HomeMy Public PortalAbout5079 SULTANA AVE_Building__ 7SA630A CE jF 808162 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELESgoo eIN (J
DEPARTMENTTY OF COUNENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUR T OF BUILDING CROSS ST
RRCHITE=OR
OR APPLICANT TO DIST RJ CT NQQ GROUP TYPE SS ED BY
S CYC T� CONST
NG O STATISTICAL CLASSIFICATION / SE ER MAP
S
CLASS NO DWELL UNITS
BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE
y9MAP HIGHWAYw NO OFSLOGS NO 0 IcIRCLEI STATEMAJORSECON OCAL
LOT OOOt NOW ON LOT USE ZONE SPECIAL A/ CONDITIONSG BL G/' TEL
�/ NO BUILDING YARD HWY STRE T AMEEXIST
SS A/ISETBACK WIDTH
' FRONTECT OR T P LER NO . 1 PDE r
kADORESS
ESS I II G.
TEL / �/ U
ACTOR NO
_ Q
DESCRIPTION OF WORK It
ADD ALTER REPAIR DEMOLISH NO OF NO OF STORIES FAMILIES
FTURE
SIGNATURE OF /
APPLICANT
VALUATION $
{�/( APPROVALS /DATE INSPECTOR 691GATURE
PC MT
FEE $ FEE $ ./L1 FOUNDATION LOCATIONmr-
FINAL
FORMS MATERIALSFIRE STOPS
1HEREIY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONBRACING BOLTS
AND 9IATE THAT THE AGOVE IB CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS SUILDINO CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HERESYIWILL NOT EMRLOY ANY PERBON IN VIOLA 'LATHTION OF THE LASOR CODE OP THL STATS OP CALIFORNIA RELAT
-70
ING TO WORKMEN 8 CO ENMTION I URANCE LATH EXT SIGNATURE OF / A _ HOUSE NUMBER COPERMITTEE V�/ RECT AND POSTEDADDRESS + /-
PLAN CHECH VALIDATION cK Mo CASH JOHN F LEWIS PR NCIPAL 5T RAL ENGINEER
PERbRT VALIDATION jK N G DASH
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'LALp4 2 8-6—� sFP13 2 3 0 2 5.001 a
Lj" 4 7 9 6t1 SU26 1 D 5 0.00- a
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES r i BUILDING'AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL INNSI �I AVEBUILDING AIF SGL T1IP4 AIV
1 BUILDINGADDRESS�O� Sul-TA#A C SCJ /�1
I here afflRll that I have a cartrfioate of consent to self I re
or a certificate of vviOrkkpers Compensation I a fled Coinj �j ^/
copy olioy Ne-"' /Ol C) CITY TE P� l / I / LOCALITY
SIZE OF LAT OF SLAGS NOW ON LOT
El Certified copy s hereby furnished //9G1 NEAREST CROSS ST
❑ Certified copy s filed with the county, buidug Inspection TRACT BLOCK LOT NO I -
z USE ZONE MAP NO
department �J"�fA��l!f������
Date/a ON 9�Applioanr� `/[ ASSESSOR MAP ROOT( RAGE PARCEL SPECIAL COND1T10NS
Ty �� e�
CERTIFICATE OF EXEMPTION FROM WORKERS QTR P141 L (. -P (y,4N(G y 7 -7255 YES ;PROW-E
COMPENSATION INSURANCE gS r YrtnuN tODo FT of scNDDL� '
(Thee Section need not be completed If the permit s for one hundred ADDRE 19 1,� A 1/ pISTpICT pROUP CONST FlRE ZOSED rfdollars(37001 a lees) /I / 4I Certify that in the performance of the work for which this permit CITY A p C �IM ZIP g/G 19IS Issued I Shall not employ arty person In arty manner so as to /` /-�beconne Subject to the Workers COnperlsatl0n Laws ARCHITECT OR ENGINEER TEL NO
MTISTICAL CLASSFICATpN OONDO
