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Home My Public Portal About5221 BARELA AVE_Building__ s � A. 76A638A Cr 8032-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY �rr, JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRIQl-Al0 P TYPE RO BY FOR APPLICANT TO FILL IN 0 CONST. f 11 t BUILDING STATISTICAL CLA ICATION S R MAP 1 ADDRESS _ BK PG CLASS. NO. DWELL. UNITS- LOT NITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED ❑ CERTIFICATE: TRACT 46 3 MAP NO.�0 / (iC IGRCVLE) STATE MAJOR SECOND, OCAL NO.OF SLOGS. '7 SIZE OF LOT NOW ON LOT l/ USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. 'I- TEL. ' OWNER NO. BUILD NG EXIST. YARD HWY STREET N E SETBACK WIDTH ADDRESS FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. a ADDRESS Q CONTRACTOR IM ADDRESS 11.3 '2,/ DESCRIPTION OF WORK !s�'''' w 0- 0 NEW ADD A ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF SIZE Ad STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF G APPLICANT VALUATION APPROVALS DATE INSPECTOR'S SIGNATURE P.C. _ PMT. /p FOUNDATION: LOCATION FEE $ FEE $ `-� f.9 FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS 14 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCT$ z. BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. ✓ TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPE SATION INSURAN LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE 1 RECT AND POSTED ADDRESSFINAL - JOHN F. LEWIS, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.G. CASH J APPLICATION FOR- BBI. ING. PERMIT " • , BV R y ^°� COUNTY OF LOS ANGELES �f" + BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS _ f I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �2Z (J EEA /��; or a certificate of Workers' Compensation Insurance,or a certified —ZZ DAKF- A AV, copy thereof(Sec.3800,Lab.C.) CITY 'Tr i 11 ZIP Policy No. Company (� LOCALITY SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. D�( � 2 NEAREST CROSS ST. El Certified copy is filed with the county building inspection TRACTD BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL ® 004 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ppTEL Ov COMPENSATION INSURANCE CHP� WIE C>V� Z17 toWITHIN 1000 FT.OF SCHOOL? 1 11 YES NO (This section need not be completed if the permit is for one hundred ADDRESS /��/V dollars ($100) or less.) H Z,7„ DELA ,, DISTRICT GROUP TYPE'CONST. FIRE ZONE PROCESSED BY —d� I certify that in the performance of the work for which this permit CITY J e•` LE C I ZIP qf-70' r r is issued, I shall not employ any person in any manner so as to �✓ �7, '� 1% become Subject t0 the Workers'Compensation Laws. ARCHITECT ORENG EER TEL NO. STATISTICAL CLASSIFICATION APT 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 subject. to the Workers' CONTRACTOR (��y� TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith I oujil-Y, FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.No. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS P L O I hereby affirm that I am licensed underprovisions of Chapter 9 U SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and Sof?.SIZF. NO.OF STORIES NO,OF FAMILIES � Professions Code,and my license is in.full force and effect. �f/ NEW ❑ BK PG O TION O WORK License Number Lic.Class DESCRIPADD VALUATION 00 IU Contractor Date a, �r L> ALTER ❑ $ 2-3, ®a v OJ (n ❑ I am exempt under Sec. REPAIR ❑ $ B.BP.C.for this reason DEMOL ❑ LDMA P/C# i•3 Date: USE OF EXISTING BLDG. {•� URM El r•r jL Signature APPLICANT(PRINT) TEL NO. LDMA Perm# _, — c: ❑ I, as owner of the property, or my employees with wages as �� Y Z -5-EJ•3 `4�f'5-0 their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DAT //�� 'Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 711 lel, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ItY Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYZ�� s �ti 4 n._'r{1 licensed contractors to construct the project (Section 7044, ves 1:1Nol° Business and Professions Code.) i 1 E-C WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING b' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 554 - -0 � ar r CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR :i j j AL _�H»_:4 o -— GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No� (:;� :I the 7,Civ. C.) Of the Work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING ;�� I r 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, .j�}Il1y r =`01 Lender's Name TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS `m MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address ) t�4i j fel s '11/96 ! OWNER OR AGENT j,. i1_ .a.e � I certify that I have read this application and state under penalty J IL of perjury that the above information is correct.I agree to comply P.C.FEEPERMIT FEE �/ �� 584A j '=; 3 f f m with all county ordinances and State laws relating to building m construction, and hereby authorize representatives of this County ISSUANCE FEE - to enter upon the above-me•tioned property for inspection purposes. /' . --� I I INVESTIGATION FEE TOTAL FEE r) N -ignature of Awl—ni or Agent Ddle C/ SEE REVERSE FOR EXPLANATORY LANGUAGE