HomeMy Public PortalAbout5016 CLOVERLY AVE_Building__ A ROAD DEPT, PERMIT IS R[QUIPt5
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r APPLICATION' FOR B.UIL.DING PERMIT i
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COUNTY OF LOS'"ANGELES BUILDING
ADDRESS 1C�7 RC1 �
a M1� DEPARTMENT ,OF COUNTY ENGINMR,
BUILDING AND SAFETY DIVISIONLOCALI
JOHN A LAMBIE, COUNTY ENGINEER NEAREST ^ 7
CASSATT D GRIFFIN SUP T OF BUILDING CROSS S r
DISTRICT"NO t GROUP �. P CESSED BY
r FOR APPLICANT TO FILL IN �- „ 7. I coNs - ^ °
BUILDING / STATISTICAL CLASSIFICATION a SEWER MAP
ADDRESS Sj9f[� ✓ld 9 BK„ PG
of} CLASS NO `' DWELL UNITS
STATE
LOT NO f0 2-t ft_ BLOCK MAP
NUMBERHWYYES` NO
t eta
TRACT ' ,, - ', : USE�ZO E SPECIAL ' - -
` }� eNO OF'BLDGS CONDITIONS - '
SIZE OF LO .
NOW ON LOT, /
USE OF z
EXISTING BLDG UILDING"+Y NEXIST
' SETBACK YARD HWY -STREET AME'^Y W DTH
OWNER 07- FRONT-F
MAIL -, 1 , -P L
ADDRESS /J ✓+P'e"' `f� SIDETEL
F L
CITY _ Q N // e�� a `NO ,
INSPECTION RECORD
ARCHITECT OR , TEL
ENGINEER NO
ADDRESS dq
TEL
CONTRACTO iY
ADDRESS
DESCRIPTION OF WORE(
446 A—
NEW ADD ALTER REPAIR DEMOLISH w c +
SQ FT NO OF / NO OF
SIZE Oma✓ C STORIES FAMILIES
USE OF
STRUCTURE
t .
SIGNATURE OF Fh
"'APPLICANT ,, r^,
DD'
, ;, APPROVALS DATE INSPECTOR S SIGNATURE >
ADDRESS ~�� �Tb �����/�� FOUNDATION LOCATION, ate= p a Y ane,
!� FORMS MATERIALS
VALUATION $ I . �> FRAME FIRE STOPS
^BRACING BOLTS
1 ' FURNACE LOCATION
FEE 31r I FEE $PMT >>�, GAS VENT DUCTS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- F LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND ,
AGREE TO COMPLY WITHKQL COUNT,Y,ORDIN ES AND
STATE-+LAWS REGU T BUILQ5NG CO TION LATH'EXT
e' (e�/ v HOUSE NUMBER COR-' , c
SIGNATURE OF ertf � RECT AND POSTED
,PER MI
'ADDRESS + ��� 'FINAL
CLYDE N DIRLAM' PRINCIPAL STR C RAL ENGINEER'
PLAN CHECK-VALIDATION CK M o CAS. r PERMIT` VALIDATIONU-KMD CASH' r
43 25
3 12 .0
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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ® L ® �
WM. ,J FOX. CHIEF ENGINEER
R APPLICANT TO FILL IN p FOR OFFICE USE ONLY
DISTRICT NO PLANCK NO Y PERMIT NO '
[7S
/� �y ///'''
" 4 / Lf ? � /A ( /.�!/RECEIVED BY DATE OF APPL ISS ED- �q E�IYM MAI - ✓E'"G�+- ADDEISS1+ Ks�+f�� fa { ��. :�+�� � LOCALITYAIL
TEL NEAREST` NO CROSS ST
A FIRE �NO OF TYPE ,��/ GROUW
ARCHITECT OR TEL , ` ZONE PLANE . L
ENGINEER NO `-;Y'' /� '
BLDG + .�.. /ORD ,NO
ADDRESS SETBACKILINE �.-' ~{ /j" y� ,
APPROVEDTEL
CONTRACTOR NO BY tj DATE i
USE APPROVED
a
ADDRESS ZONE /BY{ DATE
LEGAL ` CORRECTIONS `
DEBCRIPTION LOT NO BLOCK 4 i ti
TRACTNO OF
`•�+�TM
SIZE OF LOT`) / I NOW ON LOTS
UBE OF ��� NO OF NO OF
EXISTING BLDG ��l V1J� FAMIelEs ROOMS (� ,
DESCRIPTION OF WORK
t
NEW ALTERATION ADDITION
REPAIR MOVING DEMOLISH _401 o� + GI
SQ FTN NO OF `` f`c <r` Z
SIZE „rd'.` ROOMS J STORIES y
WALL ROOF �IN,,/� T11
