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Home My Public Portal About9071 OLIVE ST_Building__ TEMPLE CITE'. ,U.sa.eshos-i-., APPLICATION FOR BUILDING PERMIT COUNTY OF' LOS ANGELES BUILDING ! .DEPARTMENT OF COUNTY ENGINEER ADDRESS_ BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE P SED BY FOR APPLICANT TO FILISIN CONST. BUILDING STATISTICAL CLASSIFICATION SE .ER MAP ADDRESS , '� CLASS.NOZAYDWELL.UNITAl ., LOT NO. BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE: t TRACT I MAP -T®�./ HIGHwaY STATE MAJOR SECOND, OGAL NO.OF BLDGS. NO. nG� (CIRCLE) SIZE OF LOT. I NO 'ON LOT r USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. E OWNER BUILDING EXIST. YARD HWY TREET NAME SETBACK WE ADDRESS / / FRONT ARCHITECTR TEL. P.L. ENGINEER. NO. SIDE ADDRESS d-. E RS /INSPE/CT; N RECORD ,! CONTRACTO /Oz ;�`�/ ,LYSRADDESS ' .DESCRIPTION-OF WORK C�.� 'r G LuILNEW.' ADD. '..: �I• Ft REPAIR DEMOLISH. - .: ' �:., - ,•�r . Z FT. NO.OF NO.OF IZE b STORIES FAMILIE � USE OF. %Ld! i STRUCTURE '6 427 Cl V-2,0 SIGNATURE OF APPLICANT ,M1 EVALUATION$ APPROVALS DATE INSPECTOR:S,SIGNATURE P.C. PMT. FOUNDATION:LOCATION I FEE $ OT FEE FORMS,MATERIALS FRAME:FIRE STOPS, I )�/_�y ` tom! 1'�1J1/ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION,' BRACING BOLTS f J to / lA�fis:,_J AND STATE THAT THE,ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, /J ,/ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. ICERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT, _ [ •/J /I, ��e TION OF THE LABOR CODE OF THE STATE PF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURA LATH,EXT. SIGNATURE OF HOUSE PERMITTEE RECT AND POSTED rr� /' / ADDRESS FINAL fil 1 I , C'LYD'E N. DIRLAM, PRl CIPAL STRfi6XIIIIIIAL ENGINEER PLAN CHECK VALIDATION cK. M.O. cABx PERMIT VALID `TION cK. N.D. _CASH LQ0.,8 0AVo JUM26 1 0 11.5 0, WORKERS'COMPENSATION'�DECLARATIOP6, sure o affirm that I Have a certificate of consent to self APPLICATION F®R L U I L D I N G PERMIT �L�S insure, or a certificate of Workers'Compenstion Insurance,or ' a certified copy thereof(Sec. parry Lob. C.) COUNTY OF LOS ANGkLES� � BUILDING AND SAFETY Policy No. Company r�X Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS BUILDING %G' ❑ Certified copy is filed with the county building inspec- BUILDING � �r r -7 tion department. ADDRESS (Q / ' 0 Z i Ve LOCALITY 4?1-1 Date Applicant CITY ' — 1(LE CCT s ZIP NEAREST— CROSS e- CERTIFICATE CROSS ST. C��i CERTIFICATE OF EXEMPTION FROM WORKERS' q i i NO.OF BLDGS. 2 ,2• ASSESSOR COMPENSATION INSURANCE SIZE OF LOT r� K�� NOW ON LOT MAP BOOK PAGE I 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. O� ( >- Ap q SPECIAL 0 I certify that in the performance of the work for which this OWNER alit 6! YS�I�.NO.G.b�'"�Q� CONDITIONS / permit is issued, I shall not employ an person in an manner CT GROUP TYPE FIRE ESSED BYso as to become subject to the WorkesCom ensaton Laws. ADDRESS 07 6,. 001l�' S7' CONST. ZO� / ad I P ITY �LE `% ZIP / i7SD �DtSTRI l®�' 3 f"' e G Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. r, U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. J W ENGINEER NO. CLASS NO. �% / __DWELL. UNITS �+ Exemption, you should become subject to the Workers' H Compensation provisions of the Labor Code, you must forth- s ADDRESS SEWER P with comply with such provisions or this permit shall be TEL. 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 $ 7 GsZ� SQ. FT. . NO OF NO.OF CHECK License Number Lic.Class SIZE IES FAMILIES ONE $ Contractor Date DESCRIPTION OF WORKJ?eJ431=414 EW ❑ D1 am exempt from the licensing requirements as I am a DD ® -. licensed architect or a registered professional engineer ALTER ❑ FINAL / a acting in my professional capacity (Section 7051, t',6?? EPAIR E] DATE /J c•,a�� - Business and Professions Code). USE OF TW DEMOL ❑ FINAL EXIST By c Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT 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 sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 1, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 1 2 1 tion 7044, Business and Professions Code). REQUIREDTOTAL SETBACK FROM EXIST. 0 0 0 0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 2 0 - 79. 00 . the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE o o n 7(1 C 1.1= P.L. Lender's Name 09 1 P-80 $ P.C. Fee$ Permit Fee r Lender's Address t I certify that I have read this application and state that the Issuance Fee �1 a above information is correct. I agree to comply with all County Investigation Fee i ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter Total Fee a upon th above-mentioned ro rty for inspect' purposes. j w � n _ lt7 l/ SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Signature of Applican gent Dot r