HomeMy Public PortalAbout10043 LA ROSA DR_Building__ 76A638A CE#`8033-66 APPLICATION FOR BUIL15ING PE I r
COUNTY OF LOS ANGELES BuuowG
DEPARTMENT OF COUNTY ENGINEER ADDRESS O O4 3 L A Wo5A
BUILDING AND SAFETY DIVISION LOCALITY T-EN PCE CI Tti+
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINSSUP'T OF BUILDING CROSS ST. A LDL0I f
DISTRICT NO. GROUP TYPE, SED BY
FOR APPLICANT TO FILL IN S .I O T CONST. V
BUILDING {. STATISTICAL�QCLASSIFICATION SEWER MAP
ADDRESS�Ou1�eS /, , /4Z,,5) CLASS NO._95—DWELL UNITS BKI\ PG A�
LOT NO. k)e!.T �O I O F LoT C7 BLOCK USE ZONE NE NOP Z (,
TRACT Q g Z I I SPECIAL
N0. 01 BLDOS. % ZOb CONDITIONS
SIZE OF LOT SCT X a70 NOw ON LOT
kNE
OF C'; /J
EXISTING/D N /` /� / BLDG. SETBACK FROM
ERC , U 4116SQ NO LT�2�320p FRONT PROP. LINE OF (STREET)
�,^ / ^ TYPE OF EM ISTI NO SETBACK HIGHWAY + YARD = TOTAL
RESS W 3 //•C��/0OSA , w HIGHWAY WIDT 'R
M C.L.
Fyr� u� L.,iT -OC,I'; fib' l S _
HITECT OR BLDG. SETBACK FROM
INEER NO. SIDE PROP. LINE Of (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
RESS HIGHWAY WIDTH FROM C.L.
TEL. ( T + _
TRACTOR NO
d
RESS NO CORNER CUTOFF VES NO U
LID SEE REVERSE SIDE FOR SPECIAL APPROVALS o
ESCRIPTION OF WORK
n-
N
ADO ALTER REPAIR DEMOLISH `-
T. NO. ONO. OF TSTOARI ES '�FA MI LI F_5
USE IF
CTURE �1 '1— � ^' � U • I O
lsTIu 2 � s �D —0iC&
ATURE OFLICANTUATION$ �•-�.Q � 0 � .00
APPROVALS DATE INSPECTOR'S SIGNATURE
FIAT. /( FOUNDATION, LOCATION
P E$ FEE$ —f'r FORMS' M
MATERIALS
FRAME, FIRE STOPS,'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GA6 VENT. DUCT$
1UILOI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT.
TION OF THE LABOR CODE OF THE STAT OF CALIFORNIA RELAT.
ING TO WORKMEN'S CO 'FlON RA E.
LATH. EXT.
