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Home My Public Portal About5734 PRIMROSE AVE_Building__ -- APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING �� - COUNTY OF LOS ANGELES ADDRESs DEPARTMENT OF COUNTY ENGINEER CITY Cor, ZIP BUILDING ANDS DIVISION NO.OF BLDGS. +J BUILDING SIZE OF LOT a�K.r/��Q NOW ON LOT ADDRESS /� _50-sD O• -G.S. TRACT&(Q BLOCK LOT NO. LOCALIT TEL �/ NEAREST OWNER ( NO. `7 CROSS ST. ASSESSOR ADDRESS M_(? MAP BOOK PAGE 1PARCEL DISTRICTGROUP TYPE FIRE PROC SSE BY Zip r� �� CONST. ZONE ARCHITECT ..� TEL. .� 25 ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS L. CLASS NO.�DWELL.UNITS � BK _3/ CONTRACTOR N0. ONE MAP �Qa LIC. NO. ADDRESS NO, SPECIAL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDERpp��n,,� Le NAME AND BRANCH BL G.SETBACK FROM FR NT PROP.LINE OF (STREET) C ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING C SQ, FT./�7 NO. OF NO. OF CHECK HI WAY + YARD - FRONT PROP. LINE HIGHWAY WIDTH SIZE TI;7w I STORIES f FAMILIES ONE C DESCRIPTIONF WORK NEW ❑ + V ADD ❑ BLDGS CK FROM O L /2 /� i ,;.aKl SIDE PROP.L (STREET) v 1 U __'_H '0 HIGHWAY + YARD _ OTAL SETBACK FROM TYPE EXISTING USE __ -REPAIR[] SIDE PROP. LINE HIGHWA WIDTH EXISO ',�T NG BLDG. ftf_ e , DEMOL 1:1 + AP PRICANT 111,0 �. �I Np� *I CORNER CUTOFF YES ❑ NO ❑ BY (SIGNATURE) N A IN OPEN SPACE YES ❑ NO ❑ �hy ® IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ 20,90 ~ CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL . AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ! p LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF PERMITTEE ADDRESS a TEL FINAL BY Q CITY NO..s2 3 DATE 11:1(�E CHECKS PAYABLE TO: FEE $ FEE HARVEY T. BRANDT, COUNTY ENGINEER -21, PLAN CHECK VALIDATION CK. M.O. CASH _ E VALIDATION CIt. M.O. CASH Jam' S •- 76AG38A CE#803 12/72 2 9 3XJAN. •14 2 1.7 5 `98 7GA638A CEN803 9-68 e� _• r APPLICATION FOR BUIL NG PER TT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. j FOR APPLICANT TO FILL IN o1ST5PTNo. GRr TYPE Ro ED BY (Print or type only) CONST. ON BUILDING SY TRim,e Rv� STATISTICAL CLASS NO.. DWELL.IUNITS SEWER BK/ 3 ADDRESS �r P��'//� �T n LOT NO. �D a F ZI06 � BLOCK USE ZONE NO. oC o TRACT SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT �O JS NOW ON LOT , USE OF EXISTING BLDG• F_ BLDG.SETBACK FROM OWNER NO = L FRONT PROP.LINE OF -(STREET) . TYPE OF EXISTING SETBACK HIGHWAY + YARD TOTAL S p ADDRESS HIGHWAY WIDTH FROM C.L. (01 1. l + �(D =oZ Q CITY BLDG.-SETBACK FROM ARCHITECT OR I TEL. SIDE PROP.LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + - < CONTRACTOR e i-f NO. ADDRESS a NO CORNER CUTOFF YES ❑ NO ❑ CITY ( CLASS SEE Rq VERSE SIDE FOR SPECIAL APPROVAL CONSTRUCTNAME AND BRANCH CHON NDER e ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ 1�.(flV♦�cS t SIZE 3 D STORIES f FAMILIES � :+ /ADD , �� t�� STRUCTURE 1✓ 6,0 ALTER ❑ I G• /1/ Al SIGNATURE OF REPAIR❑ APPLICANT DEMOL ❑ VALUATION 5 APPROVALS iDATE INSPECTOR'S Slf�[!� E F E$ FEES a (/ ,V FOUNDATION: LOCATION FRAME: FIRE STOPS, ' �` +• 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE 15 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 r HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. �� LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO q WORKMEN'S COMPEN TION IN NCE. HOUSE NUMBER COR- SIGNATURE OF A PERMITTEE RECT AND POSTED ADDRESS FINAL -�9 JOHN F. LEWIS. PRINCIPAL STIR URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION _- M.O. CASH Fr_ 0 8 nO% JUL 3 1 D 9.00- Q WORKERS'COMPENSATION DECLARATION J et y affirm that I have a certificate of consent to self APPLICATION F OR BUILDING PERMIT insure,or acertificate of Workers'Compenstion Insurance,or a 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 ADDRESS Certified copy is filed with the county building inspec- BUILDING f� �r c� tion department.' ADDRESS / ✓ 1AW11 .0 p LOCALITY NEAREDate Applicant r CITY /F�!'/�L� Cil'J'' ZIP - p CROSS ST. rCJ CERTIFICATE OF EXEMPTION FROM WORKERS' p�,� NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT a�1.60 NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP r hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. J •?- TEL. �' SPECIAL I certify that in the performance of the work for which this OWNER �//L'6r!/�,� S ALL. O. �6 CONDITIONS permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY V so as to become subject to the Workers'Compensation Laws. ADDRESS CONST.' ZONE Date ! —/3-80Applican CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. G NOTICE TO APPLICANT: If, after making this Certificate o ARCHITECT OR TEL. ENGINEER NO. CLASS NO. — DWELL. UNITS fZ Exemption,.you should become subject to' the Workers rN Compensation provisions of the Labor Code, you must forth ADDRESSSEWER MAP ' with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. BK. j VALIDATION LICENSED CONTRACTORS DECLARATION xZ 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 $ 500 SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE /�;I8 11STORIES FAMILIES ONE $ Contractor Date DESCRIPTION OF WORK EW j' ADD ❑ I am exempt from the licensing requirements as I am a licensed architect or-a registered professional engineer ALTER ❑ FINALDATE acting in my professional capacity (Section 7051,, REPAIR ❑ Business and Professions Code). USE OFFINAL• EXISTING BLDG. GIC DEMOL ❑' Lic.or Reg.No. Date APPLICANT TEL. By OWNER-BUILDER DECLARATION PRINT ,tlwz,41?y " �1L.v NO. 8 � I hereby affirm that I am exempt from the Contractor's License ADDRESS Law for the following reason (Section 7031.5, Business and essions Code): PRESENT BUILDING' I, as owner of the-property, -ormy employees with ADDRESS ' wages as their sole compensation,will clothe work and o ' the structure is not intended or offered for sale(Section LOCALITY 2 628 A 7044, Business and Professions Code). MOVING TEL. I, as..owner of the property, am exclusively contracting CONTRACTOR NO. 0'a.0 0 0 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 2' 0 0 ']0,0.0 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK' YARD HWY PROP. LINE WIDTH S -1 hereby affirm-that there is a construction lending agency for ; ' " FRONT -' —p x 0 0 0 70.0 0 i the performance of the work for,which this permit is issued P.L. —20 C1. (Sec. 3097, Civ. C.). t SIDE ! 0. 1 5=8 0 P.L. Lender's Name _ 'o P.C. Fee$ permit Fee Lende'r's Address "I certify that I have read this application and,state that the Issuance Fee s 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 m upon the above-mentioned property for inspection purposes. [�^ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote ®s