Loading...
HomeMy Public PortalAbout10105 GREEN ST_Building__ 76A698A CE 0809 3--69 APPLICATION FOR BUILD G PER COUNTY OF LOS ANGELES BUILDINGdl.)s- DEPARTMENT OF COUNTY ENGINEER ADDRE-S BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST �� CROSS ST. FADDRESS R APPLICANT TO FILL IN DIST ICT GR TYPE ST. D BY (PRINT OR TYPE ONLY) STATISTICAL CL��$[�$IFICATION MAP Q CLASS NO. �L—.DWELL.UNITS BK PG BLOCK E ZONE MAP NO. TRACT s] SPECIAL N0. OF BLDGS. LCJ�/ CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM OP. LINE OF TEL. FONT PN0. TYPE OF RE LISTING SETBACK HIGHWAY + YARD _(STROE OWNER AL Wm. PYBOheI' ADDRESS 10105 Green Sty HIGHWAY WIDTH FROM C.L. + - CITY Temle City ARCHITECT OR TEL. BLDG.SETBACK FROM (STREET) ENGINEER N0. SIDE PROP. LINE OF TYPE OF EXLSTM SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CONTRACTOR Rigid Mfg. Comp x`263 5181 1 +LIC - ADDRESS 337 S. Woods Ave. NO 159496 CORNEA CUTOFF YES ❑ NOLIC- I CITY Los A=eke 8 CLASS C_39 - SEE REVERSE SIDE FOR SPECIAL APPROVALS CONSTRUCTION LENDER NAME AND BRANCH ADDRESS SQ. FT. NO. OF N0. OF ❑ Z SIZE STORIES FAMILIES WE USE OF ADD ❑ STRUCTURE Rwoof ❑ ALTER REPAIR SIGNATURE OF DEMOL ❑ APPLICANT VALUATION 325.W APPROVALS DATE INSPKCTOR'S SIGNATURE P.C. PMT. M FOUNDATION: LOCATION FEES FEES 9.00 T R LS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, BRACIN2, 130i-TS AND STATE THAT THE ABOVE IS CORRECTAND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- TION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I (376-5 VENT, DUCT3 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. Rigid Mfg. COSY LATH, EXT. SIGNATURE OFHOUtSE NUMBER CORRECT PERMITTEE AND POSTED ADDRESS 337 S. Wools Ave• •A• 9 22 FINAL � s JOHN F. LEWIS, PRINCIPAL STRU TURAL ENGINEER PLAN CHECK VALIDATION CK. M.o. CASH - PERMIT VALIDATION CK. M.0. CASH 69-3732 �(' 2 7 2 N01 4 1 D 9.00- DEPABM! OF COQ11Tt ffi!� DOCOUNTY OF �ANGMM BUILDING VOLL" J. �, COUNTY >tmolmmt APPLICATION . 1 CASSATT D. WUFF K GUI- OF Nm Lmmm FOR APPLICANT TO FELL IN FOR OFFICE .USE ONLY EUILDENG DIST N0. PLAT[CK.of Rio No. .j� IT NO. ADDRLS LOCALITY ` R LIVED I DATOF APrL I DATLpUm NIARIST BUILDING / OWNDt /C� ADDRESS DA DRMW .1� St MAIL LOC"�`T'' NEARIST CITY -C1 1 cR04W ST. ARCHIT'[CTo-WTEL FIRE ' NO. OF ` TYrI� GROUP / Ifid N ZONI PLANS ,LD . L '/ NO. D SETBACK LIN[ !� �+` TQ- USI .L / ArPROVID CO ON Aiffy PATE HOUSE NUMBERING AJODREM r rear MAP NU D D / O. ADSION NY DISCR rTl NO, _ COEHECPIONS TRACT NO. OF nom. S= Or LJDT 10 K USI OF r NO. OF DME311MON OF W09K D—+-62 – NEW ALNEWng" I -- O Z REPAIR DMAOL.ITION Q. IrrY , / NO. OF Sm� '\ 6 ROOMS ITORIIS IXT. WALLROOF COVERING OPOVIKRING USE OF STRUCTURIK APPEOVd18 F r IND S SIGKi1ATiT1RE D TI FOUNOATIONi LOQATION FORMS MATERIALS f S� 1 HEIREDY AClCKOWLmaI THAT 1 HAVI READ THIS AP- FRAMI' FIRE STOFS, PLICATION AND STATS THAT THI IN�rORMATION GIVEN IS BRACING EOLTH CORRECT. I TO COYTLY WITH ALL COUNTY ORDINANCID Q�CXi LOCA�;N' —_ AND STATI LAWS RMULATINO 1UU-DIMa UQi7ON.. sIt3I1ATURE of LATH. INT. PSRIi LATH. EXT. ADD FLJ►STIR 1 NT. AUTHORIZED AOT. RQ HOUSI NUMSIR coR- U v Oxy O RECT AND POO'Tta VALUATION FQ S V FINAL ;'Yr!y, i 79ACB" DES 3 9-" _ 1 � Y DrVISION OF