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HomeMy Public PortalAbout10126 LA ROSA DR_Building__ r DIVISION OF BUILDING AND SAFEPY BUILDING ' DI Department of County Engineer County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN_ FOR OFFICE USE ONLY DISTRICT NM PUN Cc.DR REc.No. PERMIT NO. BUILDING ADDRESS f B �G qf✓(Y. Q.r ,'� 07''J- LOCALITY RECEIVED BY DATE OF APPL. DATEISSUED yy f.� t-. / NEAREST 63L,^'� 'AL1 q/, / // `1 2./- 1' .CROUILDINS OWNS ST. ADDRESS ®/ (n(g ,/�A./\ �aOT1' OWNER MAIL // LOCALITY ,.J a.w.�l/IO Xf � 2- ADDREBB (0 REST I� �• CRGBSST. I � app CITY NED/=O UDS FIRE IN O.OF � TYPE � I GROUP_T% ZONE � LANE ARCHITECT OR TEL- END EL m .�? ,(}� ¢ ENGINEER .(ky"L f�JV No. BETBA LDG. LINE 9 `Y /POD CK ADDRESS 1 ezk USEE4_ 1 APPROVED TEL. ZON E/T / BY DATE CONTRACTOR �l HOUSE NUMBERING ADDRESS /{YMAP NUMBER NO. ASSIGNED BY LEGAL //�� CORRECTIONS DESCRIPTION LOT NO. BLOCK L/ TRACT ef,2 `' `A/ 3. OF SLOBS. SIZE OF LOT D ll ^ I NOW ON LOT / O USE F No H USEEXISTING BLDG. TT DESCRIPTION OF WORK °a 0 NEW ALTERATION ADDITION Z D r REPAIR DEMOLITION ' 80.FT. NO.OF SIZE R OM8 ST RIES EXT.WALL I gOOF COVERING OOVERING USE OF STRUCTURE INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION G FORMB. MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION W PLICATION AND STATEATETHAT THE INFORMATION GIVEN 19 FRAME: FIRE STOPS. CORRECT. BRACING, BOLTS G I AGREE TO S EGU WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS EGULATINB BU/I//L�DIN/GAC/+ONSTRUCTION, pAS VENT, DUCTS SIGNATURE v�✓/ "V I ✓✓ , LATH. INT. (� `B LATH. EXT. AUTRES AUTHORIZED APLASTER, INT. BT. PLASTER. EXT. E FEE HOUSE NUMBER COR- FEE RECT AND POSTED VALUATION �� FINAL 96A63BA DBS 3 1-59 RTIIIEN - • �,_ �r COUNT r G.� [NGELES UI ® � /► WM. J. FOX, CHIEF ENGINEER �7 - FO/R� APPX/LICANTITO F7IN . FOR OFFICE USE ONLY ADDEIN {` / V p„ A„ �/�p'�'pO TR NO. PLAN CK.NO. PERMIT NO. 9 a77-LOCALITY �i �-"aREECCEIIVVEEDD BBY DATE OF AAP/PL.L. /DATEISSUEE/DNEAREST �/s.CROSS T. �i?C.//I � J��(ALA-, A�•� _7'/ /ra ,3— XOWNER / -I //• �� r , \J ^DU ESS Y/�/// �GS/'F ! MAILADDRESS ,2 / sh/C �"GM�I�� �LA:/- LOCALITY /I' CITY �YiYY.lPG.7C.0-. `^��/ NE. NEAREST TEL CROSS T. I./ I ZFIRE ONE pLpryg TYPE GROUP ARCHITECT OR 1/ TEL. ENGINEER NO. BLDG. / / ORD.NU. �2J ADDRESS a SETBACK LINE 0 / i l 4• APPROVED CONTRACTOR I CONTRACTOR �al+l� NE' BY DATE E USE APPROVED ADDRESS ` Y� "tl���+Qp� �/, r zENE / BY .DA LEGAL DESCRIPTION (y LOT NO. V BLOCK L� // CORRECTIONS [� TRACT r (J XaL ' /Yh Irk/ N� �� SLOG SIZE OF LOT lo U A 2,, 4-I NOW ON LOTS. 1 _EXISTIUSE OFNG BLDG. a \ �c�\• , I F n"E. / ROOMS J / � DESCRIPTION OF WORK L4�•,�,� /�n� i,�/� F��.• NEW ALTERATION ADDITION v /- _�jr - -- —' DEMOLISH I ” E REPAIR / MOVING :'I'i ET ��(O,0 ROLL � STORIES / /(. D WALOOF COVERING OwK., I COVERING ta-, id:h - USE OF NEW BUILDI G�i�/ • c A/VLFWy koflld w M i/✓ Mn . I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION /i! SPECTOR / DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. E:,.C. v FRAMFIRE STOPS, �• SIGNATURE OF / BRE:NOR BOLTS L"�4' S (w-:I S/- Y PERMITTE LATH,INT.: / AUTHORIZED ASTO !R LATH•EXT.: �D."