HomeMy Public PortalAbout5350 PERSIMMON AVE_Building__ E! IiaMPLia:CA,
I6Ae70A CC#8011-1-61. ,APPLICATION •FOIA B�JILd®IN� P1ERti IT ,
COUNTY OF LOS ANGELES BUILDING
DEPARTIVlENT OF'COUNTY ENGINEER . • ,[NEAREST
ADDRESS
BUILDING-AND-SAFETY 'DIVISION LOCALITY '
JOHN A. LAMBIE. COUNTY ENGINEER
.WILLIAM A.JENSEN ,SUP`T OF BUILDING CROSS ST.
FOR APPLICANT TOM IN DISTRJCT O. OUP ypE , P ;SED BY
/ (J ' CONST'
2.9
BUILDINGSTATISTICAL CLASSIFICATION I BE ER MAP
-ADDRESS J S O A ) NO. K G
CLASS. �� DWELL.UNITS :E
i LOT NO. 5 BLOCK WATER
r. NOT'REQUIRED ® RECEIVED
•
CERTIFICATE: ._
TRACT q MAP HIGHWAY STATE MAJOR SECOND, CAL ,
L L NO. �� (CIRCLE)
E•OF LOT'. ' i NOW ON LOT USE ZONE I SPECIAL
$E OF ;i CONDITIONS %
EXISTING BLDG:
TEL. � ;•
OWNER O BUILDING 'YARD HWY STREET NAME EXIST. '
• SETBACK WIDTH'
_
ADDRESS—SA-,t--1
FRONT E}B)
n. ARCHITECT OR'•. TEL. P.L. o�L
i,
,ENGINEER, �?•. .1j SIDE
ADDRESS :vl.S'O
" IA-d' ';` ; .^IlY$PECTION RECORD • �. � p
CONTRACTOR $. .�Q DO O. / r
NEL. .�� ..?s i'.I - J �i i.;f�• ,✓r 1 V'
ADDRESS i:Z U•. P%%�L. ) �''.'4 i ij} �.%'.% I ra i ''_f ._:�.•
DESCRIPTION OF WORg,
NEW Z_*"ADD ALTE& 'f• REPAIR DEMOLISH /, rtf A f f' / •' Z
SQ.FT -.No.O NO.OF !:I ati}.�.• 1 r�/.jn.':l�E• i ).i 7'r.'<r� +A. •-J':•�
IZE §TORI Sp FAMILIESUSE OF
' 1 ' fr
STRUCTURE ZCJ oa L .ilk �1✓C�!%?{ 'ti '.aii'fr 9 f
S,de .
00
SIGNATURE OF ?
APPLICANT
VALUATIONmm1 '
( APPROVALS 'DATE / INSPECTOR'S SIGNATURE
FOUNDATION:LOCATION 10 i
P.C. PMT. FORMS,MATERIALS -7/bf
FEE $ FEE $
FRAME:FIRE STOPS, y f
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 I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT.
TION OF THE LABOR CODE OF THE STATE OF CALIF IA RELAT= ,
ING TO WORKMEN'S COMPENS
LATH,-EXT.
SIGNATURE OF 0
HOUSE NUMBERCOR-
PERMITTEE RECT AND POSTED
ADDRESS--.:. FINAL
CLYDE N. DIRLAM, PRINCIPAL ST C RAL ENGINEER
=PLAN CHECK VALIDATION ON,
.o. . casR PERNd[T VALIDATION :CK
M.O. cAse
Jr 3 8 & 4'120 APR 26- 2 .3 D - 3,75 "
"Lko 3,b 5 5� •'APR �6 1 D 1 5.0 0 M �;
WORKERS'COMPENSATION DECLARATIOI4'
hereby affirm fiat I have a certificate of consent to self APPLICATION FOR BUILDING "PERMIT
insure,or a certificate of Workers'Compenstion Insurance,or
o certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
Pol
ADDRESS
Certified copy is filed with the county building inspec- BUILDING — L / -,
tion department. ADDRESS ' �U /l�C, S/�'���/I/ �i VL LOCALITY
NEAREST
Date Applicant CITY / /�L� C �Tl� ZIP p CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDG . ASSESSOR !-
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for dne 7`� USE ZONE MAP
hundred dollars ($100)or less.) TRACT BLOCK LOT NO. �c NO. J }
TEL. ,�r SPECIAL P
I certify that in the performance of the work for which this OWNS % .�, M1 L` NO. y 3=��oT - CONDITIONS O
permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY (J
ADDRESS l�E� r M �QV6
so as to become subject to the Workers'Compensation Laws. n r7� 3 CONST. ZONE
CITY 7 Y 6 ewz; ZIP 917X �, �• � � I—
Date Applicant STATISTICAL CLASSIFICATION ARCHITECT OR TEL. A ONDO. U
NOTICE TO APPLICANT: If, after making this Certificate of �
ENGINEER NO.
Exemption, you should become subject to the Workers' CLASS NO. t�If DWELL. UNITS 1L
,-Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP
ith comply with such provisions or this permit shall be TEL. l�++
tll m revoked. _ CONTRACTOR NO. BK. `�'—' �a c% VALIDATION
LICENSED CONTRACTORS DECLARATION
LIC. r
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 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 CLASS $
a r SQ. FT,. • NO.OF NO.OF / CHECK
License Number Lic.Class �. SIZE oT�� STORIES FAMILIES / ONE
Contractor Date DESCRIPTION OF WORK DA i7'/Q A/= NEW
�
❑ LW
I am exempt44M from the licensing requirements as I am a T 67 — ODUTA/.STA/2S ADD
licensed architect or a registered professional engineer ? I ALTER FINAL
acting in my professional capacity' (Section 7051, .3 /_f,0 9- 134!fid UOSTA/2S• REPAIR DATE
Business and Professions Code). ° USE OF �:
DEMOL FIN f
1 EXISTING BLDG. B -
Lic.or Reg..No. Date APPLICANT TEL.
OWNER-BUILDER DECLARATION (PRINT) NO.'
I hereby affirm thatl am exempt from the-Contractor's License Itt r s
Law for the following reason (Section 7031.5, Business and l ADDRESS f .3
Professions Code): PRESENT
❑
IBUILDING
, owner of the property, or,my employees with ADDRESS 5 7S . �P Q
wages as their sole compensation,will do the work and 4 5 5�,
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code). MOVING TEL. f /Zi
❑ CONTRACTOR NO. (C 7 J, 0 0 0 0 2
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- kADDRS 2 ° ° 2 G r-I. n
tion 7044, Business and Professions Code). -
IRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY ACK YARD HWY PROP. LINE WIDTH o'n o '� !! (t v
I hereby affirm that there is a construction lending agency for T
the performance of the work for which this permit is issued P.L. 02, 1 0-8 2
.(Sec. 3097,.Civ. C.).
,5E0A
Lender's Name ' � '• a 0 0 0 e$ S73r Q Permit FeeLender's Address I.certify that I have read this application and,state that the Issuance Fee � 2•° 751, 0 G
above information is correct. I agree to comply with all County ation Fee.— i" r
ordinances and State laws relating to building construction, ° 7 1. 0 (;U
Total Fee l
and hereby authorize representatives of.this County to enter
upon the above-mentiohed property for inspection purposes.
' I SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date 1 ®s