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HomeMy Public PortalAbout9842 LA ROSA DR_Building__ J 76A636A EEe8035-65 APPLICATION FOR BUIL ING PER T � COUNTY OF LOS ANGELES BuIL01Nc DEPARTMENT OF COUNTY ENGINEER AODRESs BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST JJ _ COLEMAN W. JENKINS.SUF'T OF BUILDING CROSS ST. LQ� DISTRI T NO TYPE P B FOR APPLICANT TO FILL IN 0„ CONST G` BUILDING y' I //1I STATISTICAL SSI FICA TION SEWER MAP 'I ADDRESS / 4'�Q CLASS NO. DWELL UNITS BK PG LOT NO. �. LN E 0� D BLOCK USE ZONE MAP ' /TRACT SPECIAL NO. OF BLDGS. �) CONDITIONS SIZE OF LOT © NOW ON LOT -It - USE OF _ EXISTING BLDG. BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF (STREET) OWNER NO. TYPE OF E%ISTING SETBACK HIGHWAY + YARD - 'TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CITY ARCHITECT OR TEL. BLDG. SETBACK FROM .� ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OF E XIS TING SETBACK HIGHWAY } YARD — - TOTAL ADDRESS - HIGHWAY WIDTH FROM C.L. CONTRA CTOR ENE NOL +LIC0 ADDRESS.��/(�a ,J I$L%� NO i tl.✓ 7 �/ CORNER CUTOFF YES NO V CITY 7710 L�` SEE REVERSE SIDE FOR SPECIAL APPROVALS 0 DESCRIPTION OF WORK l/�G` �G ' —1 pA" NEW ADD ALTER REPAIR DEMOLISH - Z SQ.FT. NO. OF NO. OF SIZE STORIES FAMILIF-S _ USE OF STRUCTURE ') - ,C> SI G NA TURVO �- APPLICANT VALUATIONS A pcv APPROVALS DATE' INSPEC 6R'$SIONATURf P.C. PFOUNDATION, LOCATION / FEES F ME FORMS,FORMS. MATERIALS FRAME, FIRE STOPS, ' / Y I HEREBY AC N NOWLEDGE THAT I HAVE READ THI5 APPLICATION BRACING BOLT / AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDING CONSTRUCTION. 1 CERTIFY THAT. IN DOING THE WORK I AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LAG OR COD' OF THE STATE OF CALIFORNIA RELAT- / ING TO WORKMEN'S COMB NSATION INSURf.C'CE. ,l(/d\/I LATH. E%T. SIGNATURE OF �� HOUSE NUMBER COR- PERM ITTEE OR-PERMITTEE RECT AND POSTED ADDREss_ & — FINAL JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION G.. MO. CASH �j{ o3570JUL 19 . 1 D 25.5J- WORKERS' COMPENSATION DECLARATION APPLICATION FOR- BUILDING PERMIT F�reby.aff'r:that I have a certificate of.consent to self insure\or a certificate of Workers''CampenSation Insiironce, - ' or a 1fe>j7jFjgd'Y)py thereof (Sec. 3800, Lobi.C.) a '• - '- COUNTY OF LOS ANGELES . . BUILDING AND SAFETY _Pelt No. Company' r ' BUILDING ❑ Certified copy is hereby furnis4d. - FOR.APPLICANT TO'FILL IN 'ADDRESS - - ❑ ,Certified copy'is filed with the county building inspec- - BUILDING -Q- �: tion department. ADDRESS Date Applicant CITY Te. ZIP"L Z LOCALITY _ -i O.OF BUDGE.._, NEAREST .1 •CERTIFICATE OF EXEMPTION-FROM WORKERS' ,¢E OF LG7 -�..