/4 y7 v 1' oes-s som sc75 7-47 $ P C.III PLASTER, INT. Y- / SoOOO FEE —� PLASTER,EXT. v � /O VALUATION OI J �p0 FEE FINAL 1 OB-3 11,43 23M SETS APPLICATION FOR PERMIT DEPARTM$ NT OF BUILDING AND SAFETY V 1��fll� COUNTY OF LOS ANGELES WK J. FOX. CHIEF ENGINEER NO.OF BLDG. ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO. PLANE SETBACK LINE t� wI 19'3 FI ZZ� FIRE APPROVED lJ 1 V ZONE BY DATE RECEIVED BY DATE OF APPL. DATE/ ISSUED PROVED BYDATE 'LONE ' 1 APPLICANT FIDL IN HEAVILY OUTLINED PORTION ONLY / n BUILDING '1 -7 � F L, 9 I CJ. R p E NAME ADDR EB_ 8 _7iC yUj Z ADDRESS LOCALITY TP_ MPL,E C' /T YD NEAREST ,y /, U z CITY \ CROS ST. Yy II// CSTATE �J 7 < LICENSE NO. NO.. NAME N MAIL E NAME ADDRESS U /� O ADDRESS -ef�� CIN LTM F 4A/ - No 2 CIT• / (1 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS OAPPLICATION AND STATE THAT THE ABOVE IS CORRECT u - STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. Z LOT NO. SIGNATURE OF O SIZE OR LOT /(7Q X2.6D OWNER6 6 C, NO. OF BLDGB. /lQ./F AUTHORIZED AGT. 9 -9 BLOCK NOW ON LOT �Y N TRACT CORRECTIONS D USE OF BLDGB. - ! ) NOW ON LOT _ iYyi?J'y DESCRIPTION OF WORK USEOF BUILDING PA✓E L L Y / J-11129. Az ._ ASF Fa 7.1 C ! Iris constructicn may 1;e is v=oL^.i.cn War Production cccra on.`— ':�� - :,H .. honl d✓ar a �.r 0 cauuoimd L� .,.,,.��.. _ ,..,,- , R. , c Office before comment- Tina the work authorized in this Perrnlc, / T D NEW t/ TYPE I GROUP .Jr k' r NO'OF NO or Of t - ALTERATION ROOMS � FAMILIES �7 .d ADDITION SIZE Zoo D REPAIR STORIES I _ MOVING WALL COVERING DEMOLISH ROOF COVERING �H'IJY ELE�C $ P.C.$ FINAL APPROVAL FEE � r B'U S INSPECTOR'S -VALUATION lJ O FEE (J1 DATE I .NAME DIVISION OF BUILDING AND SAFETY BUILDING z Department of County Engineer County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN— FOR OFFICE USE ONLY DISTRICT NO. PUN Cc. OR REG.No. , (R(M IT y7NO. ADDREI08 I.G �/ 6'.0 ✓ L :s-- eJ 7 �j RECEIVED BY DATE OF APPL DAT.LEISSUED LOCALITY11 �JW v NEAREST L CR09B BT. SS ADDRESS ADDRESS OWNER //�� qq�� �• MAIL �J / LOCALITY -sawL.tiG�J�-E IArf ADDRESS �O�Ac.! Nt� NEAREST pv ,may - ✓�� T[L.tO LC��C IRE BT. !VtN CITY TEL o 4 J FIRE IINLOANH TYPE GROUP� ZONE �� �p ARCHITECT OR TEL ENGINEER NO. LDO` I /1 SET ACK LINE InD/ • ADDRESS IV el��-tl L / Q. I UBE APPROVED TEL ZON BY DATE CONTRACTOR t1 MOUSE NUMBERING ADDRESS IVIZ6 Q.Q e1. MAP NUMBER NO. ASSIGNED BY LEGAL G CORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT /io I9� .2 2/ SIZE OF LOT //O 7[ ^C4 Ad NNOW ONLOT / USE OF . NO. O EXISTING BLDGFAHILIFEn DESCRIPTION OF WORK c 9 r NEW ALTERATION ADDITION D s REPAIR DEMOLITION n so.FT. NO.DF SIZE R OM0— EXT. WALL G• A� I RODE