Loading...
HomeMy Public PortalAbout4824 BALDWIN AVE_Building__ (2) 76A638A CE.4803 2-63APPLICATION FOR BUILDING PERMIT . . COUNTY OF LOS ANGELES BUILDING • DEPARTMENT OF COUNTY ENGINEER ADDRESS g2 N. Baldwin Ave* BUILDING AND SAFETY DIVISION LOCALITY Tem le Cit JOHN A. LAMBIE. COUNTY ENGINEER 'NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. Lpmr Azzlisa ,DISTRICT NO. GUP TYPE P,R C SED BY FOR APPLICANT TO FILL IN C d C CONST. V. BUILDING STATISTICAL CLASSIFICATION - SEWER MAP ADDRESS Ave, CLASS. NO. e DWELL. UNITS - i. BK PG LOT NO. �.M l L� BLOCK WATER / CERTIFICATE: NOT REQUIRED © RECEIVED ❑� TRACT �- E� J MAP . O HIGHWAY STATE AJOR ECOND, LOCAL ' NO.OF BLOGS. NO. (CIRCLE) SIZE OF LOT "- NOW ON LOT' USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. residence TEI.,., n OWNER a Nohj1 11192 BUILDING EXIST. SETBACK .YARD HWY STREET NAME WIDTH ADDRESS 4824 N. •Baldwin Ave. FRONT' /r'' �*p� e ARCHITECT OR. � � TEL. - P. L. 7 AWN ENGINEER NO. SIDE If P. L. 0. ADDRESS -- '0 TE CONTRACTO NO 2-12 - v ce ADDRESS iog2o E Grand ,O DESCRIPTION OF WORK w a • N NEW ADD X ALTER REPAIR DEMOLISH Z SQ. FT. NO.OF _ NO. OF . . SIZE - STORIES FAMILIES USE OF STRUCTURE install wall heater SIGNATURE OF APPLICANT - VALUATION $ 120,00 r APPROVALS DATE _ INSPECTOR'S SIGNATURE P.C. PMT. M w FOUNDATION: LOCATION FEE $ FEE $ FORMS, MATERIALS - FRAME: FIRE STOPS, 1 I. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS / �.J.,. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. /a // WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS /r/ L� BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK TAUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. - TION OF HE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN;S C�MENSATI N INSURALATH, EXT. SIGNATURE OFHOUSE NUMBER COR-. PERMITTEE RECT AND POSTED J B ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STIR TURAL ENGINEER PLAN CHECK VALIDATION CK: M.O. CASH PERMIT.VALIDATION CK. '.M.O. CASH L1 o,9;5 3 5 AUG 2 8 1 -D 4.00^ F i I DEPARTMENT OF BUILDING AND SAFA ' APPLICATION FOR PERMIT `"�, COUNTY OF LOS ANGELES -ILDIN J WM. J: FOX, CHIEF ENGINEER 6v ,/ NO. OF BLDG. C NO. DISTRICT NO. ' PLAN CK'. NO. PERMI PLANS SETBACK LIN[ 1 4— i� } s V t FIR[ APPROVED ���sss/// ��^ ZONE RY OAT ECEIVED BY DATE OR ADPL. D Tt t UED' US[ APPROVED � >, d j 11 Wit! Z W T :I _ APPLICANT FIL� IN HEAVILY OUTLINED—PORTIgN (SNL a O / 1 o g NAME ADDRESSBUILDfN !s. Y W , Z ADDRESS _'LOCALITY--, 76 Ar L 6 U rdo NEAREST l t ,! CITY CROSS ST.''w A �G► `q STATE ' TEL. LICENSE NO. NO. yFj NAM[ lee 42-te. z " A� ✓ /� MAIL'' ' C NAME c p ADDRESS " 4j j� �� qtly �G TEL. < ADDRESS C!TY" NO. zCITY . ,L I ,4 ' ,�N 6 el t� 1 HEREBY•ACKNOWLEDGE THAT 1 HAVE READ THIS 8 APPLICATION AND STATE THAT THE ABOVE IS CORRECT 1 STATE TEL. ' -AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE* LICKNSE NO. NO. �J AND STATE LAWS REGULATING BUILDING CONSTRUCTION. z LOT. NO, SIZE OF LOT 02-lfo IGNATURE OR OWNER Ju NO. OR BLDGS. AUTHORIZED AGT. CLOCK NOW ON LOTolm r` J 1, TRACT . CORRECTIONS i ° USE OF BLOGS. J►NOW ON LOT ���1116 1 i DESCRIPTION OIC` WORK r•: BUILD USE OF O d /�j I��7 1LL�/"� L .,`L I2� �� � • "V 1 .y rtr i 5, C tt� < Ia. 