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Home My Public Portal About6138 GOLDEN WEST AVE_Building__ 76A6364:SCE #803 °"APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMOIE, COUNTY ENGINEER ADDRESS (X/ COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY L FOR APPLICANT TO FILL IN NEAREST CROSS ST. Print ort a on[ DISTRICT NO. GROUP ITYPE 'FR C SSED BY BUI ADDRESS NG CONST.' DD STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO. 23 DWELL,UNITS�—__/_ BKL PG � TRACT USE ZONE MAP NO.OF BLDGS. NO. 2,!550SIZE OF LOT l NOW ON LOT / SPECIAL USE OF / CONDITIONS EXISTING BLDG. TEL. /IC OWNER NO. J BLDG.SETBACK FROM ADDRESS '� L'L � !/L/ t- FRONT PROP.LINE OF (STREET) 7 .w TYPE OF JEXISTING SETBACK HIGHWAY + YARD = TOTAL CITY CIA- /A HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + _ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE LINE OF (STREET) TEL. TYPE OF EXIS G SETBACK HIGHWAY + ARD = TOTAL CONTRACTOR NO. HIGH AY WIDT FROM C.L. r LIC. C- ADDRESS Np, + = CO.> LIC. C= CITY CLASS CORNER CU OFF YES ❑ NO ❑ O CONSTRUCTION LENDER L5 NAME AND BRANCH rile /L SEE REVERSE SI OR SPECIAL APPROVALS a ADDRESS Z SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE ALTER ❑ SIGNATUR OF a REPAIR❑ A P P L I C A `T lyL MOL VALUATION $ .®�� APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. Q /� FOUNDATION: LOCATION FEE S FEE $ (,®`� FORMS, MATERIALS FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT_DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF T TATE OF •CALIFORNIA U} LATING TO WORKMEN'S CO P SATI N INS ANC E. /� LATH, EXT. SIGNATURE O V^JC/- HOUSE NUMBER COR- PERMITTEE RECT AND POSTED j ADDRESS' `2 FINAL VV JOHN F. LEWIS. PRIN I LST URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK M.O. CASH • &I6A638A+CE 4803 4/70 f.z,/ �. . APPLICATION FOR BUILDING PE IT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL A BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY /. FOR APPLICANT TO FILL IN NEAREST Print or type only) CROSS ST. BUILDING DISTRICT NO. GROUP TYPE P45CESSED BY ADDRESS 1y1i 4�L !• -1-- CONST. STATISTICAL CLASSIFICATION 6�r•/ SEWER MAP LOT NO. BLOCK CLASS NO.0/DWELL,UNITS'A • BK L PG 77 TRACToc �o"– USE ZONE MAP NO.OF BLOGS. NO. �� SIZE OF LOT - F- NOW ON LOT ,fin N L J SPECIAL USE OF CONDITIONS EXISTING BLDG. _A T E L. OWNER-n— G a C C G W C I1J NO• S� BLDG.SETBACK FROM ADDRESS/jy_jyj ME:114AP1& FRONT PROP.LI NE OF (STREET) t TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY —0 C /-y / 1� HIGHWAY WIDTH I FROM C.L. ARCHITECT OR TEL. + ENGINEER NO. BLDG.SETBACK I c��,Y[ C-7SSIDE PROP.LINE OF�-� ADDRESS (STREET) SETBACK CONTRACTOR �5 NO.EEXISTING GOTAL HIGHWAY WAY W DTHFROM C.L.C.L, HIGHWAY + YARD = LIC. - r_ _ o ADDRESS NO.;ZO'i), + U LIC. CITY CLASS CORNER CUTOFF YES ❑ NO �. p CONSTRUCTION L5 NAME AND BRANCHNDER /V40 za SEE REVERSE SIDE FOR SPECIAL APPROVALS W SQ ADDRESS NO. OF NO. OF /Zf' Ctil1 ,L� litJf� '"' T Z SIZE I7 STORIES FAMILIES j NEW USE OFADD ❑ / ! A (1 - STRUCTURE DML , .s-r; / J�` ALTER El / SIGNATUR F REPAIR❑ Slrs� P,111I,E•MN APPROVAL APPLICANT 1 jiCa i sL�i--to ❑ �:�,::: ':.::r: Ct_�C11'i-1]' /�`r _ �,,..�txc. _ BF'.'O i O t=f F l�9� tit:w;� -_164 A VALUATIO F APPROVALS DATE INSP/'T OR'S S47 FEES -:5`7. 6 L1 (O1 ,3 o FEE $ / �Gi J FOUNDATION: LOCATION FORMS, FORMS, MATERIALS 1 FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE SHAT I HAVE READ THIS APPLICATION BRACING BOLTS 12 AND STATE THAT THE ABOVE IS-CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO / WORKMEN'S CO SATION INSURANCE ., i LATH, EXT. SIGNATOR PERMITTHOUSE NUMBER COR E '' =L RECT AND POSTED ADDRESS - .::X " �" , Za FINAL 0-' C, JOHN F. LEWIS. PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cK. M.O. CASH r � 8 4- 7 8 c JAN 2 5 2 3 0 5 7.60-A _ 864 6 f7F 8 a 2 3 D ,6.3 r gin„ 8 6 4 7Cl- FES 1 D 1 :0 6.5 0._, r WORKERS'COMPENSATION DECLARATION •"r �' ` = �7 �� hereby affirm that I have r certificate of consent to self A ` aCAT I O N FOR BUILDING PERMIT insure, or a certificate of Workers' Compe ation'Insurance, ora certified o y ther f (Sec. 3800,•L 1. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ • Cer fied copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 3$ ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS ADDRESS /�'J /�► p / DateCp r O (Applicant 4�LQ& CITY ~ ZIP ! ` v LOCALITY C RTIFICATE OF EXEMPTION FROM WORKERS" - O.OF-BLDGS. - NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This sectio need not be completed if•the permit is for one ASSESSOR hundred doll ($100)or less.) TRACT BLOCK LOT NO. MAPBOOK GE PARCEL TEL SE ZONE MAP I certify that in th performance of the work for which this OWNER NO SPOECIAL ®Q @5 permit is issued, I sh I not employ any person tri any manner _. so as to become'subje to the Workers'Compensation Laws. ADDRESS s/ CONDITIONS Date APpIi nt CITY ZIP 09 NOTICE TO APPLICANT: If, of making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO ESSED BY- ENGINEER NO. r CONST. ZONE Exemption, you should becom subject to the Workers' h0�1 Al U Compensation provisions of the Lab Code-, you must forth- ADDRESS �/ /� � ! 3 with comply with .such provisions o this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATIONLIC, CLASS NO.�DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS .. NO. SEWER MAP (commencing with Section 7000)of Division 3`of the Business and _ _ LIC. / / Professions Code, and my license is,in full force an ffect. CITY CLASS BK L P .O Y VALIDATION Q ��'I� SQ. FT. - NO.O NO.OF CHECK License Number (J / Lic.Class SIZE STORIE FAMILIES I ONE VALUATION DESCRIPTION OF WORK NEW ❑ Contractor Date n ADD $� 06 ❑ 1 am exem under Sec. CNV"t w , • r � . ALTER B.&P.C. for i s reason REPAIR .❑ $ Date: USE OF DEM Date: ❑ �� # �2 1 f' EXISTING G. APPLICANT TEL. n o'o o a 23 Signature (PRINT) SIG NO. DATEFINAI � � -7, o o 4-9.Q, t- ' OWNE\IrDER DECLARATION DATE hereby affirm that I mpt from the.Contractor's License Law for the followinon (Section 7031.5, Business and ADDRESS fli FINAL / o �t C �!'1 Professions Code): PRESENT By ❑ BUILDING •a - ' *,- - .1 0621 84 I, as owner oroperty, or my.employees with ADDRESS wages as their perisation,will do the work and athe structure isen ed or offered for sale(Section LOCALITY �/ �J7044, Businessrofe ions Code). MOVING "' TEL."' 3T-2 f/ 21 Li 7 A I, as owner of pert am exclusively contractingCONTRACTOR NO.with licensed tors to construct The project (Sec- " ADDRESSa..tion 7044, Busind Prof Bions Code). 0 1/1f7. 2 -,P 6, (� REQUIRED. _TOTAL SETBACK FROM T. _ CONSTRUCTION LENDIN AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT o tf u �. �'h 3 czi' - the performance of the work-for which this-permit is issued P.L. - P P D c� ?