HomeMy Public PortalAbout6251 PRIMROSE AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES � ' L ® '
wm. d. FOX. CHIEF ENGINEER
NG
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.NO. PERMIT NO.
BUILDING JG� / Primrose Avenue
ADDRESS
(:S;
LOCALITY .4 RECEIVED BY DATE OF APPL. DATE ISSUED
CROOBBER. Wendon St. Temple City
OWNER Meeker Land Company ADDRESS SA2nS.
AMAIL
DDRESS 11236 E. Live Oak Ave. LOCALITY
TEL. DO-72151C'ROSS ST.
CITY REBT
Arcadia D. _
FIRE 140.or TYPE OROU
ARCHITECT R TEL 2 ZONE PLANE
ENE _0
ell NO. FL-7! 20
BLDG. j RD.NO.
ADDRESS SETBACK LINE g0070%4,-
APPROVED '
CONTRACTOR NOL
.' BY DATE
USE9 APPROVED
ADDRESSZONE / BY DATE
LEGAL DESCRIPTIONLOT NO. J+2 BLOCK �.�z'i'-O � CORRECTIONS
TRACT 17179
e�
SIZE OR LOT 14 /x91 I NO.OF NOW ON LOTS' none s� f)', Q
UBE 13none NO.OF NO.OF
EXISTING BLDG. FAMILIES ROOMS
DESCRIPTION OF WORK
NEW x ALTERATION ADDITION
REPAIR MOVING DEMOLISH D
:0-E ' 1118 NMI, 6 1 Z
ROOMS STORIES >
WALL
COV RING Plaster I COVERING Oor W.Shgleso
USE N
BUILDIDI NGEW Residence
Plan 1-C
Garage 18 x 20
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IB CORRECT P
FOUNDATION: LOCATION I ECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMAT MATERIALS i1
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FI RE STOPS, ,'
SIGNATUR ER LA pA BRACING.BOLTS 1 1'
PERMIT, _LATH, INT.
AUTN LATH, EXT.
76A69BA-9 7-49 $ g�:/�/ P.C,S .�/J PLASTER.INT.
FEE //i� r PLASTER.EXT.
VALUATION QV FEE FINAL
WORKERS' COMPENSATION DECLARATION L t
I hereby affirm that I have a certificate of consent to self Oki � � IT
«;•insure, dr•o certificate of Workers' Compensation Insurance, e
gr a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. 'Company
BUILDING
❑ Certified copy is hereby furnished. FOR APPLIC ANTf0jFTLIL IN n ADDRESS 9:::a?,J7
❑ Certified copy is filed with the county building inspec- BUILDING -
tion department. ADDRESS ((S/
Date Applicant (°CITY/ Or-/. C •ZIP l�� LOCALITY
NC OF BLDGS. ® NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' t SIZEOF LOT OCA �, NOW ON LOT CROSS ST.
COMPENSATION INSURANCE / ASSESSOR
(This section need not be completed if the permit is for one TRACT® �/'y BLOCK LOT NO. F MAP BOOK �� �� PAGE PARCEL
hundred dollars ($100)or less.) NR'�'3d9r SE ZONE MAP
OWNE NO. o�� aZ�
I certify that in the performance of the work for which this SPECIAL �
permit is issued, I shall not employ any person in any manner ADDRESS 2 / /� '� CONDITIONS
so as to become subject to the Workers'Compensation Laws. Q
`i CITY 'o'R � ZY ZIP 1 U
Date Applicant ARCHITECTTEL. Ix
NOTICE TO APPLICANT: If, after making This Certificate of ENGINEER Q �� NO DISTRICT GROUP TYPE FIRE PROCESSED BY Q
Exemption, you should -become subject to the Workers' ,�,)l CONST. ZONE
Compensation provisions of the Labor Code, you must forth- „ ADDRESS/40/G / _% -yw, a��� -� �/ a
with comply with such provisions or this permit shall'be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N
deemed revoked. CONTRACTOR NO. Y7
Z
LICENSED CONTRACTORS DECLARATION //' LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS(p zS — NO. Y _
/� SEWER MAP =){.,• I e s
(commencing with Section 7000)of Division 3 of the Business s CITYL &4f l r IICASS q
and Professions Code,and my license is in full force and effect. B�PG.91AA Z V/1LIDATION `i e y
SQ. Fi[A43 NO. F NO.OF CHECK
License Number Lic. Class SIZE dd ''YY STORIES FAMILIES ® ONE i I711C
r VALUATION
Contractor Date DESCRIPTION OF WORK �� r» NEW �" I i a=
ADD ❑ $ �`�`,� AL. `j ' 1 -�rt
ElI am exempt under Sec. '� �� �44y� ALTER ❑ Poo `-irl"{ 3+' _3u
ie:!
B.&P.C. for this reason REPAIR ❑ ' $ VANE J'
USE OF
Date: EXISTING BLDG leq �� DEMOL ❑. alL,.. =
Signature APPLICANT L• FINAL
OWNER-BUILDER DECLARATION QQ
(PRINT AJ $� O. `L7O A
I hereby affirm that I am exempt from the Contractor's License 7 a4 i y 771-11E, AM �-i`
Low for the following reason (Section 7031.5, Business and ADDRESS /='=11'rD�' a FINAL
"I-„
.Professions Code): 4 PRESENT�� _ ,2- By t CMA �'-+ta- .g
11L�P I, as owner of the property, or my employees.with ' <ADDRESS _ if =r' '
wages as their sole compensation,will do the work and = ' -"!•-='
the structure is not intended or offered for sale(Section . LOCALITY
7044, Business and Professions Code.) MOVING TEL. -14 A'
❑ I,as owner of the property,am exclusively contracting i; ILA CONTRACTOR NO.
with licensed contractors to construct the project (Sec,
rADDRE ?f_f'I_I-`ll'1;�i
tion 7044, Business and Professions Code.) I ... ..;
TOTAL SETBACK FROM EXIST. -• s•,
CONSTRUCTION LENDING AGENCY i YARD HWY PR LINE WIDTH ,!_!/3 ! �' %�,
Thereby affirm that there is a construction lending agency for i
the performance of the work for which this permit is issued - 'i'' } ' • 1
(Sec. 3097, Civ. C.). s 1
Lender's NameLDMA Ref`N,
Lender's Addressd� Permit Fee 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 n Fee Q
ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
and hereby authorize representatives of this County to enter ,
(Mthe=bove=mentionedprop�ertyfor nspection rp es.
�'° L 1 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent D e