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HomeMy Public PortalAbout6121 HART AVE_Building__ 7eAesen Dss.s A p p L B CA l`�°.8®fel FOR B P B Lh M N G P.0 R M I fit' DIVISIONS OF BUILDING AND SAFETY Aoo Ess � Chi Department of County Engineer — . County of Los Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSAT,T D.GRIFFIN, SUPT OF BUILDING CROSS ST: FOR APPLICANT TO FILL I1VV DISTRICT NO. GROUP TYPE EWER MAP B PG CO BUILDINGMAP ADDRESS IG �� I // ///'I /� � /6 —UMBER A '•�HWY YES OSPECIAL . .p LOT NO. �6 'Qf p�.�� J S/Dd/ BLOCK E O CONDIT ONS' i 8 NO. OF BLDGS. SIZE OF LOT (��(•� O-D I NOW ON LOT ' BUILDING YARD HWY STREET NAME EXIST, USE OF "�J nSETBACK WIDTH EXISTING BLDG. /��/II]]a JI'l QT VJ�IJ�eL}�e. ,FRONT OWNER - :� i-LeY •P (,tj A Q" _ SIDEMAIL f ° ADDRESS �p' tl �' f'T •7��'�d t OTRACT DWELL. I'UNIT /,� -� TEL.. _ 5 INDUSTRIAL CITY � ` !`! N0. - 1 DWELL. I UNIT e 6 PUBLIC BLDG. ARCHITECT O TEL: - 2 DUPLEX 2 UNITS i - ENGINEER NO. _ 7° ADDN. LT. ETC. 3APT. UNITS ADDRESS - 4 COMMERCIAL - - TEL. INSSPECTIONS RECORD ' "CONTRACTOR �( / NO. vi - o ADDRESS DESCRIPTION( OF WORK �� �6 � � v NEW - "ADD ALTER REPAIR- - DEMOLISH / ,, , SO. FT. NO. OF NO OF 2 - �- `E%T�/nn /T� U NUJ SIZE STORIES FAMILIESUSE OF STRUCTURE ._ ` SIGNATURE OF - - APPLICANT yy APPROVALS _ - r ADDRESS• / pc/ u- - DATE - INSPECTOR'S SIGNATURE . - FOUNDATION: LOCATION P. C. $ FORMS,MATERIALS jFEE FRAME: FIRE STOPS. VALUATION $ BRACING. BOLTS , FEE' FURNACE: LOCATION, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT. DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT - AND-AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. - 'AND STATE LAWS REGULATING, BUILDING CONSTRUC- TION. / LATH. EXT. SIGNATUREOF � A^'_ - il i. HOUSE NUMBER COR ' PERMITTEE f !"t..lE•s �'' �' '` �T' RECT AND POSTED � �}},,� ' ADDRESS / ' FINAL D' J/'c7Y� uj�/}1 JOHN A.LAMBIE, COUNTY ENGINEER VALIDATIONS CLYDE-N. DIRLAM, CHIEF BLDG.INSPECTOR CK MO " �kco5 8 4 MAY 1 1 .0 0 '� TEMPLi COTe ' A8 BAC f-6f � p pp yam. �}��.y/ 79 9 E#909 . APPLICATION FOIA B�, ILDING U ER T COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST / I _ WILLIAM A. JENSEN SUP'T OF BUILDING CROSS ST. -L - ✓'Gs DISTRICT NO. GR UP - PR S ED BY FOR APPLICANT TO FILL IN TYPE _ -� CONST� BUILDINGSTATISTICAL CLASSIFICATION I SEW R MAP ADDRESS 41 _ DUNITS. qq,�, o CLASS.NO._ WELL..UNITS L-� L LOT NO.IV,�meN4/Iu.,•-2.v_D'Y s"y�� /. BLOCK WATER NOT REQUIRED `-RECEIVED CERTIFICATE: TRACT/�.. L/ MAP NO.OF BLDGS. (CIRCLE) NQ. - STATE MAJOR SECON LOCAL _ SIZEOFLOT. .I NOW ON LOT USF ZONE SPECIAL ' USE OF - ' CONDITIONS _ EXISTING BLDG. ._ . . TEL. OWNER - NO. 'BUILDING EXIST. _ YARD HWY ,,STREET NAME _ -SETBACK WIDTH. ADDRESS IV., FRONT ARCHITECT ORe - EL. P.L. ENGINEER 'NO. - SIDE _ P.L. ADDRESS TEL. , INSPECTION RECORD ' CONTRACTOR � p _ ADDRESS - DESCRIPTION OF WORE v Lu a N NEW ADD ALTER REPAIR DEMOLISH Z SQ. FT. NO.OF NO.OF $IZE STORIES FAMILIES USE OF STRUCTURE '. SIGNATURE - - APPLICAN OF - - VALUATIONS - APPROVALS DATE INSPECTOR'S SIGNATURE ' P.C. -�� PMT. FOUNDATION: LOCATION , FEE -$ FEE $ FORMS,MATERIALS - FRAME: FIRE STOPS, IHEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE'ABOVE 15 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 1 WILL NOT,EMPLOY ANY PERSON IN VIOLA_ LATH, INT. ' TION OF THE LABOR CODE OF THE.STATE'OF CALIFORNIARELAT- INGTO WORKMEN'S COMPENSATION-INSURANCE.' LATH,EXT. SIGNATUREylC4=n I� HOUSE NUMBER POTEDCOR- PERMITTEE / :REST AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL'STRUCTURAL EN SER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.o, CASH �. APPUCATI®N ®R� COUNTY OF LOS ANGELES - ,-B��L®9 N G P E R M i T C-'-ZV DEPARTMENT COUNTY ENGINEER s - /BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN BUILDING ADDRESS /rY^ ��✓ BUILDING / . •rye ADDRESS 1 LOCALITY NEAREST n CITY' M 0 ell-4- ZIP CROSS ST. x ' .OF SLOGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT IGROUPITYPE FIRE PROC ED BY TRACT_S-5; BLOCK LOT NO. / J� Q� 'CONST.' Zp - �J /� TEL / OWNERS A(\ul NO. 1/ �STATISTICAL CLASSIFICATION /� .� J � SEWER MAP ADDRESS61 � NO. �� CLASS NO.�DWELL,UNITS J+ BK 6 7G CITY' ZIP USE ZONE MAP �-OU, ARCHITECT OR TEL. ` SPECIAL ENGINEER NO. - CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES NO CONTRACTOR EL• - 19BLDG.SETBACK FROM ' D 84P NO _ FRONT PROP.LINE OF (STREET) ADDRESS �a LIC. t _3 �•v. Q NO- 0�V y HIGHWAY + YARD TOTAL SETBACK FROM OF EXISTING CITYNe, - A09 LIC. /1 FRONT PROP. LIN HIGHWAY WIDTH ��J CONSTRUCTION LEN CLASS R + a NAME AND BRANCH BLDG.SETBACK FROM O ADDRESS CITY SI DE PROP.LINE OF (STREET) V NO. OF NO. OF CHECK HIGHWAY + YARD TOTAL ETBgCK FROM TYPE OF EXISTING � SQ. FT. _ o SIZE STORIES FAMILIES ONE SID PROP. LINE HIGHWAY WIDTH U ILLI DESCRIPTION OF WORK NEW 1:1 + 1 p- N ADD ❑ CORNER CUTOFF Y ❑ NO .Z ALTER - t.it-Q�L IN OPEN SPACE YE Sb NO REPAIR❑ USENG BLDG. DEMOL ❑ IN COASTAL' PERMIT ZONE Y S NO ❑ EXIAPPLICANT TEL ' (PRINT) NO. BY (SI'GNATUR ) I HEREBY ACKNOWLEDGE THA AVE READ THIS APPLICATION A ND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT .IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON ,IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENY TION INSURANC - 1 SIGNATURE-O FINAL �/�7•�'7'7 gy // PERMITTEE//•�� DATE / ADDRESS 9 C f�// L q �! CITY �� NO• -/W • �7.' P.C. Fee$ Permit Fee o2�•�S`�J VALUATION C (•! 7. 00 y �J Total Fe! / • U Q PLAN CHECK VALIDATION CK. M.O. CASH a PERMIT VALIDATION CK. M.O. CASH $..59t-Dr- �1 o 5 7.00AY 76A638A CE*803B 12/75 �v76A638A CE4803 B-64 AP LIICATIION FOR B lIL. D 7 G. PERM COUNTY OF LOS ANGELES BUoR IN DEPARTMENT OF,COUNTY ENGINEER BUILDING AND. SAFETY DIVISION LocnuTv' P JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST. COLEMAN•.W. JENKINS,SUP'T.OF BUILDING CROSS ST. DISTRICT NO GR TYPE. O UB FOR APPLICANTTO FILL INdysT.. BUILDING - STATISTICAL CL SSIFICATION. i SEWER.-MAP A-DDRESS VIL CLASS NO. DWELL UNITS A/ 13K PG. LOT NO. ei BLOCK USE ZONE�SIPECIAL AP // O..TRACT NO. OF SLOGS. Z ONDITIONS SIZE OF LOTo NOW ON LOT. USE.OF d" _ BLDG. SETBACK FROM �T EL. FRONT PROP. LINE OR (STREET) OWNER ' CNG• TYPE OR -EXISTING SETBACK •HIGHWAY YARD- _ - -TOTAL-'. ADDRESS LAC� HIGH AY 'P M C.L. - CITY C 14 .� + _ ARCHITECT EL. BLDG-. SETBACK FROM "• - , ENGINEER �( NO. _TU Qrp SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = .TOTAL'. ADDRESS HIGHWAY WIDTH PROM C.L. CL ��jjJJ T E L,, ..+ _ - 0 CONTRACTOR G O _ ADDRESS /L- p,• CORNER CUTOFF YES - NO 0 clTr D Llc SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK n fq Z NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO. OF NO. OF 3. •"'' 'm.�'r""A"'-.'"" SIZE STORIES FAMILIES USE OF STRUCTURE h �f - 0 SIGNATURE'OF APPLICANT VALUATION$ t � . APPROVALS Jw DATE INSPECT, R_'SSIGNATURE P.C. sq, PMT. FOUNDATION, LOCATION FE_E$ dJY O FE_E$ FORMS*, MATERIALS---. 'FRAME, FIRE STOPS, �R'' m i , I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT ® B Apl__ 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. 1. 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• y ING TO WORKMEN OMPENSATION INSURANC LATH. EXT. I / SIGNATURE O- HOUSE NUMBER COR- PERMITTEE ° RE.CT AND POSTED -ADDRESS Fl NAL -tj�6. � JOHN F. LEWIS, P INCIPAL STRUCTURAL ENGINEER •PLANCHECK VALIDATION CK. --M.O. CASH PERMIT VALIDATIO CK. M.O. CASH o.5 ,6 0" FEB 2 2. 3 D- 1 .4-50A -C-06, 9' 7. 3— FEB 3 1 D 2 .g.Q.ON cul i 76A638A CE#803 8-64 APPLICATIO1 tl F _ R BMJ iLDI1 tlG PER �T - COUNTY OF LOS ANGELES. BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS ov BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE-. COUNTY ENGINEER NEAREST 1 COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. DISTRICT - GROUP.:, TY E. P SS BY FOR APPLICANT TO FILL IN �j` ' @ CONST. BUILDING n STATISTICAL CLASSIFICATION SE ER MAP. ADDRESS �„/ NSI Qd N U� NO-Z­7BK CLASS DWELL UNI TS' LOT NO.'"' a BLOCK USE ZONE MAP ' NO. TRACT `J SPECIAL- - %Q,-• n NO. OF BLDGS. COND DONS - SIZE OF LOT• ID 8� NOW ON LOT I D ' USE OF EXISTING BLD BLDG. SETBACK FROM TEL./� l� og FRONT PROP. LINE OF (STREET) OW NE E3J IY /-•L NO. f'y ��`� TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS /g �O e-r ova HI NWAY WIDTH 'FROM C.L. - ARCHITECT R ^ TEL. BLDG. SETBACK FROM ENGINEER" NO., SIDE PROP. LINE OF (STREET) TYPE OF EXISTING. SETBACK HIGHWAY- + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + 9. _ _ CL .O. CONTRACTOR NO U ADDRESS LIC. CORNER CUTOFF YES NO 0 NO, _Cl I-Y CIL s 'SEE REVERSE SIDE FOR SPECIAL APPROVALS v W DESCRIPTION OF WORK / /� CL NEW ° ADD ALTER REPAIR DEMOLISH SQ.FT. '/ NO. OF NO. OF SIZE Y STORIES FAMILIES USE OF STRUCTURE �� ¢_;.' S I G N A TUR APP LICA VALUATION ��®�•_ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. r �-y FOUNDATION, LOCATION FEE$ �!'�� FEE$ / ✓- FORMS,_MATERIALS FRAME, FIRE.STOPS, I HEREBY 'ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK AUTHORIZED HEREBY I 'WILL NOT'EMPLOY ANY PERSON IN VIOLA. LATH. INT. r TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT. - �- SIGNATUR OF - HOUSE NUMBER COR- PERMITTEE _ RECT.AND POSTED ADDRESS / F I NAL JOHN F.-LEWIS, PRINCIPAL SRAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIO TR CK. M.O. CASH 1 7SEP 1 1 D 1 .5 0• L I1l�O ' 7 WORKERS' COMPENSATION DECLARATION �' 6� $ S a. .•�.' _v~ I :hereb affirm that I have a cceriificate 'of'consent to self O O p M O D O D M insure or a c'ertificate-of Workers' Compensation Insurance LG\1 �� L/�1�O O ll V N © P _ or a'certified copy theieof (Sec. 3800;-'Lob. C-) - • COUNTY OF LOS ANGELES BUILDIN A D SAFETY Pol.icyNo. W 07.1.46 .Company, nce _ Beaver.. lnsura 0 Certified•co is hereb .furnished: BUILDING pv Y FOR APPLICANT TO FILL IN ADDRESS Certified'copy is filed with th'e'county'build+ng inspec- BUILDING' ' tion department: ADDRESS 612'1 Hart Date 9:I1 . Applicant•'V I rri i n' •'•Rnnf•esti_ CITY Tempi,ezip LOCALITY L r CERTIFICATE OF EXEMPTION'FROM WORKERS' NO. OF BCDGS. - NEAREST _ COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be`completed if.the.permit is•for.one, -- ASSESSOR hundred:,dollars ($100)or,iess.) _,,i. TRACT BLOCK LOT NO MAP'.BOOK PAGE PARCEL OWNER - NOL:` US NE MAP ..