The URL can be used to link to this page

Home My Public Portal About4515 FIESTA AVE_Building__ -* APPLICATION FOR COUNTY OF LOS ANGELES , DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS �Ii✓.e. BUILDING t! F ADDRESS yg�S / !ES v�+ LOCALITY i 7 NEAREST CITY Q LC ZIP / ,0 CROSS ST NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARC � DISTRICT IGROUPITYPE FIREOC ED BY TRACT BLOCK LOT NO O 7 CONST s Z OWNER :5,2A404fFi NOL�� 7 STATISTICAL CLASSIFICATION .26 J SEWE$y,M ADDRESS S ,� q �� CLASS NO �/ DWELL UNITS BK• PG USE CITY �� / ZIP /� ZONE NAOP au f c ARCHITECT R TEL ` ` PECIAL •7 ENGINEER NO �� ONDITIONS ADDRESS /� ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO CONTRACTOR G NOL BLDG SETBACK FROM FRONT PROP LINE OF (STREET) L'C ADDRESS S/ rIC51,1NO 1 `��/ HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING 1 • LIC �j FRONT PROP LINE HIGHWAY WIDTH CITY C �E CLASS 40- CONSTRUCTI N LENDER + NAME AND BRANCH a BLDG SETBACK FROM ADDRESS CITY SIDEPROP LINEOF (STREET) SO FT NO OF NO OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING / Ir SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH Y� DESCRIPTION OF WORKl! / NEW ❑ + ADD ❑ CORNER CUTOFF YES ❑ NO Z l o W A LTER /h EPAIR❑ IN OPEN SPACE YES El1:1NO SE OF I IN COASTAL PERMIT ZONE YES ❑ NOL❑ EXISTING BLDG DwC F z 1 EMOL ❑ fy APPLICANT //.� _ TEL 1 �L// Ito rr- �,N (PRINT) �� `�"' ' NO 41)3-775 LR GNATURE) EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL ORDINANCES AND LAWS REGULATING BUILDING CON TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED Y I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE CODE OF THE STATE OF CALIFORNIA IN RELATING TO EN S COMPENSATION INSURANCE TURE OF r /&tfFINAL `�� BY S1n� ITTEE DATE Z �2 SS / � fCNOLPC Fee$ Permlt FeeQIssuance Fee ATION$ -�— Total Fee PLAN CHECK VALIDATION CK MO CASH _ PERMIT VALIDATION CK, M o CASH I A 76A638A CE#803B 12/75 T F WORKERS COMPENSATION DECLARATION hereby affirm that I have a certificate of consent self APPLICATION FOR BUILDING PERMIT insure or a certificate of Workers Compensation Insurance ' or a certified copy thereof (Sec 3800 Lab C ) Policy No Company COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING e Certified copy is hereby furnished FOR APPLICANT TO FILL IN - ADDRESS �E E ElCertified copy is filed with the county building inspec I BUILDING tion department xv ° ADDRESS �� f:-16t4—&r. LOCALITY R y ' NEAREST 1y� Date Applicant x�- CITY � E ZIP V CROSS ST �aOw�� u Rd. CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDG� ASSE SIZE OF LOT NOW ON LOT MAP BOOK O oZ PAGE Od.� PARCEL 4:93LCOMPENSATION INSURANCE (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less ) TRACT BLOCK LNO OT NO e TELQ t. �,, / SPECIAL -579 � I certify that in the performance of the work for which this OWNER NO 79_ �6 CONDITIONS _ c� y� 6", DISTRICT GROUP TYPE FIRE PROCESSED BY O permit is issued I shall not employ any person+n any manner ADDRESS J / (f�= CONST ZONE so as to become sub�jlect to the Work rs Compensation Laws T 4 Date �_ �� nAppliconir CITY C �G \ ZIP �" " STATISTICAL SSIFfiCATION - a APT CONDO } NOTICE TO APPLICANT If after making this Certificate of ARCHITECT OR TEL t R LU Exemption you should become subject to the Workers ENGINEER NO CLASS NO DWELL UNITS d Compensation provisions of the Labor Code you must forth ADDRESS a SEWER MAP with comply with such provisions or this permit shall be deemed revoked r{ CONTRACTOR NO TEL r BK PG VALIDATION LICENSED CONTRACTORS DECLARATION . Ir LIC 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS - ' NO ALUATION (commencing with Section 7000)of Division 3 of the Business'and LIC I Avi05 ; Professions Code and my license is in full force and effect CITY CLASS 4 r SQ FT JJSS7NO OF NO OF CHECK O e License Number x 4 Lic Class SIZE STORIES FAMILIES ? + ONE f P-6 Contractor Date DESCRIPTION OF WORK rm o e NEW /\ ❑ a ' ADD I am exempt under Sec 4a 9 Wiq 0 a ❑ ' �A ALTER FINAL r // DATE B&P C for this reason f / LJ _ REPAIR ❑ USE OF Date EXISTING BLDG e E DEMOL ❑ B,"AL Signature APPLICANT TEL OWNER BUILDER DECLARATION PRINT NOS I hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and ADDRESS 0` Professions Code) PR EN BUILDING I as owner of the property or my employees with ° ADDRESS 1 wages as their sole compensation will d' the work and ` t the structure is not intended or offered for sale(Section LOCALITY Q'Ej 5 bt� 7044 Business and Professions Code) 1 r' MOVING TEL *�0 I as owner of the property am exclusively contracting C NTRACTOR NO # o�o e o G'J with licensed contractors to construct the'project (Sec ADDRESS 4 tion 7044 Business and Professions Code) 4 0 5 Q REQUIRED TOTAL SETBACK FROM EXIST t CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN WIDTH o c o0 o1U 1 hereby affirm that there is a construction lending agency for FRONT - - n ,the performance of the work for which this permit is issued P L A. 2 Q_8 (Sec 3097 Civ C ) SIDE 4 y FD r PL a Lender s Name ` s h i� b P C Fee$ T r' Permit Fee Lender s Address & I certify that I have read this application and state that the Issuance Fee w T s above information is correct I agree to comply with all County Investigation Fee _ c ' ordinances and State laws relating to building construction Total Fee d and hereby authorize representatives of this County to enter yp he above mentil1{J�//fL�/.,ed pr pert r inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®_ x � f 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 or a certificate of Workers' Compensation Insurance,or a certifiedO_� copy thereof(Sec.3800,Lab. C.) CITY ZIP �^^r IF� �h �i t'e Q',+� �i�4s9^n) SIZE file—m-'11 n It 10" F'A`Q Ov LOCALITY A , _ Company OF LOT Policy NO. NO.OF BLDGS.`NOW ON LOT { ' TO Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. depar,t¢m�ent..^ Date department. � ��+ Applicant �� .�1ff?`kS�t� ASSESSOR MAP BOOK PAGE PAJCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE 1 inalp 70 WITHIN 1000 FT OF SCHOOL? YES. NO (This section need not be completed if the permit is for one hundred ADDRESS dollars ($100)or less.) DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY ' 1�R �z FP �$ �✓'t � ;a CITY ZIP 1',' ,7 ,f° •"". ..�,.,.. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toF Sl I •"�� become Subject t0 the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEC NO. + STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS f NOTICE TO APPLICANT.' If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith A ri Q � FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC. O. P L LICENSED CONTRACTORS DECLARATION ' SIDE CL CITY - LIOCLAS P L O 1 hereby affirm that I am licensed underprovisions of Chapter 9 0tIn SEWER MAP 0 (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.O, STORIES` _ NO.OF FAMILIES— Professions Code,andmy license is in full force and weffffect. -1 I I NEW ❑ BK PG , W License Number -465rl3 Lic.Class 04.E✓ DES RIPTION OF WORK /ADD ❑ VALUATION -� Contractor Al Pnr.".l Date r,�°!♦r.�i� .. r�"`,s v it,79 t.,v rrM n,?q 'tf� or,=9 � ALTER ❑ $ LL El am exempt under Sec. REPAIR :RIB V >_ __, BAP.C.for this reason1�2 syr �3t� q DEMOL ElLDMAP/C# Date: USE OF-EXISTING BLDG. URM El Signature APPLICANT(PRINT) TEL NO. LDMA Perm# r�. ID_ f ❑'I, as owner of the property, or my employees with wages as I!` Z IA LLJ their sole compensation, will do the work and the structure is ADDRESS "" O 'u�`: not intended or offered for sale (Section 7044, Business and �Cr. rt,1p.0^ pm t1A, FINAL DATE Q PfOfeSS10nS Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THANITHE ❑ I, as owner of .the property; am exclusively contracting with Q Y'1;)tY�,hp ny, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?. FINAL BY � -�i�O$7l� licensed contractors to construct the project (Section 7044; YES❑ No O Business and Professions Code.) K WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR `l'9 ' rtV GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO Mr N the performance of the work for which this permit is issued(Sec. " 01 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, �tkl"t�.A�'{i.r' - '�+ ,•-% •' 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. C) Lender's Address 0 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 P.C.FEE PERMIT FEE _with all county ordinances and State laws relating to building I` 211 co construction, and hereby authorize representatives of this County ISSUANCE FEE M to enter upon the above-mentioned property for inspection purposes. s ; f ,,% m INVESTIGATION FEE TOTAL FEE ^ c��m,a of Aow��am o.A9em Wte .. 1.} - SEE REVERSE FOR EXPLANATORY LANGUAGE