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Home My Public Portal About10425 LA ROSA DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AYD SAFETY WORKER'S COMPENSATION DECLARATION FOILAPPLICANT TO FILL IN BUILDING ADDRESS BUILDING Ay ` �) I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof .380 , b. .) CITY ZIP LOCALITY POIICy NO. W Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT 11 9-Certified Copy IS herby furnished. J NEAREST CROSS ST. Certified Copy IS filed w-R the County building inspection TRACT n BLOCK LOT NO. t depyW8Ttm//eagqt.__QQ , / S USEZONE EMAP;N / 7 Date�qA IiCan �/� ASSESSOR MAP BOOK PAGE PARCEL PJ PP D 9 i SPECIAL CONDITIONS OWNER '• TEL.NO. / CERTIFICATEPE EXEMPTION FROM WORKERS' �'h 1 WITHIN 1000 FT.OF SCHOOL? res rvo COMPENSATION INSURANCE ADD ES (This section need not be completed if the permit i3 for One hundred L DISTRICT - GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP / y� I certify that in the performance of the work tar which this permit l^/j is issued, I Shall not employ any parson in any manner a0 as to ARCHITECT OR GIN TEL NO. O become subject 10 the Workers'Compensation Lam. 41 STATISTICAL CLASSIFICATION APT CONDO Date - Applicant ADDflES6 �/� CLASSNO.�DWELLUNITS NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, I CO RACTO T NO., P you ShOUId become Sub@C[ t0 the Workers' / SETBACK YARD HWY PROPLINEACK WIDTH Compensation provisions of the Labor Code, you must forthwith JoeV"r'3 FRONT comply with such provisions or this permit shall be deemed revoked. A DRE u0.�N,0, PL LICENSED CONTRACTORS DECLARATION a ` u�cJ.cLA�ss7 p10E CD I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000) s Division 3 of the Business and 50.FT.SIZE O. F RES NO.OF F MILIES Professions Code,and m lic ns 's in full force and effect. '_ NEW ❑ BK PG � 0 DESCRIPTION OF WOR qDD r� 7 UATION 13 License Nu�r�)bar Lic.Class 7❑' /� a y Contracto 1 Date$� � /J�� ALTER $ `D z I C 03"S ""^"'rl� ` REPAIR ❑ ❑ am exempt under be, n $ B.BP.C.for this reason %ryllXN . SG� 14,6ob�.3& DEMOL ❑ Date: USE OF.EXISTING BLDG.S �7 _URM ❑ LDMA P/C It _rA v f Signature LIC{f1T PRINT TEL.NO. LDMA Farm N E ElI, as owner of the property, or my employees with wages as C to �Nbf 53 'V o'L p .. their sole compensation, will do the work and the structure is ADDRESS✓ not intended or Offered for sale (Section 7044, Business and FINAL TE Professions Code.) 1p G '"-`LIQ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIxTURE CONTAINING A HARDOUS MATERIAL EQUAL TO OR GREATER THAN A� Ela3 owner Of the property, am exclusively contracting with UTHE AMOUNTS E IFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BV licensed contractors to construct the project.(Section 7044, YES[I NO iI al D- Business and Professions Code.) �' (AL 155 l � 68 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMITFOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR GUIDELINES`/ I hereby affirm that there is a construction lending agency for YES❑ No the performance of the work for whi h this permit is issued(Sec. 3097,CIV.C. . I HAVER TH HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTI CHECKLIST I UNDERSTAND MY REQUIREMENTS UND THE LOS ANGELES m. COUNTY OOBTITLE 2 CHAPTER 220SECTIONS 2.A.iD]THROUG Tal.,.CONCERNING HAZA MATRIALSRFPORT GANDFOROBTAINI A ON THE SCAOMD. "vQI�IJ_ilJj j 3 Lender's Name i 3 = i n Lender's Address VIDW I Art —. I certify that I have read this application and state that the above R information IS correct. I agree to comply With all County P.C.FEE �i/ �[� PERMIT FEE 3 ordinances and State laws relating to building construction,and 7 �" sL here uthorize representatives of this County to enter upon ISSUANCE FEE the ove-mention roperty for?nape on purposes. INVESTIGATION FEE TOTAL FEE/Our C sv^ �wAopwnu nl ow J SEE REVERSE FOR EXPLANATORY LANGUAGE _ WORKERS' COMPENSATION DECLARATION / • of hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT Il insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, La . C.)