HomeMy Public PortalAbout4935 RYLAND AVE_Building__ I
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES Ufl
I L®I N G
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL/IN / FOR OFFICE USE ONLY
ADDRESS Gf ;� — /V�� !� // DISTRICT PLAN CK.13
NO. PERMIT NO.
LOCALITY �'/ ('/ � yt RECEIVED � DATE OF APPL. BATE ISSUED
i rr- 17 rs� C 1 �A,Z
NEAREST /'�}
CROSS ST. t9 1 V t- e. f �- /o_ cr B`UY'ING
ADDRESS �►
71
OWNER
ADDRESS
TS (J - r� LOCALITY
ADDRESS b (/J� �r I � / .—' .NEAREST
CITY �Y li[tiC J NO.' R/ Y J � FIRE CROSS ST. "^OF �Ea.� R UP 1
ARCHITECT OR
TEL ZONE I PLANS �+ (f I (J
ENGINEER v NO. , BLDG. / ORD. NO.
I SETBACK LINE ,/ 415L!
ADDRESS APPROVED
TEL. BY DATE
CONTRACTO�i�vJ`{' G7 Q7N?WL NO. USE /�� APPROVED
ZONE[/-' BY DATE
E ADDRESS HOUSE NUMBERING
LEGAL
+ DESCRIPTION I LOT NO. / (o I BLOCK MAP NUMBER fJ D FIELD CHECK BY
. TRACT / I NO. ASSIGNED BY DATE
�- X/ D I NO. OF SLOGS. CORRECTIONS
SIZE OF LOT NOW ON LOT
USE OF NO. OF
1 EXISTING BLDG. I FAMILIES
DESCRIPTION OF WORK
NEW I "'I-ALTERATION I I ADDITION I d
± REPAIR I I DEMOLITION I I
NO. OF
SQ. STORIES
FT. /
s BIZ6 /O ROOMS a{/
' EXT. WALL I ROOF e— /f t r
COVERING �_sG�jj_ COVERING -J--�� ii��/Ly.
USE O -5 RUI=TU§g
APPROVALS;
INSPECTORS SIGNATURE DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEN IS ' FORMS, MATERIALSt,- ;� ,�fr�y.
CORRECT.
1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS,
HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS
LAWS REGULATING BUILDING CONSTRUCTION.` + i.3•f.
� FURNACE: LOCATION, /Z�
SIGNATURE OF ,ff I +/ _ GAS VENT, DUCTS
PERMITTER
/ 1 ��%� `�C- tr s V
LATH. INT. �l
ADDRESS (���"�'�
PIV
AUTHORIZED AGT.
�FJ c+ l I CEJ-• 1 r�'� '��' LATH, EXT. i
PLASTER, INT. _
78ASSSA- D088 t0-80 .S P. C. $ / I/
,�'w
® 7 2-o FEE (� PLASTER, EXT.
VALUATION � FEE EZ-`J �� FINAL !a psi
/� 3/
WORKERS'COMPENSATION DECLARATION
�.insureby affirm that I have a certificate of consent•to.sel#• I ( .��R.p LIC�IT.I-O• F®R B U I L D I N-G P E RM I T ,
4 a certificate of Workers'Compensation Insurance, r
or a certified copy thereof(Sec, 3800, Lob.'C:) `'�"
-_,.COUNTY OF•LOS,.ANGELES� BUILDING AND SAFETY
P�cyNo: Company . .\.�;• �. �� y :
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS
❑ Certified copy is filed with the county building•irispec-' FADDRESS
' ` 'fion'depart'riient.
Date Applicant ZIP Q LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' •• ' J NO.OF BLDGS. NEAREST
.COMPENSATION INSURANCE `. - ��U NOW ON LOT �.. CROSS ST.
(This'section need not be completed if the+per'mit is forone ASSESSOR
hundred dollars.($100)or, less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
pp TEL p a USE ZONE MAP '
a, • OWNER -. =1� NO. 7 DO b'/..
I certify that in the performance of the work'for•which this NOTPE. }-
permit is issued,I shall not employ any person tri any'mbnner ADDRESS 5 L �� CONDITIONS V
so-as to become subject to the Workers'-Comnpensation•Laws. r.�.
Date �' ApPlicanY ' Tl ' ` CITY
ARCHITECT 611 TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTICE O APPLICANT: If; after•making this Certificate of o
ENGINEER N0' /J CONST. / ZONE
Exemption,' you'should become' subject' to 'the Workers' /' 6I�/
Compensation:provisions of•the Labor.Code, you must.forth- ADDRESS �`vt 3 _. N
with .comply•with such provisions or. this permit,shall be • TEL, STATISTICAL CLASSIFICATION I APT. 11CONDO. 1 Z
deemed revoked.. CONTRACTOR NO.
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 bf the Business and LIC SEWER MAP
Professions'Cbde,.and my license is in full force and effect. CITY CLASS -- 'VALIDATION '
SQ.FT. NO.OF / NO.OF CHECK BK. PG.
License Number'' Y ` Lic.Class ' ' `'` SIZE' STORIES / FAMILIES ONE
VALUATION_
Contractor t Date r DESCRIPTION.OF WORK M NEW ❑
,
❑ I am exempt under Sec. ADD $
ALTER
z
❑ �3468A .
B.&P.C..for this reason REPAIR El $ -
Date: - USE OF
F BLDG. ( I.1 C DEMO E] ? # o 0 0 0 0 1 ,
APPLICANT TEL.
Signature " PRINT) N - NO �� 7 FINAL' Z' I ° 2-1-s63 -
OWNER-BUILDER DECLARATION _ DATE •
-hereby affirm that..I arit exempt from the Contractor's-License -
Low for the:following reasoh (Section 7031.5, Business and ADDRESS L ilbFI _
Professidris Code):' PRESENT B - ° 0 2.1..8.6 3 v,
-� mBUILDING -
I,,as owner of ,the property, or- y employees with ADDRESS � 4 .. 11, 1 4 =8-5
wages as'their sole cornperisation,will do the work and
the structure is not intended or offered for sale(Sectiop LOCALITY -
7044,-Business and Professions.Code). MOVING TEL.'
I,as owner.of the property,am exclusively contracting CONTRACTOR NO.
❑
with•licensed•contractors to construct the project (Sec- ADDRESS } F,4 i';.;�-•�y +L c�
tion 7044;Business and Professions Code).
REQUIRED., TOTAL SETBACK FROM I T. + \. ` -- +
-, CONSTRUCTION LENDING AGENCY - SET BACK YARD HWY PROP. LINE WIDTH 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.
(Sec. 3097, Civ. C.). SIDE
P.L. ._. •r
Lender's Name ;
° P.C. Fee-$- Permit Fee R O$1 lJ LDMA•Ref. q '
Lender's Address ,7
p I certify.that I have read this application and state that the Issuance Fee O _U LDMA P/C a*
above information is correct. I agree to comply with all County Investigation Fee J ;
.ordinances and State laws relating to building construction, - Total Fee r 13 LDMA Perm. a
J and hereby authorize representatives of this County to enter ,
upontheabove-nientioned•property for inspection,
urpo es.
0 P�(Xn laql
SJ SEE REVERSE.FOR EXPLANATORY LANGUAGE •. r
z Signature of Applicant or Agent -- Dae O
r