­. I certify that in`the performance of the work for which this permit is issued, I shall not employ any person`in any,manner A ; Z- -, �. SPECIAL -id become subject to;The WorkersCompensation:Laws. ADDRESS 6-121 HartCONDITIONS V CITY__ em 1 __ ZIP .91-780 Date Applicant `` $ s ARCHITECT OR -TEL. DISTRICT ,GROUP. TYPE FIRE _ CESSED BY NOTICE TO APPLICANT: If, after'making this Certificate of ENGINEER NO. Exemption, you should become subject to- the-Workers' CONST. i ZONE , Com pensation••provisions of.the Labor Code; youtmust forth- ADDRESS 1 �l V j- with comply with-such provisions or.,this pe,rmir-shall be . _. _.. _ deemed revoked , l . . k CONTRACTOR. V• NO.287-0507ATI A TELSTATISTICAL CLASSIFICATION PT CONDO LICENSED CONTRACTORS DECLARATION. r•` - LIC. CLASS NO. DWELL UNITS I hereby,affirm that I am licensed under provisions of Chapter 9 ADDRESS P•O• BOX J N0. o650 (commenting with Section 7000)of Division3 of the Business and . _. _-_ LIC.=_ _ _ EWER MAP I S Professions Code, and my license is in`fu_II force and effect. CITY CLASS - BK PG. VALIDATION" ' SQ. FT. N NO. OF CHECK License Number 160650 Lic.Class r3•a SIZE- STORIES FAMILIES ONE VALUATION i • DESCRIPTIONOF•WORKTear-'Off"One 1'a er'S N Contractor V"I rggl n' ROOF -Co�a,e 9-l'0-86 o x..3,337.•00 E I am exempt under Sec. Of eX l st I n roof,-apply ALTER ?$ ! B.&P.C.-for this reason _, class "Alt REPAIR - :_ USE OF _. . ,. Datei EXISTING BLDG. �We1 1 Dwelling- �} s DEMOL - -- APPOCANT N0.287-0507 Si'gnafure TEL. FINAL OWNER,BUILDER DECLARATION• PRINT).V 1 C J I n ROOF CO _ __ � - .I hereby-offirm.that..I,am exempt-from,the_Contractor's License Law for the following reason (Section,7031.5, Business and ADDRESS-P 0 BOX 'J San Gabriel'. FIN Professions Code) PRESENT" _ - BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY - 7044;Business a'nd.Professions Code).' MOVING-.-,-,,_. _w... _ w.TEL. � I ❑ CONTRACTOR NO. I, as ownerof the property, am exclusively contracting -with licensed contractors to-construct the-project.(Sec- ADDRESS / tion 7044, Business and Professions Code). REQUIRED . _ TOTAL SETBACK FRO CONSTRUCTION LENDING AGENCY`"' '• SET BACK YARD HWY PROP. LINE. WIDTH 7 I hereby affirm that there is a construction lending agency for FRONT 6 Q' �' '' the'performance of the work-for:which-this permit-is•issued P.L. (Sec. 3097, Civ. C.). SIDE m . ..r. P.L. T o Lender's Name LDMA Ref. # m _ _. ._..,. P.C. Fee �._. Permrt�Fee - Lender's Address j I,certify_that.I.have read this application-.and.state that.the Issuance Fee--7-10.50 JLDMA P"/C-# a above information is correct.1 agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction; _ _ _ _ Total Fee 68.6: -' ' LDMA Perm. # d and hereby authorize representatives of this County to enter Ia upon t e above-meniioned,propert'y for inspection purposes. m . - _ r SEE REVERSE FOR EXPLANATORY LANGUAGE • - Signatureof'Applicant+or•Agen ^ D te-• I ' :.._ APIPU MOH FOR oULIO 3 PCXR 07 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, BUILDING ADDRESS ,+ or a certificate of Workers'Compensation Insurance,or a certified DIT 12.1 P ' C Copy thereof(Sec.3800,Lab.C.) p Policy No. Company �r LF— GI Ty LOCALITY y SIZE OF LOT NO.OF BLDGS.NOW ON LOT CROSS ST Certified copy is hereby furnishedNEAREST. , ❑ Certified copy is filed. with the county building inspection TRACT BLOCK LOT NO. ` USE ZONE MAP NO. department. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL z I SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? YES NO ADDRESS (This section need not be completed if the permit is for one hundred C04 �T AVE/ DISTRICT ,,�' POUP/f TYPT� T' FIRE ZONE OCESSE Y dollars($hat or IesSJ, CITY 1 �1� U ZIP / 6� �� 3 I certify that in the performance of the work for which this permit IT is issued, I shall not employ'any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. ((( "' become subject JJt,�o..,,the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant JGL/AJa !'rte_ ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the CONTRACTOR TEL.NO.Workers' `1 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ��G L�� 400—503 1 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L (73 P-. M•aiN `S 8-4616" . � LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE a� P L q I hereby 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 Professions Code,and my license is in full force and effect. 400 3q NEW ❑ BK PG ' Com. License Number Lia ClassDESC IPTION OF WORK ADD VALU TION y A-com V N Contractor Date �GM /41pD ALTER ❑ ❑ I am exempt under Sec. REPAIR ❑ BARC.for this reason DEMOL ❑ LDMA P/C#USE OF EXISTING BLDG. j Date: � UR M, El • S ' Signature APPLICANT(PRINT) TEL.NO. r _ _LDMA Perm#- L�'•: ,� ❑ I, as owner of the property, or my employees with wages as �N GLap- 2 their sole compensation,will do the work and the structure is ADDRESSatm. - i ) ( 0,Q__• not intended or offered for sale (Section 7044, Business and1-7-2551C -r�1 1 -->q FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL . !TEMO IM OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN 4--11 ❑ I, as owner of the property,.am exclusively contracting with J THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY TOTA4.P0 m 94-P licensed contractors to'construct the project.(Section 7044, YES❑ NO❑ �7u Business and Professions Code.) CHECK X80., , WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r CONSTRUCTION LENDING AGENCY COAST AlR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST CHANGE .00 FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ the performance of the work for which this permit is issued(Sec. 0000-0001 _ _ I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD r{• 0 {0 j r 23 90 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES (�t�l[IF�-y,�IJi t y �i� '3l ' m. -���A I:g 5^-P—GI LL/o COUNTYCODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING �^ is Lender's Name S:y�'1 HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. I��J�y 'I AM 7:_tl,_1 aLendersAddres� T - i0. OWNER giAGB7T o' 1 certify that I have read this application and state that the above information Is correct. I agree to Comply with all County P.C.FEE PERMIT FEE ordinances and State laws relating to building construction,and r ¢. hereby au orize repress tatives of this County to enter upon ISSUANCE FEE the m ti ned p erty for inspection purj:ses. ¢ =,.