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Home My Public Portal About10206 LA ROSA DR_Building__ ,. �Ea;o..... APPLICATION FOR BUILDING PERMIT :4 COUNTY OF LOS ANGELESnooaDElss DEPARTMENT OF COUNTY ENGINEER • BUILDING AND SAFETY DIV ON LOCALITY —18 LAM HIE,COUNTY ENGINEER NEAREST CASSATT'D.GRIFFIN,SuR•T of BUILDING CROSS ST. e. DISTRIS,W'NO." GR UP P OCESSED BY. - - � ..Q TYPE , FOR APPLICANT TO FILL IN I co NST. BUILDING rte— - ft' ADDRESS �I ` STATISTICPff-�C ASSIFICATION SEWEWE . PG' CLASS:NO. DWELL. UNITS-�• LOT NO. _ Lz BLOCK MAP STATE - YESNO TRACT /�. �� USEZONIE SPECIAL' 'HWY. , . �j0. -NO.OF BLDGS. CONDITIONS SIZE OF LOT/. .�/-X�{p� I NOW ON:LOT USEOF EXISTING XISTTI BLDG. UVB BUILDIN A UILDIN GSEXIST: YARD HWY STREET NAME SETBACK .WIDTH OWNER / FRONT rL/�.�� .MAIL P:L. � ADDRESS• y • ° p SIDE' �� .. TEL. O/dI P.L. CITY NO. i' INSPECTION RECORD ARCHITECTOR. TEL. - - - ENGINEER NO. ODRESS - PPS -- ' TEL ' CONTRACTOR NO. DDRES 3 lv5 �• -' DESCRIPTION OF WORK NEW ADD- ALTER REPAIR DEMOLISH SO:FT. -• NO.OF f NO.OF SIZE, 3LQ -. STORIES / FAMILIES ,.• - USEOF'STRUCT RE pg Z. A e . SIGNATURE OF %e--- APPROVALS APPLICANT tt,, - ADDRESS- N' I �• ATE - INSPECTOR'S SIGNATURE FOUNDATION: LOCATION 2' FORMS.MATERIALS (3/Slr v .s P,O., $ _ FRAME: FIRESTOPS... /' ;- /� I�[�-(/ FEE BRACING. BOLTS •'� /,/.5,7 VALUATION '.$ d(/ FURNACE:,LOCATION, 'f FEE. GAS VENT:DUCTS 1 HEREBY ACKNOWLEDGE THAT) HAVE READ THIS AP- - LATH. INT. PLICATION AND ST THATTHEASOVE I S CORRECT AND _ AGREE.TO C"P TH ALL COUNTY--ORDINANCES AND LATH,EXT.. ' STATE LAWS 6 TING BUILD G CO TRU CTION. SIGNATUREO : HOUSE NUMBER COR- `PERMITT RECT AND POSTED- ADDRESS 9 FINAL CLYDE N.'DIRLAM. PRINCIPALSTRUGTU RAL (NEER PLAN CHECK VALIDATION 'CK. M.O. CASH PERMIT VALIDATION cK. m. cnsx u2;3 2s� 10 1 A 6_0'0. ' a APPLICATION FOR,BUIL®ING PERMIT •_ _ COUNTY'OF-LOS ANGELES' BUILDING AND SAFETY _ WORKER'S COMPENSATION DECLARATION ` - FOR APPLICANT TO FILL IN - ' , BuiLDINc aonoR,Ess ,rc7�_ I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS x I '•- Oo'?Oli /�. or a certificate of WorkersCompensation Insurance,or a certified Zd 'io . Ir - copy.thereof(Sec.3800, Lab,C.) "�/• T C � ,�1, Le, /L ` Zp l� - LOCALITY Policy No. - Company SIZE OF LO lJ NO,OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished ' /9b X '15 - NEAREST CROSS ST ❑ Certified Copy is filed with the county building inspection TRACT. BLOCK LOT NO department USE ZONE . MAP NO. a - Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - T � SPECIAL CONDITIONS • CERTIFICATE OF EXEMPTION FROM WORKERS'. ) - COMPENSATION INSURANCE - �R MDQ p TE46 2s, Z) WITHIN 1000 FT.OF SCHOOL? YES NO (This section'need not be completed if the permit is for one hundred �L !+_ _ _ / / UD�i ^' QGS9 D� DISTRICT ' GROUP 'TYPE CONST. FIRE ZONE PROCESSED BY- dollars($100)or-less.) /y qG certify that in the performance of the work for which this permit- C'1Y �yq- /6,o is issued. I shall eot employ any person in any manner so as to _ , 1�•�o — ✓ /� become subject'to the'Workers'Compensation Laws ARCHITECT OR ENGINEER - TEL NO. STATISTICAL CL�ASS/IpKATION APT CONDO Date Applicant ADDRESS � �- - CLASS NO. c�L DWELL UNITS 1. NOTICE TO APPLICANT.' If, after mal ing this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption,' you should become Subject* to the Workers' CONTRACTOR TEL NO. - SET BACK - YARD HWY PROP LINE WIDTH ,Compensation provisions of the Labor Code, you must forthwith � FRONT ' comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO, PL _ LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS - P L I hereby affirm that I am licensed underprovisions of Chapter 9 - SEWER MAP - (commencing with Section 7000)of Division 3 of the Business and SO.FT..SIZE NO,OF STORIES NO.OF FAMILIES 'Professions Code,and my license is in full force and effect. NEW ❑ BK PG - - - d License Number Li c.Class DE IPTION OF WORK ADD ❑ ,VALUATION Contractor � Date ALTER ❑ I am.exempt under Sec. REPAIR ❑ $ — � /� 0 B&P.C. for this reason DEMOL ❑ ` U LONA PIC a W Date: USE OF EXISTING BLDG, URM ❑ LIE Signature - APPLICANT(PRINT) TEL NO. _ - _ LENA Perm♦ i tpq _ - ? �1, as owner of the property,'or my employees with wages as ` A OZ their sole compensation,-will do the*work and the structure is ADDRESS fftt _ not intended Or Offered for sale (Section 7044, Business and FINAL DATE y - Q j.],�.] ,-0, i_1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALOR GREATER THAN THE 1 EI IS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO C1 I, as owner of the property, am exclusively contracting with OR SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? 'FINAL BY ./ ' ` ` 209 25 licensed contractors to construct the project (Section 7044, - •�, - ,t \ j j A �.. m e YES❑ NO❑ r. , Business and Professions Code.) WILL - �.•1;. ;_ OCC THE INTENDED REWIRE ASE OF THE BUIDUNGONSTR BY THE MODIFICATION OR FROM T S SOUTH N 1 CHECK ,•, '7CIy ,_1 COAST AIR REWIRE A PERMIT FOR CONSTRUCTION( CAA OR MODIFICATION FROM THE SOUTH x CONSTRUCTION LENDING AGENCY GUIDE AIR Quaury MANAGEMENT DIsrRlcrtscaprnD)SEE PERmrtrlrvc cltEcxusr FOR UNES, t HAN{rI hereby affirm that there is acpnstruCtion lending agency for Yes❑ No❑ —the performance of the Work for Which this permit lS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMO PERMITTING r.3097, CIV.C.) CHECKDST.I UNpERSTAND MY REOUIREMENTB UNDER THE LOB ANGELES COUNTY.CODE +V cf�, 1 `• 1 I ' { ) n� TITLE$CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 8�0 r/L 0000—oto!,j �' Q�.��I Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMO 1 o Lender's Address 12115FM j 12 0 - gYNEP p!CEM b I certify that have read this applicationandstate under penalty o P.C.FEE PERMIT FEE R of perjury that the above information is correct.I agree to comply with all county ordinances and State laws relating to building mcOnstr and ereby authorize representatives of this County - ISSUANCE FEE to enter u Cove-mentioned property for.inspection purp444ses, ¢ � /• �� INVESTIGATION FEE TOTAL FEE mire ool�mi nom, - SEE REVERSE FOR EXPLANATORY LANGUAGE