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HomeMy Public PortalAbout6362 OAK AVE_Building__ -i1.,.,AF P L I CATION FOR COUNTY OF LOS ANGELES OF COUNTY BUIL MNG PERM•IT DEPARTMENT BUILDING D G AND SAFETY DIVISION ENGINEER BUILD FOR APPLICANT TO FILL IN AD RIESS ADDRESS 42kit-, LOCALITY NEAREST CITY G ZIP CROSS ST: NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK . PAGE PARCEL n'T / TEL. DISTRICT GROU TYPE FIRE P C BY TRACT - /3'71 BLOCK LOT. �✓ a Q �}O ,TQ Znr �J V "�— OWNER• le-41 NO. .AQ STATISTICAL CLASSIFICATION WER MAP S . D a CLASS NO. ADDRESS&3 SDWELL.UNITS )BK: G CITY . t ZIP •/ -7 v USE ONE NMA OP D , ARCHITECT OR _ TEL. �l ENGINEER I - NO. ECIAL NDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL. I ' CONTRACTOR ? .NO. -7 9 AS4& BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS/ S Cc NOA 9 7Gea- HIGHWAY + YARD• = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH CITY Y6a-o CLASS _ CONSTRUCTION LENDER + O NAME AND BRANCH BLDG.SETBACK FROM• U ADDRESS CITY SIDE PROP.LINE OF (STREET) G SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = OSETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE PROP.LINE • HIGHWAY WIDTH = DESCRIPTION OF WORK Z./)C' NEW + Z D DD ❑ -CORNERCUITOFF YES- ❑ NO ❑ ALTER ❑ IN OPEN SPACE YES ❑ 'NO ❑ USE OF Jai REPAIR ❑ IN COASTAL P MIT ZONE• YES ❑ NO ❑ EXISTING BLDG. DEMOL ❑ APPLICANT TEL (PRINT) - NO. BY(SIGNATURE) LIREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION fE E ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL O S REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN UTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIO OR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMCOM- PENSATION INSURANCE.URE OF �� BYTEE SSTEL. ee$ Permit Fee c9- NO Issuance Fee TION� /d7& Total Fee 'PLAN CHECK VALIDATION CK. M.O. CASH PERMIT'VALIDATION CK. M.O. CASH 22. 1 o •3 4.�0 m CJS 78A838A CE 1803A 8/77 WORKERS'COMPENSATION DECLARATION - l her,o'a cer that I have r certificate of consent to self APPLICATION FOR B U I��I N G P E RM I T 1 msufe, or a certificate of Workers' Compensation Insurance, .or,acertified copy thereof(Sec. 8800, Lab. C.) COUNTY OF LOS:'ANGELES �'BUIL�aNG AND SAFETY Policy No. Company BUILD Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESNG S ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS e,2 G'. J� Date Applicant CITY %� ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS: NEAREST SIZE OF LOT NOW ON LOT' CROSS ST. COMPENSATION INSURANCE /�/ ASSESSOR f (� (This section need not be completed if the permit is for one TRACT /`�6_3� BLOCK LOT NO. (d MAP BOOK I PAGE A? PARCEL hundred dollars ($100)or less.) �y ry E�p/ _ OWNER („- J USE ZONE 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 �7 04k' � SPECIAL � so as to become subject to the Workers'Compensation Laws. CONDITIONS O CITY Tj _ ZIP Date Applicant ARCHITECT OR TEL. Ix NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY O CONST. }ONE U Exemption, you should become subject to the Workers' �� / / Compensation provisions of the Labor Code, you must forth- ADDRESS !/ �,r-r8 e� s� a with comply with such provisions or this permit shall beTEL• t STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR 16W C� %PJ-C" . — 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 LIC. SEWER MAP and 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 Lic. Class SIZE STORIES FAMILIES ONE DVALUATION DESCRIPTION OF WORK NEW ❑ Contractor Date $61 100 D 0 ElI am exempt under Sec. �� .(` /7 ADD 1:1 , ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ USE OF Date: EXISTING BLDG. C DEMOL ❑ Signature APPLICANTTEL• n FINAL OWNER-BUILDER DECLARATION (PRINT) , '-•NOtF/p ' DATE 9 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL t� Professions Code): PRESENT ByBILDIN El 1, as owner of the property, or my employees with AD RESS ACCT a i wages as their sole compensation,will do the work and -' the structure is not intended or offered for sale(Section LOCALITY ' ,• 33"07 48.75 7044, Business and Professions Code.) MOVING tEl.. I,as owner of the property,am exclusively contracting CONTRACTOR NO. 1 with licensed contractors to construct the project (Sec- ADDRESSY�03 tion 7044, Business and Professions Code.) REQUIRED TOTAL SETB K FROM EXIS. qrt: CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. NE WIDTH 33 !7 i}• a I hereby affirm that there is a construction lending agency for FRONT _ z 44 the performance of the work for which this permit is issued P.L. i 1TEM0 (Sec. 3097, Civ. C.). P.L. , OTA 204® 19 Lender's Name {� 20 P.C. Fee.$ 3 a: Permit Fee [�J. /190• ( LDMA Ref. # CHECK i4.19 Lender's Address , CHANGE . 111 I certify that I have read this application and state that the Issuance Fee c; LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee s ordinances and State laws relating to building construction, Total Fee , LDMA Perm. # + 7 and hereby authorize representatives of this County to enter 0000- 1001 9/18/92 upon t b e-me tinned pro rty r inspection p pos s. �- c ;ya+i SEE REVERSE FOR EXPLANATORY LNGUAGE o, Signature of Applicant Agent Do w' WOkICERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR WILDING PERMIT insure,or a certificate of Workers'Comp e,� � a certifie co there (Sec. 3800, Lab. / Policy o ny COUNTY OF LOS ANGE ES , . BUILDING AND SAFETY Ce ' Ted copy is hereby fu Ished. �� _ FOR APPLICANT TO FILL IN BUILDING ADDRESS ertified copy is filed with the count utlding inspec- BUILDING '• / �/ tion department. ADDRESS v ! 0 /� y'�' LOCALITY NEAREST Date Applicant CITY L✓ Q f� ZIP /7�G CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' ! NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT b ;W9 NOW ON LOT MAP BOOK PAGE y PARCEL (This section need not be completed if the permit is for one USE ZONE MAP OC!3 hundred dollars ($100)or less.) TRACT 3� BLOCK LOT NO. NO. TEL -• — — ! �/�- SPECIAL CL I certify that in the performance of the work for which this OWNER f Y NO. ' — ' CONDITIONS O permit is issued, I shall not employ any person in any manner �^ ..@ DISTRICTGROUP TYPE FIRE PR ESSED•9Y U so as to become subject to the Workers'Compensation Laws. ADDRESS b �a O� CONST. ZONE CITY / (i ZIP 3 Date Applicant STATISTICAL CLASSIFICATION CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR a TEL. W Exemption, you should become subject to the Workers' if ENGINEER .Q p B NO.�3 ��. CLASS NO/� DWELL. UNITS N Compensation provisions of the Labor Code, you must forth- ADDRESS3 l SEWER MAP with comply with such provisions or this permit shall be — deemed revoked. CONTRACTOR / �lNp, C/r"� BK. 9!5—PG,a2 VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm That I am licensed under provisions of Chapter 9 ADDRESS r ` 12��� „��No �7C VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY / CLASS $ If ��. / SQ. FT NO.OF NO.OF CHECK License Number G5,, Lic.Clas a` / SIZE Gd' STORIES FAMILIES ONE Contractor ����, '. Date DESCRIPTION OF WORK NEW ❑ T r✓�r v ADD ❑ I am exempt from the licensing requirements as I am a (�Ir .l licensed architect or a registered professional engineer IV ALTER ❑ FINAL acting in my professional capacity (Section 7051, REPAIR E] DATE Business and Professions Code). USE OF AL EXISTING BLDG. DEMOL E] By AL Lic.or Reg.No. Date APPLICANT TEL OWNER-BUILDER DECLARATION PRINT) Joe ��� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS. 99 1 0 Q I !} Professions Code): PRESENT -2-3 ❑ BUILDING ° 0 0 a o 0 1 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY YQ�` r �� ©' 0 1 2 U,L'Q the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. r❑ T I, as owner of the property, am exclusively contracting CONTRACTOR NO. y�/�—dpI / 0 a 1 2 41 1, f_' U with licensed contractors to construct the project (Sec- aADDRESS tion 7044, Business and Professions Code). /— 0 Ci.0 1 —8 1 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 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 P.L. Lender's Name Ald-h'e P.C. Fee$ (Q O Permit Fee v Lender's Address I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County I Investigation Fee ordinances and State laws relating to building construction, Total Fe cind hereby authorize representatives of this County to enter uponJtie above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Appficant or Agent// Date I ®s