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HomeMy Public PortalAbout5003 ARDEN DR_Building__ DEPARTMENT OF' BUILDING AND SAFETY r APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM.)J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY +. BUILDING•;'') DISTRICT NO. PLAN CK.NO. PERMIT///NO. ADDRESS { r LOCALITY T T' RECEIVED BY DATE OF APPL. DATE ISSUED�J NEARECBSST f'�� �_/ '3/ / / 1 ��{(()j� � � ry BUILDING OWNER .�i'!.Q.�1L�. �y ADDREBB � .5- �;(�n ICH I .0 Q MAIL �y / t LOCALITY �i�n/�f��F CiZ Iy ADDRESS tJ �/bQ r,, ?I-• -- •^ E � L NEAREST -5.,QITY WLXt NCRO88 ST. 'FIRE NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANS az LOS. ENGINEER NO. y BLDG. / ORD.NO. ADDRESS ��-�G��L - SETBACK LINE 2/7 TEL. - APPROVED CONTRACTOR NO. BY DATE r USE APPROVED ADDRESS ZONE BY DATE LEGAL CORRECTIONS ,> DESCRIPTION I LOT NO. p�� I BLOCK 7. 7 TRACT y q /� 7,aC OJ.✓,�j'Til II NOWONLDGS. SIZE OF LOT � NOW ON LOT USE OF NO.OF —1 NO.OF �l- EXISTING BLDG. FAMILIES ROOMS DESCRIPTION OF WORK q NEW ALTERATION ADDITION O A REPAIR MOVING DEMOLISH 0 SQ.FT. qq c� t'F NO.OF o Z _SIZE Nom' ROOMS /� STORIES D WALL �.i- � ROOF r. f' COVERING ,0.-tr.,,,:a _> I COVERING (�„�y»;�J.42;"_ , USE OF NEW .1(�1� BUILDING !9 A.Mr.>C7 `'.n . 7 0 0 { 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ROV -S' APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION I SPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. i FRAME: FIRE STOPS, - G .6� 9 e-}�� BRACING,BOLTS f �� SIGNATURE OF � � .� V�� T OWNER LATH,INT.: AUTHORIZED AGT. LATH,EXT.: i DBS-3 25M SETS 1-47 $ P C 6 PLASTER.INT. y O O FEE O PLASTER,EXT. VALUATION FEE Z G ©� FINAL i - b EMPLE CET 76AG38A C8#8032/6U APPLICATION . FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER y " BUILDING AND SAFETY-DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST, WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. NY 110 DIST CT GROUP -rypE PRO D FOR APPLICANT TO FILL IN � � �` ' CONST.' /' BUILDING /"� STATISTICAL C IFICATION EW AP ADDRESS + Q BK CLASS.NO. IDWELL.UNITS .� 40 - LOT NO. p� - BLOCK MAPy STATE �+ NUMBER ;h y/ HWY. YES TRACT t 3 J USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT'. IN ON.LOT. USE OF EXISTING BLDG. - BUILDING EXIST. - TEL. - SETBACK YARD HWY STREET NAME WIDTH OWNER NO. FRONT P.L. 6 ADDRESS !� 3l„(1-�yQ� Q",_ m SIDE ARCHITECT OR TEL. P.L. ENGINEER . No.. INSPECTION RECORD ADDRESS - - - - T a CONTRACTO ADDRESS - V DESCRIPTION OF WORK NEW ADD _ALTER REPAIR DEMOLISH SQ.FT.• NO.OF NO.OF " SIZE �'¢ - STORIES: FAMILIES - USE OF y, STRUCTURE 1� SIGNATURE OF APPLICANT _ VALUATION$ APPROVALS .DATE INSPECTOR'S SIGNATURE FE FEE.$ ^•�- FOUNDATION: LOCATION FORMS, MATERIALS FRAME:FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- BRACING, BOLTS _ PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION. AGREE.TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS ' STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT. WILL NOT EMP Y ANY- PERSON IN VIOLATION OF THE WORKMEN'S C M NSATIO S OF CALIFORNIA. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- PERMIT" RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, P�INCIPAL STRURAL ENGINEER PLAN CHECK VALIDATION CK. "M.O. CASH PERMIT VALIDATION'_ Ci(., M.O. CASH ' U ' D ' ADD EISB 's'�®OJ /tlth64/ �� NAPPLICATION LOCALITY /eM PL Cl TX - DIVISION OF BUILDING AND SAFETY NEAR EHT V Qn d* •' m CROB9 9T. Law aJ�4 Department of County Engineer DISTRICT NO. RECEIPT NO. PERMIT NO. County of Los Angeles ICT ...7--9 WM. J. FOX, COUNTY ENGINEER ORR P DATE RECEIVED DATE ISSUED CASBATT D. GRIFFIN, SUPT OF BUILDING FOR APPLIICANT TO FILL IN TYPE CONST. RECEIVED BY ISSUED BY OWNER < O ! T/Jh 'Q, MAP MAIL NUMBER 0/0 sHWYE YES -- ADDRESS OU b Calms _ J� • UBE ZONE SPECIAL CITY `A1z C / NES.