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HomeMy Public PortalAbout10159 LOWER AZUSA RD_Building__ APPLI-CATION ' FOR BUILDING PERMIT OR APPLICANT TO FILL IN (Print or type only)' BUILDING COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY zlP BUILDING AND SAFETY DIVISION /'NO.OF BLOGS. BUILDING SIZE OF LOT /�V�c,.�(/ NOW ON LOT ADDRESS TRACT O .2_ BLOCK LOT NO. LOCALITY TEL. NEAREST OWNER !"" NO: CROSS ST. ASS SSOR ADDRESS , .�G�.e �j G.L%J�/,i MAP BOOK PAGE RCEL _ DISTRICT IGROUPITYPE FIRE PRO ES^ED BY CITY ZIP i. � CONST.�� ZONE � �( !l j� ARCHITECT OR- - TEL. 61 U _T_ -�" ENGINEER NO. STATISTICAL CLASS//IFICATION SEWER MAP ADDRESS - TEI_r� +[,9 CLASS NO.�'LDWELL.UNITS BK PG CONTRACTOR � -c V NO. ?j�)— /V USE ZONE MAP /A / !` '] NO. C/ ADDRESS V 4C I �aA� NO SPECIAL / ��'� SPECIAL LIC. �f� CONDITIONS CITY �" �TQ.eI r CLASS Ka - ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTIONNAMEAND BRANCHNDER .BLDGETBACK FROM FRON PROP.LINEOF (STREET) ADDRESS - CITY _ TOTAL SETBACK FROM TYPE OF EXISTING SQ. FTN0. OF' NO. OF CHECK NIGHWA } YARD - HIGHWAY WIDTH ' FRONT PROP. LINE SIZE V� STORIES FAMILIES 'ONE DESCRIPTION OF W/LRKNEW J�9�'LCr..vo�/�c3 ADD ❑ U BLDG.SETB FROM SIDE PROP.LIN (STREET) CC y� /- ® LTER HIGHWAY } YARD = T0TA BACK FROM TYPE OF EXISTING V (r✓ !i7REPAIRly ❑ LLJ SIDE PROP. HIGHWAY WIDTH USE EXISOTIIVG�'BLDG. / J DEMOL ❑ } _ Z APPLICANT �, i�� NELy CORNER CUTOFF YES .0 NO (PRINT) ❑ BY (SIGNA TUR [ SIN OPEN SPACE YES ❑ NO ❑ QQ �+-�j IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION,P I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I' WILL NOT EMPLOY ANY ,PERSON IN VIOLATION OF THE - LABOR CODE OF THE ST TE OALIFORNIA IN RELATING TO WORKMEN'S'COMPENS O NS E. 'J SIGNATURE OF ys 1 PERMITTEE �j� ADDRESS e_` FINAL BY CITY i / V�--`'�fAL NO. DATE - P:C. Q �* v PMT., MAKE CHECKS PAYABLE TO: FEE'$ FEE'$ HARVEY T. BRANDT, COUNTY ENGINEER 7— .PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT V DATION cK. M.O. CASH 32L'__'sF_P 18 1 21.75 ` 8 76A638A CE#803 574 ©s 76A638A CE#803(REV.11/78) APPLICATION FOR BUILDING PERMIT, COUNTY OF LOS ANGELES BUILDING AND SAFET FOR APPLICANT TO FILL IN BUILDING/A ,,/ � ADDRESS c � BUILDING LOCALITY ADDRESS 161S- 'g "7 m-a Z ' v{ NEAREST CITY ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT DS . ,L NOW ON LOT .!L MAP BOOK PAGE PARCEL r7 DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT �Q �. BLOCK LOT NO. nL CONST. TEL. 3.s'7 OWNER GA 7N0. STATISTICAL CLASSIFICATION SEWER AP ADDRESS ft y Cs`l Lel CLASS NO. DWELL.UNITS BIG CITY ' ZIP ARCHITECT OR, ' TEL. ^ ` VALUATION $ Q��Qd' ENGINEER -� \Z NO. ADDRESS 3° AC.j i"1 C ' BLDG.SETBACK F TEL. FRONT PROP.LINE OF ISTREETI CONTRACTOR ~{is NO.'. Aq-,A _ HIGHWAY + YARD _ TOTAL SET BA `F96M TYPE OF EXISTING . LIC. _ _ FRONT PR P E HIGHWAY WIATH ADDRESS TAr71 ti NO. 5 _ LIC. + CITY l�ftLTL CLASS W` BLDG.SETBACK FROM CONSTRUCTION LEND SIDE PROP,LINE OF (STREET) NAME AND BRANCH K 0N 4c- HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING � ADDRESS CITY L, - SIDE PROP.LINE HIGHWAY WIDTH_ u SQ.FT. NO.OF NO.OF CHECK + _ SIZE STORIES FAMILIES I`�. ONE at USE ZON NOP O�� 0 DESCRIPTION OF WORK 1'" � NEW SPECIAL 1,q (:-�- lj DD ❑ CONDITIONS Z ALTER ❑ FINAL BY REPAIR ❑ DATE USE OF DEMOL EXISTING BLDG.�` wLC:I \� , l\L ' F _ Q� O APPLICANT TEL �i �1 r PRINT( (q -VAA�00-1 BY(SIGNATURE( ' `•� sz I HEREBY ACKNOWLEDGE TION AND STATE he THAT THE ABOVE 15 CORRECT TAND(AGREE OHAVE ACOMPLY WITHTHIS AALLL ORDINANCES �v W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE / S WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF /s '�30 ---� U THE LABOR-CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z PENSATION INSUR CE.' ^ n g SIGNATURE OF PERMITTEE ' ADDRESS TEL. 3 J - r CITY QALIaAk NO,. / QC P.C. Fee$ Permit Fee > Issuance Fee � W 6 Total Fee DEPARMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFET7C COUNTY OF LOS ANGELES }. WILLIAM J. FOX, COUNTY ENGINEER . :�, APPLICATION U CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING p / �ryy� DISTRIC PLAN CK.OR REC.No. nS PERMIT NO. ADD ESSL� ` LOCALITY` C-�h �,�i�p RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST CROSS ST I6�. yP L-e -Z'I ,.