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HomeMy Public PortalAbout5465 GOLDEN WEST AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR ?PLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES AD ESS �y(pS DEPARTMENT OF COUNTY ENGINEER CITY ZIP jy BUILDING AND SAFETY DIVISION / 1(29 NO.OF BLDGS. nn BUILDING SIZE OF LOT NOW ON LOT O� ADDRESS �x (J TRACT ��sIV7 BLOCK LOT NO. / LOCALITYTEL NEAREST (. OWNER F NO..QW$463 CROSS ST. ASSESSOR ADDRESS IV&S r L�&:V 4JOS r MAP BOOK PAGE I PARCEL CITY '' ZIP 10(90 ON GROUP CONST FIRE PR CESSED BY y� �j SOA -` t ARCHITECT OR TEL. V i UO ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAi- ADDRESS CLASS NO. DWELL.UNITS <�' BK PG TEL (� CONTRACTOR ItJ NO. AE ZONE �E� Z� d LIC. IALADDRESS NO. JDITIONS LIC. CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG. ETBACK FROM FRO PROP.LINE OF (STREET) ADDRESS CITY - TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT.jpO NO.OF ( NO.OF CHECK HIWAY+ YARD = FRONT PROP,LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW ❑ DD BLDG.SETBACK FROM -_, r��J( SIDE PROP.LINE OF (STREETI O ALTER TOTAL SETBACK FROM OF EXISTING W �c REPAIR ❑ HIGHWAY + YARD = SIDE PROP,LINE HIGH Y WIDTH N EX STUSE TIING BLDG. DEMOL El + _ _Z APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) ,Y,) NO. ' AYG3 IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( OjOL A= IN COASTAL PERMIT ZONE YES ❑ NO O VALUATION$ oo IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT 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 PERMITTEE '14_ �.� ADDRESS (5y L)(slal� FINAL CITY 1 L-74 NO. DATE 7. BY MAKE CHECKS PAYABLE TO: FEE $ FEET $ f HARVEY T.BRANDT,COUNTY ENGINEER / PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. GASH 8491-"AAS U 15.010m . ®S 76A638A CE#803 3.75 - m 803 IREVf6/7W APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING t FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS C6DL P� �SI LOCALITY _ q ,+ NEAREST CITY TEMPLE LE 61'ry ZIP ROSS ST. NO.OF BLDGS.. ASSESSOR SIZE OF LOT aS. J yt` '. NOW ON LOT MAP BOOK PAGE I PARCEL DISTRICT GROUPTYPE E, FIRE PRO SSED BY QLTRACT f 3ZI D 5 . BLOCK LOT NO. r. CONST. ZONE OWNER DOL� l—A��fL NO.. c7 7�ZZ J LO1 '1 t STATISTICAL CLASSIFICATION SEWER MAP ADDRESS `A&'5- iLAe-�I GS CLASS NO.�DWELL.UNITS BK PG CITY ��' ��L (..��v ZIP Cl 110 C, ARCHITECT OR TEL. VALUATION $ ENGINEER NO. 7 y ! ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTOR NO. HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. LIC. + CITY CLASS' CONSTRUCTION LENDER BLDG.SETBACK FROM. NAME AND BRANCH SIDE PROP.LINE OF (STREET) TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = ADDRESS CITY SIDE PROP.LINE IHIGHWAYI WIDTH 0 SO.FT. n NO.OF NO.OF CHECK + _ SIZE � STORIES FAMILIES ONEIm ell 0 DESCRIPTION OF WORK An ra. NEW ❑ P.C..Fee$ Permit Fee 1 oop� 2 ADD a Issuance Fee Z REPAALTERR ❑ USE Total Fee / �? EXISTTI DEMOLNG BLDG. ❑ Z APPLICANT j'�t TEL C (PRINT) DoLfr Clv� rZ NO.Zt�ZS �Z�Yy 0 BY(SIGNATURE) I �' IHEREBY ACKNOWLEDGE THA HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V "✓iJ`T WORK AUTHORIZED HEREBY I WILL NOT,EMPLOY ANY PERSON IN VIOLATION OF .µ THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM Z fi O o 0 0 0 PENSATION INSURANCE. g SIGNATURE OF 0 6: r PERMITTEE ADDRESS o c2a2. .79 TEL. F CITY NO. Lo U ZONE MAP _ 4 Cl SPECIAL r CCONDITIONSS DA EL / ��O�U O BYFINA 'r .. x WORKERS'COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION. FOR BUILDING PERMIT insure, or o cc�7tificate of Workers' Compensation Insurance, or o certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ BUILDING % Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 546,6 OLlJC�! ❑ Certified copy is filed with the county building inspec- BUILDING _ tion department. ADDRESS � /y��'sp� Date Applicant CITY 6' itI JOLE �!j zip '? 