HomeMy Public PortalAbout5120 FARAGO AVE_Building__ 76A63F,.S'CE#803-10-56 APPLICATION FOR BUILDING PERMIT 1.
BUILDING AND SAFETY DIVISION Bu DDRESBUILDINGAa4 A
Department of County Engineer
County of Los Angeles LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP I TYPE SEWER MAP_
FOR APPLICANT TO.FILL IN , BK_ PG
BUILDy T� CONST
NG
ADDRESS 51&6 Et Farago, Temple Citi STATISTICAL CLASSIFICATION
LOT NO. BLOCK B CLASS. NO. DWELL. UNITS�I
oy MAP S STAT YES
TRACT 1.149! NUMBER
HWY
USE ZPNE SPECIAL
NO. OF BLDGS. CONDITIONS �-
SIZE OF LOT 75 taux.' 2-C I NOW ON LOTUSE a3 '
' EX STO NG BLDG. Delling,carport & shed BU�®� EXIST.
SETBACK YARD. HWY_ STREET NAME WIDTH
OWNER Andrew Grady FRONT
MAIL - P. L.
ADDRESS 5116 N. Farago SIDE
CITY Ttpl @ Citi NpIT% '8.7766 P. L.
INSPECTION RECORD
ARCHITECT OR TEL. _-- //
ENGINEER NO. hPG
ADDRESS
Santa Anita TEL.
CONTRACTOR q NO. EL 8°011
ADDRESS Al'. umlnffigton Dr. ,I$Onroyi - -
Ay
DESCRIPTION OF WORK Aa "' v,--elf 0/G� rs_^
NEW g ADD ALTER REPAIR DEMOLISH
SQ. FT. 1145fIiOOG NO. OF 1 NO. OF 1 � / A 7
.
SIZE STORIES FAMILIES
USE OF STRUCTURE
Duelling and Attached Garage
//6-1APPROVALS
SIGNATURE OF
APPLICANT DATE' INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
FORMS. MATERIALS
SP.C. $ Q FRAME: FIRE STOPS.
j3 ® i BRACING. BOLTS
FEE
VALUATION $ FURNACE: LOCATION.
FEE � GAS VENT. DUCTS 1 f ✓`
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH AJ, UINPNCES AND LATH. EXT.
STATE LAWS REG DING TFOJCTiON. —
SIGNATURE 01y';;
HOUSE NUMBER COR-
PERMITTE - RECT AND POSTED
ADDRESS FINAL
JOHN A.LAMBIE, COUNTY ENGINEER, CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION c m.o. cA.H
to
To 5 3 5 7- DEC 2 6 1 6 1 5.5 0 �
5 4 O U, DEC 3 0 1 3. 1 -00
v
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS
or a certificate of Workers' Compensation Insurance, or a certified
copy thereof(Sec.3800,Lab.C.) CITYZIP
Policy No. Company 1&442Ce �� C 9 LOCALITY
SIZE OF OT NO,OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. 5-49,f z, 5R NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE NE MAP /� t .y7•y
Date Applicant ASSESSOR MAP BOOK/j h�� PAGEDO A PARCELO� - SPECIAL CONDITIONS
7 r� /
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER Zz// / TEL NO.
COMPENSATION INSURANCE I� /V d -T92-/eh WITHIN 1000 FT.OF SCHOOL? ves NO
(This section need not be completed if the permit is for one hundred ADDRESS
dollars ($100)or less.)
O DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
CITY ZIP
I certify that in the performance of the work for which this permit �� r 0 //r�J � � ®
is issued, I shall not employ any person in any manner so as to
ARCHITECT OR ENGINEER TEL NO. "'�` �� l
become S bject.to the Workers' ompensation Laws. _ STATISTICAL CLASSIFICATION APT CONDO
Date�' g Applicant {� O/!L/1J 1� C- 641 l7 ADDRESS CLASS NO..s 2i DWELL UNITS
NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED' TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CONTRACTOR / TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith �L C/v FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L
LICENSED CONTRACTORS DECLARATIONSIDE
CITY LIC.CLASS PL
I hereby affirm that I am licensed underprovisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO,OF STORIES NO.OF FAMILIES SEWER MAP d
Professions Code,and my license is in full force and effect. NEW ❑ BK PG /a' ® O
RI TON OF WORK U
DESC
License Number Lic.Class ADD Ja' VALUATION �
Contractor Date !►.JLI �� cn 7L ALTER $ OQ 0—
U
W
❑ I am exempt under Sec. " REPAIR ❑ $ N
BAP.C. for this reason 1:1Z
LDMA P/C#
Date: USE OF EXISTING BLDG. UR ❑
Signature APPLICANT(PRINT) TEL 0. y LDMA Perm# +:-
I,.as owner of the property, or my employees with wages as ,v S L 1 ellA� Q "'��Z-1,a 1 Z -•-• a
their sole compensation, will do the work and the structure is ADDRESS 0 H
not intended or offered for sale (Section 7044, Business and FINAL DATE
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
licensed coo
❑ aS OWn Of the property, am exclusively contracting 4AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 5
licensed to construct the project (Section 70444,, YES❑ No❑
Business and Professions Code.) E } _,T
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING -K--- C-' '
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ) ✓ ';;1.J3_, •�• e°tJ
CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 1,/l I _
GUIDELINES.
I hereby affirm that there is a construction lending agency for =�='
'YES❑ NO❑ _ _
a the performance of the work for which this permit is issued(Sec. 5P5-
W (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 11=�f••II•-. ���'t••�� •i"
3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS L//!// "''
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. i�l_
1-r `:!: _._
o Lender's Address
OWNER OR AGENT
o I certify that I have read this application and state under penalty r
0 of perjury that the above information is correct.I agree to comply P.C.FEE �0 J PERMIT FEE
N with all c my ordinances and Sta a laws relating to building
mconstructp , and hereby autho'ze re resentatives of this County ISSUANCE FEE
to enter up the above-med prop rty for irispectio urpo
INVESTIGATION FEE TOTAL FEE
Sgrature.ol AP Kant or Agent Date �J
SEE REVERSE FOR EXPLANATORY LANGUAGE