HomeMy Public PortalAbout5447 HILTON AVE_Building__ APPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY BuiLDING ADDRESS
Department of County Engineer .—p
County of Los Angeles LOCALITY / `e 169 Cb 4p C,1, 4-w
WM. J. FOX. COUNTY ENGINEER �^'�/��
CASSATT D. GRIFFIN, SUPT OF BUILDING NEAREST
CROSS T. Det �V I
DISTRICT NO. GROUP SEWER MAP
FOR APPLICANT O L IN TYPE �\l/�'' PG
BUILDINGS II x� CONST. iV /fill
ADDRESS �.7�(•G�' MAP d STATE YES NO'
NUMBER �/'C/G/ o HWY
LOT NO. D BLOCK USEZONE SPECIAL
A .y'� u� CONDITIONS
TRACT I/n/"1 �Y�� (//,(}''/µ'
SIZE OF LOT_5(_-) XQ I NO Or BLOC .
NOW ON LOTS 6 BUILDING EXIST.
YARD HWY STREET NAME
USE OF SETBACK WIDTH'
EXISTING BLDG. FRONT
OWNER
(/�IIfYJ�4 SIDE I
MAIL P. L.
ADORESS ^
TC t+W/ TEL.. / � �
TEL. ` DWELL. I UNIT 5 INDUSTRIAL
CITY ee NO7 C'7[l 2 DUPLEX_UNIT 6 PUBLIC BLDG.
ARCHITECT OR
ENGINEER NO. 3 APT. UNITS 7 ADDN.,ALT.. ETC.
ADDRESS - 4 COMMERCIAL 8 MISCEL.
CONTRACTOR NO.
INSPECTION RECORD
ADDRESS o �_y2, -F�Ec�c FoJ FILL - SH 6AU
DESCRIPTION OF WORK
t'.n OP .Sar Rea.! IS ISS — T-cv o-1-+Lan SISe.�
EWJ ADD ALTER REPAIR DEMOLISH t-lo ¢rw¢C LI n•�.�T .n.. r.n FIS - SvG_war O
M FT. �/ NO. OF NO. OF 1 _
SIZE /:•�O STORIES FAMILIES 1L1
USE OF STRUCTUREn�•� •� �e LJ dI ..Ir L ._
SIGNATURE OF �I R1t''�,��
APPLICANT t _T ////��,�/// APPROVALS
ADDRESS DATE INSPECTORS SIGNATURE
/1-4 /1 O P C $ /5 FOUNDATION: LOCATION
1 T`I� �j O O FORMS. MATERIALS illl
®/ Q /7330 FEE l FRAME: FIRE STOPS, p^A�—
VALU�ION C (9 f 4�j p0 BRACING. BOLTS
FEE 3Z •� FURNACE: LOCATION,
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS GAS VENT, DUCTS
APPIS CORRECT
AND L AGREE TO COMPLY WITH ALL COUN YAND STATE THAT THEE ORDINANCES LATH. INT. /.+I 141GS� 1 f�L..---��'
AND STATE LAWS REGULATING BUILDING CONSTRUC-TION. LATH, EXT.
SIGNATURE OF / HOUSE NUMBER COR-
PERMITTEE / RECT AND POSTED CO/� ✓•."/..Y/�/rte.-- •�"
�/ vV _ U
ADDRESS
FINAL IL
VM. J. FOX. Cou TY F.NGINPm VALIDATION
.'%00,39.7,- FE8.10 1 6 15.0'0 j » jro2YO 4 3R wAR29 320-0 n
— DEPUTY ' -•^ DEPUTY
0
BY BY
0 DEPUTY DEPUTY
WORKERS' COMPENSATION DECLARATION r ,
hereby affirm that I have certificate of consent to selfAPPLICATION FOR BUILDING PERMIT
insure, or a certificate of Workers' CTION Compensation Insurance, r
or a certified copy thereof (Sec. 3800, Lab. C.) ' ;
'COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company '
BUILDINGd
❑ Certified copy is hereby furnished. - FOR APPLICANT TO FILLDINGL IN- ADDRESS 7 �l�-�`l 14 i L rO$4 /�V
fN ❑ Certified copy is filed with the county building inspec- ADDRESS I I L i C�M AV b TE/VL�(,E CZEY , C l7
tion department. /
Date Applicant CITY CM(ILE ZIP ( J u/ LOCALITY
NO. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT U D NOW ON LOT, C CROSS ST. d L L✓�
COMPENSATION INSURANCE ASSESSOR '0)
AAte`
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCE W
hundred dollars ($100) or less.) N�L L r5�� TEL 1-1449-15-
SPECIAL
L NO. USE ZONE MAP
I certify that in the performance of the work for which this t� I / 7f /� NO.
