Loading...
HomeMy Public PortalAbout6396 OAK AVE_Building__ APPLICATION FOR COUNTY OF LOS ANGELES OF COUNTY IPU I L D I N G PERMIT o DEPARTMENT BUILDING AND SAFETY DNI$IONER BUILDING c3 FOR APPLICANT TO FILL IN ADDRESS BUILOtNG �/ +* ADDRESS app+ / • A • i LOCA LIT CITY �TEf 1.•ff V� ZIP NEAREST Q �p CROSS ST. ASSESSOR d;r SIZE OF LOT 1"!51q 1 fly OW ON LOTS MAP BOOK PAGE PARCEL `ICAC► B CKLOT NO. DISTRICT GROUP TYPE z2k- OWNER //��' ��� f��(� TEL. �� CON y, �FIR ON 0465A RDFAI NO. STATISTICAL CLASSIFICATION //��QI.�-�S.-- /��/ ate/ _ /�' SEWE �uIAP ADDRESSG��(,p93 )• QAI/,AN �Q , Q/� CLASS NO.�DWELL.UNITS+ BK Z3 PG CITY I�IVI? nn�1 A f ZI P f '1 C�0 U ZONE NOP D 2 ARCHITECc7 ENGINEER O "G�r�•y+�✓/'��� NSPECIAL O,L�7 `J��j+f/� �V CONDITIONS D 246 ADDRESS 6 230 E. UNION — l /ISACWA ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR NEL BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS NO. HIGHWAY + YARD = TOTAL SETBACK FROM H PE OF WIDTH LIC. FRONT PROP. LINE CITY CLASS _ CONSTRUCTION LENDER + NAME AND BRANCH �' p} BLDG.SETBACK FROM (STREET) C ADDRESS CITY SIDE PROP.LINE OF C. SQ. FT�/l7nO NO: OF { NO. OF CHECK HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE A EXISTING LY SIZE v000 STORIES 1 FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH DESCRIPTION OF WORK NEW + 12 fJ 5+vrilk ADD ❑ CORNER CUTOFF YES ❑ NO ❑ ,r 1� ALTER ❑ ldft( \REPAIR❑ IN OPEN SPACE YES ❑ NO ❑ USE OF EXISTING BLDG. 001REPAIR ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ APPLICANT rA�i �iy�,�f� NOI.�Q(� �5 (PRINT) (�, {i v+ ,h. �a• BY (SIGNATURE) CV 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMP • TION INNC SIGNATURE O .do_ FINAL ��,y BY PERMITT CA 4.9 DATE (� ADDRESS LTTE P.C. Fee$ 2 l Q Permit Fee CINSITY NO QQ Issuance Fee "� VALUATION P—J O p u' Total Fee PLAN CHECK VALIDATIONCK. � M.O. CASH o PERMIT VALIDATION �-M.O. CASH 0p9 n /'a�• f aZ3J7 �� /©• L 9 9 9 AUG 5 16 3 0 &Z 76AGSBA C6#8086 12/75 WORKERS'COMPENSATION DECLARATION hereaffirm that I have certificate of consent to self APPLICATION F BUILDING ` insusu re, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANTI ELES * BUILDING AND SAFETY Policy No. Company ElCertifiedcopy is hereby furnished. FOR APPLICANT TO FILL IN A DRESSs 3qk N. OA 1( ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS •I0 �• Of Date Applicant CITY W% �.� C 1 ZIP ( �v $,`;LOCALITY p NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. L C N COMPENSATION INSURANCE ASSESSOR /� (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK Cr'3 � PAGE 0 PA /RCEL l hundred dollars ($100)or less.) j TEL. } OWNE��j4 I& saes M I Sec jqk n NOJ��a� r USE ZONE MAP I certify that in the performance of the work for which this 7 NO. permit is issued, I shall not employ any person in any manner ADDRESS4;?62. , QSPECIAL CONDITIONS a so as to become subject to the Workers'Compensation Laws. /� �r O CITY—^ L (�e CA ZIP Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIREkel, PROCESSED BY ad NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST, ZONE Exemption, you should become subject to the Workers' �� (i „f Compensation provisions of thebor Code, you must forth- i ADDRESS d ✓ t�r,t�3 a with comply with such provisions or this permit shall be > TEL, ` Z p y p p d°°:STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. 5 CONTRACTOR v J LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that lam licensed under provisions of Chapter 9 ADDRESS NO. ' SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. ; CITY CLASS BK PG VALIDATION SQ. FT. a NO. OF NO.OF CHECK >: License Number Lic. Class SIZE d STORIES FAMILIES ONE x` VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑7. $ ❑I am exempt under Sec. SEA A� -pag� t ADD L31 V 1 PM B.&P.C. for this reason �t�-1.�5 �- WIN,vq w ( oboe ALTER )REPAIR $ Date: USE OF EXISTING BLDG. 0 LLS F— DEMOL ❑ APPLICANT TEL. Signature (PRINT) NOFINAL . OWNER-BUILDER DECLARATION DATE 1 hereby affirm that I am exempt from the Contractor's License n� Law for the following reason (Section 7031.5, Business and ADDRESS FINAL +•3 Professions Code): - PRESENT By 1141 c9/� /�•� a BUILDING I, as owner of the property, or my employees with ADDRESS i e wages as their sole compensation,will do the work and 3:317 43075 the structure is not intended or offered for sale(Section LOCALITY1 7044, Business and Professions Code.) MOVING TEL. ® ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. ACCT.'®r with licensed contractors to construct the project (Sec- rInvestigation tion 7044, Business and Professions Code.) (17 158.79 TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH ' ITEMS I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued P.Lo TOTAL 207.53 (Sec. 3097, Civ. C.). CHECK ?0?o Lenders Name. ,,( r 53 LDMA Ref. # �� o[j�) r /� Permit Fee �v+ Lender's Address i I certify that I have read this application and state that the Issuance Fee 7- s LDMA P/C# ' above information is correct. I agree to comply with all County Fee 7 f �p 13000-0001 1 19/9, S ordinances and State la7 4T ws relating to building construction, Total Fee /3 LDMA Perm. # and her�eb authorize represent s of this County,to enter 763-9-1 1 AM 935 upo ov enti ed a ert r i spection ur o e . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicantr Agent Dot