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HomeMy Public PortalAbout5017 ARDEN DR_Building__ Qs 76A638A.r ' CE N80Z,(R E V.6/78) ,1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN' BUILDING ] /o ,�t ^� ADDRESS v v I /7 /� ADIDRESS 0,I / . R r--)9. J LOCALITY NEAREST CITY •- 4:::� a ZIP CROSS ST. q U cL s ,.L-- NO.OF BLDGS. ASSESSOR SIZE OF LOT t;7= NOW ON LOT MAP BOOK PAGE PARCEL t1 DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT �� BLOCK LOT NiO, o! , CONS ZONE �] OWNER '. IL TEL NO.�T� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS /!/ r1 `2io a CLASS NO. DWELL.UNITS z- BK,j6 PG CITY ft(L :`-'1�� ZIP. ARCHITECT OR TEL VALUATION $ ENGINEER NO. ADDRESS BLDG.SETBACK FROM (� j� FRONT PROP.LINE OF (STREET) N CONTRACTOR O<� ' O ��� � 1� TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY } .YARD = ADDRESS �l 2. J& , ,314 FRONT PROP.LINE HIGHWAY WIDTH A LIC. .6 CITYCLASS CONSTRUCTION LENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SO.FT SIT OF i NO.OF CHECK + _ SIZE STORIES P FAMILIES ONE y� C DESCRIPTION OF WORK NEW ElP.C.Fee$ Permit Fee 7 ADDIssuance Fee 7 B V 16n ALTER E01 _ A REPAIR ❑ Total Fee USE OF J.s DEMOL ElEXISTITI NG BLDG. 'moi . ���"""III QQQUUU��� APPLICANT t TEL ^��ej� / —7 (� (PRINT) . or N0.3 ),-71 W /,1 C ca (o D G < / BY(SIGNATURE) UA- t�r� IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP ICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPL TH ALL ORDINANCES t) AND LAWS REGULATING BUILDING CONSTRUCTION.I CERT THAT IN DOING THE S WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF (J THE LABOR CODE OF TH ATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM Z PENSATION INSURANC g d SIGNATURE OF 21-5.0,7 A PERMITTEE g ADDRESS {C 2 # o 0 0 0.0 1 f� 2 0 1" 24,00 TEL.NOW CITY ��` Q 1_OSE NMAOP� aI Q o 0 1 24,005) Y_. SPECIAL r 1,27-'7 8 CONDITIONS me FINADATE B ®fes iF l�llA� 6 76ABBBA CE#80310-88 APPLICATION FOR BUILDING PERMIT Z COUNTY OF LOS ANGELES ADDRESS U f 1Q.�C'oaf k DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY �� rpL{ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT ISO. GROUP TYPE PRO.CESSED BY FOR APPLICANT TO FILL IN ..1 - 1-1 I CONS A_+.,,,,,.�. STATISTICAL CLASSIFICATION SEWER MAP BUILDING r / / , ADDRESS �I l , © � n Y✓1� 1 v e- CLASS.NO. DWELL.UNITS SK PG LOT NO. BLOCK MAP a STATE (I NUMBER HWY. YES `djO USF O E SPECIAL TRACT _ NO.OF.BLDGS / CONDITIONS SIZE OF LOT I NOW ON LOT USE OF BUILDING EXISTING BLDG. YARD HWYEXIST. STREET NAME rr� / SETBACK I WIDTH OWNER 7 `�Ft IY U 5 c• dT e FC// FRROL T MAIL '� P. ADDRESS Q /7 {- (�, L /�� I, ' SIDE —I ... P.L. CITY T C�YY� J /7"\ rTvoE" 1 �7/z 7 INSPECTION RECORD ARCHITECT OR f TEL. ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF' SIZE STORIES FAMILIES USE OF STRUCTURE co "I-( � 'Tr' �--Y) ".I�✓t'� �� -- SIGNATURE OF APPLICANT � IZ APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION:LOCATION FORMS,MATERIALS VALUATION$ - FRAME:FIRE 4TOPS, _ BRACING,BOLTS P.C. PMT. FURNACE:LOCATION, FEE $ I FEE $ U d GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- J! I -- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH.INT. - AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGU ATING UILDING CONST CTION. LATH,EXT. SIGNATURE OF q HOUSE NUMBER COR- " PERMITTEE `1 >'d ' _ RECT AND PO TED ADDRESS - /. .i FINAL 6C' CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EVER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent self APPLICATION FOR BUILDING P RM I T insure, or a certificate of Worr kers' Compensation Insurance, �..5 or a cert'fid w�v thereof (Sec. 3800, Lab. C.) b y-65' ���� COUNTY OF LOS ANGELES BUILDING AND SAFE C P_o_lijy Ito. Company !