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HomeMy Public PortalAbout9206 WEDGEWOOD ST_Building__ • t • - ' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR 7 � BUILDING ADDRESS � 67 � I hereby affirm that i have a certificate of consent to self Insure, � I tic or a certificate of Workers'Compensation Insurance,or a certified CITY •w q zIP � V Fv copy thereof(Sec.3800,Lab.C.) ` "Y LOCALITY Policy No. Company SIZE OF LOT ( N .OF BLDGS.NOW ON LOT e Nc iiNT Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. 7 Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER , YES NO COMPENSATION INSURANCE WITHIN 1000 Fr.OF SCHOOL? ADDRESS 'of (This section need not be completed if the permit is for one hundred I., Q DISTRICT GROUP TYPE CONST.' FIRE ZONE ROCESS D BY dollars($100)or less.) [ARCHITECT ITY zIP )' 1 certify that in the performance of the work for which this permit �t -r— I^!6cv) 1 ,3 is issued, I shall not employ any person in any manner so as to O ENGINEER TEL.NO. R,3 9 ' become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CMDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.No. FRONT PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE PL p 1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP C7 (commencing with Section 7000)of Division 3 of the Business and SQ. SIZE NO.OF STORES NO.OF FAMILIES fr Professions Code,and my license Is in full force and effect. Op NEW ❑ BK PGC:) License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION al a t ContractorDate t T ALTER ❑ $ Z ❑ I am exempt under Sec. �+ / , REPAIR B.&RC.for this reason Tyr DEMOL Data: USE OF EXISTING BLI. URM ❑ LDMA P/C# Signature APPLICANT(PRIMA T O. LOMA Perm# ❑ I, as owner of the property, or my employees with wages as p their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and DATEACCT° It Professions Code.) WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL J Z yr.� ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ; �, (� tat°•J�J Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINALk-Jy licensed contractors to construct the project (Section 7044, YES❑ NO❑ Business and Professions Code.) 1 ITEM' WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING �.�} i ,�-ry��''yy OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH IO1AL _1834x.,+ o 0a CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST' FOR GUIDELINES. —^ i• I hereby affirm that there is a construction lending agency for YES❑ NO❑ CHECK the performance of the work for which this permit is issued(Sec. rLf r,!(� 11! I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD t•!�1�!-iL ° 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES g. COUNTY CODE,TITLEZ CHAPTER 220SECTIONS 220.100THR000H 2.20.14000NCERNING __ rr66 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address 9t ��� 000-JJT / o I certify that I have read this application and state that the above Information is correct. I agree to comply With all county RC.FEE PERMIT FEE 1349 1 All 1-'139 ordinances and State laws relating to building construction,and no hereby authorize representatives of this County to enter upon ISSUANCE FEE the ab mentioned property for inspection purposes. I � INVESTIGATION FEE � � f TOTAL FEE 13100 m olAnpum°a mt ��� om SEE REVERSE FOR EXPLANATORY LANGUAGE �r 0 WORKERS'COAPENSATION DECLARATION hereby affirm that I have certificate of consent self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY "Poticy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Q d ❑ Certified copy is filed with the county building inspec- BUILDING i tion department. ADDRESS y CAft 49r, CI C.� ZIP LOCALITY e Dare Applicant NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOTD NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) USE ZONE MAP � I certify that in the performance of the work for which this NO. SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS O CONDITIONS so as to become subject to t orkers'Co pensation LCL aws. U DateG^ 1�Q & 61401 - / O �" CITY Applic Va ARC TE OR TEL. DIS RICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' V P Y I O� -3 W Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. 