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Home My Public Portal About5795 ROSEMEAD BLVD_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self g P L I CATION FORBUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy ther+lbof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElCertified copy is here*furnished. FOR-APPLICANT TO FILL IN BUILDING ADDRESS � �` p�E,(,��/� I.�[, ❑ Certified copy is filed with the county building inspec- BUILDING _ tion department. ADDRESS F tD f. 7 Date Applicant CITY — ZIP 09 LOCALITY 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. MqP BOOK PAGE PARCEL hundred dollars ($100)or less.) � � OWNER ` USE ZONE OP j I certify that in the performance of the work for which this c� ��cp SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS,LQfiI Fx � CONDITIONS so as to become subject to the Workers'Compensation Laws, i�, O CITY l pl(?CT ZIP lOfOO U Dote Applicant ARCHITECT OR TEL. O! NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED_ O Exemption, you should become subject to the Workers' s CONST ZONE 15 Compensation provisions of the Labor Code, you must forth- 3 ADDRESS _je 9 Z ,j C_ with comply with such provisions or this permit shall be F TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. ZA 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 STORIES FAMILIES ONE ; VALUATION Contractor Date DESCRIPTION OF WORK NEW 1:1z.. %%. ADD 10 $ . 300(0 ❑1 am exempt under Sec. _ Z. ► - ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ _ Date: USE OF r EXISTING BLDG. DEMOL ❑ �;_ =a Signature APPLICANT TEL, IZ FINAL „,_"_ - OWNER-BUILDER DECLARATION (PRINT) A) NO DATE `+ `�� "`'° I hereby affirm that I am exempt from the Contractor's License t } �� p r-- Law for the following reason (Section 7.031.5, Business and ADDRESS FINAL Prof ions Code): PRESENT By.BUILDING 0 i�i;- 16`2 . 57 �-. I, as owner of the property, or my employees with ADDRESS t�'c _► � U -7 wages as their sole compensation,will do the work and Tau UT Y i .�fC�•:i °..�, the structure is not intended or offered for sale(Section LOCALITY ® } t I 7044, Business and Professions Code.) MOVING TEL I s•�NNIG- .L ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS IF tion 7044, Business and Professions Code.) iJl f G--I]I'iji REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH _Irj?sr, sIr k+y= 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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name per/ P.C. Fee$ O' �� Permit Fee L�/ 7 LDMA Ref.H Lender's Address I certify that I have read this application and state that the Issuance Fee a LDMA P/C 0 above information is correct. I agree to comply with all County Investigation Fee i ordinances and State laws relating to building construction, Total Fee //�• LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent �'-Date-moi WORKERS' COMPENSATION DECLARATION hereby affirm that I have r certificate of consent to self , r � T R �1 �-I L ' PERMIT i�isure, or a certificate of Workers' Compensation Insurance, !� or.'a,certified c f(Sec. 3800, Lab. C.) r—r !7 COU14TY 011`10S ANGELES BUILDING AND SAFETY Policy Nb.IN Company ", ElCertified copy is.hereBUILDINGby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed withothp County b 'ding inspec- . «BUILDING tion department. >. ADDRESS Date—&-tApplican / GAJ CI ZIP LOCALITY NO.OF BLDGS. NEAREST ERTIF CATS OF'•EXEMPTIO RO RKERS'. SIZE OF LOT NOW ON'LOT CROSS ST.' C1 COMPENSATION I SU NCE ASSESSOR (This section need not be completed i the rmit is for one TRACT' BLOCK LOT NO., c MAP BOOK PAGE PARCEL hundred dollars ($100)'or less.) TEL. OWNER NO, USE ZONE MAP I certify that in the performance of the work for which this NO. permit is issued, I'shall not employ ny,person I. y,manner ADDRESS V !' SPECIAL �- CONDITIONS CL so as to be ome ubject to the Wo k rs'Co ensu ion p �f t CI (�i ZIP