HomeMy Public PortalAbout9132 DUFFY ST_Building__ NT OF BUILDING AND
DEPART COUNTY OF LOS ANGE ESAFETY B U 0 LOL"J')' 0 N UI
WM. J. FOX, CHIEF ENGINEER APPLICATION.
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK. OR REC.NO. PERMIT NO.
ADD RE69 ✓✓ V li' n
RECEIVEDBY DATE CO/F APPL. DATE(1/09UEDy
LOCALITY I J 'f L — I/
NEAREST
CROSS ST. BUILDING
ADDRESS 3.Z U 1E I
OWNER
MAIL / LOCALITY /TX /' ^f
ADDRESS c D 4 �. NEAREST
BT. O
CITY ` TE FIRE NO.OF q - TYPE GROUPS /G
ARCHITECT OR TEL ZONE PLANS
ENOINEER NO. BLDG. / /'C.O� :NO.
r SETBACK LINE O � �7
ADDRESS / ' USE �� APPROVED
y TEL ZONE BY DATE
CONTRACTOR NO. q HOUSE NUMBERING
ADDRESS MAP NUMBER_A0 0` NO. ASSIGNED BV
LEGAL CORRECTIONS
DESCRIPTION LOT NO. BLOCK _
TRACT �L �J 7
NO. Or S.
SIZE OF LO((((T---- �o, Y777T
' a NOW ON LOT
USE OF /` NO. OF -� �✓1��r� ✓ C
EXISTIN BLDG. I FAMILIES •>rJ� n y�� -- /
DESCRIPTION OF WORK r J zD_
NEW I x ALTERATION ADDITION Z
GOOD/YI.ON H/OGIL/�n�t f
REPAIR DEMOLITION
00• FT. NO.OF'
SIZE / D � O ROOMS `7 STORIED
EXT.WALL '7� ROOF o o -
COVERINO�i( �_�� I COVERING. /
USE OF STRUCTURE
a
INSPECTION FOR APPROVALS
OCCUPANCYAS INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION C
FORM,, MATERIAL, ,-.,�,.�,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION DIVEN IS FRAME: FIRE STOPS, 1,2 /
CORRECT. BRACING, BOLTS n.. ....�. /
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES /.
FURNACE: LOCATION,
AND STATE LAWS REGULATING BUILD IN ON9TRUCTION. GAB VENT, DUCTS
SIGNATURE OF ' LATH, INT. Y / �Z-
PERMITTEE_ ^ /
dl .) - 4
LATH, EXT.
ADDRESS-1p
�— PLASTER, INT.
AUTHORIZED ADT.
PLASTER, EXT.
P6D / P..O y / ra /.
FEE ./ HOUSE AND POS ED
,.+yJCOR-
RECT AND POSTED /¢�C
VALUATION (N FEE ®JL -- FINAL
76A63BA OB53 7-$1 ,
WORKERS' COMPENSATION DECLARATION a
hereby affirm that haver certificate of consent to self �ppL0CQ7p0 .FOR BURMNG PERWT
insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800,.Lab. 'C�)/ -. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy NoftLTOC f /Company A—Vidal
BUILDINGn
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 13 2 Jpup S�
�—Certified copy is filed with the county building inspec-
//��1 •� BUIDLDEING 13"SS
AD
tion dep imenf. CIL — _.
V Y 5 a LOCALITY
C,
Zip1
G
Date Applicant NO.-OFBLNEAREST
CERT ICATE OF
EXEMPTION FROM-WORKERS' ' SIZE OF LOT NOW ON LOT CROSS ST. W I1
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK I PAGE PARCEL
hundred dollars ($100)or less.) 1 TEL.
OWNER NO �.SV USE ZONE MAP
NO. U 242
1 certify that in the performance of the work for which thisSPECIAL }
permit is issued, I shall not employ any person in any manner ADDRESS - ` CONDITIONS O
so as to become subject to the Workers'Compensation Laws, V
CITY ZIP
Date Applicant ARCHITECT OR TEL.
PP ENGINEER NO. -DISTRICT GROUP TYPE FIRE
;PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of CONST ZONE
Exemption, you should become, subject to, the Workers' w
Compensation provisions of the Labor Code, you must forth- ADDRESS '� 1� O.
with comply with such provisions or-this permit shall be TEL - TATISTICAL CLASSIFICATION At. CO N
deemed revoked. CONTRACTO �- NO. (0=3rlZ - 1 Z
LICENSED CONTRACTORS DECLARATION gDDRES; NO. y c CLASS NO.�DwELL. UNITS_
I hereby affirm that I am licensed under provisions of Chapter 9 - SEWER MAP
(commencing with Section 7000)of Division 3 of the Business /� 4 ` / LIC. �0 _i —I
and Professions Code,and my license is in full force and effect. CITY , A - /�) CLASS l_ BK.
J PG., \ VALIDATION
,,'' 9q SQ. FT. NO. OF NO. OF CHEC
License Number4UG1 [/8l -Lic. Class SIZE STORIES FAMILIES ONE
G VALUATI N \ 1
Controcto��'O?J Date 30 / DESCRIPTION Of WORK = —_ NEW / !
ADD ❑
$ V taC(t i
❑ am exempt under Sec — - [[,i I
U ALTER ❑ - D jl}� :I]
8.8P.C. for this reason W rt c S REPAIR ❑ $ 1 ITEC—
' Date: EXISTING BLDG. DEMOL ❑
TOTAL
59 - 25
Signature A PNT) TEL
OWNER-GUILDER,DECLARATION. PINT
� NO_S -3 52Z FINAL
DATE-2 CHECK
5925
.
I hereby affirm that I am exempt from the Contractor's License '
Law for the following reason (Section 7031.5, Business and ADDRESS 3 L OCiJ v U \�"J. FINA ��. (:Mat ,LII
Professions Code): PRESENT .- - BY
❑ I, as owner of thero ert , or m employees with BUILDING
P P Y YADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for'sole(Section LOCALITY i {
7044, Business and Professions Code.) MOVING _ - TEL.
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed contrbctors to construct the project (Sec: ADDRESS
tion 7044, Business and Professions Code.)
REQUIRED TOTAL SETBACK FROM EXIST. ... -
- CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT 2o O Z O
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L.
Lender's Name '
$ - /I 8: � LDMA Rel. p
P.C. Fee; Permit Fee "f'CJ
lender's Address -
a I certify that I have read this application and state that the Issuonce Fee 10 t S a LDMA P/C It- D
8 above information i e to comply with all County Investigation Fee q
or In tate laws relating building construction, Total Fee I -2S LDMA Perm. q
m and h y uthorize•representativ of this County to enter
upo the ab - nfio pr p for ection u oses.
�'9 S�
SEE REVERE FOR EXPLANATORY LANGUAGE
not o A lice or A Dale