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HomeMy Public PortalAbout9584 KENNERLY ST_Building__ DMSION OF BUUI)ING AND SAFETY - Department of County Engineer County of Los Angeles WM. J. Fox, COUNTY ENGINEER APPLICATION BUILFOR APPLICANT TO FILL IN ADDRESS �, ` , , v\Y�r- u BUILDING _ 1/ LOCALITY ADDRESSNEAREST (� CROSSLOCALITY ST. V P_II" l4 �' DISTRICT NO. PLANCK. OR Rbc NO. PERMIT NO. CROSS STNEA . e - (, O OWNER7 L/C.'. /aTT RECCE/I�V,tMAIL ,ED 13YY DATE OF APPL. DATE ISSUED ADDRESS J � ZL F C�(JLD/LJ'�- U �`Y` /` ��I1�� - � - I)-S USE ZONEj NO OF TYPE I GROUP I FIRE ZONE' C TEL. / ^ ' PLANS J CITY J � NO (D {•}y��r. , - ' ARCHITECT OR TEL �oOn\ ZONING - - DATED ENGINEER NO c APPROVED BY- CLP-",a BUILDING1 RD.No. ADDRESS SETBACK LINE © �'��-` i 1 1 Cd,1. V' TEL. APPROVED DATE CONTRACTOR By 1 HOUSE NUMBERING i ADDRESSLEGAL 1 MAP NUMBER �n ASSIGNED BAB�btm1 DESCRIPTION LOT NO BLOCK DATE I _ CORRECTIONS I INSPECTOR 7 TRACT �/// SIZE OF LOT S 7/1 17 NOW ON LOTSUSE NO _ EX STOING BLDG F MIOLIES I I 0 DESCRIPTION OF WORK - z RE IR I ALTERATION ADDITION r DEMOLITION i SQ FT NO OF SIZE O //'�//^^�� ROOMS STORIES / EXT RING vc�c.{J I COVERING OOF�� COVERING COVERING G� USE OF STRUCTURE _ APPROVALS INSP,ECTOR'S SIGNATURE J DATE C/ FOUNDATION LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME. FIRE STOPS, CORRECT. PLICATION AND STATE THAT THE INFORMATION GIVEN 18 BRACING, BOLTS v _ _ I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS 7y SIGNATURE OF lq'- C, fi�G1 /O f LATH, INT /J / PERMITTE 777...��� LATH, EXT. ADDRESS AUTHORIZED AGT. PLASTER, INT ^ / / a _ PLASTER, EXT /B �6 FEE* 7�qa-o- -HOUSE NUMBER COR-`JRECT AND POSTEDVALUATION -FEE FINAL 76ASSSA OBe S 2-5S TEMPLE CltV 76AE30A CE#803 "1`. APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT _OF COUNTY ENGINEER ADDRESS - BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUPT OF BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTR CT NO GROUP TYPE SED BY " O b CONST BUILDING //�s'�[ STATISTICAL CLASSIFICATION 79'EER MAP ADDRESS /� /�//{/ K G CLASS NO DWELL UNITS ' LOT NO BLOCK WATER CERTIFICATE NOT REQUIRED RECEIVED TRACT N / SIZE OF LOT 6O X I NOW ON LOTS , A / I(CIRCLEI IGHWAY STATE MAJOR SECOND, OCA SPECIAL USE OF //JJ �i��a U /\ / E CONDITIONS EXISTING BLDG /�� IDp/uv /�` - /� TEL OWNER a C NO T BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT 20 ARCH ITEC-r OR TEL P L J ENGINEER SIDE ' P L - � ADDRESS a _ TEL INSPECTION RECORD Ov CONTRACTOR NO - , j gx ADDRESS 7V� C - `- -Q DESCRIPTION OF WORK _ Y R NEW ADD ALTER REPAIR DEMOLISH ��` Z SQ FT- NO OF NO OF da'"f3F IZE STORIES FAMILIESUSE OF f/ STRUCTURE AVAED -- SIGNATURE OF APPLICANT I• VALUATION APPROVALS DATE A INSPECTORS SIGNATURE PC PMT FOFORMS!ON NG.® � gi41�-r FEE $ rte— FEE $ � - MATERIALS 1 FRAME FIRE STOPS, J I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHOR' E ZED HEREBY I WIL NOT EMPLOY A PERSON IN VIOLA. LATH,INT P TION OF THE LABOR CODF THE ALIF RNIA RELAT /y n JNG TO WORKMEN S C MP NSATI I RANCE LATH,EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEF7 RECT AND POSTED nn// ADORES FINAL CLYDE N DIRLAM, PRINCIPAL STRUCTURAL a6GI E R PLAN CHECK VALIDATION CK. M O. CASH PERMIT VALIDATION cK. M H i, 5 8 4 8'D- a! 7 G Ct q WORKERS' COMPENSATION DECLARATION +- I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, 'APPLICATION FOR BUILDING PERMIT or a certifies! copy thereof (Sec 3800, b C ) COUNTY OF LOS ANGELES i _` , BUILDING AND SAFETY Policy No company ❑ Certified copy is hereby furnished J_�—�aFOR APPLICANT TO FILL IN" OUILDINGADDRESS - I ❑ Certified copy is filed with the county building inspec- BUILDING Air, tion department ADDRESS Doth—T47�`APPlica t• CITY " ZIP LOCALITY CERTIFICATE OF EXEMPTIO 00 ORKERS' O OF BLDGS, NEAREST - SIZE OF LOT �' NOW ON'LOT CROSS ST "COMPENSATION INSURANCE r ASSESSOR " (This section need not be,completed if the permit is for one TRACT - BLOCK LOT NO MAP BOOK w PAGE PARCEL _ hundred dollars ($100) or less ) 3-- ' • TEL OWNER NO _ USE ZONE MAP I certify that in the performance'of'the work for which thisir NO a permit-is,issued, I shalfnot employ any person m any manner ADDRESS SPECIAL CONDITIONS so as to become subject to the Workers,Compensation Laws O ' . CITY4'444 ZIP _ U { Date Applicant ARCHITECT OR V r TIEL DISTRICT GROUP_ TYPE FIRE PR Y NOTICE TO APPLICANT If, after making this,Certificate of ENGINEER NO CON ZO 0 Exemption, you should become_ subject to'the Workers' � iU Compensation provisions of the Labor Code„you must forth- ADDRESS 1'o 8 le � as with comply with -such,provisions or this permit.shall be TEL STATISTICAL CLASSIFICATION APT deemed revoked _ CONTRALTO _ NO � Z LICENSED"CONTRACTORS DECLARATION LIC CLASS NODWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRES NO , (commencing with Section 7000)of Division 3 of the BusinessLI SEWER MAP;. CITY • and Professions Code,and my license is in full force and effect q_, p/ CLASS L BK PG VALIDATION SQ NO OF NO OF CHECK License Numbe-`��R'3 Lic Cla SIZ STORIES FAMILIES ONE ' VALUATION DESCRIPTION Contractoe �;i /'fes L Date��y" DESCRIPTION OF WORK d NEW ❑ $ j 7 4D g "ADD LJ❑ ► ; 1 am exempt under Sec t��GS R P 0 — — ALTER ❑ B&P C for this reason REPAIR_❑ a USE OF Date EXISTING BLDG- » DEMOL'`❑ Signature APPLICANT TEL _ -_ FINAL OWNER-BUILDER DECLARATION (PRINT) NO . DATE I hereby affirm that I am exempt from The Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS» FINAL t Professions Code) ` , PRESENT _, - By. ❑ I,-as owner of the property, or my employees with BUILDING ADDRESS wages as their sole compensation,will do the work and the structure is not intended or'offered for sale LOCALITY(Section 7044, Business and Professions Code") MOVING TEL y ❑ 1, 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 ) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST _ CONSTRUCTION LENDING AGENCY SET BACK PROP LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT r the'performance of the work for which this permit is issued PL - (Sec 3097, Civ C ) SIDE P L r I Lender's Name .T _ T, LDMA-Ref 4 J P C Fee$ Permit Fee - Lender's Address- 1 ddress 1 certify,that I have read this application and state that the Issuance Fee = ` LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee ordinances and State jaws relating to building construction, Total Fee / LDMA Perr4 #”' a _ and hereby authorize representatives of this County to enter upon the above-mentioned`property'for inspection purposes ?,L .'` V,I ' ;IL_ el ��/ + SEE REVERSE FOR EXPLANATORY LANGUAGE -,;� -F- nn ig u of pp rt or Agent �� /Date