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HomeMy Public PortalAbout5030 FIESTA AVE_Building__ A ROAD DEPT. PERNUT IS REQ UIREIJ FOR ANY MATERIAL STORAGE CR WORK /per DONE IN THE .ROAD RIGHT OF "WAY A . 78Aa eA "E, 8098-89 APPLICATION FOR BUILDING -PERMIT - •COUNTY OF LOS ANGELESBUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESSO BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. - z - DISTRICT NO GROUP TYPE PRb, Y FOR APPLICANT TO FILL IN. CONST. [EXISTING LDING STATISTICAL CLASSIFICATION ( S WER MAP RESS ,SUS O - BK CLASS.NO. O DWELL.UNITS `y. NO. / LOCK/ NUMAP MBER STATE YES All), ,o r CT / USE ZONE SPECIAL - 74NO.OF BLDGS. ` } CONDITION OF LOT •� X Z NOWON LOT /1—IOF �J BLDG. ^ BUILDINGEXIST. SETBACK YARD � STREET-NAME WIDTH LNEW'�, �l/V FRONTMAIL P. L. ' 640 / C• `-Z /=/�//�,�/��/7-y 6�(�/� SIDE TEL. P.L. /�P<.r C- t-A-1 NO.14 -7-VS INSPECTION 'RECORD q T OR TEL. NO. / x• TEL.. /C//ih�G 1N O /'X� Glvlay/,oAi a., •��/ n1�1\ OR NO. 7(r 0t t 7 6 CA i 7 ` /� DESCRIPTION OF W RK ` t?_ ADD ALTER REPAIR DEMOLISH - SQ. FT. NO. OF NO. OF •� SIZE ///f Cr STORIES FAMILIES fi •� ���s, // �7 �y���� . USE OF STRUCTURE -- SIGNATURE OF APPLICANT -�• APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS Ct�'Z /Fj%%�,� 1 j. Q FOUNDATION: LOCATION FORMS,MATERIALS ��'//�/ ��{,.,L•f./.�,.:•F fi� VALUATION - � FRAME:FIRE STOPS. Of BRACING;BOLTS O FURNACE: LOCA FEE TION, P.C. $ ) �^ GCTS n d,/ ,1.�-PMT. AS VENT,DU FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- n i LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND / �a O ,✓r�• �„ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT. //� ��w STATE LAWS REGULATIN BUILDING CONSTRUCTION. �a SIGNATURE OF HOUSE NUMBER COR- ✓ PERMITTEF C(� RECT AND POSTED ADDRESS �U2— FINAL �� C!l / - � CLYDE N. DIRLAM, PRINCIPAL STP RAL ENGINEER PLAN CHECK VALIDATION CK: MCO. CASH PERMIT VALIDATION CK. M.°' CASH . r �r,,ro8.9o4 rPR 72 3 A 25.5 �l . �^ ®. 4. r + WORKERS' COMPENSATION DECLARATION � hereby affirm thatf kspsconsent e• insure, or acertifcate have certificate menaurance, APPLICATION F O W B U I L D I N G PERMIT or a certified copy thereof (Sec. 3800, Lab. C.), COUNTY OF LOS ANGELES BUILDING AND SAFETY \ Policy No. ` Company BUILDING FA vI ❑ 0340Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �3t Ls Yj► Certified copy is filed with the county building inspec- gDDRESS t7 �/��T CL LcM L Cl T ING tion department. 7- _ �j CITY* && C 1 / ZIP l / d LOCALITY ' L Date Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 7Z b NOW ON LOT CROSS b S ST. LA 14q COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK d��d PAGE OOH PARCEL hundred dollars ($100) or less.) 0 �) , _ NO O USE ZONE MAP OWNER ��TUA/C�i- NO: �y I certify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS / �� CONDITIONS so as to become subject to the Workers' Compensation Laws. OU CITY ZIP Date Applicant ARCHITECT OR TEL. DISTRICT �RfOUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making.this Certificate of ENGINEER NO. CONST. ZINE U Exemption, you should become subject to the Workers' f�ffw Compensation provisions of the Labor Code, you must forth- ADDRESS . ' � with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION. APT. CONDO. Z deemed revoked. CONTRACTOR AZZAI_p� NO. — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that['am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE. STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ �O ' 10ADD ► ❑I am exempt under Sec. ALTER ElB.&P.C. for this reason REPAIR f Date: USE OF EXISTING BLDG. DEMOL ❑ APPLICANT TEL. Signature (PRINT) NO. FINAL �7 OWNER-BUILDER DECLARATION DATE Z /� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Pro essions Code):. PRESENT By property, Y P Y ADDRESS 3 r� 7 I, as owner of theor m employees ees with �� `/ – wages as their sole compensation,will do the work and .T,, the structure is not intended or offered for sale(Section LOCALITY - 7044, Business and Professions Code.) MOVING V, TEL. ?' "v ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the,project (Sec- ADDRESS "` Fx c �� tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM JW'XID"TTH CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE 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. (Sec. 3097, Civ. C.). SIDE. P.L. . Lender's Name. ,"s'`1 = a=i'i w irt3j`i±'t__ is x Ref. # - P.C. Fee$ PermitFeeMLender's Address – -I certify that I have read this application and•state that the Issuance Fee a� P/C# above information is correct:I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee Perm. # < and hereby authorize representatives of this County to enter upon tVe above-ml do ed grope r,inspection purposes. _ _��. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatul of AW scant r Agent Date ' WORKERS' COMPENSATION DECLARATION ' } insure, or° a certif catte of Workers' Comtpensat ionve a certificae of sInsurance` APPLICATION -1`0 4, -BUILDING PERMIT or as certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company F-1Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- [AUD'D ING r�si �v tion department. ESS A�Q to Date Applicant ��i7 L C T ZIP �0 LOCALITY _ NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM.WORKERS' F LOT NOW ON LOT l CROSS ST. COMPENSATION INSURANCEASSESSORL�(This section need not be completed if the permit is for one 13 32BLOCK LOT NO. MAP BOO 7Z dPAGE PARCEL hundred dollars ($100) or less:) TUSE ZONE MAPR /V L )&v ,a7 NOI certify that in the performance of The work for which this permit is issued, I shall not employ any person in any manner ESS ^- �� /96 SPECIAL �,..•..•:., } CONDITIONSr1<_•t•s o r O so as to become subject to the Workers' Compensation laws. _ CITY ZIP : Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE =PROEESSED BY -NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE A i "-' 0 Exemption, you should become, subject to the Workers' p / i U Compensation provisions of the Labor Code, you must forth- ADDRESS 7� t i zw a , i with comply with such provisions or this permit shall be _ TEL. STATISTICAL CLASSIFICATION rAPT: CONDO. N deemed revoked. CONTRACTOR NO. 1_ � l:: •_ LICENSED CONTRACTORS DECLARATION LIC. CLASS DWELL. UNITS ;�=;y>;-- _ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.- SEWER MAP LIC. (commencing with Section 7000)of Division 3 of The Business CITY CLASS and Professions Code,and my license is in full force and effect. -VALIDATION SQ. FT. NO. OF NO. OF CHECK BK el; ?% r_i'd F%i License Number Lic. Class SIZE Q STORIES FAMILIES / ONE ' r VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ ©© ADD ❑1 am exempt under Sec. ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ USE OF " ` Date: EXISTING BLDG. DEMOL ❑ APPLICANT pp I /`�TE . p Signature (PRINT).if Hav(T lN�/V l3—N Q D $ FINAL r .OWNER-BUILDER DECLARATION . DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS?x/30 / (L ST 4V&- �C< W?b Law for the following reason (Section 7031.5, Business and FINAL Pr essions Code): PRESENT B _„_�,._ I, as owner of the property, or m *employees* em to ees with v FY =`i i � 5 BUILDING ((,��y E yv: ;=: '' .. P P Y� Y P Y ADDRESS wages as their sole compensation,will do the work and ?- the structure isnot intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. ' with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions•Code.) ,_);4ktlE^).y REQUIRED TOTAL SETBACK FROM EXIST, 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 for which this permit is issued P.L. 2-G Q 2• (Sec. 3097, Civ. C.). SIDE. l P.L. Lender's Name, m �! ,tom LDMA Ref. # Lender's Address P. Fee$ i Permit Fee 0 1 certify that I have read this application and state that the Issuance Fee - 6- LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee Q 0 ordinances and State laws relating to building construction, I Total Fee Ui LDMA Perm. # a and hereby authorize representatives of this County to enter u n t above-rpentioned p ty for i pection purpos es.ovees. ✓/ -/ 7 SEE REVERSE FOR EXPLANATORY LANGUAGE I` Sign ure of s nt or Agent h� Date = ((