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HomeMy Public PortalAbout4906 RYLAND AVE_Building__ I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING / / ADDRESS f' ( �I -� /� --�-�' 34873- 3/ RECEIVEDB-$ DATE OFAPPL. DATE ISSUED LOCALITY SI_E. ""--? NEAREST CROSS ST. BUI INE ADDRESS OWNER • MAIL ttPPa� LOCALITY / L^ ADDRESS da•'' - NEAREST _ TEL CROSS ST. CITY NO. FIRE NO. OF GROUP ARCHITECT OR TEL. ZONE PLANS I `] �„" ENGINEER NO. BLDG. ORD. NO. SETBACK LINE ":V49 40 ADDRESS APPROVED TEL. BY DATE CONTRACTOR NO. USE APPROVED ZONE/ BY DATE ADDRESS HOUSE NUMBERING LEGAL DESCRIPTION 7LOT NO. BLOCK MAP NUMBER ^Z� / ZI—FIELD CHECK BY TRACT NO. ASSIGNED BY DATE NO. OF BLDGS. A / CORRECTIONS SIZE OF LOT NOW ON LOTy� A �• GT / USE OF I NO. OF c KXISTING BLDG. FAMILIES G - DESCRIPTION OF WORK NEW I - I ALTERATION ( I ADDITION O REPAIR I I DEMOLITION SQ. FT. ,! NO. OF SIZE i C. f ROOMS ��' STORIES Z D EXT. WALL ROOF r COVERING L{,�,�•�^ I COVERING USE OFTRUCTUR - ^) t"- J GLS'•)�,�. ��". n 1 APPROVALS INSPECTOR'S SIGNATURE DATE 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS .fes CORRECT. 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, L HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, SIGNATURE OF ! GAS VENT, DUCTS PERMITTE- LATH, INT. ADDRESS LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 76ASSBA- ossa to-so P. C. $ / Y © 'L Q FEE ( —' PLASTER, EXT. VALUATION FEE $ 2. FINAL f 1. Y,4-"v I �" 14kRKERS'•COMPENSMON DECLARATION • I hereby affirm that I`havecertificate of consent to self insure, APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) c� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nos Company — BUILDING Certified copy is.hereby furnished. FOR APPLICANT TO FILL IN ADDRESS (J Certified copy is filed with the cou�!Idingec- BUILDING ® tion department. ADDRESS Date "_/// o e-een3Applica CITY �L ZIP LOCALITY CERTIFI ATE OF EXEMPT ON FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. im (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL �ZG USE ZONE MAP I certify that in the performance of the work for which this OWNER NO. ! NO. A permit is issued,I shall not employ any person in any manner 91 1 SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS V CITY ZIP IN at Applicant - NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCES D BY ENGINEER NO. CONST. ZO U Exemption, you should become subject to the Workers' /� � / � � Compensation provisions of the Labor Code, you must forth- ADDRESS � 14 �/ � with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CON . Z deemed revoked. CONTRACTOR I L/�f' NO.��.3 LICENSED CONTRACTORS DECLARATION C, CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS D � O. A>t'7 S (commencing with Section 7000)of Division 3 of the Business and J LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY C o CLASS 8 1/ BK.' PGVALIDATION SQ.FT. //� V NO.OF NO.OF CHECK License Number (0 i12 Lic.Class SIZE `7� STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ /� Contractor �I—"' Date �� �� � � � $ (J I am exempt under Sec. eDIJ � �L� ADD ❑ , ALTER B.&P.C. for this reason 5 3 REPAIR ❑ $ Date: USE OF ❑ EXISTING BLDG. 4 ��'/?•t/ DE __L Si nature APPLICANT /n TEL•J i �p //g� FINAL__2 / g (PRINT) � ® NO.'7�i,J 7[Jtf7 ^ !V/y OWNER-BUILDER DECLARATION DAT law affirm that I am exempt from the Contractor's License ADDRESS I riL! -Cu diY/vG 3 3 G,7 A Law for the following reason (Section 7031.5, Business and F Professions Code): PRESENT # 0 0 0 0 0 1 ❑ BUILDING I, as owner of the property, or my employees with ADDRESS Q wages as their sole compensation,will do the work and /J- LI 6 I o 2 1 $6 3 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. o a 21 8 6 3 c=i I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 3 8 5 tion 7044, Business and Professions Code). _ REQUIRED TOTAL SETBACK FRO EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ' f I hereby affirm that there is a construction lending agency for FRONT �) the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE o P.L. o Lender's Name /) LDMA Ref. # P.C.Fee$ Permit Fee (f Lender's Address _ ' I certify that I have read this application and state that the Issuance Fee LDMA P/C# a above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee 3 LDMA Perm. # and her y authorize representatives of this County to enter upon a above- ntioned property for inspection purposes. ; SEE REVERSE FOR EXPLANATORY LANGUAGE Sig tura of Applicant or Agent Da