HomeMy Public PortalAbout10144 LA ROSA DR_Building__ I�
T-CIM PLE
76A63RACE;;6036.62APPLICATION FOR BUILDING PERMIT �.
COUNTY OF LOS ANGELES BUILDINGIUI +4- Lh �oSA
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY TGHPLE C/Ty
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST /
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. (7 L I G IC AE AA/
DISTRICT NO. GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN S• p Z CONST? 60LOVK,)
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS y BK
CLASS. NO.---L—DWELL.UNITS
LOT NO. LOCK �,. WATER
CERTIFICATE: NOT REQUIRED RECEIVED
TRACT NOP 2O I (CIRCLE) STATE MAJOR SECOND.LOCAL
SIZE OF LOT (J NOW ON LOTHWAYBLDGSPECIALZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. AA n r
-' TEL. , /`— lei 361- A � Csx
OWNER NO. BUILDING YARD NWY STREET NAME EXIST.
SETBACK WIDTH
ADDRESS �T. ,^1. '� - FRONT /T 1 1 L p OS O.
ARCHITECT OR TEL. P. L. V L
ENGINEER NO. SIDE a
P. L. O
ADDRESS
1�
, r L. P•P 3S l7• v
E
CONTRACTOR T - NO 3�
N
ADDRES ��� s - 0
DESCRIPTION OF WORN 7 ;r
EW! ADD ALTER REPAIR DlMOLISHZ
O. FT. NO.OF NO. OF
SIZE STORIES FAMILIES rr
USE OF
STRUCTURE
� I
SIGNATURE OF r i
APPLICANT
VALUATION $
—) � '3 S O PPROVALSPATE INR[CT011' BION R
� [ PMT. FOUNDATION: LOCATION
FEE SILO FEE $ FORMS. MATERIALS
FRAME: FIRE STOPS, J
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED H[REBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH. INT. I
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAY.
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH.EXT.
SIGNATUREO ,,,(((,,,� Imo^ �s HOUSE NUMBER COR- -�
PERMITTEE ��F///7,f.! - - RECT AND POSTED A
ADDRESS.S .- WSJ s�K rG.7—"— FINAL A
JOHN F. LEWIS, R CI AL STRU URAL ENGINEER
PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
U2869G APR 323 0 26.751
L jW;p4500Voo f41Y 9 1 0 53.50~ Q
�dn��v
WORKERS'COMPENSATION DECLARATION • .. z - - J'I
�I'h�by oftir,7t that I have a certificate of consent'to,self c - •' ylLJll
insure at acenificateofWorkeri Com pensatian,nsarance, APP,LICATIO•Nt FOR BUILDING PERMIT
.or a certified copy thereof (Sec. 3800, Lob,C.). i
- \'� i •y •}. � ,� COUNTY OF LOS,ANGELESti BUILDING AND.SAFETY -
PolicyNo. Company ' I y/
El Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN `r BUILDING
ADDRES10V44IO� LA Q YL
Certified copy is filed with the county building inspec- BUILDING 11 `t
tion department. ADDRESS GsI�, . y �;C, Ci�—'R r7Po
Date Applicant • CITY p L..Ge ZIP J SO LOCALITY -TGIF LL C{ t- CALIF'
CERTIFICATE OF-EXEMPTION FROM WORKERSS. -T ttiHK�.IQOXIOD X.IcL NO. OF BLDGS. I NEAREST
- COMPENSATION.INSURANCE SIZE OF LOT som $- NOW ON LOT ( CROSS ST.
