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Home My Public Portal About10217 LA ROSA DR_Building__ APPLICATION FOR BUILDING PERMIT FGRJvFr-LICANT TO FILL IN (Prior or rroB onlYl p COUNTY OF LOS ANGELES ADDRESS /C;2 / ) � gO.Sf>• U DEPARTMENT OF COUNTY ENGINEER CITY tMfa!,'/I :Gll ZIP 471 Z.9": BUILDING AND �SAFETY DIVISI�ON SIZE OF LOT 7D(( �/E/ NOWOON LOTF B S f.- ADDRESS BUILDING `O G•�' C M-J .yy �/T• TRACT BLOCK LOT NO. LOCALITY / arl - '/ ,l TEL./��{�'1 NEARESTIF OWNER W (j /Qom/ NO. ie'4 .� Hz CROSS ST. '- L - "� { �j p ASSESSOR ADDRESS ��I/ 1 X14 )P--44R&O MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE CESSEDBY CITY /�. ZIP O CONST., ZONE - APC' ITEC; OR � ) TEL. >n�r• �.+ ENGINEER S -STATISTICAL CLAS (FICA TION ' �i /S3 SEWER MAP ADDRESS n AN.N . . CLA55 NO: " DWELL.UNITS CONTRACTOR ,$ (+ NOL USE ZO E MAP /l o/ i\ OO[[ NO. C� C/ ADDRESS NO. TO 3 SPECIAL LIC. 2«- CONDITIONS CITY CLA55 G - ROAD DEPARTMENT'APPROVAL REQUIRED YES[] NO❑ CONSTRUCTION LENDER NAME AND BRANCH FRONT R SETBACK FROM �. FRONT PROP.LINE OF (STREET) � ADDRESS TY 6( _ TOTAL SETBACK FROM TYPE OF EXISTING U SO. FT NO. OF . OF CHECK HIGHWAY } YARD - HIGHWAY WIDTH FONSETBACK T�PRO , LINE - LC SIZE STORIES FAMILIES ONE h l - O DESCRIPTION OF WORK NEW ❑ } _W �" W y ADD B LOG.SETBACK FROM' F SIDE PROP. LINE OF (STREET) Z ALTER ❑ HIGHWAY } YARD - TOTAL SETBACK.FROM TYPE OF EXISTING REPAIR❑ RICE PROP.-LINE HIGHWAY WIDTH USE OF DEMOL ❑ + EXISTING BLDG. APPLICANT TEL,2,5"7 CORNER CUTOFF YES ❑ NO .❑ IPRNTI , 'f� j y BY (SIGNATURE) IN OPEN SPACE" YES ❑ NO ❑ COASTAL ZONE YES ❑ NO ❑ VALUATION$ �L��D -� CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNO LEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL - AND STATE THAT THE ABOVE ISnCORRECT AND AGREE'TO COMPLY - IMPACT EXEMPTION DECLARATION SIGNED - (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION 0,LABOR THE n W PKM E NOS EOF THE STATE OF COMPENSATION INSURANCECALIFORNIA IN RELATING TO SIGNATU RE OF /T�j 1 PERMITTEE ADDREBS- O / A FINAL BY CITY j5'Y4EAI {'✓Q/fA{� NOLO " DATE Yom/ tL1KE CII_CKS PAYABLE 7"0: FEE§ FEE HARVEY T. 6RANDT. COUNTY ENGINEER •� � PLAN CHECK VALIDATION cK. M.D. CASH _ PERMIT VALIDATION M.o, CASH 362373 OCT1623 D cK.3735s n 364 ?;3. OCT 17 1 D 6225° W 75A03BA CE9003 12/]2 ' WORKERS'COMPENSATION DECLARATION - - . I'Fi>ireb a°lire that I have a certificate of consent to self ' e insure oracer`tlficoteof:Workeri Compensation InAPPLICATION FOR BIJILDLNG :PERMIT � or a certified copy there f (S c. 3800; tab..C.) COUNTY OF LOS ANGELES BUILDING.AND SAFETY' " PalicyN � - ompony 1:VTA74r'FdH2O Cerirfied'copy is hereby furnished. - FOR APPLICANT TO FILL IN BUILDING / E r S� ADDRESS ga�ertified'iopy is filed with the'co n'y building inspec- BUILDING �1 tion�d6odiltmmeent ' ' .` n/' ADDRE-SS��D�� //C Date / / 0 /I Applican 7 r..�' /`^'s•(/ CITY /G' (-,/7- ZIP LOCALITY - NO. Of �q1 CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT D�'r� eZ• NOW ONLDGS LOT 4 - CROSS NEAREST COMPENSATION INSURANCE r ! - t (This section need not be completed if the permit•is r'one - -- - - ._ - ASSESSOR --- hundred dollars($100)or less.) TRACT BLOCK - LOT NO.' MAP BOOK - PAGE PARCEL' E�r TEL. i/i/�•?� USE Z NE MAP -. I.certify that.in the performance of the war or which this OWNER NO.77 NO. permit is issued, I shall not employ any per n i'ri'any manner -' �^ q / / SPECIAL , so as to become subject to the Workers' ompenscition Laws. ADDRESS d,2 C.- 49 lee-5W- . - '' CONDITIONS .0 Date - r Applicant CITY-. .� _ZIP - - 0 NOTICE TO APPLICANT: If, er mfiking this Certificate of ARCHITECT OR = e, Q AA TEL. DISTRICAGuP E FIRE 7ROCESSED BV O Exemption, ,you should coma subject ro the' Workeri ENGINEER c 8 V ^ NO. STRlC{ NST. `FIRE Compenso'i8n provislo of the Labor.Code, you must forth-: gDDRESs dam/ �D� /p�✓ J `� J W with comply with ch provisions or It sholl be - - . , ' D.' deemed revoke TEL STATISTICAL CLASSIFICATION APT. CO DO. . N CONTRACTOR �Q^ D NO.Y - caL ,s Z LI SED CONTRACTORS DECLARATION- LIC,. / CLASS NO. L—DWELL. UNITS_ hereby em'ho'I am licensed under provisions of Chapter 9 ADDRESS /�. T NO. (corny+ ncing with5ection 7000)of Division 3 of the Business and LIC O SEWER MAP , Pr essions Code, and my license is in full force and effect. CITY,/!0 D L- CLA55 O BK —PG. VALIDATION �Q 50. F,T9 N OF NO.-0F CHECK License Number Qs`r� Lic.Class •-^ SIZE d STORIES FAMILIES ONE J1 VALVA 10 OO 9 _a-Y� DESCRIPTION OF WORK C/.�� - NEW. Contrac/r)11 Dole ADD ❑ $ I am exempt under Sec. - D .L— GAG d I//� ❑ Poo - 7 ALTER B,BP.C. for this reason— REPAIR ❑ $ -Data: '/ USE OF EXISTING BLD )j 6Z6 �7VJr DEMO ❑ Signature -. ' `,/)� FINAL OWNER-BUILDER DEC ATION APPLPNN7 p ' jf/"" YY� DATE 0; < I hereby affirm that I am exempt _. the Contractors License • ' Law for the following reaso action 7031.5, Business and 'ADDRESS �� o�qo�. FIN - Professions Code): B / , - $7 8 2 8 A BUILDING 1, as owner,. a property, or my employees with ADDRESS - _ _ '# e'e • • e(� wages as•t6 sole compensation,will do the work and - - - _ '(,e,e 7 a.�0 . the strut a is not intended or offered for sale(Section LOCALITY 7044; siness and Professions Code). MOVING '^ TEL. ® u-- -'e • • 7 a 60 U' I, owner of theproperty, am exclusive) contracting CONTRACTOR NO. Y g .� ' '09.02-8'7. in licensed Business and Pro construct the project (Sec- - ADDRESS tion 7044, Business and Professions Coda). - - // . REQUIRED TOTAL SETBA K _ CONSTRUCTION LENDING AGENC.Y�' SET BACK YARD, MWY PROP. LINE WIDTH - - - - hereby affirm that there is aconstructi a,lending agency for - FRONT he performance of the work fo Ich this permit is issued -PA. (Sec. 3097, Civ. C.). SIDE P.L. . . Lender's Nome LDMA Ref. # m LeydeKs Address P.C. Fee$' - Permit Fee 1 o that I.have read this application and state that the Y PP - Issuance Fee LDMA P/C# I certify , above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relo'ing to building construction, and hereby authorize represe ta'ives of this county to enter ioiaf Fm MDMA Perm. # uponabove-mentione aper y for inspection purposes. .. -��p ro SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applican r Agent - - Data - •- - - - r .. APPLICATION .FOR- BUILDING PERMIT COUNTYOFLOS ANGELES BUILDING AND SAFETY. WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS _ 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 - copy thereof (Sec.3800, C.) - LOCALITY Policy No. Company SIZE OF LOT NO:OF BLDGS'NOW ON LOT ❑ Certified copy is hereby furnished, 3 !T� NEAREST CROSS 57 '❑,Certified copy is filed with,the county building inspection + TRACT BLOCK •� LOT NO. departmannt. ' - USE ZONE MAP NO. Date-.F-./ 3 Applicant �/S �, s i. ASSESSOR MAP BOOK PAGE PARCEL n • ' —� .��y ,q' / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' - OIANER TEL No. - - VES NO COMPENSATION INSURANCE y� --? .�� WITHIN 1000"T.OF SCHOOL? (This section need not be completed if the permit is for one,hundred ADDRESS ' ' '/ C - DISTRICT GROUP TVP ONST. FIRE ZONE PROCESBED'BY dollars ($100)or less.) - AL zel ' CIT 'ZIP I certify that in the performance of the work for which this permit Q . �.