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HomeMy Public PortalAbout9807 HALLWOOD DR_Building__ 76AG38A DBS-3 1Z•54 APPLICATION,. F0P:.8ULDS Q- PEP .BT �. DIVISION OF BUILDING AND-SAFETY BUILDING Q 'may ADDRESS / � /O" Department of County Engineer County of Los 'Angele ^I!9 ; LOCALITY WM.J. FOX, COUNTY ENGINE ��9 6 CASSATT D: GRIFFIN, SUPT OF BUI NEAREST CROSS ST. - I` FOR APPLICANT, TO FILL IN °ISTRICT�NO• GnOC` I TYPE SE BK MA PG BUILDING +' - sr CONST. ADDRESS O MAP ey - STATF- HWY ,/ NUMBER 'YES .� Ri LOT NO. BLOCK Lam--- USE ZONE •SPECIAL - n .. - - CONDITIONS TRACT NO. OF BLDGS. •S� SIZE OF LOT - - .I NOW.ON LOT -BUILDING YARD HWY STREET-NAME - 'EXIST. w USE OF - SETBACK WIDTH. EXISTING BLDG. FRONT P. L. 0 OWNER 9' SIDE MAIL - P. L. - ADDRESS i - - NO TEL. 1 DWELL. 1 UNIT- 5' INDUSTRIAL - CITY NO. 2 DUPLEX_UNIT 6 PUBLIC BLDG. _ TEL. - _ L+] ENGINEER NO. - O 3 APT. UNITS 7 ADDN.,ALT.:ETC: Q ADDRESS L 4 COMMERCIAL .S MISCEL:V WdAI T CONTRACTO NO: _ INSPECTION RECORD - ._..ADDRESS. . 'r-4-3C, .� ML-@°C, I� DESCRIPTION OF WORR NEW `'ADD 'ALTER REPAIR DEMOLISH SO .'FT. y NO. OF _NO. OF C'14' '� yz;o� •I h1 S� oO 1:5:4 SIZE per-6.�,SL� :STORIES FAMILIES USE OF STRUCTURE — SIGNATURE OF- APPLICANT APPROVALS ADDRESS - DATE INSPECTOR'S SIGNATURE FOUNDATION:.LOCATION `I �$ •` �v v - P.FEE. $� -,—FORMS, MATERIALS ,�/1 6� r�1l�.t�•" ,k �/.,�+ FRAME: FIRE STOPS.- VALUATION' S, BRACING, BOLTS `tt " % y. O� - FEE oG �_ FURNACE: LOCATION, ' 'I -HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT, DUCTS - APPLICATION AND STATE THAT THE ABOVE IS CORRECT - - AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH"\INT. AND STATE- LAWS- REGULATING BUILDING, CONSTRUC- TION. LATH, EXT. SIGNATURE OFY HOUSE'NUMBER COR PERMITTEE �y v II' RECT AND`POSTED _ I ADDRESS '/ y �j� �,/ •1��..�) TFI h1AL - WM. J. FOX, COUNTY-ENGINEER /t((rJ-'s"3 ,' sf.� yIDATION BY3.9 �' ? {ICY g ,1 6. 6 � B .'� MAY-25' - 1' 1 2.O 0 D.EPUT• _. DEPUTY ® j - DEPUTY - ^,�' '~ - �_ ""e''�; DEPUTY ��j 6 83.8� 3 CE #804/7�SI�PUCATIO�I FOR BUILDING PERM-IT � COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PACE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS MAKE CHECKS, PAYABLE 7'0: ADDRESS d c�. �(�C� ' L� . HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN NEAREST GCS Print ort a only) CROSS ST. BUILDING DISTRICT NO. GROUP TYPE ESSED BY ADDRESS G/ F� 'o? J CONST. STATISTICAL CLASSIFICATION SEWER MAP LOT NO. Q/ BLOCKr--- CLASS NO. DWELL,UNITS BK PG� TRACT ® USE ZONE MAP .ate �/ / NO.OF BLDGS. NO. "�- SIZE OF LOT & /( (COO NOW ON LOT � - Q, SPECIAL USE OF A- W C CONDITIONS EXISTING BLDG, D (� ti OWNER h,-11 �-(1 NOjBLDG.SETBACK FROM ADDRESS U FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK I HIGHWAY } YARD TOTAL CITY a HIGHWAY WIDTH FROM C.L. ARCHITECT ORL } _ ENGINEER - " O, � //JJ /_ BLDG.SETBACK FROM ADDRESS lg4410 G✓'E� a l,- SIDE PROP.LINE OF - - (STREET) TEL.. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CONTRACTOR- / NO. HIGHWAY WIDTH FROM C.L. O ADDRESS NO - } - -- - LIC. CITY CLASS CORNER CUTOFF YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS eq ,` _,,,,- �`)� GyA .SQ E •r r 6 STORIES NOMIOLFES NEW .❑ 'f��•/ �it/ 07 �_�'_ ,+�// ��../ •!lB'Js`r:�x vI USE OF - ADD ❑ '- STRUCTURE ,�� 1i//li� ALTER ❑ PAIR❑ S GNAIYURE 06F _ APPLICANT DEMOL ❑, VALUATION $ 6II APPROVALS - DATE INSPECTOR'S SIGNATURE P.C. PMT, � FOUNDATION: LOCATION .FEE $ FEE $ ;� FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE*IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS A STRUCTI ON. I CERTIFY THAT IN DOING THE WORK AUTHORIZED o HEREBY I WILL NOT EMPLOY ANY.PERSON IN V.IOLATION OF THE LATH, INT. •- �911 LABOR CODE OFTHE STATE OF CALIFORNIA IN REL NG TOWORKMEN'S CO SATIONtIN URANC E.