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Home My Public Portal About9716 LEMON AVE_Building__ `76A686A DSS-3 12-54 APPLICATION FOR;, BUILDING, PERMIT DIVISION OF BUILDING AND SAFETY ADDRESS 2 :7/L2 I-�/J 0 A /°'1 JY'� Depwtment of County Engineer County of-Los Angeles LOCALITY & t:. WM.J. FOX, COUNTY ENGINEER NEAREST �r /ry'� CASSATT D. GRIFFIN, SUPT OF BUILDING ' CROSS ST. �� / .!/( FOR APPLICANT TO FILL IN DISTRIC O. GROUP TYPE ISEWER-, MAP G BUILDING �/ - S �, CONST. ADDRESS 9'7IG— r o � w MAP STATE wr <�N::O)HWY - NUMBER LOT NO. e" 1/ a,0Xe/ A1D_,' BLOCK USE ZONE SPECIAL - ' TRACT NO. OF BLDGS. SIZE OF LOT I NOW ON LOT BUILDINGEXIST. USE OF ' SETBACK YARD HWY STREET NAME -WIDTH EXISTING BLDG. ` yt ' FRONT OWNER A, " J,71SG� SIDE MAIL / P L.- ' ADDRESS Y� - - - - • TEL. $p DWELL. 1 UNIT 5 INDUSTRIAL CITY LN NJ I - - _ 2 DUPLEX-UNIT- 6 PUBLIC BLDG ARCHITECT OR TEL ENGINEER NO. 3- APT. UNITS 7 ADDN ,ALT., ETC. ADDRESS 4 COMMERCIAL 8 MISCEL. O TEL. CONTRACTOR ►1//t'L� NO. - INSPECTION RECORD - ADDRESS DESCRIPTION OF WORK NEW ADD ALTER ' REPAIR DEMOLISH _ - SI FT./` I4 STORIES FAMINO OF NO LIES - So �y�,J� . USE OF STRUCTURE - - SIGNATURE OF A r��O* _ - APPLICANT • if\!�'/'�/ APPROVALS ADDRESS / .� �/"(6rA 1 A�Fl - DATE INSPECTOR'S SIGNATURE P C S FOUNDATION LOCATION FORMS. MATERIALS - //y f "FEE FRAME FIRE STOPS, VALUATION S BRACING, BOLTS - � 7ss «UTLLCf..E�� f FEE L - FURNACE' LOCATION. - GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY-WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS EGULATING- BUILDING CONSTRUC- TION. �y q LATH. EXT. SIGNATURE OF // /� HOUSE NUMBER COR- _ PERMITTEE /A a�� - RECT AND POSTED_ ADDRESS � > � � FINAL wM: J. FOX. CouNry ENGINc,.r>R VALIDATION BY' •- - �:•_� '2:8-'2 4-AY APR 2 0 1 m - DEPU'I 2'0 0 DEPUTY BY BY ® DEPUTY DEPUTY DEPARTMENT,OF BUILDING AND SA g_ 195 COUNTY OF LOS ANGELES, BUIL ® ING 1 WM. J. FOX, CHIEF ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR GFFICE USE ONLY DISTRICT ND. PLAN CK. o �REo.No. PERMIT� BUILDING �/ f ' ADDRESS (7 REqFIVED BYE OF APPL. DATE ISSUED LOCALITY 2T 26 NEAREST CR0336T. BUILDING / �.r^ /G o l ADDRESS (p 'V OWNER MAIL LOCALITY ADDRESS NEAREST /J TEL CROSS ST. --T` CITY NO. FIRE I NO. DF ARCHITECT OR TEL. ZONE PLANS —Y J ENGINEER NO. SET ACK LINE / , ADDRESS USEAPPROVED TEL. ZONE BY DATE CONTRACTOR NO. � +� /HOUSE NUMBERING '•v ADDRESS MAP NUMBER y� NO. ASSIGNE BY LEGAL CORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT / ? NO. OF BLDGS. SIZE OF LOT I NOW ON LOT . USE OF NO. OF.,-a EXISTIN BLDG. FAmI LIES DESCRIPTION OF WORK A ADDITIZ NEW ALTERATION ON �� `��r r'f G7 _ D REPAIR DEMOLITION / r Sq. FT. / i 1 NO. OF SIZE i ROOMS STORIES EXT.WALL I ROOF •- ` COVERING COVERING USE OF STRUCTURE INSPECTION FOR APPROVALS OCCUPANCYAS _ I NSPECTOR'S SIGNATURE D �°. FOU ON:+LOCATION F S, MATERIALS ��...„�t. ., ..5'7 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN I5 CORRECT. BRACING, BOLTS �- i AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS - - SIGNATURE OF-"1 LATH, INT. PERMITTEE LATH, EXT. ADDRESS _ PLASTER, INT. AUTHORIZED AST. PLASTER, EXT. FEE' '�`_ HOUSE NUMBER COR- RECT AND POSTED VALUATION ?4AoQ FEE / FINAL 76A639A DSS 3 7-Sl WORKERS' COMPENSATION DECLARATION r affirm that I have certificate of consent to self A P P L I CAT I O N � F O R: BUILDING_ P E RM I T • a certificate of Workers' Compensation Insurance, or t ifiieddccop�y thereof (Sec 3800, Lab C ) �a COUNTY OF LOS ANGELES " ' BUILDING AND SAFETY Policy Company 1 Certiflad copy is hereby furnished FOR APPLICANT TO FILL IN gppREss -' LJzJ , Certified copy is filed wigcobuil i g inspec- BUILDING- ; tion department. - AD DRESS /�r Date "�� Applicant JA IJ� CITY, �/ ZIP LOCALITY _ O OF BLDGS C NEARSS EST r 'CERTIFICATE OF EXEMPTORKERS' SIZE OF LOT 5'L NOW ON LOT COMPENSATION INSURANCE' ASSESSOR (This section need 'not be completed if the permit is for one TRACT', BLOCK LOT NO MAP BOOK - PAGE PARCEL hundred dollars ($100) or less ) TEL USE ZONE MAP s m " OWNERnAM NO NO 'I certify that , the performance of.the work for which this, �(� -permit is issued, Iahall not employ any person in any manner ADDRESS' 21L i�V V �� SPECIAL a} CONDITIONS so as to become subject to the Workers'Compensation Laws .O CIN ZIP U Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT. If, after making this Certificate of ENGINEER .,NO / CONST ZONE U Exemption, you should become, subject to the Workers, . \ / t=� Compensation provisions of the Labor Code, you-must forth- ADDRESS �� / a with comply with such provisions or this permit, shall beTEL 7 STATISTICAL CLASSIFICATION APT CONDO to deemed revoked CONTRACTOR NO { Z , LICENSED CONTRACTORS DECLARATION,- (]k LIC 7� CLASS NO DWELL UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 - ADDRESS46C4 L NO f (commencing with Section 7000)of Division 3 of the Business LIC SEWER MAP and Professions Code,and my license is in full force and effect CITY CLASS BK PG VALIDATION SQ,FT NO OF NO OF CHECK License Number �J Lic-lass' - SIZE STORIES FAMILIES ONE VALUATION Contract u Date DESCRIPTION OF WORK NEW - 1:1 $ Q er I am ex 'Sec 6� ADD y Elempt u n d poll. •• - - ALTER El B&P C for this reason " REPAIRUSE ❑ s ate EXISTOING BLDG 8 - DEMOL ❑ Signature APPLICANT - TELp,��pp FINAL O NER-BUILDER DECLA TI N (PRINT) V NO 'O x DATE', I hereby affirm thcF#I am exempt from the Contractor's License Law for the following reason (Section`7031 5,,Business and ADDRESS d FI'NAL.d-zp1 _ Professions Code) PRESENT B /�''�`"�� ;�! a BUILDING A!I, as owner'of the property, or my employees with ADDRESS El -'N �t� �n�`�•�!i4 wages as their sole compensation,will do the work and F LOCALITY �}� �• +•'J�7U� 21t�d.O,S the structure is not intended or offered for sale(Section 'l '+ )t .� `• ' t 70", Business and Professions Code ) MOVING , • TEL , - `• 1'. j 4 • 4' I�� CONTRACTOR NO ��f f .+ ❑ j, as owner of the property, am exclusivelypcontra(ting + -` = TOTAL 218.63 --With licensed contractors to construct the project Sec- EADDI x tion 7044, Business and Professions Code ) �g/�/-1 ++•�� pp �� TOTAL SETBACK FROM` EXIST * _ 1rf1G4R i'10oQ:r CONSTRUCTION LENDING AGENCY YARD HWY PROP LINE WIDTH` \ �• :��'" ti �•y I hereby'affirm that there is a construction lending agency for _ - , i • ' `> ?, 'G .00 the-performance of the work for which this permit is issued - (Sec 3097, Civ C ) - + ��1��tqry�'_n�-nn 1 -a! `7 n" Lender's Name St►tJ+ ttlrVl r! 1�a7 LDMA`-Ref # ` 4 1 -AM 9:39 � Permit Fee rLender's AddressI certify that I have read this application'and stare that the Issuance Fee d �� LDMA P/C#above information is correct I agree to comply with allCounty e s ordinances and State jaws relating to building construction, Total Fee LDMA Perm # t an he rati s of this County-to enter u pe t for inspection purposes a 1 SEE REVERSE FOR EXPLANATORY LANGUAGE _ ent Date -