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HomeMy Public PortalAbout6237 AVON AVE_Building__ c P 6A 638A CE4803 6 3A L PP ICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDREISS d DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRI_qT,NO, GROUP TYPE RO)ESSED BY FOR APPLICANT TO FILL IN CONST. BUILDING STATISTICAL CLASSIFICATION S WER MAP ADDRESS / PSG CLASS. NO.��WELL. UNITS . K. LOT NO. _ BLOCK WATER ❑ _ CERTIFICATE: NOT REQUIRED RECEIVED TRACT MAP HIGHWAY STATE MAJOR SECOND. LOCAL NO.OF BLDGS. NO. (CIRCLE> SIZE OF LOT,i NOW ON LOT USE ZONE SPECIAL USE OF / /� CONDITIONS EXISTING BLDG. OWNER . � UILDI NG EXIST. SETBACK YARD .HWY ,REET NAME WIDTH ADDRESS V l/ a FRONT y ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE ADDRESS TEL fi `.F�` L� a',f" C'%" -� 6�L.=� �,r Q CONTRALTO f- (.! ./T/ 6 O ADDRESS C yjv yo 1/C o - 0 DESCRIPTION OF WORK ri W 0. NEW ADD ALTER REPAI DEMOLISH H SQ. FT. / NO. OF NO. OF SIZE (/�� ,J STORIES FAMILIES USE OF CTURE GY 1 3 STRUCTURE Qr - SIGNATURE OF APPLICANT VALUATIO APPROVALS DATE INSPECTOR'S SI,G NATU RE P.C. pMT. FOUNDATION: LOCATION FEE $ FEE $ FORMS, MATERIALS V J�% •' !? FRAME: FIRE STOPS. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. / / >� WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS ..V�/ BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK /- 7r / e/A 7 AUTHORIZED HER I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LA OR CODE O THE STATE OF CALIFORNIA RELAT- ING TO WORKME 'S OMPENSAT N INSU NCE. LATH. EXT. SIGNATURE A A y \1 HOUSE NUMBER COR- PERMITTEE "l.J RECT AND POSTED ADDRESS ' FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN PLAN ECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH LjCol9151 Jm29 1 A 22.00, d WORKERS'.COMPENSATION DECLARATION I'ke4by firm thaA r Msure, ora afcertif carte off Workers' Compensatioa certificate of n eInsuran ent to lf APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING r� 7 ❑ Certified copy is filed with the county building inspec- BUILDING / ADDRESS IV 23 tion department. ADDRESS A -�j Date Applicant CITY 2, .ZIP / —7 LOCALITY c CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one 3ASSESSOR hundred dollars ($100)or less.) TRACT D BLOCK LOT NO. MAP BOOK PAGE PARCEL � TEL USE ONE MAP ' OWNER I certify that in the performance of the work for which this TEL _ E NO. permit is issued, I shall not employ any person in any manner ���� SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS r CONDITIONS U Z...� Date _ Applicantf CITY ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GKOUP I TYPEFIRE PROCESSED BY O Exemption, .you should become subject to the Workers' ENGINEER NO. O CONST. NE I Compensation provisions of the Labor Code, you must forth- ✓ S t/O W U ADDRESS with comply with such provisions or this permit shall be O.' deemed revoked. STATISTICAL CLASSIFICATION APT. CONDO. U). CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC CLASS NO. 2,1 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 and LIC SEWER MAP 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.Class SIZE ISTORIES FAMILIES ONE ❑ DESCRIPTION OF WORK VALUATION 7t NEW Contractor Date $ ❑ I am exempt under Sec. . c �,� �c. ADD O , 8 71. 0 A geL ALTER B.BP.C. for this reason Scyr>t�. ❑ $ # o a a 0 c,.J REPAIR Dote: USE OF DEMO, ❑ ­ 4Q50 EXISTING BLDG. Signature APPLICANT TEL. FINAL ✓ i OWNER-BUILDER DECLARATION PRINT NO. DATE Z o 0 -40,500 U� I hereby affirm that I am exempt from the Contractor's License ADDRESS 1, 05-8 8 Law for the following reason (Section 7031.5, Business and FI , Professions Code): PRESEMT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). i MOVING TEL. ❑ 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 -NUAA EXIST. 