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HomeMy Public PortalAbout4917 ROBINHOOD AVE_Building__ 76w048w 059ea s_aaAPPLICATION FO R U L®-I N G PERMIT , 1 ;DIVISION OF SZIILDING AND SAFETY ADUILDINGDRESS" lok ^ q'qi Department of County Engineer County of Los Angeles LOCALITY WM.J.FOX,COUNTY ENGINEER NEAREST q0tan u® CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO.. GROUPSEWER,- MAP. TYPE FOR APPLICANT TO FILL IN � I CONST. _e PG i BUILDING. .a MAP- �} - STATE•. '4i'! .' ADDRESS NUMBER DI Q 1IWY YES N LOT NO. F) BLOCK USVONE+ SPECIAL J. CONDITIONS TRACT 1 q04M 5000 NO.•OF BLDGSy BUILDING 'EXIST. SIZE OF LOT I NOW,ON LOT non SETBACK YARD HWY STREET NAME WIDTH USE OF FRONT,_ EXISTING BLDG- P.L. 20 Rdb inh 0.0d' _ 501 OWNE*CP.rj IPj-.'h F. Wj 11 i pmg pl LL. E Ao IL 4924 Rob inhood Avenue O TRACT DWELL. I UNIT 5 INDUSTRIAL _ CITY elft a TO 4�• L. 1 U 6 PUBLIC'BLDG. 2 DUPLEX 1 UNIT ARCHITECT OR TEL. 7 ADON..ALT.. ETC. ENGINEER. None NO. $ APT. UNITS �' - 8. MISCEL. _ ADDRESS 4 -COMMERCIA TEL CONTRACTOR Above NO.! i INSPECTION RECORD ADDRESS � '' �,/� � - /(� �- r.,%i •' .. DESCRIPTION OF WORK, lr� NEW X:: ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF r t SIZE 14'78 STORIES _]i FAMILIES /� o USE OF STRUCTURE s r Q 7 -41 ' SIGNATURE.OF� APPLICANT APPROVALS /\Cy ADDRESS DATE IJNSPECTOR'S SIGNATURE Jt6 FOUNDATION:LOCATION 6 Q O P.C. S '�,�+' FORMS,MATERIALS rl" ./ . e✓!41`U �7 �61 FEE FRAME: FIRE'STOPS, VALUATION $ BRACING.BOLTS FURNACE:LOCATIO , p �• I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT' DUCTSN APPLICATION AND STAT THAT THE ABOVE IS CORRECT AND AGREE TO COMP L WITH ALL COUNTY ORDINANCES LATH.INT. J 7 _0411f AND STATE LA S R GULATING•-BU DING CONSTRUC- TION. LATH.EXT. ��o � ' -�+✓ - SIGNATURE O If HOUSE NUMBER COR- � PERMITTEE RECT AND POSTED- ADDRESS— OSTEDADDRESS -FINAL - •WM.J.FOX,COUNTY ENGINEER _7 VALIDATION C,N. DIRLAM,CHIEF'BLDG: INSPECTOR LACE 4 § 5"i SEP 17 2. 3 A . 2 107 5 :M - UG5 0 6;0 SEP 19 1 A 4 3.5 0 APPLICATION FOR BUILDIN PERMIT FOR APPLICANT TO FILL IN (Print or type only) A BUILDING + BUILDING JL III ADDRESS CJ JJ� D• j ADDRESS CITYT ' r C,� ZIP !3o l LOCALIT NO.OF BLDGS. NEAREST SIZE OF LOT NOW ON LOT CROSS.ST. TRACT BLOCK I LOT NO. ASSESSOR MAP BOOK PAGE P RCEL TEL. _aTRICT ROUP TYPE FIRE P CESSED BY OWNER S� _ ` p_9 CONS r_s . ADDRESS I- �� ti ; /J'C' � CITYT45 }i Pj& -� � , / ZIP '_G ' 7�C) STATISTICAL LASSIFICATION �� SEWE�-P CLASS N DWELL.UNITS BK_.J` PG ARCHITECT OR TEL. ENGINEER NO. IASEtZONE NOP ADDRESSww�� SPECIAL TEL. `� CONDITIONS O ROAD DEPARTMENT APPROVAL REQUIRED CONTRACTOR NYES❑ NO❑ LIC. ADDRESS NO. BLDG.SETBACK FROM CITY LIC. FRONT PROP.LINE OF (STREET). CLASS•- _ TOTAL-SETBACK FROM TYPE OF EXISTING CONSTRUCTION LENDER HIGHWAY + YARD - NAME AND BRANCH FRONT PROP INE IGHWAY WIDTH ADDRESS CITY + SQ. FT. NO. OF NO. OF CHECK BLDG.SETBACK FROM C) SIZE STORIES FAMILIES ONE SIDE PROP.LINE OF (STREET) '"z CK VI NEW HIGHWAY + YARD = l' AL SETBACK FROM TYPE OF EXISTING 0 DESCRIPTION OF WORK v, SIDE PROP. LINE HIGHWAY WIDTH F. ADD ❑ - Lu ALTER ❑ +\ y EPAIR 1:1 CORNER CUTO F YES ❑ NOUSE OF ❑ Z t✓ EMOL [DIN OPEN SPADE YES ElNO, EXISTING BLDG. �ti(j ❑ APPLICAN • TEL .K " �� IN COASTAL ZONE YES ❑ NO ❑ (PRINT) ,� or �.. CATEGORICAL EXEMPTION YES❑ NO ❑ _ BY (SIGNA T.UR , 057 � r � ENVIRONMENTAL IMPACT EXEMPTION DECLARATION SIGNED • (DATE) VALUATION sd. agaz2fE IMPACT REPORT PROCESSED (DATE) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ' AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY - WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED - HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION of THE LABOR CODE OF E STATE OF CALIFORNIA IN'RELATING TO WORKMEN'S COMP N ATION.INSURA CE. SIGNATURE O s FINAL BY /y�y PERMITTEE �'� r DATE IS -7 If- ADDRESS P.C. .