HomeMy Public PortalAbout10639 LYNROSE ST_Building__ 76A688A CE0808 6.63 APPLICATION.FOR••_BUILDING PERMIT
COUNTY OF LOS ANGELES ' ' BUILDING, s�
DEPARTMENT OF COUNTY''ENOINEER ADDREss .
BUILDING AND- SAFETY.DIVISION LOCALITY ��AV
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
.WILLIAM A.'JENSEN,SUPT OF BUILDING ,CROSS ST.
DIST ICT NO. GROUP TYPE PRO SSED BY
FOR APPLICANT TO FILL IN CONS ...
BUILDINGSTATISTICAL CLAS IFICATION SEWER MAP
ADDRESS 10639 L nrose -St'..' T. C.. �' BK PG
CLASS:NO. DWELL.UNITS
LOT-NO. BLOCK WATER
CERTIFICATE:
NOT REQUIRED ❑ RECEIVED ❑
•
TRACT O MAP* HIGHWAY STATE MAJOR SECON
// NO.OF BLDGS. NO. �(� (CIRCLE) CAL
SIZE OF LOT -NOW ON LOT �L USE ZONE. SPECIAL
USE OF CONDITIONS
EXISTING BLDG. TEL
OWNERLionel Horsey NO.286-391 'BUIL'DINGEXIST.
SETBACK YARD HWY STREET NAME' WIDTH
ADDRESS 9047 E. Olive St. . T. C-., FRONT
ARCHITECT OR TEL P. L.
ENGINEER' NO. SIDE'
P. L.
ADDRESS
TEL
CONTRACTOR Virgin Roof 'CoIwo , 287-05 v
ADD14ESS600 So. Zan Gabriel Blvd,
'DESCRIPTION OF WORK
NEW, ADD ALTER REPAIR' DEMOLISH Z
SQ.FT. NO.OF NO.OF z
SIZE STORIES FAMILIES. '
STEOTU a Reroof house & -att'. gar.
compo. shixlgTes..
SIGNATURE OF
APPLICANT -
VALUATION S 260.00'
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: 'LOCATION
F E-$, •FEES 6.00 FORMS, MATERIALS "
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE'THAT I HAVE READ THIS APPLICATION •BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. -
WITH ALL COUNTY ORDINANCES AND STATE' LAWS REGULATING GAS VENT. DUCTS
BUILDINGCONST CTION.,I CERTIFY THAT IN DOING THE WORK _
AUTHORIZEDHER BY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LAB ODE OF THE STAT OF CALIFORNIA REL T-
ING TO WORKMEN'S MPENSATION IVSU ANCE. ,LATH. EXT:
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE •RECT AND POSTED { ,n
ADDRE a Cla .1 en, 6C Y• FINAL L
'J.OHN.F. LEWIS. PRINCIPAL ST 'CT RAL ENG iJEER
PLAN CHECK-VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
0. 5' 6 SIM OCT 1$ 1 .D' 6.0,();e
1
APPLICATION FOR
BUILDING PERMIT '
' COUNTY OF LOS:.ANGELES BUILDING.AND SAFETY
WORKER'S COMPENSATION DECLARATION' FOR APPLICANT TO FILL IN BUILDING ADDRESS /►
I hereby affirm that I have a certificate of consent to self insure, �UILD_ING q9D 0
or a certificate of Workers'Compensation Insurance,or a certified M '
copy thereof(Seo.38 0 Lab.C.) ZI
S C � � LOCALITY(-
Policy No- •R b Company x � nT SIZE OF LOT NO.OF BLDGS.NOW ON LOT
11 Certified CROSS ST.Certified copy is hereby furnished. _
❑ Certified copy is filed with the coy building inspection TRACT BLOCK LOT NO.
departure t. �' USE ZONE MAP NO.
Date Applicant `U` ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTIO OM WORKERS'
COMPENSATION INSURANCE COn�.e L 8 TEL NO J VnTHIN 1000 FT OF SCHOOL? YES NO
This section need not be Com leted if the permit is for one hundred ADR S �(�/
( P, P -Z� l� DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
dollars($100)or less.) _ ,
I certify that in the performance of the work for which this permit G er
ZI /2
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO.
become subject to the Workers'Compensation Laws. STATISTICAL CL&BSIFICATION 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' TR R� t A-FL 1 �/ SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Cade, you must forthwith I , LI v � /?J7 .!� 2, ;F
FRONT
comply with such provisions or this.permit shall be deemed revoked. ADDRES �® r �I U NO [ PL
LICENSED CONTRACTORS DECLARATION G SIDE
I hereby affirm that I am licensed underprovh ions of Chapter,9 /Q �v v ` SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE'V NO.OF STORIES NO.OF FAMILIES
Professions Code, m licgns is in full force and effect. NEW BK PG , a
Z[ C'�3�f� 4 ON OF WOR ADD ❑ VALUATION Q
License Numb r Lic.Class
Contractor A ate S��G` ALTER ❑ $
❑ 1 am exempt under Sec. 1 REPAIR ❑
B.&P.C.for this reason �i ! DEMOL ❑ LDMA P/C# W
Date: USE OF EXISTING BLDG. URM ❑ i N
Signature APPLICANT(PWNT) TEL NO. LDMA Perm# 1 Z
❑ 1,-as owner of'the'..property, or my employees with wages as : Z IT e
'their•sole compensation, will do the work and the structure is ADDRESS 0
not intended or offered for sale (Section 7044, Business and FINAL DATE 7 G 3303 107.10
Professions Code.) I WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL (/�` J ITEMS
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project (Section 7044, TOTAL 107 - -10
YES❑ NO❑
Business and Professions Code.) I WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING 107.10
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ,
CONSTRUCTION LENDING AGENCY CK
COOGUIDAIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE.PERMITTING CHECKLIST FOR =0f.=
I hereby affirm that there is a construction lending agency for YES 13 NO
❑ sr
a the performance of the work for which this permit is issued(Sec.
I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING
N 3097,CIV.C .) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, `-)Tyry�y� TT�y a 5/24/?5 .yi/p
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20:140 CONCERNING HAZARDOUS 0000 00.G /2%'/7
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.
Lender's AddressI (TJ91 1 PM 504
4
OWNER OR AGENT
c I.certify that I have read this application and state under penalty
0 of perjury that the above information is correct.I agree to.comply P.C.FEE PERMIT FEE pS l
a with all county ordinances and State laws relating to building (�s
construction, and hereby authorize representatives of this County ISSUANCE FEE ;
m to Brit (�lipon th -m gntioned property for inspection pur o s. I
INVESTIGATION FEE d
m TOTAL FEELfP
^ re m n '
SEE REVERSE FOR EXPLANATORY LANGUAGE