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HomeMy Public PortalAbout10105 OLIVE ST_Building__ TEMPLE CRT Y iBA8881%ell#8082/80 APPLICATION FOR BUILDING PERMIT - .1 COUNTY OF LOS ANGELES BUILDING J DEPAIMIENT OF COUNTY ENGINM ADDRESS / BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST T WILLIAM A.JENSEN .SUP•T OF BUILDING CROSS ST.' DISTRICT NO. GROUP TYPE P ESBED BY FOR APPLICANT TO FILL IN ! CONST:y rs V. BUIDLDING © .[� .. ADSTATISTICAL CLASSIFICATION S WER MAP RESS ®+ K P // CLASS.NO.�WELL.UNITS LOT NO. /Q 14' BLOCK MAP STATE -YES ^O}' NUMBER . HWY. TRACT T AN'- S ZONE SPECIAL NO.OF BLDGS. ra��' CONDITIONS SIZE OF LOT�7 I NOW ON L'OT USE OF EXISTING BLDG. BUILDING EXIST. p�yy YARD HWY STREET NAME A./ ® r!% NFRONT TEL SK / WIDTH OWNER /2 & .+��f r� fie,/ /•� .p• ADDRESS [C!r/�ocT dY . 17� f A V '. SIDE ARCHITECT OR /7 yJ C .L ti/ TEL. P.L. ENGINEER / l�, G/ NO. E INSPECTION RECORD = ADDRESS 4 $YoL /3iL / + TEL. CONTRACTOR ,E6-/F NO. `� O f / AbDRESB ���e.' C .�P.r __>g!_• /Rf �,Vy DESCRIPTION OF WORK `-*-w: ..��, ' /•.✓r!' �- `off-- _ e w f � N NEW ADD ALTER REPAIR DEMOLISH !/ NO.OF - NO.OF ) `�a✓-.f��r 7v: ,s :'r, a.. ..�, - r GIB SIZE STORIESFAMILIES i ' USE OF 1� Z /�`..'. •e�-��.il_ia o,: /�-/C•; ��1.'.,£�'•f-i/•�iv-f..•�it.�:=�,.,. STRUCTURE SIGNATURE OF APPLICANT ' 'T�s-�'+ �oerl'- :'�'.J�F'JM/.-J� �S lJ'j+ •O� ems`- VALUATION -- APPROVALS DATE INSPECTOR'S SIGNATURE FEE '$. FEE $ �U FOUNDATION:LOCATION /Zf FORMS,MATERIALS T FRAME:FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- BRACING,BOLTS G/ PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE:LOCATION, J AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS , !� STATE.LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH' ,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE - WORKMEN'S CO NSATI WS LIFORNIA. I LL LATH,EXT. SIGNATURE 4 r HOUSE NUMBER COR- PERMITTEE B RECT AND POSTEDT- ADDRESS FINAL 5- �vd¢✓ _.4 70 CLYDE N. DIRLAM, PRINCIPAL STRU RAL ENGINEER PLAN VALIDATION cx. M.O. CASH PFJWT VALIDATION M.O. CASH A . . . . rVENAPLE CR T Y :. FU08A C6#803 2/67 •APPLICATION FOR BUILDING• PERMIT '. •• •1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGIIMER ADDRESS / ! BUWING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST ` WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN '^T NO. I GR TYPE P E D BY • c CONST.. BUILDING STATISTICAL C SIFICATION WER MAP ADDRESS K PG CLASS.NO. DWELL.UNIT '�• .37 BLOC MAP Jl /) STATE YES N LOT NO. + t NUMBER f.+ v HWY. TRACT i r USEZONE SPECIAL / NO:OF BLDGS. + A / CONDITIONS - L SIZE OF T I NOW ON LOT /ly USE OF EXISTING BLDG. BUILDING EXIST. YARD HWY STREET NAME' )/f TEL SETBACK SETBACK WIDTH OWNER s I�fLL''r N0.6� �.7. FRONT / •. J �' P.L. ADDRESS a + . SIDE ARCHITECT OR TEL. P.L. ENGINEER i6 NO. INSPECTION RECORD. ADDRESS -5--92 ofi + T ' a CONTRACTOR ADDRESS DESCRIPfION OF WORK a0 W EW ADD ALTER REPAIR DEMOLISH FT. NO.OF NO.OF CL SIZE l STORIE§ FAMILIES USE OF STRUCTURE + r 3 SIGNATURE OF APPLICANT VALUATION$ ' r O I APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, + FOUNDATION:LOCATION FEE '$ FEE $ �7 V FORMS,MATERIALS ]HEREBY ACKNOWLE GET T I HAVE READ THIS AP- FRAME:FIRE STOPS, PLICATION AND STATE THAT T E ABOVE 18 CORRECT AND BRACING,BOLTS FURNACE:LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT DUCTS 1 CERTIFY THAT, IN DOING THE WORK AUTHORIZED i LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S COMPENSATIO LAWS 9F CALIFORNIA. LATH,EXT. 1 ' •� 81GNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRES +e FINAL CLYDE N. DIRLAM.PRINCIPAL STRYrA RAL ENGINEER PLAN CHECK VALIDATION cec M.C. cash PERMIT VALIDATION' cs. 'M.O. cash LA"o 5 .0 2 4 Z. AP fi 7 1 D 2 5.5 0 °®, WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compensation Insurance, ,. or a certified copy thereof(Sec: 3800, Lob.-C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ILDING ❑ Certified copy is hereby furnished.. I FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING j I/ tion department. ADDRESS /o! � V LOCALITY i 7 s NEAREST " Date J " Applt CITY L ! N ,OF BLDGS. ASSESSOR i ZIP CROSS ST. CERTIFICATE OF EXEMPTIO 'FROM WORKERS' SIZE OF LOT OW ON LOT MAP BOOK PAGE PARCEL COMPENSATION J SURANCE (This section need not be com ( ted if the permit is for one USE ZONE MAP hundred dollars($100)or less. TRACT BLOCK LOT NO. NO. TEL> ./ SPECIAL A. I certify that in the performance of the work for which this OWNER NO.U 1 CONDITIONS O DISTRICT GROUP TYPE FIRE PROCESSED BY permit is issued, I shall not employ any person in any manner ADDRESS � CONST. ZONE � so as to become subject to the Workers'Compensation Laws. Date