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HomeMy Public PortalAbout6018 HART AVE_Building__ 43 76i, ��(p ,`,/7 C=#8Q jt.6/78) P ► p ffy�o. 1,y�,eir I.�/��7� OT tOUNTY;OF_LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING' ADDRESS (o BUILDING ! ! / /f ADDRESS /Vr -`-'� /-\.7Q 7 /� LOCALITYfrFIJC�vil . CITY ?-atZ M?Z.rG e-•iZIP. '// I rJ CROSS ST. NO.OF BLDGS. ASSESSOR. SIZE OF LOT NOW-ON LOT MAP BOOK PAGE PARCEL G� DISTRICT GROUP TYPE FIRE OCE D BY TRACT ! Q g BLOCK . . LOL.NO..�-` I �J OQ CONST.v Z OWNER.�.1C� NO."Z S�JS3 STATISTICAL CLASSIFICATION, EW MAP ADDRESS:Ep• / CJ '-- �'-- t p` CLASS NO. DWELL.UNITS BK G q7� CITY PL _.Gl/. . . $.:.ZIP ,./�_�5,p-:.,: . �. .-7 ARCHITECT OR TEL. VALUATION $ / / ENGINEER NO. / < ADDRESS x'11 BLDG.SETBACK FROM . TEL Z �.�90 FRONT PROP.LINE OF (STREET) CONTRACTOR L Jf,/L�IrV NO. HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS �© %+ 1t7f7� LIC. . • FRONT PROP.LINE HIGHW 1ZAY WIDTH NO: 7L3Z LIC. 4- CITY CITY /T��- Sl CLASS CONSTRUCTION LENDER BLDG.SETBACK FROM. NAME AND BRANCH SIDE PROP,LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM I TYPE OF 1EXISTING ADDRESSCITY SIDE PROP.LINE IHIGHWAYI WIDTH SQ.FT++, NO:OF NO.OF CHECK + _ v SIZE V STORIES FAMILIES ONE 09 DESCRIPTION OF WORK NEW ❑ P.0 Fee$ �p ti �Q Permit Fee �f QQG ADD ❑ Issuance Fee ALTER- ❑ / z REPAIR' ❑ Total Fee �p USE OF DEMOL. ❑ EXISTING BLDG. ^', A_L p� 7& O APPLICANT A TEL) (PRINT) �/1 CiC,�(��0���'�'.'NO. T O • a � o BY(SIGNATURE) > (S! o IHEREBY ACKNOWLEDGE.THAT I HAVE READ THIS APPLICATION AND STATE 7 X THAT THE ABOVE IS COR AND AGREE TO COMPLY WITH ALL ORDINANCES - AND LAWS REGULATI UIL NG CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED EREBY ILL NOT EMPLOY ANY PERSON IN VIOLATION OF V -THE LABOR CODE THE STATE F C IFORNIA IN TING TO WORKMEN'S COM. z C Q L Z !1 PENSATION)NSU ANCE. - J V Q J f'1 . d . #(O O o O O SIGNATURE O PERMITTEE 2+° 1169,00 ADDRESS TEL. G 1 '6 9.0 0 cz): r CITY NO, G 073 1 :-:-,7 9 .I�I N FP O �1 7a7PdDAl ~ )TIONS- g FINAL ®� BY LU d DATE �� - :'RS'COMPENSATION DECLARATION i here`try affir that I have.a certificate of consent to self p � D O Q Q �N " iefsure,; ,a certificate of Workers' Compensation Insurance, o;a c copy thereof'(Sec.,3800, L'ab.'C:) a r _ COUNTY O¢-;LOS ANGELES= Tn/ORKERS'COMPENSATION DECLARATION • I `I�_ereby affirm that 1 have a certificate of consent to self ®� OO In D �n fl/1 ip'sure; r a yertificate of Workers' Compensation Insurance, �f V v �f�f (fUU u or ci, tlf#d copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poll cf No. Company ❑ -- . .. - Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILD G tion department. ADDRESS1/010/100 Date Applicant CITY C ZIP / LOCALITY_ CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT D 192 NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR' hundred dollars($100)'or less.), TRACT BLOCK LOT NO. MAP BOOK. PAGE PARCEL TEL.. USE ONE MAP I certify that,.in the performance of the work for which this . OWNER r�� NO �U NO.. permit is issued, I shall not employ any person in any mannerI SPECIAL so as to become subject to the Workers'Comp nsation