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Home My Public Portal About10665 LOWER AZUSA RD_Building__ € ?aPLI'CA'TION FOR B'U ILDI NG PERMIT •,' FOR'APPLICANT TO FILL INA (Print or type only)' BUI LDING. .�� - •COUNTY'OF.ZOS,ANGELES -� .ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION CITY . "' ZIP - _ .OF BLDGS, - BUILDING SIZE OF'_ O.O NOW ON LOT �-- . ADDRESS �6�. TRACT`��O BLOCK LOT NO. LOCALI Y _ �y\ TEL. NEAREST - OWNER_C��,�;V e�'�T1 VC)'v. NO. ...._. CROSS ST-. -. •ASSESSOR :.., .. . ADDRESS` VZ'i '�1 MAP-BOOK PAGE---` PARCEL i DISTRICT GROUP TYP FOIRE. -' ROC S- D:*BY .. NE CITY . ... �:J�, ZIP -. -' ,. -. � Z _ - ARCHITECT O TEL. ENGINEER . NO. -- - .S.TA,T.ISTICAL SIF ATI ON ''- '< ' ..._ - _. .. _ ..... - SEWER AP ADDRESS CLASS NO---o26 _DWELL;.UNITS - BK P6 •. CONTRACTOR I (�t�V NO USE ZONE NOP.'-. LIC SPECIAL - >ADDRE5Sq -NO'• �' CONDITIONS - .. ,•. / MID_ if �.j LIC. �p CONSTRUCTION Cy CLASSG ' ° �� ROAD DEPA.R TMENT APPROVAL REQUIRED :YES❑ - .NO ❑ TION LENDER NAME AND BRANCH BLDG.SETBACK FROM �. - 1• � - - (STREET)- FRONT PROP.LINE OF - - - �- ADDRESS, .CITY - - - CD HIGHWAY — TOTAL SETBACK FROM TYPE OF EXISTING U } YARD — SO_'F s NO: OF NO, OF CHECK FRONT PROP.'LINE HIGHWAY WIDTH CC SIZE - I STORIES FAMILIES �ON.E , - - _ _O NEW + Lu -DESCRIPTION OF.WORK - - ADD SLDG.SETBACKFROM' SIDE PROP. LINE OF = STREET) Z - ALTER-E] HIGHWAY + 'YAR TOTAL SETBACK FROM TYPE OF. EXISTING _ _ - D - -.: R EQ.PA I R` -SIDE PROP. LINE; HIGHWAY WIDTH USE OF e EXISTING BLDG.. f�( DEMOL APPLI.0-ANT• TEL -=.CORNER,-CUTOFF:. ' :.YES ❑ NO ❑ (PRINT) NO.. .: .. IN'OPE-N SPACE .YES.❑ •.'NO ❑ B,Y._(SIGNA TU REI.' _ IN COAST.A LZONE., .,� YES ❑;.: NO VALUATION KNOWLEDGE THAT - 1 CATEGORICALS*EXEMPTION'A� YES, NO ❑ 'AND.'S.TATE THAT' THE'ABOVE IS Co COMPLY ENV IRO_NMENT AL, E T I HAVE READ THIS APPLICATION . AL.?EXEM PTI,O NiDECLA RATION'SIGNEDA+y -(DATEb LY IMPACT y - WITH' ALL ORDINANCES'AND LAWS REGULATING -BUILDING -.CON- STRUCTION."'..I -CERTIFY. THAT IN:DOING THE__WORK"AUTHOR.I ZED. IMPACT REPORTPROCESSED (DATE) HEREBY. I WILL.NOT EMPLOY ANY PERSON- IN VIOLATION OF,THE - - LABOR CODE OF THE, .STATE OF CALIFORNIA IN'RELA'TI NG.TO. - - WORKMEN'S CO PENS N-,- UR ANCE. SIGNATURE - PERMITTEE, ADDRESS -. .. .. _ FINAL-... _ - - 'f1/(-O_ N0..6 /�'7!' [DATE.,-w.,9 BY 1 L l; KE CHECKS. NAYABLL-' TO: s PMT. F e FEE ,. HARVEY T.. COUNTY COUNTY .ENGINEER -; _ PIAN CHECR_`VALIDATION CK. M.o: =ASH -' 'PERMIT VALIDATION CK. M°a . 'CASH- 0 Z6 2PUCi .. _ - 0:2 34Z 0 C T ,- 4'. 1...D 2:. 