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HomeMy Public PortalAbout9855 VAL ST_Building__ APPLICATION FOR BUILDING PERMIT FOR #-PLIGANT M FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS XA I DEPARTMENT OF COUNTY ENGINEER CITY .---- ge_ / zIP BUILDING AND SAFETY DIVISION O.OF SLOGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS r L TRACT BLOCK LOT NO. LOCALITY TEL. NEAREST d /. ^s OWNER f NO. CROSS ST. . i' �r+ ASSESSOR ADDRESS sJ fPAI MAP BOOK -PAGE PARCEL ! DISTRICT GROUP TYPE FIRE PROCESSED BY CITY ZIP CONST. ZO ARCHITECT CrR TEL. ENGINEER NO. STATISTICAL CLgqAS�6SIFICATION SEWER MAP ADDRESS CLASS NO.2LDWELL,UNITS SK PG CONTRACTOR J' T/ T040 No USE ZONE MAP LIG. //�J NO. 10 - ADDRESS f NO. /� SPECIAL Ly LIC. O CONDITIONS CITY CLASS OAD EPARTMENTAPPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.S BACK FROM C FRONT P LINE OF (STREET) ADDRESS CITY C HIGHWAY + ARD TOTAL SETBACK FROM TYPE OF EXISTING C' SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY1 WIDTH p SIZE STORIES FAMILIES ONE F E] 4 - DESCRIPTION OF WORK - d NEW a ADD ❑ BLDG.SETBACK FROM CIO (STREET) ? SIDE PROP.LINE OF ALTER ❑ IGHWAY + YARD = TOTAL SE FROM TYPE OF EXISTING REPAIR SIDE PROP. LI HIGHWAY WIDTH USE OF DEMOL El EXISTING BLDG. APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ Q IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ d CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 15 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 ATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIF O N IN RELATI G TO WORKMEN'S COMPENS TION IN AN SIGNATURE 1F PERMITTEE ADDRESS—/ FINAL CITY /I/CJle&Oddtl(/14 NTE OL• ./ DATE�Ql��h3 BY MAKEC.HEC KS PAYABLE TO: FEE $ FEE HARVEY T. BRANDT, COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 29727 2*8 7BA538A CE NS03 12/72 S' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I reby IthW I have a certificate sof consent to self, i e, or a certificate of Workers' Compensation Insurance, or certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY P icy loo. Company BUILDING G V irit /n '�❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS .,( s ❑ Certified copy is filed with the county building inspec- BUILDING 1 �C VA(, � tion department. ADDRESS 1 J ) 1 CITY `�P1n L Q L ZIP LOCALITY e Date Applicant NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT CO6 NOW ON LOT CROSS ST. O COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) •�C't H p u TEL, OWNER S` CN C-6C N G NO, USE ZONE MAP �''� I certify that in the performance of the work for which this _ ��JJ��,,�� NO. permit is issued, I shall not employ any person in any manner ADDRESS S S(7 r AA2—'� � SPECIAL a CONDITIONS so as to become subject to the Work rs' o ensatio Laws. CITY ��fA e� c t O ZIP Date `�` Applicant ARCHITECT OR A_S�w TEL o ��pp- NOTICE TO APPLI NT: If, a r a g this Certificat ENGINEER G(fi1N6 41SOu�ZENO.�(8-297 DISTRICT GROUP TYPE FIRE PROCESSED BY Q Exemption, you s ould become subject to the Wo rs' �} �s L p Q CONST. ZONE w Compensation provisions of the Labor Code, you must forth- ADDRESS f3q J 1� �G �7 Z'12 {4 1 S` D� a- with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 2� DWELL. UNITS—]— hereby NITShereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FTNO. OF r1 NO.OF ` CHECK License Number Lic. Class SIZE �'jt'J STORIES 2 FAMILIES ! ONE VALUATION C- c Contractor Date DESCRIPTION OF WORK NEW $ 0,661),O V1) �W ❑I am exempt under Sec. �lqew CzNr7T12+VC 1Z0t� Q-k3nJ•OONAS ADD ❑ BAP.C. for this reason e�,�,� Dmxis J*GARAI lF ALTER ❑ $ �iLoH•oe USE OF REPAIR ❑ /�� G �' Date: EXISTING BLDG. D ❑ lam' 1 Signature APPLICANT �P(tG� TEL.p ta'�Z�gI FINAL OWNER-BUILDER DECLARATION ( �(�N NO. DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS 17J S F11 �(rw�G )�' Ivl ' Law for the following reason (Section 7031.5, Business and FINAL Professions Code): PRESENT n By /�/+ ❑ I, as owner of the property, or my employees with ADDRESS V1� A44ToV wages as their sole compensation,will do the work and LOCALITY , X307 1210,2� the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. 