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Home My Public Portal About5519 SARA MAR LN_Building__ 1.A.fQ APPLICATION FOR BUILDING PERMIT 1 DIM�!'ON�OF-_BUUMING AND BAFEfY BUILDING r_ ar •� OI County Engine = ADDRESS County DI Los ADgolm LOCALITY WM J FOX CouNTY ENGINEER NEAREST CA88ATT D GRIFFIN Su!T of BUILOINi C 8 ST DISTRICT NO. J_OF TYPEB BER MA FOR APPLiCANi i0 FILL IN -1 CONST euaDlNa pSTATE ADDRESS 4 D W NUMBER 2 O HWY Nb of o BLOCK USE ZONE SPECIAL LOT NO. Q� CONDITIONS O L=O TRACT 14/55,VU EAI Cie6 E% 0 NO OF III. BUILDING EXIST. SIZE OF LOT S NOW ON LOT SETBACK YARD NWY STREET NAME WIDTH U8E OP / EXISTING LD / Pp OL -C-7 6 r OWNER V OSO F OAJ6.VL SIDE P MAIL O TRACT DWELL 1 UNIT MAILADORN" S INDUSTRIAL T81CI NO DWELL. 1 UNIT 6 PUBLIC BLDG ARCHITECTO THL 2 DUPLEX 1 UNIT 7 ADDN ALT ETC. ENGINEER NO 8 APT _UNITE B MISCEL DRESS 4 COMMERCIAL CONTRACTOR T ' No C>a S 70 INSPECTION RECORD ADDRESS .S CNE CU iEAP 4ACA LI L GAC OCTR C O G ♦f�GAI AI D DESCRIPTION OF WORK lAjj NEW X ADD ALTER REPAIR DEMOLISH L K P �IBN SQ PT HO OP NO OF ` SIZE STORIES FAMILI[S �� A 6 �M Q �9L �ePn USE OF S RUCTUR 81GNATURE O! /� APPLICANT V 91.2 APPROVALS ADDRESS DATE INSPlICTOR S SIGNATURE FOUNDATION LOCATION s _ P C S , CQ FORMS MATERIALS I Z Ste¢ C -- r/ FB FRAME FIRE STOPS. _. VALUATION UAO� S n 00 BRACING BOLTS S C (J +5 FUR NACR LOCATION, 1 HERESY ACKNOWL®GE THAT 1 HAVE READ THIS GAB VENT DUCTS 1 APPLICATION AND STATE THAT THU ABOVEIS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT I Z 1J, SS AND STATE LAWS REGULATING BUILDING CONSTRUC- TION LATH EXT 41 1 SIONATV RH OF HOUSE NUMBER COR- PER] ITTBE RHCT AND POST® ADDRESS FINAL INK J.FOX.COUNTY ZHom . VALIDATION C.N. DIRLAM.CHIEF BLDG INSPECTOR JC0871E -� OCT 616 1100AU)IC878 -� OCT 10 1 2200 n WORKERS COMPENSATION DECLARATION hereby affirm that I have a certificatempe of consent Insurance or _ APPLICATION FOR BUILDING PERMIT insure or a certificate of Workers Compen,hon Insurance or a perhfied copy thereof (Sec 3800 Lob C ) COUNTY OF LOS ANGELES , BUILDING AND SAFETY y Policy No Company . Certified copy Is hereby furnished, FOR APPLICANT TO FILL IN BUILDINGADDRESS Certified copy is filed with the county budding mspec BUILDING hon department ^ ADDRE00, SS.StS/ LOCALITY Date Applicant CITY ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS NO OF&DGS ASSESSOR COMPENSATION INSURANCE I SIZE OF LOT NOW ON LOT _ MAP BOOK PAGE PARCEL (This section need not be completed If the permit is far one UX �-� hundred dollars ($100) or lase )' TRACT BLOCK LOT NO No Y TEL SPECIAL y I certify that in the performance of the work for which this OWNER NO 787-S r CONDITIONS O permit is issued I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE D BY U so ADDRESS u CONST Z ato become subject tthe Wk lomubleco e oreri Compensation laws rOu Oc N C •Date Applicant I CITY ZIP STATISTICAL CLASS CATION APT CONDO toU NOTICE TO APPLICANT If- after making this Certificate of ARCHITECT OR NO W TEL Exemption you should become subject to the Workers' ENGINEER NO DWELL UNITS_ N ,Compensation provisions of the Labor Code you must