HomeMy Public PortalAbout6023 PRIMROSE AVE_Building__ BETE 6-46
DEPARTMENT OF BUILDING AND SAFELY APPLICATION FO -�
COUNTY OF LOS ANGELES BU
I LD
1
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CIC. NO. PERMIT NO.
BUILDING
ADDRESS 3�9 N o Primrose Ave . "
LOCALITY rPpynplp. C. ty RECEIVED BY DATE OF APPL. DATE ISSUED
NEAREST' 46¢..y..� Y7 `f 24 r
CRO88 ST.
BUILDING �j
OWNER hoR Rushton 1 ADDRESS 3/MAIL
ADDRESS s arae LOCALITY �� •Y+•✓j Z ; �.%
TEL. CRO88 9T.NEAREST.
CITY NO. FIRE NO.OF y TYPE GROUP
ARCHITECT OR TEL. ZONEPLANE
-ENGINEER NO. rfl
BLDG. ;ORD. NO.
ADDRESS SETBACK LINE . �I
TEL. - -APPROVED - ' _ �•- -
CONTRACTOR p• NO. R BY DATE
USE APPROVED
ADDRESS q.3]._4 V-1 a Pico Blydo ZONE C-- BY DATE'
LEGAL
DESCRIPTION I LOT NO. I BLOCK CORRECTIONS
TRACT
NO. OF 1111.13131111.
SIZE OF LOT I NOW ON LOT ,
USE OF I NO.OF I NO. OF
EXISTING BLDG. FAMILIE® ROOMS
DESCRIPTION OF WORK
NEW ALTERATION 1 ADDITION O
REPAIR MOVING DEMOLISH D
Sq. FT. No.or Z
SIZE ROOMS 1ITO.RIES r
WALL ROOF
COVERING COVERING
uscOF NEW /� r `sem
BUILDING /i
1 HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOUNDATION: LOCATION, INSPECTOR DATA:
AND.AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS-
AND.STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME. FIRE STOPS,
SIGNATURE OR
BRACING, BOLTS
OWNER LATH, INT.:
AUTHORIZED AGT_4/� ,A�rA � 'LATH, EXT.S
P.C. PLASTER, INT.
P -
FEE EPLABTERP EXT. �y �f? M
VALUATION n�205o00 FEE ® FINAL
l� WORKERS'COMPENSATION DECLARATION
su ; acertificate self
certificate of Workers' Insurance, ` PERMIT
RM I TnAPPLICATION FOR BUILDING
or a certified copy thereof(Sec. 3800, Lab. C.) '
R2
COUNTY OF LOS ANGELES � BUILDING AND SAFETY
P No.i�&�' Company_l..lj 1211 TT�6',G � 44
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING (_
ADDRESS OZ /ZI/41 JvcJrj
Certified copy is filed wothncounty buildi i ec- BUILDING .��tion epar ment. ADDRESS 0 51 . LOCALITY ^'nMNEAREST •
Date ApplicaCITY ZIP�/ 1 CROSS ST. w(rCiERTIFI ATEOF EXEMPTOM WORKER i. NO.OF BLDGS. ASSESSOR
COMPENSATIOANCE SIZE OF LOT Q X, J NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for oneG USE Z E MAP
hundred dollars($100)or less.) TRACT J 1�1 BLOCK LOT NO. NO.
TEL. �+ ,fie y� SPECIAL
I certify that in the performance of.the work for which this OWNER {r M J NO.ZP ` J CONDITIONS
DISTRICT GROUP TYPE FIRE SSE BY
• permit is issued, I shall not employ any person in any manner ry- ZONE � '
ADDRESS (j ■ CON ,
so as to become subject to the Workes'Compensation Laws. rg
�j /
Date Appjicant CITY-re M ZIP ��"/ STATISTICAL CLASSIFICATION ' `APT. CO bo
ARCHITECT O p�" TEL. IJ
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER eW 1 S NO. D�' �d CLASS NO. DWELL. 11NITS w
'Exemption, you should become subject to the Workers' _ _
Compensation provisions of-the Labor Code, you must forth- ADDRESS Z� M SEWER MAP
,with'comply with such provisions or. this permit shall be //��__ /`
deemed revoked. CONTRACTOR .(�• C�/� • " NO. �_
e)
Qf BK PG YJ' VALIDATION
LICENSED CONTRACTORS DECLARATION • LIC.
I hereby affirrn that I am licensed undef provisions of Chapter 9 ADDRESS , NO VALUATION
(commencing with Section 7000)of Division 3 of the Business and M • LIC.
Professions Code, and my license is in full force and effect. CITY 1•FD A • �• ' CLASS- " � $
License Number ,P O ogaq. Lic.Class �—r
Sq.
ZE��7 S DRIES I FAMILOF NO. IES � CONE ,
Contractor Q O ii f<Ql�' Date 3 DESCRIPTION OF WORK �� NEW $
I am exempt under Sec. Am A • I ADD.
ALTER FINAL
B.&P.C. for this reason REPAIR DATE :2 o
Date:• USE OF DEMOL FINAL f
EXISTING BLDG. T �i� . 0 By :cJ¢-e-C.-►.J
i. Signature APPLICANT //� ' TEL.
OWNER-BUILDER DECLARATION PRINT 'lAll.D i�J, O. I
I hereby affirm-that Lam exempt from the Contractor's License ''` �
Law for the following reason (Section 7031.5, Business and ADDRESS �� '� ,
,Professions Code): PRESENT ��
BUILDING
13 4as owner of the property, or my employees with ADDRESS
wages as their sole comperisation,will do the work and ;
the'structure is not intended or offered for sale(Section 4'0CALITY
7044, Business and Professions Code). MOVING TEL.
I,as owner of the property,'am exclusively contracting CONTRACTOR NO.
with licensed contractors to"construct the project (Sec- ADDRESS J
'tion 7044, Business and Professions Code).
REQUIRED, YARD HWY TOTAL SETBACK FROM EXIST.
CONSTRUCTION-LENDING.AGENCY SET BACK PROP..LIN 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. °
tsec. 3097, Civ. C.): SIDE G• 4, t,
ii P.L.
Lender's Name S ? G
P.C.Fee$ Permit'Fee C
..
Lender's Address
I certify that I have read this application and state that the Issuance Fee r
above information is correct. I agree to comply with all County Investigation Fee ;
ordinances and State laws relating to building construction,
and hereby authorize repro motives of.this County to enter Total Fee ..
o the above-me one operty fo spectiori.pur oses. ,I
¢ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature f A i t o A ent 'Date)
g tura o p can g