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Home My Public Portal About10211 LA ROSA DR_Building__ 76A63BA CER8035-65 APPLICATION FOR BUILDING ERMIT COUNTY OF:LOS ANGELESBm DwG -2- / DEPARTMENT OF COUNTY ENGINEER ADDRESS119 BUILDING AND SAFETY DIVISION LOCALIT JOHN A. LAMBIE COUNTY ENGINEER NEAREST COLEMAN W. JENKINS SUPT DF BUILDING CROSS ST. DISTRIfLS.NO. GROUP TYPE- PRO SE Y FOR APPLICANT TO FILL IN `A7 , CONST. BUILDING Yl STATISTICAL SIFICATION SEWER MAP , ADDRESS ' U 7.... I 1 1-�R 011 �xJwS C CL ASS'NO._JLOW ELL UNITS 6K PG LOT Na. BLOCK USE ZONE MAP'�i 37� NO. f•O �� TRACT 3 - '}( SPECIAL NO. OF BL GG S. I •CONDITIONS SIZE OF LOT' NOW ON LOT USE OF Z�.S E%I STI NG BLDG. I SLOG.-SETBACK FROM UEN 1 �C NOL 93—� oaa FRONT PROP, LINE OF (STREET) OWNER �''Y /� TYPE OF EXISTING SETBACK HIGHWAY }. YARD = - TOTAL ADDRESS 107- 11 �_A •V`p'R HIGHWAY .WIDTH FROM C.L. - - BLDG. SETBACK FROM ARCHITECT OR TEL.' BIDE PROP. O -LINE OF . (STREET) ENGINEER NO. _ N'SN OF £FI SETBACK HIGHWAY } flD = TOTAL ADDRESS A/I XIGNWAY T. FROM LL CONTRACTOR 4,1 NOL l,1 Z�},�(,� - - } _ O ADDRESS I09 W GTZRy V NO •7-1LIC '1 9 CORNER CUTOFF YES � NO V CITY Tc Pl. - CHIT CILASS STRTF SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK w CIL NEW ADD ALTER REPAIR .DEMOLISH Z SQ.FT. NO. OF NO. OR SIZE STORIES FAMILIES USE OF STIRUCT U RE ..1N TRIC .1� LSi)00 TV - L1��1�,C. SIGNATURE OF APPLICANT ' VALUATIONS I SO'vv APPROVALS .DATE INSPECTOR'SSIG NATURE P.C. PMT. 4(00 FOUNDATION, LOCATION FEE FEE S FORMS, MATERIALS FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I '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 CSV 9UILDING CONSTRUCTION. t CERTIFY THAT. IN DOING THE WORK a AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT-ING TO WO RKMENS/^CCO��MPENNSSATION INSURANCE. LATH. EXT. SIGNATURE OF � n HOUSE NUMBER.COR- PERMITTEE 'r / RECT AND POSTED ADDRESS IO�T-O ��1�1.-�1� TC - FINAL - - JOHN F. LEWIS. PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK: M.D. GASH _ PERMIT VALIDATION cK. M.O CASH irfiio8 8 6 6- JAN 18 1 0 - 4.00- ro APPLICATION FOR COUNTY OF LOS-ANGELES DEPARTMENT OF-COUNTY 'ENGINEER BUILDING PERMIT BUILDING-AND SA T ION 'BUILDING FOR APPLICANT TO FILL IN ADDRESS 14 [E)ut LEI NG a. .DDRESS �/ l-1 LOCALITY TY ` 'e/vl (.�/ ZIP /(J G CROSS ST. O,pF SLOGS. ASSESSOR ZE OF LOT NOW ON LOT _ MAP BOOK PAGE PARCEL DISTRICT OUR TYP FIRE R_O SED BV TRAC 3.53 BLOCK LOT-No, E OWNERAf GSC G eNb OL ZO �� // STATISTICAL CLASSIFICATION-� SEWER P ADDRESS /(I"Z- 4 -CLASS NO.`S" OWELL,UNITS SK -'PG CITY . .e ZIP /�y US ONE NOP ARCHITECT OR TEL. SPECIAL - ENGINEER NO, - JI. CONDITIONS ADDRESS - ROAD DE PARTMENT,APPROVAL REQUIRED- YES NO TEL. CONTRACTOR NO B G.SE TRACK FROM LIC. FR NTPROP.LINEOF (STREET) ADDRESS - NO. HIG AY } YARD -_ TO AL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP. LINE HIGHWAY WIDTH CITY - -CLASS' CONSTRUCTION LENDER - NAME AND BRANCH_ _ BLOG.SETBACK FROM - ADDRESS CITY SIDE PROP. LINE OF - (STREET) CD SQ. FT. . NO. OF NO. OF CHECK HIGHWAY } YARD = TOTAL SETBACK FROM TYPE, EXISTING EC 512E _ STORIES FA MI LI ES��- ONE SIDE'PROP. LINE HIGMWAv (DTH o DESCRIPTION OF WORK NEW ❑ } CL _ - ADD ❑ CORNER CUTOFF YES ❑ NO Z LTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR❑ USE OF �� 1 ' ..._ ❑ _IN COASTAL PERMIT ZONE YES NO ❑ ' 'EXISTING BLDG. DDEMOL q APPLICANT ��{{�� /�,r // TEL (PRINT) �il'je /I„//( G�,Q / BY (SIGNATURE) HEREBY ACNN W EDGE THAT I HAVE READ THIS APPLLIICATIO AHO.STATE THAT E ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. CERTIFY THAT IN DOING THE WORK AUTHORIZED - - HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE - LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENS ION INSURANCE.- SIGNATURE OF / FINAL �L �� BY PERMITTEE / DATE lJ ADDRESS Oti LE- TEL. q CITY NO. {��q P.C. Fee$ Permit Fee / J C A Issuance Fee - -- VALUATIONS- ` Jv - — - - - '- • Total Fee PLAN CHECK VALIDATION CH. M.D. CASHPERMIT VALIDATIO CH.' M.D. CASH ,5. a�wnY 23, -1P. 1- 5.0 O.Am 76A608A-C9080313 IZ/73 O F V WORKERS' COMPENSATION DECLARATION ' hereby affirm that have a certificate of consent to ,elf APPLICATION FO BMJIL®ING APERMIT -insure, or a.certificate of Workers'Coom pe penstion Insurance, or t �/� a certfied copyihereof (Sec.'3800 Lab: C.) COUNTY OF LOS ANGEL BUILDING AND SAFETY. . Policy No. Company BUILDING .� Certified copy is hereby furnished. - •FOR APPLICANT TO FILL IN ADDRESS `�CJS ��• - f7- Certified copy'is filed with the county,t building inspec BUILDING tion department' ADDRESS - / LOCALITY C� NEAREST Date ,Applicant CITY / ZIP f CROSS ST. / - CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDCIS. ASSESSOR COMPENSATION INSURANCE ' T SIZE OF LOT NOW.ON LOT MAP BOOK. PAGE PARCEL (This section need not be completed if'�the+permit is for one ' USE ZONE . MAP TRACT. ✓ BLOCK LOT NO: NO. hundred dollars'(5100)or less ) -. - > " TEL. �J f j SPECIAL d I certify that in the performance of the work for which this OWNER NO. 3 CONDITIONS _ r - -�- O TRICT GROUP TYPE FIRE D BY. -V .permit 1s lssued,a shall riot employ any'person 1n any'manner ADDRESS .�'� C CONST. so as to become subject to the Workers'Compensation Laws. "`-'' J �}, �// \7 Date Applicant ` -, ZIP / / STATISTICAL CLATION APT CONDO. V NOTICEARCHITECT O - TEL. ` Exempt on, APPLICANT If, 'after making this Certificate of - ENGINEER NO. W CLASS NO. � DWELL. UNITS_ 1 Exemption, you-should become' subject to the' Workers'. - y 'Compensation provisions of'the Labor Code, you must forth- ADDRESS 4 SEWER MAP Z with.comply with such- provisions or Ili is permit shall be. � ) TEL — deemed revoked. - /v� - BK - PG; - VALIDATION '' '� CONTRACTOR- NO. u . LICENSED.CONTRACTORS DECLARATION, LIC. I hereby affirm that I am licensed under provisions of.Chapter 9, ADDRESS NO. VALU TI N - (commencing with Section 7100)of Division 3 of the Business and . - LIC. - yy - ' Professions Code, and my license is in full force and effect. - CITY a .CLASS ^S ` _ SO. FT. NO.OF- NO.OF CHECK ' License Number• Lic.Class SIZE O STORIES FAMILIES ONE DESCRIPTION'OF WORK 7 NEW. " ` Contractor - Date ' ❑ ❑ - ADD , I am exempt from the licensing requirements as 1 am a ' licensed architect or a registered professional engineer- - _ . ... ALTERm ❑ FINADATE acting in y professional capacity (Section 7051; REPAIR ❑ (J t i Business and Professjons Code). USE OF - _ EXISTING BLDG. - DEMOI ❑ FINAL ) - Lic.or Reg. No.