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HomeMy Public PortalAbout4934 KAUFFMAN AVE_Building__ ,76A638A CE #803 1/71 Q• fl A' �- R� A� APPIt_�'C/"'iTION FOR 4 1T.tP D I.V Gi IT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION ADDR NGESS' ADDR COLEMAN W.'JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or typeonl CROSS ST. BUILDING DISTRICT .�NO. GR`OU� CONST,• �_ ESSED BY ADDRESS. /�- CJS{ /9�J) SIC l.j B 7 - STATISTICAL CLASSIFICATION\ /� SEWER MAP LOT NO. - - BLOCK - —' � /�� O -. CLASS NO.-4 ,OWELL,UNITS B_N�$ PG77, TRACT - USE ZONE MAP �'-jy`/� NO.OF BLDGS. NO. G. CJ 'SIZE OF LOT NOW ON LOT SPECIAL - USE OF - �. CONDITIONS - EXISTING BLDG, TEL. OWNER NO. J(`''7 BLDG.SETBACK FROM ADDRESS - FRONT PROP.LINE OF (STREE-T) TYPE OF EXISTING SETBACK HIGHWAY' + YARD = TOTAL CITY ,/ �: �I" HIGHWAY WIDTH FROM G.L. ARCHITECT OR EL. ` + �� _ `�,•� ENGINEER y' NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. - TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL �. CONTRACTOR / NO. HIGHWAY WIDTH FROM C.L. U LIC. ADDRESS _ NO: + — O LIC. ,U CITY .CLASS CORNER CUTOFF YES .❑ NO Lu CONSTRUCTION LENDER m NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS SQ. FT. NO..OF NO OF SIZE STORIES , FAMILIES / NEW .. USE OF ADD. ❑- (� —STRUCTURE �� ALTER ❑ SIGNATURE OF REPAIR❑, '� �// APPLICANT DEMOL ❑ VALUATION $ '- - - 1 5 :;APPROVALS P AT INSP T 0 R'tl SIGNATURE P,C. PMT. FOUNDATION: LOCATION FEE'$ FEE $ • Q� FORMS, MATERIALS 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, I , WITH ALL ORDINANCES AND :LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED - HEREBY I WILL NOT EMPLOY.ANY,:PERSON IN VIOLATION,OF THE LATH,. INT. - LABOR CODE OF THE:STATE OF -CALIFORNIA 'IN RELATING TO WORKMEN'S COMPENS ION INS URANC 9 V LATH, EXT. - - SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED 'ADDRESS FINAL JOHN'F. LEWIS. PRIN IPAL STRUCTURAL EN ER PLAN. CHECK.VALIDATION CK. M.O..- CASH PERMIT VALIDATIO_ N CK. m 0. CASH �.76�A 638�A CE #8031/71• a APPLICATION FOR 6CIL®0N( "PERMIT COUNTY OF LO,S' ANGELES ASSESsoR DEPARTMENT OF' COUNTY. ENGINEER MAP BOOK PAGE . PARCEL. BUILDING AND SAFETY.DIVISION. BUILDINGfi ADDRESS .T(1P. --'COLEMAN #. JENKINS, !SUP'TOF.BUILDING LOCALITY FOR APPLICANT TO,FILL IN ROSS EST • Print ort e'on l' CR OSSS T: - - //,}/� ,, . // DISTRICT NO GR UP TYPE CESSED BY ADDRESSBUILDING. �Y`�///�-/�( "CONST. j�� .STATISTI;CAL CLA SIFICATION SEWER MAPY� LOT NO, / BLOCK CLASS'NO­�DWE-LL,UNIT ..BK k; TRACT/ V•� - , • USE ZONE 'MAP . 1 . - NO.OF BLDGS.' NIS SIZE.,OF�LOT NOW•ON LOT SPECIAL USE OF CONDITIONS '-• _ _ EXISTING BLDG, '• - - - „�, TEL. ^ - - OWNER '`Jj [ - / '; NO BLDG SETBACK FROM ' ADDRESS FRONT PROP LINE OF -. 2 --(STREET) • .TYPE OF EXISTING' SETBACK HIGHWAY } "YARD = TOTAL CITY " .HIGHWAY WIDTH- FROM:C.L. ARCHITECT OR / TEff' - - C ' NSb �I/ '/' ENGINEER - .}., •.Z[� Z-f� BLDG.SET.BAC K'FROM ADDRESS' - - SIDE PROP.LINEOF - - (STREET) T E TYPE OF CONTRACTOR NOs �j H G_HWAY EXISTING FROM AC C.L. CK HIGHWAY } VARD TOTAL U ADDRESS,- . �� <l� <JNO . tJI - } _ O � CITY5 oel CLASS - CORNER_CUTOFF _ - YES ❑ N0 _ ly CONSTRUCTION LENDERNAME,AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS. z ADDRESS - SQ. FT. NO. OF NO. OF, NEW /-7 SIZE [ STORIES - FAMILIES ❑ y- USE OF , Qn • :ADD STRUCTURE _RALTER ❑ ' EPAIR❑ _ SIGNATURE OF APPLICANT - DEMOL.❑ - '' J °I ' VALUATION$ ice'"Q _ APPROVALS DATE INSPE TOR'S SIGNATURE P,C, - PMT. .r•OUNDATI.ON LOCATION @!-f_� 7/ FEE $ - "'�t`�.S ' •+ FEE $ FORMS;'NIATERIALS. (' 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, _ WITHALL ORDINANCES AND. LAWS REGULATING. BUILDING, CON= GAS VENT, DUCTS' ' STRUC TION. I CERTIFY THAT IN DOING THE,WORK,AUTHORIZED -- -- , HEREBY' I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF'THE- .LATH, INT. - - LABOR CCa&S—©F THE S - E OF -CALIFORNIA IN RELATING TO _ WDRKMEr5 RCOMPE A( I N INSURANCE. H , LATH, EXT: - - SIGNATUE O - - OUSE NUMBER COR- - PERMITTEE4' - _ - - RECT AND POSTED ADDRESS / - FINAL" aL JOHN F LEWIS '_PR;INCIPALw STR U ALljZNG'INEER --PLAN- CHECK-VALIDATION -CK: M:O. .-C SH- -- PERMIT-VAL-IDATI6N -cK- cdSH GACO 2.2 6.3'� SEP 7 2 1 D _� 5 N ~ WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self A P P L� �( O M �• p p E n� insure, or a certificate of Workers'Compenstion Insurance, or /l�1 LI LI L!�1 LI LI V LIU a certified copy thereof (Seca 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING.AND SAFETY 'Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING ^ / ' tion department. ADDRESS ,/� \'��/ 4� LOCALITY NEAREST T P... I (� CROSS ST. �Y Date Applicant CITY ` CERTIFICATE OF EXEMPTION FROM WORKERS' NO. 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 USE ZONE MAP ; hundred dollars ($100)or less:) TRACT BLOCK LOT NO. �J NPE / (fi Gf TEL. 4 Q4ij: SPECIAL � I certify fhat.in the performance oft ork far which this_ OWNER, ,- _e.,6d0.`V- - 94,) / b CONDITIONS - O permit is issued, I shall not employ a y per n in any manner DISTRICT GROTYPE FIRE P CESSED BY (� so as to b ome su 'ect to the Wor r ' mpensatio s. ADDRESSf!i �/ CONST: ZONE Date 4ficanl CITY STATISTICAL CLkAFJrTSSIION APT. CONDO. W. ARCHITECT OR, •- - TEL. NOTICE TO APPLI NT:'If, after making this Certificate of CLASS NO. _ _DWELL. UNITS ENGINEER NO. Exemption, you should become subject to the Workers' try Compensation provisions of the Lab& Code, you must forth- ADDRESS SEWER MAP with comply with such. provisions or this permit shall be TEL �' 77 . VALIDATION deemed revoked. CONTRACTOR NO. - BK. PG, LICENSED CONTRACTORS DECLARATION n LI 2 I hereby affirm that I om licensed under provisions of Chapter 9 ADDR �� N�-� VALUATION �v (commencirig with Section 7000)of Division 3 of the Business and LIC. IV �j �— Professions C e, and my license is in full force and effect. CITY. 1N - CLASS 4-' .!.' $ �fA �_ _ a SQ. FT. NO. OF NO. OF CHECK License Number Lic.Class / SIZE' STORIES FAMILIES ONE . � /! �/�//�� :. p - - NEW Contractor V aZ6" Date c� �• e �— DESCRIPTION OF WORK I am exempt from the licensing requirements as I am a licensed architect or a registered prof essional'engineer• ALTER FINAL acting in my professional' capacity (Section 7051, > REPAIR DATE 04 Business and Professions Code). USE OF DEMOL` FINAL EXISTING BLDG. By Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO: c f I hereby affirm that I am exempt from the Contractors License Law for the following reason.(Section 7031..5, Business and ADDRESS r Professions Code): PRESENT . ❑ BUILDING I, as owner of the property, or my employees with ADDRESS: wages as their sole compensation,will do the work and the structure isnot intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I, as owner`of theproperty, an, exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion.7044, Business,and Professions.Code). REQUIRED TOTAL SETBACK FROM EXIST. 3 3 g 7 A CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH' z I hereby affirm that there.is a construction lending agency for FRONT #'0.0 Fo o o the performance of the work for which this permit'is issued P.L. °i .(Sec. 3097, Civ.'C.). SIDE 2 0 0 P.L. Lender's Name ���. - r 5 2 0 0' m CJ P.C. Fee$ Permit Fee 1 o o i o Lender's Address > I certify that I have read this application and state that the 2 5'—8 2 w y pp Issuance Fee above inf rmation is correct. I agree to comply with all County - Investigation.Fee ordi nces. d State laws relating to building construction, Total Fee f �— an hereby thorize representatives of this County to enter u n t a ve-mentioned rty o in ectio p rposes. = a z SEE REVERSE FOR EXPLANATORY LANGUAGE v ^ Dot Signature of Applicant or Agent �s WORKERS' COMPENSATION DECLARATION / I hereby affirm that I have a certificate of consent to self O D OO O M D D M insure, or acertificate of Workers'Compenstion Insurance, or M a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Cert'fied copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy, is filed•with the'county building'inspec- BUILDING �+ A � /J tion department. ADDRESSt LOCALITY' NEAREST Date Applicant CITY Gall E ZIP CROSS ST. W-71 4f CERTIFICATE OF EXEMPTION FROM WORKERS' NO. 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 USE ZONE. MAP ' hundred dollars ($100)or less.) TRACT BLOCK LOT NO. _ NO- "1 TEL. i / SPECIAL I,certify that in the performance of the work for which this OWNER, i�i!LHa _ ,� 7Jp NO. 7 CONDITIONS O permit is issued, I shall not employ any person in any manner DISTRICT GROUP' TYPE FIRE PR ESSED BY V ,/(�� CONST. ZONE 1129 so as to become subject to the Work Compens f' 'n Law JADDRESS U /l/1 U rt �I 3 0 �- Y �r 1^ l / / y i Datee���^' pelican ?^�� /6 7 ZIP STATISTICAL CLASSIFICATION, PT. CONDO. NOTICE TO APPLICANT: If, aft?, making this /ertificate of" CHITECT OR TEL. - GINEER - NO. CLASS NO:�DWELL. UNITS I UJ Exemption, 'you should .become subject to:the Workers' y Compensation provisions of the Labor Code, you must forth- DRESS SEWER MAP. with comply with such provisions or this.permit shall be e deemed revoked. TEL. ` BK PG VALIDATION NTRACTOR NO,J �� 17 LICENSED CONTRACTORS DECLARATION. / uC. 7 I hereby'affirm that l am licensed under provisions of Chapter 9DRESS. 2J / Q /.-NO. /- VALUATION .(commencing with Section 7000)of Division 3 of the Business and , LIC. ,q� - Professions'Code, and my license is in full force and effect. Y '_ CLASS N $ _ 6// . FT. NO. OF NO.OF CHECKLicense Numbe�- ` �" Lic.Class E VO(f STORIES FAMILIES ONESCRIPTION OF WORK pl7t2. $ p D Contractor Date NEW ❑ ry ADD ElI am exempt from the licensing requirements as I am a vl z;3 2 0,9.A licensed'architect orb-registered professional engineer, - ALTER ❑ FINAL ,.��v� I acting in my professional capacity (Section 7051, .� REPAIR ❑ DATE , # o 0 o e,23 Business and Professions Code). USE OF EXISTING BLDG. FINAL DEMOL ❑ FI r/,'j 2 0'o 1 8,0'0 Lic. or Reg.,No. Date APPLICANT- TEL. C T OWNER-BUILDER DECLARATION (PRINT) ' 'NO. Io o.o J'II 0 , /, e, 3vd� I'hereby affirm that I am exempt from the Contractor's License Law for the following,reason (Section 7031.5,.Business and ADDRESS J� 0 3;0 9—82 Professions Code):. 0— F-1BUILDING.... I, as owner of the property, or my employees with ADDRESS J O j b wages as their sole compensation,will do the work and the structure is not intended.or offered fdr sale(Section LOCALITY 7044, Business and Professions Code), MOVING TEL: —� ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. z,3 2 �,0 A with licensed contractors to construct the project (Sec- . ADDRESS Ii on 7044, Business and Professions Code). w CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST. # 0 0 0 0 0 SET BACK YARD HWY PROP. LINE WIDTH I hereb affirm that there is a construction lending agency for - �7 tF e performance of the work for which this permit is issued , FRONT 2 o t(( 0 7 5 Q Sec. 3097, Civ. C. . SIDE t ( ) 40175:0� • P.L. Lender's Name P.C. Fee$ e30 0 0'3,09-82 ta fender's Address Permit Fee (� I certify that I have read this application and state that the v^� ® Issuance Fee a ,above information is correct. I agree to comply-with all County Investigation F.ee ordinances and State laws relating to building construction, a Sa and hereby authorize representatives of this County to enter Total Fee upo<eaove-mentioned operty for'inspection purposes. -� SEE-REVERSE FOR EXPLANATORY LANGUAGE ©s Signature of Applicant or Agent Dote r' -