HomeMy Public PortalAbout5008 SULTANA AVE_Building__ APPLICATION FOR BUILDING PERMIT 3�
COUNTY OF LOS ANGELES - ' ""' BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADJAESS 0 L
I hereby affirm that'l have a certificate,of consent to self insure Bt>dOFIG '
or a Certificate of N1ork6ns Compensation Insurance or a cerbfled umbi+dA17 90
copy therea(Sec 3800 Lab C), r . CRY G rN l ` %D LOCALITY
Poky No Company SIZE I NO OF BUIS.NOW ON LOT I
_
ElCertified copy Is thereby furnished NEAREST CROSS ST N "
El Certified copy s riled with the county buidmp uson pect
TRACT KocK LOT NO A So D
department
ASSESSOR / USE ZONE MPP NO
Date Applicant ' MAP BOOT, RAGE 0p(p PARCEL yB
JJ 'J� 4/rte SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS OWNER AI--DE2 E'er '`L. 3-7 g `ES "D
COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? — NO
(The section need not be completed if the permit s for one hundred ADDRESS V O s u A
Dollars 13 7001 Or less) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
1 certify that in the performance of the work for wh permit CITY G� 71P �
s Iseled I shall rot empty n In any so es to
bet au o the Works ECT OR ENGINEER TEL NO
BUTISTICAL CLASSIFICATION APT CONDO
Date Applicant ' ADDRESS - CLASS NO t� DWELL UNITS
AKITACE TO APRUCAM II r making the Certdoate of REWIRED TOTAL SETBACK FROM "ST
Emmptlan � you should subject t0 the ,Workers TE SETBACK YARD
ITyIV PROP UNE WIDTH
Compensation provlsgre of t Labor Code you must fortt7wlth FROM
cornph'with such provelons or the permit shell be deemed revoked, AW4V4 I UC NO �� PL
LICENSED CONTRACTORS DECLARATION SIDE
I � -
l / CLASS P L
I hereby affirm that I am licensed undarprovsgn s of Chapter g C.� SEWER MAP
(canmencrtg with Sectron'7000 0l Division 3 of the Business and NO OFh�S NO OF ISS NEW BK PO , a
Professore a I e In full force and effect _ Wgur I
LoenRe Nu ter Lo Class ADD ❑ -
COntrector �—Date _ SCRP _ /.� /(� ALTER ❑ $LwTION
cc
❑II am exempt under Sec Ex l�l REPAIR ❑
BSPC for the reason I rula2I DEMOL ❑ LDNVI P/C I W
Date USE OF URM ❑ a
Signature - z
❑ I as owner of the property or my employees with wages as IAF®'TT w� TEL / LOlM Perm• A`C
their sole compensation Will do the work and the sbuctura Is ADOR �I FINAL DATe
not intended or offered la sate (Section 7044 Business and f]
Professions Code) M TIE APPUGMrT OR FUME EULDING CCGUMrn HANID.E A HAZANDIXe MATERLLL 1
❑ I as owner Of the property am e=lusroety contracting with M A 14 nit£LON "G A HAZA{pge IAATERIAL EOGAL To M GREATER n THE
AArolM1S SPECFIED ON THE HAZARDOUS MATERIA-S FfOfLUT101n GUIDE? FINAL _ 1
Kereed contractors t0 consnNOt the protect (Sector 7044 YES❑ i,K, �t_� •T
Business and Prolessore Code)
Mil TIE MENDED USE 6 TIE BUIXINe Br 1NE APR.K.AM CR F901V B111p1e
OOASTYAR 00iL E A GEM FOR CCNSTW.GrICN OR MODFR'.\TIDN FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST
NESOUNJTY MAWOEMEM GSTwcr IscApMol BEE PERMnnrw cTEacusr FOR ` 2 ITEM
I hereby affirm that there Is a cors1ructon lending agency for
rEs❑ ❑
the performance of the work for which the permit Is Issued(Sec tOTAL 359 - 02
m CHECREAD TIE RSTOD MATEWALELEORMATIDNo ANO THEUES C0AITYf OCE
3087 Cry C) LIECI(Ller UIOER3bND W REWREMENiD UNDER TIE lD9 ANGELES COIMIY LODEC
TITLE 1 CI VPTER Z 1D SECTION?110 too THiOUGH 210 tr0 CONLERNPIO HAIMO(%19 C HEC YK\
Lender s Name LIATEPoIL.9 REPOriTMO Alio FOR OBDL@1G A PERMn FgYA TIE 9CAOAo
Lendera Address CHANGE
0
fcertifypequ that have reed info mation IS and state under penalty,
of perjury that the stave information a correct I spree to Cafnply PC FEE PERMIT FEE �7
with my ordinances and Slate laws relating to budding �D••s p{ r�- I I]Q-171?Q1 lU/11J;�4
uCi hereby eutharlze representatives d County ISSUANCE FEE
roperty for I ��. _LD 7209 1 AM 'v(
o ter -mentored pnap�y- kir 7
� (U
INVESTIGATION FEE TOTAL FEE V D � a
m
SEE REVERSE FOR EXPLANATORY LANGUAGE
OF BUILDING BUILDING
apartment of County _
County ouniy of Los Angeles 4
WM. J. FLIX, UDUNTY ENGINEER r APPLICATION
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING //. ) C DISTRICT NC. PLAN Cc,DR SCG.No. PERMIT N•O..
ADDREBB d / �( I � l /�S 3
LOCALITY _— 7 a - L REI{LgIVED BY DATE OF APPL,, DATE IYUEP
NEAREST I/.-... c .�r?[.
CROBB ST. a `�O BUILDING
ADDRESS
OWNER FPr c , (�
NAIL - l`._ LOCALITY
'
ADORE BB � - 6d _
NEAREST
�^• ��� TSL _" CROSS BT.
CITY ,�- N ZONE PNo.OF LANS TYPE + ROUP-�-. .
ARCHITECT OR �(
ENGINEER �T IQ IN _/37/2- BLDG.
ADDREBB BHTBACK LINE r. )
Q L� Be / APPROVED
CONTRACTO L 'F 15 GJ Na NE�7 BY DATE
f� (( n ��ss''''�I HOUSE NUMBERING
ADDRESS /� G'� ID}�� M UMBER Z// 1 NO. ABSI ONED BY
LEGAL CORRECTIONS
DESCRIPTION LOT N0. BLOCK
TRACT
SIZE OF LOT /00 NOW OFON
BLD36
USE OF LOT �•L4iF'Y7f-A ¢/I I/IS/d-'�'
No.OF
iEXISTING BLDG. I FAHI LILB
DESCRIPTION OF WORK D
•I NEW j ALTERATION ADDITION ' L
BQ d1 f
REPAIR DEMOLITION
NO.OF
B�IZC - ROOMS '✓ BT RIL
EXT.WALL ROOF
COVEMNG :7 I- ". c COVERING,
USE OF STRUCTURE A v
INSPECTION FOR APPROVALS
OCCUPANCYAB rl bL INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION
FORMS, MATERIALS
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN IB FRAMEI FIRESTOPS,
CORRECT. BRACING. BOLTS ' 36
IADREE TO COMPLY WITH ALL COUNTY 17RDINANCE5 j
AND STATE LAWS REGULATING QIN CONSFURNACE: LOCATION,
TRUCTION. URNACEBAR T,DUCTS
SIGNATURE OF� GYy- LATH. INT
PERMITT[
ADDRESS
LATH. EXT.
AUTHGRI LD AST PLASTER, INT.
S PLASTER. EXT.
_
P.
0 B HOUSE NUMBER COR-
FEE RECT AND PORTED
VALUATION (yf "�'� ,� ���U FINAL '
rcc
7SA.BA DOS 1-52