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Home My Public Portal About10122 LA ROSA DR_Building__ �nlr ANY ,; �TERIAL STOP,A3E OR OR DONE IN THE ROAD RIGHT O WAy. mossece Rsm s/so APPLICATION FOR BUILDING PERMIT I COUNTY OF LOS ANGELES EVIL DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST ' WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NQ. U T�.PE P SED BY FOR APPLICANT TO FELL IN CONST. BUILDING A �p STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �OI�y,Je[ ftaft! �AaSJ� tS/• I Ile BK P CLASS.NO. DWELL.UNITS LOT NO. BLOCK MAP STATE YES NO NUMBER HWY. TRACT Q Z USEZONE SPECIAL NO.OF BLDGS. ,( CONDITIONS ~_ SIZE OF LOT Q I NOW ON LOT USE OF EXISTING BLDG. BUILDING EXIST. TEL. SETBACK YARD HWY TRE AME WIDTH OWNER // //[14` ss 1 G NO. FRONT P. ADDRESS11VI `, ihAI`/1/3k2l ELMLuS1 L SIDE ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECO _ Ir,1-C ADDRESS /' / _ l EL CONTRACTOR 1L1Lf�e1Mb LO/s. O.6iloci ADDRESS M��J✓T R,�.aI, - V DESCRIPTION OF WORK / • r°-'" /� ADD ALTER REPAIR DEMOLISH SO. FT. ))�� /.ya NO.OF ) NO.OF SIZE STORIES / FAMILIES / USE OF 7� Aa A d E STRUCTURE µ/W ti�-�1 �'� ` � SIGNATURE OF APPLICANT- VALUATION PPLICANT .u_'.r// 9^F• ^ .N.Y �r� /•� $ VALUATION$ �Q d - 1 PMT /' APPROVALS AT INSPECTOR'S SIGNATURE FOUNDJ FEE $. FEE $-Y FOUNDATION: LOCATION L� 1_ FORMS,MATERIALS �� FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- BRACING, BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, / //_(;) AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS IS ✓'� STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT. WILL NOT EMPLOY ANY PERSO IN OLATION OF HE WORKMEN'S COMP NN S F CALIF NI LATH, EXT. T SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRU URAL ENGINEER PLAN CHECK VALIDATION CK M.o. usx PERMIT VALIDATION c c M.o. cAax LACo:5 3 7 4 JUL 11 2 3 0 25.5 J . LATD3 8 6 4 'UL ? C s 0 5 1 .G 0 76AP38A CEVS0312/59 APPLICATION FOR BUILDING PERMIT /� COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING /O/1 JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUR T of BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST p.IDr e. t GSI CROSS ST. BUILDING DISTRICT NO. G TYPE P ADDRESS /O�LZ // C,S/}� Q� CONST. Q_ STATISTICAL CLASSIFICATION SEWER MAP LOT NO BLOCK CLASS NO.� WO DELL,UNITS_ BK4 PG TRACT NO.OF SLOGS. USE ZONE MAP O NO. SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING GB,t QBLDG. EL. NO OW NER% BLDG.SETBACK FROM ADDRESS O/LZ LJ.9 FRONT PROP.LINEOF (STREET) TYPE OF IEXISTING SETBACK HIGHWAY } YARD = TOTAL CITY �� L4 HIGHWgY WIDTH FROM C.L. L " ARCHITECT OR TEL. } _ ENGINEER NO. BDG,SETBM ADDRESS SILINDE PROP.LINE OF (STREET) TEL //��j TYPE OF EXISTING SETBACK H AY } YA RD = TOTAL CONTRACTOR ` `' NO. (J(r ♦♦ HIGHWAY WIDTH FROM C.L. ADDRESS/ C Sj, LIC CO CITY L�� tel^ CLASS GG, CORNER CUTOFF YES ElNO U CONSTRUCTION LENDER s NAME AND BRANCH SEE REVERSE SID OR SPEC L APPRO LS ADDRESS GW„ h SO, FT.^^ ST NO. OF NEW ❑ SIZE i STORIES FAMILIES USE OF ADD STRUCTURE �C , ALTER ❑ SIGNATURE OF _ (� - — REPAIR❑ APPLICANT pL,)`L -�— DEMOL ❑ VALUATION S (j� APPROVALS DATE INSPECTOR'S SIGNATURE FEE S /(J 3� FEE 5 7 rOFORMS MATERIA SIGN FRAME: F--- ---—, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE 15 CORRECT ANO AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUC TIDN. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILLNOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF CALIFOR NIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. �FLATH, EXT, SIGNATURE OF M21\Y- , , '~„` HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL � 7Z_ JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK: M.D. EAS. _ PERMIT VALIDATION CH. UP- CASH 1 1 3 5- JUN29 2 3 D 1 0.3 5- o I7( _ 1136�— JUN29 1 D 17.25" APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COIYIPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS l O I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS ��. or a certificate of Workers' Compensation Insurance,or a certified lot Z Z LL-Alpp Ws A copy thereof (Sec. 0 G) //��K ' 1 CITY y�/I ZIP QQ �A FU�1'D �EI�l�C..E � C..J � LOCAL Policy No. Company SIZE OF LOT NO OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST 191 ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department, / // ` /J�� L USE ZONE MAP NO. Date-Z�/ Applicant 11WI-[/171 .tli(.�/�v/ ASSESSOR MAP 800K PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NOC: COMPENSATION INSURANCE -Sl m '-1'1-S 56 WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS ,,L p fit' dollars($100)Or less.) O ZZ �Yl F�/St•'{ DISTRICT GROUP TV CONST FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CITY LF— C 1 2p� 1"l SO �rD l' V - J is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. F/ become Subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNIT NOTICE TO APPLICANT. If. after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' Cfi1xTRACTOR TEL PZ SET BACK YARD HWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �-� 'Foil FRONT comply with such provisions Or this permit shall be deemed revoked. ADD SS {�.Iq NO P L LICENSED CONTRACTORS DECLARATION 2 Z IJ `-13�3 SIDE CIT _,nom ` LIG G ASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 � �' C —� SEWER MAP a (commencing with Section 7000)of Division 3 of the Business and SO-FT SIZE NO.OF STORIES I NO,OF FAMILIES NEW BK PG U Professions Code,and my ltc rise is in full force and effect License Number 1?� Lia Class e-311 l/ DESCRIPTION OF WORK ADD C] VALUATION loop- Contractor� �� Date S zL��7 -TO � � E^ � ComL" ALTER ❑ $ 2 ' OO w 000SE -4- 4A"C- E 2U REPAIR ❑ ti ❑ I am exempt under Sec. �/ ' $ ? B.&P.C. for this reason 'JEAC F/ IC SJA DEMOL ❑ DMA P/C A Date: USE OF EXISTING BLDG. S/�/U� URM ❑ 1 Signature APPLICANT(PFINT,i // TEL NO. LDMA Perm# ❑ I,as owner of the property, or my employees with wages as Lz L- O their sole compensation, will do the work and the structure is ADDRESS H`_\ Y act intended Or Offered for Sale (Section 7044, Business and FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ,�' �� y T T E - OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TD OR GREATER THAN THE •' ❑ 1, as owner Of the property, am exclusively contracting with44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY Business contractors t0 construct the project (Section 7044, —ITA, _j 'L _e a ,�• business and Professions Code.) WILL ❑ No❑ _r WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 'jJ!-♦•'" 1ti`!.._i 1 OOASTA IR REQUIRE A PERMIT FOR CONSTRUCTION OR EE PERMITTING FROM THE SOUTH h_O/�/ t'- CONSTRUCTION LENDING AGENCY torsi AIR Ounury MANAGEMENT DISTRICT IscAOMoI SEE PERMlrnrvc cHEcxusT FOR T„ `6 4� �S - GUIDELINES al_{I I hereby affirm that there is construction g agency for YES El No Ela the performance of the work for r which this permitrmit is issued(Sea D� q IHEC READ THE DERSTAHAZARDOUS UNDERSTAND REQUIREMENTS UNDER THE AND THE SCAOMOPERMITTING 3097,QV.Q) TITLE 2IC TER 220 SE TI REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, y -' \ TITLE I CHAPTER TING AND 2 20OBTAINING IN THROUGH 220.140 CONCERNING HAZARDOUS `I I_t Lender's Name MATERIALS REPORTING ANO FOR OBTAINING A PERMIT FROM THE SCAOMD _ Lender's Address o wmER oR wE�+T b 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 PERMIT FEE N with all county Ordinances and State laws relating to building 1 m CORSir 1 rrdrt heT¢by a thOflie repfeee0latlVes Of this County ILSSUANCE FEE at er on above-I tinned property for ins ionp ?s�` m INVESTIGATION FEE TOTAL FEE sa SEE REVERSE FOR EXPLANATORY LANGUAGE