HomeMy Public PortalAbout9722 LIVE OAK AVE_Building__ J
CITY or, MIPIE CITY
76.638ACE#00x9-60 APDL ]CA`I"ION FOR BUILDING PERMI
COUNTY OF LOS ANGELES - BUILDING )
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALI
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING -CROSS ST
DISTRIW NO. GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN CONST
BUILDSTATISTICAL CLASSIFICATION SEWER MAP '
• ADD EISS NG — 9722'Live O" / K PG
CLASS NO LDWELL UNITS
LOT NO A' 4 r e' ZIBLOCK, MAPrSTATE YES 'NO
A—MBER�� O 'WY
TRACT iiission View aces E ZONE
SIZE OF LOTSum I NO OF BLDGS � COND TI ONS
NOW ON LOT
USE OF
EXISTING BLDG Dwelling 'BUILDING EXIST-
YARD HWY STREET NAME
OWNER Carl Le i'Ioore NO AT 1020 SFRONTK WIDTH
ADDRESS 2501- athaway,,Alhambra P L
H -�
SIDE
ARCHITECT OR none TEL P L
ENGINEER NO INSPECTION RECORD,
}
AL
ADDRESS ,L �Or 6Qt�J�a 1�p. O
CONTRACTOR Santa Anita Const NO AT 7974 �` seas,c r u
x717, L, Las Tunas,,San Gabrielv �o a �� r, e P G/ se" rte- ad
a ADDRESSA Q
DESCRIPTION OF WORK �� ���
a
• NEW-UL AD/D, --ALTER REPAIR DEMOLISH Z
SIZE
rC)IJUt.NO OF NO OF
SO T11 i 4 A STORIES 1 FAMILIES 1
' nn_
USE OF - I. 7/(� ^� 0 -0-•"<� �c
STRUCTURE elf
Dwelling L. Attached' Gara e
--
SIGNATUR t
APPLICANT
VALUATION$
_ APPROVALS 1-/DATE 'INSPECTOR'S SIGNATURE
F E �• FEE $ d� FO FORMS, MATERIIALSUNDATION ON
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 I CERTIFY THAT IN THE PERFORMANCE -- .
OF THE WORK.FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT. LATH, INT �9p�
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT _
TO THE WORKMEN S COMPENSATION LAWS OF CALIFORNIA
LATH, EXT v�
SIGNATURE �, HOUSE
RECTANDPOSTEDCOR-
PERMITTE e tl /(lXI) �JN//w
-
ADDRESS FINAL I T1 1A yI9
PLAN CHECK VALIDATIONG M O. CASH CLYDE PERNIIT VALIDATION Z.�-
RFALC ENGINEER'
r -
(� c 9 3 4 4 JUIN 2 3 D 2 1. .0 U
9 6 9 3 JUL 7 1 D L(. .C� r:
41�Cl
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self LI v L/1111 M C A U TO M FOR BU R O N S P E RvUinsure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof-(Sec 3800, Lab C') COUNTY OF LOS AWGELE`8^• BUILDING AND SAFETY
Policy No Company
BUILDING
-❑ Ceritified copy is-hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified'copy is filed with the county building inspec- BUILDING
tion department ADDRESS
Date y Applicant CITY ZIP, LOCALITY
NO,OF BLDGS NEAREST '--
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST
COMPENSATION INSURANCE'- ASSESSOR,
(This section need not be completed if the permit is for one TRACT, BLOCK LOT NO ' MAP BOOK
TEL PAGE PARCEL
hundred dollars ($100)or'le"ss )
OWNER NO USE ZONE MAP
I certify that in the.performance'of the work for which this NO
permit is issued, I•shall not employ any,person in any manner ADDRESS CONDITIONS SPECIAL" CL O / d
so as to become subject To the Workers'Compensation'Laws - O
CITY' ZIP U
Date Applicant D ARCHI ECT O TEL DISTRICT GROUP TYPE FIRE ` PROCESSED BY �
NOTICETNT If, after make g this Certi rate of ENGINEER• NO O
Exemption, you should become subject to the Workers' CO ZONE U
Compensation,provisions of the Labor 'this
must forth- ADDRE
with comply with such-provisions-•or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO N
deemed revoked CONTRACTOR NO
Z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO e�/ :DWELL,UNITS
Phereby-affirm that I am licensed under provisions of Chapter 9 ADDRESS NO G110
SEW
(commencing with Section 7000)_of Division.3-of the Business ER MAP,
and _
Professions Code,and my license is in full force'and effect CITY LIC CLASS �f' BK PG VALIDATION
SQ FT' NO OF NO OF C HECK a
License Number 0-0 312 Lic Class C, SIZE STORIES FAMILIES ONE
- VALUATION • ' '
Cyritrdctor 0 Date DESCRIPTION OF WORK NEW s A_ B ,
V�/q� 'ADD ❑ ! _
I am exempt under Sec e
ALTER ❑
B.BP C for'this reason1414
i REPAIR ❑
Date USE OF
EXISTING BLDG - �DEMO[ ❑
Signature APPLICANT TEL FINAL
OWNER-B LDER DECLAJf0N (PRINT) ON �NO I hereby affirm that I am exempt from Contractor's License / DATE
Law'for the following,reason (Sectio31 5, Business and ADDRESS V FINAL" 1
Professions Code) - PRESENT By ACCTos =
BUILDING
❑ I, as owner of the property, or my employees with ADDRESS ° ���� " 125.55
wages as their.sole compensation,will'do'th6 work'and , -
the structuress not intended or offered for sale(Section - LOCALITY D1 ITEMS-
1, ONTRACTOR NO
7044, Business,and Professions Code ) MOVING TEL,
is
- -0 I, as owner of the property, am exclusively contracting _ TOTAL :125 ® -e5
with-licensed contractors to construct the project (Sec- ADDRESS ��
tion 7044, Business and'Professions Code )
REQUIRED TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH CHANGE
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_,,. 0000-0001 6/ 4/96
Lender's Name
LDMA Ref # 6736 1 AM 9 5
- P C Fee$ Permit Fee
Lender's Address
I certify that I have read this application and state that'the Issuance Fee O LDMA P/C#
above information is correct I agree to comply with all County Investigation Fee / //��
8 ordinances and State jaws relating to building construction, Total Fee/ p� .� LDMA Perm #
and hereby authorize representative this County to enter
upynt above-mentioned�pry for inspection pu poses - -•- .
a
SEE REVERSE FOR EXPLANATORY LANGUAGE,
Signature of App i War Agent ate