forth- ADDRESS �' - SEWER MAP Z with comply with such provisions or this permit shall be — deemed revoked CONTRACTOR - TEL BK VALIDATION ' I I LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapteri? ADDRESS VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC ' Professions Cade°and my license is In full force and effect CITY LCLASSIC 2 QOOI t 50 FT NO OF NO OF CHECK License Number Lic Class SIZE/000 STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ $ + \\\ ❑ ADD ® am exempt from the licensing requirements as am a licensed architect or a registered professional engineers _ _ ALTER [:] FINAL Z _ acting in my professional capacity (Section 7051' J REPAIR E] DATg Business and Professions Code) USE OF FINAL EXISTING BLDG DEMOL ❑ T Lic or Reg No Date APPLICANT TEL ' " OWNER BUILDER DECLARATION" PRINT -- NO I hereby affirm that I am exempt from the Contractor s License T Low for the following reason (Section 7031 5 Business and' ADDRESS I i Professions Code) BUILDING ® I as owner of the property or my employees with ADDRESS _ 9 1 A wages as their sole compensation will do the work and ' the structure is not Intended or offered for sale(Section LOCALITY ' t\ . i. . . 1 7044 Business and Professions Code) MOVING TEL U I as owner of the property am exclusively contracting CONTRACTOR NO 3 O O with licensed contractors to construct the project (Sec bon 7044 Business and Professions Code) - ADDRESS REQUIRED TOTAL SETBACK FROM EXIST e e . 34, 000, CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that there Is a construction lending agency for FRONT - - O a 3 1 —8 1 the performance of the work for which this permit is Issued PL (Sec 3097 C,v C ) SIDE - - - - - PI Lenders Name _ Lender s Address PC Fee S Permit F.2,217 - r _ W I certify that I have read this application and state that the Issuance Fee above mformation a correct I agree to comply with all County Inve,ng000a Fee - ordinances and State laws relating to budding construction Tolal Fee tl and hereby authorize representatives of this County to enter ` upon the oboie It property for inspection purposes _ Igq SEE REVERSE FOR EXPLANATORY LANGUAGE S,gn a of Applicant or Agent Daf6 ms APPLICATION FOR BUILDING PERMIT COUNTY'OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING BORE I hereby affirm that I have a certificate of consent to self insure B nING ADDRESS cc . or a certificate of Workers Compensation Insurance or certified 3 /S e+9td /�'~� A•yG copy thereof lab C) r/I D �r ✓ / 7` ZIP ��/�r77 sk O'y ' LOCALITY Qg�II�y no Company SIZE LOT NO OF BLDGS NOWdPARCEL /CJ Carl oiled copy Is hereby furnished NEAREST SS ST ❑ Cemhed copy is filed with the my btu i irt9pactron TRACT BLOCK LOT NO department USE ZONE MAP NO Dat •,f 3`� 3 Applica ASSESSOR MAP BOO( PAGE SPECIAL CONATIONS CERTIFICATE OF EXEMPTION FROM WORKERS dNNER TEL NCOMPENSATION INSURANCE '^ 'D � /W e �" WITHIN 1000 FT OF SCHOOL+ vas No (This sectgn need not be completed if the pernut is for one hundred A yjdollars($100) or leas) `S / .�i0a.l /1I.R4 (.�.