HomeMy Public PortalAbout9109 RANCHO REAL RD_Building_1963-05-14 MFLE CITY
APPLICATION FOR BUILDING PERMIT lul
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COUNTY OF LOS ANGELES= AU LD N l !�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENC41NEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. £ CIS L(j�py
FOR APPLICANT TO FILL IN ' DIST ICT NO. TYPE IMC)ESSED B
/�j/ CONST. L r
BUILDING y Q STATISTICAL CLASSIFICATION SEWER MAP
ADD ESS / G / G�/7(i10 Aead CLASS.NO. DWELL.UNITS
-- 'I
LOT NO. 16 BLOCK WATER NOT REQUIRED RECEIVED
/J CERTIFICATE: 1 /T
TRACT /�. ' OD .201• MAP HIGFiwav STATE MAJOR SECOND., CA
NO.OF BLD NO - ICIRCLE)
SIZE OF LOT I NOW ON LOT USE ZONE SPECIAL
USE OF t /' CONDITIONS
EXISTING BLDG. KI M 9,; f• �liGr(1/h �!`�/J�pu//t,�.j�,rC-" (/
EL
OWNER eLp id 1a` ✓✓. /ldiear `NO. 1 p�4 3 BUILDING YARD HWY TREET N ME XIST.
ADDRESS 9Ia/ /\[�N GftO /l T>ft t: (Jj y SETBACK IDTH
FRONT
ARCHITECT OR _ T L. T P.L. x c,
ENGINEER NO. SIDE
ADDRESS
TEL. A /INSPECTION RECOOD XO
CONTRACTOR ��I F' NO. �, /, err , V
ADDRESS S 0. ' r.•. r Q
DESCRIPTION OF WORK
-77
116 Alli Tte;. � .. h
NEW AD. ALTER' REPAIR DEMOLISH 1+ i �� � - yJ., I,. Z
SQ.FT. r_ NO.OF { NO.OF 7 t i-_-12Y rn• r//•t��
IZE J STORIES / FAMILIES I
USE OF / /f M//rIJ'• /j3�w7 �1✓� L�.P�j /V
STRUCTURE' l jJ
SIGNATURE OF `-
APPLICANTV (r
VALUATION
PPROVALS {�DATE 1NSP.
AECT,OR'S,MGNATURE +�
P.C. PMT. !!�� Lt -FOUNDATION:LOCATION'
FEE $` ~� I FEE $G 7, FORMS.MATERIALS / �J r •.°:+i(/r
FRAME:FIRE STOPS, �/ �'•
I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING,BOLTS / FI
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, J �'/� r+ ,uL.•�. Uv
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK ••�.
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA-
TION OF THE LABOR CODE OF THE STATE CALIFORNIA RELAT- LATH,INT.
ING TO WORKMEN'S MPEN O INSU NCE.
LATH,EXT.
SIGNATURE OF HOUSE NUMBER'COR-
PERMITTE RECT AND POSTED I / /� ,�• ?4
ADDRESS //?FINAL _ - z i_6-' r
, CLYDE N. DIRLAM, PRINCIPAL ST URAL•ENGINEER
PLAN CHECK VALIDATION CIL N.C. CASH PERM VAIMATIO c; m.o. CASH -.
46 9 01,.3 •lf`y 1 4
-1 �;
I
APPLICATION FQRR BUILDING PERMIT
COUNTY OF LOS ANGELESt. BUILDING AND SAFETY
I _�/
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN • Buy.91Nj,G A DRES,J--7 [1d
I hereby affirm that I have a certificate of consent to self insure, e ING ADORES
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof ec.3800,Lab.C.) r CIT y ZIP LOCA PTY
07
Polez 01 7A2 I
is o.�� Company y SIZE OF LO NO.OF BCiT E
GS NOW ON LOT
Certified copy is hereby furnished. NEAREST CROSS ST.
❑ Certified copy is filed with the cc building insp n TRACT BLOCK LOT NO.
depUSE ZONE MAP NO.
artment.
Date=&Ippl[C---- ASSESSOR MAP BOOK PAGE PARCELSPECIAL CONDITIONSOF EXEMPTION OM WORKERS' OWN R ' e TEL Ido• /^ YES l' NO
COMPENSATION IN RANCE �L �G 7 WITHIN 1000 FT.OF SCHOOL?
(This section need not be completed if the permit is for one hundred AD / O
� DISTRICT GROUP TYPE NST. FIRE ZONE PROCESSED BY
dollars($100)or less.)
I certify that in the performance of the work for which this permit ZIP
-
is Issued, I shall not employ any person in any manner So as t0 ARCHI ECT ENGINEER TEL NO. _
become subject to the Workers'Compensation Laws. STATISTICALCL SIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. I DWELL UNI
NOTICE 710 APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith &/U— Cno FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L
LICENSED CONTRACTORS DECLARATION '41 Lc� 7 l-7SIDE
.1� LI 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 So. W I NO.OF STORIES NO.OF FAMILIES
Professions Code,fLnd.My license is in full force and effect. NEW ❑ BK PG a
License Number Lic.Class + RIP? NOF WOK DD ❑ VALUATION O
C.��/.7r Date ® VVr/ 7 fSlc ��� ALTER ❑ � 7 0 U
Contractor � �
0 G C &A REPAI $ O
❑ I am exempt under Sec.
B.BP.C.for this reasonDEMOL ❑ U
# jL
Date: USE OF EX TING B G. LDMA P/C
URM a
❑
Signature APPLICANT(PRINT) TEL NO. LDMA Perm# z
❑ I, as owner of the p rt;, or my employees with wages as rH •! a z
their sole compen n, will do the work and the structure is ADDRESS _' ar I:
not intended or offered for sale (Section 7044, Business and FINAL DATE Q 330 16-9.65
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALS
4 I.I%i lv
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 5i
licensed contractors to construct the project (Section 7044, TOTAL -1�' 9- 65
Business and Professions Code.) VES❑ No❑
HALL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING r•I�PECK 1 L -
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �'' Iv k V o 5
CONSTRUCTION LENDING AGENCY GUIDE
GUIDELINES.UAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR CHANGE CIO
N E
I hereby affirm that there is a construction lending agency for YES❑ NO❑
athe performance Of the Work for WI11Ch this permit IS ISSUed(SeC. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING
W 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 0000-00,31
f r 3-Lti..0 ['
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 'JX00,31 113/ 3/94
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
o Lender's Address 11.2 4 ' ACS j o g-:I•I.
O OWNER OR AGENT
oI 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 PERMIT FEE
$ with all county ordinance and State laws relating to building
Go cons and hereby t orize repress tatives of this County ISSUANCE FEE ,s� / I�O
m to ente up n the above-m oned props or inspe on purposes. prj(0
ro �9�� INVESTIGATION FEE TOTAL FEE
n Sipreture 01 AppIIGM«Rpe r
SEE REVERSE FOR EXPLANATORY LANGUAGE