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Home My Public Portal About9926 LA ROSA DR_Building__ 76AO38A CE.8o B-O3 APPLICATION FOR BUILDING PERMIT -. COUNTY OF LOS.ANGELES BUILDING C^ > DEPARTMENT OF COUNTY ENGINEER ADORE ss 1 w BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. �7C} Q GLS DISTRICT NO. GROUP TYPE PROCESSE BY F'U APPLICANT TO FILL IN -5,, _z- CONST.%/ ��_ ( / /� STATISTICAL CLASSIFICATION SEWER MAP (0 f,LQ.T O11 ^^ (✓ CLASS. NO. DWELL. UNITS �� ,�BK C�3PG n/,I� OT L.OT2$LOCK WATER NOT REQUIRED RECEIVED(CERTIFICATE: . STATE MAJOR SECON . LOCAL MAPHIGHWAYNO OF BLDGS. NO. ICIRCLEI NOW ON LOT USE ZONE SPECIAL USE OF -/ CONDITIONS EXISTING BLDG. //// TEL. OWNER /��y y) V zAGgry NO. BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS / /C C I� FRONT zo / / 6 ARCHITECT OR TEL, ENGINEER O. SIDE ADDRESS y TEL. 0 CONTRACTOR NO. V Ix ADDRESS O DES RIPTION OF WORK G W d NEW ADD ALTER REPAIR DEMOLISH N 2 SIZE T �`r� /�. / ' STORIES FAMILIES USE OF �/ 4 q 'O STRUCTURE �Y is SIGNATURE OF APPLICANT _ VALUATION $ O APPROVALS DATE INSPECTORs SIGNATURE P.C. PMT. 6'.t_lT FOUNDATION: LOCATION FEE S FEE S '� FORMS. MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. ` v WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY TWILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. / LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED l ADDRESS FINAL / �IJ ,/ JOHN F. LEWIS, PRINCI PAC STRUCTURAL E PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.D. SH, L&O1 5 4 5e JUL18 1 D 4.,00~ Q IBA898A CE#00311-97 APPLICATION FOR BUILDING PERMIT _ 1 COUNTY OF LOS ANGELES BUILDING tr DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. 1 Or TYPE SEWER MAP FOR APPLICANT TO FILL IN `j" CK �G BUILDING (� 'J CONST. ADDRESS /Ot� — STATISTICAL CLASSIFICATION SLOT NO. U£ N. ZOOI Of LO{i O BLOCK CLASS.NO-1-0WELL. UNITS MAP- STATE O NUMBER Q 6 HWYyE5. TRACT 8 U EZONE SPECIAL NO.OF BLDGS. �Lr CONDITIONS SIZE OF LOT 63 X 100 NOW ON LOT '1 USEOF O �U EXISTING BLDG. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER T-T FRONT / MAIL P.L. iQ�C� I ADDRESS 9932 LaRosa—Temple ciky SIDE -- TEL. P.L. CITY NO. INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO. ADDRESS TEL CONTRACTOR N / 4I/vim O G - A, IJG�:�/� ADDRESS 11303 Lower Azusa. Rl.�finntp .fir i DESCRIPTION OF WORK NEWX ADD ALTER REPAIR DEMOLISH NO.OF NO. 5 ZE 12L STORIES FAMOLI ES 4 USE OF STRUCTURE - - -�G-IJ G 10 L i ' SIGNATURE OF PROVALS APPLICANT 1 _ DATE INSPECTORS IGt ATURE ADDRESS FOUNDATION-FORMS,MATERIALS CATION FORMS.MATERIALS `1C� P.C. E O FRAME: FIRE STOPS. d FEE BRACING.BOLTS 'G VALUATION . S FURNACE: LOCATION. FEE GAS VENT,DUCTS uo 1 1 HEREBY ACKNOW EDGE THAT I HAV EAD THIS AP. 9 PLICATION AND STAT THAT THE ABOVE CORREC AND LATH. INT. ' AGREE TO COMPLY ITN ALL COUNTY RDINANC AND pal, STATE LAWS RE EATING 1 CONST TION. LATH, EXT. SIGNATURE F HOUSE NUMBER COR. o� PERMITTE RECT AND POSTED �Z'Z-6-Sp ADDRESS FINAL /2 -a I-J 6 Wf YY CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION / CK. M.o. CASH PERMIT VALIDATION CK. M.O. CASH i A�4 '3 .3 6 M AUG 2 g 2 3 A LAt�t f SEP 2 1 A 3 6.0 0 M APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS �C/J .J hereby affirm that I have a certificate of consent to self insure, or a certificate of WorkersCompensation Insurance,or a certified �� copy thereof(Sec.3600,lab.C.) C, W