HomeMy Public PortalAbout5829 ROSEMEAD BLVD_Building__ •0 JO ' 1
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have certificate of consent to self
; ® P P L I CAT I® FORWILDING PERMIT'
+ n �re, or a certificate of Workers'
kers' Compensation Insurance,, �® ,
or.a tit , c there (Sec. 3800, L . C:) BUILDING AND SAFETY
�� ���,;� , ��' COUNTY OF LOS ANGELES
• Poltcy o. Company BUILDING
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS r7pZ� ,t�x
Certified copy is filed wiEco' uildin Inspec- BUILDING
tion epartme t. ADDRESS
Date Applican CITY /ems �j ✓` ZIP LOCALITY
NO. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FRO 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 3 rla BLOCK LOT NO. /tJ� MAP BOOK PAGE I PARCEL
hundred dollars ($100)or less.) TEL.
OWNER � + NO.C'79 USE ZONE IMAP
I certify that in the performance of the work for which this h SPE }
40 o
permit is issued, I shall not employ-any person in any manner ADDRESS .44%ri SPECIAL CONDITIONS a so as to become subject to.the Workers'Compensation Laws. O
(� i V
CIN d,. ,1' /q ( /c/p e3 zI
Date Applicant ARCHITECT OR TEL. ?� DISTRICT GR P TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of t,ENGINEER ' NO. inti CONST. LF E
Exemption, you should -become subject to the WorkersSy/
Compensation provisions of the Labor Code, you must forth- ADDRESS 1"A f i�p G
with comply with such provisions or this permit shall be ^ TEL. STATISTICAL CLASSIFICATION PT. CONDO. Z
deemed revoked.- NTRACTOR J . —
LICENSED CONTRACTORS DECLARATION - n/� Ya LIC, CLASS NO. L. NITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDR .L / &C� UCS NO ' � SEWER MAP
(commencing with Section 7000)of Division 3 of the Business "CITY ^ /� —(' CLC
ASS ,
and Professions-Code,and�ny license is in full force and effect. BK, PG VALIDATION
/ SQ. FT. NO. OF O.OF �. CHECK
License Numbe r -Lic..CltissA& SIZE QQ STORIES FAMILIES ONE
n _ V VALUATION
Contractor
f Date J DESCRIPTION OF WORK / NEW $
ADD ❑
❑I am exempt under Sec.
LTER ❑
BAP.C. for this reason r .�� /� EPAIR ❑ $
Date: USE F DEMOL ❑
.. EXISTING BLDG. � �i
Signature
APPLICAN TEL, r
' r (PRINT 0 �' NO. FINAL
OWNER-BUILDER DECLARATION DATE
I hereby affirm that I am exempt from the Contractor's License1
Law for the following reason (Section 7031.5, Business avid ADDRESS/M/ Z 6,n FINAL /� r
Professions Code):. PRESENT BY C'I +s
BUILDINGL, ~-
❑ I, as owner of the property, or my employees with :ADDRESS
® y6� j3lsf �. t,1
wages as their sole compensation,will do the work and /
the structure is not intended or offered for sale(Section LOCALITY � �� s TES-
7044, Business and Professions Code.) r MOVING TEL. �jf I•tt ti` _
CONTRACTOR NO. �` ��«� •t•-t;•, +'�
❑ I,as owner of the property,am exclusively contracting � ,011.AL fir• 1IS� 0�..-I
with licensed contractors to construct the project (Sec- ADDRESS +d 1 BD
tion 7044, Business-and Professions Code.) LASH �-'1•-*
REQUIRED TOTAL SETBACK TROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH s_;i-{ANGE
1 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. [i l[ij 1—i)(il j s%.� %`r.L
Lender's Name �i
P.C. Fee$ Permit Fee �� Ref. # 5.1 5 1 }"h L a 139
Lender's Address / q•� "'
I certify that I have read this application and state that the Issuance Fee a i LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
ordin ces and State I s relating to building construction, Total Fee B� I LDMA Perm. #
and. e by author' r resen es of this County to enter
up'n the bove-caned or insp ctio "u—po
�
-SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatur of Applicant or Agent Date . .
