HomeMy Public PortalAbout6052 ROWLAND AVE_Building__ JFaS-3 23M SETS :0-46 'll—T
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX' CHIEF ENGINEER B QJ 0
FOR APPLICANT_TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.NO. PERMIT NO.
BUILDING
ADDRESS y!
1-� G n
LOCALITY AA/- E�fEIVED BY DATE OFAPPL. DATEtISSUErD�
NEAREST 6J r-1�^ D ! ✓VI `� �I Z'._ 11 • L/ /
CROSS ST. I� I� BUILDING
A1I (j��
OWNER
/J 0. 8 O C7 •r [� if�] _ADDRESS (9 UJ L A\(\,i'J
MAIL
ADDRESS qv OA
LCLITYNEAREST
�P �Y I p ! v
.1 if TEL. CROSS ST.
CITY V-- � 1T! NO. _
FIRENO.OF I TYPE _ GROUPS
ARCHITECT OR TEL ZONE PLANS
ENGINEER NO.
BLDG. r ORD.NO.
ADDRESS _SETBACK LINE S O 'l`C 4`
APPROVED
TEL.
CONTRACTOR 0. BY DATE
USER_ APPROVED
ADDRESS ZONE BY DATE
LEGAL
DESCRIP/TIO/N/I LOT NO. CORRECTIONS
� BLOCK
TRACT (1) I� �) SAO FT g;I W l)-
I' NO.OF SLOGS.
SIZE OF LOT SQBI'I,i y JI�1A1 I NOW ON LOT
USE orEXISTING BLDG. C.�l/,L`d rl�/�l-I FAMIND.LIES ( I ROOMS
DESCRIPTION OF WORK
NEW I ALTERATION ADDITION
O
A
REPAIR MOVING DEMOLISH p
Sq.FT. NO.OF Z
SIZE ROOMS STORIES r
WALL �'i� ROOF
COVERING t^'�V1�1�-G I COVERING
USE or NBu LDINGG GC/,�/ftnRui 5_1"npIA
dA d 3'
1 HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE��
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FIRE STOPS,
SIGNATURE OF . BRACING,BOLTS
OWNERih
J'`5�� LATH,INT.:
AUTHORIZED AOT. /// LATH,EXT.:
$ v P.a.$ PLASTER. INT.
FEE PLASTER, EXT. ' I
$ w
VALUATION FINAL
FEE i I'`r
WORKERS'COMPENSATION DECLARATION
sure, o affirm that I have a certificate of consent to self A P P L I C��T�I®N I•®R WILDING I L®I N G P E RM I T
insure, 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
❑
•
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDR S•ADDRESS �j Ire;Z
❑ Certified copy is filed with the county building inspec- BUILDING D 1 a r,�
tion department. ADDRESS �� �0�L49ND
Date Applicant CITY- -Tarnlqte 07 4ZIP C LOCALITY
N'
.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE.OF LOT S Now ON LOT D fv& ;CROSS sr.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the.permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL
OWNER (- NO,S�QS 2. L USE ZONE MAP
I certify.that in the performance of the work for which thisr NO.
.dd�,�� �vn SPECIAL d
permit is issued, I shall not employ any person in any manner ADDRESS 5ft e: ^—-� CONDITIONS O
so as to become subject,to the.Workers'Compensation La s. U
CITY ZIP ?.
Date ZApplicant ' ARCHITECT OR TEL. DISTRICT GROUP TYPE . TFIRE PROCESSED BY 0
NOTICE O A PL(CANT: If, after making this Certificate of ENGINEER NO. CONST. 9NE
Exemption, you should become subject to the 'Workers' rj LU
Compensation provisions of the Labor Code, you must forth- ADDRESS a
with comply with such provisions or this permit shall be TE ( STATISTICAL CLASSIFICATION APT. J CONDO. V)
deemed revoked. - - "CONTRACTOR � / - h::
Z
LICENSED?CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS
.—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
(commencing with Section 7000)of Division 3,of the Business
LIC. SEWER MAP
and 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 STORIES FAMILIES ONE s
DESCRIPTION OF WORK (, —/�� — NEW ❑ VALUATION
Contractor Date • $ ® O
ADD ❑ ►
❑I'am exempt under Sec. /f')
ALTER ❑
B.&P.C. for this reason $
USE OF REPAIR ❑
Date ' -
EXISTING.BLDG. RI:S !/�': �'L,`•. CIEMOL ,
Signature APPLICANT
S! • .?� �f 1�'`� �,Or�S 2t,r� FINAL
OWNER-BUILDER DECLARATION I O. ��v7' NO.
I hereby affirm that I am exempt from the Contractor's License \.l DATE
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL -
Profe ' ns Code): PRESENT By.
I, as owner of the property, or m o BUILDING
P P Y Y employees P Yees with ADDRESS L� �./�• J w `s :� + 1' i_:t
• wages as their sole compensation,will do the work and LOCALITYthe structure is not intended or offered for sale(Section -^i:: •
7044, Business-and Professions Code.) MOVING TEL. =• -
❑ I,as owner of the.property,am exclusive) contracting CONTRACTOR NO. �.,i. i�•.;•_;•x ^-;
P P Y, Y 9 I •i:;s of .��_=-� _-•-.3•�,-.
with licensed contractors to construct the project (Sec- ^-
ADDRESS f.��-t-.:• �'' n '
tion 7044, Business and Professions Code.) ,.I-4}•; • ;j,;,.::
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH :•L:.° ,;•;r' ".E^
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
3 Lender's Name / I O 56-
Q Q O .LDMA Ref.# Y s t
P.C. Fee$ Permit Fee - - 1 '
Lender's Address
I certify that I have read this application and state that the I' Issuance Fee LDMA P/C#
above information is correct. I agree to comply with all County ` Investigation Fee /D�,
ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
and hereby authorize representatives of this County to enter
upon the,.abJove-menti nedoperry for inspection pour jses,s.
Z- SEE REVERSE-FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent -- Date �-