HomeMy Public PortalAbout6032 IVAR AVE_Building__ 78A898A CE#803.T58 APPLICATION F®R ' B U I L®I N • PERM 11
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BUILDI G.AND SAFETY DIVISIONBUILDING/_
Department of County Engineer. AD°Bess IG� �" "
County of Los Angeles LOCALITY 4. 14. Ce
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST '
CASSATT_D. GRIFFIN, SUPT OF BUILDING 'CROSS ST. -
` - - - DISTRIT O. - GROUP TYPE SEWER. MAP,
FOR ,APPLICANT TO FILL.IN BK ., PG
. CONST.
BUILDING -
ADDRESS' O STATISTICAL CLASSIFICATION ,
LOT NO. / ;;I--
�]` -3 BLOCK CLASS. NO�DWELL. UNITS�I
Yv1AP STAT.E_ ...YES
NUMBER- ..��U �•-� HV1/Y
TRACT
USE-ZONE. SPECIAL
NO: OF BLOGS. - CONDITIONS -
SIZE OF.LOT ,SU'x- S S. I NOW ON LOT
`4
.USE OF-
EXISTING BLDG; 42 BUILDING- EXIST..
- �YP:RD HWYS7TREETNAME.
SETBACK - WIDTH.,
OVNNER..f/rr/v 'FPOL T /P.
MAIL .:.,.. / 7 w _
ADDRESS /oD.3.•Z SIDE - ..
TEL 'P. L.'..C.Tyzi" NO' �73/S INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER' NO: - :.
ADDRESS - - -
'
-
• DESCRIPTION OF WOR$ - f •
NEW ADD'' ALTER REPAIR DEMOLISH - -SQ..FT. NO. OF 'NO.OF - - -
SIZE - :. STORIES- ":FAMILIES "` ••" -
E"OF
APPROVALS - - -
S NATURE OF. - - .. -
�'APPLICANT DATE- INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION, - -
�L.a FORMS, MATERIALS -
'�—I/ - P..C., 1000 FRAME: FIRE STOPS,
- •.
FEE BRACING. BOLTS
:FURNACE: LOCATION. ' "
VALUATION - •. $ �. I—V• .'. -
FEEGAS VENT. DUCTS.. •y
•, I'HEREBY A4KNOWLPVDG AT I JA S CORRECT AND LATH, INT. - -
PLICATION ANII�$ B
STATE/TH - ¢
AGREE.TO CO -LY W.IT CO Y OR ?NA - S,A f LATHEXT
STATE LAWS EGU . .LA G IN N N.
` �HOUSE'NUMBER COR-
PERMITTEE
SIGNATURE OF �-^��. CT AND POSTED' - -� -
- �-- -
ADDRESS. FINAL
JOHN A. L BiE,.COUNT.Y ENGINEER, CLYDE N. DIRLAM, PRINCIPAL-STAUR L ENGINEER -
PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION% CK:' o. CASH'
2 . 2 f�tiR 1. A `
F tBULUNG .P., ERNT
.- APIRUCA MN . ".P�
4'`s• .m�" :-COUNTY OF LOS'ANGELES ,.e. '. BUILDING`AND SAFETY
WORKER'S COMPENSATION-DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ,l
BUILDING ADDRESS - d
I hereby affirm that I have a.certificate,of'consenf'to..self insure,
or a certificate of Workers.Compensation Insurance,or a certified
copy thereof(Sec..3800,Lab.C:) - - CITY t ZIP LOCALIT _ -
Policy No. Company' SIZE OF LCT • NO`OF BLDGS.NOW ON LOT
ElCertified copy is heeetiy furnished. ;'t-•
NEAREST CROSS
❑ Certified copy is filed with the county building inspection TRACT' BLOCK LOT NO
department. � ® !;Z USE ZONE MAP NO.
DateApplicant ASSESSORY AP OK .PAGE - PARCEL
- •, - SPECIAL CONDITIONS• -
CERTIFICATE OF EXEMPTION FROM WORKERS' owNER _ rEL No.
'
COMPENSATION-INSURANCE- � �� S � ��
v WITHIN 1000 FT.OF SCHOOL? ,r YES NO .
