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Home My Public Portal About5004 MCCLINTOCK AVE_Building__ 76A638A CEAS03 8-64 APPL@CA Y ION FOR V IL®INV/PERMIT CCLUNTY OF LOS ANGELES BUILDING f DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY z 2 JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST. Q v DISTRIC O. GROUP TYPE PR SSED BY I jr FOR APPLICANT TO FILL IN '� CONST. LC // STATISTICAL CLASSIFICATION S MAP �y ADORESSG ov— C 4ic CLASS NO.�3.DWELL UNITS BK ADORE / S LOT NO. t BLOCK USE ZONEMAP ! J NO. TRACT / SPECIAL - N0. OF BLDGS. l CONDITIONS SIZE OF LOT NOW ON LOT USE OF IS N BLDG. SETBACK FROM �y� ` TEL. FRONT PROP. LINE OFecz6'"� (STREET) OWNER �6.. NO. 07 r TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS Odla C / HIG AY IDT FROM C.L. CITY E (.S TY BLDG. SETBACK �M + � ARCHITECT OR TEL. SIDE PROP. LINE OF '� '(STREET) ENGINEER NO. TYPE OF EXISTING ISETBACK I HIGHWAY + YARD = TOTAL ADDRESS HIG WAY PDTH I FROM C.L.I d 01 u CONTRACTOR Ed, %, TE!E - ,Z �� + - O LIC ADDRESS CORNER CUTOFF YES NO O UN E O CITY Qfaj20QA CL� Ss SEE REVERSE SIDE FOR SPECIAL APPROVALS V W DESCRIPTION OF WORK ` y , Z NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO. OF NO. OF SIZE 79 9w&jg&A7- STORIES FAMILIES USE OF STRUCTURE Locle SIGNATURE OF APPLICANT n �, VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. - PMT. FOUNDATION, LOCATION FEE$ FEE$ _ FORMS, MATERIALS _ FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 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. LATH. EXT. COR- PERMITTEE OF -� HOUSE RECT ANDEPOSTTED ADDRESS 0 0 OOOfff C FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ErCA ER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O Ad? � A R0 D DEPT. FE i:T 13. �S.e.�cL.1:E�"3� . % FOR AN( !J'ATE l;,l. S;_;RA-* , OR WORK y DONE IN THE ROAD RiGrii OF.WAY. 78A888A CE 1808 G.n APPLICATION FOR BUILDING -PERMIT.- 1� COUNTY OF LOS ANGELES BUILDING ADDRESS 00 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE, COUNTY ENGINEER' . NEAREST CASSATT D.GRIFFIN SUPT OF BUILDING/ CROSS ST: @ DISTRICI NO. G TYP PROCESSED j3Y. FOR APPLICANT TO FILL INS . I .coNs-r , _ FUDDILR NG �yJ STATISTICAL CLASSIFICATION SS OO ///e CSG//�Ao e- / n r CLASS.NO.�DWELL.UNIT4 /. ." /00/2(fOfV 0r- LO% 'BLOCK MAP :.STATE YES O 'N NUMBER HWY. 3. USE ZONE. SPECIAL NO.OF BLDGS. — CONDITIONS F LOT O NOW ON LOT OAl� .NG BLDG. -14 . BUILDING ' YARD HWY STREET NAME EXIST. SETBACK WIDTH ' OWNER It, O1N 912 FRONTMAIL ADDRESS :SPIDE / y All TEL. �7 CITY r- NO.* INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. O ADDRESS TEL. CONTRACTOR ! NO. 0177- ADDRESS :Z7 44 3149e=414 %` DESCRIPTION OF WORK' NEW ADD ALTER REPAIR DEMOLISH SQ. FT. n NO. OF - NO. OF- �i%!•�U An i✓ 771r �`� (// C G� SIZE �iC STORIES' FAMILIES r. '' / USE OF STRUCTURE S'IIWAg f �✓C!�!i/n/ i /_ ► SIGNATURE-OF ot .4-\zIJ&19 1: Q P_lest'�•Co' APPLICA14T /T APPROVALS .DATE INSPECTOR'S SIGNATURE �f/eZir ( Qa j,Grwce,.S(�'• (� FOUNDATION:LOCATION ADDRESS �J FORMS,MATERIALS VALUATION FRAME:FIRE STOPS, BRACING,BOLTS FEE S(� FEE S FURNACE:GASVENT,DUCTS LOCATION, 1 HEREBY'ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND STATE' LAWSAGREE TOMREY WITH ALLBUILDING CONSTRUCT ONCOUNTY ORDINANCES � LATH,EXT. HOUSE NUMBER COR- PERMITITUEE OF RECTANDPOSTED ADDRES 9 FINAL CLYDE N. DIRT AM,'FSR INCIPA1.STR� RAL ENGINEER PIAN, CHECK VALIDATION CK. M.o. CA6H PERMIT VALIDATION cK. M.O. cases L&O9.7 5 1 w heti 2 2 2 .3 A ' .cJ ®% '' / (��0991 ,3 � . APR 7 I A 45. 0. �. s WORKERS' COMPENSATION DECLARATION Y insure, or affcertif catte of Workers' CompensatioI have a certificate of n ent to self Insurance, APPLICATION F O� BUILDING P E RIVI IT or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElBUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Ciie4 /,;tL C Li j 6CK Ajs ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 45—C OY XC Cl_UNLO C I< AveEj,�f� CTT i( Date Applicant CITY 7526Merr // Y ZIP 17J? LOCALITY NO. OF BLDGS. EST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST./e d 7 gf lvp .S%, 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.) — USE ZONE MAP OWNER t CC s J NO. ' NO. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS COQ �� LLIAl1_o C!C �V c' ; �`/ CONDITIONS a so as to become subject to the Workers'C mpensation Laws. �/� O X/ CIN r�/1q ,I y ZIP E U Date��Applicant ; �u r ARCHITECT OR TEL. W DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER �IJJ/E NO. CONST ZONE Exemption, you should become subject to the Workers' U Compensation provisions of the Labor Code, you must forth- ADDRESS ` w ._ 3 with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSON APT. CONDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby 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 VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic. Class SIZE T STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ '- /.--. ADD $ El am exempt under Sec. ^ t F5 Cc F �A/ ALTER ❑ pool B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. (PRINT) NO. FINAL OWNER-BUILDER DECLARATION DAT -� I hereby affirm that I am exempt from the Contractor's License ADDRESS Law for the following reason (Section 7031.5, Business and FIN 1 Professions Code): PRESENT B Ivs I, as owner of the property, or m employees with P P Y� YAD RIE"ss - ACCT�4 wages as their sole compensation,will do the work and .,� O -, the structure is not intended or offered for sale(Section LOCALITY ;® `307 6,.,,6,E 7044, Business and Professions Code.) MOVING TEL. CONTRACTOR NO. 1 ITEMS ❑ I,as owner of the property,am exclusively contracting w� with licensed contractors to construct the project (Sec- ADDRESS TOTAL 68.463 tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY rorAPROPALIINEFROM WIDTH CHECK 68.0�n I hereby affirm that there is a construction lending agency for FRONT r CHANCE n W the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name DOM—M1 6/26/8n P.C. Fee$ permit Fee LDMA`Ref. # So Lender's Address (-- it<}q 1 A�( „e 14 I certify that I have read this application and state that the Issuance Fee t J LDMA PSC# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter upo theabove-pentioneproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date