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HomeMy Public PortalAbout9502 OLEMA ST_Building__ 7/14 C9 BA jt803 9-67 IC. l.I�L'✓! • fl APPLICATION FOR BUILDI G PERM CdUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY /J JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN DISTRICT N G TYPE ErgD B CONST (Print or type only) '. BUILDING STATISTICAL C IFICATION SE R MA ADDRESS ASS®esl— �rsJ CLNO. DWELL.UNITS BK /PG LOT NO. 22 BLOCK USE ZONE MAP NO. 112 0 TRA SPECIAL NO.OF BLDGS IOU CONDITIONS SIZE OF LOT .SAX NOW ON LOT USE OF EXISTING BLDG. 7yZ BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) OWNER NO. TYPE OF EXISTING SETBACK HIGHWAY -I- YARD = TOTAL ADDRESS L�a 40AP w, HIGHWAY WIDTH FROM C.L. -�.5r 1 + D = CZO CITY y BLDG. ETBACK FROM ARCHITECT O EL. SIDE PROP.LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + — �- CONTRACTORNO. CD ADDRESS �gj 6l94d.S NO. `jr CORNER CUTOFF YES E] NO ❑ v CITY LASS SEE REVERSE SIDE FOR SPECIAL APPROVALS t3 DESCRIPTION OF WORK y 6 � �11rr L✓ � NEW e<DD ALTER REPAIR DEMOLISH �J SQ. NO. OF NO. OF SIZE s� STORIES FAMILIES \ USE OF STRUCTURE i SIGNATURE OF APPLICANT /y VALUATI0 S APPROVALS DATE IR croR's IG TU RE P.C. PMT. r�� FOUNDATION: LOCATION FEE$ FEES �� V FORMS, MATERIALS FRAME: FISTOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACIRE NG BOLTS 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 DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFO A RELAT- ING TO WORKMEN'S CO N ION INSURANCE, LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE ` RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTU AL ENGINEER PLA ' HECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. un.0. CASH 4166daAPR 8 1D 22.50- Iq I WORKERS'COMPENSATION DECLARATION 1� ( hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT v1, insure, or a certificate of Workers' Compensation Insurance, or a certifiedcopy tF��ell c. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. $ pony Frnant ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUADDRESS RESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 9502 Olive Date 11/7/85 71$5 Applicant Virptin Root Cc+• CITY 'P+ ple C.itly ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. __ (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PALL _ PARCEL d OWNER Ri�It I; air NO. USE ZONE MAP TEL. �' I certify That in the performance of the work for which This NO. Q— U permit is issued, I shall not employ any person in any mannerSPECIAL Yl so as to become subject to the Workers'Compensatiori Laws. ADDRESS 9502 Olive CONDITIONS CITY Tw*1e City ZIP Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE r Q Exemption, you should become subject to the Workers' a OC Compensation provisions of the Labor Code, you must forth- ADDRESS d STATISTICAL CLASSIFICATION APT. CONDO. with comply with such provisions or this permit shall be TEL. deemed revoked. ' CONTRACT+��rgin Pv"f CO. N0.287--0507 W LICENSED CONTRACTORS DECLARATION P.0• Box f LIC. 160650 CLASS NO. DWELL. UNITS � I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencingwith Section 7000 of Division 3 of the Business and SEWER MAP Professions Code, and my license is in full force and effect. CITY 'San Gabriel CL- 39 BK PG VALIDATION ¢¢P�f SQ. FT. NO. OF NO. OF CHECK License Number 160650 Lic.Class 0911 SIZE STORIES IFAMILIES ONE Date VALUATION Contractor Virgin Roof Co. 11/7/85 S DESCRIPTION OF WORK Re-roof house & NEW ❑ , ADD ❑ $ 2609.00'p ❑ 1 am exempt under Sec. ara a with Class A fibler las ❑ ALTER sh igiles�• 21 squares ❑ $ B.&P.C. for this reason REPAIR Date: USE OF dweIIing DEMOL ❑ ,. EXISTING BLDG. Signature APPLICANT , TEL. PRINT Virgin &100f Co. NO. ?