HomeMy Public PortalAbout9660 LEMON AVE_Building__ APPLICATION FOR G- -PERMIT .
FOR APPI
LCAN IL (Print o yp only)
BUILDING COUNTY OF LOS ANGELES
ADDwcSS _ DEPARTMENT' OF COUNTY ENGINEER --
CITY (,Z, ZIP BUILDING AND SAFETY DIVISION '
NO.OF BLDGS BUILDING
SIZE OF LOT " NOW ON LOT ADDRESS L)-$ i
TRACT BLOCK LOT NO LOCALITY /
• TEL. / NEAREST -
OWNER NO /�� /� CROSS ST
ASSESSOR
ADDRESS, MAP BOOK PAGE '
DISTRICT, GROUP TYPE FIRE PROC ED BY
CITYAk .0 1) 09, 'L] CONST,
'ARCHITECT OR TEL. Vc
ENGINEER S' -Q NO.'
STATISTICAL CLASSIFICATION- SEWER MAP
'ADDRESSCLASS NC �DWELL.LIN ITS IBK, Pb '
CONTRACTOR - To
_ ONE MAP -
LIC - NO
ADDRESS Sit NO , SPECIAL ,
LIC CONDITIONS
CITY CLASS -
ROAD OE/PvARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH.' BLDGTBACK FROM _
FRONT IVROP.LINE OF (STREET)
ADDRESS - CITY -
HIGHWAY } YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING
SQ FT. NO -OF NO. OF CHECK FRONT`PROPt LINE HIGHWAY .WIDTH-
SIZE STORIES FAMILIES ONE -
DESCRIPTION OF WORK NEW ❑ + _ CD
ADD
❑ BLDG.SETBACK FROM
'\ SIDE PROP. LINE OF (STREET) O�
ALTER ❑ TOTAL SETBACK FROM T El
EXISTING U
(.� HIGHWAY + -YARD =
REPAIR SIDE PROP LINE- HIGH WIDTH d
N
USE OF - - t _ Z
EXISTING BLDG. EMOL El
APPLICANT TEL CORNER CUTOFF YES ❑; NO. ❑` .•
_(PRINT) 6 - N0. 7-
IN OPEN SPACE YES,❑ - NO El
BY (SIGNATURE) -
,[ IN COASTAL PERMIT ZONE YES ❑ NO '❑„
VALUATION, - '
I HEREBY 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 CON- '
'STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED - _ -
HEREBY I'WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO _
WORKMEN'S COMP NSATION INSURANCE - '
r ;
SIGNATURE O �
'PERMITTEE.
ADDRESS S'�Ie SAO QZP_F)�RAI'Ael
_ FINA /` _ - BY;>
CITY S
' --ll T E L. DATE
L'' �t7
C.[} (KJ 0. N O'.
MAKE CHECKS PA FABLE TO FEE"✓ - FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK M O CASH -'PERMIT VALIDATION CK' M 0, ; CASH ✓
3'2 -5 ti•orT 22 3.6 0 ,&4
3 �6 �t(;T �' ' ' .1 D 1-2.0�0 afi
76AG38A CE#803 5/74-.
76 A638A CE 4803 4/72 � xvAPPLICATION FOReic*
LDINgPERMIT U
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
MAKE CHECKS PAYABLE TO. ADDRESS_
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY- •
FOR APPLICANT TO FILL IN NEAREST "
not or 1 e onl CROSS ST
BUILDING - DIS C N GRO TYPISES
ADDRESS ���,� ON".
•
♦ STATISTICAL CL SIFICATION
LOT NO BLOCK
CLASS NO. DWELL",UNITS
TRACT USE ZONEMAP
NO.OF BLDGS NO. Q
SIZE OF'LOT NOW ON LOT , SPECIAL
USE OF �J _ CONDITIONS
EXISTING BLDG.
OWNER D man/ NOL �/� _
/ BLD ETBACKFROM -
ADDRESS
� FRONT OP.LINE OF (STREET)
TYPE OF EXIS SETBACK HIGHWAY + YARD = TOTAL
CITY /�- e� HIGHWAY WIDT kryROM C L.
ARCHITECT OR /, TEL. _ + -
ENGINEER /1 hD c f/� "`� NO. �.I�3730-
BLDG.SETBACKFROM _ a
ADDRESS �' °1.8 SLG/K ,C��LQ s/�7�fi!/nQ+r/G SIDE PROP. LINE OF (STREET) C)
T 'TYPE OF EXISTING SETBACK HIGHWAY + +YARD TOTAL
CONTRACTOR /firl(, f}lGt Ai �}sG1 Q ja/ �19j HIGHWAY WIDTH FROM C.L +.,
[ O
ADDRESS l�Q�Z �/PC�S�+A't�fl NO �.31' + _ �'`� W
LIC.
