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Home My Public Portal About5925 KAUFFMAN AVE_Building__ 76A638A CE0803 9-68 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ,-- DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS-, SUP•T OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. GR TYPE P o S Y CONST, (Print or type only) �j FDDRESS iSTATISTICAL CLA IFICATION S WERMAPPp.�.J /a`'( �i//�/U CLASS NO. DWELL•UNITSp2 BLOCK - USE ZONE MAP n NO. d TRACT SPECI AL CONDITIONS ' NO.OF BLDGS. SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG.SETBACK FROM ' TEL. FRONT PROP.LI NE OF (STREET) OWNER I_6qq�4f J/.•(' r�•-�/ NO. YPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS.) /�g '/ A/-.r RN GHWAY WIDTH FROMC.L. CITY. fb g c,4<6'4 _ + BLID GSK FROM ARCHITECT OR TEL. SIDE PROP. LI (STREET) ,ENGINEER NO. _ TYPE OF EXISTING SETBACK I HI + YARD = "TOTAL ADDRESS- HIGHWAY WIDTH FROM C.L. /-� TEL. CONTRACTOR) !Lf//1 ffllr0s NO. ` + C LIC.•_ L ADDRESSsd y ,r .4/ NO, J�� CORNER CUTOFF YES ❑ - .NO LIC. C CITY C't� CLASS L SEE REVERSE SIDE FOR SPECIAL APPROVALS 4 CONSTRUCTION L DER a NAME AND BRANCH co'. ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES _ USE OFQ �- � DD ❑ 4-4-STRUCTURE /L� , ' ALTER ❑ SIGNATURE OF REPAIR❑ APPLICANT DEMOL ❑ VALUATION $ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE $ FEE $ FORMS, MATERIALS FRAME: FISTOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACIRE NG BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALLORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. 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 COMPENSATION INS RAN LATH, EXT. SIGNATURE OF ,L.d-tea-- HOUSE NUMBER COR- PERMITTEE [[[+++�� RECT AND POSTED ' ADDRESS FINAL JOHN F. LEWIS, PRI CIPAL STRUCTURAL ENGI ER PLAN CHECK VALIDATION CK MO _.CASH _ PERMIT VALIDATION CK. M O CASH i 4.4.7 AW15' 1 D 9.00 ew 7UA638AC68-03-6_57 APPLICATION FOR R BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING . DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALI JOHN A.LAMBIE,COUNTY ENGINEER, NEAREST CASSATT D.GRIFFIN,SUPT OEB' DINd CROSS DISTRICT f GROUPrvPESEWER.MAP FOR APPLICANT.TO FILL IN .1r. .4 j l,C8Ns-: Ste= BUILDING - ADDRESS ` �� STATISTICAL CLASSIFICATION'S LOTNO. . BLOCK CLASS NO` DWELL. UNITS MA'P'' 17 _ STATE NUMBER Q•49HWY. 'YES" 0 TRACT (0 ' USE ZONE', SPECIAL - y� ^� NO OBLDGS. - 'CONDITIONS F SIZE OF LOT- ;il �/ I •NOW ON LOT - --USE OF •- ' ~- '- EXISTING BLDG.A � BUILDING EXIST. _ YARD HWY STREET NAME OWNER /r• J�� . SETBACK _ ._WIDTH' _ FRONT MAIL P L. ADDRESS �� ,L �"/� SIDE . CITY l ?W/�GL�� -Cl/ NO _ARCHITECTOR _ _ •}..e. _ ;+- TEL., INSPECTION RECORD ENGINEER ' `n - NO`.""' ADDRESS - ' 1 TEL. - 3' ''cg PAto '�- 3-' 7 `I5zPAP . . CONTRACTOR s' A41% 3- Ni � • '7/1= - , ADDRESS A!/ `� / ! •.. _ - - DESCRIPTION OF WORK . - RRA('_f_ P'FZ TT1)A,_ZE ur.lW&C-(' NEW 1//ADD ALTER "REPAIR DEMOLISH Gf'�-q.xmICr'� SQ.FT. ' ,1 NO.,OF. / NO OF SIZE �. STORIES ! FAMILIES •'` USE OF STRUCTURE _ 7��r- d SIGNATURE'OF �� APPROVALS �. - -L " APPLICAN ADDRES f • yFOUNDATION: LOCATION DATE !�" INSPECTOR'S�SIGNATURE , FORMS,MATERIALS, - 3� �O(J ° ��(•`' , - -P.'C. $ FRAME- FIRE STOPS,`. FEE 'BRACING. BOLTS /// VALUATION $ FURNACE. LOCATION. ' FEE _ GAS VENT.DUCTS' _ I HEREBY-ACKNoWLEDGE THAT I HAVE F*AEf THIS AP- • „, ,� PLICATION A 'T,HAT THE ABOVE I /CORRECT AND LATH„INT. ''AGREE TO,C PLY.WI H ALL C eiNTY O DINANCES•AND STATE LAWS. RE_GU T_ING IL CONSTRUCTION. .'LATH, EXT. - SIGNATURE C F HOUSE.NUMBER COR V PERMITT - RECT AND POSTED •-t- , �p--� �j r _•. _ ADDRES FINAL JOHN AlAN CO TY ENGINEER, CLYDE N. DIRLAM PRINCIPAL STRUCTURAL ENGINEER PI N Cp4oK VALIDATION CK. I,i.D. CASH PERMIT VALIDATION cK. M.o.' •cases'. , APPLICATION FOR,, BUILDING