1 7 d O LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO, OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT I CROSS ST. arA�i�'uJi4i (This section need not be completed if the permit is for one ASSESSOR hundred dollars,($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZO E MAP OWNER / [� 13aV? NO. I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner �4/S ����� SPECIAL ADDRESS ca G(��S' CONDITIONS so as to become subject to the Work rs'Compensation Laws. —7 O ^ ,7 CITY /��1— �ii ZIP 11 !e(J v Date Applico AZ NOTICE TO APPLICANT: If, after making his Certificate of ARCHITECT OR IJL — 7—�P13&rC TEL.-y �7 DISTRICTJGROWP TYPE FIRE PROCESSED BY O ENGINEER G[/��' NO.G �CJ2� K10 NST. 1 ZONEExemption, you should become subject to the WorkersI�!/ Compensation provisions of the Labor Code, yoo must forth- ADDRESS with comply with such provisions or this permit shall be TEL a: deemed revoked. CONTRACTOR NO. STATISTICAL CLASSIFICATION APT. CONDO. N LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS — I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE Contractor Date VALUATION$ADD DESCRIPTION OF WORK NEW El❑ , I am exempt under Sec. 2t� !������ ❑ g ALTER B.BP.C. for this reason � REPAIR $ Date: USE OF. EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. p g FINAL OWNER-BUILDER DECLARATION (PRINT) G!— NO. O S Z DATE/ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL O 9.7.2 A Professions Code): PRESENT By '# o 0 0 0 0 BUILDING I, as owner of the property, or my employees with ADDRESS o -.49.88 wages as their sole compensation,will do the work-and LOCALITY ' the structure is not intended or offered for sale(Section o 0 0 49.88'0 7044, Business and Professions Code). MOVING TEL. QI, as owner of the property, am exclusively contracting CONTRACTOR NO. n 2 't-8 8 with licensed contractors to construct the project (Sec- ADDRESS v tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE 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.). SIDE P.L. Lender's Name m LDMA Ref. # P.C. Fee$ Permit Fee 3 Lender's Address I certify that I have read this application and state that the Issuance Fee Z A P/C# o above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # R and hereby authorize representatives of this County to enter upo a above-m ntianPrl ro erty for inspection purposes. a �}- �—•Q(� SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur' of Applicant or Agent Date WORKERS'COMPENSATION DECLARATION hereby tia cer that I havea certificate of consent to sc'.f p�- APPLICATION FOR BUILDING PERMIT Insure, or.a cer�ificbte of Workers'Compensgtion.lnsu!cince, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Py y FOR APPLICANT TO FILL IN ADDRESS �47 © hL � S 71 Certified co is hereby furnished. ❑ Certified copy is filed with the county building inspec- tion department. ADDRESS _IV r�7�_l LOCALITY 105 .®6� Cwt,%`- Date Applicant CITY �r✓ 6��� �!/ ZIP / (J CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE EMAPhundred dollars ($100)or less.) TRACT BLOCK LOT NO. �� f, TEL. �J!I certify That in the performance of the work for which this OWNER /��/Z NO. 2 8 ONS _ DISTRICT GROUP TYPE FIRE PRO SSED�Y permit is issued, I shall not employ any person in any manner CONST. ZONE so as to become subject To the Wogs'Compensation Laws. ADDRESS J � CSX© /./ />5 / f CITY /1 �4 C! ( ZIP `5 lot .� 1­2Date 4YApplicant /�� STAT-TICAL CLASSIFICATION APT. ICONDO.NOTICE TO APPLICANT- If, after makin this Certificate of ARCHITECT OR TEL. t,} MJ Exemption, you should become subject to the Workers ENGINEER NO. CLASS NO. 4;2-/ DWELL. UNITS P$, Compensation provisions of the Labor Code, you.must forth- ADDRESS SEWER MAP with comply with.such provisions or this permit shall be deemed revoked. TEL CONTRACTOR N •O. BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY INO. OF / CL/ASS $ D 0 SQ.License Number Lic.Class ` SIZE FT/C�6 ISTORIES I FAMILLIIES l CHECK , Contractor Dare �- DESCRIPTION OF WORK NEW a $ ❑ I am exempt under Sec. EKE rA4 ADD 19 ALTER ❑ FINAL B.&P.C. for this reason C] DATE REPAIR Date: USE OF G BLDG. DEMOL FINAL EXISTINC] B Signature APPLICANT TEL. Y OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm.that I am exempt from the Contractor's License ADDRESS Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT fff El BUILDING �/ # a'0 0 0 0 ADDRESS I, as owner of the property, or my employees with wages as their sole compensation,will do the work.and 2t- -,7800 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. C, o 07+ 001- ❑ I, as owner,of the property, am exclusively contracting CONTRACTOR NO. t with licensed contractors To construct the project (Sec- ADDRESS 0 5,07-8 4 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST. SET BACK YARD HWY PROP. LINE 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.). SIDE FD P.L. o Lender's Name - P.C. Fee$ Permit Fee Lender's Address • w I certifythat I have read this application and state that the Q V PP Issuance Fee above information is correct. I agree to comply with.all County Investigation Fee $ ordinances and State laws relating to building construction, Total Fee d and hereby authorize representatives of this County to enter upon the Bove-mentioned nr�p rty for inspection purposes. � L SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant or Agent Date ®s s WORKERS' COMPE(4SAT!ON AECLARATION + insure,boraa certificate of Worke srlificate Compensat oof n Insurancnt to e, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING dU�CI�.� �G� r✓ tion department. ADDRESS �S ES� � Applicant CITY ��iG G T ZIP �l 7d O LOCALITY Date CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT SOX ���t�3 NOW ON LOT CROSS ST.NEAREST Q� � COMPENSATION INSURANCE ASSESSOR (This section need not be completed if The permit is for one TRACT/3 PDS' BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. l hundred dollars ($100) or less.) USE ONE MAP / OWNER A�LIC -F40L�L NO. �'LZPj I certify that in the performance of the work for which this � NO. permit is issued, I shall not employ any person in any manner SPECIAL >_ ADDRESS 5 �S �L,[7C/�/ u/ES% — I CONDITIONS d so as to become subject to The Workers'Compensation Laws. 4 ^7o O CITY T "�LC ZIP (� !Q U Date Applicant ARCHITECT OR TEL. De DISTRICT GROUP TYPE FIRE SSED BY . NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE O H Exemption, you .should become subject to the Workers' Qg . 3 w Compensation provisions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or This N p y p permit shall be TEL. � STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 41 DWELL. UNITS 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. �/ A NO. OF NO. OF CHECK License Number Lic. Class SIZE p•y STORIES IFAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW El $ ,/ �,*,5 El am exempt under Sec. o2/Q �. 0On�t�(_ ADD 9 d� pop.❑ B.BP.C. for this reason 7011-C-7-0 611-J14 $ REPAIR ❑ Date: USE OF EXISTING BLDG. DEMOL ❑ APPLICANT Signature TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. 1 hereby affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By BUILDING G I, as owner of the property, or my employees with ADDRESS Vit.•`-) wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. , ; CONTRACTOR NO. 1N1?� • ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct The project (Sec- a tion 7044, Business and Professions Code.) ADDRESS rl s_w .•.,° REQUIRED TOTAL SETBACK FROM EXIST. "i i, ^• CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE 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. i'`•1'-' = ' - (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name. - - / LDMA Ref. # ski i<< :I± .... . . .. m _ { m'-` P.C..Fee$ Permit Fee - 3 Lender's Address , : '; ; _ , ,- o I certify that I have read this application and state that the Issuance Fee • *7 LDMA P/C# 8 aboveinformation is correct. I agree to comply with all County Investigation Fee Rordinances and State laws.relating to building construction, Total Fee 2-5, LDMA Perm. # a and hereb r authorize representatives of this County to enter upon th Bove-menT' rroperty,for inspection purposes. a l SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Applicant or Agent Date