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HomeMy Public PortalAbout9814 LA ROSA DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING e717 I ereby-affirm thaLl•have a certificate of consent to self.insure, BUILDI DR SS A Q/� �7 or a certificate of WorkersCompensation`Insurance,ora certified Copy thereof Sec. 3p@ L'L��l,a(;) p,..y AlCITY y, /" ZIP 4 sT07 l T /7 L.c GI TL / ��� LOCALITY Policy No: CyC� Company 1SIZE OF LCT NO.OF BIGGS.NOW ON LOT ` .. ❑ Certified copy is hereby fuinishetl. NEAREST CROSS ST ❑ Certified copy is filed with the county building.inspection TRACT BLOCK LOT NO. departmen - USE ZONE MAP N0. _ /•� Y �•`/" .. ASSESSOR MAP BOOK. PAGE PARCEL Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER - TEL NO. - COMPENSATION INSURANCE r /'N LWiTHIN 1000 FT OF SCHOOL' YES NO ADDRESS (This section need not be completed if the permit is for one hundred /.^/J(�II /J Q�� DISTRICT GROUP TYPE CONST FIRE ZONE PROCFA�ED BY dollars($100)or less.) (i''f F�/��TC//� J qD ^ ��� '/1]V//Atl,/rn c''y CITY ^ ZIP .i-S �,) '/J�l/ o� I certify that in the performance of the work for which this permit (, 4' is issued, I shall not employ any person in any manner so as to become su lect�to the Workers'C/9J(npensajEJ!9n Laws ARCHITECT OR EN (NEER TEL NO. ppp ggg Date/. Applicant /r / f7�v ADDRESS - - CLASSSTATISTNOL QZ CLTIDWELL UNITS ON APT - NDO NOTICE TO APPLICANT- If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST' Exemption, you should become subject t0 the Workers'- CONT AGIC5 n TEL O `�. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions Of the Labor Code' you must forthwith,. -//� pr / �S ,J/�� FRONT comply with such provisions or this permit shall be deemed.revoked. q 13- I ir; 1 �y� A L LICENSED CONTRACTORS DECLARATION dJ / SIDE 'CITY / 2 LIG CL P L I hereby affirm that I am licensed underprovisions Of Chapter 9' �- •�D�„ 1� I SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and SO FT`SIZE NO.O%STORIES NO.OF FAMILIES NEW El BK PG j CIL � Professions Code,and my license is in full force and effect. {] U License Num�bQ�„ j.r Lia Class F _ DESCRIPTION OF WORK ADD ' ❑ VALUATION ,y� , hr 1 .T .. Contractor SSS/tLL,r LL/4x Date' 3 ,�/L� �nq T�'� ALTER ❑ $ V" - 717 I C�/VSS RP— -. JJUJ +r.)ttf O ❑ I am exempt under Sec. A REPAIR ❑ $ .... f �.�. ,,.',_, I^- -B.SP.C. for this reason _ �/T S � DEMOL ❑ .,,, El c W Date: USE 0 EXISTING BLDG. DRM ❑ LDMA P/C# .T (�AL a . _r Signature . . .. - .ytt_ri t./ F1Z - .APPLICA T'(PRINT) TE 0, LDMA Perm# .. _ /L/'L 1'i/74; 0' �c� 'J�p .. ... Z CHANGE r t ❑ I, as owner of the property, ormyemployees with wages as their sole compensation, will do the work and the structure is AD S5 - _O mt intended or offered for SBIe (Section 7044, Business and �S/y- �i•�//1/// '-FINAL DATE Q Profession Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I I(I~ )� II{ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ioclo 'c J ❑ I, a5 owner.of the property, am exclusively contracting with ` Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY - 1'�.