HomeMy Public PortalAbout4855 GOLDEN WEST AVE_Building__ (2) fl
76AC38A CE#8035-61APPLICATION FOR BUILDING P IT
COUNTY OF LOS ANGELES BUILDING 3 LL
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION _LOCALITY I
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DIST ICT O. GROUP TYPE SSED BY
FOR APPLICANT O LL IN , �► CONST L_
BUILDING � - STATISTICAL CLASSIFICATION S WER MAP
ADDRESS
./�� 9 L' . BK PG
LOT NO. •/ }- Lel -��%� LOCK WATER
CLASS. NO. DWELL. UNITS
CERTIFICATE: NOT REQUIRED RECEIVED
TRACT r. � ? MAPHIGHWAY
STATE MAJOR SECOND, LOCAL
NO.OF SLOGS ,,,� s NO. ICIRCLEI
SIZE OF LOT NOW ON OT0�— USE ZONE SPECIAL
EXISTUSE ING NG BLDG. - � , /� ) CONDITIONS
OWNER ��� y �US"�1/� d/' / BUILDING EXIST.
�!' SETBACK YARD HWY ;� NAME
WIDTH
ADDRESS FRONT QQ►►,�{ hJ
ARCHITECT OR L. P. L.
ENGINEER SIDE a.
P. L. O
ADDRESS ()
� Eyp , IN,$P L r
CONTRACTOR- �N ON RCORD wO
ADDRESS
u
DESCRIPTION OF WORK a /t'. c N
rr Z
NEW ADD ALTER REPAIR DEMOLISH
SQ. FT,. NO. O NO.OF
IZE _ elft
FAMILI
USE OF
STR��'� O'-erl-P
SIGNATURE
APPLICANT
VALUATIONS
�E APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. -Z^, FOUNDATION: LOCATION
FEE $L� �_ FEE $ FORMS, MATERIALS !
FRAME: FIRE STOPS, .,.'
IHEREBY 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. ICERTIFY 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 COMPENSATION INSU ANCE.
LATH, EXT. �!
SIGNATURE f ►. HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS��..�__ - -- FINAL
�J CLYDE N. DIRLAM, PRINCIPAL STR VIAL ENGINEER
PLAN CHECK VALIDATION ( CK. M.O. CASH PERMIT VALIDATION (cr- Ijw.o. CASH
# WORKERS'COlVIPETJSATIOt� DECLAPATION -
hejepy FOR
4tr firm thyat I havb a certificate of.con-sent to self _. _ _ L CA "I
Irl .,
or a certtfitate of Worker Com rratloA Insurance . _ ALDI PERM
1 T -
o?p cgrldfl copy, ereof(Sdc 3800, L -C.) AP
-
COLINTY Off'LOS.ANGELES,. BUILDING.AN_DFET1(
Policy(Jo. � rrtpany r
Cerflfledcopyis hereby fu ed ADDRESS
FOR APDL IVT TO FILL IN ADDRESS MLDING J,5/s
Cert fled'Gopj�ls filed with'the coon bulldlnq lt4pec- BULD{NC
Hbrj deparImdnt: t ` ADDRESS
Ddte / i. Applicant LOCALITY
- ZIP
--
CR7IPrC)ATE OF` 10N t '- - NP• OF BLDGS. _ _- ._. , NEAREST
COMP�ISAN INSU S(ZE OF LOT NOW ON LOT ST t .,
(Thlr s'ectlon'i"d not be corm Isted ff the permit is for:orN
_bundled dollar.(=1QO.)or leis'. _ - MrfP BOOK' - PAGE, P.
.,r `fEL
OWN
i cert that In•the an
Ky a cp of the tvaic for whlFh this - � - - -..NO Ug / NO ;
ermlt Is fssued,'I shpll' t employ any.pr�a,l�,.�6, In arty nher _-' - ' SPECIAL• -- - - . . CL
'-- La oa to beto,(no b�ect-.to tfie W6rkenrCompenai#tld ADDk&55- - `I-- V
Applicant - - - - - - , CK' -
r}OTICF TO 'APPCJ�Mff: hF; affer_m8kli thisCeittfimfe of ARCHffECT OR (y, t;RO(1Q:- .TYPE. - _FIRE BY 0
f cerhptloh,' you'ahoOld become• ulblect' to' the Workers' y zb�
Crompen;atlon provisions bf-the'toborCode;you:must forth-
with.comply with such provlslons or"this,-perrhp &ball be" - - _ -- -` r"� - --
d tnp�.rt�voked. CONSTATISTICAL CIA_1aFCA - AFT
• f
UCENSED CONTRACTORS DECLARATION r.. - - - __ - CLASS NO. UNfTS L -
I hereby affirm that I Grp IcIensed under provfslons of Chapter 9 ADDRESS - -t p - —� LE 1~
(4OfT1 .rta'. th 7000)Of dlvWon 3 of the'Buslr�and -. - --.,- __ �r - u� -•_ 1_ SEWER MAP „•. I
Prof zoi s Code, and rry IIcerim Is in fuII ford app @Ve> t. QTY / CLASS -
NO.OF NO. PG. I _-
�� .Num�er LFc C`I -..-. F -- - ONE n.{,'J, . .
