HomeMy Public PortalAbout10611 KEY WEST ST_Building__ 76A638A CE'#6032-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY a
JOHN'A LAMBIE. COUNTY ENGINEER NEAREST t
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DIST�RI TN G TYPE P SSED BY
FOR APPLI NT TO FILL S` _ coLqST
I
BUILDING 1,041/ �,- STATISTICAL CLASSIFICATION '�'' S WER,MAP
ADDRESS BK G
CLASS NO DWELL UNITS
_A-LOT NO } BLOCK WATER i.
CERTIFICATE NOT REQUIRED 1:1RECEIVED
TRACT 2 A ',L n MAP HIGHWAY STATE MAJOR SECOND CANO OF L
SIZE OF LOT Ti!P_2 0lA2 NOW ON LOTS WA�� USOE ZONE 'SPECIAL
USE OF /] CONDITIONS %r
EXISTING BLDG "1�171�f�c /� l
OWNER
C AR I �f TEL / /
n NO BUILDING EXIST
rss•• ee SETBACK YARD HWY STREET NAME WIDTH
ADDRESS �'� �..
-Do Rr-E n FRONT
ARCHITECT.ORr' ",�N� TEL P L
ENGINEER N NO SIDE I a
P L 0
ADDRESS
C16NTRACT�Oq Ool 2o3Y,
ADDRESS C K/f1' �- _ c V
DESCRIPTION OF WORK °'
a
c7 Z
NEW ADDS, ALTER REPAIR DEMOLISH
SO FT ^0��. ST FI
S FAO F O F
SIZE d STORIES FI
LVALUATION
Y R I�/� ..
E-S _ CnA 7 _ 1,7191143 �� �14
41*
F _ F�r �"a""arvQ"A��eF��'�3��'..n , -y�r4JA'L. '!II
.n �,
APPROVALS, V , ATE INSPECT R�S�51'G f�AJU RE'
C/ FOUNDATION LOCATION
FEE $r FEE $ J FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS LY
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE .LOCATION =
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS`VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK ....
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT 0
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT
f" ING-TO WORKMEN S COMJATI O INS ANCE LATHEXTJill, ?57 '
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE / RECT AND POSTED
ADDRESS 1 ~`YLAA FINAL' ' - 4 T
JOHN F LEWIS PRINCIPAL ST TURAL ENGINEER
PLAN CHECK VALIDATION cK M o CASH - PERMIT VALIDATIO CK /, M U - CASH
AC 1 9 4 8 OCT 2. 8 2 3 D 4 '2:5 0
C' 3079 DLC
_ L,1l,D 3 ,, 1- D 8 5 0~ d
t
APPLICATION FOR RML®INC; 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 jl.r (T>1f
copy thereof (Sec 3800,Lab C) CITY 'T, ZIP,� %
LOCALITY
Policy No Company SIZE OF LOT NO OF BLDGS NOW ON LOT
'❑ Certified copy is hereby furnished NEAREST CROSS S
❑ Certified copy IS filed with the county building Inspection TRACT BLOCK _ LOT NO,
department USE ZONE MAP NO
ASSESSOR MAP BOOK _ PAGE PARCEL-
Date Applicant ` SPECIAL CONDITIONS pv1
CERTIFICATE OF EXEMPTION FROM WORKERS',,- OWN / L T ELNO
t 7 _
COMPENSATION INSURANCE W f). J r 1 �(% r � ' WITHIN 1000 FT OF SCHOOLS YES NO
(This section need not be completed if the permit Is for one hundred ADORES {
dollars ($100) or less) l I �' DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
- -^
I certify that In the performance of the work fCITY or which this permit l 7� ZIPl/
is Issued, I shall not employ any,person In any manner so as to ARCHITECT OR ENGINEER TEL NO
become subject to't/he Workers'Compensation aws STATISTICAL CLA-ISIIFICATION APT CONDO
Date, -9 Applicant • /�^ ADDRESS- CLASS NO -�:(/ DWELL UNITS
NOTICE TO APPLICANT If, after making this Ce Icate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to th Workers' TEL O SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you,must forthwith 71 S�7� 73� FRONT
comply with such provisions or this permit shall be deemed revoked ADDRESSLIC NO/ P L
LICENSED CONTRACTORS DECLARATION C7 S v n �v ,_ �`' S SIDE I
CITY _ LIC CLASS P L
hereby affirm that I am'licensed underprovisions of,Chapter'9 aSLy'? 7 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE NO OF STORIES NO OF FAMILIES
Professions Code,-and my license Is In full force andeffectNEW ❑ BK PG 1 d
License Number&!5L4 S 411t- Lic Class /� DESCRIPTION OF WORK _ - ADD ,❑ VALUATION B� Q
Contractor T I C4 Dated_ cl S ALTER El $ cc
V
El am,exempt under SEC
hl 1 �Ow f REPAIR ❑ O
B&PC for this reason y �J 'J` /���� s`j� J �� DEMOL ❑
Date 11
LDMA P/C# W
J�— S�— nj (�" USE OF EXISTING BLDG URM
' Z
Signature APPLICANT(PRINT) TEL NO LDMA Perm# _ ACICT.8e,
❑ 1, as owner of the property, or my Employees with wages as 6-7 / �� O i14 ^ i�� �n
their sole compensation, will do the work and the,structure is ADDRESS n _ .7. 3 1 .�V
not Intended or offered for sale (Section 7044, Business and 2 019P 4 1, ` - F G/+ y/7J FINAL DATE G 1 ITEMS
Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL t Zi �� J
property, am,exclusive) OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY > TOTAL �-b ?2
-b�
❑ 1, as owner*of the ropert y contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE Q 2 m _I
licensed contractors to construct the project (Section 7044, YES 1:1 No ElBusiness and Professions Code) CHECK 142■2Q
WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING ° J
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �LJ/�I,I/'E .60
CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR `��771�1111�G
GUIDEUNES _
I hereby affirm that there is a construction lending agency for YES❑ No❑ -
a the performance of the work for which this permit Is issued(Sec IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING �((yy(ryy rJ/ C�/Q
3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE VUUV—l3UO 1' 12/ 5 /5
TITLE 2 CHAPTER 2 20 SECTIO2 20 100Lender's Name MATERIALS REPORTING AND FOR OBTAININGTHROUGH A PERMIT FROM THE SCAQMD G HAZARDOUS' 35'74 1 AI 110:23
o Lender's Address
p • OWNER CR AGENT
o I certifyfthat I have read this application and state under penalty
o PC FEE PERMIT FEE ,
of perjury that the above Information is correct I agree to comply
o with all county ordinances and State laws relating to building
m construction, and hereby authorize representatives of this County ISSUANCE FEE � , O -
10 toe r upon the above-mentioned property for Inspection purposes
INVESTIGATION FEE ' TOTALFEE 0
SEE REVERSE FOR EXPLANATORY LANGUAGE