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HomeMy Public PortalAbout5130 GLICKMAN AVE_Building__ 79AE96A CE#803 2/E0 APPLICATION FOR BUILDING PERMIT I COUNTY OF LOS ANGELES BUILDING L DEPARTMENT OF COUNTY ENGINEER ADDRESS c BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING I CROSS ST. / DISTRICT NO. G TYPE PR. SED BY FOR APPLICANT TO FILL IN D CONST. BU DIN A A/7// / / STATISTICAL CLASSIFICATION SEW R MAP ADDRESS `J 13 IJ A • l f C_ A,7L /✓ ,B PG '�77�'�y� CLASS. NO. DWELL.UNITS LOT NO.. ;D O 3 �Q r�"C/ BLOCK NUMAPMBER /(� H STATE NO TRACT '�d K1. O �nrAl �I14 Kd �S '�u/� USE ZONE SPECIAL r NNO.OF OW ON LOTS V CONDITIONS SIZE OF LOT Ifp X I .4�t USE OF �y� / EXISTINGJ�BLLDG._//il- [l/K r/ BUILDING YARD HWY EET ME EXIST. OWNER/7'rE S �Q TEL. SETBACK WIDTH •� Tom' b'T p. NAO./u/6-'1/'Sf�J FRONT �•At, ADDRESS ,?-,./3 4.5. GYY��CC�1�✓ /� rC rt e(,ee-- P. L. _aG(/ SIDE ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECORD ADDRESS L TEL tLb 1 mi CONTRACTOR � dN•S GR NO.t TTrJ a ADDRESS>16 3 S Sr ld&V -9 r - ¢ V DESCRIPTION OF WORK +I-- 0 0 F NEW ADD ALTER REPAIR DEMOLISH i W SQ.FT. NO.OF / NO.OF a SIZE STORIES / FAMILIES ►yam, USE OF �cYL�li.v Fa STRUCTURE SIGNATURE OF �. APPLICANT VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE FEE FEE $ OD FOUNDATION: LOCATION FORMS.MATERIALS 1 HE EBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, 5 BRACING, BOLTS � p � if k PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS Y STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING WORK AUTHORIZED I LATH, INT. Fi > WILL NOT EMP Y ANY SO TION OF THE WORKMEN'S COP S O CAL ORNIA. LATH,EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL ST C URAL ENGINEER PLAN CHECK VALIDATION (�c&) m.o. CASH PERMIT VALIDATIO CK) M.O. CASH ? ' ' 7 �� a 76A638A CE #803 1/71 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print ort a onl CROSS ST. BUILDING DISTRICT NO. GROUP I TYPE PROCESSED BY CONST. ADDRESS STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO, DWELL,UNITS BK PG TRACT _ USE ZONE MAP _ NO.OF BLOGS. NO. SIZE OF LOT NOW ON LOT :.; pr SPECIAL USE OF I CONDITIONS EXISTING BLDG, TEL. OWNER_ - NO. ,. BLDG.SETBACK FROM ADDRESS FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + _ ENGINEER NO. BLDG.SETBACK aFROM ADDRESS SIDE PROP. LINE OF (STREET) Cl- CD TEL TYPE OF EXISTING SETBACK HIGHW ,� + YARD = TOTAL C..) CONTRACTOR _ _NO, HIGHWAY WIDTH FROM C.L. W LIC. _ 'J ADDRESS , :NO. + LIC. >c2 CITY CLASS ', CORNER CUTOFF YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS a Lu .1 ADDRESS SO. FT. NO. OF NO. OF ❑ NEW SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE - ` ALTER ❑ i IGNATURE OFA, I REPAIR❑ PPLICANT ` -- '� p DEMOL ❑ LUAT10N S no APPROVALS DATE INSPECTORS SIGNATURE PMT, erg' FOUNDATION: LOCATION FEE $ FORMS, MATERIALS Ff3OALFIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION `BRACING, BOLTS STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, H ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS C TI ON. I CERTIFY THAT IN DOING THE WORK AUTHORIZED Y I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. CODEOF THE STATE OF CALIFORNIA IN RELATING TO EN'S COMPENSATION INSURANCE. LATH, EXT, RE OF HOUSE NUMBER COR- E�^,. RECT AND POSTED FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER S VALIDATION Cl. M.O. CASH _ PERMIT VALIDATION CK. MO CASH i r WORKERS' COMPENSATION DECLARATION to sf insure, oraa certificate of Worker's Compensationoconsent Insurance,- APPLICATION FOR- BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES , BUILDING AND SAFETY Policy No 1046140 Company State" Fund ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN ADDREss Certified copy is filed with the county building inspec- I ING - tion department. ESS 5130 No. Glickman 11-1=89` Randol Roofing,; ;` 'T.-Cy'. Ca. ZIP 91780 LOCALITY—)Date Applicant NO., BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' OF LOT NOW ON LOT CROSS ST. 9 COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one. T BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.). TE ER Arlet Lovell. No�+42-.7530 USE ZONE MAP' INO I certify that in the,performance of the work for which'this D SPE ,permit is issued, I shall not employ any person in any manner ESs513O. No. Glickman [ �� SPECIAL r\ !!! CONDITIONS so Ps to_become subject To the Workers'Compensation Laws. O 5-18-89 Randol Roofing CITY. T. Cy. Ca. ZIP 91780 v Date Applicant. ARCHITECT OR TEL. De NOTICE TO APPLICANT: If, after making This Certificate .of ENGINEER NO DISJJJRIOT GROUP TYPE FIRE PROCESSED BY / ��' k CONST. ZONE C Exemption; you should. 'become subject to the Workers' L`J ��UULL / [� w Compensation provisions of the Labor Code,,you must forth- ADDRESS - VCL with comply with, such provisions or-this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO.. Z deemed revoked.: CONTRACTOR. Randol Roofing N0288-4040._ _ • LICENSED CONTRACTORS DECLARATION LIC. CLASS NiO. i* DWELL. UNITS ADDRESS 529 E' . .Valley.Blvd No 451937 I hereby affirm That I am'licensed under_provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. CITY: San Gabriel,- Ca. CLASS C-39 and Professions Code,and my license is'in full force and effect BK. pG VALIDATION 451937 G-39. SQ. FT: NO. OF NO. OF CHECK License Number Lic. Class SIZE I STORIES FAMILIES ONE Randol Roofing-, 1-30-90 Re-roof house and VALUATION DESCRIPTION OF WORK NEW ❑ ContractorDate $ 6,121.00- ❑I am exempt under Sec. garage with GA[, Timberline ADD ❑ , B.&P.c. for this reason' fiberglas shingles, Class A. ALTER El REPAIR g: $ Date: USE OF F. . . EXISTING BLDG. DEMOL ❑ APPLICANT TEL. Signature (PRINT)Randol Roofing . NO 288-4040 -FINAL '^ " OWNER-BUILDER DECLARATION - �DATE �. I hereby affirm That I am.exempt from the Contractor's License "Law for the following reason ($ection'7031.5, Business and ADDRESS 529 E. Valley Blvd. S.G. 91776 'FIN' Professions Code): PRESENTBy BUILDL'{L*4 MING 1�T ❑ I, as owner.of the,property., or my employees .with' ADDRESS it wages as their sole compensation,will do the work and 1,9 the,structure isnot intended or offered for sale(Section LOCALITY. " +s _ 9a � 7044, Business.and,Professions Code:) MOVING TEL. 1'ITM ❑ I, as owner.of the property,,am exclusively contracting CONTRACTOR NO. r, with licensed contractors'To,consTrucT The project (Sec- ADDRESS - TOW.... 476 w 75 . tion 7044,.Business and Professions Code.) ` b CHEM" .7J REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY . PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT • •�tl the performance of the work for which this permit is'issued P.L. (Sec., 3097, Civ. C.). .,SIDE .