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Home My Public Portal About9623 VAL ST_Building__ APPLICATION FOR BUILDING PERMIT ROR RF LICANT TO FILL IN (PIIH+GI 1YO* oDly) BUILDING COUNTY OF LOS ANGELES ADDRESS 3 E 1.•5 DEPARTMENT OF COUNTY ENGINEER CITY �� G ZIP BUILDING AND SAFE DMSION NO OF BLOCS BUILDING SIZE OF LOT NOW ON LOT Z ADDRESS ' TRACT 6� BLOCK LOT NO LOCAL) TEL NEARES OWNER D SA NO CROSS ST ASSESSOR ADDRESS 'j.aj y S MAP BOOK PAGE EL T DISTRICT GROUP TYPE FIRE PROCE EO BY CITY 1 C L G ZIP �O� CONST ZONE ARCHITECT OR TEL ENGINEER NO STATISTICAL CLAS$I FICA TION ER MAP ADDRESS CLASS NOQS—DWELL UNITS-----] CONTRACTOR �3.Q �/A (wp TEL O.L 5 ZONE LIC NO OCD ADDRESS NO Z 7S / SPECIAL CITY LIC CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION ENDER NAME AND BRANCH B G SETBACK FROM F NTPROP LINEOF (STREET) ADDRESS CITY Ct NIG WAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING SO FT A'w^ NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES 1 FAMILIES ONE O DESCRIPTION OF WORK aM ,A0cp NEW ❑ + DD BLDG SETBACK FR y SIDEPROP LINEOF (STREET) Z LTER ❑ HIGHWAY } YARD TOTAL SETBACK FR TYPE OF 1EXISTING EPAIR❑ SIDE PROP LINEI!NHWAYI WIDTH USE OF } EXISTING BLDG DEMOL ❑ APPLICANT TEL CORNER CUTOFF YES C] NO ❑ (PRINT) NO BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ oc lo CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (GATE) HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATIOR OF . LABOR 000E Of THE STATE OF CA IFORNIA IN RELATING TO WORKMCH S COMPENSATION IN5UAANpt SIGNATURE OF PERMITTEE ADDRESS 0t rP.iE. 2 FINAL BY CITY GIi McF'�TE NOL O DATE ll 11.L [ HLf IS P 11,1131-L 10PUT FEE FEE $ HARVEY T BRANDT COUNTY ENGINEER P �v ASo ESSM PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M 0 CASH Y1-e3 I Ar_ 3 0 3 6'73 SEP 4 1 D 2 8.50A Q 7SA630A CEN80312/72 I� APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (PNDr Pr rvice GDIY) RADDRESS ING COUNTY OF LOS ANGELES ESS94Q3 DEPARTMENT OF COUNTY ENGRTM CITYF Cl zip BUILDING' AND SAFETY DIVISION �/ NO OF BLDGS BUILDING 96Q,3 og F LOT-5-3 `/ NOW ON LOT �A�!! ADDRESS {7 BLOCK LOT NO !I LOCALITY TEL NEAREST 2 NO CROSS ST //�� ASSESSOR \ SS I-]k MAP BOOK PAGE PARCEL ZIP O DISTRICT GROUP CONST ZONE Y RE FIRE P SSED BY TECT OR TEL �A a EER NO STATISTICAL CLASSIFICATION EWER AP SS CLASS NO DWELL UNITS B PG ACTOR r " EL O�1r✓f.. USE ZONE NOP 0O�SS' /1 At �'NO CONN +' CSPECONDIIAL T ONS CITY r /Y lT LIC C G' l� R CLASS ROAD EPARTMENT APPROVAL REQUIRED YES❑ NOO CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM FRON PROP LINEOF (STREET) S ADEPT CITU _ TOTAL SETBACK FROM TYPE OF EXISTING SD FT NO OF NO OF CHECK HIGMW v } YARD - FRONT PROP LINE HIGHWAY WIDTH C SIZE STORIES FAMILIES ONE OESC RIPTION OF WORK NEW ❑ } DD Cl BLDG SET Z Ilk SI DE PROP LINE OF (STRE 1 ^ LTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY } YARD ETD SIDE PROP LINE HIGHWAY WIDTH EUSOF%EST NG BLDG �e �(� EMOL ❑ } im API LCA T Lez(�� NOL 2� CORNER CUTOFF YES ❑ NO ❑ BY (SIGNATURE) y/ IN OPEN SPACE YES ❑ NO t l� IN COASTAL ZONE YES NO ❑ VALUATION Y CATEGORICAL EXEMPTION YES NO I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCE! AND LAWS REGULATING BUILDING CON ITRYC TI ON I CERTIIY THAT IN DOING THE WORK AUTHORIIED IMPACT REPORT PROCESSED (DATE) HEREBY 1 WILL HOT EMPLOY ANY PERSON IN VIOLATION 01 THE LABOR CODE 01 THE STATE 01 CALIIORNIA IN RELATING TO WORKMEN S COMPENSATION INSURANCE SIGNATURE OF PERMITTEE p ADDRESS O GIC�j!