HomeMy Public PortalAbout5128 SULTANA AVE_Building__ PaE.9ADES E APPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY BUILDING
Depar�anl of County EngfSe9E A pa
wcDREQe
Comly of Lot Angeles LOCALITY
WM J FOX COUNTY ENOIN[QR NEAREST
CASSATT O GRIFFIN SUP T OP BUILDING CROSS ST Vg
DISTRICT NO. O OUP TYPE Q BK FG
FOR APPLICANT TO FILL IN
ER MAP'
BUILDING / �] MAP STAT[
ADDRESS J G NUMB�t HWY Y60 O
LOT NOBLOCK US[ZpN6 8PKdIAL
CONDITIONS
TRACT ,y �♦�
BIZ[OF LOTS/dd NOW ON LOTS BUILDING YARD HWY BTREQT NAME EXISTSZTBACK WIDTH
USE OF I FRONT
N DO P L
OWNER SIDE -
MAIL • '
ADDRESS •Z ✓ IV O TRACT DWELL 1 UNIT D INDU[TRIAL
TELf pW01 ; I UNIT
CITY N 8 PUBLIG BLDG
ARCHITECT ORf TEL 2 DUPLEX IUNIT .7 AVON ALT ETC
ENGINEER NO g APT _UNITS
8 MISC6
ADDRESS 4 COMMERCIAL
TEL INSPECTION RECORD
CONTRACTOR NO
ADDRESS
DESCRIPTION OF WORK e�
NEW ADO ALTAR ( REPAIR XDEMOLISH 1 I �O
QO PT NO OPOP l-L
SIZE 0 STORIES F M'
L
I
ES
UBC OP STRUCTURE
SIGNATURE OF 1
A►PLICANT APPROVALS
ADDRESS DATE INSPECTOR 9 SIGNATURE
FOUNDATION LOCATION
IS F. S FORMS MATERIALS
FE[ I ' FIRE STOPQ.
VALUATION g y �� SRACINO BOLTS
FEE !/ FURNACE LOCATION
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS OAS VENT DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT.
AND STATE LAWS REGULATIN7 BUILDING CONSTRUC.
TION V r
LATH EXT.
SIONATURE OF HOUSE NUMBER COR-
P[RY17T[E RECT AND POET®
ADDRESS FINAL -
WM.J.FOX.COUNTY EMOUS®1 VALIDATION C. N.DIRLAM.CHIEF BLDG. INSPECTOR
I 1325A OCt1_ 5 1 200 n
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have r certificate of convent to belt APPLICATION FOR BUILDING PERMIT
e, or a certificate of War jxnsatl nsurapce,�
or t roof ( C ) (/nJ/) COUNTY OF LOS ANGELES-- BUILDING AND SAFETY
-Co
E] Certified copy a hereby f rnlshed R APPLICANT TO ILL ADDRESS _
❑ Certified copy is filed w t county Ildl inspec- - BUILDING ---1 `:2 -
tion departme t C//J/`
Date iCITY - ZIP ' LOCALITY
NO OF UU>US
CERTIFICATE OF OCEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT - CREST _
CROSS ST
COMPENSATION INSURANCE
ASSESSOR
(This vection need not be completed If the perms is for one TRACE ' BLOCK LOT NO MAP BOOK PAGE PARCEL
hundred dollars ($100) or leu ) 115E ZONE MAP
INO
OWNER
I certify that in the performance of the work for which this
permit is issued,I shall not employ any person in any manner ADDRESS - CCOONDITIONS - - 0-
so as to become subject to the Workers Compensation Lows OU
CITY- ZIP
Date Applicant ARCHITECT OR TELM
DISTRICT GROUP TYPE FIRE $SED BY
NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO _ _ CONST Z E O
Exemption, you should become subject to the Workers ' L-. �-3 Q U
RE
Compensation provisions of the Labor Code, you must forth- ADDSS �l V N
with comply with such provisions or this permit shall be TE STATISTICAL CLASSIFICATION ACONDOZ
deemed revoked, CONTRACT 'Z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS_ '
I hereby offirm that I am licensed under provisions of Chapter 9 FID SEWER MAP
(commenctn th Secti n 7D00)of Division 3 o the Bu tress LIC _
and Profess y license is in full f ect CITY CLASS � BK PG VALIDATION
i SO FT - NO OF NO OF CHECK
Llcenw Nu Ic CI SIZE I STORIES- FAMILIES ONE
VAl ATION
Contracto4majim+ Dote DESCRIPHON OF WORK IF ADD ❑❑
❑1 am exempt under Sec - ,
A ER ❑
B&P C for this reason - REPAIR ❑ S
Date USE OF
EXISTING BLtz nrM i ❑
Signature APPLICANT TEL _ FINAL - -
OWNER-BUILDER DECLARATION (PRINT) NO DATE 2 IJ�93
1 hereby affirm that I am exempt from the Contractor s License _
Low for the following reason (Section 7031 5 Business and ADDRESS FINAL, O i
Professions Code) NT _ _ _ B _ _ f - a -
❑ I as owner of the property or my employees with �� T rf' t"T��
wages as their sole compensation,will do the work and - - - - - - - - - 33303r 105 _ I
the structure Is not Intended or offered for sale(Section LOCALITY popY - - - 1 ITEM.
7044, Business and Professions Code ) - MOVING TEL _ "
El =owner of the property,am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec- - ADDRESS TOTAL idr7 30
non 7044, Business and Professions Code ) -- - - - - - t ( l�,�l I
REQUIRED OTAL SETBACK FROM EXIST 'HEa 10
CONSTRUCTION LENDING-AGENCY aA YARD HWY INE _ -- -
I hereby affirm that there Is a construction lending agency for FRONT CHANGE ,Orl
the performance of the work for which this permit is Issued P L
(Sec 3097, Civ C ) SIDE
Lenders Name - P L - _ - 0000-mal L/ 1/02
-7CQ L)MA Ref 1 ---
P C Fee f Permit Fee L 1 - 2319- - 1- -AM (19�
Lender a drew J,
1 certify at 1 read thi licanon and state that the Issuance Fee LDMA P/C/
above I f rens on s come ogre to comply with all County Inve.n_patlon Fes 1
ordin a 5 e la lating to building construction, Total Fee L O)C- LDMP.Pam B -
and er t Ize r otly s of this County to enter _
u t a v t for Ins'pe/fit n r
/ J EEE REaW FOR ULPLANATORY LANGUAGE -
Signolure of Applicant or Agent Dote