The URL can be used to link to this page

Home My Public Portal About5419 SANTA ANITA AVE_Building__ OS-7q%636A .' CE/803(REIT.9/781 a ' � o APPLICATION F� R BUIL NG PERMIT COUNTY OF LOS ANG ES BUILDING AND SAFETYING -� - FOR APPLICANT TO FILL IN ADIDRESS / Gtr CiC/✓fl/C�Q- BUILDING (' ADDRESS +� P J Gt, LOCALITY NEAREST Li CITY7e: � ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT l NOW ON LOT MAP BOOK, PAGE PARCEL DISTRICT GROUP TYPE FIRE OCESS BY TRACT BLOCK LOT NO. OWNER Y Q s L( NO, - 6 v A 3 CONST.R ' E STATISTICAL CLASSIFICATION �/ j tseWER MAP ADDRESS��-J l7 "• Q V - CLASS NO. DS (WELL.UNITBK PG clTY . ;, e'_ 67-tv zip 9/ $CZ ARCHITECT OR TEL. VALUATION $ENGINEER i NO. � v r ADDRESS BLDG.SETBACK FROM ' TEL. q FRONT PROP.LINE OF L�� / (STREET) CONTRACTO o ,(i• , NO 2 aHIGHWAY + YARD __ TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS Z � �i IC � .•� -• FRONT PROP..LINE HIGHWAY WIDTH 13 G_ CITY CLASS 3 � + ✓ ��v CONSTRUCTION ENDER BLDG.SETBACK FROM IQ.FT AME AND BRANCH ( p -,_L SIDE PROP.LINE OF (STREET) (�� Cl HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF. EXISTING. DDRESS �� CITY �Vi �BUlvl�tr SIDE PROP.LINE HIGHWAY WIDTH N F NO.OF CHECK + _ u SIZE STORIES FAMILIES /�� ONE Ar DESCRIPTION OF WORK 1.GJ Le NEW P.C.Fee$.S J Permit Fee ADD ❑ ul�p (� Issuance Fee �' us IL ALTER ❑ REPAIR ❑ Total Fee 7 4 7_- USE OF7 EXISTING BLDG. e� DEMOL ❑ / Z e 0 0 0 �• APPLICANT ,i h TEL C 2 0 a 8 0 (PRINT) . �CC L'IT �j/eUi N .L��S� Q opt 3. BY(SIGNATURE) f S) 0 t 1 HEREBY LEDGE THAT I HAVE READ THIS APPLICATION AND STATE 3 �, 3 0— ! ti THAT THE ABOW IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES n w AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE 9• A Aw 7� S ,'.VP r' WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF _, U , 4.73 A - THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- '� 2 PENSATION INSURANCE - g # 0 0 0 0 0 1 IL SIGNATURE OF r�* 2 0 3'4 6 0 0 PERMITTEE ADDRESS Z 0:o 3 4 b 0 03S r7 CITY E' C C t No.2$GL$ o sj &50-79 0 USE ZO� MAPO•C`d I cJ M o -T f� NO. .3 -:1 b O N -P� a SPECIAL O CD CD CA 'D CONDITIONS DH lx FINAL 7 Z® BY DATE Jy� t. ,..w. � ORKERS'COMPENSATION DECLARATION ' % � hereby affirm that I have a certificate of consent to self APP`I CAT 1 F B U I P E RM I T insure,or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800, Lob. C.). COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with county building i spec- BUILDING r![ C I / �f t l/ tion department. ADDRESS J 7//7 .5--el � f4 fVJ rte. LOCALITY l �� J/�, ,� r^ NEAREST Date ~7� Applicant u"` v CITY -,P,e. l�+E' f�C ZIP 7 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. f ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOKPAGE'72`73 PARCEL 1244 G (This section need not be completed if the permit is for one / USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. / NO. 2 d S Q3 TEL. R—Z SPECIAL I certify that in the performance of the work for which this OWNER�n!{ 0- 6 t2 Q eJ' NO. CONDITIONS - permit is issued, I shall not emplo ny erson in any manner tee, DISTRICT GROUP TYPE FIRE C D BY ADDRESS so as to become rsubj�ect to the rke Compensati aws. �� CON✓ 21 Date 7--;L '' Applicant CRARCdII€6F6R C ZIP TEL. STATISTICAL CLASSIF TION APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER g2NGC pQ L CLASS NO. PPp /1 DWELL. UNITS CL Exemption, you should become subject to the Workers' y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be r deemed revoked. CONTRACTOR h (I t L NEJ4 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION -�j� " / LIC, _{(' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Sv CO 0 4 rn L L/ NO. 6 f✓ VALUATION (commencing with Section 7000)of Division 3 of the Business and / LIC. // Professions Code, and my license is in full force and effect. CITY nC_-e-GxGry NO.OF / CLASS �C7L $ ^`� SIQZEFT� STORIES ( FAMILIES I CHECK License Nu er Lic.Class ONE t'1 l� ate -2-3,0 ~ NEW El ❑ $ _ Contractor t5 yLDESCRIPTION OF WORK ADD I am exempt from the licensing requirements as I am a (�•PCf l(C� p'r C'i2 licensed architect or a registered professional engineer ALTER ❑ FINAL -y acting in my professional capacity (Section 7051, d REPAIR ❑ DATE 2 --L? ,! ! r Business and Professions Code). USE OF EXISTING BLD Yn FINAL DEMOL ❑ J Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT) NO. 1 4 a 3 A I hereby affirm that I am exempt from the Contractor's License „e �p2 # 0 0 Law for the following reason (Section 7031.5, Business and ADDRESS t vrc 0 0 2 39 Professions Code): P / C �� V� 2 0 0 1 4,4 O BUILDIN I, as owner of the property, or my employees with ADDRESS � wages as their sole compensation,will do the work and o -'a 111L 4 O H the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. CA-3 0-80 ❑ I, as owner of the property, am exclusively contracting F CONTRACTOR with licensed contractors fo,construcf the project (Sec- ADD tion.7044, Business and Professions Code). REQUIRED 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 g 1 4 5 4 A the performance of the work for which this permit is issued - P.L. 2.0 20 (Sec. 3097, Civ. C.). SIDE # o a o 00 1 P.L. Lender's Nome / J 2'a - 2 5,O O!V � Lender's Address Permit Fee a`v o•0 025,00 > I certify t I have read this application and state that the Issuance Fee 7 , 7,3 O—8 O fff abov mfo ation is correct. I agree to comply with all County Investigation Fee 0 0rslAanc and State laws elating to building construction, Total Fee6, a d he by uthorize r sentat' es of this County to enter ipo a ove-m d pro for inspection purposes. i ^3Q W SEE REVERSE FOR EXPLANATORY LANGUAGE o , Signature of Applicant or Agent Date ®s