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Home My Public Portal About5500 BALDWIN AVE_Building__ (2) APPLICATION FOR COMM O!UPS ANOKS Il WAUMWT O*COON M MOInmI UILDING PERMIT WXUWaAND IOir FOR APPLJCANrr TO FILL IN - ADMIS BULDWO ADORes LocAWY a 16 CIA NEAR W an a 227arcs sr. um Cr Lm l as-/ r ow aNLOr AWkp ll= IPAGE nnm oarwa � PRE TwAa Km Lar Na �•,w add OiMIIR LNo A TM CLARK NO DWlLL lldH tM rO cm EPNO. a AMCWrEUTd a10/�ler NO. ADDRlRR MOO D&WMENi APrROMAL No❑ r� aoNrRAcrve FRDNr .LRS!OF anan Jc- ADDtiBi IN W. AY + YARD WrAL RETRAaC FROM TM Or l�rNG PRDW PROP.LNE A VIDTH aTY aARR + NAME AND NANOi ELDO. rROM ADD ary RR]! rfrREel cgnm RQ FT. NO OF "MOF aHoc HQiWAY + YARD Mf AOM oA Vanni o0■t3 FAM 99_ DERMKM OF WORK P1AW + ADD OOORRL cLffw YE ❑ ALTER N OM WAa YE ❑ NO IX REPIIQ LoopY ❑ �No RLDO. DBXWXL N r ODAf�AL lwMlri mP! d El ArrLKJ1Ni iEL ti J�:'� ., I� _!: i j,dC•:'� NO. ' H>Y moNArLdB I� AOQOWLEXII 7W 1 HAVE HHRH M APRrCAnON MO QAnr HHLAtr 7H AHHDN IF G01110 IMO A 10 DDWLY VM ALL Aro A%"■DoATM wmu n ccmWc olL A c mr nHE cr u�o®moEcrn�r I Dr�rAll 00 FR&AMIM Or RAL/dY • -7#l DATE QTY N TEL P.G Fm$ PWmt Fm IurHwm FN vALWTR]N� TakA Fu RAN CHECK VALIDATION oR MAL wL _ FEWArr VALIDA w.a CAAM 6 4 0 SWUL 1.3 l D 2 2.0 0 4k 7.A6>oAVf7 � r� • ,APPLICATION FOR BUILDING PERMIT FOR [CANT TO FILL IN [Print or type only) B I ' • COUNTY OF LOS ANGELES I Al. aw . ' vg DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO.OF SLDGL BUILDING SIZE OF LOT if/Q NOW ON LOT ADORNS 6'SO d f4V• ` fi16 zBL= LOT NO. R LOCMITY TEL NEAREST OWNER CROSS ST. RF� ASSMWR 3 �(/, MAP BOOK PAGE ADDPARCEL �]TY ZIP DLSTECT GROUP TYPE T. FIRE , BY PL ENGINEER ARCHITECT OR TL PIIO. STATISTICAL CLASSIFICATION SEW�/ER P ADDRESS CLA%NO.�4DWELLUNIIS Wa PGf,y CONTRACTOR L —il t 44W. U50�E N"IA D AD :.R; # NO. !�LCONDITIONS . cff LIQ CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO 0 NAME AND BRANCH ELDG.SETBACK FROM ADDRT! CRY. AAD FROM PROP.UNE OF ISTREEn HIGHWAY + YARD . TOTAL SEMACIC FROM TYPE OF EXISTING SQ.FT OF ;W CHIM FROM PROP.UNE HIGHWAY WIDTH SIZE STORIES FAMILIES ONEd J DESCRIPTIO OF WORK' NEW ❑ •j+ /Od 8 ADD EBLDG.SETBACK FROM DE PROP.LINE OF [STREET[ m ALTER ❑ HIGHWAY + YARD - TOTAL SEfBACI(FROM TYPE OF EXISTING 'REPAIR 13 SIDE PROP.UNE HIGHWAY WIDTH APPUCAM 11i CQRNERC.UTOFF YES ❑ NO ❑ IPRIMI Q NO. d IN OPEN SPACE YES ❑ NO ❑ BY[SIGNATURE! IN COASTAL PERMIT ZONE YES ❑ NO ❑ vALwnoN$ AMIAZ' . AMT ,Qr f-AY r�_ 1 HENRY ACIMWLEDGE TINT I HAVE IAD YHO APRICATKIN AND STATE THAT THE AIM 0 OOMO AND AGREE TO COMPLY MIRK ALL OWNANO36 r e AND LAWS IEGIIATING IISLDING OOPS MIXTION.I C=FY THAT N DOING THE A C.ITi&r-z //Wj-.,o ' /%*pq av /,O P(em'Y"- WORK AU1110N»HMY 1 WILL NOT EMPLDAI ANY PRISON IN VIOLATION OP THE PINIIALAIIN CMOFTHEUATEOFGUPOINNNMATNGTOWOIKMEN'SODNI• �C� TION RM /•r Y.IP+'�.tl SIGNATURE PI vmffEE ADDRESS ' FINAL BY CITY • „'ase NCO DATE AAAKE CJiECKSPAYABLE TOS P.C.