_ • VALUATION. - - - - -- -
r DE5MPTION OF WORK'
'Contractor �I
I am exempt u Sec - ADD -- - - - — k
B.&P.C_for thH reason _- - _ - -__ - '. - -•. -
.._ _ � REPAIR- �
'Dafe:` DQSll1JG / DEMOL _ j-_ .
Slgrrafure,.��`: ..r .-� - - -- ,- - _ •- T1Z FINAL
OWN�R$UIWER DEClARAT10Nr
h h4rgby affirm that I am exempt from the-Controctoes Ucen&e --
Law for the followlhgYeaion (Sectlgo 7031.5, Buslnees End ADDRESS
�rbfes&Igris Codej:
BUILDING
�. I,,as owner of the property, or my employees with ADDRESS_
• - - -.
as their sole com ration will dd'ihe and
wogbs pe Yvork .
the structure 1¬ Intended or Offered for sale(Section QTY -51.5,3-A
.'
T04J, Bu&Ineas.Orrd Ftofottlotu Code MOVING
I, as owner of the prdp", am exclusively contracting `"
with licensed controctori to construct the.' ect _ .. _ - .--•-- -.- _ .. _ '. • _
> I (�=
tion 7044, Businela.and Professlons Code} ° °-6-
ADDRESS $6 I
CONSTRUCTION LENDING AGENCY', - YARD FWY - - - -+ =' -
I hbreby affirm that there Is a constructlpn Iehdl'ng agency for J FRONT PROP.LItE WIDTH i-o o �j i fj
the perfgrmaoce-of the work forwhlch this permit b Issued P - - _-- _ _... _ y
,(Sec. 3097, Qv. C} SIDE Q 7; ,8.�j
P.L. ]. i
{Lendges Name
Ref. �
P.0 FM; - - - Permit FM - a. I
L4ertify that I have read.this-Oppllcatlon.arrd staid thrar the _ lot
�: .` - - ---- Issuancs Few - - - -- LD�i4 P/C* -
abgve.lnformallon.lti correct. I wee to comply with all County Invv&tkpdtbn Fee 4
_.ordinances gra Stgtq lawn rolpfing to building constrVct►on, _
LPMA Perm.-0 - -
iiiJJ7 and her ati
uthorize representatives of this County'to ent+r
upon the v mention property for I on Purpgses.
M RI<Vlflt FM UPL,ANAT04Y-1./1liGUAGN
Signature of ApplkantorAgent _-
4ate �-- .•._.. . ----- -- - - - .- ... .__. __ _ •.- - - -- - m i
wO"f'COMPENSAil(J 4Ep`T'(ON
_ r t:
I.F»reby acau fiff-tatca I Faye f`W q ceritomp o ton1iis to self APPLICATION. FCSR�SU.ICDING PERMIT
fnsuros br.a Certificate qf-1Norkers' Compe•nsafion Triaurance, y
'or'grerttfled-copy'Thereaf(Sec. 3800,`-Lab: C.) .• ', ,- ' '- -' --. __..w.---_---- -_--_ � Cer�
tOUHlY'OF t0; AiI]GELES BUS N N15'SAFtrT.' _
CertFRed copy ls,,haf rnlahed . POR APPCICAN TO .11.41N '4 (, {�
L� Celtlfied cojri-'01(e� wfttrtfie egurity a'ulrgtw,I+ Peb BUILDI
L tlon de0art7ne'ht.
Dat.' + Appllchnt - GV --- -- ZIP 01,0CALITY -
' F10ATE QF EXFAAPTkw WORKERS' 1: �, t -N6 G -- - - `±r � - -- - ... _ _ �._ 4
COMPEN' TKX4 INSURAcNGB;t,' SIZE OF LOT NOw 01t 7' ST. r., r'-ti r
�..
_ .-. h seatlon need-net•bc Fomplet4d ff the permlt bs forson.' TRACT' BLOCK- -- L07 NO. - M e "' ,?AGa P !
k?undred
Al 00)or1igs}� .. -
Y: Ug ZONEMAP
r tfy tftat lii'fi,a peQ�map�ce,of tkia wont fob�JhlSli this' ~. - r ` N
permit-h fssued i itRall of hi I a� r1)d'a'n mahner _ _ _ j -- - r -
a P9Y yl�. Y
j - COM
--�1aY'to become"iul5lb(:t'to`if5p Worlier�Comp�rtTt'atlohT.aws.. .
It Tr
TICf'�O APPI I. if, '8fre r-makln�"thUj CgrtfHEate• AR��171CT OR »i DISTR)�_- GRC?lJP TYPE. RK _ Y 3
[[�� NO.
�Xornptloo; yb'u -ihbilttJ becort�e sdblect-to'the• WoNceri
Compensatlon provlglons of ffie Labor Lodex you�nusT_forth- ADDRI=SS
wlth.,comply_with..Wch. provlslobs ,or, this,permit; shall be --_. _ _ ._ . _- _ - '_ --•- _ --
¢}}mPd.revoked" No-407,0
STA195 ICAL CLtiSSIFICATlON AFT. '
sK .�. ,•I� •., .t CONTRACTOR NO. �•�,_, _ _ _.-. - _ __
LiCENSEp CON7RACTOIf.S DECIARAI}QA1 - - _ _ -- -1lC l�°�NO �# D'�L UNITS
' I.herek�Y If+n(haT l pm Ilcer»ed under pwvls)ors of Chapter 9 ADDRESS,` NO.
�comrty�r>SJnO w SectloP 7000).9f Dlvlil_oj,3'of the nbu and - _ SEWER N�
Pr¢feialoi{i Code,-aod iriy IlcehJw is'Jr> lrforcb d eff t. _ <]TY. CASS -
6K pG. --VAF_DAMN
�} �'• tS FAN
LES
1J"ciru�s�lumbeS. �-�L,�—LJc•'(.`1`air 1'�_I - - .: ,
(4urttroQfof L` Y? yw-izj f*�'� �•. Dt12IPi10N of Woax �' = IYJ - ; t� D04�, ..I�{.
ADD
l,an exempt under'Sbc' �� �l
AlfER
S.dP.C. forthls mason - UR
USE OF
DEMOL 1
EXISTING BLDG.
r _ '• --Q1 N l V>Fk DECI_ARATI ON __ _ -_ -_ _ __ ____ , __ _ DATE •�% _._.-. .___.__.'- i
Irm that Fora-exam from the-ConWagtWs Manse
Lcr�i for the followlia>UtrpUsoh (Secridn 7031.S,.Buslness aed ADDRESS
Pco#asilbt#1 Coda): ��_-.•:. _, _� - _-T = .z.��;_
r. : BUILDING
I, as owner` of'.the Ptopbrty-, pr rP employees,Wlth- — �S - — - -�- -- - ' -
wag" sq p�r,sgl Q LOCALITY
ir'C9 T '. 2 0 8= 8
M their T com I n,w II do the work ar4d
the stnxfur'n Is not Intended or.offpred far sa1.41(Sgctlpn �' "� f•' t
7W�, &nlneas'oudTP-ofesCons.CadeJ- -. mcm" r _ _..- .TEL-
-p",
Q' 1, as ownbr.•of the property,'bm exclusively contrbdlpfl - - _�-
pvlth llcenfed contcacTors ro consir}ict'thb project ($ec- -
F:tion 7044, Bwlnen and Profeslons Cod•}
-_.. CONSTRUCTION LENDING AGENJ __"- BACK - Y I Ivv1 PROP. UDE L SETBAC3C FROM 'WIDTEXrSTH
FRONT
dee performance'of he work-for.whlch thirppe�m,l�:sued
(Ser, 3097, C1v. C-)- SIDE
Lender's Name' r_
L.nder''s Address -
I_certtfy that I Fav* read this 6pplIo6ma}and statn_tFwt the _. - - ._ _ . lssoarxy Fe. _ _ -� LDMA P #_ _ -, o-
11
_
above Informatlon js correct,I;o¢ge_to'cgm*ydlth:all County InvMtlQotlorr Fee
o RPf ".9nd StgJq (aws,TelatiDfl to._�u(Id)hp 4oi t!uqtlon, --- - - Tdal Fe.
i7 ff tthh
and hereby authodid'rppresentdtives o Is County to arltw
upon tFro above-nentloned prop"for Irappctlon pixpg"s..:`
. 1, ~. f♦•■'�1/�f!PO!D�LANATU[Y LAMQ11l1W � �. i J
-V.+....w...Ot}YpllCant'Of AQan}, _ _- -_'DQt. - ��— Zr T �- _t__. _ .. -._- .�.�.� - .i , _- - _ _ ._"-� __ .. .t _ - _-- _ __1♦D I