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Home My Public Portal About6019 CLOVERLY AVE_Building__ 78A636A CE#803 1056 APPLICATION FOR BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING / G Department of County Eagmeer ADDRESS - (� D 1 Al LOVBRL` County of Los Angeles LOCALITY T�WL LG C1 JOHN A LAMBIE, COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST DISTRICT NO GROUP .NPE SEWER MAP FOR APPLICANT TO FILL IN �', 01 I 7 �K 155 CONSBUILDT NG ADDRESS r (-, Q Ilf l?Z STATISTICAL CLASSIFICATION I CLASS NO DWELL UNITS LOT NO BLOCK MAP STATE NUMBER Q-oo7 HWY YES NO TRACT USE ZONE SPECIAL NO OF BLDGS CONDITIONS SIZE OF LOT /, NOW ON LOTUSE .. EX STO NG BLDG 74L BUILDING EXIST YARD HV" STREET NAME J{� SETBACK WIDTH OWNERi✓/Gi �/ 2-0FRONT { / MAIL /�I /V. (-6Dy 6w 1' L O CL(jVE�-Y �O ADDRESS ,(/>�,p p >IDE �}� (� , CITY �'I! �Lr Cr�rZ TEL //j 07 P L INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO ADDRESS JJ ��jj/ CONTRACTOR/JM&) �/;�`�#j6 C//t(CiNO 3ajr/1'b//'' j ADDRESS-9204 Be�'�/� DESCRIPTION OF WORK NEW✓ ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF SIZE STORIES FAMILIES USE OF STRUCTURE '33000 Filmwe' � APPROVALS, SIGNATURE OF _ _ APPLICAN)T / r / { .. DATE INSPECTOR S SIGNATURE ADDRESSd20O /% ��L. /GriT• �L FOUNDATION LOCATION^ 9F� FORMS MATERIALS $ ///� (7 d P $ FRAME FIRE STOPS f/j/ r FEEE BRACING BOLTS FUR FEE NACE LOCATION 7 VALUATION $ Q O GAS VENT DUCTS r t, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH INT t PLICATION AND STATE THAT THE ABOVE IS CORRECT AND ti AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS R TIN B (LDING CONSTRUCTION LATH EXT SIGNATURE OF -� HCUSE NUMBER COR- �I PERMITTEE r r RECT AND POSTED ADDRESS a r1"714'Q FINAL -I�OI AAWW JOHN A LAMBIE COUNTY EN (NEER CLYDE N DIRLAM, PRINCIPAL ST QCT RAL ENGINEER PLAN CHECK VALIDATION CK mo CASH PERMIT VALIDATIONCK M O CASH L�' o 23,r 1 9"" HAR 2 2 - 1 D 6.0 G- fl f I .GES#803(REV I I/78) APPLICATIOr -OR-BU ING PERMIT COUNTY.OF LOS ANGELES BUILDING AND SAFETY , FOR APPLICANT TO L BUILDING / // ol ADDRESS �[✓�e 1 FADDIRESS DING LOCALITYNEAREST ZIP CROSS ST �O OF BLDGS ASSESSOR SIZE OF LOT P NOW ON LOT MAP BOOK a - PAGE PARCEL ` 11 "" "' DISTRICT GROUP TYPE FIRE CES D BY TRACT BLOCK PT NO CONST - x r TEL OWNER ^/ NO STATISTICAL CLASSIFICATION SEWER AP ADDRESS .Ce �� - W d CLASS NO DWELL UNITS r BK CITY i /U� �"" ZIP !� ARCHITECT OR TEL ENGINEER+ NO VALUATION $ ADDRESS BLDG SETBACK FROM I TEL FRONT PROP LINE OF (STREET) CONTRACTOR NO TOTAL SETBACK FROM YPE OF EXISTING LIC HIGHWAY + YARD = FRONT PROP LINE, HIGHWAY WIDTH ADDRESS I O /OO r -LIC_ + d CITY �/ CLASS CONS 10 LENDER - �- BLDG SETBACK FROM a SIDE PROP LINE OF STREET) NAME AND BRANCH } HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING d ADDRESS CITY SIDE PROP LINE, HIGHWAY WIDTH r G SO FT NO OF NO OF CHECK + _ U SIZE STORIES FAMILIES 7 ONE 0 ❑ USE ZONE MAP �/70 -. _0 DESCRIPT O ORK �` NEW NO SPECIAL ADD ❑ 1 \ �� CONDITIONS y�j ALTER DATE 7B /e:E 7Z REPAIR'Q USE OF DEMOL ❑ ` S EXISTING BLDG - ^ -Z APPLICANT TEL O (PRINT( NO Q BY(SIGNATURE) _ Q , I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOVE,IS.CORRECT AND AGREE TO COMPLY WITH ALL,ORDINANCES - p r7 p AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE _ ��H ��/ A` r WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COM .. r z - ^-# O o o O o 1 PENSATION INSURANCE � _- I - + - SIGNATURE OF 2'O ° 25004 PERMITTEE c 25,00 ADDRESS . 0 0eo11 -s0 •." - TEL -_,,.. »_ � _ r CITY NO Q . .1 C PC Fee$ Permit Fee > Issuance Feeus To Fee WORKERS COMPENSATION DECLARATION ' hereby affirm that I have a certificate of consent c self A P P L I CATION FOR BUILDING -PERMIT insure or a certificate of Workers Compenstion Insurance or , 6 certified copy thereof (Sec 3800 lab C ) a COUNTY OF LOS ANGELES- BUILDING AND SAFETY Policy No Company 111 El Certified copy is hereby furnishedBUILDING FOR APPLICANT-TO FILL IN ADDRESS Certified copy is filed with the county building inspec- / BUILDING _ tion department ' ADDRESS y LOCALITY v NEAREST e Date Applicant r CITYJ-EMftP. CITY ZIP 911WCROSS ST / CERTIFICATE OF EXEMPTION FROM WORKERS f NO OF BLDGS 2 ASSESSOR COMPENSATION INSURANCE -- SIZE OF LOT OX 117N, NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one /,,,eee,V,,,vvv� USE ZONE MAP hundred dollars ($100)or less ) TRACT BLOCK LOT NO, ' SOCIAL .4-2 0-V d I certify that in the performance of the work for ch this OWNER HENRY NO 2 AM Q CONDITIONS r O DISTRICT GROUP TYPE FIRE PRO SSEQ BY V permit is issued I shall not emplo a y person in n�manner ADDRESS CONST ZONE so as to beco a subject to the W r ers Compens fort L �� 3 rT - '� O Ilk xDote Applicant �� f CITYIEW ZIP STATISTICAL CLASSIFICATION 1� APT CONDO W -'r ARCHITECT OR -+ TEL NOTIC T APPLICANT If, 9f r making this ertificate of ENGINEER NO CLASS NO—al DWELL UNITS is ,Exemp ion you should b ome subject to /the Worker y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with, such provisions or this permit shall be TEL ./ deemed revoked ' CONTRACTOR NO BK L PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC - J 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 /` 000 + . Professions Code and my license is in full force and effect CITY CLASS $ c0 SQ FT�1 / NO OF NO OF CHECK License Number Lic Class > SIZE T�1�/> STORIES FAMILIES ONE $ � � DESCRIPTION OF WORKADDiTioN O NEW ❑ s r f Contractor Date ADD- ❑ licensing I am exempt from the Itcensg requirements as I am a I licensed architect or a registered professional engineer 1 4 ALTER ❑ FINAL /J p acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code) USE OF ' EXISTING BLDNGLE FAMILY L ❑ By AL sc� Lic or Reg No Date APPLICANT _ TEL OWNER-BUILDER DECLARATION (PRINT) NO I hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and ADDRESS S, // - P�ryg7fessions Code) PPRESENG _ 0,� ' '6 O A r I jV I as owner of the property or my employees with ADBU IDRESS 7 1 wages as their sole compensation will do the work and LOCALITY ._ # 0'0 0 0 0 1 the structure is not intended or offered for sale(Section ' 7044 Business and Professions Code) MOVING t TEL 2 016000 1 as owner of the property, am exclusively contracting CONTRACTOR \ NO s = with licensed contractors to construct the project (Sec- ADDRESS - `0(0 1 6 0� 0 0- tion 7044 Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 0 �017—8 1 I hereby affirm that there is a construction lending agency for FRONT do the performance of the work for which this permit is issued PL A) a0 � (Sec 3097 Civ C ) SIDE - PL Lender s Name Lender s Address P C Fee$ Permit Fee �. w I certify that I have read this application and state that the Issuance Fee above information is correct I agree to comply with all County Investigation Fee ordinances and State laws latmg to building construction and h y authorize rep a ntativ sof this County to enter Total Fee V a upo th above-mention rope or inspection Pur ose - m , _ s a SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Apphc or gent of �s i WORKERS COMPENSATION DECLARATION »• insure o roafcertif certificate off Workers' Comtpensation eInsuran elf APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec 3800 Lab C ) _ I r I COUNTY OF LOS ANGELES— BUILDING AND SAFETY Policy No Company -2522-07 f7BUILDING ❑ Certified copy is hereby furnished ,FOR APPLICANT TO FILL IN , €� ADDRESS ❑ Certified copy is filed with the county building inspec- 1 '� BUILDING tion department y /`- ADDRESS Date 0 Applicant t�'U� /1/ / J/ CITY � ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS O OF BLDGS NEAREST COMPENSATION,INSURANCE SIZE OF LOT NOW ON LOT CROSS ST (This section need not be completed if the permit is for one ,r ASSESSOR TRACT BLOCK hundred dollars ($100)or less ) r LOT NO ! MAP BOOK PAGE PARCEL L USE ZONE MAp I certify that in the performance of the work for which this OWNER TEO NO permit is issued I shall not employ any person in any manner SPECIAL ADDRESS e i CONDITIONS so as to become subject to the Workers'Compensation Laws J U Date Applicant' CITY IP NOTICE TO APPLICANT If, after makingthis Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O ENGINEER NO 0 CONST ZONE V Exemption, you should become subject to the Workers' r Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO U) deemed revoked CONTRACTOR NO Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP (commencing with Section 7000)of Division 3 of the Business and ./ LIC Professions Code, and my license is in full force`and effect CITY k CLASS BK ("—PGS� VALIDATION SQ NO OF NO OF CHECK License Number Lic Class_ SIZE STORIES . FAMILIES ONE VALUATION Contractor ate DESCRIPTION OF WORKt A D ❑ $ ❑ I am exempt under Sec ALTER ❑ , 2 9 5 7.2 A B&P C for this reason REPAIR ❑ $ USE OF # o 0,0 • • 1 Date EXISTING BLDG DEMOL SignatureAPPLICANT - TEL FIN $I o -, 9675 OWNER-BUILDER DECLARATION c PRINT NO DA / 0 0 - 96755 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS FI Professions Code) N ," a 1 ,0,—8 8 ❑ BUILDING O ' I as owner of the property, or my employees with ADDRESS Y r wages as their sole compensation,will do,the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code) MOVING TEL ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- r tion 7044, Business and Professions Code) ADDRESSg r >>`� `, REQUIRED TOTAL SETBACK '�'r .Yt, t J CONSTRUCTION LENDING AGENCY SET BACK YARD HWY - PROP LINE WIDTH f'\ I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE _ PL Lender's Name Y LDMA Reff# P C Fee$ Permit Fee ( �J �3} Lender's Address ✓ 1t ` pool I certify that I have read this application and state that the Issuance Fee V c LDMA P/C It �` 9 above information is correct I agree to comply with all County Investigation Fee { 0 ordinances and State laws relating to building construction, Total Fee �J LDMA Perm N and here authorize representatives of this County to enter upo h a ove-me do d propert inspeStion purposes a / ` ell 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o pplicant or A nt Dat WORKERS COMPENSATION.DECLA6 ION i r �I heithty_pjrirm that