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HomeMy Public PortalAbout10673 ROSEGLEN ST_Building__ APPLICATION FOR BUILDING PERMIT FOS APPLCANT TO FILL IN (Print Or type only) BUILDING /D(a7 3 r RSL�oL�nJ ADDRESS COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER CITY 7e4nAte. C47-1 �[ / ZIP 917 g� BJUII.DJING AND SAFETY DIVL�ION SIZE OF LOT O "�` /I •Q NOW ON LOTS -2. ADORE. UILDING /oCI� d q �^tf ! TRACT 7 / 6LOCK LOT NO.\7 LOGIALITY TQLq f NAREST OWNER R/St 7— NO. ^/ J CRI ST. osc S[BOR ADDRESS II p MAP BOOK PAGE DISTRICT I'�i Ger ZIP 9l7 0 �GIRO�JP KID CONE ZOTYPE ^E PROCKSJ Y CITY _jARCH ITEC T.OR TEL. ENOINEE NO' STATISTICAL, CLhSS1F1CA.TION SEWER MAP ADDRESS CLASS NO DWELL,UNITS EK PO CONTRACTOR TEL, E ZONE MAP LIC, NO. ADDRESS. NO SPECIAL LIC. C NDTIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM ADDRESS CITY FRONTPROP.LINEOF (STREET) HIQHWAY t YARD -_ TOTAL BETEA Cf( FROM TYPE OR CX I8TIN0 S SQ, FT" NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE �� STORIES FAMILIES ONE + O DE9"CRIPTION OF WORK NEW ❑ = L� DD BLDG,SETBACK FROM �W„ Ab SIDE PROP.LINE OF (STREET) i LTER ❑ HIGHWAY t YARD _ OTAL SETBACK FROM TYPE OF EXITING �WebX1 EPAIR❑ N SIDE PROP. LIE HIGHWAY WIDTH USE OF0- t = EXISTING BLDG. MO APPLICAi� ��]TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) �/r LbI�LJ�C2t+0. 7T dif i BY (SIGNATURE) IN OPEN SPACE Y E 9 E] NO E] t IN COASTAL ZONE YES ❑ NQ [:]VALUATION�Y 400, CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENYIRONM[NTAL AND [TAT[ THAT THE ABOYE IS CO RR[CT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS R[[UL^TIME BUILDING CON- STRUCTION. I CER TI FY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF TH[ LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'1 COMPENSATION IN_I URANC[. •' SIGNATURE OF�al%kj, PERMITTEE ADDRESS [� q FINAL CY TELCITY C/1y1 L NO. , DATE, i , 'LAKE CHE(I S PAYABLE TO: FEE $ PMT. FEE FEE HARVEY T. BRANDT,-COUNTY ENGINEER PLAN CHECg VALIDATION CK. M.O. CATH _ PERMIT VALIDATIO cK. M.O. CASH S 4 673 GCT 17 1 D 9,0 O a 7BA638A CE0803 IZ/72 q I, 76A63,%CE 9803 12/69 APPLICATION FOR BUILDING PERMIT,-' 7r f •. COUNTY'OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or a only) CROSS ST. _ DISTRICT N9. GRO P . TYPE` PR ES ED BY BUILDING �L f'7.� C � ! CONST, / ADDRESS f Ob7 J �"'VS'CCy!„f~ / pLl `� L.. ,.�.L , 1 LOT NO I,O BLOCK STATISTICAL CLAS IFICATION SEWER MAP 1 D� CLASS NO.�rLDWELL,UNITS BK�•'G-G TRACT USE ZONE MAP NO.OF BLDGS. ) NO. ..k.Y SIZE OF LOT �© x ,i NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL.e1�C-'L: Q Q OWNER �. KA�Q�S�� WAC NO. 410 �� l ^� BLDG.SETBACK FROM ADDRESS �O V / r.