HomeMy Public PortalAbout4927 ARDSLEY DR_Building__ 72_� :' C
76A,63'84''.CE#8035-65 APPLICATIO tl FOR ..BWLDl�NG .PER YjT.
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT'OF COUNTY-ENGINEER ADDRESS S'LF. P
BUILDING AND. SAFETY DIVISION LOCALITY l
JOHN A. LAMBIE. COUNTY ENGINEER . NEAREST
COLEMAN W. JENKINS,Sup•T,oF BUILDING CROSS ST. -- -,
DISTRICT:NO._.. GRO - TYPE.. •�PROCESSED, BY; ,
FOR APPLICANT T.O FILL INCONST.
a BUILDING - STATISTICAL CLASSIFICATION - SEWER-MAP "
ADDRESS `� _ 13K.' G
CLASS NOS DWELL UNITS - •
LOT-NO. - BLOCK USE ZONE -
MAP
NO.
TRACT - - SPECIAL
/ ANO. OF BLDGS. CONDITIONS '
SIZE OF LOT NOW ON LOT
USE OF - _ -
EXISTING BLDG. - BLDG. SETBACK FROM
TELFRONT PROP,-LINE'OF "�`r � 15T E )'
OWNER. NO. -:' TYPE OF EXISTING SETBACK HIG HWAY YARD = 'TOT AL
ADDRESS HIGHWAY WIDTH FROM C.L.
ESE C/'
CITY - _ BLDG. SETBACK FROM
ARCHITECT OR TEL. - - - - - - -
ENGINEER NO. - SIDE_PROP. LINE OF•' -. (STREET,)
TYPE OF . .EXISTING SETBACK HIGHWAY.'..} YARD.- ,TOTAL
ADDRESS - HIGHWAY WIDTH FROM C.L.
TEL. -" _ _ + _ - -�•,
CONTRACTOR ' E ^ NO
.0
-
CORNER CUTOFF YES
LIC
NO'
- ADDRESS - NO'
N ad
CITY CLASS - SEE REVERSE SIDE FOR SPECIAL APPROVALS:- .O
DESCRIPTION OF WORK
:NEW DD ALTER REPAIR - 'DEMO'LISH
'SQ.,F T: NO. OF - �N O. OF
SIZE - STORIES - FAMILI.F_S, - '
USE OF - ��� ��(/./< '- ... .'• 'u..�C,.-
STRUCTURE oig 71
_ '� "c• �A,,,," ,..,•�..�+J
SIGNATURE OF
APPLICANT'
VALUATION$ .,• ®�'!�'•—��' �-- _3,-� -• •` ^
V APPROVALS DATE E'.I,NSPEC7 R'S�,SIGNATUREa
P.C. V 'PLAIT. - •� - �U 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 ,dry
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
13UILDING CONSTRUCTION. I CERTIFY THAT. IN .DOING THE WORK I
AUTHORIZED HEREBY I WILL NOTr EMP OY ANY PE RSON IN V OLA- LATH. INT. ♦.�. ' .�:.rr�-
TION.OF THE LABOR CODE OF THE' TE.O CALIFOR IA LAT-
INC TO WORKMEN'S COMPE ATION URAN �".•y �^
w LATH. EXT. .
SIGNATURE OF ,� - HOUSE NUMBER COR--
PERM ITTEE
ORPERMITTEE RECT AND POSTED -
ADDRESS
�, IOU D----C.E>f ,,),IP —'rC Fl NAL �P
JOHN F. LEWIS. PRINCIPAL ST T)URAL.ENGINEER
PLAN CHECK VALIDATIONC.KM.O. CASH PERMIT VALIDATION' ."cK. M.o. CASH
Lr O'.2 9 9 2, JUIN 2 2 2 3 D
, 0 . 1 :7 JUN 3C 6.0 0!-,
/ .. � �
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent-)o self "n P
insure, or a certificate of Workers' Compensation Insurance, (/ 1�
or a certified copy thereof (Sec. 3800,,Lab.,C.)
COUNTY OF LOS ANGELES BUILDING-AND SAFETY
Policy No. BU
Company
Certified copy-is hereby furnished: ol FOR A
APPLICANT TO IN : DDING 9a
ADDRESS
Certified copy is filed with the county building inspec BUILDING 77
tion'department, - ADDRESS C�
Date Applicant CITY' C C� ZIP l3 L/ LOCALITY t
CERTIFICATE OF EXEMPTION FROM'WORKERS J NO. OF BLDGS. NEAREST
COMPENSATION INSURANCESIZE OF LOT,. NOW ON LOT CROSS ST.
