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HomeMy Public PortalAbout10619 FAIRHALL ST_Building__ t 76A638A jE#803 9-68 _ - h- Gd 17- �, PPLICATION FOR BUILDING PERMIT ~` COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS Ovov BUILDING .AND SAFETY DIVISION LOCALITY JOHN A."LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT ROUP TYPE PROCESSED BY (Print or t )� �.� CONST, type only) l/%'��•1 BUILDING / STATISTICAL SSIFICATION SEWER MAP ADDRESS 1�kl 144106,1-1 L 5/• CLASS NO. DWELL.UNITS Bq- PG,_,P' LOT NO. BLOCK - USE;ONE NOP Q - TRACT - Y SPECIAL �9 NO.OF BLDGS. " CONDITIONS SIZE OF LOT 41 �C�lfG� NOW ON LOT. USE OF EXISTING BLDG. BLDG.SETBACK FROM - TEL. FRONT PROP.'LINE OF' I��y /� (STREET) OWNER a NO. d7, TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS /0(p (� HIGHWAY WIDTH FROM C.L. CITY Zerh Q(_,CG e + _ BDG.SETBACKFROM �✓�/ y/J�j ARCHITECT OFf T L..- SIDE PROP. LINE OF (STREET) ENGINEER NO, - TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. _ CONTRACTOR 62,-jQctJ it/ NOL �, ..c�L - el O' ADDRESS '/E? NO. - - _ CORNER CUTOFF YES NO ❑ C CITY CLASS SEE REVERSE SIDE FORP CIAL APPROVALS a CONSTRUCTION LENDER NAME AND BRANCH ADDRESS SQ. FT. NO. OF NO. OF NEW 0 SIZE STORIES J FAMILIES USE OF ADD `- STRUCTURE + ALTER ❑ REPAIR❑ IGNATURE OF APPLICANT DEMOL ❑ VALUATION $ /d�'� APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, j 'a� FOUNDATION: LOCATION r +� k FEE $ FEE $ / FORMS, MATERIALS ws -C�$� 'Efrr' FRAME: FIRE STOPS, } I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS /O �J �• AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE• LOCATION, _ WITH ALL ORDINANCES AND-LAWS REGULATING. BUILDING CON- STRUCTION. ON- GAS VENT, DUCTS STRUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. ' LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSAT ON INSURANCE. LATH, EXT, SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - RECT AND POSTED ADDRESS - -TcFINAL IA?- N1 JOHN F. LEWIS, PRI CIPAL STRUCTURAL ENG ER -,PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK M O CASH % ('•,1299ON Am 5 1 D 12.00 DEPARTMENT OF, COUNTY ENGMEER DIVISION OF 'BUMDING AND SAFETY -' -�- COUNTY OF LOS ANGELES t ' " NO- WILLIAM J. FOX, COUNTY ENGINEER APPLICATION' - �- j CASSATT D. GRIFFIN, SUPT OF BUILDING i FOR APPLICANT TO'FILL IN FOR OFFICE. USE_,ONLY BUILDINGfJ r DISTRICT'NO. .' PLAN CK.OR REc.No. pPERMIT NO7 1 ADDRESS V tL7 LOCALITY RECEIVED BY DATE OF APPL. D TE ISSUED NEAREST �/: ' ' Hae et-• CROSS ST BUILDING r_ OWNER .. - ADDRESS •- 110`D I �• '� I MAIL - 1� LOCALITY I I ! ADDRESS• �I� Z. ���i NEAREST: CITY `CI /^ � TO CROSS ST. �� FIRE f NO. OF GROUP "ENGINEER-- GROU " ENGIARCiNEER--OR _ NO - • ZONE . I PLANS, it I 7_- I BLDG. I --- 1 O}D tN0 ADDRESS SETBACKJLIN i-2.O 4.� `__- CONTRA O ,. ,..-,A� A TEL 4/� ! USE I 0 APPROVED f? ZONE BY DATIE ADDRESS Z7Z �Q H 4�dI �- I } HOUSE,NUMSERING LEGAL MAP NUMBER ��/`D_LNO. ASSIGNED BY-­ A DESCRIPTION I_ LOT NO. I BLOCKI CO�ECTIONS � 4 TRACT INOOOFNBLOTGS: SIZE OF LOT ®Q. NWOA/614 i USE OF NO. OF ., ... EXISTING BLDG. FAMILIea 'D ON OF WORK i :" :' - 0 NEW ALTERATION ADDITION D -I Z REPAIR , DEMOLITION I .SQ. FT. I /'1 L� (� IF ROOMS STOR V) . SIZE l/ J EXT. WALL ROOF COVERING 0-C ID I COVERING USE OF STRUCTURE, APPROVALS INSPECTOR'S SIGNATUREDATE • v ' FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I.HAVE READ THIS AP- FRAME: FIRE STOPS, ' � Cl PS ^T PLICATION AND;STATE THAT.THE INFORMATION GIVEN,IS, BRACING, BOLTS Gw . r. CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING-'CONSTRUCTION. -GAS VENT, DUCTS .•/�/ LATH, INT. SIGNATE OF - PERMITTTTE � ADDRESS- �. ��"' �• �jv�� LATH: EXT. �2• ' fl ' PLASTER, INT,. � :. �• f AUTHORIZED,A ' PLASTER, EXT. P. c. S FEE HOUSE NUMBER COR-- - RECT AND POSTED A,odwll VALUATION •• - FEE ,a FINAL 76ASS8A Des 9-9-81t' - ®: . AP_PLICATIO,N' OR"BUILDING ,PERMIT ; COUNTY•O,F.,LOS•'ANGE_LES BUILDING`•ANDSAFE'TY t FOR'APPLICANT TO FILL IN' BUILDING ADDRESS * T t WORKER'S COMPENSATION DECLARATION ' ' • • _ + i '.' ' BUI LDI G ADDRESS' I hereby affirm that I have a certificate,of consent t_o s- 'elf,lnsureQ or a;certificate of Worker`s''Compensatlon.lnsurance,or a certfied �'' t ^ l 'S - copy,thereof}(Sec-3800,Lab C)" ° -' CITY,'; :ZIP, - '•` •+ . I. \ - - LOCALITY m C 7 . Policy'NoCompany % • - 'SIZE.OF•L T NO'OF-BLDGS NOW'ON LOT ❑'Certrfied copy'Is hereby furnished•. 1NEAREST CROSS ST 17 / 'TRACT BLOCK ••'LOT NO- - 4,4 ❑ Certrfied`copy Is filed.with the county building°inspection •department- "' - - �' USE ZONE MAP NO _ - - • ..�• - ..-. 'L i-� - ��' ;ASSESSOR MAP BOOK- PAGE, - -PARCEL', Date - Applicant CI _ '` .• SPEALCONDITIONS. CERTIFICATE OF EXEMPTION FROM WORKERS 1 OWNER -' JELL/ COMPENSATION INSURANCE — R( Y I `S �4 O - WITHIN-1000 FT OF SCHOO ,r LS YES' NO (^This section need not be completed if the permit is for one hundred ADDRESS ;r`' , /���, DISTRICT,'', GROUP TYP ONST FIRE ZONE PROCESSED,BY dollars ($100)or less) TY t I certify that ii the,performance of the work for which this permit ' \,' l 6 s Issued, I shall not employ any person In any manner'sotas to t - __�_ _ -ARCHITE T OR,ENGINEERr--_ _TEL'_NO -a• -�' = '' '• - ----- --- - ------- -——r-�-;— -become=subject=to=the'Workers'Compensation`L'aws- - STATISTICAL-CLASSIFICATION 'APT -_ CONDO' - - Date _ Applicant.^ - - ADDRESS- - - - - .CLASS•N0 DWELL'UNITS - -NOTICE'TO 'APPLICANT---If, after •'makind 'this•,Certrficate''of" • v --REQUIRED P. •: TOTAL SETBACK FROM ' ]EXISExemption, you -.•should '•become' subject-to the Workers'' -CONTRACTOR - •- •TEL NO SETBACK; YARD, HWY. PROP.LINE Compensation.provisions of the Labor,Code, you,'must forthwithFRONT-comply,with such provisions or'this permd.shalJ-be deemedrevoked-, ADDRESS - LIC NO, PL: SIDE•.LICENSED CONTRACTORS DECLARATION CITY' - LIC CLASS_ PL I hereby affirm that I 'am-licensed underprovis!opS,.of Chapter 9 " SEWER MAP ? (commencing with Section 7000)of Division 3 of the Business and - SO r S E. NO OF STORIES .,NO OF FAMILIES Professions•Code,and my license'ts'm'full-force'and'effect NEW ❑ BK' PG' .r License Number LIC Class- DESCRIPTION' ORK-- _ •• - _ - ADD, •❑: VALUATION - , r •',p 0 Contractor "�" Dated ALTER (]' $ Or �e 0, V' ❑ I am,exempf under Secy 00, REPAIR :$ y ' 0 B&PC for this reason {e DEMOL ❑,: `, - U LDMA PLC a ,. W Date. USE.OF-EXISTING,BLDG - - -- •• URMCD •,❑o• `y + �' Date, . —. 1 Signature = _ 'Ai PP;ICCAANT(PRINT __ -t EL NO 'LDMA Perm.# • -• _ + - 'Z' ❑ 1, as owner-of the property, or my employees wdh''wages as 0 ACCT: I their,sole compensation, will'do,the'work and the'structure'is .ADDRESS i+] ' not intended or offered for sale (Secttom 7044,,.Business°+and •; I - 1 FINAL DATE - _- _ O �5�3 -, ,L,C.P.55 •• Professions Code) - Q. %` ffj C i WILL THE APPLICANT OR-FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ' „,/,_, /.J : M -r y'__ITEMS •- ' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE " _ ' I, as owner of the,property, am exclusively contracting, with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES _ FINAL BY T icenseq contractors to construct, the protect.(Sectio6'7044,' ; TI7TAL' Bushes'and Professions Code)- ves❑, No 0^" J(/. - - WILL THE,INTENDED USE OF THE BY THE APPLICANT-AOR FUTURE BUILDING - - CHECK- - 125s5 OCCUPANT REQUIRE A PERMIT-FOR CONSTRUCTION OR MODIFICATION'FROM THE SOUTH,': '� ....5 - CONSTRUCTION LENDING` AGENCY COAST.AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE'PERMITTING CHECKLIST FOR CHANGE,,' - GUIDELINES - *. .- CHAhIGE; 7F i t'o 00 1'hereby affirm that,there Is a constructiowlend Ing;agency for YEs❑ No❑ - 1 - a the performance Of the'work for which this permit IS Issued(SecHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTINGI; 3097, CIV ,G a )- y. _ - CHECKLIST UNDERSTAND REQUIREMENTS UNDER'THE LOS ANGELES COUNTY CODE, ,x-r - _ .VVIJO-VVQ1 TI?V,�•.� _ •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 SCAQMD EL 'Lender's Address 547 ,1'r PMad02 •-OWNER OR AGENT •• .. _ - - .. o I certify.that L have read this application and state under penalty ' _ ofperjury tIthebove information Is correct I agree to Comply PC FEEPERMIT'FEEo' with all 'conances,-and'State laws relathg to-budding<"construction, eby authorize representatives of't is'County - - ^ ISSUANCE FEEove-mentioned property for in'spectl purp 'es, -INVESTIGATION,FEE •• - -TOTAL FEE, 'L. - � Signature of pis Bent Da,e '- SEE REVERSE FOR EXPLANATORY LANGUAGE ; WWORKERS' COMPENSATION DECLARATION. affirm that I'have a certificate of•'consent.to self ' re, r a certificate of Workers; Compensation 'Insurance', . : .. 'APPLICATION F O R- B U I.L D I:NG -PERMIT- t�cer tif;e co y thereof ( c. LQab C.) ' ' COUNTY OF LOS ANGELES ;' - 'BUILDING AND SAFETY P7tomppanY rr ❑ 'Certified`copy is hereby furnished. FOR APPLICANT TO FILL IN, ADDRESS OVJI,i , Tom• '� l L �' BUILDING •Ceri,fied copy is'filed with the county building inspec- ADDRESS J ' loon department: ' CITY ~"c Y ZIP LOCALITY (�C ' Date« Applicant * OOCROSS ST U-5F BLDGS. ERTIFI ATE OF EXEMPTION FROM WORKERS" SI OF LOT NO ON LOT - NEAREST t. COMPENSATION INSURANCE, _ ASSESSOR (This section need not be completed if the'perrnit°is'for one, TRACT