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HomeMy Public PortalAbout8620 WORTHINGTON DR - Building - 1972-06-19 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES - BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI G ADDRESS I hereby affirm that I have a certificate of consent to self Ensure, BUIL A:^D1�D,R�EnSS 7)i� �0 -e or a Certificate of Workers'Compensation Insurance,or a certified °�v Co M.Lab.C.) CIN , ZIP ,y Cc W-G`/&72 '& Company�rl �V✓ cJ �'�c LOCALI���7/OG SIZE OF LOT NO.OF BLDGS.NOW ON LOT Certified copy is hereby furnished. NEAREST CROSS ST. 415�ertified Copy is filed with the COun b Iding Inspection TRACT BLOCK LOT NO. USE-ZONE MAP NO. depa me t. L ASSESSOR MAP PAG PARCEL 0, / Date Applicant �6 �3 e_1 _1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FRO WORKERS' OWNER EL N n elf v N �� WITHIN 7000 FT OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS QQ (This section need not be completed if the permit is for one hundred O Jv DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP �j 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 this Certificate ofREQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CON OR L . 7� SETBACK YARD HWY PROP LINE WIDTH 3 3 Compensation provisions of the Labor Code,you must forthwith (Q FRONT comply with such provisions or this permit shall be deemed revoked. ADDR ZU / LIC. O. 3 P,L 0. LICENSED CONTRACTORS DECLARATION CITY !G LIC.CLASS SIDE RL V CD I hereby affirm that I am licensed under provisions of Chapter 9 �/ '— G 3 SEWER MAP SQ.FT IZ NO.OF STO ES NO.OF FA ILIES (commencing with Section 7000)of Division 3 of the Business end U NEW ❑ BK dr' PG Professions Code nd Iicans is in full force and ct. , G8�' DESCRIPTION OF WOR ADD ❑ VALUATION LU OL License Num r LID.Class T1er0U � �©�___ z Contractor�`� ` Date - �� ALTER REPAIR ❑ G El am exempt under Sec. � 3L�v� DEMOL 11B.&P.C.for this reason LDMA P/C 0 Date. USE OF EXISTING BLDG URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm M j ❑ I, as owner of the property, or my employees with wages as O ACC ,a their sole compensation,will do the work and the structure is ADDRESS 1= not Intended or offered for sale (Section 7044, Business and FINAL DATE 910-3307 �1,tj■�i, Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEAHAZARDOUSMATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN 1 !TE 1_ ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ NO❑ TOTAL :1 6®88 Business and Professions Code.) WILL THE INTENDED USE MI THE BUILDING BY THE APPLICANT IO FUTURE BUILDING CHECK 9 i 1 o L? OCCUP4NTREQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 4Offtt �Lr� lt4 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMO)SEE PERMITTING CHECKLIST FORGUIDELINES. CHANGE o LI:I I hereby affirm that there is a construction lending agency for YES ❑ NO❑ the performance Of the work for which this permit Is Issued(See. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD / { 3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES NS 2.20AWTHROUGH 2.20.140 CONCERNING 0000-0001 UJ y/}I Lender's Name CHAZARDOUNTYI CODE,M MATERIALS REPORTICHAPTER NG AND FOOR OBTAINING A PERMIT FROM THE SCAOMD. •� e Lenders Address owwm OR Aawr 2t/64 1 AM 10°05 � o I certify that I have read this application and state that the above PC.FEE PERMIT FE Information is correct. I agree to comply with all county 9, 19� ordinances and State laws rela ng to building construction,and J v hereby authorize repress t of this County toe ter u n ISSUANCE 1 the above-mentioned p for inspection pu / INVESTIGATION FEE TOTAL � p SEE REVERSE FOR EXPLANATORY LANGUAGE 76A638A CE#803 1/71 .� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING 0 ADDRESS !f COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY -) FOR APPLICANT TO FILL IN NEAREST Print ort a onl CROSS ST. \ BUILDING 1 •� q DISTRIC�10. TYPE / P OCES ED Y ADDRESS 86 10 �//IIIJ/BH /J/�• GTP R CONST. V STATISTICAL CLASSIFICATION SEWER MAP LOT NO. LaBLOCK CLASS NO, DWELL UNITS K PG TRACTUSE ZONE MAP b 0 NO.OF SLOGS. tt NO. SIZE OF LOT NOW ON LOT 1 SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL. BLDG.SETBACK FROM ADDRESS /.10 F,t w rT1 /fin A-. FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY sa q�j6, to F HIGHWAY WIDTK, FROM C.L. ARCHITECT OR TEL. + ENGINEER- NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINEOF (STREET) yy TEL. TYPE OF EXISTING SETBACK HIGHWA YARD = TOTAL 3 CONTRACTOR NO, HIGHWAY WIDTH FROM C.L. {� V ADDRESS NO t = C LIC. :- CITY CLASS CORNER CUTOFF YES ❑ NO ❑ yv CONSTRUCTION LENDER CL NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS i SQ. FT. NO. OF NO. OF NEW SIZE u 2 �_ STORIES FAMILIES USE OFADD ❑ STRUCTURE �n (76 Lie r ALTER ❑ SIGNATURE OF REPAIR❑ APPLICANT .DEMOL ❑ VALUATIONS V_ I APPROVALS DATE INSPECTOR'S SIGNATURE P.C. ��' A PMT, FOUNDATION: LOCATION FEE S-5 r " FEE 5 t � FORMS, MATERIALS 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, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. LATH, EXT, SIGNATURE OF //Jyr]/_ HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION .0. CASH sH PERMIT VALIDATIO CK. 1.1.0. ? s7 �;� Au�2 2 5.00- c LAGO 7 6 7 1—. .Auc 2'1 1 A 8.00- k1 0-. , A ROAD D=?T. Fc„•':1.T, i� i:=::'J'C=7 Plan 4 FOR ANY MATERIAL S;. %r•.: _ C,.� OU;K DONE IN THE 'ROAD RIG,T OF WAY. ,eAWBAcz#ame.t. APPLICA"T"ION FOR BUILDING PERM T 1 COUNTY OF LOS ANGELES BUILDING s!! -� T DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY I JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CROSS ST. CAS$ATT D.GRIFFIN.SUPT of BU��otNc' DISTRICT NO. GROUP TYPE P SSED BY FOR APPLICANT TO FILI. IN I CONST. BUILDIN STATISTICAL CLASSIFICATION -J, E BER MAPPGADDRESS .„Zd Worthin ton Dr. S' CLASS.NO.�DWELL.UN1TS� LOT NO. BLOCK 1QIAP ccam�... � �g /' STATE NUMBER c�L./��// `"'/ HWY.. YES O TRACTr USE ZONE SPECIAL 740.OF BLDGS. /J/¢/� CONDITIONS SIZE OF LOT 4-1 I NOW ON LOT V'I USE OF _ EXISTING BLDG. BUILDING % EXIST. SETBACK YARD HWY� ST NAME �yIDT•H OWNERJaek - FRONT MAIL P.L. ADDRESS P L ` yo CITY NAL 38273 IIVSPECTION RECORD ENGINEERARCHITECT OR NO. ADDRESS CONTRACTOR Jack Kileen TM 38273 ADDRESS DESCRIPTION OF WORK NEW X ADD ALTER REPAIR DEMOLISH S ZE 1272 STORIES Z FAMIOLIES 3. USEof STRUCTURE Residence and Two Car A tache, a go SIGNATURE OF !' APPLI P- ' APROVALS DATE INSPECTOR'S SIGNATURE' s ADD S FOUNDATION:LOCATION FORMS,MATERIALS /a r 1.i2.is� VALUATION $ FRAME:FIRE STOPS, BRACING,BOLTS PMT. FURNACE:LOCATION, FEE FEE S GAS VENT,DUCTS ) 1 HEREBY ACKNOWLED=THAT I HAVE READ THIS AP- LATH.INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH L COUNTY O NANCES AND. STATE LAWS RE LAT G BUILE G NSTRUCTION: LATH,EXT. 3 SIGNATURE O HOUSE NUMBER COR- q, . PERMITT RECT AND POSTED 7-1` ale D ADD s - FINAL CLYDE N. DIRLAM, PRINCIPAL STO RAL/ENGINEER PLAN CHECK VALIDATIONS 'M.0., CASH PERMIT VALIDATIONM.O. CASH °(0 5 1 1NO 14,;t 9 2 3 n 24_ .00H 'Vol �. ®P LAP0,8 6 4 0 n�� 1 s a 4'8.Ci 4 t^ 78A888A CE 1111803 4,7APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE, PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS (/ COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY e FOR APPLICANT TO FILL IN NEAREST Print ort a onl CROSS ST. BUILDING DISTR NO. G�P PE P S BY ADDRESS / . CONST. STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK BLDG.SETBACK FROM ADDRESS . FRONT PROP.LINEOF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH �� FROM C.L. ARCHITECT OR TEL. D ENGINEER NO. BLDG.-SETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TE TY E OF EXISTING SETBACK HIGHWAY •I• YARD = TOTAL CONTRACTOR N0, d•J3 HWAY WIDTH FROM C.L. > 11 L 1C c ADDRESS '�� /LQ� NO y%3 + CITY Z'"r CLASS CORNER CUTOFF YES ❑ NO ❑ C CONSTRUCTION LENDER t. NAME AND BRANCH �-ri SE5,R VERSE SIDE FOR SPECIAL APPROVALS a u SQ. ADDRESS NO. OF NO. OF ) Z STORIES FAMILIES / NEW ❑ ADD ALTER ❑ OF REPAIR[-] MOL ❑ S� AAPPROVALS AT I P TO!%SIGNATURE PMT. FOUNDATION: LOCATION FEES 1 FORMS, MATERIALS FRAME: FIRE STOPS, Aup I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS dc AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. i CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF 'CALIFORNIA IN RELATING TO My WORKMEN'S COMPENSATION INSURANCE. LATH, EXT, SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS 1 '��� FINAL JOHN F. LEWIS. PRI CIPAL STRYC.4URAL ENGINEER PLAN CIMCK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION (:K./ M.O. CASH IPay0357i-_:Y20 1 H 28.00 , o .• Y�1v'J 76A63BA CE 7!803 1/71 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDIN ADDRESS G 8620 E. Worthington Dr. COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY San Gabriel FOR APPLICANT TO FILL IN NEAREST Burton Print or tvae onl CROSS ST. BUILDING DISTRICT NO. OU YPE FPdCESSED BY ADDRESS 8620 E. Worthington `-' CONST, �. BLOCK LOT NO. 6 L STATISTICAL:L SIFICATION SEWER MAP �I d CLASS NO. � DWELL.UNIT BIg P4f,. TRACT 25 1 _U ZONEI MAP 2 NO.OF BLDGS. 1 t [COkCIAL L,SIZE OF LOT NOW ON LOT P USE OF family dwelling ONDITIONS EXISTING BLDG. OWNER Rs Anderson NEL' - BLDG.SETBACK FROM ADDRESS Same FRONT PROP.L OF (STREET) San Gabriel TYPE OF EXISTING TBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FR ARCHITECT OR Tibor Ginter TEL. 876-72. + _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS 1710N. la Brea Ave. H011Ywoo SIDE PROP.LINE OF (STREET)TYPE OF 6 y SETBACK r CONTRACTOR Aquatic Pools IYICoNEL'446:46 HIGHWAY EW WIDTHFROMFROM C.L. HIGHWAY + YARD - TOTAL C ADDRESS 311 E. Live Oak LIC. bJ NO. + CC CITY Arcadia CLASS CORNER CUTOFF YES ❑ NO CONSTRUCTION LENDER CASH c NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS co" ADDRESS _ ss [[ SQ. FT. 35O NO. OF 1 NO. OF NEW [� lj O�" SIZE STORIES FAMILIES USE OF Swimming Pool ADD ❑ STRUCTURE per STD plan Tr 22 ALTER [:1 REPAIR SIGNATURE OF ❑ APPLICANT DEMOL ❑ VALUATIONS 3500000 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. " FOUNDATION: LOCATION FEE 5 .�.�C FEE$ 3 -S FORMS, MATERIALS FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. i CERTIFY THAT IN DOING THE WORK AUTHORIZED ^� HEREBY 1 WILL OT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT, s L[r LABOR CODE 7H STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S C EN TIO SURANCE TH, EXT. SIGNATURE NUMBER COR- PERMITTEE RECT AND POSTED AODRES 44, FINAL �J JOHN F. LEWIS. PRIN I AL ST x CTU L ENGINEER PLAN CHECK VALIDATION619 .O. CASH PERMIT VALID ION cx M.O. CASH 'Ao6547:� 21 A 7.05,.- _ ;1 LACO 6 5 4,8-4,JUN 19 1 A .5 O N f - .