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HomeMy Public PortalAbout5459 GOLDEN WEST AVE_Building__ APPLICATION FOR � r BUILDING PERMIT BUILDING FOR APPLICANT TO FILL IN ADDRESS J �� BUILDING d ADDRESS Y� LOCALITY NEAREST CITYLo'" � zip CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT 'Z 6 NOW ON LOT MAP BOOK PAGE PARCEL pDISTRICT UP YPE FIRE ESSED BY TRACT . BLOCKLOT NO. �� f O� CONST. ZONE L TL. OWNER ( / NEO raj STATISTICAL CLASSIFICATION SEWER, P ADDRESSV /�07 (p p/q{ ov e t CLASS NO. -/ / DWELL.UNITS BK PG CITY /e ZIP USE ZONE NOP ARCHITECT OR TEL. i ENGINEER , NO ' SPECIAL CONDITIONS ADDRESS J J ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑ yO TEL. _ CONTRALTO ' / OQ NO `� °? BRONTSPROP.LKNEOFn (STREET) n LIC. ADDRESS C O. Q _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY '+. YARD - C. FRONT PROP.LINE HIG WAY WIDTH LI CITY / CLASS �^ JJll CONSTRUCTION LENDER + �6 U%moa NAME AND BRANCH O BLDG:SETBACK FROM V SIDE PROP.LINE OF (STREET) . ce ADDRESS CITY O SQ.FT. . NO.OF NO.OF CHECKHIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH N • + = Z DESCRIPTION OF WORK Q NEW Qa3v2- ADD. CORNER CUTOFF YES , ❑ NO ❑ _ ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR ❑ US STOING BLDG. fl �DE�M.O�L/�❑ IN COASTAL PERMIT ZONE YES ❑�- NO ❑f/� APPLICANT n . Or d TEL E (PRINT) BY(SIGNATURE) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY.WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF / FINAL /f(� BY PERMITTEE' DATE ADDRESS TEL P.C. Fee$ Permit Fee -/ CITY No ' NO/ _ t ✓ Issuance Fee VALUATION$ . ... -.. ... . �— Total Fee �� . PLAN CHECK VALIDATION cK.+�'3m.'o..:+ cA$H _ PERMIT VALIDATION CK. M.O. CASH 4 6 9 JUL �5 �.1 [�; 14' .8 3. � 4 :7 0 tl-tilU'v � 1 .�. � B.7 J� e y ©S 76A638B CE#8036 6/76 - "WORK''ERS'COMPENSATION DECLARATION Iop at I-hove a certificate of,consent to self iP h n ,'of'pf ��� irate of Workers' Compensation Insurance, " APPLICATION F l7 R BUILDING PERMIT or a certified copy thereof (Sec. 3600, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is l4ereby furnished: FOR APPLICANT TO FILL IN BUILDING ADDRESS lJ / Certified copy'is'filed with„the county building inspec- FADDRESS tion deportment. �'; Dater Applicant ZIP LOCALITY 'CERTIFICATE OF EXEMPTION FROM WORKERS' _ , NO.OF BLDGS. NEARESTCOMPENSATION INSURANCEv' F��... NOW ON LOT CROSS ST. (This section need not be completed if the-.permit is for one ASSESSORhundred dollars ($100)or less.) BLOCK LOT NO. / MAP BOOK PAGEPARCEL � NO. SZiNE MAP I certify that in The�,performance,of the work for which this NOpenmit is issued, I shall notemploy•any person in any manner `� , SPECIAL- IL so as to become subject To The Workers'Compensation Laws. 1 �<aa -E�-. i CONDITIONS _ V CITY �. l' c(T-, ZIP. .1 / 0: Dbte� c�yJ Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE WPROESSED BYNOTICE TO APPLICANT: If, after making'this Certificate of s ENGINEER f✓�' NO. Exemption, �you should become subject to the Workers' � 15 /�^, / [J/� CONST. ZONE � Compensation provisions of the'Labor Code,•you must forth- ADDRESS S;�r,-, ✓'.�!�.' . -�• with comply. with such provisions or; this permit, shall be deemed revoked.. TEL STATISTICAL CLASSIFICATION APT.1, 1- ]C DO. Z ? CONTRACTOR "•Z. '+� NO. LICENSED CONTRACTORS.DECLARATION - LIC.^- CLASS NO- DWELCUNITS I hereby affirm thaf.l am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with'Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FL t, NO. OF _ NO. OF CHECK License Number Li C.Class SIZE ' 1�OL STORIES NO ONE VA_ LUATION Contractor` Date DESCRIPTION OF WORK (U '�' lr1i NEW D FA ; / SCI I am exempt under Sec. ALTER B.BP.C. for this reason REPAIR Q $ USE OF ^5 EJ ' EXISTING BLDG. I'i�i�(11 L-Y I� Ci DEMOL Signature APPLICANT ' < TEL. " o OWNER-BUILDER DECLARATION PRINT) �`=�I NO. ts�6� FINAL _ �2 0 0 8 A DATEL <l hereby affirm that Lam exempt from the Contractor's License ADDRESS 5`� � �-AZ� t.3 # o o ° 023 Law for The following reason (Section 7031.5, Business and F A' -Professions Code): PRESENT BUILDING ��{ �� - � (4:)G'r I, as owner of the property, or my employees with I ADDRESS a Itt. ( a 46665- wages as their sole compensation,will dolhe work and ,t the structure is not intended or offered for sale(Section LOCALITYT�1'(�4- l i� _, 7044, Business and Professions Code). ' ' MOVING - l TEL. ° ° 4 6 6,6 5 5 I, as owner of the property, am exclusively contracting CONTRACTOR / NO. with licensed contractors to construct the project (Sec- 4DITTH �i� 9-$ 5 ADDRESS tion 7044, Business and Professions Code).CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM SET BACK PROP. LINE I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C:). SIDEP.L. Lender's Name A Ref. # 2 27.8 A Lender's AddressP.C. Fee$ �iPermit Fee J> certify that.I have read this application.and state that the Issuance Fee - A P/C# # ° ° °'° ° 1: above information is correct. I agree to comply with all CountyInvestigation Fee0 ordinances and State laws relating to building construction, Q I ° 55 9,�5 0 U and hereby authorize representatives of this County to enterTotal Feel• ��}Q , A Perm. # up the ab ve-mentionecl property for inspection purposes. ° ° 55 9.5 0 61 rc b to A w�� C.�-t�^� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicantt-or Agent - Date - - - - - - OOi APPLICATION FOR BUILDING PERMIT it COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING BUILDING ADD E,�S I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3800,Lab.C.) TY e` LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. COMIC !) QO NEAREST CROSS S ❑ Certified Copy Is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. SSESSOR MAP BOOK PGE P RCEL iifi�,,,, Date Applicant :::] _ / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OW ER TEL.NO. YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? ADDRESS n �� (This section need not be completed if the permit is for one hundred "1 DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) certify that in the performance of the work for which this permit C4T r n ( ZIP P / �� � z`• is issued, I Shall not employ any person in any manner so as to ARCHITECT OR��qENP EL.NO.ENGINEER Tbecome Subject to the Workers'Compensation Laws. wIw STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS t I CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' tk SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwithFRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL H LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PIL o I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES NO.OF FAMILIES SQ O Professions Code,and my license is in full force and effect. '59c{ NEW ❑ BK PG , F— License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION W OLD - Gg�d Btu z Contractor. Date ALTER ❑ El am exempt under Sec. REPAIR B.BP.C.for this reason DEMOL lLY LDMA P/C# Date: USE OF EXISTING BLDG. UR-M ❑ Signature APPLICANT(P T) TEL.NO. LDMA Perm# I, as owner of theproperty, or m em Io employees with wages as Z Y P Y 9 O }i their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and X5 4 69N. Cn FIN DA 7 G PFOfeSSIOr1S Code.) WILL THE APPLICANT OR FUTUREBUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ./ ❑ I, as owner of the property, am exclusive) contracting With THE A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO TI GREATER THAN Q i } ;L- " Y: P P X Y 9 THE AMOUNTS SPE FIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FI AL _ licensed contractors to construct the project.(Section 7044, ves❑ _; ug 3 7 Business and Professions Code.) "o _ _ =_r m , ._e WILL THE INTEN ED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING Ii IPf OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH -••'3 fi-•'- •..1c=n CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES.. / `•.,;S?(yC;'•.