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HomeMy Public PortalAbout6201-6201 1/2 GOLDEN WEST AVE_Building__ I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES U I L®I G ' WM. J. FOX, CHIEF ENGINEER - FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT.NO. + PLAN CK. NO. PERMIT NO. '. _ ` /• q ADDRESS L, t EyST J" ' A'C 1039 /C 6 0 ClvV(b LOCALITY L E y RECEIVED BY DATE OF APPL. DATE�,IISSUED7 NEAREST G ✓4 A�3 �'r Y/'- /y .S 3 -//���J/�/ �y��/ CROSS ST. �r/g / BUILDING ADDRESS p &r Ala. ,CA/' iy, 6 Bs !�j OWNER ,/ ' MAIL LOCALITY T/7� G/ 7"-y ADDRESSJV _ vA- NEAREST ' TEL CROSS ST. ,L r CITY ;�T NO. 1- ZI FIRE NO OF I TYPE v I GROUP.r ARCHITECT OR _ TEL. ZONE ', PLANS ./^ ENGINEER NO. BLDG. p ORD NO.• SETBACK LINE ADDRESS APPROVED 0 TEL. BY IT DATE CONTRACTOR .. All,/ �wrj)V NO. _ / USE APPROVED j'� ZONE 14-1 BY DATE ADDRESS 0_7 T e, RL HOUSE FNUMBERING LEGA �" DESCRIPTION LUG J OT NO. ,BLOCI*Ar S MAP NMBER �0FIELD CHECK BY TRACT .r �.� AG� OT �Q'0 x f p D NO. ASSIGNED BY HATE NO. OF BLGS. CORRECTIONS SIZE OF LI NOW ON LOT / q USEEXIDING BLDG. t"L- LI �' I NOFAMIOFS� PO.b - DESCRIPTION OF WORE NEW I x I ALTERATION I I ADDITION I - REPAIR I I DEMOLITION I I I - -�, •- - / - _� SQ. FT. NO. OF / �- 'I.1-CS� /��/^'s t /G I i.•� r�. L1 SIZE O ROOMS STORIES4C- f/ 'Z_ / ••I� .� ,° b' o `✓ r<'/��rlT' e camlig�L� D EXT. WALL ROOF b ° . r COVERING /e- G .I COVERING r9uj7- 19T Q��:'/�•�c USE OF STRUCTURE APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION' LOCATION CA PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS,,MATERIALS CORRECT. I AGREE , TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, / �'n/ HEREON AND WITH ALL COUNTY ORDINANCEy"- AND STATE BRACING, BOLTS LAWS REGULATING/ BUILDING CONSTRUCTION. FURNACE. LOCATION, V /� SIGNATURE OF ' i, �!// GAS VENT, DUCTS v bERMITTE LATH, INT. ADDRESS v LATH, EXT. LZ �- '�,.S•• AUTHORIZED AGT. PLASTER, INT. 76A 538A D039 10-50 r P. C. $ / ® FEE,��� PLASTER, EXT. r° VALUATION FEE .$ 2� b FINAL I DEPARTMENT OF BUILDING AND SAFETY Y APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 'WILDIN WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL INFOR OFFICE USE ONLY DISTRICT NO: PLAN CK. NO. PERMIT NO. BUILDING. uu L C/)- ADDRESS „':' .s.. v: QAC �Q7d r 0 LOCALITY /9 RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST - CROSS ST. /;I- �L� ADD ESS BUILDING �p O �.- N 4"-o /G/1/] �l J/ OWNERPzV / ,T ' MAIL LOCALITY ADDRESS - — k D NEAREST a 1 ' TEL. CROSS ST. I r ' ol CITY �71yI401, k /�/ZX NO. FIRE NO. OF q TYPE GROUP ARCHITECT OR TEL. ZONE PLANS 'ENGINEER ;•G- NO. BLDG. .t /c/ Cj b ORD. NO `a { SETBACK LINE < 1 /' ADDRESS i''��w APPROVED --- TEL. _ BY DATE CONTRACTOR% / � 7 'yl USE A_ APPROVED - '- • ZONE/+ Y DATE ADDRESS T t.— L d HOUSE NUMBERING LEGALSD. -0' C r-7X/R R-2--W"r s T J-c DESCRIPTION LOT NO. BLOCK MAP NUMBER--------;—FIELD CHECK BY TRACT fqN 7W A�� CDS Ri NO. ASSIGNED BY ❑AT - r NO. OF B-DGS. CORRECTIONS SIZE OF LOT QQ y Sb I NOW ON LOT /)9 l�/'L e5 ,ff USE OF NO OF EXISTING BLDG. i / G I FAMrLrE9/ jDESCRIPTION OF WORE NEW I I ALTERATION I ADDITION REPAIR I I DEMOLITION I I L/ t + O 9Q. FT. NO. OF Zl- ¢ t!�/ Get JCB �•fI ` ��7 I A�/C e ✓C 3 SIZE '� Q ROOMS STORIES cam!a�7. ,e. B EXT WALL I ROOF •!- I r COVERING G'Gp COVERING efs 114 _ USE OF STRUCTURE - Y r µ_ - --m----�->•- - - - APPROVALS INSPECTOR'S SIGNATURE DATE ' I HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS /'�2i/ CORRECT.