HomeMy Public PortalAbout4903 FRATUS DR_Building__ G -
76A688A`CE#809.7 56 APPLICATION FOR BUILDING PERMIT 1
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
Department of County Engineer
County of Los Angeles LOCALITY
JOHN A LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN, SUPT OF BUILDING CROSS ST
TMA DISTRICT GROUP ITYP E SEWER MAP
FOR APPLICANT TO FILL IN BK
Alf/
CONST
BUILDING /��/1� _�r��C�� f� � STATISTICAL CLASSIFICATION
ADDRESS/s J('�l� / .y
LOT NO / C.J BLOCK CLASS NO DWELL UNITS
MAP STATE YES O
NUMBER HWY
TRACT vC Ci U ZONE SPECIAL
Q NO OF BLDGS ONDITIONS
SIZE OF LOT SL) V 2— / I NOW ON LOT
USE OF 0 ee
EXISTING BLDG BUILDINGEXIST
[� SETBACK YARD HWY STREET NAME WIDTH
OWNER Q G�LI� FRONT
MAIL P L y _
ADDRESS ,� �- S�v► y SIDE
CITY S A n NO
"� b'IG
TEL
P' L
INSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO
ADDRESS _ I;•
� h'{'_'/ 1 x'� L P''t' )V-_� > _/ ms A
CONTRACTOR Aj !�" IAIeb NO /7•J"�7�I'd t I
L
ADDRESS �7�'
DESCRIPTION OF WORK -
NEW /---ADD ALTER REPAIR DEMOLISH
SQ FT ,'T NO OF /NO
SIZE ,J (,J STORIES ES _
SE OF STRUCTU � �G�^� ��a��
S ia.r, 4P
APPROVALS -
SIGNATURE OF
APPLICAN ' Ste+ DATE INSPECTOR S SIGNATURE
ADDRES7� •Z. J^�ll�°t - ��• FOUNDATION LOCATION
FORMS MATERIALS
rFEE
BRACING BOLTSVALUATIONFURNACE LOCATION
E GAS VENT DUCTS A
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND u V
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH EXT
STATE LAWS REG ULATI BUILDING CO ST CTION ,
SIGNATURE OF HOUSE NUMBER COR- _
PERMITTE ' S RECT AND POSTED
ADDRESS �� _ FINAL
JOHN A LAMBIE, COUNTY ENGINEER CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATI c cK M o CASH PERMIT VALIDATIO m o CASH
LAC0 7 248 -U) APR 16 16 - 6.51)
'LAC07249� R16 1 2600
I \�\
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate 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
Polic No V d/ Company ^5� � `�G.10 j
Certified co is hereby furnished FOR'APPLICANT TO FILL IN BUILDING q
copy y ADDRESS //3 7 b
❑ Certified copy is filed with the county bt g inspec- BUILDING _
tion department ADDRESS /
Date 11L Applicant CITY G T ZIP / LOCALITY
NO OF BLDGS NEAREST
CERTIFICATE OF EXEMPTION FR WORKERS' SIZE OF LOT NOW ON LOT CROSS ST Rio hOrd O
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 ) TEL ,�7 f7 USE ZONE MAP ,I1lJ�_1 2
OWNER /r Q NOOi G'/ � � NO /7 -/7 O'
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 i' CONDITIONS °'
so as to•become subject to the Workers' Compensation Laws 0
CITY 7TIVIOLEel"ITY ZIP-.217
Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY d'
NOTICE TO APPLICANT If, after making this Certificate of ENGINEER _ NO _ CONST' ZONE
Exemption, you should become subject to the Workers' iD
Compensation provisions of the Labor Code, you must forth- ADDRESS , �aS �J 1�6GL��� to
with comply with such provisions or this_permit shall be TEL / STATISTICAL CLASSIFICATION APT CONDO Z
deemed revoked CONTRACTOR - NO t� z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / O *Q3177 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business LIC
and Professions Code,and my license is in full force and effect CITY Q C CLASS Lv BK PG VALIDATION
oo SQ FT NO F NO OF CHECK
�J
License Number /72 Lic Class C 7 SIZE STORIES FAMILIES ONE
- VALUATION ,�}� _
r.�/� ��/y �� DESCRIPTION OF WORK JC NEW ❑ �0C9
Contractor ArF�t �J/'k Date
ADD ❑ s / ►
❑I am exempt under Sec ALTER ❑ Ell t i T.
B&P C for this reason p `rl�/��17 A 9 REPAIR s �1r`
ate USE GING BLDG ��Y,J N� � 'SS DEMOL 1
IT �t I
APPLICANT TEL /�
Signature (PRINT) tllrr 0�}Ra� NO�B)-avg FINAL TOTAL 105- 25
OWNER- ER DECLARATION
DAT
I hereby affirm that I am exempt from the Contractor's License �j t7^ n n t_HECK =°yc
ADDRESS U l / ��/ FINA
Law^for the'foll'owmg reason (Section 7031 5, Business andW-1
Professions
the,
` ` PRESENT By �.^ ifiANGE It'
❑ 1, as owner of the ro ert or m em to ees with BUILDING &- y4j
PP Y. ' Y P Y ADDRESS
wages as their sole compensation,will do the work andthe structure is not intended or offered for sale(Section LOCALITY � IIIsU'I�IJI7 rSi t
7044, Business and Professions Code )' MOVING TEL M
❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO (ii! 1`
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code )
REQUIRED YARD HWY TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK 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 PL ^
(Sec 3097, Civ C ) SIDE
PL
Lender's Name
LDMA Ref #
PC Fee$ Permit"Fee
Lender's Address
1 certify that I have read this application and state that the Issuance Fee LDMA P/C#
0
8 above information is correct I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee � . .a LDMA Perm #
a and by authoriz epresentatives of this County to enter
u e above-m toned prop ty for inspection purposes `
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig re of Applicant or Agent Date