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HomeMy Public PortalAbout6113 IVAR AVE_Building__ FORiAPPLICANT TO FILL`IN (Print or type only) .BUiyPING �L� COUNTY OF LOS 'ANGELES -ADDRESS DEPARTMENT OF COUNTY ENGINEER zIP BUILDING-AND SAFETY DIVISION. NO.OF BLDGS. BUILDING s SIZE OF,LOT-4"O&�r NOW ON LOT ADDRESS ,r •.�. TRACT" <,.,qBLOCK .LOT NO.' LOCALITY --� /� �` — " _ LV C" NOL OW NECROSS ST. , r ASSESSOR ADDRESS 7 9 } - %'t,/,(e MAP BOOK -PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED'BY CITY.. '" - ZLP. U _ ',�.,� CONS T`�Z FIRE .. ,/ E�{ ARCHITECT OR - TEL. �- ENG I'NEER NO. STATISTICAL-CL'ASSIFICATION ' SEWER MAP ADDRESS. CLASS NO. - ® � DWELL,UNITSjBK PG'; TEL. CONTRACTOR NO ,'+ USE;ZONE MAP " LIC r NO. ADDRESS NO. SPECIAL .©� CITY,... LICCONDITIONS . � .- CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑. CONSTRUCTION LENDER , NAME AND BRANCH- C BLDG.SETBACK FROM FRONT.PROP.LINEOF - --' ISTREET)" _A.DD'RESS- —_--__ CITY HIGHWAY + YARD- TOTAL'SETBACK FROM TYPE OF EXISTING 'SQ. FT.- NO. OF - NO. .OF CHECK FRONT.PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES 'ONE qq ,/.. n " DES...C RIPT.ION OF WORK NEW _ U ADD BLDG,SETBACK FROM - _ - • > � �? SIDEPROP. LINEOF - '(STREET" �- ALTER ❑ TOTAL SETBACK FROM TYPE OP EXISTING OI'- HIGHWAY. + YARD U ' - ���, RE PAIR❑ SIDE'PRO P. LINE -HIGHWAY .WIDTH d USE OF + _ EXISTING'BLDG. DEMOL'❑ Z A PPLICA t T L �� Y '•� CORNER CUTOFF YES ❑ NO "(PRINT) �-_- 0. _ BY ISI GN A'T R A - `IN OPEN SPACE YES'❑ . NO ❑ ej-�o� ati _ U V�'-�r�r. _ IN,-COASTAL PERMIT ZONE YES ❑ `..NO ..VALUATION, I HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLICATION AND,STATE THATM TE ABOVE IS CORRECT AND AGREE TO COMPLY "" .. WITH ALL ORDINANCES. AND LAWS REGULATING BUILDING CON- STRUCTION. I,CERTIFY THAT IN DOING THE WORK AUTHORIZED - HERE.BY,-I WILL NOT "EMPLOY'ANY'PERSON IN',V10 LATI ON OF'THE, -LABOR CODE".OF" ME STPTE OF -CALIFORNIA IN RELATING'TO - WORKMEN'S' PEN TION SURA CE - - i z - SIGNATU E ;�; PERMITT E - ,ADDRESS � _ TEL.- G3113 - FINgL /cam N O. DATE MAKE CHECKS PAYABLE TO P.C. $ PMT,;$ HARVEY" T:" "- BRANOT, COUNT -E GIN'EER FEE' ,O �';, FEE - PLAYCHECK VALIDATION CASH', ; PERMIT VALIDATION cK. M.o. CASH '9:2:7 c_tFP -�'� 2 3 ' - B 1. C i. 4-4roCT 7.523 a 2. 6.10e96 J 76A636A CE#803 5/71' •- .4'511-0.. ' T l.' 1 ��. ,.2'.O. ( .o' 0 Pruc, �:Q® oR Baia.®o► G: Po FOR`'APPLICANT`T0 FILL IN .(Print or'rvee.onlY)'". euILkDIN� COUNTY OF LOS ANGELES- *0DRESS / �� s .!`-` ` ] EPARTMEIV_T -OF .,COUNTY'.ENGINEER _ CITY•.�,�/`L �a�` ��. ZIP ON'4' BUILDING AND SAFETY',pNISI - (KO.OF SLOGS. meg ' BUILDING 'SIZE OF LOT ,- NOW•ON•LOT- „ADDRESS •- TRACT,, - BLOCK LOT"NO _ LOCALITY /• : _ ..TEL. NEAREST .. OW NE NO. 7 CROSS.;ST. ASSESSOR ADDRESS - y•''- .`. MAP',BOOK -' ",-PAGE PARCEL - . ., " DISTRICT•: GROUP TYPE .' FIRE P ESSEDBY' .� CONST .ZONE ` CITY ,ZIP Q?: '-ARCHITECT OR ; EL :'ENGINEER NO.. - _ S A _ TATISTIC 'L-;CLASSIFICATION; `' SEWER MAP ' ADDRESSCLASS NO DWELL;:Z, s �: B PG TEL. CONTRACTOR ✓✓�iL NO' P,' �7 NO. USE ZONE MAoOd � ..LIC {/►J� 1�.� . 'ADDRESS. - - NI 9 .� \7/ SPECIAL LIC: - J CONDITIONS. ,• ,CITY CLASS ., _ :ROAD DE PARTM ENT APR RO V,AL REQUIRED ;AYES N,O �x CONSTRUCTION LENDER NAME AND-BRANCH— =_ - � '�`JL.;� • ----BLDGSETBACK FROM— '-• FRON PROP."61NEOF"' dSTREETI ADDRESS. "• - ,. CITY SQ. FT. - 7. .HIGHWA t- `.YARD c T OT•AL•SETBA.0 K.FROM TYPE OF EXISTING .. HECK + •_F.RONT PROP.