HomeMy Public PortalAbout5324 MCCULLOCH AVE_Building__ APPLICATION FOR". WILDING PIERMM
F Ty O s ANGELES BUILDING
- DERARTN�NNTR'C.OIIIN'�IY ENGII�iE�B.,. DLtEss
AND'SAFETY D� MGS• . °' •f70'�w ,'pY, ' .• ' '
JOHN A. LAMB1E.COUNTY I NGINEElt r NEAREST
WILLIAM A.JENSEN.AuPR 'o! 'ul lmu IrI;OSS ST.
DI$'T CT NO.•, GROUP. TYP EBED BY,
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•BUILC:LNG. STATIBTL*bLNWIFIQ/ITIGN• ER MAP
ADDRESS•, 3 i'CI:AS$"N0. DWELL UNITS BK .
LST N�: BLCCIC. ,'�' wA7$B • '"' •• ,•
�., OEM TIFICATifi-.NOT.REQUIRED �.RECEIV9b
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23 MAP. .HIGHWAY STATEM`/1.1OR SECOND,.
NO.OF BLOGB. NO. telRels) i
SIZE OF,LOT NbW ON LOT USE ZONLr: SPECIAL
USE OP+- CONDITIdNB
Ex BLDG. A CJe. r
"Y
OWNER ;NOLr. BUILDING EXIST.
8L',tBACK YARd ItW)r " 8TRt;ET N M WIDTH
ADDRE S
ARCHITECT OR• TEL' i P.L'
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EN INFER' i NO. SIDE`:
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CONTRACTCIt NO. ' ;e
ADDRESS ��, w r + •h _ S
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ON OF
ADD - ALrTF4 REPAIR DF iAOL•ISH;'
RC.• r.Ao OF• NO.OF
SIZE -. I BTORIEB FAMILIES
USE OF• a. .rte •• _ .r�` �'• 'd "1: 14'•r:• 1
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SIGNATURE OF ,r 'rrr•l"`* e ..;'•:ti% ,fI ' ��
'APPLICAAf NT �1' ' y fo i •r ,.y.
.VALUATION f '
APPROVALS JOATIF -1 atil' um
P.C-. M's: ' V. 'FOUNDATION: LOCATIP
FEE.sl -+ PRES•�iik - FORMS MATERIALS'
FLAME:-FIRE STOPO'
1 wfhisap►}►CKNDwr.Rope•; '�NAVE liriio•;riil icAT o .i• :. •, .
Iu1D EfA$TXAT,•INN A�QYe,li-PWRELT AND AO 'i0'Cdy L ', gRNACEI LOCA 10�1.•, 'K -
WIiX AI�,.COu r1/ ORDINANO�G ArkD IirATE LIIA REGIILATINO" GAS'VENST,DUCTB'•
EI)R.DINIi.60NSI1KIC170N: 1 CENTFY'FHAT IN MOING THE WORK. ki
A{liflOJlDW'XEREGY 7 *ILL NOT EMPLOY ANY.P=UlON IN VIOLA-• ' IrA'rf'FI,•INT
.TON bF TIR•CAEOII OODE.
—kr THE EiATi3O�'GDI
LIFQIIA RELAT,-4. .
ING TO WOdEMEN"G r tIONINGu '�.•EX'�
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SIGNATURE-OF. ,. USE NUMBER Cott•r •ti
PERMITTEE ECT AND'POSTED r ; xACA
ADDRE88' r .'FINAt'
•' '. `": JOHN F. LOMS, PRINCIPAL ST URAL EN�INEER
r
PLAN CEECS VALJDAITQN 'Q, YA. c�nl. PF. i'r 4VALIDAT�01� riA:: ..
1 2Q MAY. 1' 2 3 •,D 2.5',CJ
• .. :. A;Q- -T .1.1' 5 0:Q�;�=.�
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,
[B:UIILDING ADDRESS `` .. `�' ,c�- C co Ck
or a certificate of Workers'Compensation Insurance,or a certified G �� CTe �A 780
copy thereof(Sec.3800,Lab.C.) �L 'e 01 + zIP 9 1-7 0
LocAUTY
Policy No. Company SIZE OF I NO.OF BLDGS.tM ON LOT
❑ Certified copy is hereby furnished. ()AJ NEAREST CROSS ST.
TRAG7 BLOCK LOT N 3 — MA `'
Certified copy is filed with the county building inspection "�
department. USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BO _. PAGE 'Ll-' )E� i apSPECIAL CONDITIONS
'CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ' ' ! g TEL NO. )�( YES NO
COMPENSATION INSURANCE `'t S N JtL�•�-' C) WITHIN 1000 FT.OF SCHOOL?
