HomeMy Public PortalAbout5203 GOLDEN WEST AVE_Building__ • X_
OF,�OUNTY ENGII�iEER
Z
RSION
�F BUII.DING AND SAFETY °�3mBUILDING
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER APPLICATION'
CASSATT D. GRIFFIN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING
/ DISTRICT NO. PLAN CK.ORREc.No. PERMIT NO:
DDRESS 4''PSA00ioD0— 0` p2. • 211�q
LOCALITY G _RECEIVED BY DATE OF APPL. DATE ISSUED
NEARESTf q/✓S G -,��� /O
/��l -71-,
MAILCROSS ST / gDDREIBUILDNG03 ✓(/SS s� A + (1 /C/-�'n (/V•P S%
OWNER b �OO ./
MAIL ?� r/ �; LOCALITY -{,�,0'� (/ /F J,y y
ADDRESS _ NEAREST' �,(�j
clrY
TEL CROSS ST.//, / 6a h /`7
FIRE NO. OFo
ARCHITECT OR TEL. ZONE---- I PLANS TYPE I GROUPT�
ENGINEER NO. BLDG. /
ADDRESS
SETBACK LINE �' �y.. tf 9 ORD. NO.
TEL. USE ,�J APPROVED
CONTRALTO O O. �f7 Z ZONE^/ BY DAT
ADDRESS 0 / P BJP HOUSE NUMBERING
LEGAL MAP NUMBER 5--•D 1 G NO. ASSIGNED BY
DESCRIPTION LOT .'S BLOCK
S to g 3 CORRECTIONS
TRACTNO.OF BLDGS.
SIZE OF LOT 4"..9je, NOW ON LOT
USE OF f- NO. OF
EXISTING BLDG. FAMILIE nal A.-Cr A+14— t�^�
DESCRIPTION OF WORK o —
NEW Y I I ALTERATION ADDITION I 9 S 4 A
ILII -,y::
REPAIR DEMOLITION /
SQ. FT NO. OF r" Oop, ~ G 4 M t
SIZE �`7[��rA ROOMS STORIES �f N
EXT. WALLI ROOF
COVERING S C COVERING D Ifo c_
USE OF STRUCTURE
/ APPROVALS
INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION // y
FORMS, MATERIALS .b d" rA.eiarL4++
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRESTOPS, r t_A y /
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS �i{,� q
CORA REE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION,
AND STATE LAWS REGULA G BUILDING CONSTRUCTION GAS VENT, DUCTS
SIGNATURE OF LATH, INT..
PERMITTE _
LATH. EXT.
ADDRESS ` q
PLASTER, INT.
AUTHORIZED AGT.
PLASTER, EXT.
per' S �� HOUSE NUMBER COR-
RECT AND POSTED 9 i
VALUATION (> - I / FEE S ---" FINAL (8
-� 76A638A 0883 8-85 I
rA ."-•.' 'WORKERS' COMPENSATION DECLARATION •:'` - _'�'i 'v" _,
hereby affirm that.I have cert ficate•nsatio I nsu to self ~y T�A P P L I Ci4T I O N _F0 - �tU. D I " G� P E RM I T
insure, or ',certificate df'W_ Compensation Insurance, -
or�d certified copy thereof (Sec 3800 o C )
COUNTY.OF LOS ANGELES BUILDING.AND SAFETY
Policy No�_Company
a Certified,copy',s_hereby furnishedFOR APPLICANT TO_FILL IN 1 BUILDING 3,.
_ ADDRESS ;
Certified copy is filed with'the county building'inspec- BUILDING
hon department i ADDRESS 3 JCitvt t TV�Jty ` I 1
Date v Appl+canti CITY ll_ *� ZIP 1 LOCALITY
CERTIFICATE OF`EXEMPTION FROM N% KERS' T - _-- _ ..__ NO OF BLDGS - NEAREST._
COMPENSATION]NSU RANCE• ' - SIZE OF LOT NOW ON LOT CROSS ST_ y, i
(This'sechon need�not'be`,completed if'the permit is-for one - --- - ASSESSOR
hundred dollars ($100)orrless ) Z TRACT BLOCK*
LOT NO TEL �a MAP BOOK- PAGE, PARCEL ;
1 - J 'OWNER- ll.X l L C�L3�. - _ NO 'Ir USE ZONE MAP
I certrfy_that,�in the performance of 4"work for which this NO
erinit is`issued, I shall not em to y an y erson in an manner t SPECIAL- ' --; - d
P, , P Y Y P Y. ADDRESS 'L S�� J "`^ - - �/'�� CONDITIONS' ~; O
sd"as to become sublect to the Workers'Compensation Laws
h CITY
Date Apolic6nt. r•, :, ,.
i. a ARCHITECT OR TEL DISTRICT _ ,GR UP TYPE -FIRE PR ESSED_BY ;;Q
NOTICE TO;'APPLICANT -If, after making tliis Certificate of U
ENGINEER NO '
Exemption, you should become subject'to the' Workers' ` !f �,�I.CONSTi, / ZONE y i LU
LU
Compensation provisions�of-thie Labor Code, you must forth- ADDRESS T U r--y•-
withL comply,,with•.such provisions•;or this permit shall be •-• - -- TEL'- , H
deemed revoked S ( STATISTICAL CLASSIFICATION APT C DO''- Z
= CONTRACTOR UJ- T^- O C
LICENSED CONTRACTORS DECLARATION - -- 1 _i IC-- CLASS NO ( DWELL UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS roc_t 5-Sa VNtCL `tlt✓1 NO 3
commencm with Section 7000 of Division 3•of the Business and _ _ .
( g ) !� ` ` -_ LIG _ Q SEWER MAP t 1
Professions Code, and 'rriy_`license is in full force and effect CITY 'c_.L1t1�'9C\('} Q CLASS C� I "" -'""' ' "-, VALIDATION-.-- "
/,1 SQ FT NO OF NO OF_ CHECK BKPG
-
License Number 8'10 Lic Class -�9 SIZE STORIES FAMILIES ONE y' t
r 1,1,90 VALUATIION j:
n Q11u ;.�c �i tt�(� �/_ DESCRIPTIOW61'WORK' `ruck �15E- NEW - Q / '
Contractor i Date1 v {� p ADD a $ - t + `
a1 am exempt under Sec s w l:
p u,( ALTER• ❑t
B&P C for this reason REPAIR.Ekin0 $--- - -
USE SE OFl-" EXISTING BLDG' `\//. DEMOL EJ
EL
Signature APPLP ICANTT, C,I� NOZS FINAL
OWNER-B DER DECLARATION _- _ _ • _ _ DATE-
I hereby affirm that I am empt from•the Contractors License J SdC�r^ ,�4 i? L _ a•, ~
Law for.the following reason (Section 7031 5, Business and ADDRESS 1_0 Q - FIN'' 9 ,
"'Professions Code)'' - ,. �} PR T JWIDTH
` - -_
BUILDING -1, age owner of the propensa or my employees with ADDRESS52 2 4 Awa esas their sole coin ensation,will do the work grd
the structure is not intended or offered for sale(Section LOCALITY 7044; Business and Professions Code) MOVING -" TEL" #1, as owner of the property, am exclusively contracting CONTRACTOR NO with-licensed,contractors to construct the-project (Sec- - ADDRESS + 7a_Q_Otion 7044, Business and Professions Code) sed•_,REQUIRED_ TOTAL SETBACK .. ____- _. . _._ oo o-].�-Q.QVLENDINGAGENCY , SET BACK "YARD" HWY PROP LINE t'I hereby affirm that'there is a construction lending agency for FRONTfhe performance of.the work for which-this permit-is-issued :PL —' - - —^ " ^'^^ - - - '0 a_�r� _8-6-'--(Sec 3097, Civ C-) SIDE *PLLender's Name
A Ref k` P'C Fee$ - - Permit-Fee^-"` ,,ender's Address•
% j,_cerhfy that 1-have read this application_and state_that the .`,_. _ :._ _ _ _ Issuance Fee----- A P/C Mabove information is correct I agree to comply with all County. Investigation Feeordinances and State jaws relating to building construction, Total Fees A Perm-#
t
u and hereby authorize representatives of this County to enter
upon the bov -mentionedoperty for inspection purposes •`
a (J// E SEREVERSE FOR EXPLANATORY LANGUAGE
- - Signature f Applicant or-Agent- --Date'_