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HomeMy Public PortalAbout6036 KAUFFMAN AVE_Building__ ©s 76A638A 1 �� CE#803(2E 1•/78) \ APPLICATI F B U ILD E RM IT COUNTY OF LOS ANGELES BUIL ING AND SAFETY, BUILDING FOR APPLICANT TO FILL IN . ADDRESS 2� BUILDING - ADDRESS r— i V11 LOCALITY NEAREST CITY ZIP . C! CROSS ST NO OF BLDGS' ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE - PARCEL n STRICT GROUP •TYPE FIR P S ED BY TRACT BLOCK I LOT NO CO _ `_� L _ OWNER C9S� CEJ/O' Z TENO �V STATISTICAL CLAS FICATION SEWER A ADDRESS v��'�`I CLASSN �DWELL UNITSPG ' CITY �'� G "ZIP ARCHITECT OR TEL .VALUATION`$',_��&� ENGINEER NO- ADDRESS O-ADDRESS BLDG SETBACK FROM TEL FRONT PROP LINE OF (STREET) CONTRACTOR NOTOT ACK FROM. YPE OF EXISTING LIC -HIGHWAY + YARD = PROP LINE IGHW WIDTH ADDRESS LIC _ + CITY CLASS BLDG SETBACK FROM CONSTRUCTION LENDER SIDE PROP LINE OF (STREET) NAME AND BRANCH HIGHWAY + YARD " = TOTAL SETBACK FROM- TYPE OF EXISTING _ ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH- C SO FT STO OF NO OF CHECK + _ V SIZE ORIES FAMILIES ONE 09 ❑ USE ZON MAP �e 0 NO 1.. 'DESCRIPTION OF WORK r NEW SPECIAL LOTf .4-e,+ ADD, ❑ CONDITIONS N ALTER ❑ FINAL BY Z REPAIR ❑ DATE USE OF EXISTING BLDG DEMOL �' •� Z APPLICANT ' TEL (PRINT) NO� 7�V y �`Q \•\ Q BY(SIGNATURE( ' �•j.l ;'• •. � > c I HEREBY AC WLEDGE THAT I HAVE READ THIS PLICATION AND STATE uYJ O THAT THE ABOVE IS CORRECT AND AGREE TO COMP WITH ALL ORDINANCES c� tL, AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE '_ 1'2'5 0 A WORK AUTH ED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF u ' THE LABOR D F THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COM- _ _ _ Z ' "NSATIO (NSU NCE' ' # O e i O O 0 1 SIGNATUR F r 2:0 0 1 9.00 PERMITTEE 6,0 ADDRESS T�v ^ 1 9,0 0�' -.TEL ° 071 5'-•80 CITY • NOMO P C Fee$ i Permit Fee / > Issuance Fee o�c W — 4 0 Total Fee C163 {,. i C163 JRE �`1ti; 78) el. � APPLICATION .OR BU I N PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN AooRE"ss BUILDING ADDRESS eAtf, iV - `J/. LOCALITY NEAREST CITY r/ri( /l ZIP CROSS ST NO OF BLDGS ASSESSOR . SIZE OF LOT 1� NOW ON LOT MAP BOOK j PAGE I PARCEL DISTRICT GROUP' TYPE FIRE , ED BY TRACT BLOCK LOT NOn. ETEL O CONS ell �2 OWNER NO d�q / STATISTICAL CLASS}�IC TION EW R MAP ADDRESS �� CLASS NODWELL UNITS PG CITY '/l,�• +� ZIP ARCHITECT OR C TEL VALUATION ENGINEERSS , G NO /}� ✓ � ADDRESS Al ,�t �� i/ BLDG SETBACK FROM .TEL FRONT PROP LINE F (STREET) CONTRACTOR NO T ACK FROM TYPE OF EXISTING LIC HIGHWAY + YARD = T ROP LINE FPGHWAY WID H ADDRESS NO _ LIC + CITY CLASS BLDG SETBACK FROM j CONSTRUCTION LENDER SIDE PROP LINE OF (STREET( NAME AND BRANCH 1+ _ HIGHWAY, + YARD = TOTAL SETBACK FROM TYPE OF EXISTING 0. ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH. O INO OFJ _ V SIZEFT STORIES FAOMIOLIES / ONE + 0 USE ZONE_ MAP 17 el DESCRIPTION OF WORK EW 1:1❑ NO SPKIAL ADD CONDITIONS y� ALTER ❑ f�/`t"'`" �� r BYY 7— Z REPAIR DATE=o , USE OF DEMOLZ EXISTING BLDG *„ 1 APPLICANT TEL ~ (PRINT) NO BY(SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE S WORK AUTHORIZED HERJEBY I WILL NOT EMPLOY ANY PERSON INV TION OF V +, ` T1�•� T THE LABOR CODE f�E TE OF CA_"O IA IN REIA G T KMEN S COM _ 2 ' PENSATION INSUR ' �J,J A _•� , 1 ,.