SIGNATURE OF ��� Q`u -/� C HOUSE NUMBER COR-
PERMITTEE, /� G� RE AND POSTED
ADDRESS�QO 3 KI Ile, IFI NAL
JOHN F. LEWIS. PRINCIPAL STR)dVTLRAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cK. NO CASH
Ao5 4 3 4�8 OCT24 1 D 4.00-'
- �il
C, 76.631HA:
CE#803(REV.6/981
-APPLICATION F R' BUILL LNG PERMIT
r
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL INJAD
DRESS
DRESS l0G
BUILDING /
ADDRESS a� �.,(`� CALITY
CITv ,, 1,E CG/ ZIP / SSST,
TJO.OF BUDGE. SESSOR
SIZE OF LOTSOJcCI NOW ON LOT P BOOK PAGE PARCEL
TISTRICT TYPE FIRETRACT aI BL�OCK . LOT N CONST. ZONE
OWNER ( 1 A"1 NOS • !/N�.N ��J/ /JTISTICAL CLA551FICATII SEWEADDRRESSrQQ 441,0,_SA PACLASSN r DWELELLUNITSCITY /`mA& c!'� ZIP 1ARCHITCTORppTEL. LUATIONENGINEER /I/FNI... NO.ADDRESS G.SETBACK FROM
TELNT PROP.LINE OF ISTREETI
CONTRACTOR .VNL NO. HWAY + YARD _ TOT ALSETBACK F ROMTYPEOF EXISTING
LIC. FRONTPROPLINE HIGHWAY WIDTH
ADDRESS NO.LIC. +
CITY CLASSDG.SETBACK FROM
CONSTRUCTION LENDER E PROP.LINE OF - (STREET)
NAME AND BRANCH `
HIGHWAY + YARD = TOTAL SETBACK L FROM TYPE IGEIWA EXISTING 0
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH Q
SO.FT. NO.OF NO.OF CHECK + = V
SIZE Q ST JE
FAMILIES ONE O
DESCRIPTION OF WORK C jo L NEW ❑ P.C. Fee$ Permit Fee
Amt d 7- L I �W �Q E ADDrl
Issuance Fee y�
CIO- ALTER /� Z
n/J ��NN�� REPAIR Total Fee
❑ (/
EXISTUSE ING BLDG. DEMOL ❑ / a/q). O'�� r
APPLICANT TEL le` E� lJ f/
IPRINTI .--r Q M NO. y , Q
O
BY ISIGNATUREI >
1 HEREBY ACKNOWLEDGE THAT I HAJ READ THIS APPLICATION AND STATE Y
THAI THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE m
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF 1 E STATE OF CALIFORNIA IN RELATING i0 WORKMEN'S COM = 3 4 4 2 6 A
PENSATION INSURA Q
d # 0 0 0 0 0 1
AGNATURE OF A
PERMITTEE / A p e - 70.00
ADDRESS/0043 4- Z * . - 70005
-�/. TEL . O ' .
CITY! /-I,+/LE C[Y y NO vaU--5 < 0517-79
0
ONE MAP
I NO. Q
U SPECIAL
CONDITIONS f
FINAL BY i
DATE ��
APPLICATION FOR BUILDING PERMIT
FOfi APPLICANT`TO FILL IN (Prla or rY oe PHIY) _
BGILDING COUNTY OF LOS ANGELES
ADDR Ess 5 A�• DEPARTMENT OF COUNTY ENGINEER
ciTv LS177 Ci ZIP f >ff0 BUILDING AND SAFETY DIVISION
/ NO.OF SLOGS.
BUILDING
SIZE OF LOTS 27v NOW ON LOT 4k ADDRESS
TRACT BLOCK LOT NO DY LOCALITY
�^ TEL. ! NEAREST
OWNER (G� 1 O. ys.S CROSS IT.
ASSESSOR
ADDRESS /6() -3 L o4e MAP BOOK PAGE PARCEL
CITY TEmP4E C! ZIP 9i �� DISTRICT GROUP TYPE FIRE PR CESSEDBY
7 CONST. ZONE
ARCHITECT OR TEL.
ENGINEER NO,
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS TE CLASS NO.�L DWELL,UNITS BK P
CONTRACTOR
NOL !J-S SS USE ZONE P 241
LLID
) NO
ADDRESS �..' OSA? L)A NO. �0 SPECIAL
Jac LIC. CON OI TIONS
CITY r��7�^I- C / CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YESET NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLOG.SETBACK FROM ,.,.. d
FRONT PROP. LINE OF �l� -0J!$ (STREET) C
L
ADDRESS CITY _ TOTAL GETBA<K FROM TYPE OF EXISTING
HIGHWAY } YARD - c
SCI. FT. NO. OF NO. OF CHECK FRONT pROP. LINE HIGHWAY WIDTH C
SIZE (� STORIESFAMILIES ONE C~.
DESCRIPTION OF WORK - QC M. NEW ❑ } /1
ADD ® BLDG.SETBACK FROM / !/ (STREET) ?
_ ,0 - o," _ SIDEPROP. LINEOF
ALTER ❑ HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING
/� 0-1'1-r�fi� 57JfA�G/w SIDE PROP. LINE HIGHWAY. WIDTH
usE of FT - ��� — /C/JG- / � REPAIR❑ } _
EXISTING BLDG. . v/n DEMOL ❑
APPLICANT TEL CORNER CUTOFF VES ❑ NO
(PRINT) ,, 1 D.
BY (SIGNATURE) IN OPEN SPACE YES O NO
Z,' IN COASTAL ZONE YES [] NO
-VALUATION s Lv CATEGORICAL EXEMPTION FEE[] NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED IOATE)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (.ATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OFT
T E O[ CALIF NIA IN RELATING TO
WORKMEN'S CO MPE NE TI NS AN[E.
SIGNATURE OF
PERMITTEE
ADDRESS ./U • 'S
FINAL
/ 1 r �.[. /, NOL.. � � DATE // / BY1./{�/
CITY 5
MAKE CHECKS PAYABLE TO: FEE FEE
HARVEY T. BRANDT. COUNTY ENGINEER --T, - 5-0
,
PLAN CHECK VALIDATION M: =ASH _ PERMIT VALIDATION CK.) M.o. EAS.
0.5`2�14AR 14 2:3 0 4 9.5.0 ®t�8 G O V-115
6
76A638A,CE#803 7/73 ✓I 7 9nAPR 24 1 0 8 2.5 0 A96
y WORKERS'-COMPENSATION DECLARATION J�
I hereby,offirm that I have a certificate of consent to self �LUI
''.nsure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING-PERMIT
r�a certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES BUILDING ANDSAFETY _
Fo;icy Na. Company
�,A Certified copy is hereby furnished BUILDING
FOR APPLICANT TO FILL N ADDRESS / 3 - i
❑ Certified copy is filed with the county building inspec- BUILDING .Cj�
• X41&Staiye
tion department. ADDRESS 0043 L KL./
SA
Date Applicant CITY p CfZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' - / I NO. OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT n JQ( Q 0 NOW ON LOT- CROSS T.
(This section need not'be completed if the permit is for one TRACT o eLr'( BLOCK LOT NO. �� MAPASSEBOR
hundred dollars ($100)or less.) _ t MAP BOOK- PAGE PARCEL
LA
jjEL. USE NE MAP
1 certify that in the performance of the work for which this OWNER 1 IVlO. NO.
permit is issued, I shall not employ any person in any manner ADDRESS Lir1 Rases SPECIAL r +
so'as-to become subject to the Workers'Compensation Laws. CONDITIONS O
Date� Applicant r l/ t CITY � C-[ ZIP
NOTICE TO APPLICANT: If, after maki, i this Certificate of ARCHITECT OR TEL DISTRICT GR UP TYPE FIRE PR ESSED BY C)
ENGINEER NO. CONST. ) ZO E F—
Exemption, you should become su tect to the Workers' - ,V/ Ea Compensation provisions of the Labor Code, you must forth- ADDRESS Ea
with comply with such provisions or this permit shall be TEL 0.