1 ITEMS I, as owner of the property,am exclusively contracting rDDRE NO. with licensed contractors to construct the project (Sec- TOTAL 1210025 DTH tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY YARD HWY TOTAPROP LICK ROM WAIST. CHECK 1 iDo `.t I hereby affirm that there is a construction lending agency for o00 the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name ((�� LDnnA Ref.# 0000-0001 3�28��Lender's Address D Io,00 Permit Fee / �/' .J� 5341 1 AM11324 0 1 certify that I have read this application and state that the Issuance Fee U' v LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee 8 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # a and hereby out orize representatives of this County to enter upon t• -menti roperty for inspection urpostsg. i /��. C/ SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Applicant or t Date o' COMP4NSATION°DECLARATION ' . � AL1 Iz APPLICATION FOR BUILDING PERMIT I hereby I tha' I have a ce�fificate sof consent to sel, insure, or uZ ertificafe of Workers' Compensation rnEtirance,` or'o certified copy thereof (Sec. 3800,-Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pce)icy No. Company I ❑ Certified copy is hereby furnished. FAUDDRE OR APPLICANT TO FILL IN BUILDING p �/' L _5 ADDRESS O V ❑ Certified copy is filed with the county building inspec- �(�(� S tion department. /n� Date Applicant '` ZI q/ J? 0 LOCALITY ` NO.OF BLDGS. NEARESTCERTIFICATE OF EXEMPTION FROM WORKERS' I NOW ON LOT CROSS ST. COMPENSATION INSURANCE , ASSESSOR (This section need not be completed if the permit is for one (f BLOCK LOT NO. ( Z MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) �r f TEL.( G NO. UPON] Op I certify that in the performance of the work for which this �. } permit is issued, I shall not employ any person in any manner ADDRESS q DIT SPECIALIONS o_ so as to become subject to the Workers'Compensation Laws. �- Q CITY `T��'1 pLV, U�'f ZIP o Date Applicant ARCHITECT OR TEL,C t W ° NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER C='wQ/(1 NO. DISTRICT G OUP TYPE FIRE PROCESSED BY Q Exemption, you should become subject t the Workers' S CONST IEE r f r LU Compensation provisions of the Labor Code, you must forth- ADDRESS /Z- /Ic ✓�S //�Vl L`J W with comply with such provisions or this permit shall be TEL deemed revoked. CONTRACTOR NO. STATISTICAL CLASSIFICATION AP CONDO. Z _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS ; I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. LIC. SEWER MAP At•t-y A (commencing with Section 7000)of Division 3 of the Business � 1-tog and Professions Code,and my license is in full force and effect. CITYCLASS 3304r^—" ^T'0" , .�adALIDATION SQ. Fr" NO. OF P� NO. OF CHECK BK' �' 330 r 7�h,Ci= License Number Lic. Class SIZE STORIES FAMILIES ONE VALU TIO TOTAL DESCRIPTION OF WORK NEW rP.' • 1 OTAL 786 o 05 Contractor Date ADD ❑ ❑I am exempt under Sec. °L VW _1r—P. �� ALTER ❑ ► CHECK !v.5 B.BP.C. for this reason Z� V REPAIR ❑ s � 0001 CHANGE .011Date' USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT(P NT) G. NO 7,0 fj FINAL IJr.�00-0001 111-40130, OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS" N S,��u 10 7161 1 AMICI°1;' Law for the following reason (Section 7031.5, Business and ` FINAL Professions Code): PRESENT By ��_ � ❑ I, as owner of the propert;, or m employees with BUILDING C-1 P P Y� YADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. NTRACTOR NO. I, as owner of the property,am exclusively contracting CO , with licensed contractors to construct the project (Sec- ADDRESS s�.r-1�P 1 NSI dye 14 tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. SET BACK PROP. LINE 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 P.L. Lender's Name /'� r MA Ref. # Lender's Address P.C. Fee$ a ♦ I✓� Permit Fee I certify that I have read this application and state that the - s a-5 Issuance Fee 3 1 O LDMA F/C# above information is correct. I agree to comply with all County Investigation Fee V ordinances and State laws relating to building construction, Total Fee 14 LDMA perm. # and hereby authorize representatives of this County to enter upo the above-mentioned pro erty for inspection purposes. ¢!a nJ Cp-�. F°-- ,1. n S REV E FOR EXPLANATORY LANG AGE � C7 77 "C 3O Signature of Applicant or Agent Dat€ /( - D, , � ,p = /�I�r �q r „_ �IZ/ I`�(-rr_6't/1"J ,/�/ Vllf�J�, IJP _F,_ ` /.,�S'COMPENSATION DECLARATION 1 U I��` � �' igberebor icd I have a ce�tC mte'of consent r self, APPLICATION FOR BUILDING PERMIT s)ure, or 'Certificate of Workers' Compensation I'nsurance,' or a,,,,certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pglicy NoQ_�Company ti ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 5 L S� PY� Y ADDRESS Certified copy isfiled with t jo ,building inspec- BUILDING /^ 1 tion department. ADDRESS A l.. Date — Applicant CI Y L PLC C l ZIP LOCALITY O. OF BLDGS. NEAREST ! I CERTIFICATE OF EXEMPTIO FR M WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. L COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. USE ZONE MAP OWNER Q NO. n NO. I certify that in the performance of the work for which this SLI r. t C Q(� SPECIAL � 15 9 e791/3 CY permit is issued, I shall not employ any person in any manner ADDRESS .�7 RLA, U` CONDITIONSCL so as to become subject to the Workers'Compensation Laws. O CITY N e'l C zip Date Applicant ARCHITECT OR TEL. IY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE ROCESSED BY CONST. ZONE 0 Compensation o Exemption, you should become subject to the Workers- I �/ �� � �Q IL Com ensation provisions of the Labor Code, you must forth- ADDRESS o V�-+ W with comply with such provisions or this permit shall be TEL. /� STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR &, NO. % n Z_ LICENSED CONTRACTORS DECLARATION LIC. CLASS No. _DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1J NO. � (commencing with Section 7000)of Division 3 of the Business r LIC. ��yy SEWER MAP and Professions Code,and my license is in full force and effect. CITY Cj) Q rIkA CLASS 1, - � BKL PG 21Q VALIDATION SQ. FT. NO OF NO.OF J CHECK License Number Lic. Class y/-1�_ SIZE / ©� STORIES FAMILIES J ONE PG Contractor C��l .� t;/l lDete 1r "�G DESCRIPTION OF WORK NEW ❑ SALUATION O� ADD ❑ �0' `� ► JW 2 ❑I am exempt under Sec. �Yb'_:J l t c9 rJ ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL Signature APPLICANT TEL, OWNER-BUILDER DECLARATION (PRINT) L �{. O. _ i �' FINAL I hereby affirm that I am exempt from the Contractor's License /► /� DATE �i Low for the following reason (Section 7031.5, Business and ADDRESS a t i. f" f0so-i )1� Al 440v FINAL V C� 37407 60.50 Professions Code): PRESENT By Elproperty, Y P Y I, as owner of the or m employees ees with BUILDING 1 ITEMS wages as their sole compensation,will do the work and LOCALITY ' Tf3� o the structure is not intended or offered for sale(Section 50 7044, Business and Professions Code.) MOVING TEL. CHECK t(�e�t; ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. H v 4. with licensed contractors to construct the project (Sec- CHANGE .013 tion 7044, Business and Professions Code.) ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT OOOO-Ot9O�, 9/11/89 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 5625 1 AM iO n-21 P.L. Lender's Name 3 P.C. Fee$ Permit Fee 010.4 LDMA Ref. q nder's Address rt! that I have re. this application and state that the Issuance Fee b LDMA P/C# b v i ormation is co r ct. I agree to comply with all County Investigation Fee r n c s and State I s relating to building construction, Total Fee 0+5 LDMA Perm. # n he e y outho' e r resentatives of this County to enter h ov;im do top rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applica or Agent ate