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HomeMy Public PortalAbout6138 LOMA AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN ti FOR OFFICE USE ONLY BUILDING e Q� _� O DISTRICT NO. PLAN^ CK.�NO. ERMIT NO. ADDRESS ! C J LOCALITY eC�' /IR�lf, �RE'CEIVED BY DATE OF APPL. DATE ISSUED NEAREST v fj�' ►� CROBB ST. BUILDING OWNER �•MAIL /-7,p �js I,a /�/-�y ADDRESS ADDRESS � /— /vo-4 o �t� LOCALITY c ST CITY 1.,� A �. No c�ose ._ �DF I L 1 FIRE NO.OF Q TYPE _ BROUP ARCHITECTOR TEL. . ZONE PLANS ENGINEER NO. ADDRESS SETBACK LINE ,,� �`�{ �j/�y(/��yTEL. *�`/� // APPROVED CONTRACTOR �flS C1?i / (a NO. ff,I.6 6'1 BY ATE ems `• - USE d�Jo APPROVED ADDREH8 A ,Gi �.�! OT�J.i'?r` ZONE _BYE DATE DESLEGAL CRIPTION LOTNO� Z. BLOCK �! rra+ CORRECTIONS TRACT X�� NO.OF BLDOH. T. SIZE OF LOU l A r NOW ON LOT USE OF NO.OF ' NO.OF ,® EXISTING BLDG FAMILIES ROOMS DESCRIPTION OF WORK NEW Yam ALTERATION ADDITION O A REPAIR MOVING DEMOLISH O 91).FTNO.OF .�� Z SIZE I V ROOMS STORIESWALL �y// f7 COVERING No­"(p- ( COVERING rdlAdk^ USE 13F NEW BUILOIINO 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE FORMS, AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FLOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORME.MATERIALS ^ ' FRAME: FIRESTOPB, vw yK (,�,✓/�/p,.n-I . SIGNATURE OF ` 7�y L/ NBRACING,BOLTS PERMITTE Y .��' lll��f7� LATH, INT. AUTHORIZED AOT LATH, EXT. , 7GA63SA-3 2-50 $ � p,C.S PLASTER,INT. FEE PLASTER.EXT. VALUATION FEE �O FINAL ��iU DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES Im IN 0 sk a G WM. J. FOX, CHIEF ENGINEER EpulLDI - FOR APPLICANT TO FILL IN i FORyOFFICE USE ONLY— �r r DISTRICT NO. - - PLANCK.NO. --»PERMIT-NO. BUILDING ADDRESS LOCALITY RECEIVED BY DATE OFAPPL: DATE ISSUED ' . NEAREST �/g� CROSS ST. / r BUILDING ADDRE9$ I ,jmw OWNER / "�' _ r� i I C1 MAIL r� LOCALITY i -A. DDRESB/A NEAREST TEL. CROSS ST, CITY �l�f'� NO. FIRE NO.OF TYP GROUP: ARCHITECT OR TEL ZONE PLANS__� ENGINEER NO. BLDG. I _ t ORD' NO. ADDRESS SETBACK)LINE TEL. APPROVED __ CONTRACTOW �-' NO.��/,� , BY i ~DATE �— T USE APPROVED ; ADDRESS ZONE BYr ' DATE LEGAL �j ; CORRECTIONS ' DESCRIPTION LOT NO. 7- ` BLOCK TRACT �( NO. OF SLOGS. SIZE OF LOT Sia 3l l]r NOW ON LOT Z— USE OF ,.-7— NO.OF ) NO.OFA. i EXISTING BIDG.� V I FAM iuES/ I ROOMS DESCRIPTION OF WORK E :; NEW ALTERATION ADDITION , -/'.7' ZJ../61 - s 11 REPAIR MOVING DEMOLISH � -� J - O BD•FT. 1 NO.OF SIZE G._— ROOMS / STORIES D WALL I ROOF COVERING COVERING � USE OF NEW BUILDING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION AND STATE LAWS REGULATING BUILDING CEINSTRUCTION. FORMS, MATERIALS - - t FRAME: FIRESTOPS, SIGNATURE OF /l BRACING, BOLTS V PERMITTEE_ �L/ � LATH, INT. AUTHORIZED AOT. ' LATH, EXT. 7SA63BA-3 10-50 $ e7v P.C.$ PLASTER, INT. FEE PLASTER, EXT. VALUATION FEE � i JsVPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT r4� COUNTY OF LOS ANGELES BUILDING WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN ; FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO.,' 13 UILDING `'�3.