HomeMy Public PortalAbout5931 CLOVERLY AVE_Building__ 7
A, ROAD DEPT 'P1,0AIT IS REQUIRED
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7ewesewce#eC9s -APPLICATION FORBUILDING PERMIT ' Zf
COUNTY OF LOS ANGELES ` BUILDING
ADDRESS ,
DEPARTMENT OF COUNTY ENGINEER 1
BUILDING AND SAFETY DIVISION LOCALITY -�
JOHN A LAMBIE, COUNTY ENGINEER NEAREST 7
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CROSS ST
CASSATT D GRIFFIN SUP T OF BUILDING
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SIGNATURE OF " Lam` y J
APPLICANT "
APPROVALS DATE INSPECTOR S SIGNATURE
ADDRESS DCO /G!��v. -CCIOI Vick- FOUNDATION LOCATION �./D
/y FORMS MATERIALS 4-11-910
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VALUATION $ % 4'Q FRAME E RAC NG BOLTSFIRE STOPS ,4 Jf�� %� / /�/�
P C �� z PMT �d - FGAS VENT DUCTS LOCATION,LRNACE Z,S'l (fll/K�LGA. I'l
FEE S 7 '�' FEE a
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY OROINAES AND L
STATE LAWS REGU TI BUIL CONS OCTA N P'TH EXT
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SIGNATURE OF OUSE NUMBER COR_
PERMITTEEPECT AND POSTED
ADDRESS O 6 , FINAL 1 1 /6 LSA
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7"630ACE#003�ao APPLICATION FOR BUILDING PERMIT l
COUNTY OF LOS ANGELES BUILDING ��� �� l .
DEPARTMENT OF COUNTY ENGINEER ADDRESS
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BUILDING AND SAFETY DMSION LOCALITY /�f2'I r e/r
JOHN A LAMBIE. COUNTY ENGINEER NEAREST v
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRICT OUP TYPE PR ESSED BY,
FOR APPLICANT TO FILL IN CONST
BUILDING STATISTICAL CLASSIFICATION SEWER MAW
ADDRESS rL BK PG
CLASS N WELL UNITS
LOT NO l tt/ BLOCK MAP STATEE O
/ NUMBER HWY
TRACT (p gr
SPECIAL
NO OFBLDGS CONDITIONS
SIZE OF LOT I NO
OW
N LOT
USE OF
EXISTING BLDG BUILDING YARD HWY STREET NAME EXIST
TEL SETBACK WIDTH
OWNERL�'/�/v/� /Q CIiO NO FRONT
P L L
ADDRESS / SIDE '
ARCHITECT d�BG� �"/!`��<�PeD P L
INSPECTION RECORD ,
ADDRESS l• '� f l/[J�}74 _ >+
CONTRACTOR ���� e NO Qi
ADDRESS
DESCRIPTION OF WORE - s �''sF ' ���� O
A4 T U
NEW ADD ALTER REPAIR DEMOLISH
SQ FP r 1Q NO OF NO OF
SIZE 7 W STORIES FAMILIES - -
USE OF
STRUCTURE
SIGNATURE OF
APPLICAN
J
VALUATION$
APPROVALS FFi�DATE INSPECTOR S SIGNATURE
PCPMT FOUNDATION LOCATION
FEE $ OD FEE $ /1 /J FORMS MATERIALS '� 0
I HEREBY-ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS
BRACING BOLTS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE LOCATION
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION r
1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH INT
WILL NOT EMPLOYY PERSON IN VIOLATION OF THE
WORKMEN S C SAT N LAWS OF CALIFORNIA LATH EXT
SIGNATURE OHOUSE NUMBER COR-
PERMITTE RECT AND POSTED T
ADDRESS FINAL 2 ��
CLYDE N DIRLAM PRINCIPAL STRUCTURAL E R
PLAN CHECK VALIDATION CK mo
CASH PEfMT VALIDATION CK M O CASK
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I'IL 0 3 0 2 7 9 JLI4 -3 (; 1 D 1 2.0 0 ,
TEMPLE C&V
76A638A CE#B03182 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS Ol /
r
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRICT NO� R U TYPE P OC E BY
FOR APPLICANT TO FILL IN CONST
BUILDING-b J131 STATISTICAL CLAS IFICATION SEWER MAP
ADDRESS • K ,
CLASS NO DWELL UNITS
LOT NO BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT No HCGRcWE) STATE MAJOR SECOND OCAL
NO OF BLDGS
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG
TEL fil
OWNERA. NO BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS (/: 2 FRONT 'f
ARCHITECT OR TEL -PL
ENGINEER NO SIRE
P L O.
ADDRESS A� 0
TEL /QL Qba.d' w �Y./w�2a�, vN V
CONTRAPTOR NO 1
V Im
ADDRESS 0
DESCRIPTION OF WORK w
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NEW ADD ALTER REPAIR DEMOLISH Z
SQ FT NO OF NO OF
SIZE $TORI S 17FAMILIES
USE OF qq �
STRUCTUR
1 770,
SIGNATURE OF
APPLICANT
A
VLUATION $
APPROVALS DATE INSPECTOR S SIGNATURE
PC C PMT FOUNDATION LOCATION
FEE $ FEE $ FORMS MATERIALS
FRAME FIRE STOPS
1 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 C O THE S ATE O CALIFORNIA RELAT
ING TO THE S
LATH EXT
SIGNATUR 0 HOUSE NUMBER COR
PERMITTER RECT AND POSTED
ADDRESS FINAL 1'S., —L 3 ,f•v//}•trtif�'Gr
JOHN F LEWIS PRINCIPAL ST RAL
CK MO CASH MI
ENGINEER
PLAN CHECK VALIDATION _ PERT VALIDATIO CK� -0 CASH
9 � � FCS 1 4 1 D 4.0 Q
76A638A CE P803 4/72
APPLICATIO FOR BUIPDING PERMIT �]
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
WAKE CHECKS PAYABLE 70
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY L
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
Print or tYDe only)
DISTRICT GROUP E�SED BY
BUILDING CONST
ADDRESS
STATISTICAL CLASSIFICATION SEWER MA
LOT NO //__ BLOCK CLASS NO DWELL UNITS BK PC3/S
TRACT 415& / USE ZONE MAP
NO OF SLOGS ` NO P- o L
SIZE OF LOT�vo KI,
�� NOW ON LOT / _q SPECIAL
USE OF ICONDITIONS
EXISTING BLDG 4555 GF�C
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OWNER E BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
ADDRESS .1'7S—
TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
CI GHWAY WIDTH FROM C L
ARCHITECT �R TEL } _
ENGINEER � NO
BLDG SETS >_ADDRESS — SIDE PROP LINE OF (STREET) O
T ����,,f TYPE OF EXISTING SET ACK HI WAY } Y = TOTAL C.7
CONTRACTOR _j NO✓ ��✓ &af HIGHWAY1 WIDTH FROM C L
O
LIC } = U
ADDRESS 10-0 :3 NO W
LIC
CITY 0Z Q CLASS CORNER CUTOFF YES ❑ NO ❑ Z
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS
SQ FT NO OF NO OF NEW ❑
SIZE S ORIES FAMILIES
USE OF ADD ❑
STRUCTURE
ALTER ❑
REPAI
SIGNATURE OF , D
APPLICANT DEMOL ❑
VALUATIONS APPROVALS DATE INSPECTOR'S SIGNATURE
P C PMT FOUNDATION LOCATION
FEE $ FEE $ �L FORMS MATERIALS
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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT -
LABOR CODE OF HE STATE OF CALIF NIA IN RELATING TO
WORKMEN 5 AR
IINSURANCE LATH EXT -
SIGNATURE � HOUSE NUMBER COR-
PERMITT OF RECT AND POSTED
ADDRESS d- FINAL
PLAN CHECK VALIDATION CK M 0 CASH _ PERMIT VALIDATION CK M 0 CASH
{ {(.� 0 0 775, I'AY 8 1 D 2 1 .75— c"
WORKERS' COMPENSATION DECLARATION
to self
Insure, oraffa certif carte of Worke s' Compensation a certificate ofconsent Insurance, APPLICATION F O R.- B U I L D I N G PERMIT
or a certified copy thereof (Sec 3800, Lab C )
��Company C� COUNTY OF LOS ANGELES � BUILDING AND SAFETY
Policy No
FX Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING 3
ADDRESS '
Certified copy is filed with the co ty ui insp c LDING 5931 & -Eloverl Ave.
