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HomeMy Public PortalAbout5537 PERSIMMON AVE_Building__ ' T MPL `. itY itAt,tACr,#aus.I-tl APPLICATION FO . ... BUILOING PERMIT COUNTY OF LOS` ANGELES BUILDING DEPARTMEN'P.OF COUNTY-ENGIIVEER ADDRESS " BUM-DING AND SAFETY DIVISION LOCALITY-- ' JOHN A.'LAMBIE, COUNTY ENQINEER NEAREST ' / ,� gg aq• t�•r� , 'WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. •' 6wr �r Fr R�r7► DIS'RI NO.'" GROUP 1YPS PS B FOR APPLICANT TO.FILL IN C CONST I . ' - BUILDING �1 �A P STATIS lCi4L31FICATION SEWER MAP ADDRESSp• CLASS.NO- DWELL.UNITS V V LOT NO. 6 a , BLOCK -WA ` NOT REQUIRED RECEIVED CERTIFICATE: TRACT �' 'l NO.OF BL GS. NOT;) O . O V (CIRCLE) STATE MAJOR SECOND, OCAL SIZE OF LOT. ;© I NOW ON LOT USE1 ZONE SPECIAL USE OFW CONDITIONS EXISTING B • q�y TNEC.I.IOWO. JETNAMEBUILDING EXS.'T. BACK YARD HWY STREWIDTH ' ADDRESS�+ ' FRONT a ARCHITECT OR TEL' P.,L. / ENGINEER, «- NO. SIDE ADDRESS: ; R'•'. !Z I TEL INSPECTIOOi RECORD. O CONTRACTOR _ /` - Q NO.�s � f::_`�' Ty V ADD-RE'S i Im E Q � 1.CGr'�, 1_' �' "t�, -`?'';• (r'' OG .18SCH TION-OF WORK /i�ir.o1f1:5�i1 j f�+,�^..�. 4�` '.•/: �F�G er .b� ?'LfJ ic/�=/}/ h. .NEW I"'Al - .ALTER • REPAIR DEMOLISH py,°'1�6 ��( ti: ry �✓ 9{�fr• ? SQ.FT. NO.OF NO.-OF IZE STORIES FAMILIES USEOF STRUCTURE d,r bre _. ( II SIGNATURE OF' ! b'��:1:.: APPLICANT 'VALUATION$ � ..pC� f{ . ✓.�. 'J APPROVALS ( D)ATAE' INSPECTOR'SSIGHAAfJURE PMT.PC FEEI FEE $ FO FORMS.MATERIALS LOCATION .V•/U�Gr.�� " ./� FRAME:FIRE STOPS, - 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING,BOLTS (/,`,'}",�4(.�j' ./';,•" • AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, WITH ALL COUNTY ORDINANCES AND-STATE LAWS REGULATING GAS VENT DUCTS F' . BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- (.,ATH,INT•. j 1� TION OF THE LABOR-CODE OF THE STATE OF CALI ORNIA RELAT- INC 70 WORKMEN'S C MPENSATION INSURANCE. - ! . I t LATH,EXT. ' SIGNATURE OF OUSE.NUMBER COR - PERMITTEE a' 4, RECT AND POSTED ADDRESS 4 FINAL- - 00 4. 1. CLYDE N. DIRLAM, PRINCIPAL STR ORAL ENGINEER' PLAN-CHECS VALIDATION Olt. M.G. CASH' PERMIT VALIDATION cK M.O. CASH LsLo:5 7 G JUN5 . ? .D ,�w Ci N _ WORKERS'COMPENSATION DECLARATION sup, y.`affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T �insuFe, or Y7 certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ S Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �� DE.•P Sr.�y Certified copy is filed with the county building inspec- BUILDING r tion department. ADDRESS ? j �/" AJ LOCALITY 'I / NEAREST Date `7'x[ 07 Applicant CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' 2 NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 3 NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one US ONE MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. i NO. * TEL. j // �' I SPECIAL y} I certify that in the performance of the work for which this OWNER i 'i� NO. 6_1/n CONDITIONS LL permit is issued, I shall not employ any person in any manner. ADDRESS 9�3 DISTRIZONE U CT G OUP CONST.TYPE FIRE PROCESSED BY �� /(� / so as to become subject to the Workers'Compensation Laws. (�/ V J ad CITY SIT�[� ZIP ` O Date Applicant STATISTICAL CLASSIFI TION APT. NDO. Ir NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers'' ENGINEER NO. CLASS NO. DWELL. UNITS Qom. Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be ADDRESS /, ��n� /,�j SEWER MAP _ deemed revoked. CONTRACTOR �i�G1V �N0.2"1 5W W1 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. C� I hereby affirm that I am licensed under provisions of Chapter 9. ADDRESS �4r/L,i�/rJ NO.c3609� ( VALUATION (commencing with Section 7000)of Division 3 of the Business and ) LIC. Professions Code, and`myyllicense is in full force and effect. CITY �l�— !J CLASS $ , 36e0(gt Lic.ClassS'_ / 5HECK rzE� JV STORIES FAMILIES CONE LicenseNumber �Q///L - Contractor C ��'�� 'S&� Date � ! DESCRIPTION OF WORK /�(//� � 1 NEW ❑ $ J��a� r_11 am exempt under Sec. � y� -y . ADD / ALTER ❑ FINAL B.&P.C. for this reason REPAIR ❑ DATE 12 7 0 61 A USE OF ,+ "id DEMOL ❑ :2E Date' EXISTING BLDG.6 -// gy # 0 0 0 0 0 Signature / APPLICANT TEL. 16� OWN R-BU ER D RATION PRINT o /L,�� NO. �`1G l 0 1 8 1, 1 3 1 hereby affirm that I am exempt from the Contractor's LicenseADDRESS �oi0 �r✓ ® o o 181-13 czi Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS 5 9 t wages as their sole compensation,will do the work and 0 the structure is not intended or offered for sale(Section LOCALITY , 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). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. JSec. 3097, Civ. C.). SIDE i P.L. � Lender's Name � b-33 P.C.Fee$ Permit Fee 1-7 Lender's Address J/� e I certify that I have read this application and state that the Issuance Fee /V �a above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, �( 2 i and hereby authorize representatives of this County to enter I Total Fee V t�y ( upon t ab6v mentioned property for inspection purposes. E 4, J/q—v, SEE REVERSE FOR EXPLANATORY LANGUAGE S gnature of Applicant or Agent Date es