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Home My Public Portal About9119 HERMOSA DR_Building__ 76A638 e CE 480�(REV`i18).F Li - .APPLICATION FOR. BUILDING PERMIT. COUNTY OF LOS ANGELES _ _ - BUILDING AND SAFETY BUILDING FOR APPLICANT TO.FILL IN ADDRESS - Ag. J BUILDING bb ADDRESS 71� LOCALITY NEAREST CITY ZIP CROSS SL NE5OF BLDGS ASSESSOR SIZE OF LOT .Q x j NOW ON LOT MAP BOOK - PAGE PARCEL TRACT BLOCK LOT NO. Q -DISTRICT GROUP CONST. -YPE FIRE IONE PROCESSED BY OWNERr NVQs-- � sv Rs s,%� z STATISTICAL'CLASSIFICATION' - SEWER MAP ADDRESS - CLASS NO. <��DWELL.UNITS CITY ZIP _ARCHITECT OR TEL; VALUATION $ - ENGINEER NO.- - 3 OO ` ADDRE55 BLDG.SETBACK FROM - - L - <Q FRONT PROP.LINE OF "'�'¢a'4� ISTREETI CONTRACTOR S ' O • IGHWAY + YARD TOTAL SETBACKFROPE OF EXISTING , �+ LI FRONT.PROP.II M NE HIGTYHWAY WIDTH ADDRESS Dol ,O o iSr f ti - + iS CITY-4.5 Cis `- . Ge BLDG.SETBACK FROM - CONSTRUCTION LENDER - - - - - ' SIDE PROP.LINE OF ISTREETI NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACKFROM TYPEOF EXISTING d ADDRESS CITY SIDE PROP,LINE HIGHWAY WIDTH 0. 50.FT. ENT OF NQ-0F CHECK + SIZE STORIES FAMILIES - ONE USE ZONE MAP ❑ - _ Q DESCRIPTION OF WORK C NEW NOS dv 9•n IlL' SPECIALAanj .' d ADD ❑ -�-' CONDITIONS- - - - - '- " - N ALTER Li FINAL , BY -- �(' Z S REPAIR •Cl DATE 3O�� '�_ 0--c-� USE OF BLDG. DEMOL LJr L✓-C'�r g I y�C er' � •, APPLICANT TEL Q/ A�^7FfYJ2G� °- ' (PRINT) jc NO. . .lov/S.:/7R2r3Cl,. Q L BY ISIGNATUREI ... ._ _ > - > p p . . p HEREBY ACKNOWLEDGE8 8 THAT I HAVE READ THIS APPLICATION AND STATE EY 2 R, 6 THAT THE ABOVE IS CORRECT AND AGREE TOOOMPLY WITH,ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V '# e O • THE LABOR CODEOF THE STATE OFCALIFORN141N.RELATING TOWORKMEN_SCOM ., - - -,,.� _ Z PENSATION INSU RAN E. g + r� O 2 p ` O n d G VQ V SIGNATURE OF .^ 2 3 6,O Q PERMITTEE - - _ ADDRESS' • .. - ._ _.- _ .O C:34.-80 CITY NO. �- • / { G P.C. Fee$ Permit Fee - �/ > SaE _6 Issuonce Fee �'�•.� Mg/L, Totol Fee i I�p 76A638A � LE►'BU316EY•6/9B1 ^APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APP5EoAj FILL IN ` BUILDING A1�9 lelll _5.d APE, ` ADDRESS !! BUILDING --ADDREss �'S'H � 1- LocAuivNEOSESTCITY Tr� r LtIIP ) CROSS Si.ASSESSOR SIZE OF LOT .a/ x IIN W OBLDG N LOT J MAP BOOK PAGE PARCEL DISTRICT GROUP TYPEFIRETRACT LOT NO.TEL ((±? c� CONST,y'OWNER /IYC NC}�Q S' %y7 �� cl//�STATISTICAL CLASSIFICATION SEWER MApADDRESS Y //r!CLASS NO. 7-1 DWELL.UNIisBK6 PGCITY -- ZIPARCHIiECTORTEL VALUATION qjENGINEERNO.ADDRESSBLDG-SETBACK FROM FRONT PROP.LINE OF ISTREETI CONTRACTOR / MR No:0,`,�=U. -7/ __ TOTALSETBACKFROM TYPEOF EXISTINGLJ HIGHWAY + YARDADDRESS � �� NO. �'S 1VFRONT PROP:LINE HIGHWAY WIDTH CITY W#e T( / - C ATICSS -1. +CONSTRUCTION LENDERBLDG.SETBACK FROM .NAME AND BRANCHSIDE PROP.LINE OF ISTREETI HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH O SO.FT. ��jj NO.OF NO.OF CHECK' + _ V SIZE of STORIES FAMILIES ONE o - p/ O DESCRIPTION OF WORK .n NEW ❑ P.C. Fee S / r Perm! Fee O-F/J''7•sU �• (Z��"8" (pJr f9G• ( A) ADD Issuance fee ATsi! tib/l �9RpsLgTfr ALTER ❑ Total Fee Z REPAIR ❑ USE OF ec-SID�NCf DEMOL ❑ EXISTING BLDG. L Z APPLICANT TEL .569� I - IPRINTIyan�4ardRv covsq,-N06 d-QS 3�- BY ISIGNATUREI TTS Z > -THAI THEBABOVEPISS CORRECTOWLEDGE TAND AGREE TOACOMPLYAWIITHAALLL ORDINANCE ��TION AND STATE �� /./F RR - A 6�6 3 5 A AND LAWS REGULATING BUILDING CONSTRUCTION-1 CERTIFY THAT IN DOING THE J� u I WORK AUTHORIZED HEREBYI WILL NOT EMPLOY ANY PERSON IN VIOLATION OF 4 1 THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM ZJ° ° PENSATION INSURANCE 2 ° a F 0 SIGNATURE OF PERMIiiE !°:° 2 9 3.5 0 ADDRESS S��a ro� �U - Z ,,L/ ITO NoG9�0.5 0.9. 1 2-79 CITY//V�1!