HomeMy Public PortalAbout4809 RYLAND AVE_Building__ DEPARYNT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ®I
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT3�8�3-7/ S b'S`3 1 PLAN CK. NO. PERMIT O��
BUILDING /�'�.\ % A/ R ' � / F
ADDRESS �j V /J [�I
LOCALITY r d �^� REC E;BY DATE OF APPL. DATE ISSUED
NEAREST / �/ A
CROSS ST, /'P.1rr '-/Il r..r BUILDING
ADDRESS 4 ��.t�f✓
OWNER I � J, $ - I I'1 6,Q ori �O l' •••
MAIL -r^
�'- LOCALITY
ADDRESS Kq /7 5 4a 5 ,/V o S 7 . NEAREST
- TEL7�//� �j CROSS 8T. �,_L �, �d
CITY g/7//, P C/ V N0.' / GP �/p FIRE I NO. OF IipYPE u I GROUP-`
ARCHITECT Olt TEL ZONE PLANS ti-s
ENGINEER NO. BLDG. D. NO.
SETBACK LINE
ADDRESS r APPROVED
TEL BY DATE
CONTRACTOR f /p///S-!�f flrf i)QNO. �/�r(p �p ZOSE
NE �' APPROVED DATE
ADDRESS •15Z_ 3 7 �^ .� S �yJ` 5 �C, HOUSE NUMBERING
LEGAL
DESCRIPTION I LOT NO. 2-A / V FIELD CHECK BY�.� BLOCK MAP NUMBER
TRACT 1 '710t7 NO. ASSIGNED BY DATE
.��n n I
NO, OF BLDGS./�/O y� CORRECTIONS
SIZE OF LOT NOW ON LOT ]�
USE OF I NO. OF
EXISTING BLDG, FAMILIES /CJ�. /� /
4l I ••-+
DESCRIPTION OF WORK
NEW I ALTERATION I I ADDITION
0
REPAIR I I DEMOLITION I I I
Q. FT, /per,C NO. OF D
SIZE / .J "• ROOMS STORIES z
S� I a
WALL ROOF Ul'd ad
�/J-/ r
lCOVERING COVERING 3;
USE OF STRUCTURE
APPROVALS 7
.•L't"" INSPECTOR'S SIGNATURE DATE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS �'„/.;j-!._.- �•'iff�!�.tt
COI AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME:FIRE STOPS
HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, HOLTSZ:�—_
LAWS REGULATING BUILDING CONSTRUCTION. - FURNACE: LOCATION,
SIGNATURE OF. j / i � GAg VENT, DUCT8 �J7y�f ry/
'I�••C.;'"fd�t•l _
LATH, INT.
ADDRESS IZ
Y� •7f [ %YL.1- r J- .L:.'n i�+-'-��' /v
P _ i LATH, EXT. f G'
AUTHORIZED AGT. •t) d 5 l/d
ME F 1111P PLASTER, INT.
7CA638A•Dons I0-50 $ IF
. C. $
® 7 2-c-9OEE G �- PLASTER, EXT.
VALUATION EE $ Z'I �%' FINAL
• I
WORKERS'COMPENSATION DECLARATION I
hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T
insure, or a certificate of Workers'Compensation Insurance, .
or a certified copy thereof(Sec. 3800, Lab. )
/y9 �' I COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policyotj6Lf3��Company,21,07—e :l1eyo BUILDING
Certified copy is hereby furnished. I. FOR APPLICANT TO FILL IN ADDRESS ® 4 Q
❑ Certified copy is filed with the county building inspec- I BUILDING
tion department. ADDRESS
I /I
Date a2 ��� Z?lpplicant r I CITY' / ` ZIP LOCALITY
I NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FR WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSU NCE
(This section need not be completed if the permit is for one ; TRACT BLOCK LOT NO. ASSESSOR MAP BOOK PAGE PARCEL
hundred dollars($100)or less.)
OWNER p• USE ZONE MAP
I certify that in the performance of the work for which this SPE
CIAL
permit is issued, I shall not employ any person in any manner I ADDRESS Q CONDITIONS a-
so as to become subject to-the Workers'Compensation Laws. OO
CITY L- ell ZIP ae
Date Applicant I ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE P CESSED BY O
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO.
rs' CONST. Z E
Exemption, you should become subject, to the Workew
15
Compensation provisions of the Labor Code, you must forth- ADDRESS �/t� J I� a-
with comply with such provisions or this permit shall be ,,, TEL STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR / NO ?, —
LICENSED CONTRACTORS DECLARATION // r--, LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9, ADDRESS • 16 NO.J4e2JZ7 2
SEWER MAP
(commencing with Section 7000)of Division 3 of the Business I LIC. n g
and Professions Code,and my license is in full force and effect. ' CITY + /�/0 Cl C�7 BK PGVALIDATION
License Number_• r��2'• Lic. Class
S. FT; STORIES NO.OF ONEK
p G G VALUATION
Contractor tl&g mfg/ 412�Date (� �j —? I
DESCRIPTION OF WORK I ® /C AND $ �7 �a 0B
❑I am exempt under Sec. (((:/"D' &QcALTER ❑ OL ►
B.&P.C. for this reason / REPAIR $
Date: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT FINAL
OWNER,4VtDER DECLARATION i (PRINT) N iP 7/vIF7, DATE
1 hereby affirm that I c exempt from the Contractor's License /p
RESS
Law for the following reason (Section 7031.5, Business and ADD B e e,dJ.4/W M16siJe'0Q FINAL
Professions Code): PRESENT By
BUILDINGr
I, as owner of the property, or my employees'with I ADDRESS �='�•(=g
wages as their sole compensation,will do the work and I LOCALITY , IJ j 98.63
the structure is not intended of offered for sale(Section
7044, Business and Professions Code.) MOVING TEL. T.�_ ..O
❑ I,as owner of the property,,am exclusively contracting CONTRACTOR NO. rr F z I Ulb'
.With licensed contractors to construct the project (Sec- ' A4DRESS. 11iLaF.� a +.k
tion 7044,-Business and Professions Code.)
REQUIRED TOTAL SETBACK FROM • EXIST. CHECK
�
CONSTRUCTION'LENDING AGENCY ' SET BACK YARD HWY PROP. LINE WIDTH '��-�'�t �L'■ +�
I hereby affirm that there is a construction lending agency for FRONT CHANGE ■lili
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C,). SIDE
P.L.
Lender's Name p/'
B P.C. Fee$ Permit Fee p O LDMA Ref.# L 718 1 AN f 1:138
Lenders Address � LU
I certify that I have read this application and state that the Issuance Fee ' 7� LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating tb building construction, Total Fee Z a ° 46 LDMA Perm. #
and he by authorize r aresentatives of.this County to enter
upon t above-menti ed proper for inspection purposes.
!.� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature Applicant or Agent Date ,