HomeMy Public PortalAbout5415 HILTON AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
_ COUNTY OF LOS ANGELES
[OWNER
UILDING 541 s- H I LTO nI � DEPARTMENT OF COUNTY ENGINEER
ADDRESS
ITY�� �'/_ /7 7 ZIP q/ BUILDING AND SAFETY DIVISION
//� n. /E NO.OF BLDGS. BUILDING
1 ZE OF LOT SPU/\ G� NOW ON LOT / ADDRESS �' �/
RACT/0mo�[Qa LOCK LOT NO. LOCALITY J
h/f-� �/ F AC EL. 25''5 328' cNR�osssi.DDRESS SPCME i15.7el.33 K PAGE PARCEL
DISTRICT GROUP TYPE FIRE RO ED BY
.CITY )' 1 ZIP �p,TEL ¢ r OQ r CONST,/ ZO�
ENGARCIINEER ITECT OR �U T�/ NO:+llJ.1J�OY J CJ I
' LL,� STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS St>cVL� �S Rr��i9vv� CLASS NO. a/ DWELL.UNITS K BK5'3PG
TEL.
CONTRACTOR NO. USE ZONE -
NOP �C
p
ADDRESS NOO. /l� SPECIAL
LIC. CONDITIONS
CITY
CONSTRUCTION LENDER CLASS ROAD DEPARTMENT APPROVAL REQUIRED VES ❑ NO ❑
NAME AND BRANCH /I-- BLDG.SETBACK FROM
4
ADDRESS ee"11C.S ,-LZ D i t FROM PROP.LINE OF (STREETI
CI Y TOTAL SETBACK FROM TYPE OF EXISTING
SO.FT. .OF NO.OF / CHECK HIGHWAY } YARD = FRONT PROP.LINE HIGHWAY WIDTH
SIZEjr
t FAMILIES / ONE �.
DESCRIPTION OF WORK OVln �.P�2f 4W NEW ❑ + 0
ADD BLDG,SETBACK FROM m
awl C1 �(�5�1.✓i+�'ZOt:>� <fe-^c. SIDE PROP.LINE OF (STREET) O
((--'' ALTER ❑ w
emJn SG j- LJt-yi,-16LJ 16 _R- C .3Y HIGHWAY + YARD = TOTAL SETBACK FROM TYPE Of EXISTING
REPAIR ❑ SIDE PROP.LINE HIGHWAY WIDTH w
USE OF
EXISTING BLDG.2es(��y � DEMOL ❑ +
APPL
WRICA
NT) _ / A! �/ r JACOfTEOL CORNER CUTOFF VES NO
BYISIGNATUREI IN OPEN SPACE VES ❑ NO ❑
NhJ IN COASTAL PERMIT ZONE YES NO
VALUATION$ (J V l./^—
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION. CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE.
SIGNATURE OF
PERMITTEE
ADDRESS -41 ` 91 p � ' FINAL /_ /J / BY
CITV�e'VC�� t Q( � C TEL �� DATE
MAKE CHECKS PAYABLE TO: .3 FEE $ FET S • p
HARVEY T. BRANDT•COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.D. CASH
2 .7 8r-,M 4 1 0• 1 5.0 0 A9d
es 76A63BACEd8033J5'
76A638.CE #8031/71 —T'G i fr
AQPLICATION FOR BUILDING PERMIT
f COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BADDUILDING ^ I
RESS !�
COLEMAN W. JENKINS, SUPT DF BUaowc LOCALITY r
FOR APPLICANT TO FILL IN NEAREST
Print or tvDe onIvI CROSS ST.
BUILDING//��//���� DISTRIC NO. GROUP TYPE /// PROC SSED BV
BUILD IJA{ "O CONSTADOR .
STATISTICAL CLASSIFICATION SEWER MAP
LOT NO BLOCK 4,• CLASS NO.�_OWELL,UNITS'+ BK JPG
53
TRACT , Z - 3 -,z - USE ZONE MAP �A �,
BIOGS.
SIZE OF LOT NOW ON LOT 21 SPECIAL
USE OF ` CONDITIONS g44/k_ Z
EXISTING BLDG. ,s'
OWNER rf r (!?P, NE �y BLDG.SETBACK FROM
ADDRESS ZOE FRONT PROP.LINE OF t L (STREET)
TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
CITY HIGHWAY WIDTH FROM C
ARCHITECT OR TEL .L.
. 5"'t_ � c5c� -7 } 2-0
= SL
ENGINEER NO.
BLDG.SETBACK FROM
LIN
ADDRESS SIDE PROP,LINE OF (STREET)
T
TEL. TYPE OF ESTING SETBACK HIGHWAY } YARD = TOTAL �
W -
CONTRACTOR y NO. HIGHWAY WIDTH FROM C.L. U
ADDRESS NO }
CD
'CITY CLASS CORNER CUTOFF YES ❑ NO ❑ W
CONSTRUCTION _ENDDEa CL'
NAME AND BRANCH �( SEE REVERSE SIDE FOR SPECIAL/APPROVALS z
ADDRESS -
SO. FT. NO. OF NO. OF NEW C1/
SIZE STORIES FAMILIES ❑
USE O ADD
STRUCTURE LU gLTER ❑ / a
REPAIR❑ .7Z
SIGNATURE OF
APPLICANT DEMOL'❑
VALUATION S �a 67 61 111
APPROVALS GATE INSPECTOR'S SIGNATURE
Ft PMT. 7's FOUNDATION:
FORMS MA TERCAL90N //_ 93 //• 9f'/� Tb�
FEEE 5 o FEE S
FRAME: FIRE STOPS, /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS W/
ANDSTATE TXAT THE ABOVE IS CORRECT dN0 AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUCTION. CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.