&7-CSt.' FINAL OWNER-BUILDER DECLARATION DATE •, ; I hereby affirm that I am exempt from the Contractor's License ADDRESS P.O. Box J# San Gabriel 91779 FINAL 1 � • t' Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT By i" t F-11, • ~ ,� "'' I, as owner of the property, or my employees with ADDRESS 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). REQUIRED YARD HWY TOTAL SETBACK FROM XIST CONSTRUCTION LENDING AGENCY SET BACK 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, a Lender's Name $4$ 7S LDMA Ref. # P.C. Fee$ Permit Fee • ' Lender's Address I certify that I have read this application and state that the Issuance Fee 10••50 LDMA P/C# above information is correct. i agree to comply with all County nvestigation Fee $59.25 ordinances and State laws relating to building construction, Total Fee _DMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Qvi Signature of Applicant or Agent Date A WORKERS' COMPENSATION DECLARATION su - affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insu or a certificate of Workers' Compensation Insurance, or a Igwified co hereof (Sec. 3800, Lab. C.) - �- y A" Ty 1 p y���Nn -�� COUNTY OF LOS ANGELES BUILDING AND SAFETY ol'c o. O Com an �, BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS qua OL Certified copy is filed with the county building inspec- BUILDING C tion department. ADDRESS SO �E✓�� Q y. C Date Applicant CITY /!7/�L E C iTV ZIP /17J o LOCALITY NO. OF BLDGS. NEAREST l._ I A O 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.) TEL OWNER �NN�4RJ NO. USEZONEMAP QS I certify that in the performance of the work for which this e^ NO. permit is issued, I shall not employ any person in any manner 63.5 ADDRESS v 0 Z �L E/j1/� SPECIAL a so as to become subject to the Workers Compensation Laws. /�LT CONDITIONS O CITY TEiyI�LE C— iTi( ZIP a v Date Applicant ARCHITECT OR TEL. W DISTRICT I GROUP TYPE FIRE ICESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. / ZONE 0 Exemption, you should become subject to the Workers' D_ -A V tV Compensation provisions of the Labor Code, you must forth- ADDRESS 1� with comply with such provisions or this permit shall be _C7EL3 O' `_� STATISTICAL CLASSIFICATION APT. CONDO. 0A1? Z deemed revoked. CONTRACTOR f A1V)� N0 6 _ LICENSED CONTRACTORS DECLARATION p LIC. CLASS NO. --!R DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ///l3 4CC/A�y NO.S6 7Z��F y LIC. /� SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITY iiw ie e7� CLASS Z-319 and Professions Code,and my license is in full force and effect. BK E PG. VALIDATION r ` --/ SIZE FT STORIIEES MILLIIES O EK License Number 5672�U Lic. Class 1.)/Za J' VALUATION � �✓AydCZ 7—S--f7 DESCRIPTION OF WORK NEW ❑ $ apt©�) c�C Contractor Date ej� ❑I am exempt under Sec. ADD ❑ ► ALTER ON B.&P.C. for this reason $ REPAIR Date: USE OF EXISTING BLDG. DEMOL Signature APPLICANT TEL FINAL OWNER-BUILDER DECLARATION (PRINT) No — _-3 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 Professions Code): PRESENT By U �i BUILDING I, as owner of the property, or my employees with ADDRESS ACCTAa wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , 3307 49.8Z 7044, Business and Professions Code.) MOVING TEL. 1 ITEMS I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS TOTAL 49.88 tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. 49.88 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. CK44M ■0C' (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name. /yy 0000-0001 9/ 5/89 P.C. Fee$ Permit Fee 3 / . LDMA Ref # Lender's Address 1 AM11:41 f I certify that I have read this application and state that the Issuance Fee / LDMA P/C# 3 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # L and hereby authorize representatives of this County to enter L� a-m ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ure of Applicant or Agent Date