-LINE; HIGHWAY WIDTH iS1Z_E .-STORIES FAMOFES -GONE. . ... _ :DESC RIP TIONOF WORK •� � NEW ❑ r i O App .a ,8LDG,SET•BA ROM' -, - (STREET) _ O I. SIDE PROP,LINE E ALTER ❑ _ TOTA M TYPE,OF EXISTING ',V - ° Y t - - REPAIR❑ D a _ HIGHWAY YAR USE OF SIDE PROP.,LINE Y WIDTH., N .EXISTING'81_ Yy-L '�_ DEMOL Z C_ CORNER CUTOFF YES . NOEl BY (SIGN,A TU IN OPEN SPACE 4. YES,❑ ..NA0 ❑_ G, IN COASTAL PERMIT ZONE YES ❑ NO ❑ 'VALUATION�� ,'Z:l•,'G.�.•,• j _ ... .. I HEREBY ACKNOWLEDGE=-THAT-THkA R EAD,.THIS•APPLICATION AND STATE-THAT-THE-ABOVE-',1'S'-CORRECT. AND,AGR.EE TO.COMPLY r`.WITH. ALL ORDINANCES AND.,LAWS'tREGULATING,�BUILOING CON- STRUCTION. I-CERTIFY THAT ..IN DOING; THE' WORKAUTHORIZED' ,HEREBY .I-.WILL' NOT EMPLOY.*ANY' I ERSON I'N, VIOLATION OF. THE „ LABOR CODE OF THE STATE OF, �CAL.IFORNIA,. I N. RELATING TO : .. _ WORKMEN'S; E SATIO ,INS AN E; - SIGNATU PERMI'TT ADDRESS 1 •• ` _' .TEL; t�� FINAL .�� BY � CITY ;%s[;.�"C C e---• N O. DATE - - _ AIAKE GNECkS',PA'YABLE'7-0:*, P;C. PMT FEE' . FEE $.'.. HARVEY T. ;BRANDT, COUNTY ENGINEER : PLAN'CHECK.VALIDATION cK... M.O. cnsH PERMIT VALIDATION . CK.' 0. "CASH 30 1 d 71 M'' .9i0 OA' .. 76A638A CE#803 5 74 - /j APPUCAT�QN FOR BULONG'PERNT COUNTY,OF LdS ANdLLES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR SS �) BUILDING ADDRESS fJ �/• •G �L� I hereby affirm that I have a certificate of consent to self insure, // le or a certificate of Workers' Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3800,Leh,C.) ,/�,+r/� f ,J//I LOCALITY ,c Policy No.�,�jJ C� `� Company t.�� ,/CL"�G/,�'a SIZE OF Ie L T ! NO.OF BLDGS.NOW ON LOT nZ'• ` ❑ Certified copy is hereby furnished. /—�T NEAREST CROSS ST. 0'Certified copy is filed,with the county building inspection TRACT BLOCK LOT NO. .department. /y'7 _ d USE ZONE MAP NO. Date"���pplicant /n �j L7y ? ASSESSOR MAP BOOK PAGE PARCEL ��— �-'7 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER, TEL NO. COMPENSATION INSURANCE R z° — l WITHIN 1000 FT.OF SCHOOL? YES NO (This section.need not be completed if the permit is for one hundred ADDRESS' DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY , dollars($100)or less.) ZIP CI I certify that in the performance of the work for which this permit j l �� ` is issued, I shall not employ any person in any manner so as to �. become subject to the Workers'Compensation Laws. ARCHITEC OR ENGINEER TEL NO. f p - - 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' CO ACA_ TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions .of the Labor.Code, you must forthwith' f " FRONT comply with such provisions or this permit shall be deemed revoked. V67 LIC.NO., P L 0 .J � LI LICENSED CONTRACTORS DECLARATION SIDE arY uc. LAss PL I hereby affirm that I am licensed underprovisions of Chapter 9 �� �< .. SEWER MAP (Commencing with Section 70 00)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my licenseisin full force and.effect. NEW El. BK . PG . D License Number6�.,y----.-�u ��� Lic.Class DESCRI IONOF WORK AD'D ❑' VALUATION a •, 1 hwe Contractor ^ ate - 7 Z —�3 ALTER " ❑ $ ' U El I am exempt under Sec. _ I . . REPAIR El $ - •..� B.