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 work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name 66 LDMA Ref. # m Lender's Address P.C. Fee$ Permit Fee , 3 o I certify that I have read this application and state that the Issuance Fee LDMA P/C# o 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 authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ature of Applicant or Agent Date WORKERS'COMPENSATION DECLARATION hereby affirm that I have'a certificate of,consent to self -A P P L I CATION FOR B U,I L D I N G P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND'SAFETY Policy No. 2 30 770 Company State 'Comp Certified copy is hereby furnished. FOR APPLICANT TO FILL IN TBUILDING � A ADDRESS Vh� © Certified'copy is filed with tk county building inspec- BUILDING 6237 N. Avon tion department. ADDRESS Date l/l/88 Applicant _Pres CITY Temple City ZIP 91775 LOCALITY CERTIFICATE OF EXEMPTION FROM R .- NOS OF BLDGS. NEAREST.. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section•need'not.be completed if the permit is for one - -• ASSESSOR -hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP.BOOK- PAGE PARCEL OWNER Ray Hanna- 81.8NO.205--33 2 USE NE MAP I certify that in The performance of'the work for which this _ NO. y permit,is issued,`I shall not employ any person in any mannerSPECIAL t� so as`to become subject to the Workers'Compensation Laws. ADDRESS 6237 Nq Avon CONDITIONS `- bate Applicant CITY-Temp le_ City 8_1,r ' 205 -33#2 NOTICE TO``APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT OUP TYPE FIRE P SSED BY. LH ENGINEER NO. Exemption, you should 'become subject to the'Workers' "' i� T' ' ✓ CONS ZONE Compensation provisions-of.the Labor Code, you must forth ADDRESS - LH with comply with such provisions- orihis,permit shall be - - ' / � deemed,revoked TEL STATISTICAL CLA IFI ATION APT. ONDO. ' CONTRACTOR Montebello Rfg NQ 722 . 6975 LICENSED CONTRACTORS DECLARATION ' --- LIC. " CLASS NO. DWELL. UNITS I he affirm that I om licensed under provisions of Chapter 9 ADDRESS 868 Truck WayNO.24885 2 (commencing with Section 7000)'of Division 3 of,tke Business and LIC. SEWER MAP - Professions Code', and my license is in'full force and effect. CITY Minintehal 10 CLASS C•»39 BK. `PGVALIDATION 248 SQ. FL NO.OF NO. OF CHECK License Nu ber- ' 852 Lic,Class C^.39 SIZE STORIES FAMILIES ONE PresD 8/3l/87 DESCRIPTION OF WORK '" -2 exi'stih - r0 9W Q N VALUATIO Contracto ate D , 5252200 . Reroof w/ class ."A" fibe A D ❑ ❑ I am exempt u de S c: _ g ass S ng , Slope ALTER ❑ ® B.BP.C: for this reason - _ REPAIR $ , _ Dare: USE DEMOL ❑ EXISTING BLDG. dwellin _ APPLICANT Signature Montebello RfgNo 722--6975 FINAL PRINT) OWNER-BUILDER DECLARATION _._ . _ DATE l - -1 hereby affirm.that I am exempt from the Contractor's License ADDRESS 868 Truck Way Law for the following reason (Section 7031.5, Business and FI Professions Code): PRESENT __ B t' n as owner of Theproperty, or m em tUILDING o ees with ADDRESS / , ? 01.7 1 n ❑ Y P .Y. wages as their sole compensation,will do the work and # 0 0 o7° o,1 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING' "' -' TEL ' I ° ° 4 9,2 5 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed'contractors to construct the project (Sec- - .- ' "' • .. - 5 0 ADDRESS ° ° ° 4 9 2 tion 7044, Business and Professions Code). p CONSTRUCTION LENDING AGENCY SET REQUIRED ACK -YARD -HWY .,IOTA SETBAINEFROM._. txlbi.WIDTH O 5 1 2 i 8 7 , hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P:L.. - - - - ` (Sec. 3097, Civ. C.). SIDE Lender's Name 48 75 LDMA Ref. # P.C. Fee_$• _ . ,.. _- Permit-Fee- Lender's ermiYFee- . ... ♦ - Lender's Address certify that I have read this application and state that the .. Issuance Fee -• 1.0„-.50 LDMA P/C# '- above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, _ - Total Fee 49,25- LDMA Perm. # and hereby authorize representatives of this County to enter' _ upon theA bove-mentioned property for inspection purposes. Pres 5/11./87 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of ppl a or Agent -Date -