HomeMy Public PortalAbout5932 IVAR AVE_Building__ •
APPLICATION FOS BUILDING' PERMIT' ' . '.... .
'FOR'APPLICANT TO FILL IN (Print:or type cnlr)
BUILDINGf COUNTY. OF LOS•'ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
c I TY f- . C �` .Z i P BUILDING AND SA TY•=�DNISION
�) �g�No.OF,BLDGS.. BUILDING' '7
SIZE OF LOT✓2 ij a NOW ON LOT ) � ADDRESS I�'g'�
TRACT 15,100 - BLOCK L .•/ Z6' _LOCALIT�Y
t
TEL. `ZNEAREST
OWNER 'GC _, 'G:�. -L•- NOr
' , R ~ CROSS ST. _ -�;
s
ASSESSOR x
ADDRESS
•� _.a"`MAP BOOK ,. PAGE PARCEL
DISTRICT' GROUP TYPE FIRE ESSE BYt
�• •-.� '� CONST, ••`Z
CITY '4..i./ .ZIP". �L��• - ,
ARCHITECT OR._, ,r -4. 'TE
ENGINEER `/ +✓.ji •� NO:
y• STA TIS TICAL,CLASSI,FICAT•ION{ .
ADDRESS
�7 �, SEWER MAP
_ CLASS NO.�DWELL',UN6TS
CONTRACTOR' T1.�f'J�C?. NOL_ U �zc
NE MAP ..
LIC. NO.
.,ADDRESS' , _..•sp,^�,.'l�=l- 0! NO �.'..a. o. SPECIAL,- ;
LIC CONDITIONS '
CITY e1' G..c'�,�,:2�� CLASS .13' " .. -
_ .ROAD DE PA,RTMENT APPROVAL REQUIRED -.'YES❑ NO
CONSTRUCTION LENDER
NAME;AND BRANCH BLDG.SETBACK FROM
FRO PROP..LINEbF • '(STREETI. ..
ADDRESS CITY NIGH AY } YARD = TOTAL SETB'A:CK'FROM TYPE=OF' EXISTING`•
5Q.-FT.' NO.-OF NO.,OF.. �CHECK: � FRONT PRO P:*LINE HIGHWAY 'WIDTHSIZE - STORIES - ` 'FAMILIES •ONE -
DESC RIPTION OF WOR-K �i �/ `NEW ❑
ADD BLDG.' BACK FROM "
C�
:� -..�- � y„� � -� �: _ �� SIDE PROP. (STREET)
.-ALT E.R ❑ O AL'S A°C K PR VPE OF EXISTING
•.. " HIGHWAY + -,. YARD'.'= W
r - SIDE PROP: LINE HI AY. WIDTH •,
- REPA.IR❑
EXISTING'.BLDG. iF �✓( DEMOL ❑
APPL I•CA.NT .pL T.EL tn..° / C ''CORNE.R CUTOFF YES..❑ ,"NO'❑
.IPRINT) .,��.�+1 'I�L�Y er NO..�
y -L •'BIZ IN OPEN SPACE _ YES ❑ NIPJ_
',BY (SIGNATURE), -
IN COASTAL PERMIT ZONE YES ❑ "NO
VALUATION��.
'.'I HEREBY ACKNOWLEDGE THAT I•HAVE READ THIS APPLICATION'
'.AND,S'TATE THAT. THE ABOVE IS CORRECT AND AGREE TO COMPLY -
"WITH ALL ORDINANCES- AND LAWS REGULATING BUILDI.NG-CON-
-'STRUCTION. I CERTIFY, THAT IN DOING.THE-WOR K,AUTHORIZED
THEREBY- I WILL "NOT.`EMPLOY,ANY PERSON IN VIOLATION OF THE $ z -
LABOR. CODE OF•THE SY TE OF''OCALIFORNI IN RELATING .TO.
-WORKMEN'S COMPENtT
S 10 'I, ANC E..' -
'
E -
SIGNATURE OF �.�
PERMITTEE -
._ -
ADDRESS-
FINAL(✓ t
TEL. B.Y.