(This section.need not be completed if thepermit is for one TRACT I IDBLOCK 2 t< LOT NO.PyASSESSOR
hundred dollars ($100)or less.) 8 �% S �I(L. MAP BOOK S PAGE J 3 PARCEL `YO
OWNER NA6D A, O MAIJ No. 4-ISO' USE ZONE MAP r7 -
I,certify that in the performance of the work for which this kNO.. G. _
permit is issued, I shall not employ any person in any manner. SPECIALt
- so as to become subject to the Workers'Compensoti n L • - ADDRESS 101 ;-A A / CONDITIONS Q
a �j ° �F YI qpo
Date 3 II S 9 Applicant • CITY E C( ZIP / p �
NOTICE TO APPLICANT. If, after making this erlifiaote of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PR SSED BY- Q
ENGINEER M. GJcjumlltj N0.ggq_ 8 CONST. ZONE CC)
Exemption, you should become subject to the ,Workers'
Compensation provisions of the Labor Code, you must forth- ADDRESS /C/ •�,J, __3E
W
With comply with,such provisions or this permit shall be D-.
deemed revoked. - „ TEL.- - STATISTICAL CLASSIFICATION CONDO. (A
CONTRACTOR' OI(III� NO, Z'
LICENSED CONTRACTORS DECLARATION - . . I tic CLASS NO. DWELL UNITS—
. I hereby affirm that I am licensed under provisions of Cho pter 9 ADDRESS NO.
(commencing with Section 7000)of,Division 3 of the Business and _tiC SEWER MAP
Professions Code, and my license is in-full force and effect. CITY CLASS - (<- BK PGt, VALIDATION - max- -
- -- - _ SO. FT. NO. OF N0. OF CHECK
_ _ ��11��// -
License Number-Tic.Cosi - SIZE IS
I FAMILIES- I. ONE ,
VALUATION t '
Contractor Date DESCRIPTION OF WORK NII-• IqU NEW ❑
1 1 ADD $
I am exempt under Sec. _ 15 x I trl0{^
ALTER ❑ �;2•9,1 49:A
B.BP.C. for this reasonDIM O/� 5�"' REPAIR ❑ $USE #-• e • • e .
Date: ' EXISTOINGBLDG. �JINf�L� �FTmII HOu DEMOL ❑ - ' 1 ;
Si nature APPLICANT T L. / / ,I •4 3 4 25
Signature—OWNER-BUILDER DECLARATION PRINT A D p q.�.( LI O.�lU�I— DATE (Q ;`hi( ••e 3 p •�5
FINA
L w for affirm that I g r exempt from the Contractor's License ADDRESS �QI l ✓'�T USA S 6IT FIN �" �s
Law for the following reason (Section 7031.5, Business and
Professions Code):
- -. .By -
-
6 BUILDING as owner of the property, or my employees with ADDRESS -
wages astheir sole compensation,will Botha work and 'U
�L pp
LOCALITY • A . GOf.1N� pM�� / t v
the structure is not intended or offered for sale(Section
7044, Business and Professions Code). - - MOVING N/A - TEL. �. i t• 1 .`;
CONTRACTOR NO. `
�I I, as owner of the properly, am exclusively contracting
L� with licensed contractors to construct the project (Sec- ADDRESS \\ `
tion 7044, Business and Professions Code). - r� C' •i.f \ \\p
' CONSTRUCTION LENDING AGENCY SETTUIRBACK YARD' HWV TOTA'PROP. LME WIDTHS*��� •s s`.(� -
_I hereby affirm that there is a construction lending agency for FRONT ;.`` .� f •}�,` v V Ty' t x,J -`+
the performance ofthe work for which this permit is issued P.L. - _ - t 5 } I•s 1` ,ti -
\ - n
(Sec. 3097, Civ. C.). SIDE _ •�
P.L. .+L
Lender's Name
_. . `J` 1
m Lender's Address +' P.C. Fee$ Permit
(,certify that I have read this application and state that the -. Issuance Fee /- LDMA P/C M 1
above information is correct. I agree to comply,with all County Investigation Fee - - - "
ordinances and State laws relating to building construction, Total Fea LDMA M. p .
and hereby authorize representatives of this County to enter
� upon the above-m ntioned property for inspection purposes,
SEE REVERSE FOR EXPLANATORY LANGUAGE ,
S' nal of Applicant or Agent • - -Date