The URL can be used to link to this page

Home My Public Portal About6158 AVON AVE_Building__ 64jWORKERS FOMPENSATION DECLARATION ebaffirm4c-. I have a certificate of consehtIns to selfAPPLICATION FOR BUILDING PERMIT race T icate of Workers Compensation Insurancerfiec py thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND"SAFETY o Company BUILDING " ❑ Certified copy is hereby furnished 3 FOR APPLICANT TO FILL'IN ADDRESS +� ❑ Certified copy is filed with the county building mspec B11ADDRESS( `7 �� s V f tion department r ~ CITY r L \ Date Applicant ZIP LOCALITY NO OF BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS r SIZE OF LOT NOW ON LOT CROSS ST' F COMPENSATION INSURANCEASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100) or less ) ' EL USE ZONE MAP OWNER S, O NO NO I certify that in the performance of the work for which this /n� _ SPECIAL r a a permit is issued I shall not employ any person in any manner ADDRESS - / \ CONDITIONS O so as to become subject to the Workers Compensation Laws L )V° CITY - - ZIP- U Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT If after makingthis Certificate of ENGINEER /�� `�L'GtNO '�� , CONST ZONE U Exemption you should become subject to the Workers O ¢ �� OSA- D `^ ou �1l °'� q W Compensation provisions of the Labor Code you must forth ADDRESS t � J s U V ___) �r��JJ (z/)with comply with such provisions or this permit shall be TEL J STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked CONTRACTOR NO LICENSED CONTRACTORS DECLARATION f LIC CLASS NO�DWELL'UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC and Professions Code and my license is in full force and effect CITY CLASS BK PG + VALID ION SQ FT Q NO OF /� NO OF CHECK License Number Lic Class t i SIZE 85 STORIES (i FAMILIES ONE Y 0'l -321.2-0 VALUATION M DESCRIPTION OF WORK ?6WLl r ,o. ^ 1 Et i NEW ❑ ; �J Contractor Date _ N ADD} ❑I am exempt under Sec '� —PI t-� T4 � ALTER ❑ j B 8P C for this reason d I �� " f'�i/' 1XJ REPAIR ❑ s /"� .Y �7 i�.r Date USE OrEXISTIING BLDG �( l (,t� DEMOL ❑ � � iZ 11 ,�I� Signature T APPLICANT TEL + ' g OWNER BUILDER DECLARATION (PRINT) AL JG N '� FIN �I CHMG } I hereby affirm that I am exempt from the Contractor s License ✓ Law for the following reason (Section 7031 5 Business and ADDRESS 6S FINAL 00 ti Professions Code) PRESENT _ w By / I Q00- i]01 ` r c 10f ❑ I as owner of the property or m employees with BUILDING VV 87 P P Y YADDRESS wages as their sole compensation will do the work and i the structure is not intended or offered for sale(Section LOCALITY 7044 Business and Professions Code ) - MOVING TEL r ❑ I as owner of the property am exclusively contracting CONTRACTOR NO f with licensed contractors to construct the project (Sec ADDRESS tion 7044 Business and Professions Code ) REQUIRED TOTAL SETBACK FROM EXIST 7 t K a CONSTRUCTION LENDING AGENCY r SET BACK YARD HWY PROP LINE WIDTH i f( I hereby affirm that there is a construction lending agency for FRONT ,� t the performance of the work for which this permit is issued P L r-� rte, J �-+ " �J C+ CA (Sec 3097 Civ C ) SIDE C3� — \� P L Q 1 J ^ti cU 6 8 Lender s Name I r Re` � �r,i - LDMA Ref �FFF****7771 yF P C Fee$ mit Fee Lender s Address Cn I certify that I hav re is application and state that the '"` Issuance l LDMFi PSC l above information corr agree to comply with all County Investigation Fee Rordinances and St to la s) re ting to building construction Total Fee , LDMA m a and her b,author z e resent tives of this County to enter _ c*1 upon th a ove m t t ro rty for inspection purposes F., F)j C'J ''I .J SEE REVERE 4R EXP6AN,&-tbJLANGHrAGE ^ Si of Ap I or gen Date rr-++ '0 .j 0 1 } r r Y WORKERS COMPI~NSATMN DEI_ A ATION hereby affirm that I have a certificate consent to self Com q ' APPLICATION. FOR BUILDING P E RM I T insure or a certificate of Workers Compensation Insurance - or a ccertrfie o y thereof ec 3800 Lab C ) _ + "COUNTY OF LOS ANGELES BUILDING-ANDt SAFETY Owl �i pant' elm a tCertrfied copy rs hereby furnished � BUILDING 1 to FOR APPLICANT TO FILL IN ADDRESS (Qe OA +> r ertified copy is filed with the cou y building rnspec i BUILDING 0 - k t tion department � f I ,r P, ADDRESS B�~H „e Dater-Applicant ' } CITY C ZIP _ LOCALITY - CERTIFICATE OF EXEMPTION FR M WORKERS SIZE OF LOTS k ` - If µNO OF NOW ON LOTS l NEAREST - - CROSS ST COMPENSATION INSU ANCE h ASSESSOR,6S? �A (This section need not be completed if the permit is for one TRACT'" ' BLOCK LOT NO ~ P BOOK Y ' PAGEW PARCEL hundred dollars ($100) or less ) _ A ' - TEL r OWNER ,v > �. Yi NO L� US ONE; ' MAP - w I certify that in the performance of,the work for which this NO ,permit is issued shall not employ any person in any manner ADDRESS � r'� _ _ SPECIAL 1 f a- CONDITIONS O so as to become subject to the Workers Compensation Laws 1 , k -1 - �, _ , >< r , r R t CITY`' - ZIP q S r _ I U ,Date Applicant, ARCHITECT OR TEL � NOTICE TO APPLICANT If after making this,Certificate of ENGINEER - NO DISTRICT GROUP TYPECONST}��-~ N FFIIRRE ROCESSED BY 17) Exemption you should become sublect+to the Workers 1 / " VE y ; ` kCompensation provisions of the Labor Code you must forth _ ADDRESS - Tti D 3 a„ " with comply with such provisions or this permit shall be A f TE ^f N deemed revoked CONTRALTO /`''C L r NO 6 � / 9 STATISTICAL CLASSIFICATION APT CONDO Z Ye a -- — LICENSED CONTRACTORS,DECLARATION ,, S-7}� LIC CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 > ADDRESS !! 9 NO ISO 2) (commencing with Section 7000)of Division 3 of the Business - LIC � SEWER MAP nn G , and Professions Code and m license is in full force and effect CITY "I�'� dr C:. CLASS VALIDATION SQ FT p NO OF NO OF CHECK BK PG >} License Numbe Lic Class —13 SIZE STORIES FAMILIES ONE < ' r // , - VALUATION Contractor + G * Date �~�-`� �v DESCRIPTION OF WORK c f dd NEW ❑ s /J/1��1 ❑I am exempt under Sec � ADD ❑ (C��-/CJ - W ALTER ❑ B&P C for this reason3 REPAIR ❑ 3 + + Y Date a USE OF C J ' EXISTING BLDG O DEMO" ❑ Signature r y APPLICANT TEL FINAL OWNER BUILDER DECLARATION (PRINT) Gp�T'— NO DATE � I hereby affirm thatI am exempt from the Contractor s License Law for the following reason (Section 70315 Business and / ADDRESS FINAL c Professions Code) 11 PRESENT - -0 By ' i v BUILDING4 �_f , El as owner of the property or my employees with ADDRESS 0TVwages as their sole compensation will do the work and the structure is not intended or offered for safe(Section LOCALITY ❑ 7044 Business and Professions Code ) MOVING TEL t i 1 ITENS w {(f I as owner of the property am exclusively contracting CONTRACTOR NO i with licensed contractors to construct the project (Sec ADDRESS y - ) ITAL ' 12 0 tion 7044 Business and Professions Code ) t .NSC lFti 122.91 REQUIRED TOTAL SETBACK FROM EXIST f CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH V r % I hereby affirm that there is a construction lending agency for FRONT CdANT .0 f the performance of the work for which this permit is issued P L (Sec 3097 Civ C ) SIDE-P L f ' Lenders Name i,-IU-1313cl 1/�ri go s c �+ti „ - ' LDMA Ref # AMI1%111 PC Fee$ Permit Fee ✓ .J Lender s Address 1 certify that I have read this application and state that the Issuance Fee "DMA P/C# 8 6. above information is correct I agree to comply with all County Investigation Fee (T) " R ordinances and State laws relating to building construction Total Fee v LDMA Perm # a and hereby authon Er sentatives of this County to enter upon the above d propertyy for inspio "purpos - e � SEE REVERSE FOR EXPLANATORY LANGUAGE SigncVre6VApphcant or Agent Date i A ; z t + P �� J DEPARTMENT OF BUILDING APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING BlDOFIR[ O ZCYE ZC IE J RECCIPT NO[[ (—� TYPE OF /^V 1 ��LL„ G BLDr 1 II III IV f '/ X I GROUP r BLDG SETBACK LINE E of jR CC/C�EIVIV[D BY DAT[ ISSUKD ORD NO 3 APPLICANT FILL IN HEAVILY OUTLINED `PORTION ONLY Ocl NAME I �oone•s� HZj AOUR E91 LOCALITY D i ZZI CITY NEAREST U W -_ CROSS ST SC C I STATE < 1 CFNSf NO TEL NO MAIL S f .�T�,..» , t �� O I NEMC Y_'ti , �iL/.il � ADDPCSS C I le/ .:J/ TrLNO LOT Z I CITU 4�S SIZE OF 0� LOT D C �l,r-t� J L U bTATE l CENSE NO ��vL� )l TFLTr NO �� y IV NO OF BLDGS 0 --1 CI ASS OF NVORK J W BLOCK NOW ON LOT D ` I USE OF BLDG TRACT NOW ON LOT NEW jx I ADDITION I_ DEMOLISH_I I DESCRIPTION OF WORK ALTERATION I 1 REPAIR USE OF I O Ori ROOMS SIZE / FNO OF MIILIES STORIES PECIFIC,ATIONS MATERIAL FOUNDATION CORRECTIONS EXTERIOR PIER! � THICKNE33__TOP i7 / f 7HICKNE33_BOTTOM � „! 1—j—pt R- 1 — ^n�v+. SUPPS7kUCTU_RE_^ e ! ��. l.II fla♦ sa..l_U I s wr I r _ GIRDERS I * BEARING WALLS . �.'�!a---��i•— _ I Z PARTITIONS ROOF RAFTER6 BILL BOLTS LUV I-rcINu �1 ROOF I HERCaY ACKNOWLEDGE THAT 1 HAVE RCALT THIS 1 -- APPLICATION AND STATE THAT TH[ ABOVE IB CORRECT AND AGREE TO COIIPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION -t♦VTM01112[O AG[KT FINAL APi ROYAL � OWNt11 011 , VALUATION i ✓VU FEE q <: DAT[ • Jt71 IN/PccTOR f NAKR �"� { of-1 10.111 r d DEPARTMENT OF BUILDING I APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING P_AHf cp ^` a_D.^. - - L/tb 1 IFUC 6, PLAN I.MK f[ - FILED /7� I ,ZONE p'[ "' � I ZONE Ptl'jM NO TYPE or -7-/ p„ T RECrIPr Na BLDG t JI tit IV IV) i GROUP DATE OP APPL C[IVED BY DAT[ ISSU[D ORD NO LI-3K ,� L/^Id- APPI ICANT FII L IN I1EAVILY OUTLINED PORTION ONLI v E G zI E BUILDING i / I.- y _ADDR EfS I/ Y f1 ( I I�-R�.� W _ZI ADDRE LOCALITY I- D =ZI CITY NEAREST / V STATE CROSS ST / ~� / ' < I L --c NO El NO NAME ( r S Z MAIL _ O I NAME 3 ADDRESS FI ADDRESS 0 I ^'C1LT, U� / O' I CITYIL U I LICENSE NO TR No D u LOT SIZE OF LOT Y a BLOCK NO OF SLOGS CI ASS OF WORK J w NOW ON LOT 1i D USE OF BLDG NEW ADDITION DEMOLISH TRACT NOW ON LOT ALTERATION REPAIR I MOVING I`— DESCRIPTION OI' ItiORK 66E OF O OF BLDG }� L-Qf OOHS t1t Arr f K SIZE OF/ / V 4,-/1 I STORES I'pI or a. �'1st .� �i L"1 JrA ��• ��t >1� l I!`Aj t�1 \7 f 1^ +r ..ar F yr,.N•� �+7+e ' MATERIAL (71.pn.yr,Ac 07'EX ER OR P !wS ._�� (,UI2I21J(,1IL1�1J I ...I..i �J. . _ Gam►- - �_L. YHICKNES8_DOTTOM DEPTH IN GROUND / SUPERSTRUCTURE R W PLATES (SILL) SIZE SPACING SPAN GIRDERS JOISTS—FLOOR n JOISTS_CEILINO 9- BEARING WALLS e7< Z PARTITIONS Y ROOF RAFTERS ta►-�-�- �I �� f� C A--Cw_ u7 ® 4 SILL BOLTS I�/I I I .0 r7 I COVERING _—I _WALL \ .I A .�/1 I ROOP j I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLiCAT1ON AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES i AND STATE LAWS REGULATING BUILDING CONSTRUCTION P I l SIGN - OMNf�• R AVTNORII[D AO[MT FINAL APPROVAL VALUATION /7 L FEE 3 k D■ ■ 1 N AAM YlPL N� ♦ wr - M DEP_1RTMENT OF RUILDLNG APi LIGATION FOR PERMIT - - COUNTY OF LOS ANGELES BUIIs-DI.14; PLANS ! BLDG DISTRICT NO PLAN Cl/K FE- c v FILED I ZONE / ZONE P P n NO 1 TYPE OF �. ? t,(LLLIPT NO _BLDG 1 11 111 IV V X rROUP 2 - 7/ BLDG EYEACK LiNb- DAT[OF APPL REC[IVED BY DAT[ ISSUED ORD NO -72-317 APPLICANT FILL IN IfEAVILI OUTLINED PORTION ONLY H u I NAME BUILDINCI ADDRESS �/^+./ V WW ' 7 ADDRESS LOCALITYT` JeL, �`� 2 Z CITY 7j NEAREST U W CROSS It STATE < LICENSE NO /y TEL No p NAME �^f \ J� ✓ QI O NAM[ ' 3 MAIL ADDRESS I✓ / �/ L.<.►'- 1"''� .. '-� ® d I _DDRE56 I Q CITY lJ d�( e 11.1.1. r TEL NO Z CITY U STATE <d C LOT �S I SIZE OF LOT %�f)x LICENSE NO TEL NO Wa NO OF SLDGS CLASS OF WORK JO BLOCK _NOW ON LOT USE OF LLDG NEW ADDITION I�I DEMOLISH TRACT NOW ON LOT AlT'ERA710N I—I REPAIR I MOVING DESCRIP1ION OF WORK / �� , r _BLDCOF �v)t L C L-I�H /1 !Z a�a.trt L!1 ROOMS �a-�-��! C (-I- /rf ♦ A f t r A t SIZe Oh r y 1 IfL.j.STORIES INq OFAX II if A i'{n`,, t FOUNDATION J `atirJ 1 n EXTERIOR I PIERS r .J I 0- 5 i T14ICKNLSS__T_O_P L t�r+rr�'^^n w«H'�'♦-a ..w '"""'—"1"`^.. -�C( --r ♦-. _ THICKN E8S-_910TTOM it r OFPTH IN rROUND I SUPERSTRUCTURE: R W PLATES (SILSIZE SPACING SPAN r L1 Elm 31PDr" �e JOIST>;__FLOOR � I LS JOISTS—CEILING -� C i BEARING WALLS _2 PARTITIONS POOF RAFTERS ( 0 �S 1 .ILL n^_TS ... f � COVERING �.,. WALL S/ .__� A 1 H[R[BY ACKNOWL[OG[ THAT 1 HAVE READ THIS APPLICATION AND STAT[ THAT THE ABOVEIf CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES I� AND STATE LAWS RtGULATJNBU(LDING CONSTRUCTION \ f16TJ �. 1.fly- Y OWNER OR H IVTARIEED AnWRT PC FEES / A APR AL VALU,T104 I FEE S � `�� v � r ♦ \ Ob S 7 77 DATE IN7KCTpR• MA ME! y y F; APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL ING AQQP9SS I hereby affirm that I have a certificate of consent to self insure, Br? • la or a certificate of Workers'Compensation Insurance,or a certified UI DIN J ADDRESS CITY ZIP copy thereof(Sec.73800,Lab.C.) p� /�d,�1 LOCALITY Policy N .h�vZ�a Compam��.�nf: �N//® SIZ F it OT NO.OF BLDGS.NOW ON LOT rt ad copy is hereby furnished. ev 3I I ��+ NEAREST CROSS ST. ❑ Certified copy is filed with th county buildi inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date :nd W Applicant ASSESSOR MAP BOOK PAGE PARCEL ///JJJ �.. � SPECIAL CONDITIONS CERTIFICATE OF EXEMPTI FROM WORKERS' ow ER _ TEL. O. /—� COMPENSATION INSURANCE / WITHIN 1000 FT.OF SCHOOL? YES No AD R S (This section need not be completed if the permit is for one hundredDISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ILM ke A.4111ml ZIP I certify that in the performance of the work for which this permitS111/11 I .+ 1 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.N7 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 become subject to the Workers' CONTRACTn TEL. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith _'C' FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY L FIDE C I hereby affirm that I am licensed under provisions of Chapter 9 P17S� SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SQo I NO.OF STORES NO.OF FAMILIES Professions Code,and my license is in full force and effect: FW ellav7 NEW ❑ BK PG 0 OF WORK License Number -ic.Class ADD ❑ VALUATION LCL, y*�1��. N ContractorCL LLL Eme ALTER ❑ _� ❑ I am exempt under Sec. REPAIR $ B. P.C.for this reason /7f� JL ❑ D USE OF EXISTING BLDG: URM. ❑ LDMA P/C# - cfl.,•,. a'4 Signaturetp APPLICANT(PRINT) TEL.NO. LDMA Perm# ❑ I, as owner of the operty, or my employees with wages as ZO their sole compen ation,will do the work and the structure is ADDRESS H .I,. not intended or offered for sale (Section 7044, Business and FINAL DA Q . 00 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J - ❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ; "• �'{ / `'i %`y`1 Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FI - licensed contractors to construct the project.(Section 7044, YES❑ NO❑ ;•�,•. 1�ry� (_� ; Business and Professions Code.) 1 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH I CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ rj sii)' 11 the performance of the work for which this permit is issued(Sec. ( h = ;^ I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD '�wl 1 '"''e) 3097,CIV.C.J. 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 o Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. a Lender's Address o. OWNER OR AGENT o 1 certify that I have read this application and state that the above information is correct. I agree to comply with all county RC.FEE PERMIT FEE ordinanc and State laws relating to building construction,and (0! a. hereb thorize repres atives of this County to enter upon ISSUANCE FEE O P1 the a o mentioned pr rty for insp tion purp000sses� �+ V a 1?V9 INVESTIGATION FEE TOTAL FEE naAvww�n Osm ' 00 SEE REVERSE FOR EXPLANATORY LANGUAGE