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HomeMy Public PortalAbout10641 OLIVE ST_Building__ '/76A83..A CE 0803 1/71' APPLICA ORB DING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS SJA; COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY r_ FOR APPLICANT TO FILL IN NEAREST Print or tvDe onl CROSS ST. BUILDING DISTRICT NO GROUP TYPE ESS ADDRESS �` t CONS STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO.!2i DWELL.UNIT-T----, TRACT go USE ZONE MAP A ��,, NO.OF BLDGS. NO. SIZE OF LOT NgE ON LOT SPECIAL USE OF _ CONDITIONS EXISTING BLDG. y OWNER r ei` No. BLDG.SETBACK FROM ADDRESS / C`lGte: FRONT PROP.LI NE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY-r (, HIGHWAY' WIDTH FROM C.L. ARCHITECT O TEL. { _ ENGINEER r NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CL CONTRACTOR �(A„9' NO, HIGHWAY WIDTH FROM C.L. C C: ADDRESS. NO + _ C LIC. CITY CLASS CORNER CUTOFF YES ❑ NO ❑ L. CONSTRUCTION LENDER Z NAME AND BRANCH i9!;LI SEE REVERSE SIDE FOR SPECIAL APPROV LS ADDRESS G SQ. FT. /���S O.R F5. FO. OF NEW ❑ J u SIZE (J ❑ USE OF ADD STRUCTURE ALTER ❑ �� SIGNATURE OF REPAIR❑ !, APPLICANT DEMOL ❑ VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEE$ FEE$ FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS ' STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VAT N CK. .O. CASH _ PERMIT VALIDATION CK. M.O. CASH JiGo - 6 6 7� A,M 2 5 7.2 0 A 7 APPLICATION FOR COUNTY OF LOS ANIfl -MENT OF COUNTY ENGINE BUILDING PERMIT DEPART BUILD NG AND AFETY DIVIS ON R FOR APPLICANT TO FILL IN ADDRESSBUILDING �/(! / I �v BUILDING ADDRESSMy LOCALITY CITY - hpl ��LG� ZIP NEAREST CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT )C 7� NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE SSED BY TRACT BLOCK L & p7� � CONST ZONE OWNER /Vr{�AN" NOL ¢ --SDI STATISTICAL CLASSIFICATION A� SEWER M P ADDRESS 01JVF 'S/T. CLASS N04D:9-DWELL.UNITS �B a G USE•ZONE MAP CITY -_M 'L. C('� ZIP No. NO. X1.6 0 ENGINEERARCHITECO 9�L �[JJ1/nV.,_LE 6'D_Z4e)`I �` SPECIAL L pn! J Zod CONDITIONS ADDRESS /rSS 3 �+ `�'+,��� 71. �I'e, /1�. ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR 'J' NOBLDG.SETBACK FROM LIC (STREET)yy FRONT PRO LINE OF (STREET) ADDRESS NO..) ��3:J HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING WIDTH LIC. Q FRONT PROP. LINE CITY CLASS (J I _ CONSTRUCTION LENDER + NAME AND BRANCH 6tv-0a t-77L BLDG.SETBACKOM ADDRESS CITYyI��L(: C/' SIDE PROP.LINED (STREET) E SQ. FT. NO. OF NO. OF ` CHECK HIGHWAY + YARD = T T SET M TYPE OF EXISTING Lti SIZE STORIES FAMILIES / ONE IDE P O . LfNE GHWAY WIDTH DESCRIPTION OF WORK NEW ���❑ I coo: yyy{{y''' + e0291 a til O R�l�a�m ADD �J ALTER CORNER CUTOFF YES ❑ NO ❑ GJ /❑ EPAIR❑ IN OPEN SPACE YES [INO E]/�f}`/•f� IDEMOL [:]USE OF IN COASTAL PERMIT ZONE YES ❑ NO 11EXISTING BLDG. APPLICANT )/ TELA �Gf. ��; ,.�.,,., (PRINT) ` *4 FilJimato NO.330"17-4L � , v„ BY (SIGNAT E) .