HomeMy Public PortalAbout6317-6319 OAK AVE_Building__ DP-$ .ji4fi d,EM S6T£ _ APPLICATION FOR FERMIT
DEPARTMENT OF BUILDING AND-SAFETY 13N T 7"KING
'COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NO.OF BLDG. ORD.•NO. DISTRICT O. PLAN CK. P���
O. - � NCS.
PLANS 6ETSACKPPROVELINE
FIRE AD
ZONE BY DATE RECEIVED BY, ,.- DATE APPPL,, DATE,ISSUED
ZONE / BYPROVED / DATE i eye!S%I G�C�J�'.fi•0 ���7� .��`� f
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
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BUILDING
p NAME ADDRE88 J Pf7"
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U W ADDRESS A- . :Ir LOCALITY .r rG"'! "" .-• —L_ G
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V W CITY j . r� frl CROSS ST. C� y�f'�.£��_ L.l �o
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G LICENSE NO. < NO.'
TATE lr
NAME
MAIL
IC -NAME ADDRESS /�,-fir•+ _ .�
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' TEL.
C ADDRESS CITY NO.
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
Z CITY
Q 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.
,�/ /� SIGNATURE OF
LQT NO:Y�y SIZE OF LOTS/I��pOWNER
NO. OF BLDGS. AUTHORIZED AGT. �`�
BLOCK NOW ON LOT
J� yam- lti -ate=a CORRECTI�Df
m TRACT PZ
D USE OF BLDGS.
NOW ON LOT
DESCRIPTION OF WORN
fes;�. ..��,�.,..,e`r:,• �,R„r.. :,�`s"�+-�r.;ta=-:;::,�,
USE OF r
BUILDING 1 ✓-
l .•.uY�Gi.Y44N..�� �j���.'.rsv Y' �
War Production Board orders. You are �
cautioned to consult with your local War �
Fzu c 111 :)u uvu Cu bifnfurL wmmenc- Z
NEW TYPE GROUP t]
NO.OF
ALTERATION ROOMS 4 FAMILIES
ADDITION SIZE
REPAIR STORIES /
MOVING WALL COVERING
DEMOLISH ROOF COVERING
s P.C.s FINAL APPROVAL
V !/ FEE
INSPECTOR'
VAT �I •
ALUION FEE • '�' DATES ��b_[f:3" I NAMEO`0"-G1��..v
WORKERS'COMPENSATION DECLARATION
hereby affirm that I have certificate of consent to self APPLICATION FOR . U I L D I N G P E RM I T
insure, or a certificate of Workers' Compensation Ins rice,
or a certified copy thereof(Sec. 3800 C.) �O COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Noon%7 T7/Company �+
❑ BUILDING
Certified copy is hereby furnished. `3 7- FOR APPLICANT TO FILL IN ADDRESS / -
❑ Certified copy is filed with the counybuldi inspec- BUILDING
I q
�Al,tion department. DR
Date3d]4�
ApplicanCITY 'zew ZIP 117W LOCALITY
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM ORKERS' 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 I LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL.
OWNER S/LI/4 NO. USE ZONE MAP/.i /..2!®J
/ r
1 certify that in the performance of the work for which this SPEC is issued, I shall not employ any person in any manner ADDRESS .o S— -r SPECIAL a
CONDITIONS O
so as to become subject to the Workers'Compensation Laws. �• �. J
CITY !C �. ZIP U
Date Applicant ARCHITECT OR TEL. DISTRICT w
GROUP TYPE FIRE P CESSED BY aeO
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER • NO. CONST ONE
Exemption, you should become subject to the Workers' 2 S
Compensation provisions of the Labor Code, you must forth- ADDRESS d' `J 6� ra
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR me) —
LICENSED CONTRACTORS DECLARATION --JLIC. o CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Z N 7ZY
(commencing with Section 7000)of Division 3 of the Business /f_/ LIC. _ SEWER MAP
and Professions Code,and m license is in full force and effect. CITY {TL C BK �i PG&'d00L- VALIDATION
/�.� SQ. FT. NO. OF NO.OF CHECK
License Number Lic. Class&3q SIZE I STORIES FAMILIES ONE
'•�� VALUATION
Contract o Date, DESCRIPTION OF WORK NEW ❑ADD $ 7�7A�e7
I � ° ❑ � J
❑I am exempt and r Sec.
° ALTER 1E]B.&P.C. for this reason & .4 REPAIR ❑ $
D e: 3_24_12:2 USE OFF
EXISTING BLDG. DEMOL ❑
Signature i FINAL
APPLICANT TEL.
OWNER-BUILDE ECLARATION (PRINT) NO.
DATE
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Q _
Professions Code): PRESENT By
JL
BUILDING
❑ I, as owner of the property, or my employees with ADDRESS-
wages as their sole compensation,will do the work and ,_;7•'1 7 .'•
the structure is not intended or offered for sale(Section LOCALITY pop
-
7044, Business and Professions Code.) MOVING TEL. i 1"=��
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. I 113- 63 s .r,=°
with licensed contractors to construct the project (Sec- ADDRESS ,*TAIL S '�-3 4 fix
tion 7044, Business and Professions Code.) j 1 ,':�f -1 -7
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CARE
'rr rri
I hereby affirm that there is a construction lending agency,for FRONT 'r��1-1'E °!•.-
the performance of the work for which this permit is issued F.L.
(Sec. 3097, Civ. C.). SIDE
Lender's Name P.L• i +.I.I.I'-):f,l?� _`f '.
LDMA Ref. #
P.C. Fee$ Permit Fee a v�?,'_ Am 4'e.5,
Lender's Address
' I certify that I have read this application and state that the Issuance Fee ' 7 i LDMA P/C#
Feeation
above information is correct. I agree to comply with all County Investigation I
ordinances and State laws relating to building construction, Total Fee ✓• LDMA Perm. #
and hereby authorize representatives of this County to enter
g° upon the above-mentioned property for inspection purposes.
D SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date I