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Home My Public Portal About6247 ROSEMEAD BLVD_Building__ APPLICATION FOR COUNTY OF LOS ANGELES COUNTY BUILDING PERMIT DEPARTMENT BUILDING A OF AFETY DIVISIONER fl BUILDING FOR APPLICANT TO FILL IN = ADDRESS r BUILDING 6So �� LOGALIT ADDRESS CITY �l L C'! NEAREST IP CROSS ST. c G 7�0 OF BLDGS. J ASSESSOR SIZE OF LOT •Q / /J KNOW ON LOT �y MAP BOOK PAGE PARCEL �r DISTRICT JGROUP TYPE FIRE J,�PBJ2;)Q�ESSED BYTRACT & BBLO//C��K�� /� LOT NOO. �J P CONST. Z OWNER da7,D) C-0 J �*4 1 45 NOLtYOr7' �►a� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ��(j, gCi CLASS NO�DWELL•UNITS BK PG CITY fP ll ZIP C ` US ZONE MAP 7 NO. pG�J t ARCHITECT OR TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR TEL. BLDG.SETBACK FROM LIC^ No. O • FRONfr PROP.LINE OF (STREET) ADDRESS r Y- NO. HIGH Y + YARD TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP. LINE ' HIGHWAY WIDTH CITY CLASS _ CONSTRUCTION LENDER + NAME AND BRANCH o BLDG.SETBACK FROM SIDE PROP (STREET) C .LINE OF ADDRESS CITY r_ SQ. FT. NO. OF NO. OF CHECKHIGHWAY + YARD = TOTAL SETBACK FROM E OF EXISTING b SIZE STORIES FAMILIES ONE SIDE PROP. LINE HI AY WIDTH cC DESCRIPTION OF WORK Jill C� r NEW ❑' + p f� t to ADD ❑ CORNER CUTOFF YES ❑ NO ❑ c ' ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR❑, USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. - DEMOL ❑) APPLIC �T`. dYj'1'►.1 TE (PRI ). N0. 4y�//r/�/1✓�-'� 4/?Y..•) L.i��.i��r( G�l /� BY (SIG I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSA N UR E• SIGNATURE OF FINAL �J BY PERMITTEE �'P DATE 19/7 ADDRESS /s �( CITY J? 4— C. i No�• �j,,D, 1 P.C. Fee$ Permit Fee VALUATION P 6 Issuance Fee ((( TO�� PLAN CHECK VALIDATION CK. M.O. CASH ® PERMIT VALIDATION GK. M.O. CASH 326r :O9 1l 1 D 21.758• 76A698A CE OB03B 12/75 ° APPL1ION FOR BUILDING PERMIT COUNTY OF L S AAIgEtEp BUILDIN AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APP ANT TO FILL IN BUILDING DRE I hereby affirm that I have a certificate of consent to self insure, BUILD G D or a certificate of Workers'Compensation insure e, a certifi d copy therec.3800,Lab.C.) CITY tM �� ` ZIP r� v LOCALITY Policy NO Company SIZE OF LOT rO.OF BLDG&NOW ON LOT ❑ Ce '' copy is ereby furnished. NEAREST CROSS ST C Certified copy is iled with the county building inspecti TRACT BLOCK LOT NO. depa 4 USE ZONE MAP NO. Date ` Applicant ASSESSOR MA BOOK PAGE PARCEL SPECIAL CONDITIONS CERTI KATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS 2,q DISTRICT GROUP TYPE CONST.ZI PROCESSED BY dollars($100)or less.) C — P r l I certify that in the performance of the work for which this permit (� �.J n is issued, I shall not employ any person in any manner so as to AR�TECT O NGINEER TEL NO -01' R - Vr F.F1 become subject to the Workers'Compensation Laws. . STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. C;V DWELL UNITS NOTICE 70 APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CON Fes} �/l• SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith v/S V U FRONT comply with such provisions or this permit shall be deemed revoked. ADDR PL O. s' 3;i SIDE LICENSED CONTRACTORS DECLARATION C LIC.CLAss PL I hereby affirm that I am liaen derprovisions of Chapter 9 - l/ SEWER MAP >" (commencing with-See 7000)of Div ion 3 of the Business and SO.FT.SI NO.OF STORIES NO.OF FAMILIES a Profession5,Code' and my license is in gill force and effect. NEW ❑ BKI PG ® � Licensg N b IC.Class •�� DESCRIPTION OF WOR _ O ADD ❑ VALUATION 9 / 0 Co. Tact a .� ALTER ❑ � 15:1 ` v w l f^v REPAIR CO) ❑ 1 am under Sec. r' `/ Z� Z BAP.C.for this reason �� 0 �" DEM ❑ LDMA P/C# Date: USE OF ENING BLDG. 1 /G. URM ❑ Signature AP LI N fPAINJ F C�� Q LDMA Perm# y ❑ I,as owner of the property, or my employees with wages as v / T Z their sole compensation, will do the work and the structure is ADDRE�S&r r 4 j— not intended or offered for sale (Section 7044, Business and V(�7 eb /V't CJU FINAL DATE Professions Code.) LL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL S :3 i y I L iyv OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J TC-1-1 ❑ I, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 1 r f.' �•' 3 licensed contractors to construct the project (Section 7044, �l_,1 AL. 6'� .45 Business and Professions Code.) YES❑ NO❑ _L' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDINGl�fsi a �•_Ii s`f OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH J1 O CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR S/�� 1� GUIDELINES /li J �• I hereby affirm that there is a construction lending agency for YES❑ NO 11N the performance Of the Work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING � 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, D (' N JI.v TITLE 2,CHAPTER 2 20 SECTIONS 2.20.100 THROUGH 2 20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address `� Z F, I� 0 OWNER OR AGENT c I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N2t. n all county ordinances and Sate laws relating to building At n,and hereby authori presentatives of this County ISSUANCE FEE m o theveINVESTIGATION FEE TOTAL FEEm scoM a Alden ONo SEE REVERSE FOR EXPLANATORY LANGUAGE