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Home My Public Portal About5208-5210-5212-5214 VILLAGE CIRCLE DR_Building__ c -- APPLICATION FOR BUILDING PERMIT / L FOR APPLICANT TO FILL IN (Print or type only) aUILDING COUNTY OF LOS ANGELES ADDRESS Dry DEPARTMENT OF COUNTY ENGINEER CITY ZIPBUILDING AND SAFE Y DIVISION LDG . NO.OF BBUILDING IV S'ZE OF LOTJjC OWON LOT ADDRESS 2" TRACT r G� 1 LOT NO LOCALITY TEL. NEAREST `OWNER S&VinggO ' CROSS ST. _ ASSESSOR ADDRESS6-1 MAP BOOK PAGE PARCEL -Take St. DISTRICT GROUP TYPE FIREP-ROCESSED BY CITY ZIP �� CONST.��. ZONE ,j ARCHITECT OR TEL. ENGINEER > + 0964-001. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS -ndjLASS NO._Z13_DWELL.UNITS t" 4 BK PG TEL. CONTRACTORNoelNO USE ZONE NOP LIC. ADDRESS Gra + NO. .i SPECIAL CITY q n LIC. CONDITIONS Teel: le Cit CLASS t-1 ❑ ❑ ROAD DEPARTMENT APPROVAL REQUIRED YES NO CONSTRUCTION LENDER C NAME AND BRANCH BLDG,SETBACK FPOM C. FRONT PROP.LINE OF ! ISTREETI �+ ADDRESS MT61RIES CITYH�,GHWAY + vARD TOTALSETBACK FROM TYPEOF EXISTING LA SQ. FT. O NO. OF FRONT PROP. LINE HIGHWAY WIDTH SIZE FAMILIES ONE p DESCRIPTION OF WORK NEW c r < CC vv�� ADD BLDG,SETBACK FROM - 4 .New Development SIDE PROP, LINE OF (STREET) ALTER ❑ _ TOTAL SETBACK FROM TYPE OF EXISTING ~ HIGHWAY + YARD - HIGHWAY WIDTH ✓✓✓ - - EPAIR❑ SIDE PROP. LINE USE OF 1 EMOL El EXISTING BLDG.$' h APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) Noel BaldwinN0. •�� BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ Q IN COASTAL ZONE YES [:] NO [:]VALUATION$ 8 \/j/�OO OO - CATEGORICAL EXEMPTION YES❑ NO I.H EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL 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 VIOLA-4 OF THE LABOR CODFE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF PERMITTEE ADDRESS 10017 amailen Street /q FINAL BY CITY Temple Cit ".. DATE Temple P.C. $ _. PMT.$ 1 KL c Hl.( K 1'.-1 l:l til_) 7Z0: FEE d+ FEE D HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CK M 0 CASH _ PERMIT VALIDATION CK M O CASH 76A638A CE*803 7/73 CE`W3(REV.11/78) •• "" �• APPLICATION FOR BUILDING PERMIT . COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDINGr ADDRESS u BUILDING -� / ADDRESS I • V l j�l-. C eiC[O b , LOCALITY _ CITY C' Ip ZIP NEAREST CROSSST. NO.OF BLDGS. ASSESSOR. SIZE OF LOT NOW ON LOT MAP BOOK PAG PARCEL e� t DISTRICT " GROUP TYPE FIRE PRO ED BY TRACT I=TT/' BLOCK LOT NO.. '��/ CONST. ZONE TEL OWNER Al , W�Ij NO. /0 STATISTICAL CLASSIFICATION SEWER MAP ADDRESS G CLASS NO. - DWELL.UNITS-i BK . 3G CITY ZIP ARCHITECT OR TEL. VALUATION $ ENGINEER NO. j ADDRESS BLDG.SETBACK FROM ee� TEL ,j�7 FRONT PROP.LINE OF (STREET) CONTRACTOR vl Nfc 4�s e sT1�l/�' NOYC /-/a Z TOTAL SETBACK FROM TYPE OF EXISTING LIC HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH ADDRESS �W N G'/}L N NO. 1744 _ ' C. + - - CITY (d CLILASS gf CONSTRUCTION LENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING 1 ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH. 0 SQ.FT. NO.OF NO.OF CHECK + = V SIZE STORIES FAMILIES. ONE USE ZONE MAP DESCRIPTION OF WORK NEW - O Q 1p� SPECIAL / S()N �F `�TC ADD E] 1 P. CONDITIONS• � l ALTER 0 FINAL / pBY L Z 6 "�-J JLAZ6;_� REPAIR ❑ DATE (p O USE OF RC�1 PI C At C'� DEMOL ❑ ' EXISTING BLDG. p /�-�. . mac.,. (A- k%/:� O . APPLICANT (PRINT)�I/vC'Cr / �aS% rj� N0.7'T� 6 0-2 7'ZI Q BY(SIGNATURE) GLt�L+GG( D I HEREBY ACKNOWLEDGE THAT I HAVE ZD THIS APPLICATION AND STATE V THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES au AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE . {=J 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." `• �0 2 1.8 n . SIGNATURE OF /, 0 0 0 0 0 1 PERMITTEE _ ADDRESS 7 6- Z 2 0 0 3 4 0 0 O ,p ,p TEL. CITY NO, o 0 o 3 4,0 0 �` ( - � . . 0506-80 P.C.Fee$ Permit Fee Issuance Fee W AL Toto_)Fee �. WORKERS' COMPENSATION DECLARATION T hereby affirm that I have r certificate of consent to self APPLICATION FOR BUILDING P E RM I T •�sVri3„o'r b-certificate of Workers'Compensation Insurance, or a certif!a co y 41sreby Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Po'cy No. mpany Certified cofurnished. FOR APPLICANT TO FI IN YJ BUILDING PADDRESS Certified copy is filed with the county buildin ins c BUILDING ^ tion dep rt ent. ADDRESS Ob LADate Applicant L� � ZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKER SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAPB K PAGE PARCEL hundred dollars ($100)or less.) TEL. OWNER NO. USE ZONE MAP I certify that in the performance of the work for which this NO. 2-73 permit is issued,I shall not em in any manner ADDRESS �� SPECIAL CONa CONDITIONS so as t ecome subject a Wofi� ork rWe ompe n Laws. O CITY ZIP U Date Applicant ARCHITECT OR TEL• DISTRICT GROUP TYPE FIRE PROCESSED BY Ix NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER CONST. _ / ZOAIE O Exemption, you should become subject to the Workers' 71/ \.:lC U Compensation provisions of the Labor Code, you must forth- ADDRESS z a with comply with such provisions or this permit shall beTEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRA OR 1 O. n, Z LICENSED CONTRACTORS LARATION C. CLASS NO. DWELL. UNITS — visions hereby affirm that I am licensed un r provisions of Chapter 9 ADDRESS • (commencing with Secti n 000)of iv !on 3 of the usiness LIC. SEWER MAP and Professions Co a i is in full force CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO.OF CHE License Numb Lic. Class SIZE STORIES Z_ I FAMILIES ONE D RIPTION OF W RK��j(� ,F NEW ' VALUATION Contract r ate py�p $ ❑I am exempt un r Sec p k 14” ❑ , B.BP.C. for this reaso N Ir ALTER ❑ $ REPAIR EXISTING BLDG. r . , OL ❑ Signature APPLICANTTEL• FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE 1 hereby affirm that I am exempt from the Contractor's License ADDRESS Law for the following reason (Section 7031.5, Business and e AL t Professions Code): PRESENT BY BUILDINGEl I, as owner of the property, or my employees with ADDRESS ;.,r•.,. wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY Poo :�•I ? . - �� 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. s s i t with licensed contractors to construct the project (Sec- ADDRESS IML 249 - 68 tion 7044; Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. •- CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH U"��E•li `•t'L` '� I hereby affirm that there is a construction lending a enc for FRONT -.� 1 the performance of the work for which t ' mit is issu P.L. i' fiN3 {? (Sec. 3097, Civ. C.). SIDE P.L. Lenders Name y� LDMA Ref. # P.C. Fee$ Permit Fee Lenders Address I certify that I have vad this application and slate that the Issuance Fee 71LDMAP/C# above information is correct. I agree to co ply with all County Investigation Fee ordinances and State laws relating [ding construction, Total Fee ��V� LDMA Perm. # and hereby ay ori re resentativ is County to enter /� n the alfa - n i n per ction purpos o f �---� SEE REVERSE FOR EXPLANATORY LANGUAGE aSigA to oa