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HomeMy Public PortalAbout4820 BALDWIN AVE_Building__ (2) a APPLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER —BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING I FOR APPLICAN 0 FILL IN ADDRESS (� pl v-- BUILDING 7 ADDRESS �� LOCALITY *_v NEAREST CITY ZIP CROSS ST OF BLDGS ASSESSOR SIZE OF 1_0115- OW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P SSED BY TRAC BLOCK I LCrT NOGG/ U 4? CON ZONE 1 A , TEL A/VS (✓ �" CONE � U„L.IV NO STATISTICAL CLASSIFICATION SEWER M P ADDRESS �0/r�,/�,4/v/C 1-A41 rCLASS NO u/ DWELL UNITS � L, B153PG CITYZIP !� USE ZONE MAP �� 6 NO ARCHITECT OR TEL SPECIAL ENGINEER NO Z` CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRACTOR TEL BLDG SETBACK FROM LIO, I FRONT PROP LINE OF (STREET) ADDRESS NO V / HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING CITY LIC FRONT PROP LINE HIGHWAY WIDTH CLASS C9 I _ f CONSTRUCTION LENDER + � CSC/ }, NAME AND BRANCH �� BLDG SETBACK FROM n' ADDRESS d CITY SIDEPROP LINEOF (STREET) C.*) SO FT NO OF NO OF / CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE PROP LINE IT WIDTH O DESCRIPTION OF WORK NEW 9 + _ ADD ❑ CORNER CUTOFF YES ❑ NO ❑ Z a ALTER ❑ ❑ IN OPEN SPACE YES ❑ NO REPAIR ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG DEMOL APPLICAN O � E4e ❑ 3 '7/17/(PRNT) G 0 BY (SIGNA TUR ) C�,aGt� im5w, iwsP—Aar NAZ I HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CCCJJJ• T WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON STRUC TION I CERTIFY THAT- IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S CO S ION INSURANCE (/y� SIGNATURE F FINAL 7 BY / PERMITTEE ° DATE p ADDRESS v � �J • TEL / PC Fee$ ZoG) Permit Fee C I T Y /NO � p/ �� �!/, O O ep,J 3 2 Issuance F o VALUATION 1r 3 Total F PLAN CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION /KJ M o CASH 3 3 9>ZJAN 26 2 3 0 1 0 y 8 0 — 5 9 4 tel- FEB 1U 1 U 2 3 7.0 0 $ 593'11--FEB 1023 0 32.40 �` � 76A638A CE#8038 1Z/73 � Lim PLICATION FOR _ COUNTY OF LOS ANGELES ' rR { DEPARTMENT OF COUNTY ENGINEER — 'BUILDING PERMIT BUILDING AND SAF DIVISION l BUILDING FOR APPLICANT TO FILL IN ADDRESS r�� - BUILDING-�J J ADDRESS e J9;2 D C] / V� LOCALITY w� ' per, NEAREST CITY Y ZIP i70 V CROSS ST .G(�y✓ F1 / _NO OF BLDGS ASSESSOR SIZE OF LOIJ,c NOW ON LOT MAP'BOOK PAGE PARCEL )DISTRICT GROUP TYPE FIRE SSED BY TRMr �� p BLOCK- L � Z ONST ZONE TELOWNER " G} ` _t1,*A17 r NO- •® �� y ` STATISTICAL CLASSIFICATION SEWEkfAAP ADDRESS d c�i iii/'�J' � CLASS NO B2O DWELL UNITS BK PG CITY 4 ZIP O>E MAP ARCHITECT OR TEL NO ENGINEER - Np J C) SPECIAL _ 7,0 CONDITIONS ADDRESSr ROAD DEPARTMENT APPROVAL REQUIRED- - YES ❑ NO❑`- CONTRACTOR il1L�y1J ;q�ea `NoBLDG SETBACK FROM LIC +� q / p FONT PROP LINE OF (STREET) ADDRESS l JOS f NO J�J bQHIGHWAY + -YARD, MTOTAL SETBACK FROM TYPE OF IEXISTING ,/ LIC FRONT PROP LINE � HIGHWAY WIDTH- CITY �1 eW a (� '`' CLASS 4 CONSTRUCTION LENDER ` + a NAME AND BRANCH r _ O BLD ROM - - r U, ADDRESS CITY SIDE PROP LINE OF 4 (STREET) � SQ FT NO OF - NO OF- CHECK HIGHWAY + YARD = TOTAL SET FROM f TYPE OF EXISTING ur SIZE STORIES FAMILIES ONE SIDE PROP LI HIGHWAY' WIDTH w DESCRIPTION OF WORK F NEW ADD ' ❑ CORNER CUTOFF YES`„❑ ` NO r = ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR ❑ USEOF,EXISTINBLDG r h ~" DEMOL ❑ IN COASTAL PERMIT ZONE o YES L❑ NO ❑ APPLICANT TEL 7 (PRINT) + NO BY(SIGNATURE)', s N =. r