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HomeMy Public PortalAbout5719 CLOVERLY AVE_Building__ 76A638A CE9803 5-65 APPLICATION F OR ,BUILDIG PERMIT COUNTY OF LOS ANGELES BUILDING ' h DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY,DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS SUP T OF BUILDING CROSS ST RDE OR APPLICANT TO-FILL IN DIS�Ic NO G UP TYPE PR Ss Y ! CONST ING STATISTICAL ASSIFICATION SE R MAP SS CLASS NO, DWELL UNITS �BK PG/ VA A LOCK USE ZONE MAP NO SPECIAL NO OF BLDOS CONDITIONS F LOT NOW ON LOT "ST, NG B - BLDG SETBACK FROM TEL FRONT PROP LINE OF (STREET) NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL SS HIGHWAY WIDTH , FROM C L r ECT R - TEL BLDG SCTBACK FROMEER NO SIDE PROP LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L TEL + _ CONTRACTOR NO O LIC ADDRESS NO CORNER CUTOFF "�Y ES � NO�� V CITY LIS SEE REVERSE SIDE FOR SPECIAL APPROVALS 0 DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAMILIES U S E O F ra'ivl/ STRUCTUR SIG A URE OF ` pIR G� APPLICANT �I VALUATION .tel APPROVALS DATE I NSP ECTOR'S SIGNATURE P C PMT FOUNDATION LOCATION FEE$ FEE$ •-5 © FORMS, MATERIALS _ t FRAME - STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS A AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION yy WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING /GAS VENT DUCTS f 9 9UILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK 4 AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT 11� ( SIGNATURE OF HOUSE NUMBER COR- PERM ITTEE � RECT OR-PERMITTEERECT AND POSTED i Ir ADDRESS FINAL JOHN F LEWIS PRINCIPAL STRUCTURAL ENGI R PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK Mc CASH 27 9 0 Ju 14 1 D 1 1 .5 0 d A P P L I CATI O N FOR COUNTY OF LOS, ANGELES ' - DEPARTMENT OF-COUNTY ENGINEER BUILDING`PERMIT BUILDING AND SAFETY DIVISION BUILDING FENGINEER OR APPLICANT TO FILL IN ADDRESS ` ADDREBUILDSS �2L + /NG NEAREST [ c f ZIP NEAREST CROSS ST dl //I1C�JJ l NO OF BLDGS y ASSESSOR LOT /{O x�C! NOW ON LOT L MAP BOOK PAGE RCEL DISTRICT GROUP TYPE FIRE PROC SED BY �(J BLOCK L Y"Nb /LCCONST Z NE _ A/Lfl� Q(�f'NOLSTATISTICAL CLASSIFICATIONJWER MAP ,»� % _Q e, L CLASS NO DWELL UNITS LJSE ZONE MAP� ffe ei� ZIP NOCT R TEL SPECIAL R NO CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ / CONTRACTOR TE BLDG TBACKFROM + �cA /� /n NO 17 p� /�� FRON PROP LINEOF (STREET) / ADORESS��If� .Zl'/T/je NO �iJa S7 HIGH AY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING CITY LIC FRONT PROP LINE HIGHWAY WIDTH e r ��� CLASS- _ CONSTRUCTION LEND R + a NAME AND BRANCH BLDG FROM O ADDRESS CITY SIDE PROPLI (STREET) G> F TOTAL SETBACK FR YPE OF EXISTING dC SQ FTIISS NO OF / NO OF CHECK HIGHWAY + YARD = AY WIDTH O SIZE 3� STORIES r/ FAMILIES ONE SIDE PROP LINE F„ DESCRIPTION OF WORK 44(tNEW + ®4('!Fg*"4. !7/o`(Se_ ADD, ❑ CORNER CUTOFF YES ❑ NO ❑ Z ALTER ❑ - REPAIR❑ IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG EMOL- ❑ AP (PRINT)ANT cvxeo/7'� „"' �_� ✓- � O �NCT i„Yt-1 _ BY (SIGN I H IBY NOWLEO THAT I HAVE RE THIS APPLICATION , AND- ATE AT THE OVE IS CORRECT D AGREE TO COMPLY _ //11,�. yj/ _ WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ST ON- � v� _/1C __ w�j � 061> STRUL TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED �6/ �cl[ HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFO NIA IN REL TING TO WORKMEN'S CO MPEN ION INSURANCE SIGNATURE OF FINAL �I* ^ BY EE PERMITTPATE f �•(� ADDRESS T E L� PC Fee$ Permit Fee CITY NO �y � Issuance Fee VALUATION $ _ - / V d L Total Fee PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION< cK M O CASH _ _ 0821, 7 1+ 69.00 ®` 76A638A CE*803B 12/78 - ,, l r�� p / 76A638A CE08078-64 APPLICATION FOR:BU_ILDI G PERMIT _ COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY - ' JOHN A LAMBIE COUNTY ENGINEER NEAREST - - - ' COLEMAN W JENKINS SUP T OF BUILDING CROSS ST " +' DISTRI NO GROUP TYPE SED BY FOR APPLICANT TO FILL IN _ CONST - elk- BUILDINGZZZ y // STATISTICAL CLASSIFICATION SE ER MAP ` ADDRESS Q(� e F-� CLASS NO _DW ELL UNITS BK PG I LOT NO V4F BLOCK USE ZONE MAP / - -NO- , - - TRACT �Jla�( SPECIAL NO FL .. CONDITIONS SIZE OF LOTSU NOW ON LOT USE OF BLDG SETBACK FROM L TEL FRONT PROP LINE OF ` (STREET) OWNER NO TYPE OF E%1971 N0 SETBACK' 'HIGHWAY YA D' = TOTALS ADDRESS 10 W Y FROM C L ,�- -V- + a CITY BLDG 9 BAC FROM — ' - ARCHITECT OR v TEL SIDE PROP LINE OF (STREET) ENGINEER NO TYPEOF E%19TING SETBACKM HIGHWAY + YARD = TOTAL GH � ADDRESS HIWAY WIDTH _ FROC L CL TEL + O CONTRACTOR iNO U LICADDRESS ff 1:L NO I CORNER CUTOFF YES NO O H CITY LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK ` Z NEW&V' ADD ALTER REPAIR DEMOLISH SO FT NO OF NO OF SIZE STORI S FAMILIES USE OF f STRUCTURE SIGNATURE OF, APPLICANT jo VALUATION$ APPROVALS - - DATE' INS ECTOR'9910 NATURE ` P C _ PMT FOUNDATION, LOCATION FEE$ FEE$ FORMS, MATERIALS_ '000, ' FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTf+ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION ' �� }] WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS A i A 9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT _ ING TO WORKMEN S COMPENSATION INSURANCE 'LATH EXT SIGNATURE OF p IHOUSE NUMBER COR- / rr PERMITTEE -ECT AND POSTED i ADDRESS ry F I N A L , JOHN F LEWIS PRINCIPAL/STRUCTURALEER ' PLAN CHECK'VALIDATION CK M O CASH _ PERMIT VALIDATION CK M. CASH LACO' 3 9 3 4 JUL 2 3 1 D �.G � Q 76A638A CE. 803 6-62 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS ` BUILDING AND SAFETY DIVISION LOCALITY ` JOHN'A LAMBIECOUNTYiENGINEER NEAREST WILLIAM A JENSEN SUP T OF'BUILDING CROSS ST _ DIS CT UP TYPESSED BY FOR APPLICANT TO FILL IN Q DNS T I . BUILDING STATISTICAL CLA SIF CATION SWEIRMAP D ADDRESS BK � CLASS NO DWELL UNITS , LOT NO — if L r LOCK WATER d CERTIFICATE NOT REQUIRED 'RECEIVED ❑ TRACT '` y MAP HIGHWAY NO OF BLDG$ NO (^.�— (CIRCLE) STATE MAJOR SECOND OCA SIZE OF LOT NOW ON LOT- USE ZONE SPECIAL ' USE OF I ��}}�� tt CONDITIONS EXISTING,BLDG '" (5y 1 �^ " - TEL �l�/ 11�� 1 ,. OWNER No BUILDING YARD HWY TREETrNAME EXIST SETBACK WIDTH ADDRESS FRONT ARCHITECT OR µ,. TEL 'P L ENGINEER i NO , SIDE I I - P L , }� ADDRESS TEL tt 0 CONTRACTOR - Y ♦ I h ADDRESS , DESCRIPTIO OF 'Vf6RK _ O " - W NEW ADD LTER REPAIR DEMOLISH 0- H SQ FT NO OF ,NO OF Z SIZE STORIES FAMILIES USE OF- STRUCTURE ' I t r r SIGNATURE OF APPLICANT VALUATION $ s� APPROVALS DATE, + INSPECTOR 5 SIGNATURE P C PMT (g' FOUNDATION LOCATION - ' FE_E $ -FEE $ 'o- - - - FORMS-MATERIAL-$- FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ ,THIS APPLICATION .. BRACING BOLTS U AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FRNACE `LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING I' 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 COD OF THE STATE OF CALIFORNIA RELAT f ING TO WORKMEN 5 COM OF N INSURANCE i e �-� LATH EXT SIGNATURE OF �,� HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS T + FINAL I JOHN F LEWIS P RIC AL STRUCT( RAL'EN R PLAN CHECK VALIDATION CK O CASH - # " PERMIT VA Oi CKB M. CASH s Lrll�0 o a 3 7� FEa 13 1 o L 6.0(D-, ,, i Y a } r • / yyry� � APPLICATION FOR BUILDING PERMIT _ FOR APPLICANT TO FILL IN (Print or type only) BUI LGI NGi t COUNTY OF LOS ANGELES 1",,ARCHITECTEL ADDRESS S' C'l�v-cam L. DEPARTMENT OF COUNTY ENGINEER CITY 7-C e C ZIP BUILDING AND SAFETY DIVISION oil NO OF BLDGS BUILDING SIZE OF LOT %C 7( '+Q NOW ON ALLOT 2— ADDRESS , /' r TRACT BLOCK •LOT N7 ? LOCALI Y ` TEL NEAREST I OWNER �G� ��(�?�� NO CROSS ST ASSESSOR ADDRESS SCJ f 9 �1.0V-4 � MAP BOOK PAGE l PARCEL DISTRICT GROUP TYPE FIRE ESSED Y ITY ���'►� �'Q f ` 6� ZIP /� CONST ZONE OR '� t ENGINEER NO STATISTICAL CLASSIFICATION S WEIR AP rAD RESS CLASS NOQ /_ DWELL UNITS BK TRACTOR a� l "' NO /Z USE ZONE NADP D -07�J RESSZ'tf0SO ySq� Q LICV T / SPECIAL /Yba ,�.,� k, CLA,SLS l CONDITIONS "''v _ RO D DEPARTMENT APPROVAL REQUIRED YES NO CONSTRUCTION LEND } NAME AND BRANCH BLDG TBACKFROM - a FRON PROP LINEOF (STREETI C C: ADDRESS CITY HIGHWA } YARD TOTAL SETBACK FROM TYPE OF EXISTING SO F I NO OF �j NO OF j CHECK FRONT PROP LINE HIGHWAY WIDTH SIZE 14 STORIES G^ FAMILIES / ONE L + �/,D ' �q+h LI 4 DESCRIPTION OF WORK NEW ❑ Z 2 �A� •► ADD BLDG SET K FROM (STREET) yy� ,! y � SIDE PROP IALTER ❑ = TOTAL SETBACK TYPE OF EXISTING ` HIGHWAY } YARD REPAIR SIDE PROP LINE IGHWAY WIDTH USE EXISTING NG BL'�D�JG�� ��s/`� C Yee� DEMOL ❑ + APPRINT) 6p�c�� �/v 11�1� NPL CORNER CUTOFF YES ❑ NO BY (SIGNATURE) IN OPEN SPACE YES ❑ NO � - IN COASTAL ZONE YES NO ❑ VALUATION �- CATEGORICAL EXEMPTION YES❑ NO ❑ 1 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) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON STRUCTION 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 TO WORKMEN S COMPE NSA �21_ c L rB /�G L,Rf/A' //✓.S / 0A1,'0AINSUR , SIGNSTURE OF PERMITTEE [)i�s��,y Q ADDRESS 2,Ija-/� ,, ?? / CITY V" NOL •?' BY FINALL37.