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HomeMy Public PortalAbout4902 CLOVERLY AVE_Building__ 76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT' COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALI { JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISI CTNO GROUP TYPE P=CES BY FOR APPLICANT TO FILL IN _Z" CONST BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �� BK PG '� CLASS NO DWELL UNITS LOT NO C ' LOCK WATER �( CERTIFICATE NOT REQUIRED d RECEIVED ❑ TRACT V� MAP HIGHWAY NO OF BLDGSNO ptQ (CIRCLE) STATE MAJOR SECOND LOCAL SIZE OF LOT NOW ON LOT to USE ZONE SPECIAL 77 USE OF CONDITIONS G C EXISTING BLDG TEL OWNER ( Z)zNO SEI BACG EXIST K YARD HWY STREET NAME WIDTH ADDRESS FRONT ARCHITECT OR TEL P L ENGINEER NO SIDE P L / r� ADDRESS T ///#A �..f'LYd'!'�fbrC� IJ�iA` � 1" ✓ v EL CONTRACTOR NO ADDRESS to — DESCRIPTION OF WORK Ut �' AzA4 Aa',,��- tau KEP ADD ALTER REPAIR DEMOLISH /r r G' /� �f B If d SQ FT SNO OF TORIES NO OF �� � ,/" GZ;44 4�1w5 ? SIZE v USE OF STRUCTURE _ SIGNATURE OF � APPLICANT VALUATION A PPROVA S rj&wg0 DATE® INSPECTOR SSIGNANTLI PC / PMT S� FOUNDATION LOCATION ' FEE - 2 / FEE $ FORMS MATERIALS �I� `,j• �',�'(�'I' FRAME FIRE STOPS �A I HEREBY ACKNOWLEDGE THA READ THIS APPLICATION BRACING BOLTS t h/f AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS N� BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK ^�� - YIn AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT yj�•iJ�+ 1 " TION OF THE LABOR COD OF THE STATE OF CALIFORNIA RELAT ` ING TO WORKMEN S COMPENSATION INSURANCE t LATH EXT � �„ —,t ., ` SIGNATURE OF Aff _ �r HOUSE NUMBER COR J —��"��r,,� // PERMITTEE RECT AND POSTED /AP-A4 T!-.ZCy '+*'� ADDRESS FINAL ! O PLAN CHECK VALIDATION cK M o` CASH JOHN F LEWIS PR CIPAL S RAL ENGINEER PERMIT VALIDATION cK M o CASH Llsj 4 5 7 OCT 62 3 D 2 6.7 5 A LAL04928-0 OCT15 1 D 5 3.5 0 WORKERS' COMPENSATION DECLARATION insure,'herebor affcertif cate of Workers' Comipensat e of on eInsurancnt to ef APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS9d2 ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS �01/�,e: CITY Te.�P�G C/�' ZIP �/7 9© LOCALITY G� Date Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT 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. OWNER ,}/,/•z L' NO. USE ZONE MAP I certify that in the performance of the work for which this NOSPECIAL >_. permit-is issued,1 shall not employ any person in any manner ADDRESS 9�2 ��O(/�.�/ CONDITIONS a so as to become subject to the Workers'Compensation Laws. _ p Date O /�-'W' �iJ' gC� V 'i'-Z�l p C42CITY ZIP i/7Applicant �'" ARCHITECT OR TEL. i DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, afte making this Certificate of ENGINEER NO. CONST. ZONE 0 Exemption, you should become subject to the .Workers' u Compensation provisions of the Labor Code, you must forth- ADDRESS f�2(7 Gv/� S% �leJ�e�c7L'� �of Y p� with comply with such.provisions or this permit shall be , TEL. STATISTICAL CLASSIFICATION APT. CONDO. rZ deemed revoked. CONTRACTOR&A- 191445 D®//�t/G N0.335-/day z_ LICENSED CONTRACTORS DECLARATION LIC.. CLASS NO. � DWELL. UNITS - I hereby affirm that I am licensed unLIC der provisions of Chapter 9 ADDRESS �7w`l�7�S SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC: S CLAS and Professions Code,and my license is in full force and effect. CITY BK. PG. VALIDATION SQ. F_T. NO. OF / NO. OF CHECK License Number LA41765 Lic. Class C•� SIZE STORIES / FAMILIES O ONE nn dd__,,rr `) VALUATION Contractor PO�� /71q/ A�NG Date, 9 2 'y2 DESCRIPTION OF WORK %Cs9e Q� �t3 NEW ❑ $ `� QO El am exempt under Sec. '�f �GQ� r /�!//>/l ADD EJ ALTER ❑ B.&P.C. for this reason //1j��C ('/,4SS tr✓JN�/�5 REPAIR ❑ $ Date: USE OF. EXISTING BLDG. DEMO[ ❑ Signature ��'�%Y [ APPLICANT TEL. Si g OWELDER DECLARATION (PRINT). C.a// �S NO. � FINAL / DATE `9...Z_-g� I hereby affirm that I exempt from the Contractor's License ADDRESS��20 C�IJ(�/�+ G ����- Law for The followingg r reason (Section 7031.5, Business and FINAL Professions Code): PRESENT By ..� BUILDING ❑ I, as owner of the property, or my employees with ADDRESSA'=1'I wages as their sole compensation,will do the work and y. -S, fj;p � �t/� - . the structure is not intended or offered for sale(Section LOCALITY ? 7044, Business and Professions Code.) MOVING :TEL. t,•� ; CONTRACTOR fNO. -+-• ❑ I, as owner of the property, am exclusively contracting _ . with licensed contractors to construct the project (Sec- ADDRESS `; tion 7044, Business and Professions Code.) tW' `s ,, +i REQUIRED TOTAL SETBACK FROM- CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP:LINE I hereby affirm.that there is.a construction lending agency for FRONT "^3 3 si the performance of the work for which this permit is"issued P.L, '''" (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name n ; D ' LDMA Ref. # f �t P.C. Fee$ Permit Fee r 3 Lender's Address l !t+''` _ `* s1 ) 0 1 certify that I have read this application and state that the Issuance Feer LDMA P/C# ,' 8 above information is correct. I agree to comply with all County Investigation Fee j/� 0 ordinances and State laws relating to building construction, Total Fee,,,/,5 .&ILDMA Perm. # a and hereby authorize representatives of this County to enter upon th above-mentioned property for inspection purposes. � � g �8•�2 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent Date