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Home My Public Portal About5340 GLICKMAN AVE_Building__ > 70A888A CE#80810-58 APPLICATION FOR BUILDING PE IT 1 COUNTY OF LOS ANGELESBUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST a CA13SATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. L DISTRICT NO. GROUP TYPE P SSED BY FOR APPLICANT TO FILL CONST. BUILDING -713 �tD I SEWER MAP ADDRESS , L;L � � STATISTICAL CLASSIFICATION BK PG CLASS.NO.�DWEI I UNITS--/-I �_ LOT NO. V'""'7 3 ,y L - MAP STATE YES TRACT O NUMBER - HWY. V J USE ZONE SPECIAL P/,y' �^ �y NO. LDGS. /� I CONDITIONS/ � [Y,' �Io SIZE OF LOT J 91 10 NOW N LOT USE OF EXISTING BLDG. BUILDING YARD HWY REET AME EXIST. SETBACK WIDTH OWNER i A FRONT Gj� MAIL /// P.L. 0!i ADDRESS f SIDE CITY NE 3 1 7� P.L. ARCHITECT OR TF�1 INSPECTIO]aT RECORD ENGINEER N _ ADDRESS Imo/ 7 CON N l$ 3 ADDRESS DESCRIPTION OF WORK EW ADD ALTER REPAIR DEMOLISH .FT. NO.OF NO.OF SIZE Q STORIES FAMILIES _ USE OF STRUCTURE 1 SIGNATURE OF ` APPROVALS APPLICANT � DATE INSP 'FETR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS.MATERIALS 7 $ L�- -- RAME: FIRE STOPS. FEE �o FBRACING. BOLTS f' L VALUATION FURNACE: LOCATION, p FEE `� / GAS VENT, DUCTS '6 <S ~ T I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT. �- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE AND = ✓' STATE LAWS RE ATING Bl11LD1% /} CO RU N. LATH. EXT. SIGNATUREOF HOUSE NUMBER COR- PERMITTEE p %�'7 •RECT AND POSTEDt,a ADDRESS FINAL CLYDE N.DIRLAM, P INCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.) CASH 2 L.t O s JUL c 3 A . Zl�Lru 419.JJ (] ®F _ J WORKERS' COMPENSATION DECLARATION ent to sf insure, or a certif catte of Workers' Comtpensat on Insurance, - APPLICATION FOR BUILDING PERMIT or a certified�y thereof 3800.Lab. C.) re COUNTY OF.LOS ANGELES BUILDING.AND SAFETY Policy N, an GJ BUILDING t ❑ Certified copy is hereby furnishe FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the ounty building' spec- BUILDING /J tion departm nt. ADDRESS r. /� _ CITY / [ ZIP LOCALITY Date Applican NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' . SIZE OF LOT NOW ON LOT CROSS ST. 101— COMPENSATION INSURANCE ASSESSOR (This section need..not be completed if.the permit is for one TRACT ' BLOCK LOT NO. I MAP BOOK PAGE I PARCEL. hundred dollars ($100) or less.) OWNER L— NO. / USE ZONE MAP /� 3 I certify that in the performance /apersqn work for'which'this J _ NO: r7 SPECIAL >_ permit is issued, I shall not employ iW2.1 anner ADDRESS ` CONDITIONS so as become su�lect to the WoCo eLaws. / O / CITY ZIP. U Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If,.after making this Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' i U Compensation provisions of the Labor Code, you must forth- ADDRESS vuuu -� .with comply with such provisions. or this permit shall be ] 1 JJ TEL. STATISTICAL CLASSIFICATION APT. CONDO: Z deemed revoked. CONTRACTOR / /� NO. v1 / _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.�L_DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS SEWER MAP NO. (commencing with Section 7000)of Division.3 of the Business LIC. and Professions Code,and myJicgnse is in full force aid effe . CITY /� CLASS BK. PG. VALIDATION 7�J y r (/.' SQ. FT. NO. OF' NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE /� f� VALUATION Contractor U /V Date DESCRIPTION OF WORK NEW ❑ $ ❑I am exempt under Sec. 71) MA-1 (r l7Lt 1S ADD ❑ ' ALTER [E]B.&P.C:.for this r ason /J j /� j K D� ` 6 REPAIR ❑ $ USE OF' Date: / EXISTING BLD /1 5-60elfi"E76 DEMOL ❑ Si nat APPLICANT EL. g . OWNER-BUILDER DECLARATION (PRINT) NO FINAL DATE � ] •' I hereby affirm that I am exempt from the Contractor's License L -- -- D E n[� Law for•the following reason (Section,7031.5, Business and AD R SS (�/1 FINAL ;1,4 - - Professions Code): PRESENT By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS u_a a wages as their sole compensation,will do the work and I€` iL the structure is not intended or offered for sale(Section LOCALITY _ - 7044, Business and Professions Code.) MOVING TEL. El1, NO.I, as owner of the property, am exclusively contracting •A'4c= with licensed contractors to construct the project•(Sec- f-if',-�L ADDRESS tion 7044, Business and Professions.Code.) REQUIREDHWY TOTAL SETBACK FROM XIST. CONSTRUCTION LENDING AGENCY SET BACK YARD 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. rt- - i , •t -as ,•', (Sec. 3097, Civ. C.). SIDE. sii-"'µ P.L.- Lender's Name LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee 3 � 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 p �� d ordinances and State'laws relating to building construction, Total Fee 13 LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date,