HomeMy Public PortalAbout9234 LA ROSA DR_Building__ DEPARTMENT OF BUILDING AND SAFETY . r, APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ® � '
WM. J. FOX. CHIEF ENGINEER V
FOR APPLICANT TO.FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.NO. PERMIT NO.
ILD 9234 La Rosa. Drive �_� y
LOCALITY Temple City, Calif ornia RECEIIVVED,BY DATE OrAPPL. DATE ISSUED
"EAREBT Fratus Drive <7 -
CRDBB BT.
T�T�AT�+� HOMES-
y� � �, g
OWNER TURNER' HOMES- INC".- - ADDRESS
MAIL
ADDREBB 26-East Santa Clara St.'-• LOCALITY 7,
NEAREBT �
TEL.DO n 3563 CROBB ST.
CITY Arnadia NO. —•
FIRE NO.OF Fq TYPE GROUP
ARCHITECT OR TEL. ZONE PLANS !� �
ENGINEER NO.
BLDG.
ADDRESS SETBACK LINE e y -� � i RD��N�O�•
APPROVED
CONTRACTOR S^•••e
TEL
By DATE
USE I APPROVED
ADDRE86 ZONE BY DATE
LEGAL "�.. I CORRECTIONS
DESCRIPTION—. •LOT NO. 46 7 BLOCK /
TRACT 1647 5-
- NO.OF SLOG
SIZE OF LOT
61 X[ 112 ( NOW ON LOTS NO "
USE OF I NO.OF I NO.OF
EXISTING BLDG. NO FAMILI[® ROOMS
DESCRIPTION OF WORK
NEW X I ALTERATION ADDITION O
A
REPAIR I • ' MOVING I DEMOLISH p
SQ.FT. O.OF 1.. I Z,
SIZE ;]ROOMS 5 STORIES -• i ; - "•
WALL ROOF -
COVERING COVERING
UBE OF NCW
BUILDING Dw i
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT+ FOUNDATION+: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS / �
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. _
' ! FRAME: FIRE STOPS, /
BIGNATURE OF BRACING,BOLTS
PERMITTEV TURNER HOMES N .
LATH, INT.
AUTHORIZED AOT / LATH, EXT.
7eA&'MA-3 7-50 $ P.C.!8 '6,38 PLASTER,INT. L o�
FEE O• PLASTER.EXT.
VALUATION (/v�a , FEE * 31 , , I
i
WORKERS"COMPENSATION'DECL'ARATION
Chert~Fr�j affirm that I have,a certificate-of consent to,self' —APPLICATION FOR B U I LDING* P E RMI T
^f sure,tor a certtficdte of'Workers' Compensation Insurance,
0"'6 t�,rhfied'-copy thereof (Sec.-3800, Lab. C.) .... _ _ _
t E,.., . •, COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.• -•• •+Company_ -
ET
Certified,copy is,hereby.furni'shed: 4 FOR APPLICANT TO FILL IN ADDRESS
Certified copy is filed with the county buildi*ng`in"spec- BUILDING
❑•. 'Certifie'd
` - " ADDRESS �7 - " t
Date. ApplicanTrz :.•,. ,•! i•. CITY `ice/ f{! GJ] ZIP + LOCALITY "
�.�.; o — NO-'OF BLDGS '- - NEAREST,
CERTIFICATE OF EXEMPTION'FROM WORKERS'
+" " r-- •t�" COMPENSATION INSURANCE' �' SIZE OF LOT p��1( NOW ON LOT. /, ' CROSS ST. -
_ __ _ _ ASSESSOR. t
Jkis,secfiontmeed••notrbe•completed if.the•permit is.for,one TRACT- 1 BLOCK LOT NO+ ZZ MAP BOOK ' ; PAGE PARCEL
hund[ed•dollars($100)or less,.) , _
v TEL i p !��l
H•3 ',r'.': t',' :.:: r - OWNER GF-�6� NO' ZZ« USE N 0; bCo
I'-certify.that in the performance of the work fo'r wh'icR this• _ i d
pt_ i. .,•. t; JJJ"" SPECIAL.; - -
er'mrt is issued, Iahall not'employ any person'i'n any mariner _ •-_ _ ADDRESS- -'.�� ,f� "I O
so'as to become subject to the Workers"Ci 'e ation'Law CONDITIONS i r +,. ;
CITY ZIP,
Date' S Applicant 1 ARCHITECT OR ' TEL O
NOTICE"TO APPLICANT- If; after ritaking1'this Certificate NO f- DISTRICT„ GROUP TYPE t FIRE PROCESSED BY r
ENGINEER G
Ezeinption, ',you' should, become`subject -to the Workers' `� CONST', - f ZONE
'Compensation•prbvisions•of•tFie Labor:Code, you must forth- ADDRESS ✓� - ;� y/-•• :-.3 s- H
i
with,.comply.,with:suchprovisions*or,•this•,permit- shall be - - — TELtro '"' STATISTICAL'CLASSIFICATION APT. CO DO ? -
deemed-revoked:;, i' - r CONTRACTOR NO 3'/ Z
LICENSED CONTRACTORS DECLARATION_ • , .- - , : --•-= -
—LIC. CLASS NO —DWELL.,'UNITS '
I hereby affirm that I'am licensed under provisions of Chapter 9 ADDRESS L NO. { SEWER MAP }�
'(commencing with Se'ction•7000),of Chvisiort 3 of the Business and, _ __ _ , LIC 1
Professions Code, and my license is in'full`force and'effecT CITY •���'t3(�Ur� CLASS'::.�' BK '- ;pG' - 'i- "VALIDATION' '
n' '' /�j t ? SQ FT. _ NO OF NO OF• CHECK
�Q 7.' ?iCi Lic CIaSs JG2f/ V SIZE STORIES f FAMILIES ONE 1. t
License Number ~. F
s •, s. • . f VALUATION
DESCRIPTION OF'WORK -' ' " NEW Z9,',
7(/ Q
Contractor y ADD Els 6?0/,+'/' i
❑ I am•exempt under Sec. _ ! �i' v ALTER ❑ '� , -__ r ' ;
B BP.C. for this'reason- _ REPAIR• s'' t9 2 O~Q 4'A
Lat_ USE OF DEM6 _
EXISTING BLDG (Je _ o o e o
APPLICANT TEL FINA # 2
Signature PRINT ;, NO C �f
O NER-BUILDER DECLARATION DATC ;• 0"0,4 1 45-' '
hereby;affirm.that I am.exempt from the Contractor's License , . w ?' -
Law-for-the following"reason 7031.5, Business and ADDRESS' S. aJ a / FIN'
0 0.0,4•_1,:4 5'
Professions Code): r., PRESENT - By /. _ ' c .
❑ I, BUILDING
as owner of the property„ or my employees with ADDRESS 9'-'8
wages a`s theiF sole compensation,will do the work and 'the structure is not intended or offered for sale(Section LOCALITY
`^7044; Business-and Professions'Code). MOVING" -- ' - :-. TEL---~
❑ `I,,as owner of the property, am exclusively contracting CONTRACTOR^ - N0- ; F �'2 0 Q 5'A' :`
•'-with-licensed'contractors-to construct the project-(Sec-
ADDRESS S
tion 704; Busmess:and Professions Code). ° ° 5 9,2 5
REQUIRED_ _TOTAL SETBACK
CONSTRUCTION'LENDING'AGENCY SET BACK YARD HWY PROP LINE _ WIDTH,
Thereby affirm:that there is a construction'lending agency for FRONT,
the performcince-of the work=for which this permit is issued - - P L-
M. (Sec. 3097, Civ. C.) SIDE .0 a 0 9" 8 5" ' !
Lender's Name, �
-
J
L/I ' -� { LDMA Ref ti
• - P-C Fee$
- . ;•Lender's Address
PermitFee
>
":I'certify_.that-I have read this.application-and state that.the _._, Issuance Fee U :7 0LDMA P/C-tl - '•- i
Q' above information is correct'-I agree to comply with all County Investigation Fee
$ ordinances and State_laws'relating to,building,construction, Total Fee : LDMA Perm #
'and hereby authorize representatives of this County to enter ;
^upon the abo me honed pr perty r inspection purposes
�L J w + f SEE REVERSE FOR EXPLANATORY LANGUAGE-
(signature of'Applicant or•Agent -- - ••. . Date- -- - - -- - _ ___ _. .- +sem___ -_ .�. . - -- - ._ . . - ._ _ _. _ . ._ :�►