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HomeMy Public PortalAbout9552-9552 1/2 LONGDEN AVE_Building__ TEMPLE CRTY 76AN&A CE#0087,/10 APPLICATION-FOR BUILDING PERMIT. Z COUNTY OF LOS .ANGELES BUILDING / DEPARTMENT OF COUNTY ENGINEER ADDRESS S S2 g Z BUILDING•AND SAFETY DMSION. . LOCALITY •JOHN[A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DISTRICT TYPEPROCESSED Y FOR APPLICANT TO FILL IN ? Q coNsr: .S STATISTICAL CLASSIFICATION SEWER MAP ADDRESS' SZ SZ / BK PG CLASS.NO._L/__'DWELL.UNITS 2_ LOT NO. BLOCK MAP O 0 STATE YES NO ��CCNUMBER HWY. TRACT I& USE ZONE, SPECIAL - NO,OF BLDGS. )' CONDITIONS SIZE OF LOT' © 8:�.. I NO.W ON LOT USE OF EXISTING BLDG. tf-•Gere i/ BUILDINGREXIST. e YAD. HWY STREET NAME OWNER •TEL, SETBACK W71DTH ADDRESS ARCHITECT OR .4 TEL. P.L. Lo d ENGINEER ,NO INSPECTION MtORD ADDRESS TEL. a CONTRACTOR � NO�e 77/._ Iy kk ADDRESS "' ' DESCRIPTI6W OF WORK ? ! nF','I ',► F�,.;�IJlI � � O ig 1 .M s `/C' 'cT'. Al N NEW ADD ALTER=` -REPAIR DEMOLISH 7I�I S' 1� SQ.FTNO.OF i NO.,OF SIZE 4p STORIES ✓FAMILIES • /� u l � ^ STRUCTURE -� ` / D/fiAT! °" (&C.s!'1170A, E SIGNATURE OF Cr/ l7;9t,IP � /-f�).Ws / APPLICATION FOR BUILDING PERMIT �] COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADD SS or a certificate of Workers'Compensation Insurance,or a certified N copy thereof(Sec.380 ,Lab.C.) CITY ZIP� STw-Awb LOCALITY Policy No. Company SIZE OF 1-01% If NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. I NEAREST CROSS ST. L�ertified copy is filed with the county building ins ecti n TRACT BLOCK LOT NO. e�p�ar/t��,�/�gri�l�t/!��' r USE ZONE MAP NO. Datelitr w7 Applicant ASSESSOR MAP BOOK PAGE PARCEL _( ( / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' oWNER� � � TEL NO. COMPENSATION INSURANCE ��yy�L WITHIN 1000 FT.OF SCHOOL? YES No This section need not be completed if the permit is for one hundred ADDRESS- r ( P �r DISTRICT GROUP 6TYCONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CITY ~ ZIP /►��ph y� is issued, I shall not employ any person in any manner so as to ARCHITECT O ENGINEER TEL NO.V v� become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION 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' CONT A R 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. ADSS l /� PC zuC. 2 PL J .LICENSED CONTRACTORS DECLARATION h SIDE C Y `1 LIC.C 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 SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and e=ffg`�t. Z _ NEW BK PG CL License Number 7211 LIC.Class �J CRIPTION OF WORK ADD ❑ VALUATION C Contractor DateW19 WAUA5 L ALTER ❑ $ C. ❑ I am exempt under Sec. REPAIR 11 $ C DEMOL ❑ C BAP.C.for this reason LDMA P/C# LL Date: USE OF EXISTING BLDG. URM ❑ a U. Signature APP N NT) t EL O. LDMA Perm# z ❑ I, as owner of the property, or my employees with wages asADDR `S c d - Q p �' Y their sole compensation, will do the work and the structure is rr � , not intended or offered for sale (Section 7044, Business-and b-+l FINAL DATE o0. 330_, 1Ly.v -- Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL qq S I pT OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J 1 EM IC ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY M0 licensed contractors to construct the project (Section 7044, YES❑ NO JQ TOTAI :134. 25 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 4. 'L�/ � +�5 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ggg HECK f s.r� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES V MI CH NGE .00 I hereby affirm that there is a construction lending agency for YES El No re CM a 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 MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, �7 I t a Lender's Name MATE2.RIAL IAL CHAPTER OR2 20 AND ION 0920.100 THROUGH 2 20.140 G A PERMIT FROM THE CONCERNING HAZARDOUS 13000-0001 ({ 9/9 o Lender's Address fj I�� a. CIf� iC�lClo5 0 c I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE /� �• N with all county ordinances and State laws relating to building m construction, and hereby suTief e representatives of this County ISSUANCE FEE + ,/ m to ter u n he a entproperty for inspect'qnp �J -CIre/ INVESTIGATION FEE TOTAL FEE m I` o m oe SEE REVERSE FOR EXPLANATORY LANGUAGE