HomeMy Public PortalAbout9832 LA ROSA DR_Building__ 761''698A.CE 0803 12/69
APPLICATION FOR BUI� PERW fl
• COUIQTY OF'LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING 23
z
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT of BUILDING LOCALITY t�l_FOR APPLICANT TO FILL IN NEAREST
Print Ot type Onl CRASS 5T.
BUILDING �J d Ipn� y� F^� DIS T�JnCT NO. GROUP TYPE -A�� SSED BY
27 n/1A7 V - P'S -AV �_ CONST. 1/
ADDRESS :T
STATISTICAL CLASSIFICATION 5 WER MAP /J
4NGBLDG�.
BLOCK CLASS NO. L/ DWELL,UNITSSK �PG7 USE ONEMAP !-� � &
NO.OF BLDGS. NO. C_(/NOW ON LOT � SPECIAL
(� CONDITIONS
. O'K" I E, /� eIy'�.`. fwwNOL �a�7Qa0BL ETBACK FROM
3-U. 'J Q. (1 b ° FRONT P.LINE OF —(STREET)
TYPE OF E%ISTI ETBACK HIGHWAY } YARD = TOTAL
CITY r%'t. A"I P G. C' IT HIGHWAY WIDTH F C.L.
ARCHITECT OR TEL }
ENGINEER NO.
BLDG.SETBACK FROM
ADDRESS SIDE PROP.LINEOF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY { = TOTAL
CONTRACTOR D W/�,/` E NOL HIGHWAY WIDTH FROM C.L.
LIC.
ADDRESS NO, + = d
LIC. l O
CITY CLASS `�,'CORNER CUTOFF ^�YES�❑
CONSTRUCTION LENDER t Y `L••K
O
NAME AND BRANCH SEE YEVERSE SIDE FORTfEq4l, APPR VATS = H-
w
ADDRESS /�jj�� / / d Z
Sl E T B(,J STORIES IF NO. OF FOMOFES NEW / ` /G
USE OF ADD C,
STRUCTURE /�{-F imecM•, ALTER ❑ t /
REPAIR❑
APPLICANT F DEMOL ❑
VALUATION $ 5, Q� APPROVALS DATE )NSP TORR•9 $ NATURE
`` FOUNDATION: LOCATION
FEE S FEE $ r V FORMS, MATERIALS iG•
FRAME: FIRE STOPS.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE.IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUC TI ON, I CERTIFY THAT IN DOING THE WORK AUTHORIZED //
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. //
LABOR CODE OF THE STATE OF CALI FOR
NIA IN RELATING TO
WORKMEN'S COMPENBA IDH INSURANCE.
LATH, EXT.
SIGIATURPERMITTEE OF � HOUSE NUMBER DOR-
�'/� �� �- RECT AND POSTED
ADDRESS X70 SO hAR I nTIl� FINAL
daFa
JOHN F. LEWIS. PRI NC IPA) STRU RAL ENGINEER
PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M.o. CASH
�� 7 1 8 3kOCT 14 1 D 3 3.00-
WORERS COMPENSATION DECARATION. Ux /� '-'(/"/`/" '.-e
/. -
K
P,�,�'-7P�I-T.,-by nafert l att; of Workers'
certificate of tion fnt to se�ff/ ^ �UC,r.����.1 I� w ��®� �c®e` .Mtl'�D'�V '�`�Y�Y'�
insure ora' ertificate of Workers' Compensation Insurance, J/; C ` /�
ora certified copy thereof'(Sec. 3800, Lab C ) �1 - - p, -
PolicyNo. _ Company AA v / - - - COUNTY OF. LOS ANGELES'- ' �� 'BUILDING AND SAFETY
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
❑ f ADDRESS V�., Jt. F
Certified'copy is filed with the county buildinginspec- BUILDING p p
tion department. ADDRESS / V 32 J a'" /-Q !� A 'W:
Date ' Applicant CITY705M,4LE . C/T)' - ZIP CA
'7 34 LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' rS2 �C/OA NO. OF BLDGS. . ' NEAREST
COMPENSATION INSURANCE, SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one /� _. ASSESSOR -
hundred dollars-($100)or less.) TRACT' BLOCK LOT NO. MAP BOOK PAGE PARCEL:
OWNER Y- /V, mC'�.CNO CYE TEL. USE ZONE MAP
I certify that'in the performance of the work for which this: TND.s�s'J- �� NO.
permit is'issued,'l shoIFnot employ any person in any manner_ 1 D g �-n r SPECIAL
so
t
so as to become subject to the Workers' omppee nnsation Laws. ADDRESS f O J •2 �-A-_' QO. r/'. ® CONDITIONS 0
�e10 P / .Yi CITY %6/Y)PLgE C/rt' eAnP '9/7&- A, . - C
Date Applicant - 0.'
ARCHITECT OR TEL r�/�� DISTRICT GROUP TYPE FIRE PROC SED BV
NOTICE TO APPLICANT If, after m Cng thls'Certificate of ENGINEER /f/Y-•./rII,1C �i�dL9U NO. J 7 -Scfr -
Exemption, .you should become subject to the Workers' _. �/1` P CONST. ZONE C~.7
Compensation provisions of,.the Labor Code, you mustforth- ADDRESS ✓l✓f� E\ 25
W
with comply with such, or this permit shall be - TEL.- STATISTICAL CLASSIFICATION APT. CO (L
deemed revoked. CONTRACTOR NO. Z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO. DWELL. UNITS_ _
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1P NO. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and - _ UG A
Professions Code, and my license is.in full farce and effect. CITY •CLASS BK PG J VALIDATION
SO. FT. NO.OF NO. OF CHECK ,
License Number Lic.Class SIZE - STORIES FAMILIES ONE
- 6WVA GG & x, VALUAT ON
DESCRIPTION OF WORK C-/�N7YC—.59. F/�Oryt NEW - ❑ '
Contractor Date $ �
❑ I am exempt under Sec. _ FL r9T ,2e �p 7`o GA BLS' (,op ADD � -
ALTER :'9 5 4.4 A
B.BP.C. for this reason 41I/t S, OPE Com Pa 3/7Te rceaF $
_. IMPAIR � - '# s e a • • 1
Date:' USE EXISTTIING BLDG. O VE'1Z 6 X/.S7-/A1F/ZRO DEMOL ❑ '
- 49,88
FFyy :I •
Signature " APPLPR NTT N/Yam MEEClPR$VFNO.• FINAL _
OWNER-BUILDER'DECLARATION - DATE, — °.• • k9. 8 8 0
I hereby offirm,thot I am exempt from the Contractor's License ' - 9 L� 20 J'A )- P `~
ADDRESS �3 O /n L-E.
Law for the following reason (Section 7031.5, Business and' °� FINAL' O 506-88
Professions Code): - - N By
BUILDING 9S'32 t.9- :Eo'8N' pY.
I, as owner.of the property, or my employees with ADDRESS _
wages ct their sole compensation,will f o the(e and '- J, EM PL fi G'/T" C
the structure is not intended or offered for sole Section LOCALITY /
7044,.Business and Professions Code). "• MOVING TEL. ,
I, as owner of the property, am exclusively contracting CONTRACTOR - NO.
with licensed contractors to construct the project (Sec-
tion 7044, Business and Professions Code). ADDRESS
CK
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTA PROP .ETBZ NE WIDTH /� '�,` A
Ihereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ, C.). SIDE
.. .P.L.
Lender's Name
LDMA Ref. q
m Lender's Address P.C. Fee E Permit Fee - ..
3 �{
certify Thar I have read this application and state that the IssuanceC!.Fee. r ®V- TDMA P/C If
above information is correct. I agree to comply with all County Investigation Fee Q
ordinances andStatelaws relating to building construction, Total Fee {/ LDMA Perm: q
and hereby authorize representatives of this County to enter
up o the above-mentioned/property
�for inspection purposes. - `
SEE REVERSE FOR EXPLANATORY LANGUAGE ,
ignature of Applicant or Agent Data - - -