Loading...
HomeMy Public PortalAbout9020 LONGDEN AVE_Building__ DR.3 if-43 ism sere APPLICATION FOR PERMIT ' DEPARTMENT OF BUI_ ING6 ND SAFETY COUNTY OF LOS ANGELES I I WM. J. FOX, CHIEF ENGINEER BUILDING � �� NO.OF BLDG. ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO. PLANS SETBACK LINE FIRE APPROVED ZONE ABY DATE RECEIVED BY DATE OF APPL. DATE ISSUED lo ZONE,—//USE APPROVED By DATE APPLICANT FILL IN HEAVILY OUTLINED PORTI N ONLY � tY BUILDING d///(O p NAME ADDRESS [/cam C ADDRESS LOCALITY I- (9 NEAREST U Z CITY CROSS ST. Q STATETEL!KEEN NO. NAME ]•\,/ LICENSE NO. NO. 3 MAIL NAME ADDRESS�!��lp !7V^� �{J�'�/ t.C.•fJ"V. O O TELr{� 1 7( Q ADDRESS' CITY �• NO.. 04 7 t7/ F {� 1 HEREBY ACKNOWLEDGE/HAT 1 HAVE READ THIS U CITY' APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. �q ,e� NO. �? �! ,e, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. � LOT NO. /,A' 4! SIZE OF LOTOO/`JV SIGNATURE OF ER S 6~ OWNER NO. OF BLDGS. p _ AUTHORIZED AGT W BLOCK NOW ON LOT V""� J TRACT cCORRECTIONS D USE OF BLDGS. e 414/J ' NOW ON LOT ' DESCRIPTION OF WORK /r USE OF ��—�=f/j�i�re—i���lJy��1.�11�•�2 /�f/ �i���r-�L�'�• BU LDIN6 s Anid114CaI � �! .,a...._u "" •`+I -- Ill V1UIC1uU11 OI War Production Board orders. You era 0 vcLuuonea to consult with your local War ing the work authorized jr, this permit Z /� D NEW TYPE43�- '�' GROUP r NO.OF r NO.OF ALTERATION ROOMS FAMILIES ADDITION SIZE REPAIR STORIES MOVING WALL COVERING DEMOLISH ROOF COVERING��� FINAL APPROVAL FEE 1/ VALUATION SY �V FEE $ DATE \4 �� NAME CTOR'S fr WORKERS'COMPENSATION DECLARATION Y appdOC�Q`��OO [� FOO .M LLJ) OG�]C� pEQ��U 1 hereb affirm that I have'a certificate of consent to self. O D O D O O . insure, or a certificate of Workers'Compenstion Insurance, or , a certified copy thereof (Sec 3800, Lob C )' I ICOUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No 230770 Company State Comte Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING dO2d ADDRESS © Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS 9020 LancIdtan LOCALITY Date 1/1 8,7, Applica Pres, CITY Tem le Gi't ZIP 91780 CROSSSST CERTIFICATE OF EXEMPTION FROM R S' NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT L NOW ON LOT MAP BOOK I PAGE PARCEL E ,I (This section need not be compUSE ZONMAP leted if the permit is for one TRACT BLOCK LOT NO NO / 5-3'— hundred dollars ($100)or less ) �. L SPECIAL I certify that in the performance of the work for which this OWNER Whar 81& 281-6038 CONDITIONS /� O permit is issued^I.shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROC USED BY U ADDRESS 9020 Longden - _ CONST ZONE so as to become subject to the Workers'Compensation Laws CITY Temple CO City zip' 91780 0 Date '' Applicant STATISTICAL CLASSIFICATIONAPT CONDO V ARCHITECT OR TEL NOTICETO APPLICANT If, after making this Certificate of ENGINEER NO CLASS NO DWELL UNITS d Exemption,- you 'should become subject to the Workers' N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or-this permit shall be . deemed revoked CONTRACTOR Montebello Rf NoTEL 722-6975 BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSIB68 Truck Way No 248852 VALUATION (commencing with Section 7000)of Division-3 of the Business and LIC Professions Code, and my license is in full-force and effect CITY Montebello CLASS C-39 $ 1679.00 SQ FT NO OF NO OF CHECK License Number 24A 59 Lic Class C-39 SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK 2 existin roofsEyv El $ Contract PresDp1e 8/31/87 g I om exem f the licensing requirements as I am a RerOOf W 17 sq C1aSS up f ADD licensed architect or a registered professional engineer . ALTER Q FINAL v acting in my professional capacity (Section 7051, l REPAIR ® DATE ' Business and Professions Code) USE OF EXISTING BLDG dwellingPe DEMOL•' Fy 11 Lic or Reg NoW A Date APPLICANT TEL BY f 'OWNER=BUILDER DECLARATION (PRINT) 'NO 722-697 I hereby affirm that I am exempt from the Contractor's License - Law for the following reason (Section 7031 5, Business and I ADDRESS Professions Code) - PRESENTEl BUILDING ' I, as owner of the property, or my employees with ADDRESS 001AAA wage's as their sole'compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY �v 7044, Business and Professions Code) MOVING TEL j, as owner of'the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS L9 56 2 4A tion 7044, Business and Professions Code) - ' REQUIRED TOTAL SETBACK FROM EXIST '#,o 0 o e o CONSTRUCTION LENDING AGENCY - SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT ',Vo - 4 9.88 the performance of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE • 0 0 0 49.88 Lender's Name I Q 1 3�8 6 m Lender's Address o P C Fee$ - Permit Fee 39 38 w I certify that I have read this application and state that the Issuance Fee above information is correct I agree td comply with all County Investigation Fee 1. ordinances-and State laws relating to building construction, 1. ordinances Fee 49- RA and hereby authorize representatives of this County to enter U upon thea ove-mentioned property for inspection purposes < 108/86 SEE REVERSE FOR EXPLANATORY LANGUAGE resignature of A.fc,V�l Agent Date _ �a