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HomeMy Public PortalAbout9555 LA ROSA DR_Building__ APPLICATION FOR BLHL®INC PERMIT CO'jNTY OF LOS ANGELES BUILDING AND SAFETY, WORKER'S COMPENSATION DECLARATIO FOR APPLICANT TP FILL IN BUILDING AD BUILDING ADDRESS I form that I have a certifica consent to If in ure, C I q r Compensatlo Insuranc o ce Ifled CITY - ZIP r b C) LOCALITY I CO SIZE OF LOT NO-OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnish d NEAREST CROSS ST ❑ Certified copy Isle with th ount b ildmg Insp Io TRACT BLOCK LOT NO -- department � USE ZONE _ MAP NO , Date Appllc t ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWN COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed If the permit Is for one hundred ADD S DISTRICT GROUP TYPE CONST FIRE ZONEZPROCESSED BY j dollars($100)or less) ' CITY ZIP f1 A I certify that In the performance of the work for which this permit, P� j✓( J IS Issued, I Shall not employ any person In any manner SO as t0 _ARCHITECT OR ENGINEER_ � TEL NO -- - — - - - - " •become subject-to the Workers Compensation-Laws - " -"- '_ STATISTICAL CL SSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO 2 DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become 'subject to the Workers' CO 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 ADD SLIC No P L -_ - LICENSED ONTRACTORS DECLARATION �31 PILE CI LIC CLAS / P L I hereby affirm at I m e s u derprovislon of ha e 9 SEWER MAP (commencing w h I 0 Ivision 3 of �u e nd SO FT SIZE NO OF STORIES NO OF FAMILIES f Professions Cc c In f I forc an t NEW ❑ BK PG , d License N LIc ass DESC P F c�� ADD ❑ VALUATI N 1 S Q Contract r ALTER ❑ � Y— , ❑ I am exempt under Sec REPAIR ❑ $ O B&PC for this reason �� DEMOL ElLDMA P/C# W Date =0rEX1STf4GLDG / URM ❑' IL Signature APPLICANT(PRINT) TEL NO LDMA Perm# _ _1 z ❑ I, as owner of the property, or my employees with wages as OZ v ACCT■ their sole compensation, will do the work and the structure is ADDRESS -. not Intended or offered for sale (Section 7044, Business and " FINAL DATE / G 3303 142,°30 Professions Code) WILL HE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _ )I-{I�`� 1 ITEMS 1' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ITEMS ❑ I, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON HE HAZARDOUS MATERIALS INFORMATION GUIDE1 FINAL BY, 0 TOTS. 142.30 licensed contractors t0 construct the project Section 7044, YES❑ NO❑ Business and Professions Code) THE INTENDED USE OF THE RUITHE APPLICANT OR FUTURE BUILDING 142 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION UCTITI ON OR MODIFICATION FROM HE SOUTH lU CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ° GUIDELINES I hereby affirm that there Is a construction lending agency for YES❑ NO❑ ��{� the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATON GUIDE AND THE SCACMD PERMITTING lrfT�Hlt7G °00 ' 3097, CIV C) _ CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE ' IL ILS SECTIONS 