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HomeMy Public PortalAbout9805 LA ROSA DR_Building__ APPLICATION FOR CITY Of TEMPLE CITY BUILDING PERMIT BUILDING AND SAFETY : DIVISIO4 Tme PPLICANT TO FILL"IN ADDRESS BUILDING ADDRESSR.psa LOCALITY NEAREST CITY Tei't ZIP CROSS ST.NO.OF BLDGS. ASSESSORSIZE OF LOTNOWONLOT MAPBOOK PAGE PARCEL DISTRICT GROUP TYPE FRE SSED BY TRACTBLOCK L T L/ O' f, CONST. ZON r TEL. ' OWNER Allen Snot NO. 287- TSTATISTICAL CLASSIFICATION . J SEWER AP ADDRESS CLASS NO.�-DWELL.UNITS BK PG CITY ` ZIP U$ ONE MAP - / / / SPE ARCHIT C TEL.: /6/ SPKIAL ZZ ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑ TEL CONTRACTORK. 'L . Rand 1 C 0 NO. 2 BLDG.SETBA K FROM FRONT PRO LINEOF STREET) ADDRES5529. E. Val ley- B.1 dLC.1 HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC - FRONT PROP.LINE HIGHAYW21H CITY' CLASS _ ' CONSTRUCTION LENDER - a NAME AND BRANCHBLDG:SETBACK OU ADDRESS ,CITY - SIDE PROP.LINE Of (STREET) p SQ.FT. NO.'OF NO.OF CHECK HIGHWAY + YARD __ TOTAL SETBAC TYPEOF EXISTING w SIZE ST FO�RIES FAMILIES ONE - SIDE PROP UNE f WAY WIDTH , w DESCRIPTION OF WORYT a r t 1 a l tile NEW ❑ + _ Z ADD ❑ -CORNERCUTOFF YES ❑ NO ❑ ALTER ``L❑L�T IN OPEN SPACE _ YES ❑ NO ❑. asphalt 'REPAIFX)G USE OF- BLDG. DEMO) ❑ IN COASTAL PERMIT ZONE YES -❑ NOEXI ❑ APFLTEL PRWT[I., ',L . Randol C'0 N0288-4040I/1.7 N'r eAhv �-. BY(SIGNATURE) THEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES . AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLATION OF _ THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM" PENSATION INSURANCE. 1 SIGNATUREO m^ FINAL / BY 'PERM I7T EE' W„ DATE - " ADDRESS 52.9_ E l 1 e • San Gabriel , Ca.. TEL. 2 P.C. Fee$ Permit Fee CITY — �.�p�q Issuance Fee 'VALUATION ,Ia�s�,.V.V. 3 ZO , - Total Fee PLAN CHECK VALIDATION CK. Wo. CASH' PERMIT 1 LIDATION CIC GM.O. 6yCASH . 819"DEC' �e 0,'76AG388CE X803B 8/]6 76Afi38A CE A503 4/72 1 v�\� C.A APPLICATION FOR BUILDING PEIT � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING . V05 CLi MAKE CHECKS PAYABLE_ TO: ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY , . FOR APPLICANT TO FILL IN CROSS ST. Q- Prlor or tvoe DDI DISTRICT NOn GROUP TYPE PR ESSED BY BUILDING �np' CONST: Onn� ADDRESS O --� 0 STATISTICAL CLASSIFICATION SEWER MAP LOT NO. ��CJC. I BLOCK � 4 CLASS NO. OWELL,UNITS_ BK'� PGO / TRACT N") (,/ USZONE MAP - I NO.OF SLOGS. NO. LV/6 SIZE OF LOT NOW ON LOT I SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL. OWNER44, NO. BLOC.SETBACK FROM ADDRESS w FRONT PROP.LINE OF A (STREET) 56i -Ps TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FROML.L. �F T ARCHITECT OR - TEL. Fp �� + ENGINEER NO. BLDG.SETBACK FROM '0• ADDRESS SIDE PROP, LINEOF � / (STREET) U EL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL C CONTRACTOR NO. r� HIGHWAY WIDTH FROM LIC. ADDRESS I IOL LIC S LLA-L" + LIC, y CITY CLASS —/ CORNER CUTOFF YES ❑ NO')4 CONSTRUCTION LENDER NAME AND BRANCH _� SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS _ �`-v Sq. FT. NO. OF NO. OF NEW ❑ SIZE Z) STORIES FAMILIES E� USE OF ADD STRUCTURE ' ALTER ❑ A _ REPAIR F-1 /J SIGNATURE OF 3 d /`" / APPLICANT ' DEMOL ❑ ,/ / / / 7CFfnPQ. VALUATION L1\ I APPROVALS I FDATE lesVT..'.,.IC NATURE FEE S FEES , 7� FOUNDATION: OFORMS MATERIAA TI FRAME: FIRE STOPS, �J I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WIT MALL OR OINANCES AND LAWS REGULATING BUILDING CON- GAS VENT,-DUCTS STRUC TI OH. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE BT1TE OF CALIFORNIA IN RELATING TO WORKMEN'S COM) PEN$ N URAHC LATH, EXT. SIGNATURE OFF // PERM ITTHOUSE NUMBER COR- / EE RECT AND POSTED ADDRESS/ 4�—�CIQ/ FINAL PLAN CHECK VALIDATION CK. M.D. GASH _ PERMIT VALIDATION ' CK. M.o. CASH, Lto g _ _ ,' . NOW '1 .D . 48.75- a I WORKERS' COMPENSATION DECLARATIONS I_hereora crthatI have r certificate of consent to self APPLICATION *' FOR BUILDING- PERMIT: • insure; or a certificate 3f Workers'Compensation Insurance, - or d certified copy thereof (Sec. 3800, Lab. C.) - - PolicyNoP' 975 585CompanRepublic Indemnity - COUNTY OF LOS ANGELES. .- BUILDING AND SAFETY ❑ - BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADD RESS0� Certified copyisfiled with the county building inspec- BUILDING - - tion department. ADDRESS ' 9805 E. -La Rosa _ LOCALITY NEAREST ' Date- 11-1-86 Applicant RandolROOfina CITY Temple City ZIP 917 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. 'ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL- '-(This section need nor.be completed if.the permit is for one U NE- MAP /1 �2� , hundred dollars ($100)or less.) TRACT BLOCK LOT NO. f NO. - -/ + - TEL. - - i SPECIAL. } I certify that in the performance of thework for which this OWNER Allan Snnw NO. R7-rqQr CONDITfONS permit is issued, I shall not employan - y 9805 E. La Rosa D TRICT G3,OUP TYPE FIRE SSED,BY O p y person in an manner ADDRESS �Q /t)— CONST ZONE V - soros to become subject to the Workers'Compensation Laws. v � 'Date 1N-9-Rh A IicantRa nAnl Rnnfi no CITY Temple CIC ZIP 91780 O PP � ARCHITECT OR _ ,TEL STATISTICAL CLASSIFICATION APT., CONDO. u NOTICE TO'APPLICANT: If, after making this Certificate of ENGINEER - - NO: -- - CLASS NO. DWELL ITS �+ 'Exemption, you should become subject,to the Workers' - Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP H - with.comply,with 'such provisions or this permit shall be ? deemed revoked. EONTRACTOR Randol Roofing - NO. 288-4040 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC .. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 'NO. VALUATION - (commencing with Section 7000)of Division 3 of the Business and LIC . Professions Code, and my license is in full force and effect. CITY San Gabriel CLASS C-39 S. 643.00 451937,. C 39 SIZE STOROS FAM OF CHECK 'License Number Lia Closs — - Randol Roof iR 10-3-86 DESCRIPTION OF WORK NEWS ❑ $ Contractor -g Date — - ❑.I am exempt under.Sec. house.with Mission Tile'. ADD ❑ - ALTER EPAI E] _ DATE FINAL /� $.BP.C. for this reason - - -- - � , REPAIR ® � A Date: USE OF SED FI L<� -- . . EXISTING BLDG. - DEMOL ❑ B -'Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT Randol Roofing NO. 288-4040. , I hereby affirm that I am'exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS 529 E. Valley Bl. + SanGabriel Professions Code):. ' PRESENT - ,�' �.r• - ❑ BUILDING - I,, as owner of the prdpefty, or my employees with ADDRESS_ r 9562„3iE{ wages as their sole compensation,will do the work and , - the structure is not intended or offered for sale(Section LOCALITY - - . _;r "`: -- '-' - =#a.• e • •'1 . 7044, Business and Professions Code). MOVING TEL. - ❑ I, as owner of'the property,am exclusively contracting CONTRACTOR NO. - -( • 3 3 0,0. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS _ -�l t 4 6 ° 3 3 0,0-cXQ REQUIREDTOTAL SETBACK FROM EXIST: ' CONSTRUCTION LENDING AGENCY SET BACK - YARD HWY PROP. LINE WIDTH ; - - `I 0. 1 3 T 8 6 hereby affirm that there is a construction lending agency for FRONT . - ' the performance of the work for which this permit is issued IT I. - (Sec. 3097, Civ. C.). SIDE P.I. 7. Lender's Name Lender's Address P.C. Fee$. Permit Fee I certify that I have read this application and state that the - - - above information is correct. agree to cIssuance F -comply with County Investigation Fee ee - g ordinancesces andand State laws relating to building construction,- TotalFeeng D and hereby authorize representatives of this County to enter r upon 11 1 e kaove/�mentiogned * perty for inspection purposes. - - - - -• - ' ' - Vll2Yy�Y 10-3-8Ci SEEREVERSE FOR EXPLANATORY LANGUAGE S gnatare of Applicant rAgent Date WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT - insure, or acertificate of Workers'Compensfion Insurance, or � - o certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELS BUILDING AND SAFETY Policy No. - 5501 Company State Compensation• �%@• F-T• Certified copy is hereby furnished.• Ins Ira In Ce FwIn FOR APPLICANT TO FILL IN BUILDING - , - . ADDRESS. Certified copy is filed with'the county building inspec- 'I BUILDING - tion department. ' ADDRESS 9805 E La Rosa D r , ocqury ✓ Date'4-1-80 Applicant Howard "L .Randol C. CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. - ASSESSOR. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permitisfor one USE ZONE MAP TRACT BLOCK LOT NO. NO. hundred dollars ($100) or less) 0. TEL (L�.'LL �f SPECIAL 0 certify that in the performance of The work for which this OWNER N — '1 " CONDITIONS permit is issued, I shall not employ any person in any manner ' ' DISTRICT GROUP TYPE FIRE O SSED BY \U ADDRESS CONST. p� so as to become subject to the Workers'Compensation Laws. � a� 12_30-80 Howard L . Randol Co ary Dote Temple Cit ZIP 91780 (/ Applican STATISTICAL CLASSIF CATION APT.. CONDO. U NOTICE TO APPLICANT:' If, after making this Certificate of - ARCHITECT OR TEL. - w Exemption, you should become subject to the Workers ENGINEER NO, CiA55 NO. / DWELL. UNITS= N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP - with comply with such provisions or this permit.shall be TEL deemed revoked. . CONTRACT 8 8-4 0 4D BK, PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chopter 9 ADDRESS NO. 12 F n 2 F VALUATION - (commencing with Section 7070).of Division 3 of the Business and - LIC. - - Professions Code, and my license is in full.force and effect. CITY San Qahriel CLASS — —39 s 468.9 . 00 SQ. FT, . NO. OF NO. OF CHECK License Number 186086 Lic. Class 1 39" SIZE STORIES FAMILIES ONE Conira<FdA Nlard L .Rdndol Dr�eO. 12=3Q-80 DESCRIPTION OF WORK _ W $ am exempt from the licensing requirements as I am d ADD licensed architect or a registered professional engineer ALTER FINAL /'. — 7 acting in my professional capacity (Section 7051, noW © DATE REPAIR Business and Professions Code), U9F Op FINAL EXISTING BLDG. DEMOL ❑ B ,Lic or Reg. Na. Date APPLICANT ' TEL. Y OWNER-BUILDER DECLARATION PRINT) d nd l C . 2$$-4040 . I hereby affirm thatJ am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BUILDING I„ os owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and _ •the structure is not intended or offered for sale (Section LOCALITY l3 S$9.A 7044, Business and Professions Cade), MOVING TEL, I, as owner of the property, am exclusively contracting CONTRACTOR NO. # st• s • 1 with licensed contractors to construct the project (Set- ADDRESS tion 7044, Business and Professions Code). - 2•• - 6.1.0 0 TOTAL REQUIRED L SETBACK FROM EXIST ' CONSTRUCTION LENDING AGENCY, SET BACK YARD HWY PRORAINE WIDTH' ' I hereby affirm that there a construction lending.agency for - FRONT - • •'• 6 1',0 0Z .the performance of the work for which this permit is issued P.L. .(Sec..3097, Civ. C.I. SIDE 1 23 1 -8 0 P.L. _ • ,. Lender's Name t t 1 P.C. Fee$ Permit Fee 54 00 Lender's Address ' I certify that I have read this application andstate that the n above information is correct. I agree to comply with all County Issuance Fee Investigation Fee, -- • - - ordinances and State law/rp�erloher to b ding construction, $.61 . DOandhereby au or' a repe his County to enterTotal Feemupon t e ve of f r inspection purposes< _�� SEE REVERSE FOR EXPLANATORY LANGUAGE g urea ApplicantAgev - Date- OOs