HomeMy Public PortalAbout4954 MCCLINTOCK AVE_Building__ 1•Jy .L
FGAR. 6A CE#603„_g, 'APPLICATION FOR BUILDING' PERMIT a.- 1•
COUNTY OF •LOS ANGELES BUILDING �- -�- '
DEPARTMENT OF COUNTY ENGINEER ADDRESS c. ,►�, G
BUILDING AND.SAFETY`DIVISION LOCALITY E;W ) j /
JOHN A.L•AMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN bol-
DISTRICT NO. GROUP I TYPE SEWER MAP
BK PG
BUILDING [[�� CONST.
ADDRESS ) � QC STATISTICAL.CLASSIFICATION
LOT NO. avyot.-All t/ BLOCK CLASS.NO-j--DWELL.bNITG J
MAP l STATE yE5 NO
NUMBER / HWY.
TRACT USE ZONE SPECIAL
j 'NO.OF BLDGS. /� /� CONDITIONS
SIZE OF LOT. ® ®' � I NOW ON LOT (J /� -I
USE OF /�
EXISTING BLDG. BUILDING EXIST.
YARD HWY STREET NAME
6 � SETBACK WIDTH
OWNER. i&.,� AJ FRONT f
MAIL 'P.
ADDRESS �.�1 '� SIDE '
CITY 4-L' / O/v TjtF NE J�7 P.L.
INSPECTION.RECORD' .
ENGlRCHNEERT OR ' o jV�
ADDRESS v k,�
CONTRACTOR
ADDRESS
' • • DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. j ! NO.OF NO.OF
SIZE [ OJ STORIES FAMILIES
USE OF STRUCTURE !N �T®/^� .•V y
i
c • t nm-p-
SIGNATURE OF �� APPROVAL'S
APPLICANT DATE i INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
FORMS,MATERIALS
Ili 7V V FEE FRAME: FIRE STOPS,
BRACING.BOLTS
VALUATIO $ * FURNACE: LOCATION,
11 FEE GAS VENT,DUCTS
I HEREBY ACKNOWLEDGE THAT I.HAVE READ TAUS AP- LATH,INT.
PLICATION AND STWTHE ABOVE IS CORRECT AND
AGREE TO COMPL- COUNTY ORDINANCES ANDSTATE LAWSrREGBUILDING CONSTRUCTION. LATH,EXT. /I
SIGNATURE O HOUSE NUMBER COR-
PERMITT RECT AND POSTED
ADDRESS FINAL
CLYDE N.DIRLA.M,PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION. cK. M.C. CASH PERMIT VALIDATION' K. M.O. ,CASH
(_ACo'5 0 1-60' SEP.19 .2 3 A 16.7 5 t1
,_ACO 5 6"5 8"T act �,. 1 A 3 9. 0 M
• APPLICATION IN PERMIT
L
COUNTY OF LOS ANGELES BUILDING AND SAFETY
i WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN B 1LLDING.eADDDRESS
I hereby affirm that I have a certificate of consent to self insure, BUILDING AD RES
or a certificate of Workers'Compensation Insurance,or a certified &UJ#r
�4^
copy thereof(Sec.3800,Lab.C.) CITM>p�r (T ZIP / Df�
LOCALITY
Policy No. Company SIZE OF LOTNO.OF BLDG&NOW ON LOT
ElCertified copy is hereby furnished. -6D V /99 NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT. �9fJ BLOCK LOT NO USE
department. 7 USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BOOK PAGE PARS
f165SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO.
COMPENSATION INSURANCE O 4622-F W.�-'A/Jl WITHIN 1000 FT.OF SCHOOL? ves No
(This section need not be completed if the permit is for one hundred ADDRESS
/� (j �� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars($100)or less.)
I certify that in the performance of the work for which this permit CITY �� �,7- z�1��
is issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER (� TEL NO.
becomes b' ct to the Workers'Comp rlsation Laws. STATISTICAL CLASSIFICATION APT CONDO
ASS NO.
NOTICETO ICANApplicant If, after�akin���Certificate of ADDRESS CLREOUIREDa�/ DWELL UNITS TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CON A G f T C SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith 5 Cd nJvt- I `� L m FRONT
comply with such provisions or this permit shall be deemed revoked. AVRF.99, e 9 /lu - LI . �_6 PL
LICENSED CONTRACTORS DECLARATION vV �f SIDE
c A&O V/ LIC.c PL
I hereby affirm that I am licensed underprovisions of Chapter 9 � -� SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES
Professions Code,end,r[�c Ii ns in full force ani//§'{fect. I NEW ❑ BK PG , a
License Number 0 6 9 Lic.Class 'y DESCRIP O QF WOK ( �f( ADD � VALUATION � Q
Contractor Date 6 (ill G� �� ALTER ❑ smoo U
l) l osAcq -e i, REPAIR ❑ $ O
cc
❑ I am exempt under Sec. V
BAP.C.for this reason It 6,��, DEMOL ❑ LDMA P/C
te: USE OF EXISTING BLDG. URM ❑ 23 IL
Signature i y APPLICANT(PRINT) TEL NO. LDMA Perm# ACCT.v Z
❑ I, as owner of the p erty, or my employees with wages as ZO 3303 50.50
their sole compensation, will do the work and the structure is ADDRESS
not intended or offered for sale (Section 7044, Business and FINAL DATE G 1
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALC n/ J
El I, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ACCT.J'
licensed contractors to construct the project (Section 7044, YES y 7❑ NO❑ yQ a.a A.14 0
Business and Professions Code.) d ITEMS
e
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING TG
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES TOTAL jL' ' }�o d'
I hereby affirm that there is a construction lending agency for YES❑ NO❑
W the performance of the work for which this permit is issued(Sec. (;(�C�`H 192.70
I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 1
a 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHANGE u�+L
TITLE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS
3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
o Lender's Address
OWNER OR AGENT
c I certify that I have read this application and state under penalty 0000-0001 11/14/95
of perjury that the above information is correct.I agree to comply P.C.FEE f� O PERMIT FEE G
cm with all county ordinances and State laws relating to building �` '� • /d _ - 3290 1 AM10O02
cons ion, and he'7by�authonze representatives of this County ISSUANCE FEE
C13
to
er on the above entioned �erty for inspe Con u poseg,r
n �� INVESTIGATION FEE TOTAL FEE '-
SipClum
(/'/ SEE REVERSE FOR EXPLANATORY LANGUAGE