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Home My Public Portal About5632 CAMBURY AVE_Building__ r I® 7 638A CE 4003 3-69 APPLICATION FOR BUILDIN PERMIT COUNT()OF LOS ANGELES BUILDING Cd. DEPARTMENT OF COUNTY ENGINEER ADDRESS,5-46.12• BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN OST ICT N GRODU TYPE CONST. PR ED BY (PRINT OR TYPE ONLY) r O j BUILDING / STATISTICAL CLLAAS$51FICATION SEWER MAP �i ADDRESS CLASS N0. E DWLL.UNITS - BK P,G�Z /- LOT N0. BLOCK USE ZONE MAPN0. 4� TRACT / SPECIAL . .l N0. OF SLOGS. CONO ITIONS SIZE OF LOT a NOW ON LOT USE OF / EXISTING BLDG. rG• BLD TRACK FROM TEL. FRONT PR NE OF (STREET) OWNER - NO. TYPE OF EXISTING 5 HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CITY ARCHITECT'DR TEL. BLDG.SETBACK FROM FEET) ENGINEER NO. ,� SIDE PROP. LINE OF TYPE OF EXISTING SETBACK HIGHWAY + YARD o TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. } CONTRACTOR NO. LIC. - / D_ ADDRESS y 3 ,� N0. CORNER CUTOFF - YES ❑ N0. f� ILI IC. K CITY j CLASS SEE REVERSE SIDE FOR SPECIAL .�APPROVALS NAME CONSTANDTBRA CH OER ��/'� -A /w�A/Lfa � W r a ADDRESS ems- .i .le1 Z S0. FT. N0. OF MID' SIZE 3 �SSTORIppES FAMILIES NEW ❑ A se.A�� .�/ ��/ ADD STRUUSE OCTURE �[(/+IA,(�. ALTER ❑ I O REPAIR ❑ U/I5/ SIGNATURE OF DEMOL ❑ APPLICANT 4p L n 7d 6L Q . VALUATION S J"/ Y APPROVALS 0 TE �LIx.R C .R'S smx r RE FEE 5 FEE 5 2-7, 7S FO FORMS O MATERAA LOSN / ' u IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, BRACING BOLTS ANP STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LOCATION, : WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS FURNACE: DUCTS TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I 'HILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH INTVlalbloltc OF THE STATE OF CALIFORNIA IN RELATING T WORKMEN'S COM- PENSATION INSURANCE. LATH, EXT. SIGNATURE OFHOUSE NUMBER CORRECT PERMITTEE_ -lq, 'l AN0 ADDRES FINAL JOHN F. LEWIS, PRINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION Cx. M.O. CASH - PERMIT VALIDATION M.O. CASH F- 4 2 6 6R pWi30 ID 2. 7.7pp5M �i^vlici�yc./ 76A638A CE,#80311-17 APPLICATION FOR BUILDING PERMIT �. COUNTY OF LOS ANGELES aLILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST C CASSATT D.GRIFFIN.SUF'T OF BUILDING CROSS ST. ` DISTRICT O. GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN I G CONST. BUILDING ADDRESS STATISTICAL CLASSIFICATION LCFT NO. BLOCK CLASS.NO. DWELL UNITS MAP - STATE YES • NUMBER HWV. TRACT s USE NE SPECIAL ' NO.OF BLDGS. CONDITIONS SIZE OF LOT (i O NOW ON LOT ' USE OF EXIST]NG SLOG. eS . BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT MAIL L. I P.L: of ADDRESS CA b YM w T SIDE L. PTEL. � .L. cITY C ti Eo.. INSPECTION RECOHIT ARCHITECT OR TEL. ENGINEER NO. ADDRESS TEL CONTRACTORC NO. ADDRESS 3 N ILva - --- -- "- DESCRIPTION OF WO NEW D ALTER REPAIR DEMOLISH SO.-FT. NO.OF - NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE ' Lihnaec SIGNATURE OF APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS.MATERIALS S �J (� P.C. S �� FRAME: FIRE STOPS. /Q 6 1 FEE BRACING. BOLTS VALUATION l.j S & FURNACE: LOCATION. FEE GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH A COUN DINANCES AND STATE LAWSE ULAT NG ONSTRUCTION. LATH,EXT: SIGNATURE OF� HOUSE NUMBER COR- - PERMITTE RECTAND POSTED ADDRES r0 FINAL CLYDE N. DIRLA M. PRwadAL STRUCTu EER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K M.D. CASH ' :; - Ma 7 6 2 S aM.11 1 A. 6.0`.0 eF APPLICATION. FO_R BUILDING PERM . ' r,IIf IIII ]fiA6�BA CE�B03 2-6] a 11 ' COUNTY OF LOS ANGELES' BUILDING / - DEPARTMENT OF COUNTY,ENGINEER ADDRESS- LGLif' BUILDING AND SAFETY DIVISION LOCALITY„ JOHN A. LAMBIE: COUNTY ENGINEER NEAREST \ WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. u DISTRICT NO. GR P TYPE CESSED B FOR 'APPLICANT TO=FILL IN i CONST. BUILDING' . STATISTICAL CLASSIFICATION EWER MAP , ADDRESS - —� 'CLASS. NO.=DWELL BK UNITS Z -LOT NO. BLOCK WATERSNOT REpUIRE0 RECEIVED: . CERTIFICATE: ;. TRACT, MAP �y ,� HIGHWAY STATE MAJOR SECOND, LOCA NO. OF BLDGS. PD. J �. (CIRCLE, SIZE'OF LOT J NOW ON LOT USE ZONE 'SPECIAL - USEOF - �� - CONDITIONS ' EXISTING BLDG. G � - ' OWNER' }+ .NO. BUILDINGYARD HWY STREET ME EXIST. _ SETBACK - WFDTH ADDRESS ` Q I-- FRONT' ARCHITECT OR TEL, P. L. _ ENGINEER NO: - islDE } ADDRESS- P Lo y OTE[-, CONTRACTOR NO. r m ADDRESS O DESCRIPTION OF.WORK, CL .NEW A D ALTER REPAIR DEMOLISH - Z Sp. FTNO. OF NO. OF SIZE .. .STORIES FAMILIES ' USE OF _ STRUCTURE Q SIGNATURE - - APPLICA -VALUATION'S (f�G/• APPROVALS DATE INSPECTOR'S SIGNATURE , FOUNDATION: LOCATION FEE $� FEES ^-^�. FORMS. MATERIALS FRAME: FIRE`STOPS. do A F,y HEREBY THAT THEL ABOE'THAT 1 HAVE CT READ THIS APPLICATION BRACING, BOLTS O I—C� ' AND STATE THAT THE ORDINAOVE NCES CORRECT TE AWS E COMPLY SV FURNACE: , DU TIONr WITH ALL ,COUNTY ORDINANCE$ ANO STATE LAWN REGULATING GAS VENT. DUCTS \. -BUILDING CONSTRUCTION.WILL 1 CERTIFY THAT IN DOING THE WORK - / - AUTHORIZED THE HEREBY•I WILL NOT EMPLOY 01 CALR50N IN VIOLANFLAT. LATH. INT. TION OF THE LADOR CODC OF•THE STATE OF CALIFORNIq RELAT. ING TO WORKMENS COM PEATION INSU • •'� ctAAHi, EXT. 9�}•'� �/�-F G� SIGNATURE OF HOUSE NUMBER COR- PERMITTEE .RECT AND POSTED p^' "ADDRESS J FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGI R PLAN CHECK VALIDATION CK. M.O. _CASH PERMIT VALIDATION, CK. N.C. Gases rLoe, o 2., i JbLL5 1 D 4.00 • WORKERS' COMPENSATION DECLARATION ' hereby affirm that I have a certificate of coInsur to self � PP,n �O - 1�MO,�n FOR �O n MDONG PERMOhf insure, or o certificate of Workers'Compenstion Insurance, or (Z=a �L (T=� u u�' u V u� u�u u - acertified copy thereof (Sec. 3800; lob. C.) _COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company / Certified co is hereby furnished. _ BUILDING ❑ copy v FOR APPLICANT TO FILL IN ADDRESS v ?