HomeMy Public PortalAbout5803 ROSEMEAD BLVD_Building__ APPLICAMI'ON F R BUILDING PERMIT �1
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILD G ODRESS
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS .S—e-
Im
or a certificate of Workers'Compensation Insurance,or a certified CITY r
0Q D ZIP Q,
copy thereof(Sec.38M,Lab.C.) 1 LOCALITYPolicy No. Company SIZE OFLT NO.OF SLOGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST.
❑ Certified copy is filed wi a county building inspection TRACT BLOCK LOT NO.
department.' USE ZON MA NO.
Date,r�plicant ASSESSOR MAP BOOK PAGE PARCEL
�. SPECIAL CONDITIONS
CEOTIFICATE OF EXEMPTION FROM WORKERS' OWNER ' TEL NO. (f YES NO
COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL?
A
ADDR99
(This section need not be completed if the permit is for one hundred �j DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
dollars($ or less.) CITY ( ZIP So
Qf�O hI certify thathat in the performance of the work for which this permit K:�i �(� D 1Ji
Is Issued, I shall not employ any person In any manner so as to ARCHITECT OR GINEER TEL.NO.
become Subj t0 the Workers'Co ensatioSTATISTICAL CLASSIF ON APT CONDO
Date Applicant ADDRESS CLASS NO. Del
W NITS
NOTIC APPLICANT.' If, after making this Certificate of OR TEL NO. REQAPED TOTAL SETBACK FROM IX]ST
COQST
Exemption, you should become subject to the Workers' SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith V j FRONT
comply with such provisions or this permit shall be deemed'revoked. ADDRESS / LIC.NO. PL
LICENSED CONTRACTORS DECLARATION' CITY. ! LIC. SIDE
I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES I NO.OF FAMILIES
Professions Code,and my license is in full force and effect I NEW ❑ BK PG ® �:
License Numbe Lic.ClD IPTION OF WORK ) ADD ❑ VALUATION �•
ass• 1
Contractor Date. — ALTER ❑ $ _�
El Ps1ZII REPAIR ❑ $I am exempt under Sec. �
B.&P.C.for this reason I DEMOL ❑ LDMA P/C A
USE OF ISTING BLDG. ORM, ❑
Date: -
Signature APPLICANT(PRINT) TEL NO. ;',_
� LDMA Penn q
.1..i _:'
❑ 1,as owner of t property, or my employees with wages as & r � C
their sole compensation,will do the work and the structure Is ADDRESS ---
not intended or offered for sale (Section 7044, Business andaas
' • fir�GC FINAL DATE Q
Professions Code.) WILLTHEAPPLICANT OR FUTURE BUILDI OCCUPANT HANDLEA HAZARDOUS MATERIAL /!�'���
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN
❑ I, as owner Of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION'GUIDE9 FINAL BY
licensed contractors to construct the project.(Section 7044, , vEs❑ NO
Business and Professions Code.) /
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING '•'•iy ivji_
CONSTRUCTION LENDING AGENCY OCCUPANT REQUIRE PERMIT FORCONSTRUCTION OR MODIFICATION FROM THESOUTH i _ ! +'.•.1
COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST
FOR GUIDELINES. •• -K �' " ._
I hereby affirm that there is a constructio dlrf�gency for YES❑ N _I-iy^ 1L
the performance of the work for wh' Is permit is issued(Sec.
1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD •� '°•'"'``'
3097,CIV.C.). PERMITTING CHEC I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES
• COUNTYCODE.TIT 2,CHAPTER 220 SECTION 5220.100THROUGH 220.140 CONCERNING
Lender's Name HAZARDOUS MAT LS REPO AND F OBTAINING A PERMIT FROM THE SCAOMD.
Lender dress OWNER OR AGENT AL
o' I certify that I have read this application and state that the above
Information Is correct. I agree to comply with all county PC.FEE / PERMIT FEE .
ordinances nd State laws relating to building construction,and
hereby horize representatives of this County to enter upon ISSUANCE FEE _ -
the ab
in,
�
p r inspection purposes. � i
INVESTIGATION FEE TOTAL FEE c4 or
� g
J
SEE REVERSE FOR EXPLANATORY LAN tIAGE.
f C=G= A4 . mac.
APPLICAT50FOR BUILDING PERMIT �.
{w COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING ADDRESS
WORKER'S COMPENSATION DECLARATION � u9�
BUILDING ADDRESS �• �•��,/
I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP
copy thereof(Se 3 00,Lab.Com„�' �. - �� j LOCALITY '����/f _
Policy t�ompany SIZE OF LOT V NO. BLDGS.NOW ON LOT t '""1� ,E a J,
Cartified oopy IS ereby furnished. Z NEAREST CROSS ST p`
❑ Certified copy is filed with the county building inspection
TRACT BLOCK LOT NO. "r'� Z
depart ant USE ZONE MAP NO.
7� ASSESSOR MAP BOOK PAGE PARCEL
Date •► .r74pplicant 1 °'� SPECIAL CONDITIONS
CE TIFICATE OF EXEMPTION FROM WORKERS` N R 14-1�� � ���I� C WITHIN 10000` FT OF SCHOOL? YES NO
COMPENSATION INSURANCE
ADDRESS �]'� r
(This section need not be completed if the permit is for one hundred ,ITY Eo J PIE--w) 3 VP DISTRICT 'GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
dollars($100)or less.)
I certify that in the performance of the work for which this permit C°^ . zip % 7�
Is Issued, I shall not employ any person in any manner so as to ARCHITECT O ENGI ER. TEL NO. J D I
become subject to the Workers'Compensation Laws. ; rs Zt 3 b j 7-,-R, •US'ATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESSt4 712 r CLASS NO. DWELL UNITS
NOTICE TO APPLICANT: If, after making this Certificate of E r,` REQUIRED TOTAL SETBACK FROM EXIST
Exemption,. you should become subject to the Workers' CON OR TEL.N SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith LJ �� FRONT
comply with such provisions or this permit shall be deemed-revoked. ADR IC.No. FRONT
( ' S^ `7 SIDE at
LICENSED CONTRACTORS DECLARATION O ,•` LI P L 01
fT 11
I hereby affirm that I am licensed under provisions of Chapter 9 - SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and 11SQ.-FTSIZE OF STORES O.OF FAMILIES
Professions Code,and my license isin full force an effe NEW, ❑ BK PG
DESCRIPTION OF WORK
License Number �+ Lia Class /T JW1P-gA - ADD ❑ VALUATION rt0 ar'r
Contractor �� �- j Date 9✓ ` / ALTER ❑
V f- i Z
❑ I em exempt under Sec.
REPAIR ❑
BARC.for this reason JD�EMOL ❑ LDMAP/C N
Date: USE OF EXISTING BLDG. M ❑
t
Signature APPLICA T(PRI T) TEL O. LDMA Perm# ,
❑ I,as owner of the property, or my employees with wages as I ✓ � � 0
their sole compensation,will do the work and the structure is ADDRESS
not Intended or offered for sale (Section 7044, Business and (J FINAL DATEr "- "2-
Professions Code.) wl THE�PLICANTORFUTURE BUIL biNGOCCLPAT RR
ANTHANDLEAHAZARDOUSMIAL j
❑ I, as owner of the ro ert; am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR ORFATEA THAN _
P P Y Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project.(Section 7044, YES❑ NO❑ --
Business and Professions Code.) Jf
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING - y- '�-: -"•-'`OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTPI ,p
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST �G
FOR GUIDELINES. ..,/� .,r f.". ..:�'� �'•�'"' ..
I hereby affirm that there Is a construction lending agency for YES❑ No❑
the performance of the Work for which this permit is issued(See. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD /
3097,CIV.C.). I PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �(� �
pu. COUNTY CODE,TITLEZ CHAPTER 2.20 SECTIONS 220.100 THROUGH 220.140 CONCERNING -
t3 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. " -
a Lender's Address OR,GEW
0 1 certify that I have read this application and state that the above P.C.FEE J
information is correct. I agree to comply with all county /�G� / PERMIT FEE
ordinances and State laws relating to building construction,and
hereby ya�u-thorize representatives of this County to enter upon ISSUANCE FEE s�
tle he o mentioned property7s,pe ion purposes. �, pt .,
�'d!'�! V�� A , y INVESTIGATION FEE TOTAL FEE �/
8q:utumaAppl=MWAWt' _ 0
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 9908160075
PHONE; (626) 28570488 EXT: �____•__
LEGALB SI S: 1 BID I W97—ADD SS:
ON FILE SIGN DESCRIPTION: WALL SIGN - 20" X 121 611 r 5803 ROSEMEAD-BL'
k •
ASSESSOR INFORMATION TEMP CA-91780'.
NUMBER: 'NEAREST CROSS STREET: LAS TUNAS
5397-012-043 THOMAS PAGE:---' GRID: LOCALITY: TEMPLE CITY
TENANT: ISSUED ON:tIRES Uzi;
UTEMPLECITY OPTOMETRY EXIST'OCC GRP:/ 08/16/99 r 02/12/00 Y$
OWNER: TEL. NO: BLDGS. NOW ON LOT: VAL TION:• FINAL DATE FINAL BY; CODE:
CALAC INVESTMENT - 1,500
9
SAN DIEGO, CA9211137 FEESPAIDSb RY1sqf0N O� WORK
ONE NEW WALL SIGN 20" X 121X6"
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL0:
A N S SIGNS (562) 287-8505- AA BLDG PERMIT ISSUANCE 27.75-
9845 1/2 ALBURTIS AV AE STRONG MOTION OTS 1500.00 VAL 0.50 SPECIAL CONDITIONS:
SANTA FE SPRINGS, CA D2 PERMIT W/O. - C -5Q0.00 VAL 82.20
L���S 110.45
CONTRACTOR: TET-NO: APPROVALS DATE INSPECTOR SIGNATURE
. S
A N S SIGNS (310) 801-0543-
98451/2 ALBURTIS AVE LIC. NO MCWTOUR AND SETBACKS
SANTA FE SPRINGS CA 90670 569180 C45
SOILS ENGINEER APPROVAL -
; •*a;
CT
3R E GI + • 0:. , 0D 0 RCH•FOS
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•�l '• ,'i.;:f : - •, :. _ ~ •• ' u• •:l.i.. :, a ;!"i1;3•j�".•:+:;i:; ..,,n`•:.^-�;;
i�nk:�• '• rkS• LAIC: NO 4aJl l 1 i 111 SUPPORT STR CTURE
14A
P N0: SEWER MAP BOOK: PAGE: FIRE ZONE:
u6MP:=� n n f/O
r D n n U U lu^Su lul�`U
0. OF FAI41LIES: DWELLING S: CO D: STAT CLASS;
- NO 20
SCHOOL HAZ OUS rte, jr
'AIR QUALITY: 1000 FEET MATERIALS ! El fitP
NO NO NO
El
4b,�c Service-aha
REPORT ID: DPR261 ROUTE TO: BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0901050001
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I
ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 5803 ROSEMEAD BL I
I (STRUCTURE: 177 1 V-B B I TEMP CA 91780 I
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LAS TUNAS I
15397-012-043 I I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl
( (
TENANT: EXIST BLDG USE: COMME USE ZONE: (ISSD ON: PROCESSED BY:
09
(TEMPLE CITY SQUARE OPTOMETRY (EXIST OCC GRP: B 102/ /09 SR
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DA FINAL BY: CODE: 1
IDR. PALINA HAN (626) 287-8505- i1 10,000 1' 1
15803 N. ROSEMEAD BL I I I
ITEMPLE CITY CA 91780 I FEES PAID IDESCRIPTIO OF WORK I
I I IT.I. OF (E) OPTOMETRY TO D MO WALLS AND BUILD NEW NON I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IBEARING WALLS AND 1 DOOR OPENING
(APPLICANT: TEL. NO: I I
ITAN (626) 688-6339- [Al PLANCHECK W/EN-HC 10000.00 VAL 211.73 1 I
1115 E. BROADWAY AVE. IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: I
ISAN GABRIEL CA 91776 IAB STATE GREEN BLDG FEE 10000.00 VAL 1.00 1 I
I IAE STRONG MOTION OTHER 10000.00 VAL 2.10 1 //�� ff..,, I
I 1A2 PERMIT W/ENERGY-HC 10000.00 VAL 249.09 I e' (,, I
(CONTRACTOR: TEL. NO: I TOTAL FEES 491.67 (APPROVALS U DATE INSPECTOR SIGNATURE 1
(SWM CONSTRUCTION INC. (626) 274-9357- 1 1I I I
2645 LEE AVENUE #3 LIC. NO I 1LOCATION AND SETBACKS
ISOUTH EL MONTE, CA 91733 836333 B I I I I I
I I ISOILS ENGINEER APPROVAL I I ' J:
(ARCHITECT OR ENGINEER: TEL. NO: - I IFOUNDATION/TRENCH FORMS I I I
LIC. NO: (SLAB/UNDER FLOOR I I I
(RAISED FLOOR FRAMING I I I
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( Vt�
IUNDERFLOOR INSULATION3 041y /0 y i k� �` IFLOOIIR SHEATHINGINO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I N I 1 I I
1 NO 22 I IROOF SHEATHING I I I
SCHOOL WITHIN HAZARDOUS I (SHEAR PANELS I I I
(AIR QUALITY: 1000 FEET MATERIALS I I I I I
NO NO NO (FRAME INSPECTION \)/Xa
I IFIRE SPRINKLER HANGERS I I
11NSUFATION/WEATHER STRIP( I I
I (INTERIOR LATH/DRYWALL I I I
(EXTERIOR LATH
IRATED FLOOR/CEIL ASSEM. I I I
IRATED WALL ASSEMBLIES I I I
(RATED SHAFTS/OPENINGS
I I
II IT-BAR CEILINGS I 1 I
I � I
ILOT DRAINAGE I I I
REPORT ID: DPR261 ROUTE TO: BS0508 I
I f• I I I I