� DATE �/2 — / / iY/ 1� MAKF CHECKS PAYABLE 70 P c Q PMT�C FEE $ FEE P HARVEY T BRANDT COUNTY ENGINEER �/ r PLAN CHECK VALIDATIONUKM O CASH _ PER VALIDATION' cK) M O CASH t 9 4 &PMAR' 6 2'3 D 4 5.4 ®� —�,\% , a(� 9 1�f1NR c?8 D 8.1 0 AS, 76A638A CE#803 7/73 2 9 2 tZMAR 28 Y 1 0 8 92 5 &9- WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Uy6( � Company rn& ��n BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 1 Certified copy is filed with the county building inspec- BUILDING ADDRESS tion department. _ Date A0)X3 1-92 Applicant &,q7—,0+6Z,rA— CITYZIP LOCALITY / NO. OF BLDGS. NEAREST ERTIFICATE OF EXEMPTION FROM WORKERS', SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR •(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less:) TEL. OWNER` L.L NO. USE ZONE MAP I certify that in the performance'of the work for which thisp NO. permit is issued, I shall not employ any person in any manner ADDRESS. L. I SPECIAL CONDITI ONS a so as to become subject to the Workers' Compensation Laws. �- O CITY ZIP Date Applicant ARCHITECT OR TEL. ! DISTRi T GROUP TYPE FIREP OCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZpNE � Exemption, you should become subject to the Workers' �{ w Compensation provisions of the Labor Code, you must forth- ADDRESS �J d with comply with such provisions or this permit shall be //11� ®® TEL. {/ STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR &Y) /' 1 NO.,3`I'9 ? LICENSED CONTRACTORS DECLARATION LIC. c�" CLASS NO. z537-1 DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 6 "r ~t NO. LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business Imo/ /L✓/3� and Professions Code,and my license is in full force and effect. CITY CLASS C'3 BK. 4- PG. d VALIDATION I SS��i� L 3 SIZE FT STORIIEES FAMILIES ONE License Number Lic. Class VALUATION Contractor C /�PA�"�� Date !-3� DESCRIPTION OF WORK �J ,Lffj�toy; NEW $ ^^�/ ❑1 am exempt under Sec. t!pst,ri � WT/f ADD El ✓ , ALTER ❑ B.&P.C. for this reason f�� ritJf9af�Lef✓� s/}7✓l?Lr� REPAIR $❑ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature. APPLICANT TEL. FINAL /y OWNER-BUILDER DECLARATION (PRINT) NO. DATE I hereby affirm that I am exempt from the Contractor's Licenses Law for the following reason (Section 7031.5, Business and ADDRESS PM //Jl I Cr ar- ®rL FINAL Professions Code): PRESENT By �a BUILDING , = _ ❑ I, as owner'of the property, or my employees with ADDRESS , wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. _ ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. )}1 f P a �,a with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) -- REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SETBACK_ YARD HWY PROP. LINE WIDTH `.'HILMI I hereby affirm that there is a construction lending agency for FRONT the performance of the-work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE _ P.L. Lender's Name. Qf m1 LDMA Ref. # i• L [ * P.C. Fee$ Permit Fee p1 / Lender's Address , a 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# 0 8 above information is correct. I agree to comply with all County Investigation FeeQyT R ordinances and State laws relating to building construction, Total Fee �lJ �• U LDMA Perm. # a and hereby authorize representatives of this County to enter upon the abov o ed property for inspection purposes. c7 ? SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Ap ' ant or Agent Dat