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HomeMy Public PortalAbout6004 HART AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT . COUNTY OF LOS`A NGELES 04 WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING S49t Al � d�� . DISTRICT NO. PLAN CK.NO. // PERMIT NO. r-.• l 0 ;11; LOCALITY �J ry f� RECEIIVE/D/81Y• DATE OOyF/APPL., DATE ISSUED NEAREST CROSS ST. /y �-!i!!�`..Cv` '� `� . u BUILDOWNER ( -�=�4 � ADDRESS ` -- u MAIL 1I �9 LOCALITY / [ ADDRESS - rNEAREST CITY \� TNO.EL. as- CROSS ST. w �/ �• / FIRE MO.OF TYPE GROUP ARCHITECTOR�. ({ CEO ZONE PLANS ENGINEER V BLDG. ORD. °'� ��� ,/ ORD.NOf. ADDRESS SETBACK LINE 1� W /� (.� ,// APPROVED TEL. BY DATE CONTRACTOR NO. USE APPROVED ADDRESS ZONE BY DATE LEGAL "� Q ' --- �� CORRECTIONS DESCRIPTION L�OfTTNO. J> BLOCK i" V TRACT 4IY/ J I NO.OF BL SIZE OF LOT USE OF �l� �+ NOW ON LOT OF ND.OF EXISTING BLDG A',,� r -d- I F� ES I I ROOMS ' DE/SCRIPTION OF WORK NEW X ALTERATION ADDITION O A REPAIR MOVING DEMOLISH Sq.FT. NO.OF - - Z SIZE / ROOMS STORIES ! WALL ROOF COVERING. [�/Jv �� AIS .dCOV�ERINGuse O BUILDFINO W i A G"� _ l(/1;f[ Pzk+ o .. Y I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS - AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, I SIGNATURE OF ;e2elt"O� .ry •�!d�.%_ BRACING,SILTS PERMITTEE v.r JE LATH,INT.: AUTHORIZED AOT LATH,EXT.: DBS-3 SOM SETS Yae $ P.C.6 PLASTER,INT. FEE 7PLASTER,EXT. LVA •T10NFEEL FINAL DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF.LOS ANGELES ' Am. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY f DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDINGS ADDRES LOCALITYa,G,//% j��/��J RECEIVED BY DATE OF ADP L. DATE ISSUED NEARESCROSS ST. � /C I�7P'�"L +✓Il l�a�L !�'� r ! 4 I. BUILD /� y.G �.t� AEI NG OWNER DDS9 MAIL ,,ff _ LOCALITY ADDRESS •��'" TTTT �� ,(,, /ya J��/ NEAREST (S - 7,-;L - CITY / '�/% �/�}• �� NO/� / / �✓✓ CROSS 9T. `-e FIRE ,�N13 OF TYPE GROUI*r RCHI T OR •� TEL. ZONE -- PLANS ENGINEER �� (( BLDG. ORD.NO. ADDRESS WORKS SETBACK LINE ""`"PV ' APPROVED CONTRACTOR ALHAM6R t17 MISSION R6A�• BY DATE A HAMBRA cixury-1-- USE APPROVED ADDRESS 2-1201 ZONE A _/BY DATE LEGALq,.,r��' DESCRIPTION LOT NO. I BLOCK CORRECTIONS TRACT n NO.OF BLDGS. SIZE OF LOT I NO13 W ON LOT USE OF NO.OFNO.OF EXISTING BLDG. FAMI LIES ROOMS � DESCRIPTION OF WORK NEW \ ALTERATION ADDITION / a��i1r��' A REPAIR MOVING DEMOLISH Sq.FT. NO.OF Z _SIZE ROOMS STORIES D WALL ROOF r COVERING I COVERING USE OF NEW BUILDING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND ST T AWS�EGU3 UW'ftG& gU�%UJF�N.• . .Cqi G w 6.N« FRAME: FIRE STOPS, SIGNATURE OF L�-I BRACING;BOLTS PERMITTTE1 11 - LATH,INT.: AUTHORIZED AGT LATH,EXT.: _ DES-3 SOM SETS 7-47 $ P.C.$ PLASTER,INT. - 00 FEE PLASTER,EXT. ��� �. i�� >$c� /��/ VALUATION FEE G.�. b0 FINALIY�I ti tj WORKERS'COMPENSATION DECLARATION ?,•,f /! 11�reb affirm that I have a certificate of consent to self O O D D D insure,or a certificate of Workers' Compensation Insurance, I' �f G'd 0 C QU 000[ OO M ' [3 M 0 d D �l C p G3Gv�0 or certifiedLopy thereof (Sec.'3800,Lab. CJ: , COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No ` - Company BUILDING a Certified copy is hereby.furnished. FOR APPLICANT TO FILL IN ADDRESS Q D DCertified copy is filed with the county-building inspec- BUILDING / /"y JJ tion department. ADDRESS CpG' L� �/ GLOCALITY /J // NEAREST C i Date Applicant ;CITY 5J_I Z a/� ZIP �i.7 C,::) CROSS ST. CERTIFICATE OF EXEMPTION'FROM WORKERS' NO.OF BLDGS. -ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT Z MAP BOOK I PAGE.; PARCEL (This section need 'not be'completed if'.the permit is for one Z '� USE ZONE MAP 9 hundred,dollars ($100)or less.) TRACT BLOCK LOT NO.�] NO. FEL /J SPECIAL } I certify that'in,the performance of the work for which this OWNERf0,0� /yI�G; ZLcr ff'ri NO:.� tro—�/-3 ' CONDITIONS permit Is issued, I shall not employ any person in any manner.. =' // , DISTRICT GROUP TYPE FIRE PRO SSED BY 0 so as To beco sub' T to 1he.Worker 'Z�sfidonlSws_— S/L ADDRESSrE'�© �� CONST. ZONE V CITY'(L�/�Lf�lG'- ! COY ZIP %.� � �( .Dat Applicant STATISTICAL CLASSIFICATION 'APT. CONDO. u /\ NOTICE TO APPLICANT: If, after making this,Certificate,of ARCHITECT OR G�� — TEL. ENGINEER ® NO 'r � Exemption, you should become subject CLASS NO. DWELL UNITS to the Workers'' d (� Compensation-provisions of the Labor Code, you must forth'- ADDRESS•'c 11V-"v)it SEWER MAP with-comply with such provisions or this permit shall be // deemed revoked. . NO.�/�irrC gK. �p(, 4� VALIDATION CONTRACTOR !I/�i�L`l� 'LICENSED CONTRACTORS DECLARATION LIC, I hereby affirm that I am licensed under'provisions of Chapter 9. ADDRESS � � NO. VALU,A 10 (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license is in full force-ond effect. CITY .. 2ti'� CLASS $ SQ:FT. NO. OF r1 NO. OF ' CHECK License Number Lie.Class SIZE STORIES l FAMILIES 1 ONE Contractor Date .4L `j DESCRIPTION OF WORK 4a /MQ/' ;NEW � $ ADD I am exempt under Sec. /�t ALTER FINAL_ B.BP.C. for this reason 7—,16 Aer,I7 .r yCG� REPAIR DATE �p Date: USE OF FINAL DEMOL < EXISTING BLDG. B Signature J APPLICANT TEL. Y OWNER-BUILDER DECLARATION PRINT NO. �jfjl� I hereby affirm that I am exempt from the Contractor's License'• 8 8 0,8 A Law for the following reason (Section 7031.5, Business and. ADDRESS Professions'Code): PRESENT .4 0 0 0 0 0 BUILDING Q I, asownerof the property, or my employees.with ADDRESS wages as their sole compensation,'will do the work and 2 0. 42 2 2 5 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL 0 0 4 2.r 2 5 55 I, as owner of the property,'am exclusively contracting r CONTRACTOR NO. i� with licensed contractors to construct the project:(Sec- ,'C '2 0 8-'�8wi tion 7044, Business,and Professions Code), ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BAC WIDTH " YARD HWY K PROP. LINE I hereby affirm that there is d constructi(on"lending agency for FRONT /rC/��/ �clozA the performance of the work for which this permit is issued P.L. , (Sec. 3097, Civ. C.). SIDE 'P.L. Lender's Name +ti b •� P.C. Fee$ Permit Fee S,� •Lender's Address I certify'thal l have read.this application and state.that the Issuance Fee above information is correct:I agree to comply with.all County Investigation Fee g ordinances and'.State;laws relating to building construction; TotoLFee. v and hereby authorize representatives of this County to enter m upon above- ntio ertyfor_inspection 5' 0. o (/�. 3EE REVERSE FOR EXPLANATORY IANGUAGE Signature of Applicant or Agent Date f ®s CUUNTY*OF LOS ANGELES-SI 0 "4• BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I ' I'hereby.affirm that I have a certificate of consent to self insure, BUILDING I` /f � O0 ro00 I1/ //�% //Y Gr a Certificate of Workers' Compensation Insurance,or a certified ' copy thereof (Sec.3800,Lab.C.) � P�E CIT ZIP 9/�j 9 v C l LOCALITY Policy No. Company SIZ OF LOT NO.OF BLDGS.NOW ON LOT / /� NEAREST CROSS ST. ❑ Certified copy is hereby furnished. X gV (,�.