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HomeMy Public PortalAbout5512 CLOVERLY AVE_Building__ 4APPLICATION FOR BUILDING PERMIT FOR APPLICANT ?O-FILL IN (Print or type only) BU CID]NG GCOUNTY OF LOS ANGELES ADDAESS J/ O 00,� DEPARTMENT OF COUNTY ENGINEER clrY Q�l�Yj Gj �' IP BUILDING AND SAFETY DIVISION OF BLDGS BUILDING SIZE OF LOT W ON LOT ADDRESS TRACT 6' # Q LOCK LOT NO LOCALITY n TEL NEAREST D OWNER Cj e NO CROSS ST C r ASSESSOR ADDRESS -7 S� IA.-- MAP BOOK PAGE PARCEL DISTRICT B GROUP TYPE FIRE PROCESSED BY CITY iM G I. � �� CONST ZONE`S^ r• ARCHITECT OR TEL r ENGINEER NO STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �^ CLASS NO� DWELL UNITS BK PG CONTRACTOR 7IJA L ,s' NOL USE ZONE MA NO ©L� ADDRESS , eu�,cr SPECIAL LIC CONDITIONS T CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BL G SETBACK FROM FRO TPROP LINEOF (STREET) ADDRESS _ TOTAL SETBACK FROM TYPE OF EXISTING O SQ FT NO OF NO OF CHECK HIGHWA } YARD - HIGHWAY WIDTH FRONT PROP LINE U SIZE STORIES FAMILIES ONE O DESCRIPTION OF WORK D� NEW ❑ } .. W BLDG SETBACK FRO d ADD _ ❑ SIDEPROP LINEOF (STREET) Z LTERHIGHWAY } YARD = TAL SETBACK FROM TYPE OF EXISTING E PROP LINE HIGHWAY WIDTH USE OF NG BLDG �� GJ�iG� DEMOL REPAIR❑1:1EXIS } APPLICANT TEL CORNER CUTOFF YES _NO ❑ (PRINT) NO IN OPEN SPACE YES ❑ O ❑ BY (SIGNATURE) Q, dQ� IN COASTAL ZONE YES ❑ NO VALUATIONY CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON STIR UC TION I CERTIFY THAT_IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING ATO WORKMEN 5 CO MPE NSATIO SURA NCE _ _ A l J SIGNATURE OF PERMITTEE ADDRESS (�V/►? I ��ST /���/v► ///i /�_��/✓� �yy _ / FINAL BY [LHARVEY"T ITY (�J (ia NO! 1� V DATE I kh C 11LC hS P 1� 1 BLL 10 FEE $ BRANDT COUNTY ENGINEER PLAN CHECK VALIDATION CK MO CASH _ PERMIT VALIDATION CK_ CASH - C, -7 It D- f S�OCT 1:;y 1 2 1.7 5 atIC 76A638A CE#803 12/72 ©s 76A638A _ CE#803(REV 11/78) , .r 7 , h APPLICA N F R BUIL _E RM IT _- COUNTY OF LOS ANGELES _ BUILDING-AND,SAFETY- BUILDING FOR APPLICANT TO FILL IN _ ADDREss BUILDING �, L IN ADDRESS 2 VC, , LOCALITY , NEAREST CITYTievK ZIP CROSS ST , NO OF BLDGS II ASSESSOR SIZE OF LOT NOW ON LOT 1 MAP BOOK PAGE CEL " DISTTTRRRIIICT GROUP TYPE ,FIRE P D BY ` TRACT BLOCK M LOT NO CON TEL - - OWNER `A Z K .�.Y NO 5 � -e-Le v tt � � _ STATISTICAL CLASSIFICATION ' SEWER ADDRESS l-I -CACLASS NO DWELL UNITS 1 BK _ CITY_rq VIA.pt �t ^' - ~ ZIP _ - _ - ARCHITECTOR1 NOL VALUATION $ ENGINEER / e ADDRESSBLDG SETBACK FROM i �Q 0 C d IN ~ TEL FRONT PROP LINE OF (STREET) CO TR CT R NO " TOTAL SETBACK TYPE O TING G HIGHWAY + YARD = FRONT PROP L E XIS LIC GHWAY D_T r9 igoADDRESS C' NOLi CITY eL MCvb-.- (!2P('6 CLASS CONSTRUCTION LENDER - BLDG SETBACK FROM NAME AND BRANCH SIDE PROP LINE OF (STREETI HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY d-` - SIDE PROP LINE HIGHWAY ' WIDTH Q V 50 FT NO OF NO OF CHECK L +- _ - ti09 SIZE - STORIES FAMILIES- ONE USEyZONE OP _ DESCRIPTION OF WORK - NEW _ 1:1SPECIAL �` ' ADD - CONDITIONS••- d Vf ` /p� d�b s /7 ALTER _El FINAL q� BY t=4 -1�- REPAIR ❑ DATE USE OF DEMOL ❑ �jr— , EXISTING BLDG Z�---- APPLICANT TEL (PRINT( NO G _ BY(SIGNATURE( _ Z U + > I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ti Um 2 9 7 a 7 A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL.ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE a y o WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF t V # �o'o O o 1 THE LABOR CODE OF THE STAT LIFORNIA IN RELATING TO WOR MENS COM t, _.. . z ., _ P r,� PENSATION INSURANCE 2 to O 3 IL O 0 - SIGNATURE OF c 0 0 0 3 a,005 5 ` PERMITTEE , yW 04,09. BO ADDRESS Z r C TEL rCITY NO Q PC Fee$ PermitFee > Issuance Fee Total Fee 76A638AOE#8032'63 APPLICATIOIV;�,F,OR BU_�ILDING.