "E:�t !�L the performance of the work for which this permit is issued P.L.' (Sec. 3097, Civ. C.). SIDE ; P.L:' C. Lender's Name n LDMA Ref. q P.C. Fee Q(J• d © p�•J •�c+:: Y ``• Lender's Address Permit Fee I certify that I have read this application and state that the / / Issuance Fee 0� �� LDMA P/C N above information is correct. 1 agree to comply with all County Investigation Fee y ordinances and State lows'relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter 4: Upon the above-mentioned property for inspection purposes. �- 0 - SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of App ica or.Agent Date ' ' - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9612120029 PHONE: (818) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: I BUILDING DDR SS: ON FILE SIGN DESCRIPTION: NEW SIGN WITH CHANNEL LETTERS WITH IN 5785 ROSEMEAD BL TEMP CA 91780 ASSESSOR1 0 0 U B R: NEAREST CROSS STREET: 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: EX ST 8 G S IS MED 0 : PROCESSED EXPIRES ON: GENERAL NUTRITION EXIST OCC GRP: 12/23/96 TC 12/12/97 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: COD CALAC INVESTMENT - 2,000 3709 SAN DIEGO, CA9211137 ES PAIDDESCRIPTION-OFWOR NEW SIGN WITH CHANNEL LETTERS WITH IN RIOR ILLUMINATION FEE DESCRIPTION: QGANTI� e B ml AMOUNT: APPLICANT: EL. 0• E) EAGLE SIGNS (909) 593-7070- AA BLDG PERMIT ISSUANCES 27.75 AE STRONG MOTION tQ,THER l2000�AL� �06�50 SPECIAL CONDITIONS: AX BUILDING REVI•E!%ftE.f �� \ 54x•70 62 PERMIT W/ENERGY f 2000.00 VAL �• 0:42 .-,TOTAL FEES �17�3.37 CONTRACTOR: TEL. N0: = •' / 1 �. APPROVALS DATE INSPECTOR SIGNATURE EAGLE SIGNS (909) 593-7070- �i /, _� 'I � / 0�� , 9380 7TH ST., SUITE C LIC. NO /;,`_ice• 0 : OCA I N SETBACKS RANCHO CUCAMONGA, CA 619628C-45 —_ _ /� I -- SOILS ENGINEER APPROVAL C TEC OR NG R: N0: 0 . U �� �U I �J FO D 0 R C FORMS LIC. NO: �J SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:00 as 0. OF FAMILIES: ELLING S: APT/CO : STAT CLA NO 20 SCHOOL TH HAZARDOUS " AIR QUALITY: 1000 FEET MATERIALS NO NO NO u REPORT ID: DPR261 ROUTE TO: BS0508 • COUNTY OF LOS ANGELES TEMPLE CITY ` BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 Ll�;WZUNAS TENANT IMPROVEMENT 90ILDING AND SAFETY / LAND DEVELOPMENT TEMOM L TY CA SL 0508 9611050010 PHONE: (818) 285-0488 EXT: -LEGAL ID: NO. OF CONST NEW BUILDI G ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5785 ROSEMEAD BL STRUCTURE: 1212 1 V B TEMP CA 91780 ASSESSOR OR ON UMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: EXIST G SE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: GENERAL NUTRITION CENTER EXIST OCC GRP: B 12/19/96 TC 11/05/97 OWNER: TEL. LA0: BLDGS. NOW ON LOT: VALUATION: FINAL DAT I /� FINAL BY: CODE: CALAC INVESTMENT - 20,580 3709 SAN DIEGO, CA9211137 FEES PAID DESCRIPTIONOF WOR �Y INTERIOR TENANT ALTERATION FEE DESCRIPTION: QO NT T OM� AMOUNT: APPLICANT: TEL. LA0: \�C • GENERAL NUTRITION CENTER (310) 869-6923- Al PLANCHECK W/EN-HCZ� 2A580=00=VAL &3395.15 11603 S. PARAMOUNT AA BLDG PERMIT ISSUANCE/'��2.7:5 SPECIAL CONDITIONS: DOWNEY, CA 90241 AE STRONG MOTION�bTHER'/20580:00-VAL \ v'32+ A2 PERMIT W/ENERGV5ACs /20580.00 VAL'�� \464"89°', .:TOTAL FEES / 892•.71`? AP CONTRACTOR: TEL. LA0: d �/ i � / // `� PROVALS DATE INSPECTOR SIGNATURE TESCO CO. INC. (630) 595-2219- 380 BEINORIS DR. LIC. NO ',LOCATION AND SETBACKS WOODDALE, IL 60191 EXPIRES - �JIj lI ,—I SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. O: � '' G 17� rte"�c U J OUNDATIO / R NCH FOR S TAYLOR, BRAD - - --- 11603 S. PARAMOUNT BLVD. LIC. N0: t ' Ii I ISLAB/UNDER FLOOR DOWNEY, CA 90241 C053688 RAISED FLOOR FRAMING `� , MAP LA0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: �1 �� '� Z � .1NDERFLOOR INSULATION 3 04 !Nx :BOOR 5H THING 0. OF FAMILIES: D L I G TS: APT/COND: STAT CLASS: NO 22 ✓ ROOF SHEATHING AIR QUALITY: 1000 FEET WITHI MATERIALS ` SHEAR PANELS NO NO NO FRAME INSPECTION IRE SP N LER A G RS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL2.2 EXTERIOR LATH RATED LOOR/C ASSEM. RATED WALL ASSEMBLIES RATED SHAF S/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE OT D AI AGE REPORT ID: DPR261 ROUTE TO: ES0508