$ /f PMTTY$ TEL. vv i- FEE YY FEE n^ CITY' NO. PLAN CHECK VALIDATION K. M.O. CASH PERMIT VALIDATION -CK. M.O. c sH 8 4 04""APR 24 .1 .9.0 ..98 -76AS38B CENS03A 5/73 .. � WORKERS'COMPENSATION DECLARATION h*reby,affirm that I have a certificate of consent to self q p p L 1 CAT I O-N FOR BUILDING PERMIT 4%sure, or a certificate of Workers'Compensation Insurance, or-a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDINGf Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS bbyl t- Ave Certified copy is filed with the county building inspec- BUILDING I,, tion department. ADDRESS d Y� Qd Q' I e \� 1 � Date Applicant CITY ZIP ! LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST fd , COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. / ICU (This section need not be completed if the permit is for one r ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER J TEL. USE ZONE MAP I certify that in the performance of the work for which this L NO. /�/�r1 NO. SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS f' / —'� CONDITIONS Q.t so as to become subject to the Workers'Compensation Laws. O. Date Applicant N Sl t ( � CITY `� ZIP NOTICE TO APPLICANT: If, after making this Certi icateof ARCHITECT R TEL. DISTRICT GROUP TYPE FIRE PR E ED BY O Exemption, you should become subject to the Workers' ENGINEER NO. CO7T. ZON1E W Compensation provisions of the Labor Code, you must forth- ADDRESS Jh with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICpTION APT. I CONDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (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 BK PG VALIDATION SQ. FT. NO OF NO.OF CHECK License Number Lic.Class SIZE 17,0 ISTORIES IFAMILIES ONE VALUATION_, NEW C3 ( .i DESCRIPTION OF WORK Contractor Date $ ♦ t ADD I am exempt under Sec. ICTU —Jkp &"� ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ 2 8 7 5 3 A Date: USE OF EXISTING BLDG. DEMOL ❑ # 0 0 0 0 o.1 Signature APPLICANT TEL. FINAL g OWNER-BUILDER DECLARATION PRINT h L! NO DATE -- - 4(150 I hereby affirm that 16m exempt from the Contractor's License ADDRESS FI o 0 o4(1500' Law for the following reason (Section 7031.5, Business and .Pro essions Code): PRESENT B / 0 1. 1 2-87 BUILDING I, as owner of the property, or my employees with ADDRESS 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. I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TOTAL SETBACK NE 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 Q► 1 LDMA Ref. #f m P.C.Fee$ Permit Fee (/ � Lender's Address !� I certify that I have read this application and state that the Issuance Fee Vi S� LDMA P/.0 ft t �. R above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee ©r LDMA Perm. 4 H and hereby authorize representatives of this County to enter upon fh above-mentions pro rtVor inspection purposes. m 4 12 [ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Appliaft or Agent Date