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HomeMy Public PortalAbout6119 ROWLAND AVE_Building__ .0 - APPLICATION FOR BUILDING PERMIT F . APPLICANT TO FILL IN (Print ortypeonly) COUNTY OF LOS ANGELES - ADDRE3_4;" f DEPARTMENT OF COUNTY ENGINEER CITY -' ZIP BUILDIN D SAFETY DIVISIO O.OF BLDGS. BUILDING SIZE OF LOT 70 NOW ON LOT N1� ADDRESS TRACT BLOCK LOT NO. LOCALITY —10 A611I� OWNER _,V-ppjNO. 77 NEAREST CROSS ST. ASSESSOR ADDRES MAP BOOK PAGE PARCEL CITY ,(.Li ZIP DISTRICT GROUP TYPE FIRE ESSED BY ARCHITECT OR EL. U L7 CONST Z { ENGINEER �/ uJ�I!S NO. v. lam— STATISTICALCLASSIFICATION SEWER M<P ADDRESS Q CLASS NO. DWELL.UNITS BK PG / TEL. CONTRACTOR C NO. E ZQNE NOP LIC. //[.7I ADDRESS NO (OZ 7 i/J SPECIAL LIC. 'Ld CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL R ED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE.OF EXISTING SO.FT. NO.OF NO.OF CHECK HIGHWAY + YARD FRONT PROP.LINE HIGHWAY WIDTH SIZE / �S STORIES FAMILIES ONE / DESCRIPTION OF WORK PSrV C� NEW + � CL 4;' O ADD BLDG.SETBACK FROM (STREET) im O SIDE PROP.LINE OF ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = SIDE PROP.LINE I HIGHWAY WIDTH . N USE OF REPAIR ❑ Z EXISTING BLDG. IDEMOL ❑ + APPLICANT'' A I TEL CORNER CUTOFF YES ❑ NO ❑ IPRINTI � N � NO. IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATUREI IN COASTAL PERMIT ZONE YES ❑ NO ❑ n VALUATION$ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Cn2C�' THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES 1 / AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WOR EN'S COM. / 4 PENSATION INSURANCE. �j r�.UQ=f ©� �i,...�• SIGNATURE OF ` r PERMITTEE ADDRESS FINAL BY TEL. DATE .� �Y CITY NO. O MAKE CHECKS PAYABLE TO:. FEET HARVEY T.BRANDY,COUNTY ENGINEER FEE ` re— ,;1.yd PLAN CHECK VALIDATION CK' M.O. CASH !� PERMIT VA-ID .I A CK. M.O. CASH 928'DEC .5023 D 124.20 6 . 607r"D-FED 51213 D 84_.386 _ ®f 76A63BA CE#803 3.75 r ,• 6 0 8 N T•EB 9 1 D ,3 4 7.6 3 &--, TT PlJ ' • s e4 a - A P 9 ATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSAVION DE&ARATION FOR APPLICANT TO FILL IN BUILDING AD I hereby affirm that I have a certificate of consent to self Insure, BUIL IN ADDRESS /' 1 or a certificate of Workers'Compensation Insurance,or a certified copy thereof(sec.3800,Lab.C.) CITY� G G Y­P ZI -7d -.0 LOCALITY Policy No. Company SIZE OF L NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CRO ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASs R ABO PA�F,� ,� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' S��-v��� Z NO � Q WITHIN 100DFT OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit is for one hundred S/�'j�,�SJ y�L��� DISTRIR GROUP TYP NST.' FIRE ZONE OC ED B dollars($100)or less.) - n �j I certify that in the performance of the work for which this permit CITY is Issued, I shall not employ any person in any mann r so S ARCHITECT ENGINEER TEL NO. �- \/ beCO bjeCt 1 WOrke CO tin ATISTICAL +IFICATION APT 1710 X Date /A/ppllCe ADDRESS CLASS NO. DWELL UNITS r`NOT() TO APPLICANT: If, after making this Ce "Cate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, CONTRACTOR TEL NO. p you Should become subject t0 the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC,CLASS FIDE 0 I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP FT.SIZE NO.OF STORES NO.OF FAMILIES (commencing with Section 7000)of Division 3 of the Business and SQ. NEW El BK PG O Professions Code,and my license is In full force and effect. DE PTION Of WORK VALUATION yv� License Number Lic.Class h C L S E— P 13- te- ADD ❑ l7 Contractor Date d ALTER ❑ $ U �L ❑ I am exempt under Sec. REPAIR El $ BARC.for this reason S DEMOL ❑ LAMA P/C If US OF (STING BL URM ❑ Date: 1 Signature APPLICANT(PRINT) TEL NO. LDMA Penn tr 1 ❑ I, as owner of the property, or my employees with wages as 0 CC their sole compensation,will do the work and the structure is ADDRESS C AL's TAA not Intended or offered for sale (Section 7044, Business and FINAL DATE 3307 2113.60 w0 Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL -) L ® n OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL To OR GREATER THAN 1 a 1 ITEMS ❑ I, as owner of the property, ru exclusively contracting ing with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY✓ _ licensed and Professions to construct the project (Section 7044, YES❑ NO❑ J'' ' TOTAL 210.60 Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK �-y OCCUPANT REOUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH i' CHECK 210.01 CONSTRUCTION LENDING AGENCY FO R GU DIE NES.ITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST �^�� v� CHANGE (�d,I,GE .I.00I hereby affirm that there is a construction lending agency for YES 11 NO 1:1 ! the performance of the work for which this permit is Issued(Sam 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD r 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES QQJ�I- 113�i 1 'I'/a.