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HomeMy Public PortalAbout10662 FREER ST_Building__ 76A630A CE x$8031-62 APPLICATION FOR- BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING O � DEPARTMENT OF COUNTY ENGINEER ADDRES *�a(%/[� BUILDING AND SAFETY DIVISION LOCALITY/ JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST DIST ICT G_ R�J,IP TYPE P CE 'ED B FADDRE R APPLICANT TO FILL IN l STATISTICAL CL IFICATION SEWER MAP a �� CLASS NO DWELL UNITS B/ P WATER 7 :36 BLOCK CERTIFICATE: NOT REQUIRED-• RECEIVED TRACT $ NADP , "CIRCLE ; .STATE MAJOR SECOND OCAL NO.OF BLDGS SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF - CONDITIONS EXISTING BLDG 'Qi (, '^ TEL A- L OWNER NO B U I L D I N G YARD HWY STREET NAME EXIST SETBACK i i WIDTH ADDRESS e -e 'Y FRONT ARCHITECT OR TEL P L ENGINEER NO SIDE P L d ADDRESS CONTRACTOR ').t TEL oZ�- u OL ADDRESS / r O F DESCRIPTION OF WORK W 50, NEW ADD LTER REPAIR DEMOLISH Z SO FT NO OF NO OF SIZE STORIES FAMILIES USE OF STRUCTURE a 7 SIGNATURE OF APPLICANT _ VALUATION $ �� s APPROVALS DATE INSPECTOR'S SIGNATURE P C. PMT FOUNDATION LOCATION FEE FEE $ 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 f 1 BUILDING CONSTRUCTION I 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- INGTO WONCSATION INSURANCE RKME 'S OMPE LATH, EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE n 4 - — RECT AND POSTED Qn 0 . ADDRESsaeI.1lO-{C[/�'C /mo7- (-- w, / (-_ FINAL AAA JOHN F. LEWIS, PRINCIPAL STR y F'�AL ENGINEER PLAN CHECK VALIDATION CK M O. CASH _ PERMIT VALIDATION CK MO. CASH Lr o 4`O o 2ad SEP 6 1 D 4.00- 76A638A CE#803 9-68 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING /O DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN V. JENKINS, SUP T OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRJc�Np>j GR TYPE BY (Print or type only) �, 0 BUILDINGjD STATISTICAL C ASSIFICATION - SEWER MAP ADDRESS (�J CLASS NO. DWELL.UNITS BK' PG LOT NO BLOCK USE ZONE MAP /} NO. TRACT SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF -(STREET) O NO. TYR OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDR S Cf n 1 HIGF� Y WIDTH FROM C.L. ' s CITY BLDG.SETBAC M ARCHITECT OR TEL. SIDE PROP.LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWA YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. ' FEL + = G 9"ro"014A AA 1 )40 NO. c C LIC. f 0:A - NO _ CORNER CUTOFF YES ❑ NO ❑ C CITY p , LIC.CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS u CONSTRUCTION LENDER u NAME AND BRANCH ? ADDRESS SQ. FT. NO. OF NO. OF NEW ElSIZE STORIE / FAMILIES USE OF ADD ❑ STRUCTURE jALTER ❑ REPAIR SIGNATURE OF -APPLICANT DEMOL ❑ VALUATION $ 46,61 ILI APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE $ FEE$ Q d 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.— - WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUC TI ON. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - RECT AND POSTED 14 1 ,f ADDRESS FINAL, JOHN F. LEWIS PRIN IPAL STR URAL ENGINEER PLAN CHECK VALIDATION 'CK M O CASH _ PERMIT VALIDATION cK mo CASH pr�.4 2 3 41E--_' VIAR26 1 D 9.00 . 7QA630A CIE#8032/9o' APPLICATION FOR BUILDING PERMIT ' 1 -COUNTY OF LOS ANGELES ADD EISS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY 45-1-11 JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP, TYPE P - SSED BY -FOR APPLICANT TO FILL IN v Sf. CONST. BUILDING / yy�� n _ Q STATISTICAL CLASSIFICATION a� I SE ER MAP ADDRESS r> L1� �'` ��K �� Li"� CLASS.NO.-_ 7 DWELL.UNITS K G LOT NO. BLOCK ,_� MAP STATE YES NUMBER A!/Li / HWY. TRACT n USE ZONE SPECIAL NO.OF BLDGS. /j CONDITIONS SIZE OF LOT /_ y ■ ��LsINOWONLOT USE OF EXISTING BLDG. yIl L.l./'iIrCT' `c--yelel G/= BUILDING YARD HWY STREET NAME EXIST. �j TEL. SETBACK WIDTH OWNER(��/'� /f� /J 9� NO. FRONT / ;e/� J� raj P.L., `[_�_(d - ADDRESS�G4 (v l /� i'� /-; SIDE - ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECORD ADDRESS BeyT E LL,,��� �la CONTRACTOR /�� NOLi�7� /�, O ADDRESS-l WO/f P .4 •L•/ C. •� U DESCRIPTION OF WORK O I7(EW) ADD ALTER REPAIR DEMOLISH W SO. T. / NO.OF NO.OF a SIZE (�! STORIES /FAMILIES STR CTURE .2. ie if. 4- 4425; _ ^ SIGNATURE OF APPLICANT f VALUATION APPROVALS DATE INSPEOTOR'S SIGNATURE F E '$ FEE $ FO FORMS,MATER ALSON - I HEREBY ACKNOWLEDGE THAT-•1 HAVE READ THIS AP- FRAME: FIRE STOPS, BRACING, BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND - GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFYTHAT IN DOING THE WORK AUTHORIZED I LATH, INT. WILL NOT'EMPLOY ANY PERSON IN VIOLATION OF THE / WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. LATH,EXT. ( SIGNATURE HOUSE NUMBER COR- PERMITTEF RECT AND POSTED ADDRESS- QA� i FINAL CLYDE N. DIRLAM, PRINCIPAL STRU AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH �e 1 :7 5 -OCT 2& 1 D DEPARTMENT OF BUILDING AND SAFETY i APPLICATION FOR PERK-:__-` COUNTY OFLOS ANGELES BUILDING WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING 'I �� —V c-) v-- ADDRESS�+ •i s G] LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST D _3 CROSS BT. J' , BUILDING OWNER �� ADDRESS MAIL LOCALITY ADDREBBNEAREST / TEL CROSS ST. ITY NO. FIRE NO.OF TYPE ORO P ARCHITECT OR / TEL. ZONE -7 PLANS iu ENGINEER NO. ORD.NO. / BLDG. ADDRESS /t/ SETBACK LINE �S­23 APPROVED TEL BY D'AT[ CONTRACTOR NO. UUSE ;/ By ADDRESS ZONEXDATE , AL DESCRIPTION LOTNO. BLOCK — CORRECTIONS TRACT NO.OF BLOGS. SIZE OF LOT ZtrJ p I NOW ON LOT USE OF NO.OF NO.OF EXISTING BLDG. FAMILIES 7 ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O � A REPAIR MOVING DEMOLISH O_ qtr w. Or Z SIZE ._I��I [� ROOMS STORIES r WALLROOF COVERING glfj /5' I COVERING {f USE OF NEW BUILDING � � f r 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 113 CORRECT INSPE¢TOR DAT[ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION:AT LOCATION /. FORME.MATERIALS AND STATE LA//W/�S� REGULATING BUILDING CONSTRUCTION. � SIQNAT IT OF / { ,r A ��J, BRACING BOLTS PERMITTEc J �!" ��////"' ,C/! L/ LATHS INT. AUTHORIZED AOT LATH, EXT. 76A63BA-3 2-50 1 "$ T•qq ® P.C.41 ® PLASTER.INT. �V FEE PLASTER,EXT. 14 VALUATION FEE Fl � � 1T•d TEMPLE CITE`' 76Ae36A CB#8032/60 APPLICATION FOR BUILDING .PERNI-IT•- COUNTY OF LOS ANGELES- BUILDING , Dc� l _ DEPARTMENT OF COUNTY. ENGINEER-- ADDRESS BUILDING AND SAFETY DIVISION .' LOCALITY" ` JOHN A. LAMBIE. COUNTY ENGINEER NEAREST . WILLIAM.A. JENSEN SUPT OF BUILDING CROSS ST. _ DISTRICT NQ. TYPE ES B FOR APPLICANT TO FILL IN o- I CONST.. BUILDING / / STATISTICALCLA IFICATION S R MAP ADDRESS ��(� �j ,Z /���%Q s f�j �I' BK P CLASS.NO.J_ILDWELL.UNITS LOT NO. BLOCK MAP / 0 STATE YES NO _ NUMBER O TRACT O _ USE ZONE SPECIAL - J NO.'OF BLDGS. CONDITIONS SIZE OF LOT ,-^7 3 Xy _�LV I NOW ON LOT USE OF EXISTING BLDG. BUILDINGEXIST. n TEL SETBACK YARD' HWY STREET NAME WIDTH OWNE /iK v NO•L' 00 FRONT ol P.L. ADDRESS /Qbf- E� SIDE ARCHITECT'OR TEL. P.L. ENGINEER . No: INSPECTION RECORD ADDRESS TEL.