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Home My Public Portal About8618 HALDEMAN ST_Building__ 76A638 �C� #803 1/71 - - ,- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES 'ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS (P d COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or tyDe onl CROSS ST - _/ DISTRICT NO Gf!P, TYPE PR D B BUILDAADD EISS C�C.l� S, ,(/ �/�� [HJT CONST, STATISTICAL CLASSIFICATION SEWER MAP LOT NO - BLOCK // CLASS NO DWELL UNITS BK �PG TRACT Y USE ZONE MAP NO.OF BLDGS �{� /SIZE OF LOT �Q �J U NOW ON LOT i - ECIALUSE OF NDITIONS EXISTING BLDG. ') OWNER /i//I /TLS NOL mC��/O BLDG SETBACK FROM ADDRESS ��il'/Y/l.911 - FRONT PROP.LINE OF (STREET) ` TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY ��GL HIGHWAY WIDTH FROM C L ' ARCHITECT OR TEL ' } ENGINEER clu NO' BLDG.SETBAC OM - ADDRESS SIDE PROP, LINE O (STREET) TELTYPE OF EXISTING1 SETBACK AY } YARD = TOTAL O CONTRACTOR G e P5-NO s�8 HIGHWAY WIDTH FROM C.L. LIC. U ADDRESS /�, i[lJ�i�- NO LIC. U CITY t i/l CLASS CORNER CUTOFF YES ❑ NO ❑ W CONSTRUCTION LENDER NAME AND BRANCH �C1`e 'SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS SQ FT - NO OF NO. OF NEW ❑ USE - STORIES FAMILIES USE OF ADD rvr STRUCTURE ALTER ❑ SIGNATURE OF REPAIR❑ , APPLICANT DEMOL ❑ - VALUATION $ APPROVALS DATE IN5PECTOR'5 SIGNATURE P C PMT FOUNDATION: LOCATION FEE $ FEE $ / A O 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 ORDINANCES AND LAWS REGULATING BUILDING CON- ; GAS VENT, DUCTS ' STRUCTION I CERTIFY THAT DOING THE WORK AUTHORIZED , HEREBY I WILL NOT EMPL NY PER N IN VIOLATION OF THE LATH, INT Lr LABOR CODE OF THE S A OF C FORNIA IN RELATING TO WORKMEN'S CO MPE NSA O NSURAN _ LATH, EXT, .. 'IGNATURE OF `ate-- HOUSE NUMBER COR- ERMITTEE RECT AND POSTED ' DOR ESS FINAL .� - JOHN F LEWIS PRINCI AL ST CT RAL ENGINEER PLAN CHECK VALIDA'T'ION CK M 0 CASH _ PERMIT VALIDA 6 CK M 0 CASH Llo 4 4 s �• ,FEB 1 2 A 1' 4.5 0 79A638A CE#808.9-60 APPLICATION FOR BUILDING PER T . COUNTY OF LOS ANGELES • BUILDING DEPARTMENT OF COUNTY ENGINEER' ADDRESS BUILDING AND SAFETY DIVISION LOCALITY -JOHN.A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST . DISTRICT NO ' G OUP TYPE;` P SED BY FOR APPLICANT TO FILL-IN CONST BUILDING e STATISTICAL CLASSIFICATION SE ER MAP ADDRESS i - -CLASS NO - I K - PG DWELL UNITS ' LOT NO - -BLOCK MAP NUMBER HWYE YES" O TRACT��Z� - USE ZONE .SPECIAL NO OF BLDGS. CONDITIONS SIZE OF LOT 86 !k I NOW ON'LOT USE OF I _ EXISTING BLDG +,p - BUILDING YARD L4WY �' E NAMEa _ - EXIST ' OWNE.)WA44(e- �csn 4rl�V SFRONTK - 'WIDTH '-ADDRESS SIDE ARCHITECT OR _ TEL _ P-L - ENGINEER NO INSPECTION RECORD- ADDRESS ' 6! G- ], t sem/►r/fa `�L tL3 �, --{�3� f G�. .sem / oU CONTRACTO L ,9,�u/ Qjn� '1O'' ADDRESS O -DESCRIPTION OF'WORK °' v a a 'NEW ADD ALTER • REPAIR DEMOLISH h Z SQ FT. 9 - NO+OF NO OF _ SIZE ��^• - STORIES FAMILIES , USE OF �y STRU RE f� YvG ( ,� `y > le it If 0 00 tot! SIGNATURE O APPLICANT • _ - - VALUATION zq - APPROVALS DATE INSPEG,TOR S SIGNATURE '7 FOUNDATION LOCATION FEE- $Z'Z a FEE $ FORMS MATERIALS FRAME FIRESTOPS, ' 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 THE PERFORMANCE "OF THE WORK,FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH, INT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBUECT ` - TO THE WORKMEN S COMPENSAT N LAWS CALIFQjiN1A - LATH, EXT SIGNATURE O ' HOUSE NUMBER COR- - - PERMITTE RECT'AND'POSTED_ . ADDRESS FINAL ' CLYDE N DIRLAM, PRINCIPAL STR AL ENGINEER PLAN CRECK VALIDATION - cK. M.O., CASH PERMIT VALIDATION M.D. CASH +UAlf 1:6-7 3G, Jfi�J: '7'2 3 A 2 2>50 12 0 T ;B 1 A. 4 5.0 6, WORKERS' COMPENSATION•DECLARATION 41 hereby affirm that I have a certificate of consent to self PERMIT insure' ,'or a certificate of Workers' Compensation Insurance, APPLICATION--FOR BUILDING ,or acertified copy thereof (Sec 3800, Lab C ) ' , 4 2 4- 7 Argonaut Ins COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N6 c 2 0� C�goA� / p A PY Y FOR APPLICANT TO FILL IN ADDRESS d I�' LL tQ P W( Certified co is hereby furnished (p Certified copy is filed with the county building'inspec- BUILDING 8618 H.aldeman ,tion department ADDRESS �Y LOCALITY " vl�C NEARESTj,1,'184 Andol Roofing ConstCITY Temple Clty zip' 917 8Q1,Date iat CROSS ST rg' ' CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT�� / NOW ON LOT _ MAP BOOK -`, PAGE " PARCEL (This section need not be'corripleted if the,permtt is for one- OTj Z -USE ZONE- MAP TRACT BLOCK LOT NO3 NO - hundred dollais ($100)or less ) TE �` _ SPECIAL 2 } I•certify that in the'performance of the work for which this OWNER D o n a l d H O r s N�8 6 0 2 3 7• V" CONDITIONS 7 CL permit is issued,.l shall'not employ an person in an manner DISTRICT GROUP TYPE F RE PROCESSED BY O_ P P Y Y P Y CONST ZONE U so as to become'sutilect to the Workers'Compensation Laws ADDRESS 8 618 �Ha'ld'eman fx CITY .1TY Tem e C i,t zIP 91 7 8 Q o' O Date Applicant STATISTICAL CLASSIFICATION APT CONDO V• -NOTICE,TO APPLICANT If, after.•makmg.th�s-Certificate of ARCHITECT OR TEL ENGINEER NO CLASS NO _DWELL UNITS W Exemption, you- should become'•sublect to the Workers'- CL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions'or this permit shall be TEL deemed revoked CONTRACTORa n d O 1 Ro o f i n NO 2884040-- - BK PG. VALIDATION e LICENSED CONTRACTORS DECLARATION -1 herebyaffirm that I am'licensed under provisions of Chapter 9 ADDRESS 529 E- y al l e y Nd 8 60 8 6 P P VALUATION (commencing with Section 7000)of Division 3 of the Business and ': $� LIC Professions Code, and'my license is in full force and'effect '&TY -' a ri (T a hr 1 e 1 CLASS • C 3 $' 1239 . 0( 18 6:0.8 6 '' C'-3 9 SQ FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES, FAMILIES ONE $ Contractor a n d o 1 R O o f 1 n Date 1-1�2 2-,,-8 3 DESCRIPTION OF WORK NEW ADD E I am exempt under Sec a-,-r O o f house and -_a r ,a reR FINAL B BP.C 'for{his reason V4,th_ 12x!8 comp ,s_hing REPAIR DATE USE OF FINAL i Date' EXISTING BLDG - - DEMOL Q By LICANT TEL Signature APP OWNER-BUILDER DECLARATION PRINT NCZ$$ 4 Q 4 0'Y I hereby affirm that I am exempt from the Contractor's License .E j7 a 11 e y S, . G, 917 7 6. C1 `7 Law for the following reason (Section 7031 5, Business and ADDRESS Professions Code) N BUILDING I, as owner of-the property, or my'employees with 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 CONTRACTOR NO �- I, as owner of the property, am exclusrvely•coniractmg^ ice with licensed contractors to construct the project-(Sec- ADDRESS tion 7044, Business and Professions,Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH: I hereby affirm that therb is a construction lending agency for' FRONT Noll.the performance of the work for which this'permit is issued P L (Sec•3097, Civ C ) SIDE a r ' PL f, Lender's Name _ _ _ - 2aa49,88 - PC Fee$ Permit Fee 3 9..3 8 Lender's Address I certify that I Have read-this application and state that the Issuance Fee 1 0_• 5 Cl• q Q fj v above mo formation.is correct I agree to comply with all County Investigation Fee I �.'ao 8 ordinances and State laws relating to building construction, Total Fee 4.9 . 88 >� and hereby authorize representatives of this County to enter upon the above-mentionedpyo arty f mspectto pu oses t '/�3 //-3 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date' ®t