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Home My Public Portal About8824 ELM AVE_Building__ 76A638A CE#803.10.56 A P P L I C A T B N FOR B U 8 L M N G P E R_.. .0 T BUILDING AND SAFETY'DIVISION Department of County Engineer A°DREss - County of Los Angeles LOCALITY' �+ JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. --� DIS TR CT N GROUP. TYPE WER 'MAP FOR APPLICANT TO FILL IN I CONST. I' BKS j PSG BUILDING /1 "�• _ l ,l: ADDRESS j STATISTICAL ASSIFICATION' - LOT NO. . 7 BLOCK CLASS. NO. XDWELL". UNITS MAP STATE YES O U y 3 ( 1 NUMBER Hwy ' ' TRACT (p USE ZONE SPECIAL. NO. OF BLDGS. .c CONDITIONS. SIZE OF LOT qq �jI NOW ON LOT USE OF (-i /�/ _ - } EXISTING BLDG. - BUILDING •.YARD HWY STREET NAME EXIST. /� /� �f SETBACK _ WIDTH ' OWNER ( IT P0Rfn• 1!�J FRONT / e'� MAIL. /' / P. L. .` ADDRESS egg /�y - SIDE TEL PL CITY /i r'• �Y Cj••/JI/3o• P. .. ._ .. . . INSPECTION RECORD ARCHITECT ORTEL. - ENGINEER NO. - b- or �. �o ip =ii✓ ADDRESS TEL. w G� /✓� �i. . •��, CONTRACTOR Py ` NO. /,L;.v iii'd c9A,4,5,t4 `_ - .y, ADDRESS V' - a DESCRIPTION OF WORK NEWDD ALTER REPAIR DEMOLISH -_ - SO. FT. NO. OF NO.OF SIZE • STORIES FAMILIES _-U-SE-OFUKE (� APPROVALS- SIGNATURE OF - - _ APPLICANT DATE 'INSPECTOR'S SIGNATURE ' �' FOUNDATION: LOCATION ADDRESS _ - .. r.•�vx -i�., .,.... FORMS. MATERIALS-- �+r�.`j •� /�/ $ X^� - P. C; $ FRAME: FIRE STOPS. - V 0 O FEE BRACING. BOLTS 9r VALUATION $ GL4 FURNACE:VE :'LOCAT S' rf FEE GAS VENT. DUCTS" 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. - - PLICATION AND STATE THAT THE ABOVE IS CORRECT AND - --_ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT.- G✓O.0 S D Ys STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF HOUSE NUMBER COR- PERM RECT AND POSTED' ADDRESS , -+' FINAL JOHN A. LAMBIE. cbUNTY ENGINEOV CLYDE N..DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CAVH PERMIT VALIDATION• ,CK: M.O.' CASH • 1 8 2, li JUL 1 6,Cl ; t APPLQCAYMM FOR., oULDNM PERS 7 �l 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, t5-" or a certificate of Workers'Compensation Insurance,or a certified copy thereof S/@pc.3800,Lab.C.) CITY / r ZIP �p l/�✓. Y Uf f�:Y'C�}� l C i b 6 Ito LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the County buildin ection TRACT BLOCK LOT NO. depart y USE ZONE MAP NO. 11 s ASSESSOR MAP BOOK PAGE PARCEL Date Applicant SPECIAL CONDITIONS -C RTIFICATE OF EXEMPTION FROM WORKERS' OWNER p T i YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred ML� s'� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CIZI `/ I certify that in the performance of the work for which this permit G"l �7 �.J —� V 3 is issued, I Shall not employ any on in an er SO 8S t0 ARCHITECT OR ENGINEE TEL.N t1 JJJ becomes b" ct t e Workers' pen�ti�p L __.7 STATISTICAL CLAS IFICATION APT CONDO Date�Z�Applicant �( AD RESS CLASS NO. DWELL UNITS NOTIC TO.APPLICANT: If, fter making.this Certificate of v" REOUIRED TOTAL SETBACK FROM EXIST CONTRACTOR TEL.NO. Exemption, you should become subject 'to the Workers' , SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of'the Labor Code, you must forthwith 3112 FRONT comply with such provisions or this permit shall be deemed revoked. ADDR SS .�I, /I LIC.NO --�f PL S �^Y/✓� 05 a D v SIDE >- LICENSED CONTRACTORS DECLARATION CITY LIC.WSS. PL - I hereby.affirm that I am licensed under provisions of Chapter 9 'g SEWER MAP $O.FT SIZE NO. STORES NO. FAMILIES (commencing with Section 7000)of Division 3 of the Business and �r/� NEW ❑ BK PG Professions Code,,a d my.license is in full force and effef7t C O�7 L�(/ �j1 DESCRIPTION OF WOR ADD VALUATI �+I License Number // Lic.Class �YJ / ,Q?p ti Contractor �E''(, Date ALTER ❑ " Z ❑ I.am exempt under Sec. REPAIR ❑ B.BP.C.for this reason DEMOL ❑ CDMA P/C# USE OF EXISTI G BLDG. Date: � URM. ❑ 1 • Signature APPLICANT(PRINT) TELg;ff .NO. LDMA Perm# [moi OLS- " z: ❑ I, as owner of the property, or my employees with wages as �� O i(T -r- their their sole compensation, will do the work-and the structure is AD RESS � / FINAL T a AC•r? not intended or offered for sale (Section 7044, Business and #V vk �6.v G 3=IFI 2 3it i Professions Code.), WILL EAPPLICANTORFUTURE BUILDING OCCUPANT HANDLE AHAZARDOUS MATERIAL (i Y! J HEMS ❑ I, as owner of theproperty, am exclusively contracting with OR A IXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN 9 r '1 ILS S Y g THEA AJ, SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL > licensed contractors to construct the project.