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HomeMy Public PortalAbout6300 ROSEMEAD BLVD_Building__ ©5 76A638A. CE 8803(REYc.6/76) ! .-APPLICATION- FOR BUILDING PERMIT A , COUNTY OF LOS ANGELES BUILDING.AND SAFETY FOR APPLICANT TO-FILL IN, BOLDING ADDRESS' 30'; (). �- � Cp � Cj BUILDING . 6/r 77�� - 1'A`` ADDRESS 6.326 �-osL In,6 6,6 LOCALITY` NEAREST CITY V1%D L ZIP CROSSST NO.OF BLDGS_ ASSESSOR SIZE OF LOT NOW ON LOT.. '. MAP-BOOK PAGE PARCEL DISTRICT GROUP ;COPN E FIRE CES E BY TRACT `��v z LOCK' LOT NO ` t Q A ST ZE OWNER VT �' NO qJ�V. � /� STATISTICAL CLASSIFICATION S ERAP ADDRESS C73 A '�IL4 -J 6 , - y CLASS NO ��-' DWELL UNITS BK PQG CITY ili A' rU1CJ1 •w L .. 'ZIP, ctot+01 ARCH( ECT OR •TELO C) ENGINEER GA)- . t:- NO VALUATION /JDO ADDRESS BLDG'SETBACK FROM TEL FRONT PROP LINE OF (STREET) _ CONTRACTOR A %v(= :NO TOTAL SETBACK FROM TYPE OF EXISTING LIC HIGHWAY t YARD = FRONT PROP LINE HIGHWAY WIDTH ADDRESS '. ! L 2011e NO ZO ZC" • ," LIC ,✓ + - CITY C)• (� CLASS' J' BLDG SETBACK FROM CONSTRUCTION LENDER . Q tCJ� _ _ - SIDE PROP LINE OF (STREET) NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY _ ` SIDE PROP LINE HIGHWAY WIDTH SG FT' NO OF NO OF ; CHECK + _ SIZE j STORIES FAMILIES ONE DESCRIPTION OF WORK lai L+- ., NEW P C Fee$ Permlt Fee �s ADD ❑ Issuance Fee SALTER I?❑ o S REPAIR "❑ Total Fee '9° b A o USE OF EXISTING BLDG. DEMOL ❑ � ��m n9 # o o I o,o 23 APPLICANT TEL �y p .. `�(�/S�+ • (PRINT) Z NO �� '2!0 0 113600 io o o3C�00� '- BY(SIGNATURE) �(� Q ' 7 HEREBY ACK N DC THAT HAVE READ THIS APPLICATION AND STATE U� '0 Q,2�51—7 9 THAT THE ABOVE ORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES .V AND LAWS REGUL NG BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE, V WORK AUTHORIZED HEREBY I'WILL NOT EMPLOY ANY PERSON IN VIOLATION OF ' THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM Z PENSATION INSURANCE g ' d3'9&;7 A.. SIGNATURE OF PERMITTEE •. :#io'o to o o J. , ADDRESS TEL' CITY, �U — NO w QQ ;oto o '5 200.6 USE ZONE MAP, C NO - O 0 0 A V-79 SPECIAL r CONDITIONS X 9 LU LU FINAL BY DATE ' owww ©5 CE#603(REV 6/781, /��d i ;Aseum I "�y�O��, • Ulf-SZbL $4• ZL1�3 t1�S tµ� Zai/S�,tYAaA G� .� PERMP —N COUNTY OF LOS ANGELESS 4 BUIaIe XND SECFETY FOR APPLICANT-TO FILL IN BUILDING LDINGk �J ADDRESS GIG ADDRESS IDRESS LOCALITY NEAREST CITY ZIP CROSS ST GO/ e NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK ' PAGE PARCEL TRACT 5u a JW DISTRICT GROUP TYPE FIRE PROCESSED BY BLOCK LOT NO _ CONST ZONE ��/ TEL ^ � / r OWNER•YY , NO /c. .5D/ j�,�r [� STATISTICAL CLASSIFICATION EWER MA ADDRESS/6 a6 Sr r, T /'U�1$ CLASS NO )�"�—DWELL UNITS BK)d PG CITY A W 604PA QQ ZIP Z:Q i;(OV _ ARCHITECTOR %&U1j� TIL `/ -3e� VALUATION $ -� ENGINEER ADDRESS 7-%:'-'IBLDG-SETBACK FROM TEL FRONT PROP LINE OF (STREET) ' CONTRACTOR NO TOTAL SETBACK FROM TYPE OF I EXISTING 3 Lb7� S1y1.TG9f�� LIC HIGHWAY + YARD=- FRONT PROP LINE HIGHWAY WIDTH ADDRESS NO CITY NOWCLASS - BLDG SETBACK FROM CONSTRUCTION LENDER / AA : NAME AND BRANCH /�► /7- SIDE PROP LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS ' CITY SIDE PROP LINE HIGHWAY WIDTH. O SO FT q_ pp.p��2 NO OF NO OF CHECK SIZE TdEL! STORIES / FAMILIES. ONE O6 t��) can` DESCRIPTION OF WORK `w / /"CA NEW ❑ P C Fee$ �j�,. ��i Permit Fee ,A, a/i r7�I,I _ A/� ADD ❑ Issuance Fee �� PFUI/ IN49 ALTER z ss��--�� a.�V �Y[_//7�� REPAIR Total Fee USE OF r Al / ?j�1/J C DEMO EXISTING BLDG r" (J QI(— /,❑ O APPLICANT)r '' 0 TELNO �Q TfV PRINT( W 1L � Q T. BY(SIGNATURE). 1 j I HEREBY ACKNOWLEDGE THAT I HAVE,READ'THIS APPLICATION;AND STATE' y / / Y�J {t� THAT THE ABOVE IS'CORRECT AND AGREE TO COMPLY WITH ACL-ORDINANCES- i Z-Y -7 AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IWDOINGITHE!t Q S WORK AUTHORIZED HEREBY I WI N EMPLOY ANY PERSON IN•VIOLATI V p THE LABOR CODE OF THE F �A NI IN RELATING TO WORKMEN O '� .� T Z 2 0 /,9 r1^� PENSATION'INS CE/� � °> = i -` ,n/L' - I° ° ° ° ° SIGNATURE OF ( "t PERMITTEE4 � 2'O 1'5 1,0 0 ADDRESS 0 3 ori. mn, , '(), '{ I y p " . TEL u S ' L� ` ` v' CITY OJ' ON/1L4. NO 1 .', � ,,� � -lJ����� 1� Q o 0L1,04`-79 USE ZONE MAP Q I NO -Z SPECIAL CONDITIONS ;•' , FINAL - BY DATE -ZSR 9 a ©s 76A638A CE g80 (REV.11/78), `•� C\�=��yC✓` n ✓ --_.. _ _ - . _ . COUNTY OF LOS.ANGELES -BUILDING AND SAFETY, FOR APPLICANT.TO,FILL.IN.' BUILDING �g • ADDRESS BUILDING �• � ADDRESS ,� -3G ..(cossrA Eat LOCALITY- ` NEAREST CITY (= ( �� ZIP' CROSSST " NO OF BLDGS ASSESSOR , SIZE OF LOT NOW ON LOT MAP BOOK I PAGE I PARCEL',5, , DIST CT GROUP TYPE '. .FIREOC ED BY TRACT ` BLOCK LOT NO m Q ON y �' OWNEL ER \J O NO J�J �C/l(J/J f�I►/ , ' 1 _ STATISTICAL-CLASSI CA ON' "' SEWER MAP ADDRESS, W LU (CLASS NO DWELL UNITS, BK PG CITY. _... ZIP HITECT OR TEL' �p t ✓ ` ENGINEER w t R IC(iN0•S(�U IVALUATION $ •� �J� 1 _ADDRESS _ 1, -�„- BLDG SETBACK FROM- TEL (j(�,.\ FRONT PROP LINE OF (STREET) ' t CONTRACTOR tj NO c�-/J�7v1 - TOTAL SETBACK FROM TYPE OF EXISTING r LIC (� HIGHWAY + YARD = FRONT PROP LINE HIGHWAY,,.WIDTH ADDRESS NO 3I d 7 Z G LIC CITY D2/0"K c; �. / •+ CLASS l� BLDG SETBACK FROM CONSTRUCTION LENDER - _ r ^�- SIDE PROP LINE OF �'"(STREET) NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACK FROM' TYPE OF EXISTING b ADDRESS CITY v a� SIDE PROP LINE - HIGHWAY ,WIDTH, 0 SQ FT NSTO'OF NO OF CHECK `-+• _ a SIZE` ORIES FAMILIES ONE IINQ SE, E MAP 0 DESCRIPTION OF WORK .- L,6 Ili z NEW-«--❑ NO' SPECIAL ADD ❑ CONDITIONS ALTER BY / FINAL -,REPAIR DATE USE OF DEMOL ,❑ J EXISTING BLDG ...