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HomeMy Public PortalAbout5188 PERSIMMON AVE_Building__ DEPARTbUM OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY BUMBUNS COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER' APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE,USE ONLY BUILDING ' DISTRICT NO. PLAN CK.oR REo.T PERMIT NO. ADDRESS � ". 1 LOCALITY :� ��/ �. R CEIVED BAYq, DATE OF APPL. DATE ISSUED NEAREST ! ' CROSS ST BUILDING OWNER ADDRESSMAIL ADDRESS' /7 ~ �� Lv,� LOCALITY NEAREST' 4 CITYX11 :° .l"1 d^ C:/ TO ;HJT CROSS ST. �y / . ARCHITECT 012 TEL. l FIRE I PLANS L! ZONE PNO. OF LI TYPE I GROUT ENGINEER NO. ,ADDRESS BLDG. Q O�tD. NO. y� r SETBACK LINE SL y CONTRACTOR �- f� �!bJ U- , NO.' / �u.�`!a + USE AA APPROVED ZONE!y-� BY' DATE HOUSE NUMBERING ` ADDRESS LEGAL 744, /� MAP NUMBER O S NO. ASSIGNED BY DESCRIPTION I LOT NO, f 4 I BLOCK CORRECTIONS. TRACT SIZE OF LOT �I .a^I NO.;OF BLDGB. h� I IFS r `.NOW ON'LOT V USE OF NO. OF r"' - EXISTING BLDG. FAMILIES DESCRIPTION OF:-WORK ' o Z NEW ALTERATIONADDITION REPAIR I. DEMOLITION H Y r Q. FT. C' NO. OF SIZE ROOMS STORIES O fl EXT.WALL ROOF, COVERING. Ail cl 6• I COVERING USE OF STRUCTURE APPROVALS INSPECTOR'S SIGNATURE DATE r FOUNDATION:LOCATION FORMS, MATERIALS /J 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS ° BRACING, BOLTS A ofo/ CORRECT. ' FURNACE:LOCATION 1 AGREE TO COMPLY WITH ALL COUNTY'ORDINANCES , i AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS Apo SIGNATRE OF t LATH, INT. U PERM17TE �� `%�/ 00V H. EXT. ADDRESS r / ._.� w �L•hl 6'/C PLASTER, INT. { AUTHORIZED AGI. $ 7 , P. C. S PLASTER. EXT: / HOUSE NUMBER COR- ��-7 D p Q C FEE l!' RECT AND POSTED 1 VALUATION FINALi TeseseA Dag 2 9-82-. (al y I 7614638A,.CE1t11033-69 APPLICATION FOR BUILDING PERMIT �I COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL,IN DISTTRICT/�NO�—I/ GRO TYPE C T. RO• S (PRINT OR TYPE ONLY) `/ a lJ O �i_eA,Z BUILDING q� STATISTICAL CL (CATION SEWER MSP ADDRESS l /M O f��j�is� O —�Jj CLASS N0. DWELL.UNITS BK PG„� LOT NO. BLOCK USE ZONE MAP NO. TRACT7 ,'�' SPECIAL NO. OF BLDGS. , rB � CONDITIONS SIZE OF LOT - NOW ON LOT a USE OF EXISTING BLDG. BACK FROM NOL 3�J�J P. LINE OF (STREET) OWNERtJ(�f�Q TYPE OF'EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS F ./ HIGHWAY WIDTH FROM G.L. j A/ + CITY (�j- ARCHITECT OR TEL. SIiBLDES TBACK FROM (STREET) ENGINEER N0. SIDE PROP. LINE OF TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + _ > CONTRACTOR NO. p LICADDRESS N0.• CORNER CUTOFF YES ❑ NO ❑ l LIC. o, CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS C CONSTRUCTION LENDER w, ' ° 5 ° ;i F- NAME AND BRANCH y�� a '� J _ �" u • a ADDRESS F > v Z SQ. FT. NO. OF NO. OF SIZE O STORIES FAMILIES ` NEW �� yLic USE OF _ - STRUCTURE �� 9^'�� ADD ALTER ❑ S O . REPAIR SIGNATURE OF DEMOL ❑ J.Pr r ///O�Lvs2fG4 c .Llii� .n�!c APPLICANT I ✓ ' r rs /h(l Rr�r� �Ca i its 3s ze... , VALUATION$ 99 APPROVALS �yDATE (/j INSP OR'S s G TORE FEE S yF MT FEE $ �a FO TIFOR MSOMATERIA SN v / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDINBRACING BOLTS G CONSTRUC- GAS VENT DUCTS TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I p� y WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. .,r• 'J(7 i/,/J/.L,�-yJ OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-_ , PENSATION INSU E. LATH, EXT. SIGNATURE OF PERMITTE HOUSE NUMBER CORRECT AND POSTED ADDRESS FINAL l� JOHN F. LEWIS, PRINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION cK. M.o. CASH — PERMIT VALIDATION CK. M.O. CASH IAA' 2 0 5 3FaN SE'34 2 3 D 2 2.95' !Ar--2 2 0 2"p�r14 1 D 3 8.2514 a -, 4- I APPLICATION ®R BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS �f BUILDI D RE.SS I hereby affirm that I have a certificate of consent to self insure, S B Ll L4 � S i p►'1 purl !l3 or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,L? C.) a +CI�T-Y� ZIP— Policy q a -7 ©® LOCALITY POIICy No. �`j Company SMVI F 1UAO SIZEF LOT NO.OF B'•L`•D��G3.NOWONLOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST rtified copy is filed with the county building inspection TROT BLOCK LOT NO. USE ZONE MAP NO. department Data ted- Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER PLM 4C,7<,- ��a SB YES NO COMPENSATION INSURANCE WITHIN 100D FT.OF SCHOOL? ADDRESS (This section need not be completed If the permit is for one hundredS a S 1 0 DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) I I certify that in the performance of the work for which this permit CITY t � z� �� C) is Issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER TEL NO. become subject to the Workers!Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.�' , DWELL UNITSI ____t NOTICE TO APPLICANT.• If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR .. TEL NO. Pe P ) you must forthwith PT LA wi ce o 6 .Z SV--pO 1 SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, comply with such provisions or this permit shall be deemed revoked. ADDRESS _ AK_ FRONT '.NO. yPL 6 1 R2 Nd-. U APL jAL L436—338 SIDE y. LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L CD thereby affirm that 1 am licensed under provisions of Chapter 9 Tef ift C l EWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OFSTOREB NO.OF FAMILIES Professions Code,and m license is in full force an NEW BK PG / Ita I- License Number 7 SdF3�� LiC.Clear ESCRIPTION OF WORK rZ0Fl A)4 DE Til O♦:w fK<. ADD ❑ VALUATION Contractor �l�G>r�orsl Date /O-/f- �.3 � E d $ _ !-5 '10' wirm .2.wtt Ajjry �/8� q�TER I am exempt under Sec. ❑ 61 • UNA d� REPAIR El❑ - B.BP.C.for this reason DEMOL ❑ LDMA PIC p 3 Date' /d~ ^/J USE OF EXISTING BLDG. URM ❑ Signature .�--- ;c-+ APP NT(PRINT) TEL NO. LDMA Perm p � ;,.t-�,�;! ulJ�� ❑ I, as owner of the property, or my employees with wages as . d'S 0�� their sole compensation,will do the work and the structure is ADD ESS �, rr /��7/� 1 i S Ef IL• not intended or offered for sale (Section 7044, Business and �•,b�/ � /.epi C=r/,'7� FINAL DATE 3 5 Professions Code.) ® TANAL Fi� `-` -K WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL i j'{, I`•� , ❑ I, as owner Of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ;2�� 1' L*r\ Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the proJect.(Sectton 7044, YES❑ No❑ GE o1 j_, Business and Professions Code.) , WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST S } FOR GUIDELINES. Il,•,(�I "l,ll}Ij s 1 ( I hereby affirm that there is a construction lending agency for YEs❑ NO 11 (f V. the performance of the work for which this permit is issued(Sec. / 3097,CIV.C.). I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 2 ; AM 1010 _ .F-_i PERMITTING CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLE Z CHAPTER 220 SECTIONS 220.100THR000H 220.140 CONCERNING Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lenders Address ERORAGEW o I certify that I have read this application and state that the above P.C.FEE PERMIT FEE Information is correct. I agree to comply with all county /a `7 D ordinances and State laws relating to building construction,and /. hereb rite preaentatives of this County to enter upon ISSUANCE FEE t me Pfil d pro -y for inspection purposes. !o T E L �Gz/��'� INVESTIGATION FEE TOTAL FEE Ilam aApwM Colo � SEE REVERSE FOR EXPLANATORY LANGUAGE