HomeMy Public PortalAbout5810 MUSCATEL AVE_Building__ APPLICATION FOR BUILDING PERMIT �1
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING ADDRESS
FOR APPLICANT TO FILL IN
WORKER'S COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS A
or a certificate of Workers'Compensation Insurance,or a certified rJ IV H L CAT FL A�(✓
copy thereof(Sec.M,Lab.C.) CITYTCZIP
M QLD �'1 T ,?v LocauTY ,�
Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST eRSr
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. 3 6 4O USE ZONE MAP NO.
Date Applicant ASSESSOR MAP OOK PAGE PARCEL
r_ O SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER � U� a (ELNO. "��� 01WIN 1000 FT OF SCHOOL? YES NO
A
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the permit is for one hundred 731 E, w 1 "VI e a t&)4 DISTRICT GROUP TYPE CONST.' FIRE ZONE CESSED BY
dollars($100)or less.) CITY A ',, ZIP g (�
I certify that in the performance of the work for which this permit AaCA D)'A C oo L"
is Issued, I shall not employ any persoq in any manner so 7 ARCHITECT OR ENGINEER TEL NO. ....//
bec�FPFP
e Workers' cation L� �"I°� STATISTICAL C IFICATION Ey
CONDO
n
DatApplicant - ADDRESS CLASS NO. DWELL UNITS
NOTWT /bA f, after a ng this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should becomeObject to the Workers' CONTRACTOR 1 TEL NO. SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith l FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO.
PL
LICENSED CONTRACTORS DECLARATION CITYuc.cLAss SSPL
IDE C
1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP C.2
(commencing with Section 7000)of Division 3 of the Business and SFL 15 NO.OF STORES NO.O FAMILIES
CJ �
Professions Code,and my license is in full force and effect. NEW ❑ BK PG O
License Number LID.Class DESCRIPTION OF WORK ADD v
vallu'pna ®
Lu
Contractor DateAdd a ALTER El e4 -J-b2 y
❑ I am exempt under Sec. 1� REPAIR ❑
B.BP.C.for this reason DEIMOL ❑ LDMA P/C()
Date: USE OF EXISTING BLDG. URM ❑
ay`
Signature APPLICANT(PRINT) TEL.NO. LDMA Penn 9 1
El 1, as owner of the property, or my employees with wages as 1• (-f "-3 JH p
their sole compensation,will do the work and the structure is ADDRESS / a F ACCT.,v
not Intended or offered for sale Section 7044, Business and .3 -c— W/ +r e�� f`(' `FINAL DATt; a
Professions Code.) ( WILLTHEAPPLICANTORFUTURE BUILDING OCCUPANT HANDLER HAZARDOUS MATERIAL C j��7t$,�;i
❑ OR A MIXTURE COKIAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN
I, as owner of the property, am exclusively contracting With PE i yr
THE AMOUNTS SIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 1 i I E Iv
licensed contractors to construct the project (Section 7044, YES❑ No TOTALo
Business and Professions Code.) nJ 'Xg 128 50
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTHH CIS U8
CONSTRUCTION LENDING AGENCY COAST'AIR DUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST // � ��'+� yi+r���
FOR GUIDELINES. 6
I hereby affirm that there is a construction lending agency for YES Q NO CHANGE
the performance of the work for which this permit is issued(Sec. I HAVE READ THE'HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD
3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES
irr,COUNTY DE TIT �� S O MRLenders Name HAZARDO EPORTI FROM THESCAQMD. JOGO-0U1 / 4/90
Lenders Address rmORT AT 11506 j AM 8o92
0 1 certify that I have read this application and state that the above
$ information Is correct. I agree to comply with all county P9•FEE PERMIT FEE 1151
ordinances and State laws relating to building construction,and
here orize represey ti of�Jsnty to enter upon ISSUANCE FEE
tha3'a mentioned prUpe f ihs osesr 307_�� INVESTIGATION FEE TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
6A689_•f:E=. 879--'8-62
JAPPLICATION FOR RELOCATION BUILDING PERMITr
COUNTY OF LOS ANGELES BUIL.oING
DZPARTMENT OF COUNTY ENGINEER nrDR.Ess ,
'BUILDING AND SAFETY `DIVISION LOCALITY -:
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST J
WILLIAM A.J'ENSEN,.SUPT OF BUILDING. CROSS ST..
DI'SY'.. .O. GROUP TYPE. SEWER'MAP PR CES BY
FOR :APPLICANT TO FILL IN r-N' �J � CONs K
PROPOSED
lC-f
B.UILDI•NG .- � � �. � WATER NOT REQUIRED ❑ RECEIVED
ADDRE5 �► SSS..���
CERTIFICATE:.
LOCALITY ^;�F d' e� '7 , MAP HIGHWAY STATE MAJOR SECON OCA
NO.
PRESENT (CIRCLET
�..
BUILDING
ADDRE5 -� U tl USE,ZONE SPECIAL: ] �ry
r COND TI.OIfJ
LOCALITY ?T-
ikg
OWNER '`� �� k BUILDING EXIST.
YARD H_ WY: STREET'NAME
MAIL ,r` � .: � SETBACK WIDTH .
ADDFRO
.RE5S ! r,r " X A NT f
/ ' TEL .�. ly P'. L.: /: ,2 .
CITY Pq. ., if'a.•..,. NOSIDE
MOVING /� f TES.. a P. L.
Q ACTORS`;' , 5: .1.
R
SUSUETY r� q DATE
' RE •$. -7'
BUI-LDIING TEL CA5H DATE RECD
CONTRACTOR NO. DEPOSIT $ FILE'S BY O,
APPROVALS DATE. INSPECTOR'S SIGNATURE ."i
ADDRESS. cle
PRESENT j�lP,. r FOJN.DATION: LOCATION
USE.OF }( `.+/`,'. ,� 1 g' 3 � a. FORMS; MATERIALS } ,,Vis. O
.BUILDING �•1'� .+� '!: '� � FR;4ME:: FIRE STOPS,
O.
PROPOSED .� BRACING•, B. LTS 1 V ",.G.�� W
USE OF r a '
BUIL DIN- �. �J 1`1 e, FURNACE: LOCATION f ��✓ ! j� /� y
GAS VENTS; .D'UCTS SI 5� 4 7 //�✓(=sf �" b° " Z
SO.'Fl T, NO. OF'. . L.AI H, INT..
SIZE. . r � ROOMS STORIES . ' /
WALL r ROOF'
COVERING ✓P..� COVE.' 'Gtr "I jij fS� ('. LATH, EXT::
. I .CRI HOUSE NUMBER COR
v/-1701
. 7.0Dp LEG � �. N .
RECT AND POSTED
TRACT• _ a13 ": r: a FINAL.
j dre NO.OF BLDGS. I•. — - .
SIZE.OF LOT/ f. I. NOW ON LOT SURETY BOND ADISTRICT ENGINEER
RELEASED .� :- *►
USE "�. y- y y NO, OF
EXISTING' BLDG. ,. +' s7 FAMILIES J. I HEREBY ACKNOWLEDGE THAT I 11AVE.AEAD, THIS APPLICATION
I HEREBY STATE.THAT THE 1 AT•ION'G Y.EN.IS AND STATE,THAT THE ABOVE' IS CORRECT'AND AGREE'TO'.COMPLY _
CORRECT'.: WITH ALL :COUNTY ORDINANCES .AND STATE L'AW5. REGU'LATIN'G
SIGNATURE OF BU ILD.4NG• CONSTRUCTION., 1 CERTIFY THAT IN DOING THE WORK
APPLICANT r r AUTHORIZED'HEREBY I 'kI.LL NOT•EMPLOY ANY'PERSON IN-VIOLA+
,/� TION OF THE. LABOR CODE OF THE STATE OF CALIFORNIA RE AT-
i4DD.RES F✓ - /'Y TNG':TO WORT( N'S COMPENSATION 1 ME
VALUATI:ON:'$ C.:s SIGNATURE OF
FEE .: PERMITTEE•
(�Q ADDRESS
FEE'.$. �
VALMATIQI4 CK: m:o Ci113N JOHN F. LEWIS,.PRINCIPAL STRUCTURAL ENGIN' E�
PERMIT VALIDATION °r wD• cAzN