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Home My Public Portal About5919 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO.OF SLOGS. BUILDING F/ SIZE OF LOT NOW ON LOT ADDRESS �V - TRACT BLOCK LOT NO LOCA LITY _ TEL. NEAREST OWNER NO. CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUPTYPE-- FIRE PROCESSED BY CITY ZIP ,,,r CONST-r 7 .Z„p,NE ARCHITECT OR TEL. __/ -1 1 1 ' - - ENGINEER NO. STATISTICAL CLASSIFICATION $EWER MAP ADDRESS CLASS NO.:'= DWELL,UNITS BK ,4 PG CONTRACTOR No. U$E ZONE MAP, ") LIC. NO. . _ YJ �l ADDRESS NO, -yam `-! SPECIAL CITY LIC. CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK FRONT PROP, LINE HIGHWAY WIDTH C SIZE STORIES FAMILIES ONE _ C 11 } C DESCRIPTION OF WORK NEW V ADD ❑ BLDG.SETBACK FROM (STREET) v SIDE PROP.LINE OF ALTER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING REPAIR❑ SId -E ROP;,!4 NE_ HIGHWAY WIDTH cC USE OF t = ` o EXISTING BLDG. OEMOL ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ H (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO E] 'n Q IN COASTAL PERMIT ZONE YES ❑ NO ❑ M� VALUATION$ 7'' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF PERMITTEE ADDRESS FINAL BY TEL DATE CITY NO. MAKE CHECKS PAYA13LL' TU: P.C. $ PMT.Q HARVEY T. BRANDT, COUNTY ENGINEER FEE FEE P / PLAN"CHECK VALIDATION CK. M O. CASH PERMIT VALIDATION CK. M.O. CASH J 76AG38A CE*803 5/74 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of,consent to Self APPLICATION FORBUILDING PERMIT ' Insure, or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800, Lob. C.) • ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company _ ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN go�REss 9� oS H�JG 75X,4> ❑ Certified copy is filed with the county building inspec- BUILDING �/ /1 ` ,tion department. ADDRESS' / �C��e_—_Ai7 - LOCALITY NEAREST Date Applicant f' CITY L C/ ZIP �/�� CROSS ST. /�? /j Iv - CERTIFICATE OF EXEMPTION FROM WORKERS" NO.OF BLDGS. ASSESSOR - COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT• MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP i0 hundred dollars ($100)or less.) TRACT BLOCK LOT NO. I NO. `T e TEL. r SPECIAL a OWNER E$ £ �.Cf� /�CYDtO. ✓/ CONDITIONS I certify that in the performance of the work for whi this O permit is issued, I shall not employ any p on in a m nner �/ DIS RICT -' GROUP TYPE FIRE PROCESSED BY V ADDRESS P�:if�lt:/9/ � CONST. ZONE so as to become subject to the Workers' en do aws. /J_ e �ji v� 7j �� ,� CITY �j/��+L� 0 ZIP II// p� Date Applica ARCHITECT OR �'/ TEL. �� STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, Ater making is Certif' ENGINEER NO. ,�' 4_ LU Exemption, you should become subject t e•Workers' CLASS NO. DWELL. UNITS Compensation-provisions of the Labor Code, ADDRESS SEWER MAP with comply with such'provisions or'this permit shall be deemed revoked. ,�y ' G TEL' sO VALIDATION CONTRACTOR L" I�• ice T` NO. BK PC'• LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9' ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full foFce and effect. CITY CLASS $ SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE L9 ISTORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW El $; ❑ p ADD ❑ licensed exempt from the licensing requirements as I am a G licensed architect or a registered professional engineer ALTER ❑ "►� �ir"`�� - acting in my professional capacity (Section 7051, REPAIR ❑ DATEL. Business.and