HomeMy Public PortalAbout9154 LONGDEN AVE_Building__ FOA898ACE#410911 APPLICATION FOR BUILDING PERM]'
COUNTY--OF LOS ANGELES. BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND'"SAFETY DIVISION. LOCALITY
JOHN A.LAMBIE.COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING =CROSS ST.
DISTRIC O. GR SEW M P
FOR-APPLICANT TO FILL IN - TYPE e - P
CONST.
BUILDING 9152 E a STATISTICAL C SSIFICATION
ADDRESS 7 I
LOT NO. BLOCK CLASS.NO. DWELL.UNITS
MAP STATE YES O
NUMBER. HWY.
TRACT USE ZONE SPECIAL
NO.OF BLDGS. d, CONDITIONS
SIZE OF LOT I NOW ON LOT-
USE OF °1 do�el li S` °
EXISTING BLDG. B LDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
8uCsSe FRONT--
MAIL
_J
MAIL (, ® pp. P.L:
ADDRESS ..1619 Forrest Ave SIDE '
CITY W.eSt. CoAl N11-JI-923 P.L. -
ARCHITECT OR TEL. INSPECTION RECORD
ENGINEER NO.
ADDRESS
�S C. o TEL. .
CON .JBC�CS®n" NO. CA2 �-
ADDRESS 4124:N.' _i'Bi.S S ZO
DESCRIPTION OF WORE
NEW ADD ALTER . REPAIR DEMOLISH. .
SQ.FT. NO.OF-., NO.OF
SIZE STORIES FAMILIES
USE OF STRUCTURE.: Termite re ai irs to•
existing dwelii T _
SIGNATURE OP7
APPROVALS
APPLICANT
y DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION "
"+ FORMS,MATERIALS
$ •
P.C. $ FRAME:.FIRE STOPS,
FEE BRACING;BOLTS
VALUATION $ FURNACE: LOCATION.
FEE . GAS VENT.DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH.INT. '
PLICATION AND STATE THAT THE ABOVE IS CORRECT'AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND.
STATE LAWS REGULATING BUILD G CONSTRUCTION: LATH,EXT.
SIGNATURE OF HOUSE NUMBER.COR-
.PERMITTE -RECT AND POSTEDell
/
ADDRESa ' FINAL //f/6
:CLYDE N.DIRL'AM,PRINCIPALS URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. cash PERMIT VALIDATIO CK. M.O:' CASH,.
� 4 APPLICATION FOR BUILDING PERMIT
+. COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL NG ADDRESS
I hereby affirm that I have a certificate of consent to self insure, BUILDIN J
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.) CI ` ZIPq
1 -780 LOCALITY 17
Policy No. Company SIZE OF L NO.OF BLDGS.NOW ON LOT
❑ 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.
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWN TEL NO.
COMPENSATION INSURANCE S WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if th permit is for one hundred ADD SS
DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars($100)or less.)
1 certify that in the performance of a rk for ich this permit `
IT r Q 2
ip
is issued, I shall not em oy any rs in any anner so as to ' 'Di
bec bject to�JJ�/�F
rkers nsation ws. ARCHITECT OR ENGINEER NO.
r -1785' STATISTICAL CLASSIFICATION APT CONDO
t✓Date ant ADDRESS CLASS NO. DWELL UNITS
N07ICE 7O APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' iR R 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. Ap E G!. ! I NO. O PL
LICENSED CONTRACTORS DECLARATION r /7 SIDE
C �/ILMC PL
I hereby affirm that I am licensed underprovisions of Chapter 9 C — SEWER MAP
(commencing with Section 7000)Of Division 3 Of the Business and SQ.FT.SIZE NO.PF STORIES NO.OF FAMILIES
Professions Code,and my license is in full force a eff to NEW ❑ BK PG }
License Number 6 ; Lic.Class ` D CRIPTI OF RK n ' ADD ❑ VALUATION , a
Contractor . Date G[J ALTER ❑ ���"a� C
111h-i REPAIR � $ FC-
❑ 1 am exempt under Sec.
BAP.C.for this reasonry - k ,
DEMOL ❑ LDMA P/C# W
DA: USE OF EXISTING BLDG. URM ❑ a
cr,
Signature APICQNT(PRI T LDMA Perm# z
ElI, as owner of the property, my employees with wag as 11%1 —25 ZO
T
their sole compensation, will do the work and the structure is Af E `,
1 91010 FINAL TE ~
not intended or offered for sale (Section 7044, Business and C 0.,I�i,,. 0-z :,
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL S N
❑ 1, as owner of theproperty, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE , a i i�t ii
Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y
licensed contractors to construct the project (Section 7044, T"y *
YES El No ElC CITAI AI 6-..-F
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK
#S�'L• •i^ �
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH I.I''33 is t L 8 a 41'�
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR _
GUIDELINES. CHANGE u y lyi
I hereby affirm that there is a construction lending agency for YES❑ NO❑ L
CIA CD the performance of the work for which this permit is issued(Sec.
I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 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 0000-01133 j 21F 15/94
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
o Lender's Address39 3v 1 All9 a 011-10
OWNER OR AGENT
Z; I ce"" that I have read this application and state under penalty
9 of pe Jy that the above information is correct.I agree to comply P.C.FEE PERMIT FEE ' !� B.0
N with all county O inances and State laws relating to building f�f
con u tion, and reby authorize representatives of this County ISSUANCE FEE
to a er pont a ve-iRentponed property for inspection purposes. (O
n� INVESTIGATION FEE TOTAL FEE
s. m Awplicaw Om Ctr O T
SEE REVERSE FOR EXPLANATORY LANGUAGE