HomeMy Public PortalAbout5927 ROWLAND AVE_Building__ A R E T. E M IRT-I �RZEQ
D.
FOR ANY MATERIAL-STORAGE OR WORK_
DONE IN THE 'ROAD RIGHT OF WAY.
78A888A CE x8088.88 • APPLICATION FOR BUILDING PO IT _ 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
5
BUILDING AND SAFETY DMSION LOCAL
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D:GRIFFIN 'SUP•T OF BUILDING CROSS ST.
DISTRICT NO. I GROUP T•Yp PR CESSED BY
FOR APPLICANT TO FILL• IN fall I CONST.
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS B PG/
r / CLASS.NO.2-DWELL.UNITS Q /25.
LOT NO.• Q _i BLOCK - MAP ' STATE YES''
�I NUMBER HWY.
TRACT 6�I �D USS ZONE SPECIAL
SIZE OF LOTS' I�T a I NOW ON LOTS Z / CONDITIONS
USE OF I s �
EXISTING B BUILDING YARD HWY STREET NAME.- EXIST.
SETBACK WIDTH
OWNER ° FRONT
MAILP.L.
ADDRESS ' SIDE
TEL. P..L.
CITY NO. INSPECTION RECORD
ARCHITECT OR TEL.
I ENGINEER NO.
ADDRESS �p
' CONTRACTOR
ADDRESS
DESC O F WOR$: x7 //'
�� /)S/S:
NEW ADD ALTERS REPAIR EMOLISH
SQ. FT. NO. OF- NO. OF
SIZE STORIES FAMILIES
STRUOF
SE
CTUR `S� "�r7 >'�.� �ir ��]P'Br"' =�►j-- . :17""
SIGUSENATURE OF / 7/1'�/rI,rA,9)
APPLICANT
a. APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS S' FOUNDATION:MATLOCATION
CA IONFORMS /i-
VALUATION$ FRAME:FIRE BRACING,BOLTS STOPS.
FORNACE:LOCATION,
FEE S FEE GAS VENT.DUCTS
. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. -213 40
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
$TATE LAWS REGULATING BUILDING CONSTRUCTION. %TH,EXT.
SIGNATURE OF USE NUM ER COR-
PERMITTE i:sCT AND POSTED —"
ADDRESS FINAL ,9 6r*416_10
416_J1.
CLYDE N. DIRLAM. PRINCIPAL STCT AL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT-VALIDATION• CK. M.O. CASH
uluo 2 ."1 4 7� JUN13 - 1. o .0 r�
hereby a I°hovea certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance, APPLICATION
PPL'CATI®N FOR: BUILDING PERIT �
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
r .
Policy No_ Company BUILDING I?
j 0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN 'ADDRESS l
Certified copy is filed with the county building inspec- BUILDING r
I tion department. ADDRESS a LOCALITY
NEAREST
Date Applicant CITY ZIP CROSS ST.
-CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. / ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT (/ NOW ON LOT i MAP BOOK PAGE PARCEL
USEZNE MAP.(This section need not be completed if the permit is for one i
hundred dollars($100)or less.) TRACT BLOCK LOT NO. d iJ NO.
1 certify that in the performance of the work for which this SPECIAL
OWNER 'rf . ! Z I
TEL
0 7� C/ CONDITIONS IL
permit is issued,I shall not employ any person in any manner ADDRESS V `{ G 5/ DISTRICT TUP TYPE FIRE BY O
ONE
so as to becom s ject to the Workers'Compen Laws. �O� QCONST / Z
I Date`� Applicant ARCHITECT OR ZIP TEL STATISTICAL CLASSIFICATION APT.
NOTICE TO APPLICANT: If, after making this a ificat of
Exemption, you should become subject to ENGINEER NO.Workers' CLASS NO. DWELL.UNITS IL
Compensation provisions of the Labor Code, you must forth- ®.
Pe P Y ADDRESS SEWER MAP 44
with comply with such provisions or this permit shall be
deemed revoked. CONTRACTOR pBK. PG,
. VALIDATION
LICENSED CONTRACTORS DECLARATION LIC, .171 SO A
i 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Zd NO. VALUI�TION
(commencing with Section 7000)of Division 3 of the Business and UC, �/fir.D/t%1 # e e e s 23
Professions Code,and my license is in full force and effect. CITY CLASS $
SQ.Fr./06VNO OF 1 NO.of / CHECK poll e 3 7&0 5
License Number Lic.Class SIZE STORIES / /�F-A('MILI`ES ONE
t Contractor Date DESCRIPTION OF WORK V �7 {, NEW $ • •3 7&0 5 0
1 am exempt under Sec. ADD
ATTER 0 FINAL 06024,87
B.BP.C.-for this reason REPAIR [] DATE
Date: USE of EAO�I FINAL rEXISTING BLDG.
Signdture A�PT .RIN rJUZN
—a ✓� J `
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License
Law for the following reason (Section 7031.5, Business and ADDRESS
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 [AD
ALITY t
the structure Is not intended or offered for sale(Section
7044, Business and Professions Code). VING TEL.
1,as owner of the property.am exclusively contracting NTRACTOR NO.
with licensed contractors to construct the project(Sec- DRESS JL
tion 7044, Business and Professions Code).
QUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY T BACK YARD HWY PROP.LIN WIDTH ® p t
I hereby affirm that there is a construction lending agency for RONT \`
the performance of the work for which this permit is issued .L.
Isec.3097,Civ.C.). IDE /
m
.L.
� e Lenders Name nil
f� _
Lender's Address Fee E U Permit Fee V
I certify that 1 have read this application and state that the
Issuance Fee
i above information is correct.I agree to comply with all County Investigation Fee
ordinance and State relating to building construction, Total Fee
and her y authori ICatives of this County to enter
u on a
tion roperty for inspection purpo 2,
� // SEE REVERSE FOR EXPLANATORY LANGUAGE - -
1 i Signatu of Ao"d Date ®s