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Home My Public Portal About4950 PERSIMMON AVE_Building__ 76A638A CF1803 3-68 `"C"✓ //�;%<-/"`�-� '` APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. - G>? FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TY NSEPRQCESSED B (Print or type only) (�/ CONPST. BUILDING STATISTICAL CLA IFICATION SEWER MAP ADDRESS lmmon CLASS NO. DWELL.UNITS BK PG LOT NO. BLOCK USE ZONEFAL P j� . C TRACT ECINO.OF BLDGS. NDI TIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. Residence BLDG.SETBACK FROM TEL. FRONT PROP,LINE OF (STREET) OWNER Moran NO. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS 4950 Persimmons HIGHWAY WIDTH FROM C.L. CITYTA=1 P City BLDG.SETBACK FRO ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWA + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CONTRACIdgid Mf • Co TEL.263-5181 } _ D � ADDRESS 337 S. Woods AvesNO 159496 CORNER CUTOFF YES ❑ NO ❑ LIC. rr CITY L A. 22 CLASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK LLJ NEW ADD ALTER REPAIR X DEMOLISH c z SQ. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE On of house SIGNATURE OF . OIIIpB � APPLICANT VALUATION $ OcS•oo O APPROVALS DATE IN5PECTOR'S SIGNATURE P.C. PMT. 9 FOUNDATION: LOCATION FEE S FEES .00 FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION, 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. LATH, INT. ING TO WORKMEN'S COMP Eq SATI.pf�)NSU R/1NCE. ftigld MIg. Company LATH, EXT. SIGNATURE OF / HOUSE NUMBER COR- PERMITTEE ` � ��u� vac ' 22 RECT AND POSTED ADDRESS 337 S. Woods Ave. L.A. FINAL 3 JOHN F. LEWIS. PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION CK. M O. CASH PERMIT VALIDATIONCK. M.O. CASH Pr_ y v y� Wr 16 � 9.0 WORKERS' COMPENSATION DECLARATION v I hereby affirm that I have certificate of consent self APPLICATION FOR BUILDING P E RM I T . insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.-C.) ""-fi C OUNTY OF LOS INGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished.. BUILDING � FOR APPLICANT TO FILL• IN ADDRESS _ ❑ Certified copy is filed-with the county building inspec- BUILDINGzffiLa If-* :" = �• a, Tion department. ADDRESS ALJJ1AOR�.v a U(ra Date Applicant CI C NO.OZIP LOCALITY - NEAREST t pp -CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT �' CROSS ST. ( Air,4 4A11-4— COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT'' BLOCK LOT NO. MAP BOOK PAGE PARCELDt7.( hundred dollars ($100)or less.). TEL'/ p USE ZONE MAP OWNFP/� . 2aZd,✓�e� NO3 ':7�0/�G IVO. A I certify that in the performance of the work for which this / SPECIAL permit is issued, I shall not employ any person in any manQ z manner ADDRESS' f ees #vv/3 Auk— CONDITIONS n}. so as to become subject to the.Workers'Compensation Laws. a O. CITY t4-; Zet Lh• ZIP 67&b U Date Applicant ARCHITECT OR TEL. DISTRICT I GROUP ITYPE FIRE PROCESSED BY NOTICE TO. APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. Z NE O Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS �1 V Ji�U �i�� I with comply with such provisions or this permit shall be � r`s� TEL. STATISTICAL CLASSIFICATION APT. CONDO. h deemed revoked. CONTRACTOR e-4r7 e,'i NO. Z LICENSED CONTRACTORS DECLARATION, 1�-� 1/' d LIC. CLASS NO.,DWEu UNITS I hereby affirm that I am licensed under provisions of Chapter 9 �\ ADDRESS c-�G�•L-Gri�c�CJ NO. (commencing with Section 7.000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and m license is in full force and effect. \ CITY CLASS /+ VALIDATION Y BK.G PGS/� ��3 SQ. FT: NO. OF NO.OF CHECK License Number L•ic. Class ! SIZE STORIES 't FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ y v 8i `= !ntom + .. ADD ••0 $ �� ❑I am exempt under Sec. n` @ 1'ZL'iob �'o`'AL ALTER ❑ , B.BP.C. for this reason '�= REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL '}�' OWNER-BUILDER DECLARATION (PRINT) NO. DATE ``- r� �+� 7. I hereby affirm that I am exempt from the Contractor's License ACCT■s Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY 3 48■75 L/C I, as owner of the property, or employees with BUILDING mY ADDRESS i wages as their sole compensation,will do the work and , the structure is not intended or offered for sale(Section LOCALITY A 7044, Business and Professions Code.) •• MOVING TEL. ACCT $ ❑ 307 5�� j6 I,as owner of the property,am CONTRACTOR NO.exclusively contracting ��r L ■�' with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code.) ADDRESS 2 ITEM REQUIRED TOTAL SETBACK FROM EXIST: TOTAL e CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH A 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. CHECK: 624.91 s (Sec. 3097, Civ. C.). SIDE 1 CHANGE ■0I0 Lender's Name � � LDA Ref. # P.C:Fee$ Permit Fee o Lender's Address , 00170_0001 1219/92' ' I certify that I have read this application and state that theIssuance Fee LDMA P/C# ,ys above information is correct. I agree to comply with all County Investigation Fee %6961 1 it M10'-LL j or finances and State laws relating to building construction; Total Fee ! �=%• / LDMA Perm. # : 'd hereby authorize reppresentatives of this County.to enter bpon the abdv -m tiorfeZi` roperty for inspection purposes. ' 7 i 17-L'Z- SEE REVERSE FOR EXPLANATORY LANGUAGE SLgnatur of APPAnt or Agent Date