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Home My Public Portal About9736 VAL ST_Building__ Taweaew Dee 21254 APPLICATION FOR BUILDING PERMIT Z D =ON OF BUILDING AND SAFETY BUILDING Department of County Engineer ADDRESS f0 If County of Lo! Angel" LOCALITY WM J FOX COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST 41, OI STRICT NO GR�fP ,n,PE SEWER MAP FOR APPLICANT TO IN 5 — Bis PG BUILDING 1 ONST ' ADDRESS MAP �(]� 2 STATE J1�� NUMBER �.% HWY v LOT NO L BOK U3�%NE SPECIAL - .CJ CONDITIONS TRACT '1 NO OF BLDOS �[[� SIZE OF LOT %.7 3Sc NOW ON LOT ' BUILDING YARD HWY STREET NAME EXIST O� SETBACK WIDTH EXISTING BLDG +i/ FRONT . O '/ P L OWNER C I ~ SIDE MAIL P ADDRESS TEL -� t DWELL I UNIT 5 INDUSTRIAL CITY NO 2 DUPLEX—UNIT B PUBLIC BLDG ARCHITECT OR TEL ENGINEER NO 9 APT UNITS ADDN,ALT ETC ADDRESS 4 COMMERCIAL 8 MISCTEL EL CONTRACTOR 01alle% NO INSPECTION RECORD ADDRESS DESCRIPTION OF WORK NEW A D A ER REPAIR DEMOLISH 30 FT _ O OF NO OF IZE DRIES FAMILIES SE O y/ 61(y(JURATE OP LIAPPROVALS P ADDRESS DATE INSPECTOR S SIGNATURE FOUNDATION LOCATION S 0 0 P C ! FORMS MATERIALS ��n FEE FRAME FIRE STOPS VALUATION co ! Q� BRACING BOLTS Lf9-/� FEE FURNACE LOCATION 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS OAS VENT DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT CONSTRUC- TION STATE LAWS REGULATING BUILDING CONSTRUC- UC- TION LATH EXT SIGNATURE OF HOUSE NUMBER COR- ERMITTEE RECT AND POSTED ADORES FINAL — �.7 wM. J FOX. CouNTY ENGINKKR VALIDATION BY AV69r JW 21 400• m ` DEPUTY �D -�' DEPUTY s I C BY EY DEPUTY DEPRTY WORKERS COMPENSATION DECLARATION �L hereby affirm cer that I have r certificate of tioncontentra ,elf APPLICATION FOR BUILDING PERMIT LI IS insure, a a cerh6mie of Workers Compensation Insurance, or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy Is filed with the county building impec- BUILDING hL `q' on deponm meADDRESS q?3L E t q L. LOCALITY Date Apphcont CITY -Em PLT- C17`j ZIP 780 CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS SIZE of Loi 7 3�a NOW ON LO �BROOK PAGE PARCft COMPENSATION INSURANCE (Tuts sedan need not he completed If the permit Is for one USE ZONE P es 3 hundred dollar(f 100)or less ) OWNSTRACT BLOCK LTEL� i SPECIAL y I certify that in the performance of the work for which this OWNER ITTaNO SS�7 CONDITIONS fl permit a issued I shall not employ any person In any manner ,/ DISTRICT GROUP TYPE FIRE PROCESSED BY O so os to become subject to the Workers Compensation Laws ADDRES-S/-' 7.3 t r A L CONST ZONE V (�M PLE QlT ZIP r7 0 - o Date Applicont Cm STATISM APT CONDO I.- NOTICE TO APPLICANT If, after, making this Certificate of ARCHITECT OR TELV Exemption you should become subject to the Worker ENGINEER NO CLASS NO : DWELL UNITS_ W Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAPa, with comply with such provisions or this permit shall he Z deemed revoked CONTRACTOR FO BK /-PG VALIDATION LICENSED CONTRACTORS DECLARATION UC I hereby off mi that I am licensed under provisions of Chapter V ADDRESS NO VALUATION (commencing with Section 7000)of Division 3 of the Business and LK Profeauona Code, and my literati is In full force and affectCITY CLASS f 110111.Contiador Data SQ FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAMUES ij ONE DESCRIPTION OF WORK LG&03 (41NEW ❑ $ pp ❑I am exempt under Sec t n ILL 8. ADD ❑ ALTER ❑ FINAL B dP C for this reason _ REPAIR D 111111' U _1P Date IX TING BLDG •ILSIl1(t UF,MOL FIN By Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT NO I hereby affirm that I am exempt from the Contractor s License Low for the following reason (Section 7031 5, Business and Qrgfe siora Code) -IfL�3 I, as owner of the property, or my employees withBUILDING ADDRESS wages as thea sole compenWhon,will do the work and : 9 5 3,7 A the structure is not intended or offered for sole(Section LOCALITY 7044, Business and Professions Cods) MOVINGTELr • •�• • ) 3 ❑ I as owner of the property, am exclusively contracting CONTRACTOR NO _ with licensed contractor to construct the project (Sec- ADDRESS - 16050 hon 7044, Bun smeand Professions Cods) REQUgCK YARD HWY PROP UN WIDTH °IR CONSTRUCTION LENDING AGENCY gTOTAL SETBACK FROM EXIST `• 1 6 O S O c=5 I hereby affirm that there u a construction lending agency for FRONT the performance of the work for which this permit is issued P t 0 203 -83 (Sec 3097,Gv, C ) SIDE p PL Lender's Name $ Lender's Address PC F"$ Permit Fr . 017 �Y I certify that I have read this application and state that the Itwance Fee 0 L50 above informatan is correct I agree to comply with all County Inveshgvtlan Fee ordinances and Sate jaws relating to building construction, Tocol Fee and hereby authorize representatives of this County to enter uPon the above-men ned operty for Inspection purposes 2 ,4 SEE REVERN FOR EXPLANATORY LANGUAG41 Srgnotar of Applicant or Agent Dft0s