- ' I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME- FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANAND STATE BRACING, BOLTS p/� 2 LAWS REGULATING BUILDING CO ST UCT FURNACE �- LOCATION, SIGNATURE OF GAS VENT, DUCTS PERM LATH, INT. ADDRESS I Tl/1 111J\, LATH, EXT. V "'i '1 AUTHORIZED AGT. PLASTER, INT. - 76A688A• DBSB 10-80 S P. C. $ ? Q.S ' ® ' j O FEE 13 • PLASTER, EXT. VALUATION FEE $ FINAL -7'"L1J I WORKERS' COMPENSATION,DECLARATION hereby affirm„that I have a certificate of consent to self r. ' APPLICATION FOR BUILDING . PERMIT insure, or a certificate of Workers'Compenstion Insurance, o� a'certif rd co y the eof Sec 3800, Lab C ) ' COUNTY OF LOS'ANGEL-ES BUILDING AND SAFETY PohcyA 4�X- Company BUILDING ❑ Certified copy,is hereby furnished FOR APPLICANT-TO FILL IN ADDRESS- Certified copy is filed with the county buildingirispec- BUILDING / /'► tion department ADDRESS` ��' Was LOCALITY � Gi -'.Z ' •��f d NEAREST. Date Applicant6/ �'/ � CITY- L� ZIP p O CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR r COMPENSATION'INSU RANCESIZE OF LOT NOW ON LOT MAP,BOOK PAGE - PARCEL (This section need not,be completed Pthe permit is for oneUSE ZONE MAP �� _ ? hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO. CJ r TEL �� SPECIAL d I certify-that in the performance of the work for which this OWNER y T ? d/ 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 Workers'Compensation Laws ADDRESS 62,4> �f CONST ZONE r 0 CITY { L� ZIP, d H Date Applicant STATISTICAL CLASSIFICATION PT CONDO U r - ARCHITECT OR- v, - - - -.TEL 'NOTICE TO APPLICANT If, after making this Certificate of - LU - - Exemption, you•-should-become'subject--to .the Workers' _ a � ENGINEER ��{/ T, NO CLASS NO DWELL UNITS H Compensation provisions of.the Labor Code, you must forth- ADDRESS SEWER MAP' with comply with such provisions or this permit shall be deemed revoked, CONTRACTOR NOS7�1jf BK L IG, VALIDATION LICENSED CONTRACTORS DECLARATION • I & I LIC q I hereby affirm that I am licensed'under provisions of Chapter 9 ADDRESS C) a NO ��! ZLG V UATION _ (commencing with Section 7000)of Division 3 of the Business andLIC Q Professions Code,tand-my license is in lull force and effect CITY CLASS ��I ZZ� I Q SQ FT NO.OF NO OF CHECK ' I License Number / Lic Class O► SIZE STORIES FAMILIES ONE - Contractsa®I Z ��� ate ^� DESCRIPTION OF WORK NEW ❑ , C!J/4c[.. ADD ❑ am exempt from the licensing fequiremenis as I,am a licensed architect or a registered professional engineer, �� ALTER- ❑ FINAL acting ,in my professional capacity (Section 7051, .v/ - C(J�'L�+ REPAIR DATE (O (p Business and Professions Code)' USE'OFFINAL' DEMOL EXISTING-BLDG 4 ❑ By Lic or Reg No Date APPLICANT TEL OWNER-BUILDER DECLARATION PRINT) NO I hereby affirm that I am exempt from the Contractor's License �~ Law for the following reason (Section 7,031 5, Business and ADDRESS- Od Professions Code) PRE ENT I, as owner of the`property, or my BUILDING employees with ADDRESS , wages as their sole compensation, will do the work and 5'8 1.4 A the structure is not intended or offered for sale_ (Section LOCALITY , .7044, Business and Professions Code) MOVING TEL 1, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project-(Sec- ADDRESS 21eto 4'a 0 Q tion 7044, Business and Professions Code) '- REQUIRED TOTAL SETBACK FROM EXIST Y t' _ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH, 0 0 0 4�,O 0 V I hereby affirm that there'is a construction,lending agency for•-” FRONT r the performance of the work for which this permit is issued -P L � 8, 2 4F—8 2 (Sec 3097, Civ C )' SIDE j Lender's Name P L r Permit Fee �° O ' Lender's Address PCI Fee$ � � � •- I certify that I have read this application and state that the Issuance Fee S Q aabove information is correct I agree to comply with all County Investigation Fee 1 - ordinances and State laws relating to building-construction, Total Fee �' N (/ and hereby authorize representative of this County to enter V a upon bove-mentioned pro or inspection Viposey a !