HomeMy Public PortalAbout5428 BALDWIN AVE_Building__ (2) UIRED
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76A638A CE#.038-69 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES ADDRESS
1 4 i L
DEPARTMENT OF COUNTY ENGINEER J�
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN, CROSS ST. .!
SUPT OF BUILDING
DISTRICT NO. TAGROUP TYPE P SSED BY
FOR APPLICANT TO FILL IN �' CONST. L�
BUILDING STATISTICAL CLAS FICATION SE ER MAP
ADDRESS* ,Q�1cG.„� �(.Ii4 PG
,,,,�� CLASS.NO. DWELL.UNITS
LOT NO. ti9/QG°�`L I,3 Lt�,j� BLOCK NUMAP MBER HATE YES, NO
TRACT GS 4y4&pA/p/d Q/),DN AIB t 7(,e SAMu 4 p#AipA USE ZONE SPECIAL
NO.OF BLDGS. -Oi_NY CONDITI NS W.
SIZE OF LOT O L) NOW ON LOT /!
USE OF L i NL" C i
EXISTING BLDG. BUILDING EXIST.
�j SETBACK YARD HWY STREET NAME WIDTH
OWNER 8L, a.+Y1-A/`�/ FRONT
ADDRESSO (J�-IGC�,i.It,�..� SIDE
TEL P. L.
CITY r,6>-j'-)'-'c C,-4 No. i INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER NO.
ADDRESS /
T EL _ �_TAm-—
CONTRACTOR k �r t NO.F
ADDRESS rj" -p-o r_�e' y"/.4
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ. FT. f NO. OF NO. OF
SIZE /��� STORIES FAMILIES
USE OF
STRUCTU E GENE Foof4tjVV,�Le_l_julll:f
SIGNATURE OF
APPLICANT .�tfNL
' APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS (� FOUNDATION: LOCATION
FORMS, MATERIALS ,.+
VALUATION $ G4✓f ?, I - U �. �I FRAME: FIRE STOPS,
BRACING, BOLTS
MT.S` FURNACE: LOCATION,
FEE �� .=� I FEE �.� GAS VENT, DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. -
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT. / ` t
STATE LAWS REGULATING BUILDING CONSTRUCTION.
SIGNATURE OFHOUSE NUMBER COR-
PERMITTEE G RECT AND POSTED
ADDRESS I FINAL
CLYDE N. DIRLAM, PRINCIPAL ST CT RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION(K. M.O. CASH
_ „ -_ _ '7 .
a
WORKERS COMPENSATION DECIARATIOl,
APPLICATION FOR BUILDING PERMIT
I hereby affirm that I have a certificate of consen'.to self '
insufe or a Certificate of Workers Compensation Insurance
"or a cern ed copy thereof (Sec 3800 Lab Com),, COUNTY OF LOS ANGELES BUILDING AND SAFETY t
Policy Z -141.11' CompanyO R-�j "'DAJ� '
Certified copy is hereby furnished I BUILDING
FOR APPLICANT TO FILL IN ADDRESS '
ICeI Certified copy is filed with the county uilding inspec BUILDING n ^LI T ,�l (�.� !
1 tion department ADDRESS ZI /J�b40 V Y r " LOCALITY
NEAREST
T
Date �pplicant CITY /L�. !T ZIP ! 7 v CROSS ST
CERTIFICATE OF EXEMPTION FROM WORKERS ,{ NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT D X V NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one - USE ZONE MAP
TRACT BLOCK I LOT NO NO
hundred dollars ($100)or less ) P
�,`/ A TEL�/�{ p��p r a SPECIAL }
I certify that in the performance of the workforwhich this OWNER�wT+� ��C7�� NO'7`f�� 8✓O CONDITIONS 4-r
permit is issued I shall not employ an person in an manner DISTRICT GROUP TYPE FIRE PROCESSED BY O ,
P P Y Y P Y ADDRESS �rn C / CI E V
so as to become subject to the Workers Compensation Laws `L/' 1ONST �
S r
CITY ZIP
Date Applicant X STATISTICAL CLASSIyICATION T CO DO V
NOTICE TO APPLICANT If after making this Certificate of ARCHITECT OR TEL
ENGINEER r NO CLASS NO �DWELL UNITS
Exemption you should become subject to the Workers a
Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP I ` s Z
with comply with such provisions or this permit shall be f' /) TELVALIDATION'
CONTRACTOR { `
deemed revoked CONTRACTOR 11-Ff �� NO U r ``� BK PG V�
LICENSED CONTRACTORS DECLARATION �/ LIC
I hereby affirm that I ani licensed under provisions of Chapter 9 ADDRESS 4l &J-k.+722,444N�yg'? VALUATION
(commencing with Section 7000)of Division 3 of the Business andT/i i CWSS
Professions Code and my license is in full force and effect CITY �7 cid
N J '1 4 SQ FT 1, NO OF / NO OF CHECK M1
License Num er' / Lic ate Class SIZE STORIES
,r / FAArMILIESONE
Contractor �
DESCRIPTION OF WORK le 06 3Zl Ilp NEW ❑ $ Y
' D � �� '�2
I�LZ-D P 40" ADD
I am exempt under Sec ' a
ALTER ❑ FINAL ' C1�
- C�/L�NGj DATE
B$P C for this reason REPAIR ❑
Date USE OF DEMOL FINAL
v EXISTING BLDG v` �D ❑ By �u 8 5 4 4 A
Signature APPLICANT //�� -�-y� TEL 1
g PRINT -E-/ /_.Pott/ � NO < # e o,e`- 23
OWNER BUILDER DECLARATION <G�TI 'r''G
I herebyaffirm that I-am exempt from the Contractor s License
Law fothe following reason(Section 7031 5 Business and ADDRESS x 2t° ° 4'9 4
I Kd Professions Code) PRESENT0 0 0 494 1'=
/ BUILDING v
/e I as owner of the property or my employees with ADDRESS ,,
wages as their sole compensation will do the work and 1s 2 2 3-8 2
x+ _ the structure is not intended or offered for sale(Section LOCALITY r e w
7044 Business and Professions Code) > MOVING TEL 2 8 5 1,5 A
I as owner of the property am exclusively contracting CONTRACTOR NO r
with licensed contractors to construct the project (Sec P # o o e e o
tion 7044' Business and Professions Code) ADDRESS
r CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST 2 ° ° b 8 b 2
SET BACK PROP LIN WIDTH
I hereby affirm that there is a construction lending agency for FRONT - o�o o (� (j 2 cS�
the performance of the work for which this permit is issued P L
(sec 3097 Civ C ) z SIDE - 12 23-82
m PL
o Lender s Name
ti y w
Lender s Address P C Fee E Permit Fee
I certify that I have read this application and state that theIssuance Fee s
above information is correct I agree to comply with all CountyF Investigation Fee
ordinances and State jaws relating to building construction
ly Total Fee
and hereby authorize representatives of this County to enter
up the ab a mentioned property for inspection purposes(
SEE REVERSE FOR EXPLANATORY LANGUAGE !
