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HomeMy Public PortalAbout10616 FREER ST_Building__ TEMPLE CH !1 Y 76A!!EA CE#a03,1—E1 APPLICATION FOR BUILDING PERMIT COUNTY OF.-LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 7710116r BUILDING AND SAFETY DIVISION LOCALITY ' JOHN•A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT N GtO S B FOR APPLICANT TO FILL IN 6' [TYPE Y T. ` BUILDINGJ �f(D � STATISTICAL CLASSIFICATION SEWERMAP• ADDRESS' •J / G n CLASS.NO. DWELL.UNITS LOT NO. FA R C LEL Z LO' -.BLOCK (,/ WATER- - NOT REQUIRE CERTIFICATE- TRACT RECEIVED .TRACT. l J YD MAP �J HIGHWAY STATE.MAJOR SECOND, LOCAL NO.OF BLDNO. �[/ © ICIRCLE) SIZE OF LOT © x! 0 D I NOW ON GS.LOT USE ZONE TJSPECIAL USE OF p f / J CONDITIONS EXISTING BLDG. L ' (t1' u OWNER �N �� • ��-LI/{NI'JN0. �lI 6 BUILDING EXIST. r' SETBACK YARD HWY .STREET NAME WIDTH ADDRESS C � ^M A Y� c �� FRONT ARCHITECT O TEL. P. L. (/ ENGINEER - LE NO. SIDE e ADDRESS tz L P L EN GJl� 1 � I TEL."/iJ INSPECTION RECORD O ..CONTRACTOR I"' _ V ADDRESS I 0 k P7Ad J#4"(ZCADIA• DESCRIPTION OF WORK ' NEW VADD ALTER •REPAIR DEMOLISH Z SQ. FT. NO OF NO OF _ USE OF /'+ IZE STORI�EIS �1 FAMILIESi STR CTURE VJ C L Lf � G �F� C— l�'J!!? SIGNATURE OF %lJ,'Aa /1 A p �����.n,•1 �.. Gt'�if•A_�LI�' - APPLICANT ,�nJJ /-'/ VALUATION$/ APPROVALS t DATE, INSPEOYOR'S SIGNATURE PCPMT.FEE $ !' DI FEE $ t 4D FORMS,MATERIIALSON FRAME: FIRE STOPS, (Yc� .. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS S -�� (oL ,/�!/B'w✓� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, If WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WI-L NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. I�_. /,�-- .INY(1-�• TION OF THE LABOR CO OF THE STATE OF CALIFORNIA RELAT-_ ING TO WORKME PEN SATION IN URANCE L+� ATH,EXT. PESIGNATURERMITTEE O HOUSE NUMBER COR- RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRU RAL ENGINEER PLAN CHECK VALIDATION cK M.O. CASH PERMIT VALIDATION cK. M.O. CASH X1100596 "'0 APR 52- 3 D 25.5,Q�} M � fi s 3 6'2 - APR 1g J' D 60.50 WORKERS' COMPENSATION DECLARATION �'d insureboraffirm a certifcatI have a certificate ofte of Workers' Compens 1onsInsurarcce, APPLICATION FbR-.,BUILDING PERMIT or a certified copy th - a ereof (Sec 3800, Lab. C.) ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished.FOR APPLICANT TO FILL BUILDING IN ADDRESS `4�/ ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Date -Applicant CITY ZIP LOCALITY O OF BLDG . NEAREST CERTIFICATE OF EXEMPTION FROM-WORKERS' SIZE OF LOT OW ON LOT "' CROSS S7 - COMPENSATION INSURANCE ASSESSOR (This section need'not-be completed if the permit is foi= 66e TRACT BLOCK " LOT NO. MAP BOOK PAGE PARCEL ' hundred dollars ($100) or less.) TEL OWNER- �j NO '�3 USE ZONE '`MAP l� 7 H X73 NO. 'I certify that in the performance of the work for which this SPECIAL CL .permit is issued, I shall not employ any person in any manner ADDRESS --E( -� CONDITIONS O -so as to become subject to the.Workers' Com ensation Laws. - U r /r cep/, orf CITY l ZIP Dat !7 Applicant ZZ"? ARCHITECT OR TEL DISTRICT GROUP TYPE .• FIRE PROCESSED BY NOTICE,TO APPLICANT: ,If, after makingthis,Certificate of ENGINEER NO. _ CONST. ZONE O Exemption,. you should become subject to the Workers' LU_ Compensation provisions,of the Labor Code, you must-forth- ADDRESS �J Da 5.1 ✓ N _ with comply with such, provisions',or this permit shall be r-�' TEL `7STATISTICAL CLASSIFICATION APT CONDO. Z CONTRACTOR deemed revoked. - '' �SDVLNO- 2— LICENSED CONTRACTORS DECLARATION UC. O CLASS N . DWELL UNITS I hereby affirm that I am licensed under provisions of.Chapter 9 .. ADDRESS Ql (?q L l Q r d_� NO 30 / LIC ,�pp SEWER MAP (commencing with Section y license of Division 3 of the Business CITY � e_r'VL-e_� CLASS 6— ? '7 VALIDATION •and Professions Code,and my license is in full force and effect. BK. PG� / _ //�� ���'' SQ FT. NO OF NO OF CHECK License Number 3 Lic.'Clase� SIZE STORIES FAMILIES ONE VALUATION Contractor 1%VY> 1-YVI��j��'DL DateNX DESCRIPTION OF WORK 1 NEW ,❑ 7t. ,`ADD ❑ $ � pop.❑1 am exempt under Sec. 'd'�Gt-� S f� [ACJ ALTER ❑ BAP.C. for this reason .S 1 Y'l,e REPAIR ❑ $ D t _ USE OF,-- EXISTING BLDG DEMOL ❑ Signature APPLICANT. TEL• FINAL Vi4Pd -BUIL DECLARA ON (PRINT) ,► �jC NOS Z' DATE' -i1`�'�/ " I hereby affirm that I am ex pt from the Contractor's Licensel _ Law for the following reason (Section 7031.5, Business and . ADDRESS 1.1 FINAL Professions Code): PRESENT'. :By M .�.• BUILDING �. ❑ I, as owner of-the' property, or'my employees with ADDRESS wages as their sole compensation,wilbdo-the work and � ✓/`� ` t9 7, m the structure is not intended or offered for sale Section LOCALITY' 1.3 ` --'•• 7044, Business and Professions Code.) - MOVING TEL Pilo" El 'I, as owner.of the property, am exclusively contracting CONTRACTOR NO.- with licensed contractors to construct the project (Sec- ADDRESS - 1 `'s - C�5 tion 7044, Business and Professions Code.) , r' :• r•r.L- •pp'�:" ;=:, F• REQUIRED,- YARD TOTAL SETBACK FROM V EXIST..' RD HWY _ iw-=•i': � . a'_t•_`r CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH y I hereby affirm that there is a construction lending agency for FRONT i:a=t 11' ?F•i '.'the performance of the work for which this permit is,issuedP L " (Sec. 3097, Civ. C.). SIDE Lender's Name p L 's;_sv _: E;.__?: i t LDMA Ref # _- m Lender's Address rmrt Fee �' P C Fee$ Pe 1 certify that I.have read this application and state that the Issuance Fee '7 5 LDMA P/C# , ~' o ' 8 above information is correct. I agree to comply with all County Investigation Feb Q R ordinances and State laws relating to building construction, Total Fee / �/' LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. F•' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of,Applicant or Agent Date