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Home My Public Portal About5303 GOLDEN WEST AVE_Building__ 76A638A CE 803,-62 APPLICATION FOR BUILDING PERMIT. COUNTY OF LOS ANGELES ADDR SS "a3 CTOL/>�'/�/ W"/ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST Q /� WILLIAM A JENSEN, SUPT OF BUILDING CROSS ST /,JL- ,ii��•�� DISTRI I N(� GROUP TYPE ' SSED BY FOR APPLICANT TO FILL IN U v � coNST `) BUILDING ,y {�� '7r �J STATISTICAL CLASSIFICATION SEVER MAPPj, ADDRESS CLASS NO DWELL UNITS LOT N BLOCK -WATER t, ) CERTIFICATE NOT REQUIRED WAY ® RECEIVED - -11 TRAC d' NOPp:z/�f (ICICLE) STATE MAJOR SECOND, OCAL y NO OF BLDGS SIZE OF LOT / K USE OFtt�3� NOW ON/�LO/T��f 2 'USE ZONE ` SPECIAL EX STING BLDG G-6/AM"`2`9 GY /2/i'•:S CONDITIONS f /` p a t OWNER Cy` CIT fP1/Y NOAT, p2l^/YD GILDING " EXIST - - /f� •' ,`tt SETBACK YARD AHW�� SJR E NAME WIDTH ADDRESS �•3U3 (-`(GL r`N vtlel7 X'✓SFRONT ARCENGINEER O NEERR GJ'fay NO SIDE ADDRESS 1 O TEL + U CONTRACTOR (�9f(� � NO ADDRESS ^y 4 w ��r 0, DESCRIPTION OF WORK a Vf NEW ADD/. ALTER REPAIR DEMOLISH Z NO OF NO OF SIZE T G// � �STORIES n A/,nFAMILIES Qom] USE STRUOCTURE/_*//VQ4j/ ti. /G/C/Y(2'�~ �l�®I•I " SIGNATURE OF ' APPLICANT- VALUATION PPLICANT VALUATION -APPROVALS DATE, INSPECTOR'S SIGNATURE ' FPC PT 77 EE $ FEES FOUNDATION LOCATION FORMS, MATERIALS jjr�f FRAME FIRE STOPS,: / ,p I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS I / .,�.� »Z4 ANDSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITHALL COUNTY ORDINANCES, AND STATE LAWS REGULATING GAS VENT, DUCTS f BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK a. , r AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF THE LABOR CODE OF THE STATE OF C IFORNIA RELAT- LATH, INT SING TO WORKMEN'SM6 �;lNS NCE r LATH, EXT SIGNATURE F I, HOUSE NUMBER-COR-- ! PERMITTEE 1 REIT AND POSTED ADDRESS 0 FINAL JOHN F LEWIS PRINCIPAL STRUCTURAL ECCA R PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION- CK M DH Limo 3 8 6 3 APR'2 p 1 G 8,CJ,0, WORKERS'COMPENSATION DECORATION hereby affirm that I have ce"�tCom a of consent to self A P P L I�t,AT I O N FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) �. COUNTY.OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING � Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS n Certified copy is filed with the county b 'Idi2.%inspec- BUILDING ,,r}- tion department. ADDRES LOCALITY NEAREST Date Applicant 6, CIT ZIP CROSS ST. O CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. TEL. SPECIAL >_ I certify that in the performance of the work for which this OWNER `� ,br N -3?q� CONDITIONS ®- permit is issued, I shall not employ any person in any manner �/1_��tp y� ZDISTICT GROUP TYPE FIRE PROCESSED BY 0 so as to become subject to the Workers'Compensation Laws. ADDRESS l � �4L ^ CONST. Z - CITY• C, ZIP O Date Applicant STATISTICAL CLAS IFICATIONAPT. CONDO. I- NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR �___.. TEL. ` b Exemption, you should become subject to the WorkersENGINEER NO. CLASS NO. r DWELL. UNITS UJ Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER M P V° with comply with such provisions or this permit shall be //� z deemed revoked. CONTRACTOR ` ��^ N L ��p BK. PG, S VALIDATION LICENSED CONTRACTORS DECLARATION ` LIC• I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS. 4 'L II NO. 6 VALUATION (commencing with Section 7000)of Division3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY Zjp9- gQ CLASS $ ► SQ'. FTfZ7 NO. NO.OF CHECK License Number Lic.Class SIZE STORIES IFAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ $ I am exempt under Sec. 7 ADD ALTER ❑ FINAL �� B.&P.C. for this reason ❑ DATE REPAIR Date: USE OF a DEMOL FINAL EXISTING BLDG. ❑ BY tZI Signature APPLICAN TEL. OWNER-BUILDER DECLARATION PRINT , t NO. - I hereby affirm that I am exempt from the Contractor's License ► Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRE ENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. CONTRACTOR NO. I, as owner of the property, am exclusively contracting -179852 A with licensed contractors to construct the project'(Sec- ADDRESS tion 7044, Business and Professions Code). ft' o o o 00'1 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction fending agency for .FRONT ► 2 0 1 6 2.3'8 the performance of the work for which this permit is issued P:L. o ) 2• (Sec. 3097, Civ. C.). SIDE m P:L. Q Lender's Name X320-84 P.C. Fee$ Permit Fee Lender's Address I certify that I have rea this application and state that the Issuance Fee V above information is c eoseves e to comply with.all County Investigation Fee / g ordinances nd St la to building construction, Total Fee u and here out ze of this County to enter m upon abo -m a operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ®_ Signature of Applicant or Agent Date