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HomeMy Public PortalAbout5030 KAUFFMAN AVE_Building__ 7,6A638A CE#803•'10-56 APPLICATION FO R B U I L®I tl V G -PERMIT •.. _ �. BUILDING AND SAFETY DIVISION BUILDING Department of County Engineer ADDRESS � �J_ M County of LOS Angeles 'LOCALITY JOHN A. LAMBIE, COUNTY,ENGINEER NEAREST I- A CASSATT D. GRIFFIN, SUPT OF BUILDING NEARSCROSS ST: ` n DISTRICT NO.I GROUP - TYPE SEWER RMAPPG FOR APPLICANT TO FILL IN I CINST: BUILDING - ADDRESS cJG. t/FFit'Y/�It,/ _ STATISTICA''L��CCLQLASSIFICATION LOT-NO.' .. BLOCK CLASS. NO.L�DWELL. UNITS I ' MAP _ STATE . NUMBER> -HWY-. YES. NO. TRACT. USEZONE SPECIAL ' - NO. OF SLDGS. // CONDITIONS - - - SIZE OF LOT(e-ex !E Q I NOW ON LOT USE OF EXISTING BLDG. " BUILDING - - EXIST. ,- SETBACK - YARD HWY STREET NAME WIDTH OWNER- �� FRONT MAIL - - P. L. -2C]..• -i VZ•t ADDRESS SIDE TEL P. L. .CITY NO. ARCHITECT OR ,� INSPECTION_RECORD. TEL. ENGINEER NO. _ ADDRESS - ADDRESS DDRESS _ADDRESS _ DESCRIPTION.OF'"WORK NEW ADD v ALTER- REPAIR DEMOLISH -- - - SQ. FT. NO. OF NO. OF SIZE. STORIES - FAMILIES _ - USE OF STRUCTURE A .. APPROVALS' SIGNATURE OF APPLICANT' DATE INSPE,&OWS SIGNATURE" ADDRESS .FOUNDATION:LOCATION _ FORMS, MATERIALS - $ FRAME: FIRE STOPS.. -7 - FEE BRACING. BOLTS v $ _ FURNACE: LOCATION. l •� ._ VALUATION w'� GAS VENT, DUCTS ` FEE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. ' PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH'ALL COUNTY INQN"CES AND _ - STATE. LAWS R �U,}�+ 1 B ILDIN T UCTION. LATH, EXT. - SIGNATURE OF y. - - HOUSE NUMBER COR- - .. PERMITTEES _ RECT AND POSTED ADDRESS - FINAL JOHN A.'LAMBIE, COUNTY ENGINEER, CLYDE N. DIRLAtvt, PRINC PAL`STRUCTURAL-ENE;INEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH sEa' , 76A638ATCE#803.10.56:!/ P y L I C A tl tl®N F®'R U'l L�D_O N'G P E:tl 11 M_ll ,• , BUILDING AND-SAFETY DIVISION? BUILDING g - 1)epQitmeril Of COnIIty'Erigin@@i ADDRESS r ( � ,.L/ County of Los,Angeles LOCALITY J014N A. LAMBIE. COUNTY ENGINEER NEAREST _ CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. - + - '± DISTRICT NO. GROUP ,TYPE 'SEWER MAP B p FOR APPLICANTJOFILL INI -6- I CONST: BUILDING (�,,� // - - - ADDRESS � V 3.O�'..1f eL 1� �,/N7.Q'�7. - STATIST.ICAL•CLASSIFICATION ,k LOT NO' -0` BLOCK - CLASS. NO. DWELL:UNITS I ' - MAP •' // HWY .. YES .. NUMBER'.,, '® J� - - ° TRACT /- _- - USE NE SPECIALNO. OF BLDG - ' SIZE OF LOT R V �( D I NOW ON LOTSONDITIONS '` - USE OF ' EXISTING BLDG. Al S - j BUILDING EXIST. / YARD HWY STREET NAME, SETBACK.. STREE 'WIDTH j OWNER., - FRONT.. MAIL ..P..L: �` ADDRESS- - SIDE - TEL P. L. r CITY. NO. INPECTIOK RECORD , ARCHITECT OR - TEL ENGINEER NO.. ADDRESS TEL. CONTRACTOR NO. . ADDRESS J' DESCRIPTIOOF WORK NEW ADD ALTERREPAIR DEMOLISH - SQ.-.FT'. ! NO. OF NO. OF SIZE: STORIES FAMILIES Xa LADDRESS F •,CT E APPROVALS - ATURE OF -LICANTDATE: 'INSPECTOR'S SIGNATURE FOUNDATION:LOCATIONFORMS..-MATERIALSC. $ .FRAME: FIRESTOP9 BRACING. BOLTTS,�✓// FEEATION /V $ FURNACE: LOCATION, r ✓f/ FEE GAS VENT, DUCTS - _ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT. 'PLICATION AND STATE THAT THE ABOVE'IS.CORRECT AND AGREE TO COMPLY WITH ALL COUNTY.ORDINANCES AND LATH. EXT: STATE .LAWS R TI BUILDING CONSTRUCTION. SIGNATURE OF �/ n v/��w���/ f� HOUSE NUMBER COR- _ _ ---,- PERMITTEE�� �; //�!/ ,,y�.v✓J_.� RECT AND POSTED ADDRESS w FINAL JOHN A.LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM, PRINCIPAL-STRUCTURAL-ETIGINEER _ PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK: M. CASH WORKERS'COMPENSATION DECLARATION. -hereby affirm that I have a certificate of consent to.self p D D p D O p p inure, or a certificate of Workers Compensation Insurance 9 • • lappd�Cla`Ta o H POQ• C�MOdDD D�IC� � pC�G3 w `� -or a certified copy thereof (Sec. 3800,tab C.) - COUNTY OF LOS'ANGELES ; BUILDING AWD;SAFETY Policy.No Company BUILDING ❑ ';'Certified-copy is hereby furnished: FOR APPLICANT TO+'FILL IN ADDRESS_ SL�'3CI f�t'0-A), ❑ Certified copy is•filed with the county building mspec'•' :BUILDING tion department. ;+ ADDRESS Date Applicarit ' CITY` ZIP { LOCALITY - NO.,OF BLDGS. CERTIFICATE`OF'EXEMPTION.FROM-WORKERS i SIZE OFOT L (q d /•N` NOW ON LOT, �. CROSSSi f /_-4J'/f `COMPENSATION INSURANCE ASSESSOR —r /� (This section need not`be completed if'the permit is for one TRACT' BLOCK LOT NO. MAP BOOK S cT PAGE Q�} PARCEL rd. -hundred dollars DO)-or-less.').• TEL. OWNER jt} E' �° Z(JjSB�/1(. ��(`r � USE ZONEv MAP I certify.ihat,,in ahe performance'of the'work for which this • r.., -' permit is issued,'I shall;not erriployanyperson'in any'monner+ SPECIAL ADDRESS) f��p. Lt <3z•a� �v� " a CONDITIONS so as to become subject to the Workers'Compensation:Laws: �,,- G� ( O ' CITY/ jy/.I?Lc �Z- % ZIP '['l 7d:� U Date Applicant 'ARCHITECT OR _ TEL. TYPE FIRE- CE NOTICE. TO 'APPLICANT:.If, after making.this Certificate:of ENGINEER / NO. P CONST. ZONE., O , Exemption, you should become subject,to the -Workers' DISTRICT OU. _ DIS GR PRO SSED BY W Compensation,provisions of-the,Labor Code, you musT forth - • ADDRESS Of �.d _ ; CL with comply. with such,provisions 'or This,permit _shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO,. deemed revoked. ., CONTRACTOR NO. _ _ , LIC CLASS NO:�DW N ` - LICENSED CONTRACTORS DECLARATION "-'� - - ELL. UNITS Z I hereby affirm that I am licensed under,provisions of Chapter 9 ADDRESS NO. (commencmg.with Section 7000)of Division 3 of the Business LIC. SEWER MAP," and Professions Code;'and mylicense is in full force.and effect. CITY- CLASS BK PG. VALIDATION EC SQ.=FT- NO:.OF NO: OF. CHECK p License Number a,. Lic.•Class SIZE. .. STORIES FAMILIES .( ONE 4 Contractor Date VALUATION DESCRIPTION OF WORKr NEW ❑ 4 ❑l.am.exempt,under Sec ADD 0 $: _ _....._ •., ALTER © , B.&P C,'.for this reason $ REPAIR 'Date r: USE OF . • - - EXISTING BLDG. DEMOLT❑ APPLICANTSi nature r9fS kt�tG �'��j FINAL(PRINT) nw NO.Ae OWNER-BUILDER DECLARATION -".•• _ DATE I hereby affirm that I am exempt from the°.Contractor s-License Low for the following reason'(Section 70 31.5, Business and1 FINAL ADDRESS '� l7f 6✓N Professions Code): ,.. ' PRESENT,_. ._ B r g. . BUILDING y Y :© I, as,owner of the'property, or,'my'employees'with ADDRESS 7 - -• wages as their sole compensation,:will do the work and the structure is not intended or'offered for sale(Section LOCALITY T a t -7044,»Business-and Professions Code ) MOVING TEL. - I ; D' ❑ I, as owner of.the property, am exclusively contracting CONTRACTOR• NO. •_ L_ with licensed coritractors to.Lonstiuct the projecT'.(Sec-, " t Tion 7044, Business and,Professions Code.) ADDRESS .'� ` REQUIRED TOTAL SETBACK'FROM EXIST.;;. YARD kW CONSTRUCTION{ENDING AGENCY` SET BACK - PROP LINE WIDTH'. I hereby affirm that there is a construction.lending agency for FRONT,. _ • 7 ; ' the performance of the'work for which this.permit'is:i'ssued P.L. ' (Sec. 3097,.Civ. C:): SIDE Lender's Name „ P1.' t • - r . F zc m _ G' CDMA Ref. # Lender's Address PC,.Fee$: Permit Fee _ o I certify that I have read this application and state that.The Issuance Fee.' LDMA P/C# g above information is correct.•I`cigree to comply with all County Investigation Fee d ordinances and State laws,relating to•building construction, _ Total Fee %• LDMA Perm. # a and here au rize represeritaiives.of.this.County.to enter upon t a ove-m ration d property for inspectiori purposes. _ a jU /a % SEE REVERSE FOR EXPLANATORY LANGUAGE, Sig ature of Applicant or Agent Date -