APPLICATION FOR BUILDING PERMIT �
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOU PPLICANT TO FILL IN F
Jhereby affirm that I have a certificate of consent to self insure, BUILDINGADDR ! ��
or a certificate of Workers'Compensation Insurance,or a certified
copy i e eqf Sec.38 C O ZIP
�7 LOCALITY
Policy No. mpany �� SIZE OF LOT NO.OF BLDGS.NOW ON LOT
rtified copy is hereby furnished.
NEAREST CROSS ST
Certified copy is filed with the coup bulldln Inspection TRACT BLOCK LOT NO. USE ZONE MAP NO.
partment.
Date Applicant LW ASS MAP BOOK PAGE PARCEL SPECIAL CONDITIONS
CAP
OW(ECERTIFICATE OF EXEMPTION OM WORKERS' TEL NO. WITHIN 7000 FT OF SCHOOL? YES NO
COMPENSATION INSURANCE ADDRESS
(This section need not be Completed if the permit is for one hundred 19,0 1 DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
dollars($ or less.) CITY ZIP 1 �.
I certify that
in the performance of the work for which this permit Ql.,S q
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO.
J-;—
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFI I APT CONDO
Date-Applicant ADDRESS CLASS NO. S .
NOTICE TO APPLICANT. If, after making this Certificate ofREQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CO OR TEL.NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith EFRONT
comply with such provisions or this permit shall be deemed revoked. AD s C
LIC.N/�
LICENSED CONTRACTORS DECLARATION IC � E
C.7
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 O. •SIZE NO.OF STORES I NO.OF FAMILIES
Professions Code nd� licen�is in full force an t. NEW ❑ BK PG
12
DESCRI N OF WO ADD ❑
License Number Lie.Class v ® �� VALUATION _
011.
Contractor Date ALTER ❑ $ A
• rrs p _
❑ �•s•I°v
13 ° REPAIR _
I am exempt under Sec. ® U DEMOL ❑ ti L i a`!"I",'`
B.BP.C.for this reason _ LDMA PIC N h
Date: USE O XISTING BLDG. URMAL
❑
Signature APPLICANT(PRINT) TEL NO. LDMA perm q
❑ I,as owner of the property, or my employees with wages as p 33'17
their sole compensation,will do the work and the structure is ADDRESS _
not intended or offered for sale (Section 7044, Business and FINAL ATE
ProfeSSlOrIS Code.) WILLTHEAPPLICANTOR FUTUREBUILDING OOCUPANTHANDLEAHAZARDOUSMATEI U L S •'/ J TOTAL A*.) 3 '° 9
❑ I, a9 owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a I IJ I• = =c +
Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project (Section 7044, / %G `.�LE�(_'i =�1°�i
Business and Professions Code. vis❑ No
WILL THE INTENDED USE OF THEBUILDING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH
CONSTRUCTION LENDING AGENCY FORT IR QUALITY
MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST
INES
I hereby affirm that there is a construction lending agency for YES❑ NO Y :
the performance of the work for which this permit is issued(Sec. 7 j 2
I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD r•
3097,CIV.C.). PERMITTING CHECKLIST.I UNDERST ND MY REQUIREMENTS UNDER THE LOS ANGELES 5183 1
COU DE.TITTIST A' ECTIONS 220AWTHROUGH220.14000NCERNING .L AhI11:2i-
Lender's
Name HAZA M TFAIALSR AND PO WINING A PERMIT FROM THE SCAOMD.