'Z deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.02 Z DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and 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 44 1 STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW o®�° I ►E] ADD © $I am exempt under Sec. C� ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Dare: USE OF EXISTING BLDG. DEMOL ❑ ro Signature APPLICANT TEL FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE0. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS p L Professions Code): PRESENT y EJ1, as owner of the property, or my employees with ADDRESS - + wages as their sole compensation,will do the work and , q � aOO the structure is not intended or offered for sale(Section LOCALITY s MO 75 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. T Tia Ls �t7t+�sC with licensed contractors to construct the project (Sec- ADDRESS lL TAL +P 6.7-5 tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST, ('�C .. ?A-.75 SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. C`j,•� ° 3 (Sec. 3097, Civ. C.). SIDE P.L. YEW$ Lender's Name / .LDMA Ref.# - � GEC° YEW I 6! P.C. Fee$ Permit Fee 3682 A AN MOW p Lender's Address , +7QLIG E Tf�1 �tu,dY I certify that I have read this application and state that the Issuance Fee LDMA p/C# above information is correct.I agree to comply with all County Investigation Fee 9 ordinances and State laws relating to building construction, Total Fee ( LDMA perm. # and hereby authorize representatives of this County to enter upoD the above-mentioned prope for inspection purposes. e D "Date SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o icant or Agent WORKERS' CC`MPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT 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 i •' BUILDING We O Certified copy is hereby furnished. � FOR APPLICANT TO FILL IN ADDRESS 9R n6 ❑ Certified copy is filed with the county building inspec- BUILDING +� tion department. ADDRESS 1 / Date Applicant CI G ZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT �C • NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT St BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. OWNER W N US ZONE MAP ✓ 1 certify that in the performance of the work for which this i NO. permit is issued, I shall not employ any person in any manner ADDRESS SPECIAL a CONDITIONS so as to become subject to theWorkers'Compensation Law OO • CITY ZIP Cie Date r Applican ARCHITECT'OR D�STRICi GROUP TYPE FIRE PROC SSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. / O —, CONST. V ZONE Exemption, you should become subject to the Workers' ' 15 Compensation provisions of the Labor Code, you must forth- ADDRESSLN � a- with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. Z 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 LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY 4 IS CLASS BK. PG. VALIDATION SQ. FT. NO. NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION , Contractor pate DESCRIPTION OF WORK NEW ❑ $ 4 Sao. o ADD ►❑I am exempt under Sec. � LTER El BAP.C. for this reason EPAIR ❑ $ USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. to FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and ADDRESS FIjAy q Professions Code): PRESENT ByTOY ❑ I, as owner of the property, or m employees with BUILDING P P Y� YADDRESS �'ts��•O wages as their sole compensation,will do the work and � � LOCALITY "A the structure is not intended or offered for sale(Section i.i:sb �,yva 7044, Business and Professions Code.) CONTRACTOR NO. VING TEL. ❑ 1,as owner of the property,am exclusively contracting _ with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. 298.5-3p CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction.lending agency for FRONT �y the performance of the work for which this permit is issued P.L. /� �� oW (Sec. 3097, Civ. C.). SIDE / P.L. �/ �^ �^ �} Lender's Name t' 15W1'�'-li�'e'"1 6/ 1/69 LDMA Ref. # P:C. Fee$ Permit Feewr SFO Fp Lender's Addres � Issuance Fee —�v LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ? C� ordinances and State laws relating to building construction, Total Feces LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for'n action purposes. D 6_ _(f SEE REVERSE FOR EXPLANATORY LANGUAGE SignatureApplicantAgent Date APPLICATION FOR BUILDING. PERMIT �l -, COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIjADDREESS BUIL ING ADDRESS I hereby affirm that I terve a certificate of consent to self Insure, E GEor a certificate of Workers'Compensation Insurance,or a certified ZIP copy thereof(Sec.3800,Lab.C.) /- n L— C Zj LocauTr•__r_�_-e ,�L G l� Policy No. COmperry SIZE OF LOT NO.OF BLDGS. ON LOT (�/� ❑ I 7Y Certified copy Is hereby furnished. O NEAREST CROSS ST. ❑ Certified copy is filed with the county building Inspection TAT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASS R MAPOOK PAGE'!�� I PARCitl. SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER i N (This section need not be completed if the permit is for one hundred O � �QODISTRICT GROUP TYPE CONST' FIRE ZONE P CESSED BY dollars($ or less.) r L/O �J� I certify thathat CITYin the performance of the work for which this permit LTs e- ZIP I60 .�I/L > Is issued. I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. L. 1 STATISTICAL CIF CATION APT CONDO Date Applicant ADDRESS CLASS NO. —DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of >qbI L 7 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the WorkersCONTRACTOR TEL NO7 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL W LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE 92. 3 I hereby affirm that 1 am licensed under provisions of Chapter 9 SEWER MAP r a a SQ.FT.SIZE NO.OF STORES NO. FAMILIES (commencing with Section 7000)of Division 3 of the Business and � 3�� �ti;� NEW BK PG 3313 Vti�+ a+LO Professions Code,and my license is in full force and effect. � � O � License Number Lic.Class DESCRIPTIO OF WORK S rJ N ADD vALw► /� _Tei 3 Contractor DateLA ii, ALTER ❑ ®"22Lf T071 AL �5'� o 9Iz ❑ I am exempt under Sec. REPAIR ❑ � ffio,Oa CHECK 859.98 (� �'` B.&P.C.for this reason �"t0btoEMOL ElLDMA PIC CHANGE .00 Date: USE OF EXISTING BLDG. "OU RM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Penn N 5/91! ❑ I,as owner of the property, or my employees with wages as p �� their sole compensation,will do the work and the structure is ADDRESS F •�24 1 Ail 9:11 not intended or offered for sale (Section 7044, Business and FINAL DATE I;� T a A ProfessionsCode.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL '�( �R/ ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN a ?; i� 121 u a 23 Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL iV licensed contractors to construct the project (Section 7044, YES❑ No 11J1i1,�LV� f ITEMS Business and Professions Code.) •� _ WILL THE INTENDED USE MI THE BUILDING BY THE APPLICANT IO FUTURE BUILDING r r TO 1 AL x 26.23 OCCUPMITREDUIREAPERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH i'1 s- m•a--� CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST + e y FOR GUIDELINES. CHECK I hereby affirm that there is a construction lending agency for YES❑ NO❑ CHANGE H {`_ the performance of the work for which this permit Is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUI ;IPHEA C- �'� Fa CHANGE :'1113 3097,CIV.C.). PERMITTING CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNro3 NG. SSCOUNTYCODE.TITLEZ CHAPTER 2.20 SECTIONS 2.2MIODTHROUG ONCER ir Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERM HE SCA . 3 e� ^J n Lender's Address ��ACEM �� k-a ' I— 90 o I certify that I have read this application and state that the above "i i 4-y q pp P.C.FEE PERMIT FEE m jai f ry '-138 information is correct. I agree to comply with all county �� o ®� [3 ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the ove-mentioned prop for Inspection purposes. '�� r s'' r �-; eF_', d 4%, INVESTIGATION FEE TOTAL FEE10, 1 Icy I yI � ar�pom Opo � L i14 SEE REVERSE FOR EXPLANATORY LAlidd .C' r' 9 -L �t DIVISION OF BUII.DING AND SAFETY DepaA on of County Engineer BUILDING Cozent� of Los Angeles WM. J. •FOX, COUNTY ENGINEER APPLICATION A �•` FOR ALICANT TO FILL IN ADD EI NG PPSSBUILDING ' /r Q Vl� r1.�c-� ADDRESS vt U Io (J V vq�1�f� �( {� LOCALITY �. y qq NEAREST LOCALITY (�.C? CROSS ST. NEAREST DISTRICT NO. PLAN CK.oR REc.No. PERMIT NO. CR088 8T. �/ - ' OWNER � (�/yCY�Q��/��� �yy[�n , /�, RECEIVED BY DATE OF APPL. ATE ISSUrE.iD ADDRESSMAIL �) i �`rrG�.CI.P�Gft•p-U'fJl. wV T� V LL� �� ' f USE ZONE NO. OF I TYPE I I FIRE ZONE ' n /1. 8•� U TEL. n L �f ?0 I.PLANS T/1/� CITY I� nw I.VLI GROUP b ARCHITECT OR TEL. ZONING DATED ENGINEER NO. APPROVED BY- 13UILDING V. ORD.NO. ADDRESS f SETBACK LINE: (/��ylr V [M TEL. BY I' ry PROVED DATE ,.Rd.N CONTRACTOR I.tA NO. I G� HOUSE NUMBERING ADDRESS A LEGAL " MAP NUMBER NO. ASSIGNED BY DESCRIPTION LAT NO. I BLOCK DATE I C01MECTIONs I INSPECTOR TRACT --II NO. OF SLOGS. SIZE OF LOT NOW ON LOT L USE OF I NO. OF EXISTING BLDG. FAMILIES I i O DESCRIPTION OF WORK Z NEW ALTERATION ADDITION Y 1-1 r REPAIR DEMOLITION I I 80. FT. NO. OF SIZE ROOMS STORIES EXT. WALL ROOF I COVERING COVERING I USE OF STRUCTURE I APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION r FORMS. MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS PLICATION AND STATE THAT THE INFORMATION GIVEN IS gRAC1NG, BOLTS CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATIO AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT. DUCTS Gr � SIGNATURE OF1/ '� I LATH, INT. ! PERMITTEE W ADDRESL;hlLATH. EXT. AUTHORIZED AGT. PLASTER, INT. PLASTER, EXT. P. C.>$ HOUSENUMBERCOR- FEE RECT AND POSTED VALUATION 'f FEE D�,U� � FINAL 76A698A DOSS 8-88 + ✓ _ V ,_ - _ AP6Ff— TIO FO9,BUiLZ I I �� • FOR APPLICANT TO FILL IN (Print or type only) CC Ty FD NG --OF OS•ANGELES SS DEPARTMENT OF COUNTY ENGINEER 1 e C ,t iIP BUILDING -AND SAFETY DIVISION NO.OF BLDGS.-; BUILDINGF LOT NOW ON LOT 2 ADDRESS �/u TRACT BLOCK LOT.NO. V LOCALITY TE NEAREST t OWNE NO. CROSS ST. 1i1 C rr • ASSESSOR I . ADDRES&,2Q(a YV.ed e ood MAP BOOK PAGE PARCEL DISTRICT 'GROUP TYPE FIRE PROCESSED.BY CITY TIbmple CftltZIP CONST„ / ZONE ' r N ARCHITECT OR TEL. t� v ENGINEER NO. STATISTICAL CLASSIFICATION SEWER-MAP ADDRESS CLASS NO. ',ter DWELL,UN ITS 6K4?,?PG PG CONTRACTOR ' NEO -USE ZONE MAP LIC. NO. L{J ADDRESS NO-1 R 60.96 SPECIAL LIC. CONDITIONS CITYSan CLASS ROAD DEPARTMENT APPROVAL REQUIRED` YES[] NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM ADDRESS CITY FRONT PROP.LINE OF (STREET)= i SQ, FT. NO. OF NO. OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPEOF EXISTING SIZE STORIES. FAMILIES. 'ONE •FRONT PROP. LINE HIGHWAY WIDTH CL _ CL DEVCRIPTION.OF WORK partial _ NEW ❑ + ,c ADD ❑ BLDG.SETBACK FROM rj-wronfjnq SIDE PROP.LINE OF (STREET) _ C • ALTER- + YARD = TOTAL SETBACKFROM TYPE OF EXISTING C~7 • _ REPAIF SIDE PROP..LINE, HIGHWAY WIDTH LLCL USE OF + = Z EXISTING BLDG, DEMQL ❑ APPLICANT�J TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) '", 'L Randol Co NP!28-&,4Q BY (SIGNATOR IN OPEN SPACE YES ❑ NO ❑ IN COASTAL PERMIT.ZONE YES ❑ NO ❑ VALUATION:$ I HEREBY ACKNOWLEDGE T.HAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS.CORRECT AND AGREE TO COMPLY - WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-' —IdaSTRUCTION. I CERTIFY THAT IN DOING THE .WORK AUTHORIZED HEREBY i -WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR'.CODE OF THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION ItIS RANCE. �•� SIGNATURE O� // F` S_ !C� PERMITTEE -� ADDRESS .529 :E: a. 1 e B1 .d G' - ,� .I5-2;) /,PC 6"y r..'i 7:r tiel C,a • /gyp ,FINAL CITY $an Ca5•r ! - NO 2.8-8-4040 DATE' /r'y i��jr- �"�M1�"•T'C_ MAKE CHECKS PAYABLE TO: FEE' C� r. FEE-1 .12,0'0 HARVEY T. BRANDT, COUNTY.ENGINEER IpmT '.PLAN'CHECK VALIDATION • CK. M.O. 'CASH o PERMIT VALIDATION'. CK. M.O. CASH 3. 4.-; '()cf ' ?.. j1 12.0.0 A DEPARTMENT OF BUILDING AND SAFETY ArYLA:Al'1V1V rvx rrtunrt' COUNTY OF LOS ANGELES WM..J.FOX,CHIEF ENGINEER ��JILDING NO. OF BLDG. ORD.NO. DISTRICT-NO. PLAN CK. NO. P RMIT NO.. PLANS SETBACK LINE -_ sz F7J� FIRE] APPROVED +� ZONE BY DATE RECEIVED BY, DATWOFf APPL. DATE ISSUED, USE / APPROVED L/p"� {�{ t''°f ��/°1el'_1•� ZONE l BY DATE .�kC.�•:"rf C �"� �e' �,e� �' `-'l A `f APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY 0: BUILDINGG�� O E NAME q ADDRESS / J��/ W Z ADDRESS LOCALITY I' i t7 ' NEAREST W ZId CITY CROSS ST. a STATE TEL. LICENSE NO. NO. E NAME � �--�•�e:'Z C'-=9.+L r WMAIL ♦ Q ADDRESS -+�� O CITY ' ` NOLO FE- � Z CITY I HEREBY ACKNOWLEDGE THAT 1 HAVE READ. THIS O APPLICATION AND STATE THAT THE ABOVE IS CORRECT U STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ZO LOT NO. V "/yam_ I SIZE OF LOT S? ST SIGNATURE OWNER OF -1[_ NO. OF SLOGS. r/�y frj a IL BLOCK �— NOW ON LOT La AUTHORIZED.AGT. Ill J W TRACT 7/-/ _ CORRECTIONS I//' O USE OF BLDGS. NOW ON LOT �v(iJ /''d� �'�i.-'lam. G/rJ��iGiT/r✓ // DESCRIPTION OF WORK USE OF BUILDING 1,717 A f'? T;T T r•.7 r-, 7 is construction may b L�i.i .T Y be s viola, r VUUCilOn card orders. You erre cautionm "-'_nath wit Your local War Produciionl3odrdOffi,- >,,r- _ X 117 1O erork authorized in this pepqx, z a " -' r NEW TYPE GROUP 100 ALTERATION ROOMS FAMILIES ADDITION SIZE (j x 2. REPAIR STORIES MOVING WALL COVERING iv DEMOLISH I ROOF COVERING P.C.$ r FEE FINAPPROY,A�L Ur VALUATION