$ FEE $ HARVEY T.BRANDTT.COLINTY ENGINEER I ) 7 PLAN CHECK VALIDATION' CLL KXL oASH PERMITVALIDATION <pg .Ka . wN S•3-SP AM 21 1 R .1.7 7.0 0 Aw eI 7AUM CESSDS 5.75' ` � Q •� r3 APPLICATION FOR BUILDING PERMIT .. COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION ?l o' I 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.) ClT r ZIP LOCALITY ,12 POIICy NO. Company SIZE OF LO ` NO.OF BLDGS.NOW ON LOT 1C� `� El Certified copy is hereby furnished. j`7 NEAREST CROSS ST. ❑ 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' O NERTEL NO. COMPENSATION INSURANCE YI .�"' ^7 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRES DISTRICT GROUP TVPf CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) 76 I certify that in the performance of the work for which this permit CITY is issued, I shall not employ any p o i y er o as to becom SU 'eCt the Workers' t' aw ARCHITECT OR ENGINEER TEL NO. �Y-y` STATISTICAL CLAS IFICATION APT CONDO \, Date +� pylic v ADDRESS CLASS NO.. � DWELL UNITS / r NOTICE TO APPLICAN : f, after making this Certificate 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. P L LICENSED CONTRACTORS DECLARATIONCITY LIC.CLASS P L SIDE I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP a (commencing with Section 7000)of Division 3 of the Business andS FT SIZE ,5 NO.OF STORIES NO.OF FAMILIES NEW BK PG U Professions Code,and my license is in full force and effect. .� !A License Number Lic.Class DESCRIP NOF ORKs ADD ❑ VALUATION a Contractor Dats� ALTER 1:1 $ 'lL e1 w Date CL REPAIR REPAIR ❑ y ❑ I am exempt under Sec. ,, I $ z B.BP.C.for this reason �L�"7 /�19� - ' DEMOL ❑ LDMA P/C# Date: USE OE.,EXISTING BLDG. 'JURM ❑ ,J •. t vZ Signature APP CANT(PRINT) TEL NO. LDMA Perm# g I,:as owner of the property, or my employees with wages as ZO their sole compensation, will do the work and the structure is A DRESS " not intended or offered for sale (Section 7044, Business and !' FINAL DATEp� Professions Code.) 'Z,— / WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I, as owner of the property, am exclusively contracting with FINAL BY AMOUNTS SPECIFIED THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, Yes❑ NO ) �� Business and Professions Code.) BBN/�V WILL THE INT DED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '�•I�i'-'+ +•-t �+"f=-y CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. `^+ h;r.,i = Ii `:' I hereby affirm that there is a construction lending agency for YES 11 INAa the performance of the work for which this permit is issued(Sec. I HAVE READ THt HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ.C. _ CHECKLI DERSTAND MY REQUI ENT NDER THE LOS ANGELES COUNTY CODE, r TIT HAP 20 ION 0. ROUGH 2.20.140 CONCERNING HAZARDOUS S,_I •., 3_^-'i Sl,,,ie•j` ,•;;+a•_• '7 Lender's Name MALS POR CSA D F 0B PERMITFROM THE SCAQMD. ❑ Lender's Address _ H-1 . C, OWN!!RA R AGENT o I certify that I have read this application and state under penalty Oof perjury that the above information is correct.I agree to comply PeFEE PERMIT FEE N with all ty ordinances and St laws relating to building SMI-tion a h� a r e resentatives of this Co nt SUANCE FEE D a / to enter u nth ab e- enti r ert ns ecti ose Y y p �' INVESTIGATION FEE TOTAL FEE 5' urea/Apps p Agent Date / SEE REVERSE FOR EXPLANATORY LANGUAGE