_ Polio :3 41,1 Company G t COUNTY OF LOS ANGELES BUI DIN D SAFETY tel—Certified copy is hereby furnished. BUILD WG U y 0 .A .FOR APPLICANT TO FILL IN ADDRESS 6L Certified copy is filed with the.county building inspec- BUILDING tion department. ADDRESS r �Z s LOCALITY Dote y " _ NEAREST , !�[ '3 Applicant CITY ZIP CROSS ST, CERTIFICATE OF EXEMPTION FRO OR S' �JNO.OF BLDGS. ASSESSOR COMPENSATION INSUR CE SIZE OF LOT / �OQ NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one / USE ZONE MAP hundred dollars ($100) or less.) - TRACT ,$ BLOCK LOT NO. I-� - NO. ` (J d TEL. / SPECIAL certify that in the performance of the work for which this OW NE / NO. CONDITIONS permit is issued, I shall not employ any person in any manner / yt//LRr�, _ DISTRICT .GROUP TYPE FIRE PROC ED B' O IJ so as to become subject to the Workers'Compensation Laws. ADDR 7215 i/i /� 'l/�j CONST. ZONE W CIT, e�,¢�1:.4 ZIP d�;H /f-3 C/ 3 0 Date Applicant - - STATISTICAL CLASSIFICATION APT. CONDO. h NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. V d/ Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS_ a Compensation,provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be Z deemed revoked. C `/GE1_5 Z7 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIG I hereby affirm that i am licensed under provisions of Chapter 9 ADDRESS N(#-c+'� '� VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS zIs SO. Ell ' NO. OF NO. OF / CHECK License Number {—�"�'c� Lia Class SIZE STORIES FAMILIES / ONE / yam/ / c NEW $ 7 4 O Contractor 11/ Oe' lrhG� Date G ��F DESCRIPTION OF WOR; ADD I am exempt under Sec. ❑ ALTER FINAL ? G€1119MG PERNUT REQUIM B.BP.C. for this reason DATE ,�'� C� —{� t P.,, P' REPAIR ❑ �rQL.Cil 1'cfic9 t7E.Jl! E:PPFEO6TEM:y�7��Zf USE :1y" Y nJt1�3 Date: EXISTING BLDG. DE OL FINAL. o�l FdefilL GRIL;;It3�; ,9P?NGk%i3: Signature APPLICANT TEL 1 OWNER-BUILDER DECLARATION PRINT tr> NO. y I hereby affirm that I am exempt from the Contractor's License e Y Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT '2 3 r 2 8 2 3 A I, as owner of the property, or my employees with i BUILDINGADDRESS /l�7 C�� # o e e e 'Z 3 wages as their sole compensation,will do the work and 7 / the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code), MOVING TEL. y'/I 2 e e 87 3 8 I, as owner of the property, am exclusively contracting .CONTRACTOR NO. / L D o 0 0 87. 3 8 cxi with licensed contractors to construct the project (Sec- ADDRESS 'tion 7044, Business and Professions Code). 0 6 15-83 CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST. , hereby affirm that there is a construction lending agency for SET BACK YARD HWY PROP. LINE WIDTH FRONT 12 8 2 4 A the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE a - 59325 m Lendeis Name $ P.C. Fee$ 3( .S s- 3 e 593256 Lender's Address Permn Fee I certifythat I have read this application and state that the Y - 06 1 5—8 3 PP a Issuance Fee 0 J-V a above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee qr 3 oZ G and hereby authorize representatives of this County to enter upon the ove-rnentior�eo4rropert for speon purposes. - SEE REVERSE FOR EXPLANATORY LANGUAGE Si ore of!f plicont rt Date ®s