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HomeMy Public PortalAbout5702 ROWLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDINGCOUNTY OF LOS ANGELES � ADDRESS 16"70.7Ale. jowl—'a'm DEPARTMENT OF COUNTY ENGINEER C I TY E Lr (!fr7,v, ZIP 1 ,16 O BUILDING ANDS Y DIVISION NO.OF BLDGSIZE OF LOT�d x a NOW ON LOTS I ADIDRESS o..,—c11 4OF' TRACT BLOCK LOT NO. LOCALITY r TE NEAREST OWNER W. NO CROSS ST. ASSESSOR ADDRESSS 0 2. 130 . LvL40 vim, MAP BOOK PAGE PARCEL y DISTRICT GROUP TYPE FIRE SSED BY CITY Cj,.�.ZIPiD CONST.,--- ZONE ARCHITECT O TEL ENGINEER , W- NO.�i STATISTICAL CLASSIFICATION 'SEWER M. P ADDRESS ' pl DI, CLASS NO.-/'L DWELL.UNITS====] BK-: V& CONTRACTOR NOL' USE ZONE MAP ff LIC. ADDRESS NO. SPECIAL CITY L LIC. CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YE ❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ` ADDRESS CITY HIGHWAY + YARD - 'TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE .2L STORIES FAMILIES ONE } DESCRIPTION F WORK NEWCD ADD ❑ BLDG.SETBACKFROM G% SIDE PROP.LINE OF t:. (STREET) C ALTER [:] HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING t- REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH d USE OF D = a N EXISTING BLDG. DEMOL ❑ + Z AP FRICANT)I, '�r TEL CORNER CUTOFF YES ❑ NO ❑ BY (SIGNATOR ) IN OPEN SPACE YES ❑ NO ❑ `� IN COASTAL PERMIT ZONE YES ❑ NO / ❑ VALUATION:$ © oV fB V 1 HEREBY ACKNOW DGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY r WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- I STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED ' HEREBY I WILL NOT EMPLOY ANY PERSON IN IOLATION OF THE LABOR CODE OF THE TATE OF •CALIFORN A IN RELATING TO V WORKMEN'S COMP ON IN NCE. SIGNATURE O PERMITTEE ADDRES .ItfU. tc:. FINAL BY 'TEL •-�/ CITY NO. gg DATE MAKE CHECKS PAYABLE TO: F.C. $ PMT.:FEE.FEE' FEE �v HARVEY T. BRANDT, COUNTY ENGINEER PLAN'CHECK VA - ON 6��M . CASH 7 PERMIT VALIDATION K. M.O. CASH a60c. a' 49.50A� 7GA638A CE*803 5/74 WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT GS insure, or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800, lab. C.) I COUNTY OF LOS ANGELES I BUILDING AND SAFETY Policy No. - Company BUILDING I 1 ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 5702. /V I D f0 LA ❑ Certified copy is filed with the county building inspec- BUILDING, ) 'j�j �stA,. `� tion department. ADDRESS,7 /,) Z /v r {Z, w L LOCALITY v •--�lip &L / /+ !� NEAREST Date Applicant CITY —ZA4, LA 61 ZIP / v CROSS ST. I V !1 1�-- CERTIFICATE OF EXEMPTION FROM WORKERS' ^/ X r �J(� NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE SIZE OF LOT (This section need not be completed if the permit is for one USE ZONE ESPECIAL P 06 TRACT BLOCK LOT NO. dd hundred dollars ($100)or less.) ILI certify that in the performance of thew for which this OWNER iAnQ /�7! NDITIONS O permit is issued, I shall not employ any p in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY U so as to become subject to the War pensation Laws. ADDRESS '70 'Q z CONST. ZONE /AJ C� .,3 V .,3 Q �C�' CITY � _ 61 ZIP 7- Date Z 74p�lican STATISTICAL CLASSIFICATION APT. CONDO. t,} NOTICE TO APPLICANT: If, after ma ing this Certificate of ARCHITE Imo}. TEL JLU L ENGINEER !1 r! �� fi I CLASS NO. �' DWELL. UNITS D- Exemption, you should become subject to the Workers' 4I1 Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be , r deemed revoked. CONTRACTOR i &L v T L BK. 4PG/10J& VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hefeby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. . 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 $ �d SQ. FT. O.OF ] NO.OF J CHECK License Number Lic.Class SIZES l i STORIES • FAMILIES / ONE Contractor - Date DESCRIPTION OF WORK L 07 NEW $' ❑ I am exempt from the licensing requirements as I am a AA-"14— ADD ❑ licensed architect or a registered professional engineer J ALTER ❑ FINAL acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code). USE OF FINAL EXISTING BLDG. DEMOL ❑ FI Lic.or Re No. _Date APPLICANT /1��/ T �2, Reg. el OWNER-BUILDER DECLARATION (PRINT (il7d�F �I�if� �1 �L,�7'✓�% I hereby affirm that I am exempt from the Contractor's License ADDRESS 5-1-70 Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 0 the structure is not intended or offered for sale(Section LOCALITY /��, 0 2 6 T 7044, Business and Professions Code). MOVING TEL. 77 �' CONTRACTOR NO ❑ . I I, as owner of The property, am exclusively contracting C # 0 0 0 , 0 1 with licensed contractors to construct the project (§ec- ADDRESS T o� tion 7044, Business and Professions Code). 2 - 1 42-00 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDINGAGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT Z o 0 1 1- 0 0 F] `�L . the performance of the work for which this permit is issued P.L. \ l (Sec. 3097, Civ. C.). SIDEf`j_ 1 P.L. Lender's Name � n P.C. � $ f .C. Fee$ V Permit Fee Lender's Address w I certify that I have read this-application lication and state that the � y pp� Issuance Fee a above information is correct. I agree to comply with all County Investigation Fee Ng' g ordinances State laws relating to building construction, / ,OF Total Fee { and hereb thorize representatives of this County to enter m upon b e-mentioned ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE n � ature of Applicant or Agent Dote _ as