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HomeMy Public PortalAbout8718 LONGDEN AVE_Building__ ©s 76A838A, E X903 19EVS8/781 / , _ 1 V •`1 VC APPLOCATOON FOR BUHLDING PERMOT COUNTY OF LOS ANGELES BUILDING AND.SAFETY FOR APPLICANT TO-FILL IN ADIDRESS BUILDING ADDRESS D LOCALITY NEAREST CITY /_ ZIP CROSSST NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK i PAGE 1JARQEL DISTRICT GROUP Ty PE FIRE PRO SSED BY TRACT BLOCK LOT NO j� CONST �ZON V i T E !/ --s. ��a OWNER / N S STATISTICAL CLASSIFICATION EWER ADDRESS CLASS NO DWELL UNITS B PG CITY , ZIP _ ARCHITECT OR TEL VALUATION 001�90 ENGINEER NO / ADDRESS BLDG SETBACK FROM TEL 3.3 FRONT PROP LINEOF (STREET) CONTRACTOR O v ve TOTAL SETBACK FROM TYPE OF EXISTING LIC HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH ADDRESS NO CITY LIC + ` .- — CLASS CONSTRUCTION LENDER BLDG SETBACK FROM NAME AND BRANCH SIDE PROP LINE OF (STREET( HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY -SIDE PROP LINE HIGHWAY WIDTH SO FT 4F NO OF NO OF CHECK + _ �7 SIZE.I STORIES FAMILIES ONE A DESCRIPTION OF WORK NEW ❑ P C Fee$ Permit Fee ADD- . Issuance Fee ALTER T _Z. REPAIR ❑ Total Fee U USE OF EXISTING BLDG DEMOL ❑ Y APPLICANT_ TEL 6-5.3O IPRINTI /Ij ahNO_ 5 Q • D BY(SIGNATURE) Q > IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE `;-'^=�••��. '_ , THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE 1- S /�• \ WORK AUTHORIZED HEREBYW ILL NOT EMPLOY ANY PERSON IN VIOLATION OF - Z O /, O n _ THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S,COM - W f•1 PENSATION INSURANCE g ' SIGN FERMI20070.00 OF 200 ,70,00 ADDRESS ~ 7- 7 O,O O o 0 TEL y �� P 7 CITY D NO Q 'Qq,25=78 p U •Z9NE,,'- MAPS SPECIAL t CONDITIONS. FINAL BY LU DATE LU 1 DATE I _ r APPL MN FOR BULUNG P'ERNT CO Y Oy LOS ANGELES, . • BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION. / QQ I hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDRESS �� r, �- or a certificate of Workers' Compensation Insurance,or a certified Cop y,thereof(Sec 3800,Lab C). CITY /� ZIP 'i"'•+ CSj�' LOCALIT Policy•No Company SIZE OF LOT NO OF BLDGS NOW ON LOT .l ❑ Certified copy,Is hereby furnished NEAREST CROS 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 , CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER0�/�w�� i TEL NO YlVr COMPENSATION INSURANCE �(/, /I/Z ?- WITHIN 1000 FT OF SCHOOL? YES NO ADDRESS - "Q ,.— ,Q �� " (This section need not be completed rf the permit Is for one hundred Z O n//7 (/ /r7✓�--- DISTRICT GROUP Tya CONST FIRE ZONE PROCESSED BY dollars($100)or less) CIT ZIP /�ry ✓- C.�Y1/2' ' I certify that In the performance of the work for which this permit B(ti'�� r -3 is issued, I Shall not employ any person In any manner so as t0 ARCHITECT OR ENGINEER TEL NO become subject to e Workers'Comp ns Ion Laws / t I STATISTICAL CL SSIFICATION APT CONDO Date + Applicant y LJ ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT, If, after~making this Certificate Of REQUIRED, TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR �TEL�yNO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you,must forthwith �e FRONT ' comply with such provisions or this permit shall be deemed revoked ADDRESS LICNOP IL LICENSED CONTRACTORS DECLARATION Z FOPS �— `"� SIDE CITY LIC'CL PL I hereby affirm that I am licensed underprovisions of Chapter 9 ��" SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and SCLFySIZE No of STORIfrS NO/F AMILIES - Professions Code,and my•Ilcense In full force an effect —�7G/'�� W BK PG a License Num t� a LIC Class .5` DESCRIPTION F WORK nJ A ADD ❑ ' VALUATION D —iedO.��CC.G:GO �o O Contractor/' - Date ALTER ❑ $ °° p ors ; \ REPAIR ❑ $ O ❑ I am exempt under Sec m B8PC for this reason — s / EMOL ❑ LDMA P/c# W Date USE OF EXISTING BLDG Q ,t /. „�— URM ❑ Signature APPLICANT(PRIN rye'fes. �-•� TEL NO LDMA Perm# _ x. Z ❑ I, as owner of the property, or my employees with wages as v ' ` �`� Z their sole compensation, will do the work and the structure IsADDRESS not Intended or offered for sale (Section 7044, Business and Z 1' P FINAL DATE Q -. Y - Professions Code) WILL THE APPLIC OR FUTURE BUILDING OCCUPANT HANDLE A ZARDOUS MATERIAL 1 a y(E); OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J Pas as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES Lensed contractors to construct the project (Section 7044, FINAL B YES 1:1 NO El > f!_I1'�L 12 ' Business and Professions Code) �. WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING f OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - A v CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR r t/ I tJ�(7 yI it f GUIDELINES 7J !7 1 S•Pll'll'll�� I hereby affirm that there Is a'construction lending agency for YES❑ No❑ !V/� N the performance of the work for which this permit Is Issued(Sec = (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 13097, CIV C) CHECKLIST I UNDERSTAND'MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, I[lf'( TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS ,' , ,IS�j It_t-3 i=i 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD =11; IL o Lender's Address b - OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above'information is correct I agree t0 comply PC FEE PERMIT FEE with all county ordinances and State laws'relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE 6?- 4, 7 _ to enter on the ve tioned property for inspection purpo eS INVESTIGATION FEE TOTAL FEE ome 1 SEE REVERSE FOR EXPLANATORY LANGUAGE