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Home My Public Portal About6130 ROWLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT FQR APPLICANT TO FILL IN (Print or type only) rADDRESS UIL ANG ' COUNTY OF LOS ANGELES ' DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING A SAFETY DIVISION O,OF BLDGS. / BUILDING / SIZE OF LOT NOW ON LOT ADDRESS J' TRACT L� BLOCK LOT NO. LOCALITY TEL. NEAREST OWNER O. CROSS 5T. ASSESSOR ADDRESS -27 MAP BOOK PAGE EL DISTRICT • GROUP TYPE FIRE P SED. Y -CITY ZIP a �y- CONSTf•1 ARCHITECT // TEL. • ENGINEER 6 1 NO. STATISTICAL CLASSIFICATION- SEWER tdAP ADDRESS + CLASS NO._j9W2-DWELL..UNITS BK PG TEL. CONTRACT NO. U�F�ZO EFM LIC. ,y' �_ADDRESS �' NOW AL'LIC. "YITIONS. CITY '•• CLASS ROAD DEPARTMENT APPROVAL )RED YES E] NO ❑ CONSTRUCTIONLENDER NAME AND BR 4NCH BLDG..SETBACK'FROM ' FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM .TYPE OF EXISTING HIGHWAY t YARD SQ.IZ FT. NO.OF NO. CHECK - FRONT PROP.LINE ' HIG AY WIDTH SIZE STORIES � FAMILIES ONE A,� � a DESCRIPTION OF WORK J t- NEW + CYC! - O ADD ❑ BLDG.SETBACK FROM fx 'SIDE-PROP.LINE OF (STREET) O ALTER ' ❑ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY. + YARD = SIDE PROP.LINE HIGHWAY WIDTH . w USE OF REPAIR 11 r Z EXISTING BLDG. DEMOL ❑ APPLICANT�L TEL CORNERCUTOFF YES ❑ NO ❑ (PRINT) r) NO. IN OPENISPACE - YES ❑ NO ❑ BY)SIGNATURE) IN COASn4L PERMIT ZONE YES ❑ NO ❑ r � VALUATION$ I HEREBY ACKNOWLEDGE HAT I HAVE READ THIS APPL16ATION AND STATE - •!N 1-0-t .a ---) THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES- 49 AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE 0, 10"L, WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN,VIOLATION OF' THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO MEN'S COM- / PENSATIONINSURANCE. SIGNATURE OF f PERMITTEE ADDRESS FINAL BY TEL. - _. DATE /g_ CIN NO. J MAKE CHECKS PAYABLE TO: FEE..$ FEET HARVEY T.BRANDT,COUNTY ENGINEER i ^� L.X. PLAN CHECK VALIDATION g .M.o. CASH PERMIT VALIDA 10 - cic M.O. - CASH a 3 0 NQEC :30 2 z3- '-P :1 2 4 2 0: 6 0 3 FEB -...9 3 D' _ 8-4.3 8 t ®S 76A638A CE#803 3.75' "` 6,0 c,FEB 34 7.6.3 A W-� . APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUIL ANG AD ESS I hereby affirm that I have a certificate of consent to self Insure, r � L A /t)� tic- , W-30 � ��jQ �_ or a certificate of Workers'Compensation Insurance,or a certified i� copy thereof(Sec.3800,Lab.C.) CI�Y�SLI, C (� n r ZIP Q / (s- 1 LOCALITY---- I �j_ Policy No. Company S ZE NO.OF SLOGS.NOW ON LOT ❑ Certified copy is hereby furnished. - - NEAREST CROSS ST ❑ Certified copy is flied with the county building inspection IACTLOCK LOT IVO. el I USE-ZONE MAP NO. Date Applicant ESSOR MAP BOOK ; C �^ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �'� I'� �I 2 TELONO � v YES NO COMPENSATION INSURANCE D ?/ WRWIN 1000 FT OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred 69 17 p f'irJ �1" DISTRICT GROUP TYPE CONST.' FIRE ZONE P CESSE dollars($100)or less.) . CI ZIP i' (J / I certify that in the performance of the work for which this permit s 17SO chJ �UX k`-_3 !Hl- is issued, I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TE.NO. become subject to the Workers'Compensation Laws. STATISTICAL C IFICATION APT CO O 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' o T OR TEL.NO. j .� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith �" F-1 S ' 3 7 v39 FRONT comply with such provisions or this permit shall be deemed revoked. A RES LIC.NO. PL 1 SIDE } LICENSED CONTRACTORS DECLARATION (C`{TyY�P ��.,� [� Llc.cu►ss °- 70 I hereby affirm that I am licensed under provisions of Chapter 9 -` - "' k' r"' ' '('v" SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SIZ NO.OF STORES NO. FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG �• License Number Lic.Class PIDES ION o5 ADD ❑ $u TfO,N , Contractor Date i �/ ALTER ❑ • %V} ❑ REPAIR I am exempt under Sec. ❑ B.BP.C.for this reason 7- DEMOL ❑ LDMA P/C# / Date, USE 01 EXISTING BLDG. URM ❑ Signafurw QC�fLJ�-�` #a rAPPLI (PRINI) TEL NO. LMA P9Rn# ❑ I,as owner of the property, or my employees with wages as L( �► _ O s their sole compensation,will do the work and the structure is DR ow�-��N 4 d( �' Fl Te Q V�).F not Intended or offered for sale (Section 7044, Business and �! f] 57 '� 1 e Professions Code.) j WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL y0 j ❑ I, as owner Of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN > :� �'41': Y 9 , THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? F! _ Y licensed contractors to construct the project (Section 7044, Business and Professions Code.) I YES❑ No❑ TOTAL AL 1 98 =87 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING I, CONSTRUCTION LENDING AGENCY ' OCCUPANT REOUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROMTHESOUTH L CHECK 198.87 COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST , FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ i (3t .00 the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD W 3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY I CODE. O Lender'sName HAZARDOUSMTERIALSREPORTINGANDFOROBTAINNGAPERMITFROMTHESCAOMD. 00LICI—CIOCI1 7/10/911 l Lenders Address OWNER ORAGEW 1741 1 Ate 9:57 o I certify that I have read this application and state that the above PC.FEE PERMIT FEE information Is correct. I agree to comply with all county ordinances and State laws relating to building construction,and e hereby authorize representatives of this County to enter upon ISSUANCE F€E �he above-mentioned prgperty fo m: etioq Purin,. J r % INVESTIGATION FEE TOTAL FEE , olApgim„taApent Dab SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION �, ,Ia hereby affirm ti certificate I have certificate of consent to self A P P L E CATION FOR BUILDING PERMIT �t insure, or certificaiat te of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) • � COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company copy y FOR APPLICANT TO FILL IN ADDRESS Certified co is hereby furnished. j Certified copy is filed with the county building inspec-, BUILDING /s n tion department. ADDRESS f `Q44 , F to Date Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one !� ASSESSOR hundred dollars($100)or less.) TRACT + BL. LOT NO. MAP BOOK PAGE PARCEL 2 p USE ZONE MAP I certify that in the performance of the work for which this OWNER �i Q NO. a—�/ 1� 0 NO. �Q O permit is issued,I shall not employ any person in any manner ADDRESS f±p�'� (� K�1�,d Q 11 SPECIAL so as to become subject to the Workers Com ensation Laws. r7 CONDITIONS V , ' Gt • CITY A ZIP / Date � �^ Applicant '—�^` ' �' ��' � ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE P CESSED BY NOTICE—FO APPLICANT: If, offer making this Certificate of ENGINEER NO. CON T. ZONE Exemption, you should become subject to the Workers' � gd Compensation provisions of the Labor Code, you must forth- ADDRESS v,:0 y with comply with such provisions or this permit shall be :AvTEL. STATISTICAL CLAS91FICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL:UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS N0. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC, `, Professions Code,and my license is in full force and effect. CITY CLASS BK V PG 2•'� VALIDATION SQ.FT. 'y NO.OF NO.OF CHECK License Number Lic.Class SIZE o: 0 STORIES FAMILIES ONE VALUATIO DESCRIPTION OF WORK , ArV NEW 1 a Contractor Date ADD $ I am exempt under Sec. Pilo.ALTER B.&P,C. for this reason I REPAIR ❑ $ DUSE OF Date: DEMOL EXISTING BLDG. APPLICANT TEL. Signature � FINAL ! OWNER-BUILDER DECLARATION PRINT NO. DATE 1 hereby affirm that I am exempt from the Contractor's License .� 7 ILL,Law for the following reason (Section 7031.5, Business and ADDRESS FINAL { Professions Code): PRESENT BY o a 0 0 0 BUILDING I, as owner of the property, or my employees with ADDRESS o n wages as their sole compensation,will do the work and o 0 0 7 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 0 605-811 I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS . tion 7044, Business and Professions Code). WM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY ED TOTAL SETBACK NEER WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 'o P.L. v Lender's Name LDMA Ref. # $ Lender's Address P.C. Fee$ Permit Fee I certif that I have read this application and state that the y pp Issuance Fee O kLDA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee ° '� LDMA Perm. # J and hereby authorize representatives of this County to enter Upon the above-mentioned property for inspection purposes. 0 ��2{�• `,rr �r t te; 60 I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent ate