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HomeMy Public PortalAbout9417 LA ROSA DR_Building__ :Rso�7P�.Ri,' 7a.e,e.Ce#8032/QG - APPLICATION FOIA UIL.D:INC PERMIT 1. COUNTY OF LOS ANGELES BUILDING f G/ DEPARTMENT OF COUNTY ENGINEER f' 1 1 ' BUILDING AND SAFETY DMSION ' LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST, _ DISTRICT NQ, GR TYPE PR Y FOR APPLICANT TO FILL IN ` CONST. �Y BUILDING / C / d STATISTICAL CLASS CATION S ER MAP ADDRESS A� D rJ 1 - T( � BK _ 2 CLASS.NO. TATEMAP /�DWEL .UNITS LOT NO. 3 BLOCK NUMBER U HWY. ' YES= NO TRACT /�6 ,2D USE ZONE SPECIAL +• NO.OF BLDGS. CONDITIONS - SIZE OF LOT 4,0 q �7` I NOW ON LOT USE OF - t ' 14- 1 EXISTING BLDG. BUILDING .-EXIST. TEL. r SETBACK YARD HWY - STREET NAME WIDTH OWNER LE'E E•r' ,LL�CA NO. - ��3+ FRP.ONT - ' L. ADDRESS G 4A JedS 1-9- SIDE D •- ARCHITECT OR TEL. P.L.ENGIN - 'ER No. ADDRESS 'INSPECTION RECORD) TEL. (l/6 -L— Z�2 i (� CONTRACTOR NO. ADDRESS: i ✓_'✓%d' s�17 `��`! �ry- . !)U DESCRIPTION OF WOR$ � ` ��" �' 0 NEW " ADD ALTER REPAIR DEMOLISH SO.FT. NO:OF NO.OF SIZE T�O STORIES FAMILIES - ✓ - !/-'- �/USE OF STRUCTURE L3 7 /i (v t 4 - SIGNATURE -SIGNATURE OF APPLICANT VALUATION$ 0. �Yfl APPROVALS DATE' INSPECTOR'S SIGNATURE P.C. PMT. - _ FOUNDATION: LOCATION FEE $ FEE- $ I FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THATA,HAVE READ THIS AP- FRAME: FI RE STOPS, PLICATION AND STATE THAT THE ABOVE IS CORRECT AND BRACING,BOLTS FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS - STATE LAWS REGULATING BUILDING 'CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT. `- �� J WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE � WORKMEN'S COMPENSATION LAWS OF LIFORNIA. LATH,EXT. �Q c,/ Gx SIGNATURE OF ,HOUSE NUMBER COR- PERMITTEE- f,Q RECT AND POSTEDI ��J• -�-�-yJ f L,- ADDRESS 196'.144 RP I�` FINAL CLYDE N. DIRLAM, PRINCIPAL ST C AL ENGINEER PLAN CMCK VALIDATION CK M.O. CASH t PERIM VALIDATION, CK. M.O. CASH c)3 8 '4 3 MAR 13, 1 D g.0 LI � t<I 76A638A CE#8031-67 APPLICATION FOR BUILD NG PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS. q417 La Roga Drive BUILDING AND SAFETY DIVISION LOCALITY Temple City , C a l i.f o r n i a JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST. DISTRICT O. GROUP T PE PROCESSED BY FOR APPLICANT TO FILL IN Ir O CONST. BUILDING STATISTICAL LASSIFICATION SEWER MAP ADDRESS 9417 Drive CLASS NO. DWELL UNITS. LEIK PC' �D 1 LOT NO. BLOCK U,,SE ZONE MAP Z 0 , TRACT6 Z, NOSPECIAL. SIZE OF LOT (,0 k l L+® No. 00 LOT CONDITIONS NOW ON LOT USE OF N '�Ca BLDG. SETBACK FROM T RONT PROP. LINE OR � y� dS�I.-• (STREET) OWNER M ' ch el F . Sch4bEL dt 287-95 YPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS 9417 La Rosa Drive HIGHWAY T FROM C.L. CITY. emp e City Lo"i l,0 + _zo = -2-a BLDG. SETBACK FROM T . L • Randol CoMo`- 288-4040 SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS B1 S HIGHWAY WIDTH FROM C.L. TEL. + _ CONTRACTOR NO ADDRESS Np CORNER CUTOFF YES NO C LIC CITY SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK c 4 O. NEW ADD ALTER DEMOLISH v 2 SQ.FT. NO. O NO. OF SIZE STORjES F MILIF-S USE OF '' STRUCTURE SIGNATURE OF APPLICANT VALUATION$ 599 . 4Q •00 APPROVALS DATE INSPECTOR'SSIGNATURE P.C. PMT. FOUNDATION, LOCATION FEE$ FEE$ 9 , 00 FORMS, FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 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 SUILOI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY AN ERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE F THE TATE C LIFO NIA RELAT- ING TO WORKMEN'S Co P SATIO i U NC LATH. EXT. SIGNATOR OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED If ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL ST TURAL ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATIO CK. M.0 CASH 5078—%o JUN 17 1 D 9.0 0 PLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER' G PERMIT BUILDING AND SA DIVISI BUILDING Q FOR APPLICANT TO FILL IN ADDRESS / C - BUILDING ADDRESS DiL� • LOCALITY CITY -P(. �- `. Zip �,� NEAREST CROSS ST. �v NO.OF BLOGS. ASSESSOR SIZE OF LOT I3z /� NOW ON LOT MAP BOOK PAGE PARCEL s� DISTRICT GROUP TYPE FIRE SSED BY TRACT IG. ,�` BLOCK LOT NOQQ3 CONST. / 1 OWNER �� 9 No. 2.167- c STATISTICAL CLASSIFICATION SEWER MAP ADDRESS /�. � Ra J �- CLASS NO.�D/WELL.UNITS BK PG CITY G��(�,,1�`.