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Home My Public Portal About6515 ROSEMEAD BLVD_Building__ ljwV IE APPLICATION FOR BUILDING PERMIT) COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADD0.E55 LDING ADDRESS (JS 15 0 LOCALITY NEAREST CITY LI ZIP CROSSST M I NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT, MAP BOOK PAGE PARCEL DISTRICT I GROUP I TTYPE FIRE PACT BLOCK L n CONSTV 2E oTVp OWNER t+o339 L-7 P ED BY � STATISTICAL CLASSIFICATION SEWER MAP ADDRESS-701 a. LAL3 � CLASS NO DWELL UNITS BK PG CITY F"�ZU JE1 ZIP 17 V Z ENGINE R CI OR T�� VALUATION /O 0 zro ADDRESS 7 Z, K%.JlA4 BLDG SETBACK FROM TEL FRONT PROP LINE OF ISTREETI CONTRACTOR C- 4P- NOR HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF E%ISTING LIC FRONT PROP LINE HIGHWAY IS ADDRESS NO 2 LICp CITY +CLASS BI BLDG SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH SIDE PROP LINE OF (STREET( HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH O SOF NO OF NO OF CHECK + = Y SIZE 7IZ STORIES I FAMILIES ONE ry + O DESCRIPTION OF WORK NEW PC Fee$ -5-7 7 Permit Fee / S 0 R IL S ADD QcQcQ it, ssuance Fee ALTER / /6 ( REPAIR ❑ Total Fee 766 _ USE OF DEMOL3 3 7 f S CI Q V R EXISTING BLDG , �' APPLICANTIPRINTI4 nQt NO Z•J :iv— 3 3Q � • • � * 23 i BV(SIGNATURE) S / "7 „t- Q ; 2 * * 3000 HEREBY ACKNOWLEDGE THAT I HAVE READ i APPLICATION AND STATE p q yu A 3 0 0 0 U THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES J -�d �� FL AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE _ WORK AUIHORIZEO HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF O 7 1 3 �7 q THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN SCOM 25461 A PENSAIION INSURANCE y �I ELL. RMTTEEEOF /Vy/�' I�D / 2 - 716600 ADDRESS 7 g • • 766000 CITY aZUSA No 58l 1 � 0713- 79 USE ZONE O O CSPECIAL 1� CONDITIONS CZ ` �LO-Rrce FEFINAL BY DATE *WORKERS COMPENSATION DECLARATION 7' 7 ' hereby a Cor that haver certificate of consent to ,elf APPLICATION FOR BUILDING PERMIT insure or a certifimte of Worker Compensation Insurance oro cert ft copy thereof Sec 3800, Lab C ) rfvc - ya(. � COUNTY OF LOS ANGELES BUILDING AND SAFETY policy No Com nY ?lJ� Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS sS- �G1 Certified co filed with the coup building ,ns ADDRESS CCII Pent county 9 BUIInING /� � hon department ADDRESS S I 0�Jr Q U Q/ Dote l� Applicant CITY ZIP LOCALITY CE IFI TE 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 ,s for one - ASSESSOR - .. hundred dollars ($100)or less ) TRACT BLOCK LOT NO MAP BOO( I PAGE PARCEL TEL owrfR <<C No 3-33 USE ZONE MAP 2 L� , 1 certify that in the performance of the work for which this � NO gr permlt is issued I sholl not employ any person,n any manner ADDRESS ` C-21 SPECIAL - d so as'` become subject to the Worker'Compensation Lows ��.•rr CONDITIONS V Date � Apphcant CRY 'e Yh ZIP i 1; NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL DISTRICT ouP TYPE FRE PROCESSED BY _ O Exemption 'you should become subject to the Workers E (NEER NO CONST ZONE C W Compensation provisions of the Labor Code you must forth ADDRESS s/' CJ or 14 d with comply with such provisions or this permit,shall be zu TEL STATISTICAL CLASSIFI TION APT CO deemed revoked CONTRACTOR �O 1 NO 77 .3(ra LICENSED CONTRACTORS DECLARATION S1_UC CLASS NO DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE55�700 �"✓ /�n �N NO (commencing with Section 7000)of Division 3 of the Business and LIC �o SEWER MAP Professions Code, and my license is in full force and effect CITY 46h I.0 T�-�"� CLASS `� VALIDATION (` LX, C.y SO FT NO OF NO OF CHECK BK PG LicenselI�lumber ,r�,+ � `r 'Luc Class � SIZE STORIES FAMILIES ONE SO I'L1 ro 2 ` ' VALUATION 2 0 8 2 5 A Contractor .�r10 E- Q1 A Date.- DESCRIPTION OF WORK I� $ NEW $ M ❑1 der Sec _ _ ADO J O O Pilo. - 2 3 am exempt un ALTER I • • 5 7 3 S B 8P C for this reason m S' tis� REPAIR $ - Date USE a O� r I MMOL • 5 7 3 8 EXISTING BLDG r yv�co Signature APa�gMr L Tr o -3 a FINAL D 1004 -84 OWNER-BUILDER DECLARATION T�-- I hereby offem that I am exempt from the Contractor s License Lav for the following reason (Section 7031 5 Business and ADDRESS 40 �/7 tL+. fanIt. s'Fljy - Professions Code) - - _ By ❑ BUILDING I, as owner of the property, or my employees with ADDRESS 2 0 8 6 0 A wages as their sole compensation will do the work and the structure is not intended or offered for sale(Section LOCALITY , # • • • • • 1 7044, Business and Professions Code) - MOVING` TEL ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO _ I is • 7 a 0 0 with licensed contractors to construct the project (Sec- ADDRESS ADDRESS • • • 7 a 0 0 tui tion 7041, Business and Professions Code) CONSTRUCTION LENDING-AGENCY-" REQUIRED SET BnIX YARD Hwr TOTALFSETBACK F ROP LINEWIDTH I hereby affirm that there is a construction lending agency for FRONT ' I al 1 -84 ' the performance of the work for which this permit is issued P L - (Sec 3097 Civ C ) SIDE 8 PL Lenders Name + g _ C LDMA Ref N Lender's Address P C Fee f- V - Permn Fee ' - I unIssuance certify that I have rood this application and state that the __ Issnce Fee 0- S-0 LDMA P/C It above information is correct 1 agree to comply wnh all County Investigation Fee y� ordinances and State jaws relating to building construction Toal Fee a - 0-0 LDMA perm If tj and hereby author, a repr ntatives of this County to enter upon above-m an roperry for,nape purposes V SEE ItFl i FON EXPLANATORY LANGLIAGf +gnatare of ],cant or Age WORKERS COMPENSATION DECV+RATIONa hereby affirm That I have a certificate of consistit to self. APPLICATION FOR BUILDING PERMIT insure, or o certificate of Workers Compotion Insurance, o. ` a certified copy thereof (Sec 3800, Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No • Coni BUILDING ❑ Certified copy is hereby furnished FOR APPLICA T TO FILL IN ADDRESS ElCertifiedcopy is filed with the county budding Inspe< BUILDING tion department ADDRESS LOCALITY NEAREST Date Applicant CITY OCIVII(110. Y) ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS NO OF&DGS ASSESSOR COMPENSATION INSURANCE SI NOW ON LOT MAP BOOK PAGE PARCEL USE ZONE MAP (This section need not be completed If the permit is for one TRACT BLOCK LOT NO NO y hundred dollars ($100)or leu ) TEL C� '1 SPECIAL O I certify that In the performance of the work for which this OWNER NO CONDITIONS permit is Issued, I shall not employ any person any manner I 7 DISTRICT GROUP TYPE FIRE SSED BV l! so as to become osis�ublact to the W ors S'gmp sotlon Laws p' E� !'O d � CONST ZONE Z03NE O Dat 7 Applicant I CITY ZIP STATISTICAL CLASSIFICATION`/ APT CONDO V OTICE TO APPLICANT If after making thea Cert state of ARCHITECT OR TEL _ / W6 ENGINEER CLASS NO DWELL UNITS_ Exemption you should become subject to the Workers to Compensation provisions of the Labor Code you must forth- ADDRESS SEWER MAP ? with comply with such provisions or this permit shall be I deemed revoked r CONTRACTOR BK A/ PG VALIDATION LICENSED CONTRACTORS DECLARATION 1Lia �,�j7 v 1 hereby offirm that I am licensed under provisions of Chapter 9 ADD E D[R VA U TI N &V (commencing with Section 7000)of Division 3 of the Business and LIC ^� I Professions Code and my hcense is in full force and effect CIN /4LE CLASS P f 11 _ I 50 T NO OF NO OF CHECK Licel�l/�yy)) ? .ms's LIC Class— SIZE STORIES FAMILIES ONE LLL... onC_'L� J DaNEW te \ DESCRIPTION OF WOR ADD ❑ S Contract ADD I am exempt from the licenainq requl menta as am a i — _ licensed architect or a registered pro essional engineer I ALTER DATE FINAL -164acting In my professional capacity (Section 7051 REPAIR Business and Professions Code) USE OF OL IV ! EXISTING f DEMOL FINAL Q� r By Lic or Reg No Date APPLICANTIr' TEL M OWNER BUILDER DECLARATION PRIr 1� N 0. /,9d �� 1 hereby affirm that 1 am exempt from the Contractor s License ADDRE Ifs ktf W �� s Low for the following reason (Section 7031 5, Business and Professions Code) r az - 5 1 4,3 A as owner of the property or my employees with ESS wages as their sole compensation will do the work and LOCALITY' �, • • • • • 1 the structure Is not Intended or offered for sole(Section 7044 Business and Professions Code) MOVING TEL I as owner of the property am exclusively contracting ScATRACTOR NO t 2 • 3 9 1 0 0 with licensed contractors to construct the project (Sec ADDRESS • - 391006 tion 7044 Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST O 0,7 _8 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 1 hereby affirm that there is a construction lending agency fori FRONT the performance of the work for which this permit Is Issued P (Sec 3097 CGv C ) SIDr PL Lenders Nome r 8 P C iFea f Permit Fee S Lenders Address - > I certify that I have read this application and state that the laeonce Fee above information is correct I agree to comply with all County Imbeigotion Fee ��aaaLLLdinonces and State lows relating to budding construction Total Fee G hereby authorae repro entad vee of This County to enter t u on a abov property for Inspection purposes Iyq L�— lP L SU REVERSE FOR EXPLANATORY LANGUAGE Signature t Appli m or Agent Dote \ 0s WORKERS COMPENSATION DECLARATION APPLICATION FO ILDING PERMIT 1 hereby at irm that I have a certificate of consent to self insure or a certificate of Workers Compenstion Insurance or a certified copy thereof (Sec 3800 Lob C ) COUNTY OF LOS ANGEL _ •BUILDING AND SAFET Policy No Company ❑ pr r FADDRE OR APPLICANT TO FILL IN ADDRESS Certified co is hereby furnished ❑ Certified copy is filed with the county building mspec DING 7 s D bon deportment RESS LVlI LOCALITY NEAREST Dote Applicant C ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS a,� X / t NO �� L COMPENSATION INSURANCE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MA T BLOCK LOT hl0 NO hundred dollars ($100)or less ) / SPECIAL IL/ ER G tJ0 0�D - / so" CONDITIONS 01 certify that in the performance of the work for which this / 1 '1� DISTRICT GROUP TYPEFIRE VVpermit is issued I shall not employ any person in any manner RESS 6 I YG' c CONST Z so as to become subject to the Workers Compensation Lawsss�� S Q/YDate Appbwnf )L'•- ZIP ' / YYCLASSI ON APT CONDO NOTICE TO APPLICANT If after making this Certificate of HITECT OR - TEL LyExemption you should become subject to the Workers INEER NO CLASS NO DWELL UNITS_ HCompensation provisions of the Labor Code you must forth RESS SEWER MAPwith comply with such provisions or this permit shall bedeemed revoked TRACTOR BK PGVALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 RESSNO VALUATION (commencing with Section 7000)of Division 3 of the Business and LICProfe ons Code and my license is in full force and effect CLASSFT NO OF NO OF CHECK License Number tic Class �� STORIESI FAMILIES ONE Contractor Date RIPTION OF WORK Bs7�Y1.1 NEW CGN//QQS� 1�t�y / 1/1 ❑ �,�/�p7c'C YY✓/� ADD 1 / I am exempt from the licensing requirements as am a 7 licensed architect or a registered professional engineer ON R�FIA S 1D� U ALTER ❑❑ DATEFINAL acting In my professional capacity (Section 7051 REPAIR Business and Professions Code) USE OF EXISTING BLDG DEMOL Lic or Reg No FBy INAL rrDate t APPLICANT L ^ r� FI '- - OWNER BUILDER DECLARATION PRINT) I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 5, Business and ADDRESS Professions Code) PRESENT ICI rlR+l as owner,of the property or my employees with BUILDING 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 2 5 1 0 A ❑ I, as owner of the property am exclusively contracting CONTRACTOR NO 1 with licensed contractors to construct the project (Sec • • • • • 1 ADDRESS non 7044 Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST Z • • 7 Q 5 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT • • • 7 5 0 the performance of the work for which this permit is issued P L (Sec 3097 Civ C ) POE 0 1 04 -82 Lender s Name Lender s Address P C Fee S Permit Fee Ori > I