7 0 I:76A63.8A'CE-#803 12/7.2:. DEPARTBU NT. OF COUNTY ENGIPiM DIVISION OF BUILDING AND SAFETYN G - COUNTY OF LOS`ANGELES �u �~ WILLIAM:J. FOX, COUNTY.ENGINEER { APPLICATION', { CASSATT D. GRIFFIN, SUP'T OF BUILDING FOR APPLICANT m TO FILL-IN FOR.OFFICE,,USE,.ONLY DISTRICT NO. 'PLAN C7 CK.OR REC.No. PPE/R�MIT :� NO ' NG ADDRBUILDESS'/ / V' 1-4 I GJ l tom! LOCALITY C/. RECEIVED BY f DATE OF APPL. DATE ISSUED, NEAREST - j""I�. 1••- - , /� •� { .. CROSS ST. sem/ ��- �♦✓ BUILDING .� { OWNER C u - - ADDRESS! W@ S / t . ' - MAIL '•-�^7 / LOCALITY , - 'ADDRESS /L ._-"` A!2'. i•� NEARESTI TELCROSS ST. CITY"-,m5 d' / NO.-A717%, .6. - FIRE E NO. OF. -TXPE.. - GROUP: _ ARCHITECT OR � - TEL ------ , 4 - .'ZONE ' PLANS ENGINEER NO. , �+- _K[ i- • ADDRESS BLDG 1 ^'' p^J D•i O. / SETBACK-LINEUSEAP , TOR ..,4,e � f TE//L11 7 //16 ZON l�BYFoRCOV.. - 'ATE CONTRA �� dS HOUSE NUMBERING LEGAL - MAP NUMBER e� NO. ASSIGNED BY- :DESCRIPTION LOT NO. I :BLOCK , .:"i CORRECTIONS -- , TRACT '.`� - - ,p5, - � _ ;'•r NO. OFNBLLDGS. I SIZE'OFLOT.;� IoD. I- NOWOOT• /USE OF NO. OF - EXISTING BLDG. FAMILIES DESCRIPTION OF WOR$ a>�r.t o _ ALTERATION RE NEW. , ( r7j DEMOLITION I� ADDITION I D F SQ. FT: IVO'.'OF- SIZE' D ROOMS STORIES `EXT.`WALL ROOF COVERING S¢Allo I COVERING USE'OF STRUCTURE APPROVS PP INSPECT R'S SIGNATURE. DA-EE FOUNDATION: LOCATION FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT-I HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS' BRACING, BOLTS '-'COF AGREE TO COMPLY WITH ALL. COUNTY ORDINANCES FURNACE:.LOCATION, p � f`7 'AND STATE,LAWS REGULATING BUILDING CONSTRUCTION.. GASVENT, DUCTS /�. SIGN:4TURE OF /' �-•- d LATH, INTI - / PERMITTE u ADDRESS - t . A7, PLASTER, INT-. - �� f 1 '/•... :AUTHORIZED AG . .. 00 -PLASTER,%EXT - -.. $'- P, C. t6 ,HOUSE NUMBER COR FEE RECTAAND POSTED VALUATION / FEE B Z.�.. FINAL •• ?/ r 78ASSSA, DBS 3, 8-52 _ 1 ^'76A638A CE'48.03 4/72 • APPLICATION. FOR BUILDING-. PERMIT COUNTY OF-LOS ANGELES ASSESSOR _ �DEPARTMENT OF .COUNTY ENGINEER MAP BOOK PAGE. PARCEL BUILDING AND SAFETY DIVISION BUILOING MAKE CHECKS PAYABLE TO: ADDRESS L.C`�CCS�O -ULcJL9/1S \ HARVEY T. .BRANDT, COUNTY ENGINEER LOCALITY M I9 FOR APPLICANT TO FILL IN. NEAREST.- 1. (Print or tVDe only) CROSS ST; Q_ ry _ DIISSTTRICT NOr GR�OOU.P- T-YPE PRO ESSED BYBUILDING - ADDRESS / J d� lX/ .Z S G�- J - rY - CONST.fe/ . STATISTICAL CLASSIFICATION', .� SEWER MAP ,LOT NO. BLOCK �T CLASS NO: 'DWELL,UNITS. ' BK-p EPG TRACT - USE ZONEMAP.�-7 NO.OF.BLDGS. - NO. ' �-✓� b _ :SIZE OF LOT- , NOW ON-LOT .�. �' SPECIAL - USE OF _ - CONDITIONS D - - - - - - EXISTING BL )G. -r'r- TEL. OW,NER �1 NO: �% BLDG.:SETBACK,FROM ADDRESS q - �\ '�'� FRON.TPROP.LINE OF- - (STREET)` , - ,TYPE OF.EXISTING .SETBACK, HIGHWAY- }, -YARD =- TOTAL 1. �.,`._ HIGHWAYWIDTH' ,FROMC.L: .....d _ - A,RCHITEtCT-OR - .