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Home My Public Portal About9509 LA ROSA DR_Building__ 76A638A OBS-3 1254 A=PPLICATION FOR OUIL®ING PERMIT ]: DIVISION OF BUILDING AND SAFETY - BUILDING Department of County Engineer ADDRESS County of Los Angeles LOCALITY ..Cr- WM. J. FOX, COUNTY ENGINEER. NEAREST CASSATT D.GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN DISTRIC�jT_NO. GROUP TYPE �/— S6WER MAP pG BUILDNG ADDRESS �f_i-)V q P4,�t M., h«/Pi MAP - STATE NUMBER�� HWY `Res— t(� ) LOT NO. - BLOCK USE ZONE SPECIAL - _ CONDITIONSNO. OF BLDG . - TRACT SIZE OF LOT x C 'J _ (n I- NOW ON LOTS BUILDING YARD ,HWY ' STREET NAMEEXIST. USE OF SETBACK - - 'WIDTH EXISTING BLDG.- FRONT - 'P. L. D- OWNER �� Q /Z,Lt•Gl SIDE - - MAIL �j ADDRESS `-'1 ��`7 TEL 1 DWELL. i UNIT 5 INDUSTRIAL CITY n.. 1/a NO. ,.I^1 2 DUPLEX_UNIT 6 PUBLIC BLDG. ARCHITECT OR - TEL. - ENGINEER NO. 3- 'SAPT.• UNITS 7 ADDN.,ALT., ETC. ADDRESS - 4 ,COMMERCIAL 8 MISCEL. f CONTRACTOR No. INSPECTION RECORD ADDRESS - DESCRIPTION OF WORT; � / ys NEW ADD t " REPAIR DEMOLISH - ,y SFT. OF SIZE STORIES STORIES FA� FAMILIES USE OF STRUCTURE SIGNATURE OF _/ APPLICANTv` l /u^+-tea •py - APPROVALS /'�� ADDRESS `- 115/+Y/' )� _X7 % DATE INSPECTOR'S SIGNATURE FOUNDATIONf LOCATION P. C. S FORMS, MATERIALS FEE FRAME- FIRE STOPS. VALUATION JC G $ a 00 BRACING, BOLTS — FEE FURNACE: LOCATION, GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE, THAT I HAVE READ THIS - APPLICATION AND STATE THAT THE ABOVE IS CORRECT - - AND AGREE .TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT.. AND STATE LAWS REGULATING BUILDING CONSTRUC- :• TION. - ' LATH, EXT. • Cn 'I'3��5 SIGNATURE OF HOUSE'NUMBER COR-- PERM-ITT OR-`PERMITTEERECT AND POSTED - `ADDRESS FINAL WM., J.- FOX. COUNTY ENGINEER VALIDATION BY Y:o s: _n 2"7 2.0 o . t- _DEPUTY / DEPUTY BY - - BY • , ® DEPUTY DEPUTY i TS S-4S ENT OF BUILDING AND SAFEAPPLICATION.FOR PERMIT COUNTY OF LOS ANGELES (Y� 1` 4� ' ® � 1 WM'. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL "IN ' . r FOR OFFICE .USE ONLY BUILDING I �e1 DISTRICT. NO. PLAN CK. NO'.` PERMITNO. ' ADDRESS a / 6- ate'"�_y_ mac. G o 1 6 3 4 3+ 1 T ' / 7 414w LOCALITY RECEIVED BY DATE OF APPL: - D E IHS ED NEAREST CROSS.ST. } BUILDING Q OWNER ADDRESS /V� I�1� Ib�s 19 1 ' ADDRESS L•OCALITY �� Ce�jIT CITY NEAREST S U ry S rz-r IJ Ly P' �'�; TEL. ��.�� CROSS ST. ^vFFFFO000 IVO FIRE NO.OF TYPE- GROUP ARCHITECT.OR _ - TEL. ZONE I--PLANS I :z ENGINEER NO. _ •s• BLDG. ORD. NO. ADDRESS. ^'^"�'® .SETBACK LINE APPROVED y /J TEL. ' _BY DATE CONTRACTONO. USE `/ APPROVED ADDRESS - res ZONE BY DATE 'LEGAL CORRECTIONS DESCRIPTION I L13T^N/O. I BLOCK ' TRACT - �a P� NO. OF SLOGS. SIZE OF LOT �f$ Y- / I NOW ON LOT [� USE OF _ - NO.OF NO. OF , EXISTING BLDG. I FAMILIES 'I ROOMS - DESCRIPTION OF WORK NEW ALTERATION ADDITION 1 O REPAIR MOVING DEMOLISH' - - D_ Sq. FT-• ` NO.OFRIES Z r SIZE 1 � O ROOMS 9T s ' n -WALL �nn/�yds I ROOF COVERING `t'� - COVERING .USE OF NEW --J 'BUILDING - ff APPROVALS I HEREBY ACKNOWLEDGE•THAT' I' HAVE READ-THIS ' 'APPLICATION AND,STATE THAT THE ABOVE IS CORRECT FOUNDATION:-LOCATION, SPECTOR DATE AND AGREE TO COMPLY WITH ALL 'COUNTY ORDINANCES. FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONBTRU_CTION. FRAME: FIRE STOPS, Yom' SIGNATURE OF _ BRACING, BOLTS OWNER - /1 LATH, INT.: AUTHORIZED AGT - LATH, EXT.: r PLASTER, INT. - P FEE 3, PLASTER,',EXT. .VALUATION V. � FINAL FEE i WPARTMENT OF BUIL3ING AND SAFETY. APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX, CHIEF* EN GINEER ® IG v O FILL IN FOR OFFICE USE ONLY FOR APPLICANT T D19TRICT NO. PLAN CK.NO. PERMIT NO. BUILDING ADDRESS +� t�\�� Ur rL.OAl �. LOCALITY /� tit` RECEIVED BY, DATE OF APPL. DATE ISSUED NEARECROSS ST.T. L QP1—Q11.JLJ..! V /9•�_ �_7"� BUILDING OWNER }� r, / ADDRESS MAIL ,,p` LOCALITY rADDRESS NEAREST �� f A �i TEL r e CR033 8T. �/ LO'G CITY w�n e l NO. -- FIRE NO.OF TYPE GROUP17,J _ ARCHITECT OR TEL. ZONE PLANE �. � ;` ENGINEER ��..-„�n I1 NO. BLDG. ORD.NO. ADDRESS SETBACK LINE - q APPROVED ' TEL. BY DATE CONTRACTOR ( 11 ...1! /L NO. USE 'APPROVED ADDRESS ZONE/ BY DATE LEGAL CORRECTIONS DESCRIPTION LOT NO. �� I BLOCK G7� TRACTNO.OF/ Z�('7 •^ SIZE OF LOT "ri� I �( �.`].��e I I NOW ON LOT B� USE OF V NO.OF NO.OFt" EXISTING BLDG. .L:1.,,.._.Q I F&4101C I RO® { DESCRIPTION OF*WORK NEW ALTERATION ADDITION r - O A REPAIR MOVING DEMOLISH p Sq.FT. //?a//�� NO.OF II Z SIZE �`I7r f 1J ROOMS 1 STORIESAL ROOPr COVERING._AJ.d�..C�®t I COVERING S"fib. USE OF NEW BUILDING �TM_t.t'.O !� /✓VY' ;ifa•::z. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION SPEC OR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OFI � BRACING,BOLTS r. E PERMITTE ` �� LATH,INT.: AUTHORIZED AOT LATH,EXT.: OBS-3 SOM SETS 7-47 $ IVO P.C.# PLASTER,INT. ' FEE PLASTER,EXT. f� �/ �,, �( FEE VALUATION 9 FINAL -. - �a �"v""(/ - WORKERS' COMPENSATION DECLARATION I hereby affirm that,I have a certificate of consent to self insure, or a certificate of Workers'Compenstion Insurance, or APPLICATION-' FOR, B U:I:L D I N G P E:RM I T a certified copy thereof (Sec.,3800, Lab. C.) ' !+ , COUNTY OF LOS ANGELES r q:18WLDING AND SAFETY Policy No. Company 1 ❑ Certified co is hereb furnished -BUILDINGS ` py. y FOR APPLICANT TO FILL IN ADDRESS"' Certified copy is filed with'the county building inspec- BUILDING r tion department. ADDRESS ��o 9509" ,E. LaRosa LOCALITY ?' NEAREST t Date Applicant, CITY, Tem le 'Cit ZIP CROSS ST:. CERTIFICATE OF EXEMPTION FROM WORKERS'- O. OF BLDGS. ASSESSOR? - COMPENSATION INSURANCE SIZE OF Lo158.5OX127•3OW ON LOT., 2 MAP BOOK. PAGE PARCEL (This section need,not be completed if the permit is for one ! USE ZONE T"" MAP `� t TRACT :� BLOCK. LOT NO. -!