^_- Date APPLICANT TEL. BY OWNER1BUILDER DECLARATION' - -(PRINT) - '- -'NO. ,. I hereby affirm that I am exempt from the Contractor's License Low forthe following reason (Section 7031.5, Business and ADDRESS Professions Cade)_. PRESENT ��'�/�� - • ' BUILDING `® 1, as owner of the property, or my employees with - ADDRESS - wages as their sole compensation,will do the work and - the structure is not intended or offered for sole v - LOCALITY - 7044, Business and Professions Code). MOVING TEL. - - I, as owner of the property, am exclusively contracting ' CONTRACTOR NO. �.e a•e a i with licensed contractors to construct the project (Sec- tion Sec tion 7044,.Business and Professions Code). ADDRESS .0 5 �.,� REQUIRED TOTAL SETBACK FROM EXIST,- r = ,CONSTRUCTION LENDING AGENCY SETBACK YARD HWY ' PROP. LINE WIDTH-- ' •-I hereby affirm that there is a construction lending,agency for FRONT. - f'e ie y54 0 0 v the performance of the work for which this permit is issued P.L. - - (Sec. 3097, Civ:C). .- - _ SIDE. ,.1_-8 1- P.L. .. Lender's Name _.. _ - _ P.C. Fee$ /�av Permit Fee e - - - m Lender's Address i - - _ .- I I certify'that I have read this applicotiomand state that the Issuance Fee 7,. above information is correct. 1 agree to comply with all County_ Invevigatlon Fee - \ i:, - _ ordinances and State IcIe elating to building construction, l � " and hereby authorize representatives of this County to enter inial Fee 4 m -up n the above-mentioned property for inspectiori p ses. - .¢ •�� '� �1 SEE REVERSE FOR EXPLANATORY LANGUAGE L _`YSi grn6�otorie of Applicant or Agent G°5 WORKERS' COMPENSATION DECLARATION . .. �: -.- '.- - -•. ��i2� �� I, liereby offirm that I have a certificate-of consent to self. .. APPLICATION R BUICDINGTERMIT insure, or o certificate of Workers'Compenslion Insurance, or a certified copy thereof (Sec, 3800, Lab. C.), _ _. . . COUNTY OF LOS'ANGELES-' - - BUILDING AND SAFETY Policy No. . Company - Certified copy is hereby furnished. BUILDING - FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy.is filed'with the county building i'nspec,. BUILDING' - tion depdrmI ADDRESS L n -LOCALITY - <" /�M J� /7e NEAREST Date Applicant - CITY �G�//' ([! r ZIP ? 70.0 CROSS ST. '-CERTIFICATE OF EXEMPTION FROM WORKERS' ^'•' !nJ/� NO. OF BLOCS, /nJ ASSESSOR _ - - ' COMPENSATION INSURANCE' - SIZE OF LOT ./� NOW ON LOT --: rT r MAP BOOK PAGE I PARCEL (This section•need not be completed if the per in for one I - USE ZONE; MAP iaO 'hundred dollars ($100) or less ) ., TRACT BLOCK LOT NO. NO. - T SPECIAL .6 certify that m the performance of the work for wh¢h this OWNER I C� eP�LT 0..7/� TW -- - CONDITIONS permit is issued I shall not employ an Q / /'• / DI TRICT GROUP TYPE FIRE SED BY V p p y y person m any manner / G C�r7 Sodsaobecome subject to the Workers'Compensation Laws. ADDRESS � -�� J� CONST�i. ? � Date Applicant -- ' CITY 2% • ZIP •v STATISTICAL CLA$SIF CATION- -- APF. ARCHITECT OR - NO, _ V ' NOTICE TO'.APPLICANT: If, after making this Certificate of W Exemption,, you should become subject to the Workers' ENGINEER ` NO. CLASS NO. DWELL. UNITS_' N Compensation provisions of the Labor Code; you must forth- ADDRESS - o- SEWER MAP t Z with comply with such provisions or this,permlt shall be deemed revoked. Z 1�2 TEL -- BK, �, VALIDATION - . - CONTRACTOR �V NO.. • LICENSED CONTRACTORS DECLARATION '= LIC. I hereby affirm that I am licensed under-provisions of Chapter 9. ADDRESSNO.- VALUATION (commencing with Section 7000)of Division 3 of the Business and - _ p& LIC. �� Professions Code,-ond my license is in full force and effect CITY ' .1'-- - • CLASS _ S _ SO. FT. NO.OF NO.OF CHECK �- License Number Lic.Class SIZE STORIES FAMILIES ONE Controctor Date , DESCRIPTION OF WORK ($ D - NEW ❑ , .. a. ADD am exempt from the licensing requirements as I am a - An ❑ licensed architect or a registered professional ertgmeer,' �7 'L - q (� ALTER ❑ FINAL- �� p/ acting in my professional capacity (Section 7051, d�L-(� (� 7 REPAIR ❑ DATE 7� U -Business and Professions Code). USE OF - DEMOL` FINAL EXISTING BLDG. -- �/l C ❑ .L�F-x+.-CJ Lic.'or'Reg: No. ' " •. Date APPLICANT ) � � ) / TEL. - BY. - - - "- ! 'OWNER-BUILDER DECLARATION - ""IPRINT)r t7/V NO, - I hereby affirm that I am exempt.from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS-- Professions Code): - PRESENT ` BUILDING IV I 1, as owner of the property, or my employees.with ADDRESS K' .wages as their solecompensation, will do the work and • - the structure is not intended or offered for sale(Section— LOCALITY. - ' 7044,Business and Professions Code). ' MOVING TEL 11, as owner of the property, am exclusively contracting' CONTRACTOR:. with l icensed-co In tractors to construct the project (Sec- z �'4 7i.7 A .. dn.o 7044, Business and Professions Code). - ADDRESS - CONSTRUCTION LENDING AGENCY REQUIRED. YARD HVJV TOTAL SETBACK FROM IST. t! ° ° ° '.• -� SET BACK PROP. LINE -WIDTH hereby affirm thatch ere is a construction lending agency for - "' - Y m 9 Y FRONTS-__ 2 . • &,Q 0 . the performance of the work for which this permit is issued P 1. (Sec. 3097,Civ. C.). - - SIDE- - P.L. Lender's Name' _ ., ._ �. �.. . . , _. - 08.3'1 '-80 Lender's Address P.0 Fee S Permit Fee ! w L certify that I havereadthis applicotion and state that the Issuance Fee °e above information is correct. I a ree to comply with all Count - _ a' 9 P y , Y,_ .., Investigotion Fee_ ordinances and State laws relating to building construction, Total Fee ' $ and hereby outhorize.representatives of this County to enter _ _ _ mupon thri'above-meJnt i.o_snJ/e'dC,p�roperty for insp cti on.purppspsesC� ' ySignatureD -SEE REVERSE FOR EXPLANATORY LANGUAGE Applicant or,Agen Date - - ®t WORKERS C6MPENSATION DECLARATION . ' _ __ F . .. . �Z i, - -• • � hereby a#firm that I have a certompie of consent to self__.,. A PP.LICi4.MON FOR BUIL DING PERMIT sure, ora certificate of Workers•Compen of c Insurance if dFr+� 'Y ` ,Y ,v, cetyl{led;copy th`er'eof (§,13800,Liab C :COUNTY OF LOS ANGELES'. o - BUILDING,AND SAFETY_ olicy No. Company 1^'.Certified copy ishereby furnished 1'; -t " 'FOR'APPLICANT'TO.FILL 11 Nr .BUILDING ADDRESS . . `Certified copy is filedwith the county building mspec- ieUILDING - '•-,�� r tion department: - -" 'ADDRESS' /� V r'L - �L'� D�� LOCALITY,-:"��/// ♦ . . I NEAREST - _ - c r � ate Appbwnt ` ` -• CITV !�/� /-� - -ZIP / CROSSST. - - CERTIFICATE OF EXEMPTION FROM WORKERS' ' NO. OFBLDGS.• - ASSESSOR t. -' 1 - %.'COMPENSATION,I NSURANCE SIZE,OF LOT .Q, ' NOW ON LOT . MAP BOOK - PAGE , . PARCEL' USE fFIE,is section'need-not be'completed if,the permit is for one , ' 1RACT BLOCK LOT NO. NCL ' . L��I. ZONE_ undyed dollars ($10iless /•+�{ T L SPECIAL - 6 o- r' " OWNER `'lIG1�0Y' CONDITIONS - cerhPy that in the performance of the work for which this_, ,�_ _ ermit is:issued I shairnot'employ any person in oriy manner' ADDRESS/&P- DDRESS ,r -��/�� y"DISTRICT- GROUP TYPE V FIRE PRO ESSFD By ,.(,L 0 oS to 6e 'ome ubject to the Work rs' om nsdI'Lows. , CON _ _ ' W $T.. ZONE Z ,/y 5d� : '-3 o APPlica t T CITV (7 (7 ZIP / STATISTICAL:CLASSIFICATION - APT. CONDO V_ ARCHITECT OR". ,. .-.TEL IOTICE-TO:APPLICANT: If, aft makingthis.Certificote of - "_ _ 'W xemption}',you should become subject fo the. Workers' ' • ' ENGINEER _ NO „ -CL /�'" D r1'r ASS NO. WELL. UNITS ompensotion provisions of the Labor Code, you must forth: ADDRESS `: •, 'SEWER.MAP Z eemed revoked- ons-,or. this. permit shall be - - . . TEL, - - I _ _ ' PY P _ .. .. CONTRACTOR ...--.— .+•. ..NO i_- ',.BK' PG; i VALIDATION . rith- cam with such.. rovlsi �LICENBED.CONTRACTORS DECLARATION TICt` hereby affirm that I am licensed under provisions of Chruc er 9 ADDRESS-, _ __ NO _ V ` ALUATION ommencing with Section 7000)of Division 3 of the Business and LIC roPessions Code;'cind rn license is in full force and effectCITY ". CLASS - • " SQ. FT. NO. OFNQOF CHECK. cense'Num Ber Lic Class SIZE STORIES FAMILIES ONE' „ DESCRIPTION OF WORK ' ,_ NEW t - .Date Ake ontract0 ` -' - , .. ] I am exempi froA the licensing regwrements.as I.am a - 'ADD licensed architectora registered professional engineer ALTER FINAL acting in my prof 'pauty essional aa (Section -7051, - REPAIR 0 •DATE Busiriess and Professions Code). _ USE OF _ - DEMOL ❑ FINAL r - - EXISTING BLDG. B c Dat or'Reg. No e APPLICANT p v TEL. Y OWNER-BUILDER-0ECLARA710N '' L "(PRINT) it NO � V hereby affirm that I am exempt fromtheContractor's License xw_for the following reason (Section 7031.5,, Business and ADDRESSr� �. rofessionsCode):. I, as owner 'of the property, or my emBUILDING ployees with ADDRESS 'wages as their sole compensation, willdo the work and. - .. the'snucture%is not,n tended or offered for sale(Section"" - LOCALITY 7044,.Business and Professions Code): MOVING' TEL j 217 Q'8 A. - CONTRACTOR - y}__ .NO ., - 'I,as owner of the.,property, am exclusively contracting" r ' #_w•,.r- with-licensed contractors to construct the project (Sec- v tion 7044',.BUsiness and Professions Code). ADDRESS r, - - ' ' - ' - '• s - - '" CONSTRUCTION LENDING AGENCY - REQUIRED TOTAL SETBACK:FROM EXIST: _ 1 2'��X5.2,0 ARD HWY •SET BACK .PROPANE WIDTH. - hereby affirm that there.is a construction lending agency for 'FRONT - - t" " - "' s � is performance'of,the work,for which-this permit is issued. R.L.' ,. - �. �:5 2�O v ' - iec•a3097,:Cv .'C.).:5. .r : .. . : .. - . . .: _ .- . . . SIDE t�,'22)—'82. P:E: .. , ender s,Name ender's Address - P.C. Fee-S. �Pe mit Fee certify that,I have read this opplicotion and state-that the Issuance Fee hove inforrincition is correct. -agreeto comply with all County __ Investigation Fee n rd poces and,Sta to laws relating,}o building construction, insp no hereby authorize representatives of this County to enter' Total Fee . _- �,.. _ pont a ve, entioned property for ection urposes - -• - ,_ - '(/L'`(� - _ gL•;. - - - SEE'REVERSE FOR.EXPLANATORY LANGUAGE -• - - - Ignotvreof,Applicont or Agent