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Home My Public Portal About5333 FARAGO AVE_Building__ a ' 76AGSOA CE#80911157 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN CONST pe rlG� BUILDING ADDRESS STATISTICAL CLASSIFICATION / CLASS NO DWELL UNITS LOT NO BLOCK MAPS {.� STATE NUMBER YES NO TRACT fj,L t ►I ^ USE ZONE SPECIAL SIZE OF LOT T.7 /� �D u NOW ON LOTSI CONDITIONS USE OF EXISTING BLDG BUILDING EXIST Q SETBACK YARD HWY S REET NAME WIDTH OWNER � 81 FRONT �( MAIL 72A- I P L ADDRESS /1- so Al Is B , .y h, SIDE TELCITY NO /d P L INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO ADDRESS rt CONTRACTOR C NO n � ADDRESS 272-A- S /A J;. 1 B , DESCRIPTION OF WORK NEW Y ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF I SIZE /� STORIES FAMILIES USE OF STRUCTURE IRE.,S cb+ a S rp, 'PL A ld & s o SIGNATURE OFakk _A 11tW APPROVALS APPLICANT 1 ��^^ DATE INSPECTOR S SIGNATURE ADDRESS /" �� FOUNDATION LOCATION kyr �/ FORMS MATERIALS $ S FRAME FIRE STOPS FEE BRACING BOLTS f1i .Pr VALUATION FEE $ FURNACE GAS VENTDUCTS LOCATION I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT �� J PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND X9 STATE LAWS REGULATIN 4 BUILDING CONSTRUCTION LATH EXT 7 7 SIGNATURE OF HOUSE NUMBER COR PERMITTEE RECT AND POSTED A !/ ADDRESS Z�� FINAL �CLYDE N DIRLAM PRINCIPAL STRUCTURALSENGII`IEER PLAN CHECK VALIDATION K M o CASH PERMIT VALIDATION K mo Q"H LAC0 3,9 7 2 AUG 18 2 3 ,A 8 3 8 A F 111,03978NO AUG 18 1 A 3350 WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION. FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY W-I�iOlo'b=E Policy No. Company Cad•!- C.Olylp JAUDID ING ' (❑�qq Certified copy is hereby.furnished. s//�9a FOR APPLICANT TO FILL IN ESS 33� �l Certified copy is filed with the county building inspec- BUILDING t tion'department. ADDRESS FARAGO AVENUE, #5333 6ci-Ul-�'12 MASSIE�di�Ftl�l6 CITY `TE[9i LE CITY ZIP 91180 LITY Date Applicant NO. OF BLDGS. EST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE'OF LOT NOW ON LOT S ST. COMPENSATION INSURANCE SOR (This section need not be completed if the permit is for one TRACT BLOCK' LOT NO. BOOK PAGE PARCEL hundred dollars ($100).or less.) TEL.OWNERFLORENCE FITZGERALD N0818 448 452ONE MAP I 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 5333 FARAM AVUM- SPECIAL > CONDITIONS d so as to become subject to the Workers'Compensation Laws. O CITYTEIVPLE CITY, CA zIP91780 Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making.this .Certificate of ENGINEER NO. CONST. ZONE 0O Exemption, you should become subject to the Workers' �i 2 Compensation provisions of the Labor Code, you must forth- ADDRESS �0 J with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked.. CONTRACTORMASSIE ROOF NG N0818/726322F7 Z LICENSED CONTRACTORS DECLARATION . LIC: CLASS NO. � DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 254'8 E. 'NALNUT ST. NO. 501048 SEWER MAP LIC. (commencing with Section 7000)of Division 3 of The Business PASADENA, CA 91107 LIC. C-39 and Professions Code,and my license is in full force and effect. CITY BK PG VALIDATION ��`O le C_3g SQ. FT: NO. OF FA OF CHECK License Number 7 Lic.'Class / SIZE STORIES FAMILIES ONE VALUATION Contractor_Mkst)i G KtziI''mUcite It' 36'- 92 DESCRIPTION OF WORK I-= & GAIL: RUff)VE NEW ❑ 3 3,5� t�U El I am exempt under Sec. Z �S R001' Dr y r'ZSiAT,T, DRIP ADD El -7 Poo.ALTER -1 B.&P.C. for this reason =1 U\DEtZLAY= & FIBEPCIA"'DS 3 EPAIR ❑ Date: USE OF. EXISTING BLDG. DEMOL ❑ Signature APPLICANT t TEL. FINAL OWNER-BUILDER DECLARATION - (PRINT), NO. DATE I hereby affirm that I am exempt from the Contractor's,License Law for the following,reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By " BUILDING ?'."•;'° ❑ 1, as owner of the property, -or my employees with ADDRESS wages as their sole compensation,will do the work and F_1P_ T, ; the structure is not intended or offered for sale(SectionLOCALITY 7044, Business and Professions Code.) MOVING' TEL. , El1, as owner of the property, am exclusively contracting CONTRACTOR NO. } with licensed contractors to construct the project (Sec.- .0s. " ADDRESS W tion 7044, Business and Professions Code:) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH " I hereby 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 P.L. Lender's Name, LDMA Ref. # ' P.C.,Fee$ Permit Fee o - Lender's Address y� 7 »e 0 1 certify that I have read this application and state that the Issuance Fee /" /� LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee j S 8 ordinances and State laws relating to building construction, Total Fee f LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date