Loading...
HomeMy Public PortalAbout9924 BOGUE ST_Building__ - APPLICATION' FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES BUILDING - ADDRESS ©. DEPARTMENT OF COUNTY ENGINEER CITY C ZIP 9/7 9O BUILDING AND SAFETY DIVISION NO OF BLDGS BUILDING SIZE OF LOT NOW ON LOT ADDRESS TRACT f BLOCK LOT NO Q' LOCALITY r� /^. ( V TEL NEAREST OWNER N jp7.37O C OSS ST -ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUP- TYPE FIRE PROCESSED BY -CITY ZIP CONST ZONE ARCHITECT O TEL/� ENGINEER NO%§ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS -o� Chi CLASS NO DWELL UNITS BK PG CONTRACT R j�-f' T USE ZONE MAP4_6e LIC �NO O ADDRES� ,QO Qf.7 •^/ SPECT L _ 111 CONDITIONS LIC CITY Cj CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG-SETBACK FROM FR OP LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING .F SQT �� NO OF NO OF CHECK HIGHWA + YARD = FRONT PROP LINE HIGHWAY WIDTH SIZ STORIES FAMILIES ONECL } DESCRIPTION OF WORK NEW + O ADD ❑ BLDG SETBACK FROM (STREET( O SIDE PROP LINE OF �.� / .7 ALTER ❑ _ ACK FROM TYPE OF EXISTING w p HIGHWAY + YARD - PI(OP,LINE HIGHWAY WIDTH N USE OF REPAIR ❑ _ Z EXISTING BLDG3 DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES NO ❑ (PRINT) NO IN OPEN SPACE YES ❑ O ❑ BY(SIGNATURE) IN COASTAL PERMIT ZONE n A YES ❑ NO VALUATION ...2 '+-W ZVEZ/V-- '+ .._- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECJ AGREE TO MPLY WITH ALL ORDINANCES AND LAWS REGULATING BLNLDIN CONSTRUCT I CERTIFY THAT IN DOING THE WORK AUTHORIZED FREBY LL NOT EMP Y ANY PERSON IN VIOLATION OF - THE LABOR CODE OF HE STA OF CALIfORN I RELATING TO WORKMEN SCOM- PENSATION INSU1 CE �J SIGNATU jVf/ r PERMITT ADDRESS FINAL �� BY - _ TEL DATE CITY NO. �+ MAKE CHECKS PAYABLE TO: F E $ FET $ / HARVEY T. BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH :/ 3 7'C-'MAY - -6 1 D L .0.5 8 d")o ®S 76A638A CE#803 3J5 73 d Cp MAY 6 -! U '� h � [,� U; rl 1 3 5.22 5 �u C sit„ /7'7 7'1 " q 7YA699A CE 4803 1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING c� (j DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST { WILLIAM A. JENSEN SUPT of BUILDING CROSS ST. FOR APPLICANT TO FILL IN Dls�alG N GRO TYPE P C 11 Y ��� �- CONST. BUILDING STATISTICAL CL (CATION SEW MAP ADDRESSC/i-L e-- KG CLASS. NO. DWELL. UNITS LOT NO. 19 BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: Ll TRACT 3 �' J MAP HIGHWAY NO.OF ILDGS. ) NO. ICIwcLE1 ST TE MAJOR SECOND L CAL SIZE OF LOT (j [� I NOW ON LOT L USE fONk SPECIAL USE OF > CONDITIONS EXISTING BLDG. TEL —c- OWNER N BUILDINGEXIST. ADDRESS 9�/ y SETBACK YARD HWY STREET NAME WIDTH .�Z L� �(", t_. L� `C-�• FRONT t, ARCHITECT OR TEL. P. L. ,� t ENGINEER NO. SIDE P.L. ADDRESS TEL. INSPECTION RECORD O CONTRACTOR NO. d' ADDRESS Q DESCRIPTION OF WORK W CL N ,�� NEW [.gul� ALTER REPAIR DEMOLISH Z SQ. FT. Jc NO.OF NO.OF �IZE / STORIES I FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT VALUATION APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION Z-1 FEE $ FEE $ FORMS, MATERIALS - FRAME: .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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. ICER TIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. Z i- TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN' CO PENSATION INSURANCE. LATH.EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - RECT AND POSTED ADDRESS G - FINAL CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION cK. M.o. cAsm PERN[IT VALIDATION cK M.o. CASH cv o WORY.,ERS' COMPENSATION'DECLARATION ".I-here yr-o'cm that f have",ikers' Come offio6I _s_'i'•self gPPLICATION I•OR Y�ILDING: PERMIT 1� insure, or ti certifica e of Wyorkers' Compensation Insurance, or a certif4d copy,thereof (Sec"3800, L6b'C'') .. - _-.._ - . . - - 1 ,• -COUNTY OF`LOS ANGELES BUILDING AND SAFETY, s' Policy,No.7Campany.y -- s O .Cerhfied,copy.'ts hereby furnished t FOR APPLICANT TO FILL IN BuaDING ADDRESS r Certified copy'is filed wttFi the'count'y.-buildin'g'inspec- "' BUI-[DING - tttt�on'departiment. 1 ADDRESS Dote, A'PPhcant !' h ' CITY _ �E., ZIP I LOCALITY ^ r 41 -e' _ _ _.. _ . l; :_ _ _I •NO OF BLDGS-- NEAREST- _ 'CERTIFICATE OF'EXEMPTION'FROM' ORKERS'':''' } =' - '• r'• COMPENSATION•INSU RANCE r ^, SIZE-OF LOT - NOW ON LOT 7 'y y� CROSS ST .� ✓fes 't- ' r ASSESSOR,': - _• -.-,•:.} (This section,'need not:be completed if-the permitis•for+one --- -"'•" - OK ` hundred dollars ($100)or.,less,) TRACTr� BLOCK LOT NO MAP BO PAGE PARCEL` } �!� � TEL. USE NE MAP r•; :.` , '..,• w t t OWNER �i''''K/1 Cir .NO I'certrfy,Thai;in'the;performance of The woik'for which this "z/ - SPOECIAL -- - - - - ` ' d permit is issued T l sh"all not employ any person in'any manner per, _ - _ , so-os to become su6lect'to the Workers'Compens6tion Laws. ADDRESS .2 t;t-L � CONDITIONS - i•- a . O DU. CIT ate' Applicant, ' " 1 ARCHITECT OR' TEL, DISTRICT - G OUP TYPE'. _};.FIRE P CESSED BY. o NOTICE TO"APPLICANT: If,,'diter'makmg',thfs=.Certificate of ENGINEER-- NO! V CONST' ;-ZONE. Eicemption!'+you.-•'sh6uld,'become- subject--to-'the'Workers' ' ' /� �� / W Compensation^proyistons of,the Labor+Code,.you�must forth ADDRESS u - TEL _ - M with':complq+,with such. provisions,on this permit shall be H p� STATISTICAL CLASSIFICATION APT CONDOI' 'deemed pvoked.-' e„ �'. CONTRACTOR " LICENSED CONTRACTORS DECLARATION -- _ sx _- LIC u.___ CLASS NO. DWELL UNITS_ �+ I,here6y;affirm that I am licensed under provisiona-of Chapter 9. ADDRESS ~ Z� NO 7 (commencing with Section 7000)of Dl�tsion 3 of the Business and•.,,".•Y _ _ _ _LIC-- _ _ SEWER MAP Professtons,Code;and my hcense•is m full force and effect CITY - /� ' CLASS - VALID'ATION , BK PG. ^/ ��--� ��,�y SQ. FT 1 NO OF __ NO OF License'Number 5 'Ltc.Class f :.. SIZE /' STORIES v FAMILIES J - ONE ? _ ' •'' p a _.._VALUATION_ `p�� 1�1/ C_© G}•r" a' "'�'�;-`i'/ DESCRIPTION'OF'WORK. _ ov- -�- _ NEWS--- s /)'O <ControcT r D fe /.�,; AD( a1 am exempt under Sec. ALTER O B.BP C. for this reason LZ _ REPAIR ] i _---- USE OF ' Date: y EXISTING BLDG. -� DEMO[ Q _r. _ " - _ _ _ ._; APPLICANT , /�� TEL. "''Si nature - .