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HomeMy Public PortalAbout5231 BALDWIN AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) FRE 5231 N Baldw� n COUNTY OF LOS ANGELES V-<— DEPARTMENT OF COUNTY ENGINEER ple City ZIP - BUILDING AND SAFETY DIVISION iN0 OF SLOGS BUILDING _3/ ,SX NOW ON LOT ADDRESS � � BLOCK LOT NO LOCALITY TEL NEAREST aS UeZ NO 28rj- CROSS ST 231 N Baldwin MAPASSBSSOR OOKPAGE CEL _ DISTRICT G P YPE FIRE PROC SSED BY CITYTemple Cit ZIP ONST ZON t ARCHITECT OR TEL '08 ENGINEER Knowlton NO EX3-30 4TATISTICAL CLASSIFICATION �`�// SEWER MAP ADDRESS1220 Lincoln Santa Monica CLASS NCC ! DWELL UNITS BK PG _ TEL E ZONE MAP / CONTRACTOR Al - �/ No ADDRESS 13012 Crenshaw NO 232111LICY, SPECIAL LIC CONDI TIONS CITY Gardena CLASS - ROr.�DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH none BLDG SETBACK FROM > FR TPROP LINEOF (STREET) CL ADDRESS CITY HIG WAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING SQ FT 200 NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH � SIZE STORIES FAMILIES ONE C _ H- _ + DESCRIPTION OF WORK NEW ❑ y LL V BLDG ETBACKFROM x Patio Cover ADD I E] SIDEP LINEOF (STREET) ? STD##38 ALTER ❑ HIGHWAY + YARD = SID OP LINE TYPE OY EG W DTH [C)EMOL EPAIR❑USE OF tEXISTING BLDG ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO �` a IN OPEN SPACE — YES ❑ NO ❑ BY (SIGNATURE) /.'. Q G!/ IN COASTAL ZONE YES ❑ NO ❑ VALUATION 500 - CATEGORICAL EXEMPTION YES❑ NO ❑ 1 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 STAT OF CALIFORNIA IN RELATING TO WORKMEN S COMPENSATION SURANCE 7 SIGNATURE OF PERMITTEE ADDRE T FINAL BY TEL DATE 7 CITY NO �� r` 1l lhE C 11LC hS P I AB1 L 10 FEE $ ` FEE HARVEY T BRANDT COUNTY ENGINEER _ / "7c 0 O PLAN CHECK VA TION CK M O CASH` PERMIT VALIDATION CK Moo{ CASH 1I 9-j uIL4k D - 3 6 0 A - 76A638A CE#803 12/72 1 pr- /I L 2 (W5 �LL 1 D 1 2 0 0A cv APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORK R' MPE ATION DECLARATION FOR APPLICANT TO FILL IN BUILDING A RESS .•_ �, f _ BUIL NG ADDRESS /// I /V I`hereb air at i ave a erti' ate of consent self insure,' z 3 Zj y �{� wI lv /L or cert) at orkers' o ensation Insuran , ,or a certif'ed 4v �.�-r ��y.. ZIP co�•ther o x.380 a C.) !�j /��L 1 /rI `• 917 �(� LOCALITY Policy N Company L`f SIZE OF LOT ('( NO.OF:BLD/GS.NOW ON LOT ❑ C ''ed c is eby furnished. NEAREST CROSS ST. ert'' d copy ' filed with the co y uilditig inspe TRACT BLOCK LOT NO. men USE ZONE MAP NO. par /. .0 < ASSESSOR MAP BOOK PAGE PARCEL Date Ap Ilcant SPECIAL CONDITIONS C TIFICATE OF E MPTION FR WORKERS' o ER 'l TEL '` G COMPENSATION INSU NCE + �� �� e 7 T f�T WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred Alr2 3 i y i /14 I 1 � /jv� G 19 C �-1 DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) L�- /� I I , 44� I certify that in the performance of-the work for which this pe Ci lErn - �� ZIP9e -7� ^yX is issued, I shall not employ'any pers in a manner as t0 gRCHITECT OR ENGINEER TEL NO. 0 6 Y becom S jest t the/�A'forkers'.0 nsati Lawsr STATISTICAL CL SIF CATION APT CONbo Date��f llcant ADDRESS CLASS NO.. DWELL UNITS NOTICE TO APPLICANT. after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you shouldbecome subject t0 the Workers' CONTRACTORL /� TEL NO. G SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith z'Weefl6v`1 V150,0 1440 -¢ .7 us 3Sd6 FRONT comply with such provisions or this permit shall be deemed revoked. qp iGSSgc , �� klC q.� Z 3 PL LICENSED CONTRACTORS DECLARATION /LI ( SIDE I hereby affirm that I am licensed underprovisions of Chapter 9 CITA-�/wlLe-e le! LIC.CI,ASS3 9 P L } (commencing with Section 7000)of Division 3 of the Business and S�/Q..FT.TT..``SIIZE C NO.OF STORIEESS NO.OF FAMILIESC SEWER MAP CD Professions Code,and my license is in full force and effect. NEW ❑ BK PG v License Number 2 Lic.Class 3 DESC IPTIO OF ADD ❑ VALUATION '.�•� ow O ContractUJ or Date 7 LL ���� � ��,�� ALTER ❑ $ /® 41Vv v S 0 Gt at Z�v 56 %'L CIO ku:zl c�i� ❑ 1 am exempt under Sec. -� REPAIR ❑ $ z BAP.C.for this reason �! Lve, x_ // C S� DEMOL ❑ LDMA P/C# Date: USE OF1T(I,N�BLODG. URM ❑ Signature A (CANT(PRIN ) T N LDMA Perm# y V1174 _e 3So& ❑.I,:as owner of the property, or my employees with wages as Z 811�-, their sole compensation, will do the work and the structure isAD 'ESS A `�� �/�� 6,Z FINAL DATE O not intended or offered for sale (Section 7044, Business and (� �� l /��/i Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J -2 / } ' ' I, as owner Of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE - property, am exclusively contracting with AMOUNTS SPECI IED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE, FINAL BY � v 5 licensed contractors to construct the project (Section 7044, _ f j!9(i€ ..a 5OF _ �'-E VES❑ NO� ' Business and Professions Code.) •• -(Z __ '-• WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ?.Hj_�_i t, A - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH eq CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR C' (�- V �� i•S3_ i ?� °`_'� GUIDELINES ]\��' I hereby affirm that there is a construction lending,agency for VES C1Ne" N the performance of the work for Which this permit is issued(.Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ.C. e ^' a ) CHECKLIST. UNDERSTAND REQ ENTS UNDER THE LOS ANGELES CO CODE, i i)1I�)(—� }11 j y_ii,l•i} 2,C 220 SECT ION HAZARDOUS.20. 0 THROUGH 2.20.140 CONCERNING HAZARDOUS r Lender's Name MAT S P SRT/ING�ND F09 OBTAIN G A PERMIT FROM THE SCAQMD. f 7 rrL A- o Lender's Address �"�� O -5-WNEIR OR AGENT o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE civ with all county ordinances and St laws relating to building m eon ruction, and hereby authoriz �reefnlafives s County ISSUANCE FEE�toe er upo the above mentio prnspe/fthi purpos s. .`o /- � INVESTIGATION FEE TOTAL FEE2�©.W` re� .oi Aod�wm or Agem SEE REVERSEFOR EXPLANATORY LANGUAGE