certifythat I have read this application and state that the PP Nuance Fee i _ above mis carted I agree to comply with all County Invesngonon Fee �fy7 $ ordinanceses and d S Stale laws relating to budding construction, fatal Fea cpC/ ' and hereby authorize representatives of this County to enter G d upon e a ove mentione P ty for inspection purposes \ • I-4-$a SEE REVERSE FOR EXPLANATORY UNGUAL! \ ^ pnorore OT Appl icon,or genu Dote / Os r. APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FILL IN SULLDIN REss I hereby affirm that I have a certificate of consent to self insure BUILDING A �/ I ,r or a certificate of Workers Compensatron Insurance ora cerhhed ^ l- copy thereof (Sec 3800 Lab C) STY � L"` ZIP 9 H>flCy � S�OF LOT l: NO OF BLOGS NOW ON LOr ❑ Certded copy s hereby furnished NEAREST CROSS ST ❑ department ccopy is filed withthe County building Inspection TRACT BLOCK LOT NO USE ZONE MAP NO Date v Applicant ASSESSOR MAP BOOK RAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS aNrrE YII COMPENSATION INSURANCE 1 "1 ar"�q� wm+IN 1000 FT OF SCHOOL+ �B NO (This section need not be completed if the permit is for one hundredADDR dollars($100)a less) W VMDLCDISTRICT GROUP I TYAE CONS! FIRE ZONEZE:SSED B I certify that in the performance of the work for which this permit CRY ZIP 1 O is issued I shall not empty arty person In any manner so as to became subtect to the Workers CCmpensaflon Lava ARCHITECT OR ENGINEER TEL NO MTISTI I APT CONDO Date Applicant ADDRESS CUSS NO RYELL UNITS NOTICE TO APPLICANT H after making this Cerldi:ate of REWIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the V.brkem TEL NO SET BACK YARD HWY PROP LHNE WIDTH Compensation provisions of the Labor Code you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L LICENSED CONTRACTORS DECLARATIONSIDE CTTV LIC CLASS P L I hereby affirm that I am licensed underpin sgns of Chapter 8 SEWER MAP (commencing with SectKXl 7000)of Dr slon 3 of the Business and SO fT ISIZE NO OF 7S I NO OF FAfADES Professions Code and my license s in full force and effect NEW BK pG , f1 License Number Lc Class ADD ❑ VALUATIONO Contractor Date ALTER ❑ ` 00() OO 8 ❑ 1 am exempt under Sec REPAIR ❑ BdPC for this reason DEMOL ❑ LDMA PICA Date 115E OF EVS11NG URM ❑ Signature (HNT w� L NO LCMH P.• 1 Z as owner of the property or my employees with was as 'IA] ZO ACCT T hen sole comperisabon will do the Work and the structure Is FINAL DATE 3103 not intended or offered for sale (Section 7044 Busness and 2�y 6 �]z ? 190.31 Professions Code) WILL TIE APRIGNT On FURPE ellLoulo QCCURMIT HANL4E A HAZMWU9 MATERVL 4 OR A M%TUlE GOHVA4q A HAZAFOOUe xMTEP1LL EOWL TO ion(YEATER TYN TIE M( ❑ 1 a3 owner Of the Property, 8m exCllusM1ey, contracting Wlih MlCum7a 9PE ON THE HAZIfi00119 AUTER4L9 NFORAATCN cauoEx FINAL IN j ITEMS licensed contractors to construct the protect (Section 7044 YEs❑ TOTAL Business and Professions Code) �- Q ,� '�, WILL TIE MENDED IuaE of THE BUOIYq BY TIE IPPDGffT OR FURPE e11ILa9V0 CHECK (T OCOUvvf!REQUIRE A FERMI FOR CONSTRUCTION on AK)I%FlGTpN FFXIM THE SCUM 170. .31 CONSTRUCTION LENDING AGENCY COAST NR Q y r AOExE1rT DISTRICT(c D)REE MRvnsNG G ECx FOR hereby affirm that there s e construction lending agency, for ao e-x CHANGE .00 tN the performance of the work for which this permit is issued(Sec HREREAQ TIEXR5WU$MRErII49NFUYANNDEOVICEIAD TIEefSW NtOACON3 n 3087 Cry C) oErxuE 2.sr I unoEBsaNp Air PEouREAENs UNDER a nNaEEiEs courry CODE TTr'H'T Lenders Name rMTETERws PfpoR YP uric o �eoul0l AA c n is 0000—OM1 7 / R 6/_0. 9 Lenders Address; a 0958 1 AM11:29 certify that I have read this application and state urcler perad[y 80 of perjury that the above Information s Correct 1 agree to cortply PC FEE PERMIT FEE with all county oNlrsnces and State laws relating tp huAThng construction fdherebaof gethisCpunty ISSUANCE FEE aparty ;�? / 0-q INVESTIGATION FEE TOTAL FEE to _; a X �L--Yf-V-3 SEE REVERSE FOR EXPLANATORY LANGUAGE