Loading...
HomeMy Public PortalAbout10721 MILOANN ST_Building__ DEPARTIVlENT OF COUNTY ENGIN88R i BUILDING DMSION OF BUILDING AND SAFETY i COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, EUYT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING I DISTRICT NO. PLAN CK.OR Rec.No. PERMIT NO. ADDRESS 7 41110 A �� 33 1--x.1 �-� s•�t� LOCALITY �r I�,S tr% ` RECEIVEDBY DATE OFAPPL. DATEISSUED NEARENEARESTPER r �.� �' �v- lc! 3 ,..� BUILDING OWNER (� 1 '1 I ADDRESS MAILI IFF G LOCALITY ADDRESS I7 N? Lr� CROSS BY, P1tJ�,•�'ti^1 "^ . TEL. NEAREST „ CITY (� C FIRE NO. OF TYPE GROUFr`' ENGINEER ARCHITECT OR TEL. ZONE •-- I PLANS /L I i/j BLDG. O�•D.� O. ADDRESS SETBACK LINE USE 1 CONTRALTO , e'TUff N I I ZONE BYPROVED DATE �Z HOUSE NUMBERING ADDRESS �. LEGAL i MAP NUMBER MO. ASSIGNED BY DESCRIPTION I LOT NO. IL BLOCK � 2 � r_,d � CORRECTIONS , TRACT QNO. OF BLDGS. SIZE OF LOT / Av •I NOW ON LOT At{. 1 USE OF I NO. OF - EXISTING BLDG. FAMILIES D ON OF WORK i 0 - NEW ALTERATION ADDITION Z REPAIR DEMOLITION r SQ. FT. NO.OF SIZE ROOMS STORIES rLXTI COVERING yc-t0 I COVER NG OhPI USE OF STRUCTURE Rr r J , • i i APPROVALS INSPECTOR'S SIGNATURE DATE r FOUNDATION:LOCATION FORMS, MATERIALS ['HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-.! FRAME: FIRE STOPS, p PLICATION AND STATE THAT THE INFORMATION GIVEN l8'� BRACING, BOLTS s CORRECT. FURNACE: LOCATION, I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES-1 GAS VENT, DUCT8 -� AND STATE LAM" ULATING BUILDING CONSTRUCTION. SIGNATURE OR F LATH, INT. PERMITTE � I Q LATH. EXT.ADDRESS6.• �'�n 1g �� a I PLASTER, INT. AUTHORIZED AGT. �y m PLASTER, EXT. ' �. /.� 0 D YFEE S n HOUSE NUMBER COR- / G p RFC AND POSTED ,� VALUATION REE $ 1!J �.. FINAL 76ABBBA DBS 3 S-52 _ _ }.k�a>I*� '.;ti' • a 1, L,w,.�; �•' APPLICATION FOR, BUILDING PERMIT �I COUNTY OF LOS ANGELES BUILDING AND SAFETY ti ' FOR.APPLICANTTO FILL IN BUILDIN ADD WOPKER'S COMPENSATION DECLARATION I hereby affirm that.I have a certificate of consent to self insure, EBUILDINGADDRESS S _or a certificate of Workers'Compensation Insurance,or a certified AVicopy thereof(Sec.3800,Lab.C.) I — �r `/ zIP �yI ,7 �p� LOCALITY Policy.No. e8i 3 Company re F&/±-0 1)ZPOF L T NO.OF BLDGS.NOW ON LOOT ❑ Certified copy is hereby furnished. ,r . ©/ NEAR ❑ Certifiedcopy is filed with the count ,building inspection • a ' y '71:IACT BLOCK LOT NO. USE ZONE MAP N O. department. .. —� ASSESSOR MAP BOOK PAGE PARCEL Date Applicant J SPECIAL CONDITIONS OV%NER TEL NO. CERTIFICATE OF EXEMPTION FROM WORKERS' WITHIN 1DOD Fr.OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS (This section need not b@ completed if the permit is for one hundred '072—) /t7 ,(�� �f C�y. DISTRICT GROUP TYPE FIRE ZONE C ED BY dollars($100)or less.) CITY ZIP V . I certify that in the performance of the work for which this permit 71PLf 12 Lb.' 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. ATISTICAL I CATION Fr NDO Date Applicant ADDRESS CLASS NO. DWELL UNITS 3 Z' t — �v• wA�C-�' ata•. NOTICE'TO APPLICANT: If,"'after making this Certificate of SQUIRED TOTAL SETBACK FROM EXIST Exemption, yoU should become subject,to the Workers' CONTRACTOR • TEL NO. "ET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith rt!G 1 /ZA L C 21 ?25?V/16./16FRONT comply with such provisions or this-permit shall be deemed'revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION CITY �! LIC.CLASS FIDE y j I hereby affirm that I am licensed under provisions of Chapter 9 gIZ NO.O STO 'NO. FAMILIES SEWER MAP t•G I°a C (commencing with that. 7000)of Division.3 of the Business and NEW ❑ BK PG Professions Code,and my license is in full force and effect: f ADD � q Ucense Number s lg 2� Lic Class" DESCRIPTION OF WORK VALUATION 1 y Contractor ��`/V���'�- Date - 4�' / ALTER ❑ $ '57/ �O � REPAIR 1:1 TOTAL AL 475 a 5 ❑ I am exempt under sec. $ {; ;('K —E B. P.C.for this reason "!fes Z. DEMOL ❑ f ° �. LDMAP/Cq ' CHANGE 001' „ USE OF EXISTINGBLDG. •• � ° Date: S i`� 'URM. ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm q � �LFLIV ❑ I,•as owner of the property, or my employees with wages as ZO their sole compensation,will do the.work and the structure is ADDRESS 11— '°11 FINAL DATE not intended or offered for sale (Section 7044, Business and 11- Professions Code. ��,, W ILL THE APPUCANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ❑•I, as.owner of the property, am exclusively-contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 3 licensed contractors to construct the project.(Section 7044, YES❑. NO 1:1 ) Business and Professions Code.) Ci • WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMIT FORCONSTRUCTION OR MODIFICATION FROM THESOUTH ' CONSTRUCTION LENDING AGENCY COAST,AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST ' k FOR GUIDELINES. . '•y I hereby affirm that there is a construction lending agency for TEs❑ NO❑ ' the performance of the work for which this permit is issued(Sec. 3097,CIV.C.. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD .h C•l HAVE CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ••P• r => 1'r7 "^'I S COUNTY CODE,TITLEZ CHAPTER 220 SECTIONS 22MI00 THROUGH 220.140 CONCERNING IT'• I= .�''e.•. 4'} 3> -�J ' Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. a�i..f Lender's Address OWNMORAGEW o° I certify that I have read this application and state that the above P.C.FEE . �� PERMIT FEE /' a^` r a ,; M 4 information; Is correct. I agree to comply with all pounty ordinances and State laws relating to building construction,and ' h6reby authorize representatives of this County to enter upon ISSUANCE FEE the o e property for Inspection pt{rposes. / = `• CJI Il ro neo ` INVESTIGATION FEE TOTAL FEE J .fi -`Ij I dr __J Dd -P *l1 C�,I G4 mAwnnmmna.e r..-4 -Z1 C:I cei co SEE REVERSE FOR EXPLANATORY LANGUAGE.