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HomeMy Public PortalAbout9929 NADINE ST_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 1 WM. J. FOX. CHIEF ENGINEER B U I L D I N G FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING! �Z/- i IgTRI�O. PLAN DK.NO. PERMIT NO. LOCALITY ` RECEIVED BY DATE OF APPL. DATE IMBUED NEAREST BUILDING ADDS /2 OWNER ' E MAIL ZLOCALITY ADORE !XSIV At (ZI6a TEL. NEAREST CITY CAO"ST. � Yp FIRE NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER ND. BLDG. ORD.NO. A D E SETBACK LINE APPROVED CONTRACTOR USE APPR ADDR 2 7 ZON BY DAT LEGAL CORRECTIONS DE LEGAL LOT NO. / BLOCK TRACT 1,7,oQ Z NO.OF SLOG SIZE DF LOT S I Z V NOW ON LOTS h UHE OF NO.OF NO.OF -E 1 ING BLDG, FAMILI[e ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION I� O A REPAIR MOVING DEMOLISH O_ Z 8 ZE ROOMS MH STORiEB O D r WALL ROOF COVERING [r I COVERING USE OF NEW BUILDING i 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE L.AWBRE L.ATING BUILDIr4131 CONSTRUCTION. CAJ FRAME: FIRE STOPS, SIGMA RE OF BRACING,BOLTS > PERMITTE • LATH, INT. AUTHORIZED AMY-'e, _ - LATH, EXT. �" PLASTER,INT. 7fiA63HA-3 7-49 $ �1D�O P.C.* 6 �tj� 7y FEE G m� PLASTER,EXT. VALUATION I ZO FEE 30 - FINAL ►/ `/ ` �PPOCATION FOR UILDING PERMIT FOR APPLICANT TO FILL IN ADDRESS BUILDING- yy ADDRESS 4. 1 LOCALITY NEAREST CITY rr—In RL�� ZIP CROSS ST. NO.OF BLDGS.SIZE OF LOT �// S /Z U NOW ON LOT v MAP BOO PAGE PARCEL TRACT (/G BLOCK• LOT NO. DISTRICT GROUP TYPE FIRE ESSED BY j� Q CONST. ZONE t OWNER R EL. 2ps12� �C� - q CSTATISTICAL CLASSIFICATION SEWER MA ADDRESS 2 , IhaCLASS NO. DWELL.UNITS BK PG CITY ZIP US NE OP p ARCHITECT OR TEL. SPECIAL O ENGINEER NO. CONDITIONS ADDRESS RO EPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL. CONTRACTO N0.3 Q BLDG.SETBACK FROM LIC FRONT PROP.LINE OF (STREET) ADDRESS 2Z NO./aJ-G 4-D TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER + a NAME AND BRANCH BLDG.SETBACK FROM u ADDRESS CITY SIDE PROP.I.INE OF (STREET) O SQ.FT. NO.OF NO.OF CHECK HIGHWAY +. YARD TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH ❑ + Z DESCRIPTION OF WORK NEW ADD ❑ CORNER CUTOFF YES ❑ NO ❑ ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR USE OF ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. DEMOL .APPLICANTTEL ` (PRINT). Oss BY(SIGNATURE • I HEREBY A EDGE THAT 1 HAVE THIS AP TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE F THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INS NCE. ,SIGNATUREF ! FINAL BY PERMITTEE DATE 129 O f'(/4b/Cam ADDRESS 1 CITY NO. P.C.Fee$ Permit Fee Q Q 6� Issuance Fee VALUATION$/ ©�O Total Fee Z-• 7S PLAN CHECK VALIDATION cK. M. . PERMIT VALIDATION cK. M.o. CASH . WORKERS COMPENSATION ®. POLICY HOLDER: �. POLICY NUMBER: /V o`2 al -?-A ��'. APPLICATION .FOR " BUILDING PERMIT FOR APPLICANT TO FILL IN AD� REss 9 ' BUILDING rr ADDRESS LOCALITY CITYNEAREST !T ZIP. ' CROSSST. /Y NO.OF BLDGS. ASSESSOR SIZE OF LOT $ NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE jFIRE =ED BY TRACT BLOCK LOT NO. CONS . n TEL. ' �•�� OWNER NO. STATISTICAL CLASSIFICAT ON SEWERMAP ADDRESS I CLASS NO. DWELL.UNITS BK G CITY C = ZIP USE ZONE NIAL ARCHITECT OR TEL.nn �/ CJ ENGINEER NO�C 6 ✓✓�_ CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ � TEL.' CONTRACTOR NO.J;. r g BLDG.SETBACK FROM LIC. . FRONT P P.LINE OF (STREETI -AD DRESS' f, IVO. L�/ TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHW Y .