HomeMy Public PortalAbout9514 PENTLAND ST_Building__ )Ew63Rw CE#0031 BE APPLICATION FOR BUILDING PERMIT, .
COUNTY OF LOS ANGELESBUILDINGD /
DEPARTMENT OF COUNTY ENGINEER ADRESS
BUILDING AND SAFETY DIVISION LOCALITY `
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST G J
DISTRICT NO GROUP /TYPE ESSED Y
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OR APPLICANT TO FILL IN S/ p CCY T CONST
EI NGG STATISTICAL CLASSIFICATION WER MAP
ESS CLASS NO DWELL UNITS BK G
O / BLOCK^ WATER NOT REQUIRED RECEIVED
CERTIFICATE
T J MAP cy� HIGHWAY STATE MAJOR SECOND OCA
r NO OF SLOGS
NO J9* ICIRCLE)
OF LOTJ� NOW ON LOT U Z E SPECIAL
OF T �A CONDITIONS
ING BLDG .//
TEL
ER NO BUILDING EXIST
SETBACK YARD HWY STR NAME WIDTH '
ESS FRONT
ECT R TEL P LNO SIDE
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RACT ,(.L.ESS 2 ' 0D CRIPTION OF WORK j�FVI ADD ALTER REPAIR DEMOLISHLT NOOFNOOFSTORIES FAMILIES
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STRUCTUREi
SIGNATURE OF
APPLICANT
VALUATION p
APPROVALS DATEwBPeCToa sslGrvwTUae
PC PMTFEE S ��— FEE $ IE FORMS MATERIALS
LOCATION
• FRAME FIRE STOPS
HEREBY ACKNOWLEDGE THAT HAVE READ THIS wPPLICATION I BRACING BOLTS ILII I
AND STATE THAT THE ABOVE 1 CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINA ES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION CERTIFY THAT IN DOING THE WORK - •� ,[`
AUTHORIZED HEREBY I W L NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR E OF THE STATE OF C FORNIA RELIT
IND TO WORKMEN PENSATION INSUR LATH EXT
SIGNATURE O SE NUMBER COR
PE RMI E RECT AND POSTED I �7
1 JOHN F LEWIS PRINCIPAL ST RAL ENGINEER
PB N CK VAL LATI CK M O CASH _ I PERMIT VALIDATION CK m. CASH
a .
Lf':3606 � �Jr" 7 0 30 0
WQRKERS'COMPENSATION DECLARATION 1 �/ r
11,� Ia�OR' L � 3e�E'�
iLiureebo®afcertificatte ofaWorkers'certificate of
APPLICATION F BUILDING P W I T
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No./OCompany 5-MW /"'-47
BD_�pl\ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING L
ADDRESS
Certified copy is filed with the county building inspec- BUILDING< �
tion department. ADDRESS /��
Dots 10 / Aplicanj CITY v <<C ZIP LOCALITY e4kir
ERTIFICATE OF EXEMPTION FROM WORK NO. OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
TEL. USE ZONE MAP
I certify that in the performance of the work for which this OWNER NO. - NO }
permit is issued, I shall no employ any person in any manner ADDRESS ,//�I SPECIAL d
so as to become subject to the Workers'Compensation Laws. z Y� CONDITIONS O
r U
Date Applicant CITU ZIP J
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL, DISTRICT G UP TYPE FIRE PROLE ED BY O
Exemption, you should become subject to the Workers' ENGINEER NO. CONST.. ZONE G
Compensation provisions of the Labor Code, you must forth- ADDRESS /� �J U-I
with comply with such provisions or this permit shall be 0-
deemed revoked. CONTRACTOR 0 L ( L�(ff.CtCG /z✓ -,a STATISTICAL CLASSIFICATION APT. CONDO. N
Z
LICENSED CONTRACTORS DECLARATION � /yV 4"6' t2 CL17✓O LIC. CLASS NO. DWELL. UNITS_ —
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE55 '/ /'f3J0SEWER P
(commencing with Section 7000)of Division 3 of the Business and LIC `n'
Professions Code, and my license is in full force and effect. CITY� LA_111141 / AdAL CLASS ;E5 ! I VALIDATION
SQ. FT. NO.OF NO. OF CHECK BK. PG
License Number-�'�93�3 Lic.Class I__5 SIZE 33 STORIES FAMILIES ONE
❑ VALUATION
Contractor Date C'f/�L`/z i Gf
J / DESCRIPTION OF WORK NEW C
7 S� n ,
I am exempt under Sec. �X�<T/Nd f-9C DD $
Y`aJ
ALTER
B.BP.C. for this reason TV dD `tV §r!97&RO.t�-F REPAIR $
0084.1 A
Date: USE OF DEMOL # e e s e a•l
EXISTING BLDG,
Signature APPLICANT. TE o 1 ( e 8 1. 13
9 OWNER-BUILDER DECLARATION PRINT -yE/F+1�? G/U NO �"`i-0 pgTE ,/�
I hereby affirm that I am exempt from the Contractor's License ��y) S/LY�GY GGaNA -�- E� z� e e 81. 135
Law for the following reason (Section 7031.5, Business and ADDRESS / FINAL ,
Professions Code): WER� By Ia05-88
I, as owner of the property, or my employees with BUILDING
wages ct their sole compensation,will f o the work and LOCALITY ,
the structure is not intended or offered for sole(Section
7044, Business and Professions Code). MOVING TEL
I, as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
REQ
CONSTRUCTION LENDING AGENCY SET ancD vnaD Hwv TOTAL ET A K WIDTH EXIST hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L.
Lender's Name
Lender's AddressP.C. Fee$ Permit Fee 0 L
3 LDMA Rel A
9 1 certify that I have read this application and state that the Issuance Fee l/ LDMA P/C e
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee f 3 LDMA Perm. It
and hereby authorize representatives of this County to enter I
upon the obove-mentioned property for inspection purposes.
�- •, T I SEE REVERSE FOR EXPLANATORY LANGUAGE
./ SignaNre o"I"' [IEi Agent Dote
z .`mo