HomeMy Public PortalAbout9846 OLIVE ST_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLIGATION'FOR PERMIT.
COUNTY OF LOS ANGELES
WM.J. FOX, CHIEF ENGINEER UIL G.
DISTRICT ISO. PLAN CK. NO. PERMIT NO.
NO. OF BLDG. ORD.NO. / •„
PLANS SETBACK LINE.
FIRM APPROVED f! 8
ZONE BY DATE RECEIVED.BY f DA EF/APL. DAT ISSU D
USE, APPROVEDE /J
ZONBY DATE �• ✓ b
APPLICANT FILL IN HEAVILY OUTLINED-PORTION ONLY
0: r BUILDING
62401% NAME ADDRESS_
F
yy f-
F Z ADDRESS LOCALITY � � ksior;,f�
co
NEAREST r
Z
W CITY CROSS ST. w
Q STATE TEL.
LICENSE NO. NO. E NAME (f�"�--" fx �l
`� �/f W MAIL
FNAME �r +J�", �,�r�I��� , 3 ADDRESS
F1 ._ ��C •L.' O TEL.
Q ADDRESS � ,. ,� �'��'• (p°" CITY NO.
ZO CITY GrG"�rC.�rt__-le-•CI 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ. THIS
SATE // 7 APPLICATION AND STATE THAT THE ABOVE IS' CORRECT
U LICENSE NO. �s'7 t NOI.� T r;) /SI� AND STATE LAWS REGULATING BUILDING CONSTRUCTIO.AND AGREE TO COMPLY WITH ALL COUNTY N.
' f
Z LOT NO s y. f� o-�"-? /d �/ SIZE OF LOT��^��Y/ O SIGNATURE OF
O OWNER
J F NO. OF BLDGS.
Q 6 BLOCK NOW ON LOT AUTHORIZED AMT.
JW TRACT / Sr S CORREV 1 IONS
D USE OF BLDGS.
NOW ON LOT L_.t__a I_e.
DESCRIPTION OlK WORK
USE OF
BUILDING
O
NEW TYPE GROUP
NO. OF NO. OF
ALTERATION ROOMS FAMILIES
ADDITION SIZE
REPAIR STORIES '
MOVING WALL COVERING „ 1 `�yytt I•
' DEMOLISH ROOF COVERING J \l,
FEE S FINAL-APPROVAL
$ j0"GI INSPECTOR'S-
P NAME
VALUATION FEE DATE
7GA638ACE#8038-64 APPLICATION FOR BUILDING PEdMIT
COtNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALIT PZ z •
JOHN A. LAMBIE•.COUNTY ENGINEER NEAREST a /
COLEMAN W. JENKINS.SUP'T.OF BUILDING CROSS ST.
DISTRICT NO. Cor2UP TYPE ESSED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING • STATISTICAL CLASSIFICATION S WER MAP
ADDRESS CLASS NO. DWELL UNITS BK L, PG
LOT NO. BLOCK USE ZONE MAP L
NO.
TRACT SPECIAL
N0. OF SLOGS. CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
F-XIS-TING BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OWNER NO. TYPE OF EXISTING SETBACKHIGHWAY + YARP = TOTAL
ADDRESS ` HIGHWAY IDTM CIj
soy
CITY BLDG. fFeTBACK FROM
ARCH ECT OW TEL
ENGINEER NO. BIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK I HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L. CL
CONTRACTOR • OL + V
L;I C7
ADDRES NO CORNER CUTOFF YES NO _ O
CI Y LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS W CLASS liQ
DESCRIPTION OF WORK )
Z
NEW ADD ALTER REPAI DEMOLISH
SQ.FT. NO. O NO. OF
SIZE STORIES FAMILIES
$US
TROF
TORE i
SIGNATURE OF
APPLICANT
VALUATION$ •® APPROVALS DATE . INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION !
FEE$ rs FEES
Q FORMS,MATERIALS /' A
FRAME, FIRE STOPS, } I
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AG TO COMPLY FURNACE: LOCATION `
WITH ALL COUNTY ORDINANCES AND 6TATE LA S REGULATING GAS VENT. DUCTS
9UILOING CONSTRUCTION. I CERTIFY THAT. IN 1 G THE WORK J 4
AUTHORIZED HEREBY I W NOT EMPLOY ANY E ON IN VIOLA- LATH. INT. 4 �,
TION OF THE LABOR CO E F THE STATE OF A FORNIA RE T- ��` i^- _
ING TO WORKMEN'S C E SATIO NSU NCE .H; EXT.,� rI,�1"Iif � Phi` /� f`'�j , •;+'/`
SIGNATURE OF HOUSE NUMBER COR-- f ,
PERMITTEE -ECT AND POSTED I! I
ADDRESS F I NAL !l 1f'A/h�
JOHN F. LEWIS. PRINCIPAL S CTU AL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIO CK. M.O. CASH
1 � 6.0 0
i r(Lo 4 6 4 6 UG 1
76AG38ACE08098-64 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES - 'BUILDING 'Eg" '
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION L O C A L I T Y
JOHN A. LAMBIE. COUNTY,ENGINEER NEAREST
COLEMAN W. JENKINS SUPT OF BUILDING CROSS ST..
DISTRICT O. G TYPE. P. O E BY
FOR APPLICANT TO FILL IN CONST.' J
BUILDIN . STATISTICAL C IF CATION SEWER MAP
ADDRESS / CLASS NO. DWELL UNITS BKPG
LOT NO. BLOCK USE ZONE MAP 0
NO.
TRACT SPECIAL-
N0. OF SLOGS. CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
E"ST,
I INC G �1 •BLDG. SETBACK'FROM
- JFTEL. FRONT PROP. LINE OF (STREET)
OWNER NO. TYPE OF EXISTINGSETBACK HIGHWAY + YARD = TOTAL
ADDRESS / I HIGHWAY WIDTHF M C
CITY Q. + 6 D
ARCHITECT OR TEL. BLDG. SETBACK FROM
ENGINEER NO. SIDE PROP. LINE OF (STREET)
_ TYPE OF EXISTING SETBACK 'HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH, FROM C.L. C
CONTRACTOR OL - + = L
ADDRES NO D Q CORNER CUTOFF YES NO ❑ C
CITY o cILAss SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SO.FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE -P
45
SIGNAT E OF
APPLICANT
VALUATION$' L
APPROVALS DATE, INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION \ ( I
FEE$ FEE$ b FORMS, MATERIALS_ % }• I
FRAME, FIRE STOPS, 1 A
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTl 1 `
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS k
9UILDI NG CONSTRUCTION. CERTIFY THAT. IN DOING THE WORK O I�
AUTHORIZED HEREBY I WI NOT_EMPLOY ANY P SON IN VIOLA- LATH. INT. fT
TION OF THE LABOR CO OF THE STATE OF C FORNIA RELAT.
ING TO WORKMEN'S E SATION SURANCE. LATH. EXT.
SIGNATURE OF .I HOUSE NUMBER COR-• 1�
PERMITTEE RECT AND POSTED
AODRESs Fl NAL
JOHN F. LEWIS. PRI CIPAL STRUCTURAL EN NE! R
PLAN CHECK VALIDATION CK. - M.O. CASH PERMIT VALIDATION CK. M.O. CAS
L&O 9 3 6 1 ,�i�R g 1 D 1 1.5 O N
i6ASSSA CE#809 B_63 APPLICATION ION FOR BUILDING PE_ RMI l
COUNTY OF LOS ANGELES BUILDING sy —
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST.
DISuGT G FWO P TYPE SSED BY
FOR APPLICANT TO FILL IN Q coNsr
BUILDING � ) �� STATISTICAL CLASSIFICATION S KR MAPG
ADDRESS / .n
CLASS. NO. DWELL.UNITS `J
LOT NO. BLOCK >, WATER
CERTIFICATE: NOT REQUIRED12 RECEIVED ❑
t /
TRACT c7 7 MAPHIGHWAY STATE MAJOR SECOND.LO
NO.OF BLDGS. NO. (CIRCLE)
SIZE OF LOT NOW ON LOT USE 7ONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. Ga &-a 7/0 us e-
TEL.
