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HomeMy Public PortalAbout8927 HERMOSA DR_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (P,iFt O. ry P. oMv) [ADG;AESS7L�:7� �� COUNTY OF LOS.ANGELES DEPARTMENT OF COUNTY ENGINEER ziP . BUILDING AND S TY DIVISIONNO.OF BLOCS. BUILDING / Ue ) NOW ON LOT ADDRESS BLOCK LOT NOl/ c�J/O// LOCA LIT NEAREST OWNER NOa p G'7 O/, CROSS ST. ` ASSESSOR ADDRESS,5 Q MAP BOOK PAGE PARCEL DISTRICT I GROUP ITYPE FIRE ESSED BY CITY ZIP egg t ARCHITECT OR - TEL ENGINEER NO. STATISTICAL CLASSIFICATION EWER MAP ADDRESS CLASS NO.,21 DWELL.UNITS Bllw�FG- CONTRACTOR NEE . USE ZONE MAP LIC. NO. D O ADDRESS NO. SPECIAL CITY - LIC. CON OITIC CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION L NDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY HIGHWAY YARD TOTAL SETBACK FROM TYPE OF EXISTIN SIZE STORIES FAMILIES Sp. FT. NO.-OF NO •ONE OF CHECK FRONT PROP, LINE HIGHWAY WIDTH _ r DESCRIPTION OF WORK NEW a ❑ CD �C uBLDG.SETBA KFROM ILD ADD ❑ SIDE PROP.LI OF (STREET) ¢ C LTER ❑ HIGHWAY } YARD _ TOTAL TRACK FROM TYPE OF EXISTING U EPAIR❑ SI HIGHWAY WIDTH w [L USE OF } = y EXISTIN BLDG. DEMOL ❑ z APPLI'Cq NT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) INOPEN SPACE YES ElNO 1:1` C IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ Od 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ TNIB APPLICATION //_ ���� �Ld� Gd C.4ridA% a✓/Tf�' AND STATE'THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .y WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STR UC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STeTE OF CALIFORNIA IN RELATING TO WORNMEN:S CO MPE NOyO,rTION INSURANCE. SIGNATURE O PERMITTEE ADDRESS FINAL BY TEL. CITY NO. DATE dL1FE CRECKS PAP:IBLE TO: P.C. $ PMT..$ FEE' FEE J HARVEY T. BRANDT, COUNTY ENGINEER PLAN'CHECK VALIDATION CK. -M.O. CASH PERMIT VALIDATION CK. M.D. CASH 7 1 S'Nov 10 1 u 1 2.0 0 ego TGAGSBA CEIIBOJ 5/74 ti APPLICATION FOR BUILDING PERMIT (FOR APPLICANT TO FILL IN (Print or Hoe only) FFN, f� ING COUNTY OF LOS ANGELES ESS J / i✓ IS�.n• /sJ DEPARTMENT OF COUNTY ENGINEER �m � �/T ZIP lid BUILDING ANDS Y DIVISIONNO.OF BL T BUILDINGFyLOT�) NOW ON LOT ADDRESS) (J BLOCK LOT NO. �O / LOCALITTEL, y / NEAREST NO. d // CROSS ST`� O� ASSESSOR E��// l/ p MAP BOOK PAGE PARCEL JR' CC A ZIP DISTRICT GROUP COYN� FIRE RO SSED BY TECT R TEL.EER NO. STATISTICAL CLASSIFICATIONEWER MAPSS CLASS NO.�DWELL.UNITS BKACTOR L!O -USE ZONE MAP LIC. q//TNO. O U NO. I` — SPECIAL -rv - LIC. ` CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SE BACKFROM. FRONT OP.LI NE OF (STREET) ADDRESS CITY _ TOTgL SETBACK FROM TYPE OF E%(STING NO. OF NO. OF CHECK HIGHWAY } YARD — HIGHWAY WIDTH SQ. FT. FRONT PROP. LINE SIZE STORIES FAMILIES ONE } — y DESCRIPTION OF WORK NEW ❑ O LOG.SETBACK FROM V 'SCp,./,yce A .y ./ ADD ❑ BIDE PROP.LINE OF (STREETI O ALTER _ TOTAL SETBA FROM TYPE OF EXISTING rN�.� /� &�� ✓ ❑ HIGHWAY } YARD - HIGHWAY WIDTH W EPAIR SIDE PROP. LI [L USE OF } = Z EXISTING BLDG. DEMOL ❑ _ APPLICAN /jTEL ` ,f CORNER CUTOFF YES Cl NO (PRINT) KJ!/per -G /fc iU NOZa7-G4d BY (SIGNATURE) - ,� IN OPEN SPACE YES ❑ NO ❑ ' IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION,$ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON �C .6i1.1��_ /0�� STRUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED / ^� � �AIC,, f�G O,,C 1 HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE ST/1TE OF CALIFORNIA IN RELATING TOG"1] WORKMEN'S COMPENSATI N INSURANCE. SIGNATURE OF ' PERMITTEE ADDRESS O TEL FINAL _ B/ C 11EY�J � `�- NO � DATE PMT ,l1AKE CHEC S PA)ABLE 7"O: P.C. QQ FEE'$ FEE''P FEE HARVEY