HomeMy Public PortalAbout6157 HART AVE_Building__ ' �IT -
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AC3 S-61ALL PU`IAAT90N F0119_IS. U9LD9N.G Y ERIVYOT17 -
COUNTY OF LOS ANGELESBUILDING.
DEPARTMENT OF'COUNTY ENGINEER ADDREss
BUILDING AND SAFETY DMSION LOCALITY �C
JOHN A. LAM BIE, COUNTY ENGINEER NEAREST '
WILLIAM A..JENSEN SUPT OF BUILDING CROSS ST.
I DISTRICT NO G•Rr TYPE P E BY'
FOR APPLICANT TO FILL IN,, � � coNST.
,BUILDING STATISTICALCLASSIFICATION SEWER KMAP G
ADDRESS
CLASS.No_rf1 DWELL.UNITS '
LOT NO. BLOCK WATER N07"REQUIRED RECEIVED
CERTIFICATE:,
TRACT - MAP /](.r,3 HIGHWAY' STATE MAJOR SEC LOCAL
NO.OFBLDGS. _ NO. V _ICIRCLE> O
SIZE OF LOT NOW ON LOT US-- ZONE 'SPECIAL _
USE'OF - CONDITIONS
EXISTING BLDG.
TEL.
OWNER- NO. BUILDING YARD HWY STREET NAME EXIST. ,
e/ 4 A SETBACK -.,.�^r=,VIDTH .
ADDRESS /✓• FRONTf�
ARCHITECT OR - - TEL .P. L.
ENGINEER .N _ SIDE
P.L. 0
ADDRESS
TEL. INSPECTION
INSPECTION RECORD.
CON RAC od NO.
DRE S
DESCRIPTION 'OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT.. NO.OF. NO.OF r �...
IZE TORIES FAMILIES
y
USE OF
TRUCTUR
SIGNATURE OF
APPLICANT j -
'IVALUATION$
"f APPROVALS DATE -INSPECTOR'S SIGNATURE
FOUNDATION; LOCATION
FEE $ I FEE $�� FORMS,MATERIALS
FRAME:..FIRE STOPS,
'1 HEREBY'ACKNOWLEDGE THAT'I HAVE READ THIS APPLICATION BRACING,-BOLTS -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TOCOMPLYFURNACE: LOCATION, '
WITH ALL'COUNTY ORDINANCES AND STATE 'LAWS REGULATING GAS VENT DUCTS '
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHOR I ZEDHEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF THE LABOR CODE OF,THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMP O INSURA CE. '
LATH,EXT. A.
P RMAITTEE O HOUCT AND POSTED E NUMBER R_- !:/ L•!/UP/
ADDRESS FINAL
CLYDE N. DIRLAM, P INCIPAL ST RAL ENGINEER
PLAN CHECK,VALIDATION cr. M.O. CASH PERMIT VALIDATION cK M.O. CASH
,' f�Y��G'✓i�I�
WORKERS'COMPENSATION DECLARATION 870339 PB
I hereby.affirm that I have a certificate of consent to self /n1 n /n1 O(�� O o n (� (�'D �(� (0� (�/�
insure, or a certificate of Workers' Compensation Insurance, (/=��f' A IM U l�i N (fUU
or a certified copy thereof (Sec. 3800, Lob. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. W0007146Company Rpaupr . I'nciirant$
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building in'spec- BUILDING
tion department. ADDRESS 61 N Hart
Date 9/29/L Applicant.Ii/'i rq i n Roof' CO_ CITY ZIP 91780 LOCALITY ,
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST
. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be completed if the permit isfor one ASSESSOR'
hundred dollars ($100)or less.) - TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
TEL. USE NE MAP
OWNER NO. .
I certify that'in the performance of'the work for which this NO:
permit is issued, I shall not employ any person.in any11 / SPECIAL
so as to become subject to'the Workers'Compensation Laws. ADDRESS CONDITIONS O
Date Applicant CITY ZIPcc
NOTICE TO APPLICANT: 1f, after making this Certificate of ARCHITECT OR TEL:. o DISTRICT GROUP TYPE FIRE PRO SSED BY CJ
ENGINEER NO. CONST. j•' ZQ[VE U
Exemption,'you should become subject.'to -the Workers' (�J _-y/
Compensation provisions,of the-Labor Code, you must forth- ADDRESS
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. NDO. N,
deemed revoked. CONTRACTOR NO. —
Z
LICENSED CONTRACTORS DECLARATION LIC• CLASS NO. DWELL.UNITS
I hereby affirm that I am Iicensed.under provisions of Chapter 9 ADDRESS 'P.O. NO. 16()650
(commencing with Section 7000)of Division 3 of the Business and LIC. ESBEWER,MAP
Li License Number and 16o61icense is-in full'.force and effect. CITY CLASS K PG
Y VALIDATION .
SQ. FT. NO. OF NO. OF' CHECK
5O Lic.Class C 39 SIZE STORIES FAMILIES ONE
, ,. VALUATION '
Contractor U 1 r 1 Il ROOF CO_Date9/29/87
DESCRIPTION OF WORK eX 15 t i n NEW ❑
9 ❑ $1000.00
ADD D
I am exempt under Sec. ❑
ALTER
B.BP.C. for this reasonREPAIR ❑ $. r
Date: USE OF
EXISTING BLDG. Dwe l i ing DEMOL ❑
Signature APPLICANT TEL: FINAL ` c�
OWNER-BUILDER DECLARATION PRINT NO: — DATE
I hereby affirm that l am exempt from the Contractor's License
Law for the following reason '(Section 7031.5, Business and ADDRESS IF
,Professions Code): PRESENT 2.82 7,'1 A
❑ BUILDING
I, a§ owner of the property, or my,employees with ADDRESS
wages as theirsole compensation,will do the work and #'.o o"o- o o y�
the structure is not intended or offered for-sale(Section LOCALITY D
7044, Business and Professions Code). MOVING TEL.
I, as owner of the property, am exclusively contracting
CONTRACTOR NO. L••o 0'4 a 5 0
with licensed contractors'to construct'the project (Sec-
tion 7044, Business and Professions Code). ADDRESS 'o o`0'4 a 5.0;=
REQUIRED TOTAL SETBACK,
CONSTRUCTION LENDING AGENCY. SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT .� 0 3�.8 7
the performance-of the work for which this permit is issued P.L:
(Sec. 3097, Civ. C.). SIDE,
P.L.
Lender's Name
ms LDMA Ref. N
Lender's Address
P.C. Fee$ Permit fee
'�
3 - ,
0 1 certify that l have read this application and state that the Issuance Fee Z P/C#
o above information is correct. I agree to comply with all County Investigation Fee
0 ordinances and State laws relating to building construction, Total Fee 4O e 50 LDMA Perm. q'
'N and hereby authorize representatives of this-County to enter
< upon'the above- entioned property for inspection purposes.
C172C1�87 SEE REVERSE FOR EXPLANATORY LANGUAGE
Si ature of Applicant or Agent Date