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HomeMy Public PortalAbout4807 CLOVERLY AVE_Building__ 76A898ADBS 912�. APPLICATION FOR BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY BUIL RED Department of County Engmeer ADD County of Los Angeles LOCALITY WM J FOX COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST A. / FOR APPLICANT TO FILL IN DISTRICT NO GROUP TYPE SEWBK MAP PG BUILDING /y - CONST ADDRESS (/ MAPSTATE YES JO NUMBER HWY LOT NO BLOCK USEZONE SPECIAL / CONDITIONS TRACT -�11'7f NO OFBLDGS SIZE OF LOT NOW ON LOT BUILDING YARD HWY STREET NAME EXIST USE OF SETBACK WIDTH EXISTING BLDG - FPOLT aIT 0,/'n v e_ ol( � OWNER SIDE /} / 041 �iUs� �-� P L V Gb` 6 MAIL _ ADD SS TEL t DWELL 1 UNIT 5 INDUSTRIAL CITY O 2 DUPLEX_UNIT 6 PUBLIC BLDG ARCHITECT 0TEL ENGINEER NO 3 APT UNITS 7 ADDN ALTs, ETC ADDRCSS jj 4 COMMERCIAL 8 MISCEL TEL CONTRACTOR �j D INSPECTION RECORD ADDRESS i .. DESCRIPTION OF WORT{ NEW ADD ALTER eRWIR DEMOLISH FT O NO OF SIZE STOR ES FAMILI ESI USE OF STRU TU SIGNATURE OF APPLICANT APPROVALS ADDRESS DATE INSPECTOR S SIGNATURE NDATION LOCATION P C ORMS MATERIALS � FEE FRAME FIRE STOPS VALUATION BRACING BOLTS FEE d �— FURNACE LOCATION IGAS VENT DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT AND STATE LAWS REGULATING BUILDCONSTRUC- TION IN LATH, EXT SIGNATUREOF HOUSE NUMBER COR- PERMITTEE IRECT AND POSTED ADDRESS FINAL was. J. FOX. CouNTY EN6tNEER VALIDATION BY _ A" I`249- `MRR 8 1 - 8.04 � DEPUTYy DEPUTY/ BY BY ® DEPUTY DEPUTY DEPARTMENT OF BUILDING AND SAFETY i APPLICATION FOR PERMIT COUNTY OF LOS ANGELES B U I L D 1 N G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY / DISTRICT NO PLAN CK NO ,1 PERMIT NO BUILDING ADDRESS /Q �CC .p a�i•+ () I� `I"� /�U LOCALITY ..7 pf� RECEIVED BY DATE OF APPL -DATE ISSUED _ �? NEAREST CROSS BT 6'• G Nv l b w fj a Z y gA ' ryC /� W // BUILDING \ A`T OWNER W �} L- d .MAIL ADDRESS �n !Tl3 ADDRE/8}�9�/� S �+ NEAREST TEL. yV L [/ LOCALITY ®��/�/Y�C�-�C� NO / /� CROSS ST c," FIRE NO OF TYPE GROUP ARCHITECT OR CEO ZONE PLANS ENGINEER BLDG �, I �RD NO ADDRESS SETBACK LINE APPROVED TEL BY DATE CONTRACTOR NO ' USE ' PROVED ADDRESS + ZONE �/ BY DATE LEGALI (' CORRECTIONS DESCRIPTION LOT NO I _ i �`� I TRACT ! / 0 -. 7' _ ) Lb NO OF SLOGS SIZE OF LOT ?0 X�'�.�1 0 NOW ON LOT /_ <-11 �� If.I'v-NO OF EX SITIE OFNG BLDG DWE.LL I FnNNO �ea I ROOMS (!i i DESCRIPTION OF WORK NEW ALTERATION ADDITION O A REPAIR MOVING DEMOLISH SQ FT 0 NO OF Z SIZE ROOMS STORIES l � WALL �j ROOF AA /� , COVERING 0 G' I COVERINOC OM 0 USE NEW IAS�� G BUILDING �Y v I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION' FRAME FIREBTOPB, SIGNATURE OF PERMITTEE--04/6 ®// F/ _ BRACING,BOLTS F - '53 LATH, INT AUTHORIZED AOT LATH,EXT OBS-3 SOM SETS 7-47 $ P C PLASTER, INT. FEE� _ PLASTER.EXT � VALUATION ' FEED FINAL ` a��/�� � I 76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING 4 1 O I DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY ,e 4 �' JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTRICT GROUP TYPE �F O� SSED BY FOR APPLICANT TO FILL IN CONST BUILDING STATISTICAL CLASSIFICATION - SEWER MAP5i6 ADDRESS e.^, 4 / BK PG 7 / CLASS NO _(i—DWELL UNITS' d LOT NO `00� BLOCK WATER CERTIFICATE NOT REQUIRED RECEIVED ❑ TRACT l MAP HIGHWAY ,/� NO OF BLDGS NO (CIRCLE) STATE MAJOR)SECOND/LOCALJ SIZE OF LOT72 (J NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG 1POir-e- / TEL n OWNER 4-.. �oZQ O V I� BUILDING EXIST �� - SETBACK YARD HWY TREET NAME /WIDTH ADDRESS tpO (lJ• l� 9 ARCHITECT OR TEL P L OS U ENGINEER NO SIDE /o% P ADDRESS TEL T ` '' O CONTRACTOR �.� � NO +� c; ADDRESS 0 y Q DESCRIPTION OF WORK , ' _ '` G R. NEW ADD ALTER REPAIR DEMOLISH O' N SO FT 5��0 OF NO OF SIZE TORIES FAMILIES USE OF // STRUCTURE tp0-1,L ' - r f SIGNATURE OF APPLICANT-- VALUATION PPLICANT VALUATION 5 OIF �,, APPROVALS ,DATE INSPECTOR SSIGNALURE FEE $��� FEE $ FOUNDATION LOCATION 1, 16 � l , FORMS MATERIALS FRAME FIRE STOPS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING + GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIF NJA RELAT ING TO �TIONWORKMOF COMPENSU LATH EXT SIGNATURE HOUSE NUMBER COR / PERMITTEE { RECT AND POSTED E ADDRESS ` FINAL JOHNRAd ENGINEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION TRCK UM O CASH Ll� a 5 0 Ef B 2 5 1 0 1 ,1`.5 0 - # I RKERS COMPENSATION DECLARATION *"sure, affirm that I havecertificate of consent to self App`I CAT i®N` F®R BUILDINGPERMIT r,suror a certificate of Workers' Compensation Insurance, orla certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY, Policy No a ompany &=— ,&2 t�f BUILDING APPLICANT TO FILL IN Certified copy is hereby furnished ' r FOR AADDRESS Certified copy is filed with the county building inspec BUILDING /� n n/ tion department ADDRESS (/ 4, K(i Date Applicant CITY ZIP O LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO SIZE OF LOT O NOW F LDGS CROSS NEAREST" COMPENSATION INSURANCE LOT (This section,need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less ) BOOK BLOCK LOT NO MAP BOOK PAGE PARCEL OWNER NO Z�ZUSE ZONE MAP I certify that m'the performance of the work for which this + NO permit is issued, I'sholl not employ any person in any mannerADDRESS - O� _ SPECIAL so as to become subject to the Workers Compensation Laws CONDITIONS O w - r U CITY - ZIP Date Applicant `^ - �Oq / y � NOTICE TO APPLICANT If, after^making this Certificate of ARCHITECT OR ` I!N TEL NO Z a/ l�b DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER CONST ZONE H Com ensation rovisions of-the Labor Code, you,must forth- Z 1510 U p p y ADDRESSCL with comply with ,such provisions or this permit shall be _ d. deemed revoked ,�' TE L STATISTICAL CLASSIFICATION APT z CgADO N CONTRACTOR NO n / Z LICENSED CONTRACTORS DECLARATION ILICCLASS NO v DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Sectiori 7000)of Division 3 of the Business,and UC SEWER MAP Professions Code, and my license is in full force and effect CITY, CLASS s BK LPG Q r VALIDATION Z t SQ FT OF NO OF CHECK License Number 3 ZY0 Lic Class` SIZE ' TORIES FAMILIES ONE G`�� D� DESCRIPTION OF WORK Y❑ YAAJION„�� Contractor at�id r^te � �j NEW ''�'',,[()) C(l[�� Q✓ - $ ADD I am exempt under Sec - ❑ ALTER C� JJ B 8P C for this reason USE OF y REPAIR ❑ $ # o 0 0 Q$ 0 C r LL Date DEMOL 1 - 27285 i d EXISTING BLDG ❑ Signature APPLICANT TEL FINAL OWNER-BUILDER DECLARATION PRINT NO Z l�3 DATE e e' 272850 I hereby affirm that I am exempt from`the Contractor's License - - Low for the following reason (Section 7031 5,Business and ADDRESS FIN � Q�5 - $8 Professions Code) PRE5ENT B s BUILDING �- 1, 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 Poo. a 7044, Business and Professions Code) w MOVING TEL f © 1, as owner of the property, am exclusively contracting CONTRACTOR - NO { a with licensed contractors to construct the project (Sec- tion 7044, BusinessADDRESS and Professions Code) E + REQUIRED TOTAL SE 1 3 8 A CONSTRUCTION LENDING AGENCY' SET BACK YARD HWY PROP LINE WIDTH ` I hereby affirm that there is a construction lending agency for FRONT �� �� v` rL� �.yLF`,\� "' � `!