� e F yv �' is issued, I shall not employ any:person in any manner so as to O �l ' ' TEL NO.,' become subject to the Workers' ARCHITEORENGINEER -Compensation 12V5. - .STATISTICAL CLA SIFICATION APT CONDO" Dale Applicant ADDRESS'' - CLASS NO. DWELL UNITS NOTICE TO APPLIC4NL' If, after making this Certificate of REQUIRED _TOTAL SETBACK FROM.'. EXIST Exemption, you should become subject to the Workers' CONTRACTOR >' TEL NO. - SET BACK YARD HWV - PROP LINE WIDTH' - Compensation provisions of the Labor Code, you must forthwith — GL G. Z FRONT - comply with suchprovisionsor this permit shall be deemed revoked. ADDRESS, LIC:NO. P L LICENSED CONTRACTORS DECLARATION S' ? PL -PILE UC'. CfT - . CIE S , I hereby affirm that Lam licensed underprovisions of Chapter'9 G i •� SEWER MAP. ' (commencing with Section 7000)of Division 3 of the Business.and SOFT.SIZE NO.OF STORIES NO.OFFAMNES Professions Code,/and my license is In full force and effect - - NEW BK ` PG , d License NUmb [.J a y LiG Class - DESCRIPTION OF VrORK v ADD ❑ VALUATION 6�' Q Contractor Date ',Z?= i - _ ALTER ❑ $ r. X ❑_ I am exempt under Sec FLC -REPAIR ❑ $ + .` 0 B.BP.C.for this reason C 'P 1 EMOL ❑. LELIA P/C Date: USE OFISTING BLDG. - URM ❑ ' CO Signature APPLICANT( IN 1 _ -- - .r - TEL NO. LDMA Perm.0 1 _ Z El 1, as owner of the property,or my employees with wages as `' " Z0 , ''(`•- + ' their sole compensation, will do the work and,the structure is ADDRESS - �iL"I 'v not intended or offered for sale (Section 7044, Business and FINAL DATE,/ .:_`1l Professions Code.) WL APPLICANT OR FUTUflEBUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL `� ❑ I, as Owner of the property, am exclusive contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY litI I ` p pe y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed,contractors to construct the project (Section 7044, Business and Professions Code:) YES❑ No❑ I I ITA , 165 - 60 _ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �) ` l OCCUPANT REQUIRE REQUIRE n PERMIT FOR CONSTRUCTION OR EE PERMITTING FROM THE SOUTH HECK 1`S FqI ' CONSTRUCTION LENDING AGENCY GOIDELNAIR EBOUAUTY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR K ' �� i I hereby affirm that there is.a construction lending agency for .,YES❑ No❑ ^^^///��V V h-HANIOE, •G �I the performance of the work for which this permit is issued(Sec. - - - m WAVE READ I HE UNDERSTAND MY REQUIREMENTS TS ATON UNDER THE COUNTMD Y ITTING 3097.CIV.C.) - CHECKLIST 2.CH UNDERSTAND T RS 2 20 100 TH UNDER THE LOe ANGELES COUNTY CODE. _ ff�� _ ^' TITLE 2 CHAPTER 220 AND➢O R OBTAINING THROUGH FROM HECONCERNING HAZARDOUS UUUO-V0U�. S/1:1 • Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. .. ✓_ ��' 'o Lender's Address - - 13 94 o o.FE Orr ACLN o I,certify that I have read this application and state Under penalty 0 of,perjury that the above)information is correct.I agree to comply PC.FEE - PERMIT FEE w with all county ordinances and State laws relating to building m construction, and hereby authorize representatives Of this County _ ISSUANCE FEE / ,/D - to ent!, the abov mention d property for inspection purposes.