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HomeMy Public PortalAbout5210 ENCINITA AVE_Building__ 7BA63BA CE#809'ft-87 APPLICATION FOR BUILDINGPERMIT ' 1' W COUNTY OF LOS ANGELES " BUILDING :2 DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND, SAFETY DIVISION LOCALITY a JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASSATT D GRIFFIN,SUPT OF BUILDING CROSS ST Al - Dl_§TRJCT NcIll GROUP; TYPE SEWER MAP 0 FOR 'APPLICANT, TO FILL 7BLOCKC', _ BK 'PG Z CONST _ BUILDING STATISTICAL CLASSIFICATION - w ADDRESSCLASS NO � DWELL. UNITSLOT NO. y,l ' MAP STATE" N NUMBER HWY YES NO" D TRACT'• US&ZONE SPECIAL h + " CONDITIONS �Q� �j�' NO OF BLDGS. SIZE OF LOT k ), I NOW ON LOT !f Z USE 6F EXISTING BLDG" Ci - - BUILDING YARD HWY - STREET NAME -EXIST. e SETBACK WIDTH OWNE r• FRONT MAIL P L i • ^ C/0 - ADDRESS•7 (J i, gg SIDE - TEL 7 e� P L CITY ` NO ARCHITECT OR TEL. - INSPECTION- RECORD_- ENGINEER • NO. ADDRESS 'a - TEL. « A CONTRACTOR NO �J ADDRESS _ DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH Jv c ,� V SQ FT. r NO OFNO OF SIZE ISTORIES, FAMILIES USE OF STRUCTURE -• ' .t \ SIGNATURE OF ( —S APPROVALS APPLICANT__ DATE INS -S.SIGNAITURE ADDRESS • FOUNDATION LOCATION _ FORMS,MATERIALS •P.C. Str 24FRAME,FIRESTOPS, �J FEE �- BRACING, BOLTS F' VALUATION .2g , ¢/ S �� FURNACE LOCATION, FEE 1GAS VENT.DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- �` PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH,INT AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND TINGBUIN. NSTRyCTION. •� ' STATE- LAWS REGU ' LATH, EXT: -'SIGNATURE OF / (�� HOUSE NUMBER COR_ - PERMITTE �m Awla �P' RECT AND POSTED ADDRESS 7" FINAL CLYDE N DIRLAM, PRINCIPAL STS -URAGINEER PLAN CHECK VALIDATION M.O. CASH PERbUT VALIDATION cK. M.O. CASH Uo n 8,'-5 0— -H-P-15 2, 3 ^_9_.r 5 U; ` (_ACo5 3:'6 9`0 SEP'2;,o 1 A . 1,8.5'0 M. :[-e3 ZL>K alas APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY C_O_iTNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER � NO.OFBLDG. ORD.NO. DISTRLICT�JO. PLAN CK. NO. PERMIT NO. PLANS SETBACK LINEG •/' FIRE APPROVED ZONE BY DATE I Rl=kIVFM BY DATE OF'APPL. DATE ISSUED- use ZONE / APPROVED ZONEDATE APPLICANT FILL IN HEAVILY OUTLINED PORTION,ONlY " BUILDING KNAMB ADDRESS / ��7-i 1'✓I otJ O E _Z' Z ADDRESS LOCALITY F- t7 i NEAREST p W CITY CR088 < STATE TEL. NAMB /1�i.Obems LICENSE NO. NO. 1 Y MAIL B F NAME t ADDRESS- 0 DDRESSaO 4 J/�+� �q� / < ADDRESS „ S O CI C� t �f NO. Ir 11 Z CITY #' 1 HEREBY ACKNOWLEDGE THAT t HAVE READ THIS U p APPLICATION AND STATE THAT THE ABOVE 18 CORRECT . STATE / TEL - 4 - AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES " -LICENSE NO. ryq NO. d� F AND STATE LAWS REGULATING BUILDING CONSTRUCTION. Z L T NO. / V SIZE OF LOT �.ar9IGNATURB OF O NO. � OWNER OF SLDGS 13 4 BLOCK NOW ON LOT ® AUTHORIZED ACT. n -' " CORRECTIONS yBj TRACT USE QF,BLDGS. NOW ON LOT DESCRIPTION