Date ` + Applicant C.,d ARCHITECT O TEL, DISTRICT GROUP TYPE FIRE PROCESSED BY 0O NOTICE TO PLICANT: If, after m Ing i Certific to of j. ENGINEER NO. CONST. Z NE t- Exemption, you should become bje t the Workers' Qp �l q U Compensation provisions of the Labor C de, ou must forth- I ADDRESS (�0 �'��J r1- i�e�,�� LLA with comply with such,provisions or t is ermit shall be t TEL. STATISTICAL CLASSIFIC TI N APT. CONDO. N deemed revoked. CONTRACTO NO. A Z LICENSED CONTRACTORS-DEC TION ) / LIC. /� CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 !.ADDRESS �. L N • lJ . .s (commencing with Section 7000)of Division 3 of the Business LIC. / SEWER MAP and Professions Code,and license is! full force and ffect. CI ! CLASS BK. PG. VALIDATION l� SQ. Fr.. NO. OF NO. OF CHECK ' License Number' Tic- Class I SIZE STO FAMILIES ONE VALLI Contractor 'Date + DESCRIPTION OF WORK , NEW ❑ `ADD LJ $ 0 , t,/S r' • . El am e '7 exempt under.Sec. V � ALTER ❑ ? ' BAP.C. for this reason REPAIR ❑ $ USE OF : Date: EXISTING BL G. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. ti; i DATE Ihereby 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 By / / J. BUILDING ❑ 1, as owner of the property, or my employees with ADDRESS.- wages DDRESS.wages as their sole compensation,will do the work and ® � i•i; the structure is not intended or offered for sale(Section LOCALITY d. 7044,•dusiness and Professions'Code.) :MOVING TEL. _ ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. _ with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) .+;.,fi�` 53. REQUIRED TOTAL ETACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PRSOPB. LINE WIDTH I herebyaffirm that there.is a construction lending agency for r 9 9, Y � FRONT -the performance of the work for which this permit is issued P.L.. "i-; H1_ -f;- z x-z, (Sec. 3097, Civ. C.). SIDE. Lender's Name ;t ti•: $ p LDMA Ref. # ' s:•NGE -: Lender's Address P.C. Fee$ Permit Fee •�O �' �'�- _, I certify that I have read this application and state that the Issuance Fee 45 - /..� "' LDMA P/C# 2 above information is correct. I agree to comply-with all County 's•. Investigation Fee :if I!_(;_I r t • :-:-� .� k. ordinances and State laws relating to building construction, Total Fee ' LDMA Perm. # an ereby a o ize representatives of this County to enterci=a i up } e a ,e- entio ned 'roperty for inspectio purp ses. o r SEE REVERSE FOR EXPLANATORY LANGUAGE ignatur iwn o App t or Agent Do 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 0210220008 PHONE: (626) 285-0488 EXT: LEGAL ID: B R OF SIGNS; I BUrLDING ADDRESS: ON FILE SIGN DESCRIPTION: "ANGEL BEAR" IN RED, "DISCOUNT SHOP" 5795 ROSEMEAD BL TEMP CA 91780 ASSESSOR 0 0 NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED S 0 : ANGEL BEAR EXIST OCC GRP: 10/22/02 JK 04/20/03 OWNER: TEL. NO: FLOGS. NOW ON LOT: ALUATIO : FINAL DATE FINA BY: CODE: 3709 9C INVESTMENT - 1,500 1--L 1.3 p3 SAN DIEGO, CA9211137 S PAID DESCRIPTION� WOW- INSTALL CHANNEL LETTERS FOR DISCOUNT/GIFT SHOP APPLICANT: 0• FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: DAVID DUONG (714) 799-7559- AA BLDG PERMIT ISSUANCE 27.75 14341 BEACH BLVD #G AC STRONG MOTION RESID 1500.00 VAL 0.50 SPECIAL CONDITIONS: WESTMINISTER 92683 D1 PLANCHECK W/-0 EN-HC -- - 1500.00 VAL 82.11 D2 PERMIT W/0'EN--HC ; -'1500..00 VAL 82.20 F.EES,� 192.56 CONTRACTOR: TEL. N0: - APPROVALS DATE INSPECTOR SIGNATURE Y2K SIGNS (714) 799-7559- 14341 BEACH BLVD #G LIC. NO �^". ,•' %: LOCATION AND SETBACKS WESTMINISTER, CA 92683 761709 C45 , . SOILS ENGINEER APPROVAL ARCHITECT OR ENGIN ER: TEL. N0: - �' j FOUNDATION/TRENCH FOR f LIC. N0: ti_ SUPPORT STRUCTURE P NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:. • „ ! 00 ' 0. OF FAMILIES: DWELLING S: AP / 0 C ASS:--- NO :___NO 20' - _ - - -- - ,-- SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO 41 REPORT ID: DPR261 ROUTE TO: BS0508