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Home My Public Portal About9032 EMPEROR AVE_Building__ ' TEMPLE Cvli�l �^ r 7SA630A CE4E03 1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES App ElsN DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUPT OF BUILDING CROSS ST / DISTRICT NO GROUP TYPE t P SSED BY FOR APPLICANTJTO FILL IN } CONsr BUILDING STATISTICAL CLASS (CATION SE R MAP ADDRESS ✓J B 9Q� CLASS NO --7DWELL UNITS C _ LOT NO /7V WATER NOT REQUIRED - RECEIVED „r CERTIFICATE TRACT �{ �y MAP HIGHWAY STATE MAJOR SECOND OCAL SIZE OF LOT � �(/ 10 I NOW ON LOTS / US'E ZONE SPECIALLE) USE OF , CONDITIONS EXISTING BLDG Res /r7 ' TEL OWNER 3 NO UILDI G EXIST yyA� SETBACK YARD HWY STREEJNAME WIDTH ADDRESS C/' FRONT ARCHITECT OR TEL P L � ENGINEER 44 NO SIDE P L ADDRESS TEL INSPECTION RECORD CL CONTRACTOR444 NO 8 ADDRESS O DESCRIPTION OF WORK G W O_ NEW ADD ALTER REPAIR DEMOLISH N SQ FT Y NO OF NO OF ? IZE STORIES FAMILIES USE OF 1 STRUCTURE L f SIGNATURE OF f' f APPLICANT J°r VALUATION$ ' q APPROVALS DATE 1 PECTOR S SIGNATURE _ PMT FOUNDATION LOCATION FEE $ FEE FORMS MATERIALS FRAME FIRE STOPS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND 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 I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH,INT TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ING TO WORKM N S PENSATION INSAE I LATH EXT SIGNATURE O HOUSE NUMBER COR- PERMITTEERECT AND POSTED 'ADDRESS FINAL l' CLYDE N DIRLAM, PRINCIPAL STRUCTURAL IN R PLAN CHECK VALIDATION CK M O CASH PERM VALIDATION CK M CASH LACo,2 8 6 8 "ALIS 13 1 0 4.0 0- IQ APPLICATION FOR BUILDING PERMIT FOR'APPLICANT TO'FILL IN (Print or type only") BUILDING �p 3oZE�� COUNTY, OF'LOS ANGELES ' ADDRESS DEPARTMENT OF COUNTY ENGINEER � �j! JL/ C y7y— ZIP �� 7 BUILDING AND SAFETY DIVISION NO OS UILDING SIZE OF LOT I �n �b NOW ON LOTADDRESS 3� �r TRA�� BLOCK LOT NO LOCALITY ' TEL NEAREST OWNE S NO CROSS ST ASSESSOR ADDRESSQ� Q ,-1& MAP BOOK PAGE PARCEL MPL45- C/SNL ZIP DISTRICT GROUP TYPE - FIRE ESSED BY ` s QCONST „ ZONE ARCHITECT OR ' TEL ENGINEER ��E � NO STATISTICAL CLASSIFICATION _ ��77�� SEWE MAP ADDRESS CLASS NOS/'DWELL UNITS BK PG, TEL - MAP CONTRACTOR NO US ZONE LIC � NO d ADDRESS A A NO SPECIAL - - LIC CONDI TIONS ` CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH /VlbNE BLDG ETBACK FROM FRON PROP LINEOF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE,OF EXISTING HIGHWA } YARD SO FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH SIZE Q STORIES FAMILIES ONE DESCRIPTION OF WORK //V NEW ❑ O- ` U �J ADD BLDG SETBACK FAtItA, SIDE PROP'LINE OF (STREET) O LTER _ T TA SE AtK TYPE XISTING I- r HIGHWAY } YARD HIGHWAY WIDTH W L/ REPAIR SIDE PROP LINE USE OF + = a� EXISTING BLDG H-0 EMOL ❑ Z APPLICA�N l/ _ TEL CORNER,CUTOFF YES ❑ NO C](PRINT) /26f /I go/ BY (SIGNA TUR IN OPEN SPACE YES-❑ NO ❑ p IN COASTAL PERMIT ZONE YES ❑ NO ❑ ' VALUATION; I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION /7 ANDSTATES ALLE THAT THE ORDINANCES BOVE AND LAWS IS CO R RECT AND REGULATING REE TO BUILDING CONCOMPLY - STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED 'HEREBY I WILL' NOT'EMPLOY ANY PERSON IN VIOLATION OF THE' LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE - SIGNATURE O 1 - PERMITTEE ADDRESS r FINAL BY ' CITY NO / DATE 7-72 PC I ' MAKE CHECKS PAYABLE 70 FEE $ FEE HARVEY T BRANDY, COUNTY ENGINEER C>71/, 7 PLAN CHECK VALIDATION CK M O CASH _ RMIT VALIDATION CK M 0 CASH 76AS38A CE*803 5/74 8 5L 2 1.7 5 ®yo x 1 WdRKERS'COMPENSATION DECLARATION v r t •r � c3ffirm that I 'have a certificate of consent,to self Ithereby insure, or a cgrtificote of Workers' Compensation Insurance, 4 N APPLICATION FOR BUILDING PERMIT or a certified'copy thereof (Sec 3800, Lab'C ) COUNTY OF LOS ANGELES BUILDING.AND SAFETY Policy No Company-4-Certified copy is hereby furnishedBUILDING 91 FOR APPLICANT TO FILL IN ADDRESS Certified 'copy is filed with the`county buildirig mspec- - BUILDING ` `'tion department t ADDRESS Date Applicant CITY ZIP � LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' " -" " - - - -NO OF BLDGS -- -]CROSS NEAREST COMPENSATION INSURANCESIZE OF LOT NOW ON LOT 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 ` r ^ OWNE - TEL US ONE MAP I cert that in the performance of the work for which' this _ C 'NO +� NO l j t0 ' permit is issued, I shall'not employ"a'ny persori in any-manner n -I SPECIAL- - -- d ADDRESS / r� �Q CONDITIONS i - so as to become sublect`to the Workers'Compensation Laws - �� f CI is i- U Date` Applic t CITQA--/;'2_AZIP, , / �i` ARCHITECT OR TEL DISTRICT_t GROUP TYPE FIRE ES ED BY O Joe NOTICE/Tb PLICANT If,'after makin this Certificate of - + i g t ENGINEER NO CONST ZONE ' Exemption, you should become subject to the' Workers' - _ 0 Compensation provisions of the Labor Code,•you must forth- ADDRESS LJt '� ]� W with ,comply>with such provisions on.this, permit shall be - ---- - - --- - -- - - - - N deemed revoked ' I , r TEL STATISTICAL CLASSIFI ATION APT CONDO Z CONTRACTOR NO LICENSED CONTRACTORS DECLARATION i - - - --- - -.- - -LIG - ' -CLASS NO 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 is in full force and effect CITY CLASS -' BK VALIDATION _ SQ FT NO OF _ NO OF _ / _ _ CHECK License, w Lic Class t ` - SIZE PG ��O ,�STORIES — FAMILIES / ONE ! r }, r I VALUATION Contractor pate DESCRIPTI WORK' - - NEW— ❑ r $ / . Q am , I exempt under Sec y 3L�o ADD P - t y ALTER ❑ B &P C for this reason REPAIR _❑ S "' - - -Date -- USE OF DEMOL EXISTING BLDG ❑ Signature - r� - APPLICANT TEL FINA OWNER-BUILDER DECLARATION l PRINTNO DAT ` I hereby affirm that I am exempt from the,Contractor's Licenser Low for the-following reason,(Section 7031 5, Business and' ADDRESS t FIN Professions Code) PRESENT - - -- -.. . -- - 13 BUILDIN or my employees with G I, as owner of the property, - ADDRESS wages as their sole compensation,wrkill do the woand 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 J NO with licensed contractors^to construct the project (Sec- ^' �` \ 5 2 9,2 A tion 7044, Business and Professions Code)• ADDRESS ` n ,,` \'V ,ti' ��Y`t` �` CONSTRUCTION LENDING AGENCY' REQUIRED ' 'YARD -HWY'--`--TOTAL SETBACK _ _ S- ��. .�- y �t��.� ` "# 0,0 o 0-0 1 - SET BACK PROP LINE WIDTH \ hereby affirm that there is a construction lending agency for FRONT \• \ + the performance of the-work for which this permit is•issued - P L- - �- - - - �' - - - ) e'o 49.88-,--- (Sec 9.8 8;--i (Sec 3097, Civ C ) SIDE _ - P L 4.9. 8 8 Lender's Name ~ �/ LDMA Ref # p ti'L.� P C Fee$ - - - Permit Fee-' - ^3 O^ - ^-- - -- 0 O,2 8, .- - Lender's Address certify that I have read this applicatwn_dnd state that the _ Issuance Fee d '�• - LDMA P/C above information is correct I agree to comply with all County Investigation Fee , ordinances and State laws relating-to building_construction, ` U and hereby authorize representatives of this County to enter - --_ - - --- Total Fee--- - - Z ` LDMA`Perm'' �` '- upon the above-mentioned property for inspection purposes " SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent -- ^- Date- I - _