HomeMy Public PortalAbout6030 1/2 GOLDEN WEST AVE_Building__ ME
78A638A CE#809-8-57 APPLICATION FOFt::bUIL®ING RERMIT , -
COUNTY OF LOS ANGELES BUILDING
DEPARTENT OF COUNTY ENGINEER ADDRESS
M
BUILDING AND SAFETY DMSION LOCALITY zeo 4E
JOHN A. LAMBIE,COUNTY ENGINEER NEAREST f
CASSATT D GRIFFIN,SUPT OF BUILDING CROSS ST
'DISTRICT NO. GROUP TYPE SEWER MAP
FOR APPLICANT TO IN —glt
CONST
BUILDING3LI STATISTICAL CLASSIFICATION
ADDRESS O � '
LOT NO 87 CLASS NO DWELL UNITS
BLOCK MAP47 Si WYE
TRACT 6561 NUMBER YES O
USE NE- SPECIAL
NO CONDITIONS
SIZE OF LOT 45x120 NOW ON LOTS '
USE OF �O
EXISTING BLDG BUILDING YARD HWY STRE NAME' EXIST._
Edward Heinrich SETBACK WIDTH,
OWNER FRONT
ADDRESS 6032 Golden West SIDE
CITY Tem le Cit No T -7-005
ARCHITECT OR TEL - INSPECTION RECORD -
ENGINEER NO - I�,� �.•+�/,J�rl'/�'f/' Ul !" !�O///�D/��LK
ADDRESS O.H ] N
CONTRACTOR 'T,Tom i 1 NOAT 7-97
ADDRESS 871 i'la"s Tunas SanGab
"DESCRIPTION OF WORK /
NEW X ADD ALTER REPAIR DEMOLISH
SQ FT. p p �r NO OF NO OF
SIZE 882-24 OCTa STORIES 1 FAMILIES 1 l _
USE OF STRUCTURE •, i�3 / �
Dwelling Gar -/(✓i9/L > :sr
SIGNATURE OF APPROVALS�! f),tl
APPLICANT DATE- INSPECTOR'S SIGNATURE `
ADDRESS FOUNDATION LOCATION !-per V
FORMS,MATERIALS
FEE $ �� FRAME S
BRACING, BOLTS O -�y� � ,may m
VALUATION $ 10-49FURNACE LOCATION," 'q �!
FEE d GAS VENT,DUCTS i' 11-1
'Fi
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT aQQ M►7D �, 7f
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND �////�� ��pp
STATE LAWS REGULAT G UI G CONSTRU T N. LATH, EXT.
SIGNATURE �r _�_ HOUSE NUMBER COR-
PERMIT
OR-
P RMITTEF _ ^ RECT AND POSTED
ADDRESS -FINAL
JOHN A. LAMBIE.COUNTY ENGINEER. CLYDE N DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION K. M.O. CABH PERMIT VALIDATION K. M.O. CASH
LACo-O GRAMY 14 1 6 A 13.0,0 1-A
;i
6'2 s.S PLAY 1 g '
1 �A 26.0.0 �_
APPLICATION FOR BUILDING PERMIT �l
COUNTY OF LOS ANGELES BUILDING AND SAFETY i
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUILDING ADDFfESS
hereby affirm that I have a certificate'of consent to self Insure, 1 Z �J�eS Y- V6-ST or a certificate of Workers'Compensation Insurance,or a certified CI ZIP L 6-J/
copy thereof(Sec 3800,Lab C) LOCALITY"'T�f awl- 1 e c I`7"L �)92 G' Ty
Policy No. ¢ Company SIZE OF I 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 USE ZONE MAP NO
department ` 1
a ..
Date Applicant J i Vv+ yG ASSESSOR MAP BOOK PAGE PARCEL =
_�� SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERSOWNER TEL NO YES No.
COMPENSATION INSURANCE A R SS AfaNcV L si WITHIN 1000 FT OF SCHOOL? g
�
(This sectiori need not be completed If the permit Is for one hundred 4 .} ft.)-4 ,L ! DISTRICT GROUP TYPE CONST FIRE ZONE OCESSE BY
dollars($100)or less) CITY ZIP 0
1 certify that in the performance of the work for which this permit I r`0tiTer e P,r V-- 5, 3
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 Lawsr STATISTICAL CLASSIFICATION APT CONDO
Date 9 :�-7— C%pphcant J I y, V P ADDRESS CLASS NO DWELL UNITS
NOTICE TO APPLICANT If, after making this &rtificate of 9 `S(:) W RLI: REQUIRED TOTAL SETBACK FROM EXIST
CONTRACTOR TEL NO
Exemption, you should become subject t0 the Workers' / / _ SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith 7 VYI e'ryL FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC NOPL
LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS ' . PIDE a
I hereby affirm that I am licensed under provisions of Chapter 9 IC ., SEWER MAP
(commencing'with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORES NO OF FAMILIES C
Professions Code, d my license Is In full force and effect I NEW ❑ BK PG
DESCRIPTION OF WORK W
License Number Llc Class VALUATION-z / ADD ❑
�- 1'1 rt 0 ALTER C3 $ z
Contractor�' ate I�� �� �
❑ I am exempt under Sec REPAIR ❑ $
B&PC for this reason DEMOL LOMA P/C M
Date USE OF EXISTING BLDG L1R�A ❑ --�(y
.a1
Signature APP ICANT(PRINT) TEL NO LOMA Perm k Z ITENE,
❑ 1, as owner of the property, or my employees with wages as a► a O r, ��
their sole compensation,.will do the work and the structure is ADDRESS _ H TOTAL 4• E-31
not Intended or offered for sale (Section 7044, Business and / FINAL DATE n Q 0 I
Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �•Sl+t �La
❑ I, as owner of the property, am exclusively contracting with
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ff hk' a�
Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 4Ht IGE I!j
licensed contractors to construct the project (Section 7044, YES❑ NO&
Business and'Professions Code)
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING _ �y_+i}{
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH IQQI�—I it,p�j 8/17/'�l I
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST U 7
FOR GUIDELINES _
hereby affirm that there is a construction lending agency for YES® No El `�9 1 AI'91f1"moi
the performance of the work for which this permit is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD
3097,CIV C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ,
COUNTY CODE,TITLE Z CHAPTER 2 20 SECTIONS 2 20100 THROUGH 2 20140 CONCERNING
Lender's Name HAZARSMATERI/uS TING AND FOR OSTAININGAPERMITFROMTHESCAOMD
Lender's Address oMruei A. V
0 1 certify that I have read this application and state that the above
PC FEE PERMIT FEE t 00
Information is correct I agree to comply with all county
ordinances and State laws relating to building construction,and
hereby authonze representatives of this County to enter upon ISSUANCE FEE
the abov entloned property for Inspection purposes
m �-17-110 INVESTIGATION FEE TOTAL FEE
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SEE REVERSE FOR EXPLANATORY LANGUAGE