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HomeMy Public PortalAbout6050 HART AVE_Building__ DEPARTMENT,OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES .`;WM. J. FOX, CHIEF ENGINEER �'� FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTNO. ,�P{LLAN CCK..NO. /\)PERMIT NO, BUILDING .-.,. �.r VRI.E 1. O� -F" U Dl ADDRESS �C ,U ,. LOCALITY 7 ' 91-6 T EIVE - -1 TE OF APPL. IG S NEAREST •• .. .�I q CROSS ST. nn - - BUILDING ADDRESS Fd orb AAd- b44,/ Ave OWNER .. PG.. .,, F&P-10 0V P /A -• % MAIL - LOCALITY ADDRESS o_�,o , HjgV-r J NEAREST TEL. CROSS ST. CITY ,� C Ir-Y NO. _ FIRE NO. OF I TYV I P ARCHITECT OR TEL. ZONE PLANS , ENGINEER - ,�, W A PG.E- NO. SETBACK LINE" �so� ��C ORD, pe ADDRESS JJ E� W AL/d(/T��e �O��y/l`J" . , APPROVED �® /VW'r/Fp'r/r- 5te!latM(N(p TEL. BY DATE CONTRACTOR ) JL dt,131 NO. 9 Y G 2,6 4-7 USE APPROVED ZONE �m� BY DATE ADDRESS 24,o.IJ�% Ffj.•p,rgiLL OLD.'. PA4.09, HOUSE NUMBERING , LEGAL DESCRIPTION I LOT NO. 3 S I BLOCK MAP NUMBER_ �'P o I •FIELD CHECK BY TRACT �90~¢ - NO. ASSIGNED BY �` �'r ATF NO. OF BLDGS. CORRECTIONS- SIZE OF LOT I NOW ON LOTUSE OFNO. OF EXISTING BLDG., y,�(,J j.,(�� I FAMILIES -DESCRIPTION OF WORK / /- Y41 b)/U j C d Aly) NEW I •�.I ALTERATION I I ADDITION i LD G✓ 6-iyld DIC u Q!/ll 0 REPAIR DEMOLITION C SQ. FT. NO. OF - SIZE '" ROOMS STORIES - Z EXT. WALL9,& N ROOF - - - r r COVERING &L)JU I JrC - COVERING USE USE OF STRUCTURE PR IU,4rE7 ,SWIAAMI(V6 Poo/- APPROVALS �! INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-' FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. , 'I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY' ORDINANCES AND STATE BRACING, BOLTS - LAWS REGULATING;BUILDING CONSTRUCTION.p P� FURNACE: LOCATION, SIGNATURE OF, .l VIAAlJ + c llwMAlN�wet ` ftL em. GAS VENT, DUCTS r PERMgIT^TEE (y�_ ��p/ PM �^ ADDRESS L`� k-v•kg�g�- - ��"• 7 M.*O, • LATH, INT. LATH, EXT. AUTHORIZED AGT. /� PLASTER, INT. . 7awe38A- DBHII -10-80 $tla v' P. C. $ © .7000 FEE �c `ao�o. PLASTER, EXT. II VALUATION .FEE $ y �"'— FINAL G WORKERS 'COMPENSATION DECLARATION +` " I'hereby affirm, that I haver certCom e�ofns ticonsent.Into self A P P��( �U�O.M P O�, U ��. �H P E R nn��'( insure, or a certificate of,Workers' Compensation. /l�1LI LI „L/�1 LI V LIO LJ LjutJ�/U LI or a certified copy.thereof (Sec .3800,'La C ) COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy'"No. Company ' c , • BUILDING ❑ Certified copy i's hereby'furnished. "FOR_ APPLICANT;TO FILL IN ADDRESS �O4J�� ❑ Certified copy,is filed with=the`countybuilding inspec- j ' BUILDING •` ' `• CC" tion department. ADDRESS , Date' Applicant" CITY'. 1(Y� ..r ( i `I'\ OF BLDG '� sz _•• \ LOCALITY NEARET CERTIFICATE OF:EXEMPTION FROM WORKERS' SIZE.OF,•LOT" �3 NOW,ON LOT CROSSSST. COMPENSATION INSURANCE ,L h (This section need'not be completed if'the permit is for one. TRACT .�C J BLOCK LOT NO �-f MAP BOOK PAGE O/7 PARCELCJ`� dollars,($100) or less:)_ " T � TEL. S'f S m hundred doll r. OWNER f^; �`I ? ��Or NO. —7 ONE,USE ZONE.. MAP I certify that i"n,the, performance"of,the-work for which"this NO. permit,is issued;`I shall not employ any person in any manner " •ADDRESS Q o � ; �!� S - SPECIAL � ,i. -,so as to become-subject to The Workers,Compensationw `Las O '� CONDITIONr. CITY`1;�i_rn V2.' "C..* -ZIP �-��. C) • Date Applicant ARCHITECT OR. TEL. Q' DISTRICT GROUP TYPE FIRE' PR ESSED BY NOTICE TO APPLICANT::#- after,:making this.Certificate•of ENGINEER NO. CONST ZONE Exemption 'you should .become ;subject.'to,'•the' Workers' �j ' / Compensation provisions.:of the Labor:Code,jyou-must•forfh- ADDRESS., �DD '� V W with "comply with'such :provisions. or this permit shall `be TEL. ��' STAT.ISTICAL•CLASSIFICATION., APT. f N deemed revoked ,_ CONTRACTOR C+.I i i C C l�'ErEIVO. �jBOe" ��//LL — LIC. CLASS NO.�DWELL UNITS Z' LICENSED CONTRACTORS DECLARATION. i } 4 I hereby,afffrm"that'1 am"licensed under'provisions of Chapter 9 ADDRESS 15 1(03 � Lt� NO. "T e S ' LIC.. SEWER MAP ' , •(commencing with Section 7000)'of Drvision,3 of,the Business �� �`"�c� �� �' ", CLASS and Profess Gris Code,and my license is in full force and effect. BK. pG, VALIDATION SQ: . OF NO. OF CHECK ,License Numbers Lic..CIass• SIZE STORIES ILIES 0 ONE VALPATION DESCRIPTION OF WORK ' .O ,j 1 NEW ❑ Contractor Date' - ❑'t am exempt under Sec DD A ❑ _ -ALTER ..❑ B.&P.C. foi this reason S E Date: USE OF PAIR •.' R ❑ EXISTING BLDG. DEMOL Signature APPLICANT TEL. sn I S „FINAL : OWNER BUILDER DECLARATION IFRINT)C�1' �L.>r NO �'fc?�� I hereby affirm that I am exempt from the Contractors License DATE ADDRESS 7t) t4 AY'y. IQV+� tC Ci.r. LOu Caw for the.following`.repson (Section 7031.5, Business and. FINAL' Profess ipns„Code) r PRESENT,.. - By .;. BUILDING” El'..'I, ds owner of the,property, or my,employees•with' ADDRESS wages astheir sole"compensation;will'do The work and the structure is nof1mended or offered for sale(Section LOCALITY - 7044, Business and Professions Code.) - MOVING" - TEL. a " L"J 1, as owner.of,the property, am•exclusively contracting CONTRACTOR, NO. witFr licensed contractors to construct the project.(Sec- -. •,_ y $�,J tion.7044, Business and Professions;Code.) ADDRESS. REQUIRED` TOTAL SETBACK FROM'; EXIST.' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY. PROP. LINE WIDTH i.., I hereby affirm that there is a construction lending agency for FRONT '•_•a t , the performance:of'the:work foi''which`th"is.permit is'iss' d° P.L. G (Sec. 3097, Civ. C.). SIDE .. B.L:. U i�, Lender's Name - .. ;LP, "• P 6.:Fee$ Permit Fee LDMA Ref #- :- :•^ Lender's Address - -•1 e 0 1 certify that I have read this application and•state that the Issuance Fee ��' c LDMA P7C# 8 above informatiori-is"correct. I agree to comply-with all County." Investigation"Fee d ordinances and State laws relating to building construction, TotalrFee l/ " LDMA Perm. # Q' and hereby authorize representatives of this County to enter upon the above-mentioned'prcperty for'i'nspection purposes. a �• ' L �-f" '"�y� SEE REVERSE FOR EXPLANATORY_ LANGUAGE Signature of ApplicJR4 or Agent Date ' WORKERS'COMPENSATION DECLARATION I hereby,affirm that I have certificate of consent to self � P P��C/�\U O O� FOR O M�d D 0 N O p E R �U • insure, or a certificate of Worker s'Compenation [!1� /rU ulnsurance, � ora certified copy thereof (Sec. 3800, Lab. C.)'. �6 !6, COUNTY OF.LOS ARICvEIES: BUILDING AND SAFETY Policy No. Company Certified co is here6 furnished. BUILDING copy v FOR APPLICANT TO FILL IN ADDRESS =-�� Certified copy is filed with the cou ty bu' ing inspec- BUILDING o ? tion department.' ADDRESS LOCALITY r F u�1dn 11 , NEAREST �•i Date Applicant CITY 1YY V ZIP CROSS ST. J CERTIFICATE OF EXEMPTION FROM WORKE �c�► �, "l' NO. OF BLDGS. /l MAP BOOK PAGE PARCEL ASSESSOR..01' COMPENSATION INSURANCE SIZE'OF LOT NOW ON LOT v fThis section need nof,be completed if.the permit is for one USE ZONE MAP• hundred dollars ($100)or,less.) TRACT BLOCK LOT NO. NO. t ci L. n i SPECIAL I certify that in the performance•of:the.work for which this OWNER 7p aL -� CONDITIONS 06 �so permit is issued, I shall not employ any person in any manner (STRICT .GROUP TYPE FIRE PROCESSED BY O as to become subject to the Workers'Compensation Laws. ADDRESS �. CONST. ZONE E Date Applicant CITY B G ZIP STATISTICAL SSIFICATIO APT., CONDO. 0 NOTICE.TO APPLICANT: If,'after making this Certificate•of ARCHITECT OR, TEL. ENGINEER NO. NO. Exemption, you should become subject to' the Workers` CLASS DWELL. UNITS Compensation provisions of the Labor.Code, you must forth- ADDRESS SEWER MAP. H with comply.with, such provisions or this permit shall be ' TEL. z deemed revoked.` CONTRACTOR (L NO. BK.�PG, � VALIDATION e LICENSED CONTRACTORS DECLARATION ,,� ��$L IC. ' I hereby affirm that I'am licensed under provisions of Chapter ° ADDRES 6 /�L-ONIC;. 0-LI 2) ALUATION ; (commencing with Section 7000)of Division 3 of the Business and 3 LIC. Professions Code, and my license'is in full force and effect. CITY CLASS. $ O©� SQ. FT. NO. OFNO.'OFCHECK D License Number Lic.,Class SIZE STORIES FAMILIES ONE' Contractor Date 6 DESCRIPTION OF W�O�RK[ `I 1fi2 VJ NEW wz ❑ $ ❑,I am exempt under Sec. 'NAR". W/"w a V WC ❑ - ALTER FINAL , B.BP.C. for this reason '�, S�� U 1O Co REPAIR E] DAT Date: USE OF EXISTING BLDG. DEMOL ❑ By Signature APPLICANT Mi ,h 11 ' TEL OWNER-BUILDER DECLARATION ' PRINT I1V IG NO: �. '� I hereby affirm that I am exempt from the Contractor's License Q I ��/1 Law for the"fol lowing reason (Section 7031..5,.Business and ADDRESS 9 (5- Amu ! D - Professions Code): ❑ BUILDING. I, as owner of the property, or',my employees with ADDRESS o o 9 F2 wages as their sole compensation,will do the work and P v the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I, as.owner of the property, am exclusively contracting CONTRACTOR NO. I 0 2 1 with licensed contractors to construct the project (Sec- ADDRESS t + �"a'� 'tion 7044, Business and Professions Code). ( L � •J^' -REQUIRED• TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ✓( yv? w I hereby affirm that there is a construction lending agency for FRONT D ,� l�• `/s"'a',�f the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ:C.). SIDE Lender's Name �� <<. 4 t z Lender's Address P.C. Fee$ Permit Fee certify that l'have read this apphicotion and state that-the Issuance Fee a above information is correct I:agree to`comply with.all County Investigation Fee' ,$ ordinances and'.State:laws relatin to building';construction, Total Fee.' d and hereby utho a represenlat J s of this County to-enter g<g upo he a ve- nt ed prop'r for,inspection purposes' - - 1'V SEE.REVERSE FOR EXPLANATORY LANGUAGE .. t or Agent' Signature of ApplicanDate ®S r APIPUCAMON FOR BULMNS-'[PERM7 COUNTY OF LOS ANGELES BUILDING_ AND SAFET WORKER'S COMPENSATION DECLARATION FOR APPLICANT YO FILL INA BUILDING BUILDING D, S� I hereby affirm that I have a certificate of consent to self insure, ! . or a certificate of Workers'Compensation Insuranc ;or rtified copy there ( e .3$_RQO, CITY ZIP. - 1�l � LOCALITY Policy No. J �— Company SIZE OF LOT NO.OF BLDGS!NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. Certified cop is filed with'the County building insp tion TRACT BLOCK LOT NO. . depar _eft. � � USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK - PAGE PARCEL SPECIAL CONDITIONS C RTIFICATE OF EXEMPTION FROM WORK owNE /TI TE No. COMPENSATION INSURANCE � � WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESSin n-7 DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($.100)or le\kers' CITY ZIP 7)/ ��!�. I certify that in the e of the work for which this permit lJ is issued, I shall nony person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to ts'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date ADDRESS CLASS NO.. DWELL UNITS NOTICE TO APPLIafter making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Sc a Subject t0 the Workers' CON��]QR TEL NNO. SET BACK YARD HWY PROP LINE WIDTH Compensation provihe bor Code, you must forthwith IYAV/ a S FRONT comply with such provisions or this permit shall be deemed revoked. ADDLIQ.N9 . ` PL LICENSED CONTRACTORS DECLARATION �j L� SIDE CITY S '� I hereby affirm that I am licensed underprovisions of Chapter 9 �'` LIC.CL PL SEWER MAP > (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES a Professions Code, n y.1' ense Is in full force a of NEW ❑ BK PG o _ DESCRIPTI N OF WOR VAL O License Numbe Lia Class ADD ❑ G C) Contrac1��L tor 0 Date Zdll) fr ALTER ❑ $ Art t p C-') LU GCJ REPAIR ❑ _. . _ a- ❑t am exempt under Sec. $ S-' 1- ,- Z B.&P.C.for this reason DEMOL ❑ ~,A- LDMA P/C# j.j, .i i• Date:. USE OF EXISTEA BLDG. ell URM ❑ u Signature s j RL APPU T P INT�j ,, TEL N LDMA Perm# 4 SH ❑,I,,as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is ADDRESS O C M R3E not intended or offered for sale (Section 7044, Business and FINAL DATE G "" Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT-HANDLE AHAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ! C11, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 3'0;'1j(-1'•f`..i 7 licensed contractors to construct the project (Section 7044, l�' t'' `z ' S. Business and Professions'Code.) YES❑ . NO.I ;•'-.�;_,� t :=�Lt __�;'' 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 GUIDEJNES.AIR QUALITY t�WAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR / hereby affirm that there is a construction lending agency for YES❑ N a the performance Of the work for which this permit Is issued(Sea IHAVE READTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I DERSTAND MY REQUIREM S UNDER THE LOS ANGELES COUNTY CODE, - TITLE 2. PT 2. S S 2.20 0 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATER S REPO G D F OB NTNG A PERMIT FROM THE SCAOMD. CL Lender's Address OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to Com P.C.FEE PERMIT FEE• �j� - - N with co U ordina and State laws relating t buil ng / m o tru nd her y authorize representativeWn , ISSUANCE FEE / co enter po the a ve- titt ned�for insm INVESTIGATION FEE TOTAL FEE /Signal—ol Applicant o AWnl SEE REVERSE FOR EXPLANATORY LANGUAGE i