HomeMy Public PortalAbout4936 HELEO AVE_Building__ 76A638A CE a$8031-62 All PUCA 11 I®N FOR BUILDING M 7 r
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DISTRICT Np. GROUP YPE P ESSED BY
FOR APPLICANT TO FILL IN coNsr. _
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS
3 CLASS. NO. DWELL. UNITS BK P
LOT NO. 3 BLOCK WATER NOT REQUIRED ❑ RECEIVED
(� CERTIFICATE: ..
TRACT '-- ! MAP HIGHWAY STATE MAJOR SECOND,, CA
v NO.OF BLDGS. '� NO. (c1RCLE)
SIZE OF LOT �J �c Q NOW ON LOT USE ZONE SPECIAL
USE OF /A' J CONDITIONS
EXISTING BLDG.
OWNER lj; BUILDING EXIST.
SETBACK YARD HWY STR T NAME WIDTH
_ ADDRESS FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
P. L.
ADDRESS A
0
pg� TE .�'1
CO NTRACTO Y" N
ADDRESS / /✓�'L`Q`d /' � A
DESCRIPTION OF WORK A W
CL
H
rNE ADD _ ALTER REPAIR DEMOLISH 4 1 wmi
SQ. Ftj
T. 1 NO. OF NO. OF _
SIZE V STORIES FAMILIES
USE OF
STRUCTURE
- SIGNATURE OF
APPLICANT .,,,,
VALUATION..$ �.- APPROVALS ATee INSPECTORS SIGNAT 1
d1PMT. FOUNDATION: LOCATION /y
FEE $ (JJ FEE $ FORMS, MATERIALS Z-1 43
FRAME: FIRE STOPS, g
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
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. I CERTIFY THAT IN DOING THE WORK y A '
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. Fyl,
TION OF THE LABOR CODE OF THE STATE OF CALIF NIA RELAT.
ING TO WORKMEN SULATH, EXT.
SIGNATUEOHOUSE NUMBER COR-
UF
PERMITTEE f gFiw(gI
� �� ��✓�S v
RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS, PRINCIPAL STR URAL ENGINEER
CK.
PLAN CHECK VALIDATION cK. M.O. CASH _ -PERMIT VALIDATION M.O. CASH
jj Lilco 4 2 0 7 -.Ilff 3 2 3 D 8.5 01'
Lr�o ? 0 1 2 ; JUL 25 1 D 5 7.0 Q`" �;}
4 OpLoC ATT ON FOGS U ONG PERMIT
PARCEL # APN• 8 5 9 0—2 2—2 3 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' 4936
copy thereof(Sec. 3800,Lab.C.) . 'TEMPLE 'CITY 0 780 LOCALITY
Policy No. Company SIZE OF LOT NO,OF BLDGS.NOW ON LOT
❑-Certified Copy is hereby furnished. NEAREST'CROSS ST. _
❑ Certified copy is,filed with,the County,building inspection TRACT BLOCK ,. LOT NO.
• department. USE ZONE' MAP NO. -
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL
85 940 22 2'3 SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS',
OWNER _ -TEL NO. / 7
COMPENSATION INSURANCE PHILIPO& FRNINI LI C IU / WITHIN 1000 FT.OF SCHOOL? YES NO
(This section heed not be completed if the permit is for one hundred ADDRESS
dollars($100)or.less.)
THE SAME
DISTRICT GROUP TYPE NST. FIRE ZONE PROCESSED BY
' CITY � _ - ZIP
I certify that in the performance of the work for which this permitO�L NO. 3 v�
is.issued, I shall not employ.any person in any manner s0 as t0 ..ARCHITECT OR ENGINEER TE ,•J
become subject to the Workers'Compensation Laws. STATISTICALCL�TION APT CONDO
Date Applicant ADDRESS - CLASS NO. DWELL UNITS -
. . NOTICE TO APPLICANT.' If, after making this Certificate of -REQUIRED TOTAL SETBACK FROM EXIST, ,
Exemption, you should become Subject t0 the Workers' CONTRACTOR - TEL NO. •SET BACK. YARD HWY PROP LINE WIDTH'
Compensation provisions of the Labor Code, you must forthwith FRONT
comply with'such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L '
LICENSED CONTRACTORS DECLARATION SIDE
CITY ,. LIC.CLASS °--P L-
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing.with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES I •
Professions Code,and my license,is in full force and effect. NEW ❑ BK PG D
DESCRIPTION OF WOR - '` ADD ❑ 0
..VALUATION
License Number Lia Class / 0
Contractor Date ALTER 'El -$
/01 "p),
�� U
• ❑ 1 am exempt under Sec. EAR ' OFF THE' CIL ROOF REPAIR 1:1O
B.&P.C.for this reason INSTALL NEW ROOF DEMOL ❑ DMATP/C# W
• Date: USE-OF EXISTING BLDG. URM. . ❑ 'j d
U)
- ( ) . •• Perm — .a `Z
nature APPLICANT PRINTTEL NOLDMA.P #
as,-owner of the property, or my employees with wages as CHU., PHILIP Z r
-.their sole compensation, will do the work and the structure is ADDRESS _s( �. p`r_6
not intended Or Offered for sale (Section 7044, Business and FINAL DATE p. - Q
_ )' WILL THE APPLICANT OR FUTURE BWLDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 12 ZO•• �3 'z J �`��,�
Professions Code. M i�. .
❑ 1, as Owner Of the property, am exclusive) contracting with, OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
P P Y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY E '
licensed contractors .to construct the project (Section 7044, TOTAL- �'-"' -3 —
YES❑ NOIR - a r
• Business and Professions Code:) f+;H�l_;�,`. 1:z�-at_t
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING _
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH L
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT,DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR :.; !�[�_
GUIDELINES. .
I hereby affirm that'there is a construction lending agency for YES El NO' r'[X ?Pv /e wj'"
a the performance Of the work for which this permit Is issued(Sec. - I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - ;•� M i'
3097,Civ.C. t}j3ft—I. i sE i i i_:' �!''
N ) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE ANGELES COUNTY CODE, '
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS
Lender's Name AT R-�°S R ORTIN AND FOR OBTAINING A.PERMIT FROM THE SCAQMD. r}y as $ a 0
o Lender's Address1� � C�HIU L PM 1".
- OWNER OR AGENT -
o I certify that I have read this application and state under penalty
o P.C.FEE PERMIT FEE of perjury that the above information is correct.I agree to comply 7
with all county ordinances and State laws relating to building d
m construction, and hereby authorize representatives of this County ISSUANCE FEE
attQJ$�ptewpon the e-mentio property for inspect n p rposes.
m fl /LC/YLL fT C� 1AIR! INVESTIGATION FEE TOTAL FEE /
r gnalore of Applic-or A onl Dace ..
SEE REVERSE FOR EXPLANATORY LANGUAGE