OFWORK, BU IL � A z0v 1001'r . I i A,N5 I "T bo jr, violation of War Production Board orders. You are cautioneEl to c ll7utt v:lull y �u: r , fjnnR_)Arc-3 nffic.D before c--ommenc- z inq the work aui:1orized in this permit. Z D r NEW TYPE GROUP NR MS.OF NO.OF ALTERATION ROFAMILIES ADDITION SIZE REPAIR STORIES ` MOVING WALL COVERING ]Y DEMOLISH ROOF COVERING s P.E s FINAL APPROVAL S �© INSPECTOR'S VALUATIOND(/ 1 r DATE NAME DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT y COUNTY OF LOS ANGELES ' L 1, WM. J. FOX, CHIEF-ENGINEER FOR APPLICANT TO FILL IN FOR.OFFICE USE ONLY y BUILDING DISTRICT NO. PLAN CK.NO. PERMIT NO. ADDRESS LOCALITY R CEIVED BY - DATE OF APPL. DATE`ISSUED .NEAREST CROSS ST. (/ /J NG OWNER t ° ADDREI3S MAIL ,/� LOCALITY , ADDRESS _ ✓rV NEAREST / TEL CROSS ST. CITY NO. eLi4FIRE NO.OF TYPE J GROUP ARCHITECT OR TEL. ZONE PLANS_ v ENGINEER - NO. y - T a - - --- - - _• BLDG: -- / I- ORD.NO L ADDRESS - SETBACKLINE3a -/ ¢ TEL. APPROVED / I - CONTRACTOR NO. BY DATE USE ,/ APPROVED ADDRESS ZONE/"// BY DATE LEGAL1 DESCRIPTION LOT NO. BLOCK CORRECTIONS i l / TRACT \` s�y �' /G/c� ��]] X NO.OF BLDGS. OAX SIZE F LOT �D I6O NOW ON LOT USE o p, Cv N G �Xy EXISTING BLDG. IQ�S� f9/'��/I7FFO O E5 I I ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O A REPAIR I MOVING DEMOLISH ///e/:"o O SQ.FT. �11� NO.OFROOMS STORIES I /9 r" Z SIZE '` /f//, /-��r9fG �a.`3C D WALLc . r COVERING ) (/�C(7 I COVERING Ce M JO I!) USE OF NEW <:int BUILDING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS OWNER LATH, INT.: AUTHORIZED AGT U a (L LATH,EXT.: DSS-3 25M SETS 4-47 $ P C $ PLASTER, INT. FEE PLASTER,EXT. VALUATION !/ FINAL- FEE ' D$PARTMENT OF BUILDING AND SAFETY APPLICATION FOR'PERMIT f. COUNTY OF LOS- ANGELES. . ' WM. J. FOX, CHIEF ENGINEERRs - - FO_R APPLICANT_ TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT :' PLAN CK.NO. PERMIT NO. ADDRESS, 1 LOCALITY /, RECEIVED BY. DATE F APP D7A E WiIB3lsu%b . ilNEAREST - - - _ - _ J CROSS BT. f" d' BUILDING- 7, sOWNER ADDR.E. _ _ 1C.: MAI'L ADDRESS `� f' - 'LOCAL'ITY' /-!�Q,�'�'�I T• y I ` rt } } CROSS 8T. TEL. ;<•_ , Y• „FIRE ' NO.O'F TYPE ORO " ARCHITECT OR - TEL. ZONE PLANS , ENo1NEce N0:7- -ORD.NO. ADDRESS SETBACIC�LJN r -- _ gyp/ TEL. APPROVED- CONTRACTOR / -NO. 'BY ' _ DATE APPROVED ADDRESS - _ ZONE BY DATE 'DESCRIPTION) -I LOT NO. -.� _I- e%ocK - D -CORRECTIONS: TRACT ANO.OF SLOGS. - SIZE OF LOT 2.'UI / NOW ON LOT _ USE OF r ��� .OF j' NO. F EXISTING BLDG. FAMILIEB ROOMS DES RIPTI OF WORK , .NEW ALTERATION ADDITION REPAIR MOVING _ DEMOLISH pSQ. FT. ND.OF' O SIZE - �L'V ROOMS ' STORIEB ( D WALL ROOF _ r ` COVERING I COVERINGUSE OF NEW -BUILDING, , \ 1 HEREBY-' ACKNOWLEDGE THAT 1- HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE'ABOVE IS CORRECT ' FOUNDATION:,LOCATION ?INSPECTOR DATE AND AGREE TO COMPLY WITH-ALL-'COUNTY ORDINANCES FORMS, MATERIALS - AND STATE LAWS REGULATING BUILDING CONSTRUCTION.