(This section need not be completed if the permit is for one.hundred ADDRESS
L
ICT GROUP- TYPE CONST. FIRE ZONE PROCESSED BY
dollars ($100)or less:) '
CITY _ ZIP - •-
I.certify thatJri the performance'of'the work for which this per
is"issued, I shall not employ.any person in any manner so as to �� ✓
become subject t0'the Worker ' pens ionn'Laws.
ARCHITECT ORE GINEER � 'TEL NO. STATISTICAL - DO
V"
T. CON
n,�C'' �� A :.{ 3
Date ADDRESS CLASS NO, DWELL UNITS'
NOTICE TO APPLICANT• If, after'making this Certificate, of ;'REQUIRED TOTAL SEFB �IE FROM EXIST
Exemption; you ShOuld`'become Subject t0 ,the Workers' CONTRACT R. '"' TEL NO. _ SET"BACK PROP LINE t.,,-WIDTH
;
,i YARD. HWV 1
Compensation provisions of'.the Labor Code, you must forthwith WVt� i FRONT
comply with such provisions or,this permit shall be deemed revoked. ADDR LIC:NO. a
VS,TE Odic"LICENSED CONTRACTORS DECLARATION - �' SIDE L =, '�- -�
CITY - LIC. -ASS _ P L CASH 1 +I:� � •-L.==•!
hereby affirm:that I am licensed underprovisions of Chapter 9 ��G-
(commencing with Section,7000)of Division 3.of the Business and SQ,FT:SIZE NO,OF STORIES- NO.'OF FAMILIES SEWER,MAP C t. r�-• r:
Professions Code,a my,license is in full force an effect: NEW ❑ BK PG 0
LEIDESCRIPTIO F W RK - : -VALUATIONS U
License Number Ljc.Class ADD €�{ { I j-{l;.,31 57 'i:W
Contractor. �f1Yl�f Date >C►�y $ , r} i _
❑
ALTER-: ct
❑_kam`exemp'Cunder Sec. 91
REPAIR'
BAP.C.for this reason DEMOL ❑ A #
LDM P/C .t y
Date USE OF EXISTING BLDG. URM ❑
Signature - - - APPLICANT(PRINT) -. TEL NO.'. - LDMA Perm a s '�'•{,•` - ^ t,.
•❑ as-owner of the property, or'my-employees with wages as ADDRESS Z. 105 tit,•_} 1
their sole compensation will do'& work and the structure'is .. ,}
not Intended or offered for Gale(Section 7044, Business and FINAL DATE ' Q ITEMS
PfOfeSS10r1S Code.). - - WILL THE APPLICANT OR-FUTURE BUILDING OCCUPANT HANDLE A•HAZARDOUS MATERIAL 33 A` 50 - '
ORA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE - - J `{f I S I'7{..:
❑ I, as owner of the property; am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY I > E,^ :f
licensed.contractors-to"construct the project (Section 7044, _ A _6 1 s•s__
P 1 NES❑ NO❑ • ASH
Business and.Professions Code.), F{y{{
WILL THE INTENDED USE OF THE BUIDLING BY THE;APPLIOANT OR FUTURE BUILDING +,. i.r! !'+i.�`
OCCUPANT REQUIRE A PERMIT FOF CONSTRUCTION OR,MODIFICATION FROM THE SOUTH - `^'`•, t
CONSTRUCTION.LENDING` AGENCY ' COAST AIR QUALITY MANAGEMENT,DISTRICT(SCACMD)SEE PERMITTING CHECKLIST FOR -
GUIDELINES.
I hereby affirm,that there is a construction lending agency for vas'❑ : No r c{ ,t
the performance of'the work for which this permit is issued(Sec.
i l{f11r Irt_t1 t
'INANE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD,PERMITTING � '•1-• ' ! .
3097,CIV.C.) CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDEWTHE LOS ANGELES COUNTY CODE,
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 6s�.9I_} 1
rn JLender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE'SCAQMD, S
Lender's Address-
er - OWNER OR AGENT
3 I certify that I have"read this application and State under penalty
IL of perjurythat the above Information Is correct I agree.to comply. P.C.FEE PERMIT FEE
10 with all county ordinances:and State laws relating g to build ng
IM constru d hereby authorize'representatives of this County ISSUANCE FEE
to ente upon th abov anti n d property for inspection purposes.
$o INVESTIGATION FEE TOTAL FEE -
N \rjg_wt a or Apocani or Aq 1 Gale
f SEE REVERSE FOR EXPLANATORY LANGUAGE