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HomeMy Public PortalAbout6332 ROSEMEAD BLVD_Building__ 78A898A'CE ry8098-88 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDIADDREs �- �a �•. 1SLV DEPARTMENT OF COUNTY ENGINEER — BUILDING AND SAFETY DMSION LOCALITY t JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. L e►v� DISTRICT NO. GROU TYPE P E SED BY FOR APPLICANT TO FILL IN - :5Iiia 4 I CONST,/j/_ BUILDING d� q STATISTICAL CLAS FICATION I SEWER MAP ADDRESS n/ BK PG LOT NO. 7`� ,S BLOCK- CLASS.NO. DWELL. UNITS itt MAP STATE (YES_)NO NUMBER HWY. TRACT USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT y y USE OF C C - 'J�G: t% EXISTING BLDG. BUILDING EXIST. L- ,y�� SETBACK YARD HWY STREET NAME WIDTH OWNER t1�r I� 1,L7Y�� tp^ `►1A1�L FRONT OJ ADDRES'S7- (> @?S�yen acs &uc1 SIDE KJo CITY f -VL-10/1 �E - N�' P.L. ARCHITECT OR TEL, INSPECTION RECORD ENGINEER NO. ADDRESS ,,��q/��� ' CONTRACTOR jOkkO SPG S NO ADDRESS [d2 S, PRIA"%ow DESCRIPTION OF WORK ME , . ADD Mi REPAIR DEMOLISH_Str _ FT..' ( J NO.OF NO.OF SIZE tlU STORIES FAMILIES USE OyFSTRUCTURE PZASTiC/ice – S [ d L PT SIGNATURE OF APPROVALS APPLICANT A ADDRESS CaZ S.�R I,/� (�y S (J/I�� FOUNDATION: LOCATION DATE INSPECTOR'S SIGNATURE FORMS,MATERIALS O �— P .C. ✓� FRAME: FIRE STOPS. BRACING, BOLTS VALUATION FURNACE: LOCATION• `�� GAS VENT.DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE.ABOVE IS CORRECT AND AGREE TO COMPLY 'T'H ALL UNTY,ORDINANCES AND STATE LAWS RE AT.ING ILDI "CONSTRUCTION. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTE 'A / RECT AND POSTED ADDRESS �' N/o FINAL J JL?"d q W�Ztix�C-tL. f - ,h CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL E NE R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 1 ; .03 3 2 ±�^x; 11 1 A 3.00 '° s' 1 _*ORK.�RS'COMPENSATION DECLARATION j I 4ereltly affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, �a c rt'fi d to y ecf (Sec. 3800, L b. C.) 4 �/�..f,. C1 COUNTY OF LOS ANGELES BUILDING ANDS ETY olicy N#.�/�t�. [47@ompany d Certified co is her�hv_furnished. BUILDING 22 /� ❑ copy , . - FOR APPLICANT TO FILL IN ADDRESS )e�V oL �ertified s;,oy is fil'er4 with the county building inspec- BUILDING tion de)partmment. t,' ADDRESS :3,3 Z • Date 7 1I— V Applicant Y CVC-k{r 6 Ksr CITY7e w7 LQ CA ZIP LOCALITY �< CERTIFICATE OF EXEMPTION FROM WORKERS' NOol 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 LOT NO. MAP BOOK PAGE PARCEL TEL. USE SONE MAP I certify that in the performance of the work for which this OWNER fjn r NO.7 73�ASoo (`/�/ NO. permit is issued, I shall not employ any person in any manner / / O L/ /„O L / SPECIAL t so as to become subject to the Workers'Compensation Laws. ADDRESS / t0 �T rv/ 1L7`{,. CONDITIONS Date Applicant CITY L,11C-4-� 1 G -t ZIP ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROUP I TYPE FIRE PROCESSED BY 0 Exemption, you should become subject to the Workers' ENGINEER NO. CONST.✓ ZONE V Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be D. deemed revoked. r� ^/ TEL U STATISTICAL CLASSIFICATION APT. C NDO. CONTRACTOR �,`(, `p V( t NO.•S-( Q 798 LICENSED CONTRACTORS DECLARATION LIC CLASS NO. c ✓ DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 3 3 33 Q r<� ti NO.4 0767 p (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 ® V` CLASS VALIDATION /r1 ` SQ. FT NO.OF NO.OF CHECK BK. PG. License Number 4 b-7 9� Lic.Class SIZE Q STORIES FAMILIES. ONE 11���1_�' —?—I— Q� �1 VALUATION Contractor•" III �— Date ~� _ C 7(7 DESCRIPTION OF WORK \ .T_v . Q t, NEW ❑ V2, U O 71 p � \ L ADD S 0 , ❑ I am exempt under Sec. V" ALTER B.BP.C. for this reason DEMOL REPAIR ❑ $ ;20 Date: USE OF c EXISTING BLDG. G..�� Ste, �g ❑ # • e%W7 • Signature APPLICANT /`_,a TEL. FINA r7 (PRINT) C3 1 e(� NO. Y4 OWNER-BUILDER DECLARATION DAT '��`� • I hereby affirm that I am exempt from the Contractor's License � .® `� Law for the following reason (Section 7031.5, Business and ADDRESS FIN 1 Professions Code): PRESENT By ❑ BUILDING -2 0 n I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and #.••o •,•Z 2 11 o � the structure is not intended or offered for sale(Section LOCALITY I •:� LL 3 6 3 7044, Business and Professions Code). MOVING TEL. 4 6 3 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. • o with licensed contractors to construct the project (Sec- rADDRE 0 7.2J `$8 tion 7044, Business and Professions Code). TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Permit Fee 1 LDMA Ref. # Lender's Address /�I certify that I have read this application and state that the Issuance Fee V1 JLDMA P/C#above information is correct. I o ree to com I with all Count 9 P Y Y Fee a ordinances and State laws relating to building construction, Total Fee and hereby authorize represe at' a of this County to enter /143 LDMA Perm. # upon a abov m t ne p p y for inspection purposes. m SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of App icant or Agent Date 1 F APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS B ILDING I hereby affirm that I have a certADDRESSificate of consent to self insure, - � G_ � � ^ or a certificate of Workers'Compensation Insurance,or a certified ©( 0 LOCALI copy thereof(Sec.3800,Lab.C.) �A 4: CI zl �'` I� km e ( j Policy No. Company J I" SIZE OF LOT NO.OF BLD S.NOW ON LOT Z ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed With the county Building Inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL ' Dat. licantn*'cT�'�sr''S SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' QWNER �� TEL.NO. YES NO COMPENSATION INSURANCE 1 WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred 1k,GfA v A 4r43o DISTRICT ' GROUP TYPE CONST.' FIRE ZONE OCESS BY dollars($ or less.) ©�/ I certify thathat in the performance of the work for which this permit t/�I e-/t-/&A/ (,-4ZIP � 31- � ' u( is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'COm ensatlonn Laws. STATISTICAL CLASSIFICATION APT CONDO Date '-2' -G) Applicant �•�� �� ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of , REQUIRED TOTAL SETBACK FROM EXIST EXem tion, you should become subject to the Workers' C TRACTOR TEL.NOS p y j / ,� � � � SET BACK YARD Hwv PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith l FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS L C. O. PL (2 3 = SIDE �. LICENSED CONTRACTORS DECLARATION r1ITY a clAss P L o '� S e I,__ C _ _ c3 1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP j (commencing with Section 7000)of Division 3 of the Business and Q.FT.SIZE NO.OF STORES NO.OF FAMILIES NEW BK PG C Professions Code,and my license is'in full force and effect._ rlf_CC-T.$a ��l�'��� C f DESCRIPTION OF WORK ADD [] VALUATION License Number o Lic.Class .4C L -.j � f I -„_a ContractorA Y 54Vd� Date � 3'�� ALTER ❑ TTEMf-. °~ z • �ILCoJ ❑ I am exempt under Sec. � � REPAIR ❑ P ] „� Q B.&P.C.for this reason (.. CwpDEMOL ❑ L F OTi” LDMA /C# 7 Date: u EOF EXISTI G LDG. URM Elf",y U ` ° Signature / ,> APPLICANT(PRINT) TEL.NO. LDMA Perm# 1 HAIN�r 2 ❑ I, as owner of the property, or my employees with wages as p their sole compensation,will do the work and the structure is ADDRESS r not intended or offered for sale (Section 7044, Business and FINAL DAJJC i ; j__;jh 71 y 4/91 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL a n i ❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ; 20 _i' Z `AM 10-43' z Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ NO❑ 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. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES m COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 220.100 THROUGH 2.20.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. G. Lender's Address OWNER OR AGENT o 1 certify that I have read this application and state that the above P.C.FEE PERMIT FEE g information is correct. I agree to comply with all county a ordinances and State laws relating to building construction,and C. hereby authorize representatives of this County to enter upon ISSUANCE FEE the Dovmentioned property for inspection pj( oses. INVESTIGATION FEE TOTAL FEE r SbnRure of App-- °r t one 70 , 3Y SEE REVERSE FOR EXPLANATORY LANGUAGE