T. BRANDT, COUNTY ENGINEER PLANCHECK VALIDATION CK. M D: CASH _ PERMIT VALIDATI cK. \ .D. CASH 710 Hov 10 1 0 12.00A 78A838A CE%003 5/74" W ' L WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of coosenl to self - APPLICATION FOR* BUILDINGS 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 copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ® Certified copy is filed with the county building indpec- - BUILDING ['' ,L ' - .r��/ / �/ - tion departmenv • /'' ' ?" ADDRESS �..7 /k/t 1 �,/ �LV(/. Date ;2 `Applicant �72E'ey/ 1320$. CITY `H7 ZIP LOCALITY --- CERTIFICATE OF EXEMPTION FROM WORKERS' ' " - NO.OF BLDGS. -- NEAREST - `COMPENSATION INSURANCESIZE OF LOT NOW ON LOT I CROSS ST. Q " (This section need.not'be completed ifthepermit is-for one - TRACT - BLOCK LOT NQ ASSESSOR..._ - hundred dollars ($100)or less.), MAP BOOK •' PAGE PARCEL TEL' USE ZONE MAP �J� - .OWNER LC/ Y I'certify that in the performance of'the work for which this qq C� - 2 C�.0 E/1� NOa3. NO, permit iE.issued, I shall not employ any person in any manner gDORE55d_3/ eL✓'�/ - �. .. !, �/ SPECIAL - - d so as'I6 become`subject to the Workers'Compensation Laws. `^ I �q CONDITIONS V CITY O/"?N 1 x"/��Nb ZIP Date Applicant ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT„ GROUP TYPE FIRE PR ESSED BY. H Exemption; 'you should become�subject to the Workers' ENGINEER NO. CONST. ZONE V W Compensation provisionsofthe Labor Code,•yov musbforfh- ADDRESS 70� �3 I d with comply with such provisions or this permit shall be _ -- -y G p ��� TE STATISTICAL C ASSIFICATIO PT CONDO - deemed revoked. ,,, CONTRACTOR ic_c �5, N •-• I _ _ LICENSED CONTRACTORS DECLARATION •1 LIC q� r CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 4), 1�0�6[Le NO..?0 .SCJ (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 Z/IL &VUI+ CLASS Q-^�� ` BR. � "• - VALIDATION _ _ SO. FT .h NO. OF _ NO.OF _ _ _ CHECK License Number e'�C/ ���jjj<J Lfc Class L7_,11/ SIZE /00 STORIES FAMILIES ONE 6A• N 23an.5.- • a p , - - - VALUATION Contracto � Date O DESCRIPTION OF WORK � NEW- o : � oc� as / ADD , 1 am exempt under Sec. /JVD //�/'°1 P.i C,, v 1 C�/ ALTER f B.BP.C. for this reason REPAIR ." Date: - USE OF DEMOL 4 8 A EXISTING BLDG. _ _ _ Signature ""'T TEL FINAL # e • e e s OWNER-BUILDER DECLARATION (PRINT) 1LeE/xI 132 N0.7 '� _DATE 1-hereby affirm that,I am.exempt from the Contractor's License 3 t.LJ. � + 4�. - ( ° ^ 4 0.;5.0 Low for the following reason•(5ection 7031.5, Business and ADDRESS PF '� "Professions Code):" - PRESENT 1 • ° ° 4 Q 5 0 U I, as owner of the property, or my employees with BUtUNING ADDRESS wages as their sole compensation,will do the work and ' �d 0 206-85 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, J with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). . - REQUIRED TOTAL SETBACK FRO X CONSTRUCTION LENDING AGENCY - SET BACK VARD HWV PROP. LINE WI DTH 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 / 7 P.I. _ Lender's Name �'.^ �. LDMA Ref. N m P.C. Fee$ -- - Permit Fee Cl - Lender's Address + I certify.form have read this a gree totio comply state that the Issuance Fee Q e LDMA P/C R , - a above information is correct. I agree to comply with all County Invesiigaiion Fee 0 ordinances and Stdte lows relating to building construction, _ _ and hereby authorize representatives of this County to enter Total Fee LDMA Perm. N - - - m upon the above- tioned property for inspection /purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE • Signature of Applicant or Agent - - Date - - -- - - -- - - - - - -� -- - ORKERS"COMPENSATION DECLARATION J insure,, affirm that Bove r certificate of