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HomeMy Public PortalAbout4959 ROBINHOOD AVE_Building__ APPLICATION FOR BUILDING PERMIT 2 ' R~APPLICANT TO FILL IN (Print or type only) BLALDING , y� COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER c)T�-1 �v ��T7� ZIP /7 BUILDING AND SAFETY D ISION )(/2%>L5�X/Q�Kysl NO.OF BLDGS. �` _ BUILDING SfZE OF LOT NOW ON LOT jnA)e- ADDRESS TRACT BLOCK LOT NO. LOCALITY TEL NEAREST OWNE �/� NO. CROSS ST. ASSESSOR ADDRESS /y. VL MAP BOOK PAGE P RCEL DISTRICT G UP TYPE FIRE P CESS BY CITY d ZIP ��ti� � q CONST ZONE ENGINEEARCHITECT OC „L J L` NOL �� p v� STATISTICAL CLASSIFICATION ER MAP ADDRESS CLASS NO.&-2_!QDWELL.UNITS !9t BK CONTRACTO TEL. USE ZONE MAP LI / LC. NO. SPECIAL ADDRESS NO, r LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH S BLDG.SETBACK FROM C FRONT PROP.LINE OF (STREET) ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING C- SQ. FT. NO. OF NO. OF CHECK HIGHWAY } YARD - FRONT PROP. LINE HIGHWAY WIDTH p SIZE STORIES FAMILI S ONE F t = C. DES'C IPT N OF WORK i NEW ❑ C BLDG.SETBACK FROM v / ADD ❑ SIDE PROP.LINE OF (STREET) ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH OF s&4ffddeiS STING BLDG. DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) N0. BY (SI GNAT IN OPEN SPACE YES ElNO ❑ � IN COASTAL ZONE YES ❑ NO ❑ VALUATIO &,Sb CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPOIT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO ,� WORKMEN'S CO PEN N (NSURANC �^ SIGNATURE OF PERMITTEE Iz ADDRESS CIT NOLT'T��� DATE CIT NAL BY SI;t KE CHECKSA}'Al3LL: '/'U: FEE „ FEE � �6140 HARVEY T. BRANDT, COUNTY ENGINEER / PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH , 3 2 3 773 SSP 17 2 3 D 9.O OA 1c, 3 2 3 ,8?3 SEP 17 1 D 15-00i 76A638A 5.0O- 76A638A CE#803 12/72 i.;ZiIAB-i8. CE 9803 4/72 t • ��� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL f BUILDING AND SAFETY DIVISION ADDRESS MAKE CHECKS PAYABLE TO: HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY • i FOR APPLICANT TO FILL IN NEAREST Print ort a onl CROSS ST. BUILDING DISTRICT NO. G TYPE PRO SED BY ADDRESS Sr� CONST. STATISTICAL CL�►SSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO DWELL.UNITS 4s BKdPPG77 TRACT _ja&40NE MAP NO.OF BLDG;. NO. SIZE OF LOT NOW ON LOT SPECIAL I USE OF ���QQQ CONDITIONS EXISTING BLDG. TEL OWNE i NO. BLDG.SETBACK FROM ADDRESS FRONT PROP.LINE OF �� (STREET) TYPE OF EXISTING1 SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH I FROM C.L. ARCHITECT'OR TEL. + ENGINEER NO. ITEMSETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) p TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL v CONTRACTOR NO. HIGHWAY WIDTH FROM G.L. gypI-.. ADDRESS NO. + - w LIC. a CITY CLASS CORNER CUTOFF YES=;❑ NO Z CONSTRUCTION LENDER NAME AND BRANCH SEE REVEN SIDE FOR SPECIAL APPR VALS ADDRESS SQ. FT. NO. OF NO. OF NEW -� f SIZE STORIES FAMILIES USE OF ADD STRUCTURE ALTER ❑ `�3 ` �� REPAIR❑ SIGNATURE OF CEJ APPLICANT 10 DEMOL ❑ VALUATION S 0 epo APPROVALS DATE IN PECTOR' SIGNATURE P.FE 7 . 9 ,s/.r FEES �®•Q FOUNDATION: MATERIALS FEE CJ FRAME: ING BOLTS FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRAC AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH40L- ALL OR D.INANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPE ;URANCE LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- y PERMITTEE RECT AND POSTED 7 r ADDRESS FINAL 8 7 r PLAN CHECK VALIDATION CK. .... CASH, PERMIT VALID ON CK. M.O. CASH I 'APu � 4 6 25 MAR g 2 3 r7 7.8 5 b rSA UO 0 0 0 57F �' R 5 2' 3 D 12,15- 0 2,15- 0 0 0 6?3 MAR 15 1 D 15 0.00-1 #I Os 76AS38)Y. CE/BONWiEV.6/78) ' AP_ PLICATION FOR BUILDING PERMIT COUNTY•OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ADIDRESS ✓ / 61,Alad, V� BUILDING /' ADDRESS t5 r ! ✓ / LOCALITY NEAREST CITY / ZIP CROSS ST. ahrO.OF BLDGS. / ASSESSOR. , SIZEOF LOT Z .=I NOW ON LOT / MAP BOOK PAGE• PARCEL / DISTRICT GROUP TYPE FIRE' PROCESSED BY TRACT 0 BLOCK LOT NO. /•3P CONST ZONE OWNER•L�t�TE�d /csd �� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS'___j' BK G CITYZIP.- ARMTECT /��/ / `� ENGINEER OR i K VGW /r NO. +a0 VALUATION 401�16?ot 0 0 ADDRESS BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) CONTRACTOR116 NO._q �l TOTAL SETBACK FROM TYPE OF EXISTING .HIGHWAY +• YARD LIC, = FRONT PROP:•LINE •..HIGHWAY WIDTH ADDRESS 1301-2- NO. 2-111 _ .r^ F ` CITY 4-88 CJV/} CLASS ✓ CONSTRUCTION LENDER BLDG..SETBACK FROM NAME AND BRANCH SIDE PROP..LINE OF (STREET( HIGHWAY + YARD = TOT LVE78ACK FROM TYPE OF EXISTING �' ADDRESS CITY IDE PROP.LINE HIGHWAY WIDTH O SQ.FT. NO.OF NO.OF CHECK + _ V SIZE �g STORIES FAMILIES. ONE O DESCRIPTION OF WORK NEW P.C.Fee$ 3 ', Permit Fee L , Q E� ADD ❑ IssuanceFee 7 , D a a Off .J3 J ALTER ❑ Z REPAIR ❑ Total Fee f 0 USE OF MMOL ❑ EXISTING BLDG. % al//1/ ZO APPLICANT r/ / TEL_ (PRINT) NO. BY(SIGNAT�u }� 6'3'7'rS q, I HEREBY ACKNOWL THAT 1 HAVE AD APPLICATION AND STATE {Y,7 :rf ° o' O ro G 3 THAT THE ABOVE IS CO CT AND AGREE TO LY WITH ALL ORDINANCES W , AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY'ANY PERSON IN VIOLATION OF - V ,2.0 043-20 4 3,2 THE LABOR CODE OFTHE STATE OF CALIFORNIA,INRELATINGTOWORKMEN'S COM- - O , PENSATION INSURANCE. �- 8. •,�O U e �I�411 G SIGNATUR PRM TTEEE OF # ° °(J � 8.Z-79•7 9 ADDRESS /Z Z' ,2 o o,6-1,.0 0 CITY C�t/A No / < ;° -'o 6.1.0 0 0 USE ZONE MAP < O 8 2 r-7 9 'telSPECIAL CONDITIONS FINAL BY. d DATE y/J WORKERS'COMPENSATION DECLARATION F by affirm that I have r certificate of consent to selfAPPLICATION FOR B:UILDING PERMIT , or a certificate of Workers' Compensation Insurance, ora certified copy thereof(Sec. 3 Lab. C COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy No/ Company n-` - -A ❑ Certified copy is hereby furnished. FOR APPLI NT TO FILL IN ADDRESSW5 Qb)h�`'1(7 de• ❑ Certified copy is filed with the county building inspec- BUILDING ttiion department. ADDRESS �Jp p ' dM �� e Gyp—q/�7 8 O Date SApplicant J W t03nd / CITY I{, Ld� zip V4 1"ID LOCALITY Or NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' • SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL, OWNER P1 NO. y' �� USE ZONE MAP I certify that in the performance of the work for which this 'a 1 NO. permit is issued, I shall not employ any person in any manner ADDRESS 5 Qh(vlJ (�� �/p SPECIAL CONDITIONS so as to become subject to the Workers'Compensation Laws. i g� / O CITY 77 ZIP Date Applicant ARCHITECT'OR TEL. aC NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' // CONST. n ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS ��li O /{• /°riLB' 3 t't o_ with comply with such provisions or this permit shall be TEL• , d STATISTICAL CLASSIFICATION APT. CONDO. rA deemed revoked. CONTRACTOR '1 - NO.� S /� Z LICENSED CONTRACTORS DECLARATION y / O LICa�g CLASS NO. 2 DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter ADDRESS)ob t CJS r�'�( NaO• SEWER MAP (commencing with Section 7000)of Division 3 of the Business �X��1 LIC• �� and Professions Code,and my license is in full force and effect CITY CLASS BK PG VALIDATION License Number u a Lic. Class � / SIE STORIIEES FAMILLIIES ONE � l .1) /�,�,, VALUATION 0 Contractor_5•�" • C'`S Date q r DESCRIPTION OF WORK NEW ❑ $ © e c� ,s Wl_ ADD ❑ , ❑I am exempt under Sec. Yee c ALTER ❑ BAP.C. for this reason aD 5J - ��M J�� REPAIR $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Codp):' PRESENT By El .BUILDING I, as owner of the property, or my employees with ADDRESS A�'tT T.T c�,� wages as their sole compensation,will do the work and LOCALITY , ,�`3,�5Q 7 Gt a � the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. ITEMS,�, ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. 1 I 1 EI IO with licensed contractors to construct the project (Sec- ADDRESS TOTAL AL 98m63 tion 7044, Business and.Professions Code.) �t �� 98.63 REQUIRED TOTAL SETBACK FROM EXIST. CHECK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is.a construction lending agency for FRONT CHANGE DID the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE Lender's Name 01300-0071 11/ 6/92 aLDMA Ref. n 63T�7 1 �iCi 5 0 P.C. Fee$ Permit Fee' , Lender's Address 224 I certify that I have read this application and state that the Issuance Fee LDMA P/C N above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee , LDMA Perm. Al = and hereb authorize represent tives of this County to enter �[9 up th ove-mentioned pj.ert r or inspection Pur/poses. O `((/'�� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A or t I Date