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HomeMy Public PortalAbout4930 BALDWIN AVE_Building__ (2) ©s 76A638A CE#803(REV 11/78) /� 1 4 1 APPLICATION FOR BUILD NG PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING <4 D FOR APPLICANT TO FILL IN ADDRESS BUILDING - ADDRESS LOCALITY / NEA REST Ate, CITY Hl (� [r ZIP CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT a2 Z NOW ON LOT / MAP BOOK PAGE PARCEL q DISTRICT GROUP TYPE FIRE ESSED BY T AC 'J�'4J0 BLO/C�K LOT NO (� / ' CONST ZONE OWNER P C (0 H1 �L TEL O �S' v ` — �' STATISTICAL CLASSIFICATION SEWER MAP ADDRESS r CLASS NO 60—? DWELL UNITS BK_J PG CITY G Q rt In ZIP ARCHITECT ORTEL ENGINEER NO VALUATION U d ADDRESS BLDG SETBACK FROM TEL FRONT PROP LINE OF (STREET) CONTRACTOR NO HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC FRONT PROP LINE HIGHWAY WIDTH ADDRESS NO LIC J �� - CITY CLASS BLDG SETBACK FROM CONSTRUCTION L ER SIDE PROP LINE OF (STREET) NAME AND BR CH �" HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING O ADDRESS y CITY SIDE PROP LINE HIGHWAY WIDTH V SO FT NO OF NO OF CHECK + _ SIZE STORIES FAMILIES ONE J NOV) S ONE MAP i1 _ DESCRIPTION OF WORK ( V) NEW I NO C/ o ' ADD ❑ CONDITIONS !0'/-22'I) I ALTER El FINAL // BY Z REPAIR ❑ DATE USE OF + DEMOL EXISTING BLDG 1 _ _ _ _ G APPLICANT TEL (PRINT) NO G ^ J BY(SIGNATURE) Q I ]L I HEREBY ACKNOWL E THAT I HAVE D THI PPLICATION AND STATE u THAT THE ABOVE IS COR ECT AND AGREE COM Y WITH ALL ORDINANCES V AND LAWS REGULATING BUILDING CONSTR TION I CERTIFY THAT IN DOING THE O 0 2 4 A WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFOR IN RELATING TO WORKMEN S COM Z PENSATION INSURANCE g IL # 0 0 0 0 0 1 SIGNATUREOF PERMITTEE 2 - - 3100 _ ADDRESSZ f0 0 0 3 1 O O x _ O TEL CITY NO c O4.23-80 PC Fee$ Permit Fee > V" Issuance Fee v W _ Total Fee 3 � _ t OMPENSA$ION DECLARATION J Y s rirm nat I have a certificate of consent toself APPLICATION FOR BUILDING PERMIT certificate of Workers Compenstion Insurance or d copy thereof (Sec 3800 Lob C ) Fcy { Company COUNTY OF LOS ANGELES @ BUILDING AND SAFETY BUILDING 1 7 Certified copy is hereby furnished , , FOR APPLICANT TO FILL IN ADDRESS > ❑ Certified copy is filed with the county building inspec BUILDING r� 1/��� tt'� tion department epament ADDRESS .J (,Z / ry!/! LOCALITY *t NEAREST Date Applicant CITY e /J C! /` ZIP CROSS ST o CERTIFICATE OF EXEMPTION FROM WORKERS i t NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT S X 6r NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one U ZO MAP hundred dollars ($100)or less ) TRACT BLOCK LOT NO i NO _ >_ 0 / /1" 'y EL a SPECIAL f1 V I certify that in the performance of the work for which this OWNER �J y� / / .VS l 3 Q� CONDITIONS Q pp�� 1STRICT GROUP TYPE FIRE permit is issued (,shall not employ any person m any manner ADDRESS c7�� lJ' F !✓� CONST Z so as to become subject to the Work s Com nsation Laws 'A /r O Date Applicant t CITY �t�/1 /!a�`I V ZIP STATISTICAL CLASS ICA ION APT CONDO U NOTICE TO APPLICANT If after aking this C f— of ARCHITECT OR �+t/ /� TEL � W Exemption you should become subject to the Workers ENGINEER J T NO CLASS NO DWELL UNITS y Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP Z with comply with such provisions or this permit shall beTEL deemed revoked ^ CONTRACTOR (C Q /�!1 LO/!t7 NOc� J�� BK PG4 VALIDATION LICENSED CONTRACTORS DECLARATION NO y I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �s ar NO?O 6 f ie. VALUATION (commencing with Section 7000)of Division 3 of the Business and _ �j LIC Professions Code and jjm/y� licensse� is in full force and effect CITY SR h /OW f'/h Qt CLASS � INO OF NO License Number _2v Y+ rw Lic Class iE_ SIZE STORIES STORIIES MILLIIES / CO EHECK y /� �1 T7e / NEW $ 74 Contractor At1�ll h Date /9—y- DESCRIPTION OF WORK _ ❑ r - ADDEJ I am exemp from the licensing requirements as I am a f" y,T I L93 0 5 2 A licensed architect or a registered professional engineer /+ _ ALTER ❑ FINAL � 7 9 y P capacity l V"GLY` -G o� C7R r REPAIR [:] DATE L/� # 23 actin m m professional ca acrt Section 7051 0 0 0 0 Business and