CITY �y SIA- CLASS CORNER CUTOFF YES ❑ NO Z
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS
SQ,E FT, '�/� NO OF No OF NEW ❑
SIZY STORIES FAMILIES
USE OF / i ! ADD -
STRUCTURE (� �/tf� co VL-7vl
7 ALTER ❑ _
SIGNATURE OF J REPAIR❑
APPLICANTDEMOL ❑
VALUATION $ 6af APPROVALS 'DATE INSPECTOR'S SIGNATURE
P C PMT, FOUNDATION: LOCATION
FEE $ FEE $ ♦ 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, -
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS -
STRUCTION_ I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HE I WILL NOT EMPLOY ANY PERSON.IN VIOLATION OF THE LATH, INT. - - - -
-LABOR CODE OF THE STATE OF CALIFORNIA IN R LATI NG 0
WORKMEN'S COMPENSATIO INSURANCE I - .
LATH, EXT, - - - -
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED,
ADDRESS
FINAL
PLAN CHEC V O �� M O CASH PERMIT VA AT ON CK MO CASH,'
,` 3 FSI} 2 2 1 D 2'.70-
1 D
�, ' 0 1-5 373 KAR22 � 9.���
N �� q' j- 4•, .� ,
- 76A638A CE>rao3'zs3 •APPLICi4TION, FORBU�I,LD'1'NG' PE'RM'IT,
FO.; ,
COUNTY- OF LOS ANGELES BUILDING-.
DEPARTMENT=OF COUNTY ENGINEER -'l FDDRE
..... _
;g BUILDING. AND SAFETY_.DIVISION' LOCALITY
JOHN=A 'LAM BI E, COUNTY ENGINEER NE4REST`,- r _
.'WILLIAM A JENSEN;'SUP T•OF°BUILDING ��c CROSS,ST,
FARE — ,�• D�STR ICT:NO t?,GRO = TYPE' - - P C SSED BYFORAPPLICANT' TO "FILL 'IN�' a _ do'G r ?' STA_T.ISTICAL CLP.SSIF,ICATION, ^-fid SER•MAP"S• 9660 I,@ITiOSI AVP"Tem' .' ' = Y / K• CLASS^rtN0 t �' DWELL UNITS •yel � "�h!:of• el-YL12a 6,,, ; 1 WATER •NOT REQUIREDRECEXCe .SCATE µ �- -- L- % i ? r.• MAP HIGHWAY'+,ji+O'.- D S', - 'NO `O (CIRCLE) STATEMAJOR SECOND,LOCAL `
LOT +I ,NOW ON'LOT.•,.,,`k 'USE OIJEt' , 'SPECIAL r _ CONDITIONSG`BL•DG Guest'-t10L1Se :StOTa e'
• •OWNER'] C t >s TO -- LDING FYARDHWY'iY'aSTREET`N.4MEr .' `i EXIST •'� "
SETBACK A. i. W;I DTH-.,' "lf,
ADDRESS 4, 3 _ r J J� r FRONT. y
,ARCHITECT_ OR p 4- :TEL
.'t =ENGINEER- - '•°� _ "� •NO' SIDE ,�itt� Y " �P• ° 'v- +' �„
r - P Ll 'a -il , �., •L />
ADDRESS ix,' a ..re x-., r' /'
'r+e, „+. 'sr r.T_EL` - 0.� dTr O.`
^1, „CONTRACTOR a NO, •(t•- _ Aej
- ADDER ESS
DESCRI ' ION"OF WORK- ' ,• ; = W
A s `r =M (L
�1 NEWS XADD;, --_ALTER ,REPAIR' 'DEMOLISH z
SQ FT .�3 p - ` r.NO tO F'.:- °NO�:OF
O r'
SIZE• •."r - •STORIES- •1FAMILI'E$
USE,OF
STRUCTURE
_ I , iA 'a - Sti 4 L ill
SIGNATURE OF'` t -'�•1 - w7 •'
l APPLIC
VALU AT ION _/-'lr� d, •.r _� .,
• �" ? r'�`"r ^�' �'` ':' Y APPROVALS'; "j+ DATE,. ,INSPECTOR'S SIGNA-TjU RE '
p' t FOUNDATION"LOCATION /
P C; r :.;;k. 'PMT"
•FEE $� - i.. �a k ,FEE'$•, ,FORMS MATERIALS_
FRAME FIRE',STOPS�,'.�`.'• `r-
'` rl,'HEREBY'ACKNOWLEDGE THAT I HAVE READ-THIS.APPLICATION+ 't'BRACING'-BOLTS 3h_" •f.,�l, � ,+• r1.
` AND STATE.THAT THE ABOVE'IS CORREC;AND AGREE'(TO COMP-LY FURNACE •LOCATION
jWITH=�ALL'; COUNTY' ORDINANCES ANDS STATE%LAWS'REGULATING=• L4;'GA'S VENT DUCTS_
+ BUILDING:CONSTRUCTION' IICERTI FY THAT, IN�DOING THE WORK
•WAUTHORIZED HEREBYI.I WILL''NOT EMPLOY ANY PERSON IN VIOLA• Y LATH INT-':�r, -_�-_ '�•tj)( w titin'
TION.OF JTHE' LABOR`CODE,OF THE STATE OF.CALIFORNIA;REL•AT _ _p ,•� q� ,
t _ING'TO WORK MEN.SCOMPEN SATION.INSURANCE . y9 - s. I^ �� t� ^,�y,`^' p. .�''' ,��- • ! -x, 71 '!I,
;t - `LATH, EXT v,• YI f B .
Ji` ��{P�•
SIGNATURE OFA - l Y HOUSE NUMBER_COR'- _. .i�'t.�•�. p
,PERMITTEE `' 'REC7T-AND POSTED' `, - }' yfi•• e ••
ADDRESS r 'FINAL
_� JOHN,F LEWI•S` PRINCIPAL STR RAL ENGINEER(
$ 'PLAN;CHECK,VALIDATION c M CASH PERMIT VALIDATION CK• Ml0'„ C ASH_
,'
ot8'�`- 4 x}}11 r ifiYt.. :� W3 �, %15
i.�VH> .y' _. }� r 'fix 4•' Y ! , , •p
L;A
�}
i t].•.i..,. .l 'e�'^�) -in. -'S .,?„r}sur�� �'r`� - }• CJ' G V +-���11.r -� - 'i�- D
* WORKERS'COMPENSATION DECLARATION
here•
insure,oraacerl,f ca
frI have a certificate of te of Workers' Compensation eInsurance, APPLICATION FOR BUILDING PERMIT
or a cersified'copy thereof'(Sec 3800, Lab C ) ti
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building inspec- BUILDING
tion department ADDRESS
Date Applicant •' CITY ZIP DD b LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' ` // NO OF BLDGS NEAREST
COMPENSATION INSURANCE - SIZE OF LOT CO3 ISD: NOW ON LOT CROSS ST
(This section need not be completed if the permit is for one _�° ASSESSOR
hundred dollars ($100)or less ), ;, TRACT JJ BLOCK LOT NO � MAp'gppK PAGE PARCEL
•' TEL USE NE
I certify that in the performance of the work for which this OWNER — NO / NO
permit is issued„I shall not employ any person_in any manner ( SPECIAL
so as to,become subject to the W ers'Comp nsa Laws. ADDRESS - CONDITIONS
Date Appicant CITY ) ZIP Q
ARCHITECT OR TEL DISTRICT G UP TYPE FIRE PR SSED,BY O
NOTICE TO APPLICANT If, after rra this C rtificate of ENGINEER N CONST Z E (--
Exemption, you should become s ct to the Workers' U
Compensation provisions of the Labor Code, you must,forth- ADDRESS ' ' LLJ
with comply with such ,provisions or this.permit shall be TEC STATISTICAL CLASSIFICATION APT DO N
deemed revoked CONTRACTOR NO
Id Z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWE
P
(commencing with Section 7000)of Division 3 of the Business and LIC
Professions Code, and my license is in full force and effect C CLASSBKVS VALIDATION”
SQ FT O F NO OF CHECK
License Number Lic Class SIZE ES FAMILIES l ONE
+ n / NEW VALUATION
DESCRIPTIO OF WORK G' A- 1; $ s� %) n
Contractor � Date- i Add ADD � +,/ (f(J pill.
,
I am exempt under Sec U WCe !f� E ❑ -
ALTER
B 8P C for this reason _ f3$ii1 'D1eA REPAIR , $USE OF 4
Dote EXISTING BLDG DEMOL ❑ 9 4 6 A
Signature APPLICANT TEL FINAL Q (�/ # o o,o',• •
OWNER-BUILDER DECLARATION PRINT NO DATE y OD o o 7 a Q Q
I hereby affirm that I am exempt from the Contractor's License
Law for the followingreason Section 7031 5, Business and ADDRESS FINA _
Professions Code ( B 0 0 0 7 8,0 0,
BUILDING Y f6
1, as owner of the property, or my employees with ADDRESS I L] 4,2 6 8.8_
wages as their sole compensation,will do the work and i t
the structure is not Intended or offered for sale(Section LOCALITY _• a \ '
� i, 1 rt . .,t �•
7044, Business and Professions Code) MOVING TEL C 1Q
I, as owner of the property, am exclusively contracting CONTRACTOR NO J y ,� f-
with licensed contractors to construct the project (Sec- fie•C� ti _ "_
tion 7044, Business and Professions Code) ADDRESS
REQUIRED TOTAL SETBACK j,V+'y 5 „ ,
+ ' +h
CONSTRUCTION'LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH
�'� t \
I hereby affirm that there Is a construction lending agency-for FRONT \ f•v `�'i r " r
the performance of the work for which this permit is issued P L `-
(Sec 3097, Civ C ) SIDE Z
Lender's Name P L ? y
rLDMA\Ref #
Lender's Address P C Fee$ Permit Fee
/� " 1
a I certify that 1 have read this application and state that the Issuance Fee (/ J V LDMA P/C p .
