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HomeMy Public PortalAbout5604 WELLAND AVE_Building__ 78AB98A B6.8 APPLICATION FOR -BUILDI101 PERMIT uss ! V DIVISION OF BUILDING AND SAFETY Bu'RDING © N Deportment of County Engineer ADDRESS County of Los Angeles LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT oR BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE SEWER MAP �� rz P BUILDINGi? Jp f w� CONST. ADDRESS D /r/G(.!7r7//Cr NUM ER /•�v �v STATE YES O GG HWY LOT NO. 'ZJ''{�(} BLOCK U�EP NE NDI IO 4 A441V& TRACT //y �(� NO.OF BLDGS. SIZE OF LOT /f L ��//, ��7 I NOW ON LOT ��. BUILDING YARD HWY STREET NAME ' USE OF J /�y� ,� SETBACK WIDTH EXISTING BLDG. � FRONT OWNER d/GSIDE P.L13 MAIL o /w` O TRACT DWELL. l. � 1 UNITADDRESS. -%)6 / fif( c ( Cx TEL. 5 INDUSTRIAL CITY ����a/( `-C NO. 7 DWELL. ' 1 UNIT 6 PUBLIC BLDG. ' ARCHITECT OW TEL. 2 DUPLEX 2 UNITS ENGINEER NO. 7 ADDN..ALT.;ETC. 3 APT. UNITS B MISCEL. ADDRESS 4 COMMERCIAL TEL k� � a-/,�G INSPECTION RECORD CONTRACTOR / i 1 NO.. /� y� �/ ADDRESS .EG CYC.'7��'t �(` ���� a t�r �( �! d'G7.'4 /�l//J al// s'he.ZA FAX DESCRIPTION OF WORK NEW. ADD ALTER REPAIR DEMOLISH en SO.FT. NO.OF J NO.OF / r ' AAA SIZE 'r GC STORIES [ FAMILIES Ile USE 4,1 SIGNATURE OF - APPLICANT / e� l / / r�e /j �►, APPROVALS G/-� p /-PlA1J /h wIl. ADDRESS �L y I ave / 7�Crz/� DATE INSPECTOR'S SIGNATURE �� ✓ FOUNDATION:LOCATION` cidy' �• �y r P.C. $ FORMS.MATERIALS FEE l FRAME: FIRE STOPS. l VALUATIONBRACING. BOLTS $ FEE FURNACE: LOCATION, /� s 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT. DUCTS �D��i' / /�.G, �3vii APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS rrREGULATING BUILRIIJV. CONSTRUC- TION. /J LATH. E SIGNATURE OF o _ qf. HOUSE NUMBER COR- PERMITTEE � RECT AND POSTED ADDRES j�'D+t BLV ` FINAL 's / JOHN A.LAMBIE,COUNTY ENGINEER- VALIDATION CLYDE N.DIRLAM. CHIEF BLDG. INSPECTOR CK MO CASH 1.ACD 9 8 12 Al nuc 31 1 6 9.0 0 6 o APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDINS7Ap �L G Nb I hereby affirm that I have a certificate of consent to self insure, BUI IN vD S W G (*,Al P or a certificate of Workers'Compensation Insurance,or a certified CITZIP copy thereof(SeQ.3800 La .CY I.) Y �• 2 _ •/` LOCALITY Policy No. D LI Company SITZ `oF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEARE7 CROSS ST. 1:1 Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. 'le departrypnt., A /_ USE ZONE MAP NO. Date �f Applicant �/ /.l�%L ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CE IFICATE OF EXEMPTION FROM WORKERS' OWNERn! TEL NO. COMPENSATION INSURANCE aa4r— .�/� WITHIN 1000 FT.OF SCHOOL? YES NO This section need not be completed if the permit is for one hundred AD RESS ( P P DISTRICT GROUP ;i�- is NST. FIRE ZONE PROCESSED BY dollars($100)or less.) fY7 �1 N/� CITY �� ZIP I certify that in the performance of the work for which this permit r�fi issued, I shall not employ any person in any manner so as to ' �7' O become subject to the Workers'Compensation Laws. ARC ECT OR INEE TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.� DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. p�� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith C —� & ,4*f -n J.OP* FRONT comply with such provisions or this permit shall be deemed revoked. AIDD -S (" LIC N . PL LICENSED CONTRACTORS DECLARATION - �� Z�Z'� SIDE C Y , r r� LIC.CLASS. PL I hereby affirm that I am licensed underprovisions of Chapter 9 •�'r J ?3 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and Sb FtSIZE NO.OF STORIES NO.OF FAMILIES Professions Code, m license is in full force and ect. NEW BK PG , IL License Number Z Lic.Class DESCRIP ON OfAVORK ADD ❑ VALUATION 0 U Contractor 2 Date « < ALTER ❑ $ ' ❑ 1 am exempt under Sec. _ REPAIR [I $ 0 6.8:P.C.for this reason y .. DEMOL E] LDMA P/C# W Date: USEff EXISTING BCD aG ` ---- URM ❑ i � Signature APPLICANT(PRINT) TEL NO. LDMA Perm+T` �; 'v e a Z ❑ I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O ??; L1 J.- '2 not intended or offered for sale (Section 7044, Business and FINAL DATE F-- Professions T•k�+� Code.) -�`7 �Gf WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ f'L I F ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY ; ^I �} 1045 . 