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Home My Public Portal About10243 NADINE ST_Building__ 76AW CE0403 3 66 APPLICATION FOR BUILDING PERMIT COUNW OF LOS ANGELES BUILDING n(fs� DEPARTMENT OF COUNTY ENGINEER ADDRESS ,N G BUILDING AND SAFETY DMSION LOCALITY c- JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS, SUP T OF BUILDING NEAREST CROSS ST FOR APPLICANT T FILL IN DII y° GR corPisr PR ESSED BY Print or type only) + �f BUILDING STATISTICAL CLASSIFICATION- WER MAP r ADDRESS CLASS NO WELL UNITS BK _1290 LOT NO ' BLOCK USE ZONE MAP NO TRACT (c, SPECIAL CONDITIONS SIZE OF LOT �� ' Q NOW ON O OF LOTS USE OF EXISTING BLDG c. 'I BLDG SETBACK FROM TEL FRONT PROP LINE OF (STREET) OWNER V NO TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS Q IV G HIGHWAY WIDTH FROM C L CITY Fbh(aA? c BLDG SETBACK FR + \ ARCHITECT OR TEL SIDE PROP L NEOF M a (STREET) ENGINEER NO TYPE OF EXISTING SET HIGHWAY + YARD = TOTAL ADDRESS �Q HIGHWAY WIDTH F C L CONTRACTO TE � a ( T ' M + It LIC C NER CUTOFF YES ❑ NO ❑ V ADDRES NO CITY �1 CLASS bf SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK a N Z NEW ADD ALTER REPAIR DEMOLISH 17 SQ FT NO OF 1 NOF i SIZE STORIES FAO 1LIES USE OF STRUCTURE C SIGNATURE OF APPLICANT VALUATION S APPROVALS DATE N. OR s 10NATURE P C PMT FOUNDATION LOCATION FEE S FEES o FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LA REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN NO THE WORK AUTHORIZED HEREBY I WI NOT EMP A Y RSON IN VIOLA LATH INT TION Or THE LABOR CO F mg E LIFORNIA RELAY INO TO WORKMEN S CO A UR LATH EXT SIGNATURE OF HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS OtmFINAL 6 JOHN F LEWIS PRINCIPAL STIR RAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PEUCT VALIDATION CK LIDM O CASH LAL0576g,2 AuG 6 1 D 22.50^' OaLllx/ J WORKERS COMPENSATION DECLARATION C APPLICATION FOR BUILDING I kereW affirm that I have a certificate of consent to self � PERMIT Jnsure or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS 9002 45 Certified copy is filed with the county building inspec4 BUILDING tion department ADDRESS ST LOCALITY NEAREST Date Applicant CITY C T ZIP 4 1 7S 0 CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERSNOW ON$��C I7 LO MAPP BOOPAGE PARCEL RK COMPENSATION INSURANCE SIZE OF LOT (This section need not be completed if the permit is for oneUSPONE NO 27� hundred dollars($100)or less) TRACT BLOCK LOT NO �� PE JAL I certify that in the performance of the work for which this OWNER .S I R I C H 0 M CNA TNO 7S IJ is I ` SCONDITIONS d permit is issued I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE P SSED BY O so as to become subject to the Workers Com ensotion Law ADDRESS S 0 V E ^ CONST ZONE % V Date —1 —ffI Applican}-S CITY ZIP STATISTICAL CLASSIFICATION APT CONDO ,,_ V NOTICE TO APPLICANT If after making this Certificate of ARCHITECT OR TEL 2/ Exemption you should become subject to the Workers ENGINEER NO CLASS NO DWELL UNITS Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be _ deemed revoked TEL CONTRACTOR daNO BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC / r�� Professions Code and my license is in full force and effect CITY CLASS S �v ► i SQ FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAMILIES ONE E Contractor Date DESCRIPTION OF WORK NEW ❑ ❑I am exempt under Sec A T TA C H f P C 0 $ f D ADD ALTER ❑ FINAL B&P C for this reason P fiT 10 REPAIR [:1DATE (0 J. USE OF FIN Date EXISTING BLDG DEMOL ❑ IS Signature APPLICANT TEL OWNER BUILDER DECLARATION PRINT NO I hereby affirm that I am exempt from the Contractor s License Low for the following reason (Section 7031 5 Business and ADDRESS ' Prof ions Code) 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 TOTAL SETBACK FROM EXIST 5 4 2 7 A CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP LIN WIDTH ► i I hereby affirm that there is a construction lending agency for FRONT # • • • • • ' the performance of the work for which this permit is issued P L • (sec 3097 civ c) SIDE I • * 5925 Lender s Name t - 59255) Lender s Address P C Fee i Permit Fee r7,01 s 7J y ; I cern that I have read this application and state that the 91 -86 certify PP Issuance fee above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction Total Fee 1 1 and hereby authorize representatives of this County to enter u inspection purposes 7/afr�y//` , 4 y. u /� SEE REVERSE FOR EXPLANATORY LANGUAGE r ®s Signature of Applicant or Agent Date • WORKERS C MPENSATION DECLARATION •nistuebo acertifcateofWorkesrtCompensatonInsuranelf APPLICATION FOR BUILDING PERMIT or a certified copy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company I ` ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING �cId .�3 � ❑ Certified copy is filed with the county building mspec BUILDING �C tion department ADDRESS 0 3 N INt- S /. Date Applicant CITY Tip 146o).r [ T ZIP f 1780 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT OSS ST Ud (This section need not be completed if the permit is for one TRACT BLOCK LOT NO ASSESSOR hundred dollars($100)or less) MAP BOOK PAGE PARCEL OWNERS [ IC N L 7 -b�6I USE Z NE MAP I certify that in the performance of the work for which this NO �. permit is issued I shall not employ any person in any manner ADDRESS D 1 N f 17" SPECIAL d so as to become subject to the Workers Compensation Laws CONDITIONS V Date 7-,-3- 9J6 Applicant S. nCITY T E n P C T zip 11710 Rt: NOTICE TO APPLICANT If after making this Certificate of ARCHITECT OR TEL DISTRICT GRRRQQQUP TYPE FIRE PRE BY Exemption you should become subject to the Workers ENGINEER NO �.� CONSV Z E // Compensation provisions of the Labor Code you must forth ADDRESS01-1 51 with comply with such provisions or this permit shall be deemed revoked TEL STATISTICAL CLASSIFICATION APT DO Z CONTRACTOR NO LICENSED CONTRACTORS DECLARATION LIC CLASS NO �•' DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code and my license is in full force and effect CITY CLASS BK PG VALIDATION SQ FT NO OF NO OF CHECK License Number Lc Class SIZE STORIES FAMILIES ONE ❑ DESCRIPTION OF WORK NEW VALUATION/ MO I am exempt under Sec �v Contractor Date $ ` , D IT10N DED 00M It ADD ❑ B 8P C for this reason ALTER E]0 M REPAIR ❑ $ Date USE OF EXISTING BLDG DEMOL Signature APPLICANTTEL CA#3)74q, — FINAL �d OWNER BUILDER DECLARATION (PRINT) PRINT S IR L R HAMItNMt O DATE 49 I hereby affirm that I am exempt from the Contractor s License ADDRESS .3 Nf►D 1 N0 ST Law for the following reason (Section 7031 5 Business and FIN Pr ions Code) 151 Q 9 A I as owner of the property or my employees with BUILD wages as their sole compensation will do the work and LOCALITY #+ • • • • • 1 the structure is not intended or offered for sale(SectionPoo- 7044 Business and Professions Code) MOVING TEL 1 * 17175 ❑ I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec • - 171755 tion 7044 Business and Professions Code) REQADDRESS CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTALPS UNE WIDTH 0 7 2 3—86 I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L (Sec 3097 Civ C) SIDE PL Lender s Name LDMA Ref # Lender s Address PC Fee$ Permit Fee 1 certify that I have read this application and state that the Issuance Fee f' LDMA P/C# above information is correct 1 agree to comply with all County Investigation Fee e� ordinances and State laws relating to building construction Total Fee 5 LDMA Perm U and hereby authorize representatives of this County to enter upon he above mentioned prop rty r inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date