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HomeMy Public PortalAbout6118 KAUFFMAN AVE_Building__ i w'4AhiR-_MENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES U I L D I N G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL INFOR OFFICE USE ONLY BUILDING /! DIST R NO. PLAN CK. NO. PERMIT NO. ADDRESS A r �- 'b 7). 7s3 LOCALITY / EIVED Y DATE OF APP\LL.. `DATE ISSUED( NEAREST CROSS ST. BUILDING A ' ADDRESS /YO G OWNER MAIL LOCALITY ADDRESS NEAREST TEL. CROSS ST. 4 . L CITY NO. FIRE NO. OF I TY I GROi;P ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. w SETBACK LINE ADDRESS APPROVED TEL. BY DATE CONTRACTOR NO. USE `�1I APPROVED ADDRESS ZONE //�_/ BY DATE HOUSE NUMBERING LEGAL 1 DESCRIPTION I LOT NO. I BLOCK MAP NUMBERo140CHECK BY - NO.1 t� �I` NO. ASSIGNED B �,.�.1 ' - DATE TRACT /Yr/� /V /T4 I mw L C 0 i NO. OF BLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT USE OF I NO. OF EXISTING BLDG. FAMILIES - DESCRIPTION OF WORK r NEW I I ALTERATION ( I ADDITION I 0 REPAIR I I DEMOLITION I I I ;a BQ. FT. NO. OF �(/.YYIriL7 (�/ ✓G i- ✓�ivf�' SIZE ROOMS STORIES `:Sl i' Z CIOEXT. WALL a (? ROOF Dr COVERIN ( COVERING e vX�� l'G .�.Q 7-ra �A-- USE OF STRUCTURE ,// _ Ca v��' ;4!2GsLS S' l.B�i lc�lw.-•-� r 1 l o t' 76"4 v 5#0 /•v TCS APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT, I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, SIGNATURE OF GAS VENT, DUCTS rERMITTEE LATH, INT. ADDRESS LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 76AG30A- DBS3 10-50 S P. C. $ r -^ j FEE r PLASTER, EXT. VALUATION D D V $ FEE FINAL I WORKEIafj'C.6M TION L ECLARATION f e of consent to self APPLICATION FOR BUILDING PERMIT �°I'rher affirm that I have e a certifica �inSu+e, or 6 certificate of orkers'tom en_tion Insurance, or a certified ropy thereof IS . 38 0, la C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company; y ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the Ziounty building irospec- BUILDING tion deportment. ADDRESS Date Applicant a• CITY �G C 7-YZIP U Cr" LOCALITY F CERTIFICATE OF EXEMPTION FROM V ?RKERS' /l ONO.OF BLDGS. NEAREST !- COMPENSATION INSURANCE'". SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be.completed if the peimit is for one - ASSESSOR ' hundred dollars ($100)or less.) TRACT /� `,// BL�O/CK LOT NO.Q (J MAP BOOK PAGE. PARCEL OWNER:v JJ/V "/ /'�// NOTEL.A �(7r10/ USE NE MAP I certify that in the performance of the work for which this �j permit is issued, I shall not employ any person i any mann r ADDRESS d Nr /` r SPECIAL so as To become subject To the Wor rs'Co nsation La s. CONDITIONS {'� p� V -�� ?r CITY_. /'!/LrG I ZIP. �� �V. 19 Date Applicant _ ARCHITECT OR n pTEL. [ L�/^ O NOTICE TO APPLICANT: If, after making T Certificate of ENGINEER L C ���'/1N0. �G //� /� DISTRIC .GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' y / CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS��� ' ���i -�• with comply with such provisions or this permit shall be i TEL STATISTICAL CLASSIFICATION APT. CODO. deemed revoked. /r CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC_ CLASS NO. _ DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS - NO. (commencing with Section 7000)of Division 3 of the Business and LIC - SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS VALIDATION SQ. FT. NO. OF' ✓ NO.OF _ CHECK BK- PG- License Number Lic.Class SIZE STORIES I FAMILIES ONE s VALUATION, Contractor Date DESCRIPTION OF WORK'j ��/'✓d/ Cy NEW ❑ ADD $ 'J ❑ u _ ❑ ,I am exempt under Sec. Y Cq•Py/ D ❑ , _ ALTER B.BP.C. for this reason -- C'LaS�— REPAIR ❑ �6 9 7. A 2 USE OF T ' Date: EXISTING BLDG. L f!6,0�L� DEMOL ❑ J o a a o 2 3 Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT) NO. DATE I o 3 2 �,3 O I•hereby affirm that I am exempt from The Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT / Q /�� ///(/, ,y�/� n BY ° - 321.3 Q c' ❑ BUILDING /< O /v ' /�/jW Pf// I _ I, as owner of the property, or my employees with ADDRESS 0 5 0'6-8 7 wages as their sole compensation,will do the work and LOCALITY 3 ,5.7-5 the structure is not intended or offered for sale(Section 7 7044, Business and Professions Code). MOVING TEL. p2 7• Y tYl 4 I, as owner of the property, am exclusively contracting CONTRACTOR NO. 0 r//17 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS REQUIREDTOTAL SETBACK.FROM EXIST. o CONSTRUCTION LENDING AGENCY SET BACK YARD ' HWY PROP. LINE WIDTH z 7 4 Q,9 A I hereby affirm that there is a construction lending agency for FRONT // a<,, P p G # the performance of the work for which this permit is issued P.L.- - • • C� c � o-•o o e o (Sec. 3097, Civ. C.). SIDE P.L © 32 &85 Lender's Name m P.C. Fee-$ � 'tL� Permit Fee J LDMA Ref' # 3 2 8 5 Lender's Address polot I certify that I have read this application and state that the -Issuance Fee / (/ ' -�� LDMA P/C# o T.06..-8 7 M above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws.relating to building construction, Total Fee Z v and hereby outhori a represen- tives of this County to enter LDMA Perm. # upon th above- tinned7A< erty for inspection purposes. G / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature oLApplicant or Agent Date