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Home My Public Portal About5626 PERSIMMON AVE_Building__ j76A63BA:cE #6034/71 '1 ` e C), 4AJ, APPLICATION FOR BUILDING l COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT `OF COUNTY ENGINEER MAP BOOK PAG ARCEL BUILDING AND SAFETY DIVISION BUILDING " I^W ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST AA Print or-tvDe onl CROSS ST. r �( 01 DIST tCT N GROUP TYPE -- ROCiE ED BY BUILDING ADDRESS 1's� J ,� CONST. STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO, DWELL UNITS BK G9_5- TRACT ONE MAP �?� NO.OF BLDGS. � NO. V_ SIZE OF LOT NOW ON LOT SPECIAL USE OF � n � CONDITIONS EXISTING BLDG. `t' TEL _ OWNER ^. NO. BLDG.SETBACK FROM ADDRESS ,!. o� .�'/s v FRONT PROP.LINE OF STREET) ,r. TYPE OF EXISTI SETBACK HIGHWAY + YARD = TOTAL CITY e• r HIGHWAY WIDT FROM C.L. _ ARCHITECT TEL. / ._ C941 + _ ENGINEER 6 r P NO. C•�W BLDG,SETBACK FROM ADDRESS 5bL(- SIDE PROP.LINE OF (STREET) TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CL CONTRACTOR f /r NO, HIGHWAY WIDTH FROM C.L. a V ADDRESS C. NO. t = 9a LIC. F- CITY CLASS CORNER CUTOFF YES ❑ NO LL CONSTRUCTION LENDM. ,�� SEE REVERSE SIDE FOR SPECIAL APPROV. LS z NAME AND BRAyNCH /�i a /��( .� �' r./� ..� � fir SQ. FT.�'Z? NO. OF NO. O NEW ❑ AP-7 � J /. SIZE CJ STORIES FAMILIES - - USE OFADDQ�g , RUh6�/�L (( P,I � e— ALTER ❑ � 1 SIGNATURE O REPAIR❑ APPLICANT ' DEMOL ❑ VALUATION S D �v APPROVALS 9ATE,, oe IN CTOR' IGNA TURE P.C. PMT. ��tFRAME&FI,R,E NDATION: LOCATION FEE 5 FEE S 0'-7 ✓ ORMS, MATERIALS Z STOPS,1HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATIONRANBOLTSAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS a., .+� er• . STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO LATH, INT. r i WORKMEN'S COMPENSATION INSURANCE. LATH, EXT, � _ � •+` SIGNATURE PERMITTEE OF J HOUSE R CT AND POSOTED int\� A ADDRESS FINALS 1. JOHN F. LEWIS. PRINc L STRU •RAL ENGINEER PLAN CHECK VALIDATIONYK. �y.0. CASH _ PERMIT VALIDA N GK. • M.O. CASH Li Lo ? a � �.2/2 3 0 a,5 4 �.- 1 66et14 JUN 27 : 1 a 82.50 ,J6A4688ArCE#8031,J/71 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ASSESSOR DiPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS DDRESS ►^/ COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY . lr G- FOR APPLICANT TO FILL IN NEAREST Print ort a onl CROSS ST. 05 6L-�/� G BUILDING DISTRICT NO. GROUP ]TYPE S D BY ADDRESS �/S� >vv`O �..Q ryiC� STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO.�' DWELL,UNITS BK t:PG TRACT USE ZONE MAP NO.OF BLDGS. NO. SIZE OF LOT NOW ON LOT Rj( SPECIAL USE OF a ` CONDITIONS EXISTING BLDG. TEL. OWNER Z15/1 t$ Q /jANO. BLDG.SETBACK FROM ADDRESS r FRONT PROP.LINE OF (STREET) TYPED EXISTING SETBACK HIGHWAY + YAR = TOTAL CITY �►�' HIGHWAY WIDTH FROM C.L. - ARCHITECT OR /�D NO. + _ ENGINEER ( BLOG.SETBACKFROM ADDRESS Vg r, s C 6�m6 SIDE PROP.LINE OF (STREET) } TEL. TYPE OF EXISTING SETBACKIG AY } YARD = TOTAL- �- CONTRACTORNO, HIGHWAY WIDTH FROM C.L. V LIC. ADDRESS NO. t = O LIC. I-" CITY CLASS CORNER CUTOFF YES ❑ NO ElW NAME AND BCONSTRUCTIRANCHON NDE �'z� SEE REVERSE SIDE FOR SPECIAL APPROVALS z LAPPLICANT -If 66 NO. OF NO. OF NEW ❑ STORIES FAMILIES ❑ ADD E ALTER ❑ OF REPAIR❑ T DEMOL ❑ S APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION """'7FEES J FORMS, MATERIALS FRAME; FIRE STOPS, 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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION LATH, EXT, SIGNATUREOF � �i HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS pp,,'�, FINAL / ��''�- s'•' Gl '� �� tl,vl JOHN F. LEWIS. PRIfiCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VA ATIQN CK. M.O. CASH b 9 o 7 1 N E90i� � D 9-.00- cl WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION F O BUILDING PERMIT - -- insure, or a certificate of Workers'Compenstion Insurance,or . - a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAF Policy No. Company , Certified copy is hereby furnished.. FOR-APPLICANT TO FILL IN ADDRES Certified copy is filed with the county building inspec- BUILDING �1 / v r tion department.' ADDRESS 1.2 C� / 51-'J U� ✓fes,' LOCALITY - T NEAREST ) Date Applicant CITY / P� C 1 �7 ZIP 1 CROSS ST. / CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT G. U I.S 0 NOW ON LOT MAP BOOK PAGE PARCEL This section need not be completed if the permit is for one p� USE.ZONE MAP hundred dollars ($100)or less.) r p TRACT 13 / BLOCK LOT NO. 32J j NO. TEL. rG1 / SPECIAL IL I certify that in the performance of the work for which this OWNER Dd/1/ESLD !/ O �Y NO. 7��JJ� CONDITIONS o permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE so as to become subject to.the Workers'Compensation Laws. ADDRESS tii 5 ;W4.1 AIV � , CONST. CITY �L� L f ZIP J ® Date Applicant STATISTICAL CLA SIFICATION A CONDO. AL ARCHITECT OR TEL. ��c�J NOTICE TO APPLICANT: If, after making this Certificate of lly✓.iJU CL Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS 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 O >"N�� BK. PG, VALIDATION t 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. Professions Code, and my license is in full force and effect. CITY CLASS _ $ SQ. FT. 10.OF NO.OF CHECK ' License Number Lic.Class SIZE FtT w ,�?'6tFAMILIES ONE $ Contractor Date DESCRIPTION OF ORK P Z )aib l..L NEW ❑ - ADD ElI am exempt from the licensing requirements as I am a rJ?I1-177r ,p C}��j) licensed architect or a registered professional engineer ALTER -� FINAL Z Z- r C1) acting in my •professional capacity (Section 7051, 3IV6 REPAIR DATE / Business and Professions Code). USE OF ❑ EXISTING BLDG. D/C11�. DEMOL FINAL ,•, �,.. By Lic.or Reg.No. Date APPLICANT NO. 7 L� OWNER-BUILDER DECLARATION (PRINT) O�f1Z-D —d✓ .3 I hereby affirm that I am exempt from the Contractor's License ADDRESS fo26 ��)I'�JI/✓�>�• e Law for the following reason (Section 7031.5, Business ander Professions Code): PRESEN BUILDING int ISI' I, as owner of the property, or my employees with ADDRESS _ r wages as their sole compensation,will do the work and 3 0.9,6 A the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. } o•o 0-0 e 1 11, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 2 0 1 60.0 0 tion 70.44, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST, o 'o 1 6 0. 0 0 6 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a constfuction lending agency for FRONT 0 3,0 1 —8 2 the performance of the work for which this permit is Issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name P.C. Fee$ Permit Fee // Lender's Address ' I certify that I have read this application and state that the Issuance Fee r r above information is correct. I agree to comply with all County Investigation Fee 3 ordinances and State laws relating to building construction, Total Fee and hereby authorize representatives of this County to enter o __-___upon the above-mentioned property for.inspecfion purposes. _ V7WPY2r-- 2C }' $2 SEE REVERSE FOR EXPLANATORY LANGUAGE D � Signature of Applicant or Agent Date ®s .'