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HomeMy Public PortalAbout5021 FIESTA AVE_Building__ 011 , LDING PERMIT BUILDING 1 -� FOR APPLICANT TO FILL IN " ADDRESS ADIDRESS 6��LDING I/ LOCALITY NEAREST �*�� p� CITY `_/' ZIP ` p CROSS ST. 1. �J�� NO.OF BLDGS. ASSESSOR SIZE OF LO ';�J�J NOW ON LOT I MAP BOOK PAGE PARCEL :5 DISTRICT GROUP TYPE FIRE P OCESSED BY �� TRACT 1 BLOCK LOT NO � J � � CONSTm •—/- � -s OWNER(;`((5, F' �� NO STATISTICAL CLASSIFICATION SEWER MAP 1 ADDRESS �.� CLASS NO. DWELL.UNITS BKJ r >G CITY ZIP USE ZONE I MAP ARCHITECT OR. = TEL. r f ENGINEER NO. SPECIAL CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO-E:] TEL. CONTRACTOR NO. BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS NO. HIGHWAY + . YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER + - } a NAME.AND BRANCH O BLDG.SETBACK FROM V ADDRESS CITY SIDE PROP.LINE OF (STREET) � SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING U SIZE STORIES FAMILIES, ONE SIDE PROP.LINE HIGHWAY WIDTH d N ❑ + Z DESCRIPTION OF WORK NEW ADD CORNER CUTOFF YES '❑ NO ❑ �p ALTER IN OPEN SPACE YES El NO ElUSE OF { /�y�� REPAIR ❑ IN COASTAL PERMIT ZONE. YES El NO ❑ EXISTING BLDG. �1 \JT�` DEMOL ❑ APPLICANT yy TEL / l n IPRINTI .G:f P NO. ,g' � A1,97 BY(SIGNATURE( A " D� ;✓ "{� r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE O FINAL C, /TJ o BY C, PERMITTEE' DATE ADDRESS TEL. P.C. Fee$ Permit Fee 7L a CITY NO, Issuance Fee �7 VALUATION$el Total Fee ,"PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT-VALIDATION, cK.' M.O. CASH' 5..5 rMY 26 1 D 7 '.v+ .mow ©$ 76A638B CE N803B 8/77 WORKERS' COMPENSATION DECLARATION _ insure, or a certificate of Workers' Compensation Insurance, A P P L I CATP N FOR BUILDING P I hereby affirm that I have a certificate of consent to self - certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING El �Q Certified copy is hereby furnished. . FOR APPLICANT TO FILL IN ADDRESS �/ -.7/. ❑ Certified copy is filed with the county building inspec- BUN SS �'L�TC� ✓ tion department. f CITY saho 61 ZIP F17eo LOCALITY r Date Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK Q PAGE PARCEL 01/ hundred dollars ($100) or less.) JEL. p OWNER .E 1 /NO. ` 8 O USE ZONE MAP I certify that in the performance of the work for which this SPE r SPECIAL d permit is issued, I shall not employ.any person,in any manner ADDRESS /[/ G Av P /�-I CONDITIONS so as to become subject to the Workers' Compensation Laws. / /� OU. CIN e' /(, C t zip 917 Lo Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. �D CONST. ZONE 1-- Exemption, you should become subject to. the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS N with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. �J LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.�DWELL. UNI7S I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of The Business �,j LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK /_ PG / VALIDATION SQ. FT. / NO. OF NO. OF CHECK •;7 License Number Lic. Class SIZE 3a IG' STORIES FAMILIES ONE VALUATION --• - p f -vi +: DESCRIPTION OF WOR NEW NEW ❑ ; O• �! Contractor Date ADD ® ►. ;, ,.,,.:•- - ❑I am exempt under Sec. ` LTER ❑ B.&P.C. for this reason ®�p����I _ - G'"_-�.-�IL�GK/ � REPAIR ❑ $ Date: USE .� /-/✓�/J�/O/ EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL _ " OWNER-BUILDER DECLARATION (PRINT). NO. , DATE —C/J I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL ( o Professions Code): PRESENT BY T BUILDING r r ){ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure isnot intended or offered for sale(Section LOCALITY TCT 7044, Business and Professions Code.) MOVING TEL. r y ;_ IFHL 7 - CONTRACTOR NO. ❑ I, as owner of the property, am exclusively contracting with licensed cADDRESS contractors to construct the project (Sec- tion 7044, Business and Professions Code.) ' _(•��,,,�` or�5j REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET.BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L• r,- (Sec. 3097, Civ. C.). SIDE. P. L. , _ _ Lender's Name, i�� Hk1 V LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee `l a 7 0 1 certify that I have read this application and state that the Issuance Fee d� / LDMA P/C# '8 above information is correct. I agree to comply with all County Investigation Fee Q � �jJ . R ordinances and State laws relating to building construction, Total Fee Q -T LDMA Perm. # < and hereby authorize representatives of this County to enter up�fn the ov -men n o t for inspection purposes. d^ SEE REVERSE FOR EXPLANATORY LANGUAGE �F Signature of Applicant or Agent Date APPLICATION FOR BUIL.DI G � FOR APPLICANT TO FILL.IN (PrintPE or type only) : E1 RMIy ` BUILDING COUNTY" OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING ,. ,� t SIZE OF LOT NOW ON LOT - ADDRESS �" t�`:. �- --) TRACT BLOCK LOT NO LOCALITY TEL. NEAREST / ZZ! u ' OWNER NO.' CROSS ST. .�?... f� ASSESSOR ADDRESS - - MAP BOOK PAGE PARCEL DISTRICT GROUP ITYPE I FIRE PROCESSED BY CITY ZIP .' CONST ZON ARCHITECT OR ` TEL, " ENGINEER - NO. .. STATISTICAL /�tCLASSIFICATION SEWER MAP ADDRESS CLASS NO�• • DWELL•UNITS BK PG CONTRACTOR NOL' USE ZONE MAP LIC. NO. m ADDRESS NO. SPECIAL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO CONSTRUCTION L DER NAME AND BRANCH BLDG,SETBACKPROM FRONT PROP.LINE OF (STREET) ADDRESS CITY HIGHWAY } YYARD = NOTAL SETBACK FROM TYPE OF EXISTING SQ, FT. NO. OF NO. OF - + CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE - STORIES -FAMILIES •ONE } — _ U DESCRIPTION OF WORK NEW W BLDG.SETBACK FROM J ADD SIDE PROP,LINE OF (STREET) W_ ALTER M4 mom HIGHWAY } YARD❑ — TOTALS CK FROM TYPE OF EXISTING ❑ REPAIR SIDE PRO . LINE HIGHWAY WIDTH USE OF } _ CD EXISTING BLDG. DEMOL ❑ APPLICANT. ,TEL CORNER CUTOFF YES ❑ O ❑ IW- (PRINT) •J A A 7' {"'%.. NO. - �k IN OPEN SPACE YES ❑ NO H S A BY ( IGTURFE I t QQ'�l .7 -.";,rte: IN COASTAL PERMIT ZONE YES ❑ NO ❑ - VALUATION,P ` IH EREBY.ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND•AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REQULATING BUILDING CON- STRUCTION,� I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I .WILL NOT EMPLOY ANY PERSON IN V-IOLATION OF THE LABOR CODE OF :THE STATE OF 'CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF -T- "';. • PERMITTEE ADDRESS TEL.,,- - FINAL IBY 'y! CITY N O. .-` � DATE ,,...+` ♦. t� MAKE CHECKS PAYABLE TO: F E'� FEE PMT.,$ HARVEY T. BRANDT, COUNTY ENGINEER PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 76A63BA CE#803 5/74 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY ZIP ,' BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING hh SIZE OF LOT NOW ON LOT ADDRESS TRACT ',.