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Home My Public Portal About4925 KAUFFMAN AVE_Building__ 76A638A C.EN803 5-65 APPLICATION. FOR BUILDING PERMIT ' COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER AooREss BUILDING AND SAFETY DIVISION .LOCALITY JOHN A. LAMBIE• COUNTY ENGINEER NEAREST /�l' COLEMAN W. JENKINS,SUP'T.OF BUILDING. CROSS ST. G ,eel DIST ICT GR UP TYPE. PROCESSED BY FOR APPLICANT.TO.FILL INS CONST. f�.y -BUILDING _ STATISTICAL CLASSIFICATION SE,WEER_MAP, 'ADDRESS �� _ 's CLASS NO. DWELL UNITS. BK 6PG LOT NO. BLOCK USE ZONE MAPO�( �I NO. Csi✓ Vv TRACT - /J71 aFe / SPECIAL. - - - N0. OF BLDGS. CONDITIONS • - SIZE OF LOT NOW ON LOT - - USE OF ' EXISTING BLDG. BLDG. SETBACK FROM - TE FRONT PROP. LINE OF �`� � �" '" (STREET) OWNER NO. TYPE OF EXISTING SETBACK HIGHWAY •+ YARD = TOTAL ADDRESS HIGHWAY WIDTH 'FROM C.L, - + CITY s, ARCHITECT OR TEL. BLDG'. SETBACK FROM j{� �'C'�- ._ ENGINEER NO. SIDE PROP. LINE OF !l0 1 C�� (STREET) TYPE OF EXISTING SETBACK HIGHWAY + -YARD = TOTAL .HIGHWAY WIDTH FROM C.L. - ADDRESS TEL. .- + 40 CONTRACTOR NO O LIC CORNER CUTOFF YES NO U ADDRESS NO CITY C LASS LICSEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK W a NEW ADD ALTER REPAIR DEMOLISH N SQ-FT. / NO. OF NO. OF SIZE co STORIES FAMI LI F_S _ USE.OF t J _,L �- STRUCTURE Y , Gf �� • SIGNATURE OF APPLICANT VALUATION$ APPROVALS DATE INSPE AS.URE P.C. PMT. / FOUNDATION, LOCATION FEE$ FEE$ FORMS, MATERIALS L" FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE'TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWSREGULATING GAS VENT. DUCTS 9UILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY.PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN'S Cn MPENSATION INSURANCE. - LATH. EXT. SIGNATURE OF�'/�^G , HOUSE NUMBER COR- PERMITTEE .�OO�� RECT AND POSTED ADDRESS F I NAL 2•- •.% JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG R PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M.O CASH t 4 7, 4 3 o SEP 1 5 1 D 11 .50- APPUC AMON FOR ULONG PERNT ] COUNTY OF LOS•ANGELES- BUILDING AND SAFETY BUILDING ADDRESS FOR APPLICANT TO FILL IN WORKER'S COMPENSATION�DECLARATION. � E � I hereby.affirm that I have a certificate of consent to self insure, BUILDING ADDRESS ora certificate of Workers' Compensation Insurance,or a'certified CITY copy thereof (Sec. 3800,Lab.C.)• rNEAREST Y �. Policy No. Company IZE OF OT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. - CROSS ST (�' �•.�- /� TRACT - BLOCK LOT NO. ❑ Certified copy is filed with the county building inspection ` NE MAP O. department. .�O Date •` Applicant ASSESSOR MAP BOOK PAGE- PARCEL,q ,/J ��`-�' (/� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNel3 J/C owi J� TEL NO. y� YES NO COMPENSATION INSURANCE lam` WITHIN 1000.F.T.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS C�!/ DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) CITY ZIP I certify that in the performance of the work for which this permit f � • is issued, I shall.not employ any person in any manner so as to ARCHIT TOR ENGINEER TEL NO. - �U 5 become subject to the Workers'Com nsation L S. STATISTICAL CLASS FICATION APT CONDO Dateplicant ell vr/✓� ADDRESS CLASS NO.,,,.� DWELL UNITS NOTICE TO APPLICANT.- If, after making this''C ificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO: SET BACK YARD HWY PROP LINE WIDTH Comperisation provisions of the Labor Code, you must forthwith ,� /�(�f�/l/ FRONT Comply with such provisions Or this permit'shall be deemed revoked. ADDRESS LIC.NO, L P L 71PSIDE • LICENSED CONTRACTORS DECLARATION CITY Ic. ss j, PL 'I'hereby affirm that I am licensed underprovisions of Chapter 9 �d� l SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE. NO.OF STORIES NO.OF FAMILIES ' Professions Code,and my license is in full force ar�ixffect. NEW ❑ BK � PG 1 D } License Number ic.Class�1�� DESCRIPTION OF WORK G �� App VALUATION �® U G P �� O Contractor,�?„A4A Aej ate ER El am exempt under Sec. T EPAIR ❑ B.&P.C.for this reason '� �/ f�� DEMOL LN' W LDMA P/C# Dater �. USE OF`X�ISTING BLDG. URM EI _ CD 7 Signature ' - APPLICANT(PRINT) TEL NO. LDMA Perm# y Z ElI, as owner of the property; or my employees with wages as ZOO r: ■a their-sole compensation, will do the work and the structure is ADDRESS FINAL D TE Q •_`i!•`52��:t ■•z_I not intended or offered for sale (Section 7044, Business and v Professions Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE - ❑ I, a5 owner Of the property, am exclusively. contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q _ �. FINAL BY .. > -.� a ...r g ....... .. licensed contractors to construct the project (Section 7044, H�•L t.v Business and Professions Code.) ves❑ No❑ t WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING _rl1v, •L2/■85 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �{�p CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR Leff V :1...�'r EVE, V y GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ ^' +� a a the performance of the work for which this permit is issued(Sec. €• ITA 2 1E3 rm 3_a O1 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, rr, C} TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS �.• �(.!1 i�>■+��-3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address CHANGE" " ... ■ICU 0 OWNER OR AGENT o I certify that I have read this,application and state under penalty o P.C.FEE .�(' PERMIT FEE of perjury that the above information is correct.I agree to comply D d i -, N with all county ordinances and State laws relating to building v'� � 0000^00 ! 5/24/93 m. construction, and hereby authorize represent ti s of this County ISSUANCE FEE n•-:; +-. All. * to enter upon the above-mentioned propert or' s ection purposes. �- 7� �I I a 7 INVESTIGATION FEE TOTAL FEET ftmture of A150—or Agent Date �'S / SEE REVERSE FOR EXPLANATORY LANGUAGE " _> WORKERS' C�CIMPENSATION DECLARATION 1 m Doi I herebyaffirm that I have a certificatetof consent to self' O O - Insure, or a certificate of Workers' Compensation Insurance, LQ p p d 0�Q�.O-O[ Q > Co3 M:M � G• 0� ~. or o certified copy thereof (Sec: 3800, Lab. C:) COUNTY OF.LOS ANGELES ) BUILDING•AND SAFETY._ y PY Policy No.—Company ' Certified co` is herebyfurnished, ` FOR APPLICANT-TO.FILL IN BUILDINGt ADDRESS �. Certified copy'is filed with the county building inspec- BUILDING tion deportnient.t ' ' '' ' ADDRESS e> VJ ►',e " q zs' i. Date ° Applicant CITY, ZIP 11�P1U' LOCALITY ' CERTIFICATE OF'EXEMPTION FROM WORKERS"= COMPENSATION INSURANCE s' SIZE OF LOT NOW ON LOT CROSS ST. (This section need n'ot•be completed if the per�mit'•is for.one - - ASSESSOR,. ', hundred dollars ($100)or less.) TRACT BLOCK. , LOT NO. MAP BOOK``' PAGE PARCEL TEL /_ � � ' USE ONE MAP ,I.certify That in the performance of the:work for which this OWNER L r'' / %i NO. C Ii NO permit.is issued, I shall not employ any p on in any manner ' 2.Wim..-, 7��; SPECIAL• - - ADDRESS I• ' !!! CONDITIONS O So,as to-become subject to'ihe Workers' pensation'Laws. j ��; CITY - - ZIP Date Applicant ARCHITECT'OR TEL. O NOTICE!TO APPLICANT:"If, ciftef' ma in �.Eerfrficate of 'ENGINEER NO. ST ON u Exemption; you-should :become. subject to the Workers' , _DI RICT•- OUP. TYPE _ .FIRE FROC SED BY !�t� • �. CONST.� NE ' Compensation•provisions of the Labor Code,•you:must forth- ADDRESS. - �J` � with•comply with`.such.-provisions or-this. permit shall be - - TEL. - deemed+revoked.' ,'. - CONTRACTOR NO: STATISTICAL CLASSIFICATION P . ST LASSIFICATIO A T .CON � LICENSED CONTRACTORS.DECLARATION + ( - - 'tIC. CLASS NO. DWELL. UNITS I:hereby affirm that.1 am licensed under provisions of Chapter 9 ADDRESS NO. V. (commencing with Seciion 7000)of-Division 3 of the Business and _ _. _ _ _ _.. _ _ SEWER AP _. _._.LIG - Professions'Code, and`'my license is n' full force and effect. CITY, � - CLASS `BK "� VALIDATION SQ.,'FT. NO.OF NO. OF-•_ CHECK, < License Number Ltc:'Class' SIZE � f' STORIES FAMILIES f ONE VALUATION ._ DESCRIPTION OF WORK" r�LO NEW ® n -C Contractor Date ADD ❑ $ �/rJ N I am exempt under Sec. --- _ _. _ . ❑ D' ALTER B.BP.C. for this-e' '' _ ._ ::. REPAIR- $ ; USE OF D6te: EXISTING BLDG. DEMOL ❑ _ APPLICANT ii TEL. Signature _ - �`0 rrc�, Cr J. FINAL . OWNER-BUILDER DECLARATION PRwT-- - NO DATE _ I.hereby affirm that d•am exempt from the Contractor's License ,j/� p, —`Law for the f(Aowing'reason (Section 7031.5, Business and ADDRESS (4q.W' Ar /�-" d/►'t '. } FIN` .Professions Code):; ._,N,,. PRESENT J r..B- BUILDING ' I, as owner of the property, or my employees with ADDRESS wagesas their sole compensation,will do the work and the structure is not intended or offered for sale(Section- LOCALITY 6 4 2;;1 •A 7044,'Business and-Professions-Code). MOVING 'TEL. 1 I, as owner of the property, am exclusively contracting CONTRACTOR NO. _ # o ° ° 0:1'. - ' ET with licensed contractors to construct the-project (Sec- ' o ' ADDRESS (,° 1 0 6.1-3 5 tion 7044, Business and Professions Code). 