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HomeMy Public PortalAbout5023 BALDWIN AVE_Building__ (2) 76A648A CE 4809 4/7APPLICATION FOR BUILDING PERMIT rf! COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING �O JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or tyoe onlvl CROSS ST BUILDING DISTRICT �Q GROU TYPE / P CESS Y ADDRESS Q R ,qwtl 0 V CONST/ e, STATISTICAL CLASSIFICATION SEWER MAP LOT NO BLOCK CLASS NO DWELL UNITS BK PG TRACT USE ZONE MAP O OF BLDGS NO SIZE OF LOT NOW ON LOT _/ SPECIAL USE OF CONDITI0,NS EXISTING BLDG n l TEL ( GGGt,�2_ OWNER C- NO BLDG SETBACK FROM ADDRESS S(` ( FRONT PROP LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY �� HIGHWAY WIDTH FROM C L ARCHITECT OR TEL } ENGINEER NO BLDG SETBACK FROM ADDRESS SIDE PROP LINEOF (STREET) TEL TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CONTRACTOR ` { - NO (Q S HIGHWAY WIDTH FROM C L ADDRESS 019ILk NO ZG S 1 + = O CITY C 0 � Vl; /l J} CLASS C-3 7 CORNER CUTOFF YES ❑ NO z CONSTRUCTION LENDER ❑ C> NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS LLI CL ADDRESS to Z_ SQ FT NO OF NO OF NEW ❑ SIZE STORIES FAMILIES ❑ USE OF ADD STRUCTUR ALTER ❑ SIGNATURE OF REPAI � APPLICANT ` DEMOL///��❑ I i1 p 0 VALUATION $ v APPROVALb DATE INSPECTOR 5 SIGNATURE PC PMT FOUNDATION LOCATION FEE $ FEE $ FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON GAS VENT DUCTS STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT LABOR CODE OF THE ST TE OF /CEFORNNA IN RELATING TO WORKMEN S C MPE INS,UR LATH EXT SIGNATURE HOUSE NUMBER COR PERMITTEE I RECT AND POSTED ADDRESS FINAL PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL STRU URAL ENGINEER PERMIT VALIDATION CK M o CASH SAF- 8 6 7 3z-- 4 1 D --1720- -- LL WORKERS' COMPENSATION DECLARATION I hereby affirm That I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.G ` Company BUILDING �n ❑ Certified copy is hereby furnished: .'FOR.APPLICANT.,.TO,FILL IN. ADDRESS (/ ElCertified copy is filed with the RE county building inspec- BUILDING ; ''� tion d�rtm� ADDSS (n�sf� ! 090 CITY' ZIP LOCALITY Date- Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCE ASSESSOR (This,section need not be completed if the permit is for one TRACT' BLOCK LOT NO: MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. OWNER Iu NO. USE ZONE MAP NO. I certify that in the performance of the .work for which thisss��,, ` /JrL:I SPECIAL a permit is issued, I shall not employ any person in any manner ADDRESS ' id lf�/ CONDITIONS so as to become subject to the Workers' Compensation Laws. O CITY ZIP Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE CESSED BY 0 NOTICE TO APPLICANT: If, after making .this Certificate of ENGINEER NO. CO ZO E 0 .Exemption, you should, become. subject to. the Workers' U Compensation provisions of the Labor Code, you must forth- ADDRESSI a with comply with such provisions or this permit shall be TEL TATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR.N547�O O NO. _ LICENSED CONTRACTORS DECLARATION , LIC. = Q CLASS NO. / DWELL. UNITS I hereby affirm that I am licensed under provisions of,Chapter 9 ADDRESS K 'P�-NO SEWER MAP \nd ommencing with Section 7000)of Division 3 of the Business LIC. Professions Code,and my license is in full force and effect. CITY �LC K /�°� CLASS BK PG VALIDATION p,, 'SQ. FT. NO. OF NO. OF CHECK License Number. ��� V Lic. Class G''V SIZE STORIES FAMILIES ONE VALUATION Contra ctoDate' DESCRIPTION OF WORK NEW 01 $ �D© ac' �' ADD ❑ El I am ex mpt under Sec. C ► ALTER ❑ B.&P.C. for this reason ! REPAIR ❑ $ Date: USE OF DEMOL ❑ EXISTING BLDG. ii Signature APPLICANT PRINT.) SFINAL 1 ( /� BSOQ 1 TTEE . OWNER-BUILDER DECLARATION - O. DATE I hereby affirm that I am exempt from the Contractor's License l // �'� Law for the fol lowing reason (Section 7031.5, Business and ADDRESS lBIO ��/5' FINAL s s202.20 Professions Code): PRESENTBy BUILDING ❑ I, as owner of the property,. or my employees with ADDRESS wages as their sole compensation,will do the work and a LOCALITY the structure is not intended or offered for sale(Section `'t'T° 7044, Business and Professions Code..) • MOVING TEL. ❑ I, as owner of the property, am CONTRACTOR NO.exclusively contracting 33 03 229.95 with licensed contractors to construct the project (Sec. ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. _ 7 ITEMS YARD HWY CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT TOTAL 432 5 the performance of the work for which this permit,is,issued RL. (Sec. 3097, Civ. C.). SIDE . P.L. Lender's Name. --'- a ,Ref. #LDMACASH 4 y a 15 � P.C. Fee$ Permit Fee 3 Lender's Address ,r� �n�"��L �'� 1 certify that I have read.this application and state that the Issuance Fee /� LDMA P/C# , CHANE no above information is correct.i agree to comply with all County Investigation.Fee // '7 ordinances and State laws relating to building construction, ©eJS "� Total Fee ,;? LDMA Perm. # r�l�- rf� fj } iesdr{ and hereby authorize-representatives of this County to enter upon the above-mention property for inspection,purpooses. a SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Applicant or Agent Date