HomeMy Public PortalAbout9463 LA ROSA DR_Building__ ' APPLICATION FOR BUILDING PERMIT.
' COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION
FOR APPLICANT TO FILL IN BUILDING ADDRESS
EE01
ADDRESS
I hereby affirm that I have a certificate of consent to self insure, r J
or a certificate of Workers'Compensation Insurance,or a certified • ZIP
copy thereof(Sec.3800,Lab.CJ
Poll No. CompanyLOCALITY / _ CITY OT. L' y I 7
NO, BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. '��
c NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT rf BLOCK LOT NO.
department. i-a G.Q 1 11 USE ZONE MAP NO.
Date Applicant
ASSESSOR MAP BOOK PAGE PARCEL
p O SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' o ER TEL NO.
COMPENSATION INSURANCE ' • W r 8� WITHIN 10DO FT OF SCHOOL? VES No
"
ADDRESS j'�
(This section need not be completed if the permit is for one hundred `�b`3 &r Po g a D f', DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESS BY
dollarsthat 5,wor less.) CITY -/ ZIP
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO.
become,subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT NDO
Date • Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT. 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 HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL
LICENSED CONTRACTORS DECLARATION CITY V LIC.CLASS SIDE
PL
I hereby affirm that I am licensed-under provisions of Chapter 9 SEWER MAP -
(commencing with Section 7000)of Division 3 of the Business and SQ.FIT.SIZE_ NO OF STORES NO.OF FAMILIES C
Professions Code,and my license is in full force andeffect. NEW ❑ BK PG
License Number Lic.Class
DESCRIPTION F WORK ADD ❑ V/TION „fLLJ
o ca kick4Arg�om
7�J Sv(
Contractor Date ALTER ❑ z
❑ I am exempt under Sec. / ) , ,
REPAIR ❑ $
B.&P.C.for this reason 1� dwl ( j l s DEMOL ❑ LDMA P/C R
Date:' USE O ISTING BLDG. URM ❑
Signature APPLICANT(PRINT) TEL NO. LDMA Perm# s � 1
❑ I, as owner of the property, or my employees with wages as p s
their sole compensation,will do the work and the structure is ADDRESS F • v
not intended or offered for sale (Section 7044, Business and FINAL ID 1 Q -Z-7
--
Professions Code.) -0 :10/ �13 o ti
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 1
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN F J l
❑ 1, as owner of the property, am exclusively,contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY `aj ITEM
licensed contractors to construct the project (Section 7044, YES❑ NO TI:+SAL'
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTHI , CHECK 70•3�,
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST r L� �i�
FOR GUIDELINES ..LHANISE .00
I hereby affirm that there is a construction lending agency for YES❑ NOX aG
the performance of the work for which this permit is Issued(Sec. Ov
'
3097,Civ.C.. - I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD
_ PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ,
COUNTY CODE,TITLE Z CHAPTER 220 SECTIONS 220100THR000H 220.110 CONCERNING ,� < '{j(} _(I("Ifti RI��/y��'I
Lender's Name OOU MATERI R TING AND F R BTAINING A P MIT FROM THE SCAOMD vt L L 0 i f/
Lender's Address
0WIft OR AGEW o•+�s.A� 197 1 Iya 17
0 1 certify that I have read this application and state that the above
R information Is correct. I agree t0 comply with all county P.C.FEE PERMIT FEE , -
ZZG ordinances and State laws relating to building construction,and
hereby authorize representatives of this County to enter upon ISSUANCE FEE 13- 00 4
the bov mentio a roper tiQr i spectio purposes.
INVESTIGATION FEE TOTAL FEE - V
n
a Applrah«Agra DW
SEE REVERSE FOR EXPLANATORY LANGUAGE,
D98-3 25M SITS 10.46
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER L
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
G / //�) DISTRICT'N0. PLAN CK:NO: - PERMIT NO.
BUILDIN-
ADDRESB�O 6 3 N A /1 A S F� IV / �C��
LOCALITY 5,O I,�e M-p�I��" �Q' / 1./ ElCEIVED BY DATE OF APPL DATE ISSUED
NEAREST S�/1/ .5�..1 iJ /V ��� �•• L! C/�
CROSS ST.
