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HomeMy Public PortalAbout9241 HECLA AVE_Building__ DIVISION .OF BUILDING AND SAFETY Department of County EngineerPul County of Los Angeles APPLICATION WM. J. FOX, COUNTY ENGINEER ' FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY /� DIBTRIC NO: PLAN CK.OR REQ.NO. PERMIT NO. BUILDING ( � ` / � ("%_jR"3 ADDRESS f (�. � / R EI D BY DATE OF APPL. DATE IBSUED LOCALITY PUAREST e il ROS®ST. BUILDING . + , ADDRESS � i// b; J7 OWNER Va P I/ MAIL /� + / LOCALITY ,T ADDRESS y a'4� NJEAREST . �r ry CROSS ST. � CITY yam- �q+J {! 7'9` NO. ��/(J l® ' FIRE NO.OF T . GROUP � 7ZONE PLANS ARCHITECT OR TELT V T ENGINEER NO. BLDG. ORD. NO. SETBACK LINE ADDRESS USE APPROVED TTL- ZONE, BY DATE CONTRAOTOR No. F" HOUSE NUMBERING: ADORE MAP NUMBER - �l NO. ASSIGNED BYI� LEGAL CORRECTIONS DESCRIPTION LOT NO. BLOCK S4'M�' As TRACT _ ` � NO. OF BLDEM SIZE OF LOT -6' _ �` 0 NOW ON LOT ' USE OF NO. OF EXISTING BLDG. FAMI LIES DESCRIPTION OF WORK A O_ NEW ALTERATION ADDITION Z D r REPAIR DEMOLITION SQ.FT. NO C.OF SIZE ROMS STORIES EXT.WALL 'ROOF COVERING /L'� Q I GOVEFtINO, och USE OF ST CTUR -� - INSPECTION FOR APPROVLS OCCUPANCYAS INSPECTO. SSIGNATURE DATE FOUNDApaw LOCATION FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, CORRECT. BRACING, BOLTS /_ ✓� fA� _ 1 AGREE TO MPLY WITH ALL.C'OUNTY ORDINANCES ' / /� - A".Z AND STATE LA B REGULATING BUILDING CONSTRUCTION.. FURNACE: LOCATION, ✓( i GAS VENT,DUCTS ^ l,� � f I J S ERM�ITTE GF �l�➢j�/f 'L:ATH, INT. II oda , � ADDRES LATH', EXT. � PLASTER, INT. AUTHORIZE AOT. - PLASTER, EXT.00 o $ P. '> L HOUSE 14UMBER COR- RECT AND POSTED VALUATION FEE P7 FINAL '76A632A DSS 3 1-52 %N,ORKERS`COMPENSATION DECLARATION, I hereby.affirm that I-have a"certificate of consent to self ���nn Liv L/-�� LI ll l/LI _insure, or a certificate of.Workers Compensation",lnsurance, Q op d0 .; �OOI�lu.�OO �dD��J' , �� or-a certified'copy,`thereof (Seca 3800, Lab C:) ; COUNTY OF.LOS'ANGELES' BUILDING AND SAFETY ' Policy No = Company ❑ Certified copy is,. ereby:furnished FOR'APPLICANT TO FILL IN - '' ADDRESS 9-z �: �' •', ` ❑ ertified copy is.fjled with the count"building inspec-' BUILDING• C " tion department „ ADDRESS' CI TY• �: F t�C E" :C-'f 7-YZIP ' f LOCALITY Date Applicant NO..OF BLC)GS.. NEAREST CERTIFICATE-OF'EXEMPTION FROM WORKERSSIZE.OF'LOT'., NOW ON LOT CROSS ST." l"�✓"�P� COMPENSATION INSURANCEASSESSOR ��r77 (This section-need:rot be completed if the permit is for one TRACT /.-738 BLOCK" LOT NO MAP BOOK`' g PAGE 0:31 PARCEL60�o hundred-dollars'($100) or less.) TEL. certify Thaf.im't OWNER � <- �•�'7T- NO.ZBIo':+C�S^3'. NE r- OP r - I he per.formance of The:work for which this, pe-mit is issued,.)shall notemploy.any.person in any manner,'.; ADDRESS :-/vZ _ � GL/4 a USE ZO •so as,ta beco e subject to.the Wo rs,Com ensation Laws. _.._ _ ._ _ _ O µ SPECIAL /�� CONDITIONS" CITY �/V/"iQ.4J ` t:! 7'V/ ZIP Date ,Ap licant ARCHITECT-OR„ TEL r•: DISTRICT GROUP TYPE FIRE PROCESSED BY ` NOTICE TO APPLIEANT:,If diter`makin this Certificate';,of ENGINEER NO. . 