LABOR [DOE OF THE STATE OF 'CALIF ORNIA IN RELATING TO
WORKMEN'S COMPE! ATION INSURANCE. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
RECT AND POSTED 7JT aM
ADDRESS �A, �ji 6 � tia L� AL
FIN
O
JOHN F. LEWIS. PRINC RAL ST �C-71�)JR.AL ENGINEER
PLAN CHECK VALIDATI cKo. CASH PERMIT VALIDATION .O. CASH
ilp9.4 9 3� D 7 7.85s V
LAW 9648 NOV 6 1 D 12 9.7 5
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
LDIN ADDftess
euI /JrG '
I hereby affirm that I have a certificate of consent to self insure, // To T
or a certificate of Workers' Compensation Insurance, or a certified [_
copy thereof (Sec. 3800,Lab. C.) clivcT/ ZIP
Policy No. x.29 91�� 1.mpany d / �1 ��� LOCALITY
/ �7 SIZE OFLOT NO.OF BLDGS.NOW ON LOT
`Certified copy is hereby furnished. NEAREST CROSS ST
❑ Certified co is filed with the count building TRACT BLOCK LOT NO. �7LIvG
copy y g inspection USE ZONE MAP NO.
department. /� /� /-/0
J Zee
_
Date Zn�pplicant _ ONvy //O Zee ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS ,
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �/ TEL N0. '
COMPENSATION INSURANCE /A"4r` �N —� O!) WITHIN 1000 FT.of SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred ADDRESS � )
p p 0/V DISTRICT GROUP TVPE,CONST FIRE ZONE PROCESSED BY
dollars ($100) or less.) �/
CITY ZIP /`.-GJ
I certify that h the performance of the work for which this permit Cy
is issued, I shall not employ any person in any manner 50 as to ARC ITECT OR ENGINEER TEL NO.
become subject t0 the Workers' mp�en5yati0n Laws. /�1� ,, STATISTICAL CLASSIFICATION APT CONDO
Date Z4 Applicant Q/W) �� -Citi ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT.' If, after making this Certificate of LFRONT
TOTAL SETBACK FROM EXIST
Exemption, you should become Subject to the Workers CONTRACTOR // __ N0. YARD Fri PROP LINE WIDTH
Compensation provisions of.the Labor Code, you must forthwith DQ O (fie — d�comply with such provisions or this permit shall be deemed revoked. AppRESS �n �� LIC.NO. / /v'LICENSED CONTRACTORS DECLARATION CITY ! LIC.CLAS 3
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO,OF STORIES No.OF FAMILIES
Professions Code,and my license is in full force and effect NEW ❑ BK PG d
License Number_ T Lic.Class DE CHIP N OF WORK �-+l ADD ❑ VALUATION
Contractor (�l9/LPJ Hd"//PO Date -_ � J// ^ /-2— ALTER 11 $
0 0Cv �
El am exempt under Sec. Y p/ REPAIR 11 $ 0
B.&PC. for this reason .Q y O.�/[h'/Ji'/ DEMOL ❑
DMA P/C# W
Date: USE of EXISTING BLDG. URM ❑ a
Signature _ Z
APPLICANT(PRINT) TE NO Q LDMA Perm#
El 1, as owner of the property, or my employees with wages as Ally O -8,L= �T9, ,Z
their sole compensation, will d0 the work and the structure is. ADDR SS
not intended or offered for sale (Section 7044, Business and /CYC I
Professions Code.) FINAL D TE Q
WILL THE APPLICANT OR FUTURE HAZARDOUS
OCCUPANT HANDLE A HAZARDOUS MATERIAL 9
❑ 1, as Owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL /� _1 i f,I
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'S ~
licensed contractors to construct the project (Section 7044, YES❑ No I--] � � O"HIL 169 - 65
Business and Professions Code.)
WILL THE INTENDED QUIRE USE OF THE BUIDUNGCONSTRUCTION
BY THE APPLICANT OR FUTURE EBUILDINGSOUTH :.w .�`�"ey--
OCCUPANT
cOASTA IR REQUIRE A PERMIT FOR CONSTRUCTION DR MODIFICATION FROM THE SOUTH i.{'I J�.
CONSTRUCTION LENDING AGENCY COAST n
ouaury MANAGEMENT DIsrRlcr IscAOMDi SEE PERMnNc cHECKusT FOR
culDauNENEs. CHANGE,`iH�4�i!- .L'ii 1
I hereby affirm that there is a construction lending agency for YES El NO❑ _i
the performance of the work for which this permit is issued(Sec.
3Dg7, QV.(,.) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING
ry CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. _ _
TITLE 2,CHAPTER 2.20 SECTIONS 2.20 100 THROUGH 2 20.140 CONCERNING HAZARDOUS i_ " 'y I y 3
Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. "t Ir'ti -i,l))� 1• 12•i�'
o Lender's Address I`}y._, 1 Ar!
p ONNER OR AGENT
o I certify that I have read this application and state under penalty
of perjury that the above information is Correct.I agree to comply P.C.FEE PERMIT FEE
01 with all county ordinances and State laws relating to building
AE construction, and hereby authorize representatives of this County ISSUANCE FEE
RR to ant Iro an the she -mi property for inspection purposes. ��• 70 '
INVESTIGATION FEE TOTAL FEE
sgoe ro jE l Nm �
F SEE REVERSE FOR EXPLANATORY LANGUAGE