Applicant 4 CITY `� ZIP STATISTICAL SIFICATION ICONDO. ARCHITECT OR ,SPL. U NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER L I sst CLASS NO. -� DWELL. UNITS 'Exemption, you should become subject to the ,Workers' ,; � Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP VALIDATION with comply with such provisions or this permit shall be TEL Z deemed revoked. i CONTRACTOR '�� Q "^ O, 7W-j ij BK. PG, LICENSED CONTRACTORS DECLARATION LIC. //// , ) I hereby affirm that I am licensed under provisions of Chapter 9 1 ADDRESS n NO. /G CYr/ V LLIATION (commencing with Section 7000)of Division 3 of the Business and i LIC. �+4✓- G6,� �f Professions Code,and-my license is in full force and effect. CITY /✓ CLASSY O CJ , /' 7 SQEFT.//� S ORIES FANO.OF MILIES CHECK License Number-3/656n Lic.Class C�-� �7 �� DESCRIPTION OF WORK NEW ❑ $ Contract. C, ,Date � 9 ADD E] ❑ I am exempt under Sec. f �✓ V ' ALTER ❑ FINAL r B.&P.C. for this reason ` REPAIR ❑ DATE +..X , USE OFFINAL Date: I EXISTING BLDG. DEMOL E] Bjr ..�,,,,(� Signature APPLICANT TEL g OWNER-BUILDER DECLARATION ; PRINT e, r+`14cs o4l NO33O'� l I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS / / �, 3 1,5 A Professions Code): • . . 1 111111 PRESEN ❑ BUILDING ir•0 a ° V ° 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 kADDRE ] �.O O 7044, Business and Professions Code). TEL. 0 0 0 7 f� CTOR NO. O O i✓ I,as owner of the property,am exclusively contracting ; with licensed contractors to construct the project (Sec- 'tion 7044, Business and Professions Code). . CONSTRUCTION LENDING-AGENCY ED TOTAL SETBACK FROM EXIST. CK YARD HWY PROP. LINE WIDTH , I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued tSec. 3097, Civ. C.):Lender's Name $ Permit Fee . 512 Lender's Address rI certify that I have read this application and state that the Issuance Fee D. above information is correct. I agree to comply with.all County Investigation Fee ordinances and State laws relating to building construction, Total Fee .c a re authorize representatives of this County to enter pon twabove-menjliogecl property for inspection purposes. may/ L1'. SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature of Applicant or Agent' Date ®s �,, APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS D O vie6 10 S t Ve- or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY ZIP & LOCALITY �• 1 Policy No.UU W039ag Company C ki � SIZE OF LOT e+ CNO.OF SLOGS.NOW ON LOT �� ' I ❑ Certified copy is hereby furnished. I NEAREST CROSS ST. ElCertified 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 TEL NO. YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP — I certify that in the performance of the work for which this permit _ �/ is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. V become subject to the Workers'Compensation Laws. STATISTICAL CL9SSIFICATION APT dbNbb 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' CONTRACTORTEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith t FRONT comply with such provisions or this permit shall be deemed revoked. ADD ES LIC.NO. PL D OL LICENSED CONTRACTORS DECLARATION TTY Ire SIDE � LIC.CLASS P L � I hereby affirm that I am licensed underprovisions of Chapter 8 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE $40.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG a License Number /9e P&L_LK;.Class ESCRIP NOF WOR` ADD ❑ VALUATION , * a ALTER ❑ Contractor ate�a_ � `7© $ - 10L,.918 � � ElI am exempt under Sec. REPAIR 11 0 V B.&P.C.for this reason DEMOL ❑ LDMA P/C# Date: �r—lO^fir USE OF EXISTING BLD . URM ❑ Signature 11elA CO APPLICANT(PRINT) TEL NO. LDMA Perm# Z 11I, as owner of the property, or m employe with wages as Z their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ NO❑ Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG 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(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ Im W the performance Of the work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING N 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LAS 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 OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address a OWNER OR AGENT G I certify that I have read this application and state under penalty 9 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE tLJ� N with all county ordinances and State laws relating to building construction,and hereby authorize representatives of this County ISSUANCE FEE . 3 O to enter e u on the ab -me Toned property for inspection purposes. m Q�O INVESTIGATION FEE TOTAL FEE D= O lure 0 AppJ n ;01 SEE REVERSE FOR EXPLANATORY LANGUAGE