HomeMy Public PortalAbout5438 BALDWIN AVE_Building__ (2) M4128A U#8011 V60 APPLICATION FOR I3UI DING PERMIT
COUNTY OF LOS ANGELES BUILDING 7
DEPARTMENT OF COUNTY ENGINEER ADDRESS
B=ING AND SAFETY DMSION LOCALITY
JOHN A `LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST L
DISTRICT N I GROUP TYpE P SSED BY
FOR APPLICANT TO FILL IN D CONST
BUILDING �7 �� I , STATISTICAL CLASSIFICATION _ S ER M_APl
ADDRESS ' Al.AA..
CLASS NO DWELL UNITS
P7 16
LOT NO O Sf�> fJ TACK MAP NUMBER HATE YESN
TRACT
Z NE SPECIAL ✓
NO OF BLD /�,q� CONDITIONS
SIZE OF LOT 1LiCJ I NOW ON OT
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USEOF
EXISTING BLDG b�� C` 1UPIODMIG YARD HWYSIRE T AME EXIST
TEL STBACK WIDTH
OWNER '
• IL. NO FRONT
P L
ADDRESS ;SIDE
ARCHITECT OR 5 TEL I P L
ENGINEER �T NO INSPECTION RECORD
ADDRESS -
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CONTRACTOR NO O
ADDRESS J V
DESCRIPTION OF WORK O-
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NEW ADD ALTER REPAIR DEMOLISH
SQ FT a NO OF NO OF - I j a
SIZE STORIES FAMILIES
USE OF
STRUCTURE I`J iI
SIGNATURE O '
APPLICANT
VALUATION d0
APPROVALS DATE, INSPECTOR S SIGNATURE
`_ PMT FOUNDATION LOCATION w�
F E $ 47 FEE $ FORMS MATERIALS v4 5' fop
FRAME FIRE STOPS I
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP BRACING BOLTS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE LOCATION n
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS
STATE LAWS REGULATING,BUILDING CONSTRUCTION
I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH INT
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE �.
WORKMEN S COMPENSATION� AW CALIFORNIA LATH EXT - A
SIGNATURE OF HOUSE NUMBER COR _ /`
PERMITTEE �VVVaa���� RECT AND POSTED I G/1-1
ADDRESS FINAL 1 -� /
CLYDE N DIRLAM PR NCI",SST CTU L ENGINEER
PLAN CHECK VALIDATION CK. MO CASH PERM VALIDATION cK m o , CASH
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✓ y / AC DEPT IT13' I IQUIP6
OR ANY MATERIIL STO'?AG- R WORK
DONE IN THE ROAD RIGHT OF WAY#
78AC38A CE#8038 EY APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES ADDRESS� � ,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY �pt
JOHN A LAMBIE COUNTYIENGINEER NEAREST t�Ll v
CASSATT D GRIFFIN SUP T OF BUILDING CROSS
DISTRICT NO I GROUP- TYPE- P ESSED BY
FOR APPLICANT TO FILL IN Jb CONSTa Lt c�
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
CLASS NO_-K—DWELL UNITS - zp 131
LOT NO-<,O !O/- /5/ a'�/j , OCK MAP STATE
� NUMBER HWY YES O
TRACTG/' %?f�ify,D(�/.(//meq/- /j�/�/9 U$EiONE SPECIAL
NO OF BLDGS CONDITIONS
f�q �Q
SIZE OF LOT v�C/ NOW ON LOT
USE OF D r
EXISTING BLDG FES 6,q,",6,F BUILDING EXIST
ARD HWY STREET NAME
SETBACK YWIDTH
OWNER ' 1�7T /CE�. FRONT
MAIL < P L
ADDRESS SIDE
TEL P L
CITY NO INSPECTION RECORD
ENGINEER OR TEL
NEERAA1'r NO
ADDRESS
CONTRACTOR �4¢/>yE NOL w
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SO FT I
NO OF NO OF
IZE LSTTORIES FAMILIES
USE OF
STRUCTURE
(C)tij, � �
SIGNATURE O
APPLICANT
APPROVALS JDATE INSACTOR S SIGNATURE
ADDRESS SA tc-- FOUNDATION LOCATION sP J�jj
VALUATION $ FORMS MATERIALS
, FRAME FIRESTOPS 1-/
Vwlwa_Tm� OEM _BRACING BOLTS
PC FURNACE LOCATION
FEE S FEE $9��r I _GAS VENT DUCTS " (Q
v �
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LOTH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULAJING BUILDIN ONSTRUCTION LATH EXT a {
SIGNATURE OF i�� HOUSE NUMBER
RECT AND POSTEDR
PERMITTEE J / 67
ADDRESS FINAL
cic m o caste MI
CLYDE N DIRLAM PRINCI AL ST IJ T 11,11,11L ENCAeH ER
PLAN CHECK VALIDATION PERT VALIDATION KhO
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76AG38A CE#8035 61 APPLICATION FOR BUILDING PERMIT "
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �7ji� ate/
BUILDING AND SAFETY DMSION LOCALITY TE' ^ �� }
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DIST CT N GROUP TYPE PVSED Y
FOR APPLICANT TO FILL IN p coNST
BUILDING-.5- STATISTICAL C SIFICATION SEWER MAP
ADDRESS -l�"7 a /V �/�.' !�Vit// 4' CLASS NO DWELL UNITS B PG
LOT NO 10 ./ BLOCK WATER �71
CERTIFICATE NOT REQUIREDni
RECEIVED
TRACT C I / /U��l/ �p f
MAP pp-1 /1 HIGHWAY STATE MAJOR CON LOCAL
NO OF BLDGS NO L� C.� (CIRCLE)
SIZE OF LOT USZ ZONE SPECIAL
USE OF p CONDITIONS
EXISTING BLDG �C-+�.�5 `�' TLl
OWNER N l{�ySlj��e' NO' 13T11
BUILDING YARD HW TREET NAME XIS
SETBACK WID
ADDRESS �' C FRONT ! it
ARCHITECT OR TEL P L 1 CJ �.
ENGINEER C NO SIDE d
P L O
ADDRESS TEL INSPECTION RECORD U
CONTRACTOR rz A1C NO O
1-�
ADDRESS V
W
DESCRIPTION OF WORK - H
Z
NEW X ADD /ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF
IZE Ot> STORIESc� FAMILIES
USE OF
STRUCTURE J�SO �D S'Q
Te, S" . 5,
SIGNATURE F�(
APPLICANT_ �
VALUATION S
APPROVALS DATE INSPECTOR S SIGNATURE
P C /J PMT (f-V FOUNDATION LOCATION
FEE $/ FEE $ FORMS MATERIALS
FRAME FIRE STOPS / y
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS HCl
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION r u I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH{INT r `
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT
INC TO WORKMEN 5 C ��R�ANCE LATH EXT
SIGNATURE HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS FINALr J z
CLYDE N DIRLAM FlfilNCIPAL STRUCTURAL E
PLAN CHECK VALIDATION m mo cABH PERMITVALIDATION cK. mo ZCABH7
Y 9527VAR13 1 p 200
I t l
3 1
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4 ~ V
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WOI EFTS' CIDWENSAT19N DECLARATIOI*
ent to s
insure,hereby
certif catte of Workers' Comtpensat on Insurancef APPLICATION FOR BUILDING PERMIT
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES _ BUILDING AND SAFETY
Policy No. Company
BUILDING ' ,/l/]A
❑ Certified copy is hereby furnished. FOR APPLICANT � DO/
)CANT TO FILL IN ADDRESS W.!
❑ Certified copy is filed with the county building inspec- BUILDING
ADDRESS
tion department.
Date Applicant CITY' vc ZIP LOCALITY
pp O. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT O O NOW ON LOT 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.) OWNER (J�s TEL.
USE
O ZONE MAP
NO.
I certify that in the performance of-the work for which this SPECIAL }
permit is issued, I_shall not employ any person in any manner ADDRESS � �i G( (� (� CONDITIONS
so as to become subject to the Workers' Compensation Laws. �/ O
CITY �/�/UD ZIP �! `�
Date Applicant ARCHITECT OR TEL.
DISTRICT GROUP TYPE FIRE. OCESSED BY Q
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. r ?i/6 CONST. Z U
Exemption, you should 'become subject to the Workers' /� I,Q J w
Compensation provisions of the Labor Code, you must forth- ADDRESS ZZ IU. �`� rlj o g� �— I U1
with;comply with such provisions or this permit shall be T TEL STATISTICAL CFICATION APT. CONDO. h
deemed revoked. CONTRACTOR (� E_ e, O. Z,
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS
-
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business LIC.
and Professions Code,and my license is in full force and effect. CITY CLASS BK PG 23 VALIDATION
SQ. FT. .. NO. OF r7 NO. OF CHECK I�/�!7
License Number Lic. Class SIZE STORIES G/ FAMILIES ONE "' iyi.•4t■T '
VAC ATION n�9 t t
Contractor Date DESCRIPTION OF WORK NEW El330 409.2
`
ADD ► 1 ITEMS
❑1 am exempt under Sec. / 2� S �N O ALTER ❑ 1 //�� /�/C�/� 1 __137
B.BP.C. for this reason cU 'u �� REPAIR ❑ $/nt / U/ ,/ / D 0 TOTAL 409
i�❑
Date: USE OF
BLDG. DE 01 ❑ V'V CHECK 409.`9
EXIAPPLICANT �11)� TEL. f�, CHANGE .00
Signature (PRINT) IAII� u/�� NO. _fig FINAL
OWNER-BUILDER DECLARATION DATE!
I hereby affirm that I am exempt from the Contractor's License G /�
Law f& the following reason(Section 7031.5; Business and ADDRESS (� �, �91n6 FINA 0000-0001 9/27/89
Professions Code): PRESENTB
BUILDINGV5977 1 AM10:39Y
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and x;
the structure is not intended or offered for sale(Section LOCALITY ,
7044, Business and Professions Code.) MOVING TEL.
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. f
with licensed contractors to construct the project (Sec-
ADDRESS , 1'
tion 7044, Business and Professions Code.) '0
REQUIRED TOTAL SETBACK FROM' EXIST. r t .+ AC. T.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP..LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT i�( r 533.25
the performance of the work for which this permit is issued P.L. _
(Sec. 3097, Civ. C.). SIDE 1 ITEMS'
�� ,��
Lender's Name n TOTAL 53131' ®.25
P.C. Fee$ 0 C7( Permit Fee LDMA Ref. # <� '=s
Lender's Address p{ C.HE{.I', "'t`!'`•-
0 1 certify that I have read this application and state that the ► Issuance Fee ►cJO LDMA P/C# , ;_;HANGE ,ill.
O above information is correct. I agree to comply with all County Investigation Fee
Rordinances and State laws'relating to building construction, Total Fee 1.9-5 LDMA Perm. #
and h authorize-representatives of this Count to enter
up tha7 Bove-mentioned property for inspection purposes. 011 !-�ii��k1 11{�,� 9/K
SEE REVERSE FOR EXPLANATORY LANGUAGE 6677 1 AM 9:4:
Signature of Ap icant or ent Date