(Section 7044, YES NO❑ b i I ISL 234 - 06 Business and Professions Code.) _ WILL HE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING t{ OCC ANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 't••. .i CONSTRUCTION LENDING AGENCY COAs AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST �E FOR G IDELINES. - -. :'`A�')NGE I If' hereby affirm that there is's construction lending agency for YES NO❑ ` the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS R S INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). PERMITi ECKLI "I UN TAND Y REQUIREMENTS UNDER THE LOS ANGELES �• ••y W. CO CO TIT HA S TIONS 2.20.100 THROUGH 2.20.140 CONCERNING (;"IE?I3 I'}_iC„Itli �r}�• ,�1''�' � Lender's Name R MA EPORTI FO ININGAPERMIT FROM THE SCAQMD. If-72 ( Ari 25.:52 Lender's Address owti 0R Err _•_ 10, 0 1 certify that I have read this application and state that the above P.C.FEE PERMIT FEE g information is correct—I agree to comply with all county 3 ordi a State law lating to building construction,and Op a. eby a orize re a ant IV s of this County to enter upon ISSUANCE FEE the abo menft'on p ert for inspection purposes �� INVESTIGATION FEE TOTAL FEE squw of M Asa" bn�e SEE REVERSE FOR EXPLANATORY LANGUAGE t� WORKERS' COMPENSATION DECLARATION M �fir insure,.orootc mtif t.-a of Wo ke s' Comipensat on Insuran eof consent tolf ora certified copy thereof (Sec. 3800, Lab.'C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No/ //9/oSi91MCompany 1 M�L'/4R 1 Q Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county buildin inspec- BUILDING' tion department. ! ADDRESS O S� U d � ( �` I Date. D Applicant i�/" CITY ) \ �'7 k/ ZIP LOCALITY t C TIFICATE OF EXEMPTION FROM'WORKERS' tJO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT ,NOW ON LOTCROSS ST. " (This section need.not be completed if the permit is for one TRACT BLOCK LOT NO. 77 ASSESSOR hundred.dollars ($100)or less.) - MAP BOOK PAGE PARCEL" TEL. -USE Z NE -` MAP certify that in the performance of the`work for which this OWNER NO. NO. permit is issued, I shall not employ any person in any manner. ADDRESS O.� El, 1 I CONDISPECIATIONS t so as to become'subject'to,the Workers'Compensation Laws'. O'; '7e CONDITIONS CITY v... -F c A ZIP V Date Applicant" o � NOTICE TO APPLICANT: If, aftef;making this Certificate of ARCHITECT OR TEL.' DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become -subject to the Workers' ENGINEER NO. �j CONST, ZONE U Compensation provisions of the Labor Code, you must,forth ADDRESS � " R ,V/ <�_l L�1- with comply withsuch provisions. or this permit shall beD-" TEL. 7/y I STATISTICAL CLASSIFICATION APT., rNDO. N deemed revoked. CONTRACTOR �6'1� _ NO. 018) Z LICENSED CONTRACTORS.DECLARATION j LIC. CLASS NO. a I DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Fj DO S O. 7 3Dl. (commencing with Section 7000).of Division 3 of the Business and LIC y� SEWER MAP Professions Code, and my license is in full force and effect. CITY 6Y'C[�.. ^� CLASS !� BK' PG. VALIDATION / t� SQ. FT. NO.OF NO.OF o CHECK License Number y7Lic.Class— SIZE STORIES FAMILIES / ONE VALUATION Contractor Al" R Date a y v DESCRIPTION OF WORK NEW Q $ [—� v� ADD 0 J I am exempt under Sec. 0 D. ALTER B.BP.C. for this reason . REPAIR $' Date: USE OF DEMOL EXISTING BLDG. Signature APPLICANT TEL. `77 FINAL OWNER-BUILDER DECLARATION PRINT ��r✓ �a-, • .5' NO. 93--7.U/ 61 DAT " I hereby affirm that I am exempt from the Contractor's License �— Law for the•#ollowing-..reason.(Section 7031.5, Business and ADDRESS c' o FINAL Professions Code): - - BY ;2,0 5 9,4 A BUILDING # o o%0 0 0 I, as owner of,the property, or my employees with_ ADDRESS wages as their sole compensation,will do the'work and-: ' LOCALITY "O ° b s 6.3 the structure is not intended or offered for sale(Section ; 7044,.Business and Professions Code). MOVING TEL. D ' _ I, as owner of the property, am exclusively contracting CONTRACTOR NO. ° 6 6..3 v ,,:with licensed contractors to construct the project (Sec- A. _tion 7044, Business and Professions Code). ADDRESS 0 9. 02, 8 8 REQUIRED TOTAL SETBACKFROM t7 CONSTRUCTION LENDING AGENCY, SET BACK YARD HWY PROP. LINE WIDTH . I hereby affirm that there is a construction lending agency for FRONT. the performance of.the work for which this permit is issued P.L. (Sec."3097, Civ. C.). SIDE' P.L. Lender's Name m LDMA Ref. # P.C. Fee$ Permit Fee. 3 Lender's Address g I certify that l have read this application and state that the Issuance Fee LDMA P/C# D above information is correct. I*agree to.comply with all County P Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # R an ereb authorize representatives of this County to enter m up th L ove-mentioned erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant on Agent ate _ WORKERS COMPENSATION DECLARATION p affirm that I have a certificate of consent to self O O O insure, or a certificate of Workers' Compensation Insurance, APPd C�L°a� (aN F0 QMD dD 1Ccs RMD I hereby or a certified•copy thereof (Sec. 3800,.Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. �s�J"/ ADDRESS, Date. jc)- ApplicarRr�/AP 0? �/2f CITY \r 4' ZIP ' ' lJ LOCALITY 'CERTIFICATE OF EXEMPTION FROM WORKERS- NO. OF-BLDGS. NEAREST COMPENSATION 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. �£(- USEANE MAP I certify that in the performance of.the work for which'this OWNER �A 'N0. - 3 Z NO. permit is issued, I shall not employ any person in any mannerSPECIALt ADDRESS' (�V112 CONDITIONS so as to become subject to the Workers'Compensation Laws. U CITY ZIP Date ApplicantARCHITECT OR TEL. NOTICE TO.APPLICANT: If, after'making this Certificate of ENGINEER NO. CONSZO / DISTRICT TYPE FIRE PROCESSED BY O T., NExemption, you should become''"subject to the Workers' `/ [GROUP -� : ./ . � V, Compensation provisions_ of the Labor Code, you must forth- ADDRESS I'-- (/U �/ Q with comply with such provisions or this -permit shall be O-° deemed revoked. _.. A r TEL. 71y STATISTICAL CLASSIFICATION APT, CO N CONTRACTOR m U-1i � NO. U LICENSED CONTRACTORS DECLARATION LIC t' CLASS NO. _-DWELL. UNITS Z' I hereby affirm that I am.licensed under provisions of Chapter 9 ADDRESS 2� �.�-��C NO.. 361�- SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect: CITY CLASS BK Ox VALIDATION +1^� SQ. FT. NO. OF NO.OF CHECK v License Number 4 /3 O4 s Z Lic.ClasSIZE STORIES FAMILIES ONE _ VALUATION DESCRIPTION OF WORK $ Contractor /�MR1.' �2Moae� 'Date -y 1 �,. NEW ❑ ADD O ❑ I am exempt under Sec. n ❑ D ALTER B.BP.C. for' this reason REPAIR $` USE OF ❑ 20323A Date: EXISTING BLDG. DEM ❑ APPLICANT ( t �+ TEL))kA O Signature - � � PRINT) C7 LSTW NO.4\ -G O� FINAL D OWNER-BUILDER DECLARATION ATE ! � , 59.2 5 I hereby affirm that lam exempt from the Contractor's License rL Law for the following_reason (Section'7031 5,."Busmess and ADDRESS ''N �kln� FINAL Professions Code):` " " PRE EN By,' • o '0.5 9. OL 5 ❑ � - BUILDING - I, as owner of the property, or my employees with ADDRESS a 0.1 8 8 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY D 7044, Business and Professions Code). 'MOVING TEL. , V ❑ I, as owner of The property, am exclusively contracting CONTRACTOR NO.- with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Profess ions.Code). REQUIRED YARD HWY TOTAL SETBACK FR CONSTRUCTION LENDING AGENCY.- SET BACK PROP. LINE WIDTH I hereby affirm that there•is a construction lending agency forOM FRONT the performance of the work for which this permit is issued P.I. (Sec: 3097, Civ. C.). SIDE e _ P.L. . Lender's Name' ' LDMA Ref. # m P.C. Fee$ Permit Fee D Lender's Address _ I certify that I have read this //''application and state that the Issuance Fee V c 5 o LDMA P/C# g aboveinformation is.correct. I agree to,comply with all County Investigation Fee a ordinances and State laws relating to building construction, N Total Fee 1,0-9, , 5 LDMA Perm. # and hereby authorize representatives of this County to enter ' �)the above-mentioned property for inspection purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date