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Home My Public Portal About4933 RIO HONDO AVE_Building__ DEPARTMENTOUNTY OF LOS ANGE ESAFETY BUILDING UiL ® iNG } -I" WM. J. FOX, CHIEF ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRNO. PLAN CK. OR RE.. PERMyT �� BUILDING /, � 1J L/ aJD HI��L�I� / 6 76 ADDRESS JAL. �tJJf7 !` if LOCALITY �•y�°r1 P t_ r +� RECEIVED BY DATE OF APPL.. DATE ISSUED NEAREST S 1- 11 � Vl L_.E r-rr ' BUILDING , ' 7- ,RD ' //� 39 9T. (�fj ADDRESS R I D H6 A- s OWNER ��d by Al C9 /l� �• ' MAIL � rLOCALITY ADDRESS � NEAREST 19 �/L Fr ®T CITY �°FI-L L (.�I 7 NO. �r � ZFIREONE I No.or PLANSa i+[� GROUP ARCHITECT OR ,I I / TEL/ / •Y ENGINEER / J NO. / BLDG. _ ORD. NO. 1 SETBACK LINE �D P7 A'l I V FPL /U_.% ADDRESS ,/ y� / USE APPROVED CONTRACTOR ,� , wyFLLF NO. II ZONE I BY DATE 'I�/� � / A/ HOUSE NUMBERING ADDRESS-100? /9 L WOO PUc/Vf� MAP NUMBER -2-01L NO. ASSIGNED BY LEGAL CORRECTIONS DESCRIPTION I JLOT NO. BLOCK TRACT NO. /1/y OF BLDOS. n/ _/ AO 93'�J SIZE OF LOT ��O �( ��r GJ I NOW ON LOT /�/jr USE OF I NO. OF ino S,64 EXISTIN BLDG. FAMILIES r A./5 aa DESCRIPTION OF WORK / D / NEW r/ ALTERATION I ADDITION ^ • r��' � n ��'�,a D REPAIR DEMOLITION C • �� J r SW.FT. / I7 NO.OF SIZE c ROOMS (') STORIES EXT.WALLRO COVERING ' -ru CC o I COVERING CO NI r n Q USE OF STRUCTURE Q� INSPECTION FOR APPROVJALS OCCUPANCYAS INSPECT ISSIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS ��, 1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, CORRECT. BRACING, BOLTS /�.r. •`� 1 AGREE TAACOMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATELlAV�9 REGULATING BUD I CONSTRUCTION. GAS VENT,DUCTS \N i SIGNATURE OF ,��wr, LATH, INT. • PERMITTE U / r /� LATH, EXT. Q ADDRE5 7v ' ,. PLASTER, INT. AUTHORIZED AMT. PLASTER, EXT. $ 1.9 o FEES$ HOUSE NUMBER COR- �r/�'� RECT AND PORTED �- VALUATION 7 FEE FINAL �� F - 79A SA OHS 3 7 57 - ffi g APPLICATION FOR BUILDING PERMIT �l COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS I hereby affirm that I have a certificate of content to.self Insure, 4933 Rio Hondo Ave. or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3300,Lab.C.) State.Compensation Tem 1 e Cit 91780 LOCALITY Policy No. 439142-9Q Company SIZE OF LOT NO. BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS S.T. ❑ Certified copy is filed with the opunty bull Ins n TRACT BLOCK LOT NO. de'_art 0. USE ZONE MAP NO. AppIICa A EMAP BOOK PA E PARC91. r SPECIAL CONDITIONS 17 CERTIFICATE OF EXEMPTION FROM W RKERS' OWNER ' TEL NO. YES NO COMPENSATION INSURANCE — WITHIN 1000 FT.OF SCHOOL? ADDRESS I (This section need not be completed if the permit is for one hundred 4933 Rio'Hondo Ave. DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that In the performance of the work for which this permit 917 O dL IS Issued, I shall not employ any person it any manner So as to ARCHI ECT OR ENGINEER TEL NO. become subject to the Wbrliers'Comperwation Laws. STATISTICAL CLASSIFICATION O APT CONDO Date Applicant ADDRESS CLASS NO. di Z DWELLUNITS NOTICE TO APPLICANT. If, after making this Certificate of CONTRACTOR TEL NO. REQUIRED TOTAL SETBACK FROM EXIST Exempt16n, you Should become subject t0 the Workers' SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith818=29=1131 FRONT comply with such provisions or this pernifshall be deemed,revoked. ADDRESS LIC.NO. PL 8819 Ins Tunas Ddyp 20&344 LICENSED CONTRACTORS DECLARATION' ci n LIC.CLASS PHIL c I hereby affirm that I am licensed under provisions of Chapter 9 `^"" Gabriel, Ca. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and 80•FT.SIZE NO.OF STORES NO.OF FAMILIES tY Professlons Code,and my license is in full force and effect. ' NEW ❑ BK PG CD License Number- 205344 Lia Class B DESCRIPTION OF WORK ADD ❑ VALUATION , CQntpi0tor L&W Haile,Calter 10-4-90 Remodel kitchen ALTER K7 $ 13.000,00co ❑ 1 am exempt under Sec; wi.thcabinets, counter REPAIR ❑ $ BARC.for"this reasonDEMOL ❑ P�,M USE F EXISTING BLDG.. Date: 'URM. ❑ LDMA • J Signature - APPLICANT(PRINT) TEL NO. LDMA Perm N s ❑ I, as owner of the property,or my employees-with wages as p ACCT.'- ' . their sole compensation,will do the work and the structure is ADDRESS F not Intended or offered for sale (Section 7044, Business and FINAL DATE 'i3 ! o V7 Professions Code.) WILLTHE APPLICANTOR FUTURE BUILDING OCCUPANTHANDLEA HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ❑ 1, as owner of the property, am exclusively contracting with �' THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FIN > ITEMS licensed contractors to construct the project.(Section 7044, YES❑ No TOTAL Business and Professions Code.) TOTAL 1-98 WILL THE INTENDED USE OF THE-BUILDING BY THE APPLICANT OR FUTURE BUILDING C•CC SGf V7 OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST n VLI FOR GUIDELINES. CHANGE I hereby affirm that there Is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit Is Issued(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELESCOUNTY CODE.ITTUEZ CHAPTER Z20 !'�(�('�i•y �•k(ry •��'y 4/950/ ' Lenders Name HAZARDOUS MATERIALS REPORTING ANSECTIONS FOR OBTAINING A PERMIT FROMTHE SCAQMD.% ++++�+V� UV iG/ Y'f 50 Lenders Address OMMORAGWr 3�1 ' a AM 8:00 o' I certify that I have.read this application and state that the above Information is correct. I agree to comply with all county P.C.FEE PERMIT FEE /�� ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. � INVESTIGATION FEE TOTAL FEE 6WnMAofAPP8C kWAF M Dd., Q I SEE REVERSE FOR EXPLANATORY LANGUAGE.