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Home My Public Portal About5819 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING PERMIT I L COUNTY OF LOS ANGELES ii. BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRES I hereby affirm that I have a cert'lficate of consent to self insure, Blylp N ADDRESS' -� / Jq or a certificate of Workers'Compensation Insurance,or a certified S �� 1-S V `S / copy thereof(Sec.-3800, b:C.) �jTYI ZIPg1� blek Policy No,D1a-s�—I� Company �j SIZE OF LOT NO.OF BLDGS.NOW ON LOT +❑ Certified copy is hereby furnished. - NEAREST CROSS ST./� T Af❑ Certified copy is filed with the county buildi g i spectio'n TRACT• BLOCK LOT NO. �✓ % �<1 ✓� department. s � USE ZONE MAP NO. fateAppiicar ASSESSOR MAP BOOK PAGE PARCEL, 0. SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS! OWNER �. TEL NO. v I YES, NO COMPENSATION INSURANCE e't 1 WITHIN 1000 FT.OF SCHOOL? , (This section need not be completed if the.permit is for one hundred ADDRESS ! �.- :G DISTRICT, GROUP' 'TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP /fA/ I certify that in the performance of the work for which this permit � W is issued, I shall not employ any person'in ,,,any manner So as to ARCHITECT OR ENGINEER TEL NO. 3 . become subject to the Workers'Compensation taws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NO710E 70 APPLICANT If, after making-this Certificate of REQUIRED TOTAL SETBACKFROM EXIST Exemption, you should become subject . to the Workers' C'O R TEL NO SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith. �/� TEL 14t FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS-' LIC.�NO. u PL '1 LICENSED CONTRACTORS DECLARATION 7 57 SIDE I' CITY �O LIC.,CLASS PL i I hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section 7000)of.Division 39f the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP Professions Code,and my license is in full force 9nd effect. NEW BK PG , d License Number 1f Lic.Class` DESCRIPTION 9F WORK ADD ❑ VALUATION U Contractor ate ALTER El $ ❑ I am exempt under Sec:- ° REPAIR ❑ B.BP.'C.for this reason DEMOL ❑ LDMA P/C# t W Date, USE OF EXISTING BLDG. URM ❑ G' g - , Si nature APPLI NT(PRINT) T NO. LDMA Perm# A'--(`•j °o z P P tY, Y employees 9 D R P� —L F '� S` "f 513.50J ❑ I,.as owner of the ro er or m em to es with wages as U3 their sole compensation, will do the work and the structure is. II // �� J� not intended or offered for sale (Section 7044, Business and ftoz; L-�Sa9Q! b . FINAL DATE (�f/ Q Professions Code.) WILL THE APPUCANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �G Z✓ •V M •"f-3 Ir OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE l"l�•'�•' °'� ❑ I, as owner of the property,',am exclusively contracting with Q 'AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL > 330,75 _ licensed contractors to construct the project (Section 7044, v'�°.c•� YES❑ NO •� Business and Professions Code.) • WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING s jE ',•'} ' OCCUR%NT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 4 _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY'MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR f�F ,GUIDEUNES. TOTAL 1•,�' m 7 ;sy I hereby affirm that there is a construction lending agency for :YES❑ NoI� - s -`O 7� a the performance of the work for which this permit is issued(Sec. I o CHH •i! ��f''" W 3097,CIV.C.) �I HAVE READ TZLOUS HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING T �•frT CHECKLIST.I UNDERSTAND MY REQUIREMENTS.UNDER THE LOS ANGELES COUNTY CODE, {F� (rITLE 2,CHAPTER 2.20 SECTIONB 2.20.700 THROUGH 2.20.140 CONCERNING HAZARDOUS CHANGE Lender's Name MATERIALS REPORRNG AND FOR OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address O OWNER OR AGENT t r A o I certify that I have read this application and state under penalty E,j1300—I_Il,+l_(1 1�,` of perjury that the above information is correct.I agree to comply P.C.FEE >�D. ,�y� PERMIT FEE j_ N with all county ordinances and State laws relating to building lJ tOP11122-54 construct' ,and hereby authorize representatives of this County ISSUANCE FEE f� m r on the above- Toned property for inspection rp sea. (f m + INVESTIGATION FEE TOTAL FEE n ;a°am L,1 ova SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION 13RUILDING PERMIT �1 �. COUNTY OF LOS ANGELES BUILDING AND SAFETY IWORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDI DDRtSS -C/1 OSL.