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HomeMy Public PortalAbout9624-9626 LONGDEN AVE_Building__ APPLICATION FOR BUILD-ING PERMIT FOR APPLICANT TO FILL IN (Print or type onlvY BUILDING COUNTY OF LOS ANGELES ADDRESS - - V DEPARTMENT OF COUNTY ENGINEER CITY jy ZIP BUILDING. AND SAFETY DIVISION SIZE OF LOT � LDING � OD NOW 140.OON OTS ADDRESS TRACT BLO K LOT NO. r LOCALITY �4 NEAREST - OWNE R .. `7 �� NOLfpg3�" 7 CROSS ST. W ASSESSOR ADDRESS lu /(f �� Ave °1=d �?'�� MAP BOOK. PAGE PARCEL. DISTRICT GROUP TYPE t FIRE PROCESSED BY CITY 6_ D4 ZIP J (� Q� '�J� CONST. ARCHITECT OR TEL. a IV) .(/- Iff — ENGINEER NO. STATISTICAL CLASS FICATION SEWER M ADDRESS e-' Q J CLASS NO. DWELL.UNITS L BK f CONTRACTOR. W/V E NOL%6�3,1" U((( zr MNO. AP 3LIC. ADDRESS• NO. SPECIAL LIC. CONDITIONS CITY GLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LVE OF (STREET) ADDRESS CITY C HIGHWAY + YA D TOTAL SETBACK FROM TYPE A EXISTING SQ. FT. NO. OF NO. OF . CHECK FRONT PROP. LINE HIGHWAY WIDTH p SIZE STORIES FAMILIES ONE FC DESCRIPTION OF WORK NEW ❑ G ADD ❑ BLDG.SETBACK FROM v SIDE PROP.LINE OF (STREET) ? ALTER ❑ HIGHWAY •I- YARD = T L SETBACK FROM TYPE OF EXISTING REPAIR❑ SID .ROP. LINE HIGHWAY WIDTH USE F EXISOT NG BLDG, DE94 �� f1tDEMOL + APPLICANT E/L n n' TEL CORNER CORNER CUTOFF YES ❑ NO ❑ (PRINT) • ,L I` /G N0.i BY (SIGNATURE)- IN OPEN SPACE - YES ❑ NO ❑ Q IN COASTAL ZONE YES.[:] NO ❑ VALUATION�Y" 300&100 CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 15 CORRECT"AND AGREE TO COMPLY IMPACT.. EXEMPTION DECLARATION SIGNED (DATE) WITH "ALL ORDINANCES AND LAWS REGULATING BUILDING CON- - STRUCTION..I,CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY NY PERSON IN IOLATION OF THE LABOR CODEOF THE ST E OF CALIFOR N RELATING,TO WORKMEN'S COMPENSAT N 1 URAN E. SIGNATURE O . PERMITTEE ADDRESS / , / ' , TEL FINAL _ BY CIT��/v V / /f NO DATE /���i r� IIA KE (HEC KS PA YA BLE TU: FEE $ FEE 4P HARVEY T. BRANDT, COUNTY ENGINEER "9. i9A� PLAN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH pr 1. 9 9 5?3 JUL 2 1 D 9.0 0 A 7GA638A C.E#803 12%72 --. W1 - ` r ;'3 WORKERSICOMPENZATION DECLARATION - ' Ibore ora4fc that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT 'insure; or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) /! , _ 96 � AM2� Civ, COUNTY OF LOS ANGELES BUILDING AND SAFETY t Policy ,z �icy No. /�~ Company Certified copy is hereby furnished. BUILDING / ICf N ' Certified copy is filed with the county building inspec- BUILDING FOR APPLICANT TO FILL IN ADDRESS tion department. ADDRESS Date L. Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTIOW;4 M WORD RS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT 465 NOW ON LOT CROSS ST. r (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL, USE ZONE MAP I certify that in the performance of the work for which this OWNS NO. a NO. permit is issued, I shall not employ any person in any manner �—� SPECIAL d so as to become subject to the Workers'Compensation Laws. ADDRESS d� CONDITIONS 0 Date Applicant CITY ZIP 0 9 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITE TOR TEL. Jot RICT GROUP TYPE FIRE PRO SSED BY ENGINEER NO. Exemption, you should become subject to the Workers' CONST. ZONEal WCompensation provisions of the Labor Code, you must forth- ADDRESS `✓� a� with comply with such provisions or this permit shall be f' TEL.. �iSOr STATIS7ICALCLA SIF CATION APi. DO. Z deemed revoked. CONTRACTOR l�l/!�/�tNJ/+b,�H ., n LICENSED CONTRACTORS DECLARATION /�, LIC. p CLASS NO. �/� DWELL. UNITS ---- I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ZZ�o V�. IdjHIT TJ�� NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY 414 mak CLASS VALIDATION / SQ.FT. NO.OF NO.OF CHECK BK. PG. License Number ��+ZO�6 Lic.Class SIZE STORIES FAMILIES ONE �d fY�q / J fW DESCRIPTION OF WORK NEW ❑ VALUATIO ;9409. 1 A ContractorIgAC� l/�/11/lt to 2 ADD ❑ $ ��• , '# 0 0 0 0 2 3 ❑ I am exempt under Sec. ❑ ALTER B.&P.C. for this reason ©� I o o -4 4,42 ❑ ; USE OF REPAIR A Date: EXISTING BLDG. DEMOL ❑ �� 1,J1 4 �-G�i 0 0 0 0 Signature APPLICANT EL. g PRINT NO. FINAL _ �/ 0 2 1,2-3,9(j OWNER-BUILDER DECLARATION DATE 1 hereby affirm that I am exempt from the Contractor's License 1,ADDRESS �� s �d FIN ) 1 5 7.0 6 Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT By ° 1, 1 5 7.0 6 6 ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ' ) 0,28-85 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I,as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS %' tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH / 1 the performance of the work for which this permit is issued P.L. F, (Sec. 3097, Civ. C.). SIDE ° I,4 ` 2;' Z7, i P.L. Lender's Name / )`� 7 LDMA Ref: # /�� �� + Lender's Address P.C.Fee$ Permit Fee V/ ' 'I certify'that I have read this application and state that the 7` L/2- Issuance Fee U. ' LDMA P/C# 4 above information is correct. I agree to comply with all County Investigation Fee ` ( ordinances and State laws relating to building construction, Total Fee J ?i: LDMA Perm. # i and hereby authorize representatives of this County to enter S upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE pi!g.nature ppl ant or Agent Date