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HomeMy Public PortalAbout6267 HART AVE_Building__ ?I3-3 11.43?,5M SETS -A—P-PLICATIO FOR S�S`llltilYdI'T` DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES BUILDING WM. J. FOX. CHIEF ENGINEER j NO.OFBLDG. ORD:NO DISTRICT PLAN CK. NO., :R / PLANSd ' SETBACK.LINE FIRE APPROVED ZONE BY DATE RE C ED BY ps DA E OF APPL. gAT�E ISSUED USE APPROVED , X/�' ./ ` "''/W ZONE BY DATE Sb' APPLICANT FILL IN HEAVILY OUTLINED PORWON ONLY BUILDING t p C NAME _ � ADDRESS Z ADDRESS LOCALITY l2:; / ,✓,.�'' I' U NEAREST U z CITY A CROSS ST. L3 17 tr Q STATETEL. NAM E LICENSE N � � NO. r 'Cl zMAIL (� <C NAME 1 ! ADDRESS yy)sy�y ! m�- Fv O U ADDRESS CITY J� NO.�� � Q 1 HEREBY ACKNOWLEDGE THAT, I HAVE READ THIS O CITY ' APPLICATION AND STATE THAT THE ABOVE,IS CORRECT U STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE WS REG LA ING BUNG CONSTRUCTION. OF LOT J��(//(Tp SIGNATURE O LOT NO. SIZE / OWNER I r g NO. OF BLDGS. AUTHORIZED A O E BLOCK NOW ON LOT ` TRACT CORRECTIONS USE OF D NOW ON LOTS DESCRIPTION OF WORDUSE OF Q_�J BUILDING ga T1 AT TT 8 LL dW V This construction may-be in violation of War Production Board orders. You are G Produciion'Boacd:�ffica befosp.,e�. �menc- /' D iriq uZe work aL,horLed in/ Pe mit. r NEW TYPE GROUP NO.OF NO.OF f ALTERATION ROOMS FAMILIES _ ADDITION REPAIR STORIES / { MOVING WALL COVERING 44 DEMOLISH ROOF COVERIN A P.$ FEE $ I n FINAL APPROVAL ? INSPECTOR'S •VALUATION FEE � DATE I, 'NAME ©s 76A638A �---- rCE#801(4EV.11/j8) o/ 6'11PPL OC III R. B U 0L E RWT . COUNTYOF LOS ANG ES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ADI�sEss 7 �T v r BUILDING /t ADDRESS Z(O Q w� V LOCALITY •�+ NEAREST CITY /yrs% �Q -/� ZIP CROSS ST. 6%CP r NO.OF BLDGS. ASSESSOR SIZE OF LOT O C7 0 NOW ON LOT _ MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE SSED BY TRACT BLOCK LOT NO..E �� CONST. TP OWNER JJ v� L..•^�v NOL l. STATISTICAL CLASSIEICAT( SEWER MAP ADDRESS CLASS NO<::-';Z!/ DWELL.UNITS BK PG CITY ZIP ARCHITECT OR TEL VALUATION s lal ENGINEER NO. 1 / L ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OFz (STREET) CONTRACTORS p tee, C :, NO. Z = TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD . / LIC. FRONT PROP.LINE GH Y WIDTH ADDRESS ✓ Tt NO.. & S S LIC. + CITY 5„v C:"t bl,e-I CLASS 131 CONSTRUCTION.LENDER BLDG.SETBACK FROM NAME AND BRANCH /g.� SIDE PROP.LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS - CITY SIDE PROP.LINE HIGHWAY WIDTH SO.FT. NO.OF NO.OF CHECK + _ 99 SIZE STORIES / FAMILIES ONE 1:1 USE ZONE MAP O� DESCRIPTION OF WORK Z O NEW • NO. SPECIAL /`wvI (moi H n .-t AD o D �/ CONDITIONS- vy ALTER FINAL BY q4' c •� 'i i f `• ❑ DATE ��.X(S REPAIR USE OF DEMOL ❑ EXISTING BLDG. APPLICANT TEL PRINT) NO. a • ID BY ISIGNAT UREI .-{fes V a I HEREBY NOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL_'ORDINANCES W AND-LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Z WOK AUTHORIZED HEREBY IHEELA OR CODE OF THE STATE OF CALIIFORNIAWILL NOTOIN ELATING TANYOO WORKMEWSOCOMF Z L 0 9 0,1 A PENSATION INSURANCE.' g #f0 0 0 0 0 1 SIGNATURE OF PERMITTEE 2 0 0&O 0 ADDRESS Z c 0 1' 0 Q 0 o v "\ O CITY NO. G 0,623-80 P.C. Fee$ Permit Fee , > ~ 1 Issuance Fee W d Total F LSU P P `L� C AM©U V• F O U BUL ON\YiJ P E R M IT COUNTY OF LOS,ANGELES BUILDING AND SAFETY LL!! WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS / 2(P I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �T, (O or a certificate of Workers' Compensation Insurance,or a certified copy thereof p(Se�c�.38 0,pLab.C'.) CITY %. ZIP- 6� `3 rm rutij C T (�V LOCALITY o SIZE OF LOT - - NO.OF BLDGS.NOW ON LOT . �-+ Policy NQrsL Company ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building i De�tion �l TRACT BLOCK LOT NO. V.• USE,ZONE MAP NO. department. a v v Date IIC}t)' 5 A 11 �r�t-�► ASSESSOR MAP BOOK PAGE PARCEL ppIlcant A �V l� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS OWN EFj•� �LZ� ���� TgS 3i� YES No COMPENSATION INSURANCE ld�J WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDR�SS ' DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) I certify that in the performance of the work for which this permit CITY zip t 756730% y2--S . is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGI ER TEL NO. become subject to the Workers'COAm,pensaJt,' n Law s. •T - _ STATISTICAL CLASSIFICATION APT CdNCV Date ld-104-S Applicant H 1 �j f�W C/ 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 WorkersCONT ACTO TEL O. Q'Q SET BACK YARD HWY, PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith IrD 3j ®p -7 I.5 .3 1 uV FRONT comply with such provisions or this permit shall be deemed revoked. l� ' r LIC A�NO.q P L, LICENSED CONTRACTORS DECLARATION P�IT acs ) SIDE CITE` �y� A _ LIC..C,{�S PL _ I hereby affirm that I am licensed underprovisions of.Chapter 9 "7 Ll�/V dip p—Ak-- C= SEWER MAP (commencing with Section 7000)of Division 3 of the Business and - SO.FT.SIZENO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effffeC�cL 11 NEW 1:1 BK PG a License Numbers; -A Lic. Class e-✓��.. DESCRIPTION OF WOR ^ ADD E] VALUATION _ Q Contractor F% Q Date L�"l O^- S T �Z `� P L ALTER ❑ ®• cc C.1 ElI am exempt under Sec. 40REPAIR $ U BAP.C. for this reason l�LA� A. ���i1�-� L�SS(� DEMOL C] LDMAP/C#, W Date: USE OF EXISTING BLDG. LIM • ❑ ' Signature - APPLICANT(P T p,,� Nom,• x�• LDMA Perm# 1 Z El 1, as owner of the property,."or my employees with wages as '' c- A< N D '7` \ " ` o A4{:T o 8tl their sole compensation, will do.the work and the structure is ADDES, �r�� 1.r not intended or offered for sale (Section 7044, Business and V�'[i Ptl 0Q AIG� FINAL DATE Q 3303 108,90 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE'A HAZARDOUS MATERIAL1- ,O i -ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL B J El 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q licensed contractors to construct the project (Section 7044, YES - No ElEl TOTAL 103- 90 Business and Professions Code.) { p WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING /'•LJChU` 1008.90OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ 4ff77CG.11rrff v CONSTRUCTION;.LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 0 y GUIDELINES. CHANGE vO I hereby affirm that.there is a construction lending agency for VES❑ No❑' N the;performance Of the work for which this permit IS Issued(.Sec. I 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. _ -_t3�lJU—lJll� 10/11/95 - a - TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CL Lender's Address 2732 1 Ali 9"06 OWNER OR AGENT O o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 1 /�Q O o with all county ordinances and State laws relating to building ` a construction, and hereby authorize representatives of this County ISSUANCE FEE M 2� 3� M to enter•up t ab mentioned property for inspection purpose _ ' a m, INVESTIGATION FEE TOTAL FEE 1 O g O co � sg�awre m Olicanl a Agent �B ' SEE REVERSE FOR EXPLANATORY LANGUAGE