HomeMy Public PortalAbout6342 TRELAWNEY AVE_Building__ ��/J71�� 4e_ C� 1
>. @Aczgmly« APPLICATION FOR BUILDING PERMIT Z
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRE88
RUnDING AND SAFETY DIVLMON LOCALITY <
JOHN A LAMBIE, COUNTY ENGINKER NEAREST
1 A JENSEN. OU"OrBull-OtmaCROSS 8T
FOR APPLICANT TO FILL IN
DIFCT NO GROUP n pg en BY
�Q CONSTMR
BUILDING STATISTICALC FICATION SEWER MAP
ADDRESS PG
�+ CLA89 NO WELL UNITS �+
LOT NO J BLOCK NU BER ITA R y� N
TRACToff USEZONB SPECIAL I
NO OF BLDG; CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BUILDING YARD HWY RE NAME EXIST
TEL SETBACK WIDTH
OWNER O FRONT
P L
ADDRESS SIDE
ARCHITECT OR TEL p
ENGINEER NO INSPECTION RECORD
ADDRESS
TEL
CONTRACTOR N 1 0
ADDRESS V
DESCRIPTION OF WORN - �'f' '"+ O
s / M Fs� /
NEW AD ALTER REPAIR DEMOLISH
SO FT NO OP NO OF I 1 CS-
SIZE ;TORIES FAMILIES
USE OF
STRUCTURE
4 /�//
SIGNATURE OF PT • z/
APPLICANT
VALUATIONS oo
APPROVALS DATE INSPECTOR;SIGNATURE
PC PMT d FOUNDATION
FORMS MATERIALS
LS
FEE FEE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND BRACING BOLTS "L
FURNACE LOCATION,
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION
1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH INT 0
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN S COMPIENSATIO W8 O CALIFORNIA. LATH EXT
SIGNATURE O HOUSE NUMBER GOR- _
PERMITTE RECT AND PoSTED
ADDRES FINAL
CLYDE N DIRLAW,PRINCIPAL STRUCTURAL
PLAN CBFJ= VALIDATION No c PERIMT VALIDATION cK. mo cAnK
LAC09884!S DEC 16 1 D 12.00 Wim,
I
I _
APPLICATION F913-BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO RLL IN - Bull-g(yp��
I hereby affirm that I have a certificate d consent to self insure �e�
or a certificate of Workers Compensation Insurance or a certified
copy thereof
(Sano 380 LLabb�C) `. 4' Nye ,� Cm G` ZIP
POIIL/Ngo `_—� C.anPsM,St '��' " I17CAIJTy
SIZE OF LOT NO OF SLOGS NOW DI LOT
❑ Certified copy is hereby furnished I NEAREST CROSS ST
❑ Certified copy,is filed with the county buildup inspection TRACT BLOCK LOT NO
rat '(/n, D C�t� �( USE ZONE MAP NO
Date Applicafll ! e-Rf,, �) — ASSESSOR AAP 8001( PAGE PARCEL
N I SPECIAL COMMONS
CERTIFICATE OF EXEMPTION FROM WORKERSTEL NO
GWN R
COMPENSATION INSURANCE YnTFUN 1000 FT OF SCHOOL' YES NO
ADDRESS
(The section deed not be completed d the permd afar one hundred �• 1 DIStAICr GROLP CONS! FIRE ZONE PROCESSED BY
dollars($100)or, less) CITY ` LP
I certify that In the performance a the work far which tins permit �O�
is riled I shall not employ arty person In ary manner so m to ITE&RCHOR ENGINEE TEL NO
M*Lbecome subject to the Workers Compensation Lawn SVTRSnCALCLAM AD AI'T CONDO
Date Appllcafll ADDRESS CLASS NO 1 UNITS
NOTICE TO APPLICANT It after making this Certificate of REOIIIRED TOTAL SETBACK FROM EAST
Exemption you should become subject to the Workers �, TEL NO_ SET BACK YARD HWY PROP LINE WIDTH
Compensationrs
provsloof the Labor Code you mat forthwith
FROM
comply with each provslons or the permit shall be deemed revoked LIC nq P L
LICENSED CONTRACTORS DECLARATION �" SIDE
LC PL
I hereby affirmthat I am licensed underprovelons a Chapter 9 — SEWER MAP
(commencing with Section 7000)of Dnnslorl 3 of the Business and SO FT S17E NO OF STORIES NO OF MtUES Ips
Professions Code(�and my license a in full force and a NEW PqC BK PG , d
License Number i--A-T"'Q' Lc Class �� DESCRIPTION OF�K ADD ❑ vALOAnON _ O
Contractor to �� %emOU ALTER ❑ $ U
4 �
❑ I am exempt under 11 under Sec � $ 1
RBPC for the reasonCNS t. DEMOL ❑ LDMA PRC• AL l ' .i W
Date USE OF FXf nhQ TO URM ❑ - l (-
L 313 037 yJS.1Q)
Signature TI � / NO LDMA Perm• Z
n nsa
l LJA� O I1 EM z 1
❑ 1 as owner of the property or my employees with wages as TOTALTL 1i - 1 j
thesole compensation will do the work and the structure E S
not intended or offered for sale (Section 7044 Business and1-6jWyA1 FL r FINAL DATE G
PrCHE ie7.Professors Code) WILL L TIE APPUGM OR a -W occURWr w DIE A INZAiDOIIs WTEPA- �j n .
K c
❑ 1 as owner of the properly am exclusmey contracting with OR A MorruE coNwMING A IlA7AMWe MAT COUAL To OR prEATEe T TIE
FIN9a
AMOlM9 6FECiID ON TIE NAZMOOUa IMTEPW.4 NFC0.MATI6n ouDFINAL
licenseBusid
contractors,
to
construct the project (Section 7044 mss❑ No 4b NANVE .CL)
M4 THE MENDED USE OF TIE BUpLNO BY THEAPPLICAM On FUTURE BULLDNO
COAST AIR OUAIIiY AInI GEI.ENT pQrBICT IeCAD l am PEawTNAE C1 Muv Poo I
CONSTRUCTION LENDING AGENCY ouDEV a )71JU-1!1!1)1 4/1�i5!
I hereby affirm that there Is a construction lending agency for YEs❑ No W is i nM 9:23
the performance of the work for which the permit a Issued(Sec
m 3087 CN C) ciEau l'"EirDEesDa+D w a u a TINE t uioEUE�s�Dcotp rY cooE
Lender a Nerve w 2 rwE xn WcnoNs z rico A cI ouiAToiEec oA�'io"16IUZAr+oas
Lenders Address
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I ceNity that I have read the application and state under penalty
g of perkuy that the above information 9 correct I agree to Comply PC FEE PERM T FEE / /.Q
with all county ordinances and Sate Laws relating to buildingG ✓S
S trucign and hafeby aulhome repnesentatws of mis County ISSUANCE FEE
21 r P n t B nT aratl property ar ma 1 r V�•I/(O s
I INVESTK3ATION FEE TOTAL FEE
m a J
o.. SEE REVERSE FOR EXPLANATORY LANGUAGE