-J IO• (� - m INVESTIGATION FEE - TOTAL FEE Mol¢ani p e C� SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY W 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0903050032 PHONE: (626) 285-0488 EXT: ILEGAL ID: N0. OF CONST I BUILDING ADDRESS: ITR: 13531 LT: 3 SQ. FT STORIES TYPE 1 10217 LA ROSA DR I (STRUCTURE: V-B TEMP CA 917803307 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN 1 18585-006-003 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, C TENANT: IEXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EX IST OCC GRP: 103/05/09 SR (OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: (FINAL T FLN L B CODE: (MORTON, WEBSTER (626) 443-2528- 10,000 110217 LA ROSA DR I ITEMP 917803307 FEES PAID JAR!3CRIP`IIOR OF WORK IIBATHROOM REMODEL REPLACE FIBERGLASS TUB WITH TILE SHOWER I IFEE DESCRIPTION: QUANTITY:'DOM.: AMOUNT: ( 1APPLICANT: TEL. N0: • SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.75 I IAB STATE GREEN BLDG FEE 10000.00 VAL 1.00 (SPECIAL CONDITIONS: IAC STRONG MOTION RESID 10000.00 VAL 1.00 182 PERMIT W/ENERGY 10000.00 VAL 238.26 TOTAL FEES 268.01 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO ILOCATION AND SETBACKS SOILS ENGINEER APPROVAL IIARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS LIC. NO: (SLAB/UNDER FLOOR (RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( IUNDERFLOOR INSULATION 1147H273 3 001 1 I I IFLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 I IROOF SHEATHING SCHOOL WITHIN HAZARDOUS I (SHEAR PANELS (AIR QUALITY: - 1000 FEET MATERIALS NO NO NO I IFRAI:.E INSPECTION (REQUIRED TOTAL SETBACK FROM EXIST IFIRE SPRINKLER HANGERS ISET BACK YARD: HWY: PROP LINE: WIDTH: IFRONT PL- (INSULATION/WEATHER STRIP( I SIDE PL- 11NTERIOR LATH/DRYWALL 1 W1 IE%TEA IO LAT RATED FLOOR/CELL ASSEM. RATED WALL ASSEMBLIES I I (RATED SHAFTS/OPENINGS I I I IT-BAR CEILINGS LOT DRAINAGE IREPORT ID: DPR261 ROUTE TO: BS0508 I I , ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEW RESIDENTIAL BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 - BL 0508 0004280003 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 13531 LT: 3 SQ. FT STORIES TYPE OCCUP GROUP 10217 LA ROSA DR STRUCTURE: 192 1 VN U1 TEMP CA 917803307 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: BALDWIN 8585-006-003 OTHER: THOMAS PAGE: 597 GRID: 34 LOCALITY: TEMPLE CITY, L TENANT: USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: 04/28/00 VG 10/25/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: MORTON WEBSTER G;EDITH R (626) 443-2528- 4,000 / .C/ �� S'=0 rL 10217 LA ROSA DR TEMP 917803307 FEES PAID DESCRIPTION OF WORK STORAGE SHED - 12%16 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 4000.00 VAL 0.50 SPECIAL CONDITIONS: AX BUILDING-REVIEW-FEE-� 54.70 D2 PERM I TiWYO'EN-HCE LE S 4000T00 VAL 115.80 P.�`� TOTALLFEES 198.75 CONTRACTOR: TEL. NO: /OS APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS / / SOILS ENGINEER APPROVAL / IJ ARCHITECT OR ENGINEER: TEL. NO: // FOUNDATION/TRENCH FORMS v LIC. NO // 1111111 SLAB/UNDER-FLOOR / LLL RAISED LOOK F AMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP._: � UNDERFLOOR INSULATION XX XX %% 301:Iu � L = O )K 3 ST LEVEL FLOOR SHEATH— NO. H A HNO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 12YY� i B .r� NO LEVEL FLOOR SHEATH SCH00 WITHIN A ARDOUS `\ (��j rf� I(�'r(�, ROOF SHA HING AIR QUALITY: 1000 FEET MATERIALS \ O U ' . NO NO NO A ® rT'®5 FIRE DEPT. FRAME INSPECT REQUIRED TOTAL T FROMBLDG DEPT. SET BACK YARD: HWY: PROPLINE: WIDTH:FROG6'/C servi That�e`� SHEAR PANELS RAME INSPECT SIDE PL- INSULATIO / EA HER STRIP INTERIOR LATH DRY EXTERIOR LATH -,io" LOT DRAINAGE SMOKE DETECTION DEVICTSF FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 <