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HomeMy Public PortalAbout5749 ROWLAND AVE_Building__ APPLICATION FOR COUNTY OF LOS ANGELES OF COUNTY BUILDING PER-MIT DEPARTMENT BUILDING AND SAFETY DNIS ON ENGINEER BUILDING FOR APPLICANT T ILL IN ADDRESS �' BUILDING ADDRESSLOCALITY CIT ZIP q/ �d (� NEAREST CROSS ST. C ✓ NO.OF BLDGS. ASSESSOR SIZE OF LOT ) NOW ON LOT MAP BOOK PAGE PARCE hh DISTRICT GROUP TYPE FIRE OCE D BY TRACT�J BLOCK �r LOT NO. QJ et�00 �L CONSI./ Z1ME TEL. V V �/ J OWNER NL NO. STATISTICAL CLASSIFICATION a l y}S_�EWER MAP ADDRES ,✓ 'CLASS NOa_DWELL.UNITS L,BK/014 zm" 'USE ZONE MAP .2,O G CITY ZIP f� NO. ARCHITECT OR TEL. /QI SPECAL ENGINEER NO. CONDTIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR TEL. BLDG.SETBACK FROM NO FRONT PROP.LINE OF (STREET) LIC. ADDRESS NO. HIGHWAY ' + YARD = TOTAL SETBACK FROM TYPE OF HIGHWAY EXISTING LIC. FRONT PROP. LINE CITY CLASS _ CONSTRUCTION LENDER + NAME AND BRANCH BLDG.SETBACK FROM o ADDRESS CITY SIDE PROP.LINEOF (STREET) C� SQ. FT. NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING O SIZE STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH U DESC TION OF WORK NEW ❑ + y ADD ❑ CORNER CUTOFF YES ❑ NO ❑ ti ALTER ❑ ,r IN OPEN SPACE YES ❑ NO ❑ REPAIR US IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. DEMOL ❑ APPLICANT q, STEL (PRINT) �/v 0. BY (SIGNATURE) I HEREBY ACKNOWLEDGE THAT I HAVE RFA PL IS APICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THEWORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO l�7 WORKMEN'S .C9,MgPENSAT ON INSURANCE.%n SIGNATURE OF FINAL �� 7,4 BY PERMITTEE DATE ',I< ADDRESS TE L. P.C. Fee$ Permit Fee .91 A 7S CITY NO. ` Issuance Fee VALUATION$ (Q / Total Fee , 1 PLAN CHECK VALIDATION CK. M.O. CASH o PERMIT VALIDATION CK. M.O. CASH 9 6 4E-tmv 19 1 D 2 1.7 5 °`:� 76AS36A CE*803B 12/75 �i_> 76A76384CE06031,'-67 APPLICATION FOR BUILDnN PERMI COUNTY OF LOS ANGELES WUI DING :j n-� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINSAUP'T OF BUILDING CROSS ST. �(- DISTRICT NO Gr I TYPE ' Fri Y FOR APPLICANT TO FILL IN O CONST. BUILDING STATISTICAL SSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL UNITS BK PG LOT NO. OS - BLOCK USE ZONE MAP0. © TRACT SPECIAL NO. OF BLDT CONDI. IONS - SIZE OF LOT o �� NOW ON LOT as-rive) USE OF i' BLDG. SETBACK FROM .. OWNER t - C� NOL. FRONT PROP. LINE OF (STREET) g� TYPE OF EXISTING SETBACK HIGHWAY + YARD =• TOTAL ADDRESS?J HIGH AY T FROM C.L. CITY .� BLDG. S TBACK FROM - ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS /� HIGHWAY WIDTH FROM C.L. CONTRACT LIC ADDRESS$ • Lid G(J NO CORNER CUTOFF YES NO O i I CITY CLASSLIC -' ;SEE REVERSE SIDE FOR SPECIAL APPROVALS 1 DESCRIPTION OF WORK NEW ALTER REPAIR DEMOLISH U SQ.FT. NO. OF OOF SIZE SMfA�N✓FAWL-IES USE OF STRUCTURE J(ft N SIGNATURE APPLICANT VALUATION$ � a .00 APPROVALS DATE INSP ECTOR'S910NATU E .P.C. PMT, FOUNDA=ION, LOCATION /�/ j/ fi FEE$ FEE$ r AME, FIRE I/i.Z (`( ,ma y"wel- FRAME, FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS �'Y[1' / i//3'+•[,CJ.L ,,,JO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .FURNACE: LOCATION V WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS Y� 9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK. I ' LATH_. INT.. AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. <), I ING TO WORKMEN'S CO P6!jSATION INSURANCE. - - LATH.