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HomeMy Public PortalAbout4836 GOLDEN WEST AVE_Building__ + A ROAD FOR Z, DONE 78A688A CE#8038.59 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES ADD BUILDING ISS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST i CASSATT D. GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRI.Sil NO. GROUP TYPE C - 'PMIESSED BY FOR APPLICANT TO FILL IN 7 _ CONST._ BUILDING STATISTICAL CLASSIFICATION I S ER MAP ADDRESS ,�j� lei BK PG CLASS.NO. DWELL.UNITS LOT NO. 0k BLOCK MAP NUMBER S�..ITyATE YES TRACT �cUSE ZONE SPECIAL -- — NO.OF BLDGS.pN�1 /yf.- CONDITIONS SIZE OF LOT _T0eOI ' I NOW ON LOT `Y F USE OF EXISTING I%LDG. BUILDINGEXIST. SETBACK YARD I HWY ; TR,E `T NAME WIDTH OWNER FRONT .yam / L�3 ADDRESS SIDE MAIL e� TEL. P.L. CITY NO. INSPECTION RECORD ARCHITECT O TEL ENGINEER NO' ADDRESS Q T '!I ,� TEL I� !"� "` �J•i'� 0'J .r ' C CONTRACTOR ADDRESS DESCRIPTION OF WORK NEW V ADD ALTER REPAIR DEMOLISH SI FT. NO. OF NO. OF SIZE STORIES - FAMILIES IUSE OF 41-12 �L•- STRUCTURE SIGNATURE OF APPLICANT SAPPROVALS DATE INSPECSAR'S SIGNATURE FOUNDATION:ATION: LOCATION r s FORMS,MATERIALS �- VALUATION $ + FRAME: FIRE STOPS, GG BRACING, _ BOLTS P.C. PMT. i` /' C� FURNACE: LOCATION, FEE S- I FEE $ GAS VENT, DUCTS 1 H REBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND I-P`'H, INT. AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RE LAT G UILDING CONST UCTION. LATH,EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS - � FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 1 '&a 7 a0 9 6S 4MAR 1 2 .3 A 21.0 0 L[SCo7378 'M g 1 A 4 2.0 0 ©5 76A638 C ( E NB03(REV.6/78) �rf APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING 4 FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS Jk I LOCALITY NEAREST CITY ZIP CROSS ST. {.�. NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCES$E BY TRACT BLOCK LOT NO. CONST. z Jj/ OWNER A 1 7 STATISTICAL CLASSIFICATIONSEWER MAP ADDRESS 4�431-0 0 CLASS NO. DWELL.UNITS•�� BK PG CITY ZIP ARCHIT C OR TEL. ENGINEER NO. VALUATION ®©C� ADDRESS BLDG.SETBACK FRO F TEL FRONT PROP.LINE OF (STREET) CONTRACTO NO HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING _ LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS D NO LIC. CONSTRUCTION LENDE + CITY CLASS BLDG.SETBACK FROM NAME AND BRANCH ) SIDE PROP.LINE (STREET( G a HIGHWAY + YARD __ TOTAL SETBACK FROM TYPE OF EXISTING a" ADDRESS �LJ I t-j v SIDE PROP.LINE HIGHWAY WIDTH It SQ.FT. NO.OF NO.OF ICHECK + = u SIZE STORIES FAMILIES ONE IM DESCRIPTION OF WORKNEW ElP.C.Fee$ Permit Fee Z 7 0 �� r ��� (ADD ❑ Issuance Fee c� N ( ' nl ALTER ❑ r> Z REPAIR ' E To ee 3T c ESE F DG s / DEMOL O APPLICANT TEL ro' PRINT( �, N ii y ~ _ o �5-707, 6A ` J BY(SIGN U -C . a00000 � I HE Vg�A�THAI E E D THIS APPLICATION AND STATE `THAT THES CORRECT AND AGR COMPLY WITH ALL ORDINANCES W 2 0 0 3 [�0 0 ANDLAWTING BUILDING CONSTRUCTION.I Y THAT IN DOING THE S WORK AUTHORIZED HE EBY I WILL NOT EMPLOY A PER N IN VIOLATION OF V THE LABOR CODE OF T STA OF CALIFORNIA IN RE ATING O WORKMEN'S COM. Z .0 o e 3 [f� 0 0 v PENSATION INSURANIL Q J 0,0'5'-79 SIGNATURE OF PERMITTEE ADDRESS Z O TEL. Y N G EZONE MAP :� � � NO. Q > SPECIAL •- CONDITIONS FINAL BY a DATE (,' 'j`i; I - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDyygqE�Jss BI�LDING ADDRESS 09 ^�-FYI I hereby affirm that I have a certificate of consent to self insure9 I, L/9�/ /p) _pig w� or a certificate of Workers' Compensation Insurance,or a certified 0 b (? l(i( S copy thereof(Sec.3800, Lab.C.) CITYe- . ZIP 7 LOCALITY Policy NO. Company SIZE OF LOT r NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed.with the county building inspection TRACT BLOCK LOT NO. department. I USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER J TEL NO. C81 i) COMPENSATION INSURANCE /Is,("I / J e �t(�u 2 X__C qq5 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars ($100) or less.) u 6 CGa I""Pe, W.2's DISTRICT GROUP S RE ZONE PROCESSED BY e I certify that in the performance of the work for which this permit QI Ae-., J C� 4 ZIP // 7 y O ��� 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 ADDRESS 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 PILE CITY _ LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 EWER MAP >_ (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES 0- Professions Code,and my license is in full force and effect. Z 3, I NEW BK PG License Number Lic.Class DESC IPTION O�WORK ADD ❑ VALUATION ' V Contractor Date P V-4'1 1 C V Z P 1' `Ln cc d p ALTER ❑ El am exempt under Sec. t aO—s REPAIR ❑ $ V BAP.C.for this reason DEMOL ❑ W LDMA P/C# IL Date: USE OF EXISTING BLDG. URM ❑ _0 ;v Z Signature APPLICANT(PRINT TEL/ TEL NO. LDMA Perm# - - ••-- - I, as owner of the property, or my employees with wages as j r �G� (GLv�cr (d�c 2�G 9/ 7 Z r' L their sole compensation, will do the work and the structure is ADDRESS r/ O ';.?,{^ ;._ not intended or offered for sale (Section 7044, Business and C dJ G G d r.�e.� FINAL DATE P Professions Code.) TTI } WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE / i s AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > , �) �.ig 2 yz ..Fx.._,3 licensed contractors to construct the project (Section 7044, �`-t t i_ 3 Business and Professions Code.) VES El NO ,�`/ _c; WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �+ / p/ -. CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR let-, / �. dw 711) GUIDELINES. hereby affirm that there is a construction lending agency for YES❑ NO❑ C4 the performance of the work for which this permit is issued(Sec. m I HAVE READTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,.Civ.C.) a CHECKLIST. UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, e{i„=_, �,_�_ 3;�t,•'�_ TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS r Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address p 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 N with all county ordinances and State laws relating to building ro construction, and hereby authorize representatives of this County ISSUANCE FEE !I � to enter upon the above-mentioned property for inspection purposes. (� < q3 INVESTIGATION FEE TOTAL FEE a Aoollcam o�Ageot ^� \\\ ` SEE REVERSE FOR EXPLANATORY LANGUAGE