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HomeMy Public PortalAbout8838 LONGDEN AVE_Building__ ©s 76A638A,r CE#803(REV 6/78) APPLOCATOON FOR. BUILDING PERMIT COUNTY OF LOS ANGELES BUILDOG AND SAFETY: ADDRESS -FOR APPLICANT TO FILL IN BUILDING - BUILDING - r ✓i��... .. •�t� ADDRESS LOCALITY NEAREST _ CITY ;uJ ��/ ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT ,NOW ON LOT MAP BOOK PAGE PARCEL ,� (�', � DISTRICT' GROUP [TYPE -FIRE WESY TRACT 7 BLOCK LOT NO ` CONST ZEE TELr OWNER NO_L".tJ f �? y� r STATISTICAL CLASSIFICATION.. SEWER MAP ADDRESS .qty r LTrA%��c�/ /� •, L�g J CLASS NO. DW ELL UNITS BK PG CITYZIP ARCHITECT OR TEL. VALUATION ENGINEER NO. ADDRESS BLDG SETBACK FROM TEL^ FRONT:PROP LINE'OF (STREET) NO. TOTAL SETBACK FROM .TYPEOF EXISTING CONTRACTOR /� LIC' HIGHWAk + YARD =. . FRONT PROP:,-LINE^ HIGHWAY WIDTH ADDRESS NO. LIC. , CITY " CLASS BLDG.SETBACK FROM CONSTRUCTION.LENDER SIDE PROP:^LINE OF L` (STREET) NAME AND BRANCH HIGHOAY,, + .Y. . ARD =M TOTAL SETBACK FROM TYPE OF 1EXISTING ADDRESS CITY ^SIDE`PROP.LINE HIGHWAY -WIDTH SQ.FT. NO.OF NO.OF CHECK + _ SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW 0 R C Feel Permit Fee ADD' l li�"sc�" ❑ Issuance Fee -� ALTER; ❑ � REPAIR Total Fee USE OF _ADEM ❑ EXISTING BLDG. C i --/l 1' 1—), Z APPLICANT _/- / 1 TEL1*1 (PRINT)A6m,: � /� sv9� N0., BY(SIGNATURE( IHEREBY ACKNOWLEDGE T aT I HAVE READ THIS APPLICATION AND STATE - - �'be ' THAT THE ABOVE'IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE - - Z /' p WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V " .�2A.9 ,1 :tnn -i " THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM" ' .Z PENSATION INSURANCE' '#"o Oi0,0. O,1 ". SIGNATURE OF :� Gm� _ 2,o,6 2 2 0 0 PERMITTEE rJ ADDRESS ./ 0 414- / �r Z lo-'o o-22 Q.OtrJ TEL O 12 CITY �/ NO. 0,311-3W— 7 9 D US N7 MAP XOSPECIAL CONDITIONS g FINAL ;Zs/ J _7 BY I DATE WORKERS' COMPENSATION DECLARATION! I herebyaffirm that I have a certificate of consent to(self O D b D D D appd�C�la` 0®. l CG3: Co3MOdD� I�. insure,,'or p certificate of Workers'.Compensation Insurance, p or!Q certified copy ihereof(Sec."•3800`Lab C.) COUNTY OF LOS'ANGELES• - BUILDING AND SAFETY Pol cy No Company BUILDING ' Q ❑ Certified copy isherekiy;fu�nished. FOR APPLICANT TO FILL IN ADDRESS BUILDING Q� ¢� ❑ Certified:copy is filed with the'countybuilding'inspec ADDRESS 3 U ,LCjsU-. tion department. Date 'Ap'plicant _ 7 7 cl CITY moi" !e - T l ZIP 5 LOCALITY. t NO. OF BLDGS. CERTIFICATE-OF EXEMPTION FROM WORKERS' SIZE OF LOT O IO••3 NO.W'ON LOT NEAREST - CROSS ST. COMPENSATION INSURANCE ASSESSOR si y /��J (This ed o l need not.lie completed,if the permit is for one TRACT BLOCK. LOT:NO. ' ASS BOOK PARC ;1 hundred dollars.($100) or less.) TEL. MAP r r. MAP. l certify that in the performance-of,the work for which this OWNER; 1 N NO. USE ZONE permit is issued;.!shall not employ arty person,in,any manner ADDRESS O ^�pll� -/ // I CL NO. � • �101 so as to.become,subiectIci:the Wo ers,Compens to L ws: r O SPECIAL CONDITIONS :- CITY �,e� ZIP. Date Applicant ARCHITECT OR TEL:(. NOTICE TO APPLICANT:'If;' after m king this Certificate of ENGINEER �rj NO. DISTRICT~; GROUP TYPE FIRE PROCESSED BY. Exemption; you .should become subject to,.the Workers'' + O �/_ 2 . CONST. ZONE Compensation'provisions of the Labor Code,,you must forth- ADDRESS ��.rU� �e - rC CQ �a 'J �' 3 a with,comply with such provisions or. this.permit shall be / TEL STATISTICAL CLASSIFICATION APT. CONDO.' deemed revoked. ; .: CONTRACTOR 12 1L) ` (� NO. �.3 _ LICENSED CONTRACTORS DECLARATION r Z LIC CLASS NO.�DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 01 kloj c, NO 163 6 of,Division 3 of a d P ofess ons ode nd m�oense is in full force and effect$ CITYFT. Com,Mb NO. C ASS 21- SEWER E� PG. � VALIDATION', (_ . 9 ) Q . OF NO. OF CHECK Lice e Number ' �.30 Lica Class ' SIZE 7 STORIES FAMILIES ONE �" ,Contractor �c Date 3 Q - DESCRIPTION OF WORK NEV /� /� 6-O' ADD - ❑I am exempt under Sec _ _ j' ' ALTER '❑ D' B.&P:.C.,for this reason REPAIR 0 ' •Date USE OF . EXISTING BLDG. DEMOL Signature APPLICANT TEL (PRINT). (y) NO. :c3 FINAL j p OWNER-BUILDER DECLARATION DATE. 6 I hereby affirm that I am exerript from the Contractor s License -`� J L [ 9 LdwforThe.followtng;reason (Section:703 T.5, Bus;nessand ADDRESSorvt`" 0L 6 `/lQMttiOF' 7 FINAL Professions Code}. PRESENT ❑ I, as owner.of The'property or my employBUILDING ees with ADDRESS - _p _ wages as their sole compensation;will do the work and a z a —3 , the structure is not intended oroffer'ed forsale(Section LOCALITY 7044,.Business•a'nd Professions Code:) » MOVING TEL .t 'HEe,r- - : _ CONTRACTOR NO. ❑ !, as.owner of the property; am exclusively contracting a ,e with licensed contractors to construct the project (Sec- ' - tion 7044, Business ana`Professions Code.). '� ADDRESS . . REQUIRED.'. TOTAL SETBACK FROM, EXIST i t _ 1; CONSTRUCTION LENDING AGENCY. SET BACK YARD HWY` PROP. LINE WIDTH v � , 3 I`nereby affirm that there.is a construction lending agency for FRONT - the performance of the work for which this permit is'issued. P.La (Sec. 3097, Civ, C:). "SIDE pr P,L. Lender s"Name. }}// m P.C. Fee$ Permit Fee LDMA'Ref. #- Lender s Address o I certify that I have read this-application and state.that the Issuance Fee / ` D.Q. LDMA P/C# D •above-information is correct. I agree to comply.with all County Irivestigation.Fee / 2 8 ordinances and w State las cti relating to,building construon, Total Fee Q•[7 J -LDMA Perm. # a and'hereby authorize-representatives of this County to.enter - `upon the.above-mentioned property for inspection purposes. a �,L(j�,N 3—?