The URL can be used to link to this page

Home My Public Portal About4941 GOLDEN WEST AVE_Building__ 7LAGMA Ct#sos.Io-EG APPLICATION FOR BUILDING -PERMIT ..1 BU11DING AD SAFETY DrMON wUDeraa N. g Depmtneiit of County Enpia«s aT, �&gft County of Los AIIQaMLOCALITY t JOHN A. LAMBIE. CouNTY EN(IINmz NUARSBT /1 CAASATT D.GRIFFIN, SUPT or SYILDINQ CROSS ST. 6L- DISTRICT NO. GROUP I Typ, 'SEWER MAP FOR APPLICANT TO FILL Ill SK ' PQ CONST BUILDING ADDRESS STATISTICAL IFICATION LAT NO. �. LACK CLAS. NO DWELL-UN ITS MAP arty - O R HWY TKTRACTTRACTNUMBE UG[ZONE[ SPECIAL NO.OF BL DGS. CONDITIONS SIZE,OF LAT (/I' NOI&ON LOT �I USE[OF �7 IST NG BUILDING .YARD HWY STREET NAMIL 'x'sT. e SETBACK _ _ WIDTH OWNER FRONT MAIL P. L. ADDRISs HIDE - T P.L. INSPECTION RECORD. -. ARCH SCT 9fi TXL ENGINEER NO. APPRESS TIL CONTRACTO NO. - ADDRESS - DESCRIPTION.OF WORK NEW AD ALTER REPAIR DIMOLISH so. FT. NO. OF NO.OF lilt[ STORIES FAN LI[H USE OF JiTRUCTURE r - ,.�„ E .(.)Y, R A'O APPROVALS - BIGNATUR[o APPLICANT DATE INSPECTOR'S 819 0ATIIRE ADDR FOUNDATION: LOCATION FORMS, MATERIALS s F.C. s FRAMI: FIIgs DTOPH. FI[ BRACING DOLTS 1 I 1 U sTT- FURNACE: LOCATION. VALUATION II 11 GAS VEM DUCTS' FIE 1 HEREBY ACKNOWLKDGE THAT 1 HAV[ READ THIS AP- LATH INT. PLICATION AND STATE THAT THE ADOVI IS CORRICT`AND V - AGREE TO COMPLY WITH ALL COUNTY RDINANC[O AND LATH KXT - STATE L.AWH UL.ATIN 1 1 CONSTRUCTION SIGNATURE O HOUSE NUMDEF�COR- PERF [ RECT AND Co ADDR FINAL JOHN A.LAMBIE COUNTY ENGINE" CLYDE N. DIRLAM PRINCIPAL.STRUCTu IN[ER F s* CZCi VALM TWX Cx. K.o, CASH PEUM VALUM T ON ax QAIH LAC-03 6 6 8D;- OU23 1 `6.00 m PPLICATION EOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY I GINEM ECJ I L D I N G P ERM I T BUILDING AND SAFETY DIVLSION BUILDING r OR APPLICANT TO FILL IN ADDRESS ' L LOCALITY NEAREST ZIP CROSS ST. Q //�� NO.OF BLDGS. ASSESSOR OT�p NOW ON LOT MAP BOOK PAGE PARCEL O jy DISTRICT GROUP TYPE FIRE P D BY �. BLOCK -fYLOT NOC011�T/ ZO TELv O NO. STATISTICAL CLASSIFICATIONSEWEFi. CLASS NO - DWELL,UNITS B G E ZONE MAP ZIP NO.CT OR NOL7.2 SONDP EIC IT ONS R ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONTRACTOR TO ?IS BLDG,SETBACK FROM LIC FRONT PROP,LINE OF (STREET) ADDR�p I NO. HIGHWAY + YARD = TOTAL SETBACK FROM TY EXISTING LIC. FRONT PROP. LINE =WAY WIDTH CITY CLASS �/ CONSTRUCTION LENDER + NAME AND BRANCH BLDG.SETBACK FROM ADDRESS CITY SIDE PROP.LINE OF (STREET) 8 SQ. FT�wNO. OF N OF CHECK HIGHWAY + YARD = TOTAL SET ACK FROM TYPE OF EXISTING � SIZE 'L STORIES FAMILIES ONE SIDE PFFOP. LINE HIGHWAY WIDTH DESCRIPTION OF WORK & EW N DD CORNER CUTOFF ❑ NO ❑ Z ALTER ❑ IN OPEN SPACE ES NO EPAIR ❑ USE OF EMOL IN COASTAL PERMIT ZONE YES NO EXISTING BLDG }b- �.fYt. APPLICAN TE - (PRINT) N BY (SIGNATUR I HEREBY ACKNOWLEDGE TH I HAVE READ THIS APPLICATION AND $TAT[ THAT THE ABOVE S CORRECT AND AGREE TO COMPLY WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEBOR RBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF Til[ LACOD[ OF THE ST [ OF CALIFORNIA I R ATI NS TO WOR KMEN'f COMPENSA I.SURANCI SIGNATURE OF FINAL �� /� BY PEFIMITTEE DATE ADDRESS CITY E, `✓a� Ra Fee 47 Pertnh Fee —� VALUATION VS I»uencp Fee �— Total Fee .�• j� PLAN CHECK VALIDA'T'ION CK. M.O. CASH _ PERMIT VALIDATION f� M.O. CASH 3 -1 5 5.5 0 71ASUA CKMGG]. 12/75 6 WOWRS'COMPENSATION DECLARATION �- .. hereby affirm that I have a certificate of consent to selfAPPLICATION -- FORBUILDING P E RM I T Insure, or a certificate of Workers' Compensation Insurance„ or a certified copy thereof (Sec. 3800, Lob. C.) 7�i, k COUNTY OF LOS ANGELES . BUILDING AND SAFETY Policy Na-? 44 16 Company J F1 Certified copy Is hereby furnished. FOR APPLICANT TO FILL INS EaCertified copy Is filed with the county building Infpec- BUILDIN /di/./ �` LTM G tlon department. ADDRESS '7��T NEAREST Date Date �` 7 Applicant GTY --rem C ZIP CROSS ST. �--> CERTIFICATE OF DVAPT}ON FROM WOOCERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE IZEOF LOT NOW ON MAP BOOK PAGE PARCH (This section need not be com let.ad if the permit Is for one hundred dollars ($100)or less. TRACT BLOCC LOT NO. I 'certify that In the.performance of the work for which this OWNER h —NO. ?Are CONDITIONS a permit Is Issued, I shall not employ any Perso DISTRICT GROUP TYPE FIRE BY O any manner ADDRESS CONST. / ZQp� U so as to become subject to the Worker Com nsatlon Laws. �v/ ✓�j me Date Ilcant CITY ZIP STATISTICAL APT. rOADO. NOTICE TO APPLICANT after making this Certificate of ENGI'�HrE - NO.ja .;M342- CLASS NOw9L UNITS W Exemption, you should become subject to the Workers' CL Compensation provisions of the Labor Code, you must forth qh f AAP N with comply with such provisions or this permit.shall be Z deemed revoked. CONTRACTOR +l /O NNOO. S BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION UC I hereby affirm that I am Ircensed under provlslons of Chapter 9 ADDRESS 2_ L NO. 2 Z2j VALU (commencing with Section 70Q0)of Dlvtslon 3 of the Business and UC Profeslons Code, and my license Is In full force and effect. CITY CLASSC—C C^61 S (((! - 2 !' / SIZE STORIES f FAMILES / CITECY ONE License Number Uc Clan C�� , DESCRIPTION OF WORK I'� ❑ s Contractor ��"�+� Date 13 I am exempt under Sec GO UG ADD ALTER D DATE — X2371 A B.SP.C. for this reason r3 T REPAIR ❑ Date' EXIST!!, BLDG,S7 DUSE 6F. # o o u e 2-3 � T TEL 6 `�3 4 I Signature' . . OWNER-BUILDER DECLARATION NT)I �' I hereby dfflrm that I am exempt from the Controctor'■License o65,34r5cerue Q Q 7 1 i 8 5 Law for the following reason (Section 7031.5, Business and Professions Code): owith SDRSSI, as owner .ProPror mY em foYAE wages as their sole compensation,will do the work and # �. 7 the structure Is not Intended or offered for sale Section b 7044, Buslness and Professions Code}. VAMRE NO. I - 87.38 EJI, as owner of the property, am exclusively contracting 0 with licermbd contractor to construct the j5roject'(Sec- 0 0 o tlon'7041, Business and Professions Code). ADDRESS Q7 CONSTRUCTION LENDING AGENCY SETRK�UYARD HWY TOTAL SETBACK FROM WIDTH , I hereby affirm that there h a construction lending agency for the performance of the work for which this permit Is issued Sec 3097 Civ.C.)Lender's Name Lenders Address s`� Permit Fey /) O I certtfy that I have rood this application and state that the. Im nu Feef/ .S Q above Information Is correct. I agree to comply with all County Invssripatlon Fee ordinances and State laws relating to budding construction, Total Fee O and hereby authorize representatives of this County to enter upon the above-mention property for Inspection purposes: . ,.— r+�`� SM R/VWM I'OR 1034AHATORY.LAPOGUA04 S4g3sature of Appikartt or Agent Date .