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Home My Public Portal About5120 KAUFFMAN AVE_Building__ 76A638A CE#803•7.56 APPLICATION FOR BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING 1f ADDRESS ..:J ��L? /I FJL'! �ih-•+'+'v-�V /tel t7G Department of County Engineer County of Los Angeles LOCALITY 7-6 , T/o JOHN A. LAMBIE, COUNTY ENGINEER NEAREST )J n CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. 14Fi /(. C.S OUT 3"m '�' '�''' DISTRICT NO. GROUP SEWER MAP FOR APPLICANT TO FILL IN �'" —f I coNTYIEST: I G JJ //'' BK PG ADD EBUILDIS$ �� /.Zb /C'p 1��Y'i7.7A 1y AV`s. STATISTICAL SSIFICATION LOT NO. r BLOCK CLASS. NO. DWELL. UNITS" MAP _STATE, YES —11 NUMBER - HWY TRACT J,S/p� USE ZONE SPECIAL NO. OF EILDGS. CONDITIONS SIZE OF LOT Gi X 1'� I NOW ON LOT - USE OF J i - EXISTING BLDG, `SiNa�� /7a�•ri! �N - / l=<`i BUILDING - EXIST. YARD HWY STREET NAME SETBACK _ WIDTH OWNER /Z. J. .(�I �J[� e1I - FRONT, MAIL _ /1//�� P. L• �, ADDRESS .�J��Ip 114,111 447--q SIDE CITY- /Qrr1 O /� /n/ •• TEL. O P. L. ARCHITECT Oft TEL. INSPECTION .RECORD ENGINEER NO. ADDRESS - ' TEL.'tI CONTRACTOR: , IJP/ar Il7T NO./`F/- J'S"?0 C, ADDRESS J 7/.Y - DESCRIPTION OF WORK , u NEW - ADD +ALTER REPAIR .DEMOLISH SQ. FT. NO. OF NO. OF SIZE - STORIES j.. FAMILIES USE OF STRUCTURE -'IAB V C' n. f n IG'J I - . n a.r► APPROVALS • SIGNATUR OF rFOUNDATION: APPLICANT /7 DATE INSPECTOR'S SIGNATURE ADDRESS ,;j /,$ - ca- e774, 7—C. LOCATIONORMS. MATERIALS P.C. S FRAME: FIRE STOPS, - /�.-y¢../� FEE BRACING, BOLTS VALUATION " — $ (J, FURNACE: LOCATION, w: ,,, ..• FEE , GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT. STATE LAWS REGULATIN'4 BUILDING CONSTRU(TIO L SIGNATURE OF /� \' HOUSE NUMBER COR-' PERMITTEE !9 / //�7/� RECT AND POSTED ADDRESS C.t'�.ce' / '�- FINAL JOHN A. LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM. PRINCIPAL:STRU URAL ENGINEER ` PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH JUN 1 1 - 85 WORKERS' COMPENSATION DECLARATION - ave hereby affirm that I.have a certific�to of ce�osenY to self D O O M 0 O D� D M D O nn insure, or a certificate of Workers'Compensation'Insurance, ;, O U V ' O t=J U��D�11 V G P T RLI V'U V or a certified copy-thereof(Sec. 3800; Lab:'C.'). q' COUNTY OF.LOS Ia,NGELES BUILDING AICD SAFETY Policy No. Company�O C k5�4• ime 1 BUILDING Certified copy is hereby furnished FOR A PPPLICANT•TO FILL,IN-- ADDRESS Certified copy is filed with thill e 4unty building inspec- BUILDING . .. tion department. ADDRESS KA LOCALITY NEARE Date --�l Applicant �' �� CITY 1 ZIP 9 1 a- _ CROSSSST. --� CE TIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE .LOT MAP BOOK PAGE PARCEL SIZE OF LOT NOW ON r (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. . -' TEL �y i44 SPECIAL certify*that in the performance of the work for which this OWNER�--�s NO.y'7 �— ` °" CONDITIONS I _ /�^ DISTRICT GROUP TYPE FIRE PROCESSED BY permit is issued,'1 shall not employ any person in any manner ADDRESS 2 /�� 1 T` CONST. ZON so as to become subject to the Workers'Compensation Laws. _ .Date ApplicantCITY ZIP' �� STATISTICAL CLASSIFICATION AP. CONDO. NOTICE you should , of ter 'subjectaig this 'Certificate of ARCHITECT OR TEL. dy NOTICE TO APPLICANT:' If, g ENGINEER NO: CLASSNO. _DWELL:UNITS Exemption, Ythe Workers'' � Compensation provisions of the Labor Code, you,must forth- ADDRESS SEWER-MAP with.-comply with such provisions .or this permit shall-be TEL r `a deemed revoked. y� �I _ BK' PG,' VALIDATION CONTRACTOR L NO. Y1 tl LICENSED CONTRACTORS DECLARATION LIC. G� ry I hereby'affirm that l_am licensed under provisions of Chapter 9 ADDRESNO. VALUATION (commencing with Section 7000)of Division 3 of the Business and �, r' LIC. P'rofes'sions Code;'and my'license is in full force and effect. CITY USM i ` CLASS ( -tet $ ' � ( SQ:"FTF .' NO. OF NO. OF CHECK', D License Number °Vz t,, tic.Classes SIZE STORIES FAMILIES ONE Contractor ar��`o `.t DESCRIPTION OF WORK sj NEW $ Date j [y, ADD I am exempt under Sec. �^ ALTER FINAL ,v .B.&P.C. for thi r anon ` REPAIR -DATE ; Date: USE OF `a ❑ I EXISTING BLDG. l/ .�.� DEMOL O BINAL -, Signatur APPLICANT TEL.: ,'// Y (PRINT)' .- .� ✓ —NO . !�� , 1 OWNER-BUILDER DECL. A IONA � Q I hereby affirm that I am exempt from;t Contractor's License . C� •— � D . �J !}—/�/. Law for the following reason (Section •7031.5, Business and, ADDRESS �� • Professions Code): PRESENT BUILDING' as owner.of the'property, or my employees with ADDRESS` "' _. (j 01 A wages as their sole compensation,.wiII do the work and LOCALITY'. the structure is not intended orbffered for sale(Section o'o 7044, Business and Professions Code). MOVING TEL. n f o o CONTRACTOR NO. ❑. I, as owner of the property, am exclusively contracting a c. with licensed contractors to construct the project (Sec- ADDRESS _ tion 7044,Business and Professions Code). a ` ,:`0 L: CONSTRUCTION LENDING'AGENCY SETT BACK OTAPREOTPAINEFRO WIDTH YARD HWY T M Y 7 her affirm that there is a construction tending agency for FRONT {� I ,� D L(; the performance of the work-for which this permit is issued P::L. (Sec. 3097, Civ. C;). SIDE . P.L. _ o Lender's Name •� P.C. Fee.$ Permit Fee• p s Lender's Addres " I certify that I 4e read this application and.state that the Issuance Fee above inform i n is correct. I agree to comply with.all County Investigation Fee $ ordinances J State-laws relating'to'building construction, Total Fee u and hereby aithorize r esentatives of this County to enter m upon t eve-ment' d property for inspection purposes. - SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A plicant or Agent Date ®s r � ON,DECLARATION I hereby ertificate of consent to self n ,/n1. D 0 D D insure, or I's Compensation Insurance, U100-H FOR BU0W01MG pEG3WU or a cer ifi%40 py t ereof(Sec. 3800,:Lab. r.) A":!J I -:�� } - . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. V-*d Companyy og,• � Certified co is hereby furnished. BUILDING Pv v FOR APPLICANT.TO FILL-IN: . ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS' /� j� LOCALITY NEAREST Date // Applicant CITY ZIP r CROSS ST. ER:FICATE OF EXEMPTION FROM WORKERS' N OF BLDGS. / ASSESSOR COMPENSATION INSURANCE SIZE OF LOT &o v(Q3NOW ON LOT / MAP BOOK PAGE PARCEL (This section'need not be completed if the permit is for one MAP hundred dollars ($100)or less.) TRACT j Q BLOCK ' LOT NO. NO. TEL - SPECIAL I certify that in the'performance of the work.for.which this OWNER• ieJEd (Ile NO.. CONDITIONS 0. permit-is issued,J'shall not employ:any person.in any manneryP� DISTRICT GRO P TYPE FIRE ESSED BY O ADDRESS` ^� J� .- V so as to become subject to the Workers'Compensation Laws. �;vCONSTZONE CITY 0 Date Applicant P STATISTICAL CLASSCONDO.IFICATION APT. u NOTICE TO APPLICANT: If, cifter making' this Certificate of ARCHITECT OR TEL. , 7 _ Exemption; you should .become subject to the Workers'. ENGINEER N07 CLASS NO. DWELL. UNITS LU Compensation provisions.of the labor Code, you must forth- ADDRESS - SEWER MAP 44 with comply, with such 'provisions or this permit shall be TEL. It VALOATION deemed revoked. CONTRACTOR F(- NO.. %� BK. PG, LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm-that I cim licensed under provisions of Chapter ADDRESS' '� 4 NO. i % LG VALUATION (commencing with'Section 7000)of Division 3"of.the Business and, LIC. / �� Professions'Code, and,my license is in full force and effect. CITY t)-L/ lye tl CLASS $ V 0>✓40 SQ.TT:'.- NO.OFNO:OF CHECK D License Number, Lic.Class SIZE ' STORIES FAMILIES ONE !Z !fir i. L/ Cv -DESCRIPTION OF WORK : ' r NEW, $ Contractor M fPl9. Date i 7 ADD ❑ I am exempt under Sec. /� ALTER .❑ FINAL B.&P.C. for this reason — ❑ DATE/ �`�/✓ Date: USE OF DEMOL _ ❑ EXISTING BLDG. FIN Signature APPLICANT TEL OWNER=BUILDER DECLARATION PRINT NO. hereby affirm that l am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS D Professions Code): PRESENT UILDING- ❑ I, as•owner'of,The property,-or my employees with ADDRESS wages as their solecompensation,will do the work and the structure is not intended or offered for sole;(Section LOCALITY 7044, Business and Professions Code). MOVING TEL ❑ 1, as owner of the property, am exclusively contracting.. CONTRACTOR NO. with'licensed contractors to construct the project'(Sec- ADDRESS . J�"8:7,5 A 'tion 7044, Business and'Professions Code). REQUIREDTOTAL•SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY. PROP.. LINE WIDTH $f ® o o ® o hereby affirm that there is a construction lending agency for kFRONT - -- the:performance of the work for which this permit is issued P.L. D ) 0 87,38 (Sec. 3097, Civ. C.). SIDE P.L. - o a 87.385, v .Lender's Name - r� C Q L $ P.C.Fee$1 Permit Fee Lender's Address d 5 8 6 certifythat F have read this application and .that the PP Issuance Fee ; above"information is correct. I agree to comply with.all County• lnvestigation.Fee - { $ ordinances.ond State laws eelating'to building construction, , u and t rize representatives of this County to enter Total Fee , n the abov mentioned property for inspection purposes. -• - — ; SEE REVERSE FOR EXPLANATORY.LANGUAGE Sign i re of Appl'-antor Agent Date ®s WORKERS'COMPENSATION DECLARATION M M nn i�h,r, o'affirm that I haver certificate of consent to self � F F� C A CT P O lJ V '�O g O U��M LI V O �LI V LI n a ure, or a certificate of Workers' Compensation Insurance, [!� U'�1 u `or a certified copy thereof (Sec. 38 La C.) ' I COUNTY OF LOS ANGELES •-BLIILDIWC �►R9D SAFETY - PolicyNib2a. gCompany, BUILDING 'l Certified copy is hereby furnished. FOR APPLICANT TO-FILL IN V ADDRESS Certified copy is filed with the nt building inspec- BUILDING tion department. ADD RES LOCALITY r NEAREST � Date AppliZQvft CITY ZIP CROSS ST. CERTIFICATE OFEXEMPTIO F OM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION URANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one ,� E JTONE, MAP hundred dollars.($100)or less.) TRACT [l BLOCK LOT NO. US�//j• NO. TEL. SPECIAL I certify that in the performance of the work for.which this OWNER NC�f DtY�'7 ZS T CONDITIONS C •permit is issued,,I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCE ED BY 0• so as to become subject to the Workers'Compensation Laws. ADDRESS D FF ig/ � CONST. ` ZO E U CITY. P UYd V/ O Dale Applicant ARCSTATISTICAL CLASSIFICATION APT. IC DO. HITECT OR TEL. Exemption, you should become subject to the Workers' F� ' l w'1 r� NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER i C (/ '� GI� NO. }CLASS NO. 4I DWELL. UNITS Yt . 4. Compensation provisions of.the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or•this, permit shall be z deemed revoked. CONTR N TEL 2S!�-O BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATIONLIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / NO. VALUATION - (commencing with Section 7000)of Division 3 of the Business and /� ,/ '//- LIC. ' Professions Code, and my license.is in full force and effect. CITY (�/V )`f'l:� �/ CLASS $ c SQ. NO.OF NO.OF' CHECK D License Numb 323/7 Lic•Class SIZE STORIES FAMILIES ONE �J1� $ DESCRIPTION OF WORK NEW ' Loniracto �Date ADD Q ' I am exempt under Sec. # 0 0 ° A� ALTER E] FINAL. F ° ° B.&P.C. for this reason L[/�!1 PL 7T� REPAIR Q DATE o 08199,x Date: USE OFEXISTING BLDG. J - DEMOL Q FI c) Signature APPLICANT TEL. OWNER,-BUILDER,DECLARATION PRINT N/�/)�L3�L.'Z /�� t•L �C` I hereby affirm that I am exempt from the Contractor's License ADDRESS /YV®K/ q/�/ / //( D• Law for the following reason (Section 7031.5, Business and Professions Code): PRESETEl 5.6. BUILDING 130 0 0 0 0; I, as owner of the property, or my.ernployees with ADDRESS ° ° 5 9 2 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY _ 7044, Business and Professions Code). MOVING TEL. °.5 9,2 5 U I, as owner of the.property, am exclusively contracting CONTRACTOR NO. I a.d 3—8 5 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code)_ ADDRESS • REQUIRED TOTAL ETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY' SET BACK YARD HWY PRSOP. LINE WIDTH I•herebyaffirm that there is a construction lendin a enc for `.•. A 9 9 Y FRONT f_ •*_ the performance of the work for which this permit is issued P.L. �``t•, (Sec. 3097, Civ. C.). SIDE m P.L. • < Lender's Name Lender's Address P.C. Fee$ �� Permit Fee (J W I certify that I have read this application and state that the SD � Y PP �. Issuance Fee • information is correct. I agree to comply With.all County Investigation Fee $ ordina ces and State laws relating to building construction, Total,Fee It and he eby out orize representati s of this County to enter e.abo -m e y for inspection-purposes. -- SEE REVERSE FOR EXPLANATORY LANGUAGE g Tureof pplicant Agent Date ®S