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Home My Public Portal About5430 WELLAND AVE_Building__ 7BA638A CE 8031-62 APPLICATION FOR BUILDIN PER6MIT99 COUNTY OF LOS ANGELES .BUILDING DEPARTMENT OF COUNTY ENGINEER ADDREss BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST' WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. _ DIST / GRQUP TYPEP SS BY FOR APPLICANT TO FILL IN CONST. BUILDING�L/ �j j, , STATISTICAL CLASSIFICATION S ER MAP ADDRESS�.a 7A 1 h. (4V K P CLASS. NO. DWELL.UNITS LOT NO. �- BLOCK WATER NOT REQUIRED11RECEIVED E ❑ CRTIFICATE: TRACT /b MAPHIGHWAY NO.OF BLDGS. NO.. STATE MAJOR SEC ND, OCAL)(CIRCLE) SIZE OF LOT I X NOW ON LOT LISE. ONE SPECIAL USE OF CONDITIONS EXISTING BLDG. TEL. OWNER NO. s`-- BUIL INC YARD HWY STR AME - EXIST. SETBACK WIDTH ADDRESS "FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE ADDRESS �rJ CONTRALTO I►^ E NB8 � ADDRESS 9/ to / ,A.t�i+ DESCRIPTION OF WORK EgrW NEW ADD ALTER REPAIRNO. ! DEMOLISH V-0 IA SIZE StrFT STORIES / FAMILINO. OFES USE OF STRUCTURE SIGNATURE OF t1il G��% r'r�Yj i•� '_•t�a ('J .if t�li-yi� :%. APPLICANT VALUATION$ L APPROVALS .Vt� 4r� DATA 1NSPECTOP'S SIGNfTu_ FEE $ FEE $ FOUNDATION: LOOATION LeiFORMS. MATERIALS n,/i:' FRAME: FIRE STOPS, II 1 HEREBY ACKNOWL DGE THAT 1 HAVE READ THIS APPLICATION BRACING•BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, �^ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -GAS VENT, DUCTS' BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK - AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.' f TION OF THE LABO CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN' O ENSATIPN INSURANCE. l LATH,EXT. SIGNATURE OF HOUSE NUMBER COR. PERMITTEE RECT AND POSTED Illy�(r {/ , /1•!/ ADDRESS µ'O�FINAL r� JOHN F. LEWIS. PRINCIPAL STRAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATION cK' M.O. CASH 4 _2 0 11133 ;-lily 32 3 D 2 8.5-G a t rii:o 7 4 .1 0 ADL 12 1 D 5 7.00- .c" WORKERS' COMPENSATION DECLARATION , hereby affirm that I have certificate of consent to self ; �� , APPLICATION FOR 'BUILDING P E RM I T insure, or a certificate of Workers' Compensation Com ensation Insurance, 1 or a certified copy thereof (Sec. 3800, La C.) �'�1 iR r+� COUNTY OF LOS ANGELES + BUILDING AND SAFETY Policy No. Company V B-__Cerfirt_ i ied copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRIESSNG vfied copy is filed withcounty building inspec- BUILDING tion deepartme t. /01 /f ADDRESS [ `� S 7� �' `' / iTY C C zip LOCALITY . Date pplicant NO.OF BLDGS. NEAREST C TIF TE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. y4 je 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.) OWN ,v TEL•NO. ER l USE ZONE MAP 1 j I certify that in the performance of the work for which this t NO. / SPECIAL >- , permit is issued, I shall not employ any person in any manner ADDRESS [ C ti CONDITIONS CL soas to become subject to the Workers'Compensation Laws. ` O OQ CITY . ZIP Date Applicant ARCHITECT OR TEL. DISTRICT OUP TYPE FIRE PROCESSED BY M NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE O Exemption, you should become subject to the Workers' 'O� `� Compensation provisions of the Labor Code, you must forth- ADDRESS J, a with comply with such provisions or this permit shall be ' ) NO• No.revoked. CONTRACTOR US v Q B STATISTICAL CLASSIFI TION APT. CONDO. Z (( _ LICENSED CONTRACTORS DECLARATION e, LIC. �j CLASS NO. (5P DWELL.UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 'v NO. Z�3�b (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions C de,and my license is in full force and effec}� CITY o �/�✓✓S CLASS BK PG VALIDATION ^iJ�� / 7; SQ. FT. STORIES FA OF CHECK Licens Number C� 7 Lic. Class `� SIZE STORIES FAMILIES ONE I DESCRIPTION OF WORK '� rb J NEW ElALUA�� C l Contractor Date c ; 0 ❑1 am.exempt under Sec. C7 7 ® ADD ❑ , I ALTER ❑ BAP.C. for this reason 54REPAIR $ i US OF Date: EXISTING BLDG. DEMOL ❑ I Signature APPLICANT ` l L�Q L FINAL I OWNER-BUILDER DECLARATION PRINT V NO7 r I hereby affirm that I am exempt from the Contractor's License r /A�� DATE Law for the following reason (Section 7031.5, Business and 1111111 ADDRESS & f v CA-vs ��//a FINAL 4 j Professions Code): PRESENT By ❑ I, as owner of theproperty, or m em to employees with BUILDING ��,��ss.+� Y P Y ADDRESS AMA A 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. a 1 ❑ 1,as owner of the property,am exclusively contracting CONTRACTOR NO. i 1 ME,) with licensed contractors to construct the project (Sec- gDDRESS ` roes ce.�7 Pion 7044, Business and Professions Code.) I REQUIRED TOTAL SETBACK FROM EXIST, CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH MCI( 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. (Sec. 3097, Civ. C.). SIDE P:L. r i sem^ Lender's Name , l I LDMAL# .P:C. Fee$ Permit FeeLender's Address I certify that I have read this application and state that the Issuance Fee / LDMAabove information is correct. I agree to comply with ail County Investigation Feeyordinances and State laws relating to building construction, Total Fee / LDMA and hereby authorize representatives of this County to enter p nth a oowe/-m�entioned pr party for inspection purposes. t, i /�(/ '� \ Sz 1 / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Do