____._ _ -- - PRINT) L CU� NO — FINAL•' g OWNER-BUILDER DECLARATION, �y __ •"DATE- .I hereby off irm that I om•exempt from-the Contractor's License gg «' Law for the following'ieason (Section 7031.5, Business and. yj ADDRESS Z! ALM �'� FIN ' '^° #•o r'o a_'o 03f1 Prof essions Code): •. _'�: . . PRESENT - - ^By _ aBUILDING I, as owner of the_ property, or my employees•with''' ADDRESS .j. L, o'�`7•�.�7 5``,• wages as their sole compensation,will do the work the structure is not intended or offered for sale(Section- LOCALITY :' o,e 1 7'1:;7.5 7044, Business and Professions Code).' ' ' MOVING'' _ `" '• TEL' ' ( ' _ ti _. _: aI, as owner of,the property, am exclusively contracting CONTRACTOR NO F�- z$ ]"'Y: _ - _ - - - i _a21: _ - with licensed-contractors to construct the project'(Sec- ' - ADDRESS'. tion 7044, Business and Professions Code). •' -' "-'• w" " '-, -�, r a - � � ' _ REQUIRED, TOTAL SETBACK FROM-„ T - " CONSTRUCTION LENDING'AGENCY " " SET BACK - 'YARD HWY -• PROP LINE WIDTH! - I hereby affirm that there is a construction lend ing agency for FRONT the performance of-the work for which-this permit is-issued, P-L •�, - -:- - - - r - -' (Sec, 3097, Civ. C'). SIDE - , - _ Lender's Name LDMA-Ref.•# m - - - -• _ - - - -- P C'Fee$ -•^ - - 'Permit Fee Lender's Address " ° . L. I'certif that I.have read thts.a lication and,.state cthaf.the (�-�V Y- PP .. . ; __ _.. -_ .__. , = Issuance•Fee- ! i- LDMA�P/C---#--• ._ - ':i --' .. : .- •��1. �-i a obove information is correct. I agree to comply,with'all County Investigation'Fee 0 ordtnances•and State laws relating to building-construction, _ _ --_ _. . _ _... .. .Total Fee, - - •-LDMA Perm #- r, and hereby authorize representatives of this County to enter Q upon the bove-m i ed property for t pection purposes. 4 " Q i SEE REVERSE FOR EXPLANATORY LANGUAGE o O A- .Signature o Pphcant• gent - - - Date,., WORKERS' COMPENSATION DECLARATION : I hereby affirm that I,have d certificate of.consent''fo self insure, or a certificate of Workers' Compensation'Insurance, —APPLICATION. FOR . B U I L D I NG.-PERMIT- or,a certified copy thereof (Sec. 3800, Lab.,G) _ COLINTY'OF•LOS,ANGELES.. BUILDING AND SAFETY" Policy No" Company + BUILDING': ; ❑ 'Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS.- ❑ Certified copy is filed"with'the'county building inspec- BUILDING ADSS ( O !l . tion department. - . - DRE - - Date ApplicanT CITY . �P: (� ZIP d O LOCALITY' NO. OF BLDGS NEAREST' t ^ CERTIFICATE-OF EXEMPTION FROM WORKERS"' SIZE OF`LOT NOW ON LOT CROSS ST COMPENSATION:INSURANCE ; ,• ASSESSOR (This section need.not be completed-4f'the permit'is foi`one . TRACT BLOCK" " ' LOT NOMAP BOOK PAGE- PARCEL Hundred dollars ($100) or lessr) - TEL +� OWNER ' 6�/ IC e e NO. oZ !.y,7 USE ZONE" MAP I certify that in the`performance of:,the work,for which;this NO. permit is issued, I shall not em to an erson in an manner ADDRESS d V ie SPECIAL- -- ' P P Y Y P Y GJ'� � ^. CONDITIONS a so as to become subject to"the Workers;Camp satidn'Laws." ��• e. O CITY, ZIP 171 D - U Date �Apphcant ARCHITECT,OR TEL: DISTRICT _ .GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO;APPLICANT:, If, 'after,makin this Certificate of ENGINEER NO. O:' . g' CONST ZO E F-• ` Exemption, you--should, become--subject to the Workers' �0�_ -? ✓ U Compensation,provision :of the Labor Code, you must forth- :>_ ADDRESS - ?' J CL . with,comply with'such •provisions or this:permit,shall be ! �Jr TEL STATISTICAL CLASSIFICATION APT CONDO. N deemed revoked. CONTRACTOR / t Felt „( NO. �� /J Z LICENSED CONTRACTORS DECLARATION i LIC .O CLASS NO c� •" DWELL. UNITS I hereby affirm that I am licensed undet provisions of•Chapter 9 ADDRESS S, /r S! A/ e N4t,67 7c y� SEWER MAP (commencing wi4h Section 7000)of,'Division 3 of the Business �+� (� LIC. CITY I�J/GGtG�CQ CLE. -7IOO6 CLASS G�3c1 and Professions Code,and my license is in'full force and effect: BK PG VALIDATION SQ.-FT, NO. OF -' - NO OF CHECK License Number ' Lic. Class �' SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION•_OF WORK NEW . ❑ O4 "' - " Contractof Date' �I �! ADD s Z V 0m— ❑I am exempt undei Sec " ' „O `L�—�SS ❑ ► ALTER B.BP.C•:for this,reason-- *' REPAIR $ USE OF Date: EXISTING BLDG. _ `DEMOC Signature r APPLICANT, TEL ATE -FINAL CL OWNER-BUILDER,DEARATION•• (PRINT) NO ' - Dt , I hereby affirm that I am exempt from the Contractor's License _ x„ ? Law for the following reason (Section 7031.5,'Business and ADDRESS FINA ` .Professions Code_ ^ PRESENT r _ Byt :?.,e BUILDING ,a ❑ I, as-owner of-the property,-or my employees with- ADDRESS _ s'" =t .-;= i wages as their sole compensation;will do the work and n t=-''r the structure is not intended or offered for sale Section LOCALITY . �L _ ( MOVING. TEL C;:';3 ` 7044, Business and Professions'Code:.) " . ❑ I, as owner of the-property,am exclusive) contractin CONTRACTOR- NO. _ 95- with , Y 9 _ _ l l�f'iL. �'_a �.. �'_ s with licensed contractors to construct the,pro' ADDRESS tion 7044, Business'and Professioris Code:) REQUIRED aTOTAL SETBACK FROM EXIST ; CONSTRUCTION-LENDING,AGENCY' SET BACK YARD HWY pROP LINE WIDTH, {;t� :1 I hereby affirm that there is a construction lending agency'for FRONT;' F the performance of�"the work for which this,permit i"s issued P L. (Sec. 3097, Crv.'.C.). SIDE ` Lender's Name P L.. , s II;IiI i-1.11ji_': •'` ='• '7 t_ m LDMA Ref. # a1 ,fd, i Lender's Address P.C. Fee$ Permit Fee � `ld.� i 1 I•certify that I have read this application and-.state thai-the Issuance Fee - LDN1A P/C# above information,is correct. I agree,to comply.with all County Investigation Fee 8 ordinances and State laws relating to buildirig•construction, - Total Fee Q and hereby'authorize represehtatives of this County,to,enter upon the above-mentioned property for,inspection purposes. SEE REVERSE FOR EXPLANATORY'LANGUAGE Signature of Applicant or Agent Date