HomeMy Public PortalAbout5335 SULTANA AVE_Building__ I TEMPLE'C0TjY
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, APPLICATION FOR BUILDING PERMIT,, ,. IIIUIII
COUNTY 10F LOS ANGELES ACID, ISI
DEPARTMENT OF COUNTY ENGIIQEEIi
BUILDING AND SAFETY DMSION LOCALITY 1
JOHN A LAMBIE COUNTY,•ENQIN¢¢R ' - NEAREST
1 WILLIAM A JENSEN Bvriof Bu ILDINB CROSSST
DIST, CT NOG TYPE P 9SED BY
FOR APPLICANT TO FILL IN CONST
BUILDING ^ STATISTICAL CLASSIFICATION �� BE ER MAP
ADDRESS S 3 3S t� K PG
CLASS NO�DWELC UNITS
-
0' NO ' BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACT MAP HIGHWAY STATE MAJOR SECON LOCA '
NO OF BLDGS NO (cIRCLE) - .v�.- -
SIZ F LOT S^ A — NOW ON LOT ,USE ZONE tPECIAL •+Y.,4
USE OF ♦ - N CONDITIONS
EXISTING BLDG „r17 •�
TEL
OWNER NO BUILDING YARD HWY STREET NAME EXIST
ADDRESSr
C' rS2`ACK WIDTH
'^ FRONT)[ 'F
ARCHITECT OR TEL P L I
ENGINEER NO SIDE
1
PL Y
ADDRESS ' S NO 1, > 1 , INSPECTION RECORD ' „ ' 10
CONTRACTOR
ADDRESS
DESCRIPTION OF WORKNEW
SOFT I ADD ALTER NOaOF AIR DEMOLISH
SIZE _ STORIES FAMILIES 7"I/� i,/ ♦/�.O I ,-O 0rA✓� r N1 mf/l..vi� '
USE OF C /"i0.1o. lu
6TRUCTURE
♦ �"_�L�'6 J �QJkQ-�O�L.4 �PM1' t/'^tR.(.Tp �
'SI GNATU RE OF S Aj dw- �1��k'I•(�
APPLICANT
VALUATION$ - h1� I111 G, �AfL.T/ /0 W♦,I _UA Q�
'} •` / '^APPROVALS (�/DJAT/E^ �INSPECT`OR SSIGNATURE
FEE $ - � FEE $ IJ FO FORMS(MATERIALS ON N 1G//�y/F)h �'fiAj.Yir ;4+"j
N FRAME FIRESTOPS I .O(-x
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS I� VIfLC `� •A
♦ AND STATE THAT THE ABOVE 11 OO RRCCT AND AGREE TO COMPLY FURNACE 'LOCATION y
♦WITH ALL COUNTY ORDINANCES ANO 6TATE LAWS REGULATING GAS VENT-DUCTS I/� J f .0 1• ^ 1
BUILDING COER EBY I WILL
CERTIFY THAT IN PORNO THE WORK 7�r�
HER
AUTHORIZED HEREBY WILL NOT EMPLOY ANYN IN VIOLA LATH INT IF ✓•4y
TION OF THE LABOR CODE'OF TH E'6TATE OF CALIFORNIAIFO RELAT 1
,ING TO WORKMEN S COMPENSATION INSURANCE Z '�jj t
� LATH EM '7T'L¢-6 Z h"
SIGNATURE OFF! ./ 77��Ll�tn r HOUSE NUMBER COR- r
PERMITTE I 'L�—/� � ./ / ,ECT AND POSTED
ADDRESS .s��•A //�.��3� �• 6
FlNAL / v, YM/
CLYDE N DIRLAM RINCIPAL STa L ENGINEER
PLAN CHECK VALIDATION cK. M,D cAnH PERMIT VALIDATION cK M o ' CASHA
Lb052su� VAY2'J ? 3 D 1r3G'Ga
1
45;`� F15`-6G" Jb,t1_ = 1 D 36UO- J
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES �� BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION0.�7Lq FOR APPLICANT TO FILL IN BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self Insure "U �'q 3 SS 4�J 1+q,
or a cerhllcate of Workers Compensation Insurance or a certifxd I _ ^�
copy thereof (Sec 3800 Lab C) LOCALITY
/ f C P / a''p
Policy No" L t 3 A2• CGmparry
p SRE PFS;9T N OF�BWG ON LOT
-O Certified copy Is hereby furnished �/ %7 "( "( 0 Q .j }� NEAREST CROSS ST
❑ Certified copy M filed with the my building Inspection TRACT BLOCK LOT NO
rt�m s�R USE ZONE MAP NO
Date �! Appticent Ro �b-ta 1 1 �0,10 PARCEL
-) ISPEC coNDmous
CERTIFICATE OF EXEMPTION FROM WORKERS ER TE}1+¢
COMPENSATION INSURANCE 9—"1`� M 4; 1 e . Y, `O` J) v IN 1000 FT OF SCHOOL? YES NO
(This sechon need not be completed If the permitfor one hundred 3J
4 DISTRICT GROUP TYPE CONST FBiE ZONE PROCE D
CILYdol Lars ($100)or less) �l C `^
I certify that in the performance of the work for which this permit /( CEL ZlP / /a d.�g
V issued I Shall not employ arty person In any manner so as to '
b9COm a subject to the Workers COmpeneatori Laws ARCHITECT OR ENGINEER TEL NO
STATISTICAL TX)N APT CONDO
Date Applicant SS CLASS NO DIIELL UNITS
Ni TO APPLICANT If after making this Cerhfcate Of REWIRED TOTAL SETBACK FROM EXIST
Exemption you should becorne subject to the Workers /� ¢LSD SET BACK YARD MYY PROP LITE WIDTH
COTIIPansetori provislals of the Labor Code you moat forthwith a' Jl- yi✓ JS`J—;� 75 FRONT
comply with Such provisions or this permit Shall be deemed revoked ADDRESS J�iro° r pP L
LICENSED CONTRACTORS DECLARATION /�"I SE`•A 1, "7 ss--L�o ,7 SIDE
CRY L... I G0 LIC CLASS /N PL
I hereby alf," that I am licensed underpnovMCM of Chapter 11 RS SSR MAP
(commencing with Section 7000)of Divrecn 3 of the Business and SO FT SIZE NO �STORES NO i FADALIES
en
Professions Code d Ilcerlse Is In full face and effect SJ NEW ❑ BK PO , as
Worse Num `J Lc S'Class SSNo(` J c�.,� ADD $UATiON CJ
Contractor - Data ALTER ❑ 3 Q
k l� h ( 3i9o /'
❑ I em exempt under Sec REPAIR ❑ $
BBPC for this reason DEMOL ❑
OAN P/C♦ W
Data USE OF EXISTING BLDG R URM ❑ D•
�.i 50.50 CO
Signature fPRT(Tl r L TEL NO y" LDMA Perm♦ ?
❑ 1 as owner of the property, or my employees with wages as r'"'✓ v SS5-977 9 Z
mar sole compensation will d0 the work and the structure is APDRESS r i...r0 /J O
not intended or�offered for Sale (Sed ri 7044 Business and L171.. Sr`� O '� FINAL DATE 1
PProfessionsnriu..v)
WILL THE IPPU!AfrT OR FUTLPE EIUUNRG OCCLPMfT HAIDLE A HALIADOUs MATEF � a
❑ 1 as owner Of the property am excluaNely Galtrachng With OR A MIXTURE GafVflla A H RDGU'WME Ea VOR LTRFATER TION TIE TIT 14g0A
licensed Contractors t0 Construct the project (Section 7044 NnOLMTs BPEPF1Eo ON 1 THE Proops NAz E KORNATa1UILFINAL GE+ ryry�����l�/T�'
Business and Professions Code) YEs El NO❑ AiTB9TrzR-
WILL THE FnE11DED 118E OF THE BUOIING BY THE AFRX:ANT OR FirRYE BUILDING
CONSTRUCTION LENDING AGENCY o�i'R"'iT COAST NR oREo�A FERIA'T Fort CONBTT1CnON OB MGDiFrAnoN man THE SCUMI
wDTY MNNOEMENT DISTRICT IBCAaA01 SEE PEW.DTNG CIECKUST FOP
GUDEUIES 1 8/ 8/9`J
I hereby affirm that there e a construction lending agency, for ,ES❑ rw❑ wY
a the performance of the work for which this permit is issued(Sec 1 . 1 FY 1 8:14
m 3087 Civ C) Ia s W RIE n�EN UNDERGTE LDE os A aELE�EsAcouENTYR cox
�1___ TITE 3 CHAPTER 230?ECTgl19 2 3m too 11WOUa13 30140 C0110ERNNG NALARDOU9
Lender B folio I.NTEPJALa PEIV(mNO IND FOR OaPNNG A PEREAi FFDM THE 9CAOA0
Lenders Address
p
..A yr
I oemfy that I have read this application and state under penalty
g of perjury that the above Information la correct I agree to comply PC FEE I'05-0 PERMIT FEE
N county ordinances and State la," relating to building �7
COr struc and hereby authorize representatives OI this County ISSUANCE FE L1
tD enter the above-mentqied property for i pDges `
3 q INVESTIGATION FEE TOT,I_FEE
n � or
SEE REVERSE FOR EXPLANATORY LANGUAGE