HomeMy Public PortalAbout5725-5727 NOEL DR_Building__ �.�...A.s •••••• APPLIC TION FOR BUILDING PERMIT Z
COUNTY OF LOS ANGELES BUILDING �` 2
DEPARTMENT OF COUNTY ENGDIEER ADDRESS
MWING AND SAFETY DMSION LOCALITY T G
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OR BUILDING CROSS ST
FOR APPLICANTTO S DIST NO G UP I ONS PROCESSED BY
ADDRESSBUILDING v Y (� y STATISTICAL CLASSI•FICI-CATION SEWER MA G
LOT NO O BLOCK CLASS NO DWELL UNIT
S re
pp J-X�I3r J /
NUMBER Z HWY MAP YES N
TRACT OO¢ !/ f. I a ( USE ZONE SPECIAL
O OF BLDGS / CONDITIONS
SIZE OF LOT NOW ON LOT 1
USE OF
EXISTING D BUILDINGEXIST
SETBACK YARD HWIf STREET NAME WIDTH
OWNER FRONT
MAIL �I P L AID e;
ADDRESS4-7 .J SIDE J;TEL P L
C ' 7` NO I NSPECTIO RECORD
ARCHITECTOR# TEL
ENGINEER NO
DR
TELLi C---
CONTRACTOR � Sr NO
ADDREss137,0,4lti�
DESCRIPTION OF WORK
NEW 0"ADD ALTER REPAIR DEMOLISH /NO OF _ r `
NO OF 22e.
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STORIES FAMILIES
USE O RUCTURE a /
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SIGNATURE OF APPROVALS
APPLICANT DATE INSPECTOR S StfillIATURE
ADDRES,8&2-004 Ad UNDATION LOCATION
s ���� FORMS MATERIALS ,
P C s FRAME FIRE STOPS
FEE BRACING BOLTS 7
VALUATION >i (9 U FURNACE LOCATION
FEE GAS VENT DUCTS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL LINTY ORDINANCES AND LATH EXT
STATE LAWS R 11 1MING RUCTION
SIGNATURE OR HOUSE NUMBER COR
PERMITTE RECT AND POSTED
ADDRES n % FINAL
CLYDE N DIRLAM PRINCIPAL STR URAL NGINEER
PLM C==VALIDATION t,/M O CASH PZMW VALIDATION CK M O CARR
L&.52 5 3M SEP 2 6 2 3 n 1 4.2 5 iR
or
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323A 3.75er
L0 5 4 7 2°° QCT 3 1 A
WORKERS COMPENSATION DECLARATION
hereby affirm that I have a certificate a of consent to self APPLICATION FOR BUILDING P E RM I T
insure or a certificate of Workers Compensation Insurance
arm certified c��thereof 3800 Lab ) p ' COUNTY OF LOS ANGELES BUILDING AND SAFETY
he o ompany i BUILDING
Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADoaEss
y(� Certified copy is filed with the co my u Idmg mspec BUILDING
aft+ tion department ADDRESS 5727 Noel LOCALITY
Date ApplicanTemple Cit Applicant CITY P Y NEAREST
ZIP CROSS ST
ERT KATE OF EXEMPT FROM WOR RS F NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed of the permit is or one USE ZONE MAP OO
hundred dollars(;100)or less) TRACT BLOCK LOT NO � NO
OWNERMr,, William Sams No 2 8 7—3 4 0 8 CONDITIONS d
SPECIAL
I certify that in the performance of the work for which this DISTRICT GROUP TYPE FIRE D BY O
permit is issued I shall not employ any person in any manner ADDRESS 6 7 5 3 N Oak CONST ZONE V
so as to become subject to the Workers Compensation Laws f
F / O of
Date Applicant ARCHITECT OR ZIP TELCITY SanGabri-el
STATISTICAL CLASSIFICATION APT CONDO U
NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO CLASS NO DWELL UNITS W
Exemption you should become subject to the Workers d
Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP N
with comply with such provisions or this permit shall be TELrz
deemed revoked CONTRACTOR NO BK PG�O S VALIDATION
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 265 N Vinedo NCO 309178 yALUATION
(commencing with Section 7000)of Division 3 of the Business and $4 LIC
Professions Code and my license is in full force and effect CITY Pasadena Ca 911071LAssC39 s 1,620 00 ►
SQ FT NO OF NO OF CHECK
License Number Lic ClassI SIZE STORIES FAMILIES ONE
W
Contractor Date DESCRIPTION OF WORK Reroof house NEW ❑ $
I ❑
❑I am exempt under Sec With 20 yr fiber glass ADD �+
REPAIR �
B&P C for this reason shingles ALTER ® DATEFINAL �+
Date USE OF FINAL
EXISTING BLDG DEMOL ❑ By
Signature �PRINTT J L SHIPLEY mild" 92-2437
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor s License 00J
Law for the following reason (Section 7031 5 Business and ADDRESS
Professions Code)
ElI as owner of the property or my employees with ADDRIESS s 4 5 5 8 A
wages as their sole compensation will do the work and LOCALITY # • • • • •
the structure is not intended or offered for sale(Section
7044 Business and Professions Code) MOVING TEL 2 • • 4 9 8 8
I as owner of the property am exclusively contracting CONTRACTOR NO F
with licensed contractors to construct the project(Sec ADDRESS • •�• 4 9 8 8 v
tion 7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY F BACK YARD HWY TOTALPRO LIN FROM WIDTH 817-83
I hereby affirm that there is a construction lending agency for FROM ,
the performance of the work for which this permit is issued P L
(Sec 3097 Civ C ) SIDE
o PL
Lender s Name
Lender s Address PC Fee E Permit Fee &
I certify that I have read this application and state that the Issuance Fee S'0
above information is correct I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction Total Pee
and hereWlkuthorize re resentatives of this County to enter
upon th ve me too ape for mspectio pur ses o,
4i
REE REVERSE FOR EXPLANATORY LANGUAGE
Signature of App scant Agent ®s