�...., P.L. CMJIJ—W1J 1 5/'i Lender's Name,' ..:.,: i ppb qp 86.25. . Al 9 DMA`Ref: # L JJt i AM *-28 P.C. Fee$ Permit Fee , 3 Lender's Address• 010.5O !tDMA P/C# I certify`ihat I have read this application-and state that the Issuan above information is correct. I agree to comply with all County Investigation Fee s $9675 . r ordin a and State laws re acing to building construction, ota . l Fee LDMA Perm. # a an er uthor' e..repr a atives of thi ounty.to enter uon t o e- ention operty f in' cTion pur oses� c S af/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent ate _ YORKERS' COMPENSATION DECLARATION L •� insure,oraa certificate of Wo ke srlificate Compenof coent to sat on Insuran elf APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lob. C.) �l c� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.© 7��-U3Company g22 Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING copy y ADDRESS j��j�/ L/G�/,1-j ❑ Certified copy is filed with the county BUILDING building inspec- 'ADDRESS 7 tion department. - Date Applicant �NiCITY f. ZIP �� LOCALITY f _ NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. P. ✓�j COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) / TEL. OWNER h o C G�- NO. USE ZONE OP i t/17 I certify that in the performance of The work for which this R > � permit is issued, I shall not employ any person in any,mbnner ADDRESS / SPECIAL d CONDITIONS so as to-become subject to the Workers'Compensation Laws. O CITY ZIP Date Applicant ARCHITECT OR TEL. DISTRICT GROUP NPE FIRE PROCESSED BY � NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZO 0 Exemption, you should become subject to the Workers' U Compensation provisions of the Labor Code, you must forth- ADDRESS (D� a with comply with such provisions or this ,permit shall be TEL.�7 STATISTICAL CLASSIFICATIO APT. CONDO. z deemed revoked. CONTRACTOR l�j �C 1 / L' NO./���/Z — LICENSED CONTRACTORS DECLARATION40-7161 NO.LIC., CLASS NO. DWELL. UNITS JV• I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS a50 LIC. � SEWER MAP (commencing with Section 7000)of Division 3 of the Business CIN �`y 11 n �J CLASS G and Professions Code,and my license is in full force and effect. 6t - BK, PG. VALIDATION �- SQ. FT. NO. OF NO. OF CHECK License Number '2�j� Z Lic. Class ^/ SIZE STORIES FAMILIES ONE y/e�t a� n VALUATION Contractol/�>�l��Lu� Date DESCRIPTION OF WORK A�/d(�L/ /�� �� NEW ❑ $ /N �tilVGZL�7 � ADD ❑ ►. ❑I am exempt under Sec. %� B.&P.C. for this reason Z/J�z%�Z_ 14 ALTER 1:1 1:1 $ US OF REPAIR I Date: EXISTING BLDG. DEMOL F-1 II Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. - DATEQ- I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, BusinessADDRESS FINA_ and Professions Code): PRESENT BY I 1 ❑ I, as owner of the property, or my employees with ADDRESS ACCT.BU MING T wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , 6307 ■�� 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. 1 ITEnS with licensed contractors to construct the project (Sec- ADDRESS iFITAL 68 Z3 tion 7044, Business and Professions Code.). REQUIRED TOTAL SETBACK FROM EXIST. Z�y'� CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH tr, OCt I hereby affirm that there is a construction lending agency for FRONT CHANE .00 the performance of the work for which this permit is issued P.L. . (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name (� � LDMA Ref. # �Y"'� �+�•+� 51301� " P.C. Fee$ � ermit Fee t Lender's Address 1 An q.-a, o I certify that I have read this application and state that the Issuance Fee i LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, otal Fee LDMA Perm. # a and hereby authorize representatives of this County to enter upon theo ioned pr, -erty for inspection purposes. s 3O' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applica1n't or Agent Date