HomeMy Public PortalAbout9476 LAS TUNAS DR_Building__ DEPARTMENT OF COUNTY ENGINEER
DIVISION OF BUILDING AND SAFETY BUILDING
COUNTY OF LOS ANGELES
.WILLIAM J. FOX, CouNTY ENGINEER APPLICATION
CASSA7T D. GRIFFIN, SUP'T OF BUILDING
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING Cl DISTRICT NO. 1 PUN CK.OR REc.No. /P'ERRMIT NO.
ADDRESS'
LOCALITY ,L%`� CNEAREST /�j / RECEIVED BY DATE OF APPL. /DSA E I88 ED
CROSS ST [ "7 I (. L a e v 3
BUILDING
OWNER ADDRESS; 9 a S
MAIL '/ ./ / LOCALITY--, C I o
ADDR 7 Y 'L.. LI- /t/14-
/ NEAREST
T �' ,P
• Z'o C E o• CROSS ST.
CITY /
ARCHITECT OR TEL. ZONE I PLANS FIRE NO. OFTY E-�y- GR
ENGINEER NO. �JL-
ADDRESS BLDG. t C ORD. N .
p SETBACK LINE Q 07
USE PA
CONTRALTO-`/Z(ii'"Y�.•/l.l'le p /ql TEL ZONE G.BYPROVED� I PATO eS S
aa HOUSE NUMBEtING
ADDRESS a R•" /-y Y wee c�
DESLEGAL CRIPTION LOT N - 1�7 BLOCK MAP NUMBER �GC�X�� NO. ASSIGNED BY X\S
11 � CORRECTIONS
TRACT la 67 z
SIZE OF LOT � I V NO. OF BLDGS.
NO ON LOT /�.�-�-:USE OF NO.
� '
EXISTING BLDG. G/tLOFo
iE
- DESCRIPTION OF WORE /! ,�� C , o —
/ A
NEW ALTERATION ADDITION c�0 `- �
REPAIR DEMOLITION H '
SQ. FT ("'�) NO. OF U- 5'3 �/"S;�S%7'L-' �CJ/C�/CEf°Wit/✓. a!uiEy
SIZE U �j/ ROOMS STORIES
EXT. WALL ROOF /t�.� 5-6/,V /� jQ FXLY.
COVERING S7u'CC _ I COVERING
USE OF STRUCTUcg� ��la'•L`��1� L✓l�G ��%�l:'S✓`�� ��Y"H/f'H
_ ) /}C.�!�C? ��. .�/�F�J'A)�� �_ .�/Y� f"di1?l� /✓d 7' ��/�;a(" "'�/��f�10�"l!E
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APPROVALS
INSPECTOR'S SIGNATURE DATE
FOUNDATION:LOCATION
FORMS, MATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, '`S
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
CORRECT.
IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS
LATH, INT: ( yrY I! I Gf7
SIGNATURE
PERMITTE O ?L�z !L (/
LATH. EXT. J
ADDRESS 2-0.3
PLASTER, INT.
AUTHORIZED AGT.
PLASTER, EXT.
$ C-90 P. C. S
FEE HOUSENUMBERCOR-
dRECT AND POSTED ,v
VALUATION OAR(
FEE S/® FINAL ... .I .�i,��,�."yy-✓�?P �/36"�
76AGSBA 086 3 8-52
/- IDEP_ARTMENT�OF BUILDING AND SAFETY 'APPLICATION
F vim:-=�.�.+MI'r
COUNTY OF LOS ANGELES
BUILDING
WM. J. FOX, CHIEF ENGINEER
NO.OF ,/ BLDG. l+�Rw ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO.
PLANS SETBACK LINE ) �\-���l . �� , �@
FIRE APPROVED 8► 40
ZONE BY DATE RECEIVED BY DATE OF APPL. DATER ISSUED
ZONE' BYUSEPROVED DATE _' - ',` _
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY O '7 Z
O NAME BUILDING b , �„ , A
Ir NAME _ � "�.a��
W 2 ADDRESS LOCALITY �,.:.. a".j t--
1- O
= NEAREST
� W CITY CROSS ST.
Q L CENSE NO. NO.TATE TEL. NAMEAF.
Z MAIL
NAME ADDRE83 L$7.,n „n+�tfp�•,?/3iQT,
14 T
F O . .»iFS /. ., NO.
EL
Q ADDRESS CITY
O CITY I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
U APPLICATION AND STATE THAT THE ABOVE IS CORRECT
STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING-CONSTRUCTIONO
Z LOT N1,11 5� �� SIZE OF LOT S�%/ IQ� e�. SIGNATURE OF /•'
O �•
OWNER �P Com/ �',,c
6 d NO. OF BLDGS. 1 ;�"'.%, � 6-' .. (� - a.