OWNER aj� /67( C�i (NO. ;9,6:421) UILDING YARD HWY R ET NAME EXIST.
{ ADDRESSfee/ v (v J FRONTSETBACWIDTH
LYARCHITECT OR TEL. P. L. r
ENGINEER NO. SIDE
P. L.
ADDRESS
TEL.
CONTRACTOR NO. V
ADDRESS
DESCRIPTION OF WORK
ul
NEW ADD ALTER REPAIR DEMOLISH N
SQ.FT. NO.OF
SIZE IBX STORIES FAMILIES
USE /� al✓a
.
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION
APPROVALS DATE, INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE $ FEE $ FORMS. MATERIALS
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. 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 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S C P NSATION IN RANCE. LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL � ��� +,/r
i JOHN F. LEWIS. PRINCIPAL STRU�yURAL ENGI ER
PLAN CHECK VA ATI CK. M.O. CA PERMIT VALIDATION CK. M.O. CASH
:�G 6 6 6 0 l_-)' cLC 10 1 D 4.v 0
16A93BA 089.3 3.69
APPLICATION FOR BUILDING PERMIT
• DIVISION OF BUILDING AND SAFETY ADDRESS 84 b 1�I OJ- ")F
a Depc'Irtment of County, Engineer � fq EJ, C Y
County of Los Angeles LOCALITY
WM.J.FOX,COUNTY ENGINEER NEAREST Cr� S 5 l
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. u
DISTRICT NO. CROUP I TYPEI S BK MA PG
FOR APPLICANT TO FILL IN CONST.
BUILDING �} `� r- D
MAP STATE
ADDRESS %�! NUMBER HWY YES
USE ZONE SPECIAL
LOT NO. BLOCK ' CONDITIONS
b�' TRACT ri 000
O x 6 I NO.CO SLOGS. BUILDING EXIST.
SIZE OF LOT USE OFLNOW ON LOT SETBACK YARD HWY STREET NAME WIDTH
EX STING BLDG. �-7 I� �fC� FRONT G tj
! i VE
{�` SIDE
OWNER P. L.
MAIL Dj Q O TRACT DWELL. I UNIT
ADDRESS / S � � :
5 INDUSTRIAL
TEL. _
DWELL. 1 UNIT
CITY f �/ NO• �/ �� 6 PUBLIC BLDG.
2
ARCHITECT OR TEL. DUPLEX I UNIT7 ADDN..ALT.. ETC:
ENGINEER NO. 3 APT. UNITS
8 MISCEL.
ADDRESS A 4 COMMERCIAL
CONTRACTOR r 4; J 0�� INSPECTION RECORD of
ADDRESS f f— 111A/_G
DESC TION OF WORK Gy
NEW ADD r-ALTER REPAIR DEMOLISH
SO. FT. NO.OF NO.OF'
SIZE STORIES J(FAMILIES
USE OF STRUCTURE ]A/� trot
SIGNATURE OF
APPLICANT APPROVALS
DATE INSPECTORS SIGNATURE
ADDRESS
FOUNDATION: LOCATION
P.C. S FORMS,MATERIALS
FEE FRAME: FIRE STOPS.
$ ..��o BRACING,BOLTS
VALUATION
FEB �//
FURNACE:LOCATION. �
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT.DUCTS _
6 ( '
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COU RDINANCES LATH,INT.
AND STATE LAWS EATING BU INd CON RUC-
TION. LATH.EXT.
SIGNATURE OF HOUSE NUMBER COR- c
PERMITTEE RECT AND POSTED
ADDRESS D / Vae4Pf� FINAL
WM.J.FOX,COUNTY ENGINEER VALIDATION C. N.DIRLAM,CHIEF BLDG. INSPECTOR
:.
LCo9 9 4-7,"A' SES. . 6 -2.00 <m
ti r
h, BUILDING
` 1}, 4] F ADDRESS
APPLICATION LOCALITY
NEAREST.
DYVISYON 'OF BUYLDING AND SAFETY CROSS ST.
HDepartment.of County Engineer DISTRICT NO. RECEIPT NO. PERMIT NO.
County of Y.os Angeles
W..f J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISSUED
CABBATiT D. GRIFFIN, SUPIT OF BUILDING•
•' j GfV
FOR APPLICANT TO FILL IN TYPE CONST. RECEIVED BY ISSUED B
OWNER MAP STATE
MAIL qq YES O
ADDRESS E 1► NUMBER oC HWY
U E ZONE SPECIAL
CITY re'6�61v Op
` qr NDI.. � / CONDITIONS
/� /
ARCHITECT OR TEL. ,�`Q�
ENGINEER NO. '
BUILDING YARD HWY 'STREET NAME EXIST.
ADDRESS SETBACK WIDTH
(J
A- FRONT � /C
' CONTRACTOR j .j �/ NO. gl I
!. ADDRESS P.L.
BUILDINGDATE CORRECTIONS INSPECTOR
ADDRESS (J`+ st
Ic LOT NO. BLOCK _ Y� �n
l C. ' U.te—1
TRACT
NO.OF SLOGS. ,
` -mi ?.mF - : -1 C ' l79.
SIZE OF LOT I NOW ON LOT / ` ~
USE OF I a 1 S L I-r`r L tz 6 R-kcr—
F_XISTING BLDG. -
DESCRIPTION OF WORKLa
NEW ADD400 ALTER REPAIR DEMOLISH . Z
B4.FT. / ,, NO.OF NO.OF f r
SIZE ,J ( STORIES FAMILIES
USE OF STRUCTURE !. l /O Cpi•_ ,
..... ......
' ,@ F !
NO.OF
ft EMPLOYEES
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP.-
PLICATION AND STATE THAT THE INFORMATION GIVEN IS APPROVALS INSPECTOR'S SIGNATURE DATE
CORRECT.
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION
AND STATE'LAWS REGULATING BUILDING CCtIBTRUCTION. FORMS,MATERIALS QJIJ y6 Gc. �i..l�
FRAME: FIRE STOPS, .,
SIGNATURE OF * BRACING,BOLT.
PERMITTE ,r40-4441 FURNACE: LOCATION,
GAS VENT,DUCTS
ADDRESS LATH, INT.
AUTHORIZED AGT.
a LATH, EXT.
/ a� �Q -
P.C.S HOUSE NUMBER COR-
�J1 v FEF. RECT AND POSTED
_
VALUATION S
FEE (} FINAL
76A638A DSS 3 Ob 5-54
-- -- - - ! APPLK:GATION FOR PERMIT
:• PARZ`1VIENT OF:BUILDING AND,SAFETY
x COUNTY OF-LOS ANGEL: =
-:.•.. :. .:. .
:WM.,.I.FOX 'CHliF ENGINEER - '�!.IL .LNG - -
NO. IVO. PLAN-CK. NO. ; PERMIT=NO
PLANS.: =
CSAINE-
DISTRICT'NO. ::_ N
FIRE, ,:+�� :APPROVED
ZONE =. - BY, DATE RECEIVED-BY DATE OF APPL. .'DATE ISSL•IED.
- USE APPROVED
ZOIV ='By-, DATE r
FILL IM HEAVILY..OUTLINED-:PORTION ONLYBUI DING
.
4':-: :•.. �.. ADDRESS 0�7 rte. .. �Ef_�fJ /^`(i :.
-NAME ':• ••
ADDRESS".' 1J' LOCALITY-'�L(i
'
CITY. -- � - CROSS ST.7._ �f?i�,,./"
STATE..:• NAME
TEL 'T� .S1�
LICENSE NO - NO. J/
.. _-.
MAIL="..
KNAME JL/ ;may: :ADDRESS'
10 F O-
U
.•�7/lA..rl.
�f TEL.
a ADDRESS /_ ', CITY - NO.
