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HomeMy Public PortalAbout6206 IVAR AVE_Building__ APPLOCA HON FOR SUELDOWG PERMOT. T . a nR APPLICANT TO FILL IN (Print or type only), COUNTY OF LOS ANGELES BUILDING ADDRESS Oa ®, DEPARTMENT OF COUNTY ENGINEER clrr ZIP BUILDING AND SAFETY DIVISION .OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS y . TRACT /,- C� I BLOCK i LOT NO.- f�j LOCALITY e OWNER -A'L 7„0. 0. �a / CROSS ST. nn ASSESSOR ADDRESS '.e�� A)t JAA1 MAP BOOK PAGE PARCEL DISTRICT GROUP. TYPE FIRE ROCEb D BY -CITY ZIP �� i1 CONST ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CLASSIFICATION rnSEWER'MAP ADDRESS CLASS NO... DWELL.UNITS v'(BK TEL. M CONTRACTO c NO.fp NE MAP - NO. . ..�/)� ..:; LIC. _7fd 'SPECIAL is` ' ADDRESS �(� 6'. LlC. e" CONDITIONS LIC CITY' CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO CONSTRUCTION•LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) 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 _ a DESCRIPTION OF WORK NEW ❑ + O " ADD BLDG.SETBACK FROM SIDE PROP.LINE OF (STREET) O ALTER ❑ r TOTAL SETBACK FROM TYPE OF EXISTING w HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH N REPAIR ❑ USE OF.._.... ._ - + _ Z EXISTING BLDG., DEMOL ❑ ; "APPLICANT__ TEL CORNER CUTOFF YES NO (PRINT) NO. FIN OPEN SPACE YES ': NOEBY(SIGNATURE)1._ COASTAL PERMIT ZONE' YES ❑ NO, VALUATION / 1 HEREBY-ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE'ABOVE IS CORRECT AND AGREE TO-COMPLY.WITH ALL ORDINANCES �D . ,AND LAWS-REGULATING BUILDING CONSTRUCTION.I 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 TOWORKMEN'S COM- PENSATION INSURANCE.,-'I.- SIGNATURE NSURANC - - - SIGNATURE OF3�'`JG PERMITTEE ADDRES l0 +� FINAL W. BY CITYV% , "^ ~ TEL L �`L.7 DATE R MAKE CHECKS PAYABLE TO: FEE - FET HARVEY T.BRANDT•COUNTY ENGINEER 9.• C'• PLAN CHECk VALIDATION CK. M.O. CASH a PERMIT VALIDATION K. f M.O. CASH 9.42 5A 96 Qt 76A638A CE#803 375 WORKERS' COMPENSATION DECLARATION I hereby affirm that.I havecertificate of`consent to self n �f �{- © j (� Q'D •n n 2 n/1. �i 'iTi vre,-or a certificate of Workers' Compensation Insurance, L(" (%� u uV [f� L9 or a certified copy thereof (Sec-, 3800, Lab. C. ^' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No._,. Company ' Certified copy is hereby furnished.,'. _ FOR.APPLICANT TO FILL 1N BUILDING nn / ADDRESS" � W" Certified copy is filed with the county,building in.spec BUILDING JA tion department. ADDRESS' !)206 /Y• .- .. Date .Applicant CITY' )4 ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS`: n •� NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT `__;, V NOW ON LOT CROSS 5T. . (This+.section nee be completed if the permit,is for one TRACT BLOCK LOT NO. ASSESSOR' , hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL• TEL�yq USE ONE . MAP I certify that in''the performance of the work for which this OWNER ; iZ S 'N 0. �"',L -� NO. E _ P employ any y'manner SPECIAL, �' permit is issued,.I shall not em Io an erson:i any ADDRESS , Fi/ - � - -• - CONDITINS so as to become subject to the Wor ers'.0 mp nsat'on Laws: CITY ��' C.) Date v Applicant (� NOTI E TO APPLICANT: 1f, after' making this Certificate of ARCHITECT OR TEL. DISTRICT. P TYPE FIRE PROCES D BY O Exemption,''you should' become subject for the' Workers' ENGINEER NO. ��} ? CONST. E V Compensation provisions of the Labor Code,.you must.forth- ADDRESS W with comply with ,such provisions'or this,permit shall be as deemed revoked _ TEL.: STATISTICAL-CLASSIFICATION APL• C DO. N CONTRACTOR NO: Z LICENSED CONTRACTORS DECLARATION _,. LIC. ,CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of•Chapter 9, ADDRESS NO: SEWER MAP (commencing with Section 7000)of Division•3 of.the Business and LIC. ���9� Professions Code,-and my license•is in full force and effect. CITY CLASS BK. VALIDATION n2 y SQ. FT. NO. OF NO. O_F CHECK License Number' Lic.Class' SIZE STORIES FAMILIES ONE DESCRIPTION'OF WORK- '�` NEW ' VA UATIO Contractor Date $ d am exemptunder Sec. - ADD. ❑ „ ALTER R � D B.&P C for-this,reason $ Date: . :REPAIR � • USE F ' -EXISTING BLDG: DEMOL' 0 a o Signature APPLICANT- OWNER-BUILDER PPLICANT �. TEL.(� FIIdAI OWNER-BUILDER DECLARATION PRINT) ; �j r s'. NOa/ � �� DATE J $•8'8 1`A` I hereby affirm that I am exempt from the Contractor s License d - t "' 0 0 0 0 o F Law for the fol lowing reason (Section.7031.5; Business and., ADDRESS ' /'� / �` ply' c :. Professions Code): .. PRE EN By. ;("° ° ( ".Q Jr'Q BUILDING;- as as owner of the property, or my employees with ADDRESS ' O=, wages as their sole compensation,will do the work and °i° °.4 Q Jr> the structure is not intended or offered for sale.(Section LOCALITY L. 7044,-Business and Professions Code). MOVING TEL., CONTRACTOR NO. n I, as owner of the property,am,exclusrv,ely contracting _ - `^" with licensed contractors to construct the'project(Sec tion 7044, Business and Professions Code). ADDRESS .. C, YARD AGENCY REQUIRED TOTAL SETBACK FR YARD HWY "SET BACK PROP. LINE •WIDTH I hereby affirm that there is a construction lending agency for FRONT• the performance oVthe,work for which this permit-is issued P.L. (Sec. 3097, Civ. C.):. SIDE P.L. ` Lender's Name ly m P.C. Fee$ Permit Fee a' LDMA Ref. # Lender's Address PP Issuance Fee V LDMA P/C N D I certifythat I have read this a lication and state that the above information is correct.I agree to comply with all County Investigation Fee 0 ordinances and State laws rel ting to building construction, • o Total Fee LDMA Perm. p and hereby authorize re ese �J%fo of this County to enter upon ove-menti ed pr r,inspection purposes. ,o SEE REVERSE FOR EXPLANATORY IAkGUAGE. Sig ature-of. p icbnt or Age Date