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HomeMy Public PortalAbout5640 CAMBURY AVE_Building__ .A=Enao„o APPLICATION 'FOR BUILDING PERMIT g COUNTY OF LOS-ANGELES ADDDRESS f L/jO �a bur DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY "f ze .JOHN.A. LAMBIE, COUNTY ENGINEER - NEAREST CASSATT D. GRIFFIN„SVP•T OF BDILDING CROSS ST. e- ®d� DISTRICT NO; GROUP TYPE P OCE ED BY - FOR APPLICANT TO FILL IN I CONST., BUILDING •�_� n STATISTICAL CLASSIFICATION I SEWERMAP ADDRESS C Jai B PG - ! �Y CLASS.NQ�DWELL.UNITSS`_ ` LOT NO. BLOCK MAP ST NUMBER ©© HWTAE' Y YES O. TRACT — - 'e U$F.`ZON SPECIAL-_ NO.OF.SLOGS I,'I!((�t// M CONDITIONS - SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. ILDINGYARD HWY STREET NAME EXIST. ,l SETBACK A . WIDTH OW NER / Y/ UrJc/�/eY FRONT- OtO. ✓ . MAIL sf P.L.. ADDRESS S_& ea' , SIDE TEL. P.L. - arY No. INSPECTION-RECORD ARCHITECT OR _ - TEL — ENGINEER NO. ADDRESS - - TEL. CONTRACTOR / 'Fel)-NI. ADDRESS DESCRIPTION OF WORK rO NEW D❑ ALTER .REPAIR ,DEMOLISH 5 ZEr STORIES FAMILIES /n '_/ �I/]'Jr• :/yQy__ - USE OF STRUCTURE Inn.F�' ,. LIZT :QE.M'OV�IF.yD p}� ' SIGNATURE OF� - - - a2O M1�5 D. `y. S F -'° APPLICANT APPROVALS - - DATE INSPECTOR'S.SIGNATURE ADDRESS �/ _ _ FOUNDATION: LOCATION' - FORMS,MATERIALS VALUATION$ Q - FIR SARA CING,BOLOTSS - PMT. d FURNACE: LOCATION. FEE $ I FEE I. GAS VENT.DUCTS I[HEREBY ACKNOWLEDGC THAT 1 HAVE READ THIS AP-' LA.TH.INT. •(r �/IA PLICATION AND STATE THAT THE ABOVE 15 CORRECT AND. .- AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND- _ /, �,/�i-�I f"" rl•�I STATE LAWS. 'REG�N BUILDING ONSTRUCTION. LATH:EXT. • < SIGNATURE OFvy!„ HOUSE NUMBERCOR- P SIGNATURE L� -REST AND NUMBER ?' ADDRESS _ FINAL CLYDE.N. DIRLAW PRINCIPAL'ST RAL ENGINEER PLAN CHECK VALIDATION CK. Mo. CASH PERMIT VALIDATION ' cK ,MO., ,CASK 1Co1, 5 8 1° Aug 21 1 .A 9.0 0 M®, TSABBB.CD#8031-B2 APPLICATION FOR BUILDING PERMIT, COUNTY OF LOS ANGELES BUILDINGr DEPARTMENT OF COUNTY ENGINEER nooREss QiCGCi7CC� BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. BY FOR APPLICANT TO FILL IN DI?; 5/ GROUP CONST.TYPEP c ssEo � ADDREISS -5,4410Fj, STATISTICAL CLASSIFICATION SEEK R MAP CLASS. NO. DWELL. UNITS -� LOT NO. & BLOCK WATER CERTIFICATE: NOT REQUIRED RECEIVED TRACT S�S MAP HIGHWAY NO. OF BLDGS. N4 - (CIRCLE, STATE MAJOR SECOND, OCAL SIZE OF LOT Q X/" NOW ON LOT Z USE ZONE SPECIAL USE OFCONDITIONS EXISTING BLDG. ES' /--o �y Tl -J OWNER aFe—G NEL,O. i -2 � BUILDING YARD HWY STREET AME EXIST. SETBACK WIDTH ADDRESS FRONT ARCHITECT OR TEL. P. L. C4f L ENGINEER NO. SIDE r ADDRESSv O CONTRACTORR : . MHT, wsAgwNOL. r /. u ADDRESS :132 4C40YA /PL ° If DESCRIPTION OF WORK K � w a: /' NEW ADD ALTER ✓ REPA_IR DEMOLISH / ,fv ////n iy q,��T[Z_' SO. FT, p NO. OF NO. OF SIZE 3 _ 2 STORIES / FAMILIES / / / USE OF Gi9MIL�^ STRUCTURE SIGNATURE OF APPLICANT �V�✓� VALUATION $ L Q APPROVALS DATE O INSPECTOR SIGNATURE FEE $ FEE $ FOUNDATION: LOCATION /}^J"W_-/4 FORMS. MATERIALS T/ X+G ^ FRAME: FIRE STOPS. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS f BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. I TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT. rr SIGNATURE OF HOUSE NUMBER COR- PERMITTEE 'r RECT AND POSTED ADDRESSC 4-t`J/1E'/c?L T> C FINAL +)3 -/,f—G2 of JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.G. CASH _ PERMIT VALIDATION CK. M.D. CASH k 0 5 S 4 3--1 OCT24 1 D 15.00- 7'6A6>6A CE0803 B-64.APPLI CAT(ON FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING1 LGIiL DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALiTv .' JOHN A.LAMBIE..COUNTY ENGINEER, NEAREST .. COLEMAN W. YE KINS,SUP'T.OF BUILDING CROSS ST.. DISTRICT NO, GI9LDuP.' TYPE 4— PURR KCESSPEGD' -GBY/// FOR APPLICANT TO FILL IN CONST. ; BUILDING AL CLASSIFICATION SEERM ADDRESS CLA9NO DWLL UIS LOT NO. BLOCK USE ZONE NO. •tel/ TRACT ! s S //� SPECIAL A,- NO. OF BLOBS. i/ CONDITIONS SIZE OF LOT NOW ON LOT ��^^/ USE$OF OO �J -�L ffU (pSLOG. SETBACK FROM '- OWNER P • ;.' v)FR& TEL�ot87o273` FRONT PROP. LINE OF V (STREET) NO. TYPE OfEXISTING SETS CN HI OX WAY =+ RD TOTAL.. ADDRESS �O �i. •�N� � HIGHWAY WIDTH FIR MEL. ' CITY P, + ARCHITECT O X,/� �^('p per•- TEL (( •� ) BLDG. SETBACK FROM ENGINEER , '( . /_C II�L/L(ID.` ['f/7!3FRS SIDE PROP..LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = ' TOTAL ADDRESS HIGHWAY WIDTH FROM C.I.. ,-CILY CONTRACTOR(••.///''��/Lrf^'.(�_ L111 yN��O L. q�C� + - O ADDRESS o& C. a L 7u'MP�{9C Iss.1 O _ CORNER CUTOFF YES E] NO E] O ITr /IRI 'SEE REVERSE SIDE FOR SPECIAL APPROVALS V W _ DESCRIPTION OF WORK NE ADD ALTER. -.REPAIR DEMOLISH Y X V SQ.FT. NO. OF NO. OF 1!l''•'a' 'O'N"ICe`CiG✓tY l"- �`•'^"e+�w.1J'^'• "✓��i°� SIZE' s/'� STORIES FAMILIES USE OF ff'�L / ffff��.• -// f STRUCTURE `, /!O/'� ST. PL , -M-1- SIGNATURE OF i 1 ' ZK/fI APPLICANT IM ( ta,:t VALUATION �(/V V '�� I - a /-�/! v APPROVALS / RATE INSPECTOR'S SIGNATURE FEE Gy , ' FPM TPM EES FOUNDATION FORM , LOCATION FORMS(MATERIALS C7 F L7 'FRAME, FIRE STOPS, - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT / AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY FURNACE: LOCATION / I _ WITH ALL COUNTY ORDINANCES AND STATE LAWS EATING GAS VENT. DUCTS 9UILOING CONSTRUCTION, I CERTIFY THAT. IN DOI TH WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PE ON I VIOLA- LATH. INT. TION OF THE LAS Oq pE OF THE 5 ATE CA IFORNI RELAT- ING TO WORKMEN'S PENSATI/O/�+�I UR E LATH..E%T. / I/ SIGNATURE OF �.. Xl HOUSE NUMBER COR- . PERMITTEE Y""✓" RET AND POSTED .rte ♦ - ADDRESS �-' FINAL JOHN F. LEMS, PRINCIPA URAL ENGINEER PLAN CHECK VALIDATIONS MA, CASH PERMIT VALIDAT CK, M.O. CASH . �ri(01_At '3 s . VLAY 11 2 � D 3.7 5 No.1 a s GG" MAY 11 , 0 1 5.00- ' COUNTY OF LOS ANGEl BUILDING AND'SAFETY WORKER'S COMPENSATION.DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I herebyaffirm that I have a certificate.of consent to self.insure, BU Gy1G DDRES/S// r /r, ( ;Dg or a certificate of Workers' Comliensation Insurance,or a certified _`,' �" .. copy thereof (Sec.3800,Lab.C.) /� /f ZIR + I r �C (.s( ( V L./ LOCALITY' Policy,NO. Company SIZE OF LOT NO.OF SLOGS O/GS.NOW ON LOT - / ElCertified copy is hereby furnished. #yNEAREST CROSS ST ❑ Certified copy is filed with the county building,inspection TfjA�Y/`(j• BLOCK LOT NO. - department. - ( /•l / (Q USE ZONE` MAP NO. _ ASSE @rFMjP,QBpK P,AI.a,E.� PA�RCsFL� - " ' . . SPECIAL CONDITIONS /„�Q •D /' Date - Applicant - fJ' SVC GOI (,E PARD CERTIFICATE OF EXEMPTION FROM WORKERS' QY*1�i1, 1� ��'O fGO� - lN�y p'�_�•�U _ - - - YES No COMPENSATION INSURANCE f�(�rIN �-b o/ �-t� 7 wIiHIN 1000 FT.OF SCHOOL? This section need not be com feted if the permit is for one hundred E '//1� �.L,r p • ( p P / / ��i�' DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY '- dollars ($100) or less.) I•�/ y� certify that in•the performance of the work for which this permit �M 11 ZP !780 L1�j,p K is issued, I shall not employ any person in any manner.so as to Cjd VD LJ become subject t0 the Workers'COT ensatiod LawS.- ARCHITECT OR ENGINEER - TEL NO. p $TATISTIGAL'GLASSIFI ATION" APT CONDO Date Applicant ADDRESS - - GLASS NO. � DWELL UNITS ' NOTICE TO APPLICANTIf, after making this Certificate of - REQUIRED TOTAL SETBACK FROM EXIST .Exemption, -yeu should become Subject t0 the Workers' CONTRACTOR TEL NO. - SET BACK YARD HWV PROP LINE WIDTH Compensation,provisions of the Labor Code, you must forthwith FRONT - - comply with such provisions or this permit Shall be deemed revoked. ADDRESS — LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE ' _ CITY LIC.CLASS P L h hereby affirm that I,,am�icensed underprovisions of.Chapters 9 SEWER MAP - (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG' D RIP ION OF..WORK 'VALUATIO 1 d License Number Lic. Class tE,� JT ,rl /' ADD ❑ p�Ij//J/,. D O Contractor - Date �+"" t�'K r„z �9 �b/oL ALTER ❑ $ /CW// - 71 REPAIR ❑I am exempt under Sec: - U B.&P.C. for this reason DEMOL X ..CDLD MA P/C 111 - Date' USE OF EXISTING BLDG. URM ❑ y d Signature APPLICANT(PRINT) TEL NO, LDMA Perm# ,Pill!_{ i= z '❑ 1, as owner of the property, or my employees with wages as Z their sale compensation, will do.the work and the structure is ADDRESS _(' . O Q� DATE ' 41 ' not intended or offered for sale (Section 7044, Business and - FINAL _ Professions Code:) -'Y JO }p�I S ”' WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J 1 �, 1 I L�a. . OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUALTO OR GREATER THAN THE �y ❑ I,.as owner of the property, am e%CIUSIV2ly contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDED 'FINAL BY I 'HI 3 ;}• ' v�C.a licensed contractors to construct the project (Section 7044, ES❑ NO❑ ( Business and Professions.Cotle:) I ,•.I:-.-., .`1 Oc WILL THE INTENDED USE MI THE BUILLINGCONSTRUCTION BY THE APPLICANT MODIFICA OR FUTURE E SOUTH '�rly1..�'i - l•C a 'U OCCUPANTOASTIR OUAUIRE A PERMIT FOR QONSTRUCTION OR EE PEIOATI TNG CH THE SOUTH CONSTRUCTION LENDING AGENCY GUIDE AIR ounuTv MANAGEMENT DlsrRlcT IscAomo)SEE PERMITTING cHEcrcusT FOR CHANCE culDeuNEs. 1 I hereby affirm that there is a.construction lending agency for YES El No❑ The performance Of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SGAQMD PERMITTING - ..rr 3097, Civ.C.) CHECKUST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, t i_itN 4[.!1_i(_], tea)" `�II i m TITLE 2 CHAPTER 2.20 SECTIONS 220.100 THROUGH 2.23\SO CONCERNING 1tAZARDOLS - LeRcef B Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. M o Lender's Address o ONNER OR WENT - • L . o I certify that I have read this application and state under penalty - Of perjury that the above information is correct, I agree to GOmp1y P.C.FEE PERMIT FEE �•,_ - - with a11.county 'ordinances and State laws relating to buildings m construction, and hereh auth ize re presentativespppf this 00 tt�5y ISSUANCE FEE • �J' nter Spa ab -t enf ed property for inspkFti !�' INVESTIGATION FEE TOTAL FEE - Ile SEE REVERSE FOR EXPLANATORY LANGUAGE r WORKERS' COMPENSATION DECLARATION r, -1 Hereby affirm that I have o'certificate of consent to self //p�� O �rrf� �/(� //p�� I�I��Ip� insure, or a certificate of Workers' Compensation Insurance, AP 11. L�,V• AT 03 .,,F. R. 13URD.ING PC�G�NT or a certified copy,thereof (Sec. 9800, Lab. C.) - - - COUNTY OF LOS ANGELES - .BUILDING AND SAFETY,- - Policy No. Company' IUILDIN. ❑ Certified copy is hereby furnished. - - FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING A nµ2, tion department. - ADDRESS l- !a ''L Date Applicant - CIN �. l ZIP �� ( LOCALITY t CERTIFICATE OF EXEMPTION FROM'WORKERS' NO. O N LOT. NEAREST; 1 COMPENSATION INSURANCE .. SIZE OF LOT NOwONLOi CROSS ST. {. V�' O �(�•' ASSESSOR (This section'need not be'completed if the permit'is for one TRACT BLOCK I LOT NO. ' J MAP BOOK I PAGE I PARCEL hundred dollars ($100) .or less.) .