HomeMy Public PortalAbout10955 DANBURY ST_Building__ a,�Ea,o„a APPLICATION FOR BUILDING PERMITS �.
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY (
JOHN.A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT O. GRIFFIN, SUPT OF BUILDING CROSS ST _
- - DISTR-ZZNO' I GROUP I TYPE PRO SED BY
FOR APPLICANT TO FILL IN. CONST.
BUILDING STATISTICAL CLASSIFICATION I SEW'R MAP lCONTRACTOR
ADDRESS �TSK PGCLASS.NO.-ILDWELLLOT NO: BLOC F}UMBER oCi J G Hwlyy.TE YES JO
MAP
TRACT_ 32 US/EIZ)NE SPECIAL -y �y7�o NOW ON LOTS CONDITINS V SIZE OF LOT 4USEOFEXISTING BLDG. BUILDING YARD 'HWY STREET NAME EXIST.
ETBACK - WIDTH
FRONTMAILR t.ADDRESS (/ /' ISIDE
CITY NOLO/3�/ P.L. INSPECTION RECORDARCHITE EL.NGINEERq ` O.
31
ADDRESS /I / S,. /� ..w! TEL! C nQ v &+� o.
ADDRESS
DESCRIPTION'OF WORK
NEW ADD ALTER .REPAIR DEMOLISH
SQ. T. �L/ NO.OF NO.OF
TT STORIES FAMILIES
USE OF
STRUCTURE
tf
SIGNATURE OF
APPLICANT. APPROVALS DATE INSPECTOR'SSIGNATURE
ADDRESS/Q2� OUNDATION: LOCATION 1
_ FORMS,MATERIALS 1-
VALUATION$ -`j ��0 FRAME:FIRE STOPS. Fn4i -
w /Tl1 BRACING,BOLTS
P.C. J �LIPMT. y l FURNACE:LOCATION. ,
FEE S / FEE S - GAS VENT,DUCTS
I HEREBY ACKNOWLED E THAT 1 HAVE READ THIS AP- ��-
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH.INT.
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND '• _ V -�yy'N
STATE LAWS REGU TING BUILDING COWSTRUCTION. LATH:EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDREl-/ff 2- INAL
CLYDE N. DIRLAM, PRINCIPAL ST I RAL ENGINEER
PLAN CHECK VALIDATION =K wsK PERMIT VALIDATION /.=K mo.
.u�R
�&.7 2 9 0 S FiAR L- 2 3 A 2 .1 .0 0 A'n
UCo7 5 8 72' MAR 11 1 A 42-00
WnRKERS; COMPENSATION DECLARATION �� I' �qo .�L 5b5aG aha �G
I her8by a�m that I have a certificate of consent to'self - 0 D ^
insure, or a certificate of Workers' Compensation Insurance, ' •Att tr L I �?u p,9 I O � _ Il 0 00- -BUI L D'�U V�iS!' PERMIT-: -
or a certified copy ther;of,(Sec. 3800 Lab. C.) - _
�1
Prcr7/Ce COUNTY OF LOS ANGELES SUILDING,AND SAFETY
Policy N-/_0G 0�ConI 1 4..;Egon d'fpC - - Y -
// BUILDING 4
Certified copy is hereby,furnished_ C .FOR APPLICANTTO FILL IN ADDRESS
. .Certified copy is filed with.the county building inspec - BUILDING • I a .'T�M1 J
lion'department ADDRESS -
Date can �/4%�ILIrUO'T/e Co, aTr G+P LC . C �. - ilP - LOCALITY .
