HomeMy Public PortalAbout9132 OLEMA ST_Building__ BA6981.Cr I♦008.S.60 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGADDRESS
INEER
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST 1 i
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. G TYPE - �F-SSED
•
FOR APPLICANT TO FILL IN o I CONST.%J[j�
BUILDING �' STATISTICAL CLASSIFICATION S WERMAP
ADDRESS //3 j(J/1r'1 /�-` P
CLASS.NO.�(LDWELL.UNITS
BLOCK MAP Grn STATE
LOT NO. / NUMBER t2-" HWY. YES O
TRA �+ USE ZONE SPECIAL
4NO.OF BLDGS. //1 CONDITIONS
SIZE OF LOT I NOW ON LOTUSEOF
V fV
EXISTING BLDG. : w to -.'JC Ir BUILDING EXIST.
TEL. SETBACK YARD HWY R ET NAME WIDTH
OWNER ((�+i� < z NO. 7 FRONT
ADDRESS y/ 3'I G ! o /'r w'w SIDE '
ARCHITECT OR TEL. P.L.
ENGINEER NO. INSPECTION RECORD
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ADDRESS _ �Jd 7iBs� d
CONTRACTOR 7e NO. O
` -n N /i 4`/U ' �Z
ADDRESS y��� U� � D� �•' - O
DESCRIPTION OF WORK W
a
y NEW (AD71N ALTER REPAIR DEMOLISH H
SQ.FT. NO.OF NO.OF
SIZE �+.�'1 STORIES FAMILIES
USE OF
STRUCTURE al C/IL��
SIGNATURE OF !
".. APPLICANT
: �
VALUATION$ 6
APPROVALS DATU 1NSPEC dR'S SIGNATURE
I PMT.
P.C. ,,.� FOUNDATION:LOCATION J'
FEE $, FEE FORMS,MATERIALS
FRAME: FIRE STOPS, °r
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING,BOLTS to Co/ a1L'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED 1 SHALL NOT LATH,INT.
EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBUECT
TO THE WORKMEN'S COMPENSATION WS OF CALIFORNIA.
L4TH,EXT.
SIGNATURE OF / r HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS-1p� ' FINAL
CLYDE N. DIRLAM, PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION aK M.O. CASH
JWORKERS' COMPENSATION DECLARATION
hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T
insut�:, or a certificate of Workers' Compensation Insurance,
or a �;rtified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.' Company
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 01s
ElCertified copy is filed with the county building inspec- BUILDING
4:7 ��'`�� Or--
ADDRESS ✓
tion department. a _ �:?
Date Applicant CITY fr (, ` ZIP 91 Z LOCALITY L. /
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' 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 BOOK PAGE PARCEL
hundred dollars ($100)or less.) y� TEL /.&
OWNER If, Zfy 44X� NO.6 7 J07 USE ZONE MAP /
I certify that in the performance of the work for which thisr NO.
permit is issued, I shall not employ any person in any manner ADDRESS IJ4r, 41CJt�, I eO'fX �G � � SPECIAL
7` CONDITIONS
so as to become subject to the Workers'Compensation Laws. /� .� �` 8 U O
CITY �N! / (," / zip
Date Applicant ARCHITECT TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Q
NOTICE TO APPLICANT: if, after making this Certificate of ENGINEER NO.
Exemption, you should become subject to the Workers' I/�D� A3 �NSir� ZOORIZ U
Compensation provisions of the Labor Code, you must forth- ADDRESS o IJ `� , _� a-
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION AP . CONDO. Z
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.
(commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP
and Professions Code,and my license is in full force and effect. CITY CLASS BK �� VALIDATION
SQ. FT. NO. OF NO.OF CHECK FFF
License Number Lic. Class SIZE STORIES FAMILIES ONE
VALUATION a ,�
Contractor Date DESCRIPTION OF WORK /�iC •.O v.-,e,e NEW ❑ $ //7�
❑I am exempt under Sec. +��/ /�/✓��J LA-PI,�
ADD ❑ �j ,
ALTER ❑
B.BP.C. for this reason vcc Lw a�// .Q r L"�j $
REPAIR ❑
Date: USE OF
EXISTING BLDG. L'' �� DEMOL ❑
Signature APPLICANT TEL. FINAL
OWNER-BUILDER DECLARATION (PRINT) NO. -+ DATE it l
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL 1
Professions Code): PRESENT B
I, as owner of the property, or m employees with BUILDING 11 A� Tov
P P Y� YADDRESS ..
wages as their sole compensation,will do the work and 3307 87.38
the structure is not intended or offered for sale(Section LOCALITY ,
Mn
7044, Business and Professions Code.) MOVING TEL. r� w1 ITEM53
❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. TOTAL "`e o. �
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code.)
EQK u7ov+
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 CHANGE .00
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L. 0000-0001 9/20/89
Lender's Name
3 P.C. Fee$ Permit Fee 00
LDMA Ref. # 5811 i 1 QM 9 e 32
Lender's Address C� L
I certify that I have read this application and state that the Issuance Fee a v o 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 "3K LOMA Perm. #
and hereby authorize representatives of this County to enter
Pon th bove-men' �tl roperty f inspectio ypurposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of App i nt or Agent Brate