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HomeMy Public PortalAbout6011-6015 ROSEMEAD BLVD_Building__ BA638A CE#808.10.56 A Y P U O AT I O Y V FOR BUIL®I NGE d p y VI E�p �- BUILDING AND SAFETY DIVISION BUILDING ' a Department of County Engineer ADDRESS County of Los Angeles LOCALITY JOHN.A.LAMBIE. COUNTY ENGINEER NEAREST ®� CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST. y. -:.:, ,.. .:.. . DISTRICT NO. GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN CONST. BU'LD I ( NG �j/ J} I ADDRESS STATISTICAL CLASSIFICATION .C� BLOCK LOT NO: CLASS. NO.- DWELL:UNITS NU BER Q HWYMAP STATE ES -NO TRXCT)x Il/jBF ZONE SPECIAL NO.OF BLD SIZE OF LOT ?(,D— J I NOW ON LOTS' / �r / CONDITIONS USE OF Apio EXISTING BLDG. BUILDING YARD HWY. STREET NAME EXIST. SETBACK WIDTH OWNER �Lv.•�L . ✓ 'FRONT .' MAIL P. L. z iaz&&Zs ADDRESS 1.1 er .�i SIDE J TEL. P. L: , NO. INSPECTION RECORD . ARCHIT CTO TEL. ENGINEER NO. f ADDRESS S A"/L TEL. CQ>WRACTOR NO. J n ADDRESS 6 a F DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ. FT. ' NO.OF NO.OF SIZE �Q STORIES FAMILIES USE O STRUCTURE ;n APPROVALS SIGNATUR F APPLICA DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION:LOCATION / FORMS. MATERIALS $ D� P.C. $ AME: FIRE STP4�/ FR RACING.BOLTOSs� L(/ S 7 i /GLl/CL4 G( f' •` FEE FURNACE:.LOCATION. FEE VALUATION $ GAS VENT. DUCTS I�HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT. STATE LAWS REGULATING BUILDING TRUCTION. SIGNATURE OFHOUSE NUMBER COR- PERMITTEE Nw,r Jr .�s'►vRECT AND POSTED Q ADDRESS FINAL % L(Cs 7 �yWL' OHN A.LAMBIE.COUNTY ENGINEER. CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. i; ..2.2 1 2V�; $EP 12 1 2400 al APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print cr type only) BUILDING A ) f�L� �L COUNTY OF LOS ANGELES Cf ADDRESS ` DEPARTMENT OF COUNTY ENGINEER ''�� BUILDING AND Y DIVISION CITY t', ZIP 0 g IN .OF BLDGS. BUILDING r SIZE OF LOT 5 D 3K NOW ON LOT ADDRESS TRACT C BLOCK LOT�NO� 5� LOCALIT r� w EL. NEAREST OWNER of O. CROSS ST. r ASSESSOR ADDRESS � . MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ESSF� BY CITY _ �' �,� ZIP- �jr� CONST, ZONE - ARCHITECT OR TEL. IfJ1V8 m, ��+ y ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO.Q�DWELL.UNITS t K G CONTRACTOR NOL, US ZONE MAP LIC. NO. e ADDRESS NO. SPECIAL LIC. CONDITIONS CITY CLASS ROAD D PARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG ETBACK FROM i FRO TPROP.LINEOF (STREET) ADDRESS CITY HIGH W Y + YARD = TOTAL SETBACK FROM TYPE OF EXISTING 1 SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH I SIZE STORIES FAMILIES ONE ) + = I DESCRIPTION OF WORK L NEWBLDG.SETBACK FRO3 ❑ n �� ��� ADD ❑ SDE PROP.LINE OF M ( EET) \` _ _ ALTER ❑ HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF E KINr,. n REPAIR SIDE PROP. LINE HIGHWAY USE OF + EXISTING BLD DEMOL ❑ APPLICA I _ ILA TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) 1 ' BY (SIGNATUR ) IN OPEN SPACE YES ❑ NO ❑ Q �j C IN COASTAL ZONE YES ❑ NO ❑ VALUATION s CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED I CT REPORT PROC ESSED (DATE) HEREBY 1 WILL NOT EMPLOY ANY PERSO IN VIOLATION OF THE LABOR CODE OF THE STATE OF CAL IN RELATING TO WORKMEN'S COVPEN3"ON I.MM NCE SIGNATURE OF s- PERMITTEE ADORES S f - FINAL / B TEL DATE 7(/ CITY NO, a MAKE_ CHECKS PAYABLE TO: FEE FEE F HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION 'CK. M.O. CASH s , PERMIT VALIDAIION(D M.O. CASH 2t,-j%FR 26 1 3. D 6.0 0 A>J3 76ABSOA CE9803 7/73 76A838A CE#803 W-MAPPLICATION FOR BUILDING PERMIT BUIL COUNTY OF LOS ANGELES ADDRESS DING IL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY t JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROS§S L. oll eF TYPE Mas, SED BY FOR APPLICANT TO FILL IN J CONST., BUILDING -LASSIFICATION SrWER MA ADDRESS STATISTICAL gy CLASS.NO. �' DWELL.UNITS LOT N � BLOCK MAPg�7& t STATE Wj�o N v BER HVIFY. �- TRACT Al USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF BLDG. EXIST. EXISTIN&B _14ok BUILDING YARD HWY STREET NAME WIDTH gg" SETBACK OWN R FRONT MAIL P. ADDRES SIDE P.L. ZOL&L z INSPECTION RECORD ARCH ITECToKl TEL ENGINEER --NO. AL312RE§S TEL CONTRACTCW_; ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OFJPPJUCTURE I J/ r- APPROVALS SIGNATURE -F APPLICANII 422 dA DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS.MATERIALS $ ob P. FRAME: FIRE STOPS- FE C. BRACING. BOLTS RNACE: LOCATION. R CE FEE VALUATION nQCE�TDUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH.INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO WITH ALL COUNTY ORJMNANCES AND LATH.EXT. STATE LAW R3 DING ft)NS RUCTION. j'3UlLDI HOUSE NUMBER COR- SIGNATURE RE F RECT AND POSTED PERMIT SS WII'mJAL ADDRESS 'CLYDE N.DIRLAM, PRINCIPAL ST CT RMt.NGINEER PLAN CHECK YALIDARIOK CK. M.O. CASH PE UT VALIDATION cr- M.O. cr LI11;a-3-117 4 3 G DEC 2 0 1 D 4.00- 4 DECLARATION WORKERS'COMPENSATION j_:hereby, certificate that'1 havecertificate of consent to self APPLICATION FOP BUILDING PERMIT ' ia-insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No k2 BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. J ADDRESS 10 !S �� �d�+' C Date Applicant 1A - v CITY ao c 42� C-/& ZIP LOCALITY Ar ERTIFICATE OF EXEMPTION FROM WORKERS' Nb.OF BLDGS. NEAREST '1� � S� COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. /_ (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER I / TEL. Z USE NE O? ! 1 certify that in the performance of the work for which this NO' 0 fC/ J permit is issued, I shall not employ any person in any manner ADDRESS GIJ, / — SPECIAL a2®jL CONDITIONS so as to become s�(u_b�I'(��_to the Workers'Compensation L s. � U Date — APPlicant v CITY aw&6 ZIP ARCHITECT OR TEL. IY NOTICE TO APPLICANT: If, after making this Certific to of DISTRICT GROUP TYPE FIRE PRO D BY O ENGINEER NO. '/ /� CONST ZONE Exemption, you should become subject to the Workers' �i�l/ ��J(`— _rJJ/ Compensation provisions of the Labor Code, you must forth- ADDRESS ! pW with comply with such provisions or this permit shall be TE QQ STATISTICAL C�;WDWELL. APT. N . Ndeemed revoked. CONTRACTOR �l D ���/LICENSED CONTRACTORS DECLARATION LIC, / CLASS NO. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1 /•� NO. ��/�� (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code,and my license is in full force and effect. CITY CLASS BK VALIDATION SQ.F7. NO.OF NO.OF CHECK License Number Lit.Class SIZE STORIES I FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW Contractor Date -� ADD ; ®I am exempt under Sec. ALTER ® &9 8 a 1 A B.B,P.C. for this reason a t4 REPAIR $ # 0 0 0 0 0 1 Date: USE OF DEMOL EXISTING BLDG. ( o 0 6 Q 5 0 APPLICANT Signature ` FINAL OWNER-BUILDER DECLARATION PRINT p �81��5 1L AdA�J/� NO. �1 DATE r 0 0 0 6 0.5 0 csi I hereby affirm that I am Oxempt from the Contractor's License ADDRESS ! ��(®l v o FIN 0 614-88 Law for the following reason (Section 7031.5, Business and Professions Code): ® SENT- BUILDING (Qwse I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY -Q �`� e-- the structure Is not Intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. I,as owner of the property, am exclusively contracting CONTRACTOR NO. with Ilcensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY AL SET L NE 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. (Sec. 3097, Civ. C.). SIDE I P.L. Lender's Name � � o LDMA Ref.q �!