HUII..DING AND SAFETY � ' D ' Department of Oo>mty Beer Oounty of Los Anweles WM. J. Fax, COuNTr EN13IN[[R APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DIMTR1OT ND. PLAN DK.ORIgX[L NO. P[RMIT Ma BUILDINGI ADDRIMI [IV[D■Y DATIC OFAPPL. DATE IM&UED L.DQALITY NtAROT CTROW JET. ' QWN[R MAILLODALITY ADDR[p CRRUUM BBT. Q LtiI /IV DI FIR[ ND.O.F r TIIr[ OR4UP ARCHITECT O TEL ZON[ PLAN■ E:7F [NOINK[R MQ- OLDIL - ORD. ND. BCTBADK LIN[ ADDREM Ulu APPROVED TEL ZDH[ BY DAT[ OONTRADTOR NO. HOUN[ HUMB[RINO ADD MAP NUMBER NO. AiB10N[D BY LLOAL CORMCTIONS DKUCPJPTION LCT M. BLQOIC TRACT MLD a. or LOT NNQO. OFW OK LOT, UO[OF NO. OF EMOTING■LDIL FAMIud DESCRIPTION OF WORK p o NEW ALTERATION ADDITION _ R[PA1R D[MQLITIDN r sq.FT. NO.DF ■12Z Rooms ■T011lp KXT.WALL R7ZDF OOV[RINO QOV[RiNOes U69 V 8TRU !![ G INSP[DTION FOR APPROVALS OOOUPANDYAB INEP[OTOR'■■IONATUR[ DAT[ MUMDATMM LDIIATIE M FORMO, MATERULLa I H[R[sY A3KNCWLKDME THAT 1 HAV[ R[AD THI■ AP- PLICATION AND STAT[ THAT TH[ INFORMATION DIVKH 1■ FRAM[: FIR[STD33% OORRICOT. ]7''OO BRACING!, COLTS AND $TATE LAN7 R[OULAmPLY ~T p SUI Muw'ryOONBTRUOTIO� FiJRNAD[l LDDATION, oAa Y[MI' DUCT\ CIONATUR[ or LATH, INT. P[RM O l 0 I T C , LATH. [XT. ADD PLAWMP[ INT. AUTHORIZED ADT- qI P.O. PLAHTttlr [XT. F[[ HOUR[NUMB[R OOR- III a R[OT AND POYT[D VALUATION FE[ FINAL Ott 7&AA3&A osa a 1-32 TEMPLE LE CIE`s � `7IIulII T.AGAU CE 10,"", APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT,OF COUNTY ENGINEER ADDRES S BUaDING AND SAFETY DIVISION LOCALITY-5(o JOHN A. LAMBIE. COUNTY ENGINEER NEARS WILLIAM A. JINBEN, EUP'T OF BUILDING CROSS ST. DIST ICT GRO TYPE RV FOR APPLICANT TO FILL IN D CONST: BUFLDING STATI BTICAL C I CATION SEWER MAP ADgRE38 O (i BK Pte_ G CLASS. NO. DWELL. UNITS LOT NO `' 7XO /r O ' WATER NOT REQUIRED RECEIVED CERTIFICATE: TRACT No Q/D ({CIRCLE) STATE MAJOR SECON GA NO.OF BLDGB. SIZE O OT NOW ON LOT USE ZONE SPECIAL USE. CONDITIONS EXI TEL. OWNER ( UILDING EXIST. < , SETBACK YARD HWY REET NAME WIDTH ADDRESS r �� FRONT If l� ARCHITECT OR TEL P. L. Cl ENGINEER NO. SIDE P. L ADDRESS Q TEL. V CONTRACTOR NO. I OL ADDRESS Q DESCRIPTION OF WORK NEW ADD ALTER REPAIR' DEMOLISH SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE R E TE o - SIGNATURE O APPLICANT VALUATION APPROVALS DATE Haar[ •s s NT.Tl1 RE P.C_ PMT. FOUNDATION: LOCATION _ 1 F FEE S FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACIN BOLTS AND STATE THAT THE ADOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. _ WITH ALL COUNTY OROINANCEa AND STATE U.WE REGULATING GAS VENT, DUCTS ■UILDING CONSTRUCTION. I CERTIFY.THAT IN DOING THE WORK r AUTHORIZED HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INTI. noN OF THE LABOR CODE OF THE STATE OF CA RNIA T. ING TO WORKM OMP -(EON IN LATH, EXT. SIGNATUR �` HOUSE NUMBER COR- PERMITTERECT AND POSTED ADDRESS —FINAL to I�"I(( i JOHN F. LEWIS, PRINCIPAL STRU URAL E PLAN CHECK VAIMATION CK. M.O. CAAH _ PkELM VALIDATION CK. M.O. CASH LAC0 3 3 1. 6 ZZ AIG 31 1 D 6.0 0- _APPLICATION FOR �B U ILD ING PERMIT PPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS, DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT 2— ADDRESS101C) Z4 TRACT �'1(J B ( LOT NO. LOCALITY UP NEAREST OWNER / TEL 443 -2Y CROSS ST. 1 ASSESSOR ADDRESS /�'� - p f' MAP BOOK PAGE PARCEL -CITY ZIP ` �/ DISTRICT GROUP CONST. ZONE PE FIRE ESSED BY ARCHITECT OR TELCJ ENGINEER N0.k1 3^ZS STATISTICAL CLASSIFICATION SEWER MAR" ADDRESS CLASS NO..'_ Z TEL. �DWELL.UNITS BK PG �hy CONTRACTOR AO. U NE NO. / r✓ ADDRESSSPECIAL O. -LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SBACK FROM FRONT OP.LINE OF (STREET) ADDRESS _�_ CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK HIGHW Y + YARD = FRONT PROP.LINE IHIGHWAYI WIDTH SIZE �3� STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW ❑ O ADD BLDG.SETBACK FROM � (STREET) O ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w -4�4HIGHWAY + YARD = SIDE PROP.LINE WAY WIDTH N USE OF REPAIR ❑ Z EXISTING BLDG. DEMOL ❑ + APPLICAN TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) a N044ki3^2S� IN OPEN SPACE YES ❑ NO ❑ BY(SIGN RE) Q IN COASTAL PERMIT ZONE YES ❑ NO $ ❑ VALUATION /, A IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT ALL ORDINANCES ��" AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY AT IN DOING THE 7 WORK AUTHORIZ EREBY I WILL NOT EMPLOY Y PERS INV IOL ON OF THE LABOR CODE T E STATE OF CALIFORNIA I LATING WORKM 'S COM PENSATION INSURA SIGNATURE OF ERMITTEE ADDRESS fes, N FINAL BY TEL.yy DATE 10, g—77 CITY —NO. MAKE CHECK PAYABLE TO: F E s- FET HARVEY T.BRANDT,COUNTY ENGINEER 1-2 �� 3 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 2 8 9�.xn_ 27 2 1.1 3 '� 2 g Ot.rtA. 27 1 i 3 5.2 � ®S 76A638A CE#803 3.75 i APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN ADIDRESS BUILDING U/d} ADDREs LOCALITY /CiC SS NEAREST CITY j ZIP CROSS ST. �/ — NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ESSED BY TRACT BLOCK LOT N/O.. r� \ ©U �� CONST. ZONE OWNER I �(7 NO. (/ STATISTICAL CLASSIFICATION SEWER P ADDRESS a CLASS NO. DWELL.UNITS BK PG CITY , ZIP ' a �' US ZONE MAP Q ARCHITECT OR TEL NO. ENGINEER NO // SPECIAL ( CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ TEL. t BLDG.SETBACK FROM CONTRACTOR �'',� NO. _ j(�,.� LIC. FRONT PROP.LINE OF (STREET) ADDRESS 2.0 irftlo 3 3 HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER + a NAME AND BRANCH BLDG.SETBACK FROM UU ADDRESS CITY SIDE PROP.LINE OF (STREET) SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SIZE Q STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH + = Z DESCRIPTION OF WORK NEW ADD CORNER CUTOFF YES ❑ NO ❑ ALTER IN OPEN SPACE YES ❑ NO ❑ REPAIR El U&E9f;. ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ _EX cr" al DG. DEMOL APPLICANT TEL IPRINTI NO. BY(SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE T COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTR ION.I CERTIFY THAT IN DOING THE WORK AUTHOR( EBY WI L NOT E OY ANY PERSON IN VIOLATION OF THE LABOR COD F THE TE ALIFOR IN RELATING TO WORKMEN'S COM. PENSATION INSURA SIGNAT �f r PERM TTIRT __: NAL .-1{ BY rrl� ADDRESS W ��) 6E± TEL. l i 1 �S P.C. Fee$ Permit Fee (/ CITY NO. 'lit Q Issuance Fee VALUATION v t Total Fee PLAN CHECK VALIDATION GK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH 573 187,00 ♦` ©s 76A638B CE N803B 8/77 a WpF ESS'COMPENSATION DECLARATION f ', I parebyr Frm that I haves ce' Come ns consent to self { APPLICATIO � FOR BUILDING PERMIT Ihwn;* �cetf-locate of Workers' Compensation Insurance, or a c• led copy thereof (Sec. 3800, Lob. C.) ' COI.