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Home My Public Portal About8622 ROCCUS LN_Building__ FSAB&BA CE0808 8-88 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. DIST R O. GR TYPE. P OCESS BY FOR APPLICANT TO FILL IN CONST--e. 12 1 BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS SK ' PG CLASS. NO. DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED ❑ .-''•RECEIVED ❑ y CERTIFICATE: TRACT ��! J MAP NO. 0 HIGHWA NOF BLDGS. STATE MAJOR SECOND, OCA O. � SIZE OF LOT NOW ON LOT ��ly USE ZONE SPECIAL USE'OF CONDITIONS EXISTING BLDG. OWNER YARD HWYSTREET NAME. EXIST. SETBACK WIDTH.. • ADDRESS,<1/3 CF_ Ly FRONT ARCHITECT TEL. P. L. ENGINEER G/ �,J' NO. OR SIDE }} ADDRESS / P. Ll Ya�i`. vv. _ ( TEL. CONTRACTOR NO. u ADDRESS DESCRIPTION OF WORK • E ADD ALTER REPAIR DEMOLISHtn SQ.FT. NO.OF SIZE d STORIES FAMILIE USS-TE OF CT RE SIGNATURE OF APPLICANT VALUATION APPROVALS DATE INSPECTOR-SqIGNATUFO FOUNDATION: MATERIALS 1.y_//�.j ;. A, // P.C. G'rJ PMT.' f ,(! FEES ✓ FEE $ '-� FRAME:•FIRE STOPS.• ,(q� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING `BOLTS /-.A..+ AND STATE THAT THE ABOVE 18 CORRECT AND'AOREE TO COMPLY FURNACE: LOCATION. . WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT..DUCTS Ad. T- !B"/ .! Fi.2.•*+ BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK ,( i - r AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. .//J�.�(/ •f �j� •�.w+j/ TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- •INC TO WORKMEN'S CO ENSATION INSURANCE. LATH.EXT. SIGNATURE OF HOUSE NUMBER COR- )/ PERM ITTEE RECT AND POSTED �� L wtr�C✓ ADDRESS FINAL eZIf JOHN F. LEWIS. PRINCIPAL STRqrjURAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH LACo-i :L'!5 80 :j&—0 -2 3 A __. LACO 2 5 7 0 o AUG 13 1 A . 6 4.0 0,-- V .BABaSA cE#808 8.88 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. DISTRICT IVO. GRO TYPE P B FOR APPLICANT TO FILL IN - CONST. [ADDR DING / STATISTICAL CLASSI ICATION SEWER MAP ESS. � U BK PG CLASS. NO. DWELL.UNITS O. BLOCK WATER CERTIFICATE: .NOT REQUIRED ❑ RECEIVED ❑ T MAP OC) HIGHWA STATE MAJOR SECOND,LOCAL NO.OF BLDGS. NO. V OF LOT NOW O LOT. USEZONEPECIAL F CONDITIONS ING BCD TEL OWNE N BUILDING YARD HWYSTREET NAME EXIST. SETBACK WIDTH ADDRESS FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. ADDRESS 11 l/ CONT ACT Bey NO u ADDRESS V B' DESCPJ?XMN OF WORK . Lu ..916 NEW ADD ALTER' REPAIR DEMOLISH H SQ.FT. NO.OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTUR 51161NATURE OF APPLICANT VALUATION $ APPROVALS DATE INSPECTOR'S SIGNATURE PMT. FOUNDATION: LOCATION FEE $ FEE $ .�,✓ FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS ' BUILD[NG- CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY ION MPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABO TE OF CALIFORNIA RELA ING TO WORKME CIN URANCE. LATH.EXT. SIGNATUR OF HOUSE NUMBER COR- PERM ITTE RECT AND POSTED ADDRESS FINAL G JOHN F. LEWIS. PRINCIPAL STRU URAL"ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK.; M.o. CASH r LG P 9 4 3 SEL,/1"21 1.50- a ' APPLICATION FOR BUILDING PERMIT �l COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILD4 ADDRESS 0 e 1 hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDR or a certificate of Workers'Compensation Insurance,or a certified C)TY/ ZIP copy there �( ec 380 ap. w /1 `j / -LOCALITY Policy N Company A NO.OFBLDGSO IZOF LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. Certified copy is filed wit�nZ my b i ing inspection TRACT BLOCKLOT NO. USEZONE MAP No. e�,�rt n//t.�� /�f'y�Date...74Applicant '��'��' (f o' �E7"y YK2 ?5b PARC�L��y SPECIAL CONDITIONS CERTIFICA77777TE OF EXEMPTION FROM WORKERS' OWNER `��iQ�ii� (JV EL'No �/12K�J� I YES No COMPENSATION INSURANCE 3 WITHIN 1000 FT.OF SCHOOLS (This section need not be completed if the permit is for one hundred ADD ��— �r DISTRICT GROUP J.TYPECON§T' FIRE ZONE PROCESSED BY dollars($100)or less.) CIN �, ZP7 I certify that in the performance of the work for which this permit / Is Issued, I shall not employ any person in any manner-so as to ARCHITE R ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. e?lz DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXISv Exemption, you should become Subject to the Workers' CON ,�f /�� t- f SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith ��/ COM7—;4 SCM comply with such provisions or this permit shall be deemed revoked. e /J L ,, P L Jam[:- SIDE a LICENSED CONTRACTORS DECLARATIONCITY,-, LIC.CLa 1 PL p I hereby affirm that 1 am licensed under provisions of Chapter 9 42 611 / I SEWER MAP (commencing with Section 7000)of Division 3 of the Business and Sq.FT.SIZE NO.OF S ORES NO.OF MILIES C Professions Code,aDgi-my license It"ll ll force and elle I. NEW ❑ BK PG License Num r Lic.Class DES Pr�l y�Fgp ,moi ' ADD ❑ val uATIO �l 4. Contractor Date �i� /✓�,� �7 �l�' ALTER w Z ". —� ✓ Gl �rl REPAIR ,K $ ❑ I am exempt under Sec. �� 8.8�P.C.for this reason r DEMOL ❑ LDMA P/C k Date: USE OF EXISTING BLDG. URM ❑ Signature APPLI Vn T L ti.`f'T � Q ^� LDMA Perm M ❑ I. as owner of the property, or my employees with wages as Pj�/ Z _''•' their sole compensation,will do the work and the structure is ADD / O not Intended or offered for sale (Section 7044, Business and /�"" FINAL DATE a Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA DOUS MATERIAL a f -s "—n ZS !QZ CIT;j[ '� ,a8 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a�,.:a 4;.r ❑ I, as owner Of the property, am exclusively contracting with THE AMOUNTS WMIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY11"(,; r}: •, licensed contractors to construct the project.(Section 7044, ❑ ti.3,•._ Business and Professions Code.) YES NO IJP( G J.? WILL THE INTTTEEENNN///DDDE��_D USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING } i'•it'j j( i1�j . OCCUPANTREQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH ' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ N +(y':^3,L the performance of the work for which this permit is Issued(Sea I ' '►(-��( 3097,CIV.C.. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD _.. PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES i • COUNTY CODE,TITLEZ CHAPTER 220 SECTIONS 2.2MIWTHROUGH 2.20.140 CONCERNING ' '0 � Ph Lenders Name HAZA S IAi�ER1AL3 REPO G AND FOR OBTAINING A PERMIT FR THESOAOMD. Lenders Address %R' n—). —0MERCAAGft �' o° 1 certify that I have read this application and state that the above information is correct. I agree to comply with all county RC.FEE PERMIT FEE ordinances and State laws relating to building construction,and /IV 41S hereby authorize re resentatives of this County to enter upon ISSUANCE FEE – Ithe ti property for inspection pure ses. p� ,� J.• INVESTIGATION FEE TOTAL FEE , rApml m . 3 SEE REVERSE FOR EXPLANATORY LANGUAGE, 1 _ i