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Home My Public Portal About5140 BALDWIN AVE_Building__ (2) 76A638A CE#803 5-61APPLICATION FOR (BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS (/ BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRI T�Q.,/ GROUP TYPE P=ESS BY FOR APPLICANT TO FILL IN ((}}�,[[ (� coNsr. BUILDING l STATISTICAL CLASSIFICATION SEWER MAP ADDRESS`> �¢� ,�jG�f�ji,i�f/ BK PG �y CLASS. NO. DWELL. UNITS- LOT NO. r-_S"" BLOCK WATER NOT REQUIRED IXI RECEIVED CERTIFICATE: TRACT TRACT vG'1�'' d' 1_37 �y MAP O HIGHWAY STATE AJOR SECOND, LOCAL NO.OF BLDGS. NO. CIRC LE) SIZE OF LOT/�0,,(�//(J NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL. OWNER NO. BUILDING EXIST. SETBACK YARD WY STR ET NAME WIDTH ADDRESS FRONT / ARCHITECT OR TEL. - P. L. ENGINEER �. fj�-c� NO. SIDE d RESS CONDTRACT / TEL. INSPECTION RECORD ADDRESS DESCRIPTION OF WORK N Z C-NEW'� ADD ALTER REPAIR DEMOLISH T. / NO.OF NO.OF IZE C/ O STORIES FAMILIES USE OF STRUCTURE }y SIGNATURE OF APPLICANT VALUATION$�� APPROVALS 12ATC INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION q FEE $`� FEE $ FORMS, MATERIALS pZ'` FRAME: FIRESTOPS, 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMP SATION INSURANCE. LATH, EXT. SIGNATURE OF LOUSE NUMBER COR- RECT AND POSTED ADDRESS / FINAL CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER cK, PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION CK- M.O. CASH Ao 0 9 6 9Z; JUN 2 2 3 03.75 ••a LALo0 9 7 0" JUN 29 1 0 15.0 0, APPLICATION FOR^$OILMNG PEkMIIT �I FOR APPLICANT TO FILL IN (Print or type only) U BUILDING / COUNTY OF LOS ANGELES AD OR ESS DEPARTMENT OF COUNTY ENGINEER CI Y ZIP - BUILDING AND SAFETY DIVISION \ lop, NO OF BLDGS BUILDING SIZE'OF LOT „NOW ON LOT ADDRESS TRACT LOCK LOT NO LOCALITY TEL NEAREST OWNER NO CROSS ST �J ASSESSOR ADDRESS ,S �I��(/ MAP BOOK PAGE PARCEL, DISTRICT IGROUR TYPE FIRE ESSED BY CITY ZIP �^ CONST ZONE - ARCHITECT R TEL Q .L�— ENGINEER NO STATISTICAL CLASSIFICATION SEWER AP I a ADDRESS CLASS NO DWELL UNITS B G CONTRACTOR NEOL 3 NO USE ONE MAP r1 p LIC ADDRESS �� NO SPECIAL I LIC CONDITIONS CITY CLASS ROA EPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LEND NAME AND BRANCH BLDG SETBACK FROM G FRONT PROP LINE OF (STREET) C ADDRESS CITY _ TOTAL SETBACK FROM HIGHWAY + YARD - TYPE OF EXISTING Q SO FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH C SIZE STORIES i FAMILIES / ONE cF DESCRIPTION OF WORK NEW ❑ + V ADD ❑ BLDG SETBACK FROM I (STREET) ? SIDE PROP LINEOF ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING 11EMOL EPAIRSIDE PROP LINE HIGHWAY WIDTH USE OF +EXISTING BLDG ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATIONV p��(/(// 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 STRUC TION I CERTIFY THAT IN IMPACT REPORT PROCESSED / (DATE) Il THE WORK AUTHORIZED _ HEREBY I WILL N0T EMP A PERSON IN F THE LABOR ODE OF THE 5 ATE CALIFOR IA ELA TO �/1,mow {� WORKMEN S COMPENSA TI ANCE Cc 12C U1 ►> (J i;7 SIGNA-URE OF PERMITTEE ,�J ADDRESS '�YGY /• •�/v 1 'Gr�'�G (/C 6*T-5/ FINAL BY CITY NO �3 DATE `� J�I,�V A1AKE C C PAYABLE TO F E $( /� FEE HARVEY T BRANDT COUNTY ENGINEER IPLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CASH (� 1 1 2 8 9 JUL 31 1 if) 2 8 5 U 76A 638A CE#803 7/73 APPLICATION FO 11-8UILDING PERMIT • � .T�'{ COUNrTY OFfLOS ANGELES s BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING DDRESS � 1 I hereby affirm that I have a certificate of consent to self Insure BUILDING ADDRESS 4111e��-/ or a certificate of Workers Compensation Insurance or a certified Copy thereof(Sec 3800 Lab C) CITYC� ZIP d� LOCALITY Policy No Company SIZE OF LCOr NO OF BLDGS NOW ON LOT 11 Certified copy Is hereby furnished NEAREST CROSS S ❑ Certified copy Is flied with the county building inspection TRACT BLOCK LOT NO USE ZONE MAP NO department ` f ASSES P OOK PAGE PARCEL Date Applicant X �L^' Q� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS �.1� J u !N�l�ld��YS" YES NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL') 1 (This section need not be completed if the permit Is for one hundred ADDRESS r1 /J)t!D dollars($100)or less) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I cCITY ZIP ertify that In the performance of the work for which this permit IS Issued I shall not employ any person In any manner SO as to ARCHITECT OR ENGINEER TEL NO 4 become subject t0 the Workers Compensation Laws STATISTICAL CLA IFICATION APT CONDO Date 3 Applicant ADDRESS CLASSING � DWELL UNITS2 NOTICE TO APPLICANT If after making this Certificate of j REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become Subject t0 the Workers CONTRACTOR d �_ TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith �vP�7C-�t� FRONT ` n comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L >- SIDE n' LICENSED CONTRACTORS DECLARATIONCITY LIC CLASS PL y O U I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES Professions Code and my license is in full force and effect NEW ❑ BK PG O License Number LIC Class DESCRIPT OF WORK , ADD ❑ VALUATION , y U LLJ Contractor Date a G ALTER $ a' N ❑ 1 am exempt under Sec x} REPAIR ❑ $ Z B&PC for this reason DEMOL ❑~ LDMA P/C a Date UV OF EXISTINCOLDG URM ❑` Signature as (PRINT) TEL NO LDMA Perm k Xtheir Oas owner of the property or my employees with wages as Ztai t T sole compensation will do the work and the structure Is ADDRESS _ not Intended or offered for sale (Section 7044 Business and FINAL DATE _� Q 93-33 70 _0 Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I as owner Of the r0 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE If 77 property am exclusive) contracting with FINALBY > 1 TENS Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE licensed contractors to construct the project (Section 7044 { YES❑ NO❑ TI ITAL 70 ® 'BID Business and Professions Code) //��"� _-} WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING — z 1 �`K(C1 7�r LU OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTHwj� CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT ISCAQMD)SEE PERMITTING CHECKLIST FOR `O �g — ( �/D /tJ�4{(,C II}�{) GUIDELINES _ �-t l rl 11 G �..! I hereby affirm that there Is a construction lending agency for YES C3NO❑ P the performance of the work for which this permit Is Issued(Sec 3097 CIV C) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING p�� ('�(^(y O ('y{ CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE V f F 11000-0301 f,2,t Qt TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD „�Iw�v� - CI a I Lender s Address J 1 „` //'�� - 1 - cc OWNER OR AGENT 1/ 31 certify that I have read this application and state under penalty (L PC FEE PERMIT FEE p of perjury that the above information is correct I agree to comply U) with all county ordinances and State laws relating to building construction and hereby authorize representatives of this County ISSUANCE FEE /,� - Q� ` to Up e above mentioned property for Inspection purposes o� /� INVESTIGATION FEE TOTAL FEE � �Q SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT �I COUNTY OFcLOS 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 BUILDING ADDRESS ' -5140 t✓t or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) ZIP 9Q� LOCALITY Policy NO Company /4,40�0, NO OF BL S NOW ON LOT ❑ Certified copy Is hereby furnished ~NEAREST CROSS ST ❑ Certified copy Is filed with the county building Inspection J TRACTBLOCK LOT NOS/� department USE ZONE MAP NO 4 i Date Applicant ASSESSOR MABOOK PPS E PARCEL ¢/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS o � »G �O -y_�� TEL NO 2 WITHIN 1000 FT OF SCHOOL COMPENSATION INSURANCE YES No (This section need not be completed If the permit Is for one hundred ADDRESS / // I DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars ($100)or less) ((lf�Y�CC v CITY yo I certify that in the performance of the work for which this permit CZIP ` Is Issued I shall not employ any person In any manner so as to come subject to the Workers C Ion aws ARCHIT C OR ENGINEER TEL NO Dat, /1- K Applicant ADDRESS _ CLASS NOSTATISTICAC _T DWELL UNITS ION APT CONDO NOTICE TO APPLICANT If after making this Certificate Of 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 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L LICENSED CONTRACTORS DECLARATION SIDE I CITY LIC CLASS P L I hereby affirm that I am licensed underprovisions 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 iull force and effect NEW El BK PG ® d License Number Llc Class DESCRIPTION OF WORK ADD ❑ VALUATION Q Contractor Date A� ALTER 1:1 � ��U0 cc ❑ 1 am exempt under Sec G REPAIR $ B&PC for this reasonDEMOL ❑ LDMA P/C# t Lll Date USE OF EXISTING BLDG URM ❑ IL to Signature APPLICANT(PRINT) TEL NO LDMA Perm# 1 ' Z ❑ I as owner of the property or my employees with wages as Z their sole compensation will do the work and the structure Is ADDRESS 0 ACCLO, not Intended or offered for sale (Section 7044 Business and FINAL DATE /!/ C ,� 1-'7-,.--5 Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ' lY J i ❑ I as owner of the property am exclusively contracting with ORA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINaBY 7 j 1 ITEMS licensed contractors to construct the project (Section 7044 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES Business and Professions Code) YES❑ No❑ ` TOTAL F WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING r OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 5T (ur Y 129: 1�CONSTRUCTION LENDING AGENCY COASTAIR QUALTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR EVE GUIDELINES O ° " I hereby affirm that there is a construction lending agency for YES❑ No❑ " N the performance of the work for which this permit Is Issued(Sec 3097 Civ C (HAVE READ I HE UNDERSTAND MY REQUIREMELS NTS TS UNDER GUIDE AND ANGELHE ES COUNTMD YITTING N ) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUMY CODE _ TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS t1{'t('t('t�flf'1f1 i 10,1619:--1 Lenders Name MATE RIALSREPORAND FOR OBTAINING A PERMIT F M THE SCAQMD lU/lV1lViL411 �LJ1IlJ1LL1i l IL Lenders Address aNN' iT ��jy 2817 A jQ'4' 0 0 1 certify that I have read this application and state under penalty 0 of perjury that the above Information IS correct I agree to comply PC FEE PERMIT FEE N with all county ordinances and State laws relating to budding m construction and hereby authorize representatives of this County ISSUANCE FEE to ent DSabo a rn ne propVrty for Inspection Pur oses INVESTIGATION FEE TOTAL FEE I Z sg �re Inud�I I o� SEE REVERSE FOR EXPLANATORY LANGUAGE