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HomeMy Public PortalAbout10243 FREER ST_Building__ 'saeaeAce#eoa +-e+ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS. ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY / JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUPT OF BUILDING CROSS ST ��! i/ Ally-711- DISTRICT NO GROUP TYPEPa�ESSED BY/ FOR APPLICANT TO FILL IN g CONST BUILDING /q // STATISTICAL CLASSIFICATION SEWER MAP ADDRESS�[��[ 7 3 6:__Ln i- . s BK PG CLASS NO DWELL UNITS LOT NO BLOCK WATER CERTIFICATE NOT REQUIRED E RECEIVED TRACT / NO OF BLDGS MAP /�� HIGHWAY STATE MAJOR SECOND, LOCAL NOS ! (CIRCLE) SIZE OF LOT NOW ON LOT 4 7 USE ZONE SPECIAL USE OF c! CONDITIONS EXISTING BLDG 37 OWNERrk1u. +�— l V I !N'lL BUILDING YARD HWY 4 STREET NAME EXIST ADDRESS ++ Z& ! eN'f,. 4� �1 (. SFRONTK WIDTH ARCHITECT OR TjfL P L ENGINEER NO SIDE P L r ADDRESS CL TEL INSPECTION RECORD CONTRACTOR NO 0 ADDRESS IY O DESCRIPTION OF WORK v W CL NEW ADD ALTER REPAIR DEMOLISH Cn SQ FT //�� NO OF NO OF ? IZE STORIES FAMILIES It USE OF �T STRUCTURE SIGNATURE OF APPLICANT VALUATION$ APPROVALS DATE INSPECTOR S SIGNATURE P C C pA.jT �© FOUNDATION LOCATION A vL/ FEE $ FEE $ FORMS. MATERIALS Y" 6 FRAME FIRE STOPS, D 4w I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS ISI AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, b• WITH ALL COUNTY ORDINANCES AND STATE SLAWS REGULATING GAS VENT DUCTS (J BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN S CO ENSATION IN SU RAN E LATH, EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED �(/,/ A 'ADDRESS t FINAL 0�1� ® �' CLYDE PLAN CHECK VALIDATION CIC M O. C"H p REMIT T( CIVVALIDATIONRM D ENC BNER H ,410 6 5 3 `7� f-lAR 1 2 2 3 D 3 5.50A L;'jLo 7 7 7 1�0 P,FR 16 1 D 7 4.5 Gl- 1, COUNTY OF LOS ANGELES APPLICATION FOR y~ DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS 16/ 2 BUILDING ADDRESS rC' e LOCALITY NEAREST CITY /`L_ _ � P CROSS ST - NO BLDGS ASSESSOR SIZE OF LOT NO ON LOT MAP BOOK PAGE PARCEL q/ DISTRICT GROU E FIR�E �SED BY TRACT` _ BLOCK LOT NO G ST ZONSTELOWNER _ /1v NO STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ' e��� CLASS NO DWELL UNITS BK PG ^ ZONE - CITY i ZIP ARCHITECT TEL / 1 SPECIAL ENGINEER NO d �J CON OI TIONS ADDRESS se ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRA CTO TEOL s�7 BLDG SETBACK FROM F ONT PROP LI NE OF (STREET) / LIC ' ADDRESS 7 L��� b/✓/Y1N0 HI WAY + 'YARD = TOTAL SETBACK FROM TYPE OF EXISTING i LIC FRONT PROP LINE HIGHWAY WIDTH CITY CJ -CLASS CONSTRUCTION LENDER 11 v+ NAME AND BRANCH a BLDG CK FROM - (STREET), 8 ADDRESS CITY } SIDE PROP LI SQ FT NO OF NO OF CHECK HIGHWAY + YARD _ TOTAL SE TYPE OF EXISTING W SIZE STORIES FAMILIES ONE SIDE PROP LINE Av WIDTH_ f:) DESCRIPTION OF WORK ��� �- NEW + 1 IF ADD ❑ - CORNER CUTOFF YES ❑ NO ❑ I� Z ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG IDEMOL ❑ ___LLL___... APPLICANT" TEL (PRINT) / 0 BY (SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED H�EREBY,,I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF, CALIF A IN RELATING TO ✓ WORKMEN'S COMPENSATT2b,.MSURA#tE SIGNATURE OF FINAL 2 7 BY PERMITTEE 1 DATE ADDRESS /� / 4 L, TEL ,11///�/1• P C Fee$ . 6-3 Permit Fee �7 �J QQ'' Issuance Fee -- - VALUATION$ /1 _ 7 6 Total Fee PLAN CHECK VALIDATIONC/ m. CASH _ PERMIT VALIDATION CASH 6 2 4 OCT 12 2.1- © 1 4.6 3 &9;) 8.7 5 76A638A CEik803B ,ZrB - 6 2 S�nrT 12 Y1- U 4. soh �� v N WORtSF COMPENSATION DECLARATION of coAent to sel insure, ora afcert f c6tte of Workers',Comtpensation Insurance, A P PL I CATION FOR BUILDING PERMIT - or a certified copy thereof (Sec 3800, Lab C ) r �TH➢`F_ �GLN�. COUNTY OF LOS ANGELES BUILDING AND,SAFETY , Policy No 6 .Co"mpan`y' Certified copy, s hereby furnished FOR APPLICANTJO FILL IN BUILDING, , ADDRESS- Ce DDRESS Certified copy is Bled with the county building mspec- BUILDING tion department ADDRESS /— p - _ f //ff J/�� 1 Cwt Date / / Applcant CITYME 4*Fl , ,• © LOCALITY /CERfIFICATE OF EXEMPTION FRO ORKERS' NO OF BLDGS NEAREST F COMPENSATION INSURANCE SIZE OF iOT NOW ON LOT CROSS ST (This section need'not be completed if the permit is for one ASSESSOR " hundred dollars ($100)or less ) TRACT ' BLOCK LOT NO MAP BOOK PAGE PARCELY /IVTEL USE ONE MAP i.�r /� r OWNER , -NO` + mA -a - I certify that in`the performorice-of the work'for whch,this NO permit is issued, I shall not employ any person in any manner , C SPECIAL so-as to become subject to the Workers,Compensate n Laws ADDRESS J �l CONDITIONS L Date //B 5 Appl cant } CITY /- 4;4ZIP NOTI E APPLICANT If, after.-ma g this Certificate of ARCHITECT OR TEL DISTRICT G UP TYPE FIRE OCE SED BY ENGINEER NO- =Exemption; you should become subject to the Workers' CONS ZOjE , Compensation provisions of the Labor Code, you must forth- _ ADDRESS r D 3 � ✓ with comply, with such provisions or this permit shall be r ' NOaK --BC6 STATISTICAL CLASSIFI ATION APT,", CONDO deemed revoked ^ CONTRACTOR .Zzz" LICENSED',CONTRACTORS DECLARATION LIC CLASS NO �• 'DWELL UNITS ; I hereby affirm that 1'am licensed under provisions of Chapter 9 ADDRESS B NO 3 77 SEWER MAP (commencing with Section 7000)of Division 3 of the Business andLIC Professions Code, and my license is in full force and effect', CITY C®'�'/77O CLASS �'3 BK PG VALIDATION. SQ F a NO OF NO OF CHECK Lcense.Number �f `�/77 Lc Class 4.111 C3 SIZE STORIES FAMILIES , ONE ^ 0 /� VALUATION U NEW 0: Contractor` �E -�/�/TT-Date �7 DESCRIPTION OF WORK /���C h�Ol�.SE ADD O $ ©�/yt` - 0 DI am exempt under Sec r �S��Ak ❑ 6�(J ® $ N ALTER W B 8P C for this reason CrL /+ REPAIR s' Date USE OF a " Z Jp � ////11 - EXISTING BLDG DEMOL „ Signature/J!`/ /��' C[7/V.11�/�l��il APPLICANT TEL O6sy FINAL / OWN -BUILDER DECLARATION PRINT) L' O'q6? DATE - I herebyaffirm that I am exempt from the Contractor's License ADDRESS 40 A f TFM Pi e� Q�yp FINA � Law for the following reason (Section 7031 5, Business and Professions Code) PRESENT. ) �,� _ BUILDING M I, as owner 'of the property, or my employees with = ADDRESS °ACCT.sLL -wages as their sole compensation,will do the work and, , w; v the structure is not intended or,offeied for sale(Section " LOCALITY 115.50 7044,-Business and Professions Code) MOVING TEL ® M ' ❑I I, as owner of the property, am exclusrvely'contracting CONTRACTOR y NO 1 ITEMS, with licensed contractors to construct the'project (Sec- a t^ C' Ghon 7044, B`usmess and Professions Code) ADDRESS , -'TOTAL `i Ia.—_'.n 0 REQUIREDTOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD, HWY PROP LINE WIDTH" a CHECK 115.50 .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 - - • . CHANGE .00 (Sec 3097, Crv'C ) SIDE P L Lender's Name 5 ^ w G LDMA Ref # 0000-0001 9h2/8 Lender's Address PC Fee$ ;r• Permir Fee /(J<_/ o 5657 4 A 111:Vc o I certify that I have read this application and state that the Issuance Fee / 191,5�/ LDMA P/C# above information is correct I agree to comply wdh all County Investigation Fee ; 0 ordinances and State jaws relating to building construction, s Total Fee' k5, 115-0 LDMA Perm # " 6 and hereby authorize representatives of this County to enter' upon the obove-mentioneg1lproperty for,inspection purposes � � SEE REVERSE FOR EXPLANATORY LANGUAGE y' Sig/lure of Apphcant or Agents Difte, - . :. APPLICATION - AORI?` '1L®ING* PERMIT •' COUNTY OF LOS Aj�3EL_S , - • BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS PBUILDINGDDRESS I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or a certified ZIPcopy thereof(Sec. a ) Q�w 4r1 -7 G LOCALITY Policy I Company V/Tr� �MP SIZE OF LOT NO.OF BLDGS.NOW ON LOT" ,,/ NEAREST CROSS ST LtG Certified copy is hereby furnished. 11.'Certified co is filed with the count bun ins ection TRACT BLOCK LOT NO. copy y build g p USE ZONE MAP'NO. de artment.' / 7 �� —z ASSESSOR MAP BOOK PAGE PARCEL Date Appli*'ant Q -- D SPECIAL CONDITIONS OWNER TEL.NO­ CERTIFICATE CERTIFICATE OF EXEMPTION FROM WORKERS' rl //yJ �tE►�. WITHIN 1000 FT OF SCHOOL? 'YES NO COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit is for one hundred r D 24 3 i—,P-e DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZI d , I certify that in the performance of the work for which this permit r.� l 70 ���� ✓ 3 �� / is issued, I shall,not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws... STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. "Z DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST _ Exemption,-you should become subject to the Workers' {)�pNTRACTOR SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the.Labor Code;you must forthwith '"4�'r� TEL.NO. a FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS y LIC.NO. PL �+ D WS A.- Q 19 1 SIDE LICENSED CONTRACTORS DECLARATION C ��, r} ! _ LIC.CLASS PL I hereby affirm that I am licensed under provisions of Chapter 9 l� t� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OFS75!FE7 NO.OF FAMILIES // / C Professions Code,and y licen is in full force and effect. NEW ❑ BK /� PG Q D SCRI ION OF WO ADD ❑ VALUATION ® W -License Number Lic.Class ,� ,y y ALTER � , ®�6 z REPAIR .ElCl I am exempt under Sec. BAR.C.for this reason DEMOL ❑ ' USE OF EXI .._BLT LDMA�P/C# , Date: URM ❑ _ Signature AP JICANT(PRINT) TEL.NO.. - ;i t LOMA Perm k - Z _ ❑ I, as owner of the property, or my employees with wages as " �Z'�-5 = 017 ''' �S' p :•. -_ ' their sole compensation,will do the work and the structure is ADDRESS. not intended or offered for sale (Section 7044, Business and `./ +4S /ud.►I.�FS. �'':,;- _ FINAL DATE / ht J Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANTHANDLEA HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN' _ ' ' _J - ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED-ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY i t I• �- !.'-; -•p,v u licensed contractors to construct the project (Section 7044, to �' w t;•it. . YES❑ NO❑, •J 'C' Business and Professions Code.) • WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING - 1% ,i ,�•:,_ f _-___r+` OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST , + FOR GUIDELINES p• {x^•a dt+-j - ( ''��= Lhereby affirm that there is a construction lending agency for YES'❑ NO❑ _ AD : the performance of the work for which this permit is issued(Sec. T f"iTr`%: = �'�`_= _ 'A'-`R 1 HAVE RETHE'HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.J. PERMITTING CHECKLIST 1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES: I - .e: --^•` :r,� / l''i..i ;' /'i COUNTY CODE,TITLE 2,CHAPTER 220 SECTIONS 2.20100 THROUGH 2.20.110 CONCERNING ...Fes_,• v. t!ci1: r3 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD _ Lender's Address oEnoaAGENT 0 1 certify that I have read this application and state that the above •j P.C.FEE PERMIT FEE information is correct. I agree to comply with all county O�76 7/ ordinances and State laws relating to building construction,and FI ��•i .�1 7.. ISSUANCE FEE hereby authorize representatives of this County to enter upon M' the ve-mentioned property for inspection purposes. INVESTIGATION FEE TOTAL FEE SgmW.of ki w Aum, SEE REVERSE FOR EXPLANATORY LANGUAGE, �I