HomeMy Public PortalAbout10525 FREER ST_Building__ 7GA638A CE#803 8-63 APPLICATION. FOR BUILDING PER T
COUNTY, OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS (�7
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER' NEAREST i
WILLIAM A. JENSEN,•SUP'T OF BUILDING CROSS ST
DIS,I.RdCT.NOL Gf�? P TY E ROCE D BY
FOR APPLICANT TO FILL IN c NST.� a/
FEXISTING
STATISTICAL CLAS 1 ATION SEWE MAP
r- - no" A7 'YAP
:CLASS NO.��L DWELL UNITS
BLOCK` WATER
CERTIFICATE: NOT REQUIRED ❑ RECEIVED ❑
Q MAP HIGHwgY STATE MAJOR SECOND. LOCAL
NO OF BLDGS NO. O (CIRCLE)
T NOW ON LOT USEZONE SPECIAL,
reslaence' CONDITIONS
BLDG1.
OWNER A.IV!.TTonkovi chNO'4489614 g IL INC EXIST
1,0525 Freer Ave. T.V. SETBACK YARD HWY STREET NAME WIDTH
ADDRESS FRONT m
ARCHITECT OR TEL. P L (J
ENGINEER NO. SIpE
P L
ADDRESSTEL
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�T
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CONTRACTOR "�� � eV He«.tZnQ7NO 2686812 �
V
ADDRESS 305 E.Valley San Czaberiel m
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DESCRIPTION OF WORK
Lu
V
NEW ADD ALTER REPAIR DEMOLISH y
SQ FT* NO 'OF NO OF
SIZE STORIES- FAMILIES
USE OF
STRUCTURE 1.-combination 3ton •air-
conditioner heating ut
SIGNATURE OF
APPLICANT - C
VALUATIONS 1. 000,00
APPROVALS DATE INSPECTOR'S SIGNATURE
P C. PMT FOUNDATION. LOCATION
FEE S FEE S 1,7 FORMS, MATERIALS
FRAME FIRE STOPS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS
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 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-
TION OF THE LABOR CODE OF THE STATE OF 'LIFORi4IA RELA� LATH. INT
ING TO WORKMEN'S COMP NSATION INSURANC
- H. EXT
SIGNATURE OF L�'f OUSE NUMBER COR- ,
PERMITTEE - ECT AND POSTED
ADDRESS - FINAL �(
JOHN
PLAN CHECK VALIDATION CK.' M O:.'• CASH PERMIT VALIDATION T CK URAL
O ENGINEER
_
q1PF:JiILD APPLICATIORI F� �G PERMITCOUNTY OF LOS ANGELES ING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN'FBUI)D;ING ADDRESS �
I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or a certified ZIP
copy thereof(Sec.3800,Lab.C.), /77 ,�G LOCALITY
Policy No.-1�5^Q 3 Company ST?Z'T1L F uAS�
- SIZE OF L07 NO.OF BLDGS.NOW ON LOT
,❑,..,/C�ertified copy is hereby furnished. NEAREST CROSS ST.
t'CBrtified copy isfiled with the county building inspection TRACT BLOCK LOT NO.
VV department. IDISTRICT
ONE MAP NO.
Date. �-- 3A Applicant )41%1 ILOW KO[�'F'I IULa ASSESSOR MAP BOOK PAGE PARCEL
pp SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. YES NO
COMPENSATION INSURANCE 6L M �T� 7��.. Z bN 1000 FT.OF SCHOOL?
ADDRESS
(This section need not be completed if the permit is for one hundred Q S 2-:5 F GROUP TY CONST.' FIRE ZONE PROCESSED BY
dollars($100)or less.)
I certify that in the performance of the work for which this permit CITY Lx C( ZIP ( �
is issued, I shall not employ any person in any manner s0 as t0 ARCHITECT OR ENGINEER TEL.NO.
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. -:2 DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST
CONTRACTOR TEL NO. Q
Exemption, you 'should become Subject t0 the Workers' G � S— [Q I 1 ' 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. P L
6 7-z Z J� au Lia- SJa SIDE
LICENSED CONTRACTORS DECLARATION CITY LIC^^.CLAS3S PL
I hereby affirm that I am licensed under provisions of Chapter 9 SQ.TarrSIZIE ENO OF STORES W05.OF FAMILIES EWER MAP
(commencing with Section 7000)of Division 3 of the Business andNEW BK PG
Professions Code,and my license is in full force.and effect. W
00
f-I39 3Sr' Lic.Clams C�3/ DESCRIPTION OF WORK App E] VALUATION
License Number
Contractor RAu Ir om U-0bate 10^ 12--93 ALTER - ❑ _z
I i`aC�OD al- exp 0 a£le¢d.- REPAIR ❑
El arr exempt under Sec.
BAP.C.for this reason 6LK- 25 /Q. LIL S"A" "fa AFAW ld5EMOL ❑
LDMA P/C# •
Date: USE pll%W�O,F�EXISTING BLDG. URM El+IC 6 SAO wADA W,*
Signature APPLICANT(PRINT) TEL.NO. LOMA Perm#
S
❑ I, as owner of the property, or my employees with wages as � p :_: ,F
their sole compensation, will do the work and the structure is ADDRESS F- _
not intended or offered for sale (Section 7044, Business and FINAL DATE Q `_F[_ۥ
Professions Code.)
cool-
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL❑ —/ � i
I, as owner of the property, am exclusively contracting with - - � '-�
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN LL-1"•THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project (Section 7044, YES C3 NO ' TOTAL '1 18n65
Business and Professions Code.) E
.WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING T J % CHECK
�)E K
OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH Ik
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLISTQl� `p
FOR GUIDELINES
J _; 'It �
I hereby affirm that there is a construction lending agency for YES❑ No❑
the performance of the work for which this permit is issued(Sec.
3097,Civ.C. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD
p ). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES
°D COUNTY CODE,TITLE 2,CHAPTER 220 SECTIONS 2 20 100 THROUGH 220.140 CONCERNING
.Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD
Lender's Address w�j 3t i �} °=`
IL OWNER OR AGENT
0 1 certify that I have read this application and state that the above PC FEE PERMIT FEE
information is correct. I agree to comply with all county
ordinances and State laws relating to building construction,and
herety,auttTorige representatives of this County to enter,upon ISSUANCE FEE
r2ab m oned roperty for inspection purposes !s'
� � INVESTIGATION FEE TOTAL FEE
sq„ewie a Applmrrt a Apxtl D)
SEE REVERSE FOR EXPLANATORY LANGUAGE