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Home My Public Portal About10046 GREEN ST_Building__ TEMPLE Cil 7GA809A CE#0092 60 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES ADD E1SS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. GRO P I TYPE PR CESSED BY FOR APPLICANT TO FILL IN ��' CONST. BUILDING STATISTICAL C SSIFICATION SEWER MAP ADDRESS// ��f/ t IE Y SK PG D` CLASS.NyO. DWELL.UNITS LOT NO. BLOCK MAPNUMBER`�--D STATE YES NO TRACT USEZONE SPECIAL NO.OF S I SIZE OF LOT /� p�L- J J I NOW ON LOTCONDITIONS USE OF G U EXISTING BLDG. BUILDING EXIST. TEL. SETBACK YARD HWY STREET NAME WIDTH OWNER fth"RNO. FRONT ADDRESS P L -o SIDE ARCHITECT OR TEL. P. L. ENGINEER � L NO. INSPECTION RECORD /� ADDRESS �7 14 m ,>4 / A / TEL. CONTRACTOR �i_� I= (�NO. O ADDRESS V DESCRIPTION OF WORK ` U NEW ADD ALTEFt< REPAIR DEMOLISH w SO.FT. ll/'l NO.OF NO.OF i _r ; .- _ a SIZE l�'(1 STORIES FAMILIES ` �E En USE OF STRUCTURE SIGNATURE OF , APPLICANT VALUATION 5la To j APPROVALS DATrE INSPE TOR'S SIGNATURE P.C. J PMT. / FOUNDATION: LOCATION it FEE I s°La FEE FORMS,MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME:FIRE STOPS, BRACING, BOLTS / ._>.' PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, -� C AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH,INT. WILL NOT EMPLOY ANY PERSON VIOLATION OF TH I WORKMEN'S C SAT LA OF CALIFORNIA. LATH,EXT. SIGNATURE HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL a CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN MIT PLAN CHECK VALIDATION CK. M.O. GASH PERVALIDATION CK. M.O. CASH i T iTif 76A638ACE#803200 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES ADDRESS ✓ ai DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALIT _- JOHN A. LAMBIE. COUNTY ENGINEER NEAREST v ' e WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. -__ DIST�21 NO. GROUP TYPE - t/ PR ESSED BY FOR APPLICANT TO FILL IN _�. �T I CONST. r ` BUILDING STATISTICAL CLASSIFICATION EWER MAP -\ ADDRESS CLASS.NO. DWELL.UNITS-d-1 SBK PG LOT NO. BLOCK MAP STATE NUMBER HWY. YE NO TRACT USE ZONE SPECIAL NO.OF BLDGS. f CONDITIONS SIZE OF LOT 13 I NOW ON LOT USE OF J1� /�' EXISTING BLDG. �'/ h. UILDING YARD HWY STREET NAME EXIST. l 'TEL. SETBACK WIDTH OWNER / NO. FRONT P.L. �� L►`4Z, �a� ADDRESS f SIDE ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECORD ADDRESS 7 `^' TEL. Qi CONTRACTOR `� NO. O ADDRESSV DESCRIPTION OF WORK Oa F NEW ADD ALTER PAIR DEMOLISH SQ.FT. /(f O O. .OF a SIZE STORIESOF / NOFAMILIES A rn USE OF '& STRUCTURE I SIGNATURE O APPLICANT VALUATION$ �--� APPROVALS DATE INSPE 0 'S SIGNATURE P.C. PMT. l t FOUNDATION: LOCATION FEE $ FEE $ / FORMS,MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, BRACING, BOLTS 7.0 _.- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY-THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF TArIE WORKMEN'S C NSATION S OF CALIFORNIA. LATH,EXT. SIGNATUR O HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL ST CTU AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH WORKERS'COMPENSATION DECLARATION _11 hereby affirm that fhave Wo certificatempo of consent to self A P P L I C ATI O F O U I L D I N G P E RM I T Insure, or a certificate of Workers'Compenttlon Insurance, or � a certlffed copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY 'Policy No. Company_ BUILDING . Certlfled copy Is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS QQ� Certified copy Is filed with the county building Inspec- BUILDING tion department. ADDRESS1�ezLOCALITY L NEAREST Da te Applicant CITY ` ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATTON INSURANCE SIZE OF LOT 9, NOW ON LOT , MAP BOOK PAGE PARCEL (This section need not be completed If the permit Is for one ,r/ r'7 USE ZONE MAP hundred dollars (;100)or less.) TAT Kl_ ^r� � LOT NO. / O� NO. dr } 7'LA I-6 ', /,5 SPEC, a I c�fy that In,the performance of the work for which this DINNER CONDITIONS O permit Is issued, I shall not employ a e son In any manner O D DIS ICT GROUPTYPE FIRE BY U so as to become subject to theFak cation Laws. "' CONST. i ZONEix �Y t4- r ZIP ,d�' (/ 3 O g C Dat ApplicaSTATISTTCAL CLASSIFICATION APT. COfJDO. NOT TO APPLICANT: If; ditis Certlfl to ofINff r OR p, a eS5 tip pwflL UNItS WdExemption, you should becoo the Workers' N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP � with comply with such provisions or this permit shall be TEL/ � — deerrled revoked. C04J, 7` NOp� BK_ , PG, VAIUDATION LICENSED CONTRACTORS DECLARATION. v p , fr,� D I hereby affirm that I am licensed under provislom of Chapter 9 /�-v1/V VALUATION (cornmendng with Section 7000)of Dlvblon 3 of the Business and �q LIG Professions Code, and my license Is In full force d effect. CITY D/`^/ CLASS � $ 19 B SQ. FT. N10. OF NO. OF CHECK LRense Number Llc.Class SIZE O STORIES FAMILIES ONE �rJ o/iii'eee��As^/� /1� NEW S Conirf�oRh_ �M/w� Date17 6b DESCRIPTION OF WOit1C ElI am exempt from the licensing requlrements as I am /�a /v ADDlicensed architect or a regisfo4cl professional engineer ALTER FINAL r� acting In my professional capacity (Section 7051, DATE REPAIR Business and Professions Code). USE OF - ` ��,y�i FINAL EXISTING BLDG. ! N�-4 DE� Lic.or'Reg.No. Date APPLICANT A TEL `' By r OWNER-BUILDER DECLARATION PRINT (J NO RS I hereby affirm that I.am exempt from the Contractors License 0 Law for the followtfig reason (Section 7031.5; Business andADDRES!Vb V Professlons Code): E I, as owner of the o y p y BUILDING pr party, yr m em to ees with ADDRESS wages as their sole compensation,wlII do the work and the structure Is not Intended or offered for sale(Section LOCALITY - 70.44, Business and Professions Code). MOVING TEL �2 6 �9 A I, as owner of the property, am exclusively contracting CONTRACTOR N O. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS # o o e • 0 1. REQUIRED TOTAL SETBACK FROM D(IST. El CONSTRUCTION LENDING AGENCY SET BACK Y'� HWY PROP. LINE WIDTH 2 0 10600 I hereby affirm that there Is a construction lending agency for FRONT ery� v the performance of the work for which this permit Is issued P.L. •20 ' ' 1 0 0 O.tm3 (Sec. 3097, Cly. C.). SIDE . P.L. I Q1 7-80- Lender's Name - - $ Lender's Ad'dreu P.0 Fee$ Permit Fee I certify that I have read this application and state that the lasuance Fee above Information Is correct. I agree to comply with all CCunty Inv*stlgatlon Fee ordin and State laws relating to building construction, Toral Fee nd ere authorI a epresentatives of this County to enter 9 `- on the bov t ned property to Inspection pur�pcsses. L /'/4- 4 Y9= 06 SfE REVUSE FOR EXPLANATORY LANGUAGE SIgnoture of App Icons or nt - Date 4%