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7EA539A CE 17 6036-62APPLLCATION FOR .BUILDING- PERMIT ,
COUNTY OF LOS ANGELES BUILDING / �y
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION- LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST.
DIST RI T NO. G UP TYPE P ESSED BY
FOR APPLICANT-TO FILL IN r�! �/ CONST. f �� !J
BUILDING ATISTICAL CLASSIFICATION SE ER MAP
ADDRESS ,:/(� _0_OW ELL UNITS t -BK PG/:5 CLASS. NO.
�� L CERTIFICATE:WATER NOT REQUIRED IJCI RECEC
EIVED ❑
r cyL\
NlAY
O. OF BLDGS. NOPE✓a' ! 'a Rc EI STATE MAJOR SECOND LOCAL
SIZE OF LOT &Z - NOW-ON LOT USE ZONE SPECIAL
USE OF - CONDITIONS
EXIST I IG BLDG14-1
BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDR t-iJ FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
P. L.
ADDRESSd
O
CONTRT C
/1�l/�// i /J�y, .fi""<V/r• 'J-•�bG-�FL(� / h
DESCRIPTION OF WORK p 'ry ' fj^/ J�/ cam/ ��" {/A { O
!V//1ry3/�/ff [gp �/,('Pl✓1 Jn!/i!et w
NEFT. ADO ALTER_ NOROFAIR DEMOLISH
OO FSH , � .lN I./! .I�� A../)l l�L..N, J4j Z
SIZE . STO_NO IES/ F MILIES OAF
rf //
USE OF /jt`�' F (/ ,1,..(j/
STRUCTURE
//�J%*a�. LCG�O✓�. � J//� }J/�-/J�da�{:�iq
SIGNATURE OF / ' •/7 y// /JJ+r✓ /���//�,A�vlw/T�/.e,, Y' _;1a/}/_/' � � A/
APPLICANT lY. / ,Mo 1Y ��.'�rl�'M NA_'�.U. �:•'� I
VALUATION $ /J �J �CJ / v - nV5� - p
L�' q✓ I r APPROVALS �(J'y�jFl iDATE INSPECTOR'S SIGNATURE
FEE $:3F ` O FEE $V 7 � FOUNDATION:FORMS. MATERIALS ON ll` h3
FRAME: FG. BOLTS / II�) 4
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING. BOLTS
AMCWITH
STATE THAT THE ABOVE IS CORRECT AND AGREE E COMPLY, FURNACE: LOCATION.
WITH ALL 'COV NTV OgO1NANCES AND STATE LAWS REGULATING GAS VENT. DUCTS �• I r d
BUILDING CONSTRUCTION: I CERTIFY THAT IN DOING THE WORK -
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- —LATH. NT. Y_
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKME COMPEN$(TIORAN E. , -
ryryry QQ--�✓111111\\ LATH. EXT.
SIGNATURE HOUSE NUMBER COR-
PERMITTEE ��/IVV"Y������` RECT AND POSTED y/?�
ADDRESS FINAL ("j�®��
' JOHN F. LEWIS. PRINCIPAL ST R TU RAL ENGINEER
PLAN CHECK VALIDATION CK. M.o. .CASH s_ PERMIT VALIDATION' DK. M... CASH
r
LAW3;1 4,52 JTAd 7 2 3 D 2 8.50
Li�o0 7 3 O`2 FEB . 8 1 D 5 7.00-
WORKERS' COMPENSATION DECLARATION ^ /� 7^ g
hereby affirm ltkr�jira haver certificate of consent'.taself ,laPP�r C 7�TION F0Iy�y� DING PER�/f��p❑��
insure'on's certifmate,of Workers Compensonon Insurance, •- �• d'll ll� �� //•ll II �' � "6�` �_ UR LC g�1g C/Il�'T
ar a certified copy thereof (Sec 3800, Lab C ) - '
+ - y+ COUNTY OF, LOS ANGELES -' BUILDING AND SAFETY . .
Policy No 'Company` ' " ,- ' /
' ElCertified.copylis hereby furnished. „ •FOR-APPLICANT,TO FILL IN ADDRESS %loos - �4�f4f
❑: Certified copy isfiled`with•the county budding Jinspec- +• BURDINGRESS
'ADD
tion department. '
✓ � / 0.O" ITY
Date CITY ZIP LOCAL
` Applicant - . _ . OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION.FROM WORKERS"". - SIZE OF.LOT - OW ON LOT -
COMPENSATION INSURANCE, ' ASSESSOR ASSESSOR
(This section need'not.be completedifthe permit isfor bne "'. TRACT - BLOCK LOT NO. � MAP800K � PAGE PARCEL
hundred dollars ($100) or less:) - . - -
'. � - * '- -- OWNER •. - USE ZONE,. MAP. -
. 'I certifyt6at in'the performance of the work for which`this- - NO,
permit is issued, I shall not employ any:person in any,manner .• ADDRESS �lo�/ +s ,� - - _ SPECIAL - V � D/ '
CONDITIONS L�///
so as to become subject to 1he.Workers'Compensation•,Laws, /f O '
' CITY ZIP % O d - V
Date Applicant - ARCHITECT OR - TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Q
NOTICE TO 'APPLICANT:,If, after making,this Certificate of - ENGINEER . NO. CO / ZONE H
Exemption, you,.should become subject to the. Workers' U
ADDRESS - '
Compensation provisions of the Labor Code, you.mus0orth- .. _ . . �� _ ? �` LG a-
STATISTICAL CLASSIFICATION - ' APT.. CONDO. V')
with comply with such,provisions or this permit"shall be 7EL. Z
deemed revoked. , CONTRACTOR (/ NO. j / _
LICENSED CONTRACTORS IbECLARATION LIC. CLASS No. 1 DWELL.;UNITS
I hereby affirm that I om'licensed under provisions of,Chapter 9' ADDRESS NO.
•
(commencing with Section 7000)of Division 3 of ihe'Business
LIC. SEWER MAP
and Professions Code,and my license is in full Force and effect. CITY CLASS. BK PG VALIDATION ,
50. FT. SNT OF NO. OF CHECK
License Number- - "Lia Class SIZE ✓ STORIES FAMILIES ONE
• - - - - - - - - VALUATION - -
., Contactor _ Date DESCRIPTION OF WORK �/ NEW ❑ �� .
�/ ADD O $ d00 • - D
❑I am exempt under Sea GAG. XL/Gif��Gli 7LGfw
y
ALTER ❑ -
B.BP.C. for this reason = "
REPAIR.'❑ $
_ Date: ... USE �/ / . . - - DEMOL ❑. . _
EXISTI G BLDGA:; .4 -
SignatureAPPLICANTS TEL _ - FINAL
OWNER-BUILDER DECLARATION• (PRINT)- NO. DATE
I hereby affirm that I am exempt from.the Contractor's.License - - -- -- - -- 1'
Law for'the following reason (Section 7031.5, Business and ADDRESS FINAL - -
7p a
Pr fessions Code): PRESENT '^ .. gy Ci ACIL.l r. -
BUILDING
1, as owner of the•property, or my employees with ADDRESS _ 5d�.j 142. 0
wages as their sale compensation;will do the work and -
the structure•is not intended or offered for sale(Section LOCALITY D 1 1 I EMS
7044, Business and Professions Code:) - - MOVING - - -- -=TEL —• — - - - -
r ❑ I, as owner of the,property;am,exclusively contracting CONTRACTOR - NO. - , .70TAL 142.; 20
with lice nsed•contractors to construct the project (Sec- ADDRESS CHECK lY'2.2CI
tion,7044, Business and Professions Code.) -
REQUIRED TOTATOTAL-SETBACK FROM EXIST:^- '• - -HR� ]C .CII
CONSTRUCTIONLENDING AGENCY_ ^� SET BACK YARD HWY PROP. LINE WIDTH 1 �1 m
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permif•is issued PA.
(Sec. 3097, Civ. C.). - SIDE
P.L. . -- 0000-0001 7/ 1/96
Lender's Name' - J - l,OcCl� 1 AN QC_/
Pi C. Fee CO LDMA Ref. p
$. Per"mit,Fee
Lender's Address - � � ^ .�� - /� � , - .. . - t .
'I certify that'I have read this application and state that the - ' - Issuance Fee 11 • LDMA Pic M D '•
S above informatiis
on correct. I agree to comply with all County Investigation Fee _ / r/a 1-5?
O._
r ordinances and State laws relating to building,consiruction, Total Fee' `l- LDMA Perm. N
a and hereby authorize representatives of this County to enter
m upon the above-mentioned property for inspection purposes. - - - -
a
n �i12ULL"G(CJL SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date '