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Home My Public Portal About6037 ROWLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLITANT TO FILL IN (Print or type only) BU LDING COUNTY OF LOS ANGELES ADDRESSj(.20_17 11-41JVE. DEPARTMENT OF COUNTY ENGINEER CITY C'f * ZIP c1 BUILDING AND Y DIVISIO e NO.OF BLDGS. BUILDING o� ' SIZE OF LOT jf& ,SQ NOW ON LOT ADDRESS TRACT BLOCK I LOT NO. LOCALITY TEL NEAREST OWNER NO,g -0 3 CROSS ST. /� ASSESSOR ADDRESS (pG (J L A1j0 MAP BOOK PAGE PARCEL /'+ (y DISTRICT GROUP TYPE FIRE RO SSED BY CITY rffilpi-4 (,. P ZIP ( 7r9 .--��-^^ CONST Zp ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CL SSIFICATION SEWER MAP ADDRESS CLASS Njd;_2DWELL.UNITS B PG TEL. CONTRACTOR L1J NO US ZONE NOP �/G ADDRESS pLjp SPECIAL CITY LIC. �tiV CONDITIONS CONSTRUCTION LENDER CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑NAME AND BRANCH CA 'U RRL SRI� BLDG.SE ROM q FRONT PfqOP.LINE OF (STREET) ADDRESS WILS R'E R&CITYY L01 NCr•ELES HIGHWAY } YARD _ !TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK S� Id,CC.O NEW ❑ } CSC.. y� ADD ❑ BLDG.SE ACKFROM O m SF SIDE PROP. E OF (STREET) Cr ALTER ❑ C _ TO ROM TYPE OF EXISTING I'— HIGHWAY } YARD - SI ROP L fi! WAY WIDTH W REPAIR❑ a EXISTING BLDG. DEMOL ❑USE OF } Z APPLICANTTEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO.,W ••d J/3 - BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL PERMIT ZONE YES ❑ N0 ❑ VALUATION,$ 000 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPEN9 I INSURANCE. SIGNATURE OF Af ' PERMITTE 4 ADDRESS FINAL BY TEL. CITY NO. DATE MAKE CHECKS PAYA13LE TO: FEE' FEE HARVEY T. BRANDT, COUNTY ENGINEER \\\C2 r 7sJ PLAN'CHECK VALIDATION CK. M.O. CASHPERMIT VALIDATION cK.' hA.O. CASH r / JAcT 30 1 0 2 1.7 5 aid 76A638A C9*803 3/74 APPLICATION FOR BUILDING PERMIT FOR•APPLRANT 7t0 FILL IN (Print or type only) B.tb L.DINGi COUNTY OF.LOS ANGELES ADDRESS 037 IAN DEPARTMENT OF COUNTY ENGINEER CITYT Q? ZIP BUILDING AND TY DIVISIO NO OF BLDGS. BUILDING SIZE OF LOTfJy 2I0 NOW ON LOT Z- ADDRESSAo 3 2 TRACT6_5 17/ BLOCK I L 04 30 LOCALIT TELNEAREST OWNER l NO. O&I -3 CROSS ST. ASSESSOR ADDRESS rQ� .g Ar} MAP BOOK PAGE PARCEL CITY J e I DISTRICT GROUP TYPE FIRE SSED BY Zip r• CONST ZONE ` /J ARCHITECT OR TEL. �r� i ENGINEER NO. STATISTICAL CLASS/IFICATIONEWER MZAP� ADDRESS ,79 L CLASS NO. r DWELL.UN ITS /�--BK 7 CONTRACTOR Aja � D NO `7s �72 USE ZONE MAP -�-7 �� gc NO. �jO�' ADDRESSZI SPECIAL CITYSA,AoQ LIC. 0 �'20 CONDITIONS CLASS ` ROAD DEPARTMENT APPRI EQUIRED YES*❑ NO❑ CONSTRUCTION LENDER 14 NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY HIGHWAY f• YARD :TOTAL SETBACK FROM TYPE OF EXISTING SQ, FTQ NO. OF NO. OF / CHECK FRONT PROP. LINE HIG WAV WIDTH SIZE of STORIES FAMILIES J ONE rT) DESCRIPTION OF WORK NEW 1:1 + ADD aaBLDG.SETBACKFROM .� SIDE PROP.LINE OF (STREET) C ALTER ❑ HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING v ❑ HIGHWAY WIDTH LV SIDE REPAIR PROP. LINE EXIST NG BLDGmSjjJ �" cr USE OF perDEMOL C] + AP PRINT)CAN I�� `�D NOI.7CJ CORNER CUTOFF YES ❑ NO ❑ • BY (SIGNATOR b-VIIN OPEN SPACE YES ❑ NO ❑ _ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION i �QJRE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GtiINu'baa �QIN � a AND STATE THAT THE ABOVE IS CORRECT AND AGREE �• STRUC.TI ON.WITH ALL ORDINANCES ERTICFY THAT LAWS DOING LITHE ING WORKILDING CON-LD e'MAv C BN ! �� Q�ST INf'-' /Q �Q�J HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LABOR CODE OF THE STATE OF •CALIFORNIA IN R WORKMEN'S COMPE ON INS E. SIGNATURE OF PERMITTEE Allelov- ADDRESS CI � O/ NOLDIATEBY MAKE CHECKS PAYABLE TO: F E y FEEHARVEY T. BRANDT. COUNTY ENG PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO cK. M.o. CASH 4 OCT 7 1 1) 6• .0 0 76AG38A CE#003 5/74 ' APPLICATION FOR BUILDING PERMIT �1 � ,1;• t _ COUNTY OF LOS ANGELES BUILDING AND SAFETY -"WORKER'S COMPENSATION DECLARATION _Bul„L.D•�G ADDRESS FOR APPLICANT TO FILL IN I hereby.affirm that I have a certificate of consent to.self insure, BUILDI G ADDf� or a certificate of Workers'Compensation Insurance,or a certified CI zl Copy thereof(Sec.3800,Lab.C.) ?