HomeMy Public PortalAbout10242 OLIVE ST_Building__ /BA688ADBB.98•BAPPLICATION FOR - BUIL®(NG PERMIT 1
D"! ON OF BUILDING AND SAFETY BUILDING
_.
ADDRESS
,Department of County Engineer e s
County of Los Angeles LOCALITY
�• a!'.
WM.J.FOX,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE pq II SE 11%/MAP PG "
...
FOR APPLICANT TO FILL IN ' cowsT.pdoi�D B/!r ,
BUILDING � MAPSTATE
ADDRESS 0 q 2 * A NUMBER .�*� HWY YES =NO
LOT NO. BLOCK USE ZQN SPECIAL
I CONDITIONS
TRACT S !v �.
a� NO.OF BLDGS. BUI DING YARD HWY STREET NAME EXIST.,
OF LOT 7' V NOW ON LOT SETBACK WIDTH
USE OF �� S ' 2 FPROL T a j
EXISTING BLDG. A ,J 26 L
OWNER 1�• /`/ ► �LS�/LJ 81DE
P.L.
MAIL O TRACT DWELL. I UNIT
ADDRESS �� - � 5 INDUSTRIAL
TEL.
1. DWELL. I UNIT
CITY NO. 6 PUBLIC BLDG.
ARCHITECT R /, TEL. 2 DUPLIX f UNIT 7 ADDN.,ALT.. ETC.
ENGINEER /�`!7 /IOLcL/.tJs NO. 3 APT. UNITS
MI8CEL.��`` -f
ADDRESS S�(..q 4 COMMERCIAL dW� TOOL
TEL
CONTRACTORINSPECTION RECORD
. � L NO. f
ADDRESS Lc T (P`A Le 1
DESCRIPTION OF WORK Uj,1 tt F2f AJ _S
NEW C DD ALTER REPAIR DEMOLISH
SQ. FT. NO.OF NO.OF
SIZE STORIES FAMILIES
USE OF STRUCTURE
®vG/157
SIGNATURE OF
APPLICANT APPROVALS
ADDRESS DATE INSPECTOR'S SIGNATURE
P.C. B b F FORMSTMATEROC�TION f J��r 11 �j� f we
v `/
� BRACING,BOLTS
FEE �� FRAME.FIRE STOPS.
VALUATION 2 OV j1 B 10
12111131111 F:URNAC6.LOCATION.
FEE
1 HEREBY ACKNOWLEDGE THAT '1 HAVE READ THIS GAS VENT.DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT.
AND STATE LAWS REGULATING BUILDING CONSTRUC
TION. -LATH.EXT.
SIGNATURE OF HOUSE NUMBER COR-.
PERMITTEE RECT AND POSTED
ADDRESS FINAL
WM.J.FOX,dour474 ENGINEER VALIDATION C.N.DIRLAM.CHIEF BLDG. INSPECTOR
Go• O 9 _19 Lr— "111 /I 1 L '� ^'•a 1:) (1 r^1 Lr
. . . • , : ' - .5 �� 'I^, � �••rte •.� _.
4
10*0-:�
WORKERS'COMPENSATION DECLARATION �p
-I suore affirm that I have certificate of consent to self 4 P pPI ®T I® R IIBU I I N G PERMIT LI IS
insure, or a certificate of Workers'Compensation Insurance, I �1
or a certified copy thereof(Sec. 3800, Lab. C.)
I COUNTY OF LOS ANGELES j . BUILDING AND SAFETY
PollcyNo. 230770 Company State Comte
❑ copy y FOR APPLICANT TO}FILL IN BUILDING �- w
Certified co is hereby furnished. ADDRESS - sC.
® Certified copy is filed with the county building Inspec- ' BUILDING
tion department. ADDRESS. 10242 Olive St LOCALITY-
NEAREST
Date 1 /1 /87 Applica 's CITY Temple Ci ZIP CROSS ST. �✓v
CERTIFICATE OF EXEM ION,FROMNO.OF BLDGS. -ASSESSOR
COMPENSATION INSURAN SIZE OF LOT NOW ON LOT MAP BOOK PAGE I PARCEL
(This section need not be completed if the permit is for one USE ZQNE MAP 2 7 7
hundred dollars($100)or:less.) TRACT BLOCK LOT NO. NO. Z
TEL. ,+ SPECIAL �.
I certify that in the performance of the work for which this OWNER NO. 442-266 ' ( CONDITIONS
permit is issued, I shall not employ any.person in any manner I DISTRICT GROUP TYPE FIRE CESSED BY
ADDRESS CONST. ZONE
so as to become subject to the Workers'Compensation Laws. 12,oe W
CITY Temple Cit ZIP r O 3 0
Date Applicant STATISTICAL CLASSIFICATION APT. CONDO.
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Z
Exemption, you should become subject to the Workers' ENGINEER NO. (CLASS NO. DWELL. UNITS Q
Compensation provisions of the Labor Code, you must forth- ADDRESS 5EWER MAP- CA
with comply with such provisions or this permit shall be TEL.
deemed revoked. CONTRACTOR Montebello R€ TEL. --6975 I 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 Montebello CLASS C,39 1$3190.00
SQ.FT. NO.OF NO.OF CHECK ! ''
License Num r ' 2'4585 2 Lic.Class C'-39 SIZE STORIES FAMILIES ONE
Contracto Pr4S�te 8/3-1/87 DESCRIPTION OF WORK• NEW C] I$
E]I am u exempt er c_ remove and reset tile, AD° ❑ ` ,.,
Slope 4/12 ALTER ❑ I DAT
FINA
B.&P.C. for this reason REPAIR
USE'OF
Date' I EXISTING BLDG. DEMOL ElFI
Signature APPLICANTT TEL.
PRINMontebello Rfg NO. 722-697
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License ADDRESS 8 65 l'ruck Way !;,� Ui / Ji
Law for the following reason (Section 7031.5, Business and y
Professions Code): PRESET ,.�
❑ ;BUILDING
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. z 5 3 3.4 A
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- :1 0 6 a 6
'tion 7044, Business and Professions Code).
ADDRESS o 0
REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. 0 0 0 6a6 3 6
CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH
I hereby affirm that there is'a construction lending agency for I FRONT $ 2 9-86
the performance of the work for which'this permit is issued
P.L.Sec. 3097, Civ. C.). SIDE
P.L.
v Lender's Name
Lender's Address I P.C.Fee$ Permit Fee5-8.13
I certify that I have read this application and.state that the j Issuance Fee
above information is correct. I agree to comply with.all County Investigation Fee
ordinances and-State laws relating to building construction, Total Fee
9 and hereby authorize representatives of this County to enter
upon thea ve-mentioned property for inspection purposes.
o S SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of AndicapfAgent Date Abs