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HomeMy Public PortalAbout6114 KAUFFMAN AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY .APPLICATION FOR PERMIT COUNTY OF LOS ANGELES �! WM. J. FOX, CHIEF ENGINEER `�1 T; ..,FOR APPLICANT TO. IN FOR OFFICE USE ONLY & DISTRICT NO. PLAN CK.'NO. PERMIT NO. BUILDING' ADDRESS 'LOCALITY' RE EIVED BY',,` DATE OF APPL. DATE ISSUED a 1'? NEAREST CROSS ST. BUILDING _ ADDRESS I V d (J M"'P •G y� OWNER MAIL LOCALITY — ADDRESS• ' 'Pa—P,,_ .NEAREST -• CROSS ST. _ p � TEL. . CITY L/ L r, NO. FIRE ',NO. OF I TY GROU TEL. ZONE `PLANS ARCHITECT OR:,.`• .,' ' ENGINEER - NO. BLDG. SETBACK LINE RL T 5Y/ ADDRESS APPROVED BY DATE --- TEL. /+ �y�.• ` CONTRACTORS NO. �9 S / .7 USE t APPROVED -p^,e tY M1 "BLOCK , W � ZONE /• BY ' DATE + ADDRESS � t/ r � HOUSE NUMBERING LEGAL DESCRIPTION I,LOT NO. - MAP NUMBE —FIELD CHECK BY TRACT V /�Y NO. ASSIGNED BY644K AT j NO. OF BLDGS. CORRECTIONS SIZE OF LOT`,•• , NOW ON LOT USE OF I NO. OF 7Zsl L' _ EXISTING BDG,. ' FAMILIES —��' ' DESCRIPTION OF'WORK A111 /�/•� 'Qp����_� NEW I' I ALTERATION I I.ADDITION I /• ! REPAIR I DEMOLITION-1, I IA., t/lG S 10 Ai1.40J SQ. FT. t NO. .OF - SIZE / I`I ROOMS , STORIES .. Z a EXT. WALL ROOF' r r COVERING I COVERING USE OF STRUCTURE, APPROVALS. ' INSPECTOR'S-SIGNATURE�,DATE 1 HERESY ACKNOWLEDGE THAT--I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND; STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS ' CORRECT. - 1 AGREE ATO•COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES'AND STATE BRACING; BOLTS- LAWS, REGULATING SUIW ING CON TRUCTION. , FURNACE: LOCATION, SIGNATURE OF GAS VENT, DUCTS PERMITTERT ' LATH, INT. ' ADDRESS - LATH, EXT. AUTHORIZED`.►GT: ` PLASTER, INT... 76wc28A, oess: to-so $ P. C. ffi © •� 0100 FEE ,,ryryy' PLASTER, EXT., VALUATION S FEE a 'rte FINAL •. _ T=ENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES a a ®� �! 5'1NNl: J. 'FOX, CHIEF ENGINEER 7� a�j `� .. o 2A S ' FOR OFFICE USE ONLY FOR APPLICANT TO FILL�IN BUILDING . . ,j;!_j DISTR NO.' PLAN CK. NO. PERMIiNO.•9 ADDRESS, // 4. W,' 5 3 3 ry �c -C R CEIVED BY. '' DATE OF APPL. DATE ISSUED LOCALITY NEAREST /'� A�� CROSS ST. •'(,7• I , BUILDING •- ADDRESS V /'T �� A OWNER � t to 6, Q. MAILLOCALITY ADDRESS �J Q Y. / � ,T NEARESTn . TEL. CROSS ST. A r�. 1 L / CITY NO. FIRE NO.'OF �I •I GR� ARCHITECT OR TEL. ZONE PLANS BLDG. S / ENGINEER NO. SETBACK LINE- 1►- IcI�7 ADDRESS APPROVED .4 TEL. BY DATE ' CONTRACTOR NO. ��v V USE PPROVED • r.,nZONE rBY DATE ADDRESS `-�-TrJ HOUSE NUMBERING LEGAL DESCRIPTION LOT N BLOC MAP NUMBE .1D-3 —FIELD CHECK BY TRACT NO. ASSIGNED BY 'ATE NO. OF BLDGS. CORRECTIONS SIZE OF LOT. ��/�.��.7 V I NOW ON LOT USE OF �� I NO. OF EXISTING BLDG. •QHS Ly�,�,(�, FAMLl DESCRIPTION OF WORN NEW I XtALTERATION I I ADDITION I ? o REPAIR _ •I I DEMOLITION SQ. FT. O. OF SIZE ROOMS• •. STORIES r EXT. WALL ROOF ,,, ......... / [i p COVERING I COVERING USE OF STRUCTURE ` �� / CE 4PIno, �1rJ b/ APP.ROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY -ACKNOWLEDGE THAT •' ( HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION-AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT-, 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, .- HEREON'AND WITH.ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS p6+ LAWS REGULATING BUILDIjqG ONS RUCTION. ' FURNACE: LOCATION, "'Y. SIGNATURE OF GAS VENT, DUCTS PERMITTEE=_D 0 • LATH, INT. ADDRESS .. - LATH, EXT.- AUTHORIZED.AGT.-. PLASTER, INT. 76A 038A• oess AG-60 $ P. C. $ �.,�, LVAL.UATIO FEE PLASTER, EXT. rN I 0 FEE $ , O FINAL "� -,77 d .�1 - / WORKERS',COMPENSATION DECLARATION • . _ hereby affirm That I have a certificate of can5enl to self ,'A R P L I C�►T I O N FOR U I L D I IV G PERMIT insure, or a certificate of Workers'Compenstion Insurance, or, a certifLed copy thepof (Sec. 3800, Lab C ) COUNTY1OF LOS ANGELES BUILDING AND SAFETY ` Policy No Company Certified co s her'eb furntsFied BUILDING //. ZI 0'' Py^ Y FOR APPLICANT_ TO.FILL IN ADDRESS Y // . I' vCertified,copy is filed with'the,coUnty building inspec- BUILDING tion department ADDRESS b �,q�f �/7/v /¢� LOCALITY _ •i- � /� /�D NEAREST Date:, Applicant CITY .'I IVY! (� ZIP /7 CROSS ST CERTIFICATE'OF`EXEMPTION FROM'WORKERS' q y NO OF BLDGS ASSESSOR F COMPENSATION INSURANCE SIZE OF LOT-�� X NOW ON•LOT MAP BOOK PAGE - PARCEL (This•section need not•be completed if4e permit is for one �L' USE ZONE MAP ' .huridred•dollor',($100)or'less') TRACT BLOCK - LOT NO . NO ��, �• TEL -7Q � SPECIAL 1L •, 1 certify That,in the performance of The ,work for which this OWNER/�Q J N�?LL���tle71 NO /7�71 CONDITIONS "`" Q permit is'issued, I shall'not employ any person in any manner _ `/�1 / ,1 DISTRICT GROUP- TYPE FIRE PROCESSED-BY V, so•as�fa become su ct to th'e Workers'Compensation Laws ADDRESS �7 �'7 i4a! WJ4P /'�✓� CONST ZONE O CITY ZIP 1! Date ' Applicarit STATISTICAL CLASSIFICATIO APT CONDOF U Y� NOTICE TQ APPLICANT If,-lifter making.this Certificate.of ARCHITECT OR TEL W 9' ENGINEER NO CLASS NO z.,X DWELL UNITS , Exemption, you should become subject to the.Workers' Compensation provisions of the Labor Code, you must forth ADDRESS SEWER MAP z ,,with comply with such provisions or this permit shall be TEL- CONTRkTOR NO L �' VALIDATION deemed revoked BK PG, '' '• LICENSED CONTRACTORS DECLARATION UC I hereby affirm that I am licensed under provisions of Ch'apter,9 ADDRESS !NO VALUATION' r (commencing with Section 7000)of Division'3 of the Business and LIC Professions.Code, and my license is-in full•'force and-effect ` CITY CLASS SQ F.T ''II NO OF l NO OF p CHECK License Number Lic�•Glass SIZE T�0 STORIES t FAMILIES- 1 ONE Contractor Date' DESCRIPTION OF WORK NEW ,/V(a�/ li���9JOQ ADD I am exempt from the licensing,requirements as I am a VfL lA�ly - h cq.�zj �iffi¢i✓CtG� licensed architect or a•registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, �no� OA>' mss!