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Home My Public Portal About5443 WELLAND AVE_Building__ 76A698A CE 8081.62 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER x•, -. ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. DIST ICT O. G OUP' TYPE P SSED BY. FOtt'R APPLICANT TO FILL IN 7" CONST BUILDING UILDIADDREG 7 —rc STATISTICAL CLASSIFICATION S ER MAP '� V CLASS. NO. DWELL.UNITS BK G LOT NO. i v BLOCK WATER- CERTIFICATE. ATER NOT REQUIRED RECEIVED J/ w, CERTIFICATE: TRACT 2 b U MAP HIGHWAY STATE MAJOR SECOND,L ALS NO.OF BLDGS. NO. (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF �q CONDITIONS EXISTING BLDG. /)[Jji T L. OWNER BUILDING YARD HWY STREET N ME EXIST. SETBACK WIDTH ADDRESS FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. ' a ADDRESS CONTRACTO � YrwA� NE 76 6 7 LADDRE t- DESCRIPTION OF WORK v _ a D ALTER REPAIR DEMOLISHW. NO.OF /� NO.OF STORIES J FAMILIES/ k t }.Os � 4 �/ 4 d �J'.; v V APPROVALS �j DATE IN6PECTop,s ?G A=3g! � P.C. PMT. FOUNDATION: LOCATION FEE $ Q FEE $ �� FORMS, MATERIALS ✓/ �' , FRAME: " STOPS � d I HEREBY ACKNOWLEDGE THAT 1 NAVE READ THIS APPLICATION BRACING BOLTS —.1•S' 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. I CERTIjY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. •7 TION OF THE LABOR CODE OF THE STATE OF CALIF. NIA RELAT- _ _ �"'�'-'� _ -9 f•1" ING TO WORKMEN'S OMPENSATION INSURANCE. LATH.EXT. SIGNATURE O :40 HOUSE•NUMBER COR- 2 PERMITTEE RECT AND POSTED a 3 ,>f'k�j�F ADDRESS FINAL ,i d JOHN F. LEWIS, PRINCIPAL ST C AL ENGINEER PLAN CHECK VALIDATIONcK. M.0. CASH _ PERMIT VALIDATION CK. M.O. CASH Ll,o 4 2 C ;ir1Y j 2 3 D 2 8.50A LiiCo 7 8 3 1:0- JUL 2 2 1 D 57.00- ', WORKERS'COMPENSATION DECLARATION to self insure, or afcertif certificate of Worke s'tificate Compensaf on of coent Insurance, APPLICATION F O RS U I L D I N G PERMIT or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N Company 52RAt CO0110!0 Jw / BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the unty buildin nspec- BUILDINGg� r. tion department. ADDRESS lilt � �.: Date Y~IJ— Applicant CITY " ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM ORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT MQXb BLOCK I LOT NO. MAP BOOK PAGE PARCEL �p TEL. USE NE MAP I certify that in the performance of the work for which this OWNER C NO. yNO. permit is issued, I shall not employ any person in any manner SPECIAL DRESS �/y �, CONDITIONS so as to become subject to the Workers'Compensation Laws. ADO Date Applicant CITY J� ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT I GRpq�l�11P TYPE FIRE PRO ED BY O Exemption, you should become subject to the Workers' ENGINEER NO. - /� /) CONST ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS SCA 6//s,( 3 W with comply with such provisions or this permit shall be 13 deemed revoked. ` L 'j STATISTICAL CLASSIFICATION APT. [CONDO. N CONTRACTOR ats s s / O. O �!'/ Z LICENSED CONTRACTORS DECLARATION LIC, C CLASS NO. DWELL.UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS f 4fJ2 NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY^/* AC CLASS C 39 BK Ii PG ?� VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES I FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK of NEW ❑ $ A7 6 i,9 A ❑ I am exempt under Sec. Ov" A / ALTER ❑ pill. # 0 0 0 0 0 B.BP.C. for this reason USE OF /� REPAIR ❑ $ o o49.88 Date: EXISTING BLDG. /i / JVJS( DEMOL ❑ APPLICANT TEL. 4 9 8 8,9 Signature FINAL ' 0 0 0 OWNER-BUILDER DECLARATION PRINT NO. DATE I hereby affirm that I am exempt from the Contractor's License 0 a 1-2-87 Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENTBy 11BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 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 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. i (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ?, Q LDMA Ref. R Lender's Address P.C.Fee$ Permit Fee ✓ 0 I certify that I have read this application and state that the Issuance Fee v.• � LDMA P/C M above information is correct. I agree to comply with all County Investigation Fee or ances and State laws relating to building construction, Total Fee LDMA Perm. R on hereby auth rize representatives of this County to enter up the above- enfioned property for inspection purposes. �� SEE REVERSE FOR EXPLANATORY LANGUAGE S oture of Applicant or Agent Date