HomeMy Public PortalAbout5437 BALDWIN AVE_Building__ A ROAD D--PT PERT 'T I;
FOR /,14, ,JAlEPIf L
DONE IN THE ROAD RIGHT OF WA
7CAE3AY CE#...EY APPLICATION FOR BUIL®IfgG PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS /
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT O GRIFFIN SUP T OF BUILDING CROSS ST
li DISTRICLDlO I GROU I TYPE PR
FOR APPLICANT TO FILL IN Z7 CONS , �
BUILDING/I.�.�% STATISTICAL CLASSIFICATION SEWER MAP
ADDRESSa/ —� K P
CLASS NO DWELL UNITS
LOT NO BLOCK MAP
QTATE
NUMBER HWY YES O
L .w
TRAC Z— USE ZONE SPECIAL
t NO OF BL GS '} /� CONDITION
621�1-;b eld
SIZE OF LOT-�,eLI I W ON L T Jam' /I �/ 4�
USE OF q U ` A I
EXISTING BLDG BUILDING YARD SERE T NAME' EXIST
�� �^ SETBACK WIDTH
OWNER
10c, ( �-CL� J Fh C FRONT a
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ADD ESS / O hu S ([J P J lt4E SIDE
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INSPECTION RECORD
ARCHITECT OR TEL
ENGINEE NO
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ADDRES
CONTRA �j6�i VLtJ E/L1NO AI=
ADDRESS C l��/ ��/1/J el V/{�(J ` •�/•� ^den—
DESCRIPTION OF WORK � —
EW ADD ALTER REPAIR DEMOLISH
yFT NO OF a NO OF
SIZE / / STORIES FAMILIES
USE OF
STRUCTURE
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SIGNATURF
APPLICA
APPROVALS DATE INSPECTOR S SIGNATURE.
ADDRES FOUNDATION
UNDATIONLOICA ION O �--L7-�--�'
FORMS J ¢
VALUATION $ FRAME FIRE STOPS �po1 �/ ) � •��1� / M���
BRACING BOLTS O
P C PMT
$/ Ali FEE ® I FURNACE LOCATION
GAS'VENT DUCTS �4 G?7 � 7.1..v' ..✓L,
s �
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO ITHALL COUNTY ORDINANCES AND
STATE S R GU TI BUILDING CONSTRUCTION LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTE �� RECT AND POSTED f\ yA
ADDRESS FINAL ��
M o cwsH CLYDE N DIRLAM PRINCIPAL STRUCTURALCnL E CASH R
HE
PLAN CCK VALIDATION cK PERM VALIDATION ,
4
1
L Co 9 B 2 1 'o A^n —523A 0 5 rJ ,
OF
f _ � oolsotPR28 1A 3900
,
WORKERS COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent self APPLICATION FOR BUILDING PERMIT �
insure or a certificate of Workers Compensation Insurance
or a certified copy thereof (Sec 3800 Lab C )
Policy Nor r 2 0-41 Z.4j, f>y 3 2 7 Ar c aG r a u t Ins j COUNTY OF LOS ANGELES BUILDING AND SAFETY _
Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING '`
Certified copy is filed with the county building inspec BUILDING ADDRESS Y
tion department ADDRESS 5437 Baldwin LOCALITY 4
11-1-8^ lRn d o l R G U f 7 I le City 91780 NEAREST
Date r ZIP
CROSS ST ,
CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDG§ ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for„one USE ZONE MAP
hundred dollars ($100)or less )
TRACT BLOCK LOT NO NO
TEL _ SPECIAL
I certify,that in the performance of the work for which this OWNER S t e l l e Brewster NO 2 8 5 4 3 / CONDITIONS d
permit is issued I shall not employ any person in any manner -Baldwin - DISTRICT GROUP TYPE FIRE PR ESSED BY O
so as to become subject to the Workers Compensation Laws ADDRESS CONST ZONE V
CITY Temple Cit zip 91780
i� 3
Date Applicant STATISTICAL CLASSIFICATION pT CONDO O
NOTICE TO APPLICANT If after making this Certificate of ARCHITECARCHITECT OR TEL NO V
Exemption you should become subject to the Workers CLASS NO DWELL UNITS a
Compensation provisions of the Labor Code you must forth VII SEWER MAP
with comply with such provisions or this permit shall beZ
deemed revoked CONTRACT Np BK NO - VALIDATION
LICENSED CONTRACTORS DECLARATION LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 529 E Valley NO VALUATION
1 (commencing with Section 7000)of Division 3 of the Business and
Professions Code and my license is in full force and effect CITY 5 an Cab r 1 e 1 CLASS � $ O C,Q
Poo.
License Number
F ('C F F Lrc Class C-3 9 SIZE STORIES MILfNO OF NOLIIES CONEK
COntraCta,a r(A C,1 Roof 1 n Date -10--,1 0 T8 3 DESCRIPTION OF WORK e roof house NEW
I am exempt under Sec 4 a IL d Qarage wl t h s h i r. 9 [:]
ALTER E] FINAL
B 8P C for this reasonREPAIR ® DATE I
USE OF
Date EXISTING BLDG S FD DEM FINAL
Signature APPLICANT TEL By
OWNER BUILDER DECLARATION PRINT R a n d G l F o o f i n g NO 2 8 8 4 0 4 0 2
j hereby affirm that I am exempt from the Contractor s License ADDRESS 5/-9 R 'Valley
,
Law for the following reason (Section 7031 5 Business and
Professions Code) pver
OBUILDING
I las owner of The property or my employees with ADDRESS
wages as their sole compensation will do the work and LOCALITY r a o Q o
the structure is not intended or offered for sale(Section
7044 Business and Professions Code 1024 -83
MOVING TEL �
j 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)
CONSTRUCTION LENDING AGENCY ' REQUIRED YARD HWY TOTAL SETBACK FROM EXIST
SET BACK PROP LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT ,
the performance of the work for rwhich this permit is issued P L plol
(Sec 3097 Civ C ) r SIDE
w s m PL �
o Lender s Name
PC Fee$ Permit Fee
Lender s Address '
o�c I certify that I'have read this application and state that the Issuance Fee 10 50
above information is correct I agree to comply with all County Investigation Fee
g ordinances and State jaws relating to building construction ' [F 1 50
d and hereby authorize representatives of this County to enter Total Fee Y�
upo&tabove men ne roper or inspe purposgs�� -
�((////�� f SEE REVERSE FOR EXPLANATORY LANGUAGE -- ,
Signature of Applicant or Agent Date" J ®t
J r