permit is issued, I shall not employ any person in any manner ADDRESS S I L'(-7 N«-/ ON AVL 1C `/ CONDITIONS O-
so as to become subject to the Workers'Compensation Laws. �" ff,, 0
CITY' Le Ct.7- ZIP (7P!/
Date Applicant ARCHITECT OR TEL. 0
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO, DISTRICT GROUP CONST. 'FE PROCESSED BY Q
Exemption, you should become subject. to the Workers' 300 - 2 >6{ V
Compensation provisions of the Labor Code, you must forth- ADDRESS 0 ✓ ✓ a
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. I CONDO.
Z
deemed revoked. CONTRACTOR NO.
LICENSED
CLASS NO. 652 UNITS_
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO' SEWER AP
(commencing with Section 7000)of Division 3 of the Business LIC. M
and Professions Code,and my license is in full force and effect. CITY CLASS. BK VALIDATION
SQ. FT. NO. OF / NO. OF CHECK
License Number Lic. Class SIZE STORIES I FAMILIES ONE '
EIUC L VALUATION
Contractor Date DESCRIPTION OF WORK �E 1'C12 Gr7 NEW ❑ �/
ADD $ ( OOUI r O D ►
❑I am exempt under Sec. �� GN �.' 7!! T� �G
ALTER
B.BP.C. for this reason (4(L OF r� M
2 662(470REPAIR ❑ $
Date: USE OF -
EXISTING BLDG. DEMOL ❑
Signature APPLICANT
(PRINT) NO� FINAL
OWNER-BUILDER DECLARATION DATE ,l•
Thereby affirm that I am exempt from the Contractor's License
Low for the following reason (Section 7031.5, Business and ADDRESS FINAL - —'} .�
Professions Code): PRESENT -. BY -
❑ BUILDING AGGT 1 _
I, as owner of the property, or my employees with ADDRESS - •�@ .. t 'T
wages as their sole compensation,will do the work and - - ,_ "ti i11� 0.75
the st{ucture is not intended or offered for sale(Section LOCALITY _ j __ -
48
70" Business and Professions Code.) MOVING TEL. pop
XI, os,owner of the property, am exclusively contracting CONTRACTOR NO.
with )h licensed contractors to construct the project (Sec- - ACCT.'
JYon 7044, Business and Professions Code.) ADDRESS ..." - ! F
REQUIRED TOTAL SETBACKFROM EXIST. �rt•4�'.•,' •" X07 212.04
CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LINE'• WIDTH ' ' '•f '
I hereby affirm that there is a construction lending agency for FRONTITEMS
the performance of the work for which this permit is issued P. -
(Sec. 3097, Civ. C.). SIDE -.t!»` TOTAL 270- 79
P.L.
Lender's Name •" ' -+ ' CHECK 270.79
$ . LDMA Ref:N
P.C. Fee$ Permit Fee -� CHANGE .UGI
Lender's Address
o I certify that I have read this application and state that the Issuance Fee a LDMA P/C N
a
S above information is correct. I agree to comply with all County Investigation Fee ..4 i O
ordinances and State laws relating to building construction, Toral Fee al 'T • LDMA Perm. N 001010-131301001010-131301I�I]1 11/25/92
a and hereby authorize representatives of this County to enter �][� 1 AM 9�14
aupon the above-me pro erty for inspection purposes. -
/rj/(/�iyr(/(�fQ/✓!f//�Y�J,,,j(/q SEE REVERSE FOR EXPLANATORY LANGUAGE 1
Signature of Applicant or Agent Date