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HomeMy Public PortalAbout9537 OLIVE ST_Building__ 76A G36A Y ENSSfl;3„68C��z `� "APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING _DEPARTMENT bF COUNTY ENGINEER ADDRESS '37 01- ve BUILDING AND SAFETY DIVISION LOCALITY G/1 Lam— �,T JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. X?L// . FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE PROCESSED BY CONST. Print or type only) BUILDING _ �, STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ,5-3 0 L- !e• CLASS NO..� L _DWEL .IINITS� BK/-) PG'� LOT NO. „� �/� �I BLOCK USE ZONE MAP NO. o TRACT ,� SPECIAL �/ O.OF BLDGS. CONDITIONS . SIZE OF LOT J /T1 NOW ON LOT USE OF EXISTING BLDG. 45 BLDG.SETBACK FROM OWNER7�Ly� TOE L. - FRONT PROP.LINE OF n L���� -(STREET) TYPE OF EXISTING SETBACK HIGHWAY •1- YARD - TOTAL ADDRESS 2 /+9� L HIGHWAY WIDTH! FROM C.L. c+ CITY /) LLL 9d ARCHITECT OR TEL. BLDG.SETBACK FROM ENGINEER �. NO. SIDE PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY •1- YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. _ CONTRACTOR 'A,� NO.LIC �^ + a ADDRESS y• NO. Q; a CORNER CUTOFF YES El v LIC. CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK z NEW XADD ALTER REPAIR DEMOLISH SQ. T. NO. OF NO. OF C !1.�/ r�'i�' :Q_r•:'if +� SIZE C STORIES ! FAMILIES / -1 USE OF /--o AF P-4/07 il, STRUCTURE o 0 c= r 1�.%�j��'-r'�i is !I, .,'��C. :%l. �%il_�:•_-.�—.:J SIGNATURE O APPLICANT VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. a -FOUNDATION: LOCATION FEE S ' FEES' Oa FORMS• MATERIALS 77 FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS ell AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- LATH, INT. '' ING TO WORKMEN'S COMPENSAT ON I SU ANCE. LATH, EXT. SIGNATURE HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATIO L`K. M.D. CASH _ PERMIT VALIDATION CK! M.O. CASH IFEB 13 9 6.0 0- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN DDREgS3y BUILDING ADDRESS c� / I hereby affirm that I have a certificate of consent to self insure, �rDING A OI I�� or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) + w ZIPq I LOCALITY Policy NO.IAY ( 5+-3 Company�-- SIZE OF T NO. BLDGS.NOW ON LOT ��m��C ❑ Certified copy is hereby furnished. Assoc., NEAREST CROSS ST. ❑ Certified copy is filed w the count Hiding i s action BLOCK LOT NO. department. ` USE ZONE MAP NO. Date 1d-t 0_" 0 Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FR 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 RESS �D�`7 DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY I certify that in the performance of the work for which this permit 1-790 1-3 1/ Is issued, I shall not employ any person in any manner so as toIT€ ENGINEER EL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLAAASSIIFICATION APT CONDO Date Applicant ADDR CLASS NO. 1=2/ DWELL UNQ NOTICE TO APPLICANT. If, after making this Certificate Of 7M REQUIRED TOTAL SETBACK FROM EXIST TACT TEL NO. Exemption, you should become subject to the Workers' NRSET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith � o FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS 19.NO. PL O SIDE LICENSED CONTRACTORS DECLARATION cls�v A � LI s PL CL U I hereby affirm that I am licensed under provisions of Chapter 8 rL C/r d SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG �. 4l/�W10( LIC.Class v DESCRIPTION ARK ADD VALUATION License Number,. ��-I 'tr. �X ` Contrector V� Date�C OA ALTER d $ •�� _� ❑ I am exempt under Se } REPAIR c- BARC.for this reason NG DEMOL ❑ LDMAPIC# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LOMA Perm# ❑ I, as owner of the property, or my employees with wages as pT their sole compensation,will do the work and the structure is ADDRESS F IAC'-I n a a not Intended or offered for sale (Section 7044, Business and FINAL DATE p 3307 Professions Code.) WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL .J � OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a s T i I•'f�� ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? NAL B ' licensed contractors to construct the project (Section 7044, •� I T { YES❑ NO❑ i� C'IL 5.I� .6 1 oa5`++`�0 Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK •�� ��c OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �.I ECK CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST U77 FOR GUIDELINES. I hereby affirm that there is a construction lending agency for FYES OR MAKE the performance of the work for which this permit is issued(Sec. 3097,CIV.C.. 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES CASES DFLender's Name HAZARDOUS MATERIALS REPORTING OR OBTAINING A PERMIT FROM THE SCAOMD. 013013-13001 1C./ICl/C13 Lender's Address OMERORAGOU 3L79 1 AMlflar_) 0 1 certify that I have read this application and state that the above PO FEE PERMIT FEE information is correct. I agree to comply with all county ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE t above-mentio pe y r inspection purposes. LO `Q Q INVESTIGATION FEE TOTAL FEE /,�� o1ApplmCn oca d' i SEE REVERSE FOR EXPLANATORY LANGUAGE .WORKERS'COMPENSATION DECLARATION i e hereby affirm that I have a certificate of consent to self A P P L I CAT I N #UILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance,or a certified copy thereof (Sec�.�3�0, Lab. C.) Policy N� cyt�pbrry COUNTY OF LOS ANGELS BUILDING AND SAFETY ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING �' j ADDRESS 'r� Certified copy is filed with the county building inspec- BUILDINGAf tion department. ADDRESS irJl I r `� LOCALITY ' NEAREST Daft! Applicant CITY ��C" 't 9_1.� ZIP w `I ��' CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT f�� Xr� NOW ON LOT MAP BOOK PAGE CEL (This section need not be completed if the permit is for one e MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. r TEL. rSPECIAL I certify that in the performance of the work for which this OWNER H GAY NO. .�2 P� CONDITIONS O permit is issued, I shall not employ any person in any manner r / GROUP TYPE FIb E BY so as to become subject to the Workers'Compensation Laws. ADDRESS S Ol 1\0 /�]� p CONST., F CITY &w e' lam% ZIP I I b© �s/ b Date Applicant STATISTICAL CLASSIFICATION A CONDO. ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' �y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or. this permit shall be ,/� deemed revoked. CONTRACTOR Q tA1 � NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC., I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC 10 v� Professions Code, and my license is in full force and effect. CITY CLASS $ SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE S Contractor Date DESCRIPTION OF WORK CB„S✓6r� O/'� NEW ❑ ❑ I am exempt from the licensing requirements as I am a o I ADD licensed architect or a registered professional engineer ALTER FINAL "1 ,..v,�l ; acting in my professional capacity (Section 7051, ( O REPAIR ❑ DATE ) � Business and Professions Code). US OF FINAL EXISTING BLDG. DEMOL ❑ BY ( ff =4-1 Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. , I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business andADDRESS a Professions Code): 1 PRESENT XN I, as owner of the property, or my employees with � ADDRESSBUILDINADDRESS 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. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. ` �! 2A 2i' with licensed contractors to construct the project (Sec- ADDRESS �10 0 o a o tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH % a o 22 00 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 c c o ' (Sec. 3097, Civ. C.). IDE c�,0G� .L Lender's Name dm P.C. Fee S 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 pp ordinances and State laws relating to building construction, Total Fee l and hereby authorize representatives this County to enter t - . � upon t bo enti�ae roper r ins ection purposQes. , SEE REVERSE FOR EXPLANATORY LANGUAGE Si na of Applicant o Agent Dote ®s