`r„-C1 ZIP ' O US ON NO P�d/ ARCHITECT OR '� TEL. SPECIAL ENGINEER `�{;{�` NO. 4100 CONDITIONS ADDRESS - ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ TEL. �- BLDG.SETBACK FROM CONTRACTOR Q ,y1�•� NO FRONT PROP.LINE OF (STREET) LIC: ADDRESS NO.NO• HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. - FRONT PROP. LINE HIGHWAY WIDTH CITY GLASS CONSTRUCTION LENDER (� NAME AND BRANCH ` �� BLDG.SETBACK FROM a' ADDRESS � CITY --- SIDE PROP. LINE OF (STREET) U SQ. FT. NO. OF NO. OFCHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING O SIZE �7 STORIES .I FAMILIEONE SIDE PROP. LINE HIGHWAY WIDTH U @�\' + W DESCRIPTION OF WORK L/V'nEW ❑ _ N Miw` W,.-T,4 �� _ & `_TrtVVR DD CORNER CUTOFF YES ❑ NO ❑ Z DEN wTo RWntL GJC,( LTER ❑ IN OPEN SPACE YES ❑ NO .❑ EPAIRUSE OF EMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. APPLICANT , ��©� TEL ���• +//(f,` (PRINT) NO. O i BY (SIGNATURE) ��, �� �f`C' % (/✓f<�ft;i>l7`✓'�r.- �'�`�':' i-t� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION l' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ' "i �� `-�!� �' �"•-' WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ­v/. ST RUC TION: I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE � a LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO o'• WORKMEN'S COMPENSATION INSURANCE. J� )� �,�7�//����" � /�yCyt• e: ' l 0./KA.JUY'y'- FINAL •�J �s. B Y SIGNATURE OF / s- PERMITTEE DATE _ .ADDRESS DR—.' TE L. 1 •�%. �� CITY Ct NO. P.C. Fee$ i Permit Fee Issuance Fee VALUATION$ - ® Total Feet PLAN CHECK V LIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH r 6` 3. 2.E APR• 13 1 0 1 0 9.5 0 76AG38A CE*803B 12/75 _ WORKERS' COMPENSATION DECLARATION ••r insure, or afcertificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING L0, 0, V-�� N>K- ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS l.-.�E �i�.� ❑ Certified copy is filed with the county building inspec- BUILDING 4��1 3 ,I tion department. ADDREESS'Sy� 1 � V •� CITY 1 li C ZIP 17g® LOCALITY Date Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' — SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL.np� MA �^- OWNER 1 Eo NO.LL7-39Z9 USE ZONE P , I certify that in the performance of the work for which this r NO. } p employ y p y ' D p VC- SPECIAL permit is issued, I shall not em to an person in an manner ADDRESS a0 CONDITIONS as to become subject to the orkers'Com ns ition.Law . �r�7a' U CITY �1 ZIP "l �J Date Applicant gmA t ARCHITECT OR• TEL. , 0 DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE O AP (CANT: If, after making this Certificate of - ENGINEER NO. CONST. ZONE U Exem tion, you should become subject to the Workers' �.•� M Compensation provisions of the Labor Code,.you must forth- ADDRESS �J`O 3 N with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT.` CON Z deemed revoked. CONTRACTOR Of OJ �eAA- NO. — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — ADDRESS hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP ` and Professions Code,and my license is in full force and effect. CITY CLASS BK L-- PG 1\OA VALIDATION SQ. FT, NO.. OF NO. OF CHECK License Number Lic. Class SIZE STORIES ' FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ 4�a� vt7 ADD $ V ► ❑I am'exempt under Sec. V • ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. Ke' ' IP.ACe_ DEMOL ❑ T �` {0 I_E'' Signature APPLICANT TEL.�/qr .,gam g OWNER-BUILDER DECLARATION (PRINT) NO.G07"3 GCJ FINALDATE I hereby affirm that I am exempt from the Contractor's License r.; Law for the following reason (Section 7031.5, Business and ADDRESSLA FINAL ` 1 Professions Code : PRESENT B __ Y x..;:17 I, BUILDING 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 sale(Section LOCALITY , :A, �,_ 5 7044, Business and Professions Code.) MOVING TEL. ` I 1L- urs _ j t ❑ 1, as owner of the property, am exclusive) contractingCONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS " tion 7044, Business and Professions Code.) Pil!} % �1•!(i REQUIRED TOTAL SETBACK FROM EXIST.' _ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONTTg- the performance of the work for which this permit is issued P.L. 0 (Sec. 3097, Civ. C.). SIDE V. P.L. r:', Tf 3'::. f71 ."::, ��, �+-„ -" Lender's Name, _�� i z..t \ LDMA Ref. # n,;t.� P.C. Fee$ Permit Fee--' Lender's Address Fri 0 1 certify that I have read this application and state that the t Issuance Fee to LDMA P/C# 0 8 above information is correct. I agree to comply with all County Investigation Fee °•wa Q GO R ordinances and State laws relating to building construction, TotalffF e V ' LDMA Perm. # a 9prd hereby authorize representatives of this County to enter 1 on the ove- nliong propeAy for inspectio purp ses. - P•:i _ t ­J Z SEE'REVkRSE FOR!EXPCA14ATDRY LANGUAGE Signature of Applicant or(agent- 4 Dat "'�1 5In --•� •