HomeMy Public PortalAbout9333 PENTLAND ST_Building__ z7, �.o f dot /17 L�
7........a...9 8. APPLICATION FOR BUILDING PERM IJ
L -
COUNTY OF LOS ANGELES RENT
DEPAHTN1EriT OF COUNTY ENGINEER'
)BUILDING AND SAFETY DIVISION , LOCALITY '
/
JOHNWILLIAM NEAREST
AA EN EN SUP T of BUILDING ENGINEER C OSS ST' G.
P DISTR Nj _ O P TYPE CESSED BY
FOR APPLICANT TO FILL IN ,q GV CDNST
BUILDINGSTATISTICAL CLASS IF I CATION EWER MAP
ADDRESS j/( /��e� BK I
CLASS NO_LL_.DWELL UNITS-1-1 j
MAPa�z STATE YES NOS
NUMBER HWV
TRACT USEZONE SPECIAL-
NO OF
SLOGS - / CONDITIO -
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BUILDING YARD HWY STREET AME EXIST
TE SETBACK WIDTH
OWNER FRONT 701
P l oL
ADDRESS / SIDE
ARCHITECT OR TEL P L
ENGINEER NO SPECTION RECORD
ADDRESSTEL
-CONTRACTOR IDYL NO t �!O E,, b y F o
ADDRESS ,E Q
DESCRIPTION OF WORK
EW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF
SIZE STORIES FAMILIES }., I",.v' y
USE OF I I 7Z '/q
STRUCTURE cp cle ji c tz c, I, el T--1
.LIFT/. i
SIGNATURE OF
APPLICANT In
VALUATION$ Q 7 B d- V/
APPROVALS DATE INSPECTOR 5SIGNATURE
�/ PMT
FOUNDATION LOCATION
FEE $ 2 FEE $ FORMS MATERIALS
J FRAME FIRESTOPS /
I HEREBY ACKNOWLFDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
,AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCESANO STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THISPERMIT IS ISSUED I SHALL NOT LATH INT / 1(
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT
TO THE WO KMENB COMPENSATION LAWS OF CALIF NIA LATH EXT
SIGNATURE OF HOUSE NUMBER COR• ��'/) V
PERMITTE RECT AND POSTED 1
ADDRESS FINAL S ��
CLYDE N DIRT AM PR NCIPAL STRU RAL ENGINEER
PLAN CHECK VALIDATION cK N o CASH PERMIT VALIDATION GK M D CASH
I '
69 - 5i��Y1.1 23 D 2250x :,
�,;�� 32b�- JLW 9 ' 1 D 4800
WORKERS COMPENSATION DECLARATION «
Iin.Nre, or
er that I have r certificate of consent to self APPLICATION FOR' BUILDING PERMIT' -
r � m ire, or a cernfi<atetof Workers,Compensohon Insurance ' «--- `
or cerhf,eeii���/co ther f (Sec 3800, Lab ) r r
let., , ' 7'�'F71�- �� "' " •COUNTY OF LOS ANGELES ' 'BUILDING AND SAFETY^ ;
Polity No �FOO Campony I
BUILDING'
Certified copy is hereby furnished FOR APPLICA TO FILL IN ADDRESS (/V Q^�
,Certified copy Is filed with the county building,inspec- - BURDIrJG- - - -
hon depoe
artment ' w^�_ ADDRESS /U S.v _-. 1, �+ L s CL
Dote
Applicant �— ` ' v" , CI C'"' !L C% jZIP LOCAUTV GNC/N/ JV oil .
