HomeMy Public PortalAbout10150 LA ROSA DR_Building__ TEMPLE
;........#.032/.. APPLICATION FOR BUILDING- PERMIT' ' h .
COUN'T'Y OF LOS ANGELES BUILDING
DEPARTMENT.OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY y
JOHN A. LAMBIE„COUNTY ENGINEER NEAREST /
WILLIAM A. JENSEN, SUPT OF BUILmnc' CROSSST.
DISTRICT P O/. GROUP TypE P ESSED BY
FOR APPLICANT TO FILL IN SAO,.lf I �� CONST':,� r '
BUILDING ///� STATISTICAL CLASSIFICATION 5 WER.MAP ,
ADDRESS. �6 I S / Oa�� JJ j SK .CPG
�' CLASS. N0:IDW ELL.UNITS�J t
`LOT NO. ntY"!%G.r.✓l. /b BLOCK MAP NUMBER - HyyE - YES
TRACT' 'USE ZONE SPECIAL .
ppf1JO.OFBLDGS. ``� CONDITIONS
SIZE OF LOT [•},5.3 7(/c :fJ I NOW ON.LOT
USE OF. -EXISTING BLDG. BUILDINGyARD HWY .STREET NAME - EXIST.
rr -/ TE SETBACK _ WIDTH
OWNER f / V'C N X FRONT
- P.L. /
ADDRE I ( ,SIDE
ARCHITECT OR - TEL. 'Pf L. t -
ENGINEER NO. INSPECTION RECORD
'ADDRESS TEL. >.
- ^e.'/1� ! lC�1/ "d"Q TT TL+f C Pr
CONTRACTOR NO. p - - /
ADDRESS �. "� •A V
DESCRIPTION'OF WORT{ � r ���' `lam .oL_s- L 1'//f/_r.— — SO
. ,
NEW .ADD ALTER REPAIR ,. ' DEMOLISH -
SQ.FT. ^ NO.OF 'NO.OF J� �m•e. W
SIZE Lf- � STORIES r FAMILIES u
STUEOF
RUOTURE {t�L..< �2✓�_/
oU
SIGNATURE.0 ,
APPLICANT /.
VALUATION eU G - - '.
APPROVALS ADATr INSPiCTUR'S SIGNATURE
"u—'c"777-07 I FEE $ FO FORMSUNDAT•MATERIALS
FRAME: FIRE STOP$, L ,
1 HEREBY ACKNOWLEDGE THAT .'HAVE READ THIS AP- BRACING: �BOLTS Z�.(D/
PLICATION AND STATE THAT THE ABOVE-IS CORRECT AND FURNACE: LOCATION,• /j
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND -GAS VENT DUCTS � M .e I,-
STATE
iSTATE LAWS REGULATING BUILDING CONSTRUCTION. LATH, INT. /d_116p ]_A"�eAA1 l a
.I CERTIFY THAT 9N DOING THE WORK AUTHORIZED I
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE - -
WORKMEN'S COMPE SAT ION LAWS OF CALIFORNIA.. 'LATH, EXT. -
SIGNATURE OF �� HOUSE NUMBER COR-'
PERMITTE -RECT AND POSTED Ii ^�/l�
ADDRESS FINAL / / `/' /
�2
CLYDE N. DIRLAM, PRINCIPAL ST OT AL ENGI R PLAN CI�CIC VALIDATION CK) M.O. c H PERMIT VALIDATION cK M.o. rw H
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Ll1Io 0 9 7 6 JAtd 1 2 2 3. 0 G 1 .0 0 ; .1;
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Lnl;o 1 1,3 9 Jai 17 0 4 5 .
_APPLICATION FOR BUILDING PERMIT
i COUNTY OF ANGELES BUILDING AND SAFETY.,
;. BUILDINGADDRESS
WORKER'S COMPENSATION.DECLARATION FOR APPLICANT i0 FILL IN /�
BUILDING ADDRESS) R
I hereby affirm that I have a certificate of consent to self insure, /S� _
ora certificate of Nbrkam'Compensation Insurance,;or a certified CI - ZIP
copy thereof.(Se- 3800,Lab.C.) Thr L.p C[-1 LOCALITY fJ yy
` O.OF SLOGS.NOW ON LOT
Policy No/p ��ob gOCompanY rSRE OFL T
❑ Certified copy Is hereby furnished. a NEAREST CROSS ST.
S, D4��
Certified co is filed With .the county building inspection TRACT BLOCK - LOT NO. +
PY 9 F 9 1 USE ZONE MAP NO. /d
de-ertment +, Gil H� �J
2_meq// ASSE OR MAP BOOK- PAGE PARCEL
oat aY��Applicant �'•- - Q� _ O� Cep/\+.�. SPECIAL CONDITIONS -
1/' I
CERTIFICATE OF EXEMPTION FROM RKERS' OWNS y T Ol� O; Y No
COMPENSATION INSURANCE - r d wI7HIN 1d00 Fr.of scRooL4
ADDRES I -
(This section need not be Completed lithe permit Is for one hundred DISTRICT GROUP TYPE CONST.' FIRE ZONE ROCESS Y
dollars($100)or less.) - cm ZIP - D(/ . nr7 .
I certity.that in the performance of the work for which this permit, 1/E /(-✓1
is issued, I shall not employ any person in any manner so as to ARCHITECT fl ENGINEER TEL. '
become subject t0 the Workers'Compensation Laws.. STATISTICAL CLASSIFICATION qq' APT CONDO
Date Applicant ADDRESS CLASS NO. 11A/ DWELL UNITS V
'NOTICE�TO APPLICANT. If; after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
EXemptlonj you should become Subject to the Workers r0>3RACTOR TFL �` SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith � $y 3oJ b FRONT
comply with such provisions or this permit shall be deemed revoked. gs8 l / ',-�Sa PL
(/ 7 a / SIDE n"t'• ' Y
LICENSED CONTRACTORS DECLARATION Cl&f i LIC.C SS PL 178
1 hereby affirm that I am'licensed under provisions of Chapter 9 LC/ SEWER MAP ,� _
SO: SIZE NO.OF STORES NO.OF FAMILIE 1E 1 f EM D'
(commencing,with Section 7000)of Division 3 of the Business and NEW ❑ BK ,PG 1 I'd O
Professions Cpad llii a se is in full force andand ffect. D� -License NU b �./Sa Lic.Cla �� D CRIPTION O ORK ADD 19 VALU ) 1!I �{- : -fes-'rte y - +wContract Date '� ALTER ❑ W ' 'F-HE�.K' '. t ) 4 - ZREPAIR ❑ HANGE .IIamexamc. i -
B.&P.C,for this reason �`� DEMOL ❑ LDMA P,CN "
USE OF ISTING BLjTG o%fi' %Oi'
URM ❑
Date: - JLILi I-iI�IIUi f,r
Signature APP T(PRINT) E NO. TDMA Parma _ fll37c 1 i1f11V.14
❑ I, BS'Owner of the property, or my employees with wages as
their sole compensation, will do the work and the structure is `�`
not intended or offered for sale (Section 7044, Business and D Sd i �I FI DATE o
Professions Code.) WILLTHEAPPLI NT OR FUTURE BUILDINGOCCUPANT HANOLEAH RDOUSMATERIAL 1-3D
OR A MIXTURE CONTAINING A HAzARCOUS MATERIAL EQUAL TO OR GREATER THAN ♦Q -
❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPE IFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? .FINAL YQ
licensed contractors to.construct the projectL(Section 7044, YES 11 NO U& Vf
Business and Professions Code.
WILL THE INTENDED USE OF THE BUILDING BY THE RMODI INT OR FUTURE BUILDING
OCCUPANT REQUIREQUALITY MANAGEMENPERMIT FOR T
DISTRICT
(S NOM D)SEED RMI FROM THECOLITH
CONSTRUCTION LENDING AGENCY' COAST AIR QUALITY MAIUGEMENT DISTRICT ISGAOMD)SEE PERMITTING CHECKLIST,
FOR GUIDELINES
I hereby affirm that there is a Construction lending agency for YES❑ NO -
the performance Of the Work for Which this permit is issued(SS . 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMd I •�• fa-4 I-I Y
3097,CIV.C.). PERMITTING CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELE$''t r m �. '
� COUNSYCODE TITLE 2,CHAPTER 2]B SECTIONS220AW THROUGH 2.2()Ai CONCERNINd U, I� A ^,i
2� Lenders Name HFIAR ou ALS REPO ING FOR OBTAINING A PERMIT FROM THE SCAOMD' -
6 ' Lenders Address rTl
I certify that I have read this application and state that the above iJ —{ _
Q P.C:FEE PERMIT FEE
$Q information is correct. I agree to comply with all county 'r HLL i n I
ordinances and State laws relating to building construction,and 3• sa.d 1 Op, p i
<. hereby'authorize,representatives of this County t0 enter upon ISSUANCE FEE /� Imfl
°Wa the m ventioned pf Pet+ r inspe tion purposes. 1,
Uri
INVESTIGATION FEE TOTAL FEE f ® l,
Mme, p
SEE REVERSE FOR EXPLANATORY LANGUAGE C,