&P.C.for this reason ` z DEMOL :b rLDMA P/C# W Date: USE OF.EXICING BLDG. - URM ❑ -:, .. ..... �' Signature - APPLICANT(PRINT) TEL NO. LDMA-Perm# - - i r Z ❑ I, as owner of the property, or my employees with wages as Z '`f`I 's their sole compensation, will do the work and the structure is ADDRESS L. ,� L > r' f not intended or offered for sale (Section 7044; Business and FINAL DATE 7 Q t i, Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ����1 t j(Et y t• OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE., l ' ❑ I, as Owner of the property, am exclusively Contracting with FINAL BY AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? -a •� licensed contractors to construct the project (Section 7044, TOTAL g ® 3 Business and Professions Code.). ves❑ no❑ r _ WILL THE INTENDED USE OF THE BUIDUNG'BY THE APPLICANT OR FUTURE BUILDING SI� LL 191 s,iirf OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �•�i' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 9 1 • GUIDELINES. - O.G/4°qy%�� O!/`-- r_I�11"!l`IG o Cie I hereby affirm that.there is a construction lending agency for YES❑ NO❑ - a the performance of the work for which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ 3097,CIV.C.) CHECKLIST,I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - � •'kms TITLE 2,CHAPTER 2.20 SECTIONS 2.20'100 THROUGH 2.20.140 CONCERNING HAZARDOUS �,��, ^; 'i+j�,.f'�•:? Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD, 0- Lender's Address ' 'F1 =' Aim "7-40 0 _ - OWNER OR AGENT o . I certify that I have read this application,and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all county ordinances and State laws relating to building CO construction, and hereby authorize representatives of this County ISSUANCE FEE 0 to en on the above-mentioned property for inspection purposes. .7. / o co `�® --4 T INVESTIGATION FEE TOTAL FEE ^ �mre a Aool, m m i - SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION I herebyaffirm that I have, a'certificate "of consent Vo self 0V L/'11 O D O D ✓ insure, r a certificate of Workers' Compensation Insurance, P P��CAU P O 1M' FOR, M U��D�H O P E RU C/u U pY-a certified copy thereof (Sec. 3800;.Cab. C.) . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO.FILL IN ADDRESS C Pol + Certified copy is filed with the county building inspec- BUILDING _ `^� tion department. ADDRESS / LOCALITY . . VIZ NEAREST c '110,11 A Date Applicant CITY A. ZIP CROSS ST. CERTIFICATE OF EXEMPTION,FROM WORKERS' OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT" MAP BOOK PAGE PARCEL (This section need not be'completed if the permit is for one U Z?NE MAP' 0. hundred dollars ($100)or.less.)-. TRACT B CK LOT NO. NPE TEL. SPECIAL } OWNER 1 NO. CONDITIONS 0. I certify that in the performance of the'work for which this x DISTRI• G UP TYPE FIRE PRO SSED DY O permit is issued, I shall not employ any person in any manner ADDRESS ' : ` f + CONST. ZONE �V so as to become subject.to the Workers'Com en at' n La s: �j I _ % < CITY ZIP / O mate Applicant ARCHITECT OR TE S ATISTICAL CLASS'IFIC'ATION PT. CONDO. u UUU NOTd O APPLICANT: If, after king this Certificat f ENGINEER NO CLASS NO DWELL. UNITS Exemption, you should become.subject to the Workers` Compensation provisions of the'-Labor Code, you must forth- ADDRESS SEWER P with comply with such provisions or:this.permit shall be deemed revoked. TEL' BK PG, VALIDATION � CONTRACTOR + NO. . 