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Home My Public Portal About5629 CAMBURY AVE_Building__ 7BA638A CE 9803-6-9% APPLICATION FOR BUILDING PE MIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY LZ. JOHN A. LAMBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN.Gorr op BUILOIN6 CROSS ST. L DISTRICT NO. GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN SK PC; CONST. BUILDING ADDRESS STATIST]CAL,SLASSI FICATION LOT NO. _ BLOCK CLASS.NO._)K ELL.UNITS MAP - p p� STATE TRACL YES O \� NUMBER /SOV HWY. USEZONE SPECIAL NO.OF SLOGS. CONDITIONS SIZE OF LOT I NOWON LOT A� USEOF EXISTING BLDG. BUILDING ygRO HWY STREET NAME EXIST. / ETBACK - WIDTH OWNER /� .1 FRONT MAIL /�� P: ADDRESS LJ(O Cc, SIDE TEL. P.L. CITY NO. ARCHITECT OR TEL. INSPECTION RECORD ENGINEER NO. � S \l ADDRESS 1 C^ TEL - J CONTRACTORp O. 1179 - ^� G_ ADDRESS YY`DYV - DESCRIPTION OF WOAK NEW � ALTER REPAIR FADEMOLISH NO-OF NO.MOFES SO. f�w RIES ILST. I. - -t— C USTO SE O STRUCTURE NAAPPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE I. ADDRESS FOUNDATION: LOCATION FORMS. MATERIALS $ ' P'C` $ FRAME: FIRE STOPS. / *700 FEE BRACING.BOLTS VALUATION 4 FURNACE:VEN .DUCTS FEE a GAS VENT.DUCT6 ' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RECALATINGjBUILCTNZ;A CONSTRUCTION. LATH.EXT. SIGNATURE F HOUSE NUMBER COR. PERMITTE ��/ RECT AND POSTED ADDRESS ��3�� YP/)hl yY/Lt/>- 4�5Jp FINAL JOHN A. LAMBIE.COUNTY ENGINEER. CLYDE N. DIRLAM. P INCI AL STRUCTURAL 'MGINEER PLAN CHECK VALIDATION CK. M.O. aSH PERMIT/VALIDATION c M. . usR- LACo -5.5 6S MAY5 1 A $ S Q � , ,VZFARTM£NT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES {� � I LOU G WM. J. FOX. CHIEF ENGINEER V� _ FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN�C/K.NOF/ - PERMIT NO. ADDREi95 2 `SCMQ VR Y 9de ^� LOCALITY -77E M PL- 2 C- 1 T y RECEIVED BIY DAT OF APPL. ••DATE IS/S UELD// NEARESTD CROSSST. LIVE QAx AVC` G �IV .I � BUILDING OWNER PAd PA'L.l FI C- Cmc _ADDRESS. MAIL O s2 A MO/ 1LA LOCALITY ADDRESS 1T NEAREST y TEL. FIRE T . G CITY L 3 O No. FIRE PN OF TYPE ARCHITECT OR TEL. ZONE PLANS3 E NOINE£R S'n NO. D Gy `6 q BLDG. ( R•I ADDRESS ��(( Z / I.Z— SETBACK LINE G� 1•// /� APPROVE,¢ _ CONTRACTOR ry M. eI, ,//RV/E.SNOL.'I R-20.2 BY - - ��r -�� DATE p ADDRESS 70 ,32- S.t dTA N014117I LA LV DI ZON/ BY LEGAL SOV7y 7 9P Lo z. +mo r*L- CORRECTIONS ' DESCRIPTION I LOT NO.. BLOCK ' 14 DICT - s •e ra 'a TRACT. �1y5�1`'51 J T 7 /U I "WON LOTNO,OF BLD SIZE OF LOT ' USE OF NO.OF NO.OF EXISTING BLDG. I-F£Rl�i f'€3 I KUUM - DESCRIPTION OF WORK NEW I ALTERATION ADDITION p p REPAIR. MOVING DEMOLISHsqNO or p ME I/ / 2- RO MS I STORIES / _ > / r WALL fCOD COVERING ERING yMwr-LG W BUILDNG L rPrMJLYRICl10�,I Wl-rA PEI-AC- FED �ThRh42e 5A1 / , D7-73 ;Z- sv I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS ' AP OVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE FOUNDATION': LOCAyf N AND AGREE TO COMPLY WITH ALL COUNTY.ORDINANCES FORMS,MATERIAYB � .�;/ AND STATE LAWS REGULATING BUILDING CONSTRUCTION. //� ` 1 FRAME:BRAC!NSR90LT88' SIGNATUREOF .p/� 'J//Plq}L' r-1 C, / N J. /O.- PERMITTEE /IP /_' — LAT , INT. AUTHORIZEDeraT_ ! �AWI I/M/�'/�/"�-` / y'✓ d1 / ATH, EXT. J r• •VGA638A-3 7-49 $ V 1 - P.C,® PLASTER,INT. PLASTER,EXT. VALUATION /� 9 3-=• FEE ?0 . FINAL ✓-Y•/1.�9YsZ.�'''/7/�� COUNTY OF LOS ANGELES BUILDING AND SAFETY - WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDwG ADDREsS I hereby affirm that I have a certificate of consent to,self insure, 'BUILDIN DDRE•S�S «- or a certificate of Workers' Compensation Insurance,or a certified Z copy thereof(Sec.3800 .C.) CITv ZIP' 3u" �� C C rr— r /•-� E?<3 LOCALITY 11 C1 . Cy NO Company — SIZE OF LOT NO.OF BLOCS.NOW ON LOT v ❑ Certified Copy is hereby furnished. d 15 1 .NEAREST CROSS ST. CX eNified copy is filed with the County building inspection TRACT BLOCK 'LOT NO, _ clep.ryno. USE ZONE MAP NO. Dat Applicant - ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS E TIFICATE OF EXEMPTION FROM WORKERS: °W TEL NO vp - 'OO WITHIN 1000 Fr..OF SCHOOL? YESNFROMEXIST COMPENSATION INSURANCE � 3(This section need not be completed if the permit is for one hundred ADDRESSdollars($100)or less.) S DIBTRICT GROUP TYPE CONST. FIRE ZONCITY ZIP JI Certify that h the performance of the work for which this permit c C ( 6, ��O ®_3 3is cometl, bject not employ any person at any manner so a5 to ARCHITECT'OR ENGINEER TEL NO. 0O ,Lbecome subject 10 the Workers Compensation Laws. STATISTICAL CLA IFI ATION Date Applicant ADDRESS - CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making 'this Certificate of _ REOUIRED TOTAL SETBACExemption, you Should' become subject t0 the Workers' T ACTOR - TEL N0. SET BACK YARD HWY PROP LI Compensation provisions of the labor Code,'you must forthwith TEL rr -7 (,i 34 Z,5 FRONT comply with such provisions or this permit shall be deemed revokea. DRESS UC.NO. P L ' LICENSED CONTRACTORS DECLARATION .u_ tj4 d —W . 7-q4f 8. SIDE /y CIT/!' ^,-i CA P L I hereby affirm that I am licensed underprovisions Of Chapter 9 /�' SEWER MAP - __. .(commencing with.Section,7000)of.Division 3 of the Business and B .SIZE NO.OF TORIES NO.IF FAMILIES Professions Code, nd my licentsa is in full force and effect. NEW ❑ BK PG D d p` Lic.Class -Iq CRIPT ON OE WORK ADD ❑ VALUATION.�� b�Q „� �O License Num/per?- L� G O Contra ,{,j�yij"71f_n�� ate ___�1 Ill 63o�o ALTER ❑ It 41J 4V- ❑ 1 am exempt under Sec. REPAIR ❑ $ I BBP.C. for this reason DEMOL ❑ LDMA Bic: ' W Date: OF EXISTING BLDG. - URM ❑ "" of Signature NT(PAIN' T NO. LOW Perm x z ❑ I, as owner of the property, or my employees with wages as Z ZO ALLT.i their sole compensation, will do the work and the structure is C17 111.90 not intended or Offered for sale (Section 7044, Business and FINAL DATE Q S;1 PfOfe551pn5 Code.) WILL THE APPIJCAW OR FU URE "DING OCCUPANT HANDLE A NAZAR00115 MATERIAL // �� (7 OR A MIXTURE CONTNMNG A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE r J 1 ITEMS IS ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS WFORMATON GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, ,YES❑ NO❑ TCITAL 117 - 90 Business and Professions Code.) WILL THE INTENDED USE MI THE eNBY THE APPLICANT OR FUTURE BUILDING CHECK 117.90 OCCUPANTOSTIR REQUIRE A PERMIT FOR ISTRI CONSTRUCTION OR EE PERMITTING FROM THE T FOR CHECK 1 T 1l CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT LY$TRCT(SLAOMOI SEE PERMITTNG CHECKLIST FOR `G 0 YES GUIDELINES .. _ �:HA,\„E .ILIO I hereby affirm that there is a construction lending agency for YES El No El ' w the performance of the work for which this permit is issued(Sea [HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING 3097,CIV.C.) CHECKUS!I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. TITLE 2.CHAPTER 2 20 2 20 ISON GH 2.20.140 CONCERNIN Lenders Name MATERIALS RImORr G AND FORSOBTAININNGTHRA PERMIT FROM THE SCAQMD G HAZARDOUS 00130-0001J/22/93 o Lender's Address Q 3801 1 AM 9:21 w+MEn OF wENi - VV o I certify that I have read this application and state under penalty - O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE $ with all county ordinances and State laws relating to building m construction, and hereby aur resentatives of this County ISSUANCE FEE / o ente n the be entionetl pr any for inspection r o S. (O a C� INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE