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HomeMy Public PortalAbout10906 WILDFLOWER RD_Building__ APP (CATION FOR RELOCATION BUILD1 2&aEZ"ITr SION OF BUILDING AND SAFETY { Department of County Engineer ADDRBUILESS County of Los Angeles ' 7SS'79�'N WM. J. FOX. COUNTY ENGINEER LOCALITY 1 DBSAB � 12.54 CASSATT D. GRIFFIN, SUPT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. I GROUP I TYPE CONST. PROPOSED ---� -�-J ADDRESS_BUILDING YES NO HWY. �, c NUMBER �..�.�.. -ice STATE j� LOCALITY USE ZONE SPECIAL ` 4 PRESENT d -J CONDITIONS BUILDING ADDREdrQ�,t SS_ ! III///��� _LOCALITY �'L'-fYJ D�L" G�/ /S/ BUILDING YARD HWY I STREET NAME EXIST. SETBACKH J / OWNER ^ P.- FRONT 'i I fo�� 1'- P. L. MA I ADDRESS ""' r �• jr v� SIDE 1 ^ / P. L. TELfi47 / CITY -�G�l f `J`,1'.9 NO.�f 7 ] SURETY ,� ��, DATE r BOND S •`�, �� FILED B MOVING TEL. 1 CONTRACTOR NO. CASH S��q J D 'C'D DEPOSITS t 1'�'�4.-✓Z`1.�; ✓' �� ADDRESS BUILDING TEL.� APPROVALS CONTRACTOR p t'�N NO. I f� DATE INSPECTOR'S SIGNATURE ADDRESS - V PRESENT FOUNDATION: LOCATION USE OF , ) 7' FORMS. MATERIALS _ BUILDING /' 'C �•�"� FRAME: FIRE STOPS. ` PROPOSED BRACING. BOLTS USE OF `�,_ FURNACE: LOCATION -p BUILDING GAS VENT. DUCTS y' LATH, INT. SQ. FT. j� NO. OF 3 SIZE a t/-/� ' ROOMS STORIES /1 LATH, EXT. f t,4 4✓1. D WALL _ ROOF HOUSE NUMBER COR- _ q COVERING .k Q ( COVERING DSC.` RECT AND POSTED O %' i,.•' LEGAL li DESCRIPTION I LOT NO. Z I BLOCK FINAL ;' •� y..,,. ,�. ; MTRICT EGINNN���ER TRACT ��L -T WORK COMPLETEDf+�'�_L.�` S ® NO. OF SLOGS. SIZE OF LOT NOW ON LOT SURETY BOND USE OF I NO.OF RELEASED 3 EXISTING BLDG. FAMILIES I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS I HEREBY STATE THAT THE INFORMATIOfN GIVFN IS COR- APPLICATION AND STATE THAT THE ABOVE IS CORRECT RECT. �^ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES SIGNATURE'OF '' �' AND STATE LAWS REGULATING BUILDING CONSTRUC- APPLICANT TION. ADDR SIGNATURE OF PERMITTEE VALUATION$ P.C. $ FEE FEE WILLIAM J. FOX. COUNTY ENGINEER VALIDATION BY7 9P; !�W�i ! 1 0.00 � O BY CC DEPUTY.; 7 p_ 2 3 3 'I � gni � 6 1 11 .00 DEp�1TY BY BY ^'ta ® DEPUTY l� DEPUTY F 1 3AS38A CE#808.10.56 APPLICATION FOR BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING. ADDRESS Department of County Engineer 2 County of Los Angeles LOCALITY JOHN A.LAMBIE. COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST.. 45 I Fes' DISTRICT NO. I G.� I SPE SEWER MAP - FOR APPLICANT TO FILL IN `7r BK PG / / CONST. BUILDADDRESS ,6���� STATISTICAL CLASSIFICATION I LOT-NO. BLOCK CLASS.NO. DWELL: UNITS NUMBER 0, 0 MAP HWY YES '- NO TRACT USE ZONE SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT I NOW ON LOT ��7/}` USE OF ,5`-b EXISTING BLDG. BUILDING- YARD HWY STREET-NAME EXIST. SETBACK WIDTH OWNER t-/r' Y f�`/Z-b!! !�� I FRONT MAIL I., 1! .7 14Q Li 5'h.1 f t3 I SIDE ADDRESS � /Z' � ''" ( - TEL P. L. r CITY ` akL ala/1. NO. -7�"?l INSPECTION Wow.,/ARCHITECT OR TEL. ENGINEER NO. ��/1��,?f» ADDRESS 11 T/A�► CONTRACTOR 4-ZR &IJL©y/f'NOI.�J �./K ADDRESS/� ,..