• a CONTRACTOR` NO. O ADDRESS - _ - U DESCRIPTION OF WORK 04 0 NEW ADD ALTER REPAIR EMOLISH SQ.FT. ' "NO.OF, SIZE STORIES FAMILIES - tn STRUCTURE- V3J 1 SIGNATURE O APPLICANT F - - VALUATION APPROVALS DATE INSPECTOR'S SIGNATURE PrfT. FOUNDATION: LOCATION - FEE $ :FEE $ if (/_ FORMS, MATERIALS I-HREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, E BRACING, BOLTS PLICATION AND STATE THAT THE ABOVE'IS CORRECT AND FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH, INT. - WILL NOT EMPLOY ANY PERSON IN VIOLATION THE WORKMEN;S COMPENSATION LAWS OF CALIF N A. LATH,EXT. SIGNATURE-OF- HOUSE NUMBER COR- PERMITTE ! RECT AND POSTED ADDRESS 4"� � � - FINAL �- CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENG PLAN CHECK VALIDATION CK. M.o.' cnet[ PERMIT VALIDATION CK. M.O. cwsH ®l APPLICATIOI .,,-FO i BUILDING PERMIT F.- COUNTY OF LOS ANGELES. .BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO,FILL IN BUILDIN G / �R I hereby affirm that I have a certificate of consent to'self Insure, BUILDING ADDRESS j -• ' - ti - or a certificate of Workers' Compensation Insurance, or a certified a -e' _ 1 Copy thereof(Sec 3800,Lab C) Cl + • ZIP Q' O- ,LOCALITY , Policy No Company SIZE OF L NO OF BLDGS NOW ON LOT El certified copy Is hereby furnished 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 BO ,�Q`�,/ PAGE - PA pp - ,S `UJ 5© � / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER Z TEL NJ ( !'�j / COMPENSATION INSURANCE {' I� WITHIN 1000 FT OF SCHOOL? -YES NO This section need not be con leted If the permit'Is for one hundred D ADDRESS ( P � I -ec,r �T, DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY ,dollars ($100) or less) v 7 i ZIP'�I•F �O_ /� I certify that In the performance of the work for which this permit � 1� , 61 is,issued, I shall not employ any person In any,manner so as to beco me-sub ect to the Workers'Compensation Laws ":` ARCHITEC R EIyGI R TEL NO 1 p I STATISTICAL CLASSIFICATION' APT CONDO Date Applicant - i ESS _ - - - CLASS NO 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 P L LICENSED CONTRACTORS DECLARATION SIDE _ ` CITY LIC CLASS P L I hereby affirm that, I am licensed underprovisions of Chapter 9 SEWER MAP (commencing,with Section 7000)of Division 3 of the Business and SQ FT SIZE NO OF STORIES NO OF'FAMILIES Professions Code,and my license Is In full force and effect NEW BK PG a License Number - Lic Class DESCR ION OF WORD f ADD ❑ VALUATION - Q Contractor Date ALTER ❑ � ❑ I am exempt,under Sec `��- `� '� s�/ = ZGaC�` REPAIR ❑ NB&P.0 for this reason IL ❑ LDMA P/C# 1 W Date tUF EXISTING BLD M •❑.- r3C0 Signature ° NT(PR T) TEL NO - LDMA:Perm# �:N?'� . .r�A�.��T �' _ Z °,8, `�I,'as owner of the,property, or my employees with wages as 0 3303 59.50 their sole compensation, will ao the work and the structure Is '° ADD ESS• not intended or offered for sale (Section 7044, Business and Lvz FINAL DATE Pr6feSSIOr1S Code) _ WILL THE APPLICANT OR URE BUILDING OCCUPANT HANDL HAZARDOUS M IAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL OR GREATER T THE J T-.,Ir d ' ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES a' 'ACCT°v FINAL BY (t� I licensed contractors to construct the project (Section 7044, YES❑ ' NO❑ > ,y,�Q j, IUtw°15 Business and Professions Code) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ITEM _OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r, - • t COAST AIR QUAUTY'MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR C CONSTRUCTION LENDING AGENCY �qq Ti�TAt 108°b-r GUIDELINES - - 7�i ;�. , I hereby affirm that there Is a'construction lending agency for YES❑ No❑ �`' - ' w the performance of the work for which this permit Is Issued(Sec r^''Kl" o cp HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE LES CO PERMITTING CHECK Ip,'.0.65 1 3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER. THE LOS ANGELES COUNTY CODE, , N TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS [/J^J " Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD /[ -� CHANGE .00 o Lender's Address O OWNER OR AGENT - o I certify that I have read this application and state under penalty r,1 OOO� 0001 7�����? o - PC FEE v' PERMIT FEE _ '� - 0- - of perjury.that the above Information Is correct I agree to comply, X/� o with all county ordinances and State laws relating to building ' �D' "� 155y 1 M 5:2 m construction, d hereby j,.Onez hrie representatives of this County - ISSUANCE FEE ^ - 1'1 7 '• - �i f '�O`•� nter up e above-mEl property for In ction purpos s a °- INVESTIGATION FEE - TOTAL FEE/,,,g ,D 9,r,. Applicant or Agent Date ` SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'-COMPENSATION DECLARATION �-I`her•eb affirm that I have a certificate of consent to self i'tnsure, aer°a certificate of Workers' Compensation Insurance, APPLICATION. FOR BUILDING PERMIT or a,certified copy"thereof (Sec.,3800; Lab;C.) . . . a COUNTY OF LOS ANGELES' BUILDING AND SAFETY Po.icy No: Cam pony BUILDING ❑ Certified copy is hereby,furnished. FOR APPLICANT TO FILL IN ADDRESS �� �- / {��— •S ❑ Certified copy is filed with the county-building inspec- BUILDING /_ --- - tion department. ADDRESS. 1C/ 2 . CITYZIP p LOCALITY Date' Applicant &ALNO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS'-• SIZE OF L �� (� NOW ON LOT CROSS ST GJ Moe) C� , COMPENSATION.INSURANCE ,` ^ ' ASSESSOR (This section need'n'at be completed if the permit is for one TRACT �J BLOCKLOT NO (p MAP BOOK PAGE PARCEL hundred dollars-($100) or.less.) / TEL.— USE ZONE MAP OWNER b r3 NO. ,I certify that in,the performance of the work for which this permit is issued,^•I shall not employ any person in any manner ADDRESS d s r SPECIAL a CONDITIONS .so,os-to become•subject to the Wo r rs'Compensation,Laws. � •� O CITY ZIP (J U Date Applicant ARCHITECT TEL .NOTICE•TO APPLICANT:. If, after, making•this;Certificate of ENGINEER s NO. DISTRICT GROUP TYPE FIRE' PROCESSED BY. 0 Exemption, you, should become'-'-subject to the- Workers' 3 CO ZONE. ( w Compensation provisions of the.labor Code, you must forth- ADDRESS- _ "�' . .J n with comply with such