_'1 —8 4- (Sec. 3097, Civ. C.). SIDE • _ P.L. Lender's Name LDMA Ref. # m P.C:Fee$ Permit Fee �O r Lender's Address I certify that I have read this-application and state that the Issuance Fee LDMA P/C_# above information is correct. I agree to comply with all County Investigation Fee /_ ordi ces and State laws relating to building construction, Total Fee (� � -LDMA Perm. # v and reby authorize representatives of this County to enter u the above-ment' ned prop y for inspec'on purposes. G o SEE REVERSE FOR EXPLANATORY LANGUAGE / O Signature of Applicant or gent - Date - - `-' - -" :' 4� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS q�� I hereby affirm that I have a certificate of consent to self insure, BUILDIN ADDRESS I �es or a certificate of Workers' Compensation Insurance, or a certified l e, • $ copy thereof (Sec`.3800,Lab.C.) CITY r LOCALITY ZIP c Policy No. 1336 s Company '""""" 1. SIZE OF LOT NO.OF BLDGS.'NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with theco building inspection TRACT BLOCK LOT NO. depart ent. � , USE ZONE MAP NO. Date QS Applicant CN`� ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ^�I'� TEL COMPENSATION INSURANCE kv Mme' CSU'+ 7.19 WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDRESS G I I6w'�Wes � DISTRICT GROUP TYP CONST. FIRE ZONE PROCESS BY S dollars ($100) or less.) v CITY T ZIP 1 certify that in the performance of the work for which this permit Q is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. O become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. a DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOPp,,, - TEL NO. - SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ` "� ►�^�F�V6L CN3 -77;— to FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO: P L t LICENSED CONTRACTORS DECLARATION 911 F' 31 Sfi 9-7S 6 3 SIDE CITY �I LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 —3 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES } Professions Code,and my lic nse is in full force and effc s F,�. NEW ❑ BK PG �1. DESCRIPTION OF WORK 0 r! - ��• VALUATION License Number �6 Lic.Class d_ ��A GQ� ADD ❑ � U Contractor ti I`�'{-c M�27 Date Z �6 ALTER ❑ $ D� Weod� REPAIR ❑ 0 El am exempt under Sec. I $ U BAP.C.for this reason DEMOL El LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ •' fl i C0 Signature e� � APPLICANT(PRINT) TEL NO. LDMA Perm# El 1,I, as owner of the property, or my employees-with wages as � " their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE Q _ Z s �• E; '= Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - El 1, as owner Of the property, am exclusively contracting with OR A MIXTURECONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY „•� '” '_'' _ •ter licensed contractors to construct the project (Section 7044, VES 1:1 NO❑ (t_s` '^ 1 a— ' Business and Professions Code.) _ —LL�Jic' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING v Ig„, •Fi --• -- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR {�'•S ii:k t:;:�;; _°sl„1 GUIDELINES. .+*.- I hereby affirm that there is a construction lending agency for YES❑ No❑ N the performance of the work for which this permit is issued(Sec. - mI HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, F"''•= _ r TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS "LlIJL`^`-`%.`-'=• •�••• '••'� Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CL Lender's Address o . OWNER OR AGENT o I certify that I have read this application and state under penalty o of perjury that the above information is correct. I agree to comply P.C.FEE PERMIT FEE " with all county ordinances and State laws relating to building (p co < construction, and hereby authorize representatives of this County ISSUANCE FEE �7 / (% to enter up above-men' ned property for inspec'on purposes. \•�v--+ INVESTIGATION FEE TOTAL FEE Signature o Pplicant or Agent D.Ib SEE REVERSE FOR EXPLANATORY LANGUAGE