�v 0a q/ 7 CONDITIONS ARCHITECT OR TEL. 14-1 ENGINEER NQ BUILDING YARD HWY STREET NAME EXIST. ADDRESS SETBACK WIDTH FRONT TEL. P.L. CONTRACTOR NO. sloe ADDRESS R. L. BUILDING B DATE CORRECTIONS INSPECTOR ADDREBB I& /9 L;.�/lAClr LOT NO. . J BLOCK TRACT y 4-3 / NO.OF BLOOB. SIZE OF LOT 230 I NOW ON LOT USE OF EXISTING BLDG. ReklddNCC r 641f46 DESCRIPTION OF WORK A a NEW ADD ALTER REPAIR DEMOLISH Z BO.FT. NO. OF NO.OF D SIZE STORIES FAMILIES r UBE OF STRUCTURE STV NO.OF EMPLOYEES ao, I•HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN 18 APPROVALS INSPECTOR'S SIGNATURE DATE CORRECT. 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS,MATERIALS FRAME: FIRE STOPS, ,/� BRACING,BOLTS 'pi ,b'.* (/qq'! SIGNATURE OF I f �! N5/ PERMITTE /` V FURNACE: LOCATION, �,�/i GAB VENT,DUCTS ./ ADDRESS SOO LATH, INT. AUTHORIZED AGT. v }1✓i 1 LATH, EXT. $+ P.C.$ �� . HOUSE NUMBER COR- FEE RECT AND POSTED q VALUATION >8 FEE � FINAL 76A638A DBS 3 4-54 /�, APPLICATION 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 copy thereof(Sec. 3800,Lab.C.) CITY e ZIP 5 LOCALITY Policy No. Company c- !I�'I) SIZ OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filedwith the county b in ction TRACT BLOCK LOT NO. depart nt. USE ZONE MAP NO. DatQppllcant ASSESSOR MAP BOOK PAGE, PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 01 TEL NO. COMPENSATION INSURANCE D �� 16116774 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRES 7 / 1� dollars ($100) or less.) (�,S,4 � DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CIT r ZIP ('// y�r� is issued, I shall not employ any person in any manner so as to I C 49" �>� become subject to the Workers'Compensation Laws. ARCHITECT.OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. c> DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you .should become subject to the Workers' CO CT 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. ADDR SS ,r LIC.NO. P L LICENSED CONTRACTORS DECLARATION CIT P L �"� f✓`-' "� SIDE J� - LIC.C SS 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 full force and effect. NEW 1:1 BK PG d License Numb�Q_1144 � .CIasS DES IPT OF ORK �_ App ❑ VALUATION Q0Contractor . to �"�^ ALTER ❑ $ cc ❑ I am exempt under Sec. Sc t js�c f��fi( REPAIR 13 $ 0 BAP.C. for this reason DEMOL ❑ LDMA P/C# 4 W Date: USE OF EXISTING BLDG. URM ❑ -' _ a• Signature '`;_'z APPLICANT,(PRINT) TEL NO. LDMA Perm# ❑ 1, as owner of the property, or my employees with wages as OZr : ;� ';`s � their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and, FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL l.''� �,j :� �.•: Zi.•"af OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ' d"F'=; jjj_� , t: P4J' : ❑ I, as owner of the property, am exclusively contracting Wlth AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 0 C .w M ` licensed contractors to construct thej Yoect (Section 7044, �;— ;'t{ i 1; P YES El NO El - •�np_.c.: w;:`_a Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ a the performance of the work for which this permit is issued(Sec. IHAVE TTING 3097,CIV.C.) CHECKLISTT..I UNDERSTAND THE UMY REQUIREMENS MATERIALS OTS UNDER THE LOS ANGELES RMATION GUIDE AND QCOUNRMICODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. IL Lender's Address CD OWNER OR AGENT 01 certify that I have read this application and state under penalty C, P.C.FEE PERMIT FEE of perjury that the above informati is correct.I agree to comply C o with all county ordin es a ate laws relating to building 00 construction, and eby u ori representatives of this County ISSUANCE FEE / p� M to ente ove- ti d is for inspection purposes. a INVESTIGATION FEE TOTAL FEE /} .Applicant or Agent Dale CJ SEE REVERSE FOR EXPLANATORY LANGUAGE iORKERS'COMPENSATION DECLARATION ertific in e, orpirm a`f'tertif carte of Worke s' Compensation Insuran elf APPLICATION FOR .. BUILDING PERMIT J h or a certified copy thereof (Sec. 3800, Lab. C. ' Polis No�So3�a- S?i8?� J�U�/O COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Company BUILDING F] Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department: �j ADDRESS 57603 412.0cly Date Applicant I94�47j CITY 4f 7511 ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST .COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. 101W iC/L• A C4 2.4 P- (This section need not be completed if•the permit is for one ASSESSOR 4 hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. U MAP OWNER �O j NO.444-916 N0. CJ I certify.that in the performance of the work for which.thi �+ SPECIAL - permit is issued, I shall not employ any person in any manner ADDRESS S�@rrl�- / � s so as to become subject to the Workers'Compensation Laws. CONDITIONS O CITY. ZIP QC Date Applicant ARCHITECT OR NO. DISTRICT GROUP TYPE FIRE TEL.. 10 NOTICE TO 'APPLICANT: If, after making this Certificate of CONST. ZONE 4 PRO ESSED BY U Exemption; you should become subject to the Workers' ENGINEER �j LU Compensation provisions of the Labor Code, you must forth- ADDRESS ` `� �r/ ✓- •' 9L with.comply with such provisions or this permit shall be - TEL, C STATISTICAL CLASSIFICATION APT. C Z DO. 9 deemed.revoked. CONTRACTOR 2.-3 �pN$7. NO.9,41( LICENSED CONTRACTORS DECLARATION /[ LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1(s7¢7 /�- K S�/>E NO. �.aSlL SEWER MAP (commencing with Section 7000)of Division 3 of the Business and C'�ieiyiJ _ LIC r Professions Code, and my license is'in full force and effect. CITY CLASS '-/ BK �, r' VALIDATION SQ. FT. NO. OF NO.OF _ CHECK License Number 3. 'Z-4frZ' Lic.-Class 8��' SIZE• STORIES FAMILIES ONE VALUATION. DESCRIPTION OF WORK 14ekAj S'T41C'C-O " NEW O /-2- $ Contractor /�-�S� Date ADD 10 ❑ I am exempt under Sec'. .SF/'`N ; 1-964A ALTER , B.BP.C. for this reason 'i LLd. REPAIR ❑ $ # 0 0 0 0-0 1 Date: USE OF �+�j ❑ EXISTING BLDG. DEMOL / I� Signature APPLICANT TEL. �_p�� FINALA-1 (PRINT) nJ d NO. "Sh OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor.'s License / 0 0 0.8 7,3 8 6 ' Law for the following reason (Section 7031.5, Business and ADDRESS/67Q�/t- ®f#rL7�1�0E E.E'+GlT4l FINA Professions'Code): PRESENT BUILDING BY 5 b.1--'8 5 ❑ I, as owner of the property, or my employees-with ADDRESS 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. - ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 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. (Sec. 3097, Civ. C.). SIDE m = P.L. Lender's Name LD MA Ref. # .� - - P.C.-Fee$ Permit Fee Lender's Address x I certify that I have read this application and state that the Issuance Fee S kLD PSC'# above information is correct. I agree to comply with all County Investigation Fee m ordinances and State laws relating to building construction, •. Total Fee 3 LDMA Perm. # and hereby authorize representatives of this County to enter a upon the above-mentioned property for inspection purposes. 0 ` � 1 _/-a� SEE REVERSE FOR EXPLANATORY LANGUAGE • Signature of Applicant or Agent Date - - - - - - - -