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HomeMy Public PortalAbout9579 PENTLAND ST_Building__ BUILDING BUILDING ; ADDRESS ^� AP_PLIC_ATION LOCALITY ' C f NEAREST ` - ✓1 DIVISION OF BUILDING AND SAFETY CROSS ST. Department of County Engineer DISTRICT NO. RECEIPT NO. PERMIT NO. County of Los Angeles --3 7 "7/ WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISSUED CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN TYPE CONST. RECEIVED BY ISSUED BY ❑WN � _ MAP _ STATE YES NO MAIL NUMBER :'� HWY ADDRE13 O - USE ZONE SPECIAL TEL. q CONDITIONS CIT ARCHITECT O TE y ENGINEER ND BUILDING YARD HWY STREET NAME EXIST. ADDRESS SETBACK WIDTH FRONT _ /1 CONTRA C TO/�{yr+�t►� -dj _ N SIDE ADDRESS9.),1l0 W4-e_, P. L. DATE CORRECTIONS INSPECTOR BLI ILDING `,. ADDRESS 0 3 r / b LOT NO. BLOCK TRACT/ 9IZE OF LOT , I NO.OF BLA NOW ON LOT C� USE OF FXIRTING BLDG. DESCRIPTION OF WORK °z x\� Q NEW" ADD ALTER REPAIR DEMOLISH_ Z 9Q.FT. r NO.OF NO. OF D SIZE /J STORIES / FAMILIES r USE OF STRUCTURE NO.OF EMPLOYEES I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS APPROVALS INSPECTOR' BIGNATURE -DATE CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION, LOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS, MATERIALS FRAME: FIRE STOPS, SIGNATURE � ,/C� BRACING,BOLTS PERM ITTEDDFURNACE: LOCATION, GAS VENT,DUCTS ADDRESS LATH, INT. AUTHORIZED AGT._ __ $ - = "L , ©a LATH. EXT. ' P.C. HOUSE NUMBER COR- / r 0 ©O FEE �� RECT AND POSTED VALUATION OO FEE FINAL • - t�� �- I .r 76A638A DBS 3 12-S3 WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a ce -lied copy thereof (Sec. 3800, Lab. C.) �y COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.�1/1�Company :26u/T/' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING Q.S7 00r&140-,A-9.S1 ADDRESS Certified copy is filed with the county building inspec- BUILDING IILL``JJ tion department. / ADDRESS 15 C Date /J—, 9 Applicant / 1L 61 CITY ZIP / 70 LOCALITY CERTIFICATE OF EXEMPTION FROM WO CERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. f (This section need not be completed if the permit is for one ASSESSOR TEL. hundred dollars ($100)or less.) TRACT BLOCK LOT.a MAP BOOK PAGE PARCEL T OWNER �yi 00 USE, ONE MAP I certify that in the performance of the work for which this 2� NO. +tOb- / NO. permit is issued, I shall not employ any person in any manner ADDRESS 9 S7 ,4V / SPECIAL so as to become subject to the Workers'Compensation Laws. �/ I CONDITIONS p CITY A( (-/ ZIP / V Date Applicant ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER 4/ NO / I CONST. ZONE - I" Exemption, you should become subject to the Workers' n�/ / ) U Compensation provisions of the Labor Code, you must forth- ADDRESS /�• �` (/� -� ✓ W a. with comply with such provisions or this permit shall be /►� TELSTATISTICAL CLASSIFICATION APT. QNDO. Cn deemed revoked. CONTRACTOR 0 /4L�!/YI, NO. Z Z ,13 LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS J30/j_ NO. // (commencing with Section 7000)of Division 3 of the Business and LIC SEWER P Professions Code, and my license is in full force and effect. CITY 6019 CLASS C 10� BK PG VALIDATION SQ. FT. r INC. OF NO. OF CHECK License Number ��/// Lic.Class 0-(40SIZE �j� STORIES FAMILIES ONE VALUATION n (' DESCRIPTION OF ORK NEW Contractor/���0 /Y�utn r Date 1 7 O I am exempt under Sec. $ ©R., /� i.5 ADD ALTER POO, 1 2 1.6 A �p 2 (� B.BP.C. for this reason .z ��c7r�I�• REPAIR E] $ I 3 ✓6 V # • • • • •,1 Date: USE OFEXISTING BLDG.BLDG. DEMOL / 1 • - 49.88 SFL Signature APPLICANT41,0 �yAa N L. PRINT - .5:�5�8 FINAL • • • q U OWNER-BUILDER DECLARATION DATE/1/7Z' ADDRESS1-5014! 1 hereby affirm that I am exempt from the Contractor's License 1-5�Dl a 4QQ 1 .f FIN Law for the following reason (Section 7031.5, Business and Professions Code) By ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ' the structure is not intended or offered for sale(Section LOCALITY 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). - REQUIRED YARD HWY TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT r, the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name � LDMA Ref. tY a P.C. Fee$ Permit Fee Lender's Address ' i 0 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# o above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned p opetty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ign ure of Applicant cfAgent Date WORKERS' COMPENSATION DECLARATION Insure boraffirm certif cane of Worke s' Compensatioa certificate of n eInsuran e, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) Poli yQ,X( S`Company y• �(/�GSJ��i COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING c�' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS S7� Certified copy is filed with the county building inspec- BUILDING tion department. L�1�y�J�/ ADDRESS/ 5 LOCALITYNEAREC Cj7` Date li/ Applicant / /,G-/ �---• CITY / G� C�// ZIP CR CERTIFICATE CERTIFICATE OF EXEMPTION FROM WORKERS' NO, OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one ACT BLOUSE ZONE MAP hundred dollars ($100)or less.) TR LOT NO. NO. TEL / 7 SPECIAL I certify that in the performance of the work for which this OWNER S[�{� 6"D�G CONDITIONS C• permit is issued, I shall not employ any person in any mannerADDRESS /�j7 DISTRICT GROUP TYPE FIRE Z CESSED BY 0 �G (� CONST. so as to become subject to the Workers'Compensation Laws. //L ZONE � i Date Applicant CITY ��� GL ZIP STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after makingthis Certificate of ARCHITECT OR TES � 7 U ENGINEER D�Ly ci�J I�t�� yG z CLASS NO. DWELL. UNITS W Exemption, you should become subject to the Workers' H Compensation provisions of the Labor Code, you must forth- ADDRESS ID K/lG 'C� SEWER MAP � with comply with such provisions or this permit shall be �j z deemed revoked. CONTRACTOR �� Nt -�y BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION L I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Z�`� VALUATION (commencing with Section 7000)of Division 3 of the Business and �7 LIC. /D�a Professions Code, and my license is in full force and effect. CITY CLASS C $ � , SQ. FT i� NO. OF NO. OF CHECK License Number / Lic.Class G�t" SIZE v STORIES FAMILIES ONE Contractor I t L��--r O Date DESCRIPTION OF WORK NEW ❑ /r� G--ti C:� GJ ❑ I am exempt under Sec. ADD ALTER ❑ FINAL 5_ for this reason G� l REPAIR ❑ DATE 3' Date: USE OF /� DEMOL FINAL EXISTING BLDG. �� r � ❑ Signature APPLICANT �J TEL, OWNER-BUILDER DECLARATION PRINT I hereby affirm that I g r exempt from the Contractor's License / Law for the following reason (Section 7031.5, Business and ADDRESS ✓� Gi / C/`l� 0/s Professions Code): PRE ENT 1:1 BU I, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 0 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). REQUIRED TOTAL SETBACK FROM EXIST 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.I. (Sec. 3097, Civ. C.). SIDE n P.L. Lender's Name _ P.C. Fee$ - �t Permit Fee Lender's Address �y I certify that I have read this application and state that the Issuance Fee a above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, and hereby qut rize representatives of th' unty to enter Total Fee upon t bo me do d perty f tion purposes. o Z SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®s