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Home My Public Portal About6327 SALTER AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OFLOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTT NO. PLAN CK. NO. PERMIT NO. ADDRESS I/? LOCALITY .�► RE IVED BY DATE OF APPL. DATE IS U NEAREST t 11 ✓� '- �- 's -2 CROSS ST, BUILDING OWNER ADDRESS yl ND ro , A MAID LOCALITY I / ADDRESS + NEAREST -+- TEL. y CROSS ST. - J CITY NO. d FIRE NO. OF �� 'ARCHITECT OR TEL. ZONE PLANS Z- TY GRI O�1/ -' ENGINEER NO. BLDG. p SETBACK LINE %U �� L ADDRESS APPROVED TEL. BY DATE CONTRACTOR NO. USE /Q� APPROVED ZONB �BY DATE ADDRESS HOUSE NUMBERING LEGAL I t I �/' S DESCRIPTION LOT N A. BLOCK MAP NUMBER FIELD CHECK BY TRACT f� LL NO. ASSIGNED BY� z-z(-cAT > rrrlll NO. OF BLDGS. CORRECTIONS SIZE OF LOT �, �� I NOW ON LOT / /JQ C USE OF _ I NO. OF T/ EXISTING BLDG. FAMILIES— DESCRIPTION OF WORK NEW I x` I ALTERATION I I ADDITION O REPAIR I I DEMOLITION I I I GG .A X SQ. FT. NO. OF SIZE ! /' 4 ROOMS STORIES Z n EXT. WALL ROOF Q 7 r COVERING I COVERING ��"�ff�' USE OF STRUCTURE .\ ✓ APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS / [- LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, S SIGNATURE OF GAS VENT, DUCTS PERMITTER! LATH, INT. l '�• ADDRESS LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 70A05BA- 0853 10-50 s P. C. $ FEE �j+� PLASTER, EXT. VALUATION O FEE $ �! 7a- FINAL I i FOR BUILDING PERMIT •'—I .,,—.APPLICATION COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUII�lDIn>Gff REss7 tZ I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or a certified �copy therec)f�800 C) r ,d ZIP /Policy No. Company tv__� l . ' [fBU1GnZ-) NO. BLDG N ON LOT LOCALITY ' ❑ Certified copy is hereby furnished. �� NEAREST CROSS ST. B-Certified copy is filed with the ty building inspection TRACT BLOCK LOT NO.dep tm t. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date_ plicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTIeRANCE OM WORKERS' TE COMPENSATION I U Y) —4S 7 WITHIN 1000 FT OF SCHOOL? YES No I (This section need not be completed if the permit is for one hundred DD 2 / T5� DISTRICT GROUP kTYPCONST. FIRE ZONE PROCESSED BY dollars($100)or less.) VZIP or I certify that in the performance of the work for which this permit C G9 c/ is issued, I shall not employ any person in any manner so as to ;1 HITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. . STATISTICAL CLASSIF)CATION L/ APT CONDO Date Applicant ADDRESS CLASS NO. / DWELL UNITS I NOTICE 70 APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' C R r TEL MO. _ n SET BACK YARD HWY PROP LINE WIDTH Compensation provisions.of the Labor Code, you must forthwith ej 2 -?z FRONT comply with.such provisions or this permit shall be deemed revoked. i ApppEs PL LICENSED CONTRACTORS DECLARATION cITY �.. LIC. s PILE 1.hereby affirm that I am licensed underprovisions of Chapter 9 C C1 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and I SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES ; Professions Code, d rI>) license" 'n full force and effect. NEW BK; PG d D NOF WORK VALUATION_ License Number Z1 Lic.Class - ADD ❑ 4� O Contracto Vl a ate . f ��rs.r i Q 0 0 ALTER ❑ $ ��Q� eREPAIR ❑ I 0 ❑ I am exempt under Sec. • B.BP.C.for this reason I ��( / /� s I OL 11LDW1A P/C W bate: USE OF EXISTING BLDG. URM ❑ I IL Signature I ACCT o 0 co APPLICANT(PRINT) TEL NO. LDMA Perm# Z ❑ 1, as owner of the property, or my employees with wages.as 0 3303 142.20 their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE ''^^ a 1 ITEM$ Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I 1 f-�{/ TOTALi- '� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with IAMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ " NO❑ 1 CHECK 142020 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHANGE .00 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH I ' CONSTRUCTION LENDING AGENCY COAST AIR ES QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUII hereby affirm that there is a construction lending agency for I. YES❑ No❑ a the performance of the work for which this permit is issued(Sec. i I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 0000-0001 11/ Cf 6)/?5 3097,CIV.C.) I CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, a 3161 1 A!1 43 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS I Lender's Name I MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address 1 0 OWNER OR AGENT c I certify that I have read this application and state under penalty C of perjury that the above information is correct I agree to comply P.C.FEE PERMIT FEE Nwith all county ordinances and State laws relating to building mCon ! n, and hereby authorize representatives of this County ISSUANCE FEE 7`n th tinned property for inspe�puroses.In91-0 CO INVESTIGATION FEE TOTAL FEE sq AP~ SEE REVERSE FOR EXPLANATORY LANGUAGE A I