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HomeMy Public PortalAbout6031 GOLDEN WEST AVE_Building__ ©S 76A836( l c�a-sJ� �• ` a603F:EV 8/781 �' l J vjf �> r APPLICATION FO = BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING'AND SAFETY CSC �J FOR APPLICANT TO FILL IN ADIDRESS LDING ADDRESS Go"-DMN vr�EsT' LOCALITY NEAREST CITY-rE Le ick-r ZIP-9(-160 v CROSSST NO OF BLDGS ASSESSOR SIZE OF LOT 100 K ZOO NOW ON LOT MAP.BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PR CESSED BY TRACT BLOCK LOT NO `h1 CONST ZONE OWNER R�S TTEL ,Uj uvµGZ NO - av �� ++Q C STATISTICAL CLASSIFICATION ,C SEWER MAP ADDRESS n 1-\ 5 ���,-E s CLASS NO ✓v DWELL UNITS L 8137 PG CITY C.ER^ TvS ZIP O ARCHITECT OR TEL f VALUATION J I ENGINEER A AMATo NO�I l 0 ADDRESS Z •�DKA1J BL-� MOr+1� �% BLDG SETBACK FROM •' / _ �t FRONT PROP LINE OF —(STREET) CONTRACTOR N . r k��_ N092 "r5�0 HIGHWAY' + YARD = TOTAL SETBACK FROM TYPE OF EXISTING G LIC FRONT PROP LINE HIG�IWAY WIDTH ADDRESSEB@F�•� NO B O S I �S It LIC - + 2_0 a� CITY C�^ CLASS CONSTRUCTION•LENDER BLDG SETBACK FROM SIDE PROP LINE OF (STREET) NAME AND BRANCH HIGHWAY + YARD = TOTAL SETBACK FROM I TYPE OF EXISTING It ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH G " FT NO OF NO OF CHECK + = 8J SIZE 5 e STORIES 2 FAMILIES ( ONE DESCRIPTION OF WORK NEW ❑ PC Fee$ (/ 2-14PermitFee / .�- J C`W s L ADD 0 _/1 n Issuance Fee 4V W`� ALTER REPAIR ❑ CSG` ^/��a Q Total Fee O�� USE TI f f/� DEMOL ❑ Z O EXISTING BLDG 1`�! APPLICANT ,/ TEL (PRINT) �� f7 f-`�ZNO �� G �. T.641 4�� �tti• BY(SIGNATURE) e Z_ 301 01• 2-Q G `/ ; IHEREBY ACKNOWLEDGE THAJ HAVE READ T APPLICATION AND STATE Ne " THAT'THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES 6- V AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE V '16�"� 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 Z PENSATION INSURANCE P RMSIGNATURT TEEE OF f o� ADDRESS �S S Z KJO p TEL CITY NO USE ZONE NOP s —,7 TTI/ b V Q (27-�i SPECIAL (/��,,-. W+L )w CONDITIONS fiG� tr pGrctia�-Y ��j ss FINAL BY � ��_� DATE 1 lJ APP.LICATIOIV FQ13,PUILDING PERMIT COUNTY OF LOS,ANGELES .BUILDING'AND SAFETY .� WORKER'S COMPENSATION DECLARATION-• FOR APPLICANT,TO.FILL IN,;;,_ BUILDING ADDRESS 'BUI G ADDRESS I'hereby,affirm that I•have,a cer'tdIL lcate of consent,to self Insure, lw cr'a certificate of Workers' CompensatloA Insuiance,ora certified `� as lr j copy,thereof, Sec 3800,Lab C)` rx, � CITY ZI LOCALITY �- PohCy NO Company K:- IN —SIZE OF LOT NO OF BLDGS NOW ON LOT. a ElCertified copy Is hereby furnished s` ` ° NEAREST CROSS ST ElCertified copy Is filed with the county bwiding"Inspection, TRACT BLOCK LOT NO •_ - ' } '' _ 'USE ZONE MAP NO del6artment ASSESSOR MAP BOOK - PAGE PARCEL Date Jj Applicant K • .. .• - - SPECIAL,CONDITIONS :- •,y4 y�; ti CERTIFICATE OF EXEMPTION FROM•WORKERS' OWNE ^ eTEL'NO YES NO- , COMPENSATION INSURANCE• " 6 I — WITHIN 1000 FT OF SCHOOLS a ADDR S - (This'section need not be completed If the permit is for one hundred/ r L DISTRICT GROUP E O T FIRE ZONE PROCESSED BY - dollars ($100).or less)._ ; _A, ^ -CITY - ZIP -' I,certify that-in'Jhe performance-of the work'for wliich'this permit is,Issued;I shall not employ any-person-sin' any manner so as t0" r ARCHITECT'OR'ENGINEE - "T L NO - bedorTie Subject-t0 the Workers',COmpehsat on Laws - .,t - A_ STATISTICAL CLASSIFICATION ,1 ' ' ;,APT,'•. CONDO ' •,Date' Applicant -'�'•' '' ADDRESS -, - '- <^ - CLASS NO � DWELL,UNITS - NOTICE TO -APPLICANT -If, after "making this 'Certificate Of REQUIRED TOTAL SETBACK FROM EXIST T. Exemption, you 'should become Subj@ct' YO thB r Workers' CONTRACTOR TE NO SET BACK YARD HWY, PROP-LINE WIDTH Compensation,provisions''of the Labor;c6db, you'must'forthwith'- - FRONT comply w th such prowsions•or this permit shall be'deemedrevoked ADD SS LIC NO P IL _ _ LICENSED CONTRACTORS DECLARATION y qT L c LASS FIDE :0 hereby'-affirm that h•am licensed underprovisions•of'Chapter, 9 '"L ( [ - `V SEWER MAP (60m Ing with Section 7000)of Division 3 of the,Buslness an`d• SO FT SIZE NO OF STORIES NO OF.FAMILIES Professlons Code,and my license Is In'full force/and°effect NEW ❑ BK' PG' - O License Number �LIc Class Jl DESCRIPTION OF WORK ADD ❑ VALUATION o-o W Contractor JK d"-L�{( • C17N�T� Date �' ��• _ ALTER ❑ N ❑ I am exempt under Sec — MREPAIR ❑ $ Z' B'&PC.for this reason '4 h( DE DEMOL' ❑ LDMA,P/C# g • `- •• Date - USE OF EXISTING BLDG ` - URM ❑ I - • .' 'I - `'^- •• :r Slgnatuie APPLICANT(PRINT) ! ,TEL NO _ LDMA Perm# Z .ACM' -❑I.as owner,of.the,property, or my,employees with'wages as. J r c, their,sole compensation;will,do tpe work and the structure Is' ADDRESS O ,!{f,y " not Intended or offered'for sale:(Section 7044, Business and :' � FINAL DATE- J �Q P.rofesslons Code) f�iZ2 ZTM1 • _ _ WILL THE APPLICANT OR,FUTURE BUILDING'OCCUPANT HANDLE A HAZARDOUS MATERIAL J ` ❑ 1, as-owner of the' r0 ert am excluslvel COntractl OR A MIXTURE CONTAINING,A HAZARDOUS MATERIAL EQUAL-TO OR GREATER•THAN THE j_7A! � p p y, y ng WITH AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY / !1 1111E ' licensed contractors to construct the project (Section 7044, YES❑•" NO 0- CHEC 7 Business-and Profession§Code) <_ - �. �� i ._a�5 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1.1`�.%�� • / e CHANGE _ 00 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST FOR .;� I - GUIDELINES I hereby.affirm that there is,a constructlon.lenai ig agency for YES❑ No r _ (,}I J sthe performance of the work•for which this permit Is,issued(Sec (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 1�1] 1�-(yll0� 1l I?! 3097,CIV C) } - CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ 96 N . ' ;-', t - TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS - - C'�I(C%S. i .Cs �`t 1 apol Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD 1 -i=" 1 i< Lender's Address - OWNER OR AGENT f 7 3 I certify that I have read this application and state under penalty Y ,•✓` 0 of perjury'that the-above'information Is correct I agree to comply PC FEE PERMIT FEE C r in with all county ordinances and State laws relating'fo'bwlding construction, and hereby authorize representatives of.this County ISSUANCE FEE toe ter upon thea ove Honed property for Inspection purposes �� INVESTIGATION^FEE TOTAL FEE �j , - - -- - -• - ��,a a Apel•am SEE REVERSE FOR EXPLANATORY LANGUAGE