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Home My Public Portal About9642 LA ROSA DR_Building__ All, or CIN OF TEMPLE CITY.. MIT � '/BA630A CEN803.0-69 APPLICATION FOR BUILDING P IT COUNTY OF LOS ANGELESBUILDING GyI , , (A RGtt L DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. CA MLrC( DISTRICT NO. GROUP TYPE P SSED BY FOR APPLICANT TO FILL. IN corvsr. C ^f BUILDING / �[ e� STATISTICAL CLASSIFICATION S ER MAP ADDRESS 6lf2 c< <H ►2dSA l� 7�/ BK CLASS. NO. DWELL. UNIIT�S_` LOT NO. ( BLOCK WATER NOT REQUIRED IYI RECEIVED CERTIFICATE: IAv TRACT C p [SIDE P HIGHWAY ee ! NO. OF BLOCS. f' tc IRCLE) STATE MAJOR SECOND CA SIZE OF LOT 5! X 60 O NOW ON LOT E ZONE SPECIAL USE OF No M y ^ CONDITIONS EXISTING BLDG.OWNER RAMI N F.ALMAS NO�397-IM e! ,/J�� IL ING YARD HWY TR NAME EXIST. ADDRESS /I µ2 C,LA "l A TBACK WIDTH RONT ARCHITECT OR . TEL P. L. tal 6e ENGINEER ADDRESS TEL. I L- —G , A O CONTRACTOR NO. U ADDRESS 01 'DESCRIPTION OF WORK W ADD ALTER REPAIR DEMOLISH _ ' 6 SQFTO Z SIZE T2 STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF ✓ v / ` � � I-APPL I CANT V�LUATION $ (G�Cj CJ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. ••••77 [) FOUNDATION: LOCATION FEE S FEE S O-2 FORMS. MATERIALS 17 -I0-6 A' FRAME: FIRE STOPS. JJ . I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS -Vs 1(., 4.� ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORUINANC ES ANO STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK �f ,�T AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. Y' Fl TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'5 COMP EATION INSURANCE. T aA,,,cJ LATH. AN SIGNATURE pF L(J�lf-� HOUSE NUMBER COR- -------------- PERMITTEE.-It.— / PERMITTEE_T RECT AND POSTED ADDRESS g/u2- f�s'a. IZR3 FINAL 7�i p7 LJ JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN NE N ER PLACHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M D. CASH 4939.o OCT15 1 D 22.00 v 11��. APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AOORESgS �✓y hereby affirm that BUILDING ADDRESS have a certificate of consent to self insure, Sa or a certificate of Workers' Compensation Insurance,or a certified copy thereof (Sec.3800,Lab.C.) — CI Y 21 Policy No. Company �TaO'YE- �(� LOCALITY G� SIZE O LCT f NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST GROSS ST. Certified copy is filed with the c unty buil g' pection TRACT BLOCK LOT NO. deparlmenl - USE ZONE MAP NO. Gote�� Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM ORKERS' OWNER TEL No. COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed it the permit is for one hundred ADDRES tf DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) CITY � ZIP�j ` I certify that the performance o1 the work for which this permit : ze i5 issued, shall not employ any person i any manner so as to i become sublect l0 the Workers Compensation ion Laws. ARCHITEeTOR ENGINEER TEL NO, STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NODWELL UNITS 1 NOTICE TO APPLICANT. It, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should - become Subject t0 the Workers' CO R CTOR TEL NO. 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. A pR�� LIC.NO, P L LICENSED CONTRACTORS DECLARATION / 6:A7OW 57- SIDE IC ASS P L I hereby affirm that am 000)o UO vision viol the of Chapter d �T� SEWER MAP 1 (commencing with Section 7000)of Division 3 of the effect. 5 and SO.Fr.SIZE NO. F STORIES NO.OF FAMILIES NEW BK PG 0 Professions Code,and my license is in full force and effect. ' U DE RIPTION VALUATION License Number 5��74�� Lia Class OF WORK ADD ' Conlractore� N/GVVVN�/1D3�.- Date s ALTER ❑ $� DD• / y 0 REPAIR ❑ ~ El am exempt under Sec. $ U W BAP.C. for this re• ��• LDMA P/C x CL on DEMOL ❑ at / USE OF VISTING BLDG. URM ❑ Z Signature APP ICANT(PRINT) TEL NO. LDMA Perm x _ ' t. ❑ I, as owner of the property, or m on with wages as ltf 2 their sole compensation, will do a work and the structure is ADDRESS rat intended or offered for sale (Section 7044, Business and lvi� •�. FINR -7- 73 �F G "'- Professions Code.) WIT THE APPUOANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL / - ( 3 � i ITEI;: OR P MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I, as owner of the property, am exclusively contracting with FINBY j Tu I HL 1 j{ m +y`` G AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? 4)1.