HomeMy Public PortalAbout5635 HALLOWELL AVE_Building__ • 76A§38A CE #803 1/71. - 1F-L4PL,�F_u; (,
�'APPLICATION FOR BUILDING PERMIT
"'"'BOUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT-OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS W: (/
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST +
Print or type-only) L
CROSS ST. _(V
BUILDING
.DISTRICT NO. GR P CONS ))) SSED BY
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ADDRESS�. � �-�
- STATISTICAL CLASSIFICATION - SEWER MAP,
LOT NO ',BLOCK: ''��� '
_ �CLASS NO.�-DWELL,UN175 BK PG
TRACT USE ZONE MAP
NO.OF BLDGS. J NO.
SIZE OF LOT "Q � NOW ON LOT / SPECIAL
USE OF - CONDITIONS
EXISTING B G.``
OWNER - V ® fiL �7�0 BLDG.SETBACK FROM
ADDRESS JZT99 'FRONT,PROP.LINE OF (STREET)
i 'TYPE OF EXISTING SETBACK HIGHWAY } ARD = TOTAL.
CITY - HIGHWAY WIDTH FROM G.L.
ARCHITECT OR- TEL.
.ENGINEER NO. _
BLDG,SETBACK FROM.
ADDRESS SIDE PROP. LINE OFAIZ
- (STREET)
r
A 1 TEL. TYPE OF EXISTING SETBACK HWAY } . YARD - _ TOTAL d
CONTRACTOR !4 NO. 'HIGHWAY WIDTH FROM-C.L, - O
U
LIC,
ADDRESS., NO. ,� t = U
LIC. H
CITY CLASSY CORNER CUTOFF' YES ❑ NO, O W
CONSTRUCTION LENDER - -"
NAME AND BRANCH `SEE REVERSE SIDE.FOR SPEOIAL APPROVALS z
ADDRESS NEW. ®�.`a '
SQ. 'FT, NO. OF NO. OF • E]..
SIZE T RIES- •FAMILIES
.USE OF. - ADDL 0
STRUCTURE ❑ F' '.
_ REPAIRZ2, - '
SIGNATURE OF q _ -
APPLICANT. . DEMO L ❑i • l
VALUATION $ 6I Poe APPROVALS- DATE: <•INSPEC 9R'S SIGNATURE
Y,
P.C. PMT: ;,,,, �. FOUNDATION: LOCATION . - -
4 FEE $ - FEE"$. _ FORMS, MATERIALS '
' FRAME: FIRE STOPS, .. y
{{t 4 .I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION S -BRACING, BOLTS' 7. -
I I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY F RNACE: LOCATION, �"`• ,
WITH ALL' ORDINANCES AND LAWS'REGULATING BUILDING CON- AS VENT; DUCTS I „`, -
,STRUC TION, 1-CERTIFY THAT IN
.DOING THE WORK AUTHORIZED. -
I HEREBY I WIL ,NOT EMPLOY ANY PERSON IN VIOLATION OF THELAT
LABOR CODE F` THE STATE OF 'M��
IAIN RELATING TOWORKMEN'S CO TIONINSURANLATH, EXT@SIGNATURE OFHOUSENUMBER COR-
RECT AND POSTED
ADDRESS FINAL -.
JOHN•F.'LEWIS. PRI CIPAL STRUCTURAL EN ER
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALI TION CK. M.O. CASH
..DEPARTMENT OF BU6LDINC ANSAFETY = - APPLICATION .FON-PERMIT
COUNTY OF LOS ANGELES. I1tQn1 1kF71I�-a11
WM. J. FOX, CHIEF ENGINEER v v a
FOR APPLICANT TO FILL Ilii FOR OFFICE USE ONLY
BUILDING -"` /�.y-r jf ,/�J / DISTRICT NO. PLAN CK.NO. PERMIT NO.
