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HomeMy Public PortalAbout9521 LIVE OAK AVE_Building__ 76A;38,IWDSS-3 12.54 - �, APPLICATION FOR. BUILDING •PERMIT ]. DMSION OF BUILDING AND SAFETY BUILDING r q ~v A_ � /4 v P, Department of County Engineer —ADDRESS " County,of Los Angeles LOCALITY WM. J. FOX,-COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING NEAREST CROSS T. I yo Y S2 DISTRICT NO. GROUP SEWER MAP FOR APPLICANT TO FILL IN p/ )y► TYPE BK ^ V O BUILDING r L Y"' CONST' - L OC ma�nVy� ADDRESS S A V P MAPf� STATE YES - NUMBER P,0 V 7 LOT NO.W�`��1`/s� 6S� BLOCK USE ZONE SPECIAL -CONDITIONS, - TRACT �•��, - - � NO OF BLDGS. • SIZE OF LOT YON LO� BUILDING YARD HWY STREET NAME EXIST Tn0 NOW USE OF SETBACK WIDTH EXISTING BLDG FRONT q OI - P L OC, OWNER ♦ SIDE - MAIL �j P L ADDRESS, C - - TE 1 DWELL. 1 UNIT Zf' 5 INDUSTRIAL CITY NO � - 2 DUPLEX UNIT 6 PUBLIC BLDG ARCHITECT 0,J TEL. ,/-. _ ENGINEER NO / 953 APT. UNITS 7 ADDN., ALT., ETC - ADDRESS 4 COMMERCIAL 8 MISCEL EL CONTRACTOR INSPECTION RECORD ADDRESS Z '. Y IL •�.:.Ey. pL�TG� "LA..+C-2S�I S DuCq-- ~ DESCRIPTION OF WORK o�• � vrs..rr- E-;; ADD ALTER REPAIR DEMOLISH CSI I Mem Ait iai� ^ NO OFNO •OF _ SIZE ���/ STORIES FAMILIES USE PF STRUCTURE SIGNATURE OF APPLICAN t APPROVALS ' ADDRESS e DATE INS gECTOR'S SIGNATURE FOUNDATION LOCATION l p �Q �P C S FORMS. MATERIALS Ze�l�a� .X t L �iQOQ - FEE ,1FRAME FIRE STOPS, VALUATION 1d S O-� ' BRACING, BOLTS FEE J O FURNACE LOCATION, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS •f} APPLICATION AND STATE THAT THE ABOVE IS CORRECT - AND AGREE-TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT.AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH, EXT. I SIGNATURE OF_ - HOUSE NUMBER COR- PERMITTE RECT AND POSTED ,yu • ADDRESS G FINAL ' WM. J. FOX, COUNTY ENGINEER VALIDATION BY � :NI�Y -1 6- 1. 4.0=0 �Y ... 04. 2,z:7� -31_ DEPUTY' j 1 U V 4 •3 4 7 U7; JUN' 5 . � BY BY ® ; DEPUTY DEPUTY J� APPLICATIQN FOR BUILDING' PERMIT. COUNTY OR-LOS ANGELES BUILDING AND SAFETY - WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN `, N; BUILDING ,ADDRESS rp I hereby.afflrm that I have a certificate of consent to self Insure, BUIL ADDRE S ^A Au� + ora certificate of Workers' Compensation Insurance,or a certified U copy thereof(Sec',3800,Lab C) CITY T �( zIP r l 1V 0 LOCALITY Policy NO Company SIZE OF LOT NO OF BLDGS NOW ON LOT ElCertified copy IS hereby furnished NEAREST CROSS ST ❑ Certified copy IS filed with the COunty'buddlng Inspection TRACT BLOCK' ' LOT NO ' 'USE ZONE MAP NO _ department I ASSESSOR MAP BOOK PAGE PARCEL Date Applicant - � SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER{t, �r j� SSSS YES NO . COMPENSATION INSURANCE J t'�}' �i WITHIN 1000 FT OF SCHOOL (This section need not be completed If the permit Is for one hundred ADDRESS ©^ /��[" Z I�. 1-� W ` DISTRICT GROUP TYP CONST FIRE ZONE PROCESSED BY dollars($100)or less_) CITYZIP r I certify that In the performance of the work for which this permit ! � IS Issued, I shall not employ any person In any manner SO as t0 •ARCHITECT OR ENGINEER TEL NO ' become subject to the Workers'Compensation Laws STATISTICAL CLAS IFI�ATION APT CONDO Date Applicant' ADDRESS CLASS NO / DWELL UNITS NOTICE TO APPLICANT If, after making' ails 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 prdvlslons of"the Labor Code, you must forthwith �Vv 'u' r FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS' LIC NO O P L - LICENSED CONTRACTORS DECLARATION SIDE • CITY LIC CLASS P L I hereby affirm that I am licensed underprovlslons of Chapter 9 SEWER MAP (commencing with Section 7000)of Division,3,of the Business and SQ FT SIZE NO OF STORIES NO OF-FAMILIES NEW 1:1 BK PG Professions Code,and my license Is In full force and effect pool. a le License Number LC Class DESCRIPTIO F WORK/ j� ADD ❑ VALUATION O O Contractor Date ALTER ❑ $ cc (�� ccEl I am exempt under Sec � '"`e�f� REPAIR $ 0 -BBPC for this reason Coo DEMOL D LOMA P/C# W Date USE OF EXISTING 13LOG URM ❑ Signature APPLICANT / T), c fto ,.,I n_ c TE O� I i LDMA Perm# Z �. Z I, as owner of the property, or my employees with wages as 'W1 rn�ll( Pili S {�•r•- a their sole compensation, will do the work and the structure Is ADDRESS O _ '�' I ° not Intended or offered for sale (Section 70.44, Business and 1`52v E . VF V AK "F , FINAL DATE Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I v f J •} '{'j�(e� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER'THAN THE Q j. T 1 Li iJ ' ❑ I, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'+ FINAL BY �! ` licensed contractors to construct the project (Section-7044, ves 1:1 No( a ' ' (� L 103 - 05 Business and Professions Code) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE*BUILDING •y OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH N _-HECK. �I i�°10 CONSTRUCTION LENDING AGENCY, COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR Di GUIDELINES / . I hereby affirm that there Is a construction lending agency for YES❑ No Ivan( E��li�L1� °I I a the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING W 3097,CIV C) CHECKLIST I UNDE�STANDVY REQUIREMENTS UNDER THE OS ANGELES COUNT•V CODE, TITLE 2 CHAPTERCTI S 2 10 G 20 C ERNING HAZARDOUSj )ryLender's Name MATERIALS REPORA D R O AIN ROM SCAOMDf�!I_I—IJ iLF T i f_ oLender's Address {{,� O OWNER OR AGENT I�L'•{t f-II {: TI 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 o with all county ordinances and State laws relating to building / J aconstruction, and hereby authorize representatives of this Co my ISSUANCE FEE CO =;;?6 - �- to ender p e ab e- a tloned pro ert o spectl n urpo'e I x INVESTIGATION FEE TOTAL FEE/ y a x C/ � s°rrekl01 npn�­«r,Aem ' \Dere SEE REVERSE FOR EXPLANATORY LANGUAGE'