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HomeMy Public PortalAbout6203 GOLDEN WEST AVE_Building__ APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OFLOS ANGELES V�� �1® WM. J. FOX, CHIEF ENGINEER NO.OF BLDG. � ORD:NO. DISTRIC`NO. PLAN CK. NO. PERMIT NO. PLANS SETBACK LIMB- � � FIRE APPROVED �/ W ev ZONE BY DATE RfiCE1VED DATE OF APPL. DATE ISSUED USE !! APPROVED -------- ZONEf BY DATE APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY' ,® � C BUILDNG ADD EISS O NAME r W Z ADDRESS LOCALITY ►11pyy Zz j NEAREST + r U W CITY CROSS ST. C Q STATE TEL. LICENSE NO. NO. NAME Z MAIL �{ C NAME 3 ADDRESS O O T < ADDRES9 /"'r ` CITY N Z CITY u I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS U APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE V TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICEN99`NO. NO. AND STATE LAWS REGULATING BUQLDING CONSTRUCTION. � f7o NER SIGNATURE-OF�SLTIC/��'! OW `' /� < I' NO. OF SLOGS. � � f ! IL - BLOCK NOW ON LOT AUTHORIZED J n'• TRACT 37 GORItECTIONS USE OF SLOGS. NOW ON LOT DESCRIPTIONOF WORK USE „ BUILDINGLhll't'cr SAA •4 V -1 1s L 1L Irbls consfrl7 I' av R in wi War Production Board orders. You are vy cut PresductlonBoardOffica before commeMg> ir"q UqfD w©r;,c auiiaoria'ri in thig per vi Z D NEW TYPE GROUPzz r NO.OF L, NO.OF ALTERATION ! ROOMs FAMilLIES ADDITION . SIZE REPAIR STORIES, (� / MOVING WALL COVERIN DEMOLISH ROOF COVERING ___P.C. s FEE $ t f�FINAL APPROVAL 6 0'�r s� � 1{ �V\j INSPECTOR'S VALUATION Paz '®'�� DA�re \ I NAME oc 1'-4a-2SX BETS I APPLICATION FOP. PLIrMIT DEPARTMENT OF BUILDING AND SAFETY ty4� C-6-tNTY OF LOS ANGELES UIL WM. J. FOX, CHIEF ENGINEER r ^ NO.OF +� BLDG. ORD:NO, DISTRICT NO. PLAN CK. NO. PERMIT NlO�. PLANS d/ SETBACK LINE FIRE APPROVED ZONE `r BY DATE RECEIV(,EEDD BY D/A/TE+OF/!ADPL. DATE ISSUED ZONE USEPPROVED DATE R`^ ` ��" 1` ` /0 -q , APPLICANT FILL IN HEAVILY OUTLINE ON ON�LY BUILDING p C NAME ADDRESS W Z ADDRESS LOCALITY C�l i I- t9 NEAREST U W CITY B CROSS ST. Q\ Ix Q STATE ,d NO. NAME LICENSE NO.� yyyy... / K VI - - ; MAIL NAME ADDRES ,C/ n P S ¢p� O /� G,0 ' ADDRESS � CITY No. �.�/' _ I Ix F I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS Z U CITY APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. Z - SIGNATURE OF O LQT NO. +e 7 SIZE OF LOT¢/W Y OWNER Q a �„�, NO. OF BLDGS. ' AUTHORIZED ACT., �x +� �'✓�J U, BLOCK NOW ON LOT - j �frn '5 ro / �GORItEC'PIONS G' y� TRACT D USE OF BLDGS. NOW ON LOT !_:.4�LtA �s��f9 DESCRIPTION OF WORN sG„�- � ��✓ `� ��,: USE OF ➢ V BUILDING I���l?r'�Y3Y� , r[INIX• � 1 A-P, r 0 T<r NEW , TYPE I GROUP NO.OF NO.OF I ALTERATION ROOMS FAMILIES ADDITION SIZE REPAIR STORIES i MOVING WALL COVERING � e DEMOLISH ROOF COVERING R"-J $ FEE $ ! FINAL APPROVAL / �' !g INSPECTOR'S'*'- VALUATION FSE / / DATE l�`� 1. NAME APPLICATION FOR11 BUILDING PERMIT �] COUNTY OF LQS ANGELES .. BUILDING AND SAFETY . ,~ `WOhKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL,IN BUILDI' DRES '( ;BUIL 1N ADDRESS '-� �� - !!� - //• `��:i`f'C-•ilC�ll��G , I hereby affirm that I have a certificate of consent�to self Insure, /e ` or a certificate of Workers' Compensation Insurance,;or a certified ' C a1 • \ ZIP Copy thereof(Sec 3800,Lab C) LOCALITY Policy NO Company Lieu P I/live) SIZE O L T NO OF BLDGS NOW ON LOP El Certified copy is hereby furnished NEAREST CROSS ST E] Certified.copy is filed with.tlie county building Inspection T CT BLOCK LOT NO department , - USE ZONE MAP NO ' ' ` ASSESSOR MAP BOOK �• PAGE PARCEL ✓� Date Applicant., • ,'SPECIAL CONDITIONS _ CERTIFICATE OF EXEMPTION FROM WORKERS' o R TEL NO /� COMPENSATION INSURANCE I{L-/ —O r WITHIN 1000 FT OF SCHOOL9': YES NO This section need not be com letedif the ermit is for one hundred A DESS ` ( p-, p �0 �• \ �`�"�' DISTRICT GROUP -TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) aa'tttJJJ ZIP' I certify that in the performance of the work for which this permit ' e4iA rO� .�f 10 is issued, I shall not employ any person In any manner so as to ARCHITE OR ENGINES TEL•NO - �: become subject to the Workers'Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO 1:22 DWELL UNITS a f. NOTICE;TO APPLICANT If, after, making this Certificate of, REQUIRED _ TOTAL SETBACK FROM EXIST Exemption, ,you Should become ',subject to the Workers' CONTRACTOR TEL NO SETBACK YARD HWY PROP LINE - WIDTH - Compensation'provisions of the Labor'Code, you must forthwith' FRONT comply'with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P IL SIDE LICENSED,CONTRACTORS DECLARATION CITY LIC-CLASS P IL I hereby affirm that I am licensed underprovisions of Chapter 9. \� SEWER MAP (commencing with Section 7000)Of Division 3,of the Business and .`�, SO FT SIZE NO OF STORIES NO OF FAMILIES NEWProfessions Code,and my license is in full force and effect Y NEW 1:1 BK PGp,O � a License Number L-ic IDESCRIPTION OF WORK %. ADD :VALUATION _ O Contractor Date r ALTER 'E3 $ S 2 9 ' �' C� REPAIR El ,.•_ °4 ❑ 1 am exempt under SEC $ H c0'��3 B&P C-for this reason 'C) DEMOL 11LDMA P/C# "307 W Date - rAP EXISTING BLDG URM ❑, - �,', _ CO Signature NT(PRINT) TEL NO LDMA Perm# ' '''T a Z f}�.t.:°a I,•as'owner of the property, or my employees with,wages aS. f _ Z -,��` , 2 0t 4heir Sole compensation;will d0 the work and the Structure Is ADDRESS 0 ;:h.�Vf �i°+ not intended or offered for sale (Section 7044, Business and FINAL DATE/ Q ITEMS Professions Code) - WILL THE APPDCANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL o(L�- _ J 1 'OR A.MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE as owner of the property, am exclusively contracting witfl,^_ AMOUNTS SPECIFIED ON THE HAZARDOUS MATER ALS INFORMATION GUIDES FINAL BY 7 TOTAL 57� m �? Ow"Censed contractors to construct the project (Section 7044, , .. cn _ Business and Professions'Code) YES❑ No❑ CHECK .�71°.�� t WILL THE INTENDED USE OF THE BUIDLING BY'THE APPLICANT OR FUTURE BUILDING ' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH.. - � °010 CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR CHANGE' i GUIDELINES f 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 ti � �• ,? 00' �I'� 3/26/93 1 ,I HAVE READ THE HAZARDOUS MATERIALS INFORMATIONGUIDE AND THE SCAQMD PERMITTING' 1 9 V �I 3097,CIV C) - + - _ - CHECKLIST<I UNDERSTAND MY RECUIREMENTS UNDER THE LOS ANGELES COUNTY CODE' - + •N TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS �'>}�'i• i M 9:57°5 3 - Lender's Name MATERIALS,REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD JVtIa. 1 HF 1 o Lender's-Address n O OWNER O AGENT - -o I certify that I have read,this.application,and state under penalty o - of perury that the above Information IS correct I agree to comply PC.FEE ' �) PERMIT FEE N with II county ordinance 'a State laws relating to building _ Co uCtlOn, anfe rye! h th ¢e representatives Of thiS'COunty ' 'ISSUANCE FEE to er_upon thovtio ed pr erty.for mspectlon urposes a • •-• '• INVESTIGATION FEE TOTAL FEE nei�o SEE REVERSE FOR EXPLANATORY LANGUAGE - APPLICATION F0R;,13l11LDING PER COUNTY OF LOS ANGELES ,, BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN' BUILD DD SS A{{ nJ r` UK,ING'ADDRESS /�/� I hereby,affirm that I have a certificate of consent to'self Insure, ,/ ,• or a certificate of