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HomeMy Public PortalAbout6404-6414 ROSEMEAD BLVD_Building__ i APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUIL G'AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI ADORES BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, ©g �� ( or a certificate of Workers'Compensation Insurance,or a certified CITY Q' ZIP J copy thereof(Sec.3800,Lab.C.) .� }� LocnuTY Policy No. Company SIZE LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CRO ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant ./ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �� FR J eEj NO. _ YES NO COMPENSATION INSURANCE /C WITHIN 1000 FT OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred N k _ DISTRICT GROUP TYPE CgpIS_T.' FIRE ZONE P CESSED BY 9S Q dollars($100)or less.) CITY ZIP C I certify that in the performance of w rk for hich this permit A/Y\ p-i N � 1 J "' is issued, I shall not employ any a o a manner so a to ARCHITECT OR ENGINEER TEL.NO. 5 become subject to the Workers'Co an STATISTICAL CLASSIFICATION AP CONDO QOTICE ate�"s plicant • — ADDRESS CLASS NO. DWELL UNITS OF TO APPLICANT. If, after makirfg this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' .e-� 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. LIq NO. PL LICENSED CONTRACTORS DECLARATION CI LI�SS�— SIDE LBK p I hereby affirm that I am licensed under provisions of Chapter 9 WER MAP v (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE O.OF TORES NO.OF FAMILIES C Professions Code,and my license is in full force and effect. NEW ❑ PGESCRIPTION OF WOR ADD ❑ LUATION 7License Number Lic.Class OContractor Date ALTER ❑ pool ❑ 1 am exempt under Sec. REPAIR ❑ BAP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ 1 Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# t El 1, as owner of the property, or my employees with wages as p ACCT., their sole compensation,will do the work and the structure is ADDRESS 58.75 t, not intended or offered for sale (Section 7044, Business and FINAL Q -.3307 58.r�'= Professions Code.) _ --r WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 4� M OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN 41 ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY()l > TCQ —J• = licensed contractors to construct the project.(Section 7044, YES❑ NO❑ IC'T AL -`__V F '- : BUSIneSS and PfOfeSSIOriS Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING u,HE tit10 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST OR GU DIEL UALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST S. l. Ft}{Y GEE I hereby affirm that there is a construction lending agency for YES ElNo El 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 t f R 4/2 -? m, COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.1 OD THROUGH 2.20.740 CONCERNING f`j 11111—(11 1=•f- �_f, 'S "a Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. EL ij� i A51 4,:r, EL Lender's Address OWNER OR AGENT o I certify that I have read this application and state that the above P.C.FEE PERMIT FEE 7 • g information is correct. I agree to comply with all county N ordinan d to aws relating to building construction,and a. hereby ut ri re resentatives of this County to enter upon ISSUANCE FEE 3. O V Bab e e y o�lnspe Ion purposes. � ' INVESTIGATION FEE TOTAL FEE - Iqn of Appil torAqV Date, SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT ;} COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS B I hereby affirm that I have a certificate of consent to self insure, ILDING ADDRESS v or a certificate of Workers' Compensation Insurance,or a certified \ copy thereof(Sec.3800,Lab.C. IT t Z Policy No C Company le. LOCALITY 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. department. USE ZONE MAP NO. Date' SF y�oolicant ASSESSOR MAP BOOK PAGE PARCEL _ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ow ER I TEL NO. COMPENSATION INSURANCE / C WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRE SSI DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) CITY Cie i ZIP I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to ARCHITECT OR QNGINEAR TEL NO. become Subject*to the Workers'COmpensatio Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLIC If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to, the Workers' CONTRACTO TEL NO. / SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith A� ONT comply with such provisions or this permit shall be deemed revoked. ADDRES , LIC.NO. PL LICENSED CONTRACTORS DECLARATION «.r SIDE CITY LIC.CtA S PL I hereby affirm that I am licensed underprovisions of Chapter 9 ' --y, SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF 6Rn NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW 13 BK PG d License Number Z Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION ' O Contractor Date tr�- MAIs ALTER El �y� U o ' REPAIR ❑ $ O El am exempt under Sec. fU B.&P.C.for this reason DEMOL ❑ LDMA P/C# �` WDate' SE F EXISTING BLD URM ❑ H_.i I IL SignatureAPPLICANT(PRINT) TEL NQ LDMA Perm ❑ I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS 0 1 not intended or offered for sale (Section 7044, Business and FINAL DATE Q ' 3 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL • GrS+• UT ❑ I, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q -•-�--c _ Er AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY .tJtiL_ .L.j licensed contractors to construct the project (Section 7044, YES❑ No =: Business and Professions Code.) K - z WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDINGOCCUP - __ OASTANT AIR QUAALIIRE A PERMIT TY MANAGEMENTFOR DCOR CT 1(SCAQMDCTION RSEEDPERMITTINGRO ECKLISTSOUTH FOR _Ili rfL 1— +'- mr d'�.E CONSTRUCTION LENDING AGENCY GUIDEUNES. -75 I herebyaffirm that there is a construction lending agency forCHECK g 9 Y YES❑ NO -' N the performance of the work for whi h this permit is issued(Sec. O1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING - I�:... Imo' 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CH,441" E TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTIN AND FO TA G A PERMIT EaQM THE SCAQMD. oLender's Address " — O OWNER OR AGENT o I certify that I have read this application and state under penalty ,: of perjury that the above information is correct.I agree to comply P.C.FEE JT-� PERMIT FEE : r N with all county ordinances and State laws relating to building construction, A herebthor' a representatives of this County ISSUANCE FEE ��' M to enter up he abo - e n pro Hj*for ins ion pur osess. "" v//• �J INVESTIGATION FEE TOTAL FEE / Qf r SgnaWre of ApolKan�or Agent Dace SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES - ' • � BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS `I hereby affirm that I have a certificate of consent to self insure, BUILDING AD64(29— � -6 w � 2 )e -:5&/,,( SL Vz) or a certificate of Workers'Compensation Insurance,or a certified CITY QIP Qa Gf 7CA ��� C opy thereof(Sec.3800,Lab.C.) ( , 1 0 LOCALITY �. Policy No. Company SIZE OF LOT vU NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. I NEAREST CROSS STT �T ❑.Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. �AJN D�Al .4 VZ � department. I USE ZONE MAP NO. ASSESS F3 P BOOK PAGE PARCEL Date Applicant 349 ,-/-/ C- SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER. O' C ' 1 T L NO. COMPENSATION INSURANCE J �1 —Y3 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT ROU TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) -� � I certify, that in the performance of the work for which this permit CITY ZIP I — is issued, I shall not employ any person in any manner so as to ARCHITECT OR GINEER TEL NO. v vU ,Y come su ject to the Workers Compe ati n Laws. STATISTICAL CLA APT CONDO Pra f to Applicant =�L-- ADDRESS CLASS NO.-� DWELL UNITS OTICE TO AP LICANT.� If, after. making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTR�TO ��iA I T NO. y ^a SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Q ✓+�C Vel FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESSZ ^ ,?(;M- � ,a„ LIC.NO. PL LICENSED CONTRACTORS DECLARATION rw' fN`rz CL SIDE CITY ((�� ,/` LIC.CLASS P L I hioreby affirm that I am licensed underprovisions of Chapter 9 yam-„ qaA4 l� �• � (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO. F FAMILIES SEWER MAP s NEW ❑ BK PG _ U Professions Code,a{p2_my li ense is in full force anrJ,effect. _ _ License Number v V Lio CIdSS �,rj DESCRIPTION OR)WORK ADD ❑ VALUpnON 1 , '=1!'� �'_ Contractor Date OJT ALTER Gon0�7tza rvJ P���+ro wa w163 nW. ElI am exempt under Sec. yew Jy REPAIR ❑ $ I�' L B.&P.C.for this reason QST 67 Ot I f� gt�`�' DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ :.)s ''s� a ie& Signature VIRAPPLICANT(PRINT) TEL NO. LOMA Perm# � � C _ AN 0 3 ❑.I,:as owner of the property, or my employees with wages as v Z -!Fri `^i_S - 'their sole compensation, will do the work and the structure is ADDRESS ` O =cf1.t ==) _221 not intended or offered for sale (Section 7044, Business and FINAL DATE a �= T cj Professions Code.) r _ ''y 1 _' 'd`� ' WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A H ZARDOUS MATERIAL i / ^ 1, as Owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN TI{E- FINAL BY ` i'f+iL. ��= dam„ a 0b B AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?. licensed contractors to construct the project (Section 7044, 'M Business w "= Business and Professions Code.) YES El No❑ .j Ct.t•; �*.)-_-I"` WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING •^C ij{i OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH "'HANG- '"– CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. hereby affirm that there is a construction lending agency for YES❑ NO❑ CM the performance of the work for which this permit is issued(Sec. ff;_js 1 10111 pl I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ •' 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, i I !vl = +` a TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS __ ,I, i Sf: � ""S'•=. 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. a /. Lender's Address O 1 OWNER OR.AGENT o I dertify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE �� ;' PERMIT FEE N with all county ordinances and State laws relating to building fCO constructitn, and hereby authorize representatives of this County ISSUANCE FEE / ato enter upon the abo e-mentioned property for inspection purposes. (p 7 4 INVESTIGATION FEE TOTAL FEE sgn=wra.ol Apa—w Apem Dare . O / SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION,DECLARATION -= �_. cf I he�e�y affirm that I have a certificate oconsent to self APPLICATION FO I L D I N G PERIOIIJT---•�� `+ insure, or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) TY OF LOS ANGELS .. _ BUILDING AND SAFETY Policy No. Company � F-1 .Certified copy is hereby furnished. FOR APPLICANT O FILL IN BUILDING ADDRES Certified copy is filed with th c ty buil n in BUILDIN A Jd�J do d pariment. ADDRES (O LOCALITY / � � NEAREST Date "� Applicant * CITY �->/v �� ZIP CROSS ST. ERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR (- SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE (This section need not be completed if the permit is for one USE ZONE MAP ®C/A hundred dollars ($100)or less.) / TRACT BLOCK LOT NO. NO. y. TEL. / Z SPECIAL I certify that in the performance of the work for4whict OWNS �'Y G NO. 