-EXT. t � SIGNATURE HOUSE NUMBER COR- I PERMITTEE RECT AND POSTED A A ADDRESS �� FINAL FT D ,- JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M.O CASH i fit 1 7 1 s nI'Ov 15 1 7.2.5- t f � �t WORKERS' COMPENSATION DECLARATION •• 1rebyt'affirm that I, a{ have ertificate of consent to self APPLICATION FOR BUILDING PERMIT ins •, ona certificate. mpWorkers' Coensation Insurance, or°e1rtified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Qolicy No. Company BUILDING ./ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Sly? &A)Z,$PAoZ v� r. ❑ Certified copy is filed with the county building inspec- BUILDING �� /q ��G��� ��� �G� �� J tion department. ADDRESS `� ! j CITY // L,.0 el /�• ZIP 7 l7 d' LOCALITY Date Applicant i NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT St'f X /8,S NOW ON LOT oZ CROSS ST. Q W COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACE BLOCK LOT NO. MAS g00K PAGE PARCEL hundred dollars ($100)or less.) TEL. OWNER �/� �(J/„S �!}, O©/C�. N0..28.J�'I 'J USE ZONE MAP _ 1 certify that in the performance of the work for which this r NO. o permit is issued, I shall not employ any erson in any manner ADDRESS cJ 7 �l�C /t/fj ���. SPECIAL >_so as to become subject to the Work Compensation LawsQ CONDITIONS n- \ / CITY 11�1p6Ii C�J e;V ZIP ` 7ap G O �( Date2Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSE BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. n CONST. V ZONE O Exemption, you should become subject to the Workers' S (~j Compensation provisions of the Labor Code, you must forth- ADDRESS b a with comply with such provisions or this permit shall be TEL. S 71STICAL CLASSI TION APT. CONDO. N deemed revoked. CONTRACTOR NO. Z_ LICENSED CONTRACTORS DECLARATION LI CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS O. (commencing with Section 7000)of Division 3 of the Business U LIC. SEWER MAP CITY CLASS and Professions Code,and my license is in full force and effect. BK PG VALIDATION SQ. FT. A bi NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK S U `� NEW ❑ VALUATI N Contractor Date ; r­j 7 , ❑1 am exempt under Sec. �,�/����� /Jlfy��,Qr ADD 19 ALTER ❑ BAP.C. for this reason /5wa '94X/ 1 REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) 10'eAl II& C'OO/C No.,�Bs%/�7S FINAL I hereby affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS J / �7 ����9�� ��� FINAL 1 Professions Code): PRESENT By El 1, or I, as owner of the property, m o BUILDING P P Y Y employees P Yees with ADDRESS ACCT.8 wages as their sole compensation,will do the work and ® 3307 ~W0 2e the structure is not intended or offered for sale Section LOCALITY o.Sti 7044, Business and Professions Code.) MOVING TEL. I,as owner of the property,am exclusively contracting CONTRACTOR NO. 1 ITEMS with licensed contractors to construct the project (Sec- ADDRESS TOTAL '790 a 25 tion 7044, Business and Professions Code.) CHECK REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. 4a IGGh ��n CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT P. ,(}�I the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name OOO�J-0001 7/12/°' 3 LDMA Ref.# P.C. Fee$ Permit Fet i p,F > Lender's Address / '1 t 1 1 7,y I certify that I have read this application and state that the Issuance Fee / o. l47� �Q LDMA P/C# 3 above information is correct. I agree to comply with all County Investigation Fee �y ordinan es and State laws relating to building construction, Total Fe v, LDMA Perm. # and h by authorize represent 'ves of this County to enter - /upo t e amione �prza nspection purposes. ][ Z12-W SEE REVERSE FOR EXPLANATORY LANGUAGE /` Signature of Applicant or Agent Date