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Home My Public Portal About6246 ROSEMEAD BLVD_Building__ Al' APPLICATION F'OR 'BUILDING PERMIT 81-=-4 FOR APPLICANT TO FILL IN (Print or type only) [ADIDRE � � -COUNTY OF LOS. ANGELES KK 1 FNDEPARTMENT OF COUNTY ENGINEER M?Lf �1 ZIP7 BUILDING D SAFETY DIVISION LDING $ S 1� NOW ON LOTS 2 ADDRESS l(j�-�SO- (�� nLRa TRACT BLOCK LOT NO. ` ' LOCALITY' f I��r O NOLi7 TEL" � ml? ROSS ST, r w, N'/�i�A ASSESSOR CITY MAP BOOK PAGE PARCEL . SDISTRICT GROUP TYPE FIRE PROCESSED BY CITY ENGINEER OR/1,��w ( SC 11 TEL NO ��69� STATISTICAL CLASSIFICATION CZONE yq c(�aJJLw� f/ /'�L �V/V O 'SEWEnR MAP ADDRESS (Ord % PJOft I&Ift 8 " CLASS NO. O DWELL.UNITS a BKI�Ia-PG CONTRACTOR TEL.NO USE ZONE MAP NO. O V LIC. .� ADDRESS NO, SPECIAL LIC. � CONDITIONS 4 e CITY CLASS CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ _ NAME AND BRANCH BLDG,SETBACK FROM FRONT PROP.LINE OF (STREET) G ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING C HIGHWAY 'F YARD C- Q. F41olG NO.-OF NO. OF O CHECK FRONT PROP. LINE. HIGHWAY. WIDTH p SIZE STORIES / FAMILIES ONEy�� C NEW + = IQ�` Q 0" u DESCRIPTION OF WORK p v ADD SIDE PROP.LINE OF (STREET) 2 ALTER ❑ HIGHWAY •F YARD = TOTAL SETBACK FROM TYPE OF EXISTING ❑ REPAIR SIDE PROP. LINE HIGHWAY WIDTH USE TI � DEMOL ❑ + o EXISTING BLDG. � - APPLICANT /�A` TEL6JI CORNER CUTOFF YES ❑ NO ❑ (PRINT) " N0. IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE)�P/I ��/j� IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ d�i/W 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- IMPACT REP T PROCESSED (DATE) STRUCTION. ,1. CERTIFY THAT IN DOING THE WORK AUTHORIZED _� HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE m LABOR CODE OF THE STATE.:O'F -CALIF.ORHIA' IN RELATING':T,O; ,_, WORKMEN'S COMPENSATION INSURANCE. e - ,, SIGNATURE OF - PERMITTEE / ADDRESS _ FIN-A'L BY ..•TELCITY .. DATE `P.,C: PMT. MA KE CHEC"KS'PAYA13LE:7,,;Ol: FEE.,$ `` � FEE HARVEY T. BRAN DT:.i:GObN"MY••ENGI.N.EEIR :•:/��, Y PLAN CHECK VALIDATION ' CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH . 3 6 8 '3 tvGv 28••2 3 D 6 9A OA 78p838p CE#803 12/72 J . n q APPLICATION FOR BUILDING -PERMIT Fq9 A...PPLICANT T&FILL IN (Print or type only) BUILDING �� COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY �� ZIP BUILDING AND S Y DIVISION IND.OF BLDGS. BUILDING_ SIZE OF LOT --"NOW ON LOT ADDRESS TRAC9.0w BLOCK LOT NO. 9.9LOCALITY n TEL. NEAREST OWNER lJ J/V NO CROSS ST. ASSESSOR ADDRESS S MAP BOOK - PAGE PARCEL r DISTRICT _GROUP TYPEFIRE SSE BY CITY �/ ZIP CONST. ZONE ARCHITECT OR TEL. Q ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAlf ADDRESS CLASS NOc2-aDWELL.UNITS 4jF_BK4�2-PG CONTRACTOR e NEOL. - USE ZONE �G� MAP N.O. C�3 ADDRES /Q 4dAlD.1Ljd, NO. D L CSPEC AL OEDIT ONS CITY LIC. n CLASS (�-� ROAD DEPARTMENT APPROVAL,REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) C ADDRESS CITY CHIGHWAY + YARD TOTAL-SETBACK FROM TYPEOF EXISTING SQ. FT I NO. OFNO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH p SIZE STORIES FAMILIES ONE F DESCRIPTION OF WORK Q �r NEW ❑ + O ❑ BLDG,SETBACK FROM v ADD SIDE PROP.LI NE OF (STREET) ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE E SOT NG BLDG. ��G DEMOL )01 + APPLICANTTEL jA,?