� 1`+ SIGNATURE OF PERMITTEE ADDRESS A; /� �" Z TEL a O CITY !9� � NO PC Fee$ Permit Fee > Issuance Fee 7 ljy Total Fee V, APPLICATION FOR BUILDING PERMIT COUNTY'OF'•LOS ANGELES BUILDING AND"SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT'TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �`� or a certificate of Workers'Compensation Insurance,or a certified Copy thereof (Sec.3800,Lab. - lD �ii, G /ry ZIP /� O LOCALITY Policy No qls-vCompany ~ SIZE OF LOT v(ri NO OJ•BLDGS NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST fled Copy Is filed with the county building inspection TRACT BLOCK LOT NO V depart��e��nt//.��////'J.J�� USE ZONE MAP NO Date� yAppllca ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO- COMPENSATION INSURANCE' WITHIN 1000'FT'OF SCHOOLS YES No (This section need not be completed If the permit Is for one hundred ADDRESS DISTRICT GROUP TYPE CONST�FIRE ZONE PROCESSED BY dollars ($100) or less) • CITY ZIP I certify that In the performance of.the work for which this permit IS Issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TELNO- /C become subject to the Workers'Compensation Laws STATISTICAL CLLAASSIIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED - TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRACTOR TE /� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,,you must forthwith Nb _7 7v FRONT comply with such provisions or this permit shall be deemed revoked ADD SS LIC P L LICENSED CONTRACTORS DECLARATION � � r �7 3 7 SIDE �' -+ // LIC CLASSi- P L CI I hereby affirm that I am licensed underprovisions of Chapter 9 /'r•��• G SEWER MAP CL (commencing with Section 7000)of Division 3 of the Business and S�T_SI�E 0 0 STORIES NO OF FAMILIES-- - � Professions Code,and y ice a Is In full force and effect L/o�/ NEW ❑ BK PG U License Number _ LIC Class �� DESCRIPTION OF WO ADD ❑ VALUATION O 0 �• 0 ContractodTi b` Date �F�p ALTER •❑ $ �O D w L �T I�T REPAIR ❑ CIO ❑ 1 am exempt under Sec ,,AAJJ $ BBP.C.for this reason N>Z�() DEMOL ❑ LDMA P/C'#, Date - - USE OF EXISTING BLDG URM ❑ - - Signature APPLICAN ) TE N LDMA Perm# - ❑ 1„as owner of the property, or my employees with wages as D��f>J6 7-70 g Z AC their sole compensation, will do the.work and the structure Is ADDR O { A / FINAL DATE F not Intended or offered for sale (Section 7044, Business and S b Q Professions Code.) -1 -� G t TFC WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J I-...- OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES Q t FINAL BY � "' !` - licensed contractors to construct the project (Section 7044, l(i°..'^ - -" " " VES❑ N r Business and Professions Code) r � 4 j)= r;( WILL THE INTE D�E OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDINGy� `�•`.'� ".1-_ - OCCUPANT REQUIRE•A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �,i CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR o CHANGE ANGE u{tI GUIDELINES +. I hereby affirm that there Is a construction•lending agency for YES❑ NO❑ N the performance of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTNG n • ' 3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - L Fi( -j_E_{ 1 /?- TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS #�' '� Lender's Name. MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD7•y:ra : A• n a o Lender's Address �W_ice N i•i z=;• O OWNER OR AGENT , o I certify that I have read this application and state under penalty o PC FEE PERMIT FEE r of perjury that the above information is correct I agree to comply 7 a N with all county ordinances and State laws relating to building construction, and hereby uthorize representatives of this County hSSUANCE FEEco enter up the above-me rty for Ins e Ion pu oses �f ID �' c !� INVESTIGATION FEE 'TOTAL FEE Q Stu a Apert SEE REVERSE FOR EXPLANATORY LANGUAGE