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HomeMy Public PortalAbout9974 BOGUE ST_Building__ 76A638A CE $803.10-56 APPLICATION FOR BUILDING P E R.li/I I Tz�R . 1 BUILDING AND SAFETY.DIVISION BUILDING 9, '57Department of County Engineer ADDRESS County of Los Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST �y CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. • L/�l�I�:- `7"' " DIS TR CT NO. GROUP SEWER MAP FOR APPLICANT so TO FILL IN i .ITYPE hh _ CONST.BUILDING V ADDRESS.' /� 7AI 0 A'G 61,6 CLASS. ICA� GDWELLTION I ' LOT NO. <V BLOCK _ MAP SeTATE NUMBER © - -HWY' YES NO , TRACT - USE ZO E SPECIAL _ NO:OF BLDGS. / CONDITIONS SIZE OF LOT V NOW ON LOT USE OF EXISTING BLDG. B LDING EXIST. ' ) TBACK YARD HWY STREET NAME WIDTH OWNER " y/. v �,['J/.... �� �h y� FRONTMAI ,//�� ADDRESS- • OCS-✓F- - 1 ��/A P. L. 20t Y. �'' ;, � SIDE I+1GTEL. `/�/l� P. L. - CITY — ' P NO. - INSPECTION RECORD'•. ARCHITECT OR TEL. ENGINEER NO. Co Z ADDRE S -- - RA T O. - I - / 5T cc o ALS 4•G„ ADDRESS 0 DESCRIPTION OF WORK NEW V , AD ALTER REPAIR DEMOLISH - - SO. F�,�,,,[�� NO. OF / NO.OF SIZE /'a © .,1 STORIES / FAMILIES USE OF STR CTURE APPROVALS, _ SIGN URE OF f + APPLICANT G - DATE INSPECTORS SIGNATURE ADDRESS W. /f FOUNDATION: LOCATION. FORMS, MATERIALS $ / P. C. S FRAME: FIRE STOPS. 1 FEE BRACING. BOLTS 0� S� VALUATION (J FURNACE: LOCATION. - FEE GAS VENT. DUCTS I HEREBY ACKNOW EDGE A I HAVE AD THI A LATH, INT. ' PLICATION AND STA- HAT ABOVE IS O RE AGREE TO CO . EXT. SIGNATURE O LATHEXT STATE LAWS RE G -- SIGNATURE OFHOUSE NUMBER COR- /I PERMITTEE LI RECT AND POSTED - ADDRESS d INAL JOHN A.LAMBIE, COUNTY ENGINEER, CLYDE Ni DIRLAM. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK, M.o. ' CASH �,1�9 9 5. 4 6.0 U . r � APPLICATION rOR. BUILDING PERMIT COUNTY'OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION. FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I:have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a certified copy thereof.(Sec.3800,Lab C.)., CITY / ZI�I p LOCALITY moi,, Policy No Company SIZE OF L C• N0.OF BLDGS NOWONLOT O VI' ❑ Certified copy is hereby furnished. NEAREST CR SSSTiall) f El Certified copy Is filed with the county building mspechon TRACT BLOCK LOT NO, Tp7p RJJ USE ZONE MAP NO department Date Applicant ASSESSO AP BOOK PAGE PARCEL - 'Fa 19op SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ' OWNER N TEL NO _ - YES No COMPENSATION INSURANCE Gv Z WITHIN 1000 FT OF SCHOOL? (This section need not be completed If the permit'Is for one hundred• ADDRESS DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY,. dollars($100)or less.) CITY ZIP 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 t0 ARCHITECTCR ENGINEER TELL NO become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APTCONDO Date_ '-�� ���j q�,"ppllcant, ADDRESS CLASS NO DWELL UNITS •• � - NOTICE TO-APPLICANT.' If, ter making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers CONTRACTQR ', 1 •TEL NO _ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must'•forthwith �Q��'LieGayl/v7t� 1/- �3 3 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS /. LIC NO PL LICENSED CONTRACTORS DECLARATION 7NJVLA �n U0" .5� SIDE CI ���� LIC ASS PL I hereby affirm that I am licensed underprovislons of Chapter 9• SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE 'NO OF STORIES I NO OF FAMILIES' Professions Code,and my license Is In full force arid effect. NEW 1:1, BK PG n , R License Number Lic Class DESCRIPTION OF WORK ADD E] VALUATION O , Contractor Date t!