COVERING � .1�{�"C7 I COVER INGe"M` IW"�j�
USE OF NEW �`�- ✓ f< '
BUILDING
f �
I HEREBY ACKNOWLEDGE THAT I 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 ✓�N3 ��/�
AND STATE LAWS REGULATING BUILDING CONSTRUCTION
FRAME FIR
8•
SIGNATURE OF
BRACING,BOLT9
PERMITTE eaa-tl
!�
LATH, INT GG
AUTHORIZED GT LATH, EXT
7GA638A 9-48
09S-3 50M SET P C $ / 41.; PLASTER,INT
FEE L PLASTER,EXT
..J d $ -�I� I/
VALUATION FEE 1� y "� FINAL
APPLICATION FOR COUNTY OF LOS ANGELES
B D I N G r P E R M I T DEPARTMENT OF COUNTY ENGINEER
U I L BUILDING AND SAFETY DIVISION
BUILDING
FOR APPLICANT TO FILL IN ADDRESS
BUILDING _
ADDRESS / LOCALITY
NEAREST
CITY CROSS ST
- +r NO Of BLDGS ASSESSOR - `
SIZE OF LOT NOW ON LOT MAP BOOK ' PAGE PARCEL `
DISTRICT G PEI
FIRE SSD BY,
TRACT BLOCK LOT NO 5 0 C NST ` yZ�E
OWNE TQ" kAt� _ STATISTICALIFICATION
EWER
MAP'
ADDRESS CLASS N✓V DWELL UNITS B43 PG
USE ZONE MAP
C I T Y r i� N O
ARCH TECT O 1 NO
��pJC SPECIAL _ w
ENGINEER //lJ CONDITIONS
ADDRESS :wgROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO
CONTRACT TEL LOG SETBACK FROM
Ca
NO PONT PROP LINE OF (STREET)
IC "
ADORES O GNWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
FRONT PROP L-INE HIGHWAY WIDTH
CITY'J CLASS
CONSTRUCTION LENDER +
NAME AND BRANCH _ d
BLDG SETBAC O
ADDRESS CITY SIDEPROP LINEOF (STREET) V
TOTAL SETBACK M TYPE OF EXISTING O
SQ F NO OF NO OF CHECK HIGHWAY + YARD =
SIZE STORIES FAMILIES ONE f SIDE PROP LINE `HIGHWAY WIDTH'
NEW + _ W
DES IPTION OF WORK
N
02 DID ❑ -- - CORNER CUTOFF YES ❑ NO ZJ
ALTER ❑ � -
IN OPEN SPACE YES ❑ NO
REPAIR❑
USE OIN COASTAL PERMIT ZONE YES ❑' NO
AF
EXIST NG BLDG ,EMOL ❑
APPLICANT
(PRINT)
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE REA HIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- ` I
STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED », +• - - _
HEREBY I WILL NOT EMPLO NY PER ON IN VIOLATION OF THE
LABOR CODE OF THE ATE F L FORNIA IN RELATING TO
WORKMEN S COMPEN ION-IN R NCE
SIGNATURE OF ,Y _ FINAL ///l �� /' , BY -
PERMITT - DATE
ADORES4�32
" TE L N PC Fee$ C;It - Permit Fee
CITY NO
i
Issuance Fee
I
VALUATION,$-
VVV Total Fee
PLAN-CHECK VALIDATION c c M o CASH PERMIT VALIDATION CK 'mo CASH
4 9 0[MAY 25;2 3 ^r 2 9.2 —5 A&6 � � t -
1 --
9-ii-MAY 25,. '1',,8 4 8.7,5 A%
` 76A638A CE*803B 12/78„
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APPLICATION FOR BUILDING PERMIT c�
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLIC*N-P TO•dLL IN BUILDING ADDRESS
BUILDING ADDRESS ✓ � Com— zS�i-GC_
hereby affirm that I have a certificate of consent to self insure, —
or a certificate of Workers' Compensation Insurance,or a certified I C, C
copy thereof(Sec.3800,Lab.C.) CITY a zIP
"��� e� f LOCALIT ._ /�� 7�
Policy No. Company "C(�rJ� SIZE OF LOT NO.OF BLDGS.NOW ON LOT �G
❑ Certified copy is hereby furnish NEAREST CROSS ST.