-GDISTRICT GROUP TY CONST FIRE ZONE9:::� iI certify that In the performance of the work for which this permit 0/e,,o/L e ZIP - _a Issued I shall not employ any parson In any manner so as t0 ARCHITE T OR ENGINEER TEL N .JG become subject t0 the Workers Corrlpensation Laws STATISTICALCLA$SIP TION APT , CONDO Date Applicant ADDRESS CLASS nq ;am IO DWELL UNITS NOTICE TO APPLICANT If after mai ilia Certificate of REWIREDTOTAL SETBACK FROM EXIST K p Etion you should become subject t0 the Woo ers - // TEL NO - SET BALI( YARD HWV PROP LINE WIDTH Compensation provlslons of the Labor Code you must forthwith ��1•✓ write i 2 —yfyG FROM comply with such provisions or this permit shell be deemed revoked ADDRESS I,J�r _ y� P L - /Z Al e !✓d)q 't-70.,� It'e /716 SIDE LICENSED CONTRACTORS DECLARATION uc LAs PL I hereby affirm that I am licensed underprovlsions of Chapter 9 �1761 _ SEWER MAP (commencing with Section 7000)of D vvoon 3 of the Business and SO FT SIZE NO OF STORIES I NO OF FAMILIES Professlors Code and my license s In full force arA affect / NEW ❑ UK PG , } License Number;GL —7"9 o Lac Class ` — DESCR�TION(may NORK�. ' ADD ❑ `�LUATOON O ContractoC' r� Date f �(G (w r-' A \ ALTER ❑ $ 1 foo O U / C o aJ Elm I am exBpl under Sec REPAIR ❑ $_ FF BBPC for this reason DEMOL ❑ - W LDMA P/C Date USE OF E NO BLIJOURM ❑ D- 1 U Signature T{PINT/ �j /' LDMA Pam♦ Z 1 Z G I ❑ I as owner of the property or mdI YGw f r y employees with wages as RS D AOF linCT,i their sole COmpersabon will LS ll d0 the work and the structure / Alr.4. O /l�[� FINAL DATE net Intended or offered for sale (Sechon 7044 Business and / " ' �} PTOfessiors Code) WU THE APR CANT OR F-FTURE WLNNG 0eei HANDLE A HAZARDOUS MATERUl � 1V L15 ❑ I as Owner of the property am e%C1USNe contract) with Ori A MIXTURE CONWMNe A HAZARDOUS MATER41 EOUAL TO On O TER TIMN 111E ekI N rig AMOLNT9 SFECFIED Wl THE HAZARDOUS MATERw1S VFORMATION GUIDE? FI > 1 ITEM, licensed contractors to construct the project (Section 7044 vaso No TOTAL 1� Q�r Business and Professions Cade) r W1 THE INTENDED USE OF THE BUIXl1q BY TIE APRXN!T OR FUTURE BVLDND OCCWANT PEOIARE A PERMT FOR OONSTRUCTCN OR MOOTICATON FROM THE SOUTH IT�y� CONSTRUCTION LENDING AGENCY COAST GInCELcrEsa V MANAGEMENT OIS'TRCT ISCAOMDI SEE r£RMTTWG CHECKOST FOR CTTL(ft 1�,�i,�� I hereby affirm that there is a construction lending agency for YES El 40 11 1' 6o I_IiAN�� .1311 the performance of the work for which this permit is issued(Sec iHAV AD TIE HAZARoous MATERws vFauuTanouDE AND TIE scnoMO PERAQITNp r V T 3097 Civ C) ,] =W.12 IECKLIBT 1 U EMAND MY REOIREMENTS UNDER THE LDS ANC£LES COUNTY CWE ' Lenders Name uwTEr�13 RiM w r s A T HROUGH Z20 FRCM'.�SCAiCMD 143 IMZArDdr OWO-0101 7/13/9-" Londe s that IhAddress Ap tlNT Oo99 1 AM11:1` certify that I have Tend thus mabo,is and slate under penalty / $ 01 perjury that file above InfOlmatlDnl 6 CWfeCI I agree 10 Comply PC FEE - PERMIT FEE �• $ with n ordinaricBs and Slate Taws relating to Wilding , GAre a mby utho a TepresBnfally24 of this County ISSUANCE FEE toe th ntioned property for Ins gytPojj(1pF m ,/ fI/�l/ INVESrIGATION FEE TOrAL FEE n j Ysv.w. _ rw //�•/• SEE REVERSE FOR EXPLANATORY LANGUAGE