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HomeMy Public PortalAbout6204 AVON AVE_Building__ • �� APPLICATION FOR BUILDING PERMIT FOR-APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES D��SI WING �� �� / v� DEPARTMENT OF COUNTY ENGINEER CITY /y �.e� /fzip j 7TJ- BUILDING AND SAFETY DIVISION NO OF BLDGS BUILDING ti - SIZE OF LOT NOW ON LOT ADDRESS TRACT v /O �J BLOCK J�� LOT N�v 1 7 LOCALITYNEAREST D- OWNER fig/q��a (L.S�/I��1� 10 2Lv7�v�� CROSS ST ASSESSOR ADDRESS Q /�r 0/J�el' �0', MAP BOOK PAGE PARCEL CITY J7/��� �/, �IG Zip 9�X- DISTRICT G�� GROUP CONST /TYPE ZDE OCE D BY NtARCHITECT OR TEL O�/ L V r T A ENGINEER NO STATISTICAL CLASSIFICATIQN ry� SEWER MAP ADDRESS CLASS NO _ DWELL UNITS /'L BK U G TEL CONTRACTOR ri NO USE ZONE MAP LIC NO U ADDRESS NO /� SPECIAL LIC CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED - YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM i FRONT PROP LINE OF (STREET) ADDRESS - CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ FT NO OF NO OF CHECK HIGHWAY + YARD = FRONT PROP LINE HIGH WIDTH SIZE STORIES FAMILIES ONE r DESCRIPTION OF WORK NEW ❑ + t O aBLDG SETBACK FROM ✓� C [amu C n"t ADD a SIDE PROP LINE OF (STREET) O U' ALTER O L SETBACK FROM TYPE OF EXISTING Y HIGHWAY + YARD = PROP LINE HIGHWAY WIDTH h USE OF ' REPAIR Z EXISTING BLDG DEMOL + APPLICANT TEL CORNER C TOFF YES ❑ NO ❑ (PRINT) NO IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( IN COASTAL PERMIT ZO YES ❑ NO ElVALUATION IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM PENSATION INSURANCE SIGNATURE O �LC� CiLG� < PERMITTEE ADDRESS / FINALBY� For TEL DATE CITY NO PC MAKE CHECKS PAYABLE TO FEE $ EET $ C HARVEYT BRANDT COUNTY ENGINEER 7 S PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION cK M 0 CASH 0s 76A638A CE#803 3 75 `AF PL-I CATION � R COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ft BUILDING PERMIT BUILDING AND SAFETY DIVISION LLL111 BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING s /� ADDRESS C✓ y �4e 6 LOCALITY NEAREST CITY S, /d/ ���� ��' ZIP 1/ / CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT �� y, NOW ON LOT MAP BOOK PAGE PARC DISTRICT GROUP TYPE FIRE ROC S D BY 08 ST TRACT B BLOCK LOT NO yy CONV, NE OWNER&,O UL hlr EL UQ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 1(//L�.(f CLASS NOcl�4DWELL UNITS M BK,0 �G CITYIA Z PRot?7 USE ZONE NOP .2--e9 (/^O ARCHITECT OR T SPECIAL ENGINEER A I VKSCONDITIONS ADDRESS je ROAD DEPARTMENT APPROVAL REQUIRED YES NO CONTRACTORIt NOL BLDG SETBACK FROM LIC a FRONT PROP LINE OF (STREET) ADDRESS NO HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING LIC FRONT PROP LINE HIGHWAY WIDTH CITY CLASS _ CONSTRUCTION LENDER + NAME AND BRANCH BLDG SETBACK FROM d ADDRESS CITY SIDE PROP LINEOF (STREET) C) V SQ F NO OF NO OF CHECK HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING � CD SIZ STORIES I FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH _ _ U + LLI DESCRIPTION OF WORK �� NEW F-1 CL ADD CORNER CUTOFF YES ❑ NO ❑ Z G LTER ❑ ;EPA IR❑ IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO EXISTING BLDG ,f //01DEMOL ❑ A PPLICAN /ly TEL ,7Qr�fo 2- �- qN- moot- fjAo �r r �(1x (PRINT) N� C -2z,74-f-4 '� Jy=i,: 'ALy BY (SIGNATURE) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ T APPLICATION �?0 �r�iN ✓, `+�-� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Q y WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED !( HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE f LABOR CODE OF THE 5 CALIFORNIA IN RELATING TO WORKMEN S COMPE NSA 0 I RANGE SIGNATURE OF 6���1�/�!�'L FINAL BY PERMITTEE DATE (��l ADDRESS L7 � CITYG /7/...