• TEL USE ZONE MAP OWNER NO. /-Ayr. 1 certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner ADDRESS �p D SPECIAL - d CONDITIONS so as to become subject to the Workers' Compensation Laws. ^ O CITY T. zip 917�0 V Date Applicont - - ARCHITECT OR TEL. - IY NOTICE TO APPLICANT: If, after making-this Certificate of ENGINEER NO DISTRICT. GROUP TYPE FIRE PROCESSED BY CONST. ZONE O Exemption, you should become subject to the- Workers' - �D / ✓ 2 V Compensation provisions of the Labor Code; you must forth- ADDRESS d ✓ a with complywith such provisions or this STATISTICAL,CLASSIFICATION APT. CONDO. N p permit shall be t. Z deemed revoked. � CONTRACTOR N . 7- 3 - • - LICENSED CONTRACTORS DECLARATION 9 wo h - ' • ' LIC NO. �1H CLASS NO. ^�'� DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 77f- p'� 0 tic. 'SEWER MAP • (commencing with Section 7000)of Division 3 of the Business '. + - and Professions Cade,and my license is in full force and effect. CITY CLASS 3 BK. PG. VALIDATION tt SQ. FT. ' NO. OF NO. OF CHECK License NumbecJLic. Class ? S I STORIES FAMILIES ONE , • II,,,, ''/r e - - - VALUATION ' Contracto�A'(/fs�_ Ala Date /IfL9 a1 DESCRIPTION OF WORK NEW ❑ $�OOQ p' - ❑ am exempt under Sec. c F S4 ADD ❑ D +B.BP.C. for this reason _SqT #N C ALTER ❑ -$ USE OF J N REPAIR ❑ Date' EXISTING BLDG. DEMOL O S'gnat re _ RICL(%y APPLICANT - - TEL. G FINAL OW R-BUILDER DECLARATION (PRINT) NO. DATE hereby affirm'th I am exempt from the Contractor's License ^ T_J-17 { Law for the following reason (Section 7031.5, Business and ADDRESS FINAL( U° -= _ ,n Professions Code): PRESENT- By � l zl_4'f_ BUILDING _ ❑ I, as owner of the property, or my employees witherADDRESS TOTAL 14 a 63 wages as their sole compensation,will do the workand - - - - the structure is not intended or offered for sole(Section LOCALITY D �' t` 7044, Business and Professions Code.) MOVING TEL. :-HECK - •=.' ❑ CONTRACTOR NO. I; as owner of the property, co exclusively oject (Sec- yy_ �A(f� liini LAG ,I!I with licensed contractors to construct the project (Sec- I / tion 7044, Business and,Professions Code.) ADDRESS- REQUIRED TOTAL SETBACK FROM - EXIST. " CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LINE I WIDTH - 01 OF-000 0 I f 11 IDI ? I hereby affirm that there is a construction lending agency for FRONT - the performance.of the work for which this'permit is issued - P.I. - Ijl l yjjj 18jy (Sec 3097, Civ. C.). - SIDE - P.I. Lender's Name Q - P.C. Fee 8 Permit Fee �'PQ LDM4 Ref. q , Lender's Address - ' o I certify that I have read this application and state that the Issuance Fee a T 7� LDMA P/C q - D - 8 above information is correct. I agree to comply with all County Investigation Fee / i/a R / R ordinances and State laws relating to building construction, Total Fee T ro lDhv4 Perm. q c and hereby authorize representatives f this County to enter upon•the above-me tion qr perry r inspection SEE REVERSE FOR EXPLANATORY LANGUAGE ' ignature o Applicant or Agent ,0001l