HomeMy Public PortalAbout9214 ROSEGLEN ST_Building__ 7&AD3AA CZ#003-6-U7 APPLICATION FOR BUILDING PERMIT .Z
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
B=ING AND SAFETY DIVISION LOCALITY
JOHN A.LAMBIE,COUNTY ENGINERR NEAREST
CASSATT D.GRIFFIN QUr-T OFIBUILDING
DI ICT NO. GROUP TYPE SEWER MAP
I' .FOR APPLICANT TO Fnl IN K
c:o
BUILDING
ADDRESS i STATISTICAL CLASSIFICATION _
LOT NO. ro BLOCK CLASH•NO EL UN
MAPSTATE ygg
TRACT T ^ q ' NUMBER HWY.
�i V rC. UBZONE SPECIAL
NO.OF BLDGS. ! CONDITIONS
SIZE OF-LOT -Z7. NOW ON LOT
UBE OF
BUILDINGYARD HY BTRHSf'NAME EXIST.
BETBACK WWE
OWNER N,
99 (�` FRONT
ADDRESS .�+ .S ! fo e V SIDE `
_ TEL P.L
ARCHITECT ORTEL IN LECTION RECORD
ENGINEER NO.
DR
TEL
CONTRACTOR (�Csre. NO. 3
Appgzas 'l/ at?
DEkMMON OF WORK
NEW ADD ALTER RBPAIR DEMOLISH
Sq.FT. NO.OF NO.OF -
SIZ6 STORIES FAMILIES
USE OF STRUCTUR-K f p
SIGNATURE OF APPROVALS
APPLICANT
(' DATE IHSPECT06= RE
ADDRESS , v FOUNDATION: LOCATION
FORMS,MATERIALS
FRAME: FIRE STOPS. t• - -
(y. FEE BRACING.BOLTS
VALUATION--z1 FURNACE: LOCATION, - I
pZrE GA&VENT.DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH INT.
PLICATION AND STATE THAT THE ABk0VEH CORRECT DAGREE TO COMPLY WI ALL COUNDINANC DSTATS LAWS REGU NG B CT N LPTFi.
SIGNATURE OF OUSE NUMBER COR-
PERIII RECT AND POSTED
ADDRESS ' FINAL ~ 1
JOHN A.LAMBIE.COUNTY ENGINEER. CLYDE N. DIRLAM PRIN IPAL TR ICT-URAL ENGINEER
PL&N am=VALmAmox w.o. cAwH PES VALMAMON JLO. -CAAH
,ice3 1 1 n 36.0"0 �'
TEMPLE CITY
APPL,ICATION FOR BUILDING PERMIT
COUNTY-OF LOS ANGE-7 BUILDING
DEPASTIUf OF'COUNTY ENGINEERADDREBH
BUILDING AND SAFETY DIVISION +L
JOHN A. LAMBIE. CouNTY ENgLmamR NEAREHT
• OF a - CROSS ST.
. . -FOS APPLICANT TO FILL YN
DISTRICT o. aR .� P s,a BY .
�� CON
BUILDINGQ' e 8TAT18TICAL CLASSIFICATION SEWER HAP
ADDRE86 ` 13M_ CLADS.NO UNITD
.LOT NO. BLOCK MAP ATS YES tl0
NUMBER
TRAM 4 USEZONE BPSCLAL
NO.OF CON ITIOND z
DEM OF LOT NOW ON LOT
USE OF
EXISTING-B QL DU ICK YARD HWY STREET NAME WI I II
W
DT
ONER Z Nb_ FRONT
jr, P.L
ADDRE88 t e e BIDE
ARCHITECT OR TEL
ENGINEER NO. 4 INSPEG'rION RECORD -
ADDRESS }
TSL .r
CONTRACTOR NO. ^
EscRumON OF WOflK
O
NEWD ALTER REPAIR DEMOLISH
SQ. NO.OF NO.OF
8I'LE V6RIES FAMILIES
USE OF
STRUCTURE
pIGNATURE OF -
APPLICANT
VALUATION S
APPROVALS D&K IMSPE R'9 3 QNATURE
FOUNDATION:LOCATION
FORMS,MATERIALS
1 HE�IEI�Y ACKNOWLHDG$THAT I HAVH FURNACE:
OLTS
BTHIS AP- $:FIREBTOPB.
PLICATION AND STATE THAT THE ABOVE I8 CORRECT AND- "RN GACE:LOCATION. _
AGREE TO COMPLY WITH ALL. COUNTY ORDINANCES AND .CAB VENT DUCTS
STATS L.kWS REGULATING BUILDING CONSTRUCTION.
1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I un..l INT
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN'SCO TI N ORNLA. unl 'R
liIONATURE OF OUSE NUMBER COR-
PEFW ITT AEC T AND POSTED
DR �.c✓
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN
PLW.CSEC& VALIDATION' , U.a awl PERMIT VALIDATION me M.O. CASH
�2
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN K*DM ADOF
I he-reby affirm that I have a certtficete of ooreerd to self kT&ure, '�1 7 C
or a certfflcate of Vlbrkero' Carrrpermticn Irreurarxce%or a oertf1w
copy thereof (sec 3806,Lab-.c.) (t cT ZIP y'j�� Loc�ury
Pdicy No. ry SLM OF LOT Na OF BLD08 NOW ON LOT
❑ Catffled copy Is hereby fumielred. NEAREST CROSS ST.
Eltf
Cwfled copy Is feed with the county building Inspection TRACT LOT Na
deQarhTlerrt OBE ZONE MAP NO.
Date Appficarit AS9ESSOR MAP BOOK PA4E :,R0EI- 9NDfPEClAL COTfON9
CERTIFICATE OF EXEMPTION FROM WORKERS' otivNE Sg� T>L S �� scFlooL2 YES NO
COMPENSATION INSURANCEFT OF
(This sectk n need not be completed If the permit is for one hundred ADDRESS
dDlim (S 100)or Ie& ) �� Olr k 7L s T OROLIP TYPE CONST. FFA 3Jr� PRCXES9E
ZP
I certffy that.In the performence of the work for which thin permit (�•% J�O ��
b lasued, I &hall not employ any pemon d any manner 90 as to ✓✓✓
ARCHITECT OR ENONEEA TEL Na
becmromt
oe Subject to the Vkrks 'Copenaation Lai& " APT 05NDO
.
Date App cant ADDRESS CLASS Na DHUL LINTS
1rC)ndis TO APPLK'ANT. H, after makiry this Certffloate ofREOIARED TOTAL SETBACK FROM EXIST
Exernption, you &hould become subject to the Vlbrhere' CCNTRACroR TEL Na SET BACK YARD HWY PROP LINE WDTH
Compervatlon provtslorr& of the Labor Code, you must for Owyttfi FR WT
corrpy with such provfsla&or thie permit shall be deemred revoked. ADDRESS LIC.No. P L
LICENSED CONTRACTORS DECLARATION SIDE
qTy Llc gAgs P L
I hereby affirm that I am Ilcerreed urrderprovisiom of Chapter 9 SEWER MAP
(comnvxx*rg with Section 7000)of Division 3 of the Bu&inesa and 8Q Soh 40.OF STORES Na OF FMIJES NEW ❑ BK Pa
rre
Pro(eaaioCode,and my boonse b In full force and affect JJ ,
Lbense Number Lb.Cieas ' w ADD ❑ M Tr
Contractor Date F ALTER ❑
El din exempt under Sec. / REPfUR El $
BAP.C.for this reason 4c, T DEMOL ❑ LDAM Pic♦ --
i X W
Date. 115 EX1S'1 URM El CI47
Signature APPUC'ANT(PFNVT) TEL Na IFMA Pwm+ 1 z
,'4l, as owner Df the Property, or my employees wtth wages as =O ACCT.# t!
their &oie compensation, will do the work and the structure is ADDRESS
rot Intended or offered for Sale (Section 7044, Budneee and FINAL DATE t 7�
Prde&EIOrffi Code.) NLL THE APPLCANT OR FUTURE w■rrra OCQ1MIPANT FXR A FMZARDOUS MQE3%AL I , J - .
❑ 45
1, as owner of the property, am exclu&vely contracri wffh OR A MUTLrE COFrMiNG A FWAFDOU&►OUT EQUAL 70 OR GIR AER THAN TFE
1 ITEtt5
AAIOl1rI8 BPECF®ON THE FIAZ.AFDOlJB ILQl3lAL&IFORYAION ellDET FINAL BY �!
keneed contractors to cxstruct the project (Rection 7044, YES❑ No❑ TOTAL 66.45
Business and Professions Code.)
%LL TFC WENDED USE OF 'n-E BUG"43.rr Rf TFE APPiX-WT OR M'URE BU DING '//''y{/ 66.45
{[[ [[C�
oOIXPAlIT FOXITE A PE}lfT FOR OFl uqo��oN FROM TFE&OUTR L ECK 66.?5
CONSTRUCTION LENDING AGENCY COAT AS DUAUTY 6VAO.GENdENT�J JEE PERYrr oa CFEC1a..IQT FCR
GIUEE .FS C r� . E .00
I hereby affirm that there Is a conehTpction lending agency for YES❑ No❑
the pertormanoe of the work for which finis permit Is blued(Rea READTFE A49IIiNE DUDE MOTHE eCAOMPera,�Trm
m 3097,Civ.C.) dEaareT. F uv�Ts..EEF TFE Loe ANGELES Coum CCOF- 1
TM-E 2,CHAPTER ZX SEcn 224100 TFFlOUOR 220.140 COMCr§ra+o RAZAFDOUe J/7J
Larder'&Name WVETaALS FEPORTM Aro FOR COV4443 A PERMT FROM THE eCAQMa
Larders Addree& COAGM OR ANINT AM 10=07
0
1 oerdfy that I Frere read this applbatbn and stabs urder pwieRy P.0 FEE PERMIT FEE O w
of perjury brat the above irrformatbn b correct.I agree to corrpy
wfth all county narrcee and State iiam ralattrrg to buliding
authorb�e repramotabvee of this Cour#y r89LIANCE
Ad-&TW Wbn rner tiorred property for Inspection
m � NVE9TY(3ATION FEE TOTAL FEE
� Aar.n a Ms
SEE REVERSE FOR EXPLANATORY LANGUAGE