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HomeMy Public PortalAbout5831 HART AVE_Building__ 76A638A CE#803 9-68 APPLICATION FOR BUIL®8 G PEPmw, COUNTY OF LOS ANGELES ,BUILDING {�y� DEPARTMENT OF COUNTY ENGINEER ADDRESS �J U BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE' COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BUILDING `CROSS ST. DISTRICT NO. GR TYPE CE BY FOR APPLICANT TO FILL IN CONST, (Print,or'type only) BUILDING STATISTICAL CL A IFICATION S WER MAP ADDRESS 5831 N. Hart CLASS No. DWELL,UNITS BK PG LOT NO, BLOCK USE ZONEMAP /1 Q- N O. lJ TRACT Q�7 CONDIT ONS PCAL NO.OF BLDGS. SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. - ' BLDG.SETBACK FROM TEL. FRONT PROP.-LINE OF (STREET). OWNER M S. Smitih7 NO. 286-7 60 TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS 1 P� ilur't HIGHWAY WIDTH FROM C.L, CITY p-mnl -jt• BLDG.SETBACK FROM ARCHITECT"OR TEL. SIDE PROP.LINE OF (STREET) ENGINEER NO, TYPE OFEXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS HIGHWAYI WIDTH FROMC.L. TEL } CL CONTRACTOR Virri_n Roof' Co. NO. AT 7-0507 � + c ADDRESS ,�'`" Y'"1P� NO "�� } CORNER CUTOFF YES ❑ No__[:] C LIC. CITYS'a r_ Gabriel CLASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS LL CONSTRUCTION LENDER CL NAME AND BRANCH ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES USE fiCni a s. ADD ❑ STRUCTURE ALTER ❑ SIGNATURE OF REPAIRS APPLICANT DEMOL ❑ - VALUATION $ 397.00 APPROVALS DATE INSPECTOR'S SIGNATURE P,C. PMT. FOUNDATION: LOCATION FEE S FEE$ c),on 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 STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENS N INSURANCE. LATH, EXT. zi SIGNATURE OFAi� �P HOUSE NUMBER COR- - PERMITTEE RECT AND POSTED ADDRESS FINAL Gf JOHN F. LEWIS. PRIN IPAL ST IRURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION M.O. CASH t r U L7 7 .0 JAWN c.5 2 � -3.� .3a"" WORKER('U`CO/�IPENSATION•DECLARATION, nn `� I herey affirms.that I ave a certificate of consent to self /Ll\ O O BURUNG �'�LI U LI LI insure, or a certificate of Workers' Compensation Insurance, L vU u C -u FOR or a'certified copy thereof (Sec. 3800, Lab: C.) /, COUNTY OF LOS:ANGELES - BUILDING AND SAFETY Poli' No:O 3TOL Companyf��,-��� ;Certified co is`hereb`furnished.' FOR APPLICANT TO FILL IN BUILDING PY,. Y ADDRESSr� . JIAE ❑_.Certified,copy is1filed with the county buildin inspec BUILDIN tion department. -I ,Date ;, .Applicant CITY.' C C-�!! ZIP `� ` ��. LOCALITY NO. OF BLD S.. NEAREST -CERTIFICATE'OF EXEMPTION.FRO DRKERS_ ` SIZE OF LOT NOW ON LOT CROSS.ST. COMPENSATION INSUR CE ASSESSOR This section need not be com feted if the'permit is for.one TRA L ( P P CT' " BLOCK LOT NO. MAP BOOK " PAGE PARCEL ' hundred dollars ($Y00) or less..) TEL., OWNER ( w N¢ r `� l USE ZONE: MAP certify that in the performance of the"work for which this ` SPECIAL permit is issued, I'shallnot employany'person.inany,manner ADDRESS 3 V CONDITIONS a so as to become subject to the Workers' Compensation Laws. `„ _ O . - CITY r, i •ZIP L) Date Applicant ARCHITECT-OR TEL. 0 NOTICE.TO APPLICANT: If; after;making this;Certificate of ENGINEER; NO . " DISTRICT GROUP TYPE' FIRE PROCESSED BY Q CONST. Z NE Exemption, you'should become 'subject to the Workers' u Compensation provisions of the Labor Code, you.must.forth- :. ADDRESSj/ d,. v with comply,with such`;provisions or: this permit shall be TEL: �/y^/` STATISTI CALCLASSIFICATION AlPT: CONDO Z deemed.revoked. CONTRACTOR NO l — LICENSED CONTRACTORS DECLARATION. r' ' LIC:, n� CLASS'NO.�DWELL..UNITS d Hereby affirm that I am:.licensed.under provisions of ChapterA ADDRESS NO.' GY LIC. SEWER MAP (commencing Y ), ofesiwith Section y license of Division 3 of the Business. $QYFT. a NO.OF NO. OF CLASS G 3CHECK i N and Professions Code,and m license is in,full force�atn�d7effect. BK PG. VALIDATIO License Number / ` Lic..Closs ��'' SIZE , 7, STORIES FAMILIES ONE e.. VALUATION. . rf/I�NST /CI TK Date Gl Lj DESCRIPTION OF WORK L/ NEW Contractor / '�. � �� ? B� Q I am'exempt under-Sec. L9 p '. •© � %�(/t�- ADD" D, B.&P.C.,for.this,reason ,� `�` - atei USE OF „ REPAIR 'L : a . EXISTING'BLDG. DEMOL 1❑ Signature: 0 ' tB — APPLICANT TEL. FINAL OWNER=B OBER DECLARATION (PRINT), >y. S /� /? /�.O. �O I hereby affirm that I aex t empt from the Contractors License DATE f v �. /� C o, / :: y Law for the following"reason':(Section 7031.'51' BusinessADDRESS 'dnd `�Y 'FINAL Profess ions.Code) " PRESENT By1. 5 BUILDING I, as owner of the property or"my employees with ADDRESS wages as their sole compensation,.will do'the work and. - t�✓ :�Jl the structure is not>intended oroffered.for sale{Section LOCALITY D /` Y.Qj6 f//(-. r ❑ ,7044, Business and Professions Code:) - MOVING TEL: CONTRACTOR NO. A I, as owner of theproperty,'am exclusively contracting with licensed contractors to.cohstruct the'prolect (Sec- tion 7044, Business and Professions Code: ADDRESS REQUIRED TOTAL SETBACK FROM EXIST: " CONSTRUCTION LENDING AGENCY SETBACK YARD; "`HWY` PROP. LINE WIDTH'' S^ yS�L 1`hereby affirm-that there is a;construction-lending.' ency for FRONT. the performance of the'work for.which this permit is issued P.L.' (Sec. 3097, Civ: C:).- SIDE•,. Lender's Name" LDMA.Ref. #' t _ Ail - �. . . - P.C. Fee$ PermifLFee _ --• •- 3 Lender's Address I certify that'(''have read this a licationcand state that the Issuance Fee x'- �d CDMA P/C'# D o Y PP above information is correct. I agree:to comply with all County Investigatwn;Fee Q 8' ordinances.and State laws relating to building construction, Total Fee �� ✓ LDMA Perm. #. a and her y author" 'representatives,of this County to.enter upon t above-m tioned pro` rty for inspection'purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE „ Signal of:Applcant'or Agent-- Ddte: