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Home My Public Portal About5639 PERSIMMON AVE_Building__ 35 76A638A / Ci`11803�l.l 1/78) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY .FOR APPLICANT TO FILL IN ADDRESS �1�� LDING ADIDRESS °$i(ji7 A 1 ,PfG�}/�ff 1H1VV/Y AYiE LOCALITY �� CNEAREST r CITY_ro/�PL� e-/ L e4lzIP tfl�� CRO555T. J�ps NO*OF ASSESSOR SIZE OF LOT NOW ONN LOT LOT , MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PRO SED BY TRACT /� / BLOCK LOT NO.. CONST ZONE OWNER AN4 {j+r�l�,r/2!//•YV7 .yL� TG�^ '")r r� � G� ADDRESS U/vf/Yi�/�/ cam' STATISTICAL CLASSIFICATION SEWER MAP �/ !,y p /� rf/ CLASS NO. DWELL.UNITS BK�1 PG CITY 14!TAffA?ih� L0r/i ZIP w rte"/ ARCHITECT OR TEL. VALUATION $ ENGINEER NO. ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTOR NO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING . LIC. FRONT PROP.LINE HfGHWAY WIDTH' ADDRESS NO.. r LIC: + O = i CITY C CLASS BLDG.SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH SIDE PROP.LINE OF (STREET( HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH O SQ.FT Ott] NO.OF NO.OF CHECK + = 69 V SIZE ' 'TG° STORIES FAMILIES. ONE 0 FIONE MAP .0-0 oDESCRIPTION OF WORK NEW �O �SPECIAL lifADD IL ❑ CONDITIONS ,q ALTER ❑ FINAL / ' BY ? REPAIR ❑ DATE USE OF fJ'r DEMOL ❑ EXISTING BLDG. ✓ • 2 APPLICANT TE (PRINT) R Q BY(SIGNATOR I H r LEDGE THAT I HAVE EAD THIS APPLICATION AND STATE bd THAT T A OVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES t,L AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE _ WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF {.7 z 0 6 0.5 A THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO ORKMEN'S COM Z PENSATION INSURANCE.' ft o 0 0 0 0 1 Alf SIGNATURE OF 2 3 4,0 D PERMITTEE ADDRESS 610 ma a Slt Z o 0 c34,0060 CITY tgLf/f�/�I�iPf�' CAWA NO: 4l:_ '7 a 0 6 0 3-8 0 0 P.C.Fee$ Permit Fee > Issuance Fee o�c Total Fee • � � '1 1 APPLICATION FOR BVILDING PERMIT q COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN � � BUILD I D BUILDA R S Adz- N � 'vv0 I hereby affirm that I have a certificate n consent to self insure, �L w Or a certificate of Workers'Compensation Insurance,or a certified ctogb C � ZIP copy thereof( ec.38 0 a _ i 01 LOCALIT� Policy N� Company SIZE OF LCIT NO.OF BLDG OW ON OT [I ` Certified copy is hereby furnished. NEAREST CRO/SS SST. Certified copy is filed with the co y building inspect' TRACT BLOCK LOT NO. �`�+�`� de artm t. USE ZONE MAP NO. rASSESSOR MAP BOOK c PAGE /� PARCEL Date Applicant �d�� Q�l �� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROW RKERS' R /� \ COMPENSATION INSURAN i��r.-! WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred AETW 6) dollars($100)Or less.) @ DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY CIT I ZIP ^L/ I certify that in the performance of the work for which this permit �a rJ � 2 Ate` Q is issued, I shall not employ any person in any manner so as to d J become Subject to the Workers'Compensation Laws. ARCHITECTIDR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRES CLASS NO. DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONT lj� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �/� �v — FRONT comply with such provisions or this permit shall be deemed revoked. ADDX" IyC.4O A� P L LICENSED CONTRACTORS DECLARATION f CJl � (! SIDE c � LIC. L ,,._;OF 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 $Q• .SIZE NO.OF STORIES NO.OF FAMILIES Professions Code, nd my lice�S a is in full force a eff� L Pftt) 1 NEW ❑ BK PG a License NU ber C7 o 0✓ Lic.Class DESCRIPTION WORK ADD ❑ VALUATION ' Q .S I� $ v Contractor L '• CCw�` Date — % �' AA . �/- ALTER ❑ ❑ I am exempt under Sec. 7 �•'' REPAIR If $ O B.BP.C.for this on w � _ DEMOL ❑ LDMA P/C# V W Date: USEUX EX N s % URM ❑ C0 Signature APPLICANT(PRINT) TEL NO. LDMA Perm# f z n. El 1, as owner of the property my employees(hJetructure wages as �• Z their sole compensation, will do the work and is ADDRESS q «:)'; _I_.;°4 t_ not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code.) WILL THE APPUCANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE !� ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY -f•"',{ licensed contractors to construct the project (Section 7044, 666 90 YES❑ NO Business and Professions Code.) !' �• _ s-; WILL THE INTE ED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHI_'{:E� •-eJ�z;: OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR )�(^ �r914 GUIDELINES '• !H HNGE -- I hereby affirm that there is a construction lending agency for .YES❑ NO CM the performance of the work for which this permit is issued(Sec. W1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING a 3097,CIV.C.) CHECKUST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. t'I I;Iri_r;r,f,1 TITLE 2.CHAPTER 2 20 SECTIONS 2.20 100 THROUGH 2.20.140 CONCERNING HAZARDOUS �..Lrl.• 'sli.i_ t Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. C3 Lender's Address 0 p4pEp 0p AGENT cI certify that I have read this application and state under penalty C of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all c unty ordinances and State laws relating to building con struc' n, and hereby author' presentatives of this County ISSUANCE FEE / ato enter p bo ention p pe nspection pirposyds (p• INVESTIGATION FEE TOTAL FEE sqm,� m A�ManM v aan ome 11ry fG C9 SEE REVERSE FOR EXPLANATORY LANGUAGE f APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDINCj'f19BfiE I hereby affirm that I have a certificate of consent to self insure, BUIL gDD S ��t 1, _ _ , �. ��(C�� % or a certificate of Workers'Compensation Insurance,or a certified CIT �� •�Z•IPJi��-� copy thereof(Sec. b&M LOCALITY Policy No. CompanyJej SI E OF LCI. I NO.OF BLgGS.NOW ON LOT ..❑ CC�ertified copy is hereby furnished. {` NEAREST CROU,6 ST,6 �ertified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. ,� USE ZONE MAP NO. Date '—� pplicant r'r ��5 ASSESSOR MAP BOO PAGE/ PARC ff6SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' owN COMPENSATION INSURANCE `S WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred AJfqS ` DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITT may, h ZI ( / :�:::] ��(/ )e. -3 e-.-I certify that in the performance of the work for which this permit S�f� l is issued, I Shall not employ any person in any manner so as t0 ARCHITECT R ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION 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' CO RAC �� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADL O3 > P L LICENSED CONTRACTORS DECLARATIONLIC.CL� � P L SIDE I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000.)of Division 3 of the Business and SO .SI E_ NO.OF STORIES NO.OF FAMILIES Professions Code,a (�Y license is in full force a effe�t. f r NEW ❑ BK PG , a b '� 1 DE RIPTION RK [� ❑ VALUA`11QN License Number n Lic.Class J!/V `!tv� C Contractor �e_1 w'*67S Date ALTER ❑ � L IX ❑ 1 am exempt under Sec. REPAIR )�- B.BP.C.for this reason DEMOL ❑ LDMA P/C# L`Iji Date: USE OF STING BLDG. URM ❑ 11 ,. 3 e.i Signature APPLI NT INT) —�Q�!) LDMA Perm# z ❑ I, as owner of the property, or my employees with wages as O :. s their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and v 1 FINAL DATE 7 7 Q JO i AL IZE-3 L m 2 7 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL o (/(� t CLIu i-t OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, aS owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL,BY •�'' <. r licensedproject (Section 7044,contractors to construct the YES❑ NO❑ Business and Professions Code.) I MLL THE INTENDED USE OF THE BUID)NG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AR UAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITnNG CHECKLIST FORGUIDE + I hereby affirm that there is a construction lending agency forJ J a the performance of the work for which this permit is issued(Sec. vEs❑ NO ❑ 1��L'I e {`( '=[i`} Q I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMTTING N 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 3 CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.CONCERNING HAZARDOUS oLender's Address avNER OR AGENT 0 o I certify that I have read this application and state under penalty o Of perjury,that the above information is correct.I agree to comply P.C.FEE fry. 0 PERMIT FEE CM with all ounty ordinances and State laws relating to building �J / constru on, and hereby autnrepp.r�esentatives' of this County ISSUANCE FEE ccLL m to ente n ove entipection purpos S. T® m ^Z�^ � INVESTIGATION FEE TOTAL FEE/a 7 7 pllean a AI Dale SEE REVERSE FOR EXPLANATORY LANGUAGE