HomeMy Public PortalAbout6219 GOLDEN WEST AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUI'1-CING s COUNTY OF LOS ANGELES
ADDRESS y° e� Cdi� ' DEPARTMENT OF COUNTY ENGINEER
CITY e 8 f ZIP - BUILDING AND SAFETY DIVISION
•I - J� NO OF BLDGS BUILDING
SIZE OF LOT O`eo2-`J 'Z NOW ON L , - ADDRESS
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ACT BL"OCK O'P' NO LOGALI Y
TEL NEARES
OWNER J. v NO CROSS ST
ASSESSOR `
ADDRES ` MAP BOOK - PAGE CEL
,DISTRICT G OUP YPE FIREaPROCSSED BY ;
CITY - ZIP, r`�� NS FON
ARCHITECT OR TEL4/'/�
ENGINEER �0. !t{" NO (f�() �I,
STATISTICAL CLASSIFICATION - SEWER M P
ADDRESS Lc� '14 CLASS NO_3�DWELL UNITS �BK' G
CONTRACTOR • v GP/U�� n/'' NOL S'Z D U ZONE NADP �.
ADDRESS aL d �C4 N1 v"l�,/3F"/�NO YS .�� SPECIAL
�J CONDITIONS `
CITY u /U (9 /7-/3 CLASS
ROAD D RTMENT APPROVAL REQUIRED YES[:] NO
CONSTRUCTION LEND EF3N kNOwN/ a
I NAME AND BRANCH lVJ BLDG ETBACK FROM C
FRON PROP LINEOF (STREET) V
ADDRESS CITY HIGHW Y + YARD TOTAL SETBACK FROM TYPE OF EXISTING Ix
SQ FT NO OF _.NO. OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE �4Q STORIES FAMILIES ONE ,
DESC TION OF WORK - - NEW- C4
❑
SLOG S BACK FROM Z
ADD SIDE PRO INE OF (STREET)
LTER ❑ _ TOTAL SETBACK FROM TYPE41DTTH
_77 71 HIGHWAY + Y - pCK FROM
HIGH
NE
REPAIR❑
USE OF + _EXISTING BLDG Gt1 � /'! 1 N Qm Q DEMOLAPPLCANT TEL CORNER CUTOFF YES NO
(PRINT) NO
71
IN OPEN SPACE YES NO
BY (SIGNATURE)
IN COASTAL ZONE YES NO _
VALUATION -_
CATEGORICAL EXEMPTION YES� NO-�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT,ANO AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE -
WORK CODE OF TH STATE OF ALIFORNIA IN RELATING TO L �/'�4,/ 000 ' 1— -O
WORKMEN'S COMPEN A ION 1 SUR CE !a 7
SIGNATURE
PERMITTE11
E •iJ� "` ® wN R' �' � /
ADDRESS J pQ/✓��15� /�'• ,[��(j L��
1.11 TEAL
.CITY - NOL S`ODIATE �Y ✓'vo/�� //�
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MAKE CHECKS PAYABLE TO p E FEE4V'
I.
HARVEY T. BRANDY, COUNTY ENGINEER �/ 1
PLAN CHECK VALIDATIONCK M O CASH _ PE T , ION CK M o CASH
x 3 0,24-MAR-29•29 1 0 ' 4 2.0 0 A98
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76A638A CEN803 7/73 _ "— — '
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�71A838A CE#8089-60 APPLICAT[0N`.F'OR BUILDING P RNA T
COUNTY OF-LOS ANGELES BUILOIN,G ~'
DEPARTMENT OF COUNTY ENGINEER 4DDRESS
BUILDING AND SAFETY DIVISION LOCALITY-_.:
JOHN A. LAMBIE, COUNTY+ENGINEER NEAREST X
WILLIAM A JENSEN SUPT OF BUILDING CROSS ST
DISTRICT'NO GROU .-r•�.pE P SSED BY
FOR APPLICANT TO FILL IN CONST
BUILDING STATISTICAL CLASSIFICATION. I SEINER MAP
ADDRESS,(L7R // 40 Q Ir' Q•- BK P
) CLASS NO DWELL UNITS
LOT NO' 'tl h 10a P G-L 4 BLOCK /V,/' NUMBERHWY
J, STATE , YES..
TRACT - .USE IZONE ,SPECIAL /
9 J. `o
114,6 I NO OF SLOGS CONDITIONS
O OT S NOW ON
1-1-71
USE OF - t
EXISTING BLDG. —' BUILDINGYARD HWY TR ET NAME EXIST-
�
l 7'EL &D 1 SETBACK _ WIDTH
OWNER V'ehG h h Il �'ip J i�2•S C NO FRONT '
AD"7j/` Yn t G 1t �1 I, /J P L
{!2.-h Cl 6-/'1 O tl! /l i" Y✓r ehy SIDE r
ARCHITECT OR TEL P L'
ENGINEER d• NO
INSPECTION,-RECORD 1
ADDRESS s, +• _ ^ '.-�.; ,✓ -+`` `CL
TEL.
