HomeMy Public PortalAbout10560 DANBURY ST_Building__ p5A5J9p GB CBG]0-63 APPLICATION FOR BUILDING PERMIT
" . COUNTY OF LOS ANGELES BUILDwG,
DEPARTMENT.0E-COUNTY ENGINEER ADDRESS /0J-2�P1 N , r//p
BUILDING AND SAFETY DIVISION LOCALTY
JOHN A. LAMBIE, COUNTY ENGINEER a NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. /]
FOR APPLICANT TO ILL I DISTRICT NO. . GROUP TYPE PROCESSED BY
O CONST h
BUILDING STATISTICAL CLASSIFICATION SEWER MAP .
ADDRESS _ '�
n CLASS. NQSK PG
�DW ELL. UNITS
LOT NO. 2 BL'O� WATER NOT REQUIRED ❑ RECEIVED,❑
- CERTIFICATE:
1 TRACT 2860,7 MAP ¢' HIGHWAY
][ NO:OF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND. O AL
SIZE OF LO LOT'
none USE ZONE P
USE OF I CONDITIONS '
.EXISTING BLDG. 'I 1/
OWNERBaldwin Bldg, rontr. NO.I� 1- 10 BUILDINGyARD HWY STRE T NAME EXIST.
ADDRESS 5041 Baldwin - Temple Cit SETBACK WIDTH
L ✓ FRONT C
ARCHITECT ORP. L. _
ENGINEER _ Lou Rodwell TE NQ�Y -68 SIDE ?,
. C
ADDRESS 1122!.1 Aralia Rd. Altadena PL- O
CONTRACTOR Baldwili'Bld . Con;oELL13-571
ADDRESS 5041 Baldwin Temple City' O
DESCRIPTION OF WORK w
a
w
NEW$ ADD AL REPAIR DEMOLISH // Z
SO. FT. i O. OF NO. OF ./\p.w..n�...n s(J.
SIZE 'p TORIES FAMILIES ,�� G mr
STIR O TUR. Re S1 15 f& _ -
L
SIGNATURE OF
APPLICANT
COO
VALUATIO
APPROVALS - DATE INSPECTOR'S SIGNATURE
P.C. 'J -j PMT. FOUNDATION: LOCATION c (1
FEE $ (J FEE $ FORMS?MATERIALS'
FRAME: FIRE STOPS, n �7r ` �"
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS. / i.
ANO 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. 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH. INT. ��� „ ^�� 0
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- _ At
ING TO WORKMEN'S R;ETION INSURANCE. T LATH. EXT. ` vJ j+�- v1SIGNATUREHOUSE NUMBER COR-PERMITTEE ��✓' RECT.AND:POSTED I _
ADDRESS .FINAL' U VKO
JOHN F. LEWIS. PRINCIPAL STR URAL ENGINEER
PLAN CHECK VALIDATION CK. M C. CASH _ PERMIT VALIDATION. cK. M.D' CASH
L,iLT7656w APR 23 D 372581 G
3 7 6-,.-- Rl'ly 1,5 ' 1 G 7 L.5 ' `^
COUNTY OF LOPeANGELES BUILDING AND AFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT fp FILL IN BUILDING ADDRESS
BUILDING ADDRESS/ /'• �Uf(,J
hereby affirm that have a certificate of conserR to If insure, �_ r / �—
flc t f =coubuildi
anc o a certified CITY ZIPc0 f LOGALITV
ZE OF LOT NO.OF SLDGS.NOW ON LOT❑ Certified copy is hNEAREST CROSS ST.❑ Certified copy is fig in ction TRACT - BLOCK LOT NO.
department. USE ZONE. MAP NODate AASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER T YES
(This
No
COMPENSATION INSURANCE WITHIN 1000 FT of SCHOOL?
(This Section need not be completed if the permit is for one hundred ADDRESS
dollars ($100)or less.) CITY ZIP
fll DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
-
I certify that in the performance of the work for which this permit o
is issued, I shall not employ any person in any manner so as to ��/ _3 L6
become Subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO.
STATISTICAL CLASSIFICATIONAPT CONDO
[)ate Applicant ADDRESS CLASS NO ;:? I DWELL UNITS
NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CONT O T SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith FRONT
comply with such provisions or this permit shall be deemed revoked. A D uC.N ^�pv P L
LICENSED CONTRACTORS DECLARATION [�(�l� SIDE
CITY LIC. LAS P L
I hereby affirm ha m licensed underprovisions Of Cha 9 SEWER MAP
(commencingMeD n 3 of ttff�����Tjjjjy'''''8 GS nd SO.FT.SIZE LA0O DF FAMILIESProfessionsin full ce �eff CL NEW ❑' BK PGLicenseMBS0 TOADp ❑ VALUA O DContrac r0 r ALTER ❑
❑ 1 am exempt under Sec. REPAIR ❑
B&PC. for This reason F DEMOL ❑ LDMA P/C A - W
Date: USE OF EXISTING BLDG. URM ❑ 1
Signature APPLICANT fPFINT) TEL NO. LDMA Perm# Z Z
ACCT.L:
❑ I, as owner of the property, or my employees with wages as }�
their sole compensation, will do the work and the structure is ADDRESS 2 3303158.85
ITEMS 1.58.85
not Intended Or Offered for sale (Section 7044, Business and FINAL DATE q !�' �Q 1 ITEMS
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �`s
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J
❑ I, en owner of the property, am exclusively contracting with Q
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GLADE? FINAL BY / � TOTAL 158 . 85
licensed contractors to construct the project (Section 7044, � /•(V/
Business and Professions Code.) YES E3 No EDCHECK 158.85
WILL THE INTENDED USE OF THE Bull BY THE APPI CANT OR FUTURE BUILDING
OCCUPANT REO IRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE .OQ
CONSTRUCTION LENDING AGENCY COAST AIR OU TY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES.
I hereby affirm that there is a construction lending agency for YES 11 No❑
the performance of the work for which this permit is issued(Sec, rnFTrTTr_�O+ i A,�L��^
IHAVER HE AZAR U ATERIALSINF MAD.N ��
ANDTHE SCAOMD PERMITTING {,j_IplJjly"I' 11 '{lrjll Lzl
3097,CIV.C.) CHEG UN R Y REOUI M OS ANGELES COUNTY CODE.
LBndefa NamB TITLE APTE CT 2 1 HR40 CONCERNING HAZARDOVS I S REPORT AND INTHE SCAOMD ,
o Lender's dress
o cwFm as woe T
o I Corti that I have ma tl t - app tion and state under penalty
o PC.FEE PERMIT FEE
of j ry the a above Information's correct,I agree to comply
o w co t ordinances St a laws relating to building
on r on nd hy a o zu
e r reSenfa[[res ISSUANCE FEE -273o
nor Ion 0 o m tion p party/7,Jnsp
INVESTIGATION FEE TOTAL FEE
�9reN�of MHIm��a,Aa�l o,�. jj O
SEE REVERSE FOR EXPLANATORY LANGUAGE