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HomeMy Public PortalAbout5011 PAL MAL AVE_Building__ DEPAHTMENT Qt- BU1LWIMU AN1J ,ArZi i ------�-----� - --- ' COUNTY OF LOS ANGELES 8 u I L ® I N WM. J. FOX, CHIEF ENGINEER FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN �y 1 DISTRICT NO. PLAN CK.NO. PERMIT NO. BUILDING iu ADDRESS VC. / -- LOCALITY `1 RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST CROSS ST. � BUILDING OWNER �j � ADDRESS MAIL4 ./l LOCALITY - ADDRESS - NEAREST TEL CROSS ST. CITY - NO. FIRE I NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANS ENDINEER NO.,..-- BLDG. ORD.NO. ADDRESS _SETBACK LINE APPROVED TEL. BY DATE CONTRACTOR NO. USE APPROVED ADDRESS ZONE BY DATE LEGAL CORRECTIONS DESCRIPTION I LOT NO. - BLOCK TRACT SIZE OF LOT / =`" •� NOW ON LOTS L_-�- USE OF NO.OF I NO.OF EXISTING BLDG. FAM LIE ROOMS DESCRIPTION OF WORK NEW ALTERATION %"'� ADDITION O -- A REPAIR MOVING DEMOLISH p SQ.FT. NO.OF SIZE - ROOMS STORIES D r WALL ROOF COVER INGiQ` = I COVERING USE OF NEW BUILDING -� > res` I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS OWNER LATH,INT.: AUTHORIZED AGT. /r - LATH,EXT.: Des-3 25M secs 1-n7 $ P.O s PLASTER. INT. FEE >d�P PLASTER, EXT. FEE ® _ VALUATION � �- FINAL � -- - f WORKERS'COMPENSATION DECLARATION r I.Iiereby affirm that I have cete of cobsentto self Insure, prp a©rtifPcate of Workers'Compensation Insurance, APPLICATION PPLICA I®N "F®R 1(,BUt IL®I N G% PERMIT - ' air a Sertified copy thereof(Sec. 3800, Lab. C.) Policy No. COUNTY F LOS ANGELES BUILDING AND SAFE �!Company BUILDING DING ��/ !� ❑ Certified copy is hereby furnished. FOR APPLICANTdTO FILL IN / ADDRESS r ❑ Certified copy is filed with the county building inspec- BUILDING f rQ / LOCALITY ` Al Tion deportment. ADDRESS / [} c^� NEARE Date Applicant CITY �� ZIP ] l / 0 CROSS ST T. CERTIFICATE OF EXEMPTION FROM WORKERS' /+" NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 4; NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one 1 US ONE MAP _ 2_73 hundred dollars($100)or less.) TRACT BLOCKI LOT NO. 130 TEL. �� SPECIAL 916 I certify that in the performance of the work for which this OWNER R)O�"P;+1 NO, CONDITIONS 0 permit is issued, I shall not employ an person in an manner t D ICi GROUP TYPE FIRE ESSED BY Q P P Y Y P y ADDRESS YO I� Q CONST. ZONE i U so as to become subject to the Workers'Compensation Laws. / I ` q o /Q[/ IM �/ CITY � L(� •vt 7 Zip, / /7 J v O Date / Applicant ARCHITECT OR TEL. ;STATISTICAL.CLASSIFICATION API'. CONDO. l- NOTICE TO APPLICANT: If; after aking this Certificate of �" Q NO. t CLASS NO. DWELL. UNITS UJI 'Exemption, you should become subject to the Workers' ENGINEER Compensation provisions of the Labor Code, you must forth- ADDRESS f, SEWER MAP with comply with such provisions or this permit shall beTEL 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. 'VALUATI (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 �. $ SQ.FT. NO.OF NO.OF CHECK ,' License Number Lic.Class SIZE a0(r, STORIES FAMILIES ONE -- � Contractor Date DESCRIPTION OF WORK /• d NEW ❑ $ }j ADD ❑ I am exempt under Sec. N r r o'i t'�` ALAR ❑ FINAL B.&P.C. for this reason Am— & REPAIR ❑ DATE 1 �- Date: USE OF G BLDG. ` DEMOL ❑ FINAL NALy EXISTINPS t^ SignatureAPPLICANT TEL. O -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): PRE5ENT BUILDING SCS KY/ I, as owner of the property, or my employees with ADDRESS 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. 4� with licensed contractors to construct the project.(Sec- ADDRESS tion 7044, Business and Professions Code). 5 8 0 A REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SETBACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for LInvestigation 0 0 0 o c the performance of the work for which this permit is issued tSec. 3097, Civ. C.). I o o 49.88 _ Lender's Name o 3 Lender's Address Permit Fee I 7 U 4— (� r I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County ee r/ ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County to enter upon the above-Tentioned property for inspection purposes. € f/-Y- SEE REVERSE FOR EXPLANATORY LANGUAGE ®s `'i s . Signature of Applicant or Agent Date .. I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES U I L D I N WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR .OFFICE USE ONLY " BUILDING ^^nn �y _ A DISTRICT O PLAN CK. NO. PERMIT NO� ADDRESS Q /1 `'-tu `I710..L �j • ' b�(/� LOCALITY ���w� I ��1� RECEIVED BY DATE OFAPPL. r DATE ISSUED NEAREST V �� f L�1 CROSS ST.. BUILDING OWNBR ' '�� ADDRESS/ O I V f' GL�•�' / _ { LOCALITY` MAIL f I w f fI� n NEAREST ADDRESS•• 1"�dl.Y.• �J'��[t�' TEL _ C' // CROSS ST. CITY r`I M1 f p, NO.' A y a J FIRE NO. OF I TYPE GROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. ORD. NO. SETBACK LINE ADDRESS APPROVED TEL BY DATE CONTRACTOR 0,14'e. y- !&1q wd NO76t G USE APPROVED— I� I ZONE BY DATE ADDRESS C/ A. P l.}'f l�/I.Q fi1 ,,:1 HOUSE NUMBERING LEGALi DESCRIPTION I LOT NO. BLOCK MAP PLUMBER FIELD CHECK BY TRACT NO. ASSIGNED BY— NO. Y NO. OF BLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT USE OF I NO. OF BLDG. EXISTING FAMILIES — DESCRIPTION OF WORK NEW I I ALTERATION ..I I ADDITION REPAIR I I DEMOLITION I I I Z SQ. FT. -'-� NO. OF Z SIZE ROOMS STORIES EXT.WALL ROOF I' COVERING I COVERING• USE OF STRUCTURE APPROVALS INSPECTOR'S SIGNATURE DATE I HERESY ACKNOWLEDGE THAT I HAVE READ THIS AP-; FOUNDATION:LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT.- I AGREIS TO COMPLY WITH THE CORRECTIONS LISTED, FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING -BUILDING CONSTRUCTION. FURNACE: LOCATION, N SIGATURE OF A/ �/ /�y t GAS VENT, DUCTS /,(j;.�j�,/ f.•%CS%�Z PERMITTEE ,1 !'-PXO}Iy i' 411.,Is."UJ r L LATH, INT. ADDREB ��'t�La/Q►,1 l.liJlU/. 1..1G41I�GAIt,R.• AUTHORIZED OGT. r/ LL`4Q. 7j'.�I O{. �LI I�I�/ LATH, EXT. PLASTER, INT. L76.AS28A68i 10=80 $ q b-6 -"^ P. C.FEE U U PIASTER, EXT. N. FEE $ FINAL ��/ s {� 76AGSBACEN8031-67 APPLICATION FOR BUIL/®I G PERMIT I.J COUNTY OF LOS ANGELES BUILDING ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY (/ JOHN A. LAMBIE. COUNTY ENGINEERM NEAREST COLEMAN W. JENKINSSup•T OF BUILDING BellCROSS ST. 'DISTRICT NO. GR911P' TYPE 1 PRO ESS` b, FOR APPLICANT TO FILL IN (J,r CONST. / G BUILDING Q ) STATISTICAL SSIFICATION SEWER MAP ADDRESS / CLASS NO. DWELL UNITS-_ BK PG LOT NO. BLOCK USE ZONE MAP j I SPECIAL SPC7� TRACT � ECIAL NO. OF SLOGS. CONDITIONS SIZE OF LOT I NOW ON LOT USE OF SLD:. SETBACK FROM To. J °RONT PROP. LINE OF (STREET) OWNER NO. ft7 - TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL ADDRESS MIGHWAY WIDTH I FROM C.L. CITY P-s 1"4BLDG. SETBACK FROM ARCHITECT OR TEL. ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESSdd-- HIGHWAY WIDTH FROM C.L. M64 e, f 'l' /NCL + ADDRESS NO CORNER CUTOFF YES NO CITY I�1 LIQ Cl — SEE REVERSE SIDE FOR SPECIAL APPROVALS 1 DESCRIPTION OF WORK 1 NEW ADD ALTER REPAIR DEMOLISH I SO.FT. NO. OF NO. OF SIZE STORIES FAMILIES STR CTURE � �sQ F� ' j I SIGNATURE OF, s APPLICANT , VALUATION$ ,0 •00 APPROVALS DATE INSPECTOR'S SIGNATURE FEE$ FEE$ 0 d FOUNDATION, LOCATION FORMS,MATERIALS FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 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 9UILDI NO 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 COMPENSATION INSURANCE. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS il ? Fl N A L JOHN F.. � A LEWIS.WIS. PRINCIL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PripntffVALIDATION CK. M.O CASH LhL.0 6 5 8 2-2 SEP 2 5 1 D 9.00-