HomeMy Public PortalAbout5835 PRIMROSE AVE_Building__ ;6AIheCe a-sa APPLICATION FOR BUILDING PERMIT
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.
DISTRICT NO. GROUP TYPE _ PROCESSED BY
77ADDRESS
R APPLICANT TO FILL IN T -I CONST.
- STATISTICAL CLASSIFICATION SEWER MAP
BK PG
CLASS.NO.�—DWELL. UNITSI Ji
BLOCK MAP STATE
NUMBER �e �; /Z HWY. YES DfO"
TRACT USEZONE SPECIAL
NO.OF BLDGS. CONDITIONS
SIZE OF LOT I NOW ON LOT i'
USE OF
EXISTING BLDG. BUILDING YARD HWY STREET NAME EXIST.
-_
OWNER -7- 4 � I SETBACK WIDTH
(L FRONT I
MAIL ,� P.L.
ESS •yl..%i i�' 4r!-�??'- _
ADDR . / SIDE
TEL. P.L•
CITY No, INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER NO.
ADDRESS
TEL.
CONTRACTOR NO,
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH -
SQ.FT. NO.OF NO.OF
_SIZE - - STORIES FAMILIES
USE OF STRUCTURE
SIGNATURE OFAPPROVALS
r
APPLICANT
DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
$ FORMS, MATERIALS L.• /' ,
: P.C• $ FRAME: FIRE STOPS.
!. FEED. BRACING. BOLTS
VALUATION $ FURNACE: LOCATION, /
FEE "'F• GAS VENT. DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCE$ AND
STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR- v
PERMITTEE - RECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL STR URAL ENGINEER
PLAN CHECK VALIDATION ,CK. i M.O. CASH PERMIT VALIDATION CK, M.O. CASH
OF
APPLICATION FOR BUI ING PERMIT r�J11^IIII
1 � L
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APP ANT TO FILL IN sul AD S �
I hereby affirm that I have a certificate of consent to self insure, BUILDING J)5
or a certificate of Workers'Compensation Insurance,or a certified CI ✓ /� ZI
copy thereof(Sec.3(300 Lab.C.) (� � LOCALITY
Policy No. �-' Comp SIZE OF LOT NO.OF BL S.NOW ON LOT L
❑ Certified copy is hereby fur ' NEAREST CROSS ST.
Certified Opy i ed with the county b (ding inspection TRACT BLOCK LOT No.
`� �/I R rtm t. USE ZONE MAP NO.
Datf(] pplicant ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM ORKERS' R J �� TEL NO. YES NO
COMPENSATION INSURAN E I WITHIN 1000 FT.OF SCHOOL?
This section need not be completed if the permit is for one hundred A 4�/'lam �/� 5
( P P ✓o DISTRICT GROUP TST. FIRE ZONE PROCESSED BY
dollars($100)or less.)
�
oe
I certify that in the performance of the work for which this permit � ZIP
�'� (� ��� _�
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws. ARCHITEGTIOR ENGINEER TEL NO.
STATISTICALCLASS( (CATION APT CONDO
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE 70 APPLICANT: If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' ��T,RSET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith �{9A ) / (,' FRONT
comply with such provisions or this permit shall be deemed revoked. DR,E�;�- � '✓v, v u�N9.� l' PL
LICENSED CONTRACTORS DECLARATION ��,,J� ( SIDE
PL
1 hereby affirm that I am licensed underprovisions of Chapter 9 u� SEWER MAP
(commencing wit Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES
Professions Co �� ' e is in full forc��
NEW BK PG ® IL
icense Number Q , Lic.Clasj� C O RK ADD ❑ VALUATION �^ U
Date t ` ALTER ❑ [q
J'
❑ I am exempt under Sec. f
REPAIR ❑ 0
BAP.C.f Is reas n /�11_/ DEMOL 11 LDMA P/C# W
at USE OF EXISTING BLDG. URM ❑ �
1
Si ature LI f f��il�T) LDMA Perm# Z
❑ I, as owner of the property, or my employees with wages as C� �r/� Z v
their sole compensation, will do the work and the structure is S O -� ({--1° I
not intended or offered for sale (Section 7044, Business and FINAL DATE Q �3�-3 1- 3l
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZAR 5 MATERIAL e,"7 .7 41 Co. I ( s EMr-
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
❑ 1, as owner of the property, am exclusively contracting 44, AMOUNTS SPECIFIED THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY "-'n>=
licensed contractors to construct the project (Section 7044, (fid CIL �4 _¢ o §.p
Business and Professions Code.) YES❑ N ❑
WILL THE INTEN D E OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHECK
OCCUPANT RE IRE A ERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR Q UTY AGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR CHANGE
GUIDELINES
I hereby affirm that there is a construction lending agency for YES❑ N
N the performance of the work for which this permit is issued(Sec. (HAVER HAZAR SMATERWLS INFORM NGUIDE!HE
D OND PERMfrTING
3097,CIV.C.) CHE .I UNDER ND MY REOUIREME ERT AN LES COUNTY CODE, M
CM TI 2, HAP 20 SECTIONS 2 20.1 T U 0.1CERNING HAZARDOUS co )_I)i ie/12/94
Lender's Name TERULLS RTI AN FOR OBTAI E 3CAQMD. AM
a Lender's Address ij°J.5
DA AGENT
o I certify that I have read this application and state under penalty
O of perjur at the above information is correct.I agree to comply P.C.FEE PERMIT FEE �O
N wi II cou y ordinances and State laws relating to building
� nstruClio and hereby authorize represe tives of this unty ISSUANCE FEE
a
to enter he abo e ' ned per or inspect'
CID INVESTIGATION FEE TOTAL FEE
Da°
SEE REVERSE FOR EXPLANATORY LANGUAGE