<.. _. ;O I RI8"2:3,2.A ; APPLICANT Ur,—y NO �� C °-° ° ° 2 3 1 _ cel {: ' BY(SIGNATURE) y 2 °,4 2 8 8.0 I HEREBY ACKNO LE E THAT I HAVE D THIS APPLICATION AND STATE uu� " THAT.THE ABOVE,IS C RECT_AND AGREEJO COMPLY.WITH-ALL ORDINANCES„ _ _ ., W 'O ° o,2880-4 AND LAWS'REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE _ , . WORK,AUTHORIZED HEREBY I WILL NOT,EMPLOY ANY PERSON IN VIOLATION OF Li THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM. 2 _ _ ( 2-1. 3'—79 PENSATION INSURANCE41 SIGNATURE OF / PERMITTEE r 8 2 3,3:A: ADDRESS — ✓= ..TEL' r Z CITY NO C 2 0 0 3 0.0 P C .Fee_ . Permit Fee ' 0[0 °-3,�•,0 0 0, Issuance Fee Total Fee ©s 76A638A CE/8031REV 6/78) A! PIl..i 11`l.IAtl I® ®II `• lVV DINGPERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO F L IN BUILDING -3 L 2- ADDRESS BUILDING q' - ADDRESS -- � LOCALITY • i - - NEAREST - CITY 1r : ZIP / CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT , MAP BOOK PAGE' PARCEL Sayer„� DISTRICT GROUP , TYPE -FIRE ED BY TRACT BLOCK LOT NO 1 /1T /� CONST ZO OWNER G TEL 'V De i .wS -.NO (D r, 1 STATISTICAL CLASSIFICATION SEWER MAP' ADDRESS yB� /h T CLASS NO DWELL UNITSBK�/ PG t CITY �N ZIP Q� ARCHITECT OR TEL VALUATION $ �dJ ENGINEER NOQ 1Q ADDRESS BLDG SETBACK FR?;M L / ` TEL 7« FRONT PROP LINE OF (STREET) CONTRACTOR j; L” f ,11j fe NOTOTAL SETBACK FROM TYPE OF EXISTING LIC HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH ADDRESS / O' jil1 NO .,SZ a� LIC + CITY , ' CLASS'l BLDG SETBACK FROM CONSTRUCTION LENDER SIDE PROP-LINE OF (STREET) NAME AND BRANCH TOTAL SETBACK FROM 'TYPE OF EXISTING HIGHWAY + YARD = SIDE PROP.LINEHIGHWAY WIDTH ADDRESS CITY SO FT NO OF NO OF CHECK + = Ca SIZE STORIES FAMILIES ONE Q! DESCRIPTION OF WORK NEW ❑ P C'Fee$ Permit Fee �' O ADD ❑ ❑ ALTER ,Issuance-Fee Z N KrrAll = .Total Fee USE OF ❑ s DEMOL EXISTING BLDG �-1Yr�j' • Y ' APPLICANT TEL 0 (PRINT) NO 7 Q BY(SIGNATURE) Q IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE u� THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES ' U AND'LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE Z WORK AUTHORIZED HEREBY I WILL NOT'EMPLOY ANY PERS N IN VIOLATION OF• " V z 4 8 3.8.'.A, THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATIN O WORKMEN S COM. •Z - PENSATIONINSURANCE - I#,O O:o 0'0'1 get SIGNATURE OF f r 2 0(o;7 9 0..0 PERMITTEE ( dj11� l� / . ADDRESS , Z l o o o 79 Q Q cii TEL 7J O L CITY 14Cy1.a+"�v NO _ Q O:6 O 8.. 7 9 �7 USE�ZONE NOP �U n� j C v SPECIAL CONDITIONS e :E FINAL LIL Q BY i DATE 78A83L CE X809-10.38 APPLICATION F®R ' BUILDING q E Nrk IT BUILDING AND SAFETY DIVISION BUILDING, Department of County Engineer' ADDRESS County of Los Angeles LOCALITY Tem l e C i*: JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST DISTRIC NO. GROUP TYPE •-tl'WER MAP- , ,FOR APPLICANT TO FILL IN ,�j S coNsr. BK PG,{ BUILDING Q STATISTICAL CLASSIFICATION _ ADDRESS y�tos .ad & Lon don - q � ' LOT NO. / BLOCK CLASS. NO.1, DWELL. UNITS __ I - ��`` n ^ MAP /1 O HWY YES NO TRACT M p- a ' I �G. NUMBER C1 USE ZONE SPECIAL NO. OF BLDGS. ^ CONDITIONS ' - SIZE'OF'L'OT I NOW ON LOT f_J �'•7 - . .USE OF EXISTING BLDG. BUILDINGEXIST. YARD HWY ' STREET NAME OWNER Market Basket Market SETBACK WIDTH FRONT MAIL P. L. l ./OQ / ADDRESS Rosen ad & Longdon- SIDE L TEL. L L1,YnP (OO CITY Temple City NO. INSPECTION- RECORD- ARCHITECT,OR TEL. ENGINEER NO. - - i ADDRESS Trial 'IA" Pdeon TEL S-f���'� fi�Jnri /I�D-Y �7d ,Q' CONTRACTOR , e NO.- 1.1015 CimLps to n -.I9H + ��1. 'moo SST �1.�1� ADDRESS - ' Ate DESCRIPTION OF WORE ' Nn I' P�iaP���� 0/)s f' ALIb_S .19 R�= /G1l i 17,-';'h.. NEW ADD ALTER REPAIR DEMOLISH ' SQ. FT. NO. OF NO.OF AIOI.SO P#r"ff"�/J x/G*64, A1,61*nt SIZE STORIES FAMILIES fit'' USE OF ST UCTURE •• .I +'&&�--r 7WIS,- a - APPROVALS _ SIGNATURE OF _ APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION:.LOCATION � .-r�/F�-p,•' n� FORMS, MATERIALS c� 0 rvt $ P. C. FRAME: FIRE STOPS. - • FEE /W BRACING. BOLTS " FURNACE: LOCATION. VALUATION O O s GAS VENT, DUCTS _•.�.nt, FEE Z� I 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND - M r v �I rJ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT. -1 I STATE LAWS REGULATI BU"NG NG CONSTRUCTION. SIGNATURE OF HOUSE NUMBER COR-- f�Q PERMITTEE RECT AND POSTED. _rte-p� (, ADDRESS 6 J - FINAL `T7' �o V JOHN A. LAMBIE, COUNTY ENG NEER• CLYDE N. DIRLAM, PRINCIPAL STRUCT4RAL ENGINEER PLAN'C$ECH VALIDATION CK. M.O. CASH PERMIT VALIDATION ercKM.O. CASH 4 JS A tq LACw. E 8803�EV.6/781 -+ APE L I C AT I®■ � F O k B U I L M■ G P�-� M O T i COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS G N L BUILDING ' ADDRESS _0 -300 LOCALITY T NEAREST CITY C • ZIP + CROSS ST NO BLDGS, ASSESSOR ' SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP T FIRE SSED BY TRACT BLOCK'd'G'l O G SJ ZO ✓.U OWNER TELNO STT, +1, ATISTICAL CLA CATI SEWER MAP ADDRESPli U_) CLASS NO DWELL UNITS BK PG CITY — ZIP Q �d ARCHITECT OR TEL VALUATION � O ENGINEER - NO ADDRESS BLDG SETBACK FROM TEL nn'' FRONT PROP LINE OF (STREET) CONTRACTOR NO' u' HIGHWAY + YARD TOTAL SETBACK FROM' •TYPE OF EXISTING = ADDRESS c ,v�� NO3&/Z3FRONT PROP LINE HIGHWAY WIDTH LIC. //!� t = CITY -- CLASS(,-46 BLDG SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH ktOAJ� SIDE PROP LINE OF (STREET) TOTAL SETBACK FROM TYPE OF EXISTING 9' HIGHWAY + YARD = ADDRESS CITY SIDE PROP-LINE 1HIGHWAY1 WIDTH 0 - SO FT NO OF NO OF CHECK , + = d SIZE STORIES FAMILIES ONEor /' O DESCRIPTION OF WORK ! Z, NEW. ClP C Fee$ GJ V _ Permit Fee &7,A3 zoe> Z ADD ❑ Issuance Fee 4A ALTER ❑ REPAIR ❑ Total Fee USE OF c DEMOL ❑ EXISTING BLDG 5 ZO APPLICANT I TEL ( (PRINT) NOZGI"�j J p BY(SIGNATUREI r• _ 5--v, yo C�L.i I HEREBY ACKNOWLEDGE THAT IIA/E READ THIS APPLICATION AND STATE �' J bg THAT THE ABOVE IS CORRECT AND AGJEE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN,DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSOWIN VIOLATION OF y THE LABOR CODE OF THE TATE OF CALIFORNIA IN RELATING TO WORKMEN S COM-' Z z'4 807 A PENSATION INSURANCE g Or0'0,0 1 SIGNATURE OF ✓/� -PERMITTEE �/ l U31U A- 2.o i o 17 Q 0 0 ADDRESS oTEL CITY L Z NO 22! =�EIAL DITIONS g a - FINAL BY d DATE ' r3 WORKERS'COMPENSATION DECLARATION t I hereby affirm that.I have a certificate of consent to self p n � p insure, or a certificate of Workers' Compensation Insurance, p�,O�L/ t1� ©� Lg U L D d VA Co. F E RPA d T Pi{r a certified copy thereof (Sec. 3800, lab C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN' ADDREN5 6 Certified copy is filed with the county building inspect BUILDING tion department. ADDRESS r Date Applicant CITY i ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS NEAREST COMPENSATION INSURANCE „ SIZE OF LOT NOW ON'LOT CROSS ST (This section need not-be completed if the permit is for one -. ASSESSOR o hundred dollars($100)'or less.) TRACT, BLOCK LOT O' MAP BOOK PAGE PARCEL ' f OWNS T 1�71 j— USE ZONE MAP, I'certify that in the performance of the work for which this O NO. permit is issued, I shall not employ.any person in any manner" ) �! SPECIAL so as to become subject to the Wor s ompensation la ADDRESS / CONDITIONS / oZ v • Dote � � Applicant � _ CITY ' /� ZIP •• � ARCHITECT OR TEL. NOTIC TO APPLICANT: If, after making this•Certifica a of s DISTRICT, GR P TYPE FIRE' PROCESSED BY O ENGINEER NO. ¢¢¢...LLL111 Exemption, you' should become subject' to'-the Workers' �-- � CONST. ZONE V Compensation provisions of the Labor Code, you must forth- ADDRESS ✓t� W with comply with such provisions or,this permit shall be' _ �j' CL. deemed.revoked. Lr�K //r1 OeeYKAf&,Ir TEU 7/ STATISTICAL CLASSIFICf1TION APT. ONDO. .,U)- CONTRACTOR, NO: — 2 I Z LICENSED_CONTRACTORS DECLARATION Sys�'l/�/-UC CLASS NO . DWELL UNITS ' I hereby affirm that,I am licensed under provisions of Chapter 9 ADDRESS //yd cz4ffka A�• NO�f�22 E"8 (commencing with Section 7000)of Division 3*of the Business and LIC SEWER MAP Professions Code, and my license is in full forceandeffect. CITY 1 7 CLASS '8`/ BK VALIDATION ' SQ. FT. - NO.OF NO OF r CHECK License Number VY;Z-2.5' o o Lir Cldss SIZE STORIES FAMILIES ONE y s DESCRIPTION OF WORK ❑ VALUATION Contractor�roPwi &4i f/ /fLC/� r NEW "• ADD $ I am exempt,under Sec. V 2� _ 0 91 `a.0 A ALTER Lj• B.&P.C. for this reason ".44 REPAIR a # o • 9.0 •;1 " Date: USE OF EXISTIING.BLDG. DEMOL • ° 2 8 5 O Signature " APPLICANT TEL FINAL = OWNER-BUILDER DECLARATION PRINT NO. DATE ° e °28,506, 1 hereby offirm'that I am exempt from.the Contractor's License Law for the-following reason.(Section 7031.5; Business and ADDRESSFINA ,1 $$ Professions Code): gy o ❑ BUILDING- 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 -7044, Business and Professions Code). MOVING TEL ". I, as owner of the property, am exclusively contracting CONTRACTOR NO ' 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 ° z 1 hereby affirm that there is a construction lending agency for FRONT the performonceaof.the.work for which this'permtt is'issued -P L (Sec. 3097, Civ.-C.) SIDE PA Lender's Name m P C. Fee b Permit fee 1 O LDMA Ref. 11 Lender's Address ' J-certify that) have read this application and state that the � Issuance-Fee • L]� LDMA P/C q above information is correct. I agree to comply with all County Investigation Fee zt j) 0 ordinances to laws relating to building construction, Total Fee (J R and h y autho ize representattves of this County to enter LDMA Perm q upo a Gbove-VAentioned property for inspection p rposes. m l/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or.Agent - Date ' _,WORKER,Fr1,COMPENSATION DECLARATION I hereby affirm-that I have a certificate of consent to self O A O O Insure, or a certificate of Workers' Cornpensation Insurance, 4 MA� Ar or a certified copy thereof'(Sec:3800,'Lab:C.r) COUNTY OF LOS,ANGELES BUILDING AND SAFETY. �I� Pojtcy No. fJ�i�di Company �( /? / BUILDING;'— FOR' /0 ICJ✓310 Certified copy is hereby furnished. Fcc��OR�/'APPLICANT TO,, ^qFILL' IN• BUILDIN (Jl/ ❑,.- Certified copy�is.filed'with the county building'inspec- gDILDQIN V(J ,`7 1 �L j" - tion department.- I Z7' l �� 1 ZIP _ ry LOCALITY ��C I / Date pplicant M I L NO OF BLDGS NEAREST. CERTIFICATE.OFEXEMPTION FROM WORK S SIZE'OF.LO� " �C Z`a NOW ON-LOT CROSS ST - COMPENS_ATION'INSURANCE ASSESSOR ' (This section need not-be completed if the'permit'is"fo`r one TRACT A BLOCK LOT NO MAP BOOK : PAGE PARCEL hundred dollars ($100)or less.) TEL 7 OWNER Lr 1��L NO. 1 .UAV USE ZONE' OP " .. ,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 4, . tAMn—, <PIw CONDITIONS d S6 as to become,subject'to the Workers'Compensatiom Laws. ,Q ZIP Date Applicant ARCHITECT OR JTEL. NOTICE TO APPLICANT: -If, after making this Certificate:of ENGINEER NO DISTRICT G UP ,TYPE FIRE PROCESSED BY 0 'Exemption, ,you should become subject to.,the Workers'- � CON ZONE U -Compensation'provisions of the Labor Code,'you muit`forth ADDRESS D� - a .with comply with such provisions 'or:this permit shall be. TEL ,. STATISTICAL CLASSIFICATION APT - CONDO. Z deemed revoked.- - CONTRACTO 1/ NO. �, � L7,' - . . -t- _ LICENSED CONTRACTORS bECLARATION ! LIC 13�� CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �� MV T'NO � LIC: SEWER MAP Y " (commencing with Section 7000)of.Division 3.of the Business //�� f /] �' a and Professions Code,and my license is in full force;and effect. CITY �N� -� �T CLASSV'-4/, - BK PG ' VALIDATION SQ FT NO OF NO. OF CHECK" License Number / 1✓� Lic Classlf 'SIZE STORIES FAMILIES ONE VALUATION Contract 4%' �61e•• 1 DESCRIPTION OFWORK i(�Y{Z, NEW ;' ADD ❑ D ❑I am exempt under Seca' k " B.BP.C: for this,reason j i 7f�..L TrI�I or 1Q4 ALTER ,❑ ; w•• ^' USE OF REPAIR.❑ 5 Date: EXISTING BLDG DEMOL-❑ } Signature " APPLICANT TE y� OWNER=BUILDER DECLARATION (PR INTIJE�I N )j ; FINAL I hereby;affirm•that I am exempt from the Contractor's License DATE v t Law for the fol lowing're6son7(Section-7031.5, Business and ADDRESS FINAL y Professions Code): PRESENT B BUILDING „ t Y ACCT.'g ❑ I, as owner of:the property, or my employees with ADDRESS ' a wages as their-sole compensation,will do the work and e r 1. - - �3C17 we CID the structure is not intended or offered for sale(Section LOCALITY 7044, Business and"Professions Code.) MOVING __ ' _ TEL _ •_-, T�M0 ,- .1 I �• . ❑ j, as owner of the property, am exclusively contracting CONTRACTOR NO 1 with licensed contractors to construct the project,(Sec- ADDRESS `• TOTAL i 7°-' 61 00• L tion 7044, Business and Professions Code.)' • . - REQUIRED TOTAL SETBACK FROM.-..EXIST +�•nEt••k f V'o CONSTRUCTION*LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH J -I hereby affirm that there is a construction lending agency for FRONT' CHANGE _.'110 ' the performance of the work for which this permit is issued PL (Sec. 3097, Civ. C). - SIDE 4 PA Lender's Name Ocrrn COOL-13001 1�.r1 �� - q hM 8 LDMA Ref #. _ 7563 1. of!11*lt - - P. Fee$ Permit Fee - .'` ' Lender's Address a I certify that I have read this application and state that the •" ssuance Fee V'•5 LDMA P/C,# ' above information is correct. I agree to comply with all County Investigation Fee ordinances and, State laws relating to building construction, Total Fee LDMA Perm # <' and hereby authorize representatives of this County to enter ;• s. " upon e- ' wed proper y for inspection purposes. " •to y SEE REVERSE FOR EXPLANATORY LANGUAGE gni re of Applicant or Agent Date ` _ - 'WORKERS' COMPENSATION DECLARATION n •1 hereby affirm That I have a certificate of consent to self • /(�\ P I J��� /U\�O©M. FOR D U R D�� G PERM insure, or a certificate of:Workers' Compensation Insurance, Lr�lu LI 11�1 L� LI V u�a or a certified copy thereof (Sec 3800, Lab: C:)(� COUNTY OF LOS ANGELES BUILDING AND SAFETY ' Polity No.�4�Compan�� 1,i'i ��� ` BUILDING Certified copy is hereby furnished.," FOR APPLICANT-.TO FILL IN ADDRESS O0 ❑ :•Certified copy is filed with the county building inspec- BUILDING/ . ��1! rfx�C� •C�Vv�1 ` tion department. ADDRESS(� - rDate 1 C�r I� PPlican Jrvf/'YZIP rl, -�- LOCALITY -CERTIFICATE OF EXEM ION FROM WORKERS'.'• SIZE OF LOT' �✓ r��! + NOw ON LOT •',Z NEAREST, COMPENSATION INSURANCE CROSS STASSESSOR '(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.). 4 �, ry TEL' 7'!, OWNE_ �C p 7 %rte USE ZONE MAP I certify,that in the.performance-of the work for which this a, NO. permit is issued,,I shall-not,employ any person•in,any manner ADDRESS' 60�• : �� C;i�p ( L'V SPECIAL = a CONDITIONS O so as,to become'subject to the Workers'Compensation Laws. - , CIN f. `i •�i zip V 5 Date Applicant ARCHITECT OR - TEL NOTICE TO•APPLICANT: If, after making this Certificate of � ENGINEER � - -•• NO Exemption, you shbuld become subject to the Workers' �j DISTRICT G UP• TYPE CONSy FIRE D BY Q ROCES E ZONE V 'Compensation provisions'of,the'Labor.Code, you must•forth- ADDRESS LJ.�(y � lV y�--k* i � with comply with such.provisi-ns or.This permit.-shall be l�4��])TE STATISTICAL CLASSIFICATION_. A CONDO Z _deemed revoked. CONTRACTO �� AP�INO. 7 � _ LICENSED'CONTRACTORS-DECLARATION r� �'`�'��i LIC. CLASS NO. DWELL UNITS 1•hereby affirm thai'l am licensed under provisions of.Chapter 9 ADDRESS 700 0,, w�ryf�( NO.Zire (commencing with Section 7000)'of Division 3'of the,Busmess y y'1�t/ LIC. G,� SEWER MAP and"Professions Code' my license ism full force and effect. CITY i-�`�" t CLASS BK pc VALIDATION �.� SQ. FT. � NO. OF NO OF CHECK ' License,Number Lic. Classes SIZE {EJ- STORIES FAMILIES ONE ' 1 VALUATION Contract Date 1�r ` ��� DESCRIPTION OF WORK NEW r/7� ADD, ❑ $ I - ❑I am exempt undee''Sec. , s „ALTER ❑ ,B.BP:C. for This reason 11 REPAIR ❑ a USE OF Date: EXISTING BLDG. � Y :DEMOL ❑ Signature APPLICANT d TEL , FIN AL (PRINT V� 10� «,10. � ', {� ; OWNER-BUILDER DECLARATION DV I �� _ DATE', U I hereby affirm that I am exempt from the Contractor's License -• -- Law"far,the following reason (SectioA"7031.5, Business and ADDRESS 7�/� �ti %tFINA 1 Professions Code).- PRESENT - - By � r'1 3r.oa DI, as owner of-the propertBUILDING y,'or•my employees'with ADDRESS. -"-� 59.25wages.as their sole compensation,will do the work-and 3 �f - the structure is not intended or offered for sole(Section LOCALITY i IIT M 7044, Business and Professions Code.•). ' s•MOVING ' -TEL 1 P& CONTRACTOR NO ^�� ❑ j, as owner of the property,,-am exclusively contracting TOTAL _9� _o 9 ®a with licensed contractors'to construct.the project (Sec- ADDRESS r t r ns tion 7044, Business and Professions Code.) CHECK ' _t`1�.25 ;REQUIRED TOTAL SETBACK FROM EXIST' �AIY � I�t; CONSTRUCTION LENDING AGENCY i . SET BACK YARD HWY PROP LINE WIDTH t CHANGE a I hereby affirm that there'is a construction lending agency for FRONT _ the performance-of the work for which thi's'permit is issued- P L.. :- (Sec. 3097, Civ. C:). SIDE- P.•L. Lender's Name ` LDMA Ref. # 7564 . 1 tt1 t 21 J Lender's Address P C.',Fee$ Permit Fee 1 0 j certify that,I have read this application and state that the Issuance FeeO,. - g' above information is correct:I agree to comply with dll County Investigation Fee: _ ordinances and State laws_rejating To building construction, Total Fee LDMA Perm # 8 and hereby auth nze re re sen totives of this County to enter upon the •ov ment' d operty for-ins ection purposes. - . SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ature phcont or Agent Date } i COUNTY OF.LOS ANGELESlOZZ — DING AND"SAFETY - '.WORKER'S-COMPENSATION DECLARATION. ' FOWAPPLICANT TO FILL IN BUI DING DDR S17 I'hereby affirm,that I have a certificate of consent to self Insure,. BUI•DING ADDRESS •- '.