Lender's Address OMEAonAGENT
0 1 certify that I have read this application and state that the above PC,FEE A •® PERMIT FEE J�
information is correct. I agree to comply with all County C'sS+ /
ordinances and State laws relating to building construction,and
7-3
hereby authorize representatives of this County to enter upon ISSUANCE FEE
the 9BBUkmentionq1yoperty IF i action pur iose
INVESTIGATION FEE TOTAL FEE
n
a�omm •
Ge-M— r—O r SEE REVERSE FOR EXPLANATORY LANGUAGE
I
WO COMPENSATION.DECLARATION
Ieereby a#f it I have a certificate of consent to self A P P L I CwT ION FOR BUILDING PERM
insure, ora cern Icate of Workers' Compensation Insurance,
or a certified copy thereofJ�Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy NQ.3902 227rrmpany "J1)/1SXlAL
❑ Certified co is hereby furnished. ��� �l�/ BUILDING ypy
copy y FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the'county building inspec- BUILDING11 /�,�
tion department. _ ADDRESS�l ,�m �1S LVJ,51('f�
Date Applicant CITY ALM L •C ZIP. LOCALITY G-C�
NO.OF BLDGS. NEAREST 107
CERTIFICATE OF EXEMPT6& FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCE' ASSESSOR �09 7 PAGE f a/(,;a
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PARCEL d-
hundred dollars ($100)or less.) TEL. D
OWNER bank, ! I2ISN, NO. V'r6 o USE MA v1`D v?�ra
1 certify that in the performance.of the work for which this SPECIAL
//��
permit is issued, I shall not employ any person in any manner ADDRESS,20 fry QN� rl UG• CONDITIONS d
so- s to become subject to the Workers'Compensation Laws. Q
CITY S ZIP //Q3
Date Applicant ARCHITECT OR TEL•;�?C DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER �� 1 U6 NO. �/ CONST. ZONE' FO
Co'Exmpensation.
you should become subject to
the Workers' J i' 9saa� � '/ 1J
Com ensation• rovisions of the Labor Code, ou must forth- ADDRESS . 06 MA 6 �/ W
with comply with such provisions -or this permit shall be -1� TEL. STATISTICAL CLASSIFICATION APT. JCONDO. N
deemed revoked. 'CONTRACTOR - 0 NO. - - • ,y -" Z
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. a DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS fJ 0 NO (7
��L� / ,t y LIC. n 4#f r SEWER MAP
(commencing with Section 7000)of Division 3 of the Business ° CITY C rrTOP CIA 95�a CLASS 1��
and Professions Code,and my license is in full force and effect. BK PG. VALIDATION
n��y��� eel/ C/$` /0 SQ. FT,
NO.OF NO.OF CHECK
License NumbeLic. Class ' SIZE STORIES FAMILIES
r.[- ONE
/ VALUATION
ftA Contractor ' I-11 Date /� /d DESCRIPTION OF WORK m 5h NEW ; ,e•�DOD• 0-0
7 •,f S - ADD ❑ J'
❑I am empt under Sec. 1 R!
ALTER ❑
pop
B.BP.C. for this reason I REPAIR ❑ $•
Date: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL. FINAL -
OWNER-BUILDER DECLARATION si (PRINT) SM I T NO. _ a
I hereby affirm that I am exempt from the Contractor's License DATE '
Law for the following reason (Section 7031.5, Business and ADDRESS 0 FINAL
Professions Code): PRESENT By
❑ 1, as owner of We property, or m employees with BUILDING -
P P Y• YADDRESS '
� :• a%•
wages as their sole compensation,will do the work and '� �1'•:'•-:�ODd'
i 1!= .=
the structure is not intended or offered for sale(Section ' LOCALITY
7044, Business and Professions Code.) MOVING TEL. _ �•+ ���/ {��r
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. V ' _ .1
with licensed contractors to construct the project (Sec- /��v •7 _
tion 7044;Business and Professions Code.) ADDRESS yv TOTAL 0s
REQUIRED TOTAL SETBACK FROM • EXIST. /�/• C, �
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CHECK 11,15.0:•~,
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit.is'issued P.L. %H NGE
(Sec. 3097, Civ. C.). SIDE.
' P.L.-
Lender's
.L.Lender's Name a{ LDMA Ref. # { ljljl sljl�i 61 Lf,',
P:C. Fee$ Permit Fee r �✓
Lender's Address 72,10 9 1 RM 8o
i 1 certify that I have read this application and state that the Issuance Fee LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
and hereby authorize representatives of this County to enter
upon t bove-me property for inspection puell
rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
ature of Applicant or Agent Date
WC COMPENSATION DECLARATION
I have a certificate of coent to self
insure, oroff a certiti atte of Workers' Compen at on insurance, i A P P L I C -TION F®R BUILDING P E RM I Ir
or a certifii//edpp/ccop�y��thereof
-(Sec. 38Lob. C.)� COUNTY'OF LOS ANGELES BUILDING AND SAFETY
P Iii N�o!"s�J_LL ompanyBUILDIN
L� Certified co is here6 furnished. i FOR APPLICANT TO FILL IN ADDRESS
copy y• ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING 6-0 2-�. f 20 L,
tion de artment. ADDRESS p i
ll UPI zip -( 1 �� LOCALITY
Date � � 0. Applicant CITY��
O. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTIO F M WORKERS' SIZE OF LOT 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' USE ZONE MAP
OWNER 0- NO. NO.
I certify that in the performance of the work for which this
SPECIAL
permit is issued, I shall not.employ any person in any manner ADDRESS CONDITIONS a
so as to become subject to the Workers'Compensation'Laws. O
CITY ZIP 7 8O U
Date AOd
pplicant ARCHITECT'OR TEL. DISTRICT GROUP. TYPE' FIRE PROCESSED BY 0
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. Z E O
Exemption, you should become• subject to the,Workers' � U
LU
Compensation provisions of the Labor Code, you.must forth- , ADDRESS CJ'P a_
with comply with such provisions or this permit shall be i ' TEL. [ STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR PVL^ NO. `J '� F1f�T} —
LICENSED CONTRACTORS DECLARATION, p LIC. n CLASS L. UNITS
I hereby affirm that I am licensed under.provisions of Chapter 9 ADDRESS f"'���' �I�O,'A` l�yZd�' NO. 1"Ifel7 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business CITY �W(V`�^�lX- q� L o(a CLASS srI �l �*
LIC
and Professions Code,and my license is in full force and elle t. BK, PG. VALIDATION
SQ: FT. NO. OF 99 NO. OF CHE
License Number- Lic. Class%/ SIZE STORIES A FAMILIES ONE
��''11''� VALUATION .
Contractary '^� 3Bate DESCRIPTION OF WORK NEW i
a D ❑ $ 3, SvO
❑I am exempt under Sec.
ALTER' ❑
B.&P.C. for this reason REPAIR ❑ $
USE OF
Date: EXISTING BLDG. r. DEMOL
Signature ❑
Si APPLICANT *i TEL.
g OWNER-BUILDER DECLARATION (PRINT) (j NO. FINAL
I herebyaffirm that I am exempt from the Contractor's License ..nn ,,,�P DATE i
1.
Law fothe following reason(Section'7031.5, Business'and ADDRESS P'0. levy Z a ���I"'sY -7v FINAL n IAM
s.i
Professions Code): PRESENT BY ✓ ;-^ a _
-tC•�'o a
:'BUILDING -�^�
El 1, as owner of the property, or my employees with ADDRESS I 330 f
wages as their solecompensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY 1
7044, Business and Professions Code.) MOVING TEL. ® r.+ sag
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ;j 7 Q
ADDRESS i �,
tion 7044, Business and Professions Code.) _
REQUIRED TOTAL SETBACK FROM � EXIST. I "3 TT j'{`='
CONSTRUCTION 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. Itr'��- ®3,63
-'�"''
(Sec. 3097, Civ. C.). SIDE r•Ir i z� � ;
P.L. ;. t.rt i�r e3y.