CITY.. - c f ',4cfflNO. / DATE /
i3-IAKE CHECKS PAY.AI3LE:.T•O: P.C.'$ PMT.;
FEE' FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN'CHECK VALIDATION CK. . M.o. CASH - o PERMIT VA D TION ;CK. M o., CASH
4 1_8 CT.'� . 1
76A638A-CE#803 574
APPUC ATT ON FOR BULL G PERNT
COUNTY OF.LOS ANGELES BUILDING AND'SAFETY
FOR APPLICANT TO FILL IN BUILDING D ESQ
WORKER'S COMPENSATION DECLARATION'' ��3� �.
hereby affirm that 1 have a Certificate,of consent to self insure, B Dg SS
or a certificate.of Workers"Compensation Insurance,or a certified
copy thereof Sec.3800,Lab.C.) ZIP
LOCALITY
Policy Compan;� SIZ OF LOT NO.OF BLDGS.NOW ON LOT f
Certified copy is hereby furnished. ` NEAREST CROSS ST.
❑ Certified copy is filed with the c my buildin n pection TRACT BLOCK- LOT NO.'
department' -USE ZONE MAP NO. -
Date, Applican ASSESSOR MAP BOOK PAGE PARCEL �j�/
r SPECIAL CONDITIONS �//
CERTIFICATE OF EXEAzl
MP FROM WORKERS'. o ER CL TEL N YES NO
COMPENSATIO INSURANCE VIN 1000 FT.OF SCHOOL?
(This section need not be completed if the per is for one hundred AQaE,A n
DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY'
dollars($100)or less.)
I certify that in the,performance of the work for.which this permit
is issued, I shall not employ any person in any manner_so as to ARCHITECT OR ENGINEERTEL NO. C!
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION 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 1. CONTRALTO SET BACK YARD .HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,-you must forthwith `'T./ '"�°P FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS r� LIC.NO. P L
LICENSED CONTRACTORS DECLARATION 1,6 �V r� 7 SIDE
L c j/l L .CLASS P L
I hereby affirm that I am.licensed underprovisions of.Chapter 9. SEWER MAP
(Commencing with Section 7000)of Division 3 of the Business and SQ.FT.S Q NO.OF STORIES NO.OF FAMILIES.
Professions Code,and m license:is in full force and effect.
effffeect. NEW ❑ BK PG'. D License Num/�b'er r 9 ? Lic.Class `•9 R TION OF WORK - ADD ❑ ;VALUATI N a
Contractor�/� � Date a ALTER ❑
1�L �Da6� I REPAIR $ O
ElI am exempt under Sec.
B.&P.C.for this re son
�' 0 EMOL ❑ LDMA P/C#. W
DatP,/1 - USE OF EXISTING BLDG. - URM ❑ Q-
.Signature KA C- _APPLICANT(PRINT) TEL NO. - LDMA Perm#
❑ I, as owner of the perty, or my employees with ages'as Zr''t'
their sole comp on, will do the work and the structure is ADDRESS O
not intended or offered for sale (Section 7044, Business and FINAL DATEy
PfOfeSSIORS Code.) WILL THE APPLICANT.OR FUTURE.BUILDING,OCCUPANT HANDLE A HAZARDOUS MATERIAL A.�j.�•L�
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE d
El I, as owner of the'property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY _ �'D
licensed contractors to construct the project (Section 7044, VES El No❑ E,z w
Business.and Professions Code.) f^•fir;•r ti;;y
-
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - _...__.. -
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR .. i''L; I'•3ieN =1�$
GUIDELINES. `=S'•`"`"'"^' »
I hereby affirm that there is a construction lending agency for YES Cl No❑
N
the performance of the.work for h' h this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING »r
3097;CIV.C.) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ,�,_,_ a)I:j I� =j•; _ , _
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS
Lender's Name - MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.
o Lender's Address
OWNER OR AGENT
o I certify that I have read this application and state under penalty
oP.C.FEE PERMIT FEE
of perjury that the above information is correct.I agree to comply
N with all county ordinances aW State laws relating to building
< construe and hereby But r e representatives of this County ISSUANCE FEE
to en e up the above-me to ed property f ns#onpuposes/ INVESTIGATION FEE TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE