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HomeMy Public PortalAbout5117 ARDEN DR_Building__ 76A638A.CE#8038-64 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY - L JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. DI TRICT NO. GROUP TYPE. PROCESSED BY FOR APPLICANT TO FILL IN S Q CONST. BUILDING - - STATISTICAL CLASSIFICATION SEWER MAP „ ADDRESS.' CLASS NO. DWELL UNITS. BK ) PG LOT NO. -;&- D - BLOCK USE ZONE MAP ao ` o L TRACT , "/.,S�' IN nA SPECIAL N0. OF BLDGS.- CONDITIONS SIZE OF LOT y'B,aZ .yo JNOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM ,A TEL. FRONT PROP. LINE OF (STREET) OWNER ! 0. TYPE OF EXISTING SETBACK - HIGHWAY + YARD = TOTAL ADDRESS S HIGHWAY WIDTH 'FROM C.L. ' CITY SLOG SETBACK FROM " ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH" FROM C.L. d yy TEL. + CONTRACT /`G✓ NO Q LIC.. -, CORNER CUTOFF YES El NO O ADDRESS O. CITY CLASSSEE REVERSE SIDE-FOR SPECIAL APPROVALS V DESCRIPTION OF WORK a - - loot- LA-r(-4 ( 0c, Z NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO. OF NO. OFY6,° FAMILIES USE STORIES Ly( U%-7TFfRA9• P_ 1 SC 0Trt...E:;o- O g�_AM C+ STRUCTURE v' SIGNATURE OF APPLICANT VALUATION$ -� o-'Q APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FO , . ON FEE$ FEE$ leQ© FORMS., LS 'FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION U WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDI NG CONSTRUCTION, I CERTIFY THAT. IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT. 4- A �� P-lv- TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- .may INC TO WORKMEN'S COMPENSATIO I RA CE. LATH. EXT. 4--T1 ,L41, SIGNATURE OF HOUSE NUMBER COR- 4- PERMITTEE RECT AND POSTED ADDRESS FINAL .S €, AW"l '"v 4-v / JOHN F. LEWIS, PRINCIPAL STRU UR&L ENGINEER PLAN CHECK VALIDATI CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH �.�IfJc oD r 0 zo APF; 1 5 D1 5.0 0 ,WORKERS'COMPENSATION DECLARATION l insure,, oraafcertif certI have ificate of Workers'tCompensaf ons�nsuranc , 'APPLICATION F O_R BUILDING PERMIT a or o'certified copy thereof (Sec. 3800,'Lab. C.)' • COUNTY OF LOS ANGELES BUILDING-AND SAFETY Policy No. - Company, El Certified Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING L7 ?t V / r /C!/ ❑' Certified copy is filed with the county building`inspec- BUILDING tion department.' ADDRESS Date Applicant CITY ZIP 22111izfV LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' - - NO:-OF BLDGS:--- NEAREST _ COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. A,- -`- ' (This-section need not be completed if the permit is for.one � •- -• - - - - ASSESSOR • -hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE- PARCEL j TEL.S USE ZONE MAP I certify that in the performance of�the work for 'Kick this OWNS ,i NO. 5%S! 7� NO. A permit is issued I shall not employ any person in any',mannerADDRESS l l _ SPECIAL - A. so as to become'subject to the Workers'Compensation Laws. G c Alert. CONDITIONS { { - Y/ Gfi.�' - _.ZIP _ � 0 O - _ — -- _ qZ2CITY.�� /.-e!_ �"� DateAc Applicant ARCHITECT O TEL. NOTICE TO APPLICANT: If, after making'this Certificate of DISTRICT.. GROUP TYPE FIRE _ PRO SSED BY ENGINEER NO.Sf CONST ZONE Exemption; you should become subject to the Workers' ZO Compensation provisions of the Labor,Code;•you must forth- ADDRESS with comply with•such provisions or this permit shall be' - - deemed revoked. ; STATISTICAL CLASSIFICATION APT. C DO:'.' CONTRACTOR NO. I LICENSED CONTRACTORS DECLARATION - K V --LIC. '- CLASS NO. 7,f L DWELL. UNITS I hereby,affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and _ -LIC. SEWER MAP Professions'Code, and'my license is in full force and effect. CITY CLASSBK 'VALIDATION SQ. FT. NO.OF NO..OF _ __ .CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE ;,• . 3 VALUATION _ _.. _... -� DESCRIPTION Of WORK NEW_- Contractor Date --❑ ❑ $I am exempt under Sec. ADD Pilo. . ❑ . _ .. ALTER__' , B.&P.C. for this reason REPAIR ❑ $ - Dater USE OF DEMOL ❑ EXISTING BLDG. - Signature APPLICANT TEL. FINAL f f OWNER-BUILDER DECLARATION- PRINT 'N 0. DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT-' - = g l f _.- o BUILDING 4 5'IL-9 A. yU I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do The work and -# o:o o o' o the structure is not intended.or offered for sale(Section LOCALITY 7044, Business and Professions Code):" MOVING' -TEL. 5 r' 1, as owner of the property, am exclusively contracting CONTRACTOR NO. I o ❑. with-licensed contractors to construct the project (Sec- o o040,5006 i tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM_., E CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 0 2'g 8.6 - the performance of the work for which this-permit•is-issued r P.L. - - - -- - (Sec. 3097, Civ. C.). SIDE P.L. - - - < Lender's Name /f LDMA Ref. # Lender's Address P.C. Fee$• Permit Fee �✓ - t I certifythat L have,read this application and state that-the J-� ,- PP Issuance Fee-- LDMA P/C# -- _ a above information is correct. I agree to comply with all County Investigation Fee /') - •-' 0 ordinances and State laws relating to building construction, _ ­_ Total Fee ✓ tDNA Perm. # u and hereby authorize representatives of this County to enter t m upon the above-mentioned property for inspection purposes. Q1/y�r�- 1 �� SEE REVERSE FOR EXPLANATORY LANGUAGE Signa�ee-off Applic nt or Agent Date 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 •rte v p or a certificate of Workers' Compensation Insurance,or a certified �// 41Z P cN ZIP copy thereof(Sec.3800, Lab.C.) (�,` GJIx _ LOCALTY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP/N,O. i7 ��� Date Applicant ASSESSOR I�QAf,BOs?K� PAG; PARCEL SPECIALCONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER l/XV�S OY v w T L O. . . YES NO COMPENSATION INSURANCE �(. i���. y 6 WITHIN 1000 FT..OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP T CON FIRENE PROCESSED BY dollars ($100) or less.) G 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 so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.- If, 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. PL LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC.CLASS PL 1 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 BK PG , iL License Number Lic.Class DESCRIPTION OF WOA ADD ❑ VALUATION �f - O Contractor Date a ALTER $ f d 6` �� U ❑ 1 am exempt under Sec. REPAIR El $ I BAP.C.for this reason DEMOL ❑ LDMA P/C# V Date: USE OF EXISTING BLDG. URM ❑ /-C, 0 ignature APPLICANT(PRINT) TEL NO. LDMA Perm# _ i5 6f' Z Z _ as owner of the property, or my employees with wages as T :11 their sole compensation, will do the work and the structure is ADDRESSPDT -• 0 not intended or offered for sale (Section 7044, Business and FINAL DATE Q _e TAl 10-_ Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL S•'-I •s•-'. ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE - P P y Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY . s licensed contractors to construct the project (Section 7044, �.-H IG °;$f YES❑ NO❑ 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 QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR f •it 11[_I_i_.� W .}�* 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. "`-'1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address O OWNER OR AGENT o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE f N o with all county ordinances and State laws relating to building iV construction, and hereby authorize representatives of this County ISSUANCE FEE to enter u on the ve-nentioned property for;?etion purposes. a �•��•� INVESTIGATION FEE TOTAL FEE ^ sreA�mm of AOW� t a SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION EOR BUILD[I'l PERMIT • COUNTY OF LOS ANGELES * t L ' 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 40-6 or a certificate of Workers' Compensation Insurance,or a certified R copy thereof (Sec.3800,Lab.C.) CITY ZIP '0 LOCALITY ' Policy No. -Company SIZE OF LCT NU OF BLDGS.NOW ON LOT. El Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. A USE ZONE MAP NO. Date Applicant ASSESSOR WP BOOK PAG E PARCEL �f/J � 3 !1�•J(� ll// d/ �/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE L N, -.IE WITHIN 1000 FT.OF SCHOOL? YES No ADDRESS (This section need not be completed if the permit is for one hundred ;DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify 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 become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. P STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. =21 DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBASK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE.K• .. WIDTH Compensation provisions of the Labor Code, you must forthwith �ti1TJ7C�J FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L 1!I.y' 7&"'. LICENSED CONTRACTORS DECLARATION SIDE _ - = CITY LIC.CLASS P L �•t-��y I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP ?I i SL wry -a (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZ NO.OF STORIES NO.OFF MILES � '"F � =11 r -•1 Professions Code,and m license is in full force and effect. NEW ❑ BK ` PG =r- Y ut;° U DESCRIPTION OF WORK f�I VALUATIO t- • - License Number Lic.Class ADD fC i 4® :?t :s. L Contractor Date ALTER ❑ $ • REPAIR ❑ ❑ 1 am exempt under Sec. $ - -% B.&P.C.for this reason DEMOL ❑ LDMA P/C# 'IJG Date: USE OF EXISTING BLDG. URM ❑ - S Z Signature APPLICANT(PRINT) TEL NO. LDMA Perm `=t^' R1 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 O > not intended or offered for sale (Section 7044, Business and FINAL DAT . . Q / - j_� PFOfeSSIORS Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J i I f , q-„t��° ❑ 1, as owner of the property, am exclusive) contracting with ORA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J:AL .{ -g3 = 66 p p Y, y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B , _ licensed contractors to construct the project (Section 7044, __ {_ ;• .. ":�° _: Business and Professions Code.) YES❑ NO❑ :1=-_.. t WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING .... pp TU OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH .� - ': !ZI '.I CONSTRUCTION LENDING AGENCYCOAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR j GUIDELINES. .. ....... ...... .. ! I hereby affirm that there is a construction lending agency for YES❑ NO❑ ?f-I �jn.j :e 7�:7 M a the performance of the work for which this permit is issued(Sec. �1 {a,S .._t_I+a rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING N 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - '''1i s f'�,I'll:),Ll TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS ,i-:-f�l .). i N =`- Lendef s Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CILender's Address C) OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FIE .� N with all county ordinances and State laws relating to building m construction, and hereby auth0'ze representatives of this County ISSUANCE FEE m to enter upon the e-menti d property for inspection purposes. INVESTIGATION FEE TOTAL r` Glgwtm o1 A°Rucam a Aw Dale SEE REVERSE FOR EXPLANATORY LANGUAGE