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Home My Public Portal About9923 WOODRUFF AVE_Building__ f, F6AG33A CE009 1-51 � APPLICATION FOR BUILDING PERM(/IT COUNTY OF LOS ANGELES 13U I LD ING ADDRESS 5� 5� E, Zt� dt ri y DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY L_� r JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. Gj20UP CONST. TYPE PR SSED BY lr9�_ FOR APPLICANT TO FILL IN _ � '/_Q' ��- � BUILDING �' /� 1l/ / _/�/ O =ADyL ' S ! LC ISR MAP DRESSJCLASS 'WELL. UNITS�I J! LOT NO.fIL2(r C "" E'.J BLOCK WATER NOT REQUIRED RECEIVED L� f CERTIFICATE; _ TRACT G='S �-j MAP HIGHWAY STATE MAJOR SECOND OCA (CI0F BLD SIZE OF LOT X I UlJ I NOW ON LOTNO GS U O Z NEO SPECIAL LEI USE OF CONDITIONS EXISTING BLDG. �7 OWNER �� C� NO. ��(� /� BUILDING EXIST. ADDRESS Ir!� ��` �f l - h - I YARD HWY STREET NAME WIDTH / - •!L�N'fD/Ca Ciy r,�Sll�A " SETBACK K ^ 4 /' ARCHITECT OR TEL. P. L. G-C/ � CO ENGINEER NO. SIDE � p P. L. CL Y LARS // P✓ jj�� NO ZC/�(' INSPECTION RECORD Ov CTOR We-,b S-5_ 2E`-- T�tJ e' C1 y /� °` O DESCRIPTIO OF W RK v W � aADD ALTER REPAIR DEMOLISH NO.OF NO.OF STORIESFAMILIES UREURE OF CANTION �L6�6 '! ? APPROVALS DATE INSPECTOR'S SIGNATURE P. FOUNDATION: LOCATION r• �.... FEE $�� FEE $ `�-� �T FORMS, MATERIALS FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, Ii 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. i .r TION OF THE LABOR CODE OF THE STATE OF CA IFO IA RELAT- ING TO WORKMEN'S C SA N IN6 AN LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED 3 ADDRESS P �'• - FINAL CLYDE N. DIRLAM, PRINCIPAL ST C RAL ENGINEER (I LAN CHECK VALIDATION elcy) M.o. c.SH PERMIT VALIDATION cic M.O. CASH C� Lam' 3 1 2 0 AUG 2 5 2 3 D j 2.0 0 A 3582: SEP10 1 D 64,00- WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self, APPLICATION FOR BUILDING PERMIT 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 copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS �3 Certified copy is filed with the county building inspec- BUILDING � _[��,1�C. tion department. ADDRESS 3 T_h)C& t C C Date Applicant CITY �� e Cil ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL � 11 TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER 41�N NO. NO permit is issued, I shall not employ any person in any manner 5 J o re-A) �-� SPECIAL 9L ADDRESS �' VVV��` CONDITIONS so as to become subject to the Workers'Compensation�Laws. � �O Date /4i"v ' Applicant -W"t' S 1��. CITY • ZIP p� 7�� 99 NOTICE TO APPLIC NT: If, after making this Certifie6te of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE C67"ESSED BY ENGINEER NO. II= Exemption, you should become subject to the Workers' CONST. ZONE Compensation provisions of the Labor Code, you must forth- �QU - IU with comply with such provisions or this permit shall be ADDRESS 0. deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. COND ME CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. 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 and LIC SEWER MAP Professions Code, and my license is.in full force and effect. CITY CLASS BK — PG,132— EXISTING /`� Z VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE ' _ VALUATION •� Contractor Date DESCRIPTION OF WORK NEW ❑ $ ADD ❑ , ❑ I am exempt under Sec. — - [E:] , ALTER B.&P.C. for this reason REPAIR ❑ $ Date: USE OF I EXISTING BLDG. DEMO! ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION i PRINT NO. DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FI Prof ssions 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. ;96067A with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). # o e a o a 1 REQUIRED TOTAL.SETBACK F OM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT -1 00.4 9.88 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE a co 4 9,8 8 9 a P.L. 1205-86 o Lender's Name .