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HomeMy Public PortalAbout4925 MCCLINTOCK AVE_Building__ APPLICATION FOR COUNTY OF LOS ANGELES /- BUILDING PERMIT DEPARTMENT ENGINEER BUILDING AND SAFETY DNIS ON BUILDINGAl Ly n� v FOR APPLICANT TO FILL IN ADDRESS o' BUILDING . ADDRESS GC- OCALITY L'J -��1 n NEAREST CITY •''/ �:.s ZIP CROSS ST. ` O.OF BLDGS. ) ASSESSOR SIZE OF LOT NOW ON LOT / MAP BOOK PAGE PARC cc �^ DISTRICT GROUP TYPE FIRE ROC ED BY TRACT 8 BLOCK LOT NC6 J e'�a� CONT! ZE TEL. u �/ OWNER9tg�1� �•�NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS oC �!U ` CLASS NO. DWELL.UNITS G BK/1 7G CITY USE ZONE MAP C �►L ZIP NO. u ARCHITECT OR TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACT �.� NOLb o[ �d BLDG.SETBACK FROM ' II'' LIC FRONT PROP.LINE OF (STREET) ADDRESS ,?,/�. , 1A/ O. q WLI HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING p`� LIC. FRONT PROP. LINE HIGHWAY WIDTH CITY �G CLASS _ CONSTRUCTION LENDER + NAME AND BRANCH a BLDG.SETBACK FROM C7 ADDRKS CITY SIDE PROP.LINE OF (STREET) v SF NO. OF NO. LI HIGHWAY WIDTH CHECK HIGHWAY TOTAL SETBACK FROM TYPE OF EXISTING YARD - C=SIZIZ E � STORIES FAMILIES ONE SIDE PROP. LINE C.7 DESCRIPTION OF WOR NEW + Ti I� '• ADD CORNER CUTOFF YES ❑ NO ❑ Z • LTER ❑ ... .., REPAIR[-] IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. DEMOL ❑ �f/ [ ��j`'� R� APPLICA TEL `�J) /y�� ljr�r/.f: •Q.4)e-4. (PRINT) � L' LL NO. � a c� !� BY (SIGNATURE)V!remlg •'�" •� '• I HEREBY ACKNOWLEDGE THAT 1 HAVE READ IS APPLICATION �(q' f fir' A pA�r r 5T'• _ AND 5TATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY ORDINANCESWITH ALL STRUCTION. II W CERTIIFY THAT LNDOING LI NG THE1 WORK AUTHORIZED ��%�7 /�7��"�.•�' � -� HEREBY 1 WILL NLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF T TATE OF CALIFORNIA IN RELATING TO i WORKMEN'S ,OMP N INSURAN E. SIGNATURE OF FINAL �� ��77 BY PERMITTEE DATE ADDRESS J CITY / NOL JI�S P.C. Fee$ ' Permit Fee .a Issuance Fee VALUATION � 1 Tgtal FeeZ g2 oc, PLAN CHECK VA TIOCK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 863c'o-.M 8 0 5 3.5 5 4 5 29A'AUG 3 1 © 89.25A98 76AG38A CEOB03B 12/75 APPLICATION FOR `"� PL COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER = �U I L D I N G PERM 1 T BUILDING AND SAFETY DIVISION 4 FOR APPLICANT TO FILL IN ADIDRESS BUILDING ADDRESS-49?--t; TAA� S ' LC CLINTOCI. LOCALIT NEAREST CITY "C�I�P�c C)'iY ZIP CROSS ST. Ii NO.OF BLDGS. ASSESSOR SIZE OF LOT�'� 1 NOW ON LOT I MAP BOOK PAGE PARC i. t DISTRICT I GROUP TYPE FIRE OC ED BY TRACT'g0 7— BLOCK 1= LOT NO. �--V S� ' CONST !IE TEL. V OWNER R\fJIN SCHRE`f NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS -"ZS M G cL[>v FCaG1C CLASS NO;! / DWELL.UNITS l� BK/f CITY ILr�.I -.� G�T� USE ZONE MAP ZIP NO. or�v � ARCHITECT OR TEL. j SPECIAL ENGINEER - IVO• CONDITIONS ADDRESS ca". ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR CELIAR PINE CDNTTN L-( iL-C3 BLDG.SETBACK FROM �� ;• FRONT PROP.LINE OF (STREET) ADDRESS f(M r. WASH INGI'QVyNO. ZA" IG HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. J FRONT PROP: LINE HIGHWAY WIDTH CITY v✓NI�'l I�R CLASS 13-1 _ CONSTRUCTION LENDER + NAME AND BRANCH BLDG.SETBACK FROM p ADDRESS CITY SIDE PROP.LINE OF (STREET) C7 SQ. FTNO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING C SIZE ,o T ) STORIES I FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH F DESCRIPTION OF WORK NEW + _ h ADD CORNER CUTOFF YES ❑ NO ❑ Z LTER ❑ -REPAIR IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. .-� ItArvLC. -�y•P/���M . bW// &6RL ❑ APPLICANT, (PRINT) Y le: =.A- VLI�+ N01. BY (SIGNATURE) ��• /-2�a 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 3 �7 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE OF,. CALI RNIA 1 RE ING TO WORKMEN' 0 P N A I 'I A CE SIG PNATURE OF FINAL S- - BY ERMITTEE d� DATE ADDRESS `� V�AS5HIN�TOI�1 SSV L. CITY VVI-kt`C`C'IG�— NO. G9Z—q-1Rg.. Fee$ Permit Fee f s Issuance Fee VALUATION$ (y V LJ Total Fee PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION (:,./o. CASH 5 9 OL'4116 10 .1- D 1 5.0 0 A98 76AG38A CK*8038 12/75 TEMPLE CB 7 V/. YU63M C8#908.1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ' DEPARTMENT OF COUNTY ENGINM ADDRESS BUILDING AND SAFETY DMSION LOCALITY t JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. �C / DISTRICT NO. GROUP TYPE ESSED BY FOR APPLICANT TO FILL IN CO/ CONST-Y-1, BUILDING / • STATISTICAL CLASSIFICATION SEWER MAP ADDRESS , CLASS.NO.-9--,)WELL.UNITS_= LOT NO. BLOCK WATER NOT REQUIRED RECEIVED J CERTIFICATE: TRACT �7 MAP cyr��Sf HIGHWAY STATE MAJOR SECOND, LOCAL i-'� NO.OF SLOGS. NO. �LC� 5 (CIRCLE) SIZE OF LOT !� �� I NOW ON LOT USE ZONE SPECIAL USE OF y CONDITIONS EXISTING BLDG. / 'TEL. OWNER O BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDR S FRONT f!i ARCHITECT OR TEL. •P.L. ENGINEER NO. SIDE •P.L. ADDRESS a TEL, INSPECTION RECORD O0 CONTRACTOR NO. ADDRESS O DESCRIPTION OF WORK G a N NEW ADD ALTER REPAIR DEMOLISH Z SQ.FT: NO.OF NO.OF IZE STORIES FAMILIES USE OF STRUCTURE ,) SIGNATURE OF APPLICANT VALUATION$ 17 APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION /J FEE $ FEE'S FORMS,MATERIALS .FRAME:.FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS 1 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. 1 CERTIFY THAT IN DOING THE WORK / AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. \ '` TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. /j r LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- P �����iCCCCCC PY RECT AND POSTED �f ADDRES FINAL 1D ;L +d ,✓"� CLYDE N. DIRLAM, PRIN61PALSTRUCTURAL EN � ER PLAN CMCK VALIDATION CK. M.D. cASR ► PERMIT VALIDATION cK. sato. CASH 'GAGS@A0 808.9.80 '� APPLICATIONOR. I BIL ING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGIl� R ADDRESS *4Z2-f— BUILDING AND SAFETY DIWSION LOCALI JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DISTRICT. O. GROUP I TYP P CESSED BY FOR APPLICANT TO FILL IN S"6 CONS`� BUILDING L' ©/1 �i�' STATISTICAL CLASSIFICATION EV1/KR MAPS ADDRESS Gi/ 1 r+ �+ CLASS.IVO. DVNELL.UNITS I LOT NO. ' ' S BLOCK F NUMBER HWYMAP '. YESNO TRACT �7 Z U USE ZONE SPECIAL e�( ` NO.OF BLDGS. CONDITIONS SIZE OF LOTS /� O I NOW ON LOT USEOFA EXISTING B DG, r— I ``'' .�^ BUILDING YARD HWY STREET NAME EXIST. OWNE O.`�v `� SFRONTK ..tr►► ^^ WIDTH P.L. oL�U (✓ • V ADDRES aZ b' lit SIDE ARCHITECT OR TEL. F.L. ENGINEER NO. INSPECTION RECORD } ADDRESS f O- TEL. 'g ! t/I / 0 t9,0CONTRACTOR � NO. //� ),),r-.l �y ADDRESS / �• DESCRIPTION OF WORK - �%> >l/ ;, rm -°Pu /1R. v• NEW ADD ALTER REPAIR DEMOLISH f - /� SQ.FT. /! s1� NO.OF ) NO.OF C�CAb/1 mat d, lel r=.