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HomeMy Public PortalAbout5100 GLICKMAN AVE_Building__ Cl, LICkrr AK 78A83BA*l:E#80310-58 APPLICATION FOR BUILDING PERMT 1 COUNTY OF LOS ANGELES BU I LDI N . DEPARTMENT OF COUNTY ENGINEER ADDREss 1 BUILDING AND SAFETY DIVISION LOCALITY , JOHN A.LAMBIE,COUNTY ENGINEER NEAREST n_' CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. [GROUP I PE + SED BY C . FOR APPLICANT ccTO FILL IN orlsr. L�.L' ADDREISSBUILD �l.Q/�/ STATISTICAL CLASSIFICATION I S BK MAPPG G' r II CLASS.NO. DWELL. UNITS LOT NO. a'4-f-a ` BLOCK MAP STATE NUM13ER _2_4 WY YES TRACT �� (7(/� el--,s USE ZONE SPECIAL SIZE OF LWT ! , , ^ gL0FNOW 0N LOTS CONDITION USE OF EXISTING BLDG. BUILDING YARD HWY REET NAME EXIST. SETBACK WIDTH OWNER FRONT I s ADDRESS qey q(-A) /7 QfL�t(„liv� �a� SIDE CITY NO �° 7�Cq P L INSPECTION RECORD ARCHITEC O 1 TEL ENGINEER NO. I t, ADDRESS . Y" STEL CONTRACTOR //��� ��88 p4LY�.C] NO. G I4)v-�-dCMut.v� �L " ADDRESS _ DESCRIPTION OF WORD fRu v ,P F v� r.vTo NEW L/ ;- T7/C•ADD ALTER REPAIR DEMOLISH _ SO.FT. NO.OF NO.OF SIZE x.46 STORIES FAM LIES USE OF STRUCTURE -71 SIGNATURE OF APPROVAL APPLICAN(T ADDRESS L{q N` ra> FOUNDATION: LOCATION D TE INSVECTOR'S SIGNATURE FORMS.MATERIALS /I�✓ ^j� AV' P.C. 3 FRAME: FIRE STOPS. r Off. 3J FEE BRACING, BOLTS VALUATION g FURNACE: LOCATION. FEE GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT T E ABOVE IS CORRECT AND AGREE TO COMPLY ITH A C ?iPT DINANCES AND �L`tfr.I STATE LAWS RE B NSTRUCTION. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR. PERMITTEE RECT AND POSTED ADDRESS FINAL. `--__QCYDE N.DIRLAM, PRINCIPAL STR5MRAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION c, M.O. CASH � "\ ®F ? _ 4 !� A 42.00 r1 � I WORKERS' COMPENSATION DECLARATION of consent to sf insure,bor a certificate of Worke s' Comaffirm that I have apensation Insurance, APPLICATION FOR BUILDING PERMIT or a rtifjed copy thereof (Sec. 3800 Lab. C.)' _ _ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy o. Companyr I ,,�❑-�{{ BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS cJl�� � �� „✓ E Certified copy is filed with the county building inspec- BUILDING _ _ tion department. ADDRESS ;t �j / 7 (bA5 - � i C%: L r CITY E C� ZIP 1-7U 6 LOCALITY Date Applicant NO. OF BLDGS. NEAREST CERTIFI ATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR. (This section need not be completed if The permit is for one TRACT BLOCK I LOT NO. MAP BOOK PAGE I PARCEL hundred dollars ($100)or less.) TEL. .•.. OWNER , .Q _ NO• �J� USE ZONE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not emCONDITIONS Oploy any person in any manner ADDRESS �j l SPECIAL d so as to become subject to the Workers'Compensation Laws. CITY—T—,e- U ZIP �� (� Date Applicant ARCHITECT OR TEL. a NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE Exemption, you should become subject To the Workers' Compensation provisions.of the Labor Code, you must forth- ADDRESS ]G�f%Jr� a with comply with such provisions or this to p y p permit, be -� TEL. , STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACT t p,� NO. LICENSED CONTRACTORS DECLARATIONUC. CLASS NO. .=� DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS L �; NO.� j l (commencing with Section 7000)of Division 3 of the BusinessCITY LIC, G SEWER MAP A CLASS ' and Professions Code,and my license is in full force and effect. ` BK. PG. VALIDATION License Number / 2fl "V 61 Lic. Class C 7 SIZEF r� STORINO. ES AMILLIIES ( ONE VALUATION •'�� _ VALUATION Contract�r��c .BUJ_ ' Date. t +-2 DESCRIPTION OF WO6K `: �/p,� _ c, NEW 0 $ j 5 ADD ❑ G V ❑1 am exempt under Sec. ti - ALTER ❑ Poo B.&P.C. for this reason + ti/� } ��%� �� $ REPAIR Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLIC ; TEL. g OWNER-BUILDER DECLARATION (PRINT) s i C.�G `�e� N07 %� DATEFINAL I hereby affirm that I am exempt from the Contractor's License Law for the following -reason (Section 7031.5, Business and ADDRESS �� L ry � FINAL Professions Code): PRESENT By V - BUILDING ❑ I, as owner of the property, or my employees with ADDRESS. V wages as their sole compensation,will do the work and q, . [j the structure is not intended or offered for sale(Section LOCALITY , U I 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. '! .� tIT_1 with licensed contractors to construct the project (Sec- ADDRESS I A r,1 tjV`5 6 25 tion 7044, Business and Professions Code.) - — - REQUIRED TOTAL SETBACK FROM EXIST. `r=!: - CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - - = I hereby affirm that there is a construction lending agency for FRONT r'=czi•E the performance of the work for which this permit is issued P.L. LaEFlMo (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name, P.C. Fee$ Permit Fee �f. + LDMA Ref. # - - -' --- Lender's Address _ pool 0 1 certify that I have read 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 R inances and State I ting To building construction, Total Fee �v�° O�� LDMA Perm. # /a and y once representativ of this County to enter upon The b ve-mentioned proper for inspection p poses. l ' SEE REVERSE FOR EXPLANATORY LANGUAGE j- !gn `re o Applican or Date r -A WORKERS'COMPENSATION DECLARATIONI__ insure, or certificate that I have r certificate of consent to self A P L I C AT I O N FOR BUILDING PERMIT b insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING s:. tion department. ADDRESS /Qo N C L ����%nnti /�� s Tpv LOCALITY Lti Z '1 ZIP �C1 CROSSNEARET. Date Applicant CITY CERTIFICATE OF EXEMPTION FROM WORKERS' ! NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT7_:)5'V1 0•O NOW ON LOT I MAP BOOK PAGE PARCEL This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less.) p TRACT BLOCK LOT NO. SPECIAL �J y , TEL ,LrI , . /l y OWNER._ AaW .-t-JRC?(REU NO. '13 5 CONDITIONS I certify that in the performance of the work for which this DISTRICT GROUP TYPE FIRE PROCESSED BY O permit is issued, I shall not employ any person in any manner ADDRESS LAV v CONST. ZE so as to become subject to the Workers'Compensatyon Laws. T * { CITY ZIP e _ ?h Date Applicant Q© f .1 STATISTI ALCLASSIF TION JCONDO. NOTICE TO APPLICANT: If, after aking this Certificate o i RCHITECT OR TEL. 19 0- Exemption, you should become subject to the Workers', ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP F 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 SQ. FT.�O() NO. OF ( NO.OF CF.--.-- ,License HECK ,License Number Lic.Class SIZE STORIES � /�FAMILIES ONE Contractor Date DESCRIPTION OF WORK ry�Room A � NEW ❑ $ �(`V G S'V� ADD �o ❑ I am exempt under Sec. ALTER ❑ FINAL B.BP.C. for this reason tit*•- rn pREPAIR ❑ DATE USE OFDate: EXISTING BLDG. G>II�d�C[-7 DEMOL ❑ By AL f� Signature APPLICANT €� n�-� n TEL. ry OWNER-BUILDER DECLARATION PRINT �}C&k,(.ELUkJt I�b*`ANO. d I hereby affirm that I am exempt from the Contractor's License /� t Law for the following reason (Section 7031.5, Business and ADDRES + N.'UUJr�i1� Profe ons Code): PRESENT �-7n l � BUILDING otf' vl 1 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY ) (, the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. 3 I, as owner of the property, am exclusively contracting CONTRACTOR NO. ^ n with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 7 F -r REQUIRED TOTAL SETBACK FROM EXIST. ` " c� CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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. (Sec. 3097, Civ. C.). SIDE m P.L. o Lender's Name _J Lender's Address P.C. Fee$ Permit Fee 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 g ordinances and State laws relating to building construction, Total Fee d and hereby authorize representatives of this County to enter m upon the above-mentioned property /for linspection purposes. a 1 AYii�lsCl�+�wi/lJC/��r�1�11 CAJ\U°� 4G� ©s SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Q nt Date