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Home My Public Portal About6230-6236 ROSEMEAD BLVD_Building__ -VISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles Nov 19;9 WM. J.-:FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING 7] nn D18TR V NO. PLAN CK.oR RED.No. PERMIT DID. ADDRE99 tr�.+ C./��'��FJ7 d ��/ r C Z-1 LODALITY } �..y RECEIVED Y DATE OFAPPL. DATE IBSUED_ NEAREST / "7�LC C+ ! �j 1 0 - -31 ,-Z.m • /,(—/C) -J z. CROSS 9T. - &'/ /s `� BUILDING L(�� BLVD � !` ADORERS („ Z � O I�aS e n.C� /\ t7 I.J Ly D OWNER fi0 /jICy JCOH/✓oSa MAIL LOCALITY "'� ��.Q I / j� ADDRESS " 642-r mF-A p 44yp NJEAREST .-� ., TEL., CROSS BT. d AJC� IV C'`� ��V CITY N s '� ZFIRE NO.air ONE I PLANE TYPE„ I BROUP ARCHITECT OR TEL TSP ENGINEER NO. L BLDG. / ORD. NO. 9ETBACK LINE '�U r'I ��-' ADDRESS USE �.,,' APPROVED CONTRACTOR40W1j/a"X- 7� NOL ZONE BY DATE 4LIIZR HOUSE NUMBERING ADDRESS MAP NUMBED V NO. ASSIGNED BY LEGAL " f, , f�pCORRECTI0I1sS DESCRIPTION LOT NO. BLOCK _TRACT LL d~ O NO. OF BLDGB., - 2- �I I 2. (216701:: rl/l/ SIZE OF LoTj-Q I NOWON•LOT USE DF ND.OF /; -j Ll %7/1 EXISTING BLDG. i DESCRIPTION OF WORK ��''�r `�' "� &'-" 2 t Ag- 'fir ° lam'-- IV f4 Y ee 1'L'!'D. NEW ALTERATION ADDITION r7 � D REPAIR DEMOLITION •.:� • .,.,P..-�� e r ROOMS STORIES 4• t� EXT.WALL iS. ROOF , -- COVERING�J rl (�n� I OOVER1NG��jQ�CS il? !1/ USE.OF STRUCTURE QweL'L1zv ca k"2. INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN 19 FRAME: FIRE STOPS,, t CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, r AND STATE LAWS REGULATING B ILDI CONSTRUCTION. GAS VENT,DUCTS SIGNATURE OF LATH, INT. %��•�� PERMITTE ADORES LATH, EXT. 1 V ' , AUTHORIZED AOT. PLABTER, INT. PLASTER, EXT. ^ °C) ^�. � �q ¢ HOUSE NUMBER COR- VALUATION VAWATION O O Q B FINAL FEE 7SA638A DBS 3 147 r_/.4 A DIVISION OF BUILDING AND SAFETY IIDepwtBment of County Engineer H L � R County of ]Los Angeles ILEI WM. J. FOX, COUNTY ENGINEER APPLICATION p FON OFFICE USE ONLY FOR APPLICANT TO FILL IN ADDRESS DISTRICT .,:. PLAM Clc.DR RED.No. MIT Np. LOCALITY v- REC �D BY DATE OF AP L. DATE//-'/3ISSUED 4pa ,s N$AREBT 6 1 GROSS ST. FSI ).��-7 BUILDING / 'G _s1 ADDRESS (� f OWNER ®.O IV(-c Y MAIL ° LOCALITY ( r ADDRESS f A .-/9 NI:AREBT ^' CROSS ST. CITY —J� L& C/, V Na ,67 FIRE NO.OF E MRDUPyrL�. ARCHITECT OR TEL ZONE PLANE ,�' ENGINEER NO. BLDG. ! ORD. NO. SETBACK LINE ADDRESS USE APPR12VED CONTRACTOR OL" ZONE BY DATE HOUSE NUMBERING A®,D� MAP NUMBER NO. ABSIGNED BY LEGAL ! CORRECTIONS DESCRIPTION LOT NO. ( i iHLODK /� TRACT • yt'�`./�' '-t� 1/Q• 3 V i�6 SIZE OF LOT a. or BLOBIL ��X/(o�rs`f'NOW OP4 LOT EXISTING BLDG. -ADWIEB CA, '-z K DESCRIPTION OF WORK °a 0 NEW ALTERATION ADDITION ' Z s REPAIR DEMOLITION r 6 FT. NO Or ZE ROQMS 13TDRIES EXT.WALL ROOF COVERING I ODVERING US ,ECWTIJUOTURE Or e7 / �/ .lJl1 C„� ,Xj INSPECTION FOR APPROVALS OCCUPANCY AB INSPECTORPS SIGNATURE DATE rouNDATIDN. ronme, MATERIALS LOCATIONd-�7�17 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, r f CORRECT. BRACING,BOLTS /, I AGREE TO OOMPLY WITH ALL COUNTY CRDINAHOEB FiIRNACE: LOCATION, AND STATE LAWS REGjJI:ATING BUIL DINO ONS RUCTION. GAS VENT,DUCTS f SIGNATURE OF a/�/)(f- 9;' r `✓'!�/1 , LATH, INT. PERMITTEE w fI e• rsgp r .•r: ,n - 7 ? ADDREB !f ;• /°i LATH, EXT. - ` A AUTHORIZED ADT. PLASTERP INT. PLASTER, Exr. �- FEE HOUSE NUMBER COR- S RECT AND POSTED VALUATION FEE "s� FINAL �� '�LS...2 76AS38A DBS 3 1-52 • WORKERS'eL)MPENSATION DECLARATION +insure oroafcertif carte of Workers's'tificate of Compensat on eInsuran ent to self f CAT® �ION I ®ING RM IT or a certified copy thereof(Sec. 3800, Lab. C.)V ad -�f COUNTY OF LOS ANGELES BUILDING AND SAFETY %)X Po cy No.4W o 'f Company l vl11Jf C�!(,L Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 3� - ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING ) `/ tion department. ADDRESS O'" TO s v Date Applicant R k �'o13�r5 CITY &_17 if r ZIP LOCALITY A /171 CERTIFICATE OF EXEMPTION FROM WORKERS' IF I NO.OF BLDGS. �r NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT .7 CROSS ST. (This section need not be completed if the permit is for one ASSESSOR TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) / y q OW D/V N L �J�f USE NE MAP I cce�rtify that in the performance of the work for which this J NO. >_ psl,nit is issued, I shall not employ any person in any manner `1 SPECIAL � soros to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS 0O ! CITY ZIP @g tsate Applicant ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' �f� am CONST. ZONE Compensation provisions of the Labor Code, you must forth- j ADDRESS J'�0 9L with comply with such provisions or this permit shall be TEL.-7e 'STATISTICAL CLASSIFICATION APT. NDE. cZ deemed revoked. CONTRACTOR4j,f.,cf/j, 4,r. r -r*1C NO. Y. LICENSED CONTRACTORS DECLARATIONLIC, AA CLASS NO. DWELL. UNITS-:L- I NITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSAl. ,j F' NC;4� 8'76 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and / LIC. Professions Code,and my license is in full force and effect. CITY �t :js'/ - '7 Z-�� CLASS BK E PG42- VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number o4 `�6 7 a Lic.Class SIZE STORIES FAMILIES ONE L / VALUATION Contractor��d+i uii7atF•�17`Date [BD IPTION OF WORK A"1 a( • •dry/ NEW ❑ ; ❑ I am exempt under Sec. C J��`� �� ADD ❑; , / ALTER ❑ ` 3526A B.BP.C. for this reason U E USE OF REPAIR ❑; ; # o a o 0 0 1 Dat �v `� EXISTING BLDG. p DEMOL Signature ANT TEO.-71Y FINAL �f /� I o o 6 Q 5 0 g OWNER-BUILDER DECLARATION INT)4;v / � Lsr .Cre*/ NOZD DATE ✓G- `��J o 0060,5053 I hereby affirm that I am exempt from the Contractor's License i Law for the following reason (Section 7031.5, Business and ADDRESS/,?-,5/ 1Y. UJII d4F/ - �+��7 *.. FIN Professions Code): T B 1 1.21 -85 ING ❑ I, as owner of the property, or my employees with SS •�}•��'�� wages as their sole compensation,will do the work and TY the structure is not intended or offered for sale(Section AI•} f],�]q.3 V 7044, Business and Professions Code). NGTEL. ❑ I, as owner of the property,am exclusively contracting RACTOR NO. ]�.3Vwith licensed contractors to construct the project (Sec- ESStion 7044, Business and Professions Code). IRED TOTAL SETBACK FRO CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP.LINE WIDTH QQ I hereby affirm that there is a construction lending agency for FRONT 6125- the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 