/ UE /� CIE!( 2-7626 T ']I� FINAL BY CITYLEQ2Pi E- `.I1 NOL 2-762� DATE � � MA KF CIIECKS PAYABLE TO PC $ PMT FEE FEE HARVEY T BRANDT COUNTY ENGINEER / 7s PLAN CHECK VALIDATION CK M o CASH NN PERMIT VALIDATIO cN M o CAB. 6 1 3rJUN 6 1 A 2 1.7 5 Ayb ]BA 63SA CERS03 ]/]3 / /1 DEPARTMENT OF RIIII.DING AND SAFETY '2- APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO PLAN CK NC PERMITNO BUILDING 7 z eia L 69 ADDRESS G LOCALITY RECEIVED BY DATE OFF APPL DATEIBSUEED NEAREST V I NI� )VQ - 4 JU L' BADDRESSUILDING L OvmER _ / MAIL !�� / LCQALITV �� e ADD REBS %� 4 't T`��//�P / �/ /� � NEAREST Sl. ., 9dt/C NOL cwo9e 9T CITY FIRE NO OF TYPEtr GROUP ARCHITECTOR TEL ZONE PLANE ENGINEER NO SORO NO SETS ACK LINE T _ AnDRERS l APPROVED DAT[ By CONTRACTOR ��J UDE APPROVED AO R[ 2 / L �� (f�h/e ZONE /BY DAT[ LEGAL CORRECTIONS DESCRIPTION LOT ND Z BLOCK TRACT '7 NO OF BLoOB - 5, SIZE OF LOT J / NOW ON Lor USE Or NO xLr-- KXISTINUALDC1 FAMILIKIIO DESCRIPTION OF WORK NEW I ALTERATION ADDITION L REPAIR MOVING DEMOLISH SQ FT OF Z BfZ[ GaJ /I ROOMS ST RIES r WALLCOVERING ` 0 COVERING USE OF NEW BUILDING 1 r-7a ki — h CG+ dl q lev - 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLIDATICN AND STAT[ THAT THE ABOVE 19 CORRECT FOUNDATION LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION p ,/ A/k FRAME FIR[BTCPB. /� C BRACIN BOLTS L F 7 LATH, INT A 1 I LATH. EXT D • 8o PLASTER,INT PLASTEREXT. S F[[ S L r FINAL l_iDl ��Z IY• I V�� VORKERS COMPENSATION DECLARATION n •I Hereby pffIM1 that I have r certificate of canon, to see APPLICATION FOR' BUILDING PERMIT Jfsl ` Insuri; dr a .ir }that I of Worked Compensation Insurance or o certified copy thereof (Sec 3800, la CJ COUNTY OF LOS ANGELES BUILDING AND SAFETY Polity _Compony —� Btlltl>ING 2 Certified copy if hereby furnished FOR APPLICANT TO FILL IN iJ ADDRESS *CERICATE isfiled with the county bui Inspec- eUII0 NG !-.�`nt ADDRESS J/ LOCIWTYDateIlcom cmzIP ASSES sr P EF EXEMPTION FROM RKERS' 1 OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 3 NOW ON LOT MAP BOOK PACE PARCEL (This section need not be completed if the permit is for oneUSE E hundred dollars (f100)or Ian ) TRACT 48"� BLOCK LOT NO �� TEL ! SPECIAL I certify that in the performance of the work for which this OWNER NO CONDITIONS d permit is Issued, I shall not employ any person In any manner _ DISTRICT OOOIWUUP TYPE FIRE PROCE BV O so as to become subject to the Workers'Compensation Lows ADDRESS �J� 2 CONST/ Z� U Date Applicant CITY ZIP STATISTICAL CLASSIFJ TION L/ APT O NOTICE TO APPLICANT If, aher making this Certificate of ARCHITECT OR _ TEL �j� �j Exemption, you should become subject to the Workers NEER NO CIA55 NO ` DWELL UNITS_ 6 Compensation provisions of the Labor Code you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be2 deemed revoked CRACTOR TEL _ BK V PG /� VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby offirm that I am licensed under provisions of Chapter 9 ADDRESS (commencing with Section 7000)of Division 3 of the Busineand VALUATION ss LIC Professions Code and my license Is in full forte and effect CITY CLASS f 101 SO FT NO OF NO OF CHECK License Number.) �Lic CI_ SIZE STORIES FAMILIES ONE ��[�L[ DESCRIPTION WORK s NEW ❑ f Contractor r -s Date ADD2 4 9.8 A i I am exempt under Sec ALTER NNAL B 8P C for this reason NIV -IG2780 DAr REPAIR Q # 00 • • 23 Date EM_I NG BIDG%TE71su•! DEMOL IF B 1 - 22377 Signature APPLICANT TEL T • • 2 2 3 7 7 OWt I am exempt DECLARATION PRIM NO ► fL& C� I hereby off mm that I am exempt ham the Contractor's License .J 0719-85 Low for the following reason (Section 7031 5 Business and Professions Code) NG ❑ 1 as owner of the Y employees ADDRESS SS property, or m em to with ADDRESS 2 7 Q 6 A wages w their sole compensation,well do the work and the structure Is not Intended or offered for sale(Section QCALITY # • • • • • 1 7044, Business and Profepions Code) MOVING TEL 1 - 27375 E] 1,as owner of the property,am exclusively contracting CONTRACTOR NO with licensed contractors, to construct the project (Sec- e is tion 7044, Buuness and Professions Code) ADDRESS 2 7 3 7 5 5 IREEpD CONSTRUCTION LENDING AGENCY SET CK YARD HWV TOTAL SETBACK FROM EXPROP LINIF WIDTH , I \,j\ ` 0814 -85 I hereby affirm that there Is a cons"chon larding agencyfor pgOj,R -p i19• i 1 the performance of the work for which this permit s Issued P L ISec 3097, Civ C ) SIDE .7\ PL Lenders Name /� $ PC Fee f A Perms Fee i1n l Lender's Address I certify that I have read this application and &tote that the Issuance Fee V above mfoZ.rr,,I.nt to comply with all County Investigation Fee ordlrancmlisting to budding construction, Tolol F« ord hertives of tun County to enter U t erty far inspeyction Jodmoyl^ / 9 WE RIVEIM FOR EXPLANATORY LANWAGE Imnt a m �& APPLICATIONS FOR BUILDINGGPERMIT COUNTY OF LOS ANGELEAND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN ADDRESS ca I hereby affirm that I have a certdte of consent to sell Insure or a certificate of Nbrkers Comlpensation Insurance or a certified aUI � y /I� n copy thereof (Sac 3800 Lab C) Cm' \ ZIP LOCALITY fftj C / CJ ioO PdILy r'omPanY SIZE OF LOIF NO OF BLDGS NOW ON LOT ❑ Certified copy a hereby furnished I NEAREST CROSS ST ❑ ertm copy a flied withtre cWMy building IrlepecllOn TRACT BLOCK LOT NO dr depp artment I USE ZONE I MAP NO Date Applicant ASSESSOR MPP BOOK PAGE PARCEL SPECIAL CONOIT10N9 CERTIFICATE OF EXEMPTION FROM WORKERS OylNER TEL NO NO COMPENSATION INSURANCE — "� YOMIN 1000 FT OF ScffoOLa VES (Ths section need not be completed If the permit s for one hundred / / DISTRICT GROUP TYPE CC"ST RRE ZONE PROCESSED BY dollars ($100)or