provisions or this N p y p permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO. Z -deemed revoked. CONTRACTOR' NO _ LICENSED CONTRACTORS DECLARATION UC CLASS NO. DWELL UNITS I'hereby affirm that I am licensed under provisions of'Chapter 9 ADDRESS NO SEWWIPG. P LIC. d icense,is in full forced effect. (commencing with Section 7000)of Division 3'of.the Business and Professions Code,anmy l °anCITY. CLASSBKC7 L VALIDATION SQ FT• )) NO OF NO. OF CHECK License'Number • Lic. Class SIZE 17 STORIES FAMILIES ONENEW . •- ,' "• •• VALUATION Coritractor Date DESCRIPTION OF WORK I� LAc`� ADD ❑ a �� 7. i}Fss ❑I am exempt under Sec. ALTER ❑ , ; 3� = f 2 .r B.BP.0 .for this reason REPAIR ❑ S j, ., Date: USE OF L•t3t:•ti EXISTING BLDG DOL ❑ L Si nature APPLICANT TEL --- !.t ii'it-1� 9._. FINAL OWNER-BUILDER DECLARATION . - (PRINT) NO. I hereb' affirm that I am exempt-from the Contractor's License DATE ;t Y P ADDRESS �f- n-.✓i I; r i r i• i'L11 j Law for,=the follawing reason (Section 7031:5, Business and FINAL j I„{ I:'•� 1u= Professions Code): 4 PRESENT „ By #1 - j ;L._t BUILDING I, as owner of the property, or my employees with ADDRESS u s y wages as their-sole compensation,,wil I do the work and • �" t the structure is not intended or offered for sale(Section LOCALITY 1 J' . i y� e 7044, Business-and Professions.Code.) MOVING TEL: T _� r • r ❑ I, as owner,of the property, am exclusively contracting. CONTRACTOR NO. -with'Iicensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and professions Code.) 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. (Sec. 3097, Civ: C.). SIDE pL - Lender's Name ) f �j //_ ! ! / LDMA Ref # P.C. Fee$ Permit Fee 3 Lender's AddressP, ; •o I certify that I have read this-application and state that the Issuance Fee �' LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 8 ordinances and State laws relating'to building construction, Total Fee ' LDMA Perm. # a and ereby-authorize representatives of this County to.enter au90 the ab vie;tion;,t�rc!pe'rty.for,.inspection purposes. t j SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant gent Date �+ A' WORKERS' CCIMPENSATION DECLARATION 7 I se aLfirm That I.have'a etificat`a"��f'consent to self gppLI�q�IoN FOR PERMIT -?A�svre,'pi a,certificate of Workers' Compensation Insurance, ^;u.n'certified copy(hereof (Sec. 3800, Lab. C.) - COUNTY OF LOS ANGELES BUILDING AND SAFETY- . Policy No. Company BUILDING ❑ Certified; opy is hereby furnished. FOR-APPLICANT TO:FILL IN ADDRESS .. ❑ Certified copy is filed with the -- _ C—ERTIFICATE_OF*EXEMPT inspec % ION_ cWILDING ADDRESS V"o�tion department. ((W INO '. t_ .T•�' L`ITY ZIPqDate• Applicant LOCALITY . F BLD NEARESTFROM WORKERS' SIZE7-OF,LOT__ _X_ QQ_-`_NOW ONLOTCROSS.ST:__— z� ; "•' _ COMPENSATION INSURANCE ASSESSOR'(This section need not be completed if the•per6t is for,one TRACT BLOCK'• LOT NO MAP BOOK PAGE 'PARCEL l hundred dollars ($100).or less.') f. ' N TEL: -ffl1`Q C. 11°!Z O S OWNERr�� USE ZONE �P I,certify that in the performance:of'the work foe which this permit is issued, I'shall'not employ any person in any-manner ADDRESS' Y `Q r• -s l- SPECIAL d CONDITIONS ' so as to become subject to-The.Workers'Com pensation"Laws. _ ,, ,• , _. 