° P.C.Fee$ Permit Fee 3� LDMA Ref. # Lender's Address r I certify that I have read this application and state that the Issuance Fee U- LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee �y ordinances and State laws relating to building construction, Total Fee / •� J and hereby authorize representatives of this County to enter . LDMA Perm.# S upon the above-mentioned property for�i spection purposes. o rill-I" c�nAAfa%^ )a ti jI SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent /' Date O 1 -` APPUCATION-FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATIONFOR APPLICANT TO FILL IN BUILDING DDRESS I hereby affirm that I have a certificate of consent to self insure, Bul oIN�ADDRESS or a certificate of Workers'Compensation Insurance,or a certified cop thereo c. 800, C � � 1/a04 I CSII E OF LOT � ZIP � LOC Po ✓ LITY / NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. 11ate pliCertified copy is filed with the county buiidin inspec' TRACT BLOCK LOT NO. department. / cant �l USE ZONE MAP NO. 9��ry ASSESSOR MAP BOOK PAGE PARCEL i SPECIAL CONDITIONS eOO O/ CERTIFICATE OF COMPENSA COMPENSATIONON FROM INSURANCE WORKERS' OWNER e V i L. 3- WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS l' � DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY 101 -7 1 r1 dollars($100)or less.) , I certify that in the performance of the work for which this permit CAUA Y D `�A ZI � .— �D fy is issued, I shall not employ any person in any manner so as to l f, oJ become subject to the Workers'Compensation Laws. AR HITECT R ENGINEER TEL NO. STATISTICAL CLASSIFICATION I APT CONDO Date Applicant ADDRESS CLASS NO. 121/ 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 �q y� I�,� +�E N / SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith —VU Q"f v O (�1 FRONT et�comply with such provisions or this permit shall be deemed revoked. A RESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION V 4� SIDE � LIC.CL� PL I hereby affirm that I am licensed underprovisions of Chapter 9 FOSieL (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF ORIES 140.OF FAMILIES SEWER MAP Professions Code,and m licensee! In full force and��fect ] NEW BK PG , a License Numb ��v Lic.Class LLao DESCRIPTI OF WORK ',q ADD ❑ VALUATION VA� W r—d O ALTER ❑ 02 U Contract - —�[�te ` ��• � ❑ 1 am exempt under Sec. 7 Cgs (7] REPAIR ❑ $ O B.BP.C.for this reason S o DEMOL ❑ % LDMA P/C Date: USE OF EYfSIG B G. URM 11 1 Signature APPLICANT(PRINT) NO1AVLDMA Perm# n z co ❑ 1, as owner of the property, or my employees with wages as ( Z ACCT o v their sole compensation, will do the work and the structure is S d 0 033 125.55 not intended or offered for sale (Section 7044, Business and 006 FINAL DATE r. Q i ITEMS Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL (—�{!/ i 1 +gyp y y g OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY `v -J TOTAL �.eL o ❑ I, as owner of the property, am exclusive) contracting with Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? i 55 licensed contractors t0 construct the project (Section 7044, YES No% CHECK 1eS Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHANGE .00 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY CCPAsr AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO� r��y �y i p ip/p a the performance of the work for which this permit is issued(Sec. �VUQ�•VQ�i 7�Z7/7 °' 3097,CIV.C. IHAVE READ THE HAZARDOUS MATERIALS IN FO RM ATI NGUIDE N THE SCAQMDPERMIrnNG CM ) TITLE 2CHECKuCH IUNDERSTAND MY REQUIREMENTS UN ER THE L GELES APTER 2.20 SECTIONS 2.20.00 THE T.RO H 2.20.1UN ER THE L4 CERNGELE.INGUHAZARDOUNTY S �J�� At i 1°o Lender's Name MATERIALS REP N D FOR OBTAINING A PE IT ROM TH Lender's Address 0 OWNER OR IIOENT cI certify that I have read this application and state under penalty 4 of perjury that the above information is correct.I agree to comply P.C.FEE tvv with all county ordinan�andte relating to buildingCO construction, and herebytives of this County ISSUANCE FEE30at ente up the above- inspection purpo CO INVESTIGATION FEE TOTAL FEE / seem m oex J SEE REVERSE FOR EXPLANATORY LANGUAGE