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Home My Public Portal About5344 PERSIMMON AVE_Building__ /6A638A CE 0803 3-69 I -� APPLICATION FOR tSUILDING -PORMIT COUNTY OF LOS ANGELES IBUILDIs DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY . JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST . FOR APPLICANT TO FILL IN °IST�T�NO,,� GRTQ TYPE T. P o (PRINT OR TYPE ONLY) �f (J d" rJ,y_ BUILDINGSTATISTICAL C SSIFICATION SEWER MAP ADDRESS 5344 No. Persimmon T.C. CLASS NO.CLASS NO. BK PG LOT NO. OC. BLOCK USE ZONE MAP NO. �J TRACT 3 i j SPECIAL NO. OF BLDGS. I CONDTIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM TEL. kRONT PROP. LINE OF (STREET) OWNER Gene G. Hetzel NO. 442-63 YPEOF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY 'WIDTH FROM C.L. CITY Tem le Cit Calif. + ARCHITECT OR TEL. BLOG.SETBA ROM (STREET) ENGINEER NO. SIDE PROP. LINE TYPE OF EXISTING SET HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. I CONTRACTOR H, L , RAndolN0. - ADDRESSNO.. _ CORNER CUTOFF YES ❑ NO c CITY San Gabriel Cal CLA'Ssl86086 SEE REVERSE SIDE FOR SPECIAL APPROVALS CONSTRUCTION LENDER c NAME AND BRANCH c ADDRESS SQ. FT. NO. OF NO. OF ❑ SIZE STORIES FAMILIES NEW USE OF ADD ❑ STRUCTURE ❑ ALTER REPAIR SIGNATURE OF DEMOL ❑ APPLICANT VALUATION$ 600,Q0 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT N: LOCATION FEE $ FEE $ 9 � 00 FOUNDATI FORMSOMATERIALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME• FIRE STOPS, BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY E SON L ION OF THE LABOR CODE LATH, INT. OF THE STATE OF CA 0 NI EL I T WORKMEN'S COM- PENSATION INSUR SIGNATURE F LATH, EXT. PERMITTEE HOUSE NUMBER CORRECT AND POSTED ADDRESS 529 E Valley Blvd ,,_, San Gab FINAL ( B JOHN F. LEWIS, PRINCIPAL ST UC-TURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CR. M.O. CASH !Ar,- 4 6-5,89 MAY 11 1 D 9.0 ON a t f WORKERS'COMPENSATION DECLARATION W1 hereby affirm that A have a certificate of consent to self APPLICATION- FOR "WILDING PERMIT insure, or a ertificate'of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY-OF LOS ANGELES I BUILDING SAFETY Policy No. V-6-1671- mpany S�}17-GZ• �✓� BUILDING ((mal Certified copy is hereby furnished. FOR APPL T TO FILL-IN ADDRESS S-3 Certified copy is filed with the county building inspec- BUILDING ' ` tion department. ADDRESS3 LOCALITY NEAREST Date Applicant CITY ZIP / 7 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 one7 USE NE MAP hundred dollars($100)or less.) TRACT/3,/,/--? BLOCK LOT NO pc NO. - 1-1 -2--77 TEL. / / SPECIAL y. I certify that in the performance of the work for which this L� NO. - CONDITIONS CL DISTRICT I GROUP TYPE FIREZOSED BY O permit is issued, I shall not employ any person in any manner ADDRESS ^/ I✓ CONST. ZONE V so as to become subject to the Workers/'Compensation Laws. p917,90 ^�� n/� �,� - 0 Date /O Applicant,r OX FAI �1�.212� CITY G(� ZIP 7 Q STATISTICAL CLASSIFICATION APT. CONDO. a ARCHITECiVR TELT/1f NOTICE TO APPLICANT: If, after making this Certificate ofM!s _ 4: Exemption, you should become subject to the Workers' CLASS NO.- DWELL.UNITS LJ Compensation provisions of the Labor Code, you must forth- ADDRESS C' ,eSEWER MAP U) with comply with such provisions or this permit shall be j/�/ rr p TEL.'7�5� '��p, / Z deemed revoked. CDNT�G1'OIP'g57 GC/STOMP+9T/OSNO.S -�7 BK. �. �v VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 7 $ LL & NO. M VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY V144,v�_IL CLASS B $ SQ.FT. NO.OF NO.OF CHECK , License Number �3 07 Lic.Class_ SIZE STORIES FAMILIES , ONE � V 435r c 45�7'6C/%Td AV f0 DESCRIPTION OF WORK t 71&,Z NEW ❑ $ Date I am exempt under Sec. ADD ALTER ❑ FINAL B.BP.C. for this reason REPAIR ❑` DATEeq DO DEMOL USE OF ❑ F ' 7�0 ��/f EXISTING BLDG. S_ienature` r .b � APPLICANT TEL.7/ �OWN9 -BUILDE E RATIO PRINT No. I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PR ENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. 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). 2 5 9 0.'� A REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HW? PROP. LINE WIDTH ® # 0 0 0 0 0 I hereby affirm that there is a construction lending agency for FRONT I o L 1 b 3 the performance of the work for which this permit is issued P.L. Sec. 3097, Civ. C.). SIDE i 18,9 6 F P.L. �i Lender's Name P.C.Fee$ Permit Fee r 3 Lender's Address rI certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with,all County Investigation Fee ordinances and State laws relating to building construction, Total Fee .and hereby authorize representatives of this County to enter up oMlgn.t.rve -me ned�Ag.Wn party for i action purposes. ,. 8 �� fp SEE REVERSE FOR EXPLANATORY LANGUAGE 4�F� nor Dae ®s