�2. -97 ADDRESS I) Cd-�1/.I1� i LOCALITY 770, 1t Z7, RECEIVED BY DATE OF APPL. DATE IBBUED NEARESTST OWNER (/ "s2/ l/ 1/�/J,�+ylA/L�p�/ � 1 ADD EISS ry MAIL ��• .r /�/ / A _ - J q +t LOCALITY ADDRESS �/J '����/(/ � �• //` l NEAREST CROSS BT. ZONE PLANS TYPE GROUP ARCHITECO T OR •J TEL. ENGINEER V NO. BLDG, ORD.NO. ADDRE�S�Sf�� / SETBACK LINE COCTRAOT�-AA_ t /NQ PX.N NO.,Gy'( �P'tq ®,+ BYPROVED DATE ZONE BYPROVED DATE ADORM LEGAL � - CORRECTIONS DESCRIPTION LOT NO. By LOCK TRACT 1 NO.OF BLOBS. SIZE OF LOT NOW ON LOT UBE OF I NO.OFI NO.OF " EXISTING BLDG. FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O A REPAIR MOVING DEMOLISH p SQ.FT. N D.O F 1 _ Z SIZE ROOMS STORIES D r WALL ROOF COVERING ! COVERING _ UB[OF N[W�/✓ „ Wj BUILDING II Xd� • 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT ) FOUNDATION.' LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING UI ING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS PERMITT[ 1 LATH, INT. AUTHORIZED AOT ' LATH, EXT. 7SA69aA-3 2-50 $ I P.C.$I(/PLASTER,INT. �` vI FEE PLASTER,EXT. g� VALUATION FEE FINALMAXIMUM ACCOMPLISHED 8-15-5 76A638A CE#893 1-67 APPLICA'T'ION FOR "BUILD IzlG PER COUNTY OF LOS ANGELES ABUILDING DDRESS DEPARTMENT OF COUNTY ENGINEER , BUILDING AND SAFETY DMSION LOCALITY w JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W JENKINSAUP T OF BUILDING CROSS ST ^ DIST�,IC 'NO I3, PE O ED B--•� FOR APPLICANT TO FILL IN ,� . (J j oNsr BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ` AM CLASS NO DWELL_UNITS BK PG LOT NO �j , BLOCK i USE ZONE MAP NO. TRACT `' - SPECIAL NO OF SLOGS CONDITIONS SIZE OF LOT NOW ON LOT ' USE OF 5 'DEA)CEF BLDG SETBACK FROM - ONT NE OF uu ,t /' TEL a TYPE OF PROP EXISIT1140 SETBACK HIGHWAY YARD = (STOTAL) OWNER- �►TN 9'+—N.�.l S O �TN'7` Cl ADDRESS -34f I OR N LOfY1* HIGHWAY FROMCL T� �.� ply �( � - + CITY BLDG'SETBACK FROM- - ARCHITECT OR TEL SIDE PROP LINE OF (STREET) ENGINEER NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS + HIGHWAY WIDTH FROM C L TEL, + _ CONTRACTOR NO - LO CORNER CUTOFF YES _ NO �, C ADDRESS- NO - ' C. IT LIQ SEE REVERSE SIDE FOR SPECIAL AP ROVALS c DESCRIPTION OF WORK r a NEW ADD ALTE REPAIR DEMOLISH V Z SQ.FT NO OF NO OR SIZE _ _ STORIES_ FAMILIES _ SUSE OF Al t- TRUCTURE FS Q€ C� CKrcy ' SIGNATURE OF } APPLICANT VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT FOUNDATION, LOCATION FEE$ ,(, 'FEE$ .^S;." ,' FORMS, MATERIALS FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ' BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS ,r SUILOING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH INT. � + � TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT• _ ING TO WORKMEN'S COMPENSATION INSURANCE ' ' LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE J I REC AND POST D ADDRESS •w` J //�J• • ' F1 NAL PLAN CHECK VALIDATION CK Mo CASH JOHN F. LEWIS PRINCIPAL ST RAL ENGINEER PERN[Il VALIDATION CK M O CASH L � 9 3� WV30 1 0 1 725- -7GA63SACrje0:�12-37 APPLICATION FOR BUILDING PERMIT COI*gjNTY OF LOS ANGELES BU ILowG DEPARTMENT OF COUNTY ENGINEER AD°REss BUILDING AND SAFETY DMSION LOCALITY ' JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUP'T,OF BUILDING CROSS ST GLA DISTRICT O. G OUP TYPELl SEWER MAP FOR APPLICANT'TO FILL IN1- BK PG, CONST BUILDIN jt - ADDRESS ��p �- ,%A-A-CX- STATISTICAL CrSSIFICATION -7 CLASS NO DWELL UNITS LOT NO.. G--_ BLOCK MAP - �1' STATE NUMBER `J HWY YES - O TRACT D U E$ONE SPECIAL NO OF BLOGS. / CONDITIONS SIZE OF LOT I. NOW ON LOT a 'USE OF w� EXISTING B BUILDING EXIST.• SETBACK- YARD HWY STREET NAME WIDTH OWNER 2�j- _ FRROL T O MAIL V 3 - lc. '� LJ ADDRESS � SIDE TEL. P L cITY TEL i - l INSPECTION RECORD ARCHITECT OR _ TEL - ENGINEER I NO - - ADDRESS ( r �/n^V y ,�9 • CONTRACTO 1\C Ln� \S NO �1�C�L` !