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HomeMy Public PortalAbout10777 FREER ST_Building__ TIEMP _76A638A CE�r9C32-63 APPLICATION FOR BU'ILDING .PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDREss BUILDING AND SAFETY DIVISION .LOCALITY- :JOHN A. LAMBIE, COUNTY ENGINEER NEAREST / WILLIAM A JENSEN, SUPT OF BUILDING CROSS ST _ DIST CT N GROU TYPE PR CES Y FOR APPLICANT TO FILL INO CONST. BUILDING /.r , - STATISTICAL CL SIFICATION •SEWER MAP ADDRESS27 x- BK bfP CLASS NO DWELL UNITS LOT NO BLOCK WATER - r El NOT REQUIRED RECEIVED TRACT 3 61--3 MAP HIGHWAY - —� NO OF BLDGS ...NO - (CIRCLE) STATE MAJOR SECOND, OCA L'• SIZE OF LOT Q ,S NOW ON LOT USE ZONE SPECIAL USE OF - CONDITIONS - - EXISTING BLDG I � ­ T /1 OWNER c Cy N BUILDING YARD HWY STREET NAME EXIST. �Z SETBACK WIDTH ADDRESS FRONT ARCHITECT OR - TEL, P L .C///• t/�, ' ENGINEER NO. '� SIDE d ADDRESS. O CONTRAC ZI /jl/ r 0 O ADDRESS . C 1 DESCRIPTION OF •WORK l avm, W'/, � � w NEWS A ALTER REPAIR DEMOLISH ',���+*✓ _ _ ��Q SQ FT. NO. OF NO OF• 4�•c• ?e SIZEKiA STORIES •f FAMILIES { �I USE OF le . STRNCTURE \ IGNATURE O & - - cPPLIC:A ` A)� VALUATION S V -ylq APPROVALS EYATE I NSP ECTOfl�S,S I G N AT_j PC PMT FOUNDATION -LOCATION F - FEE FORMS, MATERIALS - FRAME FIRE STOPS. / - •I HEREBY ACKNOWLEDGETHAT 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- LATH, INT TION OF THE LABOR CODE OF THE TATE OF CALIFORNIA�RELAT- , ' ING TO WORKME S MPENSATIO URANC_Er LATH..EXT. ✓'� SIGNATURE ® HOUSE NUMBER COR �® - PERMITT RECT AND POSTED ADDRESS -.0 FIN 6'L JOHN F. LEWIS. PRIyCIPArL STRUCTUSAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ 0 PERMIT VALIDATION cK M.o CASH LAC�b,5_,*5 4G-'SEP-24 1 p 2>S rJQ v 76A638A CE 0803 1/71 �� �� APPLICATIONF8"U,ILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING O 7 ADDRESS COLEMAN W.-JENKINS, SUPT OF BUILDING LOCALIT-Y FOR APPLICANT TO FILL IN NEAREST CROSS ST. Print ort a onl _ _ DISTRICT NO' GROUP TYPE P CESSE� BY BUILDING .ADDRESS • Q 7'7 E �F (>• CON LOT NO BLOCK STATISTICAL CLASSI'FICATION SEWER MAP // /f CLASS NO. I_DWELL,UNITS__(_­) BK - PG TRACT SO/ USE ZONE MAP NO,OF BLDGS. NO. SIZE OF LOT - NOW ON LOT •� /1 SPECIAL USE OF / CONDITIONS EXISTING BLDG. G-C S��/�Ne 9_ OWNER' a NOL 3.7 7 BLDG.SETBACK FROM ADDRESS R FFtONTPROP.LINEOF - -(STREET) e j TYPE OF EXISTING' SETBACK HIGHWAY + YARD TOTAL CITY - L ef� HIGHWAY WIDTH FROM C.L. ' ARCHITECT OR TEL. + _ .ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF - - (STREET) MESE �FT TYPE OF EXISTING SETBACK HIGHWAY + YARD • = TOTAL O CONTRACTOR d 6 HIGHWAY WIDTH FROM C.L. _ CD Lc 'ADDRESSS759 E NO 75'3 + - � O CITYZ O/Vj.E 4 CCC ILASS C 'rCORNER CUTOFF YES [J' NO ❑' w CONSTRUCTION LENDER a NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS z ADDRESS SQ. FT. NO. OF NO. OF NEW SIZE TORIES F LIES a s USE OF _ ADD STRUCTUR ALTER ❑ REPAIR❑ 'SIGNATURE OF, APPLICANT DEMOL ❑ , s VALUATION $ , APPROVALS DATE INSPECTOR'S�S IG-NA'TU RE P,C PMT, C7'(7 FOUNDATION: LOCATION FEE S 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, WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMP EN TI LOY ANY PERSON VIOLATION OF THE LATH, INT. ' LABOR CO E OF.' THE STATE OF- CAL I OR IA IN RELATING TO WORKMEN'S O PINS ANCE LATH, EXT, SIGNATURE HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ' ADDRESS FINAL - JOHN F LEWIS, PRINCIPAL STR T RAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK , M O CASH , � CO 2 2'4. 