Loading...
HomeMy Public PortalAbout6243 AVON AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print Or type only) BUILDING 0-S(3 � COUNTY OF LOS ANGELES ADDRESS "� DEPARTMENT OF COUNTY ENGINEER C I TY c) f G/ Z I BUILDING AND SAFETY DIVISION SIZE OF LOT J ) J( NOW OON LOTS ADDRESS �� TRACT) p_ BLOCK LOT NO. oZ� LOCALITY / t7 �� YID OWNER olwA *11Off NO. �/ CROSS,ST. ��j �J�O + ASSESSOR / ADDRESS (p rt /i il/ MAP BOOK PAGE PARCEL /f DISTRICT GROUP YPE FIRE 'PRO SSED BY (` �'�/ -. ON T. ZONE/ CITY +J ZIP / ,>„^ `• ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO.�'' jjDWELL.UNITS TEL. _ l BKa_t eG. CONTRACTORCIfIc° L/� �j�t�NO �{ USE ZONE MAP ,t //�� NO.LIC ADDRESS � E IPy��L NO.�d I�' ) SPECIAL � LIC. '72y CONDITIONS CITYeQ � 1/(v� e- CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLD !SETBACK FROM FRO T PROP.LINE OF (STREET) ADDRESS CITY NIGH Y } YARD ;TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES "ONE / a DESCRIPTION OF WORK i.r7y X/(j/� NEW c:) ADD r BLDG,SETBACK FROM v L✓/1P//.$Jf/-A' /a ❑ SIDE PROP.LINE OF (STREET) ALTER ❑ HIGHWAY } YARD _ TOTAL SETBACKFROMI TYPE OF EXISTING O �}Yy REPAIR[ SIDE PROP. LIN HIGHWAY WIDTH ya.J USE OF t = c EXISTING BLDG. DEMOL 1:1Z_ APPLICANT TEL CORNER CUTOFF YES ❑ NO (PRINT) t` IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE) ' Q IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION,$ Cf I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION (1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK.AUTHORI ZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF TME STATE OF 'CAL IFO NIA IN RELATING TO WORKMEN'S COMPE NS ION INSU NCE. SIGNATURE OF PERMITTEE u ADDRESS ' FINAL i TEL. DATE ' IBY CITY NO. HAKE CHECKS PAYABLE Tp: FEE PMT.;Q FEE' FEE P HARVEY T. SRANDT, COUNTY ENGINEER I PLAN CHECK VALIDATI�Ni CK. M.O. CASH PERMIT VALIDATION CK. ) M.O. CASH 9 :8 "1a:AI6. 1.2 1 0 1 5.� (� a 76A638A CE#803 5/74 "• " ' .. APPLICATION FOR BUILDING PERMIT FOR APPL'IC'ANT TO FILL IN (Print or type only) BUI-LDING � a COUNTY OF LOS ANGELES ADDRESS IV DEPARTMENT OF COUNTY ENGINEER CITY If / ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. . BUILDING SIZE OF LOT '/�,� NOW ON LOT ADDRESS r TRACT '</ BLOCK LOT NO. LOCA LIT TEL NEAREST OWNER A4 ��i j NO. CROSS ST. ``////� ASSESSOR ADDRESS17 0-, MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ROC SED BY CITY ��, ZIP �j �j CONST, ZONE ARCHITECT OR TEL. �(/ ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO.0 ._DWELL.UNITS — Al BK/OIRG NO CONTRACTOR TEL. US ZONE MAP l/ LIC. ADDRESS NO o NO. SPECIAL LIC. CONDITIONS CITY CLASS ROAD EPA,RTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRON PROP.LINEOF (STREET) CD ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING U SO. FT. NO. OF NO. OF CHECK HIGHWAY + YARD _- FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE C'7 + w DESCRIPTION OF WORK NEW ❑ a /� BLDG.SETBACK FROM ADD ❑ SIDE PROP.LINE OF TREET) Z ALTER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM TYPE 0 EXISTING REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE TI ✓� t = EXISTING BLDG. ,/`�," DEMOL APPLICANT - TEL '7( CORNER CUTOFF YES ❑ NO ❑ (PRINT) ��✓��` N0. BY (SIGNATURE) �f IN OPEN SPACE YES ❑ NO ❑ Q IN COASTAL ZONE YES [3 NO VALUATION$ ��• CATEGORICAL-EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATIO SURANCE. SIGNATURE PERMITTEE ADDRESS C "*__I__ FINAL TEL. K//SK.f/ �•�-�''� `� CITY NO. DATE CC., �'- 3IAKE CHECKS PAYABLE 'IO: FEE $ FEE HARVEY T. BRANDT, COUNTY ENGINEER ' �y d PLAN CHECK VALIDATION CK, M.O. CASH _ PERMIT V IDATION�.