��-"/� ALTER $ 000 U IY El-I am exempt under Sec REPAIR El BPC for this reason DEMOL' ❑ LDMA P/C# W Date USE OF EXISTINj5PLDG. URM .❑. q Signature APPLICAN(RINT) �, TEL NO LDMA Perm# 1 .. - z_ ❑ I, as owner of the property, or my employees with wages as 05`7� ��� JV76)- O MC 1 T'g q their sole compensation, will,do-the work and-the structure Is AD )RESS not Intended or offered for sale (Section 7044, Business*and ��1� 6✓r M / � `ri X3 FINAL DATE �J O ••1+: &W •4 -+{i PfOfeSSIODS Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL' ._7.. < J 1•NEMS ( - OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ` < C1 I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYjI-iT/i ` { 6' licensed contractors to construct the project (Section 7044, YES❑ No 1+L 8.' Business and Professions Code) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING l:r'IE K + OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - __ CONSTRUCTION LENDING AGENCY COAST-AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR, �• s�lj I GUIDELINES . CHANGE L I hereby affirm that there is a-constluction lending agency for ves❑ No I a the performance Of the work for Which this permit IS Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING } r'} 3097, CIV C), CHECKLIST i TER 2 20 SECTIONS REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, l il�l�lJ-013 j f 61.4— Lender's /.4 -'7L N TITLE 2.CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20'140 CONCERNING HAZARDOUS•, Lenders Name MATERIALS REPORTING AN F RR OG A PERMIT FROM THE SCAQMD - r. CL Lender's Address 9 0390 1' AM v�4 l R AGENT p o I certify that I have read this application and state under penalty 0 of perjury that the above Information is correct I agree.to,comply PC FEE PERMIT FEE ��. ^ with all county ordinances and State laws relating to building 0( m construction, and hereby authorize representatives of this County ISSUANCE FEE / to enter upon the above- ntioned pr perty for Inspect on purposes ao co .t�r�i"!•./�!3. i��i` -4919 , INVESTIGATION FEE TOTAL FEE n .sg of Appy a F6, e / 7 oa�e - / SEE REVERSE FOR EXPLANATORY LANGUAGE '` �WQRKERS'i COMPENSATION DECLARATION' here[jr:affirTn-finat h.have a.certificate of,consent to self- APPLICATION P p L I CATI O N - F®R.-B U i L®I N.G P E RMI T' insure, or a.certificate'of Workers' Compensation Insurance,,• /� or a certified copy thereof.(Sec: 3800, Lab. C.) COUNTY OF LOS ANGELES _ BUILDING AND SAFETY' Policy No. Company FOR APPLICANT TO FILL IN BUILDING ❑ Certified copy is hereby furnished.' G ADDRESSq 922 &C-GO C El Certified copy is filed with the County building inspec- BUILDING ADDRESS -1q7� 13O�oC�1� ST tion department. CITY --'FF—_'rL •G-T"fZIPLOCALITY Dare Applicant,' NO. OF BLDGS / NEAREST• CERTIFICATE OF EXEMPSION-FROM WORKERS' SIZE OF16T. OO X I35' NOW ON LOT ,. CROSS ST. COMPENSATION INSURANCE ASSESSOR Q (This section•rieed:not be completed if the,perrriit is for one TRACT BLOCK LOT NO. �' /app g00 . ' ;V $$ PAGE 1 S PARCEL Q�'f hundred dollars ($100) or less.) - _ r TEL. - . OWNER C. ..E &4DEK 5014 NO USE NE MAP " NO: I certify that,in the performance of the work for which this ` SPECIAL } permit,is issued,•I shall not employ -n - erson in manner ADDRESS_- CfC 7y, (-+C)6(46 /� CONDITIONS O so as To become subject,to The r Comp ion'Laws. - ���y /�' CITY U'1 PLS G�T`r -'ZIP U ')/Date �'T' Applica -+—�—�- ARCHITECT OR TEL. DIST R T GROUP TYPE FIRE PROCESSE NOTICE TO APPLICANT: If, a ter make this,Certificate of. - - ENGINEER NO - CO E 0 Exe-_ tion, ou,should become—sub b6 to the Workers' Compensate n provisions of the Labor Code, you must forth--- ADDRESS a with comply. with such, provisions cir this permit shall be - TEL. IV STXTISTICAL.0 SSI [[ATION APT ONDO. Z deemed•revoked. r CONTRACTOR DoN6 L$e NO 0q.7 LICENSED CONTRACTORS DECLARATION •'' I7�jSl,-,.�+ MAI�J�7 , LIC NO &^ 61 CLASS NO. DWELL. UNITS I hereby affirm'that I am licensed under provisions of Chapter 9.. ADDRESS SEWER MAP (commencing with Section 7000)"of Division-3 of the_Businessn LIC. , and-Professions Code,and my license is in full force'and effect. CITY ( ' ue CLASS BK PG VALIDATION SQ FT 1 NO OF NO. OF / CHECK , -License Number Lic. Class SIZE J STORIES FAMILIES 1 ONE _ . VALUATION DESCRIPTION OF WORK NEW Contractor Date pt $ '�00� ►W � ❑ - PWOM �4pD ADD ► I am exerript unlet Sec. p,� A ALTER. B.&P.C. .for this reason r 1 ' `L REPAIR ❑ $ Date: USE OFi - EXISTING BLDG DEMOL'10 ❑ Signature °= +`y APP(PRINT) I�iN� NO / ZO T FINAL ICANT TEL. OWNER-BUILDER DECLARATION DATE - I hereby affirm that l am exempt'from the Contractor's License AINg 4PLaw for,the following.reasori;(Section'7031.5, Business and ADDRESS (7 FINAL' Professions Code):-' PRESENT - By ACr r'. ❑ I, as owner of the properly, or my employees with' ADDRESS _ ,;�,7 '+7 wages as their sole compensation,will do the work and ii' °�t LOCALITY , ` the structure is not intended or offered for sale(Section i ITEC1 7044, Business and Professions Code.) MOVING r TEL ❑ I, as owner of the'prCONTRACTOR NO.operty, am exclusively contracting j!I T AL 11. e � '� with licensed contractors to-construct,The project (Sec- : ADDRESS ' 1' �• `. 4 t+ + 7 '� tion 7044;'Business and'Professions Code.)', ��it;�. REQUIRED TOTAL-SETBACK FROM EXIST. _ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE •WIDTH , = ( CHANGE °I I1 I hereby affirm that there is a construction•lending agency for ' FRONT a• _. �., 1.1 +` ` "Hti1��1t the performance'of'the work.for which this perrnit"is"issued- P L" _ ? "`•' '; (Sec. 3097, Civ.' C.). SIDE *' Lender's Name P L � , est �fti . ;Ofl�'Jr-01[II f` �.r�t�r'�'3! LDMA Ref # ji ; ". •°�18 i Hid V°y;,_, P C Fee$ Permit Fee Lender's Address Y `- 0 1 certify that I have,read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation,Fee 8 ordinances nd Stat laws relating to building construction, Total Fee LDMA Perm # a and authori a representatives of,this County to enter up e= coned property'for inspection purposes. 3 LSEE REV_ERSE FOR EXPLANATORY LANGUAGE Signa a of Applicant or Agent Date _ , WORKERS' COMPENSATION DECLAR.�OI . I here—that I have a certificate of consent to self. insure, or a certificate of Workers' Compensation Insurance, A P P L I CAT.I VON . FOR BUILDING PERMIT or a certified,copy thereof (Sec. 3800, Lab.,C.) COUNOF LOS ANGELES" BUILDING AND SAFETY TY Policy N0. ^r/ Company' '..S ty"J° •. F���y BUILDING CI a 'E1Certified copy is hereby furnished." FOR APPLICANT TO-FILL IN ADDRESS -I " ❑• Certified copy is filed with the county building inspec- BUILDING ADDRESS tion department. Y4-1 CIN /`"/% 6� ZIP .. LOCALITY PC.� Date J ' Applicant O. OF BLDGS CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST CROSS ST COMPENSATION INSURANCE ASSESSOR. (This section need not be completed if The permit is for one TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) / J, TEL OWNER' L' I':'� b SJ.V NO. _147- 7 USE ZONE MAP 1•certify.that in the performance-of the work,for which this 7 F NO permit is issued, I shall not employ any person in any manner ADDRESS 7 J /� L I SPECIAL" } CONDITIONS � so as to become subject to the Workers'Compensation•LavLs. CITY �r, ZIP tv i •;c� 1�'Y%tet cc 'Date'/ Applicant• ARCHITECT OR TEL DISTRICT G OUP TYPE FIRE PROCESSED BY Q NOTICE TO APPLICANT: 'If, after making This Certificate of - ENGINEER - NO CONST ZONE 0 Exemption,-.you should become subject to the Workers' +1 /.JX, 1/ U Compensation provisions of•the,Labor Code, you must forth- ADDRESS / �J V _ a with comply, with such provisions-or this permit shall be TEL STATISTICAL CLASSIFICATION AP CONDO. Z deemed revoked. CONTRACTOR NO. — LICENSED CONTRACTORS DECLARATION LIC CLASS NO C—DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing•with Section 7000)of Division 3 of the Business LIC 'and Professions Code,and my license is in full force and effect. CITY CLASS BK: _ PG VALIDATION � r SQ FT. NO. OF NO. OF CHECK 'License Number 41' /. Lic. Class G'"!,'7- SIZE I STORIES FAMILIES ONE Contractor/,/�"'/• , J Date I`�� / C' "y DESCRIPTION OF WORK �v=�l dJ� NEW ❑ Sr VALUATIO / ® " El am exempt under Sec." (Fftin �7-St �.vZ� ADD (�E� ► ALTER ❑ B'.BP.C. for this reason REPAIR ❑ $ Date:" USE OF EXISTING BLDG. DEMO( ❑ i I APPLICANT /1 TEL. ' ~ Signature - • (PRINT)/T� JAL- NO "FINAL i 4 • '",`� ', OWNER-BUILDER DECLARATION DATE_ \ �t'• I hereby affirm that I am exempt from the Contractor's License ! � `Law for the following reason (Section 7031.5, Business and ADDRESS v 5 /'? (/y �� FINAL` 1 Professions Code): PRESENT• By { a BUILDING A`CT off ❑ 1, as owner of the property, or my employees with ADDRESS 25 wages as their sole compensation,will do the work and:: �J3J7 _TS'•c.i ' LOCALITY the structure is not intended or offered for sale(Section , " - - i ITEMS 7044, Business and Prof essions'Code.)• MOVING - TEL CONTRACTOR NO ❑ I, as owner of thepropert am exclusive) contractings= with licensed contractors t construct the project (Se _ TOTAL AL e ?.a ADDRESS _ tion 7044, Business and Professions Code.) �HEi•fi 1q.1 REQUIRED'- TOTAL SETBACK FROM-' EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH ' I hereby affirm that there is a construction lending agency for FRONT CHANGE :•i]i] the performance of the work for which,this permit is issued P'L - (Sec. 3097, Civ. C.'). SIDE " Lender's Name 000 1�QVU1 " P C Fee$ Permit Fee r �✓ LDMA Ref # t270 i AM V:i 6 Lender's Address ) V 1 T i 1 a I certify"that I have-read this application