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Home My Public Portal About4905 CLOVERLY AVE_Building__ e_Ac_)-pvAAxVe '45PERMd �QUIRED +�_ CR-WORK DUNE IN THE ROAD RIG, OF WAY. 7"UaA CB 4602260 APPLICATION FOR BUILDING P:RMIT COUNTY OF LOS ANGELES BUILDING 7 DEPARTMENT OF-COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY -JOHN A LAMBIE, COUNTY ENGINEER NEAREST - WILLIAM A JENSEN SUP T OF BUILDING CROSS ST r_Ir DIST ICT NO GROUP nPE P ES BY ' FOR APPLICANT TO FILL IN $ CONsT BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS BK CLASS NO DWELL UNITS Q� {LOMAP STATE e T NO BLOCK NUMBER HWY YES O , TRACT USE E r a SPECIAL —I NO OF BLDGS '� CONDITIONS SIZE OF LOT ,O /�NOW ON LOT ,q}D n USE OF EXISTING BLDG BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH OWNER /(/ O FRONT —� n P L ADDRESS Ad (/ SIDE ARCHITE OR TEL P L ENGINEER NO INSPECTION RECORD ADDRESS �� )) CONTRACTOR- PON f .�//T - L 04O ADDRESS P V DESCRIPTION OF WORK O v F - A" ZA, NEW -ADD LTER REPAIR DEMOLISH v / SO FT NO OF NO OF - SIZE STORIES FAMILIES USE OF / '7 STRUCTURE kyf� SIGNATURE OF APPLICANT VALUATION C5`70-14 x - APPROVALS DATE INSPECTOR S SLINAE"UNIf PC - - PMTAq FOUNDATION LOCATION FEE $ FEE �. B(3 „FORMS MATERIALS �Ga F.at I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS, BRACING BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE LOCATION, ' AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH INT WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN S CO ENS ION LAWS CALIFORNIA LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEERECT AND POSTED , 0 ADDRESS FINAL PLAN CHECK VALIDATION CK MO CASH CLYDE PERMT VALIDATION) CT 6ALo EN ISNFEER 30--? JUL 1 ID 5.0 0 DEPARTMENT OF COUNTY ENGINEER � 11LDING �✓ AFETY �� DMSIOCNOUONTY oUF.Los ANGELEBING AND S B WILLIAM J FOX, COUNTY ENGINEER APPLICATION - CASSATT D GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO PLANCK OR REc No PERMIT NO ADDRESS 3e? 70 LOCALITY • RECEI V BY DATE OF APPL 1 DAT 183U D NEAREST CROSS ST, BUILDING r �I OWNER d • ADDRESS MAIL ,0 LOCALITY ADDRESS { NEAREST • TEL CROSS ST CITY NO, ARCHITECT O TEL' FIRE' NO OF TYPGROUP ENGINEER NO ZONE-- PLANS �" �/�.� ADDRESS BLDG SETBACK LINE c� G CONTRACTORd� NO USE APPROVED ` ZONE 4Ffl BY DATE / Z 1HOU8ENUMBERINqf ADDRESS 4 /1/ BY LEGAL o MAP NUMBER NO ASSIGNED DESCRIPTION LOT N BLOCK � CORRECTIONS TRACT - 5 NO OF BLDGS th SIZE OF LOT I NOW ON LOT v e n F3 Ate_ Ae N A wl USE OFd I NO OF EXISTING BLDG FAMILIES .� DESCRIPTION CW WORK M-73 C o^aax a -7- 15"A Aj, ✓.s,' 2"" o NEW ALTERATION H ADDITION I I�� v� `TL'A��S 41 REPAIR' HDEMOLITION ` � ' �� '� / �� 6,c/G D r SQ FT - NO OF l SIZE O ROOMS STORIES EXT WALL • I ROOF COVERING COVERING • APPROVALS INSPECTOR'S SIGNATURE DATE t FOUNDATION LOCATION FORMS, MATERIALS !1 I2 S' s I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME 'FIRE STOPS, /✓ PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT FURNACE LOCATION, �!p 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS AND STATE LAWS REGULATING BUILDING CONSTRUCTION , SIGNATURE OF LATH, INT C PERMITTE'/ ♦ �Y� r� �� ADDRESS�dy� l� eLe+�v,��d• LATH EXT /N PLASTER, INT AUTHORIZED AGT PLASTER, EXT FEE $ HOUBE NUMBER COR O (/ Li RECT AND POSTED VALUATION FEE $ „ ' FINAL / r r ti�eweaaw D69 a e-as I J APPLICATION FOR BUILDING PERMIT COUNTY OF LOS-ANGELES . /j. .BUILDING AND SAFETY I WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS / I hereby affirm that I have a certificate of consent to self Insure BUI ADDRESS or a certificate of Workers Compensation Insurance or a certified �•7 CLot/r-.�112Ly 6k..1c. _ copy thereof(Sec 3800 Lab C) CITYZIPZIP / G?-J CE C //7 7 9�7 ro LOCA TY Policy No Company SIZE QF LOT - NO OF BLDGS-NOW ON LOT ❑ Certified copy Is hereby furnished A/I v 19, NEAREST CROSS ST ❑ Certified copy Is filed with the county building Inspection TRACT BLOCK LOT NO department , ' I USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - - I SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ER TEL NO ' COMPENSATION INSURANCE /Gry/�/J �n/S GEy Zf�' Z`�3y WITHIN 1000 FT OF SCHOOLS YES NO (This section need not be completed if the permit is for one hundred ADDR�E]SS t/ _ dollars ($100)(or less) /�� L ✓t�% �� DISTRICT GROUP T ST FIRE ZONE PROCESSED BY 11 I certify that In the performance of the work for which this permit CIT C 1� zIP 9i71-0 IS issued I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NO �� become subject to the Workers Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject t0- the Workers CONTRACTOR > ��1 TEL NO SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith vow`� FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS - DC NO P L LICENSED CONTRACTORS DECLARATION SIDE � CITY r LIC CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE., NO OF TORIES NO OF FAMILIES , Professions Code and my license Is In full force and effect / f NEW ❑ BK PG License Number Llc Class DESCRIPTION OF WORK ADD ❑ VALUATION c Q' Contractor Date /w0T'!N6 ALTER ❑ $ t�v��' U ❑ I am exempt under Sec ` N�CEssy REPAIR 1:1 $ 0 B&PC for this reason DEMOL ❑ LDMA P/C# 1 L 1 W Date USE / TjNGBLDG URM ❑ A(CT.4 > Cn Signature 4! _Z A CANT(PRINT) � TEL NO LDMA Perm# x�:11?T 1 cC (�as owner of the property or my employees with wages as �Q RNs K/ Z�G' y 3y Z 36 125'' � their sole compensation will do the work and the structure IS AD S ,�/ �b � 0 1 ITEMS not Intended or offered for sale (Section 7044 Business and � �/ ��a`�C�G7 %"�= — l'G• FINAL DATE Q Professions Code) �� TOTAL 1 ®�� WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1�5 5 ❑ I as owner of the property am exclusively contracting with Q AMOUNTS SPECIFIED N THE HAZARDOUS MATERIALS INFORMATION GUIDE licensed contractors to construct the project (Section 7044 t FINAL BY > � Business and Professions Code) YES❑ No CHAKE o rye WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �.alf7l'IVG 11V OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES — / , t 1 hereby affirm that there Is a construction lending agency for f YES❑ No 19 - M-0001 9/18/95 N the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097 CIV C) �I�ZO 1 ❑M L.C(} N CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE - 2S 38 1 !'t 1 7°58 T1TLE 2 PPTER 2 20 SECT ONS 2 20 100 ROUGH 2 20 140 CONCERNING HAZARDOUS Lenders Name MATE RERO�TING A OBT�iJI PERMIT FROM THE SCAQMD o Lender s Address OWNER OR AGENT 1 t t o I certify that I have read this application and state under penalty o P C FEE PERMIT FEE ' of perjury that the above Information is correct I agree to comply with all county ordinances and State laws relating to building ro constru tion and hereby authorize representatives of this County ISSUANCE FEE `'7 O toe o the ab ntiened perty for Inspectio pur ses - / s /7 INVESTIGATION FEE TOTAL FEE SgreNre of Appbcari,a Apen, DMe , SEE REVERSE FOR EXPLANATORY LANGUAGE