�J BUILDING
OWNER zF.G. R O d�S - ADORE BSI'. ?-08'MAIL
l �,
ADDRESS �0 O 2 iy A R•p.SA' F� _LOCALITY
.���//� /� NEAREST
CITY / /e, G QTc./ NO. - - CROSS ST. -
FIRE NO. OFTYPE� GROUP
ARCHITECT OR J TEL ZONE' PLANS
I!
ENGINEER r1 NO.
' BLDG. - p ORD.NO.
ADDRESS - SETBACK LINE Z•00��1- / /�/
' APPROVED
L
CONTRACTOR NO. BY DATE_
USE /� APPROVED
ADDRESS ZONE/7-// 9Y DATE
LEGALCORRECTIONS
DESCRIPTION I/LOT NO. BLOCK
TRACT-
-A//2• / - -I.NO.OF BLDO9--./t-
L - _ _ - _-.. - ,_• - - _ - - _- -- - -
SIZE OF OT • //►� NOW ON LOT
USE OF �/ I NO.OF %INO.OF -
-EXISTING BLDG. FAMILIES ROOMS
DESCRIPTION OF WORK
NEW bl<ALTERATfON ADDITION
O
REPAIR MOVING DEMOLISH
13
Sq.FT. NO.OOF
SIZE RD MS / STORIES / D
r
WALL' ROOF N!0
COVERING I COVERING SAY, ,,YA le
USE OF NEW
BUILDING / R i-7T�r,. - oHIQ,,/9-�J��
J '
e •
I HEREBY ACKNOWLEDGE THAT I 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,- .
SIGNATURE OF BRACING,BOLTS
OWNER
\\@@'' -LATH,INT.'
AUTHORIZED AGT� -
LATH,EXT.:
P.C.6 PLASTER. INT:
�O
f�#...r► FEE PLASTER, EXT. -
v � _
VALUATION FEE FINAL
DEPARTMENT OF •BUILDING,AND SAFWRI' "APPLICATION- FOR PERMIT'
I NO
' COUIITY OF LOS,ANGELES, 1= 94 ;1
- WM. J. FOX, CHIEF ENGINEER• s - B U'� ®'
FOR APPLICANT TO- FILE' IN ' �` ;FOR.OFFICE USE ONLY
`BUILDING 1 ,ter ! _ DIHTRICT ,NO. PLAN rCK. NO.' PERM IT.,NO.
ld
,ADDRESS
,LOCALITY, RECEIVED BY 'O
DATEF�APP.L�-^ �� .,DATE,IHSUED ,
NEAREST .r., 'v �{V. � - �l' � `�\.. J /`*V .•�^Y�
CROSS- ST. •' '
_ BUILDING
OWNER •{/s L /�� ADDRESS-
MAIL
DDRES91►-� ;yl 0�-/"} •.�.! _ - k..
ADDRESS "l-��`R -' ,'.`iEtVW L1.:-y;pw''�' '� 1LOCALITY-.` /-.7K _1
C •��'y �'t•�w~�t_. -
NEARET
!CITY`' •�.'�!'� +�. -:. TEL: fa.CROS88 T.
NOa'
FIRE I NO.OF ' -TYPE' I GROUP
ARCHITECT OR -TEL., P' ` ZONE PLANH ,
ENGINEER - ,'N O. 4
,. - - ••� BLDG: - .4 ,ORD: NO.. -
ADDRESS j SETBACK*;LINE
APPROVED',
6• TEL.' - By. - . :�. .i DATE .
CONTRACTO Mwd, NO.
USE - - •APPRON
ADDRESS - �"•r- r^k. 7 ZONE] I BY
LEGAL r CORRECTIONS '
'.DESCRIPTION„- I LOT NO. l'/ I 13LOCKr' -
TRACT -
^_ • �•(j y + .-NO.fO_F^'BCDOS.
-SIZE OF LOT- �J j,�.(` rti• �I-,.NDW-ON LOT
USE".OF - NO.OF. NO. OF - -•*
.EXISTING BLDG. •• - -I FAMiucs I'ROOMS' ;• - - ,r e;h , -
'DESCRIPTION OF WORK
NEW-. ,
ALTERATION _ ADDITION r -1 - - - -iw G-
,REPAIR, MOVING DEMOLISH' - O
54. FT. ND:-OF �:.
SIZE- I' V .ROOMS STORIES- _ - - >
WALL ROOF
COVERING \� ,I COVERING.'
'USE OF NEW I -y _ I�/1' ." •� -
77
I 'HEREBY ACKNOWLEDGE THAT 1 HAVE `READ THIS ?-• - APPRQYAL.S ,
APPLICATION-AND STATE THAT THE^ASOVE•19 CORRECT. FOUNDATION: LOCATION, ` SPECTOR•` 'DATE '
AND AGREE'.TD COMP•LY.WITH ALL COUNTY 'ORDINANCES ,FORMS, MATERIAL13 - - -✓• r,�
+' AND STATE LAWS'REGULATING.BUILDING CONSTRUCTION.. "FRAME•:. FIRE_:STOP9.
SIGNATURE;OF - - BRACING, BOLTS
OWNER - LATH, INT::
AUTHORIZED' GT .`•'®
-LATH, EXT.•
. -•�•
P. III - PLASTER, INT.
V .FEE {, .' PLASTER; EXT. ` -
, VAL'UATION; FEES/ -'FINAL
-- ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF•PUBLIC WORKS 9071.AS,TUNOS ALTERATION/REPAIR
BUILDING-AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA _,- "•: BL 0508 9703030047
PHONE: (818) 285-0488 EXT:
LEGALID: NO. OF CONST UILDING ESS:
TR: 13620 LT: 11 SQ. FT STORIES TYPE !9463 LA ROSA DR
STRUCTURE: 0 V TEMP CA 917803840
.ASSESSOR OR T NEAREST CROSS STREET:
8590-011-011 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY
—TENANT: 1 EXIST BLDG USE: RE91D USTTNE: R--F— ISSUED ON: FKULESSED B P, ON:
EXIST OCC GRP: 03/03/97 TC 03/03/98
f
OWNER: T N0: BLDGS. NOW ON LOT: VALUATION: FI AL' DATE FINAL /CODE:
EDWARDS RICHARD L TR EDWARDS TRUST (818) 285-8455-. 1 5,000 !
9463 LA ROSA DR Gzw
TEMP 917803840 FEES PAID VESCRIPTIUN UF WORK
r
^^q q REMOVE EXISTING AND APPLY CDX PLYWOOD & 30 YR. COMP. SHINGLE
FEE DESCRIPTION: � QUA�NTI�lY:4UOM: AMOUNT:
APPLICANT: 0: o &
SAME AS OWNER AA BLDG PERMIT ISSUANCES _T 1 Q-27.75
AC STRONG MOTION RESIDS 5000'00-VAL\ ONO SPECIAL CONDITIONS:
D2 PERMIT W/O EN'HCS" 5000:00'VAL 133y 05'
wTOTAL FEES 161:30'>
CONTRACTOR:
TEL. NO: -� Q -APPROVALS DATE INSPECTOR IGNATURE
SAME AS OWNER - ?�1 0 O
LIC. NO r v� E' o - O LOCA ION SETBACKS
SOILSENGINEER APPROVAL
TRENC
C OR ER: . NO: (\(�JJ i(1{ til{
LIC. NO: : Littit SLABfUNDER FLOOR
U
RAISED FLOOR FRAMIWd
MAP 0: SEWER MAP BOOK: PAGE: FIRE E: CMF, UNDERFLOOR INSULATION
144H269 3 01 C ))
0 WELL TS: /CO : ST �/� 'FLOORNG
NO 21 v ROOF SHEATHING 2 C
SCHOOL SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS �3—1
NO NO NO FRAME INSPECTIO
REQUIRED TOTALAC ROM EXIST FIRE SPRINKLE_R_TRWff9R'9__
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULA /WEATHER STRI15
SIDE PL- r
INTERIOR LATH/DRYWALL
r r
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
' r
RATED WALL ASSEMBLIES
RATE D SHAFTS/OPENING
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508