� '1hi licensed contractors to construct the project (Section 7044, - f ,Lr ' i nil y;il Business and Professions Code.) As E] NO El ' , WILL THE INTENDED USE OF THE BUGLING SY THE APPLICANT OR FUTURE BUILDING - - - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAQMm SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ . NO❑ _ the performance Of tt12 Work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING ' 3097,Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 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 SCAOMD o Lender's Address O a+r.F oR wFr. o I certify that I have read this application and state under penalty o P.C.FEE PERMIT FEE of perjury that the above information is correct. agree to comply 7 C. with all county ordinances and State laws relating to building m construction, and reby Ruth Orize representatives Of this County ISSUANCE FEE w to enter It ffe- a io a roperty for p inspect) n rpo s. V `7 INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE MAMA CE#.03 0-.. - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDIADDRESs DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY - < JOHN A.LAMBIE,COUNTY ENGINEER NEAREST n CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS.ST. DISTRICT NO. GROUPI TYPE ` I P SSED BY FOR 'APPLICANT TO FILL IN CONST . BUILDINGn ADDRESS Rear OY 9812 Ia Rosa STATISTICAL GLA$$1 ER MAP FICATION SE PG CLASS. NO.�DW ELL. UNITS ea I?- Nye{ BLOCK MAP 3� � STATE" 9) Sl NUMBER rJ� C / HWY. YES TRACT ' �`YY vn Avon USE ZONE SIZE OF LOT 66x268=6 NO O BLDGS, �r CONDITIONS NOW ON LOT 2 L .USEOF Dwelling &' Det.Garage EXISTINGBGDG. BUILDING EXIST: Alexander 'Tambie YARD HWY TREET NAME SETBACK WIDTH OWNER n FRONT AMAILDDRESS 9812-la Rosa P. L. - SIDE c14v Temple City TEAT 60818 P.L- - ARCHITECTOR TEL. : INSPECTION RECORD ENGINEER none NO. ADDRESS ana Ons L7T 11)74 CONTRACTOR NO. ADDRESS 8717 Las Tunas Drive,San' Gabri DESCRIPTION OF WORK NEW X ADD rv�ALTER REPAIR DEMOLISH SIZE 1118+280 (�' r STORIES 1 FAMIILIES 1 USEOFSTRUCTURE __- Dwe in & A t ched Garage, SIGNATURE0 APPROVALS APPLICANT - ATE INSPECTO "SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS,MATERIALS 1I _ P. C. 4 ^Y�- (r FRAME: FIRE STOPS. j q / FEE !R—= BRACINGr BOLTS 4 I( VALUATION FEE $ �/•� f4 FURNACE:GAS VENTLOCATION.D U CTS I�.-.�5 arf 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'TO COMPLY WITH AL COUNTY ORDINANCES AND STATE LAWS EGULATING BUILDIN CO STRUCTION. LATH, EXT. - .1 SIGNATUREOF �' HOUSE NUMBER COR- ! PERMITTE RECTANDPOSTED _�---'�� ... ( ✓ � � ADDRESS FINAL CLYDE N. DI RLAM, PRI NCI PAL STRPCTbIRAL ENGINEER PLAN CHECK VALIDATION cw 1. M.D. CASH PERMIT VALIDATION crc. M.D. CASH ' I ;iGo 94 7 0;° J'dL -14. 2 3 A 13 .0 h ,? Lk3 6.0 0 J 9 5 9 5 � IL 16 1 A ®. ARATION WORKERS'COMPENSATION DEPL - i _ _ he y affirm Thal haver ce' CIicome of wnsent.to self APPLICATION FOS BUILDFI`j PERMITy l ' P insu a or a certificate 'h Workers Com ensattan Insurance, or o Certifiedcopy thereof (Sec 3800 Lab. C )• - - '- -' -'-' - """ '" - "-' "t C1`'"z .- _ _,. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy.No. Company - • • •- - -t`f -Certified copy is hereby furnished.-'. t n _ FOR APPLICANT TO FILL IN BUILDING �' Ceftified'copy'is file8'with the:co`unry build Ings inspec $UILDING'- - - -_- -L I /1 1 ADDRESS _ I/{ 8l C-'�i4 v F tion department ^• + s.l -e' ADDRESS r y�Y j �rq -.�. . •i p -\ �� / ! ZIP_.- ! Ge• ;. Date Applicant ,. CITY LOCALITY. �(.•, 'CERTIFICATE OF EXEMPTION,FROM WORKERS"%--'". " "" `-"" NO. OF BLDGS: - -- - NEAREST, {OMPENSATION INSURANCE ' SIZE OF LOT - - NOW ON LOT CROSS 5 . -OL (This section need not be completed if.the perm itis•for,one ----• ---•-— - +- ---- - - - ---_ ._ .. ASSESSOR tri - - r . 'hundred dollars ($100)or less.) ,,�. RAOT ' . K. O MAP BOO i _ ' S "BLOC L T NO. K .i . PAGE PARCEL TEL. j USE ZONE MAP I'rerLfy that.i ri the performance of the work for which this OWNER - (.F .� r N NO. permit is issued, I shall not employ any Pers n any`'manner _ _ �7 (/ L r '� SPECIAL: - - --- -. - - - !O -so as to become:subjecPto If W o n ation'Laws. ADDR (� - - - - / O 5- fa a CONDITIONS _ CIT _ _ _ AR HITECT OR TEL O NOTICE O APPLICANT: 14; afterymaki �"t i Certificate f C�?'"� DISTRICT GROUPi TYPE .,_ FIRE OCE SED BY Exempiion,'you should become:'subject-,to'the+-Workers' ENGINEER NO. hf'• ,? CONST.. + ZONE tV Compensation provisions of the-Labor Codep you must forth- 'ADDRESS .�.f,GO _� _ i 6 ,with Comply with,;such p _ ._. __ _ ..- ��' h py� provisions or this permit shall 'be -. � - N deemed revoked , _ TEL STATISTICAL CWS I�ICyT ION i APT. CONDO Z w CONTRACTOR LPJ��� NO. _ S5IJJ,�!f// LICENSED CONTRACTORS DECLARATION-v _-. --,.y -- J -- -- . —LICr-.__ ._.,..1 - -CLASS NODWELL UNIT S_ - hereby affirm that I am licensed under provisionspf Chapter 9 ADDRESS ° r NO. (mmm r;g viith,Section 7000)of Division 3 of the Business and .LIC.- SEWER MAP 1 - v •u , Professions Code, and my license is in full force and effect. CITY CLASS -"' VALIDATION- So . R: NO. OF NO.OF CHECK BK.�'PG. 't'•' ••'' Y -'� - - _ _ SIZE STORIES _ - FAMILIES� --"ONE _ •f License Number ' • LIC Class i VALLI t - .. -- DESCRIPTION OFWORK '_ .NEW -. co�sra tar Date s O D O L /,L} ADD I am exempt under:Sec- Ser- 4D Df•- ALTER Poo. 4- 7 B.BP.C. for this reason 96,11 iozm f�l 4Ilve REPAIR. -. Date: _ USE OF - - r EXISTING BLDG. DEM OL 1 Signature - .._._.. " ._ APPLICANT.: - - -.. 7 !/,' FINAL -OWNER-BUILDER DECLARATION (PRINT) N !T ._DATE ,hhereby offirm.that I am exempt,from the Contractor's.License Law fo the fo11Owing.reasori(Section 7031.5, Business and ADDRESS FIN t `Prof ions'Code)' "�'-""-' RE ENT• -- - - -- - "BY - BUILDING • i4 .r .,i, I, as owner of the property, or my employees with ADD RESS wag'e's as their.solecompeion nsc :will do the work and -` - ' - - -the structure is not intended a,offered for sale(Section LOCALITY - - 7044, Business and Professions Code)'- MOVING--c - - • - - TEL ^ --- - + -' - - - _ - --. - -- ' 1, as owner of the property, am exclusively contracting CONTRACTOR _ NO.' ' L. X60-7,5A ' - with licensed-contractors'to'construct the .project ADDRESS # e tion 7044, Business and Professions Code): i _ ..REQUIRED_ TOTAL SETBACK FROM_ CONSTRUCTION LENDING"AGENCY -' "" ' SET BACK - YARD '•HWY - - pROP. LINE -EXIST, �I. - - I-- it 6F�,6�J I hereby affirm that there is'a construction lending agency for FRONT - ' "' '° t the-performance-of.the'war for which t permit is issued - _ - RL_ e,6.&-6 3,0- (Sec. 3097, Civ. C.). SIDE P.L. _ _ ._ . .,_ _ " 120886 a Lender's'Name , o i3 LDMA Ref. It er_ Pe,mirFee ,T — / __ .. - ._ _ . - Lend 's_ dd Aress ,• }. ., 1 _ y:l „ (,certify.thatA.hove.read this.application.and_stote.lhmJhe -. ... _._ _ ._ Issuance Fee; D' -- -- LDMA P/C N.--- -• .. '. .... { _ Q above information is correct. I agree to comply with all County In estigatian Fee g ordi State laws relating to building construction, _ Total Fee- - - LDMA•Perm. N;-- -- - - - - - -ft nd hereby authorize representatives of this County fo enter - the abomentioned property for inspection purposes. - _ `SEE REVERSE FOR EXPLANATORY LANGUAGE~ .-- Signature APElicanror_A nt - - Do ....... APPLICATION FOR BUM ING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION BUILDDDRESSFOR APPLICANT TO FILL IN BUILDING ADD I /Z E. aLR� hereby affirm that I have a certificate of consent to self insure, x] 14 or a certificate of Workers'Compensation Insurance,or a certified CITY—F,;-,p TY� ZIP copy thereof(Sec.3(100,Lab.C.) c ,n l� er q 1" -'/ ( -7 PCJ LOCALITY POIICy N0.—Company SIZE OF LOT r NO.OF SLOGS.NOW ON LOT L L e ❑ Certified copy is hereby furnished. 11 -15' 1 NEAR�CRQS$ST. Oft ewEsT_ ❑ Certified TRACT BLOCK LOT NO. department. is filed with the county building inspection 2 USE ZONE MAP NO. U q Date Applicant ASSESSOR MAP OK PAGE PARCEL � y�_/7" 7 —�2 D Z Z ©� I �/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NOX62 YES NO COMPENSATION INSURANCE °"� - L"'`' '"f ��`� WITHIN 1"ff.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred 2(� �` ��iz(i--rP'Oa DISTRICT -GROUP TYPE CONST.' FIRE ZONE PROCESSED BY \• dollars($100)or less.) - CITY I certify that in the performance of the work for which this permit A ZIP/p �.� 46 Is Issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NO. become Subject to the Workers'Com ensetKi L S. pp STATISTICAL CLASSIFICATION All CONDO Date i0 L4 ApplicantZa- -�-�Z L / ADDRESS CLASSNO. `-"/ DWELL UNITS b NOTICE TO APPLICANT: If, after making this Certificate C{// REQUIRED TOTAL SETBACK FROM EXIST Q1I CONTRACTOR TEL.NO. Exemption, you should become subject t0 the Workers SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith J cumplywith such provisionsorthis permitshall bedeemed revoked. ADDRESS LIC.NO. FRONT PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PHIL 1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES NO.OF FAMILIES - C Professions Code,and my license is in full force and effect. NEW ❑ SK PG , O License Number LIC.Claes DESCRIPTION OF WORK ADDVALUATOM It;� O j`I Contractor Date 1 ALTER El $ �AZ'� 6' z ❑ I am exempt under Sec. T(�hoo�ti._ REPAIR ❑ $ B.BP.C.for this reason DEMOL ❑ LOMA P/C0 Date: USE OF EXISTING BLDG.. .ARM ❑ i' Signature APPLICANT(PR�WT)/'� TEL.NO LOMA Perm# %I ^ TI, as owner of the property, or my employees with wages as J_ .�9..Y `—T Yb2 &� _ _ Meir sole compensation,will do the work and the structure is ADDRESS O C i not intended or offered for sale Section 7044, Business and CF.T= ~ ACS. ( 268ca Sz�a�Fa�� 9 3 6 FINAL.DA /�)� Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ZL // j "`I� :,ivi)I1 ❑ 1, as owner Of theproperty, am exclusive contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN 1.{ Y g THE AMOUNTS SP CIFIEDONTHEHAZARDOUSMATERIALSINFORMATIONGUIDE? FlNAL '� i 11EM licensed contractors to construct the project.