` '-FRAME: FIRE STOPS, SIGNATURE OF _ v BRACING,BOLTS - OWNER LATH,INT.: ' AUTHRIZED AD OT. _ LATH,EXT.: DBS-3 zsM SETS i-ate $ P7, Y- - , PLASTER-INT. F -PLASTER,EXT. VALUATION �� FINAL.F Da•8 :i•a8 SBM SETS APPLICATION FOR PERMIT '�� 'DEPARTMENT OF BUILDING AND SAFETY1 fi COUNTY OF LOS ANGELES �� �� F ' yy WM. J. FOX, CHIEF ENGINEER } 4 NOdOF BLDG. ORD.NO. DIS O. N CK. COO PERMIT%S�; i' PLAINS SETBACK LINB d(�6 v FIRk APPROVED ZOP-i BY DATE R IV Y ATE SF APPL. /DATE ISSUED USE+ APPROVED -L�L4/ e -' ZONE BY DATE APPLICANT FILL IN HEAVILY OUTLINED �PORTION �ONLY Iq ,�! p C BUILDING 4 / -�/zG✓GL -. �C/� p NAME ADDRESS I- w tC ADDRESS I LOCALITY F t9 y NEAREST I UW CITY CROSS ST. ' Q STATE TEL. -LICENSE NO. _ NO. NAME jam!/'��6�(/�f.� -�'•y""'"�� _ _- - MAIL EO NAME Z ADDRESS a Y C TEL: Q ADDRESS - CITY / , NO. E _ Y CITY __ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS p -APPLICATION -AND STATE- THAT.THE ABOVE IS CORRECT U STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE'NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ZO LOT NO. / SIZE OF LO /�JI1 SIG_kATURE OF t IL A — NO. OF BLDGS. , AUTHORIZED AGT- BLOCK NOW ON LOT W � .J � TRACT _ -CORRECTIONS .•t +� D USE OF BLDG8. NOW ON LOT Av", DESCRIPTION OF WORKUSE OF {� �UILDNG42 / til 1 f IfAtw'a A/W ILiLM1�T` k1 / '' `V - flip�Sia ��<�(��. + ��• . I N G 1 �_ -- �f� -� ' Ll �_uvii Iiia y tM in vio au n o War Production Eo3rd orders. You cautionFd to on;ult T�rith your local Wa, �_ ilio ' o '- _ _ o;-_zcd in this nprmit D NEWr/ TYPE GROUP L, _ NO.OF NO.OP FA r >,. ALTERATION ROOMS FAMILIES � ADDITION SIZE REPAIR - STORIES MOVING WALLCOVERINN DEMOLISH ROOF COVERING $ 00 P. S a FEE FINAL APPROVAL $ e'er INSPECTOR'S VALUATION FER /D DATE I '-NAME a YellV 78AW &A CE#809.10-136 APPLICATION FOR .:P U I L®I?N G R E R IVI I T BUILDING AND SAFETY 'DIVISION BulgyDING ADDRESS. - Department of County Engineer County of Los Angeles, - _, LOCALITY JOHN A. LAMBIE'COUNTY ENGINEER NEAREST- . CASSATT D. GRIFFIN, Sup-,r OF,BUILDING CROSS ST. DISTRICT NQ_ - GROUP - TYPE SEWER,: MAP a FOR APPLICANT TO FILL' IN Irl /" - PG CONS BUILDING /� '� �j• STATISTICAL"CLASSIFICATION I y ADDRESS - r' LOT NOV -�p � _ ETS� � CLASS. NO DWELL. UNITS - �"'3 NUMAP STATE, YES MBER - HWY O j TRACT ' ' 1 US'ZONE SPECIAL' - - p NO.OF BLDGS.� �{; CONDITIONS Z SIZE OF LOT I NOW ON LOT .. USE OF - _ - _ -• - -- --- - *" _ r , EXISTING BLDG. '�/Jy�/'�•-- - -� - +1 BUILDING - _ TR - - EXIST.., - M_ SETBACK YARD,- HWY .SEETNAME _ WIDTH p. OWNER - y ­ARO - 2 MAIL - �P. L. - ' 2 ADDRESS✓ �� � ` .'SIDE _ - _ EL. 