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HomeMy Public PortalAbout4815 CLOVERLY AVE_Building__ J ( DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ka ® � WM J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT O PLAN CK NO PERMIT NO — ADDRESS RECEIVED BYE DATE OF APPL DATE ISSUED LOCALITY NEARESTA'101 _ CROSS S45� BUILDING ADDRESS OWNER ( (J MAIL LOCALITY (2-7, V ADDRESS NEAREST TEL _ CROSSST CITY NEL FIRE .NO OF IQTYPE I GROUP ARCHITECT OR TEL ZONE PLANS ENGINEER NO J BLDG I ' Sot ORD NO I SETBACK LINE ADDRESS APPROVED - ` TEL!� BY DATE CONTRACTOR O USE APPROVED — — ADDRESS ' �� ZONE �Y BY DATE HOUSE NUMBERING LEGAL DESCRIPTION I LOTNO I BLOCK MAP NUMBER FIELD CHECK,BY TRACT NO ASSIGNED BY DATE { _ NO OF BLDGS .- - CORRECTIONS SIZE OF LOT NOW ON LOT ' USE OF I NO OF — EXISTING BLDG FAMILIES DESCRIPTION OF WORE _ NEW I I ALTERATION I I ADDITION REPAIR I I DEMOLITION SQ FT NO OF 41 SIZE ROOMS STORIES 2 EXT WALL ROOF r COVERING I COVERING USE OF STRUCTURE APPROVALS INSPECTOR S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS - CORRECT 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING BOLTS LAWS REGULATF4Q BUILDING CONIPTRUCTIO Y r FURNACE LOCATION, SIGNATURE OF GAS VENT, DUCTS PERMITT LATH, INT ' ADDRESS LATH, EXT AUTHORIZED AGT PLASTER, INT 76A638A DBS3 10-50 P C ® e J�Q FEE PLASTER, EXT VALUATION / FEE © FINAL s DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT ` COUNTY OF LOS ANGELES ® � WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY �� DIBTRI PLANCK NO PERMIT NO BUILDING /��-') ADDRE69 LOCALITY "- � REC IV BY DAZ/; PL 9 DAT EBB NEAREST /J_ � / / / l CROSS BT • �/I/L SU DING / ✓ OWNER f-ll" ADDRESSMAIL C ADDREBS ` o � p�j® It LOCALITY / TEL �+/ /� NEAREST CITY / NO /' °4,01,9 CROSS BT �. FIRE NO OF PGROUP ARCHITECT OR // TEL ZONE PLANS ENGINEER V NO BLDG JO ORD NO ADDRESS ❑ SETBACK LINE APPROVED CONTRACTOR T BY DATE UBE APPROVED I� ` -ADDRESS ZONE BY 'Z.--Q}lTE ,n y LEGAL CORRECTIONS K - DESCRIPTION LOT NO BLOCK ✓TRACT ��t, y t- FSIZE OF LOT ///Lf /lr I NOW ON LOTS -C z"• l/3` 1 ' UBE OF NO OFNO OF EXISTING BLDG I FAMILIES I ROOMS .J DESCRIPTION OF WORK N I YI ALTERATION I ADDITION i O A REPAIR MOVING I DEMOLISH 0 Sq FT NO OF / Z SIZE /, ROOMS BTORIES / D WALL r I ROOF A � COVERING COVERING BUILDING NEW /i � ',/7 � BUILDI`DING 1 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 ✓` n�`� %l'���� FRAME FIRE STOPS, SIGNATURE OF BRACING,BOLTS i PERMITTE LATH,INT AUTHORIZED AOT- LATH,EXT DBS-3 SOM SETS 7-47 $ P C S PLASTER,INT FEE PLASTER,EXT. VALUATION7 ] FEE ✓`��� FINAL PP1 -- f k WORKERS COMREASATION DECLARATION - "y �- , V ' APPLICATION_ F�OR�BUILDING PERMIT J,h?+gby a�fis,, thbt I`have a c.,.f,.te.of consent to self ih$u�A or cn'�rhfic6t>5 of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800,Lab C ) - � �. COUNTY-OF LOS ANGELES BUILDING-AND SAFETY , acy,No a Company - py' y s FOR APPLICANT TO FILL IN BUILDING Certified co is hereby furnished � � _ ADDRESS ❑t Certified copy ,s filed`vvith'tF a county building inspec- - BUILDING !