(Section 7044, ! Business and Professions Code.) YES El NO 4 TOTAL v.._n �� WILL THE INTENDED USE OF THE BUILDING BY THE AP0.ICANT OR FUn-RE BUILDINp OCCUPANTREOUIRE APERMRFOR CONSTIIUCTONORMODIFICATIONFROMTHESOUTH �. CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ac*OMO)sEE PERMITTING CHECKLIST CHECK :y;7,[l I FOR GUIOEUNEE. I hereby affirm that there is a construction lending agency for YES❑ NO CHANGE ,Ill i the performance of the work for which this permit is issued(Sec. 3097,Civ.C.. - I HAVE READ THE'HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECKLIST,I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTYCODE,TULE2CHAPTFRZ.MSECTIDNSZM.lWB RW HZA.MDCONCFANING ��_ ��r({ +,_•/ I Lender's Name H.=s oD�<,,. TINGANOFO OB TAININGAPERMITFROMTHESGOMO 11 ) II)—f' 1 lUf 4I5".11 Lenders Address CVMER p1ADDR .1.7 1 AMINO. o' I certify that I have read this application and state that the above RC.FEE P MIT FEE information is correct. I agree to comply with all county / ordinances and State laws relating to building construction,and �o hereby authorize reprasentatives of this County to enter upon ISSUANCE FEE the above-/1�1�anti ed property for inspection purpo7Y� p m - ,LQQ,/ Lam•I n.+ 1� in Dgo INVESTIGATION FEE TOTAL FEE sPw..Mrop�.no APnl I Pw SEE REVERSE FOR EXPLANATORY LANGUAGE. COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9909220033 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 9481 LT: 14 BL: .001 UN: .002 SO. FT STORIES TYPE 9814 LA ROSA DR STRUCTURE: 120 VN TEMP CA 917803920 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GOLDEN WEST 8589-022-031 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-I ISSUED 0 PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 09/22/99 VG 03/20/00 OWNER: TEL. NO: SLOGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: TAKEHARA, PATRICIA (626) 2867514- 6,000 _® 9814 LA ROSA DR. TEMPLE CITY 91780 FEES PAID DESCRIPTION OF WORK ADD CLOSET 120 S.F. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. N0: PRIMARY HOME IMPROVEMENT (310) 618-1881- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 6000.00 VAL 0.60 SPECIAL CONDITIONS: AX BUILDING REVIEW:FEE 54.70 D2 PERMIT W/O-EN-H�CE L 6000:00 VAL 149.40 ` P,N TOTAL FEES 232.45 CONTRACTOR: TEL. N0: �Cj ��/LAPPROVALS DATE INS ECTOR SIGNATURE, PRIMARY HOME IMPROVEMENT (310) 618-1881- 20802 S. NORMANDIE LIC. NO LOCATION AND SETBACKS TORRANCE, CA 90502 7281958 / SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH ORMS LIC. N0:// 1111-i1 SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZON -.-CMP,'., UNDERFLOOR INSULATION 144-269 3 ' II �11 II O L � wO Ro' FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/CONDI S AT CL SS`(''�- �`-�l L� lJ �1 NO 21 \\( 6/ 8 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS O D 3l h B 9 i,If SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS Q Q I- NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST 46 -n1 Ott FIRE SPRINKLER HANGERS FSET BACK ROPL- YARD: HWY: PROP LINE: WIDTH: NT /TC Servic a That V` INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH , ,�•` RATE FLOOR/CEIL ASSEM. z RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOTDRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508