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HomeMy Public PortalAbout10506 LYNROSE ST_Building__ 7YA888A CE x!808-9-60 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING lU 06 i�y'nrose street DEPARTMENT OF COUNTY ENGINEER ADDRESS 5 BUILDING AND SAFETY DIVISION LOCALITY Temapie L' ' JOHN A. LAMBIE, COUNTY ENGINEER NEARESTJ WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST, r 1°:al DISTRICT N ROUP TYPE P SSED BY FOR APPLICANT TO FILL INI I CONST. rr�� 5u6 r-i STATISTICAL CLASSIFICATION I SEWER MAP ADDRESS i.�• 1, empl-e PG BUILDING 10 '1J nro s e b( Llt 3 T CLASS.NO. DWELL. UNITS LOT NO. 12 BLOCK MAP STATE YES NO NUMBER HWY. TRACT 26�5*54 (� USEEZONE SPECIAL SIZE OF LOT 5v h 89 I NOW ON LOTS laol�.o AlCONDITIONS USE OF A EXISTING BLDG. tl.L . BUILDING EXIST. 11 Lv _ +TEL. r/���-I _SETBACK YARD HWY TREETNAME WIDTH OWNER � P.eY'ier veto lnentNO. ( ,c.� FRONT ADDRESS 13- =-- i eoakhve• �A.rcactia SIDE ARCHITECT ORTEL. td) P. L. ENGINEER 4Y_1• l!r - !?'� NO.�- P. INSPECTION RECORD ADDRESS i$ t Q•_V erriloi�t G I enc ora ;- CL O TEL. i CONTRACTOR1=�.=i„e �pVe.L NO. uaTllA v l; ADDRESS ImDa Ike n aooye 0 O l DESCRIPTION OF WORK v W O_ NEW ADD ALTER REPAIR DEMOLISH - N Z IOZET 5pNO.OF NO. Sj_284 STORIES FAMIO IESUSE OF ! STRUCTURE 2-1or', 43-A ttev• rteslden c 6et—aca __a- Me SIGNATUREO ,q QvU"-L APPLICANT VALUATION$ /:,�F 7e tollQ C I / APPROVALS / - ,D�A E- INSPECTOR'S SIGNATURE PC DATION: LOGATION FORMS,MATERIALSp FEE 1 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 THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEDPHAL NOT t< INT. '� 7 r- EMPLOY ANY ERSON IN A NNER SO AS TO CO S ECT -. TO THE WORKMEN'S GO EN TIONLAWS O.F ALIFO NI eve" pl; Lo LATH.EXT. SIGNATURE OF / HOUSE NUMBER COR- PERMITTEE AND POSTED FINAL a' CLYDE N. DIRLAM, PRINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION aK M.O. CASH PERMIT VALIDATION K. M.O. CASH LAS�7 52 6 o' JAN ?9 2 3 0 2 2.5 0 F Y WORKERS' COMPENSATION DECLARATION F ��L � � / '� W ,�� 1„ I' / �(> "I hereby affirm that I have a certificate of consent to self /1' ®� ®;� �s insure, or o certificate of Workers' Compensation Insurance, A L/;1 E or a certified copy thq._ (Sec 3800, Lab ) COUNTY OF LOS ANGELES BUILDING'AND SAFETY t Policy Nod ?3 t�7— om�pany - , 7 ❑ Certified co is hereby furnished FOR APPLICANT TO FILL IN BUILDING ) 4 copy �y ADDRESS �/ O� �J Certified copy is filed with the county building inspec- BUILDING l ,tion department A RESS J 0 l:� 1 O cs Pi Dat ��� Applicant CITY �� ZIP _ LOCALITY CE IFIC E OF EXEMPTICIROM WORKERS' , NO OF BLDGS NEAREST COMPENSATION I SURANCE SIZE OF LOT NOW ON LOT CROSS ST - (This section need not be�completed if the"permit is for one ASSESSOR- huridred dollars ($100)or less ) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL �y7 TEL USE ZONE MAP I-certify that in the performance of the work for which this OWNER lP•.' /�I NO 7, permit,is'issued, I shall not employ any person in any manner / r /� 14,L4 I _ SPECIAL so,as to become sublecttto the kers'Compensation Laws ADDRESS / Y> Q tN 2CT y�� I CONDITIONS G CITY ZIP C Date Applicant ARCHITECT OR TEL i NOTICE TO APP,LIC T If, after akmg this Certific of DISTRICT GROUP TYPE FIRE PROCESSED BY. ENGINEER- NO ' Exemption, you' should become subject to the Workers' �l�• CONST „� E Compensation provisions of fhe Labor Code,,you must forth- ADDRESS >✓ with 'comply'with such provisions or this permit shall be r v� mr 2 D EL STATISTICAL CLASSIFICATION a APT CO deemed revoked TRACTOR O t LICENSED CONTRACTORS DECLARATION LI CLASS NO DWELL'UNITS I hereby affirm that I am licensed under provisions of Chapter'9. A D ESS �S (. , NO SEWER MAP _ (commencing'with Section 7000)of,Drvision 3 of the Business and C LIC Professions Code, and my license is m full force and effect CITY- cJ'�' (J CLA55 BK VALIDATION5 PG ~ a G �• SQ F NO OF NO OF CHECK i TJ7E:M,D LicenseNumber© n �� �! 4�)Lic Class/s_ © ST I �' /FA^MILIES ONE �� ,License '�/I 6�?!�/l • �f J f� �O O�' GV C7�Yj�S NEW ❑ VA� TION TfSI 75.7 _'� �LyI DESC i N F WORK _ Contractor ate ADD ❑ a �.H >ti ,,tl ❑ T' s I am exempt under Sec h�� ALTER '� CHANGE o B 8P C-for this reason REPAIR $ to Date USE OF jj _ J DEMOL ❑ Z EXISTING BLDG /� / i •t r�/ST Signature APPLICANT TEL- (PRINT) � i�!f—t '�I j jiiJi•O'� O ER-BUILDER DECLA ON, PRINT NO DATV_A - 03�i 2 Amill.� I hereby affirm t t I am exempt from a Contract License :c;- Law for the following reason (Section 7031 5, B iness and ADDRESS - FI L ' Professions Code) j BUILDING E ❑ I, as owner of the property, or my employees with ADDRESS t wages as their sole compensation,will do the work and the structure is not intended'or offered for sale(Section, LOCALITY n 7044, Business and Professions Code) MOVING TEL CONTRACTOR NO 1, as owner of the,property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS - tion 7044, Business and Professions Code) txlbl CONSTRUCTION,LENDING AGENCY SETBACKK YARD HWY TOTAPREOTPAIINE WIDTH ,l 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 Lender's Name ' PC Fee S Permd Fee ,S0 LDMA Ref N Lender's Address- I certify that I have read this application and state that the Issuance Fee r�V J� LDMA P/C M loop- above information is correct I agree to comply with all County Investigation Fee f� 0 ordinances and State laws relating to building construction, Total Fee U •V ✓ LDMA Perm o and hereby authorize representatives of this County to enter ; mppthe above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Appplpliican —Agent Date • - ,