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HomeMy Public PortalAbout5761 OAK AVE_Building__ DBB a a8M Bare !415 1 T DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM J FOX CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING c f, 71DISTRICT NO PLAN CK NO PERMIT NO ADDRESSISl SOi O/�'^ �` �� 4 Q -A)1 :3`� 3 LOCALITY g ` RECEIVED B DATE OF APPL. DATE ISSUED NEAREST CRO8T /V aS /` )1 a BUILDING � OWNER ADDRESS , / S^ © d /MAIL �+ r ADDRESS ��7 l SO 0c9k Si LOCALITY I C �' / NEARESTle CITY 7e-rnDle G►/ NOL�Ti(i 43-o F R�9B IIT Np OF PES GROUP ARCHITECT OR TEL ZONE ��hLANB ��Y ENGINEER NO 6 BLOB ORD NO ADDRESS SETBACK LINE r�i2�6 Rd L�rQ.. APPROVED EL CONTRACTOR , T NO Al �� BY DATE USE APPROVED ADDRESS J J- � �Lpt� ZONE "y Y DATE LEGAL CORRECTIONS DESCRIPTION LOT NO BLOCK TRACT NO OF ELDON SIZE OF LOT NOW ON LOT USE OF I NO OFI NO OF EXISTING BLDG FAMIL1a6 ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION p 8 REPAIR MOVING DEMOLISH 8 Bq FT NO OF y SIZE ROOMS STORIES r WALLROOF COVERING COVERING USE OF NEW e ` BUILDING _— w -' r 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT TH. 18 CORRECT FOUNDATION LOCATION, INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REG ING U4LDING TR C N FRAME FIRE STOPS, 81ONATURE OF �.�V BRACING, BOLTS OWNER LATH INT AUTHORIZED AOT LATH, EXT / P C 8 PLABTER, INT ...�, FEE PLASTER, EXT /gyp VALUATION FEE '2, FINALf,,,� rt. WORKERS COMPENSATION DECLARATION V.1 ersbv affirm that I have a certificate of consent to self ure "&,. a certificate of Workers Compensation Insurance APPLICATION FOR BUILDING PERMIT u ' or a certified copy thereof(Sec 38W lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec BUILDING tion department ADDRESS 'S-461 Date Applicant CITY L, 4 r7 WLOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS NO LDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST (This section need not be completed if the permit is for one TRACT BLOCK LOT NO ASSESSOR hundred dollars(=100)or less) MAP BOOK PAGE PARCEL OWNER 1G + TEL No28 2�301 USE ZONE P I certify that in the performance of the work for which this NO permit is issued I shall not employ any p an annerADDRESS �) SPECIAL so as to become subject to the Work Co a too Laws CONDITIONS C?—,) CITY LC" e l zip I l'1 fro 8 Date L�Applicant W NOTICE TO APPLICANT If after making this Certi tate of ENGINEARCHIER OR NO DISTRICT GROUP TYPE FIRE PROCESSED BY 0 Exemption you should become subject to the Workers /� CONST ZONE I— Campensafion provisions of the Labor Code you must forth ADDRESS V 9'� o CWS with comply with such provisions or this permit shall be TEL^� STATISTICAL CLAS ( TION APT CONDO y deemed revoked CONTRACTOR 11111.E Not 3 f� LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS- -: Z I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 6NO (commencing with Section 7000)of Division 3 of the Business and ,. SEWER MAP Professions Code and my license Is in full force and effect CITY Fix C� BK PG VALIDATION SO FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW 1:1 VALUATION so Contractor Date $ I am exempt under Sec ��� �� ADD 0poli. B AP C for this reason ALTER 11 ;28175 A REPAIR = Dot USE OF DEMOL # e e e e 0,1 EXISTING BLDG '��1.�i—�,2 G Signature APPLICANT Vv N 67 G t NO �6-°2 Q1 FINAL T 1 - 95925 OWNER BUILDER DECLARATION ems,J I hereby affirm that I am exempt from the Contractor s License 3 e e e 5 9 2 5 5 Law for the following reason (Section 7031 5 Business and ADDRESS � FIN Pro Ions Code) RUM By I as owner of the property or my employees with ADDRESS Q 2 2 8 7 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 ADDRESS tion 7044 Business and Professions Code) CONSTRUCTION(ENDING AGENCY SETBACK FROM iET B YARD HWY APROP LINE WIDTH I hereby affirm that there is a construction lending agency for EF- I the performance of the work for which this permit is issued (Sec 3097 Civ C ) Lender s Nome LDMA Ref N Lender s Address P Perms Fee 1 certify that I have rend this application and state that the lasuanee Fee SV (DMA P/C M o above information is correct I agree to comply with all County Ino 1 ordinances and Stcde laws relating to building construction Total Fee LDMA Perm N 1 ` and her a�tepresentatovoss of this County to enter 9 up h aproperty for inspection purpo s ; SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicantt Agent Date RKERS' COMPENSATION DECLARATION by to sel sure, or afcertif cate of Workers' Compensat on that I hove a certificate of coent Insuran of APPLICATION FOR BUILDING. PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS !�;76 I OCG /}NFr �J ❑ Certified copy is filed with the county building inspec- rAD7DRESS576/ tion department. EDate Applicant GL r ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST wi�rCOMPENSATION INSURANCE E OF LOT 466 NOW ON LOT CROSS ST. et",4,v E (This section need not be completed if the permit is for one / / ASSESSOR hundred dollars ($100)or less.) TRACT &J(� BLOCK LOT NO. 3 MAP BOOK PAGE PARCEL TEL. USE ONE MAP I certify that in the performance of the work for which this OWNER NO. NO permit is issued, I shall not employ any person in any mannerSPECIAL as to become subject to the Workers'Compensation Laws. ADDRESS FJ" CONDITIONS /,�� �� � CITY (t— ZIP Date Applicant ARCHITECT OR TEL. �/? NOTICE TO APPLICANT: If, after making this Certif ate DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER G NO. CONST. ZONE Compensation provisions of the labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SE MAP (commencing with Section 7000)of Division 3 of the Business and LIC. �Q Professions Code, and my license is in full force and effect. CITY CLASS BK PG 3 ►v w SQ. FT. NO. OF / NO. OF CHECK OL - 279, 87 U License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK ITOi✓ NEW ❑ ­ 279. 876) � Contractor Date ADD s 0 I am exempt under Sec. ch ❑ , 11,08-88 �}y� /�. ALTERLLJ B.BP.C. for this reason APO A REPAIR : N Date. USE OF DEMOL Z EXISTING BLDG. �i',/G� Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT G NO. DAT r— I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL P essions Code): E By BUILDINGVQ 1, as owner of the property, or my employees with ADDRESS ?c 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. .1 � 75with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBA K CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. N ^ P.C. Fee$ u Permit Fee ♦ Poo.Lender's Address oI certify that I have read this application and state that the Issuance Fee • LDMA P/C M above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total ee + LDMA Perm. # R and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. VJQ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or gent =Date f qWP®RKERS' COMPENSATION DECLARATION eaffirm that I have r certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a cewt4ied copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company �Q m"iT BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS C Date Applicant GV 'G(.l -r p✓ CITY ZIP LOCALITY PP NO. OF BLDGS. NEAREST ,A' CERTIFIC TE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. vY COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) a- TEL. OWNER �( NO. USE NE MAP I certify that in the performance of the work for which this '/ SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS v `� CONDITIONS 0 so as to become subject to the Workers'Compensation Laws. U CITY Y� zip Date Applicant ARCHITECT OR, TEL. DISTRICT I GROUP TYPE FIRE PROCESSED BY Q NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER 1 N//f� NO. CON ZONE H Exemption, you should become subject to the Workers' Ur 3 w Compensation provisions of the Labor Code, you must forth- ADDRESS o N with comply with such provisions or this permit shall ber' ' ` $�I EL STATISTICAL CLASCATION AP Z deemed revoked. CONTRACTOR T Q �U S Gtr NO. _ LICENSED CONTRACTORS DECLARATION ADDRESS NOLIC.. CLASS NO. ©� DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 LIC SEW E MAP (commencing with Section 7000)of Division 3 of the Business /�r VALIDATION and Professions Code,and my license is in full force and effect. NO OF' NO. OF CLASS CHECK BK. PG]3(0 License Number Lir. Class SIZE I ES FAMILIES ONE VALUATION Contractor s T 7s�H�5 C: lF DESCRIPTION OF WORK NEW $ ADD • ❑I am exempt under Sec. ALTER ❑ I"` B.&P.C. for this reason S _ 6- 50 REPAIR Dat USE OF / EXISTING BLDG. DEMOL _ f Signature �� APPLICANT S7 J-D�i\5 C o NO pY_ FINAL OWNER-BUILDER DECLARATION J Nn ,�/ O DATE C/ I hereby affirm that I am exempt from the Cont actor's License �'��v INN- Law for the following reason (Section 7031. , Business and ADDRESS -- Professions Code): PRESENT ` ❑ I, as owner of the property, or m employees with BUILDING k 'C/ - P P Y YADDRESS 1 4 - wages as their sole compensation,will do the work and T� GL the structure is not intended or offered for sale(Section LOCALITY Ty 7044, MOVING TEL. 0 Business and Professions Code ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name P.C. Fee$ Permit Fee LDMA Ref. # Lender's Address I certify that I have read this application and state that the Issuance Fee !tV ` 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 S a LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspectio purposes. a / � [�• SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Ag en Dat