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HomeMy Public PortalAbout6322 ROSEMEAD BLVD_Building__ 76AS38A�CE#80311-57 APPLICATION FOR BUILDING PE MIT .1 COUNTY OF LOS ANGELES BUILDING ZCJr�9' DEPARTNIENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY G t G JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. _O C•.- �'� DISTRICT NO. GROUP SEWER MAP FOR APPLICANT TO FILL IN. - f E I BK PG BUILDING ADDRESS 6322 NoeRosemead Blvd. STATISTICA ASSIFICATION I CLASS.NO. DWELL.,UNITS LOT NO. BLOCK MAP � J�'$ STATE NUMBER ' HWY. yES NO TRACT USEZONE SPECIAL _NO.OF BLDGS. CONDITIONS SIZE OF LOT I NOW ON LOT G 2 USE TI - T ia.Undramati C EXISTING BLDG. l.a V1_ BUILDING YARD HWY STREET NAME EXIST. OWNER L�atundnamltc & Dry. -Cleaning SETBACK WIDTH MAIL 6 322 No eRosemead B v o FI'DL T � G� 1 ADDRESS SIDE + TEL. P.L. CITY NO. INSPECTION RECORD ARCHITECT OR - TEL. ENGINEER NO. ADDRESS R I��7�, _ A. n CONTRACTOR m�e SiCo• TEL'l11•6220 ADDRESS 61 E e Verdugo Ave. Burb e — DESCRIPTION OF WORK NEW ADD • ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE C+ STORIES - FAMILIES - ,f USE OF STRUCTURE Singel FaA Face Neon a i1=: ���/.,:^ ��2-°.�I��;`S a r r Wall Sign. SIGNATURE OF APPROVALS APPLICANT • DATE INSPECTOR'S SIGNATURE ADDRESS 'TA UFOUNDATION: LOCATION FORMS,MATERIALS $ C�n•00 P.C. $ FRAME: FIRE STOPS, 550 FEE BRACING,BOLTS VALUATION $ ®® FURNACE: LOCATION, FEE & GAS VENT,DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH,INT. PLICATION AND STATE THATTFIE ABOVE IS CORRECT AND AGREE TO CO Y WITH A, qoUNTY ORDINANCES AND STATE LAWS GULA C�! DING CONSTRUCTION. LATH,EXT. SIGNATURE OF /• _ - -• �• HOUSE NUMBER COR- PERMITTE RECT AND POSTED r _ ADDRESS 6 kve. BUrbarlk FINAL �/ S ✓ �. • CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH .__ ,Co 3 5 2 6 ,. ``1` 16 1 A 5.00 pe. ©s 76A638A! GE x'803)REV.6/78) �/��/ •;/� � � '� APPLICATION FOR. BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS _G �, , FDG ZZ. hl $ „a t-�c:l i� LOCALITY ` �i NEAREST h��-e.1. Ty ZIP �-v CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT nJ l/ NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GR UP TYPE FIRE ROCE E BY TRACT BLOCK LOT NO. '57�0,6 � CONSV,' ZONE //'' / TEL V .' OWNERC-L-� , l �Yayy7tZi.i Hi . STATISTICAL CLASSIFICATION WER MAP ADDRESS o.S� `/ "� ? L a " CLASS NO. -)L- DWELL.UNITS BK PG CITY '-r.A '-.i 1'(-#4 ZIP _ ARCHITECT OR TEL. VALUATION ENGINEER NO. ADDRESS BLDG,SETBACK FROM TEL FRONT PROP.LINE OF (STREET) CONTRACTOR P-,Cr-F 4e,>�. Pel�TA C.NO. HIGHWAY + ,YARDTOTAL SETBACK FROM TYPE OF EXISTING . . LIC. FRONT.PROP..LINE HIGHWAYI WIDTH ADDRESS �EL -CG :Z NO. LIC. + CITY C^y v� ai 17 @ rt CLASS CONSTRUCTION LENDER BLDG.SETBACK FROM NAME AND BRANCH �J .,y SIDE PROP.LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SO.FT., � ��� NO.OF NO.OF CHECK. + _ SIZE I «✓V STORIES FAMILIES ONE DESCRIPTION OF WORK C-_ NEW ❑ P:C. Fee$ 60 G°v Permit Fee c- ❑ 651 ADD Issuance.Fee �. Q� ALTER 91e REPAIR ❑ Total Fee . ;? ,g A USE OF " / EXISTING BLDG. Aa:- -�1 ��T DEMOL - o o23 APPLICANT- - TEL PRINT) I +1 1-ALTS S-i1L.NO. ,-5Z5T QD 2 0 0 3 6 0 0 BY(SIGNATURE) c :o o o 3 6 0 0 v HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL.ORDINANCES W'' O R,.0'7 -7 9 AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Z WORK AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLATION OF U 6 53.9 A THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM ' Z d'� _ PENSATION INSURANCE. - Q # 0 0 0 0 0 1 SIGNATURE OF /( 1 l� / 1 // PERMITTEE L�"" v' � z o - 5200 ADDRESS ,E 3 1 �=�a�'�-4: ''� , ~ TEL. _ ZO -o 0'0 52002 CITY ”' a�7C+ N "y> 0 0 09.07-79 USE ZONE MAP r '` NO. Q � Q pZ SPECIAL -* CONDITIONS oc FINAL W DATE .