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Home My Public Portal About8615 HERMOSA DR_Building__ ,EA6B9PCE A6D3.3-63 APPLICATION' FOR BUILDING PERMIT • � COUNTY OF LOS ANGELES" BUILDING ' DEPARTMENT OF COUNTY ENGINEER' ADDRESS BUILDING;AND- SAFETY DIVISION-. LOCALITY JOHN A. LAM61E. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING - CROSS ST. .. - DISTRICT NO. GROUP TYPE PRO SED BY FOR APPLICANT TO FILL IN. ., / S CONST. ADDREINS 6, �� /' En O 5/a - /}P STATISTICAL CLASSIFICATION SEBW MAP r 4A CLASS, NO. DWELL. UNITS LO NO. .BLOCK' I WATER - _ CERTIFICATE: NOT REQUIRED ❑ RECEIVED❑ TRACT c� �. AY n I. NO. OF BLDGS NOP.�c�-� (cGRCW EI STATE MAJOR SECOND, OCA SIZE OF LOT',j 0 �1 Q NOW ON LOT. , USE ZONE SPECIAL USE OF - / CONDITIONS - EXISTING BLDG. - - - . 1. TEL. - - OWNER NO. •S - 'BUILDING YARD HWY TREET NAME EXIST. p� rr ^ SETBACK WIDTH. . ADDRESS py '.G EYVY10 D✓. ti. FRONT ARCHITECT OR . - ' - e TELa P. L. ENGINEER - NOI SIDE ADDRESS TEL. //H7 3, r /� fS//T.IJL'� T/!MI/LY O CONTRAC"�STOR - Y1 E. NO. . / �( /� ` O CRIPTION OF WORR _ w - a w ALTER REPAIRDEMOLISHZ NO.OF NO. OFSTORIES FAMILIES ' SIGNATURE OF APPLICANT VALUATION $ ��- CJ - APPROVALS DATE INSPECTOR_'$SIGNATURE ' FOUNDATION: LOCATION r/ FEE $ �� FEE $ <� FORMS. MATERIALS IO FRAME: FIRE STOPS. I HEREBY ACKNOWLEDGE THAT I Hp VE READ THIS APPLICATION BRACING. BOLTS VV •)• AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH PLL 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. LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COM ENSATION INSURANCE. LATH. EXT SIGNATURE OF U� / HOUSE NUMBER COR- PERMITTEE .I.-C-vt/ RECT AND POSTED R ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL STI RAL ENGIN R PLAN CHECK VALIDATION CK, M.O. CASH _ PERMIT VALIDATION (.CK.j M,O. CASH LAC 5 7 3 1 JUN 5 ' 1 P, 6.0 0" . 1 ..=...=E#=as...BO APPLICATION FOR BUILDING PERMIT I1 COUNTY OF LOS ANGELES BUILDING �� DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUF'TOFBVIEDING CROSSST. DISTRICT NO. GROUPTYPE PROCESSED BY FOR APPLICANT TO FILL IN 3- I I CONS BUILDING d`b/S L STATISTIC AL GLASSI FICATION -- I SEWER MAP ADDRESS Qap {{^^(� LOT NO. / O L�'SO BLOCK MAP AS. NO. /�D/W�ELL. UNITS STATE YES 1O �-p NUMBER �VV HWY. (� TRACT `� / O3 US_ EJ.o INE SPECIAL � + / NO.OF SLOGS. 1J � CONDITIONS ,y SIZE OF LOT � O �/�6 NOW ON LOT USE OF EXISTING BLDG. BUILDING EXIST. YARD• HWY STREET NAME gyp. TEL SETBACK r WIDTH OWN E Q•CY NO. FRONT nnyMe ] ♦ P. L. ✓ � �F//la�I7 ADDRESS S�(_ F. //Y)M+6'aR� , SIDE ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECORD } ADDRESS A �• TEL. ��IA� �� P/L ESS QiI�L ._'«t14 /!T-t O CONTRACTOR (7 NO. I - N ADDRESS DESCRIPTION OF WORK I` G NEW ADD • ALTER REPAIR DEMOLISH Z SQ. FT. 3316 NO.OF NO.OF SIZE /7 /J STORIES (� (FF IIyLIIES USE OF STR..TURE O�Q /{pchM A... SIGNATURE OF « AP CAN VALUATION S 00 J APPROVALS DATE INSP CTO 'S SIGNAT RE FEE $ I FFIAT.EE $/�� U FOUNDATION: LOCATION FORMS. MATERIALS /3 FRAME: FIRE STOPS, j IC/// I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS S !{ L�1 AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, ENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED I SHALL NOT LATH, INT. EMPLOY ANY PERSON IN ANY MANNER AW AS TC BECOME SV BU ECT TO THE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. I LATH, EX SIGNATURE OF HOUSE NUMBER COR- �J PERMITTERRECT AND POSTED ADDRESS 96 1 FINAL CLYDE N. DIRLAM. PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. DASH PERMIT VALIDATION CN. M.O. CASH Ll`:C,a 4 0 FEB -7) 1 ,� 1 2.0 0 ' , rr cS-O OMPENSATION DECLARATION )4,WQRKEf1ti p p Y f^� ryplr.�[s[E7I ' ■/141" e J �insurebo Q._ th� haver certificate of tion Insurance, to self PPLIC 0 ION IF%0% E�MO'�®��V insure, or o.q-m"'c ie of Workers Compensation Insurance, 6�1 !"tl �`� a1 0 -pined copy thereof (Sec. 3800, Lob. C.) , COUNTY OF LOS ANGELES BUILDING AND SAF Policy No. Company -F - Certiiied copy is hereby furnished.. FOR APPLICANT TO FILL IN BUILDING ADDRESS `J J Certified copy ii Pied'with the county build ing inspec- BUILDING �nL// (` � / �/,+ /� tion department. ADDRESS �+TP l� C., a/T.C�M C75Iy y i e. Date ,•'t r�Applicant CITYS1911 l;F�' !i. ZIP % LOCALITY C. mi-16 (?ITy CERTIFICATE OF EXEMPTION FROM WORKERS' - - NO. OF BLDGS. - NEAREST - COMPENSATION INSURANCE - SIZE OF LOT NOW ON LOT CROSS ST. (This section.need-not be completed if the permit is for one - TRACT _ BLOCK LOT NO. ASSESSOR - hundred dollars ($100)or.less.) - MAP BOOK PAGE. PARCEL TEL.. USE NE MAP- y /N/i owNERLPclvhRD „� L J1/No.�$ �<f certify that in the'perfo�mance of the work for which this NO. } permit is issued, I shall not employ any person in any manner // SPECIAL -- S so as to become subject to the Wo brs''CoiIpensation Laws. ADDRESS:34 Ht./Q CONDITIONS O •, ✓d - 4 , - CITYoS/ -�� f� - ZIP Date Applica - ARCHITECT OR TEL. O NOTICE TO APPLICANT: If, at r making this Certificate of ENGINEER N . DISTRICT _ GROUP TYPE FIRE _ PROCES D BY G Exemption, you should become subject to. the Workers' - ' `` //r /} CONST. ZONE Compensation provisions obthe Labor Code, you must forth- ADDRESS 'JI"� 7Nl IL W with comply ,with such,provisions or .this permit shall be _ - - - W deemed revoked..'. TEL. STATISTICAL CLASSIFICATION APT. Cr. Z CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATIONS - _ .. LIC:_ _ CLASS NO. Z�.. DWELL. UNITS_ hereby affirm that I am licensed under provisions ofChapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions CodI L'e, and my license is in'full force and effect. CITY CLASS BK VALIDATION • ' _ SO. FT q,1(/ NO. Of _ NO. OF CHECK „ License Nbmber 'Lic.Class SIZE �({b STORIES FAMILIES ONE-- - VALUA_TION ContractorDate J - - DESCRIPTION OF WORK NEW ❑ /I zrO f/ " tbe ADD POO.I am exempt under Sec. Cr ALTER B.BP.C. for this reason Date. - REPAIR ❑ -$ z 3 8 6 5 USE OF e a e a e EXISTING BLDG. DEMOL ❑ .� s � 1 5G 5 '-Sign`ature - -- APPLICANT - _ -- TEL. FINAL e e ,A OWNER-BUILDER DECLARATION PRINT) NO. DATE Z -.. ,' 6� V «I.hereby affirm that I am exempt from the Contractor's.License - Low for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code):'- - - - '� "' - PRESENT - - - By ® BUILDING , I, as owner of the property, or my employees with ADDRESS �• I ' wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY -7044, Business and Professions Code). - - -- MOVING - TEL. - ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO.' with.licensed contractors to construct the project(Sec- tion Sec- ADDRESS tion.7044, Business and Professions Code). ' 'CONSTRUCTION LENDING AGENCY -- - REQUIRED YARD HWY TOTAL SETBACK FROMEXIST. SET BACK PROP. LINE WIDT I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued - P.L. -- - (Sec. 3097, Civ. C.). SIDE P.I. Lender's Name /O- �^. /}/1 LDMA Ref. k s P:Co-fee$ Permit Fee- V (/V _ .. . - Lender's Address _ � w -I certifythat I have read this.a lication-ond state that-the f PP - - Issuance Fee �tl." O LDMA P/C If - Q above information is correct.I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Tmol Fee ./ S• •y-`�-- LDMA Perm.p - i, and hereby authorize representatives of this County io enter an the above-me/nti�oned property for inspection purposes. - v ` i SEE REVERSE FOR EXPLANATORY LANGUAGE ' X77_' f— -Signature of Applicant - -Date