�' �Z pj/ SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signature oflApp6c or Agent Dot _ _ - , ©s +,= WORKERS'COMPENSATION DECLARATION v y t I hereby affirm that I have a certificate of consent to self 'APPLICATION A P P L'C AT 9 O N FOR .BUIL®I N,G PERMIT insure, or a certificate of Workers' Compensation'Insurance, or a,certified copy they of (Sec 3800, Lab C ) PolicyNony LFl�%nFlL� COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished -FOR APPLICANT-TO,FILL IN BUILDING el ADDRESS Certified copy is filed with the cou4buddiec- BUILDINGtion department ADDRESS TADate Applic t CITY" f ZIP VvLOCALITYCERTIFICATE OF EXEMOM / NO OF BLDGS NEAREST COMPENSATI ,IN URANCE SIZE OF LOT l� NOW ON LOT CROSS ST (This section.need not be co pleted if the permit is for one ASSESSOR hundred dollars ($100)or less ) - TRACT BLOCK LOT NO MAP BOOK, JI PAGE PARCEL OWNER i T L USE ONE ' MAP 5 I certify that in the performance of the work for which this NO permit is issued, I shall not employ any person in any manner j �} / SPECIALa so as to become subject to the Workers'Compensation*Laws ADDRESS aG (! CONDITIONS O F CITYZIP V r� Date Applicant ARCHITECT.O its TEL/ rB NOTICE TO APPLICANT If,,after making this Certificate of ENGINEER J y61 NO�J DISTRICT OUP TYPE F FIRE PROCESSED BY -0 Exemption, you should ,become subject to the Workers' CONST V Z�; (— Compensation provisions of the Labor,Code, you must forth- ADDRESS ' V W with comply with such provisions or this permit shall be p„ deemed revokedTEL STATISTICAL CLASSIFIC TION APT O DO fn CONTRACTOR NO 2 _L Z LICENSED CONTRACTORS DECLARATION LC CLASS NOZ J—DWELL UNITS — 1 hereby affirm that I am licensed under'provisions of Chapter 9 ADDRESS Z C NO (commencing with Section 7000)of Division 3 of the Business and LIC _ SEWER MAP Professions Code, and my license is in full force'and effect CITY' L CLASS BK PG VALIDATION SQ FT. NO OF NO OF CHECK License Number Lic Class SIZE % STORIES FAMILIES ONE 8 1C�Fj/ G�$,h F3 8 _ NEW ❑ s ALUATION _ d Contractor_ ate + DESCR61 IPTION OF WORK /1 ADD I am exempt under Sec 7 T ALTER .28863A B 8P C for this REPAIR ❑ $ #•° °.° • 2 3 USE OF o 443L Dat EXISTING-BLDG DEMOL ❑ .0 70° 4 4 3 7 0 Signa re APPLICANT TEL ER-M LDER D O �- NO FINAL �� -i 0 1,2 7 8 8 DATE t, I hereby that I am exempt Tom the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS FINA Professions Code):- By y ❑ _ -he prperBUILDING - I, as owner of toty, or my employees with" T 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 ` 9 3 54 A ❑ j, as owner of the property, am exclusively contracting CONTRACTOR NO >� r ?'r1, with licensed contractors to construct the project (Sec- - ` # o,o • ••0 � ; tion 7044, Business and Professions Code) ADDRESS 1. , a-\� �yO 539,25 CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK ��'r J''• "• :� Vit. 3. SET BACK PROP-LINE WIDTH 1 t �,, ; , I hereby affirm that there is a construction lending agency for FRONT ! :' •i s. o'o = the performance of the work for which this permit'is issued P L 5'3 9,2 5 v (Sec 3097, Civ C ) SIDE Lender's Name • ' - P L - �� ,081 ,8 8 LDMA Ref ii t P C Fee S Permit Fee, m Lender's Address - 773i - � ! _ a I certify that I have read this application and state that the Issuance Fee LDMA P/Clq, t '• oabove information is correct I agree to comply with all County Investigation Fee 0 ordinances and State jaw elatin to building construction, R- `� E N and hQr y uthonze r re enta es of this County to enter Total Fee LDMA Perm N m upo /the a ve-menh ne pro ty for inspection purposes l ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of t gent Date Y• ' x