and state that the Issuance Fee / /� LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation.Fee R ordinances and State laws refuting to building construction, Total Fee a LDMA Perm # a and hereby authorize representatives of this County to enter v upon the above-mentioned property for inspection purposes. ; a �L9 SEE REVERSE•FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION 'insure, or cairm rte of Wo ke s' Com'I have a tpensat oe of n eInsuran e, APPLICATION FOR BUILDING PERMIT . or o certified copy there f ec 3800 a ) COUNTY OF LOS ANGELES BUILDING AND SAFETY',, n' i Policy No. Company Certified c py is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS El - Certified copy is filed,with the unity buildin .mspec- BUILDING de#ATE ADDRESS DateApplcant • CITY ( ZIP O LOCALITY ERTIEXEMPTI N'FROM WOR RS' NO OF BLDGS NEARESTNSATION INSURANCE SIZE OF LOT' NOW ON LOT ' CROSS ST `(This section'need not be completed if the permit is for one ASSESSOR , hundred dollars ($100)or less.) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL TEL USE�NE MAP I certify that.in the performance of the work for which this OWNER NO NO. ql- permit is issued; I shall not employ any person in any manner SPECIAL so as to become subject to the Workers'Compensation Laws: ADDRESS CONDITIONS qy7y• '' `• CITY l C . ZIPQ, Date Applicant TEL. NOTICEARCHITECT OR TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY T Exemption, you should become subject to the Workers' � CONSE J ' Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFIC TION APT J1e6NDO. deemed revoked' CONTRACTOR o NO. 1�DO LICENSED CONTRACTORS DECLARATION• CLASS NO. DWELL UNITS I hereby affirm that I am Icensed under provisions of Chapter 9 ADDRESS ?Z.LIC LIC SEWER MAP .(commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and,my licens �s tri full force and effect' CITY CLASS BK PG VALIDATION a SQ FT NO.OF NO OF CHECK License N ber Lic,Class SIZE STORIES FAMILIES ONE V DESCRIPTION OF WORK NEW' VALUATION Contra o Date ADD $ � r 0 ' I am exempt u er Sec. &11VALTER b. B.BP.C. for this reason REPAIR s N Date: USE OF FDEMOL Z EXISTING BLDG Signature APPLICANT /�D TEL. FINAL OWNER-BUILDER DECLARATION PRINT ( '} NO 3�oa� DATE Z I'hereby affirm that I am exempt from the Contractor's LicenseS> Law for the-following reason (Section 703.1.5, Business and_ ADDRESSIA- FINA Prgfessions.Code): PRESENT By 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- ADDRESS ^e' tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SET BACK REQUIRED YARD HWY •TOTAL SETBACK FROM EXIST. PROP. LINE WIDTH 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;Ctv C.). - SIDE P L GJ 3>.F. gyp•. ,C:",t : Lender's Name 2n –, • X_ O<-,I LDMA Ret.-it" 4 =' "J-1 m P C•Fee$ Permit Fee CJ ITT �a Lender's Address "� oI certify t t I have read this application and state thattheIssuance Fee' V:.S LDMA P/C# t—t o A-nreby mation is correct. a to comply with all County Investigation Fee t—' 0 and State la relator to building construction, Total Fee D LONA Perm. # 'M t au hon a resentah s of this County to enter bo oned proper for inspection Jurpos SEE FOR EXPLANATORY LANGUAGE• '®J. �Yi C.0 t_Ct , Signature o Applicant or Agent Dat -R• ro :CJ r� ' _ . . C••, 1431 '_+-t-