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HomeMy Public PortalAbout10915 WILDFLOWER RD_Building__ 8A898Ab:R '809.10-SB APPLICATION FOR BUI L.UI NG PERMIT BUILDING AND SAFETY DIVISION BUILDING Department Of County Engineer ADDRESS County Of 1.08 Angeles LOCALITY � JOHN A.LAMBIE, COUNTY ENGINEER NEAREST .. CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. DISTR�NO. GRO.I TYPE EWER MAP FILL FOR APPLICANT TO IN BK PG ' CONST. BUILDING ADDRESS O ® w1 i O of R v STATISTICAL CLASSIFICATION / LOT NO. '_3 BLOCK CLASS.NO. DWELL. UNITS MAP STATE " YES O y Q J NUMBER HWY TRACT .0 3/ / USE OIRE SPECIAL NO.OF LOGS. / CONDITIONS B SIZE OF LOT S.Za St; f0 0.�o I NOW ON LOT M O FI tf USE OF EXISTING BLDG. BUILDING EXIST. 9'13 SETBACK YARD HWY. STREET N ME WIDTH OWNER , UJ// G� FIZ. A_ D p FRONT _ 0 MAILADDRESS�12-ad y /4 1 fg� 1TH pr r/J�,�,,/t/h,/ SIDE TELa 6-4.7I1.1•RC�, NO.'!/ P. L. - CITY INSPECTION-RECORD•. " ARCHITECT OR TEL. ENGINEER NO. ADDRESS ,,I C� ,l CONTRACTOR r �, W ICIp17 � NO.'rn7��0-rB 1 G ADDRESS sjuA a DESCRIPTION OF WORK NEW t" ADD ALTER REPAIR DEMOLISH SQ.FT. (� NO.OF NO.OF SIZE /!/ b V STORIES FAMILIES J USE OF STRUCTURE /J_q RA96, APPROVALS SIGNATURE OF APPLICANT DATE INSPECTORS SIGNATURE ADDRES .(, %50 , p �A �! ��, FOUNDATION:LOCATION FORMS. MATERIALS P.C. S FRAME: FIRE STOPS. r •' ,� FEE BRACING.BOLTS I/^��/_,7r'7 U�•�i Lrt.wi� VALUATION $' �.,� FGAS VENT. DUCTSN. 1 HEREBY ACKNOWLEDGE THAT I HAVEREADTHIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND / / AGREE TO COMPLY WITH ALL COUNTY ORDINA CE AND LATH. EXT.. Ii, .Id ®ri� ��1r 2: W STATE LAWS REGU NG ILDI CO R ION. r , SIGNATURE OF OUSE NUMBER COR- I yyS" PERMITTEE r' ! RECT AND"POSTED ADDhES FINAL OHN A.LAMBIE. COUNTY ENGINEER, CLYDE N.DIRLAM.PRINCIPAL STRUCTURAL ENGINEER PLAN CH= VALIDATION 0K _ M.O. CASH P»T VALIDATION M.O. CASH ��'��0 3 2 2 6 11 1 6 OCT 9.0 �r 3 :3 8F;; OCT�. 7 1 1 .36-00 . 76A638A CE#803 2-63APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 10915 Wildflower Road BUILDING AND SAFETY DIVISION LOCALITY Temple Cit JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST. 71 DISTRICT NQS/ OU TYPE E BY ,40 FOR APPLICANT 'TO FILL IN /V�1 Vim{" CONST. BUILDING STATISTICAL C S (FIC TION WER MAP ADDRESS Wildflower Road BK. .S rG CLASS. NO. DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED- CERTIFICATE: RECEIVED TRACT• 21949 MAP HIGHWAY "'ATCCCJJJ��� NO,OF BLDGS. NO. (CIRCLE) STATE MAJOR SECON LOCAL SIZE OF LOT NOW ON LOT2 USE ZONE SPECIAL USE OF % CONDITIONS EXISTING BLDG. RnIlas and garage OWNERFrank E Stark No GI 46 BUILDING EXIST. ADDRESS 1091=5 V4-ffft WildflowerTBACK YARD HWY STREET NAME WIDTH FRONT ARCHITECT OR TEL, P. L. ENGINEERandard plp NO. SIDE P. L. �- ADDRESS nv �• R �3F� �� s n NO.S ` p P 221 CO D: ADDRE0871 Firestone Blvd. p DESCRIPTION OF WORK W CIL NEW$ ADD ALTER REPAIR DEMOLISH Z SO.FT. NO.OF NO.OF SIZE 270 STORIES FAMILIES USE OF STRUCTURE Private swJn Dool Std, pLan SIGNATURE O APPLICANT VALUATION 100.00 APPROVALS DATE }INSPECT SIGNATURE P.C. 5O PMT. FOUNDATION: LOCATION FEE $ FEE $ FORMS, MATERIALS FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. • WITH ALL COUNTY ORDINANCES AND'STATE LAWS REGULATING GAS VENT. DUCTS BUILDINGCONSTRUCTION, i CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. 1 TION OF THE LABOR CODE OF THE STATE OF C ORNIA RELAT- ING TO WORKMEN'S CO ENSATION INSUR C LATH,EXT. ' SIGNATURE HOUSE NUMBER COR- PERMITTEE ECT AND POSTED ADDRESS &571 Blvd-FINAL JOHN F. LEWIS. PRINCIPAL STRRAL ENGINEER PLAN CHECK VALIDATION cK. M.o. CASH _ PERMIT VALIDATION (C gM.O. CASH 612 AUGL>Q.2 3• D 7-50� w ;; -� LQ 9.2'7 1 u AUG 2.3 I 'D � ; REQQ i d .,,WORKERS' COMPENSATION DECLARATION . �, a 4 hereby affirm that I have certificate of consent to self A p P L I CAT I O ISI �f•O R BUILDING �P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING PY Y ADDRESS ❑ Certified copy is filed with the county building inspec- ADDRIESS /� �� 1440'�0�/� C5 /�V tion department. ,G Date Applicant CITY �l�F �- a[7—>'- ZIP 4 / LOCALITY NO.OF BLDGS. S _ CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE O NOW ON LOT CROSS ST. L'G�/¢iC COMPENSATION INSURANCE 2 ASSESSOR 2 *� (This section need not be completed if the permit is for one TRACT BLOCKK/ �J LOT NO.00 MAP BOOKe�-^73 PAGE to 37PARCEL ULA 3 hundred dollars ($100)or less.) OWNER JZ4-1&W-AJt9 (r�E1Srf O, �—�pC/ USE ZONE MAP I certify that in the performance of the work for which this NO._/ SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS 09/J� GOLvc CONDITIONS O so as to become subject to the Workers'Compensation Laws. 0 CITY Z—'M' G40 017Y zip C4 !7 c7 Date Applicant ARCHITECT OR TELIx . CT ;GROUP DISTRITYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. Exemption, you should become subject to the Workers' ff CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS .�•Q 3 .5a with rn comply with such provisions or this permit shall be ffTEL Z STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR®C"c��� L� No. _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. C27-/ DWELL. UNITS I hereby 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 Q / CLASS BK oePG VALIDATION License Number Lic. ClassE�,�- Q STORIES / FAMLIES1 ONECHECVALUATION' VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ ❑I am exempt under Sec. jQl�'! RW(, 0A77F Ff V� - ADD 1-1 7 Poo. ALTER ❑ BAP.C. for this reason -�N��Y �M. REPAIR ❑ $ Date: USE OF EXISTING BLDG.! DEMOL ❑ Signature APPICANT (PRINT) ,4-/MO,LW CC,6W,9/'�O. .,6 Z-Z FINAL QQ g OWNER-BUILDER DECLARATION DATE /Z I hereby affirm that I am exempt from the Contractor's License o Law for the following reason (Section 7031.5, Business and ADDRESS � /� �� tKQj ' �� FINAL Professions Code): PRESENT By BUILDING 1BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole com ensation,will do the work and /Q� �j the structure is not intended or offered for sale(Section LOCALITY ��an �L '=1' ❑ 7044, Business and Professions Code.) MOVING TEL. 00 I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- I?:fii =i->✓•- ADDRESS tion 7044, Business and Professions Code.) i_- REQUIRED TOTAL SETBACK FROM EXIST. a :•lis•.*. fi`_��+e i•_ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT ;};A1.ij_ °{ ,J the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name G _l:l l i--I'.)_1i =r'_ '.