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HomeMy Public PortalAbout4924 HALLOWELL AVE_Building__ 76Ae3ACE#80310-OB APPLICATION FOR BUILDING 'PERM IT, 55 COUNTY OF LOS ANGELES BUILDING 'ADDRESS DiPARTNMENT OF COUNTY ENGINEERI .BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST /)J CASSATT D.GRIFFIN SUPT OF BUILDING CROSS ST. DISTRICT'NO. GROUP npE PR BAY FOR APPLICANT TO FILL IN /� I';coNST., BUILDING'7�1 STATISTICAL��1ASSIFICAI'ION SEWER MAP ' ADDRESS �� �'L (� BK CLASS. DWELL. UNITS I_ NO. LOT NO.,y /) E BLOCK / NUMBER Q/ -. HTE YES O TRACT USE ZONE SPECIAL " = NO.OF BLDGS. ^ p CONDITIONS SIZE OF LOT A09 I NOW ON LOT USE OF II EXISTING BLDG. /\ / BUILDING - EXIST. ' YARD_, STREET NAME. OWNER'??./C/-/AI, n /L L EX - SETBACK, - WIDTH FRONT MAIL L( �J 1 ADDRESS / I Z-'T IV A 1—L 19 W L i- P.L. - 1/• .y` �Z (�'r .�.•tL�� _ ' SIDE ., Ity t>LINSPECTION.RECORD ARCHITECT OR TEL. _ ENGINEER NO. ADDRESS CONTRACTOR O N�:lZ- NO. . - '' '_• M ADDRESS DESCRIPTION OF WORK "r`"' frV •, - '1 !."" �.�a..f e4;s� �...tee°- "p"t`1 ' NEW FT. ADD/L ALTER - NOREPAIR DEMOLISH .�� _ SIZE �{7 V' .STORIOF ES / FAMILIES � �� USE OF STRUCTURE ' , /^rhe 191�b3��c :.e.�....:�' .�.-• , SIGNATURE OF APPROVALS APPLICANT - ' DATE INSPECTOR'S SIGNATURE ADDRESS - FOUNDATION: LOCATION - T $ FORMS.MATERIALS rF S FRAME: FIRE STOPS. ,/,[� '--� BRACING, BOLTS _ VALUATION" ` \ $ d-V FURNACE: LOCATION, '• ` 2 -GAS'VENT,DUCTS':: 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND • ti AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, EXT. STATE LAWS GU ING BUILDING CONSTRUCTION. - HOUSE NUMBER COR- _ •' PERMITT�r._..t r - RECT AND POSTED .I'GNiATURE 2 . h ' ADDRESS FINAL _ CLYDE N. DIRLAM;' RINCIPAL-STRUCTURAL EN E PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION 'CK. • M.O. tCXSH 3-'5 4 1ti+Y ' 5 ' '� 42 76A638A cE�803 5-65 APPLICATION FOR BUILDI .G .PERMIT COUNTY OF LOS -ANGELES BUILDING G� DEPARTMENT OF COUNTY ENGINEER ADDRESS / BUILDING AND SAFETY DIVISION "'L O C A L I T<_1Z ` JOHN A. LAMBIE. COUNTY•ENGINEER NEAREST - COLEMAN W. JENKINS,SU_P•T OF BUILDING CROSS ST DISTRICT NO GROUP TYPE -PR E S --+ FOR APPLICANT O FILL IN coNs T } BUILDING STA`TISTIC'AL SSIFICATION -� 'SEWE/g MAP ADDRESS /4 D �E4AL CLASS NO _ DWELL UNITS BK/ LOT NO, , .SinBLOCK USE ZONE 'MAP _ NO' -c�• •1 - TRACT I SPECIAL .• .y NO. OF BLDGS' CONDITIONS - - SIZE OF LOT,- Q ;fi NOW ON LOT USE OF EXISTING BLDG. SETBACK FROM TE itf FRONT PROP. LINE OF - STREET) I OWNER O. TYPE OF EXISTINGSETBACK HIGHWAY YARD'S•= TOTAL- � C• ' H ADDRESS GHWA Y -WIDTH FROM C:L. •- - CITY BLDG. SE BACK FROM.- ARCHITECT TEL.ARCHITECT NO SIDE PROP. LINE OF (STREET) -ENGINETYPE OF EXISTING SETBACK" 'HIGHWAY '+ YARD _ -TOTAL' ADDRESS HIGHWAY WIDTH FROM C L TEL CONTRACTOR NO _ LIC CORNER CUTOFF YES O NO O ADDRESS No ' GC CITY CLASS LIC SEE REV I P OVALS• 00j DESCRIPTION OF WORK- AND-PARKWAY TREE REQUIRED �. NEW ADD A�__ALTER REPAIR DEMOLISH SQ.FT.- N O. O F NO O F, Note: Permits fo curb, a r sidcve�!A „d -ivew a roach- '? SIZE STORIES _ - FAMILIES stallafioris-should be takon Oct at 1.h3 L. A.-Co. PozA Dapt., Alfade USE OF - =, eci STRUCTURE _ C4r�C .. a lengthy'delay. Survey &.Design wo:': 'ascs time and is not-start, d' until Permit Kas been issued:-Apply for parkway tree:permit at T. SIGNATURE OF - APPLICANT - - -. - VALUATION$ + r - APPROVALS DATE. + 'INSPECT R'S SIGNATURE ' FE FEE$ r� r FOUNDA FORMS!MATERIALSON / 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 + WITH ALL COUNTY ORDZ AND STATE LAWS REGULATING GAS VENT DUCTS 9UILDING CONSTRUCTIOTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I EMPLOY ANY PERSON IN VIOLA- LATH. INTTION OF THE LABOR CO �Nlll ORNIA RELATING TO WORKMEN:S COM ' LAH EXTSIGNATURE OF HOUSE NUMBER COR-PERMITTEE' RECT_AND POSTED zz ADDRESS FINAL {• JOHN•F LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK M 0. CASH _ PERMIT VALIDATION CK. M 0' CASH c:&O 9 9 9 4 FEB 2 4 1 -D 1 8 5-0 _ .. WORKERS' COMPENSATION DECLARATION ` I hereby affirm that I'have a certificate of consent to self insure, or a certificate'of Workers' Compensation Insurance, A T L-.LCAT I�?