��F '� �� or•a certificate of Workers' Compensation In ranee,or a certlfie ZIP �EIJ�LC ;�D1TS/ copy'thereof(Sec 3800,Lab.C) Clr LOCALITY Policy No• Co, SIZE OF OT NO OF BL'DGS NOW ON LOT' �Certrfied copy's hereby furnished N AREST CROSS ST, ❑ Certified copy i5 fded.wdh the ty b ng inspection TRACT '' -' BLOCK LOT NO' b� /'�„•3��'� �fl-5���/' �t/ ' 'department USE'ZONE •MAP NO Qs ` 'ASSESSOR MAP BOOK. ' PAGE - PARCEL Date�j 'Ap'phcant SPECIAL'CONDITIONS, y ' .NER TEL NO CERTIFICATE'OF EXEMPTION FROM WORKERS' ,� /�- '7�y COMPENSATION INSURANCE ' l t ' YJC/Y�•S -//J J� WITHIN 1000 FT OF SCHOOLS YES No' ' �ADRESS ' (This-section need not be completed If the permit Is for one hundred•. /J 4~ / !t Q Q J DISTRICT GROUP- TY CONST FIRE ZONE PROCESSED BY dollars•($1 ob or less'), I certify that in the performance of the work for whlch•ths"permit. � � As,issued,.I shall'not•,employ any person In any.manner so as to become Subject to the Workers'Compensation Laws, ARCHITECT OR ENGINEER TEL;NO p STATISTICAL CLASSIFICATION APT .CONDO' Date Applicant ADDRES-S,- CLASS NO, DWELL UNITS_- NOTICE"TO APPLICANT If, -after making this Certificate of '• 1 _ REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to ' the` Workers: C NTRACT R L NCr- ' 9: 'I:SET BACK YARD HWY' PROP LINE - 'WIDTH - Compensation provisions'`of the Labor;Code; you must:forthwith ( 44,qd ��IY�C' `����7/"7 FRONT comply with such provisions oc,this permit shall,be deemed'revoked A DRESS Yr / O•' P L LICENSED CONTRACTORS DECLARATION l' .SIDE LIC C ASS PL' I hereby affirm that'l am licensed underprovisions of Chapter 9' L SEWER MAP' (commencing with Section 7000)of Division 3 of the Business ands SQ Ff SIZE'• NO OF STORIES N� nF F nnlu€g Professions'Code,an m ,Ile �e Is In full force and effec ON E- 0 NEW ❑r BK- PG Llcen'se Nu r LIC Class DE ION F ORK ADD ❑ .VALUATION D, 0 Contracto ate - TER- .❑ $ ❑ I am exempt,under Sec REPAIR ❑ 0 B&PC for this reas DEMOL ❑ DMA P/C# 0 .' D �,� G; r ,USE�O X j G•BLDG�� URM ❑ - ,..- - .. LU /'Signature - •AP�PILICANT(PAINT) �y' .. TEL NO' •- LDMA Perm'# �' - _ • Z El I,'as owner'of the.property, or my employees-with wages as -'" 0s_T'a a, their,sole•compensation, will do the work and',the structure Is ADDRESS :- ' -. , , ~ ~ '> i�''. -' ' not intended dor offered for sale(Section 7044, Business'and '.'- - " ' "• � � FINAL DATE Q aLr�••� � _,I_I•, a`�.,, Professions Code), - WILL TH&APPUCANT OR FUTURE BUILDING OCCUPANT,HANDLE A HAZARDOUS MATERWL 9 i ❑ I, as owner of,the property, am exclusive) contracting OR,A`MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATERrTHAN THE v J ' i i Y. y• g-with AMOUNTS SPECIFIED•ON THE HAZARDOUS MATERIALS INFORMATION GUIDESFINAL-BYQ ry licensed contractors to construct the.-project (Section'7044', b > . _ Business and Professions Code) VES❑ No❑' "'TOTAL ',�09 ® 83 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT 0R FUTURE BUILDING _ (f - " -- .'OCCUPANT REQUIRE A PERMIT-FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - +' Ei•�! - ih' a�Jti: • CONSTRUCTION LENDING AGENCY' .COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR ' GUIDELINES' - t. %CHANGE I hereby affirm that there is'a construction lending agency for' YES'❑ ',NO❑ -, •a 'the performance Of the.WOfk,fOr WI11Ch this permlt'IS ISSUed(Sec (HAVE READ THE HAZARDOUS MATERIALS1NFORMATION GUIDE ANDTHE SCAQMD PERMITTING, - O N `3097,CIV C) , CHECKLIST•I'UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY,CODE, - • �, 'TITL.E,2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS -�!I tl.�h?-t]i I / ,1 q,_, Lender's Name' MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD CI_ Lender's Address !17�" �Ay��Ly••J��- r • ` OMER OR AGENT � •• 1. � •'nfl -7 �L,� _ • = ... o I-certify.that I have read this application and state under penalty of perjury that the above information Is correct I agree t0 comply - PC FEE PERMIT FEE with I county ordinances and State laws relating to,building OY ! con r ction, and her by author' e representatives of this County ISSUANCE FEE a to n r upon the ab e-mento d property for Inspection purposes (o VESTIGATION FEE TOTAL FEE S w,otAIN G SEE REVERSE FOR EXPLANATORY LANGUAGE J WORKERS' COMPENSATION DECLARATION I;hereby affirm that I have a certificate of consent to self ® WRONG' n� (�/,a 1� ,insure;' r.a certificate of.Workers' Compensation Insurance,' U�1 LI IJ 111 Lj t] (J�J�j �J or oder. ied copy thereof (Sec. 3800, Lab. C.) Q " COUNTY OF'LOS'ANGELES P BUILDING AND SAFETY "Policy No.0601'S Co'mpanyI1`-10*5e .622 C AS-a.ZY �• BUILDING ? feJ. ;Certified copy is he furnished. ,= FOR`APPLICANT'TO,FILL IN. c ADDRESS, �• O''. l OSe El' Certified copy Is filed with the county:building inspec-` BUILDING*`t //°�� tion department. ADDRESS•-1_ I'-�5�►'��aL7ca 1`, Date ApplicanCIT t - Y L�' i ZIP LOCALITY �e NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKER,15" SIZE OF LOT Of lL 'Z'L NOW ON LOT CROSS ST COMPENSATION INSURANCE' ASSESSOR (This section need not,be completed if the permit is-for one TRACT��()Pj QJ f � LOT NO �MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL t OWNER (�U ✓� NO. •-1,�Gp USE.ZONE• ::OP r I certify that in the performance of the.work for which this JQ permit is issued, I shall not employ any,person in any manner ADDRESSI�� °J , Iz �11� CONDITIONS so as to become,subject to the-Workers'Compensation Laws. Q Q CITY V LLi�M� ' r ZIP (2�2 U Date Applicant ARCHITECT OR TEL Z 14- NOTICE TO APPLICANT: If; after making this.Certificate of ENGINEER - � NO. — DISTRICT GROUP" TYPE FIRE PROCESSED BY Q. Exempption, you. should•become :subject t the .Workers' r1 / /ZT O// /tom CONST. , /~ ZONE a Compensation provisions of.the Labor Code;. ou must.forth- ADDRESS LZ6 L�� ��/vvCC w with comply-with such provisions:or this permit shall be TEL STATISTICAL CLASSIFICATION FAPT. - CONDO N deemed revoked. . '' .:' ,. .' ,. CONTRACTOR NO. _ , =Z LICENSED-CONTRACTORS,DECLARATION = LIC CLASS NO DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO • (commencing with SectLIC SEWER MAP,ion 7000)of-Division 3 of the Business " and Professions Code,and my license_is in full force and effect. CITY' CLASS BK PG r�-+ VALIDATION A� SQ FT4* NO. OF NO. OF /1 CHECK ACCT.26 License Number;7Y.'75 7 C) Gc. Class SIZE STORIES FAMILIES- (-O ONE VALUATION ag Contractor ��'R Date DESCRIPTION OF WORK .��.�S1J ACfi NEW ❑ sj©„ ,. 3307y 87(�a Q ADDz E❑t 1 -❑I am exempt.under Sec. LI T I �J C _ALTER �I 1 :B.&P C. for this'reasonr REPAIR ❑- S _ .- TOTAL 8-70 m2+t0USE OF ' w Date: EXISTING BLDG L. DEMOL ❑ CHECK v7t'n_e20 APPLICANT NO FINAL eVU Signature - I ), 1 i1 r TEL -7 : OWNER-BUILDER DECLARATION PRINT /� /.' I hereby affirm that I am exempt from the Contractor's License ^^ ,,'' DATE Law for the following reason (Section 7031:5, Business and ADDRESS_ / 'C� QY� T fi��6. . r FINAL Professions Code),.,_ PRESENT BY VI3VCi-Cit,LllIi•JIV9 BUILDING ❑ I, as owner of-the property,•or my:employees with ADDRESS3279 wages as their sole compensation;w • ill do the work'and the structure is not intended cr offered for sale(Section LOCALITY ❑ and-Professions 7044, Business Code.)• ••�• " MOVING TEL I,•as owner of the property, am exclusively contracting CONTRACTOR NO • e; with licensed contractors to construct the project (Sec- ACCT■t " ADDRESS ---i i� . tion 7044, Business and Professions Code: 'D4-25_ 3M REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH T I hereby affirm that there is a construction lending agency for FRONT• 1 •1T - the performance of the work for which this'permit is issued P•L r T (Sec. 3097, Civ. C.). ' • SIDE _ I�.T�. ■ L•ender's'Name C� 1034.2 $ - LDMA-Ref # - (�(�w��C PC Fee$ �, d Permit Fee L7�� 7 �r1U1I�5JG •el�� Lender's Address f ._ . Iacertify_that I have read.this application and state that the Issuance Fee /d, J +D• CDMA P/C#' . �•�y� 8 above information is correct. I agree,to,comply with all County Investigation Fee ,, WW-OW 1 7/'5/u9 ordinances and State laws relating to building construction, Total Fee 6 3 / .CDMA Perm # < and hereby authorize rep?esentatives of this County to enterT �t�F96 1 � 8.245 'upon the abo e-mentioned propert for inspection urpose SEE REVERSE FOR EXPLANATORY LANGUAGE-, Signature of Applicant'or Agent Date 'r' law WORKERS'COMPENSATION DECLARATION ` �lhere, affirm that I have certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR B UI L D I N G PERMIT or a cer"tified copy thereof (Sec. 3800, Lab. C.) -" / COUNTY OF LOS ANGELES BUILDING.AND SAFETY Policy No.m7� Company "/ 5."" BUILDING Certified copy is hereby furnished. .. FOR APPLICANT TO FILL IN e,>3 ADDREss ❑ Certified copy is filed with the county building'inspec- BUILDI />�� tion.department: ADDR J / OCA Date J APPlicant �P CITY / i ZIP LOCALITY CERTIFICATE OF EXEMPTIO O'M`WORKERS': Y NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT 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 I LOT NO. MAP BOOK 'PAGE PARCEL TEL. USE ZONE MAP f I certify that in the performance of the work for which this OWNER141/,o NO.' NO. 1.,-3 permit is issued, I shall not employ any person in any mannerOF —?j SPECIAL - so as to become subject to the Workers'Compensation Laws. ADDRESS �i 7 C' CONDITIONS O i U CITY ,ZIP _ _ IM Date Applicant ARCHITECT OR TEL. O 'NOTICE TO APPLICANT: If, after making this-Certificate of DISTRICT GROUP TYPE FIRE ESSED BY u ENGINEER NO. CONST.. ZONE Exemption, you should `become subject to the Workers' 7 G Compensation.provisions of the Labor Code, you must forth- ADDRESS !/P ^� d with comply with such provisions or. this permit shall be TEL. H STATISTICAL CLASSIFICATION APT. CONDO.` deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION - LjC. = 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 LIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY �. CLASS �� BK VALIDATION SQ. FT.' NO. OF NO.OF CHECK_ y. License Number Lic.Class SIZE STORIES FAMILIES _ i ONE VALUATION DESCRIPTION OF WORK NEW - Contractor e ADD ❑ $ ❑ I am exempt under Sec. ALTER ❑ , B.BP.C. for this reason 41.4�jl Z19*11-121W REPAIR. ❑ 5 —_Dote: USE OF EXISTING BLDG DEMOL ❑ Signature - APPLICANT TEL-.,,7/'/ FINAL (PRINT) $$(f //J NO 7 77��� ,S OWNE UILDER DECLARATION ,j •DATE ,-r/ I hereby affirm that l am exempt from the Contractor's License - j1 9a0 FIN Law for the following reason (Section 7031.5, Business and ADDRESS g Professions Code): PRESENT - ❑ BUILDING 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 7044; Business and Professions Code). - MOVING -TEL.' I, as owner of the property, am exclusively contracting CONTRACTOR NO. El with licensed contractors to construct the project (Sec- z 5 5 9.6 A tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY SETQBAC� YARD -HWY TOTAPREOTPAINEFROM WIDTH H. _ :....- ®.® o.•.e.l hereby affirm that there is a construction lending agency for FRONT � the performance of the work for which this permit is issued P.I. - - - ' - 1 - 2137.38 (Sec. 3097, Civ. C.). SIDE _ a 237,38'0 Lender's Name LDMA Ref. # a Q 9-8 6• o (1r jj m - - - - P.C. Fee$' Permit Fee ' '" "' - -• - Lender's Address A I certify that I have read this application and state that the Issuance Fee /v �Q LDMA P/C•# above information is correct. I agree to comply with all County Investigation Fee . ordinances_and State laws relating to building construction, _ _ and hereby authorize representatives of this County to enter Total Fee LDMA Perm. # upon thea ove-mentione roper for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE 0 -• nature of Applicant o gent - Date - - - - - = • _ -._ _. _ _ -. _. .. .__. WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a cerhficatq_of,consent to self ,` n �� O ®X r p . insure, or a-certificate of.Workers'.Compensation Insurance, A LI C!�1 13 1 U L5 LI11tl L1�1 or a certified copy thereof`(Sec. 3800, Lab 'C.) COUNTY OF LOS ANGELES - BUILDING AND SAFETY !.Policy No.1182923 'Company St, Fund BUILDING ® Certified copy is hereby furnished.. ' :•FOR:APPLICANT TO FILL IN ADDRESS 6300 ❑ Certified copy is.filed with the county building inspec- BUILDING- , , . - _ . ., _ tion department ' , ADDRESS 6'300 N. Rosemead 31 vd*. Date— EWE Applican 1 _t Circ Temple Cl.ty zIP"1780 : LOCALITY' NO OF BLDGS NEAREST CERTIFICATE-OF EXEMPTFON FROM-WORKERS'_ SIZE OF-LOT NOW ON LOT 2 CROSS ST COMPENSATION INSURANCE'- ASSESSOR (This section need not be completed if the-permit•is'for one TRACT- BLOCK T. LOT NO' MAP BOOK- PAGE- -TAR CEL 'hundred dollars ($100).'or less.) t ;-_ TEL 773-1'5,00 USE ZONE MAP OWNER' GUD ,Investments No . NO I certify,That in the performance of.the work for-which this SPECIAL permit is issued, Lshall,notemploy any•-personinany_mahrier ADDRESS 1160 •Harbor B1 Ful.lerton,:' CA CONDITIONS a so as to:become;subject to the Workers'Compensation.Laws.- s',- O CITY a ZIP 9263Z_- Date': Applicant - - - 1 ARCHITECT OR TEL NOTICE TO APPLICANT::,If, after makingthis Certificate"of ENGINEER NO. •.._ DISTRICT, ,GROUP TYPE FIRE PROCESSED BY CONST. 'I ' NE F- Exemption, you should •become subject to they Workers' " U Compensation provisions of'the LaborCode, you must,:forth- ADDRESS + p(/p v � ' with comply with„such provisions-or, this-permit,•shall beTEL. STATISTICAL CLASSIFICATION' APT CONDO N deemed revoked. - CONTRACTOR & Se 1 CeS- NO '-557-•6401 Z LIC. CLASS NO DWELL. UNITS' ” -LICENSED,CONTRACTORS DECLARATION.; `J515�"MaCArthu #5 603695 — I hereby affirm that'I am licensed under provisions of-Chapter 9. ADDRES Y, ' NO LIC.' SEWER MAP, t' ' (commencing with Section 7000)of Division 3.of the Business. t � CITY .Costa Mesd CA CLASS B �__ and Professions Code,.and my license'is in full force and,effect. BK PG Vti4LIDATION = SQ. FT. NO OF. NO. OF CHECK- '"'"r_ t, :60'3695 B''� SIZE ` STORIES FAMILIES ONE License Number Lii'Class - - t E ary-� ` T rA:LU�ATI.O.N'.' Contractor P&P Prop -Sere "` 'Date 93('91 ' DESCRIPTION OF'WORK NEW` ❑ �;��'; " ADD ❑ PFYft1L of ` 'd❑I am exempt'unde�Sec. t De Wd1 �. ALTER v _w•.� r B.BPC..for this reason add C6 ti is g•Ior- add' 1 'ret' spac $ ; =: "n • REPAIREl- , �it�� ��-__ Dare: USE-OF }-i EXISTING BLDG 1. Commerc al DEMOL El �lc.i' APPLICANT ' Srnnntur (PRINT). &R Pro ServT°ces"'.Nd1557-6401 FINAL v� _� OWNER-BUILDER DECLARATION DATE 1.1 hereby affirm that'I am exempt'from the Contractor's-License v_:S j -• r'E t;i,=_' ADDRE§ 515-MaC'Arthur 45 Costa-Mesa; 'CA , -Law for the following reason (Section.7031.5,"�Bu`smess•and fINAL� � Professions Code): - PRESENT' g ;__'•�-.fhl€j j ?? BUILDING Y r - € a =` ❑ I, as owner of,The property, 'or my employees with ADDRESS '- -'SIL' i 1 e_;L: - wages as their•sole compensation,will-do.the work and P - - The structure is not intended or offered for sale(Section LOCALITY 7044,,Business and Professions Code.) MOVING _ .TEL F-1I, as owner of the"property,•am exclusively contracting, CONTRACTOR NO with licensed contractors-to construct the project (Sec- « gDDRESS �, ' " f tion 7044, Business and,Professions Code.) - - s, r} REQUIRED' TOTAL SETBACK-FROM EXIST a• CONSTRUCTION LENDING AGENCY SET BACK YARD" '.HWY PROP. LINE WIDTH r ,. I hereby affirm that there is a construction lending agency for FRONT. the performance of the work'for which this'permit is issued PL - (Sec..3097, Civ. C.). ± `SIDE P.L: _ Lender's Name _ $ _LDMA Ref N - 'P.0 Fee$ - Permit Fee Lender's Address . • t►• I certify that I haveLM P/C ,'read this application and state that the Issuance Fee • 8 above information is correct. I agree to comply with all'County Investigation Fee .+ ordinances and State jaws relating"to building construction,' Total Fee3'. LDMA Perm. a < and hereby authorize representatives of this County to enter -• • ' •* m upon 1e'above-menho d property for inspec-o`Pur oses. r *,< �� � SEE•REVERSE FOR EXPLANATORY LANGUAGE Signature of A or Agent to e COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ' SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9803190051 PHONE: (818) 285-0488 EXT: LEGAL BER OF SIGN G ADDRESS: ON FILE SIGN DESCRIPTION: 2 NEW SIGNS PLUS A REFACE 6300 ROSEMEAD BL TEMP CA 917801544 ASSESSOR INFORMATIONN NEAREST CROSS STREET: LONGDEN 5382-021-026 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY EXIST BLDG U U ON: PROCESSED I ES 0 : S EXIST OCC GRP: 03/19/98 UT 3%19/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION,: FINAL DATE FINAL CODE: VANNIER WILTON E CO TR VANNIER TRUS (818) 355-1239- 7,000 g 209 OAK MEADOW RD ?-✓� SIER 910242611 FEES PAID NRWIMON OF WORK TWO NEW SIGNS PLUS A REFACE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. AD-ART SIGN CORP. (310) 523-9500- AA BLDG PERMIT ISSUANCE 27.75 19603 FIGUEROA AE STRONG MOTION OTHER 7000.00 VAL 1.47 SPECIAL CONDITIONS: CARSON, CA AX BUILDING REVI°EN=FFEE-�^Y� 54.70 D2 PERMIT W/0`-EN-EN7000 00 VAL 166.95 TOT•A (FEES 250.87 CONTRACTOR: TEL. NO: ®a r'���\ APPROVALS DATE INSPECTOR SIGNATUR AD-ART ELECTRONIC SIGN CORP (310) 523-9500- 19603 FIGUEROA ST LIC. NO LOCATION ARFTETBACKS CARSON CA 90745 711214C45 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. 