` No ' ! (A hundred dollars ($100)or less.) l } TEL SPECIAL = a z OWNERC) & -Kath . W1lSOn N6286-4006 CONDITIONS O I certify 'that in the performance of the�work for which this - DISTRICT.; "GROUP TYPE FIRE PROCESSED BY permit is is ued„I'shall not employ y person in any manner ADDRESS A Ve U so as:to"b c subject to the'W rke s'Compensation Laws. y CON ZONE � 9 / �� 1 V�f-+� i. CITY ZIP } Date Applicant STATISTICAL;CLASSIFICATION APT CONDO V NOTICE TO,-APPLICANT: If, 'after making this Certificate of ARCHITECT O TEL ;_ W Exemptton, you' should become subject' to the Workers' ENGINEER -.�•. C• . Keehn. NO CLASS NO: DWELL. UNITS C Compensation provisions of the Labor,Code, you must:forth- ADDRESS SEWER,•MAP _ with comply. with such provisions or this;permit shall be , f deemed revoked - - CONTRACTORPat •Mtl�rra• TEL VALIDATION 443-1579 BK`•F— PG, �� {• LICENSED.CONTRACTORS DECLARATION L1C I hereby affirm that I am licensed under provisions of Chapter 9' 3606 Rio Hondo Rsmd' No305.609 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 Rosemead 'CA CLASS B $; �O SQ FT NO OF NO OF CHECK License N r �d Lic ClassC �! SIZE rj 4O • STORIES l FAMILIES �- ONE NEW- IJ j1r/ [ DESCRIPTION OF WORKFam1l ROOM! ❑ $ ` Contractor Date ❑ Bath-room, `Utili•t & ADD' I am exempt from the licensing requirements as I am S licensed architect or a registered-professional'engineer �3.” • •.> ALTER ,❑ FINAL; acting in my professional capacity_(Section 7051, S K1'tChen'':`-RemOC�el, REPAIR ❑ DATE'.��"� Business and Professions Code) t USE OF� ! EXISTING BLDGReSldenp,e- DEMOL ❑ FINAL NAL Lic.or Reg No. - DaTe $ `APPLICANT �i -5„TEL $ Y Ute( •� -, ~�;i' OWNER-BUILDER DECLARATION (PRINT) t r. • `j .. _, . `No443-1579_ I hereby affirm that I am exempt fro m'the'Contractor's Licensef T 6,6 A „ Law for the following reason (Section 7031.5, Business and ADDRESS 36.06,.-Rio.-,Rondo.,; Rosemead y' Professions Code): PRESEN r `' t #•o e_•o o'o ,: r f' ' ❑ BUILDING .•:. `I, as owner of The property, or my employees with j ADDRESS wages as their sole compensation, will do the work'and ,);.. 4' % 2•o 2.0 5 0,0 the structure is notlintended or offered for sale(Section LOCALITY }, ° ,, ' 7044, Business and Professwns'Code). MOVING - TEL %- f '. 0'0'2 0S 0 0-' ❑ I, as owner of the:property, am exclusively contracting CONTRACTOR" ' NO with licensed contractors to construct the project (Sec- "i' 0 9 1 5'-8 tion.7,044, Business and Professions Code). ADDRESS !' REQUIRED Y TOTAL SETBACK FROM EXIST fir« ti s CONSTRUCTION LENDING AGENCY, SET BACK,' YARD HWY PROP LINE WIDTH' C I hereby affirm that there is a construction lending agency for 'FRONT - r the performance of the work for which this permit is issued P L (Sec 3097, Civ C.) SIDE - Lender's Name P L m •• - r. `� - + P C Fee$ - Permit Fee Lender's Address _ �o 4 w I certify that:! have read this application and state•that the Issuance Fee anformation is correct I agree to comply with all County I Inveshgahan Fee = ord to es and Slate jaws relating to building construction, J t6l Fee' 05 nd her by duthorrze representatives of this County to enter - ' on th abov - boned property for mspectio pure ses. � '•� a SEE REVERSE FOR EXPLANATORY LANGUAGE o ` Signature of AppLc ,Date