HomeMy Public PortalAbout9220 LONGDEN AVE_Building__ APPLICATION FOR BUILDING PERMIT �1
FOR APPLICANT TO FILL IN (Print or type only) !J
ffUICING COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
cfT ZIP BUILDING AND SAFETY DIVISION
CNO.OF BLDGS. BUILDING n Q
SIZE OF LOT NOW ON LOT ADDRESS r C
iL �ti d`
TRACT BLOCK LOT NO LOCALITY
TEL. NEAREST t
OWNER NO. CROSS ST.
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICT GRO TYPE FIRE loPROQESSED BY
CITY ZIP ��'�]] OONST, ZONE
ARCHITECT OR TEL. ,75 .0/9 y`
17
ENGINEER NO.
Q STATISTICAL CLA''S//SIFICATION SEWER MAP
ADDRESS ! CLASS NO.�DWELL.UNITS f� BKZ G
CONTRACTOR + S� No ,'7�j US -ZONE MAP i
LIC. 7 �� 5
ADDRESS NO. DI r� SPECIAL
fCONDITIONS
CITY � CLASS��
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCJION LENDER
NAME AND BRANCH BLDG.SETBACK FROM C
` FRONT PROP.LINE OF (STREET) C
CITY _ TOTAL SE BACK FROM TYPE OF EXISTING
HIGHWAY + YARD - L
SQ, FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH C
SIZE STORIES , FAMILIES ONE
+
DESCRIPTION OF WORK NEW ❑ C
ADD LDG,S TBACKFROM (STREET)
SIDE PR LINE OF
a �. ALTER ❑ - TOTAL SETBACK FROM TYPE OF EXISTING
' . / HIGHWAY �- RD - PROP. LINE HIGHWAY WIDTH
USE vJ� FDEE'MOL
PAIR❑EXISOTNG BLDG, J ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) N0.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
`� ��}f� IN COASTAL ZONE YES ❑ NO ❑
! VALUATION$ d , /s ao CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMIL ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE A OF CALIFORNIA IN RELATING TO
) WORKMEN'S CO MPE NSA ON SURAN,E.
SIGNATURE OF
PERMITTEE
ADDRESS
TEL. FINAL BY
CITY NO. DATE /lam 7 �. j/i7 n •., �-
' MAKE CHECKS PAYABLE TO: FE FEE ,
HARVEY T. BRANDT. COUNTY ENGINEER �. c` / �7
PLAN CHECK VALIDATION CK M O. CASH PERMIT VALIDATION CK MO ASH
4 19 2 1. ® 6.5 3 a�d
76A638A CE#803 7/73
• 76A638p CE 11803 1/71 V l
�•.�'•, ` APPLICATION FOR BUILDING PERMIV� �
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
COLEMAN W. JENKINS. SUPT OF BUILDING '
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
Print or tyl2e on[ CROSS ST.
BUILDING DISTRICT N GROUP TYPEBY
ADDRESSV,?R 1,4 ,per O CONST. Ci
LOT NO BLOCK STATISTICAL CLASSIFICATION SEWER MAP
TRACTdallt�l
CLASS NO.�DWELL,UNITI BK EPGpR�
aa �7QQ USE ZONE MAP
SIZE OF LOT&W Y f NOWOON LOTS /ZJ SPECIAL O3
USE OFCONDITIONS
EXISTING BLDG.
TEL.
OWNERS 9 S 'pi r se NO. afg'- J" BLDG.SETBACK FROM
ADDRESS pr E, FRONT PROP.LINE OF (STREET)
/ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY ej� /� J•� HIGHWAY WIDTH FROM C.L.
ARCHITECT OR TEL. I + _
ENGINEER NO. BLDG.SETBACK
ADDRESS SIDE PROP.LINE OF (STREET)
TEL. TYPE OF EXISTING SETBACK HIGH + YARD = TOTAL a
CONTRACTOR NO, HIGHWAY WIDTH FROM C.L. C
C:
ADDRESS NO + _ C
LIC. H
CITY CLASS CORNER CUTOFF YES E] NO
❑ lc
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS
SQ. FT. NO. OF NO. OF NEW ❑
SIZE STORIES FAMILIES
USEOADD
TSTRV
y�
a ALTER
' 4 9 REPAIR❑
SIGNATURE OF
APPLICANT DEMOL ❑
VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEES FEE S 62-1 C! v FORMS, MATERIALS
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE 15 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
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURAN
H. EXT,
SIGNATUREOF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS Aj' �r 1'
FINAL
JOHN F. LEWIS. PR1NC1 A STRUCTURAL EN
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDA N CK. M O. (':ASH
uiGo 7 19 _r JUL 2 6 1 0 3.0 0
WORKERS'COMPENSATION DECLARATION (�_ .-
hereby affirm that I have certificate of consent to self
insure, or a certificate of Workers'
APPLICATION FOR BUILDING P E RM I T
kers'Compensation Insurance,
IC ,ertt'fied copy thereof(Sec. 3800, Lab.
