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Home My Public Portal About10630 LYNROSE ST_Building__ 76A688ACE0805B-64 APPLICATION FOR IUILDIN'G�'PE MIT• lu1 COUNTY OF.LOS ANGELES ADDRESS. Jv, 5 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY-DIVISION LOCALIT-Y. JOHN A. LAMBIE•. COUNTY ENGINEER NEAREST,' ; COLEMAN W. ANKINS,SUP'T.OF BUILDING CROSS ST. DISTRICT-NO:-- G UP TYPE,. -'PRO E.S$ED BY . FDD OR APPLICANT TO-FILL IN �R � CONST L - STATISTICAL-CLASSIFICATION -SEWER MAP 10630 •Lynrose St.., T. 'C CLASS NO. DWELL UNITS -BK.' PG'" BLOCK USE ZONE, MAP NO. Q SPECIAL N0. OF SLOGS. CONDITIONS LOT NOW ON LOT BLDG, BLDG. SETBACKFROM TELFRONT PROP. LINE OF (STREET) ionel Horse , NO. - TYPE OR' EXISTINO. SETBACK _ HIGHWAY+, YARD = TOTAL AD13RESS9047 E. -Olive St. T. G. HIOH FROMCL. ;+ _ CITY BLDG. 9ETBACK•FROM_ - ARCHITECT OR TEL. ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE ORE%ISTINO SETBACK ' H10HWAY`• { YARD = TOTAL- ADDRESS OTALADDRESS HIGHWAY WIDTH FROM C.L. d -O c3Tlag: eR'Roof Co• NOL287-05 + - ADDRESS LICI a r, CORNER CUTOFF -YES O NO;El O H CITY San Gabrielc� S :;SEE REVERSE SIDE FOR SPECIAL APPROVALS w DESCRIPTION OF WORK _ Z NEW ADD ALTER REPAIR - DEMOLISH MFT. NO. OF NO:.OF SIZE STORIES FAMILIES USE of Reroof house & att. STRUCTURE ar, - •• • with 235# compo. slAngles. SIGNATURE OF APPLICANT VALUATION$'2 60.00 - APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION, LOCATION FEE$ FEE'$6.00 FO.RM$,_MATERIA•LA: FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING-BOLT AND STATE THAT TH ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 'GAS VENT. DUCTS + - SUILDING CONST RU TION. I CERTIFY•THAT: IN DOING THE WORK. • AUTHORIZED HEREBY• ILL N_OT EMPLOY ANY PERSON IN VIOLA: LATH. INT. - TION OF THE LABOR .LL THE STATE F CALIFORNIA RELAT- .ING TO WORKMEN'S PENSATION I�tSURA C LATH.-EXT. - ' SIGNATURE O HOUSE NUMBER COR- PERM ITTEERE AND POSTED'. i ADDRESS 60() Sr)s S.9n CTO 'i�l R}�� F-I NAL JOHN F. LEWIS: PRINCIPALS CT RAL ENGINEER PLAN CHECK VALIDATION, CK. M.O.- CASH ' _ PERMIT,VALIDATIO CK. M.O• cnsH' L o`6 5 6 -5� •OCT 18 1 D 6.Q'Q DEPARTNIENT OF COUNTY ENGINEER BUILDING " 'DIVISION OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE. USE ONLY DISTRICT NO. PLAN CK.OR RBC.NO. PERMIT NO. BUILDING 0/, ADDRESS � vm ig I W2—c) LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST M� ) 3 J"✓� CROSS ST ?�' s+ fes-►.-4,l; 1�= IDe e-Y ,gyp _ BUILDI'NG OWNER !�!/9 .i.c/ 6r'61-rY�7;,tf�.�IMAIL !`_ ADDRESS R �✓ r�� s7 ADDRESS Q f �:al f�,F r'.�l a ` LOCALITY NEAREST }.� CITY I�!� .�i�/1 TO ?14 si r♦ vs CROSS ST. sR ARCHITECT OR TEL FIRE NO. OF TYPE GROUP ENGINEER NO cjr e. ZONE I PLANS BLDG. J ORD. NO. ADDRESS SETBACK LINE � CONTRACTORZONE NO. USE �I"BBTELAYPROVED DATE HOUSE NUMBERING ADDRESS LEGALI !�. I MAP NUMBER ��4* NO. ASSIGNED BY DESCRIPTION LOT NO. .. ✓ BLOCK CORRECTIONS TRACT 'I 1 4� sa ,� I CIS. (] �`/ S/�p!r'�k"-•o iZ1 J �' p NO. OF BLDGB. q SIZE OF P .6' IV .7, I NOW ON LOT USE OF I NO. OF l EXISTING BLDG. FZILIE -��-LBG ►�f� !J _ DESCRIPTION OF WORK cam„,,� .Ja. ,�-- 0-AJ A - Vf ALTERATION ADDITION RE AIR DEMOLITION I� I Z r S ZE _ ROOMS STORIES EXT. WALL ROOF COVERING COVERING USE OF STRUCTURE , APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION:LOCATION �Q FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, /G PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS /i� .L es / l'i CORRECT. ACE:LOCATION. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES SFURNACE:VENT, DUCTS / w AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF ��,./��,,{ LATH, INT. PERMI7TEP S 61 -�F I ttT3 srZ11-a-kAy LATH. EXT. A// ADDR F a PLASTER, INT. AUTHORIZED AGT. PLASTER. EXT. $ FEE S / �JOFINAL HOUSE NUMBER COR- f RECT AND POSTED _ A p VALUATION S Ze� FEE sG �'I ,( I�rrr�r 76ABSOA DBMS 6-52 �� APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDI�JCT,A SS P- ,st4. or a certificate of Workers'Compensation Insurance,or a certified ll[[�J �� 4-6-5 copy thereof(Sec. 80�Lab.'C.) � n 1 %JC � 1 ZI�/ ?8 a rl LOCALITY Policy No.2 Company -ftt3 U� ejn4j�e SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with Athecoty building inspection TRACT BLOCK LOT NO. dep rtm/entc. USE ZONE MAP NO. Date /-7 Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION WORKERS ERf / TEL NO. YES G NO COMPENSATION INSURANCE E/ / A c✓ T11 �� WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADD SS ,7 dollars($100)Or less.) ?3 2 �LY1 � DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit C ��/� / ►� ZIP��7� ] �a ` _3 — - �� is issued, I shall not employ any person in any manner so as to f d become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLAFIF`13ATION APT CONDO Date Applicant ADDRESS CLASS NO. Ke I DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CO RA TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 4.10 FRONT comply with such provisions or this permit shall be deemed revoked. AD EB NO. f PL LICENSED CONTRACTORS DECLARATION >6� L SIDE I uc.�e[�d�s s- P L I hereby affirm that I am licensed underprovisions of Chapter 9 C4a' �- EWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions CodeAhd my)Ie e in full force an eff t. NEW BK PG ® 0} -� DESC 1 10 OF WORK License Number b Lic.Class �� ADD ❑ VALUATION 0 Contractor < Date �- J _� ALTER ❑ $ U 6 ❑ I am exempt under Sec. < < / r "S� REPAIR ❑ BAP.C.for this reason �� S` ^ DEMOL ❑ $ U LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PWNT) TEL NO. LDMA Perm# ❑ I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O ACCT.Tr not intended or offered for sale (Section 7044, Business and FINAL DATE a 330 Professions Code.) D `'`�� °-� WALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of theert ro , am exclusive) contractingOR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE p p y y with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 0 � MS licensed contractors to construct the project (Section 7044, YES[I NO❑ TOTAL X07 a :10— Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHECK 107.10 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH SS`FEL P, CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR _ GUIDELINES CHANGE °Of I hereby affirm that there is a construction lending agency for ves❑ No❑ L 4-i 1'i �,j a the performance of the work for which this permit is issued(Sec. 01 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING N 3097,Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ;}r'�} �'}�} TITLE 2.CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20 140 CONCERNING HAZARDOUS J{J'13 ��Jif a/'?L� � Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. oLender's Address OWNER OR AaEM U5 V L 11 PM 5:la=rk 0 oI certify that I have read this application and state under penalty 0of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE ry-� $ with all county ordinances and State laws relating to building 8 CO construction, and hereb r authorize representatives of this County ISSUANCE FEE m to ent pon the abo - en d property for inspecti urrss j a r l3 INVESTIGATION FEE TOTAL FEE m 1� s ro m :a:m m 4�m SEE REVERSE FOR EXPLANATORY LANGUAGE