NAME
I"tll
Lender's Name—. QQ p LDMA Ref. # t`t r
P.C. Fee$ i D Permit Fee OD•�O
Lender's Address
I certify that I have read this application and state that the Issuance Fee d� I LDMA P/C# ►
above information is correct. I agree to comply with all County Investigation Fee
r
ordinances and Stare laws relating to building construction, Total Fee LDMA Perm. # 6041 1 AMID-20
= and hereby authorize representatives of this County to enter
upon the above- entioned property for inspection ur oses.
o ��' SEE REVERSE FOR EXPLANATORY LANGUAGE
clgnature of App icon r Agent Date
WOI COMPENSATION DECLARATION hereby a t I have certificate of consent self ® ®®L�Com,`T I®N FOR B l I L®I N� PER L■ ,
in" certificate or a certificate of Workers' Compensation Insurance, �'\®
or a cerfilied copy thereof Sec. 3800, Lab. C.)1
cfGS d ��kSlrea� COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Company
ElCertified copy is hereby furnished. `� Pt.1�� y FOR APPLICANT TO FILL IN ADDRIESS
❑ Certified copy is filed with the c unty buil in pe BUILDINGa
tion department. ADDRESS ee-,4x-.T Se-n at
Date Applica ;',CITY /P l!�r -ZIP LOCALITY
NO. OF BLDGS. NEAREST
CERTIFICATE OF EXE PTION FirOM 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. y.MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) ` TEL. p i'
OWNER �fT fit[' NO.��S-SrJO`��I USE ZONE NO? -5-e Gr J
I certify that in'the performance of the work for which this
permit is issued, I shall not employ any person.in any manner ADDRESS r0 Ni /Cq mc�ti� 11/2 �/ SPECIAL a
so as to become subject to the Workers'Compensation.Laws. �. CONDITIONS O
CITY �4 S �4-0— ZIP ) O 3 V
Date Applicant ARGHFTf=O /` 1 TEL DISTRICT GROUP TYPE FIRE_ PROCESSED BY
NOTICE TO APPLICANT: If„ after making this Certificate of " ENGINEER It7�. (�Lr$�t �O NO. Z ONST ZOO( O
Exemption, you should become subject to the Workers'• �[ �y y,-`
Compensation provisions of the Labor Code, you must forth- ADDRESS vb T 0�tJ/ �M ✓� ..p t _
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATI t CONDO. N
deemed revoked. CONTRACT /1tG�^ yQ� f hS J-�1�.N0. -ZCj L -;I) ,, ,7�-•
LIC. CLASS NO. � DWELL UNITS `F ' ; °'
LICENSED CONTRACTORS DECLARATION ADDRESS' `�r b NO.'Z`-I 97S�'
I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business s CITY J ��� ���-d� CLAS -g
and Professions Code,and my lice a is in full force and effect. 1 BK PG I'-i I i�ALIDAF10111 m9-4
V511
r SQ. FT. NO. OF NO. OF CHECK n . .r
License NumberNM7 ic. Class all V51/ SIZE STORIES FAMILIES ONE tn�t�} _' .0°'=
r �- 1 // VALUATION
Contractor DESCRIPTION OF WORK_�7t5kll (� n om:! NEW $ � 11 �► °;!l'
ElI am exempt under Sec. `•.I si it s i ADD LJ
j ALTER ElQ a P(J [I(�t�) -(.. .1 5/r�� �
B.BP.C. for this reason REPAIR ❑ � $• •y �: ,,_
? USE OF l)iJ� 1 All L°48
Date: ; EXISTING BLDG. < EMOL ❑ 1, y
( t.
