The URL can be used to link to this page

Home My Public Portal About5547-49 HALLOWELL AVE_Building__ A P PL e CA— T 0 O N, FOR COUNTY OF LOS ANGELES OF COUNTY -I L®I N G PERM0 T DEPARTMENT BUILDING ANDS FETY DIVISION ENGINEER BUILDING L/ �f FOR.APPLICANT TO FILL IN AD :DREss / BUILDING ADDQESS LOCALITY , - - /� NEAREST- � CITY ZIP �DO' CROSS ST. NO.OF-BLOGS. - -- ASSESSOR - - SIZE OF LOT W ON LOT MAP BOOK' PAGE CEL DISTRICTGROUP TYPE FIRE. ROCSD ,t1 BLOCK �L NCONS TRACT (f L•� O: _ y�j _, V OWNER 'f - 17 STATISTICAL CLASSIFICATION ERMAP ADDRESS'.� O. a, CLASS NO.-�Z/ DWELL.UNITS` KBK PG -A U ONE MAP- CITY /.t,'r ZIP.r~ :'. [/Jy��J NO. ARCHITECT OR TEL. •�'� SPECIAL ENGINEER NO. Oil CONDITIONS `ADDRESS ROAD DEPARTMENT APPROVAL _REQUIRED.,,._YES,❑ NO ❑ CONTRACTOR TEL.- `. BLDG.SETBACK FROM LIC. FRONT PROP.LINE.OF iSTRE£T) • L ADDRESS NO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP. LINE. , HIGHWAY WIDTH CIT.Y . . ... 'CLASS COI,STRUC N LENDER + NAME AND BRANCH " BLDG.SETBACK FROM a ADDRESS CITY - SIDE-PROP.LINEOF (STREET) Ej SQ. FT. NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING w SIZE STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH DES IPTION OF WORK NEW ❑ + - - ADD •❑ CORNER CUTOFF YES ❑.. NO ❑ Z ALTER ❑ - -REPAIR[:] IN OPEN SPACE YES ❑ NO ❑ ' 1 USE OF - DEMOL IN COASTAL PERMIT ZONE YES C] Nb .❑- EXISTING BLDG. '� ❑ APPLICANT TEL J �jr"�,1 ,.�• - - (PRINT) NO. / :•-'�7 ^' '„'-�'F l:. �fUI Gti""`_L B-Y (SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE-READ THIS APPLICATION AND .STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON .�^' �� O STRUCTION. I CERTIFY THAT IN DOING THE ;WORK AUTHORIZED �-�•>/ ��L r / ( 1 - HEREBY I WILL NOT EMPLOY. ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO -WORKMEN'S COMPENSATION INSURANCE. - SIGNATURE OF FINAL ,�/( q BYD<��{)l��iZ PERMITTEE �ZY'1DATE 7 / ADDRESS TE L. CITY NO. P.C. Fee$ Permit Fee � � � •Issuance Fee s VALUATION Total Fee .`PLAN.CHECK-_VALIDATION CK. M.O. CASH o PERMIT VALIDATION CK. M.O. SH 24 76A638A CE#8038 12/75 BUILDING ' FOR APPLICANTTO FILL IN ADDRESS : BUILDING ADDRESS ✓' Y LOCALITY NEAREST CITY ZIP CROS5ST /(J NO.OF BLDGS ASSESSOR SIZE'OF; WORKERS-COMPENSATION,DECLARATION OU insure1. br;r afcerfNfcote of Workes' t6 pensatocertificate n Insuranelf Lr\1 0 ®R G P� Ifl- AW7 or a cea ted.copy thereof (Sec. 3800,. COUNTY OF LOS ANGELES iUILDING''AND SAFETY Policy No. Company BUILDI Certified copy is hereby furnishedADDRE .. FOR APPLICANT TO FILL IN SS_� '. C.2�LZ�IeC.0 - - �` ❑ Certified'copy is filed with the'counfy building irispec BUILDING C— y tion departmen. ADDRESS cJ Date A i CITY ZIP G i, LOCALITY CERTIFICATE OF EXEMPTION FROM.WORKERS'. COMPENSATION INSURANCE- NO:•OF BLDGS:, NEAREST SIZE OF LOT 60 ( `� 5 NOW ON LOT,. CROSS 5T (This section..need not be completed.if.the,permit is for.one 6 3p'g BLOCK LOT NO: ASSESSOR hundred dollars ($100)or less:) TRACT MAP`BOOK' PAGE PARCEL . TEL.O . � Q USE' ONE MAP. �� } N ' I certify thai'in'the performance of the"work for wkiich this OWNER_-,'""-""� NO: permit is issued, I shall not employ any person inrany manner SPECIAL. so"as to becomes ct to the Workers',Co, pens tion Laws. ADDRESS ? t � ' ' CONDITIONS O, Date .. A I .i-'•w CITY _ ZIP K� _ ARCHITECT OR TEL.' NOTICE TO'APPLICANT:.If, after making+•this Certificate of H PROCESSED O Exemption, you,should • 1-3- be" subject to.the Workers _ ENGINEER NO.'_-'. E DISTRICT GROUP TYPE RE ROCESSE BY Compensation provisions.of'the Labor.Code,.you,must forth ADDRESS LU U With comply. with-,such"provisions or,this permit shall'be SI ! n CO a N� � N deemed revoked: TEL- STATISTICAL CLASSIFICATION APT.. N (q s 3 CONTRACTOR .NO.. Z LICENSED CONTRACTORS'DECLARATION ,.. :.. . LIC. ' CLASS NO: _ DWELL.'UNITS hereby;affirm that-I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Section`7000)of Division 3-of the Business and. LIC. SEWER MAP Professions Code;-and my license.is in full force and effect. CITY` CLASSBK �:. VALIDATION SQ,FT. NO.OF NO.OF CHECK License Number Lic.Class' FAMILIES- ONE SIZE STORIES FAM a Contractor Date ❑o $ALT //C/ $�l 5J DESCRIPTION OF WORK- ori f=1T�1 F /-'!VC1dIL a t� TION NEW ❑1 am exempt under Sec. lr: fyj . . i- - - - ADD .f B.BP.C.'for this reason Zuc.. $ ALTER - " EPAIR �� 59:25. ' USE OF j Date: EXISTING BLDG. U DEMOL ❑" ° ®'0 5 9.2 5 c=i Signature FINAL' APPLICANT' • ' '- OWNER-BUILDER DECLARATION DAT / 3 �•�8 PRINT NO. / �, � 1,hereby,affirm that 1 am exempt from the;Contractor's License taw for the:following,-reason,(Section 7031 5, Business and. ADDRESS IN Professions Code). w PRE EN By BUILDING ;E I, as owner,of the property, or,my employee's'with ADDRESS - 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., •1, as owner'of the property, am exclusively contracting, CONTRACTOR NO. with licensed contractors to construct the prolect.(Sec- ADDRESS tion 7044, Business and Professions,'Code). REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING`AGENCY.• SETBACK' -YARD HWY_:'.. PROP. LINE' WIDTH hereby affirm that there is a construction lending agency for FRONT a .the performance of the work for.which this permit is issued P.L. (Sec.3097, Civ. Cl:). SIDE.. P.L Lender's Name p ao LDMA Ref. # m P.C.Fee$ - Permit.Fee. Lender's Address a - - a I certify that_I-have read this application and state that the _ Issuance Fee VL�,' LDMA P/C#' a above information-is correct. I agree to comply with all County Investigation Fee i 0 ordinances and State laws relating to building construction„ t ;• H and hereby authorize representatives of this County to enter Total Fee t LDMA.Perm. #. upon above-nmentioned prop for inspection purposes. a fj / SEE REVERSE FOR EIIPLANATOSY LANGUAGE Signature of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION' I hereby 'affirm that I-have a certificate of -consent to'self O ..LI U R nn insure,,00r a certificate of Workers Compensgtiori'Insurance,.- LI [�\l �`'J LI V .0 �`'J LI t1 LLJJ LI V��J LIVLI ll LI or a ceriified,copy thereof (Sec.'3800, Lab:C.) : s COUNTY OF LOS ANGELES BUILDING ANDcSAFETY Policy No Company ❑ ,Certified'copy is hereby fu�mshed. FOR APPLICANT TO FILL`IN- -ADDRESS r BUILDING ,. r �J -7 : ❑ :Certified copy is filed with thezounty building inspec ADDRESS '5 _ ` I.I. WFLG ' AVE = " tion department,' Date A" hcant ZIP LO- .P l�1a?I-P_ CIT LOCALITY CITY pp N .,OF BLDGS. NEAREST Y CERTIFICATE OF"EXEMPTION'FROM WORKERS' SIZE,OF LOT: Qj�'. 