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HomeMy Public PortalAbout5850 CLOVERLY AVE_Building__ 76AB38A CEMB03 8-63 APPLICATION_ FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ((Jj``""�� DEPARTMENT OF COUNTY ENGINEER ADDRESS �d�J[/ � BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTRICT N G OUP TYPE PROCESSED BY , FOR APPLICANT TO FILL IN CONST BUILDING STATISTICAL CLASSOfICATION SEWER MAP ADDRESS J L, L/ C' /v d CLASS NO DWELL UNITS ` / LOT NO Ir 49 BLOCK WATER NOT REQUIRED RECEIVED El TRACT MAP �} HIGHWAr NO OF BLDGS NO C G C�' 7 (CIRCLE) STAT MAJO ECOND OCA SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS ' EXISTING BLDG TEL OWNER NO BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH ADDRES FRROL T ARCHITECT OR TEL ENGINEER NO SPIDE ADD ESS �[�yL a No o T J� �+ ) V ADDRESS jgY_Y `reY F ' O DESCRIPTION OF WORK W NEW-!~ ADD ALTER REPAIR DEMOLISH toll S FT NO OF NO OF SIZE STORIES FAMILIES USE STR TUIE �v SIGNATURE OF APPLICANT VALUATION S�O /" FORMSMATERIALS DATE J INSPECTOR 5 SIGNATURE PC S SCJ FOUNDATION ON FEE / FEE Sr�1D 1 ` 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 / 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 COD OF THE STA OF CALIFORNIA RELAT 1 t ING TO WORKMEN S COMP NSATI SURAN E /\ LATH EXT SIGNATURE OF HOUSE NUMBER COR PERMITTEE 1 ERECT AND POSTED ADDRESS FINAL ( G� JOHN F LEWIS PRINCIPAL STR URAL~ENGI NEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK MO CASH L11t,o 5 9 2 7 NOV 17 2 3 D .0 0 •.' Lt,uo 5 9 2 8:o NOV 17 1 D 6.0 0- APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES ADD ESS �v DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND AFETY DIVISION _ ]� r N6 OF BLDGS BUILDING SIZE OF LO S„ `NOW ON LO ADDRESS TRACT&�Z BLOCK 'ND LOCALI gRL - TE NEAREST OWNER NO CROSS S ASSESSOR ADDRESSMAP BOOK PAGE PARCEL �� DISTRICT GROUP TYPE FIRE SEDY CITY _ ZIP CONST ZON ' ARCHITEC 71 OR TEL (- ENGINEER NO ' n ' STATISTICAL CLASSIFICATION ISEWER MAP r - ADDRESS CLASS NO !�72 DWELL UNITS BK PG' CONTRACTOR N USE ZONE[NO MAP NO Z C7 LIC ADDRESS d !Z NO SPECIAL LIC _/ CONDITIONS CITY1,04:5 CLASS ad a ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONS RUCTION LENDER NAME AND BRANCHah - BLDG ETBACK FROM FRON PROP LINEOF (STREET) ADDRESS +CITY NIGHW + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING SQ Y F NO OF � NO OF' CHECK FRON T,PROP LINE HIGHWAY WIDTH SIZE O STORIES FAMILIES ONE _ DESCRIPTION OF WORK NEW '❑ ,U ADD ❑ BLDG SETBACKFROM TREET) IDEPROP LINEOF LTER HIGHWAY + YARD - TOTAL SETBACK FROM_ TYPE 0 EXISTING f~.) ❑ SIDE PROP LINE HIGHWAY WIDTH a EPAIR USE OF + _ - Z EXISTING BLDGEMOL ❑ APPLICANT EL CORNER CUTOFF, v YES,[] N6 ❑ (PRINT) ' + NO BY (SIGNATURE) IN OPEN SPACE r YES ❑ NO1�❑ IN COASTAL PERMIT ZONE +�� YES ❑ NO ❑ VALUATIONI$ IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 i HEREBY I`WILLNOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSA OH INSURANCE SIGNATURE OF PERMITTEE ADDRESS TE FINAL e�+ �.