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HomeMy Public PortalAbout6336 ROSEMEAD BLVD_Building__ 76A636A CE X80310-58 APPLICATION FOR BUILDING PERMIT 1 . COUNTY OF LOS ANGELES BUILDING .DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY I '� JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT OUP TYPE P OCESSE Y FOR APPLICANT TO FILL IN - CONST. I BUILDING �3 :R` STATISTICAL CLASSIFICATION. SEWER A ADDRESS 36 . BK PG CLASS. NO. DWELL. UNITS L BLOCK MAP - STATE YES NO .� NUMBER a�B © - HWY. T USE ZONE SPECIAL NO.OF SLOGS. CONDITIONS SIZE OF LOT I NOW O LOT USE OF _ EXISTING BLD . BUILDINGEXIST. . SETBACK YARD HWY •STREET NAME WIDTH OWNER FRONT _ MAIL P.L. ADDRE S SIDE TEL. P.L. CITY No. I ARCHITECT OR TEL. NSPECTION RECORD ENGINEER NO. - ADDRESS TEL. CONTRACTOR NO. ADDRESS - DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF'STRUCTURE � A%J SIGNATURE OF APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS = FOUNDATION: LOCATION FORMS.MATERIALS P.C. $ FRAME: FIRE STOPS, FEE BRACING, BOLTS VALUATION $_ FURNACE: LOCATION, FEE CTS GAS VENT,DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAW 5 RE AT NG BUILDING CONSTRUCTION. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS 6 FINAL CLYDE N.DIRLAM, PRINCIPAL STRUCTURAL E PLAN CHECK VALIDATION CK. M.O. CASH PEEbUT VALIDATION CK. MO.,' CASH LACo 4 7 9 30A. PR 2.�0 1 A ®P. 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 9705130034 PHONE: (818) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: 1 BUILDING ADDRESS: ON FILE SIGN DESCRIPTION: ILLUMINATED CHANNEL LETTER SIGN-18"X9 6336 ROSEMEAD BL ASSESSOR INFORMATION TEMP CA 917801544 NUMBER: NEAREST CROSS STREET: 5382-021-026 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPI ES ON: AQUA WATER EXIST OCC GRP: 05/13/97 TC 05/13/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATES FINAL BY: CODE: VANNIER WILTON E CO TR VANNIER TRUS (818) 355-1239- 1,000 209 OAK MEADOW RD SIER 910242611 FEES PAID DESCRIPTION OF WORK ILLMINIATED CHANNEL LETTER SIGN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: T T SIGNS (714) 373-4840- AA BLDG PERMIT ISSUANCE' 27.75 AC STRONG MOTION RESID 1000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 1000.00 VAL 65.25. TOTAL FEES 93.50 CONTRACTOR: _ TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE T T SIGNS* (714) 373-4840- 15173 MORAN ST. LIC. NO VAS �� LOCATION AND SETBACKS -- WESTMINSTER, CA 92683 665480.C45 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: 7 FOUNDATION/TRENCH FORMS LIC. NO: SUPPORT STRUCTURE. MAP NO: SEWER MAP BOOK.: PAGE: FIRE ZONE: CMF: ; (10 0-70F FAMILIES: DWEL I G UNITS: APT/COND: STAT CLASS s NO 20 CHOOL WITHIN HAZARDO us � , AIR QUALITY: 1000 FEET- MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508 WORKERS' COMPENSATION DECLARATION I hereby affirm that ( havecertificate,'of consent To self APPLICATION FOR BUIL®I N•G PERMIT insure, or.a'certificate of Workers'Compensation Insurance, � �• or a certified copy thereof (Sec: 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No .r f''(r< ` ' Company BUILDING d� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS %(.^ / '�� yL ❑ Certified copy is filed witk the county building inspec- tion department. . / t` ADDRESS �`� ! `4 °k- t YC + a .'' isr�,,v".,ty� g r."t' A P� yd f /� �,�r//• g -� '> '. .. .....•. a ..,,...., €>^ >CI r CITY'!iF r }'G �;.