*;'. Q. 7 0 LDMA Ref. # •�..i , ° ._ P.C. Fee$ permit Fee : , _,_r y ,, ° Lender's Address I certify that I have read this application and state that the Issuance Fee • �'� LDMA P/C# 3 above information is correct.I agree to comply with all County Investigation Fee e ordinances and State laws relating to building construction, Total Fee 0 .3 D LDMA Perm. # and hereby authorize rept s ntatives of this County to enter upon the above-m ti roperty r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant orAgent Date WC,RUR%COMPENSATION DECLARATION -I r here i ti certificate that I have certificate of consent to self 4 �' APPLICATION FOR BUILDING PERMIT el Is insut�e,tor a Certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �tf ❑ Certified copy is filed with the county building inspec- BUILDING �OQ�� ( /64� JWza&)Ee ��• tion department. ADDREySS- / Yt/l IC LOCALITY NEAREST Date Applicant CITY /�ZG� rs/� ZIP Q CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT k,MAP BOOK I PAGE PARCEL (This section need not be completed if the permit is for one USE Z E OWNER MAP c o hundred dollars($100)or less.) TRACT AM<7AJV CI IL Q BLOCK LOT NO. NO. �J � f'v . CONDITIONS IAL I certify that in the performance of the work for which this _ DISTRICT GROUP TYPE FIRE PROLE ED BY O permit is issued,I shall not employ any person in any manner ADDRESS Q / /� /Z �y 2 CONST. / ZONE 0 so as to become subject to the Workers'Com ation Laws Dareo1I+3Q �/ _ !�eAPPlicant 01 CITY77 r'67 CI ZIP G �S© �t O ARCHITECT OR TEL. STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after m ing this Certificate of ENGINEER NO. CLASS NO. I DWELL. UNITS Ut Exemption, you should become subject to the Workers' 0— Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be 2 deemed revoked. CONTRACTOR NO. BK. PG; VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS n NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. �r� Q Professions Code, and my license is in full force and effect. CITY CLASS $ too , SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑� $ Contractor Date _ ❑I am exempt under Sec. CLtJ 5 Ce1/.v400 C4-1 QF ADD ❑ : 1 5 Q A ' l� � �/ ` ALTER FINAL 7e o a o 0 0 '+ B.BP.C. for this reason Iv REPAIR DATE ❑ Date: USE OF FINA ( a o 2 EK 5 J DEMOL EXISTING BLDG. /�,n� ��y/ ❑ Signature APPLICANT �� _ By o a o 2 8.J n OWNER-BUILDER DECLARATION A I hereby affirm that I am exempt from the Contractor's License ADDRESS -LGtC�c ' <l tL Low for the following reason (Section 7031.5, Business and Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS 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. ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 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 the performance of the work for which this permit is issued P.L. Poo tSec. 3097, Civ. C.).. SIPE n P.L. e Lender's Name /) P.C:Fee$ Permit Fee �L v Lender's Address r I certify that I have read this application and state that the Issuance Fee U S� above information is correct. I agree to comply with all County Investigation Fee TT ordinances and State laws relating to building construction, Total Fee V and hereby authorize representatives of this County to enter upon the ob entioned propfty for inspection purposes. AX-1s 1"30• 9 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent Date ®s