Pik 1gy l•Po� /G� Company /I COUNTY OF LOS ANGELES BUILDING AND SAFETY .
Certified copy is hereby furnishe . FBUILDING
OR APPLICANT TO FILL IN ADDRESS 2I Af
Certified copy is filed with the county building inspec- BUILDING
J,7
� tion department. ADDRESS ' LOCALITY
/ .�• ,/J NEAREST
__/N Applicant. A CITY c.-y[ ZIP CROSS ST. -
CERTIFICATE OF EXEMPTION FROM ORKER ' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURAN E SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE MAP b
hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO.
/ TEL, .�j SPECIAL A
I certify that in the performance of the work for which this OWNER / * / NO 7"feSy-- i� CONDITIONS ®-
permit is issued, I shall not employ any person in any manner ' DISTRICT GROUP TYPE FIRE PROCE ED BY
so as to become subject to the Workers'Compensation Laws. ADDRESS . c!i �( CONST. ZONE
^'�� f CITY ZIP ' `r� 0
Date Applicant STATISTICAL CLASSIFICATION ICONDO.NOTICE TO APPLICANT: If, after making th s Certificate of ARCHITECT OR TEL. U
'Exemption, you should become subject to the Workers' ENGINEER NO CLASS NO. DWELL. UNITS
Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP eR
with comply with such provisions•or this permit shall be
G2. VALIDATION
rj
deemed revoked. � CONTRACTOR NO. BK: �P ,
LICENSED CONTRACTORS DECLARATION LIC.
,I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 0 NOr D 7 VALUATION
(commencing with Section 7000)of Divisio63 of the Business and LIC.
Professions Code,and my license is in full force and effec. CITY CLASS (J $ Poo.SQ. FT. NO.OF NO.OF CHECK
License Number (� Lic.Clasp SIZE STORIES FAMILIES ONE
Contracfort>���TCD/)-fS (tuiS� Da 'a srr��l I DESCRIPTION OF WORK NEW t $�i�C �—
� ADD .❑ _
I am exempt under Sec. = ,1 0 ' 2A
ALTER FINAL
B.BP.C. for this reason (� t REPAIR ❑❑ DATE 'f �! i:' o e o o r'
USE OF , ' FINAL : K
. o `Date: EXISTING BLDG. DEMOL - ,S Q
Signature APPLICANT TEL. By
1
OWNER-BUILDER DECLARATION PRINT NO. J c e c 7 ;, Q X.
`4 hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS , 0 ti 0 r.—F
Professions Code):'. PRESENT
BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY 106 A
7044, Business and Professions Code). MOVING TEL.
❑ CONTRACTOR NO. -1 0 0 0 0 1
I,as owner of the property,am exclusively contracting •
with licensed contractors to construct the project (Sec- ADDRESS u o C! n c2
'tion 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT•
the performance of the-work for which this permit is issued •P.L• ► L1 r 0 19_ c Ll.
Sec. 3097,Civ. C.). SIDE ;
o
P.L.
L'ender's Name
3
Lender's Address P.C. Fee$ Permit Fee
=
I certifythat I have read this application and state that the O
PP � �� Issuance Fee
above information is correct. I agree to comply with.all County Investigation Fee
ordinances and State laws relating to building construction,
and hereby authorize repres itatiy63` f this County to enter Total Fee d
upo the above-ment}oned rop ty f r inspection purposes.zh /
' S—?_P y SEE REVERSE FOR EXPLANATORY LANGUAGE
Signal re of Applicant or Agent Date ®s
bVORKERS' COMPENSATION DECLARATION _
bcertificate eef A P P L I CATION FOR BUILDING P E RM I Tinsureor a certifcote of WorkersCompensationnsuranc
or a certified copy/there . a
(Sec. 3800, :.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Y Company r'`/UIW BUILDING
91 Certified copy is herebyfurnis d. FOR APPLICANT TO FILL IN ADDRESS
El Certified copy is filed with t count Gilding inspec- BUILDINGvy� Z #fG•Cl
tion department. ADDRESS V Lla7 .
t� -� Z� CITY C ZIP fJ LOCALITY
Date Applcant ` NO. OF BLDG5. NEAREST
CERTIFICATE OF EXEM ION O WORKERS'" SIZE OF LOT 'Y /L) / NOW ON LOT CROSS ST.
