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HomeMy Public PortalAbout9161 FORTSON DR_Building__ ,76A638A CElf'8a3'B-64 APPLICATION FOR BUILDING PERM - COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BJOHN A. LAMBIE. COUNTY ENGINEER UILDING AND SAFETY DIVISION LOCALITYA4121CI 1 :2L = NEAREST' COLEMAN W ANKINSALIP'T OF'BUILDING CROSS ST. n DISTRICT O: GRO P-', TYPE P CE D/BY FOR APPLICANT TO FILL IN, cONST. BUILDING .: STATISTICAL CLASSIFICATION SEWER MAP " ADDRESS .- - BK PG YI• CLASS NO. DW ELLU NI TS ,/ LOT NO. - BLOCK USE ZONE 'MAP NO. TRACT SPECIAL' ✓ - NO. OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT ` USE OF - 'E (STINGBLDG. SLOG. SETBACK FROMit / -- TEL. f FRONT PROP. LINE OF-A, (STREET) - OWNER J' NO. ` TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS .� HIGHWAY IDTH 'F Om C L. CITY ` BLDG. SETBACK FROM, ARCHITECT OR - TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. " TYPE OF EXISTING SETBACK HIGHWAY + YARD. = TOTAL ADDRESS - HIGHWAY WIDTH FROM C L. CL TEL. + = O CONTRACTOR NO U LIC. CORNER CUTOFF YES NO w 'ADDRESS NO - O LIC CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS- G W DESCRIPTION OF WORK CL NEW tAD ALTER REPAIR DEMOLISH SQ.FT. ''NO. OF NO. OF SIZE STORIES ' FAMILIES USE OF a ,M•* STRUCTURE - / .� SIGNATURE OF APPLICANT - VALUATION$ -� APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT. To FOUNDATION, LOCATION � F. FEE$ .- FORMS, MATERIAL_S___ A FRAME, FIRE STOPS; j.5`•I�(^�'.../ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT OA af`4 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION / WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 3U ILDI NG CONSTRUCTION I CERTIFY THAT IN DOIN THE WORK AUTHORIZED HEREBY I W NOT EMPLOY ANY PERS N IN VIOLA- LATH. INT. - TION OF THE LABOR C E.O THE STATE F CALIF NIA RELAT- _ / ' ING TO WORKMEN'S C ENS ION I U o7if y`" LATH EXT. _ (� n ,/•'yI Y SIGNATURE OF - ,HOUSE NUMBER COR- P �• , ERMITTEE RECT AND POSTED ADDRESS F.( N A L c U��'✓�j JOHN F. LEWIS. PRINCIPAL ST C RAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK. M O. CASH �f',�o0 4 6 9�. .AP, R13 1 D g.0 �� :7 S j. ,-16A638A CE✓8'03'2-63 APPLICATION, FOR -BUILDING'.P.ERMIT COUNTY'OF LOS ANGELES BUILDING DEPARTMENT OF`COUNTY.ENGINEER,. ADDRESS. F5, - ` BUILDINGO . AL AND SAFETY DIVISION LOCALIT ', 'JHN , AMBIE, COUNTY_ENGINEER NEAREST, „y ... ;WILLIAM,A.*JENSEN, SUP'T,rOF BUILDING CROSS,ST y DISTRICT N02A GR TYPE P -' R CE BY FOR APPLICANT TO`FILL IN coNs . BUILDING _ STATISTICAL CLAS FICATION S ER MAP - K -P ADDRESS CLASS'NO' 'DWELL UNITS - LOT.NO. " BLOCK - WATER' - ',.. NOT REQUIRED RECEIVED, • CERTIFICATE: _ ?, : HIGHWAY ,STATE MAJOR SECOND OCAL ' NO.OF BLDGS. - NOC/'�• ccIRCLE> .SIZE OF,LO�, NOW ON LOT.' USE ZONE SPECIAL _ USE OF- 1 - CONDITIONS ' EXISTING BLDG m - - OWNER i 6L - U LD NG - EXIST.