I,.HEPEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES - AND'LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OFiCALIFORNIA IN RELATING TO WORKMEN S COM 1 PENSATION INSURANCE' F M L r V / ` �W ' c /z + 7SIGNATURE OBY PERMITTEE DATE > ADDRESS _ TEL 30�t� P C Fee$ Permit Fee s CITY- �/"'�'�""'`"`''/ ur K -NO ' _M _Issuance Fee VALUATION ` / - Total Fee s PLAN CHECK VALIDATIONt ' ~ cK o e ,CASH ,PERMIT VALIDATION cK M o CASH 5�O,1 SEP` 2 23 ,ID - � �a7'0 A�:. _ 6,0, 2 -SEP" - 2 3 'R " <1 5.0 U ©S1'76A838A CE#803'A /76 u y r r ♦ � -,^ 4� APPLICATION FOR FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUIL ING ADDRESS t y'�r D4 �ri or a certificate of Workers' Compensation Insurance, or a certified Q 3A copy thereof(Sec.3800,Lab.C.) CITY ZIP e ��� LOCALITY Policy No. Company SIZE OF LOT NO. BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS` CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE tf WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDR SM f E. V DISTRICT GROUP E ZONE PROCESSED BY dollars ($100)or less.) � CITY ZIP I certify that in the performance of the work for which this permit � �t+ ! is issued, I shall not employ any person in,any manner so as to / become subject to the Workers mpensation L A CHITECT R ENGINEER TEL NO. / ��jj STATISTICAL CLASSIFICATION APT CONDO Datq,5-%7•"-.Applicant ADDRESS CLASS NO. CI— I DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' C R �J TEL NO. ,tom '/ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith !fir ���aJ 7`� FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS IC.NO. PL LICENSED CONTRACTORS DECLARATION ���� PILE CI �� LJlijCLA;iS PL I hereby affirm that I am licensed underprovisicns of Chapter 9 � � SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full forceap fect. A NEW ❑ BK PG , >- / License Numb -90!V�C Lic. Class 7 r` DESCRIPTION OF WORK f ADD El VALUATION y� Q ✓ Contracto ,F-vte cde 'a e5' / ALTER ❑ $ �� U top ElI am exempt under Sec. Xq� W rJ in 41 REPAIR ❑ $ BAP.C.for this reason 1AAr DEMOL ❑ IU LDMA P/C# Date: E E ISTING BL G. URM ❑ IL Signature APPLICANT(PRINT) TEL NO, LDMA Perm# Z JL property, or m employees with wa es as Z s,t 7 ❑ I, as owner of the y, yg O rj__ },a their sole compensation, will do the work and the structure is ADDRESS j not intended or offered for sale (Section 7044, Business and FINAL DATE 330 Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 0 S OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE � J 1 I I�,`s-' El 1, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY j licensed contractors to construct the project (Section 7044, YES 11 NO❑ TOTAL 164 85 _Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING (;NC;H OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR CHANGE GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ a the performance of the work for which this permit is issued(Sec. � I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CORE, p y TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 131JI i1,�--01.-11 f IL �i!1 ..�� 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. 21Arl 9 34' o Lender's Address 6 s O OWNER 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 a with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE � to%upon the a/b��v toned property for inspection purposes. < / - 7INVESTIGATION FEE TOTAL FEE i ant o,ge Dale / SEE REVERSE FOR EXPLANATORY LANGUAGE