9= "SEP 7 1 D 1:2 ' Q ' �an ' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES , BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I-hereby-affirm-that-I-have-a-certlflcate_of_consent_to_self insure, BUILDING ADDRESS 1O r S or a certificate of Workers' Compensation Insurance,or a certified i copy thereof(Sec 3800,Lab C) CITYZIP �7 — - —- -—— r r v LOCALITY POIICy NO Company SIZE OF LCT NO OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished I NEAREST CROSS ST OCK LOT NO E3 certified copy Is filed with the county.building Inspection TRACT BL department. USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS ' CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER E O COMPENSATION INSURANCE &0 voo/J r -iso-v) 7 WITHIN 1000 FT OF SCHOOL" YES NO (This section need not be completed if the permit Is for one hundred ADDRESS' '77 A DISTRICT GROUP TYP CONST FIRE ZONE PROCESSED BY dollars($100)or less) ' CITYn ZIP � /j _ I certify that In the performance of the work for which this permit I' �' �Q ©(jJ� - is issued, I shall not employ any person In any manner So as to, AR HITECT OR ENGINEER TEL NO become Subject t0 the Workers'Compensation Laws STATISTICAL CL�AAASS,SIFICATION APT CONDO Date Applicant ADDRESS 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 SET BACK CONTRACTOR - TEL NO , 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 DECLARATIONSIDE . CITY LIC CLASS P L I hereby affirm that I am I1censed underprovisions of Chapter, 9 1" (commencing with Section-7000)of Division 3 of the-Business and aSQ,�FT IZE NO.OF STORIES NO OF FAMILIES SEWER MAP C Professions Code,and my.license is in full force and effect L►O NEW BK PG , U License Number Lic.Class DESC IPTI NOF WORK ADD ❑ VALUATION Contractor Date 0-o { ALTER ❑ oA 0 ❑ I am exempt under Sec. rN REPAIR - ❑ $ U BAPC for this reason DEMOL ❑ LU Date USE OF EXISTING BLDG - URM ❑ LDMA,P/C# N i Z nature - APPLICANT(PRINT) TEL NO LDMA Perm# ' I, a _owner of the property, or my employees with wages as 2 their sole compensation, will do the work and the structure Is ADDRESS _0 - not tended or offered for sale (Section 7044, Business and FINAL DATE Q ) Prof ssions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - 1im Ss OR A'MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, S owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE1 q - a ensed contractors to construct the project (Section 7044, -ves❑ NO❑ FINAL BY rl/`/IiY, DI i;AL �03 ® 05 Business and Professions Code) _ WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING -` !,��(, �I.J-; OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR CHANGE z lrj - - I hereby affirm that there is a construction lending aGUIDELINES'agency for YES❑ No❑ a the performance of the work for which this permit is issued(Sec rn IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING _ ' 3097,CIV C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, it SI 03-0001 i I_s,I II:I ilf/ -i�' TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS �.�J,7. •J_ i 3 Lender's Name MATERIALS REPORTING AND FOR 08TAINING A PERMIT FROM THE SCAOMD I _ - o Lender's Address 19=91 AM - 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 PC FEE PERMIT FEE with all county ordinances and State laws relating to building CO constr tion, nd hereby authorize representative of this County ' ISSUANCE FEE to ent upo the abjove-mentioned rope y for In ection purposes. , .[i �, / INVESTIGATION FEE TOTAL FEE �qn ure al Ap is nt or Aqe Dale SEE REVERSE FOR EXPLANATORY LANGUAGE