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Home My Public Portal About9576 LA ROSA DR_Building__ DIVISION OF BUILDING AND SAFETY - Department of County Engineer. County of Los Angeles ED WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY 0 / j�'J Io DISTRICT NOS PLAN C[.OR REC.Na. /PE/RMI/T BUILDING LOCALITY �/.Q�ry��' `_ _ � RECE�BY DATE OF APPL /ODA=E'IBHU;D, NEAREST ROSH 3T. HLIILDING ADDRESS OWNER r• n MAIL // LOCALITY ADDRESS%, b '�. NEAREST TEL / '// CROSS ST. CITY l.l.W N0. `^'f � �TI✓5I FIRE I NO.OF I TYPE OUP CT I I ZONE PLANS ARCHIT,GOR TEL ENOINE£R NO. BLDG. ORD. NO. SETBACK LINE AD15RESS ,(/""I�'' USE APPROVED CONTRACTOR /AtbA 11 j rypL T 113, ZONE HY DATE HOUSE NUMBERING ADDRESS MAP NUMBER NO. ASSIGNED BY LEGAL CORRECTIONS DESCRIPTION LOT N0. BLOCK TRACT NO. OF 9LOCH. // / 7/ -✓/FX')hl 7t'� �1. /// SIZE OF LOT NOW ON LOT —moi USEOF NO. OF - EXISTING BLDG. PAwLi[6 c�i4G�.L`U C.�ina/�- DESCRIPTION OF WORK �3 �^ p NEW ALTERATION ADDITION Z f' -� D REPAIR DEMOLITION /'/F SO.FT. NO. OF ��• �� '.�lC,. /L�G'f rs✓J,4n -• a�F V17.! _ SIZE ROOMS STORIES EXT.WALL ROOF COVERING COVERING USEOFSTRUCTURE l� D INSPECTION FOR APPROVALS OCCUPANCYAS I NSPECTO R'S S I GNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRESTOPS, CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS RED LATINO BUILDING CONST///RUCTION. GAS VENT. DUCTS SIGNATURE OF 7 N !4� at�; Nt,LW LATH, INT. PERMITTEE ^ T �'O A I� �A �l I./� p� � -�G, LATH, EXT. ADDRESS ( .C, J r// y.f/HW l !1 PLASTER, INT. AUTHORIZED AOT. / l -YX�CYLI M� qq `` PLASTER. EXT. P.C. ^ FEE P,O� HOU9ENUMBERCOR- C9 RECT AND POSTED VALUATION FEE _ FINAL �6A635A 0553 1-52 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER Jut71719 U 1 L ® 1 N G FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING CL ( : DIBTRMTNO. PLAN CK.NO. PERMITND. 2,4S7 ACORES LOCALITY 2r,�, GiVE�1BY DATEOr AP=� �`� ll�?�, EI�iE CROHB 9T .aY fuZL4CA Li I OWNERA �� BUILDING Z I �PK. ®� ADDRE66MAIL �` 555rrr/'^! ff4��•��-�.. ADDRESS l�V C-S. � i,( LOCALITY CROSS 9T. CITY TLNO. FIREV5 ARCHITECT CR TfL. ZONE_s PLANE Z.. TYV[ GRO`UPI ENGINEER NO. BLDG. �]._ ( r.PI 1/R(�I[6•NO. ADDRESS p/�' rI J>/.P��} SETBACK LIN[ p'U l.- CONTRACTOR Aa'Y/`sil[A, �'N OL' �S X.i34,3Y" BYPROVED OG.T[. ADDRESS .af /(2 uscZON ABYPROVED DATE LEGAL DESCRIPTION LOTNO, BLOCK CORRECTIONS TRACT SIZE OF LOTNO tPL X I NOW ON LOTS USE OF NO.OF NO.pF p •tla /1✓ V� p Y � �/��JQ EXISTING BLDG. NA �� FAN UIE9 ROOMS DESCRIPTION OF WORK - -- NEW ALTERATION ADDITION O 9 REPAIR F ^/�1 MOVING / DEMOLISH G SIZE / ,/(A NO or ROOMB V STORIES ` WALL l � eW Ie COVERING r/I ,�,G ../ r COVERING, l VV UBE OF NEW BUI�L.DN� _ IG ! y� / I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROV S APPLICATION AND STATE THAT THE ABOVE 19 CORRECT 1 SPECTOR ATE T AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION FORMS,MATERIALS >-' 1 AND STATE LAWS REGULATING BUILDING CONSTRUCTION. / J ` � FRAME: FI RESTOPB, y SIGNATURE OF '( (/ J BRACING.BOLTO 7/V/( b 3 .PYA/3t/ PERMITTEE - LATH. INT. AUTHORIZED AOT �17 � 76g638q-3 2-50 PLASTER.INT. .� �I/l P; 1� ��•y o-FEE PLASTER.EXT. VALUATION FINAL ] /(/i.� FEE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN Bul INC ADDgEss Lplgl Rfss �i I hereby affirm that I have a certificate of consent to self insure, aul[�f XXK or a certificate of Workers' Compensation Insurance,or a certified GITV ZIP _ copy thereof (Sec.3800, Lab.C.) !id LOCA Policy N0. Company 1,7dSIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified Copy i5 hereby furnished. 