HomeMy Public PortalAbout5657 PAL MAL AVE_Building__ ` r APPLICATION FORIBUILDING PERMIT
FOR A PLICANT TO FILL IN (PrIDt Dr hDB DOIV) - R 0
BUILDING -COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY -r ZIP - BUILDING AND SA TY DIVISION
_ NO OF BLDGS BUILDING
SIZE OF LOT NOW ON L ADDRESS
A T 906 ^ K�7 /� Z LOCALITY
TEL NEAREST
OWNER �_ NO 67 CROSS ST ✓'
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICTGROUP TYPE FIRE ROC SEC) BY
CITY I, ZIP /. ^7�' CONST ZONE
ENG NIARCHTECEERT O NAU NOL �S7 Q
_ STATISTICAL CLASSIFICATION SEWEE)R�� A/nP,
ADDRESS G 2 D L. CLASS NO DWELL UNITS aI i;C
CONTRACTOR y NE ( USE ZONE MAP
n I/ NO Q
ADDRESS T NO 26aO4q �1 SPECIAL
CITY LIC
CONDITIONS
L„� CLASS C-�OI ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH /'/l. BL SETBACK FROM F
FR NTPROP LINEOF ISTREETI
ADDRESS CITY TOTAL SETBACK
HIGH AV } YARD FROM TYPEOF EXISTING O
SO F NO OF NO OF CHECK a FRONT PROP LINE HIGHWAY WIDTH U
SIZE 0 No RIES, FAMILIES ONE O
DESCRIPTION OF WORK
NEW ❑ } = U
OD BLDG SETBA (STREET) Vii
0 SIDE PROP LINEOF Z
LTER HIGHWAY - } YARD - TOTAL SETBACK TYPE OF EXISTING
SIDE PROP LINE HWAV WIDTH
EPAIR❑
USE OF }_ _
EXISTING BLDG DEMOL ❑
APPLICANT JAPPLICATION
CORNER CUTOFF - YES ❑ NO_❑
IPRIn T)_
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATURE)
IN•C OAS TAL ZONE L YES ❑ NO ❑
VALUATIONS Y-60 dLe� -
CATEGORICAL EXEMPTION YES❑ NO ❑-
HEREBY ACKNOWLEDGE THAT I HAVE RLICATION ENVIRONMENTAANOSTATE THAT THE ABOVE IS CORRECT COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL OR DI HANCES AND LAWS REGULING CON-
4'RUC TION ICERTIFY THAT IN_DOING TTHORIZED IMPACT REPORT PROCESSED (GATE)
HEREBY I WILL NOT EMPLOY AMY PERSONN O, .,,.
LABOR CODE M THE II INSURANCE
N OF CALIFORNIA IN RELATING TO �y '/D ♦S� A1/� /G 1;1" /
LABORWORKMEN 4 COOF NSATI INS Ufl ANCA % 7 N Y/�NZA1�
SIGNATURE OF /
PERMITTEE _ - -
ADDRESS
FINAL
TEL - DATE
CITY NO
ll lhl_ ( HL( /KS P it A/fLL 10 BEE $ T _ FEE
HARVEY T BRANDT COUNTY ENGINEER ((�// "/S—
PLAN CHECK VALIDATION MD CASH _ PERMIT VALIDATION CH NO CASH
, ,710 5�.APR 25 2 3 0 9.0 0 3 '
76A638A CER803 I2/72 - - 7 0 6nAPR 25 1 0 - 1 5.0 0 Ayo
Tuan-t "O3_G BB
APPLICATION FOR BUILD NG PERMYt
COUPTTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENG94M ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W JENKINS, SUP T OF BUILDING CROSS ST
FOR APPLICANT TO'FILL IN DlsrRlcr o GRH, TYPE o By
(Print or type only) �� CONST I
BUILDING / I , Ar STATISTICAL CLA )FICA TION SEWER MAP
ADDRESS S� G MAL,,,T�+PrsCj
CLASS NO--/__DWELL UNITS BK/_ PG`
LOT NO Z-7—'sLOCK USE ZONE MAP O Q
NO
TRACTSPECIAL
O OF BLOGS CONDITIONS
SIZE OF LOT ��j N
( S NOW ON LOT O
USE OF
EXISTING BLDG BLDG SETBACK FROM
OWNER (J _� FRONTPROP LINED F _(STREET)
NO T'C TYPE OF EXISTING SETBACK HIGHWAY + YARD — TOTAL
ADDRESS p 1/fe6 HIGHWAY WIDAcj /o ''T77H�� FROM C L
CITY .GLS• V + '� o - r
BLDG SETBACK FROM
ARCHITECT OR TEL SIDEPROP LINEOF (STREET)
ENGINEER NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY _WIDTH FROM C L '
��rr�� TEL + C
CONTRACTOR ��rp NO
ADDRESS LI CORNER CUTOFFC YES ❑ NO ❑ C
CITY
LIC 'Q,
SEE REVERSE SIDE FOR\SPECIALIAP�PROVALS
CONSTRUCTION LENDER, 'e
NAME AND BRANCH(1 G
c^ V
ADDRESS g L)C-L( O-P LAA.) / Ann,A
, NO OF NO
OF
SO
ZE T 16� -STORIES FAMILIES NEWUSE OF \®
07
STRUCTURE d-T��L ALTER
❑ J �.1 ADD5
1�-w
SIGNAT REPAIR[:]
APPLIC NTDEMOL ❑
VALUATION S
APPRO LS DATE 1NeP c on s slpHAn Rc
P CPMT FOUNDATION LOCATION /
FEE s FEE 5 2- FORMS MATERIALS
FRAME FIRE STOPS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BDLTS
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL ORDINAMC S AND LAWS BBGULATINB BUILDING CON- GAS VENT DUCTS
STRUCTION 1 CERTI Y THAT IN GOIMG TME WORK AUTHORIZED
HEREBY WILL NO EMPLOY ANY PERSOM I VIOLATION OF THE LATH INT
LABOR C00 NE STATE OF CA _.,Il
I IN RELATING TO
W OOKMEN CO EM ATI.T IXSUR
LATH EXT
SIGNATU E HOUSENUMBER COR- /
PERMITT RECT AND POSTED r
ADDRESS , FINAL rg�wle� '
PLAN CHECK VALIDATION cK Mot C JOHN F LEWIS PRINCIPAL ST R URAL ENGINEER
PERMIT VALIDATION
(DURAL
O CASH
tLr'a 5 '4'1�`FEa24 2 3 D 7 6.50• v
8 7 5 3G� rwtl 1 1 D 1 2 7'50— D
I L
APPLICATION FORBUILDING PERMIT
_ COUNTY OF LOS ANGELES „ BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION v - FOR APPLICANT TO FILL IN . SUILDNG ADDRESS
I hereby affirm that I have a certificate of consent to self insure Bull �ADORE i S A L A-
R
or a certificate of Workers C«npensatwn Insurance or a certified _ _ 4 p - - - ' - ,
copy t (Sec 3800 Lab C) t , GTY x ' /.� C t ZI / 1 0 LOCALRV
/17
PoiNo Company r OF LO Ka_ NO OF ELMS NOW ON LOT
❑ Certlhed'Wpy Is hereby furnished ' - NEAREST CROSS ST
❑ Cerhhed Copy Is filed wRh the county'bullding Inspection TPACT BLOCK - LOT NO -
departmerit - USE ZONE
Date - Applicant ' ASSESSOR MAP BOOK PAGE PARCEL
i "' SPECWL CONDIT10N5 J ^/
CERTIFICATE OF EXEMPTION FROM WORKERS OWNER TEL NO - - -r C/
COMPENSATION INSURANCE ` �Ga ti b - - 7 WITHIN 1000 FT OF SCIHOOLI vss NO
(This section need not be completed If the permit is for one hundred
D ADDRESS gsTRICi GROUP TY..CONST FaiE ZONE PROCESSED
dollars ($100) or less) ' Q I cerhfy,that nn the performance ofTthe work for which this PmRCtivZlP s Issued ]'shall rot employ any person In any manner so as to beco bled to the Workers nD sation Laws ` ITECT OR ENGINEER TEL NO sTnsl CL FlCATION Ae Appliranl ADDfiELr� CLASS NO DWELL UNITS TO APPLMANT If after maklrre this Certfwate of REQUIRED TOTAL SETBACKExemption you shoud become .subject to the Workers CONTRACTOR - TEL NO SETBACK YARD HWY PROP LIN
Comperlsatwn proYlswns of the Labor Code you must forthwith ,
FROM
Gangly,with Such provegnnS or the permit Shall be deemed revoked ADDRESS - — - LIC NO P L _
LICENSED CONTRACTORS DECLARATION - BIDE
CITY UC CLASS P L
I hereby affirm that I am licensed uncIerprovsnrs of Chapter 9Spw45'T SEWER MAP `
(coma in9 wfh,,Sectlan 7000)of Dnswn 3 of the iand 10SIZE NO OF TORS NO OF FAMILIES
Professions Code and my license Is In full force and effect NEW 13 BK PG }
( License Number LX: Class I OF W'O� El
f ADD - vgLUAnoN ' a
' DE P OfH Contractor Date n FK/ ALTER ❑ $ ��
y QIJFBwP"C'l� lIJ6
El $ CJ
I am exempt under Sec REPAIR ❑
$SPC for the reason DEMOL ❑ LDMA PAC -
Dale USE OF EXI G OL - URM ❑ •t + 209.25
Signature209.250-
(PRINT) TEL NO LDMA Perm♦ , Z
❑ I as owner of the property or my employees with wages as =O 1 ITEMS ,
their.sole compensation will do the work and the structure is ADDRESS
not Intended or Offered for sale (Section 7044 Business and ' } FINAL DATE Q TOTAL 209 .'25
Professions Code) _ WU THE,wEl.icwr CR FUTUE BUILDING cccnr+vrT HANDrE A HAZAROCUS MATERIAL 7
CHECK 209.25
' I as owner of the CRA Sit'E CQV ON TAA HAZARDOUS MATEHMl INFO TO aR DREATER TIW!THE
property em the protect
contracting with pAglfrTy SPECJFlED ON THE HAZARpa)S MATERLLLS VFOPAIATpN OUwE'! FINAL BY ���
licensed and Professions
to Co deucl the project (Section 7044 YES❑ -�/ { 1 CH'^�... •OD
&s+ress end Prolesswrs Cade 1
• CwTLLCC THE INTENDED 119E aF THE Bl10.nN6 6Y THE MODIFICATION
OR FROM T ELsEUTIi -
w COAST Nr REQUICUA-RE A PERMi FOR C MIETJJSE OR EE PEAMTwN FRCH THE T FOR _
CONSTRUCTION LENDING AGENCY �LA1ERsauunv nwuwEAEHr usrRlcr IscAalol SEE RFA,MTND cHEcrcusT FOR r>rtOr1_ 011 i I-TO
I hereby affirm that there s e construction lending agency for v 3❑ I„p/�y�) J�411Lo1 2476
n the performance of the work for which this permit is issued(See nHAVEREAD T,EI�u+rousMnTERuis rFaaumNcwEunTHEsuaMo aEwwrTwo ,
N3097 Civ C) C ECAl-Ier I UNDERSTAND MV REO RiEMENTe UNDER THE Lee ANOEIES G NTY CODE
F P10 AB 2n loo P 140 CONCEPM Ds
Lenders Name a =.Z.FOBTA A PEMFRCM THE 0 k,
, -
Lenders Address
o �
o y I certify that I have read this applwahon and state under penalty
Of perjury that the attoWinfo malloo la correct I a Re t0 compo PO'FEE • PERMIT FEE- �j' + ,
with-all county ondmances and State Taws relating to building I 1
construction and hereby authorize representatives of thin County ISSUANCE FEE
" to ente Dn a above-meniwned property for IIKpeCti rposes t
m _ INVESTIGATION FEE r TOTAL FEE
^ a o+wn o. ✓
SEE REVERSE FOR EXPLANATORY LANGUAGE