HomeMy Public PortalAbout10118 NADINE ST_Building__ 70A076A On&i i 68
APPLICATION FOR BUILDING PERMIT �.
DrMON OF BUILDING AND SAM= BUILDING
ADDRESS ^� 00,
Department of Coantp Eaglnees
Countt of Los Angeles LOCALITY
WM J FOX COUNTY ENGINEER NEAREST r
CASSATT D GRIFFIN.SUP T OF BUILDING CROSS ST
D18TRI T NO GROU SPE SEWER
MAPS
FOR APPLICANT TO FILL IN
CONST
BUILDING
ADDRESS NUMBER ST
YES O
LOT NO BLOCK USE ZONE SPECIAL
CONDITIONS
TRACT
NO OF
SIZE OF LOT O NOW ON LOTS BUILDING YARD HWY STREET NAME EXIST
SETBACK WIDTH
USE OF FRONT
EXISTING BLDG P L
r
OWNE SIDE
P L
MAIL `
ADDR S O TRACT DWELL I UNIT 5 INDUSTRIAL
` TEL 1 DWELL I UNIT
CIjj2L NJa 6 PUBLIC BLDG
ARCHITECT OR TEL 2 DUPLEX IUNIT 7 ADDN ALT ETC
ENGINEER NO $ APT —L�UNIT9
8 MISCEL
ADDRESS 4 COMMERCIAL
CONTRACTOW EL INSPE=ON RECORD �yij/yy
ADDRESS
DEEK.EwrION OF WORK R, ,�-� �
NEW ADD ALTER REPAIR DEMOLISH
GO FT NO OF NO OF
SIZE STORIES FAMILIES
USE Off STRUCTURE
SIGNATURfi OR ,
APPLICANT APPROVALS
ADDRESS DATE INSPECTOR S SIGNATURE
$ / P C ffi [' y F FORMSTMAT ROCASS `J_.�
FEE a V � FRAME FIRE STOPS v�
4 17
VALUATION -J ffi 77'' BRACING BOLTS
FEE S'. 00 FURNACE LOCATION a /�/,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT DUCTS B �/`l
APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH AW COUNTY ORDINANCES LATH INT
AND STATE LAWS REGULATING BUILDING CONSTRUC- /gyp
TION
LATH EXT
SIGNATURE OR A HOUSE NUMBER COR-
PERMITTfiE RECT AND POSTED
ADDRESS FINAL
WM J FOX.COUNTY"ENGINEER VALIDATION C N DIRLAM CHIEF BLDG INSPECTOR
LAC03 5 6 1n DEC20 16 8.75 --m
L&3562A DEC20 1 3500 m
7 7 �'
WORKERS COMPENSATION DEC(ARATAN,
hereby affirm that I have cart;f catK�bf consent to self APPLICATION FOR BUILDING P E RM I T
insure, or a certificate Of Workers Compensation Insurance,
.or a certified copy thereof(Sec 380, Lab C) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No2Z_21 Company�
® Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS I BUILDING 1011r
4Q E S•1
❑ Certified copy is filed with the county budding inspec- BUILDING p� / AJ
f
�tiio�n�deepaart�ment ,- /h/�/,,[0 ADDRESS (// /V
Date 1 9-99 Applicant���' • CITY ZIP I LOCALITY LC
CERTIFICATE OF EXEMPTION FROM WO NO OF BLDGS NEAREST
S' SIZE OF LOT NOW ON LOT CROSS ST
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO ( MAP j100K PAGE PARCEL
hundred dollars ($100)or less) TEL
OWNER :S• * h V NO USE ZONE MAP
1 certify that to the performance of the work for which this NO
permit is issued, I shall not employ any person in any manner ADDRESS &I Q / Al e,,,�- SPECIAL a
CONDITIONS
'Co
so as to become subject to the W kersnsation Laws Q
CITY T/;- ZIP
Date n ARCHITECT O TEL DISTRICT GROUP TYPE FIRE CESSED BY
NOTICE TO APPLICANT If after making this C ificate of ENGINEER C C.ao -/�� NO -- �f R-3
CONST r ECo mpensa yop should become subject tY the Workers' GiU - /, Q _ aCom ensation rovisions of the Labor Code, ou must forth- ADDRESS //� VV�� JJ���/ I(f`�V'""`�
with comply with such provisions or this permit shall be TEL yt� STATISTICAL CLASSIFI TION APT CONDO Z
deemed revoked CONTRACTOR I G [R S NO I T)-)'//1J _
LICENSED CONTRACTORS DECLARATIONLIC CLASS NO �- DWELL UNITS
I here affirm that I am licensed under ADDRESS-3-11- C A-1 (,! NO y$1 79
by provisions of Chapter 9SEWER MAP �FrT
(commencing with Section 7000)of Division 3 of the Business LIC "V a
and Professions Code,and my license is in full force and effect CITYUr—A04 -C/or CLASS BK 'I''1)rA�IDATION �y
//��t' SQ FT NO OF NO OF CHECK 7Q�_ 1VCI.V..
PG
License Number 9 2Sa$7 21 Ltc Class J1 SIZE STORIES �+ FAMILIES ONE
n n VALUATION 1 ITEMS
Contractor � w f f- nVS Date DESCRIPTION OF WORK NEW ❑
ec ew o ADD � $ 'W TOTAL 200_8:�
❑I am exempt under Sec ►
n ALTER ❑ ( zoo.t.1
B&P C for this reason 3 �Rpo M A 0 4 1 T l0/I/ REPAIR ❑ $
Date USE OFEXISTING BLDG P_ , DEMOL ❑ CHANGE .011
Signature APPLICANT TELFIN
OWNER-BUILDER DECLARATION (PRINT) L e Y Y�Y DA 0WO—GO01 11/13/1,'Q+
I hereby affirm that I am exempt from the Contractor s License Z C A^i1 4 S C .
Law for the following reason (Section 7031 5 Business and ADDRESS FINAL h 6729 1 AM 9:410
Professions Code) PRESENT BY ''3
❑ I, as owner of the roe or m employees with BUILDING
property rtY YADDRESS a
wages as their sole compensation,will do the work and A_CT.T
the structure is not intended or offered for sale(Section [ADD
ALITY 0 ��07 22.':;5
7044 Business and Professions Code) ING TEL t T
❑ 1, as owner of the property,am exclusively contracting TRACTOR NO 1 ITEMS
with licensed contractors to construct the project (Sec- RESS �'
tion 7044 Business and Professions Code ) a TOTAL 2 2.95
QUIRED TOTAL SETBACK FROM EXIST n C
CONSTRUCTION LENDING AGENCY T BACK YARD HWY PROP LINE WIDT CHECK i�..7 1 '
I hereby affirm that there is a construction lending agency for ONT
the performance of the work for which this permit is issued CHANGE
(Sec 3097, Civ C) E n r -'
Lender s Name1 L A RW # , 0000-0001 12/2-2/1Fee CK Permit FeeLender s Address r-+ n .r15O —+ 77. 0 1 AM E.a1
1 certify that I have read this application and state that the Issuance Fee " #
above information is correct I agree to comply with all County tigation Fee G
ordinances and State jaws relating to building construction, Total Fee r A Perm #
and hereby authorize representatives of this County to enter
UP
n t v -mentioned property for inspection purposes ►-t tl C►.
r .. SEE REVERSE FOR EXPLANATORY LANGUAIS
Signature^11licant or Agent Date
y,�y' O
>'W 7�� i Q