�� CORNER CUTOFF YES ❑ NO ❑ (PRINT) C OU NO.Q'�'/'(Q ` BY (SIGNATURE IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY AlNOWLEDGE 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. IC THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSA ON INSURANCE. SIGNATURE O PERMITTEE ADORES oe QQLl +r NO. DATE FINAL. (�fi/ IBY" CIT Ur�J �/l DATE �2r -�/ MAKE C.HEC KS PAYABLE TO: FEE � FEE HARVEY T. BRANDT, COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH 0 4 2-it DEC 6 1 0 9.0 0 A-98 76AGSBA CENS03 12/72 - 9 I WORKERS' COMPENSATION DECLARATION I I' hereby affirm that I have certificate of consent Self I APPLICATION FOR BUI L D I N G PERMIT insure, or a certificate of Workers' Compensation Insurance, I or a certified copy thereof(Sec. 3800, Lab. C.) • � COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING /�� PY � Y ADDRESS � ,. ❑ Certified copy is filed with the county building inspec- FADDRESS 6 �� bt5'��rtion department. �7Date Applicant ZIP /� �O LOCAU �.NO.OF BLDGS. NEAREST 07CERTIFICATE OF EXEMPTION FROM WORKERS' �7NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT,= BLOCK. '�� LOT NO. Tp�, MAP-BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL_ OWNE ujs- J.�l NO•a �� USE ZONE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not empty rs n in a anner ADDRESS 6 � N, �� SPECIAL tW CONDITIONS so as to bec me subiect•to theWork e" n Laws. OO cIDL - ZIP p � Date App' an ARCHITECT T DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE T AP LICANT: I , after making This ificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' ��/ Compensation provisions of the Labor Code, you must forth- ADDRESS O W a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. -- Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. AX UNITS I hereby affirm that Lam licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP rti'ti{ a a (commencing with Section 7000)of Division 3 of the Business LIC. __ _ and Professions Code,and my license is in full force and effect. CITY CLASS BK. PG. -=i1TALIDATION 1 j ii r a ijr, SQ. FT NO. OF / NO. OF CHECK License Number Lic. Class SIZE STORIES ! FAMILIES '�` ONE i• ITEMS". VALUATION DESCRIPTION OF WORK NEW M I -• 13•t 1" i 0r Contractor Date Rr ADD ❑ $ =3 LJa!1: ❑1 am exempt under Sec. � �� CH =•I. ' ALTER ❑ �� IJ DO-"� � B.BP.C. for this reason REPAIR E=•+ NGEE (,0 U�'C'�� s� ❑ $ Date: USE OFD ElEXISTING BLDG. A4*a -;gkp �-I Signature APPLIC NTT f/1 (may NO ,_yam- FINAL E L. 0l000—i I0 11 Sf!fir i'1 OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License _ �� DATE85646AM (j;.I(_I Law for the following reason (Section 7031.5, Business and ADDRE 2,, �lc� FINAL Professions Code): PRESENT By ❑ I, as owner of the property, or m em to ees with BUILDING P P Y� Y P Y 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. 1 ,i��Vo I;as'owner of the property,am exclusively contracting CONTRACTOR NO. ' " El 1 ��`� -. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED L SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAPROP. LINE WIDTH eK 4-7 1hereby affirm that there is a construction lending agency forFRONT G,o "L•'r i y, the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). te 1 'E '=' 1-LITi-1 5 3 8 o 17 Lender's Name LDMA Ref. R 'C'.ECK r�_� 1' P. Permit Fee ' a t Lender's Address , i-•• 3 l0• �•i If�NGE ,I;lj 0 1 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 Inee 17 ordinances and State laws relating to building construction,. �O 7,Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter ^;_I f upon the above-mentioned property for inspection purposes. : .-I.. AiN1a�. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date