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Home My Public Portal About5327 CLOVERLY AVE_Building__ TEMPLE- C9TY � ,.Aaa OACE#803 1-8+ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS C� BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST L/vG WILLIAM A JENSEN SUP T OF BUILDING CROSS ST GJ DISTR CT NO GROUP TYPE P SSED BY FOR APPLICANT TO FILL IN �5 e-� CONST 2 -7 J- -ot }��J ABUILDING DD ESS ✓2 / C'i[•,�(�`r �+- �iJ� STATISTICAL CLA IFICATION E KR MAPP CLASS NO DWELL UNITS LOT NO t,.4 17 cF •. p� / Y LOCK WATER NOT REQUIRED RECEIVED, CERTIFICATE TRACT /SSIV / MAP HIGHWAY STATE MAJOR SECOND L NO OF BLDGS NO (CIRCLE) SIZE OF LOT 76 ,X17-6I NOW ON LOT USE ZONE SPECIAL USE A�� r� CONDITIONS - EXISTING BLDG /� TEL A7. I OWNER . /�IATj//VSG�/✓ NO 7-4 73 9 - BUILDING EXIST SETBACK YARD HWY STREET NA E WIDTH ADDRESS FRONT ✓� ARCHITECT OR TEL P L ENGINEER NO SIDE P L \ I' ADDRESS T INSPECTION REC RD ,` 0 T CONTRACTOR tl jq / SO NOEL T 'G� �' /� W" . � `�b� ADDRESS -6-32-7 CL0I��2L T G" O DESCRIPTION OF WORK G a NEW ADD ALTER REPAIR DEMOLISH Z SQ FT NO OF NO OF �IZE STORIES FAMILIESUSE OF / STRUCTURE 0."7 /DC7 SIGNATURE OF _ APPLICANT VALUATION$ QJ Q e} / APPROVALS DATE INSPECTOR S SIGNATURE 7PMT FOUNDATION LOCATION FEE $ FEE $ FORMS MATERIALS FRAME FIRE STOPS j IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS - S9 8'1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS lliU ,p ,o BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LA—BOOR CODE OF THE STATE OF CALIFORNIA RELATING TO WORKMEN S SIGNATURE Ob'/�PE A ION INSURANCE , � LATH EXT �f��1ti J��/e {y' PERMITTEE «f/// HRECT AND POSTEDOUSE NUMBER /H' le ADDRESS FINAL CLYDE N DIRLAM PRINCIPAL S7cK. RAL ENGINEER PLAN CHECK VALIDATION CK mo CASH PERMIT VALIDATIONas o cash IjGo2 2 ,o o wI in l� 2 a 1 9 %5,'' `Y Y _ •� ��C11 J r w JIJL 2 9 1 D 3 9.b (/" 7 �• �.� TEMPLE -CITY 76A638A CE k803 2 63 APPLICATION FOR BUILDING.�S PERMIT COUNTY OF LOS ANGELES BUILDING U I LD ISS d , G ADDRESS DEPARTMENT OF COUNTY ENGINEER L C C BUILDING'AND SAFETY DIVISION LOCALITY T JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE ESSED BY FOR APPLICANT TO FILL IN CONST BUILDING ^J �7 Gym 'STA I ICAL CLASSIFICATION S WEIR MAP - ADDRESS 6S 2_ CL-D�je7&4, ✓+� o B73 G t ! _ CLASS NO DWELL UNITS LOT NO JL'/oT {�T BLOCK WATER �/ _ /t CERTIFICATE NOT REQUIRED RECEIVED TRACT /SS/O p TCN/ /7G�L�S MAP HIGHWAY NO OF BLDGS STATE MAJOR SECOND OCAL NO ICIRCLE> SIZE OF LOT JO X /Z-G NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS " EXISTING BLDG -'S _e OWNER /N T'/N SOiJ NO r, -1738 BUILDINGEXIST SETBACK YARD HWY J STREET NAME WIDTH - ADDRESS �jZ GL.n ERL �` C FRONT h ARCHITECT OR TEL P Lei ENGINEER NO SIDE P 1 � ADDRESS O TEL CONTRACTOR 'S 0 / 7/g7r/4/SO&/ NO ADDRESS + �� 17 CL-o ✓E2L, O DESCRIPTION OF WORK n w N NEW ADD/ {- ALTER REPAIR DEMOLISH / / Z SO FT B NO OF m NO OF / i�/` �_ L z STORIES ! FAMILIES USE OF ( ytita USE r /[� STRUCTURE FS IDEM l 45 SIGNATURE OF APPLICANT _ �- VALUATION $ APPROVALS DATE INSPECTOR S SIGNATURE PC I FPMT EE $ FO FORMS MATERON IALS FEE $ / 7 FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I H READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS [ '/ BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK , AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT ��5 X, TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ( ` ING TO WORKMEN 5 CO NSAT N INSURANCE " - fV 4eYlt roe .4 J LATH EXT SIGNATURE OF A , ��+'V HOUSE NUMBER COR PERMITTEE A� RECT AND POSTED ADDRESS of FINAL / PL1#N'CHC VALIDATION CK Mo CASH JOHN F LEWIS PRPNCIPAL Som AL ENGN�JEER PERMIT VALIDATION O CASH . LALO 4 5 5 0 JAN 17 1 D 1 9.7 5� �; APPLICATION. FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN sur_DING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 2 or a certificate of Workers' Compensation Insurance,or a certified 2-7 copy thereof (Sec.3800,Lab.C.) CITY _ I,� IP l LOCALITY Policy No. Company e i SIZE OF LOT NO,OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEhREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. r department. USE ZONE MAP NO, Date Applicant ASSESSOR MAP BOOK PAGE PARCEL ., SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. YES NO COMPENSATION INSURANCE ! W17HIN 1000 FT.OF SCHOOL? This section need not be completed if the permit is for one hundred ADDRESS s ( P DL.TRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) i CITY ZIP I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. ST;rISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CL4SS NO DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate Of REQUIRED TOTAL SETBACK FROMT 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 !. ,. d FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION CITY„ LIC.CLASS P L SICE a I hereby affirm that I am licensed underprovisions of Chapter 9 ~I `� - SEVER MAP C, (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SK Professions Code,and my license is in full force and effect. E NEW ❑ VA PG , U License Number Lic.Class DESCRIPTION OF WOR ADDLL ❑ VALUATION Contractor Date ALTER ❑ $ ✓�� C1I am exempt under Sec. REPAIR 13 $ BAP.C.for this reason DEMOL ❑ LD!AA P/C d Date: USE OF EXISTING BLDG. URM ❑ C C Signature APPLICANT(PRINT) TEL NO. LDMA Perm CL ❑ I, as owner of the property, or my employees with wages as ZL2IJ their sole compensation, will do the work and the structure is ADDRESS F 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 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with OR SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FR;AL 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 QUALITY 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 SCAOMD PERMITTING 3097,CW.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. .. C4 TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. ' Q Lender's Address OWNER OR AGENT o I certify that I have read this application and state under penalty 283 O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE . N with all county ordinances and State laws relating to building < construction, and hereby authorize representatives of this County ISSUANCE FEE 00 M to enter upon the above-mentioned property for inspection purposes. CID INVESTIGATION FEE TOTAL FEE " !ignalure'M A➢Il Or Agent Dale