�v\e or a certificate of Workers'Compensation Insurance,or a cjer�tififed copy thereof(Sec.3800,Lab.C. 5r��'/�j, Policy No.Qq 727�^ Company cl ` 1. ^ ZI r p LOCALITY 2t,,, n �. Cl SIZE OF LOT �i NO.OF BLDGS.NOW ON LOT tj Certified copy is hereby furnished. NEAREST CROSS ST Certified copy is flied with th county d n9 Inspection TRACT BLOCK LOT No. department. r USE ZONE MAP NO. Date°�^ 6��r. PPlice ASSESSOR MAP BOOK PAGE PARCEL /f SPECIAL CONDITIONS CERTIFICATE OF E1< IIA TION FR WORKERS' p TEL NO, G-22 C/ COMPENSATION INSURANCE _� �—`� I-3 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for hundred XD S ! /(� (�� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CI /� zIP�/ Ic I certify that in the performance�mpensation for which this permit A // 00 Is Issued, I shall not employ anyany manner so as to A OR ENGINEER TEL NO. become subject to the Workers' Laws. D n L p 3 STATISTICAL CLASSIFICATION APT CONDO Date Ap nt AD4 -I-F� CLASS NO. Z- DWELL UNITS NOTICE TO AP CANT: If, after making this Certificate of D DG _JraJ�4a 9 REQUIRED TOTAL SETBACK FROM EXIST Exemption, should become subject to the Workers' CONTRACTOR eC TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compen n provisions of the Labor Code,you must forthwith �'�( �v� ^g� Com ith such provisions or this permit shall be deemed-revoked. ADD �!, LIC.Ng. FRONT } lY� PL C SIDE LICENSED CONTRACTORS DECLARATION PL r V LIC.CLASS I hereby affirm that I am licensed under provisions of Chapter 9 �.�SIZE C A NO OF ORES NO.OF FAMILIES �� SEWER MAP C (commencing with Section 7000)of Division 3 of the Business and 1. Professions Code and m li ense is in full force aa d f NEW BK PG Lia Class P /effect. DEMIPTION OF WORK ADD ❑ VALUATION License Num r I Cont o �w ,.�,L 4 W OF r Date �'-/7^9z 6 000 00 ALTER �❑ +V tx"7Q/ z`a Ai REPAIR 11 -i•.:1_ ❑ I am exempt under Sec. � $ � L ' •I �;�3�•T., B.BP.C.for this reason —1—V 43!A6 i DEMOL ❑ 7.-,. _.. . _ Date. USE OF EXISTING BLDG. UR�W EI P/C# icr {_' Signature APPLICANT(PRINT) TEL NO. LDMA Perm 8 ❑ I, as owner of theproperty, or m e Z ' s } w c__ Y ogees with wages as O • i!I.- `' 'fl' their sole compensation,will do theork and the structure is ADDRESS - ` •.w 7 not intended or offered for sale tion 7044, Business and FINAL DATE Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANTHANDLEA HAZARDOUS MATERIAL ® 1„( :� :? IR, OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q UU1.1_Ja•r S:I..; :I!f. ❑ I, as owner of the property m exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDe? FINAL BY ^X _ 5R,?, y r,•: licensed contractors to c struct the project.(Section 7044, YES❑ NO❑ }-'1)`L "'�5.9'e” R, '25,' Business and Professio ode.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING L.l"i („,, d..l•-:, , OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONST CTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST '`4''j-.,' FOR GUIDELINES. :I"li`i:` :'�. I hereby affirm at there Is a construction lending agency for YES❑ NO❑ the performa Of the Work for which this permit Is Issued(See. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097.CIV• PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ; '}IR4A�,:din j 'j!''; COUNTY CODE,TITLE 2.CHAPTER 220 SECTION3220.100THROUGH 21Q74000NCERNING -_'.1=• `'-^'• '�'= Lender ame HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. i.j �' #.r Len rs Address f_I__ _ 13 ,0 MWERORAGOU o' I rtify that I have read this application and state that the above ' formation Is correct. I agree to comply with all County PC.FEE PERMIT FEE ordinan and State laws relating to building construction,and A5 06" here author�ize re ente 1 I!e oft is County to enter upon ISSUANCE FEE the ove-menflon property for i pection pu ossa. e 7 le /7� �_ INVESTIGATION FEE TOTAL FEE & .dPvpkW.Aq.1 GaOe O SEE REVERSE FOR EXPLANATORY LANGUAGE, PLI ATIO AOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS�j d� BUILDDRESSa ,J/ j�1jd I hereby affirm that I have a certificate of consent to self insure, ss or a certificate of Workers'Compensation Insure ce, a Milled ipvSC� ZIP copy thereof f(Sec.3800,rL�ib�.CCI)f /� Policy No.v"7� G� :; '`Compan Ie LOCALITY T'T IZE OF L T NO.OF BLDGS.NOW ON LOT ❑ rtified copy ie hereby furnished. NEAREST CROSS ST. Certified Copy is filewithen u Ing Inspect I TRACT BLOCK LOT NO. depart USE ZONE MAP NO. Date &AppASSESSOR MAP BOOK RAGE PARCEL ` �� SPECIAL CONDITIONS CERTIFICATE OFROM WORKERS' TvEs No COMPSRANCE R ' TEL �• — WITHIN 1000 FT.ORSCHOOL? ADDRESS (This section need not be completed If the permit is for one hundred ( Pr 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 4-76RI Z- Is Issued, I shall not employ any person in any manner SO 8S t0 ARCHITE R ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL C IFI19N APT CONDO Date Applicant ADDRESS CLASS NO. L UNITS NOTICE,TO APPLICANT: If, after making this Certificate of " REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' OR " TEL NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith l FRONT comply with such provisions or this permit shall be deemed revoked. MR LIC.NO. Of S1 7,Lf'- SIDE et LICENSED CONTRACTORS DECLARATION C LIC.CLASS PL C I hereby affirm that I am licensed under provisions of Chapter 9 on, SEWER MAP C.2 (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES NO.OF FAMILIES C Professions Code,and my license is in full force and I I. , NEW ElBK PG DESCRIPTIOP4 OF Wp�K License Numb r 7qS + Lic.Class ADD ❑ VALUATION _� Contractor D to G ALTER ❑ $ CO) ❑ I am exemp u de Sec. 3 � REPAIR ❑ BARC.for this reason i ��/ DEMIOL ❑ LDMA P/C 8 Date: USE OF EXISTING BLDG. URM ❑ t•5'H Signature APPLICANT(PRINT) TEL NO. _ LDMA Perm p Z ❑ I,as owner of the property, or m employees with wa es as �' ��` � Y9 DD ESS O ..1 their sole compensation,will do the work and the structure is --- not intended or offered for sale (Section 7044, Business and FINAL DATE C ."�,•' _„• .�_, Professions Code.) i 3 Q J WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a ❑ I, as owner of the property, am exclusively contracting with THEAMOUVQUIREA FIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ Business and Professions Code.) WILL THE I USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING �_;_1 OCCUPANTPERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH - CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. .'•'.." 1 hereby affirm that there is a construction lending agency for YES❑ No -n j� _ — -I the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE 3CAQMD I A -e J'_-- 3097,CIV.C.). PERMITTI G CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 1. '•i„{f"I"•i! COUNTY OD TITLEZ CHAPTER 220 SECTIONS 2.20.100THROUGH 22MI40 CONCERNING I`• ^•- ^•'• 3 Lenders NameHAZAR ERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. a Lenders Address owN AeeNr •+ . o I cerQfy that I have read this applicat' n and state that the above 1 PCF - PERMIT FEE info atIon is correct. I agree to comply with all county �� ordi ances enNKO' lating to wilding construction,and ✓ c =1j' {• t a ¢. he y authives of is County to enter upon ISSUANCE FEE Y for in coonpu Dees.� INVESTIGATION FEE TOTAL FEE Sim IAMD—WAWw SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION •J hereby`affirm that I have certificate of consent to self APPLICATION FORBUILDING PERMIT' insure, or a certificate of Workers' Compensation Insurance, or a bertified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.JJBCompany BUILDING ❑ Certified copy is hereby furnished. FOR APPLI NT TO FILL,#N ADDRESS J ❑ Certified copy is filed with the county building inspec- gpDREss 5 L tion department. fir/ Date ! ` Applicant CITY ZIP LOCALITY NO. OF BLDGS. NEAREST -CERTIFICATE OF EXEMPTION F M WORKERS' SIZE OF LOT hoc j Jag 'ar'NOW ON LOT CROSS ST. COMPENSATION INSURANCE- I ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL• OWNER `+`/ NO. USE ZONE MAP I certify that in the performance'of the work for which this nom, 1 NO. permit is issued, I shall not employ any person in any manner ADDRESS G(Jo IL �� 9 SPECIII >_ CONDITIONS a so as to become subject to the Worker'Compensation s. O �]U ` , cITY zip' D v Date ? /?Applicant' ARCHITECT % 1 !$' DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate ENGINE NO. . CONST. ZONE Exemption,' you should become subject to the Workers' �V Compensation provisions of the Labor Code, you must forth- ADDRE �Q� 'dt � 3 a- with comply with such provisions•or•this permit shall be TEL• STATISTICAL CLASSIFICATION APT. CONDO. v7" deemed revoked. CONTRACTO NO. - Z LICENSED CONTRACTORS DECLARATION n/LIC. Q, CLASS NO. DWELL. UNITS : I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS � �lT.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 License Number 35 Lic. Class ` SQ. FT./ ! STORIES I FAMILOIEs CHECK _ _ _._'Y•F r_ r VALUATION D _ r•'_a:;;. a cs . Contractor Date ` �� v DESCRIPTION OF WORK NEW N •�' / 1 ADD ❑ ❑I am exempt under Sec. Y N L� pop- ALTER ALTER ❑' ....... BAP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ :;r� -- i i,'L ;, Signature APPLICANT TEL. FINAL �'+`' " OWNER-BUILDER DECLARATION (PRINT) NO. 1= ' = _ I hereby affirm that I am exempt from the ContractorDATE 's License ADDRESS O' ' 4 ACT.a Law for the following reason (Section 7031.5, Business and FINAL• Professions Code): PRESENT By 307 1045o6 El , or m I, as owner of the property, " BUILDING P P Y Y employees P Yees withADDRESS wages as their sole compensation,will do the-work and j�- 1 ITE ' the structure is not intended or offered for sale(Section LOCALITY "1 7044, Business and Professions Code.). MOVING ' TEL. 9 TnTAL 1045.64 ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. / .�4 with licensed contractors to construct the project (Sec- ADDRESS �j/ CHECK 11��F`} tion 7044,-Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CHANGE -.0111CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 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. �QL � 1 08/27/92 (Sec. 3097, Civ. C.). SIDE Lender's Name 5230 AM 8-55 LDMA Ref. # � P.C. Fee$ ✓ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee �Y 743 LDMA P/C# pop above information is correct. I agree,to comply with all County Investigation Fee ordinances d State laws relat g to building construction, Total Fee GJ• / LDMA_Perm. # and here uthorize represe Lives of this County to enter 3 uPo a ove-menti ed rty for ' rcti urposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE ; Signature of Applic nt or Agen Date �• 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 SL 0508 0403190011 PHONE: (626) 285-0488 EXT: LEGAL UMBER OF SIGNS: 5 BUILDING ADDRESS: ON FILE SIGN DESCRIPTION: 3 SETS OF ILLUMINATED WALL SIGNS 5819 ROSEMEAD BL TEMP CA 91780 ASSESSOR FO IO NEAREST CROSS STREET: LAS TUNAS 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C TENANT: E IST LD USE: ISS E O PROCESSED B : EXPIRES ON: EXIST OCC GRP: 03/22/04 VG 03/17/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FIN9L DATE FINAL BY: CODE: CALAC INVESTMENT - 4,500 L/ b s L( 3709 CONVOY ST. `T d SAN DIEGO, CA9211137 FEES PAID D SCRIPTION OF WORK 3 SETS ILLUMINATED CHANNEL LETTERS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SUCCESS SIGN PRINTING INC. (626) 444-8181- AA BLDG PERMIT ISSUANCE 27.75 AE STRONG MOTION OTHER 4500.00 VAL 0.95 SPECIAL CONDITIONS: D1 PLANCHECK W/O EN-HC 4500.00 VAL 112.71 D2 PERMIT W/0 EN-HC 4500.00 VAL 132.60 TOTAL FEES 274.01 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN PRINTING INC. (626) 444-8181- 2812 PECK RD LIC. NO LOCATION D SETBACKS EL MONTE CA 91731 739177C45 SOILS ENGINEER APPROVAL ARCHITECTOR ENGINEER: T L. 0: FOUNDATION/TRENCH FORMS LIC. NO: SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 00 NO. OF FAMILIES: DWELLING ITS: APT/CO D: STAT CLASS: NO 20 SCHOOL WITHIN HA7ARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508