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HomeMy Public PortalAbout9994 BOGUE ST_Building__ e • APPLFCATION .FOR BUILDING_ PERMIT FOR APPLICANT TO FILL IN. (Print or 1YPe only) BUILDINGQ COUNTY OF LOS ANGELES ADDRESS / �A-sr 060644 S7 DEPARTMENT OF COUNTY ENGINEER CITY P.LE L'Ir ZIP BUILDING AND SAFETY DIVISION ' NO.OF BLOGS. BUILDING SIZE OF LOT e NOW ON LOT / QILO ADDRESS �. TRACT/# a sL BLOCK LOT NO (JCALITY ` TEI_..��• NEAREST OWNER4W4 .JJ/ qNE — NO. �.7e7W CROSS ST.. - ASSESSOR _ ADDRESS- MAP BOOK PAGE EL " .DISTRICT GRO P YPE FIRE PROC SED BY CITY - Ir ZIP NST. ZONE ' ARCHITECT OR y _"TEL. [v �• ENGINEER //D�'V•F- - NO. - -STATISTICAL CLASSIFICATION SEWER MAP ADDRESS .T / CLASS NO.SZCb—OWELL,UNIT©S hL BK,/�G CONTRACTOR OdvisrER ,Bvi�D NOLoJ- USE'ZONE!C0ONOITIONS• PLIC ADDRESS S/�/1>L QOi�E' NO j vyPECIALCITY iJ LIC. J •.CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑, CONSTRUCTION LENDER NAME AND BRANCH /)'O�✓f. BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CIN HIGHWAY .+ YARD - TOTALfgETBACK FROM TYPE OF EXISTING SQ. FT. NO, OF NO.OF •CHECK FRONT PROP% LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE . DESCRIPTION OF WORK`j /WVCX_4 ,jF &,0C*NEW •O ` U BL•DG.SETBACK FROM O! 1-04 fly ADD, SIDE PROP.LINE OF (STREET) C::) ALTER ❑ _ TOTAL SETBACK FROM TYPE OF EXISTING I— C /NiCAt_ /Ci ❑ HIGHWAY. + YARD - REPAIR J) SIDE PROP. LINE HIGHWAYa WIDTH, 01) EXISOT NG BLDG, yUSE 0 DEMOL Q + ✓ f� ��� Z APPLICANT ,�ppA�rr 6TEL�yal51L CORNER CUTOFF •YES ❑ NO ❑ (PRINT) W.,AAmyTr40/✓ - N0. W - BY (SIGNATURE IN OPEN SPACE YES ❑ NO ❑ - - IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION; 'V'/ORKER- ' COMPENSATION DECLARATION • I 'su eboraafeerti4,0';'k cote of Wo kersrtComtpensat on ensurdn elf APPLICATION F O.R B U I L D I N GI'PERMIT �l or a certified copy thereof (Sec.'3800,tLab. C ) _ BUILDING.AND SAFETY ,. COUNTY-OF L �A ��-- B Policy No, - Company BUILDING ❑' Certified copy is hereby furnished., FOR APPLICANT TO FILL IN ADDRESS v 1 ❑ Certified copy'is filed with`the county building in-spec BUILDING-,? 'ation•department: `. - ADDRESS L .� / • �'✓�/6�'E' /�i; Date Applicant CITY .Efsa�G �/ ZIP / LOCALITY - `a CERTIFICATE OF EXEMPTION FROM WORKERS' x V d NO-OF BLDGS 1 NEAREST,:._ /A 'COMPENSATION INSURANCE - SIZE OF LOT Gp �NOW ON LOT Gia/ CROSS ST (This-section need'not,be completed if-the-permit is for one TRACT /C� BLOCK ✓�1 © LOT NO. ASSESSOR P. _= hundred dollars ($100)or less.) ` e MAP BOOK PAGE PARCEL�• f.,.• . . „TEL USE ZONE MAP - -1. _ OWNER �/s4L i✓ //��1 � 6 N0'" '�.7- I certify that'in'-the performance of the work for which this NO. '• - permit is issued, I sKall'not employ any person in any manner o SPECIAL d so d's to become subject To the Workers'Compen Tion Laws. ADDRESS Dj 1✓� CONDITIONS V Date ' •�'APPliconi' ''�`' l� CITY . _ ZIP . - ;. . ._. . � NOTIC TO A PLICANT: If, after making'this Certificate of ARCHITECTOR,��� � No ' DISTRICT GROUP_ TYPE FIRE- PR^ ESSED BY _ O Exemption; you should become subject .to the-Work rs' ENGINEER CVJ �} Q CONST1 _ W � ZONE U Compensation provisions of the Labor_Code,•you must forth- ADDRESS V d with comply;with such provisions or,this`permit shall be - TEL �' STATISTICAL CLASSIFICATION APT CONDO ` 'Z deemed revoked.,. . CONTRACTOR NO LICENSED CONTRACTORS DECLARATION _. __LIC I _CLASS NO Z� '--DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 'NO (commencing with Section 7000)'of Division 3 of the Business and _ _ LIC SEWER MAP. Professions Code, and my'license isrin-full force and effect. CITY CLASS I BK PG I - VALIDATION SQ FTS/ NO.OF NO OF CHECK License Number Lic.Class—,--- SIZE i7 X fO STORIES FAMILIES ONE, ;:•. ^•t = VALUATION DESCRIPTION OF WORK QQ� NEW � Contractor'' Date ADf J'Q, Q D ❑ I am exempt under Sec ❑ , y B.BP.C. for This reason �� t� ,C7l f� ! t/ PZ 40, REPAIR _❑ S' —. -.•i Date: USE OF EXISTING BLDG. dJ/) E DEMOL ❑ _ -Signature+ APPLICANTTEL. r FINAL 4 1 2 0 A OWNER-BUILDER DECLARATION PRINT) ' ,0v A NO DAT - I.hereby affirm.that1am exempt from the Contractor's License Law for the following"reason'-(Section 7031 5, Business and ADDRESS FIN Profe ions'Code):` _ PRESENT - :By ` - �'° e'7 a�-0 .. BUILDING c yl, as owner'of the'properTy, or my employees with ADDRESS v /�` y - x wages as thL-ir,sol6compensation,will do the work and t/ c e e 7 �.� the structure is not intended or offered for sale(Section LOCALITY - - 7044, Business and Professions Code). - MOVING TEL- - ' - _ -0 2.2 6 r.8 6' - ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO ' with licensed contractors to construct the project (Sec- ADDRESS t - tion 7044, Business and Professions Code). REQUIRED, TOTAL SETBACK_FR M, EXIST _ -"CONSTRUCTION•LENDING AGENCY'- SET BACK "YARD HWY PROP LINE WIDTH I hereby affirm,that there is a construction lending agency for FRONT y `; the-performance of the work for-which this permit is issued P L. -- ,(Sec. 3097, Civ. C.). SIDE Lender's Name' /• ! _ o -F��c `o LDMA Ref�# .•. ,. . . __._. _.. - „' ". -- - P C`Fee•$- ---- - -- Permit Fee l �! - -• Lender's Address �• _1 certify that I have..read this.application-andstate that the __,. ...,- ". /��J V - LDMA P/C - - Issuance Fee•• above information is correct I agree to comply with all'County Investigation Fee, yt jI 2 ordinances and State laws relating to building construction, _ Total Fee (J(f -CDMA Perm. # t --• - t u and hereby authorize representatives of this County to enter upo the above-ment nedproperty for inspection purposes a SEE REVERSE FOR EXPLANATORY LANGUAGE - - - Signature of Applicant or Agent- -• •- Date-