HomeMy Public PortalAbout5517 PAL MAL AVE_Building__ DEPARTMENT OF BUILDING AND SAFI 1 APPLICATION FOR PERMIT
GIOUNTY OF LOS ANGELES f1 /�
WM. J. FOX. CHIEF ENGINEER U ' D ' G
1
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.NO. PERMIT NO.
Np 3 SWI-
ADDRESS L O2 J,j _Jl
ADDREBB
LOCALITY L*7 R999IVED BY DATE OF APP(L. DA�T/E INGUEDD
..J
MEAARES Al/V Y - Z—J V I _U[ I,/
BUILDING
OWNER 'ADDRESS
MAILLOCALITY — /
ADDRESS _
NEAREST
CITY Hpl" —3 CROSS ST.
FIRE NO.OF TYPE BROUP'j-
ARCHITECT R 'FEL ZONE PLANS L
ENGINEER NO.
BLDG.
ADD EBS SETBACK LINE
APPROVED
CONTRACTOR G�'i '— L. By DATE
NO
... APPROVED
ADDRESS ZONE BY DATE
LEGALYO^! - BLOCK Q Q CORRECTIONS
DESCRIPTION LOTNO.
TRACT 2 Z - ---- p T S 20 X
No.OF
SIZE OF LOT .Z O I NOW ON LDTB .B Or LOT
UBE OF •1/-0,( NO.OF NO.OF
EXISTING BLDG. FAMa¢e ROOMSJ
DESCRIPTION OF WORK G� o
NEW ADDITION e, — -^"•'^' O
A
REPAIR MOVING DEMOLISH 2O
81, FT. NO.OF D
_ BIZE ��� �jq ROOMS 4f STORIES --- r
CUVERING �Q N_o/yCA COVERING jL �'�
UBE OFNEW w ` � I ' C
BUILDING /yva.af/WY;/yt {y J��
Gfir'1 'yF'TE fo X 2 0 -�; c i C r
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 S �`
1
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
1114
� / I FRAME: FIRE STOPS,
SIGNATURE OF BRACINp,BOLTS
PERMITTEE /./
LATH, INT.
' AUTHORIZED ApT LATH, EXT. Jj
76AG39A-3 7-49
PLASTER,INT.PLASTER.EXT.
VALUATION FINAL
V A
T
A Rot^ ^ED
DONE R BUILDING>......�.#.«.... APPLICATION FO N
G PER IT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAM9IE, COUNTY ENGINEER NEAREST
CASSATT O. GRIFFIN 6UPT OF BUILDING CROSS ST.
CA A
DIT TRIC O. I GROUP TYpE E Y
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL CL SI FICATI ON SEWER MAP
ADDRESS �� K PG_
II,,��`` CLASS. NO. DWELL. UNITS
LOT N&IelO/O S -3 o sl< �T/ BLOCK MAP STATE YES O
NUMBER HWY.
TRACT USE ZONE SPECIAL
NO. OF SLOGS. ` nnn / CONDITIONS
SIZE OF LOT ,I' �' n NOW ON LOT J /� y
USE OF
EXISTING BLDG. L� r, BUILDING EXIST.
.0 SETBACK YARD HWY STREET NAME WIDTH
OWNER ✓✓ / FRONT I1�(i-f
MAIL r P. L.
ADDft ESS O -�, L L SIDE
P.L.
CITY le NO INSPECTION RECORD
ARCHITECT O TEL.
ENGINEER NO.
ADDRESS
CONTRACTOR
Zer reqZ 114TEL,
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
Sq. FT. NO. OF NO. OF
SIZE 6 D STORIES FAMILIES e6
USE OF
STRUCTURE
SIGNATURE OF
APPLI
APPROVALS DATE INSPECTOR'S SIGNATURE
LOCATION
ADDRESS '
FOUNDATION:FORMS. MATRIALS
FORMS, MATERIALS
VALUATION S FRAME: FIRE STOPS,
BRACING, BOLTS
P.C. PMT. FURNACE: LOCATION,
FEE f 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 WITH ALL COUNTY ORDINANCES AND
STATE LAWS REG TING BUILDI CONSTRUCTION. LATH, EXT.