+ YARD = FRONT PROP.LINE HIGHWAY WIDTH CITY U CLASS CONSTRUCTION LENDER _ + _ a NAME AND BRANCH BLDG:SETBA O ADDRESS CITY SIDE PROP.LINEOF (STREET). SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL.SETBA M TYPE OF EXISTING SIZE STORIES I FAMILIES I ONE SIDE PROP.LIN HIGHWAY WIDTH w DESCRIPTION OF WORK NEW ❑ = Z ADD ❑ CORNER CUTOFF YES ,❑ NO ❑ ALTER IN OPEN SPACE YES ❑ NO ❑ REPA USE OF BLDG Gv RE AIR IR ❑ IN COASTAL PERMIT ZONE YES ❑. NO-EXI ❑ APPLICANT TEL (PRINT) Nc,. BY(SIGNATU I HEREBY A NOWLEDGE THAT I HAVE READ 5 APPLICATION D STATE 7 Qom' THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE .. WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSU NCE SIGNATURE O FINAL 7C BY PERMITTEE ' DATE V , ADDRESS TEL.3�ir'_1r�Q P.C.Fee$ Permit Fee CIN NO. 7 Issuance Fee VALUATION$ 14110 d . Total Fee PLAN CHECK VALIDATION. CK. M'.0., CASH PERMIT VALIDATION CK. M.O. CASH WORKERS ComPENSATION 2 4NOV s 1 0 es �AQMQ,g0LDER:: 'POLICY NUMBERA/2--7 `fop' ...:. _.. -� APPLICATION FOR BUILDING PERMIT ,A +F COUNTY OF LOS ANGELES BUILDING AND SAFETY 'WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIDDRESS I hereby affirm that I have a.certificate of consent to self insure,' BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified �q7� byV copy thereof(Sec.3800,Lab.C.) CITY 7P �1�Qp Policy No. Company U LOCALITY SIZE OF LOT [� NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. �,7sX NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT '.r�O^ BLOCK, LOT NO. �5 ( d USE ZONE MAP NO. department. Date Applicant ASSESSOR MAP BOOK UJ V O PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERd ? TEL NO. COMPENSATION INSURANCE G W u �l }S(l WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS W160 `4_ 'nr DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) i I certify that in the performance of the,work for which this permit CITY ZIP "POP � U GG77 is issued, I shall not employ.any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR EN INEER TEL NO. I p STATISTICAL CLASSIFICATION APT CONDO Date -Applicant ADDRESS CLASS NO. 44 / DWELL UNITS NOTICE TO APPLICANT, If, after making this Certificate of• REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR 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 CffY LIC.CLASS P L 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�Fr.SIZE NO.OF;TORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. Ips' NEW BK PG a DESCRIPTION OF WORK VALUATION License Number Lic.Class ADD ❑ � Contractor Date ALTER ❑ $ ❑ I am:exempt under Sec. REPAIR ❑ BAP.C.for this reason /vJ �`-� , DEMOL ElV LDMA P/C Y .............. W Date: USE OF EXISTING BLDG. ��1 URM ❑ 1 a. lure APPLICANT(PRINT) 'j' 1 TEL NO. �1` 'LDMA Perm+Y ...... - ..... .. Z .. {y( T 4 - '- Z I, as ner of the property, or my employees with wages as 1 " 0 KICT c. _.. their s e compensation, will do the work and the structure is ADDRESS G r F ,303118.65 not int nded or offered for sale (Section 7044, Business and l F FINAL.DATE ... _... _. Q i_T� .. IS Profen IOr1S Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �i�� 1 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE" '-"-"-.... -"------' - .❑ 1, as wrier of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? - FINAL BY TOTAL 118. 65 Ii ed contractors to construct the project (Section.7044, Bu si ess and Professions Code.) YES 11 No❑ CHECK 118.65 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION ORWODIFICATION FROM THE SOUTH" CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR .... t1fR99�K _ ■ 00 . GUIDELINES. hereby affirm that there is a construction lending agency for YES El NO 11ONi the performance of the work for which this permit IS Issued(Sec., I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,Civ.C.) (}(�� �+�+w+ Z - . CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE (� -., lJ1.R.k.� 7/?3`9J a TITLE 2,CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. _ 1 AM 7:46 o Lender's Address 0 OWNER OR AGENT certify that I have read this application and state under penalty g of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building < construction, and hereby authorize representatives of this County ISSUANCE FEE �/� to ante on the abov -mentioned property for inspection pur res 00 c ____��� INVESTIGATION FEE TOTAL FEE °D F r7 r` e4wure of Appfica,X« � � Dffie . ° SEE REVERSE FOR EXPLANATORY LANGUAGE