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HomeMy Public PortalAbout10120 RANDWICK DR_Building__ 7SA638A CE*803 8-64APPLICATION FOR BUILDING PERMIT I COUNTY OF LOS ANGELES BUILDING 1 DEPARTMENT OF COUNTY ENGINEER ADDRESS /O/ 1�A n/I� w +G BUILDING AND SAFETY DIVISION LOCALITY I n D Its G I'7 JOHN A. LAMBIE-. COUNTY ENGINEER NEAREST f1 e COLEMAN W. JENKINSAUP'T.OF BUILDING CROSS ST. LJ DISTRICT NO.; -GROUP TYPEP SSED B FOR APPLICANT T0-FILL IN i� CONST- BUILDING STATISTICAL CLASSIFICATION SE ER'MAP ADDRESS JQ�a Q D wICLASS NO.-_DWELL UNITS BK PG LOT NO. BLOCK USE ZONE MAP O l G TRACT C/�(, ! NO. SPECIAL N0. OF BLDOS. .��, CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. SETBACK FROM EL.$�— `O FRONT PROP. LINE OF - A (STREET) OWNER DAr / II Del/e O p O. 7! / TYPE OF EXISTING SETBACK HIGHWAY -f' YARD = TOTAL 4 ADDRESS 1 +r. 7 HIGHWAY IDIH FROM C.L. CITY Ta•1 p be, 61T BLDG. SETBACK FROM ARCHITECT OR {� TEL SIDE PROP. LINE OF (STREET) ENGINEER {..�O NO. TYPE OF EXISTING SETBACKHIGHWAY + YARD = TOTAL ADDRESS ` HIGHWAY WIDTH FROM C.L. Cw CONTRAC/ryTyOR � Q NO (1�6 OU + - O ADDRESS /6t V Al NO /l� c�6 CORNER CUTOFF YES NO O F- CIT Y T C ' L'C 'SEE REVERSE SIDE FOR SPECIAL APPROVALS w biZSCRIPTibN OF WORK y 4' �-Z`lv S .. C:� IUA l t.l aJfo• (?/.a mac?Fy�"+..aao,�. Z NEW V ADD ALTER REPAIR DEMOLISH C►��. -��t SQ.FT. NO. OF NO OR SIZE 3 STORIES FAMILIES/ USE OF Vf��jj E7BRf�/s Ir • STRUCTURE e N L Ob SIGNATURE OFLL I APPLICANT > VALUATION$ r �� APPROVALS DATE INSPECTOR'S SIGNATURE P.C. S PMT. ��Q FOUNDATION, LOCATION FEE$ FEE$ /J FORMS,MATERIALS __. ! I FRAME, FIRE STOPS, r► I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT S ) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE• LOCATION L$'� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS : BUILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. 'elf TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S M NSATION IN URANCE. �Q _-_ ' LATH. EXT. _ SIGNATURE OF � HOUSE NUMBER COR- PE4tMITTEE .REC AND POSTED 7 ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRAL ENGINEER PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION CK. o C s LA"u-0 8 0 8 1% FEB 1 2 3 3.7 5 A Q L.0T If I Lnbo c) 2 7 5 R 8 1 D .6 7.5 0 t WORKERS' COMPENSATION DECLARATION 1 hereby f affirm'that fica I have certificate of consent to self APPLICATION FOR 'BUILDING P E RM I T insure, oris certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3600, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING PY Y ADDRESS `[ 1 O � ❑ Certified copy is filed with the county building inspec- BUILDADDRESS 8 � W ��� lL,�, �. 1 Y tion department. 1 Date Applicant CITY �I ZIP g LOCALITY N OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT X •� NOW ON LOT CROSS ST. COMPENSATION INSURANCE (�c/ (� ` ASSESSOR (This section need not be completed if the permit is for one TRACI'2-0 69 BLOCK LOT NO. 1 MAP BOOK 5615 PAGE©®2> r341 hundred dollars ($100)or less.) p-yv�`�` ,1�IV TEL c OWNER�6 M O. 519-1 p USE ZONE MAP I•certify that in the performance of the wor or which this r�e� NO. permit is issued; I shall not a any pers t a. m nner ADDRESS l lot LV tC.� SCON(TIONS PECIAL a so as to become subject to th rkers'Co pe sat! 0— O. ° CITY LE ZIPIck 0 U Date Applican ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after mak this Certificate ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become sue ct to the Worke s' /,��} 2 CONST. J NE Compensation provisions of the Labor ode,-you must fort - ADDRESS v� J a with comply with such provisions or this permit•sha.11 be TEL. STATISTICAL CLASSIFICATION APT.- CONDO. N deemed revoked. CONTRACTOR 1 1 NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC.. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK. PG. VALIDATION SQ. FT. NO. OF INO.OF CHECK License Number Lic.'Class SIZE STORIES FAMILIES ONE ..1q VALUATION Contractor Date DESCRIPTION OF WORK N NEW ❑ ; �p��r ❑I am exempt under Seca ADD ❑ �VL/v ► ' ALTER ❑ B•BP.C. for this reasonS USE OF REPAIR Date: EXISTING BLDG. DEMOL ❑ ' Signature APPL ICANT T) 16I U93 L f (� FINAL OWNER-BUILDER DECLARATION i DATE I hereby affirm that I am exempt from the Contractor's License 1©` ��(s�1C� D9, _W1 --FINAL Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ;By BUILDING I, as owner of the property,,or my employees with ADDRESS ACCT.awages as their sole compensation,will do the work and )/ the structure is riot intended or offered for sale(Section LOCALITY �(V 3�7 105.25 7044-Business and Professions Code.) MOVING TEL. ' CONTRACTOR NO. ❑ I,as owner of the property,am exclusively contracting ' with licensed contractors.to construct the project (Sec- 1 gDDRESS j ii_ ' tion 7044, Business and Professions Code.). REQUIRED TOTAL SETBACK FROM EXIST, CHECK -,C CONSTRUCTION LENDING AGENCY I SET BACK YARD HWY PROP. LINE WIDTH I 105.2L5 I hereby affirm that(here is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (�j�(�it,3 ■�iLe (Sec. 3097, Civ. C.). SIDE P.L. } Lender's Name LDMA Ref. # I it ( -I I ? � ' 3 �� � ! P.C. Fee$ Permit Fee Lender's AddressI , 9195 i = ify That I have r d thl application and state that'the' Issuance Fee TDMA P/C# abov informati is co ect..I gree to comply with all County Investigation Fee. ordin nces an S Te srelating to building construction, Total Fee �� LDMA Perm. # and ereby ou or entatives cf'this County to enter ' o the abov me ti d rtyffor inspection purposes. o OMT " SEE REVERSE FOR EXPLANATORY LANGUAGE ture of Xpplic. or ent Date WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, APPLICATION FOR BUILDING PERM or ' I' i pyoer jf�q�c. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY � 0 ` Z ,�'l CO pony f n�fur/ L/f JAf BUILDING ,1 ^ ertified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS (! o1 U ❑ Certified copy is filed with the n build spec- BUILDING tion department. ADDRESS +V C Date Applic t CITY ZIP 7 V LOCALITY CERTIFICATE OF EXE OM WORKERS' NO.OF BLDGS. NEAREST COMPEN ON INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for oneASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL LJ USE ZONE OWNER a NO. MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS UO CITY ZIP 1129 Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after makingthis Certificate of DISTRICT GROUP TYPE FIRE PR CE ED BY Exemption, you should become subject to the Workers' ENGINEER NO. �r !� CONST. ZONE 4� Compensation provisions of the Labor Code, you must forth- ADDRESS (J� V � y with comply with such provisions or this permit shall be C TEL. STATISTICAL CLASSIFICATION APT. CO O. g deemed revoked. CONTRACTOR r NO• 7 y CLASS NO._DWELL. UNITS LICENSED CONTRACTORS DECLARATION 9 LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. f SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY G CLASS RF BK. PG. VALIDATION ,( SQ.FT. NO.OF NO.OF CHECK License Number V5 ?Z gLic.Class!t7 _/ SIZE STORIES FAMILIES ONE r► (+, ❑ VALUATION .�� Contractor ITEMS&T t.CNS.Date !:U_$ DESCRIPTION OF WORK NEW ADD ❑ ; , ❑ I am exempt under Sec. ALTER E] B.BP.C. for this reason REPAIR ❑ $ Date: USE OF ❑ DL EXISTING BLDG. EMO Signature APPLICANT TEL. FINAL g OWNER-BUILDER DECLARATION PRINT -C NO. ? 6 y DATE Jr� I hereby affirm that I am exempt from the Contractor's License /n� Law for the following reason (Section 7031.5, Business and ADDRESS 630 /1` it FIN Professions Code): PRESENT By El1, A. I, as owner of the property, or my employees with ADDRESS -4'5 6,b A wages as their sole compensation,will do the work and , the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. # 0 0 0 0 0 ❑ 1,as owner of the property, am exclusively contracting CONTRACTOR NO. o ']$ O Q with licensed contractors to construct the project (Sec- o ADDRESS tion 7044, Business and Professions Code). REQUIRED YARD HWY TOTAL SETBACK ROM o 0 0 7 Q Q U CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 0 501 -86 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. ' Lenders Name $ U)MA Ref. # P.C.Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee 150 LDMq P/C# ¢ above information is correct. I agree to comply with all County Investigation Fee ordinances State laws a ng to building construction, -7k ,Total Fee DV LDMA Perm. # U and h y aut orize re ese tiv sof this County to enter up th v mentio ed aper for inspection purposes. a11 A -96 SEE REVERSE FOR EXPLANATORY LANGUAGE n ` Ignature or A nt Date