®certified copy is filed with the co my building ectio� TRACT BLOCK LOT NO.
�O- O
department. USE ZONE MAP NO.
Date '}�/T� ASSESSOR MAP BOOK PAGE PARCEL
�E y Applicant SPECIAL CONDITIONS /6//" J
CERTIFICATE OF EXEMPTION FROM WORK S' OWNER TEL NO.
COMPENSATION INSURANCE IE3� WITHIN 1000 FT.OF SCHOOL? YES No
(This section need not be completed if the permit is for one hundred ADD�RS S
dollars ($100)or less.) E(� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
I certify that in the performance of the work for which this permit CITY / /9Vp10
is issued, I shall not employ any person in any manner so as to
ARCHITECT O ENGINEER TEL NO. ���•'���'
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATIONAPT 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' CO TRACTORTJ / SET BACK YARD HWY PROP LINE WIDTH
hwith
Compensation provisions of the Labor Code, you must fort �/ J' i J / FRONT
comply with such provisions or this permit shall be deemed revoked. q DRESS � lG N0. PL
LICENSED CONTRACTORS DECLARATION hvzo � CJ Ir- J�;7—> SIDE
CIT LIC.2YS PL
I hereby affirm that I am licensed underprovisions of Chapter 9 C° SEWER MAP
}
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES
Professions Code,and my license is in full force and effect. ! NEW BK PG , O
License Numbe C� �1,�(7 Lic.Class D RIPTION OF WORK ADD E] VALUATI N O
Contractor Aate ALTER ❑ $ v
C117 REPAIR El d I am exempt under Sec. $ C01)
Ani
B.&P.C.for this reason DEMOL ❑� (� �Lt7 p M LDMA P/C#
Date: USE OF EXISTIq6 BLDG. - URM ❑
Signature APPLICANT(PRINT) TEL NO. LDMA Perm# -
❑ I,:as owner of the property, or my employees with wages as D I1-L> _0 s:-q p
their sole compensation, will do the work and the structure is ADDRESS H
not intended or offered for sale (Section 7044, Business and FINAL DATE Q "_ -
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �-'/G T T+,F
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE .� .L
I, owner of the property, am exclusively contracting 4AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y
licensed contractors to construct the project (Section 70444,, El 1:1s t_I i�iL a-4�'-" =}
YES
Business and Professions Code.) WILL THE _ _
OCCUPANT I REQUIRE A PERMIT FOR CONST NTENDED USE'OF THE BUIDLING UCTION OR MODIFIC TON FROM THE SOUTH "•'�I.`•.:ii t'�^r°s'.° ^�
»•i
CONSTRUCTION LENDING AGENCY COAST AIR QUAL TY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES. �°i �'•�V ' { w :I
I herebyaffirm that there is a construction lending agency for _.)In`13�
9 9 Y ves❑ NO❑
N the performance Of the Work for which this permit Is issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING
3097,Civ.C. _
CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, r t::•W
TITLE 2,CHAPTER 2.20 SECTIONS 2.20,100 THROUGH 2.20.140 CONCERNING HAZARDOUS 'i)fl E.f•- ij•I_i y r+ a..t�
Y
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
o Lender's AddresscP"0
i3
0 OWNER OR AGENT
o I certify t t I have read this application and state under penalty
O of perjury hat the above information is correct.I agree to comply P.C.FEE PERMIT FEE , "`
N with all c unty ordinances and State laws relating to building
constructi , and hereby thori representatives of this County ISSUANCE FEE
co to enter u on the abdve nti d property for inspection purposes.
a r INVESTIGATION FEE TOTAL FEE/
or Agem G
SEE REVERSE FOR EXPLANATORY LANGUAGE