HomeMy Public PortalAbout8762 LESLIE DR_Building__ 66�*o
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76A638A CE h8032-63 APPLICATION FOR--BUILDING PERMIT_
7
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 ST
DISTRICT NO GROUP YP,E /P ESSED B
FOR APPLICANT TO FILL IN -� CON`T (\
BUILDING �' STATISTICAL CLASSIFICATION -S WER•MAP
ADDRESS y e, •/q - BK -'PG
CLASS NO 1L DWELL UNI S -
LOT NO BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT- MAP HIGHWAY r '
N NO, OF BLDGS NO Z C/ (CIRCLE)' STATE MAJOR SECOND, OCAL
SIZE OF LOT>� V NOW ON LOT O USE ZONE SPECIAL
USE OF ,y'� ///((( CONDITIONS
EXISTING BLDG TEL . epii /} J�
•�i.O I / 1 - 1
"' �/. NO
OWNER BUILDING - EXIST
// /T SETBACK YARD HWY RE •T NAME' WIDTH
ADDRESS '-?6— -e m ?//p e 'OJT 13/vdi FRONT 7 S
ARCHITECT OR EL P L _
ENGINEER - NO SIDE
P L I O-
ADDRESS I V
' TEL '
CONTRACTOR NO •1-- i N
11i,, r fi O
ADDRESS _ -__ «.r._..._,. .. c�.:.x-,y,..�a.w,-a.�aw.:,k�.,•.• U,
DESCRIPTION OF WORK r �` "'{ a
NEW 1- ADD ALTER REPAIR DEMOLISH • - J� ` C A'�
SO FT -No
OF NO OF e'er--�•+aQ ✓L4f \��' �••'k -I \
SIZE STORIES FAMILIES
USE OF _ r:
STRUCTURE
SIGNATURE OF
APPLICANT
1 JrW-��/' fey-
VALUATION / (J"QL� `��' �.fJ�Qv U _ 4' �
APPROVALS DATE ,INSPECTORS SIGNATURE
F C, PMT
i FOUNDATION LOCATION f
E $ FEE $ FORMS, MATERIALS
FRAME FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS !I� Dr r• l �3�
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
TION OF THE LABOR CODC OF THE STATE OF CALIF O IA LAT v/�s
ING TO WORKMEN S'COMPE 10 URANCE LATH EXT
SIGNATURE OF <r HOUSE NUMBER COR- v
PERMITTEE RECT AND POSTED' ` / '�•
ADDRESS i +� 7- C. FINAL• .��r ,
CK _ JOHN F LEWIS RINiPAL ST R TURAL ENGINEER;k'
-PLAN CHECK VALIDATION Mo cnsH �
Q PERMIT VALIDATION CK M G CAS j/'
j34 8' S 2 S FE5 1 5:2 3 A 2 6.75A '
_ L. ,�lvo 8 ,S 0 2� ,FFS 2 5 1' A 5 7,C`-o-`"
APPLICATION FCR BUILDING PERMIT
+' COUNTY OF LOS ANGELES G BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN A g�SyS�
• WORKER'S COMPENSATION DECLARATION -- '/(G�(
BUILDING ADDRESS I
I herebyaffirm that I have a certificate of consent'to self Insure, i �or a certificate of Workers' Comperisation Insurance, or a certified CI Y Z L C w ZIP
t�Ci
copy thereof(Sec 3800,Lab C) G `
Policy No IfZ L -2 3 Company ST9T� fy,� /9►F ` LOCALITY
SIZE OF LOT NO OF BLDGS NOW ON LOT
❑ Certified copy Is hereby furnishedZ NEAREST CROSS ST
❑ Certified copy Is filed with the county building Inspection TRACT BLOCK LOT NO
department
_7T
-., USE ZONE MAP,NO
Date Z' ���Appllcant ����5 /� /Sj%iyG ASSESSOR MAP BOOK PAGE PARCEL i
O SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION'FROM WORKERS' OWNER TEL NO YES NO
COMPENSATION INSURANCE LV/p �j/'! WITHIN 1000 FT OF SCHOOL'?
completed If the permit is for one hundred ADDRESS
(This section need not be coin
P I/1 W, W rS Tq-y 1101 DISTRICT GROUP TYPE CO ST FI NE PROCESSED BY
dollars($100) or less)
CITY , ZIP
I certify that.in the performance of the work for.whlch this permit - ��/
Is,lssued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO �J
become subject to the Workers'Compensation Laws - STATISTICAL CLASSIFICATION' APT CONDO
Date Applicant •ADDRESS CLASS NO a/ DWELL UNITS
NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become sObject t0 the Workers' CONTR� J oG/�/L TEL NO SET BACK YARD HWY PROP LINE, WIDTH
Compensation provisions of the Labor Code, you must forthwith /(ted 0�✓�� -7/4/' 9'6(P FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC NO P L '
LICENSED CONTRACTORS DECLARATION - S-75--3
P�x�6 5 i 2 l S� SIDE
CITY LIC CLASS s4 P L -
I hereby affirm that I am licensed,underprovisions of Chapter 9 7W &- 3'i �`� / SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and' SO FT SIZE NO OF STORIES NO OF FAMILIES
Professions Code,and my license Is In full force and effect NEW ❑ BK PG }
License Number �.Zb��(r tic Class G •3 J d- / DESCRIPTION OF WORK I ADD ❑r VA ACT10N J' O- , O
Contractor Aca 6 �(rsH'f"J t� a-S3 ' %1f4,,eZ 66��� ALTER' '❑, QV
❑ under Sec / REPAIR•
I am exemptS
2 !fE .30�'� H
,BBPC for this reason _ sr/G Q ZYZ- -l✓JCbT,_;P, 7-j z__� DEMOL, ❑ LDMA P/C# y W
Datef USE OF EXISTING BLDG URM El D_
/ 10• ��v M
Signature
APPLICANT(PRINT) TEL NO LDMA Perm# 1 Z
❑ I, as'owne� f theproperty, or my employees with wages as Z
ADDRESS CI ACCT a
their sole mpensation;will do the work and the structure Is og
not Inten ed or
of
for sale (Section 7044, Business'and FINAL DATE Q00-JJV7 104.23_ e ?
Professions Code) -WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
❑ I, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY _ P-1—TOTAL
1ITEMS'
licensed contractors to construct the project (Section 7044, VES❑ No❑' "
Business and Professions Code) 20 4' ® 23
_ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '
CONSTRUCTION LENDING AGENCY, COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR Q CHECK j �4.2J
GUIDELINES CHANGE _ _
I hereby affirm that there is-a construction lending agency for ves 1:1 No❑ 7�0 , I
N the performance Of the work for which this permit Is Issued(.Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING
3097,Civ C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,
N TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS
a Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD III�Stl1'—1311'1L')i 2/
2/93
o Lender's Address -7JOJoJrL�! JJVV1i A i i 7
oI-certify that I have read'this application and state under penalty av ER oa AGENT r T 7u j ~�t 1'�e
�• of perjury that the above Information Is correct I agree to comply PC FEE PERMIT FEE
6' with all county ordinances and State laws relating to building Q
construction, and hereby authorize representatives of this County ISSUANCE FEE
cc t nter upon the abo nti d property for Inspection purposes
- -2-. � INVESTIGATION FEE TOTAL FEE iJ
<o Or
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SEE REVERSE FOR EXPLANATORY LANGUAGE ,