�MY OF LOS ANG���.S BUILDING AND SAFETY._ Policy No. Company CRrtifled copy Is hereby furnished. FOR APPLI NT TO FILL IN '� ppp� /D/Q�j Certtfled copy Is f[LL d with`the county bullding inspec- BUILDING L� ADDIR tion department Date Applicant CITY ZIP LOG1L rrY CERTIFICATE Of EXEMPTION FROM WORI(ERS' aF BLDGS :` COMPENSATIONINSURANCE SIZE OF L'OT ON 10T ST. (This section need not be com leted if the It Is for one ' '� 4. ASSESSOR hundred dollars ($100)or less. TRACT �6ck IOY�JO: '. MAP BOOK PAGE PARCEL OWt�i ~ "TEL! 5 llsE y 73 I certify that In the perform th ork f which this — }- pwmlt Is Issued, I shall hot mploy a n any annir Ll. ADDRESS ct4S so to to subject to Work m on S J' GCITY ZIP DU Dat• r cant ARCHITECT OR DISTRICT FP TYPE FIRE BYNOTICE O IG4NT: this Certificate ofExempt n, you should become subject to the Workers QCONST. ZONECompensation provisions of the Labor Code, you must forth- ADDRESS Op � � with compFy with such provisions or this permit shall be Qw, deemed revoked. 1 STATISTICAL CLtSSIFICATION AFT. CONDO. u) CONTRACTOR OR NO. z LICENSED CONTRACTORS DECLARATION CLASS NO. -7;t-/ UNrrS_� I hereby affirm that I am licensed under provisions of Chapter 9 NO. (comrrlencing with Secflon 7000)of Division 3 df the Business and 1 UC. SEWER MAP `� [,! ProfeWons Code, and m license Is In full force and effect. CTIY le �� / y °-Ass BK. PG. � A Sa NO.OF No.OF O*CK License Number LIc.Clan Sig STORIES 2 FAMIUES ONE #,• o'o o 2 3 DESUIPTION OF WORK NEW VALUAT}ON W - 321.3.0 . Controctor Date ; I am exempt under Sec. AD° , -0 ° 3 2 U.04 "`lam O C�2.3�87 B.3P.C_ for this reason REPAIR $ (/Vl! USE OF Date: EXISTING BLDG. Signature 's "T TEL 19NAL OWNER-BUILDER DECLARATION INT NO. DATE I hereby afflrm that I am exempt from the ContrcKtoes License ADDRESS 55 RNAL Law for the following reason (Section 7031.5, Business and � Pro Ions Code): PRESEN i By L"J I, as owner of the prop",-,,or my employees with AADDDRRESSSS wages as thelr sole compensation, All[do the work and ' the structure Is not Intended or.dffered for sale(Section LOCALITY 8 9 Q 5 A 70", Business and Professlors Code). MOVING TEL ', I, as owner of the property, am exclusively contrbciinq CTOR NO. with licensed contractors to construct the project (SecADDRESS - tion 70", Bwlnesi and Professions Coded •e 3 1 250 CONSTRUCTION LENDING AGENCY A"' YARD HwY PRCe. UNE I hereby affirm that there Is a construction lending agency for �` �,_', -_ 0 . � •.3-1 2 5 6 the.performance of the work for which this permit Is issued P ;•� ` (Sec. 3097, Civ. C.). SIDE, 71- Lenders Name 8 I '�/(J t N Fee"- J) LDMA f..I l ti �•;�`_� Lenders Address I certify that I have read this ap lication arpo state that the e_r 4suarxr Fee ` LDMA P/C i a on Is correct. I ro ply with all County InvesNQarbn F« $ ordl and State laws relat g to ullding constructlon, Total Fee LDMA Perm. • reby authors ropresen Ives this County to ent4W f Inspection purposes.. f✓•RlV7lM POR 11001LAMTORY LAPOG A011 of Appl caM Date r� . APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY V/ WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS - -- '-�--- hereby affirm that I have a certificate of consent to self insure, ! r , tt or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY- .m _ _ ZIP LOCALITY Policy No. Company SIZE OF LOTi NO.OF BLDGS,NOW ON LOT 1-1Certifiedcopy is hereby furnished. -"-- NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER r� 4^ T N9 j; Y NO COMPENSATION INSURANCE ADDRESS WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred t DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less.) _., CITY ZIP - -- - certify that in the performance of the work for which this permit is issued, I Shall not employ any person in,any manner so as to ARCHITECT OR ENGINEER TEL.NO. become sobjeFtit0-the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date i Applicant 4 ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you ShOUId become Subject t0 the Workers' CONTRACTOR TEL.NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 4` `" FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P IL o.. LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PIDE IL C.') I hereby affirm that I am licensed under provisions of Chapter 9 W SEWER MAP —i (Commencing with Section 7000)Of Division 3 Of the Business and SQ.FT.SIZE,. NO.OF-STORES NO.OF FAMILIES Ez Professions Code,and my license is in full force and effect. NEW ❑ BK PG , DESCRIPTION OF WORK VALUATION License Number Lic.Class ADD Q� ?:.. n. Contractor Date ALTER ❑ $ om ❑ I am exempt under Sec. REPAIR ❑ $ W B.&P.C.for this reason USE OF EXISTING BLDGDEMOL E] LDMA P/C# BLDG, URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# Z Z ❑ I, as owner of the property, or my employees with wages as 0 their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DA / /I(� Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL Gr�! ❑ I, as owner of theproperty, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q A, 1a 4+4 Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY / licensed contractors to construct the project (Section 7044, YES❑ No / , s Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - •,> CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST fERGUIDELINE I hereby affirm that there is a construction lending agency for VES ElNo� ' the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD p 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY ft6UIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLE 2,CHAPTER 22DSECTIONS 2 20ADO THROUGH 2.20.140 CONCERNING ,a Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A.PFnRMIT.FROM THE SCAQMD. a EL Lenders Address 0 OWNER OR AGENT , o I certify that I have read this application and state that the above r= information is correct. t agree to comply with all county P.C.FEE PERMIT FEE ordinances and State laws relating to building construction,and ao hereby authorize representativet of this County to enter upon ISSUANCE FEE the above-mentioned property,for inspection purposes a .,,,,,.,.,�;:,._.,r..- .