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HomeMy Public PortalAbout8914 HERMOSA DR_Building__ 165a38A 15158.8 use APPLICATION FOR BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY BUILDING ��// ADDRESS I`/'� Department of County Engineer / v County of Los Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, BuwT oP BUILDING CROSS ST. 1 p 15Tftl TNO. ROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN J BK PG CONST. BUILDING ADDRESS XI - Fq,17MAP �4 - STATE YES NO / A NUMBER Q Ca HWY LOT NOI 'SO/-</�- BLOCK USEZONE SPECIAL f f 7, CONDITIONS TRACT -3� .`,�'� / _ SIZE OF LOT /� U/n I NO.OF BLDGS. - J A O�- NOW ON LOT BUILDING YARD HWY STREET NAME EXIST. USE OF SETBACK WIDTH EXISTING SkiG. FROINT OWNER / /✓ SIDE dL LC!(J P. L. MAIL �'>-� ^r �% p /J ADDRESS `L/ Lo /J�jZ �Q�/�G, O TRACT DWELL. 1 UNIT ,�/, I TEL q�j 151 INDUSTRIAL CITY Z2t � ,,k G/�� NO. I DWELLa2J IUNIT 6 PUBLIC BLDG. ARCHITECT OR TEL. 2 DUPLEX 2 UNITS 7 ADDN.,ALT., ETC. ENGINEER NO. 3 APT. _UNITS 3 MISCEL. ADDRESS 4 COMMERCIAL CONTRACTOR nTlo' INSPECTION RECORD ADDRESS:' P Z _ ..S / 0 JZ - N =�_ j DESCRIPTION OF WORK F � a {/A EW ADD ALTER REPAIR DEMOLISH �_ CL> _f.S 7;eM44✓ SIZEF . ,l NO. OF OF Z7 Lj STORIES F N MILIES USE OF STRUCTUR _ ' L' r©111 19 .p Yv /✓ W = / - ow SIGNATURE OF APPLICANT APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION P. C. $ FORMS, MATERIALS FEE FRAME: FIRE VALUATION0� STOPS, p $ B� BRACING. BOLTS FEE FURNACE: LOCATION, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT, DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS RE UACONSTRUC- TION. L +� LATH. EXT. SIGNATURE OF t. HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS _ G - INAI - JOHN A.LAMBIE, COUNTY ENGINEER V LIDATJQN, CLYDE N. DIRLAM. CHIEF BLDG. INSPECTOR CK No GSH LAC03 DEC24 1 2.00 In XPERMl ]6A63BA CEPG031-6TAPPLICATION FOR BUILDT COUNTY OF LOS ANGELESBUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS - 0/1/711 1, L; cZ/ BUILDING AND SAFETY DMSION ILOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'i of Bu aDIHc CROSS SL -1 DIST C N P I TYPE PR B FOR APPLICANT TO FILL IN < CONST: 6 BUILDING / STATISTICAL Cy g54TFICATION SEWER MAP ADDRESS ! i CLASS NO.$ry DWELL UNITS BK PG LOT NO. BLOCK USE ZONE MAP -5 �(J NO. VV TRACT /`` SPECIAL N0. 01 BLDOS. CONDITIONS SIZE OF LOT NOw ON LOT USE OF EXISTING RLnG BLDG. SETBACK FROM TEL FRONT PROP. LINE OF (STREET) OWNER IN TYPE 01 I EXISTING I SETBACK HIGHWAY + YARD = TOTAL ADDRESS / HIGHWAY TK IBID CITY - i I + ARC TEC R TEL. 8100. !SETBACK FROM ENGINEER NO. SIDE PPOP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD C TOTAL ADDRESS HIGHWAY WIDTH IROM C.L. TEL. + _ CONTRACTOR NO >> ADDRESS LIC CORNER CUTOFF YES NO C LIC C CITY SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK 4 6 NEW ADD ALTER REPAIR DEMOLISH Z SOFSTORIES < NO OF 512E STORIES FAMILIES USE OF STRUCTURE SIGNATURE O APPLICANT VALUATION$ ' // F. / 00 V �-� �s{�� APPROVALS ' (DATE INIPECTOR'3SIGNATURE FEE$ FEE$ • L^ (J FOFORMS. MATERIALS LOCATION l/�I -�F� V .,,41J FRAME. FIRE STOPS. /— 1 I HEREBY AC N HOWLED CE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY OROI NANCES AND STATE LAWS REGULATING GAB VENT. DUCT$ 9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR COOL OF TME STATE OF CALIFORNIA RELAT— ING TO WORKMENS COMPENSATION INSURANCE. LATH. EXT. SIGNATURE OF �24 HOUSE NUMBER COft- PERMITTEE REC AND POSTED O / ADDRESS-�J�Crft' O' „Y_ cf, i:.0 NAL JOHN F. LEWIS. PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK. M.o. CASH _ PERMT VALIDATION CK. M.o CASH Lptuo 1 6 5 0�-. NOV 10 1 D 6.00- _' DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO. PLANS SETBACK LINE APPROVED / TJ ZONE BY \DATE RECEIVED BY DATE OF APPL. DATE ISSUED USEE_ APPROVED ,I ZON �/ r (�'?3J I (� APPLICANT FILL IN HEAVILY OUTLINED PORTION[ ON'ONLY x BUILDING O C NAMEADDRE$9 ��/� t 1 "'✓/'i(/���� - / F W FZ ADDRESS LOCALITY O R NEAREST W CITY /� / / CROSS ST. Q STATE LICENSE NC(// .4 >NTE . AOL L g NAME ✓[n'Ae� C / `� v V/ = MAIL O ; ADDRE NAME 99 vt1t� 0 U TEL. Q ADDRESS CITY NO. R 1- Z Z CIT. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS U APPLICATION AND STATE THAT THE ABOVE 19 CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSEE NO. �5/ NO. �7�Vq AND STATE LAWS REGULATING BUILDING CONSTRUCTION. O LOT NO.O�• �((l6 SIZE OF LOT /�� 9I OW NgRE OF n n ip NO. OF SLOGS. BLOCK _^ NOW ON LOT / AUTHORIZED AGI. 1 �l��UlILIIITTTIIl'GGGY Wg J0 3 6 a3 CORRECTIONS W TRACT O USE OF SLOGS. NOW ON LOT DESCRIPTION OF WOi2K y - 2 _ u S ry„/� �_o e--) USE OF BUILDING AA�� v � z n / r NEW TYPE GROUPL NO. OF NO. OF / ALTERATION ROOMS n {�/ FAMILIES ADDITION SIZE REPAIR STORIES / 7. !ROVING WALL COVERINGO��/� (DEMOLISH ROOF COVERING WS"'"r�11ya $ FEE FINAL APPROVAL a VALUATION FEE sJ� DATE I NAME CTOR'9/ I /� - APPLICATIONTY COUNTY OF LOS ANGELES BUILDINLGGPERANDEMIT FOR APPLICANT TO FILL IN BUILDIN�iADDRESS WORKER'S COMPENSATION DECLARATION d"9�� I hereby affirm that I have a certificate of consent to self insure, DUI IOING DDRESS Wl or a certificate of Workers' Compensation Insurance,or a certified PY �� r' copy thereof(Sec.3800,Lab.C.) CIT zIP O LOCALffV / Policy NO. Company SIZE OF LOT NO,OF BLD S.NOW ON LOT `�17j ❑ Certified copy is hereby furnished. NEAREST CROSS T. El Certified copy is filed with the county building inspection _ TRACT BLOCK LOT NO. department. I USE ZONE MAP NO. C.� O/ Date Applicant ASSES R MAP BOOK P�/ PgRCEM� G(/j In SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL No. COMPENSATION INSURANCE 'I Y7-O WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADD SS /\ y DISTRICT GROUP TYPE CONST. FIRE ZONE PROGESSED'BV dollars($100)or less.) I im (�Z CITY ZIPS ' _ I certify that in the performance of the work for which this permit YY �� •D� _� yy//i/// is issued, I shall net employ any person in any mann so as to become subject t0 the Workers' m atiOn Law ARCH ECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. A;Z DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' R TO /� TEL NO. SET BACK YARD HW V PROP LINE WIDTH CON Compensation provisions of. the Labor Code, you must forthwith i 'g ``)'GCIT"Ic filli.? •3� FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS )�, LIC.NO P L LICENSED CONTRACTORS DECLARATION S �in W a &q 7 T SIDE TY /\ UC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 J �� G SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE NO,OF 9TORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW 11 BK PG , d License Number Arl III Q 74A Li,.Class 13 G iO DESCRIPTION F WORK ADD ❑ VALUATION O Contracto Date y� Z�� C ltJ.�. ALTER /�OA B� U ❑ I am exempt under Sec REPAIR $ 0 B.BP.C.for this reason DEMOL ❑ LDMA P/C+r W Date. USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm♦ jyl.[_ i .8 ❑ I, as Owner of the property, or my employees with wages as I Z their sole compensation, will do the work and the structure is ADDRESS 0not intended or Offered for sale (Section 7044, Business and FINAL DATE Zg Professions Cade.) o WILLTHE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL " � OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EOUAL TO OR GREATER THAN THE J TOTAL ?0 ❑ I, en ed co Of the property, am exclusively contracting 44,ith AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE4 FINAL BY ' licensed contractors to construct the project (Section 7044, YES El NO❑ ChF�., ,i�'-(•i Business and Professions Code.) - WILL THE INTENDED ECURS UBE MI THE BUIDLINGCONSTRUCTION BY THE APPLICANT OR FROM T EBUILDING SOUTH OCCUPANT AIR REQUIRE A PERMIT FOR ICT(WAGING) OR EE PERMITTING FROM THE SOUTH CONSTRUCTION LENDING AGENCY coAsr AIR ounurY MANAGEMENT DIsmK;r IscgoM0)sEE RERMRnNG cHECKusT FOR Gmosurves I hereby affirm that there is a construction lending agency for YES❑ NO❑ N the performance of the work for which this permit is issued(Sea D' 3U97,Civ.(i.) (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING ��' 4.'