(This section need not be co
mpleted"if the permit is°for one ASSESSOR '
hundred.:dol.lars ($100)_or less.) a; TRACT [ BLOCK LOT NO MAP BOOK PAGE PARCEL
TEL. USE ZONE. MAP
I certify.that in ahe performance of the work for which this OWNER �;tr}� 6/�4 4_ TEL.O. NO.
permit is issued_ I shall not employ any person in any manner Z 7 r s SPECIAL
ADDRESS CONDITIONS
so as to become subject to the Worker'Co ensation Laws. C)
�,��� 7— U
Z ,Zr/ "e'�d � CITY I -e'- c Liz ZIP �.
Date Applicant :.
ARCHITECT OR TEL:
NOTIC TO`:A PLICANT: If;,afte� 6king.:this,Certificate of '' Z8``1 8�� 7 DISTR OUP O
ENGINEER NO. ICT_. G TYPE; FIRE PROCESSED BY'.
Exemption, you':shpuld .be co a subject to:the Workers � y\
CONST. ZONE
Compensation,provisions of the Labor.Code„yo.0 must forth- ADDRESS '(1 W
with comply with'such•provisions or;this:-permit shall:be
D �//� ora o
deemed revoked.,-, CONTRACTOR' C(S 2 z/�Gil' !� NO.�/'7 Opo �07p STATISTICAL CLA ATION
LICENSED CONTRACTORS DECLARATION LIC. . CLASS NO. S DWELL. UNITS
�j IFI APT: C NDO to
I hereby affirm that;I am licensed'under provisions of Chapter 9 . ADDRESS �O f' �°v NO. 7 ”
SEWER•MAP
(commencing wiih`Section 7000)of Division 3.of the Business and - (� CIC.
Professions Code,'and''my license is in.full force and effect.,' CITY. /iUCI�i CLASS C`3 w VALIDATION
r) SQ. FT NO. OF NO.OF CHECK "BK. •-'PG.
License Number LicFClass � SIZE ��` STORIES FAMILIES ONE
DESCRIPTION OF WORK /�(N� f�o
NEW_ VALUATIORI
Contractor,f r / pa16 Z r$ $ 2706
a � 7 12 8 A
am exempt under Sec. _ C7 U tet!® # o • o .�
o; o0
nl:reli `a o'5 9,2 5
B.BP C for this reason Q
REPAIR o o 0 5 9.2 5�P
Date: E-51114AXIST
PPUS'LIUSE OCANBLDG. L Q
DEMO
TEL.- -0a24y87
Signature FINAL _
NER-BUILDER'DECLARATION PRINT NO. DATE
I hereby offir that I am exempt from the Contractors License r
Law for the followm
g reason.(Section 7031.6, Business grid ADDRESS, FIN,
`Professions Code) - BY
1, as ovvneras theso BUILDING
of-.the property, or my employees with ADDRESS'• '
wages` le compensation,will do the work and
the structure is not intended or offered for sale'(Section LOCALITY
7044; Business and Professions Code) MOVING TEL
CONTRACTOR NO.
I,.os owner of.the property, am.exclusrvelycontracting .- - '
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code),
REQUIRED,,, TOTAL SETBACK F
CONSTRUCTION LENDING AGENCY' SET BACK'.. YARD Hwy PROP. LINE WIDTH
.1 hereby'affirm that there is a construction lending agency for FRONT'
the performance;of the:workfor which.this permit is'issued. P.L.
(Sec. 3097, Civ. C`.): SIDE .
P.L.
Lender's Name
MA Ref. #
m P.C:Fee$ Permit Fee-''`•'
LD
3
Lende'r's Address _
g I.certify.that Lhave read this application and.state.that he .., • issuance Fee S LDMA.P/C#•
' above information is correct. I agree to comply with all County- Investigation Fee
0 ordinances and State laws relating to building construction, Total Fee LDMA.Perm. #
and hereby au
orize representative of this-County to enter
upon. ab e-mentio ed grope for ins'ection'purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE _
Signature of Applicant or Agent; Date ..