� hon department a `J + ° t- ADDRESS y C�LDV6p t-y Aeto , Date' `1t1 I Applicant `+.t. _ CITY 66M OLE, GI- - - ^� ZIP led t LOCALITY s CERTIFICATE'OF EXEMPTION FROM WORKERS' `` ' '& - ° - NO OF BLDGS �J ; NEAREST _ d COMPENSATION INSURANCE SIZE OF LOT �O d `X' 7S NOW ON LOT y /' CROSS ST T t'- 1,1'41 - (This section need not be completed if the permit is for one - -� -- _Z�F ASSESSOR hundred dollars ($100)or less ) t 1 TRACT _ BLOCK LO TEL �- MAP BOOK' PAGE' PARCEL } PA t USE E MAP �r n OWNER 'r "`F,E��T' -NO, -Ow , `certify that in the performance of the work for whichthisr NO - .2- I - i Perm it is issued, I shall not employ any'person in any manner _ c i ,a vC V e _ �_ _ a _ - SPECIAL O t a ADDRESS ��^V CONDITIONS { _ so as to become subject'to'the Workers'Compensation Laws V ;ssa , /� A,., 1 Date VIA— 1_t Appl cant 0401. 1..�''�47- CITY_ e G! _ ZIP q I IJ 60 : - _. - -- - ,. a, NOTICE TO'APPLICANT If, after%making'this'Certificate of ARCHITECT OR TEL _DISTRICT _ GROUP' TYPE _ FIRE _ ESSED BY _ O a ENGINEER NO CONST I ZONE / Exemption'' you 'should become subject to the Workers `' W Cornpensotiomprov,s,ons of the-Labor Code, you must forth- ADDRESS 5 jf '- -- - d with comply ,with such, provisions or rthis,permit shall be - TEL STATISTICAL CLASSIFICATION APT CONDO a deemed revoked r CONTRACTOR Sijjk MS NO _ _ , _ LICENSED CONTRACTORS DECLARATION - - I I - -LIC' CLASS NO' DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP (commencing with Section 7000)'of Division 3 of the Business and _ _ _ _. r__. -LIG - - Professions_Code; and my license,s in full force and effect - VALIDATION ' y CITY CLASS , i . 1 1 1<r - I " SQ FT NO OF _ NO OFy_ _ CHECK BK PG License Number ++ h" 'Lic Class _ SIZET STORIES FAMILIES ONE t, .� • ,c •. • , .- VALUATION Contractor Y \ Date `+ - DESCRIPTION OF WORK- a9: NEW— O f ❑ 1 am exempt under Sec 13 �GA �` ADID d ALTER ❑ `- , 5 3 0 b A f ,a e orfs- c ,, B 8P C for this reason _ ft,;;nmITC./ 11 W#G AnoREPAIR -❑ -'s " - # o o e'0 2 3 ' Date USE OF DEMOL ❑ EXISTING BLDG Y © V [ / I - 3-3-S97 - Si g PRINT nature + f - - � � � APPLICANT 4o h /e,/ / �.& TELNO Q FINAL , I 5 9 7 OWNER-BUILDER DECLARATION _ _ _ ,DATE Y-1 hereby affirm'that I am exempt _from the Contractor s License _ (d Y � a L - `� � 8 2 6-+b' 6 Law for the following reason (Section 7031 5 Business and ADDRESS FINAL { "Profess ions'Code) "' PR '^BY BUILDING I, as owner of the property or my employees with ' ADDRESS wages as their sole compensation,will do the work and the structure,s not intended or offered for sale(Section LOCALITY ; 7044 Business and Professions Code) --" MOVING - -' -- TEL ❑ -I as owner of the property, am exclusively contracting CONTRACTOR NO, i - - with-1,censed'controctors to construct the project-(Sec- ADDRESS - t -;9-5'6 1,4 A hon 7044, Business and Professions Code) REQUIREDBK FROM -EXIST1 " CONSTRUCTION LENDING7AGENCY-- y SET BACK YARD' HWY TOTAPROPLCNE WIDTH SET _ # o o e o-o 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 L -^ -'- ti. - '` ' 4 - _ y ° 47.0,5,-7 5 (Sec 3097, Civ C ) SIDE n - - - - - - PL_ e o-40-575 o Lender's Name f LD"Ref sA0.1 0=86 - --- - - - r - - ^-" - -- PC Fee$ - J - Permit Fee - - 'r G - -_ --, ., .' "T Lender s Address S -;I-certify,that I have read-this application and state that the - -- Issuance FeeLDMA P/C <" above information ,s correct I agree to comply with all'County Investigation Fee g '_ordinances and,State jaws relating to building construction, _ _ - Total Fee �-LDMA Perm # - - - - - - t and hereby authorize representatives of this County to enter m upon above-me ,oned p pert for inspe ion purposes a ! y SEE REVERSE