0 CITY 1 �� ZIP '" O.,, Date 'Applicant 'ARCHITECT_OR !'I TEL. NOTICE TO APPLICANT- If, 'after makin g this Certificate of ENGINEER- -{-- NO DISTRICT G OUP TYPE. FIRE PROCESSED BY Q 'Exemption,, you should -become-sublect'•t6 the ,Workers' - _ �� Compensation-.proyisions_of the Labor Code;'you must forth ADDRESS `�,CONST- ZONE U pw with comply:with, such provisions,or this permit shall be TEL STATISTICAL,CLASSIFICATION APT - CONDO` - en' deemed revoked. CONTRACTOR NO ? z LICENSED CONTRACTORS,DECLARATION ` LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 0..... ADDRESS NO SEWER MAP (commencing with Section 7000)of Division LIC 3 of the Business ` 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. Clciss SIZE / 1 STORIES IFAMILIES ONE t VALUATION O V Contractor Date DESCRIPTION'OF WORK �'OQ� NEW ❑ S !�Q JPO+ ADD- il' (J , ' ❑I�am exempt-unde�uSec.'c',- •', e O t1 11 K ALTER, ❑ B.BP.C. for this reason, e �t� ' REPAIR ❑ $ " ,Date, USE OF' `�b�``�� I EXISTING BLDG. &$445E G_ LGL eNS CJ DEMOL ❑ Signature' APPLICANT NO FINAL, PRINT TEL OWNER-BUILDER DECLARATION - DATF Lhereby affirm that I dm exempt from the Contractor's License - �-i -z Law for the following rea"son (Section 7031.5, Business and ADDRESS FINALrN Professions Code _ _ PRESENT BY -- ,BUILDING _t — ❑ , I,.' ir a. owner of the property,, or 'my employees with ADDRESS ' ,; _ wages'as their sole compensation;will do the work and e?'t LOCALITY,, • �_ J �,' the structure is not intended or offered'forsale(Section a _' -7044; Business dnd'Professions Code.) MOVING- • • TEL , _1—_ 1 1TE CONTRACTOR NO I, os owner of the property, am exclusrvel-y.,¢ontracting . 'a- ' with ljcensed:contractors to construct the proleci (Sec- _ ,, t „ R,,-,AL -:� ADDRESS • -tion 7044, Business and Professions,,Code:) �-,� j}t '96.* — REQUIRED TOTAL SETBACK FROM' EXIST' `- s C ` - 6.l Mt CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I. 7• '+`''. ^.1 , I hereby affirm that there-is a construction lending agency for FRONT v - Y>' ,,,l��4; r, VfC:H{��C ,Li(} the performance of the work-.for which this permit-is-issued PL. (Sec. 3097, Civ. C.).. SIDE , Lender's Name p L LDMA Ref # 4t} 11 i !1 d i n - - - P C Fee•$ Permit Fee. y e_ 3 Lenders Address o I certify that I have read this application and state that the ;' " Issuance Fee ° LDMA P/C# 8 above information is correct. I agree to comply with all County. Investigation Fee o• ordinances and•State lows relating to building'construction;• Total Fee I LDMA Perm # a and hereby authorize rep r sentative's of this County'tc enter `' t ' Pon theabove-mention d `roperty for inspection urposes. a p SEE REVERSE FOR EXPLANATORY LANGUAGE Signature'of Applicbnt or Age Date :4, TION DECLARATION �'`•'" Jt hav 'a certificate of nsent to self msu c< uorate-of Worl ers' Compensat on Insurance, r0 P L I C AT I O�N F O R ,,B hL D I N}G P E RM I T or a certified copy thereof'(Sec. 3900._C?