-: BY CITY NO DATEPC ()l( MAI E CHECKS PA}ABLE 10 FEE v FEE $~ HARVEY T BRANDT, COUNTY ENGINEER q'©O PLAN CHECK VALIDATION CK MO_ CASH PERMIT VALIDATION CK MO CASH- 2 1 6-nrT' cw 1 a 9:0•0 ' 76A638A CE*803 5174 , - ` r' WORKERS COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self ,� -A P P L I CATION FOR BUILDING- PERMIT insure, air a certificate of Workers, Compensation Insurance, or a certified copY thereof (Sec 3800, Lab C ) A42% COUNTY OF LOS ANGELES BUILDINGY,AND SAFETY ' Cal v Company� liudy or L I BUILDING Certified copy,is herebyfu nished , j8_ ' FOR APPLICANT TO FILL IN ADDRESS G� Q r ❑ Certified copy is filed with the county building inspec- BUILDING 5-48 4M Le=a 1��i,4,L7 tion department ADDRESS J G w _ ' CITY pL�i �� ZIP LOCALITY - Date ApplicantN -OF BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT ' ~- NOW ON LOT CROSS ST, S r COMPENSATION INSURANCE ASSESSOR $ t' w (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 ) pp'� TEL OWNER " 5 pI IZ, USE ZONE NO `�O I tcertify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS 3 - !� I r+ CONDITIONS O so as to become subject to the Workers' Compensation Laws t - CITY- ZIP - 4 U Date Applicant 1 - ARCHITECT OR, TELW PP �e DISTRICT GROUP TYPE _�FIORE PROCESSED BY - NOTICE TO APPLICANT If, after making this,Certificate of ENGINEER NO, r CONST ` NE Exemption, you should become subject to the Workers' o Compensation provisions of the Labor Code, you must forth- ADDRESS O d with comply with such provisions or, this permit shall be ����//�� TEL w STATISTICAL CLASSIFICATION APT CONDO N deemed revoked - x CONTRACTOR �MT`J NO d 46Z L z LICENSED CONTRACTORS DECLARATION , yy `� LIC CLASS NO DWELL UNITS , I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �+���s 5 ^ NO 4I 3 SEWER MAP (commencing with Section 7000)of Division 3 of the Business / LIC 1GY� ;. and Professions Code,and my license is in full force and effect CITY , CLASS BK PG- VAL'IDATION SQ FT NO OF NO OF CHECK License Number 5t3W1?g Lic Class G q5- SIZE STORIES FAMILIES ONE M VALUATION e0 �^ �Q(V s`'F '� Q DESCRIPTION OF WORK '*L. `. NEW ❑ ; I Contractor / ` G ADa �.J X D ��l V� D ❑ ►F ❑I am exempt under Sec ALTER ❑ t` B&P C for this reason" REPAIR ❑ $ ' - Date USE OF EXISTING BLDG DEMOL ❑ APPLICANT TEL * ` Signature (PRINT) NO - - FINAL OWNER-BUILDER DECLARATION DATE' Y I hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5, Business and ADDRESS FINAL { Professions Code) PRESENT _ o _ ByBU LDING ❑ I, as owner of the property, or,my employees with ADDRESSt _ ACCTA wages as their sole compensation,will do the work and LOCALITY b `r the structure is not intended or offered for sale(Section , y a a � 7044, Business and Professions Code ) -, - MOVING TEL ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO 1 ITEM GI IJ with licensed contractors to construct the project (Sec- ADDRESS r - TOTAL 40 v 50 tion 7044, Business and Professions Code ) a REQUIRED YARD HWTOTAL SETBACK FROM EXIST _ CHECK _ (r0 �O CONSTRUCTION LENDING AGENCY SET BACK PROP LINE WIDTH °' I hereby affirm that there is a construction lending agency for FRONT CHANE the performance of the work for which this permit is,issued PL ° (Sec 3097, Civ C ) SIDE ' Lender s Name P L ^6/15/89, _ y � ? LDMA Refer# n, PC Fee$ !t Permit Fee. V © 3"4 s Lender's Address W 1 AM 9'125 0 1 certify that I have read this application and state that the 'F Issuance Fee /�-ty d LDMA P/C 8 above information is correct I agree to comply with all County Investigation Fee R ordinances and State jaws