�3/f I,I COUNTY CODE,TITLE2 CHAPTER2.20 SEC noON3221100 THROUGH 220.140 CONCERNING 0 0 � 9- Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. _ Lenders Address �,�,�,,,�,� 13331 1 AM 7:54 0 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 ordin rices and State laws relating to building construction,and here a thorize repress tatives of this County to a ter u n ISSUANCE FEE th a tiof}ec}prop rty in pection pu - (y .,•�/ � °6°/✓✓✓� INVESTIGATION FEE TOTAL FEE mwMWen,ua�ye�n Darn SEE REVERSE FOR EXPLANATORY LANGUAGE IL APPLICATION FOR BUILDING PERMIT �l COUNTY OF LOS ANGELES BUILDING MD SAFETY WORKER'S COMPENSAYION bEIrLARATION FOR APPLICANT TO FILL IN BUILDING ADDRES fil'id RM 04 1 hereby affirm that I have a certificate of consent to self Insure, Bull ING AQDRESS V or a certificate of Workers'Compensation Insurance,or a certified �' AZ5/ copy thereof(Sac.3800,Lab.C.) C T , z,P LOCALITY Policy No. Company l L' C SIZE OF LOT NO.OF BLDG ON LOT ❑ Certified copy is hereby furnished. NEAR CRO . ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP PAGE, SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ��^�-��� (J TEL NO. Ytl COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES No ADDRESS (This section need not be completed If the permit is for one hundred M s' jdV DISTRICT GROUP TYPE CON T.' FIRE ZONE PR C ED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit I iSau I Sh I not employ any person in any m ner SO as to ARCHITECT OR ENGINEER TEL NO. Kbco fN Workere'C sation ws STATISTICALQ ICATION A CO Dte AppliCen ADDRESS CLASS NO. DWELL UNITS`y OTICE TO APPLICANT. If, after making this Ce ificate of R EQUIRED TOTAL SET FROM EXIST Exemption, you Should become subject to the Workers' CONTRACTOR TEL NO. TBACK YARD HWY PROP•i E WIDTH Compensation provisions of the Labor Code,you must forthwith T comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. LICENSED CONTRACTORS DECLARATION CITY DE LIC.CLASS I hereby affirm that I am licensed under provisions of Chapter 9 I R MAP Sq.FT.SIZE NO.OFSTORES NO.OF FAMILIES(commencing with Section 7000)of Division 3 of the Business and � NEW ❑ PGProfessions Code,and my license is in full force and effect. ,License Number Lic.Class DE3CRIPTIO WORK LWADD ❑ ATION a� Contractor Date ALTER 11:11 ti Z ❑ I am exempt under Sec. REPAIR ❑ B.&P.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LOMA Penn# Z ❑ I, as owner of the property, or my employees with wages as their sole compensation,will do the work and the structure is ADDRESS O ACCT.r not intended or offered for sale (Section 7044, Business and FINAL DATE /' Q ., Professions Code.) / G 3307 41.7-' WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ( { 1� ❑ 1, as owner of theg THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY,4 + 1 TEMS licensed contractors to construct the project (Section 7044, YES❑ NO❑ TOTAL '-,$. a7 Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING [j j'�� / �• OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION ORMODIFICAMON FROMTHESOUTH / 1 C_.ilLi.•ri �t:7.75 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST �/7 by FOR GUIDELINES. —1 C� lyI CHANGE DSI I hereaffirm that there is a construction lending agency for /{X� 7 � e the performance Of the Work for which this permit is IaSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD ` l 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTYCODE,TTTLEZ CHAPTER 220 SECTIONS 22CL100THROUGH 220.140 CONCERNING �,'}l�('F^i;t•;ry.{ r}L 1� Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OEMAINING A PERMIT FROM THE SCAOMD. L1) V OC-01 GQ Lenders Address OWMORAoan 0330 1 Aid 7;54 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 �/ti� [, ordinances and State laws relating to building construction,and IIJJ J hereby authorize representatives of this County to entewo ISSUANCE FEE he a mentioned pro for ins ion pu .AJA 00 INVESTIGATION FEE TOTAL FEE . / - Ayam om" SEE RHVERSE FOR EXPLANATORY LANGUAGE