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HomeMy Public PortalAbout9854 ESTRELLA AVE_Building__ FORK��yy++ sr�� APPLICATION FOR BUILDING PERMIT PPL'ICANT TO FILL IN (Print Or type only) BUILDING COUNTY OF LOS ANGELES ADDREss DEPARTMENT OF COUNTY ENGINEER CITY CT zIP BUILDING AND SAFETY DIVISION - NO.OF BLDGS. BUILDING SIZE OF LOT/3 6Q NOW ON LOT ADDRESS He!- TRACT TRACT BLOCK LOT NO LOCALITY �� L EW TEL. NEAREST OWNER X (E 4 EW NO. Z CROSS ST. ASSESSOR ADDRESS ,< elr7 MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY CITY E ZIP CONSZ,�.� ZONE ARCHITECT OR TEL. - S O •�� �N�}}7 ENGINEER NO. ' . STATISTICAL C`Lf�ASSI FICA TION SEWER MAP ADDRESS ,CLASS NO.^/ DWELL.UNITS BK PG . TEL. CONTRACTOR <J ,- OK' USE ZONE MAP LN IC. > / ^ NO. © Q ADDRESS S E NO. JOONC'/ ^ SPECIAL LIC. C' CONDITIONS CITY EMF D CLASS b ROAD DEPARTMENT APPROVAL REQUIRED YES F] NO E]TRUCTION LENDER CONS NAME AND BRANCH 67"/ /P BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY HIGHWA } YARD TOTAL SETBACK FROM TYPE OF EXISTING SO. FT / NO. OF NO. OF CHECK FRONT PROP. LINE . HIGHWAY WIDTH SIZE (� STORIES / FAMILIES / ONE + — i DESCRIPTION OF WORK NEW ❑❑ C) ADD BLDG.SETBACK FROM _ LI_ 01= SIDE PROP. LINEOF (STREET) [��/ ALTER HIGHWAY } YARD c TOTAL B�CK FROM TYPE OF EXISTING U ZEk� O E G/A� SIDE PR LINE HIGHWAY WIDTX REPAIR❑ w USOFd EXIST NG,BLDG. 'eE1/1) /dGE DEMOL [:] } Z APPLICANT L TEL !� pp CORNER CUTOFF YES ❑ NO IP RINT) /�/ E .1 . (SIGNATURE)TUREI G IN OPEN SPACE YES ❑ NO ❑ LQ p IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATIONi$ I HEREBY ACKNOWLEDGE THAT I HAVE READ THISAPPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - WIT HALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STPTE DF 'CALIFORNIA IN RELATING TO WORK MEN'5 COMPENSATION INSURANCE. - SIGNATURE OF .L PERMITTEE— ADDRESS— TEL. ERMITTEE ADDRESS FIN AL �RII q �.� �,ryryJ'� - TEL. DATE 1.,—a..Asr-7 BV U/� %4if CITY NO. %IAKE CHECKS PATAHLE TO: FEE'$ FEE $ HARVEY T. BRANDT. COUNTY ENGINEER q -PLAN CHECK VALIDATION CK. M.o. CASH _ PERMIT VALIDATION cKA .,., CASH 9. 9 14 27 ' 1 U 3 525 w-' ]GAGSBA CE#SOS 5/16 APPLICATION FOR'BUILDIN P M�i ' a`-9R PPPLICANT TO FILL IN (Prnm1 O. type only) � 0 SU1LDING COUNTY OF//LOS ANGELES ADDRESS 8 4 Estrella Tem le Cit DEPARTMENT OF COUNTY ENGINEER EiTY Tem le Cit Ca, zip 91780 BUILDING AND SAFETY DIVISION _ - NO.OF SLOGS. BUILDING S12E OF LOT 1 NOW ON LOT ADDRESS ✓ TRACT 1671-2 BLOCK I LOT NO. 19 LOCALITY /4 LL �[ TL TEL NEAREST C� ` OWNER C a H a J O. 2 CROSS ST. J' L '1 ASSESSOR ADDRESS. 8 4 Estrella _ __ MAP BOOK PAGE PARCEL Temple p DISTRICT GROUP TYPE FIRE PR ESSED BY CITY Tem le Cit ZIP l UO CONST. F. I ARCHITECT OR TEL - L+ ENGINEER NO. _ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS _ �/7 / �— pp p o I� CLASS NO.^[.DWELL,UNITS L.SK PG CONTR :T OA-1 aC�nS tr. Cyi O.. No 2L� - 4 USE ZONE MAP /O� NC, CJ ADDRESS 1317 E. Las TUna`NO 1727-3Y CONo11T1ONS CITY San Gabriel Ca. LLaSs B-1- ROAD DEPARTMENT APPROVAL REQUIRED YES NO CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM - T FRONT PROP.LINED ISTREE TICO CO ADDRESS CITY T TqL SETBACK FROM TYPE A EXISTING U NO: OF 'NO. OF CHECK HIGH.WAV } YARD - HIGHWAY WIDTH SO. FT. F NT PROP, LINE C 812E I STORIES FAMILIES ONE UO } - DESCRIPTION OF WORKGon Vert NEW ❑ ADD ❑ BLDG.SETBACK FROM - breezeway to Qart of SIDEPROP.LINEOF (STREET) llZ 1. ALTER ® HIGHWAY } YARD TOTAL ETBACK FROM TYPE OF EXISTING REPAIR❑ kitchen. - - SIDE ROP. LINE HIGHWAY WIDTH ll EXUSE ISTING BLDG. Residential -.DEMO L.❑ } APPLICANT TEL - CORNER CUTOFF - .YES NO . (PH NT) NO. BY (SIGNATURE) IN OPEN SPACE - YES E) I] (� IN COASTAL ZONE YES NO ❑ , VALUATION$ CATEGORICAL EXEMPTION YES[:) NO 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION BIG, /' (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THATIN DOING THE WORK AUTHORIZED IMPACT REPORT P C 5 (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO 0 G WORNMEN's camp E NS ION INSURANCE SIGNATURE PERMITTEE ADDRESS" FINAL BY TEL. DATE CITY NO. 1{:\f:E CHF CE;S NA7"A BLL 'I O: IN EER FEE FEE 123 HARVEY T. BRANDY. COUNTY EN GJG f PLAN CHECK VALIDATION M O: "CASH PERMIT VALIDATION CK. M D. CASH S59�JAN35.25 9 76A638A CE A80312/,>2 vpwr OUNY OF LOS ELES r APPLICATION FOR , DEPARTMENTT OFC UN YGENGINEER 'BUILDING PERMIT ppBUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN ADDRESS 45 � yip BUILDING /` ,ADDRESS LOCALITY �c.�L ��/ CNEAREST CITY G./v � Z P 7 CROSS ST. 110.OF BLOCS. ASSESSO SIZE OF LOT NOW ON LOT / MAP BOOK PAGE PARCEL DISTRICT I GROUP TYPE FIRE ESSEO BY TRACT BLOCK LOT NO. �� O CONS NE k TE / (J OWNE �C, N (� (7 STATISTICAL CLASSIFICATION SEWER MAP ADDRES59 5d —S-rWEL44 CLASS NO..-2—/ D�{WELL,UNITS SK PG CITY 00i ZIP 7 U U!5, NOPOV-3 ARCHITECT R� AL NOL' CONDII TIONS ENGINEER a,,.J ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ TEL. BLDG.SETBACK FROM CONTRACTOR NO FRONT PROP.LINE OF —(STREET) LIC. ADDRESS `� NO. HIGHW Y + YARD TOTAL SETBACK FROM TYPEOF EXISTING CITY �+ LIC. FRONT PROP. LINE HIGHWAY WIDTH LASS _ CONSTRUCTION LENDER + NAME AND BRANCH 61-- G p}„ BLDG. CKFROM- ADDRESS — CITY SIDE PR LINEOF (STREET) SQ. FT NO. OF . NO. OF CHECK HIGHWAY + VARp _ LSET BACK FROM TYPE OF EXISTING 01 SIZE L STORIES — FAMILIES ONE SIDE P NE HIGHWAY WIDTH C��? DESCRIPTION OF WORK L• NEW + EO M AI OO CORNER CUTOFF. YES ❑� NO Z ALTER ❑ L REPAIRFI IN OPEN SPACE YES ❑ NO ❑ USEST NG BLDG. Ear . DEMOL IN COASTAL PERMIT ZONE VES ❑ NO ❑ APP LI CA TE \ ' (PRINT) /{�� NO BY ISIGNATUR I HEREBY KNOWLEDGE HAT 1 RAVE REA T IS APPLICATION AND STATE THAT THE ABOVE I C RECT A E TO COMPLY WITH ALL ORDINANCES AND REG TI UILDING CON- STRUCTION. I .CERTIFT T T DOI HE RK AUTHORIZED HERE BY I WILL NOT EMP Y P OLATION OF THE LABOR CODE DF THE A E F 0 IN RELATING TO ' WORKMEN'S CO OMP NS 1 IN R i SIGNATURE OF - FINAL - BY it PERKAL—= DATE ' ADDRESS Llf�'7 " . Fee$ Permit Fee ��.y,/v Issuance Fee VALUATION, Total Fee PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M.o. <A.H �• 58FwXT 1 1 D 55.50A 76AG38A CEY8U3B 12/75 v, APPUCAT0®EIn FOR BUIL�®�(�1LES LGGf�ES1� T COUNTY OF LOS AFETY WORKER'S COMPENSATION DECLARATION - DFOWAPFLICANT TO FILL Ill � a BUILDING ADDRESS �_.7- ^� BUILDING ADDRESS —_ (L[/f,��C..E:-«-� I hereby affirm that I have,a.certificate of consent to self insure, _ 4 or a certificate of Workers' Compensation Insurance,or a certified copy thereof (Sec. 3800,Lab.C,) CITY - ZIP �T II OCALITY POIiCy NO/�� Company NN SIZE OF LOT NO.OF BLOGS.NOW ON LOT G ❑ Certified copy is hereby furnished. NEAREST CROSS ST IF ❑ Certified copy is filed with the county building inspection TRACT BLOCK -LOT NO: USE ZONE MAP NO. department. - Date it y-r<Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS //� �9 CERTIFICATE OF EXEMPTION FROM WORKERS' owNE TEL No. ves `—�No D/ COMPENSATION INSURANCE Gztli WITHIN 1000 RT OF SCHOOL? , (This section Reed not be completed if the permit is for one hundred ADDRESS L Lr. Or tOISTRIGT GROUP TVP CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) - CITY �. ZIP - certifythat in the performance of the work for which this permit is issued, I Shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER TEL NO. became subject to the Workers'Compensation Laws. STATISTICAL CLAAS�SSI//FICATION APT CONDO Date - Applicant ADDRESS _- CLASS NO. dL DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate' of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the 'Workers' TEL NO. SET BACK YARD HWY PROP LINE WIDTH CONTRACTOR Compensation provisions of the Labor Code, you must-forthwith �,iil 2,C fWd_7. FRONT Comply with Such provision Or this permit shall be deemed revoked. ADDRESS- LIG N0: PIE. LICENSED CONTRACTORS DECLARATION "" �� -Ill ^J, SIDE CIT - Y LIG CLASS P L hereby affirm that I.am licensed GOderprovfsions of Chapter 9 si - T19 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and S .FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. r+ I NEW ❑ BK - PG D d License Number J!I 1'9 Le.Class �"�g DESCRIPTION OF WORK 06 Bim' ADD ❑ VALUATION O Contractor p2 �i Date ✓'!Je { _ ALTER ❑ $ - Elam exempt under Sec. (/ X REPAIR El $ 1 B&P.C.for this reasonTNG DEMOL 1:1 LDMA P/C a ACCT.Q + 0 _ Date: US of E BLDG. URM ❑' ��U c tt D- Si9nature APPLICANT(PRINT) TEL NO. LDMA Perm x ,�, u 45 Z ❑ I, as owner of the property, or my employees with wages as Z 1 ITEMS their sole compensation, will do'the work and the structure is_ ADDRESS _ Q TI�'�'Ai 1 � �� not intended or offered for sale (Section 7044, Business and FINAL DATE 11( (� { n j�C Professn's.Code.) ( WILL THE.APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ^I YA�� CHECK 17.r•CJ aS OWner Of Irle r0 erl am 2XCUSIVE COnlraClln Wlln OR A MIXTURE CONTAINING A HAZARDOUS MATER WL EQUAL TO OR GREATER THAN THE CHANGE •�� ❑ I. property,y. y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDED FINAL BY licensed Contractors to construct the project (Section 7044, YES❑ No❑ - - Nil Business and Professions Code.) WILL THE INTENDED USE THE BUIBY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY ) AIR QuquTv MANAGEMENT DISTRICT IscAQMDI SEE PERMITTING CHECKLIST FOR GUIDE ?l96 GulDeurvas 0000-0001 1/ I hereby affirm that there is a construction lending agency for YES El NO El 4030 1 AM10�40 the perfOimi Of the work for Which this permit is issued(Seo. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE ' TITLE 2,CHAPTER 2.20 SECTIONS 2,20 100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 1 o Lender's Address , 0 avueR on acerv* oI certify thathave read this application and state under penalty that - o Of perjury That the above information is correct.I agree t0 comply P.C.FEE PERMIT FEE $ with all county ordinances and State laws relating to building T m construction. and hereby authorize representatives of this County ISSUANCE FEE to enter up the above-mention propert far inspection purposes. — m /- /+/ INVESTIGATION FEE TOTAL FEE L� L SEE REVERSE FOR EXPLANATORY LANGUAGE