�16 BUILDING AW, [� ° OWNER----V AW,I'A ADDRESS MAIL _M LOCALITY ADDRESS NEAREST <' 'r 9 TEL. ,CROSS ST. CITY _ O ARCHITECT OR TO,,, FIRE NO.(OF TYPE..-- GROUP ENGINEER O. ZONE PLANS I ADDRESS ; BLDG. ORD. NO. SETBACK LINE TEL_'; ELA USE APPROVED CONTRACTORf� ate,k EJt L.'!a k�AN ®�F� ZONE BY DATE"-- ADDRESS ATE"--ADDRESS k' y"6 ��"�0 6 , HOUSE NUMBERING LEGAL MAP NUMBER - NO. ASSIGNED BY DESCRIPTION I LOT NO. I BLOCK CORRECTIONS' TRACT NO. OF BLDGS. SIZE OF LOT I NOW ON LOT USE OF I NO. OF EXISTING BLDG. FAMILIES DESCRIPTION OF WORK o — NEWI ALTERATION ADDITION D REPAIR DEMOLITION I ( Z D r SQ. FT. NO. OF SIZE ROOMS STORIES EXT. WALL ROOF COVERING I COVERING USE OF STRUCTURE - t 1 APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION - FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, /1 PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS / CORRECT. FURNACE: LOCATION. 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES • AND STATE LA7EG TING BUILDINGS CtONSTRUCTION. GAS VENT, DUCTS A. h. SIGNATURE OF 1�.(f ��1.� LATH, INT. PERMITTE !/ LATH. EXT. ADDRESS - - PLASTER, INT, AUTHORIZED AGT. PLASTER, EXT. $ P. C. $ OUSE NUMBER COR- FEE HRECT AND POSTED VALUATION FEE $ 7GA698A 00113 9-92 WOFKERS'COMPENSATION DECLARATION r, -ihereby afcthat 1 have certificate of consent to self APPLICATION P P L I CATION .FOR BUILDING P E RM I T nsure, or aIcerertificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.'C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT T.O FILL IN BUILDING ADDRESS Polr ❑ Certified copy is filed with the county building inspec- BUILDING 10fb tion department. ADDRESS W V� Date Applicant CITY em !tom Cit ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' [� - NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT J- NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT C �5 L BLOCK A y LOT NO../ (� MAP BOOK PAGE PARCEL TEL.OWNER { U1VC'S� e 1. NO. `g _. 0 USE ZONE MAP I certify that in the performance of the work for which this f O NO. permit is issued, I shall not employ any person in any manner `ILCi �� SPECIAL so as to become subject to the Wor er 'Compen alio aws, ADDRESS �U L. CONDITIONS TY Date Applicant - _ c t f AIRCHITECT OR�A �(�I �' ZIP TEL. 71 DI�LRI T GROUP TYPE FIRE PROCESSED BY O NO TO APPLICANT: If, after making 4his Certifica e o ENGINEER h Wq NO. CONST. ZO E F-- Exemption, you should become subject to the Workers' / / V Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. a' (c� STATISTICAL CLASSIFICATION APT. NDO. Z deemed revoked. CONTRACTOR tC/ cU / O` �� �� rv'v� LICE NSED.CONTRACTORS DECLARATION, 1 rZrr J / C NC �� / CLASS NO. DWELL. UNIT I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 6 7'' U / SEWER MAP (commencing with Section 7000)of Division.3 of the Business and I LIC. p C / Professions Code, and my license is in full force and effect. CITY �>11�r�j CLASS B / VALIDATION SQ. FT.1 2 NO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VAL ATION l —4 8 8 IL 7 A NEW Contractor Date DESCRIPTION OF WORK $ ADD ❑ (/� (f 1 '# a a a a 2 3 ❑ I am exempt under Sec. } 1/ ALTER ❑ , - 439, 111 B.BP.C. for this reason REPAIR ❑ $ Date: USE OI r BLDG., DEMOL E] ° a 4 3 9.] '1 5 EXISignature APPLICANTh TEL. C�1 �s7 .