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HomeMy Public PortalAbout9464 LEMON AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER l FOR APPLICANT TO FELL IN , FOR OFFICE USE ONLY DISTRICT N PLAN CK NO PERMIT NO. BUILDING ADDRESS RECEIVED BY DATE OF APPL. DATE ISEfUED LOCALITY NEAREST CROSS S BUILDING - ADDRESS OWNER MAIL - LOCALITY v V ADDRESSpp ' NEAREST l ,� CITY NO. � FIBRE S ST. NO. OF TYPE GROUP, ARCHITECT OR - TEL. ZONE I'PLANS ENGINEER BLDG. ORD NO. SETBACK LINE ' ADDRESS APPROVED TEL / BY DATE CONTRACTOR USE APPROVED- ZUNI- BY DATE ADDRESS ^� HOUSE NUMBERING LEGAL DESCRIPTION I•LOT NO. BLOCK MAP NUMBER FIELD CHECK BY TRACT •' NO ASSIGNED BY DATE NO. OF BLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT USE OF I NOOF EXISTING BLDG. FAMILIES DESCRIPTION OF WORK NEW I I ALTERATION I I ADDITION 0 REPAIR ( I DEMOLITION SQ. FT. NO. OF 0 SIZE ROOMS STORIES Y EXT WALL I ROOF r COVERING COVERING USE OF STRUCTURE - APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION. LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN 1S _ FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING,:BOLTS , LAWS REGULAT BUI 1 IG CONSTRUCTION. _ > > FURNACE: LOCATION, SIGNATURE OF GASVENT,•DUCTS PER MITT7;EE ��J, 3 3 79 LATH, INT. ADDRESS 1' LATH, FACT. ' AUTHORIZED AGT. _ PLASTER, INT. 76A63BA- DSS3 10-50 .� . P C. © / IFEE PLASTER, EXT. Q VALUATION V FEE p�--��- FINAL �/� Z- I ' r WORKER$' COMPENSATION DECLARATION t • to self ins rebor affcertifcatte of Workers' Compensatonent Insurance, APPLICATION FOR -BUILDINQ1 PERMIT 00 or'a certified copy thereof (Sec 38 , Lab C ) - I .I I I a COUNTY OF LOS ANGELES "BUILDING AND SAFETY Policy No Company 0 Certified,co ' sFOR APPLICANT TO FBUILDING' PY is hereb Yfurnihed ILL IN ADDRESS - ❑ Certified copy is filed With the county buildinginspec- BUILDING �� tion department f, ADDRESS 1 Dole- Applicant CITY �j yl ZIP �L/ LOCALITY NO OF BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST 'COMPENSATION INSURANCE ASSESSOR , 2 PP (This^'section need not be completed'if,the permit is for one TRACT BLOCK LOT NO MAP BOOK 30� PAGE d�'`7 PARCEL hundred'dollars ($100) or less ) AI G d �Zf % OWNER 76/ USE ZONE,, OP "I certify that in the performance of the work for which this � n OcIO permit is issued,•1 shall not employ any person in any manner ADDRESS f �/� SPECIAL d CONDITIONS O ;so as to become subject to the Workers Compensation Laws. // Q/7�� _ _, - U T•- CITY /�i Ii / ZIP 7 Date Applicant ARCHITECT OR/ TEL NOTICE TO APPLICANT If,,after,making this Certificate of;� ENGINEER- NO DISTRICT WGROUP TYPE FIRE PROCESSED BY '•CONST Z NE OExemption, you, should 'become -subject to the Workers' - UCompensation provisions of the Labor Code, you must forth- ADDRESS ; ,�� -3 J w Q_ with comply with such,provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO N Z deemed revoked •• CONTRACTOR -LIC CLASS NO �� DWELL UNITS LICENSED CONTRACTORS DECLARATION- ADDRESS ` NO I hereby affirm that I am licensed under provisions of Chapter 9 LIC SEWER MAP (commencing with Section 7000)of Division 3 of the Business and'Professions Code,and my license is in full force and,effect CITY CLASS B VALIDATION ' SQ FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAMILIES ONE - VALUATION Contractor Date DESCRIPTION OF WORK NEW t. - El ❑I am exempt under Sec. ADD ► t ALTER•.❑ •B&P C-for this reason REPAIR,F-1 $ •Date' USE-OF, . EXISTING BLDG " DEMOL ❑ Signature APPLICANT _. -TEL •• FINAL ON/NER-BUILDER DECLARATION (PRINT), NO DATE /� �Z „ I hereby affirm that I am exempt from the Contractor's License - T Law'for the following,reason (Section 7031"5,.Business and ADDRESS FINAL' )• ' .Professions Code)- PRESENT - �ey f"'C" BUILDING '��'� I; as owner of the property, or my employees with ADDRESS - • i r. wages as their sole compensation;will do the work and - Pilo -.)._��t' 7, 4 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code ) MOVING,-- - TEL i T7 N".. y 1-4 CONTRACTOR - NO ❑ I, as owner of the property, am exclusively contracting t TOTAL :Y " with licensed contractors-to construct the project•(Sec - 5^ t `r'- s = tion 7044, Business and Professions Code )• ' ADDRESS _ vREQUIRED TOTAL SETBACK FROM, EXIST �' t ,r 7 '„r•._ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH ' CHAN"”,tgf"C I hereby affirm that there is a construction lending agency for FRONT, _ the performance of the work-for whch'this permit'is (s"suecl P L" ' ' ' '.(Sec 3097, Civ C ) SIDE Lender's Name LDMA P C Fee$ Permit Fee Ref fi - - ')67 � rel i �o Lender's Address y N �' a 1 certify that I,have read this applicator and state that'the Issuance Fee �rf 7� LDMA P/C ii above information is correct I agree to comply with all County Investigation Fee Q' / - ordinances and'State laws relating'to building construction, Total Fee O (O LDMA Perm q ; a and hereby authorize representatives of,this County to enter upo a ve-mention roper for inspection purposes ; SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent - DotB V WORKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to self APPLICATION , FOR,- BUiL®ING PERMIT insure, or a certificate of Workers' Compensation Insurance, - or a cer'I'>t,ied copy thereof,(Sec 3800, Lab C•) COUNTY OF LOS ANGELES ^7a BUILDIN56 AND SAFETY Policy No 3 3 ComponySTME7 E] Certified copy is hereby furnished 'FOR APPLICANT TO,FILL IN ADDRESS BUILDING-' El Certified copy is filed with the county building inspec-' ADDRESS - tion department T �7 Date�22-9•i A' lic^.,�r C.°��'`b"__� CITY 1 ,zip G LOCALITY PP NO,'OF•BLDGS ';u7 l�. t NEAREST CERTIFICATE OF,EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT L CROSS ST COMPENSATION INSURANCE Y u;. s' • •' ASSESSOR (This section need not be completed if the permif is for one TRACT BLOCK 'S LOT NO MAP BOOK rrj�j�j1 PAGE ( PARCEL hundred dollars ($100) or less ) TEL TX OWNER G NO USE.ZONE MAP I certify that in the performance-of the work for which this q/�� PECIAL NO (O permit•is issued, I shall not employ-any,person in any manner ADDRESSa R CONDITIONS' ,so as to become subject to the Workers' Compensation Laws ' 1 0 CITY ZIP Date Applicant ARCHITECT O TEL ��jp DISTRICT GROUP TYPE FIRE PROCESSED BY 0 .NOTICE,TO APPLICANT lf;_after making,This Certificate 'of ENGINEER - NOb6 _C6 oC� CONST SNE Exemption, you should become subject to the Workers' // ✓�( ui Compensation provisions of the-Labor Code, you must forth- ADDRESS . �dQ -3 V LU with comply with such provisions or this permit,shall be ��jN NSTgr ggy '�TEL STATISTICAL CLASSIFICA ION APT CONDO Z. deemed revoked NO _ LICENSED CONTRACTORS DECLARATION �Sj Q�Sr-c.�plZ�—�lj LIC �ri Q CLASS NO DWELL UNITS — I NO av� l 7i I hereby affirm that I am licensed under provisions of Chapter 9. LIC SEWER MAP ,(commencing with Section 7000)of Division 3,of the Business G�N1f��� . Q� , g and Professions Code,and my license is in full,force and effect ITY CLASS 8 BK-01 PG VALIDATION SQ F NO OF NO OF CHECK License Number ��9 Z Lic- Class B"� SIZE STORIES FAMILIES ONE VALUATION - Contractor � D te' IS:-ZZ-`-[1 DESCRIPTION OF WORK t`�L NEW ❑ $ �, O C Ob r ADD " � pop.❑j am exempt undbr Sec: ALTER, ❑ t B 8,P C for this reason REPAIR ❑ $ Date USE OF _ EXISTING BLDG ✓.�. DEMOL ❑ $i naSu.rr� r r APPLICANT TEL g OWNER-BUILDER DECLARATION (PRINT) NO '�7— DA EL ^ - I hereby affirm that I am exempt from the Contractor's License 5�kcl t� FINAL Law for the following reason (Section 7031 5,'Business and ADDRESS Professions Code) PRESENT, •1 -BY i BUILDING ❑ j, as owner of the property, 'or my employees with ADDRESS wages as their sole compensation,will do the work andthe structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code ) MOVING TEL CONTRACTOR NO I, as owner of the property, am exclusively contracting with licensed contractors to construct the project Sec- t "- = tion 7044, Business and Professions Code ) I ADDRESS \ -_ 6y, x` {y rt 34_ r s ® ^3a REQUIRED -TOTAL SETBACK FROM- EXIST -CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I herebyaffirm that there is a construction lending agency for' FRONT 9 9 Y the performance-of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE r PL vJ Lender's Name P LDMA Ref # 1 :lI_I I1 cl't1•L �: �� i P C Fee$ Permit Fee ;i Lender's Address �y Hi. `•�L- I certify that I have read this application and stole that the Issuance Fee ' LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee D / r p ordin ces and State laws relating to building construction, Total Fee • e� O LDMA Perm # < an reby auth iz representatives of this County to enter, pan a above- e n roperty for inspection purpo es h- ' o tti L.2 I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Xpplicant o Agen Date