HomeMy Public PortalAbout10644 LYNROSE ST_Building__ 76ASSBA CE#809 B_eB APPLICATION FOR BUILDING Pl. RMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS Q
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER, NEAREST
WILLIAM A.JENSEN,SUP'T OF BUILDING CROSS ST.
DIST CT NO. GROUP TYPE P ESSED B
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL CLAS IFICATION SEWER MAP
ADDRESS 10644 L nrose St. T•• C —� --' BK PG
CLASS.NO. DWELL.UNITS -
LOT NO. BLOCK WATER NOT REQUIRED. ❑ RECEIVED ❑
CERTIFICATE.
TRACT i 0 MAP HIGHWAY
NO.OF BL )GS. % NO: �D (CIRCLE) STATE MAJOR SECON OCAL
SIZE OF LOT NOW ON LOT ` USE ZONE SPECIAL
USE OFCONDITIONS
EXISTING BLDG. `j
TEL
OWNERLionel NO.'• �-3q 1.1 BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS 9047 E. Olive St. • ' T. Ci. - FRONT
ARCHITECT OR TEL.' P. L.
ENGINEER NO. SIDE
P. L. >.
ADDRESS d
TEL. V
i
CONTRACTOR Virgin O.
ADDRESS 600 So. San GabrielO
DESCRIPTION OF WORK
' a
' N
NEW ADD ALTER REPAIR DEMOLISH Z
SQ.FT. NO.OF NO.OF
SIZE �+ house STORIES FAMILIES
USE OF
STRUCTURERerool ouse & att. gar•
wl 7T compo. silingies
SIGNATURE OF
APPLICANT �gvy7�a��or
VALUATION 260.00 JCy.AlOCI[X. APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FEE $ FEE $6.QQ 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
BUILDING CONSTRU TION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREB I WILL NOT E. LO ANY PERSON•IN VIOLA- LATH, INT. -
TION OF THE LABO CO E OF THE STA E OF CALIFORNIA RELAT-
ING TO WORKMEN'S ENSATIONQNS R CE. LATH.EXT. -
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT.'AND POSTED
arcla lria en; ec y.
ADORES FINAL
° JOHN F. LEWIS. PRINCIPAL STRAL EN (NEER
'PLAN CHECK VALIDATION. CK. M.O. CASH PERMIT VALIDATIO CK. M.D. CASH
iCo 6'-5 6 9 OCT 18 1 D 6.0 0^'
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, Z 16Z
BUIL I G Df
or a certificate of Workers'Compensation Insurance,or a certified 2
copy thereof(Sec.3800,Lab.C.) 0-1 , Z;)/ LOCALITY y
Policy.No. �'7G� Company Ul^ IZF,nP 1,011 NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST.
❑ Certified Copy is filed with.the county building inspection TRACT BLOCK LOT NO.
department
L.
USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL I
`� ✓ ,( SPECIAL CONDITIONS do,90 D/
CERTIFICATE OF EXEMPTIOaLFW WORKERS' OWN R E 0 WITHIN 100(((0 FT OF SCHOOL? r
COMPENSATION INSURANCE I @ G J"CiG ,�cb� YES NO
(This section need not be compieted'if the.permit is for one hundred
AADSSdollars($100)or less.)
DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
I certi that in the erformance of the work for which this ermit Q)AM
6is issed, I shall not employ anyperson in any manner so as to /'+ ZIP �dV(�,become subject to the Workers'Corripensation Laws. R ENGINEER TEL O.-
WAnsncAL CL/LSSIFICATION 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' CO R SET BACK YARD HWY PROP LINE' WIDTH
Compensation provisions.of the Labor Code, you must forthwith j7 n ���`�'l FRONT
comply with such provislons.or this permit shall be deemed revoked. App LIQLNO. PL
LICENSED CONTRACTORS DECLARATIONH SIDE
61TY ��
/ G LIC. L� P L
I hereby affirm that I am.licensed underprovisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division.3 of the Business and SO.FT.SIZE N F STORIES NO.OF FAMILIES.:
Professions Code, �d my licens ' in full force and effe NEW BK PG , }�
License Number •f U..Class DES ON OF RK C ADD ❑ VVALLI TION U
O
Contractor d -Date ALTER ❑
r ❑ I am exempt under Sec. REPAIR ❑ $
BAP.C.for this reason 9 A ►'► SSS' DEMOL ❑ LDMA P/C
Date: USE OF EXISTING BLDG. URM ❑ IL
Signature APPLICANT(PPoNT) TEL N0. L.DMA Perm n Z
❑ I, as owner of the prdperty, or my employees with wages as - Z
their sole compensation, will do the work and the structure is ADDRESS O'
not intended or offered for sale (Section 7044, Business and FINAL DATE a0,3303 107.10 '
Professions Code.) 7�, S
• WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 2 '�
❑ I, 8S owner Of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ' 1 ITEMS
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project (Section 7044, vss❑ No 1:1TOTAL 107 _ 10
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK , 117 u 10
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
�� GTyT L
0
GUIDELINES,
I hereby affirm that there is a construction lending agency for YES❑ NO❑
a the performance of the work for which this permit is'issued(Sec.
1 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, U�ry�ry4JL1 5/24/95/+y}�6
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS U �0 {i,•ff JJ 2 7
3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD
o Lender's Address awNEllOR NT
05$2 1 Pn `"��
o I certify that I have read this application and state under penalty <
0
P.C.FEE PERMIT FEE
of perjury that the above information is correct.I agree to comply
C4 with all c unty ordinances and State laws relating to building
constru n, and hereby authorize replesentatives of this County ISSUANCE FEE Gr
m to ente o the above- tinned property fdr inspe '
mr> (� ,.C� INVESTIGATION FEE TOTAL FEE
n tec:
.
&9=1M of Aapkaot �
SEE REVERSE FOR EXPLANATORY LANGUAGE