Professions Code): USE OF FINAL r" EXISTING BLDG. DEMOL ❑ BY aj, 4� + Lic:or Reg:No. Date- APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and' ADDRESS _ Professions-Code): PRESENT El1,I, as owner of the property, or my employees with AQDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY -7044, Business and Professions Code). MOVING TEL. 2 8 2 5A ❑ I, as owner of the property, am ex.qlusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- )� 0 0 o e o 1 tion 7044, Business and Professions Code). ADDRESS REQUIRED' TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 2 0 0 43,00 � I hereby affirm that there is a construction lending agency for FRONT .� the performance of the work for which this permit is issued P.L. 0 0 0 43,0 0 F�( (Sec. 3097, Civ. C.): SIDE 0 2 0 1 '—8 2 P.L.. Lender's Name Lender's.Address P.C. Fee$ _ Permit Fee ��=-- �J I certify that I have read this application and state that the Issuance Fee ! = above information is correct. I agree to comply with all County Investigation-Fee yy ---_ord'inances and State laws relating to building construction, Total Fee r arid herebyauthoriz resentatives of this County to enter i upon'the ov -me i wed property for'inspection purposes. L —1 SEE-REVERSE FOR EXPLANATORY LANGUAGE Sign ure of Applic nt Dote COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0802200035 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST ITR: 5904 LT: 151 SQ. FT STORIES TYPE BUILDING ADDRESS: I ISTRUCTURE: 22 V-B 5919 A 917801853 BL CA ASSESSOR INFORMATION NUMBER: I TEMP C 91780 15384-017-023 I 1 THOMASNEARESTPAGGE:596 GRID: H3 LOCALITY: TEMPLE CITY, Cl (TET EXIST BLDG USE: RESID USE ZONE: R-2 ISSUED ON: PROCESSED BY: EXPIRES ON: 1 1EXIST OCC GRP: 102/20/08 SR 08/18/08 (OWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FIN CODE: IFINIDET, BELKIS (562) 986-9495- 6,190 _ _ 15919 ROSEMEAD BL TEMP 917801853 FEES PAID 6SCRIPT ON OF WORK [ I ITEAR OFF 20 SF WOOD SHAKE AND 2 SF TORCH DOWN INSTALL 7/16 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[OSB 30 YEAR COMP W/2 SF TORCH DOWN 22 SF TOTAL (APPLICANT: TEL. NO: IBARIOFF - 1AA BLDG PERMIT ISSUANCE 27.75 I 1 I IAC STRONG MOTION RESID 6190.00 VAL 0.62 1 [SPECIAL CONDITIONS:1D2 PERMIT W/O EN-HC 6190.00 VAL 166.20 1 I TOTAL FEES 194.57 [CONTRACTOR: TEL. NO: [ [APPROVALS DATE INSPECTOR SIGNATURE I [CAL COAST ROOFING (714) 827-5371- [ [ 18341 VALLEY VIEW STREET LIC. NO [LOCATION AND SETBACKS I [ I [BUENA PARK CA 90620 828394 C39 I I- I 1 I [SOILS ENGINEER APPROVAL I [ I [ 1ARCHITECT OR ENGINEER: TEL. NO: - 1 [FOUNDATION/TRENCH FORMS [ [ I 1 LIC. NO: 1 (SLAB/UNDER FLOOR I I I 1 1 RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ I I (UNDERFLOOR INSULATION 1150H265 3 O1[ I I I IFLOOR SHEATHING [ [ I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: [ I NO 21 [ IROOF SHEATHING I I [ I I [ SCHOOL WITHIN HAZARDOUS 1 1SHEAR PANELS 1 [ I AIR QUALITY: 1000 FEET MATERIALS INO NO NO 1 IFRAME INSPECTION [REQUIRED TOTAL SETBACK FROM EXIST [ 1FIRE SPRINKLER HANGERS [ I I ISET BACK YARD: HWY: PROP LINE: WIDTH: IFRONT PL- I (INSULATION/WEATHER STRIP[ I I I SIDE PL- 1 1 [INTERIOR LATH/DRYWALL [ I I 1 I [EXTERIOR LATH [ I 1 I I I 1RATED FLOOR/CEIL AS3EM. I I I 1 1 I IRATED WALL ASSEMBLIES I 1 I I 1 IRATED SHAFTS/OPENINGS I 1 1 1T-BAR CEILINGS 1 I I 1 1 1LOT DRAINAGE 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I [ I I I I I I I