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HomeMy Public PortalAbout9722 WOOLLEY ST_Building__ • APPL�I"CAT�II� �O.R �JI_L®ISG.. ER. I ' '8A898ACE.#809=' 7•S6 BUILDING. AND SAFETY DIVISION BUILDING . Department of County Engineer ; AopREss County 9f.-Los Angeles-, .;-: LocALITY JOHN A:LAMBIE. COUNTY EI,g1NEER- "'NEAREST . C_ASSATT'D.GRIFFIN:SUPT OF BUILDING :CROSS ST. DIST NO.. LGROUP TYPE F.EWER.-MAP - FOR'APPLICANT TO� FILL:IN Bic. .. Pc CONSTj- JZ -- BUILDING �-� - ��� ADDRESS. %•/.�y /�: / /C 3TATI5tICAL'CLASSIFICATION LOT NO. ' 7� BLOCK 'CI:ASS. NO. /'- DWELL.'UNITS"' ' •`I ' MAP: STATE J NUMBER © - :HWY' .. 'YES TRACT �// �ifJ. *ONE. SPECIAL. :',OF-BLDGS.,- .r' 1 CONDITIONS SIZE OF LOT / '/ eJ �!` I:-NONOW ON LOT �^ USE OF _ JQ a EXISTING BLDG. BU'ILDING.: EXIST:. YARD HWY SRT. TEENAME - 'SETBACK' _ 'WIDTH' OWNER . G�+ FRONT, s� ' MAIL-.'- - ADDRESS' �� L. SIDE :`: C/�1S.Gi� t -TEL.. CITY.' = No. INSPECTION RECORD ARCHITECT OR- ' TEL-. .• ENGINEER ADDRESS. / `] :TEL. NJ C7� / L�1�ill- ! f'"t:11MI17 : 5,5r- f Ora •CONTRACTOR% A� ` Z :NO .� a �n - .. .: y i '_r Pt Ora ADDRESS / DESCRIPTION_-OF..WORK' — ,s„ ,♦: / _ NEW ADD ALTER REPAIR -DEMOLISH SQ..FT. ! NO. OF NO:OF. J fr'LJ _ t,%:I.f.. �I. �_•,`�f:r/ i SIZE ��I� STORIES `- I FAMILIES-/ US.F OP:STRUCTU•R .� '... APPROVALS' p �— SIGNATURE OF APPLICANT DATE INSPECTOR'S•SId!,14I1RE' ,.. ADDRESS- �/ ` O,UNDATION:LOCATION F FORMS, MATERIALS v' 'S' $ t— FRAME: FIRE STOP v ,C. S .7 DRACING,B POLTS:.:' FEE' �Ilfd FL':RNACE:•LO,CATION''... VALVA % •�, {�/ 'Ir. SQ D� CAS VENT. DUCTS I HEREBY-ACkNOWLEDGE THAT 1 HAVEi REA15 THIS AP. LATH:INT. 6 13--S-7 i Y' Fh{'V PLICATION AND'STATE THAT THE-ABOVE IS CORRECT-AND .,- ' ,} -AGREE TO COMPLY WITH ALL COUNTY'ORDINANCES•AND' ^L:ATH.'EXT. U - r- -- _ . STATE LAWS .REGPLATING,.BUILDING :CONSTRUCTION. .. SIGNATURE OF HOUSE NUMBER COR _R PERMITTEE ECT-AND POSTED t/ AoliREss FINIAL' DID S7 `//Gae, 5/ I.OH'N A:LAMBIE.-COUNTY.ENGINEER .'CLYDE N.DIRLAM.PRINCIPAL�STRUCTURAL ENGINEER -PLAN CHECK VALIDATION- cK. M.o... CASH PERMIT VALIDATION- CK. M.D. CASH-- " 8 b 9 2 MAY1 6 �: '7.. �S o 8-7 7—L .` SO-IT- .5. 1: .-6... ' C � `�j.. .. y APPLICATION FOR ,BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN Bul G ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS'•'71 2 VV 0 O or a certificate of Workers'Compensation Insurance,or a certified 1 copy thereof(Sec.3800,Lab.C.) CITY f , �T! ZIP Policy No. Company Tem o12 �" "` 9 t LOCALITY SIZE OF LOT NO.OF BLDGS.NOW ON LOT [I Certified copy is hereby furnished. ROSSsr C ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOT 9� PAGE f .� PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER , '` TEL NO. COMPENSATION INSURANCE v`� Gh 01 h O S -7 --toil 6 WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDREE,SS i dollars($100)or less.) / -7)-�— (;O 1 1 e 5'L. DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY 1 certify that in the performance of the work for which this permit CITY -T-e-I'la A C,- ZIP C• '7e O is issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER C r TEL NO. become subject to the Workers'Compensation Laws. STATISTICALCSSgCATION Al APT CONDO Date Applicant ADDRESS CLASS NO. f DWELL UNITS NOTICE 70 APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR 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. I ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 8 EWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ. NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. L� NEW BK. PG ► n License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATIO(. C Contractor Date I ^v ALTER 11 $ 3 f0• U V C ❑ I am exempt under Sec. i GO J REPAIR 0 $ r BAP.C.for this reason I jh j DEMOL ❑ LDMA P/C# LL Date: USE OF EXISTIN DG. gaiec. URM ❑ n I V Signature APPLICANT(PRINT) TEL NO. rr�' LDMA Perm# ti 7 C n /2� Tu Z' A CC1 es �7 I, as owner of the property, or my employees with wages as v their sole compensation, will do the work and the structure is ADDRESS J O a 43' 1-34.215 FINAL DATE ~ 41+ not intended or offered for sale (Section 7044, Business and Q. Q Professions Code.) I WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I Z�Z-93Col. .I. ITE" ' ❑ I, as owner of the property, am exclusively contracting with I AAR A MIXTURE MOUNTS SPECIFIED ON I THE HAZARDOUS MATERIALS INFORMATION GUIDE?NG A HAZARDOUS MATERIAL EQUAL TO OR ERTHAN THE FINAL BY 0 r < licensed contractors to construct the project (Section 7044, ves❑ Nom I OTAL 134 - 25 Business and Professions Code.) r,r WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHECK r=r a i:! OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �/j��/� CONSTRUCTION LENDING AGENCY i COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR �^•�"/�� 5 )�I? GUIDELINES CHANGE I hereby affirm that there is a construction lending agency for YES❑ NO-JO w the performance of the work for which this permit is issued(Sec. M I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING R-3,_ 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS'UNDER THE LOS ANGELES COUNTY CODE, Do- y �y r w I TITLE 2, TER 2.20 SECTIONS 2. 100 THROUGH 2.20.140 CONCERNING HAZARDOUS 113{ lily_{ I `y j, l �'{'� �� Lender's Name MATERI S R PORTING AND FO B ING ERMIT FROM THE SCAOMD. L144 I AM 10:5 o Lender's Address OWNER OR XMNT o o I certify that I have read this application and state under penalty o P.C.FEE PERMIT FEE d of perjury that the above information is correct.I agree to comply 0 G► N with all county ordinances and State laws relating to building 0 construction, and hereby authorize representatives of this County ISSUANCE FEE m to en upon the above-mentlopgd property for inspection purposes. /2-13-9-3 - i 3 INVESTIGATION FEE TOTAL FEE �f tm wmv �S SEE REVERSE FOR EXPLANATORY LANGUAGE