HomeMy Public PortalAbout9572 PENTLAND ST_Building__ BUILDING BUILDINQ
ADDRESS
APPLICATION LOCALITYNEAREST
_-
DIVISION OF BUILDING AND SAFETY
CROSS ST. -
Department of County Engineer DISTRICT NO. RECEIPT NO. PERMIT NO.
County of Los Angeles 7)Z
WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIV D DATE ISSUED
CABSATT D. GRIFFIN, SUPIT OF BUILDING .
FOR APPLICANT TO FILL IN TYPE Col NX*
E D /i ISSUED BY
OWNE f���. ✓ "�' MAP ^/ / STATE YES�NO
MAIL /1 NUMBER d G?
ADDRESS -r O H
USE ZONE SPECIAL
TE CONDITIONS
CITY O _ ..
ARCHITECT O TEL.
ENGINEER iz NO.
BUILDING YARD HWY STREET NAME EXIST.
ADDRESS SETBACK WIDTH
FRONT
' TEL. -2-
CONTRACTO NO. a 3 2
SIDE
P.L.
ADDRESS
RU 11.DI N13 r... DATE CORRECTIONS INSPECTOR
ADDRESS
LOT NO. ,S BLOCK /
TRACT l� 3 /G '
( NO.OF BLDGIL 2 `�
SN
SIZE OF LOT �X �' I NOW ON LOT
USE OF
FXIc;TING BLDG.
DESCRIPTION OF WORK
a
NEW �S- ADD ALTER REPAIR DEMOLISH Z
SIZ FT. /(y STORIES FAMILIES _ '
SIZE r
USE OF BTRUCT RE
'000V I
NO.OF
EMPLOYEES
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN IS APPROVALS INSPECTO SIGNATURE DATE
CORRECT.
IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION �
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS,MATERIALS C�
FRAME: FIRE STOPS,
SIGNATURE OF BRACING,BOLTS
PERMITTE FURNACE: LOCATION,
GAS VENT,DUCTS
ADDRESS
v,
LATH, INT.
AUTHORIZED AOT. ! .�
LATH, EXT. �` !
/2— / O OP.FEE / G` HOUSE NUMBER
AND POSTED I
zi2!l — OU
VALU ION � �d FEE FINAL Itin.
1''(•tl� �"
Z
76A63BA DBS 3 12-53 '
S'COMPENSATION DECLARATION
00,.by certificate
that I have r certificate of consent to self P L I CAT I FOR BUILDING P E 1 nn I T
insure, or a certificate of Workers'Compensation Insurance, LJIIU V Ll ❑
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company BUILDING
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS 7� e t
Date Applicant CITY C' t ty ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' 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 TRACT --v BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars($100)or less.)
TEL. USE ZC&VE MAP
I certify that in the performance of the work for which this OWNER \ '+ bC e NO. 3�7 - /08 /J`) NO.
permit is issued, I shall not employ an person in an manner SPECIAL
IL
so as to become subject to the Workers'Compensation Laws. ADDRESS 1 �e CONDITIONS
Date °7� O Applicant d'I+^l - � CITY l?" P C� ZIP 10,80 @t;
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCES ED BY
ENGINEER NO. S42- /1 CONST. ZONE
Exemption, you should become subject to the Workers' K ►T
Compensation provisions of the Labor Code, you must forth- ADDRESS
with comply with such provisions or this permit shall be
TEL. '�STATISTICAL CLASSIFICATION APT. CO �
deemed revoked. CONTRACTOR NO.
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. Z-1 DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
(commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP
Professions Code, and my license is in full force and effect. c.CITY CLASS BK PG VALIDATION
SQ.FT. NO.OF NO.OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
VALUATION
r DESCRIPTION OF WORK opec NEW 1C � �- 0-0
Contractor Date ADD $ �t
I am exempt under Sec. ALTER ❑
B.&P.C. for this reason 3 ! REPAIR ❑ $
Date: USE OF DEMOL
EXISTING BLDG. ❑;;
Signature APPLICANT TEL. FINAL ��
OWNER-BUILDER DECLARATION PRINT NO. DATE '
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS FI L A 4 8 9 9 A
(;�00 0 0 0 0
Professions Code): BUILDING
2 I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and LOCALITY1 - 49,88
the structure is not intended or offered for sale(Section44
70 , Business and Professions Code). MOVING TEL.
I,as owner of the property,am exclusively contracting CONTRACTOR NO. 0 0 0 4 9 8 8 5
with licensed contractors to construct the project (Sec- ADDRESS U 626-86
tion 7044, Business and Professions Code).
REQUIRED TOTAL 5ETBACK FROM
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH
I 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
'o P.L.
o Lender's Name Cr LDMA Ref. #
P.C. Fee$ Permit Fee 0
Lender's Address �9
I certify that I have read this application and state that the Issuance Fee V LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
$ ordinances and State laws relating to building construction, I Total Fee LDMA Perm. #
U and hereby authorize representatives of this County to enter
Iupon the above-mentioned property for inspection purposes.
a` g'b SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent D to