•12� INVESTIGATION FEE TOTAL FEE n sgnnumm,bplcemwA� - t>m SEE REVERSE FOR EXPLANATORY LANGUAGE, / APPUCAMON FORRULDNOPERMM COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that 1 have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CIT ZIP ' Py! C � LOCA ITYPolicy No. Company SIZET v / NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. J� NEAREST CROSS ST' 17 ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. - USE ZONE MAP NO. department. Date , Applicant - ASSESSOR MAP BOOK - -PAGE PARCEL . - SPECIAL CONDITIONS --- CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE UL' WITHIN 1000 FT.OF SCHOOL? YES NO ADD ESS L�!'2���.}}-- (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP ' I certify that in the.performance of the work for which this permit Cj�� �_ is issued, I shall not employ any person in any manner so as to (// ✓ F' L/92 � become subject to the Workers'Compensation Laws. A rH�I�TECT OR rENGIN ER TEL�1O. V I W N �9k �„ � STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS w O^I� ���PPPJJJ111nTTT CLASS NO.-�� DWELL UNITS ' NOTICE TO APPLICANT.' If, after making this Certificate of 44SIUAAS ��C C� �' / 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. P L LICENSED CONTRACTORS DECLARATION SIDE 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 SQ.FT.SIZE NO.of STORIES NO.OF FAMILIES a Professions Code,and my license is in full force and effect. NEW BK PG ® O License Number Lic.Class DEELCRIPTJON OF WORK / ADD VALUATI >— ��yy Contractor Date R x ALTER. ❑ $ V©C' W ❑ 1 am exempt under Sec. IDEMOL EPAIR ❑ V)z $ B.BP.C.for this reason ❑ LDMA P/C# _ Date: USE OF EXISTING BLDG. RM ,❑ •: . - '-..y - - __— SUA-61 ignatufe A IC[f�NT( INT J E LA0. LDMA Perm..# as owner of the property, or my employees with wages as 3o w �u 'p`� their sole compensation, will do the work and the structure is AD RESS ,/ t Fsa not intended or offered for sale'(Section 7044, Business and V FINAL D TE ? Q 1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ('iL•'.:M c'9' .. ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL B > r" "' Y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, Business and Professions Code.) YES❑ No° _ L'i ._ WILL THE INT LADED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING -?•t='-?= ' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ CONSTRUCTION LENDING AGENCY - COAST AIR QUALITY'MANAGEMENT DISTRICT(SCAQMD?SEE PERMITTING CHECKLIST FOR - �tTv '. -P -4.9 's 65 _E GUIDELINES f�a •' -- I hereby affirm that there is a construction lending agency for YES N„X�l a the performance of the work for which this permit is issued(Sec. Y" " 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, - - ?_.- S'`.?,?',,, =i j-° "" TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name PORTING AN R OBTAINI M THE SCAQMD. o —Address O OR AGENT / .:�j 'S`:?,I;! i:r .�.f•i'T o I certify that 1 have read this application and state under penalty UIJ of perjury that the above information is c ct.I agree to comply P.C.FEE R r� PERMIT Fly ��'.1 __ y 3's ;+ __. CCM with all county ordinances and St laws relating to buildingY'�J ' a construction, and hereb authori representatives of this County ISSUANCE FFA, ;j a 1 m f/ q lJ °' to enter b d property for in purposes ° INVESTIGATION FEE TOTAL FEE - sre� a ARw�wm o Gare . SEE REVERSE FOR EXPLANATORYNGUAGE 7 (9/1. (9