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Home My Public Portal About5831-5833 PRIMROSE AVE_Building__ TEMPLE. COTY IBA8886 CIS#803 2/80 APPLICATION. FOR BUILDING PERMIT - = - .•.1 COUNTY OF-IAS ANGELES BUILDING ��D 7 f_t� ? 2�- DEPARTMENT OF COUNTY ENGI NEER ADDRESS�7 O J/`ti+v J BUILDING AING ASAFETY DIVISION LOCALI JOHN A. LAMBIE, COUNTY. ENGINEER NEAREST WILLIAM'A.JENSEN SUPT OF BUILDING CROSS ST. `A.•� DISTRICT NO. GROUP TYpE PR CESSED BY R FOR APPLICANT TO FILL IN 7. d CONST. BUILDIN ,. STATISTICAL.CLASSIFICATION $EWER MAP ADDRESS BK PG 7CLASS.NO.�- "WELL.•UNITS LI LOT NO. . BLOCK MAPSTATE -YES NO g NUMBER d O 7 HWY.. TRACT 3r' / USE ZONE • SPECIAL . - I NO.OF BLDGS. ( uJ CONDITIONS SIZE OF LOT NOW ON LOT USE OF :{ EXISTING BLDG. BUILDING YARD HWY STREET NAME. EXIST. OWNER / NO SETBACK WIDTH. FRONT ADDRES 3 SIDE ARCHITECT OR TEL. P.L. ENGINEER- No. INSPECTION RECORD ADDRESS' 't ,• ' TEL. CON RACTOR NO e _ p O ADDRESS DESCRIPTION OF WOR_g PRP A6-r O NEW ADD. ALTER REPAIR DEMOLISH 1. _ /�,r •/ ��j SO.FT. NO.OF OF -SIZE STORIES FAMILIESUSEOF ' STRUCTURE -Ti65-Al , 6d/`! Ml t_ -4R JA1,SP►t- A41 1A1.7- SIG TURE O' �r ' ']'.� /I 7 /'G/I R... APPLICANT - VALLIATION$ (� L I r APPROVALS DATE INSPECTOR'S SIGNATURE ��d PMT /f� FOUNDATION:LOCATION FEE.$ '- ✓ iFORMS,MATERIALSAME:-FIRE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FBRACING,BOLOTSS. PLICATION AND STATE THAT.THE ABOVE IS CORRECT AND FURNACE:LOCATION, / /J AGREE TO COMPLY WITH ALL COUNTY ORDINANCES'AND GAS VENT DUCTS ( f?�O TATE LAWS REGULATING BUILDING CONSTRUCTION. G 1' CERTIFY THAT 1N DOING THE WORK AUTHORIZED 1 LATH,INT. '0/i' OT&Y. WILL NOT EMPLOY ANY PERSON IN VIOLATIONOF THE.. / /Jf /� WORKMEN'S COMPENSATION LAWS OF {FORNIA. LATH,EXT. %~KC l al /y/t N. PERMITTEE OF HOUSE NUMBERPS COR- PERMITTEE OR- �+•l �� ',23� �� P f' r RECT AND POSTEDIF w /moi r' � K ADD FINAL /3'9d�Y0L�,//�/� % ..'CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK,. M.O. CASH PERMIT VALIDATION � ctc m.-O. cash LICOt, APPLICATION FOR 13U�L®ING PERMIT COUNTY OF LOS ANGELES BUILD!WMG AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT ,eTTO/�FILL IN BUIIAgIttl 5 33 Vif I hereby affirm that I have a certificate of consent to self insure, � E 4 wt�—DS� ,L✓�.L�XJ�4J 1�G J or a certificate of Workers'Compensation Insurance,or a certified copy there c. 8 .C.) `(� \C� ZIP I (Mo LOCALITY Policy No. Comparry SIZE OF L NO.OF BLDG&NOW ON LOT Certified copy is he urnished. NEAREST CROSS ST. co filed with the co ty ding inspectio TRACT — BLOCK LOT NO. / d ar men USE ZONE MAP NO. D Applic ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS Y a/ CERTIFICATE OF EXEMPTION FROM WORKERS' NER (fes TE COMPENSATION INSURANCE ADB fl G PW�Ud -;-L— A _, WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred .J 93 '733 g i/W s� DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit ZIPel�� D C1 ? is issued, I shall not employ any person in any manner so as to ARCHITECT R ENGINEER TEL NO. a J become subject to the Workers'Compensation Laws. STATISTICAL CLASSIPPPPPPICATION APT CONDO Date Applicant ADDRESS CLASS NO.X DWELL UNITS N07ICE 70 APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' WOR TE SET BACK YARD HWY PROP LINE WIDTH NT Compensation provisions of the Labor Code, you must forthwith L FRONT comply with such provisions or this permit shall be deemed revoked. R_ES,S� p uC O/��(^� PL LICENSED CONTRACTORS DECLARATION ��.•�� , ,f�� L SIDE 2r1Bk5•r/✓r+ L o L%. 4A3� P L I hereby affirm that I am licensed underprovisions of Chapter 9 ,rJ C- c7 . SEWER MAP (commencing with Se ion 000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code, sin full fo a ff NEW BK PG � Licep/s��Number Lic.Class .I DE PTION WORK � ADD ❑ VALUATION ® 0 ConCraC�a Date ( (�` ALTER ❑ $ U cc S REPAIR ❑ $ O El am exempt under Sec. B.BP.C.for DEMOL 11 LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ q pp/ 1 (n Signat ymPLJE WPjtl I � T LDMA Perm# Z ❑ I, as owner of the property, or my a oyees with wages asN`�' 'a their sole compensation, will do the work and the structure is F =j L 1-21.15 not intended or offered for sale (Section 7044, Business and er FINAL F)ATE/�J� J I Q � _ Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL /(11 /�J J ", ORA MIXTURE CONTAI G A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ ❑ I, as owner of the property, am exclusively contracting 44, AMOUNTS SPE FIED E HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 5 licensed contractors to construct the project (Section 7044, �Ii �-'°—�' Business and Professions Code. ZERoRAwrtr— I No CHECK , .� -z ) E I NDED US OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �•: tC•�`4 .I.i1 n.1tii NT EOUIRE A P MR FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY IR DUALITY M GEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR 4Ht�i'��aE .00 NES 1 hereby affirm that there is a construction lending agency for a the performance of the work for which this permit is issued(Sec. A HE HAZARDO S MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING !' { r •} !•� / N3097,CIV.C.) ST I UNDER MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHAPTER SECTIONS 2 20.100 THROUGH 2 20.140 CONCERNING HAZARDOUS Lender's Name LS AND FOR OBTAININ RMIT FROM THE SCAOMD. y�q i e i C o Lender's Address I>_rr� 1 r Z 1 1 R AGE 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 N with cou ordinances and State Taws relating to building stru ,and hereby authorize re ntatives of this County ISSUANCE FEE m to a upo abo n' rty for ins e,�t' p oses. (p p INVESTIGATION FEE � TOTAL FEE P, Sanwa of APW=t w ARM SEE REVERSE FOR EXPLANATORY LANGUAGE