'o P.L. Lender's Name <<la ' LDMA Ref. # Lender's Address P.C.Fee$ Permit Fee J✓ (J > /' @ I certify that I have read this application and state that the Issuance Fee t/ .0 LDMA P/C# = above information is correct. I agree to comply with al County Investigation Fee ordinances and State laws relating to building construction, Total Fee ki sv LDMA Perm. # and hereby authorizer resentatives of this County to enter 3 upon the above-men;; ed property for inspection purposes. _ =--rr" � Q // J �" SEE REVERSE FOR EXPLANATORY LANGUAGE o i Signature of Applicant or Agent Da e ti O COMPENSATION DECLARATION _ •�7oinsure,"o ier of'..A tj at I,have 3 cert`jlcate of'�con'sent to self Q r a certificate of Vtior�Cers'Compensation Insurance, 'APPL!CATION F®R BU'L®iNG PERMIT or a cetified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PoIicyNoJDO Company 4-ST' wbm) 1:1Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS L7j0 1�7�-L /J �V• ❑ Certified copy is filed with the county building inspec- BUILDINGt tion department. ADDRESS • _ rt Date Applican ( CITY C ZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT G �'. NOW ON LOT G CROSS ST. C ' V C- . COMPENSATION INSURANCE Gy (This section need not be completed if the permit is for one S p BLOCK LOT NO. A55E3 OR Lr PAGE PARCEL hundred dollars($100)or less.) TRACTMAP L TEL. USE ZONE MAP / I certify that in the performance of the wo htch this OWNER NO. NO. S permit is Issued, I shall not employ �Y a ADDRESS , L-Vt 'ILS CPECIAL ONDITIONS so as to become subject to the Wo O _ CITY ZIP V NOTICE TO APPLICANT:Date Pflica or making this Certificate of ARCHIT OR TEI. DISTRICT T UP TYPE FIRE PROCE SED BY O Exemption, you should become subject to the Workers' ENGINEER (�t If TW —G Z CONST. ZONE //�///$Compensation provisions of the Labor Code, you must forth- ADDRESS �d �a C �I�• *G 5(} .l`ew I l/r Lt•I with comply with such provisions or this permit shall be - LL deemed revoked. TEL.* STATISTICAL CLASSIFI ION APT. C DO. U) CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS e I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWEZAPPG6 (commencing with Section 7000)of Division 3 of the Business and L LIC.Professions Code, and my license is In full force and effect. CITY •rT• CLASS BK. b�1L7 inmii2 3 S 1(,��>7 g SIZE . ' — ry STORIES � AMR E CHECK I 1.76524 License Number Lic.Class /O (� NEW I VALUATIO = �ontraetor I Date (.o_tS DESCRIPTION OF WOR ,. S o 1,7 6 x 2 4 3 ❑I am exempt under Sec. /Y� `� ADD ❑ :' d ® 1 (127-87 3 ALTER ❑ $ B.BP.C, for this reason REPAIR ❑..� Date: USE OF lI ' DEMOL ` EXISTING BLDG. /V ❑.. Signature APPLICANT ,! SEL. �', � FINAL g OWNER-BUILDER DECLARATION PRINT /v� lI �llLaC ;M V NO. 1DATE I hereby affirm that I am exempt from the Contractor's License p % ? 7 Low for the following reason (Section 7031.5, Business and ADDRESS 77 Ct � �✓` u -'i ` -� NPAC 9 6 7,0 A Professions Code): ❑ y BUILDING •� jb N, r # o 0 0 0.23 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY 1 a 1 9 0 7 the structure is not Intended or offered for sale(Section 044, Business and Professions Code). MOVING TEL. LI as owner of the property,am exclusively contracting CONTRACTOR NO. ° ° 1 9 5.0 7 6 with licensed contractors to construct the project (Sec- ADDRESS .0524-88 tion 7044, Business and Professions Code). 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 / / �� ' 9 b 7 1 A the performance of the work for which this permit is issued P.L. 7' 7 tF (Sec. 3097, Civ. C.). SIDE �� # 0 0 0 0 0 1 P.L. Is o Lender's Name / /�' 12.31675 m P.C.Fee$ / �VJ ,? Permit Fee 3C��}� LDAAP Ref. # Lender's Address ^ 0 2 3 1 6 7 5 I certify that I have read this application and state that the `3' ,� Issuance Fee ( S� t LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 524-88 00 ordinances and State laws relating to building construction, Total Fee5 LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE or ent pate • .:A- 1d!'IOVORKERS' COMPENSATION DECLARATION' sLeelsy affirm that I have certificate of consent to self P P L I'CAT I O N FOR BUILDING PERMIT insure, or a certificate of Workers!Compensation Insurance, 'or a.certified copy thereof (Sec. 3800,�tb. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 'P9�Ccmpany�✓•�✓fi d✓/ . .`BUILDING �� v� ' ❑' Certified copy is hereby furnished.. � FOR APPLICANT TO FILL IN BUIL I s Cert'fied copy is filed with the lidding inspec- BUILDING do de ittrtment. I ADDRESS Date 7 APlican CITY' G'��✓ ✓7� ZIP ,° LOCALITY el�t,1 ` INO.OF BLDGS. :. NEAREST CER FICATE 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 BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) // TEL. USE ZONE MAP OWNER / !�l NO. S, 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 l��f, `�G QGC 7�0� CONDITIONS a so as to become subject to the Workers'Compensation Laws. A- q/B O CITY L !/� .�A ZIP Date ' Applicant ARCHITECT OR T ix DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST ZONE' U Exemption, you should become subject to the Workers' r, , Compensation provisions of the Labor Code, you must forth- yi ADDRE of a- with comply with such provisions or this permit shall be STATISTICAL CLAS IF APT. CONDO. N deemed revoked. i CONTRACTOR 1•F �A/l TEL ��OO��;. Z LICENSED CONTRACTORS DECLARATION LIC. p / CLASS NO. DWELL. LIC. I hereby offirm'that I am licensed under provisions of Chapter 9 ADDRESS�� C ��✓ Y NO. c7 SC 6�` /` LIC. /r ! SEWER MAP (commencing with Section.7000)of Division 3 of the Business • CITY er/�► �CU°''P CLASS L -�V - and Professions Code,and my license is in full force and effect. ! BK PG VALIDATION License Number � 77 Lic. Class Ltf) SIIZE��7 0 -) STORIES d ]FAMILIES �°? ONE K t" //�/� r f •'�` VALUATION av Contractor '�" ��i` /�✓C Date' a �� DESCRIPTION OF WORK !` NEW $ 2� 147 /9W�. ' ADD ❑ :r D ❑I am exempt under Sec. _ ALTER ❑ B.BP.C. for this reason $ REPAIR'❑ ." Date: USE OF � EXISTING BLDG. C 0�� ^- DEMOL ❑ ', - • Signature � APPLICANT J pp TEL. o (PRINT)/ �/'li�le9G�,C�A�/ N /1J ��D�J FINAL O R-BUILDER DECLARATION / ll DATE L ^i"•"":'• =":s ''"'�I I hereby affirm that I am exempt from the Contractor's License ADDRESS d� er A V Law for the following reason (Section 7031.5, Business and FI Atm ` e:I; ,:6; -- Professions Code): PRESENT `7• B "- El 1, as owner of the ro to BUILDING - P. Pert Y� or m Y em P Yees 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. ti_"'_ ---.- -s.?