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HomeMy Public PortalAbout4842 RYLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT EOR APPICrCANT TO FILL IN' (Print or type only) COUNTY OF LOS ANGELES BUILDING ADDRESS Z14P41167 DEPARTMENT OF COUNTY ENGINEER CITY (,j ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. - BUILDING SIZE OF LOT NOW ON LOT ADDRESS C TRACT D BLOCK LOT NO. LOCALITY TEL. NEAREST OWNER . NO.'7 Z � CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL CITY ! ZIP `DISTRICT GROUP 'TYPE FIRE PROCESSED BY ARCHITECT OR TEL. r� , �NST!/f ZONE_ �• �L Q� L�J.eJ1'�• ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS r j BK ( PG TEL. CONTRACTOR ,.�` /-�� NQ / USE-770NE MAPLIC. �1 irf ADDRESS , / NO. / -1 Z SPECIAL [�'� LIC. bD .CONDITIONS CITY �(��o/��' CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT NO. NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW ❑ + = O / ADD BLDG.SETBACK FROM ex SIDE PROP.LINE OF (STREET) O ALTER TOTAL SETBACK FROM TYPE OF EXISTING USE OF I REPAIR El HIGHWAY YARD = SIDE PROP.LINE HIGHWAY WIDTH N Z EXISTING BLDG. = DEMOL ❑ + APPLICANT /� NOL CORNER CUTOFF YES ❑ NO Q-- (PRINT) /�/ IN OPEN SPACE YES ❑ NO go- BY(SIGNATURE) .� IN COASTAL PERMIT ZONE YES ❑ NO VALUATION$ I HEREBY ACKNOWL DGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Lj J-7-4 S`/�/�GY'✓d WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM. INSURANCE PEN$ATION . �d} ?�,/�C•� �`� � � � !��+�Lc✓7 SIGNATURE OF PERMITTEE v ADDRESS L BY DATE MAKE CHECKS PAYABLE TO: FEE ` PPP.✓✓ FET.Q HARVEY T.BRANDT,COUNTY ENGINEER P PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH 9 2 .6Na.,An 2_4 1 U 7 53 5 ...,� ®s 76A63BA CE#803 3.75' t i ^ DE.*RTMNT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES "W I L®I G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO. PLAN CK, NO, PERMIT NO. ADDRESS / ��iw' "„l a'�`�. RECEI.V DATE OF APPL. DATE ISSUED LOCALITY ;s-Q.+},1\-i? tt �C.:F•.i 3 2'� /�' NEAREST CROSS ST, tr-(�.-�,• �I •7 , / t `- BUILDINGS ADDRESS `r°/ ©T t=+ /,10 �/��.d [.r><•t.,,,/ i OWNER i 97 s IL>„ I'': f1,.�t.t.•- r`'` w. !rR I/ MAIL s ,"� �, LOCALITY ADDRESS r l7 ` �' ��J ` " - NEAREST TEL. l! s , `_ CROSS ST. CITY t ! •• NO. -7f {'` '? ,1!s ? FIRE NO. OF PE GROUP ARCHITECT OR 'j.• t TEL. ZONE I PLANS +.A L.) ENGINEER NO. BLDG. c� ORD. NO. SETBACK LINE / �� ADDRESS -! APPROVED TEL. BY DATE CONTRACTOR ar�>V,, �!: t) r -"=`NO. USE �/ APPROVED ADDRESS DATE ZONE(,�� BY HOUSE NUMBERING + LEAL DESCRIPTION I LOT NO. 3 I BLOCK MAP NUMBER pe-rrOl FIELD CHECK BY TRACT /7/07 NO. ASSIGNED BY HATE % NO. OF BLDGS. CORRECTIONS SIZE OF LOT ; A 'r� 7 I NOW ON LOT r' USE OF I NO. OF '� EXISTING BLDG. FAMILIES DESCRIPTION OF WORK NEW I �I ALTERATION I I ADDITION REPAIR I I DEMOLITION I I I 8 ZE Q Q ROOMS STORIES s EXT. WALL I ROOF �' IJ f 1' COVERING _�72,,lA aCOVERING 4 USE OF S7g0TURE INSOT,ORL PECSSIGNATURE DATE +I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. FOUNDATION: LOCATION z/ : PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS �.' .,j� /• �! CORRECT. _ 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME:FIRE STOPS, f HERRON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING 13UIILDING CONSTRUCTION. FURNACE: LOCATION, ✓ //lit'! SIGNATURE OF -j'..;/ // � GAS VENT, DUCTS PzRMITTErf 'it-s ((((�JJJJ �'4"t 0 v C-[— t �j p 'r /� n � 7 • _2 E 1 i; LATH, INT. / r7 t ADDRESS- 0 .Et. Ci+t ' ./ s,lee AUTHORIZED AGT. LATH, EXT. PLASTER, INT. 7SASaaA•08S8 10-80 -P. C. $ /' ® 7?s B FEE (p PLASTER, EXT. VALUATION FEE $ `. 