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Home My Public Portal About5017 CLOVERLY AVE_Building__ P ! �. 78A838A CE4803 B6APPLICATION FOR BUILDING PEMIT , COUNTY OF LOS ANGELES BUILDING ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY.DIVISION LOCALITY JOHN A LAMBIE, COUNTY ENGINFER NEAREST WILLIAM A JENSEN, SUP T OF BUILDING CROSS ST DISTRICT NO GROUP TY E P OCESSED BY `"`h•FOR APPLICANT TO FILL IN '1-- CONST L BUILDING STATISTICAL CLASSIFICATION S WER MAP ADDRESS ` BK G; CLASS NO DWELL UNITS Q~ r LOT NO BLOCK WATER �/ ' CERTIFICATE NOT REQUIRED El-- - RECEIVED ❑ TRACT NO fC N OF BLDGS (CIRCLE) A STATE MAJOR SECOND(060 ` 4 I} t _SIZE OF LOT NOW ON LOT USE ZONE SPECIAL } USE OF ez CONDITIONS '•� EXISTING BLDG J TE d t OWNE N BUILDING YARD HWY STREET NAME EXIST ` C q, L SETBACK WIDTH ADDRES ;/-r1i FRONT ' t ARCHITECT OR' TEL P L ENGINEER NO SIDE' P Ll ADDRESS TEL � ? 1 '<' .. ' t,�[' .�. ) S:�'��a4A V�- 0- CONTRACTOR NOO ADDRESS DESCRIPTION OF WORK ADD ALTER REPAIR DEMOLISH SQ FT IN OF NO OF SIZE1,7 USE OF 1p STORIES FAMILIES ' STRUCTURE SIGNATURE OF �/ i•+'_ APPLICANT VALUATION -/] �r� (SJ✓ vv�� APPROVALS DATE INSPECTOR 5 SIGNATURE PC �/ PMT FOUND TON LOCATI FORMSI MATERIIALSON A a ' FEE $ FEE $ .{�- FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COU NT�ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS B �' BUILDING COj�SJRUCTI ON I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLAINT �LAT`H �p . TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT N _�-1 r ING TO WORKMEN S OMPENS ON INSURANCE _r��1j /^TURE // LATHSIGNEXT t OUSE NUMBER COR- PERMpITTEE v `� HRECT AND POSTED ADDRESS FINAL (� JOHN F LEWIS P INCIPAL ST RAL-'ENGIIGEER CK PLAN CHECK VALIDATION mo CASH PERMIT VALIDATION CK M O CASH I I &o,1 2 5.6..o JUL 14. 2 3 D 2 8,5 0 A a L2377AUG 7 1 'D 57.00, -,IfA 838A CE#803 8-83 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS O �. BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST / WILLIAM A JENSEN, SUPT OF BUILDING CROSS ST , DISTRICT N GRO TYPE P ICE BY FOR APPLICANT TO FILL IN �,� OT coNs '7 BUILDING ,! STATISTICAL CLASSIFICATION SEW ADDRESS MAP ADDRESS Q y e� / BI^/ PG CLASS NO DWELL UNITS L- LOT NO / BLOCK WATER ❑ 7 CERTIFICATE NOT REQUIRED RECEIVED TRACT 4? MAP IHWA J /.� NO OF BLDGS NO (rIGRCLEI S ATE MAJOR'SECONO LOCAL SIZE OF LOT �/� / NOW ON LOT / U ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG / ^/ - TEL OWNER ey etc O NO I DINGEXIST SETBACK Al D HW S EET NAME WIDTH ADDRESS ,0 C O FRONT ARCHITECT OR TEle P L ENGINEER d e NO SIDE P L ADDRESS O /'♦ TEL QC q �l CONTRACTOR `{/� O e.--g NO JJ �,� (J ADDRESS AND PARKWAY TREE R UIRED oa /7fS Cf' � �j '� +(9' � DESCRIPTION WORE � O ttenatiom s cew be fa'-:n c-ai ct L A --o 9v � AWjot NEW ALTE REPAIR DEMOLISH C OS T. C Co S"y^a{r'. C t� hn.;,_u".,f6py It, 1R4 of l(O V SQ FT NO OFNO OF SIZE 160 `STORIES FAMILIES USE OF —fil Permit has been�lssued. A;sIy for parzfay fr6e PBtmff at Qc /STRUCTURE 12 , SIGNATU OF APPLICA T / VALUATION $ �- G}'Z) ✓� v APPROVALS DATE INSPECTOR S SIGNATURE PC PMT /JS' FOUNDATION LOCATION M FEE $ FEE $ ! -- FORS MATERIALS FRAME FIRE STOPS ,dei CL-/ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS T b AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS .. BUILDINGCONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLW LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COMPENSATION URA LATH EXT (, T SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESSFINAL t " r PLAN CHECK VALIDATION CK Mo CASH JOHN F LEWIS RINCIPAL STR AL ENGINEER PERMIT VALIDATION ST® M O CASH L _a9ex':01AJUIN 8 1 D 17.25- v i • APPLICATIQN FOR BUILDING PERMIT COUNTY OF LOS ANGELES - BUILDING AND SAFETY r FOR APPLICANT TO FILL IN BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION ^ - BUILDING ADDRESS /, ' w I hereby affirm that I have a certificate of consent to self insure, � ��_!. .l or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) CITY ZI IT >f y Mov/ 0 7 6b LOCALITY Policy No. Company SIZ OF LOT NO OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. •r+ NEAREST CROSS ST. i A ?,D So El Certified copy is filed with the county building inspection TRACT BLOCK LOT No 4 [� department. USE ZONE MAP NO. Date Applicant A SESSOR MA BOOK PAGE PAR EL ✓7 / SPECIAL CONDITIONS - J CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER iT ft/,j� YES No COMPENSATION INSURANCE /JPO lir = ( d� WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS f��v -• � -#,- v` DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) CITY ZIP I certify that in the performance of the work f r which his p I 4f M Pz.z 760iQ (/ is issued, I shall not employ any persQ ner S R HITECT OR ENGINEER TEL NO. A become bje oto the Workers'Com ns On a STATISTICAL CL_AA SIIFICATION APT CONDO Date ` ,� ( Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after in this C r Ificate REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become ubject to the WorkersC TRACTOR /., TEL NO. _ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Lab r Code, you must forthwith j; rJ r - — - FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.N P L LICENSED CONTRACTORS DECLARATION SIDE CIJj LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 e,@(4 f< SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE TORIES NO,OF FAMILIES Professions Code,and tmyY{license is in full force and effect. s� NEW ❑ BK L PG IV 19-k-7 , License Numbe LIC. CRSS DESCRIPTION OF WORK qpp VALUATION �rQ Ole Q Contractor U,Ti iilL. d Date % ALTER ❑ %. Q Y REPAIR ❑ O ❑ I am exempt under Se $ V f B.&P.C.for this s y%/ /R r DEMOL ❑ LDMA P/C# W _ te. USE Of EXISTING G. URM ❑ 0- Signature ++ 42 APPLICANT(PRINT TEL O. LDMA Perm# T .. Z C3 I, as owner of the roperty, or my employees with wages as �C �2Q Lf,G _' Z - _* their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE 0 - Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I J El 1, as Owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY~-- licensed contractors to construct the project (Section 7044, YES 1:1 NO❑ L x Business and Professions Code.) - �4 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 ElT `i A fjtl'!L � u r the performance of the work for which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING � a- 3097,Civ.C {.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, -•t HEC?". . -•-- +' /�- 1 TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS _ Lender's Name, V (, �L—/�ALV MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. ;_ �AN 3` a-- o Lender's Address �>4��7 >��"i t i A., OWNER OR AGENT O o I certify that I have read this application and state under penalty _ of perjury that the above information is correct.I agree to Comply P.C.FEE r , �-D PERMIT FEE - o with all nt in e and State laws relating to building C/F•�, L 3-9-221_ - constr io , and r a rize representatives of this County ISSUANCE FEE - -- to en oned property for inspection purposes. C • r� f711 INVESTIGATION FEE TOTAL FEE sg3„� J SEE REVERSE FOR EXPLANATORY LANGUAGE