—•q SEE REVERSE FOR EXPLANATORY'LANGUAGE gnaturre��Applicgnt orAge t ...Date : 76A638A CE#-8035-,,, AP L�CATD®N' F®u `, Lti UILDgNG II ERJT _ A• _ - . i .. _ COUNTY..OF 'LOS ANGELES BUILDING .ADDRESS DEPARTMENT OF COUNTY-ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSSST: - - "DISTRICT NO: GROUP TYPE"' j CESSEDBY''..• . FOR'APPLICANT TO FILL IN - CONST. BUILDING 4* �G STATISTICAL CLASSIFICATION - EWER MAP ADDRESS 6 G o �' C9,O C - - P CLASS.-NO.�DWELL.UNITS ' - LOT NO. O BLOCK WATER NOT REQUIRED'• RECEIVED CERTIFICATE:. - TRACT - G - MAP. HIGHWAY STATE MAJOR NO OG1_ - q y / �• NO.-OF BLDGS. NO (CIRCLE) t • SIZE OF LOT. "/ !/ b J� ^G INOWONLOT Z USF ZONE - SPECIAL -USE OF ` CONDITIONS - 'EXISTING BLDG. -V `e A� - TEL OWNER � 7�5 �(�/�.F}+`I NO#'T �3Y�I BUILDING YARD ,HWY TREET NAME EXIST. . ADDRESS Q/Q/�S G r ' "� SETBACK WIDTH' FRONT ARCHITECT OR TEL. - P. L. r _' ENGINEERNO.. SIDE ,•'► O. jq ADDRESS .. r ' 7� TEL. 7 � INSPECTION RECORD. . CONTRACTOR/ d^1DID .. ly1-lL�("IrJ NJ(O/.�Z1C/•'YA'dOy!' - I ADDRESS �.;,r �. DE,SCRIPT'ION OF.dUORg a ut NEW ADD ALTER - REPAIR DEMOLISH;. " SO.FT. NO.OF NOc OF- ' - $IZE V�U STORIES. FAMILIESmw USE OF F STRUCTURE ! � LUri� ,- SIGNATURE OF N - APPLICANT. . VALUATION$ o .✓ APPROVALS' DATE INSPECTOR'S SIGNAT=URE 'FOUNDATION: ` FEE'$ FPMT-EE $ J DATION: LOCATION FORMS, MATERIALS •V r^s a >%R' FRAME: FIRE STOPS, ?11/ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'BRACING BOLTS o• F'D�1p 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 LATHINT. , TION OF THE ,LABOR CODE OF, E STATE OF CALIFORNIA RELAT. , ING,TO WORKMEN'S OPENS INSURANCE - LATH,EXT.. - SIGNATURE OF HOUSENUMBERCOR- PERMITTEE - RECT AND POSTED - C}� ,'f - ADDRESS °� �'� L FINAL O ,-CSi, t CLYDE N. DIRLAM, PRINCIPAL STRPCTYRAL ENGINEER PLAN CHECK VALIDATION CIL M.O. CASH PERMIT VALIDATION ' C r ..M.0. CASH I �, ) 1 2'1 )5 ,. ��;'�.; ,a 1..1 .5 r' WORKERS' COMFENSATI,ON DECLARATION hereby affirm that 1'"h Workers', a certificate of.consent to'self, __1 o..M..d d D O H.� `p insure, or a certificate of Workers Compensation Insurance, �� �! v . . ' or a certified copy t��h}}ereof (Seca 3800, Lab. C:)' COUNTY+OF LOS ANGEL .ES :BUILDING AND SAFETY Poli -.No. ^2 7�:d�ompany1�7!%�lv0 y BUILDING Certified cois.hereby"furnished. FOR'APPLICANT'TO-FILL IN ADDRESS, gf 2-! „jJ p copy dam' a , Certified copy is filed with the county bBUILDING uilding inspec- G tion department. ADDRESS, . U /� LCG'1J�11 CITY ' Date. Applicarit t'GLOCALITY . NO. OF"BLDGS. NEAREST CERTIFICATE OF EXEMPTION,FIR Mi WORKERS'." SIZE.'OF`LOT' NOW ON LOT' CROSS Si. COMPENSATION INSURANCE,:, ASSESSOR (This section need not be completed if'the permit is for one TRACT" BLOCK LOT NO." MAP BOOK d.:? `PAGE �0 PARCEL DDl hundred dollars ($100)'or less ) . f L OWNER G eL ���1� IO 7. G r USE ZONE. MAP- I y lc✓ I certify that in the performance of the'work for which this _ permit is issued;`I shall not em to an erson in an' manner ADDRESS• — a P P.. Y y4P y: �/ =/' • SPECIAL /lam CONDITIONS so',as:to become subject to the Workers'.Compensation_Laws. t� y O CITY lid` ZIP Date' oe Applicant "` ARCHITECT OR TEL. DISTRICT GROUP: TYPE FIRE PROCESSED BY NOTICE JO'APPLICANT: If, after;making;this!Certificate".of ENGINEER NO. CONST. Z NE � Exemption, you, should.become subject; to the=Workers tV Compensation provisions of-the Labor Code, you must.forth ADDRESSa, with %comply .with such-;provisions, or this.permit shall,be TEL.Iy STATISTICAL CLASSIFICATION AP.T. CONDO. N deemed revoked .. `7��..�y '/).'7t CONTRACTOR' NO. �1 TtcD''-- •-Z LICENSED CONTRACTORS DECLARATION ADDRESS ] �1�"�" t�,3ts L C.. - CLASS, O. � DWELL. UNITS T1.hereby affirm that I.am-licensed under provisions of'Chapter 9 . NO. (commencing with Section 7000)of Division 3 of.the Business LIC. SEWER MAP and Professions`Code,.andi'my license-is'in-full force a' effect. CITY- 'y! CLASS BK PG 'VALIDATION / z SQ. FT. NO:'OF NO:OF CHECK License Number`� 0/ Lic. Class SIZE r STORIES FAMILIES ONE �{`� VALUATION. Contractor l�/��' G' DESCRIPTION OF WORK -NEW Q " Date ADD El ❑I am exempt uncI6"Sec. 'tV - TE B.&P.C. for this reason REPAIR ❑ $ USE OF - D� EXISTING.BLDG. "DEMOL ❑ Signature - APPLICANT TEL. FINAL WNER- UILDER DECLARATION'. (PRINT). NO` DATE I hereb affirm.that 1.6m exempt from the Contractors License Law for the following reason(Section_ 7031.5, Business and ADDRESS FINAL Professions Code)`... v'=; PRESENT.-. BY BUILDING. ❑ ,I, as owner of the property, 'or my employees:with ADDRESS & wages•as'their sole'compensation;will do the work-and r the structure is not intended or offered forsale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL': CONTRACTOR NO. ❑ 1,as owner of the.property;am exclusively contracting - Z:" with;"licensed''contractors'to construct the project (Sec, ADDRESS" Tion'7044, Business and Professions Code.) -• - REQUIRED TOTAL SETBACK FROM EXIST: ° CONSTRUCTION LENDING.AGENCY' SET BACK YARD HWY PROP. LINE WIDTH• t I hereby affirm that there is-a construction lending agency for FRONT w n' the performance of the'work for'.vv.hich this permit:is'issued `P.L. - (Sec. 3097, Ciw. C.). SIDE.,,:" P:L: e 3 ?'i Lender's Name: � � m LDMA Ref. #- P.C. Fee$ Permit Fee ` ti .: 3 Lender's Address f 0 I.certify that l have read this.application and state that the Issuance Fee LDMA P/C# D above'information is correct.-I agree to comply with all County Investigation Fee Q 8' ordinances and State'laws:relating'to.bLilding construction, Total Fee. c'� LDMA Perm. # Q, and hereby-outhorize-representati,v'es of this County to enter' upon We`above-mentioned propertyfor;inspection purposes. SEE"REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 1