00, NEW TYPE GROUP `` . .; S y +' ? sir s F•. i , f1 ' s• NO. OF NO. OP L: ALTERATION ROOMS FAMILIES s, ADDITION L#tZB /SSD S' REPAIR STORIES / !. ' MOVING WALL COVERING s DEMCLISH ROOF COVERING S , P. C. s / v v FINAL APPROVAL. V t3~ FEE Iy. r ' / V INSPECTOR-8 .s �s i VA /LU TION F l QATIC !i�� s NAfa t�•'i11 +' r 1 • WORKERS' COMPENSATION DECLARATION herey Insure bor acertificate affirm of Workers' CompensatioI have a certificate of n nInsurance, APPLICATION FOR BUILDING PERMIT , 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 ❑ Certified copy is filed with the county building inspec- BUILDING ?-T! ��e�Ar ��� tion department. ADDRESS A • %% v CITY � /� �%T ZIP ��7p� LOCALITY Date Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCEASSESSOR > 7 (This section need not be completed'if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE CSC( PARCEL hundred dollars ($100) or less.) � L�"d.1I TEL OWNER ��� /yj(//(� NO. USE ZONE MAP I certify that in the performance of thework for which this NO. permit is issued, I shall not employ any person in any manner ADDRESS 80`��4 �iq����iy 4 SPECIAL so as to become subject to the Workers' Compensation Laws. CONDITIONS O CITY ZIP 9120 U Date Applicant ARCHITECT OR TEL. � NOTICE TO APPLICANT:• If, after making.this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE Exemption, you should .become' subject to the Workers' �� `i w Compensation provisions of the Labor Code, you must forth- ADDRESS !r CL with comply with such.,provisions or this. permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR 1115- N ��J 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 LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. ClassSIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ 1-0` ElI am exempt under Sec. ��L'L/C� Wd0l� GuL ADD ❑ � C'v ► ALTER B.&P.C. for this reason N//NO4:✓S= W,r,-1 4,vA9 SLi446e- $ REPAIR ❑ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE 2--- E) hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By �� ___ ,_ • ,_ BUILDING ❑ I, as owner of the property; or my: employees with ADDRESS wages as their sole compensation,will do the work and - "' - 4 the structure is not intended or offered for sale(Section LOCALITY , Tc-,TA,'. -7 7044, Business andProfessions Code.) MOVING TEL. F"+I`i' qs LK I 1, as owner of the property, exclusively contracting CONTRACTOR. NO. _ _•:- with licensed contractors,to construct the project (Sec- ADDRESS pq .tion 7044,, Business and Professions Code.). a:, w CONSTRUCTION LENDING-AGENCY SETQBACKD YARD HWY TOTAL ROP.SETBALINEFROM 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. s'";t ( ; .�,^I,')') ;:'::1=,• - (Sec. 3097, Civ, C.). SIDE P.L.. `- Lender's Name n P.C. $ Permit Fee tY / LDMA Ref. # Lender's Address 0 1 certify that I have read this•application and state that the Issuance Fee �T / 45 LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee // / 8 ordinances and State 'laws relating to building construction, Total Fee TO' !o s LDMA Perm. # a and hereby authorize representatives of this County to enter upon e ove-mentiongd property f i spIction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE n Signatur Applicant or Agent Date