�V':FOR BUILDING PERMIT or a certified copy thereof`(Sec.'3800, Lab.C ) w COUNTY•OF lOS ANGELES .,.,BUILDING AND SAFETY Policy No. Company .1 BUILDING-- ❑ =CerTifred copy is hereby furnished.• FOR APPLICANT TO FILL IN :. ADDRESS . ❑ Certified copy is filed with'the county building inspec- BUILDING Tion department: r ADDRESS Date" Applicant CITY ZIP LOCALITY p. NO OF BLDGS.':=• NEAREST- :CERTIFICATE OF EXEMPTION'FROM WORKERS'"'' SIZE OF LOT Q 8D NOW`ON LOT" ' 'Z- CROSS'ST. - COMPENSATION INSURANCE. ASSESSOR (This section'need not be completed'if the'permit'is for one' TRACT" BLOCK' LOT'NO MAP BOOK• r PAGE: PARCEL " •hundred dollars,:($100) or less:) TEL.Vy USE'ZONE OWNER NO NO.MAP, Fcertify that in ihe'perfoi�mance,'of The work'for which this AO ..SPECIAL = : permit is issued;.I shall not.employ any person i6'any.•manner ADDRESS a V, / CONDITIONS so as'to became sublect,to-the Workers'Compensation Laws. .. O CIN ZIP Date AppI icant',' ARCHITECT-O TEL NOTICE TO:APPLICANT: If,:after, making this-Certificate of,- ENGINEER' NO. DISTRICT GROUP. TYPE FIRE PROCESSED BY Exemptionyou should- become'-subject To"The. Wotkers 1• F //'�J QQ CONST. ZONE. , Compensation provisions•of-The Labor Code; you mustjorih- ADDRESS :" v - J: I lea with .comply with such provisions or this permit shall,be ' - TEL STATISTICAL CLASSIFICATION APT' ' CONDO.' ' Z .deemed revoked.-' • — CONTRACTOR t%2J NO — LICENSED_CONTRACTORS DECLARATION. .'.r! LIC. CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions-of Chapter 9•' a. ADDRESS NO- SEWER MAP (commencing with Section 7000)of Division 3 of iherBusiness LIC and Professions Code,arid,my license is in full force and effect. CITY f CLASS BK PG )i VALIDATION SQ: FT. NO OF NO OF CHECK' °License Number Lic. Class SIZE Q STORIES FAMILIES ONE •. 11 VALUATION DESCRIPTION OF_,WORK NEW ©' s, �• Contractor Date ADD ❑ y ❑I am exempt under Sec. • _ALTER ❑ -,.. - _ - B.&P.C. for this reason C REPAIR ❑ $' USE OF ' Date: EXISTING BLDG ' DEMOL ❑ Si nature APPLICANT- z TEL' g OWNER-BUILDER DECLARATION (PRINT) NO .11 FINAL DATE � L i I hereby affirm that I am exempt from the Contractor's License <`. '". /' ;.,---,• Law for t e following-reason (Section-7031.5, Business and. ADDRESS FINAL Profe ns Code); PRESENT _ BY I as owner of.the property,, or my employees with % ADDRESSBUILDING, .� , p wages as-tkeir sole compensation,will,do the work and . • • - - �� ' - i IT I_i the structure is not intended or offered for sale(Section LOCALITY ,•.,��A' 7044, Business and'Professions Code:) MOVING-% -_TEL. ,' ;I I rAL 3,_,, „ 63 ❑- .I, as owner of the ro ert am exclusive) contractin CONTRACTOR NO. _ P P Y, Y 9 :� ��t iFi e ' ":With-licensed contractors to.construct the project (Sec- '- ADDRESS ~' - hon 70"', Business-and Professions Code.) t - - - REQUIRED .TOTAL SETBACK FROM _ •EXIST _ CONSTRUCTION LENDING'AGENCY - SET BACK YARD HWY. PROP. LINE WIDTH 1 hereby affirm•that there is a construction lending agency for FRONT ' the performance of�the work for Which_this permit is issued P'L - ; fil1�� i I( PI,'•: i j r' (Sec. 3097, Civ. SIDE PL, .�• t`1.^ J i t� ii n.ti r-- - L'ender's Name Q f� - _ r O O I LDMA Ref. #t r P.C. Fee$ - Permit Fee J Lender's Address o I certify that I have•read This,application and state that.the_ Issuance Fee 7, LDMA P/C#. , 8 above information is-cofrect. I agree to comply with all County- Investigation Fee ordinances and State jaws relating to building construction, ` Total Fee i. LDMA Perm' H a hanhereby authorize representatives of this County to�enter ve-mentioried.prope r ' ection purposes: .' r SEE REVERSE FOR EXPLANATORY LANGUAGE ignatu�e of Applicant A ent $Date - - - - • _ .