HomeMy Public PortalAbout6317 SALTER AVE_Building__ l6l(5e0AC4#.03•1-=1 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUI EIN 3 N ,�✓ "
DEPARTMENT OF COUNTY ENGIIVEER
BUILDING ,AND SAFETY DMSION LOCALITY !og b c9- 6:-Al
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.
DIST,�CT NO. G UP E P ESSED HY
FOR APPLICANT TO FILL IN Sz D CONST.
BAUI DIN y �A T STATISTICAL CLASSIFICATION S BKRMAP
CLASS.NO.---Z—DWELL.UNIT
BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE:
TRACT r.4 A..&iv4 , 'MAP /� .� HIGHWAY STATE MAJOR SECOND, OCA
NO.OF BLDGS._of NO. C ' (CIRCLE)
SIZE OF LOTS Q k /�O•• I NOW ON LOT (� .U.SE ZONE ' SPECIAL
USE OF CONDITIONS
EXISTING BLDG. /v f
OWNER /Y NO.0r 3j BUILDING YARD HWY STREET NAMEEXIST.
SETBACK WIDTH
_ADDRESS T !V �AyT67P , FRONT
ARCHITECT OR r TEL• r — .P:L..
ENGINEER SIDE
P.L.
ADDRESS ,S`� �dYhLr7�r.4'U r TEL. INSPECTION RECORD a
O
CONTRACTOR XS,—,c NO. V
�
ADDRESS G ��"IV ,SA�'r — ! `�"� t•:l/Y,�. •�Yr/Z%'� f
DESCRIPTION W WORK
' ' �. �..%.:•:' -:t �..%:��•j.'- ��;��.r
Lu
a
ADD' ALTER' REPAIR DEMOLISHJ r' �1;' ;�s• . •• /; . Z
SQ FT. NO OF NO OF I� l- •,+✓���r,!•�,i•r•� �- %'-nn:t',�i..-� 6-4`!(,1 t
IZE �' STORIES ;r`. �� V �
USE OF
STRUCTURE4 4, s:; 1 tCl: yi t ! s4✓:•.' 7.�(" ,�-t r
13,
SIGNATURE OF
APPLICANT ,' .w-•--..-,,
VALUATION•$
' APPROVALS DATE INSPECT01US SIGNATURE
PMT. �V )'FOUNDATION:LOCATION f� /� f - �. r.
FEE $ 0 FEE $ t'•• FORMS,MATERIALS
L.:v
,FRAME FIRE STOPS,
)HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION i BRACING,BOLTS-
ANDSTATE THAT THE•ABOYF IS-CORRECT.AND AGREE TO COMPLY 'FURNACE:LOCATION, 1 I • �' J
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT,DUCTS / lIt-r•
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
N•� ;• J/'}
AUTHORIZED HEREBY I WILL NOT,EMPLOY ANY PERSON IN VIOLA- LATH,INT. /1/I l / / -I
TICOF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
INGTO WORKMEN'S COMPENSATION INSURANCE. -t-LATH,EXT.
.SIGNATURE OF,,-J HOUSE NUMBER COR- ` r
PERMITTEv -&Z v�m4e a-- �� ��-y. -"��•' �� r RECT AND POSTED
3If 'IJ f J(/ j�����///('/,/�
ADDRESS 1 ��3. N �ff��Bi�• -FINAL �UI (tel i / I�VOW
CLYDE N. DIRLAM,/PpINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION - cK. M.O. CASH PERMIT VALIDATION M*O, CASH
I'tOIJ l 1 D 4 8.C. 0
WORKERS'COMPWISATION DECLARATION
I hereby affirm that I have certificate of consent to self ® PLIC~ TIF Dn DWILD
W I L D PERMIT E RM I T
insure, or a certificate of Workers'Compensation Insurance, ®�
or a certified copy thereof(Sec. 3800, Lab.-C.) I• COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company / / vov eel',
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING / S � 3,—_
ADDRESS C) / C
Certified copy is filed with the county building inspec- BUILDING />_ c / �/?f�
❑ tion department.
BU ESS
V J t- / `-• LOCALITY
Date �1/APPlican G �� /C r-h �C� ` ` NEAREST
ZIP CROSS ST.
CITY
ERTIFIEATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR
COMPENSATION.INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK 4,47PAGE PARCEL
(This section need not be completed if the permit is for one USE ZONE ESPECIAL
P
hundred dollars($100)or less.) TRACT BLO K LOT NO. . o
OWNER CJ( ��J TEL. >
I certify that in the performance of the work for which this NO, NDITIONS 0-
permit is issued, I shall not employ any person in any manner r 7 r�7 OIJISTRICi GROUP TYPE FIRE PROCESSED BY Q
so as to become subject to the Workers'Compensation Laws. ADDRESS l S �f! �-- CONST. ZONE
/ /s.
-e TY �C't/r.. r (' C [' ZIP 1 O
Date Applicant STATISTICAL CLASSIFICATION 4R. JCONI50. t--
NOTICE TO APPLICANT: If, after making this Certificate oARCHITECT OR TEL.
f IN NO. CLASS NO. DWELL. UNITS
Exemption, you should become subject to the Workers' [s
Compensation provisions of the Labor Code, you must forth- ADDRESS Gf IU 037 . SEWER MAP tr
with.'comply with such provisions or this permit shall be / ENOL /� / VALIDATION
deemed revoked. � CONTRACTOR r •�U/� } � � BKdr-• PG, JddQ��
LICENSED CONTRACTORS DECLARATION `, /! LIC. r
I hereby affirm that I ani licensed under provisions of Chapter 9 ADDRESS , U (, C� L� NO. Sze J L VALUATION
(commencing with Section 7000)of Division 3 of the Business andLIC ^ �q
Professions Code, and my license is in full force and effect. CITY `_/U CLASS ` $ _
SQ.FT. NO.OF NO.OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
C ❑ $ r
Contractor Date DESCRIPTION OF WORK r��t�✓L 7 �� � NEW
❑ I am exempt under Sec. SDC 54 L'z70L-Cc..✓a. ❑ r
// ` ALTER ❑ . FINAL
B.BP.C. for this reason e; !i
,t 3C� •� ! ./- / L. REPAIR DATE
USE OF DEMOL
Date: FINAL
•l J EXISTING BLDG. ❑ Bye
Signature `� I APPLICANT TEL.
OWNER-BUILDER DECLARATION "' PRINT NO.
I hereby affirm that I am exempt from the Contractor's License I D
Lqw for the following reason (Section 7031.5,-Business and ADDRESS
` rofessions Code): PRESENT I.• :. /,C A
❑ BUILDING
I, as owner of the property, or my employees with � ADDRESS �% � � o o �
wages as their solecompensation,.wiII do the work and. j
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code), j MOVING TEL.
❑ 1,as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
'tion 7044, Business and Professions Code).
REQUIRED 4-
TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH
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.
tSec. 3097, Civ. C.). SIDE
6 P.L.
Lender's Name
,,.•:. ..
P.C:Fee$ Permit Fee
Lender's Address
rI certify that I have read this application and state that'the I Issuance Fee �.
' above information is correct. I agree to comply with.all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee
and herebythorize representatives of this County to enter
� i
upon Ifove- Toned property for inspection purposes.
�p +.
SEE REVERSE FOR EXPLANATORY LANGUAGE ,
9 Signature-of Applicant or Agent I as