'SIDE CITY - NO = INSPECTION RECORD: -ARCHITECT OR y L, "4407 'ti' - --- ---• - - -- :_ ENGINEER / ( f^' O. '/' � Y TEL. - CONTRACTOO / NO ADDRESS DESCRIPTION,OF WORK - - NEW- ADD ALTER7 REPAIR DEMOLISH SQ. FT. `�_NO. OF NO OF SIZE i� STORIES FAMILIES ' •.,� -- ' 'USE OF STRUCTU /� •I( ., APPROVALS, S GNATU OF APPLICA T,+ .1 .. _ ATE/. INSPECT RAS SIGN URE ADDRESS /ADDRESS /d����c o �-�. }OUNDATION: LOCATION r I'\FORMS, MATERIALS i' Zv S P. C SIFRAME FIRE STOPS, �I FEE )'BRACING. BOLTS O ' _1/ VALUATION / r-URNACE.•LOCATION, t�• FEE '��'� T GAS VENT.-DUCTS '1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- N ATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECTeAND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND EXT. .e.i./ STATE LAWS REGU ING BUILDI CONSTRUCTION. SIGNATURE OF HOUSE NUMBER COR-' PERMITTEE _.,,•kECT AND POSTED !` O_ '��•i -ADDRESS ` iFINAL _ JOHN A.L'AMBIE, COUNTY ENGINEER„ w7 'CLYDE N. DIRLAM, PRINCIPAL'STRUCTURAL ENGINEER PLAN CHEC$ VALIDATION c m o CASH PERMIT VALIDATION CK. M.O. ASH - ; G 91 6 & -AUG 2 O ,• 1 12':1--�"0° ;� D85-3 ZSM SETS 111-4 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT . COUNTY OF LOS ANGELES WM. J, FOX, CHIEF ENGINEER ® ' C FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY " 0 C� ,1 DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING ADDRESS ��t�A J • EIVG, I���'� II ,J LOCALITY TE pp�l'Y pp��!. RECEIVED BY DA E OF APPL. ` DATE ISSUED NEAREST ` �/� j } �; �, off,,,, �•y, i -�'� CROSS ST.4`'iJCl% ��� -?��• 'Y 1'-,:.1..`�t: i�-% !-�Vh �'?fYV/�'1 MZ1 BUIL4DINO / OWNER ,' I �, �S � ADDRESST/�iN/G� �V/�� MAIL ADDRESS ' J Y Y„-iC\�C.d�;1��J�S �,��/;,,_ 1 LOCALITY / (, i p/��� /� NEAREST D / CITY �'S ! NO� 7`1/\ 6 I �.+� ( CROSS ST. dF FIRENO.OF TYPE GROUPF ARCHITECT OR TEL. ZONE �- PLANS ENGINEER NO. BLDG. `' ORD.NO. ` - ADDRESS- - _ ` '1 SETBACK LINE /V C�'LKG����Y JI(�INO.C/t4ISI APPROVED - - - CONTRACTOR BY DATE USE PROVED ADDRESS 1, WS160 V • ZONE �"I / BY 1�. DATE LEGAL aa / CORRECTIONS DESCRIPTION LOT NO. J BLOCK ��ll/ TRACT Z :2 / - xx NO.OF SLOGS. /n ` SIZE OF LOT Y /7' NOW ON LOTUSEOF •�G ' EX ST NG BLDG�S / 0 A0� I NO.OF 4-I NO.OF Z-- FAMILIES ROOMS DESCRIPTION OF WORK NEW ` ALTERATION ADDITION - REPAIR MOVING DEMOLISH A G1 SQ.FT. NO. OF Z SIZE ROOMS STORIES D WALL ROOF _ r COVERING L.COVERING USE OFNEW �� BUILDING l 7 i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS 'APPLICATION AND STATE THAT THE ABOVE IS CORRECTFOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. •FRAME: FIRE STOPS, SIGNATURE OF / BRACING,BOLTS OWNER I t LATH,INT.: AUTHORIZED AGT. LATH,EXT.: P,C. 'PLASTER. INT. /n FEE PLASTER, EXT. VALUATION �✓ O $ / FEE oo^� FINAL . "4WORKERS' COMPENSATION'DECLARATION eby aPntm that_I, have rk certificate of consent to self -CATION FOR U PERM-I T insure,'�or a`.'cerhficdte'of Workers' Compensation Ins`urance, s or'a certified copy lT ereof'(Sec13800, Labs ,L,, . COUNTY OF LOS ANGELES BUILDING.AND SAFETY Policy,No Company a :Certified copy.,-is hereby fu�ni'sked, a'j.'}p°• v FOR APPLICANT TO FILL IN, BUILDING ADDRESS , �;r;'Cerhfieif'copy i's ftl'aj lith the county'buildingLirispec- BUILDING - tion deparfinenT'+' t. ADDRESS 1 .