COVERING�,�•I•(� OOVERINO USE OF STRUCTURE � Q J INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FURMB, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IB FRAME: FIRESTOPS, CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS EG/ULATING BUILDING CONSTRUCTION. DAN VENT. DUCTS SIGNATURE �LANr aI LATH, INT. PERMITTE `` /v ADDREB9/,P / Ate. U a- LATH. EXT. PLASTER, INT. AUTHORIZED AST. PLASTER, EXT. $ � O 5-00 FEE HOUSE NUMBER COR- O-7 J/�U RECT AND POSTED VALUATION �� FINAL FEE 96A6..A Dnn 3 1-53 76A63BA CE98031-67APPLICATION FOR BUIL L ING PERMI. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY i r v i �• -�-- JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENK INS.SUP'T OF BUILDING CROSS ST. OIST,jiICT NO P TYPE PR SS�BY FOR APPLICANT TO FILL IN fj .- CONST. (/ ri_C `I /01 BUILDING / STATISTICAL C/I�SIFICATION SEWER MAP ADDRESS ) L i A CLASS NO.___� ' DWELL UNITS BK/ PG j .Y LOT NO. An,�` _ �' BLOCK USE ZONE MAP l� O-i TRACT �f j,�, NO, l IJ SPECIAL N0. OF SLOSS. CONDITIONS SIZE OF LOT NOw ON LOT USE OF Az BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF (STREET) OWNER S O. TYPE OF EXIST]NO SETBACK HIGHWAY YARD = TOTAL ADDRESS 2C, .. HIGHWAY. WI T {! FROM C.L. /} } ✓� r [,l CITY .�, C.il L BLDG. SETBACK FROM ENGINEER NO. ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET) TYPE OIEXISTING SETBACK HIOM WAY } YARD = TOTAL ADDRESS / HI ONWAY WIDTH FROM C.L. CONTRACTO A4 %Z�.((� ,E(�NOL - Ory }LIC - ADDRESS 9 /ENO -2o .P c CORNER CUTOFF YES NO C CITY ' r LID SEE REVERSE SIDE FOR SPECIAL APPROVALS a D SCRIPTION OF WORK 3- H c D NEW qODLTER ) REPAIR DEMOLISH C SD.FT. NO. OF NO. OF / C[ SIZE STORIES USE OF FAM LIFS STRUCTURE / VL / SI G NA T UR9,6F APPLICANT % �.� e5--slN VALUATION$ ,�� •00 fT- L A PROVAL9 DATE NSPEGTOR'SSIONATV P.C. PMT. FOUNDATION, LOCATION FEE$ FEE$ �j Y�„1 FORMS, MATERIALS _ FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS I 14T •I I �/U , ilA--`T'I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION "�I (J'' I WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS •UILDI NO CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK _ AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- 1 y PP r TION OF THE LABOR COOL OF THE STATE OF CALIFORNIA RELAT. LATH. INT. //- I / I �iT LL rlli•'. ING TO WORKMEN'S COMPENSATION INSURANCE. / LATH. EXT. SIGNATURE OF ,�{�/�`r � �K HOUSE NUMBER COR- PERMITTEE a ���- /,/ "ORE ANO POSTED goDREss ( _�. �. rE, FI NAL JOHN F. LEWIS, PRINCIPAL ST PAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.o CASH Lttl a 1 7 1 3G i'10V 14 1 D 2 7.7 5 Q Aazllz � TEMPLE CITY V5A59BACE4'NB]Y-. APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING/,)/Z,/ DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALIT JOHN A. LAMBIE. COUNTY ENGINEER NEAREST I WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. zm AV DIS T N GRO P TYPE P O D Y FOR APPLICANT TO FILL IN 0 CONST. BUILDING A y- �� STATISTICALC IFICATION SEWER MAP ADDRESS 'V /.Z LA 7-`�-F�y"'��d /YK / C1A55. NO. DWELL UNITS LOT NO. BLOCK WATER NOT REQUIRED ® RECEIVED CERTIFICATE: ET TRACT g%zMAP /0 STATE MAJOR SECON OCAL SIZE OF LOT NOW ON LOTS NO. E ICIRUEI USE ZONE SPECIAL USE OF ]] CONDITIONS EXISTING BLDG. —/ /-T I '- OWNER �x�y5 ///.Q�fc+�r.L�Q of NO.