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HomeMy Public PortalAbout5826 TREE ROSE TER_Building__ 7DAe3BA CERSO[ ""APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITYC'2 an JOHN A LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W JENKINS, BuF r OF BUILDING CROSS ST &L Din' FOR APPLICANT TO FILL IN DISTRICT NO GROUP CONPE ST PROCESSED BY PND(or • GGI BUILDING �/+ STATISTICAL CLASSIFICATION SEWER MAP AODRESS.S 26 �/ YteC G ;'PAt CLASS NO 0 DWELL UNITS BK PG LOT NO BLOCK USE ZONE OP 2 ooro TRACT SPECIAL NO OF SLOGS R-IlCONDITIONS SIZE OF LOT �. NOW ON LOTet USE OF (4x'5-zx Il7.0' US STING BLSbJ GG BLDG SETBACK FROM TEL FRONTPROP LINEOF (STREET) OWNER NC ' TYPE OF O ISTING SETBACK HIGHWAY + YARD = TOTAL 6 ADDRESS -T ' HIGHWA WIDTH FROM C L CITY C*K C BLDG SETBACK FROM ARCHITECT TEL SIDE PROP LINEOF (STREET( ENGINEER NO TYPE OF KISTI HG SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L TEL + = a CONTRACTOR NO p ADDRESS NO CORNER CUTOFF YES El NO ❑ U K -CITY CLCASS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK h z NEW ADD ALTER REPAIR DEMOLISH SO FT NO OF NO OF SIZEMM STORIES FAMILIES USE OF STRUCTURE ev, �L- SIGNATURE OF APPLICANT VALUATIO APPROVALS DATE INS IEC Tone elGKw rO n[ P CPMT FOUNDATION LOCATION FEE 5�/I V V FEES FORMS MATERIALS �� - / J �}�7 FRAME FIRE STOPS I HERESY ACKNOWLEDGE THAT I HAVE READ THIS AI ICATION BRACING BOL T$ AND STAT[ THAT THE AOOVE IS CORRECT AND AGREE To CoMFLYFURNACE LOCATION I WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING GAS VENT DUOTS /�� BUILDING CONSTRUCTION R CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT [MFLOY ANY KRSON IN VIOLA TION OF THE LABOR CODE OF THE STATE OF CA 110 IA IKIAT LATH IN121, IND TO WORKMEN S COMIC TON IHSURA, E LATH EXT SIGNATURE OF �F HOLLSE NUMBER CDR- PERMITTEE RECT AND POSTEDbl ADDRESS FINAL JOHN F LEWIS PRINCIPAL ST URAL ENGINEER PLAN CMC$ VALIDATION cK M D CAB. PERNIIT VALIDATION CK M O CASH LIC05 4 8 3�8 X16 2 5 1.00 ••� 1 - LALo5859G huw12 1 A 85.00 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Pnot Gr iyca GDyl BUILDING 81TRtE t CR2AC ' COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER clry ZIP BUILDING AND SAFETY DIVISION Z % ,s�X //7X/'•IZ NO OF BLOCS BUILDING SIZE OF�jLOOT (Z NOW ON LOT ADD] S� TRACT 4 r.��F BLOCK LOT NO LOCALITY , TEL NEAREST OWNER LCS NO CROSS ST ASSESSOR ADDRESS 5 /¢/H MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE SSED BY 5 L CONSTJ� ZONE CITY ZIP 3 ARCHITECT OR TEL ENGINEER ND STATISTICAL CLASSIFICATION SEWER P ADDRESS b 7 CLASS N /• DWELL UNITS BK PlIZ/ CONTRACTOR 1q,11 MJ977 cLfo L�/-� U ZONE NOP D p ADDRESS S3Z CL-C VL-m NO „J SPECIAL O -Z� CONDITIONS CITY TN C CLASS `.J I ROAD DEPARTMENT APPROVAL REQUIRED YE9❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH I BLDG SETBACK FROM FRONT PRO LINE OF (STREET) C ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING U SFT NO OF ) NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH Gr SIZE +\ I STORIES / FAMILIES ONE O + = U DESCRIPTION OF WORK NEW ❑ d DD BLDG SETBACK FRO y ZX ZCEAJ SIDEPROP LINEOF (STREET) S ALTER ❑ HIGHWAY } YARD TOTAL SETBACK FRO TYPE OF EXISTING REPAIR❑ SIDE PROP _INE_rWAYJ WIDTH USE OF + EXISTING BLDG A DEMOL ❑ AP PRIN TNT I N)CM�N0L .� L -� CORNER CUTOFF YES ❑ NO ❑ BY (SIGNATURE) �O IN OPEN SPACE YES 13 No IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ �;G ,.o CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I NAVE HEAD THIS APPLICATION ENVIRONMENTAL ANO STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION CERTIFY THAT 1M DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSONIM V104TI ON 01 TN[ LABOR CODE 01 THE STATE GF CALIFORNIA IM RELATING TO WORKMEN B COMPEN 10 MSU AMP SIGNATURE OF PERMITTEE ADDRESSFINAL ►J TIL DATE I� G,y BY CITY NO MT H 1hE C HL( RS P 11,1131-1: /O vEe b FEE Q d HARVEY T BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION cK No CASH PERMIT V TION « M 0 DASH �f 1 z 7 0931 1 A 1 9.00A TSASSBA CE 0803 12/72 WbyKERS' COMPENSATION DECLARATION m that I have r certificate Come of tion Intra self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Worker' Compensation Insurance, �� or a certified copy thereof (Sec 3BOO, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company r r ElCertifiedcopy is hereby furnished FOR APPLICANT TO FILL I ' BUILDING AD01TEss F-1Certifiedcopy Is filed with the county building usspec- BUILDING �T^ £ (�S ^Z tion department ( /'� Dote ApplicantOTy ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT NOW ON LOT CROSS ST COMPENSATION INSURANCE (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK ~53 97 7 PAGE PARCEL hundred dollar ($100)or less ) MAPEl OWNE £ NO 115E ZONE INDI certify that in the performance of the work for which this / �^ Permit is issued, I shall not employ any person in any manner ADDRESS 6 G_ CONDITIONS a so as to become subject to the Workers Compensation Laws O 0 CITY T ZIP Dote Appllctlnt J ' l TT ARCN CT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY Q NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO CONST Z E G Exemption you should become subject to the Workers ! Compensation provssions of the Labor Code, you must forth- ADDRESS GG N with comply with such Provisions « this perms shall be deemed revoked CONTRACTOSTATISTICAL C1A551FICATION APT CONDO Z R LICENSED CONTRACTORS DECLARATION /(��� LIC Z� CLASS NO DWELL UNITS_ BOSSISM I hereby affirm that jam licensed under provisions of Chapter 9 ADDS is r ' r' NO [ SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC 7' and Professions Code,and my license Is In full force and eff Cir CLASSG BK N PG /y/ VALIDATION SQ NO OF tJ0 OF CHECK License Number��.�075^ tic ClassC_ Y -1 SIZE STORIES FAMILIES ONE VALUATION '20,1 NJ1. 6 1.. [ s o Connector re �� DESCRIPTION OF WORK D �' L-©/h�� , 4 O ADD ❑ `,J C/ ❑I am exempt under Sec ALTER ❑ B&P C for this reason ST �' � REPAIR ❑ $ Date 115E OF EXISTING BLDG DEMOL ❑ APP"NT Signature (PRINT) NO OWNER-BUILDER DECLARATION -DATE Z�rL 1 A 1 herebyaffirm that I am exempt from the Contractor s License f-t� / ,...�[ Low fothe following reason(Section 7031 5, Business and ADDRESS O .•.. �c �"' fl 3 Professions Code) N - By �7 158.72 ❑ I, as owner of the o BUILDING property, or my employees with ADDRESS 1 IT06 wages as their sole compensation,will do thew«k and -Q the structure Is not intended or offered for sole(Section LOCALITY POP.Business and Professions Code ) MOVING TEL - - TOTAL 1�}� 7 ❑ I as owner of the property, am exclusively contracting CONTRACTOR NO CACK 158.7n with licensed contractor to construct the project (Sec- n ADDRESS . U tion 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 13 SET ACKIRED YARD HWY L Qc FROM T I hereby affirm that there Is a construction lending agency for FRONT the performance of the work f« which this permit is Issued PL Odd?-OOD1 8/19/92 (Sec 3097, Civ C ) SIDE PL 5059 1 AM 7:46 Lenders Nome PC Fee S Permit Fee '03 1DMA Ref M 2 Lenders Address g I certify that I haPIP ve read this application and state that the lauance F 1DMA P/C N above information Is correct I agree to comply with all County Invesngotion Fee /r'� /� ordinances and State jaws relating to building construction Total Fee �0. 0 LDMA Perm e and hereby authorize representatives of this County to enter allR m P•coned property for Inspecho purposes /�u.�ne,r- TJ9- LEE REVERSE FOR L%PLANATOBY LANGUAGE _ 5ignoture of Applicant or Agent Dote