PP O OF BLDGS f _..I
y`T` C TIFICATE OF EXEMPTION FROM WORKERS' , SIZE OF LOT f NOW ON LOT NEAREST , o
' COMPENSATION INSURANCE gSSESSOR F, _
1(This section need not be completed if the permit is for'one TRACT` V - BLOCK. --l-COT-NO ryp 8001( pq PARCEL
hundred dollars ($100) or lesst) '+ -•� - TEL
• ♦ ,+.' OWNER J~4 ONS No'L25 -rLJt/ USE ZONE MAP
I certify.thot ,n the performance of the work for which this SPECIAL r >
permit is issued ,I shall not employ any person in any manner - ADDRESS- f 4N CONDITIONS / ' O
so as to become subject to the WorkergCompensation,Laws •„ _ _ , ._. _ U
su ill . -t c , ..r•r CITY „'� ZIP - 9- 0-
t Date Applicant ' ARCHITECT O TEL - �
NOTICE TO APPLICANT If,_aher making thisiCertificote of^ ENGINEER--- --- - - - -NO DISTRICT GRWP TYPE
ZNI E PROCESSED BV' O
"• ONE
Exemption, youshould become subject to the Workers' J' _`.3 ✓ 4 w
Compensohon provisions of the Labor Code, you must forth- - ADDRESS - - r N
with,comply with such provisions or this permit sholl be II uC J TELT !Z' STATISTICAL CLASSIFICATION _ APT CONDO 1 Z ,
deemed revoked y, _ . CONTRACTOR �_1 7 ,NO /��- `�
, LICENSED CONTRACTORS,DECLARATION ,K' L UC 20 CLASS NO DWELL UNI75_
I hereby off um that I am licensed under provisions of Chapter 9 ADDRESS NO _
LIC' SEWER MAP. -t
�y(commenung with Section 7000)of DiFs,on 3 of the Busmess- _ �!f r �� S,
and Professions-Code and my license is in full force and e c CITY '�// CLASS s ,� VALIDATION '
{�F,•7,� T �'' SO FT OF NO OF CHECK BK PG
License Number �� Lic` Classy�L-� • SIZE STORIES FAMILIES ONE
ds `•/ -- - / ') VALUATION
Contract �"� A� J Date 1/ DESCRIPU NOF WORK �l_ ' v NEW ❑ s -�O _ _ ,t •Y'
-❑
❑ am exempt under Si 't T 4 ADD loop__ _ y ALTER_❑ - - - - y t,
B 8P C for this reason 77,-s [ ��rr"�- REPAIR $
USE OF ^
Date ` - EXISTING BLDG f_l DEMIX
Signature - (PRINT)' � 5 N J µL NO ��7 FINAL aa ' •- " f',
OWNER-BUILDER DECLARATION APPLICANT(PRINT V U TEL DATE. ''_�—I?;"!
I hereby affirm that I am exempt from the Contractors License - - - r -
Law for the following reason (Se7031 5 Business and AOOADDRESSS FINAI
ction r 1 _
•Professions Code) .- , PRESENT - r - -T By 1
Er BUILDING-i _ -rf1_L� •T r
I as owner of the property or my employees with. r ADDRESS _
7
wages as their sole compensation,will do the work and c'- - - - 3'Q _ 11c•�'!
the structure strict intended or offered for sale Section LOCALITY
7044, Business and Professions Code ) ( MOVING 4 TEL -
' CONTRACTOR ' NO `t
❑ I as owner of the property, am exclusively,contracting ... --TOTAL � 1 16 m 3L
with licensed contractors to construct the project (Sec- : w
tion 7044 Business and Professions Code ) ADDRESS° t - - lNClj,� t' 1'ii•`�_
I ° n - REQUIRED TOTAL SETBACK FROM- +EXIST - �' 6 �1�
' CONSTRUCTION LENDING AGENCY SETBACK • YARD HWY P LINE WI - , :f"ANt3E • -v - •SISI
I hereby affirm that there is a construction lending agency for -FRONT
r"tl"11'I C _
the performance of the work for which this permit-is issued a P L '
' (Sec 3097, Civ C ) SIDE -Lenders Name // y 11DI-1 I-130131 y/ _1,`7I
_ _ __ t _ -. A - ? pQ LDMA Ref N _ _ ' _ • 'fi]� 1�, O�
PC Fee S _ Permit Fee d J V 1 A l 4 '
Lender s Address
a f I certify that I have read ihis'application and state that the �•� Issuance Fee LDMA PTC R ,
8- above information is correct I agree to comply with all County Invesbgatw_n Fee , - e
R` ordinances and State jaws relating to}bwjdmg construction Total Fee }� LDMA Perm If ,? '
4anreby uthor¢e reprasentahves of this County to enterhea a-m nh,/oJ�ed properf�lf/5fo-r inspects—on p / s
1/L ��/'� .' SEE REVERSE FOR EXPLANATORY LANGUAGEr
T_. "
Signature of,App Lcant or AgeN Dat .