`'4 NOW ON LOT Z... CROSS ST. - COMPENSATION INSURANCE . ' 11 ASSESSOR (This section need not be completed if the permit is'for one TRACT LOCK \ LOT NQ 1 MAP BOOK PAGE PARCEL hundred dollars ($100) or:less.) - OWNER LTDG NO. USEZONEAP - I certify,ihot in the performance of the work for which this NO �* SPECIAL'• - - - - } Permit is issued, I shall not employ any person in ma ADDRESS - - CONDITIONS tl soastobecome subject to the War rs' o pe ati ws. y _ y, - n 3 CITY - ZIP _ Date �'�\5-O E Applicant ARCHITECT OR - • 7EL. DISTRICT ROUP TYPE - "'FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after maki g.t is Certificate of ENGINEER •- NO. / _• CONST. ZONE H Exemption,.. you should become sub)o t 'to the Workers- '\ is 1. ^� tV Compensation with of the Labor Code; youmustforth- ADDRESS. with comply with such provisions or this permit shall be - \ TEL STATISTICAL C1A55ON .APT. CONDO: Z deemed revoked. CONTRACTOR Y NO. _ LICENSED CONTRACTORS DECLARATION- LIC. CLASS NO. DWELL.UNIT,_ I hereby affirm that I am licensed under provisions of Chopier g ADDRESS - NO. LIC. SEWER Pis ' (commencing with Section 7000)of Division.3 of the Business 4 and Professions Code;and my license is in full force and effect. CITY CLASS IBK. irPG./ VALIDATION _ S NO. OF NO. OF CHECK_ 'ACCT.: —• License Number - Lic. Class 5ZE STORIES , FAMILIES ONE .4 I- - - - VALUATION VALUATION r 3307 ` 007.9 Contractor - ` •- Date DESCRIPTION OF WORK y„� NEW `OOQ 1 ITEMS iS ❑I am exempt under Sec. ADD ► B.BP.C. for th is,reason ALTER ❑ TOTAL' 307. 92 b �• REPAIR ❑ $ CHECK 307.9? . Date: USE OF. _ _ ..- r EXISTING BLDG.' Zw Z- DEMOL ❑ .. CHANGE" .nil Signature APPLICANT -TEL FINAL OWNER-BUILDER DECLARATION (PRINT) N6.NO. I hereby affirm that I am exempt from the Contractor's License - . - - - - - _ DAT r - Law for the following reason (Section 7031.5, 'Business and ADDRESS. FINi 0000'0001 v/15fG� Pro essBULDING y 1- AM 9:015 wit ions Code): PRESENT - - _ .. B C OC Iea' 1t0 I, as owner of the,property, or employees with ADDRESS _ _ _ 1y,(`• b wages as their sole compensation,will do the workand LOCALITY ' Vr AC•CT.O - the structure is not intended or offered for sole(Section El '7044, Business and Professions Code ) - - CONTRACTOR MOVING - ^ - TEL. -'• - P . 307 371.7` .NO. I, as owner of the property, am exclusively contracting L-�., 1 with licensed contractors to construct the project (Sec- ' r. - " - - 1 ITEMS tion 7044,Business and Professions Code.) ADDRESS ' yL 1 1- f '_ ( •t , REQUIRED-MM� •TOTAL SETBACK'FROM' - 'EXIST. `�• ,TOTAL 372 d 75 ' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH'. 1 i r F hereby affirm that there is a construction lending agency for FRONT _• �.t ( 'T CHECK 372.75 the performance ofthework for which this permit'is issued P.I. I' to CHANGE 011 Sec. 3097, Civ. C.). SIDE -. Lender's Name RC. Fee$ 3 Permit Fee r j DMA Raf 0 -0001 9I 8I8�' Lender's Address - I certify that I have read this application and state that the Issuance Fee O• O 1prLDMA P/C k 100- .5955 1 FM 1 4 Sabove information is correct. I agree to comply with all County Investigation Fee r ` ordin n sand State laws r g to building construction, Total Fe r LDMA Perm. q ` a. and er by uthor' re sent of this County to enter aup n h ab ve- en ion pro err' for inspection purposes. - - - - n I _ SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Applicant or- gent Date' _ "