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Home My Public Portal About5512 MCCULLOCH AVE_Building_10/1/1959_ 76AGSBA cr.#80911-87 APPLICATION FOR BUILDING PERMIT • Z COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS V BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST, r DISTRICT NO. GROUPI TYPE gyp• SEWER MAP FOR APPLICANT TO FILL IN M�//r_ BK G CONS BUILDING ADDRESS f ��j STATISTICAL C1LASSIFICATION I LOT NO. GF L BLOCK CLASS:-NO. DWELL.UNITS MAP �p � STATE YES O NUMBER CDT HWY. TRACT USE ZONE SPECIAL JJ NO.OF BLDGS. CONDITIONS SIZE OF LOT ` 1O NOW ON LOT 147 USE OF e EXISTING BLDG. � 6 F gZgS BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER Q FRONT MAIL //�� J' P.L. ADDRESS 1/ /5A k SIDE TEL P.L. CITY G D tf NO. ARCHITECT OR TEL. INSPECTION RECORD ENGINEER NO. ADDRESS TEL. ` CONTRACTOR (.(J NO. %y Z� ADDRESS !/ b -cl :�I• V t./N 'i:' T 7Z DESCRIPTION OF WORK NEW ADD ALTER REPAIR - DEMOLISH SQ.FT. NO.OF NO.OF SIZE �/ STORIES FAMILIES USE OF STRUCTURE Ca r SIGNATUREOF• • APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDR FOUNDATION: LOCATION FORMS.MATERIALS I'•C• S �' FRAME: FIRE STOPS, FEE BRACING.BOLTS �- VALUATION S� FURNACE: LOCATION. FEE GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND �_— STATE LAWSULATING BUILDING CONSTRUCT IO LATH,EXT. SIGNATUREHOUSE NUMBER COR- • PERMITTE RECT AND POSTED ADDRESS a lop FINAL CLYDE N.DIRLAM,PRINCIPAL STRVffVRAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK M.O. CASH ...._-.AC03 4 2 3 OCT I A 6.0 0 rop L APPLICATION :FOR BUILDING PERMIT COUNTY OF LOS ANGELES' • 4 BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ,/ / o� /' ✓�/V y h I hereby affirm that I have a certificate of consent to self insure, BUILDING' DRESS J � C-G f�D III, or a certificate of Workers'Compensation Insurance,or a certified. copy thereof(Sec.3800,Lab.C.) CITY "7`L�v 1 ,� (ir.T A /7�(I LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ElCertified copy is hereby furnished. ' t/ NEAREST CROSS ST. ❑",Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. ' department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER .5Q �C /C TEL NO. ` I/ COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS S•• &--r—ea,�v{ DISTRICT -GROUP TY CONST FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit Te w �, e.J 9/ 7 VC is issued, I shall not employ any person in.any manner so as to ARCHITECT R ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. Cal DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' t CONTRACTOR TEL NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions.of the Labor Code, you must forthwith O'Lv A''®2 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. ` P U , LICENSED CONTRACTORS DECLARATION PILE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovlsions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES - NO.OF FAMILIES Professions Code,and my license is in full force and effect. I NEW BK! PG , a License Number LIC.Class DESCRIPTION OF PK ADD ❑ VALUATION Contractor Date Vev 4" tig Z �a'rl ALTER 11 U a s- e[�ss b 1� r/ cc Ef z REPAIR ❑ $: O I am exempt under Sec. 11 B.&P.C.for this reason7L h f 4V S'(Q� DEMOL ❑ LDMA P/C# Date: USE OF ISTING BLDG. URM ❑ i 330312 3'' 0. Y 6;.L.t;A Signature 30 3 APPLICANT(PRINT) TEL NO. LDMA Perm# 1 I�IA z ,�,/ 1[q I, as'owner of the property, or my employees with wages as Z EMS a their sole compensation, will do the work and the structure is ADDRESS 0 i LI� L .123.65 not intended or offered for sale (Section 7044, Business and FINAL DATE Je Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL CHECK 123.65 ❑ 1, as owner of theproperty, am exclusive) contractin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Y -contracting AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY CHANGE . a 00 licensed contractors to construct the project (Section 7044, yes 11 No 11 •f Business and Professions Code.) r WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIRCATION FROM THE SOUTH �•y CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR I �II l00-00111 03/15/95 GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ I ;y 1 ( o CM the performance of the work for which this permit is issued(Sec. W I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST..I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2•CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name i MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address OWNER OR AGENT o4 I certify that I have read this application and state under penalty { of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE p� CM with all county ordinances and State laws relating to building , d co struction, nd hereby authorize representatives of this County I ISSUANCE FEE p� t nt upol ate ab -mentioned property for inspection urpo s. -4.d a ' ro f INVESTIGATION FEE TOTAL FEE � uM'ant or Agent tiara (p SEE-REVERSE FOR EXPLANATORY LANGUAGE