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HomeMy Public PortalAbout10667 HALLWOOD DR_Building__ i DEPARTMENT OF COUNTY NNaIIQEER I L®I I� DIVISION OF BUILDING AND SAFETY f COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE. USE ONLY 1�,++ BUILDING DISTRICT NO. PLANLCK.o/yR REC.No. PEERMIT NO. ADDRESS ''N �e �!=✓� R ED BY DATE OF APPL. DATE ISSUED LOCALITY 1EIV,_ I h NEAREST 6� — CROSS ST. BUILDINQ / .f B ADDRESS !J (� OWNER 1 MAIL ADDRESS �7,Z./ tJ a LOCALITY V e TEL. �7 / NEAREST CITY L, a d O /- 6/6 6 CROSS ST.:, c ARCHITECT OR TEL. FIRE ZONE �' PLANS 6► I TYPE ,�' GROUF ENGINEER NO. '�• 1 BLDG. p ADDRESS / SETBACK LINE � CONTRACTOR I� CC C� II NO. - 5�6� ZONUSEI BY DATE DATE ADDRESS Z1Z, V A e+�� �4�� k?C d. HOUSE NUMBERING 40 LEGAL MAP NUMBERy ! NO. ASSIGNED BY DESCRIPTION LOT NO. BLOCK / � CORRECTIONS TRACT NO.OF BLDGS. ,i SIZE OF LOT I NOW ON LOT $ USE OF NO. OF EXISTING BLDG. FAMILIES DESCRIPTION OF WORK o — REP IR ( � DETOLITION �___&DDITION Q r� SQ. FT. / NO. OF SIZE 07 /-^7 ROOMS / STORIES / EXT. WALL ' SROOF ''''��_�"""" ��^� COVERING �V��-Q� i COVERING Com, USE OF STRUCTURE APPROVALS INS PECTQ S SIGNATURE DA-FE FOUNDATION: LOCATION 44 FORMS, MATERIALS , bt h•d 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. FURNACE: LOCATION, 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OFLATH, INT. PERMITTE V . f LATH. EXT. ADORESS 1' PLASTER, INT. / AUTHORIZED AGT. PLASTER, EXT. © C. $ FEE $ HOUSE NUMBER COR- (� . L RECT AND POSTEDVALUATIO FEE $ �� o FINAL ll j 76A838A DBS 3 9-52 1 - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby.affirm that I have a certificate of consent to self insure, BUI© ADDRESS or a certificate of Workers' Compensation Insurance,or a certified 1G/ copy thereof(Sec.3800,Lab.C.) CIT. ZIP -4 ZIP Q`� ® I 7/ LOCALITY f Policy No. Company SIZE OF 1-01 NO.OF BLDGS./MOW ON LOT 7 ❑ Certified copy 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 0 T�jL NO. COMPENSATION INSURANCE 7-p Wb z ��* �� `�L-66 7� WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS i `/ / n !(/ l( (� I!/�• DISTRICT GROUP TY�CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) /,</ ir �O /j I certify that CITY the performance of the work for which this permit � ZIP�- 4 <?(?�(f 49 f x is issued, I shall not employ any person in any manner so as to �J become subject to the Workers' Compensation Laws. ARCHITECT ORENGINEER TEL NO. - STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR - TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC.CLASS P'L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and o/ SQ. f , NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. LfNEW ❑ BK PG , a License Number LiC.Class - DESCRIPTION OF WORK ADD ❑ VALUATION Q Contractor Date ALTER ❑ $ ego �D V ElI am exempt under Sec. REPAIR El $ F- BAP.C.for this reason DEMOL ❑ W LDMA P/C# Date: USE OF.EXISTING BLDG. -, URM ❑ �r.�+Tsi� 1008.90 ln't OO IL �/Signature APPLICANT(PRINT) TEL NO. LDMA Perm# J�.� J` 14JV n 7" z �qQ I, as owner of the property, or my employees with wages as Z Y,their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and /� El I, as owner of the ' 1 ITEMS FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 3 "/J M TOTAL 108-90 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1111 �y(} Q(y property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > .ASN 108.90 licensed contractors to construct the project (Section 7044, YES❑ NO❑ Business and Professions Code.) CHANGE ,00 WILL THE INTENDED USE OF THE BUIDLING 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 FOR GUIDELINES. �n I hereby affirm that there is a construction lending agency for YES 11 No El 0000-0001 9/13/95 N the performance Of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING •) 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 227Q 7 L PM 5:14 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address O OWNER OR AGENT o 1 certify that'I have read this application and state under penalty O of perjury t he*ced tion is correct. I agree to comply P.C.FEE PERMIT FEE _ o with all un orate laws relating to buildingmconstru ion, ndepresentatives of this County ISSUANCE FEE ito en r upo hoperty for inspectio pur os j 0 (0 co INVESTIGATION FEE TOTAL FEE I` Sgnature of Appl' n or Agen D / D SEE REVERSE FOR EXPLANATORY LANGUAGE