HomeMy Public PortalAbout5105 GOLDEN WEST AVE_Building__ y �
76A638A CE#803S-61 APPLICATION FOR BUILDING P T
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �.
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. I y
DISTRICT NO. GRO P TYPE C SEA BY
FOR APPLICANT TO FILL IN �' c CONST.
BUILDING �- STATISTICAL CLASSIFICATION ER MAP
-�G
ADDRESS ��8� [o 6��d•x L1 e S_ CLASS.NO. DWELL. UNITS.
LOT NO. / 3 BLOCK WATER NOT REQUIRED RECEIVED
3 CERTIFICATE:
TRACT J MAP HIGHWAY STATE MAJOR SECOND, LOCAL
NO.OF BLDGS. NO (CIRCLE)
SIZE OF LOT / I NOW ON LOT US= ZONE SPECIAL
USE OF A/ CONDITIONS
EXISTING BLDG. .+
TEL
OWNER �a /� NO. BUILDINGYARD HWY /S EET NAME EXIST.
SETBACK WIDTH
ADDRESS FRONT
ARCHITECT OR TEL. - P. L. �.
ENGINEER NO. SIDE a
ADDRESS
TEL ..11 INSPECTION CORD
CONTRACTOR 99
- NO. r`>' O
ADDRESS 19p//P
DESCRIPTION OF WORK W
a
Vf
Z
NEW DD ALTER REPAIR DEMOLISH
SO.FT. NO.OF NO.OF /
IZE STO IES FAMILIES
USE OF `
—STRUCTURE fOC421221
SIGNATURE OF
APPLICANT
VALUATION
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. FOUNDATION: LOCATION
FEE $ /�_ FEE $ FORMS,MATERIALS '
FRAME: FIRE STOPS,
IHEREBY 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
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK -
AUTHORIZED.HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH,INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT.
ING TO WORKMEN'S CO PEN TION INSURAN
LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE y� RECT AND POSTED
ADDRESS �``'� FINAL
CLYDE N. DIRLAM, PRINCIPAL ST SURAL ENGINEER
PLAN CHECK VALIDATION cK. M.o. cAsH PERM VALIDATION cK. ' M.o. CASH
52621 Nm 17 1 D 21 .01010
OR1�5' Qt3MPLNSATION DECLARAPON
I hereby,
,.Qc a irt-nc&r that I have &COrWorkers'
ffompensatio Ins to->eff APPI�ICAT1_C�.N F�?R-.BUILDING PERMIT
Inauro,,or a'certt{icale of Workers Comperuation Inwrdnc4p,'-
or a_cgrNfled.copy itiereof COl1NTY'OF LOS ANGELES. -. 6111LDING AI�Cy.SAFETY
Pd11cy No. Mpathy
n❑ Certified tbpy is-herek furrilahed. _ FOR APPLICANT- TILL IN BuILDiNG .
CerttRedcopy,IsfilADDRESS
edwltl the.countybulli�IngVnipK- �' &ST - _
tion departmenh., ADDMS
-
P <
Date' ,ApplLcQnf iocwTy.
NO. OF BLDG& 1E �
CEk71FlCATE OF SON FROlN.WORIG32S'. SIZ6 OFyLOT- NOWON LOT' =SST. ��' .
eOnnPENSAnON-IrRA1JC
kiss
f hli sactibh need not be corn ietgd if the permit Ls fir ooe BIOC]C JAT NO'. ASS SOR PAGE PAREfL
handfed dol4pr1(1
s"(� 0� or �'
wyt ER NO. USE Ml*
I-certify that.In.-the•pwfolmancM1h1.
lF� this : -
ipermlt b lqued,rftiall noterfipinhor ;A.DDRSS' / 1}_ L, SPECIA4 -
COMMONS
40�to.beo4_me#Q W thr,.N� aws; � O '
.. Z1P,, }' U
Dat r A4pllcbntAR(2Hn CT.OR , Ta ..NOTKT,TO A�PPLI fF `aftDISTRI 6ROyP. TYF� BY : O
rte of ::, EtJGINff32 NO. ZONE
�xarmptlon,;,you• oul.� become•subj&O-to the.Workers r T'
Corhpensatlon vlilorn of the Labt Coc40,�YdU+hurt tfgrth- AboREss �8
With comply-w�ih such �Srovislohs ;4.0ls,.perrhlt;shall be TEL STAi15TICAt CLASSIFtCA CONDp,
deemed rovoke�. r NO. — - —
LI CFNSE-p CONTRACTORS Dea A.MtON ADDRESS r4 o. ' O x.55 NO.�, ••rr�i LrN rrS
I hereby Arm that lam I Icaasod under prgvW6ns of-Chapter 9 SEWER MAP. �
(commencing wlth'S66lon 7000)of'DIyl$lort33pf.tht.susIn�as 1 UL.
and Professions,Cooq pnd my_IICOr�is lh idll , Cffy CLASS
forco-gefFetf. SG. FT. - a IEc PG:. : VA�ATFON
l.Icens4 r46ml�r qk*� �-- m STORIES FAMi B
Conirador - DQter DESCRIPTION OF WORK V TIOK -
❑ exempt-under
I am exempt under Sec s'- ]ri-
ALTER y:.
B.�P.C_ for th4-regson r ] ;
Rl�A�R LJ
° G Dom; _
Slgn6ture - APPuc rfu O TEL
NO. F - FINAL
OWNER$U ILDER-DECl.A72ATION DA7ti _
J heroby affirm thdt 1 am exempt from the Controcto�s(S.cense .. .
Law f6
the fd1lowln9�reason(Ssctfon 7031.5, 6usinr'dnd: '�
RrbfM_ slons'C43e): R. qqt�r 1
I, as owner.of the prpPerty, or`my empigy with
wages as$f Ir iol•compensation;wllGdo the work and ti. - I ,' '' [(? L►tr.lL
the atructuro h not Intended or of4� forsale(Sdctlori t -
0,. Duslnes aril Profbwlons Code.)• MQVING TEL
t
❑
[,,as ownpr of thr property,am o*clus1"!y corltractlnd _ NO.
with Ilcehied contrattors•tb'tonstrud-the pmjoo (Set. XDQRE�S .. - - - - _ X11 i lya'. 06 i
tlop,7044, Business 9rW.Ptofaslons'�A-).. �'lr, -
CONSTRUtFION LEIJDIAIG AC,ENCY YARD "HWY
I�tergby affirm.that them ls-o torwtructlon lending agency for
the perforviance pf the work•for-which this permit-Is isugd 'P.L
SIDE,
P.L. _
lenders Name 4J Ili.(') ' ] I ,qp
LDMA Rsf:% rr y { _ t��
LencWes Address
R'c Fee Perm N Fe. r.. _
I tertify-that I kiav'e read this application and statt that the Iwudnc• !• ...Q P /
above Infortratlon is cotrect, I aflr*e to comp ly-with aIl.County I on F«
Inances and State relating to building construGtron, - Total Fe.. CDMA Prat
an hereby outhb ntatly& of this County to ontw
u 4_abgve-mprop, for.lnsppolon pur0oses T' ,
— h W-1Ov¢01111PM IDQLAMATORY-LAN(Wtol
SIgnahX6 of Apel n7 `�, ' 1)(3tW