/ 1 �_�C D USE ZONE roAN O'oEIAL ODITIONS f BY FINAL /I DATE ($ WORKERS'COMPENSATION DECLARATION I' ' j " � - � �•.. ...... ' . -- �•'�� - �• �-� hereby affirm that I have certificate of consent to =elf APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, c�aicerhfled copy thereof (Sect3800, Lob. C.) COUNTY OF LOS ANGELES c BUILDING AND SAFETY _. _ Pal;y X784'=2251�mpony Fremont Indemnit - - - AA•A ,^ 0• Certified copy is hereby,furnishedBUILDING, - FOR APPLICANT TO FILL IN t ADDRESS "� Certified copy is filed with the county building inspec- BUILDING - - - ' tion deportmentA" - ' .t ADDRESS ;4 T)rilrp Date. . 4/R S,.tApplicont ,Vi rqi n Rrinf Cllr CITY. Temple City ZIP LOCALITY -� c' CERTIFICATE OF EXEMPTION•FROM WORKERS' "' NO. OF:BLDGS. - I NEAREST COMPENSATION'INSURANCE SIZE OF LOT NOW ON LOT CROSS ST., •, _ (This section•need-not be'completed if the Perri for one TRACT BLOCK LOT NO. ASSESSOR„ - - .:.c+ cF. hundred dollars ($100) K'or.less.) , t MAP BOOPAGE PARCEL OWNER Wa ne Troxel - -NO. t USE Z NE - MAP - i- .I certify that�in)he performance,of the work for which this NO. i' y permit is issued, I shall not employ any person in any manner - SPECIAL-- -- - -- -- - - d so os to become subleaI the We Compensation Laws. ADDRESS- -9119 Hermosa Drive -- - -- CONDITIONS O ..,, r. . .. U Date` A'pplicant CITVTem le Cit ZIP .. _ _ ' K NOTICE'TO APPLICANT:-If, after making this Certificate of ARCHITECT OR TEL. I -DISTRICT GROUP TYPE_ FIRE PROCESSED BY Exemption, you should become subject 'to the Workers' - ENGINEER NO. CONST. ZONE Compensation provisions of the Labor Code, you'mustforth- /E A 7/1 W with comply with forth- such provisions or this permit shall be ADDRESS - _ - • - _ ..:N TEL. STATISTICAL CIASSIFICAT ION APT. CONDO. - z deemed revoked. . +' - CONTRACTORVir in Roof NID _ LICENSED CONTRACTORS DECLARATION - - .LIC . :CLASS NO. 2'. . , DWELL UNI75 I hereby,affI'm that.)am licensed under provisions of Chapter 9 ADDRESSP•0• Box J NO. 160650- (cpmm`encing with Section 7000)of Division 3 of the Business and - LIC SEWER MAP _. .. _. Professions Code,:and my license Win full force and effect. CITY San Gabriel CLASS VALIDATION 160650 C39 SQ. FT. NO .OF NO.OF_ CHECK BK PG. license Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION. _ Ir o" o" 'Virgin ROOF C 6/-24'/8S - DESCRIPTION'OF WORK'- Reroof With _ NEW ❑Cotractor �Ae ❑ t 79$•QQ#30 _#15 #_72• 7 S s, ADDI am exempt under Sec - II q ALTER ❑B.BP.C. for this reason REPAIR. ❑ fDate: USE OF BLDG. DEMOL ❑ �-24-a4ASignature '--' -- -- -- APPLICANT - - TEL .FINAL PRINT) Vir in RoofCo• NO. 287-050 # •OWNER-BUILDER DECLARATION - DATE4 hereby offirm'that lam exemptfrom.the Contractor's.LicenseADDRESP.O.Box J San Gabriel 9177 .•t•�L ,Law for the following7reasan (Sectioh 7031.5, Business and I FIN - '( 4"0•5 0Professions'Code):"- . .. - __ PRE ENT YQ.QB BUILDING i 1 'I, as owner of the property, or my employees with ADDRESS _ _ - _ __wages as their sole compensation,willdo the work and - - ' --" 1 - 'O 71'1'r&5:-, the structure is not intended or offered for sale(Section LOCALITY -7044,-Business and Professions Code). MOVING - - TEL - - - - - - - . I, as owner of the property, am exclusively contracting CONTRACTOR NO. _ , --'with licensed contractorsconstruct the project (Sec- ADDRESS « lion 7044, Business annddProfessions Code). r i CONSTRUCTION LENDING AGENCY -' - .REQUIRED YARD HWV TOTAL SETBACK F O + + SET BACK PROP. LINE WIDTH - 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 ' n P.L..