HomeMy Public PortalAbout5007 HELEO AVE_Building__ T6A63BA CE#a03 L62 APPLICATION. FOR�.BUILDING PERMIT)
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.
DIST ICT NO. GROUP TV E SSED BY
EARCHITECT
OR,APPLICANT TO FILL IN ( ' coNsr.
ING. ['— STATISTICAL CLASSIFICATION S WER MAP
ESS �l U OBK PCLASS. NO. DWELL.UNITSAl O. BLOCK WATERCERTIFICATE: NOT REQUIRED _ RECEIVEDT / 3 MAP HIGHWAY' '.STATE MAJOR SECOND OCALNO.OF SLOGS. 'N (CIRCLET F.LOT AI 3 NOW ON LOT USE20NE SPECIAL /Y F NLg /( CONDITIONS !/ING B DG. (U� �3 NRBUILDING EXIST.
SETBACK YARD �HWY STRE T NAME WIDTH
ESS FRONT ITECTOR TEL. P. L.EER NO. SIDEP. LESS 'RACTORESS / JAMA A- - - K
' Q
DESCRIPTION OF WORK W
a
E ` ADD ALTER REPAIR DEMOLISH
SO. Fqq Z
SIZE T V STORIES FAMIIH- ES/ -
USE OF
STRUCTURE 1, - ,
SIGNATURE OF
APPLICAN PW-Vs'L.v
VALUATION $ 5
APPROVALS /DATE INSPECTORS SIGNAT'UR'E
FEE FPMT.EE S FO FO RMSI:O ATERIALSON TA1.
FRAME: FIRE STOPS, LI J/ S /) I'°
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS i _ IQ'O //y —Al
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
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-
TION
IOLA LATH. INT. -
TION OF THE LABOR CODE OF THE STATE OF CALIFORNI RELAT- _
TNG TO WORK MEN�9'CON '
,�.�6ff�1I1�''WW////JJ�I INSURANCE. LATH. EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED // "6
ADDRESSI� 7fEv ( gr
FINAL
JOHN'F. LEWIS, PRINCIPAL STRcK TURAL ENGINEER
cK.
PLAN CHECK VALIDATION 'M.O. CASH _ PERMIT VALIDATION M.D. CASH
4 2 Q.5 L^ "lY 32 3 D 2 8.50A ;*
�'t-,U 0 1 5G dpi_ 5 . t o 5 7.0 0—
,
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS 50U� 14e
I hereby affirm that I have a certificate of consent to self insure, BUILDINa�G ADDRESS a
H R
or a certificate Of Workers' Compensation Insurance,or a certified LEa
copy thereof(Sec.3800,Lab.C.) -}y� Clf'Y--ITt (� /1 ZIP� ' , U LOCALITY
Policy No. I�}'S n - Company 5 I FiT j- FL) (� ~ • G'
SIZE OF LOT NO.OF BLDGS.NOW ON LOT r
❑ Certified copy is hereby furnished. it NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. I I USE ZONE MAP NO.
Date -al-9 Applicant Td N ('�,I s c r_l ASSESSpR MAe BOOK POE^ pp0
8�C1� ..C. SPECIAL CONDITIONS
RIC I
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 's,
lraQ Q 235 1 0 2S
COMPENSATION INSURANCE M F..gx WITHIN (DDD FT.OF SCHOOL? res No
(This section need not be completed if the permit is for one hundred ADDRESS
dollars ($700)or less.) � O 0
�II DISTRICT GROUP TYPE CONST FIRE ZONE PROC SED 8V
�T�L
I Certify that in the performance of the Work for which this permit Cr- = ' i �� t ZIP ( > O V O(� v_-ii \
is issued, I Shall not employ any person in any manner so as to
ARCHITECT O ENGINEER TEL NO `l .7
lJtr
become subject to the Workers'Compensation Laws. STATISTICAL CL KATION 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' CONTRAnCTOR n TEL nNO (�p SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith f_A�SI �QQ�J �0&� f `0 FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L }
LICENSED CONTRACTORS DECLARATION 10 L; L sT 3829 3 SIDE a
CITY T LIC.C SS O P L 0
1 hereby affirm that I am licensed underprovisions of Chapter 9 7-1= (� �� ��. 1 O
SEWER MAP
(Commencing with Section 7000)of Division 3 of the Business and SO FT.SIZE NO,OF STORIES NO O FAMILIES IY
Professions Code,and my
license is in lug force and effect.Q =.L 300 1 t NEW ❑ BK PG O
License Number JR� 1 s Lie.Class —� ` DESC IPTION OF WORK ADD ❑ VALUATION , U
ContractorLLASSU. P.DCf5 Date I—.ZR—qw F— 0(r ALTER ❑ $ � G U LI , d
L U)
❑ I am exempt under Sec. L R yC REPAIR ❑ $
BARC.for this reason DEMOL ❑ LOMA P/0
Date: USE OF EXISTING BLDG. URM ❑
Signature APPLICANT(PRINT) TEL NO LOW Perm• 1
❑ I, as owner of the property, or my employees with wages as Z
their sole compensation, will do the work and the structure is ADDRESS O
not intended or offered for sale (Section 7044, Business and FINAL DATE //�� H ACCT.AT
P(Of25S10n5 Code.) `WILL THE APPUGNT OR FUTURE BUI OCCUPANT HANDLE A HAZARDOUS MATERIAL - ��1,M J 3303 125.7-
El
25`CC❑ 1, as owner Of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL ECUAL TO OR GREATER THAN THE YY a 1 ITEMS
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BV
licensed contractors to construct the protect !Section 7044, .YES❑ NO C1
Business and Professions Code.) T(ITAL " 125 - 55
WILL THE INTENDED USE MI THE BUICUNGCONSTRUCTION
BY THE APPLICANT OR FUTURE E SOUTH
OCCUPANT REQUIRE A PERMIT FOR Q TIRCT OTION OR EE PERMITTING
FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST FOR CHECK 125.55
GumEUNEs
1 hereby affirm that there i$ a construction lending agency for YES No El CHANGE .00
the Of the work for which this permit IS ISSUed(Sec,
I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SOAOMO PERMITTING
3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,
TITLE 2.CHAPTER 2.90 SECTIONS 220 100 THROUGH 2.20.140 CONCERNING HAZARDOUS (� r�(t
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE WAGING 0000-0001 1/29;%
Lender's Address
W ER.AGExT 4512 1 AM10=24
3 1 certify that I have read this application and state under penalty c pC.FEE PERMIT FEE of perjury that the above information is correct.I agree to comply
with all county ordinances and State laws relating to building
m construction, and hereby authorize representatives of this County ISSUANCE FEE 27• 3 c7
to enter upon the above-menti d property for inspection purposes.
I.yq_�(, INVESTIGATION FEE TOTAL FEE 4�
SEE REVERSE FOR EXPLANATORY LANGUAGE