`e o o e 1 the performance of the work for which this permit is issued P L { 0 3,3 1, 5 Q (Sec 3097, Civ C ) SIDE .f+ P L Lender s Name tti ti - ,y ��,o e LDMA Ref # '3�J t1,5 Q c�i m { 77 ��z` - w m - P C Fee E( ermrt Fee - - r _ Lender s Address i 1 2 2'0-,8 8 I certify that I have read this application,and state that the Issuance Fee LDMA P/C# ® a . o above information is correct I agree to comply with all County Investigation Fee S # o ordinances and State laws relating to building construction Two)Fee LDMA Perm # $ and hereby authorize representatives of this County to enter upon the above-mentione property for inspection purposes O0 r 9. SEE REVERSE FOR EXPLANATORY LANGUAGE r ,gna r of Applicant or Agent Date , , k > QV KERS' COMPENSATION DECLARATION I�hereoy affirm that I have a certificate of consent to self in6re, or a certificate of Workers' Compensation Insurance, APPLICATION F R BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) Y ���T COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo an BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILLjIN - ADDRESS 0 ❑ Certified copy is filed with the county building inspec- BUILDING D 5 tion department. ADDRESS CITY ZI,P LOCALITY Ali __ (,E c� Date Applicant NO. OF BLDG$, CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST - CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. USE ZONE MAP ^ /1 ' OWNER NO. NO. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS SPECIAL CONDITIONS so as to become subject to the Workers'Compensation Laws. O CIN ZIP Date Applicant ARCHITEC OR TEL. d. NOTICE TO APPLICANT:. If, after making this Certificate of ENGINEER Y. NO. • DISTRICT GROUP TYPE FIRE PROCESSED BY O CONST. ZONE V Exemption, you should become•subject to the Workers' `� Compensation provisions of the Labor Code, you must forth- ADDRESS �'v U `J� ✓ w CL with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. C N O. N deemed revoked. CONTRACTOR . NO. 11054 Z LICENSED CONTRACTORS DECLARATION M LIC. CLASS NO.--7-1 DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS `r�� O)WX10 (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK./— PG !UZ VALIDATION I� SQ. FT. NO. OF( NO. OF CHECK License Number��¢TLic. Class SIZE .Z TORIES FAMILIES ONE LVALUATION Contractor �7 Dat DESCRIPTION OF WORK • NEW ❑ S 30 Cl 92 f� 2-b �� ADD I polo. I am exempt under Sec. _ ❑ ry1� ALTER B.&P.C. for this reason d- 00M DfI REPAIR ❑ $ 0947 Date: ' USE OF (WHODC-L E W71116 ,-S DEMOL [E]EXISTING BLDG. Signature APPLICANT .11��..,3EL. FINAL OWN R-BUILDER ECLARATION (PRINT). .�. �iO�l�?�1w6' O. DATE I hereby affirm That I am exempt from the Contractor's License [[���� ^ _ Law for the followingreason Section 7031.5, Business and ADDRESS zJV� 1 8 FINAL "� w ( i'•.. _ Professions Code): PRESENT By _ �; --• BUILDING __:'-_• -'• .L=-'•=} ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 1 '-• the structure is not intended or offered for sale(Section LOCALITYpool F 7044, Business and Professions Code.) MOVING TEL. ('!:f'iyd 3w 3 1 _ 50 I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project.(Sec- s•=``=r -•- - tion 7044, Business and Professions Code.) ADDRESS - REQUIRED TOTAL SETBACK FROM dEl - CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (� Q _ w(Sec. 3097, Civ. C.). SIDE -rP.L. -Lender's NameLDMA Ref. # P.C. Fee$ Permit Fee Lender's Address _1 certify that I have read this application and state that the Issuance Fee `0 'sLDMA P/C# above information is correct. I agree to comply with all County Investigation Fee �Rordinances and State laws relating to building construction, Total Fee 3' \ LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. \ �� a ( � a'/P 7�* y SEE REVERSE FOR EXPLANATORY LANGUAGE S nature of Applicant or Agent Date