relating to building construction, Total Fee v tv Q LDMA Perm # r a and reby authorize re esentatives of this County to enter 1 m up above-menti proper ction urposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signator of Applicant or Agent Dafe WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of cnaent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Worr kers' Compensation Insurance, - or a certified copy thereof (Sec 3800,Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No+ Company BUILDING Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS J �sV ❑ Certified copy is filed with the county building inspec- BUILDING i LOCALITY`0 G'LG[JC—/PL ,�f[� tion department ADDRESS r NEAREST Date ApplicanT CITY 7c—m PLL !T Zip 7 jtq CROSS ST `CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO TELSPECIAL I certify that in the performance of the work for which this OWNER Hyl - NO �8 7 7c 7 7 / CONDITIONS 111L permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PR SSED BY O so as to become subject to the Work=Compensation' Laws ADDRESS o tsf�� /V 5%�y { b�g ONST / ZONE aetl� `1 CITY TE/�JPGL G'./ Am TY ZIP //7 pV c ,V/ O Date Applicant STATISTICAL CLA IFICATION APT CONDO 1-' NOTICE TO APPLICANT If, after Waking this Certificate of ARCHITECT OR TEL U Us Exemption, you should become subject to the Workers ENGINEER CLASS NO DWELL UNITS CL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be Z deemed revoked ICONTEL TRACTOR NO BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license is in full force and effect CITY CLASS $ A (f (f ► NEW $ SQ FT NO OF NO OF - CHECK License Number Lic Class SIZE ss STORIES FAMILIES - ONE PF Contractor Date DESCRIPTION OF WORK ����/ C ' 5' G ADD ❑ ❑ I am exempt under Sec ALTER E] FINAL y� DATE USE OF 'U B 8P C for this reason REPAIR [-]/� Date EXISTING BLDG VJC�UT[v S/9Lp1 , DEMOL E] FIN 1 6 3 &7 A Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT J0th fc L /—,Q 1" NO 7 7��7 # e a o 023 1 hereby affirm that I am exempt from the Contractor's License POP. ) o o (� �,(G rj Law for the following reason (Section 7031 5, Business and- ADDRESS Professions Code) - [PRESENT BUILDING • e • 4 1,4 5 5 I, as owner of the property, or my employees with ADDRESS Q 1,23-86- wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section kADDRE n 7044, Business and Professions Code) TEL # 6 3 8 fa / ❑ CTOR NO I, as owner of the property, am exclusively contracting e o o • o I with licensed contractors to construct the project (Sec- ) o 0 59.25 tion 7044, Business and Professions Code) _ ED YARD HWY TOTAL SETBACK FROM EXIST o 0 a 5 9 2 5 5 CONSTRUCTION LENDING AGENCY K PROP LIN WIDTH I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ' 1.2 3`8 6 (Sec 3097, Civ C )Lender's Name Lender's Address $ Permit Fee I certify that I have read this application and state that the Issuance Fee (V LN above information is correct I agree to comply with all County Investigation Fee ordinances and State jaws relating to building construction, Total Fee CS and hereby authorize representatives of this County to enter upon the bove-mentioned property for inspection purposes o C /- -)-3-�Y7 r SEE REVERSE FOR EXPLANATORY LANGUAGE `} ` gnature of Applicant or Agent Date w ®t