HomeMy Public PortalAbout10864 FREER ST_Building__ APPLICATION FOR BUILDING -PERMIT 1
DriMON OF BUILDING AND SAFETY ■UILD 7
DsP�� se
o! CouWy Engin wDDREss
CmmtT of Los Anuel.s LOCALITY
WM.J.FOX.COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN, Sur-T or BurLDIMs CRO"ST
Ff
T O GROUT
ITYA ti[WER YAP
FOE APPLICANT TO FILL IN T
■uiLDING ,/)1, .C� STATE ,
ADORE" �' t'. +C(J�J HWY
B E SPECIAL .
CONDITIONI
TRACT
SQE OF LOT X /"1 �+` No. of BLOT G STHOW ON LAT YARD Fi1h/Y STRiET NAME �DTFiUSE OF
N P. L + O
1 •ID[ �
OWNER
MAIL O TRACT DWE1. I UNIT
ADORES I• C D INDUSTRIAL
crry La? t CI// PEI- 1 DVOCLL. I UNIT 6 ru*LIC SLDG:
R
ACHITECT OR TE._ Q DUPLJD1 1 UNIT ADDH.. ALT.. ETC.
ENGINEER NO. 3 APT. _---UHITS '
8 MISCEL
DR ,fes s,� 4 COMM<fRCIAL
CONTRACT'GR /11 c NO. / MSPECTIONORD
D
DESCRIPTION OF WOES
NEW AD ALTER -REPAIR DEMOLISH
aQ. FT. N0.OF HO. OF
•Q[ .O STO RItl FAMILIES
USE OF ela
SIGNATURE OF Q!
APPL4CANT APPROVALS
ADDRESS DAT[ INSPECTOk'S 510P ATbEE
FOUNDATION: LOCATION
FEE .S O O FORMS, MATERIALS
/0d O FRAME: FIR[STOPS,
VALUATION BRACING,DOLTS
FURNACE:LOCAION,
1 HEREBY ACPMOWLEDG[ THAT 1 HH
AVE READ TIS GAJ VWI' DUCTTS
APPLICATION AND STATE THAT THE ASOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LA }#TINT.
AND STATE LAWS RMULATING ■UILDING �ONITRUO
TION. KKT
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POTTED
ADDRESS
WM.J.FOX,COUNTY ENaLK13M VALIDATION C. N. DIRLAM.CHIEF aLDa. INsrw�;+OR
LT3 9 0 3 MAR
�:
,APPLICATION FOR BUILDING PERMIT 1
DV MON OF BUILDING AND SAFETY ■urLDING Q
f�.,,.�..,.., ADDRESS
D/pmtnwit O! County EnGIMAM '
CocInty of Los Angel" LOCALITY
WM.J. PrOX,COUNTY ENGINEJCPt N O
r+SSATT D.GRIFFIN,/UrT OF CUU-DING
DISTRICT NO. GR M[ � S[WICR M
FOR APPLICANT TO FILL IN
BUILDINGl7 YAP STATIC YEB
ADDREES l-C r NUMBER D HWY
BLOCK U/ zorz Sr6C1AL
OT NO. BLOC
_ CONDITION/
TRACT 44 9
/QE Or LOT Q" 'J NOW ON LOT / /UILDING ErBACX YARD HWY /-rRICET HAM[ WIDTH
FRONT ff
OWNER Ys-r1,.007�,J 'IDS
MAIL
ADDRESS O TRACT DWImJ__ I UNIT
D INDUs'117.IAL ,
!� TZVowt'i r I UNIT 6 rUBLIC BLDG.
ARCHITECT T13- 2 DUPLEX 1 UNIT 7 ADDN., ALT.. [TC.
ENGINEER NO. 3 APT. UNIT/
8 MI/CEL
APPRKWM 4 COMMEZRCIAL
COHTRAC7DR o' a IN$P=ON RECORD
D 2 J- /
DESCRIPTION OF WORK
NEW ALTER REPAIR DdIOLI/H
NO.OF / NO.OF
SIZE /TORIES ( FAMILIES
USE OF Ri
/fONATUR[OF APPROVAL/
APPLICANT
ADDRESS .nR DATE INSPECTOR'S SIGNATURE
FOUNDATION:LOCATION
�
go
Q D O� P.C. !{ Q? FORA1■ MAT'RRIALI
FRANC FIR[SOPS, r
�}' d
BRACING,■OLT'16
VALUATION - *
�� FURNACL'LOCATION,
GA/VENT
1 HEREDY ACXNOLt [ R
DG[ THAT I HAV[ THIS'
DUCTS
W �. c..
APPLICATION AND SCAT[ THAT THE ABOVE 1■ CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH IM. r
AND STATIC LAW/ REGULATING BUILDING CONBTRUC, f
TION. LATH EXT.
SIGNATURE'm HOUSE NUMBER COR-
PERMITTQ RECT AND roar®
ADDRESS
Wid.J.FOX,COUNTY ENGINmt VALIDATION C. N. DIRI..AN, CHIEF BLDG. INSPECTOR
T 0 n
3453L'P, FB241 10.001 m- 1 20a .
05, FEB29
WORKERS'COMPENSATION DECLARATION
hereby affirm that I have certa of consentnt to self APPLICATION FOR B U I 'DING P E RM I T
Insure, or a certtflcate of Workers' Compensation Insurance, -
or a certified copy thereof(Sec. 3800, Lab. C-)
COUNTY OF LOS ANGELES ILDING AND SAFETY
Policy No.' Company BUILDING
FOR APPLICANT TO FILL IN
Certified copy Is hereby furnished. ADDRESS
Certified copy Is filed with the county building Inspec- BUILDING. r
Tion"department. ADORf59 IOCALTTY
NEAREST
Date. Appllcant ZIP CROW ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BL.DGS. ASSIr550R .
COMPENSATION INSURANSIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCH
CE
(This section need not be completed If the permlt Is for one USE ZONE
MAP
hundred dollars (;100)or less.) TRACT BLOCK LOT NO.
I oerttfy that In the performance of the work for which this f PE
CONDffIOtJS
permit Is Issued, I shall not employ.any person In manner DISTRICT GROUP TYPE FIRE PROCESSED BY O
,to as to become subject to the Work Co Ion Laws f CONST Z V
gyp. d�� 0
Date%1-6t _94 Appllcan ARCHITECT OR STATISTICAL r T10N QOtJDO 0
NOTICE TO APPLICANT: If, making this Certificate
4emptlon, you should' become subject tQ-the Workers' R4GINEER �' CLASS NO. DWELL UNrTS IL
Compensation provisions of the Labor Code, you'must forth- ADDRESS SEWER A41P N1
with comply with such �ovlsions or this permit ihall be TEL Z
deemed revoked. TOR NO BK PG, VALH)ATFOH
'LICENSED CONTRACTORS DECLARATION LIG
r 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 LIG
Professloru Code, and my license Is In full force and effect. CITY CLASS f ,
SQ. FT. tJO.OF NO. OF CHECY
Llcense Number Uc.Class SIZE STORIES UES ONE
f
DESC1tIPTION OF WORK NEN
Contractor Date
I am exempt under Sec FIN
r ADDLi
ALT9t AL !/ v
B.BP.0 for this reasonDAVE
REPAIR
Date: UM Of EXISTING BLDG. DEMOL El MNAL -2 7 6 1.4 A
SlgnGturq By 4��
APPUCANT TEL
OWNER-$UILDFR DECLARATION (PRINT) NO. ,�} °, • o • 1 3
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDOEM , 2`° 1 '6 Q 5.0
Prof ons Code):
BUILDING '° 1 `6.Q 5.0
I, as owner of the 'property, or my employees with A1X1RE$S
wages as their sole compensWIon,will do the work and LOCAr1TY '1. 1 '6'-82.
the structure Is not Intended or offered for sale(Section
7044, Buslnels and Professlons Code). AAOV1NG ' TEL
I, as ovyner of the property, am exclusively contracting QDNTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 70+14, Business and Professions Code).
CONSTRUCTION LENDING AGE?}CYIRED
YARD Ff4v1 TOT PROP.BACK FROM EXIST. ,
1 hereby.affirm that there Is a construction lending agency for 7DE performance of the work for which this permit Is Issuedc 3097, CIL. C.).
3 Lenders Name
Lender's Address P.G Fee f Permit Fee
I certify that I have rood this application and state that the Lsvanco Fee
above Information is carred. I agree to comply wtth.all County Investlgattgn Fee
ordinances and ,State laws relating to building construction, Total Fee
and hereby authorize represe Ives of this County to enter
' u entloned for Inspection purposes.
•� So Wiiii3I1 K*EanAIIATORy LANOUAOIt.
(cant or Agent Date