-�S WORKERS' COMPENSATION DECLARATION to sf insure,hereby aafcertif certificate of Workers' CompensaT on irm that I have a certificate f coeInsuran nt e, APPLICATION. FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, 'Lab. C.). COUNTY OF LOS ANGELESBUILDING AND SAFETY Policy No. Company BUILDING / �) ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ! IV Q_Ile iAec,CA ❑ - Certified copy is filed with the county building inspec- BUILDING tion department. ^^ _ Date ApplicanT CITY- ` ZIP --f-I2 LOCALITY MA e NO. F„BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT OW N LOT KECROSS ST. - D COMPENSATION INSURANCE ASSESSOR (This section need not becompleted if t e per" ii is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.') TE r OWNER G (r NO. - USE ZONE, MAP 1 certify that,in the pe ormanc of th o or hick thi SPE } SPECIAL - permit is issued, I shall no y rsor�i n mann r ADDRESS Q Q\� . CONDITIONS O so as to become subject to th r n a n s - i CITY LA U ZIP U Dat ,1 Applica ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR CESSED BY NOTI E TO APPLICANT: If, -m ing this Certificate" ENGINEER NO: _ CONS ZONE V Exemption, you should become subject to. the Workers' ff� R U Compensation provisions of the Labor Code, you must forth- ADDRESS - /'w I-� 2 N with comply with such provisions`or this permit shall be UQ TEL. STATISTICAL CLASSIFICATION . PT. CONDO. Z deemed revoked. CONTRACTOR NO. r�� — LICENSED CONTRACTORS DECLARATION. LIC. CLASS NO.� G DWELL UNITS I hereby affirm that am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (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 VALIDATION SQ. FT. NO..OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE + � VALUATION' DESCRIPTION OF WOR •'tom t,, Yrs NEW ❑ Contractor Date -. .DO ❑I am exempt under Sec " ✓ u4—:1 170 -ADD El ALTER B.&P:C. for this reason l✓1 Com^/ REPAIR ❑ $ Date: USE OF 1 EXISTING BLDTJ ) VIN y Z� L DEAR APPLICANT TEL. . - Signature FINAL OWNER-BUILDER DECLARATION (PRINT) ' 11 Vi Q1 ANS DATE . 'FOR �_i:} I hereby affirm that I am exempt from the Contractor's license ==3" �° Low for the following reason (Section 7031.5, Business and ADDRESSFIN t Tl ; Professions Code): PRESENT BUILDING❑ I, as owner of the property,- or my. employees'with. ADDRESS B /! S i}"}y;� 25-3 .50 wages as their sole compensation,will do the-work and ; E i ' 23.50 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. , F:�� I, as owner of the property, am exclusively contracting CONTRACTOR NO. f-t}pt 111�� with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions-Code:) ,>� REQUIRED TOTAL SETBACK FROM EXIST. t{_ }_s,.l� x ��f CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH • •;:° I hereby affirm that there is a construction lending agency for FRONT x,44 1. i. HE{ i! the'performance of the.work for which this permit is'issued P.L. (Sec. 3097; Civ. C.): SIDE P.L: Lender's Name. d LDMA Ref. # m RC, Fee$ Permit Fee Pol Lender's Address �, o I certify that I haver ead t i application and state that the Issuance Fee LDMA P/C# 8 bove'inform ion is;c rre . I agree to comply with all County Investigation Fee. d