HomeMy Public PortalAbout9622 OLIVE ST_Building__ 'BAB38A CIE#80310-88 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES ADDRESS _� ec S
DEPARTMENT OF COUNTY ENGINEER
BUILDING -AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
MKZNffDISTRICT NO. GROUP I TYPE
PRO CESSED BY
FOR APPLICANT TO FILL IN S ,__/ CONST--'/—
BUILDING
ON BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS �
CLASS.NO Y 'DWELL.UNITS--=J
`I C
LOT NO. �'�/`�yi� �r I "`r!BLOCK MAP �� STATE YES NO
NUMBER HWY.
Av�
TRACT r" w USEZO E SPECIAL
Ir
NO.OF. LOT CONDITIONS
_ �/�
SIZE OF LOT I NOW ON LOT
USE OF
EXISTING BLDG. BUILDING EXIST..
SETBACK YARD HWY STREET NAME WIDTH
I OWNER IcD,✓, % 0Ano v V rd T FRONT
MAILP.L.
ADDRESS ! l �'Y � SIDE
TEL P.L.
CITY C NO. INSPECTION RECORD
ARCHITECT OR "7 T
ENGINEER r'. O. •
4 •
ADDRESS
TEL.
CONTRACTOR NO.
ADDRESS /J
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
T. / NO.OF NO.OF
__P/,Q
,
SIZE Y,Q CD STORIES FAMILIES
USE OF
STRUCTURE 512-fe rvC�R ^T
SIGNATURE OF
APPLICANT
APPROVALS DATE INSPECTOR'S SIGNATURE _
ADDRESS FOUNDATION:LOCATION
FORMS,MATERIALS
VALUATION$ w Cl y FRAME:FIRE STOPS,
...•ne BRACING,BOLTS
FEE $ I FEE $07 --- el FURNACE:
VENT,DUCTS LOCATION,
I HEREBY ACKNOWLEDGE THAT 1 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 REGULATING BUILDING CONSTRUCTION. LATH,EXT.
SIGNATURE-OF �r e / / t HOUSE NUMBER COR-
PERMITTEF ^ OAM./�• �7 ~.11iVC/,;/C(�,�[ RECT AND POSTED /
ADDRESS �� FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EU
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. (CASH
X0 2 4 u 4114'-) SEP �, 1. A 3.00
. ';.. 4 J6 APPLICATION FORBUILDING PERMIT �
COUNTY OF LOS ANGELES . BUILDING AND SAFETY
, FOR APPLICANT TO FILL IN BUILDING ADD
R 4ORKER'S COMPENSATION DECLARATION
R
I hereby affirm that I.have a certificate of consent to self Insure, BUILDING �• � ® �� I
.or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.) CITY ZIP t V78� LOCALITY
Policy No. �� 7'00 Company SYPIK FUM 7'" MIS G/;
SIZE OF LOT � 'V NO.OF BLDGS.NOW ON LOT
Certified copy Is hereby furnished. -a 'X - /TRACT BLOCK LOT O. `NEAREST
09 C/7NEARESTREST CROSS ST
N
❑ Certified copy is filed with the county building Inspection USE ZONE MAP No.
depart ant /�53
Date MOM pU•�E/YN/S Ass RsAAe�o K ��� P�� �9
GJ d/' SPECIAL CONDITIONS 1
CERTIFICATE EXEMPTION FROM WORKERS' OWNER CA A S G V /� RAZ TEL"O.-m- 6o WITHIN 1000 FT.OF SCHOOL? YES No
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the permit is for one hundred ;2- 40" 04/j/Jr -57- 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 rr14Pe,6 C 7�D e�J
Is Issued, I'shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NO
become subject to the Workers'Compensation Laws. Q ��L D STATISTICAL CLAnFI¢ATION APT CONDO
Date Applicant ADDRESS CLASS NO. 'fid/ DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
TEL NO.
Exemption; you should become Subject t0 the Workers' CONTRACTOR SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith MAWS 0� S p1?X- 10 TT�� IoM
comply with such provisions or this permit shall be deemed revoked. ADDRESS d57Q D 3�3
PL
LICENSED CONTRACTORS DECLARATION CITY SIDE LIC.CLASS p L C91 hereby affirm that I am licensed under provisions of Chapter 9 a4E '� �' .6 FT.SIZE ORES NO.OF FAMILIES SEWER MAP im
(commencing with Section 7000)of Division 3.of the Business an SO. NEW ❑ BK PG C
Professions Code,and my license is in full force and effect. 2,2 Z v,
License Number=M' Lie.Class Q SCRIPTION FW R J Z ADD
Contractor +LYMts �• Date B ALTER ❑ `noN��� +
IVAM
❑ 1 am exempt under Sec.
/ / � "'"'z� REPAIR ❑ (O
BARC.for this reason rroe DEMOL 11LDMAP/C#
Date. USE OF EXISTING BLDG. URM, ❑
Signature AP�LLICANT fPRIN'n TEAL NO. [/�� 330 7 o
9 G li1G� 1S �O^ —7"!y� LDMAPerm# o ,tJ'rI7 701.33?
❑ I, as owner of the property, or my employees with wages as � — _
their sole compensation,will do the work and the structure is ADDRESS r� H ITEMS
EI
not Intended or offered for sale (Section 7044, Business and 3 �i G e Flwu TE� `�j Q !I 701—:39 1 :39
Professions Code. WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL ONO
TAL
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL DUAL TO OR GREATER THAN .{ l%i?
❑ 1, as owner-of the property, am•exclusively contracting with ' THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FlNAL BY y 1+r 79:L-39
licensed contractors to construct the project.(Section 7044, YES❑, ND fj CHANGE rjr,
Business and Professions Code.)
WILL THE IN DED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH
CONSTRUCTION LENDING AGENCY CO,0T AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST
FOR GUIDELINES. '} i E#j
I hereby affirm that there is a construction lending agency for FOR
❑ NOV e" '7/5 % 1313130-13 1 r�J
the performance of the work for which this permit is Issued(Sec. ''' 4' 1 AM ,:31
I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD ' iJ�f L
8.
3097,Civ.C.). PERMITTING CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES
�"� // -
cou CODE,TITLE2,CHAPTER 220 SECTIONS 2.2MI00THROUGH 2.20.140 CONCERNING
Lender's Name S M TERIALSR 1 AND R OBTAINING a PERMIT FROM THE SCAOMD.
Lender's Address ��� oG.xo V
Coof
o' 1 certify that I have read this application and state that the above P.C,FEE p T �' '/L
Information is correct. I agree to comply with all county i � ,
ordinances and State laws relating to building construction,and '
hereby authorize representatives of this County to enter upon ISSUANCE FEE / �Q
11 abovle 2
e-mentioned pro �®rin�ep�ec�tionpurpo
�� INVESTIGATION FEE TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE