HomeMy Public PortalAbout10791 FREER ST_Building__ 7eA898ACE#81a9..�57.APPLICATION FOR BUILDING PERMIT 1
COU14TY OF LOS ANGELES BUILDING
EPARTMENT OF COUNTY ENGINEER °DDRESS
•D
BUILDING AND SAFETY DIVISION -LOCALITY
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING 'CROSS ST. j '
DISTRICT NO. - G OUPI TYPE SEWER MAP
OR
FAPPLICANT TO FILL IN BK
CONST.
BUILDINGn STATISTICAL CLASSIFICATION
ADDRESS � J vc.•�� - -
LOT NO. BLOCK CLASS,NO. DWELL.UNITS
MAP STATE • YES O
TRACT -• NUMBER- �'6 HWY. '
USZgNE SPECIAL
NO.OF BLDGS. / CONDITIONS
SIZE OF LOT I NOW ON LOT t,/
USE OF V
EXISTING BLDG. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
OWNER 067 FRONT
.MAIL P.L. �Q
ADDRESS' D SIDE
TEL. -P.L.
CITY
TEL. INSPECTION RECORD
ARCH ECT TE �•�
ENGINEER NO. i
ADDRESS
TEL
CONTRACTOR N -
_ 16v' /GLtcl�
ADDRESS • DES RI ION 'O WORK �``'R
NEW' AqD/
D -' ALTER ' REPAIR DEMOLISH
T ` Al."
S ZE TORIES FAMILIES _
USE OF STRUCTURE
SIG ATURE OF APPROVALS
APPLICANT
DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION p�/G �/ /,
_ FORMS.MATERIALS IT i ,p)(,(�'
$ FRAME: STOPS
FEE BRACING.BOLTS
VALUATION S Q FURNACE: LOCATION, '
FEE 1J GAS VENT,DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT
PLICATION AND STATE.THAT�TNJE A OVE IS CORRECT AND AGREE TO COMPLY WIT OU �IN'G'
DINANCESANDSTATE LAWS REG 1 ' U INSTRUCTION. LATH,EXT.
SIGNATURE OF i HOUSE NUMBER COR-
PERMITTERECT AND POSTED
r..
ADDRESS CL FINAL
CLYDE N.DIRLAM, RI NCI PAL STRUCTURAL EN
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
T` ,3 '7`1 5"n AUG11 ti. A 8.50 to
APPLICATION FOR.* BUILDING PERMIT ,
COUNTY O OS F L ANGELES BUILDMIG 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, (� SEE�L
or.a certificate of Workers' Comion pensatInsurance, or a certified
Copy thereof(Sec 3800,Lab C.)
Policy No Company ITY �E �I
-r—
P ' yJ LOCALITY -
SIZE OF LOT NO OF BLDGS NOW ON LOT
❑ Certified copy Is hereby furnished I NEAREST CROSS ST
❑ Certified copy Is filed,with the county budding Inspection TRACT BLOCK LOT NO
department USE ZONE. MAP NO. .
' -ASSESSOR MAP BOOK PAGE - PARCEL
Date Applicant 'SPECIAL CONDITIONS _
CERTIFICATE OF EXEMPTION FROM.WORKERS' ow ER TEL NO -7 YES No
COMPENSATION INSURANCE -3 6 � EZ- Sn S Z, 1 WITHIN 1000 FT of SCHOOL" ;
(This section need not be completed if the permit Is for one hundred ADDRESS n
DISTRICT- GROUP TYJPE CONST FIRE ZONE PROCESSED BY
dollars($100)or less)
CITY ZIPc�
I certify that,In the performance of the work forwhich this permit — t i:r-:1
Is Issued, I shall not employ an person In ' manner so as to
become s b1e t to the Workers' ompen Ion Laws ARCHITECT-OF?ENGINEER TEL NO
\b STATISTICAL CLA SIFICATION APT CONDO
Date(b �� Applicantr ADDRESS - CLASS NO DWELL UNITS
NOTICE TO APPLICANT If iter making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should ec me subject to the Workers' CONTRA TOR TEL NO Z! SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions o th Labor Code, you must forthwith C� R R CC. Z(o�J 1 SZr FRONT
comply with such provisions IS permit'shall be deemed revoked ADDRESS LIC NO P L
LICENSED CONTRACTORS DECLARATIONA��Z""�`' (65 SIDE
CITY LIC CLASS P L
I hereby affirm that I am licensed underprovisions of Chapter 9 Oe-2Z_ C--39 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business anis SQ FT SIZE NO OF STORIES NO OF FAMILIES •
Professions Code,and my license Is In will force and effect f NEW BK - PG ® a
License Number LIC Class DESCRIPTION OF WORK ADD ED] VALUATION Q
is c��F w i �..-f $ ��fQrf. U
- Contractor •• Date ALTER ❑
A—W-f IFA G 6Z ��TC' REPAIR ❑ O
❑ I am exempt under Sec $ F-
B&PC for this reason T DEMOL ❑ LDMA P/C#. W
Date. USE OF EXISTING BLDG URM ❑ - CL
Signature APPLICANT(PRINT) ,- TEL NO LDMA Perm# - - s Z
❑ 1, as owner of the property, or my employees wZith wages as -
their sole compensation, will do the work and the structure Is ADDRESS _(
`y.S i�• �L°d
ATE
not Intended or offered for sale (Section 7044, Business and FINAL D�" )
Ir<�/ 1
Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALqq
1=1"�
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'S FINAL BY 5 f-_.1 AL 169 - 65
licensed contractors to construct the project (Section 7044, YES❑ NoI '-
Business and Professions Code) }jCi_:; 1 9.6,1
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ,- 1�f
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR CHANGE
GUIDELINES
I hereby affirm that there Is a construction lending agency for YES❑ NoX
cu the performance Of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTINGIFjS'-.� ! 4 31 14
3097,CIV.C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - -
TITLE 2,CHAPTER 2 20 SECTIONS 0 100 THROUGH 2 20 140 CONCERNING HAZARDOUS
Lender's Name MATERIALS ZIEPORTING AN OBTAINING A PERMIT FROM THE SCAQMD Jr1 d AM 1{4,lj2
o Lender's Address 6 0 �-✓�
O OWNER ENT -
o 11 certify that I have read this application and state under penalty
O of perjury that the above Information Is correct I agree to comply PCF PERMIT FEE -1
,
with all county ordinances and State laws relating to building
m construction, and hereby authorize representatives of this County ISSUANCE FEE
ID to enter upon the above-mentioned property for Inspection purposes. T]'"
9,- INVESTIGATION FEE TOTAL FEE
SgnaWre of AppLcan,or Agent Dale -
--- SEE REVERSE FOR EXPLANATORY LANGUAGE