HomeMy Public PortalAbout8629 HALDEMAN ST_Building__ 76A638A CE#8035-61 APPLICATION 'FOR BUILDING PERMIT ,
COUNTY OF LOS ANGELES BUILDING CV- e-til tn
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS,ST R&C
DISTRICT NO. I GRO PTYPE Jl/ PROCESSED BY
FOR APPLICANT TO FILL IN �` CONST.
BUILDING STATISTICAL CLASSIFICATION - EWER MA
BK PG
ADDRESS - CLASS NO DWELL UNITS 7-
LOT NO. BLOCK WATER NOT REQUIRED 1!/I RECEIVED
- CERTIFICATE r I
TRACT O( MAP HIGHWAY
/ NO OF BLDGS. NO U O (CIRCLE) STATE MAJOR SECOND, CAL
SIZE OF LOT - I NOW ON LOT USE ZONE SPECIAL
USE OF - / CONDITIONS
EXISTING BLDG
TEL '
OWNER NO - BUILDING 'EXIST
N
SETBACK •YARD HWY STREET AME WIDTH
ADDRESS lZef, .Q._ FRONT I _ 11//
e W!a
ARCHITECT OR TEL. P L -z-d" d�Ji1 T d
ENGINEER NO - i', - FIDE
ADDRESS V
TEL. INSPECTION RECORD
CONTRACTOR NO.
ADDRESSa v 5 Lu
DESCRIPTION OF WORK n /f as e mal '�� d
V .d 'z
NEW ADD ALTE REPAIR DEMOLISH
SQ FT. NO OF NO OF'
IZE STORIES FAMILIES
USE OF "
STRUCTURE
SIGNATURE OF
.APPLICANT
VALUATION
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION' LOCATION
FEE
FEE
P PMT FORMS,MATERIALS
$ $
FRAME: FIRE STOPS,
I HEREBY 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 ,1 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 COMPENSATION INSURANCE
- LATH, EXT
SIGNATURE OF / HOUSE NUMBER COR-
PERMITTEE
OR-
PERMITTEF K t RECT AND POSTED
ADDRESS FINAL
CLYDE N DIRLAM, PRINCIPAL STRUCTURAL E NEE
PLAN CHECK VALIDATION cK. M.O. CASH ; PERM VALIDATION cK. M.o. C I18H
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_ APPLICATION FOR BUILDING -PERMIT t
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF LOS ANGELES '
ADDRESS DEPARTMENT OF COUNTY ENGINEER
clry ZIP BUILDING AND-SAFETY DIVISION•
NO OF BLDGS BUILDING
SIZE OF LOT NOW ON LOT ADDRESS (i
1
TRACT BLOCK LOT NO LOCALITY
E NEAREST
OWNER TO CROSS ST I -a
ASSESSOR z
ADDRESS MAP BOOK 3��,b PAGE - PARCEL
DISTRICT GR UP YPE FIRE OC SED BY
CITY ZIP - ONST_ ZON
ARCHITECT OR L)TEL
ENGINEER NO
__ _ _ _ STATISTICAL C SSI FICA TION SEWERMAP
ADDRESS CLASS NO. � DWELL UNITS BK / PG
CONTRACTOR. TEL N Q., USE ZONE MAP O�V
NO
LIC ,�
ADDRESS NO SPECIAL
LIC - CONDITIONS
CIT - CLASS
ROAD_ DEPARTMENT A•PP ROVAL REQUIRED YES� NO
CONSTRUCTION LEND
NAME AND BRANCH BLDG.SETBACK FROM
FRONT-PROP.LINE OF (STREET) a
ADDRESS - - c I-t, _ TOTAL SETBACK FROM TYPE OF EXISTING CD
SQ FT NO OF NO, OF CHECK HIGHWAY } YARD - HIGHWAY WIDTH
FRONT PROP LINE
SIZE STORIES FAMILIES ONE �
_ O
}
DESCRIPTION OF WORK NEW U
ADD BLDG.SETBACK FROM uj
(STREET) vii
SIDEPROP LINEOF Z
ALTER ❑ HIGHWAY + YARD = TOTA-L SETBACK FROM TYPE OF EXISTING
REPAIR❑
SIDE PROP LINE HIGHWAY WIDTH
t =
EXISTING BLDG I
USE OF DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO
(PRINT) 0.