'ZAI CONDITIONSDISTRICT GROUP TYPE FIRE PRO ESSED BYpermit is issued, I shall not emplo y erson in a /' /}n (7 ADDRESS V /�'✓ J+ /L CONST. ZOOso as tobe omesubject to the r er C p�Yts _r /��- ,,/ �=0,( BS Date • " Applica CITY sb + IP STATISTICAL CLASSIF �I�1 V APT. ICONDO. NOTICE TO APPLICANT: If, of er making this Certificat I ENGINEERARCHITECT ORhat( J NO -� p/((� _ Exemption, you should become subject to the Workers' CLASS NO.7LDWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS r �= SEWER M P with comply with such provisions or this permit shall be �- deemed revoked. y NOTEL p/� BK. PG, CONTRALTO VALIDATION . LICENSED CONTRACTORS DECLARATION LIC. /CC 72 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS /' NO. b � VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC -Professions Code, and my license is in full force and effect. CITY CLASS SQ NO.F . NO. OF / NO. OF CHECK License Number `v ` lic.Class SIZE STORIES/ FAMILIES ONE tie Contractor t%Tom" Date '� "t DESCRIPTION ,O.FF W.00RK NEW ❑ $ ��� ❑ I am exempt fro the licensing requirements as I am a 'Gt> „�/��- � ��/✓t� ADD ❑ 0 I 'll. 2 4. A licensed architect or a registered professional engineer ALTER ❑ FINAL 9 y P P y � �� ,� ❑ DATE ° ° ° ° 23 actin n m rofessional ca acit (Section 7051, REPAIR .Business and Professions Code). USE OF 7 EXISTING BLD DEMOL ❑ FINAL NAL ° h.S J r` G 4 Lic.or Reg.No. Date APPLICANT % s-✓�! TEL. �! _O Y r 7 OWNER-BUILDER DECLARATION (PRINT) O. ` t' I hereby affirm that I am exempt from the Contractor's License - �' ��/ f / rz Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ,J I ZL 2 8 EJ1, I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and /� .;1 ° ° ° I the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL �`7 CONTRACTOR NO. �, .n 5 I, as owner of the property, am exclusively contracting j�,_• � ^ ��J _ i � y �: c i with licensed contractors to construct the project (Sec- ADDRESS � tion 7044, Business and Professions Code). p REQUIRED TOTAL' ETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK ROP. LINE WIDTH ereby affirm that there is a construction lending agency for FRONT r e performance of the work for which this permit is issued t P.L. ec. 3097, Civ. C.).' t SIDE P.I. ender's Name ( P.C. Fee$ Permit Fee _ ender's Address I certify that I have read this app6icat' n nd state that the Issuance Fee 2 above inforrnatio is correct. I agree to co ply with all County I Investigation Fee / ordinance a d tate laws relating t ilding construction, Total Fee and her u orize r ese ti f this Countyto enter upon t a a, -me ed p o rt or ins ection-pur ses. ) /�{ � ✓ Lil SEE REVERSE FOR EXPLANATORY LANGUAGE ignature cf Appli nt or Agent Doe ' - ©s / ��WOPXERS,COMPENSATION DECLARATION affirm that I have a certificate of consent to self a certificate of Workers Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.5W 3 j6Company_STATE FIA M ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING b O ��S ADDRESS E/VAE','b ❑ Certified copy is filed with the county building inspec- BUILDING (� (� AA ++ c r tion departme/nt. n ADDRESS 61+10 ROSEAA EO b LOCALITY G E.IV'(� G G; C I ( Y NEAREDate -7'­53,/ Applicant s CITY TEAA5 %97 C Try ZIP _l -7S CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP � /)0 2 hundred dollars ($100)or less.) TRACT ala BLOCK p LOT NO. NO. ate(/ OWNER M o H i)mEb RA KS W TEL.e� 1 s_ C� v SPECIAL I NO. J��' �Y.�„i CONDITIONS I certify that in the performance of the work for which this DISTRICT GROUP TYPE FIRE PROCE ED BY O permit is issued, I shall not employ any person in any manner -y^7 'W RLM t,�j / CONST. ZONE V so as to become subject to the Workers'.Compensation Laws. ADDRESS �J / / v C Q� Q R " CITY St�N GRg��6� ZIP � 1177e5 0 Date Applicant STATISTICAL CLASSIFICATI N APT. JCONDV. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO.—DWELL.DWELL. UNITS L" Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP to with comply with such provisions or this permit shall be n �t Z deemed revoked. CONTRACTOR �'F/�"� ) 4 NO. 36-�f�� BK /r( VALIDATION LICENSED CONTRACTORS DECLARATION rr�� LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Jl ( i`(� (� `�`(��/�i15¢�N0.4 1 6 5 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY 1,V,9 ltd U II CLASS C- 4 S $ Y.L ol+ -oo , _ SQ. FT. NO.OF JNO. OF CHECK License Number �� kk fl Lic.Class �L SIZE STORIES FAMILIES ONE ;21. 0 33'6 A Contractor-^ No W 1 Date - L7 DESCRIPTION OF WORK NEW S $ #'o o o o 2 3 ❑ I am exempt under Sec. iUS � JAL l tV�E(�?j1`I; (L' ADD ❑ ALTER ❑ FINAL -.o ,37,50 B.&P.C. for this reason «Li/��1i11YV%1��-� ���7�� �1t7'�U REPAIR ❑ DATE Date: USE OF DEMOL ❑ FIN o o.0 3 7,5 0 3 1PRESENT XISTING BLDG. By Signature APPLICANT TEL. 1 0 8—8 4 OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS ;91 0 6 7 A Professions Code): UILDING # 0 0 0 0 0 1 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and OCALITY ° - 33.0 0 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. _ ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. o v o 3 J3,0 0 5 with licensed contractors to construct the project.(Sec- ADDRESS 1. 13-84 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ► I hereby affirm that there is a construction lending agency for FRONT rhe performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE m P.L. o Lender's Name `S O P.C. Fee$ e t Lender's Address / I� I certify that I have read this application and state that the Issuance Fee / tv above information is correct. I agree to comply with.all County Investigation Fee jr _ g ordinances and State laws relating to building construction, Total Fee 000 u and hereby authorize representatives of this County to enter 316 upon the above-mentioned property for inspection puussssrpossees. SEE REVERSE FOR EXPLANATORY LANGUAGE i Signature of Akplicant or Agent Date ®t WORKERS'COMPENSATION DECLARATION insureboraafcertif certificate of Workers' Compensate- ion Insurancirm that I have a cert ficaof consent to e, APPLICATION FOR BUILDING PERMIT �] or a certified copy thereof (Sec. 3800, Lab. C.) Policy No,_ 6_1 44 Company STA TE Co ;COUNTY OF.LOS.ANGELES'. BUILDING AND SAFETY El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS N Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS "o -/ Date 6- JS'tC•/ Applicant A. 13-C-- S, N CITY = ( iT 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 hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER I-TE L A IJ NO. �7'�'� NO. permit is issued„I shall not employ any person in any manner SPECIAL i so as to become subject to the Workers'Compensation Laws. ADDRESS -Z 6 \,.J .• ILCONDITIONS 0, CITY C C J t ttJ ZIP U Date Applicant / O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR CESSED BY Exemption, you should become subject to the .Workers' ENGINEER �f � ��/ �- CONST.� Z�E � U Compensation provisions of the Labor Code, you must forth- ADDRESS ` tlV W with comply with such provisions or this permit shall be CL deemed revoked. ,. TEL. �, STATISTICAL CLASSIFICATION APT. r/)ONDO. (q CONTRACTOR j�- L`. J, !� CU NO. 96o fi.t� Z LICENSED CONTRACTORS DECLARATION LIC. _r� CLASS NO. 2-Z DWELL, UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / Z YDS-- — NO.J1Y8_r / (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 A L D W t. A h �" CLASS 0' %,,s BK �. PG.) VALIDATION SQ. FT. INC.OF NO.OF CHECK License Number 3S Lic.Class -�S SIZE ��, STORIES FAMILIES ONE VALUATION Contractor A- 13•C S', 6 C G Date iS � DESCRIPTION OF WORK NEW ADD $ z 7.2 7.5 A O I am exempt under Sec. ' 1J o E+ 0 ALTER B.BP.C. for this reason $ # m o 0 0 2 3 REPAIR (/ Date: USE OF DEMOL o o 3 7.5 0 ' EXISTING BLDG. Signature APPLICANT TEL.- FINAL 0 0 0 3 7,5 = OWNER-BUILDER DECLARATION (PRINT) NO. DATE 060 I hereby affirm that I am exempt from the Contractor's License I Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY BUILDING ADDRESS I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY , the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. a I, as'owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS 2 7 4 2 7 A REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH #,o,;0 0 0'0 I hereby affirm that there is a construction lending agency for FRONT - 4 9.-88 the performance.of the work for which this.permit is issued P.I. (Sec. 3097, Civ. C.). SIDE o o;0 4 9, 8 8 5 P.L. Lender's Name LDMA Ref. # 0 7,0 8�8 7 P.C. Fee$ Permit Fee 32 31 Lender's Address g I certify that I have read this application and state that the Issuance Fee. ,V LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee - L LDMA Perm. # and hereby authorize representatives of this County to enter upon he above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si tura of Applicant or Agent Date ` WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES. BUILDING AND SAFETY BUILDING Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec BUILDING /t� tion department. ADDRESS ( 7o < /�Q s ". LOCALITY . NEAREST Dd�f�lCITY . ZIPate S- `r�7 Applicant / , . CROSS ST. CERTIFICATE.OF EXEMPTION FROM WORKERS' pr® NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 9l p NOW ON LOT MAP BOOK 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. NO. � � TEL. )d SPECIAL I certify that in.the performance of the work for which this OWNER M� Ireo NO.d2S.'? -e.2ce " CONDITIONS' CIL permit is issued, I shall not employ any person in any mannermce ADDRESS S O_ /�/Ce S7 CONST. ZONE DISTRICT GROUP TYPE F E /PRCESSED BY O //Q� U so'as to become subject to the Workers'Compensation Laws. /� CC}} y �—• � � CITY <'/ ZIP 0 Date Applicant STATISTICAL CLA IFICATION T. CONDO. (— NOTICE TO APPLICANT: If, after making this Certificate of ENGINEERARCHITECOR �� 7! TEL 9i�r� y CLASS NO. Exemption,' you should become subject to the Workers'. O DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall, be / TEL. deemed revoked. CONTRACTOR �!% c.O NO.� �' BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION / ,��// LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / (f/ li <rd NO.7�3 Z®� VALUATION' (commencing with Section 7000)of Division 3 of the Business and LIC. n Professions"Code, and my license is in full force'and effect. CITY L CLASS s0. $ 000) , j� S ZEF1 STORIES OF I AMILNO. OIES CHECK License Number 79 Lic.Class_ Contractor ate �y DESCRIPTION OF WORK J Q W CA $ ADD ❑ ❑ I am exempt under Sec. ALTER E] DATE{ DATE rf B.BP.C. for this reason REPAIR ❑ Date: USE OF DEMOL FINAL t EXISTING BLDG. ❑ By Signature APPLICANT „��!! TEL. QG}f (PRINT) `%% NO.��//'�c' � OWNER-BUILDER DECLARATION , I hereby affirm that I am exempt from the Contractor's License ��d! E'1 2 9,4'A Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT # o o o o 2 3 ❑ BUILDINGt I, as owner of the-property, or my employees with ADDRESS .2'o,0 37.5 0 wages as their sole compensation,will do the'work"and the-structure is not intended or offered for sale(Section LOCALITY' o 0 0 3'7,5 0 05 7044, Business and Professions Code). _ MOVING TEL. ❑ CONTRACTOR NO. 7-84 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- 2 9 5 A tion 7044, Business and Professions Code). ADDRESS n REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH o*0 0 0 0 1 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: o'o 4 8, 0 0 (Sec. 3097, Civ. C.). SIDE 2, v Lender's Name P.L- —y� 0 0'048005 Lender's Address P.0 Fee$ Permit Fee S C/ Q 5•1 7'—8 4 I certify that I have read this application and state'that the Issuance Fee above information is correct. I agree to comply with:all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee u and her o ri rept t ves qf this County to enter m upon thea do p rty r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE P ®s Signature of ApplicUnt or Agent Date” i WORKERS'COMPENSATION DECLARATION 7-•C- 41 insure, oraffirm certif cane of Workers'lificate of Compensaton Insurancce, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company - BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified,copy is filed with the county building inspec- BUILDING tion department. ADDRESS LOCALITY 7 NEAREST Date Applicant CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK 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. �^ NO. . 694C E C SPECIAL I certify that in the performance of the work for which this OWNER 4CL CONDITIONS permit is issued, I shall not employ any person in any mapfner DISTRICT GROUP I TYPE FIRE PRO ESSED BY O so as to become subject to the Wo r 'Compe s 'on a ADDRESS t/ ONST. ZONE U Date ^ Applicant CITY ( ZIP STATISTICAL CLASSIFIC ON b APT. CONDO. 0 NOTICE TO APPLICANT: If, after aking this Certificate of ARCHITECT OR TEL. 4J LU Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO.�DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER/v1p,P with comply with such provisions or this permit shall be /R deemed revoked. CONTRACTOR C_c 'A BK. PG,70 VALIDATION LICENSED CONTRACTORS DECLARATION � 1 LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS rjY+�O �,S ��. NO. 2'�` C VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. /� ©� Professions Code, and my license is in full force and effect. CITY CLASS C' $ 0 �_ ► SQ. FT. NO. OF NO. OF CHECK License Numbery-4Z?= Lic.Class - SIZE STORIES FAMILIES ONE / afe a NEW N $ Contractor �..��! � ` (J 1 DESCRIPTION OF WORK ❑ e i ADD E] I am exempt under Sec. J ALTER ❑ FINAL 3 5 9.8 A B.BP.C. for this reason REPAIR ❑ DATE n #,o o�o o 2 3 Date: USE OF FINA DEMOL ❑ i EXISTING BLDG. By c^ a'a 3 7.5 0 Signature APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. , 0 0 0 3 7.5 0 U I hereby affirm that I am exempt from the Contractor's License 0 �12 0—'8 b, Law for the following reason (Section 7031.5,'&siness and ADDRESS Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS c 3 5 9,9 A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section kADDRE c 7044, Business and Professions Code). TEL. 0 0 0 0 ❑ I, as owner of the property, am exclusively contracting CTOR NO. 2 0'0 [�-0,5 0 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ;o 0,0 4 0 5 0 0 ED TOTAL SETBACK FROM EXIST, CONSTRUCTION LENDING AGENCY CK YARD HWY PROP. LINE WIDTH I I hereby affirm that there is a construction lending agency for ► 0 8 2 0—8 4 the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name Lender's Address $ Permit Fee I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with,all County Investigation Fee b $ ordinances and State laws relating to building construction, Total Fee u and ere authori rept se tiv sof this County to enter up t bove-me i p e f inspection urposes. a _ ^� SEE REVERSE FOR EXPLANATORY LANGUAGE Lure of Ap ica t gent Date ®1 WORKERS'COMPENSATION DECLARATION / J8 1- I hggreb• affirm that I•hmve a certificate of consent to self •insGre, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT oris c ti ted c//opy'thof,(Sec. 3800; lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY of o. Company d-co is hereby furnished. BUILDING PY Y FOR APPLICANT TO FILL IN ADDREP- SS rertified copy is:filed with the county building inspec- BUILDING ]� " on^�departmeCnt: ADDRESS Z LOCALITY Date —J�' �T Applicant �1� `�— ---• NEAREST `7 LL IlJ CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT ' NOW ON LOT MAP BOOK 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. NO. v 3 TEL. C ^ SPECIAL I certify that in the performance of the work for which this OWNER NO. CONDITIONS �. PRO SSED permit is issued, I shall not employ any person in any manner ADDRESS " CONST. ZONE DISTRICT .GROUP Y FIRE BY O so as to become subject to the Workers'Compensation Laws. � � Date Applicant CITY ZIP STATISTICAI ION ARCHITECT OR TEL. APT. CONDO, NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CLASS NO. --;20 DWELL. UNITS tit! Exemption, you should become subject to the Workers'' C, Compensation provisions of the Labor Code, you must forth- with comply with such provisions or. this permit shall be TEL.ADDRESS SEWER M,A/PPG, '7 deemed revoked. CONTRACTOR NOBK..� O 6.J N /U VALIDATION LICENSED CONTRACTORS DECLARATION '� I LIC. �'[ CY` I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS l.�` NO. 6���' VALUATION (commencing with Section 7000)of Division 3,of.the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS'C-1 S^ $ , ✓ 2 c, SQ. FT. NO.OF NO. OF CHECK 1: License Number�E3+c7-5 1 Lic.Class SIZE STORIES FAMILIES ONE OCA j ` �� Contractor Date DESCRIPTION OF WORK NEW /,�a— ' ❑ �IC,C"� / ❑ 1 am exempt under Sec. V ADD ALTER ❑ FINAL 1y1 B.BP.C. for this reason REPAIR DATE a Date: USE OF REPAIR E] 'r El 2.9 6 c R EXISTING BLDG. Signature APPLICANT TEL. f. c o a o 2 J OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License ADDRESSS— law for the following reason (Section 7031.5, Business and 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 'J 7 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code): kADDRE TEL. }; o a o o o 1 ❑' I, as owner of the property, am exclusively contracting OR NO. Z o o 9,2 5 with licensed contractors to construct the Project (Sec- ADDRESS'tion 7044, Business and Professions Code).' e , 2•5 c_i D TOTAL SETBACK FROM EXIST. �._. .- CONSTRUCTION LENDING AGENCY YARD HwY PROP. LINE WIDTH loop. 7 3 O_ I hereby affirm that there is a construction lending agency for the performance of the.work for which this permit is issued 84 (Sec. 3097,.Civ. C.).mLender's.NameLender's Address : 7i. Perm it"Fee �� l•'3 -1--certifythat I have read this application and state'that the v PP Issuance Fee (�i above information is correct. I agree to comply with.all County Investigation Fee ordinances and State laws relating to building construction, Total Fee a u and her by authorize representatives of this County to enter upon ih abo a-me tione roperty for inspection purposes. at d SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant-16rMent Date ®: dinV.. Cpt11 WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT ansure, or o certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy e. Company BUILDING C %Z//4/ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS r/ ❑ Certified copy is filed with the county building inspec- BUILDING //! f � LOCALITY tion department. ADDRESS �v l (f' NEAREST Date Applicant CITY .� ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' O. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL USE ZONE (This section need not be completed-if the permit is for one MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. �� NO. S2ao TEL. C SPECIAL ? I certify that in the performance of the work for which this OWNER /u EiW/JV NO. Io CONDITIONS iL DISTRICT GROUP.1 TYPE FIRE PROC SSED BY O permit is issued, I shall not.employ any person in any manner ADDRESS CONSTS ZONE U so as to become s]ubject to the Workers' omp nsation Laws. O IV Date �" Applicant - CITY ZIP STATISTICAL C SSIFICATI N T. CONDO. �. NOTICE TO APPLICANT: If, after making is Certificate of ARCHITECT OR TEL. �j ,,� ENGINEER NO. CLASS NO. t� 0 DWELL. UNITSUJI Exemption, you should become subject to the Workers' tn Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. PAI TEL. BK PG, 70 VALIDATION CONTRACTOR � l + NO. LICENSED CONTRACTORS DECLARATION yt LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS y yjV , /� NO. VALUATION �- (commencing with Section 7000)of Division 3 of the Business and ` LIC. Professions Code, and my license is in full force and effect. CITY /oi L�II� h U,S// �10zCLASS G-!v $ l T SL `� lu SIZE STORIOES i FAMILIES CHECK License Number Li c.Cl , r ass / I 3 1 k 4 A r —� (i NEW W $ /�,�M( (,� � ( i DESCRIPTION OF WORK wr Coniractor/'t� � �sC1L(o6 Date� :0 0 2 3 ❑ 1 am exempt under Sec. '��+ 4 ADD _.E] o'o ALTER ❑ FINAL . 2 0 - 37. 50 B.&P.C. for this reason tL DATE REPAIR ❑ W .0 o'0 3 7.5 Q V USE OF Date: EXISTING BLDG. DEMOL E] Signature APPLICANT TEL. �j 8 0 -84 OWNER-BUILDER DECLARATION PRINT (C, Lf1/�lA` G '" NO�Q I'—Z�� 1 hereby affirm that I am exempt from the Contractor's License ADDRESS Z�Ju S. ' �� 0, 2 Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT EJ1, I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and I LOCALITY r` 3 1 11,5A the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. o`0 0 0 0 1 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. i • I - with licensed contractors to construct the project (Sec- ADDRESS 2 a a 3 3 O O tion 7044, Business and Professions Code). 3 3 O O= REQUIRED TOTAL SETBACK FROM ]EX 0 0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE , 1 hereby affirm that there is a construction lending agency for FRONT 8t0 1 —8 4 the performance of the work for which this permit is issued P.L. . (Sec. 3097, Civ. C.). SIDE m Preo. L Lender's Name �! Permit Fee 22,Lender's Address > ir I certify that I have read this application and state that theIssuance Fee b. above information is correct. I agree to comply with-all County g ordinances and State laws relating to building construction, Total Fee -33, . u and hereby authorize representatives of this County to enter a upon the ab ov -menti ned property for inspection purposes. m a (1 d - SEE REVERSE FOR EXPLANATORY LANGUAGE ^ ®t Signature of A icant or Agent If Dche �y APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ITY-1 UIL IN D Ey,S d I hereby affirm that I have a certificate of consent to self insure, /V�. or a certificate of Workers'Compensation Insurance,or a certified t ZIP 11/4 7�c11 opy thereof(Sec.3809, ab. (fit n�s3J LOCAL" Poli c�rtlNe o y �ereb�furnisPfetf J ny. ZE OF LOT NO.OF LDGS.NOW ON LOT �e NEAREST CROSS ST. ❑ Certified Copy is filed With the county buildin 1 TRACT BLOCK LOT NO. depart ant. /� SE ZONE MAP NO �� Date Applicant ASSESSO��fAAP BQQ�C PA(6E PARC L ��yyy Y �3 COl z U LfJI SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM RKERS' o `F1e5 7 ° yl G' COMPENSATION INSURANCE LUT WITHIN 1000 FT.OF SCHOOL? VES No ADD ES /� `' (This section need not be completed if the permit is for one hundred Q V r(a4v DISTRICT GROUP J.TYPECONST' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP �Da / I certify that in the performance of the work for which this permit ( , ►V'/ is issued, I shall not employ any person in any.