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Home My Public Portal About9931 LOWER AZUSA RD_Building__ WORKERS'COMPENSATION DECLARATION to f insure,or a certif caf to of Workers' Compensat onI have a certificate of con3ent Insuran e, APPLICATION FOR BUILDING PERMIT or o certified copy thereof (Sec.-3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished: FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING 957 �. J�� tion deportment. ADDRESS �^ LOCALITY - NEAREST Date Applicant CITY. 7f IP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. BLDGS. ASSESSOR' COMPENSATION INSURANCE SIZE OF LOT /� 0 NO ON LOT - MAP BOOK PAGE PARCEL MAP (This section need not be completed If the permit is for one USE ZONE NO hundred dollars($100)or less.) TRACT BLOCK LOT TEL.. #f SPSPEE CIAL I certify that in the performance*of the work.for which this' • OWNER . NO.AV7 'J CONDITIONS d permit is issued, I shall not em to on In an manner' GROUP TYPE FIRE SSED•BY O P P Y Y Y ADDRESS �� 'f� CONST. ZONE V so as to com subject to the s' pensati Laws. OC Dare A lic clrY ZIP PP ARCHITECT OR TE9 �� ST TI dCAI IFIGATION CONDO. V NOTI TO APPLICANT: If, r making this Certificate of ENGINEER S�L NO. CLASS NO.. =_1 DWELL. UNITS d Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS �"" SEWER MAP H with comply-with such provisions or this permit shall be ? deemed revoked. CONTRACTOR `—' NO.NO. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. 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. Od Professions Code, and my license.is in full force and effect. CITY CLASS _ 50. FT. NO.OF NO.OF CHECK License Number lic.Class SIZE ��STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK ❑ $ ADD p I am exempt under Sec. ALTER ❑ DATE B.BP.C. for this reason REPAIR ❑ DATE Date: USEOFSTING BLDG. MMOL ❑ FINAL EXI By APPLICANT TEL. OWNER-BUILDER DECLARATION PF NO I hereby affirm that I am exempt from the,Contractor's License A , 1 0 59 A Law for the following reason (Section 7031.5, Business and DRESS Professions Code): BUILDING 1' 05 owner of the property, or my employees with ADDRESS 21-' - 2 a 5 0 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY e je e 2 $'5 0 cull 7044, Business and Professions Code). MOVING TEL. I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- 0 7'—'8 3 tion 7044, Business and Professions Code). '�RE� REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY gq YARD HWY PROP. LI WIDTH ► I hereby affirm that there Is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. - JSec. 3097, Civ. C.).' SIDE m P.L Lender's Name Lender's Address P.C. Fee$ Permit Fee r 0 I certify that I have read this application and state that the. Issuance Fee S� above Information is correct. I agree to comply with.all County Investigation Fee ordinonc and a laws relating to building construction, Total Fee and h ou r ze repre ntotives o Is County to enter u or.inspect pur ses. a SEE REVERSE FOR EXPLANATORY LANGUAGE e Ag o Icant,o ent to �s D88-3 23M 0"S 6-" - + -- DEPARTMENT OF BUILDING AND SAFETY APPLICATION . OR PERMIT COUNTY OF LOS ANGELES BU l"LD 1 N G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY D113TRICT NO. PLAN CK. NO. PERMIT NO. BUILDING ADDRESS LOCALITY RECEIVED BY DATE OF APPL. DATE 1881.&D NEAREST Gap L-.� 6--41-7- :5 /,6 CR089 ST i v BUILDING OWNER ADDRESS MAIL LOCALITY !J ADDRESS r TEL. CROSS ST. CITY � NO. ARCHITECT OR TEL. ZONE I PLANS TYPE I GROUP ENGINEER NO. BLDG. .r( �� /�[ NO. ADDRESS SETBACK LINE �(�U TEL. APPROVED CONTRACTOR NO. BY DATE UBE APPROVED ADDRESS ZON / BY DATE LEGAL ,,^,� ,..�-. CORRECTIONS DESCRIPTION I LOT NO. V I BLOCK r/ TRACT �� - 6 O ► Q 4 NO. OF BLDOB.W f� SIZE OF LOT I NOON LOT EXISTING BLDG. r FAMILIIED I ROOMS DESCRIPTION OF WORK NEW ALTERATION I ADDITION O N REPAIR MOVING ey DEMOLISH 0 H ZE�. d ROOMS /�_ STORIES WALL ROOF COVERING I COVERING Use OF NEW BUILDING APPROVALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATIONI LOCATION, INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAMEI FIRE STOPS, BRACING, BOLTS SIGNATURE OF OWNER LATH, INTI AUTHORIZED AGT 1 LATH, EXT-1 $ P. C.• PLASTER, INT. FEE PLASTER, DCT. VALUATION FEEI FINAL S f� y d I'n _' _. 