Loading...
HomeMy Public PortalAbout4946 MCCLINTOCK AVE_Building__ 76A688A CE#9081I-S7 APPLICATION FOR BUILDING PERMIT 1• -COUNTY OF LOS ANGELES BUI ElsN ' i o�: ND ..DEPARTMENT OF COUNTY. ENGINEER n k. BUILDING A .SAFETY'DIVISION LOCALITY TCptt. 1) C t JOHN A.LAMBIE.COUNTY ENGINEER NEAREST t CASSATT D.GRIFFIN,SUPT of BUILDING CROSS ST, GtiYli DISTRICT NO. GROUP I TYPE SEWER .MAP FOR APPLICANT TFILL-IN Z BK PG O- , BUILDING'.' �,,, — CONST. wl ADDRESS ! /• !- C_� OG / STATISTICAL CLASSIFICATION CLASS.NO�DWELL"UNITS LOT NO: '��/Gi' HLOCK •MAP STATE - YES NO NUMBER d� - HWY. TRACT USE ZONE SPECIAL /mow `` NO.OF BLDGS. CONDITIONS !' SIZE OF LOT vl 6 NOW ON LOT USE OF r J EXISTING BLDG. BUILDING EXIST.,. YARD HWY STREET NAME y SETBACK ]� /� L L WIDTH OWNER I� l L - & FRONT �U �/ /�` l.�t%tloGX s T P.Lt. 'Y so ADDRESS JJ I- ' SIDE p� y,. y� P.L. CITY- ' ' Z� F'F GPV� 1�.=- Nf{F7 T�.d.0 ARCHITECT OR TEyy . D ' INSPECTION RECORD ENGINEER �� NO5• /1 ADDRESS T' �Jt• _ •��. � � - ,:fc3J4•'�`{fes.!, . CONTRACTOR C • v f� ADDRESS DESCRIPTION OF WORK j NEW ADD ALTER REPAIR DEMOLISH i SQ.FT. j s� NQ.OF NO.OF SIZE J✓v4 fD STORIES FAMILIES `r USEOQ'STRUCTJ9RE •" Q ' _c SIGNATURE APPLICAN _ DATE INSPECTOR'S SIGNATURE / ADDRESSFOUNDATION: LOCATION / I /Y P.C. $ FORMS,MATERIALS // '/•�fi7' •� eZzlik 1✓'�bZ�j1 f0 7 FRAME: FIRE STOPS, �I FEE •.BRACING,BOLTS t / - / .�L/er�.�_�F".I.e.•. VALUATION ' $ - ti FGAS VENT,DUCTS LOCATION. FEE + 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THS AP- LATH,INT. E►/`'l PLICATION AND STATE THAT THE'ABOVE IS CORRECT AND AGREE TO COMP ITH A COUNTY ORDINANCES AND STATE LAWS GU Tl I' UILDING CONSTRUCTION. LATH,EXT. K• /h SIGNATURE O HOUSE NUMBER COR-,• PERMITTE RECT AND POSTED J ADDRES / FINAL i- ' CLYDE N.DIRLAM,'P INCIPAL STRU RAL ENGINEER PLAN CHECK VALIDATION OK. m.o. CAsH PERMIT VALIDATION cK. M.o.. CASH (_ACO:5 0 1 5 SEP- 19 2 -3 A 1 6.7,5 A M = !Co5 S 5 7�' QC i 1 p �1 A . 3.9.00 • _ . o WORKERS' COMPENSATION DECLARATION hereb�/ affirm that I have a certificate of consent to self APPLICATION F OR BUILDING P E 81111 I T ofjnsure,Jor a certificate of Workers' Compensation Insurance, or a c%tified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company v BUILDING ,/� �'� () 1 , s..�,,,,K �e 1E ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN . gOeREss C 6.OR//(,1L, Y/ ❑ Certified copy is filed with the county building inspec- BUILDING t - tion department. ADDRE'S/S �� ( /( l /� yr-� Date Applicant CITY '1 G;� /j// � i' (� zIP C %/¢G LocALlrr EHPL E C 7' / NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT _ / NOW ON LOT z;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. r ` OWNER , . [ NO.L^ v'J3 USE ZONE MAP NO. I certify that in the performance of the work for which this G / /! SPECIAL >- permit is issued, I shall not employ any person in any manner ADDRESS C GG z CONDITIONS EL so as to become subject to the Workers'Compensation Laws. r O CITY / ZIP 02 Date Applicant ARCHITECT OR TEL• t DISTRICT GROUP TYPE FIRE ROCESSED BY O iNOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. E t— kxempption, you p should become subject t y the Workers' �: P-3 9J Uom ensation rovisions of the Labor Code, ou must forth- ADDRESS 7 V with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSI ON APT. CONDO. N deemed revoked. CONTRACTOR NO. , Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I•iereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO.OF CHECK Lice ise Number Lic. Class SIZE ��Z STORIES FAMILIES ONE +i' VALUATION Con}rCctor Date DESCRIPTION OF WORK NEW IJ ,Y $ ADD ❑I am exempt under Sec. [��" �"• /'?ooW! irPA ALTER 0 �y//7�� B.&P.C. for this reason USE OF REPAIR ❑ $ Date: r EXISTING BLDG. nD AA DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS ,f FINAL 1 Prpfessions Code): PRESENT By ACCT. ea BUILDING © I, as owner of the property, or my employees with ADDRESS `; wages as their sole compensation,will do the work and 3307 .,. the structure is not intended or offered for sale(Section LOCALITY ,'; 1/j° ?5 7044, Burliness and Professions Code.) MOVING TEL. ® f ❑ 1,as owner.of the property,am exclusively contracting CONTRACTOR NO. ITEMS MJ with licensed contractors to construct the project (Sec- -1 . 75ADDRESS TOTAL 17 tion 7044, Business and Professions Code.) s CHECK e REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. L v 7{ ° tip CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH Pr- Ihereby affirm that there is a construction lending agency for FRONT GHANUC a[(!t the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. $ Lender's Name L� LDMA Ref. # I]000-0001 11/16/89 P.C. Fee$ Permit Fee ° �✓ 6853 1 AM11040 Lender's Address C� a 1 certify that I have read this application and state that the Issuance Fee O LDMA P/C# 00. above information is correct.I agree to comply with all County Investigation Fee ordinances and State laws relatingto building construction, and hereb g Total Fee LDMA Perm. # y authorize re esentatives of this County to enter upon th ment' d property for inspection purposes. ie — SEE REVERSE FOR EXPLANATORY LANGUAGE i icant or Agent Date