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HomeMy Public PortalAbout5563 HALLOWELL AVE_Building__ APPLICATIONW B.0 I L ' NG PERMIT FOR APPLICANT TO FILL,IN (Print or type only) BUI ADDREISS � °•' ADDRESS 6-3 CITY � CITY l_ ZIP i .OF SLOGS. LOCALITY SIZE OF LOT / OW ON LOT NEAREST ^ ,/y/� / �y CROSS ST. TRACT' 9"/ BLOCK+ LOT NO. (J ASSESSOR MAP BOOK PAGE PARCEL TEL. r�� DISTRICT GROUP TYPE FIRE PR; ESS�/EyD BY OWNER NO. •"�W �j CONS� ZON� ADDRESS ^ f, ti STATISTICAL CLASSIFICATION SE ER MAP CITY ClA•. ZIP O CLASS N0.�_DWELL.UNI.TS IVBK_ PG ARCHITECT OR - TEL. ENGINEER NO. USE ZONE MAP 1 . ADDRESS SPECIAL TEL. "'� CONDITI.ONS ' CONTRACTOR NO ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO.❑ LIC. ADDRESS NO. BLD SETBACK FROM CITY LIC. FR NT PROP.LINE OF (STREET) C LASS HIG WAY } YARD TOTAL SETBACK FROM TYPE A EXISTING CONSTRUCTION LENDER - FRONT PROP. .LI.NE HIGHWAY WIDTH NAME AND BRANCH ADDRESS CITY + — SQ. FT. NO. OF NO. OF CHECK BLDG,SETBACK FR d SIZE STORIES FAMILIES -ONE SIDE PROP.LINE OF (STREET) U DESCRIPTION OF WORK NEW ❑ HIGHWAY + YARD c IT,"-' SET OM I TYPE OF- EXISTING O ❑ SIDE P 0. . LINE IGHWAY WIDTH ADD C-:) } - w ALTER ❑ c�i� USE OF EPAIR CORNER CUTOFF YES C] -- NO E] Z rDEMOL EXISTING BLDG, f ❑ IN OPEN SPACE YES ❑ NO ❑ APPLICANT TEL IN COASTAL ZONE YES•❑ NO ❑ (PRINT) NO. BY (SIGNATURE) ENVIRONMENTAL CATEGORICAL EXEMPTION YES'❑ NO ❑. ' IMPACT EXEMPTION DECLARATION SIGNED IDA TO VALUATION$ IMPACT PORT PROCESSED (DATE) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED J� HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODEF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S CO E ISATION INSURANCE. SIGNATURE OF FINAL BY PERMITTEE DATE ADDRESS P.C. $ JF MT.$ TEL. FEE EE CITY NO. ( 2 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH s 1 8 t"_',.HPft 4 1 2 1.7 5 ®gib 76A638B CE#803A 5/73 r APPLICATION FOR BUILDING PERMIT I� FOR A14>LICANT TO FILL IN (Print or type only) BUrCoINc COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER ` BUILDING AND SAFET , DIVISION CITY IP NO. F.BLDGS. BUILDING SIZE OF LOT " NO ON LOT ADDRESS RA a1'w BL1OCK LOT NO. . LOCALIT TEL NEAREST - OWNER NO. �t E CROSS ST. _ ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE .FIRE ROC SSE BY CITY. ZIP CO. E ARCHITECT.OR - EL. Q G' ENGINEER NO. STATISTICAL CLASSIFICATION E ER MAP ADDRESS CLASS.NO_e 0DWELL•UNITS BK� PG TEL. CONTRACTORNO U ZONE MAP LIC. NO. - ADDRESS �I SP.EC AL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES NO CONSTRUCTION LENDER NAME AND BRANCH - • BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY IGHWAY } YARD —_ ',TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK i FRONT PROP. LINE HIGHWAY WIDTH SIZE T la/, IJATO.. FAMILIES ONE + = C. DES'C RI ON OF ORK NEW O U ADD ❑ G• K FROM SIDE PROP. LIN (STREET) ALTER ❑ TOTAL SETS FROM TYPE OF EXISTING F HIGHWAY + YARD = C.., REPAIR❑ - SIDE PROP. LINE HIGHWAY WIDTH Lu G7 USE OF } ••= Z EXISTING BLDG., DEM ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO (PRINT) NO. BY (SIGNATURE) _ IN OPEN.SPACE YES ❑. NO IN COASTAL PERMIT ZONE YES NO ❑ VALUATION;$ I HEREBY ACKNOWLEDGE.THAT I HAVE READ THIS APPLICATION ®3 `I"> esti ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES. AND •LAWS REGULATING, BUILDING CON- STRUCTION. I CERTIFY. THAT IN DOING THE WORK AUTHORIZED HEREBY I 'W ILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ' LABOR CODE OF ,THE STATE OF CALIFORNIA IN RELATING,TO WORKMEN'S COMP SATION INSURANCE. SIGNATURE OF PERMITTEE ADDRESS / TEL. FINAL / BY . (�fl CITYNO. DATE MARE CHECKS PA�'ABLE TO: P.C.FEEE $, PMT.;' FEE HYARVET. BRANDT, COUNTY ENGINEER PLAN'CHECK VALIDATION CK. M.O. CASH /PERMIT VALIDATION CK. M.o. CASH 414c T 17 1 15.0 0 e98 76A638A CE#803 574 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) IJ BUILDING �/ COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COU TY ENGINEER CITY _ ZIP BUILDING AND SAFqTY DIVISION //11Q�O.OF BLDGS. BUILDING4 SIZE OF LOT �- / '44OW ON LOT . ADDRESS TRACT IBLPCK LOT NO. LOCALITY ' TEL. . EAREST OWNER ROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT I GROUP ITYIE FIRE PRO SSED BY CITY �7 ZIP A �"'^ CONST gr— ZONE ARCHITECT OR _ - TEL "(/ �(�- ENGINEER NO. ��" j STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NJ.