� FINAL f_ 01.25-88 PRINT on� �� � NO. OWNER-BUILDER DECLARATION DATE L I hereby affirm that I am exempt from the Contractor's License 2,[` >/i `/� ,� f Law for the following reason (Section 7031.5, Business and ADDRESS V G t/� v V ( FINAL Professions Code): PRESENT BY BUILDING ❑ I, as owner of the property, or my employees with 'ADDRESS wages as their sole compensation,will do the work and LOCALITY Opp. i the structure is not intended or offered for sale(Section 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- tion 7044, Business and Professions Code). ADDRESS REQUIRED YARD HWY TOTAL SETBACK FR ='I - 748.5 ' CONSTRUCTION LENDING AGENCY SET BACK PROP.'LINE WIDTH hereby affirm that there is a construction lending agency for FRONT ° ° 7 4 5 0 3: the performance of the work for which this permit is issued P.L.. (Sec. 3097, Civ. C:). SIDE P.L. 0823;+88 Lender's Name 2 !) m P.C. Fee$ J�( Permit Fee t V LDMA Ref. # Lender's Address _ 3 ` g I certify that I have read this application and state that the Issuance Fee J LDMA P/C# above'information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee +� LDMA Perm. # and hereby authorize representatives of this County to enter up the above-m toned p erty for inspecticip purposes. �6 r SEE REVERSE FOR EXPLANATORY LANGUAGE Signal e%f A plicant or Age Date WORKERS'COMPENSATION DECLARATION 3dl� insure, or afcertif certificate of Workers' Compe of ensation on ent to Insuran elf APPLICATION P FOR BUILDING PE MIT Y or a certified cop thereof (Sec. 3800, Lab. C.) id�9� T�T� �_I). COUNTY OF LOS ANGELES BUILDING AND SAFETY Po icy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS 01 Certified copy is filed with the county building inspec- BUILDING r tion department. r1 ,}�1g ADDRESS J IF Datela. � Applicant �� St3tlri>? v V�In 6 CITY. % ZIP LOCALITY 4 CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT t9 NOW ON LOT M CROSS ST. (This section need not'be completed if the permit is for one ppy� ASSESSOR hundred dollars ($100)or less.) TRACT v BLOCK LOT NO. MAP BOOK PAGED PARCEL TEL. �+ / USE E MAP /) I certify that in the performance of the work for which this OWNER (. — , NO. 0�� /JZ7,g//N NO. O� permit is issued, I shall not employ any person in any manner ADDRESS.;?" )� SPECIAL. t so as to become subject to the Workers'Compensation Laws. V ` CONDITIONS 0 Date Applicant CITY Walb ZIP V� NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. qq DISTRICT GR UP TYPE FIRE PRO SED BY O Exemption, you should become subject to the Workers' ENGINEER © NO." s ao CONST. ZONE U Compensation provisions of.the Labor Code, you must forth- ADDRESS SI�� W with comply with such provisions or this permit shall be LL' T L. STATISTICAL CLASSIFICATION APT. $0NDO. N deemed revoked. CONTRACTOR p. �� � .�; Z LICENSED CONTRACTORS DECLARATION 'LIC 77 CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.44 JJ (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. Cffy�wa& CLASS BK LPG: 6 / VALIDATION SQ. FT. NO. OF NO. OF CHECK � License Number 21 2 13 Lic.Class 18 SIZE STORIES FAMILIES ONE �,/ ,`,6/^�/.�4 e DESCRIPTION OF WORK NEW VALUATION Contractor—.59 1 1'�� � L0t� Q $ ADD 7 1 am exempt under Sec. ALTER # 0 0 0 0 0 .1 B.BP.C. for this reason REPAIR $ Io o 6 p 5,0 Date: USE OF DEMOL EXISTING BLDG. 0 0 0 6 0. 5 0 5 Signature APPLICANT L. / FINAL Q OWNER-BUILDER DECLARATION PRINT NO+ � 6'�fI 11 DATF�' �'�CJ 01.0.6-87 .I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRE TEMM B O BUILDINGIpI s 1, 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. QCONTRACTOR NO. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIREDTOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH. t I hereby off irm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. 4 (Sec. 3097, Civ. C.). rInvestigation lender's NameLDMA Ref. # Lender's Address PermitteeI certify that I have read this application and.state that the Issuance Fee (< LDMA P/Cabove information is correct. I agree to comply with all County ee A o ordinances and State laws relating to building construction, Total Fee c� LDMA Perm: # R and hereby authorize representatives of this County to enter m upon th c'bc�v �,gmntionecl pr perry for inspection purposes. _ � tin� SEE REVERSE FOR EXPLANATORY LANGUAGE C �• � i�� �� ,� Signature of pplic6nt or Agen Date J