HomeMy Public PortalAbout5405 MCCULLOCH AVE_Building__ '76A636A CE#Bo9 s-61 APPLICATION FOR BUILDI G PERMIT l-
COUNTY
OF LOS ANGELES BUILDING 00
DEPARTMENT OF COUNTY ENGIINEER AD°REss
BUILDING AND SAFETY DIVISION " - LOCALITY
JOHN A.LAMBIE, COUNTY ENGINEER NEAREST .,
WILLIAM A.JENSEN UP'T OF BUILDING. CROSS ST.
DIST T'NO GRP TYPE PRO ESS
FOR APPLICANT TO FILL IN coNST.
BUILDING 16 i •/+ - !}' pl STATISTICAL C IFICATION SEWER MAPS
ADDRESS CVI ` 6 ` D
Cln� ,CLASS.NO. DWELL.UNITS
LOT NO. ' .7 BLOCK WATER NOT REQUIRED RECEIVED
/� CERTIFICATE.
TRACT 1 34( MAP HIGHWAY
OF BLDGS. NO. DJ v S ATE MAJOR SECOND, CA
81ZE OF LOT 4'0i NO (CIRCLE)IOiJ I NOW ON LOT i USE 2PNE SPECIAL ,
" SE OF EX SITING BLDG. C>q/& I*! aTt C-Ad t / CONDITIONS
TEL. ��'1
OWNER�L �•1 TE dvI BUILDING EXIST.
YARD STREET NAME
*� SETBACK WIDTH
ADDRESS 5.4,3s- AA�`/A�ULLtlw T.
` .FRONT
.ARCHITECT OR TEL. "P.L. �[L }
ENGINEER 'NO. SIDE IL
P.L. O
ADDRESS TEL. , INSPECTION RECORD,
CONTRACTOR �r►I�f6�C NO. } I• _O
ADDRESS :• f`t fl I �{ + r• f J r U
DESCRIPTION:OF WORK
;i%r + w`;
NEW DD >- ALTER,".",v-REPAIR DEMOLISH
SQ.FT. '.'NO.OF a NO.OF
IZE 1(. yyn,,!firSTORIES 1 FAMILIES•USE OF
'
STRUCTURE V1f e1.I1.f. oZ
SIGNATURE OF
APPLICANT
VALUATION$ g($®
APPROVALS DATE INSPECTOR'S SIGNATURE
PC' PMT: FOUNDATION:MATERILOCALS
. �.
FE FEE $ � » FORMS,MATERIALS 9• ....,� w'
FRAME:FIRE STOPS, jt? .2,
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION BRACING BOLTS.
fi'''
AND STATE THAT'THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, ✓ ,��r,.- ,
WITH ALL COUNTY ORDINANCES-AND'STATE LAWS REGULATING 'GAS VENT DUCTS .
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 CO TATE OF CALIF RNIA RELAT-
ING TO WORKMEN'S (PENSATI N R
LATH,EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTE. RECT AND POSTED �,PA'I
ADDRESS JL
FINALF"f1Gl�"� I .ih»k.^i �a!`/'
CLYDE N. DIf2LAM, PRINCIPAL STRUCT6RAL ENCS € R
PLAN CHECK VALIDATION cK. m.o. CASA PERMIT VALIDATION :='cK. m.c.
DEPARTMENT OF BUILDING AND SAFETY � APPLICATI®N FOR PERMIIT�'
COUNTY OF LOS ANGELES -
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
rBU1LDING.•
DISTRICT NO. PLAN CK. NO.. PERMIT NO.
ADDRESS L41 McCulloch Avenue .7 3s75-3 s7 ^a,
LOCALITY Te= e Cly 83 f r-nf A• RECEIVED BY DATE OF APPL. DATE ISSUED
NEAREST
CROE38 ST.
OWNER an70 !s{YlZLCE. c�ua.Ze V 11l. Lmmra
ADDRESS 1--I J /•° [.o i" W
MAILN PALMER DRIVE
ADD gas - L03 ANGELES 41,Cj vtl-OCALITY 7 i c j
TEL. NEAREST
CITY CROSS ST.k �c
NO. �
FIRE I NO.OF TYQE71 - ORO y�
ARCHITECT OR TEL. ZONE PLANS
ENGINEER Oi,mpr NO. I e]
BLDG. / ORD. NO.
ADDRESS SETBACK LINE •94
(C
APPROVED
CONTRA OTOR tq, LO, Parmez =9O'!4Z an BY DATE
USE APPROVED
ADDRESS ""Utz PAI mprm nw•vwZONE BY DATE
LEGAL e -
DESCRIPTION I LOT NO. C2S I BLOCK COVEECTIONS
TRACT ' TRACT No NO. Or
BLOBS.None
SIZE OF 'LOT 60"x 100• I NOW ON LOT ,
USE OF I NO.OF I NO. GF
EXISTING BLDG. FAMILIES ROOMS
DESCRIPTION OF WORK
NEW X ALTERATION ADDITION "
O
REPAIR MOVING DEMOLISH 0
p.: No.Or
FT.
A 12,16 ROOMS 6 STORIES r
WALL stucco Lei: I ROOF No., 1 RC'
COVERING R-IJ Si dl ng COVERING Shi nol pq _
USE OF NEW
BUILDING Sing] 'I
Plan No.
Sia. and Pl n' No' 7=1
1 HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS. APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS'CORREOT FOUNDATION:.LOOATION, INSPECTOR D,A�TE•s
FORMS MATERIALS IY `-
AND
AGREE.TO COMPLY WITH ALL COUNTY ORDINANCES '
/1.i
AND STATE LAWS REGULATING
t BU{ILDI�+NG CONSTRUCTION. FRAME: FIRE STOPS,
SIGNATURE OF Santa Ley? ila eSquCaz¢ e9noa BRACING, BOLTS
OWNER LATH, INT.: `
AUTHORIZED AST LATH, EXT.:'
d 5
P. C.$ C PLA5TER, INT.
09500.00 FEE .00 �
PLASTER, EXT. ^� f'_
VALUATION• FEE 20.00 FINAL ` i A.
DIVISION OF BUILDING ARID SAFETY AM
Department of County Engineer BUILD-E . W,
County of Los Angeles
WM. J. FOX, COUNTY ENGINEER APPLICATION
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.OR RED.No: PERMIT NO.
BUILDING
ADDRESS,f'yoSN, AL2 COL L at_h 1! �� �"""' /'`L �S I
RECEIVED BY DATE OF APPL. DATE ISSUED
LOCALITYE . LZ6 L /T
PI ARE IT pA ��^ � y T hY Y (� /}�� / /J
6R0888T. lJQ/✓F.S �/Q �7 d '� AUILDING
DDRESS i_8SJ ( �! �. o'if✓�%r.(7"
qq �Y
OWNER CJ A./i`f-1$ L 1 RaW E' 7-
MAIL LOCALITY Gi(/GL
ADDRESS ,*V Q4" /j/ N AREBT
CRO89 ST.
NO�7"p�&�/ I�P FIRE NO.OF E ORCUP-
AROHITECT OR ✓ TEL ZONE PLANS I J
ENGINEER- NO. BLD[.
SETBACK LINE
ADDRESS
USEAPPROVED
TEL YOKE / BY DATE
CONTRACTOR NO. TT HOUSE NUMBERING
ADDRESS MAP NUMBER �V `' NO. ASSIGNED BY
LEGALa CORRECTIONS
DESCRIPTION LOT NO. 7 -3 BLOCK
1
TRAOT {y 1 :?4 a
NO. OF BLDGB.
81ZE OF LOT &0`� � � I NOW OWLOT -e'lON6
USE OF NO.OF
EXISTING BLDG. FAMILIES
DESCRIPTION OF WORN a
NEW L-fALTERATION I ADDITION I Z
r
REPAIR. DEMOLITION
NO.Or
SQ.
ZE02 YS ROOMS BTDRIEB
EXT.WALL I "ROOFOVERING I-A q^ /
COVERING C /� o`d
USE OF STRUCTURE )
C'o V F /o /
INSPECTION FOR APPROVALS
OCCUPANCYAB. INSPECTOR1rq SIGNATURE DATE
FOUNDATION: LOCATION
F12RM96 MATERIALS
1 HEREBY ACKNOWLEDGE THAT 141"E-READ THIS AP- h * -
PLICATION AND STATE THAT THE INFORMATION GIVEN 18 FRAME: FIRE STOPS,
CORRECT. BRACING,BOLTS C,e/,�e` SI'�
1 A®REE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, of
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. [AS VENT,DUCTS
SIGNATURE OF ,/�j _'A� �` LATH, INT.
PERMITTEE ,/�
Syr�.s N, 4Le LATH. EXT.
ADDRESS _
PLASTER, INT.
AUTHORIZED AMT.
O PLASTER, EXT.
43. FEES B HOUSE NUMBER COR-
VALUATION.
AND POSTED . 1
VALUATION. FEE G Qom. FINAL dim - / r1 '�
76A638A DB8 3 1-52
WORKERS' COMPENSATION DECLARATION
hereby fffft rn that I have a certificate of consent to self APPLICATION FOR 13U I L D I N G P E RM I T
instg;e, or a certificate of Workers' Cm ensation I ranee,
or 7c�tc py�tJs re c. 38 as COUNTY OF LOS ANGELES BUILDING AND SAFETY
/ G / pa q
❑ Certified copy.is hereb urnished.. FOR APPLICANT TO FILL IN ^'BUILDING
DRIESSS V
11, .
likIM
❑ Certified copy is file it the,co, buijdin 'ins c- [ADID
DING ni [.. /
tion depart ent. RESS vvm
r
Date ZIP :s LOCALITY
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' OF'LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one CT BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL. �/ USE ZONE AP 7 7
Nwn NO. y
I certify that in the performance of the work for which this /I NO. /44
L
permit is issued, I shall not employ any person in any manner RESS m —� CONDITIONSso as to become subject to the Workers'Compensation Laws. / O
�C,17 ZIP .JDate Applicant HITECT OR O
DISTRICT. GROUP FIREPROCESSED BYNOTICE TO APPLICANT: If, after making this Certificate of INEER NO. ZONEExemption, you should become.subject to the Workers'Compensation provisions of the Labor Code, you must forth- RESS t, DQ -3 �� a
with comply with such provisions or'this permit shall be TEL 70& s:STATISTICAL CLASSIFICATION APT. CONDO. N
deemed revoked. CONTRACTO NO. Z
LICENSED CONTRACTORS DECLARATION ADORES /C N�. :ggCLASS NO. _ a DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9MEW
SEWER MAP
.(commencing with Section 7000)of Division 3 of the Business V LIC.
and Professions cense is in full for n t. CITY CLASS BK. VALIDATION
(jJ�N SQ. FT. NO. OF NO. OF CHECK
License Number / Lic. Class SIZE I STO PAS FAMILIES ONE
DESCRIPTION OF WORPd 1J1J1f4Nom' ❑ VALUATION '
Contracto Date $ 0Dd C7
' C I7 I 55 ADD ❑
❑I am exempt-under Sec. ,... .
ALTER ❑ �:'
BAP.C. for this reason REPAIR $ `%YS r�...•
USE OF ❑
Date: EXISTING BLDG. DEMOL ❑ '1"
Si nature APPLICANT TEL,
9 FIFIAL;
OWNER-BUILDER DECLARATION . (PRINT) NO. DATE''��'7 � 2-1
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL
Professions Code): PRESENT r; By
BUILDING
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and
LOCALITY
• the structure is not intended or offered for sale(Section - /a_�/-9�- ,•
7044, Business and Professions Code.) MOVING TEL.
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. 77y,
with licensed contractors to construct the project (Sec- ADDRESS 40,113 4 3
tion 7044, Business and Professions Code.)
CONSTRUCTION LENDING AGENCY RETQBACKUIRE YARD HWY TOTAL SETBACK EXIST.
II H �e
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
$ P.C. Fee$ Permit Fee LDMA Ref.#
Lender's Ad ess
° I certify th. I have read this application and stater that the Issuance Fee vj�" LDMA P/C#
°
B above inf rmation is co ct. I agree to comply with all County Investigation Fee /
ordina qhs and tate a s relatic� to building construction, Total Fee �, t� LDMA Perm. #
and h r by a th riz r present ive of.this Count to nter
upon th e- ' i p o f r inspeftio 'pur 9S�
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent D e '