COMPENSATI N IN U�RANCE / ASSESSOR "
(This section need not be complete if the permit-is for one 7RA LOCK LOT NCSY MAP BOOK �.� PAGe0 PAR
hundred dollars ($100)or less.)" TEL. d`
OWNER/�J,E s 1a.3•r �1=1r S No 011 r�' /t v 3 •USE ZONE ' MAP
I certify that in the performance of r�a wor f which this SPECIAL lvc5 }
permit is issued, I shall not employ Y peso �i any manner ADDRESS S �i�' a
CONDITIONS O
so as to b am subject to the W Co p nsation Law's. U
CITY ZIP
Date y Applican} �• ARCHITECT OR f'" TEL.
jJ� E. t/ DISTRICT GROUP TYPE FIRE PROCESSED BY 0
NOTIC TO APPLICANT: If, a er, ma ny.this Certificate of ENGINEER C/L/ C` 'f ✓ NO.— 0 -��i•l CONST. ZONE
Exemption, you should beaYme sddbj ct to the Workers' y V
Compensation provisions of the Lar r ode, you must forth- ADDRESS /S L—� r7 i./✓`rsLr"'�rGl.� �' �!�O 3 t� pW
with comply with such provisions or this permit shall be TEL• STATISTICAL CLASSIFICATION APT. CONDO.
deemed revoked. " CONTRACTOR l rd Jct' NO.�/ 1 +�/d6 Z
LICENSED CONTRACTORS DECLARATION LIC. /,yam CLASS NO. ��,/DWELL. UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �J` I*
��j'ga, NO. J
LIC. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business CITY L i✓-i A'Yi ``i�Gr' CLAS
and Professions Code,and my license is in full forge and effect. BK, PG. VALIDATION
� ti„y J SQ. FT. NO.OF NO. OF CHECK
License Number :%r/
% / 7 Lic. Class' f6 SIZE ” / STORIES FAMILIES ONE VALUATION
Contractor �"`�'L�`� + Date /~/ DESCRIPTION OF WORK L NEW - ❑ $ Q
P �!�/ �� tr 71 T 1 ADD 4 ❑ ►
❑I am exem t under Sec. / •..: ALTER ❑
B.&P.C. for this reason 'S��w���'' '. •`•, R@PAIR ❑ ;
Date: USE OF
EXISTING BLDG. ka%t AOL ❑
Signature APPLICANT "� TEL• p t FINAL
(PRINT) 92�(J/v ,[l NOMJyj, 'pI
OWNER-BUILDER DECLARATION gg�� ,,[ q DATE �Z Z
I hereby affirm that I am exempt from the Contractor's License ADDRESS dl� /°lrt� c57 l6
Law for the following reason (Section 7031.5, Business and FINAL 1
Professions Code): PRESENT By ;
ElI, as owner of,the ro ert , or m ' em to ees with BUILDING
P P Y Y P Y ADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY '•' -
7044, Business and Professions Code.) MOVING TEL. ! A
❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. `
with licensed contractors to construct the project (Sec- i+' - _ 6-3-
ADDRESS
tion 7044,'Business and Professions Code.) t y• ;-.r1
REQUIRED TOTAL SETBACK FROM' EXIST:
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH _
I hereby affirm that there is a construction lending agenry for FRONT
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L.• _
Lender's Name /� LDMA Ref. # -
? P.C. Fee$ Permit Fee00 J '
Lender's Address �' ' '
o I cZfat I have ead this application and state that the Issuance Fee LDMA P/C#
3 abrmation i correct. I agree to comply wlth all County Investigation Fee. Q jorand S�a a laws relating to building construction, Total Fee Q (v LDMA Perm. #
" any a tKor ze representatives of this Count to nter
up n t /Aabo - njoned property for,inspectio purros�es.
f� %" SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig'at a of Applicant or Agent Efate
N&RKERS' COMPENSATION DECLARATION
hereby'affirm that I have certificate of consent'td pelf APPLICATION FOR BUILDING P E RM I T
Insure, or a certificate of Workers' Compensation Insurance,
or a certified copy/there (Sec. 3800, Lab.LC.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company "„/dGr"`t1itl��
'Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING g 6,.Z
ADDRESS Z Z/ i �i(>
❑ Certified co is filed with the conn buildin ns ec_ FSSNG y /
tion department. P J.1ZN� y`/ LLQ C/�b Cy}-
Date Zf '� Appllcant /��'1�1 G�-' �i ZIP /SPD LOCALITY
/�, � NO OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTIO l Rk6V'W•RKERS' SIZE OF LOT G' `//NOW ON LOT L CROSS ST.. /(,G/iL%:�/IC
COMPENSATJON NSUR/>NCE� ASSESSOR �j '
(This section need not be completed if the permit is for one TRACF.S/�i✓ /. BLOCK LOT NO. MAP BOOK ��O l PAG PARCEL
hundred dollars ($100)or less.) TEL.
OWNER 1, NO, �� r /�r� USE ZONE OP yam r Oy��
I certify that in the.performance.of 'e work fo which this ��// SPECIAL
permit is issued, I shall not employ y pets n' any manner ADDRESS %S. //b1 ', �`` CONDITIONS
so as to become'subject to the W rs'Co nsation Laws. `�,A - O
�/ CITY ✓/n F ZIP ' '
Date�J=L' Applicant ARCHITECT OR TEL.;V7 DISTRICT GROUP TYPE FIRE PROCESSED BY O
NOTICE TO APPLICANT: If, a er r>ming( this .Certificate of ENGINEER j�^+1G/L/ - bY14- NO. �/ --/j/� CONST. ; ZONE
Exemption, you should become ttsubject to the Workers' � p / W
Compensation provisions of the Labor-Code, you must forth-- ADDRESS • 7.s'L ��//J izJ- + �1,//i ' v� ' �.OG (/ 3 .t_e� CL
with comply with such rovisions or this N
p y p permit shall be TEL. g/ ""�� STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR + ' L9f✓ Ce NO. 2��- /Q _
LICENSED CONTRACTORS DECLARATION CLASS NO. 9:2V UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS'.7 5 f� J�Ui✓ NO.•����Y�Y SEWER MAP
(commencing with Section 7000)of Division 3 of the Business LIC./T�/ 7vl�iYL/' !((81} C/6D f CLASS BK. PG.
and Professions Code,and my license is in full force and effect. CITY �� VALIDATION
SQ. FT. NO. OF NO OF r CHECK
License Number g/ Ly�� Lic. Class —��• SIZE STORIES 1 FAMILIES { ONE
VALUATION
Contractor �eMs� LQ Date' f i��l DESCRIPTION OF WORK NEW ❑
/ b ADD ❑ $ `�
❑I'am exempt under Sec. 5 TV D
48
ALTER ❑
B.&P.C. for this reason REPAIR ❑ $
Date: USE OF
EXISTING BLDG, /{�- /� (/GCi DEMOL ❑
APPLICANT�+ / TEL,61
Signature OWNER-BUILDER DECLARATION Lary A NO, 2"_ FINAL
I hereby affirm that I am exempt from the Contractor's License 2 ~� IS,`. ;1 1 DATE ^
Law for the following reason (Section 7031.5, Business and ADDRESS 7 �V0/✓ FINAL
Professions Code): PRESENT By
BUILDING
❑ I, as owner of the property or my employees with ADDRESS ` °�►
•wages as their sole compensation,will do the work.and ' ti : �•'��f -'''
LOCALITY , :.:.►3l•, t• ., .
the structure is not intended or offered for-sale(Section C 1 1'
7044, Business and Professions Code.) MOVING TEL. -
❑ 1,as owner of the ro ert am exclusive) contractingCONTRACTOR NO.
with licensed contractors to construct the project (Sec-
ADDRESS
tion 7044, Business and Professions Code.)
CONSTRUCTION LENDING AGENCY SETQBACK YARD HWY TOTAL SETBACK
LIINEFROM WIDTH
I hereby affirm that there is a construction lending agency for FRONT '
the performance of the work for which this permit is issued P.L.
P P SIDE
(Sec. 3097, Civ. C.). P.L.
Lender's Name r /� LDMA Ref.#
P.C. Fee$ d ���• / ;i:::�i." --
Lender's Address Permit Fee
3: 1 certify that .have read this application and state that the Issuance Fee LDMA P/C# , -
2 - ;:%:,
above infor• ation is cq ect. I agree to comply with all County Investigation Fee -
ordinance and•Stdtelaws relating to building construction, Total Fee +�� C� LDMA Perm. # -7. I L �_
and he y authonz� representatives of this County/to enter -- - -
c upon a bove-rr� oned property for inspection ur bses.
o //�(f/ y��✓�` }� �J SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature o'f Applicant or Agent / Date