BY (SIGNATU.RE) IN OPEN SPACE YES ❑ NO
� IN COASTAL ZONE YES NO
VALUATION$ CATEGORICAL EXEMPTION YES� NO-[:]
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
-AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT,PROCESSED (DATE)
HEREBY LL NOT EMPLOY ANY PERSOW IN VIOLATION OF THE
LABOR COD THE STATE OF CALIFORNIA IN RELATING TO
WORKME INSURANCE
SIGNA RE
PERMIT '
ADDRESS
TEL FINAL ,ry
CITY NO tea% DATE �-/gn
N,1I\L (,fll_CI\S P,1 ,4131_L- 10 FEE FEE
HARVEY T. BRANDT. COUNTY ENGINEER
PLAN CHECK VALIDATION CK M, O CASH PERMIT VALIDATION' CK M o CASH
2 G 4.973- JUL 5 2 3 A 7.ol).
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79AG30A CE y003•9-60 APPLICATION FOR BUILDING . PE , T
COUNTY OF LOS ANGELES BUILDING
°DDRESS 41
DEPARTMENT OF COUNTY ENGINEER
•BUILDING AND SAFETY'DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER _ NEAREST '
WILLIAM A. JENSEN SUPT OF BUILDING I CROSS S
DISTRI T NO. GROUP TYPE P C SED BY
FOR APPLICANT TO IN i CONST
BUILDING STATISTICAL CLASSIFICATION SAWER MAP ,
ADDRESS Q� K PG
CLASS NO C/ DWELL UNITS
'IJ —
LOT NO BLOCK MAP STATE YESO
NUMBER HWY
TRACT USEZONE SPECIAL
NO OF BLOGS. CONDITIONS 1
SIZE OF LOT P( .0 3 I NOW ON LOT X -
USE OF
EXISTING BLDG BUILDINGHT E AE EXIST
'YARD WY M
C WIDTEL SETBACK
OWNER &Q A1,06C l! a 7N0 TH
FRONT
P L
ADDRESS 'SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION RECORD
ADDRESS �� , o
CONTRACT)Odole ,geif�tr' )B? .�.(,�� 7I� �¢ O
ADDRESS &J_/� •T 410 C � / O
DESCRIPTION OF WORK W
CL
NEW/ ADD ALTER REPAIR DEMOLISH y
Z
SQ FT NO OF NO OF '
SIZE TORIES FAMILIES-
USE OF
STRUCTURE Zkaffdw L'
SIGNATURE OF
APPLICANT ,
VALUATIONS �®--•� I -
APPROVALS DATE INSPECTOR S SIGNATURE
P C �J V PMT FOUNDATION LOCATION
FEE $ GZ FEE $ `^ FORMS MATERIALS �)
FRAME FIRE,STOPS.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS ,/
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, I L
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS J
BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED I SHALL NOT LATH, INT
EMPLOY ANY PERSON IN ANY MANNER SO AS BECOME SUBUECT �y
TO THE WORKMEN S PENSATI LAWS CALdIFO RNIA
LATH, EXT - !�
SIGNATURE.OF HOUSE NUMBER COR- ' «
PERMITTE RECT AND POSTED uy'
ADDRESS FINAL
CLYDE N
PLAN CHECK VALIDATION0 ... CASH PERMITVALIDATIONTR CK. RM.O ENCASE{ER
T
LA" Z 6 7 6 � .�AiJ '�'7 2 3 A 22.5 0
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