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COUNTY OF LOS ANGELES BUILDING '
DEPARTMENT OF COUNTY ENGINEER ADDRESS. ,:61 6 No. Reno v'
BUILDING .AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKIN§SUP•T.OF BUILDING CROSS ST.
DIST T O. G.R TYPE..
T P 8
FOR APPLICANT O-FILL IN � coNSr.
BUILDING STATISTICAL ASSIFICATION PEW9R MAP
ADDRESS 61&6. "No• Reno AVe CLASS NO. DWELL �UINITS B-K. PG
LOT NO. BLOCK USE ZONE MAP ! , A7
NO. l/ (%
TRACT'e D �. / SPECIAL
N0. OF BL'D08..
CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
E G - BLDG. SETBACK FROM - -
TEL FRONT PROP. LINE OF (STREET)
OWNER a NO. -281-?.2,17TYPE OF EXISTING' SETBACK HIGHWAY YARD- _ -TOTAL'
I' ADDRESS HIGH AY M C.L.
CITY
ARCHITECT TEL. BLDG. S TBACK'-FROM'---- "
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTIN0SETBACK HIGHWAY + YARD = TOTAL
ADDRESS - HIGHWAY WIDTH 'FROM C.L. d
CON TRA CrO NOL _ + u
LIC. CORNER CUTOFF YES NO 139'ADDRESS NO. O
O
CITY cic - ; 'SEE REVERSE SIDE FOR SPECIAL APPROVALS W
DESCRIPTION OF WORK
Z
NEW ADD ALTER REPA.IRY' DEMOLISH
SQ.FT. NO. OF' NO. OF ✓f �5`+ �� F� .x .i �lL_
SIZE STORIES FAMILIES
USE OR
STRUCTURE - 6
Re-poofi4d-)
SIGNATURE O
APPLIC,
VALUATION$428G. APPROVALS DATE .INSPECTOR'9SIGNATURE
P.C. PMT. FOUNDATION,.LOCATION
FEE$ FEE$ Q . FORMS,_MA_TERIALS.__ -
'FRAME, FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ'THI5 APPLICATION L
BRACING BOT
AND STATE THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY :FURNACE: LOCATION
WITH ALL COUNTY-ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK '
AUTHORIZED HEREBY I.WILL NOT EMPLOY A PERSON IN VIOLA- LATH. INT. /•
TION OF THE LABOR COO; F THE ATE F ALIFORNIA RELAT-
ING TO WORKMEN• E ATIO I U N ,LATH. EX'S. -
[.
SIGNATUR „HOUSE NUMBER COR-
PERMIT
OR-
PERMITTEE A 7RE T AND POSTED hT
ADDRESS 52;I 'gB V$i,�Q�Bi7Vd._=_S, G FI NAL y�' ACA
JOHN•F. LEWIS. PRINCIPAL STRUCTU AL ENGINEER
.PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK.'' M.O. CASH
-:0 9 4 6E. SEP 2 9 :�`1 D_f 9.00
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRES
I hereby affirm that I have a certificate of consent to self insure, BUILDI G ADD S
C
or a certificate of Workers'Compensation Insurance,or a certified CITYIP
copy thereof(Sec.3800,Lab.C.) �L 41117 LOCALITY
Policy No. Company SIZE OF LOT NO.OF BLDG&NOW ON LOT -�
❑ Certified copy is hereby fumished. NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE ZONE MAP NO.
Date Applicant ASSESSOR BPAG PARCEL
Gto SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER • TEL NO._ � C�
COMPENSATION INSURANCE ' c1J' WITHIN 1000 FT.OF SCHOOL? YES No
(This section need not be completed if the permit is for one hundred DDR SS C DISTRICT GROUP TYP ONST. FIRE ZONE PROCESSED BY
dollars($100)or less.) �� 4
ZIP
I certify that h the performance of the work for which this permit -77 j �.12f
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws. ARCHITECT ENGINEER TEL NO.
p 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' CONTRACTOR TEL NO. SET BACK YARD 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 SIDE
CITY LIC.CLASS 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 SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES >_Professions Code,and my license is in full force and effect. NEW BK PG d
License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION Pilo. V
Contractor DateALTER ❑ $ a PeaElI am exempt under Sec. /��� REPAIR ❑ $ ��C
13rWA_� U
BAP.C.for this reason /j�!/�i DEMOL
• W
Date: SE OF EXISTING BLDG. URM 11cc
`1 Signature APPLICANT(PRINT J TEL NO. LDMA Perm# ��, 1�&u Or r.•
I, as owner of the property, or my employees with wages as Z Cr 7U
their sole compensation, will do the work and the structure is ADDRESS ° 1 ITEMS
not intended or offered for sale (Section 7044, Business and FINAL DATE Q
Professions Code.) WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL TOTAL �" o �
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J
❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �y >4 CASH 108.90
licensed contractors to construct the project (Section 7044, YES❑ NO❑ (/Jf
Business and Professions Code.) WILL .00
LL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR
GUIDELINES .f.•►/i
I hereby affirm that there is a construction lending agency for YES 11 NO 13 �—LIUV1 12 1V/8/95
\ the performance of the work for which this permit is issued(Sec.
