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HomeMy Public PortalAbout9855 KEY WEST ST_Building__ 76A638A CE#8032-63 APPLICATIONFOR BUILDING PERMIT-�. COUNTY OF LOS-ANGELES' BUILDING DEPARTMENT OF COUNTY- ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER' NEAREST WILLIAM A. JENSEN, SUP'T.OF BUILDING - CROSS S.T. _ G 'DISTRICT N UP TYPE t20CE B• FOR APPLICANT TO FILL IN �i4n, f ONST. �' ADDREISS 9�:5"S • �, -STATISTICAL CLASSIFICATION .S ,EER,BMAP ' CLASS. NO. _ DWELL. UNITS '.G LOT NO.. BLOCK WATER'., [�� CERTIFICATE: NOT REQUIRED�.LL��.141�. RECEIVED �! - ..MAPHIGHWAY TRACT '' • NO. OF BLDGS. NO. �+ tV �' (CIRCLE) STATE MAJOR SECOND LOCAL , SIZE OF LOT - NOW ON LOT USE'ZONE - -SPECIAL - USE OF -•�„w y ,/I.�j �.� CONDITIONS . ' EXISTING BLDG.; '`` OWNERC-'�„1Aale, .-a' u-so a ' NO r(pBUILDING EXIST. YARD HWY STREET NAME SETBACK_ WIDTH ADDRESS _ F FRONT, tt-� ARCH ITEC eF„ TEL. •'P. L. V L' ENGINEER Q � NO. SIDE /2 ADDRESS - .O -TEL V.;' CONTRACTOR�A Li r- L6 NO. (4 pp ADDRESS T r '1._ S Cl-A- - 0 DESCRIPTION OF WORK w CL NEW ADD ALTER REPAIR DEMOLISH Z . FT. NO. OF NO, OF SIZE 'STORIES FAMILIES USE OF STRUCTURE - �t&4,-N 1-2-0 05C �. SIGNATURE OF - APPLICANT C - �� VALUATION .APPROVALS DATE INSPECTOR'S SIGNATUR_E P.C. PMT. t FOUNDATION: LOCATION ",� +'•- •� /�,;;;f' J FORMS, MATERIALS FEE 's FEE S - FRAME: FIRE STOPS. y\ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS.APPLICATION' BRACING. BOLTS 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 i AUTHORIZED HEREBY I WILL NOT'EMPLOY ANY PERSON IN VIOLA. LATH. INT. TION OF THE LABOR CODE OF THE SSU CALIF RNIA RELAT- ING TO WORKMEN'S MPENSATION INSURANCE: LATH. EXT. SIGNATURE OF , HOUSE NUMBER COR-. PERMITTEE k 14-6 - RECT AND POSTED ADDRESS (J L�.f-'d-` c".v�.. FINAL .rr. JOHN F. LEWIS. P,PINdl'A0 STRUCTURAL ENGINEER PLAN CHECK (ATIDA..TION cli M.o. CASH _ 'PERMIT VALIDATION CK. M.O.' CASH 22 3 D 3.7 5 •° 5 5.00- LAW ` �. WORKERS' COMPENSATION DECLARATION t'h'ereby,pffirm that I have a certificate of consent to Self APPLICATION FOR BUILDING PERMIT _ insure,•ara certificate of Workers'Compempenstion Insurance, or ' a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES ­77BUILDING AND SAFETY PolPolicy No - Company BUILDING Certified copy is hereby furnished FOR APPLICANT TO FIL IN ADDRESS 2rACV tvAg'_ Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS. LOCALITY NEAREST Date' Applicant CITY ZIP CROSS ST /✓ �� CERTIFICATE OF EXEMPTION FROM WORKERS' / N OF BLDGS , ASSESSOR COMPENSATION INSURANCE SIZE OF LOT �p3X I NOW ON LOT / MAP BOOK PAGE PARCEL (This'section need not be completed if the permit is for one �/� USE ZONE MAP hundred dollars ($100) or less ) TRACT I�9g BLOCK LOT NO olV NO d TEL ��/ SPECIAL O I certify that in }he,performance of the work for which this OWNER NO '/ CONDITIONS permit is issued, I shall not employ any person in any manner �� DISTRICT GROUP TYPE FIRE PROCESSED BY V so as to become'sublect to the Workers'Compensation Laws ADDRESS 15.09' 14-3 CONST ZONE O -51 e, 04 CITY / ZIP Date Applicant STATISTICAL CLASSIFICATION APT CONDO V NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL G W g ENGINEER NO S GS CLASS NO DWELL UNITS d Exemption, you should become sublect to the Workers' H' Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such provisions on,this permit shall be TEL deemed revoked - - ' CONTRACTOR NO BK f_ PG, ,/� VALIDATION LICENSED CONTRACTORS DECLARATION LIC Y I hereby affirm that I am licensed 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 in full force and effect CITY CLASS $- Q ip SQ FT NO OF / NO OF / CHECK License Number Lic Class SIZE STORIES FAMILIES ( ONE t ❑ $ ` DESCRIPTION OF WORK /•e- NEW Contractor Date ADD I am exempt from the licensing requirements as I am a R40A, licensed architect ora registered professional engineer ALTER ❑ -FINAL acting in my professional capacity (Section 7051, y� O REPAIR ❑ DATE¢�r +U r Business and Professions Code) USE OF ❑ FINAL ..t EXISTING BLDG W FL / DEMOL ey I Lic or Reg No _Date — d APPLICANT TEL OWNER-BUILDER DECLARATION (PRINT NO I hereby affirm that I am exempt from the Contractor's License Law•for the following reason (Section 7031'5, Business and ADDRESS Professions Code)'' PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code) MOVING TEL I, as owner of'the property, am exclusively contracting CONTRACTOR ,NO with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) 1 REQUIRED TOTAL SETBACK FROM EXIST 2 1 9 1,8 A CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT # 0 0 0 0 0 1 the performance of the work for which this permit is issued P L I wxs (Sec 3097, Civ'.C ) SIDE lu 2 o 2 0 5.O 0 Lender's• a Nme 0,020500 ' PC Fee$ Permit Fee / ©v o 2,8=8 O Lender's Address O cJ w I certify that I have read 41s application nd state that the Issuance Fee L9 6 above information is correct I agree to comply with all County Investigation Fee ordinances and State jaws relating to building construction, Total Fee m � and hereby ou orize representatives of,this County to enter U upon the ab -mentione prope�tyrnsp coon �rposes c z� SEE REVERSE FOR EXPLANATORY LANGUAGE IL Signature o Applicant or Agent Date ®s