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Home My Public Portal About5428 BALDWIN AVE_Building__ UIRED 'yl'2;/�OEAY D MATERIAL R EQWOR %FOR ANY MAT�Rlr1L ,�iTJ�, � OR WORK pp DONE IN THE ROAD RlvriT OF WAY. 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