Signature 4 APPLICANT' • TEL. G c FINAL -,- °Ir r n -s-
(PRINT)G e_//eo-7 NO. 9 1-Z1Z� �r a:•
OWNER-BUILDER DECLARATION . . • DATE �:'1.{� �=• °+='••'
I hereby affirm that I am exempt from the Contractor's License �J D S�Gk fmG � i `
Law for the following reason (Sectiori 7031.5, Business and ADDRESS' FINAL /� .I,I_t t•_
Professions Code): PRESENT y B G, r �L - —.-,:
❑ I as owner of the ro art or m employees with BUILDING y `�, 1 I ITA "129 _,3�'
r P P Yr Y "ADDRESS
wages as their sole compensation,will do the work andturf={s # y:L:
the structure is not intended•or offered for sale(Section LOCALITY
7044, Business and Professions Code.) MOVING TEL. ® {:!-MANGE °DO
El1, as owner of the property,am exclusively contracting a.CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code.) ILIIII_i_( 1)il i
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH -,-
I hereby affirm that there is a construction lending agency for FRONT r. 7�01 1 AM u a!.7:
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE.,
P.L.
Lender's Name /// +�� LDMA Ref. #
Lender's Address P.C. Fee$ "191 Permit Fee
� I certify that I have read this application and state that the Issuance Fee l�' �� LDMA P/C# '
Poo
3 above information is correct. I agree to comply with all County Investigation Fee /�
ordinances and State laws r ating to building construction, Total Fee LDMA Perm. #
and hereby out rize re reMntthis County to enter
3 upon thea m lone inspection rpos s.
�J SEE REVERSE FOR EXPLANATORY LANGUAGE
10
Sig turaApplicant or Agent Dat
'• f
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 UILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS NEW COMMERCIAL
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA ''z8. _m08 9804140 2
PHONE: (818) 285-0488 EXT:
LEGALF CONST NEW
TR: 3623 LT: 105 SQ. FT STORIES TYPE OCCUP GROUP r 5829 ROSEMEAD BL j
STRUCTURE: 0 1 VN B ti.TF11t'CA-Aa78Q71
AS55SSOR INFORMATION NUMBER* NEAREST CROSS STREET:
5387-012-018 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
TENANT: E ST BL SE: USE ZONE: C-3 ISSUED ON: PROCESSED B : EXPIRES ON:
EXIST OCC GRP: 04/14/98 UT 04/14/99
OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL Y: CODE:
RUSSI, JOSEPH 000 - 1 1,000 _&�^S��
5829 ROSEMEAD
2r-
TEMPLE CITY, CA FEES PAID M SCR SPT •ON-Of WORK
FIRS UPPRESSIDN-SY-9T•EM-FOR-FAST-E0O0 DRIVE-IN RESTAURANT 1
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT-
APPLICANT: EL.
V - FIRE SYSTEMS (909) 398-1591- AA BLDG PERMIT ISSUANCE 27.75
P.O. BOX 3008 AE STRONG MOTION QT--HER--1000.00 VAL 0.50 SPECIAL CONDITIONS:
MONTCLAIR, CA 91763 D1 PLANCHECK .W/O`EN-HC_- 1000rOO VAL 82.11
D2 PERMIT W/O-Elf-HMG EL-�� 1OOO,:.00:'VAL 65.25
�C �= TOTAL"•FEES,-< 175.61
CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE
Z. ah
V-FIRE SYSTEMS (909) 398-1592- / w „� �'
P 0 BOX 3008 LIC. NO e7�/ +� •,' LOCATION D SETBACKS
MONTICLAIR CA 91763 722508 C16
�;.
y.� / ,,i` , '- _.•., ,,j.�-��•,t � �.;, SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: L. N0:
'Y�- *`' ;',!IFOUNDATION/TRENCH FORMS
�� / � r-, � T "!
LIC. N0: `r = -"; , f ' �' ! SLAB/UNDER FLOOR
--
RAISED FLOOR FRAMING
MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
15OH265 E 59 3 04 -
FLOOR SHEATHING
0. OF FAMILIES' G UNITS: P COND: STAT CLASS:
NO 19 ROOF SHEATHING
00 -HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWAL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL SSEMBLI S
S A E GS
-BAR CEIL GS
DRAINAGELOT
REPORT ID: DPR261 ROUTE TO: BSO5O8
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 r—BVn PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNASSIGN
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA �Z_&__L5D&M03 0036
PHONE: (818) 285-0488 EXT:
LEGAL ID: NUMBER OF G S: 3 RFSSe-
TR: 3623 LT: 105 SIGN DESCRIPTION: 2 WALL SIGNS AND 1 MOUNUMENT SIGN 5829 ROSeMEAb BL
ASSESSOR B NEAREST CROSS S,I'�t4321
EET:
5387-012-018 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
TENANT: E I T BLDG S ISSUED 0 PROCESSED XP R S O :
PEPE'S RESTAURANT EXIST OCC GRP: 03/12/98 UT 03/1 /99
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINALB CODE:
RUSSI, JOSEPH;MARIA 000 - 6,000 S
5829 ROSEMEAD BLVD.
TEMPLE CITY, CA FEES PID D1 OR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT 3 NEW SIGNS FOR REST AURA T__
APPLICANT: TEL. NO:
COAST SIGN, INC. (714) 529-9144- AA BLDG PERMIT ISSUANCE 27.75
1345 S. ALLEC AC STRONG MOTION RESID 6000.00 VAL 0.60 SPECIAL CONDITIONS:
ANAHEIM, CA AX BUILDING REVIEW FEE 54.70
D2 PERMIT W/O EN-HC 6000.00 VAL 150.00
TOTAL-FEES 233.05
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
COAST SIGN INC. (714) 520-9144-
1345 S.ALLEC ST. LIC. NO LOCATION D SETBACKS
ANAHEIM, CA 654238C45
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. NO: SUPPORT STRUCTURE
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
00
N0. 0 I ES: DWELLING UNITS: A CO D: STAT CL 5S:
NO 20
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
REPORT ID: DPR261 ROUTE TO: BS05O8
COUNTY OF LOPP�GELEiS TEMPLE CITY # 0508 BUILDING PERMIT
s DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS J NEW COMMERCIAL
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9611130121
PHONE: (818) 285-0488 EXT:
LEGAL D: NO. OF CONST NEW BUILDING ADD S
TR: 3623 LT: 105 SQ. FT STORIES TYPE OCCUP GROUP 5829 ROSEMEAD BL
STRUCTURE: 2159 1 V B TEMP CA 917801832
ASSESSOR F MA 0 NEAREST CROSS STREET: HERMOSA
5387-012-018 THCAAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
TENANT: EX B DG USE: S 0 E: C-3 ISSUED ON: PROCESSED BY: EXPIRES 0 :
EXIST OCC GRP: 11/06/97] UT 11/06/98
OWNER: n I TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DA:EFINAL ODE:
1 216,000
3 ' 1ST
LaSA=990=406 F E PAID DDESCRIPT11TON OF OR
NEW RESTAURANT WITH DRIVE THRU -PEPE'S FINEST MEXICAN FOOD
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICA L. NO:
THE GUTIERREZ PARTNERSHIP (909) 598-1518- Al PLANCHECK W/EN-HC 216000.00 VAL 2,008.31
404 S. LEMON AVE. #7 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS:
WALNUT, CA AC STRONG MOTION RESID i;-•216000.00 VAL 21.60
A2 PERMIT W/ENERGY.•=HOS L' 216000-0,0 VAL 2,362.73