-manner so,as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. L Q SUN $ STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS Awnw CLASS NO. -2 1 DWELL UNITS NOTICE TO APPLICANT. If, after making 'this Certificate of CONTRACTOR Q () TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' 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 deemedrevoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE a PL O I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF TORES NO.OF FAMILIES -� Professions Code,and my license is in full force and effect. NEW ❑ BK - PG / c) CD License Number Lic.Class DESCRIPTION OF WORK // ADD ❑ VALUATION , X 9 Contractor Date ALTER s�fl D z_ Q REPAIR C3 $ ❑ I am exempt under Sec. B.BP.C.for this reason DEMOL 1:1 LDMA P/C p Date: USE OF EXISTING BLDG. URM ❑ gnature APPLI N (PRI T) TEL.t? rLDMA Perm# as owner of the property, or my employees with wages as �",���1 '7lf O their sole compensation,will do the work and the structure is [ADDR r _ d d v 4 not intended or offered for sale (Section 7044, Business and r n!� FINAL DATE Professions Code.) �1-Z�-9� 001, ---- WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MAI I7AL J S i.-SG El 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 BSI 'n c Q licensed contractors to construct the project (Section 7044, YES❑ No El �{ % �' > ..�1 .e(Y 1 �= Business and Professions Code.) IIJJ -, WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING C- 'i e OCCUPANT REQUIRE A PERMIT FORCONSTRUCTION OR MODIFICATION FROMTHESOUTH CONSTRUCTION LENDING AGENCY 111 COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST j'Fik1'IGEC - FOR GUIDELINES. • i Ei I hereby affirm that there is a construction lending agency for YES 1:1NO Elthe performance of the work for which this permit is issued(Sec. 3097,CIV.C.). I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 3 i E+(� ordin _ 1:iCOUNTYCODE,TITLE2,CHAPTER 2.20 SECTIONS 220.100 THROUGH 220.140 CONCERNING Lces Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.ddressOMER OR AGENTat I have read this lication and state that the abovep,C.FEE PERMIT FEEn is correct. I g e to comply with all county s and State law r la ng to building construction,and cam'6 thorize repres tativ s of this County to enter upon ISSUANCE FEE - entioned pr pe for inspection purposes. 1 • �'V INVESTIGATION FEE TOTAL FEE t a Apenl D.. SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT �l COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRES ��-�( I hereby affirm that I have a certificate of consent to self insure, (?6 �'�I/ ��d or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY f j C 1'� ZIP -7LOCALITY Policy No. Company SIZE OF LOT l( NO.OF BLDGSS..(NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. - o department. USE ZONE AP NO. _ ' / / 5— Date MAP BOOK PAGE PARCEL�/ /l (� Date Applicant O �� T / I SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ' o(I, T��•INO C` YES No COMPENSATION INSURANCE I% "( (_v WITHIN 1000 FT.OF SCHOOL? ADDRESS f� © q� (This section need not be completed if the permit is for one hundred C �?J DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY '�QQ.� l�,,,., ZIP G{ I certify that in the performance of the work for which this permit G(M (/6ep_'V� �n ��'^ V _5 is issued, I shall not employ any person in any manner so as to ARCHIIIIECT OR EN IN ER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. PWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TELNO. SETBACK YARD HWY PROP LINE WIDTH 4 f Compensation provisions of the Labor Code, you must forthwith FRONT ADDRESS LIC.NO. � I'rs•i€L� s '"•1':• 't`� comply with such provisions or this permit shall be deemed revoked. PL SIDE »rs ,-i ��r i1 !- LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL I hereby affirm that I am licensed under provisions of Chapter 9 SQ.Fr.SIZE OOF STORES NO.OF FAMILIESEWER MAP _ S c.D N . L: "< (commencing with Section 7000)of Division 3 of the Business and NEW El BK PG °• !•E 4 °=J p Professions Code,and my license is in full force and effect. F WORK ADD VALUATION s;;-k ('-'3`-; n='..II=W License Number Lic.Class DESCRIPTI NO ©'� Contractor Date 5r ALTER ❑ $ ti El am exempt under Sec. REPAIR 13I i`1­10117. B.BP.C.for this reason DEMOL ❑ LDMA P/C# 41- Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# Z ❑ I, as owner of the property, or my employees with wages as O their sole compensation,will do the work and the structure is ADDRESS FINAL DATE Q /,, t intended oroffered for sale (Section 7044, Business and ofessions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL M 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? FINA Y > 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 REOUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH /7 n CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST 3 (/I,` FOR GUIDELINES. V /J 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 SCAOMD 3097,CIV.C.). 