HomeMy Public PortalAbout9923 NADINE ST_Building__ 78A898A CE8G9 8-GI APPLICATION F R BU ILi��Nt ' PBRMIT
'BOUNTY OF LOS ANGELES BUILDING _ S_
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS.SUP•T.OF BUILDING CROSS ST.
DISTRICT NO. GROUP YPE. P SED BY._
FOR APPLICANT TO FILL IN CONST.
BUILDING - STATISTICAL LASSIFICATION SEW R MAP
ADDRESS 3 S� w- BK PG
CLASS NC DWELL UNITS
LOT NO. BLOCK USE ZONE 'MAP-
NO.
TRACT Q "SPECIAL
N0. OF BLDGS. coNbiTioNs
SIZE OF LOT NOW ON LOT
USE OF
TIC a - 4fa a BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OWNER rS. 1LIL NO. TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL
ADDRESS �)3 �O a cJ IG M C.L. /J
CITY
ARCHITECT JDR TEL. BLDG. SETBACK ROM
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS /9TN
- HIGHWAY WIDTH FROM C.L. IL
CONTRACTOR p � C lip NOL "lLIC '1�J J + - O
ADDRESS B Jai ✓' NO O 1f CORNER CUTOFF YES El NO 0
CITY ha 7 d C&ICLALIQ3 q C SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK
1•D6� ?
NEW ADD ALT REPAI DEMOLISH
SQ.FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE a P..
SIGNATURE OF `
APPLICANT 1
VALUATION$ D
APPROVALS DATE INBP ECTOR'881GNATURE"
P.C. PMT. �./ FOUNDATION, LOCATION
FEE$ -r-� FEE$ ��i FORMS,_MATERIALS __"
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
SUILOING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK -
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENB TION INSURANCE. 1 LATH. EXT.
SIGNATURE OF 1 HOUSE NUMBER COR-
PERMITTEE R PO�STE
ADDRESS 1 FINAL
JOHN F. LEWIS. PRIM IPA UR L ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERVALIDATION M.O. CASH
2 8 2 4-2 JUN 17 1 D 6,0 .0N
• - APPLICATION-i�OR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION .FOR APPLICANT TO FILL IN BUILDING ADDRESS C s
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS• 1L `/` ,15 � /-�Z� G �(�
or a certificate'of Workers'Compensation Insurance,or a certified CITY (� ZIP ' �•` G` . Gig-+ f/7 i7.
copy thereof(Sec.3800.Lab.CJ o 17/760*
LOCALITY l!
Policy No. Company SIZE OF LO NO.OF BLDGS.NOW ON LOT
❑ Certified Copy is hereby furnished. So NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE ZONE MAP NO.
Date Applicant. ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER I TEL NO.
COMPENSATION INSURANCE -Z WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred ADDRESS
s DISTRICT GROUP E CONST. FIRE ZONE PROCESSED BY
dollars($100)or less.) q!77-3 Momloiff
I certify that in the performance of the work for which this permit CITY T C17ZIP /'7 yj 0 �D d (� f
is issued, I shall not employ any person in any manner so as to v Q
become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO.
STATISTICAL CLA FlCATIONAPT CONDO
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to ,the Workers' CONTRACT O� TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L
LICENSED CONTRACTORS DECLARATION SIDE
CITY LIC.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 SQ.9FT,�IZE NO.OF ORIES NO.OFF ILIES
Professions Code,and my license is in full force and effect. �� NEW ❑ BK PO a
License Number LiD.Class DESCRIPTI OF WORK ADD ❑ VALUATION , Q
Contractor Date ALTER ❑ $ /S 0�' U
❑ I am exempt under Sec. h( REPAIR ❑ $ Q I_ O
B.BP.C.for this reason • Q DEMOL ❑
LDMA P/C,#
Date: USE OF EXIS7ING BLDG. URM ❑ IL
co
Signature APPLICANT(PRINT) �� L r� ^� LOMA Per r Z
A'heir
as owner'of the property, or my employees with wages as Z �/ ��sole'compensation, will do the work and the structure is ADDRESS F '�7�'/
not intended or offered for sale (Section 7044, Business and Z AIADJAIELS FINAL DATE Q
Professions Code.) _
.. WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
❑ 1, as Owner of the property, am exclusively Contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q
licensed Contractors t0 construct th9AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
project (Section 7044, YES❑ NO❑
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES.
I hereby affirm that there is a construction lending agency for YES❑ . NO❑
m the 7,Civ.
C.) Of the Work for Wf11Ch this permit IS ISSUBd(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING
3097,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 OBTAMING A PERMIT FROM THE SCAOMD.
o Lender's Address.
C OWNER OR AGENT
o I certify that I have read this application and state under penalty
O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE p
$ with all county ordinances and State laws relating to building
Construction, and hereby authorize representatives of this County ISSUANCE FEE 9O
m to en t n thea ve-mentioned property for inspection ,
n `/ �� ( INVESTIGATION FEE TOTAL FEE * iy
,Z` SEE REVERSE FOR EXPLANATORY LANGUAGE (/