�rll atJ 1 ,51111 DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF Off' SIZE STORIES FAMILIES USE OF STRUCTURE APPROVALS SIGNATURE OF APPLICANT -� DATE INSPECTORS SIGNATURE ADDRE FOUNDATION:LOCATION FORMS, MATERIALS Q-e P.C,.g FRAME: FIRE STOPS. FEE BRACING.BOLTS VALUATION ! FURNACE: LOCATION. FEE / GAS VENT. DUCTS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITII-JALL COUNTY OR INAN¢ES AND TSE STATE LAWS REGULATI G BW' DI G ONS UCTION. SIGNATURE OF 44 HOUSE NUMBER COR- PERMITTEE. ��°`�"' RECT AND POSTED ADDRESS �l r` �" FINAL `pfd�j !�lf: /��it/l✓r�sbv.I OHN A.LAMBIE.COUNTY ENGINEER,, CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION cI ti m.o. cweH 017 Att 2 8 1 1 too AA WORKERS' COMPENSATION 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 BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS41 Certified copy is filed with the county building inspec- BUILDING OA y� tioR department. ADDRESS LD LOCALITY _ NEAREST Date Applicant CITY Y ZIP CROSS ST. } CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR 4. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT J MAP BOOK PAGE PARCEL 0 (This section need not be completed if the permit is for one USE ZONE MAP W hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. i c TEL, SPECIAL AA I certify that in the performance of the work for which this OWNERS LE C NO. CONDITIONS Li permit is issued, I shall not em to an erson in an manner DISTRICT GROUP TYPE FIRE PROCESSED BY p p y y p y ADDRESS CONST ZONE � 0C so as to become subject to the Workers'Compensation Laws. }+� Q CITY ZIP = 4; 1 ;.✓ r' �.-_ Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. 0 CL NOTICE TO APPLICANT: If, after makingthis Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' W Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP H 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. Professions Code, and my license is in full force and effect. CITY CLASS it , SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE �Y STORIES FAMILIES ONE Contractor Date DESC/R�IPTION OF WORK NEW $ I am exempt under Sec. (/ — hey -,oQ ADD ALTER FINAL DATE B.BP.C. for this reason REPAIR Date: USE OF DEMOL ❑ FINAL EXISTING EXISTG BLDG. L1(/� Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRE ENT r ® BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ CONTRACTOR NO. y- j I, as owner of the property, am exclusively contracting COi F 710 6'A with licensed contractors to construct the project (Sec- ADDRESS ...�f,�� tion 7044, Business and Professions Code). �J • • REQUIRED TOTAL SETBACK FROM EXIST. �J • • 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ► I hereby affirm that there is a construction lending agency for FRONT • Lry L ' 00 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE • • d� Q Prin�estigation7Fee L d Lender's Name o7 1 7-P? l Permit Fee Lender's Address u I certify that I have read this application and state that the Issuance Fee ' above information is correct. I agree to comply with all County a ordinances and State laws relating to building construction, Total Feed. and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. _ \ J SEE REVERSE FOR EXPLANATORY LANGUAGE 0 1 ®s Signature 9_f Applicant or`Agent Date