r-iRa s a S r luting to b `Iding consiructio Total Fee LDMA Perm. # a e b oriz re res ntatives of i County o en r ab e o d' per or i s ctior, rpos } t 2! SEE REVERSE FOR EXPLANATORY LANGUAGE `� '�� Signa ure of Applicant or Agent ate V �0 APPLICATION FOR BUILDING PERMIT i1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN B L Ess 3 144c) I hereby affirm that 1 have a certificate of consent to self insure, BUILDING ADDRESS Q or a certificate of Workers'Compensation Insurance,or a certified D 4 copy thereof(Sec.3800,Lab.C.) f e,. ZIP LOCA ,­ Policy No. Company SIZE OF LOT NO.OF BLDGS.NOWON LOT ❑ Certified copy is hereby furnished. NEARES CROSS ST. ❑ TRACT BLOCK LOT NO. 'V Certified copy is filed with the county building inspection USE ZONE FAO.department. s--3 Dat@ Applicant ASSESSOR MAP BOOK PAGE PARCEL AL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER Ct i( i(�l'f►-, � TEL NO. 1 7 OCJ/ YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? ADDRtl Nil �� (This section need not be completed if the permit is for one hundred a UA GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) V I certify that in the performance of he or hich this permit CI `/l /�'[�i7/1✓ ZIP6 ' is issued, I shall not employ any ers0 anner so as to A CHITECT OR ENGINEER TEL.NO. q4�? become sub'ect to the Workers'CO pen ti STATISTICAL CLASSIFICATION APT CONDO Date 0 Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. is Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' C TRAC OR T SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. qRE . �v� W IC,Ng U P L LICENSED CONTRACTORS DECLARATION ( 11 �� LIC.CLASS SIDE Lo I hereby affirm that I am licensed under provisions of Chapter 9 'J./� ��x� SEWER MAP ' v (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO STORES NO.OF FAMILIES \ �' Ica OZ NEW ❑ BK PG ++-� O Professions Code,and my li nse is in full force and effect, , .?3Ll,•• ;c e-(� DESCRIPTION QF WORK ADD El VALUATION '` LLS Number_ Lic.Class l ` J TTEMS N Contracto N S��i� Date S ^l� -� ALTER ❑ $ `� I i;€SIL 75 m 7 ❑ I am exempt under Sec. REPAIR ❑ $ CT "175.75. B.BP.C.for this reason DEMOL ❑ LOMA P/C# =MANGE CIO USE OF EXISTING BLDG. Date: URM. ❑ Signature AP LICA IT(PRINT � Z TEL.NO. / S7 LDMA Perm If Z t0i 111l 1-0rL 0� s: � qr9 6 tlLs: LILT J :rl 1 1.1 1 ❑ I, as owner of the property, or my employees with wages as �- p their sole compensation,will do the work and the structure is D RE c ut F not intended or offered for sale (Section 7044, Business and �-�] F L Uhf* �_ /Ids �FINAL D/A/ a 1 ( :o PfOfeSS10r1S Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - l "' :0 •I• ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q . Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY A •i•I o 8 licensed contractors to construct the project.(Section 7044, YES❑ NO❑ Business and Professions Code.) 3?07 .� c3 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING -i s0 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH L CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST 3 1TLM(13 FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES ElNO❑ I;I A( �9 ¢ 50 the performance Of the work for which this permit is issued(.Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD f, 3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES CHECK y•"' Cv�1 r i rn L'yv m. COUNTY CODE,TITLE 2,CHAPTER 220 SECTIONS 2.20.100 THROUGH 220.