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HomeMy Public PortalAbout6158 MUSCATEL AVE_Building__ ®S 76A63£(REV. ' CE laq(R V.6/76) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING FOR APPLICANT TO FILL IN ADDRESS e,0 BUILDING /� ADDRESS /\(19, .SC +09i I LOCALITYNEAREST �,q CITY a l e. �,l� ZIP ?P'790 CROSS ST. ✓GL �^ £ O OF BLDGS. ASSESSOR SIZE OF LOT J X �7 NOW ON LOT MAP BOOK PAGE I PARCEL DISTRICT GROUP I TYPE FIRE ED Y TRACT -^ O BLOCKLOT NO. 0 cr. . O� CONST.V ZONE TEL. 'w A OWNER JC h YI F(/I i 1"/ NO.eLS /J� rl 3 /� STATISTICAL CLASSIFICATION Jy) WERM�A-P•�� ADDRESS /� LL P.Q'� f 1 'V e• CLASS NO. DWELL.UNITS BK/"PG' CITY /J Ga to rj,�-d ZIP It 1 ? 7 ARCHITECT OR -1( TEL. VALUATION $ ENGINEER N e. NO. ADDRESS �-' BLDG.SETBACK FROM TEL. p�7 FRONT PROP.LINE OF (STREET) CONTRACTOR 0W Y! NO. �Q /oZ�I!^ HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH ADDRESS (,Q' / NO. _ LIC. + CITY w 634 b rl L ,CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER (STREET( NAME AND BRANCH B YL P SIDE PROP.LINE OF TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS +�. HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH CITY SQ.FT. NO.OF NO.OF CHECK + = 8� SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW C] P.C.Fee$ Permit Fee en I Qr e-4 r©fl M a- ADD Issuance Fee � ALTER ❑ 0. o!? a 3 REPAIR El Total Fee USE OF DEMOL ❑ EXISTING BLDG. (0—S u/J f APPLICANT ) 1L TEL OL (PRINT( ///tl/�'�O• ���3v BY(SIGNATURE) I HEREBY ACKN LEDGE THAT I HAVE READ THIS APPLICATION AND STATE C Q THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE ✓1X 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 COM- z J n n PENSATION INSURANCE. lA H 6 SIGNATURE OF 0 0 0 0 0 1 PERMITTEE ADDRESS a Z 2 0 0 31,0C S[ r TEL. 3d 0 0 0 3 1.�:J CIN NO. C USE ZO E MAP � 0 3 0'7'—7 NO. y SPECIAL �- CONDITIONS ^ :E m FINAL /� BY d DATE / J WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, APPLICATION FO R BUILDING PERMIT or o certified copy thereof (Sec. 3800, Lab. C.) - - rf� /C9�li� F CC1lft,�.+JY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING/�/g tion department. ADDRESS(fid J Date aApplic CITY !It G_ ZIP a LOrALITY r CERTIFICATE OF EXEN010 NO.OF BLDGS. NEAREST FR M WORKERS COMPENSA ON INSURANCE SIZE OF LOT 5�a1 NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR — �•�!� 77 hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE �/ PARCEL 42 — hundred USE ZONE MAP / I certify that in the performance of the work for which this OWNER e� NO. NO. permit is issued, I shall not employ any person in any manner ��� SPECIAL so as to become subject to the Workers'Compensation Laws. N ADDRESS CONDITIONS Date Applicant CITY ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR// TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER G/ / NO. CONST. Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. �' STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR • / NO. w LICENSED CONTRACTORS DECLARATION ,yy�� Lc CLASS rJ/J� CLASS NO. a� DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS r/11 I N&5, 67,0 Z/_ yER 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 f G CLASS e BK 10 PG. Gjg VALIDATION �. e �-y SQ. FT. NO.OF NO.OF CHECK r / Q: License Number Lic.Class SIZE STORIES FAMILIES / ONE 0 //l d1,411 /� �J Contractor 4, VA N s`2?/ Date —/ DESCRIPTION OF WOR�� a ' NEW em; 0:rJ ry ADD F-1 (�P , O I am exempt under Sec. �/ G ALTER ❑ Ld B.BP.C. for this reason PAIR $ D • a 7 USE OF G BLD AXISTIN /f DEMOL ❑ Signafur APPLICANT TEL.:2 ��/ FINAL WNER- UI DER DECLARATION PRINT �� NO' DATE I hereby affirm that I am exempt from the Contractor's License /fJ 1' Ir Law for the following reason (Section 7031.5, Business and ^ ADDRESS /' i FINAL ` 276 Professions Code): ` \ PRE ENT By q a ❑ BUILDING AclCT oz I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and �(� ,07 48.75 the structure is not intencled or offered for sale(Section ,�J LOCALITY 7044, Business and Professions Code). MOVING TEL. 1 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. - t1Itr4T o4 with licensed contractors to construct the project (Sec- PADDRE tion 7044, Business and Professions Code). 3307 825.72 TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY YARD HWY PROP.LINE WIDTH n I hereby affirm that there is a construction lending agency for s, ITEM the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). TOTAL 87 4.47 {] r Lender's Name �j CHECK 874-4( ' ./I f/f1 -7 LDMA Ref. q CHANGE lender's Address / Permit Fee /I certify that I have read this application and state that the Issuance Fee c7 LD.P/C q above information is correct. Iagree to comply with all County Fee rJ o� ���[i-[(pp1 2/ 1/97! ordinances and State laws relating to building construction, Total Fee �� F / 0` LDMA Perm. q and hereby e r resenfatives of this County to enter 7955 1 PMID- 1`t D upo e- ned property for inspection purposes. 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