HomeMy Public PortalAbout9624 OLIVE ST_Building__ FGA688A Cc#aos,0_89 APPL..ICATI®N• FOR !BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY L-A,..
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. _
DISTRICTf(QRP. G71.PE PRO SED Y
FOR APPLI ANT TO FILL.IN `J / I coNSTy .I
BUILDING STATISTICAL CI�kSSIFICATION SEWERAp
ADDRESS C/ _ y� BK G
_ CLASS.NO.EDWELL.UNITS_LLIr S�'
`. LOT NO. - ` BLOCK P' STATE
NUMBER.-AIG HWY. YES NO
nE SONE SPECIAL
NO.OF.BLDGS
TRACT CONDITIONS '
" _
v SIZE OF LOT I NOW OWLOT -
USE OF � �Q� '
EXISTING BLDG.. BUILDING YARD IiWY STREET NAME EXIST.
i . SETBACK WIDTH '
s OWNER // K pOL TMAIL
ADDRESS IpSIDE
TEL P.L. _
3 CITY - NO.afi ov SPECTION RECORD-
�. ARCHITECT OR TEL.'
•` ENGINEER NO. / �J
ADDRESSTEL
pp.�.� �4
CONTRACTOR {/.wJ{1 NO.
- - .,Le40794a .f'tFt-t7 il-'lc,:"?
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTE REPAIR DEMOLISH
Q.FT. NO.OF NO.OF /9-7-
SIZE STORIES" FAMILIES ,..r
USE
OF RE �N Vc�J�7' CX*AI r T^ '��• r' -d-; /x
P�r�;�o-D,SIGNATURE OF X �y Y�`"
APPLICANT APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION:LOCATION
FORMS,MATERIALS
FVALUATION$ gyp �� _ FRAME:FIRE STOPS,
BRACING;BOLTS V
FURNACE:LOCATION., //
FEE. S I FEE GAS VENT.DUCTS
1 HEREBY ACKNOWLEDGE TP1AT_I HAVE READ THIS AP- LATH.INT. t f l•:
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND 3
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
Wit
]j7; t�+fll fyyli°
STATE LAWS REGULATING BUILDIN CONSTRUCTION. LATH,EXT. �y
SIGNATU.R F HOUSE NUMBER COR-
PERM I TTE eL RECT AND POSTED L
ADDRESS FINAL 'Ys'GD ` `-�•---rte
:'CLYDE N.DIRLAM. PRINCIPAL STRUCTuRALTYICN, R
PLAN CHECK VALIDATION _ CK. M.D. cwsH PERMIT VALIDATION CK. M.O. CASH
LAC0 2 4 .8 5.ui SEP 11 1' A - 1 2:0 0 I' .
r WORKERS'COMPENSATION DECLARATION
hereby affirm'that I have certificate of consent to self APPLICATION' FOR ' B U I L D I N G� P E RM I T
insure, or a certificate of Workers'Compensation Insurance,
,or a certified copy thereof(Sec. 3800„Lob. C.
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Polity No, Company ��
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADQRIENWo
® Certified'copy is filed with the county building inspec- BUILDING 411F -
' tion epar ent. ADDRESS 0 LOCALITY
/ .e� G NEAREST
.• Date Applicant CITY T ZIP CROSS ST.',
CERTIFICATE OF EXEMPTION.FROM WORKERS' NO.OF BLDGS. rL `ASSESSOR ;
COMPENSATION INSURANCE i .SIZE OF LOT -NOW ON LOT MAP BOOK. PAGE RCEL
(This section need not be completed if the permit is for.one w USE ZONE MAP
hundred dolldrs.($100)or less.). TRACT BLOCK LOT NO. NO.
OWNER, �jf� .-liurhq�. ,Z' TEL. er SPECIAL }-
,,'I certify that in the peiformonce of the work for which this NO. CONDITIONS LL
!, d ISTRICT .. .GROUP TYPE FIRE PROCESSED BY O
permit is issued,1 shall not employ any person in any.maitnerADDRESS
/; + -7 h � v.� CONST. ZONE V
so bs to-become subject to the Workers'Compensation Laws. 'tib f'+
s � t/ Ad��
Date Applicant ;� CITY �'� ZIP STATISTICAL CLASSIFICATION O. Q
ARCHITECT OR TEL. U
NOTICE TO APPLICANT: If, bfter making this Certificate'of e�
ENGINEER NO. CLASSNO. DWELL. UNITS tu
A.
y Exemption, you should become.subject to the Workers' I': A.
Compensation provisions of the-Labor Code, you must forth- ADDRESS SEWER MAP N
with comply with',such provisions or,this permit shall be �,. ,
deemed revoked. � �9 L' �/O ^ BK. pG, VALIDATION
CONTRACTOR-- i. Qr�P% `tel
LICENSED CONTRACTORS'DECLARATION'
I hereby affirm that I am.licensed under provisions-of Chapter 9ADDRESS 710 6 Sv��G' �� 'JNO�,a�l 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 c�r/�� OG�"h�� CLASS iOn $ • c� AUG- '
'• iI? SIZE 5 ORIIES. FAMILIES F. f CONE ONE,
License'NHECK
umbe� Lic:-Classt r
dv' L $
Contractor�� //,44' Date /��/-� /�! DESCCRRIPTION OF WORK NEW Q ;
am exempt under-Sec. ADD
❑
ALTER FINAL I
B:BP.C. for this reason Ll'v ` d("T� �GJ REPAIR ❑ DATE
Date.: USE OF FINAL
L
i EXISTING BLDG. F.•S/ E� C DEMOL• ❑ ;
Signetura ✓ I APPLICANT TEL
By [(
• i,,I 1 PRINT a,�l Loi :�O .P77�o�
OWNER:BUILDER DECLARATION
I hereby affirm that I am exempt from the.Contractor's-License rj
Law for the following reason (Section 7031.5, Business and :1•.I ADDRESS J SCSI/f✓/v. E/
Professions Code): PRESENT ” I 1•7, A
BUILDING
►' + I, as owner of the property, or',my'employees.with ADDRESS ;. o 0 0- o a
wages as their sole compensation,will do the work and
the structure is not intended or•offered.for sale(Section LOCALITY •o y'� r..
?• 7044, Business bnd Professions Code). MOVING TEL. '
❑ I CONTRACTOR ' NO.
I, as owner of the property,am exclusively cohtrbcting J ' J
with licensed contractors to construct the.project (Sec-
tion 7044, Business and Professions Code). ADDRESS
0 J,
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTIONLENDING AGENCY 1 SET BACK• YARD HWY PROP. LIN WIDTH
F' I hereby affirm that there is a con'str'uction lending agency for FRONT
' the performance of the.work for which this permit is issued. I P.L. ►
!t ,(sec. 3097, Civ. C.). I SIDE
6 4 j 'P.L.
Lerider's•Naii a .I 7
t P.C.Fee$ Permit Fee: a
Lender's Address
I certify that I'have read-this�appiic' ion and state;that-the ` -4Issuance'Fee
abo4 information is correct. I agree to-'comply with,all County II , Investigation Fee' i
ordinance's'dnd State laws relating.�to building construction, Total Fee
and hereby authorize representatives of this County to enter
uponthe bove-ment'o'n/ed property for inspection purpos ;+
t � G�/�%'• ��� O SEE REVERSE FOR EXP'LAINIATORAGILIAGE
Signature•of Applicant or Agent Date i ®s
iy