00" 25N erre s-.Is � DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES S u ��` ® ' 1 wm. J. FOX. CHIEF ENGINEER N G FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN-CK. NO. PERMIT NO. BUILDING ✓� ADDRESS IV LOCALITY R IVSD B� DATE OF APPL. DATEISSUED NEAREST /_ -';2 �//�� -�I'^f� CR088 ST. 7/IiG BUILDING OWNER ADDRESS MAIL LOCALITY ADDRESS NEAREST TEV CROSS ST. CITY NO. GROUP FIREARCHITECT-OR TEL. ZONE �' I PLANB-'�`( TYPE I ENGINEER NO. BLDG. NO. ADDRESS � SETBACK LINE TEL. APPROVED CONTRACTOR NO. BY DATE UBEAPPROVED ADDRESS O ZONE BY DATE LEGAL CORRECTIONS DESCRIPTION �I/ !!2! ` LOT NO I BLOCK TRACT r' NO. OF BLD88. SIZE OF LOT I NOW ON LOT USE OFNO.Or* NO. OF EXISTING BLDG lI FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION D D REPAIR MOVING DEMOLI8H I O_ Bq. FT. NO.OF /I SIZE ROOMS STORIED /r WALLt� /y COVERINQ l�/, t� IROOF COVERING USE OF NEW ?� BUILDING APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS INSPECTOR DATE APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATIONI LOCATION, AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE 8TOPSr SIGNATURE OF. BRACING, BOLTS OWNER. LATH, INT.: AUTHORIZED AGT LATH, 13M.1 $ P. C.0 PLASTER, INT. ]( FEE PLASTER, EXT. VALUATION FEE �1 FINAL L ,S DNISIOF BUILDING AND SAFETY De FO BUILDING Department of County Engineer County of Los Angeles APPLICATION WM. J. FOX, COUNTY ENGINEER � FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DIBTR�D. P K.OR RQC.No. 6 1�% BUILDING S- ADDRESS ��ITY REO BY DATE orAPPL. �QAT IBSUEQ ot N�AREBT CROSS.8T. BUILDING HER 1� ADDRESS MAIL LOCALITY C i ADDRESS NEAREST TR CROSS BT. �C�C PITY NO. FIRE NO.OF TYPE GROUP J ZONE PLANE ' ARCHITECT OR TEL ENGINEER NO. BLDG. ORD, NO. a ' SETBACK LINE ADDRESS 7 7 .7 USE APPROVED TEL ZO{NK BY DATE CONTRACTOR NQ HOUSE NUMBERING ADDRESS MAP NUMBER NO. ASSIGNED BY LEGAL CORRECTIONS DESCRIPTION (-LOT ND. ! BLOCK TRACT T + NO. OF BLDGB. SIZE OF LOT NDW ON LOT USE OF No.OF EXISTING BLDG. FAMILCIM DESCRIPTION OF WORK °>o o NEW ALTERATION ADDITION Z D r REPAIR DEMOLITION BSIIZE�• No. DMB STORIES EXT.WALLROOF COVERING OW/ERING USE OF BT URE INSPECTION FOR APPROVALS OCCUPANCY AS INSPECTOR'S SIGNATURE DATE FOUNDATION:LOCATION F=tMB, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PL,CATION PePLICATION AND STATE THAT THE INFORMATION GIVEN IB FRAMES FIRE STOPS, CORRECT. BRACING. DOLTS 'I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACEi LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION- GAB VENT,DUCTS BIDNATURE OR •iV . LATH, INT. PERMITTE � LATH: EXT. ADORE PLASTER, INT. AUTHORIZED AMT PLASTER, EXT. P.C. FEE HOUSE NUMBER COR- RECT AND PORTED VALUATION ro EE FFINAL 76AS38A 0833 1-67 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING ADDRESS LOCALITY RECEIVED BY +DATE OF ADPL. DATE ISSUED NEAREST / EARS , J//�/ �u ,I^`1 -4 O . CROW ST. BUILDING- OWNER r ADDRESS �T 7 MAIL• LOCALITY V) ADDRESS 7 CITY NO NEAREST CROSS BT. RdLoG�d�/ 4 FIRE NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE �I PLANE ENGINEER NO. BLDG. ORD. NO. ADDRESS SETBACK LINE APPROVED TEL. CONTRACTOR. `� NO. BY DATE UBE APPROVED ADDRESS ZONE/ BY DATE LEGAL DESCRIPTION LOTN'OC/y/3 I BLOCK �- CORRECTIONS Q _0 TRACT I �� .L /- PQ S 0 k,h S ' NO OF'BLDGS. /�'Gj`a 5 SIZE OF LOT �S � NOW ON LOT USE OF I NO.Or / I NO. OF EXISTING BLDG. FAMILI[9 ROOMS DESCRIPTION OF WORK NEW ALTERATION I ADDITION O - A REPAIR MOVING DEMOLISH O_ ABq. FT. NO.OF / _ 81ZE �'� �� ROOMS STORIES WALL � ROOF COVERING �s •t I COVERING USE OF NEWS BUILDING 1 HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPROVALS APPLICATION AND. 13TATE THAT THE ABOVE 18 CORRECT FOUNDATION: LOCATION,FORMS, MATERIALS , INSP�CTpR D AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES r AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING: BOLTS OWNER LATH, INT.: AUTHORIZED AGI'!— LATH, EXT.t P. C.S PLASTER, INT. O" FEE PLASTER, EXT. . 1P � / VALUATION FEE �,V FINAL ✓ a ra J �� U� Dj,-g III-69"M seta APPLICATION FOR PFAMW DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES BUILDING WM.J. FOX, CHIEF ENGINEER .OF BLDG. ORD.NO.f DISTRICT NO. PLAN CK. NO. PERMIT NO., P NS SETBACK LINE F B APPROVED Z NE BY DATE RBCEJVED BY DATE OF ADPL. DATE ISSUED USE APPROVED A ZE '1 I J g 2 r 2 1 i ONBY DATE l� 1T / J Y APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY C BUILDINGc y O NAME ADDRESS / L usR RD ADDRESS LOCALITY E L_ O 11 F p NEAREST U W CITY CROSS ST. < STATE TEL. LICENSE NO. NO. NAME �] W, (TQQ Z MAIL /,,Z S3 a, S T� J r. NAME 3 ADDRESS O TEL. ADDRESS CITY NO. CITY I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS V APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TSL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES . LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. 9 PT Z LOT,NO. OF I3 Give OF LOT p, SIGNATURE of O OWNER O E `r NO. OF BLDGS. AUTHORIZED AG BLOCK NOW ON LOT W JTRACT CORRECTIONS D USE OF 8LbdS. NOW ON LOT DESCRIPTION OF WORK USE OF BUILDING War Production Board orders. You are caution to consult withyour ooa ar. X u%q th® work auho z in this permit; Z a NEW TVPBGROUP r NO.OF NO.OF ALTERATION 'ROOMS FAMILIES ADDITION sive REPAIR STORIES I MOVING WALL COVERING SIP DEMOLISH ROOF COVERING $ P.C.S FEE 1 . FINAL.APP OVAL r INSP VALUATION / i FRI DA I NA , " 4 WORKEFS'COMPENSATION DECLARATION I hereby affirm that I•have a certificate of consent to selfIT insure, or a certificate of Workers'Compensation Insurance, APPLICATION FOR BUILDING PERM pr c t'ertified copy thereof(Sec. 3800, Lab. C.) C � COUNTY OF LOS ANGELES BUILDING AND SAFETY olicyNo.I&llq"9 CompanyWlr'11 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING F IF tion department. ADDRESS p� �1 pry, �r Date 4'Z3*-[v Applicant � 1„VLAR+ CITY rCii-rA- ZIP �v LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' .4 NO.OF BLDGS• NEAREST ' COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one /y ASSESSOR hundred dollars(=100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL I certify that in the performance of the work for which this OWNE NO. USE ONE MAP _ permit is issued,1 shall not employ any person in any manner �. �� • CSpj�p1ATIONS , so as to become subject to the Workers'Compensation Laws. V AOFOR90/77 do Date .2,3-CID Applicant CIT ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHIZAA � DISTRICT GROUP ITYPEST. FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINES Q E Compensation provisions of the Labor Code, you must forth- ADDRESS 5.0 1 5 / a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATJON APT. PONDO. N deemed revoked. CONTRACTOR NO. /li 1 Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNI 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 effect. CITY CLASS BK EPG VALIDATION SQ. NO.OF NO.OF CHECK u X License Number �� Lic.Class SI STORIES FAMILIES ONE .tSL&C N� vALUATION (,D ContractorUINTOCA Date 4' �gh DESCRIPTION of WORK. ADD f 3 I am exempt under Sec. ALTER , B.BP.C. for this reason Date: USE REPAIR : , Q'] EXISTING BLDG. * e 5 1 Q Signature APPLICANT L. FINAL �/c,� OWNER-BUILDER DECLARATION PRINT NO. — DATE �—Z<�`�l • J Q �I cT5 I hereby affirm that I am exempt from the Contractor's License ADDRESS =_ � FINAL�A 1 Low for the following reason (Section 7031.5, Business and A 09.23-88 Professions Code): By BUILDING I, as owner of the property, or myemployees with ADDRESS , :ACCTQ* wages as their sole compensation,will do the work and , -�.� the structure is not intended or offered for sale(Section LOCALITY �7JV7 969■01 7044, Business and Professions Code). MOVING TEL. I,as owner of the property,am exclusively contracting �' 1 ITM with licensed contractors to construct the project Sec- ADDRESS TOTS. �6� iD1 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SMACK YARD HWY RE UIRED �APROP.LINE WIDTSETBACK FROM H � T OECK 969.01 1 hereby affirm that there is a construction lending agency for FRONT ` �wLt� the performance of the work for which this permit is issued P.L. rrf�97�7L .00 (Sec. 3097, Civ. C.). SIDE P.L. M�den Lender's Name J� qe LDMA Ref.M 1 4,.W` e $ P.C.Fee i (/J Permit FseL L 1 9■ Lender's Address 46 ■ 1 certify that I have read this application and state that the Issuance Fee O LDMA P/C N above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee 0 LDMA Perm.M R and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. >zb _ �{•23• a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote