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Home My Public Portal About5502 WELLAND AVE_Building__ pper�}► _ •fpr- 76A638A CE#8032-63 P ICATION FOR BUILDING 'PERMIT CO Y O' LOS ANBUILDING DEPART T O COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITYY JOHN A. LAMBIE, COUNTY-ENGINEER NEAREST 1 WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST. DIS CT N GRO P 'TYPE P OCE BY 'FOR APPLICANT TO FILL'IN Co BUILDING ��++��c++ a� STATISTICAL CYFIGATIONWER MAPS ADDRESS . 702 A-), ��/1d >Tv�. ,q CLASS. NO. DWELL.UNITS LOT NO. 2O Cp �is'f �'r�'/� BLOCK P! CWATER ERTIFICATE; NOT REQUIRED RECEIVED TRACT `Q v NO. Q (c�RCWEI STATE MAJOR SECOND CAL NO.OF BLDGS. r� SIZE OF LOT A&# ,tic � NOW ON LOT 2/ USE ZONE SPECIAL USE OF �p CONDITIONS EXISTING BLDG. �.,� EL � r • OWNER ti^,..�I�'V1J NO.=Z!'97 BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS ISi�2 v.4/0,diaad �.r FRONT 51, ARCHITECT OR TEL. P. L. ENGINEER _ NO. SIDE ) 2 ADDRESS TEL. I O CONTRACTOJO Z4,1 Alel NO. ��q � _ ��. I O ADDRESS' ll /� ' V DESCRIPTION OF WORK `'� �- nW, NEW ADD ALTER REPAIR DEMOLISH 'I -� SQ.FT. �/i�Qn NO.OF _ NO. OF SIZE T�7IfI STORIES FAMILIES 1 f USE OF STRUCTURE oat •+' SIGNATURE OF APPLICANT VALUATION S ,-3 APPROVALS DATE INSPECTOR'S SICANATURE fPMTFOUND F / FEES � FORMATION: LOCATION S. MATERIALS . FRAME: FIRE STOPS, ' I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT. THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. J WITH ALL 'COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS .BUILDING CONSTRUCTION. I CERTIFY THAT IN, DOING THE-WORK -. AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANC -LATH.EXT.. SIGNATURE OF✓/ HOUSE NUMBER COR- PERMITTEE REGT AND POSTED ADDRESS FINAL i JOHN F. LEWIS, PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERDIIIT VALIDATION CK. M.O. CASH u"Lo 8 1 7.a A°R 28- . 1 'p 6.00-. . � 'JWORKERS' COMPENSATION DECLARATION 'I h3reby affirm that i hove r certificate C mte of consent r Self APPLICATION FOR BUILDING PERMIT ir�;�u�, or a certificate of Workers' Compensation Insurance, or a caYtified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS t a V C i,04N ❑ Certified copy is filed with the county building inspec- BUILDING to ,' (� t L•.f !✓ tion department. ADDRESS , i; ` -` L 01, ' , CITY ,Y fs IfiCr I—A !�) ZIP LOCALITY Date Applicant r s NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT ( CROSSSST. �% 1 V 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.) (v y TEL. OWNER L L j\ /�y � MAP Lf NO. USE ZONE NO. I certify that in the performance of the work for which this R/ SPECIAL a CL is issued, I shall not employ any person in any manner ADDRESS CONDITIONS so as to become subject to the Workers'Compensation Laws. 0 CITY ZIP Date Applicant ARCHITECT OR TEL. gy NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE ROCESSED BY O D !2CONST. ZONE Exemption, you should become subject to the Workers' h Compensation provisions of the Labor Code, you must forth- ADDRESS �r 6� a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR r NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY CLASS 11 BK rbPG VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lic. Class SIZE Z STORIES f FAMILIES ( ONE Contractor Date DESCRIPTION OF WORK 1(v &ed JbAV-" NEW ❑71 VALLU�[ATION El I am exempt under Sec. �� - � ADD L^J $ `Q0'3q ' polot�lp(��! ALTER ❑ BAP.C. for this reason th.� REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ 1 yjr� APPLICANT'" L. Sig ure - /� / NO FINAL OWNER-BUILDER DECLARAs�ON (PRINT:. _�-/0/9 t.1 I hereby affirm that I am exempt from the Contractor's License !�- DATE Law for the following reason (Section 7031.5, Business and ADDRESS r�s�Z W r UPWO rL FINAL �(4j1 Professions Code): A�+rvyav PRESENT L B ACC i BUILDING �7r✓L W t':LLJF/Y1) y ❑ I, as owner of the property, or my employees with ADDRESS %-V3307 21$°63 wages as their sole compensation,will do the work and r4 jtii L t T CA the structure is not intended or offered for sale(Section LOCALITY pop1 1TEMS 7044, Business and Professions Code.) MOVING J TEL. CONTRACTOR fL ! NO. TOTAL 2118 .63 ❑ I,as owner of the property,am exclusively contractingt with licensed contractors to construct the project (Sec- ADDRESS CHECK 218.63 tion 7044, Business and Professions Code.) p�q {_� CONSTRUCTION LENDING AGENCY SE YARD YARD HWY ED TOTAL SETBACK FROM EXIST. ,' 1 `•rTr+�t`11M o00 I hereby affirm that there is a construction lending agency for FRONT ' the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE Lender's Name 13 LDMA Ref. # 1 Iii 9005 P.C. Fee$ Permit Fee Lenders Address I certify that I have read this application and state that the Issuance Fee 1(�.r LDMA P/C# , above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT �L COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING _ BUILDING ADDRESSADd� I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY - �� /L( ZIP / LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NO ON OT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. /`D�77 ASSESSOR MAP BO PAGE / PARCE h Date Applicant 3 � 0'L,Y� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER JE NO. YES NO COMPENSATION INSURANCE 47 dAI �D�v�/� �'`� f�Af0- y WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS �� V V � DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITYZIP I certify that in the performance of the work for which this permit �fi, L� �r � �G7� is issued, I shall not employ any person in any manner so as to ARCHITECT OR GINEER TEL NO. become,subject to the Workers'Compensation La`... STATISTICAL CLASSIFICATION APT CONDO XDat Applicant div r a ADDRESS CLASS NO.,-'?/ DWELL UNITS NOTICE TO APPLICANT If, after making this ertificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTRACTOR w TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith rl-r-9 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovislons of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO,OF STORIES NO,OF FAMILIES Professions Code,and my license is in full force and effect. NEW 11 BK PG , a License Number LIC.Class DESCRIPTION OF WORK ADD ❑ VALUATION 0 Contractor Date ALTER �S"Da r U TMC, �t 1 CC PCA k lacy REPAIR ❑ O ❑ 1 am exempt under Sec. - _ $ i V BAP.C.for this reason DEMOL 11 TDMA P/C# 4 i-. W Date: USE OF EXISTING BLDG. URM ❑ a" co Ignature APPLICANT(PRINT) TEL NO. LDMA Perm# G `j°"'Z as owner of the property, or my employees with wages as 0 13 TE their sole compensation, will do the work and the structure is ADDRESS 1`F't: _ not intended or offered for sale (Section 7044, Business and rFINAL DATE Q TOTAL�fL 10E L+ o l Professions Code.) HAZARDOUS - lrTr�•'f� i,' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OREA ER THAN THE ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? BY �! j:Hrh�1�� 1;1 licensed contractors to construct the project (Section 7044, YES NO 11 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR Il)'1 L-1 9- i j/ ILS fk s_7 GUIDELINES. _jIL -t t I hereby affirm that there is a construction lending agency for YES❑ No❑ 8 ';E .i5 a the performance of the work for which this permit is issued(Sec. -'- -I 0) 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING N 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. In Lender's Address 0 OWNER OR AGENT Z; I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building �D ;5 construction,and hereby authorize representatives of this County ISSUANCE FEE ato enter upon the above-m tinned gro�/pe�9 for inspection purposes. (p 110l T• INVESTIGATION FEE TOTAL FEE %S '� ,\SIM—W AMLCM m AW C/ SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADORES D • I hereby affirm that I have a certificate of consent to self iBUILDING ADDRESS 'insure, � O . W ALL�N� � or a certificate of Workers'Compensation Insurance,or a certified Copy thereof(Sec.3800,Lab.C.) CIT —MT ZIP 7� LOCALITY t Policy NO. Company SIZE OF LO'r IFNO OF BLDGS.NO ON LOT 11 Certified copy is hereby furnished. NEAREST CROSS ST.If All, ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL j S C SPECIAL CONDITIONS • ` CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERTEL NO. a 3 WITHIN 1000 FT.OF SCHOOL? ves No COMPENSATION INSURANCE N L914 444� a (This section need not be completed if the permit is for one hundred ADD ESS dollars($100)or less.) �g DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY + • C Y I certify that in the performance of the work for which this permit �' -� 4 1 ZIP is issued, I shall not employ any person in any manner so as to 0 ARCHITEqr OR ENGINEER TEL become subject to the Workers'Compensation Laws. O. STATISTICAL C g�S ICATION APT CONDO Date Applicant ADDRESS CLASS NO. �� DWELL UNITS I NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTQ(3 TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP y (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIESa Professions Code,and my license is in full force and effect. –r NEW BK PG , C DESCRIPTI OF WOF& VALUATION License Number Lic.Class ADD ❑ VATION C � a ��- �0 Contractor Date ALTER 11 Ir -❑ I am exempt under Sec. REPAIR 11 $ I-- s D BAP.C.for this reason DEMOL ❑ LDMA P/C# _ LL USE OF EXISTING BLDG. Date: URM ❑ Signature APPLICANT(PP/NT) TEL NO. LDMA Perm or # � tt�, Z Oil, as owner of the property, my employees with wages as Z `'x301-1 �`'° •. their sole compensation, will do the work and the structure is ADDRESS 0 j not intended or offered for sale (Section 7044, Business and FINAL DATE a �i'€'h 4 '- ° Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL � ( °V I, a3 owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J �"I ❑ AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY Jw4�z i413°10 licensed contractors to construct the project (Section 7044, YES❑ NO❑ •+ Business and Professions Code.) ITEMS WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST NR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR TOTAL 3111 . 611 GUIDELINES I hereby affirm that there is a construction lending agency for YES ElEEr: NO❑ E f 4) �f�°o'- Cy the performance Of the Work for Wf11Ch this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING f,��i N3097,CIV.C.) CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. 1_�Ifr`N1.F TITLE 2•CHAPTER 2.20 SECTIONS 2 20.100 THROUGH 2 20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address _ C OWNER OR AGENT 0000-10100 '0 0-„'10 r _ e I certify that I have read this application and state under penalty LIQ FV tl�t� 'x"�1 5" C of perjury that the above information is Correct.I agree to comply P.C.FEE PERMIT FEE A19:?, �� 70 1't-'� °13 $ with all county ordinances and State laws relating to building �� ° m construction, and hereby authorize representatives of this County ISSUANCE FEE �/ to enter upon the ab -mention property for inspec on as. •C o { INVESTIGATION FEE TOTAL FEE 10 � ry�nn.e a App'°8n1 or i Das SEE REVERSE FOR EXPLANATORY LANGUAGE