� -(pry$ BUILDING YARD HWY TREET NAME EXIST. "'�-'�•' Y SETBACK WIDTH ADDRESS IZS �E / FRONT ARCHITECT OR TEL. I P. L _ ENGINEER - NO. SIDE ADDRESS O TEL //,N CONTRACTOR, Zjp�,J=ENU/A/F_ No 41 V ADDRESS ,3n Q H DESCRIPTION O WORK o2 G t" J ` a NEW ADD ✓ALTER REPAIR DEMOLISH _ , 50. FL NO. OF NO. OF SIZE 3�� STORIES FAMILIES u11,� USE OF ! I" STRUCTURE �wE(L/.(�Q � Q� cB ��— G (+�i SIGNATURE OF 'V APPLICANT_ VALUATION S APPROVALS JDATE INSPECTOR,'S SIGN#TVJRE FOUNDATION: LOCATION FEE $ FEE $ .� FO RMS. MATERIALS FRAME: FIRE STOPS, I HEREBY CKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. v WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK ,✓ /� AUTHOR IZEO HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF TME LABOR CODC OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'5 COMPENSATION INSURANCE. LATH. EXT. SIGNATURE OF �,J .�] HOUSE NUMBER COR. PERMITTEE �--��. //l- /7 q.L RECT AND POSTED ADDRESS� j FINAL 'LrI 'J,(,(/ f J_ JOHN F. LEWIS. PRINCI AL STI AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.D. CASH ? 3 5 6d 132 3 2 3 D 9.25s v LMLO 5 2 0 1 FEB 4 1 D 1 8.5 0 TEMPLE CITY r,1/�I11 .I6A6J6A CE E6G]=-sI APPLICATION FOR BUILDING PE RMIT COUNTY OF LOS ANGELES BUILDING 1!9 / .r DEPARTMENT OF COUNTY ENGINEER ADDRESS 1 BUILDING AND SAFETY DIVISION LOCALITY/ C JOHN A. E, COUNTY ENGINEER NEAREST A. JEN WILLIAM A. JENSEN, SUPT OF BVILDING CROSS BT. DISZft ICT GROUP TYPE PROC SrED Y FOR APPLICANT TO FILL IN CcoNST. �A BUILDING STATISTICAL CLASS FICATION SEWER MAP ADDRESS Z 6 'o"4 BK /'i CLASS. NO. DWELL. UNITS LOT NO. - ),;N 3 BLOCK C WATER o CERTIFICATE: NOT jjN��OT REQUIRED © RECEIVED TRACT O AZ HWAY NOP;P(, IICIRC E) STATE MAJOR SECOND, OCAL NO.OF SIZE OF LOT n 3 ION LOTS 'USE ZONE SPECIAL USE OF _ CONDITIONS EXISTING BLDG. �i CA / TEL. OWNER / O. BUILDING EXIST. ` YARD HWY STREET NAME SETBACK WIDTH ADDRESS FRONT 11 ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. y ADDRESS' O _ TEL. �eVS .n V CONTRACTOR Z .(� NO. l� f{ c mp ? lw.Ln If m ADDRESS - .,_.,rSLIE r � � - jr DESCRIPTION OF WORK w CL N NEWADD ALTER REPAIR DEMOLISH Z SD. F NO. OF NO. OF SIZE STORIES 'FAMILIES USE OF STRUCTURE :E SIGNATURE OF APPLICANT VALUATIONS APPROVALS I DAT INSPECTOR5 SIGNATIJRE U.