HomeMy Public PortalAbout9458 PENTLAND ST_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES I � ' ® '
WM. J. FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN ( FOR OFFICE USE ONLY
DISTRICT NO I PLAN CK NO PERMIT NO(
BUILDINo
AD /• TTTTV D14- �1—• I� - /O/ _ � I¢ 3 I
LOCALITY RECEIVED BY 'Y O (ATE OF APPL -- E ISSUED
N EASE rR
BT
.'S
e BT
BUILDING
OWNER � �O ADDRESS
MAIL /I ✓1 1 / LOCALITY ' I
ADDRESS /y /-/1 A ']�
CI //LM`�
TEL
a-� J CHAO69fi
FIRE ( .ND OF n TYP GROUP)T
ARCHITECTOR TEL ZONE PLANB /� I=,GROUP' ,
ENGINEER NO
BLDG I=– ORO NOI
ADDRESS1 /i SETBACK LINE 12
i APPROVED I J (
/�z TEL BY I 1 f '+ DATE
CONTRACTOR NO
USE APPROVED
ADDRESS
ONE BY, 1 DATE
LEGAL I 9b)�i CORRECTIONS
DESCRIPTION LOT NO BLOCK 1
TRACT // 0 OF
, � ,, I_ I I
SIZE OF LOT �fT /� /V NOW ON LOOTS "+'� � tJ ( I
USE OF NO OF NO OF J \.'1"
EXISTING BLDG FA.uL.. ROOMBI7 L
DESCRIPTION OF WORK i rs a, ice^
NEW ALTERATION ADDITION
^l.J,. wI '1114. O
A
REPAIR MOVING DE M OLIBH
89 FT A NO OF L' .. _ 'O W41V-J. ryM Z
SIZE �.J (/ ROOM, `7 STORIES >
WALL n ROOF !O]I (%j ,(9'9 F
COVERING (/, COVERING /i/y/(/jV I
USE OF NEW - ^
B R
BUILDING /y(/j,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE, FORMS,MATERIALS J-4 9
AND STATE LAWS REGULATING BUILDING CONSTRUCTION
FRAME FIRE STOPS,
SIGNATURE OF /�J BRACING,BOLTS 'F
PERMITTEE •v--G � d
LATH, INT
AUTHORIZED AGT- � `yr"'�''^�
- LATH, EXT ' 7
]MG.GA 9 4B
oee-a fAM eLTe $ PC
B O a r PLASTER, INT
FEE PLASTER,EXT /
VALUATION / FEE /v/n,� FINAL
APPLICATIONzFQRBUILDING PERMIT �
COUNTY OF LOS ANGELES BUILDING AND SAFETY
•WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS r 1.
I hereby efhrrn that I have a certificate of consent to self Insure, BUILDI „ 'T
or a certificate of Ntxkers Compensation Insurance or a certlfed
COPY th f(Sec 3BOO Lab C) [�l' �' �'� {{!yr��,,�� CI LP M LOCALITY
,P..oJBCyMIs � �mDanY 912ECA LOT NO.OF BLDGS NON ON LOTNo NEAREST CROSS Si
00 Cermcl copy hereby furnished
❑ Certified copy is II Ith the Cour bulli ling Inspection TRACT BLOCK LOT NO
IIIefI USE ZONE MAP NO
Dats�APa ASSESSOR MAP BOOK PAGE n PARC�� -/ SPECIAL CON
DITIONS
CERTIFICATE OF EXEMPTIO FROM WORKERS' QWFU �1 'a D L 8 YES NO
COMPENSATION I URANCE _ I/�11 WITHIN IOOD FT OF SCHOOL?
