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HomeMy Public PortalAbout8922 LONGDEN AVE_Building__ jr.A536A 08S-3 12-64 - APPLICATION FOR BUILDING PERMIT 1 ]DIVISION OF BUILDING AND SAFETY BUILDING � Z� �h Department of County Engineer _ County of Los Angeles LOCALITY /&mr/qe WM.J. FOX, COUNTY ENGINEER NEAREST i�p�//// �// CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. /1 GSe.�Y1�l.Z' �/ XX/-1/1 FOR APPLICANT TO FILL IN Im o 1srR�NO, I GROUP I TYPE :-sr SEWER MAP PG BUILDING �x7•G� j ,9 c/6 . iD✓ Z coNsr. •ADDRESS V / f-• / /'► MAP STATE �•�^ �,/ NUMBER �Q� HWY YES. - NO LOT NO. /�•7S Sl?/ ae,�}• BLOCK USE ZONE SPECIAL - �� /?- /, -CONDITIONS - TRACT" � � - NO. OF BLDGS. sop Q SIZE OF LOT S(% >c 1 -7 I NOW ON LOT F BUILDINGYARD HWY STREET NAME EXIST. USE OF SETBACK W11DTH ' EXISTING BLDG. FRONT ' /� � � �Oh lel f(J +OWNER _/7� {tryJSIDE" �1( " MAILw, P. L. ADDRESS Di/Y V _� �� TEL.,. I DWELL. I UNIT 5 INDUSTRIAL ' CITY , m&=0 d__A_" /� yLC. NO.LV[f .Z/.j;j � . 2 DUPLEX_UNIT 6 PUBLIC BLDG. ARCHITECT OR TEL. ENGINEER NO. 3 APT. UNITS ADON.,ALT., ETC. ADDRESS Q COMMERCIAL S MISCEL.(,�u�sT TEL. v CONTRACTOR NO. - INSPECTION RECORD ADDRESS DESCRIPTION OF WORK , ADDa LALTEED REPAIR DEMOLISH 9?-4 ,f, 0 i 4, �40-6 SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES 4 E OF ST �Y- /9 t✓✓fL- P � !?L A.S�LeRUCT RE 47-7,141 ? eO SIGNATURE OF APPLICANTa'�.�/,� " APPROVALS ' ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION $ ��© p, BO P. C. $ FORMS, MATERIALS V .�i��i �.O/�,siR,4.-71✓ (� '� FEE FRAME: FIRE STOPS. VALUATION E Q® BRACING, BOLTS FEE ' FURNACE: LOCATION. - r GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CO NTY ORDINANCES LATH. INT. AND STATE LAWS REGULATINGING CONSTRUC- LATH, EXT. TION. Vc t SIGNATURE OF /y,� y � HOUSE NUMBER COR- PERMITTEE I RECT AND POSTED ADDRESS - - FINAL - WM. J. FOX, CouNTY ENGINEER VALIDATION 6Ya Ln MAR 21 1 8.00. a DEPUTY D .UTY BY BY 0 DEPUTY DEPUTY (ts 76A638A CE#8031REV.6/78) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN aol�RESSfj �¢� t BUILDING ADDRESS �" C C LITY NEAREST CITY f z CROSS ST. O.OF BLDGS. ASSESSOR SIZE OF LOT J /l .V' OW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ROCE D BY TRACT 'S 0 BLOCK.. I.LOL_NO. U �✓ �g ONST.� Z0 E OWNER I 1 ./f NO. 611 STATISTICAL CLASSIFICATION�..- EWER M`A� ADDRESS CLASS NO. . DWELL.UNITS BK(0 PG CITY ZIP ARCHITECT OR TEL. VALUATION $ &-7Z7-0 ENGINEER NO, ADDRESS BLDG.SETBACK FROM 2:A2 ' TEL. FRONT PROP.LINE OF (STREET) CONTRACTOR /v NO. HIGHWAY t YARD - TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS NO. LIC. + CITY 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. NO.OF NO.OF CHECK + = V SIZE STORIES I FA ILIES ONE O DESCRIPTION OF WORK NEW ❑ P.C.Fee$ Permit Fee / ADD' ❑ Issuance Fee ALTER ❑ C�� i REPAIR ❑ Total Fee S USE OF DEMOL ❑ EXISTING BLDG. ZC APPLICANT TEL (PRINT) Y �fNO. Q A►V C BY(SIGNATURE( Q 1 HEREBY ACKNOW DGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION,I CERTIFY THAT IN DOING THE 2 WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF t! THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM 2 PENSATION INSURANCE. S ,� d �6'80,AA SIGNATUREOF 1# o Olo•o 0;1 PERMITTEE ADDRESS Z 2 0 o 2 5,Q Q O CITY NO. G ,° ° ° 2,5.0 X01� USE ZON MO O > 09.2 O_7 9 SPECIAL r CONDITIONS' X FINAL/ -/q p/ W DATFJ '0131 / tB ���ZL�i6� l APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BuG A I hereby affirm that I have a certificate of consent to self insure, , S �( 2Zt or a certificate of Workers'Compensation Insurance,or a certified CIN ZIP copy thereof(Sec.3800,Lab.C.) ,``'ii� /'— ?1-� LOCA I _ Policy No.��������D Companyt�1 �"�`� SIZE OF LOT lX NO.OF BLDGS,NOW ON LOT � AZG ��7 Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the COU building inspection TRACT ---p BLOCK LOT No. y g S /V C� �Q USE ZONE MAP NO department. Date/D—�~�d A IiCant ASSESSOR MAP BOOK PAGE PARCEL {h� �7 pp S-3 a� Q D ,v_ .ry SPECIAL CONDITIONS OWNE TEL.NO. /� CERTIFICATE OF EXEMPTION FROM WORKEs J ,3��� NO COMPENSATION INSURANCE WITHIN 1000 FT.OF HOOL? ADDRE (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED 8Y dollars($100)or less.) CITY C s z CA ZIP qr�.7 I certify that in the performance of the work for which this permit �[A� n,- !f ITE�/ is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGIN6R (/"�^` o. become subject to the Workers'Compensation Laws. �m� �a ^f2 q0 STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. —DWELL UNITS NOTICE.TO APPLICANT: If, after making this Certificate of T41�a�i • REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' CONT TOO/ \ TEL.QAA-J L SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �,r5 �( tj^���" FRONT comply.with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. 9 PL •�S +R a SIDE s LICENSED CONTRACTORS DECLARATION CITY C,� LIC.CLASS PL o I hereby affirm that I am licensed under provisions of Chapter 9 NO.OF FAMILIES SEWER MAP SQ.FT.SIZE NO.OF STORES v (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG C. Professions Code,and my lic nse in full force and effect. e/ v L3 DESCRIPTION OF WORK ADD ❑ VALUATIONI `f License Numbe Lia Class � � � Contractor Date �)`®—= _ ALTER ❑ Agez OL 2- -Is REPAIR ❑ ❑ 1 am exempt under Sec. f a B.SP.C.for this reason DEMOL ❑ l L i ITEMS . _ LDMA P/C# USE OF EXISTING BLDG. t @. �..A=z;,I Date: URM. ❑ ' � Signature APP(y!�GpNT(PHrI_NT) TEL.NO. 2 LDMA Perm# Z ❑ 1, as owner of the property, or my employees with wages as M. lac 6 ;7-? p CHANGE their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and lJk k- 1 FIN LOATEPfOfeSSIOnS Code.) WILL THE APPLICANT OR FUTUREBUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN- a -I•.1, as owner of the property, am exclusively contracting with THE AMOUNTS S C IED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL y licensed contractors to construct the project.(Section 7044, 1 Business and Professions Code.) YES❑ No WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST C/ FOR G❑UIDELINESO I hereby affirm that there is a construction lending agency for ves No �'¢I• 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.). PERMITT T I UN RSTAND MY REQUIRE SUNDER THE LOS ANGELES COU ODE, 2,CH ER 2. ONS 2 ROUGH 22000NCERNING m Lender's Name H OU. AL POR G A f A PERMIT OM OM THTHE SCAQMD Lenders Address OWNER OR AGENT 0 1 certify that I have read this application and state that the above P.C. v 1 g information is correct. I agree to comply with all county f N ordinances and State laws relating to building construction,and FEE PERMIT FE Q•� hereb h ze representatives of this County to enter upon ISSUANCE FEE s b entio d rty fo n purposes. ^� ld I 0INVESTIGATION FEE TOTAL FEE ^ &gmt—oc Aoomxnc o,Apart Deco 6( SEE REVERSE FOR EXPLANATORY LANGUAGE o APPLICATION FOR. BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN A DRESS BUILDING AO ESS I hereby affirm that I have a certificate of consent to self insure, �Y�1> ,L or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) // Z ITY_�m ` A ZIP Y17.1. LOCALITY s� /� i Policy No`/S �0 Compare& � •dsr�i SIZE OF LOT NO.OF BLDGS•NOW ON LOT G� Gi Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the count* building inspection TRACT ` O BLOCK LOT INC. 6a J USE ZONE MAP NO. de rtment. c.JC �D-C�—`lv ASSESSOR OK PAGE OV3 PARCEL /J SPECIAL CONDITIONS Date Applicant t7 vC/ /C// OWNER TEL NO CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 3 j WITHIN 1000 FT.OF HOOL? YE NO ADDRESS (This section need not be completed if the permit is for one hundred DISTRICT GROUP J.TYPECONST' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP certify that in the performance of the work for which this permit /CJ ►C ��i �l�'Z�/ // //-/ 3 L � is issued, I shall not employ any person in any manner so as to ARC TECT OR ENGIN TEL.NO become subject to the Workers'Compensation Laws. r _ C 30F ZCLG STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS r` /� �> /ry+ CLASS NO.�DWELL UNITS NOTICE TO APPLICANT. If, after makingthis Certificate of 4®4 `_' � -ru "S <:]� REQUIRED TOTAL SETBACK FROM EXIST Exemption, I CON777���pq�CCTOR TEL.NO. p you should become SUb�BCt t0 the Workers' /a J'_s �, U ���2/' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith : ( l(X T 3(7 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRES=S` LIC.NO. P L 96 S- 441 SIDE >_ LICENSED CONTRACTORS DECLARATION CITY,�,{/ [tli c:(I$ CLAss P L a- I hereby affirm that I am licensed under provisions of Chapter 9 re SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.Fr.SITZ NO.OF STORES NO.OF FAMILIES Professions Code,andmy license is in full force and eff t. �/ Z NEW BK PG o _ r License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION w Contractor Date _ ALTER ❑ $ A0, �— REPAIR ❑ N El .AV BRC.for this reason DEMOL 11 �\ Date: USE OF EXISTING BLDG. URM [_] LDMA P/C# Signature AP ANT(QRINT) TEL.�����( LDMA Perm# El I, j I, as owner of the property, or my employees with wages as YJI� their sole compensation,will do the work and the structure is AD�f ssy� q d� 0 i 1C:(_1,g not intended or offered for sale (Section 7044, Business and T A�I` �` Cl�-r� /� FIN LDATE Q 3 l -. Professions Code.) 1 �-; fi 11 l WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ITEMS ❑ I, as owner Of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FII # _ � �1.` licensed contractors to Construct the project.(Section 7044, Business and Professions Code. YES❑ No TOT H 1� WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING L� OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '•� �r� A—_ '�`,� i•ii }.j�'iet' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST �7/ J FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES 1-1NO,r���i, s'r#3-NGE 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 CHE LIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES /D COUNT E2,CHAPIER 2.20 SECTIONS 100 THROUGH 2.20.140 CONCERNING., i�I' I C•if?'p Lender's Name H IAL PORT DFO NGAPE IT FROM THE SCAOMD. (1I�V0—}LSI i± 1L)I -•I'Jl Lender's Address —Z' 1 s 1,'1 , a OW.OR AGeNT n r.?J.I.�� 1 A 11 2": o' I certify that I have read this application and state that the above 331 1 _ N L P.C.FEE PERMIT FEE information Is correct. I agree to Comply With all County J rJ 777 ordinances and tate laws relating to building construction,and hereby a 1 e rep SBntatives of mi County to enter upon ISSUANCE FEE J`/ th v ntio pr y r' tlpurposes. INVESTIGATION FEE TOTAL FEE sipnawrea «Wane o.n _ �2-3 SEE REVERSE FOR EXPLANATORY LANGUAGE, .k5 . APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ������' / �vC BUIL ING�AaDDR¢SS � �' 6 I hereby affirm that I have a certificate of consent to self insure, �L�J4 Q, or a certificate of Workers'Compensation Insurance,or a certified copy there(Sec.3800,Lab.AC.) CITYT M /),t ZIP O/'�� LOCALITY _ Policy NO! e_ —/b Compan !!tee t0 "� uC l SIZE OF LOT NO.OF BLDGS.NOW ON LOT ���L 19 Certified copy is hereby furnished. �'��� NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT +Q BLOCK LOT NO. S /O� 6D USE ZONE MAP NO. � ` department. /- Date ru_ dApplican ASSESSOR MAP BOO PAGE PARCEL fir/ n QQj� OQ� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER '� (21 els TEL.NO.6-Z 73� ES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF HOOL? ADDRESS, (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY �� ZIP 9��D-' I certify that in the performance of the work for which this permit / J1, �� Is Issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEE TEL.NO. become subject to the Workers'Compensation Laws. ! _&_a4y e,&> STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate Of 440 -,,M 6i2lbA&ee=FRONT TOTAL SETBACK FROM EXIST CON TOR TEL.NO. Exemption, you ShOUId become subject t0 the Workers' (Z / a! / PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith S 449 J�b comply with such provisions or this permit shall be deemed'revoked. ADD ,pk o NO.(� OtLICENSED CONTRACTORS DECLARATION CITY LIC.CLASS,7 U ,®-rte(( O� I hereby affirm that I am licensed under provisions of Chapter 9 ) SEWER MAP SQ.FT.SIZE NO.OF STORES NO. FAMILIES (commencing with Section 7000)of Division 3 of the Business and 8 y / NEW BK PG � Professions Code,and my IicensQis in full force and ect. v License Number -g Lic.Class DESCRIPTION OF WORKpool. W ADD ❑ VALUATION � rA 1 z Contractor ate /� � I /. p ALTER ❑ (_ ❑ I am exempt under Sec. GFL ep( L�(Xlc�(� REPAIR ❑ B.&P.C.for this reason DEMOL ❑ LDMA P/C# U Date: USE OF EXISTING BLDG. URM ❑ Signature APP T(PR)NT) n TEL.NO 1T) W �i�/ LDMA Perm# Z El 1, as owner of the property, or my employees with wages as `�S 6^ / ,z O fit C IF their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and <6 CStGUt4 FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTUREBUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALJ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q TITtM1 ❑ 1, as owner of the property, am exclusively contracting With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL B licensed contractors to construct the project.(Section 7044, YES❑ No EI-I3L 1IJL , '` Business and Professions Code.) _ I WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK 10011.73la f OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �v� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST A is-1- FOR GUIDELINES. CHANGE GE III, I hereby affirm that there is a construction lending agency for YES 1:1NO the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 4� 3097,Civ.C.). PERMITTING CH LIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES p/ ) J'f'+ IN IT E2,CH ER 2.205ECTIONS 2.20. THROUGH 2.20.140 CONCERNING /��/� 0000—(_I001 10/ 415/9_? Lender's Name H 00 RIA PORTJpI@ f�1JD FO O PERMIT F OM THE SCAQMD. a. Lender's Address onncErrr (_., Q !i' o 1 certify that I have read this application and state that the above �3 ! V' /� • g information is correct. I agree to comply With all County P.C.FEE PERMIT FEE 3N ordinances and State laws relating to building construction,and $ / ¢- hereby a rize representatives this County to enter upon ISSUANCE FEE �� t3;1�1�22nope t inspection purposes. // !�Q vJ INVESTIGATION FEE TOTAL FEE /� 7y���7 slgne m a Appl z m Ag. C� D ro Ape .%I� SA . SEE REVERSE FOR EXPLANATORY LANGUAGE �. APPLICATION FORBUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDI S vIV I hereby affirm that I have a certificate of consent to self insure, � 019 n or a certificate of Workers'Compensation Insurance,or a certified CI zip (� copy thereof(Sec.3800,Lab.C.) LOCALI , Policy No. Company SI E OF LOT NO.OF BLDGS.NOW ON LOT Nc•- ❑ Certified copy.is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ovyytE� TEL.NO. COMPENSATION INSURANCE ADDRESS WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred �� 1 DISTRICT GROUP TYPE CONST.' FIRE ZONE OCESS BY I certify tify that or less.) P CITY zIP 50Y k 3 I cert' that in he erformance oft rk for which this rmit r�V{ is issued, I S II n employ an erson n an manner s as t0 ARCHITECT OR ENGINEER TEL.NO. become t t Workers' ompa t- aws. STATISTICAL CLASSIFICATION APT NDO Date - plican ADDRESS CLASS NO. DWELL UNITS NO E T APPLICAN7ecome er making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you shoulSubject to the Workers' CONTRA T ��� SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO.. PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL CD I hereby affirm that 1 am licensed under provisions of Chapter 9 SEWER MAP c.3 (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE N .OF TOR $� NO.OF FAMILIES NEW ❑ BK PG Professions Code,and my license is in full force and effect. DESC I ON OF WORK ADD E] VALUATION License Number Lic.Class w 1 d, Contractor Date — ALTER ❑ $ z ❑ I am exempt under Sec. _ EPAIR ❑ $ B.BP.C.for this reason e ��IIOL Date: US E STING BLDG. URM El LDMA P/C# Signature (P TMA Perm# El �r I, as owner of the property, or my employees with wages as T C`7 7 O ACC ,F their sole compensation, will do the work and the structure is ADD E H not intended or offered for sale (Section 7044, Business and -FINAL DATE 3307 38,Ou Professions Code.) WILLTHE APPLICANT OR FUTURE BUILDING OCCUPgNT HANDLER HAZARDOUS MAT IAL • C S �f y� ❑ I, as owner Of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a t ITE i Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY _ licensed contractors to construct the project.(Section 7044, YES El NO El %%6 i S l i AL = 00 Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUISV LDING _' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH H �`' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST 4!I FOR GUIDELINES. CHANGE a LO I hereby affirm that there is a construction lending agency for YES❑2TH the performance of the work for which this permit is issued(Sec. I H ARDOUS ATE S INFORMATION GUIDE D THE SCAOMD _ _ )3097,CIV.C.). P MITT I UN STA MY REQUIREMENTS UN THE LOS ANGELES {i1-- It�S[i 7F lF L) OUNTCH ER 2. SECTIONS 2.20.1 140CONCERNING �-Lender's Name HAZARS PORT G AND FOR OBTAI G A RMIT FR ESCAOMD. Lender's AddressAe �'964 1 f 9:26 o Ice ..,I have read this application and state that the above l.C.FEE PERMIT FEE i rmation is corre�tl?a to comply withallcounty yo rdinance and Stateting to build' g construction,andhereby thorize r rves of this ounty to enter upon ISSUANCE FEE the ab a-menti ed o y for ins ion purposes. 3. OLD INVESTIGATION FEE TOTAL FEE 01 V si um m Rawl t w Agent Dees1 010 t oo SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION insure, or o certif carte of Worke s' Compensat on eInsuran rlf APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lobb. C.) /�J COUNTY OF LOS ANGELES BUILDING AND SAFETY ' Policy No���0 177 Company Lo �7y BUILDING❑ d Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS J l/e•— Certified copy is filed with the cUILDING ou ild, inspec- ADDRESS tion department. �i / L CITY �1%� lid vF cl�Y" ZIP LOCALITY ter' -I-, - CERTIFICATE Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS'Jf/�-y/ SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars'($100) or less.) ,.` OWNER I�f1_ �l( �� r%r`1 NO. t I alt U USE ZONE MAP NO. I certify that in the performance of the work for which this h SPECIAL } permit is issued, I shall not employ any person in any manner ADDRESS U"f + � �Ay CONDITIONS CL so as to become subject to the Workers' Compensation Laws. /JJ CITY Sl�i C L�L7�4ZIP 7Y U Q' Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. v(�NE Exemption, you should become subject to the Workers' D -.3 /�� L�,��y w Compensation provisions of the Labor Code, you must forth- ADDRESS cam' N with comply with such provisions or this permit shall be s1 1 f TEL. 7 /_GG t7 STATISTICAL CLASSI JCATION PT. CONDO. deemed revoked. t CONTRACTOR C I. �T 1 ,6L'r'I AW (IMO V-3 (9 ll t 1 � � - Z LICENSED CONTRACTORS DECLARATION //� {?, / ) �J CLASS NO. DWELL. UNI7S ADDRESSr/&n� G YM CSL t D NO. � ` / I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business ��D ��(f � CLASS f~ CITY / VAEIDAT�ON and Professions Code,and my license is in full force and effect. BK. PG. _.._ / ( / SQ. FT. NO. OF `�J NO. OF / CHECK - r� 1� SIZE STORIES FAMILIES (� ONE License Number Lic. Class VALUATION NEW vC l�C� Date [ DESCRIPTION OF 4F WORK NEW ElYCIel_- /,Jon`��C��e - ADD ❑ S Contractor. .� I am exempt under Sec. ALTER ❑ B.BP.C. for this reason � REPAIR ❑ $ Date: r—�!n 7• USE OF - EXISTING BLDG. DEMOL ❑ APPLICANT i' / TEL ,� OC' C I j `_II'•_+ _• - SignatL F v 04 AI f i ) (Lt� t FINAL - NER-B ILDER DECLARATION (PRINT) -� ( 11 NOi _ _ DATE C e... I herebyaffirm that I am exempt from the Contractor's License < n Law fothe following reason (Section 7031.5, Business and ADDRESS !C907 � �"�r /C� Ifi ('�7• FINAL Professions Code): PRESENT By s _ ❑ BUILDING = �+ I, as owner of the property, or my employees with ADDRESS (/ _ ,• J�,j] wages as their sole compensation,will do the work and �.'i� r�-'•a' - the structure is not intended or offered for sale(Section LOCALITY --- -- • -. 7044, Business and Professions Code.) MOVING TEL. ® ✓ w-- - rinvestigation TOR NO. s - - ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ''= 1-_5 tion 7044, Business and Professions Code.) _ ED TOTAL SETBACK FROM EXIST. 'fes•..;; CONSTRUCTION LENDING AGENCY K YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for _ •��_ a j_; the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name „ / LDMA Ref. # P.C. $ Permit Fee , =jy t r;;; Lender's Address 1 certify that I have read this application and state that the Issuance Fee ' C�`� LDMA P/C# above information is correct. I agree to comply with all County ion Fee ordinances a t la.. relating to building construction, Total Fee �-� LDMA.Perm. # and here au ize (e resentatives of this County to enter upon th a enti ed property for inspect/ion pur oses. !_ SEE REVERSE FOR EXPLANATORY LANGUAGE Sygnoture of Applicant or Agent Date