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Home My Public Portal About6013 PRIMROSE AVE_Building__ MMM DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OFLOS ANGELES WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY /�� DIST R(j�T NO. PLAN CIC. NO. PERMIT NO. ADDRESS _ o I t� I -)-I -'jl . ;� ✓ �� LOCALITY 7� /� PR EIVED{BY DATE OF APPL. DATE ISSUED NEAREST Jp� A ��- ,�� CROSSOT r% ,�A'S" / F� s J' p " ADDRESS (SJ.C) OWNER r) -MAIL ` LOCALITY ` ADDRESS ,/tf '7')-v 7 Q S�� NEAREST I n TEL CROSS ST. CITY , ,T1 `/ NO. FIRE NO. OF I PLANS® I T I GRO ZONE ARCHITECT OR TEL. JJ ENGINEER NO. BLDG. SETBACK LINE ADDRESS .� APPROVED TEL. .j. BY DATE R' CONTRACTO ?, I /C! Q/(/ NO-Of. k/lk�/ USE APPROVED ZONE / BY DATE ADDRESS I' may' OV, /� r (�d`/ / e HO SE NUMBERING LEGAL -T.. ..0 I I DESCRIPTION LOT NO. BLOCK MAP NUMBER IELD CHECK BY TRACT NO. ASSIGNED BYA�AT "•. No. OF BLDGS. CORRECTIONS SIZE OF LOTS NOW ON LOT USE OF NO. OF EXISTING BLDG, ��f }�r !/ c'- I FAMILIES ( J I DESCRIPTION OF WORK ?,/- S7 �'!/7�!-� NU L NEW I I ALTERATION I I ADDITION 0 REPAIR I DEMOLITION SQ. FT. y! NO: OF Q SIZE ROOMS STORIES 2 a i EXT. WALL t-: ROOF r COVERING S-7 dil e c-el I COVERING (_;�f]-;r p USE OF STRUCTUREQ Al " r APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-.1 FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS ' FORMS, MATERIALS r �/ CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HERRON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS L LAWS REGULATING B ILDINCaICONSTRUCTION. FURNACE: LOCATION, g SIGNATURE OF t GAS VENT, DUCTS PERMITTE � // •C�lZt�1 `yg ,� ,� / LATH, INT. A13DRESS/- i, ? A✓ s�+.L< lil�,�' !� IV LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 76ASSSA- DDSB 10-80 P. C. $ ® FEE PLASTER, EXT. VALUATION �` FEE $ � FINAL I�iris S 7� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS 1 hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS O/,3 or a certificate of Workers'Compensation Insurance,or a certified E' "q �G~ copy thereof(Sec.3800,Lab.C.) CITY J� /t% ZIP LOCALITY Policy No. Company SIZE OF LOT _ / C NO.OF BLD�GS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. [ICertified copy is filed with the county building inspection TRACT BLOCK Lor No. department. USE ZONE MAP NO. Date Applicant ! ASSESSOR MAP BOOK PAGE PARCEL i SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' i OWNER, i ___-4TEL NO. COMPENSATION INSURANCE I✓�v C/7�,� O /I'' g C�7''3�'JJ WITHIN 1000 FT.OF SCHOOL? YES NO w (This section need not be completed if the permit is for one hundred ADDRESS /7 _ dollars($100)or less.) J T Z C, C/�i'ff} 4-/— 7p DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit I CIT L'- i /�� %v7�Ly -1,K / is issued, I shall not employ any person in any manner so as to I ARCHITECT O/RGEN GGINE R TEL O. V become subject to the Workers'Compensation Laws. ,gg? �� a STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS C� ✓ CLASS NO.0—**-� I DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACKYARD 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. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION I SIDE CITY uC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and I SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG , Or.. DESCRIPTION OF WOR -' ADD ❑ VALUATION Q License Number Lia Class `/%� ` % ..� ��D� $ � O-G�J. �U U Contractor Date C� ALTER ❑ � ❑ I am exempt under Sec. REPAIR ❑ $ U BAP.C.for this reason I ,r��g DEMOL ❑ LDMA P/C# t )JJ Date: I USE OF EXISTING BLIM. URM ❑ tp1 a. Signature APPLICANT(PRINT)J TEL NO. LDMA Perm# i i;• •I o 4 co ❑ I, as owner of the property, or my employees with wages as � O 3303 107.10 their sole compensation, will do the work and the structure is 1 ADDRESS riot intended or offered for sale (Section 7044, Business and 1 FINAL DATEQ 1 I{ � Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL k , J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1 r' 103 ❑ I, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY TOTAL d �' ..r licensed contractors to construct the project (Section 7044, YES❑ NO❑ CHECK 107.10 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE n CIO �1 f CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ r CM the performance of the work for which this permit is issued(Sec. 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 0000-Gooll l T/20/7p 5 a 3097,CIV. C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LAS ANGELES COUNTY CODE. TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS iLender's Name MATERIALS REPORTING AND FOR OBTNNING A PERMIT FROM THE SCAOMD. 0955 1 A;y{I C'a 10 In Lender's Address I —R-AGENT o ' C1 certify that I have read this application and state under penalty C of perjury that the above Information is correct.I agree to comply I P.C.FEE PERMIT FEE �� 3` , N with all county ordinances and State laws relating to building b� m construction, and hereby authorize representatives of this County I ISSUANCE FEE �7 s a e upon he aboYa-mention d pro erty f r inspection purposes. ref G7. • m / p "zQ•- INVESTIGATION FEE TOTAL FEE r 81pN11u1B d AppMGM a I SEE REVERSE FOR EXPLANATORY LANGUAGE