/Sri SEfe4G/ DATE 3 �� REPAIR Business and Professions Code). - USE OF � FINAL EXISTING BLDG + DEMOL By' , Lic:or Reg,No: _Date APPLICANT TEL ' OWNER-BUILDER DECLARATION.-: PRINT.) NO I hereby affirm that I am exempt from-the Contractor's License N Law-for the following reason.(Section 7031,5, Business and ADDRESS rofessions-C-ode). PRESENT ;9 , - 's- 'BUILDING - 1, os'owner of, the property, or-my employees with 'ADDRESS wages as their sole compensation,will do the work and d ', � ' the "structure is not intended or offered for sale LOCALITY(Section -" � _ �'4 4 8,•O A+' 7044, Business and Professions'Code). MOVING- TEL I',•as owner,of the property,am'exclus14y contracting CONTRACTOR NO a o1. u o e with licensed contractors'to construct the project (Sec- > - -iron 704 ,'Bbsiness and Professions Code) ADDRESS 21e,e.2 8 O O „ REQUIRED TOTAL SETBACK FROM EXIST - 'CONSTRUCTION LENDING AGENCY SET BACK 'YARD HWY PROP LINE WIDTH. _ I'hereby'affirm tl,at there is-a constiuction lending dge-ncy-for ' FRONT ',°;° 2,R O;O;r-? the,performance'of the-work for which this permit,is issued P L _ (Sec 3097, Ca v, ;C") SIDE Q Q O O'� O.8 Lender's Name m P C• Fee$ Permit,Fee (J J Lender's Address w I certify that I have read this a lication 'and state that the S 0 f � Y PP ••, Issuance Fee a above information-is.correct I agree to comply with all County Invest gation Fee' p' ordinances and State laws relating to building construction, Total Fee' 4 QO and hereby a;uthonze representatives of this County to enter upon/ylhe above-menti ed property for inspection purposes. a �✓ �Z/ ��i SEE REVERSE FOR EXPLANATORY LANGUAGE •,Signature of Applimnt or Agent ote IIL ts WORKERS' COMPENSATION'DECLARATICN. _ I-hereby affirm.that have a certificate of consE-it to sedf _ i insure,'or a certificate of Workers'Compenstion Insurance,.or ,• PP L I CA-T I O.N F O B I L D I N G PERMIT , a•certrfied copy thereof (Sec '3800, Lab C. 999 _ - COUNTY OF LOS ANGELES 'BUILDING*AND SAFETY ' Policy No Company aBUILDING' Certified copy is hereby furnished.. FOR APPLICANT TO FILL IN ADDRESS 1 a Certified copy is,filed with the county'building nspec- BUILDING / � tion department. ADDRESS' 1!/ -�1�✓ r7 l�� ' LOCALITY ' \) t' _" �j� - ZIP NEAREST Date Applicant CITY :(���'( C�� Y ^ / CROSS-ST t f CERTIFICATE OF EXEMPTION FROM'WORKERS' �ff� / NO OF BLDG S ASSESSOR`' r COMPENSATION'INSURANCE SIZE OF LOTc✓!�! ,•X (. 7Z NOW ON LOT / MAP BOOK'- PAGE PARCEL This section.need not be completed if.the' ermit;is for one y+ US ON MAP ��- hundred dollars ($100)or less ). ; p TRACT BLOCK LOT NO NO Jin,/ / �j -TEL• ///"' SPECIAL I certify that'in the performance of the Work for which this„ S OWNER��_d�a�/t ! NC-�C_ NO __7 ��� d CONDITION J` / 0 DISTRICT ��Rl:�P TYPE FIRE PR ESSED'BY V permit is issued, I shall r of employ any person in any manner ��� �J��j ���r CONST Z NE I ADDRESS so as to become subject to the Workers'Comperisattoh Laws / y O - 'CITY-./GG��G� �l< r' ZIP �! ✓ V I Date Applicant ' _ STATISTICAL CLASSIFICATION °RPT CONDO W NOTICE TO APPLICANT' If, after mdking this, Certificate of ARCHITECT.OR/�Jf,��/� `- -TEL•- /, ENGINEER /✓��/�� C. NO 7� CLASS'NO , DWELL UNITS- •-- tL Exemption, you should become subject to- th'e Workers' _ )!_ s y Compensation provision`s of the Labor Code, you•,must•forth- gDDRESS�l L.+c- (J/Vsl lN�g <�� j°`' CQ�� SEWER MAP, with comply with,such provisions'or.' this permit shall be / ` deemed revoked.. Di,e � (J(L L BK PG,; VALIDATION CONTRACTOR .LICENSED CONTRACTORS DECLARATION UC hereby affirm that I am hcensed.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 m full force and effect. . CITY CLASS. $ ;°a' SQ FTDOD NO OF NO OF % CHECK ' License Number Lic Class (SIZE 4 STORIES FAMILIES: ! ONE t. DESCRIPTION OF WORK -A& k0-om NEW- E) R• , Contractor Date d, nn .- - I CY ADD ❑ I am exempt from the licensing requirements as.I am a �, i yL��C� licensed architect or a registered professional engineer r ALTER ❑ FINAL, acting in my professional capacity, (Section ,7051, .� ��1s) (sLI�/ N �.Yi✓ � fL� DATE` Business and Professions Code)' USE OF REPAIR ❑ 3 0'8 1'-A FINAL` EXISTING BLDG DEMOL ❑ By �.�"�f" / # o o e-0 23 Lic.or Reg No. Date APPLICANT/� /70/,� ls l , TEL,�7 i-•'S-�Q I OWNER-BUILDER ' PRINTS/I!/"e/C Cbz/ /vG'n�I NO',/ •f I �p�oa� 2,° 1 3 3 4 0 I hereby affirm that I'am exempt from the Contractor's License - ADDRESS(?/� f/1 (J <� �Y / ���f r _ Law for,the.following reason (Section 7031..6,.Business and / 7 °{° 1,7J 3, O c Professions Code)- PRE ENT ` BUILDING F � 0-22V-8 2' 'I, as owner of -the property, or,my employees with _ ADDRESS' /7 ; .1w 6s'their sole compensation,will do the work-andC/ the structure is not intended br offered for sale(Section ' ' ' LOCALITY- -• r 7044, Business and Professions Code).-' MOVING. -. \TEL ❑ CONTRACTOR— NO - I, as owner of the property, am,exclusively contracting i C% with licensed contractors to construct,the project (Sec- M ADDRESS /�74: f� ay23082 A , tion 7044, Business and Professions Code) - ^{• � /' /',; /,/' u' fe' e� 1 REQUIRED -TOTAL-SETBACK FROM EXIST' # o,`o b o 0 'CONSTRUCTION LENDING AGENCY. - ,' SET BACK YA D HWY PROP INE WIDT I hereby affirm that there is a construction lending agency for FRONT ' e We performance of the work for which this permit-is-issued P L Cly V - 2 "4 0:0 0 0 (Sec 3097, Civ C ) SIDE­ P L - - o,�l 0 v- Len der's Nome —3 �6 022.6`=82 P C Fee$ 'sP Permit Fee. Lender's'Address 1.. w I certify that have read this application and state that the . Issuance Fee . , ° above information is correct I agree to comply with all County , nvest gat on•Fee= -• - t ' ordmances and State laws relating to building construction, 1 ti Total Fee b / Q D" " and hereby duthonze,repre-sentatives of,thislCounty to enter, f r. a upon if� ab v_e-mens pr ert for inspection'p rposes t „ a t �'Y•', -•--SEE REVERSE-FOR EXPLANATORY-LANGUAGE _ r �, •!L_. - Signature of Applicant or Agent ote f tS