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Home My Public Portal About5954 CLOVERLY AVE_Building__ 76AS38A DBS 9 9 58 APPLICATION FOR BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY BU11-DING ^� Department of County Engmee! ADDRE8s County of Los Angeles LOCALITY J ' a, / WM J FOX COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST D18TRIC OftGGRP TYPE SEWER MAP FOR APPLICA/N(T� TO FILL IN CONST LK �� ADDREBUILDSS //Y ' �LCv��`` NUMAP MBER STATE HWY YES NO USE ZONE SPECIAL LOT NO - Q J BLOCK ^ CONDITIONS - TRACT f(�;)! r NO OF SLOGS SIZE OF LOT 7./ NOW ON LOT BUILDING YARD HWY STREET NAME EXIST SETBACK WIDTH USE OF �S/ `v �, �' FRONT J-� EXISTING BLDG P L l OWNER . G '` C J SIDE P L MAIL /�f 0�/�/�L 7 ADDRESS -g y /✓'' G O TRACT DWELL 1 UNIT CITY ��"!4�LL / % TE�rZyJ"� 1 DWELL 1 UNIT 5 INDUSTRIAL NO 6 PUBLIC BLDG ARCHITECT OR TEL «i 2 DUPLEX 1 UNIT A14 7 ADDN AETC - ENGINEER NO �T"'T-�" 3 APT UNITS 8 MISCE ADDRESS 4 COMMERCIAL V/}jg" a% /f'007^717c C6rEL NO CONTRACTOR NO T)S�� INSPECTION RECO ADDRESS - DESCRIPTION OF WORK 2p�c-6' 1W L c�tr,rn NEW ADD ALTER REPAIR DEMOLISH 80 FT NO OF NO OF SIZE STORIES FAMILIES /S _✓�_ /� �T,1 p �6 /� USE OF STRUCTURE o ! Di /✓ .2. H d S E - r-a/2//Pi-c-a_- 17- p JT 1 — L6L '-0U � mrLjeAv7- SIGNATURE OF A1/ERySATiJFA 0'2SAPPLICANAPPROVS= - ADDRESS 407-ff &#'rS-6^DATE INSPECTOR S SIGNATURE $ FOUNDATION LOCATION P C $ FORMS, MATERIALS •�� _ FEE FRAME FIRE STOPS, VALUATION $ P d BRACING, BOLTS FEE FURNACE LOCATION 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS G'AS VENT, DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT AND STATE LAWS REGULATING BUILDI CONSTRUC- _ TION LATH, EXT SIGNATURE OF ��(, HOUSE NUMBER COR- ` PERMITTEE RECT AND POSTED ADDRESS "— _ FINAL c�-�s�6 iLU`'�LGP.i/• WM J FOX,COUNTY ENGINEER VALIDATION C N DIRLAM, CHIEF BLDG INSPECTOR LI1 b 5 0- JAN 9 1 200 _to u , _ � ® i APPLICATION FOR BUILDING PERMIT , COUNTY OF LOS'ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING DRESS I hereby affirm that I have a certificate of consent to self Insure BUllDING ADDRESS ti - 9 or a certificate of Workers Compensation Insurance or a certified �Z�� copy thereof(Sec 3800 Lab C) ZIP - �J T LOCALITY Policy No Company SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished NEAREST CROSS ST nr�sl ❑ Certified copy IS filed Iwith the county building Inspection TRACT BLOCK LOT NO department USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' WNERyy�� TEL NO COMPENSATION INSURANCE U Br-,AJA J a Q WITHIN 1000 FT OF SCHOOLS YES NO (This section need not be completed If the permit is for one hundred ADDRESS T dollars ($100)or less) - DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that in the performanceCITY ZIP of the work for which this permit -� -}� Is Issued 1 shall not employ any per n In any manner so as to . become subject to the Workers C nsa n Laws ARCHITECT OR ENGINEER TEL NO I STATISTICAL CLASSIFICATION APT CONDO Date9 7-5{,� Applicant ADDRESS _ _ CLASS NO —2— DWELL UNITS NOTICE TO APPLICANT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you Should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith -4.14 "/I( O Al 6-,C+ FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS �, NO PL 7�_/� , LICENSED CONTRACTORS DECLARATION ��`5�/V SIDE 4� LIC AS c� P L I hereby affirm that I am licensed underprovlslons of Chapter 9 �AJy0 I4 / SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE NO OF$TORIES NO OF FAMILIES Professions Code n /Il-ce7nse Is in full force and effect. ! NEW BK PG License Nu `�'/ Llc Class C-3�- D RIPTI OF WO r� ADD ❑ VALUATION Poo. 0 Contrac ate 57"'7- 911- t/ / S �, ALTER ❑ $ B� cc ❑ I am exempt under Sec REPAIR ❑ $ BBPC for this reason DEMOL ❑ LDMA P/C# W Date USE OF EXISTING BLDG URM ❑ Signature ' APPLICANT(PRINT) TEL NO LDMA Perm# ,, Z ❑ I as owner of the property or my employees with wages as OZ their sole compensation will do the work and the structure Is ADDRESS not Intended or offered for sale (Section 7044 Business and FINAL DATE Q = � Professions Code) o -Z-- 'q WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J i T f ENJ El as Owner of the property am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDORA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY 5 i C E licensed contractors to construct the project (Section 7044 - - 105 - 30 Business and Professions Code) VES 1:1 No El I I�� WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTHI=l CONSTRUCTION LENDING AGENCY ' COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMrrTING CHECKUST FOR ` GUIDELINES - �-�ri�'�11£ �r 10'_ I hereby affirm that there Is a construction lending agency for YES❑ NO❑ {1 L a the performance of the work for which this permit Is Issued(Sec - t p1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING w 3097 Civ C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE _ TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS �I`ILi j 3 Lender s Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD o Lenders Address `=t� 1 HN 21.1 CM ER OR AGENT 0 1 certify that I have read this application and state under penalty o P C FEE PERMIT FEE of perjury that the above information Is correct I agree to comply �j' o with all county ordinances and State laws relating to building Q construcn and hereby authorize representatives of this County ISSUANCE FEE to r p n tOebovAe-mentioned property for inspection purposes lei ?/ INVESTIGATION FEE TOTAL FEE ^ s�orur,of ADPko t or Awt - �0.1. 1J SEE REVERSE FOR EXPLANATORY LANGUAGE