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Home My Public Portal About5639 HELEO AVE_Building__ ::TEMPLE CHTY T6A6]9F DE FBD]2-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING [� DEPARTMENT OF COUNTY ENGINEER ADDRESS l ., BUILDING AND SAFETY DIVISION LOCALITY ` JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. DISTRICT N G TYPE B FOR APPLICANT TO FILL IN `j CONST. BUILDINGTAT (`�/ 2 �j Qy�. SCLASS.INO. CLAS IDIW DWELL. UNITS C�gKSE'ER MAP ADDRESS+J �/J / J .LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED �1 CERTIFICATE: TRACT y V MAPHIRCLEI E L GHWAY STATMAJOR SECOND OCAL SIZE OF LOT O/Y 0(� NOW ON LOTSLOGS.NO. OF SE O ICI USE ZONE SPECIAL USE OF if/ CONDITIONS EXISTING BLDG. .f OWNE NO. /1/- K! BUILDING EXIST. /g SETBACK YARD HWY STREET NAME WIDTH ADD S p.J C� FRONT //``�� ARCHITECT OR TEL. P. L. 0 ENGINEER Ale NO. '— SIDE I a P. L. ADDRESS — O TEL, n I V CONTRACTOR O N0. NO. V I j l � �._ ,A / � Ix 0 ADDRESS H+'1 V DESCRIPTION OF WORK a H NEW ADD ALTER REPAIR DEMOLISH SO. FT. NO. OF NO. OF SIZE Q Q STORIES FAMILIES USE OF STRUCTURE �,. SIGNATU OF ' APPLICAN VALUATION S � APPROVALS DATE /Af�T E�yyy.)� �INSPECTOR 581DrvgruRE UNDATION 3O FO FORMS. MATERIALS vLR'.'.W P.C. PMT. FEES FEE S - FRAME: FIRE STOPS. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. I v�.I�f� 'jE::7xjo;mcv it WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS %a BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- •LAlH`, INT,` TION OF THE LABORCODE OF THE STATE OF CALIFORNIA RELAT- ING TOWORKMEN'S PE ATION INSURANCE. LATH. EXT. SIGNATU OF HOUSE NUMBER COR- cl _ PERMITT RECT AND POSTED A /'� ,/f' ADORES _ FINAL 091165 n / JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN MKR PLAN.CHECK VALIDATION CK. M.O. DASH _ PERMIT VALIDATION CK. M.O. CASH LIII.JJ 8659 ;.iw 6 11 .50- � � ' j T ROAD DEPT. PERPAI�' .IS REQUIRED O , ANY MATERIr.L 5`JRAJE O.'- \''JORK y R ANE IN THE ROAD'; Ri`ni 'OF WAY. - =,A===•=Epi=.-== APPLICATION FOR BUILDING PER IT 1.. COUNTY OF LOS ANGELES BulLmrvc ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY A > r s JOHN A. LAMBIE. COUNTY ENGINEER NEAREST- - CASSATT D. GRIFFIN,SUPT OF BDILDING CROSS ST. DISTRICT NO. GROUP TYPE P ESSED BY FOR APPLIC T TO IN -, -171 CONST. } - /WZ�- BUILDING STATICLASTICAL CLASSIFICATION SE ER.MAP ADDRESS - - 'BK PG MAP NO. DWELL. UNITS LOT NO. BLOCK NUMBER - S{WyE YES O TRACT (C USE ZONE SPECIAL e NO.OF BLDGS. CONDITIONS ' SIZE OF LOT,5'4F [ NOW ON LOT USE OF EXISTING BLDG. - BUILDING EXIST. 7'' /��I 7-�-r�y n q ^ SETBACK YARD HWY TRE T NAME WIDTH OWNER 41 A//,A F I / ( •l L-Y FRONT MAIL P.L. ��- (J -ADDRESS - cJ t'-ve n SIDE w CITY {r / Q iC N `z7 �i ARCECT OR P.L. INSPECTION RECORD HITTE ENGINEER S� _auu N ADDRESS 51RI4 CONTRAM ADDRESS J �/lc.(!Q�.vwrl t DESCRIPTION OF WORK NEWADD ALTER REPAIR DEMOLISH - - Sq. FT. NO. OF NO. OF - SIZE STORIES FAMILIES/ USE OF STRUCTURE ---ck / SIGNATUR APPLICANT i APPROVALS GATE INSPECTORR 'S SIGNATURE ADDRE 7�l FOUNDATION: LOCATION FORMS, MATERIALS VALUATION $ �..�® I FRAME: FIRE STOPS, BRACING, BOLTS FURNACE: LOCATION. P,G. _S PML - O—1 GAS VENT,DUCTS �'�- // F5 [FEE ' - EE � L � 1 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING UILDING CONSTRUCTION. LATH. EXT. SIGNATURE OF !-,. J { HOUSE NUMBER GOR- PERMITT // �'{ RECT AND POSTED 11 .wn ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL Si CT RAL ENGINEER PL HEC$ VALIDATIO OK. M.o: DASH PERMIT VALIDATION CK M.D. CASH I p5.9 4.3:S FEB- --2;2'-3 1 ,.., .2 2 5 0 -LIC6 0 7 3 5 FEB 4 1 A 4,^5.0n,0 .2: ( •+ WORKERS'COMPENSATION DECLARATION - Hereby pffirm that I have a certificate of consent to self e3G, e Clull . •iru� oracwtificoteofWorkers' Compensationlnsurance, APPLICATIONV FOR BUILDING PERMIT or aceaified copy thereof (Sec. 38017x, Lab. C) COUNTY OF LOS ANGELES BUILDING,AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO-FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDINGS g tion department. ADDRESS t� 3 / Le�� Ly, Date Applicant CITY [-[ G1( l ZIP /! 80 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT Q !Z NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($I DO)or less.) TRACT I BLOCK LOLNO. MAP BOOK PAGE PARCEL OWNER J S/tN?/No x:286=765 USE ZONE MAP e/-7 I certify thai in the performance of the work for which this' NO. permit is issued, I shall not employ any person in any manner ' SPECIALt so as to become subject to the War eLs' ompens ion to s ADDRESS CONDITIONS Q: Dpte 3� �GApplica - r CITY WUL4 ZIP ARCHITECT OR TEL. NOTICE TO, APPLICANT: If, of mabjectt to Certificate of DISTRICT GRO P TYPE FIRE SSED By O Exemption, l ENGINEER NO. ^ p you should become subject to the Workers' ST. ZONE 1-- Compensation provisions of the Labor Code, you must forth- ADDRESS �� W with comply with such provisions or this permit shall be TEL D' deemed revoked. S TISTICAL CLASSIFICATION APT. CONDO. t/1 CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS IN (commencing with Section 7000)of Division 3 of the Business and IXLAELIC SEWER MAP Professions Code, and my license is in full force and effect. CITY LIC. . BK. PG. VALIDATION SO. FT. NO. OF NO. OF CHECK License Number tic.Class SIZE STORIES FAMILIES ONE ❑ VALUATION Contractor Dale DESCRIPTION OF WORK NEW $ 9" /)p0 0 1 am exempt under Sec. S l TIQ G� 5&4,P> ADD ❑ V ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF /�• EXISTING BLDG. ES, G 2A!!-(-' DEMOL ❑ Signature APPIICANi / �,( dNTEL.�p/�/,.y/ 7 (� ' OWNER-BUILDER DECLARATION PRINT J (/�I S�` T�d NO O(J /13 7 DATL I' y� I hereby affirm that.l am exempt from the Contractor's License LA�•A�' e S /L�pl.�', Law for the following reason (Section 7031.5, Business and ADDRESS FIN Pr es%ions Code): . PRESENTBy I, as owner of the property, or my employees with BUILDING ADDRESS wages ct their sole intended off will f o the work and ® t 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). REQUIREDTOTAL SETBACK F CONSTRUCTION LENDING AGENCY - SET BACK YARD HWY PROP. LINE WIDTH 29 1 3 5 A I hereby affirm that there is a construction lending agency for FRONT # • • •le a l� the performance of the work for which this permit is issued P.L. 1 I • * 49.88 (Sec. 3097, Civ. C.). SIDE P.L. • • • 49,88'0 Lender's Nome 1- - m - LOMA.ReE N •i - .• \ ` 'L`_.•.C 0309-88 t9 P.C. Fee$ Permit Fee - Lender's Address ""'"' '' " " ••?:._?1 I certify that I have read this application and state that the Issuance Fee LDMA P/C R• above information is correct. I agree to comply with all County Investigation Fee Com. ordinances and State laws relating to building construction, QQ' �_r r ' ,U,` j -.l •''`-`i and hereby authorize reipresentatives of this County to enter Total Fee n O O LDMA Perm. W i.i n 1 L " �•_. upon d e ab ve-mentio, ed pc ky 4•W inspection purposes. - SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date