Professions Code) USE OF--y EXISTING BLDG DEMOL AL AL 2 o s i [t 4 0 Lic or Reg No _Date APPLICANT TEL OWNER BUILDER DECLARATION (PRINT) NO o e o f i,4 0 c=i I hereby affirm that 1 am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and ADDRESS �� I i i 3-80 Professions Code) PRESENT ❑ BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation will o the work and f 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 ` # e o 0 0 o i ` with licensed contractors to construct the project (Sec ADDRESS w O 2Srw) r tion 7044 Business and Professions Code) 2 ° 5 6 6 5 0 REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 0,0 5 6 &5 0 c=, I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L Iii 3—8 0 (Sec 3097 Civ C ) SIDE PL Lender s Name / Lender s Address P C Fee$ ✓, O`d Permit Fee w I certify that I have read this application and state that the r (� Issuance Fee above information is correct I agree to comply with all County Investigation Fee 0 ordinances and State jaws relating to building construction Total Fee {o�yZ So I T and hereby authorize representatives of this County to enter < upon t above me coned property for inspection purposes m o - ^���D SEE REVERSE FOR EXPLANATORY LANGUAGE r ignature of Applic or AgjAt Date c ®s WORKERS COMPENSATION DECLARATION "I insure a certificate that I Have a certificate of consent r self nA P P L I CAT I O n1 FOR BUILDING PERMIT insure or a certificate of Workers Compensation Insurance ` r or a certified copy thereof (Sec 3800 Lob C ) y I '' ` t COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company a BUILDING ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN �� ADDRESS Certified copy is filed with the county building inspec J BUILDINGf� tion department' , r ADDRESS lq T✓ ✓e_ l Dote Applicant r ' CITY T ZIP (/ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS r - NO OF BLDGS NEAREST `COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST a (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less ) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL EL OWNER ed Joi A NO S USE ZONE MAP 1 certify that in the performance of the work for which this NO "'"'�Z7 permit is issued I shall not employ an person T any manner ADDRESS /�/�� L/e ��, SPECIAL so as to becomes ject to the War rs Com jl�sati in Laws IIIJJJ CONDITIONS O g n U Date - !O Applicant CITY TC*h ZIP ��/ 0 NOTICE TO APPLICANT If after oking ,this C r fid to of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE O SSED BY O Exemption you should become subject to t Workers ENGINEER NO CONST ZONE U Compensation provisions of the Labor Code you must forth ADDRESS ✓� ��/ 1/�—3 '�%� r W with comply with such provisions or this permit shall be 0-' deemed revoked _ TEL STATISTICAL CLASSIFICATION APT CONDO (n CONTRACTOR NO Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS A NO (commencing with Section 7000)of Division 3 of the Business and LIC P SEWER MAP Professions Code and my license Is In full force and effect CITY 0 CLASS BK Li PG VALIDATION SQ FT NO OF NO OFCHECK ; License Number Lic Class SIZE STORIES FAMILIES ONE _ � VALUATION Contractor Date ` DESCRIPTION OF WORK .0 alij r aq NEW a3 f ADD $ ©(� I am exempt under Sec ALTER B&P C for this reason REPAIR : Date USE OF ❑ EXISTING BLDG 4&rh I dW e, A DEMOL Signature APPLICANT TEL AT FINAL OWNER BUILDER DECLARATION PRINT 1Vn NO D@ 1 hereby affirm that I am exempt from the Contractor s License 30 y„ Vic, FIN Law for the followirTg reason (Section 7031 5 Business and ADDRESS Professions Code) - PRE5ENTB + �J I as owner of the property or my employees with BUILDINGADDRESS 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 aCONTRACTOR NO 2 9 1 2 7 A I as owner of the property am exclusively contracting � i + r with licensed contractors to construct the project (Sec ADDRESS t ' ` # a O ale to.1 tion 7044 Business and Professions Code) REQUIRED TOTAL SETBACK ` � �,,•� � ``� � � � `'� � � ° 1 2 C.$8 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE I hereby affirm that there is a construction lending agency for FRONT �r +� ��+ti�-- *+ �° ° 12 IL 8 8 50 the performance of the work for which this permit is issued P L , ��� 0 0$ $8 (Sec 3097 Civ C ) SIDE - + P L Lender s Name o •� • LDMA Ref P C Fee$ Permit Fee Lender s Address r � I certify that I have read this application and state that the Issuance Fee �P ,7 '� LDMAt P/C above information is correct I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction Total Fee �� U LDMA Perm # and hereby authorize representatives of this County to enter � up he abov entione roperty for inspection purposes r a, ��� SEE REVERSE FOR EXPLANATORY LANGUAGE y Signature of Appli nt or ent - - Date /� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING ADDRESS FOR APPLICANT TO FILL IN WORKER'S COMPENSATION DECLARATION QIyG 1 hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS ✓� 30 G � or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY c" e, i P LOCALITY 'J ZIP Policy _ � No. Compan y SIZE OF LOT NO. BLDGS.NOW ON LOT �G C ❑ Certified copy is hereby furnished. 9 •X 20STV I ;L— .• NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. `/ 1 ASSESSOR MAP BOOK PAGE PARCEL ��- •/-/ '�X Date Applicant S S O® 0!.9 L/--/ SPECIAL CONDITIONS OWNER TEL.NO. /� CERTIFICATE PE EXEMPTION FROM WORKERS' J, Vh OL h� fJ S' WITHIN 1000 FT.OF SCHOOL? YES No COMPENSATION INSURANCE ADDRESS J (This section need not be completed if the permit is.for one hundred G ��� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY .dollars($100)or less.) CITY`r zIP I certify that in the performance of the work for which this permit Pi✓�! /L �! (1` ,}�� .� is issued, I shall not employ any person in any manner so as to ARCHITECT OR NGINEER TEL.NO. d become subject to the Workers'Co nsation ws. STATISTICAL CLASSIFICATION APT CONDO Date 0 Applicant /— ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certif late Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL.NO. SET BACK YARD HWY 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. PL SIDE CL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL o I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES C Professions Code,and my license is in full force and effect. NEW El BK PG I; DESCRIPTI N O WORK VALUATION Oil. 4VJ License Number Lic.Class a . r0 ' • '6 ADD Contractor Date 1 ALTER ❑ $ ' ass +a REPAIR ❑ ❑ I am exempt under Sec. B.BP.C.for this reason 4Cove DEMOL ❑ USE OF EXISTING BLDG. ] LDMA P/C# Date: fa^;I WQ'!M URM. ❑ �Signature APPLICANT PRINT) f TE .NO. LDMA Perm# Z a I, as owner of the property, or my employees with wages as O e "'aY►'1 y 114 7-04 their sole compensation, will do the work and the structure is ADDRESS�,//p ^• not intended or offered for sale (Section 7044, Business and / 13 d 811ii i t4 vc, FINAL DATE Q Professions Code.) Qj —�p�Z WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL t / j OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYQ I`•.ii L+ AL _ ..5..5..,r m: w licensed contractors to construct the project..(Section 7044, VES 1:1 'NO ❑ ;.•�i •-- Business and Professions Code.) � WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING •_•S .:i+. y m wT OCCUCOAST�ANIA Q ALII ITY MANAGE ENT RE A PERMIT FOR DSTRICT(SCAQMDSTRUCTION ) PSEE RMITTING CHECKLIST �_.I"I3=3N�.E CONSTRUCTION LENDING AGENCY FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ the performance Of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD i'i1�i4,;(�.?}4 i+?;=•j•f ?t".I' 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES i_ a.L: Z I. '._ a\. COUNTY CODE,TITLE2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING o Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address OWNER OR AGENT o' I certify that I have read this application and state that the above g information is correct. I agree to comply with all county RC.FEE PERMIT FEE N ordinances and State laws relating to building construction,and a. hereby authorize voMpsentatives of this County to enter upon ISSUANCE FEE the Ile _ o menti rope for inspection purposes. INVESTIGATION FEE TOTAL FEE /,./ • j spneture ilium or Agent Date !� (� SEE REVERSE FOR EXPLANATORY LANGUAGE