The URL can be used to link to this page

Home My Public Portal About9621 LA ROSA DR_Building__ APPLICATION FOR +i BUILDING PERMIT FOR APPLICANT TO FILL IN nooeess �oS.q BUILDING ADDRESS yc/' ,21 N lX— LOCALITYT N E Giy CITY .no�Lz c! ZIP / 7V CROSSST.?-)F ojole G%7' r�o L✓� NO.OF BLDGS. ASSESSOR SIZE OF LOT7v , NOW ON LOT 'J MAP BOOK PAGE PARCEL (, DISTRICT GROUP TYPE FIRE ESSED BY TRACT y D BLOCK LOT NO. �` ��j CONST IZ�ONE EL- OWNER L-� 5 NO ..G�C7'��CP�' n STATISTICAL CLASS]FICATION - S WER AP ADDRESS % .Zr �u TZ`x 14 al -y-. �+ (� CLASS NO. DWELL UNITS K PG CITY / ri/1{o/o l,Y� - ZIP / i 7& 0 /UJ�Jf,ZONE ARCHITECT OR TEL _ K '� SPECIAL .b - ENGINEER NO. ZOV CONDITIONS ADDRESS ' ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑ TEL. CONTRACTOR NO, BLDG.SETBACK FROM LIC, FRONT PROP.LINEOF (STREET) ADDRESS NO. TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER + NAME AND BRANCH O BLDG.SETBACK FROM U ADDRESS CITY SIDE PROP.LINE OF (STREET) SQ.FT. NQ-0F NO.OF ) CHECK HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING w SIZE STORIES FAMILIES 1 ONE SIDE PROP.LINE HIGHWAY WIDTH d DESCRIPTION OF WORK 6 ,4 13IX �r00 7� NEW ❑ + Z IE,P— ADD ❑ CORNER CUTOFF YES ❑ NO ❑ ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ USE OF T� ,,L_, REPAIR ❑ IN COASTAL PERMIT ZONE YES ❑ NO Cl EXISTING BLDG. DEMOL ❑ APPLICANT TEL �. IPRINT7 Q. q IFS. X.e.L) NO-16-7'71-C�. n BY(SIGNATURE) - HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES - AND LAWS REGULATING BUYING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN SCOM- - - PENSATION INSURANCE. /) SIGNATURE OF �� / FINAL /�� BY PERMITTEE - ( �� DATE ADDRESS TEL. P.C.Fee$ Permit Fee CITY NO. VALUATION.p _ Issuance Fee / 90 @ r J Total Fee Z PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 7 4 3�ARR 6 : �2 U2 5.0 Q boa (P5 76A638SCEN803BB/77 ' 76A638p CE08038-64 APPLICATION FO BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY S JOHN A. LAMBIE. COUNTY ENG(N'c ER NEAREST } � COLEMAN W. JENKINS,SUp'T.DF BUILDING CROSS ST. DISTRICT NO. G DUE. TYPE. =2 OQESSED BY l FOR APPLICANT TO FILL IN 7✓ 9 CONST. BUILDING STATISTICAL �fL•ASSIFICATION S WER MAP ADDRESS oS CLASS N0..1 DWELL UNITS BK PG (- LOT NO. BLOCK USE ZONE MAP j aU_ NO. TRACT S SPECIAL CONDITIONS SIZE OF LOT f0.g u OW ON LOT $ USE OF NG BLOC. SETBACK FROM C EL %(, FRONT PROP. LINE OF ��` (STREET) OWNER O. O TYPE OF E%15TING SETBACK HIGHWAY } YpRD = TOTAL ADDRESS XIGHW AY IO//T Xn IR M C/.L. CITY BLDG. SETBACK FROM ARCHITECT OR I TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING ISIETBFROM CN HIGHWAY } YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. d TE } = O CONTRALTO NO t ^1J V ADDRESS /p( N0� .,7 oldCORNER CUTOFF YES NO EJ O CITv CIL SEE REVERSE SIDE FOR SPECIAL APPROVALS u /' ( W DES RIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SO.FT. NO. OF NO. OF V�fF� �•/ 'I'/ SIZE STORIES SUSE F TRUCTURE. ' (.{'J-� i/� �1_(LL'�I/aSE•(A�./y SIGNATURE OF' APPLICANT VALUATION$ ////'� r APPROVALS � ATE INSPECTOR'S SIONATVRE P.C. PMT. (J[T FOUNDATION, LOCATION q ��11//j•/ A/C FJI FEES FEE$ FORMS, MATERIALS FRAME, FIRE STOPS, F I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS AUHUD ITHORIZED CONSTRUCTION. CERTIFY THAT IN DOING THE WORK IN ON T" HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH. INT. TION OF THE L4BOR CO E� F_THE STATE OF CALIiORNIP RELAT. n[/ INO TO WORN MEN'S P 1 NSU LATH. EXT. v 1q/85 ..{/w�/i(Y SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ,moi ADDRESSFINAL ( ��9 JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION EK. M.D. CASH _ PERMIT VALIDATION cK. M.G. CASH Ir�DE; 73G'� EEB18 I D 2G.00Q - - APPLICATIONTY COUNTY OF LOS ANGELES FOR BUILDINGGPERANDEMIT FOR APPLICANT TO FILL IN BUILDIN DDRESS WORKER'S COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent.to self insure, BUILD A RE or a certificate of Workers' Compensation Insurance,or a certified ) - oPYthereof (S 390 ab.C) y ZIP^r C . ,/•t` 7 LOCALITY Policy NO. Y COmpan SIZ OF OT NO.OF BLDGS.NOW ON LOT Z ❑ Certified copy is hereby furnished. 1' CJI N NEAREST CROSS ST ❑ Certified copy is filed with the cou ?building inspec ion TRACT BLOCK LOT NO. d partm n>I USE ZONE MAP N0. Date ` ASSESSOR MAP BOOK PAGE PARCEL plicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FRO . ORKERS' OWN \ TEL No. ves No COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS C - ' dollars (S 100)or less.) DISTRICT' GROUP TYP CONST. FIRE ZONE PROCESSED BY C T •— z I certify that the performance of the work for which this permit `O O is issued, I shall not employ any person in any manner so as to � d O become subject l0 the Workers'Compensation Laws. AEGT.O L STATISTICAL CLASSIFICATION APT CON00 Date Applicant RE 1 {(,,� �(//� ��^•{(�- CLASS NO. `"2DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of l \) kREQUIRED TOTAL SETBACK FROM EXIST Exemption, you should became subject t0 the Workers' CO AC OR c rtE SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 1 1 i FRONT comply with such provisions or this permit shall be deemed revoked. E /` PL LICENSED CONTRACTORS DECLARATION v , SIDE CITY LIC.CLASS P L hereby affirm that am licensed underprpvisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and 80. E NO.OF STORIES I N0,OF FAMILIES Professions Cade, d TO licein full force and effecjj NEW ED BK PG pool } License Num FR or Lic. Class -� DESCR _ �� ^ ADD ❑ VALUAT O �r�'�• O ctor ContraDate C.../ ALTER ❑ •➢ �•�L Ir 14- REPAIR El ❑ 1 am exempt under Sec. $''�� B.BP.C. for this reason v `'V� W'� G�4 Vt S DEMOL ❑ W LDMA P/C A ____ _. Date: USE OF EXISTING BLDG. N N URM ❑ F_-%- �.i f. _.4�+ Signature APPLICANT(PRINT) ' I TEL NO. LDMA Perm A ❑ I, as owner of the property, or my employees with wages as _ j!':f�.aV=e their sole compensation, will do the work and the structure is ADDRESS _ = not intended or Offered for sale (Section 7044, Business and FINAL DATE / Q - Professions Code.)Code.) -' �t'�� WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL [:]'I, as Owner Of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL 9Y V_ < �.hf•t _ •�(�, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDED licensed contractors to construct the project (Section 7044, YES 1:1 NO❑ Business and Professions Code.) WILL THE INTENDED USE OF THE BBY THE APPLICANT OR FUTURE BUILDING - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR EE PERMITTING FROM THE SOUTH j':I_I 111-1�1 Ij 3 y 1 j'-`: CONSTRUCTION LENDING AGENCY GUIDE AIR QUAIJTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR i' - cmDELwss I hereby affirm that there is a construction lending agency for YES 1:1 No El the performance Of the WOfk for which 11115 permit IS IaSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING 3097, Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. m 'TITLE 2,CHAPTER 220 SECTIONS 2.20.100 THROUGH 220.140 CONCERNING HAZARDOUS 3: Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SOAOMD. o Lender's Address o rn NEF OR ACENT 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 P.C.FEE PERMIT FEE a with all unty ordinances and Stale laws relating to building /O mconstr F n, and hereby authori representatives of this County ISSUANCE FEE / Or tae eru/pon the ove-mention OpOrty for inspection purposes. ¢ INVESTIGATION FEE TOTAL FEE / cli roa�a SEE REVERSE FOR EXPLANATORY LANGUAGE