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HomeMy Public PortalAbout9123 HERMOSA DR_Building__ DIVISION OF BUILDING AND SAFETY ® ®p Department of County Engineer 1 @� �® - - County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION-717' - FOR APPLICANT TO FILL IN g FOR OFFICE USE ONLY -�/i DIBTRICT NO. PLAN C. OR REM.NO. PERMIT NO. BUILDING / ADDRESS I '''/ 1 R CHIVED BY DATE OF APPL. DATE ISSUED LOCALITY NEAREST ROBE T. I BUILDING ADDRESS OWNER \ I� MAIL LOCALITY ADDRESS pC i n / ' NEAREST Y G a �r TEL GROSS ST. NO. FIRE NO.OF TYPE GROUP ARCHITECT R TEL ZONE PLANS ENGINEER N0. O. L' ' I SETO. BACK LINE GI° N ADDRESS I _USE APPROVED CONTRAOTO [ICS C> °NE -� BY O- DATE HOUSE NUMBERING !:Z - ADDRESS ..rr�i�`-�✓� MAPNUMSERio�NO. ASSIGNED BY _ LEGAL / CORRECTIONS DEBCRIPTION LOT N0.3 b 'I// BLOCK TRACT -Tq O N4 OF SLDBS. SIZE OF LOT I NOW ONLOT USE OF NO. OF EXISTING BLDG. FAMILIES DESCRIPTION OF WORS ° L1--r'N — lFn rar � D23v _ NEW I I ALTERATION _ADDITION / c D REPAIR .1 DEMOLITION �4� !�3 /�!+/1 MIT.1:2 X �. NM OF ROOMS STORIES O J 1 V/V�[, EXT.WALL RDOF CQVERIN13 DDVERING USE OF STRUCTURE /✓ /- _ O INSPECTION FOR APPROVALS OCCUPANCYAB INSPECT,OR'5 SIGNATURE DATE FOUNDATION: LOCATION I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FORMS, MATERIALS PLICATION AND STATE THAT THE INFORMATION GIVEN IB, FRAME: FIRESTOPS, CORRECT. BRACING, BOLTS 1 ABREE TO COMPLY WITH ALL COUNTY ORDINANCES' FURNACE: LOCATION, ANO STATE LAWS�REGGULATIINNG/BUILDING CONSTRUCTION. GAN CE:VENDUCTS 91BNATURE °Fl /��J! f� LATH, INT. PERMITTEE ( K JJ7TTT ADDRESS I �t$�i Q.A.LJ-.c...ci-n f+^"^'"""...�i LATH', EXT. PLASTER, INT. AUTHORIZED AS - n d PLASTER, EXT. D.8 . p� FEE HOUSE NUMBER COR- RECT AND PORTED VALUATION 8 `r FINAL 96AGZeA OB53 I-5E V. DIVISION OF BUILDING AND SAFETY BUILDING Department of County Engineer County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FO OFFICE USE ONLY DISTRICT PLAN Cc. DR Rbc. PERMIT NO. BUIcDIND 3 IL. TE 1 ,� ADDRESS RE C ED BY DA OF APPL DATE IB UED LOCALITY NEAREST- _ CROBB BT. _ BUILDINGADDRESS mon OWNER LOCALITY roe L I NEAREST TEL CRO BB ST. �•'� CITY � NO. FIRE "a.NS TYPES OU ARCHITECTO U TEL ZONE PLANE ENGINEER Y NO. BLDG. rj�yl ���/ ORD. NO. SETBACK LINE 1/ ADDRESS U8E APPROVED CONTRACTOR �If' �,e/�/l/Yy NOS, '��OQb� ZONE BY DATE /� y��,� � ��' ��fHO�USE NUMBERING ADDRESS `/' JjIVE'}IbW MAP NUMBER /m"L� �NO. ASSIGNED BY LEGAL `` CORRECTIONS DESCRIPTION LOT NO. 4 BLOCK TRACT O N0. OF BLDG& Bf�' SIZE OF LOT I NOW ON LOT USE OF I N0.OF ��-� z EXISTING BLDG. FAMILIr6 DESCRIPTION OF WORK �i A c NEW ALTERATION ADDITION - - Z D REPAIR DEMOLITION r / v ) %.,,,r. Y i+ ROOMS STORIES EXT.WALL ROOF COVERING COVERING UHE OF STRUCTURE , /i A /T/ Al-r,9 L � INSPECTION FOR APPROVALS OCCUPANCYAB INSPECTORFBBIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS -z- 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IB FRAMES FIRE STOPS, CORRECT. BRACING,BOLTS 1AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FUGRNACE:RNACESAS ,DUCTS BIONATURE OF AAofw / LATH, INT. PERMITTEEy`/�/"�%9 ADDRESS LATH, EXT. PLASTICS, INT. AUTHORIZED ART IS aPLASTER, EXT. P - .0.• 9�o FE[ HOUSE NUMBER B RECT AND POSTED VALUATION FINAL 76A6311A DBS 3 1.51 "APPLICATION FOR COUNTY OF LOS ANGELES TMENT'OF COUNTY BUILDING PERMIT DBUILDNGAND SAFETY DIVSIONR FOR APPLICANT TO.FILL IN BUILDING - /'�T ADDRESS �tVY! ADDRESS �/ �c %viJ LOCALITY `l - CITY LC % p- NEAREST ZIP p C� . CROSS ST. r NO.OF BLDGS. ASSESSOR' 512E OF LOT /-5'x�.J 'NOW ON LOT` MAP BOOK PAGE PFI DISTRICT GROUP TYPEFIRE r PROC D BY -TRACT BLOCK LOT NO. r CONST. ZO rEl. .s • ' _ _l[42uo OWNE F'L /✓.L7- . .Nm2Ir,F)'��G q !/ STATISTICAL CLASSIFICATION SEWER MAP ' ADDRESS /Jw= {LASS NO.S l DWELL.UNITS BK PG - ZIP / �'C� USE ZONE MAP -2 ARCHITECTO _ TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD.DEPA RTMENT APPROVAL REQUIRED YESNO ❑ . TEL.. CONTRACTOR NO. BLDG.S A LIC. FRONT P P.LINE OF (STREET) ADDRESS NO. � . TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHWAY,'+ YARD - FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER + C. a NAME AND BRANCH BLDG.SETBACK FROM ADDRESS CITY SIDE PROP.LINE OF ISTREETI O SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL SETBAC ROM TYPEOF EXISTING U SIZE STORIES - FAMILIES ONE SIDE PROP.LI E HIGHWAY WIDTH. i DESCRIPTION OF WORK NEW ❑ + ADD ❑ CORNER CUTOFF YES ❑ NO ❑ _—:J L/V /�" e5ob 4/ ALTER IN OPEN SPACE YES ❑ N REPAIR ❑ EXISONG BLDG. _ - (+ DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ APPLICANT_ TEL IPRINTI ,J �.�L.q.✓c7 NO.'d' BY:ISIGNATUREI I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE' 4D THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH All ORDINANCESAND LAWS I CERFY ♦�/� �^ IN MING WORK AUTHORIZED REGULAT(NG HEREBY( ING ID WILL NORTSEMPLOY ANY PERSONHINTVIOLLATONTHE OF �L/ t M I -rev - - THEtABORCODEOFTHESTATEOFCALIFORNIAINRELATINGTOWORKMENSCOM_ PENSATION INSDRANCE. 75 1 SIGNATU s PERMITTEE X S FINAL BY �I: . DATE ADDRESS TEL. P.C. Fee$ - Permit Fee CITY NO. Issuance Fee VALUATION$ / G• - - Total Fee Q�� PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION , CK, M.C. CASH 3. 67i24 . 19 9.00 °b @+3 76A63BA OE d803A 6/76 APPLICATION FOR BUILDING PERMIT Il FOR-APPLICANTTOFILLIN (Print or typeonlyl - ' Bu LDING p COUNTY OF LOS ANGELES ADDRESS- //��� .a$ lvx_— DEPARTMENT OF COUNTY ENGINEER ' CI Y% j� . ZIP. y �d BUILDING AND SAFETY DIVISION ' NO OF BLDGS: BUILDING 91,23 '- SIZEOFLOTLOT ADDRESS ^. C TRACT /', BLOCK LOT NO'.p/ / LOCALITY NEAREST- OWNER Alsi NA01 �eL a NQ�'fOfo:,;f Jy - 'CROSS ST. _ ASSESSOR - ADDRESS GA:Z. MAPBOOK PAGE PARCEL qq DISTRICT -- GROUP TYPE FIRE ESSED BY -air TC e ZIP 7r,/ !� CONST. ZONE T ARCHITECT OR - TEL ' Q4 �: ENGINEER - NO: STATISTICAL CLASSIFICATION _ SEWER MO _ ADDRESS CLASS NO.V/DWELL UNITS' BK PG -- — - / TEL CONTRACTOR pip'+ NO. US ZONE NOP .* O LIC V_ ADDRESS NO. •�� �� SPKIAL - -- - - LIC. - lll CONDITIONS. CITY " CLASS CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED - YES ❑ NO ❑ NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF - ISTREETI ADDRESS - CITY' TOTAL SETBACK FROM TYPE OF EXISTING SQ,FT. NO.OF NO.OF CHECK HIGHWAY } YARD FRONT PROP _LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK �IU.S•f19/..L...• NEW ❑ + - p r / ADDBLDG.SETBACK FROM m L A� 40 ❑ SIDE PROP.LINE OF- _ (STREET) O �`\ l ALTER ❑ TOTAL SETBACK F ROM TYPE OF EXISTING w IJ � V-F/aCE B{t�L�D C° HIGHWAY } YARD = SIDE PROP.LINE HIGHWAY WIDTH USEOF - � REPAIR ❑ - Z EXISTING BLDG. yGdSE' pDEMOL ❑ } APPI TEL LCANT NO�p(�:.��T6 CORNER CUTOFF YES NO -� a0 INOPENSPACE YES ❑ NO BY ISIGNATUR �[+ , ! IVIOLATION IN COASTAL PERMIT ZONE YES NO ❑ VALUATION$ `J 0D �zC�T o�l-N ERM� J� HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPSTATE - THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WLACES ��� D �/ r✓� AND LAWS REGULATING BUILDING CONSTRUCTION. CERTIFIO THEWORK AUTHORIZED HEREBY WF NOT EMPLOY ANY PERSION OFTHE LABOR CODE A THE STATE OF CALIFORNIA IN RELATING S COM- PENSATIONINSURgNC - SIGNATURE OE - PERMITTEE ' ADDRESS ✓ _ - - -' _ TEL. DA FINAEL /2"1771, 2 BY CITY NO. MAKE CHECKS PAYABLE TO: - FEE $ FET $. HARVEY T.BRANDT.COUNTY ENGINEER / l PLAN CHECK VALIDATION Cu. M.C. CASH PERMIT VALIDATION M.C. c—ASH ' 7:2 -NPR. 1,5 ' 1 B: 12.0 ®s 76A638ACEp803375' APPLICATION FOR BUILDING PERMIT i' COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION; FOR APPLICANT TO FILL IN BUILDING ADDRESS 1 23 I hereby affirm that I have a certificate of consent to self insure.' eu f}QDS or a certificate of Workers'Compensation Insurance,or a certified --- ' •copy thereof (Sec.3800,Lab.C.) CITY—r— ZIP Policy No. ,1 LOU Company - SIZE OF LOT OF BLDGS.NOW ON LOT ALITY - •G - ❑ Certified copy is hereby furnished. I NEAREST CRO SL ❑ Certified copy is filed with the county building inspection' TRACT ,BLOCK LOT NO. - -'kL Cti'LVL��'�✓ department. USE;ZONE MAP NO. Date Applicant 'i - ASSESSOR MAP BOOK. PAGE PARCEL - i SPECIAL CONDITIONS .. G M r(/• O - CERTIFICATE OF EXEMPTION FROM WORKERS' OWPI ' C TEL NO. COMPENSATION INSURANCE /�l.�n WITHIN 10.00 FT.OF SCHOOL? YES - No (This section need not be completed if the permit is for.one hundred ACIDITIES ell ll 1)SA ,. dollars ($100) or less.) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY CITYZIP. ,J/ certify that in theperformanceof the work for which this permit G-,. 3 is issued, I shall not employ any person in any manner so as't° ARCHITECT OR ENGINEER TEL NOV ',6 come-.subject'to the Workers'Compensation Laws. . ' STATISTICAL CLfIFIGATION APT CONDO Date Applicant ADDRESS - CLASS NO DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of REOUI RED' TOTAL SETBACK FROM EXIST Exemption, .you Should become subject to the Workers' CQ:I RA TOR TEL O. SET BACK YARD HWY - PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ' e 0 FRONT comply with such provisions or this permit shall be deemed revoked. A R ss C.NO. p L LICENSED CONTRACTORS DECLARATION © N' SIDE CITY L C. SS PL I hereby affirm that I am licensed underprovisions of Chapter 9 5 SEWER MAP a (commencing with Section 7000)of Division 3 of the Business and 50. SIE NO.OF STORIES NO OF FAMILIES p Professions Cade,/an'd�m l%ice(nfs 's in full force a(�/d�eff L NEW ❑ BK PG - U License Num _L:!_V-!_ r/ Lic.Class `-� DESCRIPTION OF WORK ,(IDD ❑ VALU Contractor �M[W-6A.A4'Lvate� 7—�3 Kt ,N ALTER ❑ $ (❑ I am exempt under Sec. s 4,,,, W REPAIR ❑ $ Z B.BP.C. for this reasonn /n DEMOL ❑ LDMA PIC x - Date: USE_OF EXISTIN BLDG_ URM ❑ " Signature APPLICANT(PRINT) TEL NO. LDMA Perm S 1 ❑,I,.as owner of the property,.or my employees with wages as Z O their sole compensation, viill'do the work and the structure is ADDRESS _ not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code.) - - _LIG lbr .4'. WILL THE APPLICANT OR FUTURE HAZARDOUS OCCUPANT HANDLE A R GREATER THAN THE '� El I, a5 owner Of the OR A MIXTURE SPECIFIED ON GEA AZAR O US MATERIAL EQUAL TO OR GREATER THAN THE - J 'I" fl'_' property, am exclusively contracting with AMOUNTS SPECIFIED ON ME HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � 'r' I r"' ' licensed contractors to construct the project (Section 7044, - Business and Professions Code.) YES El No El - - ! (-7 rt! i1 WILL.THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING r . OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH' CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR `•`.`1^l\, I hereby affirm that there is a construction lending agency for 'vas❑ No❑ '-!=) W the performance Of the work for which this permit is issued(Sec. j7 pi I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PE RMRTNG 3097,CIv,C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 3 W TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2,20 140 CONCERNING HAZARDOUS 'I'I I'�i d^Z A{— Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMO. - I'I_-I! j a 771_'i Y'y' o Lender's Address -' O � - rtJ a•vI�eR 0.a Aaem •'�L IO:! - Art vd! o I certify that I have read this application and state under penalty -' . .. . O of perjury that the above information is correct. I agree t0 comply PC.FEE PERMIT FEE I'1 V n- with all county ordinances and State Iaws.relating to building m� conslru Ilion, and hereby authorize representativesg of this County ISSUANCE FEE - \lye upon the above- ti ed pr/p'p rinse ction s.. Q _\. ,.{v.. nr f�`r// /( INVESTIGATION FEE TOTAL FEE N .�� - y, 1 J_Z ~• souw..a Plum a:ymr 1 SEE.REVERSE FOR EXPLANATORY LANGUAGE