HomeMy Public PortalAbout5538 PERSIMMON AVE_Building__ IGA69eA CE#80810.68 APPLICATION FOR BUILDING PERMIT 1 .
COUNTY OF LOS ANGELES BUILDING '
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY /
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN,SUPT OF BUILDING CROSS ST. e e4L
DISTRI T O. GROUP TYPE PRCLPESSED BY
FOR APPLICANT TO FILL IN CONS
BUILDINGSTATISTICAL CLASSIFICATION I SE ER MAP
ADDRESS , S p,�J K G
S
CLASS.N WELL.UNITS
LOT NO. BLOCK NUMBER HWY YES
TRACT
/ USE ZONE SPECIAL
NO.OF.BLDGS /j CONDITIONS
SIZE OF LOT I NOW ON LOT J
USE OF
EXISTING BLDG. �� SETBACK WARD HWY STREET NAME BUILDING WIDTH
r OWNER , FRONT
MAIL P.L.
'r ADDRESS S SIDE
� TEL. P.L.
i. CITY zS ` r— No. INSPECTION RECORD
ARCHITECTOR TEL. a
ENGINEER U Ll-/ NO.
ADDRESS cl G S o ,
TEL.
�.
CONTRACTOR Cr(,o,C rA L / GCJLLNO.
ADDRESS -5 v c L'
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. NO.OF NO.OF
SIZE STORIES FAMILIESUSE OF
A
STRUCTURE
SIGNATURE OF j�J
APPLICANT APPROVALS n DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION:LOCATION
FORMS,MATERIALS �"•I ' a
VALUATION 5S Lq FRAME:FIRE STOPS,
BRACING,BOaw- LTS
M1FEE $ IPMT. LOFEE 5 FURNACE:�'`I GAS VENT,DUCTS ATION.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH.INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING SUI DI G N TION. LATH,EXT.
NUMBER COR-
SIGNATURE OF HOUSE
RECTANDPOS ED
PERMITTEE
i
ADDRESS FINAL �A .''o =h c_ iA!
CLYDE N.DIRLAM.PAINC:IPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH
LFit,0 -s Z u, AUG" $ 2 3 A 3 v $ ••�
WQRKERS'COMPENSATION DECLARATION
hjre, •sf rm that I have a certificate of consent to self P I��T ®o" BUILDING P E RM I T
itip)re, ot`9•ce4)ificate-of Workers'Compensation Insurance,-
or a Altified ippy'thereof(Sec. 3800, ab.•C.)
,,QQ ccA �j r. � ,!:0UNTY.O.VLOS ANGELES BUILDING AND SAFETY
H
Polic No(�sG'�3 /company �
❑ Certified copy is hereby furnished. FOR• PPLICANT TO FILL IN BUILDING
'ADDRESS
�1 Certified copy is filed with the county building inspec- •BUILDING' t�
J tion department. ADDRESS Ci �1 gel m j,20 e°-
Date �� 46 Applicant �� �'(.//� CITY Zen)ai= C! ZIP 7 I7d o LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' N0.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT C .S_ NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars($100)or less.) TRACT 1 /BLOCK SLOT NO. MAP BOOK PAGE PARCEL
OWNER dle[Aw [ It (. ZrfC TEL USE ZONE MAP
TEL -75 �OSi:,
I certify that in the performance of the work for which this 11 NO.
CIAL
permit is issued, I shall not employ any person in any manner ADDRESS � � L" ' CONDITIONS ,
so as to become subject to the Workers'Compensation Laws. V
CITY �t ZIP t9
Date Applicant ARCHITECT OR /��O t,�j i� NO.
NOTICE TO APPLICANT: If, after making this Certificate of r'lF+ � �7• DISTRICT GROUP TYPE FIRE PRO ESSED BY
Exemption, you should become subject to the Workers' ENGINEER 'Joy
CONST. ZONE 6�1V
Compensation provisions of the Labor Code, you must forth- ADDRESS ZSr .5 r 't~ — ��� 3
with comply with such provisions or this permit shall be
TEL. STATISTICAL CLASSIF CATION APT.
deemed revoked.. CONTRACTOR ,�s') / NO. ' �lsa
LICENSED CONTRACTORS DECLARATION / pvc. , CLASS NO. 9' DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS }�� • � %�?LfllrCpC O. 3c5'�7 .
(commencing with Section 7000)of Division 3 of the Business and ,/) LIC. SEWER MAP /
Professions Code,and my liceennse is in full force andel effect. CITY Fre- CLASS — BK 6 PG Q4 VALIDATION
3 l% 2q /�"� SQ.
ff` TORIOES FAMIOLIES fCHECK
ONE
License Number Lic.Class
r VALUATION
Contractor ng �C���.td�e v 7-1/46 DESCRIPTION OF WORK 0 d'R" `lam/ NEW ❑ $
❑ I am exempt under Sec. @4� C l ADD ,
ALTER ❑. L1,1
B.BP.C. for this reason �v 2 REPAIR ❑. $
Da /
USE OF DEMOL E]EXISTING BLDG. Y1'L!I ®�
APPLICANT r TEL. d��A��+�
_ �4836A
Signature PRINT lea NOOWNER-BUILDER DECLARATION . 7 l7''Z FINAL # 0 0 0 0.23
DATE
I hereby affirm that I am exempt from the-Contractor's License ADDRESS z �� � �� � ' FIN ( 034298
Law for the following reason (Section 7031.5, Business and
Professions Code): PRESET i By x
❑ BUILDING �' ° ° 3 4 2 9 8 c
I, as owner of the property, or myemployees with ADDRESS
wages as their sole compensation,will do the work and 0 6, 17-86
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). �Jr 0 1!5 A-
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK
L NEER WIDTH OM # o• o 0 0'0 1
I hereby affirm that there is a construction lending agency for FRONT 0 4 1 I{ 0 Q
the performance of the work for which this permit is issued P.L. o o
(Sec. 3097, Civ. C.). SIDE 0 0
P.L.
Q Lender's Name CDMA Ref. #
Lender's Address P.C. Fee$ ( � Permit Fee
I certify that I have read this application and state that the Issuance Fee V S(1 CDMA P/C#
¢ above information is correct. I agree to comply with all County Investigation Fee nn
ordinances and State laws relating to building construction, Total Fee Cl� CDMA Perm.#
u and her authorize representatives of this County to enter
upon a ove-menti d property for'nspection purposes.
¢ ��• �/ SEE REVERSE FOR EXPLANATORY LANGUAGE
LSignature of Applicant or Agent Date