3-D licensed contractors to construct the project (Section 7044, i- Business and Professions Code.) YES 11 NO WI ❑ ;;t�-I�;1;� 1L=�_-•_ LL 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(SCACMD)SEE PERMITTING CHECKLIST FOR :1 f I•� GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ _ a the performance Of the work for Which this permit is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 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 .,��• f r': i-u"'.t: Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 113 Lender's Address h OWNER OR AGENT O o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE cm with all county ordinances and State laws relating to building construction,and hereby authorize representatives of this County ISSUANCE FEEGo co to enter u on the ab a-me Toned property for insp�oti Pur oses. �f� a (� INVESTIGATION FEE m TOTAL FEE /O +150 G. c7 SEE REVERSE FOR EXPLANATORY LANGUAGE A' APPLICATION FOR.,,BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION BUILDING DDRESS FOR APPLICANT TO FILL IN BUILDING ADDpRES[S� / I hereby affirm that I have a certificate of consent to self insure, s � W,t or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof Sec.3800,Lab. ,) LOCALITY Policy No. ompany y SIZE F LOT NO.OF BLDGS.NOW ON LOT 11 Certified copy is hereby furnished. NEARE i RAS STC ❑ Certified copy is filed with the county b Wing'nspection TRACT BLOCK LOT NO. depla en P USE ZONE MAP NO. Date a� wApplicant t ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXE TION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCEZ WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred AD R ��/ / v W GZN�> DISTRICT GROUP TY ONS?. FIRE ZONE PROCESSED BY dollars($100)or less.) Alb CI / ZIP I certify that in the performance of the work for which this permit - ti Je� ` P is issued, I shall not employ any person in any manner so as to !/ A become subject to the Workers'Compensation Laws. ARCHI CT R ENGINEER TEL NO. STATISTICAL C SIFICATIONAPT CONDO Date Applicant ADDRESS CLASS NO. DWELL UN NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR ��"'� TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith AR �_ ee7'�Q 4y, FRONT comply with such provisions or this permit shall be deemed revoked. AODRESS �2 PL LICENSED CONTRACTORS DECLARATION � SIDE CITY a / �� LIC.c s PL I hereby affirm that I am licensed underprovisions of Chapter 8 ��L SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.PT IZENO.OF STORIES NO.OF FAMILIES Professions Code,an y ' ense is in full force and effect. NEW BK PG Poll. } DESCR ION OF VALUATION a License Number 7 Lic.Class > ADD ❑ Q Contractor Date r f i _ ALTER ❑ � �` V ❑ 1 am exempt under Sec. REPAIR 11 $ F- BAP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ 0- Signature APPLICANT(PRINT) TEL NO. LDMA Perm# 8 Z Int•°.i �a Z ❑ I, as owner of the property, or my employees with wages as Z =T j rwjc o their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE a TTEINr Professions Code.) _ _ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL S ,�—�� J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE , 'I 11 —.0 az .� ❑ I, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY /) Q9 1 licensed contractors to construct the project (Section 7044, YES❑ NO❑ e Business and Professions Code.) HAQr . LL THE INTENDED USE OF THE BUIDLIN6 BY THE APPLICANT OR FUTURE BUILDING f t41i OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH or i-);t t e L CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ t f iA the performance Of the work for winch this permit Is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, N 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. f•!=1 o Lender's Address C OWNER OR AGENT cI certify that I have read this application and state under penalty c of perjury that the above inis correct.I agree to comply P.C.FEE PERMIT FEE o $ with all county ordinances and State laws relating to building / construction,and hereby authorize representatives of this County ISSUANCE FEE •�/D m to ente upon the bo mentioned property for inspe�Pur ;p,6ro e-1 ` INVESTIGATION FEE TOTAL FEE N yam Mdx.'M 6r neem (�f SEE REVERSE FOR EXPLANATORY LANGUAGE