�/f�i� NO �� P C Fee$ F,®�rm Fe Issuance Fee VALUATION$ / � Total Ffe PLAN CHECK VALIDATION CK • M o CASH PERMIT VALIDATION cK mo ASH 993 = 8 © 9600 �: 76AG38A CE#8038 12/75 it 7 Ql W:DRKE a 1ENSATION'DECLAWRATION � affiYhat I^lya+- a certificate of consent to self ® ®" Fx m w „ ° i, w a w�« p pt w ar a ertrficate�of Wirkess Compensation Insurance "I APR; �ATI!LQN ,�ie® 5i 3 Z'`D �j PERMIT— _ertifiCd copy I tereof (Se"- Lab C�) �� 'e's°' "' _ """" "� �' `s+ `'s{�" a'' jp -'..t- %AI ra= fix, sty C6UNTYMOF.,�405�APIGELES,..,,� BUILDING4AND SAFETY , Policy'No—, Company ❑ Certified copy is hereby furnished �, -,FORIAPPLICANT�TOIFILL IN �,'3 Nt' ADDRESS BUILDING t �✓ + Q�( /!� J ❑ Certified copy is filed with the"county building inspec - BUILDING ' - 7 _ -- . _ -�- "V" tion department ADDRESS "filo I(/ (IC's /�n r ( ^/ i Date Applicant CITY ZA7[J�G(G L ZIP /-7 ! t LOCALITY T.I t CERTIFICATE OF EXEMPTION FROM WORKERSNO OF BLDGS ; NEAREST_,__ COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST (This section need not be completed if the permit{is for one ASSESSOR hundred dollars ($100)or less ) TRACT BLOCK n 1j� LOT NOTEL MAP �j MAP BOOK PAGE PARCEL OWNER �D 9 ACL NO � r USE ONE MAP I certify that in the performance of the work for which this NO permit is issued I shall not employ any person in any manner rr��J) _f CSC SPECIAL p} so as to become subject to the Work ;o]mip�e :tion Laws ADDRESS )%� it > CONDITIONS pate -� Applicant �a�t CITY 6- o& ZIP 1 �� a, NOTICE TO APPLIOAT If after making this Certificate of 1 ARCHITECT OR TEL DISTRICT I G OUPC TYONE PE FIRE PRO ESSED BY Q (//f ST, U Exemption you should become subject to the Workers ENGINEER NO � i6// Compensation provisions of the Labor Code you must forth ADDRESS S with comply with such provisions or this permit shall be L CL STATISTICAL CLASSIFICATION APT [!NDO to deemed revoked CONTRACTORNO Z LICENSED CONTRACTORS DECLARATION LIC 441 CLASS NO Z� 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 CLASS BK PG VALIDATION SQ FT NO OF NO OF CHECK License Number Lic Class SIZE ` STORIES FAMILIES ONE J � NEW � /0' �f� � $ ION Contractor Date DESCRIPTION OF WORK n � ADD ❑ ❑ I am exempt under Sec 17fJ TL', �.1 Yid ❑ _ ALTER B&P C for this reason l►�I (� 1) ALTER �� C REPAIR ❑ $ USE OF Cli 72tS tL) AR r- ❑ Date EXISTING BLDG tip I DEMOL APPLICANT TEL Signature FINAL OWNER BUILDER DECLARATION PRINT NO DATE '� 7 5 2 8 A I hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and ADDRESS FINA }f e • e o e I Prof sions Code) PRESENT BY i - 12488 BUILDING I as owner of the property or my employees with ADDRESS i / wages as their sole compensation will do the work and �`/ 1 Q 0 the structure is not intended or offered for sale(Section LOCALITY • • 44 Business and Professions Code) MOVING TEL ❑ I as owner of the property am exclusively contracting CONTRACTOR NO 70 o 724-87 with licensed contractors to construct the project (Sec ADDRESS tion 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY SETT REQREQBACK IRED YARD HWY TOTAPROP 1:5pI ICNE WIDTH , I hereby affirm that there is a construction lending agency for FRONT IRED the performance of the work for which this permit is issued P L I (Sec 3097 Civ C ) SIDE PL Lender s Name v LDMA Ref # P C Fee$ Permrt Fee c Lender s Address _ 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct I agree to comply with all County IM Investigation Fee ordinances and State laws relating to building construction Total Fee LDMA Perm # and he eby author a representatives of this County to enter n up the abov ntioned property for inspection purposes `o ��� ' � V SFE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent J Date ,