HomeMy Public PortalAbout6031 AVON AVE_Building__ 76A 638A CE#�d3 5 651}r, APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
? DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY 1
JOHN A LAMBIE COUNTY ENGINEER -
NEAREST
t"f COLEMAN W JENKINS SUP T OF BUILDING CROSS ST
DISTRI T NO G OUP TYP CESSED BY
FOR APPLICANT TO FILL IN qqq Co
ABUILDINGDDRESS �0 /.���C STATISTICAL CLASSIFICATION S WER MAP
1 CLASS NO el DWELL UNITS BK PG
LOT NO BLOCK USE JZOZONE MAP "
TRACT SPECIAL
ITIONS Y
SIZE OF LOT J O/r�/ �l NOWOONBLOTS /►Lt/V e
USE OFa,.
EXI ING 5LDG 1 R ,Q �} ` BLDG SETBACK FROM
OWNER �O�/� rt R/ '!��NOL AT�_�y FRONT PROP LINE OF - (STREET)
Q 7-;CA
j� ` TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS O- h4lgt 57-;;CA � I �C.. HI WAY WIDTH FROM C L -
CITY I-��7 / '^'lp/l
ARCHITECT OR �j// �"�` TELBLDG SETBACK FROM
ENGINEER NOT"6 ado SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD- = TOTAL
ADDRESS ��)��'''r aJ / ��/4�J�y fu)L`/�J HIGHWAY WIDTH FROM C L
CONTRACTOR'�/O///r y �/T� �JOL L'C7 `a�/'�/ 9�'� + _ 0
ADDRESS //�' CI NO CZIZC -6 CORNER CUTOFF YES NOEl
OU
CITY L !�/¢rl '61fA CLLS, S SEE REVERSE SIDE FOR SPECIAL APPROVALS 0
DESCRIPTION OF WORK - G
CL
E ADD ALTER REPAIR DEMOLISH h
FT /� NO OF NO OF
SIZE �J ,t STORIES FAILIFSi
USE
STRUOCTURE / C J 'o
�(/tb .4y?
SIGNATURE OF
APPLICANT /
VALUATION$ �6-d APPROVALS DATE INSP CT 1SIGNA7URE
PC PMT �Q FOUNDATION
MATERIALS ON
FEE
FEE$ $
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION I ��
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS /v5
9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODE: OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSA TIO INSUR NCE LATH EXT
SIGNATURE OF - HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED 1 -
ADDRESS FINAL
k , JOHN F LEWIS PRINCIPAL ST URAL ENGINEER
PLAN CHECK VALIDATION cK M O CASH _ PERMIT VALIDATION CK M C CASH
L{CO.6,4 21 10 OCT-132 3 A 3 Q,2 J5 A Q
LACO 7007- NOV 2 1 A 60.50, a
jyi�
90
APPLICATION FOR BUILDING PERMIT
_ COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN Bu
I hereby affirm that I have a certificate of consent to self Insure BU WING AD RESS or a certificate of Workers Compensation Insurance or a certified
copy there ec 3800 Lab C) r/'res', fir,,",,'�7 CI ZIP- w LOCALITY '
Pohc N Compan ��.rt C /
S E F LOT NO OF BLDGS NOW ON LOT
Certified copy is hereby furriished NEAREST CROSS STJF
❑ Certified copy Is filed with the c m ty build) ger, pection TRACT BLOCK LOT NO
department USE ZONE MAP NO 4
Da Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
ERTIFICATE OF EXEMPTI M WORKERS O NER A, NO �j
COMPENSATI I SURANCE ��/✓ / �� WITHIN 1000 FT OF SCHOOL? YES NO
(This section need not be comp) If the permit Is for one hundred ADDRESS
N DISTRICT GROUP TY CONST FIRE ZONE PROCESSED BY
dollars ($100)or less) -'
I certify that In the performance of the work"
CI for which this permit �—/7
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 CLASSIFICATIONAPT 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 CONTRACT TEL 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 DECLARATION C C r C fiQ LIC� SIDE -r
I hereby affirm that I am licensed underprovlsions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQ FT Sl
d NO OF STORIES NO OF FAMILIES
Professions Code n m license Is In ,ull force and_W t NEW El BK PG
License Number Llc Cla �,j S IPTION OF WORK ADD ❑ VALU ON a
s / ( $ g/y _
272
Contractor Date ALTER El 00
❑ 1 am exempt under SEC C REPAIR $ 0
B&PC for onla e, Z DEMOL ❑ LDMA P/C# W
Date VTlqF-OF EXISTING BLDG URM ❑ - Q�((�'+ _ a
co
Signatur T(PRINT) T LDMA Perm# """T a Z
rI
a3
❑ I as owner of the pr ' or my employees with wages as /� ,C z 33W 1172.45
their sole compe 'rye ,i will do the work and the structure Is ADDRESS
not Intended or ed for sale (Section 7044 Business and t CF /�CYb FINAL DATE a 1 ITEMS
Professions Code) ( � �� G` `
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ((yy //����
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J TI�TI"It. 192. 45
❑ ]Ras owner of the property am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'+ FINAL BY
a licensed contractors t0 CODStrUCt the project (Section 7044 YES❑ NO❑ - CHECK, 92
Business and Professions Code) 19..°45
WILL THE INTENDED USE MI THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING ' CHANGE � �
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r71ll7GG .QQ
CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR
GUIDELINES
I 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 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING M-0001 12/11/95
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 3674
[M4 1 fry 112:3 1
3 Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD
0 Lenders Address
0 ONNER OR AGENT J
oI certify that I have read this application and state under penalty
0 of perjury that the above Information Is correct I agree t0 comply PC FEE PERMIT FEE
with unty ordinan and State laws relating to building
m co St(ucto and hereb au horize repres atives Of this County ISSUANCE FEE �J M
er up n the above oned proper
for Inptonss
seneroa / INVESTIGATION FEE TOTAL FEE
am
oma r�i
c_
SEE REVERSE FOR EXPLANATORY LANGUAGE