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Home My Public Portal About5026 PERSIMMON AVE_Building__ liA989Acaboo•5.50 APPLICATION FOR BUILDING ERMIT COUNTY OF LOS ANGELES BUILDING Q DEPARTMENT OF COUNTY ENGINEER ADDREss BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DIT N GROUP TYPE PR STRI CFSS FOR APPLICANT TO FILL IN Q I L CONS I I f /, ' ��, STATISTICAL CLAS IFICATION SE BUILDING ro HWER MAP f �--.Q ADDRESS IC �O CLASS.NO. DWELL.UNITS J / CO LOT NO. Q MAP STATE HLOCK NUMBER D S HWY. YES N TRACT V71,71 'USE ZONE SPECIAL ' NO. BLDGS. CONDITIONS SIZE OF LOT 0 /� I NOW OF ON LOT _ USE OF EXISTING BLDG. v BUILDING YARD , y REET NAME EXIST. TEL SETBACK WIDTH OWNER NOLs J.. FRONT f I / ADDRESS O C ' SIDE ARCHITECT OR TEL. P.L. ENGINEER NO. INSPECTION RECORD ADDRESSn- /�yTEL. "� ; `r✓Llr�S L%% �1i e� ( 0 CONTRACTOR�w/V /aiy NO. JIM ADDRESS r i O DESCRIPTION OF WORK F. �'J / �"; �' r `�' �'� W AL NEW DD ALTER REPAIR DEMOLISH h SQ.FT. NO.OF ` NO.OF t, SIZE G STORIES / FAMILIES USE OF STRUCTURE m O 'kh LVALUATION F , of APPROVALS , DATE 1 SP 'CDR'S SIANATU E P. - FEE MATERC. I $ FOUNDATION: CATION 4--126V ' �� FEE $ " •�� LS .,g^ME:.FIRESTOPS. IHEREBY ACKNOWLEDGE THAT I 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 THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH,INT. �J/ J"lel? `•"• EMPLOYANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT TO THE WORKMEN'S COMPENS ION LAWS OF CAANIA* 'r LATH,EXT. SIGNATURE OR HOUSE NUMBER COR- CB' f d" ,,,_`- --.r::•�`" r •RECT AND POSTED PERM ITTE 4F ADORES FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGI R PLAN CHECK VALIDATION cK. N.C. CASH PERMIT VALIDATION cK N.C. W+$N r DEPARTNNJEhNT OF COUNTY ENGIN M ;[;,SION OF BUILDING AND SAFETY COUNTY OF LOS ANGELES BUILDINP . WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE„USE ONLY BUILDING ,g DISTRICT NO. PLAN CIC.OR Rsc,No. PERMIT NO. ADDRESSe i GSD. IBJ 117 LOCALITY ® RF RIVED BY DATE OF,A(PPL. DATE ISSUED NEAREST 6' C f CROSS ST ADDRESS �✓ b V��AI,r' L^6Rr '" l OWNERBUILDING � MAILADDRESS 7A' &41 NEAREST LOCALITY /Cl�d.�(g (� f� . TEL. 7`LOY V. to CROSS ST. � I..I.�T CITY !► j, e ' i� O !! P e+� _ ARCHITECT OR TEL. FIRE NO. OF TYPE GROUP ENGINEER NO. ZONE PLANS �j,_ • ��J ADDRESS q.q'� SETBACK LINEUSE CONTRACTOR 6�1fd/ NOI. // / / (F` ZON PROVED DATE ADDRESS / � , LJ 6 h j HOUSE NUMBERING LEGAL d. MAP NUMBER �^ NO. ASSIGNED BY DESCRIPTION I LOT NO. �/ I BLOCK /7 CORRECTIONS TRACT "—�/',�/ip�i�I• NO.OF BLDGS. SIZE OF LOT W�i/•T NOW ON LOT USE OF NO. OF EXISTING BLDG. FAMILIES - DESCRIPTION OF WORK O - E AALTERATION ADDITION IR I DEMOLITION r R SQ. FT. V ® NO.OF SIZE ROOMS STORIES . COVERING ROOF .WALL �(/` I COVER NGCom USE OF STRUCTURE 4 g a APPROVALS INSPECTOR'S-SSIIGNNATURE DATE FOUNDATION:.LOCATION FORMS,m MATERIALS CiLa�'v� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE-THAT. THE INFORMATION-GIVEN 18 BRACING, BOLTS ' ✓G CO IRECT A REB TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE:LOCATION, g,,��+� AND STATE LAWS REGULATING BUILDING.CONSTRUCTION. GAS VENT, DUCTS ''YY SIGNATURE OF , LATH, INT. � PERTE MITGv D-r ADDRESS �/ , k! v� �dQ I@/ LATH. EXT. �f PLASTER, INT. AUTHORIZED AGT. + qs �f PLASTER, EXT. P, C. S (J d HOUSE NUMBER COR- RECT AND POSTED 14s -VALUATIONp — b FEE „� �p FINAL (�s 76AG30A OBS 3 9-82 WORI&S' COMPENSATION DECLARATION APPLICATION FOR M I he4 y af?irm that I have a certificate of consent 1•S self R, 11.DING PERMIT insure, or a certificate of Workers' Compensation Insurance, or o'certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELUS i BUILDING AND SAFETY Policy No. Company EJBUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN •- ADDRESS--L 0-2—G lqc-S f +r ❑ Certified copy is filed with the county building inspec- FADNE 2 � tion department. ry • J fir& r a, v4 ,t}-�c- .st i ( ZIP I �� LOCALITY �• / Date Applicant V NO.OF BLDGS. NEAREST J CERTIFICATE OF EXEMPTION FROM WORKERS' } NOW ON LOT CROSS ST. A hfa rv-.. COMPENSATION INSURANCEASSESSORr �(This section need not be completed if the permit is for one BLOCK LOT NO. MAPBOOK PAG�C� PARCEl�hundred dollars ($100)or less.) TEL.ICI r P,f ` 1� NO. _ USE ZONE MAP I certify that in the performance of the work for which this NO. a SPECIAL apermit is issued, I shall not employ any person in any manner ZG -R jv. / A7 0 /) /7'1/� CONDITIONS O so as to become subject to the Workers'Compensation Laws. V CI� Ga/7f ZIP 9 f /7�P-o Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE I'— Exemption, you should become subject to the Workers U Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. STATISTICAL CLASSIFICATION - APT. CONDO. Z — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS' 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT NO. OF NO.OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW IDU Contractor Dafe - . ADD ❑ , ❑I am exempt under Sec. ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT �EL• FINAL OWNER-BUILDER DECLARATION (PRINT)J ,tj 100. 3 I hereby affirm that I am exempt from the Contractor's License DATE (rl Law for the following reason (Section 7031.5, Business and, ADDRESS FINAL 23 Professions Code): PRESENT By BUILDING °s I, as owner of the property, or my employees with' ADDRESS �GZ ��'� "n � ' ACOT wages as their sole compensation,will do the work and , �(� ��°r"tfJ the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. 1 ❑ 1,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.) ADDRESS g CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAL SETBACK LINEFROM ' EXIST. 16°0 I hereby affirm that there is a construction lending agency for FRONT 2 ITEMS the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE TOTAL 176 o 55 P.L. Lender's NameCHECK176.55 3 Vr� Lender's Address P.C. Fee$ ��_�`� Permit Fee CJLDMA Ref. #1 CHANGE .00 I certify that I have read this application and state that the Issuance Fee L-1; �v LDMA P/C# above information is correct.I agree to comply with all County Investigation Fee n ordinances and State laws relating to building construction, Total Fee a 0� LDMA Perm. # 0000-0001 6/24/96 = and hereby authorize representatives of this County to enter ° up the above-me ' ned p operty f inspection purposes, ii p� 7051 1 AN v'-28 �_1 {� �/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ` APPLICATION FOI ,,BUILDING PERMIT COUNTY OF LOS ANGELES q BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS + BUILDING DDRESS I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a Certified Y CIT �G , ZIP LOCALITY copy thereof(Sec.3800,Lab.C.) / A , Policy No. Company Zh SIZE OF LGT NO.OF BLDG&NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ❑ Certified copy is filed with the county building inspection TRACT6. BLOCK LOT NO. department. g USE ZONE MAP NO. Date Applicant ASSESSOR MAP BQO PAW p/ PAR EL,�i/ CU !v /T/L7// SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNEs�' TEL NO. COMPENSATION INSURANCE U✓r WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) d � � DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY CITY ZIP C! I certify that in the performance of the work for which this permit 1 IS issued, I shall not employ any person in any manner 30 as t0 ARCHITECT ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSfFICATION APT CONDO Date Applicant ADDRESS CLASS NO. �� DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CO �; TELNO. J�}l SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith L/ //r !�S %f/L(/r'L. d — (J F/ FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS / LIC.NO. ,/ P L, LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.C S � PL I hereby affirm that I am licensed underprovisions of Chapter 9 dSEWER MAP (commencing with Section 7000)of Division 3 of.the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG , (- 0., License Number Lic.Class DESCRI ON F WOK �, ADD ❑ VALUATION c $ � Contractor Date r dy �'U� ALTERG�' U ElI am exempt under Sec. REPAIR 11 $ B.BP.C.for this reason DEMO- ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ IL ACCT. Z Signature APPLICANT(PPoNT) TEL NO. LDMA Perm# 7i• Z ❑ I, as owner of the property, or my employees with wages as 0 3303 -107.10 their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE G 1 stNCZ Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIALff7/d / � J —a OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE TOTAL hL 10 �* m 10 El 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES 1:1 NO[I CHECK 107.10 07n10 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING r OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE .00 CONSTRUCTION LENDING AGENCY COAST AIR OLAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ ��{} {�� y(�({ / {}/p a the performance Of the Work for which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING Li000-0001 •1/ 8/7 5 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20 SECTIONS 2 20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS (�41.3J ' °c i Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. L e 57 o Lender's Address OWNER OR AGENT 0 c I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE CM with all county ordinances and State laws relating to building I g constructs rertid7hereby uthorize representatives of this County I ISSUANCE FEE `rs co toe upon abo enti rty for inspection pururposw. C , m s j��p /.� INVESTIGATION FEE TOTAL FEE le �q / 8p�,�lu App+rsM«Agm Dap (1 1 SEE REVERSE FOR EXPLANATORY LANGUAGE