Loading...
HomeMy Public PortalAbout4841 CLOVERLY AVE_Building__ 76A638A CE#803 B-64 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING �j1 ✓ } DEPARTMENT OF COUNTY ENGINEER ADDRESS a BUILDING AND SAFETY DIVISION LOCALITY c ✓ ,f JOHN A LAMBIE COUNTY ENGINEER NEAREST _ COLEMAN W JENKINS SUP T OF BUILDING CROSS ST' DISTRI T NO " GROUP TYPE PR C ELD ,Y , FOR APPLICANT TO FILL IN ,��� CONST - BUILDING fin/ STATISTICAL CLASSIFICATION' a SEWS MAP ' ADDRESS L� LCLASS NO / DWELL UNI TS [ BK PG Q �I LOT NO BLOCK f USE'YK MAP - ,C•, ' TRACT SPECALNOOF SLOGS CONDITIONS' SIZE OF LOT NOW ON LOT 1 USE OF "STI,0 BLDG BLDG SETBACK FROM /t") TELU FRONT PROP LINE OF ` (STREET) OWNER .'] ga NO %Al TYPE OF EXISTING SETBACK HIGHWAY + YARD - v TOTAL ADDRESS �((/� G HIGHWAY WI FROM C L - CITY - BLDG SETBACK FROM - ARCHITECT OR _ TEL SIDE PROP-LINE OF (STREET) _ ENGINEER NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL" ADDRESS - HIGHWAY WIDTH FROM C L TEL + = O CONTRACTOR NO U LIC CORNER CUTOFF YES NO w ADDRESS NO O CITY CIC SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK � lB �� , � `. � —�7, Z a. NEW ADD ALTER REPAIR DEMOLISH r 1 ��,� SQ FT NO OF NO OF SIZE STORIES FAMILIES USE OF apt � STRUCTURE pEr I r��f�/'T' 14 b I I,ellf 6 ~ t^ SIGNATURE OF C/ �. K".fi .. h r 6 APPLICANT, ' a ` ._� VALUATION$ A �I V `�J APPROVALS DAFT#E INSP CTOR'S SIGNAT RE ~ 57 FEE$ � FEE$ "„�� FOUNDATION MATERIALSONc Fl�r/ / } rl< FRAME, FIRE STOPS, ! I' `C I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT •t 1 A AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY' FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND'STATE'LAWS REGULATING GAS VENT DUCTS AU H ING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZEb HEREBY I WILL NOT EMPLOY ANY PERSON IN,VIOLA LATH INT' TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT _ ING TO WORKMEN 5 COMPENSAGIO INSURANCE -IV �e ` 4 LATH EXT / ••�� t SIGNATURE OF - HOUSE NUMBER COR- ` t PERMITTEE ' '.REC AND POSTED ADDRESS ' F Fl N AL, � 'r 'JOHN F LEWIS PRINCIPAL STR URAL ENGI- EER PLAN CHECK VALIDATION CK M 0 CASH _ I ''PERMIT VALIDATION cK Mv0 ,'CASH -I3 9 5 1w rEB26 2 3 D 2,8.50A ' 1 11 9 4 A 7:0 MART 0 5 7 .0 0 a n76A638A,S`E #8e'3 1/71 (/,,/(,`' APPLICATION FOR BUILDI� �P"Q T � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION' - BUILDING p ADDRESS SIO t1L COLEMAN W JENKINS, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST " Print or 1 onl CROSS ST „r BUILDING DISTRRICT NQp GROUP Z9.0T PROC SSED BY ADDRESS g -5 l�o STATISTICAL- CL SIFICATION SEWER MAP LOT NO BLOCK CLASS NODWELL UNITS BKk PGb TRACT ZONE MAP NO OF SLOGS / NO ©/ SIZE OF LOT NOW ON LOT I/ SPECIAL - USE OF CONDITIONS EXISTING BLDG t` Y TEL OWNER 9�/ 12 0,0,4 NO BL TBACK FROM ADDRESS FRONT P LI NE OF (STREET) TYPE OF 1EXISTING ACK HIGHWAY + YARD = TOTAL CITY HIGHWAYI WIDTH FROM , ARCHITECT ORQA f TEL + 1 _ ENGINEER r ' NO 6';l BLDG SETBACK FROM ADDRESS R SIDE PROP LINE OF (STREET) TEL TYPE OF EXISTING SETBACK HIGHWAY + YAR = TOTAL a CONTRACTOR .S NO HIGHWAY WIDTH FROM C L C7 L'C C� ADDRESS Id IV, AlURANO 