` licensed contractors to construct the protect (Section 7044, ves❑ Ngeyl _ Business and Professions Code) ^I ' `` i7-1.411 WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUNflE BUILDING _N�i.'vr'. OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT USTRILT 1SCAOMDI SEE PERMITTING CHECKLIST FOR `IIANGE FIC, GUIDELINES. - I hereby affirm that there is a construction lending agency for YES 11 NOX n the performance of the work for which this permit is issued(Sec. _ m IMgVE RCA THE HA2AR000SMATERIPLSINFORMATION GUDE AND THE SLAOMO PERMITTING f 1 ry 3097,Civ.C.) CHECKLHT I UNDERSTAND MY F EOUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 11/1P: TITLE 2 L1 PTER 22D ECTIO 20100 THROUGH 2.20 140 CONCERNING HAZARDOUS Lender's Name MATERIA REPORT OBTAINING A PERMIT FROM THE SCAOMO. - —� 1 0 Lender's Address -_Ir7 HP7 - 1 Q —ER CP AGENT 0 1 certify that have read this application and state under penalty O of penury th the above information is correct.I agree to comply PC.FEE PERMIT FEE N with alTV l C ty ordinances and State laws relating to building m COnetrUCti. and h y auth Ze representatives of this County ISSUANCE FEE ato en r an th e- a ged property for inspection our Goes. // �r/� �/ ` x . !,`�\ ,,•,;:� C INVESTIGATION/n� FEE TOTAL FEEA. / '7 D ` •/ ;P.e�.a aonw•o a/ SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR k-IJILDING ,P.ERMIT COUNTY OF LOS ANGELES:' .. -..,:! BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN 111111 ADB E S q ,T I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS in ,/0 4A Ok 4 L SA__ . or a certificate of Workers' Compensation Insurance, or a certified CITY /'/ ZIP p copy thereof (Sec.3800,Lab.C.I . ��a� LOCALITY Policy N0. Company SIZE OF LOT 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, USE ZONE MAP NO department. : Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' / "� COMPENSATION INSURANCE X C ¢LY01A LUli�y✓� � 9 5�� WITHIN 1000 FT OF SCHOOL? -YES NO (This section need not be completed if the permit is for one hundred A RES G/ 4,1 � �� DISTRICT- GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars 1$400)or less.) - CITY /I I certify that in the performance of the work for which this permit Aa.� "' �� is issued, I Shall not employ any person In any manner so as to ARCHITECT ENGINEER ZIP TEL NO �O00 ✓ � � become subject t0 the Workers'Compensation Laws, STATISTICAL CLA$S(FI ATION - - APT CONDO Date - Applicant ADDRESS CLASS NC � DWELL UNITS NOTICE TO APPLICANT... If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers CONTRACTOR /� ,, ��s L TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions Of the Labor Code, you must forthwith _ C'�/�f/—/wV FRONT comply with such provisions or this permit Shall be deemed revoked. ADDRESS LIC.NO. - P L r LICENSED CONTRACTORS DECLARATION SIDE Oa CITY 'LIC.CLASS P L U I hereby affirm that.I am licensed underprovisions of Chapter 9 SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and NEW SQ FT.SIZE NO.OF STORIES NO.OF FAMILIES L'J Professions Code,and my license is in full force and effect. % / BK PG 0 License Number Lic,Class DESCRIPTION OF WORK ADD d VALUATION , U Cllg,/ u. u�ii/DeN/8 Feu . Contractor Date G W ALTER ❑ $ ��' Il C9'lf}Z�i6!/r/riciilGv/v/✓IIM. SE�1�� • '$ ❑ 1 am exempt under Sec. REPAIR ❑ Z �A 88P.C.for this reason 71�X/ � Jn /u. /,STv(,J DEMOL ❑ LDMA P/C> S Date: USE OF—EXISTING BLDG. nature URM ❑ �t(.t�T.a AP LIC T(PRINT) TEL,�yq �/ LDMA Perm x 1,'�Il 1, as owner of the property, or my employees with wages a5 L(J�fl� . d6�Jr/3 _ 3303 14= their sole compensation, will do the work and the structure is A /R,ES x .O 1. !TENS - not intended or Offered for Sale (Section 7044, Business and �` `^ �YJ N�� FINAL DATE Professions Code.) - IaT1 fD IiIIAL 1-42 - 20 PALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE.A HAZARDOUS MATERIAL J ❑ 1, as Owner Of ther0 err am exclusive) contractin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ �/ p p �' �' 9 AMOUNTS SPEGFlED ON THE HAZARDOUS MATERALS INFORMATION GUIDE' FINAL BY '�- > -CHECK licensed contractors to construct the project (Section 7044, e Business and Professions Cade.) res❑ No G ')CHANGE .00 WILL THE INTENDED USE MI THE COOLING BY THE MODIFICATION OR FUTURE EBUILDING SOUTH OCCUPANT REOUIRE A PERMIT FOR CONSTRUCTION OTION OR MODIFICATION FROM THE SOUTH. CONSTRUCTION LENDING AGENCY consT AIR ounuTv MANAGEMENT olsTRlcr IscAomol SEE PERMITTING CHECKLIST FOR .. GUIDELINES _ �S I hereby affirm that there is a construction lending agency for YES❑ . NO 2r' 'v� 00 C` '11,_1' the performance of the work for which this permit is issued(Sec. ` [[ { I�( HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING /' T Cy46' y• AM 113 13 3OB7,QV.Ci.) CHECKLIST I UNDERSTAND MV REDUIREMENTS UNDER THE LOS ANGELES COUNTY CODE._ 1 TITLE 2.CHAPTER 2.20 SECTIONS 220.100 THROUGH 220.140 CONCERNING HAZARDOUS - LandO(S Name, MATERIALS REPORT G ND FOR OBTAINING A PERMIT FROM THE SOAOMO I Lender's Address BE a+NER ort eN I certify that I have read this application and.state under penalty / 0. of perjury that the above information is correct, f agree to comply P.G.FEE PERMIT FEE 7 m with all county ordinances and State laws relating to building m construction,and hereby authorize representatives Of this County - ISSUANCE FEE '30 o to*enlupthe abovecmentioned property for inspection purposes. '44�J��i,�� oN�'b�/'- g INVESTIGATION FEE TOTAL FEE Y. SEE REVERSE FOR EXPLANATORY LANGUAGE P