/ �"' f'lf r� BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ►"�\` Certified copy is filed with th1conty building inspec- 7ADDRESS tion department. I Z j` LOCALITYNEAREST Date — 3 Applicant v �L ZIP CROSS ST. `.tet, c� CERTIFICATE OF EXEMPTIO ROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION I SURANCE SIZE OF LOT NOW ON LOT I MAP BOOK O k� PAGE PARCEL (This section need not be completed if the permit is for one TRACT BLOCK LOT NO �1SE�ONE MAP hundred dollars ($100)or less.) . A NO. t� OWNER 6^ .NO ` �� TEL. hhh""� SPECIAL J CONDITIONS s^ I certify that in the performance of the work for which this s`c permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE O ED BY so as to become subject to the Workers'Compensation Laws. ADDRESS J Q i (ZI CONST. ZONE CITY S ZIP Date Applicant STATISTICAL CLASSIFICATION APT7 CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO."DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be EL )7 deemed revoked. CONTRACTOR i t O NO. t 'J.f/` BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS I SSI'} ( 0, C& VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. G C Professions Code, and my license is in full force and effect. CITY X1) CLASS —) ��"L( $6aXo � ► {? SQ. FT. t NO. OF NO. OF CHECK License Number Z_Z'2y31O Lic.Class ", i �= SIZE R STORIES FAMILIES ONE Contractor� ,"LIC-0 I Date / '�� DESCRIPTION OF WORK TN.a NEW $ 1 ADD I am exempt under Sec. OSU/t tki�, ALTER FINAL c' f ��� �� Z IG DATE �,Jr P ✓ B.&P.C. for this reason REPAIR Date: USE OF FINAL DEMOL Si EXISTING BLDG. I ) F� y Signature APPLICANT r r TEL. p OWNER-BUILDER DECLARATION PRINT J t�t� I IABD. 1 -,R/Z I hereby affirm that I am exempt from the Contractor's License ADDRESS U/ / f I !f ✓ , Law for the following reason (Section 7031.5, Business and Professions Code): PRE ENT BUILDING I, as owner of the property, or my employees with ADDRESS W ages 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. I, 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 EXIST. 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 FD P.L. e Lender's Name . 1 Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee LQ a above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee 67 u and here y authorize representatives of this County to enter u n the bove- ntioned grope ty for inspection purposes. c 1 /s —, j SEE REVERSE FOR EXPLANATORY LANGUAGE n Signature of Applicant or Agent Date ®s WORKERS'COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compenstion Insurance, or a certified opy hereof (S c. 3800, Lab. ���10 a t� NV COUNTY OF LOS ANGELES BUILDING AND SAFETY policy No. ompany )_ ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESSAga 01-Certified copy is filed with Ae county building inspec- FADDRESS tion department. LOCALITY NEARE Date Applicani ZIP CROSS ST. CE TIFICATE OF EXEMPTION FROM WORK[ NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less.) 1 BLOCK LOT NO. NO. /� y EM TEL � SPECIAL ti I certify that in the performance of the work for which this NO. CONDITIONSpermit is issued, I shall not employ any person in any manner TRICT GROUP TYPE FIRE PROCESSED BYso as to become subject to the Workers'Compensation Laws. CONST. ZONEDate Applicant CITY ZIP STATISTICAL CIA-31 ICATION APT. CONDO. UU NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. 41 Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NODWELL. UNITS N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be deemed revoked. CONTRACTO ` O..TEL3 37---7116 BK PG VALIDATION LICENSED CONTRACTORS DECLARATION r LIC. I hereby affirm that I am licensed under provisions of Chapter 9 A �WO-3 1 VALUATION (commencing with Section 7000)of Division 3 of the Business and q LIC. Professions Code, and my license is in full force and effect. CITY CLASS $ '. SQ. FT.-)' t NO. OF NO. OF CHECK License Nu er Lic.Class R r I SIZE 1:1 1 - STORIES FAMILIES ONE NEW ❑ Contractor Date • J DESCRIPTION OF WORK ❑ am exempt from the licen ng requirements as I am a 1�" �J e., ADD licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code). USE OF EXISTING BLDG. DEMOL ❑ FINAL rr � Lic. or Reg.No. _Date APPLICANTW, .I' TEL L. OWNER-BUILDER DECLARATION (PR INTA C NO Y17;1 1 I hereby affirm that I am exempt from the Contractor's License r p Law for the followingreason (Section 7031.5, Business and -,JA*j - • 77� 769,5A Professions Code): PRESENT ❑ BUILDING • • • • • 1 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 2 • . 6 8.6 3 7044, Business and Professions Code). MOVING TEL. ❑ CONTRACTOR NO. • • b 8.6 3= I, as owner of the property, am exclusively contracting � with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 2 1.9-8 3 REQUIRED 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 the performance of the work for which this permit is issued P L (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee . � aabove information is correct. I agree to comply with all County Investigation Fee 15 ordinances and State laws relating to building construction, Total Fee ere authorize representatives of this County to enter a P. he bove- ntioned property for inspectionPur oses. a ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Appli ant or Agent I D to °s } 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, BUILDING ADDRESS— � / ' ��; or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) / CI �/ _ zip LOCALITY Policy No. J17 Z /i Companyij/' T� °/% 9i�'L / /L� SIZE OF LOT O.OF BLDGS.7W ON LOT ❑ Certified copy is hereby furnished. 77NEAREST CROSS ST. Certified copy is filed with the county building ins p tion TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Cant :� ASSESSOR MAP BOOK PAGE PARCEL Date TLV App SPECIAL CONDITIONS OWNER TEL.NO. CERTIFICATE OF EXEMPTION FROM WO KERS' YES NO COMPENSATION INSURANCE ..�� Z� / 7 z WITHIN 1000 FT OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred )/ DISTRICT GROUP TYPE CONST. FIRE ZONE JES;E Y dollars($100)or less.) CITYZIP I certify that in the performance of the work for which this permit G� [ T 5 f)� /�-3 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. lillv become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. ;2 1—DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST CON RAQTOR TEL.NO. Exemption, you ShOUId become Subject t0 the Workers' J - A� �L t C SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 4� F °C "� �V'�.2-a' comply with such provisions or this permit shall be deemed revoked. A E LIC.NO. FRONT S 44e 6 D i -Z X, LICENSED CONTRACTORS DECLARATION CITY LIC.C S SIDE 0 I hereby affirm that I am licensed under provisions of Chapter. /1'72%0 9 T ��� _/ SEWER MAP c..) (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF STORES NO.OF FAMILIES CD NEW El BK PG Professions Code,and my license is in full force and effect. O License Numbers'`L DESCRIPTION OF WORK ADD ® VALUATION W 7 Lic.Class 6/ ���C �..1�Cc J � CL Contractor}� !l/ ru',��ur�' Date �- —`/e � /O _ `n ALTER ❑ Z /,f 7!L) �." jZC>`�. ❑ El am exempt under Sec. REPAIR B.BP.C.for this reason DEMOL ❑ LDMA P/C# USE OF EXISTING BLDG. Date: �ei��.a�y.4•-c. URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# ElI, as owner of the property, or my employees with wages as9V� ✓ 1('7 p their sole compensation, will do the work and the structure is A DRESS not intended or offered for sale (Section 7044, Business and FINAL DATE G r_„ _ 58.75 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �,i J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN I( El1, as owner of the property, am exclusively contracting With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL � 1 +I� ' licensed contractors to construct the project (Section 7044, Business and Professions Code.) ves 11 N.,4 r1�"A =ITA 5ZE, s 7 y WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r / �- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST / ( ` y�=;sEK FOR GUIDELINESp. � U f I hereby affirm that there is a construction lending agency for YES 1:1 NO1(_I CANE the performance Of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES m COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING i [�I _}��l e' f.�3 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING APERMIT FROM THE SCAQMD. .11 01 Ful 13;01 r�I j'; aLender's Address OWNER OR AGENT _I t i AM t.° o o I certify that I have read this application and state that the above RC.FEE PERMIT FEE information is correct. I agree to comply with all county 45, 75 ordinances and State laws relating to building construction,and a hereby authorize representativesLthCounty to enter upon ISSUANCE FEEnf'�t e_a ove-mentioned property f rion purposep. V �! a INVESTIGATION FEE TOTAL FEE �"�.,e,"_—,4 S fApplinsnf or Apenl De � SEE REVERSE FOR EXPLANATORY LANGUAGE