r Signature of Applicant or Agent + Date
�, s
WORKERS COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT
I
insure or a certificate of Workers Compensation Insurance r
or a certified copy thereof (Sec 3800 Lab C ) * I I
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy NoCompany 3 4
Certified copy is hereby furnished ; FOR APPLICANT TO FILL IN ADDRESS
❑ BUILDING
Certified copy is filed with the county building inspec BUILDING
tion department _s ADDRESS LA..9 r LOCALITY
NEAREST
Date Applicant CITY tj - C. ZIP a 0 CROSS ST
CERTIFICATE OF EXEMPTION FROM WORKERS c i i NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE b t SIZE OF LOT go eQ NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE MAP Cr
hundred dollars ($100)or less ) TRACT BLOCK LOT NO 3 O NO .2 d V J 3
s TEL SPECIAL
I certify that in the performance of the work for which this
OWNER_T,04.;, �ev4rrL� 49G-TING 8 -838 CONDITIONSc IL
permit is issued I shall not employ any person in any manner DISTRICT I GROUP ITYPE FIRE PR SSED BY O
r V V
so as to become subject to the ADDRESS
ers ompensation Laws Lwfro CONST ZONE
�t o,f .�J �
� CITY /'T Le' i ZIP i7eO bb A9 1
Q
1 DateG I y � ppl�cant STATISTICAL CLASSIFICATI N APT CONDO I�
TEL
NOTICE TO APPLICANT If aft along this C is of ENGINEERARCHITECT O lf NO - V
Exemption you should become subject to the Workers CLASS NO DWELL UNITS LU
Compensation provisions of the Labor Code you must forth CL
ADDRESS SEWER MAP
with comply with such provisions or this permit shall be Z
deemed revoked - TEL �' VALIDATION
NO
CONTRACTOR BK PG
LICENSED CONTRACTORS DECLARATION LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION t
(commencing with Section 7000)of Division 3 of the Business and LIC Z.4 A ,7 D� w
Professions Code and my license is in full force and effect CITY CLASS $ CI ' , t
SQ FT y1 NO OF NO OF CHECK
License Number Lic Class SIZE oc(0 STORIES FAMILIES ONE
Contractor Date DESCRIPTION OF WORK 17 610 r NEW ❑ s
ADD
I am exempt under Sec '
ALTER ❑ FINAL
B&P C for this reasonREPAIR
ti ❑ DATE
USE OF
Date EXISTING BLDG DEMOL ❑ By AL /I , ti4 b G 2 A
Signature APPLICANT TEL
L OWNER BUILDER DECLARATION PRINT NO f # 0 0 0 0 0 1
1 hereby affirm that I am exempt from the Contractor s License ' 1
Law for the following reason (Section 7031 5 Business and ADDRESS 110111. 2 o,028,50
Professions Code) N '
BUILDING ` J
I as owner of the property or my employees with ADDRESS r'o o e 2 8 5 0 s-
wages as their sole compensation will do the work and 4
the structure is not intended or offered for sale(Section LOCALITY a 9,. 3`
7044 Business and Professions Code) MOVING TEL 1
t
I as owner of the property am exclusively contracting _ CONTRACTOR NO '
with licensed contractors to construct the project (Sec ADDRESS
tion 7044 Business and Professions Code)
REQUIRED TOTAL SETBACK FdROM ;
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE
I hereby affirm that there is a construction lending agency for FRONT ,k
the performance of the work for which this permit is issued,, P L
(Sec 3097 Civ C ) t SIDE
m P t
o Lender s Name
Lender s Address P C Fee b Permit Fee I certify that I have read this application and state that the 7 Issuance Fee above information is correct I agree to comply with all County Investigation Feeordinances and State laws relating to building construction Total Fee
CJ a ereby authorize representatives of this County to enter
pont e a o e menti d property for inspection purposes
w
-/q 43 r SEE REVERSE FOR EXPLANATORY LANGUAGE r -
gnature 0
PPiic 0
nt Date Os