Workers' Compensation,lnsurance,or a'certified• V zip, t copy thereof (Sec 3800,Lab C) T - LOCALIT��, \, t Policy No Company SIZE OF'L _ NO OF BLDGS NOW ON COT ` - - ❑ Certlfled copy Is hereby furnished NEARS T CROSS S y El Certified copy Is filed with the county buil n. TRACT BLOCK - LOT NO department USE ZONE MAP,NO t Date - Applicant ASSESSOR MAP BOOK PAGE PARCEL _ • SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OVVER TEL NO V. COMPENSATION INSURANCE _ S O WITHIN 1000 FT OF SCHOOLS YES NO , (This section need not be completed If the permit Is for one hundred DRESS •A DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) , "• ., • _ ' VV« - ' I certify that'in the performance of the work for which this permit, ZIP ^ ZIP lOy, ® 2 Is Issued,41 shall not employ any person many manner SO aS t0 ARCHITEC OR E INEER TEL NO a„ D /� J become subject to the Workers'Compensation Laws STATISTICAL CLLJAS'SIFICATION APT CONDO Date Applicant ADDRESS CLASS NO �,DWELL UNITS NOTICE. TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, -you should' become Subject t0 the Workers' CONTRACTOR �d� TEL NO 'SET BACK YARD HWY PROP UNE WIDTH Compensation provisions of the Labor Code, you'must forthwith 0�� ��v _ FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L - - L•ICENSED.CONTRACTORS DECLARATION —P.L , CITY •- LIC CLASS P.L StDE- I hereby affirm that'I am licensed underprovisions (?f-Chapter 9 SEWER MAP ' (commencing with Section-7000)of Division 3 of the Business and SoS E NO STORIES NO OF FAMILIES _ Professions Code,and my license Is In full force and effect NEW K PG , a ' .License Number _ Llc Class• - DESCRI ION OF WORK' ADD VALUATtO �� ' ContFactor Date ALTER El $ �©O 0 ❑ I am exempt under Sec REPAIR 1:1 0 B&PC for this reason DEMOL El U - ' - LDMA P/C# - W Date% USE OF EXISTING-BLDG URM ❑ x, _ a CO Signature APPLICANT(PRINT) • TEL NO - LDMA Perm# M - a iF - Z .0-1, as owner-of the property,.or ry y_employee•S with wages as _ - Zr a. their sole compensation,'will"do,the,work and the structure is 'ADDRESS - O ACCT.e'` " not intended or offered for sale (Section 7044, Business and FINA�QA�/,� Q 3307 50 6 5_) - Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ' OR'A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE l J ''?ql•`� I, as owner of the property,' am exclusively cont?acting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY a � •' t �i��r licensed contractors to construct the project (Section 7044, YES❑ No❑ t Business and Professions Code) �, TEri:I ., ' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH •� ; - - -'TOTAL ® � CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES ` I hereby affirm that there-,is a construction lending agency for ves❑ NO❑ CHECK - '" ��.'I[, the performance Of the Work;for Which this permit is'issued(Sec I HAVE READ THE HAZARDOUS MATERIALSINFORMATION GUIDE AND THE SCAQMD PERMITTING CHANGE XG 3097,CIV,C) CHECKLIST I UNDERSTAND MY,REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE" TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100,THROUGH 2 20 140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM•THE.SCAQMD o Lender's Address E "t - y OWNER OR AGENT , o o I certify that I have read'this_application and state under penalty I}I q 5:03 ,Of peq y that the abolnfoatl n IS correct I agree to comply PC`FEES •PERMIT FEE - ►' 1i 1 with al county ordinatate ws relating to buildingco str tion„and h e, z repr entatives of this County ISSUANCE FEEfo me upon thea e p r �orinspecUo urp ses (� INVESTIGATION FEE TOTAL FEE n ' naW,e pf Applicant O/ Da G/ (B _- ` SEE REVERSE FOR EXPLANATORY LANGUAGE