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Home My Public Portal About9712-9714 LONGDEN AVE_Building__ ®S 76A63dA° •� ., CE 1803(REV.6/7.1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUIL INC FOR APPLICANT TO FILL IN ADDRESS B WING Z-/ ADDRESS`• �I a /1 LOCALITY Cid NEAREST CITY ZIP CROSS ST. NO OF BLDG . ASSESSOR SIZE OF LOT NOW ON LOT AV MAP BOOK PAGE PARCEL ()/(1JTf DISTRICT GROUP. TYPE FIRE ESSED BY TRACT �` BLOCK L9FWW®.v CONST. ZONE OWNER %` NO�O - ` `J.'SCJ 3 7 . / _ STATISTICAL CLASSIFICATION `SEWERMOK ADDRESS L'!�7 6 CLASS NOA DWELL.UNITTt �-BK PG CITY /e 0 Ll ZIP. ialzim ARCHITECT OR VALUATION $ ENGINEER ADDRESS `a j BLDG.SETBACK FROM TEC FRONT PROP.LINE OF (STREED CONTRACTOR , NO HIGHWAY• + YARD TOTAL SMACK FROM TYPE OF EXISTING /� LIC. - FRONT PROP.LINE HIGHWAY WIDTH ADDRESS Oil, NO LIC. + CITY CLASS CONS RUCT N LENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OF - (STREET) ` HIGHWAY t YARD TOSFROM TYPEOF EG IDE OP.LINEHIGHWAY WIDTH ADDRESS ° Vd' � ?� RH SO.FT NO.OF NO.OF CHECK + _ SIZE STORIES FAMILIES' ONE rrnnll DESCRIPTION OF WORK NEW A P.C.Fee$ (r7�.d•V Permit Fee t,'3-.3-0 ADD ❑ ' � ►�, t Issuance Fee ALTERland .-YLAJA de.kl, r-" ❑ !y . REPAIR ElTotal Fee USE OF DEMOL ❑ EXISTING BLDG." Z Z C APPLICANT TEL, (PRINT! o, O �6"/Z��a' 3 BY(SIGNATURE) X16 I HEREBY ACK EDGE THAT I HAVE READ THIS APPLICATION AND STATE 7 (�f q ]C THAT THE ABOV CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES ` d�• / '� W - ' AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING'THE ' • _ 5-5 9,0 A WORK AUTHORIZED HEREBY I WILL NOT'EMPLOY ANY PERSPN IN VIOLATION OF V THE LABOR CODE OF THE STATE OF CALIFORNIA IN.RELATIN O WORKMEN'S COM- Z PENSATION INSURANCE. g If 0 a 0 0 0 1 d SIGNATURE OF 2 5 9 0,6 0 PERMITTEE ' 4C ADDRESS — r ! Ah, • 2 6��%Z3'�D Z o0590,500 O CITY e /^ NO. I < 0.4,0,6-7.7 9 USE ZONE MAP NO. pjZiG3 SPECIAL CONDITIONS FINAL BY/ d DATE o / • rPPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN B DING RIESS I hereby affirm that I have a certificate of consent to self insure, ING ADDRESSor a certificate of Workers'Compensation Insurance,or a certifiedAV ycopy there (S c.38 0,Lab.C.) �, gL Y b _/ 141 70n LOCALITY , CePoli No. Company ��U�></ SIZE OF LOT NO OF BLDGS.NOW ON LOT rtified copy is hereby furnishe NEAREST CROSS ST. Jw ❑ Certified copy is filed with t cou ilding' spa ion TRACT BLOCK LOT NO. de�gJg'-,rt nt. USE ZONE MAP NO. Datef�/�Applies ASSESSOR MAP BOOK PAGE PARCEL / •� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTI ROM WORKERS' OW ER c `� TE �/ �J �O ®/ COMPENSATION INSURANCE Ste/ / 0 WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS zt— 10 DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit p _� is issued, I shall not employ any person in any manner so as to AR RITE ORE WEER TEL NO. J become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS N— 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 TEL `� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �J V FRONT comply with such provisions or this permit shall be deemed revoked. R SS UC.NO. PL LICENSED CONTRACTORS DECLARATION7, SIDE uC. ---- ys PL I hereby affirm that I am licensed underprovisions of Chapter 9 Crams SEWER MAP off,. (commencing with Section 7000)of Division 3 of the Business and FT.SIZE NO OF-STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effec NEW ❑ BK PG ® c�3 ` License Number Tint 7 tic.Class RIPTION OF WORK ADD ❑ VALUATION �p Contractor � .� /� �Dateazmp ALTER ❑ $ 7 w �- J7vlV CL ❑ I am exempt under Sec. REPAIR $ y Z BAP.C.for this reason y DEMOL ❑ LDMA P/C¥ D t USE OF E IS ING LDG. URM ❑ Signature (CANT rNJ�o T OLDMA Perm#I,as owner of t party, or my employees with wages as Z their sole compe sation, will do the work and the structure is / / O not intended or offered for sale (Section 7044, Business and AD � `/ 1 57 A FINAL DATE Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ii YYW Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ NO❑ j I ji o Business and Professions Code.) HALL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING _- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH i iE_.f A CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ "CHANGE ��( CM W the performance Of the Work for which this permit IS ISSUed(Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ CM TITLE 2.CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20.140 CONCERNING HAZARDOUS i {r r + Lender's Name MATERIALS REPORTING AND FOR OBNING A PERMIT FROM THE SCAOMD. �00—JI-0-013I V/' TAI o Lender's Address OWNER OR AGENT c I certify that 1 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 const ion, and he authorize representatives of this County ISSUANCE FEE /� �D to er pon thea mentioned party for inspection purposes. G"- m INVESTIGATION FEE TOTAL FEE Q D SEE REVERSE FOR EXPLANATORY LANGUAGE