HomeMy Public PortalAbout9437 PENTLAND ST_Building__ >s
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IIKp3SA Uee>4,APTLICATION FOR BUaILDI+NG PERMIT
DIVISION OF BUILDING AND SAFETY BUILDING37
Deportment of County Englna ADDRESS . _
County OI Loss Angeles LOCALITY Tew. Q
JOHN A LAMBIE COUNTY ENGINEER NEAREST C/o u P-,/-
CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST
DISTRICT NO GROUP TYPA. SEWER r MAP
PG
FOR APPLICANT TO FILL IN j 1 T
J CONST ��-
BUILDING` /� STATE
ADDRESS NUM ER L� HWY YES O
_LOT NO r O BLOCK USEZONE SPECIAL -
CONDITIONS
TRACT C'7 14-S �
N OF
SIZE OF LOTS !•51/'-/ p2p I NOW OBLDN LOGTS 1 BUILDING YARD HWY STREET NAME Ex
IS7
USE OF SETBACK WIDTH
EXISTING BLDG Rz s i C> awcc_ FRONT'
OWNER S G p Tr SIDE ,
MAIL
P L
P
ADDRESS O TRACT DWELL 1 UNIT
TEL �' 5 INDUSTRIAL
CITY _ NO I DWELL.T-2'.! 1 UNIT 6 PUBLIC BLDG '
ARCHITECT OR TEL 2 'DUPLEX 2 UNITS
ENGINEER NOPT -UNITS 7 ADDN ALT, ETC
3 ,A
8 MISCEL
ADDRESS - �y ^ 4 COMMERCIAL
TEL
CONTRACTOR gjATUS NO Q� �'9mis ), .' ; INSPECTIONRECORD I
ADDRESS12,q F &PJ erT C Aisr jAff
DESCRIPTION OF WORK
NEW ADD (ALTER REPAIR DEMOLISH WIN D o W Gn/L
NO OF
SIZE �� V+"/ STORIES I FAMILIES
USE,QP STRU 'y RE/I n;�.Z wJ
SIGNATURE 00'
-
APPLIGAN_T r- APPROVALS _
ADDRESS S G 1 D TE, INSPECTOR S SI NATU E
OUNDAION LOJ
P C S FFORMSTM TERIALA„GTION 1
FEE FRAME FIRE STOPS '
VALu iN S O BRACING BOLTS - -
FEE FURNACE LOCATION
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS + IGAS VENT DUCTS u,
APPLICATIOWAND STATE THAT THE ABOVE 19 CORRECT . I>
AND AGREE TO COMPLY>WITH ALL COUNTY ORDINANCES LATH INT
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION LATH EXT (
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL I
JOHN A LAMBIE COUNTY ENGINEER VALIDATION CLYDE N DIR'LAM,tCHIEF BLDG INeP O +
- CK NO CASH
u r • �
G �, • 1JaCO£�a +47 E - JuL23 1 800
a - V
r" ''.V1'0RKERS COMPENSATION DECLARATION
I hereby a cer hot'l hove certificate of consent r ce •� �� APPLICATION FOR BUILDING PERMIT
insure or a certificate bf \.brker3 Compensation Insurance
or a certified copy thereof (Sec 13810 La C )
' COUNTY OF LOS ANGELES BUILDING AND 5 TY
Policy No�f 3 9y9 C
ompany
Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING
❑ ADDRESS
s Certified copy is filed with the county building inspec BUILDING
non department ADDRESS
`�y�
Date � Applicant //�"^""r `vl^^^""^ CITY G• ZIP / I / V LOC4LITY
CERTIFICATE OF EXEMPTION FROM WORKERS1 I No OF BL - NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LO CRO55 ST -
(This section need not be completed if the permit is for one _ } ASSESSOR _
hundred dollars ($100)or leu ) - TRACT " BLOCK LOT NO J MAP BOO( PAGE r PARCEL
J TELMAP
I certify Ihalµln the performance of the work for which this OWNS - /} / NO USE ZONE NO
permit is issued I shall not employ any person in any manner 7 f (/�(')�I SPECIALt
so os to become subject to the Workers Compensation Laws '�RE� d t ` V\ CONDITIONS I
I . 7�
Date r
Applicant CITY _ ZIP Iia �+
ARCHITECVOR TEL
NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRED BY O
Exemption you should become subject-.to the Workers S _Q CONST��/'— ZONE F-
Compensation provisions of the Labor Code you must forth- ADDRESS UV ,�L
with compla
y with such provisions or this permit shall be - TEL STATISTICAL CLASSIFICATION APT CON (n
deemed revoked CONTRACTOR NO
LICENSED CONTRACTORS DECLARATION _ LIC CLASS NO DWELL UNITS-- Z
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO
'
(commencing with Section 70DD)of Division 3 of the Buu smeand LIC SEWER MAP + `
Professions Code and my license Is in full force and effect CITY CLASSVALIDATION
T 5SO FT NO-0F1 NO OF CHECK BK PG
License Number 1 i _Lic Class SIZE STORIES FAMILIES ONE
G .c VALUATION
Contractor Arutn .4jo/'/I/lo 1Ui/e O/111frg;IIIIDESCRIPTIONOF WORK /L NEW .7
$ d ADD $ Oc o�C D 00 ,
I am exempt under Sec /T
ALTER
B 8P C for this reason '
REPAIR f
Date USE OF • '
EXISTING BLDG DEMOL
Signature' /�'� APPLICANT TEL FINAL J
OWNER-BUILDER DECLARATION PRINT NO DATE /7- •-�
I hereby offnm,thot I am exempt from the Contractor s License
Low for the following reason (Section 7031 5 Business and ADDRESS NAL
Professions Code) iI - FI
, _ FI '
Oj BUILDING
I as owner of the property or my employeeswithADDRESS '\ 4 ;� y L .�, t'„1(t
wfA p
wages as their sole compensation will do the ork and \� q• 1 rVl It �-j'�ASIII tS���f - r
the structure Is not intended or offered for sale(Section LOCALITY
7044 Business and Professions Code) ` MOVING TEL • 'T - 4��'�•'- �'
I, as owner of the properly am exclusively controcbng r CONTRACTOR NO
with licensed contractors to construct the project 44 (Sec- ADDRESS
hon 70Business and Professions Code)
ACK
CONSTRUCTION LENDING AGENCY '' SEM
SE7 OREQUACK YARD HWY ♦ TOT PROP LINE WIDTH •,� p` l -'f 6• 3
I
herebyaffirmthat there is a construction lending agency for• FRONT v -� 1 _ Q
the performonce of the work for which this permit is issued - -P L I 0,41-
'(Sec 3097 Civ C ) F SIDE u. c '` \' �:.��3"`'♦ E �/—
Lender s Name
•1 is y C� LD -Ref Y
Lender s Address PC Fee f Permit
I certify that I have read this application and state that the luuance Fee '5 v LDMA P/C Y ' I
a above information is correct I agree to comply with all County Investigation Fee 1
$ ordinahces'an ws relahn o budding construction - imol F
R and her,b utho repress I of this County to enter TDMA Perm Y
upon the v niton r y for Inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
SoVApplpcont or Agent Dote - -