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HomeMy Public PortalAbout9070 OLIVE ST_Building__ ►6A638,Q= Eh08iI-5 APPLICATION FOR BUILDING PERMIT" 1 COUNTY OF LOS 'ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS D BU=iNG AM SAFETY DMSION LOCALITY . JA JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OR BUILDING CROSS ST. DISTRICT NO. GROUP SEWER'•MAP TYPE. FOR APPLICANT TO FILL IN �. ( ` CONST. A ;HK PG' DDRESS /0�j0 .1 STATISTICAL CLASSIFICATION' /� CLASS.NO� S DWELL.UNIT LOT NO. BLOCK MAP STATE NUMBERHWY. YES O TRACT U ZONE 'SPECIAL �j. NO.OF BLDGS. CONDITIONS' SIZE OF-LOT ��t"7f y L I NOW ON LOT USE,OF 000 EXISTING-BLDG. . BUILDINGEXIST. ,A p / A Q SETBACK YARD -HWY STREET NAME WIDTH OWNER Y{ ��VMAILg""f` � I /�P P L FRONT' Q o ADDRESS SIDE q TEL P.L. • CITY AA. . (. F�� No Ago `c 4 ARCHITECT OR TEL. INSPECTION RECORD . ENGINEER NO. ADDRESS ' CONTRACTORyy' ADDRESS_ ]] DESCRIPTION OF WORK N:&2 - ADD ALTER REPAIR DEMOLISH Q.FT. NO.OF NO.OF SIZE- STORIES FAMILIES 'USE OF STRUCTURE pg 4 AB+ SIGNATURE APPROVALS OF' �j'�',� L �� .� APPLICANT ��=�'''k c ° - DATE INSPECTOR'S SIGNATURE ADDRES FOUNDATION- LOCATION - FORMS,MATERIALS �J FRAME: FIRE STOPS. e) L. FEE $ BRACING,BOLTS S \ VALUATION $ /. Q� FURNACE:-LOCATION. FEE (� `�� GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH,ALL COUNTY ORDINANCES,AND STATE•LAWS REGU PNG UIL IN CON, T..,U!�'CTION. LATH,EXT. C o©R u �_.Ii_ SIGNATURE OF �GHOUSENUMBER PERMITTE RECT AND POSTEDR .••...��.••((( ADDRES -a' A a FINAL , —2- v CLYDE N.DIRLAM, 1 CIPAL S-rpi in-ri IIQA"*NQJk46R PLAN CHECK'VALIDATION cK M.O.. CASH PEBMIT VALIDATION• CK. ..M.O. .CASH. moo.1-_7;0-2 R JUN l'o' •1 A $d O � ®.• - PLICATI-O.N.. FSO .UIL �IIN,,G PERMIT OS ANGiE DING AIVD`SAFET ..,' COUNTY';OF'L I.,�.S. .�,,. .. .. r.: - .. ..tis .. WORKER-'S C.OMPENSATION:DECLARATION ;a '. ;"f;,. FOR APPLICANT',TO'FILL IN DDRESS;• �jJ� „ BUILD WAD KESS..,: B UILDING A (hereby affirm that I have a certificate of:Consent;to.self.,InsuYe, o �• oL�v� or a certificate of Workers'Compensation.lnsurence;,or,a`mcertified• 4: YTY copy'thereof:(Sec.380 b.C.). tGCfY ZIP' -. OWN Policy No. ;,6 Company' .01 ;.NO:OF_BLDGS NOW ON LOT. � ?SIZE OF L� :.:, ❑ Certified copy.ls hereby furnished: . .r ' ': NEARESI';CROSS STS.- I. TRACT BLOCKS -LOT-NO. Certified copy is filed with,the:oounty building:ihspection t'• departure ' 1 .. MA :.Np:.1 ASSESSOR MAP BOO PAGE PARCEL . . � USE Date' �?' pplicant .. ,.. ZONE SPEOIAL CONDITIONS'"'' ; 1 } ' 1 �� " yr •CERTIFICATE.OF:'E P.:TI,.ON FRO ORK •.- OWN R T COMPENSATION INSURANCE WITkIIN 10Uo FT.:.OF:SCHOOL7 YES NO This'section need not be.com leted if.the ermi4 is for'one hundred. Z Y i. (' P p- O•- •O LV: S -DISTRICT' GROUP.::.- TYPE-CONST. FIRE:2oNE PROCESSED CITY IZIP I certify-�that-in the parforrrlariae.of..the,work for which,this permit JIF R issued;I shall•not'employ any•pereori in any,.;manner,'sb.as•:to .` ARCHITECT R ENGINEER. TEL'N ' become subjebt,to the:Workers'Compensation Laws. L�V, :STATISTICAL CL SIF MINI'.- APT " CONDO ' :., , -Date. . .:..A Ilcant;. .. : . , .. - .. . ,. "•-:: "' D.ESS ..-: .. ... . / -�CL.ASS NO: �DVUEL"L U ITS. -AMA :AIOTICE •TO; -APP,LICANT •If, .after:,making this 'Certificate bf FIEOl1IRED i''; TOTAL SETBACKFROAA .ExiSi'�'< :. C 'TRA R :'TEL NO':' ""SET:.BAGK'. FROP'LINE•.. WIDTH: •' :Exemption., you,,should b@oorrle 'subject.: to. :the. Workers':: } YARD1 ;IiWY- ' -. �. Compensation provisions'of the.labor Code; you must-forthwith'" : gyp . Z comply:with such,provisiohs or this permit-shalrbe'deeriled revoked.'' DRESS' _ LIC.; P•L::''" :: ,:.., ......:. �i SIDE'' LICENSED CONTRACTORS DECLARATION ,. , PL I 'uc.