HomeMy Public PortalAbout4902 HALLOWELL AVE_Building__ G�G7 l
E�#803 1/71 .- -, i"• x
�PPLICATIO - F R BUILDING PERMIT
t'COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDINGAND SAFETY DIVISION BUILDING
' -ADDRESS ' l
COLEMAN W. JENKINS, SUP T of BUILDINGU
LOCALITY' :'.'
FOR APPLICANT TO FILL-IN'._,.. " " NEAREST,"
Print ort a only) CROSS ST. -
DISTRICT- GROUP- T P ROLE S BY
BUILDING • ' .. �r � CON
'ADDRESS 4 2• HdI.,I�UV�I• -�L� - S l0 ,.. '
STrATISTICA`L--CLAJSSIFICATIO' ` 'S/EW R MAP ...___
LOT NO ' - F - BLOCK CLASS.NO_._�_ -J—DWELL,UNITS. O ` PP '
TRACT - _
U ONE MAP
NO.OF B•LOGS.
SIZE OF LOT,' - - NOW ON LOT 2
�� _ � r '�� .SPECIA-L• F - -
-USE OF COND6TIONS. _ �,• .�''
EXISTING BLDG. ��L.�.
-TEL.
OWNER •'NO. BLDG.'SETBACKfFROM ,' - y
,ADDRESS- �� FRONT PROP;LI_NEOF -(ST.REET)
TYPE OF EXISTING SETBACK HIGHWAY_ �- YARD .-= TOTAL- '
CITY ' ' HIGHWAY ,WIDTH FROM C.L. -
ARCHITECTOR" -TEL.
ENGINEER - NO.. .BLDG.SETBACK'FROM
ADDRESS - - SIDE PROP.LINE OF - - (S.TREET)
•' _ TEL', TYPE OF'EXISTING SETBACK HIGHW •AY } YARD
CONTRACTOR NO. HIGHWAY WIDTH_ FROM C.L. -• - - -f. ;CU
ADDRESS - 0:.24441 • - �• �+ - • -
CD
LIC. _ - H,
CITY CLASS 'CORNER_CUT01=F• YES ❑ NO ❑yam W
CONSTRUCTION LENDER V n"
-NAME AND BRANCH Y" SEE.REVERSE SIDE FO' PEC L APPROVALS •z
ADDRESS M
SQ,.•FT.
_N
SQ. NO. OF" ❑ `7��,L,/1/ / � .`
SIZE STORIES FAMILIES •, NEW.- - .
'USE'OF- - ADD -_ ''••`•:- - - - .+ -
STRUCTURE : •- -
REPAIRLJ
SIGNATURE OF.
APPLICANT• - DEMOL-.R _
���+ r
-VALUATION $ ,i ' �V - - q„-•:. ! .APP.ROVALS' .- DATE '. I,N'SPE OR'S 51GNATURE
P.0 PMT, - �S FOUNDATION; LOCATION
;FEE-
$, _ I tiFE_ E $ y'' S. FORMS,,'MATERIALS
g
,FRAME:.FIRE,lTI2PS, _
I,.HERE BY ACK NO WN,EDGE THAT'ItHA VE READ'THIS AP.PLICATIO BRACING` BOLTS '+ ,•I7i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,! ?• + '
WITH ALL ,ORDINANCES AND-,LAWS. REGULATING' BUILDING CON- GAS VENT, DUCTS
STRUCTI'ON_,-.I CERTIFY THAT IN DOING THE 'WORK AUTHORIZED
•HEREBY I' WILL NOT;EMPLOY ANY"PERSON IN VIOLATION OF THE"
LABOR CODESVIF7E
''STATE OF CALIFORNIA IN: RELA NG•TO LATH, INT. -
WORKMEN'S CO ,T,ION INSURANCE ,LATH, EXT.,
SIGNATURE - HO NUMBER COR- r
;PERMITTEE"' E T'AND PCST,ED f
, LIZ
ADDRESS • -
,F I, A '•cr
\�, JOHN F. LEWIS PRINCIPAL'STR - AL ENGINEER if
PLAN.CHECK.,VALIDATION , M 0 CASH'' _ PERMI'T, VALIDATIO cK • M o, CASH ' '
WORKERS'COMPENSATION DECLARATION .
hereby.affirm that I have a certificate of consent to self PPL CAT I O N'- F� R '�'U ISL D IN G PERMIT
insure,'or a certificate of Workers' Compensation Insurance,
or'a,certified b;copy thereof (Sec. 3800; LaC.)'
230770' State Com - COUNTY OF-LOS ANGELES--', BUILDING AND SAFETY
Po No. Company p
BUILDING
„ FT ;Certified copy is hereby'fu�nished. FOR APPLICANT TO,FILL IN,,.