4 -&' o FINAL APPLICATION FOR BUILDING PERMIT ' �] -� .- COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 14 gr Lf 2- � ¢*,a � Al A�� i or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CIITY�4P_PH le CliLW ZIP 9/?9-D LOCALITY Policy No. Company SIZE OF 03T NO.OF BLDGS.NOW ON LOT 11 Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. , department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL O59 d t 1 , 60 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �p TEL NO. COMPENSATION INSURANCE DR S� la wl S. d V tfliRsw �. �I is �s—I2. WIjHIN 1000 FT.OF SCHOOLS ,YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) -f o•�� '1� �cF aL� (� DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit I CITY �� 12 of z ZIP (� �pD� is issued, I shall not employ any person in any manner so as to gRCHriECT OR ENGINEER TEL NO. /�- .become subject.to the Workers'Compensation Laws. STATISTICAL CLAS FICATION APT CONDO D lAJCLASS NO. DWELL UNITS Date Applicant I ADDRESS NOTICE TO APPLICANT.• If, after making this•Certificate of REQ]BACK TOTAL SETBACK FROM EXIST Exemption, ,you should become subject to. the Workers' CONTRACTOR TEL NO. SET 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. I ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P DE L P 0 I hereby affirm that I am licensed underprovisions of Chapter 9 I SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO,OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ K� PG , >- DESCRIPTION OF WORK ADD ❑ VALUATION 0_ License Number LID.Class I ©Q-{- Ori _I JI 12,-ClAeAAO ,700 Q Contractor Date ALTER ❑ cc ❑ I am exempt.under Sec. . I w ( i h tire E& r oo REPAIR ❑ $ O BAP.C.for this reason DEMOL ❑ ' LDMA P/C# -Date: I USE OF EXISTING BLDG. URM ❑ i D- Signature I APPLICCC�AAp'NNNT fPAINT) TEL NO. LDMA Perm# 1 z ❑ I, as owner of the property, or my employees with wages as � we S ' � r�t S t;_ '/�"�• , Z ACCT.s their sold compensation, will do the work and the structure is ADDRESS C 0 .,`� 9 t not intended or offered for sale (Section 7044, Busiriess and 'YZ 4�s[0 //' FINAL DATE Q O17 7 1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL A. � 1 6T �i IJ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE W. as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINA ' > TOTAL �. - 10licensed contractors to construct the project (Section 7044, Business and Professions Code.) VES 11 No 11 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ; CHECK 149.ill OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY I COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR I' ti GUIDELINES. ✓_ e (,H !'IVE o010 I hereby affirm that there is a construction lending agency for � YES❑ No❑ cm the performance Of the Work for Wt11Ch this permit IS ISSUed(Sec. r I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING r' y 1 3097,Civ.C.) I CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, I / 'r'i}(7ry�1•yn 5/13/93{�I{f CM TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 4JL700 i t 0 1 7 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCACMD. Lender's Address 9700 1 AM 8:34 OWNER OR AGENT o I certify that]have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.EEE PERMIT FEE �{ N with all county ordinances and State laws relating to building construction,and hereby t rize representatives of this County ISSUANCE FEE 1 co toe upon the above- I ned property for inspecticil pur oses. s-y 6 S I a INVESTIGATION FEE TOTAL FEE D CD5 , oS Somiure a Awam a Apen%. SEE REVERSE FOR EXPLANATORY LANGUAGE ' I