=i .ADDRESS 4•__ / ! -T'! G/ /0 . "o,
LOCALITY. Y/ '� {� f� ,m. RECEIV D BY DATE OF APPL. DATEISSUED,
NEAREST
1 CROSS ST. / y•P G. r
r ,
OWNER �� i] /9'._ ,d E? 9Z / 0 t7 Gy DDRESS
MAILe�{ 11 LOCALITY
ADDRESS ` � /r NEAREST
111
/ ,ate fI%J 6
/ ti: .l �`Sf TEL CROSS T. 6/
CITY FIRE T
/
f TEL. ZONE— PLANS _ YPE -•--- ,6RO�l�F�
ARCHITECT OR `�•- , --L�
'ENGINEER NO. _
SETBG.ACK ACK LINE / � �RD.NO.<257 - r
ADDRESS —
�Jff/ /� J
APPROVED
CONTRACTOR
•/%� `*ma y if NOLO'! 7 1, 421y BY DATE
r
f USE APPROVED
ADDRESS O 6 / A ,� �"'' Cij/t�•••L ZONE BY DATE
LEGALrr ) CORRECTIONS
DESCRIPTION I "LOT ZZ ,.,7^^( 1 I BLOCK
TRACT /V R- 9:�x—
5 I NO.OF BLDGS.
SIZE OF LOT NOW ON LOT
USE OF -T� NO.OF ' I NO.OF /
EXISTING BLDG. /l ti ga/ :�•G.lr"I FAMILIEle ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
O
A
REPAIR MOVING DEMOLISHLI
-
SQ.FT. ROOMB ( STORIES OF Z
SIZE / j C/ D
WALL e a I ROOF r
COVERING /J.�6 ..� COVERING ,/,h �,i1,4,s1r
USE OF NEW
�j BUILDING /(� • Sr.P
+.�1..-rL+✓h�-..t��•.s1Et-�;/.]. �t�Pl:t.�4-..mer-•'6<f-„-6sG'�,� ,.
r 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS- ,�,
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
FOUNDATION: LOCATION 1 NSPEC`I'DR DATE,
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
FORMS,MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: IRE
SIGNATURE O� BRACING,BOLTS
PERMITTEE
LATH, INT.:
AUTHORIZED AMT Y x LATH,EXT.:
DBS-3 SCM SETS 7-47 $ � P.C. PLASTER,INT. -
D FEE PLASTER,EXT. /
VALUATION - FEE FINAL
EPAIt�AENT OE EIIILDING ANI):SAFETY APDL C �I® F®E PERMIT
COUNTY.OF LOS ANGELES r��y
WM. J. .FOX, CHIEF ENGINEER "' t .
NO. OF. BLDG. - ORD NO, DISTRICT NO. PLAN,'CK, NO. PERMIT NO.'•
PLANS 'SETBACK LINE - ! Q,m` -
Jj I�s�/\ •�/_ i �.
.FIRE ,. � -APPROVED �-� ., -�� lV�
'ZONE - BY DATE ,Fa, RECE!VEDBY "DATEOF,APPL. DAT�.-ISSUEEDD
ZON ., BY".- DATE DATE '
APPLICANT FILL IN HEAVILY`' O$JILINEI)F PORTION. (3N
/8� �'
NAME � ��5 /t. f / i - ADDRESS
._G-"/� .. _
a .
O
IhUW - / J % 11: r�+t'SU6 LOCALITY.. '\ `
.' W 'Z ADDRESS P" ., ' !'d 4�
= NEAREST
U-W 'CITY -" '7STA � i ./ �.- "CROSS�ST.. -/'� -
Q �LICENSE NO. �6l^! No. e% ..W NAME .�Q:•i.) P S ��f I.. ' `��� G/ '4_.. .
Z MAIL. _ -
�. NAME - �-�.4 /-'L /L�. J, / ` ,(�. ' Q, ADDRESS/ 6 -/ /I~�-"//��!
. TrL
¢ ADDRESS C!/� (�. lilt f/Sfl.✓� I�.�G �/1`a CITY / t, 440 '. � Nolv5lO�J
r>
H -r
:O f+CITY �,/ .. - - - 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ, THIS
U - APPLICATION AND- STATE"THAT THE A60VE`iS CORRECT
'STATE - - - TEL ��'/� .AND AGREE�TO`COMPLY WITH ALL.COUN Y'ORDINANCIES
LICENSE 'NNO. ® / AND STATE LAWS'REGULATING`BUILDIN CONSTRUCTION..
ZI- LOT
NOOF LOT /��•� SIGNATURE OF
l . . SIZE
J'0 OWNER
NO. OF BLDGS. 11 1
.AUTHORIZED_AGT.
BLOCK NOW ON LOT
J N TRACT _ ,'s�.c- ,4, _ CORRECTIONS
W _.
Q USE'-OF BLDGS.
NOW-ON.LOT. — - -_ ��. ! •3'r , } - �r .1 .
DESCIPTI®iv; OF �-7
�s
'
BUILDING
d}
2 -
" 0
..-TYPE GROUP
-. NO. OF= !, NO. OF
=ALTERATION ROOMS c!_ --FAMILIES c'.• -
ADD!TION .,SIZE
REPAIR. STORIES
MOVING - WALL COVERING '! }167•jr✓1cr/
DEDAOC15Ii ROOF COVERING
P. c. FINAL.APPROVAL _
. _ '. �� L✓ FEE - f—
A,
INSPECTOR'S
-VALUATION FEE .�� DATE 7/' NAME .id
s
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I havecertificate of consent to self
fiWorkers'
F O uU 00 U 0 D LI V nn
insure, r•a certi{icdTe.of Worr kers' Compensation Insurance, L/111J LJ L/—U Ll\1 LI.V IJ LI�1UllU
or a c�rtiired co'py�thereof (Sec. 3800, Lab. C_) COUNTY OF LOS ANGELES BUILD NG AND SAFETY'
Policy No. Company
BUILDING
Elcertifiedcopy isr,hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �� .
❑ Certified copy is filed with the county building inspec- BUILDING / c—
tion department. ADDRESS Sio J �Q.//
J/ oL�Q-r
CITY' �cQUI tt ZIP `bo-�7
/' LOCALITY
-Date Applicant NO. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' . SIZE OF LOT" '�6 X Iia ' -NOW ON LOT CROSS ST.
COMPENSATION INSURANCEASSESSOR fj�� yy'��
8 (This section need not be completed if the permit is for one TRACT- 019S-91 BLOCK LOT NO. � MAP BOOK tJ IG7 PAGE 40 Ft�RCEL 0
hundred dollars ($100).ori less.) ( -/ TEL.,
OWNER Q•11� �2.Q�`��,IIeJ r NO. S7�'�BIS� USE ZONE MAP
I certify that in the performance•of the work for which this / SPE
permit is issued, I shall not employ any person in any manner ADDRESS 3'6 ss— '/Q 4t�'2.�1 SPECIAL >
so as to become sublect,to the Workers'Compensation laws. - Q
CONDITIONS
CITY �Caq(1 c+l ZIP oo / U
Date Applicant ARCHITECT OR J; TEL yjl /y
NOTICE:TO APPLICANT: If, after. making This Certificate of ENGINEER. d 'l I of rA e e NO.. T 7 `S�f�V DISTRICT GROUP TYPE FIRE PROCESSED BY
CONST. ZONE
Exemption; ,you should become .subject tq the Workers' i/ rU
Compensation provisions of the Labor Code, you.must forth- AbDRESS
with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFIC TION APT.' CONDO. N
deemed revoked. CONTRACTOR ill Q NO. _
Z
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.=
O. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
SEW
(commencing with.Section 7000)of Division 3 of the°Business 'LIC. ER MAP
,and Professions Code,'and my license is in full force anCITY CLASS
d effect. BK. PG. VALIDATION
SQ. O. OF NO. OF CHECK '
License Number' Lit. Class SIZE e— ONE
lVALUATION '
Contractor F.. Date DESCRIPTION OF WORK �p(15LL! C✓cG NEW ❑ $
iil7 CGLC� C' GL�APOC ADD
❑1 am exempt under Sec 'e LnbJi
1 J ( ALTER
B.&P.C. for this reason J_AIi no�P p2emade 11�'fcher�— REPAIR ❑ $
Date: USE OF 6h�t1�Q� CO DEMOL ❑
EXISTING BLDG.
Signature APPLICANT TEL. FINAL "
OWNER-BUILDER DECLARATION (PRINT) — NO. DATE
I hereby affirm that I am exempt from the.Contractor s License
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL
Professions Code): PRESENT r By
BUILDING
❑ 1, as owner of theproperty, or m em to employees with
, .,, Y. P Y. ADDRESS y(
wages as their sole compensation,will do the work and t { _._„; y ;
the structure is not intended or offered for sale(Section LOCALITY,. - -
7044, Business and Professions Code. D..
MOVING •TEL.
1, as owner of the property,;am exclusively contracting CONTRACqOR NO. ; - ,
with licensed contractors to construct the'project (Sec- - =`�iai 304 ® �=
tion 7044, Business and Professions Code.)' ADDRESS a 4 CHECK
I t
REQUIRED" TOTAL SETBACK FROM EXIST.. L g
CONSTRUCTION LENDING AGENCY SETBACK YARD HWY PROP. LINE WIDTH
I hereby affirm That there is a construction.lending agency for- FRONT ,i, t•i!F?{ �i=r'
the performance of the work for which this permit.is issued "-P.L. "
(Sec. 3097, Civ. C.). SIDE:
P.L.,
Lender's Name, -ta_ _.
W z_r w
� Lender's Address P.C. Fee$ Permit Fee LDMA Ref. # 1 •�•(l:n�.,
1 certify that I have read this application and state that the Issuance Fee LDMA P/C# D"
above information is correct. I agree to comply with all County Investigation Fee
Rordinances and State laws relating to building construction, Total Fee �� �' LDMA Perm. #
a and hereby authorize representatives of this County to enter
a up�t
above-mp5Wned op f inspe tion purposes.
�y
� SEE REVERSE FOR EXPLANATORY LANGUAGE
Si tura Applicant or Age "Date -