S�i AM��a O�
W I HAVE READ THE 3097,CIV.C.) CHECKLIST UNDDE STAND MY REQUIREMENS MATERIALS TSUNDERINFORMATION
GTHE LOS ANGELEESUIDE AND THE OCOUNTY CODE,
MD PERMITTING
CM TITLE 2,CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS
3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
Q. Lender's Address
C OWNER OR AGENT
c I certify that I have read this application and state under penalty
of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 4.0
N with all county ordinances and State laws relating to building '
construction, and hereby authorize representatives of this County ISSUANCE FEE , 00
m er upon the above- tinned proper for nspection purposes.
m o rr�r? _/J./ INVESTIGATION FEE TOTAL FEE O y D
SgR:20ro of Apg'Cnl--A011 C7
0.:.a
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN SUILDIN s
I hereby affirm that I have a certificate of consent to self insure, BUILDIy f p-
or y thereof of Workers Compensation Insurance,or a certified CITY ®� zIP/�/y
copy thereof 8 b.C.) 7
LOCALITY
Policy No. Compa SIZE OF LOT NO.OF BLD .NOW ON LOT
El Certified copy is hereby furnished. NEAREST CROSS ST.
V<ertified copy is filed with the county building inspection TRACT BLOCK LOT NO.
Dlk; tmen USE ZONE MAP NO.
�Applicant ASSESSOR MAP BOOK PAGE PARCEL
T� SPECIAL CONDITIONS
CERTIFICATE OF E MPTION FROM WORKERS' OWNER T Q2
COMPENSATION INSURANCE �"� /J WITHIN 1000 FT.OF SCHOOL? YES No
(This section need not be completed if the permit is for one hundred ADDRESS
DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars($100)or less.)
CITY `� ZIP /J D
I certify that in the performance of the work for which this permit ! /e
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws. ARCHITECT OR LINGINEER TEL NO.
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 t0 the Workers' CON /��/� TF�.,ry9®/ SET BACK YARD HWY PROP LINE WIDTH
TR
Compensation provisions of the Labor Code, you must forthwith o!3 FRONT
comply with such provisions or this permit shall be deemed revoked. ADDR t16� P L
LICENSED CONTRACTORS DECLARATION �C/ SIDE
CITY;pr LIC. S P L
I hereby affirm that I am licensed underprovisions of Chapter 8 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF SID
AS NO.OFiFAMILIES
Professions Code a e is in full force and act. r NEW ❑ BK PG a
License Nu ber
L.
Class DESCRIPTION OF WORK ADD ❑ VALUATI�/N ® O
Contractor ate ALTER El �/ ' U
0
❑ I am exempt under Sec. REPAIR $ F-
BAP.C.for this reason DEMOL ❑ U
LDMA P/C#
Date: USE OF EXISTING BLDG. URM ❑ 1 D_
w �
Signatu APP ( Jj LDMA Perm# ly{,t T o a Z
❑ I, as owner o e property, or my employees with wages as / v � � Z
their sole compensation, will do the work and the structure is ADDQQ -� /p O 3303 209.25
not intended or offered for sale (Section 7044, Business and SC, FINAL DATE o_ 1 ITEMS
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDEE A HAZARDOUS T IAL
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THE "'I
❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY > TOTAL 209 .25
licensed contractors to construct the project (Section 7044,
Business and Professions Code.) YES 11 No L� CHECK 209.25
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
.00
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR CCi
GUIDELINES. /
I hereby affirm that there is a construction lending agency for YES❑ NO[7�
rn the performance Of the work for Which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING �ryn�y (y�y�y
0) 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. 0000-0001 4/16/96
TITLE N CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20 140
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THCONCE SC ER 'NG HAZARDOUS 50898 1 AM 80-39
C3 Lender's Address
C' ER OR AGENT
61 certify that I have read this application and state under penalty
C of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE /.fj
N with all county ordinances and State laws relating to building
m construction,and hereby authorize representatives of this County ISSUANCE FEE y��
to enter upon the above-mentioned property for in tion pur s /
� INVESTIGATION FEE TOTAL FEE O��
n cm a Aim D:Jo
SEE REVERSE FOR EXPLANATORY LANGUAGE