HomeMy Public PortalAbout5408 ROBINHOOD AVE_Building__ BA09BA C8 pBOH O-BB APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES 6UIL13ING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A.LAMBIE.COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST. .
DISTRICT NO. GROUP PELaCESSED BY
FOR APPLICANT TO FILL IN I coNsr.
BUILDINGe � /f1 S ER MAP
ADDRESS /y// STATISTICAL.CLASSIFICATION BK PG
CLASS.NO. DWELL.UNIT
LOT. 0.. J BLOCK MAP STATE
YES O
NUMBER HWY.
TRACTUSE ZONE SPECIAL
1910.OF BLDGS. ,� CONDITIONS
SIZE OF LOT.--4-6-/, NOW ON LOT
USE OF
EXI G BLDG. BUILDINGEXIST.
SETBACK YARD HWY STREET AME WIDTH
OWNER' FRONT. `
MAIL / P.L.
ADDRES Z r SIDE
TE P.L.
CITY N • �7� INSPECTION RECORD
ARCHITECT O TEI�� l,[9 .
ENGINEER C / NG`J �s O� •
ADDRE S Q
TEL
CONTRACTOR NO.
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
3Q.FT. NO.OF NO.OF
SIZE d STORIES FAMILIES
USE OFrSTRUCTURF
SIGNATURE O APPROVALS
APPLICANT
' DATE INSPECTOR'S SIGNATURE
ADDRESS—of//,A/ FOUNDATION: LOCATION
$ FORMS,MATERIALS A
/�3 (Q� P.C. $ b FRAME: FIRE STOPS. .►
FEE i BRACING.BOLTS G
VALUATIONFEE $ OrJ
FURNACE: LOCATION,
.... GAS VENT.DUCTS /
I HEREBY ACKNOWLEDGE.THAT I HAVE READ THIS AP- ,ATH,INT.• i" S4 OAAn
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND , . -
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH,EXT: In
STATE LAWS EGU TING BU DIN .CONSTRU ION.
H
SIGNATURE O OUSE NUMBER COR-
PERMITTE RECT AND POSTED -
ADDRES FINAL
.77 CLYDE N.DIRLAM,PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION c m.o. CASH PESMIT VALIDATION ofaVM.O. CASH
UAC0 6 8 4 4.!R NOV 20 2 3 A 2 2.5 0 a Aj
• LAC06 9 8 1U 'NOV 25 1 A' 45.00 M
APPLICATION FOR BUILDING PERMIT
_ COUNTY OF LOS ANGELES BUILDING AN SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS C 1
Bu1�� d '�-V��l
I hereby affirm that I have a certificate of consent to self insure, C- G AD . ES �� JL , 1r�' {�
or a certificate of Workers'Compensation Insurance,or a certified U '' ri C l Q4�r� 1 C�
copy there p (hSec. S 0,Lab.C.) 1/t lIj C -� ` ZIP } �� LOCALITY
Policy No. 0�> Company ` U L v SIZE OF LOT NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST. I
❑ Certified copy is filed with the unty ilding inspection TRACT BLOCK LOT NO. �t
de da ment.
USE ZONE MAP NO.
Date�` �1 t5Applicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' (OWNEFJ TEL NO. (�
COMPENSATION INSURANCE L o cL— WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred A S
0 , DISTRICT GROUP TY CONST FIRE ZONE OSSED BY
dollars($100)or less.) ` �'/ `Q/,
Y �� J
I certify that in the performance of the work for which this permit ti
;_-p-
is issued, I Shall not employ any person in any manner s0 as t0 NA CHITECi R ENGINEER TEL O.
become subject to the Workers'Compensation Laws. STATISTICAL CL SIFICATION 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' CO �TO _ SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith v FRONT
comply with such provisions or this permit shall be deemed revoked. DRESS LNO. „ PL
L VV L SIDE
LICENSED CONTRACTORS DECLARATION C UC.CLAS PL
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and S2,rSI NO. F STORIES NO.IF FAMILIES
Professions Codei t dd m licenseis in full force and effe t. NEW BK PG ® }
License Numb r 1` Lic.Class ESCRIPTION 0 WOR ADD ❑ VA I N a
Contractor .r3 Data k L I't'X' Q.0 $ qC)'� OU
+ � ALTER El
cc
❑ I am exempt under Sec.
•Y w1 4°J REPAIR ❑ $ O
BAP.C.for this reason I �� 1���(.1�y DEMOL ❑ LOMA P/C W
Date: USE OF EXISTIN BLDG. URM ❑ (L
Signature C/)APPLICANT(PRINT) TEL NO. LDMA Perm# z
❑ I, as owner of the property, or my employees with wages as Z ACCT r
their sole compensation, will do the work and the structure is
ADDRESS O nV
not intended or offered for sale (Section 7044, Business and FINAL DATE a 3303 142020
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL -
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
❑ I, as owner of theproperty, am exclusively contracting with a �, ITE{�'IJ �-ry
project
y ( g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY TOTAL 1422 o .o_0
licensed contractors to construct the ro'ect Section 7044, '� '�'
Business and Professions Code.) YES❑ No❑
WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHECK 142.20
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR CHANGE
GUIDELINES. CHANGE o 00
I hereby affirm that there is a construction lending agency for YES ElNO❑
W the performance Of the work for Which this permit is Issued(Sec.3097,CIV.C.) IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING n (•��y
� CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 0000-0001 9/2719
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. 14 1 AI{-�11U 3zJC
C3 Lender's Address
O OWNER OR AGENT
c I certify that I have re application and state under penalty
c Of pe' ry that the ab info mation is correct.I agree to comply P.C.FEE PERMIT FEE
N with I county ordi ances And State laws rel t* to b ilding
c ns ction, and her by a rize representatives of this unty ISSUANCE FEE
m t gSo
f�pon the o ti ned property for in c+ pur S.
`1
m INVESTIGATION FEE TOTAL FEE
s mm-.. Aod.ca.l or ASal
SEE REVERSE FOR EXPLANATORY LANGUAGE