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Home My Public Portal About6167 HART AVE_Building__ DEPARTMENT OF COUNTY ENGINEER f DIVISIONONTY OFLLOSGAN GELES SAFETY ; WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, Sup'T OF BUILDING ® FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING / DISTRICT NO. PLAN CK.OR REc.No, y PER NO. ADDRESS LOCALITY R�IVED BY DATE OF APPL. DATE ISSUED vI tt NEAREST n �� J CROSS T. 6a7 -� BUILDING - /� /J / ADDRESS C,P �� `1 OWNER40 "MAIL Y' ADDRESS V I. 2 LOCALITYw. TEL. �, NEAREST c CITY . ?.3-t-� � ..-:'u �a NO - CROSS ST. - ZONE I PLANS TYPE =�'� GROUP ENGINEER NO. f ARCHITECT OR a- TEL. —rt ADDRESS BLDG. ��"/ „Q D. NO. SETBACK LINE +oGs i" m TEL. USE APPROVED ' CONTRACTON R O. ZONE�j BY ' DATE •• HOUSE NUMBERING ADDRESS LEGALI �/ r" MAP NUMBER. NO. ASSIGNED BY DESCRIPTION LOT NO 4. BLO _ ),,, �,t,,,z CORRECTIONS TRACT SIZE OF LOT / , a S NOW ON:LOT ,,. USE OF NO. OF / - - EXISTING BLDG. AM.LIES DESCRIPTION OF WORe o - NEW ALTERATION ADDITION b 1115 REPAIR �) DEMOLITION I I �,✓� Z 1' SQ. FT. NO. OF 'SIZE ROOMS STORIES EXT. WALL I .ROOF COVERING COVERING $ USE OF STRUCTURE 00 APPROVALS INSPECTQR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS LJ t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-. FRAME: FIRE STOPS, /n y o- " PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. FURNACE: LOCATION, ✓ 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS AND STATE LAWSS REGULATING BUILDING CONSTR��J}}UCTION.. SIGNATURfi OF/�� y r (] LATH, INT. PERMITTE�E/a di.y�_ _ �[[007�y�! i / ,-ts/41114' ,�,° /_ uy gI, ,� ' ADDRESS LATH. EXT. it/ Y . PASTER, INT. - AUTHORIZED AGT. PASTER, EXT. FEE $ HOUSE NUMBER COR- -�:n �Q 0 ! . RECT AND POSTED VALUATION FEE $ --ter FINAL 78A838A DBS 3 9-82 o U UM HO PERM N COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING ADDRESS FOR APPLICANT TO FILL IN WORKER'S COMPENSATION DECLARATION ' BUI I G ADD SS I hereby affirm that I have a certificate of consent to self insure, /i or a certificate of Workers'Compensation Insurance,or a certified (fl � copy thereof(Sec.3800,Lab.C.) I ZI Policy No. Company CLOCALI _ r�LOT I NO.OF BLD�S.NOW ON LOT CROSS S . ❑ Certified copy is hereby furnished. o nG/' if NEAREST ❑ Certified copy is filed with the county building inspection TRAVT BLOCK N . department. 054 04 USE ZONE MAP NO. ASSESSOR MAP BO KPAGE0. PARCEL . Date Applicant ® SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWN EL.NO. 7 YES NO COMPENSATION INSURANCE WITHIN loco FT OF SCHOOL? AD S (This Section need not be completed if the permit is for One hundred • DISTRICT • GR_ e.OUP TYPE CONST.' FIRE ZONE ROCESS BY dollars($100)or less.) CITY ` ZIP 9 �e 1 certify that in the performance of the work for which this permit � q 1'7&0 l &v c56 3 Js issued, I shall not,employ any person in any manner so as to, TEL.NO. / U become subject to the Workers'Compensation Laws. vloie& c �� es G STATISTICAL CLASSIFICATION APT O Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of ng-mCONT CTOR � TELN REQUIRED TOTAL SETBACK FROM EXIST . Exemption, you should become Subject to the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemedrevoked. ADDRESS LIC.NO. PL SIDE >' LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing.with Section 7000)of Division 3 of the Business and SQ.FT SI ®4 NO.OF STORES NO.OF FAMILIES C Professions Code,and.my license is in full force and effect. NEW ❑ BK PG DESCRIPTION OF WORKLU License Number Lic.Class ADD �� . Contractor Date ALTER ❑ ❑ I am exempt under Sec. `� l REPAIR ❑ B.BP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING MDG: / URM, ❑ Signature APP ICANT P INT) TEL.NO. LDMA Perm n' { ❑ I, as owner of the property, or my employees with wages as " p their sole compensation, will do the work and the structure is ADR not intended or offered for sale (Section 7044, Business and vice• FINAL DATE C is ,'`S Professions_COd@:) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL Ai j { ITEMS OR A MIXTURE CO TAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN j• ,l,}� ia 1, as owner of the property, am exclusively:contracting with THE AMOUNTS SP IFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FI licensed contractors to construct the project.(Section 7044, . �`t q p' i VES❑ NO 1 v I AI 1..6+ Business and Professions Code.). _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING - L, OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH /(mI '� ,,,///�� /° CHE(_I': CONSTRUCTION LENDING AGENCY COAST AIR QUnuTTT]]]��MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST U (( � FOR GUIDELINES.I - I 1�J J "�!/IV ((((((r`.4 CHANGE hereby affirm that there is a construction lending agency for YES❑ No .the performance Of the work for which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES '; •7 •� COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100THROUGH 2.20.140 CONCERNING- ;I�0—IS001 S I 5/I>;::I! a Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD:. ' Lenders Address 1668 s AM 7:5 OWNER OR AGENT . o. 1 certify that I have read this application and state that the above PC.FEE PERMIT FEE s information is correct. I agree to comply with all county Or es and State laws relating to building construction,and reby a thorize representatives of t is County to enter upon ISSUANCE FEE e bov menl: ed prop rty for ectioll purposes. s Q �, 1 UD INVESTIGATION FEE TOTAL FEE ` - ,uWn d Apgiunt or _ De11 SEE REVERSE FOR EXPLANATORY LANGUAGE!