HomeMy Public PortalAbout4813 RYLAND AVE_Building__ I
DEPARTMENT..OF BUILDING AND SAFETY APPLICATION FOR PERMIT
M. J,Y OF LOS ANGELES
Wrj ®M. J, FOX, CHIEF ENGINEER U I L 6 Nom G
FOR OFFICE USE ONLY
BUILDING
/f FOR APPLICANT TO FILL IN
ADDRESS !� �� ��/(�J, DISTRICT NO. PLAN CK. [ PERMIT NO,
I
.)' 3A8T3- So�"3
LOCALITY , 17-VREC ET� DATE OF APPL. .DATE ISSUED
.Ey,
NEAREST r f� ZI An
t6ING
/I D0161
CROSS ST, y' ✓'-�
OWNER ADDRESS
tR 2;2
MAILQy� �
ADDRESS
(J D �/ �/J'�/�rl� / NEARESTLOCALITY
CROSS 3T.
CITYTEL NO. & ��� ; L+
FIRE NO. OF s,��,PE G UP
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ARCHITECT O v TEL. ZONE PLANS ��
ENGINEER NO. BLDG. 01%P D. NO.
SETBACKLINE 7 y
ADDRESS APPROVED
TEL. BY DATE
CONTRACTOR i�Il FI"1��NO. USEAPPROVED
ZONF'4�_/ BY DATE
ADDRESS HOUSE NUMBERING
LEGAL LOT NO. 3 I BLOCK MAP NUMBER
DESCRIPTION •� FIELD CHECK BY
TRACT / NO. ASSIGNED BY DATE'
No. OF BLDGS.�j CORRECTIONS
SIZE OF LOT 8 k NOW ON LOT
USE OF I NO. OF ^ (Y
EXISTING BLDG. FAMILIES ` a d(1 2h®�_ a
DESCRIPTION OF WORK -
NEW I te-I ALTERATION I I ADDITION I
O
REPAIR I I DEMOLITIONQ. I I A
SNO* OF
Iz FT. /19 3 1 ROOMS _ STORIES ® Q
SIZE Z
EXT. WALL _{� / ROOF /� r
COVERING Cy 4 C I COVERINGpSJq&k}
USE OF STRUCTURE
J � 7 APPROVALS/
INSPECTOFVlb SIGNATURE DA71E
1 HEREBY ACKNOWLEDGE THAT F HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND'STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS
CORRECT.
I AG
TO COMPLY WITH THE CORRECTIONS LISTED FRAME:FIRE STOPS, n
HER
AND WITH ALL COUNTY ORDINANCES D STATE BRACING, BOLTS i
LAWS REGULATING BUILD G.CONSTRUCTION /� f
%� �/�,+�`b FURNACE: LOCATION,
SIGNATURE OF `J/��rL�isp GI'` C{..°�'a°eo
GAS VENT, DUCTS
PERMITTE �A � � d LATH, INT.
ADDRESS- J/ r n
w - (ivvGt '�of" IDAIf7 LATH, EXT. 7
,AUTHORIZED AGT.
PLASTER, INT.
76ASUBA-DHss so-so $ FEE C.
$ �j / r— .
® Z� �— PLASTER, EXT.
VALUATION FINAL c: ..�1�'7�/�
WOkKERS'COMPENSATION DECLARATION
hereby affirm that I have certificate of consent pelf APPLICATION L I CATION FOR BOLDING P E RM I T
insure, or a certificate of Workers' Compensation Insurance, Is.
or a certified copy thereoiom
ec. 3800, Lab. C.) i a
Folic No Ffl� t f .��u�p 1 COUNTY OF LOS ANGELES { BUILDING AND SAFETY
Policy —�4 pony ti�,Z �r--.X BUILDING! / / 9
1:1 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
ILDINL k
/� Certified copy is filed with the county building inspec- BUILDING !
tion department. ADDRESS j
Date Applicant CITY! C &ZzzieZIP LOCALITY`
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
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.) I TEL.
OWNER NO. USE ZONE MAP
I certify that in the performance of the work for which this I NO.
permit is issued, I shall not employ any person in any manner ADDRESS I SPECIAL
CONDITIONS CL
so as to become subject to the Workers'Compensation Laws. I O
CITY I' ZIP O
Date Applicant ARCHITECT OR TEL. D GOUP TYPE FIREJJRCCESSED BY 0,
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST.'�[�
'Exemption, you should become-subject to the Workers' j c 19y
Compensation provisions of the Labor Code, you must forth- ADDRESS
with comply with such provisions or this permit shall be ITEL. STATISTICAL CLASS( (CATION AP. CONDO. Z
deemed revoked. CONTRACTOR O. _
. LICENSED CONTRACTORS DECLARATION LIC. CLASS,N04�9 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 I• CLASS BK. PG VALIDATION
SQ.F ., NO. OF NO.OF CHECK
License Number •Lic. Class SIZE I STORIES FAMILIES ONE
VALUATION
Contractor Date DESCRIPTION OF RK NEW ❑ $
❑Im aexempt under Sec. !• ADD 10 ►
j ALTER • ;
B.BP.C. for this reason REPAIR $
Date: USE OF
EXISTING BLDG. DEM ❑
Signature APPLICANT TEL. FINAL
OWNER-BUILDER DECLARATION (PRINT) NO.
I hereby affirm that I am exempt from the Contractor's License DATE
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL' 1
Professions Code): PRESENT BY I ACCT,T`
❑ I, as owner of the roe or m employees with BUILDING 0
wages as their sole compensation,will do e ork and ADDRESS 3307 , 10bo 13
the structure is not intended or offered for sale(Section LOCALITY J 1 ITEMS
7044, Business and Professions Code.) MOVING TEL. !
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. TOTAL 106- 13
with licensed contractors to construct the project-(Sec- ADDRESS
tion 7044, Business and Professions Code.) I CHECK 106013
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HwY PROP. LINE WIDTH CHANGE oQ[I
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 I
'(Sec. 3097, Civ. C.). SIDE
P.L., 0000-0001 10/25/89
Lender's Name
B P.C. Fee$ Permit Fee LDMA-Ref. #
6404 1 AM118-07
Lender's Address ,
1 certify that I have read this application and state that the Issuance Fee LDMA P/C#
above information is correct.I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee LDMA Perm. #
and hereby authorize representatives of this County to enter
upon above-mentione erty for'nspection purposes.
o s'� I SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of pplieanor Agent Date j
I