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Home My Public Portal About6134 GOLDEN WEST AVE_Building__ 78A688A CE#009-10.56 APPLICATION FOR E U I'L®I IV_ CE R IVI I T - ` BUILDING AND SAFETY DIVISION BUILDING - Department of County Engineer ADDRESS ' County of Los Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST ' ' CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST DISTRICT NO. GROUP TYPE SEWER MAP PG FOR APPLICANT TO FILL IN �� I.CONST. " BUILDING ADDRESS STATISTICAL CLASSIFICATION LOT NO. y i I r CK Q CLASS. NO. DWELL. UNITS I MAP �Q Q- F{ STATE r NUMBER Wy YES O - - TRACT USE ZONE SPECIAL �,� I NO.OF BLDGS. CONDITIONS SIZE OF LOT�Q 'y NOW ON LOT USE OF _ EXISTING BLDG. BUILDING-• EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT MAIL f P. L. ADDRESS SIDETEL CITY 1 NO. --�0� P. L. ARCHITECT OR TEL. INSPECTION RECORD ENGINEER NO. - - - - ADDRESS • TEL. CONTRACTOR NO r - ADDRESS DESCRIPTION OF WORK _ ,Wrw----) .ADD ALTER REPAIR DEMOLISH - - - SQ. FT. NO. OF NO. OF _ SIZE STORIES FAMILIES - USE OF STIRUCTURE ' _ APPROVALS - SIGNATUR F _ APPLICA 6 DATE- INSPECTOR'SSIGNATURE ADDRESS FOUNDATION* LOCATION ., `- FORMS, MATERIALS= P. C. S FRAME FIRE STOPS. FEE BRACING: BOLTS / URNACE: LOCATION. _ VALUATION $ FEE GAS VENT, DUCTS _ - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND �,/I ,1 p/ AGREE TO COMPLY WITH ALL COUNTY ORDINANC S,'j'ND LATH. EXT. `I _O It77 k-�1.4�/ SIL STATE LAWS REG LATING -51ILDING STR CTION. SIGNAT��I1RE OF �� 7 HOUSE NUMBER COR- PER OR- - -� PERIGIITTE _ =�I I RECT AND POSTED ADDRESS FINAL JOHN A. LAMBIE, COUNTY ENGINEER, CLYDE N. DIRLAM, PRINCIPAL STRYATYRAL ENGINEER PLAN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION cK pM o. CASH 76Ae313A CE#S 03-10.56 APPLICATION FOR 'BUILDIN9 PERMIT, 1 BUILDING AND SAFETY DIVISION BUILDING - ADDRESS Department of County Engineer County of Los Angeles LOCALITY JOHN A.LAMBIE, COUNTY,ENGINEER NEAREST l CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST DJSr NO. , GROG P TYPE , SEWER MAP ,��I K PG FOR APPLICANT TO.FILL IN .1-� coNsr� BUILDING �/� I ADDRESS STATISTICAL CLASSIFICATION f CLASS. NO Lt—DWELL.,UNITS 'LOT•NO. a JC BLOCK MAP ' STATE. 1 �J/ NUMBER HWY ' YES O" TRACT ;4t '/? USE ZONE _ SPECIAL ' NO. OF BLDGS. � ) CONDITIONS it SIZE OF LOT � Q rZ NOW ON LOT �ff'� / ) */ - USE OF I e'fL� EXISTING BLDG BUILDING YARD HWY STRE T NAME _ EXIST. SETBACK WIDTH OWNER 'Q FRONT MAILP' L' _ (� ADDRESS' Q - - SIDE CITY - TELA: SY P. L. NO. INSPECTION RECORD ARCHITECT OR TEL. ENGINEER - NO. ... - - ADDRESS TEL. I &h'A/?' - CONTRACTOR + Q NO: ADDRESS_ a.,2 - - DESCRIPTION OF W WOR { ��? I-S7 Ok WORK NEW'Z00000'ASQ FT. q�D.-D1 ALTER REPAIR DEMOLI /1 r-7 D S ZE /V STORIES NO. OFO 1`771 USE OF STRUCTURE ��"�� •�(• rn- ` APPROVALS SIGNATURE OFzz� , APPLICANT DATE UNDATION: }y INSPECTOR'S SI'GNAATUR�jE ADDRESS/.Tk� �$(� t,. o , FOFORMS. MATERIALSION _s-/ $ P. C. $ 6�-'�. FBRACING BOLTS RAME S' FEE / FURNACE: LOCATION. �.sp� VALUATION Q Q FEE w. GAS VENT, DUCTS �L^��IL'�FE A 4 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND / �I, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT. , 12�-6-1 t IWfN 1 STATE LAWS REG TI BUILDIN C NST U TI SIGNATURE OF _ HOUSE NUMBER COR- ry41 PERMITTE _(' RECT AND POSTED ADDRESS v �` ) INAL JOHN A.LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK. M.O. CASH 01'19G6-77; SEP 4 1 6. ' 2 050 SEP 4 1 r WORKERS' COMPENSATION DECLARATION• ebaffirm that I have a certificate of consent to Self o APPLICATION FOR BUILDING P E RM I T , or a certificate of Workers'Compenstion Insurance, or � � • � '-1'1-,,fiecI.copvthereof (Sec 3800, Lab C ),032706 ST.CODIP.INS. COUNTY OF LOS ANGELES BUILDING AND SAFETY N Policy Company " Certified copy is-hereby furnishe FOR APPLICANT TO FILL IN ADDRESS ! 3 �• C� �S . Certified copy is filed with the my bui ng inY c- BUILDING 6134 S GOLDEN WEST, LOCALITY LLJJ tion department ADDRESS o 11%2/83 NEAREST Date a ApplicCITY TEMP E C - ' zIP - - CROSSST �^ G CERTIFICATE OF EXEMPTION FROM RS' NO OF BLDGS ASSESSOR COMPENSATION INSUR' E SIZE OF LOT- NOW ON LOT MAP BOOK PAGE PARCEL (This section need-not be complete the ermit is for one f �- USE ZONE MAP T T (- BLOCK LOT NO NO O hundred dollars ($100) or less )• � SPECIAL- _ per. TEL, I certify that in the performance o e work for which this OWNER NO CONDITIONS O permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY U so as,to become subject to the-Workefs'Compensation Laws ADDRESS„SAME _ CONST ZONE 09 clrY 'TEMP-LE CITY zIP Date Applicant ARCHITECT OR TEL STATISTICAL CLASSIFI TION APT 160NDO W NOTICE TO APPLICANT If, offer making this Certificate of ENGINEER' '^' NO CLASS'NO, DWELL UNITS CL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you'must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be _ deemed revoked CONTACTOR R—R ROOF CO.INJQL BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDREss 221--ELLEN WAY.- NO3721 86 VALUATION, (commencing with Section 7000)of Division 3 of the Business and LIC ' Professions Code, and my,license is in full force and effect CITY ARCADIA- --- CLASS ' '$"6 00.00 SQ FT NO OF NO OF ^CHECK License Number '372186, Lic Class C-39 SIZE - - - STORIES FAMILIES ONE R—R ROOF CO. ,�, C, 11/2/83 DESCRIPTION OF WORK REMOVE E NEW -❑ Contractor - I am exempt from the licensing reqRO-OF AND APPLY FIRE• CLA ADD E]uirements as I am a y� licensed architect or a registered professional engineer "'C" -HEAVY S �E�HAKES /� ALTER ® FINALDAVE �lJ acting in my professional capacity (Section 7051, R REPAIR Business and Professions Code) USE OF DEMOL FINAL EXISTING BLDG RE ❑ By Lic or Reg No _Date APPLICANT TEL OWNER-BUILDER DECLARATIONPRINT) I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS 221. ELLEN WAY -A C Professions Code) PRESENT3 ❑ BUILDING - - I, as owner of the property, or my,employees'with ADDRESS 6'5 2 9 A wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section LOCALITY #,0 0 0 0 0 7044, Business and Professions Code) MOVING TEL I, as owner of the property, am exclusively contracting CONTRACTOR NO ~ 2, - 8 3 8 wrth,licensed contractors to construct the project (Sec- ADDRESS oto 0 8 6 3 8'F� tion 7044, Business and Professions Code) , REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 11,02-83 1 hereby affirm that there is a construction lending agency for FRONT the performonce of the work for which this permit is`issued P L t (Sec 3097, CGv C ) SIDE ^ ' El=estigotion Lenders Name 6,t m Permit Fee~-�r� r �� Lender's.Address _ / 0,0t I certify that,I have read this application and state that the ssuance Fee • aabove infor ation is correct I agree to comply with all County 0 ordinance and State laws relating to building construction, �p s3 Total Fee and her y authoriz eprese atives of this County to enter a upon t bove-me if ape rty for inspection purposes 2 SEE REVERSE FOR EXPLANATORY LANGUAGE ' 'Sign atur plica Agent Date