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HomeMy Public PortalAbout8804 HERMOSA DR_Building__ EA tt638A .CE#803(REV.11/78) APPLICATION. FOR BUILDING' PERM,IT COUNTY OF LOS ANGELES BUILDING AND.SAFETY FOR APPLICANT TO FILL IN aunDING ADDRESS BUILDING ¢,T ADDRESS E• - 2p2O �/'�� LOCALITY ,,// p NEAREST CITY Elf-& G4. ZIP CROSSST. NO-OF BLDGS. (LI ASSESSOR SIZEOFLOT NOW ON LOT MAPBOOK PAGE PARCEL TRACT /� o; O'v --DISTRICT GROUP TYPE FIRE PR ED BY IG 2 3 I ' BLOCK , LO-TE`NO. , j O a ^ ^j CONST, t ' ZOyyE OWNER �. I'L.W'�A,+? NO.2`p700 3 _ AG J �/ JJ _ ( � STATISTICAL CLASSIFICATION SEWER MALP{/ ADDRESS �n Z J+^' CLASS NO.Q/ DWELL.UNITS / ,I/BK/OPG ARCHITECT + elk ARCHIi ECT OR TEL, VALUATION 3j ��-0 3 � � ENGINEER NO. ADDRESS BLDG.SETBACK FROM 'y FRO NT PRO P.LINE OF /L �e,✓M�-+�- ISTREETI CONTRACTOR 7 fJS'� 763�t� HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING 3 { p/ (� '.22 - FRONT PROP.LINE HIGHWAY WIDTH 73 ADDRESS -J•h•� - ,L /� LIC. - + CITY . A F CLASS \'J BLDG.SETBACK FROM CONSTRUCTION LENDER SIDE PR OP.LINE OF ISTREETI NAME AND BRANCH )- HIGHWAY HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING S ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH O V 50.FT. NO.OF "z NO.OF CHECK 4 = G, SIZE STORIES FAMILIES ONE 0 *tgUSE ZONE MAP F DESCRIPTION OF WORK NEW _11Z ��,,, NOECIAL ADD ❑ - CONDITIONS ALTER LJ FINAL ` �� •D/ BY1 _ 7 a ��/ REPAIR ❑ DATE ©CJ '-�N-'o--�g�C3 EX STUSETIING BLDG. �T DEMOL ❑ O �.'7 O 'Z o 0 o 600 APPIPR NTI TEL NO 7�'�i Q O '. a o o e b 0 0 0 g7� 01.23-80 BY(SIGNATURE) - / �._/p _7 HEREBY ACKNO E THAT I HAVE READ i APPLICATION AND STATE J KYR THAT THE ABOVE IS.CO RKi AND AGREE i0 COMPLY WITH ALL ORDINANCES LL AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE S ;287 1.5 A WORK AUTHORIZED HEREBY I L NOT EMPLOY ANY PERSON IN VIOLATION OF V THE LABORCODEOFTHEST 0. CALIFORNIA IN RELATING TO WORKMEN'S COM- Z # 0 0 0 0 0 1 PENSATION INSURANCE.' 4 SIGNATURE OF O w��•Q s 2 - 353.50 PERMITTEE _ o � 3 53,5 0 ADDRESS Z f EL.. o . . : 01,23-8C CITY ..TT NO. P.C. Fee$-A d- U Permit Fee ! S > 44,e4l!6 (�,r 0 0 Issuance Fee n Total Fee APPLICATION FOR BUILDING PERMIT `., COUNTY OF LOS ANGELES BUILDING AND SAFETY �+ WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN auILDJNG 69�RE$S BU D G ADORE ff/TY'lalY GTf- . hereby affirm that have a certificate Of consent to self insure, e(WEb i G.` [�2 or a certificate of.Workers' Compensation Insurance,or a certified CIT 'C 1AI-P 00 � h ZIP copy thereof (Sec. 3800, Lab.CJ LOCALITY Policy No. 33J j Company .. SI OF LO NO.OF BLOCS.NO O LOT L Certified copy is hereby furnished. ' NEAREST CROSS ST �. Certified copy is filed with the ounty building in Iection TRACT BLOCK LOT N0. Coop me I. USE ZONE MAP N0, Date Applicant R X ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS O/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWbLWR TEL COMPENSATION INSURANCE 4—'- ip 3 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS ^ DISTRICT GROUP TVP CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) ` - CITY certify that in the performance of the work for which this permit bissued, shall not employ any person aany manner so as t0 .gRCHITECT OR ENGINEER TEL NO. become subject t0 the Workers'Compensation Laws. STATISTICAL CL SIFICATION 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' CONTRA TOR TE NO. nn SET BACKLYARDHWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith vLL Q 0' W �•) rJfl LFRONT comply with such provisions Or this permit shall be deemed revoked. AD RESS (.��/.'• ,., L U pP LICENSED CONTRACTORS DECLARATION Z —"' ?II , S?a cq LIC C / I hereby affirm that I am licensed underprovisions of Chapter 9 ` 6 [.✓ SEWER MAP (commencing with Section 7000)of Division 3 of the Business and in� ZE NO.OFETORIES NQ F FAMILIES NEW ❑ Professions Code,and my/license is in full force d effect. Y� [? BK PG , a License Number I -00) Lic. Class 3 DESCRIPTION OF WOR 'yid' .ADD ❑ VALUATION Q Contractor A 3 (®/ �uz��' 4a $ 3 (�0�• p V (, '��,°��11�'�� � //A�LTER ❑ u G� w�Cw�c t&.,A t REPAIR `1, $ O ❑ I am exempt under Sec. B&P.C. for this reason DEMOL ❑ LDMq PIC a W Date: USE OF EXISAAG BLDG. URM ❑ .! Signature APPLICAlT(PRI iJ n^ uF,J, ray ,1s� LDMA Perm#` (`yli_;::;; =y z ❑ I, as owner of the property, or my employees with wages as I=j �Z('x ( J Z _ _ !q their sole compensation, will d0 the work and the structure is A RESS rp�q /e}— /J O not intended or offered for sale (Section 7044, Business and �i ✓ - CA ,-7 FINAL DATE a : ITP Code.) F WILL THE APPLICANT OR G A RE ARDOING OCCUPANT HANDLE A 9 GREATER MATERIAL - ❑ a5 owner Of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OP GREATER THAN THE a m +_''9-_Z p p V' y g AMOUNTS SPE�UZYE 0 ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYaij I I I I n— .$a. Business contractors t0 construct the project (Section 7044, — r; business and Professions code.) res❑ N "µL;v WILL THE INTD USE OF THE BUGLING BY THE APPLICANT OR FUTURE BUILDING OCGUPAM RE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CH-Er- UTCONSTRUCTION LENDING AGENCY UMANAGEMENT DISTRICT(SGAOMO)SEE PERMITTING CHECKLIST FOR GUIDEUNEs. f� I hereby affirm that there is a construction lending agency for YES El No� J' the performance of work for Which this permit lS issued(SeC. IHAVEREAOTHEHHZ_AF/WUS MATER LSINFOPMATION GUIDE AND THE SGAOMD PERMITTING F'Ii f_Y )V(i_If)'I i1.Z jfii'E.,i m 3097,CIV,C.) CHECK IST. UNDEESTANO MY REREMENTG UNDER THE LOS ANGELES COUNTV CODE ' ry Lender's Name MATTITE ALS REPO ER ZING90FO2 or RTAININGTA PEO RMT FPDICKO.iJDEpflCEOIONG HAZAfl0005 i+.r7` .I i` 1=t1 3 _. a Lender's Address 0 oa wervT o I certify that I have read this application and state under penalty A 4 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE /o ^ with all county ordinances and State laws relating to building con ruction, and hereby authorize representatives of Is County ISSUANCE FEE I C� t,n to ter upo the abo mentioned prop for inspe ti n p pin n a m , / INVESTIGATION FEE TOTAL FEE/ .3 ola SEE REVERSE FOR EXPLANATORY LANGUAGE