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HomeMy Public PortalAbout9565 WEDGEWOOD ST_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES " U I L®I N G E= WM. J. FOX, CHIEF ENGINEER fL��JJ '-FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS ( ( 9�a LOCALITY RE 1 ED BY DATE OF APPL. DATE ISSUED 1 NEAREST � ° CROSS ST. _ BUILDING / L- ADDRESS J ,J /_ OWNER /- I MAIL ' ZFIRE ONE I PNO. OF LANS 7 I TYP I GROUP J' ARCHITECT OR TEL. ENGINEER NO. BLDG. SETBAC (� ADDRESS APPR• ED //����TEL. '] �'I BY DATE CONTRACTOR A- iI! �O,uS �{JNO• pL✓off/ US APPROVED000 rAld / ADDRESS 1L, U T, C ZO E BY HOUSEr NUMBERING DATE LEGAL DESCRIPTION I LOT NO. I BLOCK p �. AP NUMBER-7 DIQ R ' FIELD CHECK BY 4 < % �i TRACT O. ASSIGNED BY nATE / A #II NO. OF BLDGS. /� CORRECTIONS SIZE OF LOT / NOW ON LOT V ClUSEOF NO. EXISTING BLDG. I F MILIES ` /zim 0' - DESCRIPTION OF WORK NEW I VALTERATION I I ADDITION I REPAIR I I DEMOLITION n D S ZE ROOMS STORIES 1 ? 2 EXT. WALL ROOF OF > ` , / SRP / / 1' COVERING C[ I COVERING �� ,� I� 1 Z USE OF STRUCTURE 2 1ik Qd- �° APPROVALS INSPECTOP'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- ° FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN 1S FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AN STATE BRACING, BOLTS LAWS REGULATING BUILG CONS TION. FURNACE: LOCATION, Ir- SIGNATURE OF GAS VENT, DUCTS PERMITTE V'�i�9 " LATH, INT. ADDRESS ' LATH, EXT. l �� AUTHORIZED AGT. II- 3� .r ^ PLASTER, INT. 76A698A•DBSS SO-SO ® ZrISO FEE PLASTER, EXT. VALUATION I L). Fi.S'•f�O� { FEE E �°��� FINAL y ,, ­ 1,WORMS'COMPENSATION DECLARATION I.rtier jYisftr ficate;of W r certificate of consent to self APPLICATION FOR BUILDING PERMIT Il v, 'tti�ure, or a terfificate 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 F.IL.L IN ADDRESS oaf Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS05 ft)f.,P6r—.WQAQ D S LOCALITY NEAREST Date Applicant CITY ME CLTY ZIP t71 / 0 CROSS ST. i CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR SIZE OF LOT ff�90 FT. NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE U Z NE MAP (This section need not be completed if the permit is for one Y.. hundred dollars($100)or less.) TRACT I Co /� BLOCK LOT NO. NO. Z TEL. / SPECIAL y. IL I certify that in the performance of the work for which this OWNER ��� NO. CONDITIONS (STRICT GROUP TYPE FIRE PR ED BY O permit is issued,I shall not employ any personinany manner ADDRESS (� 5�- - /]� CONST. ZONE V so as to become subject to the Workers'Compensation Laws. /�jj (/ 3 A�rr� qq 11 CITY rQb 1 ZIP vJ ` J 0 Dates Iq �• Applicant �$�LT fy (' I�D . r�o v STATISTICAL CLASSIFICATION APT. CO V NOTIC TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO.- 2—t UNITS IL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP g with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC, I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC, A_ oQO Q© Professions Code,and my license is in full force and effect. CITY CLASS $ `"T , SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE �i� STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK 4 NEW ❑ 9 s o ADD 13 1 am exempt under Sec. ALTER ❑ FINAL B.&P.C.:for this reason REPAIR ❑ DATE `o U USE OF pl Date: EXISTING BLDG. l e1 OWNER-BUILDER DECLARATION DEM [3OL Signature APPLPRINTT Q ,{,r WI® NO. I o - 68.63 1 hereby affirm that I am exempt from the Contractor's License AD—DRESS 5 �Jr�WOO® ® 0 0 0 6 a 6 3 cwt Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS 0 8,� 4:$5 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project(Sec- ADDRESS 'tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. ' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. tSec. 3097,Civ. C.). SIDE o ' P.L. o Lender's Name Q' a Lender's Address P.C.Fee$ Permit Fee Q a > i9 I certify that I have read this application and state that the Issuance Fee V above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee La and hereby authorize representatives of this County to enter ` upon the above-mentioned property for inspection purposes. or SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of 4--plIcl t or Agent• Date es