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Home My WebLink About1704A . . _.. _ � ��,_��, , � �CEp803fREV.11/781-.� . .. '. � . ' � � , , . APPLICATION..FOR BUILDiNG PERMIT ' COUNTY Of LOS ANGELES " BUILDING AND SAFETY f : FOR APPUCANT 70 FILL IN ' '. Aooaess I-��D `J �J"'1`'`� �1 � I AODRE55 ��5 �1�� .�S� ��U-�%�F+� tocautr �1.; �� f, �� '• NFAREST ciTr'L�fi'rli,%ii�- L�%C � ziv /7 . caosssr. U\�n ��C �.�CIT?, ��.��1 . � I NO.OFBLDGS. ASSESSOR. - SIZE OF LOT 'J�X '��a�T�%N� ON LOT- � MAP BOOK � PAGE PARCEL �ISTRICT � GROUP TYPE FIRE ' PROCESSEDBY - TRACT G`lUC� BIOC/K� /�' � lOT NO. ��ZO- - /�� CONSwT��+� Z OWNER:/�Jl1»c.� �C-.'� l.��/rt iNO. �J� '��3 ��lJ .' �1�` l'�' �... ��711 l. �,�/� SiATISTiCAt CLASSIFICAiION SE W ER MAP ADORE55 �I� �:_7Tf�S ��l �'�� CLASSNO. �� "DWEIL.UNIiS eK -PG . � atr � /�r4�^, i,'7 ./��'�". z�c . %�7��J ENGINEER O TE�. �,`.'� VAtUATION� `1-i(�� . ' . Y.-,i n�,�J C c�-, No.� r ;, ' ADDFESS �I/ - f„��/ ...I ✓.�� 'J ' BLDG.SETBACKfROM . , . � � �? ' TEL. FRp�.ITPRpP.LMEOF ' � ' �STREEfI . ' CONiRACiOR��'LiGt/N.` . .NO. HiGNWAY + YARD TOTALSETBACKFROM TYPEOF EXISTING � ��, . �� FRONTPROP.�INE HIGHWAY WIDTH � �' AODRE55 � -NO.�� . � .-. IIC. �_ + . CONS7RUCTiON lENOER t��s bLOG.SETBACK FROM . � . � � !� � NAME ANO BRANCN �� SIDE PROP.UNE OF ' �- ' �STREETI �- � HIGHWAY } YARD ' tOTALSETBACKFROM TVPEOF-EXISTING V ADpRE55 - CITY�.�'. "`�" SIOE PROP.IME HIGHWAY WIDTM� j 50.FT. .-,� NO.OF-'. �� NO.OF'�' . CHECN �� ' ' .+ � ' LL � SIZE ..� �SiORiES �- FAMI�IES � ONE , O USE ZONE MAP , ' � DESCRIPTIONOFWORK � � NEW �' Q � SPECIAL 02 ��T�. .,..�.:..�� ADD.. - '. CONDITIONS � . . � (� ' �{�7�`'� ' � ' ALTER ❑ FINAL,. . ' BY ,� `�7�-...,4� � � OATE � � � � F REPAIR ' USEOF /� ' ' OEMOL � E%IStINGBLDG.S/—� I�:-/�S� � � . . � . Z � A7PlICANi � iEl .�' . � � ' ' ' . �. IDRINTI��iiE��)' U.E:! N4� J� . . - Q , . ( BY ISIGNATUREI'� -'I J..l✓�'l! . �' / . . . y , l 'INEREBY OWlEOGE THAT 1 H E READ THI$AVttKAi�ON NO STAiE � � Y � � iHAi iHE A E IS CORRECf AND A REE 20 COM�LY WIM All R�INANGES' uVi � � ANDlAWSNE UTATINGBlpLO1NGCONSTRUC/10N.ICERIIFYTHAT pOINC.iHE �' S ' WORK AUiNOR12ED XEREBY 1 WILL NO�EMPLOY ANY PERSON IN VIOIAIION OF � • V • � iHELABORCODEOF7HE5iAiE �ALIfORNIAINRELATINGTOWOQKMENSCOM� ' � Z . PENSP.iION INSURANCE.' - �! MC r� I SIGNAit1RE OF / �� . �/ . . . . � . ` ��.j�,'('H I�'ry E PERMIT7EE l�-�J4i��l: C/�� ,��.5,.�.,., ' AbDRE55 /L .'LS",.:-..oG.f � ^d� • � � ��e�V��I��i�.�; ��/1 J r;. TEL.2'� � � F ��L�M�L! . CITYY'T�1�1I•��•�J�%. ��ti NQ."� '�l� . ., ' Q 1 ' �1� r • � ;I�!,��{.:N�CIG P.C.Fee S�.. . . . ' Permit Fee �,.�r C�� .� . � . ��i I��F.M�M� :Issuonce Fee�' � ��.�.�Y ' , n � , � Torol Fee � ��..� . 6 ' �I � i �,� ,�, ,�.,•.,,.:... , _ r`l �i(C�°"?:;.��` ��il�fi��z: z=.•i��=' ��'�+.r-�..�;1�'.=i�i�;�`iE=� i Yi::-r,z��;c t,i•.:a�ius� ea�..�s�a c��^��;�u;� �� _.. _�_.._.. �.._'_'_.... .._""_ '_7 . -_,i:-. . .R. {�'� o . rt.re.- ..�..,.. .. 1 �..'�: . . � �.i � .. 1 1. �,4�.i. i; � i' I ..____ ..__ .-:._� .�._� _____� _.:__.'__,.-_.w__._�_._...— i; I I �`- --- ------ ` -- � --- -- -- - �-„ '�- ' ,,(�- �` .'' � i �. 1 �' :�, I i �� ... - �( -, --: 1 -- - - - �.7= _ I _ -„. � � � , �= " � ____ ' _ _�_ __.. ,_____ --,;-„---�---!