0 NOW ON LOT CROSS 5T. COMPENSATION INSURANCE ' ASSESSOR (This secnon,need not be completed if the permit.is'for one TRACT BLOCK LOT NO. ' MAP BOOK PAGE�/�� PARCELa / hundred dollars ($100) or,less.)` TEL. E US ZONE MAP, . . .:-. OWNER t i)• "�F 1TLH�h(p+ - ,' NO. . I certify that ih the.performance of the work',for which this SPECIAL } permit is Issued 'l shall n'ot employ a y:persort in any manner ADDRESS .r7 :� ./ %4'l.LB1/V�� CONDITIONS d so as to become, ublect to'The_Wor rs:C m nsati'n L S. 0 r// ;. CITY _ 7 ' ZIP Date Applicant. ARCHITECT OR `� TEL.. DISTRICT GROUP TYPE. FIRE . PROCESSED BY NOTICE O A PLI ANT: If afT Makin is'Cer ificate of ENGINEER YGSI 14 S NO. c /� 9 CONST. ZONE Exemption u should',become: subject 'to' the.,+Workers' U z�o� I� [e�_. 2 f/ 3. ' w Compensation-provisions of the,,Labor•Code,you must forth-' ADDRESS ��+' {�,. a with comply :with, such.provisions or, this perm_ it,shrill,be. a TEL !L3, STATISTICAL CLASSIFICATION APT.,, CONDO. N deemed revoked, CONTRACTOR— LICENSED Ari IyNO. _ LICENSED CONTRACTORS DECLARATION Cn�,^ LIC ' ADDRRACTOR 7fp ONT I hereby affirmthat l am licensed under' rovisions'of Chapter ESS 0�� 1u" NO.. , � S.NO. Y P- P CL AS DWELL. UNITS -' (commencing,with Section 7000);ofDivision$of the-Business LIC. SEWER MAP and Profession ,Co CITY• "Ift T CLASS - ' effect. VALIDATION SQ.'.FL q "" NO.:OF NO:OF + CHECK' License Number ic`Class" SIZE,- ✓�� STORIES FAMILIES ! ONE an my license is m full force and a BK. PG. Contractor Date DESCRIPTION OF WORK' NEW ❑ VALUATION , iML � D!T/V14 ADD- ,.$ ❑I am exempt under Sec. ALTER ❑ D BAP.C.•for this reason REPAIR ❑ $ D6te: USE OF EXISTING BLDG. "cJ. `Y DEMOL'❑ APPLICANT TEL. 1�}- Signature A� Ia�p "�.. 3�3- ' FINAL OWNER-BUILDER DECLARATION.. (PRINT) ��1'YA-L I/�fNO. 2 2 'hJ - DATE' I hereby affirm that I am exempt fro m.the Contractor's License O f;(, ' Law'for,the-'follow ng reason'(Section.7031:5, Business and : FINAL' , ADDRESS �� Z� C / 7 /�1�LS'. Cit ��ID Professions Code). PRESENT BY ``._. ;' r• • BUILDING.: - ❑ as owner of'-the property, or my employees with, ADDRESS -=t wages as their sole-compensation;will do the work and - LOCALITY •. t the structure is not'intended'or offered for sale:(Section 'r r 7044 Business'and Professions Code-.) - _,MO•VING „TEL. ❑ I, as owner of the property, am exclusively,contracting CONTRACTOR NO. with licensed contractors to,construct the project (Sec- = - ADDRESS tion 7044,:Business and Professions'Code.) REQUIRED'. TOTAL SETBACK FROM ;EXIST. J. CONSTRUCTION LENDING AGENCY SET BACK .YARD HWY PROP. LINE WIDTH I hereby affirm that=there is a construction lending agency for FRONT_ ,� ; ` ; 1 r ; c, t[; 3 , the performance of the work for which this permit is issued P.L. (Sec. 3097; Civ: C.).. ,. SIDE' Lender's Name- W 7 P C' Fee$ Permit Fee `tom !O .'/f, LDMA Ref. # . Lender's Address" I certify that L'have read this application and'state that the ssuance FeeLDMA P/C# above information.is correct. I agree to complywith'all County Investigation Fee �� „s (j 8 ordinances and State laws relating to building construction; Total'Fee G LDMA Perm'. # a and hereby authorize representgoves of this County.to enter upon th abov - do 'e pr rty'for inspection AsV SEE REVER OR EXPLANATORY LANGUAGE Signa ure ofApp(icant r Agent D - -