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Home My Public Portal About9433 LONGDEN AVE_Building__ TEMPLE CHTY 7.,105.cx,9.0='1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENQINEER NEAREST WILLIAM A.JENSEN SUPT OR BUILDING CROSS ST. DISTRICT NO. GRO P PE TYP USED BY FOR APPLICANT TO FILL IN l T� BUILDING / STA TICAL CLASSIFICATION SE ER MAP ADDRESS f-Q )-BK G CLASS.NO. DWELL.UNITS [� 177 LOT NO. BLOCK WATER NOT REQUIREDP�Ul RECEIVED AW A ,/� CERTIFICATE: Lol Li TRACTH l4 /tN� L�u+►yNO OF BLDGS. NOP (CIRCLE) E) Q HWAY STATE MAJOR SECOND, LOCAL SIZE OF LOT �i7y��y I NOW ON LOT USE ZONE SPECIAL USEOF I � _ ✓ rjYARD NDITIONcS EXISTING BLDG. TEL. OWNER/ -Af NO. BUILDING � r EXIS SETBACK HWY STREE AME ADDRESSWIDTH FRONT ARCHITECTOR TEL. P.L. ENGINEER NO. SIDE P.L. ADDRESS a SP7pECTIGO'N) RECORD. !ECORD u CONTRACTOR -3 p — QADDRESS 11fATWS,-z�4 AN,*,,, A;QLet- DESCRIPTION OF WORK;?' , i � NEW DO ALTER REPAIR DEMOLISH y Z SQ.FT. NO.OF NO.OF 1 �`- ' I c•' IZE STORIES FAMILIES USEOF ' Z a�• STRUCTURES t LA- ?Z/ a Yr SIGNATURE O / APPLICANT-A VALUATiCI �� C►�O AAA APPROVALS IDA E INSPECTOMS 911 NATURE / FOUNDATION:LOCATION P.C. PMT. ✓ (I G �: 7 y.;:• FEE $ �T- FEE $ —� FORMS.MATERIALS FRAME:FIRE STOPS, 1 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. TION OF THE LABOR CODE THE STATE OF CALIFORNIA RELAT- ING TO WORK EN'S CO TION INSUR CE. LATH,EXT. SIGNATURE F HOUSE NUMBER COR- PERMITTE RECT AND POSTED 4• /:G l ADD. FINAL 1 , CLYDE N. DIRLAM, PRINCI AL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERM VALIDATION CK, M.C. CASH • • �_ - - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ARWIL'E �, �'!`" BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING 6AD}�REss BUILDI ADDRESS- �A I hereby affirm that I have a certificate of consent to self insure, G y L�yf Y1 Hv2 or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY. ZIP q/790 LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDG&NOW0 LOT ❑ Certified copy is hereby furnished. 'Z'y X �, o � NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP I Z PAGE V� PAR0'CEL Date SPECIAL CONDITIONS Applicant � v L> OW CERTIFICATE OF EXEMPTION FROM WORKERS' NERsu� A T�' T28 96 WITHIN 1000 FT.of SCHOOL? YES NO COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROC D BY dollars($100)or less.) CITYZIP I certify that in the performance of the work for which this permit �ejkdL Lj t sw jr (y is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. , �•.� 5;��- STATISTICAL CLASSIFICATION APT NDO ' Date Applicant ADDRESS _7 CLASS NO. � DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of I'Lob 4;- $.AM W&IjkrL, j$LVIP, 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 VW LIC.NO. P L 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 STORIES I NO.OF FAMILIES Professions Code,and my license is in full force and effect. O NEW ❑ BK PG , a VALUATION 0 DESCRIPTION F WORK ADD ❑ License Number Lic.Class Contractor Date ;-t a"a¢le amt! ALTER $ 19600, 00 0 El 1 am exempt under Sec. a(oP AcfL� REPAIR ❑ $ BAP.C.for this reason Na IA--W -5. I- DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. Ho ti URM ❑ IL (J 3 Signature APPLICANT(PRINT) TEL NO._ LDMA Perm# Z 1 I, as owner of the property, or my employees with wages as SUN a `� Z H"6-,- their :•_their sole compensation, will do the work and the structure is ADDRESS h FINAL DATE O .11 �'I=`� i not intended or offered for sale (Section 7044, Business and q4-330 60•• e4" C. a0. Professions Code.) �.-��_ L t WILL THE APPLICANT OR FUTURE BULLRING OCCUPANT HANDLE A HAZARDOUS MATE AL J j. l�f�f i:'f ❑ 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, 11-11-AL TJX 0�_� � 6 : _ Business and Professions Code.) YES❑ NOI +.� :r �--� 41 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �•SE�eL•`ti j�„l.,j N•,,; OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR f• ;�>i("F' (".1= GUIDELINES ?'!i'i•.'+� a•.. 1 hereby affirm that there is a construction lending agency for YES❑ No$ N the performance of the work for which this permit is issued(Sec. M I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING j 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, r!"I j"i-;`I +'1 /" TITLE 2.CHAPTER 2.20 SECTIONS .20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS '-1.•.: - L s .t. r "i+ ! Lender's Name MATERIALS REPORT IN FOR G A PERMIT M THE SCAQMD. s-a; �•i I 1 1 o Lender's Address 0 IXJNER OR AGENT oI certify that I have read this application and state under penalty o FEE PERMIT FEE d of perjury that the above information Is correct.I agree to comply P.C. f�'�1 �'� a with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE / ato enter u e abo -m ntione roperfy for inspection purposes. A(o• '(2 CO ��, �y [1 A INVESTIGATION FEE TOTAL FEE egrewre W MW a m SEE REVERSE FOR EXPLANATORY LANGUAGE