HomeMy Public PortalAbout5515 1/2 PAL MAL AVE_Building__ T.A.»A�.a.... APPLICATI N FOR UILDING PERMIT Z
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS a7 07
BUILDING AND SAFETY DIVISION LOCALITY _
JOHN A. LAMBIE.COUNTY ENGINEER NEAREST wA
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
TR E�S,ji
FOR APPLICANT TO FILL
NO. GRO YPES IN I CONST. �
BUILDING SEWER MAP
ADDRESS Pal M81 STATISTICAL LA SSIF]CATION �I BK PG,
CLASS. NO. DWELL. UNITS
LOT NO. E K MAP STATE YES NO
NUMBER 7 HWY.
TRACT USEZONE SPECIA
NO.OF BLDGS. J. CON DIT]
SIZE OF LOT 60 % 420 NOW ON LOT 3 /J��
If If /To IF
ESIEOF STING 2 Dwellings & Garage �T
BUILDING YARD HWY STREET AME E%IS
SETBACK WIDTH
OWNER Harry Hunt FRONT
AMAIL DDRESS 5706 Rowland P.L. Lo
SIDE
CITY Tem le City TEL..
o' P L INSPECTION RECORD
ARCH ITECT OR TEL.
ENGINEER NO.
A ORES /
CONTRACTOR Sel e C t ed Homes 40291
D 832`L Arrow HwyT Irwindale
DESCRIPTION OF WORK
S I
NEW X ADD ALTER REPAIR DEMOLISH
SQ.FT. 908 NO.OF 1 NO. OF 1
SIZE STORIES FAMILIES
USE OF STRUCTURE Dwelling and
Attached 1 z 20 darpg3vt
SIGNATURE OF y APPROVALS
APPLICANT
DATE INSPECTOR'S SIGNATURE
ADDRES FOUNDATION: LOCATION ♦ 66
FORMS,MATERIALS
$ " I _P.C. S FRAME: FIRE STOPS, r
FEELtr BRACING. BOLTS
VALUATION J YS FURNACE: LOCATION, 1
FEE GAS VENT,DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP. LATH.INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY TH ALL OUNTY ORDI NCES AND
STATE LAWS RETIN
G BCUI LDIN�, STRUCTION, LATH,EXT.
SIGNATURE OF // HOUSE NUMBER COR-
PERMITTE (,v�. RECT AND POSTED _ U
ADDRESS 16322 Arrow Hwv, lirwindalel FINAL
CLYDE N.DIRLAM, PRINCIPAL STRqgWAL ENGINEER /
PLAN CHECK VALIDATION rcl
M.O. CASH PEAKU VALIDATION V M.O. GBM
"( .. h270 IA „p, 3CJ2A 15.00 .l
' 1r�8 4 9 7 M ^.r: 4 1 A 3 r? .00 r®r
r-I
WORKERS' COMPENSATION DECLARATION
_ 1 hereby off urn that I have r certificate Compensation
of consent to ,elf APPLICATION FOR BUILDING PERMIT
insure, w a certificate of Workers' Compansahon Inver e
or a ce fLLed co hereof (Se C COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Io/ Com BUILDING
❑❑ Certified copy n hereby f m shed FORA LICA TO FILL IN ADDRESS ���6/2 /f L �jfL
I copy n filed c my building onspec- BUILDING S Z L-
on panment
Da Apphc CRY 21P LOULITY
CE IFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CRO
COMPENSATION INSURANCE CROSSSS S ST
ASSESSOR
(This section need not be completed If the permit is for one TRACT BLOCK LOTTEL NO MAPBOOK PAGE PA
w RCEL
hundred dollars (f100) less ) TEL
OWI,E NO USE ZONE MAP
I certify that in the performance of the work for which this
permit is issued, 1 shall not employ any person in any manner ADDRESS V IE0A]. NS �'>/ 02 a
so as to become subject to the Workers Compensation Lows COND" / 73 O
CITY ZI U
Date Applicant ARCHITECT OR TELa'
NOTICE TO APPLICANT If, cher making this Certificate of ENGWEER NO DISTRICT GROUP TYPE IRE PROCESSED BY !O-
Exemption you should become subject to the Workers `o _ � T v
Compensation provisions of the Labor Code, you must forth- ADDRESS �LQ /Q y a
with comply with such provisions or this permit shall beto
STATISTICAL CIASSIHUTION APT CONDO
deemed revoked CONTRA Z
LICENSED CONTRACTORS DECLARATION /_. L CLASS NO DWELL II
I hereby affirm that 1 am licensed under provisions of Chapter 9 AODRE uW7llWi4 SEWER
(commencing with Section 70DO)of Division 3 of the Business UC
MAP
and Professions Code,and my license a in full face a
Vic`
CITY CI'455 BK PG VAUDATION
�/ j SO FT NO OF NO OF CHECK
License NT'u'emh}J��j�� " `Lic Class SIZE STORIES FAMIUES ONE
ContraLpis"X 4 a I6 �v IPHON Rx � ❑ VALUATION 10
❑I am exempt under Sec Q ADD ❑ 01 ►
ALTER ❑
B&P C for this reason ; I REPAIR ❑ f
Dote USE OF
EXISTING BLDG miucii ❑
Signature APPLICANT TEL ^
OWNER-BUILDER DECLARATION (PRINT) NO FINAL
DATE
I hereby affirm that I am exempt from the Contractor's License 1
Low for the following reason (Section 7031 5, Business and ADDRESS FINAL
Professions Code) B •r— t
El as owner of the o BUILDINGr r1. - ' •t
property, w my employees with ADDRESS
l'7
wages os then sole comped or of will f o the work and LOCALITY polo
- -`
the structure n not intended w offered for vele(Section i 1TEr3
704.1, Bustneu and Professions Cods ) MOVING 7El
❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO TATA 33 - 63
with licensed contractors to construct the project (Sec-
tion 7044, Business eand Professions Code ) ADDRESSC'EC K
CONSTRUCTION LENDING AGENCYMT RACK RLQUIRED YARD HWY O IX FROMEXIST
LIN •I�l-
1 hereby affirm that there n a construction lending agency for FRONT
the performance of the work for which this permit is Issued PL
(Sec 3097 Civ C ) SIDE
PL r---_rtr ��
Larder's Name 1 I IJ I I I1 -r 195-
PC Fee Permit Fee TDMA Ref R 2'6 1 PM it 1
Lender's Address 'J
a I certify that I have read this application and state that the bwonce J- LDAM P/C s
abov formation a correct I agree to com ly with all County Investtgoaon Fes
and State laws relating to budding construction, Total Fee LDMA Perm S
` n a orize representatives of this County to enter
IYq u t ire-mentioned property for Ins�,onq�s SEE REVERSE FOR EXPLANATO[Y LANGUAGEtgn we of Applicant or Agent