` % / BLOCK LOT NO_'­ r' LOCALITY ,,�•- ,�_`.: .. e ,r `'; �.•^ TEL. NEAREST OWNER'• ' NO.,.� ; t'� CROSS ST. ASSESSOR ADDRESS f j--s MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY _ CITY Zip CONST.�. ZONE ARCHITECT OR TEL r ,r. ENGINEER .` '."ry NO. - STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO.'�_OWELL,UNITS BK PG TEL. CONTRACTOR NO USE ZONE MAP ADDRESS LIC. 0 NO. !° SPECIAL CITY LIC. f.!='f CONDITIONS CONSTRUCTION LENDER CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES NO � NAME AND BRANCH. BLDG.SETBACK FROM O FRONT PROP.LINE OF (STREET) U ADDRESS CITY HIGHWAY\, } YARD TOTAL SETBACK FROM TYPE OF EXISTING J SO. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH ti SIZE , STORIES I FAMILIES 1 ONE DESCRIPTION OF WORK NEW ❑'+. + „„ -•.- ADD ❑ BLDG.SETBACK OM C) SIDE PROP. (STREET) ALTER ❑ HIGHWAY } YARD TOTAL SETBACK FROMI TYPE OF 1EXISTING REPAIR❑ 1— PROP. LINE I HIGHWAYI WIDTH USE OF } _ + EXISTING BLDG, DEMOL ❑ APPLICANT J TEL p,. CORNER CUTOFF ES El NO (PRINT) i� A I,7) F NO '`'� f `r IN OPEN SPACE YES NO � BY (SIGNATURE) IN COASTAL ZONE YES NO ❑ VALUATION$ CATEGORICAL EXEMPTION Y NO ❑ , I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. '.SIGNATURE''OF y,,. .. x :PERMITTEE �' _ "".. '� ADDRESS TEL. FINAL B Y // )gyp _CITY N O. DATE .a"i"J' f L° ' PMT.It C 11,iKE CHECKS PAYABLE '10FEE FEE �: P.C. $ f FEE -v HARVEY T. BRANDT, COUNTY ENGINEER L +: PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.. M.O. CASH ry rt� y 76A638A CE*803 12/72 APPLICATION FOR BUILDING PERMIT p Ij FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS . ' DEPARTMENT OF COUNTY ENGINEER CITY ZIP '. '✓` BUILDING AND SAFETY DIVISION .r NO.OF BLOGS. BUILDING SIZE OF LOT ` : �' ;,d. NOW ON LOT ` ADDRESS J, C: rim TRACT/,.-rwp" BLOCK I LOT NO.;.:} .-`a LOCALITY:._ ,. ...TEL , r r NEAREST OWNER 'r'"";:, fe..P.t,- !, NO �.: }. r" ; CROSS ST. ,,,.,... ✓. �. ASSESSOR ADDRESS �„',.ft MAP BOOK PAGE PARCEL .a.. .� [DISTRICT GROUP TYPE T. FIRE "P'R'OCESSED BY CITY a ZIP ,� ,.' •',LL:° CONS ,.. ZONE .r .. .u,: .^ ARCHITECT OR '+.- TEL s e'v.:a a �, ENGINEER NO ,,;!"w.,jr STATISTICAL CLASSIFICATION SEWER MAP ADDRESS } '�,. CLASS NO_ __DWELL,UNITS BKA« Pw CONTRACTOR NQL' US ZONE MAP '^ LIC. NOr: . ,. - a ADDRESS NO, .�",:�.J SPECIAL CITY • LIC. CONDITIONS CLASS- ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCT[Of,4 LENDER (a a NAME AND BRANCH V(" a v= BLDG.SETBACK FROM O FRONT PROP.LINE OF (STREET) U ADDRESS CITY . LiJ HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING J SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH u" SIZE STORIES FAMILIES ONE y a DESCRIPTION OF WORK NEW ❑ "$ �`€ O ADD ;� BLDG.SETBACK FROM t (STREET) a SIDE PROP. LINE OF ALTER ❑ -0TAL '� BA FROM TYPE OF EXISTING HIGHWAY + YARD 'f= SIDE PROP. LI HIGHWAY WIDTH - REPAIR❑ USE DEMOL ❑ + EXISTING BLDG, - APPLICANT - TEL CORNER CUTOFF YES ❑ N (PRI ❑ NT) - NO. ..m. IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE) Q t IN COASTAL ZONE YES ❑ NO ❑ - VALUATION ^P " `- CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S CO MPENSATION1,„INSURANCE. ' SIGNATURE OF PERMITTEE ADDRESS TFINA TE B CITY - NO. DATE Q HAKE (;HEC;tiS P:�YAB1,E TO: FEE � FEE I HARVEY T. BRANDT, COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH 7 6 A 6 3 8 A CE#803 12/72