FOR EXPLANATORY LANGUAGE f - - Signature of App,cant or Agent'+ - --" - Date - 7- �, ,~ WORKERS COMPENSATION DPCLARAFAN insurebor affcertif cairm rte of Workers' Compensation elnsuran elt' APPLICATION SAF� R- BUILD 1 N G E RM I T or a certified copy thereof (Sec 3800, Lab C ) p v COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS y Certified copy is filed with the'county building inspec- BUILDING 4 (� tion department t✓ ADDRESS T J �//C (� LOCALITY / NEAREST Date Applicant L.r CITY - yjd� ZIP /� CROSS ST' 0 USq CERTIFICATE OF EXEMPTION FROM WORKERS' f % NO OF BLDGS ASSESSOR d COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 7, MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one / 11 U E ZONE MAP hundred dollars ($100)or less ) TRACT ! BLOCK LOT NO ] NO t7�D TEL SPECIAL >_ I certify that in the performance of the work for which this OWNER NO ?Z CONDITIONS d permit is issued I shall not employ any person in any manner /.�/q rs�0 DISTRICT GROUP TYPE FIRE PROCESSED BY 0 p ADDRE 4� ��� CONST ZONE o as to become subject to the W rs C s ion Lows �1 f N a t 3 - ®2�� O Date' ~ �� Applicant CITY % / ZIP 7� v STATISTICAL CLASSIFICATION APT CONDO I1-- f TO APPLICANT If, after making t is Certi cote of ARCHITECT OR TEL LU ENGINEER NO CLASS NO DWELL UNITS Exemption, you should become subject to the Workers' �. Compensation provisions of the Labor Code, you must forth ADDRESS SEWER MAP N with comply with such provisions or this permit shall be VALIDATION TEL ) S deemed revoked I CONTRACTOR NO BK I�PG ` LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 67 NO VA ATI N (commencing with Section 7000)of Division Sof the Business and LIC �� SC Professions Code, and my license is in full force and effect CITY CLASS > Poo. FTC// NO OF NO OF CHECK cense Number Lc Class SIZE 7(� STORIES FAMILIES ONE e DESCRIPTION OF WORK �/L/ 7-0 NEW Contractor Date ADD 1 am exempt under Sec ��� ��� n ALTER FINAL B 8P C for this reason a_ ND � DATE t REPAIR Date USE OF EXISTING BLDG VI/l 'L Z-� DEMOL FINAL BY Signature I APPLICANT TEL OWNER-BUILDER DECLARATION PRINT /3U ��T NO I hereby affirm that I am exempt from the Contractor's License C ��v�R Law for the following reason (Section 7031 5, Business and ADDRESS _ 1 Professions Code) PRESENT n G o o o BUILDING J I, as owner of the 'property, or my employees with ADDRESS �^ o o 5825 wages as their sole compensation,will do the work and` the structure is not intended or offered for sale(Section LOCALITY r 4 2 x 7044, Business and Professions Code) MOVING TEL ❑ C NTRACTOR NO 1 Z 2 O,r rj I, as owner of the property, am'exclusively contracting � J with licensed contractors to construct The project (Sec- ADDRESS tion 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH , c 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 (Sec 3097, Civ C ) SIDE _ m PL e Lender's Name (� P C Fee$ Permit Fee ��C y r Lender's Address ,—y� I certify that I have read this application and state that the Issuance Fee D07 `� ^ a above information is correct I agree to comply with all County Investigation Fee z ordinances and State laws relating to building construction, Total Fee � and h by authorize representatives of this County to enter , /upo t above do d p for inspection purposes - - - , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Applicant r Agent Date ®f