Loading...
HomeMy Public PortalAbout6057 PRIMROSE AVE_Building__ 76A.£38A CE 403 4.4'72 16d, • APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYAHLE 7'0: ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN NEAREST , Print or tyDe onl CROSS ST. _ DISTRICT N GROUP TYPEPROCESSED BY BUILDING _ Gt ( CONST. c. ADDRESS O c (L ! {„J LOT NO. °l 3 BLOCK STATISTICAL CLASSIFICATION SEWER MAP CLASS NO. DWELL,UNITS SK PG TRACT _ USE ZONE MAP �i NO.OF BLDGS. / NO. SIZE OF LOT NOW ON LOT I SPEC A USE OF CONDITIONS EXISTING BLDG, Q TEL.. (' OWNER L•.iQ NO. 6 J� BLDG.SETBACK FROM ADDRESS Q 0 FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGH W Y + YARD = TOTAL CITY 1j, HIGHWAY WIDTH FROM C.L. ARCHITECT 6R TEL. + \ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF y'a (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL C CONTRACTOR NO. HIGHWAY WIDTH FROM C.L. C LIC. !" i _ 4 ADDRESS NO. C lt� } �'G - c C LIC. Z CITY 0 CLASS CORNER CUTOFF YES ❑ NO CONSTRUCTION LENDER e r NAME AND BRANCH �' i✓r SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS 7 u SQ. FT, NO. OF NO. OF NEW SIZE , STORIES FAMILIES ❑ USE OF ADD STRUCTURE ALTER ❑ � „-'1 ,' SIGNATURE OF 'REPAIR❑ APPLICANT DEMOL ❑ VALUATION S / 1• `-' APPROVALS 9ATE INSPIE_OR'S SIGNATURE P.C, PMT. FOUNDATION: LOCATION \/ - FEE $ FEE$ _ � FORMS, MATERIALS 14A j � FRAME: FIRE STOPS, / I 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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSONIN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPpTI N INS RAN LATH, EXT. �- SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL ''lZ"7� PLAN CHECK VALIDATION CK. M.o. CASH _ PERMIT VALID TON�c� M.O. CASH L&O t` -7 1. JAN 2 6 I D 2 1.75— It APPLICATION FOR BUILDING PERMIT �( FOR AbRLICANT TO FILL IN (Print or type only) BUILDIN!G ,, O DEPARTMENT OF COUNTYCOUNTY OF LOS ENGINEERELES ADDRES CITYZIP C� ' C BUILDING ANDS Y DIVISION NO.OF BLDGS. BUILDING SIZE OF '- NOW ON LOT ADDRESS TRACT BLOCK LOT NO. LOCA LIT TEL r{, NEAREST OWNER NO. U {' CROSS ST. ASSESSOR ADDRESSfi!dr& MAP BOOK PAGE EL DISTRICT I GROUP TYPE FIRE 'Jj PROCE SED BY CITY ZIP r CONST. ZON , ARCHITECT OR TEL. O ENGINEER NO. STATISTICAL CLASSIFICATION SEWER AP ADDRESS CLASS NO�i//—DWELL.UNITS PG CONTRACTOR No. ONE MAP LIC. NO. 11241 ADDRESS NO, SPECIAL LIC. CONDITIONS CITY CLASS ,ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM c FRONT PROP.LINE OF (STREET) C ADDRESS CITY HIGHWAY + YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING � SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAYI WIDTH p SIZE STORIES FAMILIES ONE F DESCRIPTION OF WORK NEW BLDG.SETBA v ADD ❑ SIDE PROP.LINE OF EET) a ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF E T [IING REPAIR SIDE PROP. LINE HIGHWAY WIffX USE OF DEMOL [:] + EXISTING BLDG. APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. IN OPEN SPACE YES ❑ NO BY (SIGNATURE) Irw ❑ a IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ � 1 CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION-DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ' STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CA IF NIA RELATING TO WORKMEN'S COMPENS N NS AN SIGNATURE OF PERMITTEEpf ADDRESS / ' TE � FINAL �r B V _ I--,/ PATE CITY NO. \ MAKE CHECKS PAYABLE TO: FEE $ `--f FEE HARVEY T. BRANDT, COUNTY ENGINEER / r OO PLAN CHECK VALIDATION CK. M.O. CASH P RMIT VALIDATION .o. CASH q `-'�j L r 76A638A CE#803 12/72 3 31 0 1 3 SEP 24 D -O O PPLICATION' FOR COUNTY OF LOS ANGELES R,x OF •U'I LD 1 N G PERMIT DEPARTMENT BUILDING AND SAF TTY SION ENGINEER FOR APPLICANT TO FILL IN ADDR 55 C- �- BUILDING /'" CJ ADDRESS ©c7li',nt LOCALITY d- / y NEAREST CITY 7, J6 ZIP 700 CROSS ST. lie NO.OF BLDGS. ASSESSOR SIZEOF LOT 1OtV NOW ON LOT I MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE ESSED BY TRACT BLOCK LOTNO /� ` d� CON3Jr SNE 1 OWNER Z NO. `-DCI �- STATISTICAL CLASSI CLASSIFICATION FIICAATIOONN SEWER ADDRESS 6 L'1 S CLASS NO._Z UNITS BK PG CITY ZIP USE ZONE MAP NO.' S ARCHITECT OR TEL. ZZ SPECIAL ENGINEER NO. `J CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL. CONTRACTOR NO. BLDG.SETBACK FROM LIC FRONT PROP.LINE OF (STREET) ADDRESS 001 A( NO. TOTAL SETBACK FROM TYPE OF EXISTING G� LIC HIGHWAY !+ YARD = FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS f CONSTRUCflO LENDER a NAME AND BRANCHO BLDG.SETBACK FROM V ADDRESS CITY SIDE PROP.LINE OF 4� (STREET) of SQ.FT. INO.OF NO.OF CHECK HIGHWAY + YARD =., TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH CL 00 19 + _ .�� Z DESCRIPTION WORK NEW ADD ❑ CORNERCUTOFF YES NO_ ❑ ALTER ❑ IN OPEN SPACE ' YES ❑ NO ❑ REPAIR ❑ USEOF BLDG. DEMOL ❑ IN COASTAL PERMIT ZONE' YES ❑ NOEXISTIN ❑ APPLICANT TEL (PRINT) NO. LSLARAN NATURE) i EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE HE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES WS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF ' OR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. TURE OF FINAL_ r {� BTTEE DATEESST NO 6' �L7P•C.Fee$ Permit FeeQQIssuance Fee ATION$ G� Total Fee ��Z'•� PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIONi CASH 47 8 C2 FEB s :L D ®S 76A638A CE/803A 6/76 �.p it - APPL.ICATION FOR ' BUILDING PERMIT BUILDING FOR APPLICANT TO FILL IN ADDRESS BUILDING � ADDRESS 7 aj ie LOCALITY `/� ,, -- NEAREST CITYv ZIP el CROSS ST. 0.OF BLDGS. ASSESSOR SIZE OF LOT X NOW ON LOT I MAP BOOK PAGE PARCEL y7/ DISTRICT GROUP I TYPE FIRE --'PROCESSED BY TRACT ; l�"I BLOCK LOT NO //„ Jam' CONST. ZONE ( OWNER 'G L TO. �. J• LSC' STATISTICAL CLASSIFICATION SEWER MAP- ADDRESS ops, e o s eG! CLASS NO. / DWELL.UNITS BK PG CITY r, C,, ZIP USE ZONE MAP —7 ARCHITECT R TEL NO. � C / ENGINEER NO. —3 SPECIAL CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL. CONTRACTOR NO. BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS !' NO. TOTAL SETBACK FROM TYPE OF EXISTING y� LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS _ CONSTRUCTION LENDER + C NAME AND BRANCH BLDG.SETBACK FROM L ADDRESS CITY SIDE PROP.LINE OF (STREET) C SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH v DESCRIPTION OF WORK NEW ❑ ADD .