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HomeMy Public PortalAbout9571 LA ROSA DR_Building__ DIVISION OF BUELDING AND 'SAFETY Department of County Engineer - IL I _ _ ' , � County of Los Angeles �. - i• WM. J. FOX, COUNTY ENGINEER APPLICATION `Y^l - FOR APPLICANT TO FILL IN ADDRESS BUILDING E t�Se IJ -BUILDINGLOCALITY ADDRESS C NEAREST'�T''''� LOCALITY 1 - - CROSS ST. I i l" `1 1� 1 }• , NEAREST ^ DISTRICT NO. I PhLAW CK./ort,RRrc.No. PERMIT NO CROSS ST> OWNER Cr �L �-/ o T 1 �RECEIVyE,D� BY DATE OFF APPL. DATEIIISSUED�- MAIL ADDRESS p �-�" �OLO /� USE ZONE.�NO OF TYPE ` GROUP FIRE ZONE ` TEL PLANS I I 1 CITY NO J I I ARCHITECT OR TEL. ZONING.- _ •DATED S ENGINEER NO. i�(J(_J(b APPROVED BY U�jOL�..,�/ds j--� ADDRESS BUILDING SETBACK LINE: " TEL. APPROVED DATE, CONTRACTOR NO. BY Aa Q_-.c>J _ r RESS H//•-.O�� HUSNUMBERING �I ADD LEGAL MAP NUMBER V In NO`ASSIGNED BY`+v -`Q U� DESCRIPTION ]LOT NO. BLOCKt ` ""/��7-/�"` -• DATE I �• _CORF=TIONS� I INSPECTOR -TRACTNO OF ' SIZE OF LOT X I -7I NOW ON LOTS �4 c4��-/a "�- •-' _ _ _ .J- - ` USE OF OF 'EXISTING BLDG FA I FAMILIES DESCRIPTION OF_WORE NEW ALTERATION` DEMOLITION ADDITION A.�t+I�DAFF� `6�++''�G� a . v g� f' REPAIR '// - •aVF a� /"id.A,/ S ZEA ( I Y -ROOMS l STORIES EXT- WALLROOF COVERING jC/ - I COVERING Q�) _ �,j' Q C US OF ST CTURE 1 M [_._ �_ l 9.� �l _ � e�.� Gam• ve - o-�-�-•-- - OVALS NSPE)C�T}�OR'S�S/IGNU —DATE A/TE ' FFORMSTMATEROIALSIf Nf a,.,4��`� -i' i 7 , �• sy I HEREBY ACKNOWLEDGE THAT 1,HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME FIRE STOPS, CORRECT. BRACING, BOLTS 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION- AND STATE LAWS,REGULATING BUILDING.CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF Ca �. G� ©i r LATH, INT. •- PERMITTEF LATH, EXT. ADDRESS AUTHORIZED AGT PLASTER, INT. .� t �O PLASTER, EXT. - ('•\ E NUMBER-COR- FEE $ HOUSE RECT AND POSTED _ VALUATION FEE �� FINAL- © �� & - 76ASSBA 088 3 E-D8 APPUCATION FOR PUILDING PERMIT COUNTY OF LOS ANGELES --.�tUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN ADDRESS I hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDKESS or a certificate of Workers'I Compensation Insurance,or a certified ' C,5,4 ZIP y copy thereoff,,�7�(Sec 3800,/Lab C) Cr" I �� p Policy No 14119 7� Company ? �1 O LOCALITY SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished NEAREST CROSS ST Of ❑ Certified copy's filed with the coun bulldi sp hon T CT BLOCK LOT NO depart ent I S1?0 0 /� 2 USE ZONE MAP NO Date ppllcant ASSESSOR MAP BOOK PAGE PARCEL - I SPECIAL CONDITIONS RTIFICATE OF EXEMPTION FROM WORK S' Dw TEL NO COMPENSATION INSURANCE is. <0-;!-_ V I WITHIN 1000 FT OF SCHOOLS YES NO AD R SS (This section need not be completed If the permit Is for one hundred, GI Q DISTRICT GROUP T E CONST FIRE ZONE •PROCESSED BY dollars($100)or less) CIT 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 become subject to the Workers'Compensation Laws AR HITECT Off ENGINEER TEL NO r•. STATISTICAL CLAS/�ggglF'ICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL I TO APPLICANT If, after making this Certificate Of �O +J REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become, subject to the Workers' C RACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH - Compensation provisions of the Labor Code, you must forthwith I )✓ "T FRONT comply with such provisions or this permit shall be deemed revoked ADD ESS - - uC NO-- P I-— LICENSED CONTRACTORS DECLARATION ZD T {� S I `10 �' SIDE CI LIC ASS P L I hereby affirm that 1,am licensed underprovisions of Chapter 9 a SEWER MAP (commencing with Section 7000)of Division 3 of the Business and Sb FT SI& NO OF TORIES NO OF FAMILIES Professions Code,and my license Is In full force and effect NEW ❑ BK PG License Number`s 1I7G?_Q Llc Class D SCRIP ION OF WORK ADD ue�L VALUATION Q ContractorDate ALTER ❑ $ `/ �0V U cc El am exempt under Sec a h' REPAIR ❑ $ 0 B&PC for this reason LDEMOLI ,❑ LDMA P/C# WDate USE OF EXISTING BLDG M ❑ �. _ \ C- Signature ,� \ '� •� Z PLICANT(PRINT) TEL NO LDMA Perm# _ �� - i Jr ❑ I, as owner of the property, or my employees with wages as C�t� �' S —Q �''\ Z 1,\�i °� their sole compensation, will do the work and the structure Is ADDRESS not Intended or offered for sale (Section 7044, Business and FINAL DATE r Q Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL Z\ _ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE tJ J ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE1 FINAL BY r� rT S licensed contractors to construct the project (Section 7044, tit r °a YES❑ NO❑ Business-and Professions Code) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY _ _ COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR f i ITEy E GUIDEI hereby affirm that there Is a construction lending agency for YES❑ No❑ I_�nI{ 753 16 � m a the performance of the work for which this permit is Issued(Sec f + R - O1 (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING tl '7C'� �t ' 3097, Civ C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE 1 :Ll�t_, f JJ°..- TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD11-4A1i .013 il3 o Lender's Address - �7F111 CC 0 OWNER OR AGENT , o I certify t' t I have read this application and state under penalty o P C FEE PERMIT FEE {of perjury hat the above Information Is correct I agree to comply N with all unty ordinances and State laws relating to building (/ (� (� _ _ { i�,I' conStrUCtl , and her a orize representatives of this County ISSUANCE FEEFJ 2,t i y'!1L e�•L � to enter on the ve tied property for InspectiWPusesI INVESTIGATION FEE TOTAL FEE Sqewre a App4®n�a ABen owe (p - SEE REVERSE FOR EXPLANATORY LANGUAGE