- _ Lender's Name - > 30.O 0__ LDMA Ref. It - - ' - P.C. Fee$ - - Permit Fee '--- - - - - - - -- Lender- 's Address 10.50 I certify.that I have read this.applico tion and state that the _ - Issuance Fee- LDMA P/C N- -- ' - -.J-- - Q above information is correct. I agree to comply with all County Investigation fee $ ordinances and State laws relating to building construction, - - .0 +" u and he{eby authorize- Total Fee 45O LDMA Pemnr#representatives of this County to enter upon tt a above-mentioned pr perIl for inspection urpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE ^Sieg ure of Applicant or Agent - Date WORKERS' COMPENSATION DECLARATION insure, nsuo .,hereby affirm that have a certificate of consent to self insu , 'APPLICATION FOR BUILDING -PERMIT re, or o certificate of Workers'Compenstion Insurance, or , a certified copy,thereof (Sec. 3800, Lab. C.) - - -• -- COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company _ t n , ❑ copy v BUILDING . FOR APPLICANT TO,FILL IN ADDRESS / M Certified co is hereby furnished. C ❑ . Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS // �-' ,ur w ( e !/E LOCALITY NEAREST T Date Applicant r « CITY 6M L�-, e/7-V ZIP /7 Q CROSS STr l.ti CERTIFICATE OF EXEMPTION FROM WORKERS' - NO.OF,BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT.,JrO K 1,5 O NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one /p �c - I USE. MAP qq hundred dollars ($100)or less.) - TRACT �7.�/ BLOCK LOT NO. 3�o NO. p. 0 } TEL. SPECIAL y I certify that in tke performance of the work for which this OWNER W� N� /20 EL NO. ✓`o� CONDITIONS 0 permit is issued, I shall not employ any,person any manner DISTRICT GROUP TYPE CONST FIRE E P CESSE Y V so as to become subject to the Work s'Compensation Lows. ADDRESS ,0. , A,3 L./ 9- �'AZ- f V Do4� k1u) Appia - CITY ZIP STATISTICAL CLASSIFICATION AP CONDO. V NOTICE TO APPLICANT: If, after mo�mg this Certifica e of ARCHITECT OR . _ . _ _ .iEL. / W Exemption,, ,you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL UNITS_ d . Compensation provisions of the Labor Code, you must forth- ADDRESS - ` SEWER MAP - ? with comply with such provisions or this permit shall be r _ ,deemed revoked. - CONTRACTOR { NO C BK. P VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS .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 CLASS $ SQ. FT...,'LS6 STORIOES / FAMILIES //+nPK CHECK _ License Number tic.Class _ _ - Contractor Date DESCRIPTION OF WORK Sr LONE NEW ❑ $ _- . ❑ - -� �1 ADD am exempt from the licensing requirements as am a 1 licensed architect or a registered professional engineer _ ALTER ❑ FINAL - 6 acting in my professional capacity (Section 7051, '_ DATE 'Business and Professions Code). REPAIR: USE OF - - OEMOO'❑ 'I-FINAL ' EXISTING BLDG. �(J $/fp - ' 9y Lic.or Reg.,No. Date APPLICANT ��// I_� • TEL - / l - - OWNER-BUILDER DECLARATION, PRINT) I& I hereby affirm that I am exempt from the Contractor's License � - Low for the following reason (Section 703).5, Business and ADDRESS Lc.P/x70S� oQ 7;,%o,Fe,77 Professions Code): PRESENT ❑ _ ._- - - - - I, as owner of the property, army employees with BUILDINGADDRESS wages as their sole compensation,will do the work and -the structure is not intended or offered for sole(Section LOCALITY - - 7044, Business and Professions Code). MOVING TEL. - ❑ - CONTRACTOR NO. '•Y> - - .- - _ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS tion.7044, Business and Professions Code). - - - — - '- CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM 'EXIST:- 2 2 b'� A SEi.BACK _ PROP. LINE WIDTH a I hereby affirm that there is a construction lending agency for - ' FRONT t ' _ the performance.of the work for which.this permit is issued P.L, (Sec. 3097, Civ: Cl). ._ SIDE. P.L. - 2 . . 1 6,00 Lender's Name Lender's Address ` P.C. Fee$ Permit Fee _.. . w I certify that I have read this application 09.24-80. and state that the •, Issuance Fee - ' Qabove information is correct. I agreeto comply with all County Investi9otion.Fee .- —. - _ _ ordinances and State laws relating to building construction, Total Fee and her by outhoriza representatives of this County to enter a upo .t a above-mentioned property for inspection purposes.. a SEE REVERSE FOR EXPLANATORY LANGUAGE Isleinure of AR1511ic.ni o Age. Date ®s