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HomeMy Public PortalAbout9705 LONGDEN AVE_Building__ GE/Bad(REV.6/781 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING FOR APPLICANT TO FILL IN ADDRESS a —O BUILDING 1 r ADDRESS ri' r D b ,G6 ei h Ue LOCALITY NEAREST CITY C%>y Je ZIP q/7 CROSS ST. NO.OF BLDGS. ' ASSESSOR SIZE OF LOT NOW ON LOT /v(f/U MAP BOOK PAGE PARCEL 64,r I DISTRICTGROUP TYPE FIRE P CESSED BY TRACT.35'99j; BLOCK CONS ZOrLE t 'TEL. OWNER T, NO +' STATISTICAL CLASSIFICATION EWER MW ADDRESSg 16-2Pi/l V CLASS NO.. © ��DWELL.UNITS BK 73G bf CITY -(?;7414ZIP v ARCHITECT OR TEL. / VALUATION $ ENGINEER NO. -t iZD / f UCI ADDRESS /, BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTO NO.' HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING LIC. ry � - FRONT PROP.LINE HIGHWAY WIDTH ADDRESS c %g b 7CN7 ! NO. /c . + _ *6 LIC. CITY CLASS CONSTRUCTIO ENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OF• (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS ,�j` iy _ ITY j` SIDE PROP.LINE HIGHWAY WIDTH SQ.FT NO.OF NO. LF CHECK + , , _ SIZE STORIES FAMILIES ONE ag DESCRIPTION OF WORK /Ct3yi 6+/L+ NEW P.C.Fee$ rj-7• u Permit Fee ��• �Lj �! ADD ❑ 1 Issuance Fee Clip a/' _ALTER ❑ �y REPAIR ❑ Total Fee ( f' �� USE OF DEMOL EXISTING BLDG. Z APPLICANT TEL �? - 2 (PRINT) _ f v- 600. —24M@. -2 3 0 , BY(SIGNATURE) 9"- I -- -•�� I HEREBY AC WLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Z y g 3 5 R 8 A 15 THAT THE 15 AND LAWS GULATING BUILDING CONSTRUCRRECT AND AGREE TION.�I CERTIFY THAT IN DOING THE / -PLY WITH ALL ORDINANCES.. �/ _ WORK AUTHORIZED HEREBY I'WILL NOT EMPLOY NY PE ON IN'VIOLATION OF , y # 0 0 0 0 0 THE LABOR CODE OF THE STATE OF CALIFORNIA IN LATI TO WORKMEN'S COM- z PENSATION INSURANCE. Al 2'- 57850 SIGNATURE OF .0 - 57R506 PERMITTEE _ U ADDRESS em ' /. -7� Z 04 06-79 TEL C CITY NO. O USE ZONE MAP NO. yQ d� •� SPECIAL ~- CONDITIONS BY IOU, ATE I o 7 PPLICATION FOR BUILDING PERMIT TY OF LOS ANGELES BUILDING AND SAFETY COON I WORKER'S COMPENSATION DECLARATION - I (LDING ADDRESS FOR APPLICANT To FILL IN BUIL ANG ADDRESS� v I hereby affirm that I have a certificate of consent to self insure, d or a certificate of Workers'Compensation Insurance,or a certified CivZ I copy thereo 800,Lab.C.) C1 LOCA ITY -17 ze Poli o. Company IZE OF LOT NO.OF BLDGS.NOW ON LOT Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certifleii copy is filed with t;Ke) building n ection TRACT BLOCK LOT NO. dep tm nt., USE ZONE MAP NO. Date/.J Applicant Cr' ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPT I ROM WORKERS' OWNER _Q TEL NO. YES No COMPENSATION NSURANCE v WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred A DRESS Ob �t �� �� DISTRICT GROUP TY p CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) IT Z I certify that in the performance of the work for which this permit -I 4Wa400i-r_1 is issued, I shall not employ any person in any manner so as'toARCHITECT OR ENGINEER TEL NO. ;J become subject to the Workers'Compensation Laws. STATISTICAL CLASYFICATION too, 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' CONTRACTOR n TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith W z_ r/c 1 C —0 FRONT comply with such'provisions or this permit shall be deemed revoked. ADDRESS /n� N q P L I�L /�322 SIDE LICENSED CONTRACTORS DECLARATION - LIC.class P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division"3 of the Business and SIZE NO.OF STORIES NO.OF FAMILIES ProfessionsCode, ngmcpgnses' in full force and effe NEW ❑ BK PG ® } License Number Lic.Class RIPTION OF WORK ADD ❑ VALUATION O Contractor ate ML,,��// ALTER [I r 00A ❑ I am exempt under Sec. REPAIR ❑ Q B.BP.C.for this reason ' DEMOL ❑ LDMA P/C# Da USE O EXISTING BLDG. URM• ❑ d. co Signature 'APPLICANT(PAINT) TEL NO. LDMA Perm# s Z Z ACUAr ❑ 1, as owner of t roperty, or my employees with wages as their sole com ation, will do the work and the structure is ;ADDRESS O 3", T p 5'Ts. 1 sti n i�•: • not intended or offered for sale (Section 7044, Business and FINAL DATE a o C Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL � I I C1 IL 1, 8S owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE O i J i ❑ 1 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY -! AL 202 m 05 licensed contractors to construct the project (Section 7044, y Business and Professions Code.) YES 11 NO❑ CHECK - 02 n05 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING T7 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE * t' i CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR CHANGE • GUIDELINES I' , ' I 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. I �GI�l7—Ii IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTIN G G EM 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, V TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 65 15 Z AM. 8:.%' o Lender's Address Cl i OWNER OR AGENT ' o I certify that I have read this application and state under penalty oP.C.FEE PERMIT FEE ` b of perjury that the"above information is correct I agree to comply _ S _ N with all county ordina s and State laws relating to building m constr L n,and heregBir tatives of this County I ' ISSUANCE FEE ata e er on the q - or In i n purposes. I 1� n INVESTIGATION FEE TOTAL FEE f7D >ppnoluR 07 Apert �(! / l SEE REVERSE FOR EXPLANATORY LANGUAGE