less) 1 certify that In the performance of the work for which this permit r tY 5 ItsSxled shell not empty eery person m any manner so as, t0 :M ITE OR ENGINEER TEL NO a .. become subtest to the workers Compensation Laos STATISTICAL CLASSIFICATKNI APT CONDO Date Applicant ADDRESS CLASS NO c/ DWELL UNrT9 NOTICE TO APPLM,ANT If after malung this Certdcate of REOUIR D TOTAL SETBACK FROM EXIST Exemption you Should become subject t0 the Yorkers CONTRACTOR TEL NO SET BACK 'ARD LfiNV PROP UNE WIDTH Compensat" provlslorm of the Labor Code you must forthwith FRONT comply with such provsuns or the permit shall be deemed revoked ADDRESS UC NO Pi, LICENSED CONTRACTORS DECLARATIONSIDE CRY LIC CLASS PL I hereby affirm that I am Icersed underpraAeiore M Chapter 9 SEWER MPP (commencing with Section 7000)Of DNSNon 3 of the B119Nr10ee and I SO FT 912E NO OF STORE3 to OF FlJAILE9 Professions Code and my license Is in full face and effect NEW ❑ BK PG , } License Number L,c Cleats DESCRIPTION OF PARK I ADD ❑ VALUATION Q¢ p FW Cantractor Date ALTER V $ A f U X ❑ 1 am exempt under Sec REPAIR ❑ B&PC for the reason DEMOL ❑ —=Pic• - LL Date USE OF EXISTING BLDG URM ❑ d �/67ture APPLICANT(PRINT) TEL rA LDMA Perm. 1 Z DBI as owner of the property or Try employees with wages as = their Ada comporsatron will do the work and the Structure is ADDRESS 0 _ _ not Intended or offered for sale (Section 7044 Busmass and FrNAL DATE G ��I I� Cc,413 Professions Code) wxL THE APRJGJR OR FI %BLI DNG OCCUPANT HMOIE A HAWiDa18 MATERIAL Z-Z '$</ 1 I i E6 ❑ as owner of the properly am exctuervey contracting with OR A MxTLRE CouwlrlG A MATERIAL EO To OR o T R THAM TUE Rg AAuurtS SPH011 ED ON TUE IND DOUG MATERALS n OVNI TUN Wu 7 licensed contractors to construct the protect (Sectan 7044 vEs❑ No ElFINAL BY i > l;itAL 6 6 _ 0 Business and Professions Code) triol THEINTENDED USE a TUE BUID NG BY TIE APPLKMT OR Rm.a Wnnwo L: OGGlTMN1 REQUIRE A PERMIT FOR aON$LRUCnpN OR AgCf£ATIpN FTKMA TIE SOIRH CHECK JJ.4L1 CONSTRUCTION LENDING AGENCY WAaT AIR OUMmY MANMEARM DNSIPoCL 19LAOMDI SEE PERMTTINO CIECKLItsT FOR a Uwe lNAr11.iE ,Ijij 1 hereby affirm that there Is a construction lending agency for YES❑ No❑ ,v the performance of the work for which the permit is Issued(Sec (HAVE READ TIEINZMruL61MTERIALts NFaauTroNaLOEAND T1E suwioFERurrTNo m 3097 CN C) p1ECA(113t LMEReGtO W REaiEMENTa LW ER THE UOS ANGELES CaMTY TRUE 2 CI 11 210 MGRONS 2 M IM T10iOLAH 210 140 CONCENiNG 11AI.AROaI£ (1 JU1Ci-40 V 1 '11i 15�4 T Lenders Name MATERALR REPORTNO AND FOR 06L 114G A P RNITT FnaM THE 5('1pMO Lender aAndress 771-1 1 FM 5.413 0 onrm wlrr .6-O 1 g f party that 1 have reed the application and stale under penalty d penury that above Information is ccorrectagree to comply PC FEE PERMIT FEE � with all county ordinances; and State laws relafirg to Wilding Conatructon and hereby authorize reprowntatnes of the County ISSUANCE FEE g to en upon the above- meed InepeCtpurposespuraee OS •r o pmII INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE IF