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Home My Public Portal About5500 PERSIMMON AVE_Building__ 3 4/7APPLICATION FOR BUILDING E64AIT . UNTY OF LOS ANGELES ASSESSOR ENT OF COUNTY ENGINEER MAP BOOK PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS11-11 JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING. LOCALITY v FOR APPLICANT TO FILL IN NEAREST Print or tvoe onl CROSS ST. i 0�- BUILDING}}�� c DISTRICTrI . GRO P CONST`TYPE — O 9SSED BY ADDRESS b-5 DU C'rX lvy1` f\o �.c -o 447,;f,0t-- STATISTICAL CLASSIFICATION SEWER MAP LOT NO. �. BLOCK CLASS NO.-f'_-7—DWELL.UNITS BK4 PG TRACT f0 USE ZONEMAP NO OF BLDGS. NO. SIZE OF LOT I X %a 0 NOW ON LOT SPECIAL USE OF [CONDI TIONS -EXISTING A,BLDG. L. OWNER tlV n.' qr F.r G cB•p.r TOj"G`00 0 BLDG.SETBACK FROM ��f�v��`� ADDRESS Ct) VMS �M0 �� FRONT PROP.LINE OF (STREET) (� TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CIT�'� Q_ UI'} HIGHWAY WIDTH FROM C.L. ARCHITECT OR d�� TEL. i�` �,� + &2 _ID ENGINEER NO. f _ ADDRESS 5 DEGPROP.LIC NEFROM M / •- • � ��'L� �(STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CONTRACTOR � NO. HIGHWAY WIDTH. FROM C.L. 4 ADDRESS NO. + �+G = {' C f LIC. CITY CLASS 'CORNER CUTOFF-, YES [INO' CC CONSTRUCTION LENDER F, NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS c ADDRESS v `� I i pz SQ. FT NO. OF . NEW SIZE ,A. ))STORIES FNAOMILIESOF USE OF ADD ❑ STRUCTURE G mrOL e ALTER ❑ i �L �� 1 REPAIR ,fir— ' SIGNATOR O n Chis L (aiIIJA APPLICANT \ S — �1\1U,lti. DEMOL ❑ , r.J VALUATION Syt yty� / �j APPROVALS TE I ECTOR'S SIGNATURIJ P.CFEE S FEES 2I• ♦ �3 FOUNDATION: MATERIALS ION 2- FRAME: FIRE STOPS, *7 91, y 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS IC- /6J �"/ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF •CALIFORN A IN RELATING TO WORKMEN'S.COMPENSATION INSURANCE. , .f i r 67 SIGNATURE O (�� Q LATH, EXT. 7-4;+-7-•l �•��y� ,•.,p�.y� PERMITTEE •W `�lS-��u/�' HOUSE NUMBER COR- �.+ I. RECT AND POSTED ADDRESS J d 6 W-0,414.-Am� QL% •\o FINAL v/t -'�� j a�2,n�s✓ JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH u,; 83Q n MY 16 D 2 1 5N N 1 :7 -i-+>,ASI o g-v 6:r—it-ice•i-r i--i r - FOR APPLICANT TO FILL IN (Print or type only). BUILDING - •�;v.COUNTY OF LOS ANGELES ADDRESS V) E' rk'r + �'t+++��l c.ll DEPARTMENT OF COUNTY ENGINEER CITY' ,, �, v L,. 'ZIP �' t c- 140. � BUILDING AND Y DIVISION 1 I �}Lt4 b O.OF B OT ADDRBUILDNG��e ` 512E OF LOT• � NOW ON LOT ADDRESS TRACT ! ;%> Ta BLLOCK LOT NO. LOCALITY TELL !j NEAREST. OWNER L�..~+�'a.4 rV t�P1tu1N0. j'.tl _" n^, CROSS ST. JJ�.- ASSESSOR ADDRESS ` C C 3\•1+• m C I MAP BOOK PAGE PARCEL i (� (} DISTRICT GROUP TYPE FIRE "PROC ED Bx CITY , t+•+ 7` �' �+ •t�• ZIP "r ( tel C} CONST ZO.N�E \ '' ARCHITECT OR "- TEL. ✓. ENGINEER NO. STATISTICAL CLASSIFICATION MA // S WER P" ADDRESS CLASS NO."�LDWELL.UNITS BK G TEL. E ONE MAP CONTRACTOR - N NO, �+v LIC. - ( ADDRESS LIC. SPECIAL CITY LICCON DI TI ONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM p FRONT PROP.LINE OF (STREET) C� _ ADDRESS CITY WAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING w SO. FT. NO. OF NO. OF CHECK HIG FRONT PROP, LINE HIGHWAY WIDTH F SIZE STORIES FAMILIES ONE \ + + _ DSCRIPTION OF WORK (,1t�••i�. ��r„-d z_NEW ❑ a- W E BLDG.SETBACK FROM 1 DD ❑ SIDE PROP.LINE OF (STREET) LTER ❑ HIGHWAY +• YARD TOTAL SETBACK FRO TYPE OF EXISTING f�n R-PAIR❑ SIDE PROP. LINE GHWAY WIDTH 'USE,OF C EXISTING BLDG, ,\ \, t` �� DEM' ❑ + APPLICAN C., L CORNER CUTOFF YES ❑ NO ❑ � �..