-., YARD HVJY_' STREET NAME _SETBACK WIDTH-' - ADDRESS - FRONT •" ARCHITEC OR _ TEL - 'P 1- ENGINEER NO.. •,.'SIDE' - - _ P L ADDRESS al. '- 'TEL - .w••'=il. - - • _LAA_ O COtJTRACTO NO44- V ADDRESS ,, tv' ,. '/ r<N : •�..Sa••�f 0 DESLu CRIPTION OF- WORK." /'�� �"�• - � .. .a �//•r�iA1 r � NEW ,ADD ,- ALTER •REPAIR D_EMOLISH"' yj/e�yg,, ,O SQ - NO OF NO OFA, ,/ ,r�';'YrrR�Z/ �.J�p ' .\..�.f��'- r SIZE - STORIES / FAMILIES, 71�r r USE OF - _ •�% J%/ID+.J.�•'}�7 (�?'. _ " sY. �.�r� 4 �'-':x-10 L+� . STRUCTURE APPLICANT, •SIGNATURE'O F-. �=- a �•-��sf-• �In. - ��.i .Yf. ' � �; 1 • APPLICANT• VALUATION $ •,, v r[t; I �Lr4fI f< / 0-&' r :APPROVALS DAT,J/E ,INSPECTOR'S SIGNAT;U__RE• PC' •'t - PMT" FOUNDATION LOC`AT.ION 7' F/',� `•• .I FEE '; - FEE $ FORMS.rIv1ATERIALS - - IRA ME• FIRE STOPS, A I HEREBY ACKNOWLEDGE THAT'I HAVE READ THIS:APPLICATION �BRCING,}BOLTS AND STATE THAT,.THE ABOVE IS'-CORRECT AND AGREE TO-COMPLY•'•--FURNACE- LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS, BUILDING CONSTRUCTION'.l CERTIFY THOCA DO[ HE.WORK - _ - • ,AUTHORIZED HEREBY,I .WILL NOT EMPLOIN VIOLA--, LATH. INT- ' '�� '�� J ,/,• ',TION OF THE'.LABOR CoD- 'THE STATIA RELAT.ING TOWORKMEN'S CO ENSA N IN RLATH. EXT.SIGNATURE OF _ HOUSE'NUMBER•COR-PERMITTEE -. RECT AN D-POSTED. ADDRESS ,•~ •FINAL •'02! .. iJOE-IN F. LEWIS. PRINCIPAL' STRUCTURAL ENGINEER PLAN.CHECK VALIDATION cK M'O . CASH _ - PERMIT VALIDATION CK M.G CASH - I' �}� 0 7`47,14 ;� R •.n "1 D 78A888A CE$'808.10.58 APPLICATION FO 6 !i BUILDING BUILDING AND SAFETY DIVISION BADDREssUILDING So Dt Department of County Engineer' .,( County of Los Angeles LOCALITY-TxA4 JOHN A:LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING NEAREST d►4 - f�``�� /'y�/) F CROSS ST /" a DISTRICT NO, CTO. GRQ4J.P_ TYPE .-� S_ EWER. -MAPPG FOR APPLICANT TO FILL IN . / I CO,NST. . /W.�—•BUILD G.'G- ADD EISS / /- OY-�S'Q N D� - STATISTICAL CLASSIFICATION -LOT NO. � _ - - BLOCK CLASS. NOL�_DWELL. UNITS--1 MAP , r5 =STATE YES NO NUMBER L6 U c� HWY •TRACT ��� - LIGE ZONE - SPECIAL,- c-�-+ NO. OF BLDGS. r��, 7 CONDITIONS - SIZE OF LOT4;7 I NOW ON LOT - USE-OF ��+ 4) EXISTING BLDG. '� BUILDINGEXIST. YARD -'HWY STREET NAME SETBACK WIDTH FRONT T - �l' ! MAIL p ADDRESS / Y' 'SIDE - A� s� P. L. CITY j/ /Vt )0/9f 61 y NOA��.��i[� •_ { r " INSPECTION RECORD ` ARCHITECT OR _ TEL. ENGINEER NO. ' �e ADDRESS /t9s��J�1J/ D y Pfl,07tY TEL. — CONTRACTOR NO. - - •-- - ADDRESS - ; - DESCRIPTION OF WORE NEW ADD /'/ - ALTER REPAIR DEMOLISH Y - SQ:'FT: C NO. OF 6 NO. OF / A J3�'�1 1�'r`•aC'J�' ��d`�TI D SIZE STORIES / FAMILIES / USE O .STRUCTU E, —, �'�,-� /-'���1r � �f�r APPROVALS SIGNATURE APPLICANT - DAT/E�•-r/ INSPECTOR'S SIGNATURE ADDRESS FOUNDATION FORMS. MAT LOCATION P.C; S FRAME:-FIRE STOPS. -FEE - _BRACING, BOLTS J� S FURNACE: LOCATION... `//<!)-e VALUATION GAS VENT, DUCTSi h J (j FEE )J ��,. I HEREBY.ACKNOWLEDGE THAT 1 HAVE- AD THIS AP- LATH. INT: A6r) ' PLICATION AND STATE THAT THE ABOVE IS RRECT AND - AGREE TO COMPLY WITH,ALL COUNTY ORD ANCES AND LATH, EXT. STATE LAWS RE BUILDING NSTRUCTION.r SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED•' ADDRESS - FINAL JOHN.A'. LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM, PRINCIPAL-STRUCTURAL ENGINEER PLAN CHECK VALIDATIO cK. M.O. CASH PERMIT VALIDATION_ cK. M.O. •CASH EP;` SEP 30 1" 6 5:5 n A . -- 76A638A CE#_803.8-64 APPLICATION FOR BUILD_ I _ G PERMIT 'COUNTY-OF LOS ANGELES BUILDING DEPARTMENT OF.COUNTY ENGINEER A D D R E ss 2J BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER �Z ' NEA'REST • COLEMAN W. JENKINSSUP•T OF BUILDING CROSS ST _ •DISTRICT'NO. •GROUP- TYPE, ' .P SED BY FOR APPLICANT TO FILL IN, Sf _ Cogs BUILDING L per. STATISTICAL C.6ASSIFICATION SEWVR MAP' ADDRESS / / "/ 'SL�� r CLASS NO DWELL UNITS El PG LOT NO. /V _ BLOCK USE ZONE MAP . - TRACT __ NO. ! , SPECIAL _ NO. OF,BLOGS. CONDITIONS ' ,SIZE OF LOT. S SNOW ON LOT - , ,,t• , USE OF EXISTING BLDG. a BLDG. SETBACK FROM' TEL 2O FRONT PROP. LINE OF � - (STREET) OWNER i O• TYPE OF EXISTING SETBACK HIGHWAY-' + YARD. _ TOTAL' `�. ADDRESS /'�Y R.S �� HI�/j� WAY �I.DT., 'I,SETBACK,] C L. CITY _ i - .� �' -ARCHITECT OR TEL.' BLDG. SETBACK FROM ENGINEER, O - SIDE PROP. LINE OF - (STREET) TYPEOF EXISTING SETBACK HIGHWAY ' +" YARD- _ - TOTAL ADDRESS' - HIGHWAY WIDTH' ' FROM C.L. } a TEL +. = O CONTRACTOR NO V 'ADDRESLIC S NO CORNER CUTOFF YES NO 0 CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS' V _ w ESCRIPTION OF WORK �� Z NEW ADD -ALTER REPAIR DEMOLISH - - SQ.FT. - NO. OF -NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE-- . r r SIGNATURE OF APPLICANT - VALUATION$ y��+/�� ��� `/"•' - APPROVALS -DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION, LOCATION FEE$ FEE$ '—'-` I FORMS, MATERIALS.__. 'FRAME, FIRE STOPS, !' E I HEREBY ACKNOWLEDGE THAT-I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO'COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS J f 6 SUILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK n AUTHORIZED HERESY'1 WILL NOT EMPLOY ANY•PERSO IN VIOLA- LATH INT f TION'OF THE LABOR COD- F THE STAT OF CALIFO NI., RELAT. ING TO WORKMEN'S CO N T N IN u c - LATH. EXT. f SIGNATURE Of - ,HOUSE NUMBER COR- 11 PERMITTEE. I RECT AND POST: E ADDRESS. FINAL IIlG,�i _ ,ddb' - JOHN F. LEWIS. PRINCIPAL ST RA ENGINEER PLAN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION' CK. MO CASH _ I:� 4. S 5 -6',-0, AUlG 2 5 D 2.0 i 0 cz i yJ WORKERS' COMPENSATION DECLARATION ;J . ' ; _ "' "•' I hereby affirm that I have a certificate of consent to self f insure, ora certificate of.Workers' Compensation Insurance, APPLICATION FOR. BUILDING , PERMIT - or a certified copy thereof (Sec 3800, Lab C ) ; - COUNTY OF LOS ANGELES BUILDING AND SAFETY.. Policy No��l�'0`� Company -5TAy'FY�GfAI� Certified copy is hereby fur`ntshe.d FOR APPLICANT TO FILL IN ADDRESS :21/9 62R7S&V T� 'Certified copy is filed with the county building inspec- BUII'DING tion department ADDRESS / b Date Applicanttja4e diy��,IpLF elrX cA ZIP :2,e7ao LOCALITY ' C CERT ICATE OF EXEMPTION FRO ORKERS' NO OF BLDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS S7 (This section need not be'completed if the*permit is for one ' ASSESSOR, hundred dollars ($100)of less ) TRACT BLOCK LOT NO MAP BOOK• PAGE PARCEL'',, , TEL USE,ZONE MAP , I certify that`in the performon'ce' the work for which this - OWNER NO NO permit is issued, I shall not employ any person in any-mannerSPECIAL so"as to become subiect'to the,Workers'Compensation Laws: ADDRESS . (� l�–' CONDITIONS 4 CIT��MpOLEZIP 21zgo Date4?Z6141 Applicant ARCHITECT OR TEL. •NOTI APPLICANT: If, after make this Certificate of ENGINEER NO. DISTRICT GROUP' TYPE FIRE PROCESSED BY - Exemption, you should become 'subject to the Workers' CONST. �ZjONE Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with,such provisions or this permit shall. be TEL AA STATISTICAL CLASSIFI ATION APT CONDO deemed revoked' ; CONTRACTOR NO L'ICENSED'CONTRACTORS DECLARATIONLIC• CLASS NO DWELL UNITS >' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / ('Aj NO. 7 (commencing-with-Section 7000)of Division 3 of the Business and LIC SEWER P'••(� i Professions-Code, and my license is in full force and'effect CITY CLASS BK VpG� VALIDATION SQ. FT 0:1 NO OF NO OF CHECK Li �'• cense Number�$ 7 Licr---Z ClassSIZE ` STORIES FAMILIES ONE Q •� D "O VALUATION V•. DESCRIPTION OF WORK. NEW Contractor• I�/1C117-�1�/P/Jr�EDate7A-44&,2 ADD $ Ell am exempt under Seca L J' b C ALTER B BP.0 for this•reoson " �L rRE lVi- REPAIR $ ' USE•OF ' E] Z1 / Date EXISTING BLDG DEMOL Signature wLD�W APPLICANT j L EL FINAL WNER-B LDER DECLARATION PRINT �r-��e� DAT �—� I hereby affirm that I am exempt from the Contractor's License ADDRESS 7' I'�� C / /' it FI Law for,the following reason,(Section 7031.5, Business and i Professions Code) PRESENT 1 BUILDING r B ❑ .I, as owner•of the property, or my employees with' ADDRESS wages os their sole cornpehsation;will do the work-and ., the structure is not intended or offered for sale(Section LOCALITY' - J �� 156. 00 7044,'Business and Professions Code). MOVING TEL ' with licensed- f the property, am exclusively contracting CONTRACTOR NO I, as owner o contractors to construct the project (Sec- ADDRESS" 53 tion 7044, Business and Professions Code). TGTAL 1^ �+1 0�� ,., REQUIRED TOTAL SETBACK //�.LL��cc��++L�// { CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CHECK 153.00 .I hereby affirm that there is a'construction lendirig.agency for FRONT CHANGE e�� the performance of the work for which,this'permit is.issued P L (Sec. 3097, Civ C.) SIDE P L. Lender's Name CDMA aU -VV3 7/.31/84 P.0 Fee$ Permit Fee 3 Lender's Address ' 477s A�lii4s` g I certify that I hove read this application and state that the ' Issuance Fee above information is correct. I agree to comply with all County Les1,g-t,:on:Fe:-::�,ordinancesandStatelaws relating to building construction, b Total Fee C� © '�DMA•Perm. N and Hereby authorize•representatives of this County_to enter < upon t eabove-mentioned roperty for inspection-purposes ' •SEE REVERSE FOR EXPLANATORY LANGUAGE'D e - Signatu of Applicant or Agent