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HomeMy Public PortalAbout9144 EMPEROR AVE_Building__ -e- 76A63BA CE#6032-63 APPLICATION FOR BUILDINGPERMIT . COUNTY OF LOS ANGELES BuILDING . DEPARTMENT OF COUNTY ENGINEER ADDREss 911LIJ kwo,ror BUILDING AND SAFETY DIVISION LOCALITY San ('r i p.l JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT of BUILDINGCROSS ST. DIST ICT NO. GROUP TYPE - P_ ESSED BY FOR APPLICANT TO FILL IN jy: coNsr: t BUILDING STATISTICALCLASSIFICATION SE ER MAP. ADDRESS 1��, Ti1TJ2T'OT' CLASS. NO. Qlb DWELL. UNITS K I/ __�j LOT NO. BLOCK WATER �JI CERTIFICATE: NOT REQUIRED I.YiI RECEIVED TRACT i- - • MAP ,,,r•r© •� HIGHWAY ST�LATJJE MAJOR SECOND, OC L NO.OF BLDGS. NO.- "(CIRCLE) SIZE OF LOT NOW ON LOT UlONE SPECIAL USE OF CONDITIONS EXISTING BLDG. pgir�p rin TEL. OWNER Tlq T, A NoAi _ BUi ING YARD HWY REET NAME EXIST. ' SETBACK +STWIDTH ADDRESS Same FRONT - ARCHITECT OR TEL. P. L.. ENGINEER NO. - SIDE /w P. L. ADDRESS - - a TEL. O CONTRACTOF�a(' f C IY1. .A� NO. 112-1 734- U -ADDRESS 10920'F (Trp ii d - .. 0 O DESCRIPTION OF WORK uJa NEW ADDE� " REPAIR DEMOLISH N . I Z SQ. FT. NO. OF NO. OF ' SIZE STORIES FAMILIES USE OF STRUCTURE nstall r c 014 tIlpa - SIGNATURE OF APPLICANT - - VALUATION $ 250,00, - APPROVALS DAT_iE\ INSPECTORS SIGNATURE _ FOUNDATION: TION EE $ / ,f••, FEE $ F 600 FORMS. MATERIALS ` FRAME: FIRE STOPS, I HEREBY•ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS / J 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 T WILL NOT EMPLOY ANY PERSON IN.VIOLA- LATH; INT. J TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. / ING TO WORKMEN'S C MP NSATION INSU RANC ] LATH.EXT. SIGNATURE OF L/V72 - HOUSE NUMBER COR- l� \ PERMITTEE RECT AND POSTED �/_ ADDRESS FINAL /I 1_42 JOHN F. LEWIS. PRINCIPALS RAL ENGINEER" PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cK. M.O. CASH s 9: WORKERS`COMPERISA�h;ON DECLARATfON I hereby affirm Thar I have a,cer ca'te,af cbnsent.to self - insure, or a certificate of Workers' C mpens?tion Insurance, APPLICATION FOR BUILDING PERMIT I of a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY *Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 1 / Q� Ave ❑ Certified copy is filed with the county building inspec- BUILDING'' ',t3! /:" `, tion department. ADDRESS / 7"/ CITY ZIP LOCALITY C U 1 Date Applicant fNO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT / I NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK � 4�-� PAGED/ PARCEL OCkd9 hundred dollars ($100) or less.) // TEL. OWNER L.(D(f J 4 NO. elo USE NE . O. 1 certify that in the performance of the work for which this -2 .7--Z/2/ ECIAL a permit is issued, I shall not employ any person in any manner ADDRESS 6s a.�0 �� (/ CONDITIONS O so as to become subject to the Workers'Compensation Laws. U CITY �i7'1 C i rY zip / 7 dalb Date Applicant ARCHITECT OR TEL. / DISTRICT G OUP TYPE FIRE ROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER / V/7- NO. 7' f1®4 DI n(/ CONST ZONE Exemption, you should become subject to the. Workers' �1,�/ U��f( U Compensation provisions of the Labor.Code, you must forth- ADDRESS �iEC_L�7' with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR v e2 G. NO. — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm thot.l am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY 1.7C1,4 CLASS BK PG /1� VALIDATION SQ. FT NO. OF. NO. OF CHECK 7 License Number Lic. Class SIZE4-3 I STORIES / FAMILIES ONE VALUATION DESCRIPTION OF WORKCj( NEW ❑ Contractor Date ❑ $ / / Y , El am exempt under Sec. �/ ADI_ ❑ ALTER B.&P.C. for this reason S REPAIR ❑ $ Date: USE OF DEMOL EXISTING BLDG. Signature APP(RIANT) NO.NT TEL. FINAL OWNER-BUILDER DECLARATION DATE - Z Z 'i U I hereby affirm that I am exempt from the Contractor's License 1 Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY fiCCT.a ❑ I, as owner of the property, or my employees with BUILDING ADDRESS 1�� il0.5II wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section. LOCALITY polo 1 TTE{'1 7044, Business and Professions Code.) MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. TOTAL 60 -50 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and.Professions Code.) CHECK 60.50 REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CHANGE .00 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. -lf Qi 121..'7r1: 8_r- Lender's Name. Ley /� LDMA Ref. # pi 1 AM10:1112 P.C. Fee$ Permit Fee �✓ Lender's Address 0 pol- 1 certify that I have read this application and state that the Issuance Fee LDMA PiC# 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, Total Fee .� LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 3 WQRKEQS'f OMPENSATip!iDECLA RfiTI;UN _s^ ` I hereby affirm that t have a tertif cafe ofconsent to self ' irlsur:,;!or,a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or d certified copy thereof (Sec. 3800,,Lab_C.)_"- COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING9144 J� AVc PY' Y ADDRESS C ❑ , Certified copy is filed with the county building inspec- BUILDING r- �a tion department. ADDRESS H G / 0 . CITYl� �i�/f'I C r ZIP !J' �� LOCALITY G Date Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT •p / NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCE D ASSESSOBOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO.- ®Q MAP OK � PAGE [/�J PARCEL met hundred dollars ($100) or less.) ' TEL' p y USE ZONE MAP OWNER OU/ /VTi'Q NO NO.. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS a �, �C.O/V V j/� Q� CONDITIONS VECIAL >_ so as to become subject to the Workers'Compensation Laws. �7 O CITY . /y� C� ZIP Date Applicant ARCHITECT OR / TEL DISTRICT OU TYPE FIRE ROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of E fiR LlA/I NO. �7G�Op Compensation o Exemption,sa you should become subject to the Workers- /�-- r/ /�-``�(/ 1-3 CONST. 3E p/ 0- Com ensation provisions of The Labor Code, you must forth- ADDRESS � dl �?' � � ��- r✓1 Ub �� !/-V,((�1, with comply with such provisions or this permit shall be TEL. /,/7 STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR LJ J'O Z NO. 4T 7:�-e Z LICENSED CONTRACTORS DECLARATIONLIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS L �tl �- NO. (commencing with Section 7000)of Division 3 of the Business n LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY /y, CLASS BK PG • VALIDATION SQ. FT NO. OF NO. OF CHECK License Number Lic. Class SIZE .3 3 '7 STORIES FAMILIES ONE ContractorDate DESCRIPTION OF WORK NEW ADD (^t ❑ , " I am exempt under Sec. ALTER LJB.&P.C. for.this reason df� REPAIR El $ /(J'�► ®� Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION . (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License DATE 'Djt'y7 755.45 ADDRESS �I ,JiJ 1 Law for the following reason (Section 7031.5, Business and FINAL "' Professions Code): PRESENT By { 1❑ I, as QOwner of the property, or my employees with BUILDING ITEMS ADDRESS wages as their sole compensation,will do the work and OTAL 755. 45 the structure is not intended or offered for sale(Section LOCALITY ��•r 7r� 7044, Business and Professions Code.) MOVING TEL. Poo ( CHECK NECK 55 "c a -' I, as owner of the property, Y g CONTRACTOR NO. HA 'Iti4 p p y,'am ezclusivel contracting t t with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) > REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I3OCL-03001 9/14/89 1 hereby affirm that there is a struction lending agency for FRONT the performance of the wor {o which th' m s issu P.L. C /�M i ar P Q. �-+ l pr?{ k4 � a C.1 �y FJ _t714 1 A 1 i l a � (Sec. 3097, Civ. C.). ,O O s fr� C"? SIDE a i t ^.1 --t Lender's NameAsa - O` � •• �e•��•C� C� +• m 1P1 4W G.��J .J LDMA fW. #. l.J ►-'� P.C. Fee$ • Permit Fee Lender's Address 6P Y a I certify that I have read thistappl~cation and stat,athp the Issuancd ire / BcJ LDMA P/C# , 8 above information is correct. I agree to comply withW ounty I-nvestigationi Fee R ordinances and State laws reltin o building cotQructIon, Total Fe.- • al LDMA Perm. # W and hereby authorize.represe. ti of this CQynty to enteO upon the abov -mentioned_pr�c ape e,n,pyposejJ�43 III Im - I ry,1 •p9 r r. O f_t l._ SEE REVERSE FOR EXPLANATO ,L GUAG( _ p,�1 ,°n gnature of Applicant or A•ffdrt• '~ Bae fi'� •••rJ t:J �--' tiad tJ