HomeMy Public PortalAbout5536 PAL MAL AVE_Building__ 'ew638AOe9D3b—APPLICATION FOR BUILDING PERMIT
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DIVISION OF BUILDING AND SAFETY ADDRE99
Dep. ant of County Engineer
County of Los Angeles LOGLITY T. C
WM.J. FOX. COUNTY ENGINEER NEAREST n r
CABBATT D. GRIFFIN. 9UVT or BUILOIMc CROBB ST.
DISTRICT NO. GROUPTYPE r���/rrr SEWER MAP
P
FOR AP//PLICAN/T'7 TO FRI�IN 1 CON[T.-^- G
ADATE
DRESS 5,S �LD /-Q.I I / I a Il NUMAB ER O BH w_Y_
( / / YES NO
LOT NO. J G 7 O 1 p ` oT 3 BLOCK USE ZONE SPECIAL
J L D 41 A/ 4 /) , r( C.� j T'y - CONDITIONS
TRAe c I rc S c o p o
SIZE OF LOT 7a 312 J I NOW ON LOTS BUILDING YARD HWY STREET NAME WIDTH
USE OFcc // SETBACK WIDTH
EXISTING BLDG. ✓/- CI✓n I l✓ Re-.5'ry..-c• FRONT P-/ 1 i
P.L. /1
OWNER .r] �L tJ N i J �'7 SIDE
MAIL
�{� O TRACT pWELL. I UNIT
MAIL 9.IO�.\ OG.IA� 44),t $ INDUSTRIAL
TEL. WELL. I UNIT
CITY Ccl L G NO. O 6 PUBLIC BLDG.
ARCHITECT OR TEL. 2 DUPLEX I UNIT 7 ADDN., ALT.. ETC.
ENGINEER NO. 3 APT. _UNITS 8 MISCEL.
ADDRESS I 4 COMMERCIAL
CONTRACTORI V, I, r NO.
1 iraC. INSPECTION RECORD
ADDRESS -r??c ?.NI '� W.. x /t fI-
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH *[ I -
90• FT. NO.OF NO. OF /t
SIZE STORIES FAMILIES is
USE OF ST U TURF
C,
SIGNATURE O
APPLICANT APPROV L
DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
s _-.•- P.C. SX
FORMS.MATERIALS 6�
�O i\ FEE FRAME: FIR[STOM, J�/_y 4
VALUATION / V //may BRACING.BOLTS /
FEE �U I FURNACE:LOCATION. i Y
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TH19 GAB VFNT. DUCTS 'EC
APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT.
AND STATE LA REGU TING BUILD G PONSTRUC-
TION. /
SIGNATURE HOUSE NUMBER COR-
PERM
ITTE hT RECT AND POSTED
AD.....
WM.J. FOX, NTY ENGIN[[R VALIDATION C. N. WRLAM, CHIEF BLDG. INSPECTOR
94.74w OCT29 16 8.0 C) i in
9556r CCT31 16 1 .00A
1 Log 56711^ OCT � '` Ir
PORKERS COMPENSATION DECLARATION n
APPLICATION FOR BUILDING PERMIT ['Illi
1/hereby affum that I have a cenificate of consent to self
qa
uure, o certificate of Worker' Compensation Insurance,
or a certified co th f (Sec 3900 L COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No mpany
❑ Certified copy is hereby furnished FOR APPLICAt4T TO FILL IN AADDDDRRESSSS S r--ofym CA
❑ Certified copy Is filed with the county building Ins Bl1IlDING /L(�
hon department
Dol Iltant C17Y ZIP LOCALITY
OF NEAREST
CERTIFICATE OF EXFJNPT WORKERS' SIZE OF LOT NOW ON LOT CROSS ST
COMPENSATION INSURANCE —1ASSESSOR
(This sectlan need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOO( PAGE PARCEL
hundred dollars (SIOD)or less ) TEL
OWNER LYAP- NO USE ZONE MAP
I certify that in the performance of the work for which this NOSPECIALa
permit is Issued 1 shall not employ any person in any manner ADDRESS CONDITIONS O
so as to became subject to the Wo n' mpenvnion Laws
CITY ZIP cle
(� 0
Data `r �'Apphmnf ARCHITECT OR TEL D TRICT GROUP TYPE FIRE BY Q
NOTICE TO APPLICANT If after Ing ilio Ce"i iowe of ENGINEER NO OpNST Z E V
Exemption you should become subject to the Worker (J•
Compensation Provisions of the Labor Code, you must forth- ADDRESS
with comply with such provisions or this permit shall beTEL pp p STATISTICAL CLASSIFICATION Z
m
deeej
d revoked CONTRACTOR 6 N
LICENSED CONTRACTORS DECLARATION J t! LB'6 CASS NO DWELL UNITS_
I hereby off writ ADO NO that I am licensed under provisions of Chapter 9 �7�' SEWER MAP
(commencing with Section 7000)of Division 3 of the Businesst LIC
and Professions Cods,and my license is In full face and effect SOFT r NOOF NO OF CLASS ^CHECK BX pO
CITY VALIDATION
License Number4�& �T_Llc Clan C— SIZE J .a STORIES FAAYUES ONE VALUATION
P [, n
Controct 44 DESCRIPTION OF WORK 1 Dale D—r — ?� NEW a
❑I am exempt under Se W of B AC ►
// ALTER ❑
B dP C for this reason n < < REPAIR ❑ S
Date USE OF
EXISTING BLDG q DEMOI ❑
Signature PRRLN TT .J B`s r d'tf.p3 f FINAL
OWNER-BUILDER Dram the on I DATE `
1 hereby affirm that I g r exempt from the Contractor's License ADDRESS p r d _
11 J
Law for the following reason (Section 7031 5, Business and
Professions Code) NG By
El I, as "net of the prop" or my employees with
�r�RESSS
wag"cothen sole compensation,will do the work and ,
the structure is not Intended offered fa n sole(Sectio
LOCALITY
or _
7044, Business and Professions Code ) MOVING TEL _
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO �! A_ L —
with licensed contractors to construct the project (Sec
hon 7044 Business and Professions Cade) ADDRESS IEf
CONSTRUCTION LENDING AGENCY I� YARD IIWY TOTAL FROM EXIST r T`i��
j hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued PL
(Sec 3097, Gv C) v
y Lenders NameI IDMA Ref 111
,
^
PC Fee 1"Permit F
lende/s Address /� �L
I certify that I have read this application and state that the Imo+ice F 24- `� LDMA P/C N
above information is correct I agree to comply with all County Irveangofion Fee
ordinances and to lows relating to building consnuctian, Total Fee oS -C?q WMA Pe.m R
` and her y out onze representotrves f this County ro anter
YR upon t abov mentioned propery, r inspection purposes
2� SH KVOSF FOR 9XPLANATORY LANOUACA
ViW•of Apphmnt or