HomeMy Public PortalAbout5915 1/4 PRIMROSE AVE_Building__ 76A638A CE 0803 12/69
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES 'ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISIONBUILDING i �G
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST ®
Print or tvoe onl CROSS ST.
DISTRIC�/IT, �RP: GTROUP TYPE PR`O�ESkEDBy�_
ADDREISS 5915 Primrose Tem 1e Clt :J V U/ J� CONST. // '7�/
STATISTICAL CLASSIFICATION �� ( SEWER MCA`-�Pb�C
LOT NO. — BLOCK I CLASS NO.�LDWELL.UNITS B1�PG
TRACT "4c �� USE ZONE[MAP f� D �- .
NO.OF BLDGS. (/
SIZE OF LOT NOW ON LOT �/� CIAL
USE OF / DITIONS
EXISTIIN+G tBLDG. Residence 7
OWNEetL CX M .Enter ,/rLises NOL287-7/1 BLDG.SETBACK FROM
ADDRESS Pp O, BOX 71'55 FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY Rosemead, California HIGHWAY WIDTH FROM C.L.
ARCHITECT OR TEL. +
ENGINEER NO. BLDG.SETB%CCK-ESOM
ADDRESS p SIDE PROP.LINE OFA (STREET)
CONTRACTORSan Marino Roof NO. 285-115 HIGHWAY TYPE OF EWDTIHG H
FROM C.L. W►�Y + YARD = TOTAL
A13DRESS518 Walnut Grove No•2 9559 �+LIC. C
o
CITY San Gabriel Califs ASS CP039 CORNER CUTOFFYES ❑ NO ❑�
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS O
!r
SQ. FT. NO. OF NO. OF NEW ❑
SIZE STORIES FAMILIES ❑
USE OF ADD
STRUCTURE Residence
ALTER
Reproof REPAIR[] '
IGNATURE OF
PPLICANTJ�*S
ALc DEMOL ❑
fALUATION$ '220.*0 APPROVALS DATE INSPECTOR'S SIGNATURE
CPMT. FOUNDATION: LOCATION
S FEE$ FORMS, MATERIALS
TE�Ei • FRAME: FIRE, STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACINGBOLTS
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. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.
L,ABOR CODE OF THE STATE OF 'CALIFORNIA IN RELATING TO
ORKMEN'S OF
INSURANCE. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL711-?T7'1
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION 0 M.O. CASH ce
69 c� �CR SEP 24. 1 D 9.00-
..
!t WORKERS'COMPENSATION DECLARATION
r 1• re?y affirm that I have certificate of consent to self APPLICATION F® BUILDING PERMIT
Ensure, or a certificate'of Workers'Compensation Insurance,
or a certified copy thereof(SeLr 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No._Company
❑ Certified copy Is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS V� f�< R USS 4 J,<,; ,
❑ Certified copy Is filed with the county building Inspec- BUILDING / /2 /I
tion department. ADDRESS �9�� �`�` 4[rN 0 f F �7 -6 � y
Date Applicant CITY �— Mt_' el:ry zip LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one
ASSESSOR
hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK I PAGE PARCEL
TEL. USE NE MAP
I certify that In the performance of the work for which this OWNER NO , Y f 7 NO.
permit is issued, I shall not employ any person in any manner /y/ SPECIAL
so as to become subject to the Workers'Compensation Laws. ADDRESS /� 6tisde� �� Y r I CONDITIONS 0
Date,f® -- /54_fApplicant,C` /d FC-'&i1, CITY A dc zIP !7 d
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT G OUP TYPE FIRE PROCESSED BY Q
Exemption, you should become subject to the Workers' ENGINEER NO. _W
CONST ZONEV
Compensation provisions of the Labor Code, you must forth- ADDRESS 5� J W
with comply with such provisions or this permit shall be 0-
deemed revoked.
n— TEL. ;.STATISTICAL CLASSIFI ATION APT. DO. N
CONTRACTOR LE NO. S✓ q7L^
LICENSED CONTRACTORS DECLARATION LIC 7S_ CLASS NO. DWELL. UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS d D a
(commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP
Professions Code,and my license is in full force and effect. CITY.�O/✓R db/�4 CLASS BK PG VALIDATION
7J Lic.Class �2 SQ' �'/ NO.OF NO.OF CHECK
License Number �� ✓ SIZE [a a STORIES NO
ONE
p VALUATION
/Vj3� �i Date �p'N `$ DESCRIPTION OF WORK A 44,4 /� Qf- NEW
❑ /T
Contractor - ADD $ V
❑I am exempt under Sec. �9A6`!5 �Y f ❑
ALTER ❑s
B.BP.C. for this reason REPAIR $ @'81 2 5 A
USE OF
Date: EXISTING BLDG. �i fJfse./CC- DEMOL '
Signature APPLICANT TEL. FINAL # 0 0 0 0 0,1
OWNER-BUILDER DECLARATION
(PRINT)/,f, CT" NO. S'7?)6 b DATE
1 hereby affirm that I am exempt from the Contractor's License ADDRESS L CA). d�A tM L[�• d 4)"`s/� FINAL I o a ']$,�
Law for the following reason (Section 7031.5, Business and l
0 o a =
Professions Code): R By ,��L� 7
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and LOCALITY ® 1 (115-87
the structure Is not Intended or offered for sale(Section
7044, Business and Professions Code). MOVING TEL.
❑ 1, as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ;
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L.
Lender's Name
LDMA Ref. #
i P.C. Fee$ Permit Fee
Lender's Address
a:
I certify that I have read this application and state that the Issuance Fee �• LDMA P/C#
? above information is correct. I agree to comply with all County Investigation Fee
1 ordinances and State laws relating to building construction, Total Fee U 00 t LDMA Perm.#
and hereby authorize representatives of this County to enter
S upon he above-mentioned property for inspection purposes.
D
' AV—(el—V SEE REVERSE FOR EXPLANATORY LANGUAGE
D
Signv,5Ve of Applicant or Agent Date