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Home My Public Portal About4938 PERSIMMON AVE_Building__ DEPARTMENTCOUNTY OF LOS ANGE ESAFETY BUILDING UILD ' NG WM. J. FOX, CHIEF ENGINEER APPLICATION FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO, PLAN CK. OR RREc.No. PERMIT NO. BUILDING �, �F,�S'//YMO/Y 7 p ADDRESS '7` LOCALITY TMP.s C/'T}� RE EIV BY DATE OFAPPL TE ISSUED 6:A AN.p BUILD s �g NEAREST �5 CROSS 9T. �.., ADDRESS � (� � 'VJ / �✓�Iy/�G OWNER �0 N 09 A 4) tr, �Q,C' // MAIL (` (' LOCALITY ADDRESS `JZ 2 AFr 07D. `+�lJV'r LST NEAREST TEL CROSS ST. _CITY " _R/'/�"Ti NO. FIRE NO. OFI I G,gQUP ZONE PLANS- ARCHITECT LANEyARCHITECT OR TEL ENGINEER NO. BLDG. SETBACK LINE ADDRESS USE TEL „yam_ ZONE '/ PROVED BYDATE CONTRACTOR NO. ou HOUSE NUMBERING ADDRESS I MAP NUMBER Z'V'S„1 NO. ASSIGNED BY 'a -at DESCRIPTION I-LOT NO. d' T Z /PC � �RRECTIONS .�-�• DESCRIPTION LOT NO. �. BLOCK r4r � TRACT O d�T• XOT Fx0 TAcr NO. OF BLDGS. SIZE OF LOT �'py( /3S I NOW ON LOT is ' USE OF NO. OF r EXISTIN BLDG. I FAMILIES DESCRIPTION OF WORK 0 NEW ALTERATION ADDITION Z D REPAIR DEMOLITION , f' SQ. FT. NO. OF / SIZE O O ROOMS STORIES EXT.WALL ,t ROOF 4 COVERING ?,STfYC� O I COVERING'_,0NR0s/T/6'r' USE OF STRUCTURE 7J INSPECTION FOR APPROVALS OCCUPANCY AS _ INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION, FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRESTOPS, CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS f SIGNATURE OF rt ,� ,{Y LATH, INT. PERMITTEE 't T/ ^' So - LATH. EXT. ADDRESS V 1 PLASTER, INT. AUTHORIZED AGT. �f PLA8TER, EXT. pv FLEE 11,70 HOUSE NUMBER COR- / yo O RECT AND POSTED VALUATION l/0 $ ki FEE Z3 a FINAL 7GA63SA DBS 3 7-51 WORKERS' COMPENSATION DECLARATI_QN t � y hereby affirm that I have a certificate`of consent to-selfPPL,CATION FOR BUILDING PERMIT insura,Ibr a certificate of Workers' Compensation In��ranEe, or a certified copy thereof (Sec. 3800„Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company _ BUILDING r ) Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS C/ S Certified copy is filed with the county building inspec- \ BUILDING i 1 tion department. ADDRESS MQ t'�J LOCALITY �, > NEAREST Date Applicant CITY eA ZIP 1 CROSS ST. e 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 USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. 1A81TEL. �7 SPECIAL >_ I certify that in the performance of the wor for which this OWNER A�DNO. � ”( CONDITIONS IL permit is issued, I shall not employ an Fr in an ma �] DISTRICT GROUP TYPE FIRE PR ESSED BY so as to become subject to the Wor ersPens on s ADDRESS % C-° /► n"G / CONST. ZQNE U ate pplicant CITY l ` ZIP STATISTICAL LASSIFI ION APT. CONDO.gig O NOTICE TO APPLICANT: If, after making. s e ificate of ENGINEER O TEL. Exemption, you should become subjec to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS- 'a Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. Z deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VPIIJATIQ� (commencing with Section 7000)of Division 3 of the Business and LIC. 'r5/ Professions Code, and my license is in full force and effect. CITY CLASS �� J ► y SQ. FT. 0j / NO. F NO. OF CHECK License Number Lic.Class \ SIZE L,+�J U% STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK I`f j NEW EJ $-A dd I am exempt under Sec. 1 3f - QrYl S i� ` ALTER FINAL _� �� B.BP.C. for this reason / ('Hrt 1 REPAIR DATE Date: USE OF DEMOL FINAL / EXISTING BLDG. By J jc Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS , Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 0 I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LIN WIDTH , I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE FD P.I. V Lender's Name P.C. Fee$ Permit Fee Lender's Address _ I certify that I have read this application and state that the , v �I Issuance Fee e above information is correct. I agree to comply with all County Investigation Fee :�� $ ordinances a State laws relating to uildi g construction, Total Fee sj and hereby a thorize represents'v of th' County to enter upon a ab ve-mentioned pro for i ' tion purposes. a -gy SEE REVERSE FOR EXPLANATORY LANGUAGE � Signature�i t Agent Date Os