9 CONST ZONE ;' 1- Exem'ption;. you should"become subject to the: Workers CJ Gom ensation provisions.of the Labor Code, 'ou''must forth -- ADDRESS.. J a. with comply-with such. provisions or_this permit shall;bee_p TEL. STATISTICAL.CLASSIFICATION .. APT..' :;CONDO; deemed revoked CONTRACTOR , LICENSED CONTRACTORS DECLARATION'.>.'; LIC. CLASS NO DWELL."UNITS -I herebyaffirm•that l amlicensed,Under pro'vis,ionsofChapter9 ADDRESS3�oO�a s i© �N177r� No:3o.''70®� (commencing with Section_7000)•of Division 3 of the Business LIC. SEWER MAP-' and Professions Code;grid my'license is in'full force and.effect.' CITY, gK pG VALIDATION 1�S�aLI CLASS ' 30 C.9.T $QEFT. STORIOES FAMNO.ILOFS I ONEK Lice'nse'Num r Lic. Class j - VALUATION 8 3 :�jZ DESCRIPTION OF WORK. ;� �jL+e NEW.. Contractor /"< u�- Date /`L ' � Eu!.. ADD' - ❑ $ 7 SES�©O T X 70 —J jy/) � T- ❑I am exempt under Sec ct _ ���� ,ALTER �` D 7iuLG0• B:&P:C. for this`reason• yuC H7 S REPAIR $ Date: , USE'OF EXISTING BLDG.' S1 a ENTs DEMO L Signature APPLICANT TEL. „ FIN NO. AL OWNER-BUILDER DECLARATION• G (P.RINT) ,A-7 1!J'�A-y" 3'/ DATE' I hereby,affirm Thati am exempt from the:ContractoYs License ADDRESS��nO�o �& E � L'aw for'the following'reason;(Section-7031.5; Business and' FINAL' Professions Code) PRESENT BY ElBUILDING I` as owner of the property or..My employees with ADDRESS wages as thetrsole compensation,^will do thework:and the structure s not intended or offered for sale(Section LOCALITY 7044,.Businessand Professions•Code:)• MOVING TEL r r CO TRACTOR' NO. 1, as_owner of the.propeity,:am,.exclusively contracting a +` with licensed conTractorsrto construct the p'roject;(Sec- "' t r - p-- ADDRESS t r�;,,, tion,7044,.Business-and.Professions'Code:) (' t - REQUIRED-, TOTAL SETBACK FROM EX ISL CONSTRUCTION-LEND ING.AGENCY. :. Y' SET BACK YARD HWY PROP:LINE WIDTH Lhereby affirm that there is a* construction•lending agency for. FRONT: the performancer of,the work"for:whi_cK his`permit is issued P.L. '(Sec. 3097,Civ. C ) SIDE ; P.L.:,. -Lender's Namei is r m / LDMA Ref. # _ P.C. Fee$, Permit-Fee a. 3 Lender's Address t - o I certify That I.have read this application and state-that the Issuance Fee �'�. LDMA P/C# D ve information is correct. 1 agree to comply with all County,. ' , Investigation Fee o (din ces and State laws relating to-building construction, Total Fe '- LDMA Perm. # a nd h by authorize representatives of this County.to enter n t ve,mentioned property for inspection pu poses a 813 Q — SEE.REVERSE FOR EXPLANATORY LANGUAGE, '"Signature of'Applicant or ent Date' WORKERS' COMPENSATION DECLARATION insure, or a certif cairmrte of Worke.srtCompeficate �at oh'Insurcince, A P P��CAU M O`' u M.V FORMM O d D�_�l.G FE RM U or,a:certified',copyihereof (Sec.'380b' Lab,C:) S�'•�t'ECOUNTY-'OF LOS'-ANGELES 'BUILDING AND SAFETY PolicyNo. ' ompany -F ` 0,1 f BUILDING.. ❑' Certifie copy,is ereby furnished. FOR APPLICANT-TO FILL-IN ADDRESS' ❑':..Certified copy is filed with the county BULDING building'inspec- I Tion department;'. a , ADDRESS • CITY'. L \ Z `. Date Applicant 0 �C L t LOCALITY NO B OF LDGS CERTIFICATE OF EXEMPTION•FROM WORKERS' SIZE'OF LOT NOW'ON.LOT - NEAREST -.'COMPENSATION*INSURANCE ASSESSOR " (This section need not be