-. - _ TEL. . - -. - - r •+ .ENGI.NEER- NO` �� BLDG..SETBACKFROM.' - d ADDRESS• �. ,� - �. �,- SIDE PROP.LINE OF' (STREET) ,CC:) TE-L.- TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL CONTRACTOR W 1 �j^ - NO. - HIGHWAY WIDTH. FROM-C.L. A LIC U A_ OR ESS,/' d_ G. - C, NO. -- ,, - LIC. ❑ N. CITY -�,� ' ! CLASS _ - CORN ER_'CUTOFF YESNO Z CONSTRUCTION LIENDER - NAME AND BRANCH 1�0 -SEE REVERSE` SIDE FOR SPFCIAL APPRO�AL �. ADDRESS _ A . .SQ. FT. (� NO. OF NO.-OF NEW .t iJ.r --. .Ar!`yCliA� s l.. SIZE _( STORIES FAMILIES USE OF �aijV` -T - ADD., - . / / T3. STRUCTURE Oek y� t '� - ALTER .REPAIR❑ SIGNATURE O vj APPLICANT DEMOL 'Q - VALUATION $ "--APPRO .ALS _ P,C. PMT: j FOUNDATION:j LOCATION. - FORMS, MATERIALS 'FEE $ FEE $' -.. - � FRAME:`FIRE STOPS I HERE BY'ACKNOW LEDGE THAT I:HAVE READ THIS APPLICATION BRACING, BOLTS-- - AND.STATE THAT iHE.ABOVE ISCORRECTAND.AGREE TO COMPLY. FUR.NACE::LOCATION,. WITH ALL ORD I NANCES,AND LAWS'.RE GULATI NG' BU ILDI NG CON- .GAS VENT, DUCTS STRUCTION; I. CERTIFY THAT IN DOING THE:WORK AUTHORIZED _ - HEREBY I WILL-NOT.EMPLOY ANY PERSON IN VIOLATION'•OF THE / yF LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO LATH, INT. ee WORKMEN'S COMPENSATION INSURANCE. - .LATH, EXT. SIGNATURE 0 � HOUSE NUMBERCOR- PERMITTEE C7 ° / .i9�1JQ RECT AND.POSTE D- ADDRESS - FINAL PLAN CHECK VALIDATION CK. . M,O. - CASH _ PERMIT VALIDATION cK. ' M.O. , CASH �; :ac 21 '2-4.-.00— "_ WORKERS COMPENSATION DECLARATION - . _, _ • oy affirm,that k have'a-cerhficate of consent. to self A P P L I C AT I - f Sul PERMIT e, oda certificate of Wwkers'Cdrmpenstion Insurance, or- rtified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY licy NO.—Comp any BUILDING _ '.�• + Certified copy is hereby furnished. FOR APPLICANT TO FILL'IN ADDRESS f0� Certified copy'is filed with'the county building inspec- BUILDING' rt ' tion department. . ADDRESS 1. 6 /J/� 'LOCALITY T,. Date Applicant NEAREST PP t CITY - �' IP 'CROSS ST: CERTIFICATE OF EXEMPTION FROM-WORKERS' SIO. F BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT, QO, 'NO -0N LOT- MAP BOOK PAGE PARCEL'' (This section'need.not be completed if the permit.is/for one tv a N hundred dollars,($100)or.less.) TRACT BLOCK LOT NO. — NOP ,USE ZONE ... T � SPECIAL �- .� OWNER O. '( L CONDITIONS I certify.that in the performance of the work.for which this ., O permit is issued-' I'shall not employ any person in ony manner / DISTRICT AGROTYPE; FIRE PROCE ED BY so to become subject to'the Workers:Compensation Laws. ADDRESS( 1. CON3T�' Date Applicant CITY ZIP STATISTICAL CLAS IFICATION - PT•. LF3ND0 V ARCHITECT OR.. TEL. NOTICE TO APPLICANT:-If, after-making this Certificate of eu Exemption, you -should•become subject-to We Workers' ENGINEER N NO. CLASS N DWELL. UNITS N +Compensation'provisions of Thellabor Code you must forth ADDRESS —SE VV; MAP with comply with such provisions or this permit shall-be ill deemed revoked. CONTRACTOR" /I�S2.+ NO., , BK PG, VALIDATION. LICENSED CONTRACTORS DECLARATION. LIC. f I hereby affirm that I,am licensed under provisions of Chapter 9 ADDRESS . ;.• NO. VALUATION. (commencing with'Section 7000)of Division 3 of the Business and LIC. �l Professions Code, and my license is in full force and effect. CITY CLASS $ I L✓ a (/ SQ. FT. NO. OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE Contractor Date ai� EW O $ DESCRIPTION OF WORK t I am exempt from the licensing requirements as I am a 'ADD' licensed architect or a registered professional engineer ALTER 0 FINAL acting ;in my.,professional.capacity (Section ,7054, ) a DATE Business and ProfessAoris Code).j , USE OF, REPA DE L { FINA EXISTING BLDG v ) By Lic.or Reg No. Date APPLICANT TEL OWNER-BUILDER DECLARATION (PRINT) jIJ - NO. Z I hereby affirm that I'am exempt from the Contractor's License Law,for,the•following reason (Section 7031.5, Business and' ADDRESS` �/✓ L Pro fe ons Code) PRESENT BUILDING.. _ ` 11, as owner of the-property, or my. employees with ' ADDRESS ' wa es as their.sole compensation'will do the work and. 9 P LOCALITY r ' the structure is not intended oroffered for sale(Section ��', '.�� z V1144� 704`4, 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 ADDRES tion'.7044,-Business and Professions Code). - —/ 1.'8.'8,3 A- REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY' :' SET BACK YARD' -HWY PROP. LINE WIDTH #'o e o 0 0 �- I hereby affirm that there.is.a construction-lending agency for -FRONT ' I he performance of the'work for which this permit is issued' P.L. 2 0 0,9 (Sec.,3097, Civ: C ): •. SIDE ,.- ,• .. .1, < • 700 P.L. Lender's Name .L4 7 O0 U 7 - - P.C. Fee$ d� Permit Fee _ .,0'Q,21V'—_C7 U Lender's'Address i _ Q w I certify that I have read this application and state that the .- Issuance Fee above information is correct. I agree.to comply with all County - nvestigation Fee •-• - ordinances and State laws relating.to building construction, — ---+ and:'hereby authorize.representatives of this County. to enter Total'Fee aupon„the above-mentioned)roperty for inspection purpose a SEE-REVERSE FOR EXPLANATORY LANGUAGE _ - .Signature'of Applicant orAgent Date