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Home My Public Portal About6354 GOLDEN WEST AVE_Building__I01p, , APPLICATION FOR BUILDING PERMIT FOR APPEI CANT TO FILL IN (Print or"only) COUNTY OF LOS ANGELES ADDRESS Gar ci Go DEPARTMENT OF COUNTY ENGINEER aTY T PLS ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING1 ,l SIZE OF LOT NOW ON LOT p ADDRESS Q'� ( W L7�t�+ BLOCK -1-Cr-6 LOCALITY T OWNER '� '� NO. 6 NEAREST ST. ADDRESS 3S 6d tb Fsl C.S I MAP BOOKR PAGE PARCa DISTRICT GROUP TYPEFIRE PROCESSED BY LITY ZIP CONST. ZONE? ARCHITECT OR TEL p ` ENGINEER NO. STATISTICAL CLASSIFICATION SEW) MAP ADDRESS [ CASSNO.�L_DWaLUNITS BK PG CONTRACTOR ' r THp>< �- ��I 115E ZONE NO O LIC ADDRESS CI7CJ 'I12t Aa NO. �q _ SPEC) C11Y O -vj,.1 LIC- CONDITIONS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO CONSTRUCTION L1 ❑ NAME AND BRANCH SETBAIX FROM FRONT .LINE OF LSTREETI ADLJRE55 CIT) TOTAL SETBACK PE OF EXISTING YARD+ SQ FT. NO�CL�F I NO.OF CHECK YARD PROP.UNE HIGHWAY WIDTH SJZEFAMILI6 HIGHWAY ONE DESCRIPTION OF WORK NEW ❑ + U ADD ❑ DE PROEIP.UN OF F M (STREET) U0 ALTER EZ TOTA FROM TYPE OF EXISTING HIGFfWAY + YARD SIDE P UNE HIGHWAY WIDTH USE OF REPAIR ❑ EXISTING BLDG. L DEMO( ❑ + _ AF� NO.NT) ' A J ' �» CORN ER CUTOFF YES ❑ /�v, \ tN TJX IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION $ . I t� HE3Y AC)MMLEDGE THAT 1 HAVE READ THIS APPUCATK)N AND STATE THAT THE ADOVE IS COQ AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BULDNNG COt4ST% FK)f1L I CBMFY THAT IN DOING THE WORK AUTI40RIZED HERBY I WILL NOT EMPLOY ANY PERSON IN VFOLATION OF THE LABOR CODE OF THE STATE OF CAIJFORNLA IN RELATING TO WORKMBIM CO04 PE SAWN INSURANCE. - SIGNATURE OF ' PERMrI7EE 41 �w ADDRESS J c 7 CITY DATE FINAL Ta- NO. ( 'sl 7/ BY MAKE CHECKS PAYABLE TO, $ PMT. FEE FEE FEE HARVEY T.BRAN DT,COUNTY ENGINEER PLAN CHECK VALIDATION cv- M.O. cwsH PERMIT VALIDATION c N.O. cA✓,H 9 1- 2 8.5 0 3 (51 7&A6DBA CE Nd03 575. . 7eA69eA caeeoa 8-" APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGEI.FS BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUIIUING•ANI? SAFETY DIVISION LOCALITY JOHN A. LAMME, COUNTY ENGINEER NEAREST WILLIAM A. JENGEN, QUP'T OF BUILDING CROSS ST. K-'L- DISI' CT NO G P TYP P D FOR APPLICANT TO FIU IN co BUILDINGSTATISTICAL CLA I KATION WER MAP ADDRESS CLASS. NO. DWELL UNITS BK WPG •LOT NQ. BLOCK WATER CERTIFICATE: NOT REQUIRED RECEIVED TRACT MAP HIGHWAY ' NO. OF BLDGS. NO. (clRCLsI SPATE MAJOR SECOND L SiiZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. gF t TEL' ' OWNER O. BU L NG. YARD HWY STREET NAME EXIST' SETBACK • WIDTH ADDRESS. FRONT ARCHITECT OR FEL P. L ENGINEER NO. SIDE P. L. ADDRESS _.EL O CONTRACTOR O. V ADDRESS L� DESCRIPTION OF WORK • I NEW ADD ALTER REPAIR DEMOLISH - SQ. FT. NO. OF NO. OF •t SIZE STORIES. FAMILIES . USE O STRUCTURE SIGNATURE O APPLICANT VALUATION 8 APPROVALS DATE INGPKCT4,.e1GNAru RI P.C. PMT." FOUNDATION: LOCAT.IO - - FEE ,'j FEE f a'Q FORMS. MATERIALS PRAME: FIRE STOPS, I.HKR[DY ACKNOWLE.DGC THAT 1 HAVE READ THIS APPLICATION BR CING BOLTS AND eTATE THAT THS ABOVE,IS coRR[CT-AND AGREE TO COMPLY FURNACE: LOCATION. WiT1-_ ALL COUY L NTORDINANCES AND STATE AWO REGULATING GAS VENT. DUCTS eU ILL)ING CON 8TRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HERESY I WILL NOT SMFLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THL' LABOR CODE OF THE STATE OF CALIFORNIA RELAY, ING TO WORKMEN'S CO eATION INSU CE LATH, EXT. SIGNATUREOF' HOUSE NUMBER OR- PERMITTEE RECT ANIS POSTED ADDRESS X&lFINAL, f JOHN F. LEWES. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.D. c"R PERMIT VALIDATION CK. M.O. CASH C�� 3 91.6 9 9�_o- JUL g I - • WORKERS' COMPENSATION DECLARATION y �n � oart � cs' pslnsuoce L�INC PERMITu ; r affirm a. meaion IranAPPLICATION. FOR B � or a certified copy th (Sec 3800, Lab. C.) COUNTY OF LOS ANGEUS dU1DIN LG AND SAFETY Policy No Company4 � BU I IDI NG (fled copy Is hereby furnished. •FOR APPLICANT TO FILL IN ADDS. Certified copy is filed with the county bulkling Impar- A �I I . tlon department. CT . Dat Applloant . ` ZIP / LOCALITYNO. Of BLDGS. NEARE8T Ci• CERTIFICATE OF EXEMPTION FROM WORKERS'. SIZE.OF LOT NOW ON LOT CROSS.ST. .COMPENSATION INSURANCE AssF SSOR(This section need not be completed.if the permit Is for one TRACT BLOCK LOT NO. MAP BOOT( PAGE PARCH hundred dollars ($100) or less.). �. I 'certify that In the perfohmance of the work for which this NO ZONE MAP /�i/ permit Is Issued, I shall not employ any person In any- manner -- ADDRESS - SPECIAL CONDITIONS O so as to-become'sublect to the Workers Compermatlon Laws. CrrY _G. ZIP !7 u Date App licont' ARCHITECT OR TEL NOTICE TO APPUE If, after making this-Certificate of ENGINNO. DISTRICT GROUP TYPE PROCESSED BY O Exemption, you should becotrle sublect.-to the Workers -3 CONST. ZONE r Compensation provisions of the Labor Code,-you must forth- ADDRESS..- Z with comply with such provl}lor}s W this permit shall be Tom. STATISTICAL CLASSIFICATIONN APT. CONDO. Z deemed revoked. CONTRACTOR. NO. _ LICENSED CONTRACTORS DECLARATION DRESSIJC CLASS NO.�DWEiL UNITS I hereby affirm that I am licensed under provisions of Chgpter 9 4D NO. SEWER AARP (commencing with Sectlon 7000)of Divislom3 of the Business CL and Professions Code,and mylicermais In full force and ffeci• Cff1 CLASS BK PG. VAUDATlO* SO. Fr. NO. OF NO. OF CHECK License Number Lic. CI _SIZE STORIES FAMIUES ONE VALUATION Contractor DESCRIPTION OF WORKhim NEW LJ $- 67 ❑I am exempt under Sec ( ADD [Ell ► ALTER B.BP.C..for this reason REPAIR USE OF Date: 17(ISTTNG BLDG 1 DEA10L ❑ Slgnature APPLICANT � I CJCNO. -C2 SINAL OYVNER-BUILDER DECLARATIONDATE I hereby affirm that I am exempt from the Contractors License �yJ 3//�X Law for the following redadn {S&Olon 7031.5, Budlness and ADDRESS Vffl FINAL 1 Professions Code): 1l•T.i Eles I, as owner of the property, or my employewith ,pp NG- wogee as their sole compensation;will¢o the work and /J f the structure Is not Intended or offered for sale(Sectlon LOCALITY �U l7 7044, Business and Professions Code.) MOVING TEL T i CJ F� ❑ I, ga-owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractor* to coPstruct the proj@0 (Set- XDDRESS PaTAL 1-43 ,63 tion 7044, Bus[rift"and Professions Code.) R� AL FRCW1 [ 4{i 14 •c(`'� CONSTRUCTION LENDING AGENCY YARD 1 Mn I hereby affirm that there Is q construction lending agency for CI ;[I[L the performance of the work for which this permlt•Is Issued P.L (Sec. 3097, Civ. C.). SIDE RC Lenders Name �t UDMA Ref, t �{ .r_ ^ Lenders Address R,C. Ise Permir Fee ��yy 5� - Ah �':5 I certify that I have read this application and slate that the lasuance O� 7 LDA,tA P/C above Information Is correct. I agree to comply with all County IrnestlyatI.r! a // ordinances and-State laws relating to bullding construction, Total Fee 3�b LDAAA Perm. and hereby authorize representatives of this County to enter u2n�ve m property for inspection purposes.7 . iQ � � M R!Vlfi POR RXP ANATG�Y LAN04JAGG Slgnatun Icant_469—t Dat* WO6cERs' COMPENSATION DECLARATION r herbbyrafNrm that I haver certificate ns tionconsent to self APPLICATION F O R*iW I L D I N G P E RM I T sure, or a certificate of Workers' Compensation Insurance, or a certffled copy thereof (Sec 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pollcy No. 73�Company jx)o BU Certified copy Is hereby famished. FOR APPLICANT TO FILL INAD�� s` Certlfied copy Is filed with the county building Inspec- BUILDINGr L tion department. ADDRESS GI la I� CITY C41Al zipP 9i-7O¢i/ LOCALITY Dcrt/4 Applicant NO OF BVNEAREST CERTIFICATE OF B(E PTION FROM WORKERS' SIZE OF LOT I NOW ON LOT p L OOMPENSAT1 ON INSURANCE` ASSESSOR ry (This sectlon need not be completed If the permit Is for'one TRACT BLOCX LOT NO. MAP BOOK J I p, }p PARca J hundred dollars (;100) or less.) OWNER Z9 use zorE 3 y y I certify that In the performance of the work for which this permit Is Issued, I shall notemploy-any n In any manner ADDRESS yv —/ Cff1OfJ5 �T so as to become subject to,the Workenmpensation Laws. CITY ZJP (O l��ya, r�[t e Date Applicant ARCH=OR 2E C CT GROUP TYPE � BY � NOTICE TO- APPLICANT: If, after tm9klng this Certificate of ENrINI R O T O Exemption, you sho4ld become subject to the Workersn � � _3 _ s Compensation provisionr of the Labor Code, you must forth- D d �J with comply with such provisions or this permit shall be TIEL- STATISTICAL CLASSIFICATION CONDO. deemed revoked. CC�ITR4CTOR LICENSED CONTRACTORS DECLARATION LIC CLAM NO. 4'2/ DWELL UNITS�_ I hereby affirm That I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Sedlon 7000)of Division 3 of the BusmenLIC and Prbfesslons ,and my license Is In full force and effect. CTFY' CLASS BK.4 PG. 7� to iON V 16/ 1- No. OF License Number Ic. CI SIZE STORIES FAMI INo. OF 6 Ott11�►V yAm :' . VALUATION Controdor Lam'/ {ate IP 2T1 OF WORK NEW ❑ ❑I am exempt under - - Q ALTER ❑ B.BP.C, for this reason o REPAIR ❑ $ ^� USE OF •.J Dais. EXNG BLDG. / mAa ❑ ISTI kJ.T CAN Signature s�� T s FINAL S 4W.l t OWNER-BUILDER DECLARATION DATE I 9 I hereby affirm that I am exempt from the Contractors License G� Law for the following reason (Section 7031.5, Business and ADDRESS � FINAL 1 ITE1fS Professions Code): by BUILDING, KITfL 499 _ 7 1 ❑ - I, as owner of the property, or my employees with ADD wages as their sole compensation,will do the work and 499.71. the-structure Is not Intended or offered for sale(Section LOCALITY ' 1 704,Business and Professlons Code.) MOVING TEL I ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with Ilcensed oontractors to construct the project{Sec- ADDRESS tion 7044, Busyness and Professlons.Code.) REQUIRED I�171}"I] 1 �I11]i1 CONS RUCTIOAGENCY SET YARD HW FROM N-LENDING 74?3 1 . AN11=1: I hereby affirm that there Is a construction lending agency for FRONT the performance of the work for which this permit Is Issued P:L (Sec 3097, Civ. C.). -S44E. P.L. Lenders Name LDMA Ref. f P.C fee 7, 11 Permit Fes Lender's Address I certify that I have read this application and state that the Lssuance Fee ��' LDMA P/C i above Information Is correct. I agree to comply with all County InvntIput lon Fee / ordinances and State laws relating to bullding construction, Total Fee [7 LDMA Perm. and here authorize r resentatives of this County to enter u abovo- ti ed property for Inspection rposes. R SE REVERM FOR EMANATORY LANGUAGR 54g Applicant nt Date