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HomeMy Public PortalAbout4949 CLOVERLY AVE_Building__ ©s 76A6382 i r--- CE#803(REV 11/78) APPLICATION FO BUILDING R T COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS ADIDRESS �� /� 0 V eR LOCALITY NEAREST /i—g CITY 0 L ZIP CROSS ST ,�•(/ L AS NO OF BLDGS y ASSESSOR SIZE OF LOT 6 A X /6 NOW ON LOT ! MAP BOOK PAGE' PARCEL DISTRICT GROUP I TYPE FIRE PROCE ED BY TRACT BLOCK LOT NO CONS OWNER (� NO ..z�7-397 �TEL �� ` A STATISTICAL CL IFI TION WER MAP ADDRESS CLASS NO DWELL UNITS CITY ZIP ARCHITECT OR TEL 1 VALUATION �QaO _ ENGINEER o NO ADDRESS BLDG SETBACK FROM [G, ^y FRONT PROP LINE OF (STREET) CONTRACTOR r 4lj` _:U NO 7� 6 GZ TOTAL SETBACK F TYP OF EXISTING ADDRESS S�(/V/7 LICNO /sI HIGHWAY + YARD = FRONT PROP LI HIGHWAY WIDTH LIC J 6 + CITY / CLASS CONSTRUCTIC19 LENDER BLDG SETBACK FROM NAME'AND BRANCH �` �l"L/ SIDE PROP LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING d ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH O SORES NO OF NO OF �e CHECK SIZE STORIES FAMILIES / ONE USE ZONE MAP DESCRIPTION OF WORKAdd NEW �� NO A FV Ar SPECIAL ADD CONDITIONS - If ALTER ❑ FINAL BY regi REPAIR ❑ DATE USE OF DEMOL ❑ EXISTING BLDG - - - 1 Z APPLICANT TEL C (PRINT) by L rNO y a G l � J BY(SIGNATURE) _ /~ j IHEREBY ACKN LEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE L _ WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V ,y N , THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM z l ` PENSATION INSURANCE SIGNATURE OF2 9 9 1 7 A PERMITTEE C 1&_ A--) ADDRESS - �/\ Z 0 0 0 0 0 1 TEL -YbZ� ° 2- o 61 00 CITY NO Q 6 ! GCE P C Fee$ Permit Fe� > -- 011 1 6—co Issuance Fee � Tocol Fee . 76A638A CE4*803 8-64 APPLICATION FOR BU ILDI G PERMIT _ COUNTY OF LOS ANGELES BUILDINGr DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOC A LI T Yi JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST DISTRICT NO GRO TYPE P OC FOR APPLICANT TO FILL IN CONST BUILDING STATISTICAL WSSIFICATION SEWER MAP ADDRESS Q E CLASS NO DWELL UNITS LOT NO BLOCK USE ZONE MXP NO CY✓ TRACT ! SPECIAL + NO OP BLDGS (( CONDITIONS SIZE OF LOT NOW ON LOT USE OF r T EXISTINGQ BLDG SETBACK FROM TEL FRONT PROP LINE OF (9TRE ET) OWNER NO TYPE OF EXISTING I SETBACK HIGHWAY + YARD �= TOTAL ADDRESS4949 IOHWAY WIDTH FROM C L CITY c L BLDG SETBACK FROM ARCHITECT OR TEL SIDE PROP LINE OF (STREET) ENGINEER NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L >- CL TEL n + CONTRACTOR Q O L •/ O V G LIC CORNER CUTOFF YES NO CC ADDRESS O CITY L` LI` - SEE,REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK a NEW ADD ALTER REPAIR DEMOLISH ri � SQ FT NO OF NO OF SIZE Z O STORIES FAMILIES/ r•�!(��� /�f, -7p` /�,/A ////,,/g USE O F / / STRUCTURE - SIGNATURE OF APPLICANT '00, !� r Lia 1*de NE 6 ' A. VALUATION$ cc a� APER �A C, DAT.t' INSP EC,TOR,9S _LGNATURE FEE FPMTEE$ 7C �'> FOUNDATION, LOCATION FORMS, MATERIALS FRAME, FIRE STOPS 11 ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT !(�p AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION /R Ir O , O�vJ,�-�r WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS U HORCONSTRUCTION I CERTIFY THAT IN DOING THE WORK A AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODE: OF THE STATE OF CALIFORNIA RELAT _ ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT .41 IjA SIGNATURE OFr7/J_ _ / HOUSE NUMBER COR- PERMITTEE RECT AND POSTED 71 ADDRESS /8Uf Q��, Q FI NAL JOHN F LEWIS PRINCIPA STR URAL ENGINEER (" PLAN CHECK VALIDATION CK M O CASH i, s 7 9 PERMIT �VALIDATIION , CK M O CASH h L,,,� 2 3 - 0 2 2.0 0 r .L TEMPLE CITY .lo 79A93814c6#803 1--al APPLICATION FOR BUILDING PERMIT ' COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS ` BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST -'FOR APPLICANT TO FILL IN DIST ©N{Q/ C' CO ST � R E�Y rJY BUILDING STATISTICAL C S FICATION WER MAP ADDRESS BK G ^� CLASS NO DWELL UNITS O .✓ LOT NO BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE TRACT MAP ft HIGHWAY NO OF BLDGS NO (/` (CIRCLE) STATE MAJOR SECON LOCAL SIZE OF LOT �� I NOW ON LOT USF'ZONE SPECIAL 1 �+ USEOF .-G / �I CONDITIONS EXISTING BLDGJY TEL OWNER ! � NO 7 BUT-DING EXIST ADDRESS �1 L ` ` WARD HWY STREET NAME �^ `� W v C, SETBACK �f/f WIDTH ARCHITECT OR TEL P L 7t 1.' / O ENGINEER NO SIDE- -P L ADDRESS TEL 6 INSPECTION RECOWDCL CONTRACTOR NO .q /we V ADDRESS 1 - r =t DESCRIPTION OF WORK �' w.rte+ a+ NEW ADD ALTER REPAIR DEMOLISH SQ NO OF NO OF �• �in.G..Y _lL.�r^, I* E' Z IZE STORIES FAMILIES USE OF �al .�'..✓)-.�� i'l.Vl. �,r �� I STRUCTURE - G E r a '� _ �� '�,° ltd/�?���. �✓��' �i.� �',��' �� SIGNATURE OF APPLICANT VALUATION$ 0-v y , APPROVALS DATE INSPECTOR SSIGNATURE PC PMT FOUNDATION LOCATION- FEE $ FEE $ / V (/ 1 FORMS MATERIALS FRAME FIRE STOPS /0/, /alb/G� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS ? AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION L' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ' GAS VENT DUCTS r , BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK n AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT sh .2 f TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COTION INSURANCE '{� /., 1� / /I` LOFTN'EXT S R C - �� G a SIGNATURE OF G// HOUSE NUMBER COR- ' PERMITTEE .�� �.i RECT AND POSTED -7�r 'ADDRESS .FINAL 'a/ /.. PLAN CHECK VALIDATION CK. M O CASH 1 CLYDE p REM VAIMATIONTRucK. m o,E R + Uto2314 .,Ef 7 1 D 6 G Cl 4 3�' v ` ) w , WORKERS COMPENSATION DECLARATION r insurebor afclertificatelof Worke seCompensotfonolnsurancecnsent tos or T , APPLICATION FOR BUILDING PERMIT �rttc�opy tr o h f (Sec 38 �ddX(J�I�� N COUNTY OF LOS ANGELES BUILDING AND SAFETY P y N Compan t t t Certified copy is hereby furnishedFOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS LOCALITY NEAREST Date ur� Applicant CITY ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS N F BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT N W N LOT MAP BOOK _ PAGE PARCEL (This section need not,be completed if,the permit is for one - USE ZONE MAP hundred dollars ($100)or less ) TRACT , BLOCK LOT NO I NO Q `� SPECIAL I certify that in the performance of the work for which this OWNER 2 CONDITIONS 0 DISTRICT GROUP TYPE FIRE PRO SSEtp BY U permit is issued I shall not employ any person in any manner • CONST ZONE so as to become subject to the Worker Co sation Laws ADDRES Date t Applicant CITY ZI STATISTICAL IFI TION APT CONDO W NOTICE TO APPLICANT If after makingthis Certificate of ARCHITECT OR TEL ENGINEER NO CLASS NO �� DWELL UNITS � Exemption, you should become subject to the Workers y) Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP with comply with such provisions or"this permit shall be deemed revoked , - CONTRACT \ BK L PG to 3 VALIDATION � � N N LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALU TION (commencing with SectioA 7000)of Division 3 of the Business and LIC Professions Code and my license is in full force and effect r CITY CLASS $ NO OF CHECK SO NO OF SIZE STORIES FAMILIES ONE License Number. Lic Class t DESCRIPTION OF WORK NEW Conir c r : Date ADD I am exempt from the licensing requirements as I am a ^ ALTER FINAL / r licensed architect or a registered professional engineer t DATE acting in my professional capacity' (Section 7051 ) �� % REPAIR ❑ Business and Professions Code) USE OF EXISTING BLDG DEMOL ❑ FINAL �J 0 0'1 8 A Lic or Reg No Date APPLICANT TEL OWNER-BUILDER DECLARATION (PRINT) NO 7` ! �i�# Z 1 ` (�V t I hereby affirm that I am exempt from the Contractor s License y >2 e o;7 0 56 Law for the following reason (Section 7031 5 Business and ADDRESS Professions Code) PRESENT j o s'�'7 0 5 6 cc ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation will do the work and _ 0 6 2'2—8 1 the structure is not intended or offered for sale(Section LOCALITY r 7044 Business and Professions Code) MOVING t TEL ❑ I as owner of the property am exclusively contracting% CONTRACTOR 1 NO with licensed contractors to construct the project (Sec 0 0 1 9 A tion 7044 Business and Professions Code) 1 ADDRESS REQUIRED TOTAL SETBACK Fd i # o�o[o o e 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE I I hereby affirm that there is a construction lending agency for - FRONT 2 - 1 3,73 0 0 the performance of the work for which this permit is issued P L ' (Sec 3097 Civ C ) SIDE o to 1 33 006 PL Lender s Name 0,622-81 PC Fee$ Permit Fee ' r Lender s Address 1 > I certify that I have read this application and state that the Issuance Fee above information is correct I agree to comply with all County Investigation Fee ordinances and State lows relating to building construction Total Fee nd hereby authorize representatives of this County to enter c u the a -mentioned property for inspection purposes ISEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signatur of Applicant or Agent Date ®s APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES... BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION y FOR APPLICANT TO FILL IN BUILDIN rL ADDRESS /f,� I ftreb affirm that I have a certificate of consent to self insure, BUILDINN DRES / 0 ' W r` V + or a certificate of Workers' Compensation Insurance,or a certified / �` ���U eY ` Ve- copy thereof (Sec.3800, Lab.C.) CITY ( zIP 7p ' Policy No. Company e� `� SIZE O LCT NO.OF BLDGS.NOW ON LOT oez ❑ Certified copy is hereby furnished. 2 NEAREST CROSS T. ❑ Certified Copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO department. . S Date Applicant ASSE SOR x MAP BOOK PGE PARCEL 17 yDp O� �_ / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OwNE Ube -S.7. ✓aycz ocL -3 YES NO COMPENSATION INSURANCE J WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDR s L/ � D• �/�v�� d�/�� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) 7 w /r Q ' I certify that in the performance of the work for which this permit e L CI CITY ZIP / 11 Q� a! p" 1 - -0 4*z&4 d-el W_ is issued, I shall not employ any person in any manner so as to ARCHITECT R ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. �g DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate\of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO, P L SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL 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 STORIES NO.OF FAMILIES NEW El BK G PG ��� ia3 Q Professions Code,and my license is in full force and effect. 2.195P , DES IPTION OF WORK ADD 'XT VALUATION V License Number Lic.Class �j Contractor Date e(� r s ALTER El $ R2 / cc ElI am exempt under Sec. �•1 D REPAIR ❑ $ U B.&P.C.for this reason DEMOL ❑ LDMA P/C# d Date: USE OF EXISTING BLDG. URM ❑ Z Signature APPLICANT(PRINT) TEL NO. LDMA Perm# s.. I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is0 ADDRESS � •"-'jam- �j i a'.;:I_i not intended or offered for sale (Section 7044, Business and FINAL DATE !a .-- - Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL M L ❑ I, as owner of the property, am exclusive) contracting Wltfl OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE - P P y, Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL > licensed contractors to construct the project (Section 7044, f'l s":t a a YES❑ NO 1:1 � �� Business and Professions Code.) - WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING °j;1 -D Af'�•f a OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH " CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAQMD)SEE PERMITTING CHECKLIST FOR //� — — ' 'i Ff;_' GUIDELINES. -��" R T I hereby affirm that there is a construction lending agency for VES❑ No❑ -. I-j't` AL a the performance of the work for which this permit is issued(Sec. T - - I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE; -. _ IC f tV TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS ?� t '•f` '•"• a-' Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CHANGELender's Address a-- OWNER OR AGENT O o I certify that I have read this application and state under penalty p P.C.FEE PERMIT FEE ��V�� ✓�1.� ., _ -- 0 of perjury that the above information is correct.I agree to comply ��1�0 Co with all county ordinances and State laws relating to building SGC/ y j m const n, and hereby authorize representatives of this County ISSUANCE FEE ��, -j ^ ,/QJ �� l •� AM c_ to po the above- ention property for inspection purposes. �,F✓v7 l(/ll V l co a//_J +Q3 INVESTIGATION FEE TOTAL FEE / naw of Apo)—or nqe fe (� 119,14 SEE REVERSE FOR EXPLANATORY LANGUAGE