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Home My Public Portal About9903 LA ROSA DR_Building__ ----�- MOMC WORKERS'COMPENSATION DECLARATION - • hereby affirm That havecertificate of consent to self_ APPLICATION FOR SU_ ILDING PERMIT . insue, or a certificate of Workers' Compensation Insurance, ' w a certified copy thereof (Sec. 3800, L.P. C.) - Puficy No.�Compony r s O.N ��/ COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy'is hereby furnished. FOR APPLICANT TO FILL IN BWLDING �Gl�` L— ADDRESS Certified copy is filed with the county building inspec- BUILDING�,^ jJ •� w tion department: - ADDRESS DateT•%'6 7 Applicant. p CITY / (.:.� T- ZIP LOCALITY T I NO. OF BLDGS-- , - NEAREST CERTIFICATE OF COMPENSATION INS R A WORKERS' - ' • I COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one TRACT BLOCK LOT ASSESSOR ' .hundred dollars ($100)or,less.) MAP BOOK PAGE PARCEL .7.!{(�� /G�-� TEL. (i L' 1 USE NE MAP .1 certify that in the performance of the work for which this OWNER NO. G•:/ . 1 NO, permit is issued, I shall not employ any person in any manner _ SPECIAL 1 so as to become subject to the Workers'Compensation Laws. ADDRESS �(N� CONDITIONS O 'V Date APPlicont " CITY-_ - _ _ _ .ZIP_ pp NOTICE TO APPLICANT: If, after making'this Certificate of ARCHITECT OR TEL, DISTRICT OUP TYPE _ SSED.BY. 0ENGINEER NO. yJE ppp��,,,EEEExemption, you should become subject to the Workers' ,1 // 7 CONSTI5F /J 6Compensation provisions of the Labor Code, you must forth- gDDRE55 'U K/✓ ,�`with comply with such provisions or, this permit shall be- a deemed revoked. TL `` STATISTICAL CLASSIFlCATION ONDO. CONTRACTOR / NO. —7-YAO CLA55 NO. DWELL. UNITS_ LICENSED CONTRACTORS DECLARATION - - /'�¢ •, D,,/LIC. ' hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS S•M�JS/I/Y 'ICA NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and _ - _ - - LIC �(J Professions Code, and my license is.in full force and effect. CITY CLASS ✓-/ BK / VALIDATION � /T.�� _ SO. FT. SNO.TO IE NO. OF -_ CHECK License Number`/"� Lic.Class ` SIZE STORIES FAMILIES ONE - + •' _VALUATION Contractor / �• Date `pe—1,— / DESCRIPTION OF WORK' Zi/QE ��//�� A D O $ r Q��t am exempt under Sec - 4lPiLb •-�i(a /R3�-66 '❑ O ALTER .B BP.C. for this reason /,LXVE1,/a .REPAIR ❑ - $ - ;2 6 7 7.9 A Date: USE OF I DEMOL EXISTING BLDG. # e a o e e Signature -' APPLICANT TEL FINAL 1 tt OWNER-BUILDER DECLARATION (PRINT) NO. _ DATE -( 0 b .I I hereby affirm that I am exempt from the Contractor's License ADDRESS FIN .0[7 I o Law, for the following reason(Section 7031.5, Business and _ Professions Code): - PRESENT - 'BY O 4.O 1 -8 7 BUILDING ' 1, as owner of the properly, 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 7044, Business and Professions Code). MOVING - "" TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors toconstructthe project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY - - SETTUIRED BACK YARD -HWY - TOTAL PROP.LINESETBCKFR I WIDTH - I hereby affirm that there is o construction lending agency for FRONT the performance of the work for which this-permit-is issued - PA. - -- -' - - - (Sec. 3097, Civ. C.). SIDE m lender's Name S DAM Ref. R _ _• . Lender's Address - - P.C.'Fee E Perm itFae- , I certify that.I have read this application and state.that.the Issuance Fee LDMA P/C R h above information is correct. I agree to comply with all County Investigation Fee 77 / jg ordinances and State laws relating.to building construction, _ ..