HomeMy Public PortalAbout5628 MCCULLOCH AVE_Building__ 18A888A CE#80910-l8 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER A°DREssa
BUILDING AND SAFETY DIVISION LOCALIT
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST
DISTRICT NO. Gr ROUP I Typ I P CESSED BY
FOR APPLICANT TO FILL IN tet`' CONST.
FAD
DING / STATISTICAL CLASSIFICATION SEWER MAP v
ADDRESS--'7&-x.-7—,f MC Culloch,Temple City CLASS.NO. DWIEILL.UNITS�I rK O 6
NO. BLOCK NUM ER �(/ STATE YES(no-
TRACT
see legal c e H`""('
T USE ONE SPECIAL
CONDITIONS
NO.OF.BLDGS
OF LOT I NOW OOF
,'•, EXISTING BLDG. BUILDING E. YARD HWY STREET NAME EXIST.
SETBACK WIDTH
OWNS FRONT n�
MAIL P.L.
ADDRESS 5055 CartwriahtAve SIDE
P.L.
CITY No Hollywood-,----Calif.NO INSPECTION RECORD
ARCH ITECT OR TEL.
ENGINEER a NO. {
ADDRESS
CONTRACTOR BeCon r Ho A 68746
ADDRESS 1123 So. San Gabriel Ilvd.S.G. . 1'7. '
DESCRIPTION OF WORE
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. NO.OF NO.OF
SIZE QS S 1 FAMILIESUSE OF
1 !
STRUCTURE dwe l lin & arae
SIGNATURE
I� ? / �6 •« al�� -- -�
APPLICAN' APPROVALS DTE INSPECTOR'S SIGNATURE
ADDRESS 1_23 So Gabriel San Gabri 1FOUNDATION:
MATER ALSLOCATION lf/i/Czm;'!�
VALUATI N , -� FRAME:FIRE STOPS, `
BRACING..BOLTS 'A-' e"
JQFURNACE:LOCATION.
FEE E!Q a� I FEE $ GAS VENT.DUCTS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH.INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREETOC LY WITH ALL COUNTY ORDINANCES AND
STATE LA EGULATING I ING CONSTRUCTION. LATH,EXT.
SIGNATUR
HOUSE NUMBER COR- n
PERMITTE E e. �� RECT AND POSTED
ADORES FINAL
CLYDE N.DIRLAM,PRINCIPAL SCT RAL ENGINEER
PLANAHECK VALIDATION O-K. S.M.D. CASH PERMIT VALIDATION CK. M.O. CASH
I�I ._ u . . .
^ -WORKERS'COMPENSATION DECLARATION
tereby affirm that I have a certificate of consent to self i p I BUILDING PERMIT
lure, or a certificate of Workers'Compenstion Insurance,or I A P CATION FOR U I L D I N
:ertified copy thereof(Sec. 3800, Lab. C.) i COUNTY OF LOS ANGELES _ in AND SAFET
licy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDIN
ADDRESS
1 Certified copy'is filed with the county building inspec- BUILDING
J tion department. ADDRESS, " LOCALITY
NEAREST
ite Applicant •CITY ZIP 7 CROSS ST. O
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT -MAP BOOK PAGE PARCEL
tis section need not be completed if the permit is for'one USE ZONE Espok
//11
ndred dollars ($100)or less;')- TRACT BLOCK LOT NO. tot!
TEL. 1 IAL:ertify that in th_e performance of the work for which this OWNER N �-� DITIONS O
rmit is issued,,l shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PRO ESSED BY V
as to become subject to the Workers'Compensation Laws. ADDRESS � V �!� CONST ZONE 29
O
ite Applicant CITY ZIP STATISTICAL CLASSIFICATION PT. CONDO.
)TICE TO APPLICANT: If, after making this Certificate of I ARCHITECT ORTEL.
emption,- you should become subject to the Workers' ENGINEER N i CLASS NO. DWELL.UNITS IL
mpensation provisions of the Labor Code, you must forth- ADDRESS I SEWER MAP
th comply with such- provisions or this permit shall be `
emed revoked. TEL' BK. G, VALIDATION
CONTRACTOR NO. v
LICENSED CONTRACTORS DECLARATION JLIC,
ereby affirm that I am licensed under provisions of Chapter 9ADDRESS NO. VALUATION
tmmencing with Section 7000)of Division 3 of the Business and LIC.
3fessions Code,-and my license is in full force and effect. I 'CITY CLASS $ v 06•
SQ. FT. .1 NO.OF NO.OF CHECK
ense Number Lic.Class I SIZE Q v STORIES FAMILIES ONE
DEPTION OF WORK, NEW ❑ $
intractor Date ❑
-
I
am exempt from the licensing requirements as I am a q_-, ADD
licensed architect or a registered professional engineerALTER FINAL i(
/
acting in my professional capacity (Section 7051, REPAIR
DATE
Business and Professions Code). I US F
EXISTING BLDG. DEMOL By
FINAL
or Reg.No. Date APPLICANT - TEL.
OWNER-BU(LDER DECLARATION (PRINT) NO.
ereby affirm that I am exempt from the Contractor's License
w for the following reason (Section.7031.5, Business and ADDRESS _
i
:)fessions Code): i PRESENT -
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 2-3.1 3,3'A
7044, Business and Professions Code). MOVING TEL.
CONTRACTOR NO.
I, as owner of the property, am exclusively contracting t# o'0 0 0 0 1 ,
with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 2 0 o q 7 0
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
ereby affirm that there is a construction lending agency for FRONT ; ° ° ° 9 t,0 0
performance of the work for which this permit is.issued I P.L.
:c. 3097, civ. C.). SIDE 0 3.02-82
i
P.L.
nder's Name ' ' _
nder's Address ,1 P.C. Fee$ Permit Fee S a
I
ertify that I have read this application and state that the t - Issuance Fee a + o
ove information is correct. I agree tb comply with all County i Investigation Fee
finances and State laws relating to building construction, Total Fee 7{ 0 0
d hereby authorize representatives of this County to enter
n the above-mentioned property for inspection purposes.
I 5 t N".O, A\�,t n � yS—g GLS I SEE REVERSE FOR EXPLANATORY LANGUAGE , ®s
,
Signature of Applicant or AgentDote
I