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HomeMy Public PortalAbout5132 KAUFFMAN AVE_Building__ DEPARTMENT OF BUILDING AND S APPLICATION FOR PERMIT .! COUNTY OF LOS "(;ELESVEU . WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY -` ADDRESS ( DISTRIC NO. PLAN CK.NO. PERMIT NO. BUIL .LOCA'1TY ,F�':L' RECEIVyyEDrBY DATE OF APPAL`.] DATE ISSUED ClfGBS ST. Y �s r yp�® .s y,.f.✓ ` BUILDING OWNERIB l��VL,��..oc��Zf�._ ADDRESS. D /' !'�/.✓.+,a.. �•.�rs�,! . MAIL• o d' G��isCer ADDRESS " LOCALITY • ', NEAREST' Y CITY2` •-+GC.� � NO CROSS ST. L FIRE T—N 130 r ARCHITET OR �(�) TEL. ZONE PLAN CS TYPE ENGINEER4..�',FSa�' NO. ?; BLDG. ADDRESS SETBACK-LINE ` — � APPROVED CONTRACTOR NO. BY GATE USE APPROVED ADDR SS - ZONE BY w�1 DATE LEGACO DESCRIPTION LOT NO. BLOCK �Jb/[/ "/ CORRECTIONS TRACT 9 C. 609.1���.yf NO.OFBLDOS. ' SIZE OF LOT '�' NOW ON LOT USE OF I NO.OF I NO.OF o/jam . EXISTING BLDG. FAMiuEs'' ROOMS //Z9/o L� Ai../r_ d.t110'='-t"', DESCRIPTION OF WORK NEW ALTERATION ADDITION O � - A REPAIR MOVING DEMOLISH G SQ.IZ FT. �f - NO.OF j > SIZE iei" ROOMS STORIES / f WALL ' a, PROOF t- COVERING � v'�+t', r COVERING USE OF NEW BUILDING �(pr� cti� O�R �',�'�"` �4r.-Fm'S2- ��� � I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT INSPECTOR - DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION FORMS,MATERIALS tea. ��� �� AND STATE LAWS REGULATING BUILDING CONSTRUCTION. __ r FRAME: FIRE STOPS, G 51GNATURE1, 6L �91 BRACING,BOLTS �� / ,0 PERMITTE _ "/ LATH', INT. AUTHORIZED AGT -e. - 4G i''„, �—•�j � LATH, EXT. s �/ 7GA63BA-3 7-49 'C,FEE $/3 PLASTER,INT. ” ' PLASTER,EXT. �l VALUATION A' FEE '�� FINAL — �^- �✓ ��/"� A101PUCAMON FOR BW LONG p l v�Ji �T 1�. COUNTY OF LOS ANGELES BUILDING_AND SAFETY WORKER'S COMPENSATION DECLARATION' FOR APPLICANT TO FILL IN BUILDING q - BUILDING ADDRESS i hereby•affirm that I have a certificate of consent*to self insure, ) or a certificate of-Workers' Compensation Insurance,or a certified / �" ~ copy thereof(Sec.3800,Lab.C.) CITY - ZIP.. LOCALITY y Policy No. Company, - SlZE OF NO.OF BLDGS.NOW ON LOT - El Certified copy is•.hereby.furnished.' NEAREST CROSS ST ❑ Certified copy is'filed with the Courity building inspection TRACT- BLOCK LOT NO. department: USE ZONE MAP NO. Date. Applicant - ASSESSOR MAP BOOK - -PAGE - PARCEL ✓ SPECIAL CONDITIONS. CERTIFICATE OF EXEMPTION FROM WORKERS' ,' OWNER TEL No. Ly COMPENSATION INSURANCE. � L WITHIN 1000 FT OF SCHOOL?_ YES, NO ' (This section need not be completed if the permit is for one hundred ADDRESS- • DISTRICT GROUP TYP CONST. FIRE'ZONE PROCESSEDBY.. dollars-($100,)or less.) P n CITY - ZIP - I certify that in th_a.performance of the work for which this permit , `/ Is issued,1 shall not employ any person in any'manner so as to ARCHITECT OR ENGINEER TEL•NO: become subject rte•e Workers' ens • -`STATISTICAL CLASSIFICATION -APT CONDO Date L/! AppliCan ADDRESS CLASS NO.. oG� DWELL UNITS NOTICE TO 'APPLICANT.' If,. after making this Certificate of REQUIRED TOTAL SETBACK FROM MEXIST' Exemption, you should become subject to the Workers' CO AC OR T L N SET..BACK YARD.. HWY PROP LINE WIDTH Compensation provisions of the Labor Code,.you,must forthwith C.61 FRONT ,comply with,such provisions or this permit shall be deemed revoked DDFIE S NO: PL G/" v/C /`-' s©7t,y!.. LICENSED CONTRACTORS DECLARATION - I 17a ASS PL I 'hereby affirm that I am licensed underprovisions of Chapter 9 �`� '"ter SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF STORIES NO.OF FAMILIES Professions Code;''n m I'-.i is in full force and effect.' NEW ❑ BK . e-1 PG / , V License Num er Lic.6I2ss DE CRIPTIONhNft O - ^ - VALUATION ' ! ADD- .: ❑ .. >'. p Contractor Date ALTER ❑. $'' w CL O10 4A bYk A1'4-Aqe, REPAIR v) ❑,I am exempt under Sec. Z B.&P.C.for this reason �� !•(�� )/(}QLty DEMOL, $ — iDMA P/C# .. Date:- - _Ui�F XISTI CzBL - ©. ..-.. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm,# - y - l]:I,<as owner'of the,property,or my employees with wages as Z their sole compensation, will do.the work and the structure.is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE Q :• ,- - 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 J eo +'^+�.. e'`"',„-"�, I, as owner of the property, am exclusively contracting with .AMOUNTS SPECIFIED N THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL � �+ 3:5!, E E r licensed contractors to construct the project (Section 7044, e . tN Business and Professions Code.) - ves❑ N-0 •_ ' •� - WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �• - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTHH CONSTRUCTION LENDINGAGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDEINES. hereby affirm that there is a construction lending.agency for =YES❑ N a the performance Of the Wolk for Wt11Ch this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING �O - - S r ' 3097,CIV.C:) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, '- S tvF 3'1• TITLE 2,CHAPTER 2.20 SEC)O 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS fAIN rl Lender's Name. AT EPOR7,7y7G QIS 0 26T 'A PERMIT FROM THE SCAQMD. g _,� A•,,_- f•e CL ''"` Lender's Address O - o I certify that 1 have read this application and state under penalty q of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all county ordinances and State laws relating to building construction, and here y authorize representatives of this County ISSUANCE FEE toe upo a mentioned property for ins p tion purposes. Cif�j <D 0 1 INVESTIGATION FEE - TOTAL FEE �r��. a� - ^ ,enewre.o u m or Arem Del. d Q SEE REVERSE FOR EXPLANATORY LANGUAGE