�r FOUNDATION: LOCATION 1/ FEE' FEE S FORMS, MATERIALS / FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS /\ ANO STATE THAT THE ABOVE IS OORRECT 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. TION OF THE LABOR COOC OF THE STATE OF CALIFORNIA RELAT- \/ ING TO WORN MEN'S COMPENSATION INSURANCE. LATH. EXT. SIGNATURE OP ) HOUSE NUMBER CDR - PERMITTE'E RECT AND POSTED / ADDRESS r - FINAL I W a {� JOHN F. LEWIS. P INGIPAL STRUCTURAL EN R PLAN CHECK VALIDATION EK. M D. GASH _ PERMIT VALIDATION K. M.G. SASH Lii%o 2 9 7 3 FaDu 2 9 1 D 6.0 0 W "'�PPLICATION FOR BUILDIN PERMIT � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS ao COLEMAN W. JENKINS, SUPT OF BDILOING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print ort a ..I CROSS ST. BUILDING DISTRICT N GR TYPE PRO S O/ �- CONST. ADDRESS D STATISTICAL SIFtCATION SEWER MAP LOT NO. BLOCK CLASS NO. OWELL.UNITS_ BK PG TRACT 0 A?. \ USE ZONE MAP �{ / O NO.OF BLDG$. NO.SIZE OF LOT NOW ON LOT / SPECIAL USE OF CONDITIONS EXISTING BLDG. e.S/ Al OWNERTEL. ��(� dNYL.7M/�'Q' NO. dd BLDG.SETBACK FROM ADDRESS �d�� /E` JA FRONT PROP,LI NE OF (STREET) CITY 7Z7AMw- CrY (244,. 9f7fO TYPE OF EWI TING SETBACK HIGHWAY } YARD = TOTAL TYPEHIGHWIDTH FROM G.L. ARCHITECT OR TEL. } _ ENGINEER NO. BLDG.SETBACK FRO ADDRESS SIDE PROP.LINE OF IS TR EE TI TEL. TYPE OF EKISTING SETBACK HIGHWAY RO = TOTAL a CONTRACTOR E' NO. HIGHWAY WIDTH FROM C.L. U LIC. ADDRESS NO. + O LIC. U CITY CLASS CORNER CUTOFF YES ❑ NO ❑ Ly CONSTRUCTION LENDER d NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS Z ADDRESS SQ. FT. NO. OF NO. OF NEW SUSE OFIZE ff��S/TCOL, STORIES CO I FAMILIES STR CTURE fJ OCk: ALADD El ALTER ❑ SIGNATUREOF REPAIR❑ APPLICANT DEMOL ❑ O VALUATION $ " APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION q FEE S FEES FORMS. MATERIALS /^� 4;) ',I t oAA FRAME: FIRE STOPS. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS_ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS ST RUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HERE BTWILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPERSATIOA OfSURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER ZCOR- PERMITTEE J - RECT AND POSTED ADDRESS 10a(P A SA / C ` FINAL f b� JOHN F. LEWIS. PRIN IPAL STR TUR L ENGINEER PLAN CHECK VALIDATION K. M.O. CASH _ PERMIT VALIDATION CK. 0, CASH F r� 1 9 4 5� auG16 1 D 9.00- ; � 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 consent to self insu , / F or a certificate of Workers'Compensationn Insurance,or a certified ZIP OODY thereof(Sec.3800.Lab.C.) r/ LOCA TY rPonlicy No. Company SIZE O LOT ( NO.OF BLDGS.NOW ON LOT EA9�LE ,�i/T 93,6rtified Copy is hereby fumishad. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. I USEZONE MAP NO. �� Date Applicant ASSESSOR MAP BOOK PAGE PARCEL /)r/ SPECIAL41-1 CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ER TEL NO. WIT COMPENSATION INSURANCE YC 0 M/cg 4/1''655 WITHIN 1000 FT.OF SCHOOL? YES NO ADDRESS (This section need not be completed if the permit is for one hundred j. DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) 1 certify that in the performance of the work for which this permit alx�ITY / Z f Q �D F is Issued, I shall not employ any person in any