HomeMy Public PortalAbout5134 MCCLINTOCK AVE_Building__ 76A638A CE#803 2-63APPLICATION FOR' BUILDING. PERMIT ,.
COUNTY•'OF'LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS'
BUILDING AND SAFETY DIVISION ' LOCALITY
.JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN, SUP'T'OF BUILDING CROSS ST:'
DISTRI T N GRO P TYPE P SSED BY
FOR APPLICANT TO FILL IN L CONST.•
BUILDING
`7 / (•4 .�[�/yG C/`1 STAT.ISfICAL CLAS CATION E'K R MA G
'CLASS. NO. - DWE'L'L.UNITS �� +
LOT NO. I 0, BLOCK WATER NOT REQUIRED RECEIVED El
CERTIFICATE.
TRACT MAP HIGHWAY
SIZE OF LOT r fNO.OF S NO.tic ICIRCLEI STATE MAJOR SECOND, OCAA
NOW ON LOT
USE NE SPECIAL l
USE OF i CONDITIONS
EXISTING BLDG. oil
OWNER 40. e-40ff F/� TEL. 7
NO. B ILDI rTG YARDHWY STREET AME EXIST.
SETBACK WIDTH
ADDRESS FRONT
ARCHITECT OR TEL. P,L.
ENGINEER NO. SIDE
ADDRESS P L a
_
CONTRACTOR+ �/,'V 'VVI !"Y��� O. �lTa [ , _ O
ADDRESS O
DESCRIPTION OF WORK _ W
NEW ADD -- ALTER REPAIR DEMOLISH
SQ.FT. NO.OF NO. OF r
SIZE �� STORIES f FAMILIES USE OF -�~ n
L
L�/F 6��. �-
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FEE $ lr�� FEE FORMS, MATERIALS D (•;
FRAME: FIRE STOPS, / /� p
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS I �' ` alr,��•
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. O
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS i
BUILDING 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' COMPENSATION INSURANCE. LATH, EXT.
SIGNATURE --1
OF
�. HOUSE NUMBER COR.
PERMITTEE [�. RECT AND POSTED -
ADDRESS ® • FINAL 10-[Q-ff� t
JOHN F. LEWIS, PRINCIPAL STRUC URAL ENGI R
PLAN ECK VALIDATION. CK. M'.O.- CASH _ PERMIT VALIDATION CK. M.O. CASH
15.0
44,
L
WTy
F BUILDING AND SAFETY BUILDING
OF LOS ANGELES Rpm APPLICATION
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
y /] DISTRICT NO. PLAN CK.OR REc.NO. PERMIT NO.
ADDRESS / 4 U JA�7 f0ti N {F Y� d 167
/'� d REFELV]E�D/9Y DAT FF,#PPL. DATE�1J89UED
/
LOCALITY � � 1'7 � 'Z / ✓-�°°' � � / ��
NEAREST
ORD ST. BUILDING /�///1 �-�• ,(
ADDRESS
OWNER JV / -
MAIL BJ j LOCALITY -7—, G
ADDRESS Af JAlA 7 d,/J/ AQW0A,L /1141-07j' t4EAREST
a TELCITY /16 EA EL f 1 NO.t—but //� .L FIRE CRC388 9T. I O.OF I TYPE GROUP�
ARCHITECT OR TEL ZONE LANE y
ENGINEER /�j/7/,E, NO. BLDG. / ORD. NO.
SETBACK LINE � ! 4"�
ADDRESS USE -� APPROVED
CONTRACTOR �}W& t� TEL ZONE BY DATE
,-
NO. HOUSE NUMBERING
ADDRESS MAP NUMBER �n CJ NO. A551GNE /BY-
LEGALP"/
a .3-27 CQRRECTIONS
DESCRIPTION LOT NO. /� BLOCK /
TRACT 13g%:fAj ff4 r4 ex/.r
�• NO. OF ELDGE.
SIZE OF LOT �.J I NOW ON LOT rJ C j� �r 5^a
USE OF NO.OF 7�
EXISTIN BLDG. FAMILIES
DESCRIPTION OF WORK / D
NEW x ALTERATION ADDITION 2
f"i h?CSTo6�' ��oiJ niv �11�•.1,,
r
REPAIR J DEMOLITION
91ZE // 4 ROOMS STORIES / Zw r rAgA A- �T/e, yGGay/7'
EXT.WALL ROOF 7 T�JI
COVERING` 7,0 C_� I COVERING
USE OF STRUCTURE
�ra,Q L� A/A,1,1,
INSPECTION FOR APPROVALS
OCCUPANCYAS �-1� '� /A!� INSPECTORPS 51GNATURE DATE
FOUNDATION: LOCATION
FORMS, MATERIALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- ,-
PLICATION AND STATE THAT THE INFORMATION GIVEN 19 FRAME: FIRE STOPS,
CORRECT. BRACING,BOLTS A.
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
i GAS VENT.DUCTS
SIGNATURE OF LATH, INT. I ��
PERMITTEE
LATH, EXT.
ADDRESS-4f97
PLASTER, INT.
AUTHORIZED AST.
:Zr O O O PLASTER, EXT. i
P.C.
$ 7'�b FEE S �� HOUSE NUMBER
J�o / RECT AND POSTED
VALUATION 7 REE � Z a FINAL w /
a_7 f Ak=SA DSS 3 7-51 1
®s 76A6 .
CE/$03(REV.6/78) /
a
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDI`N� AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS, �fc _
BUILDING J
ADDRESS �7 r r1 c C C,� � 6.0 LOCALITY -� C
_ NEAREST
CITY •P 'y CLQ ('j � • ZIP (7// ` b CROSSST.
Q '4J
NO.OF BLDGS. ASSESSOR
SIZE OF LOT ..NOW ON LOT MAP BOOK PAGE PARCEL
TRACT BLOCK LOT NO. (� • DISTRICT GROUP CONST FIRE
RE CIC S D BY
0 / 3 !/ �s�' 1� °Y
OWNER CJ�1.S" � � NO. `� 73STATISTICAL CLASSIFICATION SEWER MAP
ADDRES�S` 14 Y Inc L1. (�l Cy CLASS NO. -)-/ DWELL.UNITS.—j BK'/
CITY``: >m `-tom ZIP ( / d
ARCHITECT OR TEL. VALUATION $ Z O D
ENGINEE NO.
ADDRESS BLDG.SETBACK FROM
1��, C-6
TEL. ✓/(� _ FRONT PROP.LINE OF (STREET)
CONTRACTOR <W l_Z5 TEL,42 1- 1 7� TOTAL SETBACK FROM TYPE OF EXISTING
^^ �/�/� LIC HIGHWAY + YARD. = FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS(01 b W. Y ! �a11 P— NO. -3c.)2.31
CITY �J Q CLASS l_"(0 + -
CONSTRUCTION LENDER SI DG.,SETB FROM'
SIDE PROP.LININEOF. (STREET(
NAME AND BRANCH
TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD =
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH
SO.FT. Q NO.OF NO.OF CHECK + _
SIZE J�� STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW ❑ P.C.Fee$ �"� •�O Permit Fee ;y- U
L U m Ces CK-[ AD ER ElIssuance Fee Ub
� l REPAIR ❑ Total Fee
USE OF DEMOL ❑
EXISTING BLDG. Z
APPLICANT , f TEL �') `] /G�V � a��/ C
IPRIN • Qa. ��Ib"NO��'�7
. 194 P
BY ISIG /�/ �(/(/ c
ll ° ° ° ° 23
I. REBY KNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE •LQ��Y1 "�?.� uw
TH THE VE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES ) G2 Ib
RK
LAW
TH EGULATHERE YI'DING WILLONSEMPLOY ANY PE CERTIFY
TSON INT I DOI ONTHE
w N -] U 7 U 3�- /m 2-0 021.6O
THE R DE OF THE ATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM. / z •o 0 0 21.6 0 U
TION NSU RAN'E.
SIGNATURE �
' d 01, 1 '6-79
PERMITTEE 'c 2 2 4,2{�
ADDRE 6 - 7 Z
�US
/ NAP/ Q 000 ° 01
ZONE MAP
� 2 ° ° 34;00
NO. �
SPECIAL 0 3/L O 05
DITIONS
FINAL BY• �/ // `O 7
9
DATE • �� /�
DIVISION OF BUII.DING AND-SAFETY• � !i;
DING
Depas- on t of County Engineer i Ly
County of Los Angeles
WM. J. FOX, COUNTY ENGINEER APPLICATION.
BUILDING -T�
FOR APPIWANT•;TO FILL IN ADDRESS 5 3.!P,
BUILDING r LOCALITY
ADDRESS r rS a /1 '(.rte.4/...�.s G��-- i
.� - �. NEAREST i -.
w ♦ ,�a. Jr _ CROSS ST. �w f\ �`
LOCALITY , E_-a.,..�;y_r�i=, (,r��w• x DISTRICT NO. u►N CR.•dR REG.NO. PERMI NO.
NEART
tr /J
CROSSESST.
OWNER /////RECEIVED�B^Y DATE OF APPL. DATE 1S8UED• _
MAIL ` �y,,,t� r • 611016 ..ja__
ADDRESS. 17 ��Jj'� u�^'rt�'•%F �'� USE ZONE NO. OF TYPE GROUP FIRE ZONE
CITY . per GG!.Cr�. NOL "D4!o 7 I PLANS I I I
ARCHITECT OR TEL.. AI ZONING.' _DATED
ENGINEER NO. APPROVED By--
BUILDING
ADDRESS SETBACK LINE: /
�'' TEL-. APPROVEDDATE
CONTRACTOR Aft s i _ �''NO. By,
�HOUSE NUMBERING
ADDRESS
LEGALS 4 MAP NUMBER / NO. ASSIGNED B
.roY
DESCRIPTION . LOT NO. ') I' BLOCK
/ U DATE I CORRECTIONS I INSPECTOR
TRACT
NO. OR SLOGS. '� fr. .d ��I✓E• rT „1�,-'i' .
SIZE OF LOT S_i ��^ / Llraa�i I NOW-ON LOT
IJ.7,l �'! �/ x
USE OF NO. OF
FAMILI•ES a
l YI :i(
L 4 1�
EXISTING I �) t Oi /.
L /�/ L'T•"t I ��lrv�,Gc6!"
DESCRIPTIOWOF WORK
NEW ALTERATION ADDITION - /U,�r t� IP l fJ e'Y 1 P.=��_,`� 9
�— P
REPAIR DEMOLITION - &�
SQ. FT. s�-.y� NO. OF
SIZE t 7J ROOMS ! STORIES q 1 11
EXT. WALL I ROOF r
COVERING/,Z _/ r� �7 COVERING '9tiw✓' 7y e
USE OF 81
/R CTURE
�f /I��CC� JL//�0{n -[..P /fFd. ..tr f� i / -w !r✓" q� I
I �,�- iF,.••'v-cs Jy- V
APPROV
�-
INSPECTOR• SIGNATURE DATE
_ FOUNDATION-' LOCATION
FORMS, MATERIALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-' FRAME: FIRE STOPS, f f fs
PLICATION AND STATE THAT THE INFORMATION GIVEN IS ' r
CORRECT. BRACING, BOLTS I .�•FZ' E1r�'" / 'r r3
1 AGREE TO COMPLY WITH-ALL COUNTY ORDINANCES; ' FURNACE: LOCATION,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.: GAS VENT, DUCTS"
SIGNATURE OF r .� /r r• !�y .-) x- LATH, INT.
PERMITTEE r y f.a• r a• r :•:,
ADDRESS lCr. " " ,�_ 'f .t_•F R/fj' /��� A �"`• LATH. EXT.
L/
AUTHORIZED AGT. PLASTER:' INT.
$ OPLASTER; EXT. "
P. C.$ HOUSE NUMBER COR-
` ` ,• Q FEE RECT AND POSTED F r
VALUATION FEE FINAL P.�rI r.iit
—�
; WORKERS'COMPENSATION DECLARATION
I
' re ' affirm that I have a rterti of con
insure, orra certificate of Workers'Compenstion Insurance, or � - APPLICATION
APPLICATION F
R BUILDING PERMIT
t•sertified-copy thereof(Sec. 3800, Lab. C.)
COUNTY OF LOS'ANGELES' BUILDINGAND SAFETY
Policy N,90-497--508-8 Company State Farn1-Illa�
FJ copy is hereby-furnished. FOR APPLICANT TO FILL IN p�REss 5134r n7C1itItoCk A4�
❑ -CertiWed_copy-is filed with the-county building inspec- BUILDING
tion department. ADDRESS5134 ir±CCk A,g LOCALITY
NEAREST
Date ' Applicant—' CITY ZIP CROSS ST. Ave. '
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 1 MAP BOOK I PAGE PARCEL'
(This section need not be completed'if-the permit is,for one USE ZONE MAP 1
hundred dollars ($100)or less.') - TRACT BLOCK- LOT NO. INC, I
TEL SPECIAL
I certify that in th`e performance of the work for which this OWNER N .213 4481642 CONDITIONS
permit is issued, I shall not employ any person in any manner - / D STRICT GROUP TYPE FIRE PR ESSED BY U
so as to become subject to the Workers'Compensation Laws. ADDRESS AVg� CONST. ZONE 09
J ,0VI _3O
Date Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. U
NOTICE TO,APPLICANT: If, after'making this Certificate' of ARCHITECT O.R - TEL. LLI
Exemption, you should become 'subject to the 'Workers' ENGINEER Q1 N 714 5981890 CLASS NO. DWELL. UNITS
Compensation provisions of the Labor Code, you must forth-
ADDRESS91789 SEWER MAP
' with, comply with such provisions'or this permit'shall be //
deemed revoked. CONTRACTOR �Q7. NOTE' 5981890 BK. �PG,//-C VALIDATION
LICENSED CONTRACTORS DECLARATION LIC:
I hereby affirm that I am licensed under provisions of,Chapter.9 ADDRESS FCad #6 N6.425570 VALUATION
(commencing with Section 7000)of Division 3 of the Business and-• LIC.
Professions Code, and my license is in full force and•effect. CITY' V�1rIllt CLASS'B- $ 13 0'00
, 0 0'
SQ. FT. NO.OF JNO..OF CHECK
License Number 425570 Lic.Class B SIZE 320 STORIES •'1 I FAMILIES ''1 . ONE
ContractorB,aa= 0M9ba1CldCr1 Date 8-27-84 '-� DESCRIPTION OF WORK l ^ •'NEW ❑ $ i
❑ I am exempt from.the licensing requirements as I am a ADD
licensed architect or a registered,professional engineers' 'ALTER. ❑ FINAL _
=acting in my professional `capacity (Section 7051,1 - ElDATE
REPAIR
Business and Professions Code). USE OF FINAL '
EXISTING BLDG. DEMOL ❑
By
Lic.or Reg. No. _Date APPLICANT TEL. __'fir .�, i
OWNER-BUILDER DECLARATION (PRINT) NO.`
I'hereby affirm that I am exempt from the Contractor's Licenser �''' ° rr I
Law.for the.following reason (Section 7031.5, Business and ADDRESS %
Professions Code): PRESENT '2 f 1 ) Q
❑ BUILDING
I, as owner of the property, or my employees with C1 C1
ADDRESS ,
wages as their sole compensation,will do the'work and
the structure)is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code). MOVING TEL -
❑ "I, as owner of.the property, am exclusively contracting'_ CONTRACTORBaamm 11C cn No.(714) 598189
u with licensed contractors to construct the project,(Sec- _ 91789
tion 7044; Business and Professions Code). ADDRESS
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD,, HWY PROP. LINE WIDTH
1,hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L.
(Seca 3097, Civ. C.). SIDE
P.L.
Lender's Name
a P.C. Fee$ i, i 1 Permit Fee
Lender's Address ( _
I certifythat 1 have read this application and state that the w J Issuance Fee Ab
x ab information is correct. I agree to'comply with all County Investigation Fee
or in rices and State laws relating to building construction, Total Fee J J
a h reby authoriz representatives of this County-to enter ;
= up .n he a ve-mei ti sed property for inspection purposes.
r
_ SEE REVERSE FOR EXPLANATORY LANGUAGE
a Signature of Applicant or Agent Dote