�V^�. �� FRONT PROP.LINE OF (STREET) � TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY £'r'1,P�,G C,�� �/�✓{>r HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + ,� ( = 1`•� ENGINEER NO. BLDG. ETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CONTRACTOR �' 1,`' j ) �, NO, HIGHWAY WIDTH FROM C.L. ADDRESS NL Lj0+ = a LIC. O CITE' CLASS CORNER CUTOFF YES ❑ NO ❑ C.') CONSTRUCTION LENDER C= NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESSt a cn SQ. FT. NO. OF NO. OF D SIZE ` STORIES FAMILIES I NEW ❑ _ USE OF �'` ,/�,�y ,�A/� ' STRUCTURE W`u'�.�.5` P �C�l'�1�• '4OD ALTER C M REPAIR❑ %r^! SIGNATURE OF APPLICANT / DEMOL ❑ r VALUATION $ / ✓1` APPROVALS GATE INSP cTOR'S Sic TU RE P.C. PMT. FOUNDATION: LOCATION r Q FEE $ FEE $ [ FORMS, MATERIALS !p FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I 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 STRUCTI 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 'CALIFORNIA IN RELATING TO WORKMEN'S COMP ATkON INSURANCE. LATH, EXT, SIGNATURE OF �r HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN EE PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH iA r, 7039" OCT 5 1 D 9,00- a DEPARTUM COW � DMIMM OF' �� '� BUILDINGxOF � 1 WILLIAM J. FOX, CouwrY Ummmmt APPLICATION *61 CASSLATT D. GRIFFIN, suw ol, ■1 umme FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTI qT HO. FLAX C1[,oa Rm No. FERYTr NO. BUILDING r ADDRESS b LOCALXrY RECEIVED SY DATE OF APDL, DA LiSUED HXARtET ae 0 ■UCLDIN ID WS OWNER � I lot) YAIL LOCALJT-� l ADDRESS NEAREST o6CITY So&t 'e CRASS iT. e ARCHITEOTOR TEL FIRE T{O. OF TYPLTr QRO P, ENGIN O XONI PLANES `\5L/� iETNACKLINE �20 FZ , LL 144; NO* CO V TEL USE 4ZONX 1 , APOROWD PATIF r S s4 ` HOU HUY>. rNQ D , LiGAL HAP Kvmi3KR NO. ASSIGNED*Y DESCR FTI aRRECrIONS- TRACT --- HO. OF=mQ@. SIZE 01'.LOT H ON USE OF NO. OF Q REPAIR D O ON iQ. FT- i to DT'O.p Elm WALL RdOF COVRING LtC USE OF STRUCTURE ' APPSOY IHSP R'o i1QHATURE DATE FOUHDATIONi L.00ATIOH FO YAT'ERLALN HERESY ACKNOWLEDGE THAT I HAVE READ THIS AP- F LAJ"l FIRE STOM, PL.ICATIOH AND STATE THAT THE LNFORYATION GIVEN ID ERACIN SOL'tf AI CORRICT. FU RHACE i L.00ATI ON. 1 AGREE -A Rxwj COIN WITH ALL COUNTY ORDANCES AND STATE LAWS w�rlATiNG DUQ.DOfG OpiSTRUCTIOH. GAS VENT DUCTS SIGHATURK OFLATH. INT. I LATH. EXT. ADD PLASTER INT. ALrrHOFUZM AQT. PLANTER, EXT. FlKm HOUSE NUMBER COR- ' J RECT AHD POSTED PIKEvwwwrloCrf • ��_ FINAL 7 aAssaA GSi 9-ax COMPENSATION.DECI.ARATION ' ,,. I hereby aff�a;f I have a certlficate of consent to oehf•. Insure, or d certtficate-of Worker' Compensatloh Insurance, APP_ LJ CAT1,0 N_ .F0R. BUILDING. P E RMI T 'Pollrtt th N ( tab. C ) COUNTY 00 LOS ANGELS 1FM ' BUILDING AND SA 7r�:Ce►ttfl*d copy.is herebyfumishec�-A. FOR APPLICANT TO FILL IN `Cetttfied copy 4 fired wtththe u ty bulldlnp.ln BUI (073 St e rr Han eft. N Dote 110ant. My c`'� --P LOCALfry OF NDGSr tT FICATE'01' fA�PT}ON WORKERS' S OFEOT - WON- ,ROSS 5T. ` .'