Loading...
HomeMy Public PortalAbout9180 FORTSON DR_Building__ DEPAktT krzxx OF BUILDING AND SAFETY APPLICAT70 ff PERMIT ` Z`AUNTY OF LOS ANGELES - WM. J. FOX, CHIEF ENGINEER - y'• - FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING L/j DISTRICT NO. PLANCK.NO. PERMIT NO. ADDRESS '^/��u_ LOCALITY Gam-- RECEIVED BY DATE OF APPL. DATEISSUED NEAREST :V7 �[/i�� 1�► CROSS ST. J BUILDING OWNER �"" / ADDRESS ?' - MAIL LOCALITY ADDRESS L� �^� ' NEAREST - (/ CITY No. CROSS ST. ���! / ARCHITECT OR ^_ TEL. ZONE I PLANE �v FIRE NO.0TYPE \/ I GROUP• ENGINEER NO. �� ` /L/ /%�./� r ' `pI-VTC" ADDRESS _ SETBACK LINE �d / / 00- 4� 4 C// TEL I' APPROVED CONTRACTO NO. 41 Y� BY - DATE "y USE APPROVED ADDRESS !.t// ZONE BY• DATE LEGALL/,,--// CORRECTIONS DESCRIPTION LOT NO. '�11�'7'""I` I/BLOCK TRACT AI `� I •4,.,.< G NO.OF BLDGS.wL�j,,,.� SIZE OF LOT / I NOW ON LOT !/H•,.- USE OF NO.OF NO.OF EXISTING BLDG. FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION - O ' A REPAIR MOVING DEMOLISH 0 Q. FT. �/�/ NO.OF �/ I _ SIZE -/ ROOMS % . STORIES / D - WALL ROOF r n COVERING 2i��U Il COVERIN(0 USE OF NEW - BUILDING V - r - IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECTFOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH-ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS RE ULATING BUILDING CONSTRUCTION. - ' FRAME: FIRE STOPS, _ SIGNATURE OF BRACING,BOLTS - OWNER LATH,INT.: AUTHORIZED AOT. LATH,EXT.: DBS-3 25M TS t a7 O P C 6 ( PLASTER. INT. I �d FEE V _ 'An O PLASTER, EXT. 0 VALU ION FEE - FINAL t COUNTY OF LOC-,ANGELES + BUILDING AND SAFETY y WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL DI ADDRESS V I hereby affirm that I have a certificate of consent to self insure, BUR ING- DDRESS j or a certificate of Workers' Compensation Insurance,or a certified Copy thereof�(JSe ./3800,Lab'C) CIT v - t ` •- ZIP LOCALITY Policy No " 0,l ���� Company v I SIZE OF LOT NO OF BLDGS NOW ON LOT El Certified CROSS ST Certified copy is hereby furnished _ " Pl<ertified copy IS filed with the C y u g Inspection TRACT BLOCK LOT NO department USE ZONE MAP NO Date �jApphcan ASSESSOR M ODK� PAGE PARCEL �J OYr7`J /� / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O N R TEL NO •� COMPENSATION INSURANCE IrS• Cry T 'f 111 c, 21,55 WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred A ESS p t DISTRICT •GROUP TYPE CONST FIRE ZONE PROCESSED BY - dollars ($'100)or less) O or soh CIT Z ' I certify,that In'the performance of the work f which this permit Is Issued, I shall not employ any person-in an manner so as to ' IP VQ J become subject to the Workers'Compensation Laws ARCHITECT O ENGINEER TEL NO STATISTICAL CLASSIFICATIONAPT CONDO Date Applicant ADDRESS 'CLASS NO ai:2 DWELL UNITS NOTICE TO APPLICANT •If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST. Exemption, you- should become Subject to the Workers CQTRA TOR �� TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,-you must-forthwith �P �G �� b� FRONT Comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC NO P L LICENSED CONTRACTORS DECLARATION i0y S. �� 66 f SIDE CITY L LA P L - I hereby affirm that I am licensed underprovisions of Chapter 9 SuL 4 r"a SEWER MAP (commencing with Section,7000)of Division 3 of the Business and SQ FT SIZE NO OF STORIES NO OF FAMILIES NEW BK" E PG } Professions Code,and my license Is In full force and effec 4. DE J ON OF ORK VALUATION J ' License Nu Lic Class _ 3 J� i7 F 17V � I � L ADD ❑ ©D • m Contra r Date T1oC ALTER ' ❑ ❑ I am exempt under Sec �O �' REPAIR ❑ $ 0 B&P.C.for'this reason EMOL '❑" L'DMA•P/C# W DateU l n E ISS BL Gr URM; El Signature ;:,'• •� Z LIC (PRI TE-NO• LDMA Per # , t J ❑ I, as owner of the property, or my employees with wages as r f —�a Y. `i Z ( a their sole compensation, will do the work and.the structure is ADDRE �+ ^^ O ��� 's not intended or offered for sale (Section 7044, Business and OJ •7• l3 YO t;- © C7 C FINAL DATE t Q +.31 =I3 50 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑'1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q �n YES El NO FINAL BY -'> �'• licensed contractors to construct the project (Section 7044, - � - • �-'-• a , H���.��; Business'and Professions Code.) ®— - -- WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE.BUILDING �I ti 'E '��-� ••i " OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ?w,P, •tii•j�I V 1V a�T'i . CONSTRUCTION LENDING-AGENCY COAST AIR QUADTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING.CHECKLIST FORFvl/V(` GUIDELINES �Y/•w' ��-•,� f•''.C-' ITENS, '• I hereby affirm that there is a construction lending agency for _ YES❑ NO 2 k`• N the performance of the work for which this permit Is issued(Sec jai 1 f ITAi 2 the pe CIV C. (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMDPERMITTING �q,�y\ L_ti" - 92 CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ' TITLE 2,CHAPTER ECTIONS O2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS [j i( Lender's Name MATERI NG A FO BTAINING A PERMIT FROM.THE SCAOMD i-ffE�•r: o Lender's Address �6- -� -- - ' �:HA�{faE G OWNER OR AGENT - oI certify that I have read this application and state under penalty " O of perjury that the above information is correct I agree to comply P.0 FEE PERMIT FEE CJ • - with all count r ces and State laws relating to building O / f 11�ij1�—I JILL 1 ;z�4;` m constructio d eb onze representatives of this County ISSUANCE FEE �} to ent n ove, nt ned property for inspection purposes Of �� 0434 i" "-AM S 4 �� INVESTIGATION FEE - .TOTAL'FEE '1 — u r„wm Daae 12 SEE REVERSE FOR EXPLANATORY LANGUAGE