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HomeMy Public PortalAbout5937 OAK AVE_Building__ DE,WPIENT OF BUILDING AND S APPLICATION FOR PERMIT COUNTY OF LOS ANGELESUL 8 WM J FOX CHIEFENGI EER N igU I L D G FOR APPLICANT TO FELL IN FOR OFFICE USE ONLY jAODRFB8 STRICT NO PLAN CK NO PERMIT NO BUILDING 12 ADDREBB ..GG LOCALITY L ECEI DATE OF ADPL DATE ISSUED^' NEAREST / �y c + V 7 C F/✓J LDING OWNER W MAIL ALITY ADDRESS NEAREST C G TO 2/3 CROBB BT !V FIRE NO OF TYPE GROUP ARCHITEOT OR TEL. ZONE PLANE ENOINEER NO BLDG � ORD NO ADDRESS SETBACK LINE APPROVED CONTRACTOR NOL. BY DMTE USE APPROVED ADDRESS ZONE BY DATE LEGA DESCRIPTION I LOT NO BLOCK 6 TRACT NO or SIZE OF LOT SO Y zgso NOW ON LOTS UBE OFNO OF NO OF EXISTING BLD9, 4114:0 FAMILIM Rooms DESCRIPTION OF WORK /00'0' / NEW ALTERATION ~ADDITION !� O S REPAIR MOVING DEMOLISH D Bq FT y. ND OF SIZE ROOMB STORIES WALLRODE COVERING OOVERINS USE OF NEW BUILDING O tl/C or 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT 1 SPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION LOCATION FORME MATERIALS AND STATE LAWS EMULATING BUILDING CONSTRUCTION FRAME FIRE BTOPBr SIGNATURE OF BRACING BOLTS PERMITTE LATH INT AUTHORIZED ABT LATH EXT r6A63BA 3 a so $ PCS , PLASTER INT FEC PLASTER EXT t VALUATION FINAL FEE DEPARTMENT OF BUUMING AND SAFETY iwr&&L%# a a avr r vn rr ua u A COUNTY OF LOS ANGELES BUILDING WM J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ■UILDING // DISTRICT NO PLAN CK.NO PERMIT NO ADDRESS LOCALITY RECEIVED BY /DATEorAPPL. DATE ISSUED NEAREST ROSS (� S A 6 OWNER tyJd' ADDRESSBUILDINV v //� // MAIL -e 7 r ADDRESS LOCALITY 1 1 //����/ CROS 8T f/ �� NEAREST / 1 NOL FIRE NO OF TYPE GROUP ARCHITECT OR ;EOL ZONE `. PLANS `• �--- r--- ENOINEER BLDG ORD NO ADDRESS SETBACK LING L. APPROVED CONTRACTOR �' `'� NO BY DATE UBE APPROVED ADDRESS �/ ZONE / BY DATE LEGALDESCRIPTION LOT NO 9 �7 BLOCK -�- CORRECTIONS TRACT w SIZE OF LOT NOW ON LOT oie USE OF O NO OR EXISTING BLDG D A ROOMS ` DES C TION OF WORK , NEW �� ALTERATION ADDITION D >0 REPAIR MOV DEM LISH O Bq FT NO OF _ SIZE „RGOMB ORIEB -� WALL ROOF � COVERING - COVERING i 1 i i 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROV APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION LOCATION CTOR TE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS MATERIALS _u AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME FIRE STOPS SIGNATURE OF BRACING BOLTS OWNER 2g:�(/wz� LATH.INT AUTHORIZED ACT j "g LATH,EXT DBS 3 25M BETS 1 47 $ P `. , PLASTER INT aS© mQ FEE PLASTER EXT VALUATION F. `� ' FINAL DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT 'COUNTY OF LOS ANGELES u I L ® I WM J FOX CHIEF ENGINEER JUN 7 NG FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING /�� DISTRICT NO PLAN alb NO PERMIT NO ADDRESS / --I /✓! L �i LOCALITY ,� RECEIVED BY OATS OF APPL DATE ISSUED NEAREST OOD !0/CF (�Jc�0 ✓V��fy r ✓y�ir'iGt�i^ BUILDING O-%M0�7 �(� b ADDRE OWNER BB ADORE" , /�/ /•' D/qI� LOCALITY C N.EAREBT TY C C TSL. L �Z/O OROB8 BT i GUD Q D LJ rr ARCHITECT CR i•• TEOL v `7 ZONE PLANS`"�FIRE NO or ' SPE GROUP+ ENGINEER .E N BLDG ORO NO r ADDRIiNS �/�- SETBACK LINE APPROVED DATE CONTRACTOR NOL BY � USE APPROVED ADDRESS ZONE / BY DATE GALLLOCORRECTIONS DEBC IONT O TRACT s/ / r SIZE OF LOT J NOW ON LOT v y7 r USE OF /0 NO OF NO OF U EXISTING BLDG / FA 1.lCe I ROOM DESCRIPTION OF WORK NEW ALTERATION ADDITION D e REPAIR MOVING DEMOLISH G_ SQ FT NO OF / / Z SIZE 3 ROOMS ST/O�RIESM r WALL Roof COVERING S//> //�//�G' �I COVERING SUILDFING�y TD// �L�.[. �D/T •f��.t9T f5�--/�3 L Zd �3� �S Ta ns D tai �;L D 6 v I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATION LOCATION NB TOR �--7 DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS MATERIALS / /0 -F0 AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME FIRESTOPS SIGNATURE OF BRACING BOLTS PERMITTEE LATH INT AUTHORIZED AOT LATH EXT 7"68BA a 7 49 $ P C PLASTER INT / rJ FEE • PLASTER EXT VALUATION FEE FINAL an 9 '.40 ASAI mrs 1APPLICATION FOR PJEJU IIT DEPARTMENT OF BUILDING Akl) &A-FRTY COUNTY OF LOS ANGELES BUILDING WM J FOX CHIEF ENOINKER NO OF BLDG ORD NO DISTRICT NO PLAN CK NO PERMIT NO PLANS SETBACK LINE FIRS APPROVED ZONE BY DATE R&CRIVED BY DATE OF APPL mDATE lSSUJm USE APPROVED - ZONE BY DATE APPLICANT FILL IN HEAVIL OUTLINED PORTION ONLY E BUILDINGAZ 7 Al /�w O NAME ADDRESS / VW C W Z ADDREB/ LOCALITY 20e c'ez e NEAREST A U Z CITY CROSS / �i M «q LICENSE NO NO NId STATE TEL AME ��+ P�i E NAME Ap MAIL DDRESS Gftil te /V 4;Ay a e1em Ay,id O TEL ADDRESS CITY/G G NO z&4 ir of CITY / 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 C L NO y SIZE OF LOT3D�1��� /IGNATURN OF OWNER 9NO OF BLTS / Ii3a� BLOCK y NOW ON LOOT AUTHORIZED AGT-.A& x '' TRACT CORRECTIONS use or O NOW ONBLMOB LOT ' y D`G7 /YO sfAr�O DESCRIPTION OFWORK/ USE OF ` BUILDING i / 2 '� t/ + / p/A o i - ' o z D NEW TYPE GROUPNo OF r No OF ALTERATION RODM/ A/ FAMILIES ADDITION BIZB REPAIR STORIES MOVING WALL COVERING DEMOLISH ROOF COV INQA'4.; P C / v FINAL APPROVAL ATION ruE p1� INSPECTOR S VALU DATE F \ � NAMC n■• 1.41 WIN APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOB ANGELES BUILDING WM J FOX CHIEF ENGINEER NO of BLDG ORD NO DISTRICT NO PLAN CK NO PERMIT NO �� PLANS SETBACK LINK b r"!"""` J 7 / 77 FIRE APPROVED ZONE BY DATB RECEIVED BY DATE OF APPL DATE ISSUED USE /�/f APPROVED & , 2 3 0 —g Z. 3 30_it ZONE/// / BY DATE ✓ APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY BUILDING O NAME ADDRESS Id Z ADDRESS LOCALITY = t9 NEAREST U W CITY CROSS ST < STATE TEL LICENSE NO NO NAME MAIL yasy� O NAME 3 ADDRESS DI'J� y U c < ADDRESS CITY ��J T`/GSI/ "NO Js� CITM 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS U STATE TEL APPLICATION AND STATE THAT THE ABOVE IS CORRECT LICENSE No NO AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS R/E�ODU ING BUILDING CONSTRUCTION C LOT NO Z SIZE OF LOT ur SIGNATURE OF OWNER NO NO OF BLDGS RIZ BLOCK NOW ON LOT AUTHORED AOT TRACT S G,/ RRF,CTIONS D USE OF SLOGS NOW ON LOT L �L DESCRIPTION OF 'WORN USE of OX Bu19) efl n A Li Z NEW TYPE GROUP NO OF NO OF ALTERATION � ROOMS FAMILIES ADDITION /V/ SIZE Z D REPAIR STORIES MOVING WALL COVERING DEMOLISH ROOF COVERING s P C • FINAL APPROVAL D O FEE � t I� INSPECTOR H VALUATION FEIE V` DAT$ `' NAME DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING 1 WM J FOX CHIEF ENGINEER NO OF /� BLDG ORD NO DISTRICT NO PLAN CK NO PERMIT NO PLANS SETBACK LINE Z A U / Q� r 1 FIRE APPROVED / \ t ( u ZONE BY DATE RECEIVED DATE OF APPL I DATE ISSUED USE APPROVED ONE BY DATE O APPLICANT FILL IN HEAVILY Of I[ANED PORTION ONLY BUILDING Q NAME ADDRESS �W FW-Z ADDRESS LOCALITY ZR gel U W CITY CROSSSST STATE TEL �+ LICENSE NO NO W NAME / Z MAIL U NAME 30 ADDRESS TELt ADDRESS CITY At, NO {� ZCITY I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS UAPPLICATION AND STATE THAT THE ABOVE 18 CORRECT STATE TEL AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO $1�, NO AND STATE LAWS RWULATI G B ING NSTRUCTION OLOT NO /Z 0� 3 SIZE OR LOT S^� �� SIGNATURE OF ���V OWNER NO OF BLDGS AUTHORIZED AGT BLOCK NOW ON LOT U r CORRECTIONS W TRACT USE OF O NOW ON BLOT S A DESCRIPTION OF WORK x z USE OF BUILDIN i J yr NEW TYPE GROUP NO OF NO OF ALTERATION ROOMS Y �f FAMILIES ADDITION SIZE Z REPAIR STORIES MOVING WALL COVERING , DEMOLISH ROOF COVERING s Aft P C s FINAL APPROVAL FEE ti 0 1 - /'- �2- O INSPECTORS 54-�, VALUATION FEE DATE NAME DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM J FOX CHIEF ENGINEER PLAN8BLDG FIRE DIRICT No PLAN CHK FEE PERNO FILED SETB ( ZONE STMIT ZONERECEIPT NO TYPE OF BLDG 1 it 111 IV V X GROUP Z BLDG SETBACK LINE DATE OF APDL RECEIVH BY DATE ISSUED ORD NO //_� a //-�/ APPLICANT FILL IN HEAVILY OUTLINEDPORTIONONLY O NAME _ADDRESS �j� / N ADDRESS LOCALITY /f�fh1e /,f V W CITY 13 NEAREST / 4 S ryh eJ S CROSS 8T /G. E STATE �/� pis Q LICENSE NO r' TeL No E NAME/i►��/�Q�/��r' ,� � r ' MAIL IK NAME O ADDRESSQ/7L1Q!�-PI7 Aye- ADDRESS O CITY Tei,,, J, Je I f V TEL NO Z CITY Jn LOT/V$+ .#4-/`l SIZE OF LOT V STATE W U NO NOW ONBLOT LOGS O 1�► LICENSE NO TSL No BLOCK OF Jo USE OF BLDG CLASS OF WORK TRACT ig G NOW ON LOT DESCRIPTION OF WORK NEW ADDITION DEMOLISH ALTERATION I REPAIR —I MOVING USE NO OF BLDG F/faaZ/h C51.O ROOMS SIZE OF 0 OF C3O v c O STORIES FAMIL EB O BI OC /l CORRBCTIONS SPECIFICATIONS ' FOUND ON `r EXTERIOR PIERS ^' 'r ,CSS MATERIAL r� THICKNESS—TO Go THICKNESS—BO OM J Q '-� DEPTH IN GROUND A Z 0 SUPERJ3T yCTURE t, 14 SIZE SPACING SPAN O R A ES (BILL) GIRPERSI V JOI FLOOR 4-I JOISTS—CEILING O BEARING WAL rl PARTITIONS ROOF RAFTER FINAL APPROVAL O BILL BOLTS S m U COVERING � .� 4 �9 //INSPECTORS NAM! 6 WALL ROOF 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT P C EE $�60 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STAT WS REG LATING BUILDING C NSTRUCTION VALUATION EE v F / SIGN OW BR OR AUTHORIZB AGCNT om-3 4-89 19M 78A638A CE#80312/BAPPLICATION FOR BUILDING PERT cl ul COUNTY OF LOS ANGELES ASSESSOR D: DEPARTMENT OF COUNTY ENGBWM MAP BOOK PAGE PARCEL :D /� Cr BUILDING AND SAFETY DIVISION ADDRESS e V tX ' uj JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUP T OF BUILDING LOCALITY / / � Z NEAREST ) FOR APPp�LICANT TO FILL IN CROSS ST / L /)/ // �int or tioe only) V BUILDING �j ^ DRICT NQs/ OUP TYPE CONST / E !�L lD Y �¢ ADDRESS XY Z / (4V-` /✓✓JJ �' Y STATISTICAL CL�SIFICATION SEW R MAP LOT NO BLOCK CLASS NO _DWELL UNITS BK PG U TRACT USE ZONE MAP LU NO OF BLDGS WO O $I SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS i EXISTING B DG TE �/ Ic OWNER I NO 36 x BLDG SETBACK FROM I" FRONT PROP LINE OF (STREET) Z) ADDRESS � TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL a CITY E� HIGHWAY WIDTH I FROM C L z ARCHITECT TE } ENGINEER� NO ' BLDG S FROM (STREET) ADDRESS Q SIDE PROP LIN _ l TEL TYPE., EXISTING SETBACK HI } YARD = TOTAL CONTRACTOR /Y NO HIGHWAY WIDTH FROM C L LIC ADDRESS NO } - a LIC CITY CLASS CORNER CUTOFF YES ❑ NO ❑ V CONSTRUCTIONNAMEAND BRANCH CH�MR SEE REVERSE SIDE FOR SPECIAL APPRO LS W ADDRESS d y SQ FT NO OF NO OF NEW ❑ Z SIZE STORIES FAMILIES El OF ADD STRUCTURE ALTER 10 v SIGNATURE OF REPAIR❑ APPLICANT Or ,Q�� I DEMOL ❑ VALUATIONS 1(j(/'d%L APPROVALS DATE INSPECTOR S SIGNATURE PC nAl FOUNDATION LOCATION FEES I O FEES / FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON GAS VENT DUCTS STRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COMPENS ION INSURANCE LATH EXT SIGNATURE OF HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN FF 'LEEWIS P*RIiINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION FKM O CASH _ PE31i-13a VAL DATON CK MOCA H 0 1 � 720 - 4 �`i� S A1'„7 8 O 29 KW27 ID 12.00, 41' ` 76A698A&E p809 1/71 APPLICATION FOR (BUILDING PERMIT COUNTY OF LOS ANGELES XSSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING A�1`E/ ADDRESS J ,�/1 COLEMAN W JENKINS SUP T OF BUILDING LOCALITY �j, t E c 1 /T y FOR APPLICANT TO FILL IN NEAREST / x` Print nl CROSS ST L— I BUILDING DISTRICT NO GROUP TYPE PR SSED BY ADDRESS 9� ro Z CONST V . STATISTICAL CLASSIFICATION SEWER MAP LOT NO N y 3 BLOCK CLASS NO DWELL UNITS BK PG TRACT USE ZONE MAP NO OF BLDGSNO p SIZE OF LOT NOW ON LOT C.� 07SPECIAL USE OF CONDITIONS EXISTING B DG / OWNER NOL eI BLDG SETBACK FROM ADDRESS g r FRONTPROP LINEOF (STREET) TYPE OF EXISTING SETBACK HIGH + YARD = TOTAL CITY HIGHWAY WIDTH FROM C L I ARCHITECT OR TEL + ENGINEER NO BLDG SETBACK FROM ADDRESS SIDE PROP LINE OF (STREET) TEL TYPE OF EXISTING SET HIGHWAY + YARD = TOTAL C CONTRACTOR NO HIGHWAY WIDTH FRO L C) ADDRESS NO t = O LIC CITY CLASS CORNER CUTOFF YES ❑ NO ❑ W CONSTRUCTION LENDERCn NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAM APP OVALS ADDRESS SO FT NO OF NO OF NEW ❑ r� SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE ALTER fAnX uam REPAIR❑ SIGNATOR O APPLICANT DEMOL ❑ VALUATIONS APPROVALS DATE INSPECTOR S SIGNATUFE P C PMT dj, FOUNDATION LOCATION FEE $ FEE$ FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, RACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON GAS VENT DUCTS STRUCTION IC THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION Of TME LATH INT LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COMPENSATION RANO LATH EXT SIGNATURE OF HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS FINAL Jr PLAN CHECK VALIDATION CK M o CASH �OHN�+F�*LE�WI$ P*R�I IP L T UGTURAL =CASH PE1114I VALIDATIO C M O A DEC 1,3 1 D d 0 N i - =sAPPLICATION FOR BUILDING PERMIT 1 DMSION OF SUMMIG AND SAFETY BURYMM �7 V Deposlatent of CoIDsIp Snglaeer Coltnit of Los Angeles LOCALITY WM J FOX COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OP BUILDING CROSS ST III DISTRICT NO GROUP . ypE SEWER BK MA PO FOR APPLICANT TO FILL IN ,� -,Z ONS ADDBUILRESS MAP STATE YES O NUMBER 0 O HWY60 LOT NO ' BLOCK USE ZONE SPECIAL CONDITIONS TRACT NO OF SLOGS BUILDING EXISTW SIZE OF LOT O NOW ON LOT SETBACK YARD HY STREET NAME WIDTH USE OF FRONT EXISTING BLDG p L OWNERSIDE P L MAIL ADDRESS O TRACT DWELL I UNIT S INDUSTRIAL CITY TFMPI.F G/TY TEL IO7'G�9w I DWELL I UNIT 6 PUBLIC BLDG ARCHITECT OR TEL 2 DUPLEX f UNIT ENGINEER NO ADDN ALT ETC. S APT UNITS B MISCEL ADDRESS 4 COMMERCIAL CONTRACTOR NO INSPECTION RECORD ADDRESS DES_BVnON OF WORK NEW DD ALTER REPAIR DEMOLISH SQ FTNO OF / NO OF SIZE STORIES FAMILIES `�� y USE OP UCTURB el e I= SIGNATURE OF APPLICANT APPROVALS ADDRESS DATE INSPECTOR 8 SIGNATURE S �JD /ISI T__EF C I` �FORMSTMATERLOCASTION (� EE FRAME FIRE STOPS VALUATION $�[ BRACING BOLTS 12 -2,-5�" EE /' FURNACE LOCATION 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT i AND STATE LAWS REGULATING BUILDING CONSTRUC �/ TION 446 0 % LATH OffSIGNATURE OF HOUSE NUMBER COR _ PERMITTEE194 pczdmc RECT AND POSTED �p ADDRESS J+ ✓ FINAL /Z r/?rj WM J FOX CouNTY ENGINEER VALIDATION C N DIRLAM CHIEF BLDG INSPECTOR C9388S OCT26 1 444 in I � ® WORKERS COMPENSATION DECLARATION go i hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT Il insure or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING A� , Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec BUILDING ,5-e tion department ADDRESS v < � LOCALITY NEAREST Date Applicant CITY G.W ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars($100)or less ) TRACT BLOCK LOT NO NO TEL el/� SPECIAL } I certify that in the performance of the work for which this OWNER NO — Z 1 V CONDITIONS d permit is issued I shall not employ any person in any manner DISTRICT GROUPLTYPE FIRE SSED BY O so as to become subject to the Workers Compensation Laws ADDRESS i ZONE V CITYer ZIP 9i 7�O °K o Date Applicant ARCHITECT OR TEL STATISTICAL C TIO CONDO (~1 NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO CLASS NODWELL UNITS LU Exemption you should become subject to the Workers A. Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP N with comply with such provisions or this permit shall be z deemed revoked CONTRACTOR NO BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code and my license is in full force and effect CITY CLASS $ ► SQ FT NO OF NO OF CHECK License Number Lic Class SIZE ISTORIES FAMILIES ONE Contractor Date DESCRIPTION OF WOR NEW ❑ $ ADD ❑ I am exempt under Sec 6 � ALTER ❑ FINAL B&P C for this reason REPAIR ❑ DATE USE OF FINAL Date EXISTING BLDG DEMOL ❑ By Signature APPLICANT TEL OWNER BUILDER DECLARATION PRINT NO I hereby affirm that I am exempt from the Contractor s License10. Law for the following reason (Section 7031 5 Business and ADDRESS ��, Professions Code) J V8 5 0 3 A BUILDING �-- I as owner of the property or my employees with ADDRESS Z3 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 2'o e 4 9 8 7 ❑ 1 as owner of the property am exclusively contracting CONTRACTOR NO 7's'. 00 with licensed contractors to construct the project(Sec ADDRESS . . . 4 9 8 7`0 tion 7044 Business and Professions Code) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST 1221 -82 CONSTRUCTION LENDING AGENCY SET BACK PROP LIN WIDTH ► f'},�., �� 1 hereby affirm that there is a construction lending agency for FRONT -28504A the performance of the work for which this permit is issued PL (Sec 3097 Civ C ) SIDE 'aJ #f • • • • 2 3 Lender s Name Lender s Address PC Fee E oc Q Permit Fee eC`� /, 2 • • 2 `501I certi that I have read this a lication and state that the _� �`�/ ` � 5 0�fy PP laauance Fee V, ' Qabove information is correct I agree to comply with all County Investigation::7 �I/ 1221 —82 ordinances and State laws relating to budding