HomeMy Public PortalAbout5534 MCCULLOCH AVE_Building__ IGA638A DES-3 12.84 - -'
APPLICATION . FOR BUILDING PERMIT 1'
DMSION OF BUILDING AND SAFETY BUILDING ADD
Department of County-Engineer'
County of Los AngelesLOCALITY le
WM J. FOX, COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. ro" I'
'DISTRICT NO. 7 ROUP' S f. SEWER MAPP .
FOR APPrL/ICAf NT /TO UrF11L IN B
_ I f TYPE
ADDREISS, :� �l ��`�!? / �LC.(.•1/L�1-`�Cr MAP 1®SUILDCONST. HWY
NUMBERc�
c `� ct t•D
LOT NO. n +c�I�J �R.1` BLOCK USE
QNE SPECIAL•
y / CONDITIONS
TR.4CT�sI -4 '2-. r., '
' _ Q
NO.OF BLDGS. 3
§IZE OF LOT D X A'fl I NOW ON LOT BUILDING YARD HWY. STREET NAME,' EXIST.
USE OF � ��•�,� ^� /� SETBACK WIDTH
EXISTING BLDG. 41 (rVLtC�.e�it.n.a. /1 t--1.r of � FRONT �v
OWNER L�y�v L/yV-�'^1+�� - SIDE _
MAIL
ADDRESSTEL��•. (L1iV! �� IFG�'•�f.s��;;��{+ - M
CITY��.Qf,7:�./(1, 1�(�'t,C�
NO B.Q IL / (+I DWELL, 1 UNIT 5 INDUSTRIAL
2 DUPLEX_UNIT • .6 PUBLIC BLDG.
ARCHITECT O!2 TEL:
ENGINEER tD�.�I_p�/i.�� NO. 3 APT. • UNITS' 7 ADDN.,ALT.,ETC.
" '
ADDRESS Lj COMMERCIAL 8 MISCEL.
TEL.
CONTRACTORS�.� •,.ts.���f'^�' .NO. INSPECTION RECORD _
ADDRESS
DESCRIPTION" OF WORK r
NEW ;K ADD ALTER. .REPAIR DEMOLISH
S ZE T .�x'-F . �/ 1 STORIES ' FAMIOLIES
USEfOF STRUCTURE t
SIGNATURE OFb LAPPROVALS
1 �Y1 �����J�-���
APPLICANT \ AA
ADDRESS .1 c7 �t+ / r� lI" .�F- •= -t••� DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION- r/
/�
P.C S Q FORMS. MATERIALS ?-J_Y ` I
FRAME: FIRE STOPS, R
VALUATION $" c BRACING.BOLTS
FEE '� FURNACE: LOCATION,• r I�1
GAS VENT. DUCTS ., fl 0�v�J A
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS f
APPLICATION AND STATE THAT THE ABOVE IS' CORRECT ATH. INT. V 17
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES a
AND STATE LAWS REGU TING BUILDING CONSTRUC-
TION. . LATH. EXT.
SIGNATURE OF 1 t - HOUSE NUMBER COR
PERMITTEE \ ''+ z.�` RECT AND POSTED
ADDRES FINAL
WK. J. FOX. COUNTY ENGINEER d1aiLII)ATI0N - r .
BY . . 4- (594S.
I. 1 1 6 _9.0_:Q{ Y6. 9 5 n JUN'14 1 1 8.00 �''
DEPUTY DEPUTY
BY_ ' BY
® DEPUTY 6EPUTY
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have r certificate of consent Self APPLICATION FOR BUILDING P E RM I T
insure, or a certificate of Workers' Compensation Insurance,
or a certified cop thereof(Sec. 3800 Lab. C.)
9 COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No�Company
El Certified �j
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county buildingi ec- BUILDING CS�L> C.�t
�n p�� nt. ie�l ADDRESS d�,J, , 1 �� �P '
r ��/�`� 4 CITY. ;�T�' l !l ZIP LOCALITY
Date Applican. NO.OF BLDGS.. NEAREST /
CERTIFICATE OF EXEMPTION FRO WORKERS' SIZE OF LOT' NOW ON LOT CROSS ST. G /
COMPENSATION INSURANCEASSESSOR
.(This section need not be completed if the permit is'for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($1,00)or'less.) : TEL.
OWNERS Dlr//7S�/�G� NO.���� USE ZONE MAP ,
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 ._ SPECIAL a-
so as to become subject to the Workers'Compensation Laws. CONDITIONS O
CITY ZIP U
Date' Applicant ARCHITECT OR TEL, im
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE RO SED BY
Exemption, you should become -subject to the Workers' CONST. ZONE
Compensation provisions of the Labor.Code,.you must forth- ADDRESS !
with comply with such,provisions-or this permit shall be TEL• L STATISTICAL CLASSIFICATION PT. CONDO.
f"
deemed revoked. CONTRACTORA& NO. �O��� Z
LICENSED CONTRACTORS DECLARATION IC. ` p CLASS NO. DWELL. UNITS
-
ADDRESS
hereby affirm that I am licensed under provisions of Chapter.9 ADDRESS 2�/`f NO. ���/ ��
(commencing with Section 7000)of Division 3 of the Business
LIC. SEWER MAP
CITY /'C /c CLASS
: .and-Professions Code,and my license is in full force and effect. BK: PG. VALIDATION
,. Cr T SQ. FT. NO.OF NO.OF CHECK
License Number Lic. Classc, SIZE STORIES FAMILIES ONE
VALUATION
J DESCRIPTION OF WORK �/b d{!t NEW ❑
Contractor �� c PfDate ,� r��(�
dS Gis'/ ,!)(. oc-!2 As//rpt ADD' ❑ $.
,
❑I am exempt under Sec. P /�
�-,`/ ALTER ❑
BAP.C. for this reason 37'5//2�IPJ REPAIR ❑ $
Date: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT
PRI T) NO. FINAL
OWNER-BUILDER DECLARATION DATE
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 By .
BUILDING -
❑
-I, as owner of the property, or my employees with 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 CONTRACTOR NO.
with licensed contractors to..construct the project (Sec- ='• tip` �, t 5^
tion 7044, Business and Professions Code.) ADDRESS -
REQUIRED TOTAL SETBACK FROM EXIST. =iP
CONSTRUCTION LENDING AGENCY SET BACK YARD ''HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT i .
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.).' I SIDE
P.L.
_ V
Lender's Name �:.
.LDMA Ref. #
P.C. Fee$ Permit Fee
• Lender's Address h -
I certify that I have read this application and state that the Issuance Fee U ' LDMA P/C#
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 a horize repress atives of this County to enter
o ve-mant io d perty for jpspection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE
SignaturqXf Applfccnt or Agerit Date