_ ❑ Certified copy is filed with the county building inspec- BUILDING �` Q 7 /) r tion department. _ ADDRESS +76, ✓� r �4 ,(J U/� -J LOCALITV-��s�1�L� NEAREST ` �f_ Date Applicant - CITY -(✓ G/ ZIP - CROSS ST. Yom-lv� -C> 4 CERTIFICATE OF EXEMPTION FROM WORKERS' /�� NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT WD .X I NOW ON LOT /. MAP BOOK —(:: 7 PAGE PARCEL This section need not be completed if the permit is for one (� YY USE ZONE MAP hundred dollars ($100)or less.) p TRACT �. / BLOCK LOT NO. J, NO. ��O r� SPECIAL I certify that in the performance of the work for which this OWNER L( AIZD AVA(Z(O NO.t�G—lO 1 CONDITIONS Q DISTRICT GROUP TYPE FIRE PROCESS D BY Permit is issued, shop not employ an person in qty manner V ADDRE55 5 Z . CA&(•g J R , - CONST. ZONE so as to become subject to the Workn s'OCo mpe�{ggso�tioon Laws. -- e� ZONE IX IO -I3 _ S/ i LLGC/ KN CITY Ca M LC G L ZIP Si CGi Date Applicant ARCHITECT OR , . TEL. STATISTICAL CLASSIFICATION APT. CONDO, V NOTICE TO APPLICANT:' If, after making'this Certificate of �7 i ._� W Exemption,`you should become subject to the Workers' ENGINEER NO. CLASS NO.�DWELL. UNITS_ d Compensation provisions of the Labor Code, you,musi forth- - — H with comply with such provisions or this permit shall be ADDRESS X SEWER MAP Z deemed evoked. TEL' "(! .VALIDATION CONTRACTOR J L C Ly RpjtT� N0: fj��j(A BK: PG, . LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS OZ -P-II -NO.--Z 3 4.9.83 VALUATION (commencing with Section 7000)of Division 3 o the Business and • � LIC / " Professions Code, and my license is in fulfforce and effect.' CITY el C CLASS 5 _I S (p -icense Number 2 - lU Lic.Class SIZE FTS 3Z STORIES r F I NO. OF CHECK _ O 'I ,I O FAMILIES I' ONE .oNractor•- �Lk• / /L/.G'�P/L. Date I ^I��'/ DESCRIPTION OF WORK A D D t'� CkF:T: NEW ❑ $ • I aLi m exemptfromthe licensing requirements as I am a UV AM C}c s9 iJS[a a1 M. Ptd RM ADD licensed architect or a registered professional engineerALTER FINAL _ •�( acting in my professional capacity (Section 7051, p .� c" —(vtp CZ � {-(e9 ti} [3DATE REPAIR L Business and Professions Code). USE OF FINAL EXISTING BLDG. S DEMOL B -ic. or Reg. No. - Date APPLICANT L -TEL...T1 Y . OWNER-BUILDER DECLARATION IPRINTI U V c•"'R NO. I hereby affirm that I am exempt from the Contractor's License ADDRESS Z7O32• n Ir A 51- OkA EJ 6f!'- 64 - -aw for the following reason (Section 7031.5, Business and " Professions Code): PRESENT - - BUILDING - < 1 5 1.3 A 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 - #�a.: • e a1 7044, Business and Professions Code). MOVING - - TEL. _ ' ] -1, as owner of the property, am exclusively contracting - CONTRACTOR NO. .2- 1 6 0 0 0 with licensed contractors to construct the project.(Sec- 1 b Q. Q' lion 7044, Business and Professions Code). - ADDRESS _ -, e,• 5 ' REQUIRED TOTAL SETBACK FROM EXIST, CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE wtOTH - .I p 1 3.=8 1 - - I hereby affirm that there is a construction.lending agency for. 'FRONT ' the performance of the work for which this permit is issued p. - (Sec. 3097, Civ. C.). SIDE Lender's Name T ` P.C. Fee b Permit Fee r��c1O Lender's Address - certify that I have read this application and state that the Issuance Fee )bove information is correct. I agree to comply with all County Investigation Fee xdinonces and State laws relating to building construction, Total Fee rnd hereby authorize representatives of this County to enter N ipo +e-me at property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date OO s