Loading...
HomeMy Public PortalAbout5406 BALDWIN AVE_Building__ (3) A ROAD DEPT. PERMIT IS REQUIRED FOR ANY I,IATER:AL 5 ^t 0: WORK DONE IN ThE ROAD fill f OF WAY 7GA638A CE#8038_59 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS -_"'75,'t r'l'r—­;y BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST - CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN CONST. � : 1" BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS J �'�`>,�i J�, .� /I BK PG CLASS.NO. DWELL. UNITS LOT NO. 'LTI•:;J l BLOCK MAP < STATE {{� NUMBER _6 HWY. YES NO TRAC'' y `1 ' � USE ZONE SPECIAL NO. OF BLDGS. CONDITIONS SIZE OF LOT �G' �(, /•�EJ I NOW ON LOT USE OF _ EXISTING BLDG. e` BUILDING EXIST. SETBACK YARD WY STREET NAME WIDTH OWNER �`.G.l Fr L... FRONT ,. MAIL ___ U. L. 'r0,. C ADDRESS >;1�, •)i C f SIDE —� � TEL. .'- t P. L. /la2. G -I"' CITY r.. - NO. °z. INSPECTION RECORD ARCHITECT PR TEL.. ENGINEER ) NO. 3 ADDRESS _ ` / TEL. �P9,OF Ya I CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK EW ADD ALTER REPAIR DEMOLISH i- SG!. FT. NO. OF ONO. OF SIZE ��C�i' STRIES FAMILIES USE OFr- -STRUCTURE _�•'�: !__- jr.k_ 'S • SIGNATURE OF f [. APPLICANT X 7 APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS, - FOUNDATION: LOCATION i _FORMS, MATERIALS VALUATION $ FIRE � V (J I FBRARAMECING, BOLTTSS �� �✓ 1"'�Y"�^"�" /'tom MT. .-� FURNACE: LOCATION, P-CFEE I�/•`� FEE S(�l GAS VENT, DUCTS c_ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT TH ABOVE IS CORRECT AND — AGREE TO COMPLY WITH ALL UNTY ORDINANCES AND STATE LAWS �ATIN G ILDING ONSTRUCTION. LATH, EXT. i SIGNATURE O HOUSE NUMBER COR- ' PER 1T Q'� RECT AND POSTED API)VYSS- FINAL CLYDE N. DIRLAM, PRINCIPAL ST CT� RAL ENGINEER PLAN CHECK VALIDATION �ic.� M.O. CASH PERMIT VALIDATION (CK.), M.O. CASH !ior 2 4 b c rE3 3 ;> 3 A 315 ®F LAC0 8 0 1 65D3 TIAR 21 1 A 6 3 .0 0 r APPLICATION FOR COUNTY OF LOS ANGEOF LES BUILDING PERMIT DEPARTMENT YrINEE BUILDING AND SAFETYDIVIS ON R BUILDING` /�/ FENGINEER OR APPLICANT TO FILL IN ADDRESS �j/ /V x,�•.� rrc.� G '` yJ �'7 ,r S ��Q� D/� �LILv�N /1I� LOCALITYNEAREST /Y�r � ZIP CROSS STNO OF SLOGS ASSESSOR LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE -PR ESSE BY � / A� BLOCK LOT NO ^ 2CONS ZOIT6(J NOS+ STATISTICAL CLASSIFICATION L f SEWER MAP S I}-"f0 3 d (� ,Q,9 A, E=T r CLASS NO��WELLUNITS BK8 PGUSE ZONE MAP�) 7 ZIP NOCT OR TEL -jj SPECIAL R NO CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR p C oft CO NOL )-Y V 5(,L BLDG SETBACK FROM , I.-%---- LINEOF (STREET) LIC ADDRESS,`� 0 S�/Ji/y►p�� NO ��09LICt�G HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING CITY x CLASS 1 ' FRONT PROP LINE HIGHWAY WIDTH CONSTRUCTION LENDER + NAME AND BRANCH (LI ( BLDG SETBACK F M T a ADDRESS CITY SIDE PROP LINEOF (STREET) V SQ FT NO OF NO OF CHECK HIGHWAY + YARD = 0TAL SETBACK FROM TYPE OF EXISTING SIZE I STORIES FAMILIES ONE DE PROP LINE HIGHWAY WIDTH tjj + LU DESCRIPTION OF WORK r NEW �❑ 1 N 7?d ADD ❑ ( CORNER CUTOFF YES NO ❑ Z �l'+Ti 7 @_ LTER ❑ '' /' LIt--KUSE OF IN OPEN SPACE YES ❑ O ❑ EXISTING BLDG &I04,,/r/' yrOle DEMOL /❑' IN COASTAL PERMIT ZONE YES ❑ NO ❑ AP (PRINT) /v•d�(i /•f NOL BY (SIGNATURE) I HEREBY ACN O LEDGE THAT I HAVE AD THISJ'IJ ION AN STATE THATT E ABOVE IS CORRECT AND AGREPLY WITH ALL ORDINA�NCE9 AND LAWS REGULATING BUILDINGON STRUCTION I CERTIFY THAT IN DOING THE WORED - - HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLTHE LABOR CODE OF THE STATE OF CALIFORNIA IN TO WORKMEN S COMP NSATION INSURANCE /// SIGNATURE OF �_ FINAL tC}��� BY + PERMITTEE J� !7 '� 0, DATE (� ADDREfSS jj% SO , AAU 1 CITY L.. -/-F NO PC Fee$ Permit Fee ��- Issuance Fee VALUATION ()0 I Total Fee PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION <:c� M o CASH 796NM,4Y 10 1 0 2400 ® 1 � t 7GA638A CE;*803B 12/75 TEMPLE CI'T'E' 78A630A CE 8031 ez APPLICATION �'OR BUI DI PERMIT ' COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS S �/ BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTRICT N GROUP I TYPE = BY FOR APPLICANT TO FILL IN CONST BUILDING AA) STATISTICAL CLASSIFICATION SEWER MAP ADORESS�. CLASS NO DWELL UNITS BK PG LOT NO 3 BLOCK WATER �y CERTIFICATE NOT REQUIRED I R RECEIVED ❑ TRACTel, MAP HIGHWAY L=J� p� / N OF BLDGS NOen 44 Io (CIRCLE) STATE MAJOR SECOND LOCAL SIZE OF LOTS' {p X NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG /' TE OWNER —n T' e N -�d BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT ,,y !