The URL can be used to link to this page

Home My Public Portal About4820 GLICKMAN AVE_Building__ 76AS38A DBS-3 12.54 APPLICATION FOR BUILDING PERMIT ]. DIVISION OF BUILDING AND SAFETY BUILDING / I / Department of County Engineer ADDRESS a (� (y 6. /C/�/� j� County of Los Angeles LOCALITy /.-`' Co /� WM. J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING NEAREST / -� CROSS ST. &. // DISTRICT NO. GROUP SEWER MAP FOR APPLICANT TO FILL IN I I TYPE I BK PG/ BUILDING ��/� • CONSLF ADDRESS TaQ. if MAPSTATE YES. NO _S NUMBER a:'- HWY LOT NO#G `sl�( 7� �[ �C�13LO CK r � USEZONE SPECIAL CONDITIONS s TRACT t�EE NO. OF BLOGS. SIZE OF LOT `J � I NOW ON LOT BUILDING YARD HWY STREET NAME "EXIST. USEOF SETBACK WIDTH EXISTING BLDG. p� e� FRONT yp,� 9 ,�/ Z/c.1141-1 �-1 -lil ,moo y C L IJ P. L. PSS, f If (J f /-r �fi ' OWNER SIDE MAIL P. L. 1-1 ADDRESS j9 6? c l cif IVIAA/ - rr TEL. 7 DWELL. 1 UNIT- 5 INDUSTRIAL CITY �C�yl >_/�- r / y NO. - 2 DUPLEXUNIT 6 PUBLIC BLDG. ARCHITECT OR TEL. ENGINEER NO. 3 APT. UNITS 7 ADDN.,ALT., ETC. ADDRESS 4 COMMERCIAL 8 MISCEL. TE CONTRACTOR NO.L. Cyd INSPECTION RECORD syn dy,_,��-,# 1 �7S A �r < Q.�/ - DESCRIPTION OF WORK `C/� a NEW '4-- ADD ALTER - REPAIR DEMOLISH SO. FT. �y NO. OF j NO. OF /y�(/�� //�� j �✓' '/� ' SIZE �8y STORIES ( FAMILIES USE OF STRUCTURE `S „ _ — M I k V SIGNATURE OF - APPLICANT — APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE 412-m \ FOUNDATION: LOCATION FEE $ �( FORMS, MATERIALSFRAME: FIRE FIRE STOPS. VALUATION $ ® BRACING, BOLTS - ° FEE �� FURNACE: LOCATION, GAS VENT, DUCTS HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. I/T AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. a � LATH, EXT. ��/ i SIGNATURE OF ��1 n HOUSE NUMBER COR- PERMITTEE �� !Gv/" CC RECT AND POSTED ' ADDRESS W1vL J. FOX. CouuTY ENramEER VALIDATION BY �C6 3 9 6 312 MAY 119 1 6 . 2 Q.0 O . � � !� DEPUTY -DEPUTY BY BY 0 DEPUTY ! Y' '4r' ' DEPUTY WORKERS' COMPENSATION DECLARATION insure, or a certif catte of Workers' Compensation l insurancee, APPLICATION FOR BUILDING PERMIT - or a c Xtid copy threof (Sec. 380 ab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY iCompanBUILDING yJQQ�1�T ❑ Certified copy is hereby furnished. . FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with th o ty building inspec- BUILDING epa b . ' tion dtment. ADDRESS pDate 23 `(Applicant CITY >� ZIP LOCALITY NO. OF BLDGS. NEAREST CE TIFICATE OF EXEMPTION FR WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (J (This section need not be completed if the,permit is for one TRACT BLOC LOT NO. MAP BOOK � � PAGE d�J PARCE�.�Z hundred dollars ($100)or less.) TEL. OWNER- 5 r o 61 NO. j USE ZONE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any.manner ADDRESS O j 4i I/ SPECIAL CONDITIONS so as to become subject.to the Workers'Compensation Laws. O CITY ! �j° ZIP - U Date Applicant ARCHITECT OR TEL. DISTRICTJROUP TYPE FIRE PROCESSED BY � NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. FIRE 0 Exemption, you sho-uld become subject to the'Workers' p ,'Of i/ +( wCompensation provisions of the Labor Code, you must forth- ADDRESS (O fJ Y f ,with comply with such provisions-or this permit shall be TEL. } STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked.. CONTRACTOR 3 LIC. CLASS NO. DWELL. UNITS LICENSED CONTRACTORS DECLARATION J S I hereby affirm that I am licensed under provisions of Chapter 9 ADORES ' 0� UI NO v SEWER MAP (commencing.w.ith Section 7000)of Division 3 of the Business /1 LIC• CITY -�rUl%n ¢•` ` - G and Professions Code,and m license is in full force and effect. BK. PG. VALIDATION C Sq.-FT. NO. OF NO. OF CLASS CHECK License Number Lica Class c, 3-9 SIZE STORIES FAMILIES ONE VALUATION Contractor. Q° r C- Date i.23- DESCRIPTION OF W RK NEW E: ❑1 am exempt under Sec. �r(�lfj (,p/L 7. ADD ❑ $ c ALTER B.&P.C. for this reasori - e REPAIRX $ Date: USE OF D EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT). NO. DATE / �i�j �� I hereby affirm that I am exempt from the Contractor's License • Law for the following reason (Section 7031.5, Business and ADDRESSFINAL Professions Code): PRESENT By. BUILDING � ,ir^-• y ❑ 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. CONTRACTOR NO. - ❑ I, as owner of the property,am exclusively contracting - ''L_ ``` with licensed contractors to construct the project (Sec- _ ' ADDRESSI' f Tiori'7044, Business and Professions Code.) I REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. (_�;L(_a __;l 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 P.L. iH'It� (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ®O LDMA Ref. # 'S-aw; -JUL I 'f'�_�•'• _ P.C. Fee$ Permit Fee Lender's Address 1 l 2 -•` o I certify that'l have read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee (Tp Q 8 ordinances and State laws relating to building construction, Total Fee D�� LDMA Perm. # a and hereb uthorize representativ is County to enter upon the ove- ed pro r inspectioZI Vte s. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu Applicant or Agent