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HomeMy Public PortalAbout10765 FAIRVIEW AVE_Building__ A ROAD'` DEri P+^'".i 16 f.�:JJIk_D FOR AN( PAA r?izL z)i0RAC1, `•b"DY, r DONr_ 1P4 (HE RCAD RIGriT OF WAY 76A / \l l _Y., 688A CE 9808860 IC AT FOR BUILDING PERMIT ;r =COUNTY OF LOS ANGELES` ADDREISS , /a 7��-D� l `DEPARTMENT, OF-COUNTY ENGINEER ,.� +� BUILDING AND SAFETY DIVISION LOCALITY `Y JOHN A LAMBIE'COUNTY ENGINEERNEAREST 4yyy { �r ��!! - CASSATT D GRIFFIN SUP -CROSS ST _79 OF BUILDING � ` ^ MEzzoommom DISTRICT NOGROUP T�pE PROCESSED BY Y 'FOR APPLICANT,TO� ILLIN F _ , ' ���-- 'T__ 'coNs IBfOILDINGYY, w�a= \ s STATISTICALCLASSIFICATION, " SEWBKR MAP PG -> ADDRESS 0 W�-^ a r CLASS NOLJ—DWELL UNITSI LOT NO >,/!r`^ �SNt �t BLOCK MAP 1 , zt - STATE, „YES'� _ _ NUMBER , AT . TRACT s .. _ o,� USE-ZONE SPECIAL" OF BLDGS CONDITIONS 31ZE NO OF`LOT I NOW ON LOT USE OF c: ¢ aEXISTING BLDG - r BUILDING '` EXIST s ' ; ° F 6 SETBACK , YARD, HWY STREET NAME, WIDTH ' OWNERf > >0 x - dz ,a (1 '•v c FRONT ,MAIL-,,," ADDRESS D Q I SIDE -P L CITY 66yz et Cl�.��=f, No �t'i�g1//3 - _y -,INSPECTION RECORD ARCHITECT,OR _TEL ENGINEER NO ,ADDRESS 'CONTRACTOR NO , ql ADDRESSO �1 ,,�la � , IIN� A A DESCRIPTION OF WORK 1 NEW ,'YADD ' ALTER _, REPAIR DEMOLISH SQ_FT .. /�/ NO OFNO OF SIZE B"/: STORIES '..FAMILIES- USE OF STRUCTURE^�', SNATURE OF UPPPLICANT_ ' ( APPROVALS �" _� DATE INSPECTOR S SIGNATURE R "ADDRESS, �lO !`/Go�7(P+-�lC(�F�QQI(.S/YR f�_ FOUNDATION LOCATION FORMS(MATERIALS ''"" %�'�4 G / VALUATIONt�$ ,��(j �� f " _ / FRAME FIRE STOPS , BRACING-BOLTS P C PMT DU FURNACE LOCATION �� ,GAS VENT DUCTS B/jv$Gyy FEE $2 - PMT FURNACE THEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT PLICATION ANDiSTATE THATITHE ABOVE IS CORRECT AND' ' AGREE�TO COMPLY,WITH,ALL,COUNTY ORDINANCES AND rV •��, ),,,df� �j, ,f , tSTAT,E 'LAWS' REGULATING BUILDING CONSTRUCTION LATH+EXT Q� II ra+sw.6' ` SIGNATURE OF, Ir/�; .-,/.� (�,� /y�� /J Q L, 'Hou ENUMBER COR- PERMI,TTEF µt (�f'�' �^'� vy ('Q ` ERECT AND POSTED ADDRESS ' zfel M� FINAL 1 � t,CLYDE N DIRLAM, PRINCIPALiSTRUCTURAL ENGINEER PLAN CHECK VALIDATION_ cK M O'` CASH ' PERMIT VALIDATION ' CK ' M O CASH s , -3 2,'1:03' KAR- 4 2. 3 A-' _' 2 JJWI V 4.4�S, hAR- g ` l-,A 4,2.G b M 4 �- •lti 4 ' , T APPLICATION' FO R�+``�; J COUNTY, OF LOS ANGELES . .�U�I L D I N G PERMIT ��L' DEPARTMENT' OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING FENGINEER OR APPLICANT TO FILL IN �¢ ADDRESS /47 r��!67. G 5 Lr A ��(%) 1��P LOCALITY ��i-/�J� /� CI �• J I NEAREST m L� '� ZIP CROSS ST e NO OF BL GS ASSESSOR LOT I�� NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P SSED BY �d� BLOCK LOT NO 9 �Q i- Q CONST ZONE / �14[ NO �� STATISTICAL CLASSIFICATION ' _ SEWER MAP 07to ;4L);e J¢�j CLASS'NO 12: UNITS BK PG �" ZIPUSE ZONE/,�J T OR EL /�'� V SPECIALR NO CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR ` TEL NO BLDG SETBACK FROM LIC FRONT PROP LINE OF (STREET)) L ADDRESS NO HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING - '� LIC - - FRONT PROP LINE HIGHWAY -WIDTH CITY CLASS - CONSTR TION NDER + - NAME AND-BRANCH BLDG SETBACK FROM - a SIDE PROP LINE OF (STREET) CD CITY ADDRESS U TOTAL SETBACK FROM TYPE OF EXISTING SQ FT NO OF INC, OF CHECK HIGHWAY + YARD - HIGHWAY WIDTH O SIZE .,3 STORIES FAMILIES ONE SIDE PROP LINE DESCRIPTION OF WORK NEW + LLJ n- 01) ADD CORNER CUTOFF YES ❑ NO ❑ t,�P i nt�e z ALTER [:1 ' rDEMOLEPAIR❑ IN OPEN SPACE t YES ❑ NO E]USE OF IN COASTAL PERMIT ZONE YES NOEXISTING BLDG' ❑ APPLICANT / TEL VV7 yQ�S/ (PRINT) /4i �t/ r NO 7fg !! /V ��w BY (SIGNATURE) kuuliw i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ' s STR UC TION I- CERTIFY THAT IN DOING THE WORK AUTHORIZED - HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE - LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE SIGNATURE OF � FINAL /e7��� BY PERMITTEE DATE 6 ADDRESS D ./-, e&J UC3 r TEL P C'Fee$ Permit Fee CITY 84 NO Q Issuance Fee VALUATION - - - / Total Fee PLAN CHECK VALIDATION CK' M O CAPERMIT VALIDATION,/' cK M O CASH 2,i o? ,j ? 