HomeMy Public PortalAbout9617 CRAIGLEE ST_Building__ DIVISION OF BUILDING AND SAFETY
Department of County Engineer I. I
Count. of Los Angeles
WM. J. FOX, COUNTY ENGINEER 'APPLICATION
BUILDING
FOR APPLICANT TO PILI. IN _ ADDRESS ���: r�o /��
®
BUILDING '� LOCALITY VCx./fv�
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ADDRESS epx
NEAREST •�'T'/- r_ ..,.D _ `
LOCALITY - _ - CROSS ST.
NEAREST
DISTRICT NO: PLAN CCK.oR REc. No. PERMIT No.
CROSS ST., :
OWNER RECEIVyE��D�BY DATE OF'APP_L. DATE-ISSUED ;
MAIL _ WF/! 1 i
ADDRESS f - -
USE ZONE NC OF TYP GROUP FIRE ZONE-
CITY NO _ OklrasS / I PLANS �II. H 'I
ARCHITECT OR s TEL: ZONING
ENGINEER NO. APPRO4Ec BY_
- l� ORD..No:
ADDRESS - BUILDING
SETBACK LINE: , _
TEL. A ` APPROVED DATE
CONTRACTO NO .A e: BY:
HOUdkNUMBERING.
r ADDRESS ,.. �® --« ,
LEGAL MAP NUMBER NO-ASSIGNED BY -
DESCRIPTION LOT O 40 - I•.BLOCK! �• -
- DATE I ' ; ;.`CORRECTIONS -. INSPECTOR
TRACT 4� ?��!��Pb4A4 �'•` \ ,,n� yn y/.p
SIZE OF LOT /I� I NOW ON LOT s «; '`�" Y �r�G.I-6N� ,f� 7
USE OF. - IVO. OF
EXISTING BLDG. - I FAMILIES VV 0
DESCRIPTION OF'WOR8
G NEW 'ATERATION r
ADDITION '. � fr �f
REPAIR I� LE MOLITION �
!pQ PCUSQ.
SZEA .4 ROOMS 4[� STORIES I, P07
EXT- WALL, _ I COVOERING
COVERING'
USE OF STRUCTURE -
1141 h V' .
APPROVALS
., INSPECTOR'S SIGNATURE• DATE ..
FOUNDATION: LOCATION '
FORMS, .MATERIALS `-'/� d I {'/[ ,E" .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS;
`
PLICATION AND STATE THAT THE INFORMATION GIVEN IS ) G .j•,
CORRECT:. - - _ BRACING, .BOLTS
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES - FURNACE: LOCATION, 7 ,
-
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. « GAS VENT; DUCTS
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SIGNATURE OF LATH, INT.
PERMITTE �a
W�
LATH, EXT.
.A'DDRESS -
a PLASTER;,' INT.
AUTHORIZED.AGI.
/.�,.�j PLASTER, EXT. - -_ -
$ Av 49 f]I V,�Lb• - FEE /�'«.v,.�.v" HOUSE NUMBER COR-
r
.(�{(� REC'T.AND POSTED - �I
VALUATION
FEE 7D� FINALLOMA
76A696A DBS 3 2-69 '
•
ERMIT
.,• ..,', - 7 -64
. . 1�"• /"�E' s�
6A63fiA CE#80^„6
,
COUNTY OF LOS' ANGELES'; BUILDING A°°Bess:-'> . .
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY 43
•__ _
I hereby affirm that I have a certificate of consent to self In
WORKER'S COMPENSATION DECLARATION
insure, JOHN.A. L.AMBIE'. COUNTY ENGINEER a. _ _
,. NE"A'R EST- -' '�
or a,certificate of Workers Compensation nsurance,or a certified COLEMAN W.*JENKINS,SUP'T.OF BUILDING CROSS ST , cr, I
c p ther+,pof (Sec. 3800, -ab. _ DIST' T NO. •IGRO P--,-TYPE P. S§ED.B.Y
�' q3-Ol B � FOR APPLICANT TO FILL IN ;. _._ _ coNST' _
oy o. l
Certified copy iS'hereby furnished: BUILDING v i / STATISTICASSI FICATION SE ER"MAP
.. ADDRESS \'� J1
'Certified copy is filed with the county:building'inspection / o i �L aJ i C LASS NO. DWELL UNITS cB K/1/, ,P /G 1
department. r\ LOT NO. l
V / CK _ Z,pNE MAP
s U,KJ9'E��I
Date i1/ Applicant r L' TRACT ._ -_ NO, ��i
(C/, / SP'EC1AL rt
•"'' t° N0. OF SLOGS. /� W CONDI TIONS
CERTIFICATE OF EXEMPTION FROM WOR ERS' SIZE OF LO,'J` NOW ON LOT
COMPENSATION INSURANCE
USE
of
/� C BLDG. SETBACK FROM
(This section need not be completed if the'permlt Is for one hundredEXISTING " I
�j /.rTEL. /' /^ FRONT PROP. LINE OF _(STREET)
} dollars($.100)Or less.) OWNER VL%f"{'y �/' J� O. aV T _ - AY- YARD - — A-
I certify that in the performance of the work for which this permit
�'✓
TYPE-OF--EXISTING SETBACK HIO - +- —TOT Li
is issued, I Shall not employ any person in any manner SO aS t0 ADDRESS �' �� �.� HIGHWAY F M C.L. 6l —
become subject to'the Workers'Compensation Laws. r r / cry C/ — •f
CITY �C �� + !
Date Applicant ' - ARCHITECT OR f - TEL. SIDE,PROPS LINE FOFM._• - -_ ""`- (STREET)
_;
- - - ENGINEER NO. I ET)
NOTICE TO APPLICANT If, after- making this Certificate of TYPE of EXISTING SETBACK HIGHWAY + YARD — TOTALi
Exemption, you should become subject' to' the- Workers; ADDRESS A HIGHWAY_WIDTH -._ FROM C. o-
Compensation provisions of the Labor Code, you must%forthwith TEL! � �� = 0
} {
comply with such provisions•or this permit shall be deemed revoked; CONTRACTORMalNO 1vU<
ADDIR ,� �' NO CORNER CUTOFF YES NO
LICENSED CONTRACTORS DECLARATION 0
I hereby affirm that I am'.licensed underprovisions of Chapter 9• CITY SC h LI`669A SEE REVERSE SIDE FOR SPECIAL APPROVALS
(commencing;with Section 7000)of Division 3 of the Business Ad DESCRIPTION OF WORK
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Professions Code,and my license is'm full force an effect
1,
License Number 'Z Lic.Class.
NEW ADD ALTER REPAIR DEMOLISH P "
Contractor S ..0"' I/`lCeate I q SO.FT. NO. OF N0, OF A AAeALIOAO
SIZE J STORIES FAMILIES lo- / _pp ,I
-
❑ I am exempt under Sec. USE OF �" �p!�ti L P ?�
STRUCTURE
B.&P.C.for this reason '
.Date: - SIGNATURE OF •�/
• - APPLICANT
Signature
❑ I, as owner of the,property, or.my employees with wages as VALUATION �ry ��
their sole corn pensation,'wi l l do the work and the structure is ° APPROVALS PATE INSPECTo 'SSIGNAJU
not.intended or offered for sale (Section 7044,,Business,and P.C., _ PMT. FOUNDATION, LOCATION - '` ,,ft"
Professions Code.) •, FEE$ FEE$ FORMS,..MATERIALS-_,,, ,p
'FRAME, FIRE STOPS, 'U} ��� ,•„tea+' �t
❑ I, as owner of the property, am exclusively contracting with I HEREBY ACKNOWLEDGE'THAT I HAVE READ APPLICATION BRACING BOLT
licensed contractors to construct the project (Section. 7044, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
Busiress and Professions Code.) WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDING CONSTRUCTION, ICERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
j CONSTRUCTION LENDING AGENCY TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION
//INSURANCE
..{J�'{�
I hereby affirm that there is a construction lending agency for 1117/ l!/ LATH. EXT. `
a the performance of the work for which this permit is issued(Seo. SIGNATURE O e A� � �/ .HOUSE NUMBER COR- `�°" �^-••�••
3097,Civ.C.) _ PERMITTEE, {J_ RECT AND POSTED
ADDRESS '912/7/IC�JL�LLLf�OD/ ✓t/. /' .: F )
Lender's Name ,r. FINAL
o Lenders Address JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN�y LhYEE
O U
o I certify that I have read this application and state under penalty PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M.O. CASH
O of perjury that the above information is correct.I agree to comply LAW" 3'cn rvr
o with all county ordinances and State laws relating to building LAW" " � .4 1 D 8.00
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a construction, and hereby authorize representatives.of this County :Y �,F:• '
m
to enter upon the above-mentioned property for inspection purposes.- -
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