BLOCK' LOT NO MAP BOOK PAGE PARCEL hundred dollars,($100) or'less.) TEL. _ OWNER' ♦�/)' USE-ZONE - I certify that.in.;the'performance of the work-for whichNO MAP 'this MA CONDITIONS _7 ..permit is issued,-I`sholl not employ any person in any manner ADDRESS- Q Kms, SPECIAL ' CL so_•as"to become subject to 1he,Workers' Compensation.Laws. _ •. Q :. CITY, e. ZIP - Daie Applicant- ARCHITECT OR TEL ~' NOTICE .TO APPLICANT: If,,after m6king•this Certificate'of•' ENGINEER­- NO _ DISTRICT GROUP TYPE. = FIRE,', _ ROCESSED;BY- ' CONST `ZONE %•_• Ezemption,..you should-become 'subject to the Workers' '= •' t'- •• �j U Compensation provisions of the Labor C& joy _ ADDRESS_ - —_ <✓=i= = =- '' � == _ ' 'l =`=a with;co`mply.'with.such provisions,or.,this permit shall •be T L TATISTICAL CLASSIFICATION_, APT, CONDO...' to `deemed revoked.-.- •; CONTRACTOR O: Z LICENSED CONTRACTORS DECLARATION-- L CLASS NO DWELL. UNITS hereby affirm that I am licensed under:provisions of Chapter,9. ADDRESS-• 3 (commencing With Section 7000)of Division 3''of`the,Bbsiness LIC. SEWER MAP= and Professions Code,cind'my license is in full force and effect. CITY C �"BK PG �/ VALIDATION - SQ FT NO OF NO OF CHECK License N tuber, i. Class " SIZE STORIES FAMILIES 'ONE 6� - VALUATION Coni r eeAl DESCRIPTION OF WORK NEW ❑ �© ❑ S G - ADD' $ ► I am exempt under Sec` C-O•�Q• '• , 'ALTER .❑ c s BAP.C:,for this reason ' G`.OS~ -ems IC REPAIR ❑ s' " USE OF., N Date: EXISTING-BLDG DEMOL ❑ APPLICANT, TEL., �V Signature (PRINT), — �� NO. C FINAL Q q OWNER-BUILDER DECLARATION DATE .-'!./ I hereby affirm that I am exempt from 1he:Contractor's License :Sj�f �• •�: " Law'for the following reason (Section 7031.5;Business and ADDRESS FINAL ✓f,_^J 1 Professions Code): :. PRESENT BY. /�%�"` rr'/'"� BUILDING ACC' .' ❑ . 1, as-owner of the property, or my employees•with* ADDRESS ' wages as'their sole compensation;'will do the work and "' }307 a7 �¢ the structure is not intended or,offered for sale(Section. LOCALITY ; 7044, Business and Professions Code.) MOVING TEL: - - �" I�M ❑ I, as owner of The property,am exclusively contracting CONTRACTOR NO. - 'TOTAL with licensed'coniractors:to•.consiruct the project (Sec- ADDRESS. " �1 V IAL 87 ..��.r tion 7044,.Business,and Professions Code:) iHC41K _ N x • REQUIRED .-TOTAL SETBACK^FROM EXIST CHECK 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 foc'which.this',permit`is issued P L: (Sec. 3097, Civ., C.). SIDE. Lender's Name _ WOO-0001 , v/31 u4 . P.0 .Fee$ 'Permit Fee LDMA Ref # 5x420 1'• SAM11:i0 Lender's Address o I"certify thaf:I'Navel read this•application an'd,state that the Issuance'Fee O LDMA'P/C# ►.. " above information is correct. I agree to comply with*all County ' Invest gat on Fee;' M:?:• o ••'ordinances and State lbws �elating••to-building construction, 1 Total Fee 4. 30 LDMA Perm.•# - a and hereby-authorize representatives of this County to enter " u on the° bove-menti Cpropertyftihipect'on pure ses. " a - . 8911, E.REVERSE FOR EXPLANATORY LANGUAGE` ignature of Applicant or Agent to / �'~ - ..