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HomeMy Public PortalAbout10770 FAIRVIEW AVE_Building__ DEPARTMENT COUNTY ENGINEER BUILDIN%w DIVISION OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D GRIFFIN, Sup'T OF, BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO PLANCK OR REc No PERMIT NO. ADDRESS / r/ 0 1 �� LOCALITY /e7W;p/Bca ,� C/ 7R RE_CEJ ED BY DATE OF APPL �4DAT ISS ED 2 NEAREST jl/,V/ v �� �J CROSS ST. Q°1 14 v BUILDIN6 "T OWNER Q ADDRESS A->77­9 MAIL LOCALITY ADDRESS TEL NEAREST /`��z�� CITY � NO CROSS ST ARCHITECT ORTEL FIRE NO OF T��f..,� GRO.1� ENGINEER NO. ZONE PLANS I V BLDG , q ADDRESS SETBACK LINE 0 TEL USE APPROVED CONTRACTOR NO ZONE ♦ ♦ BY DATE ADDRESS / 2 d HOUSE NUMBERING LEGAL MAP NUMBER NO ASSIGNED BY DESCRIPTION LOT NO I BLOCK �. CORRECTIONS / TRACT ^ y.� O['- Comae rte 'S/,qo V! OeNO OF -•.�_., 4l G IT'i I NOW ON LOT S SIZE OF LOT USEOF I NO O EXISTING BLDG FAM 11 LIES DESCRIPTION OF WORE o — • a A NEW ALTERATION ADDITION YjP -��-0 OIirlw- REPAIR DEMOLITION H �'�` s►"� r l� SQ FT Q NO OF SIZE ROOMS ® STORIES EXT. WALL ROOF COVER NG /a e C '0 I COVERING �I C,� USE OF STRUCTURE 77 174 APPR OV LS INSPEC 'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT.REE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION, .� AND STATE LAWS REGULATING BUILDING CONSTRUCTION GAS VENT, DUCTS SIGNATURE I'E OF001, LATH, INT. PERMIT LATH EXT. ADDRESS /Q PLASTER, INT. AUTHORIZED AGT. (/ / PLASTER, EXT — $ �/ ®D�� FEE $ HOUSE NUMBER COR- ! (�/ RECT AND POSTED VALUATION $ �� FEE FINAL 76AS88A DBS H 9-52 'APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES .. BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS _ BUILDING A DRESS - 770 I hereby,affirm that 1 have a certificate of consent to self insure,` UV or a certificate of Workers' Compensation Insurance, or a certified'V` copy thereof (Pec. 3800,Lab.C.) ZIP D 3 E p LE l•r�, 64 LOCALITY _ Policy No` Compa SIZE OF L T NO�. (LDGS.NOW ON LOT G ❑ Certified copy is hereby furnished. ' (�� NEARES ROS ST. y, G ❑ Certified copy is filed with the county bu'Iding inspection TRACT BLOCK LOT NO. +� USE ZONE MAP/� - - a7 ;WW FDat ppli �.. ASSESSOR AP BOOK PAGE PARCEL ,,,///��� �� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORS' OWNER TEL NO. '` I COMPENSATION INSURANCE lNMIN►� WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundrec�,� ADDRESS 1� dollars ($100) Or less.) �V [7D A (Li �� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CIS er erry e 4• ZIP is issued, I shall not employ any person in any manner so as to ARCHITE OR ENGINES TEL No. become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO 0`I Date Applicant y ADDRESS CLASS NO. / DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of tttV��� REQUIRED TOTAL SETBACK_FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. — �� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith S Q FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LI_C.NO. p L D SIDE LICENSED CONTRACTORS DECLARATION ITYLIC. SS PL I hereby affirm that I am licensed underprovisions.of Chapter 9 •� c_ e SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES •NO.OF FAMILIES Professions Code,an �17Y ticfel(�,�e is in full force and effect. ( '. NEW 1 BK PG Poo. } License Number �• v Lic.Class DESCRIPTION OF WORK ADp 'VALUATION -• "1 0 Contractor TbQ� C_O Date 2��"� IV6 1) S ALTER ❑ o O z:•�F oC ElI am exempt under Sec. ,• D REPAIR ❑ $ ��oj 90� '•_I.i •s O1�_ BAP.C.for this reason �l pvw DEMOL ElU _ ._ __ LDMA # Date: USE OF EXISTING DG. URM ❑ P/C "`CI" •y'T•'ji! d Signature i C'M:_ Z AP�PLt AN (PRINT)' .�� 'TEL NO. 'LDMA Pe'rm# : _ ❑ I, as owner of the property, or my employees with wages ass /< Z j HL 9- 90 their sole compensation, will do the work and the structure is SO _ not intended or offered for sale (Section 7044, Business and N ( �" y(J• FINAL DATE Q `;+,€-4 [_.�,, ':'`'p,, .`i Professions Code.) O WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL : I,,� yt�,[�"�" 1, ❑ 1, as Owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE.. JQ E•I 7r�{i'•�� a�I=I AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? ^• FINAL BY licensed contractors to construct the project (Section 7044, YES 1:1 No Business and Professions Code.) ILL THE INTENDED USE OF THE BU,IDLING,BY THE APPLICANT OR FUTURE BUILDING •y'j•� CCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH IjjI,;JI FI i"'I!I_I i •i _'fi .i CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR .,GUIDELINES: s' _ �'• i� 1 .34 I hereby affirm that there is a construction lending agency for `r a'!4 y:F YES❑ NO w the performance of the work for which this permit is issued(Sec. r ', , •_^f r j :{, , , a p1 HAVE READ THE HA ARDOUS MATERIALS INF RMATION GUIDE AND THE S F/7TvYTTING �' Y F F I N 3097, CIV.C.) CHECKLIST.I UNDERSTAND REQUIR TS UNDER THE LOS AN N 'yCODE, . rT'I -� ,Wa r•w, ,�_•I TITLE 2,C .20 ONS 2. 00 THROUGH 2.20.140 C NI A DOLS - ; } �. ' r,j,..•.-i ,:.I Lender's Name MATE ORTIN D FOR NIN S OMD. ^T f•,( f o Lender's Address � �'-' ,-, d1• R AGENT CD M•I o I certify that I have read this application and state under penalty t-ry O of perjury that the above information is correct.I agree to comply P.C.FEE PERMI E w with all county ordinances and State laws relating to building D /3r o construction, and reb uthorize repreS fives of this County ISSUANCE FEE t--• ,--�. co to on t o entio p y r inspection purposes.. ��} R F fia�'C� r INVESTIGATION FEE TOTAL FEE Si a of Applir i or Agent ate `�/ ye a y s i l7• Pa••. -..•3 .TT SEE REVERSE FOR EXPLANATORY LANGUAGr.-; �`'t 1-i F„'' F•-'' C i I- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDRESS ,^ O 70 or a certificate of Workers Compensation Insurance, or a certified f-V L,-JJ &\}� copy thereof LSec 38 ab C) CITY ZIP' ��,/i'1 LOCALITY Policy No 3 Company- IT�G !G9'L/ ' SIZE OF LOT NO OF g• LLDGOS NOW ON LOT 13 Certified copy Is hereby furnished �1T V`% NEAREST CROSS ST Certified copy IS filed with the c ty Ing I pechon TRACT BLOCK LOT NO department _ USE ZONE MAP NO Date,/— ICan ASSESSOR MAP BOOK PAGE PARCE4 7-1 S D� / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WO RS' OWNER TEL NO q /� COMPENSATION INSURANCE r lASA QOM i-'�©tv WITHIN 1000 FT OF SCHOOLS YES NO (This section need not be completed if the permit is for one hundred ADDRESS _� dollars($100) or less) V U i�u Lew j1 E-i DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit 1!4T ZIP is Issued, I shall not employ any person in any manner so as to gRCHITEC OR ENGINES TEL NO become subject to the Workers Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO C�.2 DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' C NTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith W 26 _" [ FRONT comply with such provisions or this permit shall be deemed revoked ADDRESSLIC NO P L zag V- N•-;pWb ptoi h IW If 46 SIDE LICENSED CONTRACTORS DECLARATION Ll c LASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 �%« �l4• SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES Professions Code, nd p c n is in full force and�ct Z t NEW BK PG � , License Num [L ber Llc Class. DESCRIPTION OF WORK ADD ❑ VALUATION O w $ -,POO. Contracto�r���Idl�i Date � ��� r�7 ALTER ❑ B� 0 ❑ I am exempt under Sec i REPAIR ❑ $ 0 B&PC for this reason RrIORW Date i t DEMOL ❑ LDMA P/C# W Date USE OF EK,tsTl BLD- URM ❑ -^ Signature f APPLICANT�1(PRI�T1 TEL NO y� LDMA Perm# __ Z ❑ I, as owner of the property, or my employees with wages as IJ- 0� btea -TEL n• 13 ��� �` Z their sole compensation, will do the work and the structure Isn O -= not intended or offered for sale (Section 7044, Business and 1�4 AI A• n vtr• moi' - f� FINAL DATE - Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL G , rl OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with FINAL a � > �• � '"' AMOUNTS SPECIE ON THE HAZARDOUS MATERIALS INFORMATION GUIDE licensed contractors to construct the project (Section 7044, ' YES❑ N0� Business and Professions Code) __ r .7 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING � - - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _"3': CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR - GUIDELINES I hereby affirm that there is a construction lending agency forYES ❑ A N the performance of the work for which this permit is Issued(Sec T ET-I 78 rn IHAVEREADTAR S MATERIALS INFORMATION GUIDE AND S QMD PERMITTING i"lL. 14 � u 3097, CIV C) CHEC D MV R EMENTS UNDER THE ANG S COUNTY CODE N 2 C SEC I 201 7 CO ERNING HAZARDOUS S-�..t-e-! -- 3 Lender's Name REP NG AND G A PERMIT FROM H IC - IL Lender's Address _ il1 3- p OWNER OR AGENT �^ o I certify that I have read this application and state underpenalty 0 of perjury that the above Information is correct I agree t0 Comply PC FEE Sv PERMIT FEE with all county rdinances and Stat ws relating to building ' - E_-i_i ji__{_{ y _ m construction here authorize pr --t lives of this County ISSUANCE FEE / eab yfco orins ectlon�pur/pos�e�s ql p-. INVESTIGATION FEE TOTAL FEE sg� a peaem or Apem Gaye � p( SEE REVERSE FOR EXPLANATORY LANGUAGE