manner 90 89 to ARCHITE OR ENGINEER TEL NO. OY become subject t0 th/�e,Workers'Com,(pensati,��In L l/ STATISTICAL CLASSIFICATION APT CONDO Datep� `Applicant I 'g k LCL� ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. [f, after making this Certificate Of NTRACTOR NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' SETBACK YARD HIM PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith U W U ow yi2/J � FRONT comply with such provisions or this permit shell be deemed revoked. DRE /� LIC.NO. / 4 14 / PL LICENSED CONTRACTORS DECLARATION LIC.CVSSC - SIDE ap. I hereby affirm that I am licensed under provisions of Chapter 9 A �V C �3 / SEWER MAP U (Commencing with Section TODD)Of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES I NO.OF FAMILIESC Professions Code,and my license is in full force and effect. I NEW ❑ BK Zi PG 11 , CD L DEIPTIO WORK License Number Lic.Class C ' / i - ADD E] VALUATION nG, w d`:7 N Contractor ✓+ va Date S'C"3 D —�r 1 ALTER ❑ $ �v Z 10,1 SS — — h i •P REPAIR ❑ I am exempt under Sec. $ B.BP.C.for this reason NO o5 g DEMOL ❑ LOMA P/C w Date: USE OF EXISTING BLDG. .URM ❑ Signature ICANT(FIR re TEL NO. LOMA N.If ❑ I, as owner of the property, or my employees with wages as J A dt/AL 2 / =O 1135.2 their sole compensation,will do the work and the structure is ADM not intended or offered for sale (Section 7044, Business and 0 +c ' / FINAL DA Q I ITEMS Professions Code.) G -4 c +-)c WILLTHEAPPLICANTOR FUTUREBIILDING OCCUPANT HANDLEA HAZARDOUSMATERIAL J TUTHL 10�Y o 2�� On A MIXTURE CONTAINING A HAZARDOUS MATERIAL EOUAL TO OR GREATER THAN I, as owner contractors the property, ru exclusively contracting D44. THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINALBY 1-H (ICI., licensed and Profen to construct the project (Section 7044, YES❑ NO❑WILL THE INTENDED USE OF THE BUILDING "E(-P, I'' Business end Professions Code.) FUTURET OR OCCUPANT EOUIREA PERMIT FOR CONST UGTIONOR MODIITHE FICATIION FROMTBUILDING E SOUTH CH HNUE •�IJ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No the performance of the work for which this permit is issued(Sec. ❑ 0I00-1,61101 313019ri 3097,CIV.C.). I HAVE READ THE HA2AI1000S MATERIALS INFORMATION GUIDE AND THE SCAOMD _ PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES (J h i A y` COUNTY CODE TITLEZ CHAPTER MSECTIONS24,lWT ROUGH1.W.IWCONCERNING 640 1 AN 7: 21 ,7 Lender's Name HAIMDOUS MATERIALS REPORTING AND FON OETAININGA PERMIT FROM THE SCAOMD. Lender's Address .D oxNm oP Acwr I certify that I have read this application and state that the above informP.C.FEE PERMIT F information is correct. I agree to comply with all county li�. a s ordina es end State laws relating to building construction,and he authorize rep ntetives of this County to enter upon ISSUANCE F the ova-mantic ed party for jns ion purposes. INVESTIGATION FEE T (/ wroN..mwrysn SEE REVERSE FOR EXPLANATORY LANGUAGE