23&-17 '} C7 LIC c~D L V( CLASS CORNER CUTOFF YES 1:11 CONSNO yJ NAMED BRANCHRUCTION SEE GASH SEE REVERSE SIDE jFOR SP CI APPR VALS Z NO OF NO OF Z ,� QSTORIES FAMILIES NEW ADDURE B ALTER����O� REPAIR❑RE OFNT+� DEMOLION S '.It(t1O APPROVALS DAT '0 ,E I/3P CTOR S Ic TU RE P C PMT � FOUNDATION LOCATION ✓ FEE S FEES 8• Q FORMS MATERIALS / 7� 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 WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS STRUC TI ON I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT ' LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE / LATH EXT ' SIGNATURE OF /((�JUVHOUSE NUMBER COR- PERMITTEE 7r RECT AND POSTED ADDRESS yLq �I'l. ,9:thsIt FINAL 7 JOHN F LEWIS PRINCIP i TR T-URAL ENGINEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALID` T CK M O 'CASH „�. 6 3 s 2 0 8:5.5- V LACO6 a.'� ► 1 s o 28.5 I ' > jF8C3_,8A CE9803 9-87APPLICATIONFOR BUILDING PERMIT 6 COUNTY OF LOS ANGELES BUILDING DEPARTMENti OF COUNTY ENGINEER ADDRESS �Z oloaie C BUILNING AND SAFETY 151VISION LOCALITY Q Jf f JOHN A LAMB[E, COUNTY ENGINEER COLEMAN W JENKINS, SUP T OF BUILDING NEAREST CROSS ST LC7 £ S 211 FOR APPLICANT TO FILL IN DIST�F ICT N GR TYPE P Ej�BY D CONST (Print or type only) BUILDING � c / /f STATISTICAL CLA S CATION SEWER MAP ADDRESS / G -r CLASS NO DWELL UNITS ,BK4 PG/O LOT NO (p BLOCK USE ZONE MAP /�^� NO ll TRACT / S i SPECIAL _TNO OF BLDGS l CONDITIONS SIZE OF LOT / ��,� NOW ON LOT USE OF EXISTING BLDG U BLDG SETBACK FROM TEL2g2 FRONT PROP LINE OF (STREET) OWNERC )L' NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL /s c y� HIGHWAY WIDTH FROM C L ADDRESS -/- 1` <CITY T£ m Cil 1 d + �-D ARCHITECT OR TEL BLDG SETBACK FROM ENGINEER (,(�� NO SIDE PROP LINE OF (STREET) _ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L CONTRACTOR Q (� (/r' NOL + = a LIC O CORNER CUTOFF YES ❑ NO ❑ c_.)ADDRESS NO � CITY, CLASS SEE REVS E,SIDE FOR 71SPEC APPROVALS cR DESCRIPTION OF WORKLIJ G - z NEW (ADW ALTER REPAIR DEMOLISH SQ FT i NO OF NO OF SIZE �s STORIES FAMILIES USE OF c tK STRUCTURE tyll 1/1 SIGNATURE APPLICANT �� t W VALUATION $/, QD 6o APPROVALS APPROVALS DATE INSP+ TOR s slcN ..E i P C PMT FOUNDATION +LOCATION J FEE $ FEE $ / FORMS'MATERIALS + G 6 I FRAME FIRE STOPS _ I HEREBY ACKNOWLEDGE^THAT I HAVE READ THIS APPLICATION BRACING BOLTS G AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CO E OF THE STATE OF LIFORNIA RELAT ING TO WORKMEN S CO PEN TION I URANC LATH EXT SIGNATURE O (� HOUSE NUMBER COR- PERMITTEE / RECT AND POSTED p ADDRESS Lf 1 6 �` FINAL JOHN F LEWIS PF INCIPA PLAN CHECK VALIDATION CK M 0 CASH _ PERMIT VALIDATIO STRCK URAL O ENGINEER . 4 9 1 JO `3 1 0 _1 725- APPLICATION FOR BUILDING PERMIT . COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN I hereby affirm that I have a certificate of consent to self insureBUILDING ADDRESS , a or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITt— y� ZIP r7-QJ) LOCALITY Policy No. Company SIZE!OF L C ( [ NO.OF BLDGS.NOW,OlN✓LOT El Certified copy is hereby furnished. A NEAREST CROSS ST. ❑ Certified copy is filed with the County building inspection TRACT BLOCK LOT NO. - department. s- USE ZONE MAP NO. �� .