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HomeMy Public PortalAbout9162 FORTSON DR_Building__ 76A638A CE 4803 2-63 APPLICATION FOR, BUILDING PERMIT .. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 6;2 �Q%�T p �(Z BUILDING AND SAFETY DIVISION LOCALITYj E/�,� L G I ` - JOHN A. LAMBIE. COUNTY ENGINEER NEAREST O WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST - U15TRICT NO GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL.IN ��- ,X CONST. BUILDING - STATISTICAL CLASSIFICATION SELVER MAP, ADDRESS 9162:• Fortson TC .• CLASS NO -IzDWELL UNITS - r�/BK PG% 'LOT NO l BLOCK WATER CERTIFICATE: NOT REQUIRED RECEIVED ❑ Ln 4 3` - '- MAP HIGHWAY STATE MAJOR SECOND. LOCAL NO OF BLDGS. y NO Q (CIRCLE) SIZE OF LOT _ q NOW ON LOT USEy ZONE SPECIAL USE OF denCe RI CONDITIONS Sl Re - EXISTING BLDG - TEL. .,�Q - OWNER jbe Severns NO BUILDING .YARD HWY STREET NAME EXIST. SETBACK WIDTH ' ADDRESS 9162 Fortson - T.0 FRONT ,.-J� / —©���� • ] ARCHITECT OR TEL. P, L ENGINEER NO SIDE , P. L 'ADDRESS _ - - a CONTRACTOR Virgin Roof 4Cowo AT70507 ADDRESS 600, S.' San GabrielBlvd . - O DESCRIPTION OF WORK San' Gab W a NEW- ADD ALTER REPAIR DEMOLISH SQ FT NO. OF • NO OF -I _ SIZE - STORIES FAMILIES I' - USE OF STRUCTURE Re- SIGNATURE OF APPLICANT VALUATION $ 91 X00 , I APPROVALS DATE --�MS_PECTOR'S SIGNATURE PC p •FOUNDATION LOCATION / f FEE`$ FEE_$ S.•O0 FORMS, MATERIALS FRAME FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS / t AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,GAS VENT. DUCTS BUILDING CONSTRUCTION I C RTIFY THAT IN D ING THE WORK' / S AUTHORIZED HEREB I ILL OT EMP�Y ANV SON IN VIOLA" LATH. INT (` TION OF THE LAB CO THE STATE IFO NIA RELAT- ING TO WORKMEN' M URA I �.���..���((//// LATH, EXT SIGNATURE O HOUSE NUMBER COR- PE RM ITTEE OR-PERMITTEE �+ - _ RECT AND POSTED ADDRESS 600 S. San Gabriel lv • FINAL /fi 'San Gabriel JOHN F. LEWIS, PRINCIPAL ST RAL ENGINEER PLAN CHECK- VALIDATION M D CASH, _ PERMIT VALIDATION CK. M_O.• CASH Ll' o 4 2 7 1z2o' .SEP 2 8 1 D 8.0 0� ., APPLICATION FOR BUILDING PERMIT COUNTY OF LOS-ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL G ASD SS I hereby affirm that I have a certificate of consent to self Insure, g�1LDING ADORES or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec 3800,Lab C) ' CITY' ZIP(C�d" �7n' �„l�7 j��(J LOCALITY _ Policy No Company SIZE OF LOT- NO OF BLDGS NOW ON LOT El •�•Certified copy'Is hereby furnished' !/S-V:J ,r- NEAREST CROSS ST ❑ Certified copy Is filed with the county budding Inspection TRACT BLOCK LOT NO • department. USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE - PARCEL - SPECIAL CONDITIONS CERTIFICATE OF"EXEMPTION FROM WORKERS' OWNER TEL NO COMPENSATION INSURANCE C _TG[AJ THIN 1000 FT OF SCHOOL'? YES NO" (This section need not be completed If the permit is for one'hundred ADORES dollars ($100)or less.) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY c�a�� CITY ZIP ,Q n I certify that in the performance of the work for which this permit G�, c� 1�f7�✓ h�Q is Issued, I shall not employ any person In any manner so as to_ ca ARCHITECT OR ENGINEER become subject to the Workers'Compensation Laws TEL NO. STATISTICAL CLASSIFICATION. APT CONDO Date Applicant ADDRESS - CLASS NO t DWELL UNITS ' NOTICE TO APPLICANT If, after making this Certificate of 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 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL LICENSED CONTRACTORS DECLARATIONSIDE I hereby affirm that I am licensed underprovisions; CITY LIC CLASS P Lof Chapter,9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and S 5 `� NO.OF STORIES NO OF AMILIES Professions Code,and-my license Is In full force and effect e•.SF 6/� NEW ❑ BK PG License Number LIc Class DESCRIPTION OF WORK ADD VALUATION �p Contractor Date ALTER El $ - j ❑ I am exempt under Sec REPAIR ❑ $ 0 B&PC for this reason DEMOL ❑ 0 LDMA P/C# Date USE OF EXISTING BLDG URM ❑ d Signature 2+3, . Z APPLICANT(PRINT) _ TEL NO _ LDMA Perm# fj I, as owner of the property, or my employees with wages as Z ACCT.-, their sole compensation,will do the work and the,structure Is ADDRESS = not intended or offered for sale (Section 7044, Business and FINAL DATE x Aa W-603- "" 50.50 Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALt ' •a 1 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 GUIDEI� FINAL BY ' licensed contractors t0 construct the project (Section 7044, YES❑ NO❑ V1 TOTAL 50 .50 Business and Professions Code) C WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING , 5O CO _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '•, (fi�HE�GlI�\ ■ CONSTRUCTION LENDING AGENCY COAST AIR QUADTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR -{lHAfYGE .00 GUIDELINES I hereby affirm that there.Is a construction lending agency for YES❑ No❑ - ` N the performance of the work for which this permit Is Issued(Sec + O1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING � '• p '}I9 p 3097, Civ C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, OOOO-0001 9I ! 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 SCAOMD o Lender's Address U96 1 FM 4:54 O , 'OWNER OR AGENT ACCT. ' o I certify that I have read this application and state under penalty i o P C FEE - PERMIT FEE D, - ' '3303 -767 87 of perjury that the above Information Is correct I agree to comply V'1 O.�Q e with all county ordinances and State laws relating to building M construction, and hereby authorize representatives'of this County ISSUANCE FEE 3a 1 ITEMS to enter up h a kmentloned p erty for Inspec n purpo s i '�� INVESTIGATION FEE- TOTAL FEE' IJ TOTAL - 767.. 87 ^ s i I Anoicam o. Gaya SEE REVERSE FOR EXPLANATORY LANGUAGE CHECK 767.87 r1_14MAI: _nn