ADD .l `_ p
(This section need not be completed if the permit is for one hundred 5 C7� t C rJ ` C.Y\ U C_ DISTRICT " GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
dollars($100)or less.) C� e ' ZIP
I certify that in the performance of the work for which this permit e M Q C 91-7y
1-7 k-31 3 �
Is Issued, I shall not employ any person in any manner so as to ARCHITECT R EN (NEER TEL NO. b
become subject to the Workers'Compensation Laws. S `� _ Cj i j4 14 STATISTICAL CLASSIFICATION APT CONDO
Data Applicant ADDRESSJN M&i0 a✓ C CLASS NO. DWELL UNITS
NOTICE TO APPLICANT: If, after making this Certificate of � r' G9� 1.100REQUIRED' TOTAL SEMACKFROM EXIST
Exemption, you should become subject to the Workers' CONTRACTOR i y-{� TEL NO. SETBACK YARD HWY PROP.LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith � 1 A � Tr-Cfq� �� I FRONT r
corn I with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. �-
PY . P P a,4-4' s Ll►I`taC-
LICENSED CONTRACTORS DECLARATION CITY // ,��`► LIC.CLASS SPL
IDE L`I ' 42- 1 , C
I.herebyaffirm that 1 am licensed under rovisions of Chapter 9 1 P CZ +I' SEWER MAP v
P Pt
(commencing with Section 7000)of Division 3 of the Business and 30.FT.SIZE NO.OF STORES 'NO.OF FAMILIES -
Professions Code,and my license isin full force and effect. 5 0 N e_ %1J NEW ❑ BK PG �
License Number LIC.Class DESCRIPTIO OF WORK I l!�i�3 �#-�
ADD vawanoN Iu
Contractor Date l ALTER ❑ � 'r ����'i 't`s
P S 1 e f�ES flR._ 0 REPAIR ❑ � O V CHANGE —
❑ I am exempt under Sec. -
B.&RC.for this reason J P'O O M , DEMOL ❑ -
U3 OF EXISTING BLDG. LDMA P/C* 1
Date: S. �� URM ❑ t (1�1[f[E–[E�ltii
Signature APP 1 (PR�,IN_'r7-}- CTEL NO. LDMA Perm It Z• +' j
❑ I. as owner•of the property, or my employees with wages as `'�` F �"� C W-4 ,-�Q�, p J i s
their sole compensation,will do the work and the structure is AD ESS .� a F- kC j•.s
not Intended or offered for sale (Section 7044, Business and . Re C V'l O v� G . FINAL DATE `�(� _I�,1;
Professions Code.) J_ 6 jt coo- _
WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIA J
I, as owner of the.property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a 1 ITEMS
Y g
licensed contractors to construct the project.(Section 7044, THE AMOUNTS SP FIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
'-'�'�'
Business and Professions Code.)
YES 11 No US 4-7
TOTAL 3_ 03 - 14
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING 'i i ti
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECKL-r]5Je i4
CONSTRUCTION LENDING AGENCY FOR GU DIELNES.ITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST )
I hereby affirm that there is a construction lending agency for YES 11 NO
�a3l_2 CHANGE' .610
,the performance of the work for which this permit is Issued(Sec. ti �..,
•3097,CIV.C.. I HAVE READ THE HAZARDOUS MATERIALS INFOR ION�UIDE AN
'3W7, J..''.
PERMITTING CHECKLIST.1 UNDERSTAND MY REOUI 1 lINDEA r G r [}!q !�'yy / /
�. COUNTY CODE.TITLE Z CHAPTER220SECTIONS2.20. 'TH&WGH220. CO RN �l�[I-(-I�IL)� Vf Vf I?��
ra Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAI 1 G A PERMIT FRC I�I FiFiE!$CAQD
Lenders Address awNeRcaAowr � `li' 1174 1 AM 7:44
0 1 certify that I have read this application and state that the above RC.FEE _I
information is'correct. I agree to comply with all county 9 13 ' PERMI�E'
ordinances and State laws relating to building construction,and I o
hereby authorize representatives of this County to enter upon ISSUANCE FEE
the above- entioned pro e r inspection purpos OrA
INVESTIGATION FEE TOTAL,F;E 112
J)�
Slpn hn 0f APPU-1« ab
SEE REVERSE FOR EXPLANATORY tNNGUAGE• 3� �t.