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Home My Public Portal About4926 CLOVERLY AVE_Building__ 76A636A 06b 9 8 88 APPLICATION FOR BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY BUILDING ADDRESS Deportment of County Engmeer County of Los Angeles LOCALITY /� G WM J FOX COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUP'T OF BUILDING CROSS STS"'✓ DISTRICT NO. GROUP '1•yYPE SEWER BK MA PG FOR APPLICANT TO FILL IN / I CONST L BUILDING P STATE ADDRESS NUMBER ER HWY YES _ O LOT NO BLOCK USE ZONE SPECIAL i - CONDITIONS TRACT 133e,41 � NO OF BLDGS BUILDING EXIST. SIZE OF LOT NOW ON LOT J� SETBACK YARD HWY STREET NAME WIDTH EXIUSESOF TT,NG BLDG '(/I/��L�� IY Qd/C��GC FRONT P L OWNER SIDE P L MAIL tt ADDRESS aL O TRACT DWELL ` 1 UNIT 5 INDUSTRIAL - CITY � ' T5-EE 1 DWELL I UNIT 6 PUBLIC BLDG ARCHITECT O - TEL 2 DUPLEX I UNIT ENGINEER NO 7 ADDN ,ALT ETC 3 APT UNITS - 8 MISCEL ADDRESS 4 COMMERCIAL CONTRACTOR INSPECTION RECORD /j�fA�y O � ADDRESS w ..d /� DESdRIfflION OF WORK EW ADD ALTER REPAIR DEMOLISH _ 80 FT NO OF NO OF SIZE STORIES ,n FAMILIES USE OF 9TRUCTU E SIGNATURE OF APPLICANT - �'� APPROVALS `1 ADATE INSPECTORS SIGNATURE DDRESS i �$ 6 FOUNDATION LOCATION P C $ FORMS, MATERIALS k FEE FRAME FIRE STOPS, VALUATION -" BRACING, BOLTS _ FEE FURNACE LOCATION 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT AND STATE LAWS REGULATING BUILDING CONSTRUC- TION LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE A RECT AND POSTED ADDRESS V 1NAL WM J FOX,COUNTY ENGIT EER VALIDATION C N DIRLAM, CHIEF BLDG INSPECTOR - 4pj0'2'0 3r ,mw22 1 2.0 0 76A638AE#aD9 a 64 APPLICATION FOR BUILDI� G PERM , COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS - BUILDING AND SAFETY DIVISION LOCALITY ?U ` JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS SUP T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE PFZ`I ' ESSEO BY FOR APPLICANT TO FILL IN 3'' ` CONST° ' ( J BUILDING •� STATISTICAL CLASSIFICATION SE ER MAP ' ADDRESS ° CLASS NO DWELL UNITS 6 K4 PG /1 - LOT NO BL CK USE ZONE MAP NO TRACT 1' SPECIAL NO OF BLDG9 CONDITION SIZE OF LOT NOW ON LOT } USE OF _ BLDG SETBACK FROM TEL,/) `2S FRONT PROP LINE OF (STREET) OWNE O(, J TYPE OF EXISTING SETBACK HIGHWAY _ YARD ^= TOTAL ADDRESS HIGHWAY WIDTH CITY ARCHITE OR T L BLDG SETBACK FROM - ENGINE R O SIDE PROP LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL' ADDRESS HIGHWAY WIDTH FROM C L d TEL + - 0 CONTRACTOR ® NO - LIC ADDRESS NO CORNER CUTOFF YES 0 - NO E:]NO H CITY LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS^ w DESCRIPTION OF WORK 0- z NEW ADD ALTER REPAIR DEMOLISH SO FT 7 NO OF N O O F SIZE STORIES FAMILIES USE OF STRUCTURE lk, 1 1 , SIGNATU E OF I '�'i.J .•>< A P P L I C A N T VALUATIONMr-1-1= I ( p APPROVALS DATE INSP C _9,1� P C PMT R� FOUNDATION, LOCATION �''j t� /�+' ��--- gyp �j� FEE$ FEE$ ig FORMS, MATERIALS _ '�//y;tl�y% f �'aCP/i" r a, FRAME, FIRE STOPS, �` �"� �'" I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT Z1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION r WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS SUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK �- AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT r� TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ING TowORKMZSIMPENTIO INSURANC LATH EXT SIGNATURE O G.�f'J` HOUSE NUMBER COR- v PERMITTEE -E �^ ��r��" `�f RECT AND POSTED ADDRESS cY FINAL T I JOHN F LEWIS PRINCIPAL�STR CTURAL ENGINE R 'PLAN CHECK VALIDATION CK M O CASH CK _ PERMIT VALIDATION M O CA LA0 3 3 7 110 JJL 6 1 D 1 � .5 0~ �' APPLICATION FOR BUILDING PERMIT FOR APPLIC/`NT TO FILL IN (Print or type only) �. BUILDING :39— COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY—` ZIP BUILDING AND SAFETY DIVISION ` NO OF BLDGS BUILDING 9pC j SIZE OF LOT NOW ON LOT ADDRESS TRACTY(IEY BLOCK LOT NO LOCALITY T L t NEAREST OWNE -2Jv CROSS ST / ASSESSOR ADDRESS �, MAP BOOK PAGE I PARCEL r+� A DISTRICT GROUP TYPE FIRE CESSED BY CITY ZIP �/ ��UB �- CONST ZA� , ARCHITECT O TEL ENGINEER NO STATISTICAL CLASSIFICATION SEWER MAP ADDRESS TEL CLASS NO DWELL UNITS zBK Q CONTRACTOR NO USE ZONE MAAP LIC ��) ADDRESS NO 1) SPECIAL LIC CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM FRONT PROP LINE OF (STREET) ADDRESS f CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ FT NO OF NO OF CHECK HIGHWAY + YARD = FRONT PROP LINE - HIGHWAY WIDTH SIZE STORIES FAMILIES ONE y DESCRIPTION OF WORK NEW ❑ + O ADD BLDG SETBACK FROM fzrA,1111 SIDE PROP LINE OF (STREET) O ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w HIGHWAY + YARD = SIDE PROP LINE HIGHWAY WIDTH N USE OF REPAIR ElZ EXISTING BLDG ter- DEMOL ❑ + APPLICA TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT aae'09N N OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( �O IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATIONii4 2 2 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES R ^ ;/ r /�— J AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE / ��JC/P7Z WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM 1 PENSATION INSURANCE ` m e („�/ '; w 9- ad SIGNATURE gfil l" QV 6� Y PERMITTEE ADDRESS;Z'a1d TEL _'1� DATEL CI N o/ MA HECKS PAYABLE TO FEE PC $ FEET $ HARVEY T BRANDT,COUNTY ENGINEER c�O 5-0 (/ V PLAN CHECK VALIDATION CK-7 M o CASH — l PERMIT VA D TION K M O CASH 386'rAUG 223 D 9 0.0 0 8,16 4 5 3r--SEP -50 1' D 1 5 0.0 0 ego ®S 76A638A CE#803 3 75 76AOSSA CE#.0310 59 APPL=ICATION-FOIA BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING 1` J� DEPARTMENT OF' COUNTY ENGINEER ADDRESS (r'L'{/ y /� 4 BUILDING,AND SAFETY DIVISION LOCALITY JOHN A LAMBIE. COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST DISTRICT NO GROUP ITYE PR SED BY FOR APPLICANT TO FILL IN CON§T IBUIL®ING STATISTICAL CLASSIFICATION- SEW RMAP- ADDRESS L O - + - �Bf P * CLASS NO WELL UNITS nt LOTN10 / BLOCK N MBMAPER ' STATE YES O A vlY 'TRACT !' USE ZONE SPECIAL - - _ ti /. NO OF BL A-1 '+ SIZE OF LOT 6O (/ I NOW ON LOT CONDITIONS - USE OF � EXISTING BLDG BUILDING YARD HWY STREET NAME EXIST • SETBACK �- WIDTH r OWNER 4 FRONT ' MAIL p / P L ADDRESSSIDE ,L (p _ s � ly TEL P L CITY - NO At- INSPECTION RECORb ARCHITECT OR IF -IW ENGINEER O 'O ADDRESS TEL - -5�1�J / /f (, L�.l-�s�a'I'•'+[.d , CONTRACTOR S NO '- i—r�.�cr' - ADDRESS DESCRIPTION OF WORK NEW DD ALTER REPAIR DEMOLISH - - SQ FT NO OF NO OF - SIZE -STORIES FAMILIES USE OF _ I STRUCTURE SIGNATURE OF s APPLICANT - _ 1 - APPROVALS, DATE ' INSPECTOR S SIGNATURE ADDRESS \ W FOUNDATION LOCATION FORMS,MATERIALS a 1 VALUATION$_ Cy� �� FRAME,FIRE STOPS, BRACING BOLTS �MTA FURNACE LOCATION. FEE $ FEE $�� GAS VENT,DUCTS - I HEREBY ACKNOWLEDGE THAT,.1 HAVE READ THIS AP-" - PLICATION AND STATE THAT THLTABOVE IS CORRECT AND` LATH INT AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND - - -* STATE LAWS REGULATING BUILDIN CONSTRUCTION LATH,EXT SIGNATURE'O > �j( HOUSE NUMBER COR-� PERMITTEE • RECT AND POSTED ADDRESS t FINAL M O CASH CLYDE N"DIRLAM, PRINCIPAL STR f RMAO ENS HEER CK CHECK VALIDATION � �PEMM VALIDATION '( / s ®� � nORKERS COMPENSATION DECLARATION Atli ebaffirm that I have certificate of consent to self APPLICATION FOR. BUILDING,P E RM I T +nay o e, or a certificate of Workers' Compensation Insurance, or ai�,prtified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company - IBUILDING - ❑ Certified copy is hereby furriished Y FOR APPLICANT TO FILL IN ADDRESS (� ❑ Certified copy is filed with the county building inspec- BUILDING /j v tion department , ADDRESS &_ t e _t ,i. + CITY P r ZIP p O LOCALITY �i _ Date' Applicant NO ,OF BLDGS NEAREST f ' CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT y NOW ON LOT CROSS ST a COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT " BLOCKLOT NO MAP BOOK PAGE PARCEL hundred dollars ($100) or less ) TEL 'USE ZONEMAP OWNE ' / Q (/ O I certify,,that in`the performance of the work for which this permit is is ue ,I shall t'emPECIAL y an pers n in an nner ADDRESS {� J� J CONDITIONS so as t ec a su to o s mpens n'Laws ) O CITY P ; U ARCHITECT 09 TEL Xr0 CE TO APPLI NT If,' after making this Certificate of ENGINEER i NO,?-; ^.DISTRICT' G OUP TYPE FIRE PROCESSED BY R xemption, you should become subject to the Workers' / CONST ZONE U mpensation provisions of the Labor Code, you must forth- !7 - ADDRESS �J0 l� \, _ a with comply with such provisions this N p y p permit shall be TEL STATISTICAL CLASSIFI TION _ APT CONDO -" Z deemed revoked , � r . r CONTRACTOR _VC.Q� �� NO I � _ LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Section 7000)of Division 3 of the Business CLASS SEWER MAP and Professions Code,and my license is.in full force and effect - , BK PG/ VALIDATION " FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAMILIES ONE 1 p z VALUATION i Contract Aµir 4 Dote DESCRIPTION OF WORK �, NEW ❑ ; 7 ^ o o � s ADD , ` ❑I amjexemptpunder'Sec � O y , _~ _ ALTER 5 s B&PfC for this reason REPAIR ❑ Date USE OF_ _ W EXISTING BLDG DEMOL ❑ -Signature ' APPLICANT TEL - - FINAL « OWNER-BUILDER DECLARATION (PRINT) NO G r ,DATE//)- Mf',( I hereby affirm that 1 am exempt from the Contractor's License - � "Law for the following reason (Section 7031 5, Business and ADDRESS , FINAL- IProf sions Code) PRESENT r - By j, as owner'of the property, or my employees with ADDRESS T ACCT.4 wages as their sole compensation,will do`the work and LOCALITY r f �^ ' �� e 3W7 59.25 the structure is not intended or offered for sale(Section y 7044, Business and Professions Code ) MOVING -TELT 1TG, ❑ j, as owner of the property, am exclusively contracting CONTRACTOR NO a t'Ems with licensed contractors to construct the project (Sec- ADDRESS TbTAL 59 - 25 tion 7044, Business and Professions Code ) REQUIRED YARD HWY TOTAL SETBACK FROM" EXIST a CHECK 59.215CONSTRUCTION LENDING%AGENCY SET BACK PROP LINE WIDTH - I hereby affirm that there is a construction lending agency for FRONTeQ the performance`of the work for which this permit is issued ` "P L ` " * CHA%E (Sec 3097, Civ C ) SIDE P L i. s Lender s Name C — 1 7/28/309Lender's Address LDMA Ref # - PC Fee$ Permit Fee / J 4728 1 AM1t7 29 .- - 1 v r %+. o j certify that I have read this application and state that the Issuance Fee ,fJ r LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee el_ ordinances d State jaws relating to building construction, Total Fee `Y LDMA Perm # a and he y uthori epres tatives of thi County to nter upo ve- o rop for pection poses - o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o p scant 0r gent Date `