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HomeMy Public PortalAbout9646 LONGDEN AVE_Building__ APPLICATI®N F®R'BUILDING PERMIT FOR APPtItANT TO FILL IN (Print br type only) -COUNTY OF LOS ANGELES BUILDNG ADDRESS 6y L DEPARTMENT OF COUNTY ENGINEER CITY - _L . ZIP 9 BUILDING AND SAFETY DIVISION y NO.OF BLDGS. BUILDING SIZE OF LOT A NOW ON LOT ADDRESS .��� !.y/✓ G TRACT BJEF/i--66 LOT NO. LOCALITY /�L'e �i T TEL: NEAREST OWNER NO.- CROSS ST.ASSESSOR ADDRESS 4VA5 ; �r (r{N• s�' MAP BOOK PAGE PARCEL DISTRICT GROUP TYPEFIRE PROCESSED BY -CITY ZIP " CONST.�- ZO ARCHITECT OR TEL. ' '.J— ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS TEL. CLASS NO. I DWELL.UNITS 29 /— BK7t/PG _ CONTRACTOR NO. USE ZONE MAry LIC. /J NO.P ���./ ADDRESS NO. j/ z SPECIAL - LIC. +�` CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF' '" (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.Ft. NO.OF' NO. CHECK HIGHWAY t YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE• CL } DESCRIPTION OF WORK W NEW ❑ + O ADD ❑ BLDG..SETBACK FROM (STREET) O Iry SIDE PROP.LINE•OF ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING p % HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY. WIDTH . USEOF' REPAIR Z EXISTING BLDG. DEMOL ❑ + APPLICANT TEL• CORNER CUTOFF YES ❑ NO ❑ IPRINTI NO. I 1 IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( 1 A IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ 102, IHEREBY ACKNOWLED E THAT I HAVE READ THIS APPLICATION AND STATE / THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM. PENSATION INSURANCE. S D 7;D G "✓ �� �.U'i�j'L LS r7Nit SIGNATURE OF ` �� ox TD 4lSVe.Z y/d//rfG- PERMITTEE r / ADDRESS �) p �L -7 70 /N� Ca.j -r:reS �rE,,+.�-ez//j''-7v-"Cs .�. FINA CITY ��iLe/Y/�—, NC3�"aI0 V DATE � � n'%'YQ l��?l ll t/l -G/" MAKE CHECKS PAYABLE TO: F E. $ FEET l HARVEY T.BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION 6K. ".M.C. .CASH PERMIT VALIDATION CK.. M.O. CASH 5.7-3APR; 8 . 1" © 1 5.0 0 86 76A63BA CE#803 3.75' • WCIRKERS'COMPENSATION DECLARATION ' sure:r,o i.a certificate that I have r certificate of consent to self ► APPLICATION FOR BUILDING PERMIT � insure�or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, dab. C.)� COUNTY OF LOS ANGELES BUILDING AND SAFETY Ppiic C opt)/4FO( Company 10 t 7t ff Osti . `CJ mj!; Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS 0 ❑ Certified copy is filed with th unty building inspec- BUILDING tion de rtment. ADDRESS Date 6 $ g Applicant CITY ZIP LOCALITY CE IFICATE OF EXEMPTION FROM ORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURA E SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be•completed if t e permit is for one ASSESSOR "imi!ILI hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK I PAGE PARCEL TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER t✓(f� NO. Jr7� O NO. >' permit is issued, I shall not employ any person in any manner " SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS �) �� CONDITIONS V CITY dee r ZIP 0! Date Applicant O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO ESSED BY } Exemption, you should become subject to the Workers' ENGINEER NO. (, CONST../ Z NE Compensation provisions of the Labor Code, you must forth- ADDRESS "� 0r� 1/ with comply with such provisions or this permit shall be ,, H deemed revoked. TEL. / STATISTICAL CLASSIFIC ON ,.. APT. CO DO. Z CONTRACTOR ,� ��(f'• O. 3 LICENSED CONTRACTORS DECLARATIONLIC, �i CLASS NO. 2 DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. d SEWER MAP (commencing with Section 7000)of Division 3 of the Business and f LIC. Professions Code,and my license is in full force and effect. CITY /e/ 7 CLASS CZ BK Z �� VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number 7.98!6 3 2,Lic.Class Z C1I SIZE STORIES FAMILIES ONE VALUATION Contractor , ate DESCRIPTION OF WORK NEW D s �� ❑I am exempt under Sec. ❑ , ALTER B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL 2 1 8,9 A Signature APPLICANT TEL' �^ Z 3 FINAL / # 0 0 0 0 0 1 OWNER-BUILDER DECLARATION PRINT G1e NO + DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS n dj&,< !t� FINA I o 0 6 Q 5 0 Professions Code): PRESENT By ❑ I, as owner of the property, or my employees with BUILD 0 0 a 6 Q 5 0 c=3 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 0 603-85 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). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.UNE_BACK WIDTH 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). i SIDE P.L. Lender's Name I LDMA Ref. # Lender's Address P.C.Fee$ Permit Fee I cern that I have read this application and state that the certify pp Issuance Fee J h LDMA P/C# � above information is correct. I agree to comply with all County Investigation Fee ordina nd State laws relating to building construction, Total Fee LDMA Perm. # and reby uthoriz representatives of this County to enter upo thea ove- a Toned property for inspection purp es. 4/4 SEE REVERSE FOR EXPLANATORY LANGUAGE Signaa of Applicant or Agent ate r WORKERS'COMPENSATION DECLARATION hereby afft er that I have certificate bf consent to self APPLICATION FOR BUILDING PERMIT � .1 hereby or a Certificate of Workers'Compensation Insurance, o�P i d ca y}r er�f(Sec. 3800, Lab. C.) y'icy _�r COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. CompanyT7;- ' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING 7 /lion department. ADDRESS Date l� -�y Applicant C/% ��1_ CITY 100, ZIP RZ7� LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT �do NOW ON LOT —�� CROSS ST. JJ (This section need not be completed if the permit is for one Y3 S7O ASSESSOR I hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL EL.S75,OSIPX USE ONE MAP I certify that in the performance of the work for which this OWNER S O. NO permit is issued, I shall not employ any person in t. any manner SPECIAL CONDITIONS CITY �� ZIP so as to become subject to the Workers Compensation Laws. ADDRESS o7�s i/ K O I Date Applicant— P ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO SED BY p NOTICE TO APPLICANT: If, after making this Certificate of yVG�6 CONST. ZO E V Exemption, you should become subject to the Workers' ENGINEER ��� NO. Compensatioprovisions of the Labor Code, you must forth- ADDRESS y) with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. DO! Z deemed revoked. CONTRACTOR � NO.��s��3 1F6,1116 LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. . DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and /� LIC. Professions Code, and my license is in full force and a Ft- CITY �s�0✓! 4!:5 CLA BK PGVALIDATION ��/�� yHECK SIZE g9 STORIES FAMIOLIES CONE License Number!!P 7 Lic.Class VALUATIO Contractor�[ - ✓ Date v DESCRIPTION OF WORK NEW ADD ❑ ❑I am exempt under Sec. t ALTER ❑ ` -2 2 1. 1 A B.&P.C. for this reason USE OF REPAIR ❑ $ iVVV # 0 0 0 0 2 3 Date: EXISTING BLDG. DEMOL ❑ I - 67a95 Signature APPLICANT TEL. FINAL _ OWNER-BUILDER DECLARATION PRINT NO. DATE o ° 6 7&9 5 I hereby affirm that I am exempt from the Contractor's License ADDRESS FINA �� U Law for the following reason (Section 7031.5, Business and III Professions Code): PRESENT BY 0606-85 ❑ 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 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). 2307.g A REQUIRED TOTAL SETBACK FRO If1Zj 33 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ° 1 91. 5 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 a b�-19§c=i (Sec. 3097, Civ. C.). SIDE , '9 3 0 8 0 A �j P.L. , Lender's Name 11011--f # o 0 0 0 0 %{ LDMA Ref. # Lender's Address ' P.C.Fee$ 7,rlxqs- Permit Fee a�✓. ' 11,034,25 I certify that I have read this application and state that the , Issuance Fee /� S� LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee / 22 ` ° 1.03&25'0 ordinances and State laws relating to building construction, Total Fee ( aJ i v LDMA Perm. # and hereby authorize representatives of this County to enter I u7-85 upon the above-me i ed property for inspection purposes. `` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature p icant or A Date