HomeMy Public PortalAbout5822 CLOVERLY AVE_Building__ C
c'
Z f
16A638A CE#8035 W APPLICATION FOR BUILDING ERMIT
COUNTY OF LOS ANGELES -BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T of BUILDING CROSS ST
DIST,�T O GROUP TYPE SEED BY
FOR APPLICANT TO FILL IN ?:, , CONST
BUILDING�.L �/ /> /O��v STATISTICAL CLASSIFICATION `— SE ER MAP
AD S 4Y 0 BK PG
CLASS NO_DWELL UNITS
L BLOC WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACT MAP HIGHWAY STATE MAJOR SECOND C L
NO OF BLDGS NO (CIRCLE)
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG
TEL
OWNER NO EILALDING YARD HWY ST EET NAME EXIST
SETBACK WIDTH
ADDRESS 'c, FRONT
ARCHITECT OR TEL _ P L
ENGINEER 1 NO SIDE
P L 0
L.7
ADDRESS TEL /INSPECTION RECORD_, _
CONTRACTOR O NO
ADDRESS /�-0
DESCRIPTION OF WORK - h
NEW ADD ALTER REPAIR DEMOLISH /
SQ FT y } NO OF NO OF
IZE STORIES FAMILIE
USE OF
STRUCTURE
42
SIGNATURE
APPLI C'4
VALUA ION$ ��
APPROVALS DATE INSPECTOR S,SIGNATURE
PC PMT FOUNDATION LOCATION / J
FEE $ FEE $ FORMS MATERIALS l
'FRAME FIRE STOPS
1HEREBY ACKNOWLEDGE THAT I HAVE 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 f /(Lyf� l //.2/i
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK LATH INT
AUTHOR I ZED�HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN OMP SATION INSURANCE
` LATH EXT
SIGNATURE OF HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRESS k c- FINAL
�C CLYDE N DIRLAM. RINCIPALST AL ENGINEER
PLAN CHECK VALIDATION Cr- M o CASH PERNIIT V.LIDATIO crc. b o CAIIH
c 7 2 4 1 " Ali 1l 1 5 .0'0 M
'/APPLICATIONCOUNTY OF LOS ANGELES
FOR DEPARTMENT OF COUNTY ENGINEER
B U I L D,I N G PERMIT BUILDING AND SAFETY DIVISION
BUILDING
FOR APPLICANT TO FILL IN ADDRESS 5
BUILDING f"
ADDRESS -�� , Al. LOCALITY_
NEAREST
CITY � / �jI ZIP CROSS ST
O OF SLOGS / ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT G YPE FIRE11151107CSED BY
TRACT BLOCK LOT NO
TEL /
OWNER _/LJ F/rL_.No STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS pZ �v D 7I L�-fC� l CLASS NvJ/ DWELL UNITS BK PG
U ZONE MAP
CITY )"Ld ZIP _ NO 4
jARCHITECT OR TEL SPE AL
ENGINEER NO CONDITIONS
ADDRESS /I ROAD DEPARTMENT APPIROVAL REQUIRED' YES E] NO ❑
CONTRALTO [1 NOL � FROM
pRONTPROPCLINE OF (STREET)
LIC
ADDRESS NO �// l(/D�J HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC FRONT PROP LINE HIGHWAY WIDTH
CITY � CLASS _
CONSTRLJCTION LENDER +
NAME AND BRANCH_
BLDG SETBACK FROM a'
ADDRESS CITY SIDEPROP L(NEOF (STREET)
SQ FT NO OF NO OF I CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING O
SIZE - STORIES / FAMILIES / ONE SIDE PROP LINE HIGHWAY WIDTH
DESCRIPTION OF WORK NEW ❑ CC�
ADD CORNER CUTOFF YES ❑ NO C] Z
13 n%Urrt i G
f LTER ❑
G�G G 1 O u,-- EPAIR❑ IN OPEN SPACE YES ❑ NO ❑
USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG e�'3'/DE/V��= DEMOL ❑
APPLICANT TEL l`Ga�'� ,/� J—�tJO%!G 77> �7✓�
(PRINT) NO
BY (SIGNATURE) ��✓Sf�E�-T�D� -�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I' /VO 7— /,1.x—
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ���'�"
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED �� �/��j l![j'US 4/4171C-6
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE l
LABOR CODE M THE STA R CALIFORNIA IN RELATING TO pI '�
WORKMEN'S CO MPE NSAT I SURA NCE / C•��•�•/�
SIGNATURE O FINAL V A BY
PERMITTEE � DATE ��t J
ADDRESS ! '7
TEL PC Fee$ , Permit Fee 1 /
CITY NO
Issuance Fee
VALUATION$ /�(,6 J
Total Fee /
PLAN CHECK VALIDATION CK �M o CASH _ PERMIT VALIDATION —zr— M o CASH
5 0 1 C'J'10v 29 2 3 L) 1 3.0 5
- 5-0 2r"'I'M 29 1 0 21.75 ,
76A638A CE#8038 1Z/75 O /