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HomeMy Public PortalAbout5222 DOREEN AVE_Building__ i DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRI�TyO. PLANCK. NO. PERMIT NO. BUILDINGADDRESS �[ 7 REC I V� BY DAT�F APPL. DATE ISSU = LOCALITY NEAREST / U CROSS ST. aljILDING ADDRESS Z ZZ OWNER LOCALITY J l'✓hIfilll_ e, MAIL ADDRE NEAREST O� TEL. CROSS 9T. ✓'C_y CITY �f NO. FIRE NO. OF I TYPEGROV ARCHITECTOR TEL. ZONE PLANS ��/ ENGINEER NO. SETBACK LINE ` � , ADDRESS APPROVED TEL BY DATE CONTRACTOR NO. USE APPROVED ZONE '� BY DATE ADDRESS HOUSE NUMBERING LEGAL „ DESCRIPTION LOT NO. "ice BLOCK MAP NUMBER Z FIELD CHECK BY TRACT ezoD NO. ASSIGNED BY DATE No. OF BLDGS. CORRECTIONS SIZE OF LOT N NOW ON LOTS USEOTI NO.•l I OF USE NG BLDG. '�f'(�.�yL.�/ NO.FAM. Lees DESCRIPTION OF WORK NEW I I ALTERATION I ADDITION O REPAIR I DEMOLITION I I I - A G SO. FT. NO. OF / SIZE d ROOM$ STORIES Z D WALL EXT. ROOF r COVERING COVERING USE OF STRUCTURE APPROVALS INSPECTOR'SSIGNATUR E DATE i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOU NDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING. BOLTS LAWS REGULATIN BUILDING CONSTRUCTION. 1 FURNACE: LOCATION, SIGNATURE OF GAS VENT, DUCTS ^ / LATH, INT. ADDRESS LATH, EXT. AUTHORIZED AGT. PLASTER, INT. ]6A89BA• DB89 ID-80 .rp sP. C. $ / © - l(TYJI{/� FEE PLASTER, EXT. VALUATION FEES 3 — FINALf"��� TEMPLE COTY ]ue]uYY.E Ei0E. .... APPLICATION FOR BUILDING PERMIT COUNTY OF'LOS ANGELES BUILDING UI EIN DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST, FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE j PROCESSED BY S,0 J CONST. BUILDING _�qj q STATISTICAL CLASSIFICATION SEWER MAP ADDRESS -.S /- 1 Z �;'r P f_N QQ / BK PG �y CLASS. NO.-4f—DWELL. UNITS-1 &_ 3 LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: UEJ Li TRACT ,/'L O - MAP HIGHWAY STATE MAJOR SECON LOCAL SIZE OF LOT YYQ �F �('f 6 NO. OF IS LOOT NO. Z U SCI (CIRCLE) NOW ON LOT USE ZONE SPECIAL - _,// USE OF CONDITIONS 19, T EXISTING BLDG. �Q�S * —/ Tel_ A _/ ��A z,e ,y( NO .G; I _x�. BUIILDING EXIST. OWNER CA/I/J31I SETBACK YARD HWY STREET NAME WIDTH ADDRESS S 22 /i A/�.�C// FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIOE P.L. ADDRESS TEL INSPECTION RECORD o CONTRACTOR NO. O ADDRESS DESCRIPTION OF WORK n d /`A 0 v W NEW DD ALTER REPAIR DEMOLISH h SO.FT. NO.OF NO.OF Z SIZE 1 'l' STORIES FAMILIES 5 RUC /'g 5 RUCTURE 10AAT i)A 00 T' 1 SIGNATURE OF J / APPLICANT .Y VALUATION$ APPROVALS DATE INSPECTOR'SSIGNATURE P.C. PMT. Od FOUNDATION: LOCATION FEE $ ` FEE FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS I L AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, INi I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. \ LATH, EXT. SIGNATURE OF //'/ —�� /// HOUSE NUMBER COR- PER OR- PERMITTEE I__ q1.•'`.^'" �{ / G "^^ RECT AND POSTED goDREsS /� FINAL CLYDE N. DIRLAM, PAIN (PAL STRUCTURAL EN R PLAN CHECK VALIDATION CIL M.O. CASH PERMIT VALIDATION cK. m.o. cASH LAGO 2 8 9 2 AUG 13 . 1 0 4.00- 41WORKERS' COMPENSATION DECLARATION hereby affirm that I have Workers' ome ns consent to nee, APPLICATION - FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company , BU ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDILRDESSING 5222 ❑ Certified copy is filed with the county building inspec- BUILDING J Z -Z D� f F� / flan department. ADDRESS ,{ � P`�" �� CITY G& 1 LOCALITY . Date Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK - LOT NO. MAP BOOK I PAGE PARCEL hundred dollars,($100) or less.) ^�s TEL.LLL L,p OWNER /(/,y�GO Y /t[l NO.7 ! =l 7 o USE ZONE MAP I certify that in the performance'of the work for which this ,� /LNO. permit is issued, I shall not employ any person in any manner ADDRESS �-1 �4[ E A/4 � SPECIAL Y CONDITIONS CL. so as to become subject to the Workers' Compensation Laws. /— r� O CITY GG ZIP d U Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO.. DISTRICT OUP TOPE FIRE PROCESSED BY CON E y� /7 Exemption, you should become subject to the Workers' to L-) Compensation provisions of the Labor Code, you must forth- ADDRESS r OIL with comply with such provisions or this permit shall be TEL STATISTI L CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. z LICENSED CONTRACTORS DECLARATION UC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLA55 BK. PG, VALIDATION SO. FT. NO. OF NO. OF CHECK License Number - Lic. Class SIZE STORIES 2/ FAMILIES ONE ❑ VALUATION Contractor Date DESCRIPTION OF WORK NEW I - ADD EJ $ Elam exempt under Sec. Lf.rGA S F n n ft6 G_ ALTER El $ B.BP.C. for this reason (t!J A401 REPAIR Date: USE OF EXISTING BLDG. DEMOL Signature APPLICANT TEL. (PRINT) - NO FINAL OWNER-BUILDER DECLARATION DATE here y affirm that I am exempt from the Contractor's License _ Law or the following reason (Section 7031.5, Business and ADDRESS FINAL Pro scions Code): PRESENT By BUILDING r as owner of the property, or my employees with ADDRESS Fit..�.f .A wages as their sole compensation,will do the work and - U the structure is not intended or offered for sole(Section LOCALITY , ��Z307 ��(�.5_� 7044, Business and Professions Code.) MOVING TEL. _ El1, as owner of the property, am exclusively contracting CONTRACTOR NO. n I ITEMS licensed contractors to construct the project (Sec- ADDRESS TOTAL 60 -cQ tion 7044;Business and Professions Code.) REQUIRED YARD 'HWY TOTAL SETBACK FROM EXIST. i- i05101CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH CHECK cr I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. CHANGE .0 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name. �`'' n130-00-00101 r+ �^y •t y n0� y Permit Fee 5Ov of/ LDMA Ref. N �ULIJ'I.��IJ1 f1r/ _ Lender's Address 7859 1 All 9:41 I certify that I have read this application and state that the Issuance Fee r LDMA P/C N 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, Total Fee LDMA Perm. N and hereby authorize representatives of this County to enter .. K] the above-mentip d propert for inspection purposes. 7 Z—z fJ SEE REVERSE FOR EXPLANATORY LANGUAGE / Signature of Applicant or Agent Date / WO KE,IRS' COMPENSATIOMDECLARATION ^ hereby.affirm'flat I hove a certificbte.of consent to self APPLICATION -FOR BUILDING PERMIT ,LII IIIS ..insure, or a cehiificotc of)korkers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES - BUILDING AND SAFETY Policy No. oCompany ElCertifiedcopy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS '2 ❑ Certified copy is filed with the county building inspec- BUILDING tion department. • ADDRESS ) ��•y2 2+ ���j �G//'/JOLE G 7` Date Applicant CITY l Li Cil , ZIP /S Q LOCALITY NO. OF BUDGE. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. E� COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) OWNER y /' g- L NO. J TEL. J� —/y USE ZONE MAP certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner ADDRESS )..2 � SPECIAL CONDITIONS d so as to become subject to the Workers'Compensation Laws. ? O CITY Y G f ZIP /7d D Date Applicant ARCHITECT OR �t TEL. 7J > Of NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER __fS C�/l/J CrJ.V.>J NO. 4,?o 'DISTRICT G OUP CQN$T. FIRE E TYPE PROCESSED BY rOr Exemption, you should become subject to the Workers' A V Compensation provisions of the Labor Code, you must forth- ADDRESS 4 Iz 2 �(O y � 0- with with comply with such provisions or this permit shall be TEL. STATISTICAL CLAS IFICATION APT CONDO. N deemed revoked. CONTRACTOR NO. z LICENSED CONTRACTORS DECLARATION , I LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. ACCT A and Professions Code,and my license is in full force and effect. CITU CLASS BK PG y tlXIDATION SQ. FT. 2 NO. OF NO. OF CHECK ��rr��ff p7>a 1t. License Number Lic. Class SIZE 3 STORIES FAMILIES ONE JJ07 u+'8• VALUATION O 0 1 ITEMS Contractor Date DESCRIPTION OF WORK 1�7 )/� NEW $ 139 DDD. ❑I am exempt under Sec. _ A //rz' /L/l.J ADD ❑ ► TOTAL 828 - 12 823.12 ALTER B.BP.C. for this reason EDREPAIR EJ $ CCHECK. G USE OF Date: EXISTING BLDG. DEMOL ❑ CHANGE •Du Signature APPLICANT 'TEL. FINAL �. ' OWNER-BUILDER DECLARATION (PRINT) NO. DATE 'O 1 hereby affirm that I am exempt from the Contractor's License 0000'1001 9�11/�O 9 Low for the following reason (Section 7031.5, Business and ADDRESS FINAL 4, •� Professions Code): PRESENT _ By _ / •5616 1 AM V•42 ❑ I, as owner of the property, or my employees with BUILDING ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY " t 7044, Business and Professions Code.) MOVING TEL. , / `. t ❑ CONTRACTOR NO. • '1 , I, as owner of the property, am exclusively contracting ` I ., 1 with licensed contractors to construct the project (Sec- - ADDRESS - `� •,4 ` ,•ACCT.A tion 7044, Business and Professions Code.) _ •T REQUIRED YARD HWV TOTAL SETBACK FROM EXIST. D' CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH 3307 .. .754 I hereby affirm that there is a construction lending agency for FRONT r r the performance of the work for which this permit is issued P.L. T, 1 ITEMS (Sec. 3097, Civ. C.). SIDE it P.L. Tr3TAL 984 - 75, Lender's Name LDMA Ref. q ` f-BECK X924.75 P.C. Fee S • Permit Fee 11613 Lender's Address / s �+ CHANGE ,01I I certify that I have read this application and state that the Issuance Fee /O i,5 O LDMA P/C q above information is correct. I agree to comply with all County Invesngmion Fee �{ Rordinances and State laws relating to building construction, Total Fee U LDMq Perm. q 13000-1001 11n6f''9 a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 68840 1 AM10:11", SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote