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HomeMy Public PortalAbout8712 HERMOSA DR_Building__ 76A JII) 038-84 APPLICATION FOR BUILDING PERMIT " T COUNTY OF LOS ANGELESBUILDING % I Z E I I>✓�MoSa i7E DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST ''pp COLEMAN W. JENKINSSUP'T.OF BUILDING CROSS ST.r� IE>V O 1J DISTRICT NO. GROUP TYPE PROCESSED BY po LICANT TO FILL IN L� p CONST STATISTICAL CLASSIFICATION t SEWER MAP )S CLASS NO. DWELL UNITS C BK PG BLOCK USE ZONE MAPNOI7 + SPECIALP, 328ND. OIBL000NDITIONS NOW ON LOT _ USE OF BLDG. SETBACK FROM TEL. } / jYyy FRONT PROP. LINE OF (STREET) OWNER 1! aY6OC T' GT C� TYPE OF EXISTING SETBACN HIGHWAY } YARD = TOTAL ADDRESS .I% HIGHWAY 'FROM C.L - ,rte CITY S • d 1_.c4co r7 3p } ZO - 2 VJ 11 ARCHITECT OR TEL. BLDG. SETBACK FROM ENGINEER NO. SIDE PROP. LINE OF ISTREETI TYPE OI EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. Y d TEL. } = O CONTRACTOR I - NO (J LIC CORNER CUTOFF YES NO Q ADDRESS NO Ej CITY LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS u W DESCRIPTION OF WORK Jay CT4lh T w Z_ NEW ADD ALTER REPAIR DEMOLISH 3Q,FT. NO. OF NO. OF SIZE 1SCAO STORIES FAMILIES USE OF ./1 STRUCTURE +,}' T a �l ✓ //II / GNATURE APPLICANT LICANT OF ,�,,//♦ VALUATION$ (/ '� ©©0 -64R �' V F A ROYALS JJ//++.�DA�TyE / INSPEEC�TOORR'SS SIG NATURE FEE _ 00 PMT. d FO FORMS, MATERIALS Oj!e/ f' t-t1?{7 S7"" FEES ��' FEES FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT /44/lr- •ND N STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION ////QI f C/�VY/: �"L� /. WITH ALL COUTY ORDINANCES AND STATE LBWS REGULATING GAS VENT. DUCTS 9UILDING CONSTRUCTION, 1 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 COMPENSATION INSURANCE. /'J�'�✓� - 1 LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PENMITTEE / RECT AND POSTED I✓/ ADDRESSZ f,.a rPrt FINAL JOHN F. LEWIS. PRINCIPAL STRU TURAL ENGINEER PLAN CHECK VALIDATION cK. M.D. EASH PERMIT VALIDATION CK. M.D. CASH HLo 5 3 4 5,2 SEP 8 2 3 li j ?.G 0 3 e iL05940: SPS ] 1 A 4:000- F/ APPLICATION FOR BUILDING PERMIT y COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDINpG ADORESs I hereby affirm that I have a certificate of consent to self insure, ILDING ADDRESS O O� or a certificate of Workers' Compensation Insurance,or a certified 87/a- Ne vxos-L Dr. copy thereof(Sec.3800,Lab.C.) CITY CI•� ZIP 17pO LOCALITY / Policy No. Company SIZE OF LOT N0.OF SLUGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. El 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 SPECIAL CONDITIONS /y/✓� /v/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE SO.94 P. F2O Ltd IGr 1285-0 V17-5 WITHIN 1000 FT OF SCHOOL? YE NO (This section need not be completed if the permit is for one hundred ADDRESS T DISTRICT GgOUR TYPE CO IRE Z Roc SED BY dollars l$100)or less.) S7/Z He rn,v s Y✓'. I certify that in the performance of the,work for which this permit OITI� /e e ` ZIP 1-7 FID �Q� —� is issued, I shall not employ any person in any manner s0 as to ARCHITEC OR ENGINEER TEL ONO. �� become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION 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 to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith O e S 1"/"0.! �f LOG 3 FRONT comply with such provisions or this permit shall be deemed revoked. ADDREss DC.NO. P L LICENSED CONTRACTORS DECLARATION =2- GJa SIDE CI LIG.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 104W L j2 ®q 0^AC SEWER MAP (Commencing with Section 7000)Of Division 3 Of the Business and SQ.FT.SIZE NO,OF STORIES I NO.OF FAMILIES Professions Code,and my license is in Tull force and effect. NEW El BK PG Oil. } 0 License Number Lia Class ADD DESCRIPTION OF WORK VALUATION O Contractor Date �� ALTER El Ir�� V ❑ I am exempt under Sec. O✓ wood .S P , REPAIR ❑ $ 0 U BARC.for this reason 16 !�' tP DEMOL ❑ LDAAA P/C# ' W Date: USE F EXIST I Loc. URM ❑ 1 EL Signature APPLICANT(PRINT) TEL NO. LOMA Perm# -^f''' Z U R Fo�l� a o - z P"C T ❑ I, as owner of the property, or my employees with wages as O i•y+f �' their Sole compensation, will do the work and the structure is ADDRESS n _ _� y__,_•_ not intended Or offered for sale (Section 7044, Business and Qnny Y 1 l�. FINALDATTEE Professions Code.) �( t Frr' WILL THE URE CONT OR G A HA BUILDING OCCUPANT HANDLE A HAZARD US MAN THE OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE xoIIJ ❑ I, as owner of the property, am exclusively contracting with Q 2 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � t I I f�� JL 1 a '�'5 licensed contractors to construct the project (section 7044, Business and Processions Code.) YES Ivo❑ `.ADH _yy y}c OILL THE INTENDED USE MI THE BUIDUNGCONSTRUCTION BY THE APPLICANT OR FUTURE EBUILDINGSOUTH OCCUPANT REQUIRE q PERMIT FOR CONSTRUCTION OR EE PERMITTING FROM THE SOUTH _'i n u CONSTRUCTION LENDING AGENCY COAST NAIRE Ququry MgrvgcemervT DISTRICT lscgomDl SEE PERMITnrvG cHECI<usT FOR :I: i9L'E culDsuNEs. I hereby affirm that there is a construction lending agency for YES❑ No❑ 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.O.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, m TITLE 2,CHAPTER 220 SECTIONS 220 100 THROUGH 220.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address i o avNCRo em o I certify that I have read this application and state under penalty oP.C.FEE PERMIT FEE � d of perjury that the above information is correct.I agree to comply With all county ordinances and State laws relating to building mconSVUCIIDp, antl hereby authorize representatives of this County ISSUANCE FEE /, V toent n the abovaimenti ned pro rty for inspection p (G INVESTIGATION FEE TOTAL FEE r X � �rool���s Ax�� SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION - FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING PY Y ADDRESS ElCertifiedcopy is filed with the county building inspec- BUILDING - tion department. ADDRESS Date Applicant CITY ZIP LOCALITY . CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NO, OF BLDG$ NEAREST NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TELBS USE ZONE MAP OWNER NO!L}�,�--Q NO I certify that in the performance of the work for which this SPECIAL >_y permit is issued, I shall not employ any person in any manner ADDRESS'2// CL CONDITIONS v. so as to become subject to the Wo ers'Compensation Laws, O CITY -76 ZIP ate pplicant ARCHITECT OR TELTYPE W NOTICE O APPLICANT: If, oft mak' g this Certificate of ENGINEER - NO DISTRICT GROUP CONST. yFIIRRE ,. ROCESSED BY O Exemption, you should become subject to the Workers' �D �i ? . �S U NE Compensation provisions of the Labor Code, you must forth- ADDRESS I ✓ d' JUL. N with comply with such provisions or this permit shall be -" TEL. STATISTICAL ClA$nn$IFIC//ATION APT, CONDO. Z deemed revoked. CONTRACTORJQPtF NC 8631965 CLASS NO.�DWELL. UNITS LICENSED CONTRACTORS DECLARATION gODRESs .f _ NO." /.(i X22 I hereby affirm that[am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. �, and Professions Code,and my license is in full force and effect. CITY CLASS 7rJR.? BK PG VALIDATION c� SQ. FT. NO. OF NO. OF CHECK - License Number 6 Lic Class C I SIZE STORIES FAMILIES ONE �� �/J n VALUATION Contractor ULTi DateLf DESCRIPTION OF WORK NEW ❑ $ 600 ❑1 am exempt under Sec. oc" LAID --❑ , . ALTER El8.&P.C. for this reason - x $ US - , ,� :REPAIR I,I(���}L � �L 1 ate. EXISTINGE-OFi BLDG. DEMOL U (/$'gnat re C' ` ' APPLICANT TEL FINAL PRIfJT / NO 6 '7 965 WNER- ILDER DECLARATION ( �- LLP er DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS LJ� FINAL Professions Code): PRESENT - By _ �s , El 1,I, as owner o4 the property, or my employees wBUILDING ith ADDRESS /. wages as their sole compensation,will dothework-and , ( -,-,f17 _._Iv the structure is not intended or offered for sole(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- .4I'7jy1 J'{ ® 33 tion 7044, Business and Professions Code.) ADDRESS - CONSTRUCTION LENDING AGENCY REQUIRED ygRD HWY TOTAL SETBACK FROM EXIST. SET BA K PROP. LINE WIDTH 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.L. Lender's Name '.Ijif—ialjj %:�72 P.C..Fee $ Permit FeeLDMA Ref. N 3 Lender's Address Q - o I certify that I Have read this application and state that the Issuance fee /✓ LDMA P/C q 8 above information is correct. I agree to comply with all County Invesugmion Fee - P R ordinances and State laws relating to building construction, Tool Fee l7. 0 LDMA Perm. R < and hereby authorize representatives of this County to enter m upo he above-m ti ned property for inspect' n pur ores. - / SEE REVERSE FOR EXPLANATORY LANGUAGE ^ Sign re of Applicant or Agent ate