HomeMy Public PortalAbout6226 IVAR AVE_Building__ '16A 63N9�E,#803 1/71
APPLICATION. FOR BUILDING PERMIT q
c° COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY',ENGINEER MAP-BOOK PACE ', PARCEL
BUILDING AND ,.SAFETY DIVISION ','.BUILDING , `
- ADDRESS'CB
1 , _
COLEMAN W.•.JENKWS; SUPT OF BUILDING' LOCALITY
FOR APPLICANT TO.FILL IN NEAREST'
-iCROSS ST .Print or .
e.onl� ,. •' .,
DISTRICT O. G UP CONST, -ROC SSE BY
BUILDING � � _ . ,�' yj -�`'•
ADDRESS(!.,J�w�ZCG1' /Vr .ri`0✓I+r /Cl�= C./'1L�U �J/ J -
STATISTICAL CLASSIFICATION SEWER-MAP
LOT NO.. .(zrA4 ee o Lv i,�'3 BLOCK-,. ^ ,
e� .CLASS,NO DWELL UNITS'-"!— -bKA''l PG 7f '
TRACT ZONE MAP
SIZE OF LOT
NO.OF BLOCS, - 11 NO. - .
' NOW ON LOT ,•s I - SPECIAL.,! '
USE OF - - ',� CONDITIONS.'
.EXISTING BLDG. P d L:'LC,/,LJ.•� -
r/! T E L.. ,�f.y
OWNER is",oW/�yy���/'(,.�ii�,, ¢ NO. a�i' .BLDG SETBACK,FROM'
ADDRESS6'2.`Z,6-> /L4.• (V�a�G:. /Lu C'. FRONT.�PROP.LINEOF - ' '�' •(STREET)
-TYPE OF EXISTING SETBACK HIGHWAY + YARD-. = TOTAL
'CITY' �f�-'- \V� ` 't;;a HIGHWAY WIDTH- FROM C.L. -
ARCHITECT. 02 .' TEL
ENGINEER: -�✓
.G-+Y 2 - %�I�jK�3 NO.. qc,-2,1 dv
- .- BLDG,SETBACK FROM _ -• -
ADORESS,/Z„4?j V�/.r'r� 134,00;, SID
S'ID.EPROP.L1NEpF (STREET)DG.
TEL C
TEL TYPE OF EXISTING SETBAK.. -HIGHWAY. +. •YARD' _ TOTAL4,t
CONTRACTOR ki&Q S Cp7.;lrs►. Gip.NO. 'F t_,(�JgC) .HIGHWAY WIDTH FROM C.L •• - V
ADDRESS.5Df&P8'Zt7fZ 4LIC.; • - ..
�7i2.. NO.
O
�. • LIC.. ,,1 . F.
CITY M�'A!!'i=.:�'�(if`'- - CLASS 6_ j' - • 'CORNER CUTOFF YES ❑, NO ❑ W
CONSTRUCTION LENDER,�pp/�r+ a
NAME AND•BRANCHG/�L �•g �,, :: SEE REVERSE-SIDE'FOR SPECIAL APPROVALS z
ADDRESS�(„?/`S�-rl� Lt�..-:IWd jA/'7/"ZUiJ(:'F
SQ. FT. C-y _ NO. OF. NO.;OF NEW . an
SIZE C%C's STORIES FAMILIES
USE OF - - ...NDD .I` /73
STRUCTURE`}'IsiL(LUil-vYj. L-C,> -"vALTER,
v�Xl�lOxlwT�®n/ �✓®�J'IGfJ DYL ®`.SSr�
REPAIR'❑
SIGNATURERFT ''OF - - -
APPLIC( DEMOL ❑ `~)
VALUATION $'f�.UC?f.1 .. APPROVALfr DATFc 1 \ ECTOR• 516NA'TURE
P,C. PmT. FOUNDATION: LOCATION
FEE FORMS, MATERIALS'
,FEE6 T ^ FRANE:,FIRE STOPS,S-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .'BRACING,'BOLTS
AND STATE.THAT THE ABOVE IS-CORRECT AND AGRE //0 COMPLY FURNACE' LOCATION, - -^
,WITH ALL ORDINANCES AND LAWS REGULATI NG XLDING CON- ..GAS VENT, DUCTS
STRUCTION. I CERTIFY T T,IN,DOING THEAULHORIZED
HEREBY I WILL NOT E Y.
ANY PERSON IN OLATION OF THE :LATH, INT. -
LABOR CODE OF TH TATE OF 'CALIFO A.�IN RELATING TO
WORKMEN'S COM ON INSURA �LAT.H, EXT,
SIG AT OFrJ?�' HOUSE NUMBER COR- .
PER TEE RECT AND POSTED,_ s / '
ADDRESS-: 1C. .r+jLJ •�41..4-L' A FINAL - r
A ..
JOHN F. LEWIS. PRINCIPAL STIR i;HR) L ENGINEER
PLAN CHECK VALIDA pIV CK. M.o. CASH _ PERMIT V 'LIDATION CK. M.O. ? CASH
,co'cJ -9 9 �• r 4 5 .45A
'
a r
-N FOR BULONG PERNT.
APPUCAT0 .
,COUNTY-,OF..LOS-ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION " FOR APPLICANT.--TO.FILL IN BUILDING ADDRESS
I hereby affirm that,I have a'certificate of consent to'self Insure, BUILDINGADDRESS
'or.:a certificate of Workers' Compensation Insurance, or'a certified.
L L.
Copy thereof(Sec.3800,Lab.C:) •; CITY' TY
ALI LOC
Policy No : ;'Company - - -SIZE OF LOT NO.OF BLDGS.NOW ON,LOT
❑ Certified'Copy-is hereby furnished.., - NEAREST CROSS ST.
El Certrfied copy is filed with the county building inspection ? BLOCK LOT N�j�^
-department. � P. d�M4 D F., J 7 USE zoNE MAP.No. .
k' SS
A -ESSOR M�P`BOOK '' PAGE PARCEL '
Date Applicant, /h/� SPECIAL CONDITIONS
00 ...'
3 $
OWNLB, -.. 'EL NO:.
CERTIFICATE OF EXEMPTION FROM WORKERS' . L rs ves No
COMPENSATION INSURANCE' C�-. . S_ 17HNS F}LV7 . $..B Y / WITHIN 1000 FT,OF,SCHOOL?
'ADDRESS
(This section`need not be completed if the permit is for one hundred' DISTRICT GROUP TYPE CON T. FIRE ZONE PROCESSED BY
dollars($100)or less.) AvL-
`: CITY—
ZIP - -
I certify that in,the performance of the work for which this permit C Ei '' /-77 S6
is issued, I shall not employ any.-person in,any manner So as t0 ,ARCHITECT"OR ENGINEER TEL NO. -
become subject'to the.Workers'.Compensation L s.. STATISTICAL'CLASSIFICATION APT CONDO
Date 4"12- Applicant „ "ADDRESS .
CLASS NO DWELL UNITS
• ..
NOTICE...TO. APPLICANT.' If, iter•'making':'this
Certificate. of- - REQUIRED TOTAL SETBACK FROM EXIST-
` Exemption, ,you should become-, subject to the 'Workers-, CONTRACTOR�6 ", TEL NO. - SETBACK YARD HWY- - PROP LINE WIDTH
Compensation provisions of the Labor'Code, you must forthwith --��/��/✓� FRONT
comply.with such provisions'or this permit shall be'deemedrevoked. ADDRESS LIC.NO.. P L
LICENSED CONTRACTORS.:DECLARATION sIDE .
CITY _ LIC.CLASS P L-
I,.hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing.with Section 700,0)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES I. NO.OF FAMILIES
Professions Code and,my,license is In full force and effect. NEW ❑ BK PG D a
License Number LIc.Class, `DESCRIPTION OF WORK ADD '❑ VVALUATION - Q
Contractor Date /UtLeJ` ZZ ALTER. ❑ U
REPAIR ❑ 0
❑ I am exempt under Sec
BAP.C.for.this reason 7��}/i d C/9 E �!0 5 5 y x� DEMOL ❑ LDMA P/C# W
USE OF EXISTING BLDG. - R - �-
Signature - „ APPLICANT,(PRINT) .- TEL NO. LDMAPerm# - _ - _
' - _ _
I, as owner.of the property, or,my:employees;with wages as -;T a T
Z iyi's. Z.
their sole compensation, wlll;do.the work,and the structure is' ADDRESS O n -, { rj
FINAL DATE ~ -.3::F s -
not intended or offered for sale. (Section 7044`,.Business and C
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE-A HAZARDOUS MATERIAL - 1 TT-Ml-
as
�I_Ml_
❑ I, as owner of the propIert am,exclusively contracting with OR'A MIXTURE CONTAINING A HAZARDOUS MATERIAL+EQUAL TO OR GREATER THAN THE `� �
.. Y. g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALSINFORMATION GUIDE? FINAL OT a
licensed contractors to construct the project (Section 7044, TOTAL I¢:AL -1 d x'-90
"YES❑ � NO❑
Business and Professions Code:)
_ - - WILL THE,INTENDED USE.OF THE BUIOUNG BY THE APPLICANT•OR.FUTURE BUILDING - - ('11�{ !j
OCCUPANT REQUIRE A PERMIT FOR.CONSTRUCTION OR.MODIFICATION FROM THE SOUTH _ -
CONSTRUCTION LENDING AGENCY .COAST AIR QUALITY,MANAGEMENT.DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR "- _- ;_�...
GUIDELINES. �•�'IF`��''ut a
I hereby affirm that there is:a construction.lending agency for YES❑ No El
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, ttt',ii t{{ 2193
'S f-y
w TITLE 2,CHAPTER 2'20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 11000' 1?I 111 S •{I': 1t,:���-'
3 Lender's Name MATERIALS REPORTING AND.FOROBTAININGA PERMIT FROM THE SCAQMD. - ...
o. Lender's Address 9160 • 1 AM o cc
OWNER OR AGENT,
o 1,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
with all county ordinances a d State la s, relating,to building /h
m construction, and hereby auth rite representatives of this County ISSUANCE FEE
to;pJr upon the above- h ned property for inspection purposes.
a
,,; INVESTIGATION FEE TOTAL FEE
p SEE REVERSE FOR EXPLANATORY LANGUAGE