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Home My Public Portal About5791 ROSEMEAD BLVD_Building__ A �J WORKERS' COMPENSATION DECLARATION ,hereby affirm that I have r certificate of consent to self A P P L I CAVI O N FOR 6 I L D I N G PERMIT insure, or a certificate of Workers' Compensati I urance, or a certified cgpy thereof (Sec. 3800, b. C.) COUNTY 6F'LOS ANGELES BUILDING AND SAFETY Policy No. �fy�` J� Company �� BUILDING Certified copy is hereby furnished. FOR AP LICANT TO FILL IN ADDRESS Certified copy is filed wi4thounty 'Iding inspec- BUILDING fn tion dep tment. ADDRESS �C l Date-Applicant mba CITY ZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FRO ORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION IN URA E 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 -4, for which this NO. SPECIAL permit is issued, I shall not employ ny per in any manner ADDRESS p e a- so as to come bject to the W ers' nsation Laws. - CONDITIONS O .t a CITY �` ZIP U Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after makingis Certific to of ENGINEER NO. CONST. ZONE • U Exemption, you should become subie to the W rkers' Compensation provisions of the Labor Code, you mu forth- ADDRESS with comply with such provisions or this N p y p permit all be TEL. •� 2 STATISTICAL CIASSIFICATI APT. CONDO. Z deemed revoked. CONTRACTOR 1 cd NO. ` 7 7 — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. -Z NITS — (commencing hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.�� (commencing with Section 7000)of Division 3 of the Business _-( 1,A a,. LIC. C SEWER MAP and Professions Code,and my_license is in full force and ffe CI I't-c �Z�(/pq CL'O'D BK PG VALIDATION {�'y� SQ. FT. NO. OF NO.OF CHECK License N ber J yU°� Lic. Class SIZE I STORIES FAMILIES ONE VA1`U4kTI0N ContractX64 Date DESCRIPTION OF WORK ' ADD iic��ttt��f��u ► ❑I am exempt under Sec. ALTER ❑ B.&P.C. for this reason 44 REPAIR ❑ § Date: USE OF EXISTING BLDG. fiP1Ub/V� N DEMOL ❑ Signature APPLICANT TEL, 1 g OWNER-BUILDER DECLARATION (PRINT) NO. � J FINALL- I hereby affirm that I am exempt from the Contractor's License �i CLOG./ DATE Law for the following reason (Section 7031.5, Business and ADDRESS ��"w FINAL t� Professions Code): PRESENT B bL a ❑ I, as owner of the property, or m employees with BUILDING Y i:C". t4 P P Y� YADDRESS wages as their sole compensation,will do the work and ® iLl r 62°w4 the structure is not intended or offered for sale(Section LOCALITY 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- _ (-1:l•!°A tion 7044, Business and Professions Code.) ADDRESS x �: REQUIRED TOTAL SETBACK FROM EXIST. 3337 1 s�'°='� CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 3 , 2 ITEMS EMS the performance of the work for which this permit is issued P.L. _ (Sec. 3097, Civ. C.). SIDE TlllyL 176- 16 P.L. t-ti� -,i a Lender's Name � CHECK 176 C°16 8 'r' P.C. Fee$ Permit Fee �yi r 7 LDMA Ref. q CHANGE °�lf 1 Lender's Address I certify that I ve read this application and state that the Issuance Fee LDMA P/C N 3 4ndb orma' n is correct.I agree to comply with all Count Investigation Fee Q� l_{_`vl 101 Z es and tate laws relating to building construction, g Total Fee � u LDMA Per.. N � i if 1� y au o' e representativesof this County to enter ,.y i �o -me ' e property for inspect' n purpo es. ; .424 1 Ate 5 56 I; d (� SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Applicant or gent Date APPLICATION FOR 13UILDING PERMIT 5� L � 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, BUiI DING ADDRESSD or a certificate of Workers'Compensation Insurance,or a certified ' '77F4. copy thereof(Sec.3800,Lab.C.) CITY''E/n®�� er ! 7 ZIP /�`J® LO uT Policy No. -7-rC Company p SIZE OF LOT NO.OF BLDGS.NOW ON LO7 ❑ Certified copy is hereby furnished. � '/� NEAREST CROSrT... ❑ Certified copy is filed with the county ec i TRACT BLOCK LOT NO. depa tme t. USE ZONE MAP No. Date � J Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FRO RKERS' OWNS ! TEL NO. YES NO COMPENSATION INSURANCE �O �/1 A,e-K 3/032-Bi- d WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS �+ dollars($100)or less.) 3027 PVS T AVG f/ c—H DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY 1 certify that in the performance of the work for which this permit D�,��C' ZI44 p�� is issued, I shall not employ any person in any manner so as to r&r ` become subject to the Workers'Compensation Laws. HITECT OR ENGINE a L NO- 1060201 Date Applicant �S W1Le �90�//S'/8 STATISTICAL CLASSIFICATION APT CONDO AD R99ESS..g9 �s _` C CLASS NO.� DWELL UNITS N077CE TO APPLICANT If, after making this Certificate Of �Yd' I o t "a S 79-14 V�G REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CO TRA ��J TEL NO. J� O / SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ✓7 �Qj / p �J FRONT comply with such provisions or this permit shall be deemed revoked. ADDR S / LIC.NO. PL LICENSED CONTRACTORS DECLARATION � SIDE 2M CITY I-Irl CPL I hereby affirm that i am licensed underprovisions of Chapter 9 C.•6 �- SEWER MAP 44 =s (commencing with Section 7000)of Division 3 of the Business and S FT.SIZE NO.OF STORIES NO.OF FAMILIES .�� Professions Code,Sodmy Sq I! eenseis in full force and effect. I�3 NEW ❑ BK PG 3L403 531 o A License Number S 7�:751- Lic.Class DESCRIPTION OF WORK ,_, ADD ❑ VALUAO141-9TION , �� , i q�C,� U Contractor�� W,L�Q�-re'�ate —t /O� '��m ALTER ✓�� dod �� Ll ITEMS �- ❑ REPAIR ❑ CHECK 1 am exempt under Sec. � CK 53�e BE B.BP.C.for this reason DEMOL 11LDMAP/C# CHANGE Qk Date: USE OF EXISTING BLDG. '` URM ❑ is Signature q CANT(PR�1NT) TEL NO. es LDMA Perm# z 13I, as owner of the property, or my employees with wages as IAAD AAtR' 3io3 pE'30u Z 1 -0070-0001 5/17/95— their sole compensation, will do the work and the structure is ADDRESS O r .! AM 1 i o 09 not intended or offered for sale (Section 7044, Business and /-3.27 DSr 4,v ,o p oI44 .�+.Cdz� 96sv 1 FINAL DATE Q A P Professions Code.) qA73.22 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ��7✓ f S'' � �303 ❑ 1, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE licensed contractors to construct the project (Section 7044, FINAL BY �. �ITEMSAMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?VES 1:1 NO 11 ^ Business and Professions Code.) pi —y 23„ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 1 T 13TAL 6 C� -1 -22 OCCUPANT REQUIRE A PERMIT FOR RSEE PERMITTING ION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST NR QUALITY MANAGEMENT DISTRICT(SCAOMDC E KUST FOR GUMEUNES. CHECK 673.22 I hereby affirm that there is a construction lending agency for YES❑ NoCV ❑ CHANGE ,�;] the performance Of the work for which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING N 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. O(�(�(��j}}}${}J 10 C Lender's Address OWNER OR AGENT 1 y{ — }11 �T� t o Vs/J / 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.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building /�, �� ;E construction,and hereby authorize representatives of this County ISSUANCE FEE ,� 3 < toe upon the above-mention roperty for inspection p rpg�es., A � (7`�6�1J' INVESTIGATION FEE TOTAL FEE /� �, a Annan m oao & � SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION - '' /• '�I lei subaWorkers'certificate Insurance,linreorcertifcate of Compensaton A P P L I CATION FOR BUILDING PERMIT or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY 2 h Policy No. C,IrCompany 22-6 y►5046)t? PY Y ADDRESS J !BUILDING ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN ❑ Certified copy is filed with the county building inspec- BUILDING , 7 s� �`�_0 tion department. ADDRESS ® ! 'I /�, i,1l f� CITY (,- C4-Tr zip - LOCALITY C Date Applicant NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ' SIZE OF LOT 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.) n�� TEL. ��-•.� OWNERF-PLA W1 { I�w� NO• 0 S USE ZONE MAP I certify that in the performance of the work for which this �n/ NO. SPECIAL >_ permit is issued, I shall not employ any person in any manner ADDRESS 3 fav 3 -� CONDITIONS a- so as to become subject to the Workers'Compensation Laws. O CITY ZIP Date Applicant ARCHITECT OR TEL. ix NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE 0 Exemption, you should become subject to the Workers' p U Compensation provisions of the Labor Code, you must forth- ADDRESS •CO -� f��l�w :_ o- with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. 4� Z LICENSED CONTRACTORS DECLARATION LIC. p� CLASS NO. a� DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS/ 2 /L NO. 1 (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 ON?7r- CLASS BK. PG VALIDATION �} SO. NO. OF NO. OF CHECK License Number d S Lic. Class 13 SIZE 1-T STORIES ONE VALUATION 21 Contractor— C fir: Agf� Date Z DESCRIPTION OF WORK NEW ❑ $ �°z a ADD I AC X Elam exempt under Sec. ALTER j+[! 1 +f ,r t8.'° 1 B.BP.C, for this reason USE OF REPAIR ❑ $ ; Date: 7 2 EXISTING BLDG. DEMOL Els ITEMS ,/+�G APPLICANT �L. TOTAL 188 o 7*8 Signature l (PRINT) �r-i V4 V iRl NO. �q FINAL _ OW ER-BUILDER RATION �'� "' QQ /��, [�I p,' DATE CHECK �85S°/t, I hereby affirm that I am exempt from the Contractor's License ADDRESS (�O V `•/a y�. !I`�'�.. r Law for the following reason (Section 7031.5, Business and FINAL CHANGE °!jl] Professions Code): PRESENT By ElBUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 81/1411921 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. �++��y�EE ❑ 1,as owner of the property,am exclusively contracting CONTRACTOR NO. 27x f t TT with licensed contractors to construct the project (Sec- ADDRESS 1 ITEMO tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. TOTAL j AL 249o99 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT `ti Oma' the performance of the work for which this permit is issued P.L. GitC�, Z °' (Sec. 3097, Civ. C.). SIDE CHANGE P.L. Lender's NameLDMA Ref. # _ S P.C. Fee S O O•/CJ Permit Fee � ;�_��! C�►/j4/qty Lender's Address 1 certify that I have read this application and state that the Issuance Fee �7- 7S^ LDMA P/C a , 5460 f AMI1o_i9 3 above information is correct. I agree to comply with all County Investigation Fee LL� Cj ; Z ordinances and State laws relating to building construction, Total Fee T ' / LDMA Perm. N and hereby authorize representatives of this County to enter upon the above-mention dip operty for inspPel-f-ti_ purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE %ig !cant or Agent alate -- 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, BUILD] AD SS or a certificate of Workers'Compensation Insurance,or a certified S vs 4c/n copy ther.eof(Sec38010 Lal).C.) ZIP Policy NoJ/ � 5-0 Companyl & ,. � `' �/ c &- ?( LOCALITC�y/� SIZE OF LOT r NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. I NEAREST CROSS S JkCertified copy is filed with the county building inspection TRACT BLOCK LOT NO. depa;t ent. USE ZONE MAP NO. DateA Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER / NO. 0 COMPENSATION INSURANCE �D�pWgSCSW TLf(.S o /� —;?-7�'� WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred A�70 �p� e.� DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less.) CITY— � ZIP I certify that in the performance of the work for which this permit J G+'a~N�a e„ is issued, I shall not employ any person in any manner 30 as t0 ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CL SI ]CATION APT CONDO Date Applicant ADDRESS CLASS NO. -W DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CON b1�jALo 0 TEL O. /' SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 01 I/cAagAV4 P '.J Gd' ! FRONT comply with such provisions or this permit shall be deemed revoked. ADDRE� '✓ /�� PL LICENSED CONTRACTORS DECLARATION L� `�� / SIDE CITY6.,d' �� />oq LIC.H2ASJ P L I hereby affirm that I am licensed underprovisions of Chapter 9 /T'v'T Gam(` (�' SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE NO,OF STORIES I NO,OF FAMILIES Professions Code,a my flY�ensIS is in full force anC-1;6-11 k,effect. NEW ❑ BK PG , 0}. License mb r ��O LIC.CIas3 " 3 DESCRIPTION OF ADD ❑ VALUATION O ~ U Contra Date ALTER 11 $ ❑ 1 am exempt under Sec. REPAIR ❑ $ BAP.C.for this reason DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ cc Signature APPLICANT(PRINT) TEL NO. r LDMA Perm# 2� z ❑ 1, as owner of the property, or my employees with wages as e e e / V�7d' �/ Z ACC�p� their sole compensation, will do the work and the structure is A '/ e /� O � not intended or offered for sale (Section 7044, Business and ✓W L// ' Rr 11�/�t Q Q FINAL DATE a 3303 50.50 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting 4AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 70444,, At. g YES 11N� ° Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING j �� u I J OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FORGUIDELINEITEMS I^s{S I hereby affirm that there is a construction lending agency for YES 11N i LI C4 the performance of the work for which this permit is issued(Sec. " , TOTAL 2"157 a 60I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHECK TITLE 2,CHAPTER 2.20 SECTIONS 2 20.100 THROUGH 2 20.140 CONCERNING HAZARDOUS CHECK 157.60 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CoLender's Address CHANGE °-00 0 OAMER OR AGENT c I certify that I have read this application and state under penalty c of perjury that the above information is correct.I agree to comply P.C.FEE �� PERMIT FEE r� a with all county ordinances and State laws relating to building . d 13000-0001 6/13/95 gconstruction, and hereby authorize representatives of this County ISSUANCE FEE �. �` nr i d m to enter upo the ab - entioned roperty for inspectio pur oses, �J �)O_4 1 AN 10 a ry INVESTIGATION FEE TOTAL FEE �v / O CD ,/ (/ � uro App' « , SEE REVERSE FOR EXPLANATORY LANGUAGE 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 0403040053 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: I BUILDINGADDRESS: ON FILE SIGN DESCRIPTION: 1 ILLUMINATED WALL SIGN 45 S.F. 5791 ROSEMEAD BL N TEMP CA 91780 ASSESSOR INFORMATION UMB R: NEAREST CROSS STREET: LAS TUNAS THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED B XP RES .. EXIST OCC GRP: 03/04/04 VG 02/27/05 OWNER: TEL. 0: BLDGS. NOW ON LOT: VALUATION: FIVL DATE FINAL BY: CO SUSAN LEW & ASSOCIATES (626) 292-6638- 2,500 5825 ROSEMEAD BLVD. L6 TEMPLE CITY 91780 FEES PAID DESCRIPTION OF WORK 1 SET ILLUMINATED CHANNEL LETTERS APPLICANT: T0• FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: DIVERSIFIED SIGNS INC. (714) 701-1330- D1 PLANCHECK W/0 EN-HC 2500.00 VAL 84.15 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AE STRONG MOTION OTHER 2500.00 VAL 0.53 D2 PERMIT W/O EN-HC 2500.00 VAL 99.00 TOTAL FEES 211.43 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE DIVERSIFIED SIGNS AND GRAPHICS (714) 701-1330- 5602 E LA PALMA AVE LIC. NO LOCATION ADSETBACKS ANAHEIM CA 92807 737055 C45 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: FOUNDATION/TRENCH FORMS LIC. NO: SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 00 0. OF FAMILIES: DWELLING U I S: APT/COND: STAT CLASS: NO 20 SCHOOL ITHI HAZARDO S AIR QUALITY: 1000 FEET MATERIALS NO NO NO I i i REPORT ID: DPR261 ROUTE TO: BS05O8