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HomeMy Public PortalAbout5944 HART AVE_Building__ TEMPLE CHTY 76A038A CE#606-,-61 APPLRCAT900 FOR BUILDING IPERW u- COUNTY OF LOS ANGELES BUILDINGDEPARTM NT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY 1- JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. - FOR APPLICANT TO FILL IN DISTRICT N TYPE PR BY r CONST. BUILDING STATISTICAL CLAS IFICAT ION SE ER MAP ADDRESS I G/ - `�� /� � CLASS. NO. DWELL.UNITS _ - LOT N&,")lz.• tl BLOCK WATER NOT REQUIREDRECEIVED - CERTIFICATE: TRACT O MAP HIGHWAY STATE MAJOR SECOND, OCAL NO.OF BLDGS.' NO: (CIRCLE) SIZEOFLOT. .. I NOW ON LOT -ZONE ZONE SPECIAL USE OF - CONDITIONS EXISTING BLDG TE OWNER / NO BUILDING .YARD HWY STREET NAME EXIST. SETBACK WIDTH' ADDRESS _ FRONT 0 .i71 ARCHITECT OR TEL. P. L. L� ENGINEER - NO. SIDE P.L. ADDRESS TEL. INSPECTION RECORD CONTRACTOR NO. 0 ADDRESS DESCRIPTION OF WORK /�� ' ox 1 NEW ADD ALTER REPAIR DEMOLISH V/ -_ - - Z SQ.FT NO.OF NO.OF - _ IZE STORIES FAMILIES USE OF f� STRUCTURE V SIGNATURE OF APPLICANT----- VALUATION PPLICANTVALUATION$ f. c'-v •I - APPROVALS - DATE / INSPEECCCTTTO'RR;;S SISIIGGNNA/T!URE F E $ FEE y ll �/ FOUNDATFORMS!MATERIALS LOCATION FRAME:•FIRE STOPS, /• / ' I HEREBY ACKNOWLEDGE THAT 1 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 DOING THE WORK AUTHORIZED HEREBY TWILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.-. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. /,��� LATH,EXT. � e w SIGNATURE OF '- !/ HOUSE NUMBER COR- PERMITTEE I RECT AND POSTED ADDRESS - FINAL CLYDE N. DIRLAM, PRINCIPAL.STRUCTURAL EN PLAN CHECK VALIDATION K. M.O. CASH PERMIT VALIDATION CK. M.O. CASH tiLAC033 7 8% AUG22 1 D r 76A888A CE#808, 1-61^ !t-l1ll Y U CAT O®N FOR B U R IL DN V PER O T COUNTY OF LOS ANGELES BUILDING �^ LLL111 DEPARTMENT OF COUNTY ENGINEER All., J BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST .WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP R CE D BY FOR APPLICANT TO FILL IN �— TYPE CONST. BUILDING '^" - STATISTICAL CL SIFICATION SEWER MAP ADDRESS ! CLASS.NO. -BK PG Q� DWELL.UNITS /16 LOT-NOS OBJ BLOCK WATER NOT REQUIRED RECEIVED a i t% CERTIFICATE: ���LLL JJJ TRACT /•' MAP ©o Al HIGHWAY STATE MAJOR SECOND OCAL' SIZE OF LOTD X,� i�7 I NOW ON LOT SO ZONE SPECIAL(CIRCLE) USE OF �/ CONDITIONS EXISTING BLDG. OS .574l AI!/// 4,er TEL. OWN ER_ LfS4 NO. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS FRONTO ARCHITECT OR TEL. _ P. L. Lq ENGINEER NO. SIDE (> P.L. r ADDRESS - INSPECTION RECORD a TEL. O CONTRACTOR NO. V ADDRESS DESCRIPTION OF WORK 0 ..W CL NEW ADD /ALiE52 REPAIR DEMOLISH - Z SQ. FT. . NO.OF NO.OF �IZE STORIES FAMILIES USE OF STRUCTURE 5 7-0 4,4!-49 5".o J A41."/lOy2r3mc !