DateApplicant ADDRESS - CLASS NO o2/ DWELL UNITS '
NOTICE TO APPL/GNT It after makug this Certificate of NTj�GWR�. REQUIRED TOTAL SETBACK FROM EXIST
BxaTlotion you Compensatwn provisions of the Lab-or Code you must fme Subject to the or f ith �7/` /— (�I'G C� � SET BACK YARD I-rlyy PROP UNE WIDTH
comply with Such proYsions or this permit shall be deemed revoked FRONT
LICENSED CONTRACTORS DECLARATION O YE�P(/�a o(95 SIDE
CITY / /� �./7 LLC CLASS+ 7 P L
hereby affirm that I am licensed untlarpovlsDns of Chapter 9 �--r^t (/`r l"...) SEWER MAP ,
(Commencing with Section 7000)of Division 3 of the Business and SO FT SLZE NO OF STORES NO OF FAMILIES NEW'
EW ❑ r }
Rofeaslons se s m full farce and a /� poll eK PGas
License Num /L r LTC Cla f C0 D SCR PTILkJ OF'Abu
`� �sAKNGC �,riO ADD ❑ QL.�V V
Contractor Date (� K ..lC W ALTER ❑ $ ,
AFP F/ 09E/Z CWS 107- p
❑ I em exempt under Sec REPAIR
fla
BBPC for this reason /Yf DEMOL LDMA Pic• W
Date USE OF EXISTIN3 BLDG URM ❑ d
SQnature APPLICANT(PRWTJyZ F�lro-..7 '
' LOW Perm♦ 1 yTG�h7 1LJ�JJ Z
❑ I as owner of the property or my employees with wages as /'/ '"�^ Al �f C
their sole compensation will do the work and the structure IS ADDRESS ,��'��AI C TUTAL. 125 .55-
not
25E .51cJ-
not Intended or offered for'Sale (Section 7044 Busmsas and Ca;'I/F-'Y 917 RNM-DATE K
Rolesams Code) 1-1-qS 7
vnLL TIE IPFucANr oR FurLaE aupiFD oa-LnNr HAlDIE A w,zram W a ruTEaIAi
EQUAL TO OR WU R
OR A VDC'U G CONOVNNG A HA2NiDgs V O Mil THAN T
❑ I 89 owner of the Properly am thelUSNRH contracting with IADLINTS SPEaFlED b1 THE IlA2ISi0pU,4 MA1pIIAL9 AffORAUlIpI pl,VE+ FINAL BY >4
licensed contractors to construct Me project (Sectionn 7044 res 13 ID❑
Business and Professions Code)
WILL THE KrE�oWRE LSE MI TIE BWIXN(i tN TIE AIJCOIMCT OR FUTURE a SONG
CONSTRUCTION LENDING AGENCY CS T PEgARE A FERMR FOR wNsrrXDnaN oR MaaFTCATDN FFDM THE swTR 00O0-0001 10/24/95
CM4r Aq OUNJTY AIANAOEAENi 19CX1M01 SEE PERAQTTTIILLG GELJ(LIaT FOR
d.LE1Bffe e-�
I hereby affirm that there s a construction lending agency for �S❑ NO❑ 2976 1 PM 5"31
m the performance of the work for which this permit is Issued(Sec If1A�READ 11E HAZNDOU9MATERILLSINFOFIMATW GLOEAt0 TNE6uaa0aEw.RTNo •�i
3097 CN C) G "LST I UNMRSrA D MY REOUPEI.ENTS UNDER TIE LOS ANGELES COUNTY OpOE
tt 2 0K PTER 220 SECTIONS 210100 THROVOH 220 I40 COACEP HASJJ1oa19 "
Larder s Mama WTER4LS REPORnNG AND FOR OeTUNING A PO AR FROM THE SCAOMD
o Lenders Address -
a awn oa Nxxr
I certify that I have read this appllcefl n and state under penally
8 of perjury that LINT above nformatnri Is correct I agree to comply PC FEE PERMIT FEE ���
n with all county ordinances and State laws relating to buildup 11
S
construction and hereby authorize representatives of the Cwirty ISWANCE FEE 30
mentaned property iwp�ectronpurposeg o�
/" Li �S INVESTIGATION FEE TOTAL FEE
m �-
�.e.•d Avabe s qn ry.
SEE REVERSE FOR EXPLANATORY LANGUAGE