4 NEAREST CRCAS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant - ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ow TEL No. COMPENSATION INSURANCE `�"�'�J - �Z. WITHIN 1000 FT.OF SCHOOL? vas No (This section need not be completed if the permit is for one hundred ADDRESS P P DISTRICT GROUP TVPS CONST. FIRE ZONE PROCESSED BV dollars($100) or less.) CITY certify that in the performance of the work for which this permitPOP / is issued, I shall not employ any person in any manner so as t0 ARCHITECT ENGINEER TEL NO. become subject to the Workers Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASB N0. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONT / TEL NO SET BACK YARD HWV PROP LINE WIDTH Compensation provisions Of the Labor Code, you must forthwith /�� eAe"ee-,) C�� 'd FRONT comply with such provisions or this permit shall be deemed revoked. ADDRE55 �+, - LIC.NO. PL LICENSED CONTRACTORS DECLARATION ZJ R�'.t' LIG.C �� PILE CI � G%jy_�S P L I hereby affirm that I am licensed underprovisions of Chapter 9 1 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES } Professions Code,and my liceni in full force and effect. NEW BK PGEL License Number Lie.Class DESC TION OF K ADD ❑ VALUARONO Contractor Date LGCJ ALTER ❑ $ /,P v ❑ I am exempt under Sec. REPAIR [1 $ F- B.SP.C. for this reason DEMOL ❑ LDMA P/C x W Date: USE OF EXISTING BLDG. URM ❑ IL Signature APPLICANT(PRINT) TEL NO. LDMA Permz 1 ❑ I, as owner of the property, or my employees with wages as ti_1 '_.I .T7 their sole compensation, will do the work and the structure is ADDRESS 0 not intended Or Offered for Sale (Section 7044, Business and FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �f \ J E I ❑ 1, a5 Owner Of If1E property, am exclusively contracting WIIM1 ORA MIXNTS SPE CONTAININGTHE A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE �l a -I— AMOUNTS SPECIFIED ON THE HAZARWUS MATERIALS INFORMATION GUIDE? FINAL BY +�( J licensed contractors to'construct the protect (Section 7044, III ItT.. �-�� { _: L` ES❑ NO 1:1 € Business and Professions Code.) WILL THE INTENDED USE OF THE 6UIDLINR 9V THE APPLICANT OR FUTURE BUILDING _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION GTION OR MODIFICATION FROM THE SOUTH q CONSTRUCTION LENDING AGENCY GUIDE AIR QUALITY MANAGEMENT DISTRICT(SCAOMO)SEE PERMITTING CHECKLIST FOR 1/ .t-J�1rr''!j(_� vU I GUIDELINES O '[Til�i�-1v - I hereby affirm that there is a construction lending agency for YES❑ No❑ N the performance of the work for which this permit is issued(Sec. m IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3D9].Civ.f).) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE j i xii= TITLE 2.CHAPTER 2.20 SECTIONS 2 20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS -= 1= II lI- .. 1: IJ Lender's Name MATERIALS REPOR l AND FOR OBTAINING A PERMIT FROM THE SCAQMD. _ _ �- 0 Lender's Address O O,N R OR wervT o I certify that I have read this application and state under penalty of perjury that the above information is correct. I agree to Comply PC.FEE PERMIT FEE with all county ordinances and State laws relating to building m COnstructiO , and hereby authorize representatives Of this County ISSUANCE FEE / 6� IF to enter u on thea ve entioned p party or inspection purposes. (O o INVESTIGATION FEE TOTAL FEE /O / 9grc-re If PPpleim ac npxnl IS 2QJ-Q5- SEE REVERSE FOR EXPLANATORY LANGUAGE