consent to self APPLICATION :FOR BUILDING PERMIT insure;, ora cerlifiFate of Workers' Compensation Insurance, or o certified copy thereof (Sec 3800, Lab. C.) \ \ Y " `+�. `•COUNTY;OF LOS 'ANGELES, BUIL N S FETY Policy No. Company - ^ ` '- Certified copy is hereby furnished. - F R' PPLICA T.T 'FILL I` ,-_� BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS LOCALITY Applicant CITY t ��' NEAREST Date A pp '� C ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT o X/Sa NOW ON LOT © MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TRACT (This section need not be completed if the permit is for one USE ZONE NMAP O. BLOCK LOT NO. NO. ' �-'+ TEL. V/lr / I SPECIAL I certify that in the performance of the work for which this OWNER l /�i f� fj3✓NO. .z G'6�9 �' CONDITIONS d permit is issued, I shall not employ any p rson in any manner DISTRICT .GR UP TYPE FIRE PROC SED BY Q so as to become subject to the Worke o em ti Laws. ADDRESS y L r.G �� /�/ ^I CONST ZONE U Dare YO .22`$p CITY t Q ZIP `///BD O Applicant STATISTICAL CLASSIFICATION APT. NDO. H ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of yn 5y / �q(� 3 V ENGINEER ,LL /� S /'B NO. L�7�7G CLASS NO._(%:1ZLDWELL. UNITS '� W -Exemption, you should become subject�to the Workers' d Compensation provisions of the Labor Code, you must forth- N ADDRESS - SEWER MAP with comply with such provisions or this permit shall be r Z deemed revoked. CONTRACTOR �� l t / / TEO. / Gy BK. PG, -VALIDATION A LICENSED CONTRACTORS DECLARATION L 1 hereby affirm that I am licensed under provisions of Chopter 9 ADDRES 39� �' , L Ar NO. - yAEUATION # e o e e '2 3 (commencing with Section 7000)of Division 3 of the Business and LIC. 1 Professions Code, and my license is in full force and effect. CITY CLASS $ / ���' 1 e e 57,38 SO. FT.fH NO. OF NO. OF CHECK License Number Lic.Class SIZE K! 33 STORIES^ i— FAMILIES 3 ONE �) o o e 5 7.3 8 v Contractor Date DESCRIPTION OF WORK Cm t/s /L' NEW $ #0/ 0✓ 1 Q 2 2+8 5 to ADD ❑ - A25L3A am exempt under Sea ! ALTER ❑ FINA DAT"J;- e o 0 0 23 B.BP.C. for this reason REPAIR ❑ - USE OF Date: EXISTING BLDG. � DEMOL ❑ 9y A 1 - 774,57 Si nature APPLICANT /,t g OWNER-BUILDER DECLARATION PRINT - -C_ r z77�F+`+'YS 7 7 Q, 5`J 5 I hereby affirm that I am exempt from the Contractor's License AiS///p / f�// Low for the following reason (Section 7031.5, Business and ADDRESS 3 L vG� / /y 0 7,2 5-8 5 Professions Code): PRESENTt O ` I, as owner of the property, or my employees with BUILDINGADDRESS wages as their sole compensation,will do the work and t t t # th ructure is not intended or offered for sale(Section LOCALITY 04, Business and Professions Code). MOVING TEL. ' 1 - 989.25 I, as owner of the property, am exclusively contracting CONTRACTOR NO. ; t• s with licensed contractors to construct the project (Sec- ADDRESS .�3 \ 4"` s �,t, v �,- C� ° ° 9 8 9.2 5 5 tion 7044, Business and Professions Code). _ '1 REQUIRED TOTAL SETBACK FROM EXIST. I -� i \ 1 \ 1 1 0,2 2 —8 5 CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LIN 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.I. (Sec. 3097, Civ. C.). SIDE , zo P.L. Lender's Name '7 �Q � Lender's Address P.C. Fee S / I Permit Fee /Q/Vr 75 rc 1 certifythat I have read this application and state that the 105 pe Issuance tae above information is correct. I agree to comply with all County Invesligation e 91� ` g ordinances and Stat s relating to building construction, Total Fee 8 V G and here)?y outho ze r res tatives of this County to enter up h bove- anti d r for inspection purposes. - D.- SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent Data ®s