O _ BLOCK NOWONLOT AUTHORIZED AGT. _ a _
J In TRACT 't. -J 2 a — CORRECTIONS
W , n
D USE OF BLDGS. �,.� .
NOW ON LOT ,,1
DESC[RIPTION -OF WORK
USE OFq.Cj
BUILDING
IJt9 _� kr-
No,
r o� i e
N' y pile, .
J
Q
Z
0
NEW TYPE _GROUP
NO.OF NO.OF
ALTERATION ROOMS FAMILIES
ADDITION SIZE FZ x Z'
REPAIR STORIES
MOVING WALL.COVERING
Co
DEMOLISH ROOF COVERING //�� o�� �
P.C.$ FINAL APPROVAL
FEE i "^^^*•-
s/ g 8 INSPECTOR'S
// 'r
VALUATION FEE DA, E ^�L/ /_.NAME
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT.
COUNTY OF LOS ANGELES FJ L®�
WM. J. FOX, CHIEF ENGINEER
n
PLANS. (. I BLDG. ,�} F1kc -- DISTRICT No. I PLAN CHK. FEE PERMIIT'NO.
FILED :' SETS ZONE 14a gy ZONE RECEIPT NO.
TYPE OF ass
BLDG. 1 11 111 V. V_X _ GROUP "�
BLDG. SETBACK LW � - -- DATE OF-APPL.1,6✓ 1�3�Z%RECEIVED .BYI DATE ISSUED
ORD. N O. $.,�' • o
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY d (a
cr BUILDING
O W NAME _ - p� a �4�3
ADDP,ESS "� e5e,03
W
Z ADDRESS _ LOCALITY' 74-r 7e
U W CROSS S
CITY NEAREST
IK STATE
LICENSE NO.
et _ TEL. No, � NAME
W MAIL
p Z ADDRESS '
CUF10
QE' ADDRESS 4�14,6' IV2)p j7? CITY
d _ CITY 4S® Ji1 LOT 7 / SIZE OF LOT_ ✓ ,[ F' "
U STATE // d 6 NO. OF BLDGS, f
LICENSE NO. C� /, TEL. NO.Ztt-1� �U
-- s JW 'BLOCK NOW ON LOT
,{v F 13 r`�,- USE OF BLDG.
CLASS OF WORK TRACT � 9 ' NOW ON LOT
NEW ADDITION DEMOLISH
�,v DESCRIPTION:OF WORK
_
CQ ALTERATION REPAIR I -� MOVING
USE 0BLOG.Fr _If4ydAj (ROOMS
SIZE OF' STORIES No. OF 1p :y hT
BLDG. (n ��[J I FAMILIES CORRECTIONS
SPECIFICATIONS p t
FOUNDATION
MATERIAL EXTER QRS PIERS
46-4 THICKNESS—TOP h - ------
_THICKNESS—BOTTOM✓' �B J
1 a
'. DEPTH IN GROUND N d _ Z
od
U vD SUPERSTRUCTURE — g
SIZE SPACING SPAN I O
__R.
_R. W. PLATES ($fLL)
0 '-1 '---
.._{ GIRDER$? C '
.JOISTJOIFLOO,}2 I
/�
_42EAF2lNG WALLS --
PARTITIONS
ROOF RAFTERS I FINAL APPROVAL ,f
! I
SILL BOLTS �h\ I
�n COVERING '0 •--- DAch
TE N � I INSPECTOR'S NAME
WALT_ Idsd\ I ROOF 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
�.. a AND AGREEITO COMPLY WITH ALL COUNTY ORDINANCES
P.C. FEE S mo—AND STATE/LAWS REGULATING BUILDING CONSTRUCTION.
SIGN
VALUATION S 9^ �i FEE_$ (Y) �'®� RT OWNER OR AUTHORIZED AGENT
DS-3 4-39 25M ..t�iy - Y V
i
oma/'_.UEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMITgo
COUNTY OF LOS ANGELES
CC BUILDING
WM. J. FOX, CHIEF ENGINEER .
.7 PLANS r BLDG. FIRE DISTRICT No. I PLAN CHK. FEE PERMIT NO.
FILED_ _SETS ZONE ,w 1 E IPT
f TYPE OF
71
BLDG. 1 11 III IV V X _ GROUP DATE OF APPL. CEIGED BY DATE ISSUED
y BLDG. SETBACK LINE ► �C ,6���' /,qw�
n ORD. NO.
2 APPLICANT FILL IN HEAVILY OUTLINER PORTION ONLY
al a """°' +�♦ BUILDING
O
ti IY NAME / /�f•�a _ p� �1 ��,.---- ADDRESS
W y ADDRESS
mdd! »' Cs../�' _'y,/e LOCALITYfj✓f,!�,�.,
Cj F O �r L pmt �ry NEAREST
—1 .r CITY .1+./S�/7'' /Y CROSS ST. /
cd E STATE
�d LICENSE NO-. ,f TEi. No. _NAME2�. 9:�p,®.J.B:
'1 w' 9 O a /'/s //�� W �MAIL NAME �" � =-- A� /�/3. 3 ADDRESS
Ll r --
.L �., ~ O
4 ADDRESSCITY TE NO.
1
FU
0 CITY �0,� � 1 Ja LOT Zr �(4(- SIZE OF LOT y
i2 STATE .T d C
LICENSE NO. TEL. No. NO. OF BLDGS.
J -- -- - -- -- WN BLOCK NOW ONLOT �-
i JDi I USE OF BLDGr
,/ � -
CLASS OF WORK TRACT NO'S GY NOW ON LOT
— I DESCRIPTIQN OF tW�ORK
-NEW ADDITION l�+DEMOLISH �_ Ql �� '�4 t� �4Zv fj9N�l ee.V,
ALTERATION II REPAIR MOVINGI /j�
USE OF BB ' �B lJO. OF r C.� J V 1( A° �p 7
ROOMS �-
�, i SIZE OF ! TORIES NO. OF
,� Lp BLDG., ® ^Y+� ' �-;/ FAMILIES 0-011 CTI
NS
SPECIFICATIONS -
FOUNDATION
.,MATERIAL EXTERIOR. -� PIERS
-�
Tki.ICKNESS_TOP _
THICKNESS—BOTTQM
Q
17EPTH IN GROUNJI - Z
_ -� SUPEF�ST€dUCTURE --
ji Y $ SIZE SPACING SPAN
R. W. PLATAS (, t" L!
JOISTS--FLO�;R
` 4 /
JOIS'�S—C �ILfM'G
1I �—
BEAR'pNG.
.-PART i ONS,�" _ ------
ROOW RgKgTF_RS -
--- I FINAL APPROVAL
...T a-LL BQLTS
COVERING
DATE r INSPECTOR'S NAME
MALL ROCIF 1 HEREBY ACK EDGE THAT 1 HAVE READ THIS
���... APPLICATION AN S . E THAT THE ABOVE IS CORRECT
AND AGREE TOWY P_Y WITH ALL COUNTY ORDINANCES
.,� P.C. FEE/$ •'� AND STAT 'GTL ,ING tJLLD.NG CONSTRUICTIO+N.
SIGN - D �7�'Cy�,•
VALUATION $ �- FEE $ CJt- ®� _ fy4MMERrO AUTHORIZED AGENT
i ❑6-3 A-99 25M -
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT ga
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER BUILDING
PLANS BLDG. //'' FIRE DISTRICT N6. PLAN CHK. FEE PERMIT NO.
FILED .� SETS I ZONE („e 3 ZONERECEIPT No.
TYPE OF" o ( 16 ! IR w -1 Z 1 P9 rl
BLDG;_ I it IYI IV /V J X GROUP DATE OF APPL. RECEIVED BY DATE ISSUED
BLDG. SETBACK LINE / �^
♦3•D" ORD. NO. — CIA 4 &2 C47-,," L-64/
APPLICANT FILL IN HEAVILY OUTEINED PORTION ONLY Z0?_ ¢
0 NAME 'i�� n BUILDING .T V
� Q� $— " �.`� _ADDRESS `-
W
yw Z ADDRESS v
Z I ,; LOCALITY
U W CITY �/ ® - _ CROSSS T.
iL STATE
Q LICENSE NO. I TeL. No. It NAME G '
W MAIL .
Q NAME ® :3 .ADDRESS
ADDREESAS/ rII" , / . �Gtil� O CITY , - EL NO. ,
O CITY .]Y P ��j� J�' LOT /��� �� SIZE
F LOT II,'IX I p 0' .
U STATE (M LICENSE NO. TEL. NO.W f� JN NO. OF BLDGtg.
BjOCK..�.S. 4 NOW ON LOT
VSE OF BLDG.
CLASS OF WORK I D TRACT���?� CFa4' NOW ON LOT
-- DESCRIVrION OF WORK
NEW ADDITION DEMOLISH
_ALTERATION + REPAIR �-1 MOVING
USE OF NO. OF t)
i BLDG. 1 40 �, ROOMS w
SIZE OF r / ST RI No. OF
BLDG. I 1{-.1MY LIES rJ
V—• Sto- CORR.E TIONS s
e SPECIFICATIONS /yQ,. e¢• Z i -CI• t> r
y FOUNDATION a ry
MATERIAL E IOR RIERS
THICKNESS—TOP
P.H -
THICKNESS—BOTTOM
DEPTH IN GROUND
SUPERSTRUCTURE 2
ESIZ SPACING SPAN
_R. _PLATES (SILL)
GIRDERS
JOISTS_FLOOR _� —
JOISTS—CEILING --
61 q _
'O. � BEARING WALLS'
PARTITIONS
ROOF RAFTF-RS
�} 44 - — �V _ - FINAL APPROVAL.
-'0 SILL BOLTS '' - -- -- - _
COVERING
DATE lYINSP'c.CTOR'9 NAME
WALL I 44 4> I ROOFIi/e &X49- '...-._ t 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
(. APPLICATION AND STATE THAT THE ABOVE IS CORRECT It
�. AND�ST�E
�t:GULATIITNH
t COUNTY ORDINANCES
P.C. FEE $ AND BU� � CONSTRUCTION.
`-1 1.,V FEE S sIGNVALUATION S R AUTH IZED AGENT
DB-3 4-39 25M
#803-c --
7iA630ACE9-60 APPLICATIONFOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
ADDREss
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY f
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT,,NOp�GROUP TYPE ESSED BY
FOR APPLICANT TO FILL IN �� (p CONST.
BUILDINGSTATISTICAL CLASSIFICATION ISIEWERMAP
ADDRESS � BK P
CLASS. NO. DWELL.UNITS-
LOT
NITS LOT NO. BLOCK MAP STATE YES NO
NUMBER HWY.
TRACT /� USEZONE SPECIAL
(�,y� NO.OF BLDGS. /'j CONDITIONS
SIZE OF LOT �7 JI/ :SU I NOW ON LOT e,
USE&F l0
EXISTING BLDG. (�( �i'C/T /� T BUILDING EXIST.
�[ �r n,y�•--
SETBACK YARD HWY STREET NAME WIDTH
TEL
OWNER ��(/ oP��iS� ��j`�/ N6 FRONT
FRONTI
ADDRESS ' /�S ��Ol/� SIDE I
ARCHITECT OR TEL. P, L•
ENGINEER NO. INSPECTION- RECORD
ADDRESS 'a
CONTRACTORy�I��jwr/T y, �G2 NO. ;` 7- 0
ADDRESS //���V' /� 6c1A_k1 e�A Q
DESCRIPTION OF WORK v
W
a.-
NEW HADD ALTER REPAIR DEMOLISH N
Z
SQ.FT. NO.OF NO.OF
SIZE n STORIES y FAMILIES
USE
STRUOCTURE
C
SIGNATURE OF �(
APPLICANT
VALUATION
APPROVALS DATE INSPECTOR'S SIGNATURE
P C I IFPMT.EE $ � FOFORMS! ON
FEE MATERIALS
$
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE 15 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.
EMPLOY ANY PERSON IN ANY MANNER 50 AS�j BECOME UBU ECT
TO THE WORKMEN' MPEN r N LA fdF/CALIFO 'I
(`_(�./ LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTE �
RECT AND POSTED If _ /A
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL STFMC
URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION FK./ M.O. CASH
- LH:,,,o 5 2 3 9 -i?R 1 2 1 D 3.0'
5. 0
- / r
l
J8A638A CE9803 9.67APPLICATION FOP BUILDIot PERMIT
COUNTY OF LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W.'JENKINS, SUPT OF BUILDING NEAREST
CROSS ST.
DISTRICT NO. G P TYPE PR CES BY
FOR APPLICANT TO FILL IN CONs
(Print or type only) `S. (�
BUILDING �+ /STATISTICAL'CLASOIFICATION SEWER MAP
ADDRESS CLASS NODWELL.UNITS BK PG
LOT NO. + BLOCK USE ZONE MAP
NO.
TRACT ' ' c \
CONDITIONS
NO.OF SLOGS.
SIZE OF LOT NOW ON SOT
USE OF
EXISTING BLDG BLDG.SETBACK FROM
��CC /� A( TEL. �� FRONT PROP.LI NE OF STREET),
OWNERSO L F,E(ISO
/�N IC 040• TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
ADDRESS 23� >i• F31q/b I /-L-o -s-r- HIGH'WA/Y WIDTH FROM
FROM C.L.
