HomeMy Public PortalAbout5032 FIESTA AVE_Building__ A ROAD DEPT., PEMMiT IS REO;U'R55
FOR.ANY MATERIAL STC:RAGP O;R WORK
DONE IN THE ROAD RIGHT OF. WAY.
78A'038A CE#8081�799 APPLICATION FOR BUILDING PE'RMI'T ..-. 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDREss
BUILDING'AND 'SAFETY DIVISION LOCALITY�Qib ?
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN,SUPT OF BUILDING CROSS ST.
DISTRICI N GROUP TYPE
FOR APPLICANT TO FILL IN ,, I
CONST.-:
BUILDING STATISTICAL CLASSIFICATION ,. SEWER MAP
B
ADDRESS Q I-
CLASS.NO. DWELL.UNITS
LOT.NO...^ C NUMBER �D/ HWYE/� YES NO
TRACT. Z'� �- USE ZONE SPECIAL
NO.OF BLDGS. CONDITIO
SIZE OF:LOT r 'I NOW ON LOT /-1---'/ -
USE OF 1
EXISTING BLDG. BUILDING EXIST.
SETBACK YARD STREET NAME WIDTH - \
OWNER jE, W /- FRONT
MAIL ` ./.t JJ P. L.
ADDRESS.`,G �Tr/'%f L%.. C.i7``f/.l.0 G/I� SIDE - - .
�1 TEL.
_CITYl Tr/�,�L c -i 7'y NO.X7'-7&oS4 INSPECTION RECORD, 1,1✓ '
ARCHITECT OR TEL:
ENGINEER - NO.
ADDRESS / ✓ / O
/- TEL. l�Ja»/�i x-A/. Pr A U74 LO
CONTRACTOR /—,J,�!✓ D L NO. 4-c /
ADDRESS .�(�.2 L/�"M l''i.I�' � T
DESCRIPTION OF WORKlz AU_
° _
NEW ADD ALTER REPAIR DEMOLISH 47
SQ. FT. _ NO. OF NO. OF - - -
SIZE Z� STORIES FAMILIES
USE OFSTRUCTURE
SIGNATURE
SIGNATURE OF
APPLICANT - - -
APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS IJ/J FOUNDATION: LOCATION
l FORMS,MATERIALS !
VALUATION $ I FRAME: FIRE STOPS,
BRACING,BOLTS
FURNACE:URNACE: LOCATION., \
FEE '$2-5 FEE $ d I.aGAS VENT,DUCTS
I HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS AP-
PL
P- LATHINT /�,/�p� - .L�,r�(/Q/ �„u"✓-+•�
PLICATION AND LATH, INT.STATE THAT THE ABOVE IS CORRECT AND /
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH, EXT,
SIGNATURE FHOUSE HOUSE NUMBER
COR-
PERMITT !X RECT AND POSTED
ADDRESS 3L FINAL 'r•`� �Cp /'a
CLYDE N. DIRLAM, PRINCIPAL STR' RAL ENGINEER
PLAN.-CHECK VALIDATION ' CK, M.O. CASH PERMIT VALIDATION: .c/ M.O. CASH
I . s 5655 t 23. A 25.5 . ;
la-
WORKERS' COMPENSATION DECLARATION
I Hereby JArm that I have a certificate of consent to self
iraure; or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT
or a certified copy thereof (Sec. 38000 Lob COUNTY COUNTY OF LOS ANGELES BUILDING AND SAFETY
Pohc^No 34Company'�//// �� N JI-w o BUILDING _
/CJ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING u -�
tion department.. ADDRESS
Date La���� Applicant-�3� d
CITY ZIP LOCALITY _ L�
NO. OF BLD S. NEAREST
CERTIFICATE OF EXEMPTION FRO ORKERS' SIZE'OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSUR NCE 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.) TEL' USE ZONE MAP
OWNER NO.7' NO.
1 certify that in the performance of the work for which this - SPECIAL
permit is issued, I shall not employ any person in any manner ADDRESS .� CONDITIONS a
so as to become subject to the Workers' Compensation Laws. Q
CITY C ZIP U
Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY �
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE
Exemption, you should become subject to the Workers' �f� '�/� U
Compensation provisions of the Labor Code, you must forth- ADDRESS __1 X� y�c 4c:. 0-
with
with comply with such provisions or this permit shall be / TEL / STATISTICAL CLASSIFICATION APT. CONDO. N
deemed revoked. CONTRACTOR 1" /! NO.o� �L' Z
LICENSED CONTRACTORS DECLARATIONG LIC. CLASS NO. -;'21 DWELL. UNITS
ADDRESS p�� 3
I hereby affirm that I am licensed under provisions of Chapter 9 c NO.
LIC. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business a
and Professions Code,and my license is in full force and effect. CITY ' W CLASS 3 BK. PG. VALIDATION
Q SQ. FT. rj NO. OF NO. OF CHE K
License Number / Lic.�Class r 7T SIZE STORIES FAMILIES ONE
❑ VALUATI N
Contractor / �(� Date DESCRIPTION OF WORK NEW ADD $ 3 O v
1:1 ,❑I am exempt under Sec. ALTER ❑
BAP.C. for this reason ? z' REPAIR $
411 e: USE F
EXISTING BLDG. DEMOL ❑
Signature G APPLICANT TEL FINAL
OWNER-B DECLARATION . (PRINT). NO. DATE /Z'Z-f 4,L
I hereby affirm that I a /exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL
Professions Code): PRESENT By
BUILDING' �,'g
❑ I, as owner of the property, or my employees with ADDRESS <�
wages as their sole compensation,will do the work and CK ;-' 'syy4j,ii
the structure is not intended or offered for sale(Section LOCALITY , .s 5
7044, Business and Professions Code.) MOVING TEL. Iq
❑ 1+ TEM
CONTRACTOR NO. ' 'I, as owner of the property, am exclusively contracting j;
with licensed contractors to construct the project (Sec- ADDRESST I i j A ��"5 ® J `
tion 7044, Business and Professions Code.) L3 ti,
REQUIRED TOTAL SETBACK FROM EXIST, CHECK 12 u 14
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT -Hr'iNGE iii!I
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L:
Lender's Name, I. 3001'111•I '1/2
mLDMA Ref. #
Lender's Address
P.C. Fee$ Permit Fee 11,4 7157M
,0 1 certify that I have read this application and state that theIssuance Fee LDMA P/C#
above information is correct. I agree to comply with all County. Investigation Fee
0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
and hereby authorize r resentatives of this County to enter
upon thef above-menti ed propert i for inspection purposes.
a / 0 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatur ' Applicant or Agent Date