!09 If 19W_kulSid a' TOTAL�EES�� 4,420.39
CONTRACTOR: TEL. NO: �' '
v �:� APPROVALS DATE INSPECTOR SIGNATURE
INNOVATIVE DESIGN-9ffilfflW
ow
ICNO
Pp, y � L . �� 9 � '� LOCATION AND SETBACKS
(p��g� s% SOILS ENGINEER APPROVAL
q,-x`7.,2 Ole _ ` ,
ARCHITECT OR NGINEER: TEL. 0: r , ( l< FOUNDATI N,T EN S
THE GUTIERREZ PARTNERSHIP (714) 598-1518- Q�C:` , ODE
-`d ' 3 - ` -
404 LEMON AVE #7 LIC. NO: - SLABNNDER FLOGIV
WALNUT, CA 91789 C-15523 - - - -
i
P.1=0: FR I
MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNUWRFLOOf kps L ION
150H265 E 59 3 04
- - — - FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UN S: AP /COND: STAT CLASS:
NO 19 ROOF SHEATHING
SCHOOL I IN HAZARDOUS SHEAR PA-GELS �JpA
AIR QUALITY: 1000 FEET MATERIALS �• ` ! w G++
NO NO NO _ �' FRAME INSPECTION
FIRE SPRINK ER HANGERS
INSULATION/WEATHER STRIP 740-49
:i�I,'}• � d
INTERIOR LAT L 9
EXTERIOR LATH ?Np� �Q
�1L�1,1�.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT D A NAGF—
'REPORT ID: DPR261 ROUTE TO: BS0508 Z
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 _BUIL-DING-PERMIT .,
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS – ALTERATION/REPAID
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 1 r:--=BL-0508-9814120048
PHONE: (818) 285-0488 EXT:
-LEGAL D: NO. OF CONST B Il-D +;'ADDRESS:
TR: 3623 LT: 105 SQ. FT STORIES TYPE 829 ROSEMEAD_BLr
STRUCTURE: VN TEW–CA-.917801832
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA
5387-012-018 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
TENANT- IST B DG USE: CO ME USE ZONE: C-3 TSSUED ON: PROCESSED BY: EXPIRES ON:
PEPE'S FINEST MEXICAN FOOR EXIST OCC GRP: 11/12/98 UT 11/12/
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: ODE:
RUSSI FAMILY TRUST - 1 10,000
5829 ROSEMEAD BLVD.
TEMPLE CITY, CA —FEES PAID DESCRIPTION OF WOR
f FIRE DAMAGE-REPAIR TRUSS
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
PPLICANT: TEL. O:
INNOVATIVE DESIGNS (909) 920-4141- AA BLDG PERMIT ISSUANCE 27.75
P.O. BOX 4434 AE STRONG NOTION OTHER�1,0000.00 VAL 2.10 SPECIAL CONDITIONS:
RANCHO CUCAMONGA, CA D2 PERMIT W/0 EN=f1�—0000x00 VAL 216.60
%GEL��TA��F�EEs 246.45
IONTRAATIVETOR:
DESIGNS TEL. N428-1307- APPROVALS DATE INSPECTOR SIGNATURE
P.O. BOX 4434 LIC. NO LOCATION AND SETBACKS
RANCHO CUCAMONGA, CA 91729 716219 B
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: \ FO T O R CH TOM–
LIC.
O SLIC. NO: 1111111 SLAB/UNDER FLOOR
u
RAISED FLOOR FRAMING
150H265 SEWER MAP BOOK: PAGE: FIRE ZON3: CMPOl JD C, L 0 �n�Oo 10C �N I UNDERFLOOR INSULATIO
L00 SHEATHING
0. OF FAMILIES: DWELLING : A T/CON : STAT CLASS: `
NO 22 �/7� 0 � I1 � ROOF SHEATHING
.J ❑ 7 r�3•�•I�I
SCHOOL IT A R 0 Sa e' "i T'• / S AR'P NELS
AIR QUALITY: 1000 FEET MATERIALS El
CT
NO NO NO �J 5 FRAME INSPEION
REQUIRED -TOTAL SETBAC FROM IS �8�. uOFIREE SPRINKLER HA GERS
SET BACK YARD: HWY: PROP LINE: WIDTH: L'
FRONT PL-
�e rvic a ly'5EA
�vv INSULATION/WTHER STRIP
SIDE PL-
I R OR A /DR WALL
• I
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
OT DRAI AGE t�
REPORT ID: DPR261 ROUTE T0: BS0508