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Home My Public Portal About10679 FREER ST_Building__ 76A6884 CE#809-6-57 APPLICATION FOR BUILDING PERMIT 1 'COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER A°°REss BUILDING AND' SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. •CA% DISTRICT-NO..� GROU I TYPE SEWER MAP FOR APPLICANT TO FILL IN L SK PGS .I CON BUILDING-.1,9& ADDRESS 7 o"'• STATISTICAL CLASSIFICATION CLASS NOrf� DWELL UNITS -✓ LOT NO. /^� • BLOCK. ' MAP STATE TRACT C l• G./ - NUMBER on HWY. YES NO . USEZONE SPECIAL SIZE OF LOT T/ SV ' NOW ON LOTS CONDITIONS' �i USE OF Q V-- 4,e—a /� EXISTING BLDG BUILDINGEXIST. SETBACK YARD, HWY STREET NAME WIDTH - OWNER Ie_..-•- ,FRONT MAIL P.L / ADDRESS SIDE •' TEL ,P.L. - CITY NO. ARCHITECT OR TEL, INSPECTION RECORD,. - ' ENGINEER in NO. , ADDRESS TEL. CONTRACTOR s�j �„,,, NO. - 1107,.- w ADDRESS - - DESCRIPTION OF WORK NEW ADD ALTER •REPAIR DEMOLISH - SQ, FT: NO.OF NO.OF SIZE ' STORIES. FAMILIES USE OF STRUCTURE ' SIGNATURE OF APPROVALS _ APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS , FOUNDATION- LOCATION FORMS,MATERIALS` P.C:a $ FRAME: FIRE STOPS, / FEE BRACING,BOLTS - VALUATION %-: Vic _ $ /®� FURNACE LOCATION, FEE /° GAS VENT,DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- . LATH,INT. PLICATION-AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT&,LL COUNTY ORDINANCES AND - STATE LAWS REGULAT N BUILDING CONSTRUCTION. LATH,EXT. SIGNATURE OF - f HOUSE NUMBER COR- PERMITTEE } - -ERECT AND POSTED ADDRESS FINAL O �� JOHN A. LAMBIE.COUNTY ENGINEER. CLYDE. DIRLAM, P INCIPAL STRUCTURAL ENGINE.ER PIAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH , V 1 39 4 MAR 13- 1 1 .0 0 'WORKE�,R'S'COMPENSATION DECLARATION 'It Aeby;0firm_that I have a certificate of consent to-self - APPLICATION FOR BUILDING PERMIT iiisure, oro certific ite'of Workers' Compensation Insurance, or a certifie2-lcopy thereof (Sec.•3800, Lab. C.) COUNTY OF.LOS ANGELES, BUILDING AND SAFETY " -' P❑oIicy'No: Company Certified copy is hereby furnished. 'FOR APPLICANT TO FILL IN ADDRESS xoi P/YL r .-Certified copy is filed with the•county building inspec- BUILDING // �/ //�� c tion department. ADDRESS ��t0 ',/"/�G LOCALITY e �_ - P. O NEAREST Date Applicant CITY 3L T Zip - '1 •�� CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' 81 x `� ASSESSOR BOO SIZE OF LOT NOW ON LOT MAPK �r PAGE Q PARCEL Cyt COMPENSATION INSURANCE, ,(This section need-not be completed if the permit is for one U NE MAP hundred dollars ($100)or less.) TRACT• d BLOCK. LOT NO. NO. TEL. �� — y/ SPECIAL 106 1 certify that in the performance of the work for which this OWNERtTQ, �a NO •$ CONDITIONS permit is issued, I shall not employ any person in any manner DISTRICT GROUP' TYPE FIRE PR ESSED BY O CONST ZONE lJ so as to become subject to the War rs'Compensation Laws. ADDRESS c�U , 09 G I CITY 111777 PJ, ZIP Ct Date Applicant STATISTICAL CLASSIFICATION APT CONDO I- NOTIC TO APPLICANT: If, afte maki this Certificate of ARCHITECT OR . TEL. \ ENGINEER NO. � �•- CLASS NO. , �DWELL. UNITS � Exemption, ,you should beco subject to the Workers' a . Compensation provisions of th abor Code, you must.forth- ADDRESS - SEWER MAP with comply with such provisions or this permit shall, be TEL deemed revoked. CONTRACTOR NO BK., PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION '(commencing with Section.7000)of Division 3 of the Business and LIC Professions Code, and my license,is in full force and effect. CITY CLASS $ l/ v ► SQ FT INC.OF NO OF CHECK License Number Lic.Class SIZE STORIES �� FAMILIES ONE Contractor Date DESCRIPTION OF-WORK 7y� ~�C'7* NEW ® $ I am exempt under Sec. �A�f .�ti Q 1✓ S i" �'�19 4 p a)4ALDTER Q FINAL r f. B:BP.C. for this reason a DATE (U ; �� REPAIR - Date: 8 �6 USE OF DEPA FINAL EXISTING BLDG BY Signature /// - APPLICANT TEL. NER- ILDER'DECLARATION PRINT CS-b e �+►��LJSa No I hereby affirm-that I am exempt from the Contractor's License C , Law for the following reason,(Section'7031.5, Business and ADDRESS Professions Code): r PRESENT BUILDING I; as owner of the 'property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not-intended or offered for sale(Section LOCALITY 7044,,Business and Professions Code). - MOVING TEL. c I, as owner of.the property, am exclusively contracting CONTRACTOR NO. with-licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code).,' 5.9a 9 A' CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST SETBACK YARD HWY PROP LINE WIDTH I #•0 0 0,Q 0 1 I hereby affirm thot'there is a construction lending agency for FRONT Y. the performance of the work for-which this permit is issued P L ,10;10'6,1 '3 , (Sec. 3097, Civ. C.). SIDE- •• _ . ' .. ., . g .. P.L. - .. _ , Q Lender's Name ° 1 .0 6. 1 3,5 P.C. Fee$ Permit Fee '��j } `a' - 't 1 1, 18.-8 6 — Lender's Address — "-'. 1 w I certify that I have read this application-and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee- 9 ee 9 ordinances and State jaws relating to building construction, Total Fee l ' u and hereby authorize representatives of this County to enter. . upon the above-mentioned property for inspection purposes. a ' SEE REVERSE FOR EXPLANATORY LANGUAGE' Sign ure of Applicant or Agent patO L ®s 3 WORKERS' COMPENSATION DtCLARATI(aN t= L� hereby,affirm that I have a certificate of,consent to self APP`L I C AT I O N .FOR BUILDING PERMIT r, insure, or a certificate of Workers'Compenstion Insurance, or t a certified copy thereof (Sec 3800,'Lab C ) } COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company i ❑ Certified co is here6 furnished.- BUILDING O copy v FOR APPLICANT TO FILL IN ADDRESS a Certified copy is filed with the county building inspec- BUILDING �. tion department. ADDRESS / LOCALITY NEAREST Date ALiplicant CITY ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR - COMPENSATION INSURANCE SIZE OF LOT D NOW ON LOT MAP BOOK PAGE PARCEL '(This'•section-need not be completed if the permit is for one - USE ZONE MAP hundred dollars ($100)'or less.)' TRACT CK LOT NO '- NO y T IAL CL O I certify that in the perfaimance of the work for which this OWNER - CONDITIONS permit-is issued, kshall not employ any person in any manner C GROUP TYPE FIRE P CES BY' U ADDRESS CONST ZONES % Ci so as,to become sublect to the W ers'Compensation Laws _ F7 � , o `Dat Applicant CITY ZIP STATISTICAL CLA 'IF ATION ' APT CONDO NOTI TO PPLICANT If, of m m this Certificate of PRCHITECT OR TEL LU g ENGINEER NO CLASS NO DWELL UNITS IL Exemption, you should bec e sublect to the Workers' to Compensation provisions of e Labor Code, you must forth- ADDRESS SEWER P with comply with such'provisionsor this permit shall be " TEL deemed revoked CONTRACTOR NO BK P VALIDATION .LICENSED CONTRACTORS DECLARATION LIC 1-hereby affirm that I am licensed under provisions of Chapter 9; ADDRESS NO $ALU I (commencing with Section'7000)of Division 3 of the Business and LIC (�/L Profe"ssions Code, and my license is in full force and effect CIT CLASS SQ FT ��ff NO. OF N OF CHECK License Number Lic Class SIZE l/ STORIES FAMILIES ONE Contractor r' Date D T ❑ I am exempt from the licensing requirements as I am a — f licensee)architect or a registered professional engineer f L R FINAL _ acting in my professional capacity (Section 7051, �� DATE ,• Business and Professions Code). SE OF LLLJJJ STING BLDG FINAL EMOL ❑ B Lic.,or Reg-No. —Date APPLICANT . TEL Y t OWNER-BUILDER DECLARATION (PRINT)' NO I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS Professions Code). ! . - PRESENT _ ❑ ` BUILDING'. I, as owner of the property, or my 'employees with ADDRESS wages as their sole compensation,will do the work and "the structure is not intended or offered for sale(Section kADDRE _ 7044, Business and Professions Code) TEL �3 9 9.3 A 1, as owner of the property, am exclusively contracting TOR NO with licensed contractors to'construct the project (Sec- # o o o o o 1 tion 7044, Business and Professions,Code). D TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY K YARD HWY PROP LINE WIDTH Z ° 1'6 9,0 0 I hereby affirm that there is a construction lending agency for the performance of the,work•for which this permit is issued ° 1 6.9. 0.0,1'(Sec. 3097, Civ. C 05, 14 -82 Lender's Name Lender's Address $ Permit Fee l/ i I certify that I have read this application and state that the Issuance Fee u v above information is correct. I agree to comply.with all County Investigation Fee ` ordinances and State laws relating to building construction, Total Fee and he by authorize representatives of this County to enter upon above-mention d pro erty for inspection purposes GC////► SEE REVERSE FOR EXPLANATORY LANGUAGE n� 1 Sign re of Applica t or Agent D e