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Home My Public Portal About10102 RANDWICK DR_Building__ 76A538A CEASGS 8-64 APPLICATION FOR BUILDING PERMIT (:3� COUNTY OF LOS ANGELES ABUILDING DDRESS olo� nrJ7 LU r DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINSSUP'T.OF BUILDING CROSS ST. S DISTRICT NO. GROUP TYPE. P SSED BY • FOR APPLICANT TO FILL IN $' Sj CONST. BUILDINGSTATISTICAL CLASSIFICATION SE FER MAP ADDRESS mb �/ioli CLASS NO. Q DWELL UNITS BK PG LOT NO. BLOCK USE ZONE NMA OOl /(/ / J TRACT 69 SPECIAL NO. OF SLOGS. CONDITIONS SIZE OF LOT Q NOW ON LOT USE OF �5 E 1ST NG BLDG. BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF %�� l (STREET) OWNER eve O v- N0. —� O TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS 1161 -$ HIGHWAY WIDTH FROM C.L. CITY ARCHITECT OR TEL. BLDG. SETBACKFROM ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL >. ADDRESS HIGHWAY WIDTH FROM C.L. D. CONTRACTOR JO R eNe•SNOL ' T6"6 U + V ADDRESS C/ Ilk-S L/6�' S NO O( CORNER CUTOFF YES NO 0 F- cI Y ��° /' G I CL �^ 'SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK ) A. U05e n.1 07s� Z NEW W-1ADD ALTER REPAIR DEMOLISH T. .,Q� NO: F / NO. OF VIP,Am I ►I ( C 4 0 le _ Q SIZE STOROIES / FAMILIES p� 1 USE OF Z t. L.00cs4e� F.'V 6 t..J F Q Iv STRUCTURE Le_-S%Q e o lT t/ SIGNATURE OF �� / tc4- CA DiD -,Rrc:)c�Y�dht APPLICANT 1 o LIP 4a-?— VALUATION$ U Q APPROVALS DATE{- INSPECTOR'S SIGNATURE P.C. PMT. � FOUNDATION, LOCATION REE$ �pUqq FEE$ FORMSMATERIALS ICING STOPS, i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT a0 �p �:,A--(L1 L., AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS O. �V! iT.L�AiF-GCr' 9UILDI NG CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK �� R, / t� r AUTHORIZED HEREBY•1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. �Y J ;'�,•7�Ze�?.n:,.h:g* TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S C P SATION LATH. EXT. u� .�!jSIGNATURE (a,) 4yiF , ryrw,•r,.,^'isr PERM TTEE OF HOUSE OREC NUMBER AND POSTED i A( t r ADDRESS Fl NAL JOHN F. LEWIS. PRINCPAL ST A1. ENGINEER { PLAN CHECK VALIDATION4) 32.00-4 M.O. CASH PERMIT VALIDATION cK. L PLAN 8 0 7 C):Q FEB 1 2 LL t7 L g ,_., ,_ 8 p L1 927 1:1157 64,00- APPLICATION FOR BUILDING PERMIT I ' COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILLFIN a LDING ADDRESS U �G ADDURIESS �� ✓` 'yc o _ J� I hereby affirm that I have a certificate of consent to self insure,, Y f/ or a certificate of Workers'Compensation Insurance,or a certified I copy there (Sec.3800,Lab.C.) Jr� /f � /� ` ZIP L. ALITY Policy No. , �� Company` A/'0 /o�f SIZE OF LOT I/ NO.OF BLDGS.NOW ON LOT l'l /e �l a ❑ Certified copy is hereby furnished. 1O/1-1-1175 1 NEAREST CROSS ST. Certified copy is filed with the county building inspection I TRACT BLOCK LOT NO. department. ///�_/� a USE ZONE MAP NO. Applicant 1LTd� 7 ..C/�j ASSESS P B OK PAGE 3 PA L SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' Vim" CJ TFL COMPENSATION INSURANCE gggg 1 1'e �� 0AId C—C—;7a WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred A OS/ e--' // )n e%G DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) — eZ � I certify that in the performance of the work for which this permit TZIP is issued, I Shall not employ any person in any manner so as t0 ARCHITECT OR 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 to the Workers' CONT ACTOR ''JJ TE�'�O SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /� /� O FRONT comply with such provisions or this permit shall be deemed revoked. ; AAD_DRESS �� L LIQ.N�J�„ 1 PL LICENSED CONTRACTORS DECLARATION 1 �LI 7�: _ SIDE C T TY ,A ^ LIC.CLABS� PL I hereby affirm that I am licensed underprovisions of Chapter 9 > l�J v✓ Ls SEWER MAP CL (commencing with Section 7000)of Division 3 of the Business and S SIZE NO.OF STORIES NO.OF FAMILIES C Professions Code,.and m Q n e s in full force and effect. ,3 NEW BK PG License Num r c LIC.Cl a S ` D CRIPTION OF WORK 01111. ADD ❑ VALUATION Contract0 /1 ate r �' Bye d� ..� �� / ALTER ❑ d fX ❑ I am exempt under Sec. X / �� 4p REPAIR 11 $ V BAP.C.for this reason 1;A1J7 �� LK SP1 J Vej1,. DEMOL ❑ LDMA P/C# o. Date: USE OF EXISTIN BLDG. URM ❑ z Signature 04 APL NT T) ZL LDMA Perm# �'� El 1, as owner of the property, or my employees with wages as Z i c ., their sole compensation, will do the work and the structure is AD ESS ►/ y ,c. O -7 303 i•°�0 4 not intended or offered for sale,(Section 7044, Business and Y L V9: I FINAL DATE O `� !}SL Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL A ❑ I, as Owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE �� V3 Q f TP " 53- 45 AMOUNTS SPECIFIED N THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �! O i H� �-'�•+ licensed contractors to construct the project (Section 7044, 'L,`'•, Business and Professions Code.) YES 11 NOOld CHECK155. �.yc WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH dl(1CHANGE CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR l��11CHANGE GUIDELINES. I hereby affirm that there is a construction lending agency for YES El Pk cu the performance Of the work for Which this permit i3 issued(Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 1�•! i // {- N3097,Civ.C.) CHECKLIST I UNDERSTAND MY REQUIRE NTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER ECTIO' �0. THROUGH 2 20.140 CONCERNING HAZARDOUS Lender's Name, MATE D# MCAOMD. i 2246 , r 2 6 C3 Lender's Address C OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building co ion, and here authorize representatives of this County ISSUANCE FEE / /O COD nter pon a ve- e ' ed property for inspection purposes. m �.�� INVESTIGATION FEE TOTAL FEE I�&- 6� G' of I n m D.I. / SEE REVERSE FOR EXPLANATORY LANGUAGE