•'ry'.G'K� fY� SIZEUSE OF( STORIES ( FAMILIES STRUCTURE �D SIGNATURE C APPLICANT VALUATION$ I APPROVALS DATE / INSPECTOR'S SIGNATURE FOUNDATION:LOCATION P.C. T� FPMT. �°G"� FORMS,MATERIALS ��f`r�/ r v ,�t""�' •�- $� FEE $ FRAME:FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 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 ISSUED 1 SHALL NOT LATH,INT. / 1 .saw 440 EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBU_ECT TO THE WORKMEN'S MPENSAT ON LAWS OF CALIFORNIA. ,s ///� LATH,EXT. , ((,r I {{FFFF����LZZLZZt►II 4 SIGNATURE OF / �i HOUSE NUMBER COR- � � �� i"^ PERMITT a��- RECT AND POSTED J rY V ADDRESS FINAL �_ . � CLYDE N. DIRLAM, PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATIONCK. M.O. CASH PERMIT VALIDATION cK M.o. CASH + 2 J t Lif COB 5 8 5.'o JUH D 45.00 M WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION F O SBUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy they of(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.102541 &Company El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDINGADDRESS CCC.lnJTO Certified copy is filed with the county building inspec- BUILDING 41,&S f 7 r tion department. ADDR-ESSSpm-P ,&S CCC.! ✓c—. ) Id—s--6v ZIP 1,1040 LOCALITY 7 (, Date Applicant NO.OF BLDGS. NEAREST CERTIFICA E 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 dollars ($100)or less.) TEL p /_ OWNER AD/ S�tf NO.�� i�'Q,Z (� USE ONE rNO I certify that in the performance of the work for which this SP PECIAL permit is issued, I shall not employ any person in any manner ADDRESS A A4 rw � � k-ud • ` DITIONS a- so as to become subject to the Workers'Compensation Laws. /��1 O CITY Ct (� ZIP /-7�V ix Date Applicant ARCHITECT OR TEL. DISTRICTOUP TYPE RE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. .� CON FE U Exemption, you should become subject to the Workers' w Compensation provisions of the Labor Code, you must forth- ADDRESS a„ with comply with such provisions or this permit shall be TEL. c.STATISTI L CLASSIFICATION APT CONDO. N deemed revoked. CONTRACTOR e4+Q_7, NO.�-SS Z LICENSED CONTRACTORS DECLARATIONLIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 9.6gz 6, of NO.475� �-- (commencing with Section 7000)of Division 3 of the Businessfl LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY7�Q`Nj 7 CLASS ° BK Q 9 VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ O O ADD ❑ ❑I am exempt under Sec. V ALTER ❑ B.BP.C. for this reason REPAIR.® $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT aS S No.. �3 S SQ FINAL OWNER-BUILDER DECLARATION PRINT I hereby affirm that I am exempt from the Contractor's License 3 �� I DGS �r DATE Law for the following reason (Section 7031.5, Business and ADDRESS . FINAL Professions Code): PRESENT By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS CHANa ITEMS .011 wages as their sole compensation,will do the work and ._•� the structure is not intended or offered for sale(Section LOCALITY ® ,l i TOTAL 7.8 o 090 7044, Business and Professions Code.) MOVING TEL. ., �a CONTRACTOR NO. '� . i 10KID1 01 12 f T189 ❑ I,as owner of the property,am exclusively contracting C: f. , t with licensed contractors to construct the project (Sec- ADDRESS � ��} 1 A�i11�[15` tion 7044, Business and Professions Code.) i 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 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name C 7l LDMA Ref. # P.C. Fee$ Permit Fee v (J Lender's Address 7 I certify that I have read this application and state that the Issuance F .� C/ LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fe 1S i V V LDMA Perm. # and hereby authorize representatives of this County to enter upon th above-mentioned y for inspection purposes. ? a)'• - SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date