HomeMy Public PortalAbout10607 HALLWOOD DR_Building__ DEPARTS OAF COUNTY Eiq=V ER n
DIVISION OF.BUILDING AND SAFETY
COUNTY OF LOS ANGELES '
WILLIAM J. FOX, CouNTY ENGINEER i APPLICATION
CASSATT D. GRIFFIN, SUPT OF BUILDING i
y. A•
FOR APPLICFm TO FILL IN FOR OFFICE.•USE. ONLY
1 BUILDING DISTRICT NO. i;1PLAN/CK.OR RAE/C..No. RPPERMIT NO.
ADDRESS
LOCALITY R CEIVE D BY DATE OF APPL. DATE ISSUED
NEAREST I
CROSS ST BUILDING
7 ADDRESS 0
OWNERMAIL
G\
ADDRESS �, LOCALITY
c NEAREST. Lw
CITY ) ,W'I .TO ,� 6 CROSS ST. lIzzi
ARCHITECT OR TEL. - FIRE PL OF ..TYPE.. GROUP
ENGINEER NO ZONE PLANS
ADDRESS BLDG. K 0
SETBAC �LINE �
f TEL.- 'f USE APPROVED
CONTRACTOR . /(/f! / -" ZONE �� BY I DATE
C HOUSE NUMBERING
„ ADDRESS
LEGAL MAP NUMBER Q / 6 - NO. ASSIGNED BY
DESCRIPTION ILQTNQ. BLOCK
CORRECTIONS
TRACT
NO. OF BLDGS.
SIZE OF LOT ) NOW ON LOT i.
USE OF I NO. OF
EXISTING BLDG. ® FAMILLLIL
DESCRIPTION OF WORK o —
REW ALTERATION'P ADDITION
Z
IR I-I DEMO(TION
D
r
SQ. FT. NO. OF
SIZE /O7? ROOMS STORIES
EXT. WALLROOF
COVERING .� uc.co I COVERING
USE OF STRUCTURE
8
APPROV LS
INSPECT R'S SIGNATURE DAT
FOUNDATION: LOCATION 1
L FORMS, MATERIALS
4 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, ,
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS /tea
CORA REE.TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, `` 2
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS
SIGNATURE OF r �I lRl y LATH, INT. / B .,,�•��� R
PERMITTE
Sk r 1 ' LATH. EXT. 7 �/
ADDRESS • ('u
PLASTER, INT, -
AUTHORIZED AGT.
PLASTER, EXT. f
$ pCl P. C. $ S Il
HOUSE NUMBER 41
FEE COR-
RECT AND POSTED R .I
(� a
VALUATIONFEE SS �' FINAL' V O ,
7GA898A 088 8 8-88 y
1 -
WORKER '-COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self /U\DD P L��/U\U,�(ON F O 10 D U 0 d I 0 N G-P E G°3G��`�
insure„or a-certificate of,Workers' Compensation Insurance, [i�u u u L� u
or.a certified copy thereof (Sec'3800, Lab. C.) COUNTY°OF LOSANGELES ..",.BUILDING AND,SAFETY.
Policy No. Company -
SG
• ❑ • Certified copy.is hereby furnished. - FOR APPLICANT TO FILL IN ADDRESS
ADADDRESS (p
❑ Certified copy is filed with the county building inspec- BUILDING r
tion department. ADDRESS. 66 b7.1
�a pp
Dote ' Applicant CITY''�( . S ZIP 117S& LOCALITY 1
NO. OF BLDGS. NEAREST. If
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW"ON COT CROSS`ST:
'COMPENSATION INSURANCE ASSESSOR
(This section need:not be completed if,the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE 'PARCEL
hundred dollars_($100)or less:), M TEL.
OWNER kJCI✓ C��rS�li'uftl,:N0(SIS)443-bD67 USE ZONENO.
' MAP n.7
I certify that in the performance of the work�for which this
O�
SPECIAL >_
permit is.issued, I shall not employ anyperson in any manner ADDRESS IDC(J7 C. weoe. pr A.
CONDITIONS d
so as to become subject to the Workers',Compensation.Laws. 0
CITY 14P- C;t ZIP C(17�D U
Date` Applicant ARCHITECT OR TEL,
NOTICE TO APPLICANT:.If,._aftei making this•Certificate of ENGINEER NO. DISTRICT GROUP TYPE . FIRE. ROCESSED BY
hC 0
CONS
Exemption, you should ONE become subject, to the. Workers' Z `u
Compensation provisions of the-Labor Code, you must forth- ADDRESS c J CL
with comply with such provisions or this`permit shall be TEL. STATISTICAL CLASSIFICATION APT.dr CONDO. N
deemed revoked., CONTRACTOR. Q(.t/AJ r A NO. Z
LICENSED CONTRACTORS-1)ECLARATION /_ LIC. CLASS,NO. DWELL. UNITS
-
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS !a&C1J 1&140OD No.
(commencing with Section 7000)-of Division 3 of the Business LIC. SEWER P
and Professions•Code;and my license is in full.force and effect. CITY - CLASS BK. PG. VALIDATION
1. SQ::FT. NO. OF NO. OF' CHECK '
License Number % Lic. Class 'SIZE �� I STORIES FAMILIES ONE
Ej $AL�A
Contractor Date DESCRIPTION'OF WORK I r h NEW ❑ 7
�
// ADD..
El am exempt under Sec. D-
ALTER 1:1
B.&P.C. for this reason- REPAIR ❑ $
Date: USE.OF'
EXITING BLDG. DEMO ❑
Signature _ APPLICANT J TEL FINAL�J
OWNER-BUILDER DECLARATION" (PRINT), NO.
..
iA
I hereby affirm That I am exempt from the Contractor's License _ _ DA''
Law for the following reason (Section 7031.5, Business and ADDRESS FIN
.Profe ions Code): a
PRESENT By
BUILDING (�(..I e B
I as owner of the property; or-my.employees with ADDRESS ;l L- ; -} L,8 'f''
g{ p LOCALITY / a f C7 iaG:
wa es as their sole com ensation,will do the(rk and rs �V n�� ;_•�+>3�
the structure is not intended or offered for.sale Section D - t ITEMS
❑ 7044, Business and Professions Code.) MOVING TEL. . [�
CONTRACTOR NO. 7 —e
I, as owner of the.property,.am exclusively contracting I)T 683 63
with licensed contractors to construct the project (Sec- 3 �
' tion 7044, Business and Professio-ns.CodADDRESS e.} -- �;!••���;�ti ` 68;�,
REQUIRED TOTAL SETBACK FROM 'EXIST.
CONSTRUCTION'LENDING AGENCY' SET BACK YARD' :HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT CHANGE
the performance.-.of the work for.which this permit is issued P.L:
(Sec. 3097, Civ. ,). SIDE
P.L. • . _.
Lender's Name 0000-11301 113/10/89'
'
mhM
Gender's Address' P.C.'Fee$ Permit Fee - / �. LDMA,Ref.# 6133.- 1 ttt t n 1.;
° I certify that I have read this application and state that the Issuance Fee / ✓ ® LDMA'P/C.#
above information is'correct. I agree to comply with all County Investigation Fee
8 ordinances and State laws relating.to building construction, Total Fee 13LDMA Perm.#
a and hereby authorize representatives of this'County to enter
upon the bi d proper�tynsptlion purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE -
Signatu a of Apphc t or Agent Date .