5 0 ` ,fI 76A638A CC*80313 12/75 - , - I WORKERS' COMPENSATION DECLARATION- ` I hereby aff&m that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, - A P P L I CAT I.O N FOR -BUILDING P E RM I T or a certified copy thereof (Sec 3800, Lab C ) _ COUNTYOF LO ' wNGELES BUILDING AND SAFETY Policy No Company BUILDINGt ❑ Certifiedpy"'s k eby furnished FOR APPLICANT TO FILL IN ADDRESS /��6 ❑ �Certified,copy is filed with the county bulling inspec_ BUILDING tion department � " - \ ADDRESS //�%�/y// /J�J��}/(y�rl17777 {y 7 .�/ Ll CITY ZIP LOCALITY �/1f {�[, (/� Date Applicant '11 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 PAGE PARCEL hundred dollars ($100)or less ) - I � TE e OWNER Mr Mr �{1 SAi, " USE ZONE, MAP I certify that in the performance of thew ork for hich Ith y/ NO - - >_permit is issued, I shall not employ any person in y mann r ADDRESS © !V�` �• %V V-/, - SPECIAL O CONDITIONS so as to become subject to the Workers'Compe do w r U CITY 1 Fi'iH. u �1( ZIP U Date. :ant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE O A PLICANT If, ,df r,` a ing this Certificate of ENGINEER -- _ - - NO 1^ CONST _ ZONE- Exemption, ONE__ Exem tion, you should beco ect to the .Workers 2 ,{ U Compensation provisions of th Labor I ode, you mustiforth- _ ADDRESS �� 3 ✓ L� N with comply with such proAtiaD r this,permit shall be r p.� � TEL STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked TRACTOR:j 0 K L� NO — LICENSED CONTRACTORS DECLARATION r V�( LIC v CLASS NO a/ 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 UC SEWER MAP and Professions Code;and my license is in full force and effect CITY CLASS -•�BK PG VALIDATION ' ,y SQ FT NO OF NO OF CHECK ' License Number 1 is Class_ SIZE C STORIES FAMILIES ONE VALUATION Contractor !� I - Date �? DESCRIPTION OF WORK NEW 1:1 $ �oQ B� ❑1 am exempt under Sec &-Pe ADD ► _ a 17 1ALTER B&P C for this reason REPAIR 1:1 $ nffUSE OF 7 e EXISTING BLDG DEMOL ❑ Signature e APPLICANT �1� TEL J' g OWNE ILDER ECL RATI (PRINT) ' _Ai/ .fEC-�- / NO 3I'Z=I( -7 FINAL q / ? I hereby affirm that I exempt from the Contractor's License rr ff t _ - r DATE hJ_Z l/j ACCT.' > Law for the follows g r ason (Section 7031 5, Business and ADDRESS � 3"1 67,ejYui FINAL 1 -t? Professions Code) PRESENTS r �^BY r 3`03 � c0°cl{ r; BUILDING ❑ I, as owner of the property, of my employees with ADDRESS wages as their sole compensation,will do the work and r '1 �r \ s the structure is not intended or offered for sale(Section LOCALITY ► «� t ,', fvACCTos 7044, Business and Professions Code MOVING - �. TEL ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO ) 1'3 13303 22.Z t �,withdicensed contractors to construct the project (Sec- i s ` - '} �i tion 7044, Business and Professions Code ) ADDRESS d �. f ITEM_ REQUIRED TOTAL SETBACK FROM EXIST f{ 1 Y T"TAL` 772 - 84 CONSTRUCTION LENDING AGENCY y SET BACK YARD HWY PROP LINE WIDTH `;�d. 1, O Q 1 hereby affirm that there is a construction lending agency for FRONT _ _ �_. '` CHECN i 772.84 the performance of the work-for which this permit is issued P L a r (Sec 3097, Civ C ) SIDE a r,' CHANGE aCl4� Lender's Name P L )•^r Wit`, _� \J) ti , it LDMA Ref # rn, �}�y i / t P C Fee$ D Permit Fee L]L'�Q-tit�1 7!��,�qC Lender s Address I certify that I have read thi plication and state that the Issuance Fee CTS LDMA P/C#~ �670 1 Frl! J above information correct I a ree to comply with all County Investigation Fee /J 0 ordinances and a laws rel find to building construction, g Total Fee C� 4, �9 LDMA Perm # a reby out ize r s tatrves of this County To enter m upo the abov a ort rope 1 for inspection urpos s �I. �Cp •SEE REVERSE FOR EXPLANATORY LANGUAGE gnatu f Applican or gent Dare