It. 3k
F _ I--HEREBY ACKNOWLEDGE`THAT_-•I HAVE,-READ THIS '
Z CITY. �JVi
O' APPLICATION.AND. STATE_THAT,TME ABOVE I' •CORRECT."
U 'STATE /� LLam-' 1 j` TEL.
AND'AGREE TO�.COMPLY WITH ALL COUNTY ORDINANCES
LICENSE NO; CJ �:1• N1.AIr'- `- AND.STATE LAW8 REGULATING"BUILDING CONSTRUCTION; .'
y� /6 .•J., SIGNATURErOF..
>'Z. "LOT NO. ' SIZE:OF LST
NO. OF.BLDGS. t},�-•� ` ,..� _ ..i
ad BLOCK NOW-ON LOT / AUTHORIZEDAGT, _�" ,�•.''" -
,U -
W o UTIOIeTS
B "
:TRACT t// i•: 0 � --1—-•..
.W'
D USE OF BLDGS.
NOW'-UN:LOT..- /y`�-:-c��'Y3��L.F O/c-1..:. - I Y/�'M :_G dlJ'•' -e4�.N :�;.. �. -
&SCRd�'rI®N1I m7l
USE OF:-,:
.4 106
NEW TYPE �[ GROUP
ALTERATION ROOMS- .FAMILIES
ADDITION' ". SIZE
3/ k _
.•REPAIR: STORIES -
-MOVING - °-... -.WALL- COVERING. -
J /�/ .r
-DEMOLISH ROOF COVERING
$ P.C.$ FINAL'APPROVAL
_ FEE. ' f
�� $ fflJ _` � •f r., INSPECTOR'S•
VALUATION CC FEE '� '' DATE -'% e` r I. NAME .��s� 1"f
SAGS 8A-CE#808 8-69 APPLICATION FOi\ 156✓ Gm
COUNTY OF"LOS ANGELES BUILDING
DEPARTMENT_OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY -DIVISION LOCALITY -�
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST �7 .
WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN . .: _
611 O. GR P' TYPE
CONST. ESSED BY
STATISTICAL CLASSIFICATION S WER MAP
BUILDING ���
ADDRESS MBK G
�¢,6 Fi. .
CLASS. NO DWELL.UNITS`�
LOT NO.' BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE:'
TRACT • '�� MAP FI I'GHINAY
NO.OF SLOGS.. NO' (cIRCLE> STATE MAJOR SECOND,L CALA
SIZE OF LOT. .Q X I(d NOW ON LOT USE Z NE SPECIAL
USE OF. CONDITIONS
EXISTING•BLDG. cvr i'A��
f0 T /
OWNER. �{�/ / .� r EL. (y 6 DING E)CIST.
// SETBACK YARD HWY T•NAME WIbTH .
ADDRESS (;r �C�i FRONT
ARCHITECT OR TEL. P. Ir.
ENGINEER No... SIDE
P. I_
ADDRESS //I1 , *_AL_ O
Q• TEL.
CONTRACTOR `i/ NO. V
ADDRESS - �� Qi � �i R V
DESCRIPTION OF WORK -` "A
Lu
5',M Iu
Ali_ ••_ J,C in'.',:' �n .'.ls Sr.+: IDLY "O.•
NEW ADD ALTER. REPAIR DEMOLISH — S/- 'd !� ' N
FT. NO.OF NO.OF'', 45ti to ahiYell n 'I
SIZE Q STORIES FAMILIES y+ } y/�� t t/,��s, ds�• y II
USE OF -' r;'� ifk vv
STRUCTURE �avg �i �f- 1!Y�iJiC. OD
SIGNATURE OF
APPLICANT li It, Be
VALUATION $ ! V r
APPROVALS DATE. INS
PECTOR'S SIGNATURE
P. FEE C. _ PMT.$ FOUNDATION:
FORMS, MATERIALS ON
FEE IJ..G1}S.G�
$ .,
FRAME: FIRE STOPS, 741 f r f3,�
' IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION •.BRACING. BOLTS / ,•d 9 .A•� .•' L°.•.-'f ✓ ,
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 LABORR CODE''OF THE STAT OF CALIFORNIA RELAT-
ING TO WOKMEN'S• SATIO INS ANCE: -(:{-EXT. (J •lt!ip
SIGNATURE OF HOUSE NlJ•MBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG
PLAN CHECK'VALID• . ON CK. ASH PERMIT VALIDATION CK. M.O.'.
