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Home My Public Portal About4934 DOREEN AVE_Building__ AT � APPUCAMON FOR BULL _ IG PERMIT � •� �'" �- . , COUNTY OF LOS ANGELES BUILDING AND SAFETY O WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDREss Ihereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or'a certificate of Workers' Compensation Insurance,or a,cerdfled `� - 31 copy thereof (Sec 3800, Lab.C) � (�-pp e CITY ZIP Policy No() 7 178 S IcyR lDy . �AT / C/ LOCALITY Company �j _ SIZE OF LOT ' NO.OF BLDGS.NOW ON LOT ..❑ Certified copy:is hereby furnished. - �Q��/� NEAREST CROSS ST Certified copy is filed.with_the c a ty b 'I'�in p chin TRACT "- BLOCK LOT NO. department.., ' USE ZONE - MAP NO. ' q Date 7-27/ AppliCan ASSESSOR MAP BOOK' - PAGE '"PARCEL 'SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER / - TEL No. COMPENSATION INSURANCE T d 1 WITHIN moa FT.of scnooL? YES _ No ADDRESS (This section need not 6e completed if the permit is for one hundred., DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars ($100)or less.'- ' " °-'� '�5 vlod.T.� -- N �CITYZIP I certify that in the performance of the work for which this permit' O L ,is Issued,'I shall-notemploy any person in any manner'so as to become subject do the Workers'Com enation Laws. ' ARCHITECT OR ENGINEER TEL NQ Compensation STATISTICAL CLA sIFICATION APT CONDO Date' ' Applicant ADDRESS - - CLASS NO. DWELL UNITS - NOTICE ,TO APPLICANT.' If, after making this Certificate. of LFRONT J TOTAL SETBACK FROM EXIST Exemption, you' should becbr_ne subject to the Workers' CONTRgCTOR f TEL NO. D HWV PROP LINE - WIDTHCompensation provisions of the Labor Code,-you must'toithwith / r 9' u� - ' comply with such,provisions or this permit.shall,be deemed'revoked., ADDRESS LIC NO LICENSED CONTRACTORS DECLARATION O 37'Z`rV7 CITY LIC.CLAS' " hereby affirm that I,am licensed underprovlsions of Chapter 9 - - .?s SEWER MAP (commencing with Section 7000)of Division 3 of,the Business and SO.FT.SIZE NO OF STORIES NO,OF FAMILIES Professions Code,and my license is in full force atnt�'d� effect. - NEW_ ❑ BK PG D - d License Number -7 90 7 Lic.Class IS DESCRIPTION OF WORK - ADD ❑ VALU ION • 0 O Contrzctol�u��r*'^'I�:�-I[��-Date 7- 21- 7 ��f' � $ ��v. V U _ ..ALTER cc nAP;W.; REPAIR . 071 I amexempt under.Sec. V BBP.C. for this reason y DEMOL, ❑ LDMA Pic Date: USE OF EXISTING BLDG. URM ❑ i Signature - - - W. Z APPLICANT(PRINT) - - TEL NO. 1 -LDMA Perm# Ylt T:T ^ .. Z YI - ❑ I, as owner of the property, or my.employees with wages as - - �,.,�_ ,T' � Fir p ADDRESS - - ; .. i - theirsole compensation, will do the work and the structure is � - ;� ' � Ste' .i 1 :.! ..not intended or offered for Sale (Section 7044, BusinesB and - FINAL DATE _ Professions Code.) 1 1TEE lc_ WILL THE APPLICANT OR FUTURE.BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - J OR A MIXTURE'CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR.GREATER THAN THE 1, as owner of the property, am exclusively contracting with a U. _2 2 ;Sc / AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS GUIDE? FINAL BY T- I Ni-fi -1 licensed contractors to construct the.project (Section 7044, _ _ _ _ _ VE3❑ 'NO - 'U ) 181 Business and Professions Cade:) � I_��4r-. �.�.uJ 'OCCALL UPANT JRE DED USE MI THE CONSTRUCTION THE APPLICANT OR FUTURE BUILDING 'OCCUPANT REQUIRE A MANAGEMENT FOR CONSTRUCTION DR EE PERMITTING GFROM CHECHE SOUTH . ' - ('Hkl�!. •�I{ CONSTRUCTION TENDING AGENCY GUIDE AIR QUALITY MANAGEMENT DISTRICT'SCAOMD)SEE PERMITTING CHECNUST FOR rT3- •-- LINES I hereby affirm that there is a construction lending agency for YES❑ 'NO19A the performance the work for which this permit is issued(Sec. - ATION ETHE 3097,Civ.C IH EC READ I UNDERSTANDHAZARDOMY REQUIREMENTSINFOR UNDER THE SEA COUNT PERMITTING •j111-_ ( { ,I,L OR �) ., CHECKLIST.2.CH UNDERSTAND O REQUIREMENTS UNDER THE LOS ANGELES COUNTY DOE ti TITLE REPORTED SECT10N522DN00 THROUGH FROM HE SCA RNING HAZARDOUS 3 Lender's.Name - MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. UJB i 2 AN I_' 'o Lender's Address - Q G ER OR AGENT o certify That have read this application and state'under penalty ' 9' _ of'perjury That the above information is.Correct agree to comply PC.FEE PERMIT FEE 0 with all. county ordinances and State 'avis relating to building (d Y '� GG cons 1 , and' by 1z epresentatives of this County ISSUANCE FEE t nt on t6 abo?a- ile roperty`'for inspeotlon purposes. (Q • 7-22 r� INVESTIGATION FEE TOTAL FEE / J_ ' ^ 01 roo�,.1 a Aam ova l/ " SEE REVERSE FOR EXPLANATORY LANGUAGE 76-818A.Ca#809-7.96 APPLICATION FOR BUILDING PERMIT BUILDING AND SAFETY DIVISIONBUILDING Department of County Engineer' ADDRESS County of Los Angeles LOCALITY j7 o .JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN. SUPT of BUILDING - CROSS.ST. DISTRICT N GROUP .HPE SOWER MAP FOR APPLICANT TO FILL IN J BK �/P6 O I CONST. I r (} BUILDING ] GG ADDRESS STATISTICAL CLASSIFICATION _ CLASS. NO.CILDWELL. UNITS-1 d9i LOT NO. BLOCK MAP STATE NUMBER HWY YES NO. TRACT USEZONE SPECIAL 1W' _� r) NO. OF SLOGS. CONDITIONS SIZE OF LOT �� X / ZO NOW ON LOT ' �MO USE O� W EXISTING BLDG. BUILDING EXIST. /� /' ^�s{ � / SETBACK YARD HWY STREET NAME WIDTH OWNE ��/F��j ^,�►"JOsli'� 'FRONT eC��) P. L. / yt/• / ADO RESy� // + SJ'O� !�IY SIDE TEL. P. L CITY �' NO. INSPECTION RECORD ENGIiNEERTO � - �_ / �� yN,yy�.�J�� I'// !�`a.,..n c� /I ADDRESS `='�+�E—l�•.1 /�"' ", 1L/ CONTRACTOR _ „_ _ - / TO. EL. _ 14_�iN TV/,Q r3 ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ. FT.' NO. OF NO. OF SIZE STORIEs faAMILIES USE OF STRUCTU ry /37•' APPROVALS SIGNATURE OF APPLICANT - ggDATE IN/SPPEECCTTOWS�SIGGNNATUIF ADDRESS FOUNDATION' LOCATION ORMS. M MATERIALS C. 'S , FRAME: FIRE STOPS. _ FEE BRACING. BOLTS S FURNACE: LOCATION, VALUATION OG GAS VENT. DUCTS FEE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALLCOU NT ORDINANCES AND STATE LAWS R�5/GULATING/BU�'}D CONSTRUCTION. LATH. EXT. SIGNATURE HOUSE NUMBER COR, .PERMITTEEE RECT AND POSTED n�I TDRESs I FINAL •,!/ f7 .JOHN A. LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM.PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.0. CASN PERMIT VALIDATION CK. M.O. CASH COO 5 0 7— JUL 2 2. 1 6 2.7 5 ,k EJ LACO o 55 0 E .JUL 2? 1 . 