CITYCQV G/'7 L �`0 et } _
ARCHITECT OR TEL. SID PR BACK FROM (STREET)
SDE PROP.LINE OF
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY } X ARO = TOTAL
ADDRESS HIGHWAY /WIDTH FROM C.L.
CONTRACTOR �NO.L_Z ^ `= e } a'
O
ADDRESS Z5 C ,NO *ILI L CORNER CUTOFF YES ❑ NO �
CD
CITY '- CLASS G^' 5, SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK 0-
N
z_
NEI ADD ALTER REPAIR DEMOLISH
SQ. FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE'OF
STRUCTURE
SIGNATURE
APPLICANT
VALUATION $ �®V ` O
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. CJ FOUNDATION: LOCATION
FEE$ FEE $ ? FORMS, MATERIALS
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT 1 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 REG ATING GAS VENT, DUCTS
BUILDING CONSTRUCTION. YERTI Y THAT IN DOINGOAUTHORIZED HEREBY I WILMPLOY AN P IN VIOLA-
TION OF THE LABOR COSTATE CRNIA RELAT- LATH, INT.
ING TO WORKMEN'S CONSURA C
/ LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE - RECT AND POSTED
ADDRESS t
FINAL
JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER
P"LAN—;CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
LXO'2 8 9.0 4 FEB
76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMSIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
FADDRDISTRICT NO. GROUP I TYPE PROCESSED BY
E
R APPLICANT TO FILL IN CONST.
STATISTICAL CLAS IFICATION SEWERMAP
!!- r'I BK PCs
CLASS. NO. DWELL. UNITS
- `�� - BLOCK WATERCERTIFICATE: NOT REQUIRED RECEIVED
/ MAP HIGHWAY
NO. OF BLOGS. NO. (CIRCLE) STATE MAJOR SECOND. LOCAL
NOW ON LOT USEZONE ECIAL
C DITIONS
G. .i._
TEL.
OWNER - N0. 1 BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS _ t FRONT .r
ARCHITECT OR, TEL. P. L.
ENGINEER NO. SIDE _
P. L. d
ADDRESS O
TEL. V
CONTRACTOR \i NO,.: y..'-
Lu
ADDRESS W
DESCRIPTION OF WORK >_ -
a
NEW D ALTER REPAIR DEMOLISH K
SO. FT. /} NO. OF ANO"bF` d
SIZE Gl )., (y/ .CJ STORIES FAMILIES X
USE OF Lu
STRUCTURE
SIGNATURE OF -
APPLICANT '
VALUATION
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
P.C. PMT.
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 AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL 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. LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S C MPENSATI,O INSURANCE.
f_ f,� LATH. EXT.
SIGNATURE OF - HOUSE NUMBER COR-
PERMITTEE +���' "''� RECT AND POSTED
ADDRESS i r L 2� .FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
," PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
le
t
WORKERS' COMPENSATION DECLARATION
hereby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING P E RM I T
insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.) Company BUILDING
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS
Date 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 PAGE PARCEL
hundred dollars ($100) or less.) TEL.
OWNER NO. USE ZONE MAP
certify that in the performance of the work for which this NO.SPECIAL
permit is issued, I shall not employ any person in any manner ADDRESS CONDITIONS >_
so as to become subject to the Workers' Compensation Laws. CL
O
CITY ZIP V
Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY J
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE
Exemption, you should become subject to the Workers' 'l
Compensation provisions of the Labor Code, you must forth- ADDRESS
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Q
deemed revoked. CONTRACTOR NO. dr
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS O
I hereby affirm that I am licensed under provisions of Chapter 9 N
ADDRESS O. d
(commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP w
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 Lic. Class SIZE I STORIES FAMILIES ONE
VALUATION
Contractor Date
DESCRIPTION OF WORK NEW El
S
❑ ►
ElI am exempt under Sec. ADD
ALTER ❑
B.&P.C. for this reason REPAIR ❑ $
Date: USE OF
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
Professions Code): PRESENT By
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and LOCALITY 001the structure is not intended or offered for sale(Section
7044, Business and Professions Code.) MOVING TEL.
❑ 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.)
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY REQUIREDTOTAPROP.ACK LINEFROM WIDTH
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
P.L.
Lender's Name
LDMA Ref. #
Lender's Address
P,C. Fee$ Permit Fee ,
�
a 1 certify that I have read this application and state that the Issuance Fee LDMA P/C#
S above information is correct. I agree to comply with all County Investigation Fee
R ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
a and hereby authorize representatives of this County to enter
a upon the above-mentioned property for inspection purposes.
a
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Signature of Applicant or Agent Date