-. Total Fee - VYJ' - / J LDMA Perm. IT Y' and hereby authorize representatives of this County to enter m upon a aboveCmentioned property for inspection purposes. -�-�� EEE REVERSE FOR EXPLANATORY LANGUAGE v" Signature of Applicant or Agent Date - - - -• '- "- - - - Or APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ABER I hereby affirm that I have a certificate of consent to self insure, BUILDING ADORES= �. �7 or a certificate of Workers' Compensation Insurance,or a certified /1 -- copy thereof(Sec.3800,Lab. C.) e! le ZIP, I / /�O a LOCALITY NO. Company' SIE OF L T NO OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished. ! NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection T125^�el BLOCK LOT NO� department. `7 USE ZONE MAP NO, Date Applicant ASSE OR 1 I B K PAGPAR�L�� YY (f SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �'�/S TEL NO.g-ll YES No COMPENSATION INSURANCE 10 7-k WITHIN 1000 FT.OF SCHOOLS This section need not be completed if the permit is for one hundred ADDRESS �p ( DISTRICT GROUP NST. FIRE ZONE PROCESSED BY dollars ($100)or less.) CITY ZIP I certify that in the performance of thefor which this permit is issued, 1 shall not employ any personn in in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL N0. p STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. _�L� DWELL UNITS N077CE TO APPLICANT It, after making this Certificate of REQUIREDyggp TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTRACTOR TEL NO, SET BACK HWy PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith LFRONTcomply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.N0.LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS I hereby affirm that I am licensed underprovisions Of Chapter 9 SEWER MAP 1' (commencing with Section 7000)of Division 3 of the Business andFT.SIZE NO.OF STORIES NO.OF FAMILIES d Professions Code,and my license is in full force and effect. 1. z „� / NEW ❑ BK PG poll. L) Q License Number DESC Lic.Class RIPTION OF W1�ORK � App ❑ VALUATION Contractor Date C DVC ALTER ❑ ❑ I am exempt under Sec. � � d ��9 // REPAIR ) $ Q B&PC.for this reason Fkj JV 1V POpJ"5 /A' 4&illl If DEMOL ❑ W IIILDMA P/C* y Date: �$PE OF EXI ING G c URM ❑ N �IfN w r I.� i Z Signature APPLICA (PR�IN,{y,) e' yTEL NO. LDMA Perm x I, as owner of the property, or my employees with wages as �Wel RE/w , 'S- 90-2 = Yr I r their Sole compensation, will,do the work and the structure is ADDRESS �J� 9 not intended or offered for sale (Section 7044, Business and 4 903 � 20 S9 FINAL DATE 1 l! _ Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ^L�'� O 'i L '- OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _}��i ❑ a5 owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERINFORMATION Gull FINAL BY � Tf f l r1L 105 - 30- licensed contractors to construct the project (Section 7044, YES❑ " Business and Professions Code.) NO❑ 1' 1 IV. it-IF,, !J WILL THE INTENDED USE MI THE BUIDLINGCONSTRUCTION BY THE APPLICANT OR FUTURE BUILDING SOUTH '��'I' OCCUPANT QUAUTREQUIRE a PERMIT FOR C TRICT(CTI°N°R EE PERMITTING FROM THE SOUTH t•I.- fPj i CONSTRUCTION LENDING AGENCY COAST AIR ouquiv MANAGEMENT DISTRICT IscgomDl SEE PERMrtnNG cHEcxusT FOR {.FiHps:Ot - GUIDeuNEs. I hereby affirm that there is a construction lending agency for YES❑ No❑ PI the performance Of 1112 WOfk for WII1CIl this permit is ISSIIed(Sec. HAVEREAD THE HAZARDOUS MATERIALS INFORMATIONGUIDE AND THE SOAOMD PERMITTING { { (l m 3097,Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. .W. TITLE 2.CHAPTER 220 SECTIONS 220 100 THROUGH 220.140 CONCERNING HAZARDOUS }� _ _ 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD ,7!1�' 1 t!1 iLl $ Lender's Address Q - d ER OR AGENT o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE o 1 PR with all county ordinances and State laws relating to building O j RE canal ucti , n IT Roy authorize representatives of this County ISSUANCE FEE to enter on IT - i5nad property for inspect?ion purposes. -61m ✓ - (�-(�+J INVESTIGATION FEE TOTAL FEE le A /J SEE REVERSE FOR EXPLANATORY LANGUAGE C� WORKERS' COMPENSATION DECLARATION'- r. 'AIR 17 '/T-r 7 - •� hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT. insure, or a certificate of Workers'Compenstian Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BU Policy No. Company I - Certified copy is hereby furnished. FOR APPLICANT TO FILL 6UIMING > ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING44 tion department ADDRESS / LOCALITY Dote Applicant CITY L L L— G NEAREST ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT -- / f/ NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit i5 for one ? USE ZONE MAP TRACT BLOCK LOT NO. NO. O hundred dollars ($100)or less.) > ? L-� w//-/��'r TEL.a,- -� �w SPECIAL y I certify that in the performance of the work for which this OWNER NO CONDITIONS \ O / /'C^ro DIS RICT GROUP TYPE FIRE PRO SSED BV U permit is issued, shall not employ any person in any manner / � b CONST. ZONE 99 so as to become subject to the Wo ri Co nsation Law& / ADDRESS 7 �C t" 0 3 / 3 O CITY d(I ZIP A / J /(- /I/ Date L._LAppicant � STATISTICAL CLASSIFICATION APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITE T OR �� TEL. W Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP ith comply with such provisions or this permit shall be / n deemed revoked. - CONTRACTOR TEL. VALIDATION�— NO. BK- PG, / LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS -- NO. yALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. �yt5 Professions Code, and my license is in full force and effect. CITY �� CLASS L�(I0 SQ. FT. NO. OF NO. Of CHECK License Number Lic.Class F SIZE O STORIES FAMILIES ONE S G NEW S Contractor Date DE IPTION OF WORK e P 9 �//� 7/4-A/��J G ADD am exempt from the licensing requirements as I'am a C {* licensed architect or a registered professional engineer r r s ALTER FINAL acting in my professional capacity (Section 7051, REPAIR DATE Business and Professions Code), USE OF EXISTING BLDG. DEMOL C:] FINAL Lic. or Reg.No. Date APPLICANT Co ��//}. TEL r By _ `< OWNER-BUILDER DECLARATION (PRINT) - �. I�-IC DS N''cIg,� -� 3 I hereby affirm that I am exempt from the Contractor's License '106 �- L's/O 9 - Y"I b"r//QOI�/ Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT I, as owner of the property, or my employees with ADILDING DRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY �'J 9 1.7 A 7044, Business and Professions Cade). MOVING TEL. 1, as owner of thero ert am exclusive) contracting CONTRACTOR NO. P Y� Y 9 e o o 'o e with licensed contractors to construct the project (Sec- I ADDRESS tion 7044, Business and Professions Cade). 2.e o 6 1.00 REQUIREDTOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH hereby affirm that there is a construction lending agency for FRONT ° ° . 6 1. 00 5 the performance of the work for which this permit is issued P.L. (Sec 3097, Civ. C.). - SIDE P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee w 1 certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Imesvigation Fee 0 ordinances and State laws relating to building construction, m and hereby authorize representatives of this Co my to enter - Total Fee 'r yupon tl e a ov ��(f^��`L�y�'on-d property for inspe ion purposes. C..-`�` el— / SEE REVERSE FOR EXPLANATORY LANGUAGE . Signature of Applicant or Agent Date Os WORKERS' COMPENSATION DECLARATION r II hereby affirm that I have a certificate of consent to elf .APPLICATION FOR BUILDMI�PERMIT insure, or a certificate of Workers'Compenstian Insurance,, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANCiELE AND SAFETY Policy No. Company UILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING , lion department. ADDRESS hl LOCALITY /'7� pF NEAREST ` licant CITY ZIP CROSS ST Date A 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 permit is for one U1501 i MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. O. } // TEL. /'� PECIAL 6 1 certify that in the performance of the work for which this OWNER _� <ll NO. ' f ."x CONDITIONS , O permit is issued, I shall not employ any person in any manner /, ^ DISTRICT GROUP TYPE FIRE 71 P E D BY U so as to become subject to the Workers'Compensation Laws. ADDRESS �S ,_ fy � ` CONST. / Z r 19 /jWCggqTTT !ice/ Date Applicant CITY/' ZIP ��00 STATISTIC AL CSSI��fjjjION