STATISTICAL CLASSIFIC TION APT. NDO. Z
deemed revoked. CONTRACTOR NO. �T/
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. v DWELL. UNITS-
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
(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. CITU CLASS BK LPG VALIDATION
SO. FT. "�� O. OF NO. OF CHECK
License Number Lic.Class SIZE H90 TORIES' FAMILIES ONE
Contractor Date DESCRIPTION OF WORK (� A NEW
D ❑ 6ALUAjI O D DIJ ' x.9.1 23
am exempt under Sea S� r t N -�'�+ ❑ UVV''
n� ALTER ( • 1 6 0 9 7
B.BP.C. for this reason REPAIR
Date: USE OF DEMOL • • qyqyn
EXISTING BLDG. LA q;� o
Signature APPLICANT ✓ TEII��gpI�M1 p{ �. - - / 0000
OWNER-BUILDER DECLARATION PRINT NOV
FINAL (Ly� # • • . • e,1
I hereby affirm that I am exempt from the Contractor's License C �,.,, { /! :( - 1 9'9,88
Low for the following reason (Section 7031.5, Business and ADDRESS 0 FILO , Q FIN /
Pr essions Code): PRE N By :�� ,( • x
[ /I BUILDING 1 9 9.8 8 6
u I, as owner of the property, or my employees with ADDRESS P � I
wages as their sole compensation,will do the work and i1 y r Sl��'• A s -.r0 rj, 1 6.-88
the structure is not intended or offered for sale(Section LOCALITY I I..• :y:, I;I 11�`•d. t`i J ,f
7044, Business and Professions Cade). MOVING TEL
F-1 1, NO. ♦ '� .t •
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 - RROM
EQUIRED YARD NWY TOTA FROP.LCNE WIDTH
IETBK EXIST.
I hereby affirm that there is a construction landing agency for FRONT y `
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.). SIDE
Lender's Name -/ LDMA Ref. R
m
Lender's Address P.C. Permit Fee
o I certify that I have read this application and state that the T Issuance Fee LDMA P/C R`. rl �'� •..
above information is correct. I agree to comply with all County Investigation Fee
LD"
ordinances and State laws relating to building construction, Total Fee LDMA Perm. M
and hereby authorize representatives of this County to enter
upon the above-mentioned�property
for inspection purposes. N '
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sigrebre of Applicant or Agent Date
7 . COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1203190087
PHONE: (626) 285-0488 EXT:
ILEGAL ID: NO. OF CONST 'r BUILDING ADDRESS:
ITR: 10821 IT: 6 BL: A SQ. FT STORIES TYPE 10043 LA ROSA DR
I STRUCTURE: 20 V-H TEMP CA 917803302
(ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
18565-007-009 1 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl
1TENANT: 1EXIST BLDG USE: REBID USE ZONE: R-1 11SSOED ON: PROCESSED BY: I
1 IEXIST OCC GRP: 103/19/12 SR
IOWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE:
110043, JOHN (626) 893-5211- 1 4,800 I y 1
110043 LA ROSA DR
ITEMP 917803302 FEES PAID
IDES CRIPTION OF WORK 1
1TEAR OFF EXISTING ROOF COVER UP NEW 30 YRS COM/SHINGLES
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: HOUSE ONLY
(APPLICANT: TEL. NO: I - 111
FUNG'S CONSTRUCTION CO. (626) 625-7048- AA BLDG PERMIT ISSUANCE 27.80
1437 W. WELLS ST IAB STATE GREEN BLDG FEE 4800.00 VAL 1.00 (SPECIAL CONDITIONS:
SAN GABRIEL CA 91776 IAC STRONG MOTION REBID 4800.00 VAI, 0.50
1 ID2 PERMIT W/O EN-HC 4800.00 VAL 132.60
_ TOTAL FEES 161.90 r`
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
1FUNG'S CONSTROCTION CO. (626) 625-7048- I I I
1439 W. WELLS LIC. NO ILOCATION AND SETBACKS
SAN GABRIEL CA 91775 753441 B
11
ISOILS ENGINEER APPROVAL 1 ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUNDATION/TRENCH FORMS
1 LIC. NO: 1 1SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
I I I
(MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I (UNDERFLOOR INSULATION
1147H273 3 001
I IFLOOR SHEATHING
1NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I
0 NO 21 IROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
1 NO NO NO 1 1FRAME INSPECTION
IFIRE SPRINKLER HANGERS
I I I
INSULATION/WEATHER STRIP(
INT`RIOR LATH/DRYWALL
EXTERIOR LATH
(RATED FLOOR/CEIL ASSEM.
1
RATED WALL ASSEMBLIES
I I I
RATED SHAFTS/OPENINGS
I I I
T-BAR CEILINGS
1 I
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: PS0509
I I I I I I