�:.r_,� �,,-. --� F ---- - —---- �`----� ; � r � L r . r� - -- - � �. �.� T -...P. ....'..,iTr�� ' .�. . .�, rt,.�.: ... � � . � I . . -_ .. . ..� •, ' . � '� i . .__ _ __ .. . .__,. _ ', i y - �. . � ; . , � � , ' � � � ��; . .. ��;- ..z_.._.-�,-�.,, ,..�,.��, — — --- — _ . � ,.: _r�. �, (.3 _ '' ._.___ _ � _.. . . '_ . . { � t^' _'_:_ ��.��.�". ____1.."'_.��_.."_ .=J..__ _ ,. .–� ...,. ""' ' "'__ . I �, i r________'— ._-.. . __ �, —._�� . — _ ' � �,� �� ------ . .,�{i � �i / �-- — (I .;}.-----. .—i _.- �.� ..__.__. z �I ," J '_' _._. . .._....._ _ . — .__" __,__ ." 3�."' . 4, i / I..�,..t HI �/'i`' . � , �. � 1 .�- ( ,I I + �..`._ `.I �_ `� � i �_I- � . � � � i � I � ," ��...._ _�:.._.�. �._� -�_ __'' I -,. i ' , ..1 i.��...': � I � I � '.T -�.--,._'_'._�._... -.,-... . ' :.' ��..'. . , .. .. ... ..�:1 ..J - . .� i � f` '- '_�' ,_'� - --------- - - ----- , ,, ,, � :. , -- -- - ----- _-_ _.� .._ . , ��.j - ' 7 ,,.�------- __:- � � I r _: 1__---------�__.._..____� __ ^ � "�� ' i ai , ,z I� I �; -- - --- - II � i; ,~ i � i �, , . __- .-. ---- --- — �1 �.`.; ---_..- ------_ ' _ -- , �, � ,� � - � _r - I : , ��; "' i , Y i �� u � � !: , il� � f _ __..s � t �i�� , -�� C. ; ' � � , � ! " j 1 � � � I t• � � � � j � � , �c . . .,- .-c.r....c ,... -r.. :a:. r _.�:r.:' ��I� � � � �. , . < <--- -- - � . --- -- 'i;�; i �� _-_-�--=_-F-_----_�. i f: ;,��,.,:f ''�� . LIC�NSED CONTRACTORS DECLARATION WORKERS' COMPENSATION DECLARATION I hereby affirm that I am licensed under provisions o£ I hereby affirm that I have a certificate of consent to Chapter 9 (cownencfng with Section 7000) of Division 3 self-insure, or a certificate of Workers' Compansation of the Husinese and Professions Code, and my license is Insurance, ox a certified copy thereof (Sec. 3800, Lab.C.� in full £orce and effect.• Policy No. Company License Class Lic. Number Date Contractor L� Certified copy is hereby furniehed. r_( Certified copy is filed with the county building trf I am exempt from the licensing requirements as inspection department. I am a licensed aXchitect or a reqistered Aate Applicant professional enqineer acting in my professional capacity (Section 7051, Business and Professions Code). Lic, or Reg, No. Date CERTIFICATE OF EXEMPTIQV FROM WDFtKERS' COMPENSATSCN INSURANCE OWNER-SUII�➢ER DECLAR)1TION (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I hereby affirm that I am exempt from the Contractor's License Law for the follawing reasofl (Section 7031.5, I certify that in the performance of the work for which �ness and Professions Code : this permit is issued, I shall not employ any person in Z, as owner of the property, or my employees with any manner so as to becane subj to the Woxkera' wages as their sole compensation, will do the work ' ICompensation Laws. � and the structure is not intended or offered for sale �(Date �-21-(�C� Applicant • � (Section 7044{ Business and Professions Code). � �tOTTCE TO APPLICANT: If, ter maki this Certi icate 2, as owner of the property, am exclusiwely contracting of Exemp�.ion, you should coane sub ect to the rkera' �� with licensed contractors to construct the project Canpensation provisions of the Labor