❑ CORNER CUTOFF YES ElNO ❑ ALTER u IN OPEN SPACE YES ❑ NO ❑ USE OF REPAIR ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. \ DEMOL ❑ APPLICANT TEL (PRINT) NO. BY(SIGNATURE) i • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE C THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES i AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE Of �� �O FINAL BY PERMITTEE DATE ADDRESS 1 TEL. P.C.Fee$ Permit Fee CITY 71f 01 NO. / Issuance Fee EVALUATION$ o f r Total Fee /`J PLAN CHECK VALIDATION• CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 9 8 3 Lr--N0'4 4 1 D 1 5.0 U 'a: ®S 7GA638B CE/803B 6/76 , N .,,APPLICATION FOR BUILDING PERMIT BUILDING -FORR,�APPLICANT L Ifs ADDRESS ' o,5- rv— ADDRESS ©`J LOCALITY NEAREST CITY ZIP' ?'/d.[/ CROSS ST. J r--Nb.OF BLDGS. ASSESSOR SIZE OF LOT / 3_5 NOW ON.LOT MAP BOOK PAGE PARCEL DISTRICT GROUP ITYPE FIRE JORMSSED BY - TRACT BLOCK LOT NO. CONST. ZONE TEL_ �- O ER n NO,? -t9G60 Q8 it STATISTICAL CLASSIFI SEWER MO ADDRESS CLASS NO. DWELL.UNITS BK PG CITY ZIP USE'ZONE MAP NO. L (} ARCHITECT OR -TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL-REQUIRED YES❑ NO❑. TEL. CONTRACTOR. NO. - BL SETBACK FROM LIC. FR T PROP.LINE OF (STREET)... ADDRESS NO. TOTAL SETBACK FROM TYPE OF EXISTING HI HWAY +' YARD = LIC.' FRONT PROP..LINE HIGHWAY WIDTH • ' CITY CLASS _ CONSTRUCTION LENDER + a NAME AND BRANCH BLDG. BACK FROM 0U ADDRESS - CITY SIDE PRO . E OF (STREET) SQ.FT. NO.OF NO.OF CHECK HIGHWAY +. __ TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE.PROP.LINE HIGHWAY WIDTH tn= DESCRIPTION OF'WORK NEW ElZ- ADD ' ❑ CORNER CUTOFF YES ❑ NO '❑ ALTER IN OPEN SPACE YES ❑ NO ❑ USE OF REPAIR 1:1 'IN COASTAL PERMIT ZONE YES. Q• NO ❑ EXISTING BLDG. DEMOL ❑ th APPLICANTlecL (PRINT( O. BY(SIGNATURE) • I HEREBY A WLEDGE THAT I HAVE READ THIS PLICATION AND STATE ' THAT THE ABOV IS CORRECT AND AGREE TO OOMPj0 WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF ' THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF FINAL BY PERMITTEE DATE ADDRESS' TEL. • r� P.C.Fee$ Permit Fee io. CITY NO.�6u _ ' Issuance Fee l? VALUATION$ jJ '• ' (iL! Total Fee d 'PLAN CHECK VALIDATION cK. ' M-0. .pASH' � PERMIT VALIDATION cK M.O. CASH T 5'44-0APA 6 12 ID 2 5.0 0 BS 7GA636B CE/803B 8/77 _ 76A333ADBB.312.34 APPLICATION' FO R. BUILDING PERMIT DIVISION OF BUILDING AND SAFETY BUILDING 4 .S� Deportment of County Engineer County of Los Angeles LOCALITY WM.J. FOX, COUNTY ENGINEER ry CASSATT D.GRIFFIN,SUPT OF-BUILDING NEAREST CROSS ST. FOR/APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE BMAPPG ABUILDINGDDRESS t00 / / P CONST. ISEWER ' - 6.T t� MAP ,STATE •Y N - NUMBERy ? HWY / LOT NO. 7 / ;(/ .� BLOCK USE�ZOSIE SPECIAL J' f CONDITIONS TRACT Lw NO. OF BLDGS. �/ SIZE OF LOT �d �d I h I NOW ON LOT BUILDING - EXIST. USE OF CC�� yy SETBACK. YARD HWY STREET NAME WIDTH EXISTING BLDG. �JI��✓t/C Il �, layer FRONT OWNER ��` _ (A �/J .�E �!/ SIDE tl MAIL Al. P. L. ADDRESS �7 /v J� _�1��se� TEL.- l / 1 DWELL. I UNIT •5 INDUSTRIAL CITY s�.[1�.�.+!.t�!_ n+�. NO. :7�� ARCHITECT OR 2 DUPLEX_UNIT, 6 PUBLIC BLDG. / �� TEL _ ENGINEER / N 3 APT. UNITS 7 ADDN.,ALT., ETC. ADDRESS ' f 4 COMMERCIAL 8 MISCEL. • CONTRACTOR f7 IVA-/'g'h) TEL' INSPECTION RECORD ADDRESS DESCRIPTION OF WORK 11M el)Afil- ON' R_dI9eZA16 NEW ADD ALTER REPAIR DEMOLISH SQ.FT. I _ NO. OF NO. OF � )C;4,)C;4,� ��R .SD SIZE ik STORIES / FAMILIES / USE OF STRUCTURE ERD R SIGNATURE APPLICANAPPROVALS ADDRESS DATE INSPECTOR'S 91GRATURE P.C. 5 FFORMS. M TERIALSION t4 O FEE FRAME: FIRE STOPS, /� VALUATION f— +� /J =� BRACING, BOLTS J - 2-S FEE G`' FURNACE: LOCATION, GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS • APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH, EXT. SIGNATURE �/ fes HOUSE PERMITTEE RECT AND POSTED ADDRESS FINAL (tj�'2S"53� rl/jLv(C'Cr`C�XI/ VYM. J. FOX. CouNTY F.NBINCCR VALIDATION BY : 0IN6 2 2-IS MAR 16 1 2.0 0 +� DEPUTY � '_ .DEPUTY BY BY DEPUTY DEPUTY 76A988A CE#608,0_39 APPLICATION FOR BUILDING PERMIT 1 •• COUNTY'OF LOS-.ANGELES BUILDING DEPARTMENT OF COUNTY ENGRiEER ADDRESS / '/ BUILDING AND SAFETY-DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.. f I DISTRICT NO. I GROUP TYPE MIESZED BYFOR APPLICANT TO FILL IN CONT. _ BUILDING �= / ICAL CLASSIFICATIONSEWER I E ER MAP ADDRESS S nj�7) sTAT"STjBK CLASS.NO. ��DWELL.UNITS `'= s LOT NO. {(r BLOCK N MAP STATE � YES O r TRACT � , USE ZONE SPECIAL / NO.OF.BLDGS CONDITIONS SIZE OF LOT o a l35 I NOW ON LOT USE OF �t� ' EXISTING BLDG. jg�OC�•O OP I BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER ROkP 4-kLicFRONT ., MAIL ADDRESS d°/�d2�/rI 5 fi1DE + TEL. 7�7 A! 11-4 CITY .y 1 1.11` NO.*r 7 / y INSPECiTION BECiORD ARCHITECT OR 1 TEL. ENGINEER ILII y' � NO. a ADDRESS }, TELa CONTRACTOR LU N�•� NO.*r�a 1�/ 1 Z! i 24/ _� ` ADDRESS DESCRIPTION OF WORK pp /J l' 1102 rY /-�ji .LES 1' SQ.FT.NEW ADD ALTER AIR DEMOLISH NO. F / FNO.OFAMILIES ! + SIZE �� Z//JJGr STORIES /tea /�.� JSP/Ay USE OF TRUCTURE IJCD/RQOM - - ` -f/Z �• / f 11ST 4le;6q r /is.0- SIGNATURE OF �G �1fl fTdQ�I�tt�7OJ APPLICANT APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS fj G � FOUNDATION:LOCATION FORMS,MATERIALS Lf' il '•,/,+,�;@P1Y VALUATION S FRAME:FIRE STOPS, BRACING.BOLTS 2 `6� /�>lH/t1lt.lPL4Af FEE S FEE $. I F GAS VENT,D CTS N. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LX*.INT. / PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGgUILDING CONSTRUCTION. LATH,.EXT. SIGNATURE F �� -, f/ HOUSE NUMBER COR 223" RECTANDPOSTED ADDREs F111AL ` ) ' Q 7�� ��+ T' CLYDE N. DIRLAM, *P*RIINCIPAL ST URAL ENGINEER PLA CHECK VALMATION CK. M.O. CASH � PERMT VALi1JATION CK. •M.O. CASH '�':, 7 ,8 5 6 IN-OV 2 0 1 A 9.0 0 ':' APPLICATION FOR BUILDING PERMIT lx� FOR APPLICANT TO FILL IN (Print or type only) B ILDING17 P9 I m a�. COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITYle % ` ZIP ,,d/'��L/ BUILDING AND SAFETY DIVISION ) NO.OF BLDGS. BUILDING �r SIZE OF LOT 00 NOW ON LOT � ADDRESS 4 TRACT BLOCK I LOT NO. LOCALITY & ' C , ..r - TEL. �[ NEAREST OWNER J CO NO. v •� CRS . f ASSESSOR ADDRESS� MAP BOOK PAGE DISTRICT IGROUPITYPE I FIRPROCESS D BY CITY �� ZIP / 7 T „�j CONS ZONE' ' ARCHITECT O TEL. UX ENGINEER NO. r STATISTICAL CLAS IFICATION SEWER MAP ADDRESS ( p ` CLASS NO. DWELL.UNITS BK PG CONTRACTO NOL' USE ZONE MAP LIC. NO ADDRESS —5 NO. SPECIAL CITY LIC. CONDI TIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES[] NO-g, CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) e ADDRESS CITY HIGHWAY + YARD — TOTAL SETBACK FROM TYPE OF EXISTING C SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE �r p DESCRIPTION OF WORK NEW BLDG.SETBACK FROM C ADD SIDE PROP.LINE OF `�r'7/ (STREET) G � LTER _ TOTAL. SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD SIDE PROP. LINE HIGHWAY WIDTH REPAIR❑ EXISUSE OT NG BLDG. DEMOL El + l0 APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. , BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION 6Q �- CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN EATING TO �• reg WORKMEN'S COMPEN 10 INBU ANC �.7�Cp SIGNATURE OF PERMITTEE 9.yo —a ADDRFSS @ n J FINAL 7 BY TEL. ��(�/. DATE Z_ CITY NO. fJ d� AME C HEKS 13A YA BLE TO: FEE $ FEE HARVEY T. BRAN T. COUNTY ENGINEER 3 5 z_s- PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CAS 1 .1 2792'i3 RUG20 1 D 15 525 76A638A CE0803 12/72 i WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent toself APPLICATION FGR BUILDING PERMIT insure,or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company E] Certifiedcopy is he reby furnished. FOR APPLICANT TO FILL IN ADDRESS D �r %"e"G'f G s'" ❑ Certified copy is filed with the county building inspec- i BUILDING . 0 i tion department. i ADDRESS f: j S 7 �� • 'w f0:y Pt Z LOCALITY ���✓ �P�� f� Date A licont CITY t J NEAREST Applicant_ E ZIP ` r CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE hundred dollars($100)or less.) x TRACT BLOCK LOT NO. NO. } OWNER � + � _ NO. ��/ CONDITIONS TEL. r SPECIAL CL ,' ! I certify that in the performance of the work for which this DISTRICT GROUP TYPE FIRE PROCESSED BY permit is issued, I shall not employ any person in any manner ADDRESS ` / C' C �,' le /,1 + �0 CONST ZONE so as to become subject )eito the W kers'Compe on Laws. Z Date a Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. UJI NOTICE TO APPLICANT: If, aft making this ertif' to of � ARCHITECT OR TEL. a/ y� Exemption, you should beco a subject to the , orkers' ENGINEER NO. CLASS NO. DWELL. UNITS d Compensation provisions of the Labor Code, you sf forth- � ADDRESS SEWER MAP � with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR '°t NO, BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $ Lo SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIE�SS FAMILIES ONE Contractor Date DESCRIPTION OF WORK L+1` $ NEW ❑ ❑ 1 am exempt from the licensing requirements as I am a I4/,0� epj$ o �'� ADD ❑ licensed architect or a registered professional engineer / tv ALTER ❑ FINAL acting in my professional capacity (Section 7051, �� 7 s ��l�v REPAIR E] DATE �r r �j✓ Business and Professions Code). �OFti FINAL Llc.or Reg.No. Date �` `�� `/ DEMOL ❑ i BY r• OWNER-BUILDER DECLARATION � TT4r � NO. << I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Profess' Code): PRESENT 0 3 8 6 A BUILDING t I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LADDRE # 0,0 a a a 1 7044, Business and Professions Code). TEL. ❑ R NO. 2 ° ° 1 &50 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- o 0 0 1 6 5 0 tion 7044, Business and Professions Code). TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH O 7, 17-81 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097, Civ. C.). Lender's Name P.C. Fee$ Permit Fee Lender's Address I certify that I have read this application and.state that the Investigation Issuance Feed ` above information is correct. I agree to comply with all County IFee ordinances and State laws relating to buildinj construction, Total Fee and hereby authorize rreRresentatives afti'th' aunty to enteru n theabove-menXfo ed property ftion purpo es.(/`� �♦% tl"/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant of'` gent Dote es WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self insure, APPLICATION FOR SU I L®I N G PERMIT insure, or a certificate of Workers' Compensation Insurance, . or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ 'Certified copy is hereby furnished. � FOR APPLICANT TO FILL IN ADDRESS (p n ❑. Certified copy is filed with the-county building inspec- BUILDING 0 �1f/i� SC' tion department. Date A licant CITY Tg40 a Gj/ ZIP LOCALITY Pp NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT . NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed ifthe permit is for one TRACT' BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) y , TEL. OWNER ] NO USE ZONE MAP I certify that in the performance of the work for which this SPE permit is issued, I shall not employ any person in any manner ADDRESS „ r/ � SPECIAL }a CONDITIONS O so as to become subject to the Workers'Compensation Laws. U CITY ZIP Date ApplicantARCHITECT OR TEL. DISTRICT I GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. Z NE Exemption, you should -become subject to the Workers' / Q� ua Compensation provisions of the Labor Code, you must forth- ADDRESS „�f a a with comply with such provisions or this permit shall be TEL. i STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. z LICENSED.CONTRACTORS DECLARATION ' LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ;'ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and m'y license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO.OF _ CHECK License Number Lic. Clbss SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW $ n ADD , ❑I am exempt under Sec.' 4<4 ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. a DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Cs. Professions Cade): PRESENT __ By :. BUILDING [ i, as owner of the property, or my employees with ADDRESS ' � �}-(S Q`/ - wages as their sole compensation,will do the work and ® " ! c• ='' • =T the structure is not interided or.offered for sale(Section LOCALITY :--- :- MOVING TEL. 7044, Business and Professions Code.) - ; - " ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed'contractors to'construct the project (Sec- ADDRESS c_: tion 7044, Business and Professions Code.) i = : 23 - �.: 3 REQUIRED TOTAL SETBACK FROM EXIST. _. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH '�.% I hereby affirm that there is a construction lending agency for -FRONT r•_C' the performance of the work for which this permit is issued - P.L. (Sec. 3097, Civ. C.). SIDE. P.L. ' Lender's Name .;'_ . f LD MA Ref.# :': I_: I •'i.:J P.C. Fee$ Permit Fee •,,.; Lender's Address: M,11!^ _ I certify that I have read this application and state that the Issuance Fee / LDMA P/C# ® - ?I above information is correct. I agree to comply with all County i Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby out rize repr sentatives of this County to enter LJ u I the abov l nentior%grope y for inspectio urp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Si t e of p f licap4 or Agent• Date `