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Home My Public Portal About10715 LORA ST_Building__ OF BUBMING AND SAFETY APPLMATION FOR PEBWT1 i ' COUNOF TY CoSEF�N� BUILDING FODa APPLZCJi TO Fa.L III FOa GIS= = MY DISTRICT NO. PLAN CK.NO. PERMIT No-. ADDRESS - RECEIVMD IrY K OF PPL TR IIBBUEDi LOCALITY ' 1 L :. 'iLti' /72- j sir �_ NEAREST y CROSS ST. �• BUILDING ADDRD , ESS OWNER � MAIL • / LOCALITY AADDRESS ` NKARMST TEL CIROSS ST CITY NO. IM FIRM NO.OF I TYPtI--ri _ OROUnr ARCHI OR TSL ZONE PLANE Jam' ENGIN NO. GILT ACK LINK '�.r O LAO• ADDRESS APPROVED BY DATE CONTRACTOR /� NO. r ZUSE ONE A / .BYPROVED DATE ADDRESS HOUSE NUMBERING LEGAL O S DESCRIPTION I IAT NO. BLOCK MAP NUMEM FIELD CHECK MY - TRACT NO. ASSIGNED BY nA y O/ NO.OF SIZE OF LOT /i � C7 NOW ON LOT LOT A UBM OP �. NO.OF I+ MZIBTING BLDG. RAIRIum DElcmulm or wcm NEW ✓�ALTERATION ADDITION I REPAIR DEMOLITION I G :ZK • Ao NROOMB STORIES od' Z MET.WALL ROOFRING COVERING COVM USE OF STRUCTUR Y M, &1 c- 3 yINS E I S 81ONATURK DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AR FOUNDATION:LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IB FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH T}(E CORRECTIONS LISTED FRAME:FIREBTOP% !O HEREON AND WITH ALL COUNTY ORDINANCM AND STATE BRACING, BOLTS LAWS REGULATING U 1 G RUCTION. FURNACM:LOCATION. SIGNATURM OF % F`V GAB VE T. DUCTS PERMITT I LATH, INT. 31/5 102 ADDRESS fea• LATH, ETT. AUTHORIZED AOT. 74a 11A•EMM go-go s 7 o r+aPLASTER. PNr. FEEc. � .- PL/18TER. Err. VALUATION � :-=T? FQ ,v}r, - FINAL WORKERS'COMPENSATION DECLARATION a rm rcertificate � aensu ;or ceofcate of Workes'Compensa onnsurn , APPLICATION FOR BUILDING P E RM I T or o=certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy 130. Company. BUILDING 13 Certified copy is hereby furnished. FOR APPLICANT T FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. AbDRESS /Q LOCALI Y NEAREST Date Applicant CIT ZIP d'v CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' V NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP ` / �� hundred dollars($100)or less.) TRA BLOCK LOT NO. NO. TEL. �f Q SPECIAL 9• I certify that in the.performance of the work for which this OWNE _ NO. ,yUSG CONDITIONS 0. �+ DISTRICT GROUP TYPE FIRE CESSED BY O permit is issued,I shall not employ any person in any manner ADDRESS14 1 S Off. 1 CONST. ZONE � u so as to become subject to the Workgr�s'Com ation ws.' / h �.v� 3 09 Date Applicant , CIN (� 1` IP STATISTICAL CLASSIFICATION APT. CONDO. NOTI T APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. e� / LIJ Exe ption, you should become subject to the Workers'' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit'shall be deemed revoked. CONT CTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION' LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 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 CLASS SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES I FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ ADD I am exempt under Sec. ❑ ' ALTER ❑ FINALl G� BAP.C, for-this reason REPAIR ❑ DATE G USE OF . Date: EXISTING BLDG. DEMOL ❑ BY A Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offeFed for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I, 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). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm.that there is-a construction lending agency for FRONT # a a'0 0 0 1 the performance of the work for which this permit is issued P.L. JSec. 3097, Civ. C.). SIDE I a - 4(150 0 'P.L.. Lender's Name o 0 0 4 Q 5 0 6 P.C.Fee$ Permit Fee Lender's Address 11,2 5=8 6 rI certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with.all County Investigation Fee ordinances and State laws relating to building construction, Total Fee 0 and hereby out orize representatives of this County to enter u the abo ention d property r inspection purposes. • AW �/ hg SEE REVERSE FOR EXPLANATORY LANGUAGE Signature bf Applicant or Agent Dw6 as