HomeMy Public PortalAbout6212 IVAR AVE_Building__ '�- 76AC98A._C_E0803 3-68
APPLICATION FOR BUIL® G P[cPM of
COUNTY OF LOS ANGELES BUILDING,
DEPARTMENT-OF COUNTY ENGINEER ADDRESS A-/ Ll,'--
BUILDING AND SAFETY DIVISION LOCALITY .
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W—JENKINS, SUPT OF BUILDING NEAREST
CROSS ST..
DISTRICT NO._ GROUP TYPE -� P E D BY
FOR APPLICANT TO FILL IN CONST. _
Print ort a only) _� J 1
BUILDING - STATISTICAL CLASSIFICATION. SEWEe MAP,
ADDRESS [p / flZ Ll/S CLASS NO.- DWELL,UNITS BKk PG r ,
LOT NO. BLOCK USE ZONEMAP
+� NO.
TRACT (9 /I- / -SPECIAL -
NO.OF BLDGS. LI �✓l( CONDITIONS
SIZE OF LOT Q / NOW ON LOT 40 N _
USE OF
EXISTING BLDG. BLDG.SETBACK FROM
(1 TE FRONT PROP.LINE OF (STREET).
OWNER L� (J G GNO. S�S� TYPE OF EXISTING SETBACK HIGHWAY -+ YARD' _ =TOTAL
ADDRESS (p HIGHWAY`WIDTH
FROM C.L.
CITY
BLDG.SETBACK FROM
ARCHITECT OR Z TEL. SIDE PROP.LINE OF (STREET)
ENGINEER NO. _
TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS - HIGHWAY WIDTH FROM C.L.
TE
CONTRACTOR Q(,v - NOL' + - o
LIC.
ADDRESS NO. CORNER CUTOFF YES ❑ NO ❑ V
LIC.
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS
U
DESCRIPTION OF WORK
cn
z
NEW ADD ALTER REPAIR DEMOLISH
SO. FT., NO. OF > NO. OF
SIZE C7 Q STORIES / FAMILIES. -
USE OF
STRUCTURE 6- A . . .y
SIGNATURE OF'
APPLICANT
VALUATION $� �
ffffff APPROVALS DATE IN P CTOR's SI NATURE
P.C. PMT. 7 . ✓ FOUNDATION: LOCATION
FEE$ FEE$ / �,. FORMS: MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY FURNACE: LOCATION, V
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK ,
'AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- '
TION OF TME LABOR CODE OF THE STATE OF CALIFORNIA RELAT- LATH, INT.
ING TO WORKMEN'S COMPENSATION INSURANCE. - .f
LATH, EXT.
SIGNATURE OF � HOUSE NUMBER COR- S
PERMITTEE. - RECT AND POSTED
ADDRESS FINAL G
JOHN F. LEWIS. PRIN TRUCTURAL ENGI R
PLAN-CHECK VALIDATION CK. M.O. CASH _ PERMIT. VALIDATION CK. M.O. CASH
l r 9 6 1 4'10' APR28 I Q ' 17.25-
WORKERS' COMPENSATION DECLARATION °° K 4' .• f i :: ��`
.I hereby affirm that I.rhwie a certificate of consent'to'self O
insure, or a certificate of Workers' Compensation Insurance, � D� D CL/��O O : d DD Q�� ,
oe a certified copy,Thereof (Sec: 3800 Lab. C )
COUNTY 00= LOS;ANGELES BU LDIRIG AMD SAFETY.
'Policy.No Company - ._ . =� - t_-
�Certified copy hereby furnished ,. -FOR APPLICANT TO FILL.IN +BuaDING
ADDRESS Lj
`Certified copy is'fil•ed with the county buil'di'ng inspec- -- BUILDING''
tion depar'tment.' ADDRESS
-. .• t '. 3i •,. ..- .. t E.,' 4 �.� ,-_. .- .. , -_ _ _. .... � :.,_ :__.,..- /�.fir .._ _'. _ _.. _.__ i
Date '- z -A'pplicant'.; s.r i , ., ,4 ':. S r f CITYLOCALITY
ZIP C�,7 /`�'
CERTIFICATE OF"'EXEMPTION FRONT WORKERS'a NO'.•OF.,BLDGS NEAREST /.� -• -
-r'
• - COMPENS'ATIONk'INSURANCE
„,. .,, SIZE OF LOT, NOW.ON LOT' CROSS.ST• ,
(This section need not'be completed if the permit'is for:one _ _:.- a,... .. _ ___ _ ASSESSOR. ;,
hundred dollars $100 or less„ TRACT ' BLOCK LOT NO.. t MAP,BOOK �` PAGE; PARCEL
( ) ) .c' .'
I (; ,'•_. OWNER. :. G�%V _, y,e�/ s�-:�G NO '1 �+ Uil USE'ZONE MAP L.
I certify That in the`peiform'6ce of the work for which.this O. }
E
N �
--
9F 6'
issued, I shall not *1" a; in any.manner 2, ^,' "; JAL IL
so as to become`subject't6#fie'Wg rs`Compensation Laws. ADDRESS- Z� " '.',v V ,1 CONDITIONS f
Date J / APPlicant t���.' CITY- �'�1. :
ARCHITECT OR TEL. I PRO
NOTI TOtAPPLICANT: lf, afte makin 3his:Certificate,of ENGINEER NO, - TRI OUP_ E,,-I_. _ FIRE ED BY . .-
Exemption you should become` subject to the`Wofkers' f_ UA
UA
Compensation provisions'o£the Lbbor'Code;ryou must forth- ADDRESS Joe d
with comply with"`.:such provisions ,or,this•,permit shall be -- :-- :-
CONST i ZONE
s - - TEL. STATISTICAL CLASSIFICATION - APT CONDO (.�
deemed revoked. .:� , ,:'. - �H�, °4,5 CONTRACTOR r _
ONT .•- NO.,
LICENSED CONTRACTORS DECLARATION• lw s- - - LIC.' - CLASS NO. DW
ELL' UNITS
I'hereby affirm that lrgm licensed-under.pcov,isions of Chapter 9 ADDRESS NO. : t
(commencing with.Section 7000)o'f*Division'3,of the Business and - _.:.F: -LIG-= --
_., k
Professions Code, and my` license is in full,'force'and effect CITY CLASS SBKE PG" VALIDATION'
. ._ - NO.OF OF a CHECK - --- c,
License Number ' Lic.Class
STO O
SIZE RIES F' 1LIES NE
.a .a. •-r: - - ,•,, DESCRIPTION-OF'WORK - NEW- _ LVAL
)Contractor Date- ao ,UATIONI am exempt under Sec. ADD` D
B.BP:C. for this reason $ -
ALTER t,
- REPAIR
Date: , USE OF
DEMOL
, .. EXISTING BLDG. i-. ,� ,'.- _ ❑ a _ >_�.� ._
Si nature APPLICANT' _ STEL. i ?
9 _. .• FINAL° t
s OWNER-BUILDER.DECLARATION (PRINT) NO..
'. DATE..
-I hereby affirm that I•am exempt from the•Contractor's License
Law for the followjng;reason`(Seetion 7031: Business and 'ADDRESS FINAL' "
Professions'Code) „ . PRESENT
aBUILDING - _
1, as owner of the properly, or my employees with ADDRESS t o g 7 911 A
wages os their sole compensation will do the work and
..
the structure is not intended or,offered for sale(Section LOCALITY # `
_....
7044, Business and Professions:Code),' �` : MOVING
D
I;,as owner of the: ro ert am ezcluSivel contractin CONTRACTOR
❑ .. P P Y, v 9 - ..... " rYrIG 2',m"?.9:x.7 5
NO
with'•licensed'contractors to`construct the'prolect.(Sec- "..
ADDRESS
_-..
tion 7044, Business and Professions Code). `n ,p
QUIRED YARD-" HWY"' TOTAL SETBACK.FROM . -EXIST. _ 0Cr� Su: o
CONSTRUCTION LENDING AGENCY u' SET BACK PROP. LINE': WIDTH..
hereby affirm that there is a construction lending agency for FRONT
the perforrimance"of,.the-work-for which this permit is=issued . P:L'.-- - 4 - - -- -
j-=dl �l1 o 3, 1 9 }.
(Sec. 3097; Civ. C..)-. SIDE y( ' r
P.
Lender's'-Name
o LDMA Ref. #
m _ - t
PfC. Fee$, -�-_- -- .'Permit. Fee
� .
Lender's Address
I.certify.that I.hav6..read.,this.application.and state.thatthe -- _-•- - ,_- »' Issuance-Fee'-. -.-`v i- -- LDMA;P/C'#-
Q above'information is correct. I agree to comply with all County Investigation Fee
0 ordinances and State laws relating to building.construction, «_-
m 9 ,9 Total Fee " LDMA'Perm. # -
r
U
and hereby authorize'representatives of this County to enter
upo above-mentioned property for inspection purposes.
��r{ /, V SEE REVERSE FOR EXPLANATORY LANGUAGE i
^, —LAG.
" - Signat a of Applicant or-Agent-� -.- Date