The URL can be used to link to this page

Home My Public Portal About5642 GRACEWOOD AVE_Building__ bIsJISIOF BUILDING AND SAFETY De ? � ' D Department of County Engineer • County of Los Angeles ING WM• J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY �/tD7�r ,1 /�,�a .�.w,.,� 1/Js�, DISTRICT NO. PLANK CK. OR REC.No. PERMIT NO. ADDRESS J j9 Sifr' 4fy O � RECEIVED BY DATE OF APPL. ` DATEIIBSUED LOCALITY � NEAREST CROSS ST. BUILDING ADDRESS ♦ __ _ _ OWNER MAIL _LOCALITY ADDRESS NEAREST .s r TEL. CROSS ST. _ CITY NO. FIREI NO. OF I TYF,FE--- GROUP ZONE PLANS ARCHITECT OR TEL " ENGINEER NO. BLDG. "' ORD. NO. SETBACK LINE ADDRESS USE APPROVED TEL r ZONE BY DATE CONTRACTOR + NO. i HOUSE NUMBERING ADDRESS r MAP NUMBER ---NO. ASSIGNED BY--- -- LEGAL DESCRIPTION LOT NO. BLOCK CORRECTIONS TRACT y IS `/ NO. GF BLDG8. SIZE OF LOT NOW ON LOT USE OF I NO. OF -- - EXISTING BLDG. - FAM ILIE5 DESCRIPTIM,YOF WORK Q NEW - ��` ALTERATION I ADDITION ---� Z D REPAIR _ DEMOLITION r Sq.FT. j- NO.OF — 81ZE ROOMS J4 STORIES EXT.WALL I ROOF COVERING �/ ��-• COVERINGIc USE OF STRUCTURE ,12..-1.�,4 "Of. .j „.,.,, INSPECTION FOR APPROVALS OCCUPANCYAS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FORMS, MATERIALS --- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS, CORRECT. BRACING, BOLTS -s✓ I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION, FURNACE: LOCATION,_ GAS VENT, DUCTS SIGNATURE OFLATH, INT. —1 �►�� PERMITTE L ADDRESS ATH, EXT.-- —� AUTHORIZED AOT. , PLASTER, INT. — —— $ / PLASTER, EXT. FEE HOUSE NUMBER COR- G+ RECT AND POSTED VALUATION FEE FINAL 7GA638A DBS 3 1-52 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS y E. GWoo I hereby affirm that I have a certificate of consent to self insure, BUILDING-A QDRESS L,)t I ff1 �C or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITjY "✓ ZIP kir + � LOCALITY /' Policy No. Company SIZE OF LOT NO,OF BLDGS.NOW ON LOT („� ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ElCertified copy is filed with the county building inspection TRACT BLOCK LOT NO department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP,BOOK PAGE PARCEL SPECIAL CONDITIONS ✓f! } CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO: ! COMPENSATION INSURANCE ! WITHIN 1000 FT OF SCHOOL? YES NO - �• (This section need not be completed if the permit is for one hundred ADDRESSDISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY. dollars ($100)or less.) CITY / ZIP r .!'' Z ~',��+ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to YYY �/ ffffi become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO, STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ! FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE } CITY LIC.CLASS P L � I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP 0 (commencing with Section 7000)of Division 3 of the Business and S Z NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. { NEW 1:1 BK P a DESCRIPTION OF WORK LIJ License Number Lia Class � ADD ❑ VALUATION Contractor Date i t' f $ __ LL. ALTER El } ❑ I am exempt under Sec. ' 1 REPAIR ❑ $ BAP.C.for this reason DEMOL ❑ LDMA P/C# T Date: USE OF EXISTI BLDG. URM ❑ d 23 2 Signature APPLICANT(PRINT) TEL O. LDMA Perm# T LU 41, as owner of the property, or my employees with wages as -) Z W A their sole compensation, will do the work and the structure isADDRESS - O 3303 not intended or offered for sale (Section 7044, Business and FINAL DATE Q � Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALOR A MIXTURE A HAZARDOUS MATERIAL EQUAL J El 1, as owner of the property, am exclusively contracting with AMOUNTS S EC NG F ED ON I HE HAZARDOUS MATERIALS NFORMATTIION GU DEE'ER THAN THE FINAL BY AUT M' licensed contractors t0 construct the project (Section 7044, YES NO❑ _ r 1:1 Business and Professions Code.) E,i WILL THE INTENDED USE OF HE BUIDLING BY HE APPLICANT OR FUTURE BUILDING i..A3�'J a 1 OCCUPANT REQUIRE A PERMIT OAST AIR OUAAUTY MANAGEMENT DISTRICT CONSTRUCTION R MODIFICATION SOUTH DIISTRIIC SCAOMDEEPERMITT NG C ECKLISTFOR 2) CONSTRUCTION LENDING AGENCY GUIDELINES. ITEMS I hereby affirm that there is a construction lending agency for YES❑ No❑ TOTAL 7243-3�2 N the performance of the work for which this permit is issued(Sea I HAVE READ THE �'+ AND THESCAOMD PE 3097,CIV.C.) CHECKLIST.I UNDERSTAND DMYI REQUIREMENTS UNATERIALS IDER THE ON E OS ANGELES COUNTY(CODE M 733.32 TITLE 2,CHAPTER 2.20 SECTIONS 2.20,100 THROUGH 2.20.140 CONCERNING HAZARDOUS a �ry Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMO. Ow" r00 o Lender's Address l((AA9�RR yr O OWNER OR AGENT o I certify that I have read this application and state under penalty o P.C.FEE PERMIT FEE. (q(yyl.,, � 2 ' d of perjury that the aboy ' formation is correct.I agree to comply f, s� e0,a�.-.r00 R with all county o nces and State laws relating to building T- 3. (-) %... `: � // / r ,� ro constryction, hereby authorize representatives of this County ISSUANCE FEE A{ 1. I lfi+�•4 Cl) to enf�r upon the above mentioned Pro 1�yty for inspection purpose. ,Z3 /-'�-- INVESTIGATION FEE TOTAL FEE/ Sig^a `f�y�anY or Agent Oai. SEE REVERSE FOR EXPLANATORY LANGUAGE