SIGNATURE OP y /,/f.`__ HOUSE NUMBER CDR
-
PERM ITTE RECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM. PRINCIPALS RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH
1-.o 7 0 6 1 � FEB ?9 1 A 3.0 O "®>
., . WORKERS COMPENSATION DECLARATION ^
hereby a certificate
that I have r certificate Comte of tarsen, to ranelf APPLICATION FOR BUILDING PERMIT �LI'lII3
insure or a certificate of Worker Com on Insurance,
a a con eed co or f (Sec
COUNTY OF LOS ANGELES BIALDING AND SAFETY
Policy Company '
EJ ✓/"/
Certified copy m hereby furnished FOR APPLI BUILDING NT TO FILL IN / 7
El fied copy is filed t munry building Inspec- BUILDING S� ADDRESS
ti de ment ADDRESS
?LAPP aTY ZIP LOCLOCALITYDate /6
CE IFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST
COMPENSATION INSURANCE CROSS STASSESSOR
(This section need not be completed of the permit is fa ate LOT BLOIX LOT NO MAP BOOK PAGE PARA
hundred dollars ($IOD) or less ) TEL USE ZONE MAP
OWNE NO o2
1 certify that in the performance of the work for which this _ SPECIAL a
permit is Issued, I shall not employ any person in any manner CONDITIONS
so as to become subject to the Worker'Compensation Laws O
CITY r, ZIP
Date ApplicantARCHITECT OR TEL
NOTICE TO APPLICANT if after making this Cemm
fioe of ENGINEER NO DISTRICT GROUP I
TYPE
1'1"'
FIRE PROCESSED BY O
Exemption, you should become subject to the Worker p p
Compensation provisions of the Labor Code, you must forth- ADDRESS �JO —J 1 i '
with comply with such provisions at this permit shall be TFi STATISTICAL CLASSIFICATION APT CONDO N
deemed revoked NO z
LICENSED CONTRACTORS DECLARATION _ CLASS NO DWELL UNITS-
1 hereby affirm that I am licensed under provesiom of ChopIW 9 lK `� SEWER AWP
(commencing with Section 7000)of Division 3 of the Busmen
and Professions Code,and my Itcerme m in full force and act CL BK PG VALIDATION
/' SO FT NO OF NO OF CHKX
License umbo Lec Clow—o SIZE STORIES FAMILIES ONE
V N cry
Cont Dole PnOFI RK NEW ❑ -/
El am exempt under Se< 'F N`'DADD-Fe 7pvf LJ ,
ALTER ❑
B&P C for this reason REPAIR ❑ $
j>nie LISE OF
EXISTING BLDG nt, O ❑
Signature APPLICANT
TEL OWNER BUILDER DECLARATION FINAL
I hereby off irm that I am exempt from the Contractor's License DATE 3;o-gL
Law fa the followuig reason (Section 7031 5 Business and ADDRESS FINAL 1
Professions Code) a
❑ 1, as owner of the property, or my employees with �Appp� p_-,- �x
f -
woges as then sole comped or off,well do the work tion LOCALITY _.1_t
the structure is not intended or offered fa sale(Section
70" Business and Profeneom Code ) MOVING TEL , 1 1TE1
I as owner of the property am exclusively contracting
CONTRACTOR NO 1 IDTAL 9. , - 6-3
with licensed contractor W construct the project (Sec-
tion 70", Business and Professions Code ) ADDRESS (PECK 93 IJ-1
CONSTRUCTION LENDING AGENCY I YARD HWY OTAL IX FROM IST �Hr;N'aE .I )
I hereby affirm that there m a construction lending agency far --
the performance of the work for which this permit is Issued P L
(Sec 3097 Civ C) SIDE
PL
Lenders Nome
Linde/s Address P C Faa Permit Fee .( (f TDMA Ref N 2
27 1 ?N12:1-c
I certify that I have rood this applicationL
state that the Issuance F O'c �� LDMA P/C N Pilo
abov amation m coaea I agree to[aaft all County Invatpoieon Fora
de tic and State laws relating 1. bucomtructeon, Total Fee LDMA Perm N
t an h au eze rspresentotrves of u ry t enter
TYq u n h a e-mentioned property for e ti p
SH RIVIM FOR EXPLANATORY LANDUAOE
urs of Applicant a Agent