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HomeMy Public PortalAbout6021 IVAR AVE_Building__ -�'&777,47eC-7 C r p 76A 638A CE#803 8-63 APY®LIGATION FOR BUILD IG PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS' BUILDING AND SAFETY DIVISION LOCALITY TG. JOHN A. LAMBIE, COUNTY ENGINEER' NEAREST �K -WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN G+ 1 ` CONST. . BUILDING STATISTICAL CLASSIFICATION SEWER MAP //////+++++� ADDR SS' O .l� BKMPGy� . TTT CLASS. NODWELL. UNITS // NO. / BLOCK WATER CERTIFICATE:. NOT REQUIRED ❑ RECEIVED ❑ TRACT Q MAP10100HC(CIRCLE) IGHWAY STATE MAJOR SECON OC O /I�� NO.OF BLDGS. NO. SIZE`OF LOT NOW ON LOT Z USF,ojiONE SPECIAL USE OF, CONDITIONS EXISTING G. e TEL. OWNER NO. LDING YARD HWY STREET NAME EXIST. ADDRESS �Q 0 SETBACK WIDTH FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. ADDRESS TEL. I Z•-lc�Ca-`7 iT - ��9 O CONTRACTOR NO. ADDRESS - v ~/� -- o DESCRIPTION OF WORK �� firU d4uc u / NEW ADD ALTER - REPAIR DEMOLISH IIA SQ. FT. NO. OF NO. OF ,I d-ot. 6 01 USE SIZEO ` STORIES FAMILIES ® S .a STRUCTURE -` 14 rd - A � 9 SIGNATUREOF / l •'-7�I.00t ! �FiLfif'f'+ �V(fl�T if� l, /! /l APPLICANT G a' � - f _ VALUATION $ //✓/ r 0747./AAIIL `�it�AlUfll ��p ,. APPROVALS j� DATE INSPEC1,0%S SIGNATU RE P.C. PMT. (oYO FOUNDATION: LOCATION �. f FEE $ FEE $ / FORMS, MATERIALS FRAME: FIRE STOPS. B ,I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION RACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. r WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS _ BUILDINGCONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 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 COMPENSATION INSURANCE. I LATH. EXT. ' SIGNATURE OF/ � L?u[i`"�V �' vv HOUSE NUMBER COR- PERMITTEE ��// / RECT AND POSTED _ ADDRESS �(Q1J.Z-L,J�� �j"e FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGI.NEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH LAL;o 9 6-1142 FZ JUL-19 D. 1 2:0 0 .. T• pi' Bp y^� _ - '}.^� �,pp fp' n yip, ' �^y q��•p/�p 11-5.5 ADB9.8` /61P0 l>=11CATION 0011 .BUILDING ILDING 0 ER F/II���.. � DIVISION. OF BUILDING AND SAFETY.. BUILDING ®gZ V� - A'DDRESS'• Department of County.Engineer County of Los Angeles LOCALITY O JOHN A. L'AMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST.. DISTRICT NO GROUP SEWER' MAP FOR APPLICANT TO FILL IN TYPE G ,,ee�� CONST. BUILDING -•�� . '' NUMBER W' STATEYES HWY - ADDRESSMAP O LOT NO. SLY BLOCK USE ZONE SPECIAL CONDITIONS . TRACT, 0.1 / v t NO.OF BLDGS. 4 SIZE OF'LOT O' I NOW ON LOT gU1LDING YARD. HW.Y STREET NAME .EXIST. USE OF. SETBACK WIDTH EXISTING BLDG. - FRONT w� r a OWNER , P Y OO N P. L. a �/ SIDE MAIL 6ri � f� ADDRESS .66 �> (� ' A-/\ O TRACT DWELL. .*I UNIT TEL. . 5 INDUSTRIAL CITY �. C DWELL1 UNIT f NO. / e. 6 PUBLIC BLDG. P ARCHITECT ORTEL.. •Z DUPLEX. 2 UNITS ADDN.,ALT., ETC. ENGINEER - O• 3 APT. UNIT - 8 MISCEL. ri ADDRESS 4 COMMERCIAL ' L CONTRACTOR NO. INSPECTION RECORD ADDRESS _ 6` G' � WAVY --S / /' v/ ©.A DESCRIPTION•.OF MORS NEW ADD ALTER,' - REPAIR-. DEMOLISH �•ft=C/f;. ,• , SQ.-FT. NO. OF NO. OF 7 /ems SIZE STORIESFAMILIES ' U E R RE R SIGNATURE O _ APPLICANT APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE , ' e OUNDATION: LOCATION / r P.C. $ .FORMS. MATERIALS (7 �i,7. •• FEE FRAME: FIRE STOPS. - ! VALUATION BRACING. BOLTS _ .• FEE. FURNACE: LOCATION, , 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT. DUCTS APPLICATION AND STATE THAT.THE ABOVE IS CORRECT _ AND AGREE TO COMPLY.WITH ALL COUN Y ORDINANCES LATH. INT. AND STATE. LAWS R ULATIN BUIL G CONSTRUC- TION. .I LATH. EXT. �2V�5�6 � SIGNATURE OFOR #1 4LA HOUSE NUMBER COR- ' PERMITTEE f.RECT AND POSTED ADDRESS FINAL �daO.-S(�i.. A/,' JOHN A. LAMBIE, COUNTY ENGINEER•. VALIDATLCM, CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR. CK • MO H . o'4 7.�? h1nIY 8. �� In 4880537 PB WORKERS' COMPENSATION DECLARATION I hereby affirm that I havecertificate of consent to self AP P U `�—L/11�'�© ®�' insure, or a certificate of Workers' Compensation Insurance, l� (✓ f or a-certified copy theieof (Sec. 3800,.Lab. C. COUNTY OF LOS ANGELES �UILDIPlG AND SAFETY Policy No.W0007146.Company'Beaver Ins. Certified copy is hereby furnished. FOR APPLICANT TO,FILL 1N BU LDING ADDRESS ❑X Certified copy is'filed with the county building inspec- BUILDING tion department. ADDRESS 6021 N• Ivar .Ave. Date 7-1-89 ` Applicant Vir; in Roof Co. CITY Tem le• Cit 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 is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO: MAP BOOK PAGE PARCEL ' TEL. I certify 114ot in the performance of the work for which this OWNER Edward DeNOOn NO. USE NE OP permit is issued, I shall not employ any person in any manner SPECIAL Q' so as to become subject to the Workers'Compensation Laws. ADDRESS 60.21':N.> Ivar Ave.. !� CONDITIONS "' C.1 Date Applicant.` CITY .Tem le -City ZIP. ,91780 - NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GRWP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER NO CONST. ZONE LU Compensation provisions of the.Labor Code, you must forth- ADDRESS with comply with such provisions or.tf is,-permit shall be TEL. z deemed revoked. CONTRACTOR Vir in'Roof Co. NO.287-0507 STATISTICAL CLASSIFIC TION APT. O LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.. • DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ' P':0. Box J NO. 160650 (commencing with Section 7000)of Division 3 of the-Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY San :Gabriel " CLASS '1030 BK VALIDATIOW SQ. FT. NO. OF NO. OF CHECK License Number 160650 Lic.Class C39 SIZE 19 S s. STORIES IFAMILIES ONE DESCRIPTION OF WORK Tear, off 2 WOOd NEW ❑ VALUATION Contractor Virgin Roof. CO'. pate 6-30-89 ADD $ 7000.00 am exempt under Sec. roofs then :apply plywood .& 4430 ❑ D ALTER ❑ B.i3P.C.'for this-reason Class A Fiberglass Shingles. REPAIR ❑ $ , Date: USE OF ' EXISTING BLDG. Dwelling DEMOL ❑ Signature APPLICANT TEL. FINAL PRINT Virgin •Roof Co. TEL. DATE - OWNER-BUILDER DECLARATION �� •�� ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason.,(Section 7031.5, Business and ADDRESS P.O. BOX J San Gabriel, 91778 FIN Professions Code) PRE ENT sy BUILDING f- ❑ 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and a " 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. with licensed contractors,to construct the project (Sec ADDRESS tion 7044, Business and Professions Code), x REQUIRED TOTAL SETBACK FROM o 0 0.9 7 5 cv CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 2 1 64c'8 8 .I hereby affirm that there is a.construction lending agency for. FRONT the performance of the work for which this permit is issued P.L. (sec. 3097, Civ. C.). SIDE P.L. Lender's Name ° P.C. Fee$ Permit Fee. $86.25 LDMA Ref. N Lender's Address D 3 I certify that I have read this application and state that the o Y PP - - Issuance.Fee 10:-50 LDMA P/C q g above information is correct. I agree to comply'with all County Investigation Fee . 0 ordinances and State laws relating to building.construction, o and hereby outhorize'representatives of this County to enter Total Fee 96.75 LDMA Perm. # upon the above-mentioned property for inspection purposes. `0 11-1-88 SEE REVERSE FOR EXPLANATORY LANGUAGE ture of Applicant or Agent Date