HomeMy Public PortalAbout5809-5819 ROSEMEAD BLVD_Building__ APPLI C IONFOR: BUIL®I IlIG PER
�,� ' -•..,, r COUNTY OF LOS ANGELES BUILDING AND SAFETY y
►i FOR APPLICANT TO FILL IN D
WORKER'S,
BUILDIN
COMPENSATION DECLARATION suILOING A Y{'"
BUILDING ADDRESS
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I hereby affirm that-1-have a certificate of consent to self insure, Jr�O r RQS 3ZJ/�• q
or a certificate of Workers'Compensation Ins or a Certified CITY ZIP rJ 9•� l •— S� m OStY✓j
copy thereof.128m_- Lab.q� . -ten -__ —_ .
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`-- � �• 'T ��.� .G! LOCALITY _ _
Policy Not --,- -P� COm '- _ SIZE OF LOT NO.OF BLDGS.NOW ON COT Tt M P LC GIT Y
�Certif�BQ w"-Is here rnished. NEAREST CROs ST
py. � � 2'7':.�•3'
❑ Certified copy. hi with the county building inspection TRACT BLOCK LOT NO. t_AS' TUNAS 'fD'21v
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department.:__ USE ZONETMPP NO. 4 2
ASSESSOR MAP BOOK PAGE• PARCEL ISO _6SDate —- pplicant a--- - - - ' . . '' o '- ECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' SNC ZI'i�TELO 3 v- (o WITHIN 100D FT.OF SCHOOL? YES NO
COMPENSATION INSURANCE . AODREss
Is section need not be,CDmpleted if the permit is for one hundred : ° ""GROUP '
curs 100 or.less. • .•.. ,`L0O,':OG ,?.: l�.i�:.•"•-�2.,.;�.:<�L0�11Z• � 'DISTRICT -TYPE CONET, FIRE ZONE PROCESSED BY. .
. '
I certii)i that in the performance of the work for which this permit Ldp,:' .`: s/;� 02,._ „', 6-,196 L 1-
is Issued,.I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER EL O.
become the Workers'Compensation Laws. _ STATISTICAL CLASSIFICATION ' APT CONDO
Date Applicant' ADDRESS i CLASS NO. DWELL UNITS
(_v . V �� s
NOTICE TO APPLICANT.' If, after,making .this,Certificate Of ' " _ REQUIRED TOTAL SETBACK FROM EXIST.
Exemption, you•shoultl .become subject to tti'e Workers' oR -_ __...-._f TEL NO. •//� SETBACK YARD HWY PROP LINE•. • WIDTH'
CompensatiDn'provisions of the Labor Code,you must forthwith _L09-A`b
comply with such provisions or this permit shall be deemed'revoked. RE •- _ �c Vii.- '=-''� p LNT 23-
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LICENSED CONTRACTORS DECLARATION. - r - �� . p
fD;ESlFrrEN
q-�s•... SIDE i �•� a >;
LIC ACMcc
I hereby affirm thot,I am.licensed under provisions of Chapter.9sEwERMAP � ( ;n,l =i_I(commencing.with Section 7000)of Division 3 of the Business andNO.OF STORES NO.OF FAMILIES { czProfessions Code,an rrienGse.is:in full force•and effect., .• NEW - BK. ' PGT'(ENSO a �r, IOOF WORK' ADD• .❑ VALUATION r s 5i �s
s1_NG Nim j i7 .S" _ - Lic.cI B :-_- 1 �J I $ /L.72 D�m° TIS t AL .LUL 1_`?'I W
Contra r _ eteG_ .s- ._` ALTER ❑ %° CHECKj i z•1 X22 a Z
r
111 am exempt unile�Sec. REPAIR ❑• `$ CHl'�i'i43G- AI(I
DEMOL ❑
B.BP.C.for this reason y - LDMA'P/C.#
Date' . �� •_ { USE OF EXISTING BLDG. URM., ❑ ;'
`� i Onno-i3ooi' ' 1,'!
Signature APPLICANT(PAINT) TEL NO. LDMA Penn# +,l ,';y�r' AMINO
❑ I, as"owner of the property,or my employees with wages as 1� ASSaG• 8 C,
their sole compensation;will do the work and-the structure IS ADDRESS• , '
not intended or offered for sale (Section 7044, Business and N L1% v FINAL DATE =
Professions Code.) ;•: Y
D . +•
WILL THE APPLICANT OR FUTURE BUILDING OCCURANT HANDLE A HAZARDOUS MATERIAL
OR A MIXTURE CONTAINING.A HAZARDOUS MATERIAL EQUAL TO.OR GREATER THAN
I,'as.owner of the property,Sm exclusively.Contracting with .THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?. FINAL B
licensed,contractois,to construct the project.(Section 7044;
Business and'Professions Code.) YES,
re❑ 'NO❑ '
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING -
•OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTN
•. •CONSTRUCTION LENDING AGENCY. COAST AIR QUALITY MANAGEMENT.DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST C ., •'
FOR GUIDELINES.
I hereby affirm that there is a construction lending agency for Yes❑ NO❑' , `
the performance Of.the work for.which this permit Is Issued(Sao. 1 HAVE-READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD :- '{-�.�'T` - ,Y`"'' ) .rs•n� 't: '
3097,Civ.C.). - PERMITTING-CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS-ANGELES )''7�r Tom'! ' •" �'"'f �•y "
COUNTY CODE,TITLE2,CHAPTER 220SECTIONS 210.100THROUGH 2.20.140 CONCERNING '�• zm'
Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. t'�t
1.1.17q
Lenders Address. ORe >+AevTPa. r i
-I
o I certify that I have read this application and state that the above
informal n is-correct. I agree to .comply with all county RC.FEE PERMIT
ordin as and State laws relating to building construction,andv' +'F
he uthorize represen Yves of this County to enter upon ISSUANCE FEE i�
t ve-mentlone for ion purposes.
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INVESTIGATION FEE TOTAL ��%L• �%.J �' Irl �� � ;v-; ,
��� WARA .q.., •.try a:.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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 1405010050
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW BUILDING ADDRESS:
ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 5809 5811 ROSEMEAD BL
I STRUCTURE: 1420 1 V-B B I TEMP CA 91780
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
5397-012-043 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl
ITENANT: (EXIST BLDG USE: COMME USE ZONE: [ISSUED ON: PROCESSED BY: [
I (EXIST OCC GRP: B 07/14/14 SR I
(OWNER: TEL NO: IBLDGS. NOW ON LOT: VALUATION: [ NAL DA FIN Y: CODE: [
ICALAC INVESTMENT (626) 255-7565- 1 4,000 [
13709 CONROY ST #300 1
ISAN DIEGO CA 92137 1 FEES PAID 14E CRIPTIO OF WORK [
I I [APPROVAL FOR SUBDIVIDING AISTING UNIT ONLY [
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ I
[APPLICANT: TEL. NO: [ I I
IFUNG, ALISON H (626) 320-2815- 1A1 PLANCHECK W/EN-HC 4000.00 VAL 113.20 [ 1
218 W SIERRA VISTA IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: 1
MONTEREY PARK 91754 IAB STATE GREEN BLDG FEE 4000.00 VAL 1.00
IAE STRONG MOTION OTHER 4000.00 VAL 0.80
IA2 PERMIT W/ENERGY-HC 4000.00 VAL 133.20 I_
ICONTRACTOR: TEL. NO: I TOTAL FEES 276.00 (APPROVALS DATE INSPECTOR SIGNATURE [
1JLCC CONSTRUCTION (626) 233-8496- 1 1 [
15126 FLORINDA AVE LIC. NO I ILOCATION AND SETBACKS [ [ [
ITEMPLE CITY CA 91780 404982 I 1 I I [
I (SOILS ENGINEER APPROVAL I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS
I LIC. NO: I ISLAB/UNDER FLOOR I I I
I I IRAISED FLOOR FRAMING
I I I i I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ IUND$RFLOOR INSULATION I I I
3 001 1
I IFLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I
I 0 NO 22 1 IROOF SHEATHING I I
[ SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I [
[AIR QUALITY: 1000 FEET MATERIALS I I I
[ NO NO NO IFRAME INSPECTION
I I I I I
I IFIRE SPRINKLER HANGERS I I I
[ I [INSULATION/WEATHER STRIPI I I
I [INTERIOR LATH/DRYWALL
I [EXTERIOR LATH I I
I (RATED FLOOR/CEIL ASSEM. I I
1 I IRATED WALL ASSEMBLIES I I I
I
RATED SHAFTS/OPENINGS
I I I I
I IT-BAR CEILINGS I
ILOT DRAINAGE I I
IREPORT ID: DPR261 ROUTE TO: BS0508 I [ I