ADDRESS kan&ul aw�
Certified copy-is filed wi The'counTy,building inspec- BUILDING ;
tion department ADDRESS . 4902 Hallowell .. _ LOCiLITY.
Date l/1/$5' Appy es. CITY .''. ZIP cRossssT' s k
;. CERTIFICATE OF4EXEMPTION,FRO W, ERS' - NO OF BLDGS _ ASSESSOR
COMPENSATION INSURA CE:,- SIZE OF LOT NOW ON LOT;: MAP BOOK PAGE PARCEL .
(This•sect16n need not b'b�completed if the'perrriitris for one US'Z NE MAP
huridred-dollar's ($100)or less.) ar TRACT_ - BLOCK LOT NO �� NO
Hahr TEL. SPECIAL
I certify th'arin the,performdnce of,-.the work.for`which this OWNER NO.` 25
111��� CONDITIONS ' d -
DISTRICT .GROUP TYPE FIRE' PR CESSED-BY. . O
permit,is-issued, I shall not employ any,person in any manner ADDRESS '4902 H011Owell CONST ZONE• U
so P's to b6corre,subjeci to the Workers'Compensation Laws:' �� ��D �„2 2 O ,
`' ' '' Applicant " CITY -. ZIP STATISTICAL CLASSIFICATION APT. CO 11-
Date I
ARCHITECT OR TEL.
NOTICE-TO APPLICANT: If, after..making this Certificate of ° CLASS NO. t DWELL UNITS W
ENGINEER'
NO' a '.
,Exemption,, you-'should,'become, subject-^to the Workers' fL
_Compensation provisions'of the Labor Code; you must forth-; ADDRESS - •• - - - SEWER MAP N'
with comply with such'provisions or this, permit shall be ) -'
deemed revoked. TEL. BK• LIPG �� ,VALIDATION '
CONTRACTOR NO. _
LICENSED CONTRACTORS DECLARATION' LIC -
r I hereby affirm that I am licensed under provisions of Chapter 9• ADDRESS 8 68 Truck Wa • NO 2488$2 'VALUATION
(commencing with Section 7000)of Division 3-of the Business'and LIC. "
Profession's Code, and-my•license is in full force and effect. CITY CLASS _ $ 1467.00
24882 C-39
SQ FT NO.'OF NO, OF - `CHECK
License, er Lic.Class - SIZE STORIES. FAMILIES ONE ,
$ ;.#. "1.1'3 �►
Contra ate /R�•' DESCRIPTION•OF WORK 1 eX1S t1ri NEW - ❑
`" wood shingle roof, - Reroof ADD ❑ �' 0 4 q,g g
I:am exempt n r ec. FINAL o o m 4 9$$v
erg aS _ h11R_1 ❑ DATE �, _
B.&P C.for_ this reason 7 REPAIR �,2 9 8 4
USE OF - ' FINA
Date; EXISTING BLDG dwellln _ ED
DEMOL_ ❑
B
Signature APPLICANT MOntebe110 Rf TEL 722-69'75 Y 4 4'
OWNER-BUILDER-DECLARATION - PRINT g NO:.
I hereby affirm that I am ezempf from the Contractor's License • ADDRESS 8 68.. TrllCk Wax ,
Law fog-the'following'reason (Section 7031.5, Business and -
'P.rofessions:Code):c t` T ti
>' BUILDING- t'
• I, as owner- of the property,'or-!my-empl'oyees,wrth�. ADDRESS k 't
: 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.
' I as owner of the property,'am;exclusively contracTmg C NTRACTOR NO
M
with licensed contractors To;construct The prolecT (Sec- "
tiom7044;:Business and Professions Code). 4 ADDRESS'. 4
REQUIRED TOTAL SETBACK FROM ' EXIST "
" CONSTRUCTION LENDING AGENCY SET BACK- YARD HWY PROP. LINE WIDTH
he_reby'affirm=that•th'ere is a constructiorn lending agen`cy.'fo'r -..FRONT
' the performance'of the work,for which this permit•is;issued PL
(Sec. 3097, 'Civ. C.): i, SIDE
P.L.. '
o Lender's Name-
(e
ame
P:C Fee$. Permit Fee
1. 2 � - ^-• - _
- • Lender's Address - -• '
•'I:"certify'that I Kave'read'this application and,slate that the - Issuance Fee �6.60 `
above information-is correct.,)agree to comply with a11.County Inyestigution Fee
' ordinances cind State,laws relating to building construction,- Total Fee /i'
and'�erthorize representatives of this.C6unty',to enter,
' upon -meniioned.pr oeeety.,or inspection purposes. �• _
o SEE REVERSE FOR EXPLANATORY LANGUAGE, _
Signature o p o or Agent Dote ®s