1 REQUIRED. TOTAL SETBACK FROM. IS . CONSTRUCTION LENDING AGENCY - - SETBACK YARD "HWY""` PROP. LINE WIDTH _. <:I hereby affirm that there is a construction lending agency for 'FRONT t. - - -'the performance'of the work for which ihis•permit.is issued P:Lr -- (Sec. 3097, Civ. C.). SIDE 0 1'2$ `8 Lender's Name _• - ' LDMA Ref. # P.C.-Fee-$ - - Permit Fee _. Lender's Address - 10 .�� I.certify_that.I.have read this.application and state that the Issuance Fee -LDMA P/C# ; above information is correct. I agree to comply with all County' Investigation Fee ordinances and State laws relating to building construction, -, Total Feer v v-• ./ J LDMA Perm:# - - and hereby 9101horize representatives of this County to enter upon thea v4-mentioned property for inspection purposes. : { a SEE REVERSE FOR EXPLANATORY LANGUAGE - Signature of Appilcont or Agent - - - - Date : vi WORKERS'COMPENSATION DECLARATION I `iereb affirm that I have a certificate.,of consent to self _ � D O ��( M O . oR M O O nn du insure, ora certificate of Workers' Compensation Insurance, !n1 �jLN lJ IJ V �.O LJ D U V �LI V U or a cerhfiad'copy dhereof*(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING ANDSAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS (� -� I -- t 1 Date Applicant a CITY ZIP .91 80 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS No, OF'BLDGS. 1f NEAREST , COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 1 CROSS ST. (This section need not be completed if the permit is for one TRACT O BLOCK LOT NO. ASSESSOR hundred dollars($100)or•less.) MAP BOOK PAGE PARCEL • • / • p,, TEL. o6 USE,7E ' MAP I certify that in the performance of the work for which this OWNER CCr / fr NO. ZG7 ' I NO. permit is issued, I shall not employ any per n'in my`mannerSPECIAL so as to become subject to the Workers' o jiensation Laws ADDRESS Z� �'h O`'�P CONDITIONS Date �I APPlicont • /1(U CITY. ZIP NOTICE TO APPLICANT: If, after making this C rtificate of ARCHITECT OR TEL. DISTRICT G UP TYPE FIRE PR CESSED BY. O ENGINEER NO. 5_.. CONST. ZONE V Exemption, you"should 'become subject to the Workers' �'�j 22 Compensation provisions of the Labor Code, you must forth- ADDRESS ✓ V _ W with comply with such proJisions or this.permit shall be d' deemed revoked. TEL.* - STATISTICAL CLASSIFICA ION APT. C DO. N CONTRACTOR NO. 7 LICENSED CONTRACTORS DECLARATION VLIC. CLASS NO. DWELL:UNITS I hereby affirm that l am licensed under provisions of Chapter 9 ADDRESS NO. (commencing'with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASSBK. 6 VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES. ONE �} VALUATION DESCRIPTION OF WORK ADD p NEW P` a Contractor Date ClCl $ L am exempt under Sec: ❑ D. ,- ALTER' 8.8P.C. for this reason REPAIR :� $ 7 Jr�,7 A DEMOL Date: USE OF °EXISTING BLDG. 0 #,o o.o o,o.� Signature APPLICANT '„ TEL. g OWNER-BUILDER DECLARATION (PRINT) V G. /�io NO. DATE b FINAL _ a,a 4 9 8 8 I hereby affirm that I am exempt from the Contractor's License SIj' Law for the following reason (Section 7031.5, Business and ADDRESS Flld Ll 9:8 8 r�i :o•'o Professions Code): '; L, B y o BUILDING I, as owner of the property, or my employees with ° ADDRESS _ wages as their sole compensation,will do the work and p 7.3 O t.8 7 the structure is not intended or'offered for sale(Section LOCALITY _ 7044, Business and Professions Code).' MOVING TEL. 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). LREQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction-lending agency for ONTthe performance of the work for which this permit is issued .(Sec. 3097, Civ. C.). E. Lender's Name 2 LDMA Ref. N Lender's Address P.C. Fee$ Permit Fee 3 3 Q I certify that 1 have read this application and state that the Issuance Fee V 'LDMA P/C q D above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. ti•'' ' and hereb�th representatives of this County to enter, upon the ;oned property for inspection purpas s �0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Ap licant or Agent Date I i