` /'7 / � LATHI Z_ , EXT, SIGNATURE OF l///�s� ill, HOUSE NUMBER COR- N PERMITTEE RECT ANDPOSTED ADDRESS FINAL U PLAN CHECK VALIDATION. CK. M.O. CASH _ PERMIT _ ALIDATION cK. M.o./ CASH I , WORKERS'.COMPENSATION,DECLARATIO4 f I hereby affirm that I have a certificate of. consent to self D D * D O� O O 11 insure, or a certificate;of Workers'Compenstion Insurance, or U 11 �[/�1� LI V: `�O M I-=� .DLI V U a certified copy, thereof (Sec.-3800, Lab. C. COUNTY OF'LOS ANGELES BUILDING AND SAFETY PolicyNo _Company Certified copy is'hereby furnished. ' FOR APPLICANT TO�FILL.IN BUILDING ADDRESS . Certified copy is filed with the county building inspec- BUILDING (��1 tion department. ' ADDRESS dF�' �L zll LOCALITY . Date Applicant` CITY" • C /'L c� ✓7 ZIP CROSS ST. C=n \� CERTIFICATE'OF EXEMPTION FROM WORKERS'. 04f/ NO. OF BLDGS. ASSESSOR COMPENSATION•INSURANCE,. SIZE OF LOT JJ G? NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars;($100)or less.) TRACT BLOCK LOT NO. NO. LAC:, 0 A/ f TEL. SPECIAL •• I certify that in,Ithe,performance of the work for which this OWNER /�,W - r TIC NO. —\ CONDITIONS O permit is issued; shall not employ any person in any manner 7 / DISTRICT GROUP TYPE FIRE PROCESSED BY C7 ADDRESS. �0 %�L G L[I D CONST. ZONE �, so ds to become subject to the Workers"Compensation Laws. ( ' CITY C ZIP i 1L- W s 0 Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. U. NOTICE TO APPLICANT: If, after.,making this Certificate of ARCHITECT OR TEL. LU ENGINEER NO. CLASS NO. �'� DWELL. UNITS CL Exemption, you should become subject to the Workers' - �ry Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply,withsuch provisions or this permit shall be deemed revoked. TEL. BK. PG VALIDATION CONTRACTOR' NO. . LICENSED CONTRACTORS DECLARATION LIC. .7- 1-hereby I-hereby affirm that l am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. - Professions Code; and my license-is in full force and effect. CITY CLASS $ SQ. FT.�1 �y NO. OF NO. OF CHECK License Number. Lic.Class SIZE �J V STORIES FAMILIES ONE Contractor Date \+' DESCRIPTION OF W RK ,l d�1� �,` NEW 0 _ 1 am exempt from'the licensing requirements as I am a �t �t—L ADD Licensed architect or a registered professional engineer. /7 ALTER FINAL/—') -` acting in .my. professional capacity (Section 7051•1 �� REPAIR DATE Business and Professions Code). USE OF FINAL EXISTING BLDG. DEMOL Q By --- Lic.or Reg. No. _Date APPLICANT TEL OWNER-BUILDER DECLARATION (PRINT) NO.` I hereby affirm that I am exempt from the Contractor's License t Law for.the following reason (Section 703.1.:5, Business and ADDRESS. v Professions Code) PRESENT BUILDING I,as owner.of the property, or my p yees 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. , 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. CONSTRUCTION LENDING AGENCY SET BACK YARD' HWY PROP.,LINE WIDTH zU �'A < Thereby affirm that there is a construction lending agency for FRONT' the performance of the work for which this'permit is issued P L. # o'o o 6,0 1, . (Sec. 3097,Civ. C.).. SIDE ; -P.L. P 0`'7.8,50 - Lender's Name � O C .._t m .. P.C. Fee$. .Permit Fee ©��® , o 0 0. 7.8,5 0 P2 ' Lender's Address" w 1 certify that I have read this application and state that-fhe Issuance Fee �0 0 7, 0 2—812 " above information is correct. I agree to comply with all County Investigation Fee ; 0ordinances and State laws relating to building,construction, Total Fee r S a3and hereby authorize representatives of this County to enter Qupon he above-mentioned roperfy for inspection purposes. SEE REVERSE FOR'EXPLANAT_ORY LANGUAGE ©s Signature of Applic or Agent - Date..