� z 9 i f I hereby affirm that there is a construction lending agency for YES❑ NO the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.2D.140 CONCERNING m Lender's Name HAZARDOU MAT IALS EP TIN NDF OBTAINING A PERMIT FROM THE SCAQMD. _ a Lenders Address a OWNER OR ENT .. o' 1 certify that I have read this application and state that the above PC.FEE PERMIT FEE ' information is correct. I agree to comply with all county ordinances and State laws relating to building construction,and a. hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. Q INVESTIGATION FEE TOTAL FEE SiDmWm Of 40k­t w AgeM DeM SEE REVERSE FOR EXPLANATORY LANGUAGE, WORKERS' COMPENSATION DECLARATION I have a certificate of consent to s insure,'ybra certificatffirm e of Workers' Compensation Insurancef APPLICATION FOR BUILDING PERMIT Pr a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. FOR'APPLICANT TO FILL IN BUILDING PY Y ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING T tion department. ADDRESS/. Q �y CITY' ^1 �� ZIP �1 p LOCALITY Dare Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST 2 CROSS ST. COMPENSATION INSURANCE ASSESSOR p (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK ,,�a PAGEevg. PARCEL 4-11001c_�L hundred dollars ($100) or less.) TEL. OWNER Q�h NO. USE ZONE MAP NO. I certify that in the performance of the work for which this ,,.� e SPECIAL permit is issued, I shall.not employ any person in any manner ADDRESS V�15 ` - (_ Vv CONDITIONS a CL as to become subject to the Workers' Compensation Laws. O CITY I*G�wl l� �l ZIP U Date Applicant ARCHITECT OR TEL. q�� DISTRICT GROUP TYPE FIRE PR ESSED BY � NOTICE.,TO APPLICANT: If, •after making this Certificate of ENGINEER NO. Z%ea pt CONST ZONE O Exemption, you .should become subject to the Workers' �.0 1� — U Compensation provisions of the Labor Code,-you must forth- ADDRESS jAM� 1 a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CCtIDO. N deemed revoked. CONTRACTOR moQ NO. l Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.1A DWELL. UNIT/ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY: CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK 2 r w License Number Lic: Class SIZE ® STORIES FAMILIES ONE ,_ JL DESCRIPTION OF WORK NEW {— VALUATION �(3• ' Ei} 6 i o4 Contractor Date $ L�®� "r '`,i`7 `E o? ADD it J. ❑I am exempt under Sec. �� ALTER -❑ ► _ BAP.C. for this reason A s T REPAIR ❑ ; ACCT,B• USE OF Date: EXISTING BLDG. FA4V�.G DEMOL 330".7 • -c APPLICANT �" t��� TEL.. ITEMS Signature (PRINT) DV►N 1�( NO. �`j^��((y� FINAL y eta_ OWNER-BUILDER.DECLARATION DATE f `�' I hereby affirm that I am exempt from the Contractor's License I CIT HL 2 -13 - 60 . Law for the following reason (Section 7031.5, Business and ADDRESS CJ$ 1`3 L.k FINAL ' i Professions Code): PRESENT By CHECK �.i:'`O�t a� G r BUILDING� I, as owner of the property, or my employees with ADDRESS `��`�� � ��a w�^ t�hHi�t:�E wages as their sole compensation,will'clothe work and , the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) '. MOVING TEL ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. 0010-3-0001 with licensed contractors to-construct the roject'Sec- 4 � � • � s tion 7044, Business and Professions Code.) I ( ADDRESS r;ir? J H u�))�_ IST CONSTRUCTION LENDING AGENCY SETT REQUIRED TOTAL YARD HWY IOTA PROPALINEFROM WIDTH I hereby affirm.that there is a construction lending agency for FRONT the performance of the-work for which this permit is issued P.L, (Sec. 3097, Civ. C.). -SID'E . P.L. + i Lender's Name P.C. Fee$ 3� �V LDMA Ref. # Permit Fee , Lender's Address 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State laws rel ng to building construction, Total Fee LDMA Perm. # a and hereby authorize repres ntatives of this County to enter upon t e bove-mentione property for inspection ';purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ON Signature- pplicant or Agent Date _ -