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HomeMy Public PortalAbout5814 PRIMROSE AVE_Building__ DEPARTNNT OF COUNTY ENGINM DMSION OF BURDUM AND SAFETY BUILDANGELES COUNTY OF LOS WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, SUPT of BUILDING FOR APPLICANT TO F1LI. IN FOR OFFICE USE ONLY BUILDINGDISTRICT NO. PUN CK,of REc.No. PERMIT NO. ADDRESS ®® 1 Ar 7oe;13r -11111-41 LOCALITY 4 / \ R IV DAT19OFA L. T ISSU NEAREST /� c Ll-& 13 CROS ST. S !.� V BUILDIN J— rq ADDR OWNER s^T MAIL `a /T LO LITY / ADDRESS u TEL N REST CITY ` O88 ST. ARCHITE OR TEL. ®�I PLANS ENGINEER NO. I I 6ROU ADDRESS BLDG'AA P gg�� ,[� // [`� SETBACK LINE CONTRACTOR ® )TAN G3 1"otA7IX 7T 7�� ZON BYPROVED DAT ADDRESS G#- ` 1r� 0�4 ` HOUSE NUM IN6or LEGAL MAP NUMBER -:2-t" NO. ASSIGNED BY DESCRIPTION LOT NQ. BLOCK CORRECTIONS TRACT 6i i i _ SIZE OR LOT �a a I NOW ON LOT �� USEOF ,p� EXISTING BLDG. J a A PAM ILER ;/,`/`,.,, / GzC4� (> FC'ti/F"'� DESCAZpTION O wogs / r' moo. R.4 v—s D - RE AIR I� OEM ALTORLATION ITION I-I ADDITION r Q. FT. NO.OF ® GD is 4 e ff GJ b SIZE qq ga ROOMS STORIES COV RING d p tDC�� I ROOF /VAI/]G� �u L ® u 7" �F`e`i� k?^.'e 4 COVERING( USE OF STRUCTURE QR • � �L �7WW �. ci �� �zv APPRov�I.B IN- ECTO 'S SIGNATURE ATS iFOUNDATION:LOCATION 3� FORMS, ON: ..e_.-.. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, d PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORA REE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE:LOCATION, J b AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF LATH, INT. �'q✓ PERMITTER �> .�..�� iii g � LATH. EXT. ADDRESS � •' ' PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT.P. fid/ $ 71a�9 FEE• 8 O HRECT AND P08TEDR- /phi/ .,/ VALUATION FEE i FINAL g 78A888A D1383 9.811 1 ' WORKERS'COMPENSATION DECLARATION ► L hereby affirm that I have a certificate of consent to self APPLICATION. F OR 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 S Policy No. Company BUILDING ❑ r� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING / tion department. ADDRESS / Q95 LOCALITY NEAREST Date Applicant CITY ZIP 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 �,} hundred dollars ($100)or less.) TRACT BLOCK , LOT NO. NO. ©C/ >, TEW SPECIAL0. 1 certify that in the performance of the work for which this OWNER SC NO. — CONDITIONS O permit is issued, I shall not employ any person in any manner , DISTRICT GROUP TYPE FIRE PROCESSED U ADDRESS so as to become-subject to the Workers'�omp sation La s. r '� CONST. ZONE o e. Date S Applicant CITYor [ O /ii/ ZIP V STATISTICAL CLA ICATION APT. CONDO. NOTICE T AP LICANT: If, after ing is Certificate of ARCHITECT OR TEL. LU Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO._a� DWELL. UNITS La Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL.+jt� deemed revoked. CONTRACTORST. NO. 3 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �� O. �� J{// 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 $ wld D Q / SQ.FT. INC.OF NO.OF CHECK License Number 3I S`l Lic.Class SIZE b STORIES FAMILIES ONE ContractoJJX.AJJrfi,rr emsy WC Date / Q/ DESCRIPTION OF WORK ' NEW ❑ $ ❑ I am exempt from the licensing requirements as I am aAe_ ` ADD 13licensed architect or a registered professional engineer ALTER ❑ FINAL v �� acting in my professional capacity (Section 7051, REPAIR 54 DATE g Business and Professions Code). USE OF — FINAL EXISTING BLDG. IDEMOL B G. Lic.or Reg.No. Date APPLICANT TEL Y OWNER-BUILDER DECLARATION (PRINT) I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ❑ BUILDING I, as owner of the property; or my employees with ADDRESS wages as their sole compensation,will do the work and z 1 8 4,8 A• the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 0 0 0 0 0 1 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS1 2,- 0 52.00 tion 7044, Business and Professions Code). 5 2. REQUIRED TOTAL SETBACK FROM EXIST. 0 0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH . I hereby affirm that there is a construction lending agency for FRONT RO ) 05— (Sec. 5_8 the performance of the work for which this permit is issued P.L. . (Sec. 3097, Civ. C.). SIDE - P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee ' I certify that I have read this application and state that the Issuance Fee `- above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee a ereby authorize representatives of this County to enter Po the above- enfio propertyf r inspection purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE -� natureplicant or Agent Dote i es