• tr' i� : A" ZIP `i 1 f„/ LOCALITY 1.. hb I;� s 'Date'rJ f: .r Applicant /s r A f F NO.OF BLDGS. NEAREST CERTIFICATEOF EXEMPTION FROM WORKERS' SIZE OF LOTS fs ice' NOW ON LOT CROSS ST: + COMPENSATION INSURANCE ASSESSOR (This section,need not'be completed if the permit is for-one TRACT BLOCK LOT-'NO ,,,� a. r;, MAP-BOOK PAGE PARCEL ,i hundred dol lois ($100) or fess:) �� �� f1,�F+ � o. #�y` SE ZONE MAP OWNER NO. . I certify that in'the performance of the work for which' this w , t� (� 8y SPECIAL permit is issued;I shall not.employ any person in any manner ADDRESS {_ f �1 jam+ CONDITIONS } :so as to become subject to the Workers'Compensation'Laws.: CITY 4 '(d i � w''�l`J zip O bate" -------Applicant ARCHITECT OR TEL., DISTRICT GROUP TYPE FIRE - t PROCESSED BY UJ NOTICE.TO APPLICANT: If, ,after.making This Certificate:of ZONE ENGINEER NO. t r} r' CONST.^ U_ Exemption, you .should become subject to-.the Workers Compensation'provisions of the Labor Code, you must forth ADDRESS (�� with. Ix -comply with. such provisions or'this permit shall 'be ..;; TEL..,' ' STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTOR'." !.,1- 'Jt",S fi` A,-NO. `. 'df� '. �. . deemed revoked. , LIC: CLASS NO. DWELL:UNITS O LICENSED CONTRACTORS DECLARATION r jd I b f i^/ 6. p I hereby affirm.that I.am licensed under provisions of Chapter ADDRESS d.' t✓"� ,,,j1f .Lf NO, i LIC. SEWER MAP UJ (commencing with`Section 7000)of Division 3 of the Business �. �Y„ cr�4y` F- and Professions Code,and my license.is in full force and'effect CITY W - CLASS BK PG VALIDATION ..' ^• r f� r SQ. FT r NO. OF NO. OF CHECK ' License Numberf'° ` Lic. Classc £ SIZE STORIES FAMILIES ONE �vm ,r p VALUATION + e Go-r'�v+"r '/ DESCRIPTION OF WORK i%%� ._ NEW J� j Contractor Date ADD ❑ $' ❑I am,exempt under Sec. ALTER ❑ BAP.C. for this reason' -REPAIR ❑ b Date: USE OEXISTING BLDG. Tv✓' '3 «^ DEMOL ❑ Signature APPLICANT t . u ? ,I- FINAL OWNER-BUILDER DECLARATION (PRINT) N0 ' > f DATE I hereby affirm that I am exempt from the Contractor's License gDDRESS{+' "f' t' '�-` i.¢%sF �( � F Yom. ' Law for the following reason (Section 7031.5;.Business and FINAL , Professions Code)'- ByPRESENT ❑ I,:as owner of thero ert BUILDING P P Y> or m Y.employees with ADDRESS wages as their sole compensation,will do-the work and " = the siructure.is not intended or offered for sale(Section LOCALITY , ' w i I:• 7044,.Business and Professions Code.) MOVING TEL. CONTRACTOR NO. , t ❑ j, as owner of the property, am exclusively contracting 1Ti.. t,�`� ' with:licensed contractors to*construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) s t CONSTRUCTION LENDING AGENCY SET.BACD. YARD HWY TOTAL SETBACK WIDTH zt�t I iK. I hereby affirm that there-is a construction lending agency for FRONT the performance of the work for which-this permit is issued P.L. (Sec. 3097, Civ. C.). ,SIDE_ t x•;••q s 4 P.L. Lender's Name s•y� �� LDMA Ref. # 1,` P.C. Fee$ Permit Fee Lender's Address J I certify that I have read this application and state that the Issuance Fee I ri~,i ° J LDMA P/C# 8 above information is correct: I agree to comply with all'Courity Investigation.Fee, 0 ordinances and State laws relating to building construction, Total Fee 2i LDMA Perm. # a and hereby authorize representatives of this County to enter up th—e b a-me on 07pro arty for inspection urPoses. _ .a ' ;r� r'.j,is�/ r ' f r ',( try — SEE REVERSE FOR EXPLANATORY LANGUAGE 01,gnature of Applicant or Agent Date