tion department ADDRESS y
Date 10/18/88 App11 t CITY T le Cit zIP 91780 LOCALITY t
CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 2 CROSS ST QQ
(This section need not be completed if the permit is for oneASSESSOR
hundred dollars ($100)or less ) TRACT �I, - BLOCK LOT NO MAP BOOK PAGTEL E PARCEL
OWNER Mark NOttl NO USE ZONE ` MAP +
I certify that in the performance of the work for'whch this NO
permit is issued, I shall not employ any person in any manner ADDRESS 9575 Broadwa .• 8 - R SPECIAL
CONDITIONS
so as to become subject to the Workers'Compensation Laws � ,V
' CITY Tarple City, CA 91780 zip
Date Applicant r ARCHITECT OR TEL IX
NOTICE TO APPLICANT If; after making this Certificate of DISTRICT GROUP TYPE FIRE PROCESSED BY O
Exemption, you should become subject to the Workers' ENGINEER NO CONST ZONE U
Compensation provisions of the Labor Code, you must forth- ADDRESS
with comply with such provisions or this,permit shall be 7JJ1 STATISTICAL CLASSIFICATION APTIco$boN
deemed revoked CONTRACTOR Atkins Roofing Inc' TEL NO ^^ // Z
LICENSED CONTRACTORS DECLARATION f, - LIC CLASS NO'�DWELL UNITS
I hereby affirm that I am Icensed under provisions of Chapter 9 ADDRESS 5147 Elton St., NO 462883
(commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP
Professions Code, and my license is in full force and effect CITY Baldwin Park CA 91706 CLASS C 39 t BK PG VALIDATION
SQ FT NO OF NO OF CHECK s
License Number 462883 Lc Class C 39 SIZE STORIES 2 IFAMILIES ONE VALUATION 1
Contractor Atkins Roofing Inc.Date 10/18/88 DESCRIPTION OF WORK Re r00f NEW.ADD $
13 C ,
I am exempt under Sec ALTER C3 �
B&P C for this r as REPAIR $
e USE OF DEMOL
EXISTING BLDG Residential
Signcture APPLICANT TEL FINAL
OWNER-BUILDER DECLARATION PRINT Atkins Roofinq Inc. NO DATE/ ;2 0 9 33 A
I hereby affirm that I am exempt from the Contractor's LicenseADDRESS 5147 Elton St. Baldwin Park FINA # o o to 1*,'*11
Law for the following reason (Section 7031 5, Business and
Professions Code) ', BY i •'14 3 b 3
Q -
I, as owner of the property, or my employees with BUILDINGADDRESS - ' 1 4 3 b 3=
wages as their sole compensation,will do the work and • 0
the structure is not intended or offered for sale(Section LOCALITY f
7044, Business and Professions Code) MOVING TEL
I, as owner of the property, am exclusively contracting CONTRACTOR NO Q
with,licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK
LINE WIDTH'
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
n PL
Lender's Name Iyl11 IC _
LDMA Ref #
Lender's Address P C Fee$ Permit Fee !/��
I certify that I have read this application and state that the Issuance Fee V, �lJ LDMA P/C#
above information is correct I agree to comply with all County Investigation Fee
0 ordinances and State jaws relating to building construction, Total Fee , LDMA Perm q
and hereby, horize representatives of this County to enter
uF?o2 the a e enti a roe inspection purposes
< I S 1 t,/6 e, SEE REVERSE FOR EXPLANATORY LANGUAGE
o
Signature of Apiplicant or Agent D61e - -