0: �/ �' ( FOUNDA RERN CH LIC. N0: �� ___ ` 1111111 SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: R ONE: CMP: �/��� OF FAMILIES: /C N . STAT CLAST. , - -- - --- "" NO 20SCHOOL WITHIN HAZARD009 AIR DUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS FIRE SPRINKLER BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9807200030 PHONE: (818) 285-0488 EXT: LEGA D: NUMBER OF ADDED/RELOCATEDL ING D S : ON FILE SQ. FT SPRINKLER HEADS 6300 ROSEMEAD SL STRUCTURE: 6000 TEMP CA 917801544 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5382-021-026 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON: CHIEF AUTO PARTS EXIST OCC GRP: 09/25/98 UT 09/25 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: VANNIER WILTON E CO TR VANNIER TRUS (818) 355-1239- 7,500 209 OAK MEADOW RD !^lq SIER 910242611 FEES P SCRIP 10 F WORK FIRE SPRINKLERS FOR TENANT IMPROVE ENT FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: E 0: J. B. FIRE PROTECTION (714) 525-3232- DO FIRE SPRINKLER PC 7500.00 VAL 155.55 2030 E. WALNUT AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: FULLERTON, CA AE STRONG MOTION 7500:00 VAL 1.58 D1 PLAN C H ECK-'-W/0-EN'HCt ES 7r500:&IVAL 155.55 TOTAL' F.EES 340.43 CONTRACTOR: TEL. N0: ®� �IV APPROVALS DATE INSPECTOR SIGNATURE J. B. FIRE PROTECTION (714) 525-3232- @� 2030 E. WALNUT AVE. LIC. NO FIRE TMENT INSPECT FULLERTON, CA 92831 647282C16 FIRE SPRINKLER HANGERS ARCHITECTOR ENG 0: FIRE DEPARTMENT OVA LIC. NO: 111111 MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CM0 E ��C �n n O"Er"' NO. OF FAMILIES: DWELLING U TS: A T/COND: S :\ _ v v NO 20 p le SCHOOL WITHIN HAZ ARDOUS AIR QUALITY: 1000 FEET MATERIALS �5 NO NO NO Ll 0Q� REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY t50£;� • � �' BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS •' TENANT IMPROVEMENT 'BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA �'� BL 0508 9803120076 PHONE: (818) 285-0488 EXT: LEGAL D: NO. OF CONST NEW BUILDING AD ON FILE SQ. FT STORIES TYPE OCCUP GROUP 6300 ROSEMEAD BL STRUCTURE: 0 1 VN B TEMP CA 917801544 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-026 THOMAS PAGE: '596' GRID: H2 LOCALITY: TEMPLE CITY TENANT: EMS—T USE: COMME USE Z ISSU D N: PROCESSED RES ON: CHIEF AUTO PARTS EXIST OCC GRP: B 07/06/98 UT 07/06/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: VANNIER WILTON E CO TR VANNIER TRUS (818) 355-1239- 78,000 „1 209 OAK MEADOW RD t SIER 910242611 FEES PAID DESCRIPTION OF WOR T.I.-INTERIOR REMODEL WITH MINOR EXTERIOR REMODELING FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TE 0: J & G PARTNERSHIP, INC. (714) 752-9333- Al PLANCHECK W/EN-HC 40000.00 VAL 650.14 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION;RESID 40000:00 VAL 4.00 Al PLANCHECK�W/ENH� Cg'�LESt8000_00?VAL 399.55 A2 PERMI Wtt.ENERGY�HC-;-�780001 OO�VAL 1,234.93 CONTRACTOR: TEL. NO: TOTAL 2,316.37 APPROVALS DATE INSPECTOR SIG URE JAMES FRANCIS EGNER (714) 660-0309- d 1151 DOVE ST. STE.210 LIC. NO LOC ON AND SE NEWPORT, CA 92660 526568 SOILS ENGINEER ARCHITECT OR ENGINEER: TEL. NO: / r \ FOUNDATION/TRENCH LIC. N0: !I + —�— I 111 1SLAB/UNDER FLOOR R m__10-7 RAISED FLOOR FRAMING MAP-N0: SEWER MAP B00 PAGE: FIRE ZONE: CMP,: �� ��� �� r. , �, UNDERFLOOR INSULATION 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING NTS: APT/COND: STAT CLASS: _ — _ __ —_ NO 22 / /j �a.� �' �� ROOF SHEATHING SCHOOL WITHIN HAZARDOUS `� % � �� ;e�-1' tom. ��� SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS �t- �ij� NO NO NO "�� ��� - �� �' �;i FRAME INSPECTION FIRE SPRINKLER HTM9 INSULATION/WEATHER STRIP NTERIOR /DR LL EXTERIOR LATH RATED FLOOR . RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS q Z p OT INAG 0' Q REPORT ID: DPR261 ROUTE TO: BS0508 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 9811300003 PHONE: (626) 285-0488 EXT: LE GAL ID: 0. 0 CONST UIL DDRES ON FILE SQ. FT STORIES TYPE OCCUP GROUP 6300 ROSEMEAD BL STRUCTURE: 0 1 VN B TEMP CA 917801544 ASSESSOR INFOR14ATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-026 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: S U 0 : PROCESSED BY-: - XPIRE N: AUTO ZONE EXIST OCC GRP: B 01/26/99 UT 01/26/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: VANNIER WILTON E CO TR VANNIER TRUS (818) 355-1239- 25,000 �� 209 OAK MEADOW RD V� l SIER 910242611 FEES PAID DESCRIPTION OF WUKK MINOR INTERIOR REMODEL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: JALLALI GRIFFIN ARCHITECTS, INC. (949)' 752-9333- B1 PLANCHECK' W/ENERGY_ -25-000.00 VAL 455.55 43 CORPORATE PARK AA BLDG PERMIT ISSUANCE_ 27.75 SPECIAL CONDITIONS: IRVINE, CA 92606 AE STRONG MOTI,ON_-O,T.HER�125000.00 VAL 5.25 B2 PERMIT,.'QENERG_Y;E L E S /25006!00 VAL 515.46 CONTRACTOR: TEL. NO: OCj TOTA�L`F'EES 1,004.01 AP ROVALS DATE INSPECTOR SIGNATURE JAMES FRANCIS EGNER (714)'660-0309- - 1151 DOVE ST. STE.210 LIC. NO LOCATION AC NEWPORT, CA 92660 526568 . SOILS ENGINEER APPROVAL / ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRIWER F5RlFS s LIC. N0,°' r 1111111 SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 10- L�'JUC C� V S 0R FLOOR SHEATHING OF FAMILIES: DWELLING UNI APT D: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS g° * SHE R PANELS AIR QUALITY: 1000 FEET MATERIALS NO -NO NO i0 n :` ®� FRAME INSPECTION wlpQ� FIRE SPRINKLER HANGERS 'C `Servic @ That INS LATION/WEAT ER STRIP INTERIOR AT ALL EXTERIOR LATH RATED FLOORICEIL ASSEM. RATED WALL ASSEMBLIES RATED S A /OP T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: SS0508