--J— _DWELL,UNITS BK PG TEL. �. CONTRACTOR NO USE ZONE MAP LIC. NO. ADDRESS NO.LIC. SPECIAL . LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM CL FROVT PROP.LINE OF (STREET) Ca ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING HIGH AY } - YARD - ix SQ. FT.71 NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH C SIZE �L,I� STORIES FAMILIES ONE (` } DESCRIPTIO OF WORK NEW a CA ADD ❑ BIDE PROP. LINE O OM (STREET) Z ALTER ❑ AL _FROM TYPE OF EXISTING HIGHWAY } YARD = HIGHWAY WIDTH REPAIR 11 SIDP RO P. LINE USE DEMOL ❑ } EXISTING BLDG. APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PR NT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES NO ❑ VALUATION 8. ` g5w CATEGORICAL EXEMPTION YES❑ NO ❑ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND 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 I T EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF T,HE STATE OF CALIFORNIA I RELATING TO WORKMEN'S COMP TION INSURANCE. SIGNATURE OF PERMITTEE ADDRESS TEL. FINAL BY (� CITY NO. DATED MAKE CHECKS PAYABLE TO: FEE C y PMT. HARVEY T. BRANOT, COUNTY ENGINEER FEE FEE DD 35 PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. ASH 6 7 1�JUt4 10 1 3 5.% 5 A 9 76A 636A CE#B03 7/73 WORKERS' COMPENSATION DECLARATION insure,hereby certif caste of Workers' Compensat oI have a certificate of o.elnsuran of APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. f/3Td)'S Company S� fC Evag BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN' ADDRESSSS(p LL©Wta LL Certified copy is filed with'the county building inspec- BUILDING tion department. ADDRESS �b +'YLLV W " yl� C jFr Date �`4-q i Applicant CITY' J=Y�I •� �' ZIP L' '7,qO LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR r ( ^�` (This section need not be completed if the permit is for one TRACT BLOCK LOT NO.' MAP BOOK �J -PAGE 1� PARCEL 3� hundred dollars ($100) or less.) . 3, OWNER OrI JeJ S�t r �± NO.�y�F Z S USE ZONE` AP I certify that in the'performance of the work for.which this permit is issued, I shall not employ any person in any manner ADDRESS 6j�Y&Z '�#qLLV WEL L ,�-/ SPECIAL CONDITIONS so as to become subject to The Workers'•Compensation Laws. r] 0 CITY = �L° ZIP "1, 7f?o Date Applicant ARCHITECT OR TEL. tY NOTICE TO.APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY g. CONST. ZONE O Exemption, you should become subject to the Workers' �D'(/ _� t / w Compensation provisions of the Labor Code, you must forth- ADDRESS a V CL with comply with such provisions or this permit shall be TEL. 4?t L� N deemed revoked. CONTRACTOR GL{4SS CL I�Ctr3�S NO.28& �r��lJo STATISTICAL CLASSIFICATION APT. CONDO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm That I arri licensed under provisions of Chapter 9 ADDRESS 3 r e Sr NO.3g X�3 LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the*Business CITY _rLm '� Cit CLASS C'3 and Professions Code,and my license is in full force and effect. BK. FIG. VALIDATION Z� O �3 SQ. F7. NO. OF FA OF CHECK License Number J Lic. Class SIZE STORIES FAMILIES .ONE rj p VALUATION CSSIL 20L+�J. Date �"��. ` DESCRIPTION OF WORK NEW ❑ $ Contractor _ -,� ❑1 am exempt under Sec. ADD ❑ ► ALTER ❑ B.&P.C. for this reason , REPAIR ❑ $ Date: USE OF / EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE' C hereby affyirm that I am exempt from the Contractor's License , Law for.Tlie following reason (Section.7031.5, Business aADDRESS nd FINALl Professions Code): . PRESENT By ❑ I, as owner of the propertyBUILDING, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY the structure,is not intended or offered for sale(Section , ft F _. ` ' MOVING ,. . TEL. .+�-� _ 7044;'Businesseand Professions Code.) w ❑ I, as owner of The property, am exclusively contracting CONTRACTOR NO. L�� fti `:i=! € _7 with licensed contractors to.construct the project (Sec- ADDRESS =•Fits` i' "` tion 7044, Business and Professions Code.) 'REQUIRED TOTAL SETBACK FROM EXIST. 5:= s3+3 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 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.). SIDE 14_Ejsli_I_I. I} .Ee' P.L. _ Lender's Name ``?_�` 'F m P.C. Fee$ Permit Fee f!/ d� LDMA Ref. # - Lender's Address ° I certify that I have read this application and state that the Issuance Fee L4� LDMA P/C# 0 8 above information is correct. I agree to comply with all County Investigation Fee /� O r ordinances and State laws relating to building construction, Total Fee �� % O LDMA Perm. # a and hereby authorize representatives of this County to enter upo a above-mentioned property for inspection purposes. ` L f L(-e?! SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date