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HomeMy Public PortalAbout9558 LA ROSA DR_Building__ APPLICATION FOR*4ILDIN-G-P ERMIT COUNTY OF LOS'ANGELES , tT BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION - , FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, B�LD_NG ADpftES �� A• " ;a �f �3 �C. or a certificate of Workers Compensation Insurance,or a certified _LTJ !�7 �Z copy thCA- ereof•s - 00,Lab C) 1 LOCALITY - y (e Policy No L Company i " #t SIZE OF LC NO OF BLDGS NOW ON LOT } ❑ Certified copy Is hereby furnished NEAREST CROSS ST �.� Certified copy IS filed with the county building Inspection TRACT BLOCK LOT NO department \ USE ZONE MAP NO Date Applicant �+ F� ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ow TEL NO i q COMPENSATION INSURANCE V G 22 S -2•1DZ 1 WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit'is for one hundred ADDRESS (� dollars ($100)or less) 1� �a LJr� Q DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY w- p- ZDV I certify that in the performance of the work for which this permit yZ ��p ? is Issued, I shall not employ any person In any manner so as to CJS J become subject to the Workers'Compensation Laws ARCHITECT OR ENGINEER TEL NO } 'STATISTICAL CLiASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO I DWELL UNITS - NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers CONTRACTOR ` T L NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ��1,VY� 2,v�1h FRONT_ comply withFsuch provisions or this permit shall be deemed revoked _ ADQBESSLIC NO' P L LICENSED CONTRACTORS DECLARATION , 1V SIDE CIZY LIC AS$ P L, I hereby affirm that I am licensed underprovisions of Chapter 9 A SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO O STORIES NO OF FAMILIES jL Professions Code and m lice se is In full force and effect 1 NEW ❑ BK PG i p License N be LI Class DESCRIPTION OF W p ADD VALUATION Poo.. V Contractor �� 4 '` LC ALTER ❑ $25 DDO O ❑ I am exempt under'Sec REPAIR ❑ $ f- U B&PC for this reason DEMOL ❑ LDMA P/C# W Date USE OF EXISTING BLDGfL �ec URM ❑ =- ca Signature J qq ! a ? APPLICAN (PRINT) TEL j p q �7 LDMA Perm# �` 4 }5 AC C I .s ❑ I, as owner of the property, �h � "_-� ` -6vs \ p perty, or my,employees with wages as Q.Y�' a 2 � their sole compensation, well do the work and the structure is ADDRE l EA t OIC- not intended or offered for sale (Section 7044, Business and lh $ FINAL DATE "'� aONO. (. Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 1 ❑ 1, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE '- t v AMOUNTS SPEOFIEq ON THE HAZARDOUS MATERIALS INFORMATION GUIDES _FINAL'B Q8 licensed contractors to construct the project (Section 7044, : 3^}�. + -- Business and Professions Code) YES 1:1 NO 33F % 505._J` WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 1 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1��1,i 1 t 1 v y 1 TE�°_, CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES / ��.. ,,,z I hereby affirm that there is a construction lending agency for YES NO� __> vS�ti �'Tl� j� - 82 a the performance of the work for which this permit Is issued(Sec s i_1�i�; C.- rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - c + ! 3097,CIV C) CHECKLIST I UNDERSTAND�EQUIREMENTSUNDER THE LOS ANGELES COUNTY CODE ` LTITLE 2 CHAPTER 2 20 SEOUGH 2 20 140 CONCERNING HAZARDOUSLender's Name MA IALS REPORT NERMIT FROM THE SCAQMD o Lender's Address O OWNER AGENT o I certify that I have read this application and state under penalty perjury that the above Information I5 correct I agree to comply PC FE /� !-,' PERMIT FEE of N with all county ordinances and State laws relating to building �v .`� O 2060 1 Ar Co traction, and hereby au t r¢e representatives of this County ISSUANCE FEE O to n r upon the o - nt ed pr rty for inspection +rposes _hq+ INVESTIGATION FEE TOTAL FEE "ignntwe 1 t Dute O ..7 SEE REVERSE FOR EXPLANATORY LANGUAGE DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ' C ® 0 WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. Yocum j BUILDING C ��+//�� /�� ADDRE58 Ti 4 5 A )( Z/ LOCALITY / " `/ RECEIVED BY DATE,OF APPL. DATEISSUED CNEAREST ROSS ST O n BUILDING ADDRESS- � iS MAIL LOCALITY I ADDRESS -316 SO, DATE STRM NEAREST CITY L Q^ NO' CROSS ST. J / FIRENO.OF TYPE GR07g // / ARCHITECT OR TEL. ZONE PLANS \ ENGINEER NO BLDG. r ORD.NO ADDRESS SETBACK LINE APPROVED TEL. BY � DATE CONTRACTOR NO USEAPPROVED ADDRESS $�vb ZONE BY DATE LEGAL / CORRECTIONS DESCRIPTION rlOf-N0. OCK /� TRACT-- - NEI OF SIZE OF LOT(pZ.ITX 841 NOW ON LOGTB USE NO OF NO O , C.� EXISTING FANG BLDG. FAMILIES ROOMS DESCRIPTION OF WORK NEW + ALTERATION ADDITION 9-�"7� O REPAIR MOVING DEMOLISH SQ SIZE T D�rj ROOMS J STORIES 1 Z 3' ,qQ WALL ROOF COVERING ST(JGC.Q COVERINGCC)Mpd Q USE OF NEW BUILDING J)wjL"jAjQ V I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT' FOUNDATIONi: 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 4 / PERMITTE LATH, INT. AUTHORIZED AGT LATH, EXT. 76A636A 9-48 'y DBS-3 SEIM BETS $ P.C.$ PLASTER, INT. _ FEE V PLASTER,EXT. Z VALUATION FINAL FEE WORKERS' COMPENSATION DECLARATION - I herby affirm-?hat I have a certificate of consent to self ensu, `or a certificate of Workers' Compensation Insurance, A P P L I CAT.I O N FOR, 'BUILDING, PERMIT or a certtfidd copy,thereof (Sec 38000, Lab C ) ` s I5ZOJrZ, 5 Company l',Q F� ` COUNTY OF LOS ANGELES` BUILDING AND SAFETY Policy Ivo ❑ Certified-copy is hereby furnished, FOR APPLICANT TO FILL IN ADDRESS a © Certified copy is filed with the county building inspec- BUILDING 5 5S L-0, ?"Oso, �Y. y �ttion Odeepartment \�wul ,, �} _ \ 1 -1- 1 \ 1 J -h���iS CITY�eYY� {Q•, ZIP �� LOCALITY e, ` Date Applicant ria— NO OF BLDGS NEAREST \\ CERTIFICATE OF EXEMPTION FROM WORKERS' - SIZE OF LOT NOW ON LOT CROSS ST 1A; COMPENSATION-INSURANCE ASSESSOR (This section need not be completed tf the permit,is for one TRACT- BLOCK LOT NO MAP BOOK ��7/ PAGE ��d PARCEL hundred dollars-($100) or less-) OWNER �� TEL Z$b-262 -1'Q,P- D NO USE ZONE MAP NO I certify That m the performance of The work for which this c7 ( Q - SPECIAL -• - permit is issued, I shall not•employ any person in,any manner ADDRESS 5"5-& �_ R o ��- so as to bedome,subjeCONDITIONS a ct to•the Workers' Compensation,Laws s O CITY $m \ C ZIP 1 y Date Applicant ARCHITECT OR TEL Q-' ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY O ' NOTICE TO'IAPPLICANT If, after making this Certificate of., � - - CONST Z NE UExemption, you--should become-subject to the Workers' '� p _� Compensation provisions of the;Labor Code, you must-forth- ADDRESS _ �' 0 a with comply with such provisions or this permit shall be 1 \ \ TEL 4 STATISTICAL CLASSIFICATION APT CONDO N deemed revoked _ CONTRACTORL0^\ 0kVr 9AW%0 � NO�I�`�b�' 11� F _Z LICENSED CONTRACTORS DECLARATION (� LIC CLASS NO �� DWELL UNITS — I hereby affirm that I am licensed under•provisions of Chapter 9 ADDRESS 152) YA\` &J NO O\y 6, SEWER MAP - - (commencing with Section°7000).of Division,3-of,the Business- LIC V`� • CITY A y"A _ - �✓ and Professions Code,and my license is in full force and effect- _ CLASS ' ' - BK c _PG ' d' -— --VALIDATION / !