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HomeMy Public PortalAbout5640 MCCULLOCH AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM.J.FOX,CHIEF ENGINEER BUILDWG NO. OF BLDG. ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO. PLANS SETBACK LINEL FIRM APPROVED �r '/' J✓z ZONE �/� BY DATE RECEIVED BY DATE OF APPL. DATE ISSUED ZONE/'� 3 APPROVED �vII7 • ?—/s —/ —Y-1 BY DATE GI i? t �i 1 APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY O E NAME // ADDRESS �� NZ ADDRESS LOCALITY13 a111 Z CITY 1 CROSSSST.STATE a LICENSE NO. TOLD E NAMEMAIL no: NAME ,/�✓ 3 ADDRESS -C ADDRESS / / O CITY i/ vV NOI ,r/ r Z CITY f 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS V APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE LAWS.REGULATING BUILDING CONSTRUCTION. ZO LOT NO. I (J SIZE OF LOT (r Ovr) l� / SIGNATURE OWNER OF NO. OF BLDGS. /s �.-rr 1/Y Q II. BLOCK NOW ON LOT i AUTHORIZED AGT. ���,YYYY' V G� J III TRACT 4L CORRECTIONS I] USE OF BLDGS. J' - NOW ON LOT DESCRIl;flON OF WORK USE OF BUILDING O j r NEW � TYPE � GROUP V NO. OF ! NO. OF ALTERATION ROOMS / FAMILIES ADDITION SIZE IG REPAIR STORIES _ f MOVING WALL COVERING J l•tl�, DEMOLISH ROOF COVERINGP'C FEE $,- FINAL APPROVAY: 8 Sr ��/GINSPECTOR'S // VALUATION / ( FEE / DAT -/�0 I NAME 1/`3y'%4-"✓�-- 1 - ------------ DEPARTMENT OF BUILDING AND SAFETY Hrri.tU&t iVly r V.M rMdiunr t COUNTY OF LOS ANGELES 1 a WM.J.FOX, CHIEF-ENGINEER oUILDING NO?•OF �I BLDG. ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO. PLAtVB SETBACK LINE B�a FIRE - ,� APPROVED J J 210 ZONE BY DATE RECEIVED BY DATE OF APPL.� DATE ISSUED' USE A APPROVED 7 }�- s ZONEBY DATES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY E BUILDING ••� •� )) �,dC �i'. ,f O E NAME ADDRESS 2.2—4 —`/�I®4'o reftf�{�OFck BB W Z ADDRESS LOCALITY } /� p H - I ONEAREST WW CITCT�'J,�.At *wtl( R STATE iP , _ LICENSE NO. a. .rNO,, E NAME tiG� YtsCli r laMAIL Z A ) 1 EO NAME ?� ADDRESS Vii.,..;�•' �• �' O ee^^vv It / ry V - - NOI.l� ��6 d Q ADDRESS CITY % i'✓r=+day FE• �' D Z �J I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS V CITY APPLICATION AND STATE THAT THE ABOVE IS CORRECT STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. __� av�� NO. J y AND STATE LAWS REGULATING BUILDING CONSTRUCTION. Z LOT NO.rlf.�"P` relp SIZE OF LOT66 p ?-(. SIGNATURE OF E O OWNER _��..+ r1 J F NO. OF SLOGS. J i 1 a 0 BLOCK .r NOW ON LOT AUTHORIZED.AGTT � i ju WTRACT ? g id Id D USE OF BLDGS. NOW ON LOT a+lP�S DESCRIPTION OF WORK USE OF BUILDING � C r s lu O a tom' r NEW TYPE _ice. GROUP NO. OF NO. OF ''`` ALTERATION ROOMS FAMILIES/V--,Yt f% ADDITION SIZE REPAIR STORIES MOVING WALL COVERING DEMOLISH I ROOF COVERING Jose, P.C. s- FINAL APPROVAL FEE ` J7.�'vv - �- _ �, I INSPECTOR'S/.LJlJ VALUATION FEE DATE NAME � PPMWA2VKM9lMW URI NUALULNU ALMIJ bAr %fim s�8ar�a e� COUNTY eF405 A NGEMS q,°N In � �� z 'u" I L D I N WM. J. FOX. CHIEF ENGINEER �' FOR APPLICANT TO FILL IIN FOR OFFICE USE ONLY ADD RIGH b b`iK� ( 4. (f / } DISTRICT NO. PLAN CK.NO. PERMIT RID: LOCALITY RECEIVED BY fDATE t,OFAPPL. DATE IBBIUED NEAREST Yo A tv 1 tP.� OROBB BT` 9 g t OWNER e!AILry 0 1 � /�� y Ilk e� -6 C'4� � ADDREI 9 /�j � .'t°I r�! ✓id !ti3;' ti M REBS d.� 9 "b Fo • LOCALITY /_p �I gy�"pp// �` p (� ISO NEAREST // f CITY 1�1✓ <J d NO. �� 1��+ CROBH ST. FIRE NO.or '"PC GROUP ' ARCHITECT OR � TILL. ZONE PLANS ENGINEER NOJ� 2-1 . BLDG. + / ' ORD.NO.. ADDRESS SETBACK LINE (� APPR13VED CONTRACTOR _�,/{ 4 NO BY DATE vvv USE APPROVED ADDRESS ZONEk BY DATE LEGALV�'q(�I/V BLOCK v COMMC7701 19 DESCRIPTIONA LOT NO. ` TRACT v)--t4q SIZE OF LOT ,``;y, I NO.OF SLOGS. W NOW ON LOOT /LG"7�SGL (O USE OF ,..gip p NO.OF 11 NO.OF v / EXISTING BLDG, w `�" FAMILIES ROOMS fees -DESCRIPTION OF WORK NEW ALTERATION ADDITION � � 0 REPAIR MOVING DEMOLISH I I +�_f( 0wpv � /JCC repeox 7a H G Sq.FT. A NO.OF / Z SIZE #�pp1sti ROOMS StT�ORIES�++_( WALL Roar COVERING4Y� �a�-`�i��Ae`c(� I COV RING lY L1G�1A.7cY'��it!