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HomeMy Public PortalAbout4911 PERSIMMON AVE_Building__ f{^ A ROAD DEPT: PE.?M{T IS REC7UIRpI7 =%' M FOR ANY MATERIAL 5___A­E' der`RK 4 DONE IN THE ROAD RiGllf OF 76AN/CcAy903 a.= APPLICATION FOR BUILDII4 'PERMIT ,' . . • t , COUNTY OF-LOS ANGELES BUILDING DEPARI'NIENT OF COUNTY ENGINEER A°DREss / BUILDING AND SAFETY DIVISION LOCALITY C/ms 's?-� •. JOHN A. LAMBIE. COUNTY ENGINEER NEARECEASES T. G�Lv CASSATT D.GRIFFIN,SUPT OF BUILDING DISTRICT NO. GROUP TYPE P. OCESSED BY FOR APPLICANT TO FILL IN d'�- _/ I CONST: BUILDING STATISTICAL- C IFICATION SEWER MAP ' ADDRESSy� j- CLASS.NO. DWELL.UN1T5�I HK PG LOT NO. 774 r pZ BLOCK (� MAP % STATE YES. NO r NUMBER HWY. TRACT /' Q U E ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF USE OF LOT j �J I NOW ON LOT l_ EXISTING BLDG. BUILDING YARD HWY STREET NAME- EXIST. SETBACK WIDTH OWNER " FRONT MAIL /� P.L.' ADDRESS V SIDE TEL. P.L. CITY ' NO. INSPECTION RECORD" ARCHITECT OR TEL. ENGINEER NO, I /� ' ADDRESS CONTRACTONEO,, 1If 13 r✓ -- ADDR ESS-1/��yy off. DESCRIPTION OF WORK �� !• �r .'F NEW A17D ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OI? SIZE STORIES FAMILIES USE O J2 i STRUCTURE s _ SIGNATURE OF APPLICANTy y �//0 y FOUNDAPPROVALS DATE 1NSPEC R'S SIGNA TUR ADDRESS «S/�J E ATIMATERIALSON:LOCATION VALUATION $ FORMS,�, FRAME:FIRE STOPS, - mmmi BRACING,BOLTS P.C. PMT. O O FURNACE:LOCATION, FEE •$ I FEE $�:`�I GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT'1 HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND A I STATE LAWS RE U TING BUILDING CONSTRUCTION. LATH.EXT.' SIGNATURE OF HOUSE NUMBER COR- _ PERMITTE RECT AND POSTED ADDRESS c 7& FINAL CLYDE N. PIRLAM, PRINCIPAL STCT AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH If'�0 5 2 4'1503 ' IIIAY 9 1 A '3.0 0 :°®P DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES o� ®� WM. J. FOX, CHIEF ENGINEER NG FOR APPLICANT TO FML IN FOR OFFICE USE ONLY BUILDING !Q ,C DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS �d f I ke J am$op-i 4 cl .dG� LOCALITY RECEIVED BY DATE OF APPL.f DATE ISSUED [ADDRESS EAREST`^ ■ ROSS 9T. A OWNER W di a BUILDINGD�1 o ADDRESS Ve AIL LOCALITY` NEAREST II TEL. CROSS ST, h 0 LAjFF9— 4 7 vrA Q�, ARCHITECT ORCITY ' NO. ` C -. ZONE I PLANS �I IRE TYPE� I GROUPer ` ENGINEER L 14J .,ArO. BLDG. ADDRESS SETBACK LINE .5 ►`-a f`/ e /qA ivZ>� F>.eL Z'� APPROVED �J TEL BY DATE CONTRACTOR , NO. USE APPROVED ZONE v BY DATE ADDRESS HOUSE NUMBERING LEGAL2 aj DESCRIPTION LOT NO. BLOCK MAP NUMBER FIELD CHECK BY TRACT j ^ NO. ASSIGNED BY ���% HATE NO. OF BL GS: CORRECTIONS ' SIZE OF LOT NOW ON LOTNO. OF' I� USE OF C!34=,= 721C 32-7.7 EXISTING BLDG, I FAMILIES TUG L/ DESCRIPTION OF WORK y A NEWI�ALTERATION I I ADDITION I - ��O/ 1rI 4 REPAIR I I DEMOLITION I I I SQ. FT. NO. OF m SIZE ZWALL ROOF ROOMSSTORIES �1V L 0`, CS a0 COVERING !r �cfl I COVERING ' USE OF S•RUCTURE 4 _ c i' 42e, a 'STS p,4 p r fir. rZ9,./i APPROV ES4_42I 1//1 ------�-�-'- ' INSPECT•R'S I TURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION:LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME:FIRE STOPS, HEREON ANDWI ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS r� LAWS REGULATI G UILDIN CONS RUCTION. FURNACE: LOCATION, f�I SIGNATURE OF -� 6 GAS VENT, DUCTS �� PERMITTE - + u LATH, INT. /,,e / �,�• ADORES �•��G•% ° • AUTHOR] ED AGT. LATH, EXT. - � PLASTER, INT. 76ABSBA. DBSS 10-SO S FEE• /0 0 i ` PLASTER, EXT. VALUATION FEE $ b O 'tf�Z•• ?V v/ FINAL I ` iJi t1°1i11-1rlr4Ll L VL' a V LLIL.PLM v itim LJq 0116K ra i i COUNTY OF LOS ANGELES ® ' WM. J. FOX, CHIEF ENGINEER NG FOR APPLICANT*TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. •BUILDING ADDRESS I.a LOCALITY E 4 6 %4 RECEIVED BY DATE OFAPPL. DATE ISSUED MEARES 1\ �A -BUILDING A , l OWNER C `A`r L. Ci AY 6 D Y1, ADDRESS �l f�� l J IV ADDRESS \ \. 1`C © �i� LOCALITYNEAREST [ Cl 1 /V\ U Y\ `�• NTEOL CROSS ST. _Q(.&E � FIRE NO.OF -- TYPE GROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. - - - BLDG. ORD.NO. ADDREBS SETBACK LINE ,Lr / g 9 L/ - `./ TEL. APPROVED CONTRACTOR Q yl/ NO. BY DATE �fM15L, ` `Fk` ' '{ [o.{. USE APPROVED ADDRESS" \�11 0'\\A 1, \ ZONE BY DATE LEGAL DESCRIPTI 'N ON I LOTO�) ' I BLOCK m �D / CORRECTIONS TRACT { NO.OF BLOBS. SIZE OF LOT ' . I NOW ON LOT yl LAM USE OF NO.OF��• NO.OF EXISTING BLDG. FAMILIES ROdit DESCRIPTION OF WORK NEW - ALTERATION ADDITION O REPAIR I a MOVING DEMOLISH p B4.FT. � NO.OF D SIZE .�J!fin �J ROOMS STORIES r R WALL- OOF i COVERING y ��J may' I COVERIN ;yai USE OF NEW BUILDING C2yA _ / r � » 1 /e) r 1 b r- R:t�a 'c I HEREBY ACKNOWLEDGE THAT 1 HAVE.READ THIS APPROVALS ' APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND ABREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS OWNER n . \ { LATH,INT.: AUTHORIZED AMT. � h ` l Q-P.LA v • - LATH,EXT.: DBS-3 2SM SETS I-47 $ P.C.S I PLASTER.INT. `u FEE �J PLASTER,EXT. VALUATION FINAL . FEE J _, J WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self A P P L I CATION FOR BUILDING PERMIT Insure,or a certificate of Workers'Compenstion Insurance,or a certified cgppyl thereof Sec. 3800, L b.. C•. [� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N L ompan /T Ui/ BUILDING .-Certified copy is hereby furnished. FOR APPL CANT TO FILL IN ADDRESS re rtified copy is filed with the youn y bi� i e BUILDING _1 n epartlnenf. �( ' ADDRESS � %�� �� �v� LOCALITY �+ihh �i�� NEAREST i Applicant CIT ZIP CROSS ST: 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 �j p USE ZONE, MAP hundred dollars($100)or less.) TRACT Q� • BLOCK LO NO.p[ t NO. Gx d >_ i)�L �j/j e_ SPECIAL JL I certify that in the performance of the work for which this OWNS �i1id0 7J� „ CONDITIONS O permit is issued, I shall not employ any person In-any manner f �Sraa� DISTRICT GROUP CPE FIRE ZONE PROCESSED BY y ADDRESS y so as to become subject to the Workers'Compensation Laws. ff QO 0 Date Applirant CITY ZIP STATISTICAL CLA SIFICATION. ICONDO. ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CLASS NO. DWELL. UNITS LU Exemption, you should become 'subject to the Workers' IL 'Compensdfion provisions of the Labor Code, you'must forth- ADDRESS SEWER MAP• with comply with such provisions or this permit shall be F ' r f— CONTRACT o deemed revoked. CONTRACT .NL. 1'71®x'• BK. 4! PG,/'1� VALIDATION LICENSED CONTRACTORS DECLARATIONyy�� LIC. S ' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE$ 4&—.NO._ C31 VALU I (commencing with Section 7000)of Division 3 of the Business and LIC. /3 / / Q00Professions Code, and my license is in full force and effect. CITY . CLASS ( $(e® �. SQ.FT. /�NO.OF NO.OF CHECK License Number Qi 1 L Lic.Class "` L SIZE STORIES FAMILIES ONE ��L� DESC '.Contra� TION OF WORK NEW ❑ $ ,Date ��` ADIS 'i-FT .I am'exempt from the licensing requirements as I am a r' �Qf + lcensed architect or a registered professional engineer + ALTER ❑ FINALN_� 'I acting in my professidnal capacity (Section 7051, ( REPAIR ❑ DATE C] -, Business and Professions Code). USE OF vByAL j �— EXISTING BLDG. •�y � .�/ DEMOL ❑ S /� �Cr Lic.or Reg.No. Date APPLICANT T ��jj���TEL.: , OWNER-BUILDER DECLARATION PRI ��jj U�V6C/'�YdO.� 17 • I hereby affirm that I am exempt from the Contractor's License ADDRES> r�� o`��O 2 5 7 9,,4`A Law for the following reason (Section 7031.5, Business and ' Professions Code): PRESENT ❑ BUILDING ° ° ° ° 2.3 •I, as owner of the property, or'my employees with ADDRESS wages as their sole compensation,will do the work and 2 o e 3 4 8'0 the structure is not intended or offered for sale(Section LOCALITY- 7044, Business and Professions Code). MOVING _ TEL. o'o 0 3 1L 8 0 czi I, as owner'of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 0 8 2 3—82 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. 5 7 9,5 A CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ;R 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. # 0'a 0 0 0 1 (Sec. 3097, Civ. C.). SIDE 2'- ° 5 2 ' Lender's Name � �� � o o 0 5 2. 005 P.C. Fee$ Permit Fee Lerider's Address I. certify that I have read this application and state that the Issuance Fee O d 2 'v—$2 above information is correct. I agree to comply with all County Investigation Fee gon ances and State.lows rel ting to building construction, Total Fee her y authorize r pr ntatives of this County to enter t above- en roperty.fpr inspection rposes. SEE REVERSE FOR-EXPLANATORY LANGUAGE Signature of Applicant or Agent to es '