APT. CONDO. U ARCHITECT OR TEI. /J� W 'NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER E NO. lT d Exemption, you should become subject to the Workers' CLASS NO. DWELL UNITS_ N Compensation provisions of the Labor Code, you must forth- -ADZ DRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. TEL' CONTRACTOR BK, PG, VALIDATION . LICENSED CONTRACTORS DECLARATION NO I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 70DO)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS S 50, FT. NO.OF NO. OF CHECK License Number - Lic.Class SIZE ISTFAMILIES ONE Contractor Date DESCRIPTION OF WORKIESS� / NEW ❑ S ❑ I am exempt from the licensing requirements ADD as I am o B' licensed architect or a registered professional engineer , ALTER ❑ FINAL �/ •�� acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code), USE OF DEMOL FINAL o [ EXIS NG BLDG. ❑ 8T Lic. or Reg.No. _Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS t Professions Code): PRESENT ❑ BUILDING I, as'owner of the property, of-my employees with ADDRESS 50 64 A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY # o o e o o 7044, Business and Professions Code). MOVING TEL. Q e e '�2 0 0 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 e e o 2 20 0 c=i REQUIRED CONSTRUCTION LENDING AGENCY SET BACK YARD HWV ACK FROM EXIST. TOTAL PROP.SETBSETB LINE WIDTH 0501 _8 I hereby affirm that there is a construction lending agency for. FRONT the performance of the work for which this permit is issued P,I. (Sec. 3097, Civ. C.). SIDE P,I, Lender's Name P.C. Fee S Permit Fee —� Lender's Address wI certify that I have read this application and state that the Issuance Fee aInvestigation above information is correct. I agree to comply with all County ItitiF ordinances and State laws relating to building construction, Total Fee and h by authorize representatives of this County to enter , ^ upbovge-mentioned pr erty for inspection purposes. t SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote @s 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 SL 0508 0805120038 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST BUILDING ADDRESS: IBK: 147 652 PG: PC: SQ. FT STORIES TYPE 9903 LA ROSA DR T I ISTRUCTURE: V—B TEMP CA 91780 T (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET: 18589-007-027 I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 IIS SUED ON: PROCESSED BY: EXPIRES ON: I (EXIST OCC GRP: 105/12/08 SR 11/08/08 1 TOWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: IELLIS, ARTHUR (626) 285-9028— 10,000 I 19903 LA ROSA DR. I ITEMPLE CITY, CA I FEES PAID (DESCRIPTION OF WORK I I IKITCHEN REMODEL DRYWALL I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TAPPLICANT: TEL. NO: ITIMNA POLGAR (818) 266-8978— IAA BLDG PERMIT ISSUANCE 27.75 ' 13569 RYE ST. #6 IAC STRONG MOTION RESID 10000.00 VAL 1.00 (SPECIAL CONDITIONS: ISHERMAN OAKS 91423 JB2 PERMIT W/ENERGY 10000.00 VAL 238.26 TOTAL FEES 267.01 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IREMODELING CALIFORNIA, INC. (310) 733-4232— 1 13611 MOTOR AVE #100 LIC. NO 1 (LOCATION AND SETBACKS ILOS ANGELES, CA 90034 881905 B 1 1 SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS LIC. NO: ISLAB/UNDER FLOOR � I I RAISED FLOOR FRAMING (MAP NO: SEWER MAP BOOK: PAGE: FIRE 20NE: CMP: ( (UNDERFLOOR INSULATION 1147H269 3 Oil I I IFLOOR SHEATHING IND. OF FAMILIES: DWELLING UNITS: APT/CONDe STAT CLASS: NO 21 IROOF SHEATHING I I � SCHOOL WITHIN HAZARDOUS SHEAR PANELS IAZR QUALITY: 1000 FEET MATERIALS 1 NO NO NO FRAME INSPECTION IREQUIRED TOTAL SETBACK FROM EXIST AFIRE SPRINKLER HANGERS ISET BACK YARD: HWY: PROP LINE: WIDTH: I 1 IFRONT PL- (INSULATION/WEATHER STRIPI I SIDE PL— 1 INTERIOR LATH/DRYWALL it / I I IEXTERIOR LATH (RATED FLOOR/CEIL ASSEM. 1 1 EHIf'IRE® �U�Q 1RATED WALL ASSEMBLIES 1 �YY 1 IRATED SHAFTS/OPENINGS I I I T—BAR CEILINGS I I I ILOT DRAINAGE I1 1REPORT ID: DPR261 ROUTE TO: BSOS OB 1, � � I CL�u �/ -