HomeMy Public PortalAbout5021 GLICKMAN AVE_Building__ ' D09I0N OF BUILDING AND SAFETY BUILDING� ' D
Department of County Engineer
County of Los Angeles
WM. J. FOX, COUNTY ENGINEER APPLICATION
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
/ / DISTRICT NO. PLAN CK. DR REC.No. PERMIT NO.
ADDRESS JC�I 7 ' '� Ay mow, "[ei'`..
�^ cECEIVED BY DATE OF APPL. DATE ISSUED
LOCALITY �`�( �.p�i
NEAREST
CROSS ST. AC �S.10 BUILDING
ADDRESS �V � �.._7L.....Ct...'�•L.... .�t.l..�..p
L �J
OWNER iFi C."a.v da.r 5-
MAIL Z ,{ •e LOCALITY
ADDRESS '� A•-�/t'�P iJ NEAREST
T[L CROSS ST.
CITY ! �'��"' NO. FIRE NO.OF TYPE GROUP
ZONE PLANE e I
ARCHITECT OR TEL.
ENGINEER NO. BLDG. R NO.
SETBACK LINE
ADDRESS .L �f USE / APPROVED ° l
�iSrC d viC NOLIr� ZONEf4 BY �: - DATE >�6�
CONTRACTOR. HOUSE NUMBERING
ADDR[SBMAP NUMBER b NO. ASSIGNED BY
LEIRAL CORRECTIONS
DESORIPTION LOT NO. BLOCK
TRACT .7:?e
p. NO. OF BLDGB.
SIZE OF LOT - - NOW ON LOT O�Jd
USE OF I NO.cw S-
EXISTING BLDG. FAMILIES
DESCRIPTION OF WORK
6v c .r��e7cC <_-'e-00 ZJO (n vi4 0
NEW ALTERATION ADDITION Z
REPAIR DEMOLITION
NO.OF �^
612E ROOMS BTORIEH .v Ae a T -�
EXT.WALL -.I y I ROOF
COVERING
COVERING �.+""r .'_^ ,7•+;- •J /'!�D N �•
wers� S.
USE OF ST1jUCTURE �""• '
INSPECTION FOR APPROVALS
OCCUPANCYAS INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION -.
FORMS, MATERIALS T;�:.+ < �.v J r
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS,
CORRECT. BRACING, BOLTS
1 AGREE TO COMPLY WITH'ALL COUNTY ORDINANCES FURNACE: LOCATION, - -�
AND STATE LAW6 REGULATING BUILDING CONSTRUCTION. pAS VENT, DUCTS •
SIGNATURE OF:�_
_ x LATH, INT. �a
PERMIT"E
ADORES
/� iI / , LATH, EXT. .�
TR.6 '
PLASTER, INT.
AUTHORIZED AOT.
Q
PLANEXT.
P.C.9 J TER.
FEE >a "�- HOUSE NUMBER COR-
/(/� 0
RECT AND POSTED
VALUATION - 2- �" FINAL '
76AS36A D053 1-52
.7 ;WORKERSf COMPENSATION DECLARATION -
'of consent to self
+sihe a boraa certif caffirm tharte,of Workers' Com certificateensaT on Insurance, APPLICATION F.O R, BUILDING PERMIT
ora certified co y thereof (Sec. 3800, Lab C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy�o.' Companye �'
❑ Certified copy is hereby furnish ed. =/'—�/ FOR APPLICANT TO FILL IN ADDREss ��� �/�/�/vv�IC�
UQ Certified copy is filed with the county building inspec- BUILDING ®2 �o� �� �
ADDRESS C9
tions department. � � � ! T'1P
Date r APPlicant CITY �2 P/�. ZIP LOCALITY
NO. OF BLDGS. NEAREST p
ERi TIFICATE OF EXEMPTION FR M WORKERS' SIZE`OF LOT NOW ON LOT CROSS ST. 0(4 E� +� 1'l'S�
COMPENSATION INSURANCE' ASSESSOR �j r�a, �s
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOKU(`o0dSS& PAGE a 3 PARCEL 01-1
hundred dollars ($100) or'less.) :, TEL
OWNER d__ NO. / U7"L
NE NO
I certify that in the performance of the work.for which this Lit
permit is issued, I'shall not employ any person.in any manner ADDRESS .Iv Cc LOS �z-oJ jcS' ISPECIAL
CONDITIONS
so as to become subject To,the Workers'Compensation Laws. O
CITY L" % ZIP U
Dare Applicant. ARCHITECT OR TEL.
---� DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. O
CONST. ZONE �
Exemption, you should become _subject,to the Workers` � �/ w
Compensation provisions of the Labor Code you must forth- ADDRESS U Y a-
with comply with ,such provisions or this permit shall be . TELT/ STATISTICAL CLASSIFICATION APT. CONDO.. N
�QQ Z
deemed revoked. CONTRACTOR ►GM1 NO. R 6
LICENSED CONTRACTORS DECLARATION I - �
LIC. CLASS NO. / DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 .. ADDRESS ($ , NO 2
(commencing with Section 7000),of Division 3 of the Business LIC. ,@ SEWER MAP
and Professions Code,and my license is in full force and effect. CITY' CLASS iJ BK. PG. VALIDATION
SQ. FT., NO. OF NO. OF CHECK "
License Number 8,31RI_[Lic. Class SIZE STORIES FAMILIES ONE
VALUATION
4 , DESCRIPTION OF WORK NEW meg+ El 6-0
Con}racto � Date � � � - ���
F-1I am exempt under Sec. ADD ❑
ALTER ❑ ►
B.BP.C. for this reason C REPAIR ❑ a
Date: E OF
EXISTING BLDG. DEMOL F-1
Signature, APPLICANT �� ����� TEL.7/a[ FINAL
PRINT cI
OWNER-BUILDER DEC LARATION i t �_ w NO. Sd DATE ��� G
I hereby affirm that I om exempt from.the Contractor's License A-1 AY 4Ml O l
Law for The following reason. (Section 7031.5, Business and ADDRESS �' s. CGu cdl94Gylff FINAL
Professions Code): PRESENT ByBUILD � � 1
❑ .
NG
I, as owner of the property, or my em to ee's-with ADDRESS
- q `s•3'_•`. 4 ='_
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY 't'F
7044, Business and Professions Code.) MOVING TEL.
❑• I, as owner of the property,am exclusively contracting CONTRACTOR NO. ^�-y�ry.� _ E 4;�,,w
with,licensed contractors to construct the project (Sec- ADDRESS 'rf f.t �
tion 7044,'Business and Professions Code..) ;' `'•A s ML_ 5 g
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION '
.LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH •.-HECirK
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. 'r4''`i _--
(Sec. 3097, Civ. C.)., •SIDE .
P.L.
m Lender's Name, LDMA Ref. #
P:C. Fee$ Permit Fee
Lender's Address
0 1 certify that I haveread this application and,state that the Issuance Fee ` LDMA P/C#
8 above information is"correct. I agree to comply with all County Investigation Fee
N ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
Q and by authorize rep sentatives of this.County to enter
u t above- i pr I rty for inspect' purp ses:
u Q
L SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Appli ant or Agent Date