�."PERMIT ` COUNTY OF LOS,,ANGELES_, LL i BUILDING M DEPARTMENT o OF COUNTY, ENGINEER ADDRESS �ry p ' � (,J , BUILDING"AND�'SAFETY DIVISION' LOCALITY JOHN A .L-AMBIE 'COUNTY ENGINEER NEAREST ` WILLIAM A JENSEN SUP T OF BUILDING CROSS ST,4 p - DISTR TINO'_ G OUP TYPE CESSED By FOR,APPLIC'AN'T TO FILL;IN ' �� - col '�"j-"- =ll-f2 BUILDINGSTATISTICAL,,/� ` .STATISTICAL CLASSIFICATION J '#WER MAP G a ADDRESS JrSI, CLASS NO DWELL` UNITS • LOT YJO�-'M'- y� / � CK� `WATER ' ��^ f r CERTIFICATEzNOT REQUIRED 115z" RECEIVED, +, •� TRACT MAP HIGHWAY STATE MAJOR SECOND CAL N OF BLDGS NO + (CIRCLE) , SIZE OF LOT, NOW ON LOT` USE ZONE Ii SPECIAL i USE OF,,_ CONDITIONS EXISTING BDG L 'EL OWNER Q(pi TNO BUILDING 'YARD HWY TREET NA EXIST 0 7 SETBACK t . WIDTH ADDRESS_ , .q i A do a� FRONT " ARCHITECT OR -� TEL - P I- 1 ENGINEER NO A)Q -0SIRE 'ADDRESS I d i d O V� T TE -CONTRACTOR NO < a � ADDRESS 61 o ue r e t Ir r DESCRIPTION OF WORK - '" v t ` a NEW ADD ALTER'"- REPAIR DEMOLISH I r Z SQ FT , NO-OF NO OF SIZE r STSORIES FAMILIESUSE -57VI STRUOCTU'RE- lul.AuI SIGNATURE OF APPLICANT L• ' , VALUATION $ h Y 1 {' APPROVALS LbATE INSPECTORjS SIGN,?ryjtE P C - PMT FOUNDATION LOCATION FEE $ - FEE FORMS-MATERIALS FRAME FIRE STOPS n r I HEREBY ACKNOWLEDGE THAT I HAVEc READ THIS APPLICATION BRACING BOLTS �7 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 TION OF THE LABOR CODE O THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COMP TION INSURANCE LATH EXT "SIGNATURE OF HOUSE NUMBER COR '� PERMITTEE RECT AND POSTEDy-� ADDRESS - FINAL 61 M PLAN CHECK VALIDATION cK M o F JOHN F 'LEWIS PR9NCIPAL STRUCTURAL ENG- CASH _ -PERMIT VALIDATION CK MO CASH U, V St v '1_ D .tr0ti J - _ r 76A638A CE#803162 APPLICATION FOR BUILDING PERMIT ,r COUNTY OF LOS ANGELES BUILDING f 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 DISTRICT N I GROUP TYPE PR CIA by FOR APPLICANT TO FILL IN _= CONST ABUILDING DDRESS ' STATISTICAL CLASSIFICATION ` SEWER AP �, � B K �Y�/ P CLASS NO DWELL UNITS LOT N / ,f ,k / BLOCK WATER /C CERTIFICATE NOT REQUIRED IJtI RECEIVED El TRAC �Zo 7 � MAP NO Q©NO OF HCGRCWA STATE\MAJOR SECOND OCA SIZE OF LOT,5�&s �O�Y` NOW ON BLDGLOTS Q USE ZONE SPECIAL -J USE OF 3 CONDITIONS r OLS EXISTING BLDG / q r OWNER/2 _Fo NO 6/-3 BUI DIN EXIST 1- /� /� ,/q SETBACK YARD HWY STREET NAME- WIDTH ADDRESS 9s' 1 4?s 75/ �� FRONT ARCHITECT OR TEL P iL oC ENGINEER NO J y `SIDE ADDRESS P L / !, d ��'� -4 ./ f V TEL ' Y Il��am/2y,1/e 7.,f !a`f I� ' / tee/ CONTRACTO` NO + t 7/ d X Y f^ Y 11 ADDRESS DESCRIPTION OF ORR - Y} �iC,k� � `� _C v Led NEW ' ADD+' 'ALTER REPAIR DEMOLISHSQ NO OF NO SZET/L/2 STORIES FAMIOLIES USE OF - STRUCTURE-0�/� FS SIGNATUR OF APPLICANT VALUATION } " / . APPROVALS JDATE,h, 11NSPECTOR S SIGNATURE P C PMT �/ ° FOUNDATION LOCATION FEE $� FEE $ �/ �^ FORMS MATERIALS :�'�- � d FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION t WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS,VENT DUCTS U BILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH IN 1`� (.,.,. 41 j� TION OF4THE LABOR COD OF THE STATE OF CALIFORNIA RELAT J�q y�/� ,r �✓�.� ING TO WORKMEN SCyOnMPENSATION INSURANCE LATH EXT (h,f/i_�/,r///l PERMITTEEySIGNATURE OFNO orf HOUSE NUMBER RECT AND POSTED 14--6.3- ADDRESS / WWW��� FINAL -1—/l_(o 11 %'�79wri-oiV , € JOHN F LEWIS PRINCIPAL ST -URAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK M O CASH Ao4675 SEP 21 23 D 28.50L d ''Lo4 9 7 3- SEP 2S 1 D 5 7.v0- r HY 1 a