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Home My Public Portal About5916 ROSEMEAD BLVD_Building__ 76ABSBA CE0803 9-87 I .. b -ki ' A?PLICATI®N FOR BUILDING PERMIT lul COU7 T-Y-OF LOS ANGELES BUILDING DEPARTMMgT OF'COUNTY ENGINEER ADDRESS '57A� All &S44W.4&C1 BUILDING AND SAFETY DIVISION LOCALITY T— JOHN A. LAMBIE, COUNTY ENGINEER e COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. is FOR APPLICANT TO FILL IN DISTRICT NO. GROUP CTYPE ONST. SgEtl BY �n (Print ort a only) ��J 6� BUILDING ON ADDRESS `�—1 �' 0� �. STATISTICAL WELL.IUNITS SEWER PG LOT NO. �.J� BLOCK USE ZONE MAP 2d Q NO. TRACT �f �^ CONDITIONS SPECIAL NO OF SLOGS. i SIZE OF LOT C�S�. Q NOW ON LOT ` USE OF EXISTING BLDG. -� BLDG.SETBACK FROM ! _ TEL.C� FRONT PROP.LINE OF bs � —La.1 (STREET). OWNER I NO. pS 'may TYPE OF EXISTING SETBACK HIGHWAY •I• YARD = TOTAL / HIGHWAY WIDTH FROM C.L. ADDRESS f0 �N rda 6S' + /j = is— CITY i . BLDG.SETBACK FROM ARCHITECT TEL. �� SIDE PROP.LINE OF BEET) ENGINEER NO. TYPE OF EXISTING SETBACK AY + YARD = TOTAL ADDRESS HIGHWAY WIDTH F TEL. + = a CONTRACTOR O-ACrANO. C � ADDRESS NO. CORNER CUTOFF YES '❑ NO a o: CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS t DESCRIPTION OF WORK G _ C/ _ ,z NEW 4�_DJ ALTER REPAIR DEMOLISH SQ. FT. ) NO. OF ) NO. OF / r �C SIZE �10 Q STORIES ` FAMILIES USE STRUCTURE O SIGNATURE OF APPLICANT VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION EES FEE$ FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION ItISURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE °"= RECT AND POSTED 00 ADDRESSFINAL / JOHN F. LEWIS. PRINCIPAL ST1.511C.TURAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATIO CK M.O. CASH L'C07 5 8 dS NOV25 11 2,QpN V 78A888110E08088-e4 APPLICATION OR •BUILD. . G PERMIT ll COUNTY OF LOS ANGELES BUILDINGtA DEPARTMENT OF COUNTY ENGINEER ADDRESS _ Z/U, BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE-. COUNTY ENGINEER NEAREST COLEMAN W. JENKINSSUP'T.OF BUILDING CROSS ST. DISTRI T NO. GROUP TYPE. P OC SSED BY FPAPPLICANT T :FILL IN CONST: fLGG BUILDING STATISTICAL CLASSIFICATION BONER MAP ADDRESS; CLASS NO.�DWELL UNITS`' BK .v G LOT NO. BLOCK USE ZONE MAP,- 'y NO. TRACT SPECIAL I CONDITIONS N0..`OF SLOGS. SIZE OF LNOW ON LOT USE OF E 1 TING BLD':. SETBACK FROM ' FRONS PROP. LINE OF (STREEt) OWNNO / % TYPE OF EXISTING" SETBACK HIGHWAY + YARD = TOTAL ADDR 5 HIGHWAY WIDT. OM C.L.CIT oor + (P5 BLDG. SETBACK FROM ARCHITECTEL SIDE PROP. LINE OF (STREET) ENGINEER NO. _ TYPE OF EXISTING SETBACK HIGHWAY �• YARD — TOTAL' ADDRESS HIGHWAY. WIDTH FROM C.L. 4 TEL. + CON,7W ♦ NO ADDRE56 �7 �� No C CORNER CUTOFF YES O NO C CIT 42f CLASS C' `Lie 'SEE REVERSE•SIDE FOR SPECIAL APPROVALS u DESCRIPTION OF WORK v NEW .ADD ALTER REPAIR DEMOLISH , SQ.FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF �� ST U TORE" SIGN URE OF APPLICANTt/$7� VALUATION$ APPROVALS DATE 11fSP•ECTOR'SSIGNATURE FEE FEE$ FOUNDATION, LOCATION rf FORMS..MATERIA LS FRAME, FIRE STOPS, !