1 1 .0 0 In APPLICATION FOR BUILDING PERMIT G� COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, n or a certificate of Workers'Compensation Insurance,or a certified copy.thereof (Sec.3800, Lab.C.) CITY ZIP _ LOCALRv Policy No. Company + SIZE OF LOT NO OF BLOCS.NOW ON LOT ❑ Certified copy is hereby furnished. - �� NEAREST CROSS ST Certified copy is filed with the c unty 6yildin CpecYl$n TRACT BLOCK LOT NO. department. / USE ZONE MAP NO. Date�- <�r7 / :Applicants <. " -i �Y ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDRESS dollars coon n e less.) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY CITY 21P I certify that in the performance of the work for which this permit I s issued, P shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT, If, after making this Certificate of REOUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the WorkersCONTRACTOR TEL NO. 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. ADDRESS _ LIG.N0. P L LICENSED CONTRACTORS DECLARATION 7 - SIDE CITY LIG CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP } (commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE NO.OF STORIES No.OF FAMILIES O Professions Code,and my license is in Lull force and effect. NEW ❑ SK PG ' License Number Lc.Class 1 DESCRIPTION OF WORK ADD ❑ VALUATION U Contractor Date - ALTER $ (1 LL ❑ 1 am exempt under Sec. REPAIR ❑ $ - >- B.&P.C.for this reason DEMOL ❑ LDMA P/C x < Date: USE of EXISTING BLDG. cc URM ❑ cc Signature APPLICANT(PRINT) TEL NO LDMA Perm d '. L El 1, as owner of the property, or my employees with wages as Z W their sole compensation, will do the work and the structure is ADDRESS - „,„_ �.:, r•;F not intended or offered for sale (Section 7044. Business and FINAL OATS o Professions Code.) WILL THE APPLICANT OR FUTURE 9WI-VAIG OCCUPANT HANDLE A HAZARDOUS MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE .E [ I, as owner of the property, am exclusively contracting with ON SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATON GUIOEP FINAL BY IL}rl'l i4 1 �'Y4i licensed contractors to construct the project (Section 7044, YES El NO❑ Business and Professions Code.) '. .! ....— WILL THE INTENDED USE MI THE BUIDUNG 9V N O APPLICANT OR FROMFUTURET EBUILDINGSOUTH OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION(CTION DR MODIFICATION G CH THE SOUTH CONSTRUCTION LENDING,. AGENCY GUIDE AIR Gunury MANAGEMENT o1srRlr,T IscnoMD)SEE PERMmwc cHECIcusT FOR --YMti6'L* a-'• GUIDELINES I hereby affirm that there is a construction lending agelry"-fer YES El NI the performance of the work for which this permit is issued(Sea I HAVE READ THE HAZARDOUS MATERIALS NFORMATION GUIDE AND THE SCAGMO PERMITIiNG r _ �«; {;{ 1 $097, Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE Los ANGELES COUNTY CODE. " - TITLE 2 CHAPTER 2.20 SECTIONS 220.IB0 THROUGH 2.20.1+0 CONCERNING HAZAPDOUS r Lenders Name MATERIALS REPORTING AND FOR OSTAINNG A PERMIT FROM THE SCAOMD. o Lender's Address o avrveR an x;ervT o I certify that I have read this application and state under penalty of perjury that the above information is correct.1 agree to comply P.C.FEE PERMIT FEE A N with all county ordinances and State laws relating to building / mconstm on, and hereby tut hze•fepfe5ent83ives of this County ISSUANCE FEE i to ent;rC th9 above a lone property for inspection purposes. a ^""'�- - - r INVESTIGATION FEE TOTAL FEE Er �. r= sl9 o,.reo,�ol�-,o,Ala,a SEE REVERSE FOR EXPLANATORY LANGUAGE