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HomeMy Public PortalAbout5825 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING PERMIT + II 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? e0A BUILDING ADDRESS 7 S1. or a certificate.of Workers' Compensation Insurance,or a certified S82S F05eVN copy thereof(Sec..3800,Lab.C.) CIT r ^, ZIP _ �� � (� LOCALITY Policy No.F.Lf/1�'q cl o 6 9? Company SIZE OF LUf NO.OF BLDGS.NOW ON LOT Certified copy'is'hereby furnished. NEAREST CROSS ST ❑ Certified Copy IS filed with the county building inspection TRACT BLOCK LOT NO. department. I "USES ZONE MAP NO. Date 7. • c -s+` Applicant 00"d, c LOr ASSESSOR MAP BOOK PAGE PARCEL l/.�� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' o PETEL NO. (� COMPENSATION INSURANCE 'L v 5Z.,e Q3 ITHIN.1000 FT.OF SCHOOL? YES NO ADDRESS (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST FIRE_ZONE PROCESSED BY dollars ($100)or less.) / `X«• i I certify,that in the performance of the work for which.this permit CIT t ZIPO� �� is issued,.I shall not empl10 oy any person in any manner so as to �aC!! r 'r HITE O GINEE L become subject to the Workers'Compensation Laws. 14 IT _ 7 STATISTICAL CLASSIFICATION i IRT CONDO 3_I6°,72 t iK55(y_ Date'��Applicant ��� ��tl ��� �7 CLASS NO. DWELL UNITS - I' rAD�DiR�S3S L I ��� j' i NOTICE TO APPLICANT. If; after making 1 this Certificate. of 'v, COn uA �Ce (J'�C ( "REQUIRED- TOTAL SE� �ROM _EXIST t�, Exemption, you should become subject to, the •Workers' NTRA TOR TEL NO'.I SET BACK YARD HWY PRS fin. Compensation provisions of the Labor Code, you must forthwith FRONT -�� n comply with such provisions or this permit shall be deemed revoked. ADDRESS 1�'•� po 1 LIC,NO. P L. *'HEi'�t �'-( •�+', LICENSED CONTRACTORS DECLARATION I SIDE CHANGE " �OQ,I,' TY ( LCLASS P L I hereby -affirm that I am licensed underprodisions of Chapter 9 S ` )SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SI NO.O STORIES , 0 F FAMILIES j, NEW.'. ❑ BK PG 0090-0110 7.3-1'241 a Professions Code,and m license is in full force an effect. A-;4 1 1 t License Number 1 Lic.Class DESCRIPTION OF WOR ADD EY EVALUATION , =� °,�C Contractor(cSmdlc' G_$2 - Date �'-3©'`� � ALTER � "$ u�4 i rf� Say,) D ❑ I am,exempt under Sec. REPAIR El 1$ BAP.C.for this reason DEMO,L ❑ A P/CLl Date: .Z ' USE OF EXISTING BLDG URM ❑ I' iia ._ D Signature Y employees g APPLICANT(PRINT) ' TEL NO. LDMA Perm#„ t=1L•t•i T ❑'I, as owner of the property, or m em to ees with wages as ZO 3307 276.68 I their sole compensation, will do the work and the structure is ADDRESS . lf��{'- S not intended or offered for sale (Section 7044, Business and IF DATE Q Professions Code.) - - - WILL THE APPLICANT OR FUTURE'BUILDING-OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as Owner of the .property, am'exclusively contracting with CR A MIXTURE AMOUNTS SPECIFIED CONTAINING THE HAZARDOUUS S S MATERIALS NTERIAL OFORMATOOR ION GUIDE? THAN THE I FINAL..BY I'� f i � a licensed contractors to construct the 'project (Section 7044, I CHECK 276.68 Business and Profession's Code.) :dXves❑ No❑ UIDLING BY THE APPLICANT OR FUTURE CCU ANTWILL THEINTENDED REQUIIRE A PERMIT FOR USE OF THE CONSTRUCTION OR MODIFICATION FROM THEUSOUTH I. CHANGE CONSTRUCTION LENDING AGENCY COAST AIR QUALTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR.. .. .. -. GUIDELINES. I hereby affirm.that there is a construction lending agency for YES❑ No❑' ".. 3/17/93 + -� -+, LN the performance of the work for which this permit is issued(Sec.' HE H I�I 10d-100131 3/1 f/93 3097,CIV.C. - IHECKLIS.AVE READ I UNDERSTAND NDERSTAZARNDMOUS MATERIALS INFORMATION GUIDE AND ANGELESHE COUNTMD CODE, .N- ) TITLE 2,CHAPTER 2.20 SECTIONS REQUIREMENTS 20E 00 THROUGH 2.20.1 40 CONCERNING HAZARDOUS 729 1 ASI j i 1V:CC Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. n 1 o Lender's Address OWNER OR AGENT f,1 - o I certify that I have read this application and state under penalty Oo of perjury that the above information is correct.I agree to comply P.C.FEE ,/ PERMIT FEE 766 C11 •with.all county ordinances and State laws relating to building •(p m construction, and hereby authorize representatives of this County ISSUANCE FEE J 1 I co ro to enter upon the above-mentioned property for inspection purposes. (rJ CID INVESTIGATION FEE TOTAL FEE Signature of Applicnnl at Agent Dcto 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 I TEMPLE CITY CA 91780 BL 0508 0208080072 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: I BUILDING ADDRESS: ON FILE SIGN DESCRIPTION: "MUTUAL ESCROW" IN BLUE CHANNEL LETTE 5825 ROSEMEAD SL TEMP CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5397-012-043 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON: I EXIST OCC GRP: 08/13/02 JK 02/09/03 OWNER: TEL. NO: BLDGS. NOW ON LOT.: VALUATION: FIN DATE FINAL BY: CODE: 3709C INVESTMENT - 1,700 SAN DIEGO, CA9211137 FEES PAID DESCRIPTION OF WORK SIGN FOR ESCROW COMPANY FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SIGN ART CO (626) 287-2512- AA BLDG PERMIT ISSUANCE 27.75 423 S CALIFORNIA ST AC STRONG MOTION RESID 1700.00 VAL 0.50 SPECIAL CONDITIONS: SAN GABRIEL AX BUILDING REVIEW-FEE=_--_--.= 54.70 D2 PERMIT W/O-.- N-HC==r - -----.1-700.00 VAL 82.20 TOTAL---FEES 165.15 CONTRACTOR: TEL. N0: A", r j�' "�yds`:`'., APPROVALS DATE INSPECTOR SIGNATURE SIGN ART CO. (626) 287-2512- 4Z3 S CALIFORNIA -• . LIC. NO • . , � ,�-� � ,�• LOCATION AND SETBACKS SAN GABRIEL CA 91776 491427 C45 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: �' _ \ ',','; FOUNDATION/TRENCH FORMS LIC. NO, SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP-:. 99 il r fOF Li L i NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS_NO SCHOOL WITHIN HAZARDOUS ' AIR QUAALITY: 10000 FEET MATEERIALSNO REPORT ID: DPR261 ROUTE TO: BS05O8