construction Total Fee ZAVf 71 and hereby authorize representatives of this County to enter upo above tioned property for inspection purposes n a ` , r SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent Date IDS 5 � WORKERS COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self ArP K I CATION FOR BUILDING PERMIT ,�I`ure a certificate of Workers Compensation Insurance 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 6-997 Certified copy is filed with the county building mspec BUILDING tion department ADDRESS2 e2 LOCALITY r�f� NEAREST Date Applicant CITY ZIP 17. v CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars($100)or less) TRACT BLOCK LOT NO NO TEL C/Z SPECIAL } I certify that in the performance of the work for which this OWNER NO CONDITIONS IL permit is issued I shall not employ any person in any manner 2 DISTRICT GROUP TYPE FIRE P SSED BK O so as to become subject to the Workers Compensati Laws ADDRESS .37 CONS] ZONE 0, St Date 1-29- Applicant CITY ZIPge IC STATISTICAL CLASSIFICATION APT CONDO NOTICE TO APPLI NT If after making ARCHITECT OR TEL '' AA LU Exemption you should become subject to the Workers ENGINEER NO CLASS NO DWELL UNITS Compensation provisions of the Labor Code you must forth ADDRESS SEWER MAP 44 with comply with such provisions or this permit shall be TEL _ deemed revoked CONTRACTOR NO BK PG VALIDATION LICENSED CONTRACTORS DECLARATION r I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION _ r r� i (commencing with Section 7000)of Division 3 of the Business and LIC J Professions Code and my license is in full force and effect CITY No CLASS HECK ; o /%(�(J 6 Lac Class C'�O SQ FT S ORIIES FAMILIES CONE $ 0 License Number G ContractoDESCRIPTION OF WORK NEW ❑ r to ADD 11I am exempt under Sec ALTER ❑ FINAL B ILP C for this reason REPAIR GATE ❑ '8453A Date 4COF FINAL `�� I >`s o 0 0 0 23 EXISTING BLDG DEMOL ❑ By Signature APPLICANT TEL 9/44 WER BUILDER DECLARATION NO 7 t� �� 2 ° ° 395 O I hereby affirm that I am exempt from the Contractor s License ► ��'�/ L ° o o ' O ? Law for the following reason (Section 7031 5 Business and ADDRESS Professions Code) FRMINIT 0 1 2 5—e b BUILDING I as owner of the property or my employees with ADDRESS -'7 O C-10'wages as their sole compensation will do the work and 7,S the structure is not intended or offered for sale(Section LOCALITY 7044 Business and Professions Code) MOVING TEL ��/JrV y [t 5 LI A I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec a to 0 0 0 o e 1 tion 7044 Business and Professions Code) ADDRESS rL(/ rh REQUIRED TOTAL SETBACK FROM EXIST - ° 0 9925 CONSTRUCTION LENDING AGENCY SET BAS YARD HWY pROP LIN WIDTH I hereby affirm that there is a construction lending agency for FRONT ( Y C! o c v 5 G 21" _ the performance of the work for which this permit is issued P L tSec 3097 Civ C ) SIDE 0 1 2 5—8[L o a PL Lender s Name /y Lender s Address P C Fee; Permit Feelf'�dl I certify that I have read this application and state that the i s Issuance Fee /0 J-0 O above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to budding construction Total Fee and hereby authorize representatives of this County to enter upon the above entioned property for inspection purposes o `K y SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®s