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 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address OWNER OR AGENT o 1 Certi I have read this application and state that the above P.C.FEE PERMIT FEE inf ation is correct. I gree to comply with all county 7S o inanc nd State law ting to uilding construction,and a a ereby t riz repre vas o� is County to enter u on ISSUANCE FEE / _ he abo a 1 n o ori a on purpos § j� /�J� a 17J'� ( INVESTIGATION FEE TOTAL FEE n sly�re of w Agwt DMn SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1208160025 PHONE: (626) 285-0488 EXT: ILEGAL ID: N0. OF CONST I BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 1 6410 ROSEMEAD BL I ISTRUCTURE: 55 V-B I SGAB CA 927754958 I (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15382-021-044 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl I I I I (TENANT: IEXIST BLDG USE: COMME USE ZONE: C-2 IISSUED'ON: PROCESSED BY: I IEXIST OCC GRP: 108/16/12 SR 1 I I I (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FIN DATE FIN BY: CODE: ICHANG (626) 291-2345- 151 16410 ROSEMEAD BLVD. ,800 1 /O /2- ISAN GABRIEL 91775 FEES PAID I E CRIP'ION OF WORE v _ ITEAR OFF EXISTING ROOFING MATERIAL INSTALL 04-PLY BUILT UP IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:ISYSTEM i (APPLICANT: TEL. NO: I I ITA, MANDY (909) 598-8988- IAA BLDG PERMIT ISSUANCE 27.80 I I 1516 N. DIAMOND BAR IAB STATE GREEN BLDG FEE 15800.00 VAL 1.00 (SPECIAL CONDITIONS: 1 IDIAMOND BAR CA 91765 IAE STRONG MOTION OTHER 15800.00 VAL 3.30 I I ID2 PERMIT W/0 EN-HC 15800.00 VAL 317.40 I i I I TOTAL FEES 349.50 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ISUNSHINE ROOFING, INC. (909) 598-5988- I 1 I 1516 N DIAMOND BAR BLVD #183 LIC. NO i ILOCAIION AND SETBACKS I I 1 IDIAMOND BAR CA 91765 755126 C39 I I I I I I ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I - I LIC. NO: i ISLAB/UNDER FLOOR I I I IRAISED FLOOR FRAMING I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1153H265 3 001 1_ 1 I I I I (FLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I 0 NO 22 IROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS ISHEAR PANELS ' I� (AIR QUALITY: 1000 FEET MATERIALS I I I I NO NO NO i - IFRAME INSPECTION I I I I . IFIRE SPRINKLER HANGERS I I I (INSULATION/WEATHER STRIPI 1 I (INTERIOR LATH/DRYWALL 1 I I I I I 1EXTERIOR LATH I I I I I I I IRATED FLOOR/CEIL ASSEM. 1 I IRATED WALL ASSEMBLIES I I I (RATED SHAFTS/OPENINGS I 1 I I I I I I I I IT BAR CEILINGS I I I I ILOT DRAINAGE I I I .i (REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0209160029 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 6404 6414 ROSEMEAD BL STRUCTURE: SGAB CA 917751958 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-044 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: COMME USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 09/16/02 JK 03/15/03 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI L TE FINAL Y: CODE: CHANG; LU & RAESHIAU (626) 446-1861- 14,000 922 PARK AVENUE I ARCADIA 91007 FEES PAID DESCRIPTION OF WORK DEMO FIRE DAMAGE TO BUILDING FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: TIMOTHY J CAREY (714) 630-9615- :AA BLDG PERMIT ISSUANCE 27.75 2906 E CORONADO 102 DEMOLITION INSPECTN 163.50 SPECIAL CONDITIONS: ANAHEIM 92806 TOTAL FEES 191.25 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE EMERCON CONSTRUCTION, INC. (714) 630-9615- 2906 E. CORONADO LIC. NO ! PEDESTRIAN PROTECTION ANAHEIM, CA 92806 525903/B SEWER DISCONNECTION ARCHITECT OR ENGINEER: TEL. NO: ABANDON PRIVATE DISPOSAL LIC. N0: i , _ __ - UNDERGRND STRUCT REMOVAL AND SOIL RECOMPACTION MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP. X 04 N0. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 24 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 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 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0209200005 PHONE: (626) 285-0488 EXT: ftGAL NO. OF CONSTI D NG ADDRESS: ON FILE SQ. FT STORIES TYPE 6404 6414 ROSEMEAD BL STRUCTURE: VN SGAB CA 917751958 ASSESSOR N 0 M TION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-044 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXI BLDG USE: CO ME USE ZONE: C- ISSUED ON: PROCESSED EXPIRES ON: EXIST OCC GRP: 09/20/02 JK 03/19/03 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL D TE FINAL BY: CODE: CHANG; LU & RAESHIAU (626) 291-2345- 65,000 922 PARK AVENUE '�� ARCADIA 91007 FEES PAID DESCRIPTION OF WORK REPAIR OF FIRE DAMAGED PORTION OF ROOF STRUCTURE &STUD WALLS APPLICANT: TEL. N0: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TIMOTHY J CAREY (714) 630-9615- AA BLDG PERMIT ISSUANCE 27.75 2906 E CORONADO AC STRONG MOTION RESID 65000.00 VAL 6.50 SPECIAL CONDITIONS: ANAHEIM 92806 A2 PERMIT W/ENERGY-HC 65000.00 VAL 1,091.75 TOTAL FEES 1,126.00 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE EMERCON CONSTRUCTION, INC. (714) 630-9615- 2906 E. CORONADO LIC. NO LOCATION AND SETBACKS ANAHEIM, CA 92806 525903/6 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS H C HANSEN ENG (714) 573-0073- 17371 IRVINE LIC. NO: SLAB/UNDER FLOOR TUSTIN CA 92780 3027 RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULA ION 153H265 3 04 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: NO 22 ROOF SHEATHING �. ��,42� SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST TIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIO LATH/DRYWALL r� EXTERIOR LATH RATED FlOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: SS0508