� �0T ✓� �I��� ADDRESS '�'-'� DESCRIPTION OF WORK 11 EW ADD ALTER REPAIR DEMOLISH .FT. NO OF - NO OF - SIZE•. _ STORIES FAMILIES USE OF STRUCTURE 1 r SIGNATURE OF- Sc, - APPROVALS APPLICA�NT` S _ ADDRESS O �� 'L.L�' FOUNDATION /_ / DATE_�/INSPECTJOR,'S,,SIGNATURE FORMS.MATERIALS (n�y(� '�J( � b'/�J/J/�j=LeO� f P C S ( FRAME FIRE STOPS. �� D +CGC_� FEE $ �S FURNACE BOLTS LOCATION., �J . -VALUATION FEE B'� GAS VENT.DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH,INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND _ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND ' STATE LAWS RE¢ULAT�LG BpING CONS ION LATH,EXT SIGNATURE OF 1` l{� HOUSE NUMBER COR- PERMITTEF ` RECT AND POSTED / ADDRESS D�' C (`C>1 S -�C Y FINAL ' CLYDE N DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION K M.D. CASH PERMIT VALIDATION CK. MO. ) CASH ,1.7;3=9 ,A 10 1 '6 A 2.75A.19 Cp OF [l1Vo 7 4-0 FR JM 10: 1 V 11'.010, WORKERS' COMPENSATION DECLARATION I h re, 0 affirm that I have a certificate of consent to self /O\P 1P��C/U\T�,OO OO D 0 C� p J � LLLIIh insure, or a certificate of Workers'Compenstion Insurance, or L�lJ ll u sl a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No = Company F - BUILDING ;Z 9 / A � Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS c/ t7 C�IJ �� Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS �,y� LOCALITYNEARE Date Applicant CITY ^�/�i/'L ��� ZIP �17,fo CROSSSST CERTIFICATE OF•EXEMPT16NIFROM WORKERS' O / O? NO OF BLDGS " ASSESSOR PAGE PARCEL COMPENSATION,INSURANCE SIZE OF LOT 0 J NOW ON LOT MAP BOOK (This section need not be completed if the permit is for one USE ONE MAP 7 hundred dollars ($100)or less ) TRACT BLOCK LOT NO X//� NO �� } ct TEL (�© U SPECIAL 0 certify Ihat,in the performance of the work for which this) OWNS �'✓Iy-J ��®� NO v / 07 O' CONDITIONS permit is issued, I shall not employ an erson in an manner �Q,� STRICT GROUP TYPE FIRE PROCESSED'BY CJ P P Y Y P Y ADDRESS �� 7 /J" � �/ CONST _ ZOIVJE O so as to become subject to the Workers'Compensation Laws /�/ y d /J.! CITY /�`_� L� ZIP g r�7 v Date - Applicant ' ' - STATISTICAL CLASSIFICATION A T CONDO W NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL , Exempton,'you'-should become subject to the Workers' ENGINEER - NO CLASS NO��DWELL UNITS H Compensation provisions of the Labor Code,-you must forth- ', ADDRESS SEWER MAP with*comply with such provision's or this permit shall be ' �7 'deemed revoked CONTRACTOR TEL NO BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC ' 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 $ 6(7 SQ FTNO OF NO OF CHECK' License Number Lic Class SIZE STORIES FAMILIES ONE ' -+ $ _ DESCRIPTION OF WORK C X NEW Contractor Date ❑ ❑ �� /L� /1,��t ADD I am exempt from the licensing-requirements as I am a �'—r.T7t�✓ v I architect or a registered professional engineer ALTER FINAL �� � acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code) USE OF EXISTING BLDG DEMOL ❑ FINAL ' By Lic-or Reg No _Date 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-- - --- - -- — - -- - --- - 17XTI 1, as owner of the property, or my employees,with ADDRESS - - —� w`ages`as their sole compensation,will do the work and ` the structure isnot intended o�offered foF sale•(Section LOCALITY 7044,,Business and Professions Code) MOVING TEL I, as owner of the property, am exclusively contracting CONTRACTOR • NO r ' with licensed contractors'to construct the project (Sec- ADDRESS 2 31,4 A tion 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH # e o 0 0'0 _ I hereby affirm that there is a construction lending agency for FRONT ` 0 G J 2 0 0 2 5 0 0 the performance of the work for which this permit is issued. P L V (Sec 3097, Crv, C ) SIDE ` - PL a 25,00 Lender's Name ' Lender's Address P C Fee$ Permit Fee 09,2'6-80 > I certify that I have read this application and state that the Issuance Fee above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee d hereby authorize representatives oft this County to enter aon the above-mentioned pro rty for inspectionpur osses 7 + 2 l0 U ` SEE REVERSE FOR EXPLANATORY LANGUAGE 3 o I ®s Signature of Applicont or Agent Dote J APPLICATION_ FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY �J WORKER'S COMPENSATION DECLARATION BUILDING ADDRESS FOR APPLICANT TO FILL IN ,; / � 37� ��ItiL� n -n , 1 hereby affirm that I have a certificate of consent to BUILDING ADDRESS tLJ I � self insure, •� � ���� - or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) _ /� +� ZIP 92/1 , LOCALITY Policy No. Company SIZE OF LOT `!./ NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ElCertified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date ASSESSOR P OK PAGE/ PARCEL Applicant V/ a y I SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWN FS �! T L "( / YES NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? ADD SS y� (This section need not be completed if the permit is for one hundred Z_-6 *17 /l.•C Ile DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) cl `` ZIP y 2 I certify that in the performance o the work for which this permit G /F G! 9�r (/ J Is Issued, I shall not employ a erson in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become s ject the `_Workers'C pensation Law STATISTICAL CLASSIFICATION APT D Date �AppliCe ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICAN after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Shoul�eCOme subject to the Workers' CONTRACTOR TEL.NO.A� `,' ���✓Y_! SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith (�I•�+ �i' FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASSP L Q_ U I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP SQ.FT.SIZE NO.OF STORES NO. AFAMILIES (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG Professions Code,and my license is in full force and effect. DE PTI F ADD v WORK ❑ VALUATION Lu License Number Lic.Class � �'� O N Contractor Date r, ALTER WJ A W /It?, C REPAIR /❑ ❑ I am exempt under Sec. � ) B.BP.C.for this reason F✓��� Vii'✓ ���' DEMOL ❑ LDMA P/C ri USE OF EXISTING SLOG. Date: URM. ❑ - ..- ; Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# I, as owner of the property, or my employees with wages as O - their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q '_, -"• P P Y Y fI THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ No❑ "' ` '" Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING ...- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 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. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097„CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES m. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING ' ”- •' ;B Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAININGA PERMIT FROM THESCAOMD. Lenders Address OWNER OR AGENT o I certify that I have read this application and state that the above P.C.FEE PERMIT FEE information is correct. I agree to comply with all county o inances and State laws relating to building construction,and l(J a. er y authorize representatives of this County to enter upon ISSUANCE FEE /� —I he bove-mentioned prop or inspection p�se . 2—I • 1 5_ INVESTIGATION FEE TOTAL FEE 14 re or AWin or Aon , SEE REVERSE FOR EXPLANATORY LANGUAGE, f� WORKERS'COMPENSATION DECLARATION •pn Hereby affirm that I Ff a certificate of consent to self APPLICATION FOR BUILDING PERMIT � 'Tnsyre, ora certificafe.of Workers' Compensation Insurance, or a'.ertified copy theregf (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Na. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS (J1 ✓U y/t ❑ Certified copy is filed with the county building inspec- BUILDING 1-349 � � LOCALITY' tion department. ADDRESSs�i/r ( / Date Applicant CITYJe /� P/e "�� ZIP / 7�� CROSS NEAREST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR J�3 7 2� C r� COMPENSATION INSURANCE SIZE OF LOT (/ ✓� �dJ NOW ON LOT MAP BOOK PAGE L PARCEL � (This section need not-be completed if the permit is for oneUSE Z NE MAP hundred dollars ($100)or less.) TRACT 0 BLOCK LOT NO. �� �' NO. rye TEL.. �7 p SPECIAL } I certify that in the performance of the work for which this OWNE 1�✓ �.$ ��N91e�r� NOf7-s7 CONDITIONS 9L permit is issued, I shall not employ any person in any manner "�'' /aa DISTRICT GR UP TYPE FIRE PROCESSED BY O so as to beco a subject to the W kers'Compensat'a ws. ADDRESS(.,-'hJ' ? CONST. ZONE / rj )Qt CITY 6M��U Vr�'� ZIP Date v` Applican STATISTICAL CLASSIFICATION, APT. JC& DO. ARCHITECT OR [% n ,�-'y) TEL. .. i NOTICE TO APPLICANT: If, of making this Certificate of ENGINEER t)�. t CIO i" NO. �w�.� CLASS NO. DWELL. UNITS �. Exemption, you should bec a subject to the Workers' & Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be ��g TEL LK!IV� NO. VALIDATION deemed revoked. CONTRACTOR + BK. PG, LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALU TI N (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 $ /7 ► SQ. FT.t`/� NO.OF NO. OF ) CHECK License Number Lic.Class SIZE 590 STORIES �7 FAMILIES�/ ONE /� U /✓/ NEW $ 271 1,3.A Contractor Date DESCRIPTION OF WORK n / /l/39 �/C ADD ® # 0 0 0 0 0 1 I am exempt under Sec. ra ALTER FINAL , B.&P.C. for this reason REPAIR 01 DATE 7-�s�JZ I 2 8,2.d O Date: USE OF EXISTING BLDG. DEMOL O FINAL t/ _ o,0 282006- APPLICANT p TEL. By Signature PRINT JN x76.5 0/e le N Ql�� D/(� 0601 z 8 7 OWNER-BUILDER DECLARATION , I hereby affirm that I am exempt from the Contractor's License ADDRESS Law for the following reason (Section 7031.5, Business and Professions Code): BUILDI 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 kRE 7044, Business and Professions Code). TEL. +//�� I, as owner of the property, am exclusively contracting CTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY CK YARD HWY PROP. LINE WIDTH , I hereby,jaffirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's NameLender's Address $ Permit Fee 1 �7 I certify that I have read this application and state that the Issuance Fee ! / above information is correct. I agree to comply with.all County Investigation Fee $ ordinances and State laws relating to building construction, Total Fee t 11 u and reby authorize representatives of this County to enter m up n he above-mentioned pro ty for i spection pur oses. a �rZ SEE REVERSE FOR EXPLANATORY LANGUAGE n Signature of Applicant or Agent Obate - •• ®s f APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES, BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS � E I.hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS (/ I? X)' or a certificate of Workers' Compensation Insurance,Or a certified copy thereof (Sec.3800,Lab.C.) - C �. ZIPA LOCALITY Policy No. Company SIZE OF LOT/) X �� NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. �a77J/Y{ NEAREST CROSS ST. , �� a s ❑ Certified copy is filed with the county building inspection TRACTBLOCK LOT NO.,,,? ` V Z•-- USE ZONE MAP NO. •+�•-•-• s department. � _ (-?'-_'_; ,a ASSESSOR MAP BOOK PACS PARCEL PAORCEL Date Applicant J�^J�3 C�/f/' ` �J r SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNE �J�� J < QTS WITHIN 1000 FT.OF SCHOOL? Yes COMPENSATION INSURANCE _ This section need not be completed if the permit is for one hundred ADD SS "••" ' ( P P � �� ��� � DISTRICT GROUP TYPE CONST. FIRE-70N� '�AROCe98E 4'=' �'—£ dollars ($100)or less.). ��,VVV ZIP WF - �iy£ I certify that in the performance of the work for which this permit ®l� C� is issued, I shall not employ any person in any manner so as to q HITECT OR ENGINEER TEL NO. ° I`• become subject to the Workers'Compensation Laws. STATISTICAL LASSIFICATION .y APT CONDO Date Applicant ADDRESS ^— CLASS NO � DWELL UNITS-&// _J , NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK_FROM " � EXIST + Exemption, you should become subject to the Workers' CONTRACTOR �,, TEL NO. SET BACK YARD HWY PRO �t„I[ j WIDT' ' Compensation provisions of the Labor Code, you must forthwith �C C/L/ FRONT Comply with such provisions Or this permit shall be deemed revoked. ADDRESS LIC.NO. PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SIZE NO.OF DRIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. (✓L tJ'—' NEW BK PG pool. Number Lic.Class ADD VALUATION O Contractor Date ALTER ❑ 5 0 ElI am exempt under Sec. REPAIR El $ BAP.C.for this reason DEMOL ❑ V LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm# •�...•.-• y. Z �1, as owner of the property, or my employees with wages as Z - •s a their sole compensation, will do the work and the structure is ADDRESS FINA]BY E not intended or offered for sale (Section 7044, Business and Q . TT'fr,D: Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL Z m f A!3-�f_ ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ,++' �+ P y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINA � i 11 j� 243 c+ f -3 licensed contractors to construct the project (Section 7044, YES❑ NO❑ -• Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING '-HE`K ••��+•+ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR DUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ 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 r ° 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 0000 Mrs_ N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS —_ Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. S.r"i°, LJ I o Lender's Address OWNER OR AGENT O o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to Comply P.C.FEE /y� PERMIT FEE N wi all county ordinances and State laws relating to building pia truction, and hereby authorize representatives of this County ISSUANCE FEEco o nter upon the above- enti propert or inspectio pur oses. (G V < INVESTIGATION FEE TOTAL FEE Noo:� S tura of App4rant or Agent Da SEE REVERSE FOR EXPLANATORY LANGUAGE