-L Rate. YL t_,�`4.1L '+'APPltcanT -Ml CITY i T ZIP-` LOCALITY / CERTIFICATE OF EXEMPTION FROM WORKERS' : ,'' NO OF BLDGS r,, i r NEAREST.: •, SIZE OF LOT NOW ON LOT CROSS ST • "� 1`- '';COMPENSATION'INSURANCE°�• � _ _ _.. __ ASSESSOR. (THis section need not beicompleted rf the permit%is for-on' ---�;^ - I + TRACT BLOCK LOT NO MAP`BOOK 5} "' PAGE PARCEL hundred dollars ($100)or.less ) y_ TEL $Y13' '" " t• "y :` t ,r. :, }q - OWNER USE ZONE MAP I certify That in the performance,of jlie work fo which*this { L Gt7.- GG rvi 1ix!�. NO P1Or,•- permit.is,issued, I sFiall n'ot employ any person in'any manner _- _ SPECIAL- - - so ds To b come sublect to the'Workers Compensation aws ADDRESS- pd - ' �'� � J- Y �,1 CONDITIONS a _ b". V ,,� -zip. B - I e T - ..rs'{r<' - r. - ' _ _ _�. - _�_ ._ • -__- �- t .__ _ NOTICE°TO APPL'ICANT"jlf,afte? making T is Certificate of__ ARCHITECT OR -TEL i -DISTRICT GROUP;- TYPE '.FIRE �. PR ESSED;BY_, F ENGINEER �� ._ -,NO CONST . 1 ZONE U Exemption,?you' should become`sublect',to'�the,%Workers' } tLU Compensation pro5isions•of the Labor:Code,-you must forth- ADDRESS - ,V 0 • with•comply`with such provisions.crithis permit shall°,be -•- --- --•- -- -- - �7EL_ :=i: STATISTICAL CLASSIFICATION r.. APT CON deemed revoked,,, it;a, q .• f ` ., CONTRACTOR �Q yy,�.,' ' u No _ f _'. +_• . S' :__ : „_ -' LICENSED CONTRACTORS DECLARATION y - - - c- )) -LIC c2c� CLASS NO DWELL UNITS I hereby affirm that I am licensed under,pro isions`of Chapter 9 ADDRESS -0 - ~.70 �eYe :` NO r3/"J'irf` �- SEWER MAP r "tom r (commencing with-Section 7000)of Division 3 of the Business and - _ -LIC r'= . _ ""'I' ,". ' ,,,_ , r n 'CITY w �'a.�� CLASS f Professions'Code, and my license,is in full force and effect �� R �' T" VALIDATION , . t.t�.;} , .. BK PG SQ FT's NO OF NO_OF,- CHECK =r-•'r F%- r i ILP, \A•.4$•- p SIZE STORIES FAMILIES ��e,M ONE - License Number. Class' c .:,_ .a: _ 4 s 5 VALUATION - t,:, -r' DESCRIPTION OF WORK C - -- NEW tO TUG r - i ontractor Dae a ADDi�r I arri exempt under Sec ❑ 4' .,:t ,r -r ALTER f B 8P C for this reason REPAIRMa _s ` # a o�.o•o USE OF a , EXISTING BLDG - DEMOL; itJ o-o 9675 Signature APPLICANT, TEL 9 G 7,5= " .'..,:• - _� _ FINAL , o c o Y Y OWNER-BUILDER DECLARATION - PRINT h vµ N�- _ 1 DATE - �• - I hereby affirm that I a n exempt from.the,Contractor's LicenserEt �,;: ,, 5 ,Law for the following)reason i(Section 7031 5, Business and - ADDRESS FINA 0 9-8 `Professi6hs Code)' - 1 -' PRESENT -� BUILDING -1,`as owner of The property, or my employees with ADDRESS / f n+, wages as their sole compensation,will do the work and' the structure is not intended or offered for sale(Section LOCALITY r , 7044, Business and Professions Code) --' 'MOVING"' `"" "'TEL' ' �� •. ' CONTRACTOR ' NO' y❑ 1, as owner of the'property,-am exclusively contracting^ eCON _ with licensed contractcrs`to"construct the prolect-(Sec- - •tion 7044, Business and Professions Code) ADDRESS -CONSTRUCTION LENDING AGENCY - " REQUIRED .TOTAL SETBACK F _ s _ nQ _ SET BACK YARD" -HWY PROP%LINE WIDTH `"" 1 ,I here b affirm that there is a construction lendin 'a enc for Y' 9 9 Y FRONT ` -•the performance of;the work-for-which this permit•is-issued - PL- (Sec L r (Sec 3097, Civ G p 5 SIDE` _ �' m ~Lender's~Name P L _:{_ �i LDMA-Ref # --b'• P C'Fee ' ? ` Permit Fee' -r,_ Lender's'Addiess '. w •», .,ti - • is - < _ _ .� .. _ .!J-certify that_I:have read this application and state that_the - �- - w... _. _ _ Issuance Fee_ LDMA-P/C q - - a .above information is correct I agree to comply,with all County Investigation Fee C $ , ordinances and State laws relating,to building construction, _ _ _�_•_� _� _ ,_,• S, Fee- t; and hereby authorize representatives of this County to enter' ,r.a Total Fee LDMA Perm' #:."�=;, a upon the above-mentioned property fpr inspection rposes e7 _ SEE REVERSE FOR EXPLANATORY LANGUAGE \`-- Situ�re�f licant'orAgent•- - - '-Date "- '• - �....•_. ..._-__ „_ . -- -- •- __ _--._ ._ _ _ _; ?i _ _ _ .___.,__-- '©i ,dr : APPLICATION.-FOR BCU_ ILD,I,NG':PERMIT . ° .• COUNTY OF L'OS'ANGELES ',4 ,j' Y•-' '. w -BUILDING'AND`SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILLL'E)ING ApDRESS, ;I hereby affirm that I have a certificate`of consent to self Insure, ' �< n �. or a certlficate'of Workers' Compensation'Insurance,'or'a certified" �Y v C.- /✓ �, '' + I: copy thereof(Sec'3800,Lab C 1'., ` C �� /{ �l ZIP �/��� I - Policy No' Company' J^ / LOCALITY f ,� SIZE OF LOT N O eGS NOW ON LOT .z ❑'certlfled copy Is'hereby furnished � d NEAREST CROSS ST ❑ CeRl6ed copyrls filed with the county budding inspect on• TRACT BLOCK LOT NO' - ` department _ _ USE ZONE MAP'NO • 1''_' ASSESSOR MAP BOOK PAGE PARCEL ,," ' "� �.yt-•. ,-r .Date ' Applicant SPECIAL CONDITIONS : t ' CERTIFICATE OF EXEMPTION FROM WORKERS' ^ 4 - f' COMPENSATION INSURANCE OWNER.` 4a• �! �` �,; /•x�Z7/ WITHIN 1000 FT OF SCHOOLS YES NO 1 (This section need not be completed rf the permit•is'for one hundred ADDREsjj f4^ Dr / fa o `/ �`I a dollars($100)For•less) r r J 2 O' �� q,e, IJV C. DISTRICT GROUP TYPE CONST:FIRE ZONE PROCESSED BY, _ ., -- CITY- I`certify,that`i6"the'perfoiman6e'of the work for whoh.this permit Is Issued, ]-shall not'employ any per any-manner so as to _ become subject to the Workers'Compensation Laws ARCHITECT OR-ENGINEER ` TEL NO{/ ' _ _ -©SUO/�n,Q �`CLj e�LS e�2/1�-,/�7_ STATISTICAL CLASSIFICATION _ ,� APT CONDO Date ' Applicant ADDRESS r "" CLASS NO DWELL UNITS - NOTICE, TQ,APPLICANT If; after making this Certificate of �"" • �� �3�GE� (�'IC�dG�t e / REQUIRED TOTAL.SET84CK FROM EXIST; Exemption,"you should become' subject -'to the Workers; - CONTRACTOR_/";- ,' - -TE�L"•NOO_ SETBACK _ YARD+ .HWY PROP LINE ;,. WIDTH