above Information Is correct I agree to comply with all County Investigation Fee /'� j�
0 ordinances and StateAe'n.lpc
ting to uilding construction, Total Fee V Jl LDMA Perm #
R reby out rvzetrves this County to enter
n he abov - ntoert inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig re of Appi ont or Agent Date
APPLICATFGELES FO BUILDING PERMIT ]
COUNTY OF LOS �" -, BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR AP_PLICANT Z FILL IN ( BUILDI /ADDRESS
BUIL INC ADDRE S 2 D
I hereby affirm that I have a certificate of consent to self Insure,• O O
or a,certlficate of Workers' Compensation Insurance,or a certified v
copy thereof (Sec 3800,Lab C) CITY4110-CA
,IQGAQ zIP 7 Qtti LOCALITY "
Policy NO Company SIZE OF LOT NO OF BLDGS OW ON LOT.
1:1'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
SPECIAL-CONDITIONS
Date Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER (� QD TEL NO1
COMPENSATION INSURANCE 0 S F.) . eUC-,SELL- ,q1,1,7--.6_-3SJ WITHIN 1000 FT OF SCHOOLS YES No
(This section need not,be completed If the permit Is for one hundred ADD ESS )
ADD
0 h E M®{J DISTRICT GROUP T PEC ST ZONE PROCESSED BY
dollars ($100)or less) - ••
I certify that'in the performance of the work for which this permit CITY h-��AO i A ZIP q D O + Q
is Issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NO GGG
become subject to the Workers'Compensation Laws STATISTICAL CLA IFI ATION APT CONDO
Date Applicant ADDRESS CLASS NO DWELL UNITS
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 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 P IL
LICENSED CONTRACTORS DECLARATION SIDE
CITY LIC CLASS 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 SQ FT SIZE NO OF, TORIES NO OF FAMILIES
Professions Code,and my license Is In full force and effect 5-0 1 NEW BK PG ,
License Number Llc Class DESC IPTION OF WORK ADD ❑ V Lt&W N �� 0
Contractor Date O F ALTER ❑ `1l1I
El am exempt under Sec REPAIR $ F_
B&PC for this reason DEMOL ❑ 0
CDMA P/C#
Date USE OF E/X TING BLDG URM -I - _ ._ _ CL
CD
SignatureLICANT(PRINT) ' TEL NO,-•• - j ""' -`• LDMA Perm#
011, as owner of the property, or my employees with wages as �S CS. �u ss (J 7+'S 3 S 3 - _ z g-
their sole compensation, will do the work and the structure Is AD RESS / (� _ o -- ACCT.AT
not Intended.or offered for sale (Section 7044, Business and 66O � i AkcA t q/007'_`FINAL DATE - 33 r "
Professions Code) `I� 149.10
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL-
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1 J r"
❑ I, as owner of the property, am exclusively contracting Wltt AMOUNTS SPEC_IFIEg ON THE HAZARDOUS MATER ALS INFORMATION GUIDES FINAL BY, > ITEMS
licensed contractors-to construct the project (Section 7044, qyI( ,
Business and Professions Code) VES❑ NO TOTAL 149- '9
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 1 - ,J 1'7L 7 1
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH- � � 149.10
CONSTRUCTION LENDING AGENCY GCOASTAIRUIDELINE QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR t!
GUIDELINES -
I hereby affirm that there Is a construction lending agency forves❑ No CHANGE .UU
N the performance of the work for which this permit Is Issued(Sec - '
01 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,
TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS ('I("tI'1(j�rX1('r{ /?$/p J
3 ' Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD I.JILLfFLW LVlC 01 -t l 7
IL Lender's Address +�S+SI(t I Ali 7x53
O - 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 to comply PC FEE PERMIT FEE
civ with all county ordinVres and State s relating to building
CID t lr ction, and he authorize repr s ntativeS of this County ISSUANCE FEE
M t nt r upon the v menhone o y for inspection purposes 1/lJ•
ID 3
INVESTIGATION FEE TOTAL FEE / O
A-0d m« nt ooze
SEE REVERSE FOR EXPLANATORY LANGUAGE