completed if the,permit is for one TRACT BLOCK LOT NO. ' .i MAP BOOK PAGE G / PARCELIi`li hundred dollars'($100)'or less.) . TEL. 4 2 t, OWNER. L C'. .., NO. 43 3C USE ZONE MAP ; I certify that-in the performance of,the work for which this s NO. permit is issued, I shall•not,errSploy any person in any manner ADDRESS �} (` _ SPECIAL d CONDITIONS so as to become subject`to the'Workers CompensationL•aws. -0 , ,. , . CITY ZIP U Date Applicant, ARCHITECT OR TEL. TYPE FIRE PROCESSED BY king this Certificate of ENGINEER'. NO... (STRICT P 'CONST ONE Com t sti,y unovio W of the.ea s bject 'to, the Workers' Dry U NOTICE.TO'APPLICANT: If, .afters ma [/ P Y P. , P i f- 'r:Code, you must forth ADDRESS 2 r a ' with;,comply -with such.provisions or.this permit shall be TEL. I „ STATISTICAL CLASSIFICATION APT.` CONDO. N deemed revoked CONTRACTOR 't d 0 NO. b � Z LICENSE D,CONTRACTORS DECLARATION vvJJ LIC: r7 CLASS NO DWELL. UNITS I herebyaffirm;that l am licensed under provisions of Chapter 9 ADDRE 1 NO:s ' (commencing with Section:7000)`of Division 3>of the Business eL� LIC. SEWER MAP and.Professions,Code,and myrlilcense as in full force and effect. CITY, "`CLASS.G BK FG VALIDATION License Number 1 n /� Lic. Class C " 3 I. SI SQ.IZE TOI NO.RS FAMF NO1 MES ONE r:. �j Contractor ..5� A 6�O e'Tly�C Lhe DESCRIPTION OF WORK p� O�C` C 15?1 hNEV0 . _ .❑ V.ALUATION ADD 0 0'I am exempt under.Sec W.I 'T� k �� t' S $ �l< D ALTER D 01 - •.,B.&P:C. for this reason' REPAIR El $ Date.: USE'OF EXISTING'-BLDG. DEMOL• D SignatureATEL. FINAL . PPLICANT ` OWNER- DECLARATION (PRINT).' NO: I hereby affirm that I'am exempt from the ContractDATE ors License _ Law for the followingJbason (Section 7031.5, Business and ADDRESS FIPIAL Professions Code) PRESENT _ By .. • .�. � AUT �.a a Ir. El I; as owner of the',property, or my:employees with ADDRESS -€ 3_ wages as their soIe`c'ompep§ation;'will do he work and - ' the structure is not intended or offered for,°sale(Section LOCALITY _ _ E 7044, Business and Professions Code.) 4.. MOVING TEL:. .. D lei C ' CONTRACTOR NO. - -r i +v, ❑ I, as,owner of the property,.am exclusiively contracting f.11 ^}). 128 - 63 • ' with licensed•contractorsJo,construct the project-(Sec- ADDRESS tion 7044, Business and Professions Code.) i¢}LF}• i�st n is �R'QU IRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING.AGENCY ET BACK . YARD HWY' PROP. LINE WIDTH �gata` .I'ha• I hereby affirm that there' is a construction,lending agency for RONT the performance of•The.work,for,which this'Permit'is.issued C:(Seca 3097, Civ. C.). IDE, Lender's Name. ., -L P. f, i LDMA.Ref. # 551 a t iAll s rt� P C.'Fee$' Permit.Fee .�O t Lender's Address a Lctrtify that I.have'read'thjs application*'and state that the Issuance Fee /'ot tDNA-PiC# D above,information is correct. I agree to comply,with all County' lnGestigotion•Fee 0 ordinances and Stdte Maws relating to*building construction, Total Fee / �•0 "(� LDMA Perm. # - and.hereby authorize representatives of this County to,enter �.. upo th ab -me tinned property for..inspection purposes. a o SEE REVERSE FOR EXPLANATORY LANGUAGE `. .Signature of Applicant or Agent - Date - .,