2 20 100 TRSG HAZARDOUS Lender's Name MATERARREPORTING AND FOROBTAININGA PMT FROM HECAOMD 0000-W01 -8/15/95 IL Lender's Add r ss ONT�ER GR AGENT n-f o I certify th I have r d his apphc n and ate under penalty 1873 1 5:rt! o PC FEE PERMIT FEE of perjury at th ov Informatlo I correct agree to comply Q , N with all ty dI ces and St e laws r lat Ktobui[ding /< constr an he uth ze senta e o ISSUANCE FEEcN on t ve- t d per Insp i < INVESTIGATION FEE TOTAL FEE - D A SEE REVERSE FOR EXPLANATORYyLANGLIAGE J » TEMPLE CITY 1� µµ I 79A888A CC#803 1-6, APPLICATION FOR BUILDING PERMIT lJ COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. je DISTRICT NO G�F,Of7 TYPE BY FOR APPLICANT TO FILL IN <�� CONST. BUILDING qq y. STATISTICAL CL IFICATION S ER MAP ADDRESS L �J`/ `Lr� B P qq CLASS. NO.-14DWELL. UNITS — / LOT NO. OC..� BLOCK WATER NOT REQUIRED RECEIVED ///_ CERTIFICATE: TRACT 3 Y 2 0 MAP HIGHWAY _ NO. (CIRCLE) STATE MAJOR SECO<1 LOCAL NO.OF BLDGS. __ SIZE OF LOTS ✓yJJt� /3`v NOW ON LOT USZ ZONE SPECIAL OFUSE CONDITIONSCONDITIONS BLDG. yW�-K 1 -x-�`� C •-� j4, 1 EX ST OWNER 7/L * - UI-DING EXIST. _ fI� SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT ARCHITECT OR / EL. F. L. ENGINEER ` O SIDE ADDRESS �{ .LCA/ TEL._IItINSPECTION RECORD O CONTRACTOR �� NO. v ADDRESS ) S 5 �- 6t� \ 0 DESCRIPTION OF WORK V W d NEW ADD ALTER REPAIR DEMOLISH to SQ. FT...T. 2 NO.OF NO.OF Z J STORIES FAMILIES USE OF STRUCTUREje SIGNATURE OF APPLICANT VALUATION S j APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEE P C ©��� FEE S _'ORMS, MATERIALS S FR 4ME: FIRE STOPS, IHEREBY ACKNOWLEDGE THAT I 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 BUILDING CONSTRUCT] N. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH, INT. TION OF THE LABOR ODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S OMPENSATI N INSURANCE. LATH, EXT. SIGNATURE OF /A HOUSE NUMBER COR- PERMITTEE _ ✓"� RECT AND POSTED ADDRESS S S~ �� FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E R PLAN CHECK VALIDATION cK. M.o. CASH PERMIT VALIDATION CK. M.O. CAS"_i L) i SETS 8-44 �� - -- ' DEPARTMENT OF BUILDING AND SAFETY APPLICATION}FOR, PERMIT COUNTY OF LOS ANGELES �o1MR 1 M M. J. FOX, CHIEF ENGINEER U.-' .L D 1 N G FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING /L 1 DISTRICT`NO. PLAW-CK. NO. PERMIT NO.' ADDRESS 5 Ga 0347�— LOCALITY - RECEIVEDp 'BY DATE OF APPL. DATE ISSUED ` NEAREST T",p/> CROSS ST. ' + _ W _ BUILDING -`L l ,•}� 'OWNER - w t ADDRESS Ivr F► _ �S'� d/ , MAIL{ 8 V11a ■' 'LOCALITY �. M L 'L�' T /• > `ADDRESS /� �• CITY, �/ 'ANOv 9 1 f NEAREST /-��NJ"� /; ' 01,.� TEL. CROSS 8T. 01 A G� r FIRE NO.OF TYP GROUP .- , ARCHITECT OR 'TEL. ZONE - I SO PLANS •` - e ENGINEER - NO.�• "+- BLDG. ORD-.'NO. ' ADDRESS " '•` - ¢ - r -- .SETBACK LINE •,,.�•_.,..,/�-�,4Z, APPROVED _}_._��- - • - — - t CONTRACTOR4 NO• BY ~DATE ' USE - APPROVED ADDRESS �W°�"'"" - ZONE �" •-BY- zw= DATE - LEGAL e�/ DESCRIPTION I COT NO. f� •I BLOCK CORRECTIONS TRACT� -(] 1\•�' lVaa'1 l - 6Q NO. OF SLOGS.' SIZE~OF LOT `"�Dx ,ti1 I NOW ON LOT ` USE'OF - WO.OF _ ANO. OF EXISTING BLDG. I FAMILIES I ROOMS DESCRIPTION OF WORK = NEW ALTERATION I ADDITION 1 _ _ _ _ 1r REPAIR MOVING DEMOLISH p SQ.. FT. NO.OF, /I^ Z" SIZE ,D O -ROOMS W STORIES "+ r WALL' I ROOF COVERING' -COVERING-f"& USE-OF NEW �• _ - 'j-" _+� 1 , 'SWLDING - - % ` APPROVALS' I HEREBY,_ACKNOWLEDGE THAT I HAVE READ THIS I' -APPLICATION 4N6,,' THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, r {_ PECTOR DATE AND AGREE TD COMPLY WITH ALL COUNTY ORDINANCES FORMS;-MATERIALS ' AND"STATE LAWS•REGULATING BUILDING CONSTRUCTION. - k I, - FRAME:- FIRE 'STOPS; - `t' "F BRACING;-BOLTS SIGNATURE OF OWNER LATH, INT.: y AUTHORIZED AOT - - LATH, EXT.:t, r P. C 'PLASTER INT. FEE PLASTER,'EXT. 3 VALUATION. U r - FEE ;��, FINAL' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1105030068 PHONE (626) 285-0488 EXT (LEGAL ID I NO OF CONST BUILDING ADDRESS I ITR 13620 LT 22 1 SQ FT STORIES TYPE 95S5 LA ROSA 3 I (STRUCTURE V-B 'S TEMP CA 917803827 (ASSESSOR INFORMATION NUMBER 1 NEAREST CROSS STREET TEMPLE CITY 1 18590-014-010 1 THOMAS PAGE 597 GRID A4 LOCALITY TEMPLE CITY, Cl (TENANT 1EXIST BLDG USE RESID USE ZONE R-1 11SSUED ON PROCESSED BY 1 I (EXIST OCC GRP 105/03/11 SR 1 I 1OWNER TEL NO IBLDGS NOW ON LOT VALUATION 1F AL DATE FINAL BY CODE ISAKAIDA HENRY - 1 9,980 1 1 19555 LA ROSA DR 1 1 ,-3 1 (TEMP 917803827 I FEES PAID DESCRIFrTIOW OF WORK I I I (REPLACE ROT WOOD WINDOWS WITH RETROFIT 18 WINDOWS 1 I 1FEE DESCRIPTION QUANTITY UOM AMOUNT 1 I (APPLICANT TEL NO 1 I 1GENE CHAN (626) 786-4363- 1AA BLDG PERMIT ISSUANCE _ _ 27 80 _ 12458 NEWPORT BLVD IAB STATE GREEN BLDG FEE 9980 00 VAL 1 00 1SPEOIAL CONDITIONS I COSTA MESA 1AC STRONG MOTION RESID 9980 00 VAL 1 00 1 1 ID2 PERMIT W/O EN-HC 9980 00 VAL 217 10 I I I IFR INV WORK W/O PERMIT 257 00 DOL 257 00 I I (CONTRACTOR TEL NO 1 TOTAL FEES 503 90 (APPROVALS DATE INSPECTOR SIGNATURE 1 (GENE CHAN CONSTRUCTION (626) 786-4363- 1 1 12458 NEWPORT BLVD LIC NO 1 - 1LOCATION AND SETBACKS (COSTA MESA CA 92627 535646 B 1 1 i I I 1SOILS ENGINEER APPROVAL 1 1 1 1ARCHITECT OR ENGINEER TEL NO 1 (FOUNDATION/TRENCH FORMS I I I 1 LIC NO I 1SLAB/UNDER FLOOR I1 11 1 I I i IRAISED FLOOR FRAMING I 1 I IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP 1 IUNDFRFLOOR INSULATION I I 1144H269 3 001 1 1-1 I I 1FLOOR SHEATHING I I 1 INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 1 1 I I I NO 21 i 1ROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS 1 (SHEAR PANELS I I 1AIR QUALITY 1000 FEET MATERIALS I I I I NO NO NO 1 1FRAME INSPECTION I I I I 1 1FIRF SPRINKLER HANGERS 1 I I I I I I 1 (INSULATION/WEATHER STRIPI I 1 I 1 11NTERIOR LATH/DRYWALL I 1 1 I I I I 1 1EXTERIOR LATH I I I I I I 1 (RATED FLOOR/CEIL ASSEM I 1 1 I I I I I RATED WALL ASSEMBLIES I 1RATED SHAFTS/OPENINGS I 1 I I I 1 1T-BAR CEILINGS I 1 1 I 1 ILOT DRAINAGE 1 I 1 I I I (REPORT ID DPR261 ROUTE TO BSO508 1 I I I I I