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HomeMy Public PortalAbout6004 ROSEMEAD BLVD_Building__ �`�\ - Ds 76A638A' N�` nh �4 E N803(REV•11/78) v" iCUILD_ING, . ' r APPLICATION F . R PE ICK I`�s Ll—, L COUNTY OF LOS ANGELES BUILDING AND SAFETY // LDING FOR APPLICANT TO,FILL IN ^/19ASSESSOR ADIDRESS "DdX/.ADILDING"DRES4 �p a� !r( :.l�• LOCALITY - NEAREST CITYPZIP CROSSST.NO.OF BLDGS. SIZE OF LOT c J00 X NOW ON LOT MAP BOOK PAGE PARCEL TRACT 3/4BLOCK LOT NO.- DISTRICT GROUP TYPE , FIRE PR SSD BY _O� - CONST./ ZONE 13 DWNER pL1eLK'-/5j%&vKk NO STATISTICAL CLA�IC TION / SEWER MAP ADDRESS •/Z /2� y(��s . ` CLASS NO. DWELL.UNITS JL E BK�p PG CITY pC c C�J—� ZIPUCWUa 9 c ENGINEER O �! NO. �/�D[ VALUATION $ J n ADDRESS 3 Q. O 1 •L; O F xjo s / BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) CONTRACTOR/VO11yaa '.9,J', I(?. NO.!9121-, ag! TOTAL SETBACK FROM TYPE OF EXISTING . LIC HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH ADDRESS /'L7. s NO. Z _ `' gg a LIC. + t�'i v CITY CLASS CONSTRUCTION LENDE BLDG.SETBACK FROM NAME AND BRANCH L�• �, S; ` , SIDE PROP.LINE OF (STREET) p� HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS V7 OroA49 CITY SIDE PROP.LINE HIGHWAY WIDTH V SO.FT NO.OF NO.OF CHECK + _ SIZE J a STORIES Z FAMILIES 5 ONE USE ZONE MAP DESCRIPTION OF WORK {avl��d� CL '9NEW t�J NO. �J 1r-ro �.� A SPECIAL ADD ❑ fl CONDITIONS I s P 4C lSaAci ALTER DATEFINA '� _ r (yZ BY REPAIR USE LJ DEMOL NG BLDG. C APPLICANT TEL '7 l pro (PRINT) 1, NO. O BY(SIGNip_ I HEREDGE T I VE READ THIS APPLICATION A ATE // G Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES (p'�f�O W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V 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 COM- Z PENSATION INSURANCE.' J g ^ 0. SIGNAT E OF DERMITTEE ) ADDRESS Z �• Z TEL.-7 L y O CITY NO.. 40 G /�•3.3. 7s . I.C.Fee$ o b,��o Permit Fee y �, 0 70- -7 Issuance Fee �` `�" 4, P (rt�(p..ZO C Total Fee LAi �f r� c WORKERS'COMPENSATION DECLARATION j � � ��� ��I� G 9G PERMIT 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, PPHICATI or a certified coY3thereof(Sec. 3800,�b. C.) b-6 O COUNTY OF LOS ANGELES BUILDING AND SAFETY � / . Policy No. Company FYI 3 ;. BUILDING ❑ Certified copy is hereby furnished. /� x FOR APPLICANT TO FILL IN ADDRESS ,�W �• �. ❑ Certified copy is filed with the county building inspec- BUILDING' tion department. ADDRESS 0 l v G /b/. U/ 9 CITY �� ZIP LOCALITY / Date Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST •.CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one .TRACT BLOCK LOT NO. s MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) �•,�✓y o/'Tf i 1?V.TEL, co li'I i'. MAP OWNER • GwNCi7l /.rUG . N&. FCI USE ZONE 7 7 _} NO. 1-4—P lye �G'eS I certify that in the performance of the work for which this permit is issued, I shall not employ.any perEon in any manner SPECIAL ADDRESS f O o •NJCm F!� ,- .� CONDITIONS ,so as to become subject to the Worker'Compensation Laws. OO CITY lL_ /mac ZIP Date Applicant ARCHITECT ORTEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT:'.If, after making this Certificate of ENGINEER NO. Exemption, you should become. subject to the Workers' /n� `� CONST. NE W Compensation provisions of the Labor Code, you must forth- ADDRESS J!�i" 3 a . with comply with such provisions or this permit shall be TEL. '. N deemed revoked. CONTRACTOR v Lr,0 wo NO. 7.?.9 z r j-� STATISTICAL CLASSIFICATION APT. CONDO. Z LICENSED CONTRACTORS DECLARATION LIC: f ` CLASS NO.�DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS /' �r� ��`, NO. LIC. a SEWER MAP (commencing with Section 7000.)of Division 3 of the Business CLASS ,_ �� and Professions Code,and my license.is in full force and effect. CITY , •�Nh BK,-P7 PG r�/� VALIDATION L� / P, SQ. FT. NO. OF NO. OF CHECK License Number7 7rf`c-f�i�Lic. Class SIZE I STORIES FAMILIES ONE 8 �- VALUATION Date �i(� Q f';L DESCRIPTION OF WORK 'e y�-P� NEW Contractor/7�G✓O/l� a/rC:�' � ❑ ' $ (v J v 3 ADD [I❑I am exempt under Sec. / /A6JA� I ❑ $ BAP.C. for this reason Y2EPAR� • Date: USE.OF EXISTING BLDG. DEMOL ❑ :%s•, Signature. APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE °' 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section.7031.5, Business and ADDRESS FINAL 1 Professions Code): PRESENT d B y ❑ I, as owner of the property, or m employees with BUILDING Y { (ns P P Y� YADDRESS ` -, wages as their sole compensationJ ,will do-the work and "' ® �07 144.63 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. 1 ITEMS ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. it -�143 with licensed contractors to construct the project (Sec- ADDRESS TOTAL 143-63 tion 7044,.Business and Professions Code.) t� 13.E REQUIRED TOTAL SETBACK FROM EXIST. CHECK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm•that there is a construction lending agency for FRONT CHANGE the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE. P.L. r' �-G�101 iG/29/92 Lender's Name G p 6245 t,� 9: (Pi O d LDMA Ref. # 1 AM 00 P.C. Fee$ Permit Fee Lender's Address �/ 1 certify that I have read this application and-state that the Issuance Fee a T 7= LDMA P/C# 3 above information is correct.-I agree to comply with all County Investigation Fee ordinances and State laws relciting fo building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter V upon the above-mentioned ro y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant err Agent Dat _ WORKERS'COMPENSATION DECLARATION V / APPLICATION FOR BUILDING. PERMIT "I heoreby affirm that I hgye a ceryficate of consent to self rtpsure,or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is hereby furnished. FOR PPLICANT TO FILL IN ao�eess s U ❑ Certified copy is filed with the county building inspec- BUILDING c�/► nn (� / tion department. ADDRESS od SrE �/T'/ ((s (f I/ LOCALITY ; J NEAREST �. Date Applicant CITY L� ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 9 cz, X �j . NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is far one t ?> USE ZONE MAP '1 _• hundred dollars ($100.)or less.) TRACT BLOCK LOT NO. j� NO. Lv a•, TEL. /� i Y SPECIAL g, I certify that in the performance of the work for which this OWNER ZW SAV.til tQ� NO. �'Y 6 CONDITIONS (� permit is issued, I shall not employ any person in any manner / �7 DISTRICT GROUP TYPE FIRE PRO SSED�Y U so as to become subject to the Wor Cc pensation Law . ADDRESS 2 v CONST. ZONE S, 0/� 24— 0 Date "94 Applicant CITY ZIP STATISTICAL CLASSIFICATION PT. CONDO. U ARCHITECT OR _ - TEL. , NOTICE TO APPLICANT: If, after making th' Cert icate of rr / LU M Exemption, you should become subject f the Workers' ENGINEER e NO. (�j CY9 "1 CLASS NO. DWELL. UNITS t� Compensation provisions of the Labor Code, you must forth- ADDRESS ,[�• 3 �h�Un SEWER MAP - with comply with, such provisions of this -permit shall be r deemed revoked. TEL' 4 VALIDATION CONTRACTOR (J 1 NO rI y BK. L PG,I�p LICENSED CONTRACTORS DECLARATION �I LIC. f I hereby affirm.that I am licensed under provisions of,Chapter 9 ADDRESS S W LN / /� VAL ATI It1� (commencing with Section 7000)of Division 3 of the Business and -}- LIC Professions Code, d license i3 i full force a d effec CITY I �, CLASS $ �� / p�� SQ. FT. NO.OF NO.OF CHECK License Number / Lic.Clas+s�_ SIZE STORIES FAMILIES ONE n NEW $ Contractor [� Date �G` DESCRIPTION OF WORK - . ❑ I am exempt from the licensing requirements as I.am a IF,' f - pA, ADD ❑ , licensed architect or a registered professional engineer ALTER ❑ FINAL C` acting in m'y professional capacity (Section 7051, ! a DATE ..' USE OF REPAIR ❑ n o o n Business and Professions Code).' ^ate I ._ 21 EXISTING BLDG. �oZ DEMOL ❑ FINAL )( � 1-e. B ' Lic.or Reg.No. Date APPLICANT TEL. y C o 0 3 a 28 OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License � �• ­'0 a 3!5 2 C Law for the following reason (Section 7031.5, Business,and ADDRESS i Professions-Code): `PRESENT I 1,O 9-8 I ❑ BUILDING I, as owner of the property, or my employees with ADDRESS 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. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- II 9'O r' tion 7044, Business and Professions Code). ADDRESS _ o n o 0 0 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 Zoo 7 a O O the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE o ,77 0,(; P.L. Lender's Name (' 11.09'—Sl P.C. Fee$ -vt d/ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee above information is co ct. I agree to comply with all County Investigation Fee 4 ordina a ws relati to building construction, Q and re o z represent tves of this C unt to nter�, Total Fee up n e- ned pro erfy for inspe io p os SEE REVERSE FOR EXPLANATORY LANGUAGE 11 nature—VrA)Fipbnt or Agent Date ` ®s ` WORKERS'COMPENSATION DECLARATION hereby affirm that I have.a certificate of consent to self APPLICATION -F O I� I L®I N G PERMIT , , insure,or a certificate df Workers'Compenstion Insurance, or ' a certified copy thereof(Sec. 3800, La C,) I _ A S C .LINTY OF LOS ANGELS BUILG AFETY Poli y No. Company �., %��� .Certified copy is hereby furnisher/' _ ` FOR APPLICANT TO FILL IN ADDRESS GOOD '�l �V ❑ Certified copy is filed With the count din inspect• t BUILDING `61; tion department. ADDRESS .�Qd c �'t. cr-G I �° LOCALITY / Q�.,✓� s ez i f NEAREST J f Date Ap icon i CITY [Q �i ZIP CROSS ST. t�-.P�A11 0 CERTIFICATE OF EXEMPTION FIRW WORKERS' I NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE , OF LOT / Z NOW ON LOT MAIi BOOK PAGE PARCEL (This section need not be,completed if the permit is for one 2 USE ZONE �MAAhundred dollars($100)or less.) TRACT 378.30 BLOCK /� LO LNO. �j �/ ope 1 1 OWNER/0D t C S[ LGS /z Q a rra — ONS. -�� I certify that in the performance of the work for which this O 1 cerperrtify is issued, I shall not employ any person work in r manner ' I / '1�,� DISTRICT G P fj�ZI�IRE P ED BY U ADDRESS / ZZr]• / so a's to b co a subject tot rker omp s Laws. - , / (� / / Date per► s ` I CITY .�l CCt.ctG ZIP f( (o STATISTICALCLASSI TION A CONDO. NOTICETO APPLICANT: If, after'mak g t is•Certificate o ARCHITECT R TEL. EtSemption, you should become subject to the Workers' ENGINEER- �//+l� NO. CLASS NO DWELL. UNITS' y Compensation provisions of-the Labor Code, you must forth- ." ADDRESS io t -L Kce, SEWER MAP-- with comply:with such 'provisions or this permit shall be deemed revoked.. TEL' gKVALIDATION CONTRACTOR OC u K , NO. ^ Ll , LICENSED CONTRACTORS DECLARATION.-, LIC .+�1�� I.hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.d f�T SS•Z VALUATION (commencing with Section 7000)of Division 3 of the Business and, LIC. d'D Professions Code, and my license is,in full force and effect. CITY CLASS• $ �r. Q 3C -64451z— HECK SIZE STORIOES AMILOIES CONE License NumberrT Lic.Class Contractor t�y -� Date 3 6 DESCRIPTION OF WORK ` p� n(�y NEW, $ ' h _ •L L"A' - °'�0..fLX. ADD ❑:: am exempt from the licensing requirements as I am a C licensed architect ora registered professional engineer ALTER ❑ L' Q acting In my professional capacity (Section 7051, REPAIR Business arid Professions Code). USE OF DEMOL EXISTING BLDG. ❑ FINAL ? a �. . ;Lic,or Reg.No. Date APPLICANT I r TEL. y r.. OWNER-BUILDER DECLARATION PRINT C' / NO. 11 hereby affirm that I am exempt from the Contractor's License � 1 Law for the following reason (Sectiori:7031.5, Business and h ADDRESS ` S Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compenscit.icin,will do the work and _ `41 2 R 6 A the structure is not intended-or offered for sale(Section LOCALITY /•, 7044, Business and Professions Code). MOVING TEL. 1 o O•,o o P ❑ CONTRACTOR NO. 1 �. I,,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS C ' ° 7. L; tion 7044, Business.and:Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work-for which this permif:is issued P.L. v,•0 4 (Sec. 3097, Civ. C.).. SIDE o .�r P.L. f Lender's Name4'�v' �'`Zr^• ° Lender's Address r 7� Pf,—a- -4: ese�Lra�/ P.C. Fee$ Permit Fee ' I certify that I have read this�applica ion and state that that Issuance Fee above information is'correct. I agree to comply with all County . Investigation Fee ; ordinances and State laws relating to building construction, Total Fee . and hereby author' �enes ofthis County fo enter on the ntionedy for inspection urpente [ SEE REVERSE FOR EXPLANATORY LANGUAGE 1 o j Signatureo pylic nt or Agent to ®s • WORKERS'COMPENSATION DECLARATION I hereby affirm that I'have a certificate-of consent to self I A P��CAU��N F .i p U I L� P E I T insure, or a certificate of Workers'Compenstlon Insurance,or Lr a rtified co t ereof(S c 800, Lab. C.) 'I l9NTY OF Q.®S Ahl9fv� S - Bl9BL®Ih19Cs iVD ETY �. cony _ 6�� r -- .� Pofi�nNo. S d���3� � � d- �" Certified copy is hereby furnished: FOR APPLICANT TO FILL IN BUILDING ADDRESS 46o4 ^ - - TC -_--.0 3{tf Certified copy is filed with the county building Ins c- BUILDINGy-p ..—� tion department., ADDRESS���fi 2tC v LOCALITY •/ C7 NEAREST Date IZ �7 Appl an CITY (.e �c ZIP CROSS ST. .�Wsl or OS CERTIFI ATE OF EXEMPTION FROM OR RS' / NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT �(e NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP - hundred dollars($100)or less:) • TRACT BLOCK LOT NO. f NO. a } OWNER TEL.. r, s r SPECIAL /� � L Ife'Y�� I certify that in the performance of the work for whieh this �a f�t4.s� ' tk u� ' NO. CONDITIONS l� permit is issued, I shall not employ any person in any manner r p ^�� DISTRICT GROUP TYPE FIRE PROCESSED BY U so as to become subject to the Worke s'Com ensation Laws. I ADDRESS ZZ- LJ n CONST. ZONE r UC. Date Applicant ' C�• CITY ZIP 911496 STATISTICAL CLASSIFICATION APTTEL. . CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of �INEERE NO. 4'©0 V3 I L CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' / Compensation provisions of the Labor Code, you must forth- ADDRESS .(�. > X �{ .7-_'L.4 WE . IJ SEWER SER MAP z with -comply with such provisions or this permit shall beVTEL `` deemed revoked.. - CONTRACTOR d n r.� NO. O8b BIC. �PG; �' VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am-licensed under provisions of Chapter 9 - ADDRESS NO:34 Z VALUATION (commencing with Section 7000)of Division 3 of the Business and - /� LIC tTO Professions Code, and my license is in full force and effect. CITY k La.., CLASS $ SQ.F NO.OF NO.OF CHECK License Number Z Lic.Class 'o SIZE STORIES ' FAMILIES ONE i•p $ Contractor O Ila,- a'�+s'rx to i� Z�- O I DESCRI ION OF WORK NEW ❑ I am exempt from 5-A 1 F' the licensingtrequirements as I am a ADD licensed architect or a registered professional engineer ALTER FINAL acting'in my professional capacity (Section 7051, REPAIR DATE r• C-� ?I , o 2,3 Business and Professions Code). USE OF DEMOL FINAL `, EXISTING BLDG. By � 2 2 1 7,2 G Lic.or Reg.No. Date APPLICANT `` TEL. " PRINT C/C - o NO. ��' OWNER-BUILDER,DECLARATION ,,--^^ 1 . e o 2 1 "2 0 I hereby affirm that I am exempt from the Contractor's License ADDRESS ��$ W° -C Law for the following reason (Section 7031.5, Business and G�"� 0 3.26-81 Professions Cbde): PRESENT �� BUILDING I, as owner of the properfy,•or my employees with. ', ADDRESS 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.. [;.5 [) 2 A ❑' 1, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- I �+ tion 7044, Business and Professions Code). ' ADDRESS` r1• a n ° ° ° 1 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 2 ° 2 7 R 5 0 Ihereby affirm that there-is a construction lending agency for FRONT .the performance of the work for-which this permit is issued P.L. ° p �"� +z rt czt (Sec. 3097, Civ. C.). , SIDE �7 , e P.L. 0 3,2 6—8 1 Lender's Name K�-�/Q�• �� �• (���-�--` !a Lender's Address �'/�!s Da_+ JQ, o �C?�..0 D P.C. Fee$ Permit Fee r i J > I certify that I have read this application and state that thal- ti Issuance Fee above information is correct. I agree to comply with all County Investigation Fee �. ordinances and'State laws relating to building construction, g and her aut repr tatives of this County to'enfer' Total Fee r Q i u on a ent' croperty for inspection purposes. —`�� •" Z._ o I SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of Applicant or Agent Dote 60zl` f,,,w y� ®s ;�5 - i VVORPCERS'COMPENSATION DECLARATION hereby.a certificate I have a certificate of consent to self I APPLICATION FOR �U I L D I N O PERMIT insurL,or a ertificcate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800 Lob. C.) COUNTY OF LOS ANGELES BUILDIN AND AR TY Poly Nor )---3 pa 1 ��f _ J s_ AM TY Certified copy is hereby furnished. FOR, PI:I T TO FILL IN ADDRESS 4Da Certified copy is filed with the county'bui g ! c- BUILDING tion depart ent. 6 ADDRESS �fj j ":w�-fat �1 LOCALITYNEAREST Date j Al �� CITY �,q )7 _ �c t ZIP CROSS ST. RTIFI ATE OF EXEMPTIO FRO OR RS' O.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT�Z �C NOW ON LOT MAP BOOK PAGE PARCEL. (This section need not be completed if the permit is for one USE ZONE MAP D 7 .• hundred dollars ($100)or less.) TRACT ;B t BLOCK LOT NO. NO. " � TEL."W4 /� SPECIAL OWNER1J` p, CONDITIONS I certify that in the performance of the work for which this Z( - LLvK wo'L NO!' V permit is issued, I shall not employ any person in any manner Vim. DISTRICT GROUP TYPE FIRER E D BY ADDRESS so as to become subject to the Workers:Cam pensati on'Laws. CITY'. ol` Gki w� ZIP Date Applicant - STATISTICAL CLASSIFICATION AP : CONDO. U NOTICE TO APPLICANT: If, after making this Gertificate of TOR fJ TEL. r p� i W Exemption, you should become subject-:,to the Workers' ENGINE L� NO. 'C6��• CLASS NO. DWELL. UNITS tZ Com ensation provisions of the Labor Code, ou must forth- �y to P p y• ADDRESS;P,().� �!J Q� � * r SEWERiMAP - z with comply'with such provisions or'this permit shall be deemed revoked. ? { TELJA 10 BK. VALIDATION CONTRACTOR 6 NO. LICENSED CONTRACTORS DECLARATION LIC• I.hereby affirm that I am licensed under provisions of Chapter_9 ADDRESS -,Z�. NO�A g VALUATION (commencing with Section 7000)of.Division 3 of the Business andff LIC CM Professions Code, and my license is Tri full force and effect. CITY Lcrv<d CLASS SQ. / O.OF NO.OF CHECK License Number r-945_Z_'�Jf Lic.Class SIZ TORIES FAMILIES ONE ' / Contractorouo d test �r'r r Date ,, DESCRIPTION OF WORK r �� ` NEW $ ❑ I am exempt from the licensing requirements as I am a J ,LA .x`x_C.." ADD ❑ licensed architect or a registered professional engineer ALTER ❑ FINIA acting in my professional capacity (Section 7051, �© O REPAIR El DATE Business and Professions Code). USE OF DEMO FINAL ' 'EXISTING BLDG. ❑ B Lic.or Reg.No. Date APPLICANT � Jq� TEL. Y OWNER-BUILDER DECLARATION (PRINT)/V, /� v )e NO. I herebyaffirm that I am exempt from the Contractor's License ^� Law fo /G the following reason(Section 7031.5, Business and ADDRESS f Professions Code): PRESENT BUILDING as owner of the property, or my employees with ADDRESS 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. F-1 1, as-owner of the property, am exclusively contracting CONTRACTOR _ NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. ) kyr CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH c✓�/ o• (� I hereby affirm that there is a construction lending agency for FRONT the performancft of the work for which this permit is issued P.L. "� i, ':J le (Sec. 3097, Civ. C.)., h SIDE. P.L. Lender's Name e�,� � ' Lender's Address .f�� �/r wf-V its • • ���w�1-f ! P.C.PCFee$ Permit Fed..% 19.0 > I certify that I have this applic tion and state th� Issuance Fee e% above information is correct: I agree to comply with all County Investigation Fee p' 3 ordinances and State laws relating to building construction, Total F90 or g and hereby authorize represent Tues of this County to enter I 1, a ov i erty for inspection purposes. [ Amb I SEE REVERSE FOR EXPLANATORY LANGUAGE Sig r of App cant or Agent D to I• ®s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA* BL 0508 9707220025 PHONE: (818) 285-0488 EXT: L 0. OF COS BUILDING ADDRESS: TR: 37830 • LT: 1 UN: 7 SQ. FT STORIES TYPE 6004 ROSEMEAD BL 7 STRUCTURE: 0 TEMP CA 917801558 ASSESSOR 0 T 0 NUMBER: NEAREST CROSS STREET: HERMOSA 5384-016-054 THOMAS PAGE: 5964_=—_H,3, LOCALITY: TEMPLE CITY TENANT: ST BLDG E: R S USE ZONE: SSE ON: PROCESSED EXIST OCC GRP: 07/22/97TC 07/22/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE INAL0 HATCHER JONATHAN L;JILL S (626) 285-3026- 15 0 �o _ 6004 ROSEMEAD BL TEMP 917801558FEES PAD IFE—sc-UPT-16-i OF WORK f DEMOLISH 81 DIAMETER SPA LOCATED IN llnMMON AREA FOR 15 UNIT FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: CONDOS-VILLA-SIERRA HOMEOWNERS ASSOCIATION APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 02 DEMOLITION INSPECTN 163.50 SPECIAL CONDITIONS: _ y ` i'TOTAL FEES 191.25 CONTRACTOR: TEL. N0: `" �, y__-- -==;�-i ' , APPROVALS DATE NSPECTOR SIGNATURE SAME AS OWNER LIC. NOPEDESTRIAN PROTECTION SEWER DISCONNECTION ARCHITECT OR G R: TEL. NO: s' `• + 4. ABANDON PRIVATE DISPOSAL LIC. N0: UNDERGRN T UCT REMOVAL AND 9E1I tr Qlr MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 15OH265 04 0. I I S: DWELLING UNITS: A CO . STAT C SS: NO 24 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS \;, •. — NO NO NO — • , `.+yY tet.�+ 1 ` �-.T_�--- �- 'ta' + REPORT ID: DPR261 ROUTE TO: BS0508 I 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 0207150042 PHONE: (626) 285-0488 EXT: LEGAL D: NO. OF CONST BUILDINGADDRESS: TR: 37830 LT: 1 UN: 1 SQ. FT STORIES TYPE 6004 ROSEMEAD BL 1 STRUCTURE: VN TEMP CA 917801557 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5384-016-048 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY TENANT: E X IST WCDG USE: RESID USE ZONE: R-3 TNUEF-OF PROCESSED 8 EXPIRES . EXIST OCC GRP: 07/15/02 JK 01/11/03 OWNER: TEL. 0: B DGS. NOW ON LOT: VALUATION: FINp DA_� FI BY: CODE: HAE S PARK;YEUN OK YU - 33,000 g� 6004 ROSEMEAD BL TEMP 917801557 FES PAID TE-SCRIFTION OF T/O;INSTALL NEW OSB PLYWOOD & 30YR SHINGLE (ALL 3 BUILDINGS) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: L. NO: OSMOND CONSTRUCTION & DEV INC (626) 675-7052- AA BLDG PERMIT ISSUANCE 27.75 1108 S CALIFORNIA ST AC STRONG MOTION RESID 33000.00 VAL 3.30 SPECIAL CONDITIONS: SAN GABRIEL D2 PERMIT W/O EN-HC 33000.00 VAL 575.85 TOTAL-FEES 606.90 CONTRACTOR: TEL. N0: APPROVALS DATE I SPECTOR SIGNATURE OSMOND CONSTRUCTION AND DEVELOPME (621) 451-0699- 1108 S. CALIFORNIA ST. LIC. NO LOCATION AND SETBACKS SAN GABRIEL, CA 91776 7913698 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: T 0: FOUNDATION/TRENCH FOR LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRA NG MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION X 3 01 FLOOR SH H NG 0. OF FAMILIES: DWELLING UN TS: AP /CO D: SAT CLASS: 1 YES 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PA E S AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM X S SPRINKLER ANG RS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED S S E N S T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508