HomeMy Public PortalAbout6276 ROSEMEAD BLVD_Building__ WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of cohsent to self D D �( D
..insure- certificate of Workers' Compensation Insurance; L/"'�1� �
or a•certified copy thereof (Sec 3800, Lab C ) I
r �11" �t _COUNTY OF LOS ANGELES BUILDIWG'AfdD SAFETY
Po cy No company - '`:*, ~� - -
Certified copy'is hereby furnished ' FOR APPLICANT TO FILL IN- ' _ _ _ BUILDING �Z f
ADDRESS Y�
Certified copy is file74 the unty building mspec- BUILDING . sm
,tio depa ment , ADDRESS �L/� LOCALITY LR
NEAREST
Dare Applicant CITY �L'`� ZIP CROSS ST
RTIFI ATE•OF EXEMPTION FROM WORKERS1. NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE' SIZE OF LOT NOW ON LOT MAP BOOK I PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE MAP
hundred dollars ($100)or less )' TRACT' BLOCK LOT NO I NO
,`T TEL' :� ' SPECIAL
I certify that in the performance of the work for which this OWNER V\ NO CONDITIONS 2
permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE aEXSSEI BY „O
so as to become subject to the Workers'Compensation Laws ADDRESS CONST ZONE W
�� C ZIP ot '�' , `r 0
Date Applicant CITY i ` STATISTICAL`CLASSIFICATION APT NDO O
NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL `
LU
Exemption, you should become subject to the Workers' ENGINEER tJ0 CLASS NO DWELL'UNITS
Compensation provisions of the Labor,Code, you must.forth- ADDRESS SEWER MAP N
with comply with such provisions_'or this permit-shall be z
deemed revoked CONTRACTOR 'TEL�O NO BK' VALIDATION =
a
LICENSED CONTRACTORS DECLARATION �Q''11
I hereby affirm that I am licensed under provisions of Chapter"? ADDRESS—V` 1Z 3h ,SL��LQ.NO VALUATIO T
(commencing with Section 7000)of Division 3 of the Business and LIC ff� /�/�
Professions Code, and my license is m full force and effect ' CITY :) CLASS f $ / (/v
`�f�-yam( SQ FT' NO OF NO OF CHECK
%V{ D
License Number \ Lic•Class SIZE STORIES FAMILIES ONE
Contract Date DESCRIPTION OF WORK Z NEW $ -
I amrexempt under Sec U _ ADD
ALTER El FINAL { 2 7 2-0'A
B 8P C for this reason j S`�c�#.� REPAIR DATE- 8J # o e o 0 0,�
USE-OF
68,63
FI
e e
' Date• EXISTING BLDG _ .. DEMOL � FINA 1'
Signature APPLICANT TEL '
OWNER-BUILDER DECLARATION (PRINT)- NO o o e 6 &6 3 C6
I hereby affirm that I am exempt from the Contractor's License D
Law for the fol lowing*reason (Section 7031 4 5:,Business and ADDRESS
Professions Code) " :PRESENT �'� =$5
BUILDING c
❑+ j, 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-
the
7044, Business and Professions Code) MOVING TEL
a' I, as owner,of the property, am exclusively contracting CONT ACTOR NO
with licensed contractors to construct the project (Sec- ADDRESS, r
tion 7044, Business and Professions Code)
REQUIRED TOTAL SETBACK FROM EXIST L
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN WIDTH, D
1 hereby affirm that there is a construction lending agency for FRONT 4
the performance of the work for which this permit is.issued `_PL
(Sec 3097, Cry C ) SIDE
PC -
Q
Lender's Name '
$ Lender's Address P C Fee,$ Permit Fee �/�0
I certify that I have read this application and state that the Issuance Feb' Cl;570
' above information is correct I agree to comply with all County Investigation Fee ""
ordinances and State laws relating to building construction, Total Fee Y3
d hereby uthonze representatives of this County t enter
up b ve-mentioned projierty'for inspection p po s
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signat re of Applicant Agent Vie ®s
BS-3 25M SETS 6-46 i
DEPARTMENT --jF BUILDING AND SAFETY APPLICATIJN FOR MIT _
COUNTY OF LOS ANGELES ' D
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING DISTRICT NO. PLAN CK. NO. PERMIT NO.
ADDRESS �
LOCALITY '-:1
I EI DATE OF APPL. DATE IBS ED
NEAREST - r 2 `-- /'°
1-6
CROSS ST. �-+� .�fE..-�-✓
i
(� / BUILDING r�
OWNER .�.C.,� ADDRESS V
IF
MAIL
ADDRESS rJ y�i!f j-a t-� •.� 'r' ' C����f[Itl� LOCALITY
NEAREST
CITY r`11, C•✓ 'y TEL. CROSS ST.
NO.
FIRE JNo.or
ARCHITECT OR TEL- ZONE i PLANS I TYPE i OROU
ENGINEER r=-Q,4y- e'll NO.
BLDG. ORD. NO.
ADDRESS �- G re"';'. r . cc, "-F' SETBACK LINE
f- , APPROVED
TEL.
CONTRACTOR -fj_�. '� r�` NO. BY DATE
�ry ,{ - USE APPROVED
ADDRESS9 ✓ ZON�� •1 IBY DATE
•
LEGALCORRECTIONS
DESCRIPTION I LOT N $ I BLOCK
TRACT
f if NO. OF SLOGS.
SIZE OF LOT �/ I NOW ON LOT
USE OF Ate"' . T��/��'17�NO.OF NO. OF
EXISTING BLDG. w r+!;.r {�"KFAMILI[8 I ROOMS
�
DESCRIPTION OF WORK
NEW ALTERATION ADDITION _ O
REPAIR MOVING DEMOLISH _ Q_
Sq. FT. NO.OF Z
_SIZE Z ' ROOMS STORIES __ D
/// r
WALL �VL"'Y'- I ROOF
COVERING ;yCOVERING ��yy�•jy
USE OF NEW
BUILDING —
r
APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS - -
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS.
SIGNATURE OF y,./� BRACING, BOLTS
OWNER {�(�� LATH, INT.:
AUTHORIZED A134 rJ f�� / �T .:! i
-► LATH, EXT.:
P. C. $ PLASTER, INT.
FEE _ PLASTER, EXT.
VALUATION - FINAL
1 .
FEE � ."�„_.•„
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ' ® '
WM. J. FOX. CHIEF ENGINEER
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN
BUILDING DISTRICT NO. PLAN CK.NO. PERMIT NO.
ADDRESS d /► . 4SE
LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED
NEAREST /� [f.5 �� !J� ��` t <340
CROSS ST.
BUILDING
OWNER f ADDRESS \ (� �J� •���5
LOCALITY eo/J
MAIL
ADDRESS EI��GC7 /
NEAREST / .0� /
T TEL CROSS ST. /v
CITY L� C�! NO. `���
FIRE NO.OF TYPE V` ' GROUP, .i
ARCHITECT OR TEL. ZONE PLANS
ENGINEER NO.
BLDG. �� . / ORD�NO.
ADDRESS SETBACK LINE
APPROVED'
CONTRACTOR V ��/Y �O��NO BY �' .' DATE ��- -
USE APPROVED
ADDRESS ZONE, ?--BY DATE
LEGAL p. CORRECTIONS
DESCRIPTION LOT NO. p BLOCK
TRACT
NO.OF.BLDGS. 7
SIZE OF LOT 73 ��, NOW ON LOT 3
No OF
EX ST NG BLDG.J7o1-�"..� FUSE OF N� Es. I ROOMS
DESCRIPTION OF WORK
NEW ALTERATION I ADDITION I - O
A
REPAIR MOVING L DEMOLISH �7
Sq.FT. NO.OF - - Z
SIZE a"a ROOMS STORIES r
WALL 00
COVERING ���Q�?�� ,(3(1/q/� COVERING
/>>o USE OF NEW
D BUILDING
Z,c--Z RTf A
Wol T,6� o,-- Gos7,n" PcrJ'/J',-04/.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATIOM: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FIRE STOPS,
SIGNATURE O
� BRACING,BOLTS
F� y'
PERMITTED - ! s LATH, INT.
AUTHORIZED AGT LATH, EXT.
76AG38A s-aa PLASTER,INT.
DBS-3 SOM SETS $ P.D.$
FEE PLASTER,EXT. �I
VALUATION �� FEE $ �� FINAL
OBS-3 25M BETS 8-45
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK. NO. PERMIT NO.
BUILDING i // <�
ADDRE99•/' '�,.'.�. .=�� ..
LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED
NEAREST 4' - y .. - 41
CROSS ST. r e4l .,t...
...BUILDING
OWNER
ADDRESS
MAIL
DDRLOCALITY
AESS �, -S�t.{���Gll..F='y-�. '
NEAREST —� '
TEL. y^ CROSS ST. 1 T
CITT� f/ NO. L.¢Y
FIRE I NO.OF – TYPE � GROUP
ARCHITECT OR- j TEL. ZONE PLANS I j
ENGINEER �' NO.
BLDG. ORD. NO.
ADDRESS SETBACK LINE
APPROVED
TEL. SY DATE
CONTRACTOR NO.
USE APPROVED
ADDRESS ZONE BY DATE
LEGAL I L '� CORRECTIONS
DESCRIPTION LOT NO I BLOCK �'
TRACT 2-
G Gj� '2
NO. OF SLOGS. /
SIZE OF LOT 3 X 76 I NOW ON LOT
USE OF �',i�"'t NO OF OF _{I NO. OF _---_
EXISTING SLID-. - (''e' I FAMILIES — I ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION O
REPAIR MOVING DEMOLISH O_
Sq. FT. n NO.OF Z
SIZE , / ROOMS STORIES r
WALL r! / ROOF
COVERING ��.f4_ / y^-;t COVERING
USE OF N&
BUILDING .t
i ! J
APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS,
BRACING, BOLTS
SIGNATURE OF
OWNER LATH, INT.:
AUTHORIZED AGT �''� � LATH, EXT.:
$ P. C. III PLASTER, INT.
FEE -- PLASTER, EXT.
�W s -
VALUATION FINAL
FEE
l
Fp% , __ _7 -DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT /y V
COUNTY OF LOS ANGELES t ® I (�
WM. J. FOX, CHIEF ENGINEER BU- 1 LINC;
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING 658 N. Rosemead DISTRIbT O. -PLNO.
AN-CK.NO. P�jERMIT
ADDRESS
LOCALITY Temnl a Ci tRECEIVE S/Y DATE OFAPPL. I DA7TE ISSUED
C oss r. Gari baldi & T.nngden / `� ��I
Hawkins
BUILDING //' �%?71d�6/
OWNER R. HaWklsins � ADDRESS )
MAIL - LOCALITY
ADDRESS 658 N. Rosemead _
CITY Temple City NOL CROSS BT. j
FIRE NO.OF -TYPE_ GROUP
ARCHITECT OR TEL ZONE _ S PLANS =
ENGINEER NO.
BLDG.
ADDREH9 SETBACK LINE
_ _ APPROVED - t "" - r�• - "".'".-;� '
CONTRACTOR Neon Co. of NOL Ci . 3-6$ BY DATE`
UBE APPROVED
ONEQT Ca ZBY. - - ' DATE.
ADDRESS '
LEGAL
DESCRIPTION LOT NO1.1 a" I BLOCK CORRECTIONS ,
TRACT
NO.OF BLDGB. '
SIZE OF LOT I NOW ON LOT T "USE OF NO.OF NO.OF -
EXISTING BLDG, I'FAMILIES I RODMB t _ - „` �,- _• --
DESCRIPTION OF WORK
NEW X ALTERATION ADDITION y ti _...
O
REPAIR MOVING DEMOLISH p
Q.FT. NO.OF -"' Z
SIZE ROOMS STORIES rD,
WALL ROOF
COVERING COVERINGUSE OF
-
BUILDINGW Erecti6n of Double Face
Neon Sign with" 21t ransformars
1 HEREBY ACKNOWLEDGE THAT I 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 -
AND STATE LAWS REGULATING BUILDING CO TRUCTION.
//
,�7 FRAME: FIRE STOPS,
SIGNATURE OC.! - BRACING.BOLTS
PERMITTEE LATH,INT.:
AUTHORIZED AOT LATH,EXT.:
DOS-3 50M SETS 1-48 $ P L. PLASTER,INT.
FEE i LASTER,EXT. /I
200.00 I. r (�
VALUATION FEE 1.00 L N `�
,WORKERS'COMPENSATION DECLARATION
�kereby affirl m that I haXe a certificate of consent to self O D O
insure, or a tertificate�of Workers' Compensation Insurance, F 00 C2 CD3 M D d O D G�]G p E R D�
or a certified cgpy,thereof (Se 3800, Lab C )
I ' / COUNTYOF LOS ANGELES -.BUILDING AND SAFETY
Polis Nor^, 2- ampany t BUILDING,
Certified copy a hereby furnished .�'. -) "FOR�APP.LICANVTO'FIL'L� lN' +j':a "a- ADDRESS ` 6
❑ Certified copy is filed with the county building inspec- BUILDING ' ti w�
4ion department ADDRESS 2 `�r� Q LOCALITY
���� - NEAREST
Date Applicant CIN C ZIP CROSS ST
CERTIFICATE OF EXEMPTION FR ORKERS' O OF BLDGS ASSESSOR
COMPENSATION INSU NCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO USE ON� OP O
hundred dollars ($100)or less )
a TEL > SPECIAL }
I certify that in the performance of the work for which this OWNER NO CONDITIONS' p6
permit is issued, 1 shall not employ any person in any manner 0p1/�� A . - I TRICT GROUP TYPE FIRE PR 'ED BY
O
so as to become subject to the Workers'Compensation Laws ADDRESS lF�. �$SP�dlX l /� n-� CONST ZONE U
Date
'Applicant ' CITY ZIP 1�`dWf lyJS 3 O
pp ~� STATISTICAL CLASSIFICATION APT DO t—
AR
CHITECT OR TEL'
NOTICE TO APPLICANT 'If, after making this Certificate of ENGINEER NO _ ((� U
Exemption, you should become subject.,to the Workers' CLASS NO u DWELL UNITS W
U
Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N
with comply with-such provisions or this Hermit shall be Z
NO
deemed revoked CONTRACTOR (� `:�i�' TEL - 7 BK PG, VALIDATION-
LICENSED CONTRACTORS DECLARATION LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE NO 3 rL =L�UFAT
(commencing with Section 7000)of Division 3 of the Business and � � f�� LIC Professions Code, and my license is in full force and effect CIT CLASS
/•/ � SI FT NO OF NO OF CHECK D 2 2$7A
License Number t Lic Class SIZE STORIES FAMILIES ONE
NEW ❑ $ o o'0 0 2 3Contracto Date'v^�- y DESCRIPTION OF WORK #
I am exempt under Sechl�J' -Shd AILTEC]
DD ❑ i� e a 9 7 222B&P.0 for this reason s7 I1T � /j`"'��• REPARR ❑ pNAL 0 9 ],2 2 0
��
Date: USE OFBLDGBLDG - DEMOL E] t/ p -r8 5
EXISignature APPLICANT TEL -�
OWNER-BUILDER DECLARATION PRINT NO
I hereby affirm that I am exempt from the Contractor's License D
Law for the following reason (Section 7031 5, Business and ADDRESS _
Professions Code)
BUILDING
as I, as owner of the property, or my employees with' ADDRESS
wages as their sole compensation,will do the work and 2 6 Q 7 A
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code) MOVING TEL
# o 0 0 0 0,1
I, as owner of the property, am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec- a� o 1 2 4.8 8
tion 7044, Business and Professions Code). ADDRESS
REQUIRED TOTAL SETBACK FROM EXIST o a 1 2 4 8 8 U
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH D
I hereby affirm that there is a construction lending agency for FRONT 8 Q�7 8 5
the performance of the work for which this permit'is issued P L
(Sec 3097, Civ C ) SIDE
PL
�.
Lender's Name
Lender's Address � • '
P C Fee$ r� Permit Fee //-/,,38
- `, - • '
I certify that•1 have read this application and state that the, Issuance Fee G.s�
above information is correct I agree to comply with all County Investigation Fee
ordinances and State jaws relating to building construction, Total fee
Cf and hereby authorize representatives of this County to enter y =
upon the above-mens ed pr perty for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Si ure of Applicant or Agent Date ®s
COUNTY OF LOS ANGELES , TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0911170074
PHONE (626) 285-0488 EXT
ILEGAL ID + NO OF CONST NEW BUILDING ADDRESS.
ITR. 5904 LT: 15 SQ FT STORIES TYPE OCCUP GROUP 6276 ROSEMEAD BL 1
I ISTRUCTURE. 120 1 V-B B I TEMP CA 917801560
(ASSESSOR INFORMATION NUMBER 1 NEAREST CROSS STREET LONGDEN 1
15384-005-001
THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, C
TENANT IEXIST BLDG USE COMME USE ZONE (ISSUED ON PROCESSED BY
1ROSE DONUTS & SANDWICHES 1EXIST OCC GRP B 102/25/10 SR 1
OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINAL DATE FINAL BY CODE
IYIP, SIV (626) 28,7-1488- 1 4,800
16276 ROSEMEAD BLVD �O�
1TEMPLE CITY CA 91760 FEES PAID ID OPTION OF WORK
IT I WORK WILL BE REMODEL CUSTOMER AREA ADD 4 YOGURT MACHINEI
(FEE DESCRIPTION QUANTITY UOM AMOUNT 1AND TWO COLD TABLE (FOR YOGURT TOPING)
(APPLICANT TEL NO I
XU (626) 388-4919- IA1 PLANCHECK W/EN-HC _ 4800 00 VAL 129.62 1 ,
16260 TEMPLE CITY BL IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS i
ITEMPLE CITY CA 91780 'IAB STATE GREEN-"BLDG FEE 4800 00 VAL 1.00 I
,AE STRONG,-MOTION OTHER 4800 00 VAL 1.01 ,
IA2 PERMIT W/ENERGY-HC 4800 00 VAL 152 49 1
ICONTRACTOR TEL NO i, TOTAL FEES 311 87 (APPROVALS DATE INSPECTOR SIGNATURE 1
(UNITED STAND CONSTRUCTION (909) 709-0405- 1 _
17748 SAN FRANCISCO ST. LIC NO ( ILOCATION AND SETBACKS
IHIGHLAND, CA 92346 840168 B _
1SOILS'ENGINEER APPROVAL I
1ARCHITECT OR ENGINEER. TEL. NO 1 FOUNDATION/TRENCH FORMS
1 LIC NO .1 ISLAB/UNDER FLOOR
I I I
1 i1 1RAISED FLOOR FRAMING
IMAP NO SEWER MAP BOOK- PAGE FIRE ZONE: CMP _ (UNDERFLOOR INSULATION
I I I
3 041
I FLOOR SHEATHING
INO OF FAMILIES DWELLING UNITS. APT/GOND STAT CLASS- 1
1 NO 22 �� (ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS ` ISHEAR PANELS I
(AIR QUALITY 1000 FEET MATERIALS
I NO NO NO 1
� FRAME INSPECTION I
(FIRE SPRINKLER HANGERS
(INSULATION/WEATHER STRIP,
7y ('INTERIOR LATH/DRYWALL
v
1 1 (EXTERIOR LATH , I
(RATED FLOOR/CEIL ASSEM.
� I .
(RATED WALL ASSEMBLIES I
1 1 IRATED,SHAFTS/OPENINGS ,
1 1 IT-BAR CEILINGS
I
ILOT DRAINAGE I ,
1 (REPORT ID DPR261 ROUTE TO BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS FIRE SPRINKLER
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0706010033
PHONE (626) 285-0488 EXT
(LEGAL ID I NUMBER OF ADDED/RELOCATED 1 BUILDING ADDRESS- I
ITR 5904 LT: 15 I SQ FT SPRINKLER HEADS 1 6276 ROSEMEAD BL I
I ISTRUCTURE I TEMP CA 917801560 1
(ASSESSOR INFORMATION NUMBER. I NEAREST CROSS STREET I
15384-005-001 1 I THOMAS PAGE. 596 GRID H2 LOCALITY TEMPLE CITY, Cl
I I I I
ITENANT (EXIST BLDG USE- (ISSUED ON: PROCESSED BY EXPIRES ON- I
IROSE DONUTS (EXIST OCC GRP 106/01/07 SR 05/26/08 I
I I I I
(OWNER TEL NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DAT BY CODE I
ISMALDINO LOUIS P,DOROTHY A - I 1,500 1EXPIRM
113583 WHITTIER BL I 1
(WHIT 906051935 1 FEES PAID IDESCRIPTION OF WORK
I I (INSTALLATION OF FIRE SUPPRESSION SYSTEM
IFEE DESCRIPTION QUANTITY UOM: AMOUNT I I
(APPLICANT: TEL NO:
IEDISON FIRE EXTINGUISHER CO (323) 259-9999- IAA BLDG PERMIT ISSUANCE 27 75 I I
13621 EAGLE ROCK BL. IDO FIRE SPRINKLER PC 1500"00 VAL 82 11 ISPECIAL CONDITIONS: I
ILOS ANGELE CA 90065 ID2 PERMIT W/O EN-HC 1500"00 VAL 82 20 I I
I 1 TOTAL FEES 192 06 1 I
I I I I
ICONTRACTOR TEL NO I IAPPPOVALS DATE INSPECTOR SIGNATURE 1
IEDISON FIRE EXTINGUISHER CO" (323) 259-9999- 1 1 I
13621 EAGLE ROCK BLVD LIC NO I IFIRE DEPARTMENT INSPECT 1 I
ILOS ANGELES CA 90065-3621 569185 C16 I I 1 1
I I IFIRE SPRINKLER HANGERS 1 I 1
I I I I I I
(ARCHITECT OR ENGINEER TEL NO: I IFIRE DEPARTMENT APPROVAL( I I
1 LIC NO. I I I I I
I I I I I I
I I I I I I
IMAP NO SEWER MAP BOOK- PAGE FIRE ZONE: CMP I I
1 001
I I I I I I
N0" OF FAMILIES DWELLING UNITS APT/GOND" STAT CLASS I I I
NO 20
SCHOOL WITHIN HAZARDOUS I I I
(AIR QUALITY• 1000 FEET MATERIALS I I I
NO NO NO I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
IREPORT ID DPR261 ROUTE TO BS0508 I 1 1
I I I I I I
r,