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Home My Public Portal About10213 NADINE ST_Building__ DEPARTIMM OF BUILDING AND SAFETY ' APPLICATION FOR PERJIT COUNTY OF LOS ANGELES � ' ® � WM d FOX CHIEF ENGINEER NG FOR APPLICANT TO FILL IN FOS OFFICE USE ONLYILDINN _ ~ /J�A . r DISTRICT NO PLAN OK No PERMIT NO ADDRESS •/7DI/y/pC V t,� /�Q �2 /7 3 7 LOCALITY ✓`/J ` /T RECEIVED MY DATE orAAPPL✓ 9DATE IBSUUCD NEAREST ��n��N jj ,- -3 • �✓ //f BUILDING / " s' OWNER ��A'L� �� //(/V /� ADDRESS C� Gail MAILe t / LOCALITY ADDRESS /`3I� Y�+ ✓J�I/V ✓ rUU�L. C //� L� /r TEL ! �� NEAREST 75 e4/cl c"J G,V+ FI AROHITECifaill TEL ZONE PLANE TYPE OROUP�— ENGINEER �� NO BLDG I ADD B Ill BETBACK LINE V �� G.• APPROVED TEL. BY t DATECONTRACTOR 02/ , , No- USE WIPPROVED ADDRESS er ZONE BY DATE DESCEGAL RIPTION I LOT NO BLOCK �U� CORRECTIONS TRACTNo /C fl Now ON LLOTS SIZE Or LOT USE OF NO Or d NO or f EXISTINGBL MIROOMS -FA J DESCRIPTION OF WORK (c^ NEW ALTERATION ADDITION __ O >0 REPAIR MOVING DEMOLISH t S 12E j Z NO OF 2 9 ROOMS STORIES 30 r WALL v-*" � ROOF 7 ' COVERING e� COVERING + t USE or NEW _ BUILDING eF f if I HEREBY ACKNOWLEDGE THAT i HAVE READ THIN t APPROVALS APPLICATION AND STATE THAT THE ABOVE IB CORRECT IN OTOR DJ�TE ANO AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION LOCATION / AND STATE LAWS REGULATING BUILDI CON UCTIO(�',, FORMS MATERIALS r` FRAME FIREOLTS SIGNATURE Or 1� �h/ted BRACING BOLTS PERMITTE � [� LATH INT AUTHORIZED AGT N LATH EXT 76ASMAA a 7.49 $ p O a +� PLASTER INT 7DOV FEE 6Lr"06? PLASTER EXT VALUATION FEE �+t ,D FINAL ,� DEPARTMENT OF BUnMING AND SAFETY l APPLICATION FOR PERBSIT COUNTY OF LOS ANGELES BUILDING ' ®■� ® ' WM J FOX OHIEF ENGINEER T ` FOR APPLICANT TO FILL IN FOR OFFICE USE ONL ` G7 L I J] DISTRICT N PLAN OK NO ��NO� BUILDING '7 M�� (per ADDRESS filedliag LOCALITY T Cj RECEIVED SY DATE OF APPL DATE ISSUED NEAREST C BUILDING �f OWNER ADDREBB G.. MAIL LOCALITY ADDRESS A-10,015 Al�� NEAREST CI Co.ab Tp ORDER BT FIRC NO OF TYORO ARCHITECT OR TEL. ZONE PLANS PE ENOINEER 1/1r NO BLDG ORD NO ADDRESS SETBACK LINE APPROVED CONTRACTOR wo �R NO BY DATE Use APPROVED ADDRESS ZONEBY DATE S DESCRIIPPTLION LOT NO BLOCK CO O�s TRAOTNo or Z Ia G Al n/ll�G size OF LOT %S-6 NOW ON LOTS U8E OF NO OF , NO OF EMU 1 F MILIEE RO M DESCRIPTION OF WORK NEIN ALTERATION ADDITION O >0 REPAIR MOVING DEMOLISH p B ZE 0 ROOMS BTORI`ES WALL our COV RING COVERING UBE OF NEW BUILDING r 1 NEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IN CORRECT FOUNDATION LOCATION INBP CTOR T AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORM8 MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION �» FRAME FIRE BTOPs. 810NATURE OR ;0 50w BRACING BOLTS PERMITTZ. LATHOINT AUTHORIZED ANT LATH EXT 7"6'.VM a s so $ O� P O • I PLANTER INT 2S70 mos FEE (� PLASTER EXT VALUATION FEE 1 �® FINAL , � p-v-f7 't APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure BUILDING ADDRESSO C--- - � # or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) C - ZIP Company S tL—IL-M t;tirl j� LOCALITY Policy No M&Ay b/ SIZE OF LOT O OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished I \ NEAREST CROSS ST $ertdied copy Ls filed with the county building Inspection TRACT BLOCK LOT NO department USE ZONE MAP NO Dat IR ��® ASSESSOR MAP BOOK PAGE PARCEL �Plicant � �� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS OWNER TEL NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? vEs SIO (This section need not be completed if the permit Is for one hundred ADDRESS dollars($100)or less) S} DISTRICT aGROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CITY ` ZIP 'O� ARCHITECT -1 Is Issued I shall not employ any person In any manner so as to R E GINEE -TEL NO S' become subject to the Workers Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS N077CE TO APPLIC0INT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith comp) with such provisions or this permit shall be deemed revoked FRONT Y Pe ADDRESS � LIC NO PL LICENSED CONTRACTORS DECLARATION a SIDE crnr uc CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES } Professions Code and my license is in full force.andd effect 1 NEW ❑ BK PG , IZ License Number v LIC Class _19 DESCRIPTION OF WORK _ ADD ❑ VALUATION O Contractor p d= ^^te S—/`/-�t Y' (8 ALTER ❑ $ 06 ❑ I am exempt under Sec Cho% REPAIR 13 $ B 8P C for this reason 1.0 F MOL ❑ LDMA P/C# W Date US OF EXISTING BLDG RM 13Q.S i DLIq 4.kA L- FW Signature CANT(PRm1T) TEL NO LDMA Perm# Z ❑ 1 as owner of the property or my employees with wages as O -, 122.2 2 their sole compensation will do the work and the structure is ADORES 3103 not Intended or offered for sale (Section 7044 Business and L / FI�CDAT 0 1 ITEM Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1 as owner of the property am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDEI FINAL BY > TI ITAL 122.22 licensed contractors to construct the project (Section 7044 YES❑ NO 122 22 Business and Professions Code) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE 8UILDING _ -w �� OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH rlA {GE CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there Is a construction lending agency for YES❑ NO* N the performance of the work for which this permit is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 0000-0001 9/19/99 co 3087 CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lender s Name MATERIALS REPORTING AND FOR OBINNING A PERMIT FROM THE SCAOMD or,f J 1 AI{�111 a 99 0 Lenders Address Q s e= z - C ONMER—AGENT c I certify that I have read this application and state under penalty of perjury that the above Information is correct I agree to comply PC FEE PERMIT FEE N 72, with all county ordinances and State laws relating to building construction and hereby authonze representatives of this County ISSUANCE FEE ro to enter upon the above mentioned property for inspection purposes OVA• ! �1�, ;1 I '�`.{'" 1O �� v C~ c� CD •1 INVESTIGATION FEE T65Z FEE �eWr l`l su SEE REVERSE FOR EXPLANATORY LANGUAGE