(This section need not be completed d the permit Is for orte hundred A a ' I` ) IL DISTRICT - 1"7P TYPE CONST FIRE ZONE PROCESSEDBY
dollars(=100)or Ins) 7VI certify that In the perfomurKe o/the workfon which thispermit VIuk . I V "7
s issued. I shall not employ any person In any manner so as toCTOR INEER EL O J
become subject to the Nbrkers Compensation Laws 11-00 -3 STATISTICAL CLASSIFICATION AFT CONDO
Data Applicant A CLASS NO �DWELL UNITS
lora o 6d ass rnw
NOTICE TO APPLICANT If after making this Certificate of T REQUIRED TOTAL SETBACK FROM -EXIST—
Exemption you should become subject l0 the Workers _ ��( SET BACK -NWY PROP LINE WIDTH
.+----Compeneetlon provision of the-Labor Code you must forthwith nID- r"
comply with such provslorle or the permit shall be deemed revoked (.y�ESS f^ o rC�—p7 pP L�
�`� ' VRV 6L t, DJ I SIDE
LICENSED CONTRACTORS DECLARATION 0� r�'� /� n to I I _ LICPL
s
I hereby affirm that I am licensed under provwrs of Chapter 9 1 I'` C "I l(� I SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and FT S NO OFFIM I MILIES Po O
Professions Code tl II a in full force and
NEW ❑ BK F
lJceneeN bar �A LIG Claes �t I 1lON.0 7Rf rO I ADD V T _O,p
Contracfo Dote r D ALTER ❑ s ' ?
❑ I em exempt under REPAIR ❑
B&PC for this reason DEMOL ❑ LOMA P/C a
Date USE OF EXISTING BLDG . URM ❑
SlgnetureIPRINT) L`` O p LOMA RarM0 1• ` `=�
❑ 1 as owner of the property or my employees with wages m CT10Y: �6 O
their sole compensation will do the work and the structure Is ` /ny ���I i
not Intended or offered for sats (Section 7044 Business and fl O1-U A_ (� 1 vl I0 FINAL DATe
Profmlons C.ode) WILLTHEAPRInANr Oil eUIDINa OCCUPAIR INNDLEAMAZABOd1S IMTFALLL `
❑ I ae owner of the property em exclusive) contracting with OR A Iu-ruie CONnaNING A I ARDOUS MATFALLL EQUAL TO OB aREATER?IAN {
Y B Trio nuouNrs sPEriRra oN THE IAzwoous MATeauslNFxxsuTnN ouoEv FINAL BY
licensed contractors to construct the project (Section 7044rYes1:1
w
a
Business and Professions Code) E NTETID❑ED USE of THE BU Luno By TIE AFPLIONr OR RnuRE eUILOING
•,, � ' _3GR h7i,5`r
CONSTRUCTION LENDING AGENCY R� ARErouTFOR cora-rRxwmwoa )SEE TwN circ eanN C _
coAsr An auALm uAruaEraBlr oISTRIcr IxwoMDl SEE FERwmND wEuxLsr
I hereby affirm that Mere Is a cWstructlon lending agency for Tim❑ No❑ 2 �]� ,
the performance of the M10/c for which this permit is Issued(Sec ` r �, (T .y� S �3
U I NAVE READ TIE 11/TARDOl15 MATERLNa NFOIWAT ON WIDE AND TIE SCAOMO , ,I, , t� . 70 1 - 72 0- 62
3097 CN C) ' PDMITTUe CHECI(L6n LMEPBTAND MY REOUIREMEHr9 LNDER TIE L09 ANOElEa l
Lender's Name 0 � NTYcoOr;T clAPrelxaTeEcrKes ISDTIROUGH zaTlucoNCETu+INa CHECK 7?I1,Lendees Address L I uxF'1%'LTE 11
a
I certify that I have read this application and state that the abovePC FEEf
Information Is correct 1 agree to comply with all county
7y' PERMIT
ordinances and State laws relating to building construction and
��
S ereby authorize representatives o1 this County to ter �A�FEE ``��
7x1` elxTve-me toned pr P!Y for Irspectlon pu o�/'/S -t 154 1
1 9 INVESTIGATION FEE TOTAL FEE /
,nyy (O
SEE REVERSE FOR EXPLANATORY LANGUAGE