� ` X SIGNATURE OF - APPLICANT ' VALUATION$ - J APPROVALS DATE INSPECTOR'S SIGNATURE P FOUNDATION: LOCATION 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING'CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL'.NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. -n LATH,EXT. SIGNATURE OF ! HOUSE NUMBER COR- PERMITTEE _ RECT AND POSTED L `�,0�/tI ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STAUCTURAL E7—H R PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. LAC 0:3-3 4 4 AUG 2.2 1 D 1 2.00- . TEMPLE CITE' 7GA66A'Cc#803-'1-611. AL ATEON FOR . R • BALDpG EM. D :COUNTY OF LOS :ANGELES, BUDILDING `DEPARTMENT OF COUNTY ENGINEER AD°KESS BUILDING AND, SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRI T NO. GROUP TYPE, , .P ESSED BY -FOR APPLICANT TO FILL coNsr. BUILDING "� STATISTICALCLASSIFICATION S RK ADDRESS. �'�' __ /' r CLASS.NO:--5—DWELL.UNITS P LOT NO. V 'BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: TRACT MAPHIGHWAY STATE MAJOR SECOND L CAL NO.OF.BLOGS: - NO'. ."� -7.(CIRCLE) SIZE-OF^LOT. I NOW ON LOT US ZONE SPECIAL - - ° USE OF - - ` CONDITIONS EXISTING BLDG. - - T OWNER. BUILDINGi - EXIST. SETBACK. YARD HWY STREET N ME WIDTH" ADDRESS'', oe '1 FRONT - ARCHITECT' - - �'T `. -:P. L'•.I ENGI-NEER O. SIDEI. - P.L! - ADDRESS- •( 'TEL. 1; ,�' INSPECTION RECOfb_Y ' O CONTRACTOR- ' ' -NO I B L (J ADDRESS DESCRIPTIONit, WORK L ri ��`: u 7� �'(/"vS �l e' O tuj " NEW ADD ALTER. OREPAI" DEMOLISH fl/ SQ.-FT. - NO. NO'.OF O-9� ">=/a''� _ .G� 1,11 IZf - } STORIES :.FAMILIES USE OF STRUCTURE • - IL L1 SIGNATURE OF' VALUATION.$ APPROVALS- DATE ,i INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION[ LOCATION FEE $' FEE $ -,.FORMS, MATERIALS - - FRAME: FIRE'STOPS, - ' I.HEREBY ACKNOWLEDGE THAT IHAVE 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 DOING THE WORK - ,- AUTHORIZED HEREBY'I-WILL NOT EMPLOY<ANY PERSON IN VIOLA LATH, INT.. TION OF THE"LABOR C OF THE STATE OF CA LI PORNIA RELAT- ING TO WORKMEN'S EN N INSURANC E.- LATH,EXT. - - SIGNATURE.OF HOUSE NUMBER COR_ PERMITTEEt RECT AND POSTED ADDRESS _ FINAL CLYDE N. DIRLAM,.FIRiNCI aAL ST.RUETURAL ENGI R MIT PLAN CHECK VALIDATION CK. .M.O. CASH PERVALIDATION CK. M.O. CASH 5 2 .00 r TEMPLE Civ Y . q • u 76AG33A CE»905 1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADD ESS s-9 44 /Y, 1-&-_r S DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY d (- C JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. 2' _ N/J._1we 5 DISTRICT NO. GROUP TYPE;:T PRO Y FOR APPLICANT TO FILL IN 5-, p ✓` CONS BUILDING STATISTICAL CLASSIFICATION SEWERMAP PG ADDRESS �� '� [7"ll-sC r �r— CLASS. NO. sf� DWELL. UNITS "=_ K_ 6 C LOT NO.N_4 tJ ( c/ v/-' 3 ) BLOCK WATER NOT REQUIRED2. RECEIVED CERTIFICATE: El TRACT J`} [✓ ¢ MAP HIGHWAY STATE MAJOR SECONR LOCA NOOF BLDGS. NO. do (CIRCLE) SIZE OF LOT 4 U ,A /*r3, I NOW. ON LOT L USE ZONE SPECIAL USEOFnKy 4 /A.f, S/z�_2q�0 k� CONDITIONS EXISTING BLDG./G s `� TEL. OWNER ��' j� V/ '9 r•�C-tl NK NO. BUILDING EXIST. YARD HWY STREET NAME C � SETBACK WIDTH S ADDRESS '��7/ FRONT i' ARCHITECT OR TEL. P. L. /` ./"— J-0 ENGINEER NO. SIDE P. L. } ADDRESS TEL, INSPECTION RECORD O CONTRACTOR NO. tN� � _ � ADDRESS DESCRIPTION OF WORK ^'a ' r't - 3 `L -'\ 4 t)�) i$1- i l a NEW ADD ALTER REPAIR/ DEMOLISH h SQ. FT. c N NO.OF z IZE // STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT— VALUATION PPLICANT VALUATION$ t 4� 3� APPROVALS DATE INSPECTOR'S SIGNATURE P.C. q/o.N>L PMT. ��� FOUNDATION: LOCATION FEE $ /' FEE $ '� 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STAT F CALIFORNIA RELAT- ING TO WORKMEN'S CO PENSA 10 U CE. LATH,EXT. SIGNATURE OF .OUSE NUMBER COR. PERMITTEE RECT ANQ POSTED ADDRESS--- - FINAL /J! CLYDE N. DIRLAM, INC AL STRUCTURAL ENG4NEER PLAN CHECK VALIDATION CK. M.O. CABH PERMIT VALIDATION CK. M.O. CASH 76A6381 CE..�e 8032-63 AP LICA Y IOI V OR. BUILDING'PERMIT MIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT .OF COUNTY ENGINEER AD°REss oN. Hart BUILDING .AND SAFETY DIVISION LOCALITY Terri_le '0'tv JOHN A. LAMBIE. COUNTY.ENGINEER NEAREST / WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT N GR UP TYPECESSED BY FOR APPLICANT TO FILL IN CONST. BUILDING STATISTICAL CLASSIFICATION S WER MAP ADDRESS �Q i y, �% - K a PG CLASS. NO. __DWELL. UNITS" LOT NO. C NOT REQUIRED RECEIVED BLOCK WATER p CERTIFICATE: ❑ TRACT _ - L MAPHIGHWAY, -STATE MAJOR SECOND, OCA NO..OF BLDGS. NO.� (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE 9PECIAL. _ USE OF - - - CONDITIONS EXISTING BLDG. - rA i(-] ,/•��� TEL. �J L OWNER.P. MnaaNO.At--7348� BUIL15ING YARD HWY ST ET NAME EXIST. SETBACK WIDTH ADDRESS same FRONT _ - ✓�->> ARCHITECT OR TEL. - P. L ENGINEER NO. - SIDE j R L. a ADDRESS .t T E OU CONTRACTORPacific InstallerSNO 2mm12 0 . F I ADDRESS 10920:E, Grand - DESCRIPTION OF WORK -_A, .d 1;W j LU Z. NEW ADD ALTER REPAIR DEMOLISH . SQ. FT. NO. OF NO. OF - SIZE STORIES - FAMILIES " USE OF STRUCTURE iristall 35M. wall heater- SIGNATURE OF APPLICANT VALUATION $ 2o OO APPROVALS DAT`E� INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEE S. FEES FORMS, MATERIALS f j FRAME: FIRE STOPS, '1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, SOLTS 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 DOING THE WORK e AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- ,LATH. INT. TION OF THE,.LASOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMP SATION INSURANC LATH, EXT. �I SIGNATURE OFA HOUSE NUMBER COR- PERMITTEE RECT AND POSTED i ADDRESS FINAL A JOHN F. LEWIS. PRI NCIPALSTR RALE ENGEN ER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT.VALIDATION ' CK. M.O. CASH _J Go,4 9 3 5 [AN 28 1 D 6.00- c, :TEMPLE cory ,76A666A CE})603,1-61... APPUCA ION FOR. BUILDING PERMIT .. COUNTY OF LOS ANGELES BUILDING 9 4 4 A/. f/*,t-r � r1 DEPARTMENT OF COUNTY ENGINEER *BUILDING AND SAFETY DIVISION LOCALITY /:4r1t11 iflr- JOHN A. LAMBIE. COUNTY ENGINEER NEAREST ,J WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. /`Q O-P FOR APPLICANT TO,FILL IN DISTRICT NO. GROUP TYPE 'I -PRO BY - ,rj�.' O� CONST. BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS S-�I44 N K ST BK PG .1 CLASS:NO.�DWELL.UNITS O - I I:. 6 C. LOT NO.•v- , SvO oVo.. 3 Sr' BLOCK. WATER NOT REQUIRED RECEIVED [—p / CERTIFICATE: TRACT J / D'y �.5 MAPHIGHWAY STATE MAJOR SECOND, LOCAL r NO.OF BLDGS. NO: oCJ (CIRCLE) SIZE OF LOT 4 1J X l V`3 , J I NOW ON LOT �- USE ZONE SPECIAL USE OF - - /) �/ CONDITIONS EXISTING BLDG.AiSS f7:JJ1.�}��L:rJC.nbr 1�+l - OWNER .L TI' •TEL. l /-Iljn/rrolV! NO. . BUILDING EXIST. YARD HWY STREET NAME ADDRESS 5 SETBACK WIDTH' ARCHITECT OR TEL. FRONT T P. i• l��Px-T -.� � ENGINEER NO. SIDE P.L. ADDRESS TEL. INSPECTION RECORD CL CONTRACTOR - NO. cv 0 04164 4,-04IIT-4 .T . ADDRESS DESCRIPTION, OF WORK Sup, J z =` /°,,.� O po .�7i — J VF No f(i r E. a NEW ADD ALTER ..REPAIR DEMOLISH r y SO.FT. 9 h'./,S v t -NO.OF � r Z SIZE iA c 3-1 ' -STORIES: FAMILIES— USE OF STRUCTURE s . �l2Nrrcae L- Alor 1202 L.;YiNi- "°!joys SIGNATURE OF —APPLICANT--- /* VALUATO N$ '- T"o ! I , APPROVALS DATE INSPECTOR'S SIGNATURE -� PMT. �J FOUNDATION: LOCATION FEE $ FEE $ /i Dl�� FORMS,MATERIALS FRAME: FIRE STOPS: 1 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 DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. - TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE.- ` LATH,EXT. SIGNATRE OF - HOUSE NUMBER COR- PERMITTEUE RECT AND POSTED ADDRESS :kINAl - CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION �174Z - r� 76A638AG`iI6038"154 APPLICATION OR BILJ��®��� PE. ,MI COUNTY OF LOS ANGELES BUILDING r' DEPARTMENT OF COUNTY ENGINEER ADDRESS Nor— BUILDING AND SAFETY DIVISION LOCALI T Y . 1 JOHN A. LAMBIE-, COUNTY ENGINEER NEAREST I COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. i DISTRICT -G OUP TYP P C SED B - : FOR APPLICANT TO FILL IN CONST ,`- . C BUILDING STATISTICAL ASSIFICATION, �SE ER MAP ADDRESS .5944 art Cit ��+ T- CLASS NO.=DWELL UNITS. �r -BK "PG LOT NO. BLOCK USE ZONE MAP,' .-.�f 4•G'' •- . �{ _ NO. TRACT - - - SPECIAL . NO. OF SLOGS. CONDITIONS- - - SIZE OF LOT - NOW ON LOT •• :I USE OF _ - EXISTING BLDG, BLDG. SETBACK FROM f - Mar Kiley FRONT PROP. LINE OF (STREET) OWNER r^y^ Y NO, 2'85-4559 TYPE OF EXISTING, SETBACK HIGHWAY _+' .YARD TOTAL ADDRESS5944 Ne Hart HI 'WAY WIDTH -I'FROMC.L, ' CITYci ARCHITECT OR TEL. BLDG. S TRACK FROM le ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OFEXISTING• SETBACK- HIGHWAY' +. 'YARD..=.- -TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. d 0. CONTRAcibir in Roof Coco` 2.87-050 + ADDRE�O So. - San G'abriia.160 650 'LIC CDR CUTOFF YES O NOVO O CITY San. Gabriel CL� s C39 SEE REVERSE'SIDE FOR SPECIAL APPROVALS W DESCRIPTION OF WORK Z NEW ADD ALTER REPAIR- DEMOLISH SQ.FT. NO. O NO. OF- SIZE FSIZE STORIES FAMILIESUSE OF 'STRUCTUR'E Reroof main house roof . & . diningarea-1 layer -30#, 90# SIGNATURE OF APPLICANT 'VA..LUATION$312.0.00- - _ APPROVAL'S 1?14TE � INSP ECTOR'S,SIGNATURE P.C. - PMT,. FOUNDATION, LOCATION • FEE$.: 'F FEE$ -6.00 FORMS,_MATERIALS,__ - 'FRAME, FIRE-STOPS, 1 w I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS'AP LICATION BRACING BOLT1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE O COMPLY FURNACE:.LOC.A.TION WITH .ALL COUNTY ORDINANCES AND STATE LAWS EGU�ATING GAS VENT. DUCTS 9UILDING CONSTRUCTION. I IFY THAT. I /CPE THE WORK AUTHORIZED HEREBY I WIL T EMPLOY A YNINVIOLA• ATH. INT.TION OF THE LABOR COD F E STATE F RNIA RELAT- .ING TO WORKMEN'S CO SA ONrNSU E - i fry. •IE LATH. EXT.