� P.C.Fee$ Permit Fee r Lender's Address�t •�/✓i;4AIAJ r•-� �+i 13 1 certify that I have read this application and state that the Issuance Fee LDMA P/C 0 above information is correct. I agree to comply with all County Investigation Fee ? ordinances and State laws relating to building construction, 1 Total Fee V LDMA Perm. t1 and hereby authorize representatives of this County to enter upon the above-mentioned prop ty for inspec7_11� urpose —7.t o &L,/. � � GV L No SEE REVERSE FOR EXPLANATORY LANGUAGE f'vase ST"041 Signature of Applicant or ent r Date------- C7 ���e�� y�_ /. tT r3lJ. Of Upper l' ' WORKERS'COMPENSATION DECLARATION .e,off f" APPLICATION FOR BUILDING PERMIT UN IT I-,h&reb fi'F,m f at'I have a certificate of consent to self D idsuce, or a certificate of Workers'Compensation Insurance, / or a certified copy thereof (Sec. 3800, Lab. C.) _ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.R 44Q 7 o Company— ( e-M Diet Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS O/� /V f N�1 � 1; p Eltion copy is filed with the county building inspec- BUILDING r pg )) p� .r� y� h / f tion'department. / 1 ADDRESS VpJX d/I ,�1/w5 EMu"�/ 15LVP �7L_G c-(-r Y w, �r �/'/�.� Date � J1 a v Applican w V CITY L� C4 I 7 ZIP PT LOCALITY �! 1"'✓`-'" �o 'v ''"t"� t u/•t CERTIFICATE OF EXEMPTI N FROM WORKERS' NO.W OFONT BL LOOT NEAREST r �i •�U�/� COMPENSATION INSURANCE SIZE OF LOT 6'700 NO .CROSS OR (This section need not be completed if the permit is for one p �j Z-G ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT .k MAP BOOK PAGE PARCEL TEL'. USE ZONE MAP I certify that in the performance of the work for which this OWNER NO. NO. permit is issued, I shall not employ any person in any mannerr� A � SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS 115 I CONDITIONS U Date 6�! � ApplicantST•1C� cirY �r � zip l3 ARCHITECT OR 51 p/t N J fie- TELL.. DISTRICT GR UP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after makingthis Certificate of 1�"l� rrK� CONS ZONE I" Exemption, you should become subject to the Workers' -'� �`, p.� �] J,(/ _ '/7/ (� Compensation provisions of the Labor Code, you must forth- ADDRESS W `�z"' V �"" VO3 �+cvv V a with comply with such provisions or this permit shall be ,09 TEL. STATISTICAL CLASSIFICATION APT. htONDO. I N deemed revoked. CONTRACTOR NO. ` LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. 1 I.L.DWEUNITS-%— I NITS 4 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC, SEWEXPG- P Professions Code, and my license is in full force and effect. CITY CLASS BKVALIDATION SQ. _ / NO.OF tZ NO.OF i CHECK License Number Lic.Class SEIZE L[? STORIES �- FAMILIES 1 ONE Contractor Date ®E b CIOCRIPT ONp�OF�yO�RK r i Jry1��ll�j l�!E 1-r ' NEW ❑ VALU TION; 1 ❑ 131 s/ " U7v)7 ADD ❑ :.:• $ (�JJ I am exempt under Sec. ❑ USE OF CAI?, a ALTER B.BP.C. for this reason REPAIR ❑ $ 9 Date: EXISTING BLDG. y DEMOL ❑ 1 - 569.93 Signature APPLICANT ( � O TEL. FINAL OWNER-BUILDER DECLARATION PRINT �m w Lec NO. V2 DATE o - 569,936 I hereby affirm that I am exempt from the Contractor's License ADDRESS E 0 226-88 Law for the following reason (Section 7031.5, Business and FINAL 6 Professions Code): PRESENT BY ❑ 1, as owner of the property, or my employees with ADDRESS 6Q� wages as their sole compensation,will do the work and _ II � the structure is not intended or offered for sale(Section LOCALITY ( '-� ffp D l�rLf7 v 9 8 8 O A 7044, Business and Professions Code). MOVING L. Er I, as owner of theproperty,am exclusive) contracting CONTRACTOR NO. Y 9 # 0 0 0 0 0 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). - 681.00 REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT o - 681.005 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE O 614-88 L , f� V P.L. Lender's Name � LDMA Ref,,# o P.C. Fee$ V Permit Fee �V L�� Lender's Address �j� 1 certify that I have read this application and state that the Issuance Fee J (! 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 17W fDD LDMA Perm. # and hereby authorize representatives of this County to enter L �pon the above-mentioned property for inspection purposes, 0 61!l�I Pf SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signature of Applicant or AV& Date `'►�'� 4"JORKER$'gOMPENSATION DECLARATION U+q 1-r ,&�Wert.iyjF dillfWnthat I have certificate of consent to self P L I CAT I� FOR WILDING P E RAAr insure, or a certificate of Workers'Compensation Insurance, Y `�. 3 or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Y . Policy No. Company T T riME� W, gY7 t-_MJ-WD �(3W BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS N, R05 ❑ Certified copy is filed with the county building inspec- BUILDING .-. �/r PZ5C-Mt�/��Ln g �� Y tion department. ADDRESS I v D J�� , /m,�^� C, Date , ' Applicant "V ` CITY L G1 T Y ZIP � LOCALITY r tl •-`"�v J l UK FO/P,#4L2*9 CE TIFICATE OF EXEMPTION FROM WORKERS' a Lp NO.OF BLDGS. NEAREST p� COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. 6y (This section need not be completed if the permit is for one /z ASSESSOR hundred dollars($100)or less.) TRACT BLOCK ' LOT NO. MAP BOOK PAGE PARCEL t TEL. USE ZONE 1 certify that in the performance of the work for which this OWNER V(. ��� NO. NO. permit is issued, 1 shall not employ any person in any manner '' S- 2Z" 1` 3 SPECIAL dt CONDIT so as to becomeADDRESS IONS subject to the Workers'Compensation Laws. U -Date (� Applicant �✓ e9� L�/j CITY ZIP fl ARCHI CT OR TEL. �8 DISTRICT G UP TYPE FIRE PROCESSED BY O NOTICE T APPLICANT: If, after making this Certificate of ddqA(�A l C Exemption, you should become subject to the Workers' *Netmw /�1 ,v '! NO. at? �-j� I CONST'./ ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS46 itu b3 V with comply with such provisions or this permit shall be O�C�kisY TEL. deemed revoked. trlS`SL STATISTICAL CLASSIFICATION APT. C NDO. fn .. CONTRACTOR � / LICENSED CONTRACTORS DECLARATION o CLASS NO.___�J L DWELL. UNITS` I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS - O 7' (commencing with Section 7000)of Division 3 of the Business and LIC. SEWERPAP Professions Code, and my license is in full force and effect. CITYAWA4CLASS ;, BK VALIDATION SQ. FT a^�Q NO.OF NO.OF CHECK License Number Lic.Class SIZE l ! �1 STORIES FAMILIES ONE �O VALUATION Contractor Date DE IPTION OF WOR NEW $ '78' 9 0 5 7 A I am exempt under Sec. � VJV iT W ADD ❑ yj. ® $# 0 0 0 0 2 3 ALTER ❑ I o 55272 B.BP.C. for this reason Z rr�� �1fREPAIR $ USE OF ❑ a x552721 Date: EXISTING BLDG. DEMOL ❑' . Signature APPLICANT TEL. FINAL 0 6 2 6-8 8 OWNER-BUILDER DECLARATION PRINT M©IV t V 4 NO. DATE -may I hereby affirm that I am exempt from the Contractor's License �L IN Law for the following reason (Section 7031.5, Business and ADDRESS B Professions Code): PRE ENT p� /� / ❑ BUILDING O I t KfS�"1�y 151, -D 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALIT n ® ( `rU� :,' the structure is not intended or offered for sale(Section �7044, Business and Professions Code). MOVING TEL. I,as owner of the property, am exclusively contracting CONTRACTOR NO. LJ9 8'7 9 A with licensed contractors to construct the project (Sec- ADDRESS # a o 0 0 0 1 tion 7044, Business and Professions Code). _MMMMig REQUIRED TOTAL SETBACK 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - 86 (175 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. 0 0 8(�(] 7 5 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ���--� i��[onJL tcc_� 4- o6. 14-88 o P.C.Fee$ Permit Fee Sd,Zs- Lender's LDMA Ref. fi Address I certify that I have read this application and state that the Issuance Fee .�) C LDMA P/C N above information is correct. I agree to comply with all County Investigation Fee -�/ �✓ ordinances and State laws relating to building construction, Total Fee V t /J LD MA perm.q and hereby authorize representatives of this County to enter $ upon the above-mentioned property for inspectionspppuurpo;es. (Na I --E�—�-�/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant r Agent Date