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING APERMIT FROMTHESCAQMD. i f )NGE eiI?E Lender's Address OWNER OR AG ENT o I certify that I.have read this application and state that the above P.C.FEE PERMIT FEE -, informatict. I agree to comply with all county1 4 llj)I1 i-��j�l� 5/1 L i?.; ordi claws relating to building construction,and J ¢. herfbie-V- PtVione r entatives of this County to enter upon ISSUANCE FEE L�,i i Lei-: the roperty for inspection purposes. `� " INVESTIGATION FEE TOTAL FEE o.� 1) SEE REVERSE FOR EXPLANATORY LANGUAGE i a APPLICATION FOR BUILDING PERMIT ` COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS `� BUILDI G ADDRESS G Z OS G M Q(20 I hereby affirm that I have a certificate of consent to self insure, 3 Z_Z^ a ? 2O or a certificate of Workers'Compensation Insurance,or a certified �1 �r G' copy thereof(Sec.3800,Lab.C.) CITYI` C ` p ZIP Cis t —LOCALITYM Policy NO. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST.- ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. 1-.CSN ' O►J 4- l`USeM��� department. USE ZONE MAP N Date A licant ASSESSOR MAP BOOK PAGE PARCEL /JJ d C;2PP � G' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER —ra N N I G 9A L.D TEL.NO. r V I S ZYES NO COMPENSATION INSURANCE ADDRESS- WITHIN 7000 FT OF SCHOOL? ,o�/�/�JI (This section need not be completed if the permit is for one hundred 2 Z t 1/TC Y ��I10 DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY '�' l7 I� 3 I certify that in the performance of the work for which this permit r C 80 TE is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER ZIP�j L.NO. Z71 � become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 12;70. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL.NO. 1 SET BACK YARD HWY PRQR;I.INE WIDTH n„ Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP --? (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES C `s ;•; 4.217 z 1! Professions Code,and my license is in full force and effect. NEW ❑ BK PG 1 DESCRIPTION OF WORK VALUATION 'H fNG, °`'IL' W License Number Lic.Class �� 1 ADD C] Contractor Date ALTER $/� 4000' O z ❑ ❑I am exempt under Sec. REPAIR B.BP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ i Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# Z I, as owner of the property, or my employees with wages as 0 their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and ' FI DATE Q Professions Code.) J� G WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLER HAZARDOUS MATERIAL CCC..11l��� J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ NO❑ (�jf Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ __.. the performance of the work for which this permit is issued(Sec. 3097,CIV.C.. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES m. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING I I:i7 ''9` P"'• S'"'`' " Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address r v t I� OMER OR AGENT F..:. r n =' o I certify that I have read this application and state that the above ;�,•, $ Information is correct. I agree to Comply With all County P.C.FEE ry PERMIT FEE �y © y ,FIi• ordinances and State laws relating to building construction,and OY OYd i a. hereby authorirepres atives of this County to enter Upon ISSUANCE FEE the ab me one ro arty for inspection purposes. �� r " !"r• a res 7 INVESTIGATION FEE TOTAL FEE n II41 :tom m rem Apo—t°r we 1-''' d4 SEE REVERSE FOR EXPLANATORY LANGUAGE