� -• ) j f�,.7 INVESTIGATION FEE TOTAL FEE < F Signature of APPI-1 ,Agent Dete SEE REVERSE FOR EXPLANATORY LANGUAGE • APPLICATION FOR BUILDING PERMIT } COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S•-COMPENSAnON DECLARATION FOR APPLICANT TO FILL.,IN BUILDfi(3 ADDRE I hereby affirm that I have a owtl5mte.of ooneent to eeff hwra, �788 or a certifk-a a of Vrbrkero' Compenset6n Ineuranca or a certffled 40 copy thereof (Sea 3800,Lab.C.) Zp /� �dyNa / V ' CaPPerN OF. N0.OF ON LOT . E3Certified copy le hereby fumbhed. NEAREST MOSS 8f. 11 Certified copy is filed wlth. *oounty balding hiapec6w TAT BLOCK LOT NO..�� dap-trr at USE ZONE MAP NO. Date Applloarrt ASSESSOR MAP BOOK E . 3 sP+=aAi Co►mrrlaua CERTIFICAYE OF EXEMPTION FROM WORKERS' Mo. YES COMPENSATION INSURANCE, wTI N i000 F-rof scri ? (This section need not be com0eted ff the PerTTtt Is for one hundred ADDRESS Dt8TR1CT GROUP FiiF a7t•E PROCESSED BY ddlars (51DO) or less.) I certffy that In the performance of the work for which this pen it Is lsaUed, I &hap not enpioy arty person In any manner so m to �C beoorne m blec,'t'to the Wcrkars'Compensation Laws. �frECT. EN(W4 ER- TEL 40. 819TSTr L CASSF)GglON AFT CONDO Deter-AppllcarTt. ADDRESS CLA89 NO _ mELL UNTrB AA`)T]CE TO APPL.iC AW..• ff, after maklrip thle CertfM1cBte of REQUIRED TOIL 8ETBACKFROM Ex1ST' Exemption, You 9hco ct berne subject to ♦tae Workers' SET BACK )AM HWY PROP LINE WEh, Cornpenaatfon prwialons of the Labor Code, ybu must-fortf-rw t FRONT corrpfy with arch pfovlabna or thle permtt shell be deemed revoked ADDRESS PL LICENSED CONTRACTORS DECLARATIONSDE crry LIC,CLASS P L I hereby affirm that I am Iloerased ube-rprwiebre of Chapter 8 (commeoc withSection 7000)of DMal n 3 of the Business and Sa NO.OF STORES NO.OF FAMILES Pr ofesabrm Code;and my Ibehee is tri full foie and effectNEW BK PQ [}� Lk>an.ee Number. Lb.Class T DEBCFdPTK)N waDRnc- ADD ❑ HPLUAITIT 4N , S V/ /�O Contactor Date ALTER ❑ ❑ I am exempt under Sea REPAIR ❑ BAP.C.for this reason DEm6L ❑ LpM,Pic r Dete: USE OF C9S7NG BLDG URM ❑SkxiabuDe 1 No. LDW Porm'r. Z ❑ 4 kg owner of the property, or my employees with wagee as Z AGC:T.Y their.sola compeneafion, w01 do the work and the at ctie IiB 17'4.65 not hTtended or offered for sale (Section 7044, Budrreae and FNAL DATE 3303 ProfeaaJaTs Code.) /(- ' li� wLL THE Aa+��xflrWor�a10 FUTA E auDr�o oca�rwxT w�rorF A ruZA�orreµQavi i ITEM - 4 as owner of the property, am exduehefy contraCtirTg with OR A►�tE A HAZAFDOUa MAFSaAL EGO W TO CR OFEJTM TWA1 THE AA40LW8 WEA ON THE HAZARDOUS W9SalA1b IPO%kq"owe? FW/11, BY Acen ed contractors to corebuct the project (Secton 7044, vEs El 'No 94--' TOTAL 17�_ 65 Bui lneas and Profesabns Code.) /��£{� i }r} CCCV&L lW rrrE?om 118E OF THE eWLMU BY AaPLx�-r OR FP"A BlibJrH 417L1 F\ 1(i,'6.CI - �l'Alff A F£JtHT FOR OR MOOFaG4pN Fa'aO►1 Tt�.SOUTH CONSTRUCTION LENDING AGENCY 0( MAHAa�T DSTF,cr c l t_Pt_TTM cfdare Fos .Oct a I hereby affirm that there la a,conatruot n lendUV agency k c rp�. the performance of the work for wNch this permit is lagged(Sec- 3097, Sea iwve AND TFE Ery T, Le ems -m-LE ago zoo Arioe Ee f Q-{ I]1 4/.5/55, TME Lafader a addrear; C�a 9797 1 010:94 I "Uftion and state Lrder penalty � b P,�FSE d ell Tawe to blAing of County ISSUANCE I �+ff�ea pS(d NVE8tK3ATlON FEE TOp,L FSE' � O( SEE REVERSE FOR EXPLANMURY LANGUAGE