The URL can be used to link to this page

Home My Public Portal About5635 HELEO AVE_Building__ A ROAD DEPT. PERP!UT -IS REQUIRED d&R ANY !.IAT♦,RIA.L STOR:,GE OR %YORK ' NE IN "fii ROAD U,,-.T OF WAY. ..A<., =5a.o„-=. APPLICATION FOR BUILDING PERMIT Z COUNTY OF LOS ANGELES BUILDING ADDRESS DEPARTMENT OF COUNTY ENGINEER - c BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER - NEAREST L CASSATT D. GRIFFIN, SuP,T op CROSS ST. BVILOINc DISTRICT NO. GROUP •rypE SED BY 77 CC FOR APPLICANT TO IN '� ^ CONST. BUILDING !'I STATISTICAL CLASSIFICATION SEI✓ER MAP ADDRESS (� BKS PG es, CLASS.NO. DWELL.UNITS LOT NO. ,5 - BLOCK MAP STATE YES O ��JJ(( NUMBER HWY. TRACT X.3 USE ZONE SPECIAL �� r A� NO.OF BLDGS. ^ CONDITIONS _ SIZE OF LOT NOW ON.LOT 0 USE OF EXISTING BLDG. BUILDING - EXIST. ��{{^^� y. SETBACK YARD HWY TRE,T NAME WIDTH OWNER kTLk Icy/MAILn J L FRONT I ADDRESS /� ..J �`Yf- D. - SIDE P.L. CITY •-A �(' M INSPECTION RECORD ARCHITECT OR TEL 79 ENGINEER 'l� .n NO T(1 79 ADDRESS .J AI—[O�/'J♦VS� 1 lr CONTRACTS A DDRESS74 �� 4GGY-Ga.LL•C(�a DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH Sq. FT. /n NO. OF NO. OF SIZE ” STORIES FAMILIES USE OF STRUCTURE pp - SIGNATURE O -� APPLICANT i q APPROVALS DATE INSPEC 'S SIGNATURE ADDRESS — t0 f `�� FOUNDATION: LOCATION l ,r/ FORMS,MATERIALS 'I �"�0 �h VALUATI)ON775 ,Q/Q�(J FRAME:BRAC:FIRE SLOOPS / FEE S LG `L pm" � "/ , I FURNACE: LOCATION, FEE 5 GAS VENT, DUCTS I HEREBY ACKNOWLED E THAT 1 HAVE READ THIS AP- LATH, INT. / (♦ PLICATION AND STATE THAT THE ABOVE IS CORRECT AND v AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AIJO STATE LAWS B UL INGBUT, IN LATH.EXT. SIGNATURE OF� CO UCTI HOUSE NUMBER COR- PERMITTE RECO AND POSTED ADDRESS � � 7-" Q.L!-Q�/u '� � ��` NAL ♦♦.y_. CLYDE N. DIRLAM, PRINCIPAL ST 71URAL ENGINEER PLAN CHECK VALIDATION' aK. ^+•o: CASH PERMIT VALIDATION CK/./ M.O. -5H L&.5,9 4,4 IS FEB, 22 3. A 2 2.50 A M LfiCo 6.0 7 21S FEB 4 - 1 A 4 5.0 0 APPLICATION FOR BUILDING PERMIT COUNTY OF L6%ANGELES BUILDING-AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADD BUILDIN I hereby affirm that I have a certificate of consent to self insure, or a Certificate of Workers'Compensation Insurance,or a certified zIP CITY I copy(((((((hZ�ef�Bf//(ST/eecc3�380000,La//b.C.) / /� — • (, `Y PoIICyIVO' ✓Au rJ / %6 -4 pan;;— '/�/L ilI"J LOCALITY SIZE OF LO NO.OF SLOGS.NOW ON LOT Certifies copy is hereby furnished. NEAREST CROSS ST. T514ertified Copy is filed With the county building Inspection TRACT BLOCK LOT NO. departm nt. / /^L,/ � - USEZONE MAPNO. Data A IiCant /O�LOtlJ-� ASSESSOR MAP BOOK PAGE PARCEL Pp SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION TION N FROM WORKERS' OWNE G 8 - ro 3 7 WITHIN 1000 FT.OF SCHOOL? YES NO ADD E S (This section need not be completed if the permit is for one hundreds S�3 TJ DISTRICT -GROUP TYPE CONST.' FIRE ZONE PROCESSED BY sellers($700)or less.) CITY _ -ZIP 3 I certify that in the to employ an peesf the work for manner s per, If c D� Is issued. I shell not employ any person in any manner so as to A CHITECT R ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. 11 STATISTICAL CLASSIFICATION APT CONDO Date Applicant -• ADDRESS CLASS NO. I-0— / DWELL UNITS NOTICE TO APPLICANT: IL after making this'Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers CO CR E NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisionsofthe Labor Code, you must forthwith /C Or- � FRONT Comply with such provisions or this permit shall be deemed revoked. 9E$B LIPIL Lf,L LICENSED CONTRACTORS DECLARATION a LIC. SIDE 0_ PL I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing With Section 7000)of Division 3 of the Business and SPIP-rIONHOF NO.OF S ORES NO.OF FAMILIES C Professions Code,and�m-y. license is in full force an effect. NEW ❑ SK PG , R License Number. '�T� LiC.Cis s WORK- ADD ❑ U VALU Contract ri �. REPAI ALTER ❑ $ �' z ❑ 1 am exempt unser Sec. $ 1 B$P.C.for this reason / ,— - DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. .URM ❑ Signature ANT(PRINT, T O. LDMA Perm# j ❑ 1, as owner of the property, or my employees with wages as `� - - p ,7�'r.i_i •s -their sole compensation,will do the work and the structure is Ay Z , FINAL DATE < -".711 =�+1•=!LI not intended or offered for sale (Section 7044, Business and - Professions Code.) WILLTHEAPPLICANTFUTUREBUILDING HANDLE A�RDCUS MATERIALyq 3 1 FEE- El I, as owner of the property, am exclusive) COMfaCTln With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN P P y y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licenses contractors to construct the project.