�/ ARCHITECT OR TEL P L CJ CI ENGINEER NO SIDE ss } P L ADDRESS d O CONTRACTO TEL NO -D I e V ADDRESS �3'�7 S / t.!IJA-'J ►V a-F�-�/C i G.� ' �/ .fir./'l/.L /LU7f�' A '.� � 0 0 DESCRIPTION OF WORK �l W a a NEW DD� ALTER REPAIR DEMOLISH i} Z SQ FT NO OF NO OF O SIZE STORIES FAMILIES USE OF / STRUCTURE /cP-i,//J / t , J f SIGNATURE OF APPLICANT VALUATION APPROVALS DATE INSPECTORS SIGNATURE PC PMT 0FOUNDATION LOCATION /} FEE $ FEE $ FORMS MATERIALS 1 I FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS j 1 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 I 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 5 CO ION 1 �SURANC LATH EXT SIGNATURE OF I HOUSE NUMBER COR A I_ PERMITTEE a RECT AND POSTED ADDRESS d FINAL1r3 A 3 `- „,44, PLAN CHECK VALIDATION CK M o CASH ' JOHN F LEWIS PRINCIPAL STR URAL ENGINEER PERMIT VALIDATION cK M O CASH L-ALO o o 1 713, JAN ?2 , D 1 1 5 0 a WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or certified copy thereof (Sec. 3800, Lab. C.) _ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. t( 2'> Company�/J-eA-)l I F lcrq Certified co is hereby furnished. FOR APPLICANT TO FILL 1N ADDRBUILDING SIN I 81�P0,XJ copy Y ADDRESS b Certified copy is filed with the county building inspec- FADDRESS ia C� �.11� Tion deportment. ADr Date IL �� Applicant LG NO. OF BLDGS.ZIP NEARELOCALITY 1.E CJ CERTIFICATE OF EXEMPTION F WORKERS' NOW ON LOT CROSS ST. (/t COMPENSATION INS NCE ASSESSOR (This section need not be completed i the permit is for one BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. C%� �(��/� NO.�S A USE ZONE MAP I certify that in the performance of the work for which thisrD NO.permit is issued, I shall not employ any person in any manner �� s• )Ark- 1 �M SPECIAL CONDITIONS d so as to become subject to the Workers' Compensation Laws. O CITY 01J1"U1A ZIP U Date Applicant ARCHITECT OR TEL: DISTRICT I GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after:making this Certificate of ENGINEER NO. CONST. ZONE O Exemption, you should become subject to the Workers' �O� �.� U Compensation provisions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall be TEL. j�ZZ STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR'�/"� 3�v"vJ � 1 NO. �►7 2 �J�� Z LICENSED CONTRACTORS DECLARATION nY per.., LIC. �0 �� CLASS NO.�DWELL. UN95 I hereby affirm that I am licensed under provisions of Chapter 9 ADORES f1�43U L F-i fl No• G SEWER MAP (commencing with Section 7000)of Division 3 of the Business /�A LIC. and Professions Code,and my license is in full force and effect. CITY r7^ CLASS �/ BK. PG. VALIDATION / /n1 �{('� SQ. FT. NO. OF NO. OF CHECK License Number Cb�J �'� Lic. Class `✓ ` l SIZE STORIES FAMILIES ONE VALUATION Contractor Date-/ 2-1/47" DESCRIPTION OF WORK �CvJ �1r�ll. NEW ❑ $ 3200 ADD ❑ , ❑1 am exem under Sec. ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF / '4 EXISTING BLDG. C.� ��� �� /'"'� DEMOL ❑ Signature APPLICANT q6r�2.7 FINAL OWNER-BUILDER DECLARATION (PRINT)-nm �GLJA/V NO.`</ �• ,,9 .1 �` DATE 1 hereby affirm that I am exempt from the Contractor's License ADDRESS 1 �J llv�V�7i►'-+:✓`r(_ Law for the following reason (Section 7031.5, Business and FINAL t r Professions Code): PRESENT BY i I s BUILDING �`. .T ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and �.FI ! r• oh the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. El1, NO.I, as owner of the property, am exclusively contracting r.�•-� a with licensed contractors to construct the project (Sec- �`.CT3 ADDRESS '» tion 7044, Business and Professions Code.) � ?j(Jr 113.82REQUIRED TOTAL SETBACK FROM EXIST.- CONSTRUCTION LENDING AGENCY SET BACK YARD '•HWY PROP. LINE WIDTH- ! I hereby affirm that there is a construction lending agency for FRONT ITEMS the performance of the work for which this permit is issued P.L. TtiT�ti. J +' �. , (Sec. 3097, Civ. C.). [Investigation IDE .L. Lender's Name, CHECK 191.It m LDMA Ref. # i Lender's Address . Fee$ Permit Fee � tt�� "LiLi 1 certify that I have read this application and state that the Issuance Fee `75 LDMA P/C# , above information is correct. I agree to comply with all County Fee { �� 03131,,10-x]401 1/.•'1/9" 8 ordina es and State laws relating to building construction, Total Fee / LDMA Perm. # a and h y authorize representatives of this County to enter 7749 1 Am10:54 aupo a ove-mentioned property for inspectio purpoS. / 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Si a re of Applicant or Agent Dat GANAPPLICATION FOR BUILDING PERMIT 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, BUILDIN ADDRESS "" ) or a certificate of Workers' Compensation Insurance,or a certified O 1 &- 1 copy thereof (Sec.3800,Lab.C.) CITY ZIP ©Qi e- LOCALITY Policy No. �p���Q Company� �l A�� J N� SIZE OF LCT NO.OF BL GS.NOW ON LOT e❑ Certified copy is hereby furnished. NEAREST CROSS ST. Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. S department. (A1 USE ZONE '4K I - A 4 Date / Applicant �,�� ��y,p,�YV ASSESSOR MAP BOOK PAGE PARCEL 7 G�� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O ER TEL NO. COMPENSATION INSURANCE 5.9-951 a. WITHIN 1000 FT.OF SCHOOL? VES NO (This section need not be completed if the permit is for one hundred ADDRES DISTRICT GROUP TYPE CONST. FIRE dollars($100)or less.) S ZONE PROCES I certify that in the performance of the work'for which this permit CITY ZIP is issued, I shall not employ any person in any manner s0 as t0 V1 -21 ARCHITECT ORAE GINEER TEL NO. 1 6 become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CO O Date Applicant ADDRESS CLASS NO. _9� DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' EPNTRACI0 TEL tNO.$17 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the'Labor Code, you must forthwith TT W( Y/3 083D FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.rrr���O. PL LICENSED CONTRACTORS DECLARATION 12, A \oS o— V• Llc.6 ss Q PSIDE 1 hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP Professions Code, El my license is in full force and effect. NEW SK PG O License Nu e*- Lic.Class G' �jCI DESCRIPTION OF WORK ADD ❑ VALUATION , U l ally r E t $ Contractor Date ' ��' n IN Roe ALTER ❑ a W O I am exempt under Sec. ISG P, F G1 ew REPAIR ❑ $ Z 1/ L. 1'(r 6.8P.C.for this reason RJLF� �ppF C'r OgV`S< $wl%ADEMOL El LDMA P/C# Date: USE OF EXISTING BLDG. URM 1:1Signature y+l Ntar 5 ~` APPL ANT(PRINT) TEL NO. 8I LDMA Perm# ❑ 1, as owner of the property, or my employees with wages as IwVp $ 2 their sole compensation, will do the work and the structure isA DRESS O not intended or offered for sale (Section 7044, Business and Ee (cOa AU= Csv4 0/1GL- FINAL DATE Q 131 Professions Code.) O_ _ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL .� -IX ACCT. FF 8 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ACC! ='ff ❑ 1, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY j �R licensed contractors to construct the project !Section 7044, YES❑ No❑ � ��03 295-40 Business and Professions Code.) i •� WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ITEMS! OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR p f GUIDELINES. TO y i ti`L 295 = 4 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. yes❑ No❑ .HECK 295.40 3097,CIV.C.) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE,LOS ANGELES COUNTY CODE, N TITLE 2,CHAPTER 2.20 SECTIONS 2.20 100 THROUGH 2.20.140 CONCERNING HAZARDOUS �':IJAI,t _ !lfni11�-99 GG..C =0 m Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address OWNER OR AGENT 1 certify that I have read this application and state under penalty 0000-0001 1!11/96.- a. of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all county ordinances and State laws relating to building O 4238 1 FIM 6'-00 m construction, and hereby authorize representatives of this County ISSUANCE FEE I �� to enter upon the above-mentione property for inspection purposes. +�, ff �M d 1 1 Lpr. 4 1 INVESTIGATION FEE TOTAL FEE N sgNture of Apel-a Agan, �� ` 11 Dale CK I SEE REVERSE FOR EXPLANATORY LANGUAGE