• El Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAG E RCEL DO� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' R' TEL No / COMPENSATION INSURANCE "1110 V0�S � `AA ial j_ 2-9 �' 60p 1 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred A DREss� ,k �! -r WE DISTRICT GROUP TYPE CONST, FIRE ZONE PROCESSED BY dollars ($100) or less.)" '; to ` �C 7�- I certify that in the performance of the work for which this permit V` j��-i,— C� 7- ZIP �� r� /, is issued, I.shall not employ any person in any manner so as,to ARCHITECT OR ENGINEER - ' TEL NO.LJ(� become subject to the Workers'Compensation Laws. STATISTICAL CL�ASSS�IFICATION APT CONDO Date - Applicant ADDRESS - - CLASS NO. r DWELL UNITS ' NOTICE .TO APPLICANT.' If, after making'this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST I' Exemption, you should- become Subject to the Workers' CONTRACTR ELN / / SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ©w►�� Q C�JOe ( FRONT comply with such provisions or this permit shall be deemed revoked. A DRESS LIC.NO. PL _ LICENSED CONTRACTORS DECLARATION � r � I SIDE G/�v� c/ T LIC.CLASS PL ' .1 hereby affirm that I am licensed underprovisions of Chapter (�C— SEWER MAPS Q (commencing with Section 7000)of Division 3 of the Business an SO.F.T.SIZE NO.OF STORIES NO.OF FAMILIES ._ W 0 BK PG Professions Code,and my license'is in full force and effect License Number Lia Class DESCRIPTION/OvF^�RK f ,L ADD VALUAaN �0 D Q Contractor Date JJ / AL $ QQ T i TER ❑ I'!?li 774 m 60cc �. REPAIR .❑ ( `�E �.!_ ❑ I am exempt under Sec. $ :r40_4� B.&P.C.for this reason Cjf� ( ��[_ DEMOL ❑ LDMA PIC# s �ilt� jf:;W Date: E o EXISTING B G. URM ❑ 3303 . n - Lb tI]6 Lc� . . ( l��i� 330 �rti o CO Signature - spy CANY(PRINT ELN LDMA Perm# - r -. .. Z ❑a, as owner of the property, or my employees with Wages as 6,69 their.sole compensation, will do the work and the structure is A DRESS �c ' l nn f 4 f }- 9 f€�Q� not intended or offered for sale (Section 7044, Business and.• �� 1 V�` 1'� e4., A Ci - FINAL DATE a t Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL"' O NECK K 9 fi't'•��3 E] I, as owner of the propert am exclusively contractin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE y, y g licensed contractors to construct the-project (Section 7044, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINA B - VES❑ Z' Business and.Professions Code.) NO - - WILL THE NO USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH" y CONSTRUCTION LENDING.AGENCY COAST MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR F('}IJI'-I�!it fl'I�i 7/22/9,1y _ ij I hereby affirm that there is a construction lending agency for YES❑ No - �'Ld Vti 1 AM7. f % w the performance of the work for which this permit is issued(Sec: HAVE REA THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING ,3097,CIV.C.) CHECK UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - ' ... ... ' TITLE C APTER 2.20 SECTIONS 2.20.1 0 THRO 140 CONCERNING HAZARDOUS - a Lender's Name MAT R PORTING AND IITAI ING A P IT FROM THE SCAOMD. �.. ❑ Lender's Address OWNER OR AGENT O j o I certify that I have read this application and state under penalty t j 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEET N with all county ordinances and State laws relating to building / < :construction, and hereby authorize representatives of this County ISSUANCE FEE ,+ I. 10 to enter upon the above-mentioned property for inspection purposes. j•. ;p' INVESTIGATION FEE TOTAL FEE ^ Signature of Apli—I or A9.I 0- SEE REVERSE FOR EXPLANATORY LANGUAGE