• OAAPEIJSATI ON'I NSU ASSESSOR Is ie troe-n' roof be coin leted if the (Th ped per�nit Is for one TRACT'.' BLOtK LOT NO" BOOK 3� hundred-dollars($100)or.less. P�C;f RAl�CE1 O Q t.l certi�fyy t9t.fn the pphformanae of the work #or w7,ldi ,Tris ' : NO. •p'Pe-tmlt:Is Issued;l+� Ihr�qrimpray-arty pe*n In any manner ADDRESS - - KICLAaXzt10'rq5 �. ,.,vo,as to beabme-sabg60 tq the Worker .Cornponsolon:Laws , L, `. ExFY.. . Zip: - - U Date r r. .. AppII' - I f ARCH OR TEL NOTICE TO APPLI v. ROUP TYPE HIRE - PROCESSED.BY � CAN,. If,,af(er,rhaklnq thls Certtftcate of �I� Na. v � . �E � Exemption,',ygv, should 1aecorne..av>j4e t ta-The Worker, ' } Compensation.provIsIgr of the Labor Code,,you must forth- ADbkESSp. with comply vjlth ;ucr'pcovrslons or'•thl• permit shall be. _ STNISTI.�P.p►S�,gTIQN AP,T, rp0 - '.deemed revoked. ; Cdf(TRACT L tJO. ' UaNS!EbIOD rTR CTOF, 'DEO XP,. Tior4:' wDkEss d 3 w' FM1� NO lQ S�?3 ° No. uNrrs I hereby dffirm tricrj I am licensed under provlslons of Chapter9 - . LTC SEINER AARP (cgmmenclp with Section 7990 ,of Division 3-of thi Blrsiness. ; 9L�d Professlgr Code,and m license b IR fyllforcepndeffett. GrrY. ap�SS Cid. �t B1C' PG. VALDATIOI{ _ ✓� g fir, No. of NOt-1* \. CNEIC c _. llcgnse Num ¢3 IG Clair' / STOk1ES AAA] ONE VALUATION . (� // , 4 r.� � ...� fi L 9/ DESMPT10N OF WOOK 0 NEW '�r{.ant6alc r 41T f-r�DateT� L arri exempt under'Sec G�!� • f A1jP Y ALTER BARC. for this reason�- — N • REPAIR LD-I USE PLDG. • Slpgtsture E?4 C�4NF TR. , . _ �� F I'7KAL OWNER-BUILDER DECLARATION NO. I'herebyafflrm that I am exempt from the C9nfrectoes Ucense DA Law'for the followlntj recmgn- ($ectlon 7091:5,,Buslnetis`dnd ADDRESS P1WLL - prroorfenlpn{Cod e) - LJ I, as.owner,of the or m em I 'with Bt11CDINC7 ���', Y .. p oY� - wapes as thelr,iole compenagtion;will do the-+% r and the structure Is notlntekied qr offeredforsgle{Section r' 7044, Businegs and Ilrofesatons:Co¢e,) r MOVING . . _. TEL' I� 1, as oW of the property, Pm exclUslvely•coiifipct1r�q OR 1, IT� with Ucegted cgntradory to tonstruct the prole& (Set-. ADDRI S - �� Q0' +. tion,7045, l3u}I11w.and Prgfpsklons lode.) ; . . ' CON$TRUCT1Ohl L�NLIING-AGB�}Cl' . ; - � _ YARpI 'FiV1r1„ TOTAL ({J-� I'hereby affirm tharthore Is mconslrUctIon.iendIng agency for the performance:gf the work for which this permit Is Issued'• PL - - (Sec 3097, Cly. C.}' SIDE ,. y LendeYs'Name� rr�•a�yy__r•�r�� L �y ^' P.t Frr Permit Fie -Cr? ram 1DW-Prr. 1. l!ll,AJ-lRF1t� 6�24�71 . Lenders Address' - ? f 1 7 ' I cdrttfy that I bave read this app1fcgtlon'and state that the towance /✓ '' � P/E i_-' , 1 + r. ' o above In Ion is oorrgct. f ogroe:to comply with all.County" Invepipatlbrr .yy prdlnances and St" Ia*ti'rol Ing to buirdlhQ conatruttion Total Fsr �o�'6`d lflAAA Paan and hereby auth6rlmatives of thls;Co.unty.to enter ?ypon the abovo-mentipn party for-Inspectlon;u.(?t� _ I.. --�I 40 11114MM PQR ID(P M1ATO[Y LAMUAW .. -SlpnahlM,of Ilton Agent iDate