I have a certificate of consent to self _ APPLICATION FOR BUILDING P E n'�Ti"rRMIT re�,yj a ,ertificate of Workers Compensation Insurance • or a certifged copy thereof (Sec 3800, Lob Com�) _ n _ P❑olicy No f d�/v I Company 7-Cz � fr' COUNTY OF LOS ANGELES BUILDING AND SAFETY , Certified cP")y is herby furnished ° BUILDING FOR APPLICANT TO FILL IN,, - ADDRESS 01 CLO VFPIC ❑ Certified copy is filed with the county building inspec - BUILDING /GJ+` C_ t tion department ADDRESS a I,I_ C��rJ ��, , G� C� Dote Applicant "6'!`r CITY CG�'NI.t' ZIP~ / o - LOCALITY CE TIFICATE OF EXEMPTION FROM WORT ERS' NO OF BLDGS A `> wv+- NEAREST COMPENSATION INSURANCE SIZE OF LOT {+ a(` L NOW ON LOT CROSS ST � r ' (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less ) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL TEL USE ZONE MAP I certify that in the performance of the work for which this OWNER U/V NO f NO 1 �( permit is issued, I shall not employ any person in any manner --rye SPECIALi so as to become subject'to the Workers'Compensation Laws ADDRESS 1 CONDITIONS U Date' ' Applicant CITY & ZIP NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL - DISTRICT GROUP TYPE FIRE SSED BY O ENGINEER NO =09'2 ' CONST . ZONE 'Exemption you should become subject to the Workers' t V Compensation provisions of the Labor Code,,you must forth- ADDRESS ✓, �b y with comply with such provisions or this permit shall be COW'( TEL GJ �7 STATISTICAL CLASSIFICATION APT CONDO L'n deemed revoked CONTRACTOR C i`+/ ( NO ( / Z LICENSED CONTRACTORS DECLARATIONG r LIC Z 'R- CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS � � Sli °t NO (commencing with Section 7000)of Division 3 of the Business and m ,{ ,�j LIC (Q SEWER MAP Professions Code, and my license its in full force and effect CITY Yl' O r�9' `�7 CLASS ,`Y BK PG VALIDATION NO yr ( � Q SIOZEFT STORIES I FAMILNO OIES lJ CHECK License Number Lic Class + � � �Tl!`l NEW VALUATION Contractor TT!`l Date DESCRIPTION OF WORK _ ADD ® $ ❑ I am exempt under 11 Sec o ❑ ALTER B&P C for this reason � C �� REPAIR � $ Date USE OF EXISTING BLDG L DEMOL ❑ ` Signature APPLICANTFINAL / OWNER-BUILDER DECLARATION PRINT EL O _ DATE I hereby affirm that I am exempt from the Contractor's License- ADDRESS 0 C�V2� `t Law for the following reason (Section 7031 5, Business and FINA Professions Code) BUISINT LDING p' �Lplf — , y ❑ I, as owner of the property or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code) MOVING TEL ❑ j, as owner of the property, am exclusively contracting CONTRACTOR NO A with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBA SET BACK YARD HWY PROP LINE JLDN 5/-flpkI hereby affirm that there re a construction lending agency for FRONT `�, 4 '� ` `� „ r'i - rthe performance of the'work for which this permit is issued P L(Sec 3097, Civ C ) SIDEPL 47Lender's NameA Ref # + tP C Fee S PermitFee �Lender's AddressI certify that I have read this application and state that the Issuance Fee tomA P/C#above information is correct I agree to comply with all County Investigation Feeordinances and State laws relating to building construction, Total Fee 6 .-TA Perm 1l R and her9by authorize representatives of this Count to er)ter upon t ve mentioned perry for inspection County poses SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu f Applican or Agent Date