HomeMy Public PortalAbout4875 ROBINHOOD AVE_Building__ 141898$ E*809.7.38 APPLICATION FOR BUILDING. PERMIT 1
BUILDING AND SAFETY DIVISION BUILDING 7 e
ADDRESS
Depoxbnent of County Engineer •
County of Los Angeles LOCALITY 1.1
JOHN A.LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS
I My
DISTRICT GROU . YYPE SEW MAP
FOR. APPLICANT TO FILL IN . I x PG
_ CONST. �' v
BUILDING ` TATII
ADDRESS STICAL CLASSIFICATION
I LOT NO. j� BLOCK CLASS. NO. DWEEL��L. UNITS
MAP,. TRACT / �a 3 STATE
NUMBER O 'L/ HWY YES. NO
U E Z NE SPECIAL
J NO.OF BLDGS. :v CONDITIONS
SIZE OF LOT ® I NOW ON LOT
USE OF
EXISTING BLDG. BUILDINGEXIST.
YARp HW.Y STREET NAME EXIST.
WIDTH' .
OWNER s!' �MAIL /� 7 O 'N S j a J FRONT ,4 f - - . _ J5 0
ADDRESS (G 3 S• A?a I p w !AI' P. E �� �V
�j SIDE
NO. /'CUSP P. L.
CITY /�r c� •a.. INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER NO.
ADDRESS •�J / 'f B
CONTRACTOR ' !1.y� /T O NS&1- N0./�� �{ 1
/ ri' S E . — pO!Alr
ADDRESS tY Y.i
4e 6
1
DESCRIPTION OF WORK `s .
NEW ADD ' ALTER REPAIR DEMOLISH _
SQ. FT. NO.OF NO.OF V
SIZE STORIES FAMILIES
U_SE F STRUC RE
I/# A Y kcD
APPROVALS
SIGNATURE OF
APPLICANT_
PPLICANT DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION:LOCATION � �f•• � 1`,
FORMS, MATERIALS /' Al .I P• 6,111
$ Clw P.C. S �'0 FRAME: FIRE STOPS.
FEE J BRACING. BOLTS .e•� .i
®d rFURNACE: LOCATION. iJ
VALUATION6121 FEE f r � CTAS VENT..DUCTS
f
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. !f''7/J��a•�J �i/i/
PLICATION AND ST TE.THA CORRECT AND
AGREE TO COMP WITH L C TY OR NANCES AND LATHEXT
STATE LAWS G LD LSTRuc31ION. ,
SIGNATURE OF HOUSE NUMBER. COR- `` I r •
PERMITTEE RECT AND POSTED fQ 21y
ADD REss FINAL 7
I.OHN A.LAMBIE, COUNTY ENGINEER. 'CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATIO CK.7% M.O. CASH PERMIT VALIDATION CK. M.O. CASH
7 , 4 1
7-7 lis /two X,pr!�c of
WORKERS'COMPENSATION DECLARATION / L.s
I hereby affirm that I have r certificate of consent to self ��L H C /�,T 0 C F®I 3 U : M'T
insure, or a certificate of Workers'Compensation Insurance, lJ 'L..a- kJ"`t� IJP fJ`�
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. �� Company a.
Certified copy is hereby-furnished. I FOR APPLICANT TO FILL IN epWING 3—
Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS LOCALITYNEAESTL
Date--&() Applicant CITY"�J a ZIP 9f 7gL' CROS ST.
CERTIFICATE OF EXEMPTIfM WORKERS' I NO.OF BLDGS. ASSESSOR
COMPENSATION IANCE SIZE OF LOT NOW ON LOT MAP.BOOK PAGE PARCEL
D j
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. yA / NO.USE ZONE MAP ` /
hundred dollars($100)or less.). I TEL. SPECIAL
I certify that in the performance of the work for which this OWNER NO. I CONDITIONS
permit is issued, I shall not employ any person in any manner I DISTRICT GROUP TYPE FIRE PR ESSED BY
so as to become subject to the Workers'Compensation Laws. i ADDRESS �/ CONST. ZONE
S,C?5 3 "Ire 0
Date Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO.
NOTICE TO APPLICANT: If, after making this Certificate'of ARCHITECT OR TEL.
ENGINEER NO. CLASS NO. DWELL. UNITS IIJ
Exemption, you should become subject to the Workers' _ MOMSL
Compensation provisions of the Labor Code; you must forth- ADDRESS SEWER MAP L
with comply with such provisions or this permit shall be ffEL. Z
deemed revoked. CONTRACTOR NO"943462! BK• a m? VALIDATION
LICENSED CONTRACTORS DECLARATION LIC.
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / N 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 $ &,5 f
SQ.FT. NO.OF NO.OF CHECK
License NumberT ,'� _Lic.Class ' ' i SIZE STORIES FAMILIES ONE
t? DESCRIPTION OF WORK NEW ❑ $
Contracto0!1,m L/L�a a o ate t _
am exempt-under Sec. _�_ ((UJJ ADD ❑ , •; .
ALTER FINAL
9
B.BP.C. for this reason 1 REPAIR DATE �.
USE OF / FINAL
D te: j EXISTING BLDG. �" - DEMOL �Cn] By r ' yys.�i
Signature APPLICANT TEL. Y'
ER-BUILDER DECLARATION PRINT NO. /D s
I hereby affirInt,am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS
Professions Code): I PRESENT n• 7 n
❑ BUILDING'
I, as owner of the property, or•my employees with ADDRESS
wages as their sole compensation,will do the work and ° ° a ° °
the structure is not intended or offered for sale(Section I LOCALITY •
7044, Business and Professions Code). I MOVING TEL. [ a.° O u: 7 �
11 I,as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- I �, 4 C 1
'tion 7044, Business and Professions Code). ADDRESS
REQUIRED TOTAL SETBACK FROM EXIST. i}
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH � •C 2. � 5-� 4
1 hereby affirm that there is o'construcfion lending agency for FRONT
the performance of the work for which this permit is issued P.L.
tSec. 3097, Civ. C.). SIDE
0
t P.L.
e
Lender's Name
d•.
P.C.Fee$ Permit Fee
Lender's Address
xI 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
and hereby authorize representatives of this County to enter :. :..,. _. :•..
upon a ab mentioned property for inspection purposes.
a 11 ', SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date es