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HomeMy Public PortalAbout5040 BALDWIN AVE_Building__ (2) APPLI_q&TION FOR BUILDING PERMIT t �i FO APPLICANT TO FILL IN (Print or type only) BUILCING , , COUNTY OF LO ANGE ADDR_S DEPARTMENT OF COUNTY ENGINEER CITYz I P j - BUILDING AND SAFETY DIVISION IO OF BL)DGS , BUILDING SIZEOF LOT NOW ON LOT J ADDRESS TRACT BLOCK LOT N Vy/ LOCALITY TEL NEAREST OWNER r- NO CROSS ST ASSESSOR ADDRE Mj(f MAP BOOK PAGE PARCEL �� DISTRICT GROUP TYPE FIRE PROCESSED BY CITY ZIP r / �� CONST ZONE ARCHI ECT TEL ENGINEER NO STATISTICAL C ASSI ICA TION SEWER MAP ADDRESS Y T CLASS NO„3!L DWELL UNITS —� oe.,BK PG44 CONTRA CTO S' NOL / US.E ZONE MAP j1/0 I LIC NO ADDRESS It NO -1 PECIAL I U LIC ONDITIONS CITY ✓If`O/ CLASS x ROA DEPARTMENT APPROVAL REQUIRED YES NO CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM d FRONTPROP LINEOF (STREET) C ADDRESS CITY , _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD - C SO FT NO OF , NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH C SIZE STORIES FAMILIES ONE t. + - LL DESCRIPTION OF WO NEW V ADDDG SETBACK FR ElB DE PROP LINE OFOM (STREET) ? ALTER ❑ ' OTAL SETBACK FROM TYPE OF EXISTING I` HIGHWAY + YARD = SIDE PROP LINE HIGHWAYI WIDTH REPAIR[:] USE OFi + _ EXISTING 2L G DEMOL ❑ APPLICA TEL _CORNER CUTOFF, YES ❑ NO,❑ (PRINT) N BY (SIGNATUR IN OPEN SPACE YES NO ❑ IN COASTAL ZONE YES Cj NO ❑ ALUATION$ / CATEGORICAL EXEMPTION YES NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON STIR UC ON _I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERS0 IN VIOLATION OF THE LABOR CODE OF TH STATE OF CALI RNIA IN EL ING TO WORKMEN 5 COMPEN A ION INSURA E '= V SIGNATURE OF v-s e,/^o ^o� • ' PERMITTE ADDRESS TE FINAL / BY _ C I T ll NO L,.7`-O' C/'��/ DATE Z � PMT Q MA KF Cllf CKS PAYABLE TO FEE na / FEE HARVEY T BRANDY COUNTY ENGINEER // !/� ` ✓// PLAN CHECK VALIDATION CK M O CASH 1 ;RMIT VALIDATIO cH MIO T CASH 9 3 10-JUN 23 2,1 © 1 2.6,3 A 638A CE#B03 7/73 932�JUN 23 1 U 4 875 A98 76 V' Ifl 76A638A CE#8.325 65 APPLICATION FOR BUILDI G PERIVII COtJNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS ((�� BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST _ COLEMAN W JENKINS SUP T OF BUILDING CROSS ST --- DISTRICT NO G TY E SS FOR APPLICANT TO FILL IN f CONST BUILDING �Q STATISTICAL FICA TION SEW R MAP ADDRESS .S"o40 `AL-D f�t1�N ��� BK PG_ L /J// CLASS-NO DWELL UNITS/.� IP LOT NO PG,e-r/py B/� 6 r BLOCK ZO MAP Q^ NO ( l' TRACT IO6/Xl SPECIAL ` NO OF SLOGS CONDITIONS SIZE OF LOT NOW ON LOT USE OF 1 EXISTING BLDG BLDG SETBACK FROM TE I I ' n FRONT PROP LINE OF (STREET) OWNERIP ATRICf� BELL' NO 7 4-1093 TYPE OF EXISTING SETBACK HIGHWAY -'+'� YARD -_"TOTAL' ADDRESS����+' /e'e li�tr�2.. HIGHWAY WIDTH FROM C L CITY / ARCHITECT OR TEL BLDG SETBACK FROM T ENGINEER NO SID PROP LINE OF 'ISTREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L TEL Q, / + _ CONTRACTOR /N NO C: ��d( O LIC CORNER CUTOFF YES NO V ADDRESS MI9/L NO CITY �G4 cl` SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK v W t a NEW ADD ALTER REPAIR DEMOLISH SQ T 10 OF O SIZE J 32 STORIES FAMIOLIFS USE OF a !T/ � y "' STRUCTURE t, S_-7P1, J SIGNATURE OF APPLICANT VALUATION$ �F APPROVALS DATE INSPECT R SSIGNATURE FOUNDATION LOCATION FEE$ FEE$ FORMS MATERIALS G 1 FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CATION BRACING BOLTS lA AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COM SATION INSURANCE LATH EXT SIGNATURE / HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS FINAL �`�" PLAN CHECK VALIDATION CK M O CASH _ JOHN TR PERMIT VALIDATION STRUCTURAL EN CASH `ACO 1 4?8 0'D APR22 1 D 2 2 CSO— att (, y`c , // i APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS 1 hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec.3800,Lab.C.) CITYZIP C ILEC l 780 LOCALITY Policy NO.?�Z�OZO/ Company � SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified Copy is filed with the county building inspection TRACT BLOCK LOT NO. .s department. USE ZONE MAP NO. Date- Applicant SEISM l G SAFF�ItiI C ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER N TES . _ COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS eC' L?w l� Ave, - DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) d !/ V I certify that in the performance of the work for which this permit T'F� �s D 780 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER l7 CITY ZIW :roe �i become subject to the Workers'Compensation Laws. n ��I TEL RD_ l iE O STATISTICAL CIL S1CATIONAPT CONDO Date Applicant ADDRESS ` T CLASS NO. , DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of S AL -5O1tv A,A-SA. 9110-4 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith f S E? Nl8 411'2'3612 FRONT comply with such provisions or this permit shall be deemed revoked. AgDRE S AO ^s v �� LIC. O.h If�� PL LICENSED CONTRACTORS DECLARATION // / /� !s SIDE C47/iC� P�A / LIC. SS PL I hereby affirm that I am licensed underprovisions of Chapter 9 /� �V SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF TORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG , d License Number 662'92'6 LIC.,ClaSS .3 DESCRIPTION OF WORK ADD ❑ VALUATION O Contractor Date eda/ 9, � LL ,ALTER ❑ $ 524 0 SSSM lG S&F&TY, I0 -3 �7 OC ❑ 1 am exempt under Sec. �EPAIR ❑ $ 0 B.&P.C.for this reason DEMOL ❑ 0 LDMA P/c# Date: USE OF EXISTING BLDG.:S�T URM ❑ � Signature APPLICANT(PRINT) -�[[// TEL NO. LDMA Perm# i z ❑ I, as owner of the property, or my employees with wages as ZO H'•_CIA?' a their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044,.Business and FINAL DATE Q �• t t.� _i I E_I Professions Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL T�T'—�'•'!-` OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J } NEMS' °i° ❑ 1, as owner of the property, am exclusively contracting with FINAL BY AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, s' �'` Business and Professions Code.) YES❑ No❑ / t Li;(- 107 � '_g WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING r•' !-f �+ 0 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 'C `EE K •i•�I� 3•y 1 CONSTRUCTION LENDING AGENCY COl•!jAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR `a ;.. GUIDELINES. ::lNGE n I jl j SI hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance Of the Work for which this permit Is Issued(.Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCACMD PERMITTING 3097,CIV.C.) CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, Z !�C ,!- TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140'CONCERNING HAZARDOUS 0000-00011 6,; 3l 9 t Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. LL Lender's Address t ! O OWNER OR AGENT o I certify that I have read this application and state under penalty O of perjury that the above information is correct. I agree to comply P.C.FEE PERMIT FEE with all c y ordinances and State laws relating to building pS constr o , and he aut a representatives of this County ISSUANCE FEE / co to en o�the e d property for inspection purposes. cq(, (7 INVESTIGATION FEE TOTAL FEE `O V / S5 AO t or nM Dale ��DZMIG Sd•FPiTY Int SEE REVERSE FOR EXPLANATORY LANGUAGE