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Home My Public Portal About5201-5203 VILLAGE CIRCLE DR_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) S' i; CING COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY ZIP ) BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING 'ZE OF LOT NOW ON LOT ADDRESS '�v TRACT ""� Bt0 ` LOT NO LOCALITY = _ TEL. NEAREST OWNER NO. CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT IGROUPITYPE FIRE PROCESSED BY CITU ZIP _ CONST.. ZONE. =r �.- ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CLASSIFICATION SEWER AP ADDRESS - CLASS NO.,'- �__""DWELL.UNITS± 'r»"' BK PG CONTRACTOR TECLASS USE ZONE MAP '✓, / LIC. NO. :� ' •/ (,.•; ADDRESS NO• SPECIAL CITY LIC. ` CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ G CONSTRUCTION LENDER C NAME AND BRANCH BLOG.SETBACK FPOM c_ FRONT PROP.LINE OF (STREET) 4 ADDRESS CITY HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE 4 SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH Z - �' > _ 4 DESCRIPTION OF WORK NEW ❑ + C ❑ BLDG.SETBACK FROM CL ADD SIDE PROP. LINE OF ISTREET'� 4 ALTER ❑ - TOTAL SETBACK FROM TYPE OF EXISTING ~ HIGHWAY + YARD = HIGHWAY WIDTH REPAIR❑ SIDE PROP. LINE USE OF } _ EXISTING BLDG. DEMOL ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ Q IN COASTAL ZONE YES ❑ NO [:]VALUATION Y CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY 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 ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LAI aOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WO R KAQ£M'9^�C@ M.PENSATION INSURANCE. SIGNATURE OF ��; -;t �.. •'j PERMITTEE ADDRESS �- _ FINAL BY TEL. E CITY r �_.. �..... N O. :j ..,. �!AR : <./it_( K1 P.1}�:113Lfi �10: ' C. Q PMT. FEE $ FEE HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION CK M O CASH 76A638A CE#803 7/73 j � APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) FADDRESS COUNTY OF LOS ANGELES d —a3 DEPARTMENT OF COUNTY ENGINEER rZIP BUILDING AND SAFETY DIVISION O.OF BLDGS. BUILDINGOT NOW ON LOT ADDRESS �-� L r. TRACT BLOCK LOT NO. LOCALITY �e TEL. NEAREST OWN NO. CROSS ST. ASSESSOR ADDRESS / ddo MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIREd�P�SSED BY CITY ZIP CONST ZONE t ARCHITECT OR TEL. O _ ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS BK PG TEL. CONTRACTOR NO Q 'USE ZONE MA LIC 10. ADDRESS 17 SPECIAL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDCj.SETBACK FROM FRO PROP.LINE OF (STREET) ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING SQ. F NO. OF NO. OF CHECK HIGH + YARD - FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES -ONE a DESCRIPTION OF WORK NEW 1:1 BLDG.SETBACK FROM CJ ADD ❑ SIDE PROP.LINE OF (STREET) Cr ALTER ❑ _ TOTAL SETBACK F TYPE OF EXISTING I- HIGHWAY + YARD - AY WIDTH C� REPAIR❑ SIDE PROP. LINE 1.1 USE OF _ a N EXISTING BLDG. DEMOL 13 + Z APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO 13 IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY C WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- • �N� STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED MERE WILL NOT EMPLOY ANY PERSON IOLATION OF THE LAB CODE 0 E 5T�1TE •CA RN IN REL G TO WOR PE 'A NON IN ANC — / -75- SIGNATURE O PERMITTEE ADDRESS TELFINAL BY CITY /c4 NO. DATE . �� aa MAKE CHECKS PAYABLE TO: FEE'$ FEE 'I' HARVEY T. BRANDT, COUNTY ENGINEER f4f. PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO K. M.O. CASH 004cu-"FEB �_'8 1 158.85090 7GA638A CH*803 5/74 / ®S 78#688( , CE#803(RAV.6/78) ' APPLICATION FOR BUILDING- PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN' BUILDING ADDRESSL' 1i BUILDING ,r ADDRESS V 1 LL" Pr % eLC. . LOCALITY NEAREST CITY C j' (� ry& ZIP•' /• CROSS ST. A4 fUJ CQ.(.t_. ti NO.OF BLDGS. I ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCES BY TRACT K LOT NO. i 18> 3 CONST ZC1A�E ✓ 'TEL. U � '- OWNER �' Al NO.�] S'�O`J�jc �y STATISTICAL CLASSIFICATION COWER MAP ADDRE LL WL,o / b R+ CLASS NO. :2- j DWELL.UNITS 8K PG rG CITY (�C' p�Y Y C/ ZIP / U ARCHITECT OR TEL VALUATION ENGINEER NO. ADDRESS ' 1 y e BLDG.SETBACK FROM CONTRACTORU N e L .�7 e0 5 r�AQ!NOL `1ST FRONT PROP.LINE OF (STREET) ) / HIGHWAY + YARD = TOTAL SETBACK FROM TYPE A EXISTING ADDRESS /LV,A 0 N(:Dd'Al LIC.NOJU 6 FRONT PROP.LINE HIGHWAY WIDTH CITY /Ct�A IO®G� CLASS �' 1;2 + BLDG,SETBACK FROM CONSTRUCTION LENDER NAME AND BRANCH SIDE PROP.LINE OF (STREET( HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SQ.FT. NO.OF NO.OF CHECK + _ SIZE STORIES FAMILIES. ONE &S DESCRIPTION OF WORK r r(r NEW ❑ P.C.Fee$ Permit Fee '�' 9 Q ADD ❑ Issuance Fee / ALTER ❑ REPAIR ❑ Total Fee USE OF EXISTING BLDG. Nr tL 119 (_ DEMOL ❑ Z APPLICANT TEL - C (PRINT)VlN e-c- erosr VrN0.�y77IT?2 a c BY(SIGNATURE) > I HEREBY ACKNOWLEDGE THAT I HAVE REA IS APPLICATION AND STATE Y THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES w AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE _ 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- Z PENSATION INSURANCE. . -2 6 2 9.7 A- d R SIGNATUREO # o o i 0 0 0 1 PERMITTEE �� a ADDRESS — Z 2 0 0 2 2.0 CITY NO.- Q — 2200H O USE ZONE OP U a 08.2 3-79 P�✓ SPECIAL CONDITIONS FINAL //--7�J BY IL DATE l p WORKERS' COMPENSATION DECLARATION Thereby,affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T •i,�sure, or b certificate of Workers' Compensation;Iyuncor a cerfifi d p ther f (Sec. 3800, La . C. COUNTY OF LOS ANGELES BUILDING AND SAFETY 'Po No. _ Company BUILDING Certi ied copy i hereby furnished. ' _�.J" FOR APPLICANT TO FILL ADDRESS Certified copy is filed with the county building inspeBUILDING on dep mment. tiJ_ ADDRESS `(� r Date �I Aplicant , 13L CITY ZIP LocLOCALITYO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT B K LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) C �/ TEL' �J f USE ZONE MAP OWNER i G / NO. /! NO. 1 certify that in the performance of th c or . ich this / l - permit is issued, I shall not empl y person in any manner ADDRESS ` �• T ) SPECIAL / CONDITIONS so as to become subject to orkers Compensation Laws. 0 CITY A. ZIP 7-0 Date Applicant ARCHITECT OR TEL. DISTRICT GROUP PE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. ONST. ZO F- Exemption, you should become subject to the Workers' e w Compensation provisions of the Labor Code, you must forth- ADDRESS i � -s 0- with with comply with such provisions or this permit shall be T TEL. STATISTICAL CLASSIF ATION APT. CONDO. Z deemed revoked. CONTRACTOR – NO. _ LICENSED CONTRACTORS D LARATION rJ �, LIC. CLASS NO. I DWELL. UNITS I hereby affirm that I am licensed and provisions of Chapter 9 ADDRESS L, NO. (commencing with Sec'on 7000)of givision 3 of the Business nA� LIC. SEWER MAP and Professions Code, nd a is in full forc n ct. CITY f1"/ 6f CLAP/ BK. PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number L • Class SIZE STORIES AMILI ONE �J VALUATI r�A�y,/�((i�� Contract0 1 ateelq(� DESCRIPTION OF WORK EW ❑ $ UV6, ❑1 am exempt under Sec. t r XLTEADD ❑ f (f , ALTER ❑ B.BP.C. for t�S=—Dcrte: LW'OF �'•�' REPAIR $ hr I EXISTIN BLDG. . EMOL Signature APPLICANT OWNER-BUILDER DECLARATION (PRINT) FINAL 2 h- DATE V I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS t -e FINAL Professions Code): PRESENT V By i ❑ I, as owner of the property, or m employees with BUILDING P P Y� YADDRESS q:'_.j ,7 wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. - r - CONTRACTOR NO. � I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS , tion 7044, Business and Professions Code.) ��' -` CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAPROPALINEFROM WIDTH I hereby affirm that there is a construction lending agency for FRONT :�,:,--• the performance of the work for which this ermit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name f i!: r LDMA Ref. # P.C. Fee$ Permit Fee 9 • ,t, ,, •� Lender's Address _ , _:� s i-!i s. I certify that I have read this application and state that the Issuance Fee �s LDMA P/C# '- above information is corraivs with all County Investigation Fee �• 3 ordinances nd State lag construction, Total Fee / �• LDMA Perm. # and her u ori reounty to enter up t abo e e ontijnp po SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of App aDate