,NO.OF,BLDGS. NEAREST A
CERTIFICATE OF EXEMPTION FROM WORKERS`„ ; F SIZE OF LOT NOW ON LOT CROSS ST. - Stent TA rl"-17y ' --
COMPENSATION INSURANCE _ _ ASSESSOR„- i
(This section-needrs ($1 of be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL "
hundred dollars($100)or less ) - 2 ' TEL �7 /� y
.. - OWNER-- 7-7Ai$90'PA - • NO.3-,/D IG/0.7 USE.ZONE:�.: MAP
1 certify that in the performance of the work for which this NO. i
permit is issued; I shall'not employ day person in any manner ADDRESS C� AN'13✓Itr I - - _ J SPECIAL
CONDITIONS
so as to become subject to the Workers'Compensation1ows. • - _ O
' /"l/�� C - ZIP' U
CITY
Date- Applicant ` ' -• ARCHITECT OR ' - �
DISTRICT' - GROUP. TYPE FIRE'• - PR CESSED BY
NOTICE TO APPLICANT:,If, after making this Certificate of
- ENGINEER NO - C
Exemption,,you should become subject to the Workers - '7 V
//\\ ONST,� ZONE
Compensation=provisions of-the;Labor-Code,.,you-must.,forth . -_--- ADDRE -,a _
with comply with.such provisions.or this permit shall be /� �^.w-,� T
deemed revoked CONTRACTOR r"CGr' - WA GF STATISTICAL C ON '
5 LASSIE CATI ._APT C
LICENSED CONTRACTORS'DECLARATION LIC CLASS NO. DWELL. UNITS
'lhereby'offirm that l dmlicensed under provisions of Chapter 9 . ADDRESS'• f� � " `a r�iw/,fT NO.^..f^Yy�-a C7L - �' � '- --
Z
tt LIC. SEWER MAP
(commencing with Section 7000)of license
is in fu 3 of the Business CITY t./7 "7 CLASS �'3i
and Professions Code,andmy license is in full force and effect. BE. PG. L VALIDATION"-
LSQ. FT. NO, OF NO. OF CHECK
'License Number SQ.sO/;y 'Lic. Class 3"� SIZE STORIES FAMILIES ONE
SKr+/'Y - / Cr, . VALUATION
Contractor 4l..'uF-n't'PPb !05 Date' �'�8 �� DESCRIPTION OF WORK / NEW ❑_ _
v.l_I
❑I am exempt under Sec. P< t,,0e f. G0 S� n �t` ADD S �Q
ALTER
,B.BP.C. for this reasonUSE OF j
T REPAIR
' Date: EXISTIING BLDG. .W—C6I&-01U .. .DEMOL'❑ v_ -.f-1. cL-= .
S t �� .• APPLICANT VCJt4Le, TEL._ - FINAL CHCt~lt,t Lill
/OMNER-BOLDER DECLARATION. (PRINT). L.t:PG7e 2u' i G NO. - 2 L
_ //`` II // DATE . O •G/
hereby affirm that am exempt from the Contractor's Busin License ADDRESS o Wc.(.N✓ 'f' %'jr\
Law for the following reason (Section 7031 5, Business and ' 'FI is-,
Professions Cade): _ PRESENT - - --• - - I'I;f71 i=tILI ti _. , 'T
❑ - BU UDING
I, as owner of the property;'or my employees with ADDRESS ? { •u:a0'J:
wages os their sole compensation,will do the work and - - -
the structure is not intended or offered for sale(Section LOCALITY
-7044,'Business and Professions Code.) r MOVING- TEL. - • - "
❑ CONTRACTOR NO. .
I, as owner of the property, am exclusively contracting ,
.. - with licensed contractors to construct the project (Sec- ADDRESS - 'I
tion 7044, Business and Professions Code.) - I
REQUIREDTOTAL SETBACK FROM' -EXIST -'
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH -
Ihereby 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
Lender's Name -
m
-3 LDMA Ret. p
_ P C Fee$ Permit Fee 5 V' 13 ' -
Lender's Address -
'I certify that I have read this application and state that the Issuance.Fee .Jv LDMA P/C'N ®s
8 above information is correct. I agree to comply with,all County _ lnvesfig.1mr,Fee _- _
d ordinances and State lows'relaiing to building construction, Tool Fee 12S ,LDMA Perm. N -
a and hereby author' a representatives of this County to enter -
m upon a bove- ntioned property for inspection purposes. -
i
W- 3JU- - SEE REVERSE FOR EXPLANATORY LANGUAGE. _ .. _ .. ,• _ "
Signature of Applicant or Agent - Date c