HomeMy Public PortalAbout6267 SULTANA AVE_Building__ v -
76A638A CE-71803 3-69
APPLICATION FOR BUILDI G PER T �I
COUNT( OF LOS ANGELES BUILDING // 'J
DEPARTMENT OF COUNTY ENGINEER ADDRESS (Q o�
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN
[D7TOO. GROyB- TYPE C PR E(PRINTOR TYPE ONLY)
BUILDING TATISTICAL CLASSIFICATION SE ER MAP
ADDRESSC LLASS N0. DWELL.UNITS BKr-PG
LOT N0. BLOCK SE ZONE MAP ✓j r} /1�
y_ NO. pl_V (/
TRACT D I SPECIAL
NO. OF SLOGS. COND TIONS
SIZE OF LOT NOW ON LOT
USE OF +
EXISTING BLDG. BLDG. SETBACK FROM
W NE ELFRONT PROP. LINE OF (STREET)
O
PE OF EXISTING SETBACK HIGHWAY + YARD = NOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
CITY
LD .ARCHITECT OR TEL. SIDE PROP. LINE ETBAOM (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK WAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
�g,� TEL. _
CONTRACTOR V v� NO. +
ADDRESS NO.LIC. CORNER CUTOFF YES ❑ NO f
IC.
CITY CLASS SEE REVERSE SIDE FOR5aCIAL APPROVALSCONSTRUCION LEI
NAME ANDTBRANCHNDER /37/70 „Zv�1Z` z !
ADDRESS
f (/ 1
SO. FT. N0. OF NO. OF ❑
SIZE STORIES FAMILIES NEW
USE OF
STRUCTURE • ADLTER ❑
SLEPAIR
G URE 0 DEMOL E]APP CANT
VALUATION$ APPROVALS DATE INSPECTOR'S SIG ATURE
P.G. PMT. �J� FOUNDATION:
FORMS, M TERI,A SN -+
FEE $ FEE$ �� (f (/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS,
BRACI G BOLTS i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FUR NACE:•LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC-
TION.
GAS VENT DUCTS
TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I
WELL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT.
OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE. LATH, EXT.
SIGNATURE OF HOUSE NUMBER CORRECT
PERMITTEE AND POSTED
ADDRES INAL
JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION CK. M.O. CASH
LAP 44979 ARI5 s Q 6.00 4
f,Ve WORKERS'COMPENSATION DECLARATION
APPLICATION FOR BUILDING PERMIT
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY.
Policy No. Company
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN q ESS K4!5, 02 7
❑ Certified copy is filed with the county building inspec- BUILDING /' !� ��`���� �� •
tion department. ADDRESS
Date Applicant CITY �^ / ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. v
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. ASSESSOR
hundred dollars($100)or less.) MAP BOOK PAGE PARCEL
TEL. US ONE MAP
I certify that in the performance of the work for which this OWNER /�✓ N NO.
permit is Issued, I shall not employ any person in any manner ADDRESS/.� CONDITIONS
ECTAL 1
so as to become subject to the Workers'Co ens3 ion Laws.
CITY /u'9 ZIP V
IX
Y Dat f Applicant ARCHITECT OR TEL, 0 O
NO ICE TO APPLICANT: If, after making this er ificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE SSED BY
Exemption, you should become subject to the Workers' S o (/J�� S CONS ZONE V
Compensation provisions of the Labor Code, you must forth- - ADDRESS �J� v�
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N
deemed revoked. CONTRACTOR NO.
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
(commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP
Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION
SQ.FT. NO.OF NO.OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
VALUATION
DESCRIPTION OF WORK NEW 00
Contractor Date $ ®�
I am exempt under Sec. I� . ILC loADD ❑o r- ,
t to v u ALTER ❑
B.&P.C. for this reason P�'�'0`t t'�A1 r'L �� �P�N� j �jfb REPAIR ® $
USE OF
Date: EXISTING BLDG. DEMO" ❑
Signature APPLICANT TEL. FINAL
OWNER-BUILDER DECLARATION PRINT NO. DATE
I hereby affirm that I am exempt from the Contractor's License ADDRESS FINAL
Law for the following reason (Section 7031.5, Business and
Prof ssions Code): PRESENT By
X,I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and LOCALITY
the structure is not intended or offered for sale(Section LOCA
7044, Business and Professions Code). MOVING TEL.
I, as owner of the property, am exclusively contractingCONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). •E ,�0'0
CONSTRUCTION LENDING AGENCY SETQBACK YARD HWY TOTAPROPpLINE WIDTFROM H
I hereby affirm that there is a construction lending agency for FRONT �7a�
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L.
m Lender's Name U LDMA Ref, # �i
m P.C.Fee$ Permit fee , It aF
Lender's Address c
I•certify that I have read this application and state that the Issuance Fee //' LDMA P/C N `
o above Information Is correct. I agree to comply with all County Investigation Fee �-�1 / ��97
9 ordinances and State laws relating to building construction, Total Fee ' I LDMA Perm.M
Nand hereby authorize representatives of this County to enter
upon t e abov entioned property for inspection purposes.
$ / SEE REVERSE FOR EXPLANATORY LANGUAGE
m
Signature o licant or Agent Date