HomeMy Public PortalAbout4930 CLOVERLY AVE_Building__ 11 i
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DIVISION OF BUILDING AND,SAFETY BUILDING
Department of County Engmeer ADDRESS
County of Los Angeles LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST
F APPLICANT TO FILL IN DISTRICT O GR P TYPE SEWER MAP
1C I P6
CONST L
BUILDINGf A' MAp STATE -
ADDRES Y NUMBER HWY, YES N +
LOT NO BLOCK USE Z NE S E IAL
/ CONDITIONS
TRACT _.&P 11,4/i)—a =-
NO OF BLDGS 3
SIZE OF LOT / I � NOW ON LOT Z BUILDING YARD HWY STREETrNAME EXIST
USE OF
SETBACK WIDTH
�„
EXISTING BLDG FRONT
P L
OWNE SIDE
MAIL f P L _ '+
ADDRESS V +v ti°"M O TRACT DWELL 1 UNIT
t r- f•. . - 5 INDUSTRIAL
TELhCITY, NO �� l� 1 DWELL 7 1 UNIT
6 PUBLIC BLDG ,
ARCHITECT OR TEL 2 DUPLEX 2 UNITS
7ENGINEER NO ADDN.ALT, ETC
3 APT UNITS 8 MISCEL
ADDRESS 4 COMMERCIAL -
TEL INSPECTION RECORD
CONTRACTOR NO
ADDRESS �.d (p _ t9�� ` lA I A L_'.
DESCRIPTION OF WORK A
NEW ADD ALTER REPAIR DEMOLISH
NO OF No
STORIES FAMIOLIES J'
-USE OF STRUCTURE _
SIGNATURE OF
APPLICANT APPROVALS
ADDRESS PPY5 DATE INSPECT R S SIGNATURE
17,
_ FOUNDATION LOCATION /
$ / 7 �Q P CS
t9� FORMS MATERIALS
FEE FRAME FIRE STOPS /n� n_
VALUATION O $ - BRACING BOLTS [�/ 7w, � � aV Vow.
FEE �s FURNACE LOCATION ,f
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT DUCTS `� A
,APPLICATION AND STATE THAT THE ABOVE IS CORRECT x
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 RECT AND POSTED arc e.Y
ADDRESS' - FINAL 'k
JOHN A LAMBIE. COUNTY ENGINWR VALIDATION CLYDE N DIRLAM, CHIEF BLDG INSPECTOR
CK MO CASH -
• 1
3 7 fiUr, 21w l 1 6 i 4 f7i S 4J6-7,L AUG 21 1 3.o.0,'4
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APPLICATION FOR BUILDING PERMIT �l
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUILDIyG ADDRESSL-
1 hereby affirm that I have a certificate of consent to self 'insure, /'ILLI J
or a certificate of Workers'Compensation Insurance,or a certified CITY ZIPq
copy thereof( ea 3800,Lab.C.) CITY
�
Policy No. � Company '^"^-� SIZE OF LOT NO.OF BLDGS.NOW ON LOT
Certified copy is hereby furnished.
NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
depffa.��.rt, __/ret.
USE ZONE MAP NO.
Date l Applicant pic Ifieff) I'/ ASSESSOR MAP BOOK PAGE PARCEL
l4-VI? SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 1 TEL.NO.
COMPENSATION INSURANCE 1 � �`� WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred ADDR�Sd4v � , �� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
dollars($100)or less.) (/Ut /"� ��} /
certify that in the performance of the work for which this permit CITY : ZIP _t ( �J
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. c%
become subject to the Workers'Compensation Laws. STATISTICAL CLAS IFICATION 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 to the Workers' CO RACT R /- TEL.NO.
P Y 1 LG• {� W dG v SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith ty W FRONT
comply with such provisions or this permit shall be deemed revoked. ADDDRE,5S11G• P L
2-45, L4 Fb
LICENSED CONTRACTORS DECLARATION CITY LIC CLASS SIDE o
1 hereby affirm that I am licensed under provisions of Chapter 9 �A`� SEWER MAP v
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO:OF STORES I NO.OF FAMILIES
Professions Code,and my license is in full force d effect. NEW El BK PG O
License Number < , LIC.Class it DESCRIPTION OF WORK ADD ❑ , W
1 VALUATIO
Contractor �I�e> Date l a 0 t N O ALTER $ 1706 XXA rn
�— ALO M_ oa 1-0�wS. REPAIR C3ElI am exempt under Sec. $
B.&RC.for this reason DEMOL ❑ LDMA P/C a
p Date: Z-' r USE OF EXISTING BLDG. URM ❑
Signature ! T� APPLICANT(PRINT) TEL NO. LDMA Perm# s
El 1, as owner of the property, k my em oyees with wages as ZO
their sole compensation,will do the work and the structure is ADDRESS
!; not intended or offered for sale (Section 7044, Business and FINAL DATE �y G 7.371 ^
Professions Code.) / -��v// _
WILL THEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLER HAZARDOUS MATERIAL ` J 3 " ^IC. � •
❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN _ Q
Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project.(Section 7044, '• '' �c:
YES❑ NO❑ 0 _I I I«•sL 55.«.F ee 3'' - E
Business and Professions Code.) '�
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING _ r.x:: • ,�{K '••?i„
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH `.•€"I C'j «a,
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST _
FOR GUIDELINES. Y.yNi `
I hereby affirm that there is a construction lending agency for YES❑ NO❑
the performance Of the Work for which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD
3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES
m. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING e`{ i3�^-"1",y 4(�s i' .il^€"I
ia Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.
Lender's AddressF
Ip. OWNER OR AGENT
o 1 certify that I have read this application and state that the above P.C.FEE PERMIT FEE
information is correct. I agree to comply with all county
Z7 z—
ordinances and State laws relating to building construction,and
a hereby authorize representatives of this County to enter upon ISSUANCE FEE
the above-mentioned property for inspection purposes. _
INVESTIGATION FEE TOTAL FEE
Signature of Applicant o,Agent Deb
SEE REVERSE FOR EXPLANATORY LANGUAGE,