°j e_ r '''�`r^r• USE OF NEW �x 4F7,E" 1Q � V 1 \ 1 + BUILDING VtF 11 ry� 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROV� APPLICATION AND STATE THAT THE ABOVE 18 CORRECT INH OR .-DAT FOUNDATION.LOCATION /pEJp�JT' _ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALSZ�P'f AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME* S FIRE BTOPB. 'Z, SIGNATURE OF (� BRACING.BOLT PERMITTEE V LATH. INT. r. AUTHORIZED AGT s LATH. EXT. (� •7 3�`-'!� 76AG38A-3 a-sn D,a PLASTER.INT. A FEE q PLASTER.EXT. ' VALUATION FEE S FINAL ',^�C APPLICATION FOR BUILDING PERMIT �] + COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING S �- I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a certif' d q copy thereof(S c.38 OrLjb, CITY „ ZIP Policy No a�(p Company LOCALITY _ 'A SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ElCertified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department: Date- Applicant ✓! J 1 _ ASSESSOR MAP BOOK PAGE PARCEL : - SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' o R TEEN COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred RSO / ��y DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) cJ J� CITY ZI I certify that in the performance of the work for which this permit /774 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TE NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. =;21 DWELL UNITS NOTICE TO APPLICANT' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' COYrRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 347el- � FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATIONy`V d9A Zf_ SIDE C LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO OF STORIES NO.OF FAMILIES Professions Code,pr1d my Iiceno is in full force and fect. I NEW ❑ BK PG ® a `•L — DESCRIP N OF WORK ADD ❑ VALUATION License Number Lic.Class _ �fl Contractor`Zw` 11�:+k1� Date 3 ALTER E) $ �d�' C `iw Ile ❑ I am exempt under Sec. REPAIR ❑ $ C BAP.C.for this reason DEMOL ❑ LDMA P/C# LL Date: USE OF EXISTING BLDG. URM ❑ a. ll Signature �' ' `� APPLICANT(PRINT) TEL NO. LDMA Perm# 1 L ❑ I, as owner of the property, d my irk loyees with wages as Z - - their sole compensation, will do the and the structure is ADDRESS O 1-ti.41 o v not intended or offered for sale (Section 7044, Business and FINAL DATE G `il_�` Professions Code. 1'`^ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J { T`�t ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY t licensed contractors to construct the project (Section 7044, ^, ` q I�' �'`n;'y VES❑ NO❑ I)Ti'tL -fl.C12:e �IJI0 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH t•�� �E CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. ^ I hereby affirm that there is a construction lending agency for YES❑ No❑ 1"f ANG-E cli the performance Of the work for Wf11Ch this permit IS ISSUed(Sec. 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. N TITLE 2 CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20 140 CONCERNING HAZARDOUS 't �' �'{••r^i i/�:•; Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. - o Lender's Address y+ 1 i p OWNER OR AGENT o 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 9140- YJ N with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE CO to enter upon the above-mentioned property for inspection purposes. ID INVESTIGATION FEE TOTAL FEE �© , 0 SWI"—d MPurt m Rpm SEE REVERSE FOR EXPLANATORY LANGUAGE