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Home My Public Portal About8733 HERMOSA DR_Building__ 76n636A OE e6019-63 APPLICATION FOR BUILDING PERMIT - '• COUNTY OF LOS ANGELES ADDRESS q DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. DISTRICT NO. G TYPE P O ES DIBY FOR APPLICANT TO FILL IN � CONST. BUILDING AT CLASSIFICATION SEWER MAP ADDRESS p �/ K p CLASS. NO. DWELL, UNITS LOT NO. Z k/�7$�✓' BLOCK WATER CERTIFICATE: NOT REQUIRED ❑ RECEIVED ❑ TRACT O 3 MAP mGHwAv STATE MAJOR SECON , LOCAL SIZE OF LOT 07zl_ NOW ON LOTLOGS SE D IR B ONE USE ZONE SPECIAAL USE OF ^ CONDITIONS .• EXISTING BLDG. / ' I TELA,t /ll OWNER Dry NO.rr'T[7 f ILDING EXIST. YARD HWY STREET NAME 'C J TBACK IDTH ADDRESS L GRONT IWO ARCHITECT OR TEL. P. L ENGINEER NO. SIDE ADDRESSP L O TEL. 6 vV CONTRACTOR NO. � O O I ADDRESS H V DESCRIPTION OF WORK a I h Z E ADD ALTER REPAIR DEMOLISH _ Q. FT. yy II// NO. OF NO. OF SIZE �l T STORIES FAMILIES USE OF �a STRUCTURE/ J - a o2 .X2.3- SIGNATURE OF APPLICANT VALUATION S APPROVALS DATE INSPECTOR'5 SIGNATURE P.C. r7 V PMT p� FOUNDATION: LOCATION 'FEE 5 FEE S_ FORMS. MATERIALS FRAME: FIRE STOPS. HEREBY ACKNOWLEDGE THAT 1 HAVE REAP THIS APPLICATION BRACING. BOLTS T .wN•r AND STATE THAT THE ABOVE 15 CORRECT AND AGREE E COMPLY FURNACE: LOCATION. WITH ALL COUNTY ENDININCESNCE5 AND STATE LAWS REGULATING GAS VENT. DUCTS I ✓J / / /�' AUTHORIZED CONSTRUCTION. CERTIFY THAT IN PORNO THE WORK �j yy VIOLA- TION THE HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLA LATH, INT. /o// / J��'Y TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- /� rA"_4- ING TO WORKMEN'S.?EV INSV NCE LATH. EXT. • �/j�M SIGNATURE OF HOUSE NUMBER COR- PERMITTEEGC RECT AND POSTED yyy�G ADDRESS ` U � INAL Zy't� yy/jyy � JOHN F. LEWIS, PRINCIPAL URAL ENGINEER PLAN CHECK VALIDATION CR, M.O. CASH _ PERMIT VALIDATI M.G. GASH L 1�c 6 1 4 3 IVIR 3 ?_ 3 A 2 8.50 I,'f06296 fIlAR 6 1 A _ 7.00 iY5-drrrh�� WORKERS' COMPENSATION DECLARATION hereby affirm that havecertificate of consent Ia self APPLICATION FOR -BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, L In. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. el"lKl 3'rli 1 Company � - � , Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BulLDINU ?—j ADDRESS ® 11 J Certified copy is filed with the county building inspec- BUILDING 3 (7 n tion department ADDRESS Date to App ice nt CITY IP _ LOCALITY' CERTIFICATE OF EXEMPTI FRO ORKERS' NO.OF BLDG$. NEAREST COMPENSATIO 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 iEl. USE ZONE MAP I certify that in the performance of the work for which this OWNER NO. '� NO. permit is issued;I shall not employ any person in any manner SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS CITY ZIP Date - Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIR ENGINEER NO. CO CESSEDB r(� Exemption, you should become subject to the Workers' - v Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. 5 iISTICAL C C il0 PT, CONDO. deemed revoked. CONTRACTOR NO 96(„6 / LICENSED CONTRACTORS DECLARATION LIC_ CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS /to NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY + ..r CLASS BK PG VALIDATION d SO. FT. NO. Of NO.OF CHECK License Number 4�3 r 7 7 Lic Class S 3,9 SIZE STORIES FAMILIES ONE VALUATION Controctq( .•fid DaIte g DESCRIPTION OF WORK NEW ❑ ADD ❑ $ LE0.-� 1 am exempt under Sec. ❑ U ALTER B.BP.C. for this reosa _ REPAIR ❑ $ LU Dote: USE OF - EXISTING BLDG. DEMOL ❑ Z .. Signature APPUCANT 1 n j TEL FINAL / NER-BUILDER DECLARATION PRtNi) .LJ A DATE I hereby offi thin I am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and ADDRESS -Tv 'T Professions Code): PRE ENT - ❑ BUILDING I, as owner of the property, or my employees with ADDRESS . 6 49. 1 A wages as their sale compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY rf. o a e e e 7044, Business and Professions Code). MOVING TEL 1, as owner of the property, am exclusively contracting CONTRACTOR NO. 4 e a 86 75 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code), e a o f 6 7 5 5 CONSTRUCTION LENDING AGENCY RSET BACKEQUIRED YARD HWY TOTAL I�NE WIDTH ROP. I hereby affirm that there is a construction lending agency for - FRONT - G 1 0-89 the performance of the work for which this permit is issued, P.L. (Sec. 3097, Civ. C.). - SIDE P.I. Lender's Name LDMA Ref. If m Lender's Address P.C. Fee b Permit tea , i 0 1 certify that hove read This application and slate that the Issuance Fee / LDMA P/C N above information is correct. I agree to comply with all County Imestigotion Fee ordinances and State laws relating to building construction, i and reby authoriz epresentatives of this County to enter Total Fee LDMA Perm. If up n he above-m io 'ed property for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of Applimnt or Agent D to