* SIGNATURE OF, HOUSE NUMBER COR- PER M I TT E E OR-PERMITTEE REST AND POSTED ADDRESS 9 F IN A L OIr3�m41 � A •/ h �`' K JOHN.F. LEWIS, PRINCIPAL ST C .•RAL-ENGINEER - PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION(cK. M.O. CASH L too 5.6 5 7 S`P 16 1 D .'6 .0 0' I WORKERS' COMPENSATION DECLARATION RM nt to self insure,oron errtif cate of Worke s' Compensatiothat I'have a*certificate of n Insurance, AP P M CAU M 'R FOR or a_plfieci"copy-th�reof(Sec. 3800, Lab.'C.) S'� g�� ��^-� COUNTY OF LOS ANGELES BUILDIWG AWD SAFETY PolicQS"� Company �+ A CV ❑ Certified copy is hereby furnished.'• .., . . • FOR APPLICANT TO FILL IN j' goDREs �> ( Av., Certified copy is filed w' ounty build' g inspec- BUILDING do clartment.' ADDRESS DateC11 ONAPPIic CITY ZIP' / �® LOCALITY a C� NO. OF,BLDGS. NEAREST . CERTIFICATE OF.EXEMPTIO .FR KERS'' SIZE OF LOT NOW ON LOT Z CROSS S7. COMPENSATION SURA ASSESSOR C4 (This section"need'not be completed if t permit is for one TRACT BLOCK LOT NO. MAP BOOK J J PAGE per% PARCELObrp hundred dollars,($100)or less.) TEL USE ZONE OP -- OWNER NO. I certify that in the performance of.the work for which this SPECIAL'-' " permit is issued, I shall not employ any person in any manner ADDRESS /' d. CONDITIONS so as to become subjecT.To the,Workers'Compensation-Laws. ,� �• r-•� � O - CITY e_"R (Q T- ZIP ` ! Date Applicant, ARCHITECT'OR TEL.- W NOTICE TO APPLICANT: -If,. after makingthis Certificate of ENGINEER NO.. DISTRICT _ GROUP.. TYPE FIRE ��DY, ., TY ZONE Exemption,, you should become subject to the:.Workers' �f" j w Compensation provisions of the Lobor Code you must forth- ADDRESS % •Q /�-5' /� I q; with comply with such-provisions or This permit-.shall be G NT �j �/��L. y STATISTICAL CLASSIFICATION APT. CONDO. N deemed,revoked : 'CONTRACTOR N� ��y7 n / Z LICENSED,CONTRACTORS DECLARATION `LIC.' CLASS NO. o+ DWELL: UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �/ � NO: �(� i " LIC. SEWER MAP (commencing with Section 7000)of-_Division 3 of the Business CLASS and Professions Code,and my license is in full for effect. CITY r(/ BK.` PG VALIDATION SQ. FT.. NO. OF NO:OF. CHECK License Number / Lic. Class SIZE STORIES FAMILIES �' ONE VALIDATION . Contract Date DESCRIPTION OF WORK NEW ;❑ /�-� ❑I am exempt under Sec. ADD " $ C, _ .. '. ,�yy dd � ALTER ,❑ BAP.C. for this redson („fwd ����� ....�G'���y2•�/ ' REPAIRi1❑ $ Date: USE OF EXISTING BLDG. • DEMOL Signature APPLICA ^� TEL ' Cc FINAL OWNER-BUILDER-.DECLARATION "(PRINT). K No U DATE' I hereby affirm that I am exempt from the Contractor's-License Law for the following reason (Section 7031.5, Business and ADDRE ''�J ��dL FINAL ? Professions Code): PRESENT. $y A0,E T ❑ I, as owner of the property, or my.employees with. ILDING ADDRESS `-_t •r"1 wages as their sole compensation,will do the work and :- LOCALITY . the structure is not intended or offered for sale(Section D i , 7044, Business and Professions Code.) MOVING TEL. A CCT ❑ I,'as owner of the.propeity,,am exclusively contracting CONTRACTOR NO. i-I° '•_,t.s with licensed contractors to construct the ro'ect,. Sec- tion 7044; Business dnd Professions Code.) I. ( ADDRESS inn 9V REQUIRED TOTAL'SETBACK FROM» EXIST. iLY 9W , CONSTRUCTION LENDING AGENCY SET BACK YARD HwY PROP.�r�LINE WIDTH - ''' I hereby'affirm that there is a.construction lending agency for FRONT TI:`: —� the performance of the.work for which this permit is issued P.L: 4 Tf �._ ii® tt (Sec. 3097, Civ. C.). SIDE t_:;-f)_ t 1 (id.�•7 P.L` Lender's Name {;I••If^!NGE ;0t} Lender's Address P:C. Fee$ d/ Permit Fee �f �� LDMA Ref.# " , I certify-that that I-ha'a read this application and state that the Issuance Fe o iDMA PiC'# i 1001 1�(n 7� y PP 1001 9/10 92- above information is correct. I agree to comply with all County Investigation Fee 8 ordina sand Slate la relating to building construction; Total.Fee LDMAPerm. # ^rx: 1 till O a ere b authori re resentatives of this Count to enter pon the ov tio, ed property for in SP pur s s. a z_ � SEE REVERSE FOR EXPLANATORY LANGUAGE , Signa re o plica'nt or Agent D e WORKERS' COPAPENSATIQN DECLARATION (J I he;e�y affirrt."tKat_a have'e certificate of consent to self LrU1J LI ��CL/�1UM V �OR • OD U�'�"O VIG .p� o ff !insure, or a certificate of WdAers' Cor'npensation Insurance, IJ LI [/�� U V U lJ\1 or cr certified copy•thereof (Sec. 3800, Lab. C.) $�� R.,V.s Policy No.•' ` Company - COUNTY OF LOS ANGELES'- WILDING AND SAFETY ��� BUILDING' '�! .0 'Certified copy is hereby furnished., 1 kFOR APPLICANT_TO FILL IN. t, } ADDRESS BUIL - Certified copy is filed with the county building inspec BUILDING Ail,— V . tion department. ; ADDRESS � Date A licant CITY' r ZIP LOCALITY PP r NO. OF BLDGS., . NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT �3 W O LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (. (This section need not be completed if the permit is for one TRACT BLOCK LOT b AG MAP BOOK, PE: PARCEL hundred dollars($100)or'.less:) TEL. _ OWNER f NO. USE ZONE MAP / " I certify that in the performance of the work for which this T NO. PECIAL SP permit is issued,.I shall not employ any person in any manner ADDRESS' ZO OLS'-�/ �G � �/ CONDITIONS � so as to become subject to the Workers'Compensation_Laws. 0 CITY ZIP 9170 ; i Date Applicant ARCHITECT OR TEL. Z "1ry2 DISTRICT. GROUP. TYPE FIRE. ' PROCESSED BY 0 NOTICE TO APPLICANT: If, after making thin Certificate of ENGINEER Zf ?� NO. 0 CONST. ZONE " Exemption, you should_become' subject 'to. the.Workers' p,L/ O' /(� P ? V U Compensation provisions of the Labor Code; you•must forth- ADDRESS 0 Lf(�1�s `/3 / �� C dt "" —� W Q_ TEL. N with comply with such .provisions or this permit shall be L� "QQQ/� STATISTICAL CLASSIFICATION APT. " CONDO. Z deemed revoked. CONTRACTOR NO. — LICENSED CONTRACTORS DECLARATION-. LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP" (commencing with Section 7000)of Division 3 of the Business LIC CITY , Q 1 CLASS and Professions Code,and my license is in full force and effect. BK. PG. VALIDATION SQ. FT./_ NO. OF NO. OF,. CHECK License Number Lic.,Class SIZE, STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ b =1� Contractor Date ^ $ -_ !/ �I?/7 p'p I f V/l� ADD D �3 I�` ❑I am exempt under Sec. / /r�/�/� I� K(�(�6'l 1 .. -ALTER ❑ $ /2�7 VVl/1 C Lt B.&P.C. for this reason ' �'� �✓ USE OF / REPAIR Date EXISTING BLDG. $f h /(jTI�L DEMOL APPLICANT _ TEL. 7 �/ CHECK 392° `: Signature i J) J r - FINAL OWNER-BUILDER DECLARATION, PRINT), L%� NO. DATE �" - Z, ';'A I her y.affirm that I am exempt from ihe:Contractor's License [ADDRESS Z � (�V �� FINAL La for the.following'reason (Section.7031 5;`Business an Pr fessions Code): PRESENT -- By {' BUILDING S ! ['( I It ti( titi •`_r,'ruf I,,as owner-of the property, or my employees with ADDRES r J�A' ! wages as their sole compensation,'vAl'do the work and " ' rig• �' , . ; -f� T 4s„' AN o the structure is not intended or offered:for sale(Section LOCAL D '`/}i(�- 1. ` i .� ==. 7044, Business and Professions Code )• MOVIN 818 p p TEL." C���. 1fi CONTRACTOR /z-Iz to O NO. (A ❑ I, as owner of the property, am exclusively contracting - a .with licensed contractors to construct the project (Sec- RE ADDSS _s9� 9 tion 7044, Business and Professions Code.) I)T 577 e I REQUIRED TOTAL SETBACK FROM-" EXIST.' CONSTRUCTION LENDING AGENCY SET.BACK YARD. �HWY PROP. LINE WIDTH , ITEMS I hereby affirm that there is aconstruction lending agency for FRONT = --� 2 1 i LEMS the performance of the workJor which this permit is issued P.L. 7 (Sec. 3097,-Civ. C.). SIDE . . DOTAL iTAL _t>= 73 00 P.L. - Er 1 Lender's Name. LDMA Ref. # ~ ° CO- j -.:` '` HANGE P.C. Fee$, 9 Permit Fee 3" Lender's Address I certify that I have read this'a lication and state that the Issuance Fee r LDMA P/C# o Y PP • above information'is correct. I agree to-comply with all County Investiga' ee 800 1 d ordinanc d Sidte laws relating to building construction,, Total Fee �. 1 LDMA Perm. # and he by ut ize repre entative f this County to"enter 6;15 t) °I'3? up e a v - entioned roper fo ectio rp'oses. / i1= " < E \ �� SEE REVERSE FOR EXPLANATORY LANGUAGE ignat A plic "t r A t" Da`� ` COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADORE BUILD( G A DRES I hereby affirm that I have a certificate of consent to self insure, of a certificate of Workers'Compensation Insurance,or a certified CITY 47 - 1ZIP copy thereof(Sec.3800,Lab.C.) LOCAL( Policy No. Company' n 2&" SIZE OF LOJ I NO.OF'BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. V 133 NEARES S T El Certified BLOCK LOT NO.Certified Copy IS filed with the County building inspection USE ZONE MAP NO. 6a r4 department. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant ---) SPECIAL C TIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL,NO. YES NO COMPENSATION INSURANCE WITHIN 1000.FT.OF SCHOOL? ADDRESS - (This section need not be completed if the permit is for one hundred a y DISTRICT GROUP TYPE C ST. FIRE ZONE O E D BY dollars($100)or less,) CITY JV ZIP I certify that in the performance of the work for which this permit r I is issued, I shall not employ any,person in any manner so as to ARCHITECT OF1 E GINEE TEL.NO. become subject to the Workers'Compensation Laws. rT TWATISTICAL CLASS (CATION PT 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 CONTRA TOR 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 SIDE LICENSED CONTRACTORS DECLARATION I CITY LIC.CLASS PL p I .affirm that I am licensed,under provisions of Chapter 9 SEWER MAP U (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF STORES NO.OF FAMILIES CD CD Professions Code,and my license is in full force and effect. NEW BK PG D DESCRIPTION OF WORK ADD ❑ License Number Lic.Class VALUATION W Contractor Date ALTER El $ ®® ® z Die kE — ❑ iamexemptunderSec. y�� ( s��a PAIR ❑ $ ) ii':'_ ,a B.BP.C.for this reason `LJ2 l �z�!T* v EMOL ❑ LDMA P/C# USE OF EXISTING BLDG. �tsJ t RM El _ Date: ew .�_= Signature APPLICANT( INT). TEL-NO. LDMA Perm# - ❑ I, as owner of the property, or my employees with wages as p -f 1 L 673 - "= their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE _ PrOfeSSl011S Code.) WILL THE APPLICANT OR FUTUREBUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL .i 1,• )'I �� aj�' ❑ I, as-owner of theproperty,am•exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY y licensed-contractors to construct the project (Section 7044, YES❑ NO❑ _ Business and Professions Code.) `'i 6/27/T-11 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING �}'{�i(.� 4I,f`)._1 .- OCCUPANT REQUIRE APERMIT FOR CONSTRUCTION ORMODIFICATION FROM THE SOUTH J�� -• {? + CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST A ,O I� / ; '.j 8:17 FOR GUIDELINES. I hereby affirm that there is a construction lending agency for FOR No El (n the performance of the work for which this permit is issued(Sec. YES 3097,CIV.C.). I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD m PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES -I m. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING ;B Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. /� t aLendersAddreSS ONTIERORAGEW (POU o° I certify that I have read this application and state that the above g inf ation IS correct. I agree to comply With all county PC.FEE PERMIT FEE 3 dinar, s and State laws relating to buil • uction,and ! ere thorize repres tives cm of t my to nter upon / D/ ISSUANCE F CJ thea a an' ned pr rty for' ur s (p (�! VESTIGATION FEE TOTAL FEE ISigne: of Appllran:o SEE REVERSE FOR EXPLANATORY LgNdGJWE, 1