vv ADDRESS B CONDITIONS O Da-t6/1912'0CITY A�� e ZIP ' 0 Applican ARCHITECT OR �/� TEL. NOTICE'TO APPLICANT: If, after making this Certificate of ENGINEER d�iC NO. y DISTRICT GROUP TYPE FIRE P CESSEDBY O Exemption, you should become`'subject to the Workers' A ,��,'j CONST. ZONE C3 Compensation provisions'of the Labor Code, you must forth- ADDRESS r - PLUG( �-j y r . V Co� W with comply with.such provisions or this permit shall be deemed revoked. TEL•® STATISTICAL CLASSIFICAWN AP CONDO. fn CONTRACTOR NO. �l! Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS hereby affirm'that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3"of the Business and LIC SEWER MAP Professions Code,-and my license is in full force'and effect. CITY CLASSt3K d .VALIDATION SQ. FT. NO. OF , NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE' ' AA I -VALUATION (� DESCRIPTION OF WORK 4U NEW ❑ $ � /1�l /� Contractor Date, V(J U ✓ o D ADD 2 8 0 7.5,A I am,exempt under Sec. ALTER '❑ #,o 0 -0,23 .. -'e B.&P.C. for this•reason REPAIR, ❑ $ Date: USE OF EXISTIING BLDG. IJJ IlJLti�3UCC DEMOL ❑ ;�,:ro`0 8 1,2 9 Signature APPLICANT TEL.. > x g FINAL o 0 a 8.1,2 9, OWNER-BUILDER DECLARATION PRINT t ��A� NO. DATE I hereby affirm that-I am exempt from-the Contractor's License ADDRESS �i1 0 /,/moi-'�T>�'/�l '�l7 � ) 7:�.8 7 Low for the following reason(Section 7031.5, Business'and, FINAL Q 0 Professions Code)' R By' V� BUILDING I,, as.owner of the property, or my employees.with ADDRESS wages as their sole,compensation,will do the work and i the structure is not intended or offered for salej• 1 _(Section LOCALITY �, 7044, Business and Professions Code). MOVING: TEL. D i as owner of the property; am exclusively contracting CONTRACTOR 'NO." ,_ ,l,� ( � ._ °�-8 7 9,9 A with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED. TOTAL SETBACK r # o e o 0 0>1 % CONSTRUCTION LENDING AGENCY SET BACK"' YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending.agency for FRONT t' 1;1 e.1 0 b 1 3 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ :C.). a SIDE e e 1 0 6 1 3 6 P.L. Lender's Name C LDMA Ref. # O t1,,1 9`8 8 m Lender's Address P.C. Fee$ , Permit Fee J oI certify that I have read this application and.state that theIssuance Fee r� U) PTC# g above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Fee Total 2 and hereby aut orize representatives of this County to enter i ✓ LDMA Perm. N upo th abov kn&fio �property for inspection purposes. r t SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ture�of Applicant or Agent Date N WORKERS' COMPENSATION DECLARATION, 1-hereb affirm that I have a certificate of consent to self O D O D O D insure, ar a'certificate of Workers' Compensation Insurance, C,��1� :Jr a certified copy thereof (Se c._'3800, lab. C.) COUNTY OF,i6fOS ANGELES BUILDING AND SAFETY Policy No. Company tr BUILDING ❑ Certified copy is.hereby furnished. FOR APPLICANT TO`F1 LL IN' ADDRESS ❑ Certified copy is filed•with the county building inspec- BUILDING, Ty ILHP1��r" „ tion.•depdrirnent. ADDRESS Q C3C. , Date Applicant CITY LE.. ZIP l.�A 1 a V .. /... • _ LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE`OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. 'T COMPENSATION INSURANCEASSESSOR (This section need not be completed if the'permit is for one TRACT' BLOCK LOT NO. MAP BOOK' �� PAGE ® y- PARCEL �' hundred dollars ($100)or less.) TEL. OWNER NO� USE ZONE. OP I certify that in the performance of the work for,which this SPECIAL permit is issued,.1 shall not employ any person in any manner ADDRESS O ):ARTCONDITIONS a so as to become subject to the-Workers' Compensation Laws.. O CITY L,G CATY ZIPCA U Date Applicant ARCHITECT OR TEL. DISTRICT '.GROUP TYPE FIRE PROCESSED.BY NOTICE TO -APPLICANT: If, after;making this Certificate.of ENGINEER. NO. CONST. ZONE Exemption, you should. become, subject to,the Workers' " D/ U _ u.must forth= ADDRESS Compensation provisions of the Labor Code, you. Q"Q /� ✓ !� • 3 a with comply with such-provisions ,or this permit„shall be TEL. 0 STATISTICAL CLASSIFICATION APT: CONDO. -Z deemed revoked. CONTRACTOR. NO. I _ LICENSED CONTRACTORS,DECLARATION LIC. CLASS NO: .1;2 j DWELL. UNITS I hereby affirm that tam licensed under provisions of Chapter 9 ADDRESS NO. - -. SEWER MAP (corn mend ng with Section,7,000)of Division 3-of the'B21ness LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT- NO. OF NO. OF CHECK License Number Li' Class SIZE `� STORIES - FAMILIES ONE /�' VALUATION Or Contractor Date DESCRIPTION OF WORK ci NEW $ nom, l ❑1 am exempt,under Sec. ADD. (/V V V ALTER D ' B.BP.C, for;this reason REPAIR,❑ $ Date:' USE OF L(` y DEMOL EXISTING BLDG. RES) ' GJ C Signature APPLICANT TEL. _ FINAL OWNER-BUILDER DECLARATION (PRINT). NOoJ DATE 1� . I hereby affirm that I am exempt from the Contractor's License y Law'for the following,reason-(Section 7031.5, Business'and ADDRESS ! �- FINAL Pro essions,Code) PRESENT, .By - s i BUILDING I, as owner of the property, or,my employees with ADDRESS 3 i i 6 , wages as their sole compensation;will do the work and D F;=• '`j the structure is not intended or offered forLOCALITY,sale-(Section 7044, Business and Professions-Code.) MOVING TEL. CONTRACTOR 0 NO. ?;< �t�t, )h;I, as owner of the property, am_exclusively contracting - with licensed contractors to construct the project'(Sec- ADDRESS tion 7044, Business a nd..Professions,Code:•) _ REQUIREDTOTAL SETBACK FROM EXIST.:. - s CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE - WIDTH 3 it i1-)"' '_a'=m' 3 i:' y, -=• I hereby affirm that there is a construction lending agency for FRONT the performance of the work for,which'this permit is issued P.G• (Sec. 3097, Civ. C.). ;`SIDE P.L. . Lender's Name P.`C. Fee$ Permit Fee LDMA Ref. # 3 Lender's Address ^y 1 certify that I have read this application.and state that the Issuance Fee of LDMA P/C# D o - . 8 above information is correct. I agree to comply with all County Investigation Fee.. R ordinances and State laws relating to.building construction, Total Fee /6► / LDMA Perm. # a and hereby authorize representatives of this County to enter up a abov -mention d roperty for inspection purposes. a a O A.I Z- SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ure of App a t r gent • Datfi