G4 ZIP / OO LOCALITY Policy No. Company SIZE OF LOT NO.OF SLOGS NOW ON LOT le JL/ ❑ Certified copy is hereby furnished. NEAREST DR055 ST. - ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department I USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS � O/ CERTIFICATE OF EXEMPTION FROM WORKERS' OV% R TEL NO.C COMPENSATION INSURANCE Bcd 4H/ 2¢(v Z WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT CROUP TVP,E/CONST. FIRE ZONE PROCESSED By dollars($100)or less.) /'�-/-C_� CITY ZIP I certify that in the performance of the work for which this permit is issued, I Shall not employ any personaany manner so a5 f0 ARCHITECT OR ENGINEER TEL NO. 0 become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFI ATION APT CONDO Data Applicant ADDRESS CLASS NC DWELL UNITS NOTICE TO APPLICANT.. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWV PROP LINE WIDTH 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 SIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9ER MAP (commencing with Section 7000)Of Division 3 of the Business and SO.FT.SIZE NO,OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BX PG , d License Number Lie. Class DESCRIPTION OF WORK ADD ❑ VALUATION O Contractor Date o I �� ALTER ❑ $ �O U cc ❑ I am exempt under Sec. /U* Mekd f REPAIR ❑ $ 0 BAP.C.for this reason Sv/ PI y DEMOL ❑ LDMA P/C W Date: USE OF EXISTING BLD . URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm# 1 Z I, as owner of the property, or my employees with wages as Z x their sole compensation, will do the work and the structure is ADDRESS O Atdn.T.3 -not intended Or Offered for Sale (Section 7044, Business and FINAL DATE Q 37M3 123.45 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL /(f ❑ 1, as owner of the property, am exclusively contracting with OR A MIXTURE COWAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER MAN THE "� Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? 9 1 !TENS Ella [!FINAL BY licensed contractors to construct the protect (Section 7044, YES El No El TOTAL 123 - 45 Cc Business and Professions Code.) WILL THE INTENDED USE OF THE BUIOUNG BY THE APPUCANT OR FUTURE BUILDING 1' (1/ ECK OCCUPANT REOUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CH123.45 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT SCAOMDI SEE PERMITTING CHECKLIST FOR GUIDELINES CHANGE I hereby affirm that there is a construction lending agency for YES El No❑ CHANGE ,OLS the performance 01 the Work for which this permit is Issued(SOC. [HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING m 3097, CIV.C.) CHECKLIST I UNDERSTAND MY REOUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. ({T(� n ;� TRUE 2.CHAPTER 220 SECTIONS 2.20 100 THROUGH 220.140 CONCERNING HAZARDOUS oU41V�'J`�J 1 6/330/95 J�� / C Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMID V/ JJA 9'- 0 Lender's Address 1192 1 AM11%20 o wat:A w Acexr o I certify that I have read this application and state antler penalty O Of perjury that the above information is correct.I agree to Comply PC.FEE PERMIT FEE ' P, with all county ordinances and State laws relating to building !O ma construction, and hereby authorize representatives Of this County ISSUANCE FEE ppr � to eru onthe ab I e-mentioned property for i Decon urpos 3. a /per�j�� _�%I / INVESTIGATION FEE TOTAL FEE / X sym�a a.uw.. ov. SEE REVERSE FOR EXPLANATORY LANGUAGE