�, '- ' - ""' _ _ - COUNTY OF LOS ANGELES BUILDING AND-SAFETY Policy Na, Company - - - - a ,Certrfie; ,copy.is hereby'furnished::; FOR'APPLICANT TO FILL.IN' BUILDING iIS ' ADDRESS' c4C,enified copy is filed with county buildi'ng'inspec- BUILDING' ' "`-pon'department ADDRESS 'Fr �r S,fi t Date` - Applicant. i CITY' VY\• -` ZIP LOCALITY �Li�U 'CERTIFICATE OF EXEMPTION FROM•WORKERS',%­ 4''' ---- -` NO OF-BLDGS -- NEAREST COMPENSATION INSURANCE•k i• + SIZE OF LOT NOW ON LOT CROSS,ST k, L•l}v( ( (This section need•not'be completed-if:thd permit'is+fo0one 1 - - -- - - - --- ASSESSOR._ "" - �,^ • c, hundred dollars,($100)or less.) TRACT BLOCK, . LOT NO' , MAP.BOOK -, `. ;'PAGE' PARCEL i-.._ _ TEL' USE ZONE. MAP' OWNER /•N a�. f1 "` 'l'� NO`� �'q NO I certify that,in the performance of the work fo'r which this' } permit is issued shall not employ any person m an'ymanner ``-- -/ SPECIAL`--- - •- --- "•--- •-- -. 4 0 ADDRESS`�OLL'�a - I^.�Qi- 5'- .. .. ! CONDITIONS. so'as'to become'subject to the Wor ers'Compensation L s. r Date- pPPlicant i CITY ._.. . ZIP ./�. _ j i r QC NOTICE TO-APPLICANT-If, after` akmg this Certificate of ARCHITECT OR �, TEL. ;O ENGINEER NO. DISTRICT'._GROUP' TYPE FIRE CESSED BY,.— Exemption;r you should become'• subject 'to''the -Workers' ` CONST ZONE' ;. U Compensation',provisions:oCthe'Lab,or.Code;you+'must,forth- ADDRESS with comply with4such-provisions .or Tthiil permit shall be -- -- - - TE `- �- deemed revoked.,,, ,•. : . „-,A , ,•� TEL STATISTICAL CLASSIFICATION APT''. CONDO• a CONTRACTOR '•, NO - - - LICENSED CONTRACTORS DEGLARATIONt :`,, -- - = LIC" = CLA3S'NO ��t ' DWELL' UNITS ' I hereby affirm tho(l am licensed under•provisions of Chapter 9 ADDRESS" NO , (commenting with Section 7000)of"Droision 3 of the Business and SEWER MAP �•' .. Professions Code;'dnd my licenaecis''in full'fo�ce and effect. CITY CLASS r "' VALIDATION BK PG - SQ FT NO. OF- NO OF _ CHECK License Number „ 'Lic.Class` SIZE' STORIES -' FAMILIES , . ,.•. .,,r.. F J VALUATION. Contractor + Date 1 DESCRIPTION OF WORK "'- - NEW, ,-� ^.�.1 ADD. am exempt under Sec. �v +; t ALTER r 1 = B:&P.C. for this reason "r GC:d :REPAIR. O — S• " - -` _. _. _._ _ Date:'. 1. USE OF :. ' p DEM "; --- " EXISTING BLDG tl,'`� L L.: .-` APPLICANT. TEL i O , i "Signature C FINAL I' ± 'OWNER DECLARATION PRINT) NO DATE- , I hereby affirrmthat I om,exempt-from.the Contractor's.License• , Law for'The following reason'(Section 7031 5, Business and ADDRESS FINAL f�Pr7o{fe`ssions'Code): >• :.:r w,..,: ._ PRESENT jay _ _ :- --_• ' ,1, as owner f the ro erT BUILDING" _ _ •_�.. __. o p p y,`or .my employees with' ADDRESS ' + ;_F;{;,• a � ' ' wages ds their sole'compensatior%,w,ill do the work and • i not intended ff f ti LOCALITY the structure s o m{e oro ered or sale(Section ( 7044, Business and Professions Code)•:`' "-' MOVING' - TEL - 1, as owner of,the property,'am exclusively contracting CONTRACTOR NO with licensed contractors'to_construct the.proj"ect'(Sec- "' -' 2 ` `"' 6 0'"3"5 A tion 7044, Business and Professions Code) ADDRESS REQUIRED_-, -.',-TOTAL SETBACK FROM-_ X T?. _...__ _ _# P. o_o o• o., CONSTRUCTION.LENDING . SET BACK YARD" HWY PROP. LINE WIDTH' the hereby erform'ance that ofthere the work fo�swhicion h thrsnderma9s'nssued cy for FRONT. 4 Y3 I 0-0'-78 0' __ _ .(Sec. 3097_.Gv-C_) . - - ---- « =_-- -- - _ =SIDE= P L 1- =8 6 Lender's Name n" �. m LDMA Ref N • +-•• '- - ._ .._ -- P'C Fee$ - - - - __..- Permit Fee` W /.'i ^� - -- . . .. _ a-i,t"t+ +" _.. {• .. Lender.'s Address f ..I.certify that I have read this apphcation;:an'd state.tKat.the __ . -- _.• - .. _ _ ._ _. Issuance-Fee / b• -J` CDMA P/C_# •• ------ above information is correct I agree to comply with'all County 0 ordinances antate laws relating Investigavon Fee T ,' dd Sjelatin uilding construction, m _ -to t - -- `^-'-- Total-Fee---- . . -- .-Q U- ' '-LOMA Perm it U and hereby authorize representatives- -this this County to enter. . a upo ,the above-mentionedperty for Inspection*purposes. a ;'�'� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or'Agent•-- - -- -- -Date• '--« -�-••_�, _ ,-. -_ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance,or a certified ' copy thereof (Sec.3800,Lab.C.) CT ZIP s ( t LOCALITY Policy No. Company SIZE OF LOT` NO.OF BLDGS.NOW ON LOT - F, ❑ Certified copy is hereby furnished. NEAREST CROSS ST: ❑ Certified copy is filed with the county building inspection TRACT r BLOCK LOT NO. 1. ,, USE ZONE MAP NO. department. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant d } ,j 11 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL No. ,r COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES No ADDRESS (This section need not be completed if the permit is for one hundredDISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I� dollars ($100) or less.) ~ ..CITY Y ZIP f I certify that in the performance of the work for which this permit 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 ' �"AQDRESS CLASS NO. DWELL UNITS !, NOTICE TO APPLICANT.' If, after making this Certificate of � REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 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. P L LICENSED CONTRACTORS DECLARATION SIDE > CITY "`� LIC.CLASS P L I hereby affirm that I am licensed underprovjsions of Chapter 9 SEWER MAP 0 (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO,OF FAMILIES V Professions Code,and my license is in full force and effect. NEW 17 BK PG LU License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION , J Contractor Date ALTER ❑ /"t LL i REPAIR ❑ ❑ I am exempt under Sec. $ Q< BAP.C.for this reason DEMOL ❑ LDMA P/C# a� Date: USE OF EXISTING BLDG. PAM ❑ fn3 Q„ Signature APPLICANT(PRINT) TEL NO. LDMA Perm# LLL.I I, as owner of the property, or my employees with wages as` ZO 143s J�J their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE 0 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL}'p OR GREATER THAN THE JWMA ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 5 {{ i licensed contractors to construct the project (Section 7044, YES 1:1 NO Eli M "�+ Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ ,�j�'�i�j 1::CK w the performance Of the Work for Which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING �a17 3097,CIV:C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS A Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address O OWNER OR AGENT o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE ++ with all county ordinances and State laws relating to building 1 WNW GD construction, and hereby authorize representatives of this County ISSUANCE FEE " 1ranter upon,ihe above-mentioned property for inspection purposes_ f! f° ' INVESTIGATION FEE TOTAL FEE of Appfi—t or Ayeof' - 'Dare SEE REVERSE FOR EXPLANATORY LANGUAGE