^ SQ FT NO OF NO OF CHECK License Number a����� '\\' 'lic Class'��r�-1�i C� SIZE STORIES FAMILIES ONE ConiracTor �1MGL,4C ZQ1W10Q\" Date 1l'`Ju"1 J DESCRIPTION OF WORK NEW ❑ VALUATION - ❑I am exempt under Sec h���+Y��h R�m,�Q+\M ADD ' ❑ ; too I ► Q \_ (� ALTER B&P C for this reason 1- �^SOT \�QMH�b a+� T REPAIR ❑ $ Dare USE OF - EXISTING BLDG p'S DEMOL ❑ Signature APPLICANTTEL L OWNER-BUILDER DECLARATION ` (PRlrtr) , �%U�I NO `�`�b�+��D FINAL � Y,( I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Se6bn 7031 5, Business and ADDRESS 1q� 3 a ►� UdL �^� FINAL Professions Code) }' PRESENT By 41 ❑ I, as owner of the,property, or my"employees with BUILDING ADDRESS rit-t- t •ir . wages as their,sole compensation,will do the work and _ 4 _• 5D.5'_- the - 5,, the structure is not intended or offered for sale(Section LOCALITY , 1307- 7044, I= -}'-E•-'- 7044, Business and Professions Code ) MOVING TEL r ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ITEMS tion 7044, Business and Professions Code ) ADDRESS ,• 1 •7 REQUIRED TOTAL SETBACK FROM d y Etj}} • 252 - 55 CONSTRUCTION LENDING AGENCY YARD HWY SET BACK PROP LINE I hereby affirm that thele is a construction lending agency for FRONT ^ :^°' - :_�"IELt. X5_2.5 , the performance of the work for which this permit is issued P L Sec 3097, Civ C L{�� ( ) SIDE '. w °HAN-3E t tl 1 Lender's Name+ P L - $ d LDMA Ref # _ P C Fee$ (/ ✓r/ Permit Fee T OFJ[ i-10 1Lender's Address t LDMA P/C# Ail,'a`-.,7 0 1 certify that I have read this application and state that the Issuance Fee 8 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 # a and hereby authorize representatives of this County to enter upon the above- e_nf oned'property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE y Signa(uJe,6�AppI1c&t or Agent Date i Y 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 0308270027 PHONE: (626) 285-0488 EXT: LEGAL D: NO. OF ADDRESS:BUrLDING TR: 13329 LT: 58 UN: .002 SQ. FT STORIES TYPE 9558 LA ROSA DR STRUCTURE: VN TEMP CA 917803828 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY BLVD 8590-018-022 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY TENANT: S BLDG USE: RESID US - SS S EXIST OCC GRP: 08/27/03 JK 08/21/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI LDA r FINAL BY: CODE: GEE BEATRICE - 5,200 (a _ -D-� / 9558 LA ROSA DR D S 4 l J C� `' TEMP 917803828 FEES PAID WORK T/0 HOUSE & GARAGE; RESHEET OF SOLID SHEETING;INSTALL 1LAYER APPLICANT: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 30#FELT & 30YR ELK SHINGLE AJR ROOFING CO (949) 548-6654- AA BLDG PERMIT ISSUANCE 27.75 200 16 PLACE UNIT C AC STRONG MOTION RESID 5200.00 VAL 0.52 SPECIAL CONDITIONS: COSTA MESA CA D2 PERMIT W/O EN-HC 5200.00 VAL 149.40 TOTAL FEES 177.67 CO TRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE A J R ROOFING COMPANY (949) 548-6654- 200 16TH PLACE, UNIT C LIC. NO SETBACKS COSTA MESA, CA 92627 588479 C39 SOILS ENGINEER APPROVAL IT EN . N0: F A 0 RM LIC. NO: SLAB/UNDER FLOG RAISED G A NO: SEWER MAP BOOK: PAGE: FIRE ZONE: MP: UNDERFLOOR INSULATION 144H269 3 01 NO. OF MIL D LLI S: P CO FLOOR NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PAI= AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED 0 FROM EXIS HANGER-9-- SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- _ INSULATION/WDFTRFR STRIP SIDE PL- N /DR XTER OR LAT RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508