� M.O. CASH, cam. 273 AOG 1 1 D 3.0 OA n' 76A638A CE 9803 12/72 _ . APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY �G % zIP 191.7,e& BUILDING AND SAFETY DIVISION ��jjyy �/�� NO.OF BLDGS. BUILDING �l ` SIZE OF LOT_3V-y/2 NOW ON LOT ADDRESS �✓vz TRACT �� BLOCK—� LOT NOXI LOCALITY TEL. 7� NEAREST OWNER O. L!!J' CROSS ST. ADDRESS "f �/ ASSESSOR MAP BOOK PAGE PARCEL 11 /,`,/ DISTRICT GROUP TYPE FIRE ESSED BY CITY �/� ZIP �j�'" 8 � ICONSTV � ZON � ARCHITECT OR TEL. �i� ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO.v _DWELL,UNITS � BK 02 CONTRACTOR TEL. USE ZONE NOP LIC �i �•� I ADDRESS NO . l O SPECAL -. LIC. CONDITIONS CITY CLASS _ ROAD DE PARTMENT APPROVAL REQUIRED YES NO CONSTRUCTION LENDER NAME AND BRANCH L� BLDG.SETBACK FROM �. FRONT PROP.LINE OF (STREET) Q ADDRESS�OOd .�r, L� CITY o� /J�G7 /�'�/�' / CK HIGHWAY } YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING C.7 SII,E T STORIES / FAMILIES ! ONEFRONT PROP. LINE HIGHWAY WIDTH Q + ,-2a = �' z DESCRIPTION OF WORK c"u0 30ege a D BLDG.SETBACK FROM y F SIDEPROP. LINEOF (STREET) Z ALTER ❑ HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING - REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE OF - — DEMOL ❑ + EXISTING BLDG. APPLICANT ��`TEL GCORNER CUTOFF YES ❑ NO ❑ (PRINT) f- N0. 7 BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ;2eIN COASTAL ZONE YES [:] NO F]Q /y a ca VALUATION •Y �4o CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSE (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ` LABOR CODE OF THE STAT OF CALIFORNIA IN RELATING TO Gj_'7 •� '2 . WORKMEN'S COMPENSATI NSURANCE. a� !✓ C 7 ,p ,¢}� /� SIGNATURE OF ,/% O'd��v' —,11/ 7/Z 4 ®t-I/ l ��SV• ®r�g PERMITTEE ADDRESS lia����„ls�/= .t✓z e FINAL BY CITY 1� NOL DATE (/".. /1;1/�E CfIEChS P;l}'AI3f_�' '10: $ F.0 Q PMT. FEE 9 FEE ' HARVEY T. BRANDT, COUNTY ENGINEER PLAN ECR VALIDATION CK! M.O. CASH - - PERMIT VALIDATION( CK.a 1 M.O. CASH r n %x �1C�'L i v r` i Y"_ 2 4 2 9.3 JUL 25 , D 1 5 C.O0L 76A638A CE 4803 12/72 WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING. PERMIT insure, or a certificate of Workers' Compensation Insurance, or a cernfied py thereof (Sec. 3800, Lab. C.) Poe,�jj td✓e6� r COUNTY OF LOS ANGELES BUILDING AND SAFETY NO. 0 7O7 ompany J Pili 0�� ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 62 L 3 ADDRESS LI Certified copy is filed with Zco�ty building inspec- BUILDING 2 ` tion department. ADDRESS 6.V 3I^ / r Date r/2. _Appi n CITY ��+`^ eC&J�1 ZIP 7� LOCALITY CERTIFICATE OF EXEMPTION FRO ORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSUR NCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one7 ASSESSOR hundred dollars ($100)or less..) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. p/ USE NE MAP I certify that in the performance of the work for which this OWNER j �v b I S NO.z�'3 fc�7s NO. permit is issued, I shall not employ any person in any mannerSPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS CITY ZIP Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT ROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER NO. 5j CONST. / ZO�IE Compensation provisions of the Labor Code, you must forth- ADDRESS "' U6 1 —/ V S with comply with such provisions or this permit shall be / NO. �j -7b STATISTICAL CLASSIFIC TION APT. TONDO. deemed revoked: CONTRACTOR (� Q G 2GG [ NO �(�_3 LICENSED CONTRACTORS DECLARATION LIC CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 6_72 ;4 q/4 NO. 3� �_ (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. CITv,�fj�rK4 ` CLASS Ga 7 BK PG. VALIDATION (/ J� g SQ. FT. NO. OF NO. OF f CHECK 0 License Numbe ��� Lic.Class `� SIZE STORIES FAMILIES ` ONE O //� / �/! / VALUATION V Conirmcf �C / o°77Kf Date �r 2�r DESCRIPTION OF WORK F_ �b/�� w NEW ❑ $ ❑ -eGj'4,+1.le t_L1�� � ADD ❑ 1 am exempt under Sec. ❑ W ALTER B.BP.C. for this reason 3 b C �� o REPAIR $ N1 DUSE OF Date: Y DEMOL ❑ - EXISTING BLDG. � l— Signature APPLICANT TEL. t FINA OWNER-BUILDER DECLARATION (PRINT) �4c NO. �Z7 `� DAT I hereby affirm that I am exempt from the Contractor's License ��� Law for the following reason (Section 7031.5, Business and ADDRESS 0 10 t J-C p re-9.S FIN Professions Code): PRE IENT BBUILDINY �_ qq I, as owner of the property, or my employees with ADDRESS ;Ct7 U 1,J wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section LOCALITY011. ITEMS 7044, Business and Professions Code). MOVING TEL. 5 ,1 f^1"�-a 13 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. T TOTAL , 6 9 with licensed contractors to construct the project (Sec- w'{ �;t: 106_0 tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK CHANGE C CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE, WIDTHfIYG .I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. �_ (Sec. 3097, Civ. C.). SIDE 03 00-00ol �+ =`�`r P.L. Lender's Name 0'384 f AM1=U4 LDMA Ref. # e P.C. Fee$ Permit Fee m Lender's Address n _ gI certify that I have read this application and state that the Issuance Fee (/. 5 kLD P/C# above information is correct. I agree to comply with all County Investigation Fee r 0 ordinances and State laws relating to building construction, Total Fee , / LDMA Perm. # , and here thorize representatives of this County to enter upo ve-m roperty f rection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SignaWre pplicant or Agent Date 5 . WORKERS'COMPENSATION DECLARATION ure-aafirm certif carte of Worke s' Compensat Qn a certificate of Insurancnt to ef 1 APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab.*C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.'f7' 34 91 y Company 7-641 ( BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING �1 tion department. ADDRESS 6 243 10 LOCALITY NEAREST Date / Applicant CITY a'G ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROAA WORKERS' NO. OF BLDGS. / ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT / MAP BOOK PAGE PARCEL (This section need not be completed.if.the permit is for one p US ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT N Z/ NO. p TEL. ( SPECIAL. y. I certify that in the performance of the work for which this OWNER IR I I . NO:2 CONDITIONS IL permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PRO ESSED BY CONST. ZONE EJ so as to become subject to the Workers'Compensation Laws. ADDRESS U i,0� � �••• � '�/� Dare Applicant CITY ZIP STATISTICAL CLASSIFICATION I APT. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. j Exemption, you should become subject to the Workers' ENGINEER Q� NOCLASS NO. DWELL. UNITS UJI Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall.be TEL. �^ deemed revoked. CONTRACTOR Al( NO. - ISZ sSg BK. PG,��L VALIDATION -LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS f Z Y't NS NO. 1 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. /J ~ Professions Code, and my license is in full force and effect. CITY � r 4 CLASS fF` $ �© !/ Gam/ / SQ. FT. NO.OF NO. OF CHECK License Numbers 32 Lic.Class 1� SIZE STORIES FAMILIES ONE NEW $ Contractor Date 9-�5 DESCRIPTION OF WORK 1 am exempt under Sec. ADD 9 _ ALTER FINAL B.BP.C. for this reason Z 3g DATE /S REPAIR Date: USE OF DEMOL FI EXISTING BLDG. S Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT {� t� NO. 5/S I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code):' PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- PADDRE tion 7044, Business and Professions Code). TOTAL SETBACK FROM EXIST. �5 5 4,0 A CONSTRUCTION LENDING AGENCY YARD HWY WIDTH PROP. LINE I hereby affirm that there is'a construction lending agency for ► # o 0 o e o}1 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). m Lender's Name Permit Fee Lender's Address I certify that I have:read this application and'state.that the Issuance Feeabove information is correct. I agree to comply with.all County :Fee- ordinances and State:laws relating to building construction, Total.Fee. u and hereby authorize representatives of this County to enter upon'the above-mentioned property for.inspection'purposes. atS t7 SEE REVERSE FOR EXPLANATORY LANGUAGE - S Si ature o Applicant or Agent Date ®s