CONTRACTOIRGGS ,4pe NO.
ADDRESS' ' ++J•/ .� �- .�C"CJ �'.ltu-��=`. f ti "� •: `0
DESCRIPTION-OF WORKLu
! I P +•, '�..t �;=> �
rJEW''/-•ADD ALTER r '•REPAIR DEMOLISH qq /' ((� -j 1 �`. 1f/ ' •` Z
SO FT. 'NO-PF ) NO OF / rJ �C/u!'�.\ P''/�.+rs ..f
SIZE ��.;.SCi'Z' STORIES-/ FAMILIESUSE
• STRUOCTUREI rtM e-' A�'L 1 'P t°u-+'a'a_i rt r��."' �'. ,
a r a+' �,'I '.° 2 d V °� ��, 6. ix 4�-ces
;SIGNATURE OF /L���y %' 7.1��/�.S Y S t G
APPLICAN �
t I` �-
#• Clti•Ib-"S d°r is'eor 4,?
VALUATION$ 1 • - �- be F "•-
,� APPROVALS ! DATE =•INSPECTdR'S SIGNATURE G•+z.
'PC - PMT r FOUNDATION LOCATION AA A
'FEE $ • '-I FEE FORMS, MATERIALS �� .vG�./ G•r_,_, X'A L.;-_
FRAME FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT•I HAVE READ THIS APPLICATION BRACING„BOLTS
AND STATE THAT THE,ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION., 1 j�
' WITH ALL_COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT'-DUCTS, y { •y
BUILDING CONSTRUCTION I CERTIFY•THAT IN THE PERFORMANCE Y/���I �•
-OF'THE"WORK`FOR•WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH, INT
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN 5 COMPENSATION LAWS OF CALIFORNIA
LATH, EXT ����[l.�°�•� �'"' ��Lr!
SIGNATURE OF' HOUSE NUMBER COR- / ti , i{ ^
PERM ITT RECT AND POSTED 'o n1:Aa,�`''PG �u .k
ADDRESS FINAL
CLYDE
PLAN CHECK VALIDATION CK. M O. CASH P DERMIT VALIDATIONTR CK. RM 0.ENCASH INEbt
76A638A CE#8033 61 APPLICATION FOR BUILDING PER T -
COUNTY OF LOS ANGELES BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGINEER I
BUILDING AND SAFETY DMSION LOCALITY '
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN Sur•T of BUILDING CROSS ST
DI CT NO TYPE Y „
FOR APPLICANT TO FILL IN GR d CONST. ai
BUILDING / q i/ STATISTICAL C ICATION SE MAP
ADDRESS BK PG
CLASS NO DWELL UNITS
LOT NO. BLOCK I WATER
_ CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP _3 HIGHWAY STATE MAJOR SECON LOCAL
NO OF BLDGS. NO (CIRCLE)
SIZE OF LOT 10 x d NOW ON LOT / USE ZONE SPECIAL
USE OF CONDITIONS '
EXISTING BLDG '
TEL
OWNER NO. BUILDINGYARD HWY STREET NAME EXIST.
SETBACK WIDTH
ADDRESS FRONT o
ARCHITECT OR TEL. P L r
ENGINEER .NO SIDE -� 0
P L
ADDRESS TEL. INSPECTION RECORD
CONTRACTOR NO O
F
ADDRESS W
DESCRIPTION OF WORK N
z_
NEW ADD ALTER REPAIR DEMOLISH
SQ FT. NO OF NO OF
IZE cS0 STORIES FAMILIES
USE OF
STRUCTURE '
oq
SIGNATURE OF
APPLICANT "
VALUATION S -do
APPROVALS DATE INSPECTOR'S'SIGNATURE
PC PMTFOUNDATION LOCATION -
FEE S FEE S FORMS, MATERIALS
FRAME FIRE STOPS, _
I 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'COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS '
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED,HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH"INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- '
ING TO WORKMEN 5 CO PEN SATION INSURANCE
LATH,EXT
SIGNATURE OF HOUSE NUMBER COR
-
PERMITTE RECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM, P INCIPAL STRUCTURAL ENGINEE
PLAN CHECK V TION CK. , M.O. CA6H PERMIT V ATION cK. a.o. r.a ,
w ;2 0' 2 9 JUL ;L/r- 1 U6.0 0-cil