17 LICENSED CONTRACTORS DECLARATION LIC. I`hei•eby affirm that I am licensedunder.provisions of Chapter 9. ADDRESS NO. [�VAZLUAT;10N (commencing with Section 7000)of Division 3 of the Business and LIC. Frrofessions Code, and my license is in full force and effect. CITY. CLASS r SQ. FT. NO.OF- NO. OF: CHECK yr�icense Number Lic.Class SIZE Q STORIES FAMILIES ONE li NEW $ Contractor Date DESCRIPTION OF WORK • ADD am exempt under Sec. FINAL ' B.&P.C. for this reason I ALTER REPAIR Q DATE Dater USE OF DEMOL FINAL EXISTING BLDG. Signature' " APPLP T NTr 1 NO.a %3 2 6 4- A OWNER-BUILDER DECLARATION. 1 hereby affirm that I am exempt from the Contractor's'License D 0 0 0 '0 0 Law for the following reason.(Section 7031.5, Business and ADDRESS �r Professions Code): PRESENT ,2 0 2 3 7,318 QBUILDING I, as.owner of the-property, or my employees with ADDRESS L z = wogesas:their sole compensation,will do the work and ° ° 2 3 7,3 8 0 the structure is not intended or offered for sale(Section.. LOCALITY 7044, Business and Professions Code). MOVING TEL. O 629-83 I, as owner of the property, am exclusively contracting CONTRACTOR NO: with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING REQUIRED TOTAL SETBACK FROM EXIST. AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a.constFuction lending agency for FRONT D the performance of the work for which this permit is,issued P.L. (Sec. 3097,.Civ. C:):' - SIDE. . m Q Lender's.Name Lender's Address P.C. Fee$ Permit Fee I certify that I have.read this application and state that,the. g Y PP Fee Issuance. " a above information is correct. I agree to comply with,all County Investigation Fee $ ordinances and State laws relating to building construction; Total€-2_3 O _ and hereby authorize representatives of this County to.enter upon.the above-mention d prop rt 41br inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ®s nature of App ca t or Age Date CO - �FI!TTO �UTLDIIv APPLICATION FOR PERMIT IT 6f.L03 ANGELES, BUILDING IL`INS - 111-00. .111, Q1111THICT NQ�& LAN NR. cc Q. RtetlrT NO,: n * BLD0.^-'' ,t`DA OI Ar ' zr R[Ctl DATt 90 x--wmm*tvtL--APPLICANT FILL IN AEAYILY OUTLINED PORTION ONLY »A..�y��../. 4. vult ON'tLOCAIfTY lq"�1Kj, 1`� T`'`.�.�i►i:3� t L �. 2 i CTTT NIGREST t STATt _fN�. �'�J•tea 141 IlAll- tiTYV` �CiL t4A3/r+i;jr. .• +Rtl3 TATC 't.4 l C[Nft�N�~ •.'�' ~ i MCI:K �K NOW ONSLL O46 r �jOT tri I a CL WORK E D � ACT • �;r NSM ol►BLDG... ,..; t rs: • N ADD `' �[wOitSM� ` [► °�' pY1MYf CRIi ION t OF R'0 L A r., YSt OR Y NO.01 y�.y.Ve '•� •1 r ,.i• • BLDO.t�` �• +�.. ROOMS a �... e SISM 01. STORIO. '''} M0.01•-. Q ,.•P BLDG. FAMIE �sao FOU ND ON _ 1w 4KAw*t'—. •ORREMON �.; 1 �. -, �� rw tZTO110Rh �►IMwS _ y�I ,��� 44 lwoob— iCK►Kf f wc-ty7el�w� xvgUPLRST UCTUR R..�. A+•n.':r.•:+.L :.:. ffZt SPACING ,SIAN �+.' �' .•i't. G�1� +.tG'r �,af'-�.�'/ '' OtRD[Rtl��s�a - :�� �. �'�liir'`�!�r4 :}{}++••. �V +ME�t. r fir. _ r�r .:3''!�/�'+>..t.'"r'�.z: ,.:yr.. �.��:'•R'+1'ti�'r�R: vii B[ARINb-WALIaI �' � 4 r Z ti1i1 ,�. w ttA /.+0 SILL OCLTi*m or 111112,111 AIM �.r�.c..i'``•"�''«"{'. _COVERING s..ai+Li�a,uwiAwe;-e...q. M?9 + -'L ''= 9Lb��"-"•. ,�:, ' w•� "ho, stws"w. rr• / �$ tiwlhltlt�:�att'". '..n�¢rT 1`nr S►'►Y+...1 HIR[DY ACRNOWLMDOt THAT t MAVt R[AO THIS t yurlrge� • 3SNvlM APPLICATION AND STATE THAT TNM ABOV19 It CORR[CT �$! i•is�+ .M'.¢ti K SIW49i -AND AOR[t TO COMPLY WITH AL1.COUNTY ORD?NANCtiS pt. AND SLS LAr►SJI[OU TIN BUILDING CONSTRUCTION.IG ' !� !>,6*�fGsth.= -`J%:i+►°>b="'ll';'s .'.t"i."� "Sitio ,j +4" OWN"oil AVTMOnlzco c FINAL'APPROYAI:` P.0 Ftt _ UATTO r R• L L. .r ' I1R ►•�s