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Home My Public Portal About4823 GLICKMAN AVE_Building__ 76A638A CE;rB036-62APPLICATION FOR BUILDING PE IT 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. DISTfT NO. GROUP TYPE ESSED BY FOR APPLICANT TO FILL CONST. BUILDING STATISTICAL CLASSIFICATION S WERMAP ADDRESS-' BK G CLASS. NO. DWELL. UNITS LOT NO. BLOCK WATER NOT REQUIRED11RECEIVED 11ERTIFICT AE: TRACT Z CNO X/ IWAY IC RCLE> STATE MAJOR SECOND, CA NO.OF SLOGS. SIZE OF LOT NOW ON LOT USE ZONE SPECIAL n 7 USE OF t I CONDITIONS /0• v EXISTING BLDG. OWN (?�Ya BUILDINGEXIST. SETBACK YARD HWY EE �IJAME WIDTH ADDRESS x/`6- .:-G G' fi[GvFRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. ADDRESS CLO T V CONTRACT GG /L ADDRESS .1' DESCRIPTION OF WORK 44, FE ADD ALTER REPAIR DEMOLISH �-- ,� ) / 4. to Q. FT. • NO. OF NO. OF � Z SIZE STORIES FAMILIES USE OF �� 1 STRUCTURE r� SIGNATURE OF + APPLICANT VALUATION $ )�. C APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. Q 40 FOUNDATION: LOCATION FORMS, MATERIALS FEE $ FEE $ ` FRAME: FIRE STOPS. OI 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- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S MPE NSATION I SURANCFI. - LATH, EXT. SIGNATURE OF � HOUSE NUMBER COR- /,' PERMITTEE RECT AND POSTED r ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION JK. M.O. CASH _ PERMIT VALIDATION CK. M.U. CASH �0 3 2 3 3 r, f,PR 1 2 3 D �ft�;o 3 4 7:� AIPR 1. 3 "� D 57 0- v 4 ' I ' APPLICATION FOR BUILDING PERMIT COUNTY OF LOSVVGLL' S BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT.TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS' or a certificate of Workers' Compensation Insurance,or certified - �� 7 / copy thereof(Sec.3$00 -ab.C.) CITY. L ZIP 1 �� C Policy No. , O /✓ 1 C LOCALITY Company SIZE F LCT NO.OF BLDGS.NOW ON LOT ❑ Certified ereby furnished. NEAREST CROSS ST. ertified copy is filed with the county building ins tion TRACT BLOCK LOT NO. depa tmept. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. YES NO COMPENSATION INSURANCE S M WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS LDISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) �C�'�e CITE ZIP !� �y I certify that in the performance of the work for which this permit �n �L V �� //is issued, I shall not employ any person in any manner so as to ARCHITECT O NGINEER TEL No. V become subject to.the Workers'Compensation Laws. .STATISTICAL CLSIFICATION 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' CONTFJAC.TOFi ¢ �7 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 11�`I Cl S FRONT comply with such provisions or this permit shall be deemed revoked. ADDRLIC.NO. SIDE PL S LICENSED CONTRACTORS DECLARATION CITY Q LIC.CLASS P L I hereby affirm that 1 am licensed underprovisions of Chapter 9 1/ (commencing with,Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP � Professions Code and my en in full force and of ect. NEW BK PG Q DESC PTI OF WORK VALUATION , 0 License Number t Z V Lic.Class ct �} Q� _ v ADD ❑ $ / /�j Contracto ae '�( I ALTER ❑ ��J v — y OC ElREPAI I am exempt under Sec. $ $ H B.&P.C.for this reason 2� r* DEMOL ❑ LDMA P/C# Date: USE OF IST G BLDG. r URM ❑ I L s < < ... N Signature a HL —.a•_= = 60 Z APPLICANT(PRINT) L K LDMA Perm# ❑ I, as owner of,the property, or my employees with wages as 11 �V Z their sole compensation, will do the work and the structure is ADDRESS O A not intended or offered for sale (Section 7044, Business and . g ®�j r0i FINAL DATE a t'` Professions Code.) + IJn WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL L ❑ 1, as Owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE.HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, _iF�i�,'I Business and Professions Code.) YES El ❑ `G WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �;:� •t, E•'•i1'# '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 1:1No Ela 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 SCAOMD PERMITTING N ) 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 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. IL Lender's Address 0 OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building vK oo �e nstruction, and hereby authorize representatives of this County ISSUANCE FEE t ent p�y t above mentio d property for inspection purposes. 1p. Q is1.n�1L 0 3 g INVESTIGATION FEE TOTAL FEE me— r Apoiment o, sent Date / k? SEE REVERSE FOR EXPLANATORY LANGUAGE