--- (PRI NTI , ` 11 Y t\��'•l C�^ BY (SIGNATURE) - READ CAREFULLY •� , L1 THIS APPLICATION IS A BUILDING P;RMIT WHEW PROPERLY FILLED VALUATION OUT, SIGNED, AND MACHINE VALIDATED FOR THE CORRECT PERMIT FEE IN THE VALIDATION SPACE BELOW. PERMISSION IS THEREFORE • 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GRANTED TO DO SUCH WORK AS INDICATED IN THIS APPLICATION, _. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IN ACCORDANCE WITH, AND SUBJECT TO, ALL OF THE PROVISIONS WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GF THE BUILDING CODE, ORDINANCE •-2225 OF THE COUNTY OF STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED LOS ANGELES. AND RELATED LAWS. HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF TME LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO THIS PERMIT BECOMES NULL AND VOID IF WORK 15 NOT COMMENC- WORKMEN'S COMPE SATION INSURANCE. ED WITHIN 120 DAYS FROM THE DATE OF ISSUANCE OR IF WORK IS C / SUSPENDED AT ANY TIME DURING CONSTRUCTION FOR MORE TKAN SIGNATURE OF 120 DAYS, OR IF ANY WORK 15 DONE ON THE SAID BUILDING OR PERMITTEE 1�'�`��” '' t '1{� STRUCTURE IN VIOLATION OF ANY COUNTY ORDINANCE OR STATE .} J 2 �) ` ,.. t.,..J LAW RELATING THERETO. ADDRESS J A ROAD DEPT. PERMIT 15 REQUIRED FOR ANY MATERIAL STORAGE TEL.; OR WORK DONE IN THE ROAD RIGHT OF WAY. CITY , ..�.. .,i i_�r l +. NO. -4 i:11i1. P.C. $ �' /�� FEE PMT. �' MAKE (:/!f_'[:tiS P:1} L 70: FEE ®� HARVEY T. BRANDT. COUNTY ENGINEER Go�01� Off— GDG G9y� PLAN CHECH VALIDATION CK. M.O. CASH m ll PERMIT VALIDATION CK. M O CASH 90' LO WOYjft Cvm�oG�-�d OCCrJP/ED 3 yfes,�L 6F s �T CoD� • %Yr Timms or G��''ss)'�uc;�o�v 76A638A CEc803 7/73 --Bu-rcU riFOR APPLICANT TO FILL IN (Print or tvDe only) COUNTY OF LOS ANGELES ADDRESS U� A71 5'1lv1vle,1Lj DEPARTMENT OF- COUNTY ENGINEER ZIP 'Y� BUILDING AND TY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS r 'Ave TRACT BLOCK LOT NO LOCALITY ✓C� FtirL+'�T�i f _ TEL NEAREST ' OWNER 1 NO. E i CROSS ST. _ ASSESSOR ADDRESS S MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P OLESS-0 BY ZIP sJ-�d CONSTi,r ZONE ��+// % AR HITECT OR TEL. 7^ / ENGINEER NO. STATISTICAL CLASSIFICATION V* SEWER MAP ADDRESS CLASS N '# DWELL,L�JMI BK 6 PG TEL. USE ZONE MAP `._ '� y CONTRACTOR NO NO ADDRESS NO. w 1 SPECIA`L"_ �9 LIC. CONDITIONS CITY CLASS ROAD DEPART ENT APPROVAL REQUIRED'y,YES❑ NOD CONSTRUCTION LENDER p} NAME AND BRANCH BLDG.SEiTBACK FROM at ` � O FRONT P OPIN20F -;a ISF2FT! ^ODRESS CITY _ TOTAL SETBACK FROM TYPE OF 1EXISTING LLJ NO. OF NO. OF CHECK HIGHWAY t YARD - !+J FT. FRONT P OP., NE HIGHWAY WIDTH S = 1j STORIES FAMILIES ONE LLJ t �( C 'CRIPTION OF WORK NEW ❑ 1 •�} BLDG,SETBACK FROM d ADD (SIDE PROP.LINE OF ISTREE 17' /��_- LTER ❑ .HIGHWAY t YARD TOTALSETBACK FROM TYPE E)�11NG - REPAIR SIDE PROP. LINE HIGHWA N OTH \, USE OF tp a DEMOL El CORNER EXISTING BLDG, f�7 APPLICANT /� ALA" TELA (// ' � CORNER CUTOFF YES ❑ NO ❑ (PRINT) JN0. _I y b f BY ISIGNA ,RElrj Jq READ CAREFULLY THIS APPLICATION 15 A BUILDING PERMIT WHEN PROPERLY FILLED VALUATION rC�u OUT, SIGNED, AND MACHINE VALIDATED FOR THE CORRECT PERMIT FEE IN THE VALIDATION SPACE BELOW. PERMISSION IS THEREFORE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GRANTED TO DO SUCH WORK AS INDICATED IN THIS APPLICATION, AND STATE THAT THE ABOVE IS CORRECT AND'AGREE TO COMPLY IN ACCORDANCE WITH, AND SUBJECT TO ALL OF THE PROVISIONS WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- OF THE BUILDING CODE, ORDINANCE --2225 OF THE COUNTY OF STRUCTION. I 'CERTIFY THAT IN DOING THE WORK AUTHORIKED LOS ANGELES. AND RELATED LAWS. HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENC- LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO ED WITHIN 120 DAYS FROM THE DATE OF ISSUANCE OR IF WORK IS WORKMEN'S COMPENSATION INSURANCE. SUSPENDED AT ANY TIME DURING CONSTRUCTION FOR MORE THAN SIGNATURE C�F;!�'/�r 120 DAYS. OR IF ANY WORK 15 DONE ON THE SAID BUILDING OR i PERMITTEE STRUCTURE IN VIOLATION OF ANY COUNTY ORDINANCE OR STATE 3 ADDRESS �, ` .a) — LAW RELATING THERETO. I A ROAD DEPT. PERMIT IS REQUIRED FOR ANY MATERIAL STORAGE TELt Y�/ OR WORK DONE IN THE ROAD RIGHT OF WAY. CITY L NO.y �iG D i� ' MAKE CllE(:KS41A}•ARl.G TO: FEE $ SCS � �� FEE HARVEY T. BRANDT. COUNTY ENGINEER �� L,�j. �� . 1 PLAN CHEC$ VALIDATION CK. M.O. CASH o v_/PERMIT VALIDATION CK. M 0. CASH ��'t1j Lost/ lvo�/•� Ga�r.�G�T�d b 04� 3 �a7 0E m°t1'T T/f Ill 7bB 0-,—,-r/ 6A C e803 7/73 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS D ZG +C or a certificate of Workers'Compensation Insurance,or a certified CIN ZIP copy thereof(Sec.3800,Lab.C.) � Jf _Q— LOCALITY1=1 Policy No.� �S- Company Vl3f SIZE OF LO NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. ' NEAREST—CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. A//� Datel-Z-eLl' Applicant t1,t1 AA.LtO,w-y ASSESSOR MAP BOOK RAGE PARCEL SPECIAL CONDITIONS /f/p, CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. C�• COMPENSATION INSURANCE L-1Ltq&— gyp'' WITHIN 1000 FT.OF SCHOOL? YESNO (This section need not be completed if the permit is for one hundred ADDRESS p DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that CITY ZIP the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to ARCHITECT R ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSSIFI/CATION 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' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith as.� ,f 03-p�2 FROM. comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION 3 7 -k �Z 6LtSo-03� SIDE CI LIC CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 C_3 EWER 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 }d License Number naS Lic.Class C-31 DESCRIPTION OF WORK ' DD ❑ VALUATION � O Contracto' Date �'^Z"+�S ALTER ❑ $ ❑ I am exempt under Sec. keaoREPAIR ❑ $ BAP.C.for this reason DEMOL ❑ _ V LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ ACCT Jr', a. Signature APPLICANT(PRINT) TEL NO. LDMA Perm# 3303 172.65 co ❑ I, as owner of the property, or my employees with wages as , a T& 07-IDS'Z Z 1 T Ej+kiJ their sole compensation, will dothe,work and the structure is ADDRESS O not intended or offered for's-aN_(Section 7044, Business and �. FINAL DATE a TIS Al 172 - 65 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL172.65 'Z ►•! c OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J CHEC•I�a s{2 e O ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIrrr��ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q licensed contractors to construct the project (Section 7044, FINAL BY > r 3_E a � Business and Professions Code.) YES 13 NO CHANGE WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COIDE NES.QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR c 111 hereby affirm that there is a construction lending agency for YES No GQCIO-Q001 C4 the performance Of the work for which this permit Is Issued(Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 0238 1 A" 8:31 Z3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. TITLE 2.CHAPTER 2 20 SPVTIONS 2 20 100 THROUGH 2 20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPO G FOR OBTAINING A PERMIT FROM THE SCAOMD oLender's Address IOMMRVKAs�EM 1 0 o 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 N with all county ordinances and State laws relating to building 5 ro construction, and hereby authorize representatives of this County ISSUANCE FEE !� / V) to enter upon t e,ab -mentioned property for inspection purposes. p{/p CD 1 ( i11 U 3-'-Z--Ts— INVESTIGATION FEE TOTAL FEE S0.0—d AW.-taAgM Wo I SEE REVERSE FOR EXPLANATORY LANGUAGE �IVORKERS'COMPENSATION DECLARATION / r hereby affirm that I have certificate of consent to Selz "APPLICATION FOR U I L D I N G P E RM I T insurc' or a certificate of Workers'Compensation Insurance, C• or a certified copy thereof(Sec. 3800, Lab. C.) e, COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDINGQ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING I �.� tion department. ADDRESS Q 0/v LOCALITY NEAREST Date Applicant CITY ZIP ��v 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 one USE ZONE MAP + 3 hundred dollars ($100)or less.) TRACE / BLOCK LOT NO. L 2 NO. !" SPECIAL I certify that in the performance of the work for which this OWNER kle, ,W r A/,4 �DNO.� 6 � �� CONDITIONS IL permit is issued, I shall not employ an arson in an manner DISTRICT GROUP TYPE FIRE PRO SSED BY V P p Y Y p y ADDRESS l/r'/l�li�� CONST. ZONE so as to become subject to the Workers'Compensation Laws. 09 Y-,D-tTe Applicant CITY l ZIP STATISTICAL CLAS FICATION APT. ICONDO — No . IARC ITECT OR TEL. U ICE TO APPLICANT: If, after making is Certificate of �- ENGINEER NO. CLASS NO. UNITS W Exemption, you should become subje to the Workers' CLI Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. BK.6T—PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. 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. p Professions Code,and my license is in full force and effect. CITY CLASS $ -17a6 SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE NEW $ Contractor Date DESCRIPTION OF WOyR�K. ADD I am exempt under Sec. / ( // IG ALTER FINAL B.BP.C. for this reason REPAIR DATE USE OF FINAL Date: EXISTING BLDG. DEMOL By Signature APPLICANTTEL. OWNER-BUILDER DECLARATION PRINT 1V14A)NO. JIVIAS14� I hereby affirm that I am exempt from the Contractor's License ADDRESS o/� //� i ® _ G/f Law for the following reason (Section 7031.5, Business and O f� �- J! c./c J (Ct �-( Professions Code): IPRESENT / Q� \ I, as owner of the property, or my employees with ADDRESS (:" (� �,5 A wages as their sole compensation,will do the work and the structure is not intended or.offered for sale(Section LOCALITY 1"0'0'0'0 0 7044, Business and Professions Code). MOVING TEL. 11 I,as owner of the property, am exclusively contracting CONTRACTOR NO. 2 0 0 2 8 O 0 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). o '0'0 2 F+ U G� REQUIRED TOTAL SETBAC PROP. LINE WIDTH K FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY • I hereby affirm that there is a construction lending agency for FRONT N11111. 1. 1 6-82—82 the performance of the work for which this permit is issued P.L. tSec. 3097, Civ. C.). SIDE l ii P.L. Lender's Name v ; a P.C.Fee$ Permit Fee i Lender's Address I certify that I have read this application and state that the Issuance Fee 's-0 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 upon the above-mentioned property for inspection purposes. �' U✓ it.f/Lr•`� /��`�� SEE REVERSE FOR EXPLANATORY LANGUAGE ' �\ Signa re of A scant or Agent Date i 03