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Home My Public Portal About10135 NADINE ST_Building__ Cl rX OF TQMPLE LI-ty APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILMING �/�5 /..i�d/N� COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY rf",000W G/� ZIP BUILDING AND SAFETY P.DIVISION NO OF BLDGS BUILDING /O 3s /I//j-,d/^/� SIZE OF LOT NOW ON LOT ADDRESS ,` TRACT BLOCK LOT NO �/ LOCALITY ;QK0 J�K t NEST OWNER %�J 400 �kC&7�y NOL�J —4o 4 CROSS ST /�/A1A0t �B�"!•�/F�iN/ /� / ASSESSOR ADDRESS AI.315- MAP BOOK PAGE PARCEL CITY �IO•JP� C/ ZIP DISTRICT GROUPCONS Z PROCESS D BY ARCHITECT OR TEL rAj ENGINEER No STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO DWELL UNITS===] BK PG CONTRACTO �.AA NEO.L f.7/^�1ar USE ZONE MAP IND ADDRESS 2r/� 0✓ NO 71S9y4 SPECIAL LIC CITY ��®� CLASS (�f ///777 CONDITIONS CONSTRUCTION LEND �� ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ NAME AND BRANCH 4,4; �e BLDG SETBACK FROM FRONTPROP LINEOF (STREET) ADDRESS CITY HIGHWAY + YARD TOTAL SETBACK FR TYPE OF EXISTING SQ F NO OF NO OF CHECK FRO PROP LI HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW O BLDG SETBACK FROMIZA v /� DD SIDEPROP LINEOF (STREET) !/ LTER ❑ HIGHWAY + YARD/= TOT L TBA FROM TYPE OF EXISTING t3 EPAIRCI SI ROP LI E HIGHWAY WIDTH 4i USE OF EXISTING BLDGf1.V.=« �/ A��Ga+" MOL [:] + 11v , Z AP PRIM (PRINT) �� 7ry/ NO'6-7/ CORNE CUTOFF YES ❑ NO ❑ BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION a, pa 0®, od I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION R `—g r 00 AND STATE THAT THE 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 JQVIFORNIA IN RELATING TO WORKMEN S COMPENSATON SUR SIGNATURE OF 12510 PERMITTEE ADDRESS TEL FINAL BY CITY NO �' DATEPCJ MAKE CHECKS PA}ABLE TO FEE PMT HARVEY T BRANDT COUNTY ENGINEER ZA ZtO� PLAN CHECK VALIDATIONcK O CAB VALIDATIO CK M O CASH 0 8 fl�AW 19 3 x,2 0 " 0AM 19 0 4 2.0 0 76AGSBA CIS 0803 B/sa — ^ -- 76 w6$6 A000A8 6 A IfPPLICATION FOR BUILDING PERMIT 1 /DIVMON OF SUIIMG AND SAFETY ADDRE9IN8 d ==Sew LOCALITY WM J FOX COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTRICT NO GROUP TYPE SEWER MAPS N - .i X CON BUILDING / MAP NUMBER q YES NOADDRESS D HWY USBZONE SPECIAL LOTNO d BLOCK CONDITIONS TRACT / D SIZE OF LOT NOW ON L& I G YARD HWY STREET NAME EXIST 8 BACK WIDTH USE or 1-0 EXISTING BLDG FRONT 0 OWNER ' SIDE MAIL ADDRESS O TRACT DWELL I UNIT 8 INDUSTRIAL T 1 DWELL / I UNIT CITY 6 PUBLIC BLDG ARCHITECT ORTEL 2 DUPLEX I UNIT 7 ADON ALT ETC ' ENGINEER NO 3 APT _UNITS 6 MISCEL ADDRESS L 4 COMMERCIAL TEL •51 INSPECTION RECORD CONTRACTOR ADDRESS � � ZO DESCRWnON OF WORK NEW ADD ALTER REPAIR DEMOLISH BQ FT NO OR NO OF SIZE STORMS FAMILIES U F!A CTURE r A SIGNATURE OF APPLICAN I APPROVALS ADDRESS DATE INSPECTOR S SIG ATURE FOUNDATION LOCATION I S P C S FORMS MATERIALS J O Q REB FRAME FIRE STOPS VALUATION /� Q d S BRACING BOLTS FEB FURNACE LOCATION I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT DUCTS ✓ A APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT AND STATE LAWS REGULATING BUILDING CONSTRUC ✓ I TION JT /� � LATH ®CT SIGNATURE OFHOUSE NUMBER COR r� PERMITTfiE }' RECT AND POSTED ADDRESS V "` FINAL WM J FOX COUNTY ENGINEER VALIDATION C N DIRLAM CHIEF BLDG INSPECTOR LACo5003P; F811 16 8501m L&5004V; FM11 1 3400 " J 1�v . v WORKERS COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C ) Policy No��Company COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDDgS l0 3S /J ST Certified copy is filed with the coun b g insp BUILDING s T Qtion department ADDRESS zoos- G AJ�t^iF X5 71 LOCALITY Date f?— [ Applic , CITY CI%-J ZIP /� / 6 O CROSS NEAREST T CERTIFICATE OF EXEM FR O NO OF BLDGS ASSESSOR COMPENSATI NSURAN SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed of th permit is for one / USE ZONE MAP hundred dollars($100)or less) TRACT Z 2 S BLOCK LOT NO Z-b NO TEL IAL I certify that in the performance of the work for which this OWNERJ�n0,46- NO CONDITIONS IL permit is issued I shall not employ any person in any manner `1 r .�. DISTRICT GROUP TYPE FIRE PROCESSED BY O so as to become subject to the Workers Compensation Laws ADDRESS �O 3 S N 4M 3 r CONST ZONE V 4� c!T zip o 0 Date Applicant CITY �' 8 G S ISTICAL C IFI' TION CONDO 0 NOTICE TO APPLICANT If after making this Certificate of ARC ENGINEER HITECT OR TEL NO V Exemption you should become subject to the Workers CLASS NO DWELL UNITS d Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP to with comply with such provisions or this permit shall be Z deemed revoked CONTRACTS -V� J3W L�S TEL `f RR � BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC REIRREERE 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS/00 2 (7 NO 7/y.?y a VALUATION (commencing with Section 700D)of Division 3 of the Business and LIC �'y �O 00 Professions Code an/d my?license is in full force andel effect CITY A, CLASS B $'S-00 ► NO OF HECK License Number 3` ✓ G Lic Clan—LL— SO FT STORIES FAMILIES CONE Contractor/"(� �WSSIOJ &�pp�A�uDate p r3- DESCRIPTION OF WORK NEW $ I am exempt under Sec COADD B fort son _ ALTER FINAL &P C REPAIR DATE �! Date USE OF BLDG S C�/�(t- DEMO 0 BNA -L Y Signatur1owing (PRINT 3rd 1 L N 7 BU E DECLARATION I hereby offiam exempt from the Contractor s License ADDRESS 002 7 /! 3 Law for thereason Section 7031 5 Business and Professions Code) FRIMINIT BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation will do the work and LOCALITY the structure is not intended or offered for sale(Section 7044 Business and Professions Code) MOVING TEL z 3 4 Q 9 a I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec # • • • • • 1 tion 7044 Business and Professions Code) '�R� REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN WIDTH ► 2 - - 7 8 0 0 I hereby affirm that there is a construction lending agency for FRONT o o a 7 8 O O the performance of the work for which this permit is issued P L (Sec 3097 Civ C ) SIDE 0813-84 ,p P L Lender s Name Lender s Address P C Fee$ Permit Fee I certify that I have read this application and state that the lssuonce Fee above information is correct I agree to comply with all County Investigation Fee ordinances and State la relating to building construction 4157 Total Fee and hereby onz esentatry f this County to enter n e ab4 ed proper or inspection purposes �—o SEE REVERSE FOR EXPLANATORY LANGUAGE Signa a Ap I�ea Agent Date �s