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Home My Public Portal About9817 LA ROSA DR_Building__ '76A636A CE#8035-6, APPLICATION FOR R BUILDING PE 1- COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DWISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OI BUILDING CROSS ST. P _ DISTRICT N GROUP TYPE P SSED BY,- FOR APPLICANT TO FILL IN � CONST, BUILDING STATISTICAL CLASSIFICATION 5 WER MAP ADDRESS CLASS. NOA�Dl ELL. UNITSjgJlK f- LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: TRACT 94 MAP HIGI NO.OF SLOGS. NO. (CIRCLET STATE MAJOR SECOND, LOCAL SIZE OF LOT (NOW ON LOT Us- ZONE SPECIAL USEOF JI / CONDITIONS 'EXISTING BaG. /J[Jfi OWNE BUILDING YARD HWY S EET AME EXIST. _ SETBACK WIDTH AD S '- FRONT ARCHITECTOR TE P. L. Y ENGINEER .NO. SIDE ADDRESS ! INSPECTION RECORD CONTRAC ya ADDRESS /W DESCRIPTION OF WORK F �r '�° —'� - �� d IL ADO ALTER NO.OF REPAIR DEMOLISH SO.FT. NO.OF 1R-LCl WSJ�,ELG.{F! NAIL. /✓ /.�- SIZE ^STOYRIES FAMILIES •f STRUCTURE C ! n r f SIGNATURE P APLICANT lywLlz � VALUATION$ '• APPROVALS .DATE INSPECTOR'S SIGNATURE qqPMT. FOUNDATION: LOCATION .-3/9 9/0 7 .f' �f F E $ Cr FEE $ FORMS.MATERIALS �G'� V LL- i�d.�2�L� • FRAME: FIRE STOPS, /J 41 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS L A // AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, • WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK n AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PE N VOLA. LATH. INT. 1 In // TION OF TME LABOR CODE OF,THE STATE OF CAL. IA RELAT . TNG TO WORKMEN'SCO PENSA N IN6U RANGE. . LATH,EXT.SIGNATURE ^^ ''� ^✓/A II NUMBER P RMIITTEE OF HOUSE AND POS EDR �/ F ADDRESS — FINAL .� CLYDE N. DIRLAM, P IN61PAL STR RAL EN A EER PLAN CHECK VALIDATION cc M.O. CASH PERM VALIDATION CK M.O. GSH 7342 JAN 2323D 22.50on, D fe, ,7751 � FEB 2 1 0 45.00 APPLICATION. FOR BUILDING PERMIT �\ COUNTY OF LOS ANGELES BUILDING AND SAFETY r FOR APPLICANT TO FILL IN - BURDiN ADDRESS WORKER'S COMPENSATION DECLARATION , -' I hereby affirm that I have a certificate of consent BUILDING ADDRESS to self insure, �� -n0isA Dr or a Certificate of Workers'Compensation Insurance,or acertified CITv� ZIP COPY Hereof(Sec.3800,Lab.C.) ( F H{SLE c �'�O LOCALITY Y, Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. X(60.p NEAREST CROSS ST. I RACT BLOCK LOTNO. ❑ department. Copy 19 }fled with the county building IDSpeCti00 USE ZONE MAP—NO, department. - - ASSESSOR MAP B PAGE o PARCEL Date-Applicant �y I ODp ®/O SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER W)I I i cLAAn ERAW H NO - YES No COMPENSATION INSURANCE 1 WITHIN 1000 FT OF SCHOOL? . ADORES�u"Q /, dA /••� (This section need not be Completed if the permit is for one hundred ! V�7 I� Dr' DISTRICT "GROUP TYPE CONST' FIRE ZONE PROCESSED BY dollars($100)or less.) CITYT�aH^LE i .ZIP z, p a certify that in the performance of the work for which this permit ll GEC (E 1 i3 issued, I Shell not employ any person in any manner a0 83 l0 .ARCHITECT OR ENGINEER TEL.NO. �l become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATIONAPT CONDO Date Applicant ADDRESS CLASS NO. �/ DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate o REQUIRED TOTAL SETBACK FROM EXIST p I Exem tion, you should become subject t0 the Workers' CONTRACTOR TEL.NO. SETBACK YARD HWY PROP LINE WIDTH f Compensation provisions of the Labor Code, you must forthwith FRONT comply With such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PILE 1 1 hereby affirm that I am licensed under provisions of Chapter Q SEWER MAP (commencing with Section 7000)of Division 3 of the Business an SL.FT SIZE NO.OF STORES NO.OF.FAMILIES Professions Code,and my license is in full force and effect.. - y�3 NEW R BK PG U DESCRIPT ON„ F WORK VALUATON W pool License Number Lic.Class O�(�t6 ADD Lr- y Contractor Date \ ALTER ❑ $ 3_4 M�13_nING REPAIR ❑I amexempt untler Sec. $B.&P.C.for this reason — ❑ LOMA PIC#Date: . ' 11RM ❑ L. Signature APPLICANT( I r Tf�L. O �^- LDMA Form# •='�' ❑ I, as owner of the property, or my employees With Wages as Ir r 3 D'� YL �� 0 ' A'Ir•t s their sole compensation, will do the work and the structure is ADDRESS � `` F ��^' -- not intended or offered for sale (Section 7044, Business and 0- eAr'Ol Cl FINAL DATE "y= Professions Code.) OR A MEAPFLICANi ORFUNRE HAZARDOUS S MATERIAL EQUAL TO O RGREAMATERIAL ❑ I, 83 OWOe! Of theproperty, am eXC USIVeI contracting Wllh OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EDWL TO TI GREATER THAN Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL By \ licensed contractors to construct the project (Section7044, Business and Professions Code.) WILL ❑ No❑ W WILL THE INTENDED USE OF THE BUILDINGUCT THE APPLICANT IO FROM?UTURE ESOUNGOCCU CONSTRUCTION LENDING AGENCY COAST ANT BEDUIITY MANAGEMENT TFOR DISTRICT rS NORMOOIFIGTmN TING CHECKLIST COAST AIR DUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR GUIDELINES. _ '-[['-'��- { I -A J1 �f' v � .7 J.1iiI. 1 hereby affirm that there is a construction lending agency for vFs❑ No❑ ' the performance of the work for which this permit is Issued(Sec. CAiQMD 3097,CIV.C.. I HAVE READ THE HAZARDOUS I UNDERSTAND MATERULS INFORMATION GUIDE AND THE ANGELES - - — - ) PERMITTING C,TITLE SL I CHAPTER MY REQUIREMENTS UNDER THE LOS ANGELES - HAZARDCOUNTY OUS 2. REPORTING NDFO OBTAINING IT FROM CONCERNING ' ilL moi'\ ;4v?�iT 3 Lenders Name HAIAnDOUS MATFAIALS flEPORTING AND FOR OBTAININOAPERMIT FROM THESCADMD. Lenders Address a a'mrAaa�aFNr o' I certify that I have read this application and state that the above information is Correct. I agree to comply with all county P.C.FEE p PERMIT FEE ' ordinances and State laws relating to building construction,and I� / _;jld[j i— 1 7{ hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. w a ? n 'f INVESTIGATION FEE TOTAL FEE - SEE REVERSE FOR EXPLANATORY LANGUAGE.