HomeMy Public PortalAbout9669 LONGDEN AVE_Building__ -DEPARTMENT OF BUILDING AND SAFETY
' COUNTY OF LOS ANGELES B U I L D 1 N G
WM. J. FOX, CHIEF ENGINEER 1 19 IS53 APPLICATION _
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
UILDING // DISTi IVT NCL
�` P(L�ANf CK.OR REC.No. �PERMIT NO.
ADDRESS O ! ,� ��U /, �� `O 1
,y�� REC EDB D E OF PL. DATE ISSUED
LOCALITY �J-�",.F�>f�f/� ef' J [,�r' q, y
NEAREST / r y� w-c � /} yy+/� �f Pupl `�p - �
CROSS ST. L / �! (!J ,r,s{j C'ir BUILD'
OWNER /I/ ADORE 8 6A,
MAIL71 LOCA ITY /�e-r7 ,V
ADDRESS V� - J 9!24, NEARESTTEL.
CROSS ST.,,
CITY / ` �i'-!�/3`� NO. Fyr FIRE NO.OF TYPE -O:L7..T GAP
A�RCH�•ITECT OR TEL ZONE PLANS
ENGINEER NO. BLDG. ORD. NO.
SETBACK LINE
ADDRESS USEk �! APPROVED
L
iJ r TEf Ir ZONE r7�SY ' A E
COINITRACTOR/7/�/-/G!. j;?� y NO. >'� ter'/�� HOUSE NUMBERING
7: f r
ADDRESS 7` �"" fi/ zw' > .� l•J:+t! /,G'%� MAP NUMBE `�C NO. ASSIGNED BY
LEGAL ! ' R TIO
DESCRIPTIONLOT NO �
. BLOCK �. , P( �` !
Y`
TRAC -/✓1Y 0 lg/
Ij rO b I Nd CF BLDGB:
SIZE OF LOT NOW ON LOT /� //f� -✓
USEOFI NO. OF (1-da
EXISTIN BLDG. FAMILIES
DESCRIPTION OF WORK °
NEW ALTERATION ADDITION
FI),i2.,✓Fl r_gill-5411"' 7- /t: QZQQ 2— a
REPAIR DEMOLITION I t'
FT. fid f/ / o c-. Il
._.,�,s
sq.
ZE Q ROOMS `7` STORIES / .r Li-r r )V
EXT.WALL `/` I ROOF s+'
OVER
CING / e C'i''�') COVERING C�: i?'r✓`j� D. ?n' f n
USE OF BTR OTURE ,C A ,
INSPECTION FOR APPROVALS
OCCUPANCYAS IN PECT.DR15,81,13INATURE DATE
FOUNDATION: LOCATION
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FORMS, MATERIALS
PLICATION AND STATE THAT THE INFORMATION GIVEN I5 FRAME: FIRE STOPS,
CORRECT. BRACING, BOLTS
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION,
AND STATE LAWS REGULATpli
BUILD CONSTRUCTION. GAS VENT, DUCTS
/
SIGNATURE OF ` / A• �,��� LATH, INT.PERMI7TE JlJ - � J
!� /� (��I �f .f' ✓� LATH. EXT.
ADORES
_ M
PLASTER, INT.
AUTHORIZED AST.
PLASTER, EXT.
FEE m v HOUSE NUMBER COR-
RECTAND POSTED
VALUATION FEE S1/ d v FINAL
76A633A 088 3 7-51
++ WORKERS' COMPENSATION DECLARATION
I hereby-firm that I have a certificate of consent to selfF "WILDING PERMIT
irrw ; or a certificate of Workers' Compensation Insurance,
or a certifi d c y thereof(Sec. 38 6 -j COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
E] Certified copy is hereby furnished. FOR APPLICANT TO FIL4 IN ADDRBUILDING
S /_AN10 b O'y1
Certified copy is filed with the county building inspec- BUILDING
tion department. r. ADDRESS D middle
'�'� CITY f ZIP �� ,,.: ,
'�(/l " LOCALITY
DateJJ Applican' 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 dollar ($100)or less.) TEL.�n G/ n
s OWNER ��s ot11S NO aO O fc/ USE ZONE MAP aC
I,certify that in t e performance of the work'for which this NO.
permit is issued, I hall not employ-any person in any manner :;'ADDRESS SPECIAL a
CONDITIONS
so as to become s ject:to the Workers'Compensation Laws. ;. O
cITY ZIP
Dare pplicant K ARCHITECT OR TEL. O
t DISTRICT G UP TYPE FIRE ROCESSED BY G
NOTICE TO•APPLICA If, after- making this Certificate of I ENGINEER NO. CO
NTI
Exemption, JAE
you shou become subject to the Workers'
Compensation provisio bf the Labor Code, you must forth- ADDRESS
with,comply with sP.
uch provisions or this permit shall be -'{- (tms( ((� TEL. �^�, STATISTICAL CLASSON APT. CONDO. N
deemed revoked. COZ4T OR NO.��S �6 1 -`. : Z_
LICENSED CON RACTORS'DECLARATION TIC. �p CLASS No. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS loaS S S (� NO. C 2oll
—
�_� ( LIC. /t SEWER MAP
(commencing with Section 7000)of.Division'3 of the Business ';CITY, �7} 1 ` •
and Professions Code,and m license is in full force and effect. ��L CLASS BK. L PG. VALIDATION
SQ. FT. NO. OF• NO.OF CHECk L
I.
LicenseNX tuber Lic. ClassC� SIZE . STORIES FAMILIES ONE hY
''{� VALUATION
Contractor }pie { Q DESCRIPTION OF WORK l a ;� ,}�rZ•- NEW ❑ $ �.
E]I am exempt under Sec. e ADD El
U ALTER ❑
B,BP.C. for this reasori
USE OF REPAIR i $
O"te' s EXISTING BLDG.. DEMOL
Signature :APPLICANT" TEL.
OWNER-BUILDER DECLARATION (PRINT)) NO. �g5'�`i�o d`:" FINAL
I hereby affirm that I am exempt from the Contractor's License ATE. �'c-
E1 (�, �n D
Law for the following reason (Section 7031.51 Business and ADDRESS ��d S •J�"� S "+�" "_ FIWA '• � i'.• � •' 3307t�aC
Professions Code): PRESENT ',-
<<BUILDING
❑ I, as owner of the property, or my employees with t;ADDRESS " :4.ITEMS
wages as their sole compensation,will do the work and LOCALITY �. ( Z •• TOTAL o
.the structure isnot intended or offered for.sale Section
7044, Business and Professions Code.) MOVING TEL. ; 'CHECK ,►s;
CONTRACTOR NO.
. ❑ I,as owner of the property,am,exclusively contracting '
with licensed contractors to.construct the project (Sec- ADDRESS t-HANG • .00
tion 7044,•Business and.Professions Code.) ;
REQUIRED TOTAL SETBACK FROM EXIST. .
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP, LINT WIDTH ,-
I hereby affirm That there is a construction lending agency for FRONT I 0000-0001 10/27/89
the performance of the work for which this permit is issued. P.L.
(Sec. 3097, Civ. Cr).. , 4 SIDE 6425 1 AN 9:22
P.L. ;
Lender's Name
P.C. Fee$ Permit Fee Y CDML# J
Lender's Address I certify that I have•read this application and state that the ;' Issuance Fee 'CDMabove information is correct.I agree to comply with all County IInvestigation Feeordinances and Stat aws relating to building construction, Total Fee CDM
and h eby_ thori resentative;of this County to enter - ;
u on t ab -me ti d property for inspection purposes.,
e n
ID p! I SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applin n or Agent Date' 11