HomeMy Public PortalAbout9720 VAL ST_Building__ DWISION OF BUILDING AND SAFETY p ¢ ~�
Gk_ JDepartment of County Flngin `J� BUILDING
County of Los Angeles J U t 3_ 1
WM. J. FOX, COUNTY ENGINEER APPLICATION
FOR APPLICANT TO FILL IN A FOR OFFICE USE ONLY
_ D HTRI O PUN CI[ NO P[RNITrNO.
BUILDING ...+ ` / C�b`�8
ADOR[BB K+ L .J f�
LOCALITY7-7 C RCPMVKD BY DA PFAPPL.
N[AOREBT / - $ 77777
BT
K/ BUILDING .�•t �r /�/1 / !,�
l AD EBB V rI` J
DINNER C• A _
MAIL LOCALITY LCsz
ADDRESS NEAR[6T .y.
TEL CRO"ST.
STY N PIR[ NO OF
ZONE PLANB'/
ARCHITECT OR TEL -
ENGINEER MGM SLncL- -i••, - . ORD NO
SETBACK LIN[
ADDRKAM
USE Z 'A�PROV[D_.. -
QO 4;1,6TO 27 ZONE
BY ♦ ... - OAT[
Agr �e40 HOUS NUMBCRING
D A--� MAP NUMBER 7•fl0 3L—NO ABRIGN[D BY
D LEGAL CORRECTIONS
TRACT
am!� Nq OF SLOGS'
SII[ OF LOT 3 z-d NOW ON LOT
USE OF NO.OF
EXISTING 11-18N p ►AMrLIq d
DESCRIPTION OF WORK
a
G ./ zgr .v L n w p
NEW ALTIrRATION ADDITION =
1
REPAIR DEMOLITION r O � �
Bq.FT. NO.OF
BIZE ROOMS BTORI[B
IncT W,wu
COVERING QOv[INMG p `o
USE OF BTIOICTUR[ If
<✓ rl' / r .P arr /.4 tZD v6IV4
INSPECTION FOR APPROVALS
OCCUPANOYAB INBPECTOR•SSIGNATURE DAT[
FOUNDATIONS LOCATION
1 HERKBY ACKNOWLEDGE THAT I HAVE READ THIS AP
MATERIALS . �M - 2 3-5-2
PLICATION AND BTAT[ THAT THE INFORMATION GIVEN IB FRAME FIR[STOPS.
CORRECT SPACING,BOLTS
1 BRKZ TO COMPLY WITH ALL COUNTY ORDINANOE>v FURNACE LOCATION.
AND ATE LAWS REGULATING BUILDING CONSTRUCTION GAG VENT DUOTB
BIONATUR[ OF A . �A w / LATH. IMT 10
PERMITTEE w
ADDRE LATH. EXT. �1Q
AUTNORIZ[D Ag T PLASTER. INT
PLASTER, CCr
>8 / P.Q •
/� 3 � FE[ Hauer.NUMBER ED
7 g6CT AND POSTED
VALUATOR-
ION B 3 GFEE FINAL
v� Ree 3 1•u
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANQELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN Bul G AmREss .y
I hereby affirm that I have a certificate of consent t0 self Mswe
&11 ` 5
or a certificate of Workers CCmpensabon hsurance or a cerldled
Copy thereof c B0_ o!, prSj) GTY LP
I SO LOGLRY
Policy �mperrY LOT NO OF BLDGS NOW ON LOT
❑ Ceritft9d copy 6 hereby iummlled J� NEAREST CROSS 9T
,W�'Ger/lZ copy B filed with the Co Waling impaction TRACT BLOCK LOT NO
ileo mBnl USE ZONE MAP NO
Date�pllcant ASSESSOR NAAP BOOT( PAOE PARCEL
SPECIAL CON DMONS
CERTIFICATE OF EXEMPTION FM RKERS' YES L NO
EL
COMPENSATION INSU E e WTiHIN 1000 FT OF SCHOOL?
3 ^62( G
(This section need not be completed If the permit Is for one hundred AdDW%ES
dollars ($100)or less) kJ� DISTRICT ROUP CONST FIRE ZONE PROCESSED BY�7 p
1 certify that In the performance of the work for which this permit
is issued I shall not employ any person in any manner s0 as t0 Jr
become subject to the Workers Compensation Laws ARCHITECT OR ENGINEER TEL NO
SWLSTX,PL GY ICATON I APT CONDO
Date Applicant ADDRESS CLASS NO S ONELI UNITS
NOTICE TO APPLICANT If after making this Cerhhcate of REQUIRED TOUL SETBACK FROM E%IST
Exemption you should become subject to the Workers TOR TEL NO c SET BACK VARD ITV✓Y PROP LINE VllDili
Compensation provisions of the Labor Code you must forthwith V vC'i CC
FROM
comply with such provslcns w the permit shall be deemed revoked Ao E P L
LICENSED CONTRACTORS DECLARATIONdi� J \ SIDE
(� P L
hereby al/mm that am licensed urderprovsars of Chapter 9 ) SEWER MAP
(commenctrq with Section 7000)of DNlsuon 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMIUES
Professions Coda and my Ince a s m full force S NEW ❑ BK PG Poo. d
License Numbe�LIC Classtf—n l RIPT1 OF WORK ADD ❑ VALUATION
�O
C«rtractorC ws ( Date / -2 TER ❑ $ •� �- —
1 " w °C
❑ I am exempt under Sec REPAIR ❑ $
BBPC for this reason EMOL ❑ MA P/C.
Date USE OF EXISTING BLDCI URM ❑ 3303 M.55 in
Signature APPLICANT(PRINT) TEL NO LDMA Perm• 1 ITEMSZ
❑ 1 as owner of the property or m y emWoYaes with wages ns Z
their sole compensation will do the work and the structure Is ADDRESS F TOTAL 1LJ rJr�
rot Intendedno�r��offered far sale (Sectan 7044 Business and FINAL TE_, a
Professions G:Klc) wit TE MPLCJJIT qi FU1lfiE eUIDINO OCGIiMNr IWAE A WSAROOIIa MXER ,- 1&;q1 , 4fIGM M.55
❑ I as owner 01 the property am exClusNely contracting with OR A M OONWNSNO A VLV_Appg19 MATERIAL EQUAL TO OR ORENTER THAN THE ry���t/�� tT�T��
licensed Contractors t0 construct the project (Section 7044 N1O11N19 a GRED ON THE INZAADOU9 MATERVLS ISORM ION oUloEi FINAL By �j l�7MIn1C. .00
Business and Professions CAde) YES❑ No❑ , /
VAL
THE MENIED LAE OF THE RUDUN0 EY THE A QANT OR FUTURE aeLDWO
CONSTRUCTION LENDING AGENCY g�'E A EEwm NT lmu s a(SCA N oR PETpvpN GRCH THE sarrR 1 11�29�955
MR AIR OUAUIY NANAOEYFM oI.RmLT IECAOMO)9Fe PERAfI'TWO ClEGUJ9T TOP
I hereby affirm that there is a construction lending agency for vEs❑ Np❑ 3466 1 AM 9:01
a the perfomnance of the work for which this permit Is Issued(Sec
m IHECUST I U HAZAfpIX My
UITONONOE ANS TFIEUESCCUEYCODE
3087 CN C) LIECKIJeT UIDEn30 SE R REWFEI20 00 THRKXKWI IINVER THE 109 ANOELE9 CWMV CODE
Lander s Name MATERIA 9 REPORIW3 MMD FOUR OHPFYpun A PEPNr SFR&I THE SGh01.0 20 140�RNRIO RIS
Lenders Address
o aw.�n°"AorNr
I certify that I have read the application and state under penalty
of Perjury that the above Information Is correct I agree to Comply PC FEE PERMIT FEE
R with all county orthnances and State taws relating to building
Comet ion and hereby authonZe representatives of this County ISSUANCE FEE / g
to a loon e-men6 property for inspection purposes
�— p�j JO
m 1\—e2 - INVESTIGATION FEE TOTAL FEE . L�
o a hit �6�—r�-- a7
SEE REVERSE FOR EXPLANATORY LANGUAGE