HomeMy Public PortalAbout9046 LAS TUNAS DR_Building__ 76A838A CE#803 ,).,. APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING CC
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY )
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP •I PROCESSED BY
FOR APPLICANT TO FILL IN
BUILDING // ; STATISTICA IFI SEWER MAP
ADDRESS l0 ��S SSBK PG,
CLASS. NO. DWELL. UNITS
LOT NO. �� BLOCK MAP STATE
NUMBER CTI® HWY• ' YES NO
TRACT Z -7 USE ZONE SPECIAL
NO OF BLOGS. CONDITIONS
SIZE OF LOT I NOW ON LOT �J
USE OF
EXISTING BLDG BUILDINGEXIST•
SETBACK YARD HWY STREET NAME WIDTH
OWNER I V Lt FRONT _
MAIL P L.
ADDRESS SIDE _ -
TEL. P.L.
CITY No,
o I
ARCHITECT OR TEL. NSPECTION RECORD- _
ENGINEER NO.
ADDRESS
TEL. '
CONTRACTORO� - �'e NO.
ADDRESS '49- V S��� �N VWA l v\
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ-FT' NO OF NO.OF
E C STORIES FAMILIES
USE OF ST URE
SIGNATUREOF APPROVALS
APPLICANT n DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
FORMS,MATERIALS
FFEE
FRAME- FIRE STOPS.
1 QQ BRACING. BOLTS
VALUATION \ Q� +2 � FURNACE: LOCATION.GAS VENT.DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT.
PLICATION'AND STAT HAT THE ABOVE p C RRECT AND
AGREE TO COMPLY H A L COUNTY �NCND
STATELAWS RE TI BUI IN. LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTERECT AND POSTED /J
ADDRESS FINAL
CLYDE N.DIRLAM, PRINCIPAL STR RALE GI ER
PLAN CHECK VALIDATION CK. M.O. CA✓iH PE@NIIT VALIDATION s(CK/ M O.' CASH
!��C05 o 8- 9-n ' APR-15 . I A 2.0q
F
{ APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self Insure, qQ4 Las T"nAS Dr,IV�
or a certificate of Workers' Compensation Insurance,or a certified /
copy thereof(Sec 3800,Lab C) CITY�e� �E tit zIP �/ ��4
1 LOCALITY
Policy No Company SIZE OF LOT NO Of BLDGS NOW ON LOT,
❑ Certified copy Is hereby furnished NEAREST CROSS ST
❑ Certified copy Is filed with the'county budding inspection TRACT BLOCK LOT NO
department USE ZONE MAP NO
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS ,
1 "
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER j h / TF N2 ��Y' YES No
COMPENSATION INSURANCE Il �YL p J WITHIN 1000 FT OF SCHOOL?
(This section need not be completed if the permit Is for one hundred ADDRESS �)/ / ` Tti�� �Y�Iv` 'DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
dollars ($100)or less) / �/•i} /
I cer Ify that in the performance of the work for which this permit CITY f- �� �I I, ZIP ! I.7 p.O r.'l� ^
1s sued, I shall not employ any person in any manner so as to
/CT 1 //ll % o !J V 3
c0m sub ect to the Workers'Comp nsatio Laws ARCHITECT OR ENGINEER TEL NO
STATISTICAL CLASSIFICATION APT C O
Date 1M Applicant —� ADDRESS /��jqe 1_ er CLASS NO DWELL UNITS
NOTICE TO APPLICANT If, after making ,this rtificate of V p REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you Should become Subject t0 the Workers' CO TEL O SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith L 1 V1 FRONT
comply with such provisions or this permit shall be deemed revoked ADDeRESS LIC NO Sa„6a r'1'll PL
LICENSED CONTRACTORS DECLARATION 60 s S 1 9 SIDE
CIjY � �,(`• R�-�� LIC CLASS P L
I hereby affirm that I am licensed underprovisions of Chapter 9 Com/I 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 and effect NEW BK PG , 771 '2351-1
71i
u '2351-°cl D_
License Number Llc Class
DESCRIPTION•/�OF"_WORK ADD ❑ VALUATION vy*_ L Q
,�•�•�� IADY �� 7D�' �, � ,_ C�
Contractor Date i ALTER C3 $
ElI am exempt under Sec REPAIR ElTOTALCHER
B&PC for this reason DEMOL ❑ LDMA P/C# W
Date USE OF EXISTING BLDG URM ❑
Signature APPLICANT( NT) �,/ —TEL NO// LDMA Perm# _ '• Z
❑ I, as owner of the property, or my employees with wages asD�I O g
their sole compensation, will do the work and the structure is ADDRESS 1 �`' E '$
not Intended or offered for sale (Section 7044, Business and 2 SDM enol f W� 5"04h wog CA• -//10(F FINAL DATE Q �,
Professions Code) 3~J /11 G
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL •� •j•j� ,�
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J
❑ I, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � _ €�
licensed contractors to construct the project (Section 7044, YES❑ NOW TOTAL 50 � 50
Business and Professions Code) i4�
WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDINGf_!3�'��,; 50.511
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH iH'-1! -
CONSTRUCTION LENDING AGENCY COAST, IR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR r• • °[I(E
GUIDELINES �+ 1-
I hereby affirm that there is a construction lending agency for YES❑ N0,9
4THS ?PERMI-rillu
1-•''the performance of the work for which this permit Is Issued(Sec _c• 5f 1
3097,CIV C HAVE ECKLISD ITHE UNDERSTAND MMATERIALS INFORMATION GUIDE ACME ..,. iI •fir .1 Iv �:CHECKLIST UNDERSTAND MY REQUIREMENTS UNDER THE LOUNTY CSE _ r1 1 TILE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 14KAZARD'M C (I 1,Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM : I rA• " �1 1-
o Lender's Address F i ,films: °
0 OWNER OR AGENT 1"`I j
o I certify that I have read this application and state under penalty M
o PC FEE PERMIT FEE •••X
of perjury that the above Information Is correct I agree to comply �0. �1 �, `C 1-0
o with all county ordinances and State laws relating to building V
m c'9prBIruction, and hereby authorize representatives of this County ISSUANCE FEE .�O
o r on the above- e boned property for inspect on purposes
m J � � "`��/ �T/?/94,L ' INVESTIGATION FEE TOTAL FEE i F I'pi a'
SEE REVERSE FOR EXPLANATORY LANGN4 �` e�0 10 O