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Home My Public Portal About5952 - 1/2 - 1/4 CLOVERLY AVE_Building__ t �¢�601 ^57'r-1 S - IVISION-OF;BUILDING AND SAFETY 1 ' 1 Department of County Eng>neer ` County of Los Angeles Y 1 ~'WM. J FOX, COUNTY ENGINEER ,�1� ti APPLICATION - FOR APPLIQANT TQ FILL IN FOR OFFICE USE ONLY BUILDIN -� DISTRICT NO PLAN�(CK ORREC No r PERMIT NO ADORE BH O� LG�/��L 5 La 4 IO�I(D� ECEIVED BY DATE OF ADPL. DATE ISSUED LOCALITY p' nAREST OBSST tJ t BUILDING ADDRESS 57L ;E -�_l OWNER /jJ�.C�/� MAILr _ LOCALITY ADDRESS 15 ?X&I Alo OL 01/C L S/ I NFARE13T �M ��, NO FIRE HT I NO OF TYPE GROUP// CITY �✓,6 �►� TeL/I d/_/l�' j� /'T G {O.i ZONE PLANS ARCHITECT OR TEL ENGINEER NO BLDG NO k SETBACK LINE ADDRESS /- USE /? APPROVED CONTRACTOR (.�,E,� NO fdGfO/ ZONE BY DATE //yyyy�� HOUSE NUMBERING � �� ADDRESS o. L_LOdr.�- �. MAP NUMBE NO ASSIGNED BY LEGAL n CORRECTIONS DESCRIPTION LOT NO. a O BLOCK i TRACT � f NO. QF SLDQS. � Z�(S 3 FI/A/1 Y n Bs�1/1 SIZE OF LOT Q ° NOW ON LOTJ F-O P, c 'V S TJ5 E5 n- USE OF NO OF J Ge� EXISTING BLDG FAMILIae DESCRIPTION OFWORK _ /f H�', A f=�� trJ"'Ertl p NEW ALTERATION ADDITION r REPAIR DEMOLITION ' F,rX C (r /__ ` d Al .V/47o. _B81ze 0 540 � woomra /2- BTDRIEB 2 Cr0 Ni'r#/ M2 01S d.�// � EXT avER NO �T!I E*t* Q I COVERINo r./Gl19 DASiYiaN N k A/ ��/ d N <J d1�07'" UBE OF STRUCTURE a-.r 7- K-0�k.� r rte',d,✓13J S - ►�G/�7rS' l AJ W&,r h Poi M Wo LL -- ,INSPECTION R OCCUPANCY ASILLS a /% TRAP-APPROINSPECTok4$SG—pRoR9600E►✓Gga E DAT FOUNDATION LOCATION r � I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FBRMS, MATERIALS PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME. FIRE STOPS, i CORRECT BRACING, 13OLTB 1 AGREE TO AND STATE LAWS REGULATING BLY WITH LUILDING CONSTRUCTION `,/'OMP %UN //TY I FURNACE. LOCATION, / //l ,�� @A9 VENT. DUCTS f/ SIGNATURE OF LATH, INT PERMITTEE� rnA nsa/1/ 9"& vW . ADDRESS✓y B� LATH, EXT PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. FEE \r/ HOUSE NUMBER COR- '�'^ RECT AND POSTED VALUATION FEE FINAL 76AS36A DBS 3 1-52 I r t, APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION ``' FOR APPLICANT TO FILL IN BUILDI G rDDRESS BUILDING ADD ESS I hereby affirm that I have a certificate of consent to self Insure or a certificate of Workers Compensation Insurance or a certified J copy thereof (Sec 3800 Lab C) CITY ZIP (- LOCALI f Policy No Company^� p v SIZ F LOT r NO OF BLD SNOW ON LOT L ❑ Certified copy Is hereby furnished ` - NEAREST CROSSAT �/ to TRACT r BLOCK LOT NO L7 Certified copy is filed with the county bulldingrinspection department d�/ w� USE ZONE MAP NO Date�L Applicant O B® i� ASSESSOR MAP BOOK PAGE PARCEL t SPECIAL CONDITIONS _ CERTIFICATE OF EXEMPTION FROM WORKERS' o N/�R T o COMPENSATION INSURANCE Dcr / err "" 'WITHIN 1000 FT OF SCHOOL'S YES No This section need not be completed if the permit Is for one hundred ADDRESS ( P F- /� DISTRICT GROUP TY ONST FIRE ZONE PROCESSED BY dollars ($100) or less) tJ C� O1k CI Y 1 ZIP I certify that h the performance of the work for mance this permit @ /T L', a ` "' - 1 is issued I shall not employ any person In any manner,so,as to �� f -�,c become subject to the Workers Compensation Laws ARCHITECT OR ENGINE TEL NO 1 P STATISTICAL CLASSIFICATION IP, APT CONDO i Date Applicant ADDRESS, CLASS NO DWELL UNITS NOTICE TO APPLICANT' If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the.AWorkers CONTRAC�TV IF TEL NO � SET BACK1_ YARD HWY PROP LINE WIDTH Compensation provisions'of the Labor Code you must forthwith NO 10 . orW �� FRONT, comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L LICENSED CONTRACTORS DECLARATION `S� '�� ` ~ ��®�s� SIDE CITY CLS PL I hereby affirm that I am licensed underprovisions of,Chapter 9 Y9V SEWER MAP a (commencing with Section 7000)of Division 3 of the Business and SQ FT S& NO OF STORIES NO OF FAMILIES Professions Code and my license is In full force and effe t '�` NEW El BK PG , V License Number, �Xt ` jLIC Class C DESCRIPTION OF WORK ADD VALUATION Contractor HO/ Date r 5z-.�D�9�! ~� r a 1 ALTER ❑ $ �� ` F_ F_ElI am exempt under Sec C i its 4-� REPAIR ❑ $ W BBPC for this reason Cf</,S/j�j _ DEMOL ❑ LDMA P/C# a 4 Date Y USE OF EXISTING DG CO URM ❑ I o Z Signature 1, 1 AP LICANTINT) f r TE�NOO� LDMA Perm# Z -i_r-TaaP El as owner of the property or my employees with wages as d ,� •ff I - their sole compensation-.will do the work and the structure1s A DRESS �1 O :v�+ Zl i 6Or� not intended or offered for sale (Sectionr7044 Business and _n .�� T� ✓P, 1010A1, FINAL DATE Q Professions Code) O 1 ITEnS WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 0` M ElGUIDE' FINAL BY 5 TOT, L :10 -35 0 licensed contractors to construct the project (Section 7044 Business and ProfessionsrCode) YES 11 No❑ - - b L HEO l�lc a jj 1 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING, OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '� „i.f.'C n II CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR !i ii'31 GUIDELINES I hereby affirm that there Is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING ry�{ 77 77 3097 Civ C) .I CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODEIV a ” TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD 0, Lenders Address 0 , OHNER M AGENT , J o I certify that I have read this application and,state under penalty .o of perjury that the above Information IS correct I agree to comply PC FEE PERMIT FEE 17 P with all county ordinances and State laws relating to building �� m construction and h reby authorize representatives of this County ISSUANCE FEE ��• - 4 to enter u n the ove bone proper for Inspection p rposes a INVESTIGATION FEE TOTAL FEE D /] i' ,_W re of A-0p nt«Ate, SEE REVERSE FOR EXPLANATORY LANGUAGE