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Home My Public Portal About6233 ROSEMEAD BLVD_Building__ 869 SSM BETS 6-46 i - .--r EPARTMENT OF BUILDING AND SAFETY , APPLICATION FOR PERMIT A COUNTY OF LOS ANGELES nn WM. J. FOX, CHIEF ENGINEER U 0 L 1Now- FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING v/� A11zpj"a' ✓fDISTRICT NO. PLAN CK. NO. PEEERMIT NO. ADDRESS (/J •C1 ��'✓yL.'V 4M;»✓fie&'` �"�+ /, / /�Cx LOCALITY V, ZIVED BY DAT,Ery-.OF AP Lam.• DATEISSUED NEAREST ►yi' Ll /6 'G M'1' A, CROSS ST. l�,�W+�l/ •Lfcl+ L � �� f BUILDING /.y ADDRESS (a / 1/—tea ca �--� ✓�-� (i�` OWNER �j r MAIL 1 •`�d <�I��f �T '�_.r i;'r(Qj! LOCALITY ADDRESSta/'�` ! �( �L.• --- r•{� cRoss N ' ST.o�T ,� /�. FIRE NO.OF /7 ARCHITECT OR TEL. ZONE .. I PLANS .I TYPE Y I GROUP ENGINEER Vt �`\_ NO. BLDG. ORD. NO. ADDRESS SETBACK LINE APPROVED STEL. BY DATE CONTRACTOR �-�� NO. ' USE f APPROVED 'ADDRESS ZONE&f BY DATE LEGAL DESCRIPTION I LOT NO. I BLOCK CORRECTIONS TRACT a /a•'b/- 526" /- NO. OF SLOGS. ' +' b SIZE OF LOT/4 es'le �w1� NOW ON LOT usc orEXISTINQ BLDG. /�GrL�o ! +�/"I FAMiLIEN J I ROOMS DESCRIPTION OF WORK J NEW ALTERATION ADDITION O 7u REPAIR` ! / MOVING / DEMOLISH _ 0_ SW. rT d,,�t�/ R OMB / STORIES ` 10 Z SIZE r r WALL I ROOF COVERING 4�_Jei� COVERINQ •`1le• USE OF NEW p ""f BUILDINGtGr� (_ s 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS A AND STATE LAWS REGULATING BUILDING CONSTRUCTION. � FRAME: FIRE STOPS, \ SIGNATURE OF • BRACING, BOLTS 1� /^, OWNER ] , LATH, INT.: AUTHORIZED AGTT . It , LATH, EXT.: �J p, C,G PLASTER, INT. FEE PLASTER, EXT. N ^ VALUATION � � FEE FINAL I ' ' DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES B U 0 L®I N G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING f DISTRICT. PLAN CK. NO. PE MIT NO. ADDRESS ,? �i./ o 'v•O �i D y/ l LOCALITY ��i�/l �/ 1VED BY DATE OF APPL. DATE ISSUED NEAREST - � �v S CROSS ST. BUILDING /,� '7 ADDRESS OWNER jje .A Z5 0. A : C� MAIL ar n-,� _`� LOCALITY e TADDRES66 /V, �5dAe7 /5 NEAREST ® N C D r N CROSS ST. CITY C��"t��?� (�// y TEL O. L6 FIREZONE I NO. OF .iy l TYPE _=JwGROUP- f ENGINEER ARCHiTECT OR� A/.X NO BLDG.' PL`A�NS NO SETBACK LINE y -GJ /— d`�^' /ORDr 90n ADDRESS i APPROVED . TEL.'- BY DATE CONTRACTOR /I -S . , ['y NO. W�7 USEAPPROVED ZONE s Y DATE 4-w HOUSE NUMBERING LEGAL DESCRIPTION LOThCr BLOCK MAP NUMBER FIELD CHECK BY TRACT Q •-,4 NO. ASSIGNED BY DATE / I NO. OF BLDGS. CORRECTIONS SIZE OF LOT� � NOW ON LCT L/ USE OF �7 yy�� NO. OF EXISTING BLDG, jQf/�VL/Arl(- 71071 ' FAMILIES DESCRIPTION OF WORK NEW I I ALTERATION I I ADDITION 0 REPAIR I I DEMOLITION I I SQ. FT. NO. OF �� Q SIZE G ROOMS STORIES z EXT. WALL �'�/�f L ROOF e r COVERING COVERING USE OF STRUCTURE Dom,✓• APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT.' _ I 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS,- •fes, HEREON AND WITH ALL COUNTY ORDINANCES,AND STATE . BRACING, BOLTS LAWS REGULATING BUl DIN ON 'T RUC I FURNACE. LOCATION, v SIGNATURE OF . J' GAS VENT, DUCTS PERMITTEE___' 1' LATH, INT. J ADDRESS— LATH, EXT. V AUTHORIZED AGT. PLASTER, INT. �ewasaw•Haas so-so $ �. P. C. $ ti m /� m FEE PLASTER, EXT. VALUATION r $ �® C�• .' ) /� (J 7 FEE VVV FINAL 10 I j 1, WORKERS'COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I hereby affirm that I have a certificate of consent to.self 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. Co.mpony Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 6BUILI)ING / Certified copy is filed with the county building inspec- BUILDING t 2Q� �Vf 1�/a� tion department. I ADDRESS ,J fry/ t Applicant CITY �V!{� �� (/�TZ- Date ZIP ?o LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT v U 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 TEL. I certify that in the performance of the work for which this ' OWNER 1 O Fri' USE NE NO permit is issued, I shall not employ any person in any manner 7 / SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS l/ �1 1% CONDITIONS CITY , ZIP Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate ofENGINEER NO. 71�WPR� UP CONSTYPE FIRE PROCESSED BY T, ZONE / Exemption, you should become subject to the Workers' r/ Lli'J J Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICAL CLASS ON APT. J=NDO. 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. 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 CLASS I BK.[ PG. U VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES I FAMILIES ONE✓1 V / VALUATION Contractor Date i DESCRIPTION OF WORK 19 ^� NEWs C): 0* I am exempt under Sec. 1 6 ADD ALTER $ , a B.BP.C. for this reason � REPAIR N USE OF Date: EXISTING BLDG. DEMOL Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT NO. DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS F Law for the following reason (Section 7031.5, Business and ('rof ssions Code): PRE EN 1 0 5 n BUILDING n 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 , }` 0 0 0 0 0 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. ° - 6(150 with licensed contractors to construct the project (Sec- ADDRESS ° ° ° 6 Q 5 0 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK gLIINEF WIDTRO H 10,3 1 '"8 8 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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name i LDMA Ref. # Lender's Address P.C.Fee$ Permit Fee V V L! I certify that I have read this application and state that the Issuance Fee (/ LDMA P/C# ? above information is correct. I agree to comply with all County Investigation Fee / ,0 ordinances and Stat laws relating to building construction, Total Fee (/t S LDMA Perm.# and hereby thori esentatives of this County to enter upon the v - n o raprty for inspection purposes. -A-A) &.2 , `'— 7 SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of plicant or Agent Date I WORKERS'COMfENS/&TION DECLARATION I'rTerrly affirm that I have o cdrtlficafe of consent to self insure or a certificate of Workers'Compensation Insurance, APPLICATION FOR BUILDING PERMIT or.a crtified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND FETY PolicyVo. Company ElCertified copy is hereby furnished. FOR APP T TO FILL IN BUDDINGO 6E M2b Y) ADDRESS �v� (�(/ ❑ Certified copy is filed with the county building inspec- BUILDING - j , J tion department. ADDRESS 1x.1/ Date l _Applicant CITY ) ZIP LOCALITY _ 61r CERTIFICATE OF EXEMPTION FROM WORKERS' �O � NO.OF BLD S. NEAREST SIZE OF LOT COMPENSATION INSURANCE NOW ON LOT CROSS ST. (This iection need not be completed if the permit is for one ASSESSOR hunded dollars ($100)or less.) TRACT BLOCK LOT. MAP BOOK PAGE PARCEL TEL. 7 USE NE MAP I certfy that in the performance of the for whi h this OWNER �(,��Z NO. fa I NO. permit is issued, I shall not employ any p nner ) �/ fL3 SPECIAL so o0o become subject to the Worker ' p i L S. ADDRESS L t'/ 1! ff�� CONDITIONS I � CITY ZIP Date• Applicanf ARCH( ECT OR. — TEL. NOTICE TO APPLICANT: If, after ma ?Wer of &awDISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER NO. CONST. ZONE Exe+lon, you should become subject to the Workers' ,/ Compensation provisions of the Labor Code, you must forth- ADDRESS — /V `_/ with(comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. JgO 4DO. deemed revoked. CONTRACTOR NO. I LICENSED CONTRACTORS DECLARATION , LIC. CLASS NO. DWELL. UNITS I her#by affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (comkmencing with Section 7000)of Division 3 of the Business andVV LIC, Profusions Code, and my license is in full force and effect. CITY tl CLASS BK PG VALIDATION SQ. FT. /� NO.OF NO.OF CHECK Lice a Number Lic.Class SIZE Q STORIES FAMILIES ONE- V VALUATION ContF.C.0exempt tr Date DESCRIPTION OF WORK ADD ❑ $ /Y 91 I ❑ under Sec. T ALTER ❑ _ B.BP.C. for this reason ❑ $ Pilo. '� . --'J REPAIR '''I' 10 Date: USE OF 1 DEMOL ❑ ;L ITER-13- -EXISTING I BLDG. / Signature APPLICANT TEL. FINA TOTAL �+s OWNER-BUILDER DECLARATION (PRINT) NO. DAT I-: a 0.901 I heieby affirm that I am exempt from the Contractor's License (yR'r;j' La for the following reason (Section 7031.5, Business and ADDRESS -2 3 FINAL ti t t;t- Professions Code): PRESENT ByJ _i _- t� BUILDING }T' I, as owner of the property, or my employees with ADDRESS 7`1 wages as their sole compensation,.will do the work and the structure is not intended or offered for sale Section LOCALITY ' i f; _�(,, i •'' i's`` 7044, Business and Professions Code). MOVING TEL. i I, as owner of the property, am exclusively contracting CONTRACTOR NO. i?', : ' `�' with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). ! REQUIRED YARD HWY TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY 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 permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Nome (..�'7 �f� LDMA Ref. q s P.C.Fee$ Permit fee 1 G •-� `•'' Lender's Address I certify that I have read this application and state that the Issuance Fee l v • J� LDMA PSC ft above informa'on is correct. I agree to comply with all County Investigation Fee I J D C� ordinances a St to laws relating to building construction, Total Fee J r LDMA Perm. # Q and hereby, ze rep sentatives of this County to enter upo �,.,..�fAppkanl'or_Age_nt operty for inspection purposes. i op- SEE REVERSE FOR EXPLANATORY LANGUAGE i Date j