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HomeMy Public PortalAbout9847 OLIVE ST_Building__ A658A CE#8051-62 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER. .ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. D�7 /ICT N - -G P' TYPE S BY FOR APPLICANT TO FILL IN (/) coNsr. -T BUILDING STATISTICAL CLA IFICATION SOWER MAP ADDRESS oP� �� �f K pp�� - -CLASS.NO. DWELL.UNITS i'J LOT NO. /Y a BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: El TRAC ,. jf;7 A41 g ' d MAP JJ►► HIGHWAY STATE MAJOR SECON NO.OF BLDGS. NO. 0 (CIRCLE) - LOCAL SIZE OF LO +� NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. //V w / h TEL OWNER N B ILDING YARD HWYSTREET NAME EXIST. SETBACK WIDTH ADDRESS FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. S113E ' ADDRESS 40-9" C CONTRACTOR ' TEL. c O. O ADDRESS ` W_ I—6' C •DESCRIPTION OF WORK Ll u d NEW _ADD ALTER REPAIR DEMOLISH 6 SQ.FT NO.OF NO. OF m SIZE STORIES FAMILIES USE O STRUCTUR '94' " SIGNATUR APP T �2 VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION �, g ' � FEE $ FEE $� �a FORMS, MATERIALS. F� FRAME: FIRE.STOPS, ` J 1 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 COUNTY ORDINANCES;AND STATE LAWS REGULATING GAS VENT, DUCTS A� BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- LATH. INT. .r� I., j �WqJKME�RS.COMPENISATION INSUR E. LATH,EXT. 'HOUSE NUMBER COR-. RECT AND POSTED ADDRESS FINAL J JOHN F. LEWIS.'FftIF4CIPAL STRRAL ENGINEER CK. PLAN CHECK VALIDATION cK. . M.o. CASH _ PERMIT VALIDATION M.O. CASH A05 -7 1 6OCT 1 8 2 3 D 1 9.7 5® cQ Lt i,o 6 6 4 1 t0l.. 7 1 D 3 Q~ APPLICATION FOR BUILDING PERMIT ' COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN I hereby affirm that I have a certificate of consent to self insure, BU N DDRESS ©�f �1-1 or a certificate of Workers'Compensation Insurance,or a certified CI ! ZIP copy thereo)( ec 800,Lab.C.) ,/ LOCALITY Policy N Company �� SI E OF LOT NO.OF BLDGS.NOW ON LOT v Z ❑ Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the c ty building ins action TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date, /Applica (1 ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMP G ROM WORKERS' OWN R Q Q YES NO COMPENSATIO �IF�SURANCE 1 WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRES& DISTRICT GROUP TYP ONSi. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to oe become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CL IFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTRACTOR _//��I� TEL c� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /-,F v X66 FRONT comply with such provisions or this permit shall be deemed revoked. ADD S//�� //�� r/' LIC.N P L LICENSED CONTRACTORS DECLARATION V�`v P//y!/�e� C/r 3 SIDE C C A u Lest P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ. SI NO.OF STORIES NO.OF FAMILIES NEW ❑ BK PG } Professions Code,and license is in full force and effect. �1 pool. a License Number f LIC.CI D IPTION OF WORK ADD ❑ VALUATION Q Contracto Date DU$ /� ALTER ❑ C/ U ❑ I am exempt under Sec. --16� t� 10y REPAIR ❑ V B.&P.C.for thi n DEMOL ❑ LDMA P/C# W D e: U E NG BLDG. URM ❑ CIL SignatureDi� 3 303 125.e5'Z ` NT(PRINT) TEL O LDMA Perm# � �•„ ❑ I, as owner of the pro arty, or my employees with wages as �U �� +2�� ZO 1 ITEMS their sole compens will do the work and the structure is ADDRESS / ,ate �r ,,-� not intended od for sale (Section 7044, Business and �! / CiY r FINAL DATE Q r re0.TOTAL 2 55 Professions CON.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A ZARDOUS MATERIAL m® {u �/ ❑ I, as owner of theproperty, am exclusive) contracting Wlttl OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE "y5� Q CHECK 125.rr Y AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ NO❑ CHANGE .00 Business and Professions Code.) @f2i ___J 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 agency for GUI ❑ No❑ 01000-0110 1 r# 18/9-9 CIA W the performance of the work for which this permit is issued(Sec. 1,5 4 1 AH 9 o 16 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING $097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. CY 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. Lender's Address -- C IXJNER OR AGENT o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE ev q� $ with all county ordinanc an State laws relating to building 6 cavi constructs d hereb a�pmoper olives of this County ISSUANCE FEE m to enter on a above- r inspection purposes. a 7�` CD INVESTIGATION FEE TOTAL FEE n San w a aon cm«ua•nt Dvo (7f SEE REVERSE FOR EXPLANATORY LANGUAGE