• LOCALITY f E7 &I Policy No. Company SIZE O LOT NO.OF BLDGS.NOW ON LOT (d ❑ Certified copy Is hereby furnished. I NEAREST CROSS ST, ❑ Certified Copy is filed with the county building Inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. ASSESSOR MAP BOOK PAGE PARCEL • Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OVVNER � TEL NO. • COMPENSATION INSURANCE ' �� ADD WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit Is for one hundred DISTRICT GROUP 3TYPE CONST.' FIRE ZONE OCESS BY dollars($hat or less.) Cl zIP �, �jev- 3 � A I k-3 I certify that in the performance of the work for which this permit /'�Q /�/(J!) Is Issued, I shall not employ any person in any manner so as to ARCH OR ENGINEER TEL NO: become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATIONAPT DO 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 to the Workers' CONTRACTORo� TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provision's of the Labor Code,you must forthwith FRONT comply with such provisions or this permit shall be deemed7revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE PL p I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIESCIC Professions Code,and my license is in full force and effect. 0 / / NEW ❑ BK PG C3 1DESCRIPTION OF WORK VALUATION , W License Number Lic.Class' �X A C ADD ❑ a' Contractor Date ` ALTER ❑ $ Z ❑ I am exempt under Seo ^� ~ REPAIR. ❑ $ B.BP.C.for this reason 1 /J.O N MOL LDMA PIC N Data. USE OF EgISTIN91 BLDG. 'URM ❑ IV Signature APPLICANT(PRINT) TEL NO. LDMA Perin'S ❑ I, as owner of the property, or my employees with wages as n pa their sole compensation,will do the work and the structure is ADDRESS) �•°a not intended or offered for sale (Section 7044, Business and FINAL DATE 11— �� 88.01. l Profssions Code.) WILLTHEAPPUCANT OR FUTURE BUILDING OCCUPANTHANDLEAHAZARDOUS MATERIAL T t• ❑ I, es owner of the roperty, am eXCIUSlV81 contrectin Wlth OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EOUAL TO OR GREATER THAN 1 TT`M` P Y 9 THE AMOUNTS SPECIFIED ON'THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ No❑ 0 0 Business and Professions Code.) TOTAL "'P '° • WILL THE INTENDED USE OF THEBUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REOUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST ��(.fE� D 3 (q CHANGEFOR GUIDELINES. 1 °OctI I hereby affirm that there is a construction lending agency for vEs❑ NO❑ the performance of the work for which this permit Is Issued(See. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES' G/ ,, ,j {� COUNTY E,TITLEZERIAL REPORTING AND FONOBTAINI GAPERMIT ER I2 D.140FROM CONCERNING, C/ �.31Ji.30—LiI.i411 7I �Vf�f}Jf Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAININGAPERMITFROMTHE SCAOMD. Lenders Address 1822 f €m v e owneaawnav+r '1 o' I certify that I have read this application and state that the above !' P.C.FEE PERMIT FEE � information is correct. I agree to comply with all county ordinances and State laws relating to building constructio and , o herebt/Athorize representatives of this County to an upo ISSUANCE FEE the,ebpve-menti arty for inspection pure ® INVESTIGATION.FEE TOTAL FEE i SEE REVERSE FOR EXPLANATORY LANGUAGE, / !,. z• "}WTO RKERS' COMPENSATION DECLARATION in�u. . r. certif cotta of Workers'tCompensat ons Insuto rancelf APPLICATION FOR U I L D I N G PERMIT o�a c�rfified copy thereof(Sec. 3800, Lab. C.) COUNTY=OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 6 rJ WG N �, . El Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS &3 7 WLAA' D A1/0- G r /7rY0 Date Applicant CITY' G LC e-/7-_y ZIP /'80 LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF'EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT' / CROSS ST. &- /8 A 4,P ! COMPENSATION INSURANCE ASSESSOR (This'section need not be completed if the permit is for one TRACT BLOCK LOT NO: MAP BOOK ,r3 8S PAGE PARCEL OOS hundred dollars-($100)or less.) /�• TEL. OWNER JD USE ZONE FNI SP I certify that,in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS L ✓�. DITIONS M so as to become subject to the Workers'Compensation Laws. O CITY A LG C/ ZIP O Date Applicant ARCHITECT OR TEL. DISTRICT O TYPE ] LFIRE ROLES BY 0 NOTICE TO you-should ul If, after making subject this Certificate of ENGINEER NO. OY CONST`/ ONE O Exemption, you should become sub'ect to the Workers' V V Compensation provisions of the Labor Code, you must forth- ADDRESS a a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIF TION AP1f CONDO. N deemed revoked. CONTRACTOR NO. !� Z LICENSED CONTRACTORS-DECLARATION LIC. CLASS NO. �C' DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITY CLASS and Professions Code,and my license is'in full force and effect. BK. PG. VA` ' !1fbN SQ. FT. NO.OF NO OF CHECK License Number Lic. Class SIZE STORIES FAMILIES I ONE VALUATIO TOTAL 573 m``3_ a Contractor Date. DESCRIPiION OF WORK ,Vo S�O� NEW ElS& •�/� CHECK 573.85 El1 am exempt under Sec. H�cG r3[`f�2flO�S Tu/o ADD ALTER ❑ .. ► ChANUE•=. B.&P.C. for this reason 8A T74 a..` t_IeL. REPAIR ❑ Date: EXISTING BLDG. -DEMOL ❑ $ � USE OF �DO f E0 iQCI-Cigo1 3/ 2/91, Signature APPLICANT 30eoi5 Awl0 -M TEL. FINAL ��j��p ` OWNER-BUILDER DECLARATION (PRINT) NO(b%% $r�'T DATE Fi' 1.T ' A � �a t(_'t I hereby affirm that I am exempt from the Contractor's License ADDRESS FINAL' 3307 74.5'' Law for the following reason (Section 7031.5, Business and t e Pr9fessions Code): PRESENT By 1 ITEMS jj I, as owner of the property, or my employees with BUILDING IlE ADDRESS t74 .59 wages as their sole compensation,will do the work and y „ ti r �� the structure is not intended or offered for sale(Section LOCALITY , • / CHECK 74.,i. 7044, Business and Professions Code.) MOVING TEL. ` ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. CHANGE .00 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. I-y�QI�_I) U1 7.r��►U CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH, J I hereby affirm that there is a construction lending agency for FRONT . 7 the performance of the work for which this permit is issued P•L• G ti ,.-a S-r' 3> F.,, 1817 1 AH 7` (Sec. 3097, Civ. C.). SIDE P.L. rri —1 Lender's Name Qi r G� L� MA Reffr# ' P:C. Fee$ ✓ • ✓ Permit Fee r a� Lenders Address , , 3 1 certify that I have read this application and state that the ti Issuance Fee LDMA P/C# 3 above information is correct. I agree to comply with all County Investigat`n Fee Z ordinances and State laws relating to building construction, Total Fee i LDMA Perm. # 171 + = and hereby authorize represen fives of this County to enter 1) upon the abov -mentioned p arty for inspection purposes. _Y � of o SEE REVERSE FOR EXPLANATORY LANGUAGE #„ r.•,l Signature of Applicant or Agent Date ~• '"un r�! �j tr cj• I