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HomeMy Public PortalAbout8616 ROCCUS LN_Building__ IGA638A CE#803 8_63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. DIST15;1-NO. G�tOUP TYPE C E BY FOR APPLICANT TO FILL IN s�� CONST. BUILD NG STATISTICAL CLASSIFICATION SEWER MAP ADDRESS / BK PG CLASS. NO-90–DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED ❑ CERTIFICATE: TRACT MAP NO.OF BLDGS. NO. (CIRCLEHIGHWAY) STATE MAJOR SECOND, OCAL SIZE OF LOT ! NOW ON LOT USE ZONE SPECIAL "USE OF /?/ CONDITIONS EXISTING BLDG. c_,.,� OWNER,. 7 &(.IeS-&-X O. 49 BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS J E• Vv , -1-2 FRONT ARCHITECT OR TEL P. L. ENGINEER j„f. V NO.(Z!1//S SIDE P. L. , p ADDRESS 6/. 6. t�r ,(l Jy�am// �•/fj TEL. � CONTRACTOR b/A0&_/& NO. f V ADDRESS /Al DESCRIPTION OF WORK116 v . w ADD ALTER REPAIR DEMOLISH In SQ.FT. �_.i/ ./ NO.OF NO. OF SIZE `fSoO STORIES FAMILIES USE OF STRUCTURE C`r� ,�! IG ATUREOF APPL I CANT VALUATION $ I S ��� I Z ©-D APPROVALS DATE INSPECTOR'S SIGNATURE p•C• p.S' To rr�L A L pMT- FOUNDATION: LOCATION p,► ,; ti 4 FEE $ 30 ' FEE $ l� FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE HATH HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. 'y )+'/� �� f ,///•' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS ,r/l/ ���// � f<f1r(./•`!Fkk: BUILDINGCONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. �� V TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S CO NSATION INSURANCE. LATH.EXT. , �•� SIGNATURE OF HOUSE NUMBER COR- / �VL_4 PERMITTEE / RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL STURAL ENGfNEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH LAW 1 '1'5 ?% JULIO 2 '3 A 3 0.254_ Lko'2 5 6 9- AUG 13 1 A 6 4.00- 4. APPLICAT1014.FfOR BUILDING PERMIT COUNTY OF LOS ANGELES/- BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRE ! � s BUILD AD SS �J l I hereby affirm that I have a certificate of consent to self insure, f„ � �C G U S _r c or a certificate of Workers'Compensation Insurance,or a certified CIT `� // ZIP 44A)15— copy thereof(Sec.. 80 ,Lab.C.) ,� � LOCALITY Policy NA ' Company SIZE OF OT NO.OF BLDGS.NOW ON LOT l—Certified copy is hereby furnished. I NEAREST CROSS ST. ❑ Certified copy is filed with the county building i s ection TRACT BLOCK LOT NO. de ar en R USE ZONE MAP NO. /I�� ASSESSOR MAP BOOK PAGE PARCEL Date lJ Applicant l SPECIAL CONDITIONS CERTIFICATE CO COMPENSATIONEXEMPTION INSURANCE ORKERS' OWNER ' W „�l !))L-Q f SHIN 1000 FT.OF SCHOOL? G' YES NO (This section need not be completed if the permit is for one hundred ADDRES c DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP 4 I certify that in the performance of the work for which this permit �J is issued, I Shall not employ any person in any manner So as t0 ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Cc pensation Laws. STATISTICAL Cl, IFICATION APT - D Date Applican ADDRESS CLASS NO. DWELL UNITS 1 NOTICE 70 APPLICA If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you sbdbld become subject to the Workers' TRACTOR�j ,, TEL NO. G SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith AJ Y�(�( V'� 5 L FRONT comply with such provisions or this permit shall be deemed revoked. A Dr--iq =NO PL C,q P L LICENSED CONTRACTORS DECLARATION FIFS �cLf.�: ��l � (-&, Z ` SIDE CI LIC.CL PL I hereby affirm that I am licensed underprovisions of Chapter 9 �` �S SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES } Professions Code a dy Ii se is in full force a eff NEW ❑ BK PG a DESCRIPTION OF WORK License Number Lic.Class ADD ❑ VALUATION �Ci O Contractor Date ✓ V ALTER ❑ ❑ I am exempt under Sec. REPAIR 1 $ F�- BAP.C.for this reason DEMOL ❑ V LDMA P/C# W Date: USE OF EXISTING G. URM ❑ i Signature APPLICAN ( NT) TEL NO. LDMA Perm# 1 Z ❑ I, as owner of the property, or my employees with wages as I �^ z RCGT o a their sole compensation, will do the work and the structure is ADDRER F- ��� 142.20not intended or offered for sale (Section 7044, Business and FINAL DATE O Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as Owner of theOR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY I 1 ITEMS property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? ` ..I licensed contractors to construct the project (Section 7044, �/� T[I L 142 a 2n Business and Professions Code.) YES 11N r`� i 42 WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING E�i 14 e'?0 OCCUPANT REQUIRE A PERMITMANAGEMENT FOR CONSTRUCTION OR EEPERMITMODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY GUIDE AIR NES QUALITY MANAGEMENT DISTRICT(scAQMD)SEE PERMITTING CHECKLIST FOR CHANGE .00 I hereby affirm that there is a construction lending agency for YES❑ NO P-** CM the performance of the work for which this permit is issued(Sec. W IH VE READCHECKLIST I UNDERSTAND ND M REQUIRE ENTS UNDEnON R HE LO D ANGELHE ES COUNTMD YITTING UUUtJrQ�V l 10/17/95 C', 3097,CIV.C.) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE L09 ANGELES COUNTV CODE, .1 TITLE 2,CHAPTER 20 SECTIONS 2.20.100 JiOUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPOF�NG�IND FOR OBTiVNIN)3 A PERMIT FROM THE SCAOMD. I 28 4 { AM 8:09 f s AQ o Lender's Address o��Lf�1 O OWNER OR AGENT o I certify that I have read this application and state under penalty 4 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 1 1 .[,^ D N with all county ordinances and State laws relating to building ` — construction, and ,pby authorize representatives of is C unty ISSUANCE FEE n . m o n r on the bOVb7mentioned property for ingpgcti ur G INVESTIGATION FEE TOTAL FEE { Z ZD m 1� s' awro i ao m«Aaem areL 11 SEE REVERSE FOR EXPLANATORY LANGUAGE