- Ass: CT I.here :affirm•that I am licensed under covisions of.Cha ter.9: . C� -.. `•' SEWER•MAP' p p... S "-• SIZ NO:OF•STORIES. ``NO:OF' AMILIE commencin :with;Section.'7000)of Dnrlsion.3,of;the Business and ..,..-.:. 9 / EW;,:;..,-❑ % .,BKS:"...:,•. FG �:.�,.; �.,..,�' - S••' Professions Code,and,m 'license:is-in full force,and effect.: :. a' ;a DESC PTIO OF WORK ' VALUATION .. A 4'I s a LjcenseNuhl6er;.• Lic:.Class '•, _ .ADD • •,••- - 'C d Contracto Date ALTER O� +?Wk � �' S't:7`3 GC - lam. PAIR'-... •1� I-�E�'{'�=.'� C am exeiri .under'SeC..- t ;.78 .. B.&P.C..for this reason � :::. �'�fT,��J : � 'C DEMOL�'�.❑: ..CDMA;P/,G'* ;:.� >' ,' LL OF.EXISTING BLDG: ... .. .Date:'. ��-- •—�L, .,. . -USEURM. .'❑:' . .. ..... - - 'r On Signature _. r 'G ;1 . :. ,... , T(PROVTJ• .. ]".TEL LDMA-Perm#'�.•-.:-. �� • APPLICANT j:aLy •A•' �U• '�I ❑:I„as•ow of the property employees with•wages as' - ' ;'• `'Z %• ADDRESS : ,;,+..::.._ ';t a :0 f,; ,.:;:;• ' ;their.sole,compensation,•will do, a work.and the structure Is- ,': � - . not intended or.offered for sale Section 7044, B(isiness•and FIN AL, Professions Code.)''.. Wlu.TH • E APPLICANT OR'FUTURE BUILDING',OCGUPANT:,'HANbLE A�HAZARDOQS MATER '•' OR A MIXTURE;CONTAINING.A HAZARDOUS MATERIAL EQUAL 7O OR:GREATER THAN.T} ,.'. ❑;II:a3:ownet of;'the. per y, am.,exclusively;COrltracting Wlth AMOUNTS SPECIFIED ON THE DOyS MATERIAL3.INFORMATION'GUIDE7;. a '' s '• ��v'L�} AR t,1 FINAL.B I .contracture:to Construct the:`project.'(Section:7044, t;- ;'''Y �' is . .r''VES'� ANO❑` Business and Professions Code..,'` t . :: ). �QC( .. WILLTHE:INTEiJDED USE..OF THErBUIDUNG-By THE.APPLJCANT�OR.�FUTURE'BUILDING' . ,. •,:.. -OCCUPANT REQUIRE..A ., xY ::. .i �irr i�t7G -. _ .. PERMIT�FOR'CONSTRUCTION,OR MODIFICATION FROM THE,SOUTH:'• . .. :•:'''•y:: :., t�COAST AIR QUALITY MANAGEMENT DISTRICT.(SCAQAAD)SEE PERMITTING,.CHECKLIST'FOR' CONSTRUCTION-LENDING AGENCY r .GNB ' >;` GUIDELINES..:. n In a enc for!--.....• ?.: :, ' .. I hereb I h t:there Is.a construction led . y � •.•--• : ::••�.; ': ' '�.;. :� .:�� —,•�'�'yi �} ) /[}i-'. y aff rm t a 9 9 .VES❑ NO❑ ',y' ., .. •,. ; •(i�iJ�..:1JUI.71`.`�• �"('I'L�f 7a. �. 'N•,. the performanceof the work for which this permit'Isissued(Sec.• '• " _ .. W .� ':I HAVE READ THEHAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING'. ((��p ttry q01: 0'`; 3097:,CIV.C: :. ;CHECKLIST.I;UNDERSTAND'MX REQUIREMENTS UNDER LOS ANGELES-COUNTY CODE” '''ti - "•L}7:'t'L'f. �• 'S ? I, ): `' ` : _ '• ':,:-• '• �' 7iTLE"2,CHAPTER'2.20•SECTIONS 2,20..tOQ:THROUGH'2.20.1A0 CONCERNIN6'HAZARDOl13•`' .�w..; ' "r Lender's Name. .: :.>"r o _ MATERIAL.S'REPORTIN AND.FOR OBTAINING',A PERMIT FROM,THE SCAOMD.; . h.w , ::;•o' Len :.> ) der s address c: ER.OR AGENT;" I.cert) this a lication and state under ipertalt ' F,;;. fy,that I have read, PP Y . .. o . , P.0 FEE to tour I .. .,:. ^r Of er ur that the above Information Is correct.I,a ree,,., ,. R 1 Y - �'• Y, .N '�.to��'biiildi � relatin n ^. 'with ,all-.county ordinances:arid�.State .jaws• gam,.-. g � •. • '•' tfi 3 COU ISSUANCE FEE• construction;and'hereb eauthorize representatives.of;. ... nty.' :.f;;::: ''to - ro ert for:ln so Imp .poses: D er upon the above,mentloned p p_,.y ;:' r.• r INVESTIGATION'FEE TOTAL FEE +' >.:' .. ... .. , .,• - �.... ,,,. tt ISEERE•.V. ERSE.,� ' A_XPANATORYGUAGE. ti. . `+P , APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGEIXS ' BUILDING AND SAFETY b WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILD GAD RESS or a certificate of Workers'Compensation Insurance,or a certified ©L[ S0�P copy thereof(Sec.380 b.C.) CITY L ZIP T-P zz G'Z LOCALITY Policy NO. 6 Company SIZE OF L�T / NO OF BLDGS.NOW ON LOT NEAREST CROSS ST El Certified copy is hereby furnished. (Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. departure USE ZONE MAP NO. Date r� Applicant ASSESSOR MAP 800 s PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF E PTION FRO RK OWNER T YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred AD ES T c dollars($100)or less.) O D Q 4-5 77. DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CITY ZIP is issued, I shall not employ any person in any manner so as to ARCHITECT R ENGINEER TEL N • Y become subject to the Workers'Compensation Laws. `/ �. O,r 3�0 STATISTICAL CLA§SIF ATION APT CONDO Date Applicant A DRESS 'V I/ 7` CLASS NO. �x�� DWELL UNITS NOTICE 70 APPLICANT.' If, after making this Certificate Of Z dl Y I R��Kp ri�l, REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the WorkersC TRA R TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith pFRONT comply with such provisions or this permit shall be deemed revoked. AMDRESS LIC. PL LICENSED CONTRACTORS DECLARATION 6 �` SIDE CIT O LIC. ASS PL 1IR /� I hereby affirm that I am licensed underprovisions Of Chapter 9 CAL 6 - SEWER MAP ._ (commencing with Section 7000)of Division 3 of the Business and SIZ NO.OF STORIES NO OF;AMILIE NEW ❑ BK PG 27 1 Professions Code,and m license is in full force and effect. S . DESC PTIO OF WORK 'l ADD VALUATION f-i4 n V a License Number U..Class G!• �N d� �� �_ CC.�. Contracto Date ALTER �( $ 0 0 3307 r 34 n t -,� ON-KI C.0 HACMR WPAIR ❑ $ 1 ITEMS C ❑ 1 am exempt under Sec. —fop [rC au DEMOL ❑ LDMA P/C# 1TOTAL 734 78 LL B.&P.C.for this reason a� Date:��6fn 9 S USE OF EXISTING BLD'G6 M �U URM ❑ `` -F- • -i-ll SI r,VM RAM r�sf'n(L'U Signature APPLICANT(PRINT) TEL NO. LDMA Perm# SO- GE ti z 11I, as ow of the property r employees with wages as Z �� JC7 a ADDRESS O ?"r'. their sole compensation, Will d0 a work and the structure is FINAL DATE not intended or offered for sale (Section 7044, Business and �/1 a �_ l+g}E }Gyp Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATE RIRL / 13014-3 I l 4�F&o 4 u7— Professions 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR'GREATER THAN TF a �� r�+{ i n�^ Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL B > �;•i; AN-,,L•n 5-7, licensed contractors to construct the project (Section 7044, YES❑ NO❑ Business and Professions Code.) CHINNIGE X0 WILL THE INTENDED USE OF THE BUIDLING 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 �ency for YES❑ NO1310-10-113-130131 1 rz••_x t7''T W ss the performance Of the Work for which this permit Is Issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING }r, •� nC�: N 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE OpF Ti L AMI KI n-3 i 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 OWNER OR Ar ENT 0 c I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE �LL �J PERMIT FEE N with all county ordinances and State laws relating to building ` / construction, and hereby authorize representatives of this County ISSUANCE FEE co to �Upon,the above-mentioned property for in ection p poses. INVESTIGATION FEE TOTAL FEE D " a uQ 0.u SEE REVERSE#0,R EXPLANATORY LANGUAGE