Code, you must (Section 7044, Business and Professions Code). £orthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENAING AGENCY I hereby affirm that there is a construction lending agency Eor the performanae of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the above infox�m�ation is correct. I agree to comply with all county ordinances and,state laws relating to building construction, and hereby authoxize representati.ves of this county to enter upon the above-mentioned proper for inspection purposes. � � �,,,�� , ,� ,7-u� ignature f Applicant or ent Date Job Address 5B 1664 < _ � 1� �^'it f COUf1T�' OF l05 Rf1GElE5 °�` � `�, °- . ,�� .: f�EPRRTfI'lEf1T O� COU(1TY Ef1GIf1EER-F(�CIIITIES � � q Rp�� STFPf�ENJ.KOONGE BUILDING AND SAFETY DIVISION CovWrv c�vGiNEER 532 S�UTH VERMONT AVENUE, LOS ANGELES, CA 90020 gOARDOF SUVERrrr�OAS kAY1�if�Y1'tT�W.LOOMIS PETER F. SCHABAfftiiM FFssistant Counry Englneer (213)738-2111 KENNETH HRHN EDMUND D. EDEtMAN tARR'V'Ah11VAON OWl`Z�R-BUILDER VERTFICATION YVONNE BRATHWAITE BUR'�E Suuerintpndent of Bu�ldinq BAXTER WRFtO Attention Property Owrier: An 'ovrmer-builder` building permit s been appl'ed for ' yo n and ! laearing your signature at ,/� ,�y.,�J , �� Please complete and return this info�nation in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. 23o building permit wi11 be issued until this verification is received. 1. I personally plan to provide the majoz l�bor and materials for construction of the propose property improvement (yes or no) rt.��,6 . � 2. I (have/have not� signed an application fox a building permit for the proposed work. 3. 2 have contracted with the follav�ring person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: � Name Address City Phone Contractors License No. 5. I will provide same of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: Property OHmer Social 5ecur' y number Date: /,Z /� ",�'�[7 �.�3. 1� v^"t �� COUf1T� OF lOS f�f1GElE5 �` . ; :� DEPf�RT(1"lEf1T OF COUf1T�' Ef1GIflEER-FRCIIITIES • 4� SPlPNENJ.KOONCE BUILDING AND SAFETY DIVISION CO171f1T17'ENGINEER 532 SOUTH VERMONT AVENUE, �OS ANGELES, CA 90020 60ARD OF SUPERVt'SEYq3 FIAS�N(Old�W,LOQMIS PETER F. SCHA9AftYlM A5•satant County Engineer (Z�3)�3$'Z�� KENNETH H1CFiN EDMUND D. EDElMRN lR`RRV'A1{MpION OT(VNER-$UILDER VERIFICATIQN YVONNE BRATH4VAITE 9UR'I�E Svperinl'encJvn(of Bu-dding BAXTER Vf1A(�'D Attention Property Owner: An 'owner-builder' building permi,t has bee applied fo in yowr name d , bearing your signature at f(v/� �� ,� �cc..� Please c�nplete and return this i.nform,ation i,n the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing yaur building p�ermit. No building ,permit wi11 be issued until this vezificatian is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) l -e:� l 2. I (have/have not) ��,�� signed an application fox a building permit for the proposed work. 3. I have contracted with the following person (firne) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to gronide portians of the work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I v�till provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: � �/ Property Owner ,�G �-- �� Social Security wnher S Date: ��1��J