.O. CASH '
6 G 5 9 DEC 10 1 D 1 1-5 N
LI'iL3 .
WORKERS'COMPENSATION DECLARATION]-
lf
insure,-or aherebfirm certif cafe of Wo ke s'that I have aiificate Compensation Insuraof consent to nce, I APPLICATION R I d I L I N G PERMIT
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES I BUILDING AND SAFETY
Policy No. Company I t
Certified co is hereby furnished. BUILDING
❑ Pr Y FOR APPLICANT TO FILL IN ADDRESS at /1/,lz
❑ •Certified copy,is filed with the county building inspec- BUILDING 9J)
tion department. ADDRESS V O
Date ' Applicant CITY knlQ ZIP LOCALITY Jj�W +
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 02", CROSS ST. /AJ
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars ($100)or less.) TRACT BLOCK / LOT NO. �7 /�f ,MAP BOOK PAGE PARCEL
I 1 1
UM
"TEL.. � �0��"+ USE ONE ' MAP
I certify that in the performance of t e work for which this OWNER NO.
permit is issued, I shall not employ an person in any man er SPECIAL 0�,+
ADDRESS _ CONDITIONS
so as to be com subject to the War s'C/ pen ttiA),
00
i/jCITYZIP
Apf,'of //�`L_;;// ARCHITECT OR TEL.
NOTICE TO APPLICANT: If, afte making this Cerfificat of DISTRICT G UP TYPE FIRE PROCESSED BY O
ENGINEER NO. ^ CONST ZONE (--
Exemption, you should become subject to the Workers' _ (>
Compensation provisions of the Labor Code, you must forth- ADDRESS LLI
with comply with such provisions or this permit shall be 01
TEL. STATISTICAL CLASSIFICATION APT. CONDO, fn
deemed revoked. CONTRACTOR NO. Z
LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and LIC.
Professions Code, and my license•is in full force and effect. CITY I CLASS BK. VALIDATION
SQ.FT. NO.OF; NO.OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
VALUATION
Contiacfor Date DESCRIPTION OF WORK a NEW C] $ 0 2 8 5 Q 8'A
I ADD
❑ I am exempt under Sec. � lev�1 f b ALTER Q ® #ro 0 0 0 0 1
B.$P.C. for this reason I� F REPAIR ❑ $ 0 0 3.3'0'0
USE OF
F BLDG. 0!� C r� 7 DEMOL ❑ x
a 0.a33.000
Signature APPLICANT - T �7 FINAL
W R-BUILDER DE� R 10 PRINT NO. 1 DATE
I hereby affirm that I am exempt from the Contractor's License ADDRESS r -ta ON / l +� FINAL 12 3 87
Low for the following reason (Section 7031.5, Business and
Professions Code): i ,ey 0
❑ 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 LOCALITYa,.+,
7044. Business and Professions Code). MOVING TEL. } f1 �1
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO, ,Lr�' ,��
with licensed contractors to construct the project (Sec-
ADDRESS iG' L(
tion 7044, Business and Professions Code). 01
CONSTRUCTION LENDING AGENCY IM
SEETQBACK YARD I HWY TOTAPROP A NE WIDTH r�'�r �'� ^ l
.' r' '},L•; J.
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. i
Lender's Name
{�-� LD
MA
Address S MA Ref. q
Lender' P.C. Fee Permit Fee Z'So .
I certify that I have read this application and state that the Issuance FeeS_Q CDMA P/C#
above information is correct. I agree to comply with all Count' Investigation Fee
ordinances and State laws relating to building construction, Total FeeLDMA Perm. q
and hereby authorize re r sentatives of this County'to enter
he bove- anti a prgperty for inspection purposes.
(Jtir hu.-tpi1 rPI-O'� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Age — ate--