��}- 4'•rii T CHECKUST.I UNDERSTAND MY REOUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TITLE?.CHAPTER 2.20 SECTIONS 220 100 THROUGH 2.20,WO CONCERNING HAZARDOUS $ Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. ' '— o Lender's Address o MNER OR Assm . o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 0, with all county ordinances and State laws relating to building l6 m construction, and hereby authorize representatives Of this County ISSUANCE FEE �t e tqr n then the above r perty for inspection purposes. ' \IZ`7J INVESTIGATION FEE TOTAL FEE sb mw al.,nm�v+¢.. SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FO_R r BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY u WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN RES I hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDRESS �� or a certificate of Workers' Compensation Insurance, or a Certified copy thereof (Sec.3800,Lab.C.) ' Cay ZIP DUALITY Policy No.11s�$34 �5 Company 5TAT� rrUNl1 P�,� SI E UP LOT J NO.OF BLDGS-NOW ON LOT- ET't rtified Copy is hereby furnished. I NEAREST CROSS ST. ❑ Certified copy isfiled with the county building inspection TRACT BLOCK LOT NO department. ¢ - USE ZONE MAP NO. Date Z-13-9`Applicant �M�� `RO�F(11C: I�P- ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' I COMPENSATION INSURANCE - ILL !J' 1 DZ WITHIN 1000 FT of SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars (5100) or less.) DISTRICT GROUP TY CONST FIRE ZONE PROCESSED BY CITY ZIP ,/0 I certify that in the performance of the work for which this permit dfT, ✓/ is issued, shall not employ any person in any manner so a5 t0 dARCHITECT OR ENGINEER - TEL NO become subject to the Workers'Compensation Laws. STATISTICAL CLASSIppppppKATION APT CONDO_ ' Date Applicant ADDRESS - CLASS NQ DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' DO TRACTOR TEL SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith G �/f`r/7e791FRONT comply with such provisions or this permit Shall be deemed revoked. I? ESS L O. PL LICENSED CONTRACTORS DECLARATION SIDE V n Jr,.CLe SS P L I hereby affirm that I am licensed underprovisions of Chapter 9 IT-AIII o `' SEWER MAP (commencing with Section 7000)of Division 3 of the Business and 0.FT.SIZE NO.OF STORIES NO.OF FAMILIESv Professions Code,and m_y lice_nse is in full force and effect. NEW BK PG d License Number 4�o50b Q Lic.Class C' SLiCRIPTION OF WORK ADD C] VALU TION O Contractor SAI 0,F-.r EDW 1NC .Date 2- I-F,-51�1F nrylkYE ALTER ❑ $ J 1 V ❑ I am exempt under Sec. Q I IWMDSAIII REPAIR ❑ $ Q e&PC.for this reason 6 -R DEMOL ❑ LDMA P/c e W Date: USE of EXISTING BLDG. URM ❑ {{ d Signature APPLICANT(POINT)U�,�,�r TEL O LOMA Perm# i__ _ s Z ❑ I, as owner of the property, or my employees with wages as GJ OC I�I Ei NO�f G -7 Z their sole compensation, will do the work.and the structure is ADD EO not intended or offered for sale (Section 7044, Business and T - We 'el QQ FINAL DATE 2-JAS - Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 2 � 1 1 1'ice' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE El I, as owner of the property, am exclusively contracting with FINAL BY licensed contractors t0 construct the project (Section 7044, AMOUNTS SPECIFIED O THE HAZARDOUS MATERIALS INFORMATION GUIDE? y Business and Professions Code.) Yes❑ __ WILL THE INTENDED USE MI THE BUIDLINGCONSTRUCTION BY THE APPLICANT OR FUTURE BUILDING ':HL(:t1 '�'i v iLl OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR OUAUTY MANAGEMENT DISTRICT ISCAOMO)SEE PERMITTING CHEGKUST FOR HAITI GUIOEuwEs. t„.H146- I hereby affirm that there is a construction lending agency for YES C1 NO N the performance of the work for Which this permit is issued(Sec. 01 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,(`iIV.Ci.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, N iii it l_j- Il i%i ri iii(rte TRLE 2,CHAPTER 2 20 GTIONB 2 20.100 THROUGH 2.20.1 40 CONCERNING HAZARDOUS Lender's Name M LS REPORT G 0 R OBTAINING A PERMIT FROM THE NGERNI. E_ A QA� CFi L:.ti r i°I 17ia T o Lender's Address "•-" '`- ��` '- o a.v l oA ncExr o I certify that I have read this application and state under penalty O of perjury that the above information is correct I agree to comply P.O.FEE PERMIT FEED with all county ordinances and State laws relating to building mconstruction, and hereby authorize representatives of this County ISSUANCE FEE to enter upon the above-mentioned property for inspection purposes. (p A m INVESTIGATION FEE TOTAL FEE/D /�J / D sVnv�re or roor�i o+am out. SEE REVERSE FOR EXPLANATORY LANGUAGE