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Home My Public Portal About5917 MUSCATEL AVE_Building__ Cep-" - � APPLICATION FO COUNTY OF LOS ANGELES fr DEPARTMENT OF COUNTY ENGINEER U I L D I N G PERMIT BUILDING AND SAFETY DIVISION BUILDING FOR APPLICANT TO FILL IN ADDRESS / '71. 221, dp BUILDING „ � ADDRESS I r / Cdr LOCALITY,NEAREST CITY ,O 1,6 &/yZIP CROSS ST. NO.OF BLDGS. / ASSESSOR SIZE OF LOT oXIOo NOW ON LOT / MAP BOOK PAGE PARCE DISTRICT GROUP TYPE FIRE IPROCE D BY TRACT r.- OCK LOT NO. CONST. ZONE OWNER %J NOL ��9Z STATISTICAL CLASSIFICATION WER MAP ADDRESS ` ooa �7 ' CLASS NO.�DWELL,UNITS �Liqad OZG US EEE ZONE MAP CITY G"G Zoe,- ZIP NO. C111-00 ARCHITECT OR z r TEL, o ,SSPECIAL ENGINEER NO. �o� 'CONDITIONS ADDRESS y /y ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR I�s/ NOL' Lv/--Z� BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) A ADDRES h I(f SNO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OFEXISTING CITY e�+D LIC. FRONT PROP..LINE HIGHWAY WIDTH �.c� CLASS '� � _ CONSTRUCTION LENDER + - NAME AND BRANCH BLDG.SETBACK FROM a' ADDRESS CITY SIDE PROP.LINE OF (STREET) v SQ, FT NO. OF NO. OF CHECK HIGHWAY + YARD --TT OTAL SETBACK FROM TYPE OF EXISTING G SIZE �S� STORIES ` FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH DESCRIPTION OF WOR IA EW ❑ y J - ADD CORNER CUTOFF YES ❑ NO ❑ ' �vaAl ALTER ❑ I 12 y` 4,0 ❑ IN OPEN SPACE YES ❑ NO REPAIR ❑ USE OF IN COASTAL PERMIT ZONE YES E] NO EMOL ❑ EXISTING BLDG. ❑ I2 01 APPLICANT `� TEL �y /�F� (PRINT) ��%Y NO. 12+N� BY (SIGNATURE) ii�'t•Jr ' c . I HEREBY ACKN+ LEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. - SIGNATURE OF FINAL -3-�, BY PERMITTEE DATE ADDRESS C .tih TEL./6%ZT�, 7,5 CITY NO.(�r P.C. Fee$ Permit Fee 1 Q � Issuance Fee VALUATION$ �! 4 Total Fee PLAN CHECK VALIDATION CK. M.O. CASH o P T VALIDATION cK. M.O. CASH 19 D - ,&�c 3 7 ��,r=ov �1 4 �8.?_ 5 7GA638A CE#80313 12/75 '- - WrrORKEP�S'COMPENSATION DECLARATION hereby ce that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT 'I`nsure; or aa certificate of Workers'Compensation Insurance, or-a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY r. BUILDING Picy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING �,o sus tion department. ADDRESS ! T, ^ `, Date Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' / NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT Q / NOW ON LOT CROSS ST. 164 (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL 2 OWNER USE ZONE MAP I certify that in the performance of the work for which this NO. til v J permit is issued, I shall not employ any person in any mannerSPECIAL IL so as to become subject to the Workers'Compensation Laws. ADDRESS —� CONDITIONS u0 IN Date)• S � Appl!cant�i� � CITY % ZIP ARCHITECT R TEL. DISTRICT GROUP TYPE FIRE ESSED BY NOTICE TO APPLICANT: If, after makin this Certificate of � g ENGINEER NO. CONST. ZONE V Exemption, you should become subject to the Workers' .� Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICALCASSIFI TION APT. CONDO. Z deemed revoked. CONTRACTOR ^ NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS _ NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. / Professions Code, and my license is in full force and effect. CITY CLASS BK [V� VALIDATION SQ.FT. N OF NO.OF CHECK License Number Lic.Class SIZE STORIES I FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW $ J� ,❑ I am exempt under Sec. ADD 13ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: JA-�%Sy" ;eY�Cs USE OF : ❑ /� T' EXISTING BLDG. � �.rp DEMOL Signature Y_i► a.i_ f.4lt APPLICANT 1EL FINAL NOa2 �Crr OWNER-BUILD EC RATION PRINT DATE G I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRES /Yz tT� rQ. /��. FINAL a Professions Code): PRESENT BY ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ' the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED YARD HWY TOTAL SETBACK FRO _ �5 6 6 2 A CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work r which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. I o a6EL63 Lender's Name LDMA Ref. # 0 0 0 6 8.617 Lender's Address P.C.Fee$ Permit Fee , 'p I certify that I have read this application and state that the Issuance Fee U• LDMA P/C# ;1 0. 1 5—86 = above information is correct. I agree to comply with all County Investigation Fee p ordinances and State laws relating to building construction, Total Fee �5 . LDMA Perm. # J and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. a fflo , Ml o /� /S /. SEE REVERSE FOR EXPLANATORY LANGUAGE p i at f App' A g t Date