HomeMy Public PortalAbout5612 GLICKMAN AVE_Building__ 76A638A CE9803 5-65 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST F
COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST. "�1/ �...'.;, '`•
DISTRICT NO. GR TYPE .�"'"i PROC.E$SED BY
FOR APPLICANT TO FILL IN �"';" '� CONST. y `
BUILDING 9TATISTIC0 CL FICATION SEWER MAP
ADDRESS ; . CLASS NO.-DWELL UNITS GK PG
LOT NO. BLOCK USE ZONE MAP ,
_ i NO.
TRACT SPECIAL
NO. OF BLDGS. / 111 CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTIN BLOG. 4 BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OWNER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS - - HIGHWAY WIDTH FROM C.L.
+ -
CITY �._ �-
- BLDG. SETBACK FROM
ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL �
ADDRESS HIGHWAY WIDTH FROM C.L. 0-
TEL.
TEL. + - O
I CONTRACTOR NO
LIC CORNER CUTOFF YES NO Lu
ADDRESS NO
LL
CITY CILA SEE REVERSE SIDE FOR SPECIAL APPROVALS }
DESCRIPTION OF WORK Q
NEW ADD ALTER REPAIR DEMOLISH O
'SO:FT. NO. OF NO..OF
SIZE STORIES FAMILIES H
USE OF
STRUCTURE .. ♦ ¢:
SIGNATURE OF
APPLICANT
VALUATION$ APPROVALS DATE I NSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION
FEE$ FEE$ FORMS, MATERIALS
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE - RECT AND POSTED
ADDRESS + Fl N A L
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION: CK. M. CASH
.: 4 25t;
WORKERS'COMPENSATION DECLARATION
I,hereby affirm that 4'have a certlflcb4 of consent to self
InsureoracertlflcateofWprkedCom rnQilonInsurbnce,. PPLICATI I . N FOR BUILDING PERMIT
or a certified copy th . 3800, L b C. � - .' _ .
Policy fro ; mpan y COUNTY OF LOS ANGELES �IJILDING AND SAF
EA
`
Certified copy Is hereby furhIshed. R A uCANT TO fILL IN BUILDING
Certlfled copy.is filed wlth'the county bullding Inspoc gUILDINc3
No rtment. ADDRESS
�p ,
Dote`- r Applicant N CITY r— � •LP gym,
KATE OF EXEMPTION PRbM WORlm , OF BLDGS -
COMP94SATIQN INSURANCE SPI OF L& NOW ON OT ST.
(This•ectlon need not.be•cgmpleted tf'the permit 11'for one TRACT BLOCK' LOT NO: ASSE45OR
hundred dollars ($100)or leas.) �Aw BOOK
TB — USE ONE
I.derttfy that In the pinrformance of'thd work fq�f which this OMR }
permit Is Issued, I shall-nhallemploy anXpe n In any mannof �� WECA1 G:
to as to betome sublgct'to the Wbri4enCompaniatlon Saws. ADORES CONWTlO
DateAppllcant Qr1 P , '^
ARcHrrECToR. DISTRICT RRE By O
NOTICE TO'APPLICANT If,'after'making this Cer'tlffcetb of UJCNO.
Udmptlon, yo LL' Wiao,ld become',sublgct to .The Worked ODI
Compdnsatlon provlslonl of the iabor Code, you•must forth- ADDRESS, J.l V 0 LLI
with comply with such, provision{ or this permit shall be _ `
dammed revoked. : CONTRACTOR All3TK.4L C{/CSSIFIU1TION APT. Cn
d .
LICENSED CONTRACTORS DECLARATION LtG CL-M-NO. cySL UNITS Z
ir
I hereby affirm that Ism licensed under provisions of ChppW 9 U NO.
(comrngr dng with Sedlon'7000)of DIvIslon l.of tM Buslneq and gWER ASAP
Professl6ps Code, and my license Is In full force and effggt. C17Y CLASS -MZPG _VALEATION
Sp FT. NO. OF No.OF IE«
Ljcense Number Llc.CI Sig STORIES _ FAN LES I .
,•.�I NEW V T10N , I f
Gontroctor (ice l�SiL r a DES[RI OF 4VOR1C S Y
i }
_ AVSD 1,0 8.$
l am exempt under$ec. ALTBt #to • o,o
: o
�.. B.d.F.C. for this reason {iEPAIR - " - �� 2.51.$2
Da1'. U U OF BLDG. 511.8.2 6'
1 s+4rKrfu ` 'rNT
O(�(�IY. NCO. nNAL
by am
a DEom the*I on G DJk77
:. I here a#Irm that l-stn ex• from the.Coniroctafs:L4cense - ,
IJ.rnv for the following red+on (SicHoh 7031.5, Busfr ees and
f'rgf*nlons Codd); BU LDtiVG .. c..
I, .ce owr_e".of the property, or.my employees'wlth ADDRESS
W09"as+elr sole co mpensatloh,,wlH do the work and
the structure h not Intend•doroffered for sale jSbctlon' LAY
7041, Business-and ProfMalonrCodo� MOWING I. - • TEL ,
• i, a owrw' of the pSoperty, am exclusively Contracting �'
with llcettsgd-contradors to'-construct the project(Sec-
tion 7041,Business and ProfeefiFons Code),
CONSTRUCTIQN LENbING AP,ENCY YARD FWY
I hereby-affirm that.therq.Ia a construtHbn landing agency for FRONT
the performance of the-Work for which-this permit Is Issued 7.L -
(Sec.'W."civ. C. 54 DE
P.L
LenckWs Name Rif.
U.
8 -
P.C_ Few$ Perm ItFee.
Lenders Address
- fy.that I}cow read thls oppllcatlon and state that the issuance Fee LDAOA P—/Cf'
2 a Info7hotbn Is cooed. I agredto comply with all County. InveslL�atbn Fsa
ordlnancaa and State laws relating to bullding constrbctlon, Twol Pee LDAM Perm. #
andF�pn
orize reprea*ntaHvis of.thls County to enter
uponnt� � entionpr
f sort pu
b�
>sa Rt:Vlfi PO!DlT[A'1iATORY LANOlU1W
�.� WORKERS,CONDENSATION DECLARATN _.
LSI_ ai Firm tf,at I have a �:rtifltat. of consent to self APPLICATION FOR BUILDING P E RMI T
Inturo, or a certificate of Worker' Com�ensatlon Insurance,
or a cb'tlfled 2dpy+erecLatc. 3800, Lab. C.
COUNTY OF LO$ ANGELES 6UILDING AND SAFELY
PolleyN.o1aLe7W pony
Certified copy,hherebf furnished. FOR APPLICANT TQ FILL IN ,ppm .�
Certified copy Is'filed with the countK budding Inipec- BUILDING
tion`cepa rot. [ ADORMS
Dab [r ilcant A* TT. /J/7 CRY ZIP
(Aga LOCALrrY
CERfiFICATE OF DMYPTION FROM WORKERS' _NO. OF:BIaGS,
COMPSATJCNN INSURAiNa, SIZE CIe LOT NOW LOT
ST.
ENtV
(This wctlon-meed hot be co m leted if the permit Is fbr,oni TR BLOck LbT.NO AMP p4CA PARC$
hundred dollar(;100)or lesa
. TEL
I certlfy-that fn the MAP
performance of the work for which-this OWNER NO.
permit Is bw�d,,l shalhtbt employ artypersop In arty manner
. I —
so osfabeto a subject to the Workers: Compenwtlon Laws. I /y r SPECK
$T
Ak PplCITY
bate � AQ
NOTICE It afW making`fhls CertffTcate of ARCHITECT OR DISTRICT. GROUP. Wit. FIX PRCK
EY
Exemption, you should become subject to ,tF4 Woekeri n
ComPertsatlon provisions of the Labor Code, you must forthADDRESS
fJ
with comply with -such provisions'or thl.4 permit ;hall.be . . . -'
deemed.Fevoked. TRSTORSTSSATISTICAL CLASS F)CAbON AFT.
LICBNSED OONTRACTORSUECLARATION CLANO. UNITS
I herebyL afflrm that I am li eneed urtd6r provisions of Asx 9 ADDRESS NO
(mmrnrr,,.ocinp wkhS.ctlon 7000)of Dtvlaloa3 Qf tis.arsl6ion prod - _ SEWER AW
Profssslhns Cbd�, and my I101'n" FF,in full.forte ai CITY BK PG.006
VALDArF DH -
Sa OF OF CHECK
License Number Lk,Clam ` �4WY StgFT. CW.-
Goniracioi � ('� DESCRIPTION OF WORK' : J
m /'
q, _ �'' sop pppSSS Ip ,
n I aexempt under Sec.
ALTER
.B.3P.L for this reason NR S-
Date. E
EXISTING BLDG. _
Signature APPUCA►R
OWNERS DKl.ARATION (PPJNT) DATM
I hereby afflnwthat�l am a pt from thaContractori Llcertse 1� 1 rr I
Law for the following reason (Section 7031.5, Buslne}s'and ADDRESS y T0,2 9 a 5� -
ProfeWons Cad.); BUILDt1JG: o 2 9 a y5 0
I, as ovvrter of the property, or my employees withADDRESS
wagers as their sold compensatiore,:will do the work and _ `
the ittucture b not Intended or offered for sale(Section LOCALITY I �;13 8
7044, Business and Prpfealons'Code). MOVING TEL.. ' -
I, as owniw of thb property, am exclusively contracting
with licensed'odntractors to'cohstruct the project (Sec-
filen 7044, Business and Professions Code} -
L a MACK FROM
CONSTRUCTION LENDING AGENCY YARD kfWY PROP. UNE III
I heraby aff.Irm that tftere Is a construction-lending agency for FRONT
the performance of tfiavvork for which this permit. Is Issued
(Sec. 3097,,Clv. C} SIDE
$ Lertdet}.Nam» LDMA Rsf. 1
Leod9et Address P.C. i P«mN Fee
I csnttfy that I have read this cq*1 ation and state that the isuana. LDMA P/C f
above Information Iscorrect. I agree to comply vrlih all County lnvNti�cf4orr.Fss '
$ ' ordlna and Slate lows.relating to building construction, _
$ and authorize representatives of this,Coenty to.enter Total F« 50' Per., + \ `•.
bove-mtentl Pr Y for spectio^
may hOR oa1.AKATan LAPGUAoa
Aott or Agent D44