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HomeMy Public PortalAbout5013 CLOVERLY AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES B U 1 L ® ! N G L~ WM. J. FOX, CHIEF ENGINEER F,OR-APPLICANT TO FILL IN FOR OFFICE USE ONLY /--�1 // DISTR)+IC�T�N.O PLAN CK NO PERMITJJ2O BUILD 1 N G ` ''lf,./�-',~�G. /r, _�[/a ADDRE9H l LOCALITY //q, _ RECEIVED BY DATE OF APPL DATE ISSUED NEAREST CROSS 9T ! / // tADDLRESS V �� f ,G� OWNER MAIL ADD /C/✓ J LOCALITY RESS NEARESTTEL y� CITY ��`�/^� NO °v�S�7 CROSS 9T >(j(�/ ,/NO p.,[ FIRE NO OF TYPE GROUP ARCHITECT OR TEL ZONE PLANS ENGINEER /�f/J� BLDG ORD{NCO ADDRE9Sa//O � I A.G�(6L.J SETBACK LINE V ^T APPROVED CONTRACTOR CONTRACTOR /Xi(�J�rs/�J NO �L/ (1/1�1`J BY DATE >" J�"�.,' USE APPROVED ADDRESS �,p� ZONE BY DATE LEGAL ''n •��1 // CORRECTIONS DESCRIPTION LOT NOL I BLOCK OCO�CJ TRACTNO OF BLDG_ SIZE OF LOT/{� ��/� I NOW ON LOTS?2,0,,C- USE OF NO OFNO OF EXISTING BLDG FAMILIES_ ROOMS DESCRIPTION OF WORK NEW v' ALTERATION ADDITION O A REPAIR MOVING DEMOLISH / SP B ZET O� �R01300mS STORIESWALL R13OF / D COVERING �/ p/_�/y 6I COVERING UBE OF NEW BUILDING v 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOUNDATION LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION �7 FRAME FIRE STOPS, SIGNATURE OF U� BRACING,BOLTS PERMITTEE ��� LATH, INT AUTHORIZED ADT LATH,EXT �. De9-3 SOM SETS 7 47 $ P C PLASTER,INT FEE PLASTER,EXT VALUATION ` FEE FINAL r DEPARTMENT OF BUILDING AND SAFETY t_ APPLICATION FOR PIT z � COUNTY OF LOS ANGELES B U 1 L ® 1 N G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DIBTRICT N.Or PLANCK NO PERMIT HO BUILDING ADDRESS ` t S O� ys� q z� LOCALI / RECEIVED BY DATE/6 FA L DATEISSUEDNEAREST �J CROSS BT r/� /! . IBUILDI Sh OWNER _ ��, Y ADDRESB (/ �� / A af��YYYIiiee ` �y�/,Air.i P,, MAIL n '/ �'�.y{/� �f ' LOCALITY ADDRESS A C IP-</- NEAREST � 5; _�` n NEAREST C ITY��-J ..A�ioa� NO —! CR0966T � '� 7 FIRE N❑ OF TYPE GROUP ARCHITECT OR T L ? C // ZONE �- PLANB ENGINEER �iP10 �t:� Sa. c,pZ�J' �i BLDG / �� ORD NO ADDRESS /J Q� SETBACK LINE o ; ) _,yam/ APPROVED 17 CONTRACTOR CiC./�/J�-i�.f/I/ NO /',j�C) '� BY DATE USE ADDRESS " ZONEl/ BY'APPROVED DATE LEGAL '/ l CORRECTIONS DESCRIPTION oL�OT NO � BLOCK / TRACTlLl NO OF SIZE OF LOT a //\rvC/0 I NOW ON LOTS / USE OF NO OFNO OF EXISTING BLDG FAMILIES—I ROOMS DESCRIPTION OF WORK �� S '"o �c s�/�•� NEW / ALTERATION ADDITION REPAIR MOVING DEMOLISH I�Qi f q L If �o (/�/p �+ ` G1 BQ FT NO Or i B ZE /49/1�1 ROOMS STORIES – 1p` VP or r WALL ROOF .a,. COVERING COVERING USE OFN W BUILDI 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS v AND STATE LAWS REGULATI aG BUILDING/CONSTRUCTION 'r: '�/ S�J�l7'�'/J fi�"-n../�".'7 FRAME FIREOTOPS, SIGNATURE OF���.fy� BRACING,BOLTS PERMITTEE LATH,INT. A `3 AUTHORIZED AOT , LATH,EXT DBS-3 50M SETS 7-47 $ / P C $ /Jy rl Q I PLASTER, INT FEE jPLABTER,EXT. 16it; L h VALUATION 00 $/ �'•• FINAL ADDREISS .�O BUILDING APPLICATION LOCALITY �� NEAREST DIVISION-OF BUILDING AND SAFETY CROSS ST Department of County Engmeer DISTRICT NO RECEIPT NO PERMIT NOS^ County of Los Angeles `�- ��— 3-32,5-9' 9 WM. J. FOX, COUNTY ENGINEER DROIIP DATE RECEIVED DATE ISSUED CASSATT D GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN TYPE CON RECEIVED ISSUE B WN ER 149 IV G MAP N G MAIL �r NUMBER Z ePl4/ STATE v NOS ADDRESS .SD�3 ( _ La[JL�2LY //b' USE ZONE SPECIAL ' /��j / CONDITIONS CITY N/ J-D T / Y TELNo .g7T ,i ARCHITECT OR (o j/1 6 /6 ENGINEER /J }� NO,�� Qp /JD �j/ H J n BUILDING YARD HWY - STREET NAME EXIST ADDRESS�d/2l L.� /I�O S'/4 Z2Q SETBACK WIDTH FRONT TEL P L CONTRACTOR ��'L ( "��A/, NO SIDE P L ADDRESS DATE CORRECTIONS INSPECTOR BUILDING ADDRESS 4 L,,4;7Lo Qf 4it., LOT NO 4e 2— BLOCK C� , i f n ' TRACT f 3 11�V lf�O d� I NO OF SLOGS SIZE OF LOT /J )X� NOW ON LOT Z USE OF YT �7�i dP .� EXISTING B DD /J C'/'_ DESCRIPTION OF WORK / `I)L&-t—_o NEW ADD k ALTER REPAIR DEMOLISH 1 Z SQ FT /c5 STORIES FAMIO IES / © '� Ar�� Gdl �a�L4 vP" LIG. C D SIZE { n_ r USE OF ST CTUR -90AO NO OF EMPLOYEES I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS APPROVALS INSPECTOR•SSIGNATURE DATE CORRECT 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION* LOCATION s AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS,MATERIALSf'.l FRAME FIRE STOPS, SIGNATURE OF �I/ BRACING,BOLTS //iJ�� FURNACE LOCATION, GAS VENT.DUCTS ADDRESS C:f C7/'? LATH, INT AUTHORIZED AOT LATH, EXT. ♦C'7 1.0.L $ �O /� P C HOUSE NUMBER COR- / FEE RECT AND POSTED r VALUATIONFEE FINAL AW 7GA638A DBS 3 11-53 DEPARTMENT OF BUILDING AND SAFETY fi APPLICATION FOR PERMT COUNTY OF LOS ANGELES WM J FOX. CHIEF ENGINEER BlUmILDING TO FILL IN FOR_OFFICE USE ONLY FOR APPLICANT T DISTR NO ' PLANCK NO PERMIT NO BUILDEI NG ADDSS:_�D LOCALITYI EIVED Y DATE OF APPL DATEISSUED NEAREST / '�e �' CROSS ST ,�IIL[��`��r/ BUILDING /�� OWNER /V °"�C72 ADDRESS Xb /3 e �0✓�i(i�+/ MAIL ,�) / �� ` , LOCALITY / ADDRESS 46'g „/� �� � NEAREST CITY Oj,-y,7/ SST TO P4C ,0 FIRE NO OF I I GR@�YP ' ARCHITECT OR/ ` EL " ZONE PLANS ,tf ENGINEER / V NO BLDGF�Cy i SETBACK LINE ADDRESS APPROVED I TEL BY DATE CONTRACTOR NO USE APPROVED- ZONE A-1 BY DATE ADDRESS HOUSE NUMBERING r 1 , LEGAL fR/ /6 DESCRIPTION LOT NO I BLOCK MAP NUMBER FIELD CHECK BY NO ASSIGNED BY /Sr DATE TRACT /g.9 `� NO OF BLDGS CORRECTIONS SIZE OF LOTf2 y_yj�I�NOBW ON LOT /USEOF EXISTING BLDG,�/Jyyd to b� � !- °�A I FAMILIES DESCRIPTION OF WOI - NEW I� I ALTERATION I - I ADDITION 0 REPAIR I I DEMOLITION SQ FT /f yea} NO OF D SIZE �! 'G ROOMS / STORIES J Z EXT WALL ROOF ..�� ,J 4. COVERING I COVERING /JsQ yr. USX OF STRUCTURE V APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT I AGREETO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, HfiRHON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION f! FURNACE LOCATION, SIGNATURE OF GAS VENT, DUCTS PERMITTE +�}yy 1/�_ /�� ADDRESS 2621 J *' � • ala."iczo�ll LATH, INT ' f�' LATH, EXT AUTHORIZED AGT PLASTER, INT 70A628A D802 10-00 $ P C $ , ® FEE PLASTER, EXT VALUATION C) 5 FEE b v� FINAL APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a certified /'? �d/��'iL copy thereof (Sec. 3800,Lab.C.) CITY zip / -e � _ "^ LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON(LOOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. . Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE 14 ,7 < �� �y''�"J WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) '4"(' C74lCw' �V ' CITY ZIP/� I certify that in the performance of the work for which this permitL. .� %�7,�� ��p 2 AGt is issued, I shall not employ any person in any manner So as t0 ARCHITECT OR ENGINEER TEL NO. J 16 become subject to the Workers'Compensation Laws. STATISTICAL CLA SIFICATION 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 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 LICENSED CONTRACTORS DECLARATION SIDE 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 Professions Code,and my license is in full force and effect. NEW BK PG , d License Number Lic.Class DESCRIPTIO OF WORK / ADD ❑ VALUATION O �-- $ .- cg Contractor Date �� V ALTER ❑ El am exempt under Sec. REPAIR El B.&P.C.for this reason DEMOL ❑ LDMA P/C# U W Date: USE OF EXISTING BLDG. URM ❑ –+•'%'y–% +C'�' `� C' .. _. y,,_l.k= _ Signature APPLICANT(PRIN ) - TEL NO.,,+ _ LDMA Perm# ,%;_ z I, as owner of the property, or my employees with wages as �f �– /��/'f ) J e ! y"�J �� O #'` their sole compensation, will do the work and the structure is ADDRESS T-10TAL 105 —_ not intended or offered for sale (Section 7044, Business and 7 Fl '� �:"`G��� '� � /� FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL G 1 4 j'•tEEt_.i' S fLt a•_I licensed contractors to construct the project (Section 70444, OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE laS owner of the property, am exclusively contracting 4, FINAL BY AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q l Business and Professions Code.) YES❑ No❑ � 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 QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ N w the performance of the work for which this permit is issued(Sec. 4 =' �a! '51_= ='^ � 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, N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CL Lender's Address OWNER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all county ordinances and State lPDT relating to building V m construction, and hereby But h repr tives of this County ISSUANCE FEE to enter upon the above-me ned inspection purposes. Q((� INVESTIGATION FEE TOTAL FEE 5qm,, /D SEE REVERSE FOR EXPLANATORY LANGUAGE