+ V 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT DLOCATION / 1 1 ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY, Fi UOAS VENT. ATIO WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. I.CERTIFY THAT: IN DOING THE WORK I J AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-. LATH. INT. i f TION OF THE LABOR CO C OF THE STATE OF CALIFORNIA RELAT- INC TO WORKMEN'S CM?;.,T..-NI.SURANCE. LATH. EXT.SIGNATURE O HOUSE NUMBER COR- `�- PERMITTEE RECT.ANO POSTED l _ • -r• -ADDR SS/_-_f_:i<Z /1l�Q FI NALr� zit�✓ r7 JOHN F. LEWIS. PRINCIPAL STR -URAL ENGINEER -PLAN CHECK VALIDATION K. M.O'. CASH _ :1 PERMIT VALIDATION • CK.. M.D. CASH LA o.1!;5 6 3 MAY 1.2 1 D 6,Q Q^e Qla FOA888A CIE#803 I!;a57 APPLICATION ION FOR BUILDING PERMIT -�.. •COUNTY OF LOS ANGELES BUILDING / DEPMRTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DM- SION LOCALITY JOHN A.LA'MBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO, GROn,PE SEWER -MAP FOR APPLICANT TO FILL IN �' SK PG CONST. I BUILDING C L STATISTICAL ASSIFICATION ADDRESS' J9�U �• Rosemead; Temple City. J�� . LOT No. North 65 feet of LA 168 BLOCK CLASS.NO. DWELL.UNITS_SG— MAP o HWYE LYES , NO TRACT 5904 NUMBER E ZgNE SPECIAL NO OF BLDGS. / CONDITIONS SIZE of Lor' 65ft. .x 85 ft. NOW ON LOT 1 O USE OF HOMO , EXISTING BLDG. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER Richard J. Thompson FONT O i MAIL P.1 ADDRESS. 5916 N. Rosemead Blvd. , SIDE AT 7-4494' :L. CITY Temple City, Calif. NO.No. INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS _ .� ,•/•;4 lJ / ,�•�, TEL t '!1 'J!Y� �- /PPI 7/� /F:i,7-, CONTRACTOR NO. ADDRESS . = /' DESCRIPTION OF WORK. /::? �' :�:'//)N' "i /,. '/,,QPz—� NEW ADD ALTER REPAIR DEMOLISH SR.FT. NO.OF NO.,OF 6" /� �� ./7ir!!Ii i/ f.'U ,r• �� ft f1/t:: SIZE STORIES FAMILIES 1 USE OF STRUCTURE Extra Bedroom t Bath SIGNATURE O APPROVALS AYR. APPLICANT 1 DATE INSPECTOR'S SIGNATURE ADDRESS 5916 . 'Rose ad Bl .'� Temple City' FOUNDATION: LOCATIONf. v FORMS,MATERIALS / � 0 /T7 Y/./,lr��('{' OO11 ''ll L� P.C, $ FRAME: FIRE STOPS, _ �� /� j/ � • VQ V FEE yBRACING,BOLTS �/ VALUATION IO FEE $ !7L/ FURNACE: N.GAS VENT,DUCT8GDO 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT. PLICATION ANDAGREE TO COMP, ATE TH T T ABOVE IS CORRECT AND ND STATE LAi WITH ATII L UN N OR OI TRUCTION. LATH,EXT. • SIGNATURE OF HOUSE NUMBER COR- PERMITTE REdT AND POSTED ADDRESS N 'RosemQ B 'T C' FINAL Ir 'S Wd J. CLYDE N.DIRLAM, PRINCIPAL STRUCTURAL EN ER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. SH LAC0.54 1 8°°, OCT 1 1 A 12.00. �� APPLICATION FOR BUILDING IT COUNTY OF LOS ANGELES BUILDING AND AFETY ®. WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified � /& copy thereof(Sec.3800,Lab.C.) CITYfvo, (,!Z C/ ZIP LOCALITY Policy No. Company SIZE OF Lqr NO.OF BLDGS,NOW ON LOT ❑ Certified copy is hereby furnished. go � NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL ('p SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NER �— TEL NO. COMPENSATION INSURANCE Clf � �� /��I SO $S S d WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred TRESS / S-714 4/ OS�� ,�/'�� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) ' Y P P CIT�Y� r ZIP ! D� I certify that in the performance an of the work for which this s to 7!�L O D r 1 j L p_- _ J is issued, I shall not employ any person in an Manner so as to ARCHITECTOR ENGINEER TEL NO. J s.�L�� becomes bO to the Workers'Com aws. STATISTICAL CLASSIFICATION APT CONDO Date s 3 Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT' If, ter ma ing this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should be ome subject to the Workers' FADDREFS3 _ /�D' TEL N0.��/ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith a2 S/r (� I FRONT comply with such provisions or this permit shall be deemed revoked. LIC.NO. PL LICENSED CONTRACTORS DECLARATION /✓I2D S /¢(/�. f(p�3 SIDE CIT LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 �� l CL 23` SEWER MAP (commencing with Section 7000)of Division 3 of the Business and 90.FT.SIZE NO,OF STORIES NO,OF FAMILIES Professions Code,and y ice n a is in full force a�acleff t. NEW ❑ BK PG D. License Numbera Lic.CIBSS •-� _ DESCRIPTION OF WORK ADD ❑ VALUATION D0 Contractor GO—G�'��s Date S 3 A:LHCS pAMA�� 0,QOdY $ ,+ ALTER ❑ a��M f�OdfR5,4.1"� It1 b�L�2- a ❑ I am exempt under Sec. REPAIR $ C B.BP.C.for this reason /N r0o%AfdS' J�JC'IQ'P49 DEN OL ❑ LDMA P/C# LL USE OWX G BLDG. /� ° URM ❑ Q Signature APPLIC (PRl{PRI ) EL NO. LDMA Perm# i 2 k, ce•4✓5S %G :647/ z ACCT.AT ❑ I, as owner of property, or my employees with wages as Cl their sole com nation, will do the work and the structure is #.11]' not intended or offered for sale (Section 7044, Business and A S U A?it FINAL DATE f�j C `' Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAININ A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J El I, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED O E HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY f Q licensed contractors to construct the project (Section 7044, Gam// ACCT.g Business and Professions Code.) Yes❑ No �! t [ WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING 3t?.a03 �� 0 ru OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR S I i^ ITEMS Iv I hereby affirm that there is a construction lending agency for YES 11TOTAL 3 a ' the performance of the work for which this permit is issued(Sec. p1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING •- CHECK .�` ii,��s�i 3097,Civ.C.) CHECKLIST.I UNDER D M UIREMENTS UNDER THE LOS ANGELES COUNTY CODE, t �Lfl +t C4 TITLE 2,C .20 2.20.100 THR 2.20.140 CONCERNING HAZARDOUS �`' Lender's Name MATER R I OR OBTAINING A RMI FROM THE SCAQMD. .011 o Lender's Address owN Nr CHANGE' 0 o I certify that I have read this application and state under penalty P.C. E PERMIT FEE of perjury that the above information is correct.I agree to comply j� 01300-13i]1 6/15/93 N with all county ordinanc and State laws relating to building �/�+ of u 9 construction,and authorize sentatives of this County ISSUANCE FEE 0263 I AM pC0? 0 to ent po t -mentioned pro y for inspec'on pu oses. J ` m 6 /S� INVESTIGATION FEE TOTAL FEE Z V s9,,.m tlGu,l 1 e SEE REVERSE FOR EXPLANATORY LANGUAGE