HomeMy Public PortalAbout10786 LYNROSE ST_Building__ 6A686A CE#003 f0-66 APPLICATION FOR BUILDING PERMIT '1•
COUNTY OF LOS ANGELES BUILDING— .
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN SUPT OF BUILDING CROSS ST. Z�
DISTRICT O. GROUP gYpE SSED BY
FOR APPLICANT TO FILL IN coNST.
-
BUILDING �J ( E ER MAP
ADDRESS Q/ 66 4vYR,6 STATISTICAL CLASSIFICATION
BK -- PG
�+ CLASS.NO.�DWELL.UNIT --
LOT NO. /G Y � (— BLOCK MAP c�+� y�� STATE
NUMBER r�� �i � HWY, `YES' NO
TRACT USE ZONE SPECIAL
/ NO.OF BLDGS. CONDITIONS
SIZE OF LOT 3X 71 I NOW ON LOT
USE OF
EXISTING BLDG: BUILDING - EXIST.
c �! SETBACK YARD HWY EET NAME- WIDTH
OWNER C .LEiY T FRONT
MAIL /_ S P:L.
ADDRESS /LO SIDE
CITY NO.
ARCHITECT OR TEL. t- .INSPECTION RECORD
ENGINEER NO. �.
ADDRESS
TEL.
CONTRACTOR NO. v `
ADDRESS tI
DESCRIPTION OF WORK
NEW. , ADD ALTER REPAIR DEMOLISH
FT. • NO.OF NO.OF �� /I /�
SIZE eJ Com.. STORIES FAMILIES
USE OF STRUCTURE
SIGNATURE OF APPROVALS
APPLICANT DATE INSPEf3BR'S-51.O VATURE
ADDRESS FOUNDATION: LOCATION
FORMS,MATERIALS -
P.C. $ FRAME: FIRE STOPS,
/[1 ,f�®/"") FEE S��' �� BRACING.BOLTS -
�V �/ FURNACE: LOCATION.
VALUATION J FEE $ GAS VENT.DUCTS ry ~J� r �� �� •'
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TELLS AP- LATH.INT.
PLICATION AND STATE HAT THE ABOVE 1S C AND
AGREE TO COMPLY W ALL CO TY OR A AND LATH,EXT. !✓ ",� _
STATE LAWS REG UCTION.
SIGNATUREW HOUSE
RECTANDPOS POSTED
PERNIITTE - G
ADDRES FINAL
CLYDE N.DIRLAIVI:RRINctPAt'ST URAL ENGINEER
PLAN C=CK VAMATION cK. M.C. CAeH PEE=VALIDATION cIc M.C. ' CASH
ILO4 9 5 6 n APR 1 3 2 3 A 2 2.5 0 . OF
ihC4• 95.7n Al_Rl'3' : 1 A 45.00' M
APPLICATION FOR BUILDING PERMIT
j COUNTY OF LOS -ANOELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING ADD
WORKER'S COMPENSATION DECLARATION • E /
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRES d/ (o
or a certificate of Workers'Compensation Insurance,or a certified r�s�
copy thereof(Sec.3800,Lab.C.) C v ZIP h
1746 V LOCALITY
Policy No. CompanySIZE OF LOT NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST
Jr
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS'
OWN �C 2
COMPENSATION INSURANCE S`7 �J / ✓ WITHIN 1000 FT.OF SCHOOL? Yes No
This section need not be completed if the permit is for one hundred ADR S
( P P QJ� DISTRICT GROUP T CONST. FIRE ZONE PROCESSED BY
dollars($100)or less.)
CITY ZIP G
I certify that in the performance of ork for which this permitQO _�
is issued, I shall not employ any p in y manner so as to ARCHITECT OR ENGINEER TEL NO. IJ
bec a ubjec l�le Workers'C e Sa n Laws. STATISTICAL CLASSIFICATION APT CONDO
Dat ?Applicant ADDRESS CLASS NO. �� DWELL UNITS
NOTIC 70 APPLICANT. If, after m king this Certificate Of A A REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become jest to the Workers' RAC T SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith n Q. % FRONT
comply with such provisions or this permit shall be deemed revoked. R ES k IC.NO. PL
LICENSED CONTRACTORS DECLARATION vt l L' PILE
I AD _ IC.ORAS 9 PL
I hereby affirm that I am licensed underprovisions of Chapter 9 'V� C� 7 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and S FT. NO.OF TORI NO.of FA 1LIES
Professions Cod d my i e is in full force ark of 1 �i
�O NEW ❑ BK PG , a
License NumbeJ I ic.CI (j �j {%eRIPTION OF K 4 ADD ❑ VALUATION
Contractor Date A� fal �f ALTER ❑ $ a_ C
❑ I am exempt under S 7 REPAIR�I $
B&P.C.for this reasonLDMA P/C#
DEMOL ❑ C
LL
Date: USE OPTXl G. URM ❑ U
Signature AP NT f Z
TEL NO. LDMA Perm# Z
� -Li�s'7r1 r�
❑ 1, as owner of the property, or my employees with wages as O �:i•� f =`s
their sole compensation, will do the work and the structure is ADDRESS
not intended or offered for sale (Section 7044, Business and FINAL DATE
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL t� G ;T�+I
❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
Y g AMOUNTS SPECIFIED N THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project (Section 7044, ves 11 NO ;OTA185 m 85
Business and Professions Code.) 'r. -rr;
WILL THE INTENDED USE MI THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING (;��t,;I+� 135 a L:i•J
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES I_;i-lANG
I hereby affirm that there is a construction lending agency for YES❑ N
a the performance of the work for which this permit is issued(Sec. IHAVE READ TH ARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING
W 3097,CIV.C.) CHECKLIST.I U AND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, .r, /
TITLE 2,CHAP SE IONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUStJ3 �. !fI:'
3 Lender's Name MATERIALS R IN FOR OBTAINING A PERMIT FROM THE SCAOMD.
o Lender's Address _ 'A b• .5 -(�!'t
a. OWNER OR AGEN
cI certify that I have read this application and state under penalty
4 of perjury that the ab information is correct.I agree to comply P.C.FEE PERMIT FEE
$ with all county ordin s and State laws relating to building
co construction, and here thorize representatives of.this County ISSUANCE FEE
C9 to enter upon the abov a Toned operty for i c Qnpu rf • / 'l ` . ='' +• ";
INVESTIGATION FEE TOTAL FEE---7—Q . Q'
IDU O
NOW—of AO~W Agent Daie
SEE REVERSE FOR EXPLANATORY LANGUAGE