(Section 7044, T!=!TAS . - - 00 YES❑ NO❑ Business and Professions Code.) CHECK J WILL THE INTENDED USE REA MI THE BUILDING BY THE APPLICANT IO FURORE BUILDING L.I}Lt C'\ V=a C!Li CONSTRUCTION LENDING AGENCY OAST AIR QUALOCCUPANT ITY MANAGEMENT DISTRICT(T FOR I CAOMDON OR )SEE PERMITTING CHECN FROM THE KLIST ,(�f/] !,� FOR GUIDELINES. �•"M� 1 `-'>��ITI'+'� '110 I hereby affirm that there is a construction lending agency for YES❑ NO❑ the118OCe Of the Work for which 1h13 permit IS ISSUed(SRC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE CAOMD 3097.7,Civ. IV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES - !II I_I-I iL!i j 3 !/ _t1 j' 3 Lender's Name COUNTY CODE.TITLE;CHAPTER2ASECTONS 2.20.1WTHROUGH 2.20AQ CONCERNING HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE CAOMD. Lendees Address 59,-34 _ A i!==1C 15 UN M MAGE o' I certify that I have read this application and state that the above information is correct. I agree t0 Comply with all County P.C.FEE PERMIT FEE ordinances and State laws relating to building construction,and n ��eBy-e or!ze repres tetiV4�0 County to enter upon ISSUANCE FEE _ the above-m tion pr rdpert for in action purposes. otl_s J INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE. WORKERS' COMPENSATION DECLARATION H ereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure,,r'a certificate of Workers'Campenstion Insurance, or - o certified copy thereof (Sec. 3800, Lab. C.) - COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Na. _ Compony / Certified copy Is hereby furnished. FOR APPLICANT TO FILL IN - nooe ss��(t�`�C Certified copy is filed with the county building inspec- BUILDING - - tion department. ADDRESS GPCJ LOCALITY / NEAREST Date Applicant CITY 'e '! ZIP CROSS ST. -CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS, ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP �q hundred dollars ($100)or less.) TEL TRACT BLOCK LOT NO. SPOECIAL G� 1 � /, certify that in the performance of the work for which this OWNER 1 NO _ lSypp CONDITIONS 0 permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FP SED BY V so as to become subject to the Workers'Compensation Laws. ADDRESS - e ,�Q CONST. ZONE z 69 Dated' ee Applicant �y �� CITY ZIP STATISTICAL CLASSIFICATION ]'il APT. CONDO. -u NOTICE TO,APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. w Exemption, you should become subject to the Workers ENGINEER NO. CLASS NO. DWELL. UNITS_ H Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be TEL ( �'�c,'( VALIDATION deemed revoked. CONTRACTOR /s ,/ y^ O. �//sJ BK. PG, LICENSED CONTRACTORS DECLARATION LIC, / `/9 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ^(�(� T S NO. VALUATION O .(commencing with Section 7000)of Division 3 of the Business and I LIC. Professions Code, and my license is in full force and effect. CITY Lj CLASS $ ��/ F/ / SO. FL NO. OF NO.OF CHECK ` License Num be, ( O Lic ClassIf—6 SIZE STORIES FAMILIES ONE -. L S / 7`r,5 —0 DESCRIPTION OF WORK NEW 1 Contractor /VfvDate D ❑ ❑ •L ADD I am exempt from the li ensinq requirements as I am a I licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, y �� 0DATE � pb/ Business and Professions Code). USE OF REPAIR EXISTING BLDG. DEMOL FINAL ! Lic. or Reg. No.--Date APPLICANT TEL, BY OWNER-BUILDER DECLARATION (PRINT) NO. 2 01.7 A I hereby affirm that I am exempt from the Contractor's Licensee # e e o e 23 Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENTBUILDING - 0 I, as owner of the property, or my employees with ADDRESS .2 ° • 4 3?O wages as their sole compensation, will do the work and e e o Q 3 2 0 the structure is not intended or offered for sale (Section LOCALITY 7044, Business and Professions Code). MOVING TEL O'4 0'5_8 0 El I, as owner of the property, am exclusively contracting LDR TOR NO. - with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). D - TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY K YARD HWV PROP. LINE. WIDTH I hereby affirm that there is a construction lending agency for 220'1,8 A the performance of the work for which this permit is issued(Sec. 3097, Civ. C.)'Lender's Name 2'^'^'61, 0 0 Lender's Address 8 1 Permit Fe61.00I certify that I have read this application.and state that theIssuance Feet above information is correct. I agree to comply with all County ion Fee .0 ni,O 5"8 0 ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives oCthis County to enter a upon the above-mentioned r pe"y for 'aspection purposes. sr —,5 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Ap and or Agent Dole