HomeMy Public PortalAbout10836 ARROWOOD ST_Building__ g, p`II I� p�pp. oq, I� 1��j
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BUILDING AND SAFETY DIVISION BUILDING
Department of County Engineer AD6REss / f
County of Los Angeles
LOCALITY �- D
t
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST t .
CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. - -
DISTRICT NO. GROUP - .TYPE SEWER MAP
FOR APPLICANT TO FILL IN I Ic -
' CONST.
BUILDING / O,9'1 / A',Ra wooer
ADDRESS O .f� STATISTICAL�C}.ASSIFICATION _ ,
4 'LOT,NO. J I BLOCK CLASS NO.-DWELL.DWELL.,UNITS I'
MAP _STATE YE N
TRACT /y O 2 GD NUMBER' HWY`
U E ZONE SPECIAL
NO. OF CONDITIONS -
NOW ON LOTS
SIZE OF LOT S,-3 X /. � / � '
USE OF -7-' -
EXISTING BLDG. /X14/}S .EPZt9.�L A9EZ&UTAR" BUILD NG EXIST.
YARD HWY - STREET.NAME
- - -. SETBACK - - .WIDTH
OWNER �G-Of-D /AUG-e- /y - FRONT
-_ MAIL / /� P, L.
P• ADDRESS /0 9-9 4, R.�/•?O WOG .� SIDE
• CITY Z; 1. C/TY TEL.G/-�3.��'r .: P. L.
ARCHITECT OR TEL, INSPECTION.
RECORD -
ENGINEER - NO.
ADDRESS MP� /�.'✓fid' " .a
TEL.
CONTRACTOR NO. ,�eA '. °�e t � �S � ./v
f►�
ADDRESS DESCRIPTION OF WORK 17
NEW-X ADD ALTER REPAIR'* DEMOLISH fl I
SQ. FT./.j7::6 r NO OF NO.OF
SIZE /Sa!7J STORIES f FAMILIES ` - / _ / l "001 `
USE OF STRUCTURE. A01 6—
v
oe
SIGNATURE OF APPROVALS_- _ •
/f , /.L/'_ /) ,ff_ -
APPLICANT_� •�t'�t P_s1 .(J iycaLJL-1L�_ -
f� t /} DATE.- INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION,
FORMS, MATERIALS �i7'
P. C. $ O�Q FRAME: FIRE STOPS.
e FEE BRACING, BOLTS
FURNA
VALUATION ;. $ CE: LOCATION.
L //'''' �
FEE GAS VENT, DUCTS.
I.HEREBY ACKNOWLED E THAT I HAVE REA THI AP- LATH..INT.
PLICATION AND T T THE BO 1 CO AND
AGREE TO COMP IT ALL C IN AND
LATH, EXT.
STATE LAWS U ING B L IN CON CTION.,
SIGNATURE HOUSE NUMBERCOR-
PERMITT RECT AND POSTED
'• AODREss` FINAL
JOHN A. LAM ' COUNTY ENGINEER• CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENG
PIAN CHECS VALIDATIO VK. .G. CASH -PERMIT VALIDATION CK: M.o. CASH
2',2`5 7D; SEP 12 12 0.5(!A�2 4'"6 g- SEP 19 j4 1 .0 0
APPUCAMON FOR BULONG. PERNT
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, BUI /IG RF /� ^� ���/'�
Ora certificate of Workers' Compensation Insurance,'or a certified.: " ,e
:ZIP
copy thereof(Sec.3800, Lab:C.) f o LOCALI
VV
Policy No, Company SIZ T ' �� NO.OF BL GS.NOW ON LOT •-
❑,Certified copy is hereby furnished. 'NEAREST CROS ST.
❑ Certifiedcopy.is filed with the county building inspection TRACT - BLOCK, - LOT NO.,
department. USE ZONE MAP NO, f
Date �Applicant ASSESSOR MAPBOOK - . PAGE - •PARCEL
_SPECIAL.CONDITIONS-'• r
CERTIFICATE CIVEXEMPTION FROM WORKERS' _ OWN TEL NO.�
COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? I YES NO
(This section need not be completed if the permit,is for one hundred ADDRESS
DISTRICT `..GROUP - TYPE CONST. FIRE ZONE PROCESSED BY
'dollars($100)or less.) +
t 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 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 thisCertificate of- -REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should. .become subject to the Workers' CONTRACTOR/�l _ ') TEL NO. - SET BACK YARD HWY PROP LINE WIDTH
Compensation:'provisions of the Labor Code, you must forthwith L/i4/'�/���`�Zo/�s�/ FRONT
comply with such provisions or this permit shall be;deemed revoked:, ADDRESS LIC.-NO. P L
LICENSED CONTRACTORS DECLARATION SIDE
CITY 'LIC.CLASS- P L
- - - -r � -
I hereby affirm,that I am licensed underprdvisions of Chapter 9 SEWER-MAP if
(commencing with Section 7000)of Division 3 of.the Business and SQ.FT. I NO.OF STORIES NO.'OF.FAMILIES -
Professions Code,and my license is in lull force and effect. // NEW BK PG License Number Lic.Class ESCRI N.OF.WO ADD ❑. VALUATION
O
Contractor Date. ALTER 11
❑ I am exempt under SEC.-
REPAIR ❑ O
BAP.C.for this reason
Q DEMOL ❑ LDMA P/C-,#
Date: usE.oF. Is Loa. URM ❑
—+Signature - 'APPLICANT(PRINT) - - TEL NO.,-,--- ,- ,LDMA Perm,#. _ 8 Z
as owner of theproperty, or my employees with wages as z it 125ee
their sole compensation, will do the work and the structure is ADDRESS ' 0 eJ•� '
not intended or offered for.sale (Section 7044, Business and I - :FINAL DATE' Q
ns Code.) i
.. - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE AHAZARDOUS MATERIAL 1_ .'�-� .�� J •,. ITEMS.
El I, as owner Of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALSINFORMATION GUIDE?. FINAL BY n ' Tf �' C�
licensed contractors to construct the project (Section 7044, ,L .++._- ® 5�B a
Business and Professions Code.) ves'❑ No❑ w (�j[r�J
WILL THE INTENDED USE OF THE BUIDLING•BY THE APPLICANT OR FUTURE BUILDING CHECK �.' 125.55
OCCUPANT REQUIRE A PERMIT FOR OONSTRUCTIONLOR MODIFICATION FROM THE SOUTH,'
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR { (�
GUIDELINESe. - ` ,`NIG+- o_131.1
-1 hereby affirm that there is'a construction lending agency for 'YES
ElNo❑ — -
a the performance of the work for which this permit is Issued(Sec. HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING '
3097,Civ.C.
w ) - CHECKLIST. UNDERSTAND REQUIREMENTS UNDER THE LOS ANGELES CODE, - q �-oo�,I ']/7
Lender's Name 'I l(•yyi
TITLE2,CHAPTER 2.20 SECTIONS 2.20 100 THROUGH 2.20.140'CONCERNING GAZA HAZARDOUS f}-\�ital'I+{�jf e C
- MATERIALS REPORTING AND FOR OBTAINING 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 P.C.FEE PERMIT•FEE - - -
of perjury that the above informatio rrect.I agree to comply o
with all countyordina ces a tate ws relating to building
constr o and r rize Yep entativeS of this Cou ty ISSUANCE FEE /J
m to n th Ion rt or inspecti purpo s. /• 30
INVESTIGATION FEE TOTAL FEE
f V
Sgnature of nt or, n1 � i -•
SEE REVERSE FOR EXPLANATORY LANGUAGE