� /• Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNE No• COMPENSATION INSURANCE WITHIN 1000 FT.OF.SCHOOL? ves No This section need not be completed if the permit is for one hundred ADD S ( / 7 C DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) L ii � ] / / I certify that in the performance of the work for which this permit CITY 6 C� ZI q(fv t p _3 .- is issued, I shall not employ any person in any manner so as to Q become subject to the Workers'Compensation Laws. ARCHITECT O ENGINEER TEL NO. STATISTICAL CLAFIOATION APT CONDO Date Applicant ADDRESS CLASS NO. G/ DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY 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. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 —STORIESSEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW 11 BK PG , IL License Number Lic.Class DE RIPTION OF W RK ADD VALUATI N Q Contractor Date LLALTER 11 $ P U cc /�, LGA EPAIR ❑ O El am exempt under Sec. $ I- BAP.C.for this reason >C 7 �j�fL J/ !�-/ ,�. DEMOL ❑ V LDMA P/C# IjJ Date: u, o% N L.�1%1G�L�l / URM ❑ 23 fn Signature APPLICANP RINT `� TEL NO. LDMA Perm#. Z 1, as owner of the property, or my employees with wages as , ",L S z ACCT. their sole compensation, will do the work and the structure is ADDRESS /1 0 r not intended or offered.for sale (Section 7044, Business and /! l"�Gf�Ct�G(1', FINAL DATE 3; 50�E Q 1 °'-- Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLEpTrtyny •�/�� j J y ❑ I, as owner of the'property, exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER T AN�fHE am y g lh AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY / /IT 8 licensed contractors to construct the project (Section 7044, YES 1:1 NO❑ �.f9/ AC/IT o 4 ti.. Business and Professions Code.) {(yyam WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING � . ,3*.SLIJ. 5+'j22•7� OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH r`zt`t„ CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR �'_ '7 ITEMS GUIDELINES. �'- I hereby affirm that there is a construction lending agency for YES❑ No❑ ,TOTAL e ` a the performance of the work for which this permit is issued(Sec. - IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING •� `•! g }J [►/ 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, e ti 't�.(NECK 579.27 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS I CHANGE 'y d Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CHANGE .130 0 Lender's Address 0 OWNER OR AGENT o I certify that I have read this application and state under penalty Of perjury that the above information is correct.I agree to comply P.C.FEE , 1�� PERMIT FEE �� Al n�{y�M�`n •� i r r!( o with all county ordinances and State laws relating to building 000 00 1 1J 4 00 constructs n, and hereby authorize representative of this County ISSUANCE FEE 4096 1 AM11:01 M pon thea entio tion purposes. a '0 J--- • INVESTIGATION FEE TOTAL FEE�r['�� r7 of Aoomem or AD nt Dale 77 . SEE REVERSE FOR EXPLANATORY LANGUAGE