PERMIT i1 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS RESS I hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDS or a certificate of Workers'Compensation Insurance,or a certified CIN V� ZIP ` r copy thereof(Sec.3800,Lab.C.) V LOCAL+ GITy POIICy NO. Company SIZE OF LOT I NO.OF BLDGS. WON LOT 221 J ❑ Certified Copy is hereby furnished. NEARES CROSS T ❑ Certified copy is filed with the county building Inspection TRACT BLOCK LOT NO. department. <j d 0 USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant 8 O SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER EL.NO. T —q2,\ WITHIN 1000 FT OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit is for one hundred S DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($ or less.) CITY zip �o-0 -3 I certify thathat in the performance of the work for which this permit ' a' U is issued, I shall not employ any person in any manner s0 as to ARCHITECT OR ENGINEER V TEL.NO. becom�e_suubjjeect to the Workers' orrsal ion La rV1STATISTICAL'CLASSIFICATION A CONDO Date OAppliCent �� Q.� ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of CONTRACTOR TEL NO. REOUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS — LIC.NO. PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL o 1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v SQ.FT SIZE NO. STORES NO..OF FAMILIES (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK,.. PG � Professions Code,and my license is in full force and effect. v DESCRIPTION O WORK ` ADD ❑ VALUA7160. �Jr� I+� License Number Lic.Class \O 00Contractor Date ALTERZ ❑ I am exempt under Sec. REPAIR B.&P.C.for this reason DEMOL ❑ LDMA P/C N USE O STI G. - URM ❑ Date: � i 1 Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# Z .(_ El 1, as owner of the property, or my employees with wages as — O "g their sole compensation, will do the work and the structure is ADD E FINAL D TE Q _X707 �1w �c 58.r.: not intended,or offered for sale (Section 7044, Business and G v; ProfessionslCOde.) WILL THE APPLICANT OR FUTURE BUILD INGOCCUPANTHANDLE A HAZAR SMATER-A ^� ' / J 1 ITEMO OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN 1, 'as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Fl Y () > u licensed/co*retractors to construct the project (Section 7044, TOTAL °q-A ® _e Business and Professions Code.) YEs❑ No❑ •� �` ! CHECK ��,7 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING i.•ilC�•�\ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST I S HAKE e I3L FOR GUIDELINES. _ L �2 2 'I hereby affirm that there is a construction'lending agency for res❑ No❑ Lr� v '( p. ' the performance'of the work for which this permit is issued(Sec. i 1 HAVE READ CHECKLIST I UNDERSTAND MATERIALS INFORMATION GUIDE AND THE ANGELES I 00 �y_0001• 7/ J�,L 1 3097,CIV.C.). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES > (}LJtJ1 I ILL / J ' COUNTY CODE,TITLE?,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20140 CONCERNING _ Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. (y( j AM ry� 7-'3323 Lender's Address OR AaExr o' I certify that I have read this application and state that the above information Is correct. I agree t0 comply with all County PC.FEE PERMIT FEE �, ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE th a ve-mentioned pr for jnspection purposes. Q -7- 1� INVESTIGATION FEE TOTAL FEE m Slg, .of Aroll�aApra Om SEE REVERSE FOR EXPLANATORY LANGUAGE •WORKERS' COMPENSATION DECLARATION hereby affirm that.I have a.cer.T I ific'ateof consent to self T I N F R I D.I N G PERMIT insure, or a cert,frcate•of`Workers'Compenstion Insurance, or AP.P�.ICA ® - a certified copy thereof Sec„3800, Lab C ) , o ZZ - ,+ COUNTY OF CLOS ANGELES BUILDING AND SAFETY Policy NCompany BUILDING F-1Certified,copy,-is hereby furhis cl FOR APPLICANT TO FILL IN ADDRESS �� 5 �a-P• YCe rtified%dcd,py„is4iled.with the county building inspec- i BUILDING Cj�� tion epartrne`nt' 6 ADDRESS. [[ - LOCALITY ^ 0;S � . NEAREST' <` X•Date' w v' :Appl,cant' , CIT.Y. L. ZIP - CROSS ST t' CERTIF,ICATE•OF"EXEMPTION FROM WORKERS', NO OF BLDGS ASSESSOR, i• COMPENSATION INSURANCE- S SIZE OF LOT.- NOW ON LOT MAP BOOK PAGE PARCEL USE rZNE MAP (This section,need not,be completed",f;the permit is for one<' TRACT BLOCK - LOT-NO NO IU, hundred dollars-($1 less ) ;',. } i a �p tTEL. �' • SPECIAL IL r• .' Y ".1" OWNER C i NO CONDITIONS_ O I ,certify that ,n.the*perfor,mance of the work for which this -- - DISTRICT GROUP TYPE FIRE PRO ESSED BY, V permit is issued,I shall riot employ any person in any manner ADDRESS CONST Z NE 'so as to become subject to'the Workers'Cdrnpensat,on'LawS. /Q� d' S� j% p' Date - Applicant > a<'. CITY ZIP 1 STATISTICAL CLASSIFICATION Y PT ]CONDO U ARCHITECT OR' TEL. NOTICE•TO APPLICANT.' I'f,•after making th,s,Cerhficate of` ' ENGINEER NO e /" tial ' Exemption,',you`should 'become -subject .to 'the” rkers'•. CLASS NO DWELL. UNITS' N Compensation provisions of the Labor Code, you must forth- '' ADDRESS Y SEWER MAP with comply with such.,provisions or this permit ,shall- be,- < deemed revoked \' CONTRACTOR a�NEp / BKG,,��/ VALIDATION`; LICENSED CONTRACTORS DECLARATION.. L C r/ I hereby affirm that I am licensed under,pro_v_iswns'f Chapter 9 ADDRES 1 �JG i. U e NO LID VALU T (commenting with Section 7000)of D,vision.3 of the Business arid- r- "; LIC_ �I ProfessIOKs Code;'and my license fs m`full'force and-effect' _ CITY. OIJI CLASSd_ $ y�(j�'' �jwr SQ FT NO OF NO OF CHECK License Number�J� VV� 1 Lic.Class' �'v✓ SIZE STORIES FAMILIES O Q �G � . $ , Contract org O�.`�� t.�Dates y .`� DESCRIPTION OF WORK. NEW I am exempt'from,the I,censing'requirements as I am a r , 0 „ •�-'�, vlf ADD' licensed architect or a redis'tered professional engineer ALTER FINAL y 9 Y P. capacity (. 7 Li Q.Ir -e, DATE .actin in m 'professional ca acit 'Section, 051, .REPAIR" Business and Professionstode). USE OF FINAL ' EXISTING BLDG ` yle DEMOL r Lic or Reg No. i J :'' Date APPLICANT TEL By - OWNE_R-BUILDER,DEC-L'ARATION :• (PRINT)` Y"Q.. - .' NO351 I hereby'affirm th'at'I a ri exempt from the Contractor's License /�� a r•rn �� Low'for the following" reason (Section.7031.'5, Business'and' ADDRESS_bl Professions Code)-, PRESENT; r BUILDING ' t I,. as owner 'of the property, or.<my employees, with ADDRESS - "wages as their sole'co'mpensation,will do the-work and; -the structure,is-not intended or offered for;sale,(Section' LOCALITY 1,-- �' 6"5'6;:5tiA 7044, Business and-Professions-.Code) MOVING TEL I� , I, as owner of�the property, am exclusively contracting ' CONTRACTOR ,NO # o o i o o with licensed;contractors to'construct ihe'p'roject)(Sec- ADDRESS _ Z G 3 O O tion-7044,,Business and Professions Code) - - - CONSTRUCTION LENDING AGENCY REQUIRED TOTAL'SETBACK FROM EXIST r SET BACK YARD HWY p p.LINE WIDTH ° e•° /� Q�,� I herebyaffirm that ther'e•is a construciiomlend,n ci enc for' 9 ,9 Y FRONT r the performance of the work for which this perm it.is issued P'L (Sec 3097, Civ^-C )- -SIDE PL . _ ' Lender's Name C9 ' PC. Fee$ Permrt Fee - - Lender:s Address w I certify.that I'have-read this,application and state that the 'Issuance Fee r: above information is correct agree to c lnt ply,with,al County'•. Invest,gotion Fee" o. ordinances and State, laws relating to building construction, 3� Total Fee and hereby authorize representatives ofthis County:to enter a u' n th'e above=me onecl ro erty for.inspection purposes w, ; SEE REVERSE FOR EXPLANATORY-LANGUAGE, t, Signdture of Applicant or Agent- Dote