Compensation^provisions of`the=Labor Code;'you must forthwith FRONT comply'wlth such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L LICENSED CONTRACTORS-DECP LARATION I CITY ,� y LIC CLASS _ PL IDE 0 I hereby affirm that I am licensed underprovision"s,of,Chapter 9 /Tr P��' C� v ,(COmmenCing'wlth Section 7000)OftDIVISron 3 Of•the Business and SO FT SIZE .NO OF STORIES -NO OF,FAMILIES-- SEWER MAP Professions Code,-and my license Is h full force and effect• � NEW. C3BK PG -O License Number Lic,C18SS• DESCRIPTION OF WORK ADD ❑ VALUATIO , U Contractor Date /h O G�G /'O O.y $ BL2�• �'� »0.s' , 2350,50 W ALTER ❑ 1 am exempt under-Sec L2 fI Cha'*W-CAP REPAIR' ❑ 'ER z B&PC for this reason /ZG IJI�ipq j DEMOL El $ J0J, ? Qe5l�' LDMA,P/C 0 Date USE OF EXISTING BLDG' URM ❑ A , A/•r 1L Signature APPLICANT/(PRINT) ? TEL NO y. LDMA Perm•Y _ �� T e 8 ❑ I, as owner,of the,property;orrny'employees with wages as Z 3303 "50.50 their sole compensation,.wdl,do the.work and thestructure i9 ADDRESS. - O _ •riot intended'or offered for sale'"(Section 7044,.Business`and L- FINAL DATE' Q ] .Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ANT.4r ❑ I; as owner.of the property; am eXCIUSIV21 ^ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE y; y contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q FINAL BY �• c licensed contractors to construct the project (Section 7044, . `3'k37�d e .i Business and Professions'Code) ' YES C3Ao C1 • WILL THE INTENDED USE,OF THE BU106NG BY-THE APPLICANT.OR FUTURE BUILDING ITEMS _ _ _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION,FROM THE SOUTH - CONSTRUCTION LENDING AGENCY - COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR : ",'`' �`9y� -@ 5 GUIDELINES•- , T ITA . 'm`.,7_ .8 t hereby affiFm that'there-is a,construction lending agency for YES❑ 'No❑ LI r 7 the performanceCHECK,of the work for-which this permit is-issued(Sec K L r 9_IF, IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THESCAQMDPERMITTNG - ,- 3097,CIV C ' '•- „ CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, i- TITLE 2,CHAPTER'2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING'HAZARDOUS '�•'' CHANGE - �JO m, Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD i Lender's'Address , - - , t> »` 7 Er - OWNER OR AGENT - \�. - c - , , 000070001,-, 1 3 1 certify that I have read this application and state under penalty 0000_0001, i/?�/ni h 0- - -PC FEE PERMIT FEE - .5529 of perjury that the'above information Is.correct I agree-to'comply' SO eC� `7q7�, Cn with all county ordinances and S6te_,Iaws relating-to budding- J d �`T`�: k���1 M construction, and hereb honze representahves of this County ISSUANCE FEE ? o, toe , pon the above- tuned property for mspectloggqnpurposes o� •,�� •� , �' 3" INVESTIGATION FEE TOTAL'FEE /,,(y N qulwe of n,w Agent - D.. `1: J Vf,4 (O f `• • SEE REVERSE-FOR EXPLANATORY LANGUAGE