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Home My Public Portal About5637 GOLDEN WEST AVE_Building__ DIVISION OF BUUMING AND SAFETY Department of County Engineer BUILDING County of Los Angeles WM. J. FOX, COUNTY ENGINEER BUILAPPLICATION FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS 3O L D LOCALITY NEAREST LOCALITY CROSS ST. DISTRICT NO. PLAN CK. OR REc.'No. PERMIT NO. NEAREST CROSS ST. OWNER �/' / /�Q•G{� - ECEIVED BY DATE OF APPL.MAIL DVATE ISSUED ADDRESS /'�Q /V r Q L I T USE ZONE PLANS I I- GROUP I FI�E.ZONE TEL. J CITY NO. ARCHITECT OR TEL. o ZONING . _ DATED ENGINEER NO. APPROVED BY- BUILDING / _L O D No. ADDRESS �/j (, SETBACK LINE: •�� [ "r 9 y' CONTRACTOR:;?� /�( A�j C 1Z,s BA� TE �p p�77TS APPROVED DATE Z"I'— f I�/ Q HOUSE NUMBERING, ADDRESS d LEGAL MAP NUMBER L O NO. ASSIGNED BY DESCRIPTION LOT NO. / BLOCK - /11,31 �� DATE I CORRECTIONS I INSPECTOR TRACT +� NO. OF BLDGS. SIZE OF LOT ` Q�� 3 ! I NOW ON LOT, USE OF - NO. OF EXISTING BLDG. FAMILIES O DESCRIPTION OF WORK Z NEW ALTERATION ADDITION I I r REPAIR DEMOLITION' SQ. FT. O NO OF SIZE ROOMS STORIES CIXOVERING s�U G G n IROOF COVERING coM po USE OF STRUCTURE I ' G'Al2A6�. I I APPROVALS INSPECTOR'S SIGNATURE ,ADATE FOUNDATION: LOCATION FORMS, MATERIALS r�A 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS /1' CORRECT. I AGREE T COMP WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE G TIN ILDING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE O LATH, INT. PER -I-T LATH, EXT. ADDR S PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. F H C.lg OUSE NUMBER COR- ECT AND POSTED VALUATION FEE �� FINAL Z► /t S'� ,1'j'�•�-�� 76AC33A DBS 3 2-85 DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY 3 BmumILDING" COUNTY OF LOS ANGELES 2 g 195 " ;r WILLIAM J. FOX, COUNTY-ENGIN EER OCT APPLICATION CASSATT,D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY L DISTRICT NO. PLAN CK.OR REC.No. GPERMIT NO. ADDRESS--BUILDING G3 L EIV / Is 7 6 6r ;LOCALITY RECEIVED BY DAT OF APP DATE ISSU NEAREST -3CROSS 8ST O � !! BUILDING <:t OWNER ,Q Z S u)0 ADDRESS v l_7' 1 P-I E��`C ADDRESS D /v R n/ 'A CAL ' 'F MAIL LOCALITY ` � NEAREST TEL CROSS ST. �/e r �a• CITY NO. ARCHITECT OR TEL FIRE NO OF _ TYP� GROUP ENGINEER NO. ZONE I PLANS BLDG. ADDRESS SETBACK LI E / ORD. N%/ y� TEL USE APPROVED - A CONTRACTOR/i f�/e,CO No. O ZONE BY DATE ADDRESS (G Z C+dN�CJ /�DNf HOUSE NUMQfAING /^I LEGAL MAP NUMBER �O( J� NO. ASSIGNED BY DESCRIPTION LOT NO. I BLOCK tJ ///3 / 3 j CORRECTIONS TRACT ,�/ f7 LNO OF BLD SIZE OF LOT O I NOW ON LOT B/Y G�/V e, USE OF NO. OF EXISTING BLDG FAMILIES DESCRIPTION OF WORK ,/��,�,F S', �.,, !� t"I R4&- I-wJ o - X NEW IALTERATION ADDITION REPAIR DEMOLITION �`5 r 6Q. FT NO. OF / L/6/1-`J� SIZE ROOMS STORIES EXT. WALL ROOF COVERING r t V G G CI I COVERING G 6 C „ J4� USE OF STRUCTURE t -. � 0 V LO G L L aci �xZ� / APPROVALS _ INSPEG'I"OR'S SIGNATURE DATE/J FOUNDATION: IO FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. 01 1 ACRE O PLY COUNTY DINANCES FURNACE: LOCATION, y AND STA LAWS EG TIN IL ING Cog GAB VENT, DUCTS C _._ r SIGNATURE O LATH, INT. PERM LATH. EXT. j y A REBS -7 PLASTER, INT. AUTHORIZED AGT. /Q s PLASTER, EXT. i / $dG�- FEE p,b P. C. $ / HOUSE NUMBER COR- �� I 1 _ / RECT AND POSTED t' VALUATION FINAL 76ASSBA 088 3 9-82. WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, 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 tion department. ADDRESS = " Date,, 4� "✓` .' Applicant '. rf •,�� ]�� CITY r" ZIP;i i LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO, OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR BLOCK hundred dollars ($100)or less.) TRACT LOELNO.MAP BOOK PAGE P nARCEL d OWNER = r" r NO. `..' r.' USE ZONE MAP O I certify that in the performance of the work for which this _ NO. permit is issued, I shall not employ any person in any mannerSPECIAL GJI so as to become subject to the Workers'Compensation Laws. ADDRESS — / 2 CONDITIONS "I LL ,l, /'`r .. ZIP'- .. }. Date Applicant ARCHITECT R TEL. NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROUP I TYPE FIRE PROCESSED BY d Exemption, you should become subject to the Workers' ENGINEER NO. CONST, ZONE 0 Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. .. STATISTICAL CLASSIFICATION APT. CONDO. a- deemed revoked. CONTRACTOR NO. UJI LICENSED CONTRACTORS DECLARATION LIC.__ CLASS NO. DWELL. UNITS— I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1`.r' (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.Classr SIZE STORIES f FAMILIES ✓ ONE _ VALUATION DESCRIPTION OF WORK NEW El Contractor.+'X" `..�-/ a�' Date❑ O $ADD , I am exempt under Sec ALTER B.&P.C. for this reason ,�: • REPAIR $ Date: USE OF DEMOL EXISTING BLDG. Signature APPLICANT TEL FINAL OWNER-BUILDER DECLARATION PRINT / r , NO. DATE : w v I hereby affirm that I am exempt from the Contractor's Licensees�� z -- Law for the following reason (Section 7031.5, Business and ADDRESS - / FINAL Professions Code): PREENT By ** v r BUILDING I, as owner of the property, or my employees with ADDRESS ! 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. DI, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM 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. C (Sec. 3097, Civ. C.). SIDE j P.I. Lender's Name LDMA Ref, q m Lender's Address P.C. Fee$ Permit fee ' 3 o I certify that I have read this application and state that the Issuance Fee LDMA P/C# 2 above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction,61 Total Fee LDMA Perm. M and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. j � ��,r - .�,gd��.• "'� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Apples „or Agent Date WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self A P P L I C AT I.O N •FOR BUILDING' P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800, Lob C ), ' µ COUNTY OF LOS ANGELES BUILDING AND SAFET P y No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed'wrth the county building inspec- BUILDING tion'department ADDRESS Date3z?exApplicant h/ CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS'' NO OF BLDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CRO55 ST (This section need not be completed if the peimit is for one ASSESSOR hundred dollars ($100)or less ) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL TEL SE NE MAP I,certify that in the performance of the work for which this OWNER N NO permit is issued, I shall not employ any person in any manner , SPECIAL ' so as to become subject to the Workers'Compensation Laws ADDRE gelCONDITIONS C) ' CITY ZIP U Date Applicant' NOTICE TO APPLICANT If, after making 4is Certificate of ARCHITECT TEL DISTRICT GR UP TYPE FIRE PROCESSED BY O ENGINEER NO y� CO ST E U Exemption, you should become subject •to the Workers' , Compensation provisions of the,Labor Code, you must forth- ADDRESS •4 v W with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION - APT tL IL deemed revoked CONTRACTOR — N Z: LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby offirm•that I am licensed under provisions of Chapter 9 ADDRE N (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 G CLASSY BK PG VALIDATION SQ FT NO OF NO OF CHECK License Number 3/3,1 Lic Class�t SIZE STORIES FAMILIES ONE �,�,,�—+,� /� O VALUATION ContractoS4:4!�rftl�yG" Date DESCRIPTION OF WORK NEW f I am exempt under Sec op , LTER B.BP C for this reason REPAIR $ USE OF ;2 9.1 A 3 A Date EXISTING BLDG DEMOL Signature APPLICANT TEL FINAL OWNER-BUILDER DECLARATION PRINT N DATE # o 0 0 I hereby offirm that,]am exempt from the Contractor's License ADDRESS, Law for the following reason (Section 7031.5, Business and BYUILDING o,c (L Q R U Professions Code) AL j, as owner of the property, or my employees with ADD ESS O 3.0 3s88 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 j, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS hon 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TOTAL NE WIDTH" ' .1 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 PL Lender's Name m PC Fee$ Permd Fee LDMA Ref # Lender's Address � �1" I certify that I have read this application and state that the Issuance Fea (/t J� LDMA 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 upon the ove-mentioned property for inspection.purposes * SEE REVERSE FOR EXPLANATORY LANGUAGE signot I ui_e_ofApll Agent Dote -