��' I! ��^' � '`— �-/ G// jL ,91C — AJ/ 1 HEREBY KN WLEDGE TH T AVE RE THIS APPLICATION �j/�� AND STATE THAT ME ABOVE CORRECT AND AGREE TO COMPLY WITH ALL ORDIN NOES AND LAWS REGULATING BUILDING CON- STRUCTION. I C TIFY THAT IN DOING THE WORK AUTHORIZED ED HEREBY I WILL OT PLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF STATE OF CA ORNIA IN R�TING TO WORKMEN'S COMP NS SON INSURA - 2� SIGNATURE40 �� FINAL -� �� BY— E DATE ADDRESS =� a TEL CITY i /1 No.9' 0—�Q P.C. Fee$ Permit Fee QQ ^ Issuance Fee VALUATION 7 Q�i- v Total Fee PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K M.O. CASH 4 5 2LIZZ FEB 3 1 0 6 9.0 0 a7,o 76A638A CE*80313 12/75 lJ WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION F O BUILDING PERMIT insure,or a certificate f Workers'Compenstion Insurance,or a certified co y thereof(Sec 3 0 ,, ab. C.) r Policy No96 �� � �m�c6iy"' ,/c�(t?'f?u COUNTY OF LOS ANGE ES �_-B11U-MNG AND SAFETY V� tified co is hereby furnished. BUILDING C:rrt PY y 7a—/--e/ FOR APPLICANT TO FILL IN ADDRESS ified copy is filed with the county building inspec- BUILDING f 4' l �'';on d�/p/artment. / ADDRESS ° �� `/�e v / LOCALITY Date //i3/�G� APPl icant �1�''�(Ot B'�/ % ��/� CITY l�"l��ffl�` [ ZIP 7 �� CROSSNEAREST. �� a ./� �-L;.t9 �.(L'.' y�%. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR PAGE PARCEL COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK (This section need not be completed if the permit is for one USE ZONE MAP AA hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. I > ��) TEL. 1 , SPECIAL IL I certify that in The performance of the work for which this OWNER ♦�' //�7 w�✓�/v NO. t7 4 CONDITIONS O permit is issued, I shall not employ any person in any manner ADDRESS(� ��� 4 ' U� ✓r� �/ DISTRICT GROUP TYPE ICONFIRE E POC D BY so as to become subject to the Workers'Compensation Laws. �9 'goo O CITY ri;A,;, •'Le- 6 � ZIP `�1 7�V �C/G Date Applicant STATISTICAL CLASSIF ATION APT. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TELLU ENGINEER NO. CLASS NO. DWELL.UNITS Exemption, you should become subject to the Workers' u7 Compensation provisions of the Labor Code, you must forth- d with comply with such provisions or this permit shall be ADDRESS SEWER MAP o deemed revoked. TEL, VALIDATION CONTRACTOR E`2:��'U'' (' NO. BK. PG, LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS O? i1A[C� NO. •./ �vT/.J�a VALUATION GsC! (commencing with Section 7000)of Division 3 of the Business andj LIC Professions Code, and my license is in full force and effect. CITY 6 , CLASS , $ ` �^ 6 SQ. FT. NO.OF NO.OF CHECK License Number ' ��� Lic.Class SIZE STORIES F ILI ONE Contractor Date DESCRIPTION OF WORK NEW $ ❑ I am exempt from the licensing requirements as I am a s7 �' �`•� ��� ADD licensed architect or a registered professional engineer ALTER ❑ FINAL 1 ' acting in my professional capacity (Section 7051, 0 REPAIR DATE � Business and Professions Code). USE OF ❑ FINAL ' EXISTING BLDG. DEMOL ❑ B i Lic.or Reg.No. _Date APPLICANT TEL.�—,� y OWNER-BUILDER DECLARATION (PRINT) + tYl� "i� NO ,.T + 1 hereby affirm that I am exempt from the Contractor's License 7 / Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENBUILDING T e.7"I, as owner of the property, or my employees with ADDRESS 4 Jr 9 A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. # 0 0 0 0 23 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 2 0 0 21.60 tion 7044, Business and Professions Code). 21.6001 11 0 U REQUIRED TOTAL SETBACK FROM EXIST. o'0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT ; 21 8-80 j the performance of the work for which this permit is issued P.L, ,. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name / a=3 4 b 0 A Lender's Address P.C.Fee$ , (Q D Permit Fee &-,2i�Zi I # 0 0 0 o a 1 I.certify that I have read this application and state that the Issuance Fee 2 0 0 3 4 0 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to buildjng construction, Total Fee o 0 0 3[ and hereby authorize representatives of this County to enter upon they bove-m bonedKrefor*1spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent D to ®s WORKERS'COMPENSATION DECLARATION s I herby affirm that I have a certificate of consent to Self insur ,or a certificate of Workers'Compenstion Insurance,or APPLICATION F®R BUILDING PERMIT a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL INI ADDRESS � BUILDING � Certified copy is filed with the county building inspec- BUILDING ©� / � �r--- tion department. ADDRESS 0� L} LOCALITY NEAREST Date Applicant CITY Fji� G ZIPCROSS STREST. . CERTIFICATE OF EXEMPTION FROM WORKERS' ' O.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT. MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one �{ USE ZONE MPhundred dollars ($100)or less.) TRACT V BLOCK LO7 NO. O.w�I , 1 TEL. SPECIAL IL I certify that in the performance of the work for which this OWNER F /V NO. ' CONDITIONS 0 permit is issued, I shall not employ person in any manner �c/ DISTRICT GROUP TYPE FIRE PROC SED BY U �[• so as to become subject tc the W s'Comp ion La ADDRESS Q -1 .� /JG�J v/� 'o'/ � CONS ZONE /♦ / ! /�'i' CITY !/Z6 fiT. �' ��// ZIP r U Date t Zr Applican t STATISTICAL CLASSIN A CONDO. L.1 NOTICE TO APPLICANT: If, after malting this Certificate of ARCHITECT OR TEL. CL Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS H Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP j with comply with such provisions or this permit shall be EL I' deemed revoked. CONTRACTOR t1 U.I If r}L NO. vir BK. S PG.I&� VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1 &_; J6sri P* NO./ Y`7'��' 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 f a a- j� CLASS ` A f ` SQ. FT. NO.OF NO.OF CHECK .License Number f ! Lic.Class 16 1 SIZE STORIES FAMILIES ONE V•�s L� �� `l p'U DESCRIPTION OF WORK NEW ❑ $ 13 2 0,9 A Contractor Date ❑ - ADD 0 0 0 0 2 3 I am exempt from the licensing requirements as I am a aff licensed architect or a registered professional engineer ALTER ❑, FINAL acting in my professional capacity (Section 7051, �.20 REPAIR DATE t 2"� (� 2 ° - 43,20 ❑.. Business and Professions Code). USE OF DEMOL FINAL tom` ` , o'o-0 4 3,2 0 20- EXISTING BLDG. ❑'" By 4— �.J Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. 11.2-5-80 I hereby affirm that I am exempt from the Contractor's License �� Law for the following reason (Section-7031.5, Business and ADDRESS 0 Professions Code): PRESENT F] 1, ;9-32 1.0 A I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 0 0 0 0 0 1 the structure is not intended or offered for sale(Section LOCALITY , 7044, Business and Professions Code). MOVING TEL. 2 ° - 61,00 I, as owner of the property,am exclusively contracting. CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQADDRESS 0 0 o O 1,0 0 v T. ' CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROPAINEFROM WIDTH I 1.2 5,-8 0 1 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 7 i P.C. Fee$ 32 O Permit Fee 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 Investigation Fee / 3 =ignciture dlaws relating to building construction, Total Fee / representatives of this County to enter t�(/ oged foperty for inspection urp s. r [ �� SEE REVERSE FOR EXPLANATORY LANGUAGE 0 licant or Agent DFate ®s