_: • 5r. with licensed contractors•to construct the project (Sec- ADDRESS i•- tion 7044, Business and Professions Code.) --r- 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 FRONTU. '=L the performance of.the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE .. _... _ Lender's Name P.C. Fee$. / /• (1� Permit Fee 3 LDMA Ref. # Lender's Address ► _ __ I certify that I have read this application and state that the Issuance Fee LDMA P/C# above info tion is co ct. I agree to-comply with all County Investigation_Fee, - t; ` : ordinan Sta a aws relating to building construe"on, Total Fee F s , LDMA Perm. # ``` '`+- s and h eb thori representatives of this Coun to nter I upo th ve- ntioned property for inspect'o Pur oses. XSEE REVERSE,FOR EXPLANATORY LANGUAGE Signatur` of Applicant or Agent ate ORKE;tS'COMPENSATION DECLARATION "Lnsure, affcertifi cj I hovt� cs�ti{om a of cion i of to self APPLICATION R BUILDING F E I N E RM I T or a certificate c�'Workers'Compensation Insurance, tl� V itified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. BO -9Company <TAA-M fr-►f5ll�T) BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 2el Z LV ❑ Certified copy is filed with the count building inspec- BUILDING y j. tion department. ADDRESS (i��-�7J Date Applicant CITY �f% L� ZIP LOCALITY ERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT f� ! 3` NOW ON LOTS CROSS NEARESST. COMPENSATION INSURANCE (This section need not be completed if the permit is for onet ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. / �;;MAP BOOK 46- PAGE PARCEL V iU TEL. 'USE ZONE MAP I certify that in the performance of the work for which this 9 -VOWNER NO. NO. 2-6 It permit is issued, I shall not employ any person in any manner s I�( �` SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS t. L• CONDITIONS O U CITY ' ZIP C=LDate Applicant ARCHITECT OR TEL. DISTRICT G OUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER G �� CONST. ZONE 0 Exemption, you should become subject to the Workers' _ ' / () Compensation provisions of the Labor Code, you must forth- ADDRESS � v&- �61 1 V I _5 DW. with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFIC TION APT. J CONDO. fn deemed revoked. CONTRACTOR NO. �- LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS 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 ��11 LIC. " SEWER MAP Professions Code, and my license is in full force and effect. CITY l r (! , CLASS Y BK. —PG. VALIDATION f CHECK License Number 062a Lic.Class � SIZE � TORIIES � AMIOLIES CONE Will- � / NEW VALrUATI N Contractor� LWDM �� Date DESCRIPTION OF WORK (� $ ❑ I am exempt under Sec. L-A)/ ADD ❑'° ® t 8 2 2 Q A ^ ��] ALTER ❑.. # 0 0 0 0 y', B.BP.C. for this reason 4-J, LA REPAIR $ /�y/J► /� ( 1.765-4 Date: USE OF ,L,t�+ DEMOL ❑ _ v- [/ EXISTING BLDG. �" Signature APPLICANTn `��1 L NO. FINAL ,JJ� 1.i 6 5 2 4 PRINT T r/ OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License ( G Law for the following reason (Section 7031.5, Business and ADDRESS FINAL—G Q. Professions Code): PRESENT /BY ❑ BUILDING ,� 6,� 0 Z7 Q 9 6 I, as owner of the property, or my employees with ADDRESS f- 6 8 A ! wages as their sole compensation,will do the work and o i 09 0 2 3 the structure is not intended or offered for sale(Section LOCALITY I 7044, Business and Professions Code). MOVING TEL. 00 0 0 1 p 5. 7 5:E3I, as owner of the property,am exclusively contracting CONTRACTOR NO. 0 52 47 y with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). �. REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ` 3 I hereby affirm that there is a construction lending agency for FRONT i f the performance of the work for which this permit is issued P.L. }Z� Z' ��+ 1 2 3 1 6 (sec. 3097, Civ. C.). P.L. . ` 1 t�_ �, !� - 231 6755 Lender's Name r/ LD MA Ref. # o524-88 m P.C. Fees ,4( C Permit Fee O� �V � Lender's Address �) I certify that I have read this application and state that the ��U Issuance Fee Q Sv LDMA P/C# g above information is correct. I agree to comply with all County Investigation Fee 0q ordinanc +ad�tate laws relating to building construction, Total Feee� LDMA Perm.# 0 and here a repres tatives of this County to enter m upo e-e ova- d r party r inspection purposes. n �3�' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 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 BL08 010125008 PHONE: (626) 285-0488 EXT: LEGAL ID: N0. OF CONST BUILDING ADDRESS: 1TR: 5904 LT: 92 SQ. FT STORIES TYPE 6230 ROSEMEAD BL I ISTRUCTURE: 30 V-B 1 TEMP CA 917801565 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15384-005-008 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl TENANT: (EXIST BLDG USE: RESID USE ZONE: R-3 ISSUED ON: PROCESSED BY: 1 1EXIST OCC GRP: 101/25/11 SR OWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: IFI FI t Y: CODE: IBANH, HO (909) 598-8988- 1 9,800 1 1 16230 ROSEMEAD BL. I I I ITEMPLE CITY CA 91780 I FEES PAID I SCR TION OF WORK I [TEAR OFF EXISTING ROOFING MATERIAL, 4 PLY HOP MOP, ENERGY [ [ FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:JSAVING TITLE 24 [APPLICANT: TEL. NO: I I I IMELODY, MAO-THAM (909) 598-8988- 1AA BLDG PERMIT ISSUANCE 27.80 I [ 1516 N. DIAMOND BAR JAB STATE GREEN BLDG FEE 9800.00 VAL 1.00 ISPECIAL CONDITIONS: [ DIAMOND BAR CA 91765 [AC STRONG MOTION RESID 9800.00 VAL 1.00 ID2 PERMIT W/O EN-HC 9800.00 VAL 217.10 I [ TOTAL FEES 246.90 ICONTRACTOR: TEL. NO: [ (APPROVALS DATE INSPECTOR SIGNATURE [ ISUNSHINE ROOFING INC. (626) 581-7688- I 1 I 1516 N DIAMOND BAR BLVD #183 LIC. NO [ ILOCATION AND SETBACKS [ [ IDIAMOND BAR, CA 91765 755126 C39 [ I-. I I I ISOILS ENGINEER APPROVAL 1 1 1ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNDATION/TRENCH FORMS I [ I 1 LIC. NO: [ 1SLAIVUNDER FLOOR 1 1 1 IRAISED FLOOR FRAMING I 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION 1153H265 3 001 1 1 I I [ I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I- I I I 1 NO 21 1 IROOF SHEATHING 1 [ 1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS [ [ (AIR QUALITY: 1000 FEET MATERIALS [ I I [ NO NO NO [ (FRAME INSPECTION [ [ I 1FIRE SPRINKLER HANGERS 1 1 1 11NSULATION/WEATHER STRIP( I I 1 1 11NTERIOR LATH/DRYWALL I [ I [ I 1EXTERIOR LATH I I I I I IRATED FLOOR/CEIL ASSEM. 1 1 1RATED WALL ASSEMBLIES 1 I I I 1 (RATED SHAFTS/OPENINGS 1 1 1 IT-BAR CEILINGS I I [ I � I [ I ILOT DRAINAGE 1 I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I