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Home My Public Portal About4935 CLOVERLY AVE_Building__ 7 79AGSCA Cl#803 2/60 APPLICATION -FOR BUILZING PERM �. COUNTY OF LOS ANGELES - BUILDING ADDRESS S DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING! = CROSS ST / DISTRICT OUP TYPE P O BY FOR APPLICANT TO FILL INL. '/I CONST i BUILDING �i ^ STATISTICAL C SS DATION SEWER MAP ADDRESS / BK -rj CLASS NO DWELL UNITS LOT NO 121 BLOCK , MAP STATE YES O NUMBER o HWY TRACT ZZ `5:� USE ZONE SPECIAL. NO OF BLDGS j CONDITIONS SIZE OF LOT I NOW ON LOT I/ USE OF ) EXISTING,BLDG / /J BUILDING EXIST TEL SETBACK YARD HWY STREET NAME WIDTH OWNER �j NO P FRROL T �l o ADDRE l SIDE 3� ARCHITECT oft TEL P L - ENGINEER NO -INSPECTION RECORD ADDRESS TEL a CONTRACTOR NO O ADDRESS V DESCRIPTION OF WORK oG O NEW ADD ALTER REPAIR DEMOLISH SO FT NO OF / NO OF a SIZE .Z STORIES / FAMILIES y USE OF STRUCTURE 'r A - SIGNATURE OF APPLICANT - VALUATIO / /" APPROVALS DATE INSPECTOR S SIGNATURE P C PMT FOUNDATION LOCATION FEE $ FEE $ (f(J FORMS MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 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 1 LATH INT WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN S C/O PENSATION LAWS OF CIFORNIA LATH EXT SIGNATURE OFl / HOUSE NUMBER COR- PERMITTE Z RECT AND POSTED ADDRESS / I FINAL 1 CLYDE N DIRLAM P 1NCIPAL STRUCTURAL ENG ER PLAN CHECK V ATION CK M 0 CASH PERMT VALIDATION CK M 0 cASH ' TEMPLE CITY , 76AG38A CE#8032/910 APPLICATION FOR BUILDING PERMIT - COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS--'/ / BUILDING AND SAFETY DMSION LOCALI —G JOHN A LAMBIE. COUNTY ENGINEER NEAREST / WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTRICT N OUP TYpE PRO S BY F APPLICANT TO FILL IN �� CONST I STATISTICALIFICATION SEWER MAP iS B PG t CLASS NO DWELL UNITS BLOCK MAP STATE YESNUMBER HWY USE ZONE SPECIAL �P NO OF BLDGS CONDITIONS SIZE OF LOT .9 'q;(-1'5' NOW ON LOT / USE OF —EXISTING BLDG / BUILDING YARD STREET NAME EXIST/ -r TEL SETBACK WIDTH - OWNER I i NO&;r-G-&T7 FRONT ADDRESS e SIDE ARCHITECT OR - TEL P L ENGINEER NO INSPECTION RECORD ADDRESS4 '� � n 0y [ TEL a CONTRACTOR_ NO 1 O ADDRESS DESC OF WORK NEW ADD ALTER REPAIR DEMOLISH ll NO OF NO OF SIZE lbrdN do.C] (3� nCL��f'' ,"� STORIES I F MILIES USE OF STRUCTURE ! SIGNATAPPLURE T_ 1 "T' E9ti �taS Lr nI VALUATION APPROVALS DATE INSPE OR S SIGNATURE B C PMT 0 FOUNDATION LOCATION FEE $ r-ORMS MATERIALS O 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FR4BRA FIRE STOPS, // ACING 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 I CONSTRUCTION - 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH INT WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN S COMPENSATION LAWS{ CALIFORNIA LATH EXT SIGNATURE OFgp HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS t ' FINAL l[ Ino CLYDE ND PLAN CHECK VALIDATION CK M 0 CASH PERMIT IIT VALIDATIONTR TUR CK MO �xc �� Pf 7 2 6 3 3 OCT 4 i C TEMPLE CITY 76AS30A CE#0032/60 APPLICATION FOR BUILDING-PERMIT ' COUNTY OF LOS ANGELES BUILDING 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 DISTRICT NO GROUP TYPE SED BY FOR APPLICANT TO FILL IN �r coNsr BUILDING , STATISTICAL CLASSIFICATION SE ER MAP ADDRESS — K P CLASS NO DWELL UNITS / LOT NO BLOCK MAP / STATE _ NUMBER ! '' HWY YES NO , TRACT USEZONE SPECIAL NO OF BLDGS /I / CONDITIONS ' SIZE OF LOT /5-? NOW ON LOT Z /f/-f-� USE OF EXISTING BLDG BUILDING EXIST TEL _ SETBACK YARD HWY STREETNAME WIDTH OWNER NO FRONT P L s ADDRESS S SIDE ARCHITECT OR TEL P L ENGINEER _ NO INSPECTION RECOFb ADDRESS TEL >y CONTRACTOR Z NOA7 7115v 0 ADDRESS 60"" Ofiz w V DESCRIPTION F WORK--45'9a O H NEW ADD ALTER y REPAIR DEMOLISH SQ FT N NO OF a SIZE STORIES FAMILIES tn USE OF STRUCTURE i SIGNATURE OF APPLICANT VALUATION$ APPROVALS DATE INSPECTOR SSIGNATURE FOUNDATION LOCATION FEE FEE $ FORMS MATERIALS 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 COMPS ATIONLAW OF CALIFORNIA LATH EXT SIGNATURE . RHOUSE NUMBER COR- PERMITTE OFRECT AND POSTED / I " ie- ADD] FINAL CLYDE N DIRLAM PfiINCIPAL STRUCTURAL E PLAN CHECK VALIDATION CK M o CASH - PERM VALIDATION CK M CASH OCT ? 1 U 5 ®� 1 I � v WORKERS COMPENSATION DECLARATION 1 nt to self insure bor afcertif caste off Wo ke srtComtpensat on eInsurance, A P P L I CATION 'FOR BUILDING PERAAIT or o certified copy thereof (Sec 3800 Lab C ) ,. COUNTY OF LOS ANGELES r BUILDING AND SAFETY Policy No Compony a ' Certified copy is hereby furnishedFOR APPLICANT TO FILL IN BUILDING Certified copy is filed with the county buildmg,mADDRESS spec- BUILDING / `� tion department ADDRESS 3S— CL-Q V E E L Z4 14T� Date Applicant I 1C1TY_F'E7mP 'LF_ C f' ZIP q 1 L LOCALITY CERTIFICATE OF EXEMPTION'FROM WORKERS - NO OF III DGS NEAREST COMPENSATION INSURANCE t+ SIZE OF LOT NOW ON LOT CROSS ST YA S (This section need not be completed if the permit is for one TRACT BLOCK LOT NO ASSESSOR hundred dollars ($100)or less ) p G-p MAP BOOK - PAGE PARCEL TEL OWNER J t? Q(/ NO p(-pA USE ZONE MAP I certify that in the performance of the work for which this NO permit is issued, I shall not employ any person in any manner a SPECIAL x so as to become subject to the Workers'Compensation Laws ADDRESS JS ��vVL �� r CONDITIONS 0 �O( -� y CITY ��!—_QI ZIP `71 -11 ,50 t V Date Applicant "`� ARCHITECT OR TEL � NOTICE TO APPLICANT If, after making*this Certificate of DISTRICT GROUP TYPE FIRE PR SSED BY 0 ENGINEER NO Exemption, you should become subject to the Workers' / _ CONST ZONE U Compensation_provisions of the Labor Code, you must forth- .�wx 2/, with comply with such provisions or this permit shall be ADDRESS OW., deemed revoked STATISTICAL CLASSIFICATION APT CONDO N CONTRACTOR NO to �I Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm thot,l am,lcensed under provisions of Chapter 9 ADDRESS NO (commencing with Section 7000)of Division'3 of the Business and LIC SEWER MAP Professions Code,'or d my license is in full force and effect CITY CLASS VALIDATION- SQ FT NO OF NO OF CHECK BK PG License Number Lc Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK I NEW ❑ (/`�- i ADD ❑ ; I am exempt under Sec ❑ , ALTER B&P C for this reason REPAIR S 2 8 5 6 8 A Date T' USE OF DEMOL EXISTING BLDG C] _ # • e • o •�� Signature APPLICANT TEL // FINAL PRINT e NO��lO' OWNER-BUILDER DECLARATION DATE � / � ,� e - 29.50 I hereby affirm that I am exempt from the Contractor s License �r 1 / ^' .- ADDRESS J 1v lhd V Ce- S Law for the following reason (Section 7031 5, Business and FI o o�"e'2 9 5 0 v Professions Code) t n 12'1 `1 —87$7 I, as owner of the property, or my employees BUILDING with ADDRESS wages theiras o compensation,will o the work and the structure iss nott f intended or offered for sale°(Section LOCALITY 7044, Business and Professions Code) MOVING TEL y I, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS F tion 7044, Business and Professions Code) !!! ' REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY Elnvesti6ation YARD HWY PROP LINE WIDTH ` I hereby affirm that there is a construction lending agency for the+performance of the work for which this permit is issued (Sec 3097, Civ C ) r r ,Lender's Name LDMA Ref # 4 s Permit Fee Lender's Address j certify that I have read this application and state that the` , r Issuance Fee LDMA P/C# t oabove information is correct I agree to comply with all County ee 0 ordinances and State laws relating to building construction, Total Fee [J LDMA Perm # 1 R and hereby authorize representatives of this County to enter m upon the above- ent property for inspection purposes 0 `- ' J - W SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date a ` • . APPLICATION FOR BUILDING PERMIT • . COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN ILDING ADDR SS_ hereby affirm that I have a certificate of consent to self insure, BU IN AD RESS L or a certificate of Workers' Compensation Insurance, or a certified �Lo U Ly AL& ' copy thereof(Sec.3800,Lab.C.) CITY C l ZIP O V LOCALITY Policy NO. Company - SIZE OF LOT i., NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. fb x ' 5LZF NEAREST CROSS ST. ^ El BLOCK LOTO.Certified copy is filed with the county building inspection c 4 department. "�li USE ZONE MAP NO. Date Applicant A SES O MA BO F7 o PAGE n PARCEL ,�/ IV �///. 6/ —/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' Q\W��N`ER � �p,� /�^ a TEL NO. �1� COMPENSATION INSURANCE �Jo o ^' �t �iP`� �� 1� WITHIN 1000 FT.OF SCHOOL? YES NO ADDRESS (This section need not be completed if the permit is for one hundred yo OL)�n 1 (�_,-- S^ DISTRICT GROUP TYPE CONST. FIRE ZONE PROCE SED BY dollars($100)or less.) 49 1�l tTV�I CITY ZIP �j f I certify that in the performance of the work for which this permit '790 D� /� 1 is issued, I shall not employ any person in any manner so as to ARCHITEC QR ENGINEE TEL O. I _ yy become subject to the Workers'Compensation Laws. ,S( Oma(. / .,^„ STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS l 1 ) CLASS NO.- DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of ".1 REQUIRED' TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR / TEL NO. SET BACK YARD HWY PROP LINE WIDTH a Compensation provisions of the Labor Code, you must forthwith = L � !� FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS P L I hereby affirm that 1 am licensed underprovisions of Chapter 9 SEWER MAP >- (commencing with Section 7000)of Division 3 of the B siness and SQ.FT.SIZE. NO.OF STORIES NO.OF FAMILIES O NEW ❑ BK PG /D.3 Professions Code,and my license is in full force and effi ct. A,, ( ® U License Number Lic.Class DESCRIPTION OF W RK ADD VALUATION C7 0 Contractor Date a C ALTER ❑ $ C S400 U c~� ❑ 1 am exempt under Sec. REPAIR ❑ $ z BAP.C.for this reason DEMOL ❑ LDMA P/C# Date: US OF STING BLDG. URM ❑ _ Signature LI A ( RINT) TEL LDMA Perm# -- *,as owner of the property, or my employees with wages as � � � Z �- their sole compensation, will do the work and the structure is DRESS '(� ' ^ O _ - • -i �J 1..0L)C-IzI FINAL DATE ~ not intended or offered for sale (Section 7044, Business and C .. -- " PfOfeSS10r1S Code.) WILL THE APPLICANT OR FUTURE BUILDING OCC PANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J s ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY Q licensed contractors to construct the project (Section 7044, YES❑ No❑ - - Business and Professions Code.) _- WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING – '�'+�'„ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR _ GUIDELINES. I hereby affirm that there is a construction lending agency for 'YES❑ NO❑ N the performance Of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTINGS 3097,CIV.C.) CHECKLIST.IUNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. - TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS - i^• 'r(-•�•_ __if.;, Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. •–- ' 1`f;i G-1- o Lender's Address i t__ -- 0 OWNER OR AGENT - o I certify that I have read this application and state underpenalty o If of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE 17-173. N with all county ordinances and State la relating to building m construction, hereby authorize repr tatives of this County ISSUANCE FEE / '/' up a ab a-me lone r y for irispection purpos /•70 (0d L/ INVESTIGATION FEE TOTAL FEE na um.ol Applicant drr4ent De e SEE REVERSE FOR EXPLANATORY LANGUAGE t